医学综合评价性问题的定性分析与定量灰关联分析研究

采用定性分析与定量灰关联分析相结合的方法处理医学综合评价性的问题和诊断性的问题。定义了诊断值，诊断灰度和信息覆盖率等医学新概念，实例应用说明，这种分析研究和于临床诊断时，诊断符合率高，误诊率低，而且克服了一般医学诊断模式只能定性分析，不能作定量分析的缺点。     

Reforming the coroner and death certification service

The intention of the Home Office is to introduce a new system that combines an independent check on all deaths and a professional oversight of death patterns, with, for the majority of cases, the minimum of bureaucracy. No public consultation is intended, so that reforms are not delayed. However as the proposals are developed in the coming months, the details, practicalities and costs will be discussed “with relevant professionals (not defined) and those with experience of the existing arrangements”. The imperfections of the present system are outlined. It is hoped the medical profession will have an input, since statements such as “ ‘hospital post mortems’, which are for medical research and public health protection purposes” need amendment. There should be a change in perception of the audit value of this procedure to BOTH the family and the treating doctor. Unfortunately it is proposed the new system in total should cost no more than at present. “Professionals” (not defined) will be involved in the financial detail.All deaths, after verification and certification of the medical cause of death (if known) would then be referred to the ‘medical examiner’ based in the coroner's office. He/she would be a qualified doctor employed by the new coroner service and independent of the Health Service. The medical examiner could provide supplementary advice on medical matters required by the coroner. “Retention of tissue should only take place where absolutely necessary and the coroner and his or her other staff should take account of the needs of families and friends carefully throughout the process.” “Coroners could take advice from their medical examiner to ascertain and prescribe the minimum level of invasiveness to establish the cause of death.” This issue is far from resolved, as signified by a recent call from the DoH giving a grant to study the value of MRI versus a full post mortem. No thought is given to systemic diseases, which may present in one organ system or another disease process, other than that causing death. Medical examiners will have to keep abreast of current developments in medicine BUT will be outside the NHS, which could cause problems. Medical examiners will be appointed (with an input from Regional Directors of Public Health) and managed from within the coroner service. They would work closely with the registrar of births and deaths.Deaths from unnatural causes or when the medical cause of death is unknown will result in judicial inquests. The medical examiner will have an input into causes of death and relevant investigations.Details of the proposed structure of the system are given, as well as the investigative and other roles of Coroner's officers.The establishment of medico-legal centres, as “examples of good practice” is advocated. The drawbacks of this system are stressed in this paper. There is at present an on-going review of forensic pathology services and it is hoped thought will be given to the increasing trend for sub-specialisation in medicine.     

Lymphoma arising in an adenolymphoma

A malignant lymphoma that originated in association with an adenolymphoma (Warthin's tumor) of the parotid salivary gland is reported. The occurrence of lymphomas in salivary glands is discussed briefly.     

Successful treatment of chronic idiopathic urticaria and angioedema with cimetidine alone

We have studied a 50-year-old white man with chronic urticaria and angioedema who has responded to treatment with cimetidine alone for over 2 yr. In a double-blind, placebo-controlled study, cimetidine alone was at least as effective as chlorpheniramine in relief of urticaria and angioedema. Additionally, cimetidine significantly inhibited (p less than 0.01) the wheal response to histamine when it was compared to placebo. The inhibition of wheal response to histamine by cimetidine was significantly higher (p less than 0.05) than chlorpheniramine. The presence of predominantly H2- rather than H1-histamine receptors in the cutaneous blood vessels may be responsible for the therapeutic effects of cimetidine in this patient.     

海口市"三级甲等医院"医务人员人格特质调查研究

目的研究试图通过对海口市三甲医院医务人员人格特质的测量与分析,在与全国常模进行对比的情况下,得出海口市三甲医院医务人员人格特质的基本描述,建立医务人员人格特质的常模,为最终科学地建立海南省医学人才人格特质考评体系奠定必要的工作基础,也为海南省医学人才的培养和利用提供一项可行性的管理模式.方法采取分层整群随机抽样方法对海口市五家三甲医院医务人员人格特质进行调查,使用国际著名的人格问卷-加利福尼亚心理调查表CPI作为工具,对海口市三甲医院医务人员人格特质进行调查.结果被调查的海口市三甲医院588名医务人员人格类型分布以Beta型为主,各型分布情况为：Alpha型171人,占29.1%,Beta型302人,占51.4%,Gamma型59人,占10.0%,Delta型56人,占9.5%;在V3自我实现水平上海口市三甲医院医务人员有较高得分,除1例处于第二水平和4例处于第三水平外,其余583例都分别处于第四至第七水平;海口市三甲医院医务人员在20个分量表的测试中,在CS、IN、EM、SC、GI、WB、CM、TO、AI、AC、IE、PY、FX等13个分量表的平均得分上明显高于全国常模组（P〈0.01）,而在DO、SY、SP、SA、SO 5个分量表平均得分上明显低于全国常模组（P〈0.01）.结论海口市三甲医院医务人员各分量表平均得分大部分高于全国常模水平,尤其是在测量成就潜能方面的3个分量表AC、AI、IE平均得分全部明显高于全国常模水平（P〈0.01）,表明海口市三甲医院医务人员较常模有更强烈的成就动机,对智力活动与知识成就有较强的追求,在工作中能更有效地发挥智能,注重办事效率,见识广博,比较适合在激励自由和个人首创精神的场所独立地开展工作,并且能够专心于别人看来较为枯燥的工作.在测量社会价值内化程度的7个分量表中有5个（SC、GI、CM、WB、TO）高于全国常模水平.     

Osteotomy around the knee: Assessment of quality,content and readability of online information

BackgroundAs knee osteotomy surgery becomes increasingly accessible, more patients may turn to the Internet for information. This study examined the source, quality, content and readability of online information regarding osteotomy around the knee.MethodsThe first 70 websites returned by the top four search engines were identified using the key words: “knee osteotomy” and “high tibial osteotomy.” The websites were categorised by type and assessed using the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria and a novel Knee Osteotomy-Specific Score (KOSS). The presence of the Health On the Net (HON) code accreditation seal was noted. Readability of each website was assessed using eight readability formulae. The mean reading grade level (RGL) was compared to the 6th and 8th grade reading levels. The mean RGL of each category was also compared.ResultsOf the 45 unique websites analysed, the majority were Physician (33%) and Journal websites (31%). The mean DISCERN score was 36.7 (±8.9) which is classified as ‘poor.’ The mean JAMA benchmark criteria score was 2.04 (±1.5) and Physician websites were most likely to be scored zero. The mean KOSS was 15.4 (±5.7). The highest scoring website was a Commercial site but, overall, Journal category sites provided the best quality information. Websites that bore the HONcode seal obtained higher DISCERN, JAMA benchmark criteria and Knee Osteotomy - Specific Scores.The cumulative mean RGL was 13.2 (±2.2) which exceeded the 6th grade level by an average of 7.2 grade levels and the 8th grade level by an average of 5.2 grade levels. No website (0%) was written at or below either the 6th or the 8th grade reading levels. The mean Flesch Reading Ease Score of all websites was 41.13 (±14.7) which is classified as ‘difficult.’ Journal websites had the highest RGL.ConclusionThe information available online regarding osteotomy around the knee varies tremendously in quality and completeness. Physician sites predominate, but these were among the lowest scoring of all websites. Even where high quality information is available, it is set at too high a level to be easily understood.Level of evidenceSurvey of materials – Internet.     

基于USB2.0的医用内窥镜超声探头旋转扫描成像系统

介绍基于USB2．0接口的医用超声内窥镜旋转扫描成像的设计与实现。根据超声成像的特点，本系统采取脉冲回波成像方式，文中介绍了超声波激发、接收电路以及收发隔离电路。针对旋转扫描的特点，设计了基于FPGA的同步控制电路和基于USB2．0接口的数据传输电路。对采集到的原始图像，进行坐标变换，获得了按直角坐标显示的灰度图像。利用连续旋转马达对实际物体扫描成像的实验结果，验证了系统的正确性。     

Evaluation of activities in the health services

For planning or co-ordinating health services it is necessary to have reference points for evaluating similar departments in which homogeneous or equivalent activities are carried out. It is also necessary to consider the cost/benefit of the services. The paper presents several new indices of performance which may be applied to this problem and which enable quantitative comparisons to be made between hospitals and between departments. These indices include assessment of electrical hazards and service ability of equipment as well as the ratio of technical support staff to inpatient stay. The indices have been evaluated in a few large hospitals and found to be an effective management tool.     

Time-resolved particle image velocimetry and laser doppler anemometry study of the turbulent flow field of bileaflet mechanical mitral prostheses

Dynamic particle image velocimetry (PIV) was applied to the study of the flow field associated with prosthetic heart valves. The results were compared with those of laser Doppler anemometry (LDA). Anatomically and antianatomically oriented Jyros (JR) and St. Jude Medical (SJM) valves were compared in the mitral position to study the effects of valve design on the downstream flow field. The experimental program used a dynamic PIV system utilizing high-speed, high-resolution video to map the true time-resolved velocity field inside the simulated ventricle. This system was complemented by a study using the more traditional LDA system for comparison. Based on the experimental data, the following general conclusions can be made. High-resolution dynamic PIV can capture true chronological changes in the velocity and turbulence fields. It also produces very detailed velocity and turbulence information comparable to the LDA results. In the vertical measuring plane that passes both the center of the aortic and mitral valves (A-A section), the two valves (the SJM and the JR) show distinct circulatory flow patterns when the valve is installed in the antianatomical orientation. Small differences in valve design can generate noticeable differences, particularly during the accelerating flow phase. The SJM valve maintains a relatively high velocity through the central orifice; the curved leaflets of the JR valve generate higher velocities with a divergent flow during the accelerating and peak flow phases. In the velocity field directly below the mitral valve and normal to the previous measuring plane (B-B section), where characteristic differences in valve design will be visible, symmetrical twin circulations were observed because of the divergent nature of the flow generated by the two inclined half-disks installed in the antianatomical orientation. The SJM valve, with a central downward flow near the valve, is contrasted with the JR valve, which has a peripheral downward circulation with higher, turbulent stresses.