导航监测下股骨旋转角度及胫骨截骨后内翻角度对下肢动态力线的影响

目的 在计算机导航系统监测下模拟全膝关节置换术,观察不同股骨假体旋转角度及胫骨内翻角度对下肢动态力线的影响。方法 应用计算机导航技术于假骨上模拟人工全膝关节置换术,分别设定在股骨侧假体外旋不足及股骨侧假体过度外旋的情况下,设定胫骨截骨后内翻为0°、3°、5°不同角度时,活动膝关节记录膝关节0°、30°、60°、90°时下肢力线角度并进行分析,得到其变化的趋势和规律。结果 在股骨假体外旋不足的情况下,随着胫骨截骨后内翻角度的逐渐增大,下肢机械轴线内翻角度随之减少(P＜0.05或＜0.01);在股骨假体外旋不足的情况下,相同的胫骨截骨后内翻角度,在0～90°区间内下肢机械轴线内翻角度逐渐减少(P＜0.05);在股骨假体过度外旋情况下,随着胫骨截骨后内翻角度的逐渐增大,下肢机械轴线内翻角度随之增大(P＜0.05或＜0.01);在股骨假体过度外旋情况下,相同的胫骨截骨后内翻角度,在0～90°区间内下肢机械轴线内翻角度逐渐增大(P＜0.05)。结论 股骨假体旋转角度及胫骨内翻角度是影响下肢力线的重要因素。     

湖南省郴州市一起新型冠状病毒肺炎聚集性疫情流行病学调查

目的 通过分析郴州市一起新冠肺炎聚集性疫情相关病例发病确诊过程,探讨新冠病例早发现、早报告以及病例诊断和隔离观察解除的策略依据。 方法 对该起新冠肺炎聚集性疫情的病例和密切接触者进行现场流行病学调查,描述性分析流行病学史、临床和实验室资料。 结果 利用大数据比对监测,在转送监测对象至集中场所隔离医学观察时发现了新冠肺炎确诊病例何某华,由此发现一起新冠肺炎家庭聚集性疫情,何某的5名密切接触者中有3人发病确诊（包含1名重症病例）,其中重症病例黄某第7次新型冠状病毒核酸检测阳性进而确诊,密切接触者中胡某有流行病学史、血常规白细胞下降和肺炎影像学改变,但是5次咽拭子核酸检测阴性,未确诊。 结论 大数据比对监测对发现传染病有积极作用;早期对有流行病学史人员单独隔离医学观察对防止聚集性疫情发生有重要意义;将2次核酸检测阴性作为新冠肺炎病例的排除标准和将核酸检测阳性作为确诊新冠肺炎病例的必备条件,值得探讨,这都可能放走传染源,导致新冠肺炎传播。     

基于数据分析的医生绩效奖金分配方案

目的:结合医生可量化的工作量和业务工作价值两大核心维度赋予权重分析,从而设计可量化的绩效奖金分配方案,有效激励医生和调动医生的积极性。方法:在门诊、会诊和手术的3个方面,以工作量、工作强度和工作价值贡献的多个维度衡量工作绩效,利用大数据BI工具开发绩效奖金分配模型,并对绩效奖金模型权重系数进行校正优化,得出最优模型。该绩效方案是一套可量化、可追溯的绩效管理方案,在总奖金池金额不变的情况下精准分配奖金,提升医生的工作积极性。结果:基于医生工作量的大数据绩效分析方案在没有改变医院以往总奖金金额的情况下,体现了绩效的公正性、有效性,给医院提供了一个合理和更加有效激励医生的绩效奖金管理方案。同时,医院基本实现了绩效考核无纸化和精细化。结论:建立一套以工作量及工作价值为衡量标准的医生绩效管理体系,通过大数据实现绩效数据的自动采集与核算的绩效管理方案可有效激励医生的能动性,并实现绩效管理精细化,从而有效提升医院的绩效管理水平。     

Major taste loss in carnivorous mammals

Mammalian sweet taste is primarily mediated by the type 1 taste receptor Tas1r2/Tas1r3, whereas Tas1r1/Tas1r3 act as the principal umami taste receptor. Bitter taste is mediated by a different group of G protein-coupled receptors, the Tas2rs, numbering 3 to ～66, depending on the species. We showed previously that the behavioral indifference of cats toward sweet-tasting compounds can be explained by the pseudogenization of the Tas1r2 gene, which encodes the Tas1r2 receptor. To examine the generality of this finding, we sequenced the entire coding region of Tas1r2 from 12 species in the order Carnivora. Seven of these nonfeline species, all of which are exclusive meat eaters, also have independently pseudogenized Tas1r2 caused by ORF-disrupting mutations. Fittingly, the purifying selection pressure is markedly relaxed in these species with a pseudogenized Tas1r2. In behavioral tests, the Asian otter (defective Tas1r2) showed no preference for sweet compounds, but the spectacled bear (intact Tas1r2) did. In addition to the inactivation of Tas1r2, we found that sea lion Tas1r1 and Tas1r3 are also pseudogenized, consistent with their unique feeding behavior, which entails swallowing food whole without chewing. The extensive loss of Tas1r receptor function is not restricted to the sea lion: the bottlenose dolphin, which evolved independently from the sea lion but displays similar feeding behavior, also has all three Tas1rs inactivated, and may also lack functional bitter receptors. These data provide strong support for the view that loss of taste receptor function in mammals is widespread and directly related to feeding specializations.     

Predictive energy landscapes for protein–protein association

We investigate protein–protein association using the associative-memory, water-mediated, structure, and energy model (AWSEM), a coarse-grained protein folding model that has been optimized using energy-landscape theory. The potential was originally parameterized by enforcing a funneled nature for a database of dimeric interfaces but was later further optimized to create funneled folding landscapes for individual monomeric proteins. The ability of the model to predict interfaces was not tested previously. The present results show that simulated annealing of the model indeed is able to predict successfully the native interfaces of eight homodimers and four heterodimers, thus amounting to a flexible docking algorithm. We go on to address the relative importance of monomer geometry, flexibility, and nonnative intermonomeric contacts in the association process for the homodimers. Monomer surface geometry is found to be important in determining the binding interface, but it is insufficient. Using a uniform binding potential rather than the water-mediated potential results in sampling of misbound structures that are geometrically preferred but are nonetheless energetically disfavored by AWSEM, as well as in nature. Depending on the stability of the unbound monomers, nonnative contacts play different roles in the association process. For unstable monomers, thermodynamic states stabilized by nonnative interactions correspond to productive, on-pathway intermediates and can, therefore, catalyze binding through a fly-casting mechanism. For stable monomers, in contrast, states stabilized by nonnative interactions generally correspond to traps that impede binding.     

Changes in circumpapillary retinal vessel density after acute primary angle closure episode via OCT angiography

Purpose

To investigate the changes and evaluate the diagnosis value of circumpapillary vessel density (VD) in cases of acute primary angle closure (APAC).

Design

Case–control study.

Methods

APAC patients with a history of unilateral acute attack were enrolled. The eyes with acute episode constituted the case group while the contralateral eyes without attack consisted of the control group. Ophthalmic examinations including slit-lamp examination, best-corrected visual acuity, intraocular pressure and visual field were carried out. Retinal nerve fiber layer (RNFL), macular ganglion cell complex (GCC) were measured by spectral-domain optical coherence tomography, while VD was assessed by optical coherence tomography angiography.

Results

The whole en face image vessel density (wiVD), circumpapillary vessel density (cpVD) and inside disk VD for both all vessels and capillary were all significantly lower in the APAC eyes compared to the fellow eyes (P?<?0.01 for all). In APAC eyes, the wiVD, inside disk VD and cpVD both for all vessels and capillary were all positively correlated with RNFL and GCC thicknesses but negatively correlated with the mean deviation (MD), pattern standard deviation (PSD) and the duration of acute attack (all P?<?0.01). From the ROC curve, the cpVD_cap, wiVD_cap, cpVD_all and wiVD_all all showed comparable diagnostic ability with RNFL, GCC and MD to differentiate eyes with APAC from the fellow eyes (all P?>?0.05). The inside disk VD_cap and VD_all demonstrated significant lower diagnostic ability than the cpVD_cap, wiVD_cap, cpVD_all and wiVD_all (all P?<?0.001).

Conclusions

In APAC eyes, circumpapillary VD decreased significantly compared with the fellow unaffected eyes. They were significantly correlated with thicknesses of RNFL and GCC, and visual field MD and PSD in the APAC eyes. The patients with longer duration of acute attack were more likely to have lower cpVD. For APAC, the diagnostic ability of wiVD and cpVD was similar with RNFL, GCC and MD and was higher than inside disk VD.

     

PVP-coated Sb2Se3 nanorods as nanotheranostic agents for photoacoustic imaging and photothermal therapy in NIR-I bio-windows

Antimony selenide (Sb₂Se₃) as a simple, low toxicity, low-cost p-type semiconductor material with broad absorbance ranging from the UV to the NIR region has many potential applications in photovoltaic, thermoelectric, and phase-change memory devices. Owing to these excellent properties, Sb₂Se₃ nanorods were firstly synthesized with triphenylantimony and dibenzyldiselenide under solvothermal conditions. In order to enhance the biocompatibility of the Sb₂Se₃ nanorods, polyvinylpyrrolidone (PVP) was coated onto the surface of the Sb₂Se₃ nanorods to form PVP-coated Sb₂Se₃ nanorods. The cell viability of PVP-coated Sb₂Se₃ nanorods toward Hep-2 cells was assessed for 24 h using a Cell Counting Kit-8 (CCK-8) assay. The results showed that Hep-2 cells treated with PVP-coated Sb₂Se₃ nanorods were alive at a concentration as high as 100 μg mL⁻¹ in the absence of NIR irradiation. In vivo assessment confirmed that PVP-coated Sb₂Se₃ nanorods exhibited excellent photoacoustic imaging and PTT performance, which yielded complete ablation of tumors after laser irradiation (808 nm or 980 nm) in the NIR-I bio-window.

Herein we reported a biocompatible PVP-coated Sb₂Se₃ nanorods as PTT nanotheranostic agent, which is responsive to the light (808 and 980 nm) in NIR-I bio-windows and effective for photoacoustic imaging and photothermal destruction of cancer cell.     

Tacrolimus trough levels after month 3 as a predictor of acute rejection following kidney transplantation: a lesson learned from DeKAF Genomics

Most calcineurin inhibitor (CNI)‐based protocols reduce blood trough goals approximately 2–3 months post‐transplant in clinically stable kidney transplant recipients. The CNI target trough level to prevent rejection, after reduction, is unknown. Using a multivariate Cox proportional hazards model, we determined the association of time‐varying tacrolimus (TAC) trough levels with acute rejection (AR) occurring in the first 6 months post‐transplant, but specifically we assessed this association after 3 months. A total of 1930 patients received TAC‐based immunosuppression prior to AR in a prospective study. Of the 151 (7.8%) who developed AR, 47 developed AR after 3 months post‐transplant. In an adjusted time‐varying multivariate model, each 1 ng/ml decrease in TAC trough levels was associated with a 7.2% increased risk of AR [hazards ratio (HR) = 1.07, 95% confidence interval (CI) (1.01, 1.14) P = 0.03] in the first 6 months. There was an additional 23% increased risk of AR with each 1 ng/ml decrease in the TAC trough levels in months 3–6 [HR = 1.23, 95% CI (1.06, 1.43) P = 0.008]. In conclusion, lower TAC trough levels were significantly associated with increased risk of AR in the first 6 months post‐transplant with additional risk of AR between months 3 and 6 post‐transplant. The timing and practice of TAC dose reduction should be personalized based on the individual's risk factors.     

大面积外伤性脑梗死的血管成像特点与手术疗效

目的探讨大面积外伤性脑梗死（traumatic cerebral infarction,TCI）的梗死区CT血管造影（CTA）成像特点及手术治疗效果。方法回顾性分析34例大面积TCI病例资料,采用CTA观察梗死区血管情况。并采取扩容、解痉、高压氧等综合治疗措施。结果 TCI闭塞血管主要为大脑中动脉、大脑前动脉或大脑后动脉以及基底动脉的远端小动脉或脑深部穿支血管和皮质小血管,未见大脑前动脉、大脑中动脉和大脑后动脉或基底动脉的主干血管闭塞。手术治疗28例,保守治疗6例。随访4~28个月,按GOS评分标准,恢复良好12例,中残8例,重残4例,植物生存3例,死亡7例。结论大面积TCI闭塞的血管主要为脑深部的穿支血管和皮质小血管,早期采取减压手术等综合治疗可取得较好疗效。