Objective:To describe the effect of distraction lengthening to correct nail deformity in unilateral congenital brachydactyly type D (BDD).Methods:Patients with unilateral BDD who were treated by distraction lengthening between January 2020 and December 2021 in the Department of Plastic and Reconstructive Surgery of Shanghai 9th People’s Hospital were retrospectively reviewed. A transverse osteotomy was applied on the middle diaphysis of distal phalanx, and one pin was inserted percutaneously on both sides of the osteotomy site, then a mini external fixator was installed. Distraction lengthening was performed with a slow and sustained procedure. The aesthetic and functional results were compared preoperatively and postoperatively. Patient satisfaction questionnaires were recorded.Results:35 patients were enrolled, including 12 males and 23 females, with a mean age of 29.5 years. 17 thumbs were left and 18 thumbs were right. The time for distraction lengthening was 10-17 days, and the mean time was 12.3 days. The total time for external fixator maintenance was 55-70 days, with a mean time of 61.4 days. The mean follow-up was 18.6 months. The mean thumbnail length was increased from (9.2±0.6) mm to (14.2±0.4) mm [lengthening ratio, (54.4±7.5)%] after distraction lengthening ( P<0.05). The ratio of nail length to width changed from 0.63±0.05 to 1.05±0.04 [increase ratio, (68.2±10.5)%, P<0.05], which was equal to the normal value (1.07±0.03) ( P>0.05). Meanwhile, the distal thumb length increased from (22.6±0.7) mm to (29.6±1.0) mm ( P<0.05), with a mean increase of (6.9±1.0) mm, and the increase ratio was (30.8±4.8)%. The ratio of nail length to distal thumb length changed from 0.41±0.03 to 0.51±0.02 [increase ratio, (23.6±8.3) %, P<0.05]. The thumb function was not significantly influenced ( P>0.05). 33 patients (94.3%) were very satisfied with the results. Conclusion:Short nail deformity in BDD can be corrected by distraction lengthening with a good aesthetic appearance and without functional impairment.

并指畸形是指相邻指间软组织和(或)骨骼不同程度的融合,是最常见的手部先天性畸形之一,手术分离是其最重要的治疗手段.通过引入精准康复理念,对并指畸形术后康复方案进行全面优化,可以进一步提高患者康复疗效.本共识以循证医学证据为依据,经过全国专家组反复讨论,同时借鉴和参考国内外近年来的研究成果,供全国手外科医师、康复医师、康复治疗师、康复工程师、护理人员等在临床工作中参考使用.本共识主要内容包括先天性并指畸形术后康复的目标、关注的问题、治疗的主要内容、团队的组成与职责、治疗手段与措施以及推荐康复方案等.

新型冠状病毒肺炎(以下简称新冠肺炎)发生以来,综合医院的急诊科成为一道坚实的防火墙.在救治急危重症的同时,如何短时间内有序、有效、快速和安全地开展抗击新冠肺炎工作,是疫情期间急诊科医疗工作所面对的重大挑战,本文总结北京大学第三医院急诊科抗击新冠肺炎疫情的防控实践经验,为同行提供参考.

目的 鉴定一个中国先天性指间关节黏连家系的致病基因,为遗传咨询提供依据.方法 Sanger测序对NOG及GDF5外显子区域进行测序分析.计算机模拟突变noggin-gdf5三维空间结构.C2C12细胞体外成骨诱导分化,验证突变noggin蛋白对成骨分化的抑制作用.结果 Sanger测序结果显示患者均存在NOG基因(c.499C>G p.R167G)杂合错义突变.蛋白质空间结构模拟显示突变位点位于noggin与gdf5结合处.体外细胞分化显示突变蛋白体对C2C12成骨抑制作用减弱.结论 NOG基因c.499C>G杂合错义突变使noggin抑制成骨作用降低,产生关节黏连的表型,是该家系的致病原因.

目的 探索采用指间关节侧方减容的方法 治疗厚皮指症的临床效果.方法 对15例(58指)厚皮指症患者采用指间关节侧方减容的手术方式进行矫正,使用Strickland TAM标准评价术后关节功能,采用温哥华瘢痕评分量表评价术后瘢痕情况,运用密歇根量表评价患者满意度.结果 患者术后平均随访2.2年,根据Strickland TAM标准,优58指,优良率100％;VSS瘢痕评分平均1.2分;密歇根量表评分13例患者为非常满意,2例患者为满意.结论 指间关节侧方减容的手术方法 可有效矫正厚皮指症的外形,术后瘢痕不明显,对手指关节功能无不良影响.

目的分析脑动脉CT血管成像（CT angiography,CTA）、磁共振血管成像（Magnetic resonance angiography,MRA）分别联合血清基质金属蛋白酶9（matrix metalloproteinase 9,MMP-9）、天冬氨酸特异性半胱氨酸蛋白酶3（Caspase-3）在颅内动脉瘤诊断中的应用价值。方法选取上海市第一人民医院收治的86例疑似颅内动脉瘤患者,术前常规检查血清MMP-9、Caspase-3水平,并行CTA与MRA诊断,以手术病理为"金标准",比较CTA、MRA分别联合血清MMP-9、Caspase-3诊断准确性、特异度、灵敏度,观察2种联合诊断方式对动脉瘤分布的检查情况。结果 CTA联合血清MMP-9、Caspase-3诊断颅内动脉瘤灵敏度97.37%,特异度90.00%,准确性96.51%,Kappa值0.84;MRA联合血清MMP-9、Caspase-3诊断灵敏度85.53%,特异度70.00%,准确性83.72%,Kappa值0.41;CTA联合血清MMP-9、Caspase-3诊断灵敏度、准确性显著高于MRA联合血清MMP-9、Caspase-3（P＜0.05）,且在诊断动脉瘤分布情况方面优于MRA联合血清MMP-9、Caspase-3。结论与MRA相比,CTA联合血清MMP-9、Caspase-3对颅内动脉瘤诊断灵敏度、准确性更高,CTA在动脉瘤分布情况显示方面具有更大优势。

PBL是一种以问题为基础的学习,其教学模式以学生为主体,以小组讨论为形式.近年来,PBL教学法在各学科的教学中均得到了广泛应用.本文对手外科的学科特点、传统教学的局限性、PBL教学法的优势,以及PBL教学法在手外科教学中的应用进行阐述.

It has been 10 years since the residency training in China has been gradually implemented and standardized. Orientation is playing an important role in the transition from medical students to residents in a new work environment to ensure medical safety. The daily work of the emergency room is characterized by high intensity, fast pace and high risk. Orientation is even more important here. This article compared the similarities and differences between orientation program of emergency medicine in China and the United States, it was found that the orientation programs in the United States usually lasted for a longer time, the training was various in forms and the contents were more comprehensive. A multi-dimensional evaluation was designed for orientation also. It is worth summarizing and drawing lessons to provide reference for improving the orientation of emergency residents in China.

学习急症处理是全科医师转岗培训急诊教学的重要一环,对培养全科医师处理社区急症具有重要意义.传统的临床教学方法难以改变学生理论知识丰富而临床能力欠缺的现状.翻转课堂教学"课前知识传授,课堂知识内化"的方式有利于全科医师将急诊理论知识与临床实践紧密结合,锻炼其处理临床问题的能力.本文探讨翻转课堂教学模式在全科医师急诊培训中的应用,希望对提高全科医师急诊培训教学水平有一定的参考意义.

The emergency management training for general practitioners during job-transfer training is an important part of clinical teaching.At present,there are many problems in emergency management teaching,such as teaching contents are extensive but the class hours are limited,traditional teaching cannot meet students' needs for studying and lack of practice for emergency management skills,leading to poor teaching effects.In the teaching of emergency management of general practitioners during job-transfer training,we cultivated emergency management ability by elaborating teaching content,strengthening their clinical thinking of emergency management,carrying out a variety of training models,enhancing skill training,and stressing the evaluation of performance and so on.

手及上肢先天畸形患者中约有1％存在多发畸形,致病机制复杂,表现多样,通常单一科室难以完成疾病的完整诊治及研究.多学科联合诊治模式(MDT)不仅为这部分患者的诊治带来希望,而且为手外科的教学引入了全新的模式.本文就手外科多学科联合诊治教学模式的建立与实施进行介绍.

目的 设计基于胜任力的调剂药师能力提升体系,提高药学服务能力.方法 进行儿科调剂药师的岗位胜任力分析,制定岗位说明书和工作流程.儿科调剂药师的岗位胜任力应包括法律法规知识、药学专业知识和人文素养.结果 儿科调剂药师岗位胜任力中,法律法规包括国家和地方法 规文件以及本院规章制度.药学专业知识,包括各年龄段儿童用药特点、药物治疗相关指南、处方审核要点和用药交代.人文素养包括人文关怀、药学服务礼仪和沟通技巧.结论 本体系值得在调剂药师培训中推广,在教学中应注意理论课和案例教学相结合,并通过继续教育和评估调剂药师工作能力加以完善.

目的 对我国一个短指家系进行致病基因进行鉴定.方法 应用全外显子测序对该短指家系进行基因突变检测,并用Sanger测序对突变位点进行验证.结果 该家系共有3名患者,均为短指表型,符合常染色体显性遗传.全外显子检测提示患者均存在GNAS基因(NM_001077488:exon13:c.A1145T:p.D382V)杂合错义突变,Sanger测序验证与全外显子结果一致.结论 GNAS基因第13号外显子上c.A1145T杂合错义突变是该短指家系的致病原因.

《医疗机构处方审核规范》对药师审核处方能力提出了很高的要求,药师应对处方的合法性、规范性、适宜性等项目进行审核.本院设计的针对药师儿科处方审核能力培训课程分为四个模块:法规和规章制度;各年龄段儿童生理特点及处方适宜性审核;儿科各专科通用的药物处方适宜性审核;儿童常见专科用药处方适宜性审核.该培训体系具有同质化和标准化特点,理论课和案例教学相结合,可操作性强,值得在药师儿科处方审核培训中推广.

OBJECTIVE:To explore the effectiveness and necessity of pharmacists providing medication instruction for discharged patients in therapy management.METHODS:The situation of discharged medication in medical practice was analyzed.The methods and processes of medication instruction for discharged patients in our hospital were elaborated,and the current situation and effectiveness of medication education were conducted.The related consequences and experiences were summarized.RESULTS & CONCLUSIONS:There were some problems,such as the process of drug taking out of hospital was simple and irrationalities of use of drug was found;medical staff lacked professional knowledge of drugs;patients had poor awareness of medication safety.The scope of medication instruction provided by pharmacists in our hospital included prescription checking and education,among which education involved the improvement of medication guidance materials,pharmacists participating in the clinical treatment,etc.In the above process,the discharged patients had high satisfaction with the propaganda and education work of our hospital,and hoped that pharmacists would provide more propaganda and education about ADR.Medication instruction for discharged patients indicated the direction for our hospital to further optimize and improve the pharmacists' working mode,and deepened the trust between doctors and patients.Publicity materials had become the safe medication principle for patients after discharge.Medication instruction for discharged patients plays a pivotal role in drug therapy management,which is an effective method to promote rational drug use in discharge patients.

Emergency practice is an important part of clinical study.At present,the emergency teaching content of general practice is so wide that the teaching time is not enough,We do not pay enough attention to the cultivation of clinical thinking,pre-hospital care,two-way referral,and first aid skills training and so on.In this paper,the development of community emergency oriented teaching content,cultivation of de-escalation clinical thinking,and the pre-hospital emergency training and other aspects are studied for the students' teaching in emergency practice in order to improve the clinical practice teaching level of general medicine sttdents.

Objective To explore the ultra-structural changes and functional protein expression of enlarged nerves in patients with type Ⅱ macrodactyly. Methods The ultra-structure of the enlarged nerves in type Ⅱ macrodactyly patients was observed under electron microscope. The expression of S100, LN and H3K27me3 were evaluated by immune-fluorescence staining. Normal digital nerves from polydactyly patients were used as control. Results The number of myelinated fibers was significantly decreased, and some myelinated lamellar structures were shrunk and destroyed. The number and morphology of Schwann cells did not change significantly. There was no significant difference in the expression of S100 between the macrodactyly group and control group. LN was low expressed in the normal digital nerve, and in the enlarged nerve samples, LN showed a stronger expression. In addition, the expression of H3K27me3 in both enlarged nerve tissue and normal nerve tissue were positive. Conclusion The neurofibromatosis of type Ⅱ macrodactyly is benign hyperplasia. In patients with type Ⅱ macrodactyly, the sheath of the enlarged nerves was damaged. However, LN positive staining indicates a repair mechanism to compensate for nerve injury. Therefore, the neurosurgical procedures should be determined according to the neurological damage and compensatory situation in patients in typeⅡmacrodactyly.

Syndactyly is one of the most common congenital hand differences, characterized with certain degrees of fusion of adjacent digits in soft tissues or bones. It can be associated with polydactyly, camptodactyly, brachydactyly or symphalangism. Diversity of manifestations and incomplete penetration of heritage make the diagnosis and treatment lack of a clear routine. The management of syndactyly was based on the individual experience over the past years with shortage of the knowledge in genetics and surgical strategy. Therefore, to standardize the treatment and update the surgical procedure in syndactyly, to decrease the huge waste of medical resources, the Hand Surgery Branch of Chinese Medical Association, Chinese Medical Doctor Association and Chinese Association of Rehabilitation Medicine convened an expert panel specialized in syndactyly with 10 famous domestic medical colleges and affiliated hospitals, to discuss and formulate about the spectrum of diagnosis and treatment. The consensus statement on diagnosis and clinical management of syndactyly was established for clinical references.

Objective To investigate the effect of montelukast on the airway hyperresponsiveness in children with asthmatic bronchitis.Methods Total of 76 children with asthmatic bronchitis admitted to Shanghai Jiaotong University Affiliated Xinhua Hospital from Dec .2013 to Mar.2015 were included in the study,and divided into control group and observation group based on a random number table,38 cases each. The control group was treated with conventional therapy,while the observation group was added with monte-lukast treatment,once per day,4.0 mg per time.The treatment course of both groups was one month.The therapeutic effect of the two groups was compared.Results After treatment,total effective rate of the obser-vation group was higher than the control group [ 97.4%( 37/38 ) vs 84.2%( 32/38 ) ] , the difference was statistically significant ( P <0.05 ) .The asthma, wheeze, cough disappearing time and hospital stay of the observation group were less than the control group [(2.1 ±0.4) d vs (4.4 ±1.2) d,(2.2 ±0.8) d vs (5.2 ±1.8) d,(4.1 ±1.2) d vs (6.2 ±1.8) d,(4.2 ±1.4) d vs (6.8 ±1.3) d],the differences were statistically significant(P<0.01).After treatment,ECP,LTE4,IL-10 of the observation group were lower than the control group [(9.6 ±1.2) μg/L vs (15.5 ±2.8) μg/L,(38 ±8) pg/L vs (80 ±9) pg/L, (9.3 ±1.4) pg/L vs (14.3 ±2.0) pg/L],IL-12 was higher than the control group[(58 ±10) pg/L vs (42 ±8) pg/L],the differences were statistically significant(P<0.05).Conclusion Montelukast sodium has a significant effect for asthmatic bronchitis in children ,which can improve children′s airway hyperrespon-siveness,prevent the further development of the disease to a certain degree,and help improve the quality of life of the children,thus is worthy of the clinical application.

目的 探讨低分子肝素皮下注射辅助治疗急性加重期慢性阻塞性肺疾病(AECOPD)的有效性和安全性.方法 选择2014年3月至2015年4月上海交通大学医学院附属新华医院收治的120例AECOPD患者为研究对象,按照随机数字表法分为对照组和观察组,各60例.对照组采用常规治疗措施,观察组在对照组治疗的基础上加用低分子肝素钠200 U/kg,每日1次,连续使用1周.比较两组患者的临床疗效、血气分析指标、凝血指标以及肺功能指标.结果 观察组患者的总有效率为96.7％ (58/60),高于对照组的53.3％ (32/60),差异有统计学意义(P＜0.05).治疗后,观察组患者的动脉血氧分压、动脉血氧饱和度高于对照组[(72±7) mmHg(1 mmHg=0.133 kPa)比(66±13) mmHg,(93±3)％比(90±8)％],差异有统计学意义(P＜0.05).治疗后,观察组凝血酶原时间、部分凝血活酶时间长于对照组[(14.6±2.2)s比(13.6±2.2)s,(39±6)s比(33±10)s],纤维蛋白原和D-二聚体低于对照组[(3.98±0.16) g/L比(4.05±0.22) g/L,(1.77±0.25) mg/L比(2.29±0.28) mg/L],差异有统计学意义(P＜0.05).治疗后观察组第1秒用力呼气量、第1秒用力呼气量/用力肺活量高于对照组[(1.59±0.21)L比(1.42±0.22)L,(76±13)％比(65±11)％],Borg评分低于对照组[(2.4±0.5)分比(3.3±0.6)分],差异有统计学意义(P＜0.05).观察组和对照组住院时间分别为(10.8±1.4)d和(14.3±3.5)d,观察组短于对照组(t=7.192,P＜0.01).结论 低分子肝素钠可有效提高AECOPD患者的临床疗效,改善患者的高凝、高黏状态,降低血栓发生率,促进血液循环,改善缺氧和二氧化碳潴留,从而促进患者的预后,值得临床应用.