一种基于Web的病理质控工作站的设计与应用

目的：为了解决病理科以人工为主的传统工作流程存在的一些弊端,辅助病理科的取材、切片工作,提出了一种基于Web的病理质控工作站。方法：病理质控工作站是典型的数据驱动应用,体系结构（自上而下）分为：用户界面层,业务逻辑层,数据存取层,数据库对象层;模块包括：取材工作站,切片工作站,划价收费工作站。结果：该病理质控工作站与其他医院信息系统能够无缝融合。结论：该病理质控工作站能够使用户在分布式环境下协同工作,有效地服务于病理科的病理检查申请和标本管理业务流程。     

Endoscopic resection of submucosal tumors

Submucosal gastrointestinal tumors represent a unique, diverse and challenging group of lesions found in modern medical practice. While management has traditionally been surgical, the development of advanced endoscopic techniques is challenging this approach. This review aims to investigate the role of endotherapy in treatment pathways, with a focus on carcinoid and gastrointestinal stromal tumors. In particular, we will discuss which lesions can be safely treated endoscopically, the evidence base behind such approaches and the limitations of the current evidence. The review will consider how these techniques may change the management of submucosal tumors in the future.     

Creating an IHE ATNA-Based Audit Repository

Compliance with the Health Insurance Portability and Accountability Act (HIPAA) requires gathering audit information from picture archiving and communications systems (PACS) regarding evidence trails of human interactions. Until recently, most PACS users have had limited access to auditing information. Access required resources to handle manual inspection of audit logs, and access to proprietary databases was not always available. Some vendors now produce eXtensible Markup Language (XML) audit logs based on certain events occurring in PACS. However, it is up to the user to convert this information into an easily mined data repository supporting compliance and quality control. This process can be handled in multiple ways, which could mean different audit mechanisms depending on the PACS (or other hospital system) used. It is apparent that an organized method of dealing with audit information is needed. This help may be provided within the Integrating the Healthcare Environment (IHE) framework. The IHE initiative defines a set of profiles, actors, and transactions that create common scenarios for particular workflow processes. The Integration Profiles depict security as a fundamental requirement of the framework. Specifically, the Audit Trail and Node Authentication (ATNA) profile defines standards based mechanisms for securely transmitting and storing audit records in a central repository. The data structure defined by the profile provides a number of record types that capture different audit events. A general feasibility study for storing currently available PACS audit information following the profile is defined, and steps to an automated solution are discussed.     

基于Web的医院决策支持信息系统设计与实现

集成众多的数据源为医院提供一个良好的决策支持信息系统,是医院网络时代对信息系统的基本要求之一。本文给出了Web环境下医院决策信息支持系统的实例,并探讨了相关的技术及实现方法。     

A randomized study of metabolic effects of four low-estrogen oral contraceptives: I. Results after 6 cycles

Healthy, non-smoking, normotensive, well-motivated young women were assigned at random to one of four different, commercial, low-estrogen, oral contraceptive products. Measurements of biochemical parameters were made on blood specimens collected from fasting subjects twice during the late pretreatment cycle, then again during each late treatment cycle for six months. All women assigned to one product (0.5mg NET + 35 microgram EE) dropped out of the study before the end of the fifth cycle, but discontinuations with the other three products were few. While numbers of subjects are small, the groups are closely matched and most metabolic differences are statistically significant. Products containing EDA and NET were associated with increases in serum total cholesterol and triglycerides, but decreases in HDL-cholesterol. In contrast, the LNG-containing preparation produced significantly less effect on these tests. A similar pattern was seen with a range of blood coagulation and fibrinolytic factors, Minimal alterations were seen with the LNG preparation, while those containing NET or EDA showed marked increases in factors I. VII, VIII, X and plasminogen, associated with a decrease in antithrombin III. It is suggested that differences in the metabolic impact of the various commercially available low-estrogen preparations, combined with effects on intermenstrual bleeding, allow a choice of the progestogen component most suitable for general use.     

血清酸溶性蛋白定量在日本血吸虫病研究中的应用

本文研究动物感染日本血吸虫及毗喹酮治疗过程中血清酸溶性蛋白(ASP)浓度的动态变化。结果显示:家兔感染早期,血清ASP浓度明显升高,中期降至正常水平,末期再次明显升高,感染小鼠经吡喹酮治疗,血清ASP降低程腰与疗效、减虫率、病变消退等相符合。本文提示:血清ASP浓度测定可作为监护病情、判定药物疗效的指标,有一定的临床实用价值。     

Pharmacokinetics,pharmacodynamic and endometrial effects of a single dose of 200 mg norethisterone enanthate

Ovulation was confirmed by daily analyses of the peripheral plasma levels of estradiol (E₂)⁴) and progesterone (P) in a pre-treatment cycle of 14 subjects. An endometrial biopsy was taken either in the proliferative or in the secretory phase of the cycle. On the 5th day of a subsequent cycle 200 mg norethisterone enanthate (NET-EN) was administered intramuscularly. The levels of E₂, P and those of NET were analyzed during the next 19 days and again during 44–60 days following the injection. The endometrial biopsy was repeated on the 23rd and 59th day of the treated cycle. The levels of NET reached a peak of 34.3 nmol/1 on the sixth post-injection day and decreased to below detectable limits in 3 of 12 subjects by the end of the observation. Ovarian activity was completely suppressed in all women during the first period, but returned to different levels in 11 subjects during the second. Four of them exhibited ovulatory steroid pattern. The morphologic changes of the endometrium reflected the progestogen effect in the first post-injection period but were characteristic of the ovarian reaction in the second.     

血清酸溶性蛋白定量测定在疟疾研究中实用价值的探讨

本文采用Bradford法的改良法,对感染伯氏鼠疟(P.b,ANKA株)及用酮替芬、青蒿素、放线菌酮、氯喹、威灵仙5种抗疟药治疗后小鼠血清ASP进行定量测定。结果显示:感染疟疾小鼠血清ASP含量显著高于正常小鼠,其浓度与疟原虫感染率成正比关系;用以上5种抗疟药治疗后,小鼠血清ASP含量显著降低,但有差异,其浓度与抗疟药对疟原虫的抑制率成反比关系。以上结果提示,血清ASP定量测定,可作为疟疾病情监护和判定抗疟药疗效的一项指标,亦是抗疟药筛选的一种较好方法。     

Ki-67 proliferative index predicts progression-free survival of patients with well-differentiated ileal neuroendocrine tumors

Ki-67 proliferative index (Ki-67 index) is suggested to be an important prognostic variable and is included as one of the grading parameters for neuroendocrine tumors. The present study was undertaken to determine the usefulness of the Ki-67 index and the corresponding tumor grade in predicting progression-free survival (PFS) of patients with ileal well-differentiated neuroendocrine tumors (wNETs). Tumors from 57 patients with ileal wNETs were studied. Immunohistochemical staining for Ki-67 was performed on the primary as well as selected metastatic tumors and quantitated by computer-assisted image analysis using the Ariol system. The tumors were graded based on mitotic activity and Ki-67 index. Clinical and pathological variables affecting the PFS were analyzed. There were 29 women and 28 men, with a mean age of 59 years. At the time of initial presentation, 8 patients (14%) had localized disease (stages I and II), 29 patients (51%) had regional (nodal/mesenteric) spread (stage III), and 20 patients (35%) had distant metastasis (stage IV). Twelve patients experienced disease progression during subsequent follow-up. Patients with initial stage IV disease were more likely to experience disease progression (P = .005). Additionally, higher histological grade (as determined by Ki-67 index >2%) was associated with a decreased PFS (P = .001). Ki-67 index greater than 2% at either the primary site or the metastatic site was found to be the only significant predictor of PFS after consideration of all other variables in an adjusted analysis. In conclusion, the Ki-67 index predicts PFS of patients with ileal wNETs.