营利性医院医疗服务自主定价政府监管的思考

营利性医院医疗服务自主定价是践行十八届三中全会“市场在资源配置中起决定性作用”在医疗服务领域的举措。对营利性医院医疗服务自主定价进行阐述,并通过分析营利性医院医疗服务自主定价出现的问题,提出完善其政府监管的具体途径：完善政府对营利性医院自主定价的引导措施,完善营利性医院自主定价信息公示,畅通政府监管的信息传输渠道以及政府监管部门加大对违规自主定价的处罚。     

救治人员总协调制度在严重多发伤早期救治中的作用

目的 探讨院内救治人员总协调制度对严重多发伤早期救治的作用,以进一步优化创伤病患救治流程。方法 选取2013—2014年在苏州市立医院救治的严重多发伤病人共130例为研究组,同时回顾2011—2012年苏州市立医院救治的严重多发伤病人共123例为对照组,比较研究组与对照组在院内术前时间、在院监护时间、早期漏诊率、早期死亡率及并发症发生率等指标的变化。结果 研究组病人的院内术前时间、在院监护时间较对照组显著缩短,早期漏诊率、早期死亡率和并发症发生率均显著降低。结论 院内救治人员总协调制度的执行可有效提高严重多发伤早期救治效率。     

Parametric analysis of the biomechanical response of head subjected to the primary blast loading – a data mining approach

Traumatic brain injury due to primary blast loading has become a signature injury in recent military conflicts and terrorist activities. Extensive experimental and computational investigations have been conducted to study the interrelationships between intracranial pressure response and intrinsic or ‘input’ parameters such as the head geometry and loading conditions. However, these relationships are very complicated and are usually implicit and ‘hidden’ in a large amount of simulation/test data. In this study, a data mining method is proposed to explore such underlying information from the numerical simulation results. The heads of different species are described as a highly simplified two-part (skull and brain) finite element model with varying geometric parameters. The parameters considered include peak incident pressure, skull thickness, brain radius and snout length. Their interrelationship and coupling effect are discovered by developing a decision tree based on the large simulation data-set. The results show that the proposed data-driven method is superior to the conventional linear regression method and is comparable to the nonlinear regression method. Considering its capability of exploring implicit information and the relatively simple relationships between response and input variables, the data mining method is considered to be a good tool for an in-depth understanding of the mechanisms of blast-induced brain injury. As a general method, this approach can also be applied to other nonlinear complex biomechanical systems.     

正肝化症方联合隔姜灸对原发性肝癌行经肝动脉化疗栓塞术患者肝功能和免疫功能的影响

目的:探讨正肝化症方联合隔姜灸对原发性肝癌(PHC)行经肝动脉化疗栓塞术(TACE)患者肝功能和免疫功能的影响。方法:选取2015年2月～2018年11月期间广东省第二人民医院收治的PHC患者121例,根据数表法将患者随机分为对照组(n=60)和研究组(n=61),其中对照组予以TACE治疗,研究组在对照组基础上予以正肝化症方联合隔姜灸治疗,比较两组患者临床疗效、生活质量及肝功能、免疫功能指标水平,记录两组治疗期间不良反应发生情况。结果:研究组治疗后临床总有效率为75.41%(46/61),高于对照组患者的56.67%(34/60)(P0.05)。两组患者治疗后谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)均较治疗前降低,且研究组低于对照组(P0.05)。两组患者治疗后CD4~+、CD4~+/CD8~+均较治疗前升高,且研究组高于对照组(P0.05);CD8~+较治疗前降低,且研究组低于对照组(P0.05)。两组患者治疗后健康调查简表(SF-36)评分较治疗前升高,且研究组高于对照组(P0.05)。研究组不良反应总发生率低于对照组(P0.05)。结论:正肝化症方联合隔姜灸辅助TACE治疗PHC患者,疗效确切,可有效改善患者肝功能以及免疫功能,提高患者生活质量,减少不良反应发生率。     

Comparative study on different therapies on patients with primary central nervous system lymphoma

Objective

To compare and analyze three therapies on patients with primary central nervous system lymphoma (PCNSL), aiming to provide evidences for future treatment and prognosis.

Association between hypertension and cutaneous melanoma,and the effect of aspirin: extended follow-up of a large randomised controlled trial

BackgroundThe association between hypertension and melanoma is unclear, and previous analyses of data from the ASPirin in Reducing Events in the Elderly (ASPREE) study demonstrated a reduced number of invasive melanoma events amongst aspirin-exposed hypertensive individuals.MethodsData from the ASPREE study which included (1) the intervention period with a median follow-up of 4.7 years, and (2) the observational period with an additional 2 years follow-up, were combined for this analysis. Logistic regression analyses examined the association between baseline hypertension and treatment status and past melanoma history. Survival analyses examined the association between hypertension and melanoma risk, and the effect of aspirin across hypertension groups. Cox proportional hazards models were used to compare incidence across groups.Results19,114 participants (median age of 74 years) were randomised to daily 100 mg aspirin or placebo. At baseline, hypertension and past melanoma history were recorded in 14,195 and 685 individuals, respectively. After adjustment for confounders, hypertension was significantly associated with past melanoma history (OR=1.34, 95%CI: 1.11–1.62). In a prospective analysis, baseline hypertension was not associated with melanoma risk. However, aspirin was associated with a reduced risk of incident melanoma amongst individuals with uncontrolled hypertension (blood pressure ≥140/90 mmHg; HR=0.63, 95%CI 0.44–0.89), but not in those with controlled hypertension (HR=1.04, 95%CI 0.74–1.46).ConclusionOur results support a reduced melanoma incidence amongst individuals with uncontrolled hypertension exposed to aspirin. Additional studies are required to confirm these findings.     

Development of the post-natal growth plate requires intraflagellar transport proteins

In the post-natal growth plate, chondrocytes are arranged in columns parallel to the long axis of the bone. Chondrocytes divide perpendicular to this axis and then move into position one on top of another in a process called "rotation" that maintains columnar organization. Primary cilia are non-motile microtubule base appendages extending from the surface of almost all vertebrate cells. Primary cilia were described on chondrocytes almost 40 years ago but the function of these structures in cartilage biology is not known. Intraflagellar transport (IFT) is the process by which primary cilia are generated and maintained. This study tested the hypothesis that IFT plays an important role in post-natal skeletal development. Kif3a, a subunit of the Kinesin II motor complex, that is required for intraflagellar transport and the formation of cilia, was deleted in mouse chondrocytes via Col2a-Cre-mediated recombination. Disruption of IFT resulted in subsequent depletion of cilia and post-natal dwarfism due to premature loss of the growth plate likely a result of reduced proliferation and accelerated hypertrophic differentiation of chondrocytes. Cell shape and columnar orientation in the growth plate were also disrupted suggesting a defect in the process of rotation. Alterations in chondrocyte rotation were accompanied by disruption of the actin cytoskeleton and alterations in the localization of activated FAK to focal adhesion-like structures on chondrocytes. This is the first report indicating a role for IFT and primary cilia in the development of the post-natal growth plate. The results suggest a model in which IFT/cilia act to maintain the columnar organization of the growth plate via the process of chondrocyte rotation.     

A switch in the cellular basis of skeletogenesis in late-stage sea urchin larvae

Primary mesenchyme cells (PMCs) are solely responsible for the skeletogenesis during early larval development of the sea urchin, but the cells responsible for late larval and adult skeletal formation are not clear. To investigate the origin of larval and adult skeletogenic cells, I first performed transplantation experiments in Pseudocentrotus depressus and Hemicentrotus pulcherrimus, which have different skeletal phenotypes. When P. depressus PMCs were transplanted into H. pulcherrimus embryos, the donor phenotype was observed only in the early larval stage, whereas when secondary mesenchyme cells (SMCs) were transplanted, the donor phenotype was observed in late and metamorphic larvae. Second, a reporter construct driven by the spicule matrix protein 50 (SM50) promoter was introduced into fertilized eggs and their PMCs/SMCs were transplanted. In the resultant 6-armed pluteus, green fluorescent protein (GFP) expression was observed in both PMC and SMC transplantations, suggesting SMC participation in late skeletogenesis. Third, transplanted PMCs or SMCs tagged with GFP were analyzed by PCR in the transgenic chimeras. As a result, SMCs were detected in both larval and adult stages, but GFP from PMCs was undetectable after metamorphosis. Thus, it appears that SMCs participate in skeletogenesis in late development and that PMCs disappear in the adult sea urchin, suggesting that the skeletogenesis may pass from PMCs to SMCs during the late larval stage.     

Adaptive neuro-fuzzy modelling of anaerobic digestion of primary sedimentation sludge

Modelling of anaerobic digestion systems is difficult because their performance is complex and varies significantly with influent characteristics and operational conditions. In this study, Adaptive Neuro-Fuzzy Inference System (ANFIS) were used for modelling of anaerobic digestion system of primary sludge of Kayseri municipal WasteWater Treatment Plant (WWTP). Effluent Volatile Solid (VS) and methane yield were predicted by the ANFIS. Two stage models were performed. In the first stage, effluent VS concentration was predicted using pH, VS concentration, flowrate of pre-thickened sludge and temperature of the influent as input parameters. In the second stage, effluent VS concentration in addition to first stage input parameters were used as input parameters to predict methane yield. The low Root Mean Square Error (RMSE) and high Index of agreement (IA) values were obtained with subtractive clustering method of a first order Sugeno type inference. The model performance was evaluated with statistical parameters. According to statistical evaluations, the models satisfactorily predict effluent VS concentration and methane yield.