某三甲医院临床路径管理的应用效果评价

目的 评价临床路径应用于7个有代表性单病种的临床效果。方法 用历史对照法选取单病种6 865例实施临床路径管理（路径组）和6 902例非临床路径管理（非路径组）,对住院费用、住院时间、抗生素的使用费用等指标进行综合比较 、评价。结果 路径组与非路径组住院费用、住院时间和抗生素费用比较,P均﹤0.05,2组在3项评价指标上比较,差异有统计学意义（P﹤0.05）。结论 7个单病种的临床路径管理可以降低住院费用及抗生素费用,缩短住院时间。     

临床路径在老年性白内障手术患者中的应用评价

目的 探讨临床路径在老年性白内障手术患者中的应用及实施效果。方法 选取2009年6月—2012年6月期间在某三甲医院住院手术治疗的3 758 例老年性白内障病人为研究对象,采用对照研究,经患者同意,将其分为对照组（1 995例）和观察组（1 764例）,比较两组平均住院日、平均住院费用、西药费用、辅助诊断费、患者满意度、健康知识知晓程度。结果 观察组的平均住院日、平均住院费用、西药费用、辅助诊断费、并发症发生率均低于对照组（P <0.000 1）, 患者满意度及健康知识掌握情况均高于对照组（P<0.05）,差别具有统计学意义。结论 临床路径应用于白内障手术,可以缩短住院天数,降低医疗费用及辅助诊断费,提高患者的满意度,提高患者对健康知识的掌握率,减少术后并发症的发生。     

急性缺血性脑卒中临床路径管理模式的优化及实践

目的 评价优化后急性缺血性脑卒中临床路径管理模式的优越性。方法 随机选取医院实施急性缺血性脑卒中治疗临床路径管理优化前后收治的急性脑梗死患者各200例,采用回顾性分析比较各组患者的相关指标。结果 路径优化管理后,患者诊疗等待时间缩短,疾病规范诊疗比率进一步提高,医护工作量大大减少,患者满意度进一步提高。结论 实施临床路径能够改善医疗质量,更好地利用医疗资源。临床路径优化后医疗质量进一步提高。     

电子病历系统对临床路径管理的影响研究

目的 探讨电子病历系统对临床路径管理的影响。方法 入选河北北方学院附属第一医院2014年1月—2014年6月进入临床路径管理的512例患者（包括胆囊结石腹腔镜胆囊切除术、慢性鼻-鼻窦炎、2型糖尿病3个病种）作为观察对象,其中258例患者采用电子病历系统进行临床路径管理,254例患者采用纸质病历系统进行临床路径管理,比较两组病历质量、路径变异率、病种治疗费用及患者满意度。结果 观察组甲级率明显高于对照组、乙级率明显低于对照组,差异均具有统计学意义（均P<0.05）;观察组路径变异率为7.8%（20/258）,显著低于对照组15.0%（38/254）,差异具有统计学意义（P＜0.05）;观察组3个病种的治疗费用均显著低于对照组,差异均具有统计学意义（均P＜0.05）;观察组患者满意度为95.3%（246/258）,显著高于对照组的77.2%（196/254）,差异具有统计学意义（P＜0.05）。结论 电子病历系统与临床路径管理结合有助于降低路径变异率,提高医护人员工作效率,降低医疗费用,提高患者满意度。     

医院战略性绩效评价指标体系研究

目的 基于医院战略,构建同医院战略相匹配的绩效评价指标体系。方法 运用Delphi法对绩效指标体系进行全面的筛选与整理,利用层次分析法来确定绩效指标体系的各级指标的权重。结果 设计出最能反映医院绩效的12个方面共50个指标,构建了以战略为导向的医院绩效评价指标体系。结论 基于医院战略的绩效评价,有利于提升医院核心竞争力,促进医院战略的实现。     

老年性白内障日间手术临床路径模式效果分析

目的 借鉴国内外日间手术管理经验,在医药分开综合改革的背景下,探索实施老年白内障日间手术临床路径新模式。方法 对首都医科大学附属北京同仁医院2010年（临床路径实施前）、2013年（临床路径实施后）和2016年（日间手术临床路径模式开展后）老年性白内障治疗人均费用、平均住院日、术后感染率进行比较。结果 实施老年白内障日间手术临床路径新模式,平均住院日缩短,人均治疗费用降低,且差异均有统计学意义（P>0.05）。2010年、2013年、2016年的手术感染率都较低,差异无统计学意义（P>0.05）。结论 在保障医疗质量的前提下,老年性白内障日间手术临床路径新模式的实施,不仅提高医院和科室的经济效益,为政府节约医疗资源,而且还能降低患者的治疗费用,提高患者满意度。     

临床路径在梗阻性分娩治疗中的应用分析

????????目的 制定梗阻性分娩临床路径标准,并对实施效果进行评价。方法 采取随机分组方法,对梗阻性分娩患者分为实验组（实施临床路径）和对照组（常规治疗）。结果 实验组与对照组患者在年龄、病情、文化程度、城乡分布无显著差异（P＞0.05）,术前住院时间、术后住院时间及总住院时间有显著性差异（P<0.05）,药费、处置费及总住院费用上有显著性差异（P<0.05）,两组之间的满意度无差异。结论 梗阻性分娩中实施临床路径管理,对缩短住院时间、降低和控制住院费用、提高患者满意度方面有着重要的作用,但在路径的实施过程中也存在一些有待改进的问题。     

病种质量管理方式探讨 ——以剖宫产为例

目的 以剖宫产为例研究病种管理方式,探讨病种纳入标准。方法 采用统计学分析法,对不同指征剖宫产按照住院天数、住院费用进行分组,并对其住院费用的影响因素进行分析。结果 5组不同指征剖宫产数据根据住院费用指标可分为3组,按照住院天数指标分类则可归纳为2组,并且经分析发现,影响不同指征剖宫产术住院总费用的因素主要为药费、住院天数。结论 可以依据医疗资源消耗的相似性制定病种纳入标准,扩大病种质量控制体系范围;此外,通过控制关键影响因素来加强病种质量管理,降低患者医疗费用。     

老年性白内障患者住院费用及相关因素的现况调查

目的 探讨老年性白内障住院患者住院费用的年龄、性别和不同医院的分布特点,为提供科学收费标准提供参考依据。方法 采用整群抽样的方法对2009年不同医院9 464例老年性白内障患者的住院费用及相关因素进行横断面调查并进行初步分析。结果 将老年白内障患者按<60岁、60~80岁、>80岁分为3组,床位费、西药费、检验费、放射费、特检费、治疗费、手术费和护理费均随年龄增加而增加且存在统计学差异。以上费用,男性患者均高于女性且存在统计学差异。海军医院患者最高（P<0.05）,其他由高至低依次为全军陆军医院、全军空军医院和全军二炮医院患者。结论 卫生决策部门应针对其不同特点制定适宜收费标准,有必要跟进研究不同病种费用区别的制度或管理层面的原因。

     

心脏外科术后随访数据库的建立及完善

目的 构建新型、双向交互式、远程医疗随访平台,完善心脏术后临床数据的收集,并为患者提供可靠优质的随访服务。方法 运用现代通信、计算机及网络技术,开发与移动网兼容的随诊数据库及软件,以术后随访率、术后重要指标的随访质量,作为评估随访系统的标准。结果 系统正式运行1年余,共录入术后患者1392例,总随访率80.1%,其中超声心动图1065人次,心电图953人次,胸片567人次,国际标准化比值3856人次。结论 三爱医疗随访平台能有效地进行临床资料的收集,并将医疗服务延伸,给患者带来更多的帮助。     

Preparation of hair for measurement of elements by inductively coupled plasma-mass spectrometry (ICP-MS)

The preparation of hair for the determination of elements is a critical component of the analysis procedure. Open-beaker, closedvessel microwave, and flowthrough microwave digestion are methods that have been used for sample preparation and are discussed. A new digestion method for use with inductively coupled plasma-mass spectrometry (ICP-MS) has been developed. The method uses 0.2 g of hair and 3 mL of concentrated nitric acid in an atmospheric pressurelow-temperature microwave digestion (APLTMD) system. This preparation method is useful in handling a large numbers of samples per day and may be adapted to hair sample weights ranging from 0.08 to 0.3 g. After digestion, samples are analyzed by ICP-MS to determine the concentration of Li, Be, B, Na, Mg, Al, P, S, K, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, Ge, As, Se, Rb, Sr, Zr, Mo, Pd, Ag, Cd, Sn, Sb, I, Cs, Ba, Pt, Au, Hg, Tl, Pb, Bi, Th, and U. Benefits of the APLTMD include reduced contamination and sample handling, and increased precision, reliability, and sample throughput.     

外泌体在白血病中的重要调控作用

目前,白血病复发是患者死亡的主要原因之一。肿瘤细胞和微环境的相互作用,以及隐匿在骨髓中的肿瘤干细胞,促进了白血病的复发和向淋巴组织的转移,因此白血病的治疗、转移和复发问题受到广泛关注。外泌体是由绝大多数细胞分泌的双层脂质膜囊泡,可以调控细胞间的交流和信息传递。在白血病细胞、基质细胞和内皮细胞之间的相互联系中都涉及到外泌体,白血病细胞来源的外泌体存在于白血病患者的血浆中,能把其携带的白血病相关抗原及微小RNA呈递给靶细胞,促进白血病肿瘤细胞的增殖,有助于肿瘤细胞实现免疫逃避,保护白血病细胞抵抗化疗药物导致的细胞毒性作用,促进血管生成及肿瘤细胞的迁移。因此,外泌体与白血病的转移、治疗及预后密切相关,可以用来检测和监测白血病的进展。本文综述了外泌体的来源、形成与分泌机制,以及外泌体在白血病发生前、发展中、预后和免疫治疗中所扮演的重要角色。     

日本北海道虻类雌性外生殖器形态(双翅目：虻科)(英文)

【目的】利用日本北海道虻类评估和验证外生殖器在分类学上的意义。【方法】将虻类成虫标本浸渍在生理盐水中并置于双目显微镜下通过针和镊子在培养皿中进行解剖并绘图,观察第9背板、第10背板、尾叶、第8腹板、受精囊、受精囊管及生殖叉器的形态特征。【结果】在日本北海道共记录了虻科(Tabanidae) 3亚科7属38种。我们观察并描述了3亚科其中的6属24种的雌性外生殖器的主要特征。亚科之间存在明显差异;然而在一般情况下属之间很难建立一种方法来确定共同点;种之间只有在斑虻属Chrysops中有相似之处,其他属中则比较多样化。因此,亚科鉴定根据第9背板、第8腹板及受精囊足以进行区分,属及种鉴定需要结合第9背板、第10背板、尾叶、第8腹板、受精囊、受精囊管及生殖叉器各自的特征组合在一起才能区分开来。我们也制作了虻类外生殖器的检索表。【结论】和许多其他昆虫一样,外生殖器是虻科的重要分类特征,对于促进分类学和系统学的发展具有重要意义。本研究首次对分布在日本北海道的虻科雌性外生殖器进行了系统研究。     

Ecological importance of sedges: a survey of the Australasian Cyperaceae genus Lepidosperma

Background

Sedges (Cyperaceae) form an important ecological component of many ecosystems around the world. Sword and rapier sedges (genus Lepidosperma) are common and widespread components of the southern Australian and New Zealand floras, also occurring in New Caledonia, West Papua, Borneo, Malaysia and southern China. Sedge ecology is seldom studied and no comprehensive review of sedge ecology exists. Lepidosperma is unusual in the Cyperaceae with the majority of species occurring in dryland habitats.

Scope

Extensive review of ecological literature and field observations shows Lepidosperma species to be important components of many ecosystems, often dominating understorey and sedge-rich communities. For the first time, a detailed ecological review of a Cyperaceae genus is presented.

Conclusions Lepidosperma

species are long-lived perennials with significant abundance and persistence in the landscape. Speciation patterns in the genus are of considerable interest due to complex biogeographical patterns and a high degree of habitat specificity. Potential benefits exist for medicinal products identified from several Lepidosperma species. Over 178 organisms, including 26 mammals, 42 birds, six reptiles, five amphibians, eight arachnids, 75 insects, three crustaceans and 13 fungi, are found to be dependent on, or making use of, Lepidosperma species. A significant relationship exists between Lepidosperma species and the moth genus Elachista. Implications for the conservation and ecology of both sedges and associated species are discussed.     

Frequency of cyanogenesis in tropical rainforests of far north Queensland, Australia

BACKGROUND AND AIMS: Plant cyanogenesis is the release of toxic cyanide from endogenous cyanide-containing compounds, typically cyanogenic glycosides. Despite a large body of phytochemical, taxonomic and ecological work on cyanogenic species, little is known of their frequency in natural plant communities. This study aimed to investigate the frequency of cyanogenesis in Australian tropical rainforests. Secondary aims were to quantify the cyanogenic glycoside content of tissues, to investigate intra-plant and intra-population variation in cyanogenic glycoside concentration and to appraise the potential chemotaxonomic significance of any findings in relation to the distribution of cyanogenesis in related taxa. METHODS: All species in six 200 m(2) plots at each of five sites across lowland, upland and highland tropical rainforest were screened for cyanogenesis using Feigl-Anger indicator papers. The concentrations of cyanogenic glycosides were accurately determined for all cyanogenic individuals. KEY RESULTS: Over 400 species from 87 plant families were screened. Overall, 18 species (4.5 %) were cyanogenic, accounting for 7.3 % of total stem basal area. Cyanogenesis has not previously been reported for 17 of the 18 species, 13 of which are endemic to Australia. Several species belong to plant families or orders in which cyanogenesis has been little reported, if at all (e.g. Elaeocarpaceae, Myrsinaceae, Araliaceae and Lamiaceae). A number of species contained concentrations of cyanogenic glycosides among the highest ever reported for mature leaves-up to 5.2 mg CN g(-1) d. wt, for example, in leaves of Elaeocarpus sericopetalus. There was significant variation in cyanogenic glycoside concentration within individuals; young leaves and reproductive tissues typically had higher cyanogen content. In addition, there was substantial variation in cyanogenic glycoside content within populations of single species. CONCLUSIONS: This study expands the limited knowledge of the frequency of cyanogenesis in natural plant communities, includes novel reports of cyanogenesis among a range of taxa and characterizes patterns in intra-plant and intra-population variation of cyanogensis.     

Micromanipulation of Gene Expression in the Adult Zebrafish Brain Using Cerebroventricular Microinjection of Morpholino Oligonucleotides

Manipulation of gene expression in tissues is required to perform functional studies. In this paper, we demonstrate the cerebroventricular microinjection (CVMI) technique as a means to modulate gene expression in the adult zebrafish brain. By using CVMI, substances can be administered into the cerebroventricular fluid and be thoroughly distributed along the rostrocaudal axis of the brain. We particularly focus on the use of antisense morpholino oligonucleotides, which are potent tools for knocking down gene expression in vivo. In our method, when applied, morpholino molecules are taken up by the cells lining the ventricular surface. These cells include the radial glial cells, which act as neurogenic progenitors. Therefore, knocking down gene expression in the radial glial cells is of utmost importance to analyze the widespread neurogenesis response in zebrafish, and also would provide insight into how vertebrates could sustain adult neurogenesis response. Such an understanding would also help the efforts for clinical applications in human neurodegenerative disorders and central nervous system regeneration. Thus, we present the cerebroventricular microinjection method as a quick and efficient way to alter gene expression and neurogenesis response in the adult zebrafish forebrain. We also provide troubleshooting tips and other useful information on how to carry out the CVMI procedure.     

Fine Structure of Sperm of Ekphymatodera thomasoni (Heteroderinae,Nemata)

Fine structure of developing sperm of the monospecific genus, Ekphymatodera, was compared with other Heteroderinae as part of a study to recognize diversity and phylogenetically informative characters within the subfamily. Sperm of Ekphymatodera originate from germ cells connected to a central rachis, a character which is shared with Globodera, but not with other Heteoderinae. In Ekphymatodera, and cyst-forming genera, a layer of cortical microtubules lies just beneath the surface of the plasma membrane. Sperm of Ekphymatodera are unique among Heteroderinae examined by the presence of spiral surface elevations on the filopodia, a character that may prove to be a synapomorphy for Sarisoderini. Fibrous bodies are abundant in spermatids; however, they do not persist in sperm of Ekphymatodera as they do in Meloidodera and Verutus. The male gonad of Ekphymatodera is lined by epithelial cells, which are greatly enlarged near the ejaculatory canal. These enlarged cells contain vesicles with concentric lamellar inclusions, not observed in other genera of the subfamily. Sperm of Heteroderinae are rich in diversity, and examination of additional representative species may indicate new phylogenetically informative characters.     

A phylogenetic analysis of 100+ genera and 50+ families of euasterids based on morphological and molecular data with notes on possible higher level morphological synapomorphies

 A data matrix of 143 morphological and chemical characters for 142 genera of euasterids according to the APG system was compiled and complemented with rbcL and ndhF sequences for most of the genera. The data were subjected to parsimony analysis and support was assessed by bootstrapping. Strict consensus trees from analyses of morphology alone and morphology + rbcL + ndhF are presented. The morphological data recover several groups supported by molecular data but at the level of orders and above relationships are only superficially in agreement with molecular studies. The analyses provide support for monophyly of Gentianales, Aquifoliales, Apiales, Asterales, and Dipsacales. All data indicate that Adoxaceae are closely related to Dipsacales and hence they should be included in that order. The trees were used to assess some possible morphological synapomorphies for euasterids I and II and for the orders of the APG system. Euasterids I are generally characterised by opposite leaves, entire leaf margins, hypogynous flowers, “early sympetaly” with a ring-shaped corolla primordium, fusion of stamen filaments with the corolla tube, and capsular fruits. Euasterids II often have alternate leaves, serrate-dentate leaf margins, epigynous flowers, “late sympetaly” with distinct petal primordia, free stamen filaments, and indehiscent fruits. It is unclear which of these characters represent synapomorphies and symplesiomorphies for the two groups, respectively, and there are numerous expections to be interpreted as reversals and parallelisms. Received August 28, 2000 Accepted August 7, 2001     

Design and Use of Multiplexed Chemostat Arrays

Chemostats are continuous culture systems in which cells are grown in a tightly controlled, chemically constant environment where culture density is constrained by limiting specific nutrients.^1,2 Data from chemostats are highly reproducible for the measurement of quantitative phenotypes as they provide a constant growth rate and environment at steady state. For these reasons, chemostats have become useful tools for fine-scale characterization of physiology through analysis of gene expression^3-6 and other characteristics of cultures at steady-state equilibrium.⁷ Long-term experiments in chemostats can highlight specific trajectories that microbial populations adopt during adaptive evolution in a controlled environment. In fact, chemostats have been used for experimental evolution since their invention.⁸ A common result in evolution experiments is for each biological replicate to acquire a unique repertoire of mutations.^9-13 This diversity suggests that there is much left to be discovered by performing evolution experiments with far greater throughput. We present here the design and operation of a relatively simple, low cost array of miniature chemostats—or ministats—and validate their use in determination of physiology and in evolution experiments with yeast. This approach entails growth of tens of chemostats run off a single multiplexed peristaltic pump. The cultures are maintained at a 20 ml working volume, which is practical for a variety of applications. It is our hope that increasing throughput, decreasing expense, and providing detailed building and operation instructions may also motivate research and industrial application of this design as a general platform for functionally characterizing large numbers of strains, species, and growth parameters, as well as genetic or drug libraries.     

Literature based species occurrence data of birds of northeast India

The northeast region of India is one of the world's most significant biodiversity hotspots. One of the richest bird areas in India, it is an important route for migratory birds and home to many endemic bird species. This paper describes a literature-based dataset of species occurrences of birds of northeast India. The occurrence records documented in the dataset are distributed across eleven states of India, viz.: Arunachal Pradesh, Assam, Bihar, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura, Uttar Pradesh and West Bengal. The geospatial scope of the dataset represents 24 to 29 degree North latitude and 78 to 94 degree East longitude, and it comprises over 2400 occurrence records. These records have been collated from scholarly literature published between1915 and 2008, especially from the Journal of the Bombay Natural History Society (JBNHS). The temporal scale of the dataset represents bird observations recorded between 1909 and 2007. The dataset has been developed by employing MS Excel. The key elements in the database are scientific name, taxonomic classification, temporal and geospatial details including geo-coordinate precision, data collector, basis of record and primary source of the data record. The temporal and geospatial quality of more than 50% of the data records has been enhanced retrospectively. Where possible, data records are annotated with geospatial coordinate precision to the nearest minute. This dataset is being constantly updated with the addition of new data records, and quality enhancement of documented occurrences. The dataset can be used in species distribution and niche modeling studies. It is planned to expand the scope of the dataset to collate bird species occurrences across the Indian peninsula.