Selection criteria for liver resection in patients with hepatocellular carcinoma and chronic liver disease

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide with an annual occurrence of one million new cases. An etiologic association between HBV infection and the development of HCC has been established with a relative risk 200-fold greater than in non-infected individuals. Hepatitis C virus is also proving an important predisposing factor for this malignancy with an incidence rate of 7% at 5 years and 14% at 10 years. The prognosis depends on tumor stage and degree of liver function, which affect the tolerance to invasive treatments. Although surgical resection is generally accepted as the treatment of choice for HCC, new treatment strategies, such as local ablative therapies, transarterial embolization and liver transplantation, have been developed nowadays. With increasing detection of small HCCs from screening programs for cirrhotic patients, it is foreseen that locoregional therapy will play an important role in the near future.

Improved scoring system for the electrocardiographic diagnosis of left ventricular hypertrophy

BACKGROUND Left ventricular hypertrophy(LVH) is a common manifestation of cardiovascular disease and a risk factor for cardiovascular morbidity and mortality, but available methods for its electrocardiographic(ECG) diagnosis have limited accuracy.AIM To investigate findings associated with LVH on ECG and developed an improved system for the diagnosis of LVH.METHODS A cohort study comparing ECG data acquired within 30 days of transthoracic echocardiography(TTE) was performed. Multivariate regression analysis identified ECG findings associated with increased LV mass and mass index. A scoring system was derived and performance compared to established criteria for LVH.RESULTS Data from 5486 outpatients with TTEs and corresponding ECGs were included in the derivation cohort, 333(6.1%) of whom had LVH by TTE. In the primary regression analysis, findings associated with LVH were amplitudes of Q in V3, R in V6, S in V3, T in V6, P' in V1, P in V6, as well as R and T-axis discordance, R peak time in V6, QRS duration, weight, height, sex, and age. From this we derived a score consisting of 5 criteria, and validated it in an independent cohort of 910 patients. With a threshold of 1.5 points, sensitivity and specificity were67.9% and 81.4%, and 62.5% and 83.2% in the derivation and validation cohorts,respectively. With a threshold of 2 points, sensitivity and specificity were 42.3% and 93.0%, and 37.5% and 93.4% in these cohorts.CONCLUSIONS This score had superior sensitivity for detection of LVH by ECG while making a modest sacrifice in specificity compared to conventional criteria.

Radiofrequency ablation vs surgical resection in elderly patients with hepatocellular carcinoma in Milan criteria

BACKGROUND Surgical resection and radiofrequency ablation(RFA)represent two possible strategy in treatment of hepatocellular carcinoma(HCC)in Milan criteria.AIM To evaluate short-and long-term outcome in elderly patients(>70 years)with HCC in Milan criteria,which underwent liver resection(LR)or RFA.METHODS The study included 594 patients with HCC in Milan criteria(429 in LR group and 165 in RFA group)managed in 10 European centers.Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching(PSM)and Cox regression.RESULTS After PSM,we compared 136 patients in the LR group with 136 patients in the RFA group.Overall survival at 1,3,and 5 years was 91%,80%,and 76%in the LR group and 97%,67%,and 41%in the RFA group respectively(P=0.001).Diseasefree survival at 1,3,and 5 years was 84%,60%and 44%for the LR group,and 63%,36%,and 25%for the RFA group(P=0.001).Postoperative Clavien-Dindo IIIIV complications were lower in the RFA group(1%vs 11%,P=0.001)in association with a shorter length of stay(2 d vs 7 d,P=0.001).In multivariate analysis,Model for End-stage Liver Disease(MELD)score(>10)[odds ratio(OR)=1.89],increased value of international normalized ratio(>1.3)(OR=1.60),treatment with radiofrequency(OR=1.46),and multiple nodules(OR=1.19)were independent predictors of a poor overall survival while a high MELD score(>10)(OR=1.51)and radiofrequency(OR=1.37)were independent factors associated with a higher recurrence rate.CONCLUSION Despite a longer length of stay and a higher rate of severe postoperative complications,surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients(>70 years)with HCC in Milan criteria.

French pre-hospital trauma triage criteria:Does the “prehospital resuscitation” criterion provide additional benefit in triage?

AIM:To evaluate the performance of the specific French Vittel "Pre-Hospital(PH) resuscitation" criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value(PPV) of pre-hospital trauma triage.METHODS: This was a monocentric prospective cohort study of injured adults transported by emergency medi-cal service to a trauma center. Patients who met any of the field trauma triage criteria were considered "triage positive". Hospital data was statistically linked to prehospital records. The primary outcome of defining a "major trauma patient" was Injury Severity Score(ISS) > 16. RESULTS: There were a total of 200 injured patients evaluated over a 2 years period who met at least 1 triage criterion. The number of false positives was 64 patients(ISS < 16). The PPV was 68%. The sensitivity and the negative predictive value could not be evaluated in this study since it only included patients with positive Vittel criteria. The criterion of "PH resuscitation" was present for 64 patients(32%),but 10 of them had an ISS < 16. This was statistically significant in correlation with the severity of the trauma in univariate analysis(OR = 7.2; P = 0.005; 95%CI: 1.6-31.6). However,despite this correlation the overall PPV was not significantly increased by the use of the criterion "PH resuscitation"(68% vs 67.8%).CONCLUSION: The criterion of "pre-hospital resuscitation" was statistically significant with the severity of the trauma,but did not increase the PPV. The use of "prehospital resuscitation" criterion could be re-considered if these results are confirmed by larger studies.

Evaluating Project Management Software Packages Using a Scoring Model—A Comparison between MS Project and Primavera

Since the Mid 1980’s, an increasing number of project management software packages (PMSP) has appeared in the market to support project management organizations. Despite the wide spread of PMSP, projects based organizations are left unguided as to how they should select the most appropriate software tool for their intended business use. The aim of this research was to apply a scoring model developed using ISO/IEC 14,000 software evaluation criteria to evaluate the effectiveness of two software packages in terms of functionality and price, and produce a summary of the evaluation records. To achieve research objective, a questionnaire survey method was used to investigate the two different project management software packages. One questionnaire was circulated among software users in various locations and another was targeting the software vendors. The findings of this study revealed differences between the two packages under investigation and highlighted the strength and weakness of each package. The author was able to assess the efficiency of each software package and provided a score for each attribute which helps the user to understand how the software package performs. This investigation revealed that the software user is not concerned with the most sophisticated package, or the package that has more advanced tools and features. What is more important for the user is their need to produce simple time charts, simple resource and cost analysis and basic reports.

Inter-Observer Variability in the Interpretation of 68Ga-PSMA PET-CT Scan according to PROMISE Criteria

Aims & Objectives: Aim of the study was to evaluate inter-observer variability in interpretation of Gallium-68 labeled Prostate Specific Membrane Antigen sub-type 11 (68Ga-PSMA-11) Positron Emission Tomography-Computed Tomography PET_CT scan according to Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria. Method and Materials: Forty-four consecutive patients of prostate cancer were prospectively studied between the duration of January 2021 to June 2021 at Institute of Nuclear Medicine and Oncology (INMOL), Lahore. All PET-CT scans were assessed by a researcher and 3 nuclear physicians and divided into two groups, interpreted in two phases. In the first phase, each group independently evaluated the scans while in the second phase, a consensus meeting was held and all the cases with discordance were discussed. Cohen’s Kappa test was used to measure interobserver variability with the cut-off of K’s alpha Results: The study showed 41 out of 44 scans with positive PSMA findings while 03 scans were negative for any PSMA avid disease. In the first phase of image analysis, the level of agreement was slight in T stage (Kappa = 0.068, p = 0.65), moderate in the miN stage (Kappa = 0.46, p = 0.02) and substantial in miM stage (Kappa = 0.77, p ≤ 0.001) was seen. For PSMA score, overall agreement was substantial agreement (Kappa = 0.64, p Conclusion: Remarkable inter-observer agreement was seen in PROMISE criteria.

Effectiveness of Gardnerella vaginalis culture and Nugent scoring in identifying bacterial vaginosis in pregnant women

Background:Bacterial vaginosis(BV),a lower genital tract syndrome,has been linked to adverse pregnancy outcomes and is regarded as the prevalent type of vaginal infection in females of childbearing age.Objectives:To determine the accuracy of Nugent scoring and Gardnerella vaginalis culture in the diagnosis of bacterial vaginosis(BV)among pregnant women attending antenatal clinic in Nnamdi Azikiwe University Teaching Hospital,Nnewi,Nigeria.Method:This cross-sectional study evaluated biospecimen from 333 pregnant women enrolled through systematic random sampling technique.Biospecimens of vaginal discharge were tested for BV infection using Amsel’s criteria,Nugent’s score and culture of G.Vaginalis.Using Amsel’s criteria as a“gold standard”,the Nugent’s score and culture of G.vaginalis were estimated.Results:Prevalence of 26.12%,25.82% and 28.20% of BV was found using Amsel criteria,Nugent’s method and culture of G.vaginalis,respectively.No statistical relationship exists between socio-demographic characteristics and BV(P>0.05).Sexual exposure,and vaginal hygienic practices influences BV(P<0.05)infection and also with fishy odor during or after sexual intercourse,Gardnerella morphotypes,Bacteroides morphotypes and BV(P<0.05).An inverse relationship existed between lactobacilli morphotypes and BV.The prevalence of HIV was 5.41% and 16 out of 18 had BV diagnosed using Amsel criteria.Nugent method correlated strongly with Amsel criteria(P<0.05).In comparison with Amsel criteria,it had 78.16% sensitivity,92.68% specificity,79.07% positive predictive value,92.31% negative predictive value and 88.89% accuracy rate.This was in contrast distinction to the culture of G.vaginalis,which had 56.32%sensitivity,81.70% specificity,52.13% positive predictive value,84.10% negative predictive value and 75.08% accuracy rate.Conclusion:Nugent method correlated strongly with Amsel criteria(P<0.05)and had 78.16% sensitivity,92.68% specificity,79.07% positive predictive value,92.31% negative predictive value and 88.89% accuracy rate.Contrariwise,the culture of G.vaginalis had 56.32% sensitivity,81.70% specificity,52.13% positive predictive value,84.10% negative predictive value and 75.08% accuracy rate for BV diagnosis.

煤制甲醇虚拟仿真实验操作评分系统优化

为解决化工及相关专业实习难、实验“两性一度”不足的问题,郑州大学于2010年开始建设了国内首套煤制甲醇虚拟仿真实验系统,并开设了相关课程。为提高煤制甲醇虚拟仿真实验教学质量,针对其操作评分系统中普通步骤操作分占比过高,质量步骤操作不细的问题,通过优化,大大提高了实验的挑战度和操作质量的区分度,调动了学生的积极性。通过该实验培养了学生的工程素养和运用专业知识分析问题的能力,为新工科建设提供了有利支撑。

人员易损性分析研究进展及应用综述

人员是战场中的核心要素,是最易损、最复杂的对象之一,其易损性研究涉及力学、数学、统计学、医学、生物学等多学科交叉,研究难度大,但对于开展杀伤效能评估、防护效能、战伤救治等具有重要价值。通过总结不同目标易损性分析的文献,提出损伤评分及杀伤判据是人员易损性分析中的两个重要环节。回顾了人员损伤评分的研究现状,重点介绍了4种常用评分方法(简明创伤评分、损伤严重度评分、校正损伤严重度指数、军用战伤评分)及应用情况;给出了典型战场环境中冲击波、投射物、冲击振动、热4种主要杀伤元对无防护人员损伤的研究动态、评估模型、杀伤判据。分析了基于数字化人体模型开展的人员易损性分析应用技术,探讨了易损性分析结果的主要应用场景,分析了该领域可能的主要发展方向。所得结果可为人员易损性研究提供重要参考。

以简明损伤定级标准与创伤严重程度评分为基础的分级护理在急诊创伤骨折患者中的应用效果

目的:探讨以简明损伤定级标准与创伤严重程度(AIS-ISS)评分为基础的分级护理在急诊创伤骨折患者中的应用效果,为临床护理提供依据。方法:选取2021年1月—2022年12月福建医科大学附属第一医院急诊科收治的100例创伤骨折患者作为研究对象,采用随机数表法将其分为对照组与试验组,每组各50例。对照组患者采用急诊常规护理,试验组患者在急诊常规护理基础上实施以AIS-ISS评分为基础的分级护理。比较两组患者的救治效果、护理服务质量及护理满意度情况。结果:试验组患者评估伤情时间、入院检查时间、有效救治时间、住院时间均明显短于对照组,救治成功率高于对照组,并发症发生率低于对照组,差异有统计学意义(t=13.205、7.815、10.289、10.978,χ^(2)=7.527、5.005,P<0.05)。试验组患者感知护理服务质量评价量表中各维度评分均明显高于对照组,差异有统计学意义(t=6.941、6.661、6.836、8.971,P<0.05)。试验组患者护理满意度量表中各维度评分及总分均明显高于对照组,差异有统计学意义(t=6.350、12.034、9.176、7.509、16.005,P<0.05)。结论:以AIS-ISS评分为基础对急诊创伤骨折患者实施分级护理,能够提高护理服务质量,缩短患者救治时间,提高救治成功率,改善患者临床结局,进而提升护理满意度。

住院病案首页附页数据质量评分标准清单研究——基于AHIMA数据质量管理模型

目的构建住院病案首页附页数据质量评分标准清单,以实现附页数据质量的定量评价。方法以美国健康信息管理协会数据质量管理模型为框架制定附页数据质量评分标准清单,并对湖北省卫生健康委发布的《住院病案首页附页》进行评分以展示该清单的应用。结果《住院病案首页附页》40个数据项目的平均得分为6.725分。主要质量缺陷体现在所有项目都没有明确填写责任人,也未明确定义填报时限。此外,部分项目与首页项目重复(占35%)或不具有摘要性质(占40%)。结论住院病案首页附页数据质量仍有较大的提升空间,特别是在设置附页项目时应明确填报责任人和填报时限,对首页项目起到补充和延展的作用,并应用有效的质量控制手段。

论马克思主义中国化时代化的“答卷模式”

习近平总书记将答好时代“答卷”与推进马克思主义中国化时代化联系起来,创造性地提出了推进马克思主义中国化时代化的“答卷模式”。时代“答卷”是由时代给出,并蕴含着马克思主义中国化时代化需要面对的问题解答与评价,审明时代“答卷”是推进马克思主义中国化时代化的关键,答好时代“答卷”是推进马克思主义中国化时代化的目标与归宿,“人民评分标准”是评价马克思主义中国化时代化的根本标准。这些重要论述与观点形成一个集观点、方法与标准为一体的理论体系。

毕达哥拉斯犹豫模糊集多属性决策研究

针对属性间相互关联,评价信息为毕达哥拉斯犹豫模糊信息的多属性决策问题,首先通过研究犹豫度对决策结果的影响,提出一种新的毕达哥拉斯犹豫模糊集得分函数,解决了现有得分函数中存在的不足。其次,提出一种最小公倍数规范化原则,解决了现有方法容易引入误差的缺陷。最后,针对属性关联的多属性决策问题,基于λ-模糊测度与Choquet积分,提出了一种拓展交互式多准则决策(interative multi-criteria decision-making,TODIM)方法,既解决了属性关联的问题,又通过前景理论反映了决策者的心理行为特征。实例分析与敏感性分析验证了所提算法的正确性与有效性。

一种核电项目经济性目标考核的方法

当前,各方对核电项目的经济性愈发关注,而设计阶段是影响核电经济性的关键环节,研发设计能否降低机组主要工程量水平,制约着项目的经济性能否真正提升。本文从管理角度出发,研究如何利用考核的方式对核电项目研发设计过程中的经济性进行有效控制,提出了一种以经济性指标、综合测评指标、调节项指标为评分标准的经济性目标考核方法,通过实例分析,验证了这一方法的可实施性,可通过管理方法的创新进一步确保经济性目标的实现。

太湖水质评价中底栖动物综合生物指数的筛选及生物基准的确立

对太湖8个区域共60样点进行底栖大型无脊椎动物采样,共获得底栖动物24种,其中软体动物14种,节肢动物5种,甲壳动物5种。根据Hilsenhoff生物指数确定了15个相对清洁的样点和45个污染样点,然后进行21种生物指数的综合评估,结果表明,总分类单元数、（甲壳动物＋软体动物）分类单元数、%（甲壳动物＋软体动物）、%腹足纲、Goodnight-Whitley指数、Hilsenhoff生物指数和%直接收集者等7个底栖动物生物指数可以用作判别太湖水质的敏感生物指数。通过5,3,1记分法对6种生物指数统一量纲后,获得变化范围为7-35的综合生物指数,运用四分法划分了太湖水质判别的生物基准：7-14很差,15-21差,22-28一般,29-35好,并对60个样点进行重新记分,获得了太湖水质的基本生态分区现状,太湖的东南区属水质较好的区域,而西北区属水质较差的区域。该水质生物基准基本适合评价太湖不同区域的水质状况。

基于“互联网+”实验教学新模式下“评分树”考核体系的构建

在"互联网+"实验教学新模式和工程教育专业认证背景下,构建了符合人才培养要求的、线上线下全程化监督和多元化评价的"评分树"考核体系。该体系能支撑工程认证要求,科学、公正、合理地评价学生的实验水平和操作技能,对激发学生学习实验的兴趣和积极性、培养学生自主学习能力、实验综合能力、创新能力和工程实践能力具有重要意义,实验教学质量和效果有所提升。

常规超声联合超声弹性成像在诊断甲状腺占位性病变中的应用价值

目的:为了进一步提高临床对甲状腺占位性病变的诊断率,分析和探讨常规超声配合超声弹性成像应用的必要性。方法:随机选取我院两腺外科门诊就诊的139例患者,共162个甲状腺占位性病变,均采用常规超声和超声弹性成像检查,且对照患者术后病理结果,分析应用超声弹性成像诊断甲状腺占位性病变的可行性。结果:常规超声检测结果,敏感度为84.48%,特异度为82.69%,准确率为83.33%;超声弹性成像(UE)检测结果其敏感度为91.38%,特异度为89.42%,准确率为89.02%。在鉴别甲状腺占位良恶性方面,常规超声与超声弹性图诊断的准确率相比较,差异有统计学意义(P<0.05)。结论:临床上在分辨甲状腺占位病变良恶性时,超声弹性成像具有一定的诊断价值,可以配合常规超声进行诊断,从而提高诊断准确率。

多脏器功能障碍评分系统:一种适应于中度高原地区ARDS/MODS的诊断标准

目的 判别高原急性呼吸窘迫综合征和多器官功能障碍综合征( H ARDS/ MODS)各项诊断指标参数界值与平原地区的差异,修改建立更合理的H ARDS/ MODS诊断标准。方法 按统一标准将总数为50 5例ARDS/ MODS患者根据海拔高度分为平原( <43 0 m)对照组( CG,n=1 1 3 )、中度高原( 1 51 7m) 1组( H1 G,n=3 1 4 )和中度高原( 2 2 61～2 40 0 m) 2组( H2 G,n=78)。3组分别用平原常用的ARDS/ MODS评分诊断标准(庐山及Marshall标准)和兰州H- ARDS/ MODS评分,建立3个数据统计模型,绘制受试者运行特征性曲线( ROC曲线) ,计算约登指数( Yoden)和最佳界值,验证3个标准在高原和平原预测ARDS/ MODS结局的准确性、敏感性和特异性。结果 用庐山、Marshall和兰州3个标准检验CG时,其ROC曲线下面积、最大Yoden、各指标总分的最佳界值、敏感性、特异性。多脏器单一指标的ROC曲线分析进一步发现,肺、脑、心、肾等项指标的ROC值在兰州标准中的总体水平明显优于庐山和Marshall标准( P<0 .0 5和P<0 .0 1 )。结论 1平原常用的ARDS/ MODS诊断标准参数不适合中度高原以上地区,修订重建H ARDS/ MODS标准是必要的;2海拔高度>1 50 0 m以上地区可能是区分平原和高原ARDS/ MODS诊断标准的一个有意义的分界线。

BISAP与Ranson's评分对急性胰腺炎患者预后评估的比较

目的比较BISAP评分与Ranson’s评分在预测急性胰腺炎(acute pancreatitis,AP)的严重度及病死率方面的运用价值。方法以2007年6月到2010年10月入住本院的AP患者为研究对象,资料完整诊断明确者共有652例,采用BISAP(the bedside index for severity in AP)评分与Ranson’s评分比较,受试者工作特性曲线(receiver-operating curve,ROC)行回顾性分析,在预计AP的严重度及病死率方面的差异。结果在652例患者中,通过发病48 h内出现器官衰竭确定为重症者108例(16.6%),共死亡21例(3.2%),BISAP评分≥3分的44例(6.7%),入院48 h内Ranson’s评分≥3分者213例(32.7%)。BISAP与Ranson’s评分二者在评价预后方面的差异有统计学意义,其中严重度的曲线下面积BISAP、Ranson’s评分系统分别为:0.846(95%CI 0.808～0.883),0.771(95%CI 0.722～0.820);死亡率分别是:0.809(95%CI 0.699～0.920),0.762(95%CI 0.638～0.885)。结论 BISAP评分系统在急性胰腺炎早期,针对患者严重度、死亡率的预后评估的准确性明显高于Ranson’s评分,是目前最简易、及时、连续性强并且对患者而言经济花费少的评分系统,可在临床广泛推广。

国家自然科学基金资助项目综合评价:基于Vague集多准则决策

采用基于Vague集的多准则决策方法,对国家自然科学基金11类主要竞争性资助项目的实施情况进行综合评价和排序.首先,通过问卷调研的方式,由国家自然科学基金项目评审专家采用"高"、"不高"和"不清楚"三类语义,对各类项目按照"评审公正性"、"管理规范性"、"科研创新性"和"社会影响力"四个准则进行评价;然后,根据问卷统计结果,将语义评价转化为Vague估计值,并利用一种新的评分函数计算各类项目在各准则下的得分;最后,采用正态分布的OWA算子集结各准则下的得分,得到所有项目的综合评价和排序.本文的研究结果将为完善国家自然科学基金的资助结构与管理模式提供重要参考依据.