ObjectiveTo evaluate the incidence of osteoporosis and relevant factors in the elderly male patients with chronic obstructive pulmonary disease(COPD).Methods Forty elderly male patients with COPD were enrolled and thirty age-matched healthy subjectss were enrolled.The BMD of lumbar vertebrae and proximal end of the femur were measured by dual energy X-ray absorptiometry.Serum levels of osteocalcin （BGP）and lung function were measured while blood-gas analysis of arterial blood was conducted.Results The BMD of lumbar vertebrae and proximal end of the femur(including lumbar 1 to 4，femoral neck，wards triangle，trochanter and shaft) in the COPD group were significantly lower than those in the control subjects(all Plt;0.01).Serum BGP level in the COPD group was higher than that in the control group[(5.67±1.59)ng/mL vs (4.37±1.47)ng/mL，Plt;0.01).The prevalence of osteoporosis among the COPD patients was significantly higher than that among the control subjects（65% vs 40%，50% vs 20%，both Plt;0.05）.BMD in the COPD patients who had a history of smoking was significantly lower than those who did not smoke cigarettes（Plt;0.01 or Plt;0.05）.BMD in the COPD patients treated with glucocorticoid were significantly lower than those who were not receiving glucocorticoid therapy(Plt;0.01 or Plt;0.05).BMD was positively correlated with PaO2，BMI，FEV1%pred and FEV1/FVC(Plt;0.01 or Plt;0.05).Conclusions Compared with age-matched normal controls，BMD in elderly male COPD patients are significantly lower with increased osteoporosis risk.Osteoporosis induced by COPD is high change-over pattern. BMD in patients with COPD may be correlated with hypoxia，lung function，smoking，low body mass index and glucocorticoids therapy.
目的：探讨多层螺旋CT（MSCT）在急性主动脉综合征（AAS）的临床应用价值。方法：采用西门子Sensation 16层螺旋CT扫描机，对59例主诉急性胸背痛患者进行MSCT检查。结果：59例患者中主动脉夹层（AD）40例，主动脉壁内血肿（IMH）11例，穿透性粥样硬化性溃疡（PAU）8例。MSCT能够显示三种疾病的特征性征象：AD可见内膜片和双腔征；IMH主动脉壁呈新月形或环形增厚≥5 mm；PAU为凸出于主动脉管腔外的造影剂充盈的龛影。结论：MSCT是一种快速、无创的检查方法，能为AAS的诊断提供重要信息。
Objective To investigate whether antipsychotic drugs will increase the risk of venous thromboembolism (VTE) and pulmonary embolism (PE), and to provide evidence for the prevention of VTE and PE in patients with APs exposure. Methods Databases including PubMed, Web of Science, CNKI, VIP and Elsevier were searched from inception to July 2016 to collect case-control studies and cohort studies on the association between APs exposure and the risk of VTE and PE. The literature were screened according to the inclusion and exclusion criteria, the data were extracted and the bias risk of the included studies were evaluated by two reviewers independently. The Meta-analysis was performed by using Stata 12 software. Results Nineteen studies were included. The results of meta-analysis showed that APs exposure was associated with VTE (OR=1.50, 95%CI 1.30 to 1.74,P<0.001). Exposure to low-potency FGA (OR=2.28, 95%CI 1.02 to 5.10,P=0.045), high-potency FGA (OR=1.68, 95%CI 1.37 to 2.05,P<0.001) and SGA (OR=1.74, 95%CI 1.24 to 2.44,P=0.001) revealed an increased risk of VTE. Exposure to APs also signi?cantly increase the risk of PE (OR=3.69, 95%CI 1.23 to 11.07,P=0.02), especially exposure to FGA (OR=2.54, 95%CI 1.22 to 5.32,P=0.013), but exposure to SGA could not revealed an increased risk of PE. Conclusion FGA and SGA exposure maybe associated with an increase in the risk of developing VTE. And exposure to the FGA could increase the risk of PE. The occurrence of VTE and PE should be monitored when taking Aps.
Objective To summarize the nutritional management strategies of patients undergoing electively gastrointestinal surgery. Methods This article reviewed the recent researches on perioperative nutritional management in electively gastrointestinal surgery, including four major directions: preoperative nutritional evaluation, glucose level control, nutritional type, and immunonutrition. Results At present, preoperative nutritional evaluation methods included anthropometry, laboratory tests, subjective global assessment (SGA), nutritional risk screening (NRS) 2002, Reilly nutritional risk screening, nutritional risk indicator (NRI), and so on. For preoperative nutritional assessment system, however, current data could not single out superiority for any nutritional assessment methods in the ability to predict surgery-related complications. The usage of enhanced recovery after surgery (ERAS) protocol to reduce surgical stress and preclude postoperative insulin resistance had recently been clearly linked to reductions in postoperative morbidity and adverse outcomes. There were specific criterias for perioperative parenteral and enteral nutrition in undernourished patients, who were defined in clinical guidelines recently, such as the Guidelines for Adult Perioperative Nutrition Support issued by Chinese Society of Parenteral and Enteral Nutrition (CSPEN). Several systematic reviews showed that immunonutrition could reduce both morbidity and length of stay after major electively gastrointestinal surgery. Conclusion Perioperative nutritional management can ensure patients benefit from nutritional support by nutritional assessment, can reduce the nutritional risk and metabolic disorder caused by operation, can achieve the goal of optimal nutrition support in surgical patients, and can ultimately reduce postoperative complications.
COPD 是一种可预防、可治疗, 以气流不完全可逆受限并呈进行性发展为特征的疾病, 与肺部对有害气体或有毒颗粒的异常炎症反应有关。在全球范围内COPD 是引起死亡和功能致残的主要疾病之一。COPD 在全球患病率和死亡率位居第四, 并呈不断上升的趋势[1] 。本病具有明显的肺外效应, 包括引起全身系统性炎症、代谢改变、神经激素激活,以及对肌肉骨骼、心血管系统等其他系统的影响等[2] 。既往认为COPD 仅引起红细胞增多, 但近期研究发现COPD 引起的系统性炎症可影响红细胞的生成, 贫血亦同样存在于部分COPD 患者。目前认为, COPD导致的贫血与其他许多慢性疾病如慢性心衰一样, 同属于一种慢性病性贫血( anemia of chronic disease, ACD) , 称为COPD 相关性贫血, 其患病率高于继发性红细胞增多症在COPD 的患病率[3-5] 。本文就COPD 相关性贫血的流行病学概况、病理生理机制、临床重要性及干预的最新研究进展如下综述。
Objective To investigate the effectiveness of double-needle suture for mixed meniscus tear repair under arthroscope. Methods Between April 2006 and January 2011, 22 patients with mixed meniscus tear were treated with double-needle suture under arthroscope. There were 14 males and 8 females, aged 18-41 years (mean, 31.3 years). All injuries were caused by sports. The time between injury and admission ranged from 2 days to 4 years (median, 11 months). International Knee Documentation Committee (IKDC) score was 42.5 ± 15.2, Lysholm score was 45.5 ± 13.5, and Tegner score was 2.9 ± 1.6. Seventeen cases complicated with anterior cruciate ligament injury. Results Healing of incision by first intention was achieved in all patients. No injury of nerve and blood occurred. The patients were followed up 12-48 months with an average of 27.6 months. According to Barrett et al. standard, 19 cases (86%) got clinical healing. The IKDC, Lysholm, and Tegner scores were improved to 77.1 ± 8.9, 79.8 ± 9.9, and 6.8 ± 1.6 respectively at last follow-up, showing significant differences when compared with preoperative scores (P lt; 0.05). Conclusion Arthroscopic meniscus repair using double-needle suture can provide good effectiveness because it has high firmness.
Objective To study the MRI diagnosis of sacral fracture with sacral neurological damage and its cl inical appl ication. Methods From October 1999 to October 2007, 20 cases of sacral fracture (Denis classification, Type II)with sacral neurological damage were examined by obl ique coronal MRI of sacrum to show the whole length of sacral nerve. There were 17 males and 3 females, aged 30-55 years. The time from injury to hospital ization varied from 1 day to 23 months. The injury was caused by traffic accident in 10 cases, smash of heavy object in 8 cases and crush in 2 cases. Eight cases were accompanied by pubis fracture and 4 cases by urethral disruption. All patients accepted the examination of X-ray, CT and spiral CT 3D reconstruction. X-ray showed the displacement of fracture fragment was backwards and upwards, and sacral-hole l ine was vague, asymmetric and distorted. CT showed that sacral neural tube was left-right asymmetry, the displacement of fracture fragment was backwards and upwards, combining with the compression and intruding to sacrum center at different section levels. The cl inical manifestations, international standards for Neurological Classification of Spinal Cord Injury recommended by American Spinal Injury Association International Spinal Cord Society, comparison between normal and abnormal MRI and Gierada’s results were the basis for cl inical diagnose and MRI diagnose, which was confirmed by operation. Results Nerve injury diagnosed by cl inical manifestation were S1 (17 cases), S2 (14 cases), S3 (7 cases), and S4 (6 cases). Nerve injury diagnosedby MRI were S1 (17 cases), S2 (14 cases), S3 (3 cases), and S4 (2 cases). Nerve injury confirmed by operation were S1 (17 cases), S2 (14 cases), S3 (7 cases), and S4 (1 case). Obl ique coronal MRI of sacrum showed the whole length of sacral nerve and its adjacent relationship, detecting bone fragment compression and route alteration of never were evident in 5 cases, the fat disappearance around the site of nerve root injury in 19 cases, narrowness of sacral nerve canal in 17 cases and the abnormally enlarged sacral nerve in 11 cases. Conclusion Obl ique coronal MRI of sacrum is of great value in the local ization and the qual itative diagnosis of sacral neurological damage.
Objective To estimate the effects of N-acetylcystein (NAC) combined with conventional treatment on the patients with stable COPD. Methods Literatures published between January 1995 and September 2010 were searched in the databases including PubMed, CHEST, CNKI, CBM, VIP and WANGFANG for collecting the randomized control trials (RCTs) of NAC combined with the conventional treatment versus the conventional treatment on patients with stable COPD. The studies were screened according to the inclusive and exclusive criteria, the data were extracted, the quality was assessed and the meta-analysis was conducted with RevMan 5.0 software. Results A total of seven RCTs including 404 patients with stable COPD were enrolled. The meta-analysis demonstrated that, a) the short-term usage of NAC could improve PaO2 (SMD=0.05 mmHg, 95%CI –0.23 to 0.32) and PaCO2 (SMD= –0.29 mmHg, 95%CI –0.76 to 0.17) without significant differences compared with the control group; and b) the NAC could significantly improve FEV1 (SMD=1.11L, 95%CI 0.69 to 1.50) and clinical symptoms (RR=17.32, 95%CI 7.11 to 42.18), and reduce the frequency of acute exacerbation (RR=0.20, 95%CI 0.07 to 0.54) with significant differences. Conclusion The NAC used in a short-term can significantly improve arterial blood gas (ABG) and pulmonary function, and it can improve clinical symptoms and reduce the frequency of acute exacerbation. But for the possibility of moderate bias due to lower quality of the included studies and unclear implementation of RCTs, this conclusion should be cautiously applied in clinic with patients’ conditions in considered and it has to be verified with more large-scale and high-quality RCTs.
【摘要】 目的 了解学生对医院感染职业防护的基础知识的认知程度和学习需求。 方法 2010年3月采用自行设计问卷，对参加《医院感染与职业防护》课程学习的医学学生进行摸底调查。 结果 92.73%不知道标准预防措施和锐器伤后的正确处理方法及补救措施；27.27%不知道抽血时应戴手套；25.45%不清楚医务人员“六步洗手法”；90.91%不知晓工作服应交医院统一洗涤。 结论 学生防护知识薄弱，防护行为不全面、不规范。教学应重点帮助学生树立标准预防观念，掌握正确职业防护知识，在临床工作中以避免和减少各种危险因素的侵袭。【Abstract】 Objective To examine and evaluate the students’ knowledge and needs in studying hospital infection control and occupational protection. Methods Using a self-designed questionnaire in March 2010, we did a survey on students who attended the course of hospital infection control and occupational protection. Results Among all the students, 92.73% did not know standard prevention measures, and the correct treatment and remedial measures for sharp injuries; 27.27% did not know gloves should be worn at the time of blood drawing; 25.45% did not know the "six-step" hand-washing; and less than one out of ten students used hospital laundry to wash their uniform. Conclusions The students have a low level of relevant knowledge on occupational protection, and their protection behaviors were not complete or standard. Therefore, the teaching should help and support students to have a concept of standard prevention, and acquire sound knowledge and behavior of occupational protection in order to avoid and reduce the risk factors from their future clinical practices.
目的:探讨大肠癌致肠梗阻的诊断和手术方法。方法:回顾分析2002～2008年间65例结直肠癌致肠梗阻病例的外科治疗资料。结果:术后出现并发症9例,切口感染6例,腹腔感染2例,吻合口瘘1例。结论:结直肠癌致肠梗阻应争取Ⅰ期切除吻合。合理选择手术方式,做好术中结肠灌洗和围手术期治疗是手术成功关键。