眼电图的正常值

用Nicolet公司的Compact Four电生理诊断仪对138只正常跟进行常规EOG检测。受检者年龄6～72岁,平均年龄36.5岁。检测Arden比值为2.04±0.34。经统计学处理,年龄与Arden比值呈负相关关系,而性别及眼别对Arden比值无明显影响。以生理发育过程为年龄分组的依据,建立了Arden比值的正常值。同时发现散瞳及屈光不正对EOG检测结果有一定影响。     

Lessons from the SYNTAX trial

Despite the fact that CABG is the standard of care for patients with multivessel coronary arteries and/or left main stem stenosis, PCI has become a rival to CABG in patients with multivessel coronary artery disease or left main disease. However, the need for repeat revascularization, in-stent stenosis and thrombosis remain the achilis heal of PCI. SYNTAX trial randomized patients with left main disease and/or three-vessel disease to PCI with TAXus stent or CABG with the concept that PCI is not inferior to CABG. At 1 and 2 years follow up, MACCE was significantly increased in PCI patients mainly attributed to increased rate of repeat revascularization; however, stroke was significantly more with CABG. The composite safety endpoint of death/stroke/MI was comparable between the 2 groups. Therefore the criterion for non-inferiority was not met. What we learn from SYNTAX is that multi disciplinary team approach should be the standard of care when recommending treatment in more complex coronary artery disease. SYNTAX makes interventionists and surgeons come together, it may set the benchmark for MVD revascularization. PCI and CABG should be considered complementary rather than competitive revascularization strategies. There is no substitute for sound clinical judgment that takes into account the patient’s overall clinical profile, functionality, co-morbidities, as well as the patient’s coronary anatomy. The SYNTAX Score should be utilized to decide on treatment of patients with LM/MVD. Patients with low and intermediate score can be treated with PCI or CABG with equal results. Those with high score do better with CABG. SYNTAX trial showed that 66% of patients with 3VD or LMD are still best treated with CABG. In the remaining 1/3 of patients with low syntax score, PCI may be considered as an alternative to surgery. Finally, medical treatment should be optimized in patients going for CABG.     

Complex syntax used by school-age children with specific language impairment (SLI) in child-adult conversation

The present study is an investigation of complex sentence structures produced by school-age children in ordinary 100-utterance language samples. A total of 15 children with specific language impairment (SLI) and 15 of their classmates with typical language (TL) were the participants. Each child’s conversational sample was coded for several types of complex sentence structures. While a 100-utterance language sample was adequate to yield exemplars of several types of spoken syntactic complexity, findings raise concerns about the content validity of conversational language sampling in the assessment of spoken syntactic complexity. Results also indicated that, although the children with SLI produced fewer complex sentences as well as combined complex sentences than their classmates with TL, they produced some examples of most spoken complex sentence structures in their conversations. Implications for using conversational language sampling to assess complex syntax are discussed.

Learning outcomes

The reader will (a) explain the strengths and weaknesses of language sampling in assessment of spoken syntactic complexity in school-age children, and (b) describe differences in children with SLI and children with TL for spoken syntactic complexity in child–adult conversation, as well as how to account for those differences.     

基于图像识别句法分析的心电图计算机自动分析

心电图的计算机分析一直热门话题，但临床上心电图的计算机分析应用并不广泛，其原因是心电自动分析的精度较低。随着DSP的广泛应用和计算机数字图像处理技术的发展．我们具备了采用更高精度算法的软硬件条件。心电图作为波形图像处理时．包含了比单纯电压信号更多的信息，对波形图进行分析和识别可以对心电图形变异的捕捉更加敏感和精确。作者通过采用标准正交Hermite核函数来扩展生成基元，并将基元的参数作为或然神经网络的输入，神经网络的输出作为判别结果．取得了令人欣喜的效果。     

Clinical contrast sensitivity testing; the current status

This paper reports part of a series of studies into the development of clinically applicable methods for measuring human contrast sensitivity functions. The experience gained with the Arden Grating Test in clinical trials is reviewed. Current clinical methods of measuring contrast sensitivity are described and the requirements for an ideal clinical contrast sensitivity testing package are derived.     

A comparison of the treatment of trochanteric fractures of the femur by internal fixation with a nail plate and the Ender technique

In our experience, trochanteric fractures fixed with Ender nails achieved a degree of success similar to those treated by nail plating, but the risk of wound infection was much less with the former method. The results of 78 trochanteric fractures of the femur internally fixed with Ender nails have been analysed and compared with the results in 100 similar patients treated by nail plate fixation. The Ender method has advantages over existing operative methods, in that in our series the infection rate was zero and we found that the operation produced less shock. We consider that this method, although technically more difficult, can be used for most intertrochanteric fractures and merits further trial.     

Accessing complex patient data from Arden Syntax Medical Logic Modules

ObjectiveArden Syntax is a standard for representing and sharing medical knowledge in form of independent modules and looks back on a history of 25 years. Its traditional field of application is the monitoring of clinical events such as generating an alert in case of occurrence of a critical laboratory result. Arden Syntax Medical Logic Modules must be able to retrieve patient data from the electronic medical record in order to enable automated decision making. For patient data with a simple structure, for instance a list of laboratory results, or, in a broader view, any patient data with a list or table structure, this mapping process is straightforward. Nevertheless, if patient data are of a complex nested structure the mapping process may become tedious. Two clinical requirements – to process complex microbiology data and to decrease the time between a critical laboratory event and its alerting by monitoring Health Level 7 (HL7) communication – have triggered the investigation of approaches for providing complex patient data from electronic medical records inside Arden Syntax Medical Logic Modules.Methods and materialsThe data mapping capabilities of current versions of the Arden Syntax standard as well as interfaces and data mapping capabilities of three different Arden Syntax environments have been analyzed. We found and implemented three different approaches to map a test sample of complex microbiology data for 22 patients and measured their execution times and memory usage. Based on one of these approaches, we mapped entire HL7 messages onto congruent Arden Syntax objects.ResultsWhile current versions of Arden Syntax support the mapping of list and table structures, complex data structures are so far unsupported. We identified three different approaches to map complex data from electronic patient records onto Arden Syntax variables; each of these approaches successfully mapped a test sample of complex microbiology data. The first approach was implemented in Arden Syntax itself, the second one inside the interface component of one of the investigated Arden Syntax environments. The third one was based on deserialization of Extended Markup Language (XML) data. Mean execution times of the approaches to map the test sample were 497 ms, 382 ms, and 84 ms. Peak memory usage amounted to 3 MB, 3 MB, and 6 MB.ConclusionThe most promising approach by far was to map arbitrary XML structures onto congruent complex data types of Arden Syntax through deserialization. This approach is generic insofar as a data mapper based on this approach can transform any patient data provided in appropriate XML format. Therefore it could help overcome a major obstacle for integrating clinical decision support functions into clinical information systems. Theoretically, the deserialization approach would even allow mapping entire patient records onto Arden Syntax objects in one single step. We recommend extending the Arden Syntax specification with an appropriate XML data format.     

视黄醇结合蛋白4评价冠状动脉病变严重程度的研究

目的 探究视黄醇结合蛋白4(retinol binding protein 4,RBP4)评价冠心病(coronary heart disease,CHD)患者冠状动脉病变的严重程度.方法 选取2018年12月至2019年8月于中国医科大学附属盛京医院行冠状动脉造影的患者202例,根据冠状动脉造影结果将患者分为冠心病组(159例)及正常组(43例);其中,根据诊断将冠心病组分为急性ST段抬高型心肌梗死组(36例)、急性非ST段抬高型心肌梗死组(35例)和心绞痛组(88例).采用SYNTAX评分评估冠状动脉病变的严重程度,并收集患者血液样本,检测血清RBP4水平,分析比较各组SYNTAX评分与RBP4水平的相关性.用Pearson相关分析方法分析RBP4水平与SYNTAX评分的相关性;应用ROC曲线评估RBP4水平预测重度冠状动脉病变的最佳切点.结果 冠心病组RBP4水平显著高于正常组[(42.51±19.00)ng/ml比(36.44±11.13)ng/ml],差异具有统计学意义(P<0.05);其中,急性ST段抬高型心肌梗死组、急性非ST段抬高型心肌梗死组RBP4水平显著高于正常组[(47.82±29.98)ng/ml、(44.82±15.23)ng/ml比(36.44±11.13)ng/ml],差异具有统计学意义(P<0.05);心绞痛组[(39.42±21.43)ng/ml]与正常组[(36.44±11.13)ng/ml]之间差异无统计学意义(P>0.05);急性ST段抬高型心肌梗死组RBP4水平显著高于心绞痛组[(47.82±29.98)ng/ml比(39.42±21.43)ng/ml](P<0.05);冠心病组患者RBP4水平与SYNTAX评分呈正相关(r=0.412,P<0.001).ROC曲线分析结果提示,RBP4预测重度冠状动脉病变的最佳切点是33.37ng/ml,敏感度为0.76,特异度为0.49.结论 冠心病患者RBP4水平较正常人显著升高,RBP4与冠状动脉病变严重程度呈正相关,当RBP4>33.37ng/ml,可能存在重度冠状动脉病变风险.     

Value of syntax score II for predicting in-hospital and long-term survival in octogenarians with ST-segment elevation myocardial infarction: A comparison of six different risk scores

BackgroundThe aim of this study was to evaluate the usefulness of the Syntax Score II (SSII) in predicting in-hospital and long-term mortality in octogenarians who presented with ST-segment elevation myocardial infarction (STEMI) and were treated with primary percutaneous coronary intervention (pPCI) in addition to compare SS II with other risk-scoring systems.MethodsWe retrospectively enrolled 312 consecutive STEMI patients in the eighth decade of life or older who underwent pPCI. The octogenarians were divided into two groups according to their median SSII (low SSII ≤ 43.6 and high SSII > 43.6), and these groups were compared in terms of mortality. The performance of the SSII in predicting patients’ outcomes was further compared with that of other well-known risk-scoring systems.ResultsIn the study, the SSII was an independent predictor of long-term mortality (OR: 1.036 95% CI: 1.005–1.068; p = 0.024). Both in-hospital (20.8% vs. 1.2%; p < 0.001) and long-term mortality (45.0% vs. 11%; p < 0.001) were higher among the patients with a high SSII compared to those with a low SSII. An ROC curve comparison showed that SSII was a better predictor (AUC: 0.807; 95% CI: 0.750-0.863) of long-term mortality than SS, PAMI, TIMI, and GRACE risk scores but not CADILLAC.ConclusionsBased on the study findings, octogenarians with a high SSII had worse in-hospital and long-term survival. The SSII, which includes several clinical and anatomical parameters, may be a better predictor of mortality than other risk-scoring systems in octogenarians.