间歇充气加压装置不同使用模式对预防直肠癌腹腔镜术中患者静脉血栓的效果

目的 探讨腹腔镜直肠癌手术患者术中不同模式间歇充气加压装置(intermittent pneumatic compression,IPC)预防下肢深静脉血栓(deep vein thrombosis,DVT)的效果.方法 2020年4月—2021年4月,在温州市某三级甲等医院结直肠外科连续选择符合纳入标准的130例拟行...     

Transcatheter closure of ventricular septal defect in aortic valve prolapse and aortic regurgitation

ObjectiveTo report intermediate follow-up result of transcatheter closure of ventricular septal defect (VSD) in presence of aortic valve prolapse (AVP) with or without aortic regurgitation (AR).MethodThis is a retrospective review of 19 patients with VSD with AVP with AR who underwent transcatheter closure in between September 2011–July 2014. Mean age was 8 years (1–16 years, standard deviation [SD] 4.08 years) and mean weight was 26.03 kg (9–81.5 kg, SD 16.57 kg). Among them 2 had subarterial VSD, 6 had subaortic VSD and 11 had perimembranous VSD. All of them had mild AVP and 13 of them had AR (trivial or mild). Median VSD size was 4.3 mm (4–6 mm). Transcatheter closure was done either by retrograde technique using the Amplatzer Duct Occluder-II in 17 patients or antegrade technique using the Duct Occluder-I in 2 cases. Mean follow-up period was 18 months (12–36 months).ResultImmediate major complications were encountered in 2 (10.5%) cases. Significant aggravation of device related AR was seen in one case & device embolised to right pulmonary artery in another case and both of them were managed surgically.During follow up, 1 child had significant additional VSD requiring device closure. One child developed moderate AR, requiring surgery. None of the other had shown any increase in severity of AR.ConclusionDevice closure of VSD in presence of mild AVP and mild AR appears to be safe. Longer follow-up is necessary to draw final conclusion.     

社区多部门系统干预模式对慢性精神分裂症患者症状、社会功能及生存质量的干预效果研究

目的　探讨社区多部门系统干预模式对慢性精神分裂症患者症状、社会功能及生存质量的干预效果。方法　于2016年3—5月,采用方便抽样法选取上海市浦东新区花木社区卫生服务中心在册管理的、被明确诊断的精神分裂症患者128例为研究对象。随机分为对照组和干预组,每组各64例。对照组由社区卫生服务中心精神卫生防治工作者（精防工作者）按照目前浦东新区精神疾病管理方法对患者进行常规管理;干预组在对照组的基础上增加街道办事处、派出所、残疾人联合会、民办非企业单位（组织）等部门进行多部门管理。两组干预时间均持续1年。干预前和干预后1年时,分别采用阳性与阴性症状量表（PANSS）、个人和社会功能量表（PSP）、世界卫生组织生存质量测定量表简表（WHOQOL-BPRS）、家庭功能评定量表（FAD）评估患者症状、社会功能及生存质量。结果　干预前,两组患者PANSS、PSP、WHOQOL-BPRS、FAD评分比较,差异均无统计学意义（P>0.05）。干预后,干预组PANSS一般精神病理症状评分及总分低于对照组,PSP各项评分及总分高于对照组,WHOQOL-BPRS生理、社会关系评分及总分高于对照组,FAD问题解决、沟通、情感反应及总的功能评分低于对照组,差异有统计学意义（P<0.05）;两组PANSS阳性症状、阴性症状评分,WHOQOL-BPRS心理、环境评分,FAD角色、情感介入、行为控制评分比较,差异无统计学意义（P>0.05）。结论　社区多部门系统干预模式能够有效改善慢性精神分裂症患者症状,提高其生存质量和社会功能,对精神分裂症患者的康复起到了积极作用。     

Technical Indicators to Evaluate the Degree of Large Clot Formation Inside the Membrane Fiber Bundle of an Oxygenator in an In Vitro Setup

The most common technical complication during ECMO is clot formation. A large clot inside a membrane oxygenator reduces effective membrane surface area and therefore gas transfer capabilities, and restricts blood flow through the device, resulting in an increased membrane oxygenator pressure drop (dpMO). The reasons for thrombotic events are manifold and highly patient specific. Thrombus formation inside the oxygenator during ECMO is usually unpredictable and remains an unsolved problem. Clot sizes and positions are well documented in literature for the Maquet Quadrox‐i Adult oxygenator based on CT data extracted from devices after patient treatment. Based on this data, the present study was designed to investigate the effects of large clots on purely technical parameters, for example, dpMO and gas transfer. Therefore, medical grade silicone was injected into the fiber bundle of the devices to replicate large clot positions and sizes. A total of six devices were tested in vitro with silicone clot volumes of 0, 30, 40, 50, 65, and 85 mL in accordance with ISO 7199. Gas transfer was measured by sampling blood pre and post device, as well as by sampling the exhaust gas at the devices’ outlet at blood flow rates of 0.5, 2.5, and 5.0 L/min. Pre and post device pressure was monitored to calculate the dpMO at the different blood flow rates. The dpMO was found to be a reliable parameter to indicate a large clot only in already advanced “clotting stages.” The CO₂ concentration in the exhaust gas, however, was found to be sensitive to even small clot sizes and at low blood flows. Exhaust gas CO₂ concentration can be monitored continuously and without any risks for the patient during ECMO therapy to provide additional information on the endurance of the oxygenator. This may help detect a clot formation and growth inside a membrane oxygenator during ECMO even if the increase in dpMO remains moderate.     

基层卫生院政府配送设备使用情况及影响因素分析——以重庆市基层检验科为例

[目的]了解基层卫生院政府设备配置情况,探讨影响设备使用率的相关因素并提出应对策略.[方法]应用定量问卷调查和重点访谈相结合的方式,在重庆全市范围内,对基层检验科专业设备进行普查,系统收集基层检验科政府配置设备情况、设备损坏与闲置情况资料.[结论]政府配置设备使基层医疗水平有了较大改善,但设备损坏率和闲置率相对较高,使用率偏低,需引起重视,采取针对性措施,实现资源效益最大化.     

The majority of US combat casualty soft-tissue wounds are not infected or colonized upon arrival or during treatment at a continental US military medical facility

Background

The microbiology of war wounds has changed as medicine and warfare have evolved. This study was designed to determine the microbial flora and bacterial quantification of present-day war wounds in US troops from Iraq and Afghanistan upon arrival at the National Naval Medical Center (NNMC).

Methods

Patients with extremity combat wounds treated with a vacuum-assisted wound closure device were enrolled in study. Wounds were biopsied every 48 to 72 hours with quantitative microbiology performed on all biopsies.

Results

Two hundred forty-two wound biopsies from 34 patients; 167 (69%) showed no growth, and 75 (31%) showed positive growth. The incidence of any bacterial isolation from biopsies weekly from the time of injury was 28% (first), 31% (second), and 37% (≥third). Acinetobacter baumannii was the most prevalent isolate.

Conclusions

Most soft-tissue wounds from Iraq and Afghanistan do not have significant bacterial burden upon arrival to and during initial treatment at NNMC. Improved evaluation of combat wound microbiology at all levels of care is warranted to determine shifts in microbiology and to impact care practices.