药品温湿度物联网综合监控平台的建立与应用

目的 提高医院药品院内物流运行的质量。方法 建立感染病院药品温湿度物联网综合监控平台,并观察其特点与应用效果。结果 利用物联网技术构建三级监控平台,实时记录存放药品的环境和设备温湿度数据,动态监测调拨和下送的冷链药品在途温度,借助远程预警短信及时处理异常情况,应用6个月,共收到报警信息526条,调控药品冷藏柜10台,更换不符合温控标准的冷藏柜2台。结论 药品温湿度物联网综合监控平台的建立,使药品院内物流过程温湿度可控,通过药师主动干预,将药品质量管理下沉到临床一线,降低断链风险,提升医院药学服务水平。     

妊娠合并血小板减少的病因、治疗方案及其分娩方式探讨

 目的 探讨妊娠合并血小板减少的病因、规范化治疗方案及分娩方式的选择。方法 回顾性分析2009-01至2018-12解放军总医院第七医学中心产科127例妊娠合并血小板减少患者资料,对其病因、规范化治疗方案、分娩方式及妊娠结局等进行临床分析。结果 妊娠合并血小板减少的病因以妊娠相关性血小板减少症(pregnancy-related thrombocytopenia,PAT)和特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)居多,构成比分别为62.20%和19.69%,显著高于妊娠期高血压疾病(pregnancy hypertensive disorders,PHD)、妊娠期胆汁淤积综合征(intrahepatic cholestasis of pregnancy,ICP)及系统性红斑狼疮(systemic lupus erythematosus,SLE)。根据具体病情及病因选择监测观察、治疗原发疾病、糖皮质激素及免疫球蛋白输注、血小板输注等治疗。分娩方式主要由产科指征决定。结论 正确诊断并规范化、个体化治疗妊娠合并血小板减少,是降低妊娠并发症发生率、改善妊娠结局的关键。     

水通道蛋白过表达对脊髓损伤大鼠便秘的影响

目的 探讨脊髓损伤大鼠结肠水通道蛋白(AQPs)的表达及其与粪便含水率的关系。方法 将48只雌性Sprague-Dawley大鼠分为对照组(n = 24)和脊髓损伤组(n = 24)。脊髓损伤组行T₈横断脊髓损伤,对照组仅行椎板切除术。于造模前,造模后第1、3、7、14、28天,采用Basso-Beattie-Bresnahan (BBB)评分评价后肢运动功能;于术前,术后第3、14、28天检测粪便含水率;于术后第3、14、28天取结肠标本,免疫组化检测AQP1、AQP3和AQP4的表达。结果 脊髓损伤组术后BBB评分(t > 69.230, P< 0.001)和粪便含水率(t > 5.814, P< 0.001)均显著低于对照组。术后第3、14、28天,脊髓损伤组结肠AQP1、AQP3和AQP4表达均明显高于对照组(|t|> 5.165,P < 0.01)。脊髓损伤后AQPs表达与粪便含水率呈显著负相关( r = -0791~-0.730, P< 0.001)。结论 脊髓损伤后大鼠结肠AQPs表达上调,可能与脊髓损伤后结肠过度吸收水分有关。     

误诊为黏液瘤的左心室机化血栓1例

病例男,42岁,主因“右侧肢体麻木无力34 h”以“脑梗死”入院。既往高血压病史1年,糖尿病病史2年,均未规律用药。无冠心病、心肌炎等病史,近期无发热、腹泻等。体格检查:血压103/83 mmHg(1 mmHg≈0.133 kPa),心率74次/分,窦性心律,无意识障碍,四肢运动正常,无感觉构音障碍,四肢动脉搏动正常。     

野战麻醉机的研制现状与发展趋势

野战麻醉机以其良好的便携性被广泛地应用于灾难发生现场、野战医院等特殊环境。从使用环境特殊性方面,分析了对野战麻醉机的特殊要求,回顾了其国内外发展简史,重点介绍了国内野战麻醉机研发和使用现状,并对未来发展方向进行了展望。     

Image quality evaluation of dual-layer spectral detector CT of the chest and comparison with conventional CT imaging

ObjectivesTo evaluate image quality parameters of virtual mono-energetic (MonoE) and conventional (CR) imaging derived from a dual-layer spectral detector CT (DLCT) in oncological follow-up venous phase imaging of the chest and comparison with conventional multi-detector CT (CR_MDCT) imaging.Materials and methodsA total of 55 patients who had oncologic staging with conventional CT and DLCT of the chest in venous phase were included in this study. Established image quality parameters were derived from all datasets in defined thoracic landmarks. Attenuation, image noise, and signal-/contrast- to noise ratios (SNR, CNR) were compared between CR_DLCT and MonoE as well as CR_MDCT imaging. Two readers performed subjective image analysis.ResultsCR_MDCT showed significant lower attenuation values compared to CR_DLCT and MonoE at 40–70 keV (p ≤ 0.05). Moreover, MonoE at 40–70 keV revealed significantly higher attenuations values compared to CR_DLCT (p < 0.001). Noise was statistically lower in CR_MDCT compared with CR_DLCT and MonoE at 40 keV (11.4 ± 2.3 HU vs. 12.0 ± 3.1 HU vs. 11.7 ± 5.2 HU; p < 0.001). In contrast, all MonoE levels showed significantly lower noise levels compared to CR_DLCT (p < 0.001). SNR was not significantly different between CR_MDCT and CR_DLCT (13.5 ± 3.7 vs. 14.4 ± 5.3; p > 0.99). SNR values were significantly increased for MonoE at 40–80 keV compared to CR_MDCT and CR_DLCT (p < 0.001). CR_DLCT and MonoE (40–70 keV) from DLCT revealed significantly higher CNR values than CR_MDCT (p < 0.001). In subjective analysis, MonoE at 40 keV surpassed all other image reconstructions except for noise in MonoE at 70 keV.ConclusionIn dual-layer spectral detector CT, MonoE at low keV showed superior image quality compared to conventional images derived from the same system and may therefore be added to clinical routine imaging protocols. Whether MonoE reconstructions yield additional diagnostic information is still unknown.     

A comparison of new drug availability in Canada and the United States and potential therapeutic implications of differences

BackgroundClaims are made that new valuable drugs are not available in Canada at the time that they are marketed in the United States. This study uses a convenience sample of new drugs marketed in the United States and determines how many of these products are initially unavailable in Canada and their therapeutic value.MethodsIssues of the Canadian edition of The Medical Letter from May 12, 2003 to June 21, 2004 were hand searched for evaluations of new drugs and the following information was recorded: indication, availability in Canada and conclusions about therapeutic value. For drugs not available in Canada two clinical pharmacologists rated the therapeutic value of the products and the type of FDA review (standard or priority) was recorded. A database from the Therapeutic Products Directorate was searched to see if any of the drugs initially unavailable were subsequently marketed.ResultsThirty-two of 37 drugs were not available in Canada. Between 9 and 11 of these products were rated as offering moderate to significant therapeutic gains. Twelve of the 32 drugs eventually were marketed in Canada.InterpretationAlthough the majority of new drugs marketed in the United States but not available in Canada do not offer any therapeutic advantage, between about a quarter and a third of may offer moderate to significant therapeutic gains. The reasons why these drugs are unavailable and how much their absence affects the treatment Canadians receive should be the subject of future research.     

《黄帝内经》的术数理论探析

探索和认识由术数的世界观所支撑的中医理论大厦，对中医学的发展有创新性意义。本文从医学理论的角度分析了《黄帝内经》的主要术数范畴-阴阳、五行、六律、九宫八风、运气干支等的特点及其与传统术数的有关方面的区别和联系，提出了采用术数作为理论的底层去解释生命现象的思想，阐述了术数理论和方法对于中医基础理论建设的意义。     

番茄红素的研究及应用

本文对番茄红素的理化性质、生物学功能、制备、分析与检测和应用情况的进展进行了概述。