2013-2017年我国四种恶性肿瘤住院费用水平及结构变动度分析

背景　恶性肿瘤给家庭、社会带来了沉重的医疗、经济负担，极易导致部分家庭“因病致贫”或放弃治疗，目前相关研究多集中于单一病种、分散地域的研究，仍缺乏对于全国范围与多病种恶性肿瘤住院费用变化及结构构成的考量。目的　分析2013-2017年我国4种恶性肿瘤住院费用水平以及影响住院费用的主要项目和结构变动情况，为控制医疗费用上涨、深化新医改提供参考依据。方法　本研究数据来源于《2014中国卫生和计划生育统计年鉴》《2015中国卫生和计划生育统计年鉴》《2016中国卫生和计划生育统计年鉴》《2017中国卫生和计划生育统计年鉴》以及《2018中国卫生健康统计年鉴》，样本跨度为2013-2017年。统计“30种疾病人均住院费用”中的胃恶性肿瘤、肺恶性肿瘤、食管恶性肿瘤以及膀胱恶性肿瘤的数据，4种恶性肿瘤的人均住院费用包括药费、检查费、治疗费、手术费和手术材料费。2019年4-8月，采用结构变动度法分析我国2013-2017年4种恶性肿瘤的住院费用的结构变动情况〔结构变动值（VSV）、结构变动度（DSV）、结构变动贡献率〕。结果　2013-2017年，4种恶性肿瘤的人均住院费用逐年上升，其中胃恶性肿瘤的人均住院费用始终最高，且肺恶性肿瘤的人均住院费用上升幅度最大。2013-2017年，在4种恶性肿瘤住院各项费用的占比中，药费占比最高且总体逐年下降。从4种恶性肿瘤住院各项费用的实际变化来看，药费在2013-2014年有所上升，2014-2017年逐年下降；检查费在2013-2014年下降，2014-2017年缓慢上升；手术费与手术材料费在2013-2017年逐年上升。2013-2017年，在4种恶性肿瘤住院各项费用中均是药费的VSV最大；4种恶性肿瘤药费、检查费的VSV均呈负向变化，手术费和手术材料费的VSV均呈正向变化，治疗费的VSV增减均不明显。2013-2017年，4种恶性肿瘤住院费用的DSV从大到小依次为肺恶性肿瘤、胃恶性肿瘤、食管恶性肿瘤、膀胱恶性肿瘤。2013-2017年，4种恶性肿瘤住院各项费用中均是药费的结构变动贡献率最大，治疗费的结构变动贡献率最小；除药费外，胃恶性肿瘤、肺恶性肿瘤住院各项费用中均是手术材料费和手术费的结构变动贡献率次之，食管恶性肿瘤住院各项费用中手术费、检查费的结构变动贡献率次之，膀胱恶性肿瘤住院各项费用中检查费、手术材料费的结构变动贡献率次之。结论　2013-2017年我国4种恶性肿瘤手术费的结构变动贡献率虽然较为理想，但药费、治疗费仍是住院费用结构的重点调整对象；同时为有效降低恶性肿瘤的人均住院费用，应当加强控制手术材料费与检查费；而胃恶性肿瘤与肺恶性肿瘤患者的疾病经济负担严重，若要缓解应加强疾病的早期预防与住院费用管控。     

193例遗传咨询病例外周血染色体分析

分析遗传咨询病例１９３人的外周血染色体，发现异常核型２２例，占１１．４％，其中常染色体异常１５例，性染色体异常７例。就诊原因以不良孕产史占多数（６０．１％），智能低下及发育异常次之（２４．９％）。在所发现的２２例异常核型中，以智能低下及发育异常所占的比例最高（２２．９％），性发育异常次之（１８．２％）。     

食管癌筛查队列操作流程与建设标准方案探讨

癌症防治工作的重点在于一级预防和二级预防,通过健康教育引起人们对疾病的重视、自觉改变不良行为习惯、主动参加定期体检是防治癌症性价比最高的措施之一。食管癌作为我国疾病负担较重的恶性肿瘤之一,定期筛查和早诊早治是该病防治工作的重点。而队列研究有助于了解食管癌的自然史和危险因素、识别食管癌高危人群。本研究拟从危险因素调查、疾病监测、生物样本信息搜集等方面对食管癌多维动态随访共享队列的建设规范进行探讨,为今后建立规范统一的食管癌筛查队列研究操作流程和建设标准提供参考。     

海军新兵基础训练期间军事训练伤的流行病学调查

查明海军新兵基础训练期间军事训练伤的发生率和分布特征。方法：以整群抽样的方式选取驻粤海军某部参加１９９８年度基础训练的新兵５９２人,对训练中受伤的战士进行病学调查。结果在９０ｄ的训练中,军训伤的累积发生主为２８．２％,开训后第８周为发生高峰,各部位损伤中以下肢的发生率为最高。     

慢性肺原性心脏病病人血浆内皮素及降钙素基因相关肽水平的检测

目的：对不同临床分期慢性肺原性心及病病人血浆内皮素－1（ET－1）及降钙基因相关肽（CGRP）进行检测,方法：采用放射免疫法对标本进行测定,以呼吸系统急性感染病人的作为对照。结果：代偿期肺原性心脏病病人血浆ET－1水平显著高于对照组（P＜0．01）,而CGRP水平无差异,失代偿期病人ET－1水平显著高于代偿期病人（P＜0．05）,CGRP水平无差异,失代偿期病人ET－1水平显著高于代谢期病人（P＜0．05）,CGRP水平则显著低于代偿期病人（P＜0．01）,结论：ET－1及CGRP在慢性阻塞性疾病的发生和发展过程中起一定作用。且与疾病的严重程度相关。     

Nanoporous gold particles modified titanium electrode for hydrazine oxidation

A nanoporous gold particles modified titanium electrode (Au/Ti) was prepared by using a hydrothermal method. Gold nanoparticles were stably immobilized on the Ti surface from a mixture of aqueous HAuCl₄/polyethylene glycol (PEG) to form a nanoporous network texture. Electrocatalytic activity of the Au/Ti towards hydrazine oxidation in 1 M NaOH solution was assessed utilizing cyclic voltammetry (CV), linear scanning voltammetry (LSV) and electrochemical impedance spectroscopy (EIS). At the Au/Ti electrode, hydrazine oxidation in 1 M NaOH took place at a potential of −0.55 V (vs. Ag, AgCl) which was 0.53 V less than polycrystalline Au electrode. The Au/Ti electrode also presented much larger current density of hydrazine oxidation than Au electrode. Cyclic voltammetric responses of the Au/Ti electrode showed an irreversible electro-oxidation process of hydrazine. Linear plots of the reduction peak current density from the CVs of the Au/Ti vs. hydrazine concentration provided a potential detection of low concentration hydrazine. The kinetic parameters such as the number of electrons transferred in rate-determining step and total numbers of electrons involved in the hydrazine oxidation were determined using CVs and LSVs. CVs at the Au/Ti electrode also illustrated (relatively) weak interactions of hydrazine with electrode surface at all stages of the hydrazine oxidation process. Further, EIS data showed significantly high electrocatalytic activity of the Au/Ti electrode for hydrazine oxidation in alkaline solutions.     

Oxygen plasma assisted enhanced photoresponse of ZnO nanowires fabricated by catalyst-free chemical vapor deposition

In this paper, in order to enhance the performance of fabricated ZnO nanowires (NWs) by chemical vapor deposition (CVD) without catalysts, oxygen plasma was used to modify the ZnO nanowire-based interdigital microelectrode array photodetectors (IDA-PDs) at different times. The surface states of ZnO NWs with O₂ plasma treatment were characterized via X-ray photoelectron spectroscopy (XPS). Results showed that the photocurrent of the IDA-PDs continuously increased from 4 to 28 μA as the plasma-treatment time increased from 0 to 10 minutes. The response mechanism of O₂ plasma treated ZnO NWs was investigated by illustrating the intensity of the surface oxygen atoms of ZnO NWs.This sample handling method can be beneficial in improving the performance of semiconductor photodetectors.

Photocurrent of the ZnO nanowire-based photodetectors was enhanced 8 times by modifying the surface of nanowires with oxygen plasma.     

Prediction of diagnosis results of rheumatoid arthritis patients based on autoantibodies and cost-sensitive neural network

Clinical Rheumatology - To analyze and evaluate the effectiveness of the detection of single autoantibody and combined autoantibodies in patients with rheumatoid arthritis (RA) and related...     

Fast removal of Co(ii) from aqueous solution using porous carboxymethyl chitosan beads and its adsorption mechanism

Porous carboxymethyl chitosan (PCMC) beads were synthesized via ionic coacervation/chemical crosslinking, using polyethylene glycol (PEG) as a porogen and calcium chloride and glutaraldehyde as physical and chemical cross-linkers. The as-synthesized PCMC beads were characterized using SEM, EDS, BET, TGA, FTIR and XPS analysis and then tested for the removal of Co(ii) from aqueous solution. The effects of the initial pH, Co(ii) concentration and temperature were investigated. It was found that the adsorption equilibrium is reached within 6 h and the maximum adsorption capacity is 46.25 mg g⁻¹. In addition, the kinetics and equilibrium data are well described by pseudo-second-order kinetics and the Langmuir isotherm model. Moreover, the desorption and re-adsorption performance was also studied, and the results revealed that the prepared new adsorbent still showed good adsorption performance after five cycles of regeneration. Finally, the adsorption mechanism, including chemical and physical adsorption, was proposed on the basis of the microstructure analysis, adsorption kinetics and isotherm results, and chemical adsorption was found to be the main adsorption mechanism during the process of the removal of Co(ii).

The as-prepared adsorbent exhibits excellent adsorption capacity and fast kinetics for Co(ii).     

通道法前列腺电切术在高危前列腺增生症中应用

目的探讨通道法前列腺电切术治疗高危前列腺增生症的安全性及临床效果。方法回顾性分析行通道法前列腺电切术治疗的高危前列腺增生症病人89例的临床资料,对病人手术前后生命体征变化情况、血红蛋白(Hb)及血清钠变化情况,术中出血量、手术持续时间,术后膀胱冲洗时间、继发性出血等进行分析以评价手术安全性;对手术前与手术后3个月、1年的国际前列腺症状评分(I-PSS)、生活质量评分(QOL)、最大尿流率(Qmax)、残余尿量(RUV)进行统计学分析以评价手术效果。结果全部病例均顺利完成手术,围手术期生命体征平稳,无低钠血症发生,Hb无明显变化,术中出血量少,手术用时少,膀胱冲洗液转清时间早,随访期间无严重并发症发生。术后3个月、1年I-PSS、Qmax、QOL、RUV与术前比较差异有显著性(F=457.542~7 829.355,P<0.05),术后3个月与1年上述指标比较差异无显著性(P>0.05)。结论通道法前列腺电切术治疗高危前列腺增生症安全、有效,值得临床推广。