宣肺豁痰法治疗哮喘（冷哮证）的临床研究

目的：探讨宣肺豁痰法治疗冷哮证的临床效果及其改善肺功能的机制。方法：将125例冷哮证患者随机分为实验组和对照组，实验组（宣肺豁痰法，74例）采用三拗汤和华盖散加减治疗，对照组（51例）采用小青龙汤治疗。用药治疗7天后停药，比较两组拜药后的症状、体征、改善时间及疗效。结果：实验组在哮喘主要症状和体征（除咳嗽外）的控制率明显优于对照组，且这种差异在磋疗的早期即已体现并持续至治疗结束；实验组的起效日寸间明显短于对照组；治疗后随着两组患者临床症状的改善，气道高反应的状态多数得以纠正，治疗后丽组PEF均有显著增加，差异有显著性（P〈0．05），与对照组相比较，实验组在缓解气道痉挛、改善大气道∥能方面有明显优势。治疗后EOS绝对计数及百分比明显下降，实验组下降更显著（P〈0．05）。结论：宣肺豁痰法治疗冷哮证在扩张小气道、缓解其痉挛、消除痰栓、减轻其陶塞等方面较对照组有明显优势。     

子痫前期并可逆性后部白质脑病综合征分析

目的:探讨子痫前期并可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)的临床表现、影像学特点,以便早诊断、早治疗,获得良好的预后。方法:回顾性分析57例病例报道及同仁医院发生的1例子痫前期并可逆性后部白质脑病综合征。结果:产前46例,产后9例,3例发生时间不详。58例均有高血压、蛋白尿伴头痛、视物不清、进而皮质盲。58例中30人行头颅CT检查,2l例未发现异常,7例表现为局灶性低密度改变,以双侧枕部多见,2例表现为病灶广泛、弥漫性水肿。19例行头颅MRI,5例未发现异常,12例提示后部脑白质血管源性水肿。积极治疗、及时终止妊娠视力完全恢复47例,2例视力未恢复,8例未报结局,1例入院后未及时终止妊娠19 h死于脑出血。结论:高血压、蛋白尿伴头痛、皮质盲是子痫前期伴RPLS常见的临床表现,其特点是可逆性大脑皮质性视觉障碍,MRI是诊断的首选方法;早期诊断,及时终止妊娠,合理治疗,预后良好。     

Simulated learning activities as part replacement of clinical placements in osteopathy: A case study

Simulation has played an important role in health professional education for over 50 years but is relatively new to osteopathy. Simulation provides an opportunity to control some of the variables in clinical education such as adequate patient numbers and case mix exposure and provide a meaningful contribution to the students' clinical education. Simulation learning (SL) is a process where the learner practices a procedure or routine in a simulated learning environment. SL has recently been investigated as a valid part replacement of traditional clinical placements in physiotherapy. This case study endeavours to provide osteopathy educators with a framework to develop, implement and evaluate simulated learning in osteopathic education.This case study outlines simulated learning activities that part replaced clinical placements in osteopathy education and provides an overview of costs and resources required. Student feedback obtained throughout the project suggests structured simulated learning activities may build critical practice skills and be used as an acceptable clinical learning tool.     

Recurrent neural networks with specialized word embeddings for health-domain named-entity recognition

BackgroundPrevious state-of-the-art systems on Drug Name Recognition (DNR) and Clinical Concept Extraction (CCE) have focused on a combination of text “feature engineering” and conventional machine learning algorithms such as conditional random fields and support vector machines. However, developing good features is inherently heavily time-consuming. Conversely, more modern machine learning approaches such as recurrent neural networks (RNNs) have proved capable of automatically learning effective features from either random assignments or automated word “embeddings”.Objectives(i) To create a highly accurate DNR and CCE system that avoids conventional, time-consuming feature engineering. (ii) To create richer, more specialized word embeddings by using health domain datasets such as MIMIC-III. (iii) To evaluate our systems over three contemporary datasets.MethodsTwo deep learning methods, namely the Bidirectional LSTM and the Bidirectional LSTM-CRF, are evaluated. A CRF model is set as the baseline to compare the deep learning systems to a traditional machine learning approach. The same features are used for all the models.ResultsWe have obtained the best results with the Bidirectional LSTM-CRF model, which has outperformed all previously proposed systems. The specialized embeddings have helped to cover unusual words in DrugBank and MedLine, but not in the i2b2/VA dataset.ConclusionsWe present a state-of-the-art system for DNR and CCE. Automated word embeddings has allowed us to avoid costly feature engineering and achieve higher accuracy. Nevertheless, the embeddings need to be retrained over datasets that are adequate for the domain, in order to adequately cover the domain-specific vocabulary.     

新鲜周期单囊胚移植314例临床结局

目的 探讨新鲜周期单囊胚移植(single blastocyst transfer,SBT)的可行性。方法 回顾性分析314个新鲜周期行SBT患者的临床资料,从年龄、囊胚分级等方面比较分析临床结局。结果 妊娠组患者的年龄显著低于未妊娠组(P0.001);选择性SBT(elective SBT,eSBT)组的临床妊娠率显著高于非选择性SBT(non-elective SBT,non-eSBT)组(P0.05);年龄≤35岁的患者,eSBT组的临床妊娠率与双囊胚移植(double blastocyst transfer,DBT)组无统计学差异,但多胎妊娠率显著降低(P0.001);而35岁的患者,eSBT组的临床妊娠率低于DBT组(P0.05),组间的多胎妊娠率无统计学差异(P0.05);囊胚扩张和孵化的程度与临床妊娠率显著相关,优质囊胚可获得更好的妊娠结局。结论 妊娠结局与囊胚的质量及患者的年龄显著相关,对于年龄≤35岁,有优质囊胚的患者,可以进行SBT。     

漂浮导管技术在急性心衰患者中的临床应用

目的探讨漂浮导管技术应用于急性心功能衰竭患者的临床效果、指导意义。方法 2007年5月～2010年12月入住我科ICU的75例急性心衰患者中35例患者在漂浮导管监测下给予常规心衰治疗,另40例患者未予漂浮导管监测下给予经验性常规心衰治疗,比较两组患者治疗前后的病情缓解时间。结果 35例在漂浮导管监测指导下治疗的患者较未予漂浮导管监测治疗的患者病情缓解时间短、心衰并发症发生率低（P〈0.05）。结论漂浮导管技术对于血流动力学不稳定的急性心力衰竭患者的临床治疗有重要的指导价值。     

网络培训对提高重症监护病房护士临床思维能力及专科理论水平的效果观察

目的观察网络培训对提高重症监护病房护士临床思维能力及专科理论水平的效果。方法采用配对设计,将重症监护病房护士40人分为观察组和对照组各20人,对照组采用传统方法培训,观察组采用网络培训,培训时间持续6月。比较两组的理论测试成绩及加利福尼亚批判性思维倾向问卷得分。结果理论测试成绩观察组为(76.62+6.39)分、对照组为(69.33+5.12)分,两组比较,t=3.98,P=0.038;加利福尼亚批判性思维倾向问卷各思维特质得分组内培训前后比较,观察组有统计学意义,对照组无统计学意义。结论网络培训能提高重症监护病房护士临床思维能力及专科理论水平。     

Comparison of Observational and Controlled Clinical Trials of Diltiazem in the Treatment of Chronic Anal Fissure

Diltiazem has been extensively studied in the treatment of chronic anal fissures, but efficacy in clinical practice is not fully established. The aim of the present study was to evaluate the safety and efficacy of topical application diltiazem in observational studies as well as in controlled clinical trials in the treatment of chronic anal fissures. A systematic literature search was carried out from 1966 to 31 December, 2007 on PubMed, Medline, Embase and Cochrane database, using the appropriate search words. We found six observational studies with 392 patients and five controlled clinical trials with 289 patients in which topical diltiazem treatment was given. Efficacy was found to be very high in observational studies (56.88%), whereas it was found to be modest in controlled clinical trials (29.41%). In observational studies, most of the patients reported complete healing of fissures within 6–12 weeks, whereas in controlled trials healing was reported within 8 weeks, with tolerable adverse effects of diltiazem. On the basis of the above studies, it can be concluded that topical application of diltiazem is useful in the treatment of chronic anal fissure, but to fully establish its efficacy, larger prospective double-blind study is required in the near future.     

PPH治疗出血性内痔128例临床观察

为探讨吻合器痔上黏膜环切术（PPH）治疗出皿性内痔的町行性，对128例出血性内痔行PPH。结果显示，128例患者手术顺利，手术时间30～45min，平均35min．住院时间4～7d．术后48h无疼痛，术后未见肛门有明显的出血；5例术后出现直肠刺激症状，肛门见异常。结果表明，PPH治疗出血性内痔疗效确切．并发症少，恢复快，值得临床推广。