2018年澳大利亚糖尿病足网(Australian Diabetic Foot Network)发布了《澳大利亚糖尿病足选鞋指南》(以下简称2018版指南),对2013年制订的《糖尿病患者选鞋实践指南》(以下简称2013版指南)进行了更新,对糖尿病足的分级及诊断、糖尿病鞋的专业术语和要求、糖尿病足畸形对鞋的要求、不同风险等级糖尿病足的选鞋推荐等方面进行了详细的介绍,尤其对于足部畸形、溃疡前病变和溃疡愈合的患者,推荐使用医疗鞋或足部矫形器对足部高压区进行减压.本文就该指南的一些要点进行简要解读.

目的 探讨全骨盆切除术后胸廓承重接受腔和交互步态行走假肢的设计、装配和使用方法.方法 报道1例全骨盆切除术后患者.接受腔主要承重部位在下胸廓,悬吊依靠接受腔前后方向作用力,行走假肢由接受腔、交互步态行走矫形器的髋关节、假肢膝关节和SACH假脚组成,调节对线,进行步行训练.结果 患者借助接受腔直立每次可达4 h,借助腋拐可使用假肢以交互步态连续行走200 m,耗时30 min.改良Barthel指数评分由入院时的41.5分提高到出院时的93分(使用接受腔)和83分(使用假肢).结论 合理选择接受腔的受力位置、悬吊方式可以实现全骨盆切除者直立,合理选择假肢部件、正确力线和步行训练可以实现借助腋拐交互步态行走,从而提高日常生活活动能力.

下肢不等长(leg length discrepancy,LLD), 是指双下肢长度不相等,分为结构性不等长和功能性不等长 [1-4].结构性不等长是指下肢存在骨性长度差异 [4,5],根据长度差异及引起不等长的原因可以采用手术或补高鞋、足部矫形器等保守方法.功能性不等长是由下肢关节的生物力学功能差异引起的 [3,4],如单侧足部过度旋前 [5]、骨盆倾斜、软组织挛缩等,其治疗方法也要根据原因合理选择足部矫形器、功能锻炼或手法治疗.LLD会引起脊柱、骨盆、膝关节、踝关节的姿势和步态改变 [6],增加行走时肌肉的能量消耗 [7].当LLD>5 mm时,会出现步态不对称 [8].

目的 为了运用项目管理实现对于门诊抽血服务的具体优化,在最大范围内缩短患者的门诊抽血排队的等待时间.方法 工作人员主要运用项目管理的具体方式,深入研究与分析门诊抽血排队时间长的发展现状,积极寻找产生这一现象的具体原因,在这一发展背景下调整人员配置,实现对于项目流程的优化和管理,最终实现门诊抽血服务的优化.结果 应用项目管理的具体方法可以使门诊治疗室抽血排队平均时间明显缩短,数据可以显示出下降率高达75.0％;同时门诊患者满意度也得到了大幅度提高,而门诊患者的投诉率则是在大幅度下降.结论 应用项目管理方法能够在很大程度上提高门诊服务效率与质量,进而实现患者对医院满意度的提高.

Objective To establish the population pharmacokinetic (PPK) model of vancomycin in intensive care unit (ICU) patients,for guiding the adjustment of dosage regimen.Methods A total of 112 routine blood vancomycin concentration monitoring data were collected from 54 cases of ICU patients.A nonlinear mixed effect modeling pro gram was used to establish one-compartment model with NONMEM soft ware.Internal model validation by goodness-of-fit and bootstrap were performed to evaluate the robustness and prediction of the final model.Ninety-five routine blood vancomycin concentration monitoring data was collected from 35 cases of ICU patients,and the external validation of the model was performed by goodness-of-fit parameter method.Results The results of internal and external validation of the model showed that the model was stable and could predict the dynamic variation of vancomycin concentration well.Conclusion The in vivo process of vancomycin after intravenous administration in ICU patients was consistent with the single-compartment PPK model.The clearance of vancomycin was significantly influenced by meropenem.

Objective To apply problem-based learing(PBL)and case-based learning(CBL)in course of Outcome Measures in Prosthet-ics and Orthotics.Methods The undergraduate students in Grade 2012 of Prosthetics and Orthotics Engineering in Capital Medical Universi-ty (group A, n=27) were taught in traditional teaching, and those in Grade 2014 (group B, n=25) were taunght with PBL and CBL. Both groups received an immediate test after class,and group B also fulfilled an anonymous questionnaire.Results The score of immediate test was better in group B than in group A(t=-4.972,P<0.001).Most students in group B recognised that the new strategy of learning could im-prove their ability of independent solving clinical problems,literature retrieval,communication and expression.Conclusion Application of PBL and CBL in teaching of Outcome Measures in Prosthetics and Orthotics can promote students'activity in learning and improve teaching quality.

Objective To analyze the podiatric conditions of athletes with intellectual disabilities.Methods From May eleventh to 17th, 2015,779 athletes who participated in the sixth National Special Olympics were enrolled partly.Their lower limbs and feet were evaluated with Fit Feet Healthy Athletes Screening Form.Results Common podiatric conditions found in Special Olympics athletes included flat feet (52.2% in left side and 51.7% in right side), over pronation (56.1% in left side and 56.9% in right side), callus (44.7%), wrong nail cut (46.6%),ingrown nail(21.1%),and cross over toes(6.8%),etc.Conclusion Special Olympics athletes have podiatric structural,functional, nail and skin problems,which may relate to intellectual disabilities.

Objective To investigate walking ability of amputees with unilateral transtibial prosthesis. Methods From April to Decem-ber, 2016, 20 unilateral transtibial amputees (patients) and 20 healthy adults (controls) were tested with L test, balance test, 6-minute walk test (6MWT) and 1000 m walking outdoor on various terrain. Results There was no significant difference in time of L test between the am-putees wearing Solid Ankle Cushion Heel (SACH) and Storage Foot (t=0.675, P>0.05). In balance tests, there was no significant difference in the total track length, confidence ellipse area, maximum horizontal deviation and maximum vertical deviation between the patients and the controls (t<0.803, P>0.05). Each parameter was significantly different in 6MWT between them (t>2.774, P<0.01), as well as the time and energy expenditure of outdoor 1000 m walk test (t>4.130, P<0.001). Conclusion The walking ability of the unilateral transtibial ampu-tees wearing prostheses is different from normal people. The transtibial prosthetic feet that the amputees wear may impact their walking abil-ity.

The pharmaceutical microbiological examination in medical institutions is an important method to ensure the safety of preparations.It is of great significance to popularize the techniques of drug microbiological examination in primary medical institutions.This article started with the purpose, plan and training contents of the microbiological examination training program, which combined with theory teaching and practical operation, two-phase practical teaching, group teaching and collective teaching and guided students to design and plan experiments to carry out the teaching work,and then explored the ways and improving measures of the pharmaceutical microbiological examination training for hospital pharmacists, which could provide reference for the training and teaching of hospital pharmaceutical microbiological examination.

目的:培养符合国际教育标准要求的假肢矫形工程专业高级人才.方法:组织学生阅读原版英文教材,定期召开读书报告会,教师进行考核和点评,并采用自制问卷对学生进行调查.结果:开拓了学生的专业视野、增强了自主学习的意识和能力、提高了英语水平和综合素质.结论:读书报告会教学法有助于提高学生的专业理论水平和综合素质,值得在假肢矫形工程专业教学中应用.

目的 研究急性淋巴细胞白血病(ALL)患儿接受大剂量甲氨蝶呤(MTX)化疗后发生贫血的相关影响因素.方法 回顾性分析183例ALL患儿的临床资料,用Ordinal回归分析ALL患儿的性别、年龄、MTX剂量、化疗开始后第24,42 h的MTX血清浓度(C24和C42)与化疗后贫血发生率的相关性.结果 在540例次大剂量MTX化疗中,446例次化疗后发生贫血,贫血的发生率为82.59％.多元Ordinal回归分析显示,年龄(P＜0.01)、剂量(P＜0.05)和C24(P＜0.01)与化疗后贫血的发生显著相关,其回归系数估计值分别为0.057,0.487和0.014.结论 年龄、剂量和24与ALL患儿接受MTX化疗后的贫血发生率显著正相关,加强甲氨蝶呤血清浓度监测与甲酰四氢叶酸钙解救,有助于降低贫血的发生率.

The foot overpronation is termed as pronation persisting more than 25%of stance phase in a walking cycle, which may re-sult from some antenatal or postnatal conditions. Overpronation would lead to abnormal alignment of ankle, knee, pelvis and spine, and re-sult in a set of syndromes of chronic pain. The Navicular Drop Test and the Foot Posture Index are often used as the assessment tools, how-ever, there are several empirical ways for clinic. Foot orthoses, special shoes, taping and training of muscle strength are effective on overpro-nation as well as chronic pain.

Objective To systematically review the evaluation tools for walking ability of lower limb amputees wearing prostheses. Methods A computer-based search of PubMed, Wanfang Data and CNKI.net was performed for articles related to the evaluation of walking ability of lower limb amputees wearing prostheses published from January, 1995 to December, 2015. Results and Conclusion A total of 20 papers were selected, including 18 foreign literatures and 2 Chinese articles. There were many evaluation tools for walking ability of lower limb amputees wearing prostheses, and should be chosen according to the actual situation.

目的 研究影响急性淋巴细胞白血病(ALL)患儿甲氨蝶呤(MTX)血清浓度的相关因素.方法 回顾性分析207例ALL患儿的临床资料,用独立样本t检验与多元线性回归分析ALL患儿的性别、年龄、MTX剂量和肝功能状态与化疗开始后第24,42 h的MTX血清浓度(C24和C42)的相关性.结果 独立样本t检验分析显示,性别(P＜0.05)、年龄(P＜0.01)、剂量(P＜0.01)和肝功能状态(P＜0.01)与C24显著相关;年龄(P＜0.01)和剂量(P＜0.01)与C42显著相关.进一步多元线性回归分析显示,年龄(P＜0.01)、剂量(P＜0.01)和肝功能状态(P＜0.01)是C24的显著独立影响因素,其标准化回归系数分别为0.197,0.235和0.128;而考察的4个因素与C42均无显著关系.结论 年龄、剂量和肝功能状态是C24的显著独立影响因素,应加强与重视MTX血清浓度监测,以期提高MTX化疗的有效性和安全性.

目的 建立流式细胞术(flow cytometry,FCM)分析循环血小板活化(circulating platelet activation,CPA)与血小板-白细胞黏附(platelet-leukocyte adhesion,PLA)方法,为临床开展血小板相关疾病研究奠定基础.方法 选择50例健康志愿者,收集枸橼酸钠抗凝血,采用CD61/PAC-1/CD62P三色法检测CPA,分析血小板早期活化率(PAC-1+ CD62P-)和晚期活化率(PAC-1+ CD62P+);并设置0、5、10、15、20、30、60 min 7个时间点染色,分析样本放置时间对血小板活化的影响,建立参考值.采用CD61/CD3/CD19/CD11 b/CD14/CD45六色法检测PLA,分析血小板-白细胞黏附CD45+ CD61+ (PLA)、血小板-T淋巴细胞黏附CD3+ CD61+ (PTLA)、血小板-B淋巴细胞黏附CD19+ CD61+ (PBLA)、血小板-单核细胞黏附CD14+ CD61+ (PMA)、血小板-中性粒细胞黏附CD451ow+CD11 b+CD61+ (PNA)表达率.结果 宜选用15 min点建立健康人血小板活化参考范围,早期活化百分比为:3.75(1.00～9.80)％,晚期活化百分比为:0.10(0.00～0.10)％;FCM检测PLA、PTLA、PBLA、PMA、PNA表达率,其中PMA比例最高为:(10.75 ±3.23)％.结论 CPA检测血样放置时间不应超过15 min,PLA检测关键在于PMA分析.建立快速、稳定、准确的CPA和PLA检测方法是正确评价血小板功能的技术保障.

With the development of the industry, all the parts of bilateral hip disarticulation prosthesis have been improved. The patients with bilateral hip disarticulation prosthesis can achieve the swing-to gait or swing-through gait, even the reciprocal gait.

Objective To compare the energy expenditure of a hemicorporectomy amputee moving with different mobility devices. Methods A middle-aged male hemicorporectomy amputee was measured with cardiopulmonary exercise test when moving with 4 kinds of transport:socket, cart, wheelchair, and prosthesis. Results The patient moved the slowest with prosthesis, fastest with wheelchair. The heart rate was the highest with prosthesis and lowest with cart. The absolute oxygen consumption, the relative volume of oxygen consumption and metabolic (Mets) were the most when hand walking with socket, and lowest with cart. Conclusion Hand walking with socket costs the larg-est energy when walking, and the rest are prosthesis, wheelchair, and cart.

Objective To compare the walking ability between bilateral transtibial amputees and normal controls, and develope refer-ence indexes of bilateral transtibial amptees' walking ability while wearing prostheses. Methods 11 bilateral transtibial amputees served as amputation group, 12 normal subjects served as controls. The indoor gait characteristics, outdoor time cost and energy consumption, and stat-ic balance of both groups were evaluated. Results After the indoor gait analysis, the average self-selected-speed of the amputees was 1.07 m/s, while the self-selected-speed of the normal people was 1.29 m/s. When the subjects walked with their self-selected-speed, there were significant differences in some of the gait spatial and temporal parameters between 2 groups (P<0.05). When the subjects walked on a spe-cially designed 1 km outdoor trail, differences of energy consumption and time cost were also observed (P<0.05). Static balance presented no significant difference between 2 groups (P>0.05). Conclusion The walking ability of the bilateral transtibial amputees wearing prosthe-ses is different from normal people. Quantitative evaluation of walking ability can provide more accurate reference for the rehabilitation of amputees.

Through the observation on 56 cases of the elderly patients before and after permanent pacemaker installation operation,we found the we should pay attention to nursing during peri operation period especially preoperative psychological nursing according to the characteristics of elderly people.We should try to obtain the trust of patients and eliminate their psychological barriers,thus to enable them to adjust to the best state to accept operation.After the operation,we can prevent the occurance of complications and improve the nursing quality through close observation of temperature,the changes of blood pressure and blood glucose,prevention of electrode displacement,nursing the wound,skin and bowel carefully.By make carefully health guidance,the elderly patients can use the pacemakers correctly and fulfill the maximum extension of the use time of pacemakers.

Objective To design a reciprocal gait prosthesis connecting with the other prosthetic accessories for the bilateral hip disarticulation amputees.MethodsThe principle of reciprocal gait orthosis for paraplegia was used in the design,fitting reciprocal gait prosthesis for an amputee,which was compared with an ordinary bilateral Canadian type hip disarticulation prosthesis in the walking velocity and energy expenditure.ResultsThe amputee walked at lower energy expenditure and more like normal gait with reciprocal gait prosthesis while the walking velocity decreased,compared with the conventional prosthesis.ConclusionThis reciprocal gait prosthesis for bilateral hip disarticulation amputee needs less energy expenditure during walking like normal gait.