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Health Promotion and Disease Prevention as a Complement to Community Health Indicators

Application progress of venous pressure monitoring in arteriovenous fistula

Venous pressure monitoring is an important indicator for the arteriovenous fistula evaluation. Direct static venous pressure monitoring is recognized as the most accurate way of venous pressure monitoring, which is widely used in the functional monitoring, functional evaluation of arteriovenous fistula, the diagnosis of complications and the evaluation of surgical efficacy. Venous pressure monitoring has obvious advantages and disadvantages, so it is necessary to improve relevant knowledge to correctly guide clinical diagnosis and treatment. In this paper, the study of static venous pressure monitoring of arteriovenous fistula was summarized, in order to improve the understanding of the significance and clinical application of static venous pressure monitoring of arteriovenous fistula.

Value of Somatosensory Evoked Potential Monitoring in Cervical Spinal Cord Injury Patients

目的　探讨躯体感觉诱发电位（SEP）在颈脊髓损伤术前、术中监测的意义。 方法　纳入2010年1月－2012年4月治疗的241例颈脊髓损伤患者，术前按美国脊柱脊髓损伤协会（ASIA）评分并分级，确定损伤平面。术前与术中SEP监测，分析不同损伤分级以及不同损伤平面术前的波幅及潜伏期的差异，术中SEP监测以波幅下降＞50%和或潜伏期延长＞10%为预警标准。 结果　各损伤分级组术前SEP监测：A级组SEP波消失，呈一直线，而B、C、D、E级组均测出SEP波形，根据是否可测出SEP波形，可将A级与B、C、D、E及组区别。B、C、D级组之间波幅和潜伏期均无统计学意义（P＞0.05）。E级组较B、C、D级组波幅增高、潜伏期缩短，差异有统计学意义（P＜0.05）；不完全性颈脊髓损伤组内不同损伤平面组之间波幅和潜伏期差异均无统计学意义（P＞0.05）。术中SEP对脊髓功能损伤监测的灵敏度83.3%、特异度98.7%。其中术中：SEP阳性8例，真阳性5例，4例术者处理后波幅及潜伏期回复至正常范围，术后无新的神经功能损伤，另1例术者采取各种处理后波幅及潜伏期无恢复，术后神经功能损伤较术前加重；假阳性3例，1例麻醉师给予升高血压后波形恢复至正常，另2例经麻醉师调整麻醉深度后波形恢复正常，此3例术后无新的神经功能损伤。SEP阴性233例，真阴性232例，术后无新的神经功能损伤；假阴性1例，患者术中、术后波形未见异常，术后运动功能损伤程度较术前加重。 结论　① SEP能准确评估完全性和不完性颈脊髓损伤，但对不完全性颈脊髓损伤的损伤程度不能作出准确评估、也不能区分颈脊髓损伤的损伤平面；② 术中SEP监测能较好地反映颈脊髓功能完整性，对减少颈脊髓损伤术中发生医源性颈脊髓损伤风险具有重要意义。

一例发生强直持续状态成年Lennox-Gastaut综合征患者的治疗体会

重症监护病房呼吸机相关性事件监测结果与分析

目的了解重症监护病房（ICU）呼吸机相关性事件（VAE）的发生状况，为制定干预措施提供参考依据。 方法采用前瞻性监测方法，对2013年4月1日－7月31日所有入住ICU且使用机械通气时间＞2 d、年龄≥18岁的患者进行VAE监测，并与2012年同期呼吸机和相关性肺炎（VAP）监测情况进行比较。 结果监测到有效病例31例，共发生VAE 6例，发生率为19.35%；患者平均住院时间12 d，平均机械通气时间10 d；预后：存活25例，死亡6例，病死率为19.35%；抗菌药物使用率100%。2013年的VAE监测与2012年同期院内VAP目标性监测VAP千日感染率分别为2.83、29.57例/1 000导管日，差异有统计学意义（P＜0.05）。 结论VAE监测及其诊断标准客观量化、简单易行，但是否适用于我国ICU患者VAP的诊断，值得商榷。

2020 年 V1 版《NCCN 非小细胞肺癌临床实践指南》更新解读

Clinical effect of cortical electrode monitoring on intractable epilepsy caused by double pathology

ObjectiveTo investigate the clinical effect of Electro-Cortico-Graphy (ECOG) monitoring on refractory epilepsy caused by double pathology. MethodsA retrospective analysis was performed on 10 patients with refractory epilepsy who underwent surgical treatment in Hunan Brain Hospital from January 2020 to December 2021. The diagnosis of postoperative disease was dual pathology of medial temporal lobe sclerosis (MTS) and focal cortical dysplasia (FCD), and the effect of oral drugs was poor. All patients underwent full preoperative evaluation to determine the scope of excision of epileptogenic lesions. Cortical electrodes were used to monitor the location and scope of epileptic discharge during the operation. Epileptogenic lesions were excised, cortical heat cautery was performed, and then cortical EEG monitoring was performed to adjust the excision strategy. The patients were followed up for 24 to 48 months, and the prognosis was assessed according to the Engel scale. ResultsAmong the 10 patients, 1 patient had acute subdural hemorrhage after surgery, 1 patient had speech and naming disorders, but all of them were recovered at discharge. The other patients had no neurological defects such as intracranial infection, hemiplegia, aphasia, etc. Engel grade I was observed in 9 cases (90%) and Engel grade III was observed in 1 case (10%). ConclusionCortical electrode monitoring is safe and effective for refractory epilepsy caused by double pathological signs.

Establishment of predictive model for surgical site infection following colorectal surgery based on machine learning

ObjectiveTo establish a predictive model of surgical site infection (SSI) following colorectal surgery using machine learning.MethodsMachine learning algorithm was used to analyze and model with the colorectal data set from Duke Infection Control Outreach Network Surveillance Network. The whole data set was divided into two parts, with 80% as the training data set and 20% as the testing data set. In order to improve the training effect, the whole data set was divided into two parts again, with 90% as the training data set and 10% as the testing data set. The predictive result of the model was compared with the actual infected cases, and the sensitivity, specificity, positive predictive value, and negative predictive value of the model were calculated, the area under receiver operating characteristic (ROC) curve was used to evaluate the predictive capacity of the model, odds ratio (OR) was calculated to tested the validity of evaluation with a significance level of 0.05.ResultsThere were 7 285 patients in the whole data set registered from January 15th, 2015 to June 16th, 2016, among whom 234 were SSI cases, with an incidence of SSI of 3.21%. The predictive model was established by random forest algorithm, which was trained by 90% of the whole data set and tested by 10% of that. The sensitivity, specificity, positive predictive value, and negative predictive value of the model were 76.9%, 59.2%, 3.3%, and 99.3%, respectively, and the area under ROC curve was 0.767 [OR=4.84, 95% confidence interval (1.32, 17.74), P=0.02].ConclusionThe predictive model of SSI following colorectal surgery established by random forest algorithm has the potential to realize semi-automatic monitoring of SSIs, but more data training should be needed to improve the predictive capacity of the model before clinical application.

Treatment and surveillance for non-muscle-invasive bladder cancer in China: an evidence-based clinical practice guideline (2018 simplified version)

静脉胰岛素泵联合持续血糖监测系统对肝移植术后患者血糖控制的有效性及安全性：附 1 例报道

目的 总结 1 例肝移植患者术后使用胰岛素泵联合持续血糖监测系统（CGMS）进行血糖控制的有效性及安全性。 方法 回顾性分析笔者所在医院科室于 2015 年 11 月收治的 1 例肝移植患者的临床资料，该患者术后使用胰岛素泵联合 CGMS 进行血糖控制。 结果 本例患者的血糖控制时间为 4 127 min。血糖控制参数：最大值 9.8 mmol/L，最小值 4.7 mmol/L（自觉无头晕、乏力等低血糖症状），平均 6.9 mmol/L，目标血糖达标时间为4 030 min，占 98%。血糖变异参数：标准差（SD ）为 1.1 mmol/L，血糖不稳定指数为 7.32（mmol/L）2/（h·d），平均血糖波动幅度为 0，平均日内血糖改变为 3.4 mmol/L。控制期间营养情况：肠内营养的碳水化合物用量为 115 g，全胃肠外营养的碳水化合物用量为 516 g，胰岛素用量为 139 U（用量均值为 2 U/h），平均采样时间为 109 min。肝移植术后 3 周患者痊愈出院，术后 1 个月随访无不适，复查糖化血红蛋白为 4.9%。 结论 胰岛素泵联合 CGMS 的血糖控制效果较好，但该结论仍需要大样本、多中心及前瞻性的随机对照试验给予证实。