Protective and Risk Factors for Humerus Head Necrosis After Proximal Humerus Fracture Treated with Internal Locking Plate

BackgroundProximal humerus fractures (PHF) are common and lead to post-traumatic humerus head necrosis (HHN) in 3–35% after ORIF with an internal locking plate. Few studies focus on this condition and risk factors remain a discussion topic. Hertel’s criteria for initial head ischemia right after fracture (fracture complexity, medial hinge displacement and short metaphyseal head extension) have recently been correlated to HHN, but there is still a clear lack of evidence on the topic. Due to its anatomical similarities to the proximal femur, some authors argue that PHF may as well benefit from early surgery to avoid head necrosis.MethodsIn this 10-year retrospective study, we assessed 305 patients from a single center. All cases were treated with a PHILOS plate through a deltopectoral approach. The mean follow-up time was 467 days. The primary endpoint was HHN.ResultsHHN was diagnosed in 12 patients (4%), 10 of which were diagnosed within the first year and one case 4 years after surgery. A positive correlation (p < 0.04) was found between HHN and fracture type (both in AO and Neer’s classification), initial neck-shaft-angle (NSA) and metaphyseal head extension (MHE). Medial hinge displacement (MHD) occurred in all HHN cases. Achieving perfect reduction (< 2 mm dislocation) was relevant to avoiding HHN (p = 0.035). Although HHN developed in 32% of the high risk cases (four-part fractures with a short MHE), it was completely avoided (0%) when perfect reduction was achieved. Time until surgery after admission was neither a protective nor a risk factor for HHN.ConclusionWe conclude that fracture complexity (four-part and C-fractures) as well as disruption of the medial hinge with a metaphyseal head extension smaller than 8 mm are relevant risk factors for humerus head necrosis. A combination of these criteria generated an high risk pattern with a 32% rate of HHN. Though often difficult to achieve, perfect reduction was a clear protective factor and reduced HHN to 0%. Perfect reduction may be key to inosculation and, therefore, salvage of the humerus head, especially in high risk cases. Surgery timing did not correlate with HHN.Level of EvidenceLevel 3, retrospective cohort study.     

Male Sexual Function After Pediatric Kidney Transplantation—A Cross-sectional Nationwide Study

BackgroundData on adult sexual functioning after kidney transplantation (KTx) during childhood or adolescence are scarce.AimTo assess the long-term sexual and psychosocial quality of life after pediatric KTx.Methods29 young men (median age 27.1 years) were examined 18.7 years (median) after KTx. 56 age-matched healthy men (median age 30.0 years) served as controls.OutcomeWe studied the influence of sociodemographics, previous renal replacement therapy, current reproductive hormonal serum levels, testicular size, and data on several validated mental and physical questionnaires on participants' Derogatis Interview for Sexual Functioning self-report scores.ResultsThe KTx recipients had significantly poorer sexual functioning than their healthy peers. KTx men had less frequent sexual activity with a partner (P = .03) and poorer orgasms (P = .002) than the controls but no erectile dysfunction (P = .5).Clinical implicationsDepressive symptoms, relationship status, and longer dialysis duration predicted poor adult sexual functioning in KTx recipients, whereas age at transplantation or at the time of the study did not.Strengths & LimitationsThis study contributes extended follow-up data to the very scarce literature on adult sexual functioning in pediatric KTx recipients. Relatively small population and low participation rate limit the comprehensive data interpretation in a population-based cohort of male KTx recipients.ConclusionSexual functioning is often impaired in young men after pediatric KTx, emphasizing the need for long-term monitoring of sexual health and sexuality as important dimensions of quality of life.Tainio J, Jahnukainen T, Jalanko H, et al. Male Sexual Function After Pediatric Kidney Transplantation—A Cross-sectional Nationwide Study. J Sex Med 2020;17:2104–2107.     

新型冠状病毒肺炎疫情下喉镜检查的防护策略

目的探讨新型冠状病毒肺炎（COVID 19）疫情下耳鼻咽喉头颈外科喉镜室如何做好防护工作,在保证临床诊疗工作顺利完成的同时保护好医务人员及患者健康、避免院内交叉感染。方法本研究查阅相关资料并总结医院的疫情防控经验及应对策略,在患者合理分流、喉镜室工作环境的布置及工作人员的个人防护、喉镜检查前的准备工作、检查中的操作流程及注意事项及检查后的清洁消毒工作等方面做好疫情期间周详合理的工作安排。结果疫情期间,耳鼻咽喉头颈外科喉镜室每日临床工作顺利完成,所有医务人员及患者均未感染新型冠状病毒,也未出现其他院内交叉感染。结论耳鼻咽喉头颈外科喉镜室的防护策略合理有效,能够在完成临床诊疗工作的同时有效保护医患的健康。     

新冠肺炎危重型患者气管切开术初步经验与体会(附1例报告)

新型冠状病毒肺炎(新冠肺炎,COVID-19)是指由2019新型冠状病毒(新冠病毒,2019-nCoV)感染导致的肺炎。新冠病毒传播途径主要为呼吸道飞沫传播和接触传播,并存在气溶胶传播可能。由于肺部严重感染易导致急性呼吸窘迫综合征,新冠肺炎危重型患者气管切开术可作为一种救治手段,但术中可能会产生大量的病毒飞沫通过气道扩散在空气中形成气溶胶,增加院内感染风险。本文根据国家卫健委新冠肺炎相关诊疗方案和措施,结合我院的1例危重型患者在重症监护隔离病区行气管切开术的经验,探讨危重型新冠肺炎患者气管切开的必要性、手术方式、术前准备、术中操作、术后护理及医护防护措施等相关问题。     

Ideas on several issues of acupuncture-moxibustion science

The Shanghai Journal of Acupuncture and Moxibustion and Journal of Acupuneture and Tuina Science witnessed a development of numerous authors. On the occasion of the 6th anniversary of Journal of Acupuncture and Tuina Science, I＇d like to share my ideas about several issues on acupuncturemoxibustion science.     

不同服药时间对辛伐他汀调脂及抗炎效应的影响

目的比较晨起及晚间顿服常用剂量辛伐他汀对混合性高脂血症患者的调脂作用以及抗炎效应的差异。方法103例混合性高脂血症患者随机分为晨起服药组(n=52)及晚间服药组(n=51),均口服20 mg辛伐他汀,疗程6个月。观察治疗前后主要血脂参数的变化率和达标率、超敏C反应蛋白浓度变化及不良反应。结果与治疗前相比,不同时间服药均能明显降低患者血清总胆固醇、低密度脂蛋白胆固醇和甘油三酯水平(P<0.001);两组相比较,晨起服药组降低甘油三酯的幅度明显优于晚间服药组(38%比19%,P=0.035),其降低总胆固醇和低密度脂蛋白胆固醇的作用虽略低于晚间服药组,但仍可使两者分别下降21%和31%。按我国“血脂异常防治建议”的目标,晨起服药组甘油三酯的达标率更高(51%比33%,P=0.038),且三项(总胆固醇、低密度脂蛋白胆固醇和甘油三酯)全部达标者也明显优于晚间服药组(36%比29%,P<0.05);而低密度脂蛋白胆固醇的达标率晚间服药组高于晨起服药组。不同时间服药均能明显降低血清超敏C反应蛋白水平,两组间比较差异无显著性(P>0.05)。结论与传统的晚间服药相比,晨起服药可更有效降低血清甘油三酯水平,调节轻中度混合性高脂血症患者的血脂异常。并且同晚间服药一样具有显著的抗炎作用。     

浙江省肾综合征出血热(HFRS)-Ⅰ型鼠脑纯化疫苗安全性、血清学、防病效果和免疫策略研究

目的　现场观察、考核兰州生物制品研究所生产的HFRS -Ⅰ型鼠脑纯化疫苗的安全性、血清免疫学与防病效果 ,并确定其免疫程序和免疫策略。方法　试验组和对照组按随机整群分组法进行分组 ;采用 0、7、2 8d及免后 1年加强 1针的免疫程序 ;分别采集免前、全程接种后 2周、加强前、加强后两周、加强后 1、2、3、4、5年的部分接种者全血和微量耳垂血 ,分别测定其中和抗体和IFA抗体 ,观察疫苗的血清免疫学效果和现场流行病学防病效果。结果　在 1995年 8月～ 2 0 0 1年 12月的 6年时间里从疫苗开始接种到加强后 5年 ,观察了HFRS -Ⅰ型鼠脑灭活纯化疫苗的安全性、血清免疫学效果和流行病学防病效果等。纵观结果 :证明该疫苗除了因疫苗中残留蔗糖导致较重较普遍的局部反应外 ,未发现其他严重的副反应 ,证明疫苗有较好安全性。从血清免疫效果看 ,86例全程接种后两周的免疫者血清 ,IFA抗体阳转率达 10 0 % ,中和抗体阳转率为4 4 4 4 % (8/ 18)。 1年后 ,IFA抗体和中和抗体阳性率分别下降到 2 8 5 7%和 14 80 %。但加强后 2周的血清IFA抗体和中和抗体阳性率分别反弹至 83 33%和 5 5 5 6 % ,其抗体几何平均滴度也随之回升 ,但不十分明显。此外 ,在加强后 2年IFA和中和抗体阳性率再次下降到较低水平 ,分别为     

禽巴氏杆菌OmpH外膜蛋白DNA疫苗的免疫效果

目的:研究禽多杀性巴氏杆菌omph DNA疫苗在小鼠体内诱导的免疫保护效果。方法:利用PCR技术扩增出禽多杀性巴氏杆菌的omph基因片段,克隆到pMD18-T上,再亚克隆到真核载体pcDNA3.1(+)上,构建重组质粒pOMPH,体外转染SP2/0细胞,RT-PCR、间接免疫荧光试验、Western blot检测其转录及表达情况。然后进行动物免疫,实验动物分为三组即:pOMPH组、pCDNA3.1(+)空载体组和PBS对照组,每组16只BALB/c小鼠,pOMPH组和pCDNA3.1(+)组以100μg/只的剂量肌注免疫,PBS组每只小鼠肌注100μl1×PBS,各组均进行了三次免疫,每次间隔两周。间接ELISA检测免疫后小鼠血清特异性抗体水平,MTT法检测免疫小鼠脾淋巴细胞增殖情况,三免两周后检测脾淋巴细胞IFN-γ分泌情况。强毒攻击,计算小鼠存活数目及保护率。结果:间接免疫荧光试验、Western blot和RT-PCR检测结果均表明pOMPH可在体外培养的SP2/0细胞中表达目的蛋白。动物免疫后,pOMPH组免疫小鼠血清抗体水平持续上升,与pCDNA3.1(+)组和PBS组相比差异极显著(P0.01)。经提取的外膜蛋白(Omps)刺激后,pOMPH组的刺激值(SI值)与pCDNA3.1(+)组及PBS免疫组相比均差异显著(P0.05)。免疫小鼠脾细胞产生的IFN-γ极显著高于两对照组产生的IFN-γ(P0.01)。攻毒后pOMPH组保护率明显高于两对照组,可达70%。结论:成功构建了禽多杀性巴氏杆菌omph DNA疫苗,该疫苗可诱导免疫小鼠产生较强的体液和细胞免疫应答及较好的保护效果。     

心理训练对战斗机飞行员军事应激损伤防护效果

目的：探讨军事应激条件下战斗机飞行员心理健康状况和心理训练对战斗机飞行员军事应激损伤防护的效果,为临床心理工作提供理论依据。方法：将参加重大演习任务的69名战斗机飞行员随机分为训练组和对照组,比较两组飞行员心理训练前后心理健康状况。结果：参演战斗机飞行员症状自评量表躯体化、强迫、焦虑、敌对、恐怖、偏执因子分显著高于军人常模（t＝3．753,2．219,3．141,2．032,2．060,2．772;P＜0．05）,心理训练后训练组躯体化、强迫、焦虑、敌对、偏执因子分显著低于对照组（t＝－2．656,－2．247,－2．244,－2．106,－3．181;P＜0．05）。结论：心理训练能够调节战斗机飞行员军事应激反应,改善其心理健康状况。     

甲状腺肿瘤217例手术治疗

目的探讨颌面外科医生手术治疗甲状腺肿瘤疾病的疗效。方法回顾收治并行手术切除的217例甲状腺包块的患者,对甲状腺手术治疗的风险、治疗效果和并发症进行分析。结果本组患者中有58例行甲状腺部分切除术,146例行甲状腺次全切术,13例行一侧腺叶切除＋峡部切除术。217例患者中术后有3例出现暂时性喉返神经损伤症状,1例伤口感染,2例甲状腺癌术后两年复发,其余病例均未出现喉返神经、喉上神经损伤、甲状腺、甲状旁腺功能低下等症状。结论颌面外科医生可以有效治疗不同甲状腺疾病。