External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.

Study of the External Dose Rate and Retained Body Activity of Patients with Hyperthyroidism Who Are Receiving Ⅰ-131 Therapy

Hyperthyroidism refers to a clinical state that results from inappropriately hight hyroid hormone levels in the tissues;.Ⅰ-131 therapy plays a critical role and provides a remarkable curative effect in targeting thyroid diseases. Thyroid cells can take up isotope I-131, which emits not only beta rays but also

The clinical study of preoperative external lumbar drainage in patients with aneurysmal subarachnoid hemorrhage in Hunt and Hess grades Ⅰ～Ⅲ undergoing early surgery

Objective To explore the therapeutic effect of preoperative external lumbar drainage in Hunt and Hess grade Ⅰ～Ⅲ patients with subarachnoid hemorrhage (SAH) undergoing early surgery for intracranial aneurysms. Methods 101 cases of gradeⅠ～Ⅲ patients according to the classification of Hunt and Hess

Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

Simulated patient methodology as a“gold standard”in community pharmacy practice:Response to criticism

The simulated patient methodology(SPM)is considered the“gold standard”as covert participatory observation.SPM is attracting increasing interest for the investigation of community pharmacy practice;however,there is criticism that SPM can only show a small picture of everyday pharmacy practice and therefore has limited external validity.On the one hand,a certain design and application of the SPM goes hand in hand with an increase in external validity.Even if,on the other hand,this occurs at the expense of internal validity due to the trade-off situation,the justified criticism of the SPM for investigating community pharmacy practice can be countered.

Advantages of Ilizarov External Fixation in an Elderly Patient with Pilon Fracture with Severe Soft Tissue Injury and Severe Osteoporosis: A Case Report

Introduction: Pilon fracture in elderly individuals is characterized by senile skin atrophy, poor dermal extensibility, and thin subcutaneous tissue. The use of bulky internal fixation material can thus cause the swelling that accompanies the fracture to induce secondary injury to skin tissue. In addition, initiation of postoperative weight-bearing is delayed due to bone fragility and difficulties with partial weight-bearing, causing a tendency toward prolonged hospitalization. Mean duration of hospitalization after pilon fracture for elderly patients in our department was 79.2 days. Case Presentation: An 80-year-old woman with pilon fracture with soft tissue injury and severe osteoporosis was transferred to our department. The fracture was treated using Ilizarov external fixation. Fourteen days postoperatively, walking with full weight-bearing was permitted. The hospital stay was 28 days. The external fixator of the ankle was removed 87 days postoperatively, at which time the patient was anatomically and functionally recovered and able to walk unaided. Conclusion: Ilizarov external fixation may represent a useful option in elderly patients with pilon fracture showing severe soft tissue injury and severe osteoporosis. The present case provides evidence that this procdure can be successfully applied to the management of such pilon fractures in elderly patients.

增强型体外反搏对老年高血压患者血压及内皮功能障碍的改善作用

目的原发性高血压与内皮功能障碍密切相关,本研究旨在评估增强型体外反搏(EECP)对老年高血压患者血压及内皮功能障碍的改善作用。方法入选2021年11月至2022年7月于河北省第八人民医院(河北省老年病医院)住院及门诊就诊的360例老年原发性高血压患者为研究对象,随机分为三组,每组各120例。对照组予以生活方式指导和服药依从性管理,药物组在生活方式指导基础上给予比索洛尔口服,药物+EECP组在生活方式加比索洛尔治疗基础上给与EECP,每周5次,1h/次,共治疗3个月。比较三组患者干预前、后血清内皮素1(ET-1)和一氧化氮(NO)水平、颈动脉超声及临床血压和24 h动态血压情况。记录干预期间副作用。结果与对照组和药物组患者相比,药物+EECP组的内皮功能显著改善:血清ET-1水平、临床血压和24 h动态血压较干预前和其他两组降低,NO水平及颈动脉超声参数收缩峰值速度(PSV)、舒张末期速度(EDV)和流体剪切应力(FSS)升高(P<0.05)。相关分析显示,FSS与ET-1(r=-0.121,P=0.022)、NO-1(r=0.151,P=0.004)和临床收缩压(r=-0.154,P=0.003)变化值(干预后-干预前)之间呈相关关系。即使校正了混杂因素,这种相关性仍存在(P<0.001)。结论比索洛尔联合EECP可改善老年原发性高血压患者血管内皮功能。

吕晓东“表阴证”辨法治疗老年外感寒咳初期解析

老年外感寒咳患者素体虚寒易感寒邪,邪初在表,但病易传变,若施治误治易迅速入里生并病,现代医学在治疗老年咳嗽患者不能从根本上降低患者咳嗽敏感性。而中医学中《伤寒论》辨病分六经,结合八纲辨证近代医家提出少阴病即表阴证,聚焦于本虚与外感风寒反应于表,从根本论治。吕晓东教授善于辨证施治,以此辨证治疗老年外感寒咳初期,符合老年患者本虚体质特征并感寒邪病机,其特点在于注重本虚之温补,而非表邪之攻解。结合临床验案1例,望为老年外感寒咳患者的精准化治疗、研究以及预防预后等提供一定的临床思路。

组合式外固定架治疗高危老年肱骨近端骨折患者术后凝血功能改变与年龄相关性分析

目的探究组合式外固定架治疗高危老年肱骨近端骨折术后患者凝血功能与年龄的相关性。方法回顾性分析2020年1月至2021年12月于河北省中医院骨伤科行组合式外固定架固定手术治疗的70例高危老年肱骨近端骨折患者的临床资料,其中男25例,女45例;60~69岁组22例,70~79岁组28例,80~89岁组18例,90~99岁组2例。比较4组患者术前1 d,术后1、3、7、14 d凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体各指标变化情况。结果4组患者术前1 d,术后1、3、7、14 d PT、APTT、TT、FIB、D-D差异无统计学意义(P>0.05)。术后70例患者均未出现上肢深静脉血栓。组合式外固定架固定术治疗高危老年肱骨近端骨折手术前后患者凝血四项、D-二聚体指标变化与年龄的相关性较小。结论组合式外固定架固定术治疗高危老年肱骨近端骨折术后患者凝血功能不受年龄影响而改变,深静脉血栓的发生率低。

日语间接被动句中「られ」的轻动词特性分析

先前研究对日语间接被动句中如何指定主语论元角色一直存在争议。本文从生成语法的角度,基于Chomsky(1995)的轻动词理论和Lin(2001)的事态谓语理论对这一问题进行了研究。本文的研究表明,日语间接被动句中的「られ」具有一定的轻动词特性,可以视作轻动词中表达“经验者”的事态谓语,在这种观点下生成的句法结构能有效排除井上(1999)的句法结构中动词对论元指定的干扰,并且达到自主指定论元的效果。

“循环论证”是一种误读——基于《1844年经济学哲学手稿》第一手稿的分析

《1844年经济学哲学手稿》中是否存在“循环论证”的问题是学术界长期争论的焦点。实际上,“循环论证”是对马克思的一种误读。在《1844年经济学哲学手稿》第一手稿中,马克思从批判国民经济学出发,用国民经济学的语言和规律阐释问题。准确把握异化、外化和私有财产三个概念及其相互关系是破解“循环论证”的关键。外化劳动是私有财产的根源,外化劳动产生了基于自身劳动基础上的私有财产,而私有财产权的社会分化使得私有财产具有资本属性,进而产生异化劳动。马克思在《1844年经济学哲学手稿》第一手稿中提出要研究异化劳动的起源和私有财产的本质,这对于人们理解劳动从个体向社会的转变具有重要意义,而这一问题的提出本身就打破了“循环论证”。

人工牛黄甲硝唑胶囊致男性患者外生殖器多形红斑型药疹的诊疗分析

目的:分析1例人工牛黄甲硝唑胶囊致男性患者外生殖器多形红斑型药疹的诊疗过程,为临床该药的用药安全提供参考。方法与结果:该患者因牙痛而自行购买人工牛黄甲硝唑胶囊服用,但第2天患者发现外生殖器不行米粒至豆粒大小的红斑,呈密集对称分布,伴轻微瘙痒,遂自行停药;但停药多日后仍未见好转,皮损还逐渐增大,且表面出现糜烂、渗出,遂入院治疗;入院后,对患者予以了抗炎、抗感染治疗,2周后患者红斑基本消失,1个月后患者皮损也基本痊愈;其间,医生采用诺氏评估量表考察多形红斑型药疹与人工牛黄甲硝唑胶囊的关联性,结果评分为6分,即关联性为“很可能”。结论:人工牛黄甲硝唑胶囊所致药疹仅出现在外生殖器部位而未涉及身体其他部位的情况较为罕见,临床在宣教时应做好用药交代,以便于患者早分辨、早治疗。

二阶论证何以解疑难案件裁判之困?

疑难案件是存在法律争议的案件,具体呈现为规范模糊、规范冲突、规范缺失和规范适用不正义等典型样态。裁判疑难案件的关键在于解决上述的法律争议,为司法三段论证立可靠的裁判规则。这在法律论证上呈现出二阶构造,第一阶段证立裁判规则,第二阶段适用裁判规则、证立裁判结论。因此,二阶论证能够破解疑难案件的裁判困境。它以合秩序裁判为理论基础,强调法官可以背离个别法律规则,但不能逾越法的框架秩序;在外部证成中依据丰富的论证渊源、运用多元的论证方法、遵循可废止性的论证程序,证立裁判规则、要件化案件事实;在内部证成中以裁判规则为大前提、以要件事实为小前提,经由环环相扣的复杂演绎证立裁判结论。

论元视角下汉语受事主语句的英越翻译对比——以《布洛陀史诗》“稻作之源”为例

受事主语句作为古代汉语中的一种重要的句法结构,对该类句型的研究能够帮助我们更好地理解中国古代文献和历史文化。该文以从论元理论为视角,对《布洛陀史诗》第四章“稻作之源”语篇中的受事主语句进行语义分析,以期深入阐释中国古代汉语的语言结构和功能,为语言在实际应用中的优化提供新的可能。同时,该研究通过对比分析《布洛陀史诗》中汉语受事主语句在英语和越南语中的翻译策略,提出受事主语句翻译的注意事项,旨在促进新时代背景下布洛陀文化对外话语体系的构建,提高中国文化对外传播力量。研究发现,在不同语种的翻译中,由于语言结构和表达习惯的差异,汉语受事主语句的翻译往往需要调整语序或增加额外信息以确保译文的流畅性和准确性。

Manual reduction with traditional small splints for distal radius fracture in older patients

Objective:To investigate the effect of manual reduction with traditional small splints fixation for distal radius fractures in older patients in the emergency department.Methods:Older patients(aged at least 60 years)with distal radius fractures were enrolled in this study.The patients were randomly divided into the treatment group and the control group.The treatment group was treated with manual reduction and small splints fixation.The control group was treated with manual reduction and resin plaster fixation.Before treatment,after reduction,and 3 months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length were recorded.Before treatment and 3 months after treatment,the Cooney wrist joint scores were recorded.The time of fracture healing and related adverse events during the treatment were recorded.Results:Before treatment and after reduction,there were no statistically significant differences between the two groups in palmar tilt angle,ulnar deviation angle,or radial length(P>0.05).Three months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length of the treatment group were better than those of the control group(P<0.05).The Cooney wrist scores of the treatment group was significantly higher than that of the control group three months after the treatment(P<0.05).The time of fracture healing of the treatment group was shorter than that of the control group,but the difference was no statistically significant(P>0.05).Conclusions:Compared with resin plaster fixation,traditional small splints fixation for distal radius fractures in older patients have the advantages of less loss of fracture reduction and faster functional recovery.Besides,the method is simple and low cost thus,it needs to be promoted.

Three-dimensional finite element analysls for external midface distraction after different osteotomy in patients with cleft lip and palate

Objective To study three - dimensional finite element analysis for external midface distraction after different osteotomy in patients with cleft lip and palate ( Clp) . Methods Three - dimensional Fem models of Le Fort Ⅰ,Ⅱand Ⅲ,osteotomy in Clp patients were estabolished. External midface distraction were simulated. An anteriorly and inferiorly directed 900 g force was

The effects of enhanced external counterpulsation on the serum level of C-reactive protein and endothelin-1 in patients with ischemic stroke

Objective To explore the effects of enhanced external counterpulsation(EECP)on the serum level of C-reactive protein and endothelin-1 in patients with cerebral ischemic stroke,to provide clinical evidence for the treatment and secondary prevention of patients with serebral ischemic stroke.Methods Total 187 patients with ischemic stroke and enrolled measure the serum level

“用户生成视频”著作权合法性的法理论证——以洛克财产权理论的限制性条件切入

网络用户创作UGC视频的合法性存在争议。我国理论与司法实践尚未就UGC视频创作的合法性判断形成一致标准,这一现象无疑加重了UGC创作者的著作权侵权风险。洛克财产权理论规定的两个限制条件,“足够多且同样好”与“禁止浪费”为著作权法的限制与例外制度提供了启示。结合依赖理论和市场失灵的经济分析应用洛克限制条件,能够划定著作权人行使权利的边界:著作权人对作品的控制不应损害网络用户的信赖利益和创作自由;正外部性瞩目且私人利益有限的UGC视频创作也不应受著作权人支配。符合上述要件的UGC视频创作具有法哲学和法经济分析层面的正当性。以洛克财产权理论为基础,兼而吸取国际著作权公约对“三步检验法”的解释经验,可为UGC视频创作在我国的合理使用认定提供适当解释路径。

医生对医患冲突的抗逆力建构过程研究

基于质性研究方法,对医生面对医患冲突的抗逆力建构过程进行研究。采用半结构式访谈,对7名某三甲医院医生进行深度访谈,运用扎根理论研究方法对访谈数据进行深入分析。研究结果显示,医生在面对医患冲突的过程中,真诚沟通与共情可以有效提升医生沟通能力,帮助其应对冲突,同事支持为重要的外在保护因子。因此协同医疗系统各方资源与力量,促进医生心理沟通技巧提升、发展医生群体互助合作同盟机制,可为医生群体提供有效支持。

裁判文书援引党内法规和规范性文件的类型化研究——基于法律论证的视角

作为独立于国家法律的规范体系,党内法规和规范性文件已多层次地进入裁判文书。在审判实践中,这些被援引的党内法规和规范性文件具有极强的说服力,个别党政联合发文还构成了现实的裁判依据。人民法院对党内法规和规范性文件的援引需遵循法律论证的逻辑,基于法律论证视角廓清人民法院纷繁复杂的援引活动,可以为司法实践提供可能的具体指引。经过类型化,人民法院的援引可分为司法不介入、界明争议概念、加强释法说理三种典型样态。其中,加强释法说理又可以进一步分为提供外部证成、填补法律漏洞两种类型。党内法规和规范性文件深刻影响着司法过程,党内法规和规范性文件在政治上的权威、作为具有法律意义的事实、在特定领域内的规范效力,递进式地构成其进入裁判文书的深层逻辑。