脑血管介入治疗患者穿刺点压迫方法的研究进展

综述了脑血管介入术穿刺点压迫方法（包括人工压迫、弹力带加压、压迫器加压、血管闭合装置压迫、止血敷料压迫、气囊加压6种）、止血压力以及压迫时间，提出由于穿刺点和压迫方法的不同，其压迫时间、减压时间和压力大小等需要进一步探讨，为脑血管介入术后患者穿刺点的临床护理提供参考。     

基于文献的老年人群常见证候分布特征研究＊

目的 了解我国老年人中医证候分布特征，为中医药辨治老年人提供参考依据。方法 系统检索中国知识基础设施（CNKI）、中文科技期刊数据库（CCD）、万方数据资源系统数据库（CSPD），纳入研究对象为老年人的临床流行病学调查研究文献，对其调查目的、调查疾病及调查结果等进行描述统计。结果 ①最终纳入168篇文献，其中2010至2020年之间发表138篇（82.14%）；调查地区涵盖全国28个省市自治区，共纳入43948例老年人，累计覆盖340个研究中心；②主要研究结果显示，老年人中医证候阴虚阳亢证（10.05%）>血瘀证（9.5%）>痰浊（湿）证（8.91%）>阴阳两虚证（4.98%）>痰瘀互结证（4.96%）；单元证分布阴虚证（14.70%）>痰证（11.22%）>气虚证（7.15%）>肾虚证（4.72%）>血瘀证（4.18%）；涉及病变脏腑肾>肝>脾>肺>心。结论 根据统计结果，可以看出老年人证候分布虚证多于实证，虚证中又以阴虚证、气虚证最为多见，实证常见血瘀证、痰浊（湿）证等，且多见痰瘀互结证；老年人五脏皆损，其中又以肾、肝、脾功能失调最为突出。     

高密度多孔聚乙烯植入体在鼻整形中的应用

目的 探究高密度多孔聚乙烯植入体在鼻整形中的应用价值方法 选取2019年5月-2021年8月我院接受综合鼻整形手术的106例患者为研究对象，采用照随机数字表法分为对照组和观察组，各53例。 对照组采用自体肋骨植入术，观察组采用高密度多孔聚乙烯植入体植入治疗，比较两组临床手术指标(手术时间、恢复时间)、整形优良率、鼻指标(鼻高度/鼻长度比例、鼻唇角)、并发症发生率以及疼痛评分结果 观察组手术时间、术后恢复时间均短于对照组(P＜0.05)；观察组整形优良率为94.34%，高于对照组的86.79%，差异有统计学意义(P＜0.05)；观察组鼻高度/鼻长度比例高于对照组，鼻唇角小于对照组，差异有统计学意义(P＜0.05)；观察组并发症发生率为5.66%，低于对照组的15.09%，差异有统计学意义(P＜0.05)；观察组疼痛评分低于对照组，差异有统计学意义(P＜0.05)；观察组治疗满意度为 96.23%，高于对照组的84.91%，差异有统计学意义(P＜0.05)结论 高密度多孔聚乙烯植入体在鼻整形中的应用效果理想，可减轻患者疼痛度，缩短手术和恢复时间，降低并发症发生率，改善鼻高度/鼻长度比例和鼻唇角，实现理想的整形效果。     

China special issue on gastrointestinal tumors-Radiological features of pathological complete response in mismatch repair deficient colorectal cancer after neoadjuvant PD-1 blockade: A post hoc analysis of the PICC phase II trial

Neoadjuvant programmed cell death protein 1 (PD-1) blockade exhibits promising efficacy in patients with mismatch repair deficient (dMMR) colorectal cancer (CRC). However, discrepancies between radiological and histological findings have been reported in the PICC phase II trial (NCT 03926338). Therefore, we strived to discern radiological features associated with pathological complete response (pCR) based on computed tomography (CT) images. Data were obtained from the PICC trial that included 36 tumors from 34 locally advanced dMMR CRC patients, who received neoadjuvant PD-1 blockade for 3 months. Among the 36 tumors, 28 (77.8%) tumors achieved pCR. There were no statistically significant differences in tumor longitudinal diameter, the percentage change in tumor longitudinal diameter from baseline, primary tumor sidedness, clinical stage, extramural venous invasion status, intratumoral calcification, peritumoral fat infiltration, intestinal fistula and tumor necrosis between the pCR and non-pCR tumors. Otherwise, tumors with pCR had smaller posttreatment tumor maximum thickness (median: 10 mm vs 13 mm, P = .004) and higher percentage decrease in tumor maximum thickness from baseline (52.9% vs 21.6%, P = .005) compared to non-pCR tumors. Additionally, a higher proportion of the absence of vascular sign (P = .003, odds ratio [OR] = 25.870 [95% CI, 1.357-493.110]), nodular sign (P < .001, OR = 189.000 [95% CI, 10.464-3413.803]) and extramural enhancement sign (P = .003, OR = 21.667 [2.848-164.830]) was observed in tumors with pCR. In conclusion, these CT-defined radiological features may have the potential to serve as valuable tools for clinicians in identifying patients who have achieved pCR after neoadjuvant PD-1 blockade, particularly in individuals who are willing to adopt a watch-and-wait strategy.     

"五习惯"医患沟通评价量表的构建及信效度研究

背景 医患沟通障碍是导致医疗纠纷发生的主要原因之一。目前，我国对医务人员医患沟通能力的评价研究较少，缺乏信效度良好的评估工具。 目的 构建"五习惯"医患沟通评价量表（5HCS），检验其信度和效度。 方法 2014年3月，采用Brislin翻译法在"四习惯"医患沟通评价体系（4HCS）的基础上，形成5HCS初稿；2014年4—6月，采用德尔菲法，使用问卷分两轮征求专家意见，根据专家意见修订条目后形成5HCS定稿；2018年3月，使用新构建的5HCS对127名住院医师的医患沟通能力进行评估，通过分析其评价数据，检验量表的内部一致性、评价者间信度、内容效度和标准关联效度。 结果 正式版5HCS包含5个维度（"尊重示善，融洽关系""采集信息，引导观点""表达共情，建立信任""风险告知，知情同意""提供诊断，协商决策"），21个条目。量表的Cronbach's α系数为0.716，各维度与量表总分的r值为0.524~0.692，各条目的内容效度指数（I-CVI）≥0.81，量表总分的评价者间信度r值为0.912，组内相关系数（ICC）=0.912，标准关联效度以中文版医患沟通技能评价量表（SEGUE）为标准，两个量表总分之间的r值为0.377（P<0.01）。 结论 5HCS具有良好的信度和效度，可将其作为我国住院医师医患沟通能力测评工具加以推广应用。     

Analysis on internal mechanism of zedoary turmeric in treatment of liver cancer based on pharmacodynamic substances and pharmacodynamic groups

Zedoary tumeric (Curcumae Rhizoma, Ezhu in Chinese) has a long history of application and has great potential in the treatment of liver cancer. The anti liver cancer effect of zedoary tumeric depends on the combined action of multiple pharmacodynamic substances. In order to clarify the specific mechanism of zedoary tumeric against liver cancer, this paper first analyzes the mechanism of its single pharmacodynamic substance against liver cancer, and then verifies the joint anti liver cancer mechanism of its "pharmacodynamic group". By searching the research on the anti hepatoma effect of active components of zedoary tumeric in recent years, we found that pharmacodynamic substances, including curcumol, zedoarondiol, curcumenol, curzerenone, curdione, curcumin, germacrone, β-elemene, can act on multi-target and multi-channel to play an anti hepatoma role. For example, curcumin can regulate miR, GLO1, CD133, VEGF, YAP, LIN28B, GPR81, HCAR-1, P53 and PI3K/Akt/mTOR, HSP70/TLR4 and NF-κB. Wnt/TGF/EMT, Nrf2/Keap1, JAK/STAT and other pathways play an anti hepatoma role. Network pharmacological analysis showed that the core targets of the "pharmacodynamic group" for anti-life cancer are AKT1, EGFR, MAPK8, etc, and the core pathways are neuroactive live receiver interaction, nitrogen metabolism, HIF-1 signaling pathway, etc. At the same time, by comparing and analyzing the relationship between the specific mechanisms of pharmacodynamic substance and "pharmacodynamic group", it is found that they have great reference significance in target, pathway, biological function, determination of core pharmacodynamic components, formation of core target protein interaction, in-depth research of single pharmacodynamic substance, increasing curative effect and so on. By analyzing the internal mechanism of zedoary tumeric pharmacodynamic substance and "pharmacodynamic group" in the treatment of liver cancer, this paper intends to provide some ideas and references for the deeper pharmacological research of zedoary tumeric and the relationship between pharmacodynamic substance and "pharmacodynamic group".     

COX20基因变异线粒体复合物Ⅳ缺乏症相关的遗传性周围神经病4例病例系列报告及文献复习

背景：原发性线粒体病具有高度的临床和遗传异质性，其中周围神经是线粒体病的常见受累器官之一。 目的：总结COX20基因变异相关周围神经病的临床表型及遗传学特征。 设计：病例系列报告。 方法：回顾性收集2018年5月至2020年5月复旦大学附属儿科医院诊治的COX20基因变异相关周围神经病患儿的临床资料，总结其临床表现、基因检测结果及治疗效果，并以“COX20”、“线粒体复合物Ⅳ缺乏症（Complex Ⅳ deficiency）”为关键词检索中英文数据库。检索时间均为从建库至2021年12月。总结已报道COX20基因变异与临床表型的关系。 主要结局指标：临床表型和COX20基因变异位点。 结果：4例患儿纳入分析，男、女各2例，其中3例自幼运动发育落后。4例均在儿童期起病，均以行走不稳为首发症状。肌电图均提示多发性周围神经损害改变，感觉神经轴索受累为主。4例患儿均携带COX20基因复合杂合变异，包括错义变异2个，无义变异和移码变异各1个，其中移码变异c.262delG(p.E88Kfs*35)尚未见报道。文献复习目前共报道COX基因变异18个家系22例患儿（包括本文病例）,起病中位年龄为5（1.0~17）岁，22例均以行走困难或步态不稳起病，11例（50.0%）有精神运动发育迟滞，病程中14例(63.6%)出现构音障碍，14例(63.6%)出现肌力下降和/或足部畸形，8例（36.4%）出现共济失调，6例(27.3%)出现肌张力障碍，5例（22.7%）存在认知倒退等。21例患儿行神经传导及肌电图检查，19例(90.5%)提示多发性周围神经病变。头颅（18例）及脊髓（10例）MR检查提示，脊髓萎缩4例（40%），小脑萎缩4例（22.2%）。9例患儿已无法独立行走，丧失独立行走能力中位年龄为10（7~21）岁。目前共报道9个变异位点，4种变异类型，其中错义变异5个，剪切变异2个，无义变异和移码变异各1个。 结论：COX20基因变异患者多早期起病，以周围神经系统病变为主要表现，可合并构音障碍、共济失调、肌张力障碍、认知倒退等，病情逐渐进展，致残率高。COX20基因变异类型以错义变异最常见。     

Higher Preimplantation Opioid Doses Associated With Long‐Term Spinal Cord Stimulation Failure in 211 Patients With Failed Back Surgery Syndrome

ObjectiveSpinal cord stimulation (SCS) is an effective treatment in failed back surgery syndrome (FBSS). We studied the effect of preimplantation opioid use on SCS outcome and the effect of SCS on opioid use during a two-year follow-up period.Materials and methodsThe study cohort included 211 consecutive FBSS patients who underwent an SCS trial from January 1997 to March 2014. Participants were divided into groups, which were as follows: 1) SCS trial only (n = 47), 2) successful SCS (implanted and in use throughout the two-year follow-up period, n = 131), and 3) unsuccessful SCS (implanted but later explanted or revised due to inadequate pain relief, n = 29). Patients who underwent explantation for other reasons (n = 4) were excluded. Opioid purchase data from January 1995 to March 2016 were retrieved from national registries.ResultsHigher preimplantation opioid doses associated with unsuccessful SCS (ROC: AUC = 0.66, p = 0.009), with 35 morphine milligram equivalents (MME)/day as the optimal cutoff value. All opioids were discontinued in 23% of patients with successful SCS, but in none of the patients with unsuccessful SCS (p = 0.004). Strong opioids were discontinued in 39% of patients with successful SCS, but in none of the patients with unsuccessful SCS (p = 0.04). Mean opioid dose escalated from 18 ± 4 MME/day to 36 ± 6 MME/day with successful SCS and from 22 ± 8 MME/day to 82 ± 21 MME/day with unsuccessful SCS (p < 0.001).ConclusionsHigher preimplantation opioid doses were associated with SCS failure, suggesting the need for opioid tapering before implantation. With continuous SCS therapy and no explantation or revision due to inadequate pain relief, 39% of FBSS patients discontinued strong opioids, and 23% discontinued all opioids. This indicates that SCS should be considered before detrimental dose escalation.