Risk Factors and Ultrasound Can Predict Chronic Hepatitis Caused by Nonalcoholic Fatty Liver Disease

The diagnosis of nonalcoholic fatty liver disease (NAFLD) is underrecognized. The aim of this study was to develop a scoring system that separates NAFLD diagnosis as a cause of chronic hepatitis from controls by using clinical features and liver ultrasound. A retrospective review of consecutive NAFLD cases and other liver disease controls was undertaken selecting patients from an abnormal liver function test code. To qualify for analysis all patients had to have elevated liver injury tests for more then 6 months, a biopsy-confirmed diagnosis, and an ultrasound as part of the evaluation. There were 84 cases of NAFLD and 75 liver disease controls. The NAFLD group had a larger body mass index (BMI) (34.9 versus 26.1; P ≤ 0.0001), a larger liver span (9.8 versus 8.1 cm; P ≤ 0.0001), and higher triglycerides (252 versus 142.6; P ≤ 0.0001). The ultrasound reports recorded features consistent with fatty infiltration in 65.5% of NAFLD cases, compared to 5.3% of other liver diseases (P ≤ 0.0001). Diabetes mellitus was found in 35% of NAFLD and 6.7% of other cases (P ≤ 0.0001). The BMI was >30 in 79.8% of NAFLD cases and 22.7% of other liver disease cases (P ≤ 0.0001). The liver span was >8 cm in 78.6% of NAFLD cases and in only 16% of controls (P = 0.0001). On multivariate analysis using logistic regression, the odds ratio of having ultrasound report findings suggestive of fatty infiltration was 15.9 (CI, 4.1–60). The odds ratio was 9.4 (CI, 2.3–37.9) for diabetes, 5.0 (CI, 1.7–14.6) for BMI >30, and 2.3 for liver span >8 cm (CI, 1.36–3.90). A scoring system using clinical features and ultrasound was shown to reliably separate NAFLD from other cases of chronic hepatitis.     

ECG feature extraction and disease diagnosis

An important factor to consider when using findings on electrocardiograms for clinical decision making is that the waveforms are influenced by normal physiological and technical factors as well as by pathophysiological factors. In this paper, we propose a method for the feature extraction and heart disease diagnosis using wavelet transform (WT) technique and LabVIEW (Laboratory Virtual Instrument Engineering workbench). LabVIEW signal processing tools are used to denoise the signal before applying the developed algorithm for feature extraction. First, we have developed an algorithm for R-peak detection using Haar wavelet. After 4th level decomposition of the ECG signal, the detailed coefficient is squared and the standard deviation of the squared detailed coefficient is used as the threshold for detection of R-peaks. Second, we have used daubechies (db6) wavelet for the low resolution signals. After cross checking the R-peak location in 4th level, low resolution signal of daubechies wavelet P waves and T waves are detected. Other features of diagnostic importance, mainly heart rate, R-wave width, Q-wave width, T-wave amplitude and duration, ST segment and frontal plane axis are also extracted and scoring pattern is applied for the purpose of heart disease diagnosis. In this study, detection of tachycardia, bradycardia, left ventricular hypertrophy, right ventricular hypertrophy and myocardial infarction have been considered. In this work, CSE ECG data base which contains 5000 samples recorded at a sampling frequency of 500 Hz and the ECG data base created by the S.G.G.S. Institute of Engineering and Technology, Nanded (Maharashtra) have been used.     

凝血指标检测与急性冠状动脉综合征患者Gensini及GRACE评分的关系研究

目的探讨急性冠状动脉综合征（ACS）患者血浆凝血指标（D-二聚体（D-D）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）及纤维蛋白原（FIB））含量变化及与Gensini和GRACE评分的关系。方法检测并比较55例ACS患者和34例健康对照者血浆D-D、PT、APTT及FIB含量。结果ACS组血浆凝血指标（D-D、PT、APTT及FIB）含量分别为0.16±0.19mg/L、11.9±1.91s、30.4±6.25s、2.41±0.96g/L,对照组含量分别为0.07±0.08mg/L、11.9±0.91s、27.5±3.36s、2.36±0.73g/L。D-D在ACS不稳定型心绞痛（UA）、非ST段抬高型心肌梗死（NSTEMI）和ST段抬高型心肌梗死（STEMI）三个亚组中的含量分别为0.10±0.07、0.08±0.10、0.25±0.28mg/L;ROC曲线下面积D-D检测为0.64,Gensini评分检测为0.99,GRACE评分检测为1.00。D-D在GRACE评分低风险组、高风险组和极高风险组中的含量分别为0.13±0.18、0.18±0.25、0.18±0.14mg/L;D-D在Gensini评分中危组、高危组和极高危组中的含量分别为0.10±0.05、0.09±0.09、0.23±0.28mg/L,D-D含量与Gensini极高危组评分成正相关（r=0.911,P〈0.05）。结论ACS患者尤其STEMI患者四个凝血指标仅D-D显著升高;较Gensini和GRACE评分,D-D能粗略反映ACS患者冠状动脉严重程度,可指导临床治疗。     

Rockall评分系统在急性非静脉曲张性上消化道出血患者中的应用

目的探讨Rockall危险积分在急性非静脉曲张性上消化道出血患者中的应用,评估其对死亡及再出血的预测能力准确性。方法回顾性分析上海浦东医院消化科ANVUGIB患者474例,按年龄段分为〈40岁组、40～59岁组、60～79岁组和／〉80岁组,应用Rockall评分系统进行评分,采用受试者工作特征曲线（ROC）下面积（AUC）评估其对ANVUGIB再出血及死亡的预测能力。结果474例ANVUGIB患者中男性与女性之比约为2．36：1,死亡22例（4．64％）,再出血54例（11．39％）。Rockalli~分系统预测死亡的AUC=0．849（P〈0．05）,预测再出血的AUC=0．675（P〉0．05）。各组再出血率分别为10％、7．53％、12．58％、19．58％。Rockall评分系统评估各组再出血率AUC分别为0．610、0．740、0．632、0．727。各组死亡率分别为0％、5．48％、2．65％、10．3％。结论Rockall评分系统对ANVUGIB死亡的预测能力良好。Rockall评分系统对40～59岁组、≥80岁组ANVUGIB患者再出血预测价值较高。     

不同臀位分娩方式的选择对母婴影响的临床分析

目的:观察不同臀位分娩方式对母婴的临床影响,探讨提高母婴身心健康的臀位分娩方式。方法:按照不同的分娩方式将532例单胎臀位分娩产妇分为阴道分娩组和剖宫产分娩组,比较两组产妇并发症、新生儿并发症及新生儿产后Ap-gar评分情况。结果:剖宫产组的产妇并发症、新生儿并发症及新生儿产后Apgar评分情况好于阴道分娩组,差异有统计学意义(P<0.01,P<0.05)。结论:做好孕期保健,及时发现胎位异常并矫正胎位;臀位分娩时宜适当放宽剖宫产手术指征,分娩方式以择期剖宫产为主,可改善母婴预后。     

冠脉评分法在急性心肌梗死应用中的相关性

目的 探讨在急性心肌梗死患者中3种冠状动脉评分方法的相关性.方法 对我院2007～2010年收治确诊为急性心肌梗死并行冠状动脉造影的301例患者的临床资料进行回顾性研究.采用相关分析,探讨3种评分方法间的相关性.结果 301例确诊为急性心肌梗死患者中,Gensini评分和Leaman评分的相关系数为0.856,ACC ...     

MELD评分评估血浆置换治疗慢性乙型重型肝炎的疗效

目的应用终末期肝病模型（MELD）评价血浆置换（PE）治疗慢性乙型重型肝炎的临床疗效。方法对112例慢性乙型重型肝炎患者进行PE治疗,检测总胆红素、国际标准化比值和肌酐水平以计算MELD分值。按照治疗前患者MELD分值〈30分、30～40分和≥40分分成三组,观察各组3个月内的病死率。结果 PE治疗后112例患者血生化指标改善;3个月内,在MELD评分〈30的63例患者中,死亡12例（19%）;在30≤MELD评分〈40分的34例患者中,死亡20例（58.8%）;在MELD评分≥40分的15例患者中,死亡15例（100%,P〈0.05）。结论 MELD评分系统能预测PE治疗慢性乙型重型肝炎患者的预后。     

Programming InterStim™ for faecal incontinence

Objective  Sacral nerve stimulation (SNS) for faecal incontinence (FI) is achieved by implanting a pulse generator attached to a tined lead with individually programmable electrodes. Our aim was to establish whether the 'ideal' programme for the treatment of FI has been used most commonly. We also wished to determine whether re-programming changed the symptom severity scores.
Method  The following data were extracted from our SNS patient database: the frequency with which each programme was used, the length of time it was effective for, the number of months from implantation that the programme was started and the symptom severity scores prior to a change or no change in programme.
Results  Thirty-eight patients have had implanted pulse generators inserted since 2004. One hundred and two programme changes were documented in the database. The 'ideal' programme was not most commonly programmed. The common programmes were effective for longest. The electrode furthest from the tip was used in the initial programme only once and the median duration from implantation to the start of a programme including it is 13 months. Symptom severity scores were significantly higher in patients who required re-programming than in those whose programme remained unchanged.
Conclusions  In our patients the 'ideal' programme was not the programme used most frequently, nor for the longest duration. The theoretical migration of the tined lead inwards with time is upheld by our results. Patients who feel the sensation of SNS perianally have lower symptom scores than those who do not and who require re-programming.     

Role of orthoptics and scoring system for orbital floor blowout fracture: surgical or conservative treatment

AIM: To assess the role of orthoptics in referring patients with orbital floor blowout fracture (OFBF) for conservative or surgical treatment and based on the results, to propose a scoring system for such decision making. METHODS: A retrospective analysis of 69 patients with OFBF was performed (35 treated conservatively, 34 surgically). The role of orthoptics in referring to surgery or conservative treatment was retrospectively evaluated, the factors with the highest significance for decision making were identified, and a scoring system proposed using Logistic regression. RESULTS: According to defined criteria, the treatment was unsuccessful in 2 (6%) surgically treated and only in one (3%) conservatively treated patient. The proposed scoring system includes the defect size and several values resulting from the orthoptic examination, the elevation of the eyebulb measured on Lancaster screen being the most significant. CONCLUSION: The study demonstrates the benefits of orthoptic examination when making decisions on conservative or surgical treatment and for diagnosing ocular motility disorder (with or without binocular diplopia) in OFBF patients. The proposed scoring system could, following verification in a prospective study, become a valuable adjunctive tool.