Modernización de la gestión hospitalaria en instituciones prestadoras de salud

Se realizó una revisión breve con aproximación teórica a la actual organización hospitalaria y su modernización. Se muestra un enfoque de la actual organización hospitalaria. Además, se presenta el procedimiento y las particularidades de los rumbos del sector hospitalario; pudiendo posteriormente analizar los mecanismos de modernización a entes relacionados con el bienestar de la población y poder hacer uso de manera óptima de las metodologías de dirección. Los factores que motivan el cambio, por ser las organizaciones con mayor complicación en su área en específica; siendo así que sus actividades que varían en diversos sectores de acuerdo a lo especificado en sus lineamientos puedan ser entendidas de manera clara, aun cuando se consideren las peculiaridades de cada organización.

A brief review was carried out with a theoretical approach to the current hospital organization and its modernization. An approach of the current hospital organization is shown. In addition, the procedure and the particularities of the directions of the hospital sector are presented; Being able to later analyze the mechanisms of modernization to entities related to the well-being of the population and to be able to make optimal use of management methodologies. The factors that motivate the change, because they are the most complicated organizations in their specific area; being so that its activities that vary in different sectors according to what is specified in its guidelines can be clearly understood, even when considering the peculiarities of each organization.

Simplification of multiple prescription medications for the elderly / 中华老年医学杂志

Multiple medications can increase the risk of adverse drug reactions and adverse events in the elderly.Simplification of multiple medications is a systematic process of weighing the benefits and harms of drug use under the supervision of medical personnel, combining the patient's medical condition, current clinical status and personal preferences and tapering or stopping certain drugs while ensuring efficacy.Simplification of multiple prescription drugs can reduce falls, shorten the lengths of hospitalization, and reduce emergency visits for patients.This article gives a brief overview of simplification of multiple prescription drugs for the elderly and introduces the current available tools to do so.

Increasing hepatitis virus screening uptake at worksites in Japan using nudge theory and full subsidies

BACKGROUND@#Despite the importance of hepatitis screening for decreasing liver cancer mortality, screening rates remain low in Japan. Previous studies show that full subsidies increase screening uptake, but full subsidies are costly and difficult to implement in low-resource settings. Alternatively, applying nudge theory to the message design could increase screening at lower costs. This study examined the effects of both methods in increasing hepatitis virus screening rates at worksites.@*METHODS@#1496 employees from a Japanese transportation company received client reminders for an optional hepatitis virus screening before their general health checkups. Groups A and B received a client reminder designed based on the principles of "Easy" and "Attractive," while the control group received a client reminder not developed using nudge theory. Additionally, hepatitis virus screening was offered to the control group and group A for a co-payment of JPY 612, but was fully subsidized for group B. The hepatitis virus screening rates among the groups were compared using a Chi-square test with Bonferroni correction, and the risk ratios of group A and group B to the control group were also calculated. To adjust for unobservable heterogeneity per cluster, the regression analysis was performed using generalized linear mixed models.@*RESULTS@#The screening rate was 21.2%, 37.1%, and 86.3% for the control group, group A, and group B, respectively. And the risk ratio for group A was 1.75 (95% confidence interval [CI] 1.45-2.12) and that of group B was 4.08 (95% CI 3.44-4.83). The parameters of group A and group B also were significant when estimated using generalized linear mixed models. However, the cost-effectiveness (incremental cost-effectiveness ratio (ICER)) of the nudge-based reminder with the full subsidies was lower than that of only the nudge-based reminder.@*CONCLUSIONS@#While fully subsidized screening led to the highest hepatitis screening rates, modifying client reminders using nudge theory significantly increased hepatitis screening uptake at lower costs per person.

Síntese, avaliação biológica e modelagem molecular de potenciais antitumorais análogos da sanguinarina planejados por simplificação molecular / Synthesis, biological evaluation and molecular modeling of potential antitumors analogues from sanguinarine designed by molecular simplification

A sanguinarina é um alcaloide capaz de inibir Bcl-xL, uma proteína antiapoptótica que se encontra superexpressa em linhagens tumorais e que está frequentemente relacionada à resistência destas frente a quimioterápicos antineoplásicos. No intuito de identificar potenciais agentes antitumorais, o objetivo deste trabalho foi sintetizar três séries de análogos da sanguinarina planejados por simplificação molecular e avaliar sua atividade biológica. Dez N-benzil-naftil-aminas (3a-e; 4a-e) e dez arilisoquinolinas (6a-e; 7a-e) foram sintetizadas em duas a três etapas reacionais, utilizando-se métodos de aminação redutiva e acoplamento de Suzuki. Insucesso na etapa de reação de Heck impossibilitou a síntese da terceira série, benzofenantridínica, apesar de testadas diversas condições reacionais. Avaliação da citotoxicidade em linhagens de glioblastoma U87MG revelou que a série N-benzilnaftil-amina apresenta melhor atividade quando comparada às aril-isoquinolinas, sendo para ambas, observada atividade superior à temozolamida, principal fármaco para o tratamento de glioblastoma. Estudos em linhagem não tumorigênica MRC-5 demonstraram que os análogos foram significativamente superiores à sanguinarina em relação à seletividade. Os compostos mais mais promissores, 4a e 6e, induziram morte celular por apoptose e causaram despolarização da membrana mitocondrial, indicando morte apoptótica pela via extrínseca. Ademais, 4a interrompeu o ciclo interrompeu o ciclo celular na fase G2/M, indicando que o mesmo seria um agente ciclo celular específico. Simulações de dinâmica molecular sugerem que os compostos interagem com a proteína Bcl-xL principalmente por interações hidrofóbicas, e que o composto 4a apresentaria afinidade com o alvo semelhante à sanguinarina, embora esta tenha apresentado atividade superior em células U87. Perspectivas incluem estudos das vias de indução de morte celular, além da expansão do painel de células. Conclui-se, portanto, que os análogos da sanguinarina representam um arcabouço a ser explorado pelos químicos medicinais no desenvolvimento de potenciais antineoplásico

Sanguinarine is an alkaloid able to inhibit Bcl-xL, an antiapoptotic protein which is overexpressed in tumor cells and related to their resistance against antineoplastic chemotherapy. Regarding to develop potential antitumor agents, the aim of this work was the synthesis of three series of sanguinarine analogues designed by molecular simplification and their biological evaluation. Ten N-benzyl-naphtyl-amines (3a-e; 4ae) and ten aryl-isoquinolines (6a-e; 7a-e) were synthesized in two or three reaction steps through reductive amination and Suzuki coupling. Failure about Heck-type reaction had impaired the synthesis of the thirth series, benzophenanthridine, although several conditions were tested. Cytotoxicity evaluation against U87MG glioblastoma cell line showed that N-benzyl-naphtyl-amines are more active than aryl-isoquinolines and both series were superior to temozolamide, the main drug for glioblastoma treatment. Tests against non-tumorigenic cell MRC-5 indicated that the analogues were significantly superior to sanguinarine regarding selectivity. The most promising compounds, 4a e 6e, induced cell death by apoptosis and mitochondrial membrane depolarization, indicating apoptotic death by extrinsic pathway. 4a provide cell cycle arrest at G2/M phase, suggesting that it is a specific cell cycle agent. Molecular dynamics suggested that compounds interact with Bcl-xL mainly by hydrophobic interactions and 4a has affinity to the protein like sanguinarine, although the last showed superior activity against U87 cells. Perspectives include mechanistics studies about cell death pathway and expanding cell panel. In conclusion, sanguinarine anlogues represent a scaffold to be explored by medicinal chemists to the development of potential antitumor agent

Synthesis of novel papulacandin D analogs and evaluation of their antifungal potential

Systemic fungal infections are a growing problem in contemporary medicine and few drugs are licensed for therapy of invasive fungal infections. Differences between fungi and humans, like the presence of a cell wall in fungal cells, can be explored for designing new drugs. (1,3)-β-D-glucan synthase, an enzyme that catalyzes the synthesis of (1,3)-β-D-glucan, a structural and essential component of the fungal cell wall, is absent in mammals and this makes it an excellent target for the development of new antifungal agents. Papulacandins are a family of natural antifungal agents targeting (1,3)-β-D-glucan synthase. In this study we describe the synthesis and biological evaluation of two new Papulacandin analogs as potential (1,3)-β-D-glucan synthase inhibitors.

Esthetic Reanatomization in Posterior Teeth with Bulk Fill Resins: Case Report / Reanatomização Estética em Dentes Posteriores Por Meio de Resinas Bulk Fill: Relato de Caso

A constant appearance of new technologies and restorative materials has provided innumerable treatment options. Bulk Fill resins represent one of these options for posterior teeth. Better physicochemical properties, simplify use, wear resistance, possibility of single increment, less polymerization shrinkage stress are some of their advantages. These products would be suitable for simplified techniques, such as matrix technique that allows a better esthetic. The objective of this study was to describe a clinical report of multiple restorations in posterior teeth in association of occlusal matrix, diagnostic wax-up techniques and using single-increment technique of Bulk-Fill composites. The technique of occlusal matrix associated to the use of Bulk-Fill resin allowed aesthetic predictability for oral of rehabilitation using a single increment technique in cases of multiple restorations. (AU).

O surgimento constante de novas tecnologias e materiais restauradores vêm propiciando inúmeras opções restauradoras. As resinas do tipo Bulk Fill representam uma destas opções para dentes posteriores. Melhores propriedades físico-químicas, facilidade de uso, resistência ao desgaste, possibilidade de incremento único, menor contração de polimerização são algumas de suas vantagens. Esses produtos são adequados para técnicas simplificadas, como a técnica da matriz, réplica ou carimbo oclusal que permite melhor estética oclusal. O objetivo trabalho foi descrever um caso clínico de múltiplas restaurações em dentes posteriores por meio do emprego das técnicas de matriz oclusal e de enceramento diagnóstico, utilizando compósitos Bulk-Fill em incremento único. A técnica de matriz oclusal associada ao uso da resina Bulk-Fill permitiu previsibilidade estética para realização da reabilitação em casos de múltiplas restaurações. (AU)

Efeito da simplificação sintática sobre a compreensão de leitura de crianças do ensino fundamental / Effects of syntactic simplification on reading comprehension of Elementary School students

RESUMO Objetivo Investigar o efeito da estratégia de simplificação sintática de textos sobre o desempenho em compreensão leitora de escolares de 20 a 40 ano do ensino fundamental. Métodos Estudo transversal, analítico, caso controle. Participaram 112 escolares do ensino público, do 20 ao 40 ano escolar. Os participantes foram distribuídos em Grupo TO - expostos ao texto expositivo original e Grupo TS - expostos ao texto simplificado. Os grupos foram pareados segundo acurácia e não diferiram quanto à capacidade de compreensão leitora. O texto original foi submetido às seguintes modificações sintáticas: divisão de sentenças complexas, simplificação de marcadores discursivos, supressão de voz ativa e anáforas, inversão na ordem de cláusulas, com deslocamento da sentença principal para o início e utilização exclusiva da ordenação sujeito-verbo-objeto. Para atestar a simplificação, utilizou-se a ferramenta computadorizada CohMetrix-Port. A análise da compreensão por meio dos recontos dos textos lidos computou o total de ideias (centrais, detalhes) e de enlaces recontados. Resultados A análise comparativa dos grupos identificou diferenças quanto ao total de ideias centrais (U=1029,5, p=0,001), de detalhe (U=599,5, p=0,000) e total de ideias recontadas (U=1247,5, p=0,041), com melhor desempenho para o Grupo TS. A análise da escolaridade mostrou que o 30 e o 40 ano mais se beneficiaram da simplificação sintática. Conclusão A simplificação dos textos, atestada pelos parâmetros do CohMetrix-Port, produziu efeitos de facilitação sobre o processamento microestrutural do texto de escolares do 30 e 40 anos do ensino fundamental, promovendo maior retenção das ideias.

ABSTRACT Purpose To investigate the effects of Syntactic text simplification on the reading comprehension performance of Elementary School students. Methods Cross-sectional, analytical, case-control study. Study participants were 112 students regularly enrolled in the 2nd-4th grades of public Elementary Schools. Participants were divided into two groups: Group OT - students exposed to the original expository text and Group ST - students exposed to the simplified expository text. The groups were matched for accuracy and did not differ with respect to reading comprehension capacity. The simplified text was obtained by submitting the original text to the following syntactic modifications: separation of complex sentences, simplification of discursive markers, suppression of active voice and anaphora, inversion of clause order with displacement of the main clause to the beginning of the sentence, and exclusive use of the subject-verb-object order. Text simplification was verified using the Coh-Metrix-Port computational tool. Comprehension analysis through retell of the texts read determined the total of ideas (central and detailed) and retold links. Results Comparative analysis of the groups identified differences between the total of central, detailed and retold ideas, with the best performance observed in the Group ST. Students from 3rd and 4th grades benefitted the most from syntactic simplification. Conclusion Text syntactic simplification, verified by the Coh-Metrix-Port parameters, facilitated the micro-structural text processing of 3rd and 4th grade students, promoting greater retention of ideas.

Simplification of Mental Quality Inventory for nurses based on classical test theory / 中国实用护理杂志

Objective@#To simplify the Mental Quality Inventory for Nurses (MQIN), and evaluate its reliability and validity.@*Methods@#The second sampling to include the 1 067 nurses from 5 third-class hospitals were investigated to screen items using dispersion tendency, independent-samples t test, coefficient correlation, factor analysis, Cronbach α coefficient and expert consultation. The reliability was evaluated by Cronbach α coefficient, the correlation coefficient of each dimension with scale to evaluate its content validity, the exploratory factor analysis to evaluate its structural validity.@*Results@#The simplified scale (MQIN-72) includes 72 items belonging to 5 dimensions, and accounted for 55.378% of the accumulated variances. The Cronbach′ s α coefficient was 0.856, the content validity index was between 0.599 and 0.903,@*Conclusions@#The simplified MQIN scale with excellent reliability and validity, this scale can be used as one of simple screening indexes for nurse′ s selection, cultivation and engagement.

Nuevas estrategias de intervención desde terapia ocupacional para personas con enfermedad pulmonar obstructiva crónica (EPOC) / New intervention strategies from occupational therapy for patients with chronic obstructive pulmonary disease (COPD)

Antecedentes: La enfermedad pulmonar obstructiva crónica (EPOC), tercera enfermedad con mayor prevalencia a nivel mundial, es un trastorno de carácter respiratorio, que se acompaña de síntomas crónicos como disnea, tos y expectoración. Hipótesis: La aplicación de técnicas de simplificación de métodos y adaptaciones menores disminuye la carga cardiovascular (CC) en la ejecución de las actividades de la vida diaria (vestuario y baño ducha en personas con EPOC). Métodos y muestra: Esta investigación es de tipo semiexperimental y cuantitativa, con una muestra utilizada por conveniencia, compuesta por 6 sujetos pertenecientes a la Región Metropolitana. Resultados: Vestuario: Del total de la muestra, el 100 por ciento disminuye su porcentaje de CC tras la aplicación de técnicas de simplificación de métodos. Baño y ducha: Del total de la muestra, el 80 por ciento disminuye su porcentaje de CC tras la aplicación de técnicas de simplificación de métodos. Conclusiones: La implementación de las estrategias de intervención basadas en la técnica de simplificación de métodos demuestra ser efectiva para el grupo control que constituye esta muestra.

Reference: Chronic obstructive pulmonary disease (COPD), third most prevalent disease around the world, is a respiratory disorder, with chronic symptoms, as dyspnea, cough and expectoration. Hypothesis: the implementation the of methods simplification techniques reduces the cardiovascular load (CL) in daily activities performance (“clothing” and “bath and shower” in persons with COPD). Methods and sample: this is a quasi experimental and quantitative type. With a simple used by convenience, composed of 6 subjects from the Metropolitan Region. Results: Clothing: from the 6 subjects, the 100 percent decreases the CL percentage after the application of methods simplification techniques. Bath and shower: (in this case, the sample is composed by 5 subjects): 80 percent of the total sample decreases its CL percentage after the implementation of methods simplification techniques. Conclusions: the implementation of the intervention strategies based on the methods simplification technique evidence to be effective to the group that constitutes this sample.

Development of Simplified Ajou Version of MarkeTrak Survey to Evaluate Hearing Aid Use / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: MarkeTrak Survey is designed to evaluate the sociodemographic and HA factors of hearing aid (HA) users and their satisfaction of use. The questionnaire is inconvenient to use because it asked too many questions and requires long time to answer. The purpose of this study was to develop a simplified ("Ajou") version of MarkeTrak Survey and to evaluate its reliability. SUBJECTS AND METHOD: Forty-five HA users who visited the Ajou Hearing Center from 2014 to 2015 were included in the present study. To examine the correlation of the Korean version and the Ajou version of MarkeTrak Survey, 42 patients completed each survey simultaneously. To examine the reliability of Ajou version, test-retest and internal consistency methods were used. For the test-retest method, 22 HA users repeated the survey 2-4 weeks later. RESULTS: The newly developed "Ajou" version of MarkeTrak Survey consisted of 12 questions and was more simplified. Most of the questions of the two surveys showed significant correlation coefficient values (Spearman correlation, p<0.05). For the test-retest method, most questions showed significant correlation coefficient values (Spearman correlation, p<0.05), but they showed lower values than 0.6 in many cases. It showed high internal consistency of overall HA satisfaction. CONCLUSION: The Ajou version may be used as a simplified and alternative questionnaire for the Korean version of MarkeTrak Survey.

Efecto de una estimulación musical en el desarrollo fonológico del lenguaje en niños del nivel preescolar / The effect of a musical stimulation in the phonological development of language in preschoolchildren

Introducción: en la edad preescolar, los niños frecuentemente intentan simplificar su lenguaje. Estas estrategias de simplificación, llamadas procesos de simplificación fonológica, los cuales se sub dividen en tres: de estructura silábica, de asimilación y de sustitución; estas son eliminadas paulatinamente durante el desarrollo fonológico hasta presentar nulos o escasos procesos a los seis años. Si los procesos persisten se considera un trastorno fonológico la cual es abarcada mediante la terapia fonológica tradicional la cual ofrece varias estrategias que buscan la generalización en las producciones del niño, es decir sin abordar todos los blancos posibles ya que los procesos presentan una importante variación individual. Una estrategia innovadora dentro de este enfoque es la aplicación de la música, la cual presenta varias similitudes con el lenguaje hablado. Objetivo: determinar el efecto de la estimulación musical con canciones infantiles en el desarrollo del aspecto fonológico del lenguaje de los alumnos de preescolar del Centro Educacional "Sagrados Corazones de Jesús y de María". Materiales y método: experimental intra-grupo, porque se realiza una intervención en una misma población que sirve de control. Se utiliza el TEPROSIF-R como instrumento de evaluación a 55 niños que acuden al preescolar y las canciones infantiles como instrumento de intervención. Resultados: se observó post intervención, una reducción significativa de la media de los procesos de estructura silábica y de los procesos de sustitución. Se apreció que la disminución de la media de los procesos de asimilación en relación a la media de los procesos de sustitución fue menos significativa, debido a que estos fueron menos frecuentes en los sujetos de estudio. Conclusión: tendencia a la reducción de los casos de niveles en riesgo y en déficit y por ende, un aumento significativo del número de alumnos con un nivel de desempeño fonológico normal en un 20%, debido al efecto directo de la intervención con canciones infantiles.

Introduction: in preschool, children often try to simplify their language. These strategies of simplification, called phonological simplification processes, which are sub divided into three: syllabic structure, assimilation and substitution are gradually eliminated during phonological development until they are reduced with little or no process at age of six. If processes persist they must be considered a phonological disorder which is approached by the traditional phonological therapy which offers several strategies that seeks generalization in productions of the child, without addressing all possible targets as processes exhibit significant individual variation. An innovative strategy in this approach is the application of music, which has several similarities with spoken language. Objective: to determine the effect of musical stimulation with nursery rhymes in the development of the phonological aspect of language in students who attend preschool education at the Educational Center "Sagrados Corazones de Jesus y María". Materials and methods: experimental intra-group because an intervention on the same control population is performed. The TEPROSIF-R is used as an assessment tool to evaluate the phonological aspect of language to 55 children attending the preschool education and nursery rhymes as an instrument of intervention. Results: a significant reduction of the average in the processes related to syllabic structure and substitution processes is observed. It is noted that the decrease in mean of assimilation processes in relation to the average substitution process was less significant, because these were less frequent in the study subjects. Conclusion: a tendency of reduced cases in levels at risk and deficit is evident and therefore, a significant increase in the number of students with a normal level of phonological performance by 20% due to the direct effect of the intervention with nursery rhymes.

Procesos de simplificación fonológica en niños de 4, 5 y 6 años con dificultades fonológicas / Phonological simplification processes by children aged 4, 5 and 6 years with phonological difficulties

Se estudia a niños con dificultades fonológicas (DF) desde la perspectiva de la teoría de la fonología natural. Según ella, el desarrollo consiste en la paulatina eliminación de procesos fonológicos de simplificación (PSF) que afectan a la producción de palabras. Los niños con DF no eliminan adecuadamente los PSF y, por ello, sus emisiones son poco inteligibles y similares a la de niños de menor edad. Existe información en español acerca de la eliminación de PSF en el desarrollo típico, pero es escasa en menores con DF. Objetivo: comparar el manejo de PSF en niños con DF de 4, 5 y 6 años. Método: Se trabajó con 34 menores, con DF y diagnóstico de TEL, alumnos de escuela de lenguaje, distribuidos en tres grupos: 4.0 a 4.11 años (n12); 5.0 a 5.11 años (n11) y 6.0 a 6.11 años (n11). Fueron evaluados individualmente en su establecimiento educacional con el Test para evaluar procesos de simplificación fonológica (TEPROSIF-.‐R). Resultados: Se constató que la eliminación de PSF en los niños con problemas fonológicos es evidente entre los 4 y 5 años, pero se lentifica entre los 5 y 6 años, en especial, en los relacionados con la estructura de la sílaba y de la palabra.

This paper studies children who have phonological difficulties (PD) from the theoretical principles of natural phonology. This theory holds that the development consists in the gradual loss of the phonological simplification processes (PSP) which affect the production of words. Children with PD do not delete properly the PSP and therefore their speech is unintelligible and similar to that of younger children. Studies on the loss of phonological simplification processes in children with typical language development have been carried out in Spanish. However, far too little attention has been paid to this loss in children with PD. Objective: to compare the management of phonological simplification processes by children aged 4, 5 and 6 years with PD. Method: 34 children with PD and diagnosed with Specific Language Impairment (SLI), students enrolled in a language school, divided into three groups: 4.0 to 4.11 years (n12); 5.0 to 5.11 years (n11) and 6.0 to 6.11 years (n11). Children were assessed individually in their schools using the Test para Evaluar Procesos de Simplificación Fonológica (TEPROSIF-.‐R). Results: it was observed that the loss of PSP in children with PD is evident between children aged 4 and 5 years, but it is slower between children aged 5 and 6 years, especially, those related to the structure of the syllable and the word.

Simplified protocol of nuchal translucency measurement: Is it still effective?

OBJECTIVE: Nuchal translucency (NT) is the most powerful screening tool for Down syndrome and congenital cardiac anomaly, therefore strict guidelines were established to get accurate NT values. However, to stick to the guideline in all pregnant women is time-consuming and superfluous in majority of low risk population. We undertook this study to investigate whether the simplified protocol enables to select low risk group and is effective in them even if we skip the suggested NT measurement. METHODS: NT and crown-rump length (CRL) were measured prospectively. First, CRL was measured in the ordinary view that was mid-sagittal section of fetus in neutral position, and NT was measured at the same frozen screen (first measured value, 1MV). Then, NT was measured again according to the Fetal Medicine Foundation (FMF) guideline (second measured value, 2MV). RESULTS: There was good correlation between 1MV and 2MV in each case (r = 0.83, P or = 2 mm was only 23.8% of all cases, namely we had only to measure 2MV in 23.8% patients. Every 95th percentile or more 2MV could be detected with this simplified protocol. CONCLUSION: If NT is less than 2 mm at ordinary CRL view, we may skip suggested NT measurement according to FMF guideline.

The Contradictive Tendencies in Medical Treatment of the Hellenistic Age: Diversity versus Simplification, Chronic Extension(Physical Therapy) versus Rapidity, Humane Medicine versus Worldly Success / 의사학

It is a one-sided view to find the greatness of Hippocrates just in seeking after scientific medicine(medicina scientia) and sublating superstitious treatment. The scientific medicine did not begin with him, and the succeeding generations of him were not one and the same in opinions. For example, there were the confrontations between the school of Kos and that of Knidos in the very age of Hippocrates, as well as the opposition of rationalism and empiricism. The school of Kos was alleged to succeed the tradition of Hippocrates, taking into consideration individual physical conditions and being based on the principle of various clinical methods of physical therapy assuming chronical extension. On the contrary, the school of Knidos tended to define the diseases in simple aspects, paying no much attention to the difference of physical conditions and developmental stages of illness. Futhermore, the latter grasped the diseases rather in the point of individual organs than the disorder of physical state of the body. It can be said that the anatomical knowledge was more useful for the school of Knidos. The difference between the two schools can also be found in what purpose the medicine sought after. While Hippocrates attached much importance to physical therapy and made the people including the poor as object of medical treatment. there were doctors in no small number, we can suppose, in pursuit of money, power, worldly glory. As time passed, however, the two schools gradually got similar to each other, the difference of them reduced as well as the tradition of Hippocrates faded. The opposition between rationalism and empiricism in the Hellenistic Age shared, in some aspect, the difference of Kos and Knidos. According to Celsus, the conflict between rationalism and empiricism did not refer to pharmacy or anatomy, but just to diet. The rationalism materialized various methods of therapy considering environmental elements as well as individual physical conditions, but the empiricism in reality tended to expedite simplification of treatment. This tendency of simplification of the latter corresponded to the contemporary need of society, that is, speedy and effective treatment for the wounded in war or for epidemic in the army, farms of collective labour or much crowded cities. The bigger the groups were, the more the methods of treatment got simplified, individual conditions not much accounted. Then, the empiricism came to be united with anatomy, as the anatomy, being much developed in the process of curing the wounded in war, goes with simplification of medical treatment in the hospital of large scale. It can be said that the origin of simplified definition of diseases goes back far to the school of Knidos. On the other hand, in Hippocrates the drugs were in contrast to the diet. While the diet was to help health and rehabilitate physical conditions, the drugs were to result in strong effects of change. The drugs like as poison, eye-salve, ointment were to be made use f for rapid, effective change of physical state or for the treatment of a concrete, limited part of the body, These drugs were also much developed in the Hellenistic Age of the state of chronic war. In initial stages, the toxical drugs as well as the anatomy and surgical operations must have been developed on peaceful purpose, such like as 'theriaca' detoxicating(antidoting) animal's poison, or for easing childbirth. With the increasement of social inequality and unexhausted human desire, however, the toxical drugs or anatomical knowledges got to be used for undesirable purposes. Thus, we can not estimate Hippocrates simply in the point whether he developed scientific medicine or not. The great fame of Hippocrates could be found rather in his method of medical treatment as well as the principle of medicine, as he believed that the medicine should not be exploited for worldly power or wealth but for the convenience of all the people. He pursued healthy life matching to natural state(physis) and took much account of different physical states of individual to embody various methods of treatment, which presupposed chronic delay. The opposite to the Hippocratic medicine is called for the wounded by war, or the collective labourer of large farm with intensive labour exploitation. The medical treatment for them assumed anatomical surgery and drugs of rapid, strong effect.

An Improved Mesh Simplification Algorithm Based on Quadric Error Metrics / 대한의료정보학회지

OBJECTIVE: Quadric Error Metrics (QEM) algorithm can simplify complex 3D models. However, for its simple error metrics, QEM is not suitable to simplify medical model that contains many minute detail features. We need to develop a new algorithm because we are often interested in these features. METHODS: Based on QEM, We classify the vertex into seven classes. Different class has different cost of collapse. In our algorithm, collapse usually occurs with the lowest cost during simplification, thus minute feature can be preserved as possible. We also introduce the average of correlative triangles' area to estimate the volume change during the simplification. RESULTS: We test our algorithm on several complex medical models and find that our improved algorithm is effective and fast. CONCLUSION: To simplify a complex medical model, we want to preserve the minute feature during simplification. By classifying the vertexes, we develop an improved algorithm based on QEM. The testing results shows that our algorithm not only maintains the high efficiency of QEM algorithm, but also meets the high requirements of medical image processing on fidelity and mesh quality.

Simplification of Protein Sequence and Alignment?-free Sequence Analysis / 生物化学与生物物理进展

Alignment-free comparison is a recently developed method for sequence alignment, which has high computational efficiency and suitable to the low identical sequences. Alignment-free comparison was successfully applied in the DNA analysis. However, the accuracy of analysis is not high when it was applied in protein analysis because the complexity of protein is larger than DNA by consisting of 20 types of residues. Thus, residues are clustered into a few groups based on their similarity of physicochemical features. Using such simplified alphabets, the complexity of protein sequences is reduced and at the same time the key information encoded in the sequences remains. Therefore, the accuracy of alignment-free comparison is improved.

Role of Simplified Luteinizing Hormone-Releasing Hormone Stimutation Test in Diagnosis of Precocious Puberty / 实用儿科临床杂志

Objective To explore the simplified method by examining the levels of luteinizing hormone(LH),follicle-stimulating hormone(FSH),estradid(E2) and stosterone(T) at different times in the stimutation test of luteinizing hormone-releasing hormone(LHRH).Methods Sixty patients with precocious puberty accepted LHRH stimutation test.The levels of E2,T,FSH,LH before injection and after 30,60,90 minutes were compaired.The levels of stimutation test of LHRH examined with ACS:180 chemiluminesence.Results There were 39 patients in the group of central precocious puberty(CPP).The levels of FSH and LH in CPP group significantly increased after LHRH 30 minutes injection.The ratio of LH/FSH was higher than 1.The peak level of LH was higher than 12 IU/L.There were 21 patients in group of peripheral precocious puberty(PPP).Compared with the results before injection,the levels of LH were similar to the results of 30,60 and 90 minutes after LHRH injection.Compared with the result before injection,the levels of E2 and T were similar to the result of 60 minutes after LHRH injection.The peak levels of LH and FSH in two groups all focused in 30,60 minutes.Conclusions LHRH stimutation test is mainly based on the peak level of LH and the ratio of LH/FSH,the test can be simplified to examine the levels the of LH and FSH before the test and 30,60 minutes after injection as a basis for the clinical diagnosis.

Experience of Simplified Protocols in In-Vitro Fertilization and Embryo Transfer Program / 대한산부인과학회잡지

During the past few years much effort has been put into simplifying the clinical man-agement of in-vitro fertilization/embryo transfer cycles. One important step was the intro-duction of transvaginal ultrasound-guided oocyte collection, as previously described. This study describes further simplifications in the clinical management of ovarian stimulation and luteal support, and in-vitro fertilization procedure. During the period from October 1994 to September 1995, two major simplification steps were introduced. All cycles were administe-red with a gonadotrophin-releasing hormone agonist according to a long or short protocol preventing premature LH surge. During period I (Group I, n=62 cycles), closer monitoring by several pelvic ultrasound scans and serum oestradiol was used for monitoring the ovarian stimulation ; HTF media with fetal cord serum was used for insemination, growth and tran-sfer media in IVF-ET procedure ; progesterine in oil was daily used by intramuscular injec-tion for luteal support. During period II(Group II-I, n=71 cycles), only several ultrasound scans were used for monitoring the ovarian cycle ; Medi-cult IVF media containing synthetic serum replacement was used for insemination, growth and transfer media; Progesterine in oil was used daily by intramuscular injection for luteal support. During period III(Group II-II, n=16 cycles), further simplification of the clinical management was introduced by using a intravaginal micronized progesterone(Utrogestan) for luteal support. Retrospective analysis between Group I and Group II showed no differences in the number of oocyte(13.2+/-0.8/14.6+/-1.0), fertilization rate(71.5 %/60.7 %), cleavage rate(63.6 %/57.9 %), number of embryos transfered(5.0+/-0.5/4.5+/-0.5). Ongoing pregnancy rates obta ined from the three groups(Group I, Group II-1, Group II-II) were 25.8 %, 25 % and 40 %, respectively(p=ns). But introduction of minimal monitoring gave a significant reduction in the average number of US measurements in the simplified groups(Group II) compared with the group using the conventional monitoring protocol(Group I)(3.8+/-1.0/8.7+/-2.8, p<0.05). In the above groups, five patients developed severe OHSS but there was no differenc e in the distribution. Conclusively, simplified protocols including minimal follicle monitoring only by US, IVF-ET with Medi-cult IVF media containing synthetic serum replacement and the luteal support with intravaginal micronized progesterone gave a increased efficacy of the clinical phase of IVF treatment without a reduction in the success rate.