完全清醒无血无止血带局部麻醉技术联合闭合复位经皮克氏针顺行固定术治疗第四、五掌骨颈骨折

目的 探讨完全清醒无血无止血带局部麻醉（wide-awake）技术联合闭合复位经皮克氏针顺行交叉固定治疗第四、五掌骨颈骨折的临床应用价值。方法 回顾性研究。纳入徐州市仁慈医院2017年1月—2019年12月第四和/或第五掌骨颈闭合性骨折患者19例,均为男性,年龄11~45岁、平均20.8岁。第五掌骨颈骨折14例,第四掌骨颈骨折3例,第四、五掌骨颈骨折2例;横行骨折17例,粉碎性骨折2例（其中1例骨折累及掌指关节）;骨骺板未闭4例。19例均采用wide-awake技术联合闭合复位经皮克氏针顺行交叉内固定手术治疗。观察指标：（1）手术时间;（2）手术相关并发症;（3）术后随访观察患侧第四、五掌骨颈掌屈角度,骨折愈合情况,骨骺板闭合情况,掌指、近指间及远指间关节的主动活动度和抓握力;（4）末次随访时,按指关节总的主动活动度（TAM）系统方法以及肩臂手功能障碍评分量表（Quick-DASH）评定疗效。结果 本组19例患者均顺利完成手术,手术时间22~46 min、平均31.8 min。术后18例患者获随访6~12个月,1例失访。所有患者骨折均愈合,愈合时间为8~12周、平均9.3周,无一例并发感染、局部疼痛、骨折再次移位、掌骨缺血性坏死或掌指关节退行性征象以及断针或退针等并发症,其中骨骺板未闭4例均未见骨骺早闭。末次随访时患者第四、五掌骨颈背侧成角角度从术前的45.6°±14.6°降至11.0°±1.7°,差异有统计学意义（t=10.55, P < 0.001）;患者的掌指及近、远指间关节主动活动度良好,握力良好,无指体旋转畸形;按指关节TAM系统方法及Quick-DASH评价,18例患者疗效均为优。结论 采用wide-awake技术联合闭合复位经皮克氏针顺行固定治疗第四、五掌骨颈骨折,固定可靠,对关节无影响,愈合时间短,疗效满意,是较好的治疗选择。     

Predicting kidney disease progression in patients with acute kidney injury after cardiac surgery

Objective

The study objective was to identify patients who are likely to develop progressive kidney dysfunction (acute kidney disease) before their hospital discharge after cardiac surgery, allowing targeted monitoring of kidney function in this at-risk group with periodic serum creatinine measurements.

Approach of Social Groups With Little Sensitization to Organ Donation: Pilot Study in the Gypsy Population to Assess the Best Approach to Determine the Attitude Toward Organ Donation for Transplantation

Background

There are social groups with very low donation rates, and action is needed to try to reverse this situation. The goal of this study was to determine which approach is the best to use with the gypsy population in Spain to determine their attitude toward organ donation.

Effect of mandibular advancement device on sleep bruxism score and sleep quality

Statement of problem

The use of mandibular advancement devices (MADs) in the treatment of sleep bruxism is gaining widespread importance. However, the effects of MADs on sleep bruxism scores, sleep quality, and occlusal force are not clear.

Colchicina administrada en el primer episodio de pericarditis aguda idiopática: estudio multicéntrico abierto y aleatorizado

Introduction and objectivesThere is a paucity of information about the real benefit of colchicine administration in the first episode of acute idiopathic pericarditis (AIP). The main objective of the present study was to assess the real efficacy of colchicine in patients with AIP who did not receive corticosteroids.MethodsRandomized multicenter open-label study. Patients with a first episode of AIP (not secondary to cardiac injury or connective tissue disease) were randomized into 2 groups: group A received conventional anti-inflammatory treatment plus colchicine for 3 months, and group B received conventional anti-inflammatory treatment only. None of the patients received corticosteroids. The primary endpoint was the appearance of recurrent episodes of pericarditis. The secondary endpoint was the time to first recurrence. Follow-up was extended to 24 months.ResultsA total of 110 patients (83.6% men, age 44 ± 18.3 years) were randomized to group A (n = 59) and group B (n = 51). No differences were found in baseline demographics or in the clinical features of the index episode or in the type of anti-inflammatory treatment administered in both groups. The follow-up was completed by 102 patients (92.7%). No differences were found in the rate of recurrent pericarditis between groups (12 patients [10.9%]; group A vs group B, 13.5% vs 7.8%; P = .34). The time to first recurrence (group A vs group B, 9.6 ± 9.0 vs 8.3 ± 10.5 months; P = .80) did not differ between groups.ConclusionsAmong patients with a first episode of AIP who had not received corticosteroids, the addition of colchicine to conventional anti-inflammatory treatment does not seem to reduce the recurrence rate. Clinical trial registration: URL: https://www.clinicaltrialsregister.eu. Identifier: EudraCT 2009-011258-16.Full English text available from:www.revespcardiol.org/en     

Mammographic and Sonographic Features of Triple-Negative Invasive Carcinoma of No Special Type

The aim of this study was to compare the mammography, ultrasound (US) and histologic features of triple-negative (TN) invasive carcinoma of no special type (NST) to non-TN invasive carcinoma of NST. The second aim was to assess whether the distinct imaging characteristics of TN breast cancer would persist after controlling for the histologic features. A total of 344 invasive carcinomas of NST in 337 patients from January 2007 to February 2008 were included in this study. Two radiologists retrospectively reviewed the mammography and US findings using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon and our institution's criteria. On mammography, TN invasive carcinoma of NST most commonly presented as a mass with round shape and non-spiculated margin. On US, it was more likely to have internal hypoechogenicity, an abrupt boundary and posterior acoustic enhancement. TNBC lacked major suspicious imaging findings such as an irregular shape, spiculated margin and calcification.     

肿瘤内科病人住院期间外出不归的心理需求分析及护理对策

[目的]通过分析肿瘤内科病人住院期间外出不归的心理需求,探寻相应的护理对策,减少病人外出不归的现象,从而降低医疗纠纷的发生。[方法]采用自行设计问卷调查,对我科2014年1月—2014年10月住院期间有外出史的180例病人进行心理需求的分析,根据不同的心理需求,探索相应的护理对策,对不听劝说,坚决要求外出而不归者,设计并使用住院病人外出请假协议书。[结果]对180份问卷进行整理,总结出住院病人外出不归的心理需求有对亲人的依恋、需要安静舒适的环境、睡眠障碍、角色转换与适应、躯体不适需要家人照顾、不习惯医院饮食、保护隐私等7个方面,并且各年龄段的病人心理需求也有所不同。[结论]根据肿瘤病人住院期间外出不归的心理需求,因人而异采取相应的护理对策,在一定程度上满足了病人的心理需求,降低了病人外出期间的安全隐患,减少医疗纠纷的发生。     

Eye gaze technology: a South African perspective

Purpose: Based on the bioecological model by Bronfenbrenner, this paper will provide a broad perspective on factors that need to be taken into account in order to facilitate communication and participation in preliterate children making use of electronic Augmentative and Alternative Communication (AAC) systems accessed through eye gaze. Method: Two case studies of children who have been provided with the technology described are presented. The case studies were analysed using the four nested systems of the ecology as a framework to describe not only the environment, but also the processes and interactions between the persons and their context. Results: Risk and opportunity factors are evident at all levels of the ecology. Conclusions: While a good fit between the person and the technology is an essential starting point, additional factors pertaining to the partner, the immediate environment as well as meso-, exo- and macrosystemic issues (such as societal attitudes and funding sources) have a significant influence on benefits derived. In resource-limited environments, the lack of support at more distal levels of the ecology (meso-, exo- and marosystemic levels) seems to be a factor that differentiates these environments from more resourced ones.

• Implications for Rehabilitation

• Within resource-limited environments lack of support from wider ecological systems pose a risk to the implementation of eye gaze technology.

• Attempts to improve collaboration between all role players could provide the opportunity for the establishment of an integrated plan for intervention and set the stage for information sharing and multiskilling between role players.

• Intervention should not only be aimed at addressing the needs of the individual client and their family, but also focus on building community capacity that could provide support to others.

     

经自然腔道取标本完全腹腔镜下结直肠癌根治术的临床效果分析（附50例报道）*

目的探讨免腹部辅助切口、经自然腔道取标本法(NOSES)完全腹腔镜下结直肠癌根治术的操作要点、可行性、安全性和近期疗效。方法回顾性分析2016年1月-2017年6月该科50例行NOSES法完全腹腔镜下结直肠癌根治术患者的临床资料。结果 50例患者均顺利施行NOSES法完全腹腔镜下结直肠癌根治术。术中出血量(70.0±23.4)ml,手术时间(140.0±29.0)min,术中清扫淋巴结(14.0±2.3)枚,术后无盆腹腔感染及至随访截止日无肿瘤复发,术后下床时间(2.0±0.5)d,术后肛门排气时间(2.0±0.5)d,术后住院时间(8.5±3.0)d,术后发生吻合口漏1例,术后发生肺部感染0例,术后切缘癌细胞残留率0。所有患者随访3~24个月未见肿瘤局部复发及转移。结论免腹部切口NOSES法完全腹腔镜下结直肠癌根治术在临床上是安全可行,同时具有微创、快速康复、美容效果好和术后并发症少等优点。