儿童频繁瞬目征的病因及综合治疗

[目的]探讨儿童频繁瞬目征的发病原因及其治疗措施。[方法]随机抽取148例门诊频繁瞬目征患儿,对其生活习惯、眼部情况进行详细询问并进行病因分析及综合治疗。[结果]通过克服不良生活习惯、去除诱因、调节心理和综合治疗措施,148例频繁瞬目征患儿经2周~5周的治疗,115例患儿治愈,28例好转,5例无效。[结论]频繁瞬目征与玩电脑、看电视及偏食有一定关系,针对性综合治疗可获得较满意的疗效。     

儿童异常瞬目症645例分析

正常瞬目频率为每分钟8~20次[1],属非随意眼睑运动,对眼角膜上皮起滋润保护作用[2]。儿童频繁眨眼,每分钟可达15次以上,称为儿童异常瞬目症。本研究对2013年1月至2014年3月来院的645例异常瞬目患儿的诊治过程进行分析总结。1资料与方法1.1一般资料将每5秒钟以内瞬目一次作异常瞬目。随机收集我科门诊异常瞬目患儿645例,男421例,女224例,年龄8个月~15岁,平均5岁,起病时间年所有患儿主要表     

小儿多瞬症420例诊治探讨

目的分析小儿频繁瞬目的发病原因及治疗。方法对我院2006年2月至2009年2月频繁瞬目2～15周岁小儿420例，依据其病史、视力、眼位、结膜、角膜检查、裂隙灯、眼底镜、屈光检查以及其他辅助检查等方面寻找病因，进而治疗。结果420例频繁瞬目小儿中各类屈光不正共189例，占45％，验光后暂时停止使用电脑及游戏机，等瞳孔恢复正常大小后配镜及时矫正屈光不正，177例患儿异常瞬目症状逐步消失，12例减轻表现。眼表疾患共158例，占37．61％，其中包括慢性结膜炎、春季卡他性结膜炎、滤泡性结膜炎、沙眼、结膜结石、内翻倒睫、霰粒肿、浅层点状角膜炎、睑缘炎等眼疾病，其中慢性结膜炎占105例，使用针对病因的治疗后，其异常瞬目症状也基本消失，有效率达98％。另外发现40例与营养不良有关，19例与神经功能系统疾患有关，不良习惯14例。结论多种病因可导致小儿频繁瞬目，其中屈光不正和眼表疾病是小儿多瞬症的主要病因，对小儿多瞬症的治疗，要认真细致的检查，找出其病因，及时治疗。     

小儿频繁瞬目的临床分析

小儿频繁瞬目是眼科门诊常见的一种症状，本文对112例患者进行了统计分析，现总结如下。 1 临床资料 112例患儿均以频繁瞬目为主要症状，男72例，女40例，年龄3～14岁，平均年龄8．25岁。起病时间1周以内者64例，1周以上者46例，1个月内治愈者36例，反复发作者（间断发作3次以上者）52例。饮食与体形：食欲差消瘦者65例，食欲一般营养中等32例，食欲好肥胖者15例。所有患者智力均正常，无面部抽动等并发症。裂隙灯、眼底检查。     

头颈部放射治疗致口腔黏膜炎病人的饮食护理

[目的]探讨临床头颈部放射治疗中采取综合饮食护理措施和方法，以减轻放射治疗致口腔黏膜反应带来的治疗障碍及病人的痛苦，提高病人的生活质量。[方法]选取鼻咽癌需头颈部放射治疗病人82例，随机分成干预组和对照组，干预组采用综合饮食护理干预，对照组则不予系统饮食干预。于放疗第2周、第4周、第7周对口腔黏膜进行评估。[结果]干预组第4周、第7周Ⅲ级、Ⅳ级口腔黏膜炎发生率明显低于对照组。[结论]综合饮食护理干预措施的实施减轻了头颈部放射治疗的毒性反应。     

小儿地中海贫血同胞异基因造血干细胞移植术后并发出血性膀胱炎的护理

[目的]探讨小儿地中海贫血同胞异基因造血干细胞移植术后并发出血性膀胱炎的护理策略。[方法]对收治的小儿地中海贫血同胞异基因造血干细胞移植15例患儿中并发出血性膀胱炎(HC)的5例患儿的护理措施及效果进行总结和分析。[结果]5例出血性膀胱炎患儿通过细致观察、及时准确用药、精细护理,尿频、尿急、尿痛等膀胱刺激征症状消失,无一例出现出血性膀胱炎相关死亡。[结论]在小儿地中海贫血同胞异基因造血干细胞移植过程中,细心观察并发症的出现、准确分析并发症出现的原因、及时正确处理是关键因素,有助于提高移植成功率及改善患儿的生活质量。     

30例过敏性紫癜性肾炎患儿的临床观察及护理干预

[目的]总结过敏性紫癜性肾炎患儿的临床观察及护理干预措施。[方法]对30例过敏性紫癜性肾炎患儿进行治疗,同时加强临床观察及护理干预。[结果]本组患儿控制好转出院27例,自动出院或转院3例;5例出院后再发入院,1例因住院期间饮食不当再发而延长住院。[结论]加强过敏性紫癜性肾炎患儿的临床观察及护理干预有利于预后。     

28例支气管哮喘患儿的护理

[目的]总结儿童支气管哮喘疾病的临床护理经验。[方法]选择收治的28例支气管哮喘患儿,进行对症、支持、抗感染治疗,同时给予相应的护理措施。[结果]28例哮喘患儿经过治疗和综合护理后,症状控制,未出现并发症,效果良好,全部治愈出院。[结论]对临床确诊的支气管哮喘患儿及时治疗,精心护理,可减少并发症,降低复发率,提高患儿的生活质量。     

手足口病患儿的消毒隔离与护理

[目的]探讨消毒隔离及护理手足口病的方法,以便及时护理,尽早发现病情变化,患儿能得到正确有效的治疗,减少致残和死亡。[方法]回顾性分析我院护理的手足口病患儿144例,采取严格消毒隔离,综合护理方法,包括注意休息、加强营养、皮肤和口腔等对症护理措施。[结果]144例患儿全部治愈出院,无任何并发症。[结论]消毒隔离及综合护理是减少手足口病传染、感染及致残或死亡的有效方法。     

家庭护理干预对首发儿童精神分裂症病人疗效的影响

[目的]探讨家庭护理干预对首发儿童精神分裂症病人疗效的影响。[方法]选择在我院门诊就诊的60例首发儿童精神分裂症病人，随机分为常规组和研究组各30例。常规组给予一般的门诊服务，进行常规的用药指导及预约门诊。研究组除给予一般的门诊服务方式外，进行家庭护理干预，采取面谈、电话等形式与病人及家属进行心理沟通。8周后按我国现行4级疗效评定标准进行疗效评估。[结果]两组患儿治疗8周时，显效率比较有统计学意义（P〈0．05）。[结论1家庭护理干预能明显提高首发儿童精神分裂症病人的治疗效果，是药物治疗手段以外的重要辅助治疗措施，对病儿及家属尤为重要。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.