改良B-T分流手术治疗106例紫绀型先天性心脏病效果及随访

目的 评估改良B-T分流手术的手术方法、围术期处理及其在紫绀型先天性心脏病治疗中的重要性.方法 2000年10月至2012年8月,106例紫绀型先天性心脏病患儿接受改良B-T分流手术.男64例,女42例;年龄生后1天～37.2个月,平均(3.8±1.1)个月;体质量2.3 ～ 12.0 kg,平均(5.0±2.1) kg.室间隔完整型肺动脉闭锁25例,室间隔缺损型肺动脉闭锁45例,三尖瓣闭锁11例,重度法洛四联症(TOF)7例,单心室18例.术前患儿均严重发绀,78例应用前列腺素E1维持动脉导管开放;经皮血氧饱和度0.69±0.23.应用不同口径的PTFE人工血管,3mm8例,3.5mm 11例,4mm65例,5 mm26例.结果 患儿术后住院1 ～18天;住监护室1～12天;机械通气4h ～7天.术后住院期间死亡3例(2.6％),人工血管急性栓塞、严重低氧和循环衰竭各1例.术后患儿经皮血氧饱和度上升到0.79±0.12.4例出现人工血管栓塞再次行对侧改良B-T分流手术.94例随访患儿中,血氧饱和度0.63～0.92,平均(0.81±0.10);2例远期(术后17和25个月)死亡.截至现在,86例次患儿行进一步手术治疗,其中TOF根治手术6例,Rastelli手术31例,Glenn手术25例,Fontan手术18例.结论 改良B-T分流手术可提高紫绀型先天性心脏病患儿的经皮血氧饱和度,明确增加肺血流,提高血氧含量,挽救患儿生命,为进一步手术争取机会并创造更好的条件.     

Following up the follow up—Long-term complications in paediatric burns

Paediatric burn follow-up optimally follows a balance between complication detection and avoiding unnecessary hospital visits. In a long-term review, we assessed complication patterns in children with burns requiring surgery. Using the Welsh Burns Centre database, a retrospective note review of paediatric burns over 3 years from 1995 was performed, identifying all children undergoing surgery for their burns. 94 patients were identified with a median follow-up since injury of 13.6 years. Mean age was 5.27 (SD = 4.9) years. TBSA ranged from <1 to 70%. 94% underwent split-skin grafting. 18% (n = 17) developed contractures and 33% (n = 31) developed hypertrophic scarring. Those developing contractures were younger, and suffered significantly greater TBSA burns (p < 0.05) than those developing hypertrophic scarring or those without complications. All contractures developed within 1–13 months, and hypertrophic scarring within 1–17 months. All patients sustaining axillary burns developed contractures, whilst 75% of contractures developed around the upper limb.     

The long-term stability of temperament traits measured after a suicide attempt. A 5-year follow-up of ratings of Karolinska Scales of Personality (KSP)

The main aim of the present study was to investigate whether or not temperament dimensions are stable over time. Twenty-six patients (21 women and five men) filled in the Karolinska Scales of Personality (KSP) both at admission after a suicide attempt (index) and at follow-up 5 years later. KSP changes were significantly associated with low severity of psychiatric symptoms and no reported reattempts at follow up. There were significant changes of all five groups of KSP, most prominently in anxiety-related scales. At index, KSP scores did not differ between those who later would repeat a suicide attempt (repeaters) and not, but repeaters more often tended to have a personality disorder and their 24-h urinary cortisol tended to be lower. In this limited sample, repeaters seem to have a protracted high anxiety level as mirrored by high and stable KSP scores over time.     

Interaction of child disability and stressful life events in predicting maternal psychological health. Results of an area-based study of very preterm infants at two years corrected age

This study aimed at exploring the relationship between severe neuromotor and/or sensory disability in very preterm infants assessed at 2 years corrected age and their mothers’ psychological health. Data on 581 Italian singletons born at 22–31 weeks of gestation in five Italian regions and their mothers were analyzed. Maternal psychological distress was measured through the General Health Questionnaire short version (GHQ-12). The prevalence of any maternal distress (GHQ scores ≥ 2) and of clinical distress (scores ≥ 5) were 31.3% and 8.1% respectively. At multivariable analysis, we found a statistically significant association between child's disability and mothers’ GHQ scoring ≥5 (OR 3.45, 95% CI 1.07–11.15). Also lower maternal education appeared to increase the likelihood of psychological distress (OR 1.38, 95% CI 1.14–1.66). The impact of child disability was weaker in women who had experienced additional stressful life events since delivery, pointing to the existence of a “ceiling” effect. Maternal psychological assessment and support should be included in follow-up programs targeting very preterm infants.     

APT在胶质瘤假性进展与复发鉴别中的应用

目前,高级别胶质瘤术后常辅以放疗或同步放化疗。治疗后呈现的假性进展与肿瘤复发在常规MRI中表现极为相似,两者在临床上难于鉴别。酰胺质子转移（APT）技术通过检查组织中的酰胺质子含量对鉴别两者有较高的敏感性和特异性。就APT在胶质瘤假性进展与复发鉴别中的应用,以及相比动态磁敏感对比增强灌注加权成像（DSC-PWI）、磁共振波谱成像（MRS）、PET技术的优势予以综述。     

Five-year attrition,active enrollment,and predictors of level of participation in the Longitudinal Assessment of Bariatric Surgery (LABS-2) study

BackgroundReporting high-quality bariatric surgery outcomes depends on participant attrition and level of study participation among enrolled participants.ObjectivesOur aims are to report participant attrition, active enrollment, and level of participation, and to evaluate pre-surgery sociodemographic, physical health, and psychosocial factors as predictors of attrition and level of participation through 5 years.SettingThe Longitudinal Assessment of Bariatric Surgery-2 study which enrolled 2458 adults undergoing a first bariatric surgical procedure at 1 of 6 US cites from 2006 through 2009.MethodsIn-person research assessments were conducted pre-surgery and annually for five years. Extensive retention strategies including offering remote assessments (telephone, email, mail, or a combination) were fully implemented in 2009. Among living participants, including those inactivated, annual follow-up assessments were categorized as in-person, remote or missed through 5 years.ResultsBy year 5, 1.7% of participants had died and 3.2% had withdrawn or were inactivated by the study staff; thus, attrition was 4.9% (n = 121). Controlling for site and calendar year, missed assessments increased from 14.7%–21.8% between years 1 and 2 and then stayed relatively stable (20.8%–19.6%) for years 3–5. Younger age, male sex, White race, lower body mass index, smoking, illicit drug use, and higher weight loss expectations preoperatively were independently associated with a higher likelihood of a missed versus in-person assessment across follow-up.ConclusionThe LABS-2 participant attrition was low. The percentage of missed assessments did not increase after year 2, perhaps due to implementation of a comprehensive retention plan. Predictors of missed assessments highlight subgroups to target for focused retention efforts.     

A Case Series of Olfactory Dysfunction in Imported COVID-19 Patients: A 12-Month Follow-Up Study

Objective The scientific community knows little about the long-term influence of coronavirus disease2019(COVID-19) on olfactory dysfunction(OD). With the COVID-19 pandemic ongoing worldwide, the risk of imported cases remains high. In China, it is necessary to understand OD in imported cases.Methods A prospective follow-up design was adopted. A total of 11 self-reported patients with COVID-19 and OD from Xi’an No. 8 Hospital were followed between August 19, 2021, and December 12, 2021.Demographi...     

植入式输液港与外周静脉置入中心静脉导管在化疗患者中长期随访效果观察

目的 观察比较植入式输液港(IVAP)与外周静脉置入中心静脉导管(PICC)应用于化疗患者的中长期效果,为血管通路的科学选择提供依据。 方法 选择2014年4月至2015年4月安徽医科大学第一附属医院272例化疗患者为研究对象,根据中心静脉置管方式不同分为IVAP组115例,PICC组157例,置管方式由患者意愿决定。分别对IVAP组和PICC组患者进行跟踪随访,直到导管取出或此项研究结束(2017年4月30日)止,比较两组患者一次性操作成功率、导管相关性并发症、舒适度。 结果 在一次性操作成功率、导管相关症状性血栓、导管相关性感染、堵管、疼痛方面,两组比较差异无统计学意义(P>0.05);IVAP组湿疹、异位、总体并发症发生率(0.87%,0.00%,10.43%)均低于PICC组(12.10%,8.28%,33.76%),差异有统计学意义(P<0.05)。IVAP组舒适度得分(6.97±0.97)分高于PICC组(5.98±0.58)分,差异有统计学意义(P<0.05)。 结论 IVAP与PICC均为安全的中心静脉置管方式。在减少并发症和提高患者舒适度方面IVAP优于PICC,临床实际应用时要全面综合评估患者,合理制定置管方案,科学选择血管通路。