四川省互联网医疗服务监管平台建设及思考

随着“互联网+”战略的不断推进,医疗卫生领域的互联网技术运用日益成熟。以四川省互联网医疗服务监管平台为研究对象,结合传统医疗监管模式存在的针对性不强、监管局限以及监管滞后等问题,从设计监管理念、监管模式、平台服务以及监管要点等方面对政府监管方式进行了阐述。同时,对未来监管平台建设提出完善医师多点执业、强化医疗平台责任、构建多元共治体系、打造统一的卫生行政执法平台等建议。     

白虎汤类方研究

白虎汤及其加减方主要治疗某些传染病和寄生虫病,如流行性出血热、流行性乙型脑炎等病症;白虎加人参汤及其加减方主要治疗内分泌、营养和代谢疾病,如糖尿病;白虎加人参汤及其加减方主要治疗某些中医病证,如发热。竹叶石膏汤及其加减方主要治疗消化系统疾病、某些传染病和寄生虫疾病,如小儿口疮、伤寒、流行性出血热、复发性口疮等病症。通过白虎汤类方现代应用的研究可以看出类方研究是学习经方的系统方法之一,值得推广用于经方的教学、科研、临床之中。     

三种充填技术根管封闭能力的研究

目的:利用葡萄糖定量法检测根管微渗漏模型,评价侧向加压充填技术、垂直加压充填技术及固核载体充填技术对根管微渗漏的影响.方法:选取71颗直根管上前牙,根管预备后随机分为7组,A组(14颗)用热牙胶垂直加压加AH Plus充填;B组(8颗)仅用热牙胶垂直加压充填;C组(13颗)用侧方加压加AH Plus充填;D组(8颗)仅用侧方加压充填技术;E组(11颗)用Thermafil加AH Plus充填;F组(7颗)仅用Thermafil充填;G组(10颗)为阴性对照组,用粘蜡充填根管.牙根外表面、根管口及根尖孔处涂二层指甲油.于第7 d、14 d、21 d、28 d用葡萄糖氧化酶法检测从冠方向根方漏出的葡萄糖量.结果:采用重复测量方差分析,发现第7 d、14 d、21 d、28 d A、C组及C、E组微渗漏值有显著性差异(P＜0.001),但A、E组无显著性差异(P＞0.05).各时间点C、D组比较有显著性差异(P＜0.001),但A、B组与E、F组比较无显著性差异(P＞0.05).第7 d、14 d及第21 d、28 d各组内比较无显著性差异(P＞0.05),但各组第14 d与第21 d比较有显著性差异(P＜0.05).结论:侧方加压充填技术封闭根管的能力优于垂直加压充填技术及固核载体充填技术,而后两种充填技术封闭根管的能力相当.     

Tip-Edge Plus矫治器矫治慢性牙周炎致错(牙合)畸形的疗程观察

目的 比较3种矫治器矫治慢性牙周炎致前牙病理性移位患者的疗程.方法将60例慢性牙周炎致前牙病理性移位的患者分为3组(每组20个人),分别应用3种矫治技术进行矫治,并对3组患者的疗程进行统计学分析. 结果应用固定矫治器矫治,牙周状态评估指数为预后极佳;疗程在3组有显著性差异(F=130.67,P=0.0001), Tip-Edge Plus组疗程最短,平均缩短5.6个月,具有统计学意义.结论 Tip-Edge Plus矫治器矫治效果好,病程短,明显优于其它两种矫治器的矫治,更适合牙周炎致错(牙合)畸形的矫治.     

Push-out bond strengths: the Epiphany-Resilon endodontic obturation system compared with different pairings of Epiphany, Resilon, AH Plus and gutta-percha

AIM: To assess the bond strength of the new resin-based Epiphany-Resilon root canal filling system, and to compare this with bond strengths of different pairings of AH Plus, gutta-percha, Epiphany and Resilon. METHODOLOGY: A total of 65 extracted human single-rooted teeth were used. All teeth were instrumented using a set of ProTaper rotary instruments. Irrigation was performed with 15 mL of 1.25% NaOCl between each instrument and the smear layer was removed during and after instrumentation with 5 mL of 17% EDTA. The canal spaces were filled with different combinations of core and sealer using lateral condensation, as follows: group 1, AH Plus + gutta-percha; group 2, AH Plus + Resilon; group 3, Epiphany + Resilon; group 4, Epiphany + gutta-percha; group 5 (control), gutta-percha only. Cylinders of root dentine 1.13 (0.06)-mm long were prepared from the coronal sections of the 65 teeth. The test specimens were subjected to the push-out test method. After adhesion testing, the remaining sections were examined under a stereomicroscope at x 25 magnification to determine the nature of bond failure. The values of bond strength were analyzed by one-way analysis of variance (ANOVA) and the post hoc Tukey's test, with significance set at P < 0.05. RESULTS: The respective mean push-out test values for groups 1-5 were: 2.000 +/- 0.369, 1.380 +/- 0.154, 1.706 +/- 0.340, 2.857 +/- 0.523 and 0.078 +/- 0.027 MPa. Significant difference (P < 0.001) occurred between the groups. Multiple paired comparisons (Tukey's test) revealed that group 4 (Epiphany + gutta-percha) had significantly (P < 0.001) greater bonding strength than all the other groups; group 1 (AH Plus + gutta-percha) had significantly (P < 0.05) greater bonding strength than group 2 (AH Plus + Resilon); and group 5 (control) had significantly (P < 0.05) lower bonding strength than all the other groups. Inspection of the surfaces revealed the bond failure to be mainly adhesive to dentine for all groups. CONCLUSIONS: The Epiphany-Resilon combination (group 3) was not superior to that of the AH Plus-gutta percha combination (group 1).     

Ion Release,Porosity, Solubility,and Bioactivity of MTA Plus Tricalcium Silicate

Introduction

The aim of this study was to evaluate MTA Plus (Prevest Denpro Limited, Jammu, India, for Avalon Biomed Inc) material's properties, namely calcium release, the pH change, solubility, water sorption, porosity, surface morphology, and apatite-forming ability after immersion in simulated body fluid.

Methods

Two tricalcium silicate powders (MTA Plus and ProRoot MTA; Dentsply Tulsa Specialties, Tulsa, OK) and Dycal (Dentsply Caulk, Milford, DE) were tested. After incubation at 37°C and 99% relative humidity, calcium and hydroxyl ion release were tested up to 28 days in deionized water at 37°C. Water absorption, interconnected pores, apparent porosity, and solubility were measured after 24 hours of immersion in deionized water at 37°C. The morphologic and elemental analysis of the materials' surfaces were examined using an environmental scanning electron microscope/energy dispersive x-ray analysis after storage at 37°C for 1–28 days in simulated body fluid using the ISO 23317 method.

Results

All 3 materials created an alkaline pH within 3 hours, which continued for 28 days. MTA Plus had a higher ion release than ProRoot MTA and Dycal; the use of the MTA Plus gel enhanced the initial calcium release and the increase of the pH. Both MTA materials were more porous, water soluble, and water sorptive than Dycal and more bioactive. After aging in simulated body fluid, MTA Plus material caused precipitation of an apparent calcium phosphate layer.

Conclusions

MTA Plus showed improved reactivity and prolonged capability to release calcium and increase the local pH to alkaline values in comparison with ProRoot MTA. These pronounced ion-releasing properties are interlinked with its noticeable porosity, water sorption, and solubility and with the formation of calcium phosphorus minerals. The finer calcium silicate powder may explain the higher ion release, water sorption, porosity, and solubility of MTA Plus compared with ProRoot MTA. For clinicians, MTA Plus represents a lower-cost bioactive tricalcium silicate material with interesting chemical-physical properties that could be a convenient alternative to the conventional calcium silicate mineral trioxide aggregate–like cements.     

桂枝加龙骨牡蛎汤辨治心悸

桂枝加龙骨牡蛎汤出自《金匮要略》,为治疗失精之常效方,但仲景原文只列症状,不言病机,而临床上大凡出现心悸症状者,用之亦能取得良效,故有必要对此进行探讨。本文将从荣卫、心神及心肾3个方面阐述心悸发生的病因病机,及该方治疗心悸的机制,并附临床验案一则,以期为临床运用提供指导和借鉴。     

Genetic characterisation of 19 autosomal STR loci in a population sample from the Southeastern Anatolia Region of Turkey

Background: Southeastern Anatolia is the smallest, yet the most densely populated region among the seven major geographic constituents of Turkey. Situated in the Upper Mesopotamia, Southeastern Anatolia was also the northernmost extension of the Fertile Crescent, which is often considered as the earliest cradle of civilisation.

Aim: To investigate the autosomal STR polymorphisms associated with a truly representative population sample pool from Southeastern Anatolia.

Subjects and methods: Samples from a total of 257 volunteers were analysed by 19-loci autosomal STRs using the commercially available COrDIS Plus Kit. Allele frequencies, statistical parameters of forensic interest and Nei’s D_A distances with respect to the nearby and distant populations were calculated, besides performing exact tests of population differentiation with the same populations.

Results: A combined matching probability of 1.49978?×?10^?23 and a combined power of exclusion of 0.999999961 were obtained for the novel Southeastern Anatolian autosomal STR dataset. Furthermore, the Southeastern Anatolia population was found to have close genetic affinities with the other regional populations from Turkey, along with those from an apparent genetic continuum extending from the Near East to Southeastern Europe.

Conclusions: The novel Southeastern Anatolian dataset is expected to be useful in regional forensic genetics investigations and molecular anthropology applications.     

虚拟护理工作室预检分诊与分级派单制的居家护理服务实践

目的 探讨基于互联网平台的虚拟护理工作室的运营方式与实践效果。方法 2020年11月构建虚拟护理工作室平台,实施网上预约和线下服务。2021年2月针对实施中存在的问题,重组虚拟护理工作室成员,根据护士资质分成普通护士、市级专科护士和省级专科护士;由工作室护理长定岗线上预检分诊,实施分级派单;不同级别的护士上门实施护理,为患者提供延续性、全程、精确的居家照护服务。结果 线上预检分诊与分级派单制实施后,预约错误、退诊、退费发生率显著降低,实际服务例数、服务对象满意率显著提高,与实施前比较,差异有统计学意义(P<0.05,P<0.01)。结论 虚拟护理工作室实施线上预检分诊与分级派单制可以精准对接患者需求,减少不良事件,提高服务对象满意度。