肩关节脱位外旋固定疗效的meta分析

目的分析系统性评价初发性肩关节脱位手法复位后内旋位固定与外旋位固定疗效的差异。方法计算机检索Cochrane图书馆（2013年第10期）、MEDLINE（1966年至2013年10月）、EMBase（1966年1月至2013年10月）、中国生物医学文献数据库（1979年1月至2013年10月）、Pub Med（1966年6月至2013年10月）、万方数据库和维普数据库以及手工检索中文骨科期刊,收集关于初发性肩关节脱位手法复位后内旋位固定与外旋位固定疗效的相关文献。筛选符合纳入标准的文献,对其进行严格的质量评价后应用Rev Man 5.2软件进行meta分析。结果符合纳入标准的文献共7篇,包含640例患者。meta分析结果显示：两种固定方法治疗初发性肩关节脱位后,肩关节脱位复发率组间差异有统计学意义（OR=2.43,95%CI：1.16~5.11,P=0.02）,外旋位固定组患者治疗后肩关节再脱位发生率明显低于内旋组。结论初发性肩关节脱位手法复位后应用外旋位固定可明显降低患者肩关节脱位的复发率,优于传统的内旋位固定法。     

中西医结合外治疗法治疗角化型手足癣41例临床观察

目的：观察中西医结合外治疗法治疗角化型手足癣的临床疗效。方法：将61例患者分为中西医结合治疗组（治疗组）41例,以中药浸泡结合0．25％盐酸阿莫罗芬乳膏外涂患处;西药治疗组（对照组）20例,仅用0．259／6盐酸阿莫罗芬乳膏外涂。观察5项主症及真菌学检查等指标。结果：治疗组愈显率为88．2％,对照组愈显率60．0％,两组愈显率比较差异具有统计学意义（P〈0．05）。结论：中西医结合外治疗法治疗角化型手足癣疗效明显优于单纯西药治疗。     

荆菊溶液外用治疗婴幼儿湿疹的临床疗效

目的：探讨中药荆菊溶液外用治疗婴幼儿湿疹的临床疗效。方法将123例患者随机分为2组,治疗组63例以中药荆菊溶液外涂治疗,对照组60例外涂维生素B6治疗,进行临床疗效观察。2组均以7 d为1个疗程。结果治疗组总有效率为96.83%。对照组总有效率为83.33%,差异有统计学意义（P〈0.05）;治疗组平均治愈（8.63±2.25）d,对照组（10.08±3.91）d,治疗组显著少于对照组（P〈0.05）。结论荆菊溶液外涂,组方简单,安全性好,疗效确定,简便效廉,值得临床推广。     

形寒与寒饮对小鼠呼吸道粘膜免疫分子影响的实验研究

目的观察形寒与寒饮对小鼠呼吸道粘膜免疫分子的影响。方法将40只昆明小鼠随机分为常温对照组、形寒组、寒饮组、形寒寒饮组4组,置于人工气候箱中,于第18天处死小鼠,检测各组气道液中分泌型免疫球蛋白G(IgG)、分泌型免疫球蛋白A(SIgA)和肿瘤坏死因子(TNF-α)。结果形寒组、寒饮组与形寒寒饮组气道液TNF-α和IgG表达值与常温对照组比较均明显升高(P0.05),形寒寒饮组升高最明显;形寒组、寒饮组与形寒寒饮组气道液中SIgA的浓度与常温对照组比较均明显下降,形寒寒饮组降低最明显,差异具有统计学意义。结论形寒与寒饮伤肺之时,肺部出现感染导致TNF-α、IgG浓度升高和SIgA的浓度降低,其程度以形寒寒饮两者相合的外感病因最为明显,形寒组次之、寒饮组再次之。     

临床实验室质量管理和患者安全简

临床实验室检测结果的准确性对患者的安全至关重要,质量管理是控制检测过程质量,保证患者安全的有效途径。结合室间质量评价、室内质量控制、实验室认可、质量指标、六西格玛管理方法、风险管理、相关规范和标准等管理方法和理论,阐述了对临床实验室有效进行质量管理,保证患者安全的研究成果,并提出了下一步研究计划。     

基层医院严重多发伤中骨折的损伤控制治疗

目的探讨严重多发伤伴骨折患者在基层医院的损伤控制治疗。方法回顾性分析我院2006年1月—2011年1月应用损伤控制(早期迅速、有效的骨折固定及清创,术后ICU进一步复苏,病情平稳后行确定性手术)救治的25例严重多发伤伴骨折患者的临床资料。结果 25例中抢救成功22例(88.0%),死亡3例(12.0%)。骨盆骨折及四肢不稳定骨折早期予以外固定架固定,其中10例作为确定性固定手段。结论损伤控制同样适用于基层医院严重多发伤伴骨折患者的治疗,但应准确把握其适应证。外固定架在骨折的早期固定中具有重要意义,值得推广。     

驻黎维和中国二级医院第七批51例眼外伤l临床分析

目的分析联合国驻黎巴嫩临时维和部队（UNIFIL）中国二级医院眼科眼外伤的致伤原因、特点,以预防和减少眼外伤的发生。方法对UNIFIL中国二级医院眼科第七批医疗队2011年3月1日～10月20日任务期内眼科门诊及住院眼外伤患者病例进行回顾性分析。结果 51例（55眼）眼外伤中,男46例,女5例;年龄9～48岁,平均30.15岁;右眼25例,左眼22例,双眼4例;维和军人34例,当地及国际雇员16例,当地学生1例;国籍：黎巴嫩16例,西班牙9例,法国6例,尼泊尔4例,中国3例,坦桑尼亚3例,韩国3例,马来西亚2例,葡萄牙2例,意大利1例,德国1例,印度1例;受伤至就诊时间：24 h以内30例,1～7 d 17例,7 d以上4例;受伤分类：眼球钝挫伤占45.09%,其他各类眼外伤（如电光性眼炎、角膜结膜异物、角结膜烫伤化学烧伤、角膜擦伤等）占54.91%;受伤原因：工作中受伤30例,运动中受伤7例,拳击伤6例（均为外国军人）,各种意外伤7例。在二级医院接受治疗48例（门诊43例,住院治疗5例）,1例角膜白斑未治,送三级医院遣返回国手术治疗2例。结论眼外伤是维和人员常见的眼病,应加以重视并积极预防,一旦发生,及时到专科诊治,减少并发症的发生。     

Limb lengthening over plate

Background:

The limb lengthening over plate eliminates the associated risk of infection with limb lengthening over intramedullary nail. We present our experience of limb lengthening in 15 patients with a plate fixed on the proximal segment, followed by corticotomy and application of external fixator.

Materials and Methods:

15 patients (7 females, 8 males) were included in this consecutive series. The average age was 18.1 years (range 8–35 years). Fifteen tibiae and one femur were lengthened in 15 patients. Lengthening was achieved at 1 mm/day followed by distal segment fixation with three or four screws on reaching the target length.

Results:

The preoperative target length was successfully achieved in all patients at a mean of 4.1 cm (range 1.8–6.5 cm). The mean duration of external fixation was 75.3 days (range 33–116 days) with the mean external fixation index at 19.2 days/cm (range 10.0–38.3 days/cm). One patient suffered deep infection up to the plate, three patients had mild procurvatum deformities, and one patient developed mild tendo achilles contracture.

Conclusion:

Lengthening over a plate allows early removal of external fixator and eliminates the risk of creating deep intramedullary infection as with lengthening over nail. Lengthening over plate is also applicable to children with open physis.     

Sagittal flexion of the femoral component affects flexion gap and sizing in total knee arthroplasty

The purpose of this study was to determine how much sagittal rotation of the femoral component affects the flexion gap and femoral component sizing using a computer-simulation technique. The study comprised 25 knees scheduled for total knee arthroplasty (TKA). The femoral component was positioned at -2°, 0°, 2°, 4°, or 6° of flexion to the anterior femoral cortex, and the resected portion of the posterior medial femoral condyle was measured for 3 total knee systems. The amount of the resected bone of the posterior medial condyle decreased approximately 1 mm for every 2° of additional flexion in all TKA systems. Intentional sagittal flexion of the femoral component by several degrees during TKA can be a useful downsizing technique for the femoral component without excessively increasing the flexion gap.     

Geographic factors are associated with increased risk for out-of hospital cardiac arrests and provision of bystander cardio-pulmonary resuscitation in Singapore

Background

Bystander Cardio-Pulmonary Resuscitation (BCPR) can improve survival for Out-of-Hospital Cardiac Arrest (OHCA). This study aimed to investigate the geographic variation of BCPR provision and survival to discharge outcomes among residential OHCA cases, evaluate this variation with individual and population characteristics and identify high-risk residential areas with low relative risk (RR) of BCPR and high RR of OHCA at the development guide plan (DGP) census tract levels in Singapore.

Methods

This was a retrospective, secondary analysis of two prospectively-collected registries in Singapore from 2001 to 2011. We used Bayesian conditional autoregressive spatial models to examine predictors at the DGP level and calculate smoothed RR to identify high-risk areas. We used multi-level mixed-effects logistic regression models to examine the independent effects of individual and neighborhood factors.

Results

We found a total of 3942 OHCA with a BCPR rate of 20.3% and a survival to discharge rate of 1.9% and 3578 cases eligible for BCPR. After adjusting for age, witnessed status, presumed cardiac etiology and longer response time, the risk of BCPR provision significantly increased by 0.02% for every 1% increase in the proportion of household size 5 and above in the DGP area (odds ratio1.02, 95%CI = 1.002–1.038, p < 0.026). We identified 10 high-risk residential areas with low RR of BCPR and high RR of OHCA.

Conclusion

This study informed that neighborhood household size could have played a significant role in the provision of BCPR and occurrence of high-risk areas. It demonstrates the public health potential of combining geospatial and epidemiological analysis for improving health.