Constructing Large Scale Cohort for Clinical Study on Heart Failure with Electronic Health Record in Regional Healthcare Platform: Challenges and Strategies in Data Reuse

Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management. It is a common requirement to reuse the data for clinical research. However, we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform. In this paper, we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology. We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform. Secondly, we built special disease case repositories (i.e., heart failure repository) that utilize the graph to search the related patients and to normalize the data. Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure, we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository. After the propensity score matching, the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired. Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients. This paper presents the workflow and application example of big data mining based on regional EHR data.     

酸性染料比色法测定乌头属不同药材中乌头生物碱含量

目的:测定毒性中药附子、川乌、草乌、雪上一枝蒿的乌头生物碱含量,对这4种药材的临床用量进行控制。方法:用酸性染料比色法,测定制附子、川乌、草乌中雪上一枝蒿的乌头生物碱含量。结果:附子中生物碱含量为0.2403 mg/g,川乌为1.0412 mg/g,草乌为2.1149 mg/g,雪上一枝蒿为0.6702 mg/g。结论:本实验中建立的酸性染料比色法测定乌头生物碱含量,可作为评价毒性药材质量的根据。     

"双轨合一"背景下非针灸专业硕士研究生针灸科规范化培训方案应用研究

本文将本院需参加住院医师规范化培训非针灸专业硕士研究生60人采用随机数字表法分为2组,每组30人.对照组采取传统方式授课,观察组采取新的教学方法教学.1个月轮转结束后进行考评,采用SPSS17.0对2组学生成绩进行统计学分析,探讨针灸科新教学方案对非针灸专业硕士研究生在针灸科规培中的学习效果.结果,观察组理论成绩、技能成绩、病种诊治率及调查问卷总评分高于对照组(P<0.05).表明针灸科新教学方案的教学效果优于传统教学方法,为针灸学教学在住院医师规范化培训中提供新思路.     

深圳市学龄前儿童血清K+、Na+、Cl-、TCa、TCO2、FBG、CRP干化学法测定参考区间调查

目的：调查深圳市学龄前期（3～6周岁）健康儿童干化学法血清钾离子（kalium ion,K+）、钠离子（natrium ion,Na+）、氯离子（chlorine ion,Cl-）、总钙（total calcium,TCa）、总二氧化碳（total carbon dioxide,TCO2）、空腹血糖（fasting blood glucose,FBG）、C-反应蛋白（C-reactive protein,CRP）的参考区间。方法：通过随机分层抽样选取3～6周岁体检儿童,筛选出839名健康儿童抽取静脉血,用美国强生VITROS 350干式化学分析仪进行检测并分析结果。结果：本市学龄前期健康儿童K+、Na+、Cl-、TCa、TCO2、FBG、CRP的参考区间分别为3.8～4.9、136～146、102～110、2.29～2.63、20～28、4.0～6.1 mmol/L、0～7 mg/L。结论：建立起本地区学龄前期健康儿童干化学法血清K+、Na+、Cl-、TCa、TCO2、FBG、CRP项目的参考区间,可为本地区儿童相关疾病的诊疗提供更准确的实验依据。     

数据驱动的三叉神经纤维束自动分割算法

目前三叉神经的纤维跟踪成像过程中普遍存在人工依赖性问题,主要包括人工绘制感兴趣区域(ROI)及手动筛选目标纤维束,导致结果的不确定性和数据误差。针对此类问题,提出一种数据驱动的三叉神经纤维自动分割算法。利用多组大脑样本的纤维数据,建立数据驱动的纤维聚类图谱,实现新样本纤维数据的自动分割,直接得到三叉神经纤维束。在实验中,选择25组青年健康人的数据作为样本数据。首先,利用FSL软件分割工具提取脑干作为ROI,进行确定性纤维跟踪。其次,通过对20组纤维数据进行多样本配准和谱聚类,创建数据驱动的纤维聚类图谱。根据三叉神经细小的特点,在建立纤维图谱过程中,通过对脑干纤维束进行二次分类来标注三叉神经纤维束。最后,选择5组青年健康人的新样本数据,将其脑干纤维数据应用纤维图谱自动分割得到三叉神经纤维束,并计算同一样本数据的自动分割结果与手动分割结果之间的加权Dice系数。结果显示,所提出的方法成功分割5组数据的三叉神经纤维束,而传统人工方法成功识别4组三叉神经纤维束,两者结果之间的加权Dice系数分别为0.865,0.939,0.824,0.942。该方法可以有效避免人为因素的影响,提高神经外科医生...     

Early-Stage Geopolymerization Process of Metakaolin-Based Geopolymer

The geopolymerization of aluminosilicate materials in alkaline environments is a complex physicochemical process that greatly influences the microstructure and engineering performances. This work aims to reveal the geopolymerization process of metakaolin-based geopolymer (MKG) in the first 5 d. Physicochemical characteristics of different evolution stages are disposed of in chronological order. The evolutions of electrical resistivity, dehydration process, volume deformation, and ionic concentration are comprehensively analyzed. Results show that chemical dissolution produces large dismantled fragments rather than small free monomers. The formation of a solid matrix follows the “spatial filling rule”, which means that gels grow by locking swelling fragments to form a framework, then densely filling residual space. Based on chemical models, early geopolymerization of MKG can be divided into six stages from the physicochemical perspective as dismantling, locking fixation, free filling, limited filling, second dissolution, and local mending. Those findings expand the understanding of the phase evolution of the early geopolymerization process; thus, the microstructure of MKG can be better manipulated, and its engineering performances can be improved.     

Individual treatment strategy for single urethrocutaneous fistula after hypospadias repair: a retrospective cohort study

BackgroundUrethrocutaneous fistula (UCF) remains the most common complication after hypospadias repair, and the recurrence rate of UCF is still high if the surgical techniques is not chosen properly, which called for better approaches to this problem. UCF presents different clinical characteristics due to their different locations and sizes, therefore we retrospectively analyzed the effects of different surgical techniques on single UCF after hypospadias repair in order to reduce the recurrence rates of UCF.MethodsA total of 602 patients diagnosed with UCF after hypospadias repair from January 2014 to December 2021 were enrolled. Baseline clinical characteristics such as age of patients, UCF location, size, surgical techniques were recorded. Patients were followed up in the outpatient clinic. The recurrence of UCF was defined as outcomes. Patients were divided according to the location of the UCF into a coronal UCF group and a non-coronal UCF group, which was then further classified according to the diameter of the UCF. The surgical technique and the recurrence rate of different types of UCF were analyzed and summarized.ResultsA total of 425 patients satisfied the inclusion criteria and 71 patients (16.7%) had recurrent UCF. Five surgical techniques were used to repair the UCF, namely tubularized incised plate (TIP) urethroplasty, Mathieu urethroplasty, double ligation, simple classical closure and trap-door procedure. The recurrence rate was 24.1%, 14.3%, 15.1%, 16.7%, and 22.2%, respectively. TIP or Mathieu urethroplasty is recommended for patients with coronal UCF with glans dehiscence or patients with coronal UCF diameter ≥4 mm without glans dehiscence. In patients with coronal UCF without glans dehiscence, double ligation is recommended for small UCF with diameter <2 mm, and simple classical closure is recommended for UCF with diameter 2–<4 mm. In patients with non-coronal UCF, double ligation is recommended for UCF with diameter <3 mm, and simple classical closure is recommended for UCF with diameter ≥3 mm.ConclusionsSingle UCF can be classified according to the location and size of the UCF. Different types of UCF should be treated with more appropriate individualized strategies, which can effectively reduce the recurrence rate of UCF.     

Outcomes of Eight‐Plate Epiphysiodesis for Residual Clubfoot Deformities

ObjectiveThe outcome of congenital clubfoot treatment is still challenging if the feet deformities are not completely corrected. Here we explore a minimal invasive procedure with an eight‐plate implant to correct the residual forefoot adduction deformity after treatment of neglected or relapsed clubfoot.MethodsWe retrospectively reviewed patients with residual forefoot adduction deformity after clubfoot treatment between January 2013 and June 2016. The patients underwent temporary epiphysiodesis of the lateral column of the mid‐foot, which in detail, an eight‐plate was placed on each side of the calcaneocuboid joint. The foot deformities were recorded according to the weight‐bearing radiographic measurements including talo‐first metatarsal angle, calcaneo‐fifth metatarsal angle and medial‐to‐lateral column length.ResultsA total of 13 patients (20 feet) with an average age of 7.8 years old were located with an average duration of 40.8 months follow‐up (range, 28 to 54 months). The average talo‐first metatarsal angle improved from 28.3° (range, 19° to 47°) preoperatively to 8.3° (range, 3° to 18°) and the calcaneo‐fifth metatarsal angle improved from 29.1° (range, 19° to 40°) preoperatively to 8.4° (range, 0° to 21°) at final follow‐up. The mean ratio of the medial‐to‐lateral column length improved from 1.14 ± 0.06 to 1.55 ± 0.09 with statistical significance (t = 3.566; P < 0.001).ConclusionsEight‐plate epiphysiodesis is an easy and effective method for the correction of residual forefoot adduction deformity after clubfoot treatment in growing children without the need of osteotomy.     

黄芪、前胡、白蒺藜对培养的肺动脉平滑肌细胞增殖及胶原分泌的影响

目的:寻找抑制肺动脉高压肺血管重建的药物。方法:体外培养的肺动脉平滑肌细胞(PASMC)加入中药制剂黄芪口服液、前胡口服液、白蒺藜口服液分别大、小两个剂量(大剂量10mg/ml,小剂量1mg/ml)干预,并掺入~3H-胸腺嘧啶脱氧核糖核苷(`3H-TdR),~3H-脯氨酸(~3H-Pro)检测每分钟液闪值(cpm),反映 PASMC 增殖及胶原合成分泌的改变。结果:~3H-TdR掺入值在加入黄芪、前胡、白蒺藜口服液后,无论大、小剂量,PASMC 均被抑制(P<0.001);对~3H-pro 的掺入值,在加入黄芪、前胡口服液后,大剂量、小剂量皆有阻抑作用(P<0.01和 P<0.05),白蒺藜只在大剂量时有作用(P<0.01)。结论:中药制剂黄芪、前胡、白蒺藜口服液可不同程度地阻抑 PASMC 的增殖和胶原合成过程,可能对肺动脉高压肺血管结构的重建起一定防治作用。     

鲨肝活性肽对对乙酰氨基酚致小鼠急性肝损伤的保护作用

目的探讨鲨肝活性肽(sHSS)对对乙酰氨基酚(AAP)致小鼠急性肝损伤的保护作用。方法用AAP(200 mg·kg^-1,ip)诱导小鼠急性肝损伤,用改良赖氏法测血清ALT和AST,通过光镜和电镜观察肝细胞显微和亚显微结构的变化,用流式细胞仪分析肝细胞凋亡,同时用RT-PCR方法分析Fas mRNA表达水平。结果sHSS 3.0和1.5 mg·kg^-1可显著降低肝损伤小鼠血清ALT和AST的水平;改善模型鼠肝组织细胞坏死及炎症反应;高剂量sHSS(3 mg·kg^-1)对肝线粒体具有保护作用,下调Fas mRNA的表达水平,并具有抗凋亡作用。结论sHSS对AAP诱导的肝损伤具有明显的保护作用,其机制可能与保护肝线粒体、抑制Fas基因表达及肝细胞凋亡有关。