目的 比较吻合器痔上黏膜环切术(PPH)与传统痔切除术(Milligan-Morgan，MM)治疗混合痔的临床疗效。方法 200例混合痔患者中行PPH和MM治疗各100例，比较2组患者的疗效及并发症。结果 PPH在疗效及术后并发症发生方面与MM组比较，差异均无统计学意义（P＞0.05）。结论 在治疗混合痔方面PPH不优于MM。
Abstract: Objective To compare the multiple organ dysfunction score (MODS), the sequential organ failure assessment (SOFA), the acute physiology, age, and chronic health evaluation system Ⅱ(APACHE Ⅱ), the acute physiology, age, and chronic health evaluation system Ⅲ(APACHE Ⅲ) in evaluating risks for patients after cardiac surgery, in order to provide better treatment and prediction of prognosis after cardiac operation. Methods A prospective study was carried out on 1 935 cardiac postoperative patients, including 1 050 males and 885 females, enrolled in cardiac postoperative intensive care unitof Anzhen hospital between October 2007 and April 2008. The age of the patients ranged from 18 to 86 years with the mean age of 53.96 years. The patients underwent the surgery because of various cardiac diseases including coronary heart disease, valve disease, congenital heart disease, aortic aneurysm, pericardial disease, atrial fibrillation, and pulmonary embolism. We used MODS, SOFA, APACHE Ⅱ, and APACHE Ⅲ respectively to calculate the value of the first day after operation, the maximum value during the first three days, the maximum value, and the change of the value between the third day and the first day for every patient, and then we compared the calibration and discrimination of these different systems using HosmerLemeshow goodnessoffit analysis and Receiver Operating Characteristic (ROC) curve. Results There were 47 perioperative deaths because of circulating system failure, respiration failure, kidney failure, liver failure or nervous system diseases. The death rate was 2.43%. In discrimination analysis, the area under the curve (AUC) in ROC of the first day value after operation, the maximum value, the maximum value during the first three days, and the change of value between the third day and the first day for MODS were respectively 0.747, 0.901, 0.892, and 0.786; for SOFA were respectively 0.736, 0.891, 0.880, and 0.798; for APACHE Ⅱ were respectively 0.699, 0.848, 0,827, and 0.562; for APACHE Ⅲ were respectively 0.721, 0.872, 0.869, and 0.587. In calibration analysis, we compared the χ2 value of the first day value, the maximum value, the maximum value during the first 3 days, and the change of value between the third day and the first day of these systems. χ2 value of MODS was 4.712, 5.905, 5.384, and 13.215; χ2 value of SOFA was 8.673, 3.189, 3.111, and 14.225; χ2 value of APACHE Ⅱ was 15.688, 10.132, 8.061, and 42.253; χ2 value of APACHE Ⅲ was 13.608, 11.196, 19.310, and 47.576. AUC value of MODS and SOFA were all larger than those of APACHE Ⅱ and APACHE Ⅲ (Plt;0.05); AUC value of APACHE Ⅱ was smaller than that of APACHE Ⅲ (Plt;0.05). Conclusion MODS, SOFA, APACHE Ⅱ and APACHE Ⅲ are all applicable in evaluating risks for patients after cardiac surgery. However, MODS and SOFA are better than APACHE Ⅱ、APACHE Ⅲ in predicting mortality after cardiac surgery. In cardiac surgery, the complicated APACHE Ⅱ and APACHE Ⅲ systems can be replaced by MODS and SOFA systems which are simpler for use.
Objective To investigate the applied significance of adjustable low-concentration of mixed oxygenand nitrous oxide inhalation sedation combined with lidocaine local anesthesia in anorectal surgery. Methods Three hundreds patients underwent anorectal surgery in our hospital were divided into control group （n=154） and observation group （n=146）. Patients of control group underwent pure lidocaine local anesthesia， and patients of observation group underwent mixed oxygen and nitrous oxide sedation analgesia combined with lidocaine local anesthesia. Vital signs before and after operation as well as results of sedation and analgesia were compared between the 2 groups. Results Anorectal surgeries of all patients were performed successfully. There were no significant differences on change of heart rate， blood pressure， and oxygen saturation between the 2 groups before and after operation （P＞0.05）. The operation time between the control group 〔（36.3±6.8） min〕 and observation group 〔（35.4±6.5） min〕 had no statistically significant difference（t=-0.607， P=0.544）. The analgesic effects （Z=-6.859， P=0.000） and sedative effects （Z=-5.275， P=0.000） of obser-vation group were both better than those of control group. Conclusions Low-concentration of mixed oxygen and nitrous oxide inhalation sedation combined with lidocaine local anesthesia can relieve the discomfort of fear and pain， no side-impacts on vital sign before and after operation were observed，and it has better effects of sedation and analgesia， therefore it can be recommended to clinical application.
Wavelet entropy is a quantitative index to describe the complexity of signals. Continuous wavelet transform method was employed to analyze the spontaneous electroencephalogram (EEG) signals of mild, moderate and severe Alzheimer's disease (AD) patients and normal elderly control people in this study. Wavelet power spectrums of EEG signals were calculated based on wavelet coefficients. Wavelet entropies of mild, moderate and severe AD patients were compared with those of normal controls. The correlation analysis between wavelet entropy and MMSE score was carried out. There existed significant difference on wavelet entropy among mild, moderate, severe AD patients and normal controls (P<0.01). Group comparisons showed that wavelet entropy for mild, moderate, severe AD patients was significantly lower than that for normal controls, which was related to the narrow distribution of their wavelet power spectrums. The statistical difference was significant (P<0.05). Further studies showed that the wavelet entropy of EEG and the MMSE score were significantly correlated (r=0.601-0.799, P<0.01). Wavelet entropy is a quantitative indicator describing the complexity of EEG signals. Wavelet entropy is likely to be an electrophysiological index for AD diagnosis and severity assessment.
目的比较单孔腹腔镜与传统腹腔镜胆囊切除术的临床效果。 方法选取2012年9月至2013年5月期间于我院就诊的胆囊良性疾病患者，分别接受单孔腹腔镜胆囊切除术（单孔腹腔镜组，45例）和传统腹腔镜胆囊切除术（传统腹腔镜组，48例），分别观察并对比2组患者的手术时间、术中出血量、术后（6 h和24 h）疼痛评分、止疼药物的应用率、术后住院时间及患者对切口的满意度。 结果2组患者术前的一般特征差异无统计学意义（P＞0.05）。单孔腹腔镜组的手术时间明显长于传统腹腔镜组〔（59.11±14.15）min比（40.21±11.11）min，P=0.00〕，术后6 h疼痛评分及止痛药物应用率均明显低于传统腹腔镜组〔6 h疼痛评分：（3.33±1.41）分比（4.60±1.30）分，P=0.00；止痛药物应用率：6.67%（3/45）比31.25%（15/48），P=0.04〕，术后患者对切口的满意度评分明显高于传统腹腔镜组〔（4.76±6.00）分比（2.60±0.76）分，P=0.02〕。单孔腹腔镜组和传统腹腔镜组的术中出血量、术后24 h疼痛评分及术后住院时间比较差异均无统计学意义〔术中出血量：（14.67±4.80）mL比（13.85±3.85）mL，P=0.36；24 h疼痛评分：（1.60±0.65）分比（1.80±0.70）分，P=0.14；术后住院时间：（3.11±0.77）d比（3.06±0.67）d，P=0.75〕。2组均无并发症发生。 结论单孔腹腔镜较传统腹腔镜胆囊切除术可减轻术后疼痛，美容效果好，且并不增加手术风险。
ObjectiveTo analyze the policy environment of clinical research in China, providing valuable insights for the formulation and enhancement of policies. MethodsAt the national level in our country, policies related to clinical research were selected as the research subject. The method of text mining was employed to extract high-frequency words from policy texts. By constructing the policy modeling consistency (PMC) index model, evaluations of the relevant policies regarding clinical research in our country were quantified from multiple dimensions including internal consistency, effectiveness, and scope of influence. ResultsThe average PMC index of 22 clinical research policies in our country was 6.87. Among them, 10 policies demonstrated an excellent performance, while 12 policies were considered qualified. This suggested that the overall quality of clinical research policies at the national level was good, yet there was still considerable room for improvement. ConclusionPolicies regarding clinical research have entered a high-speed development stage and exhibit basic completeness in China. However, these policies appear somewhat independent of each other and inadequate rule of law.
Evidence serves as the driving force shifting medical practice from empirical medicine towards evidence-based medicine. In the current era of information explosion, it is challenging for clinical surgeons to extract evidence from the vast pool of primary research literature to address clinical issues. Literature reviews, as a form of synthesized evidence, are particularly crucial for precise and efficient evidence utilization. A new form of review within the framework of evidence-based medicine, systematic reviews, also has widespread application in the surgical domain. With the development of methodological approaches in evidence-based medicine, the types of systematic reviews continue to diversify. This paper outlines and summarizes the common types and methodologies of systematic reviews in the surgical field, aiming to provide a clear framework for surgical practitioners to select evidence for both confirming and innovating clinical practices in specific clinical challenges.
目的 观察两种手术方式治疗翼状胬肉的临床效果。 方法 对2007年1月－2012年6月一般情况较好的73例单纯原发性双眼翼状胬肉患者进行了回顾性研究，比较同一患者双眼分别行翼状胬肉切除+生物羊膜移植（左眼）和翼状胬肉切除+自体角膜缘干细胞移植（右眼）手术后痊愈率、复发率及并发症。 结果 行翼状胬肉切除+自体角膜缘干细胞移植（右眼）的痊愈率达93.15%，复发率1.37%，并发症率5.48%，其痊愈率更高而复发率及并发症均更低。 结论 翼状胬肉切除+自体角膜缘干细胞移植用于治疗翼状胬肉比翼状胬肉切除+人工羊膜移植的疗效更好，值得临床推广。
The integral and individual-scale wavelet entropy of electroencephalogram (EEG) were employed to investigate the information complexity in EEG and to explore the dynamic mechanism of child absence epilepsy (CAE). The digital EEG signals were collected from patients with CAE and normal controls. Time-frequency features were extracted by continuous wavelet transformation. Individual scale power spectrum characteristics were represented by wavelet-transform. The integral and individual-scale wavelet entropy of EEG were computed on the basis of individual scale power spectrum. The evolutions of wavelet entropy across ictal EEG of CAE were investigated and compared with normal controls. The integral wavelet entropy of ictal EEG is lower than inter-ictal EEG for CAE, and it also lower than normal controls. The individual-scale wavelet entropies of 12th scale (centered at 3 Hz) of ictal EEG in CAE was significantly higher than normal controls. The individual-scale wavelet entropies for α band (centered at 10 Hz) of ictal EEG in CAE were much lower than normal controls. The integral wavelet entropy of EEG can be considered as a quantitative parameter of complexity for EEG signals. The complexity of ictal EEG for CAE is obviously declined in CAE. The wavelet entropies declined could become quantitative electrophysiological parameters for epileptic seizures, and it also could provide a theoretical basis for the study of neuromodulation techniques in epileptic seizures.