基于MRI的辽宁汉族成人面部软组织侧貌角度测量及分析

目的 探讨中国辽宁地区汉族成人面部软组织侧貌数据,为正畸、正颌及整形的临床诊疗提供参考数据.方法 随机选取符合纳入标准的辽宁医学院在校学生100人(女性50人、男性50人),使用GE超导1.5T MRI扫描仪对其进行头颈联合扫描.将获取的图像信息导入VG Stduio2.2 MAX软件分析系统实现三维颅面重建,采用Fa...     

吉非替尼治疗化疗失败晚期肺腺癌的临床观察

目的：观察吉非替尼治疗化疗失败的晚期肺腺癌的疗效及安全性。方法：33例患者均每日口服吉非替尼250mg,直到病情进展时停药。同时选择性配合营养支持疗法、降低颅内压和止痛等治疗。观察症状变化、近期疗效、肿瘤进展时间、生存期及不良反应。结果：服药1个月后33例患者CR3例（9．09％）,PR21例（63．6％）,SD8例（24,2％）,PD1例（3．03％）。有效率（RR）为72．7％,疾病控制率（DCR）为96．97％。中位肿瘤进展时间（TTP）9．9个月。疗效以不抽烟者为好,P〈0．05。性别间疗效差异无统计学意义,P〉0．05。3例生存时间〉19个月,6例〉14个月,1年生存率27．3％。13例生存时间〉9个月,8例〉6个月,3倒〉3个月。毒副作用主要为胸面部丘疹及色素沉着和轻微的消化道反应。结论：化疗失败的晚期肺腺癌应用吉非替尼治疗效果较好且安全,患者的耐受性及顺从性好。进一步的疗效和应用范围以及安全性有待更深入地研究、观察。     

数据分类算法智慧诊疗模型在皮肤痤疮诊断中的研究与应用

目的建立一种基于数据分类算法、人工智能与皮肤诊断学等多学科融合的寻常型痤疮智慧诊疗模型。方法通过采集陆军军医大学第一附属医院皮肤科2018-2020年门诊患者中明确确诊的寻常型痤疮皮肤影像数据为依据,利用数据分类算法、卷积神经网络、深度学习等技术定位影像数据中的痤疮关键部位,进而提取、处理、分析和总结归纳寻常型痤疮影像的病理特征。结果建立痤疮分类诊断模型与知识库,构建智慧痤疮诊断模型标准与规范。结论数据分类算法智慧诊疗模型可实现对寻常型痤疮图像的自主诊断,提高诊断准确率与工作效率。     

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.     

浅谈教师专业道德

教师专业化及教师专业道德的发展越来越得到社会各界的重视,相关研究也日益成为研究热点。本文通过分析教师专业道德的内涵和特性,探讨教师专业道德在教师专业化发展中的作用,为促进教师专业化的健康发展提供了理论依据。     

徐州市脑卒中患者生存质量及相关因素研究

目的研究徐州市脑卒中患者的生存质量(QOL)状况及相关因素。方法采用随机整群抽样方法抽取徐州市4所医院为研究中心,采用自编调查问卷及脑卒中患者生存质量量表(QOLISP)进行评估。结果调查的303名脑卒中患者的生存质量总分为(115.8±16.6)分,处于中等水平。单因素分析显示文化程度低、未康复治疗、基础健康差、康复信心缺乏的患者生存质量差;多因素分析表明基础健康和信心是生存质量的主要影响因素。结论重视医疗保健水平、开展综合护理、健康教育、树立信心、建立符合当地医疗水平的"卒中单元"有利于提高生存质量。     

专职随访对捐献肾移植受者生活质量影响的研究

目的 探讨专职随访对器官捐献肾移植受者生活质量的影响。方法 将成人公民逝世后器官捐献肾移植受者192例随机分为对照组97例和试验组95例,对照组采用常规随访模式,试验组实施专职随访,运行科室-门诊-网络闭环随访管理。比较2组患者的非计划再入院率、自我护理能力评分、生活质量评分以及随访满意度情况。结果 出院后6个月,试验组的非计划再入院率18.95%,低于对照组29.90%,差异有统计学意义(P<0.05);出院后1、6个月,试验组自我护理能力得分、生活质量得分、随访满意度均高于对照组,差异有统计学意义(P<0.05)。结论 专职随访可有效降低肾移植受者非计划再入院率,提高自我护理能力,改善生活质量,并提升患者的满意度。     

独立学院应届毕业生心理健康状况调查

目的 了解独立学院应届毕业生心理健康状况,为学校开展心理健康干预提供理论依据.方法 以自编学生一般情况问卷表和症状自评量表对76名应届毕业生进行调查分析.结果 独立学院毕业生心理健康各因子得分中强迫症状、焦虑、敌对和精神症性高于全国青年组常模,差异有统计学意义(P<0.05);文科学生得分高于理科学生,男生得分高于女生...     

对接大健康产业发展的康复治疗学人才培养体系的构建

在大健康产业发展背景下,康复服务产业发展模式和服务理念逐步转变。康复人力资源是康复服务产业发展的基石,文章基于《国际功能、残疾和健康分类》(international classification of functioning,disability and health,ICF)康复科学理论体系,切合康复服务产业化和专业化需求,重构康复治疗学专业人才培养的课程体系,强化实践教学,探讨构建康复治疗学专业人才培养新模式。     

白芍总甙对局灶性脑缺血大鼠脑组织炎症信号表达的影响

目的观察白芍总甙对局灶性脑缺血(Focal Cerebral ischemic,FCI)大鼠脑组织Toll样受体4(TLR4)基因表达的作用。方法参照longa等方法制成大鼠局灶性大脑中动脉梗死(MCAO)模型,将80只SD雄性大鼠随机分为假手术组,溶剂组,白芍总甙低、高两个剂量组,采用RT-PCR法检测缺血灶周围脑组织TLR4基因表达水平。结果生理盐水组TLR4基因相对表达均明显高于假手术组(P<0.01);白芍总甙中高剂量组TLR4相对表达量明显低于生理盐水组(P<0.01)。结论生理盐水组大鼠缺血灶周围脑组织TLR4基因高表达,白芍总甙对TLR4表达有抑制作用,这可能是其抗炎作用的机理之一。