Brunnstrom分级取穴治疗脑卒中后偏瘫的临床观察

目的:观察Brunnstrom分级取穴对脑卒中肢体偏瘫运动功能和ADL的影响。方法:将95例脑卒中患者随机分为观察组48例和对照组47例,观察组按Brunnstrom分级取穴,对照组采用传统方法取穴,两组均进行常规神经内科处理,并Bobath技术为主的康复训练;并对两组采用简式Fugl-Meye运动功能评测(FMA)和Barthel指数在治疗前、治疗后1个月、3个月进行量化评定;结果:治疗1、3个月后两组FMA评分、Barthel指数与治疗前比较均有提高,治疗1个月后观察组FMA评分和Barthel指数评分优于对照组(P<0.05),治疗3个月后观察组FMA评分和Barthel指数评分明显优于对照组(P<0.01),结论:按照Brunnstrom分级取穴可以明显改善偏瘫肢体的运动功能,提高ADL能力。     

A Hybrid Grey Wolf Optimizer for Process Planning Optimization with Precedence Constraints

Process planning optimization is a well-known NP-hard combinatorial problem extensively studied in the scientific community. Its main components include operation sequencing, selection of manufacturing resources and determination of appropriate setup plans. These problems require metaheuristic-based approaches in order to be effectively and efficiently solved. Therefore, to optimize the complex process planning problem, a novel hybrid grey wolf optimizer (HGWO) is proposed. The traditional grey wolf optimizer (GWO) is improved by employing genetic strategies such as selection, crossover and mutation which enhance global search abilities and convergence of the traditional GWO. Precedence relationships among machining operations are taken into account and precedence constraints are modeled using operation precedence graphs and adjacency matrices. Constraint handling heuristic procedure is adopted to move infeasible solutions to a feasible domain. Minimization of the total weighted machining cost of a process plan is adopted as the objective and three experimental studies that consider three different prismatic parts are conducted. Comparative analysis of the obtained cost values, as well as the convergence analysis, are performed and the HGWO approach demonstrated effectiveness and flexibility in finding optimal and near-optimal process plans. On the other side, comparative analysis of computational times and execution times of certain MATLAB functions showed that the HGWO have good time efficiency but limited since it requires more time compared to considered hybrid and traditional algorithms. Potential directions to improving efficiency and performances of the proposed approach are given in conclusions.     

Current trends in candidate selection,contraindications, and indications for lung transplantation

Lung transplantation is an established treatment option that can improve quality of life and prolong survival for select patients diagnosed with end-stage lung disease. Given the gaps in organ donation and failures to make effective use of available organs, careful selection of candidates for lung transplant remains one of the most important considerations of the transplant community. Toward this end, we briefly reviewed recent trends in pretransplant evaluation, candidate selection, organ allocation, and organ preservation techniques. Since the latest consensus statement regarding appropriate selection of lung transplant candidates, many advances in the science and practice of lung transplantation have emerged and influenced our perspective of ‘contraindications’ to transplant. These advances have made it increasingly possible to pursue lung transplant in patients with risk factors for decreased survival—namely, older recipient age, increased body mass index, previous chest surgery, poorer nutritional status, and presence of chronic infection, cardiovascular disease, or extrapulmonary comorbid conditions. Therefore, we reviewed the updated evidence demonstrating the prognostic impact of these risk factors in lung transplant recipients. Lastly, we reviewed the salient evidence for current trends in disease-specific indications for lung transplantation, such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, emphysema due to alpha-1 antitrypsin deficiency, and pulmonary arterial hypertension, among other less common end-stage diseases. Overall, lung transplant remains an exciting field with considerable hope for patients as they experience remarkable improvements in quality of life and survival in the modern era.     

腹针治疗周围性面瘫选穴规律研究

目的 研究腹针治疗周围性面瘫的选穴规律。方法 通过计算机及手工检索,选取近15年有关腹针治疗周围性面瘫的相关文献,以临床研究、疗效观察、现代对比实验研究为依据,进行分析归纳,探讨腹针的选穴规律。结果 腹针治疗周围性面瘫主要取任脉、肾经、胃经及脾经上的穴位及腹部新穴,使用频率依次为55.70%、15.44%、14.09%、2.68%、12.08%;腹针治疗周围性面瘫选用的标志性穴位组合规律:主要有引气归元、腹四关、天地针、调脾气,其使用频率依次为48.48%、27.27%、12.12%、12.12%。结论 合理运用腹针,遵循其选穴规律,可有效治疗周围性面瘫。     

Addition of alfa fetoprotein to traditional criteria for hepatocellular carcinoma improves selection accuracy in liver transplantation

Objectives: Liver transplantation in hepatocellular cancer (HCC) is curative only for a selection of patients. Commonly used criteria are mostly based on tumor size and number. However, patients within criteria do have tumor recurrences after transplantation and patients outside criteria are excluded even though some could benefit from transplantation. The tumor marker alpha fetoprotein (AFP) is associated with poor outcome and has already been reported to improve selection. We investigated the hypothesis that AFP level combined with traditional selection criteria could ameliorate the selection accuracy for liver transplantation in HCC.

Materials and methods: A retrospective national cohort study in 336 patients who had liver transplantation for HCC in Sweden 1996–2014.

Results: AFP cut-off levels of 20, 100, 1000 and >1000?ng/mL stratified both survival and tumor recurrence, with estimated 5-year survival rates of 74, 61, 49 and 31%, respectively. A simple score, combining three risk levels according to Milan and UCSF fulfillment with three levels of AFP, increased predictive accuracy. A high score identified 35 at-risk patients with estimated post-transplant 5-year survival rate of only 29% compared to 50% for 76 patients excluded by UCSF. More patients were within the combined score cut-off compared to within UCSF, but 5-year survival was similar, 67% versus 66%.

Conclusion: AFP combined with traditional selection criteria ameliorates the selection accuracy for liver transplantation in HCC.     

基于数据挖掘的脑白质疏松症相关因素分析

目的 利用数据挖掘技术分析脑白质疏松症相关因素。      

基于项目反应理论的儿童睡眠问卷项目分析

目的　采用项目反应理论对儿童睡眠问卷进行项目分析,评价儿童睡眠问卷在国内的适用性。方法　2015年5—7月采用多阶段分层整群随机抽样方法,随机抽取了北京市西城、朝阳、昌平、顺义、房山、怀柔和门头沟共7个区县的25所幼儿园和中小学学校,共计11 420例儿童。采用儿童睡眠问卷调查其睡眠情况,该问卷主要包含与儿童睡眠呼吸障碍相关的4个维度,即呼吸、睡眠、行为、其他。统计分析采用基于二参数Logistic模型的项目反应理论,计算各条目的区分度和难度参数,并绘制项目反应特征曲线。结果　大多数条目具有较好的区分度,但“睡觉偶尔尿床”和“是否超重”的区分度明显低于其他条目（区分度参数估计值分别为0.441和0.124）,且难度参数均较大（分别为4.378和6.172）。测验信息量结果提示删除这两个条目后,问卷提供的信息量几乎没有变化。结论　儿童睡眠问卷在评价儿童睡眠障碍中可以提供较好的初筛效果,但国内应用可以考虑对其进行简化。     

Thalamic afferents to prefrontal cortices from ventral motor nuclei in decision‐making

The focus of this literature review is on the three interacting brain areas that participate in decision‐making: basal ganglia, ventral motor thalamic nuclei, and medial prefrontal cortex, with an emphasis on the participation of the ventromedial and ventral anterior motor thalamic nuclei in prefrontal cortical function. Apart from a defining input from the mediodorsal thalamus, the prefrontal cortex receives inputs from ventral motor thalamic nuclei that combine to mediate typical prefrontal functions such as associative learning, action selection, and decision‐making. Motor, somatosensory and medial prefrontal cortices are mainly contacted in layer 1 by the ventral motor thalamic nuclei and in layer 3 by thalamocortical input from mediodorsal thalamus. We will review anatomical, electrophysiological, and behavioral evidence for the proposed participation of ventral motor thalamic nuclei and medial prefrontal cortex in rat and mouse motor decision‐making.     

血站质量管理体系不合格项回顾性分析

目的验证质量管理体系对不合格项管理的有效性。方法通过回顾性分析2015年-2017年不合格项的分布情况,评价质量管理体系是否持续改进。结果2015年-2017年不合格项分别有28项、31项、37项,均为一般不合格 项,后续全部落实了纠正预防措施。不合格项主要分布在体采科（市区）及郊区县采血点、计供科,主要涉及要素是献血服务、血液保存、发放与运输及记录。结论日常工作中识别的不合格项及质管科识别的不合格项逐年增 多,说明工作人员质量意识逐年增强,这有利于质量管理体系的持续改进,也有利于血站质量管理水平的逐步提高。