Derivation and validation of the CANP scoring model for predicting the neurological outcome in post-cardiac arrest patients

Objectives:To establish and validate a prognostic scoring model in a Chinese population to predict the neurological outcome among comatose survivors of cardiac arrest (CA).Methods:159 CA patients between January 2016 and November 2020 were recruited in this retrospective study. In the derivation cohort, prognostic factors available from arrest circumstances and early in-hospital indicators were measured. The Cardiac Arrest Neurological Prognosis (CANP) score was then constructed to predict unfavorable outcomes at 30 days after CA. The assessment of predictive effectiveness of this scoring model was conducted in both derivation and validation cohorts.Results:Witnessed status, bystander cardiopulmonary resuscitation, initial rhythm, duration of resuscitation, Glasgow Coma Scale motor score, pupillary/corneal reflex, gray-white matter ratio and neuron-specific enolase exhibit strong correlations with the neurological outcomes in the derivation cohort (all p<0.05), and a risk scoring model for the prediction of an unfavorable outcome was created using these factors. In the validation cohort, significantly higher CANP scores were noted in the unfavorable outcome group. A CANP score ≥5 was associated with unfavorable neurological outcomes (sensitivity 68.8%, specificity 100%).Conclusion:The CANP score was established and validated for predicting the possible neurological prognosis in comatose post-CA survivors.

Cardiac arrest (CA) is among the main causes of mortality in modern medicine. Continuous improvements in managing CA patients, such as high-quality cardiopulmonary resuscitation (CPR) with early defibrillation, have made it possible for more survivors to achieve return of spontaneous circulation (ROSC); however, a substantial number of even optimally managed victims experience devastating neurological outcomes, despite “successful” resuscitation.¹ Early prognostication might aid in allocating treatment, and for providing sufficient information to their relatives.² For comatose patients after ROSC, the current guidelines recommend a multimodal neurological prognostication algorithm on the basis of clinical examination at 72 hours or later after CA and several additional approaches, including neuroelectrophysiology, neuroimaging, and serum biomarkers.³ However, there is not a single clinical protocol, examination or test perfect for the determination of neurological prognosis given the variability in brain injury patterns noted in CA patients.⁴Recent studies have expanded the prediction models and scoring systems to support early prediction as well as risk stratification in patients with ROSC after CA.^5-9 These approaches share satisfactory performance but they vary widely in terms of their components and cause difficulties in obtaining reproducibility and external validation.¹⁰ These scores have improved the evaluation of the severity in CA patients in spite of the heterogeneity. However, these scoring models fail to take some known prognostic factors into account and have not been validated in different populations. Therefore, this study was to establish a prognostic scoring model in a Chinese population to predict the neurological outcomes among comatose survivors of CA. In the analysis, the first step was to determine the association between prognostic factors available from arrest circumstances and early in-hospital indicators and unfavorable outcomes at 30 days in a derivation cohort. The second step was to construct a clinically useful scoring system for the prediction of an unfavorable outcome and to perform an external validation.     

公立医院纪检机构监察对象范围及职能定位探讨

深化监察体制改革是党中央全面加强党的领导、推进全面从严治党向纵深发展的重大决策部署.公立医院的人员构成复杂,《监察法》对医疗卫生单位的监察对象边界规定较为模糊,实践中也存在医院纪检机构职能定位不明确等问题.文章对新形势下公立医院人员构成、监察对象范围、内设纪检机构职能定位进行分析,通过厘清内设纪检机构与派驻纪检监察组的...     

雄激素受体有望成为乳腺癌中新的生物标志物

生物标志物可用于靶向治疗的诊断、预后和预测。雌激素受体（ER）和人类表皮生长因子-2(HER-2)已经成为指导乳腺癌治疗的标准生物标志物。雄激素受体（AR）是一种属于核受体超家族中的类固醇受体，与前列腺癌的发展有关。越来越多的证据表明AR在乳腺癌中起着重要的作用，AR被认为是乳腺癌中有用的生物标志物。现有的生存分析表明，AR在ER+乳腺癌中起到肿瘤抑制作用，是一种有利的预后标志物，而AR在ER-乳腺癌中起肿瘤启动子作用，包括在HER-2阳性型和三阴性乳腺癌（TNBC），是一种不良预后因素。AR还被证明可以预测ER+乳腺癌对辅助激素治疗和TNBC中新辅助化疗的反应潜力。然而，也有相关研究得出与以上相互矛盾的结果，这可能是肿瘤和AR阳性评分方法之间的内在差异导致的。有人建议应用AR表达状态来指导不同乳腺癌亚型的治疗。在未来，AR将成为乳腺癌的可行生物标志物，在乳腺癌中使用AR拮抗剂的临床试验是活跃的，单独靶向AR或其他治疗剂为乳腺癌的现有疗法提供了替代方案。因此，如果要使用AR靶向治疗，AR表达将是必要的。     

超声心动图定量参数与急性心肌梗死患者ECMO早期撤机结局的关系探讨

目的 探讨超声心动图定量参数与急性心肌梗死患者体外膜氧合器（ECMO）早期撤机结局的关系。方法 回顾性分析2020年2月—2022年2月淮安市第二人民医院收治的82例采用ECMO救治的急性心肌梗死患者的临床资料。采用彩色多普勒超声诊断仪测量患者上机和撤机后的超声心动图参数，包括左室射血分数（LVEF）、二尖瓣侧壁瓣环收缩速度（Sa）、右室面积变化分数（RVFAC）和左室流出道速度-时间积分（LVOT-VTI）；统计患者撤机后28 d生存情况，比较死亡患者和生存患者上机和撤机后超声心动图参数的差值；采用一般多因素Logistic回归分析影响急性心肌梗死患者ECMO早期撤机结局的因素；绘制受试者工作特征（ROC）曲线分析超声心动图定量参数对急性心肌梗死患者ECMO早期撤机结局的预测效能。结果 撤机后随访28 d,82例急性心肌梗死患者有24例死亡。死亡患者的多脏器功能衰竭占比、多支血管病变占比均高于生存患者（P<0.05）；死亡患者上机和撤机后LVEF差值、Sa差值、RVFAC差值、LVOT-VTI差值均低于生存患者（P<0.05）；一般多因素Logistic回归分析结果显示，...     

前列腺癌的雄激素受体及嗜铬粒蛋白A表达率与MRI特征的相关性分析

目的探讨前列腺癌(PCa)的雄激素受体(AR)及嗜铬粒蛋白A(CgA)表达率与MRI特征的相关性。方法选取2018年1月至2019年5月在南京医科大学附属淮安第一医院行经尿道前列腺切除术治疗的60例PCa患者作为研究对象。根据病理组织学Gleason评分结果分为中高分化组(n=30)和低分化组(n=30)。采用免疫组化链霉菌抗生物素蛋白-过氧化物酶连结(SP)法检测两组的AR、CgA表达率,分析两组的AR、CgA表达率与MRI(K^transs、K_ep、V_e)特征相关性。结果中高分化组的AR阳性表达率明显低于低分化组,CgA阳性表达率明显高于低分化组,差异具有统计学意义(P<0.05);中高分化组的K^transs、K_ep、V_e参数低于低分化组,差异具有统计学意义(P<0.05);AR表达率与K^transs、K_ep、V_e参数水平呈负相关,CgA表达率与K^transs、K_ep、V_e参数水平呈正相关(P<0.05)。结论PCa的AR表达与MRI(K^transs、K_ep、V_e)特征呈负相关,CgA表达与MRI(K^trans、K_ep、V_e)特征呈正相关。临床检测患者的AR、CgA表达指标的同时,结合患者的MRI(K^transs、K_ep、V_e)特征,可进一提高PCa患者病情诊断的准确率。     

微螺钉支抗种植体在口腔正畸中的应用效果

目的 探讨微螺钉支抗种植体在口腔正畸患者中的应用效果。方法 选取2020年3月-2022年3月 于我院行口腔正畸的60例患者为研究对象，随机分为对照组和试验组，每组30例。对照组采用传统强支 抗进行正畸，试验组采用微螺钉支抗种植体进行正畸，比较两组牙齿情况、口腔功能评分及不良反应发 生率。结果 试验组磨牙移位、上下中切牙凸距差、上中切牙倾角差均优于对照组，差异有统计学意义 （ P ＜0.05）；试验组咀嚼能力、固位能力、美观度、语言能力及舒适度评分均高于对照组，差异有统计学 意义（ P ＜0.05）；试验组不良反应发生率低于对照组，差异有统计学意义（ P ＜0.05）。结论 微螺钉支抗 种植体在口腔正畸中的应用效果确切，可有效改善患者的牙齿情况，有利于提高患者的口腔功能，且不良 反应发生几率较小，安全性较高，值得临床应用。     

关于中医美容教学法改革的探索与思考

近年来，中医美容行业快速发展，中医美容市场需要大批具有临床实践技能、经验丰富的医 师。但传统中医美容教学法以传授法为主，教师主要传授理论知识，缺乏实践环节，难以培养学生的临床 实践技能，也难以培养中医美容市场急需的应用型人才。因此，中医美容教学法亟待改革。本文主要分析 中医美容教学中存在的问题，并提出针对性的解决策略，推荐可行的教学法，旨在为中医美容教学方法改 革提供可供参考的建议和思路