Diagnostic Accuracy and Predictive Value of Clinical Symptoms for the Diagnosis of Mild COVID-19

Objective: To assess the diagnostic accuracy and predictive values of clinical symptoms in patients with suspected mild COVID-19 to identify target groups for self-isolation and outpatient treatment without additional testing. Methods: We conducted an open-label prospective study in patients aged 18 to 72 years with suspected mild COVID-19. The clinical diagnosis was based on the acute onset of such symptoms as olfactory dysfunction, hyperthermia, myalgia, nasal congestion, nasal discharge, cough, rhinolalia, sore throat, without pneumonia in persons in contact with a confirmed case of COVID-19. The physician assessed clinical symptoms using a 4-point scale. The patient self-assessed clinical symptoms using a ten-point visual analogue scale (VAS). All enrolled patients underwent laboratory testing to confirm the diagnosis of COVID-19. Results: Of the 120 patients underwent testing, the diagnosis of mild COVID-19 was confirmed in 96 patients and ruled out in 24 patients. When assessing symptoms by a physician according to the correlation analysis, hyperthermia, myalgia, nasal congestion and rhinolalia have a positive predictive value with a significance level of more than 0.6. When self-assessing symptoms by a patient, fever, myalgia and nasal congestion have a diagnostic accuracy with a significance level of more than 0.5. Nasal discharge, cough and sore throat have negative predictive values. Conclusion: The presence of these symptoms in patients with an acute onset of the disease can help to make a clinical diagnosis of coronavirus disease and identify target groups for self-isolation and outpatient treatment without additional testing. Highly suspect asymptomatic patients are not considered as those who have possible mild COVID-19 infection.

Predictive value of alarm symptoms in Rome IV irritable bowel syndrome:A multicenter cross-sectional study

BACKGROUND Irritable bowel syndrome(IBS)is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria.Alarm symptoms have long been applied in the clinical diagnosis of IBS.However,no study has explored the predictive value of alarm symptoms in suspected IBS patients based on the latest Rome IV criteria.AIM To investigate the predictive value of alarm symptoms in suspected IBS patients based on the Rome IV criteria.METHODS In this multicenter cross-sectional study,we collected data from 730 suspected IBS patients evaluated at 3 tertiary care centers from August 2018 to August 2019.Patients with IBS-like symptoms who completed colonoscopy during the study period were initially identified by investigators through medical records.Eligible patients completed questionnaires,underwent laboratory tests,and were assigned to the IBS or organic disease group according to colonoscopy findings and pathology results(if a biopsy was taken).Independent risk factors for organic disease were explored by logistic regression analysis,and the positive predictive value(PPV)and missed diagnosis rate were calculated.RESULTS The incidence of alarm symptoms in suspected IBS patients was 75.34%.Anemia[odds ratio(OR)=2.825,95%confidence interval(CI):1.273-6.267,P=0.011],fecal occult blood[OR=1.940(95%CI:1.041-3.613),P=0.037],unintended weight loss(P=0.009),female sex[OR=0.560(95%CI:0.330-0.949),P=0.031]and marital status(P=0.030)were independently correlated with organic disease.The prevalence of organic disease was 10.41%in suspected IBS patients.The PPV of alarm symptoms for organic disease was highest for anemia(22.92%),fecal occult blood(19.35%)and unintended weight loss(16.48%),and it was 100%when these three factors were combined.The PPV and missed diagnosis rate for diagnosing IBS were 91.67%and 74.77%when all alarm symptoms were combined with Rome IV and 92.09%and 34.10%when only fecal occult blood,unintended weight loss and anemia were combined with Rome IV,respectively.CONCLUSION Anemia,fecal occult blood and unintended weight loss have high predictive value for organic disease in suspected IBS patients and can help identify patients requiring further examination but are not recommended as exclusion criteria for IBS.

Omicron Infections in Otolaryngology Practice: A Retrospective Observational Study on Testing, Symptoms and Vaccination Status

Background: With the appearance of the SARS-CoV-2 Omicron variant the high rate of vaccination breakthroughs showed that current vaccines against COVID-19 can no longer provide adequate protection against infection. However, it is still assumed that vaccination might have a positive effect on the course of the disease. In Germany, general practitioners and specialists are usually the first treatment providers for acute illnesses. In addition, patients with infections of the upper respiratory tract often primarily consult an ear, nose and throat specialist. Most of the Omicron-infected people have a mild course of the disease and, if necessary, receive medical care on an outpatient basis. Little is known about the effectiveness of corona vaccinations on Omicron infections in relation to the clinical symptoms. In our outpatient office, we recorded a sharp increase of corona positive Omicron-infections in the beginning of 2022, despite of vaccinations against COVID-19. In a retrospective analysis, we evaluated the data of our SARS-CoV-2 tested patients with regard to clinical symptoms reported and vaccination status. The focus was particularly on the question to what extent the vaccination status in the case of Omicron infections influences the symptoms of the disease. Methods: We retrospectively evaluated the data of all patients in the first quarter of 2022 who were suspected for COVID-19. At that time, the Omicron variant was dominant in Germany. Clinical symptoms, cycle threshold (Ct) values, and the vaccination status were recorded. Symptomatic patients who tested negative for SARS-CoV-2 served as a control group. Results: Of the total cohort (n = 353), 241 (68%) patients were tested SARS-CoV-2 positive. The symptoms of the corona-positive patients were essentially similar to those of a mild to moderate cold, but compared to SARS-CoV-2-negative patients (n = 69) with a clear shift in favor of fever (35% versus 16%), cough (76% versus 52%) and increased feeling of illness (59% versus 43%), respectively. Ct values revealed no difference between unvaccinated (mean 19.15;SD 3.52) and vaccinated cases (mean 18.15;SD 3.87;p = 0.272). There was no significant correlation between the vaccination status and clinical symptom score in different age groups (age 12 to 17, r (28) = 0.26, p = 0.26;age > 18 to 60, r (191) = 0.06, p = 0.378). Conclusions: According to our results with infections with the Omicron variant, there were no differences between unvaccinated and vaccinated patients concerning clinical symptoms or potential infectivity, especially in children and adolescents. This might have impact on further vaccination programs.

脑卒中患者在急诊卒中绿色通道中常见症状及早期筛查的临床价值研究

目的 探讨脑卒中患者在急诊卒中绿色通道中常见症状及早期筛查的临床应用价值。方法 2022年1月开始,本院急诊卒中绿色通道中应用了早期筛查措施,选择实施前(2021年1月1日—12月31日)和实施后(2022年1月1日—12月31日)经急诊卒中绿色通道收治的脑卒中患者各70例,分别作为对照组和早筛组。对照组常规开启急诊卒中绿色通道接诊患者,此基础上,早筛组增加早期筛查处理,总结患者常见症状,对比两组急救效率、初步诊断结果等情况。结果 早筛组急诊抢救时间、治疗后NIHSS评分、住院时间、转运意外事件发生率少于对照组(P <0.05)。早筛组急诊初步诊断与临床诊断结果符合率为95.71%(67/70),高于对照组(80.00%,56/70)(P <0.05)。结论 急诊卒中绿色通道患者症状多样,及时进行早期筛查,可有效提升急救效率,改善患者预后,应用效果良好。

家庭参与式护理对精神分裂症患者依从性、临床症状及睡眠质量影响

目的:探究家庭参与式护理对精神分裂症患者治疗依从性、临床症状以及睡眠质量的影响。方法:选取2020年7月至2022年9月泉州市第三医院收治的精神分裂症患者100例作为研究对象,按照掷骰子的方式随机分为对照组和观察组,每组50例。对照组单纯接受常规护理,观察组在常规护理的基础上增加家庭参与式护理,对比2组患者干预依从性、住院患者护理观察量表(NOSIE)评分、阳性与阴性症状量表(PANSS)评分、匹兹堡睡眠质量指数(PSQI)得分差异。结果:护理前2组患者的依从率、NOSIE得分、PANSS得分、PSQI得分组间差异均无统计学意义(均P>0.05),护理后观察组患者完全依从率达到46.00%,显著高于对照组的20.00%,差异有统计学意义(P<0.05),观察组患者总积极和总病情维度得分明显高于对照组,总消极维度得分明显低于对照组,差异均有统计学意义(均P<0.05),观察组治疗8周时PANSS评分和PSQI得分均低于对照组,差异均有统计学意义(均P<0.05)。结论:对精神分裂症患者开展家庭参与式护理有助于提高患者的治疗依从性,改善其临床症状,同时对缓解患者睡眠障碍具有积极意义,建议临床推广运用。

症状管理理论下的姑息护理对宫颈癌晚期患者的应用价值

目的 探究症状管理理论下的姑息护理对宫颈癌晚期患者的应用价值。方法 选取2019年7月至2022年7月南通市第三人民医院抽取的100例宫颈癌晚期患者作为研究对象,按照随机数字表法将其分成对照组和观察组,每组50例。对照组采用常规的姑息护理,观察组在对照组基础上增加症状管理理论下的姑息护理,两组均护理1个月。比较两组干预前后中文版压力知觉量表(CPSS)、癌因性疲乏(CRF)量表,及世界卫生组织生活质量测定量表(WHOQOL-BREF)。结果 干预后,两组CPSS、CRF评分低于干预前,且观察组低于对照组(P<0.05)。干预后,两组WHOQOL-BREF评分均高于干预前,且观察组高于对照组(P<0.05)。结论 针对宫颈癌晚期患者采取症状管理理论下的姑息护理,可在降低患者心理弹性表现的同时,还能够改善患者的CRF量表评分,进而提高患者的患病后生活质量,值得各个科室借鉴采纳。

清热除湿汤与皮炎汤治疗湿热内蕴型面部脂溢性皮炎的临床价值分析

目的 分析湿热内蕴型面部脂溢性皮炎实施清热除湿汤与皮炎汤治疗的临床价值。方法 随机选取2022年1月—2023年9月南京市江宁区中医院收治的60例湿热内蕴型面部脂溢性皮炎患者为研究对象。按治疗方法分为对照组(n=30)实施清热除湿汤治疗,研究组(n=30)实施皮炎汤治疗。比较两组的临床疗效。结果 治疗后,研究组患者的面部油脂改善情况、大便干燥、口渴情况均明显优于对照组,差异有统计学意义(P均<0.05);治疗后,研究组患者面部皮肤评分低于对照组,差异有统计学意义(P<0.05);治疗后,研究组患者生活质量评分高于对照组,差异有统计学意义(P<0.05);研究组患者的治疗有效率(100.00%)高于对照组(76.67%),差异有统计学意义(χ^(2)=5.822,P<0.05)。结论 皮炎汤治疗热内蕴型面部脂溢性皮炎,可以改善患者的中医症状及面部皮肤状态,提高生活质量,临床效果显著。

耳穴压籽联合海派儿科推拿手法治疗儿童腺样体肥大的临床分析

目的针对腺样体肥大患儿行耳穴压籽联合海派儿科推拿手法治疗,观察其对患者临床症状、腺样体大小及A/N值的影响。方法以随机数字表法对2021年1月—2022年12月期间收治的60例腺样体肥大患儿随机分组,每组30例,采用常规西药治疗的为对照组,应用耳穴压籽联合海派儿科推拿手法治疗的为观察组。对比两组疗效,评估治疗前后症状改善情况,检查患者腺样体大小、A/N值。结果总有效率比较观察组(93.33%)与对照组(73.33%)差异明显(P<0.05);治疗前各项临床症状积分组间差异不明显,P>0.05,治疗后观察组低于对照组,P<0.05;腺样体大小及A/N值治疗前组间比较P>0.05,治疗后均降低,观察组低于对照组,P<0.05。结论耳穴压籽与海派儿科推拿手法联合应用于儿童腺样体肥大治疗,可改善患者临床症状及A/N值,缩小腺样体,疗效显著。

Sport burnout inventoryDual career form for student-athletes: Assessing validity and reliability in a Finnish sample of adolescent athletes

Background:The pressure of pursuing an athletic career simultaneously with education may set adolescent student-athletes at risk for sport and school burnout.Although the 2 life domains of student-athletes are strongly intertwined,so far,there has not been an instrument for investigating sport burnout parallel to school burnout.The aim of the present study was to introduce a sport burnout measure for adolescents in a dual career context and investigate its validity and reliability by using confirmatory factor analysis.Methods:The participants were 391 student-athletes(51%females)who filled in a questionnaire of sport burnout and background variables in the beginning of upper secondary school.Results:A 3-factor model or a second-order-factor model described the data better and gave better reliability indices than a 1-factor model.The 3 dimensions of sport burnout were shown to be separate,but closely related constructs.Evidence for convergent and discriminant validity was obtained by correlating the 3 sport burnout dimensions with depressive symptoms,self-esteem,and sport task values.Conclusion:The results suggest that Sport Burnout InventoryDual Career Form(SpBI-DC)is a valid and reliable instrument for investigating sport burnout among adolescent student-athletes.

子宫内膜异位症患者血清叶酸受体1、间皮素表达及与临床症状关系

目的:探讨子宫内膜异位症(EMs)患者血清叶酸受体1(FOLR1/FRα)、间皮素(MSLN)表达水平及与患者临床症状关系。方法:选择2018年5月--2021月5月本院收治的96例Ems患者为Ems组,根据r-AFS分期分为I期22例、II期30例、III期26例、IV期18例,年龄相近的体检健康女性80例为对照组。均采用酶联免疫吸附试验法检测血清FOLR1、MSLN水平并差异比较。绘制受试者工作特征曲线(ROC)确定血清FOLR1、MSLN截断值,采用Pearson相关分析血清FOLR1、MSLN与Ems临床症状关系。结果:Ems组血清FOLR1(365.20±80.41 pg/ml)、MSLN(10.36±2.33μg/L)水平均低于对照组(113.25±30.36 pg/ml、3.25±0.66μg/L),且Ems组随着临床分期增加而升高(均P<0.05)。ROC曲线确定,血清FOLR1、MSLN截断值分别为230.22pg/ml、6.52μg/L,根据截断值分别分为FOLR1、MSLN高水平组和低水平组,FOLR1、MSLN高水平组Ems患者痛经、盆腔痛、性交痛、肛门坠胀等临床症状评分均高于低水平组(P<0.05),血清FOLR1、MSLN水平与Ems临床症状均呈正相关(r=0.421、0.388,均P<0.05)。结论:Ems患者血清FOLR1、MSLN水平异常升高,水平变化与Ems临床症状呈正相关。

多模式CT在脑出血诊疗中的应用价值

目的:探讨多模式CT在脑出血诊疗中的应用价值。方法:选择2021年12月—2022年12月收治的脑出血患者70例,按照随机数表法分为对照组和观察组,每组35例。所有患者均经手术治疗且术后病理证实满足脑出血标准。对照组术前采用常规CT诊疗,观察组采用多模式CT诊疗。比较两组诊断结果及对术后评估的作用。结果:两组脑出血不同部位的诊断符合率比较,差异无统计学意义(P>0.05),但总符合率观察组高于对照组,差异有统计学意义(P<0.05)。观察组术后美国国立卫生研究所脑卒中评分(NIHSS)和并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:多模式CT检查可提高不同脑出血部位、不同血肿体积诊断效果,从而为手术治疗提供更多可靠的依据,确保手术更安全有效,同时更好地改善患者的神经功能缺损症状。

抗精神病药合并帕罗西汀治疗慢性精神分裂症的应用价值研究

目的探讨并分析抗精神病药联合帕罗西汀治疗慢性精神分裂症的有效性和安全性,评价联合用药的临床应用价值。方法选择2012年5月~至2013年5月期间贵阳医学院第二附属医院收治的108例慢性精神分裂症患者的病例资料进行回顾性分析,并按数字表法随机分为对照组和实验组。其中,对照组(n=52)仅接受抗精神病类药物治疗,实验组(n=56)采用抗精神病药联合帕罗西汀的方法治疗。在治疗前与治疗2周、4周、8周和12周后分别以阳性症状、阴性症状量表(positive and negative syndrome scale,PANSS)和副反应量表(treatment emergent symptom scale,TESS)评定2种治疗方法的临床疗效和副反应的发生情况。结果治疗8周后,实验组的PANSS总分、阴性症状分均比治疗前降低,差异有统计学意义(P<0.05),而在12周后,其差异具有显著的统计学意义(P<0.01);对照组的PANSS总分及各项评分治疗前后差异均无统计学意义。2组患者治疗8周及12周后的PANSS总分和阴性症状的评分差异有统计学意义(P<0.05)。实验组总有效率为96.43%,显著高于对照组80.77%,差异有统计学意义(P<0.05);实验组的不良反应发生率为10.71%,对照组为9.62%,差异无统计学意义。结论抗精神病药联合帕罗西汀治疗慢性精神分裂症可改善患者阴性症状,临床疗效显著,安全性高。

C/A值与甘薯丛枝病症状发生的关系

采用高效液相色谱（ＨＰＬＣ），对比测定了由植物类菌原体（ＭＬＯ）引起的甘薯丛枝病病株和甘薯健株中细胞分裂素和生长素含量在整个生长周期内的变化。结果显示：甘薯中细胞分裂素以玉米素为主。病株中玉米素含量一直处于较高水平，而吲哚乙酸含量仅在芽萌发时期病、健材料间存在明显差异，随着甘薯的生长，这种差异逐渐消失。结合甘薯丛枝病发病特点，讨论了植物激素Ｃ／Ａ值的改变对病状发生的作用。

下消化道高危症状对结肠癌的预测价值

目的研究下消化道高危症状(消瘦、便血、黑便、腹泻、排便改变、腹部包块)对结肠癌的预测价值。方法选取2000年1月-2011年12月期间在解放军第八五医院因下消化道症状首次行结肠镜检查的6 936例患者,分析性别、年龄、主要症状、结肠镜及病理检查结果。结果 6 936例患者中,结肠癌的发生率为2.7%(185/6 936),其中只有58.4%(108/185)的患者有结肠癌高危症状,总体敏感性和特异性分别为9.6%和94.0%,总体阳性似然比、阴性似然比分别为2.46和0.96,只有腹部包块的阳性似然比>5。结论大部分结肠癌患者并没有肿瘤形成的高危症状;除腹部包块以外,其他下消化道高危症状不能准确预测结肠癌。

论症状与证候标识

症状在临床是疾病现象,是不依赖医生主观意识的客观存在,与病人自身感受密切相关;在书面,是主体理论,从一般意义反映某种疾病性质。病机是疾病本质,临床疾病现象和本质的关系不是机械的线性关系,把握本质需要认知症状内涵的病机意义值,使症状从自然客观转化为带有主体认知逻辑的证候标识。证候标识是证候病机的证据,由病机要素标识、病标识有机构成。症状的病机要素标识意义是最基本的,根据其与病机的关系,可分为正值症状和负值症状。症状和证候标识存在主次关系、同异关系和多样关系、归一关系。

云南烟草丛枝症病害研究 Ⅶ 激素的变化

采用植物激素ＥＬＩＳＡ测定试剂盒，对比测定了烟草感染丛枝症的病株与健株体内细胞分裂素（ｉＰＡ和ＺＲ）与生长素（ＩＡＡ）含量的变化．结果表明：生长素含量在整个发病期间健株都较高于病株，细胞分裂素含量在发病初期明显高于健株，随后呈下降趋势并趋于稳定，Ｃ／Ａ值在病程中相对处于较高水平．

浙江省麻风可疑症状监测系统卫生经济学评价

目的:评价麻风可疑症状监测系统研究项目的经济学意义。方法:采用成本—效果、成本-效用、成本-效益分析的方法,对浙江省麻风可疑症状监测系统研究项目的资料进行卫生经济学评价。结果:浙江省麻风可疑症状监测系统研究项目共投入成本157.23万元。疾残发生率较前下降了43.48%:麻风患者平均误诊次数下降了1.8次;平均延迟期缩短了18.1个月,节省医疗费用、交通费、DALY等约2158.18万元。结论:麻风可疑症状监测系统的应用可降低畸残率,减轻麻风患者的经济负担,具有重要的经济学意义。

果树酸害的症状及生理敏感性

研究了葡萄、柑桔等１５种果树的酸害症状表现，并以Ｅｂｅｒｈａｒｔ－Ｒｕｓｓｅｌｌ模型分析了果树酸害的生理敏感性差异，结果表明：①叶片伤斑大多出现在叶脉之间，初期表现为失绿，呈水渍状，且边界模糊。伤斑颜色因果树不同而异，有黑褐色、棕色、灰白色等。受害重时导致伤斑穿孔或落叶。②不同果树对酸雨胁迫的相对敏感性不同：猕猴桃等５种果树属敏感类型；葡萄、樱桃属于中等敏感类型；枇杷等８种果树的相对敏感性较低。③ｐＨ ２．５～３．０是大多数果树产生显性伤害的酸度阈值，而ｐＨ３．５可作为隐性伤害阈值的参考。

内蒙古大型真菌毒菌物种多样性及药用价值

报道了内蒙古自治区东部地区大型真菌毒菌种类99种,其中子囊菌5种、担子菌94种,15种具有抑制肿瘤作用,5种为剧毒菌,分别为灰花纹鹅膏菌(Amanita fuliginea)、栗色环柄菇(Lepiota castanea)、褐鳞环柄菇(Lepiota helveola)、毒粉褶菌(Rhodophyllus sinuatus)、白霜杯伞(Clitocybe dealbata)。分别描述了每种毒菌的中毒类型和药用价值。

经颅黑质超声及非运动症状评估对早期帕金森病的诊断价值

目的探讨经颅黑质超声、非运动症状评估及两者联合在早期帕金森病患者中的诊断应用价值。方法纳入早期帕金森病患者65例(帕金森病组)和健康体检者53例(对照组),分析2组经颅黑质超声和非运动症状评估量表的差异,分别计算两种方法以及它们联合诊断帕金森病的敏感性、特异性和阳性预测值。结果帕金森病组经颅黑质超声示,黑质强回声阳性比例和非运动症状量表评分阳性比例较对照组明显增高。经颅黑质超声、非运动症状评估量表的敏感性、特异性和阳性预测值分别为64.6%、88.6%、87.5%和52.3%、84.9%、80.9%。联合使用两项指标的敏感性、特异性和阳性预测值为43.1%、96.2%、93.3%。结论联合使用经颅黑质超声及非运动症状评估可提高早期帕金森病的诊断特异性。