目的：探讨高龄老人临终治疗方式和地点需求的选择，为临床更好的开展临终关怀护理服务，提高患者生存质量，建立完善的临终关怀服务体系提供科学依据。方法：结合相关量表自行设计问卷对204名80岁以上的住院患者进行调查。结果：在选择临终治疗方式时，依次为对症治疗、听取医生的安排、选择不治疗、希望继续高技术治疗、听取子女们的安排。选择临终地点时，依次为愿意在医院、在家中和在养老院渡过生命的最后时光。结论：高龄老人的临终需求是多元化的，因此，在临床工作中应针对不同的需求提供个性化护理。
【摘要】目的探讨喉癌手术后患者对两种不同雾化方式的耐受性,为选择最佳雾化方式提供参考。方法将49例喉癌手术后患者随机分为观察组(25例)和对照组(24例),观察组采用氧气雾化吸入,对照组采用空气压缩泵雾化吸入。分别记录两组患者雾化吸入前及吸入15 min时脉搏血氧饱和度(SpO2)及心率;雾化过程中患者有无心慌、气紧等不适以及雾化后痰液的性质及量。采用SPSS 13.0软件进行统计分析。结果两组患者雾化吸入15 min时的SpO2差异有统计学意义(Plt;001),观察组高于对照组;而两组患者雾化吸入前SpO2、心率、不适主诉及雾化后痰液的性质差异均无统计学意义(Pgt;005)。结论氧气雾化吸入可以提高喉癌手术后患者雾化过程中的SpO2,使患者感觉更加舒适。【Abstract】Objective To investigate postoperative patients with laryngeal carcinoma atomization of two different forms of tolerance, in order to choose the best means of atomization. Methods Fifty postoperative patients with laryngeal carcinoma were divided into observation group using oxygen inhalation and control group using the air compression pump inhalation. Two groups of patients were recorded the value of SpO2 and heart rate before 15 minutes after the inhalation,as well as the discomforts such as flustered,gas tight during the atomization process and the nature and olume of sputum. Results The results of two groups of patients at the time of 15 minutes inhalation SpO2 statistically significant difference (Plt;001), the observation group than in the control group average SpO2 high; and two groups of patients with preinhalation SpO2 average, average heart rate, Discomfort chief complaint and the nature of sputum after aerosol compared no significant difference (Pgt;005). Conclusion Oxygen inhalation in patients with laryngeal cancer can improve the atomization process SpO2 value, so that patients feel more comfortable.
Lung cancer is one of the malignant tumors with the greatest threat to human health, and studies have shown that some genes play an important regulatory role in the occurrence and development of lung cancer. In this paper, a LightGBM ensemble learning method is proposed to construct a prognostic model based on immune relate gene (IRG) profile data and clinical data to predict the prognostic survival rate of lung adenocarcinoma patients. First, this method used the Limma package for differential gene expression, used CoxPH regression analysis to screen the IRG to prognosis, and then used XGBoost algorithm to score the importance of the IRG features. Finally, the LASSO regression analysis was used to select IRG that could be used to construct a prognostic model, and a total of 17 IRG features were obtained that could be used to construct model. LightGBM was trained according to the IRG screened. The K-means algorithm was used to divide the patients into three groups, and the area under curve (AUC) of receiver operating characteristic (ROC) of the model output showed that the accuracy of the model in predicting the survival rates of the three groups of patients was 96%, 98% and 96%, respectively. The experimental results show that the model proposed in this paper can divide patients with lung adenocarcinoma into three groups [5-year survival rate higher than 65% (group 1), lower than 65% but higher than 30% (group 2) and lower than 30% (group 3)] and can accurately predict the 5-year survival rate of lung adenocarcinoma patients.
Objective To explore the characteristics of vibration response imaging ( VRI) among heavy smokers whose pulmonary function is normal. Methods 67 heavy smokers with normal pulmonary function, 60 healthy non-smokers, and 60 patients with COPD were recruited. History taking, physical examination, lung function test, chest X-ray, and VRI examination were performed. The difference of VRI dynamic imaging between the three groups was analyzed. Results VRI vibration energy curve which appeared low, flat, sunken-in, and single peak accounted for 43.3% , 16.4% , 16.4% , and 14.9% respectively in the heavy smokers, accounted for 6.7% , 3.3% ,0% , and 0% respectively in the healthy nonsmokers, accounted for 60% , 33.3% , 18.3% , and 16.7% respectively in the COPD patients. The results between the heavy smokers and the healthy non-smokers were significantly different. Compared with the heavy smokers, the COPD patients exhibited more low and flat in expiration period. The energy peak value ratio of inspiration and expiration phase in the heavy smokers, the healthy non-smokers, and the COPD patients were 0.56,0.74, and 0.54 respectively. There was no significant difference between the heavy smokers and the COPD patients in peak value ratio of inspiration and expiration phase. Conclusion The vibration energy curve of the VRI in heavy smokers with normal pulmonary function is significantly different fromhealthy nonsmokers, but there is no significant difference between heavy smokers and COPD patients.
【摘要】 目的 分析临床实习对护理本科生专业认同的影响，探讨提高专业认同的措施。 方法 2010年6—10月，对某综合性大学60名2007级普通全日制护理本科生进行抽样调查，评价其实习前1个月和实习后3个月的专业认同情况，比较实习前、后的变化并分析影响因素。 结果 实习后专业认同的专业价值观得分[（3.13±0.85）分]高于实习前[（2.78±1.00）分]，实验专业期望得分[（12.09±2.13）分]低于实习前[（13.13±1.30）分]，差异有统计学意义（P=0.045，0.002）；而专业认识、情感、意志、技能和专业认同总分方面，实习前、后差异无统计学意义（Pgt;0.05）；其影响因素由强到弱依次为:带教老师（37.04%）、实际的护理工作（33.33%）、实习科室（22.22%）、他人态度（7.41%）。 结论 临床实习可提高护理本科生的专业价值观，带教老师及实际护理工作对专业认同影响较大。【Abstract】 Objective To analyze the effect of clinical practice on student nurses’ professional identity and explore measures to develop their professional identity. Methods Convenience sampling was used to select 60 general full-time student nurses who entered a comprehensive university in 2007. Then we assessed their professional identity at the time of one month before, and three months after clinical practice, compared the two results, and analyzed the related factors. Results The score of professional value dimension after clinical practice was higher than before (3.13±0.85 vs. 2.78±1.00, P=0.045), while the professional expectation dimension was lower than before (12.09±2.13 vs. 13.13±1.30, P=0.002), and the differences in above-mentioned indexes were statistically significant. There was no statistical difference before and after clinical practice in professional knowledge, professional affection, professional volition, professional skill dimensions, and total score of professional identity (Pgt;0.05). The related factors in a order from b to weak were clinical teacher (37.04%), practice work (33.33%), training department (22.22%), and others’ attitudes (7.41%). Conclusion Clinical practice may improve professional values but impair professional expectations of the student nurses, and clinical teacher and practice work have a great effect on student nurses’ professional identity.
【摘要】 目的 探讨使用营养风险筛查（nutritional risk screening，NRS）2002与生理生化指标联合评估大肠癌患者术前营养及二者的定量关系。 方法 对2008年4月-2009年3月收治的367例大肠癌患者，用NRS 2002与生理生化指标分别评估其术前营养风险和营养状况，对其进行相关性分析。 结果 有28%的大肠癌患者术前即存在营养风险，各评价指标对营养不良状况的检出率存在差异（9.3%～31.6%），且NRS 2002营养风险评分与血红蛋白（r=-0.117，P=0.025）、血清前白蛋白（r=-0.205，P=0.046）、血清白蛋白（r=-0.175，P=00.001）、体量质指数（r=-0.231，P=0.000）均呈负相关。 结论 大肠癌患者术前即存在较高的营养风险和营养不良，且营养风险与术前营养状况有关。【Abstract】 Objective To assess the preoperative nutritional risks and status of patients with colorectal cancer by nutritional risk screening 2002 (NRS 2002) combined with physiological-biochemical indicators, and explore their quantitative relationship. Methods NRS 2002 combined with physiological-biochemical indicators were applied on the 367 patients with colorectal cancer in Gastrointestinal Surgery Center in West China Hospital between April 2008 and March 2009 to assess their nutritional risks and status, and correlation analysis was done to explore their quantitative relationship. Results Among all the patients, 28% had preoperative nutritional risks. Different physiological-biochemical indicators detected different rates of malnutrition (9.3% to 31.6%), and there was a negative correlation between NRS 2002 and such physiological-biochemical indicators as hemoglobin (r=-0.117,P=0.025), pre-albumin (r=-0.205,P=0.046), albumin (r=-0.175,P=0.001), and body mass index (r=-0.231,P=0.000). Conclusion Many colorectal cancer patients have preoperative nutritional risks and malnurtrion, and the nutritional risks are correlated with preoperative nutritional status.
Objective To explore the factors associated with clinic follow-up of old patients with colorectal cancer and provide more evidence to improve the efficiency and quality of clinic follow-up after sugery. Methods The data of 253 patients who were underwent sugery because of old colorectal cancer in our hospital from January 2009 to May 2010 were reviewed. Data about the rate and times of clinic follow-up within 6 months after operation were collected via Hospital Information Systerm, then the follow-up rate was calculated, and to analyse the possible factors associated with follow-up times and rate. Results The total follow-up rate was 84.2%（213/253）, and the total times of follow-up was between 0 to 24 times per one, （4.08±0.03）times on average. On the times of follow-up, patients inside the city was higher than that outside, patients with medical or postoperative complications were higher than those without, and patients with a stoma was lower than that without, and the differences were statistically significant （P＜0.05）.While on the follow-up rate, patients underwent a radical sugery or with a stoma were lower than those not or without, and the differences were statistically significant （P＜0.05）. Conclusions The clinic follow-up of old colorectal cancer patients is not satisfactory, and the possible factors associated with follow-up times or rate are the distance between residence and hospital, have medical complications or not, have postoperative complications or not, radical sugery or not, and with a stoma or without.
Objective To explore the clinical characteristics, diagnose and treatment of bronchiolitis obliterans (BO) associated with lymphoma and paraneoplastic pemphigus (PNP). Methods One patient with BO associated with lymphoma and paraneoplastic pemphigus was presented and literatures which searched through Wanfang Med online and PubMed on this subject were reviewed. Results A 44-year-old woman was admitted to this hospital because of oral ulcer for two years, and persistent dyspnea for fourteen months. She had been diagnosed with PNP one year earlier. Pulmonary function displayed severe obstructive ventilator dysfunction, negative response to the bronchodilator. Chest CT showed bronchiolectasis. The ratio of neutrophils increased in bronchoalveolar lavage fluid. The pathology of ultrasound-guided neck and inguinal lymph node biopsy showed non-Hodgkin’s lymphoma. Based on the clinical presentation, the image and pathology of this patient, the diagnosis of having PNP with BO secondary to the lymphoma was made. After 10 cycles of CHOP chemotherapy, lymphoma and PNP went into remission, but the patient died from respiratory failure. The literatures were reviewed and 15 patients were found, out of them 60% (9/15) were female, 47% (7/15) follicular lymphoma and 47% (7/15) diagnosis of clinical BO which did not be supported by pathology. Lymphoma-PNP-BO was a clinical syndrome and 67% of the initial presentations were PNP. Patients died within 7 to 60 months. Conclusions BO associated with lymphoma and PNP is rare and the most common initial presentation is PNP. BO is the major cause of death. Treatments included chemotherapy, corticosteroid and immunosuppressor, lymphoma and PNP can be alleviated, but BO is aggravating.
ObjectiveTo provide reference for further treatment by analyzing the relationship between mutant genes of breast cancer and histological classification and molecular typing of breast cancer.MethodsRetrospectively collectted the pathological specimens of 46 breast cancer patients who treated by the Dongguan Maternal and Child Health Hospital and the Dongguan Houjie Hospital between February 2016 and August 2017 without chemotherapy. Among the selected 46 breast cancer patients, we detected tumor tissue estrogen receptor (ER)/ pregnancy hormone receptor (PR)/human epidermal growth factor receptor-2 (HER-2) status by immunohistochemistry and classified the pathological tissue section. By using multiple PCR techniques, we detected 207 hot mutation regions of the 50 extended tumor-related genes on the semiconductor sequencing platform.ResultsThere were 8 cases of grade Ⅰ, 18 cases of grade Ⅱ, 20 cases of grade Ⅲ in 46 breast cancer patients according to histological grade. Of the 46 cases, there were 23 cases of Luminal B, 9 cases of Luminal A, 9 cases of HER-2 (+), 5 cases of type besal-like according to ER/PR/HER-2 expression status. Moreover, we found that there were 33 gene locus mutations of 8 genes, including AKT1, APC, BRAF, CDKN2A, KRAS, PTEN, PIK3CA, and TP53. Among of them, the mutation of PIK3CA gene took the most of 24 cases, followed by TP53 (18 cases), 2 cases of CDKN2A gene mutation, and 1 case in the remaining four types of genes respectively. we found that the gene mutations of breast cancer were not related to the histological classification and molecular type (P>0.05), the PIK3CA gene mutation was related to the histological classification of breast cancer, the lower the histological classification level, the higher PIK3CA gene mutation rate (P<0.05). TP53 gene mutation was not related to histological grading and molecular type (P>0.05).Conclusions The PIK3CA gene mutation rate in patients with histological grading Ⅰ level increased significantly. The combination of PIK3CA gene mutation and histological grading of breast cancer may become a molecular biological indicator to judge the degree of malignancy and prognosis of breast cancer.
Subject recruitment is a key component that affects the progress and results of clinical trials, and generally conducted with eligibility criteria (includes inclusion criteria and exclusion criteria). The semantic category analysis of eligibility criteria can help optimizing clinical trials design and building automated patient recruitment system. This study explored the automatic semantic categories classification of Chinese eligibility criteria based on artificial intelligence by academic shared task. We totally collected 38 341 annotated eligibility criteria sentences and predefined 44 semantic categories. A total of 75 teams participated in competition, with 27 teams having submitted system outputs. Based on the results, we found out that most teams adopted mixed models. The mainstream resolution was applying pre-trained language models capable of providing rich semantic representation, which were combined with neural network models and used to fine-tune the models with reference to classifier tasks, and finally improved classification performance could be obtained by ensemble modeling. The best-performing system achieved a macro F1 score of 0.81 by using a pre-trained language model, i.e. bidirectional encoder representations from transformers (BERT) and ensemble modeling. With the error analysis we found out that from the point of data processing steps the data pre-processing and post-processing were very important for classification, while from the point of data volume these categories with less data volume showed lower classification performance. Finally, we hope that this study could provide a valuable dataset and state-of-the-art result for the research of Chinese medical short text classification.