刃针治疗膝骨性关节炎的疗效及对X线片生物力学影响的临床研究

目的 探讨刃针疗法治疗膝骨性关节炎的临床疗效及对膝关节X线片生物力学的影响.方法 膝骨性关节炎患者100例,随机分为治疗组和对照组,各50例.治疗组运用刃针疗法治疗,对照组予普通针刺.观察治疗前后两组疗效及X线片生物力学的变化.结果 治疗组治愈32例（64%）,显效14例（28%）,无效4例（8%）;对照组治愈19例（38%）,显效20例（40.0%）,无效11例（22%）.治疗组疗效明显优于对照组P〈0.05）.治疗组与对照组股骨角、关节间隙角有统计学意义P〈0.05）,说明治疗组生物力学较对照组明显改善.结论 刃针疗法能提高膝关节骨性关节炎的临床疗效,并能明显改善其X线片生物力学失衡.     

体外冲击波联合激光针刀治疗跟痛症的临床研究

目的观察体外冲击波技术联合激光针刀治疗跟痛症的临床疗效,并探讨其治疗机制。方法将符合纳入标准的90例患者随机分为激光针刀组、体外冲击波(EWST)组及联合治疗组,每组30例。激光针刀组采用激光针刀治疗,EWST组采用体外冲击波疗法,联合治疗组采用激光针刀和体外冲击波联合治疗。三组患者在治疗1个疗程后1、3、6个月采用Maryland评分表,进行足部疼痛及功能评分比较。结果三组患者治疗后,Maryland疼痛及功能评分比较,联合治疗组分数高于激光针刀组及EWST组,三组比较差异有统计学意义(P0.05)。结论激光针刀疗法联合体外冲击波治疗跟痛症疗效显著。     

Needle tract seeding of papillary thyroid carcinoma after fine-needle capillary biopsy: A case report

BACKGROUNDFine-needle biopsy is an accurate and cost-efficient tool for the assessment of thyroid nodules. It includes two primary methods: Fine-needle capillary biopsy (FNCB) and fine-needle aspiration biopsy. Needle tract seeding (NTS) is a rare complication of thyroid fine-needle biopsy mainly caused by fine-needle aspiration biopsy rather than FNCB. Here, we present an extremely rare case of a papillary thyroid carcinoma (PTC) patient with FNCB-derived NTS. CASE SUMMARYWe report a 32-year-old woman with PTC who showed subcutaneous NTS 1 year after FNCB and thyroidectomy. NTS was diagnosed based on clinical manifestations, biochemistry indices, and imaging (computed tomography and ultrasound). Pathological identification of PTC metastases consistent with the puncture path is the gold standard for diagnosis. Surgical resection was the main method used to treat the disease. After surgery, thyroid function tests and ultrasound scans were performed every 3-6 mo. To date, no evidence of tumor recurrence has been observed.CONCLUSIONFNCB is a safe procedure as NTS is rare, and can be easily removed surgically with no recurrence. Accordingly, NTS should not limit the usefulness of FNCB.     

Needle Catheter Jejunostomy complicated by Pneumatosis Intestinalis: a case report

Needle catheter jejunostomy is a technique to allow enteral feeding after upper abdominal surgery. An unusual postoperative complication is pneumatosis intestinalis which can be life-threatening. A case of a 76-year-old man with pneumatosis intestinalis due to needle catheter jejunostomy, in whom diagnosis was made by CT-scan, is described. Needle catheter jejunostomy complicated by pneumatosis intestinalis needs attention and careful treatment. Removal of the catheter seems necessary, although controversy remains.     

Determination of the appropriate catheter length and place for needle thoracostomy by using computed tomography scans of pneumothorax patients

Introduction

The primary goal of this study was to compare the chest wall thicknesses (CWT) at the 2nd intercostal space (ICS) at the mid-clavicular line (MCL) and 5th ICS at the mid-axillary line (MAL) in a population of patients with a CT confirmed pneumothorax (PTX). This result will help physicians to determine the optimum needle thoracostomy (NT) puncture site in patients with a PTX.

Materials and methods

All trauma patients who presented consecutively to A&E over a 12-month period were included. Among all the trauma patients with a chest CT (4204 patients), 160 were included in the final analysis. CWTs were measured at both sides and were compared in all subgroup of patients.

Results

The average CWT for men on the 2nd ICS-MCL was 38 mm and for women was 52 mm; on the other hand, on the 5th ICS-MAL was 33 mm for men and 38 mm for women. On the 2nd ICS-MCL 17% of men and 48% of women; on the 5th ICS-MAL 13% of men and 33% of women would be inaccessible with a routine 5-cm catheter. Patients with trauma, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 2nd ICS-MCL. Patients with trauma, lung contusion, sternum fracture, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 5th ICS-MAL.

Conclusions

This study confirms that a 5.0-cm catheter would be unlikely to access the pleural space in at least 1/3 of female and 1/10 of male Turkish trauma patients, regardless of the puncture site. If NT is needed, the 5th ICS-MAL is a better option for a puncture site with thinner CWT.     

针孔腹腔镜经腹腹膜前疝修补术治疗腹股沟疝的临床疗效

目的探讨针孔腹腔镜经腹腹膜前疝修补手术（NP-TAPP）治疗腹股沟疝的安全性与可行性。 方法回顾性分析2019年1月至2019年12月,大庆油田总医院行腹腔镜手术治疗的85例单侧腹股沟疝患者的临床资料。其中腹腔镜经腹腹膜前疝修补手术（TAPP）组患者53例,NP-TAPP组患者32例,观察记录2组的手术时间、术中出血量、术后住院时间、疼痛评分、腹壁瘢痕满意度及手术并发症等指标并进行对比分析。 结果85例患者均顺利完成手术,2组手术时间、术中出血量、术后住院时间比较,差异均无统计学意义（P>0.05）;NP-TAPP组术后疼痛程度、腹壁瘢痕满意度均优于TAPP组,差异有统计学意义（P<0.05）。2组术后并发症发生率及复发率比较,差异均无统计学意义（P>0.05）。 结论NP-TAPP治疗腹股沟疝安全有效,能最大程度减少手术创伤,提高术后腹壁切口美容效果。     

改进输液针头固定方法的探讨

静脉输液时采用弹性绷带固定输液针头法１１８８例次，并与传统的胶布固定法１３００例次相比较，其针头的脱出率分别为２．３６％、４．６９％，经统计学检验（Ｐ＜０．００５），有极显著性差异。说明弹性绷带固定输液针头法优于胶布固定法。     

What has been achieved in HIV prevention,treatment and care for people who inject drugs, 2010–2012? A review of the six highest burden countries

ObjectiveIn 2010 the international HIV/AIDS community called on countries to take action to prevent HIV transmission among people who inject drugs (PWID). To set a baseline we proposed an “accountability matrix”, focusing upon six countries accounting for half of the global population of PWID: China, Malaysia, Russia, Ukraine, Vietnam and the USA. Two years on, we review progress.DesignWe searched peer-reviewed literature, conducted online searches, and contacted experts for ‘grey’ literature. We limited searches to documents published since December 2009 and used decision rules endorsed in earlier reviews.ResultsPolicy shifts are increasing coverage of key interventions for PWID in China, Malaysia, Vietnam and Ukraine. Increases in PWID receiving antiretroviral treatment (ART) and opioid substitution treatment (OST) in both Vietnam and China, and a shift in Malaysia from a punitive law enforcement approach to evidence-based treatment are promising developments. The USA and Russia have had no advances on PWID access to needle and syringe programmes (NSP), OST or ART. There have also been policy setbacks in these countries, with Russia reaffirming its stance against OST and closing down access to information on methadone, and the USA reinstituting its Congressional ban on Federal funding for NSPs.ConclusionsPrevention of HIV infection and access to HIV treatment for PWID is possible. Whether countries with concentrated epidemics among PWID will meet goals of achieving universal access and eliminating new HIV infections remains unknown. As long as law enforcement responses counter public health responses, health-seeking behaviour and health service delivery will be limited.