肝与衰老相关性理论探讨

从肝藏象入手,深入探讨了肝在人体衰老中的地位和作用,突破了传统的脾肾衰老观,明确提出肝气虚是人体进入衰老期的启动因子,并以此初步探讨了通过保肝养肝、怡情疏肝以延缓衰老的新途径。     

联合培养中心肌细胞诱导结状神经节神经元的迁移及P物质的表达

目的：探测联合培养中心肌细胞对迷走神经结状神经节神经元的迁移和P物质表达的影响作用。方法：建立Wistar大鼠结状神经节与心肌细胞联合培养的模型,用倒置相差显微镜观察结状神经节与心肌细胞培养不同时间的活细胞生长状况。联合培养72、96h,用Holmes还原银染色法观察神经元的迁移,用免疫组织化学法观察P物质的表达。结果：联合培养72、96h,与单纯培养的结状神经节组织块相比,结状神经节与心肌细胞联合培养的标本中神经元迁出的数目明显增多（P＜0.05）。结状神经节与心肌细胞联合培养96h,探测到了P物质免疫反应阳性神经元和神经纤维。而在单纯结状神经节组织块培养72、96h以及结状神经节与心肌细胞联合培养72h的标本中,均没有探测到P物质的表达。结论：联合培养中心肌细胞可诱导神经元的迁移和神经递质P物质的表达。神经元在形态学上的发育成熟可能需要72h就可以完成,而在联合培养中神经递质合成的发育成熟则需要96h。神经元在形态学上的发育成熟并不能代表神经递质合成的发育就已经完成。这一结果对于进一步研究心肌细胞的选择性神经支配以及神经与心肌的相互作用开辟了一条新的研究途径。     

人工神经网络技术诊断附件包块良恶性的可行性研究

目的 探索运用计算机智能人工神经网络技术建立诊断模型来判断附件包块良恶性的可行性.方法 180例附件包块患者随机分为训练组和测试组.训练组结合统计学多因素分析方法筛选出的参数建立人工神经网络诊断模型;测试组通过ROC曲线分析比较与恶性风险指数模型诊断性能的高低.结果 18项指标中单因素分析有14项指标对判断附件包块的性质有意义（P＜0.05）.由统计学多因素分析选出的参数（年龄、血清CA125、包块内壁突起、腹水及血流平均速度）共5项作为神经网络模型输入层参数,建立模型.ROC曲线证实神经网络模型较恶性风险指数模型的诊断性能高（P＜0.05）.结论 人工神经网络诊断模型对附件包块良恶性判断有良好的诊断性能.     

血清超敏C反应蛋白与尿碘水平联合预测先兆流产患者保胎结局的研究

目的观察血清超敏C反应蛋白(hs-CRP)与尿碘水平联合对先兆流产患者保胎结局的预测效能。方法前瞻性选取海南医学院第二附属医院2018年1月至2020年1月收治的112例先兆流产患者作为研究对象,根据保胎结局将患者分为保胎失败组(n=20)与保胎成功组(n=92)。检测两组入院时各主要指标[甲状腺功能相关指标、血清孕酮(P)、β-人绒毛膜促性腺激素(β-HCG)、hs-CRP、尿碘水平],采用Logistic回归分析各主要指标与先兆流产患者保胎结局的关系,并分析入院时血清hs-CRP、尿碘水平对先兆流产患者保胎结局的预测效能。结果保胎失败组P、β-HCG水平低于保胎成功组,hs-CRP水平高于保胎成功组,合并甲状腺功能异常、尿碘水平异常占比高于保胎成功组(P<0.05)。经Logistic回归分析结果显示,先兆流产患者甲状腺功能异常、hs-CRP表达上调、尿碘水平异常是保胎成功的危险因素(OR>1,P<0.05);先兆流产患者P、β-HCG表达上调是保胎成功的保护因素(OR<1,P<0.05);绘制受试者工作特征(ROC)曲线发现,先兆流产患者hs-CRP...     

消化性溃疡患者患病行为调查分析

目的了解消化性溃疡患者患病行为状况,以指导临床护理工作。方法选择消化性溃疡患者79例为溃疡组,选择健康体检人员89例为对照组。两组均使用《患病行为问卷》进行测评和比较分析。结果溃疡组患者中疑病指数（WI）〉6分占23％,患者一般疑病（GH）,疾病信念（DC）、疑病指数（WI）和疾病确信（DA）因子得分高于对照组,心理取向（P／S）得分低于对照组,差异均有统计学意义（P〈0．05）。情感压抑（AI）、否认心因（D）因子在不同职业消化性溃疡患者中得分差异有统计学意义,分别以农民、家庭妇女为最高;D因子得分各年龄段之间差异有统计学意义,以30～50岁患者得分最高。结论消化性溃疡患者“病感”明显,故治疗开始应尽快控制症状以诱导患者自觉接受正规的治疗方案,同时应加强心理护理和有效的护理沟通,提高患者满意度。     

东莞市各级医院263名护理人员沟通能力现状调查

目的 了解东莞市各级医院护理人员自我沟通理念和技能水平,提出应对措施.方法 采用问卷调查的方法,对东莞市三级甲等医院160名护理人员和二级或以下医院110名护理人员进行沟通理念和沟通技能调查,收回有效问卷263份,对263名护理人员的数据资料进行分析.结果 被调查的263名护理人员中,在与亲密朋友共享信息和分享情感方面的沟通方面能力较强,在处理不明确或不确定的问题时沟通能力较差.护理人员的各项沟通能力中,倾听能力》语言表达能力》自我克制力》处理人际关系中的冲突和摩擦能力.三级甲等医院的护理人员沟通能力明显高于二级或以下医院的护理人员(P＜0.05);高职称、高学历护理人员的沟通能力明显高于低职称、低学历的护理人员(P＜0.01);30岁以上的护理人员沟通能力明显高于其他低年龄组护理人员(P＜0.01);护龄10年以上护理人员的沟通能力明显高于其他低护龄组护理人员(P＜0.01).结论 东莞市各级医院临床护理人员的沟通能力需要进一步培训和提高,尤其要做好低年资护理人员沟通技巧的培训.     

Morel-Lavallée损伤诊疗进展

Morel-Lavallée(MLL)损伤是由剪切力等暴力使皮肤、皮下组织与深筋膜分离而引起的复杂的软组织闭合性撕脱损伤,疾病初期具有复杂性和隐蔽性,常因延迟诊断而导致感染、截肢、多器官衰竭甚至死亡等.目前,MLL的治疗尚无统一指南,需根据损伤情况及患者意愿综合考虑.在合并开放伤、骨折、神经血管肌腱损伤时,处理的优先顺...     

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.     

脐血和新生儿外周血CD4+CD25+调节性T细胞的表型特征及意义

目的 探讨脐血和新生儿外周血中CD4 CD25 调节性T细胞的表型特征及其意义.方法以18份脐血和9份新生儿外周血为标本,细胞膜表面抗原采用单抗直接标记法,检测胞内抗原(CD152、FoxP3)时先标记膜表面抗原,固定破膜后再标记胞内抗原,应用多参数流式细胞仪进行检测和结果分析.结果脐血和新生儿外周血中的CD4 CD25 T细胞显示为独立的细胞群,脐血中该群细胞占CD4 T细胞比例为(9.26±2.43)%,新生儿外周血中的比例则为(9.35±2.30)%;在表型方面,大部分是CD45RA 的细胞,同时表达CD62L、胞浆内的CD152,也表达FoxP3,CD4 CD25 FoxP3 占CD4 T细胞比例为(1.92±0.28)%.结论 脐血和新生儿外周血中存在着一群单纯且水平较高的CD4 CD25 调节性T细胞,它们可能在发挥对母体非遗传性抗原的耐受及防止母体对胎儿的排斥反应中具有独特的作用.     

HACCP原理在中小冷冻饮品生产企业中的应用

通过前期的基线调查,对浦东新区7家未实施HACCP计划的中小冷冻饮品生产企业的状况有了充分的认识,在此基础上,我们与企业共同制订了HACCP计划,确定了关键控制点,并在实际运行中进行纠偏和验证。事实说明各企业的生产过程卫生状况明显改善,提高了产品的安全性。