急性心肌梗死静脉溶栓治疗后ST段再抬高的临床意义

目的探讨急性心肌梗死(AMI)静脉溶栓治疗后ST段再抬高的临床意义。方法将首发AMI并接受静脉溶栓治疗的77例患者,按静脉溶栓治疗后心电图有无ST段再抬高分为ST段再抬高组(A组)和ST段无再抬高组(B组),比较两组梗死相关血管再通率、再灌注心律失常、心功能、梗死后心绞痛及并存疾病等。结果①A组梗死相关血管再通率82.1%、B组81.6%(P>0.05);②两组再灌注心律失常、心功能分级、梗死后心绞痛、左室射血分值(LVEF值)比较,无统计学意义(P>0.05);③两组伴发糖尿病、原发性高血压及吸烟比较,无统计学意义(P>0.05)。结论AMI静脉溶栓治疗后ST段再抬高,可作为心肌再灌注成功的一种临床表现,可作为成功、有效的再灌注指标之一。     

立体定向适形放射治疗肺癌的临床观察

目的观察立体定向适形放射治疗肺癌疗效和副反应。方法研究组采用立体定向适形放疗技术对40例Ⅰ-Ⅳ期肺癌病人进行治疗,单次靶区周边处方剂量2-6Gy,每周3-5次,总量60-72Gy;对照组采用常规放射治疗肺癌病人40例,DT1.8-2Gy/次,1次/天,总量60-70Gy;比较两组治疗后疗效、临床症状改善和不良反应。结果研究组治疗有效(CR PR)35例,占87.5%,其中CR8例占20%,PR27例占68%,临床症状改善率96.7%,放疗副反应发生率为13.5%;对照组:治疗有效(CR PR)31例,占77.5%,其中CR3例占7.5%,PR28例占70%,临床症状改善率为81.63%,放疗副反应发生率为25%。两组对比,研究组有效率高于对照组,但P>0.05无统计学意义。临床症状改善率研究组高于对照组,P<0.05,有统计学意义。放疗副反应发生率研究组明显低于对照组,P<0.001,有显著性差异。结论立体定向适形放射治疗肺癌有较好的近期疗效和症状改善率,与传统的常规放疗方法比较副反应明显减轻,患者易耐受,是一种有效、安全的治疗肺癌新的放疗方法。     

γ-氨基丁酸受体基因多态性与特发性癫痫的相关性研究

目的探讨GABA受体基因GABBR1多态性在特发性癫痫发病（IGE）中的作用。方法采用PCR、琼脂糖凝胶电泳技术分析46例IGE患者（研究组）rs3025627、rs3025628和rs29220基因型频率变化,并与50例健康查体者（对照组）比较。结果观察组与对照组rs3025627TT基因型频率分别为0．362、0．245,P〈0．01,rs3025627AT基因型频率分别为0．354、0．447,P〈0．05。两组rs3025628和rs29220基因型频率无统计学差异（P〉0．05）。结论rs3025627基因型频率改变可能是导致GABBR1基因外显子7在IGE病中起作用的原因。     

紫杉醇与异环磷酰胺治疗妇科恶性肿瘤临床比较研究

目的观察紫杉醇与异环磷酰胺治疗妇科肿瘤的疗效。方法采用紫杉醇治疗妇科恶性肿瘤37例,其中卵巢肿瘤27例,输卵管癌6例,宫颈癌3例,宫内膜癌1例。33例为术后或化疗后复发病例,4例为原发卵巢癌。异环磷酰胺（IFO）为相应时间内复发的37例妇科恶性肿瘤,其中卵巢癌30例,输卵管癌3例,宫颈癌3例,宫内膜癌1例。紫杉醇化疗前6、12?h给预防用药地塞米松、西咪替丁、苯海拉明,化疗前0.5h给地塞米松+甲氧氯普氨。然后紫杉醇135～150mg/m²静注3h(或腹腔灌注),联合卡铂。异环磷酰胺2.0g+卡铂。结果紫杉醇化疗组与异环磷酰胺总体生存期分别为37个月和25个月。有效率（CR+PR）分别为48.6%与28%,差异有统计学意义(P＜0.001)。化疗毒副反应主要是骨髓抑制与脱发。结论紫杉醇治疗卵巢癌及输卵管癌疗效好,毒副反应较轻。     

p21活化激酶1基因在大肠癌细胞中的表达及意义

目的 探讨p21活化激酶l（PAK1）基因在大肠癌细胞中的表达及意义。方法 运用免疫印迹技术检测PAK1基因在8株不同转移和恶性潜能大肠癌细胞（LoVo、SW480、SW620、SW1116、HT29 HCT116和CO-LO320细胞）中的表达。结果 与HCT116、HT29、SW480、SW1116和LST细胞相比,PAK1在LoVo、COLO320和SW620大肠癌细胞中蛋白表达明显增加,而HT29和SW480细胞中的PAK1蛋白表达亦强于SW1116和LST细胞,但PAK1在SW1116和LST细胞几乎无表达。结论 PAK1蛋白过度表达可促进大肠癌的发生、发展,且可能与大肠癌的恶性生物学表型密切相关。     

某院护士长沟通能力调查分析

目的 了解护士长的沟通能力,为制定有效的护士长培训方案提供依据。方法 采用《沟通能力启测量表》对某院19名护士长及护士长助理进行测试、分析、统计。结果 2名护士长沟通能力较差,16名护士长中等,1名护士长较好。调查对象在沟通过程中的诚信度、控制问题能力及不良信息控制上有明显缺陷。结论 护士长的沟通能力有待于进一步提高和培养,管理层要有充分的认识和足够的重视。     

糖尿病合并肺结核患者饮食问题的循证护理

目的通过循证的方法为糖尿病合并肺结核患者的饮食问题提供科学的护理干预,从而提高糖尿病并存结核病患者的治疗效果和生存质量。方法确定护理问题为糖尿病合并结核病患者的饮食问题,在中国期刊全文数据库中进行检索,以“肺结核、糖尿病、营养、健康教育、饮食”为关键词,1992年1月-2004年6月的文献中检索到符合要求、设计合理的文献共26篇。评价者对试验的方法学质量及纳入标准的恰当程度进行了评价,对资料进行了提取,分析各试验干预措施的差异,当资料允许时计算出合并结果。26篇文献中,评价为1级证据8篇,2级2篇,3级4篇,4级10篇,5级2篇。结果根据系统评价的结果,认为：（1）两病并存应适当放宽饮食限制;（2）首选优质蛋白、含糖量低、高纤维素、高维生素的蔬果及乳类食品;（3）禁止食用或限制食用对结核病并存糖尿病病情及治疗有负面影响的食物;（4）对自控能力差或饮食习惯不良的患者,要根据患者的实际情况和接受能力,进行循环互动式健康教育。在循证护理过程中,注意结合患者的个体差异实施护理,取得了良好效果：95％患者饮食控制理想,87％胸片显示病灶吸收,62％血糖控制好,营养不良患者从38例减少至5例,治愈率为94％。结论通过引入循证证据对结核病并存糖尿病患者的饮食护理提供指导,疗效明显提高,循证护理是整体护理的深化,在人力资源许可的情况下,应大力推广循证护理方法。     

纳络酮、脑活素治疗婴儿蒙被综合征的疗效及后遗症观察

目的探讨纳络酮、脑活素治疗婴儿蒙被综合征的疗效及后遗症发生率。方法采用病例对照方法,将54例婴儿蒙被综合征患儿随机分为两组,对照组(常规组)26例采用常规综合治疗;治疗组28例在此基础上加用纳络酮(0.1mg.kg-1.次-1,每日1次)和脑活素(5～10ml/次,每日1次)静滴,5d为1个疗程。对有效率及6～12个月后遗症发生率进行比较。结果治疗组显效15例,有效10例,无效2例,死亡1例,有效率89%;对照组显效10例,有效6例,无效8例,死亡2例,有效率61.5%;6～12个月随访后遗症发生率对照组为26.9%,治疗组为7.1%,差异均有显著性意义(P<0.05)。结论在综合治疗基础上应用纳络酮、脑活素能迅速改善病情,提高疗效,降低病死率及后遗症的发生率,值得推广应用。     

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.     

儿童共同性外斜视手术治疗59例

目的:探讨影响儿童共同性外斜视手术疗效的因素。方法:对59例平均随访17.7(3～64)mo的儿童共同性外斜视术后患者,按年龄、双眼视觉、斜视类型、术式分组进行回顾性研究,经统计学处理,观察各因素对疗效的影响。结果:眼位:正位43例(73%);内斜3例(5%);外斜13例(22%)。眼位正位率与手术年龄、斜视类型无相关性;与术前有无融合功能、斜视是否为间歇性、术式有关。学龄前手术组的立体视功能恢复率较高。结论:儿童共同性外斜视在斜视仍为间歇性、融合功能未丢失之前手术疗效较好。术式对术后眼位有较大影响。早期手术有利于双眼视功能的恢复。