加味香砂六君子汤治疗糖尿病胃轻瘫36例临床观察

目的　观察加味香砂六君子汤治疗糖尿病胃轻瘫的临床疗效。方法　糖尿病胃轻瘫患者 70例 ,随机分为 2组。治疗组 3 6例用加味香砂六君子汤治疗 ,每日 1剂 ,水煎服。对照组 3 4例用吗丁啉 (多潘立酮 ) 1 0mg,每日 3次口服。 2组均治疗 2～ 3周 ,停药 2个月后观察疗效。结果　治疗组总有效率 94.4% ,对照组总有效率 70 .6% ,2组比较有非常显著性差异 (P <0 .0 1 )。结论　加味香砂六君子汤治疗糖尿病胃轻瘫疗效确切。     

花椒果实不同部位及其种子油资源性化学成分分析与评价

该研究对花椒成熟果实不同部位及其种子油中的多类型资源性化学成分进行分析评价,为其资源的精细化利用提供科学依据。采用气相色谱-质谱联用法分析花椒果皮、花椒种子及种子油中的挥发油类、脂肪酸类化学成分的组成及含量;采用高效液相色谱法分析花椒果皮、花椒种子及种子油中的黄酮类及酚酸类化学成分的组成及含量。结果显示,花椒果皮、花椒种子及花椒种子油中分别检测到26,19,11种挥发性成分,其中萜类及其含氧衍生物为其主要组成成分,芳樟醇及其酯化物在花椒果皮中相对含量较为丰富;3样品中总脂肪酸的质量分数分别为108.42,331.63,966.04 mg·g-1,并且均以油酸、亚油酸、亚麻酸含量相对较高;花椒果皮中还含有较为丰富的黄酮类化学成分金丝桃苷、槲皮苷、芦丁、异槲皮苷及酚酸类成分绿原酸等,而在花椒种子及种子油中未检测到上述成分。该研究结果证实花椒果实中含有丰富的资源性化学成分,且不同部位中所含成分的组成和含量有所差异,为花椒果实的系统利用与精细化产业开发提供了科学依据。     

Optimized strategy of rotational atherectomy of underexpanded coronary stents in patients with acute coronary syndrome

BACKGROUND: Stent under-expansion is a main cause of acute coronary syndrome (ACS), which can lead to serious clinical outcomes. The rotational atherectomy of underexpanded coronary stents (academically called stent ablation, SA) by intravascular ultrasound (IVUS) may provide more visual reference in the intervention. We aim to analyze the procedural and long-term outcomes of the optimized strategy of SA in patients with ACS and to provide real-world data on this technique.     

安定配合硬膜外阻滞镇痛分娩的临床研究

目的:探讨产程活跃期应用安定加低浓度、小剂量、局麻药甲磺酸罗哌卡因及舒芬太尼实施自控镇痛泵镇痛分娩方法及对产程和母婴的影响。方法:实验组采取活跃期安定缓慢静脉推注联合低浓度、小剂量的1.192%甲磺酸罗哌卡因复合舒芬太尼实施硬膜外阻滞,微量自控泵给药的镇痛分娩;对照组自然分娩;两组比较分析。结果:实验组产妇第一产程平均时间(186.46±8.52)min、自然分娩率增91.25%、剖宫产率6.25%。产妇身心状态评估:宫缩时表情自然73例,心率、血压平稳,宫缩无影响。对照组产妇第一产程平均时间(270.68±12.34)min、自然分娩率66.25%、剖宫产率28.75%,产妇身心状态评估表情自然12例(P<0.01);心率、血压增快,具有统计学意义(P<0.05)。结论:安定配合硬膜外阻滞镇痛分娩的效果好,能缩短产程,降低剖宫产率,保持产妇良好的心态,提高产科质量,是比较理想的分娩镇痛方法。     

An Efficient Approach for Automated Mass Segmentation and Classification in Mammograms

Breast cancer is becoming a leading death of women all over the world; clinical experiments demonstrate that early detection and accurate diagnosis can increase the potential of treatment. In order to improve the breast cancer diagnosis precision, this paper presents a novel automated segmentation and classification method for mammograms. We conduct the experiment on both DDSM database and MIAS database, firstly extract the region of interests (ROIs) with chain codes and using the rough set (RS) method to enhance the ROIs, secondly segment the mass region from the location ROIs with an improved vector field convolution (VFC) snake and following extract features from the mass region and its surroundings, and then establish features database with 32 dimensions; finally, these features are used as input to several classification techniques. In our work, the random forest is used and compared with support vector machine (SVM), genetic algorithm support vector machine (GA-SVM), particle swarm optimization support vector machine (PSO-SVM), and decision tree. The effectiveness of our method is evaluated by a comprehensive and objective evaluation system; also, Matthew’s correlation coefficient (MCC) indicator is used. Among the state-of-the-art classifiers, our method achieves the best performance with best accuracy of 97.73 %, and the MCC value reaches 0.8668 and 0.8652 in unique DDSM database and both two databases, respectively. Experimental results prove that the proposed method outperforms the other methods; it could consider applying in CAD systems to assist the physicians for breast cancer diagnosis.     

Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis

Background

Arthroplasty has been shown to be superior regarding low risk of reoperation and better function score to internal fixation for treatment of displaced femoral neck fractures at short-term followup. However, there are unanswered questions regarding the efficacy of arthroplasty in the longer term compared with internal fixation.

Questions/purposes

We performed a meta-analysis comparing arthroplasty (hemiarthroplasty or THA) with internal fixation in patients with displaced femoral neck fractures with respect to (1) mortality, (2) reoperation, (3) functional recovery, and (4) complications, including only randomized trials with a minimum of 4 years followup.

Methods

Computerized databases, including PubMed (MEDLINE), EMBASE, Cochrane Register of Controlled Trials databases, and Web of Science^™ were searched for studies published from the inception date for each database to March 2014. Eleven randomized controlled trials that compared arthroplasty (either hemiarthroplasty or THA) with internal fixation for treatment of patients with a femoral neck fracture were included in our analysis. The quality of the trials was assessed according to the Cochrane Handbook and meta-analyses were conducted using RevMan 5.2 software from the Cochrane Collaboration. The heterogeneity among studies was evaluated by the I-squared index (I²) and publication bias was assessed using forest plots.

Results

There were no differences between the internal fixation and arthroplasty groups for patient mortality at mid-term (48.4% vs 46.8%) or long-term followup (83.2% vs 81.5%). Arthroplasty was associated with a lower risk of reoperation at mid-term (7.2% vs 39.8%; relative risk [RR] = 0.10; 95% CI, 0.06–0.07) and at long-term followup (14.3% vs 43.8%; RR = 0.10; 95% CI, 0.06–0.07). Arthroplasty was associated with better functional recovery at mid-term followup (standard mean difference [SMD] = 0.55; 95% CI, 0.02–1.09), whereas function at long-term followup (SMD = 0.14; 95% CI, −0.35 to 0.62) was not different between the arthroplasty and internal fixation groups. There were no significant differences in subsequent ipsilateral fractures (1.5% vs 1.2%; RR = 2.18; 95% CI, 0.32–14.67; p = 0.42) and deep infections (2.7% vs 2.9%; RR = 0.89; 95% CI, 0.40–2.01; p = 0.78) between patients treated with arthroplasty and internal fixation.

Conclusions

Based on our results, we found that compared with internal fixation, arthroplasty may result in a lower rate of subsequent reoperation at mid- and long-term followup, and better mid-term functional recovery. Future studies should investigate the mid- and long-term results of THAs compared with hemiarthroplasty.     

小腿内侧皮瓣联合内侧半比目鱼肌瓣桥式带蒂转移术治疗对侧小腿软组织缺损

目的探讨小腿内侧皮瓣联合内侧半比目鱼肌瓣桥式带蒂转移术治疗对侧小腿软组织缺损的疗效。方法回顾性分析2012年1月至2016年1月甘肃省兰州市兰州手足外科医院骨科收治的8例小腿软组织缺损患者资料。男5例,女3例;年龄19~50岁,平均35岁。所有患者均以胫后动脉为蒂小腿内侧皮瓣联合内侧半比目鱼肌瓣桥式带蒂转移术治疗。软组织缺损的范围为10 cm×9 cm^13 cm×8 cm。肌瓣和血管蒂表面行一期中厚网状游离植皮,供区直接缝合。末次随访时按Iowa等提出的胫骨骨折疗效评定方法评定疗效。结果术后所有患者的皮瓣和肌瓣全部成活,没有发生血管危象。有1例患者发生肌瓣远端小块植皮坏死,经2周换药处理自然愈合。术后所有患者获2.5~4.5年(平均3.8年)随访。受区外形较好。末次随访时按Iowa等提出的胫骨骨折疗效评定方法评定疗效:优3例,良4例,可1例。结论小腿内侧皮瓣联合内侧半比目鱼肌瓣桥式带蒂转移术适用于治疗小腿仅有1条主要血管的软组织缺损,可减轻供区损伤。     

1例脂蛋白肾病患者的3种治疗方案分析及药学监护

目的：为脂蛋白肾病的治疗提供参考,同时探讨临床药师在整个治疗过程中发挥的作用。方法：对1例脂蛋白肾病患者所采用的3种不同治疗方案（包括免疫抑制疗法、双重血浆滤过、降脂降尿蛋白护肾疗法）进行疗效评价,临床药师协助医师制定治疗方案、通过药学监护提供用药调整建议、借助随访进行患者教育及预后分析。结果：1免疫抑制疗法对患者病情无效;2双重血浆滤过起效快,但费用高、易复发;3降脂降尿蛋白护肾疗法疗效较好、相对安全、经济,且维持较长时间不复发。结论：降脂降尿蛋白护肾疗法最适合该患者的病情,临床药师协助医师,保证患者在可耐受不良反应的前提下获得最大治疗效果,在整个治疗过程中发挥了重要作用。