高血压患者不同社区随访管理模式干预效果评价

目的 了解浙江省杭州市余杭区不同社区随访管理模式对高血压患者管理效果的影响,为探寻新的管理模式提供理论依据。方法 采用分层随机抽样方法在杭州市余杭区抽取的2 187例高血压患者进行问卷调查,应用SPSS 19.0统计软件分析不同社区随访管理模式对高血压患者高血压知识知晓率、服药依从性和行为改变的影响。结果 余杭区高血压患者高血压知识知晓率、总体服药依从率和总体行为改变率分别为73.07%、54.78%和43.80%;单独式随访模式高血压患者高血压知识知晓率为70.00%,低于集体式随访模式的82.93%（χ²=253.621,P<0.001）;单独式随访模式高血压患者总体行为改变率为45.98%,高于集体式随访模式的36.80%（χ²=9.370,P<0.05）;单独式和集体式11种随访模式比较,医生上门+定期集中模式高血压患者高血压知识知晓率最高（99.67%）,医生上门+病人到门诊模式高血压患者服药从率最高（88.24%）,电话随访模式高血压患者行为改变率最高（67.15%）。结论 集体式随访模式有利于高血压患者高血压知识知晓率的提高,而单独式随访模式更有利于患者行为的改变。     

外踝骨折的治疗(附40例分析)

目的探讨外踝骨折的治疗。方法回顾分析40例有移位的外踝骨折的病历资料。25例行切开复位内固定术,其中合并有内侧三角韧带扭伤的外踝骨折21例均行手术治疗,不合并内侧结构损伤的单纯外踝骨折19例有4例行手术治疗,有15例选择手法整复石膏固定。结果手术组与非手术组治疗结果优良率分别为84．0％、86．7％。结论合并内侧三角韧带扭伤的外踝骨折切复内固定手术治疗、不合并内侧结构损伤的单纯外踝骨折非手法治疗,两者均可获得优良疗效。     

抗雄药物诱导性神经内分泌前列腺癌的研究进展

接受新型雄激素受体途径抑制剂（ARPI）的去势抵抗性前列腺癌（CRPC）的患者往往在治疗应答中表现出耐药性,肿瘤获得雄激素受体（AR）-独立亚型,使癌细胞不再依赖于AR通路继续生长。CRPC患者在接受ARPI治疗后,部分患者不仅未达到临床获益,反而出现疾病进展,即神经内分泌前列腺癌（NEPC）,NEPC与不良预后密切相...     

CLINICAL ASSISTED REPRODUCTION: Uterine Leiomyomas and Their Effect on In Vitro Fertilization Outcome: A Retrospective Study

Purpose: The effect of uterine leiomyomas on the outcome of in vitro fertilization (IVF) treatment has been controversial. This study was undertaken to clarify influence of fibroids on IVF success, in a large population with age and other potential confounding variables controlled for in the analysis.Methods: A population of 141 patients with and 406 without leiomyomata undergoing their first IVF cycle was studied.Results: The association between uterine leiomyomas and assisted reproduction treatment outcome was not statistically significant (OR = 0.73, 95% CI: 0.49–1.19, p = 0.21) after controlling for age and other risk factors. Also, fibroids neither affected the risk of spontaneous abortion (OR = 1.06, 95% CI: 0.44–2.60) nor the risk of ectopic pregnancy (OR = 0.78, 95% CI: 0.08–8.02). Location of fibroids (intramural vs. submucosal/subserosal) and their size had no significant effect on pregnancy outcome.Conclusions: Results from our analyses indicated that in vitro fertilization outcome was not affected by the presence of uterine leiomyomas. Therefore, in patients with normal uterine cavities and fibroids less than a certain size (i.e., <7 cm), undergoing myomectomies as a prerequisite for assisted reproduction treatment is seriously questionable.     

鼻内镜下鼻腔泪囊吻合术17例

目的探讨鼻内镜下鼻腔泪囊吻合术治疗慢性泪囊炎及其他原因造成的鼻泪管阻塞的疗效。方法回顾分析2004年7月至2006年7月收治的17例（19眼）鼻内镜下鼻腔泪囊吻合术的临床资料。结果17例(19眼)中,女11例(12眼),男6例（7眼）,治愈18眼,好转1眼,有效率100％;鼻内吻合口在3个月内上皮化。结论鼻内镜下鼻腔泪囊吻合术是治疗慢性泪囊炎及其他原因造成的鼻泪管阻塞的切实可行的手术方法。     

鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术

目的探讨经单侧鼻腔直接入路行蝶窦及经蝶鞍区微创手术的方法。方法鼻内镜下用Hardy′s撑开器外移中鼻甲,扩大鼻腔,直达并开放蝶窦前壁,联合显微镜切除病变。结果12例孤立性蝶窦炎术后窦口开放良好,症状消失。9例蝶窦囊肿、脑膜瘤一次手术切除。1例蝶窦骨瘤术后症状消失。1例外伤性失明视神经管减压,术后视力无恢复。33例垂体瘤中 18例行全切除术,12例行次全切除术,3例行大部分切除术,术后补充X刀治疗。56例术后随访6个月～3.5年,蝶窦炎、蝶窦囊肿、脑膜瘤、蝶窦骨瘤术后无复发,3例垂体腺瘤复发,无颅内及鼻腔并发症。结论鼻内镜联合显微镜经单侧鼻腔直接入路行蝶窦及经蝶鞍区手术,创伤小、时间短、出血少、并发症少、效果好,是目前较好的蝶窦及经蝶鞍区微创术式。     

儿童左束支区域起搏六例临床观察

目的探讨儿童左束支区域起搏(LBBAP)的安全性及有效性.方法回顾性分析2019年1月至6月于北京安贞医院小儿心脏科住院采用LBBAP方式行永久心脏起搏器植入术的6例患儿(男1例、女5例)的临床资料、起搏心电图及参数并进行随访.组间比较采用t检验.结果6例患儿年龄9~14岁,体重26~48 kg;三度房室传导阻滞5例,右室心尖起搏术后伴心功能下降1例;1例患儿心功能降低,余5例心功能均正常;QRS波时限(95±13)ms;左心室舒张末径(LVEDD)Z值为1.85±0.65.起搏心电图V1呈右束支传导阻滞样,QRS波时限(111±20)ms,与术前相比,差异无统计学意义(t=-1.610,P>0.05).起搏阈值为(0.85±0.26)V,感知(15.0±4.3)mV,阻抗(717±72)Ω.3例可记录到P电位.起搏钉至左心室激动时间为(56±5)ms,不同输出电压下数值恒定.术后超声提示电极均位于室间隔左心室心内膜下.随访无心肌穿孔、电极脱位等并发症发生,患儿术后3个月阈值、感知及阻抗分别为(0.60±0.09)V、(16.1±3.9)mV、(662±78)Ω.左心室射血分数(LVEF)降低者LBBAP术后3d恢复正常(45%比57%).术后3个月LVEDD Z值降至(1.1±0.3),较术前明显减小(t=2.383,P<0.05).结论LBBAP可实现窄QRS波起搏,接近生理性起搏,起搏参数稳定,可快速、有效地纠正长期心动过缓所致的左心扩大及长期右室心尖起搏所致的心功能低下及心脏扩大.较大年龄儿童行LBBAP近期安全性、有效性好,远期潜在风险有待进一步观察研究.     

Prognostic factors of facial nerve function after vestibular schwannoma removal via translabyrinthine approach

Background: Prediction of facial function is a major concern when proposing surgery for patients with vestibular schwannoma (VS).

Aims/objectives: To evaluate postoperative facial function of patients who underwent operation of VS via a translabyrinthine approach (TL), and to analyze factors that influence facial functions.

Material and methods: A total of 91 VS patients, who were operated via a TL approach, between March 1997 and December 2016, were analyzed. Demographics, tumor-related factors, and operative findings were collected. Facial function was assessed according to the House-Brackmann (HB) grading system before surgery, immediately after surgery, and 1-, 3-, 6-months, and 1 year after surgery.

Results: In cases of patients that had a tumor that extended to the CPA, an unsatisfactory facial outcome was noted in 12 (30.0%) patients. FN outcomes after tumor removal depend on tumor size (p?=?.040). Among FN-related factors, only the FN recovery timing was correlated with facial outcomes (p?=?.030). Univariable and multivariable analysis revealed that tumor size and the timing of FN recovery were significant as favorable prognostic factors for good facial outcomes.

Conclusions and significance: Tumor size and the FN recovery timing are significant prognostic factors of facial outcome in VS patients who underwent operations via a TL approach.     

基于早期预警评分应用于子痫前期患者的效果

目的 探讨基于早期预警评分应用于子痫前期患者的效果及对母婴结局的影响。方法 将2019年1月—2020年12月我院收治的80例子痫前期患者纳入研究,按照随机数字表法分为两组,对照组40例予以常规妇产科干预,研究组40例予以基于早期预警评分的护理。比较两组干预前后心理状态、实施救治所需时间、终止妊娠时孕周、住院时间、血压、24 h尿蛋白量以及母婴结局。结果 研究组HAMD、HAMA评分低于对照组（P <0.05）。研究组实施救治所需时间、住院时间短于对照组,终止妊娠时孕周长于对照组（P <0.05）。研究组血压和24 h尿蛋白量低于对照组（P <0.05）。研究组产后出血、胎盘早剥、肝肾损伤发生率低于对照组（P <0.05）。研究组胎儿生长受限、胎儿窘迫、新生儿死亡、新生儿窒息发生率均低于对照组（P <0.05）。结论 子痫前期患者应用基于早期预警评分可有效改善患者心理状态,缩短患者的救治时间,延长孕周,控制病情进展,缩短住院时间,改善母婴结局。