优质护理在慢性乙型病毒性肝炎患者护理中的应用分析

目的分析优质护理在慢性乙型病毒性肝炎患者护理中的应用分析。方法选取2015年8月～2018年7月期间,我院收治的慢性乙型病毒性肝炎患者92例,随机分为对照组(46例)和观察组(46例),对照组患者行常规护理,观察组患者行优质护理,观察两组患者的生活质量评分、生活质量达标率和治疗依从性。结果观察组患者的消毒隔离达标率、病室管理达标率、护理能力合格达标率与对照组比较,差异有统计学意义(P0.05);观察组患者的物质生活评分、社会功能评分、心理功能评分、躯体功能评分与对照组比较,差异有统计学意义(P0.05);观察组患者的规律服药率、坚持疗程率、家属监督率、保持乐观率与对照组比较,差异有统计学意义(P0.05)。结论给予慢性乙型病毒性肝炎患者优质护理,可以提升护理效果,并提高患者的治疗依从性和生活质量,值得推广应用。     

Comparison of Foaming Properties Between the Shirasu Porous Glass Membrane Device and Tessari’s Three-way Stopcock Technique for Polidocanol and Ethanolamine Oleate Foam Production: A Benchtop Study

PurposeTo compare the characteristics of polidocanol (POL) and ethanolamine oleate (EO) sclerosing foams produced by a Shirasu porous glass membrane (SPGM) device with those made using a 3-way stopcock (3WSC).Materials and MethodsFoam half-life times were measured in an ex-vivo benchtop study. Computed tomography (CT) images of each foam were obtained over the time course, and a CT texture analysis was conducted. The bubble size in each foam was measured by an optical microscope.ResultsMedian foam half-life times were longer in the SPGM group than in the 3WSC group (POL: 198 vs 166 s, P = .02; EO: 640 vs 391 s, P < .01). In the CT texture analysis, median standard deviation (SD) and entropy (randomness) were lower, and median energy (uniformity) and gray-level cooccurrence matrix (GLCM) homogeneity were higher in the SPGM group than in the 3WSC group (POL SD: at 30 s and 50–300 s; POL entropy: at 0–60 s; EO SD: at 0–600 s; EO entropy: at 0–460 s; POL energy: at 0–40 s; POL GLCM homogeneity: at 0–250 s; EO energy: at 0–360 s; EO GLCM homogeneity: at 0–480 s; all P < .05). Median bubble diameters in the SPGM group and in the 3WSC group were 69 and 83 μm (P < .01), respectively, in the POL foam; and 36 and 36 μm (P = .45), respectively, in the EO foam.ConclusionsPOL and EO foams had greater uniformity and longer foam half-life time when prepared with an SPGM device than with a 3WSC.     

What is a safe distal resection margin in rectal cancer patients treated by low anterior resection without preoperative radiotherapy?

Aim The aim of this study was to examine what constitutes an acceptable distal resection margin (DRM) when performing sphincter‐saving surgery for rectal cancer without preoperative radiotherapy. Method This national study consisted of 3571 patients for whom information on DRM was available and who were radically treated by anterior resection between 1993 and 2004. Of these, 3342 (93.5%) patients had not received preoperative radiotherapy. The DRM was measured on fixed specimens. Results The 5‐year local recurrence rate was 14.5% for patients with a DRM of 0–10 mm compared to 9.6% for patients with a DRM of 11–20 mm, 8.9% for a DRM of 21–30 mm, 7.0% for a DRM of 31–40 mm, 7.7% for a DRM of 41–50 mm and 8.7% for a DRM of > 50 mm. After adjustment for other independent prognostic factors, a DRM of 0–10 mm was found to have significant impact on local recurrence. The DRM had no impact on distant metastases or overall survival. Conclusion For rectal cancer patients treated without radiotherapy, a DRM of > 10 mm is recommended.     

全手皮肤脱套伤的分型和治疗

目的总结全手皮肤脱套伤的伤情特点,探讨全手皮肤脱套伤的分型标准及治疗方法。方法 1999年12月-2010年5月,收治41例全手皮肤脱套伤。男28例,女13例;年龄18～58岁,平均35岁。致伤原因:碾压伤28例,挤压伤13例。受伤至手术时间1～10 h,平均3 h。根据自定全手皮肤脱套伤分型标准:Ⅰ型11例,Ⅱ型5例,Ⅲ型4例,Ⅳ型8例,Ⅴ型13例。Ⅰ型采用吻合血管回植术;Ⅱ型采用带足背皮瓣的甲瓣、第2趾甲瓣再造术;Ⅲ型采用双足带足背皮瓣的第2趾甲瓣再造术;Ⅳ型采用吻合血管回植术;Ⅴ型采用带足背皮瓣的甲瓣再造(8例)或腹部皮瓣修复术(5例)。足背皮瓣切取范围为9 cm×6 cm～17 cm×11 cm,足背供区游离植皮修复。结果术后Ⅰ型6例发生部分手指坏死,Ⅳ型6例发生部分手指及手掌皮肤坏死;其余患者皮瓣、再造指及回植皮肤均成活。足背供区及腹部供区均顺利愈合。40例患者获随访,随访时间6个月～7年,平均14个月。采用吻合血管回植治疗者,手部皮肤颜色、质地接近正常,功能恢复佳,感觉恢复至S2～S4;采用甲瓣及趾甲瓣再造手指者,手功能基本恢复,再造指感觉恢复至S2～S3;采用腹部皮瓣者,手功能恢复欠佳,手部感觉恢复至S1～S2。结论采用自定标准对全手皮肤脱套伤程度进行分型,并指导临床治疗方案的选择,可获得较好临床疗效。     

Criterion-related validity and test–retest reliability of the 20 m Square Shuttle Test

We assessed validity and reliability of the new 20m square shuttle run test (SST) for predicting maximal oxygen uptake (V O(2max)) and compared it with its predecessor, the 20m Multistage Shuttle Run Test (MST). In a repeated-measures randomised-block design, 74 healthy adult males performed the SST, the MST and a treadmill test (TT). To assess reliability, 40 of the total 74 volunteers were randomly-selected to perform the SST and MST twice. Unlike the SST (p>0.05), mean predicted V O(2max)(V predO(2max)) from the MST was significantly increased from that measured during the TT (p<0.05). The V predO(2max) from SST and MST correlated with TT V O(2max) at r=0.95 (p<0.001) and r=0.63 (p<0.001), respectively. Prediction error of SST was -0.3+/-3.3mlkg(-1)min(-1) with a coefficient of variation of +/-3.5%, while the equivalent values for MST were 4.2+/-7.3mlkg(-1)min(-1) and +/-7.4%. Mean test-retest V predO(2max) did not differ for both SST and MST (p>0.05), while the corresponding test-retest correlation coefficients were r=0.85 (p<0.001) and r=0.72 (p<0.001). Reliability errors in 95% limits of agreement were 0.3+/-4.8 and 0.6+/-6.8mlkg(-1)min(-1) while coefficients of variation were +/-5.2% and +/-6.8% for the SST and MST, respectively. It is concluded that SST is a more valid proxy than MST for predicting laboratory V O(2max) based on the current procedures, while both tests are sufficiently reliable in healthy male adults.     

Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application?

Objective

Thoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown—this is important because in proximal (Stanford type A) aortic dissections, 10% to 30% are not accepted for surgery and 30% to 50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated by using TEVAR.

Nationwide outcomes of newborns with rectosigmoid versus long-segment Hirschsprung disease

PurposeHirschsprung Disease (HD) is a common congenital intestinal disorder. While aganglionosis most commonly affects the rectosigmoid colon (rectosigmoid HD), outcomes for patients in which aganglionosis extends to more proximal segments (long-segment HD) remain understudied. This study sought to compare postoperative outcomes among newborns with rectosigmoid and long-segment HD.MethodsThe Nationwide Readmission Database was queried from 2016 to 2018 for newborns with HD. Newborns were stratified into those with rectosigmoid or long-segment HD. Those who received no rectal biopsy or pull-through procedure during their newborn hospitalization were excluded. A propensity score-matched analysis (PSMA) of newborns with either type of HD was constructed utilizing 17 covariates including demographics, comorbidities, and congenital-perinatal conditions.ResultsThere were 1280 newborns identified with HD (82% rectosigmoid HD, 18% long-segment HD). Patients with rectosigmoid HD had higher rates of laparoscopic resections (35% vs. 12%) and less frequently received a concomitant ostomy (14% vs. 84%), both p < 0.001. Patients with long-segment HD were more likely to have a delayed diagnosis (12% vs. 5%) and require multiple bowel operations (19% vs. 4%), both p < 0.001. They experienced higher rates of complications, including small bowel obstructions (10% vs. 1%), infections (45% vs. 20%), and Hirschsprung-associated enterocolitis (11% vs. 5%), all p < 0.001. After PSMA, newborns with long-segment HD were found to have a longer length of stay and higher hospitalization costs.ConclusionNewborns with long-segment HD experience significant delays in diagnosis, surgery, and complications compared to those with rectosigmoid HD. This information should be utilized to improve healthcare delivery for this patient population.Type of StudyRetrospective comparative study.Level of EvidenceIII.