不同保湿预处理法对口腔器械清洗灭菌效果的影响

目的 探究不同保湿预处理方法对口腔器械的清洗灭菌效果。方法 选择2019年11月—2020年11月本院口腔诊疗器械反光镜、牙钻手机、止血钳等共560件,随机分为观察组和对照组各280件,对照组进行无菌水擦拭,观察组在无菌水擦拭的基础上使用泡沫酶保湿剂,两组均保存于密闭容器中。集中由清洗消毒中心统一清洗消毒后,对两组常规检测结果、隐血残留检测结果、蛋白检测及三磷酸腺苷（ATP）检测结果进行对比。结果 两组经肉眼检查合格率观察组为100%,对照组为98.93%,经放大镜检查口腔器械合格率观察组为99.29%,对照组为98.57%,两组比较差异无统计学意义（P> 0.05）;观察组器械总隐血阳性率明显低于对照组（P <0.05）,器械表面的蛋白检测合格率为、ATP检测合格率均明显高于对照组（P <0.05）。结论 经无菌水擦拭联合泡沫酶保湿的预处理降低了口腔器械的隐血阳性率,提高表面蛋白检测及ATP检测的合格率,有效清除有机物残留,为后续清洗灭菌起到积极的作用。     

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。     

Effects of In-Process Ultrasonic Vibration on Weld Formation and Grain Size of Wire and Arc Additive Manufactured Parts

Wire and arc additive manufacturing (WAAM) is a competitive technique, which enables the fabrication of medium and large metallic components. However, due to the presence of coarse columnar grains in the additively manufactured parts, the resultant mechanical properties will be reduced, which limits the application of WAAM processes in the engineering fields. Grain refinement and improved mechanical properties can be achieved by introducing ultrasonic vibration. Herein, we applied ultrasonic vibration to the WAAM process and investigated the effects of wire feed speed, welding speed, and ultrasonic amplitude on the weld formation and grain size during ultrasonic vibration. Finally, a regression model between the average grain size and wire feed speed, welding speed, and ultrasonic amplitude was established. The results showed that due to the difference in heat input and cladding amount, wire feed speed, welding speed, and ultrasonic amplitude have a significant influence on the weld width and reinforcement. Excessive ultrasonic amplitude could cause the weld to crack during spreading. The average grain size increased with increasing wire feed speed and decreasing welding speed. With increasing ultrasonic amplitude, the average grain size exhibited a trend of decreasing first and then increasing. This would be helpful to manufacture parts of the required grain size in ultrasonic vibration-assisted WAAM fields.     

Immune checkpoint inhibitors in head and neck squamous cell carcinoma: A systematic review of phase-3 clinical trials

BACKGROUNDThe outcomes of patients diagnosed with head and neck squamous cell carcinoma (HNSCC) who are not candidates for local salvage therapy and of those diagnosed with recurrent or metastatic disease are dismal. A relatively new systemic therapy option that emerged in recent years in the treatment of advanced HNSCC is immunotherapy using immune checkpoint inhibitors (ICIs). The safety profile and anti-tumor activity of these agents demonstrated in early phase clinical trials paved the way to the initiation of several promising phase-3 trials in the field.AIMTo evaluate the evidence on the effectiveness of ICIs in HNSCC, based on published phase-3 clinical trials.METHODSWe searched PubMed, Cochrane Library, Embase, and Scopus to identify published literature evaluating immunotherapy using ICIs in recurrent or metastatic HNSCC (R/M HNSCC) and locally advanced head and neck squamous cell carcinoma (LAHNSCC). We used a combination of standardized search terms and keywords including head and neck squamous cell carcinoma, recurrent, metastatic, locally advanced, immunotherapy, immune checkpoint inhibitors, monoclonal antibodies, programmed cell death protein-1 (PD-1), programmed death-ligand 1 (PD-L1), cytotoxic T- lymphocyte associated protein-4 (CTLA-4), and phase-3 clinical trial. A sensitive search filter was used to limit our results to randomized controlled trials.RESULTSFive phase-3 clinical trials have reported the data on the effectiveness of immunotherapy in HNSCC so far: Four in R/M HNSCC and one in LAHNSCC. In patients with R/M HNSCC, anti-PD-1 agents nivolumab and pembrolizumab demonstrated improved survival benefits in the second-line treatment setting compared to the standard of care (standard single-agent systemic therapy). While the net gain in overall survival (OS) with nivolumab was 2.4 mo [hazard ratio (HR) = 0.69, P = 0.01], that with pembrolizumab was 1.5 mo (HR = 0.80 nominal P = 0.0161). The anti-PD-L1 agent durvalumab with or without the anti-cytotoxic T- lymphocyte associated protein-4 agent tremelimumab did not result in any beneficial outcomes. In the first-line setting, in R/M HNSCC, pembrolizumab plus platinum-based chemotherapy resulted in significant improvement in survival with a net gain in OS of 2.3 mo (HR = 0.77, P = 0.0034) in the overall population and a net gain in OS of 4.2 mo in the PD-L1 positive (combined positive score > 20) population compared to standard of care (EXTREME regime). In patients with PD-L1 positive R/M HNSCC, monotherapy with pembrolizumab also demonstrated statistically significant improvement in survival compared to EXTREME. In LAHNSCC, immunotherapy using avelumab (an anti-PD-L1 agent) along with standard chemoradiation therapy did not result in improved outcomes compared to placebo plus chemoradiation therapy.CONCLUSIONAnti-PD-1 agents provide survival benefits in R/M HNSCC in the first and second-line settings, with acceptable toxicity profiles compared to standard therapy. There is no proven efficacy in the curative setting to date.     

甲状旁腺激素相关蛋白及转化生长因子β与乳腺癌的相关性研究

目的 观察乳腺癌原发肿瘤组织中甲状旁腺激素相关蛋白（PTHrP）和转化生长因子β（TGF-β）的表达情况,并探讨其与乳腺癌肿瘤生物病理学特征的相关性.方法 以免疫组化染色（Envision法）对乳腺癌及乳腺良性肿瘤标本进行检测.分析研究PTHrP及TGF-β与乳腺癌肿瘤生物病理学特征的相关性;Kaplan-Meier 方法分析患者无病生存情况;Log-Rank （Mantel-Cox）时序检验比较无病生存分布.结果 ①约60%的乳腺癌组织中存在TGF-β的阳性表达,PTHrP在90%以上的乳腺癌中表达阳性,而乳腺良性肿瘤组织PTHrP表达的阳性率很低;②TGF-β表达阳性的患者具有较高的淋巴结转移率,且组织学分级较差;③乳腺癌组织中PTHrP高表达与较大的肿瘤直径、较多的腋淋巴结转移、累及皮肤、较差的组织学分级相关;④PTHrP与乳腺癌患者术后无病生存无明显相关性;⑤TGF-β阳性表达与乳腺癌患者术后复发转移率有明显的相关性;⑥TGF-β阳性且PTHrP高表达的患者无病生存率最差,而TGF-β阴性且PTHrP高表达组的预后最好.结论 乳腺癌肿瘤组织中PTHrP和TGF-β的表达均与乳腺癌进展呈正相关.PTHrP联合TGF-β检测可能成为乳腺癌预后有意义的预测指标.     

Intradural extramedullary capillary hemangioma with intramedullary component: A case series

Rationale:Capillary hemangioma in the spinal cord is an exceedingly rare entity that is liable to be misdiagnosed. To summarize the clinical presentation, radiological characteristics, and pathological features of capillary hemangioma in the spinal cord and to share our experience for the diagnosis and treatment of intradural extramedullary capillary hemangioma.Patient concerns:Three patients underwent surgical treatment at our hospital between January 2020 and August 2020. All patients were male[median age at presentation: 57 years (range: 56–60)]. Two patients were experiencing pain and numbness in the lower back, and 1 patient was experiencing numbness and weakness in the left lower limb. The duration of symptoms ranged from 1 to 5 months.Diagnosis:All patients were diagnosed with spinal cord capillary hemangioma after treatment. All lesions were in an intradural extramedullary location and involved spinal cord components. Two patients had lesions in thoracic segments (T8, Th9-10), and 1 patient had a lesion in lumbar segment (L1).Interventions:All patients underwent microscopic laminectomy and complete resection of the extramedullary and intramedullary components of the spinal cord capillary hemangiomas.Outcomes:Postoperatively, all patients experienced transient numbness and pain in the lower limbs, which gradually decreased over time. None of the patients experienced bleeding, severe numbness or pain, or recurrence of symptoms at 3-month follow-up.Conclusion:Intradural extramedullary capillary hemangioma has unique morphological characteristics. Gross-total resection of the extramedullary and intramedullary components of spinal cord capillary hemangioma is recommended for patients with symptoms of spinal cord compression. Careful preoperative imaging and intraoperative decision-making may help avoid residual lesions or reoperation.     

Can the patient pinpoint where the ingested fish bone is impacted?: A single-center,retrospective study

Among the plethora of foreign body impactions, fish bones are common examples that patients may struggle to properly disclose in clinical situations. This study investigated whether patients could pinpoint where the ingested fish bone was lodged. In addition, we investigated the differences between fish bone and other foreign bodies, the usefulness of computed tomography (CT), and the related risk factors for hospitalization. The cases of patients who underwent an endoscopic removal of fish bone between April 2008 and April 2020 were retrospectively reviewed. The clinical outcomes, X-ray scan, CT, and complications of each patient were investigated. A total of 96 patients were included in this study. The mean size of the impacted fish bone was 23.78 mm, and most were found in the upper esophagus (n = 38). There was a weak correlation between pain location and the actual lesion location (r = 0.419, P < .001). Compared to those of other foreign bodies, the location of impacted fish bones was different (P < .001), the X-ray detection rate of fish bones was lower (P < .001), and the complication incidence was higher (P = .030). CT (95.89%) showed higher sensitivity than X-ray scanning (11.24%) (P < .001). Foreign body size (P = .004) and door-to-endoscopy time (P = .029) were related to admission. Patients only managed to point out the approximate location of the ingested fish bone. CT detected fish bones well, but scans should include at least the entire esophagus instead of solely the area where pain is felt. Fish bone impaction has different clinical characteristics from other foreign bodies. Endoscopic removal without delay can reduce the admission rates.     

Assessment of functioning in Dutch primary care: Development study of a consultation tool for patients with chronic conditions and multimorbidity

BackgroundIn primary care, a shift from a disease‐oriented approach for patients with multimorbidity towards a more person‐centred approach is needed.AimTo transform a self‐report questionnaire for patients with chronic conditions in primary care, the Primary Care Functioning Scale (PCFS), into an understandable, visually attractive and feasible consultation tool for patients and health care providers. The consultation tool consists of a web‐based version of the PCFS, which is filled in by the patient and is processed to a feedback report that summarizes and visualizes the main findings. The feedback report can be discussed with the patient to facilitate a more person‐centred conversation for patients with chronic conditions and multimorbidity in general practice.Design and SettingIn this qualitative study, we developed the consultation tool by using design thinking in a participatory developmental process.MethodsIn the first phase, we constructed five different feedback report templates to summarize and display the results of a completed PCFS questionnaire in a series of two expert meetings with patients and general practitioners (GPs). In the second phase, we performed an exploratory qualitative interview study involving dyads of patients with chronic conditions and their practice nurses. In an iterative process, we explored their experiences with the consultation tool.ResultsPatients, as well as GPs, preferred a clear manner of presenting the results of the questionnaire in a feedback report. In 18 interviews with patients and practice nurses during three different interview rounds, we adjusted the feedback report and consultation tool based on the input from patients and practice nurses. After the final interview round, patients and practice nurses consented that the consultation tool was useful for having a more in‐depth consultation about functioning and patients'' preferences when integrated into the regularly scheduled consultations.ConclusionWe were able to develop an understandable and feasible consultation tool that is applicable in already existing chronic disease management programmes in general practice in the Netherlands.Patient or Public ContributionTo increase the understandability and feasibility of the consultation tool, we collaborated with end‐users and actively involved patients, GPs and practice nurses in a participatory development process.