目的:探讨护理干预对减少新生儿溢乳的效果。方法:将159例新生儿依随机数字法分为干预组(80例)与对照组(79例),干预组按计划进行护理干预与常规护理,对照组仅进行常规护理。结果:干预组溢乳发生13例,发生率1625%,对照组46例,发生率5823%,两组比较差异有显著性(Plt;001)。结论:护理干预降低了溢乳发生及生理性体重下降过快过长,促进新生儿身心发育。
Objective To review the efficacy and safety of interventions for preventing infections in nephrotic syndrome using evidence-based principles for clinicians to practice easily. Methods We searched Cochrane controlled trials register database, MEDLINE, EMBASE and Chinese Biologic Medical database. Results Total 11 articles were obtained including RCTs, non-controlled clinical studies and traditional narrative reviews. No systematic review or meta-analysis was identified. Prophylactic interventions for reducing risks of infection in nephrotic syndrome included intravenous immunoglobulin, thymosin, traditional Chinese herb, lamivudine, pneumococcal vaccination and chemoprophylaxis. Conclusion At present, the studies about interventions for preventing infection in nephrotic syndrome were limited in quantity and poor in the quality of methodology, therefore, the promising conclusions were unavailable. Rigid randomized placebo-controlled clinical trials with blinding or systematic review or meta-analysis would be very necessary for further assessing the efficacy and safety of the prophylactic interventions for preventing infections in nephrotic syndrome
Stomach cancer is a malignancy arising from the stomach mucous epithelium. It accounts for 95% of all stomach malignancy cancer. The prevalence of stomach cancer is high in China and the treatment is debated, especially regarding choice of chemotherapy and treatment duration. In order to identify the best treatment and follow-up for patient with stage T2N0M0 stomach sinus cancer, we searched MEDLINE, SUMsearch, The Cochrane Library (Issue 4, 2004), Clinical Evidence (Issue 4, 2003) and CBMdisc (1981 to 2004). A total of 3 systematic reviews, 28 randomized controlled trails, 3 cohort studies and 3 observational studies were identified. We evaluated the quality of included studies.All studies were divided into 5 grades by the levels and grades of recommendation. We drew a conclusion by synthesizing the results of included studies: The primary treatment for the patient was surgery treatment including gastric deuto-total resection and D1 lymph node dissection. There was no evidence supporting chemotherapy use in either systematic or abdominal cavity after surgery. The survival rate was high in 5 years and 10 years, so the follow-up time should not be long and the follow-up infermission should not less than 1 year. Follow-up included the dynamic and delayed MR sequence with Gd-DTPA, the level of serum CA199, endoscope, and stool occult blood test.
【摘要】 目的 老年综合评估法筛查75岁以上2型糖尿病（type 2 diabetes mellitus，T2DM）合并老年综合征的情况，并观察以甘精胰岛素为基础的治疗方法对老年综合征、血糖、低血糖事件、治疗满意度等的影响。 方法 应用老年综合评估中的日常生活能力、工具性日程生活能力、简易智能量表、老年抑郁量表、微型营养评定法，分别评估2005年12月—2009年12月老年门诊及病房住院的日常生活能力、认知功能状态、情绪障碍和营养状态，对其合并功能障碍、痴呆、抑郁、营养障碍、伤害性跌倒等老年综合征的患病情况进行横断面调查；筛选至少合并一种老年综合征和一个其他合并疾病，血糖控制差、预期寿命有限的患者进行以甘精胰岛素为基础的降糖治疗，采用自身前后对照的方法了解对糖化血红蛋白（hemoglobin A1c， HbA1c）、低血糖事件、治疗满意度的影响，并观察甘精胰岛素治疗方案对上述老年综合征的影响。 结果 132例老年门诊及病房住院的75岁以上T2DM患者功能障碍者高达50.0%（66例），罹患包括轻度认知功能障碍在内的痴呆比例为39.4%（52例）；合并抑郁症28.0%（37例）；营养失衡30.0%（39例）。33例患者符合甘精胰岛素治疗纳入标准，经过2年的随访发现，以甘精胰岛素为基础的治疗方案在适当降低HbA1c水平时，不增加老年综合征的患病率，但可以减少胰岛素多次皮下注射的次数，降低低血糖事件发生次数（由1.58次/例降为0.81次/例），提高患者治疗满意度。 结论 75岁以上T2DM患者合并老年综合征的比例高，老年综合评估能及时发现老年综合征；以甘精胰岛素为基础的治疗方案不增加老年综合征的发生，并能显著降低低血糖事件数、改善营养状态、提高患者对治疗的满意度。【Abstract】 Objective To screen geriatric syndrome in patients older than 75 years with type 2 diabetes mellitus (T2DM) by the method of comprehensive geriatric assessment, and observe the impact of glargin-based therapy on geriatric syndrome, blood glucose level, the event of hypoglycemia and treatment satisfaction degree in patients older than 75 years with T2DM who suffered at least one kind of Geriatric syndromes. Methods From December 2005 to December 2009, activity of daily living (ADL), instrument activity of daily living (IADL), mini-mental state examination, geriatric depression scale and mini-nutritional assessment in comprehensive geriatric assessment were used to assess daily living ability, cognitive function status, emotional disorder and nutritional status of out/in-patients older than 75 years with T2DM in the Department of Geriatrics. Cross-sectional study was carried out to investigate geriatric syndromes such as combined functional disorder, dementia, depression, nutritional disorder and impairment falls in those patients, and patients with T2DM combined with at least one kind of geriatric syndrome and another kind of combined disease were screened out. A glargin-based anti-hyperglycemic therapy was carried out for those patients with poor blood glucose control limited remaining life time. The effects of this therapy on hemoglobin A1c (HbA1c), the event of hypoglycemia and treatment satisfaction degree of the patients were studied through a self-comparison method. Then, its effect on the above-mentioned geriatric syndromes was observed. Results Among all the 132 out/in patients older than 75 years with T2DM, the prevalence rates of functional disorder (including ADL and IADL), dementia including mild cognitive disorder, depression, and malnutrition were respectively 50.0% (66), 39.4% (52), 28.0% (37), and 30.0% (39). Only 33 patients met the criteria of glargin-based treatment. After 2 years of follow-up, we found that the glargin-based treatment could properly decrease the level of HbA1c without increasing the prevalence rate of geriatric syndrome. Moreover, it could reduce the frequency of insulin injection and the events of hypoglycemia, and treatment satisfaction degree was also significantly improved. Conclusions Geriatric syndrome has a relatively high prevalence rate in patients older than 75 years with T2DM. Comprehensive geriatric assessment is beneficial in finding out the geriatric syndrome, and glargin-based hypoglycemic therapy can significantly reduce the events of hypoglycemia, improve nutritional status, and increase treatment satisfaction degree without increasing the rate of geriatric syndrome .
ObjectivesTo review the value of sleep deprivation EEG methodology in the diagnosis of epilepsy.MethodsSuch databases as Pubmed, MEDLINE, The Cochrane Library, Wanfang, VIP and CNKI Data are searched electronically and comprehensively for literature on the diagnosis of epilepsy by sleep deprivation EEG from inception to January 2021. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using Stata software.ResultsA total of 14studies involving 1221 patients were included in total. The results of meta-analysis showed that: Duration of sleep deprivation and effect value of positive rate [ r=0.670, 95%CI (0.664, 0.696), P<0.001 ], duration of the awake period records and effect value of positive rate [ r=0.659, 95%CI (0.596, 0.722), P<0.001 ], duration of sleep period records and effect value of positive rate [ r=0.67, 95%CI(0.619, 0.721), P<0.001 ], with significant differences.ConclusionsThe duration of sleep deprivation, the awake period records, and the sleep period records of sleep deprivation EEG examination, sleep deprivation time between 16 h to 24 h, the awake recording time ≥30 min, and the sleep recording time ≥ 60 min (≤ 3 h) can obviously improve the positive rate of sleep deprivation EEG.
Objective To evaluate the correlation between hyperuricemia (HUA) and benign prostatic hyperplasia (BPH). Methods A total of 666 elderly male patients, who had been admitted to the West China Hospital for routine physical examination in May, 2010, were included in this study. All the following indexes were collected: blood pressure, waistline, medical history, international prostatic symptom score (IPSS), serum uric acid (UA), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG-2), prostate-specific antigen (PSA), and prostate volume (PV) measured by ultrasound. Patients with higher level of UA more than 420 μmol/L were included into the HUA group (n=151) while the other patients with normal UA (NUA) were in the NUA group (n=515). Both the metabolic and prostate related indexes in the two groups were compared, and the correlation between HUA and each indexes were analyzed using logistic regression model. Results HUA was significantly associated with abdominal obesity (OR=1.575, 95%CI 1.059 to 2.340), hypertriglyceridemia (OR=2.78, 95%CI 1.877 to 4.118), metabolic syndrome (CDS2007) (OR=1.912, 95%CI 1.267 to 2.885), BPH (OR=1.464, 95%CI 1.465 to 1.635) and lower urinary tract symptoms (LUTS) rating (OR=1.782, 95%CI 1.173 to 1.522). Conclusion HUA is correlated with BPH, meanwhile it is highly accompanied with other risk factors of cardioascular diseases. Hereby, comprehensive medical screening should be considered when treating such patients.
ObjectiveTo explore the short-term effectiveness of Mako robot-assisted total hip arthroplasty (THA) via posterolateral approach.MethodsThe clinical data of 64 patients (74 hips) treated with Mako robot-assisted THA via posterolateral approach (robot group) between May 2020 and March 2021 were retrospectively analyzed and compared with the clinical data of 52 patients (55 hips) treated with traditional THA via posterolateral approach (control group) in the same period. There was no significant difference in general data such as gender, age, side, body mass index, disease type, and preoperative Harris score between the two groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. Acetabular inclination angle, acetabular anteversion angle, and lower limbs discrepancy were measured after operation. At last follow-up, the improvement of hip pain and function was evaluated by visual analogue scale (VAS) score, Harris score, and forgetting joint score (FJS-12).ResultsIn the robot group, 3 patients (including 1 patient with acetabular fracture during operation) were converted to routine THA because the pelvic data array placed at the anterior superior iliac spine was loose, resulting in data error and unable to register the acetabulum; the other patients in the two groups completed the operation successfully. The operation time and intraoperative blood loss in the robot group were significantly higher than those in the control group (P<0.05). All patients were followed up 1-10 months, with an average of 4.6 months. In the robot group, 1 patient with ankylosing spondylitis had acetabular prosthesis loosening at 2 days after operation, underwent surgical revision, and 10 patients had lower limb intermuscular vein thrombosis; in the control group, 1 patient had left hip dislocation and 5 patients had lower extremity intermuscular vein thrombosis; there was no complication such as sciatic nerve injury, incision exudation, and periprosthetic infection in both groups. There was no significant difference in the incidence of complications between the robot group and the control group (17.2% vs.11.5%) (χ2=0.732, P=0.392). At last follow-up, the acetabular anteversion angle and FJS-12 score in the robot group were was significantly greater than those in the control group, and the lower limbs discrepancy was significantly less than that in the control group (P<0.05); there was no significant difference in acetabular inclination angle and VAS score between the two groups (P>0.05). The Harris scores of the two groups were significantly improved when compared with those before operation (P<0.05), but there was no significant difference in the difference of pre- and post-operative score between the two groups (t=1.632, P=0.119).ConclusionCompared with traditional surgery, Mako robot-assisted THA can optimize the accuracy and safety of acetabular cup implantation, reduce the length difference of the lower limbs, and has a certain learning curve. Its long-term effectiveness needs further research to confirm.
ObjectiveTo investigate the effectiveness of total elbow arthroplasty (TEA) via olecranon osteotomy approach. Methods Between January 2011 and December 2021, 22 patients (25 sides) with elbow joint disease were treated with TEA via olecranon osteotomy approach. There were 9 males and 13 females with an average age of 52.0 years (range, 32-80 years). The disease involved unilateral elbow joint in 19 cases, including 12 cases on the left side and 7 cases on the right side, and 3 cases with bilateral elbow joints. There were 3 cases (3 sides) of osteoarthritis, 7 cases (9 sides) of rheumatoid arthritis, 6 cases (7 sides) of traumatic arthritis, 4 cases (4 sides) of distal humeral fracture, and 2 cases (2 sides) of elbow tuberculosis. The operation time, intraoperative blood loss, and postoperative complications were recorded. The Mayo Elbow Performance Score (MEPS) and range of motion (ROM) were used to evaluate the elbow joint function, and imaging was used to review the position of the prosthesis and the healing of the osteotomy. ResultsThe operation time ranged from 53 to 120 minutes (mean, 90.6 minutes); intraoperative blood loss ranged from 10 to 200 mL (mean, 68.4 mL). All incisions healed by first intention. All patients were followed up 3.9-126.7 months, with a median time of 47.6 months. At last follow-up, the MEPS scores of 22 patients ranged from 72 to 100 (mean, 91.6); the elbow joint function was rated as excellent in 17 sides, good in 7 sides, and fair in 1 side, with an excellent and good rate of 96%. Elbow joint ROM was 98°-140° in flexion (mean, 119.7°), 5°-23° in extension (mean, 13.9°), 70°-90° in anterior rotation (mean, 83.3°), and 63°-90° in posterior rotation (mean, 79.4°). The follow-up time of 17 patients (20 sides) without fracture and joint stiffness before operation was 3.9-126.7 months, with a median time of 53.9 months; at last follow-up, the MEPS score and the elbow joint ROM were significantly better than those before operation (P<0.05). The follow-up time of 5 patients (5 sides) with fracture and joint stiffness before operation was 12.0-124.2 months, with a median time of 40.1 months. At last follow-up, MEPS scores ranged from 89 to 100 (mean, 91.2), and elbow joint ROM restored. Two cases (2 sides) developed ulnar nerve symptoms after operation, and 1 case (1 side) suffered from periprosthetic fracture and periprosthetic infection after revision, and the elbow prosthesis was removed. The prosthesis survival rate was 96%. During follow-up, no prosthesis loosening occurred. ConclusionThe intraoperative visual field exposure of TEA via the olecranon osteotomy approach is sufficient, which can reduce the incidence of complications such as triceps weakness and ulnar nerve injury, effectively improve the function of the elbow joint, and obtain satisfactory effectiveness.
Objective To compare the difference of anterior knee pain between mobile-bearing prosthesis and fixedbearing prosthesis after total knee arthroplasty (TKA). Methods Between January 2008 and October 2008, 72 patients withosteoarthritis were treated with primary TKA. All patients were randomly divided into fixed-bearing prosthesis group (n=37)and mobile-bearing prosthesis group (n=35). In fixed-bearing prosthesis group, there were 8 males and 29 females with an average age of 69.6 years (range, 57-76 years), weighing from 55 to 92 kg (mean, 66.7 kg); the locations were the left knee in 20 cases and the right knee in 17 cases; the body mass index (BMI) ranged from 17.6 to 37.3 (mean, 26.2); the disease duration was 3-22 years; the Knee Society Score (KSS) knee score, function score, patellar score, and pain score were 29.4 ± 15.3, 33.4 ± 16.8, 7.2 ± 2.5, and 2.5 ± 2.2, respectively; and the Insall-Salvati (I-S) index was 1.6 ± 0.3. In mobile-bearing prosthesis group, there were 9 males and 26 females with an average age of 68.2 years (range, 58-73 years), weighing from 50 to 86 kg (mean, 67.9 kg); the locations were the left knee in 30 cases and the right knee in 5 cases; the BMI ranged from 18.4 to 34.4 (mean, 25.6); the disease duration was 6-18 years; the KSS knee score, function score, patellar score, and pain score were 30.9 ± 14.7, 31.4 ± 14.4, 6.8 ± 3.1, and 2.0 ± 2.3, respectively; and the I-S index was 1.6 ± 0.2. There was no significant difference in general data between 2 groups (P gt; 0.05). Results All incisions healed by first intention; no deep vein thrombosis of lower l imbs or pulmonary embol ism occurred. All patients were followed up 12-16 months. In mobile-bearing prosthesis group, knee infection occurred in 1 case, dislocation of the knee in 1 case, and cl icking of the knee in 3 cases; in fixed-bearing prosthesis group, cl icking of the knee occurred in 1 case. There was no significant difference in KSS knee score, function score, patellar score, or pain score between 2 groups (P lt; 0.05) at last follow-up; and there was no significant difference in congruence angle, lateral patellofemoralangle, patellar tilt angle, lateral patellar displacement, patellar displacement, or I-S index between 2 groups at last follow-up (P gt; 0.05). Anterior knee pain occurred in 7 cases (18.9%) of the fixed-bearing prosthesis group and in 5 cases (14.3%) of the mobilebearing prosthesis group, showing no significant difference (χ2=0.227, P =0.634). There were significant differences in KSS knee score, function score, patellar score, and I-S index between patients with anterior knee pain and patients without anterior knee pain (P lt; 0.05). Conclusion Fixed-bearing prosthesis and mobile-bearing prosthesis have the same short-term effectiveness and the incidence of anterior knee pain.
Objective To investigate the morphological anatomical abnormal ities of high congenital dislocation of hip in adults and provide anatomical basis for the total hip arthroplasty (THA). Methods From May 1997 to July 2008, 49 patients (57 hi ps) with high congenital dislocation of hip (Hartofilakidis type III) were treated. There were 6 males and 43 females with an average age of 29.4 years old (18-56 years old). The locations were left in 24 hi ps and right in 33 hi ps. The morphological parameters (including femoral length, isthmus, height of femoral head center, neck-shaft angle, medialhead offset, anteversion angle, canal flare index, anteroposterior diameter of the true acetabulum, posterior thickness of the true acetabulum, depth of the true acetabulum) of suffering hips (dislocation group, n=57) were measured by preoperative X-ray, CT and intraoperative cl inical observation and were compared with those of contralateral hips (control group, n=41). The intraoperative situations of hip were observed. Results The height of dislocation was (45.41 ± 2.15) mm. The length difference of both lower extremities was (40.41 ± 2.02) mm. In dislocation group, isthmus was shortened; height of femoral head center, neck-shaft angle and medial head offset were decreased; and anteversion angle was increased. CT showed that the canal flare index was larger than 4.7, femoral shape was funnel-shaped according to Noble classification. Anteroposterior diameter of the true acetabulum became smaller, posterior thickness of the true acetabulum became thicker, and depth of the true acetabulum was shallower. There were statistically significant differences in the morphological parameters of femur and acetabulum between two groups (P lt; 0.05). The intraoperative measurements showed that the anteroposterior diameter of acetabulum was (32.98 ± 1.02) mm and the depth of acetabulum was (14.21 ± 0.56) mm. There was no statistically significant difference between intraoperative measurements and preoperative measurements (P gt; 0.05). The acetabulum was full of fat and fibrous tissues. Running of the sciatic nerve in 40 cases were changed and it ran upward and laterally. Conclusion When high congenital dislocation of the hip in adults is treated with THA, anatomical variation must be fully taken into account. The acetabulum is expanded toward posterosuperior, excessive reamed should be avoided to prevent femoral fractures, and appropriate or tailor-made prosthesis was selected.