基层医院使用国产造影剂做静脉肾盂造影时毒副反应控制对策

目的:为了减少基层医院使用国产造影剂做IVP检查时毒副反应的发生。方法:对57例行IVP检查的患者进行认真细致的毒副反应发生情况的观察。结果:只要操作者思想上重视、技术上熟练,毒副反应将得以有效控制。结论:基层医院完全没有必要因担心毒副作用的发生而放弃IVP检查技术。     

What is the Level of Evidence Substantiating Commercial Payers’ Coverage Policies for Total Joint Arthroplasty?

BackgroundThe prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States.MethodsThe references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease.Results282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA.ConclusionMost of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.     

Impacto del nivel socioeconómico sobre el perfil del paciente amputado de miembro inferior por causa no traumática

IntroductionTo analyse the influence of socioeconomic status on the clinical profile of patients undergoing non-traumatic lower-limb amputation.MethodsRetrospective study of 697 lower-limb amputee patients in an Angiology and Vascular Surgery Department during a 5-year period. Patients were classified according to their socioeconomic status (low, medium and high). We analysed demographic (age and gender) and clinical variables (cause of amputation, comorbidity, cardiovascular risk factors and amputation level).ResultsMean age was 70.5 ± 11.9 years, and the median was 72 years. The low socioeconomic status group presented a higher frequency of amputations in men. Cardiovascular risks factors were more frequent in this socioeconomic group, and the difference was statistically significant for diabetes (85.8% low, 69.3% medium, 65% high; P<.01) and obesity (31.4% low, 22.6% medium, 12.5% high, P<.01). Diabetic retinopathy was the only comorbidity with a significant association with low socioeconomic status (21.1% low, 15.3% medium, 12.5% high, P<.03). Regarding the cause for amputation, there was no difference in terms of socioeconomic status. The low socioeconomic level showed a higher frequency of major amputation, which was a significant difference (63.6% low, 41.2% medium, 55% high, P<.04) and a higher predisposition for this amputation level.ConclusionsThe low socioeconomic status has been shown to determine an unfavourable vascular risk profile in lower-limb non-traumatic amputees and a higher predisposition of a major amputation. This socioeconomic level demonstrates a negative influence on these patients’ diabetes, obesity and diabetic retinopathy.     

“医教协同”模式下专业学位硕士研究生压力感知及学术能力提升需求调查

目的 对医学专硕学术科研水平的影响因素进行调研与分析,以期为提高其学术科研水平提供参考和借鉴。方法 选取某医院正在参与住院医师规范化培训的医学专硕作为研究对象,采用问卷调查的方式对其学术水平影响因素进行调研。结果 研究生对于提升自身学术科研水平有较大的需求,且普遍存在学术科研方面的压力,随着年级的上升其压力亦明显呈上升趋势（线性χ2 = 21.624,P＜0.001）。本科的知识储备、个人英语水平、兴趣爱好对其学术科研水平均有一定影响。结论 改革创新研究生学术科研水平的培养是各大高等医学院校亟待解决的问题,研究生学术科研水平的提高,需要学生、导师与高校三者进行有机结合通力协作。     

COVID-19 vaccination in pregnant women in Sweden and Norway

Vaccines against SARS-CoV-2 are highly effective in preventing severe disease and mortality. Although pregnant women are at increased risk of severe COVID-19, vaccination uptake among pregnant women varies. We used the Swedish and Norwegian population-based health registries to identify pregnant women and to investigate background characteristics associated with not being vaccinated. In this study of 164 560 women giving birth between May 2021 and May 2022, 78% in Sweden and 87% in Norway have been vaccinated with at least one dose at delivery. Not being vaccinated while being pregnant was associated with age below 30 years, low education and income level, birth region other than Scandinavia, smoking during pregnancy, not living with a partner, and gestational diabetes. These results can assist health authorities develop targeted vaccination information to diminish vaccination inequality and prevent severe disease in vulnerable groups.     

Epidemiology and virulence gene expression of intracellular group A streptococci in tonsils of recurrently infected adults

Intracellularly persistent group A streptococci (GAS, Streptococcus pyogenes) have been associated with recurrent tonsillopharyngitis and antibiotic treatment failure. As a supplementation of the published in vitro data, conventional bacteriology and molecular epidemiology was performed on material from 29 adult patients of a German army hospital with anamnestic signs of recurrent tonsillopharyngitis. Pre-surgery tonsil swabs and the surgically removed tonsils were examined with respect to growth of aerobic bacteria in absence and presence of antibiotics with exclusively extracellular activity. Under such antibiotic selection, Staphylococcus aureus and GAS were cultured from specimens of 13 and 3 patients, respectively. In every material GAS-positive by culture methods, the intracellular location of the penicillin-susceptible GAS isolates was confirmed by immunohistologic examination of tonsillar sections using a GAS-specific IgG antibody. The three intracellular GAS isolates were typed by emm gene sequencing and could be associated to types M6 and M49 (two isolates). The bacteria were serially passaged on sheep blood agar, and semiquantitative mRNA analysis from virulence genes was performed using bacteria of the 4th and 25th passage after isolation. An M-type-specific pattern of virulence gene expression and different gene expression levels in relation to the passage number were observed.     

基于直方图拟合的MRI图像水平集分割

利用混合高斯模型对MRI图像直方图进行分析,将拟合获得的特征参数作为水平集曲线进化的约束条件,对医学图像进行分割。分割中采用的自适应Level Set方法,能够自适应地确定曲线进化方向（扩张或收缩）,而不必在分割之前指定其进化方向,减少了人工干预;同时也克服了传统测地活动轮廓线（GAC）方法对图像梯度信息的过分依赖,以及由于对图像进行大尺度高斯平滑处理造成边缘点移动、定位准确度下降的缺陷。分别对MRI仿真和真实图像进行了实验,MRI仿真实验的分割敏感性、专一性和总体性能指标分别达到了94.72%、97.52%和97.22%。分割结果的定量分析和定性分析表明算法的有效性以及较高的分割准确度。     

多节段颈椎间盘脱出的脊髓型颈椎病治疗的回顾性分析

目的：研究多节段颈间盘脱出症术式选择、减压范围及植骨的处理。方法：对48例患者的发病因素、病程及影像学表现特征进行分析。本组均采用颈椎前路减压自体髂骨植骨融合术,术后随访最平均4．7年。结果：治疗效果优：28例（58．3％）良：11例（22．9％）。可：6例（12．5％）,差：3例（6．3％）。结论多节段间盘脱出症减压手术应首先考虑前路手术。如临床症状不缓解,可待植骨愈合后再后后路减压手术。一般两个节段的间盘摘除基本可以解决多间盘脱出的颈椎病。有的原则是务必保持椎间高度。