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癫痫：从儿童至成年的医疗过渡—来自安大略省癫痫执行工作组的建议

从儿童到成人的医疗保健系统的转变对许多患有癫痫的年轻人及其家庭来说是一个挑战。最近，加拿大安大略省卫生部和长期医疗部门成立了一个过渡工作组（Transition working group，TWG），为安大略省癫痫患者的过渡提出建议。在此对这项工作做出总结。TWG 包括儿科和成人癫痫病专家、精神科医生和来自学术界和社区的家庭医生，从事儿童和成人癫痫项目的社区医师、护士和社会工作者，以及青少年内科医师、律师、职业治疗师、社区癫痫机构的代表、癫痫患者和患者父母。该小组主要解决 3 个领域的问题：① 癫痫的诊断和管理；② 癫痫患者心理健康和社会心理需求；③ 癫痫患者经济、社会和法律支持。目前虽然还没有对过渡方案的结果进行系统研究，但 TWG 能早期识别处于过渡失败风险的青少年，在实际过渡之前即应协调儿童和成人神经科医师以及其他专家。过渡期是重新思考诊断和重复诊断检测（特别是基因检测，现有技术较多年前可发现更多病因）的理想时期。在转至成人医疗系统后部分筛查应重复。文章提出的 7 个步骤可以促进过渡，从而有助于为青少年癫痫患者转出儿童保健系统提供持续且合理的医疗服务。

青年臀肌筋膜挛缩症近期疗效分析

目的 总结采用臀肌筋膜挛缩松解术、联合医用胶黏合切口治疗青年注射性臀肌筋膜挛缩症的临床疗效。 方法 2005 年7 月－ 2008 年10 月，对27 例青年臀肌筋膜挛缩症行挛缩松解术，术毕用医用胶黏合切口。男9 例，女18 例；年龄16 ～ 23 岁。病变均位于双侧。病程10 ～ 18 年，平均14.6 年。 结果 术后切口均Ⅰ期愈合。27 例均获随访，随访时间6 ～ 36 个月，平均21 个月。切口未遗留明显瘢痕。双下肢功能根据黄耀添等评价标准评定：优18 例，良6 例，可2 例，差1 例，优良率为88.9%。 结论 对于青年臀肌筋膜挛缩症，术中彻底松解挛缩带，检查髋关节功能，术后积极康复训练，可获得满意疗效；联合医用胶黏合切口可避免术后遗留明显瘢痕。

Effectiveness analysis of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients

Objective To compare the effectiveness of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients. Methods The clinical data of 55 young and middle-aged patients with Pauwels type Ⅲ femoral neck fracture between June 2021 and December 2022 was retrospectively analyzed. All patients were treated with closed reduction and internal fixation with hollow screws, 25 cases were treated with biplanar vertical fixation (study group), 30 cases with inverted triangle fixation (control group). There was no significant difference in gender, age, affected side, cause of injury, underlying diseases, and time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy times, guide needle puncture times, starting time of weight bearing, time of full weight bearing, time of fracture healing, and complications were recorded and compared between the two groups. The hip joint function was evaluated by Harris score at 1 day, 6 months, 12 months after operation, and at last follow-up, and the pain relief was evaluated by visual analogue scale (VAS) score. The femoral neck shortening was measured on the X-ray film at last follow-up. Results All patients were followed up 12-31 months (mean, 22.0 months), and there was no significant difference in follow-up time between the two groups (P>0.05). The operation time, intraoperative blood loss, and fluoroscopy times in the study group were higher than those in the control group, but the difference was not significant (P>0.05). The guide needle puncture times in the study group was more than that in the control group, and the time of starting weight bearing and the time of full weight bearing in the study group were shorter than those in the control group, the differences were significant (P<0.05). Bony healing was achieved in both groups, and there was no significant difference in fracture healing time between the two groups (P>0.05). No osteonecrosis of the femoral head and incision-related complication was found in the two groups during follow-up, and the femoral neck shortening length in the study group was significantly shorter than that in the control group at last follow-up (P<0.05). There was no significant difference in Harris score between the two groups at 1 day after operation (P>0.05), and the Harris score of the study group was significantly better than that of the control group at other time points (P<0.05); there was no significant difference in VAS score between the two groups at each time point after operation (P>0.05). Conclusion Compared with the inverted triangle fixation, the treatment of Pauwels type Ⅲ femoral neck fracture with biplanar vertical fixation can effectively reduce femoral neck shortening without affecting fracture healing, and improve hip joint function in early stage.

Clinical Study of the Relevant Risk factors of Hepatic Adipose Infiltration in Young People

目的:探讨青年人群中脂肪肝的相关危险因素。方法:收集2008年在我院体检中心同期体检,年龄≤45岁脂肪肝患者127人,非脂肪肝患者116人,询问病史,进行身高、体重、血生化及B超检查并分脂肪肝组和非脂肪肝组进行比较。结果:脂肪肝组肥胖、饮酒、高血脂、高血糖、肝功异常发病率明显高于对照组。结论:肥胖、饮酒是脂肪肝的重要危险因素,脂肪肝患者多伴有糖脂代谢紊乱及肝功受损。

Youth Volunteers of West China Medical School/ West China Hospital of Sichuan University after the Wenchuan Earthquake

After Wenchuan earthquake on May 12, West China Medical School/ West China Hospital of Sichuan University organized a youth volunteer team for earthquake rescue and relief. A volunteer network was formed and relevant service regulations were formulated immediately. Volunteers have played an important role in post-earthquake evacuation of patients, emergency reception, ward care, on-call service, a service to help people find family members, telecommunications and some other major tasks.

青年非小细胞肺癌患者临床特点与预后因素分析

目的　探讨青年（≤40岁）非小细胞肺癌（NSCLC）患者的临床特点、手术疗效，分析影响预后的因素。　方法　回顾性分析苏州大学附属第四医院2000年1月至2009年12月经手术治疗48例40岁以下青年NSCLC患者的临床资料，其中男31例，女17例；年龄（32±6）岁。29例术前明确为NSCLC，12例术前高度怀疑为肺癌，7例误诊为肺良性疾病；手术根治性切除37例，姑息性切除9例，手术探查2例。　结果　术后并发症发生率12.5% （6/48），1例死于探查术后呼吸衰竭，病死率2.1% （1/48）。术后组织病理学检查示腺癌26例，鳞癌16例，腺鳞癌5例，大细胞肺癌1例。术后病理分期示Ⅰ期3例，Ⅱa期9例，Ⅱb期15例，Ⅲa期17例，Ⅲb期3例， Ⅳ期1例。随访45例，随访率93.8% （45/48），随访时间23 （3～120） 个月。总的3年和5年生存率分别为39.6%和25.0%。肿瘤TNM分期、淋巴结转移状况、肿瘤直径、手术性质、术前新辅助化疗及术后规则放化疗是影响预后的重要因素，肿瘤TNM分期是影响患者预后最主要的因素。　结论　青年NSCLC误诊率高，恶性程度高，分期偏晚，手术根治性切除率偏低，应加强早诊早治意识。手术根治仍是青年NSCLC患者治疗的首选。

Modified Ilizarov hip reconstruction in treatment of adolescent hip instability

ObjectiveTo evaluate the effectiveness of modified Ilizarov hip reconstruction in the treatment of hip instability.MethodsThe clinical data of 13 young patients with hip diseases treated with modified Ilizarov hip reconstruction between January 2010 and March 2018 were retrospectively analyzed. There were 2 males and 11 females, aged from 14 to 34 years, with an average age of 24.2 years. There were 1 case of hip dysplasia and dislocation due to spinal bifida, 3 cases of hip dysplasia after pyogenic arthritis of the hip, 2 cases of developmental dysplasiaof the hip (DDH) accompanying femoral head necrosis who rejected hip replacement, 6 cases of young DDH refused to undergo hip replacement, and 1 case of bilateral hip dysplasia with dislocation due to sputum cerebral palsy. The disease duration was 2-20 years, with an average of 8.5 years. Preoperative Trendelenburg sign was positive in 12 cases and negative in 1 case. The preoperative Harris score of hip joint was 53.5±8.9 and the unequal length of lower limbs was (46.08±15.73) mm. Postoperative Harris hip score and patients' satisfaction with effectiveness evaluated according to their self scoring were used to assess the effectiveness.ResultsAll 13 patients were followed up 1-5 years, with an average of 2.6 years. Five patients developed postoperative needle infection, which improved after dressing change; 7 patients had limited knee joint activity and improved after knee joint function training. The Trendelenburg sign was negative at 1 year after operation, and the patient’s hip pain symptoms were relieved or disappeared. The Harris hip score of patients at 1 year after operation was 84.5±6.1, which was significantly improved when compared with preoperative one (t=－10.538, P=0.000). According to Harris hip score, the effectiveness results were excellent in 4 cases, good in 5 cases, and fair in 4 cases, with an excellent and good rate of 69.2%. The unequal length of lower limbs was (15.38±7.27) mm, which was significantly better than that before operation (t=11.826, P=0.000). At last follow-up, the patients' satisfaction score was 80%-95%, with an average of 88%.ConclusionModified Ilizarov hip reconstruction can be used to treat young patients with hip disease who are unsuitable or refuse to undergo artificial hip replacement. Its effectiveness is reliable, and it has unique advantages in limb limp improvement and limb shortening correction.

The Clinical Analysis on 23 Cases of Young Patients with Colorectal Cancer

目的:探讨青年人大肠癌临床表现、病理特点。方法:回顾性分析四川省成都市第五人民医院普外科1997年7月至2007年12月收治的23例35岁以下青年大肠癌患者临床资料。结果:23例青年大肠癌患者平均年龄24.5岁,男女比例为2.8∶1;病变部位以直肠多见,组织学分型以低分化腺癌与印戒细胞癌最多;Dukes分期:A期1例,B期3例,C期13例,D期6例。结论:青年大肠癌表现为病理分化程度低、Dukes分期晚,更具进展性。提高认识及早期行肠镜检查有助于早期诊断。

青年精神分裂症患者颅内静脉血栓形成一例

生物型人工全髋关节置换术治疗青年强直性脊柱炎髋关节病变的中期疗效

目的 总结生物型人工全髋关节置换术治疗青年强直性脊柱炎髋关节病变的中期疗效。 方法2003年4月－2007年10月，采用生物型假体对18例（23髋）青年强直性脊柱炎髋关节病变行人工全髋关节置换。男12例（17髋），女6例（6髋）；年龄19～34岁，平均26.4岁。左侧8例，右侧5例；双侧5例。合并髋关节病变5～8年，平均6.8年。术前髋关节屈伸活动度为（30.3 ± 21.4）°，髋关节功能Harris评分为（43.2 ± 2.7）分。 结果术后切口均Ⅰ期愈合，无下肢深静脉血栓形成、肺栓塞、深部感染等并发症发生。患者均获随访，随访时间4年6个月～8年，平均6年。术后2例（2髋）发生异位骨化，1例（1髋）自觉大腿轻度酸痛。术前步态异常患者中除1例仍存在轻度摇摆外，其余患者步态均恢复正常。随访期间无假体脱位及翻修发生。末次随访时，Harris评分为（90.3 ± 3.5）分，髋关节屈伸活动度达（95.3 ± 27.6）°，与术前比较差异均有统计学意义（P lt; 0.05）。 结论生物型人工全髋关节置换术治疗青年强直性脊柱炎髋关节病变中期疗效满意。