建立人工氣道實施機械通氣是治療嚴重呼吸衰竭過程中挽救患者生命最常用的措施之一，然而通過人工氣道的機械通氣也增加了相關并發癥發生的機會，如呼吸機相關性肺炎（VAP）等[1]。多數患者在應用呼吸機進行通氣支持治療中，當呼吸衰竭及其病因的病情緩解或明顯改善時就可以解除人工氣道和終止通氣支持，但20%~30%的患者需要逐漸解除呼吸機的通氣支持，謂之撤機（Weaning）[1]。盡管文獻中撤機的定義略有不同，但主要指的是需要逐步減弱及停止通氣支持和解除人工氣道的一個時間過程。有慢性呼吸功能不全的患者撤機尤為困難，撤機困難患者的撤機時間可占總機械通氣時間的40%[2]。機械通氣時間延長與VAP發生率和病死率增加相關。一般來說，機械通氣時間gt;3 d，VAP的發生率增加；機械通氣時間gt;5 d，并發的VAP為晚發性醫院獲得性肺炎（HAP），其感染的病原體多為耐多藥細菌，治療難度加大，病死率高于早發性HAP。因此，對于機械通氣患者來說，一旦建立人工氣道實施有創通氣，就應該積極創造條件，盡快撤機，去除人工氣道。然而過快地降低和停止通氣支持以及過早的氣管拔管，可導致撤機失敗和再插管。因此時機不成熟的撤機和延時撤機同樣可造成機械通氣時間過長，導致VAP發生率和病死率升高，以及醫療費用增加[2]。撤機的模式和方法有多種，但最佳的撤機方式仍有爭議[1]。近年來無創通氣（NIV）作為一種撤機方式用于臨床已引起人們的興趣和關注，但至今臨床研究所得結論并未達到一致，NIV是否可以作為一種常規撤機方式用于臨床尚無定論。本文通過總結近年來相關的臨床研究，評價NIV用于機械通氣撤機的可行性和利弊，探討需進一步優化研究方案來解決的有關問題。
Based on peer-reviewed systematic reviews and randomized controlled trials published from January 1990 to April 2016 with regards to the management of osteoarthritis (OA) of the hip, the American Academy of Orthopaedic Surgeons (AAOS) developed the clinical practice guideline for the treatment of hip OA. This guideline provided practice recommendations including risk factors for hip OA, oral drugs and intraarticular injectables, physical therapies, perioperative hemostatic drug, anesthetic types, approach exposures, etc. The evidence of guideline was graded according to it’s strength. This article interpreted this guideline so as to provide reference for Chinese medical staffs and guideline developers.
ObjectiveTo summarize the epidemiology of nonalcoholic fatty liver disease (NAFLD) and the epidemiological and economic burdens of NAFLD, so as to provide a reference for hospital management decision-making. MethodThe domestic and foreign guidelines relevant to NAFLD and the literatures relevant to epidemiological investigation and disease burden researches were summarized and its research progress was reviewed. ResultsThe global prevalence of NAFLD was increasing over years. The incidence, mortality, and disability adjusted life years of liver cirrhosis and liver cancer caused by NAFLD had increased year by year. The patients relevant to NAFLD of inpatients and outpatients had increased obviously, and the overall medical expenses had also shown a rising trend. The possible reasons were health care awareness, new drug research, population aging, and excessive medical consumption. In addition, children and adolescents with NAFLD had a obviously increased risk of liver or extrahepatic diseases. ConclusionsBy understanding the epidemiological trend of NAFLD, it is a certain understanding of the disease burden of NAFLD and the related factors affecting the increase of its treatment cost. It is believed that it is necessary to further pay attention to and strengthen the genetic characteristics, pathogenesis, drug research and development, and early diagnosis of cirrhosis and liver cancer relevant to NAFLD in the future. At the same time, the NAFLD group of children and adolescents should not be ignored.
In recent years, due to the dramatic increase in the number of surgical operations, there has been a clinically significant increase in the demand for medical adhesives capable of cohesion in a moist environment that can overcome blood or tissue fluids in vivo. As the understanding of the mechanisms and key elements of natural adhesion to aquatic organisms continues to develop, a variety of medical adhesives have been developed by mimicking adhesion procedures or utilizing key functional groups. This article will review the classification, adhesion mechanism, use, research progress and development prospects of biomedical adhesives inspired by aquatic organisms octopus and mussels.
【摘要】 目的 探討心理干預對糖尿病患者血糖控制及情緒的影響。 方法 2001年3月-2009年7月將120例2型糖尿病患者隨機分成干預組和對照組，每組各60例。兩組均給予正規藥物治療，干預組同時予心理干預。8周后用焦慮自評量表（self-rating anxiety scale，SAS）、抑郁自評量表（self-rating depression scale，SDS）評定兩組患者情緒變化，同時測定空腹血糖、餐后2 h血糖。 結果 干預前后干預組空腹血糖及餐后2 h 血糖下降值多于對照組，差異有統計學意義（Plt;0.05）；通過干預，干預組患者SAS、SDS評分均有明顯改善，干預前后評分差異有統計學意義（Plt;0.05），對照組干預前后差異無統計學意義（Pgt;0.05）；患者血糖與SAS、SDS評分等因子呈現中等程度的相關性（|r|為0.4~0.6，Plt;0.05）。 結論 糖尿病患者血糖與SAS、SDS等情緒指標相關，心理干預能顯著改善血糖和患者情緒。【Abstract】 Objective To study the effect of psychological intervention on blood-glucose control and emotions of diabetic patients. Methods A total of 120 patients with type 2 diabetes treated between March 2001 and July 2009 were randomly divided into the intervention group and the control group with 60 patients in each. Medicine treatment was carried out for patients in both groups, and psychological intervention was applied only to the intervention group. Eight weeks later, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate emotion changes of the patients. Fasting blood glucose, post-meal blood glucose (P2hBG) examination were conducted at the same time. Results The result showed a significantly larger decrease of both fasting blood glucose and post-meal blood glucose in the intervention group than the control group (Plt;0.05). Through these methods, the SAS and SDS evaluation of patients in the intervention group improved significantly (Plt;0.05); However, the change of these two scores was not statistically significant in the control group (Pgt;0.05). There was a mid-level correlation between the blood sugar level of diabetic patients and SAS, SDS evaluation scores (0.4lt;|r|lt;0.6, Plt;0.05). Conclusion The blood sugar level of patients with diabetes is closely related to SAS and SDS scores, and psychological intervention can significantly improve the control of blood glucose and emotions of the patients.
With the implementation of the “Health China 2030” strategy, sports medicine has played an increasingly important role in clinical treatment, chronic disease management, and population health promotion. West China Hospital of Sichuan University has actively explored the development and optimization of its sports medicine discipline outpatient management system, establishing a comprehensive model that integrates diagnosis and treatment, functional rehabilitation, exercise-based health management, and extended care services. This article systematically summarizes the practical experiences of the sports medicine outpatient department, including subspecialty setting, exercise prescription services, outpatient assistant mechanisms, online expert teams, multi-campus coordination, and full-process health management. Emphasizing a function-oriented and patient-centered approach, the article also discusses the extended value of outpatient services in translational research, smart healthcare, and preventive health strategies. This model provides a replicable and scalable reference for the development of sports medicine outpatient clinics.
Objective To provide the anatomic evidences and the choice of tendon graft for anatomic reconstruction of posterolateral complex through the morphological and biomechanical study on posterolateral structures of the knee in normal adult cadavers. Methods Twenty-three fresh lower l imb specimens from voluntary donators and 9 lower l imbs soaked by Formal in were selected for anatomic study on the posterolateral complex of the knee. Six fresh specimens were appl ied to measure the maximum load, intensity of popl iteus tendon, lateral collateral l igament, and popl iteofibular l igament, which were key components of the posterolateral complex. Results Popl iteus musculotendinous junction was located at 7.02-11.52 mm beneath lateral tibial plateau and 8.22-13.94 mm medially to fibular styloid process. The distances from femoral insertion of popl iteus tendon to the lower border of femoral condyle and to posterior edge of femoral condyle were 10.52-14.38 mm and 14.24-26.18 mm, respectively. Popl iteofibular l igament originated from popl iteus musculotendinous junction and ended at fibular styloid process. Lateral collateral l igament was located at 10.54-16.48 mm inferior to fibular styloid process, and the distances from femoral insertion to the lower border of femoral condyle and to posterior edge of femoral condyle were 14.92-19.62 mm and 14.66-27.08 mm, respectively. The maximum load and intensity were 579.60-888.40 N and 20.50-43.70 MPa for popl iteus tendon, were 673.80-1 003.20 N and 24.30-56.40 MPa for lateral collateral l igament, and were 101.56-567.35 N and 8.94-36.16 MPa for popl iteofibular l igament, respectively. Conclusion During anatomical reconstruction of posterolateral complex, the bony tunnel of the key components should be located according to the insertion mentioned above. On the basis of this study, the maximum load and intensity of selectable grafts should exceed 833 N and 36 MPa.
目的 探討心理行為干預對痛風患者遵醫行為的影響。 方法 2006年1月－2010年9月，選取痛風患者190例，隨機分為干預組和對照組，兩組均進行遵醫行為評價和疾病相關檢查；對干預組進行認知行為干預，分析患者存在的痛風飲食治療的認知誤區，有針對性地進行心理行為干預。 結果 干預后，干預組認知行為總分和各單項分均高于對照組（P＜0.05），膽固醇、甘油三酯和體質量指數均低于對照組（P＜0.05）；干預組19例（20.0%）復發，對照組36例（37.9%）復發，兩組復發率比較，差異有統計學意義（χ2=7.390，P=0.007）。 結論 行為認知治療可提高痛風患者的治療依從性，從而有助于改善尿酸等相關指標。
ObjectiveTo review the bioactive strategies that enhance tendon graft healing after anterior cruciate ligament reconstruction (ACLR), and to provide insights for improving the therapeutic outcomes of ACLR. Methods The domestic and foreign literature related to the bioactive strategies for promoting the healing of tendon grafts after ACLR was extensively reviewed and summarized. ResultsAt present, there are several kinds of bioactive materials related to tendon graft healing after ACLR: growth factors, cells, biodegradable implants/tissue derivatives. By constructing a complex interface simulating the matrix, environment, and regulatory factors required for the growth of native anterior cruciate ligament (ACL), the growth of transplanted tendons is regulated at different levels, thus promoting the healing of tendon grafts. Although the effectiveness of ACLR has been significantly improved in most studies, most of them are still limited to the early stage of animal experiments, and there is still a long way to go from the real clinical promotion. In addition, limited by the current preparation technology, the bionics of the interface still stays at the micron and millimeter level, and tends to be morphological bionics, and the research on the signal mechanism pathway is still insufficient.ConclusionWith the further study of ACL anatomy, development, and the improvement of preparation technology, the research of bioactive strategies to promote the healing of tendon grafts after ACLR is expected to be further promoted.
ObjectiveTo investigate the risk factors of contralateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction. Methods A retrospective review was conducted on the 716 patients with ACL injury who received primary ACL reconstruction surgery and met the selection criteria between January 2012 and September 2018. After a mean follow-up period of 7.6 years (range, 4-10 years), 65 patients (9.1%) experienced contralateral ACL injury (injured group) and 651 patients (90.9%) did not (uninjured group). There was no significant difference in age, body mass index, and preoperative Lachman test degree between groups (P>0.05). However, the proportion of female in the injured group was significantly higher than that of male (P<0.05), and the preoperative posterior tibial slope (PTS) was significantly higher than that of the uninjured group (P<0.05). Using the outcome of contralateral ACL injury as the dependent variable, the clinical data of the patient was first used as the independent variable, and univariate COX regression was used to analyze the prognostic influencing factors. Then, the indicators with differences in univariate COX regression were used as the independent variable, and multivariate COX regression was used to analyze the independent risk factors affecting prognosis. Log-Rank (Mantel-Cox) test was used to test and analyze the occurrence time of contralateral ACL injury in patients of different genders; X-tile software was used to analyze the occurrence time of contralateral ACL injury in patients with different PTS using Log-Rank (Mantel-Cox) test and PTS cut-off values. ResultsUnivariate COX regression analysis showed that gender and PTS were influence factors for contralateral ACL injury (P<0.05); further multivariate COX regression analysis showed that female and increased PTS were independent risk factors for contralateral ACL injury (P<0.05). The Log-Rank (Mantel-Cox) test results showed that the contralateral ACL injury occurred in female at 8.853 (8.600, 9.106) years, which was significantly shorter than that in male [9.661 (9.503, 9.819) years] (χ2=20.323, P<0.001). Using X-tile software to analyze the cut-off value of PTS, it was found that the cut-off value of PTS for contralateral ACL injury was 10.92°. According to the Log-Rank (Mantel-Cox) test, it was found that the contralateral ACL injury occurred in 5.762 (4.981, 6.543) years in patients with PTS≥10.92°, which was significantly shorter than patients with PTS<10.92° [9.751 (9.650, 9.853) years](χ2=302.479, P<0.001). ConclusionFemale and PTS≥10.92° after primary ACL reconstruction are independent risk factors for contralateral ACL injury.