金属烤瓷修复体制作的临床体会

目的:探讨金属烤瓷修复体在制作中出现的问题及补救措施,如何提高金属烤瓷修复工艺的技术问题.方法:选择近4a制作的230例,共260件金属烤瓷修复体,记录在制作中出现的问题.结果:铸造缺陷4件,占154%,瓷裂5件,占192%,气泡9件,占346%,色泽不协调8件,占31%.结论:金属烤瓷修复体的制作是一个复杂而细致的过程,其中任何一个环节的失误都可能导致修复体的失败,因此在制作时提高熟练程度,每一步都严格遵循操作规程,才能获得最好的修复效果.     

呼吸机消毒与灭菌

呼吸机作为生命支持类设备,是医院内最常见的医疗器械,尤其在抢救重症肺炎患者中已经成为了早期治疗的重要手段。而在针对病毒性肺炎患者的治疗中,呼吸机的消毒灭菌及有效管理对防止呼吸性传染疾病在院内传播有着很重要的意义。     

Leveraging population‐based exome screening to impact clinical care: The evolution of variant assessment in the Geisinger MyCode research project

Exome and genome sequencing are increasingly utilized in research studies and clinical care and can provide clinically relevant information beyond the initial intent for sequencing, including medically actionable secondary findings. Despite ongoing debate about sharing this information with patients and participants, a growing number of clinical laboratories and research programs routinely report secondary findings that increase the risk for selected diseases. Recently, there has been a push to maximize the potential benefit of this practice by implementing proactive genomic screening at the population level irrespective of medical history, but the feasibility of deploying population‐scale proactive genomic screening requires scaling key elements of the genomic data evaluation process. Herein, we describe the motivation, development, and implementation of a population‐scale variant‐first screening pipeline combining bioinformatics‐based filtering with a manual review process to screen for clinically relevant findings in research exomes generated through the DiscovEHR collaboration within Geisinger's MyCode® research project. Consistent with other studies, this pipeline yields a screen‐positive detection rate between 2.1 and 2.6% (depending on inclusion of those with prior indication‐based testing) in 130,048 adult MyCode patient‐participants screened for clinically relevant findings in 60 genes. Our variant‐first pipeline affords cost and time savings by filtering out negative cases, thereby avoiding analysis of each exome one‐by‐one, as typically employed in the diagnostic setting. While research is still needed to fully appreciate the benefits of population genomic screening, MyCode provides the first demonstration of a program at scale to help shape how population genomic screening is integrated into routine clinical care.     

Overreporting of smokeless tobacco use by adolescent males

This study evaluates the impact of a pipeline assessment (salivary cotinine determination) on the accuracy of self-reported use of cigarettes and smokeless tobacco by 160 rural seventh-and eighth-grade males ranging in age from 12 to 16. Half of them were randomly assigned to complete a questionnaire on tobacco use prior to revealing the biochemical validation materials and collecting samples. The others had the samples collected prior to receiving and completing the questionnaires. The questionnaire-first group reported significantly greater smokeless tobacco use than did the pipeline-first group. Only for the latter were their self-reports significantly corroborated by the cotinine results. These results suggest that the utilization of a biochemical pipeline not only can improve self-reported tobacco use but also may help identify perceptions about the social desirability of using harmful substances.This research was supported by Grant PHS 1 RO1 CA38337 from the National Cancer Institute.     

一次性使用的医用塑料输液管辐照灭菌的安全性研究

本文按1985年版中国药典所规定的细菌检测方法及Ames法对用⁶⁰Co源辐照灭菌后的医用塑料输液管进行了灭菌效果、有效期及致突变研究。结果表明,辐照灭菌的效果可靠,有效期一年以上,对人体无致突变作用。因此,辐照灭菌后的塑料输液管是一种值得推广的新型医疗用具。     

A Java-based fMRI Processing Pipeline Evaluation System for Assessment of Univariate General Linear Model and Multivariate Canonical Variate Analysis-based Pipelines

As functional magnetic resonance imaging (fMRI) becomes widely used, the demands for evaluation of fMRI processing pipelines and validation of fMRI analysis results is increasing rapidly. The current NPAIRS package, an IDL-based fMRI processing pipeline evaluation framework, lacks system interoperability and the ability to evaluate general linear model (GLM)-based pipelines using prediction metrics. Thus, it can not fully evaluate fMRI analytical software modules such as FSL.FEAT and NPAIRS.GLM. In order to overcome these limitations, a Java-based fMRI processing pipeline evaluation system was developed. It integrated YALE (a machine learning environment) into Fiswidgets (a fMRI software environment) to obtain system interoperability and applied an algorithm to measure GLM prediction accuracy. The results demonstrated that the system can evaluate fMRI processing pipelines with univariate GLM and multivariate canonical variates analysis (CVA)-based models on real fMRI data based on prediction accuracy (classification accuracy) and statistical parametric image (SPI) reproducibility. In addition, a preliminary study was performed where four fMRI processing pipelines with GLM and CVA modules such as FSL.FEAT and NPAIRS.CVA were evaluated with the system. The results indicated that (1) the system can compare different fMRI processing pipelines with heterogeneous models (NPAIRS.GLM, NPAIRS.CVA and FSL.FEAT) and rank their performance by automatic performance scoring, and (2) the rank of pipeline performance is highly dependent on the preprocessing operations. These results suggest that the system will be of value for the comparison, validation, standardization and optimization of functional neuroimaging software packages and fMRI processing pipelines.     

Enhancing self-report of adolescent smoking: the effects of bogus pipeline and anonymity

Adolescent smoking prevalence is usually assessed via self-complete questionnaires. However, concern has been expressed about the validity of such self-report. One approach to increase validity involves the threat of biological validation, known as the bogus pipeline method (BPL).This study aimed to assess the effects of BPL, using an expired air carbon monoxide monitor, and of questionnaire anonymity on student smoking self-report data. High school students (n=801) were randomly allocated to one of four conditions: anonymous questionnaire+BPL, named questionnaire+BPL, anonymous questionnaire without BPL and named questionnaire without BPL. Overall, 37% of students agreed that questionnaires were a good way to obtain honest answers. In a logistic regression analysis, students in the BPL condition had significantly higher odds of reporting weekly smoking (OR=1.83 95% CI 1.27-2.65) and monthly smoking (OR=1.66 95% CI 1.21-2.28) but not of lifetime smoking compared with non-BPL students. Students in the named questionnaire condition had a significantly higher odds of reporting lifetime smoking (OR=1.49 95% CI 1.08-2.04) compared with anonymous students. Studies assessing current smoking patterns in adolescents should consider incorporating a BPL method.     

医院中心供气发展状况

随着医工技术的发展和医疗设备的不断进步，中心供气逐渐在各级医院普及。中心供气系统一旦投入使用，就与临床工作密不可分，成为一线工作的坚强后盾。因此系统安全是需要重点强调的问题。本文基于本医院的建设经历，介绍了一些工作中常见的问题，并提出解决方法和防范措施以供研究和探讨。