Objective To demonstrate the possibility when discriminating between severe and nonsevere tricuspid regurgitation by E-wave velocity in tricuspid flow.Methods The peak velocity of the tricuspid inflow E-wave was measured in 107 patients,who were divided into mild group(n =39),moderate group(n =42)and severe group(n =26)according to the degree of tricuspid regurgitation(TR).Results Peak E-wave velocity of mild group,moderate group and severe group was (48.6 ±13.8)cm/s,(47.4 ±11.7)cm/s,and (78.3 ±26.1)cm/s, respectively.Mean E-wave velocity of mild group and moderate group were similar,which were lower than that of severe group (P <0.01).A peak E-wave velocity of over 62 cm/s had a sensitivity of 71% and specificity of 92% for the detection of severe TR.Conclusion Increased peak tricuspid E-wave velocity is associated with severe TR and thus can be used as a simple measure of TR grade.

Objective To improve the precision of the traditional segmentation of echocardiogram, by suppressing the influence from inherent speckle noises in medical ultrasonic images. Method An automatic segmentation method based on reconstructed morphology was proposed in this paper. First, the opening and closing operations by reconstruction were imposed to the ultrasonic image. Second, the top-hat operation was used to extract the bright and/or dark features and to find out the boundaries corresponding to these features, whereby implemented the automatic segmentation. Result The segmented echocardiogram had less artificial boundaries resulted from speckle noise, and could accurately be extracted the artery and ventricle. Conclusion The presented method can detect both dark and bright objects accurately, and the boundary has a fine continuity. In addition, the algorithm is also applicable to the extraction of sole bright/dark features, accordingly to reduce the complexity and time needed and to improve the accuracy.

Objective To compare the clinical effects of improved posterolateral minimally invasive approach and traditional posterolateral approach combined with modular femoral head prosthesis in the treatment of femoral neck fractures in the elderly. Methods The study involved 70 patients with femoral neck fractures (26 males and 44 females; at age range of 67-95 years,mean 78.3 years) treated from October 2008 to June 2010.There were 62 patients with fresh femoral neck fractures and eight with old femoral neck fractures (2-4 months post-injury),all of whom were type Ⅲ or Ⅳ fractures according to the Garden' s classification.All surgeries were completed by the same operation group.The improved posterolateral minimally invasive approach group involved 32 patients including 12 males and 20 females and the traditional posterolateral approach group involved 38 patients including 14 males and 24 females.The two groups were compared in aspects of incision size,operative time,perioperative complications,prosthesis stability and hip functional recovery. Results All patients were followed up for an average of 16 weeks (range,12-18 weeks).The differences between the two groups were significant regarding the incision length,perioperative blood loss,and blood product transfusio amount (P ＜0.01 ),but insignificant in operative time ( P ＞ 0.05 ).All patients were able to take weight-bearing walk six weeks postoperatively.The two groups showed significant difference in the hip joint function by Chamley's criteria six weeks postoperatively ( P ＜ 0.05 ),but insignificant difference in the hip joint function by Harris' s criteria at the last follow-up ( P ＜ 0.05). Conclusion The modified posterolateral minimally invasive approach combined with modular femoral head prosthesis is a satisfactory method in treatment of femoral neck fractures in senile patients,for it can result in less intra-operative soft tissue damage and blood loss,as well as shorter rehabilitation time.

Objective To explore the clinical characteristics of acute calculous cholecystitis in over 80 years old patients.Methods A retrospective study was made on the clinical data of 71 cases diagnosed as acute calculous cholecystitis and receiving surgical treatment from Sep 2006 to Sep 2016.Patients were divided into three groups:Early LC group (25 patients),PTGD group (29 patients),the staged LC group (17 patients) after PTGD.Results There was statistically significant difference in the gallbladder wall thickness,operation time and blood loss between the two LC groups.There was no statistically significant difference between the two LC groups in other baseline data and hospital stay,hospital cost,rate of postoperational complication,rate of conversion to open procedure between the two LC groups.There was statistically significant difference between the early LC group and PTGD group in the baseline data.Logistic regression analysis indicated that the TG13 grade was an important influence factor for treatment selection of PTGD (OR=3.957,P=0.015,95％CI:1.30-12.043).Conclusion Laparoscopic cholecystectomy was safe for good risk over 80 years old patients.For poor risk patients,PTGD is recommended before a LC attempt.

OBJECTIVETo assess the association of polymorphisms of oncostatin M receptor (OSMR) gene with dilated cardiomyopathy (DCM) in a Han Chinese population.

METHODSFor 351 DCM patients and 418 healthy controls, two single nucleotide polymorphisms (SNPs) of the OSMR gene, namely rs2292016 (promoter, -100G/T) and rs2278329 (missense, Asp553Asn), were genotyped with a TaqMan SNP genotyping assay. Two hundred of the patients were also followed up for (49.85 ± 22.52) months.

RESULTSFor rs2292016, carriers of GT genotype were more likely to develop DCM compared to those with GG and TT genotypes (OR=1.45, 95%CI: 1.09-1.92, P=0.01). For those who did not receive cardiac resynchronization therapy, the GG genotype of rs2292016 was an independent indicator for poor prognosis (OR=1.69, 95%CI: 1.11-2.63, P=0.017). No association was found between genotypes of rs2278329 with the susceptibility or prognosis of DCM.

CONCLUSIONPolymorphisms of the OSMR rs2292016 locus are related to the development and outcome of DCM.

Asian Continental Ancestry Group ; genetics ; Cardiomyopathy, Dilated ; etiology ; genetics ; China ; ethnology ; Genotype ; Humans ; Oncostatin M Receptor beta Subunit ; genetics ; Polymorphism, Single Nucleotide

Objective The aim of this research was to study the prevalence and differences of depressive symptoms and related factors in elderly in both urban and rural areas so as to develop relative strategies on this issue.Methods Ten-question-version of the Center Epidemiologic Studies-Depression scale (CES-D) was applied to score the depressive status.Data used in this research was from the 2013 China Health and Retirement Longitudinal Study (CHARLS).Binary logistic regressions method was applied to examine the influential factors related to depression symptoms.Results In the elderly population,the mean score on depressive symptoms was 8.3 ± 5.9,with a prevalence as 26.8％.The incidence rates on ‘Elderly depression'in urban and rural areas were 16.4％ and 30.0％ respectively.The prevalence of depressive symptoms was relatively low (P＜0.05)with protective factors including:being male,status related to self-rated health,without chronic diseases,active participation in social activities etc.noticed,among elderly in both urban and rural areas.Age and alcohol consumption appeared factors that influencing the depressive symptoms of the elderly in rural areas,while the average income was an influencing factor on the elderly in urban areas.Incidence of depression was relatively low in age ≥75 years group in rural areas.However,elderly in the rural areas with abstinence of alcohol intake showed higher incidence of depressive symptoms (P＜0.05).Incidence of depression was reltively low (P＜0.05) among elderly with high income in the urban areas.Conclusions Incidence of depression appeared high among the elderly and even higher in the rural areas.Strategies would include the following points:to strengthen the construction of urban-rural integration,improving and strengthening the rural pension insurance system,upgrading the urban social assistance for low-income elderly,strengthening the psychological consultation service of primary medical institutions and actively developing the three-tier levels related to the prevention of chronic diseases.

This review introduces a qualitative methodology called institutional ethnography (IE) to healthcare professionals interested in studying complex social healthcare systems. We provide the historical context in which IE was developed, and explain the principles and terminology in IE for the novice researcher. Through the use of worked examples, the reader will be able to appreciate how IE can be used to approach research questions in the healthcare system that other methods would be unable to answer. We show how IE and qualitative research methods maintain quality and rigour in research findings. We hope to demonstrate to healthcare professionals and researchers that healthcare systems can be analysed as social organisations, and IE may be used to identify and understand how higher-level processes and policies affect day-to-day clinical work. This understanding may allow the formulation and implementation of actionable improvements to solve problems on the ground.