Objective To determine the affected factors of intraorbital hemodynamic results in diabetic retinopathy (DR) and the risk factors related to the occurrence of DR. Methods Posterior ciliary artery (PCA), central retinal artery (CRA), central retinal vein (CRV), and vortex vein (VV) of 68 patients with DR were measured by color Doppler flow image (CDFI). Thirty-one hemodynamic parameters, including systolic velocity, diastolic velocity, mean velocity, resistive index, pulsatility index and accelerative velocity of ophthalmic artery (OA), and other variates (blood pressure, blood sugar, gender, age, duration of the disease, and so on) were collected and clustered in a principal components analys is following a forward, stepwise logistic regression on these components. Results Nine principal components were extracted from 37 original variates, reflecting the velocity of OA, velocity of PCA, resistance of OA, velocity of CRA,resistance of CRA, resistance of PCA, time-related factor, venous drainage factor and gender factor, respectively. In the result of logistic regression, resistance of OA, velocity of CRA, resistance of PCA, time-related factor, and venous drainage factor were the risk factors related to DR. Conclusion The first risk factor affecting DR is time, and intraorbital hemodynamic abnormity influencing the development of diabetic retinopathy may be the increase of resistance of OA, decrease of velocity of CRA, decrease of resistance of PCA, and increase of venous drainage. (Chin J Ocul Fundus Dis，2004，20：98-100)
ObjectiveTo compare the differences in the learning curve and surgeon's perception for pulmonary lobectomy performed by a single surgeon using the da Vinci surgical robot versus a domestically-made robotic system. Methods A retrospective analysis was conducted on the clinical data of the first 70 consecutive patients who underwent lobectomy with the da Vinci robot and the first 70 with a domestic robot. All procedures were performed by a single thoracic surgeon at Gansu Provincial Hospital who initiated the use of both systems concurrently between 2021 and 2024. Data were analyzed using SPSS 26.0, and learning curves for both groups were plotted and analyzed using the cumulative sum (CUSUM) method. Results The da Vinci group included 41 males and 29 females with a mean age of (66.0±6.83) years and the domestic robot group included 42 males and 28 females;with a mean age of (65.09±6.14) years. For the da Vinci group, the mean operative time was (196.14±29.63) min. The CUSUM learning curve was best fitted by a cubic equation (R2=0.986; CUSUM=0.012X3?1.799X2+69.149X?59.239, where X was the surgical volume), which peaked at the 26th case, delineating the learning and mastery phases. Statistically significant differences were observed between these phases in operation time, setup time, console time, intraoperative blood loss, postoperative day 1 drainage, and number of lymph nodes dissected (all P<0.01). For the domestic robot group, the mean operative time was (187.57±24.62) min. Its CUSUM learning curve also followed a cubic fit (R2=0.910; CUSUM=0.008X3?1.152X2+40.465X+91.940), peaking at the 18th case. Significant improvements between the learning and mastery phases were also found for the same surgical metrics (all P<0.05). The surgeon's perception score was significantly higher for the da Vinci system compared to the domestic system (4.21±0.88 vs. 3.29±1.02, P<0.05). ConclusionCUSUM analysis effectively distinguishes the learning and mastery phases for both systems. The learning curve for da Vinci robotic lobectomy is overcome after 26 cases, whereas the domestic robot required 18 cases. In the mastery phase, operative time, setup time, intraoperative blood loss, and postoperative day 1 drainage are significantly lower, while the number of lymph nodes dissected is significantly higher compared to the learning phase for both systems. There are no significant differences in short-term efficacy or safety between the two groups. However, the da Vinci system provids a superior surgeon experience.
Objective To analyse the content and structure of the health management policy text for chronic obstructive pulmonary disease (COPD) in China, and to provide a reference for the optimization and improvement of subsequent relevant policies. Methods We searched for relevant policy documents on COPD health management at the national level from January 2017 to December 2023, constructed a two-dimensional analysis framework for policy tools and chronic disease health management processes, coded and classified policy texts, and used content analysis method to analyze policy texts. Results Twenty-four policy texts were included. There were 183 codes for policy tool dimension, with supply based, environmental based, and demand based tools accounting for 43.72%, 47.54%, and 8.74%, respectively. There were 124 codes for the dimension of health management processes, with health information collection and management accounting for 12.10%, risk prediction accounting for 14.52%, intervention and treatment accounting for 66.13%, and follow-up and effectiveness evaluation accounting for 7.26%. Conclusions At present, the proportion of policy tools related to the management of COPD in China needs to be dynamically adjusted. Environmental tools should be appropriately reduced, the internal structure of supply tools should be optimized, the driving effect of demand tools should be comprehensively enhanced, the coupling of COPD health management processes should be strengthened, and the relevant policy system and overall quality should be continuously improved.
OBJECTIVE: To investigate the therapeutic effect of flap transplantation in repairing soft tissue defects of children. METHODS: From January 1997 to May 2002, 75 cases of different soft tissue defects (52 males and 23 females, with the age of 3-14 years) were repaired by axial and non-axial flaps transfer, and axial flaps transplantation by microvascular anastomosis. The flaps area ranged from 3 cm x 5 cm to 15 cm x 42 cm. Emergency operation was performed in 26 cases and secondary operation in 49 cases (infective wound such as osteomyelitis and plate extra-exposed of fracture). The defect regions included the forearm, back of the hand, thumb, index finger, leg and foot. The types of flap graft and application range included 39 cases of axial flaps transfer or transplantation (27 cases of along- or contra-transfer of transplantation and 12 cases of microvascular anastomosis). The non-axial flaps transfer were designed along- or contra-transfer near the wound area in 36 cases. The ratio of length to width was 2.5:1-3.5:1 in 27 cases, and larger than 3.5:1 in 9 cases. Adequate anesthesia method should be chosen according to the characteristics of children, non-traumatic operating during surgery and postoperative supervision and nursing of flaps should also be paid enough attention. RESULTS: After operation, blood circulation crisis occurred in 2 cases (1 case of artery failure and 1 case of vein failure). The flaps survived in 37 cases and partially survived in 1 case and necrosed in 1 case. The survival rate was 96.2%. The postoperative follow-up period was 3 to 60 months, the blood supply, elasticity and texture of flaps were good. The effect of repair was satisfactory. CONCLUSION: Different types of transplantation of blood-supply of flaps may repair the different types of soft tissue defects in children. Free flap transplantation is safe and beneficial in children, different defects of soft tissue were repaired by axial and non-axial flaps transfer, axial flaps transplantation by microvascular anastomosis. Non-traumatic operating and postoperative supervision and nursing of flaps should also be paid enough attention.
摘要:目的:評價孟魯司特用于過敏性鼻炎的臨床療效和安全性。方法:計算機檢索PubMed、維普及CNKI數據庫,手工收集有關孟魯司特用于過敏性鼻炎治療的臨床研究,根據納入和剔除標準匯集文獻,采用Jadad量表進行納入文獻質量評價,對總體治療有效性使用Revman4.2軟件進行Meta分析。結果:療效評價共納入9個臨床隨機對照研究共650例。有效率孟魯司特組高于對照組,異質性檢驗顯示各亞組及其合并總有效率P值均大于0.1,I2lt;50%,采用固定效應模型計算。2周時孟魯司特組和對照組無統計學差異(Pgt;0.1),但2月、3月時二組均有顯著性統計學差異(Plt;0.000 01),三個亞組綜合分析孟魯司特組和對照組有顯著性統計學差異(Plt;0.000 01),不良反應差異無統計學意義。結論:現有臨床證據顯示孟魯司特較傳統抗過敏藥物對過敏性鼻炎的治療有效,但由于納入研究存在選擇性偏倚和測量性偏倚的可能性,勢必影響結果的論證強度。故期待更多高質量的隨機雙盲對照試驗性研究,以提供更高質量的證據。Abstract: Objective: To evaluate montelukast for allergic rhinitis clinical efficacy and safety. Methods: We searched the PubMed,VIP and CNKI databases, manual collection of clinical study about allergic rhinitis treatment of montelukast, based on inclusion and exclusion criteria for pooling of literature, Jadad scale used for quality assessment of the literature. Then use Revman4.2 Meta analysis software to evaluate the overall effectiveness. Results: Nine RCT clinical study have been included, The results showed that montelukast group was higher than control group on efficient control, Heterogeneity test showed that the subgroup and its total effective rate is Pgt;01,I2lt;50%. Therefore, we adopted a fixed effects model. After 2 weeks montelukast group and the control group no significant difference (Pgt;0.1). But after 2,3 month the two groups were statistically significant differences(Plt;0.000 01). On a comprehensive analysis of the three subgroups, montelukast group and the control group statistically significant differences(Plt;0.000 01), adverse drug reactions was no significant difference. Conclusion: The available clinical evidence to show that montelukast for the treatment of allergic rhinitis and effective, However, due to the existence of selection and measurement bias, This may affect the outcome of the argument strength.Therefore look forward to more highquality randomized and doubleblind controlled trials to provide highquality evidence.
Objective To explore the change of EEG waveform recorded by clinical EEG under different filtering parameters. Methods22 abnormal EEG samples of epilepsy patients with abundant abnormal waveforms recorded in Peking University first hospital were selected as the case group (abnormal group), and 30 normal EEG samples of healthy people with matched sex and age were selected as the control group (normal group). Visual examination and power spectrum analysis were then performed to compare the difference of wave forms and spectrum power under different settings of filter parameter between the two groups. ResultsThe results of visual examination show that, lower high-frequency filtering has an effect on the fast wave composition of EEG and may distort and reduce the spike wave. Higher low-frequency filtering has an effect on the overall background and slow wave activity of EEG and may change the amplitude morphology of some slow waves. The results of power spectrum analysis show that, Compare the difference between the EEG normal group and the abnormal group, the main difference under the settings of 0.5~70Hz was on the θ and α3 frequency band, different brain regions were slightly different. In the central region, the difference in the high frequency band (α3, γ1, γ2) decreases or disappears with the decrease of the high frequency filtering. In the rest of the brain, the difference in the δ band appears gradually with the increase of the low frequency filtering. Compare the difference between frontal area and occipital area under different filter set, for the normal group, under the settings of 0.5 ~ 70 Hz, the difference between two regions is mainly on the θ, γ1 and γ2 band. When high frequency filter reduces, the difference between two regions on high frequency band (γ1, γ2) are gradually reduced or disappeared. And when low frequency filter increases, the difference on δ band appears. For the abnormal group, the difference between frontal and occipital region under the settings of 0.5 ~ 70 Hz is mainly on γ1 and γ2 bands. When the high-frequency filter decreases, the difference between two regions on high-frequency bands are gradually decreased or disappeared. All the results can be corrected by FDR. ConclusionThe results show that the filter setting has a significant influence on EEG results. In clinical application, we should strictly set 0.5 ~ 70 Hz bandpass filtering as the standard.
Cardiovascular disease (CVD) is one of the leading causes of death worldwide. Heart sound classification plays a key role in the early detection of CVD. The difference between normal and abnormal heart sounds is not obvious. In this paper, in order to improve the accuracy of the heart sound classification model, we propose a heart sound feature extraction method based on bispectral analysis and combine it with convolutional neural network (CNN) to classify heart sounds. The model can effectively suppress Gaussian noise by using bispectral analysis and can effectively extract the features of heart sound signals without relying on the accurate segmentation of heart sound signals. At the same time, the model combines with the strong classification performance of convolutional neural network and finally achieves the accurate classification of heart sound. According to the experimental results, the proposed algorithm achieves 0.910, 0.884 and 0.940 in terms of accuracy, sensitivity and specificity under the same data and experimental conditions, respectively. Compared with other heart sound classification algorithms, the proposed algorithm shows a significant improvement and strong robustness and generalization ability, so it is expected to be applied to the auxiliary detection of congenital heart disease.
ObjectiveTo systematically review the efficacy of different nucleosides (acids) in preventing hepatitis B virus reactivation after chemotherapy in cancer patients. MethodsThe Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of different nucleosides (acids) to prevent HBV reactivation after chemotherapy in cancer patients from inception to June 7th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Network meta-analysis was then performed by using Stata 16.0 software. ResultsA total of 43 RCTs involving 3 269 patients were included. There were 7 interventions, namely entecavir (ETV), lamivudine (LAM), adefovir dipivoxil (ADV), telbivudine (LdT), tenofovir dipivoxil (TDF), lamivudine combined with entecavir (LAM+ETV), and lamivudine combined with adefovir dipivoxil (LAM+ADV). The results of network meta-analysis showed that the efficacy of reducing the reactivation rate of ETV, LAM, ADV, LdT, TDF, LAM+ETV, LAM+ADV were superior than the control group. The ETV, LAM and ADV were not as effective as LAM+ETV. The leading drug combinations were LAM+ETV (94.8%), LdT (81.5%) and LA+ADV (58.0%). ConclusionsCurrent evidence shows that LAM+ETV, LdT, and LA+ADV are more effective in preventing hepatitis B virus reactivation after chemotherapy in cancer patients. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo systematically review the correlation between HDL-C level and lung cancer. MethodsSuch databases as PubMed, EBSCO, ISI Web of Science, The Cochrane Library (Issue 8, 2015), VIP, and CNKI Data were electronically searched from inception to September 23th, 2015 to collect studies about the correlation between HDL level and lung cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 12.0 software. ResultsFifteen studies involving 2 015 lung cancer patients and 15 505 controls were finally included. The results of meta-analysis showed that the total HDL-C level in the lung cancer group was lower than that in the control group (SMD=-0.68, 95%CI-0.97 to -0.40, P=0.000). Further subgroup analysis showed that the incidence of lung cancer of different clinical classification (SMDⅠ~Ⅱ=-0.65, 95%CI -1.07 to -0.23, P=0.002; SMDⅢ~Ⅳ=-0.61, 95%CI -0.73 to -0.50, P=0.000), different pathological types (the small cell lung cancer excluded) (SMDAC=-0.76, 95%CI -1.13 to -0.38, P=0.000; SMDSC=-1.51, 95%CI -2.47 to -0.56, P=0.010; SMDSCLC=-1.19, 95%CI -1.42 to -0.95, P=0.000), different quality scores (SMD≥6 score=-0.60, 95%CI -0.89 to -0.29, P=0.000; SMD< 6 score=-0.77, 95%CI -1.48 to -0.0, P=0.015), the number of different studies (SMD≥100 cases=-0.48, 95%CI -0.80 to -0.15, P=0.004; SMD< 100 cases=-0.80, 95%CI -1.33 to -0.27, P=0.003), smoking (SMD=-1.47, 95%CI -2.51 to -0.43, P=0.006) and Asia (SMD=-0.92, 95%CI -1.21 to -0.63, P=0.000) was correlated with the level of HDL-C. ConclusionThe level of HDL-C is related to the incidence of lung cancer, and low HDL-C level may increase the risk of lung cancer. In view of the limitations of the studies, the above conclusions need a great many large samples and adjust the smoking status of the prospective cohort study at home and abroad to verify.
ObjectiveTo systematically review the prevalence and risk factors of the chronic post-cesarean section pain (CPCSP). MethodsPubMed, EMbase, The Cochrane Library, CINAHL, PsycInfo, CBM, WanFang Data, VIP, and CNKI databases were electronically searched to collect studies on the prevalence and risk factors of CPCSP from inception to August 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 15.1 software. ResultsA total of 43 studies involving 12 435 participants were included. The results of meta-analysis showed that the prevalence of CPCSP for 2 to 5 months, 6 to 11 months, and at least 12 months were 19% (95%CI 15% to 23%), 13% (95%CI 9% to 17%), and 8% (95%CI 6% to 10%), respectively. The risk factors included preoperative pain present elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety, postpartum depression, etc. ConclusionsThe current evidence shows that the overall prevalence of CPCSP is high. Preoperative pain presents elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety and postpartum depression may increase the risk of CPCSP.