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Retrospective study of ureteral stenosis after holmium laser lithotripsy 钬激光碎石术后输尿管狭窄的回顾性研究
IF 1.6 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-14 DOI: 10.1177/03000605241275333
Jia Wei He
ObjectiveTo identify the factors influencing postoperative ureteral stenosis following holmium laser lithotripsy.MethodsA retrospective study was conducted of 106 patients who underwent ureteroscopic holmium laser lithotripsy. The effects of variables including stone location, stone size, the duration of surgery, water intake, disease duration, and stone-associated polyps were investigated.ResultsLogistic regression analysis revealed significant associations of ureteral stenosis with stone location, stone size, duration of surgery, water intake, disease duration, and stone-associated polyps. Patients with proximal stones, with large stones, who underwent long surgical procedures, who drank a large amount of water, who had long-term disease, and who had stone-related polyps were more likely to develop postoperative ureteral stenosis.ConclusionSignificant perioperative complications of holmium laser lithotripsy are associated with prolonged disease, large ureteral stones, long incarceration periods, and the presence of polyps. Surgeons should consider these risk factors during the preoperative evaluation of patients and surgical planning to minimize the risk of postoperative ureteral stenosis.
方法 对 106 名接受输尿管镜钬激光碎石术的患者进行了回顾性研究。结果逻辑回归分析显示,输尿管狭窄与结石位置、结石大小、手术时间、水摄入量、病程和结石相关息肉有显著相关性。结论钬激光碎石术的围手术期并发症与病程长、输尿管结石大、嵌顿时间长和息肉的存在有关。外科医生在对患者进行术前评估和手术规划时应考虑到这些风险因素,以最大限度地降低术后输尿管狭窄的风险。
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引用次数: 0
Incarcerated gravid uterus liberated by vaginal gauze packing under general anesthesia: a case report 在全身麻醉下通过阴道纱布包扎解放嵌顿妊娠子宫:病例报告
IF 1.6 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-12 DOI: 10.1177/03000605241275006
Mingbao Li, Zhou Yang, Wanjun Yin, Yafei Ma, Rui Li, Yonghui Jiang, Yuan Liu
Incarceration of the gravid uterus is a rare and serious obstetric complication that can lead to severe complications. We present the case of a 32-year-old woman (gravida 5, para 2022) at 12 weeks and 5 days of gestation who presented with urinary retention and lower abdominal pain. Despite attempts at positional changes and manipulative repositioning under epidural anesthesia, the incarceration of the gravid uterus persisted. Subsequent intervention under general anesthesia involved partially reducing the uterine fundus into the abdominal cavity and using gauze strips in the posterior vaginal fornix to maintain traction. In addition, the bilateral round ligaments of the uterus were sutured to release the incarcerated uterus via laparoscopy. Vaginal gauze packing under general anesthesia may be a beneficial intervention for addressing cases of an incarcerated uterus, particularly in patients in whom passive maneuvers and manual pressure fail to resolve the condition.
妊娠子宫嵌顿是一种罕见的严重产科并发症,可导致严重的并发症。我们介绍了一例妊娠 12 周零 5 天的 32 岁产妇(孕 5,para 2022),她出现尿潴留和下腹痛。尽管在硬膜外麻醉下尝试了改变体位和手法复位,但妊娠子宫的嵌顿依然存在。随后在全身麻醉下进行了干预,将子宫底部分缩入腹腔,并在阴道后穹窿处使用纱条保持牵引力。此外,还通过腹腔镜缝合了双侧子宫圆韧带,以释放嵌顿的子宫。在全身麻醉的情况下进行阴道纱布包扎可能是解决嵌顿子宫病例的一种有益干预措施,尤其是对那些被动操作和人工加压都无法解决问题的患者。
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引用次数: 0
Medullary infarction with central facial paralysis as the only symptom: a case report 以中枢性面瘫为唯一症状的髓质梗死:一份病例报告
IF 1.6 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-12 DOI: 10.1177/03000605241276468
Ruiqi Tian, Yingying Zhou, Wei Tang, Zhen Zhu
The anatomical structure of the medulla oblongata is complex, its nerve fibers are dense, and its blood vessels are complex. Clinical manifestations of ischemic damage to the medulla oblongata are therefore relatively diverse, and include vertigo, dysphagia, and dysarthria. Although facial paralysis may also occur, medullary infarction with facial paralysis as the first and only symptom is rare. Herein, we report a case of medullary infarction with ipsilateral central facial paralysis as the only symptom.
延髓的解剖结构复杂,神经纤维密集,血管复杂。因此延髓缺血性损伤的临床表现相对多样,包括眩晕、吞咽困难和构音障碍。虽然面瘫也可能发生,但以面瘫为首发和唯一症状的延髓梗死并不多见。在此,我们报告了一例以同侧中枢性面瘫为唯一症状的髓质梗死病例。
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引用次数: 0
Distribution of mHealth applications in Germany: analysis of the FeverApp registry 德国移动医疗应用程序的分布:对 FeverApp 注册表的分析
IF 1.6 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-10 DOI: 10.1177/03000605241274550
Moritz Gwiasda, Larisa Rathjens, David D. Martin, Ricarda Möhler, Silke Schwarz, Ekkehart Jenetzky
ObjectiveIn this observational study, we determined the distribution of mHealth applications (apps) in Germany using data from the FeverApp registry.MethodsThe registry data were processed to assess general monthly trends in app distribution, and a seasonal autoregressive integrated moving average model was decomposed to investigate time series. A sample comparison was made matching data from cold-called against self-registered distributers of the FeverApp.ResultsAmong 881 pediatric and adolescent medical practices, 27,300 app users were recruited between 2019 and August 2023. The number of monthly recruited users increased steadily. A seasonal trend was observed, showing a higher distribution in winter months. Self-registered pediatric practices did not recruit significantly more app users than cold-called practices, with approximately every 25th family recruited in both groups.ConclusionsThe trend of more app sign-ups during winter is likely related to the flu season in Germany. Intrinsic and extrinsic motivational factors of the practices seem to have a large impact on the distribution. We observed a positive trend in the app distribution. Seasonal febrile infections and individual distribution methods among practices influence the distribution of the FeverApp in Germany. Family factors may have a greater influence than the motivation of distributing practices.
方法 对注册数据进行处理,以评估应用程序分布的总体月度趋势,并分解季节性自回归综合移动平均模型以研究时间序列。结果2019年至2023年8月期间,在881家儿科和青少年医疗机构中,共招募了2.73万名应用用户。每月招募的用户数量稳步增长。观察到的季节性趋势显示,冬季的用户分布较多。自我注册的儿科诊所招募到的应用程序用户数量并没有明显多于冷召诊所,两组诊所中大约每25个家庭就招募到一个应用程序用户。诊所的内在和外在动机因素似乎对分布情况有很大影响。我们观察到应用程序的分发呈积极趋势。在德国,季节性发热感染和各医疗机构的分发方法影响着发热应用程序的分发。家庭因素的影响可能大于分发机构的动机。
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引用次数: 0
The difficulties and solutions in operationalising a hybrid operating room 运行混合手术室的困难和解决方案
IF 1.6 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-10 DOI: 10.1177/03000605241270700
Tahmid Zaman, Aman Berry Williams, Tejas Singh, Grace Ellwood, Zoheb Williams
As the population ages and grows, health services must evolve in ways to offer versatile patient care, whilst improving patient outcomes and maintaining long-term economic viability. A facility assisting in the provision of such healthcare is the hybrid operating room (HOR): a specialised suite allowing simultaneous radiological and surgical diagnostics and therapeutics in a single episode of care. Versatile and customizable, the HOR is utilised by a broad range of subspecialties in elective and emergency settings, including (but not limited to) vascular surgery, trauma surgery and interventional radiology. Though the benefits of hybrid techniques to patient care are well known, the actual steps in operationalising the HOR can be challenging if not considered and coordinated appropriately. The intention of this narrative review is to highlight issues and suggest solutions in the design and commissioning of an HOR. Key areas in need of specific attention include stakeholder involvement, economic feasibility, suite location, workflow planning, hybrid equipment choice, and team organisation.
随着人口的老龄化和增长,医疗服务必须与时俱进,以提供多功能的病人护理,同时改善病人的治疗效果,并保持长期的经济可行性。混合手术室(HOR)就是协助提供此类医疗服务的设施之一:这是一个专门的套间,可在一次治疗中同时进行放射和手术诊断及治疗。混合手术室用途广泛且可定制,可用于各种亚专科的择期手术和急诊,包括(但不限于)血管外科、创伤外科和介入放射科。虽然混合技术对患者护理的益处众所周知,但如果考虑不周、协调不当,实际操作 HOR 的步骤可能会具有挑战性。本综述旨在强调 HOR 设计和调试过程中存在的问题,并提出解决方案。需要特别关注的关键领域包括利益相关者的参与、经济可行性、套间位置、工作流程规划、混合设备选择和团队组织。
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引用次数: 0
A few-shot learning framework for the diagnosis of osteopenia and osteoporosis using knee X-ray images. 利用膝关节 X 光图像诊断骨质增生和骨质疏松症的少量学习框架。
IF 1.4 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-01 DOI: 10.1177/03000605241274576
Hua Xie, Chenqi Gu, Wenchao Zhang, Jiacheng Zhu, Jin He, Zhou Huang, Jinzhou Zhu, Zhonghua Xu

Objective: We developed a few-shot learning (FSL) framework for the diagnosis of osteopenia and osteoporosis in knee X-ray images.

Methods: Computer vision models containing deep convolutional neural networks were fine-tuned to enable generalization from natural images (ImageNet) to chest X-ray images (normal vs. pneumonia, base images). Then, a series of automated machine learning classifiers based on the Euclidean distances of base images were developed to make predictions for novel images (normal vs. osteopenia vs. osteoporosis). The performance of the FSL framework was compared with that of junior and senior radiologists. In addition, the gradient-weighted class activation mapping algorithm was used for visual interpretation.

Results: In Cohort #1, the mean accuracy (0.728) and sensitivity (0.774) of the FSL models were higher than those of the radiologists (0.512 and 0.448). A diagnostic pipeline of FSL model (first)-radiologists (second) achieved better performance (0.653 accuracy, 0.582 sensitivity, and 0.816 specificity) than radiologists alone. In Cohort #2, the diagnostic pipeline also showed improved performance.

Conclusions: The FSL framework yielded practical performance with respect to the diagnosis of osteopenia and osteoporosis in comparison with radiologists. This retrospective study supports the use of promising FSL methods in computer-aided diagnosis tasks involving limited samples.

目的我们开发了一种用于诊断膝关节 X 光图像中骨质增生和骨质疏松症的少量学习(FSL)框架:我们对包含深度卷积神经网络的计算机视觉模型进行了微调,以实现从自然图像(ImageNet)到胸部 X 光图像(正常与肺炎、基础图像)的泛化。然后,基于基础图像的欧氏距离开发了一系列自动机器学习分类器,以便对新图像(正常与骨质疏松症与骨质疏松症)进行预测。FSL 框架的性能与初级和高级放射科医生的性能进行了比较。此外,梯度加权类激活映射算法也被用于视觉判读:在队列 1 中,FSL 模型的平均准确度(0.728)和灵敏度(0.774)均高于放射科医生(0.512 和 0.448)。由 FSL 模型(第一位)和放射科医生(第二位)组成的诊断流水线比单纯由放射科医生组成的诊断流水线取得了更好的效果(准确性为 0.653,灵敏度为 0.582,特异性为 0.816)。在 2 号队列中,诊断管道的性能也有所提高:与放射科医生相比,FSL 框架在诊断骨质疏松症和骨质疏松症方面具有实用性。这项回顾性研究支持在涉及有限样本的计算机辅助诊断任务中使用前景广阔的 FSL 方法。
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引用次数: 0
Wernicke encephalopathy in a patient with medullary infarctions: a case report. 一名延髓梗塞患者的韦尼克脑病:病例报告。
IF 1.4 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-01 DOI: 10.1177/03000605241274570
Lu Wang, Guan-Jie Song, Hong-Jun Su

Wernicke encephalopathy (WE) is an acute life-threatening neurological condition caused by thiamine (vitamin B1) deficiency. Patients with WE often present with a triad of symptoms consisting of ophthalmoplegia, gait ataxia, and mental confusion. If WE is not treated in a timely manner, it can lead to serious complications such as confusion, coma, or death. Although alcohol abuse is the most commonly reported cause of WE, nonalcoholic causes-although rare-do exist. Herein, we present the case of a nonalcoholic woman with medullary infarctions who presented with intractable vomiting. Her clinical state subsequently progressed to include ophthalmoplegia and gait ataxia. A diagnosis of WE was suspected based on her clinical presentation; this was confirmed by brain magnetic resonance imaging (MRI) and the finding of decreased serum thiamine levels. Brain magnetic resonance imaging demonstrated the complete resolution of abnormal hyperintensities during a follow-up visit, 6 months after treatment.

韦尼克脑病(Wernicke encephalopathy,WE)是一种由硫胺素(维生素 B1)缺乏引起的危及生命的急性神经系统疾病。WE患者通常会出现眼球震颤、步态共济失调和精神错乱三联症状。如果不及时治疗,WE 可导致严重的并发症,如精神错乱、昏迷或死亡。虽然酗酒是最常见的 WE 病因,但也存在非酒精性病因(虽然罕见)。在此,我们介绍一例患有髓质梗塞的非酒精性女性患者,她出现了难治性呕吐。她的临床症状随后发展为眼球震颤和步态共济失调。根据她的临床表现,怀疑她被诊断为 WE;脑磁共振成像(MRI)和血清硫胺素水平下降证实了这一诊断。在治疗 6 个月后的随访中,脑磁共振成像显示异常高密度完全消失。
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引用次数: 0
Association between interleukin-6 levels and stroke: a systematic review and meta-analysis. 白细胞介素-6 水平与中风的关系:系统综述与荟萃分析。
IF 1.4 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-01 DOI: 10.1177/03000605241274626
Xinyi Huang, Manman Zhang, Jiaojiao Wang, Fuyong Hu

Objectives: We aimed to evaluate the association of interleukin-6 (IL-6) expression levels with stroke.

Methods: According to the set search strategy, we systematically screened relevant studies using PubMed and extracted study results regarding IL-6 from the literature for comprehensive quantitative analysis to explore the relationship between IL-6 level and stroke risk.

Results: This study included 15 publications with a total of 1696 participants, with 975 cases in the case group and 721 cases in the control group. Meta-analysis showed that IL-6 levels were significantly higher in the stroke population than those in the control group (standardized mean difference = 1.22, 95% confidence interval = 0.79-1.64). Subgroup analysis showed that there was no significant difference in heterogeneity for IL-6 detection methods between the two groups (I2 = 0, P = 0.47). The difference in heterogeneity test results regarding geographic region was statistically significant (I2 = 89.7%, P < 0.01). The results of heterogeneity testing for mean participant age were also statistically significant (I2 = 84.3%, P = 0.01).

Conclusion: The present study results showed that IL-6 may be significantly associated with stroke development.

目的:我们旨在评估白细胞介素-6(IL-6)表达水平与中风的关系:我们旨在评估白细胞介素-6(IL-6)表达水平与脑卒中的关系:根据设定的检索策略,我们使用 PubMed 系统地筛选了相关研究,并从文献中提取了有关 IL-6 的研究结果进行综合定量分析,以探讨 IL-6 水平与脑卒中风险之间的关系:本研究共收录了 15 篇文献,共计 1696 名参与者,其中病例组 975 例,对照组 721 例。元分析显示,中风人群的 IL-6 水平明显高于对照组(标准化平均差 = 1.22,95% 置信区间 = 0.79-1.64)。亚组分析显示,两组间 IL-6 检测方法的异质性无明显差异(I2 = 0,P = 0.47)。地理区域的异质性检验结果差异有统计学意义(I2 = 89.7%,P 0.01)。参与者平均年龄的异质性检验结果也具有统计学意义(I2 = 84.3%,P = 0.01):本研究结果表明,IL-6 可能与脑卒中的发生密切相关。
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引用次数: 0
Nudging strategies to influence prescribers' behavior toward reducing opioid prescriptions: a systematic scoping review. 影响处方者减少阿片类药物处方行为的激励策略:系统性范围综述。
IF 1.6 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-01 DOI: 10.1177/03000605241272733
Salwan Diwan,Andreas Vilhelmsson,Axel Wolf,Pether Jildenstål
OBJECTIVEThis systematic scoping review aimed to map the literature on the use of various nudging strategies to influence prescriber behavior toward reducing opioid prescriptions across diverse healthcare settings.METHODSA systematic database search was conducted using seven electronic databases. Only articles published in English were included. A total of 2234 articles were identified, 35 of which met the inclusion criteria. Two independent dimensions were used to describe nudging strategies according to user action and the timing of their implementation.RESULTSSix nudging strategies were identified. The most common strategy was default choices, followed by increasing salience of information or incentives and providing feedback. Moreover, 32 studies used the electronic health record as an implementation method, and 29 reported significant results. Most of the effective interventions were multicomponent interventions (i.e., combining nudge strategies and non-nudge components).CONCLUSIONSMost nudging strategies used a passive approach, such as defaulting prescriptions to generics and requiring no action from the prescriber. Although reported as effective, this approach often operates under the prescriber's radar. Future research should explore the ethical implications of nudging strategies.INPLASY registration number: 202420082.
目的本系统性范围界定综述旨在对不同医疗机构中使用各种劝导策略影响处方者减少阿片类药物处方行为的文献进行梳理。方法使用七个电子数据库进行了系统性数据库检索。仅收录以英文发表的文章。共发现 2234 篇文章,其中 35 篇符合纳入标准。根据用户行动及其实施时间,使用两个独立维度来描述引导策略。最常见的策略是默认选择,其次是增加信息或激励措施的显著性以及提供反馈。此外,有 32 项研究使用电子健康记录作为实施方法,其中 29 项报告了显著的结果。结论大多数劝导策略采用被动方法,如默认处方为非专利药,不要求处方者采取任何行动。尽管据报道这种方法很有效,但它往往在处方者的眼皮底下运作。未来的研究应探讨诱导策略的伦理意义。INPLASY 注册号:202420082。
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引用次数: 0
Risk factors for patients with tracheal stenosis: a systematic review and meta-analysis. 气管狭窄患者的风险因素:系统回顾和荟萃分析。
IF 1.6 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-09-01 DOI: 10.1177/03000605241275884
Siqi Hong,Xiaobing Wu,Haihuan Feng,Qing Zhang,Xiaohan Wang,Minmin Chang,Xiuli Chen,Weijuan Liu
OBJECTIVETo systematically evaluate potential risk factors for tracheal stenosis and to provide a reference for the prevention and management of patients with this condition.METHODSDatabases were searched to identify studies of the risk factors for tracheal stenosis, from their inception to October 2023, then a meta-analysis was performed. The study was registered with PROSPERO under the registration number CRD42023428906.RESULTSTen studies of a total of 2525 patients were included. The meta-analysis showed that tracheotomy, diabetes, the duration of intubation, the duration of mechanical ventilation, respiratory tract infection, a high incision, and a ratio of intratracheal tube cuff diameter (C)/transverse diameter at the level of the clavicle (T) >150% were risk factors for the development of tracheal stenosis.CONCLUSIONMeasures such as shortening the duration of mechanical ventilation and intubation, reducing and avoiding tracheotomy after prolonged intubation, early tracheotomy in patients with obesity who require prolonged mechanical ventilation, appropriate choices of incision location and catheter, the maintenance of appropriate C/T, the prevention of respiratory infection, and the control of diabetes mellitus should limit the risk of tracheal stenosis.
目的系统评估气管狭窄的潜在风险因素,为气管狭窄患者的预防和管理提供参考。方法检索数据库,确定从开始到 2023 年 10 月有关气管狭窄风险因素的研究,然后进行荟萃分析。该研究已在 PROSPERO 注册,注册号为 CRD42023428906。结果共纳入 10 项研究,涉及 2525 名患者。荟萃分析表明,气管切开术、糖尿病、插管时间、机械通气时间、呼吸道感染、切口过高以及气管导管袖带直径(C)/锁骨水平横径(T)之比大于 150% 是气管狭窄发生的危险因素。结论缩短机械通气和插管的时间、减少和避免长时间插管后的气管切开、对需要长时间机械通气的肥胖患者尽早进行气管切开、适当选择切口位置和导管、保持适当的 C/T、预防呼吸道感染和控制糖尿病等措施应能限制气管狭窄的风险。
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引用次数: 0
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Journal of International Medical Research
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