Altman’s Z-Score模型在企业风险管理中的应用研究

随着市场竞争的加剧,信息化、高科技化进程的加快,企业决策难度、经营成本和收益的波动增大,企业风险管理彰显出重要性。笔者通过对沪、深证券交易所2007年～2009年暂停上市或终止上市的32家公司的Z值分析,认为用Altman’s Z-Score模型预测企业风险是有效的。根据对Altman’s Z-Score模型组成变量的比较分析,笔者提出了企业防范风险的有关措施。

Sequential organ failure assessment score is superior to other prognostic indices in acute pancreatitis

BACKGROUND Acute pancreatitis(AP)is a common surgical condition,with severe AP(SAP)potentially lethal.Many prognostic indices,including;acute physiology and chronic health evaluation II score(APACHE II),bedside index of severity in acute pancreatitis(BISAP),Glasgow score,harmless acute pancreatitis score(HAPS),Ranson’s score,and sequential organ failure assessment(SOFA)evaluate AP severity and predict mortality.AIM To evaluate these indices'utility in predicting severity,intensive care unit(ICU)admission,and mortality.METHODS A retrospective analysis of 653 patients with AP from July 2009 to September 2016 was performed.The demographic,clinical profile,and patient outcomes were collected.SAP was defined as per the revised Atlanta classification.Values for APACHE II score,BISAP,HAPS,and SOFA within 24 h of admission were retrospectively obtained based on laboratory results and patient evaluation recorded on a secure hospital-based online electronic platform.Data with<10%missing data was imputed via mean substitution.Other patient information such as demographics,disease etiology,and patient outcomes were also derived from electronic medical records.RESULTS The mean age was 58.7±17.5 years,with 58.7%males.Gallstones(n=404,61.9%),alcohol(n=38,5.8%),and hypertriglyceridemia(n=19,2.9%)were more common aetiologies.81(12.4%)patients developed SAP,20(3.1%)required ICU admission,and 12(1.8%)deaths were attributed to SAP.Ranson’s score and APACHE-II demonstrated the highest sensitivity in predicting SAP(92.6%,80.2%respectively),ICU admission(100%),and mortality(100%).While SOFA and BISAP demonstrated lowest sensitivity in predicting SAP(13.6%,24.7%respectively),ICU admission(40.0%,25.0%respectively)and mortality(50.0%,25.5%respectively).However,SOFA demonstrated the highest specificity in predicting SAP(99.7%),ICU admission(99.2%),and mortality(98.9%).SOFA demonstrated the highest positive predictive value,positive likelihood ratio,diagnostic odds ratio,and overall accuracy in predicting SAP,ICU admission,and mortality.SOFA and Ranson’s score demonstrated the highest area under receiver-operator curves at 48 h in predicting SAP(0.966,0.857 respectively),ICU admission(0.943,0.946 respectively),and mortality(0.968,0.917 respectively).CONCLUSION The SOFA and 48-h Ranson’s scores accurately predict severity,ICU admission,and mortality in AP,with more favorable statistics for the SOFA score.

Short-term efficacy of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy via Huang’s three-step maneuver for advanced upper gastric cancer: Results from a propensity scorematched study

BACKGROUND Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated procedures.AIM To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy(SPSHL)for advanced gastric cancer(GC)by Huang’s three-step maneuver.METHODS A total of 643 patients who underwent SPSHL were recruited from April 2012 to July 2017,including 35 patients who underwent robotic SPSHL(RSPSHL)and 608 who underwent laparoscopic SPSHL(LSPSHL).One-to-four propensity score matching was used to analyze the differences in clinical data between patients who underwent robotic SPSHL and those who underwent laparoscopic SPSHL.RESULTS In all,175 patients were matched,including 35 patients who underwent RSPSHL and 140 who underwent LSPSHL.After matching,there were no significant differences detected in the baseline characteristics between the two groups.Significant differences in total operative time,estimated blood loss(EBL),splenic hilar blood loss(SHBL),splenic hilar dissection time(SHDT),and splenic trunk dissection time were evident between these groups(P<0.05).Furthermore,no significant differences were observed between the two groups in the overall noncompliance rate of lymph node(LN)dissection(62.9%vs 60%,P=0.757),number of retrieved No.10 LNs(3.1±1.4 vs 3.3±2.5,P=0.650),total number of examined LNs(37.8±13.1 vs 40.6±13.6,P=0.274),and postoperative complications(14.3%vs 17.9%,P=0.616).A stratified analysis that divided the patients receiving RSPSHL into an early group(EG)and a late group(LG)revealed that the LG experienced obvious improvements in SHDT and length of stay compared with the EG(P<0.05).Logistic regression showed that robotic surgery was a significantly protective factor against both SHBL and SHDT(P<0.05).CONCLUSION RSPSHL is safe and feasible,especially after overcoming the early learning curve,as this procedure results in a radical curative effect equivalent to that of LSPSHL.

Short-term and long-term outcomes of laparoscopic vs open ileocolic resection in patients with Crohn's disease: Propensityscore matching analysis

BACKGROUND Laparoscopic ileocolic resection(LICR)is the preferred surgical approach for primary ileocolic Crohn’s disease(CD)because it has greater recovery benefits than open ICR(OICR).AIM To compare short-and long-term outcomes in patients who underwent LICR and OICR.METHODS Patients who underwent ICR for primary CD from 2006 to 2017 at a single tertiary center specializing in CD were included.Patients who underwent LICR and OICR were subjected to propensity-score matching analysis.Patients were propensityscore matched 1:1 by factors potentially associated with 30-d perioperative morbidity.These included demographic characteristics and disease-and treatment-related variables.Factors were compared using univariate and multivariate analyses.Long-term surgical recurrence-free survival(SRFS)in the two groups was determined by the Kaplan-Meier method and compared by the log-rank test.RESULTS During the study period,348 patients underwent ICR,211 by the open approach and 137 laparoscopically.Propensity-score matching yielded 102 pairs of patients.The rate of postoperative complication was significantly lower(14%versus 32%,P=0.003),postoperative hospital stay significantly shorter(8 d versus 13 d,P=0.003),and postoperative pain on day 7 significantly lower(1.4 versus 2.3,P<0.001)in propensity-score matched patients who underwent LICR than in those who underwent OICR.Multivariate analysis showed that postoperative complications were significantly associated with preoperative treatment with biologics[odds ratio(OR):3.14,P=0.01]and an open approach to surgery(OR:2.86,P=0.005).The 5-and 10-year SRFS rates in the matched pairs were 92.9%and 83.3%,respectively,with SRFS rates not differing significantly between the OICR and LICR groups.The performance of additional procedures was an independent risk factor for surgical recurrence[hazard ratio(HR):3.28,P=0.02].CONCLUSION LICR yielded better short-term outcomes and postoperative recovery than OICR,with no differences in long-term outcomes.LICR may provide greater benefits in selected patients with primary CD.

Multi-locus genetic risk score predicts risk for Crohn's disease in Slovenian population

AIM: To develop a risk model for Crohn&#x02019;s disease (CD) based on homogeneous population.METHODS: In our study were included 160 CD patients and 209 healthy individuals from Slovenia. The association study was performed for 112 single nucleotide polymorphisms (SNPs). We generated genetic risk scores (GRS) based on the number of risk alleles using weighted additive model. Discriminatory accuracy was measured by area under ROC curve (AUC). For risk evaluation, we divided individuals according to positive and negative likelihood ratios (LR) of a test, with LR &#x0003e; 5 for high risk group and LR &#x0003c; 0.20 for low risk group.RESULTS: The highest accuracy, AUC of 0.78 was achieved with GRS combining 33 SNPs with optimal sensitivity and specificity of 75.0% and 72.7%, respectively. Individuals with the highest risk (GRS &#x0003e; 5.54) showed significantly increased odds of developing CD (OR = 26.65, 95%CI: 11.25-63.15) compared to the individuals with the lowest risk (GRS &#x0003c; 4.57) which is a considerably greater risk captured than in one SNP with the highest effect size (OR = 3.24). When more than 33 SNPs were included in GRS, discriminatory ability was not improved significantly; AUC of all 74 SNPs was 0.76.CONCLUSION: The authors proved the possibility of building accurate genetic risk score based on 33 risk variants on Slovenian CD patients which may serve as a screening tool in the targeted population.

Midnight Salivary Cortisol and Other Effective Factors in the Graduation of Clinical Suspect of Cushing Syndrome: Is There Any Reasonable Clinical Score?

Background: Diagnosis of Cushing’s Syndrome (CS) at the right time and with the right method is getting more important for the patients and clinicians due to high mortality rate. The most appropriate laboratory test will provide great benefits in terms of cost-effectiveness in the well-chosen group of patients. Selection of the high risk group is of crucial importance for the true diagnosis and treatment on time. Aim: The aim of this study was to evaluate the worth of the midnight salivary cortisol and to establish other effective factors in the graduation of clinical suspect of CS. Material and Methods: 115 patients were evaluated in weight, height, body mass index (BMI), waist/hip ratio, systolic, diastolic blood pressures, hirsutism, weight gain, purple-stria, plethore, buffalo-hump, supraclavicular fullness, temporal fat cushion, acnea, moonface, proximal muscle weakness, lower limb edema, ecchymosis, loss of libido, depression, diabetes mellitus, hypertension, allopecia of all patients were noted in the evaluation forms (23 findings). Patients were grouped according to clinical scores, low (16). Results: When we compare the groups in terms of midnight salivary cortisol, morning salivary cortisol after overnight dexamethasone suppression test, we found statistically significant relationship between the low and high clinical score groups, as well as between medium and high score groups (p: 0.0001). Urinary free cortisol was statistically significant only between low and high clinical score groups (p: 0.0001). Conclusion: This clinical scoring system which includes clinical signs and laboratory findings both, can be used for selection of the high risk group.

Nutech functional score: A novel scoring system to assess spinal cord injury patients

AIM To develop a new scoring system, nutech functional scores(NFS) for assessing the patients with spinal cord injury(SCI).METHODS The conventional scale, American Spinal Injury Association's(ASIA) impairment scale is a measure which precisely describes the severity of the SCI.However, it has various limitations which lead to incomplete assessment of SCI patients.We have developed a 63 point scoring system, i.e., NFS for patients suffering with SCI.A list of symptoms either common or rare that were found to be associated with SCI was recorded for each patient.On the basis of these lists, we have developed NFS.RESULTS These lists served as a base to prepare NFS, a 63 point positional(each symptom is sub-graded and get points based on position) and directional(moves in direction BAD → GOOD) scoring system.For non-progressive diseases, 1, 2, 3, 4, 5 denote worst, bad, moderate, good and best(normal), respectively.NFS for SCI has been divided into different groups based on the affected part of the body being assessed, i.e., motor assessment(shoulders, elbow, wrist, fingers-grasp, fingers-release, hip, knee, ankle and toe), sensory assessment, autonomic assessment, bed sore assessment and general assessment.As probability based studies required a range of(-1, 1) or at least the range of(0, 1) to be useful for real world analysis, the grades were converted to respective numeric values.CONCLUSION NFS can be considered as a unique tool to assess the improvement in patients with SCI as it overcomes the limitations of ASIA impairment scale.

The Application of the Emerging Market Score Model in China During the Global Crisis Period： A Countertrend

The global economic crisis that blew up at the end of 2006 in the United States has had extremely negative impacts on the social, political, and economic fields. The countries operating in the most affected macro areas---the United States and Europe---have put through the wringer the domestic trade relationships as well as the international ones, by injecting a chain reaction into the global economic scenario. However, there are countries that seem to be free from the economic and financial contagion overflowing over the past years, as they are moved by an ＂invincible projection toward the growth＂. The present study aims to analyze how much the main emerging market of China has been effectively involved in this vicious circle. More specifically, the study intends to propose an empirical analysis on the real connection between the macroecnnomic data and the strong structure of the Chinese publicly listed companies. This paper investigates the prediction of failure among 3,220 Chinese publicly traded companies （listed companies） during the global crisis period. By analysing the financial accounting data over the past seven years （2008 to 2014）, the emerging market score （EMS） has been adopted in order to investigate the impact of the crisis on financial distress in the main emerging market of China. The results confirm the following hypotheses： On one hand, the great majority of companies have not been suffering the downturn, since 71.93% of the entire samples present no risk of financial distress during the global crisis; on the other hand, only 6.18% have a reasonable risk of financial distress.

Assessing gestational age of babies: Performance of obstetric ultrasound scan compared to that from the combination of Naegle’s rule and Dubowitz score in the 21st century

Background: Some researchers have suggested that when Naegle’s rule (NR) and Dubowitz score (DS) are combined, it could out-perform obstetric ultrasound scan (USS). Others still believe that obstetric USS alone is still effective relative to the combination of NR rule and DS in assessing the gestational age (GA) of babies. Objectives: To determine and compare the GA of babies using obstetric USS, NR and DS;and to provide relevant public health information on obstetric USS in the 21st century. Methods: Subjects were selected using systematic random sampling and the GA of babies was determined using obstetric USS, NR, and DS. Statistical package for social science (SPSS) statistical software version 16, Illinois, Chicago USA was used for all data analysis. Results: Eightyfive mother-baby pairs were studied. Forty-four babies (52%) were males and 41 (48%) females. Sixty four (75%) were term with a mean (SD) BW of 3.02 (0.59) at 95%CI (2.89 -?3.14) kg. The overall mean GA of the babies was 38.49 (2.89) at 95%CI (38.14 -?38.85) weeks. The mean GA using obstetric USS, NR and DS were 38.52 (1.98) at 95%CI (38.14 -?38.99), 38.09 (4.13) at 95%CI (37.20-?38.99) and 38.82 (2.02) at 95%CI (38.39 -?39.26), but comparison of these means was not significant (p = 0.256). Combined mean GA by NR and DS was 38.46 (3.26) at 95%CI (37.96 -?38.95). Comparing this mean with mean GA obtained by obstetric USS was also not significant (p = 0.885). Conclusion: The GA assessments by Obstetric USS, NR and DS were all reliable, and Obstetric USS performed effectively relative to combined NR and DS.

臂丛颈丛神经阻滞麻醉联合瑞芬太尼在锁骨骨折中的应用及对OAA/S评分、VAS评分的影响

目的:观察臂丛颈丛神经阻滞麻醉联合瑞芬太尼用于锁骨骨折手术的效果。方法:选取吉安市永丰县中医院2019年1月~2022年11月就诊的锁骨骨折患者140例为研究对象,按照收治的先后顺序随机分为试验组和对照组各70例,对照组予以臂丛颈丛神经阻滞麻醉,试验组在对照组基础上加用瑞芬太尼。记录两组麻醉前(T0)、臂丛颈丛神经阻滞麻醉后15 min(T1)、辅助用药后3 min(T2)、手术开始后5 min(T3)、手术开始后15 min(T4)、手术结束时(T5)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO 2)。同时观察两组期间的不良反应以及血管活性药麻黄碱、阿托品、尼卡地平以及艾司洛尔的例数。比较两组患者麻醉满意度的差异。结果:对照组T2时血压降低、心率减慢均不明显,与T0比较差异无统计学意义(P>0.05)。试验组T3、T4时血压升高、心率增快明显,与T0和对照组比较差异有统计学意义(P<0.05)。试验组T2血压降低、心率减慢明显,与对照组和T0比较差异有统计学意义(P>0.05),随后趋于平稳。试验组血管活性药物尼卡地平以及艾司洛尔的例数少于对照组,差异有统计学意义(P<0.05)。两组视觉模拟评分(VAS)及镇痛效果满意率比较差异有统计学意义(P<0.05)。结论:臂丛颈丛神经阻滞麻醉联合瑞芬太尼用于锁骨骨折切开复位内固定手术,镇静镇痛效果确切,呼吸循环稳定,患者麻醉满意度高,是一种安全、有效的麻醉方法。

Comprehensive effects of traditional Chinese medicine treatment on heart failure and changes in B-type natriuretic peptide levels: A meta-analysis

BACKGROUND Heart failure(HF),a common cardiovascular condition,is characterized by significant morbidity and mortality.While traditional Chinese medicine(TCM)is often used as a complementary approach in HF management,systematic evalua-tions of its impact on clinical outcomes,TCM syndrome scores,and B-type natriuretic peptide(BNP)levels are lacking.This study fills this gap through a comprehensive analysis of randomized controlled trials(RCTs)focusing on TCM for HF treatment.It encompasses an assessment of methodological quality,a meta-analysis,and an evaluation of evidence quality based on established standards.The results offer crucial insights into the potential advantages and constraints of TCM in HF management.RCTs on TCM for HF treatment published since the establishment of the database were searched in four Chinese and English databases,including China National Knowledge Infrastructure,Wanfang,VIP Information Chinese Science and Technology Journal,and PubMed.Methodological quality was assessed for the included studies with the Cochrane risk-of-bias assessment tool,and the meta-analysis and publication bias assessment was performed with the RevMan5.3 software.Finally,the quality of evidence was rated according to the GRADE criteria.RESULTS A total of 1098 RCTs were initially retrieved.After screening,16 RCTs were finally included in our study,which were published between 2020 and 2023.These RCTs involved 1660 HF patients,including 832 in the TCM group[TCM combined with conventional Western medicine(CMW)treatment]and 828 in the CWM group(CWM treatment).The course of treatments varied from 1 wk to 3 months.TCM syndrome differentiation was analyzed in 11 of the included RCTs.In all included RCTs,outcome indicators included comprehensive clinical outcomes,TCM syndrome scores,and BNP levels.The meta-analysis results showed significant differences between the TCM and CWM groups in terms of comprehensive clinical outcomes[risk ratio=-0.54;95%confidence interval(CI)=-0.61,-0.47;P<0.00001],TCM syndrome scores[weighted mean difference(WMD)=-142.07;95%CI=-147.56,-136.57;P<0.00001],and BNP levels(WMD=-142.07;95%CI=-147.56,-136.57;P<0.00001).According to the GRADE criteria,RCTs where"TCM improves clinical comprehensive outcomes"were rated as low-quality evidence,and RCTs where"TCM reduces TCM syndrome scores"or"TCM decreases BNP levels"were rated as medium-quality evidence.CONCLUSION TCM combined with CWM treatment effectively improves comprehensive clinical outcomes and diminishes TCM syndrome scores and BNP levels in HF patients.Given the low and medium quality of the included RCTs,the application of these results should be cautious.

血清S-100β、BUN联合APACHE Ⅱ评分评估老年脓毒症患者预后的价值

目的:探讨血清中枢神经特异性蛋白β(S-100β)、血尿素氮(BUN)联合急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分评估老年脓毒症患者预后的价值。方法:选取2022年4月至2023年6月新余北湖医院收治的102例老年脓毒症患者,根据APACHE Ⅱ评分将其分为轻、中、重3组,按改良Rankin量表将患者分为预后良好组与预后不良组,比较各组S-100β、BUN、APACHE Ⅱ评分的差异,并分析S-100β、BUN与APACHE Ⅱ评分的相关性,以及三者评估老年脓毒症患者预后的价值。结果:重度组的S-100β、BUN、APACHE Ⅱ评分高于中、轻度组,预后不良组的S-100β、BUN、APACHE Ⅱ评分高于预后良好组(P<0.05);S-100β、BUN与APACHE Ⅱ评分呈正相关(r=0.458、0.479,P<0.05);ROC曲线分析显示,S-100β、BUN联合APACHEⅡ评分评估老年脓毒症患者预后的曲线下面积为0.928,高于三者单独评估。结论:S-100β、BUN联合APACHEⅡ评分对老年脓毒症患者预后有较高的评估价值。

血清组织蛋白酶S、胱抑素C水平与冠状动脉粥样硬化病变严重程度相关性的研究——附107例报告

目的:探讨冠状动脉粥样硬化性心脏病(冠心病)患者血清组织蛋白酶S(cathepsinS,CatS)及胱抑素C水平与冠状动脉病变程度的关系。方法:对155例疑诊心绞痛患者进行冠状动脉造影(coronary angiography,CAG),根据CAG结果分为冠心病组(107例)及对照组(48例),测定所有入选者的空腹血清CatS、胱抑素C水平,采用Gensini积分对冠状动脉病变程度进行评价并分析它们之间的关系。结果:冠心病组血清CatS、胱抑素C水平较对照组高(P(0.01),前者上升幅度更大,血清CatS水平与Gensini积分呈正相关(r=0.69,P(0.01),Logistic回归分析剔除年龄、性别、收缩压、血清总胆固醇等因素后,此相关性仍存在(r=0.71,P(0.01)。结论:冠心病患者的血清CatS、胱抑素C的水平增高,且CatS与冠状动脉粥样硬化病变程度密切相关,说明CatS及胱抑素C可能参与细胞外基质重塑的过程。

早期针刺对创伤性脑损伤大鼠血清GFAP和S-100B蛋白水平的影响

目的观察针刺对创伤性脑损伤(TBI)大鼠血清胶质纤维酸性蛋白(GFAP)和S-100B蛋白水平的影响,评估针刺对创伤性脑损伤的疗效。方法按随机数字表法随机将120只雄性SD大鼠随机分成3组,每组40只:假手术组、模型组、针刺组。假手术组只开骨窗,不进行模型制备;模型组和针刺组制备TBI模型;针刺组造模后即接受针刺治疗,每日1次。术后6 h、1 d、3 d、5 d 4个时间点每组均随机选出10只大鼠进行血清GFAP、S-100B蛋白水平和改良的神经功能缺损(m NSS)评分观察与检测。结果相较假手术组,模型组6 h即检测到血清GFAP和S-100B蛋白水平升高(P<0.01)。伤后6 h、1 d检测发现针刺组GFAP水平比同期模型组降低(P<0.05),伤后6 h、1 d、3 d检测发现针刺组S-100B蛋白水平比同期模型组显著降低(P<0.01)。4个检测时间点上,模型组大鼠m NSS评分均高于同期假手术组(P<0.01),针刺组评分显著低于同期模型组(P<0.05或P<0.01)。结论 TBI早期采用针刺干预可明显减轻大鼠脑损伤的程度。

基于B/S结构的考试成绩管理与分析系统的设计与实现

本文对基于B/S结构的考试成绩管理与分析系统的设计及其相关问题进行了探究,重点探讨了该系统结构与功能,论述了设计过程中的关键问题的解决方法。

模糊S-P表在学生测验结果评价中的应用

项目质量分析既是试题质量评价的重要组成部分,又是对试题进行修订、筛选、积累或建立题库的必要条件,针对项目难度分析中学生测验结果常用的S-P表方法中0-1记分法的局限性,应用模糊数学中的隶属度进行改进和完善,通过实例分析,结果令人满意,从而进一步拓展了原S-P表的使用范围,对教学质量评价的定量分析,具有较高的实际应用价值。

莱文征结合TIMI危险评分对急性胸痛患者的筛选急性冠脉综合征(ACS)的研究

目的：莱文征结合心肌梗死溶栓疗法危险评分（TIMI 危险评分）与单独运用 TIMI 危险评分比较，探讨两种方法在急性胸痛患者筛选急性冠脉综合征（ACS）的临床价值。方法对171例胸痛患者随机分成试验组81例（TIMI 危险评分＋莱文征阳性）与对照组90例（TIMI 危险评分），根据患者的 TIMI 危险评分值，将其分成低分组（0～2分）、中分组（3～4分）与高分组（5～7分），在3个分值段内分别比较单独应用 TIMI 危险评分与 TIMI危险评分联合莱文征阳性对 ACS 发生率的差异性。结果TIMI 危险评分低分组中，用试验组方法13例，3例诊断为 ACS，筛查率为23．08％，用对照组方法11例，2例诊断为 ACS，筛查率为18．18％。两者进行χ2检验，差异无统计学意义（P ＞0．05）；TIMI 危险评分高分组患者中，用试验组方法41例，33例诊断为 ACS，筛查率为80．49％，用对照组方法46例，35例诊断为 ACS，筛查率为76．09％，进行χ2检验，差异无统计学意义（P ＞0．05）；在 TIMI危险评分中分组（3～4分）患者中，用试验组方法27例，20例诊断为 ACS，筛查率为74．07％。用对照组方法33例，17例诊断为 ACS，筛查率为51．52％。两者进行χ2检验，差异有统计学意义（P ＜0．05）。在中分组中，运用TIMI 危险评分联合莱文征与冠脉造影术这一金指标进一步比较后，发现运用 TIMI 危险评分联合莱文征诊断ACS 的敏感性为86．84％，特异性为90．91％，诊断符合率为88．33％（P ＜0．001）。结论TIMI 危险评分结合莱文征后，在中分组急性冠脉综合征的发生率比单独运用 TIMI 危险评分的发生率高，与单独运用 TIMI 危险评分系统相比，可以更好地预测 ACS 的发生，可以作为在急性胸痛患者筛选急性冠脉综合征的一项简单、有效工具。

醒脑静对急性脑梗死患者血清S-100B蛋白的影响

目的:探讨醒脑静对急性脑梗死患者血清S-100B蛋白水平和临床症状的影响。方法:入选157例急性脑梗死患者随机分为两组,常规治疗相同,治疗组用醒脑静30mg静脉滴注,每天2次,对照组用注射用水,方法疗程同治疗组,共治疗14d。分别在入院0,24,48,72,96,120和144h采血,用ELISA法测定血浆S-100B水平;分别在0,1,2,4和14d进行美国国立卫生卒中量表(NIHSS积分)评定。结果:治疗组与对照组的S-100B水平均在第4天达到高峰,从入院后96h开始,两组的S-100B水平出现显著统计学差异(P<0.05),7d治疗后两组患者血清S-100B水平有极显著统计学差异(P<0.01),醒脑静治疗组的S-100B水平明显低于对照组;两组NIHSS分数均随着治疗时间的增加而呈现下降趋势,在入院1,4,7和14d有显著统计学差异(P<0.05),治疗组在第1,4,7和14d时的NIHSS总分明显低于对照组。结论:醒脑静可改善NIHSS积分,改善神经功能,降低血清蛋白S-100B水平。

金融排斥对农户收入的影响——基于PSM方法的经验分析

从贷款、储蓄、证券和关系4个维度构建金融排斥指标,采用倾向得分匹配法分析了4种类型的金融排斥对中国农户收入的影响。研究发现:证券排斥对农户收入的影响最大,储蓄排斥、贷款排斥和关系排斥的影响依次递减;证券排斥和储蓄排斥对东部地区农户收入的冲击较大,贷款排斥和关系排斥对西部地区农户收入的影响较大。指出:高收入地区应注重开发涉农金融产品,低收入地区应保证提供基础信贷;应实施分类瞄准的普惠性金融政策。

改良aEEG评分联合S-100β和GFAP对儿童癫痫性脑病早期诊断价值的分析

目的 探讨改良振幅整合脑电图(aEEG)评分联合中枢神经特异蛋白S100β(S-100β)和神经胶质纤维酸性蛋白(GFAP)对儿童癫痫性脑病早期诊断的价值。方法 选择2018年1月至2020年12月在新疆医科大学第一附属医院小儿神经内科就诊的癫痫持续状态患儿92例为研究对象。收集患儿的临床资料,在入院1~3d内行aEEG检查,入院24h内抽取空腹外周静脉血2mL检测S-100β和GFAP水平。根据有无癫痫性脑病将患儿分为癫痫性脑病组(34例)与非癫痫性脑病组(58例),比较两组的改良aEEG评分及S-100β、GFAP水平,并采用受试者工作特征(ROC)曲线评估各指标单独检测与联合检测对癫痫持续状态患儿癫痫性脑病的早期诊断价值。结果 在92例癫痫持续状态患儿中,有34例诊断为癫痫性脑病。癫痫性脑病组患儿的改良aEEG评分显著高于非癫痫性脑病组,S-100β和GFAP水平也显著高于非癫痫性脑病组,差异均有统计学意义(t值分别为3.411、7.261、6.579,P<0.05)。ROC曲线分析显示,改良aEEG评分及S-100β、GFAP水平对癫痫持续状态患儿癫痫性脑病早期诊断的截断值分别为8.10分、1.16μg/L、4.61ng/L,曲线下面积(AUC)分别为0.751、0.876、0.809,三者联合诊断的AUC为0.908,联合诊断效能均高于单独指标的检测(Z值分别为4.821、5.013、3.961,P<0.05)。结论 儿童癫痫性脑病可引起改良aEEG评分及S-100β、GFAP水平的改变,其均可作为儿童癫痫性脑病早期诊断指标,三者联合检测可提高诊断效能。