Thermoregulation,scratch, itch and sleep deficits in children with eczema

Successful sleep onset and maintenance is associated with a reduction in core temperature, facilitated by heat loss at the distal periphery. Problems with initiating and maintaining sleep in children with eczema may relate to impaired thermoregulatory mechanisms, which also contribute to itching and scratching. Our hypothesis was that nocturnal distal skin temperature in eczematous children would be lower than controls, and would also be related to poor sleep quality.We compared overnight polysomnography and distal (finger) and proximal (clavicle) skin temperature in 18 children with eczema and 15 controls (6–16 years). Children with eczema had longer periods of nocturnal wakefulness (mean [SD] = 88.8 [25.8] vs. 44.3 [35.6] min) and lower distal temperatures (34.1 [0.6] °C vs. 34.7 [0.4] °C) than controls, whereas proximal temperature and the distal–proximal gradient were not significantly different. In children with eczema, a higher distal temperature was associated with indicators of poor sleep quality, whereas lower distal temperature was related to more scratching events during sleep. In conclusion, our findings indicate complex interrelationships among eczema, thermoregulation and sleep, and further, that deficits in thermoregulatory mechanisms may contribute to sleep disturbances in children with eczema.     

“血浊”理论在中医现代化中的作用及启示

文章总结了前期有关血浊理论的成果，提出血浊理论是应现代疾病谱系变化而提出的新的"中医理论"，用血浊理论指导中医临床可以纳入检验医学等更多的现代诊疗手段，扩展中医四诊范畴，配合"援药理论"，初步形成了适应现代临床的"理法方药"系统，为指导治未病提供了良好的时代落脚点，为中医现代化提供了良好的理论典范和启示。     

国内住培中医患沟通研究现状的分析与思考

目的通过文献计量法分析国内住院医师规范化培训(简称住培)中关于医患沟通的研究现状,为提高住培过程中医患沟通能力提出建设性对策。方法应用文献检索策略,在中文期刊全文数据库搜索并导出自2000年1月1日—2020年2月29日以来有关住培中医患沟通的全部文献,以文献标题、发表时间和研究内容等构建Excel数据库,并进行统计分析。结果查到住培相关医患沟通的相关文献共70篇,均于2009年以后发表,文献研究数量逐年增加;文献作者所在地域分布不均匀;作者单位主要以大学附属医院为主;文献多出自于教育类、临床类和管理类期刊;文献的研究方法主要以理论论述为主,缺乏干预性研究;文献的被引次数较低,文献质量相对较差;文献的研究内容主要对医患沟通的重要性、内涵建设、现状与挑战和提高医患沟通措施方面进行了阐述。结论医患沟通培训在住培中并未受到充分重视,需在住培期间加强医患沟通教育,培养医患沟通能力,为创建新型医患关系奠定坚实的基础。     

Reunion of post nail aseptic non-union of diaphyseal femoral fractures by augmentation plating,decortication and bone grafting – Replacement for exchange nailing

IntroductionThe aim is to re-unite post nail aseptic non-union of diaphyseal femoral fractures in an economical and safe way with almost certainty, reducing dependence on others with early rehabilitation. The cascade of fracture healing is dependent on mechanical stability and uninterrupted cellular and bio-chemical responses (biology). Intra-medullary nailing in fresh diaphyseal femoral fractures is gold standard treatment with high success rate, still non-union of these fractures is reported, though the incidence has declined considerably.MethodThis prospective study conducted at level one trauma centre on twenty-one patients in four years starting from July 2015 to June 2019. Eighteen patients had non-union with intact implant and three had broken nail. Non-union site approached through lateral approach. Non-union site fixed by 4.5 broad combi-hole LCP or distal femoral locking compression plate (DF-LCP) depending on fracture site. Decortication, Bone grafting done retaining the previous nail in situ in eighteen patients and in three patients, broken nail was exchanged with same size of unreamed nail and then, similar procedure carried out.ResultAll non-unions in 21 patients reunited without any complications. All patients regained painless unsupported walk.DiscussionThe most preferred treatment for this complex non-union is reamed exchanged nailing. Larger nail increases mechanical stability by better frictional contact with surrounding bone in isthumic fracture but fails in cases of fractures with comminution, spacious distal fragment and fracture with small distal fragment. Various studies reported success rate in reamed exchange nailing from 53-96% with an average 74%. The main cause of instability is rotational stress which is completely obliterated by augmentation plating and various studies report 100% success. Augmentation plate with retained nail increases stiffness and strength of construct. Concomitant decortication and cancellous bone graft stimulates osteogenesis.ConclusionIt is a simple, safe and economical procedure, correcting and providing both mechanical and biological environments to convert non-union into osseous union. It will be a treatment of choice in times to come.     

2013-2018年山东省食品镉污染状况调查与分析

目的 了解2013-2018年山东省食品中镉污染状况。方法 2013-2018年在山东省范围内应用完全随机采样法采集市售18类28 867份食品,按照国家标准操作程序进行实验室检测。结果 镉含量合格率为98.85%（28 535/28 867）。镉含量较高的食品为藻类、水产品、坚果及籽类和食用菌,均值分别为0.7085 mg/kg、0.2656 mg/kg、0.0633 mg/kg和0.0633 mg/kg;镉含量较低的食品为饮料酒类、乳类和水果类,均值分别为0.0021 mg/kg、0.0027 mg/kg和0.0030 mg/kg。408份海蟹的镉检出率为92.89%（379/408）,超标率为42.65%（174/408）,蟹膏、蟹黄镉超标率分别为90.24%、82.86%,最高超标38.80倍。结论 山东省市售食品镉超标率较低。水产品特别是海蟹的蟹膏、蟹黄部分超标严重,建议居民谨慎食用海蟹蟹膏、蟹黄。     

某医院粒籽源永久性植入治疗病房的剂量监测结果分析

目的 研究某医院粒籽源永久性植入治疗病房内的外照射剂量水平和分布情况,对其辐射风险进行评估,为加强粒籽源永久性植入治疗放射工作人员的放射防护与监督提供科学依据,同时提出合理化的辐射防护建议。方法 采用热释光剂量测量方法对粒籽源永久性植入治疗病房内10类区域的剂量水平进行为期1年的监测,并结合病人植入粒籽源数目和住院天数进行剂量分析。结果 该病区一年内共收住病人1232人次,其中行粒籽源永久性植入治疗病人432人次（190人）,共植入粒籽源2.746843×10¹¹ Bq（7423.9 mCi）,人均6.3566×10⁸ Bq（17.18 mCi）,粒籽源永久性植入治疗病人年度住院天数2478天,平均住院6天。热释光剂量监测结果表明,各监测点处的剂量范围为0.23～13.94 mSv,均值为3.37 mSv,中值为1.90 mSv。其中病床两侧和输液架处的剂量范围明显高于其他点位处,经剂量/活度和剂量/（活度·天）分析,其差异依旧存在,均存在统计学差异。结论 该粒籽源永久性植入病房内存在外照射剂量偏高的点位,医护人员和陪护人员应减少在此点位居留的时间或远离此点位。医护人员年度个人剂量监测结果远低于国家标准要求,亦低于本次实验点位剂量监测结果,与医护人员的实际工作和居留情况有关。工作人员在穿戴防护用品的情况下,在剂量安全范围内,可适当增加粒籽植入活度和住院天数。患者在术后穿戴防护,可明显降低其对医护人员的外照射剂量。     

正畸烤瓷美容在前牙龈下冠折修复治疗中的应用效果

目的 分析正畸烤瓷美容在前牙龈下冠折修复治疗中的应用效果。方法 选取2021年1月-2022年 10月于济阳区中医医院接受治疗的前牙龈下冠折患者52例,随机分为对照组和观察组,各26例。对照组给予基 础桩冠修复,观察组给予正畸烤瓷美容治疗,比较两组临床疗效、咬合度、美观度、牙周咬合功能、牙周健康 及修复满意度。结果 观察组治疗总有效率为96.15%,高于对照组的65.38%,差异有统计学意义（P＜0.05）;观 察组咬合度、美观度评分高于对照组,差异有统计学意义（P＜0.05）;观察组牙周咬合功能及牙周健康优于 对照组,差异有统计学意义（P＜0.05）;观察组修复满意度为96.15%,高于对照组69.23%,差异有统计学意 义（P＜0.05）。结论 采取正畸烤瓷美容修复治疗前牙龈下冠折可改善患者咬合度及美观度,促进牙周咬合 功能提升,维持牙周健康,疗效确切,更易被患者接受,具有较高的临床应用价值。     

中国乳腺癌专病队列研究：人群队列研究方法及基线特征

目的 乳腺癌在女性癌症中发病率第一且逐年上升。2016年9月,国家重点研发计划精准医学研究中国乳腺癌专病队列项目启动,旨在整合队列资源、提高随访质量、构建标准共享的乳腺癌专病队列,为实现乳腺癌发现、预防、早诊、治疗及预后研判等提供研究基础与标准化数据共享平台。方法 本研究基于社区人群,采用询问调查、身体测量、生物样本采集、乳腺超声和钼靶X线检查建立前瞻性队列,采用区域健康监测和定向监测随访队列。结果 整合乳腺癌专病社区人群队列112 118人,其中完成55 419人标准化队列调查,54 304人采集生物样本。平均年龄51.7岁,超重/肥胖女性占62.7%,绝经女性占48.9%。结论 本研究将为中国女性乳腺癌精准防治提供队列基础和研究平台。