Improving the international prognostic index score using peripheral blood counts: Results of a large multicenter study involving 520 patients with diffuse large B cell lymphoma

The main purpose of this study was to assess whether it is possible to improve the prognostic impact of international prognostic index (IPI) score by combining it with peripheral blood counts. Thus, we evaluated the prognostic power of lymphocyte, neutrophil, and monocyte counts in 520 patients with diffuse large B cell lymphoma treated with R-CHOP, confirming that these parameters have a strong impact on overall survival (OS). Using revised IPI (R-IPI), 44% of patients were categorized as poor-risk and showed an OS at 5 years of 46%. As OS at 5 years of the 520 patients is 67%, it is clearly evident that R-IPI tends to overestimate the proportion of patients with poor prognosis. Accordingly, in an attempt to improve the discriminating power of R-IPI, we evaluated and compared three different scores by combining the neutrophil lymphocyte ratio (NLR) and absolute monocyte count (AMC) with the following values: (a) IPI score 3-5, (b) age > 60 years and performance status, (c) age ≥ 65 years and LDH > ULN. The three indexes studied, had a similar 5 years OS for the high-risk group (46%-52%), but the proportion of patients classified as poor-risk were 37%, 20%, and 32%, respectively, which are lower than 44% identified with R-IPI. Thus, while R-IPI overestimates the number of high-risk patients, after applying our models, it is possible to recognize patients who are truly at high-risk. Of the three scores, the most accurate appears to be that based on NLR, AMC, LDH > ULN and age ≥ 65 years, which identifies 32% of high-risk patients, correlating well with what is seen in clinical practice.     

基于VAS评价右美托咪定在宫颈癌根治术后镇痛及术后快速康复中的临床效果

目的:研究右美托咪定在宫颈癌根治术后镇痛及术后快速康复中的临床应用效果。方法:将2015年7月至2018年7月在本院行宫颈癌根治术的86例患者随机分为对照组和观察组各43例。对照组术后镇痛采用舒芬太尼和格拉司琼，观察组术后镇痛加用右美托咪定。采用视觉模拟评分法（VAS）评价患者术后1 h、6 h、12 h、24 h、48 h疼痛情况，采用Ramesay评分法评价患者不同时间点镇静状况，记录并比较两组患者不同时间点收缩压、舒张压、心率及呼吸频率变化，比较两组患者不良反应发生情况。结果:观察组患者术后6 h、12 h、24 h、48 h VAS评分均明显低于对照组（P＜0.05），Ramesay评分均明显高于对照组（P＜0.05）；观察组和对照组患者术后不同时间点呼吸频率比较，差异无统计学意义，但术后6 h、12 h、24 h观察组患者收缩压、心率均明显低于对照组（P＜0.05），术后1 h、6 h观察组患者舒张压明显低于对照组（P＜0.05）；观察组患者恶心呕吐、高血压发生率较对照组明显减低。结论:右美托咪定用于宫颈癌根治术后镇痛，可以提高镇痛镇静效果，稳定患者血流动力学，有助于术后快速康复。     

急诊治疗重症心力衰竭的方案及疗效探析

目的探讨急诊治疗重症心力衰竭的方案及疗效。方法选择本院80例2016年2月-2019年2月重症心力衰竭患者。随机分组,常规治疗组采取常规方法治疗,急诊治疗组则采取全面急诊治疗。比较两组重症心力衰竭疗效;重症心力衰竭症状改善的时间、心功能改善两级的时间;治疗前后患者舒张压、平均心率以及左心射血分数;不良反应。结果急诊治疗组重症心力衰竭疗效、重症心力衰竭症状改善的时间、心功能改善两级的时间、舒张压、平均心率以及左心射血分数相比较常规治疗组更好,P<0.05。两组未见严重不良反应,P>0.05。结论全面急诊治疗重症心力衰竭可获得较好预后,可有效改善患者的心功能,缓解症状,且安全性高,无明显不良反应。     

认知行为干预在冠心病患者护理中的应用效果

目的观察认知行为干预在冠心病患者护理中的应用效果。方法选取本院2016年12月～2018年2月期间收治的53例冠心病患者,根据住院号奇偶性情况将其随机分为观察组(n=27)和对照组(n=26),对照组予以常规护理,观察组予以认知行为干预。比较两组患者控制态度评分、心理状况评分、生活质量改善情况及依从性。结果观察组控制态度评分、心理状况评分、生活质量改善情况及依从性与对照组比较,差异有统计学意义(P0.05)。结论在冠心病患者护理中给予认知行为干预应用效果极佳,可作为临床干预首选措施。     

Parkinson's disease may reduce sensitivity to visual-tactile asynchrony irrespective of dopaminergic treatment: Evidence from the rubber hand illusion

BackgroundThe feeling of body ownership relies on the binding of multisensory body-related signals. Various sensory abnormalities have been described in Parkinson's disease (PD).ObjectiveTo assess the rubber hand illusion (RHI) in patients with PD (PwPD) and age-matched healthy controls (CTRL). To evaluate the influence of the dopaminergic system in a PwPD subgroup OFF medication.MethodsThe RHI paradigm was applied to 42 PwPD and 48 CTRL. In this experimental setup, stroking a visible plastic hand simultaneously with the covered real hand elicits the feeling of ownership over the seen hand. Asynchronous stroking served as a control condition. Proprioceptive bias and an illusion score based on a questionnaire were used as measures of the RHI. Seventeen PwPD additionally underwent the experiments “OFF medication”.ResultsCompared to CTRL, PwPD showed higher proprioceptive bias independent of the stroking condition (p = 0.015), and had higher illusion scores in the asynchronous condition (p < 0.05). In PwPD, there were no significant differences between ON- and OFF-medication state.ConclusionIn PwPD, responses to the RHI are less specific with respect to the degree of synchronicity of brushstrokes. This might be attributed to a less stable body representation, internal “noise” during multisensory integration, or a blur of temporal discrimination in PD. The fact that RHI measures did not differ between ON- and OFF-medication states indicates an involvement of non-dopaminergic transmitter systems in this finding.     

Peak C-reactive protein levels do not predict 30-day mortality for bacteremia: A retrospective cohort study

IntroductionAlthough peak C-reactive protein (CRP) levels are correlated with the prognosis of some diseases, there have been no reports regarding the association between peak CRP levels and mortality in patients with bacteremia. The present study aimed to determine the association between peak CRP levels and prognosis in patients with bacteremia.MethodsThis retrospective cohort study was conducted in a single tertiary hospital and included patients with bacteremia admitted to the emergency department from November 2012 to March 2017. Cox regression analysis was performed to examine the association between peak CRP levels and 30-day mortality. We also performed propensity score adjustment using potential confounding factors.ResultsOne hundred fifty-nine patients were included in the study. Peak CRP levels were significantly higher in the β-hemolytic streptococci (P = 0.001) and Streptococcus pneumoniae (P = 0.003) groups. The C-statistic of the multivariate logistic regression model for the propensity score was 0.88. For 30-day mortality, peak CRP levels >20 mg/dL did not show significance in the Cox regression analysis (hazard ratio, 0.866; 95% confidence interval, 0.489–1.537; P = 0.62). Even after propensity score adjustment, no significance was noted (hazard ratio, 0.865; 95% confidence interval, 0.399–1.876; P = 0.71).ConclusionsPeak CRP levels were not an independent predictor of mortality in patients with bacteremia in the emergency department. Clinicians should consider that patients with extremely high peak CRP levels do not necessarily have high mortality and vice versa.     

针灸治疗对脑卒中偏瘫患者总有效率的影响

目的:探究针灸治疗对脑卒中偏瘫患者总有效率的影响。方法:将2017年1月-2018年12月在我院接受治疗的58例脑卒中偏瘫患者作为研究对象,随机数字表法分为观察组与对照组,每组29例,分别给予针灸治疗与常规治疗,对两组患者治疗前后神经功能缺损评分(Neurological Impairment Score Scale,NIHSS)、日常生活能力(Barthel指数)以及临床治疗效果进行综合评价。结果:观察组患者治疗后的NIHSS评分明显降低,Barthel指数提高,与对照组比较差异有统计学意义(P<0.05);观察组患者治疗后总有效率与对照组比较,差异有统计学意义(P<0.05)。结论:针灸治疗脑卒中偏瘫患者,能够促进神经功能改善,提高患者日常生活能力,效果显著,值得推广应用。     

当归龙荟片联合普芦卡必利治疗慢性功能性便秘的临床研究

目的探讨当归龙荟片联合普芦卡必利治疗慢性功能性便秘的临床疗效。方法选取2018年5月-2019年5月在北京市肛肠医院治疗的慢性功能性便秘患者122例,根据用药的差别分为对照组(61例)和治疗组(61例)。对照组口服琥珀酸普芦卡必利片,2mg/次,1次/d;治疗组在对照组基础上口服当归龙荟片,4片/次,2次/d。两组患者均经4周治疗。观察两组患者临床疗效,同时比较治疗前后两组患者临床症状评分、PAC-QOL积分、结肠传输试验积分、Bristol和SF-36评分,及血清5-羟色胺(5-HT)、血管活性肠肽(VIP)、P物质(SP)和一氧化氮(NO)水平。结果治疗后,对照组和治疗组临床有效率分别为80.33%和96.72%,两组比较差异具有统计学意义(P<0.05)。经治疗,两组症状积分均明显降低(P<0.05),且治疗组比对照组降低更明显(P<0.05)。经治疗,两组患者PAC-QOL积分和结肠传输试验积分明显降低(P<0.05),而Bristol和SF-36评分明显升高(P<0.05),且治疗组患者明显好于对照组(P<0.05)。经治疗,两组患者血清SP、5-HT水平均显著升高(P<0.05),而VIP和NO水平均明显降低(P<0.05),且治疗组患者SP、5-HT、VIP和NO水平明显优于对照组(P<0.05)。结论当归龙荟片联合普芦卡必利治疗慢性功能性便秘可有效改善患者临床症状,促进患者生活质量改善,具有一定的临床推广应用价值。