衰减伪影对冠心病患者门控心肌灌注显像图像质量及灌注结果的影响

目的探讨衰减伪影对冠心病患者门控心肌灌注显像(GMPI)图像质量及灌注结果的影响。资料与方法回顾性分析2020年3月—2021年3月在郑州大学第一附属医院核医学科经冠状动脉造影证实且于造影前后1周行GMPI的99例冠心病患者的图像,定性及半定量分析衰减校正前后GMPI图像结果,比较衰减校正前后左心室各壁段平均放射性计数及灌注结果的差异,进一步分析衰减校正前后灌注结果不一致部分的受检者的节段性室壁运动及增厚情况。结果与衰减校正前比较,衰减校正后左心室间隔、下后壁及侧壁的平均放射性计数较高(Z=-7.302、-8.014、-3.991,P均<0.001),心尖部较低(Z=-8.021,P<0.001)。其中女性衰减校正后前壁平均放射性计数减低(Z=-2.314,P=0.021)。男性衰减校正前后下后壁放射性计数差值明显高于女性(t=-8.408,P<0.05)。衰减校正后44%(44/99)的左前降支及37%(37/99)的右冠状动脉分支供血区域显像结果发生改变,结合超声心动图及GMPI结果显示其中85%(35/41)的左前降支及81%(29/36)的右冠状动脉分支供血区域室壁运动及室壁增厚率均正常。结论衰减伪影对GMPI的图像质量和灌注结果有较大影响,结合室壁运动和增厚情况等有助于鉴别衰减伪影,提高诊断准确度与特异度。     

七叶一枝花甾体皂苷种类及含量差异研究进展＊

重楼是我国传统的名贵中药，七叶一枝花为历版《中国药典》收载的重楼药材两个基原植物之一，具有清热解毒、消肿止痛、活血化瘀等功效，其主要活性成分为甾体皂苷类物质。由于重楼市场需求量剧增和七叶一枝花成药时间较长，导致大量依靠人工种植。然而，人工种植过程中产地、采收年限和采收月份都会影响七叶一枝花的甾体皂苷含量。本文系统地总结了七叶一枝花中主要活性成分甾体皂苷的种类，以及不同产地、不同生长年限及不同采收月份的七叶一枝花根茎中甾体皂苷含量差异的研究现状，以期为进一步研究七叶一枝花品质差异、野生资源驯化及规范化种植提供参考。     

Contemporary Epidemiology of and Risk Factors Associated with Removal of a Pathologically Normal Appendix in Children with Suspected Appendicitis

BackgroundThe goal of this study was to characterize contemporary performance benchmarks and risk factors associated with negative appendectomy (NA) in children with suspected appendicitis.MethodsA multicenter retrospective cohort analysis of children undergoing appendectomy for suspected appendicitis was performed using data from the 2016–2021 NSQIP-Pediatric Appendectomy Targeted Public Use Files. Multivariable regression was used to evaluate the influence of year, age, sex, and WBC count on NA rate, and to generate rate estimates for NA based on different combinations of demographic characteristics and WBC profiles.Results100,322 patients were included from 140 hospitals. The overall NA rate was 2.4%, and rates decreased significantly during the study period (2016: 3.1% vs. 2021: 2.3%, p < 0.001). In adjusted analyses, the highest risk for NA was associated with a normal WBC (<9000/mm³; OR 5.31 [95% CI: 4.87–5.80]), followed by female sex (OR 1.55 [95% CI: 1.42–1.68]) and age <5 years (OR 1.64 [95% CI 1.39, 1.94]). Model-estimated risk for NA varied significantly across demographic and WBC strata, with a 14.4-fold range in rates between subgroups with the lowest and highest predicted risk (males 13–17 years with elevated WBC [1.1%] vs. females 3–4 years with normal WBC [15.8%]).ConclusionsContemporary NA rates have decreased over time, however NA risk remains high in children without a leukocytosis, particularly for girls and children <5 years of age. These data provide contemporary performance benchmarks for NA in children with suspected appendicitis and identify high-risk populations where further efforts to mitigate NA risk should be targeted.Level of EvidenceIII.     

基于CiteSpace的结直肠癌患者生命质量研究

目的：通过中英文文献了解结直肠癌患者生命质量研究现状及发展趋势。方法：运用CiteSpace对中国知网（CNKI）、万方数据知识服务平台、中国生物医学文献数据库、Web of Science核心数据集、PubMed、Cochrane Library中收录的关于结直肠癌患者生命质量研究的中英文文献进行可视化分析。结果：检索得到中文文献1 285篇，英文文献871篇，中英文文献发文量均呈上升趋势，相关研究关注的重点主要是结直肠癌患者造口、抑郁、免疫、肠道功能、化疗及化疗药物，但机构之间、学者之间合作程度及研究类型等方面存在一定差异。结论：中文文献相关研究起步晚、发展快，但在研究质量与研究深度等方面与英文文献相比还有一定差距；国内学者之间、机构之间应加强合作，关心患者肠道功能、心理状况，提高患者体力活动水平，开展更多高质量研究。     

沙盘游戏疗法在肿瘤放疗患者中的应用

目的探讨沙盘游戏疗法对肿瘤放疗患者心理痛苦及生活质量的作用。方法采用便利抽样法,选取2019年1—12月于上海市质子重离子医院住院进行放疗的49例肿瘤患者为研究对象,采用分层随机分组方法,将患者随机分为对照组28例和试验组21例。对照组给予常规心理护理,试验组在此基础上给予沙盘游戏疗法。采用心理痛苦温度计和欧洲癌症研究与治疗组织生命质量核心量表中的5个功能维度比较两组患者干预前后的心理痛苦程度和生活质量水平。结果干预后,两组患者心理痛苦温度计得分均低于干预前,且试验组得分低于对照组,差异有统计学意义(P<0.01)。干预前后试验组患者的躯体功能、角色功能、认知功能、情绪功能、社会功能维度得分下降程度均小于对照组,差异有统计学意义(P<0.01)。结论沙盘游戏疗法对肿瘤放疗患者的心理痛苦和生活质量有一定改善作用。     

EEG functional connectivity contributes to outcome prediction of postanoxic coma

ObjectiveTo investigate the additional value of EEG functional connectivity features, in addition to non-coupling EEG features, for outcome prediction of comatose patients after cardiac arrest.MethodsProspective, multicenter cohort study. Coherence, phase locking value, and mutual information were calculated in 19-channel EEGs at 12 h, 24 h and 48 h after cardiac arrest. Three sets of machine learning classification models were trained and validated with functional connectivity, EEG non-coupling features, and a combination of these. Neurological outcome was assessed at six months and categorized as “good” (Cerebral Performance Category [CPC] 1–2) or “poor” (CPC 3–5).ResultsWe included 594 patients (46% good outcome). A sensitivity of 51% (95% CI: 34–56%) at 100% specificity in predicting poor outcome was achieved by the best functional connectivity-based classifier at 12 h after cardiac arrest, while the best non-coupling-based model reached a sensitivity of 32% (0–54%) at 100% specificity using data at 12 h and 48 h. Combination of both sets of features achieved a sensitivity of 73% (50–77%) at 100% specificity.ConclusionFunctional connectivity measures improve EEG based prediction models for poor outcome of postanoxic coma.SignificanceFunctional connectivity features derived from early EEG hold potential to improve outcome prediction of coma after cardiac arrest.     

Functional outcomes of soft palate free flap reconstruction following oropharyngeal cancer surgery

IntroductionThe objective of this study was to assess the impact of surgical resection and free flap reconstruction of soft palate cancer on speech, swallowing and quality of life, and to identify the factors influencing functional outcomes and quality of life.Material and methodsPatients treated with surgical resection of squamous cell carcinoma and free-flap reconstruction of the soft palate were reviewed at least 12 months after surgery. Speech was assessed using the Hirose intelligibility scoring system, nasalance scoring, GRBAS scoring and the Voice Handicap Index 30 (VHI30) questionnaire. Swallowing was assessed by fiberoptic endoscopy and the Deglutition Handicap Index (DHI). Quality of life was assessed using EORTC QLQ-C30 and QLQ-H&N35 questionnaires.Results29 patients were included. Speech outcomes were satisfactory, demonstrating normal or slightly below normal speech intelligibility in 75.9% of the patients, moderate or no rhinolalia in 72.4% of the patients and mean overall VHI30 scores indicative of slight or no handicap in 86.2% of the patients. Swallowing outcomes were satisfactory, with mean overall DHI scores indicative of slight or no handicap in 82.8% of the patients. Patient quality of life was preserved as demonstrated by mean quality of life and functioning scales scores all superior to 80%.ConclusionThe sequelae arising from surgical resection and free-flap reconstruction of soft palate cancer are tolerable, involving slight handicap in terms of speech and swallowing and relatively little impact on quality of life.     

正念行为护理对肺癌合并肺结核患者的护理效果观察

目的探讨正念行为护理对肺癌合并肺结核患者的护理效果。方法选取2019年1月至2020年1月间陕西省结核病防治院收治的97例肺癌合并肺结核患者,采用随机数表法分为对照组和观察组。对照组49例患者采用亲情护理,观察组48例患者采用正念行为护理。比较两组患者的屈服、回避和面对评分、自我效能感量表(GSES)、抑郁自评量表(SDS)和焦虑自评量表(SAS)评分及生活质量。结果护理后,两组患者的屈服、回避、SDS和SAS评分均较护理前降低,且观察组均低于对照组,差异均有统计学意义(均P<0.05)。护理后,两组患者的面对、GSES、情绪功能、社会功能、认知功能、躯体功能和角色功能评分均较护理前升高,且观察组均高于对照组,差异均有统计学意义(均P<0.05)。结论正念行为护理能促进肺癌合并肺结核患者养成积极的应对方式,提高自我效能,减轻不良情绪,提高生活质量,值得推广。