Direct-Q超纯水仪典型故障维修1例

Direct-Q超纯水仪用于产生电阻率大于18. 2 MΩ的纯水,主要应用于对水要求较高的环境,如生物实验、药液配置等,是生物、药物等研究必不可少的设备之一.超纯水滤柱是Direct-Q超纯水仪的主要部件之一,价格高昂,不能轻易更换,因此对该部件故障的判断和排除非常重要.本文分析了一个典型故障,供同行参考.     

不同注射器对微量注射泵质量控制的影响研究

为了评估不同注射器对微量注射泵性能参数及应用质量的影响,本文运用瑞典奥利科公司多通道输液泵/注射泵分析仪Rigel Multi-Flo配合3种不同品牌注射器对26台Injectomat Agilia微量注射泵进行质量控制检测,获取微量注射泵流量、阻塞报警压力、阻塞时间、快推容量等数据,并利用统计学方法进行分析。结果表明普通注射器在流量、阻塞报警压力、阻塞时间、快推容积方面与专用注射器有明显差异(P0.01),提示临床医护人员在使用微量注射泵时尽量选用与其兼容的注射器,为临床科室安全、合理使用微量注射泵提供依据和指导。     

医用注射泵质量控制与数据分析

目的 为进一步规范医用注射泵质量控制，探讨医用注射泵质量控制。方法 选择陆军特色医学中心在用医用注射泵941台，分布在中心56个临床病区，如重症监护病房、急诊科、麻醉科、神经外科等。医用注射泵品牌有12个，分别为德国贝朗、德国费森尤斯、日本泰尔茂、深圳迈瑞、山东威高等。依据军队规范《输液泵和注射泵质量检测技术规范（试行）》，采用Datrend Infutest 2000E型输注泵检定仪进行质量检测，并分析查找相应的原因。结果 2021年，医用注射泵周期检测941台，有67台初检不合格，初检合格率为92.9%。引起医用注射泵初检不合格的主要原因是科室人员操作不规范或对潜在风险危害不清楚，未及时替换设备进行维修。提出整改措施和建议。结论 探索医用注射泵质量控制与分析，有助于提升医疗安全和医疗质量，具有重要的现实意义。     

微量注射泵在新生儿科的应用

微量注射泵(简称微量泵)是一种新型泵力仪器,将少量药液精确、微量、均匀、持续地泵入体内,操作便捷、定时、定量,根据病情需要可随时调整药物浓度、速度,使药物在体内能保持有效血药浓度,运用微量泵对新生儿静脉输液,能减轻护士工作量,提高工作效率,并能准确、安全、有效地配合医生抢救.     

Prismaflex连续性血液净化装置故障维修2例

1 故障一 故障现象:废液泵在运转时噪声过大,影响患者治疗. 故障分析与排除:首先检查废液泵电机运转是否正常.将泵头拆下,开机进入维修模式,运行废液泵,设置转速至"30"以上,等待一段时间无明显噪声,电机正常工作.接着安装泵头,运行废液泵,此时有明显异响,可以判断泵头存在故障.检查发现泵头两侧滚轴运转阻力增大,用无水乙醇清洁表面后滴入石蜡油进行保养,待转动平稳装回机器,运行时已无明显异响,故障排除.     

医用电子直线加速器驻波加速管系统故障定位与安装调试方法研究

目的：探讨医用电子直线加速器驻波加速管故障定位及安装调试方法的实现,使加速器各项性能指标符合国家标准GBl5213—94《医用电子直线器性能及试验方法》的要求。方法：基于故障树分析法,将驻波加速管常见故障构建故障树,可分为五类：电子枪故障,微波输入窗故障,钛泵外围故障,偏转盒及电子输出窗和加速管真空度联锁（WGVACUUM）故障。经过剖析这五种故障定位方法的机制和特点,结合工作实例,发现一些故障最终需要更换驻波加速管来解决。这就需要提出安装调试驻波加速管的工艺流程。结果：利用这些方法可快速解决医用电子直线加速器驻波加速管的常见电气故障。同时利用安装调试驻波加速管的工艺流程,可快速有效地更换加速管。结论：实践证明利用这些方法维修和安装医用电子直线加速器驻波加速管切实有效,简单可行。     

飞利浦DR故障分析与维修2例

作为大型影像精密仪器,飞利浦DR使用频率较多,其故障频率也相对增多,但可以通过故障现象对其进行大致的分析和判断,本文主要介绍2例典型故障以及维修措施以供参考. 1 故障一 1. 1 故障现象 Digital Diagnost dual detector release 1. 5 不能曝光.     

瓦里安Clinac iX型直线加速器故障维修2例

作为目前国内放射治疗常用机型之一,瓦里安Clinac iX 直线加速器结构复杂,在维修时需要充分掌握其设计和工作原理,以对其故障进行有效分析和针对性排除.本文对瓦里安Clinac iX型直线加速器的2例典型故障进行分析,供同行参考. 1 故障一 故障现象:治疗过程中叶片突然不动,出现MLC联锁.     

品管圈对微量泵注药患者安全隐患发生率的影响

目的：探讨品管圈活动前后对微量泵注药患者安全隐患发生率的影响。方法成立品管圈活动小组,讨论分析微量泵注药患者安全隐患发生的原因,制定相应措施并组织实施,对比应用此方法前后患者安全隐患发生率。结果通过使用品管圈方法进行质量改进,使微量泵注药患者安全隐患发生率由31.02%降低到7.52%。结论运用品管圈方法可使微量泵注药患者安全隐患发生率明显降低,充分发挥出护理人员的积极性、创造性、主动性,促进了护理质量的持续改进。     

东芝系列CT机Asteion/VR软件安装及软件故障维修两例

<正>0引言CT机的软件系统在整个CT机运行过程中起着至关重要的作用。软件系统相对硬件来说故障率稍高些,所以对软件的维修维护尤为重要。软件系统的维修维护主要包括安装系统、设置系统、消除误操作、清理垃圾软件等。准确快速地排除软件系统故障不仅能更好地服务于临床,还能为医院节约大量的维修成本。下面介绍软件的安装和2例典型故障供同行参考、借鉴。1软件安装关机将MOD和光驱换上,先备份医院的信息,     

多脏器功能障碍患者胃肠功能衰竭中药治疗的研究

目的探讨中药治疗对多脏器功能障碍（MODS）患者胃肠功能衰竭改善的影响。方法回顾分析121例危重病患者在治疗过程中,合并胃肠功能衰竭时加用中药组（治疗组,68例）与未加中药组（对照组,53例）。比较两组胃肠功能衰竭的缓解率、缓解时间及MODS的发生率、病死率、ICU住院时间等。结果治疗组胃肠功能衰竭的缓解率明显高于对照组（75.0%vs55.7%,P=0.027）;治疗组比对照组胃肠功能衰竭的持续时间明显缩短[（2.52±2.10）dvs（10.85±3.85）d,P=0.00]、MODS的发生率明显减少（13.2%vs24.5%,P=0.027）、平均ICU住院时间明显缩短[（4.60±3.63）dvs（15.92±3.9）d,P=0.00];治疗组病死率与对照组比较差异无统计学意义（19.1%vs20.8%,P=0.741）。结论中药治疗结合常规治疗对危重病患者胃肠功能衰竭具有较好的治疗作用,可明显降低MODS的发生率、ICU住院时间,但对病死率无明显影响。     

益气温阳中药治疗慢性舒张性心力衰竭的疗效观察

目的 了解益气温阳为主的中药治疗慢性舒张性心衰的临床疗效。方法 收集2015年10月~2017年7月在天津市和平区中医医院就诊患者,随机分为对照组与治疗组,每组50例。对照组采用单纯西医治疗,治疗组在此基础上加用益气温阳类中药加减治疗。收集治疗前和治疗后超声心动、NYHA分级、E/A值、BNP值、心律失常患者数、6 min步行试验结果、心衰生活质量评分、中医临床疗效。结果 治疗后两组6 min步行试验、心力衰竭生活质量评分、中医临床疗效方面均优于治疗前,治疗组治疗后6 min步行试验、心力衰竭生活质量评分、中医临床疗效分别为（355.52±65.03）s、（67.02±8.91）分、61.22%,优于对照组的（388.51±66.32）s、（63.14±9.33）、33.33%,差异有统计学意义（P＜0.05）;左室大小、左室射血分数等方面比较,差异统计学意义（P＞0.05）。结论 益气温阳类中药治疗慢性舒张性心衰可以协助改善患者生活质量,提高运动耐力,提高疗效。     

重点监控管理对中药注射剂使用的影响

目的 探讨重点监控管理对中药注射剂使用情况的影响。方法 通过HIS系统调取我院2015~2017年中药注射剂的销售数量、销售金额等数据,对DDDs、DDC、B/A值进行统计分析,比较重点监控前后中药注射剂的使用情况。结果 2015~2017年中药注射剂重点监控品种DDDs最高为注射用血栓通,最低为红花注射液,且重点监控后,中药注射剂各品种DDDs均低于重点监控前。中药注射剂重点监控品种DDC最高为注射用红花黄色素,最低为舒血宁注射液;B/A值结果显示,注射用血栓通、参麦注射液、红花注射液B/A值接近1,注射用红花黄色素、丹参川芎嗪注射液B/A值＜1。结论 通过重点监控管理可减少中药注射剂使用,促进临床合理用药。     

中药治疗在慢性阻塞性肺疾病机械通气治疗中的作用研究

目的探讨中药治疗在慢性阻塞性肺疾病（COPD）并呼吸衰竭患者机械通气治疗中的影响作用。方法回顾分析125例COPD合并呼吸衰竭患者在机械通气及常规治疗过程中,据分期辨证施治结果加用中药组与未用中药组。比较两组患者呼吸力学参数,观察两组患者呼吸机相关性肺炎（VAP）的发生率、死亡率、机械通气时间、ICU住院时间、总住院时间等。结果两组机械通气呼吸参数、总的住院时间、死亡率差异无统计学意义（P〉0.05）;治疗组患者VAP发生率降低,病人机械通气时间及ICU住院时间明显缩短,与对照组比较差异有统计学意义（P〈0.05）。结论中药治疗结合常规治疗能有效降低COPD患者机械通气VAP发生率,缩短机械通气时间及ICU住院时间,但对机械通气呼吸参数、总的住院时间、死亡率无明显影响。     

人工心脏泵辅助对左心室血流动力学影响的数值研究

目的采用数值模拟方法研究人工心脏辅助装置植入对左心室内血流动力学的影响。方法首先利用心血管集中参数模型获取了健康状态、心衰状态以及人工心脏泵辅助状态下收缩末期左心室三维几何模型,其中选取超弹性材料Ogden为心肌材料,以左心房压力,主动脉压力以及通过左心室容积计算获取的左心室壁面位移作为边界条件,利用CFD方法对上述三种情况进行左心室的数值模拟。同时对比了健康时的模拟结果和生理状态下的左心室压力,以及心衰和人工心脏泵辅助两种状态下的血流动力学指标的差别。通过左心室压力和流速等评价灌注和负荷的情况,通过壁面切应力和涡流,评价人工心脏泵辅助后的左心室血流动力学变化规律。结果健康状态下模拟的左心室压力与生理指标相符合。在心衰和人工心脏泵辅助状态下,收缩期内左心室压力与健康状态比分别降低了1718 Pa和8455 Pa,辅助后左心室最大压力下降速度高于心衰时。人工心脏泵辅助后,舒张期壁面切应力峰值由4.3 Pa降低至3.8 Pa,收缩期壁面切应力峰值由4.1 Pa降低至1.3 Pa,射血速度峰值由1.61 m/s降低至0.68 m/s,主动脉瓣开放时间由0.25 s增加至0.65 s,左室射血分数由43.6%增加至52.7%,心室底端漩涡持续时间由0.35 s增加至0.51 s,顶端漩涡出现血流分离。结论左心室压力对比表明本研究方法可以用来模拟左心室的行为。人工心脏泵辅助能够快速降低心室内压力和心室负荷,增加灌注时间,提高器官灌注,降低左心室壁面切应力以及提高左心室内血液流场的涡流强度,延长涡流持续时间。     

Enhanced sympathetic activity and cardiac sympathetic afferent reflex in rats with heart failure induced by adriamycin

Our previous studies have shown that the cardiac sympathetic afferent reflex is enhanced in rats with chronic heart failure(CHF) induced by coronary artery ligation and contributes to the over-excitation of sympathetic activity.We sought to determine whether sympathetic activity and cardiac sympathetic afferent reflex were enhanced in adriamycin-induced CHF and whether angiotensin II(Ang II) in the paraventricular nucleus(PVN) was involved in enhancing sympathetic activity and cardiac sympathetic afferent reflex.Heart failure was induced by intraperitoneal injection of adriamycin for six times during 2 weeks(15 mg/kg).Six weeks after the first injection,the rats underwent anesthesia with urethane and α-chloralose.After vagotomy and baroreceptor denervation,cardiac sympathetic afferent reflex was evaluated by renal sympathetic nerve activity and mean arterial pressure(MAP) response to epicardial application of capsaicin(1.0 nmol).The response of MAP to ganglionic blockade with hexamethonium in conscious rats was performed to evaluate sympathetic activity.The renal sympathetic nerve activity and cardiac sympathetic afferent reflex were enhanced in adriamycin rats and the maximum depressor response of MAP induced by hexamethonium was significantly greater in adriamycin rats than that in control rats.Bilateral PVN microinjection of angiotensin II(Ang II) caused larger responses of the cardiac sympathetic afferent reflex,baseline renal sympathetic nerve activity and MAP in adriamycin rats than control rats.These results indicated that both sympathetic activity and cardiac sympathetic afferent reflex were enhanced and Ang II in the PVN was involved in the enhanced sympathetic activity and cardiac sympathetic afferent reflex in rats with adriamycin-induced heart failure.     

Transplantation and regeneration in the heart of the Mediterranean

The second half of the 20th century witnessed the birth of organ transplantation, and failing organs can now be replaced with healthy ones procured from living or cadaveric donors, allowing their recipient to start, or return to, an active life. Major milestones in the field were set in the eighties and nineties at the University of Pittsburgh Medical Center (UPMC), an institution that made it a mission to spread its expertise internationally. A successful partnership between UPMC and the Region of Sicily gave rise to the Mediterranean Institute for Transplantation and Highly Specialized Therapies (ISMETT), the only Italian facility entirely dedicated to transplantation of all solid organs and therapies for the treatment of end-stage organ failure. In its first seven years of activity, ISMETT has become a major referral center for patients from the entire Mediterranean Basin and the Middle East. Despite the fact that organ transplantation is the current gold standard for end-stage organ failure, the field is facing a worldwide emergency represented by the chronic shortage of organ donors. Research aimed at understanding the molecular networks involved in organ-specific ageing and their relationship with maintenance networks and organ failure should be actively encouraged and supported as it could ultimately allow to control organ performance and lifespan, increasing the number of organs available for transplant.     

Chromatin decondensation, pronucleus formation, metaphase entry and chromosome complements of human spermatozoa after intracytoplasmic sperm injection into hamster oocytes

Obtaining karyotypes from human spermatozoa after microinjection into Syrian golden hamster oocytes is difficult and the hitherto reported results are unsatisfactory. This may be related to the injection and culture technique or to the high susceptibility of the hamster oocytes to undergo parthenogenetic activation or both. Therefore, we investigated the hamster oocyte-human sperm microinjection model using the following two approaches: (i) application of contemporary techniques for injection (touching the sperm tail) and culture (hamster embryo culture medium, HECM-3, 10% CO2) and (ii) omission of Ca2+ from the injection medium. Thus, in the first series of experiments, 252 hamster oocytes were injected with human spermatozoa. Among the 219 (87%) oocytes that survived the injection procedure, the mean percentages of male pronucleus formation [two pronuclei (2PN), two polar bodies (PB)], mitotic metaphase entry and sperm chromosome spreads were 41.4, 27.8 and 18.2% respectively. Analysis of the oocytes which failed to develop the male pronucleus following injection revealed that most of them had developed only the hamster female PN while the sperm nuclei were either intact or swollen (partially decondensed), indicating that failure of oocyte activation was not the likely reason for the failure of male PN formation in these oocytes. In the next series of experiments, sibling oocytes were alternately injected with spermatozoa suspended either in the regular (1.9 mM Ca2+) or Ca2+-free injection medium (experiment set 2, n=278). A significant improvement was noted in the mean percentages of oocytes with 2PN, 2PB, metaphase entry and sperm chromosome spreads in the Ca2+-free group versus the regular group (2PN, 2PB: 51 versus 36.6%, metaphase entry: 36.3 versus 26.9% and sperm chromosome spreads: 28 versus 20.4%; all P < 0.04). Thus, parthenogenetic activation appears to be one of the contributing factors for the failure of male PN formation after heterospecific hamster ICSI. From these experiments it can be concluded that application of the advanced injection and culture techniques and omission of Ca2+ from the injection medium are promising for the routine application of the hamster oocyte microinjection for karyotyping of human spermatozoa with poor fertilizing capacity.      

The medical philosophy of Francis Bacon (1561–1626)

Francis Bacon's view of man is dualistic but, although he takes note of mental faculties, he makes the relation between mind and body, rather than the substance of mind, the basis for enquiry into mental processes and, more particularly, for the medically relevant study of mind. (He uses ‘mind’ and ‘soul’ as equivalent terms.) The healing of the body requires study of the body, and the ineffectiveness of physicians is due to their failure in this respect rather than to the body's complexity. To learn about the body requires clinical observation and recording, together with the comparison of bodies, experiments on living animals and attention to pathological changes. The aims of medicine should include not only the restoration of health but also the relief of suffering, and they are not to be limited by putting aside a disease as incurable. To learn from treatment it must be fixed in its ordering with controlled and limited variation. Bacon has no separation of medicine from natural science; his philosophy of medicine is his general philosophy of the advancement of knowledge, but limited to a particular field of application. If medicine is separated from natural philosophy it is changed wholly or greatly into empiricism.