目的 回顾分析上海方舱医院临床一线病患志愿者的感染防控知识技能需求,掌握病患志愿者的实践体验,为科学、安全、高效应对新型冠状病毒肺炎(COVID-19)疫情,做好科学感控管理提供支持.方法 采取提纲汇总方式,围绕方舱医院感控管理重点,回顾分析93名病患志愿者感控需求及实践体验.结果 93名志愿者均认为需要学习感控知识技能,且均认为非常重要和重要;18.28％的志愿者每日洗手10次以上,45.16％的志愿者每日洗手4～6次以上,3次及以下仅占4.3％;服务体验方面,普遍表现积极向上,100％认为承担志愿者工作具有获得感,且能实现自我价值.结论 上海方舱医院救援一线病患志愿者认为:学习感控知识与技能均为必要,且更愿学习并应用到服务实践中;加强援沪一线方舱医院病患志愿者服务管理、教育培训与必要的健康指导,对顺利完成医疗照顾、提升医护服务水准及圆满完成整体救援任务具有重要意义.

This study aimed to retrospectively explore the relationship between facet tropism (FT) and cervical disc degeneration in cervical spondylotic radiculopathy (CSR) patients on 3-dimensional views. A total of 180 middle-aged patients with single-level CSR at C4/5 who underwent cervical CT and MRI in our hospital were included. The incidence of FT (or called FT (+), defined as FT ≥ 7 degree) at C3/4, C4/5, C5/6 levels were measured and calculated by reconstructed CT images on 3-dimensional views. The grade of cervical disc degeneration at three levels was assessed by MRI images by the method of Miyazali. Univariate analysis was performed to compare their cervical disc degeneration grade and CSR incidence between two groups stratified by FT (+). Moreover, a logistic regression model was used to investigate the association between FT (+) and grade of cervical disc degeneration and incidence of CSR adjusting for age, gender, and BMI. Grade of cervical disc degeneration and incidence of CSR in axial FT (+) group were both significantly increased compared to axial FT (-) group, while sagittal and coronal FT (+) groups showed no difference. Axial FT (+) was significantly associated with the grade of cervical disc degeneration and incidence of CSR. in middle-aged patients with CSR, axial FT (+) might be the risk factor for cervical disc degeneration but not sagittal and coronal FT (+). Also, axial FT (+) was positively associated with CSR incidence. Therefore, axial FT might play a vital role in the progression of cervical disc degeneration and CSR occurrence.

Arrhythmogenic cardiomyopathy (AC) is a rare inherited myocardial disorder, a cause of sudden death in young people and atheletes; biventricular involvement is often involved. We report on a case of AC diagnosed with multimodality imaging, including transthoracic echocardiography (TTE), two-dimensional strain echocardiography (2DSE), real-time three-dimensional echocardiography (RT-3DE) and cardiac magnetic resonance (CMR) imaging. Especially, combination of 2DSE and RT-3DE was utilized in the diagnosis of AC. In a word, we review the cardiac anomalies associated with AC by multiple imaging techniques and highlight the supplementary role of new echocardiography techniques diagnosing AC when CMR contraindications exist for AC patients.

Hypertension is a common and chronic disease, caused by high blood pressure. Since hypertension often has no warning signs or symptoms, many cases remain undiagnosed. Untreated or sub-optimally controlled hypertension may lead to cardiovascular, cerebrovascular and renal morbidity and mortality, along with dysfunction of the autonomic nervous system. Therefore, it could be quite valuable to predict or provide early warnings about hypertension. Heart rate variability (HRV) analysis has emerged as the most valuable non-invasive test to assess autonomic nervous system function, and has great potential for detecting hypertension. However, HRV indicators may be subtle and present at random, resulting in two challenges: how to support continuous monitoring for hours at a time while being unobtrusive, and how to efficiently analyze the collected data to minimize data collection and user burden. In this paper, we present a machine learning-based approach for detecting hypertension, using a waist belt continuous sensing system that is worn overnight. Using 24 hypertension patients and 24 healthy controls, we demonstrate that our approach can differentiate hypertension patients from healthy controls with 93.33% accuracy. This represents a promising approach for performing hypertension classification in the field, and also we would improve its performance based on a large number of hypertensive subjects monitored by the proposed pervasive sensors.

Objective To evaluate the clinical efficacy of the minimally invasive treatment with Zista system for lum-bar spinal stenosis. Methods April 2016 to October 2017, 45 patients with lumbar spinal stenosis (2 or 3 segments) were retro-spectively collected, including 21 males and 24 females. Age 50-74 years, average 62.5 ±11.2 years, which were divided into mini-invasive surgery group and open surgery group. In the mini-invasive group, 19 cases were treated with mini-invasive decompres-sion and intervertebral fusion internal fixation through Zista channel, including 14 cases with two segments and 5 cases with three segments. 26 cases were treated with traditional open surgery, 17 cases in two sections and 9 cases in three sections. The Japanese Orthopaedic Association score (JOA) and visual analogue scale (VAS) were used to assess the clinical effect postoperatively. The change of spinal canal in the mini-invasive group was assessed by lateral recess angle. Results All of the 45 operations had been completed successfully. The average operation time in mini-invasive surgery group was 240 ± 15 min (range, 230-310) for 2 seg-ments and 320 ± 15 min (range, 320-370) for 3 segments. The average operation time in open surgery group was 255 ± 15 min (range, 210-300) for 2 segments and 315±20 min (range, 330-390) for 3 segments, there was no significant difference between two groups. The intraoperative blood loss in mini-invasive surgery group was 220±25 ml (range, 190-310) for 2 segments and 340±30 ml (range, 280-410) for 3 segments. The intraoperative blood loss in open surgery group was 550 ± 25 ml (range, 500-730) for 2 segments and 840 ± 20 ml (range, 750-920) for 3 segments, the bleeding volume of the open surgery group was more than that of the mini-invasive group. All patients were followed up, and the follow-up time was 7.3±3.2 months (range, 3-12 months) in mini-invasive surgery group and 8.1 ± 2.6 months (range, 3-12 months) in open surgery group respectively. The VAS score of low backpain and lower limb pain in the two groups was decreased 4.2 and 5.4 in mini-invasive group, 4.7 and 5.1 in open surgery group at 3 months after operation. The average JOA score of the two groups increased 13.3 in mini-invasive group and 12.7 in open surgery group at 3 months after the operation. The latera recess angle in mini-invasive group between preoperation and postoperation was significantly different. No incisional infection, implant loosening, discitis and leakage of cerebrospinal fluid were found. Conclu-sion Mini-invasive decompression and internal fixation through Zista channel for lumbar spinal stenosis is a safe, effective and minimally invasive method of operation with the characteristics of short operation time, less intraoperative blood loss and low com-plications.

Objective To describe our experience with the transvaginal natural orifice transluminal endoscopic surgery (NOTES) in female patients,and to evaluate its clinical value.Methods Between May 2010 and April 2017,a total of 289 female patients underwent transvaginal NOTES in our center,including 31cases of adrenal tumors,46 cases of renal tumors,188 cases of non-functional kidneys,5 cases of renal cysts,4 cases of duplex kidney,7 cases of renal tuberculosis and 8 cases of renal pelvis tumors.Among them,146 cases were on the left side,142 cases on the right side,and 1 case on both sides (renal cysts).The median age was 39.4 (range 23 to 76) years,and the median body mass index was 21.8(range 15.4 to 32.6) kg/m2.After general anesthesia,the patients were positioned in lithotomy with ipsilateral lumbar at 30°-60° angle to the floor.Hybrid and pure transvaginal NOTES were performed.The specimen was removed through an extended incision at the posterior vaginal fornix.Results Transvaginal NOTES was successfully completed in 281 patients.Two patients required conversion to suprapubic-assisted laparoendoscopic single-site surgery because of the rectal injury in pure transvaginal NOTES nephrectomy.Six patients underwent open conversion.The various transvaginal hybrid NOTES procedures included adrenalectomy (31 cases),nephrectomy (206 cases;simple 174 cases,radical 32 cases),partial nephrectomy (13 cases),heminephroureterctomy for duplex kidney (4 cases) and hybrid endoscopy for nephroureterectomy (7 cases).The mean operative time was 105 min (45-310 min),the mean estimated blood loss was 87 ml (20-800 ml),the mean visual analogue score (VAS) of 48 hours after operation was 2.5 (1-4) points and the mean hospitalization was 7.3 d (4-13 d) for transvaginal hybrid NOTES.The various pure transvaginal NOTES procedures included nephrectomy (22 cases;simple 21,radical 1),renal cyst excision (5 cases).The mean operative time was 170 min (60-320 min),the mean estimated blood loss was 140 ml (20-500 ml),the mean VAS of 48 hours after operation was 1.7 (1-3) points and the mean hospitalization was 5.5 d (3-10 d) for transvaginal pure NOTES.Complications occurred in 56 cases (19.38％),including 20 cases (6.92％) of severe complications,and no death occurred.After a mean follow-up of 51 (range 3 to 86) months,umbilicus scar was hidden.The incision in the vagina healed well.No infection in the abdominal or pelvic cavity or celiocele occurred.The umbilicus scar is not obvious after surgery,and 3 months after surgery.The median Patient Scar Assessment Questionnaire (PSAQ) score was 38 (31-58) and the median Female Sexual Function Index (FSFI) score was 28.2 (22.5-32.2),and the quality of life index was significantly higher than that of preoperation.Condusions Transvaginal NOTES could treat variousprimary diseases,and improve the postoperative quality of life.It does not increase the incidence of related complications,or cause negative effect on the female sexual function,pregnancy or fertility.It can lead to good cosmetic outcome and less pain,which is worth applying in clinical practice.

We have established a novel method named transumbilical two-port laparoscopic varicocele ligation (TTLVL) for varicocele, which is still needed to evaluate. In this study, 90 patients with left idiopathic symptomatic varicoceles of grades II-III according to the Dubin grading system were randomly assigned to TTLVL (n = 45) and conventional laparoscopic varicocele ligation (CLVL) (n = 45). The demographic, intraoperative, postoperative, and follow-up data were recorded and compared between the two groups. All the procedures in the two groups were completed successfully with no intraoperative complications and no conversions to open surgery. No significant difference was found in the operative time, resuming ambulation, bowel recovery, postoperative hospital stay, and postoperative resolution of scrotal pain between the two groups (P > 0.05). However, the postoperative mean visual analog pain scale scores for TTLVL group were all less at 24 h, 48 h, 72 h, and 7 days postoperatively compared to CLVL (P = 0.001, 0.010, 0.006, and 0.027, respectively). The mean patient scar assessment questionnaire score in postoperative month 3 was 29.7 for TTLVL group compared with 32.1 for CLVL group (P < 0.001). There was no testicular atrophy observed in both groups during the follow-up period. The study shows that TTLVL is a safe, feasible, and effective minimally invasive surgical alternative to CLVL for the treatment of varicocele. Compared with CLVL, TTLVL may decrease postoperative pain and improve the cosmetic outcomes.

Objective:To investigate the learning curve of transvaginal natural orifice transluminal endoscopic surgery (NOTES) assisted laparoscopic simple nephrectomy.Method:A retrospective analysis was carried out on the clinical data of 90 consecutive patients who underwent transvaginal NOTES-assisted laparoscopic simple nephrectomy by a urologist with advanced laparoscopic skills from May 2010 to July 2013 in our center.The patients were divided into six groups (group A,B,C,D,E and F,with 15 cases in each group) by operative sequence.The operation time,estimated blood loss,recovery time of gastrointestinal function,intraoperative and postoperative complications,conversion to standard laparoscopic or open surgery,the time for drainage and postoperative hospital stay were compared among the six groups.Result:The operation time and estimated blood loss in groups A and B were significantly greater than those in group C,D,E and F (P＜0.05),but no significant difference was found between group A and B or among group C,D,E and F (P＞0.05).The rate of conversion to standard laparoscopic or open surgery,intraoperative and postoperative complications decreased in group C,D,E and F compared with group A and B,but the difference was not statistically significant (P＞0.05).No significant difference was found in recovery time of gastrointestinal function,the time for drainage or postoperative hospital stay (P ＞0.05).Conclusion:For a urologist with advanced laparoscopic skills,the learning curve of transvaginal NOTES-assisted laparoscopic simple nephrectomy would tend to flatten out after completing about 30 cases.

目的：探讨高频超声和彩色多普勒超声对甲状腺肿瘤的诊断价值。方法：选择笔者所在医院2013年5月-2015年5月收治的55例甲状腺肿瘤患者，对所有患者行超声检查，经术后病理诊断为甲状腺肿瘤的进行分析。结果：55例患者超声诊断，单发结节36例，多发结节19例；其中被诊断为良性肿瘤38例，良性肿瘤患者中囊性病变27例、甲状腺囊肿1例、结节性甲状腺肿6例、亚急性甲状腺炎4例，恶性肿瘤17例。其中1例被超声诊断为结节性甲状腺肿，而病理检查证实为甲状腺癌，超声诊断准确率为98.18%(54/55)。且行彩色高频多普勒超声检查对恶性肿瘤血流信号的检出率较高。结论：高频超声和彩色多普勒超声能够快速准确的确诊患者甲状腺肿瘤病情，全程患者轻松无痛苦，为甲状腺恶性肿瘤的治疗提供了关键信息，值得临床推广使用。

Objective To investigate the efficacy and safety of a novel slideable pedicle screw-rod system in the treatment of lumbar degenerative diseases.Methods Analysed 71 patients (47 males and 24 females) with lumbar degenerative diseases underwent lumbar fusion using the novel slideable pedicle screw-rod system from June 2014 to June 2016,aged 30-73 years by average 57.6 years.All patients were divided into 2 groups according to different operative methods:autogenous bone group (34 patients,fusion with autogenous bone plus slideable pedicle screw-rod) and cage group (37 cases,fusion with cage and autogenous bone plus slideable pedicle screw-rod).The Japanese Orthopaedic Association score (JOA) and visual analogue scale (VAS) were used to assess the clinical effect postoperatively while X-ray and CT were used to evaluate the fusion situation and the height variation of fusion segment,Results The average operation time was (98.5±26.72) min in autogenous bone group,(110.4±23.41) min in cage group.All patients were followed up for 3-18 months and 5 cases were followed for more than 12 months.The height of fusion segment decreased postoperatively,however,there was no neurologic symptoms.The VAS score of low back pain and leg pain decreased by 4.7 and 6.8 points in autogenous bone group after 3 months postoperatively,it decreased by 5.1 and 6.3 points in cage group.JOA scores of 2 groups after 3 months after operation were increased by 20.8 and 19.9 points compared with preoperative scores.According to the criteria,the excellent and good rate was 91.5％.1 case out of 5 cases followed more than 12 months can not be determined whether fusion was complete.Conclusion The novel slideable pedicle screw-rod system can provide a satisfactory outcome for the treatment of lumbar degenerative diseases and can promote the decompression segment fusion effectively.

生活环境会深刻影响人的身体健康,包括温度、气压、空气污染、水体污染、职业污染等,其作用于人体,引起健康损害.本文通过分析常见环境因素对人体健康参数的影响,简要介绍了目前环境健康风险评估的一些应用实例,提出可以利用长期人体健康评估系统为环境健康风险评估提供实时个体健康效应数据,总结了目前长期远程多参数人体健康评估系统的研究现状,并展望了其发展趋势,为评估环境对健康影响提供科学依据.

Objective To explore the relationship between the echocardiographic indices with the risk score of atrial fibrillation thrombo-embolism. Methods There are 300 cases of patients with atrial fibrillation come to our hospital for treatment at the time from June 2012 to June 2014. These patients were divided into low risk group,the moderate and high risk group according to the scoring criteria of CHADS2 and CHA2 DS2 - VASc. The supersonic cardiogram and the echocardiographic indices of all the patients were checked. The relationship between the several indicators with the risk score of the atrial fibrillation thromboembolism were analyzed. Results Through the scoring system of CHADS2 ,we divided the patients into low risk group,the moderate and high risk group with 73 patients,72 patients and 155 patients respectively. There are several supersonic indicators associated with the score of CHADS2 ,such as the thickness of ventricular septal,thickness of left ventricular posterior wall,diameter of left atrial,diameter of pulmonary artery,diameter of right ventricular,diameter of aortic and LVEF. Through the score of CHA2 DS2 - VASc,we can find out the number of patients had been seperated into low risk group,the moderate and high risk group is 32,66 and 202 respectively. There are also have several indicators having significant relationship with the score of CHA2 DS2 - VASc,such as the thickness of ventricular septal,thickness of left ventricular posterior wall,diameter of left atrial,diameter of pulmonary artery,velocity of aortic leaf and LVEF. Conclusio With the improvement of scores of CHADS2 and CHA2 DS2 - VASc,the indices of echocardiographic included mainly for the following several aspects such as the expand of left atrial,left ventricular hypertrophy,increasing of the diameter of pulmonary artery and reducing of LVEF.

To develop a handling platform for loading, unloading, fixation, deployment, withdrawal and etc of medical materials in field conditions. Classified handling was performed for different function units with the de-vice developed, which was composed of a trolley, a railroad, a hydraulic handling board, a fixation belt and a vehicle-mounted tractor. The platform could enhance the efficiency of materials handling, which behaved well in the hos-pital without any handling device. The modular handling platform is easy to unload, carry, transport, fix and maintain, and thus is worthy popularizing practically.

OBJECTIVES:To report our initial experience with transumbilical multiport laparoscopic nephrectomy (TMLN) with transvaginal specimen extraction.PATIENTS AND METHODS:Between January and July 2010, 5 married and parous female patients were submitted to TMLN with transvaginal specimen extraction in our center. All data referring to patient demographics, surgery, pathology and perioperative outcomes were recorded. Sexual function was assessed with the Female Sexual Function Index questionnaire before and after surgery. The cosmetic result was investigated by administering the Patient Scar Assessment Questionnaire and Scoring System (PSAQ).RESULTS:All procedures were completed successfully. The mean operative time was 136 min (range 110-160 min, standard deviation [SD] 20.7). The mean estimated blood loss was 66 ml (range 40-100 ml, SD 24.1). The mean postoperative hospitalization stay was 4.8 days (range 4-6 days, SD 0.8). All patients reported unaltered sexual function after surgery. The better cosmetic results were confirmed by the PSAQ score.CONCLUSIONS:TMLN with transvaginal specimen extraction is feasible and safe for married and parous female patients. This technique is a natural evolution towards natural orifice transluminal endoscopic surgery (NOTES). By acting as an intermediate-type procedure, it provides a bridge through which NOTES may ultimately gain clinical acceptance.

目的 探讨良性前列腺增生(BPH)病变程度与血管损害危险因素的相关性.方法 182例确诊BPH患者,经直肠超声测得前列腺体积(PV)、国际前列腺症状评分(IPSS)及测算最大尿流率(Qmax)以评估梗阻程度.血管损害因素包括年龄、高血压、2型糖尿病、血脂异常、吸烟、肥胖及同型半胱氨酸(Hcy).资料采用单因素方差分析及多元线性回归进行分析.结果 单因素方差分析提示:病变程度不同的各组资料间比较,除甘油三酯(TG)及Hcy外,随着其他血管危险因素程度增加,BPH病变程度随之增加.多元线性回归分析提示:糖尿病在PV、IPSS及梗阻程度评估中为最显著的相关独立因素(均P＜ 0.05),血清TG及Hcy均非显著的相关独立因素(P＞0.05),年龄、吸烟、肥胖、高血压及血脂异常均为BPH显著相关独立因素.结论 各种血管损害危险因素在BPH病变程度中发挥作用,其中糖尿病为最显著相关危险因素.

To report our experience with suprapubic‐assisted laparoendoscopic single‐site surgery (SA‐LESS) in urology.

Objective To explore the curative effect of pedicled bifoliate scrotal flap repair transferring via subcutaneous tunnel in the treatment of large urinary fistula postoperative hypospadias. Methods From August 2008 to May 2012, five patients with large urinary fistula underwent pedicled bifoliate scrotal flap repair transferring via subcutaneous tunnel, with the fistula diameter of 10 to 14mm, and there were two central fistula cases of penis and three cases of fistula at the junction of penis. For all cases, a circu-mcision of the skin at the fistula edge was used to divide the skin around the urethral fistula into two layers.bifoliate flaps on both sides of given scrotal raphe were taken, and then trimmed in accordance with the size of fistula and the thickness of skin surround fistula.The bifoliate flaps were half folded together to form a double-layer flap, and sutured to skin around the fistula together after sneaking into the fistula via the subcutaneous tunnel. Results All cases underwent the procedure successfully at one time. During 12~40 months following-up, no urinary fistula recurrence was observed. Conclusion Pedicled bifoliate scrotal flap with advantage of enougy blood supply, small tension in the skin at the suture fistula edge, large area of resulting flaps, is especially suitable for large urinary fistula at central and root penis.

Objective To explore the clinical progression factors for the metabolic syndrome(MS)on elderly benign prostatic hyperplasia(BPH).Methods A total of 155 elderly BPH were divided into two groups:simple BPH(n =86)and BPH with MS(n =69)groups,the differences of the metabolic and BPH index between two groups were compared.By multiple linear regression,the effects and correlation of prostate volume(TPV),residual urine volume,Qmax,international prostate symptom score(IPSS),prostate-specific antigen(PSA),and annual prostate growth rate with various components of MS were analyzed.Results There were statistical differences(P 0.05) on TPV,Qmax,IPSS,PSA,and annual prostate growth rate between BPH and BPH with MS groups.The multiple linear regression showed that the TPV has a significantly positive correlation with FBG and HOMA-IR.Residual urine volume showed a significantly positive correlation with HOMA-IR.Qmax has a significantly negative correlation with HOMA-IR.IPSS has a significantly positive correlation with BMI,FBG and waist circumference.PSA has a significantly positive correlation with FBG.Annual prostate growth rate has a significantly positive correlation with FBG and FINS.Conclusion MS has evident effects on the development of BPH.

ObjectiveTo present our initial experience with pure transvaginal natural orifice translumenal endoscopic surgery renal cyst decortication.MethodsFrom December 2010 to July 2011, five female patients with symptomatic renal cyst in the anterior portion and lower pole of the kidney were submitted to pure transvaginal natural orifice translumenal endoscopic surgery renal cyst decortication in our center. Under general anesthesia, the patients were placed in the lithotomy position with the affected side elevated by 60°. A 3‐cm incision was made at the posterior vaginal fornix and a modified three‐channel port was deployed across the vaginal incision. The cyst was dissected and the cyst fluid was aspirated using a suction device. The cyst wall was circumferentially excised.ResultsAll five procedures were successfully carried out without additional transabdominal trocars. The median operative time was 80 min (range 60–90 min). The median estimated blood loss was 25 mL (range 25–50 mL). The median visual analog scale score was 1 on postoperative day 1. None of the patients required narcotic pain medications beyond postoperative day 2. Intestinal function recovered on postoperative day 1–3. There was no intraoperative or postoperative complication in any of the patients. During the follow‐up visits, all the patients were in good condition. All the patients reported unaltered sexual function after surgery by the Female Sexual Function Index questionnaire.ConclusionOur initial experience suggests that pure transvaginal natural orifice translumenal endoscopic surgery renal cyst decortication is feasible and safe in selected patients.