Evidence for the Reliability and Validity of the Arabic Version of the Student Risk Screening Scale for Internalizing and Externalizing Behaviors (SRSS-IE)

School-based universal screening for behavioral/emotional risk is a necessary first step to providing services in an educational setting for students with emotional and behavioral disorders (EBDs). Psychometric properties are critical to making decisions about choosing a screening instrument. The purpose of the present study was to examine the psychometric properties of the student risk screening scale for internalizing and externalizing behaviors (SRSS-IE). Participants included 3145 students and their teachers. Item-level analyses of the current sample supported the retention of all items. The internal consistency of the SRSS items ranged from 0.83 to 0.85. Convergent validity between the SRSS-IE and a well-established screening tool, the strength and difficulties questionnaire (SDQ), was found for the total score (r = 0.70). Additionally, the results of this study demonstrate strong social validity, suggesting the SRSS-IE to be a useful and functional screening tool. We conclude that the SRSS-IE is a valid and reliable instrument for assessing the level of emotional and behavioral difficulties among elementary students.

MicroRNA-based targeting of the Rho/ROCK pathway in therapeutic strategies after spinal cord injury

Spinal cord injury(SCI)is one of the leading causes of disability and is a devastating condition that requires long-term care,reduces social productivity,and gives an immense emotional burden on patients and their fa milies.SCI frequently occurs due to traffic accidents,falls,slips,violence,sports,and medical accidents in today's society.The initial mechanical damage triggers a secondary injury cascade that induces more intractable damage(Silva et al.,2014).Secondary injury mechanisms have been postulated,including neuronal apoptosis,inflammation,oxidative stress,and excitotoxicity.

Internal fixator vs external fixator in the management of unstable pelvic ring injuries:A prospective comparative cohort study

BACKGROUND Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently.There is a debate on using either an anterior subcutaneous pelvis internal fixator(INFIX)or an anterior supra-acetabular external fixator(EXFIX)to manage an unstable anterior pelvic ring fracture.AIM To compare the functional and radiological outcomes and complications of INFIX vs EXFIX in managing unstable pelvic ring injuries.METHODS A prospective cohort study included 54 patients with unstable pelvic ring fractures.The patients were divided into two groups;the INFIX group,in which 30 cases were fixed by INFIX,and the EXFIX group,in which 24 patients were treated by EXFIX.The average age in the EXFIX group was 31.17 years(16-57 years),while in the INFIX group,it was 34.5 years(17-53 years).The study included 20(66.7%)males and 10(33.3%)females in the INFIX group and 10(41.7%)males and 14(58.3%)females in the EXFIX group.The radiological outcomes were evaluated using Matta and Tornetta's score,and the functional outcomes using the Majeed score.RESULTS The results revealed a statistically significant difference between both groups(P=0.013)regarding radiological outcomes,according to Matta and Tornetta's score in favor of the INFIX group.Sitting,standing,and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules.It was significantly better among the INFIX group than the EXFIX group in all three modules.At the final follow-up,both groups had no statistically significant difference according to the Majeed score;92.35 in the INFIX group and 90.99 in the EXFIX group(P=0.513).A lower surgical site infection rate was noticed in the INFIX group(P=0.007).CONCLUSION Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures.

Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery:Four case reports

BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA injury plays a crucial role in the prognosis of patients.Neurosurgeons have reported multiple techniques and management strategies;however,the literature on managing this complication from the anesthesiologist’s perspective is limited,especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.CASE SUMMARY We describe 4 cases of ICA injury during neurosurgery;there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma.After the onset of ICA injury,all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation.Three patients were transferred to the hybrid operating room,and one patient was transferred to the catheter operating room.Three patients underwent covered stent implantation,and one patient underwent embolization.All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation.After the neurosurgery,one patient was extubated and returned to the ward,and the other three were delayed tracheal extubation and returned to the intensive care unit.One patient died from serious neurological complications after 62 d in the hospital,but the other three showed good clinical outcomes.CONCLUSION ICA injury imposes a high risk of massive hemorrhage and subsequent infarction.Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons,anesthesiologists,and interventional neuroradiologists.Effective hemostatic methods,stable hemodynamics sufficient to ensure perfusion of vital organs,airway safety during transit,rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.

Clinical study on the surgical treatment of atypical Lisfranc joint complex injury

BACKGROUND Lisfranc injuries have not received much attention by orthopedic doctors in the past,and there is little related research on the diagnosis and treatment of these injuries.In recent years with the rise in foot and ankle surgery,doctors are now paying more attention to this type of injury.However,there is still a high rate of missed diagnosis due to insufficient attention causing treatment delays or inadequate treatments,which eventually result in greater sequelae;including long-term pain,arthritis,foot deformity etc.In particular,for cases with a mild Lisfranc joint complex injury,the incidence of sequelae is higher.AIM To select an active surgical treatment for an atypical Lisfranc joint complex injury and to evaluate the clinical efficacy of the surgical treatment.METHODS The clinical data of 18 patients,including 10 males and 8 females aged 20-64 years with Lisfranc injuries treated in our department from January 2017 to September 2019 were retrospectively analyzed.All patients were treated with an open reduction and internal fixation method using locking titanium mini-plates and hollow screws or Kirschner wires.X-ray images were taken and follow-up was performed monthly after the operation;the internal fixation was then removed 4-5 mo after the operation;and the American Orthopedic Foot and Ankle Society(AOFAS)score was used for evaluation on the last follow-up.RESULTS All patients were followed up for 6-12 mo.A good/excellent AOFAS score was observed in 88.9%of patients.CONCLUSION For atypical Lisfranc joint complex injuries,active open reduction and internal fixation can be performed to enable patients to obtain a good prognosis and satisfactory functional recovery.

Selection of suitable internal controls for gene expression normalization in rats with spinal cord injury

There is a lack of systematic research on the expression of internal control genes used for gene expression normalization in real-time reverse transcription polymerase chain reaction in spinal cord injury research.In this study,we used rat models of spinal cord hemisection to analyze the expression stability of 13 commonly applied reference genes:Actb,Ankrd27,CypA,Gapdh,Hprt1,Mrpl10,Pgk1,Rictor,Rn18s,Tbp,Ubc,Ubxn11,and Ywhaz.Our results show that the expression of Ankrd27,Ubc,and Tbp were stable after spinal cord injury,while Actb was the most unstable internal control gene.Ankrd27,Ubc,Tbp,and Actb were consequently used to investigate the effects of internal control genes with differing stabilities on the normalization of target gene expression.Target gene expression levels and changes over time were similar when Ankrd27,Ubc,and Tbp were used as internal controls but different when Actb was used as an internal control.We recommend that Ankrd27,Ubc,and Tbp are used as internal control genes for real-time reverse transcription polymerase chain reaction in spinal cord injury research.This study was approved by the Administration Committee of Experimental Animals,Jiangsu Province,China(approval No.20180304-008)on March 4,2018.

Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans

Background:Large numbers of post-deployment U.S.veterans are diagnosed with post-traumatic stress disorder(PTSD)and/or traumatic brain injury(TBI),leading to an urgent need for effective interventions to reduce symptoms and increase veterans’coping.PTSD includes anxiety,flashbacks,and emotional numbing.The symptoms increase health care costs for stress-related illnesses and can make veterans’civilian life difficult.Methods:We used a randomized wait-list controlled design with repeated measures of U.S.military veterans to address our specific aim to test the efficacy of a 6-week therapeutic horseback riding(THR)program for decreasing PTSD symptoms and increasing coping self-efficacy,emotion regulation,social and emotional loneliness.Fiftyseven participants were recruited and 29 enrolled in the randomized trial.They were randomly assigned to either the horse riding group(n=15)or a wait-list control group(n=14).The wait-list control group experienced a 6-week waiting period,while the horse riding group began THR.The wait-list control group began riding after 6 weeks of participating in the control group.Demographic and health history information was obtained from all the participants.PTSD symptoms were measured using the standardized PTSD Checklist-Military Version(PCL-M).The PCL-M as well as other instruments including,The Coping Self Efficacy Scale(CSES),The Difficulties in Emotion Regulation Scale(DERS)and The Social and Emotional Loneliness Scale for Adults-short version(SELSA)were used to access different aspects of individual well-being and the PTSD symptoms.Results:Participants had a statistically significant decrease in PTSD scores after 3 weeks of THR(P≤0.01)as well as a statistically and clinically significant decrease after 6 weeks of THR(P≤0.01).Logistic regression showed that participants had a 66.7%likelihood of having lower PTSD scores at 3 weeks and 87.5%likelihood at 6 weeks.Under the generalized linear model(GLM),our ANOVA findings for the coping self-efficacy,emotion regulation,and social and emotional loneliness did not reach statistical significance.The results for coping self-efficacy and emotion regulation trended in the predicted direction.Results for emotional loneliness were opposite the predicted direction.Logistic regression provided validation that outcome effects were caused by riding longer.Conclusion:The findings suggest that THR may be a clinically effective intervention for alleviating PTSD symptoms in military veterans.

Establishment and verification of a surgical prognostic model for cervical spinal cord injury without radiological abnormality

Some studies have suggested that early surgical treatment can effectively improve the prognosis of cervical spinal cord injury without radiological abnormality, but no research has focused on the development of a prognostic model of cervical spinal cord injury without radiological abnormality. This retrospective analysis included 43 patients with cervical spinal cord injury without radiological abnormality. Seven potential factors were assessed: age, sex, external force strength causing damage, duration of disease, degree of cervical spinal stenosis, Japanese Orthopaedic Association score, and physiological cervical curvature. A model was established using multiple binary logistic regression analysis. The model was evaluated by concordant profiling and the area under the receiver operating characteristic curve. Bootstrapping was used for internal validation. The prognostic model was as follows: logit(P) =-25.4545 + 21.2576 VALUE + 1.2160SCORE-3.4224 TIME, where VALUE refers to the Pavlov ratio indicating the extent of cervical spinal stenosis, SCORE refers to the Japanese Orthopaedic Association score(0–17) after the operation, and TIME refers to the disease duration(from injury to operation). The area under the receiver operating characteristic curve for all patients was 0.8941(95% confidence interval, 0.7930–0.9952). Three factors assessed in the predictive model were associated with patient outcomes: a great extent of cervical stenosis, a poor preoperative neurological status, and a long disease duration. These three factors could worsen patient outcomes. Moreover, the disease prognosis was considered good when logit(P) ≥-2.5105. Overall, the model displayed a certain clinical value. This study was approved by the Biomedical Ethics Committee of the Second Affiliated Hospital of Xi'an Jiaotong University, China(approval number: 2018063) on May 8, 2018.

“Emotional Dwarfism”Is a Failure to Thrive Emotionally-Whence the Childhood Roots of Hate,Psychosis,Violence,and Nucleargeddon-All Curable

VIOLENCE IS NOT ONLY WRONG,IT’S DISEASED-it’s always painful and too often fatal-as with Martin Luther King,no less.When emotions run high,doctors have difficulty making progress-calm,dispassionate review of the obvious evidence is vital,if you aim for less pain and fewer deaths.This paper is based on the self-evident precept that violated children unmistakeably predate violent adults.The remedy,highlighted here,is unusual in all psychiatry,in that it is backed by solid,irrefutable,objective,scientific evidence-from brainscans,no less-at least it is,for those willing to look.The paper has 6 parts:1.Introduction;2.Un-memorising Terror;3.Nutritious Emotions;4.Tyrannical Revenge;5.The Way to Cure Nucleargeddon Is Paved With Good Intentions;6.Conclusion.Parenting is a troubled skill,largely because mis-parenting perpetuates itself.As the poet Philip Larkin says of parents-“they fill you with the faults they had,and add some extra just for you”.Larkin moderates his criticism with“they may not mean to,but they do”.Sadly his“solution”-“don’t have any kids yourself”can extinguish the human race as reliably as ever revengeful Emotional Dwarfism will.

Semi-skeletonized Internal Mammary Grafts and Phrenic Nerve Injury:Cause-and-effect analysis

Summary： Phrenic nerve injury after cardiac surgery increases postoperative pulmonary complications. The purpose of this study was to analyze the causes and effects of phrenic nerve injury after cardiac surgery. Prospectively collected data on 2084 consecutive patients who underwent cardiac surgery from Jan. 1995 to Feb. 2002 were analyzed. Twenty-eight preoperative and operation related variables were subjected to logistic analysis with the end point being phrenic nerve injury. Then phrenic nerve injury and 6 perioperative morbidities were included in the analysis as variables to determine their independent predictive value for perioperative pulmonary morbidity. An identical approach was used to identify the independent risk factors for perioperative mortality. There were 53 phrenic nerve injuries （2.5 %）. There was no phrenic nerve injury in non-coronary surgery or coronary surgery using conduits other than the internal mammary artery. The independent risk factors for phrenic nerve injury were the use of internal mammary artery （Odds ratio （OR）=14.5） and the presence of chronic obstructive pulmonary disease （OR=2.9）. Phrenic nerve injury was an independent risk factor （OR=8.1） for perioperative pulmonary morbidities but not for perioperative mortality. Use of semi-skeletonized internal mammary artery harvesting technique and drawing attention to possible vascular or mechanical causes of phrenic nerve injury may reduce its occurrence. Unilateral phrenic nerve injury, although rarely life-threatening, is an independent risk factor for postoperative respiratory complications. When harvesting internal mammary arteries, it should be kept in mind avoiding stretching, compromising, or inadvertently dissecting phrenic nerve is as important as avoiding damage of internal mammary artery itself.

Higher Child-Reported Internalizing and Parent-Reported Externalizing Behaviors were Associated with Decreased Quality of Life among Pediatric Cardiac Patients Independent of Diagnosis:A Cross-Sectional Mixed-Methods Assessment

Background:Pediatric cardiology patients often experience decreased quality of life(QoL)and higher rates of mental illness,particularly with severe disease,but the relationship between them and comparisons across diagnostic groups are limited.This mixed-methods cross-sectional study assessed the association between QoL anxiety and behavior problems among children with structural heart disease,arrhythmia,or other cardiac diagnoses.Methods:Children(6–14 years,n=76,50%female)and their parents completed measures of QoL(PedsQL),behavior(BASC-2,subset of 19 children)and anxiety(MASC-2,children 8+years).Pearson correlations/regression models examined associations between QoL,behavior and anxiety,controlling for age,sex,diagnosis and condition severity.Student t-tests compared results to published normative values.Semi-structured interviews(15 children,13 parents)examined self-and parent-reported perceptions of the patient’s emotional health.Results:Child reported social QoL(95%CI difference:−11.0,−2.1),emotional well-being(95%CI difference:−12.5,−3.8)and adjustment skills(95%CI difference:−13.9,−3.0)were significantly below published norms(p<0.05).Neither age,sex,nor diagnosis were significantly related to questionnaire responses.Compared to children with mild conditions,child and parent-reported QoL was significantly lower in children with complex conditions(np2≥0.14,p<0.05).Lower QoL was strongly associated with more internalizing problems based on both child(r=−0.78,p<0.001)and parent(r=−0.67,p<0.001)reports.Interview responses suggested emotional distress was attributed to“normal”child problems rather than the child’s cardiac problem.Conclusion:Children with complex cardiac conditions,regardless of diagnosis,had diminished QoL.Using the PedsQL in clinical settings may help identify pediatric cardiology patients experiencing emotional distress(i.e.,anxiety and depression).

The Emotional Lexicon and Its Correlates Following Traumatic Brain Injury

Traumatic brain injury (TBI) can often influence the way subjects process and cope with their emotional life. In spite of the huge amount of studies investigating facial emotion recognition in subjects with traumatic brain injury, none of them has examined if their emotional lexicon, i.e. the ability to express emotions through words, may be affected. In this case-control study, we investigated the emotional lexicon of a group of 16 severe TBI subjects, comparing their performances with an healthy control group. A set of 25 visual stimuli (10 single picture images, 5 cartoon story pictures and 10 video clips) were selected. All the stimuli were chosen for their high emotional content by ten blind judges. The participants were asked to describe the stimuli, focusing on their emotional content. To get a better understanding of the correlates of emotional lexicon, all the participants were administered with the backward version of the Digit Span test, the Ekman and Friesen 60 Faces, the 20-Item Toronto Alexithymia Scale and the Empathy Quotient. Results pointed out a significant difference between TBI subjects and healthy controls only for cartoon story and video clip description. Conversely, TBI subjects performed similarly to controls when asked to describe the single picture images. A significant correlation was found in TBI subjects between the results of the Digit Span and number of emotional words, while no correlation was detected between emotional terms and the three scales used to assess TBI subjects’ emotional profile. These outcomes highlight that, for more complex stimuli, difficulties in emotional lexicon may depend on factors other than empathy, alexythimia or emotion recognition. These difficulties seem to be related to reduced working memory capacity, which prevent the subjects from correctly processing the emotional content of stimuli.

Erratum to “Muscular Contraction Ability Develops in the Lower Trapezius Muscle of the Dominant Arm in Team Hand-Ball Players” [Advances in Bioscience and Biotechnology 6 (2015) 368-374]

Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the trapezius muscle between their dominant arm and non-dominant arm, to clarify the correlation between the muscle thickness and muscular strength during internal and external rotation in the shoulder joints used to throw a handball. We measured the thickness of the middle and lower trapezius muscles at an abduction angle of 90° descending by the ultrasonic LOGIQ e and measured internal and external rotational muscular strength of the glenohumeral joint by BIODEX. The players showed significantly greater thickness of the lower trapezius muscle during constriction in the dominant arm than that in the non-dominant arm. Furthermore, a positive correlation was observed between muscle thickness of the lower trapezius muscle and the muscular strength during internal rotation of the glenohumeral joint. It is highly probable that the height of the constricting ability in the lower trapezius muscle in the dominant arm is related to the prevention of throwing injuries.

Erratum to “Muscular Contraction Ability Develops in the Lower Trapezius Muscle of the Dominant Arm in Team Hand-Ball Players” [Advances in Bioscience and Biotechnology Vol.6 No.5 (2015) 368-374]

Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the trapezius muscle between their dominant arm and non-dominant arm, to clarify the correlation between the muscle thickness and muscular strength during internal and external rotation in the shoulder joints used to throw a handball. We measured the thickness of the middle and lower trapezius muscles at an abduction angle of 90&deg descending by the ultrasonic LOGIQ e and measured internal and external rotational muscular strength of the glenohumeral joint by BIODEX. The players showed significantly greater thickness of the lower trapezius muscle during constriction in the dominant arm than that in the non-dominant arm. Furthermore, a positive correlation was observed between muscle thickness of the lower trapezius muscle and the muscular strength during internal rotation of the glenohumeral joint. It is highly probable that the height of the constricting ability in the lower trapezius muscle in the dominant arm is related to the prevention of throwing injuries.

An Isolated Displaced Fracture of the Coracoid Process Treated with Osteosynthesis—A Case Report and Review of Literature

Coracoid process fractures are relatively rare and few cases have been reported in the orthopedic literature. In this article, we report the case of an active, thirty years old, male patient with isolated, displaced fracture of the coracoid process, associated with a blunt injury to the shoulder, during a motor vehicle accident. We describe the incidence, mechanism of injury, and surgical treatment. Although rare, a high index of suspicion, special radiographic views, can detect an isolated coracoid process. Knowledge of the associated injuries will help the clinician to order further imaging and treat them accordingly. We recommend that a displaced, isolated fracture of the coracoid be treated with open reduction and osteosynthesis, to achieve early use of the extremity, good radiological union and clinical function.

Muscular Contraction Ability Develops in the Lower Trapezius Muscle of the Dominant Arm in Team Hand-Ball Players

Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the trapezius muscle between their dominant arm and non-dominant arm, to clarify the correlation between the muscle thickness and muscular strength during internal and external rotation in the shoulder joints used to throw a handball. We measured the thickness of the middle and lower trapezius muscles at an abduction angle of 90&deg descending by the ultrasonic LOGIQ e and measured internal and external rotational muscular strength of the glenohumeral joint by BIODEX. The players showed significantly greater thickness of the lower trapezius muscle during constriction in the dominant arm than that in the non-dominant arm. Furthermore, a positive correlation was observed between muscle thickness of the lower trapezius muscle and the muscular strength during internal rotation of the glenohumeral joint. It is highly probable that the height of the constricting ability in the lower trapezius muscle in the dominant arm is related to the prevention of throwing injuries.

Hoffa骨折内固定相关问题探讨

Hoffa骨折是不稳定关节内骨折,具有明显的再移位倾向,伴有股骨远端髁间或髁上骨折时,易被漏诊,CT扫描是诊断Hoffa骨折的金标准。治疗原则是解剖复位关节面、可靠内固定、早期功能活动。目前主要的治疗方式是经关节面螺钉固定,但螺钉固定时因螺钉尾帽需埋头处理,致关节软骨形成不可愈合的医源性损伤;术后膝关节早期功能活动时骨折块在胫骨平台的作用下反复受到向后、向上的剪切力,是内固定失效的主要原因。钢板辅助螺钉固定可增加局部力学稳定性,但仍不能避免软骨医源性损伤的缺陷,同时因没有专用解剖钢板术中需进行钢板塑形,存在增加手术创伤和手术耗时等问题。Hoffa骨折理想固定方式应兼具:(1)避免关节面软骨医源性损伤。(2)具备后方抗剪切阻挡钢板功能。(3)内固定物更靠近负载界面,以便获得更大的载荷、更好的固定强度。

On the Academic Value and Influence of Wang Hao-gu’s ‘Yinzheng Lueli’

The magnum opus of the famous physician Wang Haogu in the Yuan Dynasty,"Yinzheng Lueli(Brief Examples of Yin Syndromes)",invented the"Yin Syndrome"theory based on"The Treatise on Febrile Diseases",systematically discussed the theory of"cold drinking leads to internal injury",and advocated the treatment of warm tonifying the spleen and kidney rather than heat tonification,initiated the study of"warm tonification"in the subsequent Ming and Qing Dynasties.These have played an important role in the inheritance and advancement of the Yishui School,and also have a profound impact on the Chinese medicine theory and the diagnosis and treatment of diseases in later generations.

Syndesmotic Internal Brace^(TM) for anatomic distal tibiofibular ligament augmentation

Reconstruction of unstable syndesmotic injuries is not trivial, and there is no generally accepted treatment guidelines. Thus, there still remain considerable controversies regarding diagnosis, classification and treatment of syndesmotic injuries. Syndesmotic malreduction is the most common indication for early re-operation after ankle fracture surgery, and widening of the ankle mortise by only 1 mm decreases the contact area of the tibiotalar joint by 42%. Outcome of ankle fractures with syndesmosis injury is worse than without, even after surgical syndesmotic stabilization. This may be due to a high incidence of syndesmotic malreduction revealed by increasing postoperative computed tomography controls. Therefore, even open visualization of the syndesmosis during the reduction maneuver has been recommended. Thus, the most important clinical predictor of outcome is consistently reported as accuracy of anatomic reduction of the injured syndesmosis. In this context the Tight Rope~?system is reported to have advantages compared to classical syndesmotic screws. However, rotational instability of the distal fibula cannot be safely limited by use of 1 or even 2 Tight Ropes~?. Therefore, we developed a new syndesmotic Internal Brace^(TM) technique for improved anatomic distal tibiofibular ligament augmentation to protect healing of the injured native ligaments. The Internal Brace^(TM) technique was developed by Gordon Mackay from Scotland in 2012 using Swive Locks~? for knotless aperture fixation of a Fiber Tape~? at the anatomic footprints of the augmented ligaments, and augmentation of the anterior talofibular ligament, the deltoid ligament, the spring ligament and the medial collateral ligaments of the knee have been published so far. According to the individual injury pattern,patients can either be treated by the new syndesmotic Internal Brace^(TM) technique alone as a single anterior stabilization, or in combination with one posteriorly directed Tight Rope~? as a double stabilization, or in combination with one Tight Rope~? and a posterolateral malleolar screw fixation as a triple stabilization. Moreover,the syndesmotic Internal Brace^(TM) technique is suitable for anatomic refixation of displaced bony avulsion fragments too small for screw fixation and for indirect reduction of small posterolateral tibial avulsion fragments by anatomic reduction of the anterior syndesmosis with an Internal Brace^(TM) after osteosynthesis of the distal fibula. In this paper, comprehensively illustrated clinical examples show that anatomic reconstruction with rotational stabilization of the syndesmosis can be realized by use of our new syndesmotic Internal Brace^(TM) technique. A clinical trial for evaluation of the functional outcomes has been started at our hospital.

积极反刍思维训练对青少年伴非自杀性自伤行为抑郁症患者情绪调节策略的影响

目的:探讨积极反刍思维训练对青少年抑郁症患者非自杀性自伤行为(NSSI)及情绪调节策略的干预效果。方法:纳入南京脑科医院2021年3月至2022年6月有NSSI青少年抑郁症患者167例,按随机数字表法分为对照组(n=84)和干预组(n=83)。对照组实施精神科常规治疗及护理;干预组除常规治疗护理措施外,实施积极反刍思维训练。采用SPSS22.0对数据进行统计分析,采用t检验比较差异,计算Cohen’s D值估计差异效应量。结果:干预后干预组积极反刍思维、情感表达、自我负强化、表达抑制、认知重评策略分量表得分与对照组差异有统计学意义(P<0.05或P<0.01),情感表达、自我负强化、认知重评分量表Cohen’s D值达到中等效应(0.5≤D≤0.8);干预后3个月,干预组各量表分与对照组差异具有统计学意义(P<0.05或P<0.01),Cohen’s D值均有提升,认知重评策略分量表达到较大效应(D>0.8),积极反刍思维、情感表达、利己社交、自我负强化、表达抑制分量表达到中等效应(0.5≤D≤0.8),消极反刍思维分量表减分值效应较小(0.2≤D≤0.5)。结论:积极反刍思维训练有利于改善青少年抑郁症患者情绪调节策略,减少非自杀性自伤行为,且随着时间推移,效应逐步提升。