探讨HL7标准在HIS与PACS/RIS集成中的应用

目的在医院信息系统（hIS）与PACS/RIS（Picture Archiving and Communication System/Radiology Information System）中实施hL7医疗信息数据交换标准，解决系统间数据共享的问题，同时对hL7标准的优缺点进行分析讨论。方法分析hL7消息格式，结合医院现有的hIS与PACS/RIS数据交换流程，设计基于hL7标准的hIS与PACS/RIS接口引擎，通过实际应用来分析hL7标准的优缺点。结果实现了hIS与PACS/RIS的集成，方便了医院各科室信息的统一管理与共享，提高了影像科的工作效率。结论hL7标准可进行多应用系统间的文件和数据交换，使集成的系统可扩展性和可维护性大大提高，但仍存在一些规定含糊不清，有待进一步发展和完善。     

对我国PACS建设的几点意见

随着信息科学和现代计算机技术的进展 , PACS系统进而远程影像学 /医学等信息数字化建设 , 已成为医学影像学的重要发展趋向 . 近年来 , 我国 PACS系统的开发、建设进展迅速 , 有些大型以至中型医院 , 与 RIS( 放射信息系统 , Radiology Information System)或 /和 HIS( 医院信息系统 , Hospital Information System) 相结合 , 建成了小型 ( mini )和院级 PACS系统 , 运行顺利 , 收到了良好的社会和经济效益 . 但有的单位也不无负面教训 .     

基于Web技术的医生工作站调阅LIS/RIS/PACS图文报告的接口设计与实现

随着医院信息化的飞速发展,医院信息系统( HIS)、检验科信息系统(LIS)、放射科信息系统( RIS)、影像存档与通讯系统(PACS)已成为医院最重要的几个信息系统,它们之间的融合程度标志着医院信息化的使用水平.本文详细介绍了HIS/LIS/RIS/PACS系统的集成接口设计原则和方法.实现了基于Web技术的各计算机工作站,能够随时、方便地调阅图文报告.有效地提高了医疗服务的效率和质量.     

浅析医院医学影像信息系统

医学影像信息系统(PACS)是应用于医院环境中对医学影像数据实施计算机管理的专业化信息系统,它是当今医院信息化建设中的重要构成部分。我院自2004年末开始设计研发全院医学影像信息系统,遵循信息系统工程研发规律,进行系统工程总体方案设计,并分步实施。我院信息系统工程从放射科医学影像(RIS)数字化开始历经三个阶段:第一阶段进行RIS系统研发;第二阶段实行RIS系统与医院信息系统(HIS)无缝联接,系统应用向全院临床科     

数字化影像学科建设与管理相关问题探讨

随着数字化医学影像设备的引进和使用,医学影像学已成为临床医学中发展最快的学科之一.而将这些数字化影像设备完全网络化、信息化,首先要依赖近年来标准化协议基础上的医学图像存档与传输系统(Picture Archiving and Communication System,PACS)的应用.此外,PACS还要与医院信息系统(Hospital Information System,HIS)和放射信息系统(Radiology Information System,RIS)进行集成整合,相互协同.这样,就实现了以PACS为轴心,将现代化医院和学科推进至数字化、网络化和信息化水平,逐步形成了取代传统模式影像科的趋势,对学科建设也提出了新要求.     

基于HL7的PACS与HIS/RIS接口设计

随着医院信息化和医疗数字化的发展,医院各系统间整合和通信已成为充分利用系统资源的关键环节.本文介绍了PACS与HIS/RIS信息交换中的协议标准,同时对两系统的通信接口设计进行了阐述.     

PACS／HIS对影像科室工作流程的优化

近年来，PACS（Picture Archiving Communication System）和HIS（Hospital Information System）的迅速发展为医院的信息化建设提供了坚实的平台。PACS系统主要由采集、存储和显示3部分组成，负责整个医院的各成像设备、显示设备的图像通讯和存储；HIS主要对全医院的病人信息、经费信息、物流信息进行管理。而在医院的医疗诊断工作中，PACS系统更具重要性。PACS发展已进入大型化、分布式时代。系统功能复杂，使用者的要求不同，对流程信息的需求愈显迫切。基于全院HIS系统，合理重建影像科室工作流程是成功实施PACS系统，提高医院整体效益的关键环节之一。     

医院信息集成平台的构建与应用

本文详细阐述了以中间件为解决方案的医院信息集成平台的架构及平台建设过程,并以医院信息系统（hIS）与医学影像系统（PACS）/放射学信息系统（RIS）集成为例,介绍各系统间的信息交换流程以及符合hL7标准的流程消息定义。该平台有效突破了hIS点对点的互联方式的局限性。     

医院信息系统的集成技术探讨

本文简要介绍了医院常见的几个信息系统:HIS、RIS、PACS和LIS等.详细探讨了这几个系统之间集成的技术.     

HIS、RIS与PACS系统在医院计算机综合管理中的应用

目的 探讨HIS、RIS与PACS系统在医院计算机综合管理中的应用.方法 分别用计算机及人工操作方法对2003年全年病历及影像资料进行分析.结果 计算机网络技术在医院综合管理中与手工操作比较有明显优越性.结论 HIS涵盖了医院管理的各方面内容.RIS解决了病历档案的大容量存储问题,可以有效地进行信息处理,简化作业流程,对影像资料实现完全保存和对历史资料的快速准确的查询,以及进行检查费、日常工作量和综合信息的快速准确统计等工作.PACS以数字成像技术、计算机技术和网络技术为基础,全面解决医学影像的获取、显示、处理、贮存、及传输和管理,PACS是HIS和RIS系统的一个重要组成部分.     

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.