Direct comparison of reproducibility and reliability in quantitative assessments of burn scar properties

IntroductionDetermining the efficacy of anti-scar technologies can be difficult as qualitative, subjective assessments are often utilized instead of systematic, objective measures. Perceptions regarding the reliability of instruments for quantitative measurements along with their high cost and increased data collection time may discourage their use, leading to use of scar scales which are relatively quick and low-cost. To directly evaluate the reliability of instruments for quantitative measurements of scar properties, instruments and two qualitative scales were compared by assessing a variety of cutaneous scars.MethodsScar height and surface texture were evaluated using a 3D scanner and a mold/cast technique. Scar color was evaluated by using a spectroscopy-based tool, the Mexameter®, and digital photography with image analysis. Scar biomechanics were evaluated using the BTC-2000?, Dermal Torque Meter (DTM®), and ballistometer®. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to qualitatively evaluate the same scar properties. Intraclass correlation coefficients (ICC) were used to determine inter- and intra-user reliability (poor, moderate, good, excellent) with all instruments and the kappa reliability statistic was used to asses inter-user reliability (poor, fair, moderate, good, very good) for VSS and POSAS. Time for measurement collection and after collection analysis was also recorded.ResultsThe Mexameter® was the most reliable method for evaluating erythema and pigmentation compared to digital photography and image processing, POSAS and VSS. Digital photography and analysis was more reliable than POSAS and VSS. Assessment of scar height was significantly more reliable when using a 3D scanner versus VSS and POSAS. The 3D scanner and mold-cast techniques also offered an additional benefit of providing an absolute value of scar height relative to the surrounding tissue. Intra-user reliability for all mechanical tests was moderate to good. Inter-user reliability was greater when using the BTC-2000? and ballistometer® versus the DTM®. All quantitative measurements took less than 90 s for collection, with the exception of the mold/cast technique.ConclusionNon-invasive instruments allow scar properties to be quantitatively assessed with high sensitivity and as a function of time and/or treatment without the need for biopsy collection. Overall, the reliability of scar assessments was significantly improved when quantitative instruments were utilized versus scar scales. Quantitative assessment of color and biomechanics were swift, requiring less than 90 s per measurement while assessments of texture and height required additional analysis time after collection. With proper training of clinical staff and well-defined protocols for measurement collection, reliable, quantitative assessments of scar properties can be collected with little disruption to the clinical workflow.     

基于SWOT-PEST分析模型的我国老年慢性病智慧健康管理发展对策研究

慢性病严重威胁我国老年人群的健康,智慧健康管理作为老年慢性病管理的全新途径,其发展过程必然受到政治、经济,社会和技术多方面因素的影响。本文基于SWOT-PEST分析模型对我国老年慢性病智慧健康管理的内外部因素进行分析,旨在明确自身的优势与劣势,理清外部的机会和威胁,进一步提出相应发展对策,以期为促进我国老年慢性病智慧健康管理可持续发展提供思路。     

基于社会网络分析方法的黑龙江省县域医联体建设问题分析及思考

目的:梳理与明确黑龙江省县域医联体建设中的关键问题,为黑龙江省县域医联体建设提供参考意见。方法:文献分析法、社会网络分析法等。结果:黑龙江省县域医疗体系在政策和相关卫生资源的配置上存在医疗资源薄弱、县域医联体政策、配套措施不足等问题;医联体成员间、医生间利益分配和激励机制不足、农村基层医疗机构服务能力不足以及政府对于医共体财政补助不足是目前被学者们普遍认同的关键问题。结论:重构利益分配和激励机制、以政策与相关配套措施推动县域医联体建设、补齐县级医院短板是黑龙江省县域医联体建设的必要之举。     

个人剂量监测中异常结果的调查与分析

目的 对2014—2017年本实验室个人剂量监测过程中出现的异常结果进行调查与原因分析。方法 放射工作人员佩戴热释光个人剂量计监测个人剂量当量H_P(10),对测量结果超过调查水平的进行统计分析。结果 2014—2017年,本实验室共出现40个单位69人次个人剂量监测结果异常,其中从事诊断放射学的占83%;剂量结果在1.25～5.00 mSv占54%;导致剂量结果异常的主要原因有剂量计佩戴不规范（67%）、原因不明（20%）、工作量增加（10%）和设备维修（占3.0%）等。结论 加强放射工作单位对放射工作人员的管理及放射防护培训,提高个人防护意识。     

北京市健康体检机构放射卫生管理现状分析

目的 了解我市健康体检机构放射诊疗工作开展情况,规范健康体检机构放射诊疗行为。方法 依据《北京市卫生和计划生育监督所关于开展2019年健康体检机构放射诊疗专项监督检查工作的通知》的要求,采用现场检查、现场访谈方式开展调查工作。结果 本次健康体检机构的调查表明,北京市健康体检机构放射卫生管理工作总体良好,放射诊疗许可证持有率为100%。健康体检机构的放射诊疗工作以X射线摄影为主,215家健康体检机构共配置的放射诊疗设备822台,其中CT机138台,体检车20台,CT机占16.8%;健康体检机构的X射线摄影设备占总应用频次93%,CT机占总应用频次7.0%。215家健康体检机构全年放射诊疗应用频次约500万人次,被处罚机构占比较低,仅占2.8%,其中给予警告6户次,罚款2户次,发出处罚决定书6份,整改3户。结论 北京市健康体检机构放射卫生管理工作总体良好,在CT机合理应用、防护用品配置等方面仍存在一些问题,需进一步解决。     

中国女性青年人体惯性参数的CT—图像分析法测定及其回归方程的研究

采用CT成像和图像分析技术，在尸体研究的基础上，对50例女性样本（18～23岁）进行全身CT横断层扫描、图像分析和测算以及建立数学模型等方面的研究。获得了人体的质量分布、质心位置和转动惯量等惯性参数。据此，建立了直接计算中国女性青年人体各环节惯性参数的二元回归方程。为中国人体运动学和动力学研究提供了基础数据；也为运动员的选材提供了有力的手段。     

脑血管病及其病因病CBA检测的临床研究

应用CBA，CV-300型脑血管动力学检测仪对脑血管病及其病因病进行检查，发现阳性率均在92.5％，98.46％，其脑血管动力学参数（CVDI）的临床意义特点：脑出血和脑梗塞在急性期均出现明显异常，脑出血的CP增高、脑梗塞的动脉硬化发生率为其特点。同CT对比，CVDI异常与CT定位大多数相一致，且比CT出现得早，存在早期诊断价值，高血压糖尿病的CVDI特点为双侧对称性异常，出现明显不对称性异常，可视为卒中前改变。     

Autoradiographic characterisation and localisation of 5-HT1D compared to 5-HT1B binding sites in rat brain

Summary The regional distribution and the pharmacology of the binding sites labelled with the novel 5-hydroxytryptamine (serotonin) 5-HT_1B/1D selective radioligand serotonin-O-carboxy-methyl-glycyl-[¹²⁵I]tyrosinamide (abbreviated [¹²⁵I]GTI for the sake of simplicity) was determined using quantitative autoradiography in rat brain. The distribution of [¹²⁵I]GTI binding sites was largely comparable to that of [¹²⁵I] iodocyanopindolol ([¹²⁵I] ICYP) which labels 5-HT_1B binding sites (in the presence of 8-OH-DPAT (8-hydroxy-[2N-dipropylamino]tetralin) and isoprenaline, to prevent binding to 5-HT_1A and -adrenoceptor binding sites), although a detailed analysis revealed differences.The pharmacology of the [¹²⁵I]GTI binding sites was analysed using compounds known to display high affinity for and/or distinguish between 5-HT_1B and 5-HT_1D sites: 5-carboxamidotryptamine (5-CT), sumatriptan, CP 93129 (5-hydroxy-3(4-1,2,5,6-tetrahydropyridyl)-4-azaindole), (–)pindolol, PAPP (4[2-[4-[3-(trifluoromethyl)phenyl]-1-piperazinyl]ethyl] benzeneamine), rauwolscine, and 8-OH-DPAT. The displacement of [¹²⁵I]GTI by 5-CT was monophasic. By contrast, the selective 5-HT_1B compound CP 93129 and (–)pindolol produced biphasic curves showing a majority of high affinity sites in the globus pallidus and the substantia nigra, whereas PAPP and sumatriptan (which are somewhat 5-HT_1D selective) produced biphasic curves indicating a minority of high affinity sites in these areas. In addition, by blocking the 5-HT_1B sites with 100 nM CP 93129, the remaining population of [¹²⁵I]GTI binding sites could be studied and was found to have high affinity for PAPP, rauwolscine and 8-OH-DPAT. The pharmacological profile of the major binding component was typical of the 5-HT_1B type: 5-CT > CP 93129 (–)pindolol > sumatriptan >/ PAPP > rauwolscine. The profile of the minor component of [¹²⁵I] GTI binding is best characterised as that of a 5-HTID site: 5-CT > PAPP sumatriptan > rauwolscine > (–)pindolol CP 93129.The localisation of the non 5-HT_1B [¹²⁵I]GTI binding sites was characterised by blocking the 5-HT_1B receptors with 100 nM CP 93129. Low densities of the 5-HT_1D recognition sites were found to be present in globus pallidus, ventral pallidum, caudate-putamen, subthalamic nucleus, entopeduncular nucleus, substantia nigra (reticular part), nuclei of the (normal and accessory) optic tract, different nuclei of the geniculate body and frontoparietal cortex, although higher densities of 5-HT_1B sites were always observed in the same structures. Thus, in agreement with the recent cloning of a rat 5-HT_1D receptor cDNA, the presence and the distribution of 5-HT_1D sites could be documented in rat brain. However, when compared to 5-HT_1B sites, 5-HT_1D sites represent only a minor component of the [¹²⁵I]GTI binding in the rat brain structures studied.Correspondence to: D. Hoyer at the above address     

复方柴胡汤加减对大鼠酒精性肝损伤形态学和线粒体的定量研究

目的：探讨中药复方对酒精性肝损伤的防护作用。方法：形态学观察（光镜,电镜）应用MPIAS－500病理图文分析系统做线粒体定量分析（面积,周长,等效直径,平均光密度）,结果：光镜损伤组肝细胞破坏明显,呈气球样变,有酒精小体,汇管区有炎细胞浸润,而防治组与正常组相似,肝小叶排列规则,细胞体积大,分界清晰,电镜损伤组细胞不规则,胞质疏松,含大量脂滴,而防治组与正常组相似,核大而规则,含丰富的细胞器,无或少量脂滴,线粒体各指标损伤组与防治组差异显著（P＜0．01）。结论：本中药复方对酒精性肝损伤具有一定的防护作用。