基于肥厚型心肌病临床数据管理系统的设计与应用

目的设计一款简单易操作的数据管理系统,解决目前零散的肥厚型心肌病临床数据,将临床信息科学有效地进行整合管理,便于医生及科研人员查询、统计。方法采用Foxtable搭建一个数据库管理软件框架,并建立局域网外部数据源,实现数据的存储、查询、共享、导出。结果基于肥厚型心肌病数据管理系统的设计与应用能够满足临床医生和科研人员的基本工作需求,很大程度上节省了数据整理时间。结论该系统操作简单、移植性高、实用性强,广泛适用于各临床科室有科研项目的小型数据库管理。     

活心方对急性心肌梗死大鼠血流动力学及梗死面积的影响

目的观察活心方对结扎冠状动脉前降支所致急性心梗大鼠血流动力学及梗死面积的影响。方法采用结扎冠状动脉前降支的方法构建急性心梗模型,大鼠随机分为假手术组、模型组、贝复济组、血竭小复方组和活心方组,干预8周。检测大鼠血流动力学指标,HE染色观察心肌组织形态改变,计算梗死面积。结果模型组大鼠心肌梗死面积与左室收缩压(LVSP)及左室内压最大变化速率(+LVdp/dtmax)呈负相关(P=0.001),与左室舒张末期压(LV-EDP)呈正相关(P=0.005)。与模型组比较,活心方组、血竭小复方组大鼠LVSP均升高(P<0.05,P<0.01),LV-EDP降低(P<0.01),+LVdp/dtmax加大(P<0.01),-LVdp/dtmax加大(P<0.05,P<0.01),梗死面积缩小(P<0.01);与血竭小复方组比较,活心方组大鼠LVSP增高(P<0.05)、+LVdp/dtmax加大(P<0.05);梗死面积更小(P<0.05)。结论心肌梗死大鼠梗死面积与血流动力学指标存在相关性。活心方干预能缩小心梗大鼠的梗死面积,改善心梗后大鼠左室舒缩功能,并优于血竭小复方。     

Arterial Lactate in Cardiogenic Shock: Prognostic Value of Clearance Versus Single Values

ObjectivesThis study sought to compare single lactate values at admission (L1) and after 8 h (L2) with lactate clearance (LC) for mortality prediction in cardiogenic shock (CS).BackgroundEarly estimation of prognosis in CS complicating acute myocardial infarction is crucial for tailored treatment selection. Arterial lactate is the most widely used point-of-care parameter in CS. In septic shock, lactate reduction over time—LC—has been extensively investigated. However, in CS, only limited data exist, and the prognostic value of LC is unknown.MethodsThis study is a subanalysis of the IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock II) trial and the corresponding registry. Lactate levels were prospectively collected. All-cause mortality at 30 days was assessed as primary endpoint.ResultsFor 671 of 783 (85.7%) patients, L1 and L2 values were available. The area under the receiver-operating characteristic curve (L1: 0.69; L2: 0.76; LC: 0.59) showed no difference between L1 and LC (p = 0.20). In contrast, L2 was a significantly better predictive parameter than L1 or LC (p < 0.001 for both). In multivariable stepwise Cox regression analysis, L2 ≥3.1 mmol/l (best cutoff value by Youden index) and LC <–3.45%/h remained independently predictive for time to death (p < 0.001 for both), with L2 showing the highest chi-square test score (42.1) and hazard ratio (2.89; 95% confidence interval: 2.10 to 3.97).ConclusionsArterial lactate after 8 h is superior in mortality prediction in comparison with baseline lactate and LC. A cutoff value of 3.1 mmol/l for lactate after 8 h showed the best discrimination for assessing early prognosis in CS and may serve as new treatment goal. (Intraaortic Balloon Pump in Cardiogenic Shock II [IABP-SHOCK II]; NCT00491036)     

应用Fast-fix 360全内缝合技术修复半月板Ramp区损伤的临床研究

目的探讨应用Fast-fix 360全关节内缝合技术修补半月板Ramp区损伤的方法和疗效。方法2016年10月至2018年4月,中部战区总医院骨科足踝与运动医学中心使用Fast-fix 360缝合技术修补经镜下确诊为内侧半月板Ramp区损伤病人15例,其中男14例,女1例,平均年龄为23.6岁,病人均合并前交叉韧带(anterior cruciate ligament,ACL)断裂,均予以一期行ACL自体腘绳肌单束重建,6例合并外侧半月板损伤亦同期处理。术后行膝关节标准化功能康复。收集病例手术时间、术中出血量、术后并发症情况;术前、术后半年、术后1年的Lysholm膝关节评分、国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分;术后半年、1年分别复查患膝关节MRI,评估Ramp区损伤修复情况。结果病人随访13~26个月(平均17.8个月)。手术时间为(90.8±21.4)min,术中出血量为(50.5±10.6)ml。术后2例病人移植肌腱供区伤口浅表感染,经延长换药后均愈合;无伤口深部感染及膝关节感染;未出现腘窝血管神经损伤情况。术后半年及1年的Lysholm膝关节评分、IKDC评分均显著高于术前,差异均有统计学意义(P均<0.05)。术后半年MRI评估Ramp区的愈合率为73.3%,术后1年其愈合率提高至86.7%。结论使用Fast-fix 360全关节内缝合技术修补半月板Ramp区损伤,同时一期重建ACL,可获得较满意的临床疗效,方法简单、手术时间短,可作为半月板Ramp区损伤的一种常规修复方法。     

人工智能在医学领域应用浅析

医疗与人工智能相结合,是医学发展的重要方向。作者综述了人工智能在诊断、治疗、预防、科研、教学等医学领域的应用情况,分析了人工智能发展面临的问题和挑战,对人工智能的应用前景进行了展望。     

Nurse Practitioner Student Clinical Placements: A Rural Community Immersion

This article describes a collaboration between a university and a medically underserved area in California’s central valley. Students participate in a community-based clinical immersion to provide care to a medically underserved population. Faculty collaborate with community-based partners to develop and implement clinical experiences. Students are provided opportunities to meet clinical course objectives while developing skills necessary to care for a medically underserved population as part of an interdisciplinary team.