健骨益肾汤促进个性化3D打印脊柱CLIF术后恢复的临床研究

目的：研究健骨益肾汤对个性化3D打印脊柱微创猫眼侧方腰椎融合术（CLIF）术后恢复的影响。方法：选取2019年1月至2020年1月在河南省洛阳正骨医院接受CLIF术治疗的50例腰椎退行性侧弯患者,将其中单纯手术治疗的24例患者纳入对照组,将其中于CLIF术后应用健骨益肾汤治疗的26例患者纳入观察组。比较两组患者临床指标、临床症状评分,术前、术后2周、术后1个月及预后（术后1年）观察两组患者的腰椎Oswestry功能障碍指数问卷表（ODI）评分的变化情况,术后1年的矫正效果。结果：观察组患者术后引流量少于对照组,差异具有统计学意义（P <0.05）;观察组患者术后下肢麻木、腰部疼痛、步行障碍、感觉障碍评分均低于对照组,差异具有统计学意义（P <0.05）;术后2周、术后1个月,观察组患者ODI评分均低于对照组,差异具有统计学意义（P <0.05）;两组患者预后侧凸Cobb角度、骨盆倾斜角度、腰椎前凸角度、矢状面轴向距离、冠状面平衡均低于术前,差异具有统计学意义（P <0.05）,两组患者术前、预后各项指标组间比较,差异无统计学意义（P> 0.05）。结论：健...     

Mental health and socioeconomic status impact adherence to youth activity and dietary programs: a meta-analysis

PurposeSubstantial efforts have gone into reducing the physiological and psychological harm of obesity in youth, but few studies have reviewed the factors contributing to adherence to pediatric weight management programs. The attrition rates to programs offering multiple components to address BMI improvement and healthy lifestyle change among youth are quite high. The purpose of this study is to review the literature for factors contributing to adherence to these programs among children and youth with obesity and determine pooled effect of these factors.MethodsA systematic literature search and meta-analysis was conducted through the PubMed database on pediatric weight management interventions offering at least physical activity and dietary support for obese youth aged 10–17 years, where variables contributing to adherence were reported. Only those studies achieving a threshold of methodological rigour were included.ResultsAltogether, seven studies were included in the analysis. There was a pooled RR of lower socioeconomic status on non-adherence of 1.34 [95% confidence intervals 1.19–1.52] and poorer mental health on non-adherence of 1.12 [95% confidence intervals 1.08–1.17].ConclusionIt is important to address barriers related to lower socioeconomic status in pediatric weight management programs to increase adherence. Further, addressing supports for those with poorer mental health can reduce the risk of non-adherence in multi-disciplinary programs targeting youth with obesity.     

Marginal,Low, and Very-Low Food Security among Children Are Associated with Intake of Select Dietary Factors during Summer

BackgroundSchool meals are associated with improved food security status and dietary intake. Children receiving free and reduced-price school meals lose access to these meals during the summer. The association between food security status and dietary intake in these children during summer is unclear.ObjectiveTo examine the association between food security status (high, marginal, low, and very-low food security) among children and intake of select dietary factors during summer in children certified for free and reduced-price school meals by age group (3 to 4 years, 5 to 8 years, 9 to 12 years, and 13 to 17 years).DesignCross-sectional analysis.Participants/settingSecondary data from 11,873 children aged 3 to 17 years in the control group of the US Department of Agriculture Summer Electronic Benefit Transfer for Children Demonstration Project.Main outcome measuresConsumption of total fruits and vegetables; fruits and vegetables, excluding fried potatoes; whole grains; added sugars; added sugars, excluding cereals; added sugars from sugar-sweetened beverages; and dairy products assessed using questions from the 2009-2010 National Health and Nutrition Examination Survey Multifactor Diet Screener.Statistical analysisMultiple linear regression.ResultsFor the majority of age groups, marginal food security, low food security, and very-low food security were associated with lower fruit and vegetable consumption and low food security and very-low food security were associated with lower dairy consumption, with children from households with very-low food security having the lowest consumption. Children from households with very-low food security consumed 0.73 (95% CI –0.93 to –0.53) to 0.99 (95% CI –1.59 to –0.39) cup equivalents less per day of fruits and vegetables and 0.49 (95% CI –0.65 to –0.34) to 0.68 (95% CI –1.07 to –0.29) cup equivalents less per day of dairy compared with children from households experiencing high food security.ConclusionsLower food security was associated with reduced consumption of fruits and vegetables and dairy products during summer in children from low-income households.     

Social Media Content of Idiopathic Pulmonary Fibrosis Groups and Pages on Facebook: Cross-sectional Analysis

BackgroundPatients use Facebook as a resource for medical information. We analyzed posts on idiopathic pulmonary fibrosis (IPF)-related Facebook groups and pages for the presence of guideline content, user engagement, and usefulness.ObjectiveThe objective of this study was to describe and analyze posts from Facebook groups and pages that primarily focus on IPF-related content.MethodsCross-sectional analysis was performed on a single date, identifying Facebook groups and pages resulting from separately searching “IPF” and “idiopathic pulmonary fibrosis.” For inclusion, groups and pages needed to meet either search term and be in English, publicly available, and relevant to IPF. Every 10th post was assessed for general characteristics, source, focus, and user engagement metrics. Posts were analyzed for presence of IPF guideline content, useful scientific information (eg, scientific publications), useful support information (eg, information about support groups), and potentially harmful information.ResultsEligibility criteria were met by 12 groups and 27 pages, leading to analysis of 523 posts. Of these, 42% contained guideline content, 24% provided useful support, 20% provided useful scientific information, and 5% contained potentially harmful information. The most common post source was nonmedical users (85%). Posts most frequently focused on IPF-related news (29%). Posts containing any guideline content had fewer likes or comments and a higher likelihood of containing potentially harmful content. Posts containing useful supportive information had more likes, shares, and comments.ConclusionsFacebook contains useful information about IPF, but posts with misinformation and less guideline content have higher user engagement, making them more visible. Identifying ways to help patients with IPF discriminate between useful and harmful information on Facebook and other social media platforms is an important task for health care professionals.     

新建内镜中心验收时纯水系统染菌情况调查与处置

 目的 调查新建内镜中心验收过程中发现的纯水系统菌落数超标原因,并给予解决方案。方法 采集纯水制备与使用的所有环节水样,明确细菌超标原因,根据原因制定处置措施,并监测强化消毒效果维持时间。结果 排查后推断纯水箱出水口至进入内镜洗消设备前,新铺设的输水管道为此次细菌超标的主要原因,根据原因采取管路改造、增加消毒设施、对输水管道和洗消设备清洗消毒等组合处置措施。综合干预后各个采样点均未再检出细菌,内镜中心顺利投入使用,并确定水路强化消毒间隔时间为12周。结论 新建内镜中心启用前的验收工作非常重要,新纯水管道需在铺设之前进行冲洗,以保证终末漂洗水质量。     

The Protective Roles of Exercise and Maintenance of Daily Living Routines for Chinese Adolescents During the COVID-19 Quarantine Period

PurposeAdolescents are particularly vulnerable during the COVID-19 quarantine periods and may be at risk for developing psychological distress symptoms that extend beyond a crisis, including depression. This study examined adolescents’ postquarantine depressive symptoms associated with pandemic stressors. The primary aim was to identify potential protective factors that may buffer the association between the presence of COVID-19 cases in adolescents’ communities and their postquarantine depressive symptoms.MethodsAdolescents from public schools were recruited from Zhengzhou city, Henan, China (N = 1,487, M_age=13.14 years, 50% girls). Adolescents reported the presence of confirmed or suspected COVID-19 cases in their communities, their daily activities and routines during the 2-month quarantine period, and depressive symptoms after the quarantine period.ResultsThe presence of cases in adolescents’ communities during the quarantine contributed to more depressive symptoms in adolescents after the quarantine. This association was buffered by adolescents’ spending more time on physical activities and better maintenance of daily living routines during the quarantine period. The presence of community infection was also more strongly associated with depressive symptoms in older adolescents.ConclusionsThe presence of COVID-19 cases in communities contributed to adolescents’ poorer mental health, and the association was stronger for older adolescents. Spending time on physical activities and maintaining daily living routines during the quarantine appear to be practical strategies that can be used by adolescents to mitigate the association between pandemic stressors and their diminishing mental health.     

Optimizing Disclosure of HIV Status to a Diverse Population of HIV-Positive Youth at an Urban Pediatric HIV Clinic

PurposeThe purpose of the study was to increase the proportion of youth living with HIV (YLWH) aged ≥11 years who undergo developmentally appropriate disclosure about their HIV status.MethodsA quality improvement project was initiated at an urban pediatric HIV clinic between July 2018 and March 2020. The primary outcome measure was the proportion of YLWH aged ≥11 years who were disclosed to about their HIV status. The proportion of undisclosed YLWH who had documented nondisclosure status was also assessed as a process measure. Plan-Do-Study-Act (PDSA) cycles for change included monthly clinic staff check-ins to discuss new disclosures, quarterly team meetings to discuss strategies to improve disclosure, and modifying a clinic note template to prompt providers to document disclosure status. Annotated run charts were used to analyze the data.ResultsBefore the first PDSA cycle, 26/46 (57%) of the target population of YLWH aged ≥11 years had their HIV status disclosed to them, and none of the undisclosed youth had disclosure status documented in their medical record. After 20 months and six PDSA cycles, the proportion of YLWH aged ≥11 years disclosed to about their HIV status increased to 80% and the proportion of undisclosed YLWH with documentation of their disclosure status increased to 100%.ConclusionsSeveral interventions integrated throughout the pediatric HIV care process were associated with an increase in the proportion of YLWH with developmentally appropriate HIV disclosure and documentation of disclosure status, an important psychosocial aspect of care in these individuals.     

嗜碱粒细胞组胺释放试验检测抗高亲和力IgE抗体及其受体

目的 探讨慢性荨麻疹的发生机制。方法 用嗜碱粒细胞组胺释放试验,检测慢性特发性荨麻疹患者的血清组胺释放活性。结果 32例中,有15例（46．9％）患者血清组胺释放活性增高,提示FcεR1抗IgE自身抗体的存在。结论 部分慢性荨麻疹的发生与自身免疫机制有关。     

多节段前外侧入路腰椎椎间融合联合后路内固定术治疗腰椎退行性侧凸伴矢状面失衡的疗效分析

【摘要】 目的：探讨多节段前外侧入路腰椎椎间融合（oblique lumbar interbody fusion,OLIF）联合后路内固定治疗腰椎退行性侧凸伴脊柱矢状面失平衡的效果。方法：回顾性分析2017年9月～2020年4月于我院就诊并接受多节段OLIF联合后路内固定治疗的17例腰椎退行性侧凸伴脊柱矢状面失平衡患者,男3例,女14例;年龄55～81岁（67.8±6.3岁）;随访时间13～39个月（25.9±7.6个月）。在术前、术后与末次随访时的全脊柱X线片测量脊柱冠状面及矢状面相关参数,包括：腰椎侧凸Cobb角、C7铅垂线-骶骨中垂线距离（C7 plumb line-center sacral vertical line,C7PL-CSVL）、胸椎后凸角（thoracic kyphosis,TK）、胸腰段后凸角（thoracolumbar kyphosis,TLK）、腰椎前凸角（lumbar lordosis,LL）、腰椎前凸分布指数（lordosis distribution index,LDI）、脊柱矢状面垂直轴（sagittal vertical axis,SVA）、脊柱骶骨角（spino-sacral angle,SSA）、躯干整体倾斜角（global tilt,GT）、GAP评分（Global Alignment and Proportion score）、骨盆入射角（pelvic incidence,PI）、骨盆倾斜角（pelvic tilt, PT）、骶骨倾斜角（sacral slope,SS）。记录术前、术后与末次随访时的Oswestry功能障碍指数（Oswestry disability index,ODI）、日本骨科协会（Japanese Orthopaedic Association,JOA）评分、腰部和下肢疼痛视觉模拟（visual analogue scale,VAS）评分。对术前、术后和末次随访时的影像学和临床指标进行统计学分析。结果：17例患者均顺利完成手术,手术时间120～480min（327.4±85.4min）,出血量50～1100ml（504.7±275.1ml）,融合节段3～8个（3.8±1.2个）。1例患者术后左侧大腿外侧腹股沟区感觉减退,给予营养神经药物后20d症状缓解;1例患者术中发生椎体终板骨折,调整融合器置入路径避开骨折部位,同时一期附加后路椎弓根螺钉内固定,随访未发现融合器进一步沉降。术后和末次随访时的腰椎侧凸Cobb角、C7PL-CSVL、TK、TLK、LL、LDI、GT、GAP评分、PT、SS与术前比较均有显著性差异（P＜0.05）,腰椎矢状面平衡相关参数均获得改善;术后与末次随访时比较均无显著性差异（P>0.05）。术后和末次随访时的ODI、JOA评分、腰部VAS和下肢VAS评分与术前比较均有显著性改善（P＜0.05）,末次随访时进一步改善,与术后比较差异均有显著性（P＜0.05）。结论：多节段OLIF联合后路内固定术可以有效缓解腰椎退行性侧凸患者的症状,同时矫正脊柱三维畸形、重建矢状面和冠状面平衡,提高患者生活质量。