健康教育工作手册的应用与管理

针对医院健康教育工作开展中的实际需要,制定统一规范的健康教育工作手册,建立了工作的规范引导和质量控制标准。经3年临床实践运用,加强了对全院健康教育工作的规划、协调和考核;促进了工作的规范化、科学化管理,有效提高了组长的工作能力,确保了全院工作的同步开展与落实。     

Using machine learning to aid treatment decision and risk assessment for severe three-vessel coronary artery disease

BACKGROUNDThree-vessel disease (TVD) with a SYNergy between PCI with TAXus and cardiac surgery (SYNTAX) score of ≥ 23 is one of the most severe types of coronary artery disease. We aimed to take advantage of machine learning to help in decision-making and prognostic evaluation in such patients.METHODSWe analyzed 3786 patients who had TVD with a SYNTAX score of ≥ 23, had no history of previous revascularization, and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) after enrollment. The patients were randomly assigned to a training group and testing group. The C4.5 decision tree algorithm was applied in the training group, and all-cause death after a median follow-up of 6.6 years was regarded as the class label.RESULTSThe decision tree algorithm selected age and left ventricular end-diastolic diameter (LVEDD) as splitting features and divided the patients into three subgroups: subgroup 1 (age of ≤ 67 years and LVEDD of ≤ 53 mm), subgroup 2 (age of ≤ 67 years and LVEDD of > 53 mm), and subgroup 3 (age of > 67 years). PCI conferred a patient survival benefit over CABG in subgroup 2. There was no significant difference in the risk of all-cause death between PCI and CABG in subgroup 1 and subgroup 3 in both the training data and testing data. Among the total study population, the multivariable analysis revealed significant differences in the risk of all-cause death among patients in three subgroups.CONCLUSIONSThe combination of age and LVEDD identified by machine learning can contribute to decision-making and risk assessment of death in patients with severe TVD. The present results suggest that PCI is a better choice for young patients with severe TVD characterized by left ventricular dilation.

Coronary artery disease (CAD) is the leading cause of death and disability worldwide.^[1] Three-vessel disease (TVD) is the most severe form of CAD and is characterized by significant stenosis in all three major coronary arteries. The application of myocardial revascularization techniques, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), has significantly improved the clinical outcomes of patients with severe CAD. CABG has traditionally been the standard therapy for complex coronary lesions, including TVD.^[2] In recent years, with the advancements in PCI technology and the accumulation of operators’ experience, the incidence of periprocedural and long-term adverse events of PCI has substantially decreased, and PCI has been gradually applied in the treatment of TVD.^[3,4] Current guidelines recommend use of the SYNergy between PCI with TAXus and cardiac surgery (SYNTAX) score and diabetes status to guide the revascularization strategy for patients with TVD.^[5,6] Current practice guidelines do not recommend PCI for patients with TVD with a SYNTAX score of ≥ 23. However, using the SYNTAX score to guide clinical decision-making between PCI and CABG remains controversial, and its reasonability has been questioned since a newly published meta-analysis showed no significant association between the SYNTAX score and the comparative effectiveness of PCI and CABG.^[7] Moreover, the SYNTAX score is a quantitative indicator of the anatomical complexity of TVD and does not include clinical variables that may have significant effects on the patient’s prognosis. Whether some patients with specific clinical characteristics can obtain a comparable or even greater survival benefit from PCI than from CABG is unclear. Moreover, risk assessment for patients with TVD after revascularization therapy remain challenging.^[8–10]Machine learning has recently emerged as an important research method and has been successfully applied in many scientific fields, including clinical medicine.^[11–13] The decision tree algorithm, a common approach in machine learning, can handle non-linearity, heterogeneous effects, and high-dimensional features and partition a trial population into subgroups characterized by multiple simultaneous characteristics.^[14] In the present study involving a large cohort of patients with TVD with a SYNTAX score of ≥ 23, we employed a decision tree algorithm to generate specific subgroups, compared the long-term prognosis between patients who underwent PCI or CABG in each subgroup, and conducted a comparative analysis of the long-term prognosis between subgroups generated by machine learning. We evaluated whether machine learning can help in selecting the optimal revascularization method and assessing risk in patients with severe TVD.     

安徽省2007～2008年志贺氏菌流行株菌型分布及脉冲场分子分型

目的了解安徽省志贺氏菌的流行菌型,并建立脉冲场凝胶电泳（PFGE）分子分型方法,为菌痢防控提供理论基础。方法对22株志贺氏菌进行血清分型、药物敏感试验和PFGE试验。结果22株志贺氏菌血清分型：B群19株,占总数86.5%;C群1株,占总数的4.5%;D群2株,占总数的9.0%。成功建立了菌痢的PFGE分子分型方法,并将我省22株流行株分为若干带型。试验结果进一步作聚类分析。结论安徽省菌痢流行株以福氏为主;安徽省PFGE分子分型方法和初步带型数据库对提高细菌检测水平有一定意义。     

ATOM P-600输液泵常见故障及检修

本文简单介绍了ATOM P-600输液泵的基本原理及组成结构,并对气泡报警、阻塞报警、流速不准、Err1＆Err2报警及其处理方法进行了分析。     

软腭骨瘤1例报告及文献复习

骨瘤是常见的由分化成熟的骨组织构成的良性肿瘤,多来源于邻近骨质,发生于骨膜内层骨母细胞,由成骨性纤维组织、成骨细胞及所产生的新生骨组成。发生于口腔软组织的骨瘤极为罕见,作者报道1例软腭骨瘤病例,结合有关文献对其组织来源、病理分型、鉴别诊断和治疗等进行了讨论。     

新型冠状病毒IgG和IgM抗体检测的诊断价值探索

目的:通过对血清中新型冠状病毒1gM和IgG抗体的定性检测,探索新型冠状病毒1gM/gG抗体检测试剂盒(胶体金法)的临床诊断价值.方法:本研究以2020年1月3日至2020年3月19日于十堰市西苑医院收治的新型冠状病毒肺炎感染确诊患者141例和141名健康体检者为研究对象,采用胶体金免疫层析技术对患者血清中的新型冠状病...     

卒中后抑郁新的病因假说——谷氨酸能障碍

卒中后抑郁（post-stroke depression,PSD）是卒中后常见的神经精神症状之一,以心境低落、 兴趣下降为主要特征,不仅影响患者神经功能的康复,而且显著增加卒中病死率。其发病机制尚未 明确,伴随离子型谷氨酸受体拮抗剂氯胺酮的快速抗抑郁作用的出现,谷氨酸（glutamate,Glu）能神 经系统在抑郁症及PSD中的作用日益突出,也为抗抑郁治疗带来新的契机。     

核素心肌灌注显像定量分析技术诊断本地人群冠心病的价值

Objective To evaluate the accuracy of automated quantification of myocardial perfusion imaging (MPI) using a method based on a Western normal database for the detection of coronary artery disease (CAD) in a group of Chinese patients. Methods Seventy-two Chinese patients who underwent coronary angiography (CAG) and MPI within 3 months were recruited into this study. Eighty selected from 140 Chinese patients with low probability of CAD ( ＜ 5% ) were enrolled into local normal database of 99Tcm-methoxyisobutylisonitrile (MIBI) MPI using Cedars quantitative perfusion SPECT (QPS) database. Two Western MPI normal databases (CSMC MibiMbiAuto and Mibimibi) were used for processing the Chinese CAD patients recruited in this study, and the results were compared with those using local normal database and visual interpretation. T-test and z-test were used for statistical analysis. Results The extent (EXT)measurement obtained from Mibimibi and local database was ( 10.73 ± 14.54)% and ( 14.22 ± 16.51 )%,respectively ( t = 7.87, P ＜ 0.001 ); the severity (SEV) was 1.07 ± 0.93 and 1.34 ± 1.20, respectively ( t =7.45, P＜0.001). The area under curve(AUC) by using EXT measurement for local database (0.85 ±0.05) was larger than that for CSMC MibiMbiAuto ( AUC = 0.72 ± 0.06, z = 2.50, P ＜ 0.01 ) and Mibimibi ( AUC = 0.77 ± 0.06, z = 2.47, P = 0.014). The AUC of local database showed no significant difference from that of visual interpretation (AUC=0.83 ±0.05, z=0.05, P＞0.05). Conclusion Quantification of MPI of our Chinese patients using Western normal database would decrease the accuracy for the detection of CAD.     

前列腺动脉的解剖及临床意义

前列腺动脉的起源和走行具有较高的变异性;传统解剖学中的前列腺动脉描述与活体影像解剖的表现有部分差异;正确辨认前列腺动脉及其与周围血管的吻合是血管内介入诊疗前列腺疾病的首要和关键.     

VEGF、VEGFR-2和MVD在肾上腺皮质癌中的表达及意义

目的探讨VEGFR-2、VEGF和MVD在肾上腺皮质癌(ACC)中的表达及其临床意义。方法选取经手术治疗且具有完整的临床、病理资料的肾上腺皮质肿瘤存档石蜡标本37例,其中良性组20例,恶性组(ACC组)17例。采用免疫组化技术,检测良、恶性肾上腺皮质肿瘤中VEGFR-2、VEGF和MVD的表达情况。结果 VEGFR-2在ACC组中呈高表达(76.47%),在良性组中表达较低(25.00%),ACC组与良性组之间VEGFR-2的表达有显著性差异(P0.05)。VEGF在ACC组中呈高表达(70.59%),在良性组中表达较低(25.00%),VEGF在ACC组中的表达与在良性组中的表达有显著性差异(P0.05)。MVD在ACC组中的表达为(76.40±15.64),良性组中为(21.05±8.07),两者之间有显著性差异(P0.05)。结论 VEGFR-2和VEGF以及MVD在ACC中的高表达为抗肿瘤血管生成治疗在ACC中的应用,提供了一定的理论依据。