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以脊髓病變為突出表現的神經皮膚黑色素沉著癥一例

單眼扇形視網膜色素變性合并慢性閉角型青光眼一例

A Status Survey on Inpatient Disease Constitution in Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from 2008 to 2010

Objective　To investigate inpatient disease constitution in Traditional Chinese Medicine (TCM) Hospital of Xinjiang Uygur Autonomous Region from 2008 to 2010, in order to provide baseline data for medicine allocation of hospitals in western China and development of TCM hospitals. Methods　A questionnaire combined with a subject interview was carried out, and the case records of inpatients from 2008 to 2010 were collected. The diseases in discharge records were classified according to International Classification of Diseases (ICD-10) based on the first diagnosis. Data including general information of the inpatients, discharge diagnosis etc. were rearranged and analyzed by Excel software. Results　a) The top four systematic diseases seen commonly from 2008 to 2010 were as follows: circulatory system diseases, musculoskeletal system and connective tissue diseases, respiratory system diseases and digestive system diseases. The top four single diseases were hypertension, intervertebral disc disease, diabetes, bronchitis, emphysema and other chronic obstructive pulmonary diseases. Respiratory system diseases ranked the third in 2009 and 2010 from the fourth in 2008, and circulatory system diseases had ranked the first during the past three years; b) The following diseases as hypertension, bronchial emphysema and other chronic obstructive pulmonary diseases, diabetes, fractures, airway (bronchus, lung) cancer, and viral hepatitis were commonly seen in males rather than in females. By contrast, intervertebral disc disease, gallstone disease and cholecystitis, and anemia were commonly seen in females; and c) Hypertension was commonly seen in the aged above 60 years old; intervertebral disc disease mainly focused on the patients at the age of 15 to 59; and bronchial emphysema and other chronic obstructive pulmonary diseases, airway (bronchus, lung) cancer involved in the patients who were mostly over 60 years old. Conclusion　a) The top four systematic diseases seen commonly from 2008to 2010 are as follows: circulatory system diseases, musculoskeletal system and connective tissue diseases, respiratory system diseases and digestive system diseases. The top four single diseases are hypertension, intervertebral disc disease, diabetes, bronchitis, emphysema and other chronic obstructive pulmonary diseases. So these diseases should be taken into well consideration when making development plans by hospital and complementing essential drugs list by local development; b) Chronic diseases become the main disease for troubling Xinjiang population; and c) Male and female are susceptible to different diseases which should be rationally avoided in order to prevent the induced occurrence.

腹腔鏡十二指腸-空腸手工側側吻合治療腸系膜上動脈壓迫綜合征4例報道

目的 探討腹腔鏡十二指腸-空腸手工側側吻合術治療腸系膜上動脈壓迫綜合征的安全性及可行性。 方法 回顧性分析4例接受腹腔鏡十二指腸-空腸手工側側吻合術治療的腸系膜上動脈壓迫綜合征患者的臨床資料。 結果 本組4例患者均確診為腸系膜上動脈壓迫綜合征，均順利完成腹腔鏡十二指腸-空腸手工側側吻合術，無中轉開腹或死亡病例。手術時間分別為95、118、103和89 min，術中出血量分別為35、45、30和25 mL，術后肛門排氣時間分別為2、3、3和2 d，術后住院時間分別為8、7、9和6 d。術后造影見造影劑順利通過吻合口，近端小腸顯影，未見逆蠕動和造影劑反流情況。術后患者腹痛、腹脹癥狀消失，無吻合口出血、吻合口漏等嚴重并發癥發生。 結論 腹腔鏡十二指腸-空腸手工側側吻合術治療腸系膜上動脈壓迫綜合征安全、有效。

Effects of exercise on blood lipid for patients with hypertension: a network meta-analysis

ObjectiveThis study aimed to compare the effects of aerobic training, resistance training, and aerobic training combined with resistance training on blood lipid levels for patients with hypertension using network meta-analysis. MethodsWe searched the CNKI, VIP, WanFang Data, PubMed, Web of Science, The Cochrane Library, and EMbase databases to collect randomized controlled trials (RCTs) on the effects of exercise on blood lipid levels among patients with hypertension from inception to September 16th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Stata 15.1 software and RevMan 5.0 software were then used to perform network meta-analysis. ResultsA total of 29 RCTs involving 2 519 patients were included. Compared with the control group, aerobic training (MD=?0.47, 95%CI ?0.62 to ?0.319, P<0.001), resistance training (MD=?0.37, 95%CI ?0.63 to ?0.11, P<0.05), and aerobic training combined with resistance training (MD=?0.61, 95%CI 0.88 to ?0.34, P=0.005) reduced total cholesterol levels; aerobic training (MD=0.14, 95%CI 0.08 to 0.20, P<0.001), resistance training (MD=0.10, 95%CI 0.02 to 0.19, P<0.05), and aerobic training combined with resistance training (MD=0.12, 95%CI 0.02 to 0.23, P=0.038) increased high-density lipoproteins; aerobic training (MD=?0.32, 95%CI ?0.48 to ?0.15, P=0.001), resistance training (MD=?0.19, 95%CI ?0.48 to ?0.01, P<0.05), and aerobic training combined with resistance training (MD=?0.40, 95%CI ?0.70 to ?0.11, P<0.05) reduced low-density lipoproteins. The SUCRA probability sorting results showed that aerobic training had the most significant effect on the improvement of systolic blood pressure and diastolic blood pressure; aerobic exercise combined with resistance training had the largest effect on total cholesterol, triglycerides, low-density lipoproteins, and high-density lipoproteins. ConclusionsAerobic training combined with resistance training is the most effective exercise method to improve blood lipid levels for patients with hypertension. Due to the limited quantity and quality of the included studies, the above conclusions are needed to be verified by more high-quality studies.

老年糖尿病腎病維持性血液透析患者透析中發生低血糖的護理體會

ACCURACY STUDY ON PREOPERATIVE MEASUREMENT OF PEDICLE SCREW FIXATION FOR THORACOLUMBAR VERTEBRA IN SPINAL VIRTUAL SURGERY SYSTEM

Objective To employ spinal virtual surgery system (SVSS) for preoperative planning of thoracolumbar pedicle screw fixation, and to establ ish the measurement method for pedicle screw-related parameters. Methods Eight thoracicand lumbar spine specimens (T11-L3) were selected. First of all, SVSS was used for the preoperative planning of pedicle screw and the parameters of both sides of pedicle were measured in every vertebral segment, including angle of axial view (Aa), angle of sagittal view (As), x-direction entrance (XE), total pedicle length of axial view (TLa), total pedicle length of sagittal view (TLs), pedicle height (PH), pedicle width (PW), and pedicle spongy width (PSW). Then the corresponding parameters of the right and left pedicle screws of the specimens were measured actually. Finally, its accuracy was verified by comparing the data by virtual measurement and actual measurement. Results There was no significant difference in the parameters of virtual measurement (Aa, As, TLa, TLs, XE, PW, PSW, and PH) and actual measurement (Aa, As, TLa, XE, PW, PSW, and PH) between the right and left sides (P gt; 0.05). Except XE of the L3 vertebral segment and PSW of T11 and T12 vertebral segments (P lt; 0.05), the differences in other parameters of other segments were not significant (P gt; 0.05). Conclusion After statistical analysis and comparison, the feasibil ity of preoperative planning of thoracolumbar pedicle screw fixation and the accuracy of the measurement of the SVSS is verified.

Effectiveness of N-acetylcysteine Combined with Low-Dose Glucocorticoid for Patients with IPF: A Meta-Analysis

Objective　To systematically evaluate the effectiveness of N-acetylcysteine (NAC) combined with low-dose glucocorticoid for patients with idiopathic pulmonary fibrosis (IPF). Methods　Such databases as The Cochrane Library (Issue 12, 2012), EMbase (January 1974 to July 2012), PubMed (January 1966 to July 2012), CHEST (January 1995 to July 2012), CNKI (January 1994 to July 2012), CBM (January 1978 to July 2012), VIP (January 1989 to July 2012) and WanFang Data (January 1995 to July 2012) were searched to collect the randomized controlled trials (RCTs) about NAC combined with low-dose glucocorticoid versus glucocorticoid alone for IPF patients. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then the meta-analysis was performed using RevMan 5.1 software. Results　A total of seven RCTs including 264 IPF patients were included. The results of meta-analysis demonstrated that, compared with the glucocorticoid used alone, a) NAC combined with low-dose glucocorticoid could significantly improve PaO2 (SMD=0.82 mmHg, 95%CI 0.30 to 1.35, P=0.002) and DLco (SMD=0.59 mmHg, 95%CI 0.16 to 1.03, P=0.008) with a significant difference. b) NAC combined with low-dose glucocorticoid could significantly improve all clinical symptoms (RR=1.56, 95%CI 1.26 to 1.92, Plt;0.000 1). Conclusion　NAC combined with low-dose glucocorticoid for IPF patients can significantly improve PaO2, DLco, and the clinical symptoms such as cough, difficulty breathing after activities, cyanosis, and Velcro rales. Due to the quantity and quality limitation of included studies, this conclusion still needs to be further proved by more high quality and double blind RCTs.

Clinical Observation of Ulinastatin for the Treatment Multiple Injuries

目的 觀察烏司他丁對多發傷患者的治療作用和對肝、腎功能的保護作用。方法 46例多發傷患者隨機分為治療組（23例）和對照組（23例）。治療組從入院第1天開始，每天靜脈點滴烏司他丁10萬單位+生理鹽水100 ml，每8 h 1次，連續用藥6 d，觀察患者的臨床指標判斷療效，并在入院時以及術后第1、3、5、7天檢測谷丙轉氨酶（ALT）、谷草轉氨酶（AST）、血尿素氮（BUN）、血肌酐（Scr）、血漿腫瘤壞死因子-α（TNF-α）、白細胞介素-2（IL-2）、白細胞介素-6（IL-6）以及白細胞介素-8（IL-8）含量的變化。結果 多發傷患者治療組平均住院時間及平均住ICU時間均低于對照組，差異有顯著性意義（P＜0.05）； 治療組術后血漿ALT、AST、BUN及Scr濃度均明顯低于對照組（P＜0.05）； 治療組術后血漿TNF-α水平逐漸降低，對照組維持在較高水平； IL-2、IL-6及IL-8水平低于對照組（P＜0.05）。結論 烏司他丁對多發傷有治療作用，并能減輕機體的全身炎癥反應程度，有保護和改善肝、腎功能的作用。

Application of Bispectral Index in Pediatric Anesthesia

目的　研究腦電雙頻指數（BIS）在小兒麻醉中的應用，為BIS在小兒臨床麻醉上的廣泛應用及提高小兒麻醉的安全性提供依據。 方法　2011年1月－3月擬行腹部外科手術的患兒60例，男39例，女21例；年齡1～4歲，美國麻醉醫師協會分級Ⅰ～Ⅱ級，隨機分為兩組，每組各30例。S組：七氟醚、瑞芬太尼和維庫溴銨維持麻醉；P組：丙泊酚、瑞芬太尼和維庫溴銨維持麻醉。采用BIS監測麻醉深度，將BIS控制在50 ± 5，記錄麻醉誘導前到手術探查期間不同時點的血流動力學參數及蘇醒、拔管時間。 結果　手術過程中P組血壓及心率明顯低于麻醉前水平（P＜0.05）。S組蘇醒迅速、完全，蘇醒時間與P組比較差異有統計學意義（P＜0.05）。S組的血流動力學穩定性優于P組，蘇醒時間、拔管時間相對較短。麻醉誘導前兩組的BIS值均為97 ± 1，意識消失時的BIS值為71 ± 2。BIS值為50 ± 5時，結果顯示手術過程中（T4、T5、T6、T7）兩組的心率、血壓都很平穩。 結論　BIS作為小兒麻醉鎮靜深度的監測指標有臨床意義。