The Effectiveness of a Multidisciplinary Collaborative Model for the Diagnosis and Treatment of Vertigo

Objective:To investigate the effectiveness of applying a multidisciplinary collaborative model for the diagnosis and treatment of patients with vertigo.Methods:The study was carried out in Xianyang Hospital of Yan’an University,in which 100 patients with vertigo were selected from April 2021 to April 2022 and were divided into two groups:the control group was under the single diagnosis and treatment model,whereas the experimental group was under the multidisciplinary collaborative diagnosis and treatment model,with 50 cases in each group.The diagnostic effects of the two groups were compared.Results:The diagnostic and therapeutic efficiency of the patients in the experimental group were 94%and 98%,respectively,while those of the patients in the control group were 78%and 82%,respectively,with a significant difference between the two groups(p<0.05).The balance scores of the patients in both groups were low before the treatment,in which the difference was not significant(p>0.05);after the treatment,the scores improved,with those of the patients in the experimental group being significantly higher than those in the control group(p<0.05).Moreover,the satisfaction rate of patients in the experimental group(98%)was significantly higher than that of the control group(80%)(p<0.05).Conclusion:The application of the multidisciplinary collaborative diagnosis and treatment model in the diagnosis of patients with vertigo is effective.The multidisciplinary model can improve clinical diagnosis,enhance the treatment effect,improve the clinical symptoms of patients,and increase the satisfaction of patient care.Hence,it is of high clinical application value.

Preoperative diagnosis and operative effect of intracranial aneurysm with three-dimensional computed tomography angiography

BACKGROUND ： Digital subtraction angiography （DSA） is always regarded as the golden standard for diagnosis of intracranial aneurysm; however, the procedure is complex, traumatic, expensive and easy to induce vascular complication. Three-dimensional computed tomography angiography （3D-CTA） can make up deficiencies of DSA; therefore, it is used in clinical therapy wider and wider. OBJECTIVE ： To evaluate the clinical effect of 3D-CTA on disruption and hemorrhage of intracranial aneurysm pre- and post-operation and compare with the effect of DSA. DESIGN ： Auto-control contrast observation SETTING ： Department of Neurosurgery, Shengjing Hospital of China Medical University PARTICIPANTS ： A number of 106 patients with disruption and hemorrhage of intracranial aneurysm were selected from the Department of Neurosurgery, Shengjing Hospital of China Medical University from January 2003 to April 2006. All patients were diagnosed with cranial operation and consent. There were 47 males and 59 females aged from 3-76 years with the mean age of （47±13） years. Among them, 82 patients had extensive subarachnoid hemorrhage （SAH）, 7 had hemorrhage at longitudinal fissure, and 17 had hemorrhage at ambiens cistema and lateral fissure. Moreover, intraventricular hematocele was accompanied on 13 patients and hematom on 9 patients. METHODS： （1） 3D-CTA examination： Siemens SOMATOM Sensation 64 CT was used in this study. The thickness was 1 mm and interval of reconstruction was 0.8 mm. Localizing section was plainly scanned as the standard of canthus line. Scan ranged from 30 mm below sella to 50 mm above sella. Non-ion contrast medium of Omnipaque 350 （concentration of iodine was 350 g/L） was inserted into anterior vein of elbow with 18G trochar retained with high-pressured injectoc pum. The speed was 4.5 mL/s and the total volume was 80-100 mL with the means of 90 mL. Scan started at 10-20 s after injection of contrast medium. Original image was dealt with Leonardo workstation and retreated with Syngo software. Volume rendering and maximum intensity projection were used to reconstructed images, （2） All 106 patients suffered from occlusion of aneurysm clamp. Before operation, 3D-CTA was undertaken and DSA was followed. After operation, patients were rechecked with 3D-CTA. MAIN OUTCOME MEASURES： Comparisons between 3D-CTA and DSA. RESULTS ： All 106 patients were involved in the final analysis. （1） Examination of 3D-CTA and DSA： Among 118 patients with aneurysm, 110 were checked with 3D-CTA and the detected rate was 93.2% （110/118）. Among other 8 cases, 3 were negative and checked again with DSA; 1 had pericallosal aneurysm, 1 ophthalmic aneurysm, and 1 anterior choroidal artery of aneurysm. 3D-CTA results of other 5 cases were suspicious, and then, they were regarded as having aneurysm with DSA. Before operation, correlation among site, body, neck of aneurysm and peripheral anatomic structure were shown sufficiently. After operation, 82 patients were rechecked with 3D-CTA, which was complete occlusion, precise, unobvious constriction, emphraxis or remains as compared with 3D-CTA those pre-operation. （2） Characteristics of 3D-CTA： With multiple vessels and angles, 3D-CTA observed the relationship between aneurysm neck and carried artery and showed thrombosis in cavity of aneurysm, calcification of aneurysm wall and peripheral structure of vessel at the same time. However, DSA could not detect the reactions mentioned above. It could delete image of cranium, simulate image of operative route, eliminate artifact induced by metal, but not distinguish blood stream direction. Meanwhile, posterior communicating artery was always poor during circle of Willis artery showing. CONCLUSION： （1） 3D-CTA is characterized by simple operation and non-invasive showing vascular stereo structure and correlation. Therefore, it is significant for diagnosis and designing plan of operative approach and focal location pre-operation and evaluating effect post-operation. （2） 3D-CTA does not completely replace DSA on the diagnosis of intracranial aneurysm.

A case of 9p deletion syndrome with congenital infantile glaucoma,effective method of diagnosis,and treatment

Dear Editor,I am Dr.Jia X from the Department of Ophthalmology,Second Xiangya Hospital,Central South University,Changsha,China.I write to present a rare case report of 9p deletion syndrome with congenital infantile glaucoma in an infant,accompanying with an effective method of both diagnosis and treatment.

Intelligent Diagnosis of Short Hydraulic Signal Based on Improved EEMD and SVM with Few Low-dimensional Training Samples

The high accurate classification ability of an intelligent diagnosis method often needs a large amount of training samples with high-dimensional eigenvectors, however the characteristics of the signal need to be extracted accurately. Although the existing EMD（empirical mode decomposition） and EEMD（ensemble empirical mode decomposition） are suitable for processing non-stationary and non-linear signals, but when a short signal, such as a hydraulic impact signal, is concerned, their decomposition accuracy become very poor. An improve EEMD is proposed specifically for short hydraulic impact signals. The improvements of this new EEMD are mainly reflected in four aspects, including self-adaptive de-noising based on EEMD, signal extension based on SVM（support vector machine）, extreme center fitting based on cubic spline interpolation, and pseudo component exclusion based on cross-correlation analysis. After the energy eigenvector is extracted from the result of the improved EEMD, the fault pattern recognition based on SVM with small amount of low-dimensional training samples is studied. At last, the diagnosis ability of improved EEMD＋SVM method is compared with the EEMD＋SVM and EMD＋SVM methods, and its diagnosis accuracy is distinctly higher than the other two methods no matter the dimension of the eigenvectors are low or high. The improved EEMD is very propitious for the decomposition of short signal, such as hydraulic impact signal, and its combination with SVM has high ability for the diagnosis of hydraulic impact faults.

Velocity Diagnosis of Critical Surface at Microwave Band in Laser-Induced Plasma

The velocity of critical surface at microwave band in laser-induced plasma was measured and the results are presented. The results indicate that the velocity of critical surface with low electron density is larger than that with the high one; and the velocity of critical surface increases with the laser power density.

Comments on National guidelines for diagnosis and treatment of pancreatic cancer 2022 in China(English version)

Pancreatic cancer is a serious threat to human health,and the incidence is on the rise.Due to lack of obvious symptoms in early stage,it is often diagnosed in late stage.Its biological behavior is poor,and up to now,surgery and medical treatment have not achieved optimal effect.

Influence of heating effect in Thomson scattering diagnosis of laser-produced plasmas in air

A state diagnosis of laser-produced plasma in air generated by a 1064 nm pulse laser was investigated by the Thomson scattering(TS)method.The evolutions of the electron temperature and electron density were obtained as a function of the time delay which ranged from 300-3200 ns.The heating effect produced by the 532 nm probe beam with different energies on the air plasma at different interaction times was further studied using a time-resolved optical emission spectroscopy technique.The influence of the probe beam on the electron density was found to be negligible,whereas its influence on electron temperature is evident.In addition,the heating effect of the probe beam on the plasma strongly depends on the energy of the probe beam,and gradually weakens with increasing time delay.Our results are helpful for further understanding the TS method and its application in plasma diagnostics.

Effect of Qinling granule in treatment of 102 patients with chronic hepatitis B

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Physiological Effects of Iron Deficiency on Pyrus pashia Buch-Ham

Pyrus pashia Buch-Ham, a wild specie was used to investigate the physiological effects of iron deficiency in culture solution. The result showed that Chla, Chlb, total chlorophyll content and photosynthesis rate(Pn) decreased sharply, and the decrease of Pn was prior to that of Chl content under the iron deficiency. The iron deficiency symptoms were visible when the iron concentration in culture medium was less than 25 μmol L-1. Peroxidase(POD) and catalase(CAT) activity in iron-deficient leaves declined significantly, and POD was more sensitive than CAT to Fe deficiency. However, the positive correlation between CAT activity and Chl content was more significant than that between POD activity and Chl content. The content of nutrient elements in Fe-deficient leaves, which changed irregularly, were higher than that in normal leaves. There were a most significant positive correlation between active Fe and Chl content, and between active Fe and Pn respectively. Therefore, active Fe could be useful physiological predicting index for diagnosis.

Analysis of Serum Ferritin Level and Its Clinical Value in Advanced Gastric Cancer

Objective: To investigate the concentration and clinical significance of serum ferritin (SF) in patients diagnosed with advanced gastric cancer before and after treatment. Methods: Forty patients with advanced gastric cancer diagnosed by cytology or pathology in our hospital were selected, including 25 males and 15 females, aged from 48 to 85 years, and the median age was 61.0 years. 40 healthy volunteers matched with age and education were selected as the control group. In order to study the changes of SF level in the treatment of advanced gastric cancer, we divided the patients into effective group (efficacy evaluation as partial remission or complete remission), ineffective group (efficacy evaluation as no remission) and recurrence group according to the efficacy after treatment. Then the difference of SF level between different groups and the relationship between SF level and curative effect were analyzed. There was no significant difference in gender and age among all groups. Results: The SF levels in the newly diagnosed group, stage III patient group and stage IV patient group were significantly higher than those in the control group. The level of SF in stage IV patients was significantly higher than that in stage III patients. There were significant differences in SF level between the effective treatment group, the newly diagnosed group and the ineffective treatment group, but there was no significant difference in SF level between the newly diagnosed group and the ineffective treatment group. Conclusion: SF level has a certain value in the auxiliary diagnosis of gastric cancer, and it also has a certain guiding significance for the evaluation of curative effect and prognosis after treatment.

The comparison of epidemiological characteristics between confirmed and clinically diagnosed cases with COVID-19 during the early epidemic in Wuhan,China

Background:To put COVID-19 patients into hospital timely,the clinical diagnosis had been implemented in Wuhan in the early epidemic.Here we compared the epidemiological characteristics of laboratory-confirmed and clinically diagnosed cases with COVID-19 in Wuhan.Methods:Demographics,case severity and outcomes of 29,886 confirmed cases and 21,960 clinically diagnosed cases reported between December 2019 and February 24,2020,were compared.The risk factors were estimated,and the effective reproduction number(Rt)of SARS-CoV-2 was also calculated.Results:The age and occupation distribution of confirmed cases and clinically diagnosed cases were consistent,and their sex ratio were 1.0 and 0.9,respectively.The epidemic curve of clinical diagnosis cases was similar to that of confirmed cases,and the city centers had more cumulative cases and higher incidence density than suburbs in both of two groups.The proportion of severe and critical cases(21.5%vs.14.0%,P<0.0001)and case fatality rates(5.2%vs.1.2%,P<0.0001)of confirmed cases were all higher than those of clinically diagnosed cases.Risk factors for death we observed in both of two groups were older age,male,severe or critical cases.Rt showed the same trend in two groups,it dropped below 1.0 on February 6 among confirmed cases,and February 8 among clinically diagnosed cases.Conclusions:The demographic characteristics and spatiotemporal distributions of confirmed and clinically diagnosed cases are roughly similar,but the disease severity and clinical outcome of clinically diagnosed cases are better than those of confirmed cases.In cases when detection kits are insufficient during the early epidemic,the implementation of clinical diagnosis is necessary and effective.

Bile duct injuries associated with laparoscopic and open cholecystectomy: Sixteen-year experience

AIM: To summarize the experience in diagnosis, management and prevention of iatrogenic bile duct injury (IBDI). METHODS: A total of 210 patients with bile duct injury occurred during cholecystectomy admitted to Hunan Provincial People’s Hospital from March 1990 to March 2006 were included in this study for retrospective analysis. RESULTS: There were 59.5% (103/173) of patients with IBDI resulting from the wrong identification of the anatomy of the Calot’s triangle during cholecystectomy. The diagnosis of IBDI was made on the basis of clinical features, diagnostic abdominocentesis and imaging findings. Abdominal B ultrasonography (BUS) was the most popular way for IBDI with a diagnostic rate of 84.6% (126/149). Magnetic resonance cholangiography (MRC) could reveal the site of injury, the length of injured bile duct and variation of bile duct tree with a diagnostic rate 100% (45/45). According to the site of injury, IBDI could be divided into six types. The most common type (type 3) occurred in 76.7% (161/210) of the patients and was treated with partial resection of the common hepatic duct and common bile duct. One hundred and seventy-six patients were followed up. The mean follow-up time was 3.7 (range 0.25-10) years. Good results were achieved in 87.5% (154/176) of the patients. CONCLUSION: The key to prevention of IBDI is to follow the "identifying-cutting-identifying" principle during cholecystectomy. Re-operation time and surgical procedure are decided according to the type of IBDI.

Costs and cost-effectiveness of HIV early infant diagnosis in low- and middle-income countries: a scoping review

Background:Continuing progress in the global pediatric human immunodeficiency virus(HIV)response depends on timely identification and care of infants with HIV.As countries scale-out improvements to HIV early infant diagnosis(EID),economic evaluations are needed to inform program design and implementation.This scoping review aimed to summarize the available evidence and discuss practical implications of cost and cost-effectiveness analyses of HIV EID.Methods:We systematically searched bibliographic databases(Embase,MEDLINE and EconLit)and grey literature for economic analyses of HIV EID in low-and middle-income countries published between January 2008 and June 2021.We extracted data on unit costs,cost savings,and incremental cost-effectiveness ratios as well as outcomes related to health and the HIV EID care process and summarized results in narrative and tabular formats.We converted unit costs to 2021 USD for easier comparison of costs across studies.Results:After title and abstract screening of 1278 records and full-text review of 99 records,we included 29 studies:17 cost analyses and 12 model-based cost-effectiveness analyses.Unit costs were 21.46-51.80 USD for point-of-care EID tests and 16.21-42.73 USD for laboratory-based EID tests.All cost-effectiveness analyses stated at least one of the interventions evaluated to be cost-effective.Most studies reported costs of EID testing strategies;however,few studies assessed the same intervention or reported costs in the same way,making comparison of costs across studies challenging.Limited data availability of context-appropriate costs and outcomes of children with HIV as well as structural heterogeneity of cost-effectiveness modelling studies limits generalizability of economic analyses of HIV EID.Conclusions:The available cost and cost-effectiveness evidence for EID of HIV,while not directly comparable across studies,covers a broad range of interventions and suggests most interventions designed to improve EID are cost-effective or cost-saving.Further studies capturing costs and benefits of EID services as they are delivered in real-world settings are needed.

分级诊疗体系医生协作共生效应测评问卷研制及维度内在关系研究

目的研制分级诊疗体系医生协作共生效应测评问卷,剖析并验证医生协作共生效应的结构维度及其内在逻辑关系。方法采用文献资料及专题小组讨论法阐释分级诊疗体系医生协作共生效应的概念内涵及构成要素,研制其测评问卷。采用多阶段抽样对1959名医生进行现场问卷调查。结果医生协作共生效应测评问卷包括协作认知、协作信任、协作意愿、协作行为4个维度,共10个条目。问卷总体及4个维度的Cronbach’sα系数均大于0.7。探索性因子分析提取4个公因子,方差累计贡献率为86.7%;验证性因子分析结果显示,医生协作共生效应测评问卷4个维度的组成信度均大于0.7,平均方差萃取量均大于0.5。协作认知通过协作信任与协作意愿的链式中介作用影响协作行为。结论研制的医生协作共生效应测评问卷信效度较好,其各维度契合了“知”“情”“意”“行”相互影响的结构关系,可作为分级诊疗体系不同医疗机构间医生协作共生效应及程度评价的参考工具。

DIP付费对医疗服务项目诊疗强度的影响研究

目的:探索DIP付费对医疗服务项目诊疗强度的影响。方法:收集某市2020年1月至2022年12月330家医疗机构住院患者开展数字化摄影诊疗的数据,利用独立样本t检验比较诊疗强度的变化,采用间断时间序列分析考察DIP付费对诊疗强度的影响。结果:DIP付费后三级医院、一级医院数字化摄影诊疗强度分别增加了0.03和0.04,二级医院下降了0.06;三级医院诊疗强度在短期内增加(β_(2)=0.061),长期却呈现下降趋势(β_(3)=-0.007)。结论:DIP付费对医疗服务项目诊疗强度的政策效应可能与政策预期不一致,异质性和同质性并存;要强化DIP支付方式改革与医疗服务价格改革的协同路径。

国内部分三级公立医院互联网诊疗服务现状调研及分析

为了解目前国内医院互联网诊疗服务的现状,采用问卷调研与现场访谈法,对国内部分具备互联网诊疗服务的三级医疗机构互联网诊疗服务内容建设现状的相关内容进行调研。根据调研结果从互联网医院服务范围、管理制度、保障措施等方面进行分析总结,并提出相关建议。

单中心180例心脏肿瘤的诊断及外科治疗效果分析

目的总结单中心10年心脏肿瘤的诊断及外科治疗策略,讨论心脏肿瘤临床治疗效果及预后。方法回顾性分析2013年01月至2022年12月于高州市人民医院心血管外科住院诊断为心脏肿瘤并外科手术治疗的患者资料。收集整理患者的围术期临床资料及随访情况,分析其诊断及外科治疗策略。结果全组180例,其中男76例,女104例,年龄为(55.96±16.01)岁;良性肿瘤为165例(91.67%),恶性肿瘤为15例(8.33%)。术中完整切除肿瘤169例(93.89%),次全切除11例(6.11%)。术中同期合并冠状动脉旁路移植术10例(5.5%),主动脉瓣置换1例(0.55%),二尖瓣成形2例(1.11%),三尖瓣成形术3例(1.67%)。体外循环时间为(105.22±11.24)min,主动脉阻断时间为(43.17±24.61)min,机械通气时间为(14.21±3.18)h,术后重症监护病房(ICU)停留时间为(2.46±1.21)d,胸液总量为(317.25±43.15)mL。全组围术期无死亡,随访时间为45.28(1~120)个月,黏液瘤复发3例(1.9%),恶性肿瘤复发3例(20%),死亡17例(9.4%)。结论心脏肿瘤缺乏特征性临床表现,需要综合影像学检查明确诊断。原发性良性心脏肿瘤的手术效果满意,安全可行;并且可采用更加微创化的治疗方式。恶性心脏肿瘤的预后差,建议及早治疗及个体化治疗。

公立医院DRG临床路径管控方案探索及效果评价

目的:探索基于DRG的临床路径管理方案,评价其实施效果。方法:选取重庆市医保局本土化DRG分组后的数据进行分析,采用Wilcoxon秩和检验对比评估临床路径效果。结果:实行基于DRG的临床路径管控后,不同分组的患者住院费用有效降低,且差异具有统计学意义;DRG组层面,相比非路径组,RE13、RW19、CB19等路径组住院费用均降低且具有统计学意义;同一DRG组的检查费、药品费、耗材费、治疗费及其他费用均有效降低,且差异均有统计学意义。结论:基于DRG的临床路径管理可以通过有效降低具体病种费用,最终达到控制医疗支出、节约医保基金的目的。

基于关联规则的互联网医疗服务平台在肿瘤患者诊疗管理中的应用

目的探讨基于FP-Growth算法的有效强关联规则分析在肿瘤患者诊疗管理中的应用。方法在现有互联网医疗服务平台和电子病历系统基础上增加FP-Growth算法功能,通过FP-Growth算法挖掘2017年12月-2021年12月样本医院肿瘤放射治疗中心2075例患者和其中高危群体患者基线资料间的有效强关联规则,并将之用于肿瘤放射治疗中心。结果FP-Growth算法共反馈有效强关联规则15条,其中全部患者10条、高危群体患者5条,根据反馈结果调整了肿瘤放射治疗中心患者的治疗方案。结论增加了FP-Growth算法功能的互联网医疗服务平台具有临床应用价值。

某三甲中医医院DRG付费实施效果评价

目的评估按DRG付费对某三甲中医医院单病种住院费用的影响。方法以某三甲中医医院2020年1月—2021年12月心内科DRG病组为FM19(经皮冠状动脉支架植入术)的患者住院信息为研究对象,利用Stata15统计软件、运用中断时间序列模型、双重差分法等评估该病组按DRG付费前后的费用变化趋势。结果按DRGs付费实施后,FM19病组年平均总费用下降了26503.62元(P<0.001),年平均耗材费用下降了23937.32元(P<0.001)。FM19病组整体中医中药费用显著下降(P<0.05)。心绞痛患者的总费用、耗材费和药品费整体呈下降趋势;心肌梗死患者的药品费用减少不明显,总费用和耗材费下降显著。结论某病种开展按DRG付费后控费效果显著,中医中药治疗费用下降明显。三甲中医医院需提早布局,应对和适应付费改革。