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西安地區192例嬰幼兒眼內疾病構成分析

損傷控制外科新理念在肺創傷急救中的臨床應用

目的 探討損傷控制外科（damage control surgery，DCS）新理念在急性肺創傷中的應用策略及臨床意義。 方法 回顧性分析2001年10 月至2010 年3 月，中國人民解放軍第一一七醫院收治的187 例肺創傷患者的臨床資料，其中男132 例，女55 例；年齡16 ～ 75歲。交通傷124 例，墜落傷42 例，刀刺傷21 例；合并傷172 例。根據對肺損傷患者采用的搶救方式不同，將187 例分為兩組，DCS 理念搶救組（DCS 組）：2004 年4 月至2010 年3 月收治的135 例患者，按DCS 理念進行搶救；對照組：2001 年10 月至2004 年3 月收治的52 例患者，按傳統處理方式進行搶救。比較兩種處理方式的搶救成功率、平均住院時間、彌漫性血管內凝血（DIC）和肺部并發癥發生率。 結果 圍術期共死亡8 例，其中DCS 組死亡3 例，病死率為2.2%；對照組死亡5 例，病死率為9.6%。DCS 組搶救成功率明顯高于對照組（97.8% vs.90.4%, P ＜ 0.05）；住院時間短于對照組[（11.5±2.9） d vs.（ 13.1±3.3）d, P ＜ 0.05]；DIC 發生率（7.4% vs.17.3%, P ＜ 0.05）和肺部并發癥發生率（11.1% vs.23.1%, P ＜ 0.05）低于對照組。 隨訪72例（DCS 組57 例、對照組15 例），隨訪時間1 ～ 36 個月，患者生活恢復正常，均未殘留嚴重后遺癥。失訪107 例（DCS組75 例、對照組32 例）。 結論 對急性肺損傷患者，根據DCS 理念，按肺損傷程度不同，采取合理的處理方式，可有效地提高搶救成功率，降低并發癥的發生率，促進患者早日康復。

Ideas and practices of construction of tertiary prevention network of retinopathy of prematurity in China

Retinopathy of prematurity (ROP) is the leading cause of blindness for children, early detection and treatment can prevent ROP progression and improve the visual prognosis. ROP prevention system, including advocacy, screening, diagnosis/treatment and follow-up, is the key to reducing the rate of blindness in children. The proposed tertiary ROP prevention network includes primary health centers in county-level, secondary health centers in municipal-level and tertiary health centers in provincial-level or national-level. The idea is to explore the greatest benefits in the ROP prevention process from the existing allocation of medical resources, but also to avoid wasting at the current stage of social development. We tested this idea in Shaanxi Province recently. The preliminary practice results indicated that ROP tertiary prevention network can increase the ROP screening coverage, promote the prevention and treatment of ROP. However this work is still in its infancy. We need to expand its scope and strength the advocacy efforts to find a way to prevent and treat ROP in China.

綜合ICU醫院感染監測的效果分析

目的 對綜合ICU開展目標性監測，控制醫院感染。 方法 2008年1月-12月開始對綜合ICU進行目標性監測；將感染率、呼吸機相關性肺炎（VAP）、動靜脈置管、泌尿道插管的感染率及抗菌藥物使用及病原菌情況與2006年進行對比。 結果 2008年患者618例，感染率7.6%，例次感染率7.9%；2006年患者509例，感染率14.7%，例次感染率15.5%，2008年呼吸機相關性肺炎為51.1%，動靜脈置管感染率為0.17%，泌尿道插管感染率為016%；2006年呼吸機相關性肺炎感染率為100%，動靜脈置管感染率為1.0%，泌尿道插管感染率為1.0%；VAP感染率兩者比較有差異，動靜脈置管與泌尿道插管感染率無差異。 結論 ICU患者存在諸多醫院感染的易感因素，目標性監測能有效控制醫院感染。

Lentivirus-mediated polypyrimidine bundle binding protein-associated splicing factor inhibits retinal neovascularization in mice of oxygen-induced retinopathy

ObjectiveTo investigate the inhibitory effect of lentivirus-mediated polypyrimidine bundle binding protein-associated splicing factor (PSF) on retinal neovascularization (RNV) in mice model of oxygen-induced retinopathy (OIR).MethodsOne hundred and twelve 5-day-old C57BL/6J mice were randomly divided into normal control group, simple OIR model group, OIR model + lentivirus empty vector treatment group (Vec group) and OIR model + PSF lentivirus treatment group (PSF group), with 16, 32, 32 and 32 mice, respectively. When the mice were 7 days old, the mice in the normal control group were fed in a routine environment, and the mice in the OIR model group, Vec group and PSF group were established OIR model. The mice in the Vec group and PSF group were given an intravitreal injection of 1 μl of lentiviral vector and PSF lentivirus (titer 1×1011 TU/ml) at the age of 12 days. No injection was performed in the normal control group and simple OIR group. RNV was evaluated by counting the number of pre-retinal neovascular cells and analysis of non-perfusion area by immunofluorescent staining of the mouse retina. Real-time quantitative PCR was applied to detect the mRNA expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and hemeoxygenase-1 (HO-1). Western blot analysis was applied to detect the protein expression of Nrf2, HO-1 and PSF. Results Of the normal control group, simple OIR model group, Vec group and PSF group, the number of pre-retinal neovascular cell nuclei were 0.00, 14.36±5.50, 15.67±4.96, 8.13±2.09, the non-perfusion area were 0.00%, (35.71±2.81)%, (36.57±4.53)%, (15.33±4.75)%, respectively. The differences of the number of pre-retinal neovascular cell nuclei and non-perfusion area among 4 groups were significant (F=24.87, 165.70; P＜0.05). Compared with the normal control group, there were more pre-retinal neovascular cell nucleis and larger non-perfusion area in the simple OIR model group and Vec group (P＜0.05). Compared with the simple OIR model group and Vec group, there were lower pre-retinal neovascular cell nucleis and smaller non-perfusion area in the PSF group (P＜0.05). Real-time quantitative PCR and Western blot showed that the mRNA expression of Nrf2, HO-1 (F=53.66, 83.54) and protein expression of Nrf2, HO-1 and PSF (F=58.38, 52.69, 24.79) among 4 groups were significant (P＜0.05). The mRNA expression of Nrf2, HO-1 and protein expression of Nrf2, HO-1 and PSF in the simple OIR model group and Vec group decreased significantly than those in the normal control group (P＜0.05). The mRNA expression of Nrf2, HO-1 and protein expression of Nrf2, HO-1 and PSF in the PSF group were increased significantly than those in the simple OIR model group and Vec group (P＜0.05). model group and Vec group (P＜0.05).ConclusionIntravitreal injection of lentivirus-mediated PSF inhibits RNV in mice model of OIR possibly through up-regulating the expression of Nrf2 and HO-1.

Influence of Health Education by Nurses on Effects of Blood Pressure Control in Hypertensive Patients: A Clinical Controlled Trial

ObjectiveFor better health interventions, blood pressure control and reducing risk of cardiovascular events, we explored the effects of health education by nurses on hypertension patients after discharging. MethodsHypertensive discharging-patients from the department of cardiology of the West China Hospital of Sichuan University were enrolled from January to October in 2011. They were divided into two groups, including a health education group and a control group. The patients in the health education group were given all-side care, health guidance, education lectures and telephone follow-up by nurses. The control group got no intervention. After one year follow-up, the information about situation of blood pressure control, new-onset cardiovascular events and changes of life habits were collected from the two groups. SPSS 19.0 was used to perform statistic analysis. ResultsA total of 300 discharged hypertensive cases were included, with 150 cases in each group. The systolic blood pressure of patients in the health education group was significantly lower than that of the control group (P < 0.05). Both blood control rates and the habit of low salt intake in the health education group were also better than those of the control group (both P < 0.05). There was no significant difference in changes of smoking, drinking, physical exercise and new-onset cardiovascular events between the two groups. ConclusionHealth education by nurses could effectively improve the management of blood pressure in patients with hypertension.

損傷控制外科在嚴重腹部創傷中的臨床應用

目的 探討損傷控制外科（damage control surgery，DCS）在救治嚴重腹部創傷患者中的臨床應用。 方法 回顧性分析 2013 年 4 月至 2015 年 4 月解放軍總院海南分院采用 DCS 理念（簡單快速手術、液體復蘇和確定性手術）救治的 40 例嚴重腹部創傷患者的臨床資料。總結應用損傷控制理念救治嚴重腹部創傷的適應證和治愈率。 結果 40 例患者中痊愈 35 例，治愈率為 87.5%；死亡 5 例，死亡率為 12.5%。 結論 應用損傷控制理念救治嚴重腹部創傷為比較安全的救治方法，可有效提高臨床治愈率。

Preliminary study on monitoring patient-specific volumetric modulated arc therapy quality assurance process with statistical process control methodology on the basis of TG-218 report

Patient-specific volumetric modulated arc therapy (VMAT) quality assurance (QA) process is an important component of the implementation process of clinical radiotherapy. The tolerance limit and action limit of discrepancies between the calculated dose and the delivered radiation dose are the key parts of the VMAT QA processes as recognized by the AAPM TG-218 report, however, there is no unified standard for these two values among radiotherapy centers. In this study, based on the operational recommendations given in the AAPM TG-218 report, treatment site-specific tolerance limits and action limits of gamma pass rate in VMAT QA processes when using ArcCHECK for dose verification were established by statistical process control (SPC) methodology. The tolerance limit and action limit were calculated based on the first 25 in-control VMAT QA for each site. The individual control charts were drawn to continuously monitor the VMAT QA process with 287 VMAT plans and analyze the causes of VMAT QA out of control. The tolerance limits for brain, head and neck, abdomen and pelvic VMAT QA processes were 94.56%, 94.68%, 94.34%, and 92.97%, respectively, and the action limits were 93.82%, 92.54%, 93.23%, and 90.29%, respectively. Except for pelvic, the tolerance limits for the brain, head and neck, and abdomen were close to the universal tolerance limit of TG-218 (95%), and the action limits for all sites were higher than the universal action limit of TG-218 (90%). The out-of-control VMAT QAs were detected by the individual control chart, including one case of head and neck, two of the abdomen and two of the pelvic site. Four of them were affected by the setup error, and one was affected by the calibration of ArcCHECK. The results show that the SPC methodology can effectively monitor the IMRT/VMAT QA processes. Setting treatment site-specific tolerance limits is helpful to investigate the cause of out-of-control VMAT QA.

Advances in research and development of echinococcosis vaccines

Echinococcosis is a zoonotic and parasitic disease caused by tapeworms of the genus Echinococcus. The most common forms of the disease are cystic echinococcosis (CE) and alveolar echinococcosis (AE), caused by Echinococcus granulosus and Echinococcus mutilocularis, respectively, and posing a serious health challenge and economic burden to human society. The most adapted treatment is surgical excision plus chemotherapy, although which mostly is effective, the traumatic damage from the invasive procedure and the adverse effects of the prolonged chemotherapy are profound. Conventional preventions include controlling the source of infection, improving the sanitation in livestock slaughter, strengthening surveillance, and increasing public health education. However, the outcome is limited by the complicity of the geographical nature, cultural background, and unique lifestyle. Vaccination is the most safe and cost-effective way to control infectious diseases. The partial success of recombinant Eg95 as a veterinary vaccine had established a theoretical foundation for the development of a human echinococcosis vaccine, which will shed a light on the prevention, control, and eventual elimination of the human infection. There are promising vaccine candidates in the research and development pipelines in the form of parasite tissue extract proteins, recombinant proteins, nucleic acids, synthetic antigenic epitopes, and vector vaccines. These candidates have shown potential to induce protective humoral and cellular immune responses that block the invasion, eradicate the worm at an early stage, or prevent the onset of infection. We reviewed the progress in the vaccine development and discussed the challenges and solutions in the research and development to facilitate the licensure of a vaccine against human echinococcosis.

Anomaly Detection of Multivariate Time Series Based on Riemannian Manifolds

Multivariate time series problems widely exist in production and life in the society. Anomaly detection has provided people with a lot of valuable information in financial, hydrological, meteorological fields, and the research areas of earthquake, video surveillance, medicine and others. In order to quickly and efficiently find exceptions in time sequence so that it can be presented in front of people in an intuitive way, we in this study combined the Riemannian manifold with statistical process control charts, based on sliding window, with a description of the covariance matrix as the time sequence, to achieve the multivariate time series of anomaly detection and its visualization. We made MA analog data flow and abnormal electrocardiogram data from MIT-BIH as experimental objects, and verified the anomaly detection method. The results showed that the method was reasonable and effective.