Detecting inspiratory flow limitation with temporal features of nasal airflow

BackgroundInspiratory flow limitation is a breathing pattern during sleep caused by upper airway (UA) narrowing that occurs during snoring and various degrees of obstructive sleep apnea (OSA). Clinical examination of flow limitation relies on identifying patterns of airflow contour, however this process is subjective and lacks physiological evidence of UA narrowing. Our objective is to derive the temporal features of nasal airflow contour that characterize flow limitation. The features that correlate with UA narrowing can be used to develop machine learning classifiers to detect flow limitation with physiological support.MethodsSixteen healthy adult men underwent full daytime polysomnography where the nasal airflow was recorded. Before and after sleep, we measured UA anatomical parameters including neck circumference (NC) and upper-airway cross-sectional area (UA-XSA). We extracted various temporal features of airflow and investigated their relationships with the UA anatomical parameters.ResultsWe found that three features were correlated with the anatomical parameters associated with UA narrowing: deviation index vs. baseline UA-XSA (r = −0.67, p = 0.01), peak amplitude variability vs. baseline UA-XSA (r = −0.69, p < 0.01), peak amplitude variability vs. ΔNC (r = 0.74, p < 0.01) and peak number vs. baseline UA-XSA (r = −0.54, p = 0.04).ConclusionsTemporal features of airflow were associated with UA narrowing. Future studies could utilize the features to develop classifiers to detect flow limitation and assess the severity of breathing disorders during sleep in high-risk populations such as pregnant women and children.     

How representative are insomnia clinical trials?

ObjectivesTo address the question of how representative subjects studied in hypnotic clinical trials are of the broader insomnia population, this study assessed initial contact rates and reasons for inclusion and exclusion during recruitment to an efficacy trial and to a safety trial of Food & Drug Administration (FDA) approved hypnotics.MethodsOtherwise heathy persons meeting Diagnostic Statistical Manual, Fourth Edition, Revised (DSM-IVR) criteria for insomnia were recruited. In one study, persons 32–65 yrs, were invited to a 12 month trial of nightly use of zolpidem or placebo. In the other, persons 21–64 yrs with driver's licenses were recruited to test the effects of a hypnotic on live on-the-road driving ability. In both studies screening was conducted through an initial telephone interview followed by a clinic visit.ResultsIn the United States (US) study 13% (n = 410) of 3180 initial contacts and in the Netherlands (NL) study 67% (n = 53) of the 79 initial contacts proceeded to the clinic visit. Of those at clinic 25% of US and 37% of NL participants failed to meet additional insomnia criteria. Mental health exclusions accounted for 24% of US and 23% of NL participants and medical problems accounted for 23% of US and 9% NL exclusions. Finally 20% of US and 26% of NL participants were excluded for drug use/abuse histories. After all screening 4% of the initial US contacts and 0% of the NL contacts entered the study.ConclusionsThese data suggest persons entering insomnia hypnotic clinical trials are a highly selected sample that is unlikely to be representative of the broad insomnia population or the population of potential medication users.     

Cerebellar peduncle injury predicts motor impairments in preterm infants: A quantitative tractography study at term-equivalent age

Purpose

Cerebellar injury is well established as an important finding in preterm infants with cerebral palsy (CP). In this study, we investigated associations between injury to the cerebellar peduncles and motor impairments in preterm infants using quantitative tractography at term-equivalent age, which represents an early phase before the onset of motor impairments.

腹壁切口疝分型的历史演变及现代观点

腹壁切口疝是腹部手术后常见的远期并发症之一。根据切口疝类型不同,其治疗及预后均存在差异。近年来,国内外专家先后提出多种腹壁切口疝分型标准,但由于切口疝的复杂性,目前仍存在分型标准不统一,对临床指导价值有限等问题。本文就腹壁切口疝的分类及其历史演变情况进行系统回顾和总结。     

老年长期照护分级综合评价模型初步构建研究

目的　构建适用于居家、社区及养老服务机构的普适性“老年长期照护分级综合评价模型”。方法　在文献研究、理论析取及质性访谈基础上建立模型指标项目池;采用德尔菲法初步筛选指标形成老年长期照护分级评估问卷;采用问卷调查法再次筛选指标形成最终模型指标体系并进行信效度检验;采用综合评分法计算模型总分,三等分法探讨指标分级,聚类分析法探讨模型分级。结果　最终模型指标体系包括7个一级指标和119个二级指标。7个一级指标的Cronbach's α系数为0.782~0.986,重复测量Pearson相关系数为0.917~0.980（P<0.05）。其中,日常生活能力、认知能力、跌倒风险、压疮风险这4个一级指标采用目前已广泛应用且十分成熟的量表;医疗护理项目、异常表现/症状、自我照护知识需求这3个指标均为本研究自主建立,Bartlett's球形检验结果0.745~0.883,探索性因子分析主成分分析萃取公因子依次为4、3、1个,对总累计方差贡献率分别达68.044%、59.492%、65.395%;经验证性因子分析,修正后公因子分别为4、4、3个。7个一级指标权重依次为0.24、0.15、0.15、0.12、0.12、0.11、0.11,应用综合评分法计算总分后模型可分为5级,分别为：无须依赖、轻度依赖、中度依赖、重度依赖、极重度依赖,级别越高总分越低,表示所需照护强度、力度或难度就越大。结论　老年长期照护分级综合评价模型7个一级指标均具有良好的信效度,采用综合评分法计算模型总分简便易行,各级评分区分度较好,能较全面、具体、确切地反映老年人群对他人照护的依赖程度,可为后期长期护理保险分级定价制度研究提供参考依据。     

中国中西部地区2010至2011年60岁以上股骨颈骨折流行病学对比

目的对比分析我国中、西部地区2010至2012年60岁以上股骨颈骨折的流行病学特点。 方法利用医学影像计算机存档与传输系统及病案查询系统收集2010年1月至2011年12月中、西部地区44家医院诊治的股骨颈骨折资料。将安徽省、河南省、吉林省、山西省、湖北省、湖南省、黑龙江省定为中部组;将新疆维吾尔自治区、四川省、重庆市、甘肃省、广西贵族自治区、贵州省、西藏自治区、内蒙古自治区、宁夏回族自治区、青海省、陕西省、云南省定为西部组。对比两组患者性别、年龄、骨折分型及侧别构成等。 结果共收集60岁以上股骨颈骨折3 683例,中部组2 067例,男女比为1∶1.98;西部组1 616例,男女比为1∶1.76。中部地区76~80岁年龄段构成比最高,西部地区71~75岁年龄段构成比最高。两组均以31B2型骨折患者构成比最高,中部组51.1%（1 056/2 067）,西部组48.3%（781/1 616）;31B1型构成比最低,中部组21.5%（444/2 067）,西部组19.7%（318/1 616）。中部左侧1 077例（52.1%）,右侧990例（47.9%）;西部组左侧797例（49.3%）,右侧819例（50.7%）。 结论老年股骨颈骨折以女性多见,中部地区以76~80岁年龄段构成比最高,西部地区以71~75岁年龄段构成比最高;中、西部均以85岁以上年龄段构成比最低。两地区31B2型骨折居多,中部地区31B1型构成比较西部高,31B3型较西部低;中部地区左侧股骨颈骨折多于右侧,西部地区右侧多于左侧。     

献血不良反应分类规范的修订与应用

目的依据献血不良反应分类指南,对试点采供血机构2017年10月-2018年4月上报的献血不良反应进行评估分级,为完善河北省献血不良反应分类规范提供参考。方法对上报的26例献血不良反应进行评估判断,从反应程度评估、反应类型的肯定程度、反应与献血相关性3方面进行评价。结果在反应程度评估方面,1级（非重度献血不良反应）发生概率最高,占96.15%;在反应类型的肯定程度方面,肯定占69.23%,疑似占15.38%;在反应与献血相关性方面,可能无关（2级）占57.69%,排除了全部其他原因相关性极高（5级）占23.08%,可疑相关（3级）占11.54%,可能相关（4级）占7.69%。结论献血不良反应评估分级增加了判断的准确性和严谨性,有利于管理者根据反应的不同类别与级别进行后续处理,为进一步完善献血不良反应分类分级标准奠定了良好基础。     

基于熵权改良TOPSIS法对医院现场评价结果分析

目的对北京市属18所医院2016年现场评价的14项指标进行分析,为进一步优化医院管理提供科学借鉴。方法依据《北京市医院管理局2016年绩效考核现场评价工作指标》,运用熵权改良TOPSIS法,并结合最低合理可行(ALARP)准则对各项指标进行分析并评估其风险分级。结果本次评价中绝大多数指标(64.29%)处于1级风险,属于“可接受,且不必进行管理审视”。“危急值报告及处置”“医疗不良事件上报及管理”和“感染监测”等3项指标处于2级风险,属于“可接受,但需要进行管理审视”,是需要进一步加强管理的着力点。“知情同意管理”和“手卫生”处于3级风险,属于“不希望发生,需要管理决策”,是本次现场评价中发现的重点问题。结论本次现场评价医院亮点与不足并存,特别是“知情同意管理”和“手卫生”两方面需要着力改进,建议加强医院之间的相互交流,普及持续改进理念,运用管理工具解决实际问题,促进医院医疗质量和服务质量进一步提高。