主动脉出口血压对左心室血流特性的影响

采用Mimics对心脏进行三维重构，用3-matic进行模型优化以及模型误差分析，对左心室室壁运动做速度分布假设，基于UDF宏文件对左心室室壁运动编写程序，将血液视为非牛顿流体，采用动网格技术研究不同血压对左心室血液流动的影响。模拟发现当左心室收缩时，压力梯度明显，内部压力减小。当左心室舒张时，内部压力逐渐增高。二尖瓣口处的速率先增大后减小。血压升高，左心室内剪切应力持续增大，极易破坏红细胞结构，产生溶血现象，导致心脏功能紊乱。     

奥美拉唑三联疗法治疗小儿消化性溃疡的临床研究

目的 探讨奥美拉唑三联疗法治疗小儿消化性溃疡的临床疗效.方法 选择2020年1月—2021年1月在新郑市中医院就诊治疗的90例消化性溃疡患儿,按照入院先后顺序将所有患儿分为对照组和治疗组,每组各45例.对照组采用雷尼替丁三联疗法进行治疗:口服盐酸雷尼替丁胶囊,3～5 mg/(kg·d),2次/d;口服克拉霉素缓释片,15～20 mg/(kg·d),2次/d;口服阿莫西林胶囊,30～50 mg/(kg·d),2次/d.治疗组采用奥美拉唑三联疗法进行治疗:口服奥美拉唑肠溶胶囊,0.6～0.8 mg/(kg·d),1次/d;克拉霉素缓释片、阿莫西林胶囊用法用量均与对照组相同.两组患儿治疗6周.观察两组患儿的临床疗效,比较两组患儿治疗前后的炎性因子水平、胃肠道激素水平.结果 治疗后,治疗组患儿的总有效率(93.33％)高于对照组(77.78％),组间比较有显著差异(P<0.05).治疗后,两组患儿血清白细胞介素-25(IL-25)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平均明显降低,有统计学差异(P<0.05);治疗后治疗组患儿血清IL-25、CRP、TNF-α水平均低于对照组,组间比较有显著差异(P<0.05).治疗后,两组患儿血清胃动素(MTL)、胃泌素(GAS)水平均明显降低,生长抑素(SS)水平明显升高,有统计学差异(P<0.05);治疗后治疗组患儿血清MTL、GAS水平低于对照组,SS水平高于对照组,组间比较差异有显著差异(P<0.05).治疗后,治疗组患儿的幽门螺杆菌根除率为91.11％,高于对照组的幽门螺杆菌根除率77.77％;治疗组患儿溃疡愈合率为80.00％,高于对照组的溃疡愈合率62.22％,组间比有显著差异(P<0.05).结论 奥美拉唑肠溶胶囊三联疗法治疗患儿消化性溃疡具有较好的临床效果,可减轻患儿的炎性反应、调节胃肠道激素,安全性较高,值得临床上借鉴.     

Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities

Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly. The development of foot ulcer in a diabetic patient has been estimated to be 19%-34% through their lifetime. The pathophysiology of diabetic foot ulcer consist of neuropathy, trauma and, in many patients, additional peripheral arterial disease. In particular, diabetic neuropathy leads to foot deformity, callus formation, and insensitivity to trauma or pressure. The standard algorithms in diabetic foot ulcer management include assessing the ulcer grade classification, surgical debridement, dressing to facilitate wound healing, off-loading, vascular assessment (status and presence of a chance for interventional vascular correction), and infection and glycemic control. Although especially surgical procedures are sometimes inevitable, they are poor predictive factors for the prognosis of diabetic foot ulcer. Different novel treatment modalities such as nonsurgical debridement agents, oxygen therapies, and negative pressure wound therapy, topical drugs, cellular bioproducts, human growth factors, energy-based therapies, and systematic therapies have been available for patients with diabetic foot ulcer. However, it is uncertain whether they are effective in terms of promoting wound healing related with a limited number of randomized controlled trials. This review aims at evaluating diabetic foot ulcer with regard to all aspects. We will also focus on conventional and novel adjunctive therapy in diabetic foot management.     

保乳术后放疗中钛夹动度与乳腺大小及钛夹位置的相关性

【摘要】目的:分析保乳术后放疗患者钛夹动度，并探讨其与乳腺大小、钛夹位置的相关性。方法:随机选取保乳术后放疗患者15例，每周两次锥形束CT。测量乳腺基底面直径（D）和乳高轴（H），以瘤床质心为原点将临床靶区分4个象限。记录各象限内钛夹在左右、腹背、头脚方向动度（MLR、MAP、MSI）以及其与临床靶区最内、最前、最上的距离（DSLR、DSAP、DSSI）。结果:MLR、MAP、MSI分别为（2.2±3.0）、（-1.1±3.6）、（0.8±4.7） mm；系统误差Σ在左、右、腹、背、头、脚分别为1.7、2.2、2.0、2.4、2.9、3.0 mm，随机误差σ分别为2.4、4.0、3.2、4.0、4.7、4.7 mm；靶区对应外放5.9、8.3、7.2、8.8、10.5、10.9 mm。一象限内，当D×H<99.89 cm2，MAP和D×H强相关（r=0.805），MLR、MAP均和DSLR、DSAP、DSSI强正相关（r=0.94, 0.94, 0.91；0.87, 0.91, 0.92），MSI和DSLR、DSAP强正相关（r=0.91, 0.94）；四象限内，当D×H<90.71 cm2，MAP和DSLR，MSI和DSAP均强负相关（r=-0.96；-0.95），MLR和DSLR强正相关（r=0.91）。结论:钛夹动度有各向异性，以SI方向外扩最大，并易受乳腺大小、钛夹位置影响。     

Evaluation of timolol maleate gel for management of hard-to-heal chronic venous leg ulcers. Phase II randomised-controlled study

BackgroundVenous leg ulcers (VLUs) often take a very long time to heal. Timolol maleate has been reported as displaying efficacy in healing of VLUs.ObjectivesTo evaluate the efficacy of timolol maleate gel in the management of hard-to-heal VLUs and to assess its safety as a topical agent during 12 weeks of use in combination with conventional treatment.MethodsA prospective, phase-II randomised-controlled trial with a sample size based on Fleming's one-stage design (P0 = 0.25, P1 = 0.45, alpha = 0.1, beta = 0.2) was planned. Patients with VLUs present for ≥ 24 weeks and with ≥ 50% granulation tissue were included. One drop of sustained-release timolol gel (Timoptol® LP 0.5%, Santen, Tampere, Finland) per 6 cm² VLU area was applied every 2 days for 12 weeks in timolol-treated patients, as adjuvant therapy to the standard care protocol (interface dressing and multilayer venous compression). Controls received standard care alone. The primary endpoint was to obtain ≥ 40% reduction in ulcer area at week 12 (W12).ResultsForty-three patients were randomised to the study, with 40 receiving at least one treatment and included in the analysis: 21 timolol-treated patients and 19 controls (females: 70%; median age: 72.5 [range 35–93] years). At W12, ≥ 40% ulcer-area reduction was achieved in 14/21 (67%) timolol-treated patients vs. 6/19 (32%) controls. No serious adverse events occurred. Local wound infections not requiring systemic antibiotics occurred in 5 cases in the timolol group and in one case in the controls.ConclusionsThese results support the benefit and safety of using timolol maleate to manage hard-to-heal VLUs, but confirmation is required in a larger multicentre randomised phase-III study.     

基于心冲击信号的心率检测方法

针对现有基于心冲击描记图进行心率检测存在的抗干扰性不足问题，提出一种鲁棒的心率检测模型，首先对原始信号中受干扰的片段进行补偿重构，然后将J峰作为特征波形，通过基于J峰频段的滤波与差分增强处理放大特征，并设计改进的峰值提取算法定位心跳点，进而得到心率估计值。实验结果表明，所用模型对于不同情形下的心冲击描记图信号均表现出良好的适应性，逐拍检测平均覆盖率为98.3%，平均准确率为98.4%。心率输出结果与金标准一致性高，误差范围控制在[±]5%以内，且运算实时性好，可以为临床或家庭保健提供良好的心率检测方案。     

Validity and reliability of the Turkish version of the pressure injury knowledge assessment tool 2.0

AimThe aim of this study was to develop a Turkish version of the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0) and determine its validity and reliability.Materials and MethodsThis was a cross-cultural adaptation and validation study. The study sample included a total of 451 participants (232 nurses and 219 nursing students). The validity of the Turkish version of the PUKAT 2.0 was evaluated with linguistic validity, content validity, item validity (item difficulty, discriminating index), and construct validity (known-groups technique) analyses. The reliability of the tool was evaluated by conducting a test–retest analysis.ResultsContent validity index (CVI) for the items (Item-CVI) ranged from 0.83 to 1.00 and the CVI for the scale (Scale-CVI) was 0.95. The difficulty index for 21 items ranged from 0.10 to 0.63. Four items were found to be too difficult. Item discriminating index values ranged from 0.00 to 0.61. The overall intraclass correlation coefficient (ICC) was found to be 0.80.ConclusionThe Turkish version of the Pressure Injury Knowledge Assessment Tool 2.0 (PIKAT 2.0-Tr) is supported by acceptable psychometric properties and can be used to evaluate the knowledge of nurses and nursing students in Turkey about the prevention of PI.     

放疗计划系统DeepPlan光子放疗剂量计算的临床可行性验证

目的:评估DeepPlan放疗计划系统患者计划剂量计算的准确性和临床应用的可行性。方法:剂量算法准确性评估主要是针对YY 0775号和YY/T 0889号报告中的例题内容进行测量验证。临床病例验证是基于Pinnacle计划系统设计的前列腺肿瘤患者9例、胸部肿瘤患者13例和头颈部肿瘤患者5例，试验将各病例原计划优化的子野等信息直接导入DeepPlan进行重新剂量计算，比较不同计划系统得到的靶区和危及器官剂量分布，并用PTW VeriSoft软件对两组计算结果进行全空间剂量γ分析。结果:DeepPlan光子剂量算法通过了剂量计算准确性验证，YY 0775号报告中所有测试例题误差均在2%以内。YY/T 0889号报告中所有患者计划的γ通过率均在96.8%以上，复合野的γ通过率平均值为98.1%。在病例验证中，前列腺肿瘤病例的等中心层面2D γ通过率平均值为97.6%，3D γ通过率平均值为96.9%。胸部肿瘤病例的等中心层面2D γ通过率平均值为98.7%，3D γ通过率平均值为98.3%。头颈部肿瘤病例的中间层面2D γ通过率为98.6%，3D γ通过率平均值为98.8%。结论:通过模体实际测量和临床病例测试，验证了DeepPlan光子放疗剂量计算的准确性和临床应用的可行性。