倒置 T波正常化改变在冠状动脉心脏病诊断中临床价值研究

目的：研究动态心电图中倒置T波正常化改变在冠状动脉心脏病诊断中临床价值。方法210例进行动态心电图检查的患者按照是否出现倒置T波正常化改变分为实验组与对照组,实验组104例,对照组106例。比较实验组和对照组临床症状、主要诊断、冠状动脉造影检查结果。结果实验组中发生胸痛的比例为56．73％,对照组为16．98％,实验组发生胸痛的比例高于对照组,差异具有统计学意义（χ2＝35．72,P＜0．05）。实验组诊断为高血压的比例为66．35％,对照组为20．00％,实验组发生胸痛的比例高于对照组,差异具有统计学意义（χ2＝46．62,P＜0．05）。实验组冠状动脉造影诊断阳性为67（64．42％）,对照组为17（16．03％）,实验组冠状动脉造影诊断阳性率高于对照组,差异具有统计学意义（χ2＝52．21,P＜0．05）。结论动态心电图出现T波动态改变现象的出现可能是心肌缺血的标志之一,对冠心病诊断有早期预测价值。     

规范中医问诊症状医患会话用语在临床评价中的价值管窥

问诊以言审五病,医生必须娴熟地运用好语言技巧,才能准确地了解病情,从而为判断病位、确定病性和辨证治疗打下良好的基础。中医问诊症状医患会话用语与科技术语的正确转换,是问诊医患会话语意不被扭曲及临床评价的前提。文章从基本的中医接诊流程入手,进行医患会话用语临床评价中关键环节问题分析,探索问诊症状医患会话用语规范化在临床评价中的作用,认为规范问诊医患会话用语,利用信息技术形成问诊内容的标准记录格式在临床评价中具有重要价值。     

Systematic Approaches for Incorporating Control Spots and Data Quality Information to Improve Normalization of cDNA Microarray Data

Background: Normalization and data quality control are two important aspects in microarray data analysis. Proper normalization and data quality control ensure that intensity ratios provide meaningful and accurate measurement of relative gene expression values. Control spots such as spikes and housekeeping genes with known concentrations in two channels are often used for calibrating experimental parameters. They provide valuable information about experimental variation which can be utilized for better normalization. They are also needed for proper normalization in cases that the most of the spots tend to change in one direction. In addition, it is desirable to include information on spot quality. Such information is available in a typical microarray data set, but is not fully utilized by existing normalization methods.

Results: We propose two extensions of the two-way semi-linear model (TW-SLM) for appropriately combining control genes and spot quality information in normalization. The first extension (TW-SLMC) is designed to systematically incorporate control spots in a semi-parametric model to calibrate estimated normalization curves so that the relative fold changes of gene expressions are accurately estimated. Extrapolation is not required in this approach. The second extension (TW-SLMQ) is proposed to incorporate spot quality measure into normalization. This approach down-weights spots with lower quality scores in normalization. These two extensions can be used simultaneously for normalizing a data set. Two microarray data sets are used to demonstrate the proposed methods. Availability: An R based computing package is developed for the proposed methods and available from the corresponding authors.

Contact: Deli Wang: deliwang@uab.edu or Jian Huang: jian-huang@uiowa.edu.     

Normalization of Marijuana Use: Its Effects on Adolescents’ Intentions to Use Marijuana

The comparative salience of attitudes, normative influences, and perceptions of the ease or difficulty of engaging in marijuana use was examined in 91 adolescents from three subsamples: those living in Nimbin, Australia, where marijuana use appears to have become normalized, a control group, and a group of homeless adolescents, surveyed in 1997. There were no differences between two of the groups in relation to their attitudes towards marijuana, and no differences in perceived access to the drug. For those who intended using marijuana, personal beliefs were significantly more salient than beliefs about what important others thought they should do.     

Use of Normalization Process Theory to explore key stakeholders’ perceptions of the facilitators and barriers to implementing electronic systems for medicines management in hospital settings

BackgroundLimited data exist on the facilitators and barriers to implementing electronic systems for medicines management in hospitals. Whilst numerous studies advocate system use in improved patient safety and efficiency within the health service, their rate of adoption in practice has been slow.ObjectiveTo explore the perceptions of key stakeholders towards the facilitators and barriers to implementing electronic prescribing systems, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospital settings using Normalization Process Theory as a theoretical framework.MethodsIndividual face-to-face semi-structured interviews were conducted in three public hospitals in Ireland with 23 consenting participants: nine nurses; four pharmacists; two pharmacy technicians; six doctors; and two Information Technology managers.ResultsEnhanced patient safety and efficiency in healthcare delivery emerged as key facilitators to system implementation, as well as the need to have clinical champions and a multi-disciplinary implementation team to promote engagement and cognitive participation. Key barriers included inadequate training and organisational support, and the need for ease and confidence in system use to achieve collective action.ConclusionsMany themes that are potentially transferable to other national settings have been identified and extend the evidence base. This will assist organisations around the world to better plan for implementation of medication-related eHealth systems.     

重大出生缺陷研究中的样本采集与管理

出生缺陷是一种不正常发育引起的患儿先天性结构或功能异常。中国出生缺陷人群数量较大,这个问题在经济发展相对落后的农村更为严重。由于大多数出生缺陷发生机制还不明确,尚无有效治疗手段,故进行相关机制研究尤为重要。为更好地开展重大出生缺陷的研究,必须优化实验的顶层设计,并在样本采集、保存、运输等环节做到规范化、标准化,保证样本的质量。同时采用现代信息系统对样本进行集约化管理,力求达到资料完整、查询方便、信息共享,为后续研究打下坚实基础。     

甲型HIN1流感电子病历与手写病历规范化比较

目的比较我院点选式电子病历与手写病历在甲型H1N1流感住院患者临床应用中的规范性差别。方法选我院甲型H1N1流感住院患者手写病历117份、电子病历127份。对甲型H1N1流感常见症状如发热、咳嗽等进行统计,分析两者病案规范性差别。结果电子病历与手写病历在症状、体征的描述记录上有显著性差异。结论点选式电子病历较传统手写病历对甲型H1N1流感住院患者病史收集记录更加全面、规范。医生应加强规范化收集病史的意识。     

Evaluating the forensic application of 19 target microRNAs as biomarkers in body fluid and tissue identification

RNA‐based body fluid and tissue identification has evolved as a promising and reliable new technique to classify type and source of biological evidence in crime cases. In particular, mRNA‐based approaches are currently on the rise to replace conventional protein‐based methods and are increasingly implemented into forensic casework. However, degradation of these nucleic acid molecules can cause issues on laboratory scale and need to be considered for a credible investigation. For this reason, the analysis of miRNAs using qPCR has been proposed to be a sensitive and specific approach to identify the origin of a biological trace taking advantage of their small size and resistance to degradation. Despite the straightforward workflow of this method, suitable endogenous controls are inevitable when performing real-time PCR to ensure accurate normalization of gene expression data in order to allow a meaningful interpretation. In this regard, we have validated reference genes for a set of forensically relevant body fluids and tissues (blood, saliva, semen, vaginal secretions, menstrual blood and skin) and tested 15 target genes aiming to identify abovementioned sample types. Our data showed that preselected endogenous controls (miR26b, miR92 and miR484) and miR144, initially selected as potential marker for the detection of menstrual blood, were the most stable expressed genes among our set of samples. Normalizing qPCR data with these four validated references revealed that only five miRNA markers are necessary to differentiate between the six different cell types selected in this study. Nevertheless, our observations in the present study indicate that miRNA analysis methods may not provide straightforward data interpretation strategies required for an implementation in forensic casework.     

中西医结合人才队伍建设现状及问题研究

通过研究我国中西医结合人才队伍建设的现状,分析了目前存在的问题：国家没有制定中西医结合医院建设标准;对中西医结合医师的准入比较含糊;对中西医结合医师的判定条件没有统一标准;没有制定中西医结合专业人员的规范化培训和继续医学教育制度;中西医结合教育的学制、教材及师资队伍均存在问题;中西医结合医院的专业人才队伍职称、学历结构不合理,中西医结合拔尖人才培养不到位等。     

外照射治疗数学模型

治疗计划的外照射模型用来对包含多个影像层面的外照射患者的三维剂量分布进行计算。每一个射束即可为固定的SAD照射亦可为连续旋转照射。实际上,任意一个计划都可以有任意数目的射束。剂量在分布于待计算区的网点上被计算。该距阵尺寸可据定义在每个层面100至16384个计算点不等。至少128层面可以同时得到计算并显示剂量分布.