简介：摘要目的探讨Snyder希望理论在肝硬化腹水患者健康教育中的应用效果。方法采用方便抽样法，选取2018年1月—2019年12月肝硬化腹水患者115例为研究对象，采用随机数字表法分为观察组56例和对照组59例。对照组在住院期间实施常规健康教育，观察组在此基础上，在患者住院期间实施基于Snyder希望理论的护理，患者出院后给予随访并继续实施基于Snyder希望理论的延续性护理，干预共8周。干预前后应用Herth希望量表（HHI）、心理弹性量表（CD-RISC）、健康调查简表（SF-36）对干预效果进行评价。结果干预后，观察组希望量表总分[（27.02±3.40）分]高于对照组[（25.17±4.15）分]，差异有统计学意义（t=2.607，P=0.010）。观察组心理弹性量表总分[（62.95±11.24）分]高于对照组[（53.46±14.02）分]，差异有统计学意义（t=3.992，P<0.001）。观察组SF-36量表情感职能[（72.92±7.61）分]、心理健康[（61.03±12.40）分]评分高于对照组[（68.20±9.14）、（53.08±11.29）分]，差异有统计学意义（t=3.001，P=0.003；t=3.598，P<0.001）。结论基于Snyder希望理论对肝硬化腹水患者开展健康教育，有助于提高患者希望水平和心理弹性，帮助患者重拾治疗信心，提升生活质量，具有较高临床应用价值。

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简介：摘要目的探究Snyder希望理论的护理干预对急性高血压性脑出血患者心理应激状态评分、生命质量及神经功能的影响。方法选取西安交通大学第二附属医院2017年6月至2018年12月收治的100例急性高血压性脑出血患者作为研究对象。按随机数字表法，将患者分为观察组和对照组各50例。对照组患者给予常规康复护理模式，观察组患者在对照组的基础上给予Snyder希望理论的护理干预。比较2组患者的抢救时间、恢复时间和并发症发生率，采用焦虑自评量表（SAS）、抑郁自评量表（SDS）、SF-36生命质量量表和美国国立卫生研究院卒中量表（NIHSS）、格拉斯哥昏迷量表（GCS）分别评价2组患者焦虑、抑郁程度、生命质量和神经功能并比较。结果观察组患者抢救时间为（58.13 ± 10.36）min，恢复时间为（12.7 ± 5.3）d，对照组分别为（85.71 ± 8.30）min、（21.1 ± 3.3）d, 2组比较差异有统计学意义（t值为14.691、10.646，均P<0.05）。2组患者干预前SAS、SDS、NIHSS、GCS、SF-36各项评分比较差异无统计学意义（P>0.05），观察组患者干预后SAS、NIHSS、GCS评分分别为（40.56 ± 1.72）、（11.23 ± 2.85）、（13.12 ± 4.11）分，对照组患者分别为（46.56 ± 1.62）、（14.97 ± 4.55）、（11.13 ± 3.15）分，2组比较差异均有统计学意义（t值为17.956、4.926、3.212，P<0.01）。2组患者干预后SF-36各项评分比较差异有统计学意义（t值为7.124~13.014，P<0.01）。观察组患者并发症发生率为8.0%（4/50），明显低于对照组患者的24.0%（12/50），差异有统计学意义（χ2值为4.762，P<0.05）。结论Snyder希望理论的护理干预对急性高血压性脑出血患者焦虑抑郁情绪状态好转有明显作用，值得推广应用。

简介：摘要目的探究Snyder希望理论的护理干预对急性高血压性脑出血患者心理应激状态评分、生命质量及神经功能的影响。方法选取西安交通大学第二附属医院2017年6月至2018年12月收治的100例急性高血压性脑出血患者作为研究对象。按随机数字表法，将患者分为观察组和对照组各50例。对照组患者给予常规康复护理模式，观察组患者在对照组的基础上给予Snyder希望理论的护理干预。比较2组患者的抢救时间、恢复时间和并发症发生率，采用焦虑自评量表（SAS）、抑郁自评量表（SDS）、SF-36生命质量量表和美国国立卫生研究院卒中量表（NIHSS）、格拉斯哥昏迷量表（GCS）分别评价2组患者焦虑、抑郁程度、生命质量和神经功能并比较。结果观察组患者抢救时间为（58.13 ± 10.36）min，恢复时间为（12.7 ± 5.3）d，对照组分别为（85.71 ± 8.30）min、（21.1 ± 3.3）d, 2组比较差异有统计学意义（t值为14.691、10.646，均P<0.05）。2组患者干预前SAS、SDS、NIHSS、GCS、SF-36各项评分比较差异无统计学意义（P>0.05），观察组患者干预后SAS、NIHSS、GCS评分分别为（40.56 ± 1.72）、（11.23 ± 2.85）、（13.12 ± 4.11）分，对照组患者分别为（46.56 ± 1.62）、（14.97 ± 4.55）、（11.13 ± 3.15）分，2组比较差异均有统计学意义（t值为17.956、4.926、3.212，P<0.01）。2组患者干预后SF-36各项评分比较差异有统计学意义（t值为7.124~13.014，P<0.01）。观察组患者并发症发生率为8.0%（4/50），明显低于对照组患者的24.0%（12/50），差异有统计学意义（χ2值为4.762，P<0.05）。结论Snyder希望理论的护理干预对急性高血压性脑出血患者焦虑抑郁情绪状态好转有明显作用，值得推广应用。

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：摘要目的探讨基于Snyder希望理论的早期康复护理对脑卒中患者神经功能、日常生活活动能力及生活质量的影响。方法2018年1月至2019年1月选取上海市第一康复医院脑卒中患者80例，随机分为参照组与试验组，各40例。参照组患者给予常规护理，试验组患者在常规护理的基础上给予基于Snyder希望理论的早期康复护理，调查两组患者干预前后神经功能、日常生活能力及生活质量的改善情况。结果实施基于Snyder希望理论的早期康复护理后，试验组患者的NIHSS评分显著低于参照组，患者的Barthel指数评分显著高于参照组，患者的生活质量评分显著高于参照组，差异均有统计学意义(均P<0.05)。结论对脑卒中患者实施基于Snyder希望理论的早期康复护理，能有效改善患者的神经功能与日常生活能力，提升生活质量。

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：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

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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.

简介：AbstractPurpose:The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement (Fraser's type II). This study aims to evaluate and compare the functional outcomes among different Fraser's type II floating knee injuries after surgical management.Methods:Twenty-seven patients with Fraser's type II floating knee injuries (54 fractures) between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser's floating knee classification into three different groups as type IIA (ipsilateral femoral shaft and tibial intra-articular involvement, n = 11), type IIB (ipsilateral tibial shaft and femoral intra-articular involvement, n = 9) and type IIC (both femoral and tibial intra-articular involvement, n = 7). The differences among the groups were evaluated and compared. The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score (KOOS) which covers 5 subscales of pain, other symptoms, activities of daily living, sports and recreation, and quality of life. The result was also compared with standardized age-sex matched healthy population using paired samples t-test.Results:All the patients were male, and the injury mechanism was solely roadside accident. The mean age was 29.8 years and injury severity score 17.9 (comparable in all the three groups). Most injuries were observed on the right side (20 cases, 74.1%). Based on paired samples t-test, the KOOS score of patients with Fraser's type IIA was found to be better than that of type IIB and type IIC. Compared with the reference age-sex matched control group, patients with Fraser's type IIB and IIC fractures had significantly lower mean score in all KOOS subscales (all p < 0.01). However, Fraser's type IIA only revealed significant difference regarding the subscales of activities of daily living (p < 0.0001), sports and recreation (p < 0.0001), and quality of life (p < 0.0001).Conclusion:The results of this study show that patients with Fraser's type IIA fractures had a better functional outcome as compared to those with type IIB and IIC fractures. This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.

简介：【摘要】目的：探讨6S管理在护理管理中的作用。方法：选取该院2020年2月到2021年2月收治120患者进行研究,平均分为两组,其中对照组60例,给予常规护理,观察组60例,给予6S管理。比较两种护理模式下患者的护理满意度和不良护理事件的发生概率。结果：观察组的护理满意度优于对照组，不良护理事件的发生率低于对照组，2组相比，差异具有统计学意义（P

简介：AbstractBackground:The antioxidant effects of bilirubin in Parkinson’s disease (PD) have recently gained much attention from the research community. However, results from these studies have been conflicting. This meta-analysis is conducted to assess the relationship between the serum bilirubin concentration and the risk of PD.Methods:Two reviewers performed a systematic literature search across five databases (MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials). The case-control studies regarding bilirubin levels in PD patients published up to April 2020 were included. These studies were subjected to rigorous scrutiny and data extraction to determine the standard mean difference (SMD) and the 95% confidence interval (CI), which were analyzed using the Stata V.12.0 statistical software.Results:A total of eight studies which included 1463 PD cases and 1490 controls were incorporated into our meta-analysis. SMD analysis showed that there was a higher total bilirubin (TBIL) and direct bilirubin (DBIL) levels in PD patients compared with controls (for TBIL, SMD: 0.300, 95% CI: 0.050-0.549, P = 0.018; for DBIL, SMD: 0.395, 95% CI: 0.102-0.688, P = 0.008). However, no significant relationship was found between the serum indirect bilirubin and PD patients (SMD: -0.223, 95% CI: -0.952-0.505, P = 0.548). A subgroup analysis based on ethnicity indicated that the serum TBIL was higher in PD patients of Caucasian descent in contrast to matched healthy controls (SMD: 0.511, 95% CI: 0.324-0.698, P = 0.000, I2 = 58.0%).Conclusion:Higher serum bilirubin levels in PD patients suggest that bilirubin might play a role in the pathogenesis of PD and have the potential to be utilized as a biochemical marker for PD diagnosis and treatment.