影像会诊系统建设的核心需求分析

针对远程会诊中影像会诊系统的建设情况,对影像会诊系统与相关信息系统的关系、核心功能、系统内数据组织形式进行了需求分析,以达到规划建设一个高效、方便的影像会诊系统的目标.     

The impact of teleradiology in clinical practice--a Malaysian perspective

Teleradiology is the most mature and rapidly evolving specialty in telemedicine. The use of teleradiology has grown tremendously during the past few years. This article describes the role of teleradiology in health care along with a brief history of its development in tandem with advances in telecommunications and computer technologies. Teleradiology standards, image acquisition, data compression, transmission and image interpretation are summarised. The impact of teleradiology in the practice of radiology, traces the evolution of the modality especially in the Malaysian perspective and its current and future role are discussed.     

Health Care Financing Administration (HCFA) and reimbursement in telemedicine

Telemedicine has real potential to improve the availability of services and advice of medical specialists to primary care practitioners and their patients. Use of the term “telemedicine” for the purposes of this article will refer to two-way, interactive video systems over which medical consultation takes place. This does not include the use of telecommunications technology to transport still images, particularly radiologic images, from one site to another. We are quite aware that teleradiology and telepathology is already in common use in many sites. We are currently exploring the question of quality standards for teleradiology in addition to other forms of telemedicine.     

Teleradiology/Telepathology requirements and implementation

Teleradiology and telepathology form an integral part of the telemedicine concept. Teleradiology is becoming a mature technology because of advances in imaging technology, database design and communications infrastructure and capabilities. Telepathology has also made significant progress but more development is needed in the definition of required images, database design and standards. While the requirements of most clinical applications of teleradiology are well established, telemammography still presents some impediments. Technical difficulties in telemammography are presented in terms of the lack of a clinically accepted digital imaging system and large data volume required per image. Another important aspect in tele-imaging is the database question. Workstations constitute a window into database. Comprehensive database development is the most difficult and expensive technology for tele-imaging and operational features of such systems are discussed. Finally, we explore current examples of the use of telepathology and teleradiology in the global telemedicine context.     

Medical Images are Safe – an Enhanced Chaotic Scrambling Approach

The patient data confidentiality is one of the vital security aspects in e-Health and m-Health services. In particular, providing confidentiality to the patient’s medical image is essential and the protection approaches have to be explored in-depth due to the rapid progress in the technologies of teleradiology and PACS. In this study, the pseudo random number generators (PRNGs), namely, the linear congruential generator (LCG) and XOR shift generator (XSG) are improved and combined with improved logistic 2D coupled chaotic map to provide enhanced chaos based encryption. The proposed scheme encrypts the Digital Imaging and Communication in Medicine (DICOM) images to protect the patient confidentiality during the storage and transfer in radiological information system (RIS). The cipher image was measured with various security analyses and tested with different test suites to prove its randomness.     

MDA-Image: An environment of networked desktop computers for teleradiology/pathology

MDA-Image, a project of The University of Texas M. D. Anderson Cancer Center, is an environment of networked desktop computers for teleradiology/pathology. Radiographic film is digitized with a film scanner and histopathologic slides are digitized using a red, green, and blue (RGB) video camera connected to a microscope. Digitized images are stored on a data server connected to the institution's computer communication network (Ethernet) and can be displayed from authorized desktop computers connected to Ethernet. Images are digitized for cases presented at the Bone Tumor Management Conference, a multidisciplinary conference in which treatment options are discussed among clinicians, surgeons, radiologists, pathologists, radio-therapists, and medical oncologists. These radiographic and histologic images are shown on a large screen computer monitor during the conference. They are available for later review for follow-up or representation.     

多基因风险评分在恶性肿瘤风险预测中的应用展望

多基因风险评分通过综合多个易感位点的累积效应预测个体的肿瘤发病风险,对肿瘤高危人群的筛查和有效防治具有应用价值。近年来,多基因风险评分的构建方法和应用范畴得到了进一步拓展和完善。本文就多基因风险评分应用于恶性肿瘤风险预测的最新进展进行简要介绍,总结其应用展望和挑战。     

The risk of risk assessment

Appropriate risk management can only be based on sound risk assessment. The sources of uncertainty involved in risk assessment are discussed and a number of approaches to improving such assessments are recommended.     

1 000例社区骨质疏松高危人群患病的危险因素分析

目的 探讨郑州市商都路社区中老年骨质疏松高危人群患病的危险因素.方法 选取2019年5月至2020年11月在河南省洛阳正骨医院郑州院区健康管理中心体检的郑州市商都路社区常住中老年居民1000例为研究对象,采取问卷调查及现场测量方式分别获得研究人群年龄、性别、身高、体质量以及饮食、运动、疾病史等资料.使用双能骨密度仪进行骨密度测定,采用单因素、多因素logistic回归分析骨质疏松高危人群患病的危险因素.结果 1000例居民中,有160例患骨质疏松,骨质疏松发生率为16.00％,其中男性为10.78％,女性为20.52％.多因素logistic回归分析显示,年龄(OR=1.401,95％CI:1.091～1.455)、性别(OR=1.396,95％CI:1.024～1.468)、身体质量指数(BMI)(OR=1.382,95％CI:1.011～1.485)、糖尿病(OR=1.408,95％CI:1.024～1.458)、高血压(OR=1.025,95％CI:1.011～1.474)、跌倒(OR=1.352,95％CI:1.025～1.385)、饮酒(OR=1.411,95％CI:1.063～1.438)、吸烟(OR=1.385,95％CI:1.285～1.402)均为骨质疏松高危人群的患病危险因素.结论 高龄、女性、低BMI、糖尿病、高血压、饮酒、吸烟、跌倒史等是骨质疏松高危人群患病的危险因素.     

有血管源性危险因素的患者中认知功能障碍发病情况及其危险因素的调查研究

目的 利用认知障碍自我辨识、筛查工具在社区、门诊中对有血管源性危险因素的患者进行筛查,探讨认知功能障碍的发病情况及其危险因素,为早期辨识血管源性认知障碍(VCI)提供依据.方法 采用国际公认的简易精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)作为诊断依据,将610例有血管源性危险因素的患者分为认知正常组、轻度认知障碍组(mVCI组)、痴呆组(VD组),分析认知功能障碍的发病情况及其危险因素.结果 610例中认知正常组230例,mVCI组215例,VD组165例.610例中有认知障碍的患者380例,占62.3％.对3组性别分布进行卡方检验,P＞0.05,说明各组内男女比无明显差异.对3组年龄进行方差分析,P＜0.01,差异有统计学意义.结论 筛查中发现多数患者存在不同程度的认知功能障碍,说明对有血管源性危险因素的患者进行认知功能的早期辨识筛查意义重大.有血管源性危险因素的患者中性别不是发生认知功能障碍的危险因素,年龄是发生认知功能障碍的危险因素之一.     

海口市脑卒中高危人群颈动脉超声异常检出率及危险因素分析

目的通过对海口地区健康体检脑卒中的高危人群颈动脉超声异常检出率与危险因素的分析,探讨脑卒中患病危险因素,提出针对性的预防措施,以降低脑卒中的发病率。方法收集2012年1月1日—2016年12月31日,在海口市人民医院体检,并要求做颈动脉超声检查的人群资料,从人群个体特征、不同慢性病与颈动脉内-中膜增厚、斑块形成和颈动脉狭窄发生率等进行回顾性统计分析。结果纳入研究人群共13 589人,颈动脉内-中膜增厚7 659例(56.36%),斑块形成5 594例(41.17%),颈动脉狭窄392例(2.88%)。不同年龄段、不同性别和不同文化水平人群的颈动脉内-中膜增厚、斑块形成的发生率差异有统计学意义(P0.05),不同年龄段和不同文化水平人群的颈动脉狭窄发生率间差异有统计学意义(P0.05)。合并不同慢性病如高血压、糖尿病、冠心病等人群的颈动脉内-中膜增厚、斑块形成、颈动脉狭窄发生率均高于未合并者(P0.05)。在合并不同慢性病的种类中,合并两种、三种及以上慢性病的颈动脉内-中膜增厚、斑块形成、颈动脉狭窄发生率均高于未合并慢性病者(P0.05)。结论海口市体检人群颈动脉内-中膜增厚、斑块形成的检出率均较高,针对危险因素,对目标人群进行健康教育,提高人群对脑卒中的认识,掌握预防和控制知识是防控脑卒中的有效措施。     

Multiple risk factor clustering and risk of hypertension in the Mongolian ethnic population of China

Objective To evaluate whether the clustering of risk factors, both environmental and genetic, increases the risk of essential hypertension (EH) and the accumulation of risk factors influences the blood pressure level in normotensives. Methods On the basis of a prevalence survey, 501 subjects of Mongolian ethnicity (243 hypertensives and 258 normotensives) who were not related to each other were selected to conduct a case-control study. All subjects were interviewed with questionnaires and their blood specimens were collected. Renin gene insertion/deletion (I/D) polymorphism, a new genetic marker, was genotyped with PCR and polyacrylamide gel electrophoresis. Results Overweight, alcohol consumption, and renin gene I/D polymorphism were significant risk factors of EH (P<0.05). The odds ratios (OR) for the number of risk factors were 2.39 (95%CI: 0.98-6.74) for one risk factor, 5.03 (95%CI: 2.06-14.18) for two, and 6.09 (95%CI: 1.85-22.38) for three respectively after adjusting for age and sex. In normotensives, age- and sex-adjusted mean blood pressures increased with more accumulation of risk factors. However, there were no significant differences among the different blood pressure levels according to the number of risk factors (P>0.05). Conclusion Overweight, alcohol consumption, and renin gene I/D polymorphism are risk factors of EH in the Mongolian ethnic population of China. The accumulation of the risk factors causes a sharp increase of the risk of EH.     

牡丹江市脑卒中的危险因素及其人群归因危险度的分析

目的探讨脑卒中的危险因素,为预防和控制脑卒中的发生提出干预对策。方法采用1∶1配比病例对照研究方法,初步估计并分析脑卒中的比值比、人群归因危险度和几种因素的综合人群归因危险度。结果高血压、吸烟、饮酒、喜食咸食是脑卒中的危险因素,OR值分为4.658、2.483、2.209、3.623,调整人群归因危险度(PAR s)分别0.4 698、0.1 776、0.1 078、0.2 271,综合的人群归因危险度(PAR)为0.6 835;常喝鲜奶和经常进行体育锻炼是脑卒中的保护性因素,OR值分为0.236和0.423。结论控制高血压,并对其生活行为方式和饮食习惯加以干预,可降低脑卒中的发生率。     

Discussing breast cancer risk in primary care

Options for managing breast cancer risk now include screening, genetic testing, lifestyle modification, medication, and surgery. A woman's knowledge of her risk factors for breast cancer, her perceptions of that risk, and her concerns about cancer all shape her decisions about cancer screening and prevention. Physicians should involve women patients in making informed screening decisions, while reviewing their health risks and the benefits and risks associated with different courses of action. All women should be involved in this process, with special attention to older socioeconomically disadvantaged women, who are frequently left out of such discussions. Physicians can play a major role in reducing cancer disparities and the corresponding rates of breast cancer morbidity and mortality by keeping current in their knowledge of risk assessment, broadening the range of patients with whom they communicate about risk, and enhancing their communication skills to address diverse patient needs.     

卵巢恶性风险计算法在卵巢癌风险评估中的应用价值

选择100例卵巢癌患者（卵巢癌组）、69例卵巢良性肿瘤患者（良性组）和95例健康女性（对照组）,检测血清人附睾分泌蛋白（HE4）和糖链蛋白（CA）125水平,计算卵巢恶性风险计算法（ROMA）指数。通过制作受试者工作特征（ROC）曲线,以曲线下面积（AUC）反映预测的准确性。以敏感性和特异性反映预测的真实性。结果显示,卵巢癌组、良性组和对照组ROMA指数分别为83．0％、8．9％和8．7％,差异有统计学意义（P〈0．01）。以良性组为参照时,卵巢癌组ROMA指数单项检测的AUC为0．900。ROMA指数预测卵巢癌的敏感性和特异性分别为81．0％和92．8％。提示ROMA指数可作为卵巢癌风险评估的指标,诊断的准确度优于HE4和CA125。     

Managing liability risk in the office laboratory

New technology has created new responsibilities and new risks for office practitioners who develop and use an office laboratory. Mistakes are bound to occur, but a system organized along the lines suggested is a workable way to minimize the number of mistakes and lessen the consequences of any mistakes that do occur. If a significant problem occurs and these guidelines have been ignored, it is likely they will be used as a framework for inquiry. The benefit to the physician and patient far outweighs the risk of using the new technology and procedures. Any risk is manageable because the physician has the opportunity to control the technology selected, the procedures and protocols used, and the persons involved in the testing process.     

Cardiovascular disease risk factors in homeless people

Abstract

Background. Cardiovascular diseases (CVD) are associated with significant morbidity and mortality, which is highest in Eastern Europe including Estonia. Accumulating evidence suggests that life-style is associated with the development of CVD. The aim of this study was to evaluate the informative power of common CVD-related markers under unhealthy conditions.

Subjects. Subjects (n = 51; mean age 45 years; 90% men) were recruited from a shelter for homeless people in Tallinn, Estonia, and consisted of persons who constantly used alcohol or surrogates, smoked, and were in a bad physical condition (amputated toes, necrotic ulcers, etc.).

Methods. Blood pressure, pulse rate, and waist circumference were measured, and body mass index (BMI) was calculated. The following markers were measured in blood serum: total cholesterol (TChol), high-density lipoprotein cholesterol (HDL-Chol), low-density lipoprotein cholesterol (LDL-Chol), plasma triglycerides (TG), apolipoproteins A-l (ApoA1) and B (ApoB), lipoprotein(a) (Lp(a)), glycated hemoglobin (HbA1c), glucose (Gluc), high-sensitivity C-reactive protein (hsCRP), serum carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Except smoking, the anamnestic information considering eating habits, declared alcohol consumption and medication intake were not included in the analysis due to the low credibility of self-reported data.

Results. More than half of the investigated patients had values of measured markers (hsCRP, TChol, LDL-Chol, TG, HbA1c, ApoA1, ApoB, Lp(a), Gluc) within normal range. Surprisingly, 100% of subjects had HDL-Chol within endemic norm.

Conclusion. This study demonstrates that traditional markers, commonly used for prediction and diagnosis and treatment of CVD, are not always applicable to homeless people, apparently due to their aberrant life-style.     

Cardiovascular disease risk factors in homeless people

Background

Cardiovascular diseases (CVD) are associated with significant morbidity and mortality, which is highest in Eastern Europe including Estonia. Accumulating evidence suggests that life-style is associated with the development of CVD. The aim of this study was to evaluate the informative power of common CVD-related markers under unhealthy conditions.

Subjects

Subjects (n = 51; mean age 45 years; 90% men) were recruited from a shelter for homeless people in Tallinn, Estonia, and consisted of persons who constantly used alcohol or surrogates, smoked, and were in a bad physical condition (amputated toes, necrotic ulcers, etc.).

Methods

Blood pressure, pulse rate, and waist circumference were measured, and body mass index (BMI) was calculated. The following markers were measured in blood serum: total cholesterol (TChol), high-density lipoprotein cholesterol (HDL-Chol), low-density lipoprotein cholesterol (LDL-Chol), plasma triglycerides (TG), apolipoproteins A-l (ApoA1) and B (ApoB), lipoprotein(a) (Lp(a)), glycated hemoglobin (HbA1c), glucose (Gluc), high-sensitivity C-reactive protein (hsCRP), serum carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Except smoking, the anamnestic information considering eating habits, declared alcohol consumption and medication intake were not included in the analysis due to the low credibility of self-reported data.

Results

More than half of the investigated patients had values of measured markers (hsCRP, TChol, LDL-Chol, TG, HbA1c, ApoA1, ApoB, Lp(a), Gluc) within normal range. Surprisingly, 100% of subjects had HDL-Chol within endemic norm.

Conclusion

This study demonstrates that traditional markers, commonly used for prediction and diagnosis and treatment of CVD, are not always applicable to homeless people, apparently due to their aberrant life-style.     

重庆地区人群中的健康危险行为簇聚特征研究

目的 掌握重庆地区人群的健康危险行为(HRB)的现状及其簇集性特征研究.方法 采用整群分层抽样的方法,抽取重庆市1263名社区居民作为调晒对象.应用白编的<居民健康行为调查表>进行渊查并对数据进行统计分析.结果 被调查人群中广泛存在吸烟、饮酒、缺乏有效体育运动、超重、不系安全带等行为,且行为簇集性现象明显.其中缺乏有效体育运动(78.1%)排序第1位;男性、体力劳动者和文化程度较低的人群HRB簇聚特征更为明显,吸烟和饮洒的行为伴随现象最高.结论 被调查人群中HRB簇集特征明显,迫切需要寻找有效的行为干预措施.