小针刀治疗屈指肌腱狭窄性腱鞘炎疗效的Meta分析

目的 :通过系统评价,比较小针刀疗法和封闭疗法治疗屈指肌腱狭窄性腱鞘炎的疗效以及安全性。方法 :检索中国知网(1962~2015年)、维普数据库(1993~2015年)、万方数据(2000~2015年)、pubmed中文数据库(1994~2015年),并且应用手工输入法检索相关医学期刊,纳入小针刀疗法与封闭疗法对比治疗屈指肌腱狭窄性腱鞘炎的随机对照试验,经2名评价者按要求对筛选后的资料进行交叉核对后,采用Rev Man 5.2软件进行Meta分析。结果:共纳入7个随机对照试验,包含患者1 174例,但没有筛选到高质量文献。Meta分析结果显示,小针刀组治疗屈指肌腱狭窄性腱鞘炎总有效率明显高于对照组,OR=9.07,95%CI[4.64,17.76],Z=6.44,P0.00001;小针刀组治疗屈指肌腱狭窄性腱鞘炎痊愈率明显高于对照组,OR=7.86,95%CI[5.75,10.74],Z=12.93,P0.00001。结论:小针刀治疗屈指肌腱狭窄性腱鞘炎疗效优于封闭疗法。由于纳入试验数目有限且文献质量较低,漏斗图表现出发表偏倚,需设计更严格的随机对照试验来进一步验证上述结论。     

Application of 3D Scanning as an Indirect Method to Analyze and Eliminate Errors on the Manufactured Yoke-Type Forgings Forged in SMED Device on Modernized Crank Press

This article proposes an indirect measurement method based on a dimensional and shape analysis of forgings for the evaluation of the manufacture and the proper operation of the key elements of the crank press, in which after modernization, a quick tool assembly based on SMED (Single Minute Exchange of Die) was implemented. As a result of the introduced changes aiming at improving the forging aggregate and increasing the production efficiency, errors were observed on the manufactured products-forgings in the form of twists and joggles. In order to solve the problem, a lot of advanced methods was used, including: dynamic system of deformation analysis, numerical modeling and as well as dimensional and shape analysis by 3d scanning. Despite the above, this approach (classic way) did not solve the problem. A proprietary method with the use of 3D reverse scanning was proposed, which allows to solve the problem of forgings errors. Based on the measurement results and analyses for a few variants of production cycles, the necessary changes were obtained, making it possible to minimize the errors and obtain proper products in respect of geometry and quality.     

Anabolic steroids in the UK: an increasing issue for public health

Aim: The aim of the paper was to identify changes in the extent and patterns of anabolic steroid use in the United Kingdom to better understand the public health implications within the context of the current health-related evidence base. Methods: Using the two time points between 1995 (prior to legislation changes in the United Kingdom) and 2015, a review of the evidence related to health harms was conducted, in conjunction with needle and syringe programme (NSP) data in Cheshire & Merseyside (UK) relating to anabolic steroid users. Findings: Dramatic increase in the number of anabolic steroid users accessing NSPs, 553 in 1995 to 2446 in 2015, now accounting for 54.9% of clients. With the inclusion of pharmacy NSPs, this rose to 5336 individual anabolic steroid users. Conclusions: Key changes in our knowledge during the 20 years, in particular, in relation to HIV prevalence, changes in the market and patterns of use make anabolic steroid use a public health concern. In the context of increasing numbers of injectors, there is a need for comprehensive interventions.     

甲状腺结节细针穿刺检查的临床病理分析

目的:评价甲状腺结节细针穿刺检查价值,并进行临床病理结果分析,从而为甲状腺结节患者的临床诊断、治疗工作提供参考。方法:选择2018年7月~2019年7月本院收治的200例甲状腺结节患者,予以单纯超声检查的患者作为对照组,超声辅助细针穿刺检查的患者作为观察组。比较不同检查方法下2组检查的准确率、灵敏度、特异性以及病理检查良性、恶性情况,并分析观察组检查患者的风险性情况。结果:此次受试的200例甲状腺结节患者中,观察组检查准确率、灵敏度均明显高于对照组,P<0.05。组间特异性差异无显著性,且观察组患者的安全性较高,P>0.05。结论:甲状腺结节细针穿刺检查灵敏度较高,能够有效区分甲状腺疾病患者的疾病类型以及结节性质等情况,从而为疾病治疗提供参考。     

碱性和中性多酶清洗剂清洗复用骨穿针效果比较

目的：比较碱性和中性多酶清洗剂清洗复用骨穿针的效果。方法：将2014年1-2月本院消毒供应中心回收的污染复用骨穿针按清洗日期分为实验组和对照组,每组150件。实验组用1：270的碱性多酶清洗剂清洗,对照组用1：270中性多酶清洗剂清洗,比较两组器械的清洗效果。结果：实验组和对照组的器械表面清洗合格率分别为98.67%、97.33%,比较差异无统计学意义（P〉0.05）,而实验组针腔内壁清洗合格率为96.00%、杰力试纸检测合格率为95.33%,分别高于对照组的90.00%、88.67%,差异均有统计学意义（P〈0.05）。结论：碱性多酶清洗剂清洗复用骨穿针的效果优于中性多酶清洗剂,值得推广使用。     

Navigation-guided core needle biopsy for skull base and parapharyngeal lesions: a five-year experience

The aim of this study was to evaluate the diagnostic accuracy of navigation-guided core needle biopsy for skull base and parapharyngeal lesions. Twenty patients with skull base and parapharyngeal lesions were included in this study. The preoperative design and intraoperative real-time image guiding was done using an optical navigation system. A spring-loaded semi-automatic biopsy gun and biopsy needle were used for specimen harvesting. Accuracy was established on the basis of the postoperative pathology. All patients underwent needle biopsy successfully without any immediate or delayed complications. The subzygomatic approach was adopted in all cases. The number of passes ranged from three to five. The diagnostic accuracy was 90% (18/20). Navigation-guided core needle biopsy offers an easy approach for the diagnosis of skull base and parapharyngeal lesions, with a high yield of specimens and good patient tolerance.     

YOUNG PEOPLE TODAY

The new sociology of childhood sees children as competent social agents with important contributions to make. And yet the phase of childhood is fraught with tensions and contradictions. Public policies are required, not only to protect children, but also to control them and regulate their behaviour. For children and young people in the UK, youth justice has become increasingly punitive. At the same time, social policies have focused more on children's inclusion and participation. In this interplay of conflict and contradictions, the role the media play is critical in contributing to the moral panic about childhood and youth. In this article, we consider media representations of “antisocial” children and young people and how this belies a moral response to the nature of contemporary childhood. We conclude by considering how a rights‐based approach might help redress the moralised politics of childhood representations in the media.     

Lack of definitive presurgical pathological diagnosis is associated with inadequate surgical margins in breast-conserving surgery

PurposeTo determine the impact of definitive presurgical diagnosis on surgical margins in breast-conserving surgery (BCS) for primary carcinomas; clinicopathological features were also analyzed.MethodsThis retrospective study included women who underwent BCS for primary carcinomas in 2016 and 2017. Definitive presurgical diagnosis was defined as having a presurgical core needle biopsy (CNB) and not being upstaged between biopsy and surgery. Biopsy data and imaging findings including breast density were retrieved. Inadequate surgical margins (IM) were defined per latest ASCO and ASTRO guidelines. Univariable and multivariable analyses were performed.Results360 women (median age, 66) met inclusion criteria with 1 having 2 cancers. 82.5% (298/361) were invasive cancers while 17.5% (63/361) were ductal carcinoma in situ (DCIS). Most biopsies were US-guided (284/346, 82.0%), followed by mammographic (60/346, 17.3%), and MRI-guided (2/346, 0.6%). US and mammographic CNB yielded median samples of 2 and 4, respectively, with a 14G needle. 15 patients (4.2%) lacked presurgical CNB. The IM rate was 30.0%. In multivariable analysis, large invasive cancers (>20 mm), dense breasts, and DCIS were associated with IM (p = 0.029, p = 0.010, and p = 0.013, respectively). Most importantly, lack of definitive presurgical diagnosis was a risk factor for IM (OR, 2.35; 95% CI: 1.23–4.51, p = 0.010). In contrast, neither patient age (<50) nor aggressive features (e.g., LVI) were associated with IM.ConclusionLack of a definitive presurgical diagnosis was associated with a two-fold increase of IM in BCS; other risk factors were dense breasts, large invasive cancers, and DCIS.