卒中一级预防指南的执行摘要

卒中仍然是一个重要的医疗问题,所带来的人力和经济代价是惊人的。美国每年约79．5万人发生卒中,其中约61万为首次发作,现在美国有640万卒中后存活患者。     

Improving apparent diffusion coefficient estimates and elucidating tumor heterogeneity using Bayesian adaptive smoothing

The spatial distribution of apparent diffusion coefficient (ADC) estimates in tumors is typically heterogeneous, although this observed variability is composed of both true regional differences and random measurement uncertainty. In this study, an adaptive Bayesian adaptive smoothing (BAS) model for estimating ADC values is developed and applied to data acquired in two murine tumor models in vivo. BAS models have previously been shown to reduce parameter uncertainty through the use of a Markov random field. Here, diffusion data acquired with four averages was used as an empirical gold standard for evaluating the BAS model. ADC estimates using BAS displayed a significantly closer accordance with the gold standard data and, following analysis of uncertainty estimates, appeared to even outperform the gold standard. These observations were also reflected in simulations. These results have strong implications for clinical studies, as it suggests that the BAS postprocessing technique can be used to improve ADC estimates without the need to compromise on spatial resolution or signal‐to‐noise or for the adaptation of acquisition hardware. A novel measure of tumor ADC heterogeneity was also defined, which identified differences between tumors derived from different cell lines, which were reflected in histological variations within the tissue microenvironment. Magn Reson Med, 2011. © 2010 Wiley‐Liss, Inc.     

Developing tools to predict outcomes following cardiovascular surgery

Background: Surgical decision‐making tools may help surgeons achieve better outcomes by providing more personally relevant information to patients. This paper describes approaches to developing statistical tools capable of estimating the probability of morbidity and mortality after cardiovascular surgery. Our aim is to inform surgeons about the important stages that contribute to the development of decision tools. Methods: The key elements described include study design (data quality, cohort size, etc.) and statistical methodology for developing and testing decision tools. Mention is made of the delivery of decision tools, simplicity of use, ease of interpretation of results and accessibility. Information specific to cardiac and vascular surgery is included. Results: Development of useful and effective decision tools is dependent on robust and reliable data, unambiguous outcome requirements and considerable statistical expertise. Decision tools must also be extensively tested for validity and reliability, both internally and with external data. Conclusion: Understanding the development and assumptions that underlie surgical decision tool development will help cardiovascular surgeons appreciate the value of applying such techniques at a clinical level.     

Frequency of use and knowledge of the WHO-surgical checklist in Swiss hospitals: a cross-sectional online survey

Background

The WHO-surgical checklist is strongly recommended as a highly effective yet economically simple intervention to improve patient safety. Its use and potentially influential factors were investigated as little data exist on the current situation in Switzerland.

Methods

A cross-sectional online survey with members (N?=?1378) of three Swiss professional associations of invasive health care professionals was conducted in German, French, and Italian. The survey assessed use of, knowledge of and satisfaction with the WHO-surgical checklist. T-Tests and ANOVA were conducted to test for differences between professional groups. Bivariate correlations were computed to test for associations between measures of knowledge and satisfaction.

Results

1090 (79.1%) reported the use of a surgical checklist. 346 (25.1%) use the WHO-checklist, 532 (38.6%) use the Swiss Patient Safety Foundation recommendations to avoid Wrong Site Surgery, and 212 (15.7%) reported the use of other checklists. Satisfaction with checklist use was generally high (doctors: 71.9% satisfied, nurses: 60.8% satisfied) and knowledge was moderate depending on the use of the WHO-checklist. No association between measures of subjective and objective knowledge was found.

Conclusions

Implementation of a surgical checklist remains an important task for health care institutions in Switzerland. Although checklist use is present in Switzerland on a regular basis, a substantial group of health care personnel still do not use a checklist as a routine. Influential factors and the associations among themselves need to be addressed in future studies in more detail.

     

Difficulty Assisting with Health Care Tasks Among Caregivers of Multimorbid Older Adults

BACKGROUND  

Family caregivers provide assistance with health care tasks for many older adults with chronic illnesses. The difficulty they experience in providing this assistance, and related implications for their well-being, have not been well described.     

用改良消减法克隆类风湿性关节炎滑膜细胞中的高表达基因

0　引言　在类风湿性关节炎 (rheumatoid arthritis,RA)中 ,关节内滑膜细胞 (fibroblast- like synovial cells,FL S)的过度增生是造成关节软骨破坏和关节畸形的关键环节 ,为了研究滑膜细胞发生增殖的机制 ,我们采用赵忠良等人设计的改良消减杂交法[1 ] ,并以骨性关节炎 (osteoarthritis,OA)滑膜细胞为对照筛选 RA滑膜细胞中的高表达基因 .1　方法　将 RA滑膜细胞和 OA滑膜细胞分别设定为实验组和扣除组 ,用扣除组的 c DNAs杂交扣除掉实验组中与前者相同的 c DNAs,得到的就是目的产物 :实验组中高拷贝数的或独有的 c DNAs,也就是 …     

三种阳离子脂质体介导血管内皮细胞基因转染效率的比较

目的:评价不同阳离子脂质体介导基因转染血管内皮细胞的转染效率。方法:实验于2006-12/2007-02在中山大学生化实验室及广州市创伤外科研究所完成。采用增强型绿色荧光蛋白基因为报告基因,分别采用Lipofectin、Lipofectamine、Dosper3种不同的阳离子脂质体为载体,转染人脐静脉血管内皮细胞。在24孔板中,每孔加入人脐静脉血管内皮细胞悬液(1×106个细胞),各孔分别加入3种不同阳离子脂质体增强型绿色荧光蛋白质粒复合物,分别于培养24,48h后用荧光显微镜及流式细胞仪测定增强型绿色荧光蛋白在细胞内的表达及转染效率。结果:3种不同阳离子介导的增强型绿色荧光蛋白基因转染的人脐静脉血管内皮细胞内均有绿色荧光蛋白表达,24h后明显,48h后达高峰。Dosper介导组绿色荧光细胞百分比明显高于Lipofectin介导组及Lipofectamine介导组,差异有非常显著意义(P<0.01)。结论:Dosper介导的血管内皮细胞基因转染效率较高,较适合作为血管内皮细胞的基因转染载体。