The comparison of Nail Psoriasis Severity Index with a less time-consuming qualitative system

Objective Reliable assessment of severity in nail psoriasis is essential to document treatment responses in clinical trials and routine clinical usage. In this study the correlation between Nail Psoriasis Severity Index (NAPSI) and Cannavo's scoring system was assessed, and inter‐rater correlation of NAPSI scores were evaluated. Materials and Methods Forty‐five patients with nail psoriasis were included. Target nails were selected and graded by the first dermatologist with both scoring systems. The nails were reevaluated by the second dermatologist with NAPSI. Results The two systems were highly correlated (P < 0.001). For NAPSI inter‐rater correlation was also significant (P < 0.001). Conclusion Our results showed that the qualitative and quantitative evaluations of the same rater were similar. Although the qualitative scoring system of Cannavo's is less time consuming than NAPSI, to suggest this system inter‐rater correlations should be evaluated.     

数字胸片筛查肺癌的限度分析

目的 分析数字胸片筛查肺癌的限度，评价其临床应用价值。方法 选择肺癌高危人群（大于等于50岁，吸烟史大于等于20a）387例行数字胸片及低剂量多层螺旋CT（MSCT）全肺薄层扫描检查，分析数字胸片检出中央型和周围型肺癌的敏感性、特异性，并对数字胸片漏诊病例进行分析。结果 数字胸片正确诊断2例周围型肺癌和。1例中央型肺癌，敏感性分别为33．3％、20．0％，特异性分别为99．2％、99．2％；1例周围型肺癌和3例中央型肺癌未被检出；数字胸片对早期肺癌征象检出率低，有3例周围型肺癌被误认为良性病变。结论 除结构重叠外，图像处理也影响数字胸片筛查肺癌的检出率，细致的图像后处理可以提高其应用价值。     

CT导引下电化学治疗肝癌

目的：评价CT导引下电化学治疗肝癌的临床效果。方法：在CT导引下利用电化学对67例肝癌患者进行治疗。铂金电极针精确地插入肿瘤内，阳极位于肿块中央区，阴极分布四周，针间距2．0－3．0cm。按照1cm直径肿瘤80－100C电量的治疗标准，取电压6－10V，电流60－100mA。根据肿瘤直径的大小，将67例分为3组，A组：直径≤3cm（24例）；B组，直径3-8cm(31例）；C组：直径≥8cm（12例）。分别观察3组的1、2、3年生存率。结果：肿瘤体积与疗效呈负相关。A组1、2、3年生存率分别为91．67％、87．50％、70．83％；B组分别为70．97％、48．39％、29．03％；C组分别为50．00％、25．00％、8．33％。结论：在CT导引下利用电化学治疗中，小肝癌效果显著，是1种简便、安全、有效的方法。对那些不能耐受手术又对化疗不敏感的大肝癌患者，电化学疗法仍可作为1种选择的治疗方法。     

思茅城区娱乐场所推广100％安全套使用效果评价

目的：在思茅城区娱乐场所中推广100％安全套使用，促进暗娼行为改变。方法：召开老板业主协调会，与法人业主签订项目干预活动协议书，要求娱乐场所摆放安全套，推广100％安全套使用，每月统计上报安全套发放和销售情况。结果：通过干预，暗娼对艾滋病传播知识知晓率从干预前的79．05％上升到92．07%对艾滋病预防知识知晓率从干预前的72．53％上升到91．37％；最近一个月与客人发生性关系安全套使用率从干预前的84．00％上升到100％~最近一次与固定性伴发生性关系安全套使用率从干预前的41．30％上升到67．30％。结论：在娱乐场所中开展100％安全套推广使用预防性病艾滋病，实践证明是可行的。在运作过程中，政府和公安部门的态度对此项工作的影响至关重要。     

层次分析法与Delphi法结合建立科护士长考核体系

目的 建立科护士长考核体系,以综合指数对其工作进行评价,使考核更全面、更科学.方法 以Delphi法和层次分析法相结合,由专家进行4轮咨询确定科护士长考核指标和指标间两两比较的数值;以层次分析法确定各项指标的权重,通过一致性分析(CR＜0.10),获得组合权重和综合指数.结果 建立了由护理内部质量、顾客满意度、个人职业精神、学习与成长4个一维指标和17个二维指标构成的医院科护士长考核体系.结论 在医院的护理管理中,对管理人员的工作做出客观、公平的评价是有难度的,而层次分析法就提供了一个简便、快捷的决策方法.     

C-Reactive Protein to Albumin Ratio in Patients Undergoing Transcatheter Aortic Valve Replacement

ObjectiveTo evaluate whether the serum C-reactive protein to albumin ratio (CAR) could be used for risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS).Patients and MethodsFrailty is a predictor of poor outcomes in patients undergoing AS interventions. The CAR reflects key components of frailty (systemic inflammation and nutrition) and could potentially be implemented into assessment and management strategies for patients with AS. From March 1, 2010, through February 29, 2020, 1836 patients were prospectively enrolled in an observational TAVR database. Patients (prospective development cohort, n=763) were grouped into CAR quartiles to compare the upper quartile (CAR Q4) with the lower quartiles (CAR Q1-3). Primary end point was all-cause mortality. Results were verified in an independent retrospective cohort (n=1403).ResultsThe CAR Q4 had a higher prevalence of impaired left ventricular function, atrial fibrillation, diabetes, and cerebrovascular disease and a higher median logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) vs CAR Q1-3. After median follow-up of 15.0 months, all-cause mortality was significantly higher in CAR Q4 vs CAR Q1-3 (P<.001). In multivariable analyses, risk factors for all-cause mortality were CAR Q4 (>0.1632; hazard ratio, 1.45; 95% confidence interval, 1.05 to 2.00; P=.03), N-terminal pro–B-type natriuretic peptide Q4 (>3230 pg/mL [to convert to ng/L, multiply by 1), high-sensitivity troponin T Q4 (>0.0395 ng/mL [to convert to μg/L, multiply by 1]), above-median logistic EuroSCORE (16.1%), myocardial infarction, Acute Kidney Injury Network stage 3, and life-threatening bleeding.ConclusionElevated CAR was associated with increased risk of all-cause mortality in patients undergoing transfemoral TAVR. The CAR, a simple, objective tool to assess frailty, could be incorporated into assessing patients with AS being considered for TAVR.     

Extremely Elevated Erythrocyte Sedimentation Rates: Associations With Patients' Diagnoses,Demographic Characteristics,and Comorbidities

Objective

To study associations between extreme erythrocyte sedimentation rate (ESR) elevations (≥100 mm/h) and diseases, age, sex, race, Charlson Comorbidity Index (CCI), and C-reactive protein (CRP) level.

电子束CT双期增强对肺门区肺癌可切除性的评估

目的采用电子束CT(EBCT)双期增强扫描,对肺门区肺癌进行术前前瞻性评价,探讨其指导手术的临床价值。方法对40例拟诊为肺门区肺癌的患者行EBCT双期增强扫描后分析肿物与气管、主支气管、及肺门、纵隔大血管的关系,与手术结果进行对照。结果手术病理证实肺门区肺癌38例,术前根据EBCT扫描将病变分为:可切除组28例,与手术结果符合25例,符合率89.3%;不可切除组10例,与手术探查结果符合8例,符合率80%。EBCT双期扫描评价肺门区肺癌与肺门、纵隔结构关系的敏感度为92.6%(25/27),特异度为72.7%(8/11),准确度86.8%(33/38)。结论EBCT双期扫描对肺门区肺癌的术前评价是准确而可行的,具有较高的临床价值。     

手法治疗椎动脉型颈椎病的TCD和BAEP观察

目的 观察手法治疗椎动脉型颈椎病的经颅多普勒超声（TCD）和脑干听觉诱发电位（BAEP）变化，从血流速度及神经电生理角度探讨手法治疗的作用机理。方法 将60例椎动脉型颈椎病患者分为手法治疗组30例和常规治疗组30例，治疗前及治疗2周后检查TCD和BAEP，观察手法治疗对椎动脉型颈椎病患者血流速度及脑电生理的影响。结果 （1）2组治疗后总有效率分别为96．6％和90％，其中手法组临床治愈率为46．6％，常规组临床治愈率为33．3％，2组间疗效及平均治疗时间无统计学差异。（2）治疗前疾病组椎基底动脉（VBA）流速明显低于对照组（P＜0．05）。TCD异常率为76．7％（46／60例），以VBA流速降低为主要特点。BAEP异常率为80％（48／60例），以脑干型异常为主。（3）治疗后2组VBA血流速度均有改善，手法治疗组比常规治疗组椎动脉流速改善更显著（P＜0．05）。治疗后2组神经传导功能均有改善，与常规治疗组相比，手法治疗组V波PL，Ⅲ-Ⅴ和Ⅰ-ⅤIPL改善更显著（P＜0．05）。结论 手法治疗可改善椎动脉型颈椎病椎基循环的血流速度及脑干神经传导功能。     

Correlation of Body Composition and Low Back Pain Severity in a Cross-Section of US Veterans

Objective

Back pain is more prevalent in the obese, but whether back pain severity is directly correlated to obesity in veterans is unknown. We sought to determine if there was a correlation between body composition and low back pain severity in a sample of veterans. The hypothesis was that veterans with higher body mass index values would report higher low back pain severity scores.