以患者为中心的血液透析系统开发设计

探讨在上海同济大学附属同济医院建立血液透析系统，介绍系统硬件设备、结构、开发工具、关键技术、功能及系统实现。通过建立血透系统提高血液透析中心的工作效率，降低医疗风险，以患者为中心制定透析方案，提高治疗质量。     

基于CT三维重建技术绘制骨折地图的临床应用进展

CT三维重建技术已经广泛应用于骨折诊断及其分型。基于CT三维重建的骨折地图绘制技术,通过绘制骨折模型来直观展现骨折线的形态学,包括骨折线的起止、走行、骨折面积等。骨折地图绘制技术为骨折诊断、骨折分型、治疗方案选择、手术内固定物设计、骨折好发部位统计、骨折标准化模型制定均提供了一个全新的方法。本文将回顾目前国内外包括对于肩胛骨骨折、胫骨远端骨折、尺骨冠状突骨折、胫骨平台骨折、桡骨小头骨折、股骨转子间外侧壁骨折、髋臼四边体骨折等骨折地图的研究进展,归纳总结了以上各个骨折模型的骨折好发部位及骨折地图绘制技术在骨折分型等方面的应用,并探讨骨折地图的临床应用前景及骨折地图绘制技术存在的问题等。     

A Bipolar-Bisection Piecewise Encoding Scheme for Multi-Source Reverse Time Migration

Conventional shot-record reverse time migration (RTM) suffers from a high computational burden when dealing with massive data. The computational cost of RTM can be reduced by shot-encoding techniques, and plane-wave encoding is a commonly used and effective shot-encoding scheme. However, plane-wave encoding requires long time padding to avoid information loss, which decreases the efficiency of the time-domain wavefield extrapolator, and the time padding becomes longer with the increasing distance between multiple sources. The piecewise plane-wave encoding scheme cuts multiple sources into several segments prior to implementing plane-wave encoding, hence reduces the time padding, but brings new crosstalk due to the mutual interference between shots in different source segments. We suppress the crosstalk artifacts by a new bipolar-bisection amplitude encoding method, in which half of the encoding array of each migration is different from that of any other migrations to reduce the number of crosstalk terms with as few migrations as possible. We embed the bipolar-bisection method into piecewise plane-wave encoding. Compared with plane-wave encoding, the proposed scheme requires considerably shorter time padding and thus works more efficiently and can generate a qualified imaging result. The feasibility of the proposed method is tested on the 2D SEG/EAGE salt model and the Marmousi model.     

Rotavirus,vaccine failure or diagnostic error?

Immunochromatography (ICG) is highly used in clinical settings for rotavirus (RV) diagnosis. The specificity of the tests differs by brand type and is not 100%, therefore its use when the prevalence of the disease is low (i.e. in vaccinated children) may result in a proportion of false positive diagnoses.In some areas, vaccine effectiveness studies or surveillance is done using ICG. Our objective was to estimate the validity of ICG test in vaccinated children, and estimate the number of false positive results in the Valencian Region of Spain, where all RV infections are diagnosed using ICG and are not confirmed by PCR.Population based registries were used to identify all results from the RV antigen tests performed between January 2008 and June 2012 in children under 37 months. Hospitalization and vaccination status of the patients were obtained by linking different databases through a unique identification number. The Positive Predictive Value of the ICG test depending on the vaccination status of the child, hospitalization and the rotavirus season was estimated by a Bayesian model of latent classes.Of the 48,833 tests with valid results, 9429 were done in vaccinated children, and of those 3963 (42%) during the rotavirus season. The prevalence of positive results in vaccinated varied from 2.9 to 21.4% of the tests depending on the hospitalization and seasonality. The estimated PPV also varied from 27.1 to 84.6% when stratified by these two parameters. Globally it is calculated that approximately 267 out of the 520 (51.3%) positives in vaccinated children were false positive tests.The large percentage of false positives, due to an excessive number of tests in vaccinated and out of the RV season, if interpreted as vaccine failures, can cause a loss of confidence in the vaccine and lower the estimates of vaccine effectiveness.     

经胸超声心动图对纵隔占位性病变的诊断价值

目的探讨纵隔占位性病变的超声特点,以提高早期诊断率。方法回顾性分析我院经胸超声心动图(TTE)检出并经病理或临床结合CT证实的纵隔占位性病变7例,扫查心脏左室长轴、胸骨上窝、剑下切面,重点观察心包周围、升主动动脉前方区域、降主动脉两侧和心脏后方。结果7例中,前纵隔占位4例;3例为囊性占位,分别为皮样囊肿、胸腺囊肿和肺癌并包裹性纵隔胸膜积液;胸腺囊肿及皮样囊肿均边界清,内部透声好。肺癌并包裹性胸腔积液形态欠规则,后壁可见松软低回声物质积聚。实性占位1例,为胸内甲状腺肿,边界清,呈实性不均质回声。后纵隔占位3例,其中神经纤维瘤1例,肝癌、肺癌并后纵隔转移各1例。神经纤维瘤呈中等回声的实质性团块,边界清晰,其内回声欠均匀;肝癌、肺癌并后纵隔转移边缘不规则,呈实性不均质团块回声。结论根据TTE检查切面的特点,结合纵隔占位的图像特征,提高TTE医师对纵隔内占位性病变的扫查意识,有助于纵隔内占位性病变的早期诊断和治疗方案的制定。     

Organización del quirófano e instrumental específico para el implante de prótesis de pene

After more than 1600 penile implant surgeries, we can affirm the need for a procedure protocol of the steps prior to this type of surgery, and the importance of carefully control the preparation for the surgical act.The instruments that must be available for surgery include elements that have been specifically designed for this type of intervention, such as the Cavernotomo dilators (Rossello®) or the Furlow. These are essential for penile implant surgeries in the usual practice, especially in complex cases or when complications arise.We should avoid complications as much as we can, or at least we should be able to minimize, address and resolve them with effective organization and adequate instruments.Undoubtedly, the surgeon's skills and experience are one of the key components for success, but the great importance of an adequately performed and rigorously applied protocol by all team members should not be underestimated. The objective of this article is to explain the basis of the details of this procedure in a clear and realistic way.