急救护理路径在急性心肌梗死患者抢救中的应用效果观察

【】目的：探讨急救护理路径在急性心肌梗死患者抢救中的应用效果。方法：选择2015年12月～2017年2月间到我院急诊科就诊的急性心肌梗死的患者共112例,所有患者均行经皮冠状动脉介入治疗(PCI),按照随机原则分为两组,对照组56例患者采取常规护理干预,观察组56例患者按照急救护理路径进行护理,比较两组患者抢救效果。结果：观察组患者分诊评估时间、静脉通道构建时间、进出急诊室时间、球囊扩张时间、住院时间均明显短于对照组患者(P＜0.05),急性心肌梗死复发率、再行PCI手术率、死亡率均明显低于对照组患者(P＜0.05),护理总满意度明显高于对照组患者(P＜0.05)。结论：急性心肌梗死患者抢救过程中应用急救护理路径能够有效缩短各急救环节时间,提高抢救成功率,提高患者护理满意度,建议临床推广应用。     

“养筋汤”加味联合盐酸氨基葡萄糖片治疗膝骨性关节炎28例

目的:观察"养筋汤"加味联合盐酸氨基葡萄糖片治疗膝骨性关节炎的临床疗效。方法:将56例膝骨性关节炎患者随机分为治疗组与对照组,每组28例,治疗组采用"养筋汤"加味联合盐酸氨基葡萄糖片治疗,对照组单纯口服盐酸氨基葡萄糖片。结果:治疗组疗效优秀18例,良好7例,无效3例,优良率为89.3%;对照组疗效优秀10例,良好8例,无效10例,优良率为64.3%,差异有统计学意义,P0.05。结论:"养筋汤"加味联合盐酸氨基葡萄糖片治疗膝骨性关节炎的临床效果明显,值得临床推广。     

股骨头坏死保头手术治疗的研究进展

股骨头坏死是多因素导致的病理生理过程。未经有效治疗的股骨头坏死患者中约80%在发病4年内出现股骨头塌陷。股骨头坏死的治疗方案应根据患者的病因和病程制定,早中期患者多可通过保头手术预防或延缓病情进展。保头手术主要包括髓芯减压术、植骨术、多孔钽棒置入术、截骨术、细胞因子或干细胞移植术。本文就上述治疗方法的研究进展作一综述。     

Two consecutive randomized controlled pertussis booster trials in children initially vaccinated in infancy with an acellular vaccine: The first with a five-component Tdap vaccine to 5-year olds and the second with five- or monocomponent Tdap vaccines at age 14–15 years

Prior study children from a DTaP efficacy trial were recruited at ages 5 and 15 years to randomized booster trials addressing immunogenicity and reactogenicity; 475 preschool children received mixed or separate injections of a reduced antigen vaccine (Tdap5, Sanofi Pasteur MSD) and an inactivated polio vaccine, and 230 adolescents received the same or another booster vaccine (Tdap1, SSI, Denmark).Pre-vaccination antibody concentrations against pertussis antigens were significantly higher at 15 than 5 years of age, probably due to natural boosting between the studies. Tdap5 induced comparable anti-PT concentrations at both ages, but antibody responses were significantly higher to filamentous haemagglutinin, pertactin and fimbriae 2/3 in adolescents. As expected, a higher amount of PT (Tdap1, 20 μg) induced a stronger anti-PT response than a lower amount (Tdap5, 2.5 μg).The frequency of adverse events was low and there were no serious adverse reactions. All local reactions had an early onset and a short duration. A large swelling or redness of more than half of the upper arm circumference was reported in 8/475 5-year-olds and in 6/230 15-year-olds. Children vaccinated with Tdap5 reported more moderate pain in adolescence than at preschool age, whereas itching was only reported in preschool children.Sweden introduced DTaP vaccines in 1996 after a 17-year hiatus with no general pertussis vaccination and pertussis was still endemic at the time of the studies. The frequency of adverse events was nevertheless low in both preschool children and adolescents and antibody responses were adequate. These studies document immunogenicity and reactogenicity in a trial cohort consecutively vaccinated with acellular pertussis vaccines from infancy to adolescence.The adolescent study was registered at ClinicalTrials.gov on 26 March 2009 (NCT00870350).     

Integrative modeling of multi‐platform genomic data under the framework of mediation analysis

Given the availability of genomic data, there have been emerging interests in integrating multi‐platform data. Here, we propose to model genetics (single nucleotide polymorphism (SNP)), epigenetics (DNA methylation), and gene expression data as a biological process to delineate phenotypic traits under the framework of causal mediation modeling. We propose a regression model for the joint effect of SNPs, methylation, gene expression, and their nonlinear interactions on the outcome and develop a variance component score test for any arbitrary set of regression coefficients. The test statistic under the null follows a mixture of chi‐square distributions, which can be approximated using a characteristic function inversion method or a perturbation procedure. We construct tests for candidate models determined by different combinations of SNPs, DNA methylation, gene expression, and interactions and further propose an omnibus test to accommodate different models. We then study three path‐specific effects: the direct effect of SNPs on the outcome, the effect mediated through expression, and the effect through methylation. We characterize correspondences between the three path‐specific effects and coefficients in the regression model, which are influenced by causal relations among SNPs, DNA methylation, and gene expression. We illustrate the utility of our method in two genomic studies and numerical simulation studies. Copyright © 2014 John Wiley & Sons, Ltd.     

Dynamic path analysis – a useful tool to investigate mediation processes in clinical survival trials

When it comes to clinical survival trials, regulatory restrictions usually require the application of methods that solely utilize baseline covariates and the intention‐to‐treat principle. Thereby, much potentially useful information is lost, as collection of time‐to‐event data often goes hand in hand with collection of information on biomarkers and other internal time‐dependent covariates. However, there are tools to incorporate information from repeated measurements in a useful manner that can help to shed more light on the underlying treatment mechanisms. We consider dynamic path analysis, a model for mediation analysis in the presence of a time‐to‐event outcome and time‐dependent covariates to investigate direct and indirect effects in a study of different lipid‐lowering treatments in patients with previous myocardial infarctions. Further, we address the question whether survival in itself may produce associations between the treatment and the mediator in dynamic path analysis and give an argument that because of linearity of the assumed additive hazard model, this is not the case. We further elaborate on our view that, when studying mediation, we are actually dealing with underlying processes rather than single variables measured only once during the study period. This becomes apparent in results from various models applied to the study of lipid‐lowering treatments as well as our additionally conducted simulation study, where we clearly observe that discarding information on repeated measurements can lead to potentially erroneous conclusions. Copyright © 2015 John Wiley & Sons, Ltd.     

A causal model for longitudinal randomised trials with time‐dependent non‐compliance

In the presence of non‐compliance, conventional analysis by intention‐to‐treat provides an unbiased comparison of treatment policies but typically under‐estimates treatment efficacy. With all‐or‐nothing compliance, efficacy may be specified as the complier‐average causal effect (CACE), where compliers are those who receive intervention if and only if randomised to it. We extend the CACE approach to model longitudinal data with time‐dependent non‐compliance, focusing on the situation in which those randomised to control may receive treatment and allowing treatment effects to vary arbitrarily over time. Defining compliance type to be the time of surgical intervention if randomised to control, so that compliers are patients who would not have received treatment at all if they had been randomised to control, we construct a causal model for the multivariate outcome conditional on compliance type and randomised arm. This model is applied to the trial of alternative regimens for glue ear treatment evaluating surgical interventions in childhood ear disease, where outcomes are measured over five time points, and receipt of surgical intervention in the control arm may occur at any time. We fit the models using Markov chain Monte Carlo methods to obtain estimates of the CACE at successive times after receiving the intervention. In this trial, over a half of those randomised to control eventually receive intervention. We find that surgery is more beneficial than control at 6months, with a small but non‐significant beneficial effect at 12months. © 2015 The Authors. Statistics in Medicine Published by JohnWiley & Sons Ltd.     

LNG-IUS辅助子宫内膜去除术治疗功能失调性子宫出血疗效探讨

目的:分析左炔诺孕酮宫内缓释系统(LNG-IUS)辅助子宫内膜去除术治疗功能失调性子宫出血的疗效.方法:回顾性分析近两年来该院妇产科就诊的功能失调性子宫出血患者共90例,随机分为两组,观察组给予LNG-IUS辅助子宫内膜去除术治疗,对照组单纯给予子宫内膜去除术治疗,统计患者术前、术后3、6、12个月月经情况、血红蛋白浓度、子宫内膜厚度及不良反应发生情况.结果:术后两组患者PBAC评分明显降低,闭经率明显提高,血红蛋白浓度明显升高,子宫内膜厚度明显增加,且观察组比对照组改善作用更显著(P＜0.05);总有效率方面,观察组明显高于对照组,差异有统计学意义(P＜0.05).结论:LNG-IUS辅助子宫内膜去除术治疗功能失调性子宫出血不良反应少,能够有效减少月经量,纠正贫血,抑制子宫内膜增生.     

Evaluation of the safety and efficacy of a Pipeline Flex embolization device for treatment of large,wide-necked intracranial aneurysms

Objective: To investigate the safety and effectiveness of the Pipeline Flex embolization device (PFED) in the treatment of large and wide-necked aneurysms in the internal carotid artery (ICA).Methods: The clinical data of 78 cases of large and wide-necked aneurysms in the ICA treated with this Pipeline Flex embolization device in Shanghai Hospital of the Second Military Medical University and Southern Hospital of Southern Medical University from February 2017 to June 2018 were retrospectively analyzed.Results: A total of 66 cases were treated with a Pipeline Flex embolization device, 10 with a pipeline flex embolization device, and 2 with a double tubride stent (10 patients were treated with a pipeline stent-assisted coil embolization in; and 2 patients were treated with two pipeline stents). The patients were followed up for 3 to 18 months (average, 9.25 months). Among them, 63 cases had complete occlusion of the neck of the aneurysm (Raymondl Class I; MRS score 0; 80.8%). Aneurysms recurred in 12 cases (Raymondl Class II; MRS score 1; 15.4%). Delayed ischemic complications were observed in 1 case (MRS score >2; 0.13%). There was 1 case of poor release of stent and 1 case of stent stenosis (0.13%).Conclusion: The treatment of large, wide-necked aneurysms in the ICA with PFED has a high total occlusion rate and good prognosis was better than coil embolization, but the placement of PFED still has some neurological complications.