目的 探讨营销服务理论（8P）在体检信息系统建设中的应用与实践效果。 方法 借鉴8P理论与理念，以现代信息技术为手段,设计和构建以客户为中心的体检信息系统。 结果 体检信息系统的建立，优化了体检流程，提高了服务效率和报告质量，增加了客户满意度，取得良好的经济和社会效益，为健康体检工作的数字化、规范化管理奠定了良好的基础。 结论 加强体检中心的信息化系统建设，能全面提升中心的工作效率和服务质量,增强市场竞争力。
Abstract： Objective To evaluate the incidence and prognosis of postoperative acute kidney injury （AKI） in patients after cardiovascular surgery， and analyse the value of AKI criteria and classification using the Acute Kidney Injury Network （AKIN） definition to predict their in-hospital mortality. Methods A total of 1 056 adult patients undergoing cardiovascular surgery in Renji Hospital of School of Medicine， Shanghai Jiaotong University from Jan. 2004 to Jun. 2007 were included in this study. AKI criteria and classification under AKIN definition were used to evaluate the incidence and in-hospital mortality of AKI patients. Univariate and multivariate analyses were used to evaluate preoperative， intraoperative， and postoperative risk factors related to AKI. Results Among the 1 056 patients， 328 patients（31.06%） had AKI. In-hospital mortality of AKI patients was significantly higher than that of non-AKI patients （11.59% vs. 0.69%， P＜0.05）. Multivariate logistic regression analysis suggested that advanced age （OR=1.40 per decade）， preoperative hyperuricemia（OR=1.97）， preoperative left ventricular failure （OR=2.53）， combined CABG and valvular surgery （OR=2.79）， prolonged operation time （OR=1.43 per hour）， postoperative hypovolemia （OR=11.08） were independent risk factors of AKI after cardiovascular surgery. The area under the ROC curve of AKIN classification to predict in-hospital mortality was 0.865 （95% CI 0.801-0.929）. Conclusion Higher AKIN classification is related to higher in-hospital mortality after cardiovascular surgery. Advanced age， preoperative hyperuricemia， preoperative left ventricular failure， combined CABG and valvular surgery， prolonged operation time， postoperative hypovolemia are independent risk factors of AKI after cardiovascular surgery. AKIN classification can effectively predict in-hospital mortality in patients after cardiovascular surgery， which provides evidence to take effective preventive and interventive measures for high-risk patients as early as possible.
Simulations can mimic the environment that refers to the surgery operation to improve the technical skills of the trainees. In this paper, we designed a new cardiac surgery simulative training system. The isolated pig heart was selected as the heart model. A mechanical device was designed to achieve the beating of heart model. At the same time, adjusting frequencies of mechanical movement could change the rating of heartbeat. In order to validate the rationality of the system, 12 non-medical specialty students and 12 medical specialty students were divided into two groups, which consecutively accepted seven-days of training for off-pump coronary artery bypass grafting using the cardiac surgery simulative training system. The time for completing bypass grafting before and after training were recorded. And the bridging outcomes of each trainee were assessed by 3 surgery cardiac surgeons using the object structured assessments of technical skill (OSATS) criteria. After training, each trainee could finish the bypass suturing in a shorter time than before training, and the scores of each trainee assessed by OSATS criteria were also improved. The results showed that the cardiac surgery simulative training system had better training effect in improving the surgical techniques, operation skills and proficiency of surgical instruments of trainees.
ObjectiveTo explore the preparation method, physical and chemical properties, and biocompatibility of a conductive composite scaffold based on polypyrrole/silk fibroin (PPy/SF) fiber with " shell-core” structure, and to provide a preliminary research basis for the application in the field of tissue engineered neuroscience.Methods The conductive fibers with " shell-core” structure were prepared by three-dimensional printing combined with in-situ polymerization. PPy/SF fiber-based conductive composite scaffolds were formed by electrospinning. In addition, core-free PPy conductive fibers and SF electrospinning fibers were prepared. The stability, biomechanics, electrical conductivity, degradation performance, and biological activity of each material were tested to analyze the comprehensive properties of fiber-based conductive composite scaffolds.ResultsCompared with pure core-free PPy conductive fibers and SF electrospinning fibers, the PPy/SF fiber-based conductive composite scaffolds with " shell-core” structure could better maintain the stability performance, enhance the mechanical stretchability of the composite scaffolds, maintain long-term electrical activity, and improve the anti-degradation performance. At the same time, PPy/SF conductive composite scaffolds were suitable for NIH3T3 cells attachment, conducive to cell proliferation, and had good biological activity.ConclusionPPy/SF fiber-based conductive composite scaffolds meet the needs of conductivity, stability, and biological activity of artificial nerve grafts, and provide a new idea for the development of a new generation of high-performance and multi-functional composite materials.
Objective Investigate zinc finger protein 36 (ZFP36) and zinc finger protein 36L1 (ZFP36L1) expression in peripheral blood of patients with chronic obstructive pulmonary disease (COPD). Methods Peripheral blood samples were collected from 42 individuals with acute exacerbation of COPD (AECOPD), 21 with stable COPD, and 18 healthy participants. The levels of ZFP36 and ZFP36L1 proteins and mRNA expressions were evaluated using ELISA and qPCR techniques. Difference in expression levels among the three groups was examined. Spearman analysis and receiver operating characteristic (ROC) curve were carried out for assessment of diagnostic and predictive value of FP36 and ZFP36L1 for COPD and AECOPD. Results Compared with the healthy group, ZFP36L1 protein expression was downregulated in the COPD stable group. ZFP36 protein expression was downregulated in the AECOPD group compared with the COPD stable group. Similar differences were observed in mRNA expression levels. ZFP36 and ZFP36L1 levels were negatively correlated with inflammatory markers. ZFP36 levels were positively correlated with ZFP36L1 and lung function, and negatively correlated with smoking index, modified Medical Research Council score, occurrence of respiratory failure during hospitalization, exacerbation frequency within 3 months, and total hospitalizations. The area under the curve (AUC) for diagnosing AECOPD using ZFP36 was 0.980, with sensitivity of 95.2% and specificity of 90.5%. When combined with FEV1%pred, the AUC improved to 0.985, with sensitivity of 92.9% and specificity of 100%. For predicting post-discharge exacerbations in AECOPD when combined with neutrophil-to-lymphocyte ratio (NLR), sensitivity of ZFP36 alone was 66.7% and specificity was 88.9%. The AUCs for diagnosing COPD using ZFP36, ZFP36L1, and interleukin-8 (IL-8) were 0.889, 0.989, and 0.981, respectively. The sensitivities were 61.9%, 90.5%, and 95.2%, and specificities were 100%, 100%, and 94.4%, respectively. Conclusions Peripheral blood ZFP36 has good diagnostic value for AECOPD. Combined with FEV1%pred, it can further increase diagnostic value. As a predictive indicator for frequent exacerbations within 3 months of discharge in COPD patients, its predictive sensitivity and specificity are superior to inflammatory markers such as NLR. ZFP36 exhibits anti-inflammatory effects in AECOPD. Peripheral blood ZFP36L1 has good diagnostic value for COPD.