高清视频数字化手术室关键技术研究

手术视频示教是医学临床教学和医院管理的一个重要环节,依托宽带网络和高清视频设备,构建了高清手术室视频示教系统平台,完成了高清音视频互动、直播、点播和文本信号网络传输,同时提供强大的系统管理功能,较好地满足了医院需求.     

手术示教在远程医疗教学中的应用架构探析

医院远程手术示教系统是利用计算机网络视频通信技术,对临床诊断或手术现场的画面影像进行全程实时记录和远程传输,使之用于远程教学、远程观摩、远程诊断等的视频通信系统.系统充分整合了IP网络、视频、存储、信息等领域的技术,通过一个综合视频处理、视频交换与视频传输平台完成了医院医疗视频教学、医疗视频远程观摩、远程医疗会诊、医院视频监控等的综合应用.提高了医院的医疗资源利用率和工作效率,开创医疗信息化的新领域.     

基于IP的视频手术示教系统设计和应用

为了提高临床教学水平,设计了基于IP的视频手术示教系统.高清视频技术将手术音视频以及医学影像数据进行全程录制存档,通过网络,手术室与示教室之间能够进行有效的互动交流,达到远程进行手术直播或专家远程会诊功能,方便查询及有效管理.     

远程高清手术示教系统构建

利用计算机多媒体技术采集并转换音、视频信号，通过网络通信路由技术实现音、视频文件的直播、录播、转播和点播，建立远程高清手术示教系统。介绍系统功能、设计方案及组成，指出该系统实现手术现场以及示教室的高清视频传输和语音对讲，提高临床手术教学的技术水平。     

大规模多路并发的数字化手术示教系统设计

结合实践介绍了大规模多路并发的数字化手术示教系统设计方案.主要对系统功能设计、结构设计和技术实现进行了讨论,并综合运用网络技术和多媒体技术实现了基于IP网络的手术示教视音频双向实时传输和交互.通过教学应用,表明系统具有图像清晰、并发流畅、自动备份、操作简便和管理规范等优点,为临床手术技能培训和管理提供了现代化的手段.     

浅谈护理操作技术示教

提高护理质量的首要措施就是要提高护理操作技术,各医院一般都是通过护理操作技术考试来衡量护士、护生们对护理操作技术的掌握和熟练程度。而护理操作技术示教是护理操作技术考试的前题。它是用娴熟的操作技能将理论性的规范操作步骤流程,生动、正确地演示和详细讲解的过程,也是引导护士、护生们正确、快速掌握各项护理操作技术的一条捷径,还是护士、护生们仿效练习的相对性的指标和规范。1有效的护理操作示教护理操作技术示教是临床教学中不可缺少的一个重要环节,示教质量的优劣直接影响到见习护士、护生们对规范化护理操作技术的认知和理解。准确无误地遵照各项护理操作技术规范和原则要求,结合娴熟的操作技能和深入浅出的讲解是有效护理操作技术示教所必须具备的条件。一次高质量的护理操作技术示教可正确的引导见习护士、护生们准确地掌握规范化的护理操作技术,且能通过仿效和加强练习使得个人操作技术水平得以有效的提高。2护理操作示教者所具备的特征B ergm cm和G a itsk ill在研究中发现护理同行与学生均认为:善于表达和有知识是有效的临床带教中老师的特征。一项护理操作技术的示教不仅仅是一项操作技术简单的演示过程。它其中函盖了示教者的仪表、语言、行为规...     

全高清1080P手术示教系统的设计与实现

临床手术示教系统通过音视频多媒体技术和计算机网络技术实现手术过程的异地观摩。扩展了手术室的空间。很好地满足了手术教学、专家指导、手术评价、家属观摩等实际需要。将全高清1080P技术应用到手术示教系统中去。极大地提高了手术视频的清晰度和准确度。能够更好地满足手术远程指导、远程会诊等对图像质量的严格要求。介绍了全高清1080P技术在手术示教系统中的应用,并结合手术示教系统的实际需求提出了全高清1080P手术示教系统的设计与实现方法。     

手术示教系统建设与应用

在对中日友好医院手术示教系统需求调研的基础上,阐述其建设方案的制定,包括现有条件的调研分析、视频技术和医疗设备的调研分析、系统功能需求分析、系统架构设计,并通过比较最终确定所选产品,进而构建高清手术示教系统。     

基于5G技术及4K/3D手术系统的显微外科远程手术会诊平台的设计及实践

目的 搭建基于4K/3D手术系统的远程手术会诊平台,评价5G通信技术支撑下4K分辨率3D样式画面在显微外科远程手术会诊中的应用效果。方法 设计基于“端云端”的系统软硬件架构,依托国产4K/3D显微手术成像系统,实现术野的双视点光场采集、智能图像处理、硬件3D交织、低延时网络传输和超高清立体显示。将该系统应用于侧颅底疑难病例的远程手术会诊,从4K/3D视频传输延时、峰值信噪比（Peak Signal to Noise Ratio,PSNR）、结构相似性（Structural Similarity Index Measure,SSIM）、画质及舒适度等方面评价该平台的效能。结果 在非专用5G组网方案下,手术会诊平台的4K/3D视频传输延时1.18 s;评价视频传输质量的客观指标PSNR和SSIM显示4K/3D视频传输前后的视觉差异和结构差异小。27名医生针对8段手术视频片段的问卷调查结果显示,视频传输后画质无改变或改变轻微不影响观看的样本占比为89.35%,96.30%的医生认为远程传输后的4K/3D视频足以支撑显微外科远程手术指导。结论 4K/3D显微手术成像系统产出的超高清立体视频经5...     

大型医院数字化手术观摩示教系统的设计及应用

针对南京军区南京总医院信息化系统的特点,论文详细介绍了基于计算机多媒体技术和网络技术的手术室远程示教系统的设计思想、系统架构、特点及件功能.实际应用表明,远程示教系统能实时传输视频与音频信息,使协作成员可以远距离进行直观、真实的视音频交流,从而为全面数字化手术室建设奠定了基础.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.