国产低场磁共振设备脂肪组织T1值的计算

目的 求得国产低场磁共振机(ASM-016P)人体脂肪抑制的零点时间。材料和方法:对20例健康志愿者的上腹部和头颅(眼眶)同一层面进行SE序列两次独立的扫描,其中重复时间(TR)不同(200～500ms),回波时间(TE)不变(30ms)。然后行对应区域的脂肪组织信号强度(S)测量,并各取平均值,最后代入T_1值计算公式:S′/S″=1-e~(-TR/T1)。结果:求TR分别为200、300、400和500ms时,人体脂肪组织信号强度分别为:2846±467、2916±449、2995±498、和3042±499,脂肪组织T_1时间为135±11ms。结论:经实践检验的计算结果是准确和可信的。并有较大的临床意义。     

Civic Participation and Self-rated Health: A Cross-national Multi-level Analysis Using the World Value Survey

Objectives:

Civic participation, that which directly influences important decisions in our personal lives, is considered necessary for developing a society. We hypothesized that civic participation might be related to self-rated health status.

Methods:

We constructed a multi-level analysis using data from the World Value Survey (44 countries, n=50 859).

Results:

People who participated in voting and voluntary social activities tended to report better subjective health than those who did not vote or participate in social activities, after controlling for socio-demographic factors at the individual level. A negative association with unconventional political activity and subjective health was found, but this effect disappeared in a subset analysis of only the 18 Organization for Economic Cooperation and Development (OECD) countries. Moreover, social participation and unconventional political participation had a statistically significant contextual association with subjective health status, but this relationship was not consistent throughout the analysis. In the analysis of the 44 countries, social participation was of borderline significance, while in the subset analysis of the OECD countries unconventional political participation was a stronger determinant of subjective health. The democratic index was a significant factor in determining self-rated health in both analyses, while public health expenditure was a significant factor in only the subset analysis.

Conclusions:

Despite the uncertainty of its mechanism, civic participation might be a significant determinant of the health status of a country.     

降钙素原和1，3-β-D葡聚糖联合检测诊断ICU危重患者深部真菌感染的价值

目的：探讨降钙素原(PCT)和1,3-β-D葡聚糖(G试验)联合检测诊断ICU危重患者深部真菌感染的价值。方法将我院2012年11月至2014年8月确诊为深部真菌感染的ICU危重患者106例作为真菌组,非深部真菌感染者519例为对照组,分别进行血清PCT和1,3-β-D葡聚糖含量检测,以配对t检验比较结果的差异性。结果真菌组血清中PCT和1,3-β-D葡聚糖含量分别为(0.701±0.22) pg/ml和(37.82±18.43) pg/ml,明显高于对照组的(0.238±0.12) pg/ml和(14.96±4.37) pg/ml,两者结果比较差异均有统计学意义(P<0.05);真菌组血清中PCT阳性检出率为57.5%(61/106),明显低于1,3-β-D葡聚糖阳性检出率[89.6%(95/106)],差异有统计学意义(P<0.05)。结论 ICU深部真菌感染危重患者血清中的PCT和1,3-β-D葡聚糖含量均明显高于ICU非深部真菌感染的危重患者,PCT和1,3-β-D葡聚糖联合检测对ICU危重病患者深部真菌感染诊断有重要的临床意义。     

Non-HDL-C和AI对冠心病患者病情的评估价值

目的：探讨非高密度脂蛋白(Non-HDL-C)和粥样动脉硬化指数(AI)评估冠心病病情的临床价值。方法以冠心病患者为病例组(398例),以健康者为对照组(150例),全自动生化分析仪检测并比较不同组别受试者的一般临床资料、血脂、血糖、Non-HDL-C、AI等指标。结果冠心病组年龄、BMI、血压、甘油三酯、Non-HDL-C、AI等均高于对照组(P<0.05);慢性冠心病组年龄、BMI、收缩压、甘油三酯、TC、LDL-C、HDL-C、空腹血糖、Non-HDL-C、AI等高于不稳定型心绞痛组、急性心肌梗死组(P<0.05);Non-HDL-C与AI具有正相关关系(r2=0.1611,P<0.05);Non-HDL-C、AI均与年龄、HDL-C呈负相关,与LDL-C、TC、甘油三酯呈正相关(P<0.05);Non-HDL-C、AI与冠状动脉病变总分呈正相关(P<0.05)。结论冠心病患者的Non-DHL-C和AI水平明显高于对照组,且Non-DHL-C和AI水平越高,冠心病病变越严重。二者可用于评价冠心病病情严重程度。     

Diagnostic Utility of Diffusion-weighted Magnetic Resonance Imaging in Differentiating Small Solid Renal Tumors (≤4 cm) at 3.0T Magnetic Resonance Imaging

Background:

The aim of this study was to assess the performance of apparent diffusion coefficient (ADC) measurement obtained with diffusion-weighted magnetic resonance imaging (DW-MRI) to distinguish renal cell carcinomas (RCCs) from small benign solid renal tumors (≤4 cm).

Methods:

In this cross-sectional study, 49 consecutive patients with histopathologically confirmed small solid renal tumors, and seven healthy volunteers were imaged using nonenhanced MRI and DW-MRI. The ADC map was calculated using the b values of 0, 50, 400, and 600 s/mm² and values compared via the Kruskal–Wallis and Mann–Whitney tests. The utility of ADC for differentiating RCCs and benign lesions was assessed using a receiver operating characteristic curve. Multiple nonenhanced MRI features were analyzed by Logistic regression.

Results:

The tumors consisted of 33 cases of clear-cell RCCs (ccRCCs) and 16 cases of benign tumors, including 14 cases of minimal fat angiomyolipomas and 2 cases of oncocytomas. The ADCs showed significant differences among benign tumors ([0.90 ± 0.52] × 10⁻³ mm²/s), ccRCCs ([1.53 ± 0.31] × 10⁻³ mm²/s) and the normal renal parenchyma ([2.22 ± 0.12] × 10⁻³ mm²/s) (P < 0.001). Moreover, there was statistically significant difference between high and low-grade ccRCCs (P = 0.004). Using a cut-off ADC of 1.36 × 10⁻³ mm²/s, DW-MRI resulted in an area under the curve (AUC), sensitivity, and specificity equal to 0.839, 75.8%, and 87.5%, respectively. Nonenhanced MRI alone and the combination of imaging methods led to an AUC, sensitivity and specificity equal to 0.919, 93.9%, and 81.2%, 0.998, 97%, and 100%, respectively. The Logistic regression showed that the location of the center of the tumor (inside the contour of the kidney) and appearance of stiff blood vessel were significantly helpful for diagnosing ccRCCs.

Conclusions:

DW-MRI has potential in distinguishing ccRCCs from benign lesions in human small solid renal tumors (≤4 cm), and in increasing the accuracy for diagnosing ccRCCs when combined with nonenhanced MRI.     

Application of Percutaneous Balloon Mitral Valvuloplasty in Patients of Rheumatic Heart Disease Mitral Stenosis Combined with Tricuspid Regurgitation

Background:

Tricuspid regurgitation (TR) is frequently associated with severe mitral stenosis (MS), the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty (PBMV) procedure in rheumatic heart disease patients with mitral valve (MV) stenosis and tricuspid valve regurgitation.

Methods:

Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV: MV area (MVA), TR area (TRA), atrial pressure and diameter, and pulmonary artery pressure (PAP). The patients were followed for 6 months to 9 years.

Results:

After PBMV, the MVAs increased significantly (1.7 ± 0.3 cm² vs. 0.9 ± 0.3 cm², P < 0.01); TRA significantly decreased (6.3 ± 1.7 cm² vs. 14.2 ± 6.5 cm², P < 0.01), right atrial area (RAA) decreased significantly (21.5 ± 4.5 cm² vs. 25.4 ± 4.3 cm², P < 0.05), TRA/RAA (%) decreased significantly (29.3 ± 3.2% vs. 44.2 ± 3.6%, P < 0.01). TR velocity (TRV) and TR continue time (TRT) as well as TRV × TRT decreased significantly (183.4 ± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P < 0.01; 185.7 ± 13.6 ms vs. 238.6 ± 11.3 ms, P < 0.01; 34.2 ± 5.6 cm vs. 60.7 ± 8.5 cm, P < 0.01, respectively). The postoperative left atrial diameter (LAD) significantly reduced (41.3 ± 6.2 mm vs. 49.8 ± 6.8 mm, P < 0.01) and the postoperative right atrial diameter (RAD) significantly reduced (28.7 ± 5.6 mm vs. 46.5 ± 6.3 mm, P < 0.01); the postoperative left atrium pressure significantly reduced (15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P < 0.01), the postoperative right atrial pressure decreased significantly (13.2 ± 2.4 mmHg vs. 18.5 ± 4.3 mmHg, P < 0.01). The pulmonary arterial pressure decreased significantly after PBMV (48.2 ± 10.3 mmHg vs. 60.6 ± 15.5 mmHg, P < 0.01). The symptom of chest tightness and short of breath obviously alleviated. All cases followed-up for 6 months to 9 years (average 75 ± 32 months), 2 patients with severe regurgitation died (1 case of massive cerebral infarction, and 1 case of heart failure after 6 years and 8 years, respectively), 2 cases lost access. At the end of follow-up, MVA has been reduced compared with the postoperative (1.4 ± 0.4 cm² vs. 1.7 ± 0.3 cm², P < 0.05); LAD slightly increased compared with the postoperative (45.2 ± 5.7 mm vs. 41.4 ± 6.3 mm, P < 0.05), RAD slightly also increased compared with the postoperative (36.1 ± 6.3 mm vs. 28.6 ± 5.5 mm, P < 0.05), but did not recover to the preoperative level. TRA slightly increased compared with the postoperative, but the difference was not statistically significant (P > 0.05). The PAP and left ventricular ejection fraction appeared no statistical difference compared with the postoperative (P > 0.05), the remaining patients without serious complications.

Conclusions:

PBMV is a safe and effective procedure for MS combined with TR in patients of rheumatic heart disease. It can alleviate the symptoms and reduce the size of TR. It can also improve the quality-of-life and prognosis. Its recent and mid-term efficacy is certain. While its long-term efficacy remains to be observed.     

Prioritizing HIV comparative effectiveness trials based on value of information: generic versus brand-name ART in the US

Value of Information (VOI) analysis examines whether to acquire information before making a decision. We introduced VOI to the HIV audience, using the example of generic antiretroviral therapy (ART) in the US.

Methods and Findings:We used a mathematical model and probabilistic sensitivity analysis (PSA) to generate probability distributions of survival (in quality-adjusted life years, QALYs) and cost for three potential first-line ART regimens: three-pill generic, two-pill generic, and single-pill branded. These served as input for a comparison of two hypothetical two-arm trials: three-pill generic versus single-pill branded; and two-pill generic versus single-pill branded. We modeled pre-trial uncertainty by defining probability distributions around key inputs, including 24-week HIV-RNA suppression and subsequent ART failure. We assumed that, without a trial, patients received the single-pill branded strategy. Post-trial, we assumed that patients received the most cost-effective strategy. For both trials, we quantified the probability of changing to a generic-based regimen upon trial completion and the expected VOI in terms of improved health outcomes and costs. Assuming a willingness to pay (WTP) threshold of $100?000/QALY, the three-pill trial led to more treatment changes (84%) than the two-pill trial (78%). Estimated VOI was $48?000 (three-pill trial) and $35?700 (two-pill trial) per future patient initiating ART.

Conclusions:A three-pill trial of generic ART is more likely to lead to post-trial treatment changes and to provide more value than a two-pill trial if policy decisions are based on cost-effectiveness. Value of Information analysis can identify trials likely to confer the greatest impact and value for HIV care.     

新生代产业工人的心理特征分析:基于量化研究和质性研究

目的:深入理解新生代产业工人态度、行为的深层次影响因素。方法:采用定量与定性研究相结合的混合设计。结果:与老一代相比,新生代产业工人重视开放和自我加强的价值观;其需要呈现多样化,看重学习与工作本身的内在意义,对个人发展普遍抱有期望。结论:新生代工人体现了人的发展的固有倾向和全面需求,对社会、组织和个人都提出了新的挑战。