CT预测泌尿系结石行气压弹道碎石易碎性的研究

的：探讨CT是否可以被用来预测泌尿系结石行气压弹道碎石（APL）时的易碎性，希望为临床上选择合理的治疗方法提供更多的科学依据。方法：选择2004年3月至2006年12月间120枚开放手术获得的结石，按同单位体积（mL）结石APL次数分成A、B、C3组。将3组的平均CT值分别进行比较。结果：A、B、C3组间的平均CT值差异均有统计学意义。结论：术前患者结石的平均CT值可以估计碎石的难易程度。选择治疗方案及时机时要综合分析结石部位、数量、自身操作水平、设备性能、患者耐受性等因素，在考虑到结石易碎性这一因素时，我们建议原则上对于≥1400HU且体积较大的结石宜选择开放手术；而≤920HU且结石体积不大时首选腔内碎石或体外震波碎石     

Clinical and radiographic predictors of difficult primary shoulder arthroplasty

BackgroundAnecdotally there is a spectrum of complexity in performing shoulder arthroplasty, however, there is limited information to predict easy versus difficult cases. The purpose of this study was to identify clinical and radiographic factors that are associated with difficult primary shoulder arthroplasty.MethodsAll consecutive primary shoulder arthroplasties performed by one-of-five high-volume shoulder and elbow fellowship-trained surgeons from 4/2018-8/2018 were included. Mean (range) surgeon years in practice was 19.4 (6-29). Surgeons completed a preoperative questionnaire estimating the level of complexity in performing the operation from very easy, easy, average, difficult, and very difficult. The same questionnaire was completed immediately postoperatively regarding level of complexity. Difficult group was defined if the surgeon rated as difficult or very difficult on the postoperative questionnaire. If the procedure was difficult, the postoperative questionnaire assessed what aspect of the procedure made it difficult. Demographics, clinical and radiographic factors, and procedure time were collected.ResultsDuring the study period, 224 primary shoulder arthroplasties were performed (53% reverse, 44% anatomic, 3% hemiarthroplasty with concentric glenoid reaming). Difficult group consisted of 95 shoulder arthroplasties (42.4%). Difficult group procedure time was a mean 21.8 minutes longer (120.7 ± 3.1 min vs. 98.9 ± 2.4 min; P <.001). Glenoid reaming and implantation (48.4%) were the most common reason for difficult cases, followed by glenoid exposure (33.7%). The surgeon correctly predicted level of complexity in 77% of cases (i.e., predicted difficult preoperatively and assigned difficulty postoperatively). There were 39 cases that were incorrectly predicted easy preoperatively and assigned as difficult postoperatively. Of all the cases predicted to be easy, those cases that were rated as difficult postoperatively were associated with younger age (67.1 ± 1.4 vs. 71.2 ± 0.7; P =.006), males (61.5% vs. 34.3%; P = .003), higher BMI (31.7 ± 0.9 vs. 29.6 ± 0.5; P = .045), history of instability (30.8% vs. 10.5%; P = .003), decreased passive external rotation (17.5 ± 3.1 vs. 25.1 ± 1.4, P = .031), larger inferior humeral head osteophyte (14.1mm vs. 7.8mm, P = .001) and B2 or B3 glenoids (39.3% vs. 17.2%; P =.026).Discussion and conclusionFor experienced high-volume shoulder and elbow surgeons performing primary shoulder arthroplasty, cases that were unexpectedly difficult were associated with younger age, males, stiffness, history of instability, large inferior humeral head osteophyte, and posterior glenoid bone loss. Difficulty with glenoid reaming and glenoid component implantation were the most frequent reason for difficult cases. This information may allow surgeons to anticipate difficult cases, appropriately schedule their operative day, and identify potentially difficult cases that warrant referral to high-volume shoulder arthroplasty surgeon.Level of evidenceLevel III; Prospective Case-Control Study     

乳腺癌根治术一期静脉淋巴管吻合预防术后患侧上肢淋巴水肿探讨

目的：探讨乳腺癌根治术一期静脉淋巴管吻合预防术后患侧上肢淋巴水肿的临床效果。方法方便选取该院2013年9月—2014年7月收治的80例乳腺癌患者按就诊编号分为两组,每组均40例。对照组实施乳腺癌根治术治疗,观察组在对照组的基础上一期实施静脉淋巴管吻合术治疗,对两组均进行12个月的随访。对比两组手术相关指标、术后上肢淋巴水肿情况。结果对照组的手术时间和术中出血量分别为(100.5±14.6)min、(190.2±34.3)mL均明显低于观察组的(169.5±17.4)min、(357.8±42.7)mL,差异有统计学意义(P﹤0.05);对照组的上肢淋巴水肿发生率为27.5%明显高于观察组的7.5%,差异有统计学意义(P﹤0.05)。结论乳腺癌根治术一期应用静脉淋巴管吻合术治疗效果显著,,有效降低术后上肢淋巴水肿的发生率。     

ARIMA乘积季节模型在山东省肺结核发病预测中的应用

目的 根据山东省肺结核的季节性、趋势性建立求和自回归移动平均(ARIMA)乘积季节模型,预测山东省肺结核发病趋势,调整防控措施。 方法 应用R软件对2010年1月至2019年12月山东省肺结核传染病疫情月度数据建立最优模型,预测2020年1月至10月肺结核发病数,并与实际值进行比较,以此评估模型的预测效果,预测2020年11月至2021年12月的发病趋势。 结果 山东省肺结核发病数表现为年度周期性,最优模型为ARIMA(3,1,0)(0,1,1)₁₂,2010年1月至2019年12月拟合结果准确性显示平均绝对百分比误差仅为5.50%, 2020年1月至10月模型预测效果的平均相对百分比误差为21.69%,2020年11月至2021年12月的发病数较同期有轻微变化。 结论 ARIMA乘积季节模型能够较好地对山东省肺结核发病趋势进行拟合及预测。     

用多分子标记物预测新辅助化疗疗效

目的探讨ER、PR、C-erbB-2和P53与乳腺癌新辅助化疗疗效的相关性。方法局部晚期乳腺癌患者接受EC或TP方案化疗,化疗前空芯针穿刺活检,采用免疫组化法检测肿瘤组织的ER、PR、C-erbB-2和P53的表达情况。结果22例新辅助化疗RR达81．8％,其中CR5例（22．7％）,pCR4例（18．2％）,PR13例（59．1%）,SD4例（18．2％）。研究发现ER、PR和C-erbB-2表达在3组间有显著性差异,但与新辅助化疗的疗效无关联性。结论ER、PR和C-erbB-2的表达在不同疗效组有差异,但目前不能预测新辅助化疗的疗效。     

血清生长激素释放肽对脓毒症并发脑病的早期预测价值

目的探讨脓毒症病人并发脑病的危险因素及血清生长激素释放肽(Ghrelin)的早期预测价值。方法2017年1月至2020年1月上海交通大学医学院附属新华医院崇明分院收治的脓毒症病人163例作为脓毒症组，同期在本院进行体检的健康志愿者150例作为正常对照组，对比两组血清Ghrelin水平的差异。根据脓毒症病人入院28 d内脓毒症相关性脑病(SAE)的发生情况将其分为SAE组46例、非SAE组117例，采用单因素、多因素分析SAE发生的危险因素，采用受试者工作特征(ROC)曲线分析入院时血清Ghrelin水平对脓毒症病人入院28 d SAE发生的预测价值。结果脓毒症组血清Ghrelin的水平高于正常对照组［(705.32±184.29)μg/L比(526.19±100.27)μg/L，P<0.05］。SAE组、非SAE组病人的性别、年龄、生活习惯、合并症分布差异无统计学意义(P>0.05)；入院时急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)、S100B蛋白(S100B)、神经元特异性烯醇化酶(NSE)、降钙素原(PCT)、Ghrelin的差异有统计学意义(P<0.05)。入院时APACHEⅡ、S100B、NSE、PCT、Ghrelin较高分别是脓毒症病人SAE发生的独立危险因素(P<0.05)。结论血清Ghrelin水平较高是脓毒症病人SAE发生的独立危险因素，且对SAE具有早期预测价值。     

Performing Precise Biopsy in Naive Patients With Equivocal PI-RADS,Version 2, Score 3, Lesions: An MRI-based Nomogram to Avoid Unnecessary Surgical Intervention

PurposeThe primary objective of the present study was to avoid unnecessary prostate biopsy in biopsy-naive patients with Prostate Imaging Reporting and Data System, version 2 (PI-RADS v2), score 3, lesions.Materials and MethodsWe reviewed our prospectively maintained database from January 2012 to July 2018. Logistic regression analyses were performed to test different clinical factors as predictors of clinically significant prostate cancer (CSPCa) and build nomograms. Calibration curves were used to assess the concordance between the predictive value and the true risk. Decision curves were created to measure the overall net benefit.ResultsThe prostate cancer (PCa) and CSPCa detection rates were 37.2% (81 of 218) and 23.9% (52 of 218) in the PI-RADS v2, score 3, cohort. More PCa cases (61.7%; 50 of 81) and CSPCa cases (75%; 39 of 52) were found in the peripheral zone than in the transitional zone. Multivariate analysis showed that age, prostate-specific antigen density, lesion region, and apparent diffusion coefficient (ADC) were predictive factors for CSPCa and PCa. Internally validated calibration curves showed that the predicted risk of CSPCa was closer to the actual probability when the threshold was > 60%. Decision curves showed that a better net benefit was achieved when the model was used to guide clinical practice.ConclusionsMore cases of PCa and CSPCa were seen in the peripheral zone than in the transitional zone among patients with PI-RADS v2, score 3. The positive predictive value for a positive ADC (< 900 μm²/s) for the detection of CSPCa and PCa improved with an increasing prostate-specific antigen density. Biopsy can be avoided if the equivocal lesion has a negative ADC (> 900 μm²/s) and was in the transition zone.     

SARS-CoV-2 viremia may predict rapid deterioration of COVID-19 patients

COVID-19 has raised worldwide concern as spiraling into a pandemic. Reports about comprehensive investigation of COVID-19 viremia are extremely scanty. Herein, we present four COVID-19 patients with positive SARS-CoV-2 nucleic acid test in blood, accounting for 12.12% of 33 detected cases. Rapid deterioration of these cases with septic shock, accompanying with lung CT images enlarged rapidly, decrease of blood oxygen, heart rate drop (with asynchrony of hypoxemia) accompanied with SARS-CoV-2 viremia. It indicates that massive replication and releasing into blood of SARS-CoV-2 and secondary inflammation storm may lead to injury of multiple organs and poor prognosis. So, positive COVID-19 nucleic acid test in blood may be a good forecasting marker of rapid deterioration of COVID-19 pneumonia. In addition, clearance of viremia may indicate tendency for recovery.     

通过医院门诊量预测评估科室贡献情况的探讨

目的设计针对医院科室贡献情况的评估方法。方法采用SPSS13.0中多元线性回归模型估计2010年各个月份的门诊量,并结合构成比,设计三种10分制权重标准对科室进行综合评分,评估其实际贡献。结果三种评估方法结果各异,某院重点科室业务量趋于饱和,采用平均分配的评估方案。结论医院管理者可以根据自身医院的业务发展情况,选取与之相适应的一种评估方法对门诊科室进行贡献评价。     

临床血液需求量趋势的ARIMA模型研究

目的建立临床血液需求量预测的时间序列ARIMA模型,预测临床血液需求量,为血液招募工作提供理论依据。方法收集2006～2010年成都市临床血液月用血量,建立ARIMA模型,预测2011年1～3月需求量。结果临床血液需求量构建为MA（1）,1～60月资料所建立模型模型可用作预测,2011年1～3月预测值与实际值基本一致,相对误差依次为1.3%、3.6%、1.5%。结论 采用时间序列MA（1）模型预测短期临床血液需求量,能为开展血液招募采集工作提供科学依据。