青海藏药产业竞争力与区域经济发展耦合关系实证研究

本文以青海省为研究区域,通过构建青海藏药产业竞争力与区域经济发展两个子系统共20个二级指标,运用耦合协调度模型,实证分析了2008-2017年青海省藏药产业竞争力与区域经济发展的耦合协调程度。研究结果表明,青海藏药产业的发展滞后于区域经济的发展,但二者的耦合协调程度总体呈上升趋势,且分为两个阶段,即2008-2012年的失调阶段与2013-2017年的协调阶段,当前两系统处于初级协调状态。     

肱桡肌止点与桡骨茎突骨块形成的关系:解剖与X线对比研究及临床意义

目的 探讨肱桡肌止点的解剖特点及其在桡骨远端骨折茎突骨块形成中的作用。方法 2015年3—9月选取14例成人新鲜尸体上肢标本,观察肱桡肌肌腱的解剖结构及其止点的位置、形态,测量止点范围长度、宽度、面积以及与桡骨茎突尖的距离。选取2014年7月—2016年4月收治的29例伴有茎突骨块的桡骨远端骨折患者腕关节正位X线片资料进行回顾性分析,将茎突骨块分为完整型和碎裂型,茎突骨块完整型测量茎突骨块长度,茎突骨块碎裂型分别测量干骺端骨块长度和关节面骨块长度。采用SPSS 17.0统计软件对解剖学和X线片观察指标进行对比分析。结果尸体上肢标本解剖测量显示:肱桡肌肌腱向远端走行途中分别与前臂深筋膜、旋前方肌及第二伸肌间隔的腱膜组织通过坚韧的纤维组织相接续;肱桡肌肌腱以纤维形式牢固附着于桡骨茎突表面,止点形态近似水滴状,尖部指向近端;肱桡肌肌腱止点范围长(18.80±3.67)mm,宽(11.23±2.06)mm,止点附着面积(141.53±4.55)mm²,肌腱附着部近端距桡骨茎突尖距离(26.59±3.76)mm。临床X线测量结果显示:11例茎突骨块完整型的茎突骨块长(24.42±4.30)mm;18例茎突骨块碎裂型,茎突骨块总长(28.08±4.93)mm,其中干骺端骨块长(16.32±3.87)mm、关节面骨块长(11.76±3.46)mm。与标本解剖测量结果比较,茎突骨块完整型和碎裂型的茎突骨块长度与肌腱附着部近端至茎突尖的距离差异均无统计学意义(t=1.345、1.334,P值均＞0.05),茎突骨块碎裂型的干骺端骨块长度与肱桡肌止点长度差异也无统计学意义(t=1.839,P＞0.05)。结论 肱桡肌肌腱止点牢固附着于桡骨茎突,是桡骨远端骨折形成茎突部干骺端骨块的解剖基础。     

Altered intrinsic regional brain activity in female asthmatics with or without depressive symptoms: A resting-state functional magnetic resonance imaging study

Background: Previous studies have suggested that asthma patients are more susceptible to anxiety or depression and have more specifically elevated depressive symptomology. These psychological factors are associated with anatomical brain changes. However, little is known about alterations in spontaneous brain activity in asthma patients with depressive symptoms. Here we hypothesized that asthma patients exhibit an altered regional spontaneous brain activity, which may contribute to their increased susceptibility to depression and poor perception of asthma symptoms. The purpose of this study was to examine spontaneous brain activity in female asthma patients using resting-state functional magnetic resonance imaging (rs-fMRI). Methods: Eleven asthmatics without depressive symptoms (ASs), 14 asthmatics with depressive symptoms (ADs), and 15 age- and education-matched healthy controls (HCs) completed rs-fMRI. The regional homogeneity (ReHo) value was calculated based on rs-fMRI to assess local signal synchrony strength and compared among the groups. Correlation analyses were conducted between both ReHo values and clinical parameters. Result: Compared with HCs, ASs showed a significantly increased ReHo in the right insula; whereas ADs showed a significantly decreased ReHo in the right insula, which positively correlated with nocturnal symptom score in the Asthma Control Test (r = 0.562, P = 0.036). No significant correlation was observed between the total ACT scores and right insula activities (r = 0.263, P = 0.364). Conclusion: Decreased ReHo in the right insula may play an important role in depressive symptoms and abnormal asthma symptom perception.     

Segmental myocardial velocities in dilated cardiomyopathy with and without left bundle branch block

Purpose:

To quantify three‐directional left ventricular (LV) myocardial velocities and intraventricular synchrony in dilated cardiomyopathy (DCM) with and without left bundle branch block (LBBB) using MR tissue phase mapping (TPM).

Materials and Methods:

Regional velocities were assessed by TPM (spatial/temporal resolution = 1.3 × 1.3 mm² × 8 mm/14 ms) in DCM patients with (n = 12) and without LBBB (n = 7) compared with age‐matched volunteers (n = 20). For the evaluation the AHA 16‐segment and an extended LV visualization model was used.

Results:

Radial velocities in DCM patients were reduced in 75% (systole) and in 94% (diastole) (P = 0.0001 – P = 0.0360), long‐axis velocities in 31% (systole) and in 75% (diastole) of the 16 segments compared with controls (P = 0.0001 – P = 0.0310). LBBB resulted in inferolaterally delayed diastolic long‐axis velocities (P = 0.0012 – P = 0.0464) and shortened TTP for septal systolic radial velocities (P = 0.0002). Intra‐ventricular radial systolic TTP differed up to 150 ms between segments in patients with LBBB (89 ms without LBBB, 34 ms in volunteers) reflecting an increased dyssynchrony. LV twist was altered in all patients with reduced and delayed systolic and diastolic peak velocities.

Conclusion:

TPM identified previously not described alterations of the spatial distribution and timing of all myocardial velocities in patients with DCM and LBBB. This may help to optimize therapy management in future. J. Magn. Reson. Imaging 2013;37:119–126. © 2012 Wiley Periodicals, Inc.     

重组人血管内皮抑制素联合静脉化疗和腹腔热灌注化疗治疗晚期卵巢癌的临床研究

目的 观察重组人血管内皮抑制素(恩度)联合静脉化疗和腹腔热灌注化疗治疗晚期卵巢癌的临床疗效.方法 将61例晚期卵巢癌患者按照随机数字表法分为治疗组(31例)和对照组(30例),治疗组给予恩度+TP方案(紫杉醇静脉化疗+顺铂腹腔热灌注化疗);对照组给予恩度+TP方案(紫杉醇静脉化疗+顺铂静脉化疗).观察两组患者的复发率、生存率、生活质量改善情况及不良反应.结果 治疗组患者中64.5％(20/31)的生活质量得到改善,显著高于对照组的33.3％(10/30)(x2=5.931,P=0.015).治疗组患者的1、2年复发率显著低于对照组[17.2％(5/29)比41.4％(12/29)和34.5％(10/29)比62.1％(18/29),P=0.043、0.036].治疗组患者的1、2年生存率显著高于对照组[93.1％(27/29)比72.4％(21/29)和79.3％(23/29)比51.7％(15/29),P=0.037、0.027].治疗组患者恶心、呕吐的发生率为67.7％(21/31),对照组为93.3％(28/30),两组比较差异有统计学意义(P=0.012).两组患者骨髓抑制、脱发及肝肾功能损害等的发生率比较差异无统计学意义(P＞0.05).结论 恩度联合静脉化疗和腹腔热灌注化疗治疗晚期卵巢癌安全、有效,可以提高患者的生活质量,降低复发率,延长生存期.     

上海新一轮区域卫生规划的特点和实施探讨

在研读《上海市区域卫生规划（2011-2020年）》和分析上海近年卫生发展状况及挑战的基础上,指出上海新一轮区域卫生规划在目标的设定上遵循需求导向和问题导向,在任务和指标设计上统筹考虑了立足上海和服务全国、＂立地＂和＂顶天＂、硬件和软件、当前需求和未来发展,以及具有分级规划和可落地性等特点,并建议规划的实施要注重工作机制的建立、改革的配套和发挥社会力量的作用等。     

医保统筹费用的预算与模拟监控初探

目的：探索多区域医保统筹费用在医院各专业的预算方式,以便在区域医保统筹费用框架范围内,实施合理的监控。方法根据多个区域医保统筹费的要求,以医院各专业工作量为基础,前瞻性的预算各专业不同区域的医保统筹费用,并模拟跟踪监控。结果通过模拟监控,预算的工作量与预算的各专业医保统筹费用波动一致,预算的各专业医保统筹费用值与半年实际发生值的统计检验无显著差异。结论本预算和模拟监控方法简单便捷、符合实际,可供同行参考和进一步探讨。     

Délais de prise en charge des quatre cancers les plus fréquents dans plusieurs régions de France en 2011 et 2012

Measuring waiting times is a good indicator of quality of cancer care and could reveal inequalities in cancer care access.AimsTo determine the most representative waiting times in breast, lung, colon and prostate cancer care in several regions of France. To analyze the influence of individual, medical or health care system factors on those waiting times.MethodsThis study was piloted by the French Cancer Institute in partnership with the National Federation of the Regional Health Observatories and was driven by the Regional Oncology Networks and the Regional Health Observatories. In 2011, 2,530women with breast cancer and 1,945 patient with lung cancer were included in eight regions, and in 2012, 3,248 patients with colon cancer and 4,207 men with prostate cancer were included in 13 regions, two of which were overseas departments. Data were analyzed from multidisciplinary discussion reports and from medical records.ResultsThe mean time intervals (± standard deviation) for the various components of access to care were as follows in breast cancer: mammography to pathologist diagnosis, 17,7 days (±15,9); diagnosis (or treatment proposal) to surgery, 22,9 days (±13,9). In lung cancer: first suspect medical image to pathologist diagnosis, 21,5 days (±17,6); diagnosis to treatment proposal, 13,5 days (±10,7). In colon cancer: coloscopy to pathologist diagnosis, 4,5 days (±4,1); diagnosis to surgery, 18,9 days (±14,9). In prostate cancer: pathologist diagnosis to treatment proposal, 36,5 days (±26,5); treatment proposal to surgery, 45,2 days (±30,1). Data collection was particularly difficult because of very heterogeneous way in medical records filling by care centers, so the data collection method used in the study could not be used in routine procedures. Waiting times measured in the four cancers had an important variability. In fact, age, circumstance of diagnosis, tumor stage and category of care center had an influence. After considering those different factors, differences between regions remained from range 2to 4. Those regional differences could be explained by organizational factors but were not explored in our study. In the same way, data on individual factors (social vulnerability, category of employment) were not available to measure their effects on this study. Besides, our results were comparable to those in international publications or national recommendations in other countries.ConclusionsThese results suggest that waiting times could be good indicators and could reveal inequalities in cancer care access. Measuring them would lead to characterize those inequalities and to propose actions to improve access to cancer care whose impact could be measured.     

What's new in surgical oncology breast

It is on the backdrop of advances in tumor biology and systemic therapy for breast cancer, that progress in locoregional treatment has focused on management of the breast for invasive cancer, imaging for staging and therapeutic decision-making, and de-escalation in the management of the axilla.     

A phase I/II study to evaluate radiation therapy and hyperthermia for deep-seated tumours: A report of RTOG 89–08

The purpose of this paper is to evaluate the safety and efficacy of deep hyperthermia in conjunction with radiation therapy. This study employed ‘second generation’ electromagnetic devices which were felt to be better able to confine heating and spare normal tissue than the devices evaluated in a previous study (RTOG 84–01). Sixty six patients at six institutions were enrolled on a prospective Phase I/II study. Eligible deep seated tumours were treated with a combination of external hyperthermia and radiation therapy. Radiation consisted of 1·7–2 Gy per fraction, 4–5 fractions per week, to > 20 Gy (previously irradiated lesions) or > 50 Gy (no previous radiation). Deep hyperthermia was delivered with electromagnetic devices: BSD 2000 for 92% of cases, Thermotron for 5% of cases, other low frequency electromagnetic for 4% of cases. Hyperthermia was delivered ≤ twice weekly. Overall complete and partial response rates were 34% and 16% respectively. Response was not correlated with maximum tumour temperature or disease site. There was, however, a strong association with radiation dose: 54% CR with ≥ 45 Gy versus 7% with < 45 Gy (p < 0·0001). The achieved temperatures were less than ideal. Although the average maximum tumor temperature was 41·9°C (range 35·7°C–46·7°C), the minimum tumour temperatures were low. The average minimum tumour temperature was 38·5°C and was never > 41·8°C. Treatment was well tolerated with no fatalities. There were four acute grade 3 or 4 toxicities (6% of patients). Patient discomfort resulted in interruption or discontinuation of sessions in 30% of the sessions. In 12 cases (18% of patients) the planned course of hyperthermia was discontinued due to acute discomfort. The devices used in this study were better tolerated than the devices used in the previous Phase I/II deep hyperthermia trial (RTOG 84·01) with less patient discomfort and no problems with severe systemic cardiovascular stress. In the previous study 68% of the hyperthermia courses were prematurely terminated primarily due to patient discomfort and toxicity; in the present study 18% were prematurely terminated. However, as indicated by the low minimum tumour temperature, fundamental problems with achieving acceptable temperature distributions remain.