Resection and reconstruction in high-grade pancreatic head injuries

This study by Chui et al adds further important evidence in the treatment of highgrade pancreatic injuries and endorses the concept of the model of pancreatic trauma care designed to optimize treatment,minimize morbidity and enhance survival in patients with complex pancreatic injuries.Although the authors have demonstrated favorable outcomes based on their limited experience of 5 patients who underwent a pancreaticoduodenectomy(PD),including 2 patients who were“unstable”and did not have damage control surgery(DCS),we would caution against the general recommendations promoting index PD without DCS in“unstable”grade 5 pancreatic head injuries.

Hepatocellular carcinoma in developing countries:Prevention,diagnosis and treatment

Hepatocellular carcinoma(HCC)occurs commonly and with increasing frequency in developing countries,where it also carries an especially grave prognosis.The major risk factor for HCC in these regions is chronic hepatitis B virus(HBV)infection,although dietary exposure to aflatoxin B1 also plays an important etio-logical role.Prevention of HCC in developing regions is unlikely in the foreseeable future.Although an effec-tive vaccine against HBV is available,the percentage of babies born in developing countries that receive the full course of immunization remains low.Moreover,the usually long interval between infection with HBV and the development of HCC means that 30 to 50 years will elapse before the full effect of the vaccine will be realized.Practical measures to prevent aflatoxin B1 ex-posure are not in place.Serumα-fetoprotein levels are a useful pointer to the diagnosis of HCC in low-income countries,but definitive diagnosis is hampered both by the lack of the sophisticated imaging equipment now available in developed countries and by obstacles to obtaining histological proof.In the majority of patients in low-income regions,the tumor is inoperable by the time the patient presents.Hepatic resection is seldom possible in sub-Saharan Africa,although the tumor is successfully resected in a larger number of patients in China.Liver transplantation for HCC is rarely performed in either region.Sophisticated new radiotherapy tech-niques are not available in developing countries.The beneficial effects of the multikinase inhibitor,sorafenib,are encouraging,although financial considerations may restrict its use in low-income countries.

Diabetic nephropathy in Africa:A systematic review

AIM:To determine the prevalence and incidence of diabetic nephropathy in Africa.METHODS:We performed a systematic narrative review of published literature following the MOOSE Guidelines for Meta-Analysis and Systematic Reviewsof Observational Studies.We searched Pub MedMEDLINE for all articles published in English and French languages between January 1994 and July 2014 using a predefined strategy based on the combination of relevant terms and the names of each of the 54 African countries and African sub-regions to capture the largest number of studies,and hand-searched the reference lists of retrieved articles.Included studies reported on the prevalence,incidence or determinants of chronic kidney disease(CKD) in people with diabetes within African countries.RESULTS:Overall,we included 32 studies from 16 countries;two being population-based studies and the remaining being clinic-based surveys.Most of the studies(90.6%) were conducted in urban settings.Methods for assessing and classifying CKD varied widely.Measurement of urine protein was the most common method of assessing kidney damage(62.5% of studies).The overall prevalence of CKD varied from 11% to 83.7%.Incident event rates were 94.9% for proteinuria at 10 years of follow-up,34.7% for endstage renal disease at 5 years of follow-up and 18.4% for mortality from nephropathy at 20 years of followup.Duration of diabetes,blood pressure,advancing age,obesity and glucose control were the common determinants of kidney disease.CONCLUSION:The burden of CKD is important among people with diabetes in Africa.High quality data from large population-based studies with validated measures of kidney function are still needed to better capture the magnitude and characteristics of diabetic nephropathy in Africa.

Hepatocellular carcinoma in African Blacks: Recent progress in etiology and pathogenesis

Occult hepatitis B virus (HBV) infection was shown to be present in 75% of Black Africans with hepatocellular carcinoma (HCC) in whom the tumor was hitherto not thought to be caused by chronic HBV infection. The association between chronic HBV infection and the development of the tumor is thus even closer than was originally thought. HBV viral load was found to be significantly higher in patients with HCC than in Black African controls. As in other populations, HBV e antigen-positive patients with hepatocellular carcinoma had significantly higher viral loads than patients negative for this antigen. The significance of this finding is discussed. The risk for HCC development with genotype A of HBV, the predominant genotype in African isolates, has not been investigated. Genotype A was shown to be 4.5 times more likely than other genotypes to cause HCC in Black Africans, and tumours occurred at a significantly younger age. Increasing numbers of patients with human immunodeficiency virus (HIV) and HBV co-infection are being reported to develop HCC. A preliminary case/control comparison supports the belief that HIV co-infection enhances the hepatocarcinogenic potential of HBV. A study from The Gambia provides the first evidence that dietary exposure to afltoxin B1 may cause cirrhosis and thatthis may play a contributory role in the pathogenesis of aflatoxin-induced HCC. An animal model has provided experimental support for the clinical evidence that dietary iron overload in the African is directly hepatocarcinogenic, in addition to causing the tumor indirectly through the development of cirrhosis.

Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system

AIMTo determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS.METHODSA prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome.RESULTSThere were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P<0.005).CONCLUSIONReliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.

Blood pressure,prevalence of hypertension and hypertension related complications in Nigerian Africans:A review

To review studies on hypertension in Nigeria over the past five decades in terms of prevalence,awareness and treatment and complications.Following our search on Pubmed,African Journals Online and the World Health Organization Global cardiovascular infobase,1060 related references were identified out of which 43 were found to be relevant for this review.The overall prevalence of hypertension in Nigeria ranges from 8%-46.4% depending on the study target population,type of measurement and cut-off value used for defining hypertension.The prevalence is similar in men and women(7.9%-50.2% vs 3.5%-68.8%,respectively) and in the urban(8.1%-42.0%) and rural setting(13.5%-46.4%).The pooled prevalence increased from 8.6% from the only study during the period from 1970-1979 to 22.5%(2000-2011).Awareness,treatment and control of hypertension were generally low with attendant high burden of hypertension related complications.In order to improve outcomes of cardiovascular disease in Africans,public health education to improve awareness of hypertension is required.Further epidemiological studies on hypertension are required to adequately understand and characterize the impact of hypertension in society.

AME特邀来稿|初始联合降压治疗在卒中初级预防中的作用

因为心血管危险因素高发生率和难以控制的结果,心血管疾病成为全球发病率和病死率的首要原因[1-4]。由于血压和心血管事件之间的直接和线性关系[5]以及高血压的高患病率等,高血压被认为是最危险的心血管危险因素,据估计全球大约有10亿成年人患病[2]。估计全球每年有940万例死亡与高血压有关,因心脏疾病死亡的至少占45%,

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

AIM To benchmark severity of complications using the Accordion Severity Grading System(ASGS) in patients undergoing operation for severe pancreatic injuries. METHODS A prospective institutional database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. One hundred and thirty patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection(pancreatoduodenectomy, n = 20, distal pancreatectomy, n = 110), including 30 who had an initial damage controllaparotomy(DCL) and later definitive surgery. AAST injury grades, type of pancreatic resection, need for DCL and incidence and ASGS severity of complications were assessed. Uni-and multivariate logistic regression analysis was applied. RESULTS Overall 238 complications occurred in 95(73%) patients of which 73% were ASGS grades 3-6. Nineteen patients(14.6%) died. Patients more likely to have complications after pancreatic resection were older, had a revised trauma score(RTS) < 7.8, were shocked on admission, had grade 5 injuries of the head and neck of the pancreas with associated vascular and duodenal injuries, required a DCL, received a larger blood transfusion, had a pancreatoduodenectomy(PD) and repeat laparotomies. Applying univariate logistic regression analysis, mechanism of injury, RTS < 7.8, shock on admission, DCL, increasing AAST grade and type of pancreatic resection were significant variables for complications. Multivariate logistic regression analysis however showed that only age and type of pancreatic resection(PD) were significant. CONCLUSION This ASGS-based study benchmarked postoperative morbidity after pancreatic resection for trauma. The detailed outcome analysis provided may serve as a reference for future institutional comparisons.

Bibliometric analysis of research on the effects of human immunodeficiency virus in orthopaedic and trauma surgery

BACKGROUND There is little research investigating how human immunodeficiency virus(HIV)affects outcomes in orthopaedic surgery.With advances in treatment,HIV has become a chronic health problem and the chance of orthopaedic surgeons encountering it in clinical practice is increasing.AIM To ascertain the quantity and quality of peer-reviewed publications in orthopaedic journals about HIV.METHODS A search of the Web of Science database was carried out,identifying any articles relating to HIV published in orthopaedic journals.These were assessed for geographic origin and level of evidence.RESULTS Of 48.7%of orthopaedic journals listed on the Web of Science database had published articles relating to HIV.There were 168 articles about HIV in orthopaedic journals with only 40.5%(n=68)published in the time frame we analysed(January 2007 to September 2017).Very few articles came from lowincome countries and any articles published from that setting were collaborations.All of the articles were low level of evidence.CONCLUSION There is a need for more high level orthopaedic and trauma research investigating the effects of HIV,particularly research from low-income countries,where higher level research will help to guide improvements in their treatment of its musculoskeletal manifestations and complications.

Exercise-induced albuminuria and circadian blood pressure abnormalities in type 2 diabetes

AIM To investigate the relationship between circadian variations in blood pressure(BP) and albuminuria at rest,and during exercise in non-hypertensive type 2 diabetes(T2D) patients.METHODS We conducted a cross-sectional study in well controlled T2D patients,non-hypertensive,without clinical proteinuria and normal creatinine clearance.In each participant,we recorded the BP using ambulatory bloodpressure monitoring(ABPM) for 24-h,and albuminuria at rest and after a standardized treadmill exercise.RESULTS We enrolled 27 type 2 patients with a median age of 52;and a mean duration of diabetes and HbA 1c of 3.6 ± 0.8 years and 6.3% ± 0.5% respectively.Using a 24-h ABPM,we recorded a mean diurnal systolic blood pressure(SBP) of 128 ± 17 mmH g vs nocturnal of 123 ± 19 mmH g(P = 0.004),and mean diurnal diastolic blood pressure(DBP) of 83 ± 11 mmH g vs nocturnal 78 ± 14 mmH g(P = 0.002).There was a significant difference between albuminuria at rest [median = 23 mg,interquartile range(IQR) = 10-51] and after exercise(median = 35 mg,IQR = 23-80,P < 0.001).Patients with exercise induced albuminuria had an increase in nocturnal BP values on all three components(128 mmH g vs 110 mmH g,P = 0.03 for SBP;83 mmH g vs 66 mmH g,P = 0.04;106 vs 83,P = 0.02 for mean arterial pressure),as well as albuminuric patients at rest.Moreover,exercise induced albuminuria detect a less increase in nocturnal DBP(83 vs 86,P = 0.03) than resting albuminuria.CONCLUSION Exercise induced albuminuria is associated with an increase in nocturnal BP values in T2D patients.

Hepatitis E virus: Western Cape, South Africa

AIM To conduct a prospective assessment of anti-hepatitis E virus(HEV) Ig G seroprevalence in the Western Cape Province of South Africa in conjunction with evaluating risk factors for exposure.METHODS Consenting participants attending clinics and wards of Groote Schuur, Red Cross Children's Hospital and their affiliated teaching hospitals in Cape Town, South Africa, were sampled. Healthy adults attending blood donor clinics were also recruited. Patients with known liver disease were excluded and all major ethnic/race groups were included to broadly represent local demographics. Relevant demographic data was captured at the time of sampling using an interviewer-administered confidential questionnaire. Human immunodeficiency virus(HIV) status was self-disclosed. HEV Ig G testing was performed using the Wantai? assay.RESULTS HEV is endemic in the region with a seroprevalence of 27.9%(n = 324/1161) 95%CI: 25.3%-30.5%(21.9% when age-adjusted) with no significant differences between ethnic groups or HIV status. Seroprevalence in children is low but rapidly increases in early adulthood. With univariate analysis, age ≥ 30 years old, pork and bacon/ham consumption suggested risk. In the multivariate analysis, the highest risk factor for HEV Ig G seropositivity(OR = 7.679, 95%CI: 5.38-10.96, P < 0.001) was being 30 years or older followed by pork consumption(OR = 2.052, 95%CI: 1.39-3.03, P < 0.001). A recent clinical case demonstrates that HEV genotype 3 may be currently circulating in the Western Cape.CONCLUSION Hepatitis E seroprevalence was considerably higher than previously thought suggesting that hepatitis E warrants consideration in any patient presenting with an unexplained hepatitis in the Western Cape, irrespective of travel history, age or ethnicity.

Ethambutol induced toxic optic neuropathy in HIV positive patients

AIMTo determine whether HIV and the use of antiretroviral therapy is a risk factor for the development of ethambutol toxic optic neuropathy. To describe the clinical course of ethambutol toxic optic neuropathy in patients with HIV and to identify prognostic factors.

Exercise-induced albuminuria vs circadian variations in blood pressure in type 1 diabetes

AIM To investigated the relationship between exerciseinduced ambulatory blood pressure measurement(ABPM) abnormalities in type 1 diabetes mellitus(T1DM) adolescents. METHODS We conducted a case-control at the National Obesity Center of the Yaoundé Central Hospital, Cameroon. We compared 24 h ABPM and urinary albumin-to-creatinine ratio(ACR) at rest and after a standardized treadmill exercise between 20 Cameroonian T1 DM patients and 20 matched controls. T1 DM adolescents were aged 12-18 years, with diabetes for at least one year, without proteinuria, with normal office blood pressure(BP) and renal function according to the general referencepopulation. Non-diabetic controls were adolescents of general population matched for sex, age and BMI.RESULTS Mean duration of diabetes was 4.2 ± 2.8 years. The mean 24 h systolic blood pressure(SBP) and diastolic blood pressure(DBP) were respectively 116 ± 9 mm Hg in the diabetic group vs 111 ± 8 mm Hg in the nondiabetic(P = 0.06), and 69 ± 7 mm Hg vs 66 ± 5 mm Hg(P = 0.19). There was no difference in the diurnal pattern of BP in diabetes patients and non-diabetic controls(SBP: 118 ± 10 mm Hg vs 114 ± 10 mm Hg, P = 0.11; DBP: 71 ± 7 mm Hg vs 68 ± 6 mm Hg, P = 0.22). Nighttime BP was higher in the diabetic group with respect to SBP(112 ± 11 mm Hg vs 106 ± 7 mm Hg, P = 0.06) and to the mean arterial pressure(MAP)(89 ± 9 mm Hg vs 81 ± 6 mm Hg, P = 0.06). ACR at rest was similar in both groups(5.5 mg/g vs 5.5 mg/g, P = 0.74), but significantly higher in diabetes patients after exercise(10.5 mg/g vs 5.5 mg/g, P = 0.03). SBP was higher in patients having exercise-induced albuminuria(116 ± 10 mm Hg vs 108 ± 10 mm Hg, P = 0.09). CONCLUSION Exercise-induced albuminuria could be useful for early diagnosis of kidney damage in adolescents with T1 DM.

Aorto-oesophageal fistula after corrosive ingestion:A case report

BACKGROUND Aorto-oesophageal fistula(AOF)are uncommon and exceedingly rare after corrosive ingestion.The authors report a case of AOF after corrosive ingestion that survived.A comprehensive literature review was performed to identify all cases of AOF after corrosive ingestion to determine the incidence of this condition,how it is best managed and what the outcomes are.CASE SUMMARY A previously healthy 30-year-old male,presented with a corrosive oesophageal injury after drain cleaner ingestion.He did not require acute surgical resection,but developed long-segment oesophageal stricturing,which was initially managed with cautious dilatation and later stenting.An AOF was suspected at endoscopy performed two months after the ingestion,when the patient represented with massive upper gastrointestinal bleeding.The fistula was confirmed on computerised tomographic angiography.The initial bleeding at endoscopy was temporised by oesophageal stenting;a second stent was placed when bleeding recurred later the same day.The stenting successfully achieved temporary bleeding control,but resulted in sudden respiratory distress,which was found to be due to left main bronchus compression caused by the overlapping oesophageal stents.Definitive bleeding control was achieved by endovascular aortic stent-grafting.A retrosternal gastroplasty was subsequently performed to achieve gastrointestinal diversion to reduce the risk of stent-graft sepsis.He was subsequently successfully discharged and remains well one year post injury.CONCLUSION AOF after corrosive ingestion is exceedingly rare,with a very high mortality.Most occur weeks to months after the initial corrosive ingestion.Conservative management is ill-advised.

HalcyonTM Acuros XB vs AAA: A RapidArc Planning Comparison for Head &Neck Cancers

The Halcyon O-ring gantry linear accelerator from Varian Medical Systems is delivered with a hardcoded beam-source model and Analytical Anisotropic Algorithm dose calculation algorithm as standard, while the Acuros XB algorithm is a purchasable option. The models in both algorithms are factory-configured and do not permit fine-tuning by the user. In this study, we compared the two algorithms for sequential boost RapidArc treatment planning of Head & Neck cancers using D98%, D95%, D50%, D2% and maximum dose to assess dose coverage of nodal and tumor planning target volumes (PTV_N and PTV_T, respectively), and cochlear D5%, parotid D20%, D50%, mean dose, and cord maximum dose to evaluate doses to organs- at-risk. The conformity index (CI), homogeneity index (HI) and total number of monitor units (MU) quantified plan quality. We found statistically significant differences in PTV_N D2%, maximum dose, HI, PTV_T D98%, D95%, D2%, Max, HI, and total MU. Statistically significant differences in Cochlear D5% and Parotid mean doses were also encountered. These differences may not necessarily be clinically significant, however. Therefore, we believe that both calculation algorithms are adequate for RapidArc planning of Head & Neck cancers.

Audit of Outcomes of Endoscopic Cholesteatoma Ear Surgery

Background: The objective of cholesteatoma surgery is not only to eradicate disease, but also reduce the risk of recurrence. While the use of the endoscope has been shown to reduce the rate of residual disease, there is currently insufficient data on recidivism and hearing outcomes following exclusive endoscopic use in cholesteatoma ear surgery. Objectives: Auditing outcomes of exclusive endoscopic surgery (EES) for the surgical management of cholesteatoma, with a secondary aim of comparing recidivism and hearing outcomes of 4 different surgical techniques, namely, EES, microscopic canal wall down (CWD), microscopic canal wall up (CWU) and combined endoscopic-microscopic techniques (CEM). Methods: A retrospective chart review was conducted at two tertiary academic hospitals in Cape Town, namely, Red Cross War Memorial Children’s Hospital (RCWMH) for patients below13 years and Groote Schuur Hospital (GSH) for patients above 13 years, over a 5 year period, between January 2012 and December 2016. Results: 128 cholesteatoma surgeries overall;110 patients were from GSH and 18 from RCWMH. Eight RCWMH patients underwent EES, 7 had CWU, 2 had CWD and 1 underwent CEM. Overall recidivism in the RCWMH population was 33% (6/18), 2 underwent EES, 2 underwent a microscopic CWU, 1 had a CWD and 1 underwent CEM. The mean postoperative hearing in this group was 40 dB from 50.3 decibels (dB) preoperatively. In the GSH group, 23 underwent an EES, 42 had a CWU, 40 underwent CWD and 5 underwent CEM. Overall recidivism for the GSH group was 17% (19/110). Of those, 7 underwent EES, 8 underwent microscopic CWU, 1 underwent CWD and 3 underwent CEM. Mean postoperative hearing was 47.4 dB from 48.4 dB preoperatively. Conclusions: The CWD technique demonstrated superior outcomes. In the GSH group, the EES approach had the same recurrence rate as CWU. Much higher recidivism was observed in the RCWMH group. Management of cholesteatoma requires a highly individualized approach to determine the most appropriate surgical treatment paradigm.

慢性胰腺炎外分泌功能不足患者菊粉和乳糖呼吸氢试验比较:对碳水化合物吸收不良参考标准的评价

Although often used as a reference standard in the breath hydrogen test(BHT), lactulose fermentation produces more hydrogen, compared to starch, and may there fore not be ideal. This study compares inulin with lactulose as reference standa rd in the study of carbohydrate malabsorption. Seventeen patients with malabsorp tion due to chronic pancreatitis and 15 normal controls were studied. Following overnight fasts, BHTs were performed after ingesting 10 g lactulose, 10 g inulin , and 200 g(16 g highly resistant starch) maize meal. Lactulose fermentation pro duced significantly more hydrogen than inulin in patients with malabsorption (97 ±20 vs 45±22 ppm·hr; P < 0.05) and controls (43 ±18 vs 21 ±10 ppm·hr; P < 0.05). Patients produced more hydrogen than controls with both standards (lactul ose, 97 ±20 vs 43 ±18 ppm·hr, P < 0.05; inulin 45 ±22 vs 21 ±10 ppm·hrs; P < 0.05), suggesting adaptation of the colonic flora. Calculated CHO malabsorpti on was 2.5 ±0.8 vs 5.2 ±3.8 g with lactulose and 5.2 ±3.1 vs 11.2 ±9.6 g wit h inulin as standards in controls and patients, respectively (P < 0.05). Lactulo se produces more breath hydrogen than inulin. Calculation of CHO malabsorption u sing these standards is therefore not comparable.

Antimicrobial stewardship and targeted therapies in the changing landscape of maternal sepsis

Pregnant and postnatal women are a high-risk population particularly prone to rapid progression to sepsis with significant morbidity and mortality worldwide.Moreover,severe maternal infections can have a serious detrimental impact on neonates with almost 1 million neonatal deaths annually attributed to maternal infection or sepsis.In this review we discuss the susceptibility of pregnant women and their specific physiological and immunological adaptations that contribute to their vulnerability to sepsis,the implications for the neonate,as well as the issues with antimicrobial stewardship and the challenges this poses when attempting to reach a balance between clinical care and urgent treatment.Finally,we review advancements in the development of pregnancy-specific diagnostic and therapeutic approaches and how these can be used to optimize the care of pregnant women and neonates.

Prevalence and correlates of depressive symptoms in adult patients with pulmonary tuberculosis in the Southwest Region of Cameroon

Background:Tuberculosis(TB)remains a global health challenge and depression is a significant contributor to the global burden of disease.Current evidence suggests that there is an association between depressive symptoms and TB,lower adherence to treatment,and increased morbidity and mortality.However,there is paucity of data regarding these associations in Cameroon.This study aimed to determine the prevalence and correlates of depression in adult patients with pulmonary TB(PTB)in the Southwest Region of Cameroon.Methods:A hospital-based cross-sectional study involving 265 patients with PTB was conducted from 2nd January to 31st March 2015 in the Limbe Regional Hospital and the Kumba District Hospital.Depression was diagnosed using the standard nine-item Patient Health Questionnaire,and classified as none,mild or moderate.Logistic regressions were used to investigate correlates of depression in these patients.Results:Of the 265 patients(mean age 36.9±10 years)studied,136(51.3%)were female.The prevalence of depression was 61.1%(95%CI:55.1–66.8),with a significant proportion(36.6%)having mild depression.Multivariable logistic regression analysis showed that being female(aOR=3.0,95%CI(1.7–5.5),P<0.001),having a family history of mental illness(aOR=2.5,95%CI:1.3–5.4,P>0.05),being on retreatment for TB(aOR=11.2,95%CI:5.2–31.1,P<0.001),having discontinued treatment(aOR=8.2,95%CI:1.1–23.3,P<0.05)and having a HIV/TB co-infection(aOR=2.5,95%CI:1.2–6.5,P<0.001)were factors associated with having a higher chance of being depressed.Conclusion:Our study suggests that there is a high prevalence of depression among PTB patients,with more than one in two patients affected.Multidisciplinary care for TB patients involving mental health practitioners is highly encouraged,especially for high-risk groups.

Ⅱ区屈肌腱修复装置——多中心、随机、盲试、临床试验

背景：不锈钢Teno Fix肌腱修复装置的生物力学特性较缝合修复有所改善．并在狗模型中有很好的相容性。本文的目的是在临床上对Teno Fix修复与缝合修复作比较。方法：67例单纯Ⅱ区屈肌腱损伤随机地用Teno Fix修复或4股交叉缝合修复。共85个损伤指：34个指用Teno Fix，51个指作对照．采用改良Kleinert康复技术，术后4周开始主动屈指。术后6个月由肓测检查者测定患者的手指活动范围．臂、肩、手的伤残（DASH）记分，捏力，握力和口诉的疼痛记分以及评价肿胀和神经系统恢复。经常间断地监测包括装置的移动和断裂等不良结果。结果：51指缝合修复中有9指肌腱断裂，而Teno Fix修复中无一指肌腱断裂（p〈0．01）。断裂的9指中5指因抵抗医疗装置的活动而造成。组间的活动范围，DASH记分、捏力、握力、肿胀或神经系统恢复差异无显著性。Teno Fix组疼痛和肿胀的消退比对照组稍慢。患者在6个月随访时，24例Teno Fix修复中16例和27例对照修复组中19例结果为优良。1例Teno Fix装置移动和被挤出，继发伤口感染。总的85指手术中，4指肌腱粗细不适合于用所提供的装置，9指被认为暴露不适当而无法置入锚。结论：如肌腱粗细和暴露满意，用Teno Fix修复屈肌腱损伤是安全和有效的。与传统修复方法相比．用Teno Fix作肌腱修复，其肌腱断裂率较低而功能结果相似，特别适用于对康复方案不配合者。