Objective To investigate the serum level of surfactant protein D ( SP-D) in patients with chronic obstructive pulmonary disease ( COPD) and its clinical significance. Methods Serumlevels of SP-D in patients with acute exacerbations of COPD ( n = 29) , stable COPD ( n = 26) , and control subjects ( n = 19 ) were measured by ELISA. Multiple regression modeling was performed to determine the independent relationship between SP-D and lung function variables. Results The serum SP-D levels were significantly increased in the patients who experienced an acute exacerbation [ ( 70. 6 ±20. 7) ng/mL] compared with the patients with stable COPD and the control subjects [ ( 47. 9 ±13. 3) ng/mL and ( 31. 2 ±11. 4) ng/mL] ( both P lt; 0. 01) . The serum SP-D levels in the patients with stable COPD increased significantly than the control subjects ( P lt; 0. 01) . Smoking index and staging of COPD were positively related to SP-D level. Serum SP-D levels were also found to be inversely related to FEV1% pred in stable COPD. Conclusion Serum SP-D may be a potential diagnostic and staging biomarker for COPD.
目的 观察比较右美托咪啶复合丙泊酚应用于无痛纤维支气管镜检查，及对呼吸循环、苏醒时间的影响和不良反应。 方法 2011年3月－2012年12月选择美国麻醉师协会评分Ⅰ～Ⅱ级行无痛纤维支气管镜检查患者50例，采用随机数字表法分为两组（n=25），即右美托咪啶复合丙泊酚组（A组）和芬太尼复合丙泊酚组（B组）。A组术前15 min给盐酸右美托咪啶负荷剂量0.6～0.8 μg/kg泵入，B组泵入相同剂量的生理盐水后，缓慢静注芬太尼0.05 mg；两组静注1～2 mg/kg丙泊酚负荷量，后以2～4 mg/（kg·h）泵注丙泊酚维持。记录两组患者麻醉前、置纤维支气管镜前、置纤维支气管镜后2 min、15 min、苏醒时的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、血氧饱和度（SpO2）和心电图（ECG）等情况，并记录手术时间、术后苏醒时间及丙泊酚用量和检查治疗期间患者肢体躁动、呛咳等情况。 结果 与B组比较，A组术中的MAP、HR和RR较为平稳，缩短了术后苏醒时间，可减少丙泊酚的用量（P＜0.05）。 结论 右美托咪啶复合丙泊酚应用于无痛纤维支气管镜检查，是一种安全、可行的麻醉方法。
ObjectiveTo understand the experiences of out-patient services of the elderly patients, and to analyze the impact factors of the satisfaction of elderly patients, so as to produce evidence for healthcare quality improvement. MethodsBased on the data collected from the out-patient survey of the 2015 Evaluation of the National Healthcare Improvement Initiative, we compared the disparities of patient satisfaction among different age-groups, between different geographic regions and different types of hospitals. We conducted multivariate binary logistic regression analysis to identify factors, associated with the satisfaction of the elderly outpatients. We also compared satisfaction of the Chinese elderly patients with healthcare services with other countries. ResultsSatisfaction scores of the Chinese elderly out-patients were statistically significant higher than that of the young and middle aged out-patients in the domains of hospital environment (satisfaction score=4.42), process efficiency (satisfaction score=4.20), and overall satisfaction (satisfaction score=4.47) (P < 0.001). On the contrary, the elderly out-patients were less satisfied in the domain of hospital informationization experience (satisfaction score=4.25) than the young and middle aged out-patients. This was also the case for the three indicators under this domain, including convenient appointment (satisfaction score=4.27), diversified payment methods (satisfaction score=4.24) and self-service devices (satisfaction score=4.26) (P < 0.001). Western region and traditional Chinese hospitals had significantly lower elderly outpatient satisfaction comparing with eastern and central regions, and general & specialist hospitals (P < 0.05). Trustful doctor-patient relationship (OR=3.45), respected and comfortable care (OR=1.45), clear and reliable mechanism and channel for praise and complain (OR=1.39), length of communication time with doctors (OR=1.35) and length of waiting time until consultation is acceptable (OR=1.29) were the major factors associated with the overall satisfaction of the elderly out-patients. The overall satisfaction of the Chinese elderly out-patients is a bit lower than that in our neighboring country Japan. The satisfaction towards length of communication with doctors of the Chinese elderly patients is lower than that in most of the industrialized countries. ConclusionSpecial demands of the elderly patients should be carefully considered by hospitals in the process of developing new appointment methods and hospital informationization with the aim of healthcare improvement. Longer communication time with doctors, shorter waiting time until consultation, improving human care and building efficiency mechanism and channel for praise and complain are the priorities for future healthcare improvement.
ObjectiveTo observe the retinal microcirculation changes in chinchilla rabbit with branch retinal vein occlusion (BRVO), and to evaluate the feasibility of laser speckle imaging (LSI) technology as monitoring tool for retinal microcirculation. MethodsTen 4-month-old chinchilla rabbits were used for the experiment, selecting the right eye as the experimental eye. The main retinal vein, adjacent 0.5-1.0 mm to the optic of rabbit retina, was selected to the target vessel under surgical microscope. The software of LSI instrument was used to measure the diameter of target vein and blood flow of 0.2 mm2 area of target vein. The BRVO rabbit model was induced by photodynamic therapy, then measure the diameter and blood flow in the same region using the method as before and after 10 minutes modeled. ResultsThe retinal color pictures, infrared laser and the distribution of blood flow pseudo-color were synchronous displayed by LSI technology. Before and after modeling, the target vessel diameter were (0.104±0.009), (0.128±0.008) mm, and the 0.2 mm2 area blood flow of target vessel were (563.500±28.788), (256.000±53.319) PU. The diameter of target blood vessel after modeling was significantly thicker than before, with the significant difference (t=12.14,P=0.008). The blood flow in 0.2 mm2 area of target vessel was significantly lower than before, also with the significant difference (t=183.00,P=0.009). ConclusionsThe diameter of target vessel of the BRVO rabbit model is enlarged, and the target vessel area of 0.2 mm2 blood flow is reduced significantly. LSI system can monitor the retinal microcirculation real-time and quantitatively.
ObjectiveTo systematically review the effect of implementing the medicines zero mark-up policy in Chinese public hospitals.MethodsCNKI, WanFang Data, VIP, Sinomed, Web of Science, PubMed and EMbase databases were electronically searched to collect quantitative evaluations of the effect of implementing the medicines zero mark-up policy in Chinese public hospitals from inception to October 30th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Descriptive analysis was then performed.ResultsThe existing evidence on the effect of implementing the medicines zero mark-up policy in Chinese public hospitals was from 3 studies based on national samples and 7 provincial level studies in Beijing, Shannxi and Fujian. After the implementation of the medicines zero mark-up policy, all included studies found that the medicines expenditure and the proportion of medicines expenditure to the total expenditure per outpatient visit or per hospitalization decreased. The expenditures of medical supplies, tests & examinations per outpatient visit or per hospitalization increased, and the medical expenditure per outpatient visit or per hospitalization increased in Beijing. The hospital annual revenue generated from medicines and its proportion to the total annual revenue both decreased across the country. Although the government allocated increased subsidy to compensate the revenue reduction of the public hospitals due to the implementation of the medicines zero-mark-up policy, the total annual revenue of traditional Chinese medicine hospitals at the county level across the country still decreased significantly.ConclusionsBased on the available evidence, we conclude that the policy objective of abolishing the mechanism of "compensating medical care with revenue generated from prescribing medicines" is achieved, while that of establishing a scientific compensation mechanism for public hospitals are partially achieved. Compared with other regions, Beijing has appropriately adjusted the prices of medical care while removing the mark-up of medicines, thus is a contributor to the establishment of a scientific compensation mechanism for public hospitals.
Malignant tumors are the major diseases which threat human beings. Anti-cancer medicines play important roles in the treatment of malignant tumors, especially for the new targeted therapies. They bring the life hope for cancer patients who were sentenced to death, and improve quality of life, and some patients may achieve normal lifetime. However, the new anti-cancer medicines are usually too expensive to afford, and most of them have not yet been included in Chinese public health security system, the accessibility of the new anti-cancer medicines is seriously limited. This paper introduces the accessibility of high-cost anti-cancer medicines in China, analyzes the influence factors, and proposes policy recommendations to improve the accessibility of high-cost anti-cancer medicines in China.
Objective To formulate a medical endoscopy service evaluation system, so as to guide the hospitals to select products, provide advices for manufacturers to improve the service, and finally improve the overall service capacity of medical endoscopy industry. Methods The whole study was conducted from January to December 2018. Firstly, Delphi method was used to establish the evaluation indexes, which helped to get the evaluation scenario. Secondly, the evaluation mechanism was established through the association of three central hospitals with their medical treatment partnerships and collaborative hospitals. Thirdly, the popular medical endoscopy brands in China were evaluated for a long time by means of information technology. Results Finally, more than 80% of the provinces of China were covered by the medical endoscopy services evaluation, and 51 hospitals participated in the evaluation. At the end of 2018, 1 450 valid data were collected, of which the annual average abnormal data was less than 5%. With the score ranking, the highest score was 4.45, the lowest score was 3.27, and the average score was 3.85. The preliminary evaluation results were sent to medical endoscopy manufacturers. Conclusions The " multi-center hospital” medical endoscopy service evaluation system established in this study has the characteristics that the indexes are scientific, and the evaluation is comprehensive and wide-coverage. It provides a feasible and effective solution for medical endoscopy service evaluation and plays an important role in improving the whole medical endoscopy service level and brand value.
Heart sound analysis is significant for early diagnosis of congenital heart disease. A novel method of heart sound classification was proposed in this paper, in which the traditional mel frequency cepstral coefficient (MFCC) method was improved by using the Fisher discriminant half raised-sine function (F-HRSF) and an integrated decision network was used as classifier. It does not rely on segmentation of the cardiac cycle. Firstly, the heart sound signals were framed and windowed. Then, the features of heart sounds were extracted by using improved MFCC, in which the F-HRSF was used to weight sub-band components of MFCC according to the Fisher discriminant ratio of each sub-band component and the raised half sine function. Three classification networks, convolutional neural network (CNN), long and short-term memory network (LSTM), and gated recurrent unit (GRU) were combined as integrated decision network. Finally, the two-category classification results were obtained through the majority voting algorithm. An accuracy of 92.15%, sensitivity of 91.43%, specificity of 92.83%, corrected accuracy of 92.01%, and F score of 92.13% were achieved using the novel signal processing techniques. It shows that the algorithm has great potential in early diagnosis of congenital heart disease.
The multi-window time-frequency reassignment helps to improve the time-frequency resolution of bark-frequency spectral coefficient (BFSC) analysis of heart sounds. For this purpose, a new heart sound classification algorithm combining feature extraction based on multi-window time-frequency reassignment BFSC with deep learning was proposed in this paper. Firstly, the randomly intercepted heart sound segments are preprocessed with amplitude normalization, the heart sounds were framed and time-frequency rearrangement based on short-time Fourier transforms were computed using multiple orthogonal windows. A smooth spectrum estimate is calculated by arithmetic averaging each of the obtained independent spectra. Finally, the BFSC of reassignment spectrum is extracted as a feature by the Bark filter bank. In this paper, convolutional network and recurrent neural network are used as classifiers for model comparison and performance evaluation of the extracted features. Eventually, the multi-window time-frequency rearrangement improved BFSC method extracts more discriminative features, with a binary classification accuracy of 0.936, a sensitivity of 0.946, and a specificity of 0.922. These results present that the algorithm proposed in this paper does not need to segment the heart sounds and randomly intercepts the heart sound segments, which greatly simplifies the computational process and is expected to be used for screening of congenital heart disease.
Aiming at the problems of obscure clinical auscultation features of pulmonary hypertension associated with congenital heart disease and the complexity of existing machine-aided diagnostic algorithms, an algorithm based on the statistical characteristics of the high-frequency components of the second heart sound signal is proposed. Firstly, an endpoint detection adaptive segmentation method is employed to extract the second heart sounds. Subsequently, the high-frequency component of the heart sound is decomposed using the discrete wavelet transform. Statistical features including the Hurst exponent, Lempel-Ziv information and sample entropy are extracted from this component. Finally, the extracted features are utilized to train an extreme gradient boosting algorithm (XGBoost) classifier, which achieves an accuracy of 80.45% in triple classification. Notably, this method eliminates the need for a noise reduction algorithm, allows for swift feature extraction, and achieves effective multi-classification using only three features. It is promising for early screening of pulmonary hypertension associated with congenital heart disease.