简介：AbstractThe Draf Ⅲ procedure involves the creation of a common frontal sinus cavity. The most common indication for the Draf Ⅲ procedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative interventions such as bilateral Draf Ⅱa procedures. Primary Draf Ⅲ may be indicated in patients with a high risk of failures such as those with severe polyposis and those with a frontal sinus opening less than 4 mm on computed tomography imaging. Other indications for the Draf Ⅲ include access for tumor removal and repair of traumatic fractures of the frontal sinus. The "inside-out" Draf Ⅲ procedure is the standard approach when the frontal recess anterior-posterior diameter is wide enough for instrument access, usually larger than 4-5 mm. The "outside-in" Draf Ⅲ procedure can be done when the frontal recess is too narrow to safely accommodate instruments. Regular follow-up with debridement should be done to prevent neo-ostium stenosis.

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简介：AbstractPurpose:To analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture.Methods:A retrospective analysis of patients with Klammer III posterior Pilon fractures were conducted in our department from January 2018 to December 2019. Before the surgery, the patients were fully relieved of swelling and pain, and a comprehensive examination was carried out. The posteromedial approach exposed the posterior and medial fracture block of the distal tibia. According to the fracture of external malleolus, it is determined whether to combine a lateral incision and protect tendons and vascular nerves by a retractor, and then perform a fracture reduction and internal fixation. Postoperatively, the patients were treated with analgesia, detumescence, anticoagulation and rehabilitation exercise. The American orthopaedic foot and ankle society (AOFAS) score and visual analogue score were recorded at regular follow-up after surgery. A t-test was used for the comparison of the preoperative and final AOFAS score.Results:There were 7 male and 13 female (n = 20) included in the study, aged 22 to 88 years (average age 54.2 years). The injury mechanisms were falling from a height (n = 7), traffic accident (n = 6), walking injury (n = 2) and heavy injury (n = 5). The postoperative follow-up duration was 12—24 months (mean 16.95 months). The AOFAS score of the 20 patients before and after surgery were compared. The preoperative AOFAS score was 38.90 ± 3.91, and the final AOFAS score was 80.55 ± 4.20, (p < 0.001). The mean final visual analogue scores at rest, active and weight-bearing walking were 0.30, 0.85 and 1.70, respectively. One patient reported poor postoperative wound healing and required a return to hospital for debridement and anti-infection treatment.Conclusion:In the treatment of Klammer III posterior Pilon fractures, the modified posteromedial approach can fully expose the fracture block and the collapsed articular surface of the medial malleolus, achieve good reduction and internal fixation with limited injury of the tendon and vascular nerves, and have a better prognosis.

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简介：【摘要】：方法 对于Simon III级男性乳房发育患者采取垂直单蒂法切除乳房及多余皮肤，同时对乳头乳晕复合体重新定位，观察疗效。目的 探讨联合治疗的方式对腺体和皮肤增生达到Simon III级的男性乳房发育患者的疗效。结果 我院乳腺外科自2019年1至2021年6月使用此方法共治疗Simon III级男性乳房发育患者23例，均取得良好治疗效果，患者对术后外观表示满意。结论 对于Simon III级男性乳房发育患者使用垂直单蒂法手术治疗，效果确切，患者痛苦小，恢复快，美容效果明显，值得推广。

简介：【摘要】目的：探究上颌颌垫式双曲舌簧矫治器对替牙前期III类错合的临床矫治效果。方法：以我院2020年1月～2021年12月收治的64例替牙前期III类错合患者为研究对象，随机均分为A、B两组，A组接受下颌连冠式斜面导板矫正，B组应用上颌颌垫式双曲舌簧矫治器矫正，对比两组临床矫治效果。结果：B组患者乳牙期、替牙期矫正器折断数量和折断率均显著低于A组，矫正后2周、4周、10周、14周B组牙齿矫正效果优良率均显著高于A组患者（P＜0.05）。结论：替牙前期III类错合患者应用上颌颌垫式双曲舌簧矫治器进行矫正，可大幅降低矫正器折断率，矫正效率极高，效果显著，值得应用。

简介：摘要目的分析不同手术方式治疗Bismuth-Corlette III、IV型肝门部胆管癌(HCCA)的疗效及预后，探讨其合理的治疗方式。方法回顾性分析2010年1月至2016年12月安徽医科大学第一附属医院手术治疗的86例Bismuth-Corlette III、IV型HCCA患者的临床资料，其中男性45例，女性41例，年龄(59.5±10.5)岁。按照手术方式不同分为扩大肝切除组(57例)和围肝门切除组(29例)，比较两组患者的围手术期指标和生存率。通过住院复查、定期门诊复查或电话随访。单因素及多因素Cox回归分析影响预后的因素。结果扩大肝切除组的手术时间和术中失血量均大于围肝门切除组[320(270，380)min比270(210，300)min，P<0.001；300(200，400)ml比100(100，150)ml，P<0.001]。扩大肝切除组Clavien-Dindo III级及以上并发症发生率和国际肝脏外科研究组C级肝功能衰竭发生率均高于围肝门切除组[36.4%(20/57)比13.8%(4/29)，P＝0.037；13.8%(7/57)比0(0/29)，P＝0.047]，差异均具有统计学意义。扩大肝切除组手术后1、3、5年累积生存率分别为89.5%、38.6%、19.3%，围肝门切除组分别为86.2%、20.7%、10.3%，两组比较生存差异具有统计学意义(P＝0.048)。多因素分析显示围肝门切除(HR＝1.958，95%CI：1.174~3.268，P＝0.010)、非R0切除(HR＝6.040，95%CI：2.915~12.513，P<0.001)、TNM分期III/IV期(HR＝2.144，95%CI：1.257~3.654，P＝0.005)是影响HCCA患者手术后总体生存的独立危险因素。结论Bismuth-Corlette III、IV型HCCA行扩大肝切除术后总体生存率高于行围肝门切除者，但其手术并发症和肝功能衰竭的发生率也增高。

简介：AbstractBackgrounds:GALLIUM is a global phase III study that demonstrated significant improvements in progression-free survival (PFS) for obinutuzumab plus chemotherapy (G-chemo) vs. rituximab plus chemotherapy (R-chemo) in previously untreated patients with follicular lymphoma (FL). This study aimed to report the results of a subgroup of patients in China.Methods:Patients were randomized to G-chemo or R-chemo. Responders received maintenance therapy for 2 years or until disease progression. The primary endpoint was investigator (INV)-assessed PFS. Secondary endpoints included the overall response rate (ORR) and complete response rate (CRR) at the end of induction chemotherapy, overall survival (OS), and safety.Results:Overall, 58 patients with FL were randomized to the G-chemo (n = 25) and R-chemo arms (n = 33). The INV-assessed PFS rate at 3 years was 81.8% in the G-chemo arm, vs. 70.2% in the R-chemo arm (hazard ratio 0.35; 95% confidence interval: 0.09-1.34; P = 0.1120). The INV-assessed CRRs (without positron emission tomography [PET]) in these arms were 24.0% and 21.2%, respectively, whereas the ORRs were 80.0% and 90.9%, respectively. INV-assessed CRR-PET was 52.6% in the G-chemo, vs. 60.9% in the R-chemo. Median OS was not reached in either arm. Grade 3 to 5 adverse events were more frequent in the R-chemo arm (97.0% vs. 88.0%).Conclusions:The results of this subgroup analysis were consistent with those of the global population, and they suggest that G-chemo has a positive benefit-risk profile in patients from China with FL.Trial registration:ClinicalTrials.gov, No. NCT01332968.

简介：摘要： 本文基于文献研究和大学英语课程思政示范课建设的实践探索，从顶层设计、教材、教师、教学设计和教研等方面探讨大学英语课程思政的教学创新成效。着重论述了大学英语课程思政教学模式的构建、课程思政元素的设计和实施过程。在“互联网+”背景下，通过线上学习与线下课堂相结合的混合式教学模式、挖掘大学英语课程中蕴含的思政元素，并将其融入语言知识中，开展大学英语课程思政教学，将知识传授、能力培养和价值塑造融为一体, 以实现“立德树人”的根本目标。

简介：【摘要】目的：探讨黄芪鳖甲汤对气虚血瘀型Ⅲ型前列腺炎治疗的临床效果。方法：取我院2020年3月-2021年2月时段内诊疗的54例气虚血瘀型Ⅲ型前列腺炎患者，西医组为常规治疗，中医组为常规治疗配合黄芪鳖甲汤，比较总有效率、症状改善时间、不良反应发生率。结果：和西医组比较，中医组总有效率较高（96.30%）、症状改善时间较短、不良反应发生率较低（3.70%）、数据比较有意义（P＜0.05）。结论：针对气虚血瘀型Ⅲ型前列腺炎患者，常规治疗的基础上配合黄芪鳖甲汤治疗，既可提高治疗效果，还可缩短症状改善时间，安全可靠，有推广价值。

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简介：摘要：幼儿期家庭教育是幼儿社会化教育的根，根深才能叶茂，本文从为什么、是什么、怎么做三个方面进行了“家庭教育的关键期——幼儿期”的论述。幼儿期家庭教育重在游戏和日常生活教育。人生百年立于幼学，在幼儿期开展好家庭教育对幼儿终身学习和发展有着至关重要的影响，通过游戏的方式在家庭的一日生活之中，让幼儿德智体美劳全面发展，为幼儿的终身幸福奠基。

简介：AbstractBackground:This study was to explore the clinical efficacy and safety of darbepoetin alfa injection replacing epoetin alfa injection (recombinant human erythropoietin injection, rHuEPO) for the treatment of anemia associated with chronic kidney failure in Chinese patients undergoing hemodialysis.Method:This study was a multicenter, randomized, open-label, intergroup parallel control phase III noninferiority trial from April 19, 2013 to September 9, 2014 at 25 sites. In this study, the members of the darbepoetin alfa group underwent intravenous administration once per week or once every two weeks. The members of the control drug epoetin alfa group underwent intravenous administration two or three times per week. All subjects underwent epoetin alfa administration during the 8-week baseline period. After that, subjects were randomly assigned to the darbepoetin alfa group or epoetin alfa group. The noninferiority in the changes of the average Hb concentrations from the baseline to the end of the evaluation period (noninferiority threshold: -1.0 g/dl) was tested between the two treatments. The time-dependent hemoglobin (Hb) concentration and the maintenance rate of the target Hb concentration (the proportion of subjects with Hb concentrations between 10.0 and 12.0 g/dl) were also evaluated. Iron metabolism, including changes in the serum iron, total iron-binding capacity, ferritin, transferrin saturation, and comparisons of the dose adjustments between the two groups during the treatment period were analyzed further. Adverse events (AEs) were also observed and compared, and the safety was analyzed between the two treatment groups. The conversion rate switching from epoetin alfa to darbepoetin alfa was also discussed. SAS® software version 9.2 was used to perform all statistical analyses. Descriptive statistics were used for all efficacy, safety, and demographic variable analyses, including for the primary efficacy indicators.Results:Four hundred and sixty-six patients were enrolled in this study, and ultimately 384 cases were analyzed for safety, including 267 cases in the darbepoetin alfa group and 117 cases in the epoetin alfa group. There were 211 cases in the per-protocol set, including 152 cases in the darbepoetin alfa group and 59 cases in the epoetin alfa group. The changes in the average Hb concentrations from the baseline to the end of the evaluation period were -0.07 and -0.15 g/dl in the darbepoetin alfa group and epoetin alfa group respectively. The difference between the two groups was 0.08 g/dl (95% confidence interval [CI]: -0.22 to 0.39), and the lower limit of the 95% CI was -0.22 > -1.0 g/dl. The average Hb concentrations of the two groups were 10.88-11.43 g/dl (darbepoetin alfa) and 10.91-11.38 g/dl (epoetin alfa) during the study period of Weeks 0-28, with the maintenance rates of the target Hb concentration ranging within 71%-87% and 78%-95% in the darbepoetin alfa group and epoetin alfa group respectively. During the period of comparison between the two groups, the incidence of AEs in the darbepoetin alfa group was 61.42%, while in the epoetin alfa group it was 56.41%. All of the adverse events and reactions in the study were those commonly associated with hemodialysis.Conclusion:The overall efficacy and safety of darbepoetin alfa for the treatment of Chinese renal anemia patients undergoing hemodialysis are consistent with those of epoetin alfa.

简介：[摘要]目的：探讨重组III型人源化胶原蛋白修复液在光子嫩肤治疗痤疮后期色素沉着后创面修复的应用效果。方法：选择2022年5月~2022年7月我院接诊的痤疮后期色素沉着的患者40例，按随机数表法分为观察组和对照组，每组20例，两组均接受光子嫩肤治疗，在此基础上，对照组采用胶原蛋白敷料治疗，观察组使用重组III型人源化胶原蛋白修复液治疗，对比两组结痂时间、痂皮脱落时间、愈合时间、不良反应。结果：（1）术后，观察组结痂时间（1.8±0.3）d、痂皮脱落时间（3.1±0.4）d、愈合时间（5.2±0.7）d，均明显低于对照组，P＜0.05；（2）两组均未发生严重不良反应，P＞0.05。结论：重组III型人源化胶原蛋白修复液对光子嫩肤治疗痤疮后期色素沉着后创面修复效果较好，可有效改善患者皮肤状态，安全可靠。

简介：摘要：一期与二期闭式循环水场设计方案，二期闭式循环水场设计容量减少很多，从工艺运行角度和管道布置情况，结合一期与二期闭式循环水场的不同运行情况进行了分析，对一期与二期循环水联通方案进行了研究。

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简介：摘要目的探讨妊娠期、围生期带状疱疹的临床特征、治疗及预后。方法收集2011年1月至2020年12月郑州大学第一附属医院住院治疗的妊娠期、围生期带状疱疹患者的临床资料，回顾分析临床特征、治疗及预后情况。结果纳入25例，其中妊娠期22例（孕10 ~ 38周，孕早期1例、孕中期13例、孕晚期8例），产后1周内3例；年龄22 ~ 37岁，病程2 ~ 9 d。临床表现：皮疹位于头面部8例，胸背部5例，腰腹部7例，上肢1例，下肢3例，会阴1例，3例为播散性带状疱疹。皮疹形态均为红斑、丘疱疹、水疱，其中4例合并血疱，3例合并大疱，6例合并糜烂、渗出；5例发热，7例轻度、6例中度、11例重度疼痛。治疗：16例妊娠期、3例产后患者进行抗病毒治疗（口服或静脉滴注阿昔洛韦、单磷酸阿糖腺苷、膦甲酸钠氯化钠注射液），24例应用营养神经药物，1例妊娠期患者、3例产妇进行镇痛治疗，其他治疗包括抗感染、湿敷、红光照射等。预后：1例妊娠期患者早产，其余妊娠期患者均足月生产，新生儿无异常。3例妊娠期患者出现后遗症，1例为疼痛，2例为瘙痒。结论本文25例妊娠期、围生期带状疱疹的治疗未观察到对胎儿、新生儿有明显影响。

简介：摘要：在妊娠期内，孕妇的营养均衡对于为满足胎儿的生长发展需要具有直接影响，且随着孕期内胎盘发育、乳房增大等因素的影响，所需的营养较正常情况下更多。在此背景下，在妊娠期内，若孕妇出现营养平衡失调，不仅会对母体健康与婴儿的正常生长发育，甚至还会诱使围生期并发症的产生。因此，为了提前预防妊娠并发症的出现，必须对孕期内孕妇营养平衡做进一步的规划，为孕妇提供足够、合理的营养，保证胎儿的正常生长发育。