国内外PACS现状及发展趋势

医学影像存储与传输系统(Picture Archiving and Communication Systems,PACS)是近年来随着数字成像技术、计算机技术和网络技术的进步而迅速发展起来的,旨在全面解决医学图像的获取、显示、存储、传送和管理的综合系统.PACS的名称是在此之前1984年召开的第一届国际PACS和个人健康数据(PHD)会议上正式提出来的.西方发达国家从大处着眼80年代初就认识到PACS在医疗诊断和治疗过程中所处的重要地位,并着手研究该系统中涉及到的大量影像数据存储、影像传输速度、影像质量及存储和传输的标准等关键技术.从80代至今,20余年PACS已取得了长足的进步.     

一体化数字医院PACS的实现

本文从PACS的关键技术，如影像数据的采集方法、影像存储及介质的选取、影像传输的网络、中间组件技术等方面阐述了一体化数字医院PACS的建设及其特点。     

Discussion on the implementation standard of PACS

目的 通过制定和遵循影像存储与传输系统(picture archiving and communication system,PACS)的实施规范,以提高PACS安装速度,降低PACS故障率和安装实施成本.方法 PACS实施规范包括系统安装前的需求分析、实施计划书的制定、工作表单的编写、与HIS等软件接口开发、PACS软件实施中的规范要求、项目验收6个工作步骤.结果 本实施规范是笔者多年对多个医院PACS实施和维护经验的总结.只有规范化操作和实施,才能降低PACS故障率,提高项目建设速度.结论 PACS系统涉及多个领域,需要不断总结,才能达到最佳实施效率.     

影像存储与传输系统实施规范的探讨

目的 通过制定和遵循影像存储与传输系统（picture archiving and communication system,PACS）的实施规范,以提高PACS安装速度,降低PACS故障率和安装实施成本.方法 PACS实施规范包括系统安装前的需求分析、实施计划书的制定、工作表单的编写、与HIS等软件接口开发、PACS软件实施中的规范要求、项目验收6个工作步骤.结果 本实施规范是笔者多年对多个医院PACS实施和维护经验的总结.只有规范化操作和实施,才能降低PACS故障率,提高项目建设速度.结论 PACS系统涉及多个领域,需要不断总结,才能达到最佳实施效率.     

基于PACS的彩超影像采集工作站的设计与应用

为了使医院模拟彩超诊断仪能够接入现有PACS系统,促进医院数字化与信息化发展,本文介绍了一种基于PACS系统的彩超影像采集工作站的设计方法及其应用.该系统使彩超诊断仪与PACS系统得以紧密地联系起来,实现了彩超图像的采集,同时按照DIC0M标准实现了彩超图像的存储与传输等一系列功能,推动了PACS系统的发展和医院信息系统的完善.     

PACS系统影像存储解决方案

医学图像存档与传输系统(PACS)是目前数字化医院建设的重点和难点,PACS系统需要一个高性能的影像存储系统支撑.本文分析了PACS系统影像存储的特点,介绍了分级存储机制实现对医学影像的存储管理,并比较了三种在线存储设备解决方案的优点和缺点.     

PACS系统及在我院的应用

1 什么是PACS PACS是Picture Archive and Communication system的简称,就是影像存档与通讯系统.被赋予的功能还包括影像与数据采集、影像的管理、显示与处理、硬拷贝输出以及至关重要的工作流管理和诊断报告系统等.     

手术中影像数据调播新设想

随着计算机信息技术的飞速发展,临床医疗工作依赖于计算机及医用网络信息数据系统。诸如HIS、LIS及PACS等网络信息影像数据系统仍处于未整合的时期。该文立足于迅速高效便捷地为手术作业者获取病患相关数据影像信息的角度,对常规手术室规划提出了一种新的可行性构想,并在实际应用中对现有各种网络信息影像数据系统的整合做出新的设想。     

数字化医院中的PACS系统定位

在数字化医院中如何定位PACS系统，涉及到建设数字化医院的软硬件架构及未来的应用基础。本文主要描述数字化医院的框架结构，提出数字化医院的管理层面(传统HIS等)和业务层面(PACS、RIS、诊疗工作站等)的研究内容，分析了PACS系统建立过程中的重点，并结合公司研发机构对医学影像应用方面的研究，临床PACS(Clinical-PACS)将是以后PACS建设的方向，提出以影像应用为核心建立Angelplan-eH3MPACS系统的思想，就如何突出和延伸PACS系统中影像资料价值及临床应用价值提出自己的看法。作者认为，PACS系统是建设数字化医院的核心工作之一，也是医院信息系统建设中投资较大的系统，只有具备影像临床应用功能，能为诊疗提供服务，符合国际标准的PACS才能在未来的数字化医院建设中发挥更大的作用，也是数字化医院建设的基础与关键。     

利用Mimics和Freefrom建立翼内、外肌三维数字化模型

目的:探索一种建立精确翼内肌、翼外肌三维数字化模型的方法.方法:选择1具合适的尸体头颅标本,采用64排螺旋CT扫描仪实行全头颅连续薄层CT容积扫描,通过Mimics软件对层厚为0.625 mm的CT断层影像进行分析处理,再使用FreeFrom自由造型系统进行修正.结果:利用CT数据,在Mimics 10.01软件和FreeFrom自由造型系统中建立了翼内肌、翼外肌的具有比较清晰解剖学形态三维数字化模型.结论:重建获得的翼内肌、翼外肌三维数字化模型,有较高的真实性和精确度,可以进行在体的形态结构测量,有利于进一步活体解剖学形态和功能的研究,并为软组织的生物力学研究奠定基础.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.