成人脊柱畸形患者矫正术后力学性并发症发生率及其危险因素分析

摘要 目的：研究成人脊柱畸形患者矫正手术后力学性并发症的发生率以及影响其发生的危险因素。方法：纳入2016年6月到2020年6月在我院接受脊柱畸形矫正术的患者80例,术后对所有患者进行为期12个月的随访。根据患者术后随访期间是否出现力学性并发症分为力学并发症组和无力学并发症组,调查两组患者年龄、BMI、术中失血量、手术时间、合并神经损伤、术中截骨、性别、主弯角度、矫正率、手术史、入路以及疾病类型等病历资料,并通过单因素和多因素Logistic回归分析成人脊柱畸形矫正术后发生力学性并发症的独立危险因素。结果：80例脊柱畸形矫正术患者术后发生力学性并发症患者18例（22.50 %）,分别为内固定失败4例、近端交界性失败5例、远端交界性失败4例以及术后冠状面失平衡5例。单因素分析结果表明,手术时间（OR=6.924,P=0.015）、年龄（OR=2.803,P=0.011）、矫正率（OR=3.215,P=0.032）、合并神经损伤（OR=1.629,P=0.021）、术中截骨术（OR=5.876,P=0.005）以及手术史（OR=1.692,P=0.043）与成人脊柱畸形矫正术后力学性并发症的发生有关。多因素Logistic回归分析结果表明,手术时间（OR=2.265,P=0.002）、年龄（OR=4.035,P<0.001）、合并神经损伤（OR=3.024,P=0.003）以及术中截骨术（OR=3.982,P<0.001）是成人脊柱畸形矫正术后发生力学性并发症的独立危险因素。结论：成年脊柱畸形患者矫正术后易发生力学性并发症,手术时间较长、年龄较大、合并神经损伤以及术中截骨术均会增加其发生风险。     

Ear examination

Adolescent idiopathic scoliosis is the single most common form of spinal deformity seen in orthopedic practice. Our knowledge about the epidemiology, etiology, natural history, and treatment has recently increased dramatically. The incidence of small curves is rather high (2% of the population), whereas severe curves are much less common (<0.1%), but we cannot always predict which curve will progress. Abnormalities of the neuromuscular system and of calcium metabolism, and certain growth, genetic, and mechanical factors may all play roles in the pathogenesis of the disorder. The physiologic secondary effects of severe scoliosis relate to restrictive lung disease, but most patients do not have a deformity great enough to affect their cardiorespiratory function. The psychological and social effects of scoliosis are significant for patients but difficult to quantitate. For most patients with moderate scoliosis—that is, more than 25 to 30 degrees—treatment with an underarm brace or electrical stimulation is adequate to “control” progression of the curve. Surgical fusion allows actual correction of the curve but is indicated in only a small percentage of patients—usually those with more than 50 degrees of deformity.     

A new dental unit for both patients in wheelchairs and general patients

Objective: To develop a dental unit to accommodate both patients in wheelchairs and general patients, and to evaluate the acceptability of the new chair for patients and dentists. Design: To integrate a unit for patients in wheelchairs and a unit for general patients into a single dental unit. Results: (1) The newly developed dental unit could be used for both patients in wheelchairs and general patients and could be installed in nearly the same space as occupied by a conventional dental unit. (2) The dentists could take the home position because of the height‐adjusting and tilting mechanisms. (3) The patients could be treated with a sense of assurance because of the wheelchair immobilizer and the safety devices. (4) The dentists could perform patient treatment safely. (5) As patients did not need to be transferred from their wheelchairs, assistance was unnecessary. (6) From the questionnaires, both patients and dentists rated the newly developed dental unit favourable. Conclusions: The new dental unit for patients in wheelchairs and general patients permitted dentists to perform and patients to receive dental treatment safely and in a comfortable position. Also, as a single unit could be used for treatment of both types of patients, it required no extra space. Therefore, it has the potential to be installed in the clinics of general dental practitioners to treat both groups of patients.     

Wind as a negative factor in human comfort and its implications for planning

In all comfort formulae the wind appears as a positive factor with low velocities not exceeding 10 m/s. To date most researchers have ignored the negative effect which strong winds can have on man's comfort. Although they are not destructive, such winds blowing continuously for many hours of the day, over long periods of the year may have a negative effect on human comfort. Therefore, until a formula is developed which incorporates high wind velocities as a possible negative factor, the many comfort indices will not fulfill their role in objectively ascertaining man's comfort. Examples are cited from Israel. The most dominant region is the Jordan Rift Valley and its southern extension to the Gulf of Elat. This region is now undergoing intensive development and the strong winds are a factor which must be considered in regional planning, in settlement location and in their detailed planning.     

近50年京津冀气候舒适度的区域时空特征分析

受气候变化影响,区域气候舒适期势必会发生不同程度的变化。从气候舒适性的视角出发,利用京津冀地区1966—2015年的170个观测站点50年逐日气象资料,以温湿指数、风效指数、着衣指数及其综合指数为气候舒适性的评价指标,统计分析区域气候舒适期的起止日期、天数及其年际间变化规律,揭示京津冀区域气候舒适度的时空变化特征,为区域人口合理分布和气候资源评价提供科学依据。此外,以日为时间尺度进行气候舒适期分析,有利于气候变化背景下区域间横向和区域内纵向的比较研究。结果显示:(1)京津冀气候舒适度指数近50年来的变化趋势基本相同,综合指数呈显著增加趋势;但各地间变幅存在一定差异,其中天津气候舒适度指数变化幅度最为明显,北京变化相对平稳。(2)从气候舒适度综合指数来看,京津冀地区气候舒适期年内分布呈"M"型,舒适期相对集中在4—5月、9—10月,舒适和较舒适等级的月累计日数均达到28 d以上,其中5月气候最为舒适,舒适等级日数最多,达到24—26 d;北京年平均舒适天数最多(100 d),天津最少(91 d)。(3)从单一气候舒适度指数来看,京津冀舒适和较舒适等级的初始日期大多呈显著的提前趋势;终止日期和天数大多略有增加,但变化趋势不显著。而综合指数显示,1966—2015年较舒适等级的初始日期变化最为显著,大约每10年提前3—4 d;天津和河北终止日期变化也达到显著水平,大约每10年推迟1—2 d,北京增加趋势不明显。(4)京津冀气候舒适期的空间分布显示,舒适等级的日数从西北向东南地区呈减少特征,河北北部舒适等级的年平均日数最多达115—120 d,东南部最少,不足90 d。     

Teleosts as models for human vertebral stability and deformity

Vertebral development is a dynamic and complicated process, and defects can be caused by a variety of influences. Spinal curvature with no known cause (idiopathic scoliosis) affects 2-3% of the human population. In order to understand the etiology and pathogenesis of complex human skeletal defects such as idiopathic scoliosis, multiple models must be used to study all of the factors affecting vertebral stability and deformity. Although fish and humans have many of the same types of offenses to vertebral integrity, they have been overlooked as a resource for study. The most common morphological deformity reported for fish are those that occur during the development of the spinal system, and as with humans, curvature is a common morphological consequence. Here we review spinal curvature in teleosts and suggest that they are an unexploited resource for understanding the basic elements of vertebral stability, deformity, development and genetics. Fish can be a value to vertebral research because they are tractable, have a diversity of non-induced vertebral deformities, and substantial genomic resources. Current animal models lack non-induced deformities and the experimental tractability necessary for genetic studies. The fact that fish are free of an appendicular skeleton should allow for analysis of basic spinal integrity without the biomechanical constraints observed in quadrupedal and bipedal models. To illustrate the point we review human idiopathic scoliosis and the potential contribution teleosts can make for the identification of causes, risk factors, and treatment options.     

The next generation of exoskeletons: lighter, cheaper devices are in the works

Many researchers and engineers are busy in their laboratories working on devices that will bring mobility to people who have lost function in the lower body due to an accident, stroke, multiple sclerosis, or other disorders. "Several pretty sophisticated exoskeletons are already on the market now, and they are all similar to each other in terms of technologies, but we're not ready to replace the wheelchair yet," said exoskeleton developer Homayoon Kaz Kazerooni, Ph.D., professor of mechanical engineering at the University of California (UC) at Berkeley. "Eventually, we will have devices that are used by individuals on a daily basis to replace wheelchairs but not with the existing technology. We're at the beginning of a much bigger era in exoskeletons."     

Comfort evaluation as the example of anthropotechnical furniture design

Human health is becoming an increasingly important issue in contemporary hectic lifestyle imposed at work and by struggle to save time and money. Sitting comfort and quality of chairs which we use for the most of our time have, thus, become essential for healthy lifestyle. Sitting discomforts arise from prolonged sitting on the inappropriate chairs, which failing to provide sufficient support to the body cause discomfort and tiring. The studies of the office chair constructions have identified differences in perception of comfort provided by different types of seats. Four seat constructions and the comfort they provide to the sitters were compared by means of subjective indicators. After a two-day sitting on each of the studied chairs the subjects scored their perception of comfort and discomfort, using the questionnaire with 17 statements. Constructional forms and materials which contributed more to the sense of comfort by minimizing fatigue and pains developed by sitting were determined.     

Pelvis morphology, trunk posture and standing imbalance and their relations to the Cobb angle in moderate and severe untreated AIS

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis and usually affects young girls. Studies mostly describe the differences between scoliotic and non-scoliotic girls and focus primarily on a single set of parameters derived from spinal and pelvis morphology, posture or standing imbalance. No study addressed all these three biomechanical aspects simultaneously in pre-braced AIS girls of different scoliosis severity but with similar curve type and their interaction with scoliosis progression. The first objective of this study was to test if there are differences in these parameters between pre-braced AIS girls with a right thoracic scoliosis of moderate (less than 27°) and severe (more than 27°) deformity. The second objective was to identify which of these parameters are related to the Cobb angle progression either individually or in combination of thereof. Forty-five scoliotic girls, randomly selected by an orthopedic surgeon from the hospital scoliosis clinic, participated in this study. Parameters related to pelvis morphology, pelvis orientation, trunk posture and quiet standing balance were measured. Generally moderate pre-brace idiopathic scoliosis patients displayed lower values than the severe group characterized by a Cobb angle greater than 27°. Only pelvis morphology and trunk posture were statistically different between the groups while pelvis orientation and standing imbalance were similar in both groups. Statistically significant Pearson coefficients of correlation between individual parameters and Cobb angle ranged between 0.32 and 0.53. Collectively trunk posture, pelvis morphology and standing balance parameters are correlated with Cobb angle at 0.82. The results suggest that spinal deformity progression is not only a question of trunk morphology distortion by itself but is also related to pelvis asymmetrical bone growth and standing neuromuscular imbalance.     

Are people more averse to microbe-sharing contact with ethnic outgroup members? A registered report

Intergroup biases are widespread across cultures and time. The current study tests an existing hypothesis that has been proposed to explain such biases: the mind has evolved to interpret outgroup membership as a cue to pathogen threat. In this registered report, we test a core feature of this hypothesis. Adapting methods from earlier work, we examine (1) whether people are less comfortable with microbe-sharing contact with an ethnic outgroup member than an ethnic ingroup member, and (2) whether this difference is exacerbated by additional visual cues to a target's infectiousness. Using Chinese (N = 1533) and British (N = 1371) samples recruited from the online platforms WJX and Prolific, we assessed contact comfort with targets who were either East Asian or White and who were either modified to have symptoms of infection or unmodified (or, for exploratory purposes, modified to wear facemasks). Contact comfort was lower for targets modified to have symptoms of infection. However, we detected no differences in contact comfort with ethnic-ingroup targets versus ethnic-outgroup targets. These results do not support the hypothesis that people interpret ethnic outgroup membership alone as a cue to infection risk.     

Physician attitudes towards pharmacological cognitive enhancement: safety concerns are paramount

The ethical dimensions of pharmacological cognitive enhancement have been widely discussed in academic circles and the popular media, but missing from the conversation have been the perspectives of physicians - key decision makers in the adoption of new technologies into medical practice. We queried primary care physicians in major urban centers in Canada and the United States with the aim of understanding their attitudes towards cognitive enhancement. Our primary hypothesis was that physicians would be more comfortable prescribing cognitive enhancers to older patients than to young adults. Physicians were presented with a hypothetical pharmaceutical cognitive enhancer that had been approved by the regulatory authorities for use in healthy adults, and was characterized as being safe, effective, and without significant adverse side effects. Respondents overwhelmingly reported increasing comfort with prescribing cognitive enhancers as the patient age increased from 25 to 65. When asked about their comfort with prescribing extant drugs that might be considered enhancements (sildenafil, modafinil, and methylphenidate) or our hypothetical cognitive enhancer to a normal, healthy 40 year old, physicians were more comfortable prescribing sildenafil than any of the other three agents. When queried as to the reasons they answered as they did, the most prominent concerns physicians expressed were issues of safety that were not offset by the benefit afforded the individual, even in the face of explicit safety claims. Moreover, many physicians indicated that they viewed safety claims with considerable skepticism. It has become routine for safety to be raised and summarily dismissed as an issue in the debate over pharmacological cognitive enhancement; the observation that physicians were so skeptical in the face of explicit safety claims suggests that such a conclusion may be premature. Thus, physician attitudes suggest that greater weight be placed upon the balance between safety and benefit in consideration of pharmacological cognitive enhancement.     

Influences of culture and environmental attitude on thermal, emotional and perceptual evaluations of a public square

The main objective of the present quasi-experimental study was to examine the influence of culture (Swedish vs Japanese) and environmental attitude (urban vs open-air person) on participants’ thermal, emotional and perceptual assessments of a square, within the PET (physiological equivalent temperature) comfortable interval of 18–23°C. It was predicted that persons living in different cultures with different environmental attitudes would psychologically evaluate a square differently despite similar thermal conditions. Consistent with this prediction, Japanese participants estimated the current weather as warmer than did Swedish participants and, consistent with this, they felt less thermally comfortable on the site, although participants in both countries perceived similar comfortable thermal outdoor conditions according to the PET index. Compared to the Japanese, the Swedes estimated both the current weather and the site as windier and colder, indicating a consistency in weather assessment on calm-windy and warm-cold scales in participants in both cultures. Furthermore, Swedish participants felt more glad and calm on the site and, in line with their character (more glad than gloomy), they estimated the square as more beautiful and pleasant than did Japanese participants. All this indicates that thermal, emotional and perceptual assessments of a physical place may be intertwined with psychological schema-based and socio-cultural processes, rather than fixed by general thermal indices developed in line with physiological heat balance models. In consequence, this implies that thermal comfort indices may not be applicable in different cultural/climate zones without modifications, and that they may not be appropriate if we do not take into account the psychological processes involved in environmental assessment.     

Contrasting effect of hemodialysis and peritoneal dialysis on the inhibition of in vitro calcification by uremic serum

Our findings support the earlier observation of Yendt, Connor and Howard that uremic serum inhibits the calcification of rachitic rat cartilage in vitro. We also confirmed their studies showing that this inhibition is not the consequence of increased levels of serum magnesium or blood urea. In addition, we have shown that aqueous solutions of creatinine and uric acid in concentrations up to 20 mg./100 ml. do not cause any inhibition.Hemodialysis of uremic patients does not change the inhibitory activity of their blood. In contrast, after 24 hours of peritoneal dialysis, the blood of most patients does not inhibit calcification.The inhibitory activity of uremic serum, observed in vitro, may be important in the pathogenesis of osteomalacia in patients with renal failure. Failure of hemodialysis to alter this activity may contribute to the progression of renal osteodystrophy in patients on maintenance hemodialysis.     

Rocky mountain spotted Fever

We compare health maintenance organization enrollees'' evaluations of the care they received from family physicians and chiropractors for low back pain. Patients of chiropractors were three times as likely as patients of family physicians to report that they were very satisfied with the care they received for low back pain (66% versus 22%, respectively). Compared with patients of family physicians, patients of chiropractors were much more likely to have been satisfied with the amount of information they were given, to have perceived that their provider was concerned about them, and to have felt that their provider was comfortable and confident dealing with their problem. Although the more positive evaluations of chiropractors may be related to differences in the patient populations served by the two providers or to benefits of spinal manipulation, it is suggested that a potentially more potent force--the therapeutic effect of the patient and provider interaction itself--may explain the observed differences.     

Employee Attitudes about the Impact of Visitation Dogs on a College Campus

Therapy and visitation dogs are becoming more common on college campuses to provide comfort and support to students, but little attention has been given to the concerns of faculty and staff who share space with the dogs in their workplaces. The purpose of this study was to assess the perceptions of faculty and staff with regard to both the benefits and the hazards (e.g., dander, bites, fleas) and risks associated with the presence of visitation dogs in their workplaces. One hundred and thirty-eight employees who worked in buildings with resident visitation dogs completed an online survey about their perceptions of the hazards and risks of the dogs and the effects of dogs on the wellbeing of both students and employees. In general, employees perceived that the dogs presented minimal risks, and most employees believed that they can reduce stress and provide comfort to students on campus. There were a few employees, however, who reported that the dogs did not improve the work environment and conferred no benefits to the staff or students. The findings of the present survey support the mostly positive attitudes that people have for dogs in the workplace, but they also highlight a potential challenge: accommodating individuals who believe very strongly that dogs do not belong in work environments.     

Corrections in grasp posture in response to modifications of action goals

There is ample evidence that people plan their movements to ensure comfortable final grasp postures at the end of a movement. The end-state comfort effect has been found to be a robust constraint during unimanual movements, and leads to the inference that goal-postures are represented and planned prior to movement initiation. The purpose of this study was to examine whether individuals make appropriate corrections to ensure comfortable final goal postures when faced with an unexpected change in action goal. Participants reached for a horizontal cylinder and placed the left or right end of the object into the target disk. As soon as the participant began to move, a secondary stimuli was triggered, which indicated whether the intended action goal had changed or not. Confirming previous research, participants selected initial grasp postures that ensured end-state comfort during non-perturbed trials. In addition, participants made appropriate on-line corrections to their reach-to-grasp movements to ensure end-state comfort during perturbed trials. Corrections in grasp posture occurred early or late in the reach-to-grasp phase. The results indicate that individuals plan their movements to afford comfort at the end of the movement, and that grasp posture planning is controlled via both feedforward and feedback mechanisms.     

Congenital kyphoscoliosis and spinal cord lesion produced in the rat by beta-aminopropionitrile

Pregnant rats received the lathyrogen beta-aminopropionitrile (1,500 mg/kg) intraperitoneally on day 16 (plug day = 0 day). Kyphoscoliosis was produced in a high incidence in the fetuses at the level of the upper thoracic spine as early as 24 hours after treatment. Although most of the affected newborns died within two weeks, survivors were studied until 20 weeks after birth. Survivors developed paraplegia in consequence of kyphoscoliosis. Both spinal deformity and motor disturbance were progressive. Biochemical and electron microscopic observations suggested that beta-aminopropionitrile treatment resulted in an inhibition of collagen formation in the spinal column and surrounding longitudinal ligaments of the fetuses six hours after the treatment. In addition, electron micrographs of vertebral bodies showed a decrease of proteoglycan granules in the extracellular matrix. Therefore, rupture and collapse of weakened ligaments and vertebral bodies might result in severe spinal deformity and spinal cord lesion.     

Body Actions Change the Appearance of Facial Expressions

Perception, cognition, and emotion do not operate along segregated pathways; rather, their adaptive interaction is supported by various sources of evidence. For instance, the aesthetic appraisal of powerful mood inducers like music can bias the facial expression of emotions towards mood congruency. In four experiments we showed similar mood-congruency effects elicited by the comfort/discomfort of body actions. Using a novel Motor Action Mood Induction Procedure, we let participants perform comfortable/uncomfortable visually-guided reaches and tested them in a facial emotion identification task. Through the alleged mediation of motor action induced mood, action comfort enhanced the quality of the participant’s global experience (a neutral face appeared happy and a slightly angry face neutral), while action discomfort made a neutral face appear angry and a slightly happy face neutral. Furthermore, uncomfortable (but not comfortable) reaching improved the sensitivity for the identification of emotional faces and reduced the identification time of facial expressions, as a possible effect of hyper-arousal from an unpleasant bodily experience.     

An analysis of influential factors on outdoor thermal comfort in summer

A variety of research has linked high temperature to outdoor thermal comfort in summer, but it remains unclear how outdoor meteorological environments influence people's thermal sensation in subtropical monsoon climate areas, especially in China. In order to explain the process, and to better understand the related influential factors, we conducted an extensive survey of thermally comfortable conditions in open outdoor spaces. The goal of this study was to gain an insight into the subjects' perspectives on weather variables and comfort levels, and determine the factors responsible for the varying human thermal comfort response in summer. These perceptions were then compared to actual ambient conditions. The database consists of surveys rated by 205 students trained from 6:00 am to 8:00 pm outdoors from 21 to 25 August 2009, at Nanjing University of Information Science & Technology (NUIST), Nanjing, China. The multiple regression approach and simple factor analysis of variance were used to investigate the relationships between thermal comfort and meteorological environment, taking into consideration individual mood, gender, level of regular exercise, and previous environmental experiences. It was found that males and females have similar perceptions of maximum temperature; in the most comfortable environment, mood appears to have a significant influence on thermal comfort, but the influence of mood diminishes as the meteorological environment becomes increasingly uncomfortable. In addition, the study confirms the strong relationship between thermal comfort and microclimatic conditions, including solar radiation, atmospheric pressure, maximum temperature, wind speed and relative humidity, ranked by importance. There are also strong effects of illness, clothing and exercise, all of which influence thermal comfort. We also find that their former place of residence influences people's thermal comfort substantially by setting expectations. Finally, some relationships between thermal perception and amount of exercise, thermal experience, mood, clothing, illness and microclimate, etc., are established. Our findings also shed light on how to resist or adapt to outdoor hyperthermic conditions during summer in subtropical monsoon climate areas.     

舒适护理在肠镜下早期结肠扭转复位中的应用

目的:探讨舒适护理在肠镜下早期结肠扭转复位中的应用及效果。方法:选择我院收治的早期结肠扭转患者50例,随机分成2组。观察组25例,在常规护理的基础上给予舒适护理;对照组25例,给予常规护理。观察两组患者的治疗情况、舒适度及满意度。结果:观察组的手术时间明显短于对照组(P0.05);观察组患者舒适度中的高度、低度比例与对照组差异显著(P0.05);观察组患者非常满意、较差的比例与对照组差异显著(P0.05)。结论:在早期结肠扭转复位中应用舒适护理使患者感受到舒适及亲人般的温暖,可提高患者的满意度,增加患者对医护人员的信任感,提高护理服务质量,丰富护理的内涵,顺应护理的发展。