2022年2月20日，举世瞩目的北京第二十四届冬季奥林匹克运动会圆满落下帷幕，秉持贯彻"绿色可持续"的办奥理念和"节俭办奥"的原则，经北京冬奥组委运动会服务部医疗服务处组织，由首都医科大学宣武医院互联网医疗诊治技术国家工程研究中心（下称"国家工程研究中心"）牵头，首都医科大学附属北京世纪坛医院（下称"北京世纪坛医院"）具体承担，联合国内多家单位研发的5G移动CT救治单元圆满完成北京冬奥会五棵松冰球场馆医疗保障任务。国际奥委会医疗代表Dr. Bruce Forster特别指出五棵松冰球场馆配备的小型移动CT救治单元，是有史以来奥运会医疗装备史上的第一次，实现了从"0到1"的突破。现就本次医疗保障的组织方式及保障经验报道如下。

为总结医疗纠纷发生的高危因素及原因,对北京某三甲医院2017年?2019年经北京市医调委调解的医疗纠纷案例共66件进行分析,结果显示外科(34.9％)、内科(33.3％)和妇产科(16.7％)为医疗纠纷高危专业,外科有责比例显著高于内科(87.0％ vs 45.5％,P=0.003).妇科(16.7％)、普外科(13.6％)、心血管内科(13.6％)是医疗纠纷高危科室.医生职称越高,医疗纠纷发生风险越高.医疗纠纷发生的主要原因为手术失误(24.4％)、治疗不及时(19.5％).医院要对医疗纠纷高危科室进行重点管理,做好纠纷防范工作,针对发生原因采取预防措施,将医疗风险管理窗口前移.

目的 探索综合医院新型冠状病毒肺炎(COVID-19)防控体系的建立与应用,制定行之有效的防控策略,为综合性医院建立科学的疫情防控体系提供可借鉴的经验,成为长效机制.方法 以管理传染病三个环节"传染源、传播途径、易感人群"为原则,加强人员培训、健康监测、消毒防护、物资调配及健康科普工作,优化诊疗区域及通道,建立应急预案及督导机制,强化重点科室管理及人工智能应用,结合医院实际情况,制定科学有效的防控策略,注重细节,保障防控措施落地.结果 医院诊疗活动有序开展,防控措施有效可行,医患传染病防控意识明显增强,防控知识知晓率达到100.00％,医务人员手卫生依从性提高,穿脱防护用品及消毒灭菌规范合理,医院工作人员、门急诊及住院患者均未感染COVID-19.结论 科学的医院感染防控体系的建立与应用,可以有效控制综合医院新型冠状病毒肺炎的传播与感染.

Objective To explore the causes and prevention strategies of wound complications after operative fixation of calcaneal fracture.Methods A retrospective analysis was performed of the 65 patients with calcaneal fracture who had been treated with operative fixation from January 2008 to January 2013 at our department.They were 38 males and 17 females,19 to 68 years of age (average,45 years).Laterality:29 on the left side and 36 on the right side.According to Sanders classification,16 cases were type Ⅱ,35 type Ⅲ,and 14 type Ⅳ.The duration from injury to surgery ranged from 3 hours to 14 days,averaging 7.1 days.The fractures were treated by the extended lateral approach,internal fixation with plate and bone transplantation.Their postoperative wound complications were documented.Wound complications occurred in 9 cases (13.8％) but did not in the other 56 ones.The 2 groups were compared in terms of age,gender,fracture type,American Society of Anesthesiologists(ASA) grading,fall height,operation time,tourniquet time and other surgery-associated factors to screen out the risk factors associated with wound complications.Results We found that ASA grading Ⅱ or above (OR =8.750,P =0.002),fall height (OR =9.570,P =0.003),operation time (P=0.027),tourniquet time (P-0.020),fime from injury to operation(P=0.004),hospital stay (P =0.013),hypoproteinemia (OR =6.000,P =0.012) were significantly associated with wound complications.Conclusions On the basis of routine treatment,these risk factors should be targeted by prevention measures.The postoperative wound complications after operative fixation of calcaneal fracture can be effectively prevented by careful assessment of soft tissue defects,proper timing for surgery,shortening operation time and tourniquet time,and rational management of postoperative wounds.

Osteoporosis is a systemic metabolic disease characterized by low bone mass with deterioration of the bony microstructure which leads to both bone brittleness and increased risk of fracture. Sclerostin is a protein encoded by the SOST gene which is specifically expressed in osteocyte. Monoclonal antibodies of sclerostin can promote bone formation by antagonizing its inhibitory action. However, the effectiveness of monoclonal antibodies to exert such effects are limited by the large molecular mass and high immunogenicity. Here, we report that we purified a high immune affinity, single-chain antibody of SOST: SOST–single-chain Fv (scFv). Real-time polymerase chain reaction amplification of the variable regions of the heavy- and light-chain gene from a secretory anti-SOST antibody was performed. Animal experiments showed that SOST–scFv promoted bone healing in a rat model of osteoporosis.

ObjectiveTo compare the clinicalefficacy of locking platefor internal fixationand humeral head replacement inthe treatment ofcomminuted fracturesof theproximal humerus inseniorpatients.Methods Clinicaldata of 74old patients atthe age of (76.35±4.78) years withcomminuted fracturesof theproximal humerus admitted in our department from January 2008 to December 2012 were collected and retrospectively analyzed. Forty-sevenpatients were treated bylocking platefor internal fixationand 27 cases operated with humeral head replacementfor 3- and 4-part fractures according to Neer classification system. The2 groups were compared in the operation time, blood loss and NeerScores atthe end offollow-up.Results The follow-upperiodwas 23.7 months (ranging from 12 to 43 months), which wassimilarinthe 2 groups. Theoperation time was(95.4±8.57)minin the internal fixation group and(72.60± 9.45)min in the replacement group, blood loss was(277.50±31.65)ml and(287.20±42.51)ml,andthe rate of excellent and good outcomesby Neerscoring system was 82.9% and 85.2%, respectively, in the 2 groups. The operation time was significantly longer in the internal fixation group thaninthe replacement group (P<0.01). But there was no difference in blood loss and Neer score (P>0.05). ConclusionBoth locking plate for internal fixation and humeral head replacement show good efficacy and satisfactory clinical outcomes for comminuted fracturesofproximal humerusin the elderly. We suggest that locking plateis suitable to the younger patients who areable to reach intraoperative repositioning. Whilefor the elderly withserious comminuted fractures, especiallyaccompanied with severe osteoporosis,humeral head replacement may be the bestoption.Surgeons should makeindividualizedmanagement according to the specific fracture condition.

OBJECTIVE:To study the impact of sclerostin single chain Fv on osteoporotic fracture healing in ovariectomized rats. METHODS:24 SD rats were ovariectomized. One week later,the middle shaft transverse fractures model of the femur of left lower extremity was established. Model rats were randomly divided into model group and treatment group with 12 rats in each group. Model group was given intrathecal injection of phosphate buffer 0.2 ml,and treatment group was given intrathecal injection of sclerostin single chain Fv 2.5 mg/kg,twice a week,for consecutive 12 weeks. The contents of calcium,phosphorus,alkaline phosphatise and osteocalcin in serum were determined. BMD,Tb.Th,Tb.Sp,BVF,SMI and morphologic change of left femur were also determined. RESULTS:The contents of calcium,phosphorus,alkaline phosphatise and osteocalcin in serum of model group were(1.92±0.54)mmol/L,(1.54±0.61)mmol/L,(64.43±13.92)U/L and(9.04±0.71)ng/ml;above index of treatment group were(2.43±0.28)mmol/L,(1.58±0.26)mmol/L,(79.25±12.49)U/L and(9.57±0.83)ng/ml. BMD,Tb.Th,Tb.Sp,BVF and SMI of model group were(91.51±12.33)mg/cc,(0.09±0.02)mm,(0.47±0.22)mm,0.18±0.03 and 1.42±0.31;above index of treatment group were(135.15±11.12)mg/cc,(0.01±0.03)mm,(0.34±0.11)mm,0.29±0.01 and 0.65±0.34,respectively. Compared with model group,the contents of calcium and alkaline phosphatise,BMD and BVF were increased significantly in treatment group(P<0.05),and SMI was decreased significantly(P<0.05);there was no statistical significance in other index(P>0.05). The amount of osteoblast in treatment group was more than in model group under microscope. CONCLUSIONS:sclerostin single chain Fv promotes osteoporotic fracture healing in ovariectomized rats.

The use of lawyers witness of preoperative conversation in clinical area not only provides the guarantee for the implementation of the informed consent,but also reduces the occurrence rate of the medical informed infringement damages.Based on the implementation of lawyers witness at current stage,this article presented a realistic value and significance of the lawyer witness of preoperative conversation,and,hereafter,proposed an outlook on how to build relevant hospital management system in this area.

近20年来,有关医患关系的研究一直是我国医院管理的研究热点.大量研究显示,影响医患关系的主要因素不外乎是医疗费用负担、医患沟通不足、患者医学专业知识欠缺、医疗技术问题和医生责任心问题等方面[1-2].虽然医患关系的医患双方认知存在差异[3],但笔者认为基于医患关系冲突行为中的施动主体往往来自患方群体,因此,立足患方立场看待医患关系问题尤为重要.本研究立足于患方对医患关系影响因素的认知,试图以患者本位来思考推进医患关系管理的对策建议.

Objective To study the values of repairing canine femoral neck fracture by injectable osteoinductive material monitored by ra-dionuclide imaging. Methods Bone imaging was used to monitor the distribution of radioactivity in the fracture at 4,8,12 weeks after operation. Results 99mTC-MDP uptakes and ratios of the region of interesting( ROI) indicated that there had a rising tendency in experiment group. Conclusion Injectable Osteoinductive Material has good ability to repair femoral neck fracture,99mTC-MDP ECT is a effective method to moni-tor the repairing process.

通常,良好而有效的医患沟通能有效降低医疗纠纷的发生[1-3].但从目前的研究和实践来看,对于如何进行有效的医患沟通还需要进一步的探索.国内有报道提示,律师见证术前谈话或许能有效防范医疗纠纷的发生[4].所谓律师见证通常是指,律师根据当事人(包括法人、公民)的委托,对一定范围的民事行为的真实性、合法性做出证明的特定的法律行为.律师见证是一种常见的、合法的非诉讼单项法律事务,是《律师法》第25条第6项所规定的律师办理"非诉讼法律事务"的重要组成部分,并受《律师法》的充分保护[5].我院自2010年开展律师见证术前谈话,取得了一定的效果.

医务社会工作是促使病患达到身心健康、促进社区民众的整体健康、提高公共卫生水平、形成健康照顾的社会工作范畴[1].在许多发达国家,医务社会工作者为临床提供广泛的社会服务是医疗团队中不可或缺的成员[2].目前世界各国普遍将医院医务社会工作机构和专业人员作为医院质量评审的必要条件[3].然而,自1921年北京协和医院培养了我国第一批医务社会工作者后,我国的医务社会工作几度沉浮却一直未能得到真正发展[4-5].

Objective To evaluate the preliminary outcome of cannulated screw internal fixation in treatment of the tarsometatarsal joint injuries.Methods From January 2005 to October 2010,21 patients(14 males and 7 females)with the tarsometatarsal joint injuries were treated.Their age ranged from 21 to 62 years(average 38.2 years).According to anatomical three-column classification,there were four patients with single medial column injury,four with medial and middle column injuries,three with middle and lateral column injuries,two with single lateral column injury and eight with three column injuries.The injury causes included traffic injury in nine patients,machine injury in eight and fall from height injury in four.The period from injury to admission was 2-15 hours(mean 5 hours).During operation,open reduction was performed,followed by internal fixation with the cannulated screw.X-ray examination was done in the regular follow-up and function was evaluated by using Maryland scoring system.Results Of all,19 patients were followed up for 4-47 months(mean 20 months),which showed no infection,loosing or breakage of the internal fixation.According to the Maryland scoring system,the clinical outcome was rated as excellent in eight patients,good in seven,fair in two and poor in two,with excellence rate of 79％.Conclusions The three-column theory plays an important role in clinical diagnosis and therapy of the tarsometatarsal joint injuries.Open reduction and cannulated screw internal fixation may attain satisfactory clinical results in treatment of the tarsometatarsal joint injuries.

Objective: To compare the therapeutic effectiveness of plate-screw and locked intramedullary nailing on treatment of tibial diaphysis fractures.Methods: The study included 87 patients from 2003.1 to 2008.1,in them 52 males,35 females,mean age 40(18~68) years.87 patients with 93 tibial diaphysis fractures,6 patients had bilateral involvement.41 cases were treated by intramedullary nailing and 52 cases by plate-screw fixation.Operation time,knee joint and ankle joint range of motion,time to union,and complications after a mean follow-up of 15(range 10 to 30) months were compared between the two groups.Results: The mean operation time and the mean range of motion of the ankle and knee were found similar in both groups(P0.05).The mean time to union was 4 months in intramedullary nailing,and 4.2 months in plate-screw fixation,there was no significant difference between them(P0.05).Plain radiographs showed rotation in two patients following intramedullary nailing and angulation in three patients with plate-screw fixation,all of them had distal-third tibial fractures.Conclusion: Plate-screw internal fixation and locked intramedullary nailing can all yields satisfactory results in treatment of tibial diaphysis fractures.

目的评价手法复位外固定架固定治疗老年人桡骨远端骨折的疗效。方法2004年3月-2007年3月应用手法复位可调式外固定架固定治疗老年人桡骨远端骨折60例,术后随访3个月～3年,以临床疗效和X线片表现为指标,按照Jakim评分系统进行疗效评分。结果60例患者,优40例,良16例,优良率为93.3%。结论手法复位可调式外固定架固定是一种治疗老年桡骨远端骨折的良好方法。