改良的复方聚乙二醇电解质溶液剂量分配方案应用于肠道准备的效果评价

目的肠道准备标准方案中3L复方聚乙二醇电解质溶液(polyethyleneglycol electrolyte solution,PEG-ES)的服用方法为结肠镜检查前1晚服用1LPEG-ES、检查当天早晨服用2L PEG-ES。由于部分患者对于晨起服用2LPEG-ES的耐受性较差,本研究设计交换检查前1晚和当天早晨两次服用剂量的改良方案,旨在比较患者行改良方案与标准方案的肠道准备质量和耐受性差异。方法本研究为单中心单盲随机对照试验,选取2022年1月1日至2023年4月30日在首都医科大学附属北京友谊医院行结肠镜下息肉切除的206例住院患者为研究对象,采用随机数字表法将其按1:1分为对照组(n=103)和试验组(n=103)。对照组执行标准方案,分别于结肠镜检查前1晚19:00服用1LPEG-ES,结肠镜检查当天早4:00服用2LPEG-ES。试验组则交换两次服用PEG-ES的剂量。观察两组患者的肠道准备质量评分、肠道气泡评分、结肠镜检查操作时间、新发息肉检出率、患者不良反应、睡眠质量及再次行同样肠道准备的意愿。结果两组患者的性别、年龄、学历、体重指数的差异无统计学意义(P>0.05),且均顺利完成肠道准备和结肠镜检查。试验组与对照组的肠道准备质量评分分别为(6.45±1.06)分和(6.61±1.36)分,差异无统计学意义(P=0.333),并且两组肠道准备充分率(P=0.372)、肠道气泡评分(P=0.191)、结肠镜检查操作时长(P=0.629)及新发息肉检出率(P=0.460)差异均无统计学意义,但两组患者不良反应发生率(P=0.009)、睡眠质量(P<0.001)及再次行同样肠道准备的意愿(P<0.001)的差异有统计学意义。结论改良的PEG-ES剂量分配方案对于晨起服用PEG-ES耐受性较差、睡眠质量不佳的患者,具有可根据个人耐受度、服药习惯自主选择PEG-ES剂量分配方案的优点,改良方案具有安全性、可行性。

湿地动植物标本信息系统建设与实验教学应用

动植物标本数字化是实验教学中标本制作的重要环节,也是标本馆管理的重要手段,可应用于标本数据共享和科普宣教。基于Vue+Java、二维码识别技术,实验室建设了湿地动植物标本信息系统。系统包括标本信息管理和系统管理两个模块,需要学生依据所采集的实物标本编辑信息,教师可进行标本信息修正和人员管理。通过标本数字化实验教学,有助于学生准确、全面地理解专业知识,提高学生实践操作能力,亦使湿地动植物标本馆易于管理和应用。

腕部支持带的影像学研究进展

腕部支持带是前臂深筋膜在腕关节周围增厚的部分,可分为掌侧的屈肌支持带和背侧的伸肌支持带,对腕部肌腱和神经具有稳定、支持和保护作用,但腕部支持带的存在也与某些疾病的发生密切相关。本文就腕部支持带的解剖结构、正常影像学表现及发生相关疾病时的影像学表现进行综述。

基于MICS-CoTNet的黑木耳品质分类方法

针对传统黑木耳品质分类效率低,识别准确率不佳等问题,提出一种基于卷积神经网络和Transformer相结合的黑木耳图像品质分类方法。该研究以CoTNet模型为基础网络,设计了MICS-CoTNet黑木耳品质分类网络模型。首先,重新规划CoTNet模型主干特征提取模块的迭代次数,降低模型的计算冗余;其次,提出坐标归一化注意力机制以增强黑木耳图像局部关键特征权重,抑制主体特征干扰;最后,引入MobileNetV2模型中特征提取模块Inverted Block,并优化CoTNet模型核心模块CoT block,增强模型对黑木耳数据的特征提取能力。将MICS-CoTNet模型与EfficientNetV2、NfNet等12种模型进行对比,结果表明,综合模型准确性和轻量性等方面,MICS-CoTNet模型表现最佳。其中,MICS-CoTNet模型在干黑木耳数据中识别准确率可达98.45%,相较标准CoTNet提升5.22个百分点;在鲜黑木耳数据中识别准确率可达98.89%,相较标准CoTNet提升2.60个百分点。MICS-CoTNet模型占用内存为30.98M,相对于原CoTNet模型减少96.57M。将MICS-CoTNet模型部署到Jetson TX2 NX中,实时推理速度为18帧/s。该研究提出的MICS-CoTNet黑木耳品质分类模型识别准确率高,运算速度快,为黑木耳实时品质分级的实际应用提供了理论基础及技术支持。

顺产产妇会阴损伤预防与修复护理最佳证据总结

目的 :总结顺产产妇会阴损伤预防与修复护理相关最佳证据,为产科护士及助产士的临床决策提供参考。方法 :系统检索与筛选专业团体网站、临床实践指南网站、数据库的会阴损伤预防与修复相关循证指南,采用AGREEⅡ对其进行方法学质量评价,选取其中的A级指南进行推荐意见的提取、翻译,B级指南予以排除;之后按照一定的原则对内容相同或相似的推荐条目进行综合;最后通过专家论证,遴选出适宜我国国情的护士及助产士权限范围内的推荐意见。结果 :共检索出国内外331篇文献,符合指南初筛纳入排除标准的指南为7部,AGREEⅡ评价后显示4部为A级,3部为B级;仅对4部A级指南的推荐意见进行提取,共得到92条推荐意见,按照相应的原则将推荐意见综合后得到63条最佳证据;专家论证后发现其中27条最佳证据属于我国护士及助产士权限范畴。结论:会阴损伤预防与修复的证据较为丰富,护士及助产士权限范围内的证据涉及范围较广但数量有限,有必要进行更多的实践探索及科学研究来丰富护理及助产领域的相关证据。

近5年我国护理证据总结类论文的方法学质量分析

目的:检索国内相关数据库,参考JBI循证卫生保健研究中心证据总结制作的核心要素,分析护理证据总结类论文的常见方法学问题,为证据总结的撰写和发表提供参考。方法:使用"证据总结"为检索词检索近5年中国知网、万方数据库、维普数据库中发表的证据总结类论文,将其共性问题进行归纳总结并探讨对应的处理策略。结果:经筛选后共纳入证据总结类论文78篇,其循证问题的提出、证据的检索、筛选、评价以及证据的分级和推荐强度的制定等方面均存在一些共性问题。结论:规范证据总结的报告方法将有利于临床科学决策。

产后出血预警评估工具的构建及验证

目的:构建产后出血预警评估工具,并验证其效度。方法:对北京市某三级甲等医院6790例孕产妇的病例进行回顾性分析,验证产后出血预警评估工具的效度。结果:评估工具ROC曲线下面积(AUC)为0.632[95%CI(0.613,0.651)],最佳临界值为5分,对应灵敏度为51.9%[95%CI(48.7%,55.1%)],特异度为66.7%[95%CI(65.5%,67.9%)]。结论:产后出血预警模型具有一定的准确性,为临床医护人员预测患者产后出血的发生提供模型。对有发生产后出血可能的患者早期预警并实施干预措施,从而减少产后出血的发生。

COVID-19疫情紧急状态下护理证据总结类论文的问题及对策

针对特定循证问题的证据总结为临床提供了科学依据,在当前新型冠状病毒肺炎(COVID-19)疫情紧急状态下,证据总结的作用尤为凸显。但由于疫情突发,受时间、证据数量、证据质量等因素的限制,也给证据总结的制作带来了挑战。因此,在此疫情紧急状态下,本文针对证据总结类稿件存在的问题进行分析并提出合理的对策。

维持性血液透析后疲乏管理最佳证据总结

目的检索、评价、总结血液透析后疲乏管理相关的最佳证据,为临床开展相关循证实践提供参考和依据。方法在JBI、安大略注册护士协会等7个指南网站初次检索相关指南和证据综合,在中国知网、PubMed等12个中英文数据库补充检索系统评价和专家共识,按照既定原则及程序进行质量评价、筛选及整合。结果共纳入文献15篇,包括11篇证据综合、3篇系统评价、1篇专家共识,从健康教育、评估、饮食管理、运动管理、睡眠管理、穴位管理、芳香疗法7个方面归纳后共形成32条推荐意见。结论最佳证据可指导相关临床实践,帮助患者减轻透析后的疲乏感,提高护理质量及患者生命质量。

产后盆底康复护理管理循证实践方案的构建

目的:整合现有证据,基于我国国情和临床现况构建产后盆底康复护理管理的循证实践方案。方法:以知识转化模型为理论指导,成立循证实践研究小组,通过文献研究及临床现况调查确定研究问题,检索、评鉴、整合相关的证据,进行临床适用性评价,明确证据转化的阻碍因素,制定相应的行动策略,完成产后盆底康复护理管理循证实践方案的构建。结果:共纳入7部循证指南、4部证据总结、3篇专家共识,构建产后盆底康复团队管理原则及相关人员培训规划、产后盆底康复管理流程及产后盆底康复健康宣教手册为主体内容的循证实践方案。结论:本研究构建的循证实践方案基于证据、在具体临床情境下充分考虑利益相关者的价值观和意愿形成,方案内容全面完整易于理解、推荐意见清晰明确,可为临床产后盆底康复护理管理提供借鉴和指导。

脑卒中吞咽困难识别与管理社区循证实践方案初步构建

目的 构建适用于社区医疗卫生站的脑卒中吞咽困难识别与管理循证实践方案,推动医院医疗护理向社区下沉.方法 在已有三甲医院方案的基础上,采用文献研究法,检索国内外吞咽困难相关证据,结合利益相关者会议更新证据,进而更新和调适循证实践方案.结果 对脑卒中吞咽困难识别与管理循证实践方案进行社区医院跨机构调适后,吞咽障碍筛查工具由标准吞咽功能评定量表改为洼田饮水试验(护士用)和吞咽障碍指数(患者用),营养风险管理工具由NRS2002改为营养不良通用筛查工具,并增加中医护理技术和远程卒中管理.根据修订结果,重新修订工作流程,更新健康教育材料等.结论 脑卒中吞咽困难识别与管理社区循证实践方案的构建,为在社区医院开展循证实践提供了框架.

2005至2020年中国西南地区肝豆状核变性住院费用影响因素分析

目的:研究肝豆状核变性患者住院费用的影响因素,为卫生政策的制定提供依据。方法:回顾性收集2005至2020年首次入住四川大学华西第四医院肝豆状核变性患者的病历数据,使用多重线性回归明确肝豆状核变性患者住院费用的影响因素;使用协方差分析控制混杂因素明确自变量对住院费用的影响。SPSS 20.0(IBM)用于数据分析。结果:纳入346例肝豆状核变性患者,使用多重线性回归分析后发现就诊年份、年龄、合并症数量、住院天数及并发肝硬化失代偿可导致住院费用变化。控制混杂因素后,发现随着合并症数量的增加及并发肝硬化失代偿可导致住院费用增加,同时2005—2006及2007—2008年患者的住院费用较其他年份减少。结论:肝豆状核变性是一种慢性病,其住院费用受就诊年份、年龄、合并症数量、住院天数及并发肝硬化失代偿影响,需通过不断完善就诊流程、建立临床路径、纳入门诊特殊病管理、减少合并症及延缓肝硬化失代偿发生的时间,从而减少肝豆状核变性的疾病负担。

A multicenter,retrospective.epidemiologic survey of the clinical features and management of bone metastatic disease in China

Background:Bone metastases are common in patients with advanced cancer.Bisphosphonates(BPs) could prevent or delay the development of skeleton-related events(SREs).The present study aimed to identify the clinical features of and treatment strategies for Chinese patients with bone metastases.Methods:Consecutive cancer patients who had bone metastases and received BP treatment were enrolled.A questionnaire was developed to collect the patients' clinical data,as well as information on the diagnosis and management of bone metastases.Physicians' awareness of the guidelines and knowledge of the application of BP were also assessed.Results:A total of 3223 patients with lung cancer(36.5%),breast cancer(30.9%),prostate cancer(8.5%),and gastrointestinal cancer(5.7%) were included in this study.The sites of bone metastases were the thoracic spine(56.0%),lumbar spine(47.1%),ribs(32.6%),and pelvis(23.2%).The SRE frequency was the highest in patients with multiple myeloma(36.6%),followed by those with lung cancer(25.9%),breast cancer(20.2%),prostate cancer(18.2%),and gastrointestinal cancer(17.3%).Irradiation to the bone was the most frequent SRE(58%in lung cancer patients,45%in breast cancer patients,and 48%in prostate cancer patients).Our survey also showed that 45.5%of patients received BP within 3 months after their diagnosis of bone metastases,whereas the remaining 54.5%of patients did not receive BP treatment until at least 3 months after their diagnosis of bone metastases.The SRE frequency in the former group was significantly lower than that in the latter group(4.0%vs.42.3%,P < 0.05).In patients with more than 6 months of continuous BP treatment,the mean time to the first SRE was significantly longer than that in patients with less than 6 months of continuous BP treatment(7.2 vs.3.4 months,P < 0.05).In addition,12.2%of the physicians were not aware of the efficacy of BP in preventing and delaying SRE.Only half(52.3%) of the physicians agreed that the BP treatment should persist for at least 6 months unless it was intolerable.Conclusions:Our study suggested that prompt and persistent BP treatment was associated with a reduced risk of SREs.However,our survey also revealed that the proper application of BP was not as common as expected in China.

The impact of both platinum-based chemotherapy and EGFR-TKIs on overall survival of patients with advanced non-small cell lung cancer

Both platinum-based doublet chemotherapy(PBC) and epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs) prolong the survival of patients with advanced non-small cell lung cancer(NSCLC). In early studies, most patients underwent PBC as first-line treatment, but not all patients could afford EGFR-TKIs as second-line treatment. To understand the impact of PBC and EGFR-TKIs on NSCLC prognosis, we evaluated the association between the receipt of both regimens and overall survival(OS). Using MEDLINE and EMBASE, we identified prospective, randomized, controlled phase III clinical trials in advanced NSCLC that met the inclusion criteria: in general population with advanced NSCLC, the percentage of patients treated with both PBC and EGFR-TKIs was available in the trial and OS was reported. After collecting data from the selected trials, we correlated the percentage of patients treated with both PBC and EGFR-TKIs with the reported OS, using a weighted analysis. Fifteen phase III clinical trials—involving 11,456 adult patients in 32 arms—were included in the analysis, including 6 trials in Asian populations and 9 in non-Asian(predominantly Caucasian) populations. The OS was positively correlated with the percentage of patients treated with both PBC and EGFR-TKIs(r = 0.797, P < 0.001). The correlation was obvious in the trials in Asian populations(r = 0.936, P < 0.001) but was not statistically significant in the trials in predominantly Caucasian populations(r = 0.116, P = 0.588). These results suggest that treatment with PBC and EGFR-TKIs may provide a survival benefit to patients with advanced NSCLC, highlighting the importance of having both modalities available for therapy.

SPARC expression and prognostic value in non-small cell lung cancer

Secreted protein,acidic and rich in cysteine(SPARC) is expressed in numerous types of tumors and is suggested to have prognostic value.Moreover,because of its strong affinity for albumin,and hence albumin-bound drugs,SPARC has increasingly become a focus for research.In this study,we aimed to determine SPARC expression in patients with non-small cell lung cancer(NSCLC) and investigate the association of SPARC with disease prognosis.Tissue microarrays were constructed with specimens from 105 patients with NSCLC treated at Sun Yat-sen University Cancer Center,and immunohistochemical analysis was performed on these tissue microarrays to assess SPARC expression.Our results showed that SPARC expression status did not significantly relate with age,gender,and tumor stage.However,SPARC was expressed more frequently in squamous cell carcinoma than in adenocarcinoma(75% vs.43.5%,P = 0.004).Patients with smoking history had higher SPARC expression than non-smokers(68.2% vs.33.3%,P = 0.002).In both univariate and multivariate analyses,SPARC was a prognostic factor of overall survival(HR = 0.32;95% CI:0.16-0.65) but not disease-free survival.Our study indicates that SPARC expression is higher in squamous cell carcinoma than in adenocarcinoma in NSCLC.Most notably,SPARC can be used as a prognostic factor for NSCLC.

Predictors of super-response to cardiac resynchronization therapy： the significance of heart failure medication, pre-implant left ventricular geometry and high percentage of biventricular pacing

Background Super-responders （SRs） are defined as patients who show crucial cardiac function improvement after cardiac resynchro- nization therapy （CRT）. The purpose of this study is to identify and validate predictors of SRs after CRT. Methods This study enrolled 201 patients who underwent CRT during the period from 2010 to 2014. Clinical and echocardiographic evaluations were conducted before CRT and 6 months after. Patients with a decrease in New York Heart Association （NYHA） fimctional class 〉 1, a decrease in left ventricular end-systolic volume （LVESV） ≥ 15%, and a final left ventricular ejection fraction （LVEF） ≥ 45% were classified as SRs. Results 29% of the 201 patients who underwent CRT were identified as SRs. At baseline, SRs had significantly smaller left atrial diameter （LAD）, LVESV, left ventricular end-diastolic volume （LVEDV） and higher LVEF than the non-super-responders （non-SRs）. The percentage of patients using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers （ACEI/ARB） was higher in SRs than non-SRs. Most SRs had Biventricular （BiV） pacing percentage greater than 98% six months after CRT. In the multivariate logistic regression analysis, the independ- ent predictors of SRs were lower LVEDV [odd ratios （OR）： 0.93; confidence intervals （CI）： 0.90-0.97], use of ACEI/ARB （OR： 0.33; CI： 0.13~3.82） and BiV pacing percentage greater than 98% （OR： 0.29; CI： 0.16~.87）. Conclusion Patients with a better compliance of ACEI/ARB and a less ectatic ventricular geometry before CRT tends to have a greater probability of becoming SRs. Higher percentage of BiV pacing is essential for becoming SRs.

Expression of RRM1 and its association with resistancy to gemcitabine-based chemotherapy in advanced nasopharyngeal carcinoma

Gemcitabine has high activity against nasopharyngeal carcinoma(NPC).The level of ribonucleotide reductase subunit M1(RRM1) expression is closely related to the efficacy of gemcitabine on non-small cell lung cancer and pancreatic cancer.However,the expression of RRM1 and its association with sensitivity to gemcitabine-based chemotherapy in advanced NPC is not known.In this study,we retrospectively collected 48 formalin-fixed,paraffin-embedded NPC tissues to evaluate the expression of RRM1 using immunohistochemistry.All patients were diagnosed and treated with gemcitabine-based chemotherapy at Sun Yat-sen University Cancer Center.RRM1 expression was positive in 17(35%) patients.RRM1 expression was not associated with sex,age,performance status,WHO histological type,number of distant metastases,previous treatment,or cycles of gemcitabine-based chemotherapy(P> 0.05).The progression-free survival of the RRM1-positive group was shorter than that of the RRM1-negative group(5 months vs.7 months,P = 0.036),and the response rate of the RRM1-positive group was somewhat lower than that of the RRM1-negative group(51.6% vs.35.3%,P = 0.278).There was no significant difference in median survival between the RRM1-positive and RRM1-negative groups(22 months vs.19 months,P = 0.540).Our results show that RRM1-negative expression is related with longer progression-free survival in advanced NPC patients treated with gemcitabine-based regimens.

缺氧激活前药evofosfamide(TH-302)在体内和体外对鼻咽癌的疗效

背景与目的肿瘤缺氧被认为是肿瘤转移和疾病复发的重要因素。Evofosfamide是一种缺氧激活前药,可选择性地靶向实体瘤的缺氧区域。由于缺氧诱导因子?1α(hypoxia?inducible factor?1α,HIF?1α)在鼻咽癌(nasopharyngeal carcinoma,NPC)组织中高表达,本研究探讨了evofosfamide在鼻咽癌中的疗效。方法我们评估了evofosfamide作为单药或联合顺铂(DDP)在NPC细胞系CNE?2、HONE?1和HNE?1以及裸鼠异种移植瘤模型中的疗效。结果 Evofosfamide在NPC细胞系中表现出缺氧选择性细胞毒性。在缺氧条件下,对CNE?2、HNE?1和HNE?1细胞的50%抑制浓度(50%inhibition concentration,IC50)分别为8.33±0.75、7.62±0.67和0.31±0.07μmol/L。与常氧对照组相比,在缺氧条件下其增敏率为9–300倍。通过联合指数值评估,evofosfamide联合DDP对NPC细胞的细胞毒性具有协同效应。在缺氧条件下用0.05μmol/L的evofosfamide处理后,细胞周期G2期被阻滞。在缺氧条件下用evofosfamide处理后,组蛋白H2AX磷酸化(Histone H2AXphosphorylation,γH2AX)(DNA损伤的标志之一)表达增强,而HIF?1α表达受到抑制。在HNE?1 NPC异种移植瘤模型中,evofosfamide作为单药或联合DDP显示出抗肿瘤活性。异种移植物组织缺氧区在evofosfamide单药治疗和联合DDP治疗后均明显减少。结论我们的结果为evofosfamide作为单药或联合DDP可选择性靶向鼻咽癌缺氧部分提供了临床前证据,为evofosfamide治疗鼻咽癌的潜在临床应用提供了理论依据。

Clinical outcome of cardiac resynchronization therapy in dilated-phase hypertrophic cardiomyopathy

Backgrounds Clinical trials have demonstrated that cardiac resynchronization therapy （CRT） is effective in patients with ＂non-is- chemic cardiomyopathy＂. However, patients with dilated-phase hypertrophic cardiomyopathy （DHCM） have been generally excluded from such trials. We aimed to compare the clinical outcome of CRT in patients with DHCM, idiopathic dilated cardiomyopathy （IDCM）, or ischemic cardiomyopathy （ICM）. Methods A total of 312 consecutive patients （DHCM： n = 16; IDCM： n = 231; ICM： n = 65） undergoing CRT in Fuwai hospital were studied respectively. Response to CRT was defmed as reduction in left ventricular end-systolic volume （LVESV） _〉 15% at 6-month follow-up. Results Compared with DHCM, IDCM was associated with a lower total mortality （HR： 0.35, 95% CI： 0.13-0.90）, cardiac mortality （HR： 0.29; 95% CI： 0.11-0.77）, and total mortality or heart failure （HF） hospitalizations （HR： 0.34, 95% CI： 0.17-0.69）, independent of known confounders. Compared with DHCM, the total mortality, cardiac mortality and total mortality or HF hospitalizations favored ICM but were not statistically significant （HR： 0.59, 95% CI： 0.22-1.61; HR： 0.59, 95% CI： 0.21-1.63; HR： 0.54, 95% CI： 0.26-1.15; respectively）. Response rate to CRT was lower in the DHCM group than the other two groups although the differences didn＇t reach statistical significance. Conclusions Compared with IDCM, DHCM was associated with a worse outcome after CRT. The clinical outcome of DHCM patients receiving CRT was similar to or even worse than that of ICM patients. These indicate that DHCM behaves very differently after CRT.

Cardiac resynchronization therapy improved the clinical outcomes in pacemaker patients upgraded to biventricular device

The right ventricular pacing （RVP） is the standard treat- ment for patients with severe bradyarrhythmias; however, it may cause and exacerbate heart failure symptoms in a long run under some circumstances.{1] In fact, significant left ventricular （LV） systolic dysfimction and symptomatic heart failure （HF） is commonly found in patient population with pacemaker implantations.