生物信息学在肝细胞癌风险预测中的应用

生物信息学是一门交叉科学,通过综合运用数学、计算机科学和生物学的各种工具,来阐明和理解大量生物数据所包含的生物学意义。随着基因组学测序技术的不断发展,产生大量的生物学数据资源,从大数据中挖掘所蕴藏的生物学意义,已成为了当前亟待解决的主要任务之一。本文主要归纳总结基于特征基因的肝癌风险预测模型,为肝癌的早期检测、预后和治疗方案的优化提供新观点。     

Nerve ultrasound reference data in children from two to seven years

ObjectiveWe examined selected peripheral and spinal nerves of children aged between two and seven years.MethodHigh resolution ultrasound was performed in 116 children (2–7 years of age) at 19 predefined landmarks of median, ulnar, tibial, fibular, sural and radial nerves, the vagus as well as cervical spinal nerve 5 and 6. Further, side-to-side measuring and grey-scale analysis was done at selected nerve sites.ResultsNerves of children were on average smaller than those of adults. Nerve growth correlates significantly with age in all nerves, the mean values were similar in the age of two to four years and five to seven years. Body mass index (BMI) and gender showed moderate effect at some nerve sites, however not uniformly in all. A side-to-side difference of up to 30% in median, and up to 20% in tibial nerve can occur in healthy individuals. Grey-scale analysis for echointensity has been performed in median, ulnar and tibial nerves.ConclusionNerve size increases with age, BMI and gender have moderate effect. A side-to-side-difference of up to 30% can exist.SignificanceReference values of nerve cross-sectional area, side-to-side-difference and echo intensity are necessary to detect nerve pathology in children as well as in adults.     

肿瘤性复杂性胸壁缺损的修复策略及对肿瘤治疗的积极影响

复杂性胸壁缺损的修复一直是一项极具挑战性的工作。肿瘤性复杂性胸壁缺损的修复决策及其执行困难是限制胸壁肿瘤治疗方法选择及影响预后的重要因素之一。皮瓣解剖学研究的深入、胸壁支持结构重建技术的进步、显微外科技术的发展、麻醉护理的发展、对综合治疗的重视和治疗手段的进步等,使传统认为不可切除的胸壁肿瘤得以彻底地切除和安全有效地修复,从而使与缺损修复相关的肿瘤切除及辅助治疗的禁忌证缩减到最小程度,有效地提高了胸壁肿瘤患者的生存质量,并很大程度上延长了生存率。作者以湖南省肿瘤医院整形外科15年565例胸壁肿瘤切除后修复重建的临床资料为依据,充实了胸壁肿瘤切除及修复的策略:(1)可靠的胸壁骨性支架重建;(2)有效的软组织修复;(3)麻醉及护理与手术团队的合作;(4)系统有序的综合治疗。并进一步明确了复杂胸壁肿瘤切除及重建的细节理念,包括胸部肿瘤治疗中加强多学科合作的密切性和科学性,整形外科医生参与肿瘤治疗整体规划的主动性和时机前移等。     

Endoscopic gastroplasty to treat medically uncontrolled obesity needs more quality data: A systematic review

Endoscopic gastroplasty (EG) has been used in clinical practice to treat obesity. This systematic review has the objective of assessing if there is an acceptable level of scientific evidence on the safety and effectiveness of EG. A thorough search strategy was used up to October 2018, including the 2 most common techniques: endoscopic suturing and the primary obesity surgery endolumenal procedure. The quality of the studies was evaluated through the Joanna Briggs Institute Critical Appraisal tools for use in Systematic Reviews—“Checklist for Case Series”—and summarized using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Only 1 randomized controlled trial (moderate GRADE evidence) was found, and the remaining were case reports or small case series (very low GRADE evidence). The literature has low scientific quality. All studies, with 1 exception, are small case series with short follow-up. One of the randomized controlled trials did not meet the primary endpoint for weight loss in both groups (EG × sham) after 1-year follow-up. The case series reported from 16% to 19% total weight loss, but few had more than 6 months of follow-up. Serious adverse events ranged from 2% to 10%. Based on current literature, there is not enough quality scientific evidence regarding long-term weight loss and the procedure’s safety to recommend the use of EG in current clinical practice.     

脑出血围手术期护理安全中细节管理的重要性分析

目的分析脑出血围手术期护理安全中细节管理的重要性。方法将于2018年6-10月在该院接受治疗的60例脑出血围术期患者作为该研究的常规组。将于2018年11月-2019年3月在该院接受治疗的60例脑出血围术期患者作为该研究的细节组。该院于2018年11月开始实施细节管理,以加强保障脑出血围术期患者的安全。对比两组患者的护理满意度、手术失败率、死亡率、住院时间及日常生活能力。结果细节组护理满意度明显高于常规组(P<0.05)。常规组的手术失败率、死亡率为均高于细节组,差异无统计学意义(P>0.05);细节组的住院时间明显短于常规组(P<0.05),ADL评分明显大于常规组(P<0.05)。结论细节管理在脑出血围手术期护理安全中具有相当重要性,可提升护理满意度,加快恢复速度,提升恢复效果。     

甘肃省和政县农村老年性白内障防盲项目的卫生经济学评价研究

目的 对2014-2016年在甘肃省和政县开展的白内障综合防盲干预项目进行卫生经济学评价。设计 横断面调查。 研究对象 甘肃省和政县2014-2016年老年性白内障手术前407例患者及术后半年109例患者。方法 对所有调查对象进行卫生经济学问卷调查。通过净效益法、成本效益分析法和成本效果分析法评价项目产生的经济效益和总成本。主要指标 直接成本、间接成本、直接经济效益、间接经济效益、总成本、总效益、净效益、成本效益比、成本效果比。结果 2014-2016年项目期间甘肃省和政县白内障所致总体疾病经济负担为2142.28万元。白内障手术产生的总效益为3398424.98元，总成本为2939125.20元，净效益为459299.78元，效益成本比为1.16:1。项目每投入1万元可降低50岁以上白内障患者导致的0.027%的致盲率和0.164%致残率；项目每降低1%的50岁以上白内障患者的盲率，需投入36.47万元；每降低1%50岁以上白内障患者的残率，需投入6.11万元。结论 在甘肃省和政县开展的老年性白内障防盲综合干预项目具有较好的产出回报比和较高的防盲技术效率。（眼科，2020，29： 298-303）