动态血压变异性与主观认知下降进展的相关性CSCD

Objective To analyze the correlation between ambulatory blood pressure variability and the progression of subjective cognitive decline (SCD). Methods In this prospective observational study, the overall sampling method was used to continuously select 100 patients with SCD in the Department of Neurology, Changshu First People′s Hospital and Changshu Xinzhuang People′s Hospital from January 1 2016 to June 30 2017. The baseline demographic characteristics of the patients were collected. The Chinese version of SCD‑Q9 questionnaire was used to self‑evaluate SCD, and the Montreal Cognitive Assessment Scale (MoCA) was used to evaluate objective cognitive impairment. All patients received 24 h ambulatory blood pressure monitoring, and 24 h systolic coefficient of variation (SCV) and diastolic coefficient of variation (DCV) were calculated. The follow‑up period was 4 years after the first visit, and the MoCA scale was evaluated once a year. Finally, 83 patients completed the follow‑up and were included in this study. According to the MoCA score at the end of follow‑up (<26 or ≥26), the patients were divided into progression group (39 cases) and non‑progression group (44 cases). The difference of MoCA score between baseline and last follow‑up was calculated in the progression group. The difference in demographic characteristics between the two groups was compared with χ2 test. The difference of 24 h SCV and 24 h DCV between the two groups were compared by rank sum test. The correlation between 24 h SCV and MoCA score difference or SCD‑Q9 score in the progression group were tested by multiple linear regression analysis. Results The 4‑year progression rate of SCD patients was 46.99% (39/ 83). There was no significant differences in baseline age, gender, education level, medical history, smoking history, SCD‑Q9 score and MoCA score between the progressive group and the non‑progressive group (all P>0.05). The 24 h SCV in the progressive group was significantly higher than that in the non‑progressive group [13.4% (9.9%, 15.6%) vs 10.9% (9.7%, 12.7%), U=594.50, P= 0.016]. There was no significant difference in 24 h DCV between the two groups (P>0.05). In progressive group, the 24 h SCV was negatively correlated with MoCA score difference (r=-0.368, P= 0.021). Conclusion There is a correlation between ambulatory blood pressure variability and SCD progression, high 24 h SCV may be one of the factors of SCD progression and has certain predictive value. © 2023 Chinese Journal of Health Management. All rights reserved.     

Ultrasonic follow‑up observation on size changes of 4C type thyroid micronodule classified by C‑TIRADSCSCD

Objective To observe the size changes under ultrasound of 4C type thyroid micronodules classified by 2020 Chinese Thyroid Imaging Reporting and Data System (C‑TIRADS) during follow‑up. Methods In this cross‑sectional study, the data of thyroid ultrasonography in physical examination center in the Affiliated Zhongshan Hospital of Dalian University between December 2017 and December 2021 were retrospectively included, thyroid nodules were classified according to C‑TIRADS, to observe the changes by ultrasound of maximum diameter and volume of 4C type thyroid micronodules during follow‑up. Results A total of 102 subjects receiving physical examinations with 103 thyroid micronodules were enrolled in this study. The maximum diameter and volume of thyroid micronodules at initial examination was 5.0 (4.0, 7.0) mm and 52.5 (25.2, 113.4) mm3respectively, and it was 6.0 (4.0,7.0) mm、65.6 (25.2,147.0) mm3 at the last examination, respectively. Of the thyroid micronodules, 79 (76.7%) remained stable, 14 (13.6%) magnified and 10 (9.7%) shrunk during the follow‑up. The cervical lymph nodes in all physical examiners were normal. There were significant changes in the maximum diameter and volume in the thyroid micronodules between the initial and last examination in subjects whose micronodules shrunk or magnified during the follow‑up (all P<0.05). Conclusion Size of most C‑TIRADS 4C thyroid micronodules remains stable or even decreases during ultrasound follow‑up observation, for such thyroid nodules, follow‑up observation appears to be a safe and feasible way to postpone surgery. © 2023 Chinese Journal of Health Management. All rights reserved.     

广西中小医院住院患者营养风险原因调查

Objective To investigate the causes of nutritional risks among inpatients in middle and small hospitals in Guangxi Zhuang Autonomous Region of China. Methods All the screened subjects were surveyed through classified collection of medical records and telephone follow-up. Factors including education background of patients and their family members, career, income, residence, medical payment methods, grade of hospital, and awareness of nutrition were analyzed. Results Lower education background of patients and their family members,less income, and self-funded health care payment were significantly associated with higher nutritional risks ( P ＜0. 01 ). The scores of malnutrition risks were significantly lower in patients whose careers were involved with culture, education and health and in patients whose family members had higher education levels (P ＜ 0.01 ). The nutrition risk was also significantly higher in patients from the rural areas than those from urban areas ( P＜0.01 ). It was also significantly higher in middle and small hospitals than in tertiary hospitals ( P＜0.01). Patients who had good awareness of nutritional knowledge had significantly lower incidence of nutritional risk (P ＜ 0. 01 ). Conclusion Low education level and poor economy in Guangxi are the main reasons for high nutritional risks.     

融合空气数据的深度网络慢阻肺评估测试评分预测模型的构建及意义CSCD

Objective To construct a chronic obstructive pulmonary disease (COPD) assessment test (CAT) score prediction model based on a deep network fused with air data, and to explore its significance. Methods From February 2015 to December 2017, the outdoor environmental monitoring air data near the residential area of the patients with COPD from the Respiratory Outpatient Clinics of Peking University Third Hospital, Peking University People′s Hospital and Beijing Jishuitan Hospital were collected and the daily air pollution exposure of patients was calculated. The daily CAT scores were recorded continuously. The CAT score of the patients in the next week was predicted by fusing the time series algorithm and neural network to establish a model, and the prediction accuracy of the model was compared with that of the long short‑term memory model (LSTM), the LSTM‑attention model and the autoregressive integrated moving average model (ARIMA). Results A total of 47 patients with COPD were enrolled and followed up for an average of 381.60 days. The LSTM‑convolutional neural networks (CNN)‑autoregression (AR) model was constructed by using the collected air data and CAT score, and the root mean square error of the model was 0.85, and the mean absolute error was 0.71. Compared with LSTM, LSTM‑attention and ARIMA, the average prediction accuracy was improved by 21.69%. Conclusion Based on the air data in the environment of COPD patients, the fusion deep network model can predict the CAT score of COPD patients more accurately. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

Influencing factors of post stroke cognitive impairment in patients with acute ischemic stroke and their correlation with cognitive scoresCSCD

Objective To analyze the influencing factors of post stroke cognitive impairment (PSCI) and their correlation with cognitive scores in patients with acute ischemic stroke. Methods In this cross‑section study, 36 patients diagnosed with acute ischemic stroke and post stroke cognitive impairment (PSCI) admitted to the Department of Vascular Neurology of Beijing Tiantian Hospital Affiliated to Capital Medical University from June 1, 2022 to September 30, 2022 were selected as the PSCI group. And one to one matching was performed for patients without PSCI (PSNCI group) with an age±1 year and same gender admitted to the hospital during the same period (as control, 36 cases). Basic clinical data of the two groups were collected, the laboratory and imaging examinations were completed. Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) were used for cognitive evaluation by neuropsychologists. Hypothesis testing was used to compare the differences in basic data, laboratory tests and lesion sites between the two groups. Multi‑factor conditional logistic regression was performed to analyze the influencing factors of PSCI, and Spearman correlation analysis was carried out to analyze the correlation between influencing factors of PSCI and the cognitive scores. Results Compared with those in PSNCI group, the proportion of patients with stroke/transient ischemic attack history, hyperhomocysteinemia (HHcy), apolipoprotein E(ApoE) ε4 carriers and the ratio of temporal lobe and thalamus infarction were higher in PSCI group (41.7% vs 13.9%, 36.1% vs 2.8%, 30.6% vs 5.6%, 22.3% vs 2.8%, 25.0% vs 5.6%), the MMSE and MoCA scores were lower in PSCI group [16.50 (8.25, 19.00) vs 28.00 (27.00, 30.00), 10.00 (4.25, 14.50) vs 27.00 (25.00, 28.00)] (all P<0.05). Logistic regression analysis showed that HHcy was a positive correlation factor for PSCI (OR=2.342, 95%CI= 1.186-4.622, P=0.014). Spearman correlation analysis showed that MMSE (r=-0.415) and MoCA (r= -0.417) scores were negatively correlated with homocysteine (Hcy) (both P<0.05). Conclusion HHcy is an important factor affecting the occurrence and development of PSCI in patients with acute ischemic stroke, and Hcy level is negatively correlated with cognitive scores in those patients. © 2022 Chinese Medical Journals Publishing House Co.Ltd     

11例甲型H1N1流感孕产妇的临床分析

Objective To study the clinical characteristics and therapeutic effect of pregnant women infected with severe influenza A(H1N1), to survey the disease effects for the newborns. Methods The clinical data of 11 pregnant women infected with influenza A(H1N1 ) in our hospital from November to December 2009 were analyzed retrospectively. Results All the cases were in serious conditions, and 3 cases were in critical. All the patients were with symptoms of fever and cough, the temperature were in 38.7-39.6 ℃, and duration were 3-14 days. There were 9 cases with low lymphocytes, and 9 cases with high WBC. CRP were elevated in all the cases ( 12-129 mg/L), 9 cases were with hypochromia (22.4-30.2 mg/L). X ray showed increases of pulmonary hilar density for all the cases. By comprehensive treatment, 10 patients were cured and one showed marked progress. 9 cases continued pregnacy. One infant with septicemia was cured, other newborns and fetus were in good condition. Conclusions Pregnant women infected with influenza A (H1N1) are likely to develop severe condition. It is important to use antiviral treatment promptly,supplementary comprehensive treatment. Continuing pregnancy is safe, but the outcome to newborn needs further study.     

关节镜辅助下自体半腱肌腱重建内侧髌股韧带治疗髌骨脱位

目的 评价自体半腱肌腱重建内侧髌股韧带治疗髌骨脱位的临床效果.方法 2007年1月至2010年1月,用半腱肌腱重建内侧髌股韧带治疗复发性髌骨脱位患者16例.在关节镜辅助下采用自体半腱肌腱重建内侧髌股支持带,髌骨侧固定于髌骨内缘中上1/3和中点的位置,股骨侧固定于股骨内上髁和内收肌结节之间骨道内.结果 所有患者术后即行渐进性膝关节活动度训练,3个月恢复正常行走,6个月可进行体育锻炼.16例患者术后全部获得随访,随访时间7～54(26.36±20.48)个月.手术切口均一期愈合,膝关节功能恢复正常.术后Lysholm评分(93.21±4.68)分,与术前的(76.53±8.35)分比较差异有统计学意义(P＜0.05).结论 自体半腱肌腱重建内侧髌股韧带治疗髌骨脱位方法简便,能够有效恢复髌骨正常运动轨迹,是治疗复发性髌骨脱位的一种有效手术方法.

Abstract：

Objective To evaluate the clinical effects of medial patellofemoral ligament reconstruction using the semitendinosus tendon autograft for the treatment of the patellar dislocation.Methods From January 2007 to January 2010,16 cases of patellar dislocation were included in this group.Lysholm score was averaged preoperatively.Arthroscopic-assisted in the semitendinosus tendon autograft reconstruction of the medial patellofemoral ligament,the central graft were fixed on the inner edge of the patellar in the upper 1/3 and the mid-point location,the end were fixed on the channel of femoral epicondyle and adductor tubercle.Results All the patients that lined progressive knee rehabilitation after operation,returned to normal walking for 3 months,6 months could be sports.Followed up for 7-54( 26.36 ± 20.48 ) months,all of patients incision were healed as grade Ⅰ,knee function were normal.Postoperative Lysholm score (93.21 ± 4.68) scores compared with preoperative ( 76.53 ± 8.35 ) scores was significant difference (P ＜ 0.05 ).Conclusions Using the semitendinosus tendon autograft for the treatment of the patellar dislocation method is simple and can effectively restore normal patellar trajectory.At the same time,which is an effective surgical method to treat recurrentdislocation of the patellar.     

西安地区92例帕金森病患者药物治疗情况调查

Objective To investigate the treatment status of antiparkinsonism in Xi'an. Methods Six general hospitals were randomly chosen in Xi' an and all Parkinson' s disease (PD) patients were interviewed by questionnaire from Jan. 2007 to Apr. 2007. Results 92 PD outpatients were enrolled in, including 48 males and 44 females, from 43 to 86 years old (mean 65.6±17.1) with duration of the disease from 0.2 to 27.8 years (mean 4.4 ±9.4). The preference of the drug use from the patients were: 40 (43.5%) preferred taking levodopa, 25 (27.2%) with amantadine and/or trihexyphenidyl, 14(15.2%) with levodopa and others, 4(4.4%) with dopamine agonist and others, 2 (2.2%) with other drugs, 7 (7.6%) with no treatment. There were 69 (75.0%) patients onset with resting tremor, 15 (16.3%) with bradykinesia, 6 (6.5%) with rigidity, and 2 (2.2%) with unknown symptoms. There was no startically significant difference in anti-PD drugs among the patients onset with different symptoms (P>0.05). 45 patients appeared the onset of disease before 65 years old and with no dementia, 47 onset after 65 with or without dementia. There was no significant difference of anti-PD drugs between the two groups (P>0.05). Most patients initiated anti-PD treatment with levodopa but few of them chose dopamine agonist. According to the classification of Hoehn & Yahr, 25(27.2%) belonged to Grade Ⅰ, 53(57.6%) to Grade Ⅱ ,8(8.7%) to Grade Ⅲ ,3(3.3%) to Grade Ⅳ and 3 (3.3%) to Grade Ⅴ. There was no significant differences of anti-PD drugs between different grades of the disease (P>0.05). 55.3% of the patients changed their anti-PD drugs randomly during the therapy, but with no relation to their gender, age, educational level, dementia, the number of family members, course of diseases, or the degree of Hoehn & Yahr, frequency and categories of medicine. Conclusion Anti-PD treatment in Xi' an did not strictly follow the standardized protocol, with few patients using dopamine agonist and over 50% of the patients changed their drugs randomly.     

Influencing factors of anxiety and depression in patients with secondary lower extremity deep venous thrombosis after radical cervical cancer surgeryCSCD

Objective To investigate the influencing factors of anxiety and depression in patients with secondary lower extremity deep venous thrombosis (LEDVT) after radical cervical cancer surgery. Methods Retrospective analysis method was used, a total of 92 patients with anxiety and/or depression secondary to LEDVT after radical cervical cancer surgery admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region from June 2019 to June 2022 were included as the observation group, according to the presence of anxiety or depression, they were divided into anxiety group (65 cases) and depression group (58 cases) (some patients had both anxiety and depression). Another 90 patients who did not have anxiety or depression after radical cervical cancer surgery with secondary LEDVT were selected as the control group in the same period. The questionnaires of clinical data and disease cognition were designed to investigate the clinical data and disease cognition of patients, social support rating scale (SSRS) was used to assess the level of social support of patients, and univariate analysis was performed to identify the influencing factors of depression and anxiety in patients with secondary LEDVT after radical cervical cancer surgery. Results The percentage of patients with self‑pay, no children, unemployed or jobless, monthly family income <5 000 CNY, less social support, and disease awareness <80 scores in the anxiety group and depression group (36.92%, 67.69%, 69.23%, 66.15%, 46.15%, 70.77% and 34.48%, 68.97%, 72.41%, 65.52%, 44.83%, 68.97%) were higher than the control group (14.44%, 40.00%, 33.33%, 32.22%, 11.11%, 23.33%) (all P<0.01). The percentage of mixed thrombus, central thrombus, peripheral thrombus, bilateral thrombus, right thrombus, and left thrombus in the anxiety group and depression group (30.77%, 20.00%, 49.23%, 16.92%, 35.38%, 47.69% and 32.76%, 15.52%, 51.72%, 12.07%, 37.93%, 50.00%) were not significantly different from those in the control group (32.22%, 17.78%, 50.00%, 10.00%, 36.67%, 53.33%) (all P>0.05). Univariate analysis showed that self‑pay, unemployed or jobless, no children, monthly family income <5 000 CNY, less social support, and disease awareness <80 scores were correlated with depression and anxiety status in patients with secondary LEDVT after radical cervical cancer surgery (all P<0.01). Conclusion Depression and anxiety in patients with secondary LEDVT after radical cervical cancer surgery are related to self‑pay, unemployed or jobless, no children, low monthly family income, less social support, and low disease awareness. © 2021 Chinese Medical Association. All rights reserved.     

Eribulin for heavily pre-treated metastatic breast cancer patients

AIM: To discuss treatment with eribulin in clinical practice outside a clinical trial.METHODS: Archives of patients treated for metastatic breast cancer were reviewed and 21 patients treated with the new chemotherapeutic eribulin mesylate, a synthetic analog of a natural marine product, were identified. Information on patients' characteristics and treatment outcomes was extracted. Treatment with eribulin mesylate was initiated at the recommended dose of 1.4 mg/m2 on days 1 and 8 of a 21-day cycle in 17 patients and at a decreased dose of 1.1 mg/m2 on days 1 and 8 of a 21-day cycle in 4 patients due to comorbidities and frailty. Efficacy of the drug was evaluated using the revised Response Evaluation Criteria in Solid Tumors criteria. Progression-Free Survival and overall survival(OS) were calculated using the Kaplan-Meier method starting from the date of eribulin therapy initiation to the date of disease progression documentation or death, respectively.RESULTS: The median age of patients at the time of eribulin mesylate treatment was 53 years(range 34-75). Sixteen patients had estrogen receptor(ER) and/or partial response(PR) positive disease and 5 had ER/PR negative disease(all triple negative). Eight patients had received 2 or 3 previous lines of chemotherapyfor metastatic disease and 13 patients had received 4 or more lines of treatment. The median number of cycles of eribulin received was 3(range 1-16 years). All patients, except one, discontinued treatment due to progressive disease and one patient due to adverse effects. Six patients had a dose reduction due to side effects. All patients had progressed at the time of the report with a median time to progression of 3 mo(range 1 to 14 mo). Fifteen patients had died with a median OS of 7 mo(range 1-18 mo). Six patients were alive with a median follow-up of 13.5 mo(range 7 to 19 mo).CONCLUSION: This series of patients confirms the activity of eribulin in a heavily pre-treated metastatic breast cancer population consistent with phase Ⅱ and Ⅲ trials.     

对医院护理管理队伍建设的几点思考

文章分析了当前医院护理管理队伍存在的主要问题：知识结构不合理；专业思想不纯正；接受继续教育不足：工作效能低下。提出了建设高素质护理管理人才队伍的思路：严格标准，搞好选才；加强思想教育和引导；加大培养力度；建立科学考评和激励机制；完善人才合理流动措施；合理编制，突出效率。     

医学科技成果信息资源网络开放利用的原则探析

医学科技成果信息资源网络开放利用，为资源的开放共享创造了良好条件，它使医学科技信息得到了高效传播和最大利用。网络开放利用医学科技成果信息资源，利用的主体和核心是其信息内容。信息内容是网络用户从中提取知识和所需资料的主要来源，同时也是信息破坏者发动攻击的主要目标之一，因而，信息内容的安全是信息安全的基本问题，主要包括信息内容的规范性、完整性与真实性、知识产权保护与利用的合理性等。要做好这些工作，应该遵循相应的原则和要求。     

政府公共财政支出分配公平性研究进展

政府公共财政支出是社会再分配的一种形式，其目的是促进社会公平。因此，政府的公共财政支出应该具有较强的目标针对性，应该向社会贫困人群倾斜，使其从中受益。本文通过查阅国内外政府公共财政支出分配公平性的相关文献资料。阐述了相关研究的进展情况，井着重探讨了政府公共财政支出分配公平性的内涵、研究范围、测算方法和研究意义。以及实际研究中存在的问题，最后提出我国政府公共财政支出分配公平性的研究方向和需要进一步完善的地方。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。