电阻抗断层成像技术在儿科呼吸系统疾病诊治中的应用

电阻抗断层成像技术(electrical impedance tomography,EIT)作为一项新兴的功能性成像技术,具有无损伤、便携、图像监护等突出特点。肺功能成像是目前EIT最主要的应用领域,可以实现实时动态监测肺通气及血流灌注。本文对肺EIT在儿童呼吸系统疾病及其诊疗过程中的应用基础及临床研究进展进行总结,为未来EIT技术在儿科临床急救领域的推广应用提供帮助。     

反射性共聚焦显微镜对早期蕈样肉芽肿定位诊断与疗效监测的研究

【摘要】 目的 分析早期蕈样肉芽肿（MF）皮损的反射性共聚焦显微镜（RCM）与组织病理学特征的一致性，探讨RCM作为病理学诊断早期MF的辅助价值及动态监测治疗反应的可行性。方法 2014年1月至2018年1月在杭州市第三人民医院皮肤科门诊收集临床疑诊MF病例40例，男26例，女14例，年龄（47.0 ± 17.6）岁。根据总结的早期MF的RCM特征，对活检部位进行初步定位后行组织病理学检查，对比MF的RCM与病理特征。对MF确诊病例进行窄谱中波紫外线联合干扰素治疗，运用RCM对靶向皮损跟踪随访，9个月后评价疗效。结果 在40例临床疑诊MF病例中，根据RCM特征初步诊断典型MF 8例，疑似MF18例，排除14例；根据MF病理学特征诊断典型MF12例，疑似14例，排除14例。一致性分析显示，RCM特征分类与病理诊断结果的Kappa系数为0.848，P < 0.01。RCM与组织病理学特征之间表皮低折光细胞浸润的相关性最高（Kappa系数 = 1，P = 0.005），其次是红斑期的真皮纤维化（Kappa系数 = 0.714，P = 0.035）。MF的RCM特征随着治疗的进行逐步恢复正常，但直至临床皮损完全缓解，非典型淋巴细胞依然存在。结论 RCM技术可用于早期疑诊MF皮损的病理取材定位，同时可尝试作为一种动态监测MF疗效的方法。     

Effective vaccine management through social behavior change communication: Exploring solutions using a participatory action research approach in the Solomon Islands

Addressing vaccine management bottlenecks, including high vaccine wastage rates, has traditionally been addressed through health worker training and other didactic methods of technical assistance or support as required. It has been shown, though, that the high level of technical skills, expertise, and responsibility required in vaccine handling and management cannot be achieved by mere didactic learning. While gains have been made in vaccine management and handling with these approaches, there remain challenges of high vaccine wastage rates and poor vaccine management practices across the board. Interestingly, approaching vaccine management through social behavior change has not been documented. Through Participatory Action Research (PAR), which is increasingly being used in health sciences, we explore an attempt at strengthening vaccine management and thus reducing high vaccine wastage rates by working together with health workers to identify plausible, realistic solutions to vaccine management through social behavior change. Select health workers directly involved with the immunization program in the four major provinces of the Solomon Islands were identified purposively to use action media and come up with concepts and materials for social behavior change communication that will have an impact on effective vaccine management and reducing wastages. This is the first documented use of such methodology in addressing vaccine management issues.     

老年糖尿病患者并发低血糖的临床护理

目的：探讨老年糖尿病患者低血糖发生的情况分析，分析相应的护理预防措施。方法选取我科112例老年糖尿病患者，对所有患者在住院过程中实施血糖监测，分析监测数据结果。结果共计监测血糖4969例次，其中28例患者发生低血糖52例次，发生率为25％。无严重低血糖发生情况。结论对于老年糖尿病患者并发低血糖应引起足够的重视，对血糖的控制应采取个体化，依患者不同情况采取不同的血糖控制方法，对降低低血糖发生率具有积极的意义。     

Titration of Mechanical Insufflation–Exsufflation Optimal Pressure Combinations in Neuromuscular Diseases by Flow/Pressure Waveform Analysis

IntroductionThe aim of this study was to assess several air-pressure settings for MI–E to determine their effect on peak cough flow (PCF), and to compare the best pressures with those are more common used in the literature (±40 cmH₂O) in patients with neuromuscular disorders (NMD).MethodsAdults with NMD in whom MI–E was indicated were recruited. Assisted PCF was measured by an external pneumotachograph. The protocol included 9 PCF measures per patient: 1 baseline (non-assisted), 4 with increasing inspiratory pressures without negative pressure (10, 20, 30 and 40 cmH₂O or maximum tolerated), and then 4 adding expiratory pressures (?10, ?20, ?30 and ?40 cmH₂O or maximum tolerated) with maximum inspiratory pressure previously achieved.ResultsTwenty one patients were included, 61% with amyotrophic lateral sclerosis (ALS). Mean PCFs with recommended pressures (±40 cmH₂O) were lower than the scored in the individualized steps of the titration protocol (197.7 ± 67 l/min vs 214.2 ± 60 l/min, p < 0.05). Regarding subgroups, mean PCF_max values in ALS patients with bulbar symptoms were significantly higher than those achieved with recommended pressures (163.6 ± 80 vs 189 ± 66 l/min, p < 0.05).ConclusionThe PCF_max obtained with the protocol did not always match the recommended settings. It may be advisable to perform MI–E titration assessed by non-invasive PCF monitoring in patients with NMD, especially in ALS with bulbar involvement to improve the therapy detecting airway collapse induced by high pressures.     

超声监测药物流产的临床指导作用

目的为了减少不全流产的发生率，准确的评价超声在药物流产中的作用，并选择不同的治疗方案。方法对270例药物流产患者流产前后进行超声监测并对效果进行评估。结果270例中流产成功258例，流产不金22例，流产失败5例；流产失败患者根据超声所见宫内回声多少给予不同的处理。结论超声不仅能对药物流产的全过程进行监测，还可根据药物流产后出血的子宫的血流特点，为临床分析药物流产后出血时间延长的原因提供依据，并可根据子宫内超声图像指导临床治疗。     

The under-representation of minority ethnic groups in UK medical research

Objectives . The paper investigates differences in engagement with medical research between White British and Black, Asian and Minority Ethnic (BAME) groups in the UK, using data from the Wellcome Trust Monitor (WTM).

Design. The study used two waves of the WTM (n?=?2575) to examine associations between ethnic group and participation in medical research, and willingness to participate (WP) in medical research. Logistic regression models controlled for socio-economic and demographic factors, and relevant outlooks and experiences that are assumed to be markers of engagement.

Results. Respondents from the BAME group were less likely to have participated in medical research compared to those from the White British group, but there was only patchy evidence of small ethnic group differences in WP. Influences on engagement with medical research varied somewhat between the White British and BAME groups, in particular in relation to occupation, education, health, attitudes to medical science and belief.

Conclusions. These findings consolidate previously context-specific evidence of BAME group under-representation in the UK, and highlight heterogeneity in that group. Efforts to address the under-representation of those from BAME groups might benefit from targeted strategies for recruitment and advocacy, although improved data sets are required to fully understand ethnic differences in engagement with medical research.     

1995～2002年湖北省碘缺乏病监测结果分析

目的 了解湖北省碘缺乏病发展动态，探索其影响因素，为防治提供依据。方法 按照《全国碘缺乏病监测方案》对8～10岁儿童甲状腺肿大率、尿碘水平和盐碘等指标进行流行病学调查。结果 8～10岁儿童甲状腺肿大率1995、1997、1999和2002年分别为6．2％、5．1％、7．4％和6．5％；儿童尿碘中位数分别为233．4、390．8、331．2和197．0μg／L；居民户碘盐合格率分别为47．8％、86．4％、90．2％、93．5％；学生健康教育平均分1997、1999、2000年分别为70．0、63．5、53．6。结论 湖北省碘盐质量逐年提高，覆盖率稳定在较高水平；人群碘营养逐步改善，但健康教育平均分呈逐年下降趋势，应引起高度重视。     

监护仪应用于569例骨科手术患者的护理效果分析

目的探讨监护仪应用于骨科手术中病人的护理体会。方法入选我院骨科2005年1月至2013年1月手术中应用心电监护仪的569例患者做为观察组,与同期应用传统血压计和听诊器等监测的560例骨科手术患者进行比较。对比两组患者术中各项生命体征的变化情况、护理时间和不良反应等。结果观察组术中2h和4h生命体征较对照组平稳．差异均具有统计学意义（均P〈0．05）;观察组用于生命体征监测的护理时间显著低于对照组,因未及时观测到生命体征而产生的不良反应率也显著低于对照组,差异均具有统计学意义（均P〈0．05）。结论监护仪应用于骨科手术病人中可直观、动态且持续地观察到生命体征．随时了解病情变化,缩短护理时间和减少不良反应。