直肠癌切除术后排便功能障碍的发生率及其危险因素分析

目的 分析直肠癌切除术后排便功能障碍的发生率及其危险因素.方法 回顾性分析2015年1月至2020年2月蚌埠医学院第一附属医院收治的直肠癌病人60例,均行腹腔镜下直肠全系膜切除术(TME)治疗,中途无转开腹;对所有病人资料进行整理,根据是否发生排便障碍分组,排便功能障碍组38例、非排便功能障碍组22例,分析影响术后排便功能障碍的危险因素.结果 60例直肠癌切除术病人,术中出血量(65.14±23.50)mL,手术时间(246.15±60.33)min,术后肿瘤病理学标本最大径(3.65±0.72)cm,肿瘤最大径(4.02±1.63)cm,术后吻合口距肛缘距离(2.42±0.53)cm,术后尿管拔除时间(5.47±3.95)d.随访3个月,随访成功率100.00％.单因素分析病人术后吻合口距肛缘距离、肿瘤大小、术前同步放化疗等是造成病人术后排便功能障碍的因素(P<0.05).Logistic多因素分析,影响排便功能障碍危险因素是肿瘤最大径>5 cm、术前同步放化疗、术后吻合口距肛缘距离<3 cm(P<0.05).结论 肿瘤最大径>5 cm、术前同步放化疗、术后吻合口距肛缘距离<3 cm是造成直肠癌切除术后排便的危险因素,因此,术后应当予以高度重视.     

Geographic proximity to immunization providers and vaccine series completion among children ages 0–24 months

ObjectivesIn the U.S., vaccination coverage is lower in rural versus urban areas. Spatial accessibility to immunization services has been a suspected risk factor for undervaccination in rural children. Our objective was to identify whether geographic factors, including driving distance to immunization providers, were associated with completion of recommended childhood vaccinations.MethodsWe analyzed records from Montana’s immunization information system for children born 2015–2017. Using geolocated address data, we calculated distance in road miles from children’s residences to the nearest immunization provider. A multivariable log-linked binomial mixed model was used to identify factors associated with completion of the combined 7-vaccine series by age 24 months.ResultsAmong 26,085 children, 16,503 (63.3%) completed the combined 7-vaccine series by age 24 months. Distance to the nearest immunization provider ranged from 0 to 81.0 miles (median = 1.7; IQR = 3.2), with the majority (92.1%) of children living within 10 miles of a provider. Long distances (>10 miles) to providers had modest associations with not completing the combined 7-vaccine series (adjusted prevalence ratio [aPR]: 0.97, 95% confidence interval [CI]: 0.96–0.99). After adjustment for other factors, children living in rural areas (measured by rural-urban commuting area) were significantly less likely to have completed the combined 7-vaccine series than children in metropolitan areas (aPR: 0.88, 95% CI: 0.85–0.92).ConclusionsLong travel distances do not appear to be a major barrier to childhood vaccination in Montana. Other challenges, including limited resources for clinic-based strategies to promote timely vaccination and parental vaccine hesitancy, may have greater influence on rural childhood vaccination.     

Sound healing reduces generalized anxiety during the pandemic: A feasibility study

ObjectivesThis study examined the feasibility and effectiveness of a virtually-delivered, biofield-based sound healing treatment to reduce anxiety for individuals meeting criteria for Generalized Anxiety Disorder.DesignThis one-group, mixed-method feasibility study was conducted virtually via Zoom during the SARS-CoV-2 Pandemic. Fifteen participants with moderate to high levels of anxiety as determined by the Generalized Anxiety Disorder-7 (≥10), were enrolled.InterventionFive certified Biofield Tuning Practitioners performed the interventions. Participants were given three weekly, hour-long sound healing treatments virtually, over a month’s period.Outcome MeasuresAttrition rates and reports on feasibility of intervention delivery and outcomes assessment were obtained by participants. Data on anxiety, positive and negative affect, spiritual experience, perceived stress, and quality of life were obtained via validated surveys and analyzed via repeated-measures analysis of variance with intention-to-treat. Linguistic inquiry and word count was utilized to assess changes in affective processing as reflected in participants’ spoken words over the course of the intervention. Qualitative interviews were conducted to further determine tolerability and experiences with receiving BT that may not have been captured by survey and language data.ResultsAttrition rates were 13.3%, with two participants dropping out of the study after one session. The remaining participants reported acceptability of the data collection process and intervention delivery. Intention to treat analyses revealed statistically significant reductions in anxiety (State-Trait Anxiety Inventory), negative affect (Positive and Negative Affect Scale), and perceived stress (Perceived Stress Scale) (p < .001 in all cases). Linguistic and word count analysis revealed a significant linear decrease (p = .01) of participants’ use of negative affect words over the course of the intervention. Qualitative data results are reported in another paper.ConclusionsResults indicate that BT delivered virtually is feasible and amenable to study, and that the impact of BT may be substantial in reducing anxiety and improving mental health. This is the first study of its kind to report clinically significant reductions in anxiety levels in response to a virtually-delivered, biofield-based sound therapy. Data will be used to power a randomized controlled trial to more deeply examine the effects of BT on whole-person healing for those suffering from anxiety.     

A distance measure between intuitionistic fuzzy sets and its application in medical diagnosis

The intuitionistic fuzzy set, as a generation of fuzzy set, can express and process uncertainty much better. Distance measures between intuitionistic fuzzy sets are used to indicate the difference degree between the information carried by intuitionistic fuzzy sets. Although some distance measures have been proposed in previous studies, they can not satisfy the axioms of distance measure, or exist counter-intuitive cases. In this paper, we give a new distance measure between intuitionistic fuzzy sets, which is based on a matrix norm and a strictly increasing (or decreasing) binary function. The new distance measure not only satisfies the axiomatic definition of distance measure, but also overcomes the counter-intuitive cases. It is proved that the new distance measure is reasonable by numerical examples. Moreover, we give the algorithms for pattern recognition and use it to solve medical diagnosis problems.     

Effect of distance to the base of skull and tumor size characteristics on cranial nerve injuries in carotid body tumor resections

ObjectiveIn the present study, we aimed to confirm the findings reported by Kim et al. They stated that the tumor’s distance to the base of the skull was predictive of injury to the cranial nerves and their branches during carotid body tumor resection in an Austrian cohort.MethodsIn the present retrospective observational trial, we included all consecutive patients who had been discharged from our tertiary care teaching hospital with the diagnosis of a carotid body tumor (CBT) between January 2004 and December 2019. Tumor-specific parameters were measured from the preoperative contrast-enhanced computed tomography or magnetic resonance imaging studies. Patient-specific data were obtained from the patients’ medical records. The effect of these parameters on the occurrence of cranial nerve injuries was calculated using univariate logistic regression analysis. Parameters significant on univariate analysis were included in a multivariate model.ResultsA total of 48 CBTs had been resected in 43 patients (29 women [67.4%] and 14 men [32.6%]), with a mean age of 55.6 years (95% confidence interval, 51.8-58.5). The mean distance to the base of the skull was 43.2 mm (95% confidence interval, 39.9-46.5). A total of 18 injuries to the cranial nerves and their branches in 10 CBTs were detected. The tumor-specific parameters that were significant on univariate analysis were the distance to the base of the skull (P = .009), craniocaudal tumor diameter (P = .027), and tumor volume (P = .036). Stepwise multivariate logistic regression analysis revealed that the distance to the base of the skull was the only parameter that remained statistically significant.ConclusionsWe found that the distance to the base of the skull is a highly predictive parameter for injuries to the cranial nerves and their branches during CBT resection and should be included in the surgical risk assessment and patient information.     

In Different Gender Groups,What Is the Impact of the Fibular Notch on the Severity of High Ankle Sprain: A Retrospective Study of 360 Cases

Objectives

The role of the distal tibiofibular ligament in the occurrence of high ankle sprain (HAS) has been widely studied. But previous studies have overlooked the physiological and anatomical differences between males and females and have not further refined gender. Therefore, the impact of the anatomical morphology of fibular notch (FN) on HAS in different genders is still unclear. This study aimed to explore the impact of different types of FN on the severity of HAS and to estimate the prognosis of patients with HAS while excluding anatomical differences caused by gender.

Methods

One hundred and eighty patients with HAS were included in this study as the experimental group (i.e., HAS group). They were further divided into four groups according to gender and FN depth, with deep concave FN ≥ 4 mm and shallow flat FN < 4 mm. Another 180 normal individuals were set as the control group. The FN morphological indicators, tibiofibular distance (TFD), and ankle mortise indexes were measured and compared with those in HAS group. The independent t-test was used to compare continuous variables between groups, the intraclass correlation coefficient (ICC) was used to analyze the reliability of intra-observer measurement, and the Pearson correlation coefficient was used to verify the correlation between FN and the severity of HAS.

Results

In males with shallow flat type, the measurements of anterior tibiofibular distance (aTFD), middle tibiofibular distance (mTFD), posterior tibiofibular distance (pTFD), front ankle mortise width (fAMW), middle ankle mortise width (mAMW), posterior ankle mortise width (pAMW), and depth of ankle mortise (DOAM) in HAS group were significantly larger than those in normal group (p < 0.05). In male patients with deep concave type, the measurements of aTFD, mTFD, fAMW, mAMW, and DOAM were significantly larger than those in normal group (p < 0.05). Among female patients with shallow flat type, the measurements of aTFD, mTFD, pTFD, fAMW, mAMW, pAMW, and DOAM were found to be significantly larger than those in normal group (p < 0.05). Among female patients with deep concave type, the measurements of mTFD, pTFD, fAMW, mAMW, and DOAM were found to be significantly larger than those of the normal group (p < 0.05). The depth of FN was negatively correlated with TFD, and the AOFAS score of patients with shallow flat type was significantly lower than that of patients with deep concave type after treatment (p < 0.05).

Conclusions

In different gender groups, compared with the normal controls, the TFD and partial ankle mortise indices were significantly different in HAS patients. Moreover, FN depth was negatively correlated with TFD, and the AOFAS score of shallow flat patients was significantly lower than that of deep concave patients. These suggested that shallow flat FN may be associated with more severe distal tibiofibular ligament injury and ankle mortise widening, leading to poorer prognosis. This should be taken seriously in clinical practice.     

The effect of crossword puzzle activity used in distance education on nursing students’ problem-solving and clinical decision-making skills: A comparative study

AimThe study was planned to determine the effect of crossword puzzle activity in distance education on nursing students’ problem-solving and clinical decision-making skills.BackgroundIn online education, increasing nursing students’ learning skills, motivations and participation is important.DesignThe study is a randomized-controlled trial.MethodThe study sample consisted of 132 nursing students registered to the Pediatric Nursing distance course in the 2020–2021 academic year. 20 students who were assigned to the control group did not agree to participate in the study and did not fill in the data form. Accordingly, the study was completed with the participation of 112 students, with 66 students in the experimental group and 46 students in the control group. In the 14-week distance education, 20-question crossword puzzle activity per unit was applied to the students in the experimental group. The standards for reporting consort guidelines for reporting parallel group randomized trials were used to report this research. The students in the control group were taught in the form of presentation. At the beginning and end of the study, CDMNS and PSI were applied to the students. Ethics committee approval (Number: 2021/79) was obtained from the relevant university to conduct the research.ResultsA statistically significant difference was found between pretest and posttest scores of the experimental group in PSI and CDMNS scales (p < 0.001).ConclusionCrossword puzzle activity used in distance education developed the students’ problem-solving and clinical decision-making skills.