超声多普勒对颈总动脉云雾样声像的临床研究

目的探讨颈总动脉（CCA）云雾样声像（CUI）的血流动力学特点，以此论证其性质。方法将原发性高血压患者和正常人双侧CCA内CUI观察区限于分叉部以下长约3～4cm，高频超声在其两端分别测量上游最大流量（UFQ-max），下游最大流量（DFQmax），二者差值为最大返流量（RQmax）；返流最大截面积（RAmax）和对应2D截面积（Acui）；偏离轴心流体（DAVF）最大流速至轴心距离（r—a）。结果原发性高血压组（观察组）CUI内返流频谱特点呈脉动流模式，两组RQmax、Acui、RAmax及r—a值比较差异有非常显著性（P〈0．01），观察组RQmax与r—a值相关性好（P〈0．05）。结论观察组CUI所致血流动力学改变符合达西定律，其CUI充当了多孔介质。     

儿童急性淋巴细胞白血病6q16.3微卫星DNA缺失及生物信息学分析

目的定位儿童急性淋巴细胞白血病（ALL）杂合性缺失（LOH）的集中区域,探索新的肿瘤抑制基因.方法取6q16.3的15个微卫星标记,用聚合酶链反应-变性凝胶电泳-银染技术对165例ALL患儿等位基因LOH的情况进行生物信息学分析;同时分析其与临床预后因素的相关性.结果至少1个位点的LOH率为32.7%,D6S1709-D6S1028及D6S2160-D6S1580是高频率集中缺失的区域,早期复发患儿的LOH率高于无早期复发患儿;谷氨酸受体6基因（GRIK2）可能为抑癌基因,2个区域存在可能代表新基因的表达序列标签12个.微卫星LOH与白细胞计数、病态细胞数、核型分析、早期复发均有相关性（P值均＜0.05）.结论D6S1709-D6S1028和D6S2160-D6S1580为目前国内外所确定的最精确缺失区,该区域可能存在1个或数个肿瘤抑制基因,6q16.3的LOH的发生与ALL预后有一定关系.     

Evaluation of the implementation and effect of the healthcare cloud information platform for diabetes self‐management: A case study in Shanghai

With the high prevalence of diabetes, its long‐term treatment, and many complications, there is a need for a new diabetes self‐management model in developing countries. Therefore, this study aimed to assess the implementation and effect of a new diabetes self‐management model, known as the healthcare cloud information platform, in Shanghai, China. The implementation of the new model was evaluated in terms of the equipment coverage in community health service centres and the services provided. The effect was assessed according to the treatment rate and control rate from 2012 to 2017. Their correlations with the self‐management rate were analysed using Spearman's test. It was found that the Shanghai healthcare cloud information platform had covered a total of 237 community health service centres in all of the 16 administrative districts, equipping them with 2489 health stations, by 2017. An average of 8966 people uploaded data to the healthcare cloud information platform every day, with the accumulated service up to 12 043 508 person‐times and an average daily increase of 13 227.9. The treatment rate of diabetes patients in Shanghai increased from 42.9% in 2012 to 78.0% in 2017, and the control rate increased to 72% in 2017, compared with 63% in 2012. Furthermore, there was a significant correlation between the treatment rate, control rate, and self‐management rate. The findings indicate that it is feasible to implement the new healthcare cloud information platform for diabetes self‐management and that it is effective.     

Universal monoclonal antibody-based influenza hemagglutinin quantitative enzyme-linked immunosorbent assay

Seasonal and pandemic influenza infections remain a serious public health concern. Many health authorities recommend annual vaccination as the most effective way to control influenza infection. Accordingly, regulatory guidelines ask vaccine manufacturers to determine vaccine potency at the time of release and throughout shelf-life to ensure vaccine quality. The potency of inactivated influenza vaccine is related to the quantity of hemagglutinin (HA). Since 1970s, single radial immunodiffusion (SRID) assay has been standardly used for the quantitation of HA in influenza vaccine. However, SRID is labor-intensive, inaccurate, and requires standard reference reagents that should be updated annually. Therefore, there have been extensive efforts to develop alternative potency assays. In this study, we developed and tested a new HA quantitative enzyme-linked immunosorbent assay (ELISA) using a universal monoclonal antibody that can bind to HAs from various subtypes in group 1 influenza A virus (IAV). We analyzed the conserved stalk domain of HA via a library approach to design a consensus HA antigen for group 1 IAV. The antigens were expressed as a soluble form in E. coli and were purified by Ni-affinity chromatography. When tested with variety of HAs from IAVs or influenza B viruses (IBVs), the mAbs exhibited specific binding to group 1 HAs, with potential exception to H9 subtype. Among various conditions of pH, urea, and reducing agents, pretreatment of HA at low pH exposing the conserved stalk domain was crucially important for optimal ELISA performance. Calibration curves for various HAs were generated to determine accuracy, specificity, sensitivity, and linear dynamic range. The ELISA method shows high sensitivity and accuracy compared with the SRID assay. The HA group specific universal mAbs against the consensus stalk domain of HA are conducive to establishing an ELISA-based standard procedure for the quantitation of HA antigens for annual vaccination against influenza infection.     

乙型肝炎病毒基因分型的标签序列研究

目的 快速、准确地鉴定HBV基因型,寻找基因型间特异性的序列标签.方法 通过生物信息学手段,比对分析美国国立生物技术信息中心数据库中930条各型HBV基因组序列的大S区域,选择型间具有高度特异性的序列片段作为分型标签序列,以此设计引物,通过PCR实验对重庆地区的80例临床HBV阳性血清样本进行分型观察. 结果 HBV基因组大S区的149～169 nt和461-483 nt两段区域含有多个保守的型间差异位点;在8种基因型标签对构成的28种型组合中,27种组合的碱基总差异数均≥6;PCR实验和电泳结果证实,来自该两区段的序列标签引物能够获得特异性的产物,有效鉴定出HBV基因型.结论 HBV基因大S区的149～169 nt和461～483 nt两段序列可作为HBV基因型分型标签序列,用作引物探针设计或测序标签.     

云计算在区域医疗信息系统建设中的应用

采用云计算实现集中统一的区域医疗信息化建设和维护,不仅降低了大规模区域数据中心建设仞期所需的一次性投资成本,同时还满足了快速部署及差异化需求等多方面要求。通过对区域数据中心软硬件资源虚拟化方案的详细讨论,突出展示了厶计算在区域医疗信息化建设中的强大功能。云计算不但提高了区域医疗信息的可靠性和使用价值,且通过虚拟化技术实现了软硬件资源的动态按需分配,提高了资源的利用效率,实现了绿色计算。     

医院信息系统CA认证方案探讨

针对目前医院信息系统电子病历信息存在的安全和可信问题,分析CA认证原理及其在医院系统的特殊性,提出了将签名数据与被签名的资料转换成标准明文,使用带界面控制格式的XML文档单独保存到签名XML数据库中的CA认证方案。通过CA认证服务系统收集医疗信息,建立云架构的医疗信息数据平台以及医疗信息搜索引擎,实现区域医疗信息共享。     

云计算对医院信息安全及系统成本的影响研究

概述了当前国内医院信息化建设在信息安全及系统成本等方面所面临的实际问题,通过分析同济医院云计算数据中心的论证和建立过程,结合实用效果,阐述了通过云计算技术解决这两大问题的信息化建设思路。     

依托物联网及云计算技术提高老龄慢病管理服务质量

未来30年,世界人口将加速老龄化。中国在2050年后,老年人口比例将维持在30％以上,进入重度老龄化的平台期。现阶段,在中国庞大的老龄群体中近七成人患有慢性非传染性疾病（以下简称慢病）,其中一半患者患有两种及以上的慢病,需要大量的日常治疗、健康监控、疾病管理和紧急救治方面的服务。如何确保老龄群体保持良好的健康状况,成为全世界关注的课题。以国家自然科学基金项目“基于物联网技术的呼吸、脉搏异变及跌落的实时监测与报警的关键技术研究”为背景,基于物联网与云计算技术,以改变传统的被动健康服务模式为主动的自我健康管理模式为主线,在如何应对中国老龄化以及老龄患慢病群体的健康问题上,率先提出利用远程健康监护平台,依托无处不在的网络,建立“慢病管理系统”,为老龄患慢病群体提供更优健康管理和服务的解决方案。     

基于私有云构建医院数据中心

针对医院现有数据中心规模庞大、架构复杂、自动化程度低等问题,提出利用IBM SKC易云技术建设数据中心,介绍其建设原则、目标与架构,阐述数据中心管理域和数据中心资源域建设内容,为数字化医院建设夯实基础。