三维斑点追踪技术用于川崎病患儿冠状动脉检测结果的比较和分析

目的 了解二维和三维斑点追踪技术用于川崎病患儿左室收缩功能检测和评价的差异,为该技术的临床使用提供理论经验。 方法 2014年1月-2016年12月期间,对我院收治的50例川崎病患儿进行研究,分析使用2D-STE和3D-STE分别检测患儿心脏不同部位(基底部、中间段、心尖部)具体参数(左心室舒张末期容积、收缩末期容积、左心室射血分数、纵向应变、环向应变、径向应变)、冠状动脉扩张与不均匀情况的统计学差异。 结果 患儿分别使用2D-STE和3D-STE进行检测,EDV、ESV、LVEF结果的差异均显示出统计学意义(均有P<0.05);LVEF结果的差异无统计学意义(P>0.05);分别使用2D-STE和3D-STE检测患儿心肌各部位的应变,检测基底部时,LS、CS、RS的差异均有统计学意义(均有P<0.05);检测中间段,LS的差异均有统计学意义(均有P<0.05);检测心尖部,LS、CS、RS的差异均有统计学意义(均有P<0.05);使用2D-STE检测患儿,不同部位LS、CS、RS检测结果的差异有统计学意义(均有P<0.05);使用3D-STE检测患儿,不同部位LS、CS、RS检测结果的差异有统计学意义(均有P<0.05); 患儿分别使用2D-STE和3D-STE进行心脏探察,两种方法检测左冠脉、右冠脉(扩张和不均匀)时,其检测结果的差异均无统计学意义(均有P>0.05)。 结论 3D-STE相比2D-STE检测方法,其检测应变的结果更为全面和精确,也能更早的反映川崎病患儿左室的收缩功能。     

长链非编码RNA在肝细胞肝癌中的研究进展

肝细胞肝癌(HCC)是肝癌最常见的病理类型,患者病死率高。对HCC发生发展机制的认知局限是其不良预后的重要原因。长链非编码RNA(lncRNA)是基因调控的重要组成部分,在不同疾病患者和不同组织中的表达具有特异性。近年来,lncRNA在癌症发生发展中作用的研究逐渐深入,这为HCC早期诊断、病情控制和预后评估提供了新的方法和思路。本文就长链非编码RNA在HCC中的研究进展作一综述。     

短语小处方在门诊换药患者健康教育中的应用

【】目的 探讨短语小处方在门诊换药患者健康教育中的应用效果。方法 选取门诊换药室手外伤换药患者170例,按首次换药时间先后分为对照组85例,观察组85例;对照组在换药后予常规健康教育处方指导,观察组予健康教育短语小处方指导。观察两组患者健康教育知晓率、护理服务满意度、伤口愈合时间和感染发生率。结果 观察组健康教育知晓率、满意度均高于对照组,差异有统计学意义(均P<0.01),伤口感染发生率低于对照组(P<0.01),伤口愈合时间短于对照组(P<0.01)。结论 短语小处方提高患者健康教育知晓率,缩短伤口愈合时间,降低伤口感染发生率。     

Genes associated with venous thromboembolism in colorectal cancer patients

Essentials

• The underlying pathophysiological mechanisms behind cancer‐associated thrombosis are unknown.
• We compared expression profiles in tumor cells from patients with and without thrombosis.
• Tumors from patients with thrombosis showed significant differential gene expression profiles.
• Patients with thrombosis had a proinflammatory status and increased fibrin levels in the tumor.

Summary

Background

Venous thromboembolism (VTE) is a frequent complication in patients with cancer, and is associated with significant morbidity and mortality. However, the mechanisms behind cancer‐associated thrombosis are still incompletely understood.

Objectives

To identify novel genes that are associated with VTE in patients with colorectal cancer (CRC).

Methods

Twelve CRC patients with VTE were age‐matched and sex‐matched to 12 CRC patients without VTE. Tumor cells were isolated from surgical samples with laser capture microdissection approaches, and mRNA profiles were measured with next‐generation RNA sequencing.

Results

This approach led to the identification of new genes and pathways that might contribute to VTE in CRC patients. Application of ingenuity pathway analysis indicated significant links with inflammation, the methionine degradation pathway, and increased platelet function, which are all key processes in thrombus formation. Tumor samples of patients with VTE had a proinflammatory status and contained higher levels of fibrin and fibrin degradation products than samples of those without VTE.

Conclusion

This case–control study provides a proof‐of‐principle that tumor gene expression can discriminate between cancer patients with low and high risks of VTE. These findings may help to further unravel the pathogenesis of cancer‐related VTE. The identified genes could potentially be used as candidate biomarkers to select high‐risk CRC patients for thromboprophylaxis.

     

EHR Adoption and Hospital Performance: Time‐Related Effects

Objective

To assess whether, 5 years into the HITECH programs, national data reflect a consistent relationship between EHR adoption and hospital outcomes across three important dimensions of hospital performance.

Data Sources/Study Setting

Secondary data from the American Hospital Association and CMS (Hospital Compare and EHR Incentive Programs) for nonfederal, acute‐care hospitals (2009–2012).

Study Design

We examined the relationship between EHR adoption and three hospital outcomes (process adherence, patient satisfaction, efficiency) using ordinary least squares models with hospital fixed effects. Time‐related effects were assessed through comparing the impact of EHR adoption pre (2008/2009) versus post (2010/2011) meaningful use and by meaningful use attestation cohort (2011, 2012, 2013, Never). We used a continuous measure of hospital EHR adoption based on the proportion of electronic functions implemented.

Data Collection/Extraction Methods

We created a panel dataset with hospital‐year observations.

Principal Findings

Higher levels of EHR adoption were associated with better performance on process adherence (0.147; p < .001) and patient satisfaction (0.118; p < .001), but not efficiency (0.01; p = .78). For all three outcomes, there was a stronger, positive relationship between EHR adoption and performance in 2010/2011 compared to 2008/2009. We found mixed results based on meaningful use attestation cohort.

Conclusions

Performance gains associated with EHR adoption are apparent in more recent years. The large national investment in EHRs appears to be delivering more consistent benefits than indicated by earlier national studies.     

孕前体重指数及孕期增重与小于胎龄儿的关系

目的 探讨孕前BMI、孕期增重与小于胎龄儿(small for gestational age,SGA)的关系,为预防小于胎龄儿的发生提供理论依据.方法 以2012年3月至2014年7月在山西医科大学第一医院产科分娩的4 754例单胎孕妇为研究对象,收集其一般人口学特征及健康状况、分娩情况等资料,测量其孕前身高、体重和分娩前体重,计算孕前BMI及孕期增重并分组,收集新生儿出生结局,了解孕前BMI和孕期增重对SGA的影响.结果 SGA发生率为9.26%(440/4 754).孕前体重较低组、正常组及超重/肥胖组SGA发生率为9.85%、8.54%和9.45%,调整孕妇年龄、孕产史等因素后,孕前BMI过高和超重/肥胖者SGA发生率低于孕前BMI正常范围的孕妇(OR=0.714,95%CI:0.535～0.953);不同孕期增重组SGA发生率分别为孕期增重低于美国医学研究所(IOM)建议范围下限组12.20%、增重在建议范围组9.23%、增重超过建议范围上限组8.45%;调整孕妇年龄、孕产史等因素后,孕期增重低于IOM建议范围下限增加SGA的发生风险(OR=1.999,95%CI:1.487～2.685),无论是孕前BMI较低、适宜还是超重/肥胖,分别以增重适宜作为参照,孕期增重低于IOM建议范围下限均增加SGA的发生风险,OR值分别为2.558(95%CI:1.313～4.981)、1.804(95%CI:1.258～2.587)、3.108(95%CI:1.237～7.811).孕前高BMI和孕期增重不足间未发现相加和相乘交互作用.结论 孕前BMI超重/肥胖者SGA发生率低于孕前BMI正常范围的孕妇,孕期增重不足增加SGA的发生风险,无论孕前BMI较低、正常还是超重/肥胖的孕妇增重均应避免低于IOM推荐的增重范围下限,以减少SGA的发生.     

Constructing the meaning of ultrasound viewing in abortion care

As ultrasound scanning becomes increasingly routine in abortion care, scholars and activists have forwarded claims about how viewing the ultrasound image will affect pregnant women seeking abortion, speculating that it will dissuade them from abortion. These accounts, however, fail to appreciate how viewing is a social process. Little research has investigated how ultrasound workers navigate viewing in abortion care. We draw on interviews with twenty‐six ultrasound workers in abortion care for their impressions and practices around ultrasound viewing. Respondents reported few experiences of viewing dissuading women from abortion, but did report that it had an emotional effect on patients that they believed was associated with gestational age. These impressions informed their practices, leading many to manage patient viewing based on the patient's gestational age. Other aspects of their accounts, however, undercut the assertion that the meaning of ultrasound images is associated with gestation and show the pervasiveness of cultural ideas associating developing foetal personhood with increasing gestational age. Findings demonstrate the social construction of ultrasound viewing, with implications in the ongoing contestation over abortion rights in the US.     

PLNseq: a multivariate Poisson lognormal distribution for high‐throughput matched RNA‐sequencing read count data

High‐throughput RNA‐sequencing (RNA‐seq) technology provides an attractive platform for gene expression analysis. In many experimental settings, RNA‐seq read counts are measured from matched samples or taken from the same subject under multiple treatment conditions. The induced correlation therefore should be evaluated and taken into account in deriving tests of differential expression. We proposed a novel method ‘PLNseq’, which uses a multivariate Poisson lognormal distribution to model matched read count data. The correlation is directly modeled through Gaussian random effects, and inferences are made by likelihood methods. A three‐stage numerical algorithm is developed to estimate unknown parameters and conduct differential expression analysis. Results using simulated data demonstrate that our method performs reasonably well in terms of parameter estimation, DE analysis power, and robustness. PLNseq also has better control of FDRs than the benchmarks edgeR and DESeq2 in the situations where the correlation is different across the genes but can still be accurately estimated. Furthermore, direct evaluation of correlation through PLNseq enables us to develop a new and more powerful test for DE analysis. Application to a lung cancer study is provided to illustrate the practical utilities of our method. An R package implementing the method is also publicly available. Copyright © 2015 John Wiley & Sons, Ltd.     

基于信息技术的社区卫生服务绩效管理模式设计

本研究针对社区卫生服务绩效管理工作中的实际问题,探讨社区卫生服务与信息技术之间的结合点,设计社区卫生服务经费测算模型、评分基准、考核方案、异常绩效分析知识库等,以期通过信息化手段提升社区卫生服务绩效管理效率,构建基于信息技术的新型社区卫生服务绩效考核标准循证机制、信息流通机制和过程监督反馈机制。     

体感交互技术 Kinect 在脑卒中后下肢功能康复的应用

①目的探讨体感交互技术 Kinect 在脑卒中患者下肢运动康复过程中的应用效果。②方法脑卒中患者40例,随机分为对照组20例,干预组20例。对照组接受常规康复训练,干预组在对照组康复项目基础上,实施体感交互技术 Kinect 辅助训练,于实验前和实验第4周时进行简化 FMA 运动功能评定。③结果4周后两组患者的 FMA 评分均有不同程度的提高,干预组在屈肌系统运动、伸肌协同运动、坐位伴有协同运动及总成绩4项评分均比对照组提高更为明显,差异有统计学意义（ P ＜0．01或 P ＜0．05）。④结论体感交互技术 Kinect 结合常规康复训练对脑卒中后下肢运动功能的恢复更加有效。