不同地区煤工尘肺读片差异分析

目的 探讨不同地区尘肺诊断差异的原因,为提高尘肺病诊断读片的准确性和一致性提供依据.方法 选择因行肺灌洗治疗和行高千伏X线检查的不同地区经原单位诊断(地方诊断组)的尘肺病患者163例,高千伏X射线胸片由5名有经验的尘肺病诊断医师(课题专家诊断组)进行集体读片诊断;对诊断期别结果记录表采用统计学方法分析课题专家诊断组2次读片结果及课题诊断组与地方诊断组读片结果的差异.结果 课题专家诊断组2次诊断结果,经一致性的Kappa值分析,结果Kappa值=0.807 ＞0.75,说明2次诊断结果存在相当满意的一致程度,诊断符合率85.89％;地方诊断组和专家诊断组的Kappa值=0.177 ＜0.4,说明2组结果一致程度不够理想,诊断符合率49.69％.各地方诊断组与课题专家诊断组在变异系数(CV％)、过高诊断率、过低诊断率、相符合率方面存在差异,分别为7.19％ ～ 75.22％,7.14％ ～ 83.33％,0.00 ～ 66.67％,14.29％ ～ 87.50％.结论 地方诊断组和课题专家诊断组存在读片差异,应通过控制相应条件,提高胸片质量、准确把握诊断标准、定期培训、对照标准片集体读片、坚持实事求是和提高诊断人员职业道德,必要时行CT鉴别诊断可以缩小诊断误差,提高诊断准确率.     

成人颈椎X线与CT重建图像中矢状面参数的差异及相关性研究

目的分析研究成人颈椎X线与CT重建图像中矢状面参数的差异及相关性。方法收集我院2013年1月至2015年12月间就诊的58例患者为研究对象,所有患者均在同期行颈椎侧位X线及颈椎CT检查。测量参数包括C2-7 Cobb角、C2-7 Gore角、CCI。结果对不同检查方法间参数比较及相关性分析,结果显示,颈椎X线测量的Cobb角、Gore角均大于CT检查结果,差异具有统计学意义(P0.05);两种方式的CCI结果相当,组间比较未见显著性差异(P0.05);两种检查方法Cobb角、Gore角及CCI间的相关系数分别为0.013、0.009、0.015,差异具有显著性(P0.05)。结论颈椎CT重建图像中矢状面参数与常规X线比较具有显著性差异,但两种测量结果间存在较强的相关性,颈椎CT可做为疾病诊断和术前评估的重要方式。     

Comparative effectiveness of heel-specific medical devices for the prevention of heel pressure ulcers: A systematic review

BackgroundPressure ulcers (PUs) impact on patient's quality of life and are costly for healthcare providers. Heels are a particular concern due to specific risk factors. Relative effectiveness of medical devices, e.g., dressings, off-loading devices, heel cushioning devices, to reduce PU development is unknown.MethodsSystematic review of the effectiveness of heel-specific medical devices for the prevention of heel PU (HPU)s. Database searches were performed from inception to June 2021 for RCTs. The primary outcome was incidence of new HPUs. Trials were assessed for risk of bias and data analysed with risk ratios, mean difference or hazard ratios as appropriate.ResultsFifteen RCTs (4724 participants) were identified.Dressings, as constant low pressure (CLP) devices vs standard care: eight trials (very low quality) showed no-significant difference in effectiveness (RR 0.31, 95%CI 0.10 to 1.01).Off-loading devices vs standard care: three trials (low quality), showed significant reduction in development of Category≥1 HPUs (RR 0.20, 95%CI 0.05 to 0.80) two trials (medium quality), showed significant reduction in development of Category≥2 HPUs (RR 0.08, 95%CI 0.01 to 0.67).Comparisons between off-loading devices: two trials (low quality) showed no clear difference in HPU incidence.In a paediatric post-surgical population, one trial of off-loading device and one of a dressing (CLP device), both versus standard care, showed no clear difference in HPU incidence (RR 0.19 95%CI 0.02 to 1.55 and RR 0.89 95%CI 0.56 to 1.42 respectively).ConclusionsOff-loading devices may reduce HPU incidence, from low-quality evidence. There is insufficient evidence to suggest that dressings reduce HPU incidence.     

“差序格局”与“团体格局”对村级卫生人力资源配置的影响研究——基于北京市M县的实地观察分析

"团体格局"中农村卫生人力资源配置的制度安排、政策要求都要在村落"差序格局"的场景中运行。农村改革以及卫生改革使得国家行政权力和卫生管理体制均悬置于乡镇一级,带来了村级卫生管理的"末端失灵",同时增加了"差序格局"的影响。目前的村级卫生人力资源配置方案制定时,未能充分考虑"团体格局"与"差序格局"变化的现实,导致"团体格局"中的设计在"差序格局"中落地时出现了一系列不兼容问题,对村级卫生人力资源的合理配置造成了不利影响。     

Effects of recurrent tonal information on auditory working memory for pitch

This study ascertained the influence of repeating pitch information within an intervening tonal sequence upon the extent of interference for a pitch standard held within auditory working memory as measured by the difference limen for frequency (DLF). Standard and comparison tones were presented to subjects and same/different responses were obtained using a touch screen monitor and the DLF was measured using single interval adjustment matrix (SIAM) procedure [Kaernbach, C., 1990. A single-interval adjustment-matrix (SIAM) procedure for unbiased adaptive testing. J. Acoust. Soc. Am. 88, 2645–2655]. Estimates of the DLF were obtained in a control condition with a silent inter-comparison interval and three conditions containing intervening tones within the temporal gap between the standard and comparison stimuli. The presence of intervening stimuli produced a significant increase in the DLF when the intervening tonal sequence contained tones with pitches that differed from that of the standard (Int condition) as well as when the sequence contained a tone with a pitch identical to that of the comparison (RptCmp condition). Further, the DLFs obtained for RptCmp condition were significantly higher than those measured in the Int condition. The DLFs measured in the condition where the pitch of an intervening tone was identical to the standard were significantly lower than those for the Int and RptCmp condition, but did not differ from the DLFs for the control condition. These results indicate that either a release from or an increase in interference in auditory working memory for pitch can occur dependent upon the frequency relationships between of the standard, comparison, and intervening tones.     

手术治疗妇科急腹症219例

目的:探讨需手术治疗妇科急腹症的临床特点,以提高诊断率。方法:对我院219例手术治疗妇科急腹症的临床资料进行分析。结果:异位妊娠破裂出血、卵巢肿瘤扭转、破裂、感染是常见的妇科急腹症,常与急性阑尾炎混淆。结论:妇科急腹症临床表现各异,在诊断时,应仔细询问病史、月经史,认真全面查体,迅速检查尿HCG、B超、血、尿常规,注意与外科疾病鉴别。     

不同职业特勤人员疗养需求差异分析

目的分析不同特勤人员疗养需求差异,提高疗养服务的针对性。方法采用自行编制的特勤人员疗养需求调查问卷,对来自17个疗养部队的676名特勤人员进行调查。结果不同职业特勤人员之间疗养需求具有明显差异,飞行员强调体检鉴定,潜艇员更注重体育训练和心理疏导;在文化娱乐和饮食营养方面,不同特勤职业之间没有显著性差异。结论不同职业特勤人员疗养需求不同,应针对不同需求采取相应的服务内容不断提高疗养质量。     

洛伐他汀对血管内皮细胞与平滑肌细胞增殖调节作用的对比实验研究

目的探讨洛伐他汀对人血管内皮细胞与平滑肌细胞的调节作用及其调节差异性。方法配制含不同浓度洛伐他汀的培养基f0、0．001、O．01、0,1、1、10μmol／L）,分别于96孔板中进行人脐静脉内皮细胞（HUVECs）与血管平滑肌细胞（VSMCs）培养,在培养24、72、120h后以MTT法对两种细胞进行细胞活性及增殖情况评估。结果培养24h,0．1μmol／L的洛伐他汀对HUVECs存在明显的促进增殖作用;培养72h,1斗mol／L的洛伐他汀对HUVECs存在明显的促进增殖作用;培养120h后,O．001、0．01、0．1、1μmol／L的洛伐他汀与对照组相比HUVECs增殖活性无明显差异,10μmol／L的洛伐他汀表现出明显的增殖抑制作用。培养24h和120h,各浓度组洛伐他汀对VSMCs的增殖无显著调节作用;培养72h,0．001、0．01、1、10μmol／L的洛伐他汀对VSMCs的增殖存在部分抑制作用,未发现剂量相关规律性。结论洛伐他汀对人血管内皮细胞增殖存在双向调节作用,与浓度相关。体外浓度0.1、1μmol／L时可以表现出明显的促进增殖作用,浓度达10μmol／L时则表现出抑制作用。相同浓度下,洛伐他汀无促进VSMCs增殖的作用,并且存在部分抑制VSMCs增殖的作用。     

应用噬菌体随机肽库筛选结肠癌患者血清中的肿瘤标记物的研究

目的用噬菌体随机呔库技术对结肠癌病人血清进行差异性筛选。以获得特异性的肿瘤标志物。方法用噬菌体随机十二肽库与结肠癌病人血清和正常人血清进行淘选．经过几轮吸附和洗脱得到重组噬菌体库。采用ELISA方法进行单克隆鉴定。挑选20个阳性范隆测序获得相同的序列：19B（GSMSRYVRWYIP）。人工合成小肽19B的寡核苷酸序列,并将其与原核表达载体PGEX-4T—I连接。转化大肠杆菌BI-21（DF3）,诱导融合蛋白的表达。以Glutathione Sepharose 4B进行纯化。结果用纯化的蛋白包被抗原板检测24例正常人血清和24例结肠癌病人的血清．证实小肽在正常人血清和结肠癌病人血清间存在差异。结论小肽19B有可能作为检测结肠癌的生物标志物。     

凉山州彝族、汉族妇女对宫颈病变高危因素认知差异的研究

[目的]通过对凉山州彝族、汉族妇女宫颈病变的流行病学调查结果,找出彝族、汉族妇女宫颈癌发病的高危因素差异,探讨降低宫颈癌发病率和病死率的有效措施。[方法]以凉山州内5个地区县城及各乡镇周边村的成年妇女为调查对象进行问卷调查,调查内容包括一般资料、既往病史、性行为和生育史、避孕史及吸烟史、生活习惯等方面。[结果]多因素Logistic回归分析显示:彝族妇女患宫颈癌危险因素中初次性生活年龄、生育次数、教育程度、妇科病治疗地点、怀孕次数等高于汉族妇女。[结论]凉山州彝族、汉族妇女间宫颈癌发病高危因素存在差异性,为制定进一步的防治措施提供理论依据。