Real-time identification and archiving of micro-embolic Doppler signals using a knowledge-based DSP system

Identification of micro-emboli in the cerebral circulation using transcranial Doppler ultrasound provides valuable clinical information, but, currently, embolic signal detection and analysis are significantly limited because they mainly rely on costly off-line analysis by human experts. In this study, a reliable, high-resolution, real-time automated system for the detection and archiving of embolic signals was designed and implemented using expert system theory and modern DSP technology. Preliminary tests were conducted to evaluate the functions and the performance of the system using data from ten carotid endarterectomy patients and two normal volunteers. Using the widely accepted 7 dB threshold for human reliability and a human expert, majority-decision gold standard, the real-time system reached sensitivity and specificity of 93.6% and 99.3%, respectively, which were close to the results obtained by three human experts under ideal laboratory conditions (90.1% and 99.8%, 98.4% and 99.9%, 98.9 and 99.9%). The new system has the potential to be used either as a bedside monitoring and signal acquisition device, or as a laboratory investigation tool.     

实时辐射数据对介入手术人员辐射暴露的影响

目的 了解医务人员辐射暴露情况,为介入手术医务人员,提供实时辐射剂量监测数据。方法 选择2019年9月—2022年3月在介入手术室参与心脏手术的医务人员96人次作为研究对象。按时间进展进行分组,干预组43人次,对照组53人次。干预组研究对象在手术过程中,提供实时剂量监测数据;对照组研究对象按常规流程进行手术。比较2组研究对象的平均术中辐射剂量率。结果 干预组研究对象的中位辐射剂量率为88.80 μSv/h,对照组研究对象的中位辐射剂量率为188.40 μSv/h。干预组较对照组研究对象,辐射剂量率明显降低,差异有统计学意义（U = 637.000,P = 0.000）。结论 为介入手术医务人员提供实时剂量监测数据,可有效降低医务人员职业辐射暴露,改善医务人员的职业辐射防护。     

时点实时预约挂号的实践与思考

预约挂号是医院管理服务系统中基于人性化理念提出的,是对医院门诊服务流程的创新和调整,科学组织开展时点实时预约挂号工作,能有效帮助门诊患者高效率参与就医活动,医院的门诊服务效率也会得到显著的提升。该文对时点实时预约挂号的实践应用情况、管理方法以及实践应用效果进行了系统的探究,希望能为门诊服务流程进行进一步优化,实现对门诊就医环节的有效精简,在为患者提供高质量服务的同时,争取保障门诊服务能够得到患者群体的认同和肯定。     

西安市134例百日咳疑似病例不同标本百日咳鲍特菌检测阳性率比较

目的比较百日咳疑似病例鼻、咽和鼻咽拭子标本百日咳鲍特菌(Bordetella pertussis,Bp)检测阳性率。方法选择西安市两家医院2018年1-7月134例百日咳疑似病例,同时采集鼻、咽和鼻咽拭子标本,进行Bp分离培养和实时荧光定量聚合酶链反应核酸检测。结果百日咳疑似病例的Bp检测总阳性率为44.78%(60/134),其中鼻、咽、鼻咽拭子阳性率分别为36.57%、32.09%、39.55%(χ²=1.64,P=0.440);发病后0-7d、8-14d、15-21d、22-28d、29d采样的阳性率分别为23.33%、64.52%、63.89%、42.86%、23.33%(χ²=22.13,P=0.000)。鼻、咽、鼻咽拭子Bp核酸检测阳性率分别为36.57%、32.09%、39.55%(χ²=1.64,P=0.440);分离培养阳性率分别为0.00%、0.00%、4.59%(Fisher精确概率法,P=0.036)。在Bp核酸阳性病例中鼻和/或咽、鼻和/或鼻咽、咽和/或鼻咽拭子阳性分别占93.33%、91.67%、100%(Fisher精确概率法,P=0.080)。结论百日咳疑似病例鼻、咽和鼻咽拭子Bp检测总阳性率相当;核酸检测阳性率以鼻咽拭子最高,组合采样可提高Bp核酸检测阳性率;分离培养仍建议选择鼻咽拭子。     

黑龙工省基本医疗保险跨省异地就医直接结算现状及靶点问题分析

目的:分析黑龙江省基本医疗保险异地就医直接结算运行现状,找到靶点问题,并给出政策性建议。方法:采用SPSS 20.0软件对黑龙江省异地就医人次、统筹基金支付金额、实际报销比例及转外就医定点医院情况等进行描述性分析。结果:黑龙江省异地就医人次呈现直线上升趋势;作为参保省的统筹基金支付约是作为就医省的11.8(26.92/2.28)倍;实际报销比例差距较大,待遇差较严重;转外就医主要集中于京津的肿瘤专科医院与综合三级甲等医院。结论:基本医疗保险面临着严峻的基金外流问题挑战,亟需加快医疗卫生服务供给侧改革,实现医保与医疗服务的协同发展,同时将基本医疗保险异地就医直接结算政策嵌入黑龙江省特色发展战略,推动社会现代化发展。     

宁河区手足口病肠道病毒检测及流行特征分析

目的了解手足口病(HFMD)病原学特点及主要流行特征,为HFMD疫情的控制和常规监测提供可靠的数据。方法选取2017年1月-2019年12月天津市宁河区医院肠道门诊及儿科住院部HFMD病例的粪便样本382份进行检测。采用实时荧光定量PCR法,对手足口病毒进行分型检测。结果 2017年1月-2019年12月宁河区HFMD年均发病率为31.83/10万;2019年发病率最高为34.00/10万;2017年发病率最低为29.25/10万。在382份粪便标本中,肠道病毒分型EV、EV71、CV-A6、CV-A10、CV-A16阳性检出率分别为15.71%、5.24%、56.81%、1.83%、20.41%,其中CV-A6型阳性率高于其他分型。男孩病毒核酸阳性检出率高于女孩,25岁的年龄段检测阳性率最高,发病高峰集中在78月和10月。结论近三年宁河区HFMD发病分型以CV-A6感染为主,多无典型临床症状,无重症病例。因HFMD主要通过呼吸道的飞沫及粪便传播,传播速度相对较快,需进一步加强辖区内HFMD检测和宣传力度,培养孩子良好的卫生习惯,减少发病患儿与他人的玩具和日常用品之间的直接接触,做到早发现、早医治、早隔离,从而减少辖区内HFMD的发病率。     

运动强度对幼龄大鼠海马VEGF及其受体Flk-1 mRNA表达的影响

为了研究不同强度跑台运动对5周龄大鼠海马表达血管内皮生长因子(vascular endothelial growth factor,VEGF)和胎肝激酶-1(fetal liver kinase-1,Flk-1)受体mRNA水平的影响,5周龄雄性SD大鼠被随机分为对照组和小强度、中等强度、大强度3个跑台运动组,并通过定量real-time PCR技术,观察不同强度跑台运动1周后大鼠海马内VEGF和Flk-1mRNA表达的影响。采用3-磷酸甘油醛脱氢酶(glyceraldehyde-3-phosphate dehydrogenase,GAPDH)作为管家基因内参,以样品中所测得的VEGF和Flk-1基因拷贝数除以该样品中内参基因拷贝数进行校正后,各组动物海马内VEGF mRNA相对水平分别是:对照组为2740±2229,小强度运动组为3599±2386(P<0.05),中等强度运动组为1654±1136,大强度运动组为1572±1071。各组动物海马内Flk-1mR-NA相对水平分别是:对照组为147±47,小强度运动组为281±182(P<0.01),中等强度运动组为208±100;大强度运动组为54±31。以上结果提示,大鼠海马内VEGF和Flk-1mRNA的表达受运动的调节,且与运动强度有关。小强度跑台运动可对VEGF和Flk-1mRNA的表达产生促进作用,而大强度运动则不影响VEGF和Flk-1mRNA的表达。     

Detection of Mycoplasma pneumoniae in serum specimens from patients with mycoplasma pneumonia by PCR

There are few data on detection of Mycoplasma pneumoniae from blood, serum or plasma, and systematic studies on this diagnostic approach in community-acquired pneumonia (CAP) are scarce. Compared to testing respiratory specimens, this approach has the advantages that it is less dependent on proper specimen collection, serum is easily stored and handled, and the pathogen is detected in a primary sterile site, where colonization can be ruled out. In this study, acute-phase serum specimens from 29 patients of Vienna University Hospital (treated between 11/1994 and 6/2004; female: 14, male: 15; median age: 31 years, range: 15-66 years) with CAP and serologically verified M. pneumoniae infection, who had not received anti-mycoplasma therapy prior to serum collection, were tested for M. pneumoniae by conventional PCR and real-time PCR. Conventional PCR yielded negative results for all specimens, but real-time PCR detected M. pneumoniae in 15/29 patient sera (52%). These findings indicate that M. pneumoniae is present in the bloodstream of a substantial proportion of patients with mycoplasma pneumonia. Despite the possible adherence of M. pneumoniae to human erythrocytes, the pathogen can be detected from serum, if a method with enhanced sensitivity is applied. However, the negative predictive value of PCR from serum with regard to etiological diagnosis is low. With regard to the potential clinical benefit of blood-based PCR diagnosis of mycoplasma pneumonia the diagnostic accuracy of this approach using either serum or whole-blood specimens should be addressed by large-scale studies.     

高速铁路软土地基处理对策及效果分析

介绍了沪宁段铁路沿线的软土分布特征,将沿线软土地基分为4类,并从技术和经济两方面,分别对各类软土地基的处理进行了分析和比较,提出了相应的处理建议。     

血府逐瘀口服液的膜分离澄清研究

“血府逐瘀口服液”是由桃仁、红花、川芎、赤芍、柴胡等11种中药材并添加蜂蜜配制而成。蜂蜜的加入对复方成份起了絮凝和结团作用，使产品出现沉淀。作者采用平均孔径为0．45μm、2μm和5μm的微滤膜以及截留分子量为10000和30000道尔顿的超滤膜进行了终端膜分离试验。结果表明膜分离可以使产品得到澄清，分离除去杂质后的口服液产品经高效液相色谱分析，发现其芍药甙浓度提高了2～6％。在试验条件下，求取了膜分离过程的膜通量与污染速度数据，并推断可能的单程膜分离处理量，为放大试验或生产装置选择设计参数提供了参考。本文系攀登计划支持性课题——“膜组件污染与再生过程的实时监测与分析”的应用研究。