胡桃夹综合征的诊治进展简

胡桃夹综合征又称左。肾静脉压迫综合征,是左肾静脉在腹主动脉和肠系膜上动脉所形成的夹角或腹主动脉和脊柱之间的间隙处受机械挤压后导致左肾静脉回流受阻从而引起左。肾、输尿管及生殖腺静脉内压增高所产生一系列临床症候群的现象,临床上较为少见。结合文献报道和临场诊治经验,对胡桃夹综合征的病理生理、诊断、治疗及其进展进行了总结如下。     

Robert Liberman's Influence on Supported Employment

The authors have developed individual placement and support using many of the principles of psychiatric rehabilitation of Robert P. Liberman. These included respect for the individual, working in collaboration with the family, integrating skills and supports, using simple behavioral techniques to teach skills in a particular context, combining clinical and rehabilitative approaches, and insisting on rigorous research. As individual placement and support has become an evidence-based practice and has spread around the globe, Bob continues to be a tireless mentor, supporter, colleague, and friend.     

载距突螺钉导向器在跟骨载距突螺钉置钉中的应用

背景：跟骨关节内骨折手术治疗时准确置入载距突螺钉可获得最佳固定效果。但由于跟骨复杂的解剖特点和术中有限的X线透视效果,完成载距突螺钉的准确置钉工作难度极大。而准确置入载距突螺钉的方法仍存较大争议。目的：探讨跟骨关节内骨折手术治疗时使用跟骨载距突螺钉导向器辅助载距突螺钉的准确置钉效果。方法方法：回顾性分析2010年7月至2013年12月手术治疗的42例（48足）跟骨关节内骨折病例,男35例,女7例;年龄15-67岁,平均38.9岁。根据Sanders分型：Ⅱ型22足,Ⅲ型19足,Ⅳ型7足。所有手术均采用跟骨外侧入路,术中使用跟骨载距突螺钉导向器辅助置入跟骨载距突螺钉。术后复查X线与CT,验证螺钉置入载距突的准确性。结果：42例患者术后随访7-28个月,平均17.4个月。按美国足踝外科协会Maryland足部功能评分标准进行功能评定：优21足,良19足,可8足,差0足;术后Maryland足部评分平均为87.8分,优良率83.3%。共置入53枚载距突螺钉。1枚螺钉从跟骨后关节面内下方露出部分螺纹,1枚螺钉从载距突前方穿出,1枚螺钉穿出载距突关节面进入距跟中关节,1枚螺钉远端一半螺纹在载距突下方露出,余49枚螺钉位于载距突内;螺钉置入精确率为92.5%（49/53）。结论：跟骨载距突螺钉导向器能辅助术者从跟骨外侧入路准确完成载距突螺钉置钉。     

全覆膜金属支架在无法行外科手术的胰腺导管内乳头状黏液性肿瘤患者中的应用

目的 探讨全覆膜金属支架在治疗无法行外科手术的胰腺导管内乳头状黏液性肿瘤（IPMN）患者中的应用价值。方法 回顾性分析2015年12月-2020年6月在江苏省苏北人民医院内镜诊治中心行内镜逆行胰胆管造影术（ERCP）,在胰管留置全覆膜金属支架的9例IPMN患者的临床资料。结果 9例患者均行ERCP,术中见乳头呈鱼嘴样开口,插管后均可见胶冻状液体流出,造影见主胰管局部或弥漫扩张,分枝胰管呈囊状扩张,5例置入10 mm×80 mm、4例置入10 mm×60 mm全覆膜金属支架,2例术中同时置入胆道支架。术后患者腹痛和恶心呕吐等症状明显缓解,2例术后出现高淀粉酶血症,给予对症治疗后缓解,无胰腺炎、胆管炎、出血和穿孔等并发症发生。术后随访12～24个月,无腹痛和复发,无支架移位,合并糖尿病患者血糖控制稳定,无新发糖尿病,1例随访至16个月时,支架堵塞,行胰管清理及支架更换。出院当天生活质量卡氏评分为（96.67±3.54）分,较术前的（82.78±3.63）分明显提高,两者比较,差异有统计学意义（P <0.05）,术后3和6个月生活质量卡氏评分为（94.82±3.87）和（91.33±2...     

Experiences after international clinical placement as nursing students in a paediatric ward

AimThe aim of this study is to investigate nurses’ experiences after participating in an international clinical placement programme as nursing students while staying for one to three weeks in a paediatric ward.BackgroundStudent mobilisation is expected to increase the quality of education. Hence, offering international clinical placement programme in low- and high-income countries is a commonly used learning activity in bachelor programmes in nursing. Many studies have mainly examined the general experiences gained from international clinical placement programme but have not specifically focussed on the setting of paediatric wards in hospitals. Nursing students are required to acquire knowledge of paediatric nursing with children as patients.Design and methodIn this qualitative study, a hermeneutic, phenomenological approach was adopted. Data were collected through individual interviews with eight nurses after they participated in an international clinical placement programme as nursing students in a paediatric ward.ResultsMeetings with children’s destinies as patients were overwhelming, being an observer provided insights into and an overview of paediatric nursing, access to the resources required for treating children is limited, nurses had a different role and parents had an extended caring role.ConclusionAll participants gained knowledge of children as patients at a hospital and also gained knowledge of the parents’ and nurses’ roles and the treatment methods of various diseases that are relevant to paediatric nursing. This helped provide them with the cultural knowledge, awareness and sensitivity required, given the contrasting situation at their home country.     

Innervation zone locations in 43 superficial muscles: Toward a standardization of electrode positioning

Introduction: We describe the innervation zone (IZ) location in 43 muscles to provide information for appropriate positioning of bipolar electrodes for clinical and research applications. Methods: The IZ was studied in 40 subjects (20 men and 20 women) using multichannel surface electromyography (sEMG). Signal quality was checked visually to identify motor unit action potentials and estimate muscle fiber conduction velocity. Results: Results in 33 muscles were classified as excellent or good, because it was possible to identify an area which is favorable for appropriate positioning of an electrode pair without the need to previously determine the IZ location. Conclusions: Knowledge of IZ location will increase standardization and repeatability of sEMG measures. Muscle Nerve 49 :413–421, 2014     

皮下埋植吻合口在结肠损伤中的应用（附53例报告）

目的 探讨皮下埋植吻合口在结肠损伤中的临床价值.方法 回顾性分析53例一期行吻合术并皮下埋植吻合口的结肠损伤患者的临床资料.结果 53例患者手术均顺利完成,无术中死亡病例.手术时间为2.3～4.8h,平均（3.4±1.1）h;术后通气时间为2.4～5.5d,平均（3.5±1.1）d;住院时间6～45d,平均（10.5±3.5）d.53例患者中,3例患者术后出现多器官功能衰竭而死亡;9例患者出现吻合口瘘,予以伤口换药或覆盖造口袋后10～55d后痊愈;5例术后出现伤口感染或脂肪液化,伤口换药7～15d后痊愈;4例术后1个月内出现肠梗阻,予以保守治疗后痊愈.余病例均无明显并发症.结论 皮下埋植吻合口在结肠损伤一期吻合术中有一定的临床可行性,便于术后及时发现和尽早地处理吻合口瘘,减少吻合口瘘的并发症.