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简介：AbstractThroughout the past 2020, the pandemic COVID-19 has caused a big global shock, meanwhile it brought a great impact on the public health network. Trauma emergency system faced a giant challenge and how to manage trauma under the pandemic of COVID-19 was widely discussed. However, the trauma treatment of special population (geriatric patients and patients taking anticoagulant drugs) has received inadequate attention. Due to the high mortality following severe traumatic hemorrhage, hemostasis and trauma-induced coagulopathy are the important concerns in trauma treatment. Sepsis is another topic should not be ignored when we talking about trauma. COVID-19 itself is a special kind of sepsis, and it may even be called as serious systemic infection syndrome. Sepsis has been become a serious problem waiting to be solved urgently no matter in the fields of trauma, or in intensive care and infection, etc. This article reviewed the research progress in areas including trauma emergency care, trauma bleeding and coagulation, geriatric trauma and basic research of trauma within 2020.

简介：摘要目的探究剪切波弹性成像(SWE)联合S-Detect智能辅助诊断技术在甲状腺微小乳头状癌淋巴结转移的诊断价值。方法选取2017年1月至2020年12月山西省中医院超声科诊断并进行治疗的120例甲状腺微小乳头状癌患者，男54例，女66例，年龄(46.87±2.90)岁，年龄范围为34～56岁。按照手术病理情况淋巴结是否转移分为转移组(n＝44)与未转移组(n＝76)。比较两组患者的一般资料、SWE诊断情况。采用Kappa检验对SWE诊断与病理结果的一致性进行分析、对S-Detect智能辅助诊断与病理结果的一致性进行分析、联合诊断效能分析、采用受试者工作特征曲线(ROC)对SWE诊断与S-Detect智能辅助诊断的曲线下面积进行比较。结果转移组患者的年龄、肿瘤形态不规则率、肿瘤边界不清晰率、存在钙化率、存在血流异常分布率显著高于未转移组，差异有统计学意义(P<0.05)。转移组患者的弹性模量值最大值[(66.10±11.77)kPa]、弹性模量值平均值[(46.76±11.17)kPa]、弹性模量值最小值[(14.55±5.77)kPa]均显著高于未转移组[(50.46±10.98)kPa、(32.98±11.01)kPa、(10.26±5.74)kPa]，差异有统计学意义(P<0.05)。SWE诊断与病理结果的一致性较高，差异有统计学意义(Kappa＝2.381，P＝0.123)。S-Detect智能辅助诊断与病理结果的一致性较高，差异有统计学意义(Kappa＝2.777，P＝0.096)。联合诊断的准确率、特异度、阳性预测值均显著高于SWE诊断、S-Detect智能辅助诊断，差异有统计学意义(P<0.001)。联合诊断的ROC曲线下面积(0.892)高于SWE诊断(0.775)与S-Detect智能辅助诊断(0.603)，差异有统计学意义(P<0.05)。结论SWE诊断联合S-Detect智能辅助诊断技术对于甲状腺微小乳头状癌淋巴结转移情况具有显著的鉴别意义，建议临床推广。

简介：AbstractObjectives:Describe the h index as a bibliometric that can be utilized to objectively evaluate scholarly impact. Identify which otolaryngology subspecialties are the most scholarly. Describe if NIH funding to one’s choice of medical school, residency, or fellowship has any impact on one’s scholarly output. Determine other factors predictive of an academic otolaryngologist’s productivity.Study design:Analysis of bibliometric data of academic otolaryngologists.Methods:Active grants from the National Institutes of Health (NIH) to otolaryngology departments were ascertained via the NIH Research Portfolio Online Reporting Tools Expenditures and Reports database. Faculty listings from these departments were gleaned from departmental websites. H index was calculated using the Scopus database.Results:Forty-seven otolaryngology programs were actively receiving NIH funding. There were 838 faculty members from those departments who had a mean h index of 9.61. Otology (h index 12.50) and head and neck (h index 11.96) were significantly (P < 0.0001) more scholarly than the rest of subspecialists. H index was significantly correlative (P < 0.0001) with degree of NIH funding at a given institution. H index was not significantly higher for those that attended medical school (P < 0.18), residency (P < 0.16), and fellowship (P < 0.16) at institutions with NIH funding to otolaryngology departments.Conclusions:H index is a bibliometric that can be used to assess scholarly impact. Otology and head and neck are the most scholarly subspecialists within otolaryngology. NIH funding to an individual’s medical school, residency, or fellowship of origin is not correlative with one’s scholarly impact, but current institutional affiliation and choice of subspecialty are.

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简介：AbstractObjective:Scoping review of published literature to establish clinical characteristics and audiologic outcomes in patients diagnosed with Susac’s Syndrome(SS) who have undergone cochlear implantation (CI).Data sources:All published studies of CI in SS and contribution of two of our own patients who have not been reported previously.Methods:A comprehensive search of MEDLINE (via PubMed) was carried out in March 2020 using the following keywords and related entry terms: Susac’s Syndrome, Cochlear Implantation. Results: Our search identified a total of five case reports of CI in SS. With the addition of our two patients reported here, we analyzed characteristics and outcomes in seven patients. Mean age at implantation was 30 years old (range 19-46), with six women and one man implanted. Mean time from onset of hearing loss to implantation was 17 months (range three months to four years). Best reported postoperative speech understanding was reported via different metrics, with six of seven patients achieving open set speech scores of 90% or better, and one subject performing at 68%. Vestibular symptoms were present preoperatively in four of seven patients (57%), with vestibular testing reported in two patients, and showing vestibulopathy in one patient. No complications were reported following cochlear implantation.Conclusion:Cochlear implantation is a viable option for hearing rehabilitation in patients with SS, with levels of attainment of open set speech comparable to other populations of CI candidates.

简介：摘要目的探讨完全后腹腔镜经膀胱外途径规范化直视下(P.R.E.S.S.)膀胱袖套状切除术的操作要点和疗效。方法回顾性分析2017年8月至2020年12月收治的95例上尿路尿路上皮癌(UTUC)患者的病例资料，分别为海军军医大学长征医院30例，北京大学第一医院21例，烟台毓璜顶医院20例，大连医科大学附属第二医院21例，东部战区总医院3例。男57例，女38例。平均年龄(67.7±10.0)岁。中位肿瘤最大径3.0 cm。95例均行单次体位全程后腹腔镜肾输尿管全长切除联合P.R.E.S.S.技术膀胱袖套状切除术，根据术者手术习惯和经验分别采用四孔法(36例)和五孔法(59例)套管布局完成手术。四孔法组和五孔法组的年龄[(66.3±11.2)岁与(68.6±9.1)岁]、性别(男/女：25/11例与32/27例)、体质指数[(25.0±3.0)kg/m2与(24.8±3.4)kg/m2]、肿瘤最大径[2.8(1.6，3.5)cm与3.0(2.0，4.0)cm]、肿瘤侧别(左/右：19/17例与34/25例)、临床分期(T1～2/T3～4/Tis期：25/10/4例与49/10/0例)、多灶性肿瘤(3例与2例)比较差异均无统计学意义(P>0.05)；术侧合并肾积水(13例与39例，P＝0.004)、肿瘤位置(肾盂肾盏及上段输尿管/中段输尿管/下段输尿管：23/9/4例与35/4/20例，P＝0.005)的差异均有统计学意义。术中行P.R.E.S.S.技术膀胱袖套状切除时，以脐动脉索为解剖标志，扩大输尿管周围的盆底侧方腹膜外间隙，切开膀胱壁后形成气膀胱效应，进行充分的膀胱袖套状切除和确切的膀胱袖口关闭。记录围手术期临床指标及随访结果。比较四孔法组和五孔法组的相关临床指标，分析套管布局方式对手术操作的影响。结果本研究95例中，91例(95.8%)采用P.R.E.S.S.技术完成膀胱袖套状切除；1例(1.1%)因出血中转开放手术；3例(3.1%)因局部空间显露困难，仅以Hem-o-lok夹闭输尿管远端完成手术。手术时间中位值180(125，230)min。术中估计出血量中位值100(50，100)ml。总体并发症发生率10.5%(10/95)，其中术中并发症2例(2.1%)均为出血，1例术中输血400 ml，1例中转开放手术，未输血；术后并发症8例(8.4%)，其中Clavien-DindoⅡ级7例[继发出血3例，药物过敏、急性肾功能减退(血肌酐490 μmol/L)、肺部感染及淋巴漏各1例]，Ⅲa级1例(肠梗阻，局麻下置入肠梗阻导管)，患者经对症治疗后均顺利出院。四孔法组和五孔法组在手术中转率[8.3%(3/36)与1.7%(1/59)]、术中估计出血量(100 ml与60 ml)、术中淋巴结清扫率[25.0%(9/36)与20.3%(12/59)]、P.R.E.S.S.技术膀胱袖套状切除成功率[91.7%(33/36)与98.3%(58/59)]、并发症发生率[13.8%(5/36)与8.5%(5/59)]、肿瘤病理分期(pT1～2/pT3～4/pTis期：22/11/3例与37/19/3例)以及复发转移比例[8.3%(3/36)与3.4%(2/59)]方面差异均无统计学意义(P>0.05)；在手术时间(190 min与170 min，P＝0.011)和术后住院时间(5 d与6 d，P＝0.005)方面差异均有统计学意义。结论P．R.E.S.S.技术通过建立扩大的盆底侧方腹膜外间隙和气膀胱效应，以脐动脉索为解剖标志，可直视下确切地行膀胱袖套状切除术，用于单次体位完全后腹腔镜肾输尿管全长切除术安全、可行。五孔法布局较四孔法布局更适用于下段输尿管肿瘤患者，但可能延长术后住院时间。

简介：摘要强迫症(obsessive-compulsive disorder，OCD)以强迫思维和强迫行为为主要临床特征，被世界卫生组织列为十大致残性疾病之一。错误相关负波是在错误情况下的神经认知警报信号，该脑电成分的个体差异反映了错误敏感性的不同和内部感知威胁的差异性。越来越多研究发现，强迫症患者的错误相关负波波幅出现明显增强，因而过度活跃的错误监测活动是强迫症的核心功能障碍之一，与过度担忧与怀疑、反复检查等核心症状密切相关。此外，错误相关负波增强有望作为强迫症诊断或预测的生物标记物，同时也是该疾病潜在的干预目标。因此，进一步厘清错误相关负波增强与强迫症之间的关系对强迫症的有效诊疗具有重要作用。文章就强迫症患者错误相关负波的研究成果进行阐述，内容包括强迫症患者错误相关负波的实验范式、来源脑区、特征表现、影响因素以及临床价值与应用，为今后临床实践和科学研究提供参考。

简介：AbstractBackground:Meniere’s disease (MD) is an idiopathic disorder of the inner ear, which manifests as cochleo-vestibular dysfunction. Hearing loss will progress to a profound levelin a subset of patients with MD, and vestibular interventions can independently cause loss of hearing. The aim of this study was to systematically review the published literature describing the safety and efficacy of CI in patients with MD.Materials and methods:A systematic literature review was conducted in accordance PRISMA guidelines to identify articles that assessed at least one functional outcome in patients with MD who underwent CI. Demographic information, disease history, MD symptoms, outcomes measures, and complications related to CI were extracted from included studies.Results:In total, 17 studies were included, and 182 patients with MD underwent CI. The weighted-mean age was 61.9 years (range 27-85). Study objective and methodology varied, and there was significant heterogeneity in CI outcome measures reported. In total, 179 (98.3%) of 182 patients reported objective improvements in at least one hearing metric after CI. A total of 69 patients (37.9%) reported vertigo or severe dizziness prior to CI, compared to 22 patients (15.4%) postoperatively. Two studies reported significant reductions in postoperative Tinnitus Handicap Inventory score (THI). Quality of life assessments varied between studies. Complications rates were low with only nine patients (4.9%) reporting a serious CI-related complication.Conclusions:This systematic review evaluated 17 studies describing the safety and efficacy of CI in patients with MD and encountered many challenges due to small sample sizes, and heterogeneity in study design and outcomes measured. Despite these limitations, this study of 182 patients is to the best of our knowledge the largest systematic review evaluating the safety and efficacy of CI in MD. The results of this study support the need for a standardized approach to evaluating outcomes of CI in patients with MD in future studies.

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简介：AbstractTraumatic brain injury (TBI), a growing public health problem, is a leading cause of death and disability worldwide, although its prevention measures and clinical cares are substantially improved. Increasing evidence shows that TBI may increase the risk of mood disorders and neurodegenerative diseases, including Alzheimer's disease (AD). However, the complex relationship between TBI and AD remains elusive. Metabolic dysfunction has been the common pathology in both TBI and AD. On the one hand, TBI perturbs the glucose metabolism of the brain, and causes energy crisis and subsequent hyperglycolysis. On the other hand, glucose deprivation promotes amyloidogenesis via β-site APP cleaving enzyme-1 dependent mechanism, and triggers tau pathology and synaptic function. Recent findings suggest that TBI might facilitate Alzheimer's pathogenesis by altering metabolism, which provides clues to metabolic link between TBI and AD. In this review, we will explore how TBI-induced metabolic changes contribute to the development of AD.

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简介：摘要：目的：实验将探析采用6S管理在护理管理中的价值。方法：将2019年1月~2020年1月本院接收的100例患者纳入本次研究，按照入院顺序将这100例患者分为两组，将2019年1月~2019年6月入院的患者为作为对照组，将2019年7月~2020年1月入院的患者为作为观察组，两组患者人数均为50例。对照组患者接受常规管理，观察组患者则接受6S管理，并且对比两组患者护理质量。结果：观察组的基础护理、药品管理、服务态度、护理安全评分均明显高于对照组，差异有统计学意义（P

简介：摘要：目的：探讨中医脉象在象数、物波和质量中的应用性。方法：通过资料整理分析。结果：认识到脉象原理可应用到对象数物波和质量的研究中。

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简介：【摘要】目的: 分析体外冲击波碎石术（ESWL）治疗泌尿外科患者的应用效果。方法：随机抽取院内2019年1月与2020年2月内78名泌尿结石患者作为观察对象，按照双色球分组原则将78名患者平均分为两组，一组设为对照组，实行常规排石颗粒治疗，一组设为观察组，实行体外冲击波碎石术治疗，对比两组患者治疗效果。结果：两组患者结石清除率、并发症发生率比较差异明显，具有统计学意义（P

简介：摘要：目的：观察针刺结合冲击波治疗肩周炎的临床疗效。方法：将发生肩周炎的患者60例随机分为2组。观察组30例采用针刺结合冲击波方法，对照组采用针刺方法。结果：针刺结合冲击波治疗肩周炎有显著疗效。

简介：摘要：目的：观察针刺结合冲击波治疗肩周炎的临床疗效。方法：将发生肩周炎的患者60例随机分为2组。观察组30例采用针刺结合冲击波方法，对照组采用针刺方法。结果：针刺结合冲击波治疗肩周炎有显著疗效。

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简介：AbstractSevere acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis (EPN). Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported. However, extension of retroperitoneal necrosis to the scrotum causing Fournier’s gangrene is uncommon. We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation. He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay. During the 3rd month of hospital stay, the patient started developing pain and ulceration over the scrotum. He was diagnosed with Fournier’s gangrene based on clinical examination and was planned for debridement. During surgery, the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination. The case highlights a rare but potentially fatal complication of Fournier’s gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement. Concomitant management of two potentially fatal conditions poses numerous challenges.