Fuzzy rules to predict degree of malignancy in brain glioma

The current pre-operative assessment of the degree of malignancy in brain glioma is based on magnetic resonance imaging (MRI) findings and clinical data. 280 cases were studied, of which 111 were high-grade malignancies and 169 were low-grade, so that regular and interpretable patterns of the relationships between glioma MRI features and the degree of malignancy could be acquired. However, as uncertainties in the data and missing values existed, a fuzzy rule extraction algorithm based on a fuzzy min-max neural network (FMMNN) was used. The performance of a multi-layer perceptron network (MLP) trained with the error back-propagation algorithm (BP), the decision tree algorithm ID3, nearest neighbour and the original fuzzy min-max neural network were also evaluated. The results showed that two fuzzy decision rules on only six features achieved an accuracy of 84.6% (89.9% for low-grade and 76.6% for high-grade cases). Investigations with the proposed algorithm revealed that age, mass effect, oedema, post-contrast enhancement, blood supply, calcification, haemorrhage and the signal intensity of the T1-weighted image were important diagnostic factors.     

1例用药错误事件的分析与改进

采用根本原因分析及行动法对1例儿科用药错误事件进行分析,确定根本原因,从人员、环境、制度等方面提出针对性改进措施。采取措施后,类似不良事件未再发生。建议医疗机构加强关键环节的有效沟通,鼓励患者参与医疗安全管理,营造病区安静环境,严格执行查对制度,正确识别患者身份,优化护理人力资源配置,以保证患者用药安全。     

糖尿病患者药物治疗认知、态度与依从性研究

目的 了解糖尿病患者药物治疗依从性现状及其影响因素,探讨药物治疗认知、态度与依从性之间的关系,为改善药物治疗依从性提供参考。方法 采用分层抽样方法,在山东省东中西部地区选取900名纳入基本公共卫生服务的糖尿病患者进行问卷调查,对842份有效问卷进行描述性分析、χ2检验以及多因素logistic回归分析。结果 842名糖尿病患者中,52.7%的患者药物治疗依从性较好。年龄越大的患者药物治疗依从性越差（OR = 0.66,95%CI:0.46～0.94,P = 0.022;OR = 0.46,95%CI:0.30～0.71,P＜0.001）;病程5～10年的患者比小于5年的患者药物治疗依从性更好（OR = 1.43,95%CI:1.03～1.98,P = 0.034）;药物治疗认知水平越高的患者药物治疗依从性越好（OR = 2.78,95%CI:1.21～6.38,P = 0.016;OR = 2.89,95%CI:1.27～6.58,P = 0.012）;药物治疗态度较好的患者比较差的患者药物治疗依从性更好（OR = 2.58,95%CI:1.28～5.18,P = 0.008）。结论 糖尿病患者的药物治疗依从性仍有待提升;提高患者的药物治疗认知水平与治疗态度有助于提高药物治疗依从性;应加强对糖尿病患者的健康知识教育,转变患者的药物治疗态度。     

甘露醇联合吡拉西坦治疗脑出血致脑水肿的疗效及其安全性分析

目的分析甘露醇联合吡拉西坦治疗脑出血致脑水肿患者的疗效及其安全性。方法选择2019年9月-2020年5月在沈阳市第五人民医院接受治疗的脑出血致脑水肿患者118例,按随机数字表法分为观察组和对照组各59例,两组入院后均实施常规治疗,在此基础上对照组予以甘露醇治疗、观察组给予甘露醇联合吡拉西坦治疗,比较两组的疗效、药物安全性,以及治疗前和治疗20d后神经功能和神经肽Y水平。结果观察组总有效率为98.31%,高于对照组的86.44%,差异有统计学意义(P<0.05)。治疗后两组美国国立卫生研究院卒中量表评分及神经肽Y水平均较治疗前下降,且观察组较对照组更低,差异有统计学意义(P<0.05)。观察组不良反应总发生率为8.47%,高于对照组的5.08%,但差异无统计学意义(P>0.05)。结论甘露醇联合吡拉西坦治疗脑出血致脑水肿的疗效较单独应用甘露醇更好,而且能够改善患者神经功能,安全性较高,值得推广。     

Undiagnosed Depression among Hypertensive Individuals in Gaza: A Cross-sectional Survey from Palestine

BackgroundThe aim of this study was to estimate the prevalence and to determine the associated factors of undiagnosed depression amongst hypertensive patients (HTNP) at primary health care centers (PHCC) in Gaza.MethodsA cross-sectional survey was conducted including 538 HTNP as a recruitment phase of a clustered randomized controlled trial. Data were collected through face-to-face structured interview, and depression status was assessed by Beck''s Depression Inventory (BDI-II). Data were analyzed by STATA version 14 using standard complex survey analyses, accounted for unresponsiveness and clustering approach. Generalized linear regression analysis was performed to assess associations.ResultsThe prevalence of undiagnosed clinical depression was 11.6% (95% confidence interval [CI]: 8.1, 16.3). Moreover, prevalence of 15.4% (95% CI: 10.8, 21.6) was found for mild depression symptoms. We found that non-adherence to antihypertensive medications (AHTNM) (β = 0.9, 95% CI: 0.17, 1.7), having more health-care system support (β = 2.8, 95% CI: 1.6, 3.9) and number of AHTNM (β = 1.5, 95% CI: 0.6, 2.5) remain significantly positively associated with BDI-II score. On the other hand, older age (β = -0.1, 95% CI: -0.2, -0.02), having better social support (β = -6.8, 95% CI: -8.9, -4.7) and having stronger patient-doctor relationship (β = -4.1, 95% CI: -6.9, -1.2) kept significantly negative association.ConclusionThe prevalence of undiagnosed depression was about one-quarter of all cases; half of them were moderate to severe. Routine screening of depression status should be a part of the care of HTNP in PHCC.     

硒补充剂对妊娠期糖尿病患者血糖和血脂代谢及妊娠结局的影响分析

目的探讨硒补充剂对妊娠期糖尿病患者血糖、血脂代谢和妊娠结局的影响。方法将2018年7月-2019年6月盘锦市中心医院收治的45例妊娠期糖尿病患者随机分为对照组21例和硒酵母组24例。两组患者均给予健康教育、饮食指导、运动指导等常规治疗,硒酵母组在常规治疗基础上给予硒酵母片治疗。比较两组治疗前后空腹血糖、胰岛素抵抗指数、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平及妊娠结局。结果治疗后两组空腹血糖和胰岛素抵抗指数均较治疗前下降,且硒酵母组两项指标均低于对照组,差异均具有统计学意义(P<0.05)。治疗后两组孕妇总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平较治疗前下降,且硒酵母组三项指标水平低于对照组,差异均具有统计学意义(P<0.05)。治疗后硒酵母组高密度脂蛋白胆固醇水平高于治疗前,差异具有统计学意义(P<0.05)。对照组治疗前后以及两组治疗后高密度脂蛋白胆固醇水平差异均无统计学意义(P>0.05)。硒酵母组新生儿高胆红素血症发生率和新生儿住院率均低于对照组,差异均具有统计学意义(P<0.05)。两组其他不良妊娠结局差异均无统计学意义(P>0.05)。结论硒补充剂能够进一步改善妊娠期糖尿病患者的血糖和血脂代谢,同时,也能降低新生儿高胆红素血症发生率和住院率,值得推广使用。     

《2020 ACOG实践简报:孕龄≤70 d药物流产(No.225)》解读

药物流产(MA)是早孕期避孕失败的补救措施,主要药物为米非司酮和米索前列醇,二者联合使用,可使早孕期孕妇完全终止妊娠率达到90%。但是,MA导致的患者阴道流血时间长、量多,甚至阴道大流血,而需采取急诊刮宫术治疗等,尚未被彻底解决。如何安全、有效终止早孕期妊娠,保护女性生殖健康是目前国内外该领域的研究重点。美国妇产科医师学学会(ACOG)发布的《2020 ACOG实践简报:孕龄≤70 d药物流产(No.225)》对早孕期孕妇终止妊娠,具有重要指导作用。笔者拟就该简报对MA用于孕龄≤70 d孕妇的临床效果评估,MA用药方案、禁忌证、适应证,MA前咨询和检查,MA疼痛管理,MA后观察、预防性抗菌药物使用、随访管理、避孕措施9个方面基于循证医学推荐进行解读。     

C-spine clearance in poly-trauma patients: A narrative review

The incidence of cervical spine injury in patients with polytrauma is 3.7%. Early identification and management of cervical spine injuries in these patients play a crucial role in preventing secondary cervical spine and cord injuries. C-spine clearance assumes a pivotal role in reducing the morbidity and mortality associated with cervical spine injury. Despite the availability of various validated management algorithms and protocols for C-spine clearance, there are several controversies regarding C-spine clearance, such as the ideal protocol and imaging modality, clearance of obtunded patients and management of patients that lie out of the described protocols and rules. The current article aims to provide a comprehensive review of the relevant literature and address the prevalent controversies.     

基于数据挖掘的中医药治疗小儿湿疹组方用药规律研究

目的：通过应用中医传承辅助平台（V 2.5）挖掘中医药治疗小儿湿疹的组方用药规律,并对高频药物、用药模式及治疗思路进行探讨。方法：搜集国家知识基础设施数据库（CNKI）、中国学术期刊数据库（CSPD）及中文科技期刊数据库（CCD）中2000—2021年应用中医药治疗小儿湿疹的相关文献,经过筛选后建立方药数据库,运用中医传承辅助平台（V 2.5）集成的改进互信息法、关联规则Apriori算法、复杂系统熵聚类与无监督熵聚类等算法对药物频次、性味归经、用药模式、规则分析及新处方等结果进行输出,并进行网络可视化展示。结果：纳入处方200首,共涉及206味中药,高频药物包括甘草、白鲜皮、薏苡仁、茯苓、生地黄、金银花、蝉蜕、地肤子、防风、牡丹皮等,药性以寒性（52.76%）居多,药味以甘（38.89%）、苦（33.37%）、辛（21.96%）味为主,归经以胃经（1 138次）、脾经（1 088次）、肝经（1 061次）居多,并且得到药物之间的关联规则,以及新处方6个。结论：小儿湿疹用药以补虚药、利水渗湿药、清热药、清热解毒药、解表药为主,治疗以疏风清热,燥湿健脾,养血活血为主要大法,分析结果与本病诊疗指南较为吻合,可为小儿湿疹的临床治疗及新药开发提供参考。     

Validation and psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) in type 2 diabetes patients in Spain

AimsTo validate a translated and culturally adapted version of the Morisky Medication Adherence Scale for use in Spanish population, and to examine the psychometric properties of this scale in patients with type 2 diabetes mellitus in Spain.DesignThis cross-sectional study was conducted in a single university hospital in Spain. Patients diagnosed with type 2 diabetes mellitus at least 1 year before inclusion, being treated with anti-diabetic medication were included.InterventionWe used the Spanish version of the scale to measure treatment adherence.Principal measurementsthree level categorical scale is broken down into low adherence (score of <6), medium adherence (score of 6 to <8) and high adherence (score of 8). To validate the questionnaire, we measured internal consistency through Cronbach's α, confirmed construct validity through an exploratory principal component analysis and assessed test–retest reliability.Results232 patients met the inclusion criteria. The Cronbach's α coefficient was 0.40 (95% CI 0.28–0.52). The exploratory principal component analysis showed three components. The intraclass correlation coefficient was 0.718 (95% CI 0.564–0.823).Conclusionsthe Spanish version of the Morisky Medication Adherence scale showed low internal consistency, the exploratory factor analysis identified three dimensions, and the test–retest reliability was acceptable, therefore, psychometric properties of MMAS-8 are not suitable for measuring medication adherence in type 2 diabetes mellitus patients from Spain.