基于DEA-Tobit两步法分析四川省公立医院技术效率及其影响因素

目的测算四川省319家公立医院技术效率,并探讨影响医院技术效率的影响因素,为提高医院效率提供参考依据。方法采用数据包络分析方法(data envelopment analysis,DEA)测算医院技术效率,以测算出的总技术效率作为因变量,涉及投入及结构、过程、医疗质量、患者负担、环境及其他方面相关指标作为自变量,采用Tobit回归模型探讨影响因素。结果公立医院总技术效率平均值为0.807,纯技术效率平均值为0.835,规模效率平均值0.968,16.3%的医院DEA技术效率有效,23.5%处于规模收益不变,59.6%规模收益递减,16.9%规模收益递增;技术效率与人均工作量呈正相关,与平均住院日呈负相关;阿坝、甘孜、凉山地区效率较成都平原、丘陵及盆周山区低;二乙医院技术效率较低。结论提高人均工作量,缩短平均住院日可提高医院技术效率,医院所在地经济发达是提高医院效率的有利因素,二乙医院技术效率值较低。     

国际脊髓损伤肠功能扩展数据集

国际脊髓损伤肠功能扩展数据集主要供研究而用并提供一个标准化格式用于收集和报道脊髓损伤后更多的肠功能信息,它还便于评价和比较各项有关脊髓损伤后肠功能研究的结果。学习并使用国际脊髓损伤肠功能扩展数据集,有助于提高我国脊髓损伤患者的肠道功能障碍的研究水平。     

CT肺功能成像技术研究

目的探讨CT肺功能成像技术的可行性,着重研究CT肺功能参数与肺功能检查(pulmonary functional test, PFT)参数的相关性.方法共69例,包括PFT正常者21例,阻塞性通气功能障碍者37例,限制性通气功能障碍者9例,混合性功能障碍者2例,均在1周内完成PFT和胸部CT检查.采用最大吸气末和呼气末屏气螺旋CT扫描.扫描参数120 kV,175 mA,每层螺旋扫描时间1 s,床速20 mm/s,螺距2∶1.将CT图像经医学数字影像与通讯(DICOM)协议接口接到计算机上.利用自行研制的CT肺功能定量软件进行数据分析.结果通过吸气末CT测得的肺体积(Vin)与PFT的最大肺总量(TLC)存在明显相关性(r=0.866,P<0.001),呼气末CT测得的肺体积(Vex)与残气量(RV)有相关性 (r=0.833,P<0.001),呼吸比(Vex/Vin)与RV/TLC有相关性(r=0.590,P<0.001).吸气像平均CT值与第1秒量占预计值的百分比(FEV1%),第1秒用力呼吸量(FEV1)/用力肺活量(FVC)存在相关性(r=0.382, P<0.05 ; r=0.682, P<0.01).像素指数(PI)=-910～-950 HU与FEV1、FEV1%、 FVC%、FEV1/FVC均存在相关性,其中与FEV1/FVC的相关性最好(r=0.747～0.772,P<0.01).呼气像平均CT值与FEV1、FEV1%、FVC%、FEV1/FVC存在相关性(r=0.624, P<0.01; r=0.654, P<0.01; r=0.452, P<0.01 ; r=0.758, P<0.01).呼气像CT各阈值与PFT参数均存在相关性.结论最大吸气末和最大呼气末行螺旋CT扫描,可获得肺部解剖和肺功能情况的参数,与PFT结果相关性好,因此本法是行之有效的CT肺功能定量成像技术.     

Guided review by frequent itemset mining: additional evidence for plaque detection

Purpose  A guided review process to support manual coronary plaque detection in computed tomography coronary angiography (CTCA) data sets is proposed. The method learns the spatial plaque distribution patterns by using the frequent itemset mining algorithm and uses this knowledge to predict potentially missed plaques during detection. Materials and methods  Plaque distribution patterns from 252 manually labeled patients who underwent CTCA were included. For various cross-validations a labeling with missing plaques was created from the initial manual ground truth labeling. Frequent itemset mining was used to learn the spatial plaque distribution patterns in form of association rules from a training set. These rules were then applied on a testing set to search for segments in the coronary tree showing evidence of containing unlabeled plaques. The segments with potentially missed plaques were finally reviewed for the existence of plaques. The proposed guided review was compared to a weighted random approach that considered only the probability of occurrence for a plaque in a specific segment and not its spatial correlation to other plaques. Results  Guided review by frequent itemset mining performed significantly better (p < 0.001) than the reference weighted random approach in predicting coronary segments with initially missed plaques. Up to 47% of the initially removed plaques were refound by only reviewing 4.4% of all possible segments. Conclusions  The spatial distribution patterns of atherosclerosis in coronary arteries can be used to predict potentially missed plaques by a guided review with frequent itemset mining. It shows potential to reduce the intra- and inter-observer variability.     

A new method to evaluate the completeness of case ascertainment by a cancer registry

BACKGROUND: Epidemiologic research into cancer and subsequent decision making to reduce the cancer burden in the population are dependent on the quality of available data. The more reliable the data, the more confident we can be that the decisions made would have the desired effect in the population. The North American Association of Central Cancer Registries (NAACCR) certifies population-based cancer registries, ensuring uniformity of data quality. An important assessment of registry quality is provided by the index of completeness of cancer case ascertainment. NAACCR currently computes this index assuming that the ratio of cancer incidence rates to cancer mortality rates is constant across geographic areas within cancer site, gender, and race groups. NAACCR does not incorporate the variability of this index into the certification process. METHODS: We propose an improved method for calculating this index based on a statistical model developed at the National Cancer Institute to predict expected incidence using demographic and lifestyle data. We calculate the variance of our index using statistical approximation. RESULTS: We use the incidence model to predict the number of new incident cases in each registry area, based on all available registry data. Then we adjust the registry-specific expected numbers for reporting delay and data corrections. The proposed completeness index is the ratio of the observed number to the adjusted prediction for each registry. We calculate the variance of the new index and propose a simple method of incorporating this variability into the certification process. CONCLUSIONS: Better modeling reduces the number of registries with unrealistically high completeness indices. We provide a fuller picture of registry performance by incorporating variability into the certification process.     

Data assimilation using a gradient descent method for estimation of intraoperative brain deformation

Biomechanical models that simulate brain deformation are gaining attention as alternatives for brain shift compensation. One approach, known as the “forced-displacement method”, constrains the model to exactly match the measured data through boundary condition (BC) assignment. Although it improves model estimates and is computationally attractive, the method generates fictitious forces and may be ill-advised due to measurement uncertainty. Previously, we have shown that by assimilating intraoperatively acquired brain displacements in an inversion scheme, the Representer algorithm (REP) is able to maintain stress-free BCs and improve model estimates by 33% over those without data guidance in a controlled environment. However, REP is computationally efficient only when a few data points are used for model guidance because its costs scale linearly in the number of data points assimilated, thereby limiting its utility (and accuracy) in clinical settings. In this paper, we present a steepest gradient descent algorithm (SGD) whose computational complexity scales nearly invariantly with the number of measurements assimilated by iteratively adjusting the forcing conditions to minimize the difference between measured and model-estimated displacements (model-data misfit). Solutions of full linear systems of equations are achieved with a parallelized direct solver on a shared-memory, eight-processor Linux cluster. We summarize the error contributions from the entire process of model-updated image registration compensation and we show that SGD is able to attain model estimates comparable to or better than those obtained with REP, capturing about 74–82% of tumor displacement, but with a computational effort that is significantly less (a factor of 4-fold or more reduction relative to REP) and nearly invariant to the amount of sparse data involved when the number of points assimilated is large. Based on five patient cases, an average computational cost of approximately 2 min for estimating whole-brain deformation has been achieved with SGD using 100 sparse data points, suggesting the new algorithm is sufficiently fast with adequate accuracy for routine use in the operating room (OR).     

异位妊娠患者社会支持状况的调查研究

目的研究异位妊娠患者的社会支持状况,并探讨相应的护理对策。方法应用肖水源的社会支持评定量表,对2008年3月至5月在妇科住院的95例异位妊娠患者所获得的社会支持状况进行调查。结果异位妊娠患者获得的社会支持总均分为（37．08±8．37）分,与常模（34．56±3．73）分比较,差异有统计学意义（t=2．94,P〈0．01）。同时还发现已婚患者获得的社会支持总均分及主观支持、客观支持均分较未婚患者高,差异有统计学意义（P〈0．05）;而支持利用度方面,未婚患者较已婚患者偏高,但差异无统计学意义（P〉0．05）。结论护士应帮助异位妊娠患者优化社会支持网络,并鼓励她们主动利用;同时对未婚异位妊娠患者,护士群体也应成为社会支持的重要组成部分。以提高她们的社会支持及对支持的利用度。     

应当加强我国青光眼遗传资源的收集和利用

阳性家族史是发生青光眼的主要危险因素之一,提示基因缺陷在青光眼发病中具有重要作用。遗传学研究的进展为从遗传学角度阐明青光眼的发病机制提供了更多的依据。欲了解和研究与疾病相关的遗传因素的前提就是要拥有足够的与疾病相关的遗传资源。国外基于对青光眼遗传资源的利用,已经确定了多个与原发性青光眼相关的基因或位点。我国拥有世界上最丰富的疾病人群资源。但是我国目前在疾病遗传资源的收集、保存和利用等方面,仍然存在很多问题,包括缺少严格的操作规范,缺少临床医师的积极参与,基础医学和临床人员不能共同合作参与,疾病资源不能充分利用,遗传资源外流等。我们应当正视这些问题。当前,合理地开发和利用我国的遗传资源是当务之急.     

DNA Sequence Copy Number Aberrations Associated with Histological Subtypes and DNA Ploidy in Gastric Carcinoma

We have analyzed DNA sequence copy number aberrations (DSCNAs) and DNA ploidy by using comparative genomic hybridization and laser scanning cytometer in gastric carcinomas (GCs) to elucidate the genomic aberrations in relation to clinicopathological parameters. Thirty-two out of 33 cases showed one or more DSCNAs with a mean number of 11.7 per tumor. High-level gains were detected at 2p, 3q, 6p, 7p, 7q, 8q, 12p, 13q, 19q, and 20q. Frequency of gross genomic abnormalities and chromosome regions that have genomic aberrations were similar in both intestinal-and diffuse-type GCs, except aberrations at 8p, 9p, 12q, and 20q. The overall number of DSCNAs was significantly greater in DNA aneuploid tumors than that in DNA diploid tumors. We detected genomic aberrations characterized by histological subtype, tumor location, and DNA ploidy status: gain of 20q and losses of 8p and 9p in intestinal-type GCs, gains of 8p and 12q in diffuse-type GCs, gain of 20q in the lower third GCs, and loss of 5q, 9p, lOq, 16q, and 18q in DNA aneuploid GCs. Furthermore, 5q loss is associated with DNA aneuploidy ( P =0.0001) or the total number of losses ( P =0.001), gain+losses ( P =0.004), and high-level gains ( P =0.001) in GCs. Among these loci, chromosome 8p was unique. Gain of 8p was more common in diffuse-type GC, whereas loss of 8p was more frequently detected in intestinal-type GC. In conclusion, we describe chromosomal regions of 5q, 8p, and 20q, which are of interest for further investigation of GCs.     

基于数据挖掘探讨中药治疗卵泡发育不良用药规律及实验验证

目的：数据挖掘中药治疗卵泡发育不良的用药规律,并探讨聚类分析所得中药新方对排卵障碍大鼠卵巢功能的影响。方法：检索近20年相关中英文文献,提取、整理中药信息,采用SPSS Modeler18.0、SPSS Statistics 24.0软件分析中药治疗卵泡发育不良的用药特点、关联规则。确定聚类分析所得中药新方用于实验研究,将SD雌性大鼠随机分为对照组、模型组(雄激素致排卵障碍大鼠模型)、来曲唑组(模型组+来曲唑)、补肾健脾方组(模型组+补肾健脾方),每组10只。苏木精-伊红(HE)染色观察大鼠卵巢内各级卵泡发育情况、酶联免疫吸附试验检测大鼠血清雌二醇(E₂)、促黄体素(LH)、促卵泡素(FSH)、孕激素(P)等性激素水平。结果：研究纳入132个方剂,包含146味中药,涉及肾虚血瘀证、肾阴虚证等8个证型,使用频次≥20的有当归、熟地黄、菟丝子等27味中药,药味以甘、辛为主,药性以温、平为主,归经以肾为主,脾、肝次之。关联规则强度最高药对为当归、熟地黄-菟丝子,聚类分析获得三类新药组合,经专家讨论新方“补肾健脾方”用于实验研究。结果显示雄激素所致排卵障碍大鼠模型卵巢内大...