临床SYNTAX计分及其衍生计分在冠心病血运重建预后中的应用价值

冠状动脉粥样硬化性心脏病的不良预后常与冠状动脉复杂病变相关,而冠状动脉病变程度的评估在临床中经常应用冠状动脉造影计算。其中SYNTAX计分是一种基于冠状动脉病变的复杂性和严重性来指导治疗决策的计分系统,并且预测冠状动脉粥样硬化性心脏病患者的临床预后。但因SYNTAX计分只涉及解剖因素,对于预后有重要影响的临床因素却未纳入,降低了其预测能力,因此,在其基础上提出了临床SYNTAX计分的概念,现就该计分研究进展和临床应用进行综述。

沙美特罗替卡松改善老年支气管哮喘患者肺功能临床疗效观察

目的观察沙美特罗替卡松治疗老年支气管哮喘的临床疗效。方法将62例老年哮喘患者随机分为2组,对照组常规口服茶碱控释片;治疗组加用沙美特罗替卡松吸入。2组治疗前、后分别进行肺功能检测及临床症状计分,2组患者其他常规治疗均相同。结果治疗组与对照组比较,肺功能显著提高(P<0.01),临床症状计分明显下降(P<0.01);未发现明显副作用。结论沙美特罗替卡松能明显改善老年哮喘患者肺功能,减少哮喘发作次数,且安全性较好。

血小板胞浆钙离子与脑梗塞

为研究血小板活化程度与脑梗塞临床严重程度之间的关系，选择２６例健康对照者和３０例脑梗塞患者，以Ｍａｔｈｅｗ、Ｔｏｒｏｎｔｏ和Ｂａｒｔｈｅｌ计分代表临床严重程度，水母发光蛋白导入－凝胶过滤法测量血小板胞浆钙离子浓度。结果表明，脑梗塞组血小板胞浆钙离子浓度明显高于对照组，脑梗塞组是（２．８７±０．３５）μｍｏｌ／Ｌ，对照组是（２．０１±０．３１）μｍｏｌ／Ｌ，两组间有极显著差异（Ｐ＜０．００１）。血小板胞浆钙离子与３种临床计分之间均无明显相关性。脑梗塞组血小板胞浆钙离子明显升高，显示脑梗塞患者急性期血小板处于易激活状态。血小板胞浆钙离子与３种临床计分无明显相关，表明血小板活化指标不能预示临床严重程度。

中西医结合治疗重症肌无力对乙酰胆碱受体抗体和CD_4^+CD_(25)^+T调节免疫细胞的研究

目的:比较中西医结合治疗(包括免疫抑制剂和以补中益气汤为主的辩证加减联合治疗)和单纯免疫抑制剂治疗重症肌无力两种治疗方案的临床疗效和免疫调节细胞CD_4^+CD_(25)^+Tr的影响研究。方法:选择2006年1月—2008年1月在石家庄市第一医院住院治疗的明确诊断220例重症肌无力全身型患者。将患者随机分为两组即A组和B组,各组均有110例患者。A组治疗方法为免疫抑制剂(甲泼尼松龙和硫唑嘌呤)配伍中药重剂补中益气汤治疗;B组治疗方法为单纯免疫抑制剂(甲泼尼松龙冲击配伍硫唑嘌呤)治疗,监测两组患者治疗后6个月和18个月的乙酰胆碱受体抗体(AchRAb)值和免疫调节细胞CD_4^+CD_(25)^+Tr百分比的动态变化,同时用许氏评分法的相对临床计分来判定治疗后6个月和18个月的临床疗效。结果:(1)治疗后6个月:因各种原因没有完成治疗的出组患者A组3例,B组5例;(2)治疗前两组患者乙酰胆碱受体抗体(AchRAb)浓度值和CD_4^+CD_(25)^+Tr百分比比较,差异无统计学意义(P>0.05);(3)分别比较两组患者治疗后6个月的乙酰胆碱受体抗体(AchRAb)浓度值、CD_4^+CD_(25)^+Tr百分比、临床相对计分,其差异无统计学意义(P>0.05);(4)两组患者治疗后18个月,A组患者的乙酰胆碱受体抗体(AchRAb)浓度值明显低于B组,且差异有明显统计学意义(P<0.01);A组患者的CD_4^+CD_(25)^+Tr百分比明显高于B组,且差异具有明显的统计学意义;A组患者的临床相对计分50%以上的患者人数高于B组,两组相比差异有统计学意义(P<0.05)。结论:免疫抑制剂配伍重剂补中益气汤辨证加减治疗重症肌无力可使乙酰胆碱受体抗体(AchRAb)值下降更明显、CD_4^+CD_(25)^+Tr免疫调节细胞值明显升高,患者的临床完全缓解率高,且稳定而不易复发。

下肢静脉功能不全患者手术疗效评价与术后生活质量调查

目的评价下肢慢性静脉功能不全(chronic venous insufficiency,CVI)患者的手术疗效和术后生活质量。方法171例CVI患者(193条患肢)根据术式被分为A、B、C三组。采用临床严重程度计分(venous clinical severity score,VCSS)和生活质量调查表(chronic venous insufficiency questionnaire,CIVIQ)评价3种不同术式组术后的VCSS变化和生活质量状况。结果3组患者术后VCSS记分较术前均显著降低(P<0.01),术后3组间VCSS记分差别无统计学意义(P>0.05);三组术后CIVIQ均在80分以上,各组间差别无统计学意义(P>0.05)。结论根据患者病情选择合适术式,可以有效治疗CVI;应用VCSS和CIVIQ可以客观评价下肢CVI患者的手术疗效和生活质量。

Survival analysis of cholangiocarcinoma:A 10-year experience in Malaysia

AIM:To investigate the clinical features and survival of patients treated for cholangiocarcinoma in our institution and to analyze the factors affecting their survival.METHODS:This retrospective cohort study assessed patients diagnosed with cholangiocarcinoma between January 1997 and December 2007 at the University Malaya Medical Centre in Malaysia.The clinical data and associated outcomes were collected using a structured proforma.RESULTS:Of the 69 patients diagnosed with cholangiocarcinoma,38 (55%) were male;mean patient age was 61 years.Twelve patients (17%) had intrahepatic,38 (55%) had perihilar and 19 (28%) had distal tumors.Only 12 patients underwent curative surgery,including seven R0 resections.Only one patient died within 30 d after surgery.The overall median survival was 4 mo,whereas the median survival of R0 resected patients was 16 mo.The overall 1-,2-and 3-year cumulative survival rates were 67%,17% and 17%,respectively.Survival rates were significantly associated with curative resection (P=0.002),intrahepatic tumor (P=0.003),negative margin status (P=0.013),early tumor stage (P=0.016),higher tumor differentiation (P=0.032) and absence of jaundice (P=0.038).Multivariate analysis showed that tumor location was a significant independent predictor of patient survival.CONCLUSION:Curative,margin-negative resection of early stage,well-differentiated intrahepatic tumors is associated with improved patient survival.

Impact of comorbidities on the severity of chronic hepatitis B at presentation

AIM:To evaluate the clinical relevance of each cofactor on clinical presentation of chronic hepatitis B.METHODS:Out of 1366 hepatitis B surface antigen(HBsAg) positive subjects consecutively observed in 79 Italian hospitals,53(4.3%) showed as the only cofactor hepatitis D virus(HDV) infection [hepatitis B virus(HBV)/HDV group],130(9.5%) hepatitis C virus(HCV)(group HBV/HCV),6(0.4%) human immunodeficiencyvirus(HIV)(group HBV/HIV),138(10.2%) alcohol abuse(group HBV/alcohol);109(8.0%) subjects had at least two cofactors and 924 were in the cofactor-free(CF) group.RESULTS:Compared with patients in group CF those in group HBV/alcohol were older and more frequently had cirrhosis(P < 0.001),those in group HBV/HDV were younger(P < 0.001),more frequently resided in the south of the country and had cirrhosis(P <0.001),those in group HBV/HCV were older(P < 0.001) and more frequently had cirrhosis(P < 0.001).These cofactors were all independent predictors of liver cirrhosis in HBsAg positive patients.Multivariate analysis showed that an older age [odds ratio(OR) 1.06,95% CI:1.05-1.08],alcohol abuse with more than 8 drinks daily(OR 2.89,95% CI:1.81-4.62) and anti-HDV positivity(OR 3.48,95% CI:2.16-5.58) are all independently associated with liver cirrhosis.This association was found also for anti-HCV positivity in univariate analysis,but it was no longer associated(OR 1.23,95% CI:0.84-1.80) at multivariate analysis.CONCLUSION:Older age,HDV infection and alcohol abuse are the major determinants of severe liver disease in chronic HBV infection,while HCV replication plays a lesser role in the severity of hepatic damage.

Effect of Timing of Tracheotomy on Clinical Outcomes: an Update Meta-analysis Including 11 Trials

Objective To estimate the relative effect of early vs. late tracheotomy on clinical end-points in unselected intensive care unit （ICU） patients undergoing mechanical ventilation. Methods We searched electronic databases （up to February 27, 2013） for both randomized control trials and observational studies satisfying the predefined inclusion criteria.

A Non-inferiority Trial Design without Need for a Conventional Margin

The NI （non-inferiority） trial design based on the likelihood ratio test eliminates the dependency on the conventional NI margin, and it explicitly uses the MCID （minimum clinical important difference） that links the statistical analysis to the clinical sense. Different from the conventional trial design, the new methodology is self-adaptive to the change in the sample size and overall cure rate, and it has an asymptotic property. It is shown that MCID is de-composite into constant MCID and statistical MCID. Along with this concept, the concept of the allowed inferiority does not exist, the interpretation of the trial result is more accurate and consistent to the statistical theory as well as the clinical interpretations.

The history, hotspots, and trends of electrocardiogram

The electrocardiogram （ECG） has broad applications in clinical diagnosis and prognosis of cardiovascular disease. Many researchers have contributed to its progressive development. To commemorate those pioneers, and to better study and promote the use of ECG, we reviewed and present here a systematic introduction about the history, hotspots, and trends of ECG. In the historical part, information including the invention, improvement, and extensive applications of ECG, such as in long QT syndrome （LQTS）, angina, and myocardial infarction （MI）, are chronologi- cally presented. New technologies and applications from the 1990s are also introduced. In the second part, we use the bibliometric analysis me- thod to analyze the hotspots in the field of ECG-related research. By using total citations and year-specific total citations as our main criteria, four key hotspots in ECG-related research were identified from 11 articles, including atrial fibrillation, LQTS, angina and MI, and heart rate variability. Recent studies in those four areas are also reported. In the final part, we discuss the future trends concerning ECG-related research. The authors believe that improvement of the ECG instrumentation, big data mining for ECG, and the accuracy of diagnosis and application will be areas of continuous concern.

Myofibrillogenesis regulator-1 overexpression is associated with poor prognosis of gastric cancer patients

AIM: To investigate the expression of myofibrillogenesis regulator-1 (MR-1) in relation to clinicopathological parameters and postoperative survival in a group of Chinese patients with gastric cancer. METHODS: In our previous study of human wholegenome gene expression profiling, the differentially expressed genes were detected in the gastric cancer and its adjacent noncancerous mucosa. We found that MR-1 was associated with the location and differentiation of tumors. In this study, MR-1 protein expression was determined by immunohistochemistry in specimens of primary cancer and the adjacent noncancerous tissues from gastric cancer patients. A set of real-time quantitative polymerase chain reaction assays based on the Universal ProbeLibrary-a collection of 165 presynthesized, fluorescence-labeled locked nucleic acid hydrolysis probes-was designed specifically to detect the expression of MR-1 mRNA. The correlation was analyzed between the expression of MR-1 and other tumor characteristics which may influence the prognosis of gastric cancer patients. A retrospective cohort study on the prognosis was carried out and clinical data were collected from medical records. RESULTS: MR-1 mRNA and protein could be detected in gastric cancer tissues as well as in matched noncancerous tissues. MR-1 was up-regulated at both mRNA (5.459 ± 0.639 vs 1.233 ± 0.238, P < 0.001) and protein levels (34.2% vs 13.2%, P = 0.003) in gastric cancer tissues. Correlation analysis demonstrated that high expression of MR-1 in gastric cancer was significantly correlated with clinical stage (P = 0.034). Kaplan-Meier analysis showed that the postoperative survival of the MR-1 positive group tended to be poorer than that of the MR-1 negative group, and the difference was statistically significant (P = 0.002). Among all the patients with stageⅠ-Ⅳ carcinoma, the 5-year survival rates of MR-1 positive and negative groups were 50.40% and 12.70%, respectively, with respective median survival times of 64.27 mo (95%CI: 13.41-115.13) and 16.77 mo (95%CI: 8.80-24.74). Univariate and multivariate analyses were performed to compare the impact of MR-1 expression and other clinicopathological parameters on prognosis. In a univariate analysis on all 70 specimens, 6 factors were found to be significantly associated with the overall survival statistically: including MR-1 expression, depth of invasion, distant metastasis, lymph node metastasis, vascular invasion and the tumor node metastasis (TNM) stage based on the 7th edition of the International Union against Cancer TNM classification. To avoid the influence caused by univariate analysis, the expressions of MR-1 as well as other parameters were examined in multivariate Cox analysis. Clinicopathological variables that might affect the prognosis of gastric cancer patients were analyzed by Cox regression analysis, which showed that MR-1 expression and TNM stage were independent predictors of postoperative survival. The best mathematical multivariate Cox regression model consisted of two factors: MR-1 expression and TNM stage. Our results indicated that MR-1 protein could act as an independent marker for patient overall survival [Hazard ratio (HR): 2.215, P = 0.043]. CONCLUSION: MR-1 is an important variable that can be used to evaluate the outcome, prognosis and targeted therapy of gastric cancer patients.

Assessment of volumetric bone mineral density of the femoral neck in postmenopausal women with and without vertebral fractures using quantitative multi-slice CT

Objective： To demonstrate the validity and reliability of volumetric quantitative computed tomography （vQCT） with multi-slice computed tomography （MSCT） and dual energy X-ray absorptiometry （DXA） for hip bone mineral density （BMD） measurements, and to compare the differences between the two techniques in discriminating postmenopausal women with osteoporosis-related vertebral fractures from those without. Methods： Ninety subjects were enrolled and divided into three groups based on the BMD values of the lumbar spine and/or the femoral neck by DXA. Groups 1 and 2 consisted of postmenopausal women with BMD changes 〈-2SD, with and without radiographically confirmed vertebral fracture （n= 11 and 33, respectively）. Group 3 comprised normal controls with BMD changes 〉-ISD （n-46）. Post-MSCT （GE, LightSpeed16） scan reconstructed images of the abdominal-pelvic region, 1.25 mm thick per slice, were processed by OsteoCAD software to calculate the following parameters： volumetric BMD values of trabecular bone （TRAB）, cortical bone （CORT）, and integral bone （INTGL） of the left femoral neck, femoral neck axis length （NAL）, and minimum cross-section area （mCSA）. DXA BMD measurements of the lumbar spine （AP-SPINE） and the left femoral neck （NECK） also were performed for each subject. Results： The values of all seven parameters were significantly lower in subjects of Groups 1 and 2 than in normal postmenopausal women （P〈0.05, respectively）. Comparing Groups 1 and 2, 3D-TRAB and 3D-INTGL were significantly lower in postmenopausal women with vertebral fracture（s） [（109.8±9.61） and （243.3±33.0） mg/cm^3, respectively] than in those without [（148.9±7.47） and （285.4±17.8） mg/cm^3, respectively] （P〈0.05, respectively）, but no significant differences were evident in AP-SPINE or NECK BMD. Conclusion： the femoral neck-derived volumetric BMD parameters using vQCT appeared better than the DXA-derived ones in discriminating osteoporotic postmenopausal women with vertebral fractures from those without, vQCT might be useful to evaluate the effect of osteoporotic vertebral fracture status on changes in bone mass in the femoral neck.

Analysis on clinically drug-used law for lung-intestine related diseases

OBJECTIVE： To analyze the application laws of clini- cal drugs by descriptive statistical method with the clinical literatures guided by ＂lung being connect- ed with large intestine＂ used as the object. METHODS： Retrieve publicly published clinical litera- tures about ＂lung being connected with large intes- tine＂ in recent 30 years, establish the data base of clini- cal literature, and study on the clinically drug-used laws by descriptive statistical analytic method. RESULTS： The common high frequent drugs used for the lung-intestine related diseases were Gualou （Ructus Trichsanthis）, Dahuang （Radix et Rhizoma）, Kuxingren （Semen Armeniacae Amarum）, Gancao （Radix Glycyrrhizae）, Houpu （Cortex Magnoliae Offi- cinalis）, Zhishi （Fructus Aurantii Immaturus）. For the different clinical syndrome types, in the commonly used drugs there were different characteristics, re- flecting the principle of TCM syndrome differentia- tion treatment.CONCLUSION： The common high frequent drugs used for the lung-intestine related diseases are Gua- Iou （Fructus Trichsantffis）, Dahuang （Radix et Rhi- zoma）, Kuxingren （Semen Armeniacae Amarum）, Gancao （Radix Glycyrrhizae）, Houpu （Cortex Mag- noliae Officinalis）, Zhishi （Fructus Aurantii Immatu- rus）, which are commonly-used drugs for the lung-intestine related diseases ,with differences for different syndrome types.

Smartphones for sensing

Simple, portable analytical devices are entering our daily lives for personal care, clinical analysis, allergen detection in food, and environmental monitoring. Smart- phones, as the most popular state-of-art mobile device, have remarkable potential for sensing applications. A growing set of physical-co-chemical sensors have been embedded; these include accelerometers, microphones, cameras, gyroscopes, and GPS units to access and perform data analysis. In this review, we discuss recent work focusing on smartphone sensing including representative electromag- netic, audio frequency, optical, and electrochemical sen- sors. The development of these capabilities will lead to more compact, lightweight, cost-effective, flexible, and durable devices in terms of their performances.

Analysis of Clinical Syndromes in 47 Patients with Pancreatic Cancer at Late Stage

Objective:To analyze the law governing the distribution of traditional Chinese medicine(TCM) syndromes of pancreatic cancer.Methods:The authors used retrospective study to statistically analyze TCM syndromes of patients,separated complex syndromes and calculated the frequency of appearance of single syndromes.Results:The patients mainly suffered from 4 syndromes:blood stasis syndrome,qi stagnation syndrome,qi(yang) deficiency syndrome,and phlegm dampness syndrome.The distribution of syndromes is rarely related to sex,age and morbid site of patients.Conclusion:Owing to complicated distribution of its syndromes,pancreatic cancer should be diagnosed and treated according to its characteristics of deficiency in origin and excess in superficiality.

VARIABLE SELECTION FOR RECURRENT EVENT DATA WITH INFORMATIVE CENSORING

Recurrent events data with a terminal event （e.g., death） often arise in clinical and ob- servational studies. Variable selection is an important issue in all regression analysis. In this paper, the authors first propose the estimation methods to select the significant variables, and then prove the asymptotic behavior of the proposed estimator. Furthermore, the authors discuss the computing algorithm to assess the proposed estimator via the linear function approximation and generalized cross validation method for determination of the tuning parameters. Finally, the finite sample estimation for the asymptotical covariance matrix is also proposed.