人类后基因组研究进展

人类对自身基因组的研究不断发展，已从结构基因组学转向功能基因组学阶段。本文概述了人类后基因组的研究内容及进展状况。     

Refining the debate on GM crops using technological foresight—the Danish experience

Rapid developments in and the controversial nature of biotechnology call for communication, networks, partnerships, and collaboration in research, not just among researchers, but also between researchers and research “users” in industry, government, and elsewhere. Technological foresight appears to offer a coordinating method for developing and strengthening those linkages. To test this, a technological foresight study was performed on genetically modified (GM) crop technology in the Danish context. The background of the study was the conflict and intense debate in Denmark over applications of gene technology, especially over the deliberate release of genetically modified (GM) crops. However, the current debate characteristically involves sharply opposed fronts, lacking willingness and courage to engage in a free-flowing and open-minded debate on both rational and normative components of biosafety. In it, stakeholders and experts on both side of the conflict advocate widely differing opinions. Without a proper generally intelligible dialogue, the broader public audience finds it hard to comprehend this type of debate. The study pursues the notion that public dialogue can act as a driver of future applications in the technological domain, specifically GM crops. The study concluded with a stakeholder workshop that revealed three key issues that might provide helpful starting points for a more free-flowing and open-minded debate about the future of GM crops. The issues were those arising from the following statements: a broad perspective on risk is crucial; international regulation must make allowance for developing countries; a better configuration of the risk debate is needed. These issues are discussed in more details in the article.     

Improving an outpatient clinic utilization using decision analysis-based patient scheduling

This study presents a predictive model to be used in scheduling patients in an urban outpatient clinic. The model is based upon actual patient characteristics from a physical therapy clinic within an urban health and wellness center situated in a public university. A number of reported patients' characteristics such as age, education level, distance from the clinic, historical attendance records, etc. were examined to determine if they significantly impacted the patients' missing scheduled appointments (no-shows.) Decision tree analysis was used to develop a model that assessed the likelihood of a patient's no-show, using key patient characteristics and attendance records. Such a model can be used to assist with scheduling patients in an outpatient clinic, while attempting to increase the clinic's overall utilization. Four tree growing criteria were examined to develop the model with the strongest predictive power. Predictive power of each method was assessed by using the entire dataset as well as using split sampling. The results were then compared with those of a Bayesian networks model and a neural networks model. In addition, the trade-off between the selected decision tree model's predictive power versus simplicity of the associated classification rules was examined. We also assessed the impact of various levels of overbooking on the clinic's utilization when using patients' schedules based on the predictive model.     

When does economic model type become a decisive factor in health technology appraisals? Learning from the expanding treatment options for relapsing–remitting multiple sclerosis

Objectives: Specific economic model types often become de facto standard for health technology appraisal over time. Markov and discrete event simulation (DES) models were compared to investigate the impact of innovative modeling on the cost-effectiveness of disease-modifying therapies (DMTs) in relapsing–remitting multiple sclerosis (RRMS). Fingolimod was compared to dimethyl fumarate (DMF; in highly active [HA] RRMS), alemtuzumab (in HA RRMS) and natalizumab (in rapidly evolving severe RRMS). Comparator DMTs were chosen to reflect different dosing regimens.

Materials and methods: Markov and DES models used have been published previously. Inputs were aligned in all relevant respects, with differences in the modeling of event-triggered attributes, such as relapse-related retreatment, which is inherently difficult with a memoryless Markov approach. Outcomes were compared, with and without different attributes.

Results: All results used list prices. For fingolimod and DMF, incremental cost-effectiveness ratios (ICERs) were comparable (Markov: £4206/quality-adjusted life year [QALY] gained versus DES: £3910/QALY gained). Deviations were observed when long-term adverse events (AEs) were incorporated in the DES (Markov: £25,412 saved/QALY lost, versus DES: £34,209 saved/QALY lost, fingolimod versus natalizumab; higher ICERs indicate greater cost-effectiveness). For fingolimod versus alemtuzumab, when relapse-triggered retreatment was included in the DES, large cost differences were observed (difference between incremental cost is £35,410 and QALY is 0.10).

Limitations: UK payer perspective, therefore societal approach was not considered. Resource utilization and utilities for both models were not derived from the subpopulations; as the focus is on model type, input limitations that apply to both models are less relevant.

Conclusions: Whilst no model can fully represent a disease, a DES allows an opportunity to include features excluded in a Markov structure. A DES may be more suitable for modeling in RRMS for health technology assessment purposes given the complexity of some DMTs. This analysis highlights the capabilities of different model structures to model event-triggered attributes.     

The visible hand: the role of government in China’s long-awaited industrial revolution

China is undergoing its long-awaited industrial revolution. There is no shortage of commentary and opinion on this dramatic period, but few have attempted to provide a coherent, in-depth, political-economic framework that explains the fundamental mechanisms behind China’s rapid industrialization. This article reviews the Embryonic Economic Development theory put forth by Wen (2016a). This article reviews the Embryonic Economic Development theory put forth by Wen . It illuminates the critical sequence of developmental stages since the reforms enacted by Deng Xiaoping in 1978: namely, small-scale commercialized agricultural production, proto-industrialization in the countryside, a formal industrial revolution based on mass production of labor-intensive light consumer goods, a sustainable ‘industrial trinity’ boom in energy/motive power/infrastructure, and a second industrial revolution involving the mass production of heavy industrial goods. This developmental sequence follows essentially the same pattern as Great Britain’s Industrial Revolution, despite sharp differences in political and institutional conditions. One of the key conclusions exemplified by China’s economic rise is that the extent of industrialization is limited by the extent of the market. One of the key strategies behind the creation and nurturing of a continually growing market in China is based on this premise: The free market is a public good that is very costly for nations to create and support. Market creation requires a powerful ‘mercantilist’ state and the correct sequence of developmental stages; China has been successfully accomplishing its industrialization through these stages, backed by measured, targeted reforms and direct participation from its central and local governments.     

综合治疗方案在中晚期宫颈癌中的应用

观察综合方案治疗中晚期宫颈癌的近远期疗效,探索这一治疗方案在中晚期宫颈癌治疗中的应用价值。     

论颈椎间盘突出症患者的非手术及理疗

本文主要探讨了椎间盘病学特征、病理特征、临床分型、临床症状与表现、非手术及治疗以及康复治疗的一些实际问题。     

瑞舒伐他汀与替格瑞洛联合用药方案治疗非ST段抬高型急性冠脉综合征患者的临床效果及不良反应

目的探讨瑞舒伐他汀与替格瑞洛联合用药方案治疗非ST段抬高型急性冠脉综合征(ACS)患者的临床效果及不良反应。方法选取2018年1月至2019年7月沈阳积水潭医院收治的70例非ST段抬高型ACS患者作为研究对象,依据随机数字表法分为对照组和观察组,每组35例。对照组采用替格瑞洛治疗,观察组采用瑞舒伐他汀与替格瑞洛联合用药方案治疗,比较两组临床疗效、心肌损伤指标、炎症介质水平、不良反应发生率。结果观察组治疗有效率高于对照组,差异有统计学意义(P<0.05);观察组肌酸激酶同工酶、肌钙蛋白水平低于对照组,差异有统计学意义(P<0.05);观察组炎症介质水平、不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论瑞舒伐他汀与替格瑞洛联合用药方案治疗非ST段抬高型ACS临床效果显著,不仅可以改善临床相关指标、心肌损伤,还可减轻炎症反应,且不良反应发生率低。     

胶质母细胞瘤PTEN基因突变和Ki-67表达的研究

目的对胶质母细胞瘤内部PTEN基因突变以及Ki-67表达情况进行研究,并对两者关系展开探讨。方法取胶质瘤石蜡切片102例为研究对象,其中胶质母细胞瘤切片42例,对所选样本行聚合酶链反应-单链构象多态性处理分析（PCR-SSCP）,对其PTEN基因突变进行检测;并对Ki-67在胶质瘤中的表达行免疫组化SP检测法进行检测。结果在胶质母细胞瘤中,PTEN基因突变发生率与剩余60例相比明显更高（P〈0.05）;在Ki-67平均标记指数方面,胶质母细胞瘤与其它胶质瘤相比数值更高（P〈0.05）。结论在胶质母细胞瘤中,PTEN基因突变对其发生以及发展具有重要作用;其病理恶性程度则与Ki-67表达程度呈明显的正相关;Ki-67表达程度同PTEN基因突变之间的关系也表现为正相关。     

基于web的基因检测服务现状分析

芯片技术把数以万计的寡核苷酸以点阵的方式排列在固体介质表面， 实现了基因（组）的快速、高能量、敏 感和高效率检测。基因检测在一定程 度上可以预测疾病风险及个 体特性， 而将基因检测服务和无处不在的网络 平台相结合，则真正实现了个人遗传 信息（personal genetic information, PGI）快捷可读，实现了预防医学、IT 科技和商业的完美结合。通过互联网 进行基因检测服务销售与广告，将加 快实现基因检测服务商业化进程和推 动其快速发展。从而将基因革命和基 因检测服务推到一个全新的平台，即 基因检测服务电子商务化。这将在临 床疾病检测和健康监测等领域掀起一 股高科技消费热潮。