青年期先天性髋关节脱位的全髋置换治疗

目的:探讨青年期先天性髋关节脱位的治疗方法.方法:先天性髋关节脱位患者13例,年龄16～19岁,全部存在髋臼、股骨头、颈发育不良.采用陶瓷-陶瓷假体给予全髋置换治疗.应用Harris评分进行功能评价.结果:13例患者Harris评分81～94分,步态正常,患髋无痛感.结论:对青年期先天性髋关节脱位患者,采取陶瓷-陶瓷假体全髋置换手术治疗可以取得满意的疗效,但其昂贵的价格限制了使用范围.     

青年人急性心肌梗死的特点及预防

目的：探讨青年人急性心肌梗死的特点及预防。方法：对28例青年人（≤40岁）心肌梗死的临床资料进行分析。结果：本组男性26例，占92．9％；7-9月份发病16例，占57％；体力劳动者22例，占78．6％；有明显冠心病危险因素者28例，占89．3％；发病前有诱发因素者23例，占82．1％。结论：青年人心肌梗死具有男性多见、夏季多见、体力劳动者多见、危险因素多明显、诱发因素多突出、先兆少、症状多典型等特点。其发生多与不良生活方式有关。加强健康教育，建立良好的生活方式是预防青年人心肌梗死的关键。     

不同的阻滞方法对75岁以上高龄老人阻滞效果及循环功能的影响

为比较硬膜外隙阻滞(硬外)、蛛网膜下隙阻滞(腰麻)和单侧蛛网膜下隙阻滞(腰麻)在75岁以上高龄股骨颈骨折手术中的阻滞效果及对循环的影响.选ASAⅢ～Ⅳ级90例,随机等分为3组,Ⅰ组为硬外阻滞组(A组),用1.5%Lidocaine 4ml试验剂量并确认无脊麻后,根据情况追加1.5%Lidocaine 4～6ml;Ⅱ组为腰麻组,Ⅲ组为单侧腰麻组,两组注药速度均为0.1ml·s-1,注药过程均不作往返吸注.Ⅱ组用0.75%布比卡因1ml(7.5mg),注药后仰卧;Ⅲ组患侧在下侧卧,用0.75%布比卡因0.6ml(4.5mg)、10%葡萄糖液0.4ml,注药20min后平卧.结果显示:①患侧痛觉阻滞起效由快到慢为Ⅱ组、Ⅲ组和Ⅰ组.②三组阻滞前后的心率比较,均无显著性差异;Ⅲ组阻滞前后的平均动脉压也无显著性差异,但Ⅰ和Ⅱ组的阻滞前后的平均动脉压均有显著性差异.③患侧痛觉阻滞达标率(无痛平面达L1的百分率)为Ⅰ组93.3%,Ⅱ和Ⅲ组均为100%.④阻滞不全者Ⅰ组3例,而Ⅱ和Ⅲ组则无.⑤发生低血压者Ⅰ和Ⅱ组各3例,且同时都伴有ECG的ST段下移;Ⅲ组则无.表明①单侧腰麻组起效较快、阻滞完善和患侧痛觉阻滞达标率高.②单侧腰麻所用剂量小,阻滞范围小,对循环干扰轻和阻滞平面似乎更易控制.因此,小剂量布比卡因单侧腰麻可能更适合高龄老人下肢手术.     

Drug use as a ‘practice of the self’: is there any place for an ‘ethics of moderation’ in contemporary drug policy?

This paper offers a series of critical interrogations of the principles and practice of harm minimisation. This critique draws from Michel Foucault's account of ethics, pleasure and moderation in pointing to some significant gaps and conceptual problems within Australia's National Drug Strategy. I argue that this strategy has had only indirect impacts upon the ways in which illicit drugs are consumed in Australia, and on the behaviour of individual users. Part of this problem lies in the ways in which the cultures and the contexts of illicit drug use have been conceptualised within contemporary drug policy. Following Foucault, I argue that drug use ought to be conceptualised as a distinctive ‘practice of the self’. I argue further that Foucault's work on pleasure and ethics offers important new ways of understanding the changing nature of drug use for young people, as well as providing new conceptual bases for the design and delivery of harm minimisation strategies within those settings and contexts in which drug use takes place.     

青壮年股骨颈骨折患者行闭合复位内固定手术后发生股骨头无菌性缺血坏死影响因素分析

目的探讨青壮年股骨颈骨折患者经闭合复位内固定手术治疗后发生股骨头无菌性缺血坏死的影响因素。方法回顾性分析自2015年1月至2020年1月北部战区总医院骨科收治的经闭合复位内固定手术治疗的62例青壮年股骨颈骨折患者临床资料,包括年龄、性别、体质量指数、骨折侧、Garden分型、损伤至手术前时间、术前是否牵引、内固定是否取出、股骨头后倾角度、是否有股骨颈皮质粉碎、术后负重活动时间、复位质量等,并分析上述指标对术后发生股骨头无菌性缺血坏死的影响。结果青壮年患者发生术后股骨头无菌性缺血坏死与Garden分型、内固定是否取出、股骨头后倾角度、股骨颈皮质粉碎情况、复位质量相关(P<0.05)。多因素Logistic分析显示,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头无菌性缺血坏死关系密切(P<0.05)。结论青壮年股骨颈骨折闭合复位内固定术后发生股骨头坏死的影响因素较多,其中,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头坏死密切关系。     

青年人直肠癌33例诊治体会

目的总结33例青年人直肠癌的诊断治疗体会。方法回顾性分析l994~2005年33例青年人直肠癌患者的临床资料。结果青年人直肠癌术前常有误诊,本组误诊率为63.6%。33例中行根治性切除术23例,根治率69.7%,未切除肿瘤或放弃治疗者平均存活5.4个月。结论提高对青年人直肠癌的认识,重视直肠指检和纤维结肠镜检查。     

Factors associated with intention to receive vaccines for bacterial sexually transmitted infections among young HPV-vaccinated Canadian women

ObjectiveThe aim of this study was to explore the acceptability of bacterial STI vaccines among young HPV-vaccinated Canadian women to inform future vaccine program implementation.MethodsA 20-item cross-sectional questionnaire was administered from June 2019 to June 2020 to HPV-vaccinated participants of the pan-Canadian QUEST cohort. Multivariable logistic regression models assessed interest in chlamydia, syphilis, and gonorrhea vaccines using a priori variables and factors significant in bivariate analysis.ResultsOf the 1092 respondents analyzed, 82% indicated interest in receiving one or more future STI vaccines. Respondents had a median age of 19.6 years (range 16.9–23.4), and 75% of respondents identified as white/European descent. In adjusted analyses, intent to engage in positive health behaviours was associated with vaccine interest for syphilis (OR = 5.76, 95% CI 4.03–8.27), chlamydia (OR = 5.27, 95% CI 3.66–7.63), and gonorrhea (OR = 5.96, 95% CI 4.15–8.60). Willingness to pay for an STI vaccine was also associated with vaccine interest for syphilis (OR = 2.02, 95% CI 1.29–3.19), chlamydia (OR = 2.41, 95% CI 1.50–3.90), and gonorrhea (OR = 2.29, 95% CI 1.44–3.63). Ever having sexual intercourse and identifying as LGBTQ were significantly associated with vaccine interest for all infections, while age and ever being immunosuppressed were not significant in any adjusted models.ConclusionFindings indicate over 80% of participants in a cohort of young HPV-vaccinated Canadian women are interested in receiving future bacterial STI vaccines. Further exploration of STI vaccine acceptability among diverse populations is required to inform future bacterial STI vaccine program implementation.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-022-00648-2.     

心理暗示干预在老年人牙拔除术中的应用

目的：探讨心理暗示干预在老年人牙拔除术中的应用价值。方法：将老年人拔牙患者118例随机分为心理暗示组及对照组各59例。心理暗示组在拔牙术前采用心理暗示干预的方法,对照组未给予任何暗示,按照沉稳型、张乱型及混合型三个等级统计数据,进行对比研究。结果：心理暗示组的沉稳型率显著高于对照组（P〈0.01）,张乱型率显著低于对照组（P〉0.05）。结论：心理暗示干预应用于老年人牙拔除术时,可明显降低患者的畏惧程度,缩短手术时间,确保手术的顺利进行,有一定的应用价值。     

探讨老年肾虚证与骨密度的关系

为探讨老年肾虚证与骨密度的关系 ,通过随机选择 60～ 78岁的肾虚证者 2 1 4例作为观察组 ,并设虚证 (肝肾两虚、肝虚、脾虚证 )组 366例和健康对照组 1 0 0例 ,采用超声成像骨密度测定法 ,测定足跟骨的骨密度。结果 :肾虚证组的骨密度低于正常对照组和肝肾两虚证、肝虚证、脾虚证组 (P <0 0 1 )。提示老年肾虚证与骨密度有直接相应变化的关系 ,骨密度测定可作为肾虚证本质辨证的客观评价指标和观察肾虚证治疗效果的参考依据。     

医疗机构互联网便民惠民移动应用测评研究

通过多维度测评方法评估北京地区医疗机构互联网移动应用建设、管理情况,介绍测评范围、方法、指标体系,分析测评结果并提出建议,包括明确移动应用定位,建立业务规范和标准,加强诊中和诊后服务等.