略论陆渊雷医学思想之日本汉方医渊源

陆渊雷（1894--1955）是近代中西医汇通派代表人物之一,是“中医科学化”的积极倡导者。日本汉方医对“中医科学化”思想的影响,是近代中国全方位学习日本在医疗领域的体现。陆渊雷在“诸病皆中毒说”、“科学阐述仲景学说”、“药不暝眩厥疾弗疗论”、“伤寒六经非经络说”、脉诊的价值、五运六气的意义等几个方面的观点,与日本汉方医存在着渊源关系。     

88-A型牙体聚合度测量仪临床应用比较

目的探讨88-A型牙体聚合度测量仪的临床效果。方法选取驻地官兵需全冠修复患者36例74颗患牙,其中尖牙30颗,随机分为A、B两组,每组15颗,第一前磨牙44颗,随机分为C、D两组,每组22颗,由同一有经验医师行烤瓷单冠牙体预备,A、C组借助88-A型牙体聚合度测量仪完成轴向预备,B、D组不使用,牙体预备完成后,以精细藻酸盐印模材取模,超硬石膏灌注,以平行研磨仪测定各牙代型颊舌向聚合度,进行统计分析。结果A组15颗尖牙颊向聚合度平均为(6.07±0.95)°,舌向聚合度平均为(5.02±0.71)°,B组15颗尖牙颊向聚合度平均为(9.94±1.71)°,舌向聚合度平均为(11.65±1.59)°;C组22颗第一前磨牙颊向聚合度平均为(5.17±1.30)°,舌向聚合度平均为(6.99±1.16)°,D组22颗第一前磨牙颊向聚合度平均为(10.91±1.67)°,舌向聚合度平均为(12.71±1.70)°。A组与B组,C组与D组相比,颊向聚合度和舌向聚合度均有显著性差异(P<0.05)。结论使用88-A型牙体聚合度测量仪能够显著提高牙体预备质量。     

Rigid Registration of Medical Images Using 1D and 2D Binary Projections

Image registration is a necessary procedure in everyday clinical practice. Several techniques for rigid and non-rigid registration have been developed and tested and the state-of-the-art is evolving from the research setting to incorporate image registration techniques into clinically useful tools. In this paper, we develop a novel rigid medical image registration technique which incorporates binary projections. This technique is tested and compared to the standard mutual information (MI) methods. Results show that the method is significantly more accurate and robust compared to MI methods. The accuracy is well below 0.5° and 0.5 mm. This method introduces two more improvements over MI methods: (1)for 2D registration with the use of 1D binary projections, we use minimal interpolation; and (2) for 3D registration with the use of 2D binary projections the method converges to stable final positions, independent of the initial misregistration.     

威海市实施结核病归口管理结果分析

目的　掌握可疑肺结核病人、肺结核病人(以下简称结核)转诊、报告情况,采取有效措施提高结核病人归口管理水平。方法 对8年来各综合医院相关科室检查的资料进行统计分析。结果 综合医院转诊、报告率逐年提高。结论 行政干预,强化医院内部管理是提高结核病转诊、报告率的关键。     

大连市实施肺结核归口管理的作法与成效

目的　探讨归口管理在结核病控制中的作用。方法 在卫生行政部门的干预下,依据《大连市结核病防治管理办法》开展归口管理工作。对转诊发现的涂阳病例全部予以全程监督化疗。结果 综合医院可疑肺结核报卡由1997年448张上升至2000年2533张。肺结核截留率由1997年74.0%下降至2000年2.8%。1997～1999年登记的新发涂阳病例中转诊发现分别占65.9%、88.0%、90.7%,新发涂阳登记率较归口前上升显著。新发涂阳病人登记满一年转归队列分析,1997～1999年初治涂阳治愈率分别达93.9%,95.3%,94.9%。结论 1 病人发现水平与归口管理力度呈正比。2 综合医院可疑者转诊是发现新发涂阳病例的主要途径。3 归口管理与DOTS是保证新发涂阳病人高发现,高治愈的有效措施。     

2004年三门峡地区肺结核病人归口管理调查分析

目的为了解三门峡地区2004年各级综合医院肺结核病人归口管理情况,探讨提高转诊率的有效方法。方法检查2004年13所综合医院呼吸内科门诊及住院病例、X线胸片、转诊单,并与结防机构实际接到的转诊单核对。结果归口管理工作开展不平衡,部分医院存在漏报和转诊不到位情况。结论需要积极采取有效措施,减少漏转现象,提高转诊到位率。     

福建省61所市县医院肺结核归口管理督导结果分析

目的　检查督导综合医院肺结核归口管理现状与存在问题,以利于改进工作,提高病人发现水平。方法 检查61所综合医院有关肺结核归口管理的科室资料,同时检查57所结防机构有关资料,分析其报告、转诊以及痰检、胸片诊断等情况。结果 综合医院报告率84.1%,转诊率29.2%,转诊到位率70.3%;胸片诊断存在过诊、误诊;初诊病人查痰率仅为41.8%,涂片阳性率14.7%,均显著低于结防机构。结论 通过行政干预与专业督导相结合的措施,促进结核病归口管理的落实。     

Insuficiencia de convergencia con diplopía: tratamiento quirúrgico en adultos

ObjectiveTo study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia.MethodsThe study sample comprised 9 cases (7 women). The length of MR plication was collected. Other variables reported were postsurgical deviation, overcorrections in the early postoperative period and at the end of follow-up, final horizontal deviation at near and at distance vision, diplopia, and mean follow-up from surgery. Surgical outcome was considered to be favorable when diplopia and symptoms were resolved and final exotropia at near was ≤8 pd at the end of follow-up.ResultsA central mini-plication of the MR was performed in 9 patients (8 unilateral). Mean (± SD) age was 58.66 (21.39) years. Mean near preoperative deviation: 16.22 (± 2.9) pd and distance preoperative deviation: 6.88 (± 4) pd Overcorrection at distance vision was recorded in 5 cases; this resolved by 3 months postoperatively. There was not overcorrection at near vision except one case. None of the cases operated on had overcorrection at the end of follow-up The final horizontal deviation was ≤8 pd at near vision, except for 3 cases (mean: 6.22). Symptoms and diplopia resolved in 8 cases. The mean follow-up was 10.33 months.ConclusionCentral mini-plication of 1 or 2 medial rectus muscles can improve the symptoms and signs of exotropia associated with convergence insufficiency when exercises and the prisms are rejected by the patients and when these approaches have not solved the problem.     

Phenotypic presentation of Mendelian disease across the diagnostic trajectory in electronic health records

PurposeTo investigate the phenotypic presentation of Mendelian disease across the diagnostic trajectory in the electronic health record (EHR).MethodsWe applied a conceptual model to delineate the diagnostic trajectory of Mendelian disease to the EHRs of patients affected by 1 of 9 Mendelian diseases. We assessed data availability and phenotype ascertainment across the diagnostic trajectory using phenotype risk scores and validated our findings via chart review of patients with hereditary connective tissue disorders.ResultsWe identified 896 individuals with genetically confirmed diagnoses, 216 (24%) of whom had fully ascertained diagnostic trajectories. Phenotype risk scores increased following clinical suspicion and diagnosis (P < 1 × 10⁻⁴, Wilcoxon rank sum test). We found that of all International Classification of Disease–based phenotypes in the EHR, 66% were recorded after clinical suspicion, and manual chart review yielded consistent results.ConclusionUsing a novel conceptual model to study the diagnostic trajectory of genetic disease in the EHR, we demonstrated that phenotype ascertainment is, in large part, driven by the clinical examinations and studies prompted by clinical suspicion of a genetic disease, a process we term diagnostic convergence. Algorithms designed to detect undiagnosed genetic disease should consider censoring EHR data at the first date of clinical suspicion to avoid data leakage.     

ABVS冠状面征象“云雾征”对乳腺肿物的诊断价值

目的本研究通过分析乳腺肿物的自动乳腺全容积扫描(automated breast volume scanner, ABVS)冠状面声像图特点, 初步探讨ABVS冠状面征象"云雾征"对乳腺占位性病变的鉴别诊断及预后评估价值。方法本文为横断面研究。收集2020年1月至2021年1月在广州医科大学附属第三医院就诊的经ABVS扫查, 乳腺影像报告和数据系统(BI-RADS)分类在3类以上, 且经过手术病理证实的乳腺肿物共154例。通过回顾性分析乳腺肿物是否出现"云雾征"及"汇聚征", 分别比较"云雾征"与患者年龄、肿物大小、肿物良恶性、是否为浸润性及淋巴结转移之间的相关性, 使用χ2检验进行统计分析, 对比冠状面"云雾征"及"汇聚征"对乳腺占位性病变诊断的灵敏度、特异度、准确度。结果本研究一共纳入乳腺肿物154个, 包括良性病变42个, 年龄(40.5±10.9)岁, 肿物长径(26.7±13.7)mm;恶性病变112个, 年龄(55.4±11.4)岁, 肿物长径(17.9±11.5)mm。"云雾征"出现率在不同年龄组、不同肿物长径组间差异均有统计学意义(P<0.001、P=0.013)...