人工智能在儿童骨龄影像诊断的应用及发展

目的:探讨人工智能在儿童骨龄影像诊断的优势、应用现状以及发展趋势。方法:介绍并分析了几种传统的基于图像关键特征的骨龄测定方法,通过跟踪近几年人工智能在儿童骨龄影像诊断方面的研究进展以及结合最新的骨龄智能化辅助诊断系统在两所儿童医院的落地实施情况,对比分析了人工智能辅助阅片的性能和效率优势,探讨了人工智能辅助医学影像诊断发展中存在的问题,并对该技术未来的发展趋势进行展望。结果:通过对比发现,人工智能阅片相较人工阅片,在效率和准确率上具有明显优势。结论:人工智能的应用可以有效地缓解当前的医疗资源紧张的现状,医生和AI协作阅片将成为影像医生工作的新模式。     

小儿肺炎支原体感染的临床分析

目的分析小儿肺炎支原体(MP)感染的症状与诊疗方法,进一步提高小儿肺炎支原体感染的临床认识和诊疗水平。方法对该院接诊的286例小儿肺炎支原体感染病人的症状与诊疗方法进行回顾分析。结果 106例(37.1%)肺外感染与200例(69.9%)支原体肺炎,其余受累系统包括神经、心血管、泌尿、血液、消化系统,还有皮肤和淋巴结。结论肺炎支原体感染症状多变,还会损及其余系统。早期诊断与最终确诊分别根据临床症状和MP—IgM抗体。     

Malaria diagnosis: Memorandum from a WHO Meeting

This Memorandum reviews (1) the diagnostic requirements for malaria control within the primary health care system; (2) the current methods of malaria diagnosis used both in the clinic and in epidemiological studies; (3) the status of research on alternative methods to microscopy for the diagnosis of malaria; and (4) the application of new diagnostic methods in individual cases, in the community, and in the mosquito and their possible integration into existing epidemiological studies and control programmes. It also identifies priorities for the development and validation of new and reliable diagnostic techniques, and makes recommendations for the improvement, standardization, and utilization of current methodology.     

A stable feature extraction method in classification epileptic EEG signals

Epilepsy is one of the most common neurological disorders. Electroencephalogram (EEG) signals are generally employed in diagnosing epilepsy. Therefore, extracting relevant features from EEG signals is one of the major tasks in an accurate diagnosis. In this study, the local ternary patterns, which is an image processing method, was improved in order to extract robust features from epileptic EEG signals. The EEG signals that were recorded by the Department of Etymology in the Bonn University were employed in the evaluation and validation of the proposed approach. Low and up features, which were extracted by the proposed one-dimensional ternary patterns, were classified by some machine learning methods such that support vector machine, functional trees, random forest (RF), Bayes networks (BayesNet), and artificial neural network, while the highest accuracies were obtained by RF. Achieved accuracies were found successful according to the current literature.     

Computer-aided diagnosis system for classifying benign and malignant thyroid nodules in multi-stained FNAB cytological images

An automated computer-aided diagnosis system is developed to classify benign and malignant thyroid nodules using multi-stained fine needle aspiration biopsy (FNAB) cytological images. In the first phase, the image segmentation is performed to remove the background staining information and retain the appropriate foreground cell objects in cytological images using mathematical morphology and watershed transform segmentation methods. Subsequently, statistical features are extracted using two-level discrete wavelet transform (DWT) decomposition, gray level co-occurrence matrix (GLCM) and Gabor filter based methods. The classifiers k-nearest neighbor (k-NN), Elman neural network (ENN) and support vector machine (SVM) are tested for classifying benign and malignant thyroid nodules. The combination of watershed segmentation, GLCM features and k-NN classifier results a lowest diagnostic accuracy of 60 %. The highest diagnostic accuracy of 93.33 % is achieved by ENN classifier trained with the statistical features extracted by Gabor filter bank from the images segmented by morphology and watershed transform segmentation methods. It is also observed that SVM classifier results its highest diagnostic accuracy of 90 % for DWT and Gabor filter based features along with morphology and watershed transform segmentation methods. The experimental results suggest that the developed system with multi-stained thyroid FNAB images would be useful for identifying thyroid cancer irrespective of staining protocol used.     

我国布鲁氏菌病诊断方法应用及思考

布鲁氏菌病是一个全球的公共卫生问题,其诊断方法的研究仍然是热点领域之一。本文将对中国、美国和WHO布鲁氏菌病诊断标准进行比较。对我国目前布鲁氏菌病的主要检测方法及现阶段分子生物学检测进展进行阐述,并对各种诊断方法的特点进行比较。虽然我国已经建立了较完整的诊断体系,但是到目前为止仍没有一种既简单又快速,且灵敏度和特异度都很高的检测方法,这需要进一步研究,为以后完善我国布鲁氏菌病诊断标准提供科学依据。     

An overview of the diagnosis and management of Clostridium difficile infection

The diagnosis and treatment of Clostridium difficile infection are becoming increasingly complex with the introduction of novel diagnostic techniques and new pharmacologic and nonpharmacologic treatments. The integration of these new approaches with older, established methods is a challenge to individual clinicians and hospital systems. This article provides an overview of the current methods for the diagnosis and treatment of C difficile infection.     

抗震救灾中野战医疗方舱展开超声诊断的特点及意义

目的:讨论抗震救灾中野战医疗方舱如何迅速高效地开展超声诊断工作。方法:分析地震灾害中伤病员的伤情特点及在抗震救灾中野战医疗方舱开展超声诊断的必要性和客观要求,以及诊断工作的状况,流程中存在的优缺点,提出改进措施,并对超声诊断在野战方舱中的发展趋势进行展望。结果:总结了抗震救灾中超声诊断在野战医疗方舱中展开的特点及意义。结论:野战医疗方舱平台和超声仪影像诊断技术在伤病员诊治及挽救伤病员生命中发挥了更重要的作用。     

基于VBA计量与质量控制档案管理的系统实现

目的：实现医院医疗设备计量及质量控制文档管理的标准化和自动化。方法：通过系统分析、总结和归纳等方法,分析当前医院计量及质量控制文档工作流程,并设计出其系统执行方案。结果：结合医院计量及质量工作中文档管理特点,编制出计量与质量控制档案管理系统软件。结论：通过建立文档管理系统,健全了文档管理制度,实现医疗设备计量及质量控制的标准化和自动化,能够降低维护成本,确保医疗设备的正常运行。     

Surgical management of mediastinal tumors based on experience with 1000 cases]

One thousand operated mediastinal tumours are analysed. Their characteristic features are discussed and some uncommon manifestations are presented. It is emphasized that in most cases (80-90%) the traditional simple X-ray methods can give a sufficient information for the diagnosis. On the other hand, vascular lesions, cervicomediastinal goiters, dumbbell neurinomas, lymphatic diseases and esophageal lesions should be detected carefully by especial diagnostic methods before surgery because of the different operative tactics and consequences. The diagnosis of the mediastinal neoplasm indicates surgery due to their compressive behaviour.     

浅析心肌炎在心电综合分析系统的表现

目的探讨心肌炎在心电综合分析系统的表现及与普通心电图的结果对比。方法采用自身对照的方法，分别对13例患者进行心电综合分析系统及普通心电图检查。结果心电综合分析系统的各项结果与普通心电图对比：频谱心电图、心率变异性及心向量图有显著差异（P〈0．05）。结论心电综合分析系统比普通心电图对心肌炎诊断的帮助有更大的临床意义。     

医学图像纹理分析的方法及应用

医学图像中的纹理特征变化反映了机体的病理改变,因此,图像纹理分析对于疾病的鉴别诊断具有重要意义。目前,由于医学图像及其纹理的复杂性,尚未有一种通用的、适合各类医学图像的纹理分析方法。医学图像纹理分析中有4种常用的纹理特征提取方法,其每种纹理特征提取方法均存在优点和缺点。对不同医学影像(CT、MRI、B超及数字X线片)上肝部及肺部疾病的图像纹理分析表明,基于肝脏病变CT图像的计算机辅助诊断系统提取的纹理特征对图像内容有较好的区分性;通过纹理分析可对早期肺癌进行检测。     

Development of instrumental technologies of assessment of higher mental functions in health and disease

The current increase in the incidence of nervous and mental diseases makes it necessary to use monitoring means for dysfunctions of the central nervous system. The paper analyzes promising ways of development of medical engineering technologies for studies, diagnosis, and rehabilitation in higher mental dysfunctions. Particular emphasis is laid on the instrumental methods for examining the higher nervous performance and relevant technical means.     

胃癌肿瘤标志物临床意义与检测方法的研究现状及展望

目前对胃癌的早期诊断尚缺乏特异性的实验室检测方法,形态学诊断和活检仍是主要检查手段,但这两种检查方法对仪器设备和操作人员的要求较高,且费用昂贵,有一定的痛苦。胃癌肿瘤标志物检测由于其具有简便、快捷、无损伤、便于动态监测的特点,可以在临床实验室检测中早期发现、诊断胃癌病人,已成为一个研究的热点领域。针对当前胃癌肿瘤标志物的研究现状与展望作综述。     

The development of market approaches in Russia

In the late 1980s, it became clear that poor outcomes of the Russian health system were caused not only by underfunding but also by inadequate management of health care. Some features of the system led to great inefficiency in medical care provision and an irrational structure of medical care. The recognition of this fact has intensified the search for new methods of finance and management. The underlying idea of health care reforms in Russia is to weaken providers' dominance, to make them more responsive to consumer preferences, and to change the structure of medical care. The main developments of the reform parallel the reforms in Western countries. These are primarily the separation of finance and provision of medical care, with the shift from an integrated to a contractual model of relationships between payers and providers. But the specific characteristics of the health care situation, primarily the great underfunding and the absolute dominance of state-owned medical facilities, make the reform in the Russian health sector more radical. This paper highlights the issues of the current and planned developments in the Russian health sector. After presenting the main characteristics of the current health systems, it addresses economic experiments which are underway in several regions of the new Russian Federation. They are designed to introduce elements of market relations into a highly bureaucratic system. The main features and the impact of the experiments are discussed. Then the new model of finance, which is based on a transition from tax-financed to the health insurance system, is presented.     

The diagnosis and differential diagnosis of endogenous Cushing's syndrome

Cushing's syndrome (CS) is a physically and psychologically disabling disease associated with high morbidity resulting from inappropriate elevation of circulating free cortisol levels. The main features of CS are disturbance of the normal circadian rhythm of cortisol secretion, impairment of the normal feedback of the hypothalamo-pituitary-adrenal (HPA)-axis, and excessive integrated 24 hours cortisol secretion. All biochemical tests used for the diagnosis of CS rely upon the ascertainment of a disturbance of these features. However, the diagnosis of CS (endogenous hypercortisolism) still remains a challenge, although the evolution of several diagnostic tests has allowed diagnosis at an earlier stage. In the initial investigation of CS, tests of high sensitivity are required to identify patients at risk, which are followed by tests of high specificity to confirm the diagnosis and establish the precise aetiology. This review will discuss the various causes of endogenous CS and focus on established and evolving diagnostic procedures used for its diagnosis, as several studies with large number of patients have recently appeared in the literature validating current practice and proposing improved diagnostic algorithms.     

医院常用绩效评价方法分析

随着新医改不断深入推进,绩效评价在医院管理体系中发挥的作用日益凸现。为进一步提高医护人员工作积极性,优化人才结构,客观评价医护人员的劳动量和劳动所得,医院需要不断探索和完善绩效评价方法。而以资源为基础的相对价值比率(resource based relative value scale,RBRVS)和(疾病)诊断相关分类(diagnosis related groups,DRGs)作为以工作量为基础的绩效评价方法,对正在进行的医院绩效改革具有一定的借鉴意义。前者以资源投入为基础,以相对价值为尺度,依据医师消耗的资源成本测算工作量,最初是美国用于合理支付医师服务费用的评价体系,这种评价体系有效解决了美国医疗服务市场失灵问题,使医疗收费价格趋于正常化;后者侧重通过制定统一疾病诊断分类标准,评价医疗技术水平,实现医疗资源利用标准化。该文主要对上述两种方法和现阶段医院常用的绩效评价方法进行对比,明确相关方法的应用优势,从理论和实践层面为制定基于医护人员工作量的奖金分配方案提供参考依据。     

从影响因素角度试构建北京市区域医联体效果评价指标体系

北京区域医联体建设已经具备一定规模,建立了多种管理形式的区域医联体,基本形成了有关制度框架。根据政府建设区域医联体的政策目标,北京区域医联体实现了全市居民全覆盖,已经实现部分医联体的稳定运行,逐步完善医联体内的双向转诊等核心制度。综合看来,北京区域医联体以政府主导、以公立医院为主体、以行政区域为限,但地域的重复性覆盖、功能发挥有限的建设特点非常显著,医疗资源供需关系仍然紧张,需要通过有效的制度设计,不断引导的医疗资源进行整合,通过建立评价体系,以切实衡量北京区域医联体的建设效果。该研究通过文献查阅、调查研究、专家论证等方法,以国家政策及指标内容为导向,参考北京市现行医联体考核指标体系,在此基础上针对性的构建评价指标体系,有助于深化对北京区域医疗服务体系发展特点的认识,有助于提升北京区域医联体服务效果,有助于提高北京区域医疗资源的利用效率,更好地对国家推行的分级诊疗制度发挥技术支持作用。     

Multimag-M magnetotherapy system of the new generation

The Multimag-M microprocessor chronomagne-totherapy system of the new generation is described. The system provides on-line diagnosis of the pulse parameters and the breathing rate during a biotechnical feedback session. The requirements to the system software, as well as its specific features and design principles, are considered.     

典型发达国家和地区门诊保障政策比较及经验启示

利用文献综述法梳理典型发达国家门诊保障的相关政策并进行比较分析,为我国构建具有中国特色的门诊保障制度提供参考借鉴。分析认为可供我国借鉴的经验为:门诊统筹是医疗保险发展的必然趋势,是其有机组成部分,原则上不用单独缴费筹资;应该因地制宜制定门诊社区首诊政策;根据门诊服务的提供管理方式来确定供方的补偿方式及门诊待遇目录的详细程度;分类管理门诊服务,并分别制定支付政策;把监管的重点放在对门诊医生的管理上,外部监管应是符合目前我国情况的监管方式;患者也要承担一定的门诊支付责任,但医保支付封顶线不宜过低;对弱势群体实行一定的倾斜政策,可以考虑在统一制度下对其医药费用进行部分减免。