Progress in diagnosis and treatment of acute injury to the anterior talofibular ligament

Injury to the anterior talofibular ligament(ATFL)is a common acute injury of the lateral foot ligament.Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients.The purpose of this paper is to review the anatomy and the current methods of diagnosis and treatment of acute injury to the ATFL.The clinical manifestations of acute injury to the ATFL include pain,swelling,and dysfunction.At present,non-surgical treatment is the first choice for acute injury of the ATFL.The standard treatment strategy involves the“peace and love”principle.After initial treatment in the acute phase,personalized rehabilitation training programs can be followed.These may involve proprioception training,muscle training,and functional exercise to restore limb coordination and muscle strength.Static stretching and other techniques to loosen joints,acupuncture,moxibustion massage,and other traditional medical treatments can relieve pain,restore range of motion,and prevent joint stiffness.If the non-surgical treatment is not ideal or fails,surgical treatment is feasible.Currently,arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice.Although open Broström surgery provides good results,the modified arthroscopic Broström surgery has many advantages,such as less trauma,rapid pain relief,rapid postoperative recovery,and fewer complications,and is more popular with patients.In general,when treating acute injury to the ATFL,treatment management and methods should be timely and reasonably arranged according to the specific injury scenario and attention should be paid to the timely combination of multiple therapies to achieve the best treatment results.

Clinical diagnosis and surgical treatment of pancreatic and/or duodenal injuries

Objective: To investigate the points of the clinical diagnosis and surgical treatment for pancreatic and/or duodenal injuries. Methods: Clinical data of 30 patients who suffered from pancreatic and/or duodenal injuries were reviewed. Results: There were 29 cases who received surgical management. Of the 30 cases, 22 cases were cured, seven cases died, and postoperative complications occurred in 16 cases. The cure rate was 73.3%. Conclusion: Pancreatic and/or duodenal injuries are severe abdominal injuries and difficult to treat. The mortality and complication rate are high. The keys to successful treatments for pancreatic and/or duodenal injuries are early diagnosis, careful exploration and proper operational management.

Diagnosis and Treatment of 42 Cases of Multiple Injuries with Pancreatic Injury

In order to summarize the clinical diagnosis and treatment methods for 42 cases of multiple injuries with pancreatic injury, a retrospective analysis on 42 cases of multiple injuries with pancreatic injury from January 1990 to January 2006 was carried out in our hospital. Most cases were associated with hemopneumothorax and rib fractures （52.3%）, shock （50%）, multiple fractures （47.6%）, and severe brain injury （26.1%）. In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases （97.6%） were cured （including 40 cases receiving surgical operation and one case receiving the conservative treatment）. Postoperative complications occurred in 16 cases （21 cases/times）： pancreatic fistula （5 cases/times） and incisional wound infection （5 cases/times）, intra-abdominal infection （3 cases/times）, stress ulcer （3 cases/times）, pleural effusion （3 cases/times）, pulmonary infection （one case） and wound dehiscence （1 case）. The principle therapy of multiple injuries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries which endangers life at last, and the pancreatic injury to increase the survival rate and survival quality.

Hepatorenal syndrome: Update on diagnosis and treatment

Acute kidney injury(AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome(HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice.

Research progress of viral sepsis:etiology,pathophysiology,diagnosis,and treatment

Sepsis is a common systemic disease characterized by various physiological and pathological disorders.It can result from infection by various pathogens,such as bacteria,viruses,and fungi.The rate of culture-negative sepsis is almost 42%,indicating that most patients may have nonbacterial infections.With the outbreak of coronavirus disease 2019,viral sepsis has attracted growing attention because many critically ill patients develop sepsis.Viral sepsis can be caused by viral infections and combined with,or secondary to,bacterial infections.Understanding the common types of viral sepsis and the main characteristics of its pathogenesis will be helpful for effective diagnosis and treatment,thereby reducing mortality.Early identification of the causative agent of viral sepsis can help reduce the overuse of broad-spectrum antibiotics.In this article,we reviewed the common viruses of sepsis,their potential pathophysiology,targets of diagnosis,and remedies for viral sepsis.

An expert consensus on the evaluation and treatment of acute thoracolumbar spine and spinal cord injury in China

This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview （one item）; pre-hospital care （one item）; evaluation and diagnosis （13 items）; treatment （23 items）; prevention and treatment of major com- plications （12 items）; and rehabilitation （four items）. This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with ＂1＂ cor- respondJng to neutrality and ＂5＂ representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.

Acute Kidney Injury: Treatment with Unani Medicine—Case Report

A male named Anwer Jamal, age 45 years, married, visited Clinic Rafaheaam Dawakhana Ajmali on March 29, 2013, with history of glomerulonephritis, inherited renal diseases, hypertension and previously hooked on voltaren 50 (Diclofenic Sodium, 50 mg) and was not on dialysis. Different diagnostic parameters showed the patient was suffering from acute renal failure according to the RIFLE criteria. AKI is life threatening when kidneys suddenly is unable to filter waste products from blood. The patient was treated and managed with herbal medicines according to Unani system of medicine. Reversal of the parameter such as serum creatinine from 7.90 mg/dl (6.58 fold high) to 0.81mg/dl within two weeks clearly shows the remarkable recovery in a short period of time. During this period the other related parameters e.g. blood urea nitrogen (BUN), serum albumin, albuminuria, blood pressure were also normalized whereas clinical sign and symptom exhibited improvement.

Experiences on the Integrative Medical Diagnosis and Treatment of Acute Kidney Injury

The definition of acute renal failure（ARF） has not gotten common understanding yet in a long time,which leads to the difficulty in comparing the outcomes of some different studies,and has impacted the advance of diagnosis and treatment on the illness to certain extents. Most of the scholars hold that the attention paid to the early diagnosis and intervention of ARF was insufficient in recent years. Lots of clinical researchers indicated that even a slight impairment of renal function could result in the increasing of the morbidity and mortality of ARF.

Guideline for diagnosis, prophylaxis and treatment of invasive fungal infection post burn injury in China 2013

Invasive fungal infection is one of the major complication of severe burns which can induce local or systemic inflammatory response and cause serious substantial damage to the patient. The incidence of fungal infection for burn victims is increasing dramatically during recent years. This guideline, organized by Chinese Society of Burn Surgeons, aims to standardize the diagnosis, prevention and treatment of burn invasive fungal infection. It can be used as one of the tools for treatment of major burn patients.

Synthesis of evidence for the treatment of intersection syndrome

Intersection syndrome is a rare sports overuse injury occurring through friction at the intersection of the first and second compartment of the forearm. Differential diagnosis must be carefully made, especially from De Quervain tendonsynovitis. Clinical examination provides with the necessary information for diagnosis, still magnetic resonance imaging scans and ultrasonography may assist in diagnosis. Treatment consists mainly of rest, use of a thumb spica splint, analgetic and oral nonsteroidal anti-inflammatory drugs and after 2-3 wk progressive stretching and muscle strengthening. Should symptoms persist beyond this time, corticosteroid injections adjacent to the site of injury may be useful. In refractory cases, surgical intervention is warranted.

Guideline for diagnosis and treatment of spine trauma in the epidemic of COVID-19

Outbreak of COVID-19 is ongoing all over the world.Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production.Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery.The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients.To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease,multidisciplinary collaboration is needed.This expert consensus is formulated in order to(1)prevent and control the epidemic,(2)diagnose and treat patients with spine trauma reasonably,and(3)reduce the risk of cross-infection between patients and medical personnel during the treatment.

Primary duodenal tuberculosis misdiagnosed as tumor by imaging examination:A case report

BACKGROUND Primary duodenal tuberculosis is very rare.Due to a lack of specificity for its presenting symptoms,it is easily misdiagnosed clinically.Review of the few case reports and literature on the topic will help to improve the overall understanding of this disease and aid in differential diagnosis to improve patient outcome.CASE SUMMARY A 71-year-old man with a 30-plus year history of bronchiectasis and bronchitis presented to the Gastroenterology Department of our hospital complaining of intermittent upper abdominal pain.Initial imaging examination revealed a duodenal space-occupying lesion;subsequent upper abdominal contrastenhanced computed tomography indicated duodenal malignant tumor.Physical and laboratory examinations showed no obvious abnormalities.In order to confirm further the diagnosis,electronic endoscopy was performed and tissue biopsies were taken.Duodenal histopathology showed granuloma and necrosis.In-depth tuberculosis-related examination did not rule out tuberculosis,so we initiated treatment with anti-tuberculosis drugs.At 6 mo after the antituberculosis drug course,there were no signs of new development of primary lesions by upper abdominal computed tomography,and no complications had manifested.CONCLUSION This case emphasizes the importance of differential diagnosis for gastrointestinal diseases.Duodenal tuberculosis requires a systematic examination and physician awareness.

多学科协作诊疗模式下的临床护理路径对多发伤急诊患者救治成功率的影响

目的:探讨多学科协作诊疗(MDT)模式下的临床护理路径(CNP)对多发伤急诊患者救治成功率的影响,为临床护理提供依据。方法:选取2020年1月—2021年1月常州市第一人民医院收治的120例急性多发伤患者作为研究对象,按照随机数表法将其分为常规组和联合组,每组各60例。常规组采用常规急救护理,联合组在常规护理基础上实施MDT模式下的CNP护理。比较两组患者抢救时效、创伤严重程度[创伤严重程度(ISS)评分]、救治成功率、并发症发生情况。结果:联合组患者急诊停留时间、急诊检查时间及会诊医生到诊时间均明显短于常规组,差异有统计学意义(t=8.861、14.790、9.184,P<0.05)。护理后,两组患者ISS评分均低于护理前,且联合组低于常规组,差异有统计学意义(t=13.380,P<0.05)。两组患者救治成功率比较,差异无统计学意义(χ^(2)=1.365,P>0.05)。联合组患者并发症发生率明显低于常规组,差异有统计学意义(χ^(2)=15.790,P<0.05)。结论:MDT模式下的CNP护理能够提高多发伤急诊患者救治成功率,缩短急诊停留时间及检查时间,降低术后并发症发生率。

基于多学科协作诊疗团队的护理服务在压力性损伤患者伤口护理中的应用效果观察

目的探讨基于多学科协作诊疗团队的护理服务在压力性损伤患者伤口护理中的应用效果。方法2021年7月—2023年7月,选取医院收治的60例压力性损伤患者为研究对象,采用随机数字表法分为观察组(n=30)与对照组(n=30)。对照组接受常规护理,观察组在对照组基础采用基于多学科协作诊疗团队的护理服务。评估患者创面愈合情况,对比两组护理前后压疮愈合计分量表(PUSH)评分、抑郁自评量表(SDS)和焦虑自评量表(SAS)评分。结果观察组创面愈合率为96.67%(29/30),高于对照组的70.00%(21/30),差异有统计学意义(P<0.01)。两组护理后创面形态、创面面积、24 h渗液量评分及PUSH总分较护理前降低,且观察组创面形态、创面面积、24 h渗液量评分及PUSH总分低于对照组,差异有统计学意义(P<0.01)。两组护理后SAS、SDS评分较护理前降低,且观察组SAS、SDS评分低于对照组,差异有统计学意义(P<0.01)。结论压力性损伤患者伤口护理,在常规护理基础上开展基于多学科协作诊疗团队的护理服务,有助于促进创面愈合,缓解患者不良情绪。

2018—2022年某三级口腔专科医院工作人员职业暴露情况调查

目的:探讨口腔专科工作人员职业暴露危险因素和职业伤害情况,为制定针对性职业防护措施提供依据。方法:回顾性分析2018年1月1日—2022年12月31日某三级口腔专科医院工作人员的职业暴露现状,探讨口腔专科医护工作人员职业暴露的风险因素。结果:5年职业暴露率分别为9.65%、6.54%、4.96%、5.38%、3.96%。151名职业暴露人员中,84.77%的职业暴露源不明;以女性[128人(84.77%)]、护士[63人(41.72%)]为主;暴露科室主要以综合门诊科/部(21.85%)和牙周黏膜科(17.22%)为主;主要发生于口腔诊疗操作(48.34%);08:00~11:59(51.66%)是1 d中发生职业暴露次数最多的时间;手部(87.42%)是最主要的暴露部位;暴露器械多为根管锉、牙科钻、洁治器头(38.41%)及注射针头(33.11%);2020年后工作人员职业防护考核得分有大幅度提升(P<0.05)。结论:口腔专科职业暴露风险较综合医院有其专科特色,建议在推广安全器具使用的基础上,进行喷溅操作多、诊疗次数多的操作之前开展病人血源性检测,同时在进行职业安全防护、标准操作规程、职业暴露处置等相关培训时要结合人群特点,培训形式应与受训者群体特征相适应。

椎间盘结构异常类型及相关机械载荷与生物力学因素

背景:椎间盘损伤退变的问题已经在很多方面得到研究,许多研究表明椎间盘损伤退变是由机械载荷因素驱动引起,然而,关于椎间盘损伤退变常见表型与机械载荷因素潜在的联系却少有被归纳。目的:归纳已发表文献中椎间盘损伤退变表现出的常见结构异常类型,总结在体外实验研究中导致这些结构异常的机械载荷类型的潜在联系。方法:在PubMed、中国知网和万方数据库中以“Intervertebral disc failure,Intervertebral disc injury,Mechanical load,Mechanical factor,Load factor,Biomechanics”为英文检索词,以“椎间盘结构异常,椎间盘损伤,机械载荷,载荷因素,机械因素,生物力学”为中文检索词,检索椎间盘损伤退变与机械载荷因素相关的文章,按照入选标准和排除标准进行文献筛选,最终纳入88篇文献进行综述。结果与结论:①椎间盘常见结构异常类型包括椎间盘高度下降或椎间盘膨出及骨质增生、纤维环撕裂、椎间盘突出或脱出、终板损伤及许莫氏结节及椎间盘钙化等,其容易受压缩、屈曲、轴向旋转以及复合载荷等机械载荷类型的影响。②压缩载荷主要引起蛋白聚糖含量减少和椎间盘结合水的能力降低,导致椎间盘高度下降或膨出以及椎间盘进一步的损伤退变,另外,过度的压缩载荷对终板的损伤较大。③屈曲载荷和轴向旋转载荷对纤维环的损伤比终板更大,持续长时间或重复的屈曲载荷会导致纤维环撕裂和椎间盘的突出或脱出,而单纯的轴向旋转载荷对椎间盘的损伤较小,只会引起纤维环撕裂。④然而,当不同的载荷类型结合作用时更容易导致椎间盘出现高应力,椎间盘损伤的风险更大。⑤椎间盘的损伤退变呈渐进式的结构破坏,在临床实践中前期的预防和保护尤为重要,未来的组织工程研究可从早期修复椎间盘入手。

135例脓毒症急性肺损伤患者证候分布规律与中医诊疗理论认识思考

目的探讨脓毒症急性肺损伤患者的中医证候分布规律与特征,为临床提供辨证论治依据。方法采用回顾性研究方法,收集山东中医药大学附属医院2017年1月至2020年12月脓毒症急性肺损伤患者临床资料,设计中医证候调查表,建立数据库,运用SPSS26.0软件统计分析。结果共收集135例患者病历,平均年龄(64.38±17.61)岁,61~80岁年龄段患者最多。28 d生存患者占比61%,平均年龄(57.78±17.86)岁;死亡患者占比39%,平均年龄(70.98±17.37)岁。主要基础疾病以高血压病、心脑血管疾病、糖尿病居多。单一证候例数:热毒证>痰热证>血瘀证>腑实证>气虚证>痰浊证>阳虚证>阴虚证。复合证候例数:两种证候复合>3种证候复合>1种证候。两种证候复合以热毒证+腑实证最多,3种证候复合以热毒证+痰热证+腑实证最多,1种证候以热毒证最多。证候虚实例数:实证>虚实夹杂证>虚证,生存率相反。结论基本病机为邪实正虚,肺失宣降。病理性质总属标实本虚。病理因素包括热毒、痰、瘀。证型以热毒、痰浊、血瘀、腑实等实证为主,以复合证候多见,虚实夹杂证尤其是虚证多预后不良。脓毒证急性肺损伤治疗应以清热、化痰、活血、通腑为主,辅以益气、温阳、养阴,年老患者尤其需要扶助正气。本病病情复杂,应从整体出发,进一步把握疾病全过程证候演变规律,丰富完善辨证体系。

下尿路和外生殖器战创伤及其诊疗研究进展

近年来,随着现代战争模式、武器及防护装备的不断革新,战创伤的发生机制、模式发生了很大变化。防弹衣及简易爆炸装置的广泛使用使泌尿生殖系统战创伤发生率逐渐升高,且泌尿生殖系统战创伤的模式也发生了改变,即从内部结构(肾脏、输尿管、膀胱)转移到外部结构(阴囊、睾丸、阴茎、尿道),提示应将泌尿生殖系统战创伤的研究重点逐渐转移到下尿路及外生殖器创伤。本文就数次现代战争中泌尿生殖系统战创伤的发生率、治疗以及预后进行综述,主要阐述下尿路及外生殖器战创伤相关情况及其诊疗的相关进展。

Is laparoscopy equal to laparotomy in detecting and treating small bowel injuries in a porcine model?

AIM: To evaluate the safety and effectiveness of laparoscopy compared with laparotomy for diagnosing and treating small bowel injuries (SBIs) in a porcine model. METHODS: Twenty-eight female pigs were anesthetized and laid in the left recumbent position. The SBI model was established by shooting at the right lower quadrant of the abdomen. The pigs were then randomized into either the laparotomy group or the laparoscopy group. All pigs underwent routine exploratory laparotomy or laparoscopy to evaluate the abdominal injuries, particularly the types, sites, and numbers of SBIs. Traditional open surgery or therapeutic laparoscopy was then performed. All pigs were kept alive within the observational period (postoperative 72 h). The postoperative recovery of each pig was carefully observed. RESULTS: The vital signs of all pigs were stable within 1-2 h after shooting and none of the pigs died from gunshot wounds or SBIs immediately. The SBI model was successfully established in all pigs and definitively diagnosed with single or multiple SBIs either by exploratory laparotomy or laparoscopy. Compared with exploratory laparotomy, laparoscopy took a significantly longer time for diagnosis (41.27 ± 12.04 min vs 27.64 ± 13.32 min, P = 0.02), but the time for therapeutic laparoscopy was similar to that of open surgery. The length of incision was significantly reduced in the laparoscopy group compared with the laparotomy group (5.27 ± 1.86 cm vs 15.73 ± 1.06 cm, P < 0.01). In the final post-mortem examination 72 h after surgery, both laparotomy and laparoscopy offered a definitive diagnosis with no missed injuries. Postoperative complications occurred in four cases (three following laparotomy and one following laparoscopy, P = 0.326). The average recovery period for bowel function, vital appearance, and food re-intake after laparoscopy was 10.36 ± 4.72 h, 14.91 ± 3.14 h, and 15.00 ± 7.11 h, respectively. All of these were significantly shorter than after laparotomy (21.27 ± 10.17 h, P = 0.004; 27.82 ± 9.61 h, P < 0.001; and 24.55 ± 9.72 h, respectively, P = 0.016). CONCLUSION: Compared with laparotomy, laparoscopy offers equivalent efficacy for diagnosing and treating SBIs, and reduces postoperative complications as well as recovery period.

新生儿颅脑损伤多学科协作诊疗管理体系的实践应用效果

目的:观察新生儿颅脑损伤(NBI)多学科协作诊疗(MDT)管理体系的应用效果。方法:本院从2022年1月开始应用NBI MDT管理体系,应用前(2021年1-12月)159例为对照组,应用后(2022年1-12月)228例为观察组,比较两组治疗前与治疗3个月后新生儿神经行为量表(NBNA)评分、贝利婴儿发展量表(BSID)评分、症状缓解时间、住院时间、并发症及临床疗效。结果:治疗后观察组总有效率(95.6%)高于对照组(89.9%),NBNA原始反射(5.16±0.68分)、一般反应(5.02±0.63分)、主动肌张力(6.83±0.92分)、行为能力(10.12±1.76分)及被动肌张力(6.95±0.94分)评分均高于对照组(4.29±0.75分、4.48±0.71分、5.14±0.83分、8.65±1.32分、5.23±0.87分),BSID运动发育指数(104.17±10.75分)、智力发育指数(96.12±9.85分)评分均高于对照组(91.32±10.06分、84.35±8.62分),头皮血肿(5.73±1.02d)、面色苍白(5.90±1.13d)、囟门张力高缓解时间(4.85±0.84d)及住院时间(11.05±2.73d)均短于对照组(6.12±1.05d、6.34±1.08d、5.72±1.26d、12.96±3.14d),并发症总发生率(4.8%)低于对照组(18.9%)(均P<0.05)。结论:NBI MDT管理体系应用可促进患儿症状缓解,缩短住院时间,降低并发症风险,提高临床疗效。