不同年级和类别军医大学生学习自控能力的比较

目的比较不同年级和类别的军医大学生学习自控能力。方法使用自制量表,比较某军医大学所有在校学员不同年级和类别之间的学习自控能力。结果不同年级、类别军医大学生自评的学习自控能力没有差异(χ2=11.673,26.5933,P均0.05)。不同年级、类别学员在对自己最佳学习状况的清楚程度(χ2=29.304,32.242,32.770,P均0.01)和学习自主性方面(χ2=19.357,19.883,54.844,52.604,56.909,25.534,P均0.05)均有不同。结论年级越高,学员对自己最佳学习时间越清楚,但学习自主性却下降;无军籍学员最清楚自己最佳学习状态,学习自主性最好。     

Prevalence of Various Orofacial Pain Symptoms and Their Overall Impact on Quality of Life in a Tertiary Care Hospital in India

Background

Pain is a major public health problem and is the most commonly reported symptom of oral and dental disease that has a significant impact on both individual and community. The present study was prevalence of various orofacial pain symptoms and their overall impact on the quality of life in a tertiary care hospital.

Materials and Methods

This study was carried out in the outpatient department of the Government Dental College and Research Institute, Bangalore. The severity of the chronic orofacial pain symptoms was assessed using the Chronic Pain Grade Questionnaire by Von Korff.

Results

The results showed that toothache (57.6 %) was the most commonly reported symptom and burning mouth sensation (6.4 %) was the least commonly reported. Majority of the patients had grade 3 level of pain-related disability (34.8 %) followed by grade 2 (26.8 %), grade 1 (22.4 %) and grade 4 levels (16 %). The mean pain intensity was reported to be more among females and maximum among patients with facial pain.

Conclusion

The present study demonstrated that orofacial pain symptoms have a significant impact on the patients suffering from it. Therefore, proper measures should be taken for the management of the patients with these symptoms and associated conditions.     

北京三级甲等医院新护士心理健康状况与工作压力源调查

目的探讨新护士工作压力源与心理健康状况的相关性,为护理管理措施的制定提供相关依据。方法采用问卷调查法,对北京市3家三级甲等医院155名工作不满1年新护士,采用护士工作压力源量表和症状自评量表（SCL-90）进行测评,对其结果进行相关性分析。结果新护士的心理健康总分（53．03±46．33）与常模总分（129．96±38．76）比较,差异无统计学意义（t=1．631,P〉0．05）。在临床新护士工作压力源项目方面,工作量及时间分配问题得分最高为（2．71±0．71）分,其次是护理专业及工作方面的问题,得分为（2．51±0．61）。新护士工作压力源各个因子与心理健康状态（即SCL-90总分）呈正相关（P〈0．01）;新护士值夜班与压力源呈正相关。新护士倒夜班数与工作量和护理专业方面带来的压力之间差异有统计学意义（P〈0．05）,其余各项均无明显差异。不同科室护士在“工作量”“工作环境”及“管理及人际关系”等压力源及压力源总分方面比较,差异有统计学意义（F值分别为3．06,0．7254,2．920,2．920;P〈0．01）。结论工作方面的压力对新护士的心理健康状况有着重要的影响作用,管理者应积极采取相应的措施,减轻新护士的工作压力,同时关注新护士的心理需求,使其保持健康的心理状态。     

Pancreatic neuroendocrine tumors: A single-center 20-year experience with 100 patients

Background/ObjectivesPancreatic neuroendocrine neoplasms (NENs) are rare tumors, exhibiting several morphological, functional, and behavioral characteristics. However, only few reports have evaluated large case series of pancreatic NEN.MethodsWe conducted a retrospective review of 100 consecutive patients with pancreatic NEN diagnosed pathologically and treated at the National Cancer Center Hospital between 1991 and 2010.ResultsThe study included 48 males and 52 females (median age: 55 years). Fourteen patients had clinical symptoms caused by excess hormone secretion at diagnosis. Twelve patients were diagnosed with neuroendocrine tumor (NET) G1, 54 with NET G2, and 32 with neuroendocrine carcinoma (NEC) as per the 2010 World Health Organization classification. Distant metastases were observed in 25%, 43%, and 84% of the patients with NET G1, NET G2, and NEC, respectively. Serum levels of neuron-specific enolase and lactate dehydrogenase significantly increased in patients with NEC compared with those in patients with NET G1/G2. The 5-year survival rates of patients with NET G1, NET G2, and NEC were 91%, 69%, and 10%, respectively. Good performance status (PS), lower stage, and histopathological grade were identified as independent favorable prognostic factors.ConclusionsPatients with NET G1/G2 treated with surgical resection had a good prognosis. Most patients with NEC exhibited distant metastases and had a poor prognosis. Staging classification and the WHO 2010 grading are important factors for selecting the appropriate treatment strategy and predicting prognosis for patients with pancreatic NEN.     

纹理分析T1WI对比增强图像分级脑胶质瘤

目的探讨纹理分析T1WI对比增强图像在分级脑胶质瘤中的价值。 方法回顾性分析2014年10月至2019年10月在扬州大学附属医院,经手术病理证实的29例低级别胶质瘤(LGG)和63例高级别胶质瘤(HGG),使用MaZda软件提取T1WI对比增强(CE-T1WI)肿瘤纹理特征并分析比较两组间9个直方图参数,包括平均值(mean)、变异度(variance)、偏度(skewness)、峰度(kurtosis)和第1、10、50、90、99百分位数(Pere.1%、Pere.10%、Pere.50%、Pere.90%、Pere.99%),采用多变量Logistic回归对有统计意义的参数进行建模并绘制受试者工作特征曲线(ROC)曲线评价在两组间差异有统计学意义的参数及多变量Logistic回归模型鉴别两者的效能。 结果LGG组的3个参数(kurtosis,pere.1%,pere.10%)高于HGG组(P均<0.05),4个参数(mean,variance,pere.90,pere.99%)低于HGG组(P均<0.05),而skewness、pere.50%这2个参数在两组间无明显差异(P均>0.05);在两组间差异有统计学意义的7个参数中,variance鉴别两者的效能最佳,灵敏度、特异度及AUC分别为79.4%、86.2%、0.878,7个参数建立的多变量Logistic回归模型的效能优于所有参数,灵敏度、特异度及AUC分别为87.3%、79.3%、0.882。 结论基于CE-T1WI的直方图参数可有效鉴别LGG与HGG,而以两组间差异有统计学意义直方图参数建立的多变量Logistic回归模型诊断效能更佳。     

从等级医院评审看医疗质量规范化管理

目的探讨等级医院评审对提升医疗质量规范化管理的作用。方法以开展等级医院评审工作期间的数据和经验为依托,对照等级医院评审前后医院发生的变化,分析评审工作对医院及医疗质量规范化管理带来的影响。结果开展等级医院评审工作以后,医院的整体状况得到极大改观,医疗质量得到明显提升。结论等级医院评审是提升医院管理水平、规范各项医疗活动、保障患者安全、减少医疗隐患和纠纷的较好手段,适合我国国情,值得推广。     

脓毒症急性胃肠损伤评估的研究进展

近年来,胃肠道作为脓毒症病理生理过程中最早和最严重受累的器官之一,其重要性逐渐被人们认识。早期、客观、及时、准确的评估脓毒症患者的急性胃肠损伤程度,及早进行干预,可减轻由其诱发的失控性炎性反应,改善脓毒症患者的预后。目前,临床上对脓毒症急性胃肠损伤仍缺乏特异性的诊断指标或体系。为此,作者总结了近几年脓毒症急性胃肠损伤的评分及分级系统、血清生物学标志物的研究进展,为脓毒症急性胃肠损伤的早期诊断及治疗提供一定的参考依据。     

湖北省"三甲医院"和"二甲医院"创伤住院患者分析

目的 对湖北省不同级别医院间创伤患者住院情况进行调查,为不同级别医院有重点地预防和干预创伤提供参考依据.方法 收集湖北省 5 所不同级别医院 2003 年创伤住院患者临床资料,对 5 所医院患者数量、性别、年龄段、伤者职业、致伤原因、Glasgow 昏迷评分(GCS)、损伤严重度评分(ISS)、手术及疾病结局的构成进行统计.结果 三甲医院收治患者数多于二级医院,性别以男性为主.三甲教学医院患者主要以无业人员、工人、其他职业为主,普通三甲医院及二级医院中农民亦占较高比例(30.40%～41.40%).患者致伤原因均以机动车撞伤为主,暴力及摔跌亦为主要致伤因素.三甲医院手术率、GCS 评分 3～8 分(昏迷)组比例、ISS 评分 16～25 分(重伤)组及≥25 分(严重伤)组比例均高于二级医院,且三甲教学医院以上比例高于普通三甲医院.治疗效果在不同级别医院间无明显差异.结论 不同医院间应根据收治患者特点采取有效预防和干预创伤发生的措施.     

Prospective validation of the Parkland Grading Scale for Cholecystitis

Background

The Parkland Grading Scale for Cholecystitis (PGS) was developed as an intraoperative grading scale to stratify gallbladder (GB) disease severity during laparoscopic cholecystectomy (LC). We aimed to prospectively validate this scale as a measure of LC outcomes.

Psoas Major Swelling Grade Affects the Clinical Outcomes after OLIF: A Retrospective Study of 89 Patients

Objects

Oblique lumbar interbody fusion (OLIF) has gained increasing popularity recently. However, complications resulting from intraoperative retraction of psoas major (PM) sometimes occur. The aim of this study is to evaluate the degree of PM swelling by developing a scoring system called the Psoas Major Swelling Grade (PMSG), and to investigate the correlation between the PMSG and clinical outcomes after OLIF.

Methods

Patients who underwent L4-5 OLIF at our hospital from May 2019 to May 2021 were reviewed and all data were recorded. The extent of postoperative PM swelling was determined by calculating the percentage of change in the PM area before and after surgery on MRI and divided into three grades subsequently. Swelling within the range of 0% to 25% was defined as grade I, 25%–50% was grade II, and more than 50% was grade III. All patients were grouped into the new grade system and followed up for at least 1 year, during which the visual analog scale (VAS) and Oswestry disability index (ODI) scores were recorded. Categorical data were analyzed using chi-square and Fisher's exact tests, while continuous variables were assessed with one-way ANOVA and paired t-tests.

Results

Eighty-nine consecutive patients were enrolled in this study, with a mean follow-up duration of 16.9 months. The proportion of female patients in the PMSG I, II, and III groups was 57.1%, 58.3%, and 84.1%, respectively (p = 0.024).  Furthermore, the total complication rate was 43.2% in the PMSG III group, significantly higher than 9.5% and 20.8% in the PMSG I and II groups (p = 0.012). The incidence of thigh paraesthesia was also considerably higher in the PMSG III group at 34.1% (p = 0.015), compared to 9.5% and 8.3% in the PMSG I and II groups. Among the patients, 12.4% exhibited a teardrop-shaped PM, with the majority (90.9%) belonging to the PMSG III group (p = 0.012). Additionally, the PMSG III group demonstrated a higher estimated blood loss (p = 0.007) and significantly worse clinical scores at the 1-week follow-up assessment (p < 0.001).

Conclusion

PM swelling adversely affects the OLIF prognosis. Female patients with teardrop-shaped PM are more likely to develop swelling after OLIF. A higher PMSG is associated with a higher complication rate of thigh pain or numbness and worse short-term clinical outcomes.