针刀治疗腕管综合征的病例对照研究

目的:研究针刀治疗腕管综合征的疗效。方法:2014年7月至2016年12月,60例门诊收治的腕管综合征患者分为两组,针刀治疗组(治疗组)和支具药物组(对照组),每组30例。治疗组男8例,女22例;平均年龄(49.38±7.43)岁。对照组男7例,女23例;平均年龄(50.23±8.71)岁。治疗前两组患者的年龄、性别、病程、感觉神经传导速度(SCV)、感觉神经动作电位波幅(SNAP)、运动传导末端潜伏期(DML)差异无统计学意义。治疗组患者采用针刀治疗1~2次;对照组患者口服塞来昔布、维生素B1、维生素B12,并采用支具固定;疗程结束后观察两组患者SCV、SNAP、DML变化。结果:两组患者治疗后,SCV分别为(48.63±7.33)、(41.24±6.15)m/s,SNAP分别为(9.89±3.71)、(8.22±2.19)m/s,DML分别为(5.11±2.28)、(6.13±2.23)m/s,均较治疗前改善,且治疗组优于对照组。结论:针刀疗法可以减轻患者症状,具有可行性,适合在临床中推广使用。     

前列腺泡沫状腺癌7例报道

目的 探讨7例前列腺泡沫状腺癌的临床病理、免疫组化特征及鉴别诊断。方法 复查上海交通大学附属第六人民医院1994—01——2002-06间702例前列腺穿刺活检病例，检出7例泡沫状腺癌，做12种免疫组化标记和特殊染色。结果 7例泡沫状腺癌的临床表现与经典型腺癌相似。镜下瘤细胞以丰富的泡沫状黄色瘤样胞质为特征。核的不典型不明显，也常缺乏明显增大的核仁，但有结构异常和浸润性生长方式。其假良性的细胞学表现使之易被误诊为良性病变，或者使肿瘤的组织学级别被低估。在肿瘤周围常伴有泡沫型高级别PIN。结论 泡沫状腺癌是一种有侵袭性生物学行为的特殊组织学类型高级别前列腺癌。     

临床护理人员针刺伤及相关因素调查分析

目的了解临床护理人员发生针刺伤的状况,分析发生针刺伤的相关因素,并探讨预防对策。方法对某综合性医院全体临床护理人员323位进行问卷调查,了解其针刺伤的发生状况及相关因素,并对调查结果进行分析。结果本次接受调查的323名护理人员在12个月内被针刺伤率为41.80%。针刺时正进行的操作主要是配药、拔针、处理废弃物等;9:00～11:00为针刺伤发生的高发时段;多数护士发生针刺伤时无干扰因素;针刺伤发生与护士视力、工作环境光线的关联不显著;操作中采取防护针刺伤措施的护士的比例为10.07%;刺伤后向护士长报告的仅有16.32%。结论护士发生针刺伤率较高。应提高护理人员重视程度,并减轻临床护士的工作量,督导护士执行操作规程和职业暴露防护措施,以减少针刺伤的发生。     

Evaluation of a novel thoracic entry device versus needle decompression in a tension pneumothorax swine model

Introduction

Tension pneumothorax (tPTX) remains a major cause of preventable death in trauma. Needle decompression (ND) has up to a 60% failure rate.

关于提高经皮胸穿针吸活检技术效果的初步探讨

本文分析了63例经皮胸穿针吸活检资料.细胞学标本获取率为96.9%,组织学标本获取率达62.5%,肺癌的针吸活检阳性率(敏感性)为92.5%,活检诊断肺癌的准确率(特异性)为100%,气胸发生率10.8%。认为应用适当粗的(18～17.5gauge)活检针和同轴穿刺针,采取透视与 CT 两种导向手段结合选用的方法,注意穿刺抽吸的关键性手法,会极有助于提高穿刺成功率和组织学标本获取率,而并发症发生率不高。     

CT引导下置双针穿刺硬化治疗双肾多发肾囊肿的应用及对患者血流动力学的影响

目的 探讨CT引导下置双针穿刺硬化治疗双肾多发肾囊肿的应用及对患者血流动力学的影响。方法 选用我院在2016年1月-2018年6月所收治的双肾多发肾囊肿患者108例,平均分为两组,对照组应用腹腔镜肾囊肿去顶减压术进行治疗,研究组应用CT引导下置双针穿刺硬化进行治疗。结果 研究组患者的治疗效果要优于对照组（P<0.05）;研究组患者术后第1天引流量、住院天数、治疗费用以及术后复发例数都少于对照组（P<0.05）;治疗前两组患者的V_s、V_d、RI、PI没有差异（P>0.05）,治疗后研究组患者的V_s、V_d、RI、PI要小于对照组（P<0.05）。结论 在对双肾多发肾囊肿患者的治疗过程中,应用CT引导下置双针穿刺硬化进行治疗,其治疗效果比较满意,在临床上可以进一步广泛应用。     

超声引导自动肾活检的临床应用

目的 超声引导自动肾活检给肾脏疾病的早期诊断提供了可靠的病理依据。方法 在超声引导下对66例肾脏病患者进行了肾活检。结果 66例患者共穿刺72次，无重大并发症发生。结论 超声引导自动肾活检，安全可靠，操作简单，对肾脏疾病的早期诊断与治疗重要意义。     

A GIS-based methodology for improving needle exchange service delivery

Background

A variety of legal, social and logistical factors can prevent individuals from accessing formal needle exchange programmes. One common solution to this problem is satellite exchange, which involves collaborating with people who already use an exchange to deliver needles and other supplies to those unable to access the exchange. While this approach can be very successful, one potential problem is that those most willing to deliver needles to their peers are often members of social networks that are already well connected with the needle exchange, leading to duplication of effort.In this paper we describe a simple and novel method for identifying groups of people who are demonstrably in need of improved access to needles, and for re-targeting efforts to meet the needs of those people. The method described was piloted at the Homeless Youth Alliance, San Francisco, USA, and further refined at Clean Needles Now, Los Angeles, USA.

Methods

People accessing needle exchange sites were asked to participate in a survey with two questions: “where were you and what time was it last time someone borrowed a needle from you?” and “where were you and what time was it last time you had to borrow a needle from someone else?” Responses were geocoded, and maps produced showing ‘hotspots’ where people were frequently finding themselves without needles.

Results

Satellite needle exchange was refined from an ad-hoc activity into one which focused on delivering needles to those with empirically demonstrable need. Maps produced in the process also proved valuable in discussions with local officials and other agencies about funding, as well as needle provision policy and practices.

Conclusion

We describe a method for rapidly assessing, describing, and responding to unmet and under-met need among injecting drug users. The method is particularly well-suited to organizations with extremely limited resources.     

Linkage into specialist hepatitis C treatment services of injecting drug users attending a needle syringe program-based primary healthcare centre

Injecting drug users (IDUs), the key risk population for hepatitis C virus (HCV) infection, constitute just a small proportion of HCV treatment clients. This study describes an HCV treatment assessment model developed by an inner-city IDU-targeted primary healthcare (PHC) facility and, using a retrospective clinical audit, documents predictors of successful referrals to a tertiary liver clinic. Between July 2006-December 2010, 479 clients attended the PHC, of whom 353 (74%) were screened for HCV antibody. Sixty percent (212/353) tested positive, of whom 93% (197/212) were screened for HCV-RNA with 73% (143/197) positive. Referrals to a tertiary liver clinic were provided to 96 clients, of whom 68 (71%) attended. Eleven clients commenced antiviral therapy (AVT), with seven achieving sustained virological responses by December 2010. Clients who had not recently injected drugs and those with elevated ALT levels were more likely to attend the referrals, while those not prescribed psychiatric medications were more likely to commence AVT. The relatively high uptake of referrals, the number of individuals commencing AVT and final treatment outcomes are reasonably encouraging, highlighting the potential of targeted PHC services to facilitate reductions in liver disease burden among IDUs.     

A high proportion of users of low-threshold facilities with needle exchange programmes in Switzerland are currently on methadone treatment: implications for new approaches in harm reduction and care

Background

Increasingly, patients receiving methadone treatment are found in low threshold facilities (LTF), which provide needle exchange programmes in Switzerland. This paper identifies the characteristics of LTF attendees receiving methadone treatment (MT) compared with other LTF attendees (non-MT).

Methods

A national cross-sectional survey was conducted in 2006 over five consecutive days in all LTF (n = 25). Attendees were given an anonymous questionnaire, collecting information on socio-demographic indicators, drug consumption, injection, methadone treatment, and self-reported HIV and HCV status. Univariate analysis and logistic regression were performed to compare MT to non-MT. The response rate was 66% (n = 1128).

Results

MT comprised 57.6% of the sample. In multivariate analysis, factors associated with being on MT were older age (OR: 1.38), being female (OR: 1.60), having one's own accommodation (OR: 1.56), receiving public assistance (OR: 2.29), lifetime injecting (OR: 2.26), HIV-positive status (OR: 2.00), and having consumed cocaine during the past month (OR: 1.37); MT were less likely to have consumed heroin in the past month (OR: 0.76, not significant) and visited LTF less often on a daily basis (OR: 0.59). The number of injections during the past week was not associated with MT.

Conclusions

More LTF attendees were in the MT group, bringing to light an underappreciated LTF clientele with specific needs. The MT group consumption profile may reflect therapeutic failure or deficits in treatment quality and it is necessary to acknowledge this and to strengthen the awareness of LTF personnel about potential needs of MT attendees to meet their therapeutic goals.