"虚拟中国人Ⅰ号"的动脉灌注

目的 :在“虚拟中国人Ⅰ号”建模前对其动脉进行灌注填充 ,使其能与静脉区分。方法 :一侧颈总动脉双向插管 ,按 40～ 45ml kg体重的灌注量 ,以 4.0× 10 4 Pa的灌注压力 ,灌注红色填充剂。结果 :共灌入填充剂 2 70 0ml。结论 :为“虚拟中国人I号”赋加了动脉显示特色。     

Monitoring, past, present, future

Summary A little over 40 years ago, anesthesiology in the United States became recognized as a specialty. At that time, its practice was largely that of an art, the science of which was yet to come. A finger on the pulse, observation of color, skin turgor, perspiration, and perhaps a blood pressure cuff in adults, and an estimation of the reflex signs of anesthesia were the standards for the assessment of the patient status and the depth of anesthesia. How far have we come in the intervening years? The journey, as reflected in the experience of one physician, will be held up to the looking-glass; easily as astounding as that through which Alice passed.Caught as we are in the socio-economic climate of the present, how shall we react? Has the gadgetry and electronics of this day given us a meaningful cost-effective handle on a decreased morbidity and mortality? What impact is there on decision-making and outcome? What indeed is the contribution of the machine versus the newer agents, techniques, and the advanced educational milieu.The first attempts at monitoring were clearly directed toward the cardiovascular system. The devices developed were simple and non-invasive. The Riva-rocci method of measuring blood pressure was first applied in anesthesia by Harvey Cushing at the turn of the century. But it was 40 years before the electrocardiogram was introduced as an instrument of potential importance. It took another 25 years for it to have general acceptance, and even later for the anesthesiologist to become comfortable with it as a diagnostic tool. In the early 40s, Peterson, at Pennsylvania, began the applications of invasive blood pressure monitoring for clinical purposes. Subsequently, the use of the central venous catheter, and finally the Swan-Ganz catheter, became acceptable. The application for the technology of cardiac output was a long time in gaining clinical credence. However, this last link surely depended on the computer to make it a clinically useful instrument. The measurement of the cardiovascular system was first, because the means were there.The assessment of respiratory function was more cumbersome, and while the pneumotachygraph was available 40 years ago, its vagaries made it a research tool. Meters for respiration also were available, but too cumbersome for clinical use. The integration of respiratory measurements and blood gas analysis have gone hand-in-hand, the latter far outstripping the former in clinical utility. Shall it be invasive or non-invasive, what is the price? Lastly, our technology has introduced the means for what is a meaningful clinical measurement of neurological and neuromuscular activity. Nerve-muscle stimulators, electromyography, processed electroencephalogram, and the evoked potential as devices for assessment are only the beginning. In all this technological advance there is the black box and the electronic marvels that are part of this age. While invasive techniques surely have a place, the utilization of non-invasive techniques like the measurement of oxygen, carbon dioxide, and all the agents that we employ have changed forever the nature of our practice. Finally, the need to document the anesthesia course objectively will, and has already begun, to impact on our practice. How did we get where we are and where are we going will be explored in this personal journey.     

三维及多平面重建CT技术在鼻部整形中的应用价值分析

目的:分析在鼻部整形中三维及多平面重建CT技术的应用价值。方法:选择2018年2月~2019年7月本院收治的60例行鼻部整形的患者进行分析,所有患者均开展三维及多平面重建CT技术检测,结合检查结果,开展相应的隆鼻手术。分析术后不良反应、患者满意度。术后6个月,在CT测量下,检测前后鼻部解剖数据。结果:在鼻部整形中,三维及多平面重建CT技术的应用,可以准确了解鼻部结构,如观察侧鼻骨、鼻部皮肤、鼻根等情况。术后评价,患者对鼻部整形满意度较高,术后6个月,患者对鼻部整形满意度较高,术后与术后6个月患者鼻部满意度相比,无统计学意义,P>0.05。术后60例患者没有出现出血、切口感染等反应,同时也没有出现肋软骨外漏与倾斜等现象。经随访术后6个月发现1例患者的鼻背软骨出现轻度弯曲,但无明显表现,没有做特殊处理;其余患者,鼻部外形均表现为鼻尖挺拔、鼻背曲线流畅。结论:在鼻部整形中,应用三维及多平面重建CT技术,可以辅助提高隆鼻手术准确度,并在CT技术的引导下,准确植入自体肋软骨,可以为手术成功奠定基础,促使鼻唇与周围器官形态的协调性,进一步提高患者满意度。     

新型冠状病毒Alpha变异株实验室检测研究

目的 对一例新冠肺炎境外输入病例进行实验室检测,并对新型冠状病毒（severe acute respiratory syndrome coronavirus 2,SARS - CoV - 2）变异株进行鉴定,了解不同样本类型中新冠病毒的检出情况。方法 采集咽拭子、痰液、粪便、尿液和血液多种类型样本共13份,分别提取核酸,用荧光RT - PCR法检测SARS - CoV - 2。使用纳米孔MinION Mk1C测序仪,对阳性咽拭子样本进行实时SARS - CoV - 2靶向扩增全基因组测序,运用artic - ncov2019、DNAstar和Mega等软件对测定序列进行处理和分析。结果 咽拭子、痰液、粪便、血浆和尿沉渣样本中均检出SARS - CoV - 2核酸,咽拭子和血浆样本在发病的前四天均能检出,尿沉渣样本在发病当天能检出。基于纳米孔测序技术,7 h即获得SARS - CoV - 2全基因组数据,经分析显示为新冠病毒Alpha变异株。结论 本例境外输入新冠肺炎确诊病例的病原为SARS - CoV - 2 Alpha变异株,咽拭子、血浆样本和尿沉渣样本在发病早期均能检出SARS - CoV - 2核酸。     

基于CT的三维数字化导航技术在肺癌介入微波消融治疗中的应用价值

目的 在肺癌微波消融治疗中探究基于CT的三维数字化导航技术的应用价值。方法 回顾性分析我院收治的92例肺癌患者,随机进行三维数字化导航微波消融或传统CT引导下微波消融,分为三维导航组和传统组,依据肿瘤位置、大小（最大径差值≤2 mm）及微波消融条件不同两两配对,共46对,比较2组手术时间、微波针穿刺次数、CT剂量指数、术中并发症发生率、术后病灶控制情况。结果 三维导航组与传统组的手术时间分别为（30.07 ± 6.36）min、（47.20 ± 9.65）min、穿刺次数分别为（1.72 ± 0.69）次、（7.13 ± 3.00）次、CT剂量指数分别为（11.16 ± 2.20）mGy、（26.67 ± 8.72）mGy、术中并发症发生率分别为10.87%、34.78%,以上3个指标三维导航组均低于传统组,三维导航组治疗有效率（93.48%）高于传统组（71.74%）,差异均有统计学意义（P < 0.05）。结论 CT引导下利用三维数字化导航技术行肺癌微波消融治疗,使介入穿刺手术的操作更加精准安全。     

国际学术出版技术商面向科技期刊的业务特征分析及启示

【目的】 研究国际主要学术出版技术服务商面向科技期刊服务的业务特征,为国内科技期刊行业发展提供参考。【方法】 通过对13家典型的国际学术出版技术服务商进行信息收集和整理,总结其业务范围及产品和服务方案,并结合国内同类机构进行比较分析。结合文献探讨专业化的学术出版技术服务商的发展趋势。【结果】 国际学术出版技术服务商的业务范围覆盖学术出版全过程,近年来呈现服务领域不断延伸、服务内容更加分工细化的趋势。国际学术出版技术服务商充分运用数字信息技术,其规模和业务范围大于国内同类企业。【结论】 利用好技术手段,发展成熟完善的学术出版技术服务产业,有利于科技期刊将资源集中于核心内容,有利于提高科技期刊整体质量。     

Reported Challenges in Health Technology Assessment of Complex Health Technologies

ObjectivesWith complex health technologies entering the market, methods for health technology assessment (HTA) may require changes. This study aimed to identify challenges in HTA of complex health technologies.MethodsA survey was sent to European HTA organizations participating in European Network for HTA (EUnetHTA). The survey contained open questions and used predefined potentially complex health technologies and 7 case studies to identify types of complex health technologies and challenges faced during HTA. The survey was validated, tested for reliability by an expert panel, and pilot tested before dissemination.ResultsA total of 22 HTA organizations completed the survey (67%). Advanced therapeutic medicinal products (ATMPs) and histology-independent therapies were considered most challenging based on the predefined complex health technologies and case studies. For the case studies, more than half of the reported challenges were “methodological,” equal in relative effectiveness assessments as in cost-effectiveness assessments. Through the open questions, we found that most of these challenges actually rooted in data unavailability. Data were reported as “absent,” “insufficient,” “immature,” or “low quality” by 18 of 20 organizations (90%), in particular data on quality of life. Policy and organizational challenges and challenges because of societal or political pressure were reported by 8 (40%) and 4 organizations (20%), respectively. Modeling issues were reported least often (n = 2, 4%).ConclusionsMost challenges in HTA of complex health technologies root in data insufficiencies rather than in the complexity of health technologies itself. As the number of complex technologies grows, the urgency for new methods and policies to guide HTA decision making increases.     

Assessing the Economic Value of Clinical Artificial Intelligence: Challenges and Opportunities

ObjectivesClinical artificial intelligence (AI) is a novel technology, and few economic evaluations have focused on it to date. Before its wider implementation, it is important to highlight the aspects of AI that challenge traditional health technology assessment methods.MethodsWe used an existing broad value framework to assess potential ways AI can provide good value for money. We also developed a rubric of how economic evaluations of AI should vary depending on the case of its use.ResultsWe found that the measurement of core elements of value—health outcomes and cost—are complicated by AI because its generalizability across different populations is often unclear and because its use may necessitate reconfigured clinical processes. Clinicians’ productivity may improve when AI is used. If poorly implemented though, AI may also cause clinicians’ workload to increase. Some AI has been found to exacerbate health disparities. Nevertheless, AI may promote equity by expanding access to medical care and, when properly trained, providing unbiased diagnoses and prognoses. The approach to assessment of AI should vary based on its use case: AI that creates new clinical possibilities can improve outcomes, but regulation and evidence collection may be difficult; AI that extends clinical expertise can reduce disparities and lower costs but may result in overuse; and AI that automates clinicians’ work can improve productivity but may reduce skills.ConclusionsThe potential uses of clinical AI create challenges for health technology assessment methods originally developed for pharmaceuticals and medical devices. Health economists should be prepared to examine data collection and methods used to train AI, as these may impact its future value.     

Do Cost-Effectiveness Analyses Account for Drug Genericization? A Literature Review and Assessment of Implications

ObjectivesWe investigated how health technology assessment (HTA) organizations around the world have handled drug genericization (an allowance for future generic drug entry and subsequent drug price declines) in their guidelines for cost-effectiveness analyses (CEAs). We also analyzed a large sample of published CEAs to examine prevailing practices in the field.MethodsWe reviewed 43 HTA guidelines to determine whether and how they addressed drug genericization in their CEAs. We also selected a sample of 270 US-based CEAs from the Tufts Medical Center’s CEA Registry, restricting the sample to studies on pharmaceuticals published from 1991 to 2019 and to analyses taking a lifetime time horizon. We determined whether each CEA examined genericization (and if so, whether in base case or sensitivity analyses), and how inclusion of genericization influenced the estimated incremental cost-effectiveness ratios.ResultsFourteen (33%) of the 43 HTA guidelines mention genericization for CEAs and 4 (9%) recommend that base case analyses include assumptions about future drug price changes due to genericization. Most published CEAs (95%) do not include assumptions about future generic prices for intervention drugs. Only 2% include such assumptions about comparator drugs. Most studies (72%) conduct sensitivity analyses on drug prices unrelated to genericization.ConclusionsThe omission of assumptions about genericization means that CEAs may misrepresent the long run opportunity costs for drugs. The field needs clearer guidance for when CEAs should account for genericization, and for the inclusion of other price dynamics that might influence a drug’s cost-effectiveness.     

Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set

ObjectivesThis study aimed to develop the Indian 5-level version EQ-5D (EQ-5D-5L) value set, which is a key input in health technology assessment for resource allocation in healthcare.MethodsA cross-sectional survey using the EuroQol Group’s Valuation Technology was undertaken in a representative sample of 3548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. The participants were interviewed using a computer-assisted personal interviewing technique. This study adopted a novel extended EuroQol Group’s Valuation Technology design that included 18 blocks of 10 composite time trade-off (c-TTO) tasks, comprising 150 unique health states, and 36 blocks of 7 discrete choice experiment (DCE) tasks, comprising 252 DCE pairs. Different models were explored for their predictive performance. Hybrid modeling approach using both c-TTO and DCE data was used to estimate the value set.ResultsA total of 2409 interviews were included in the analysis. The hybrid heteroscedastic model with censoring at ?1 combining c-TTO and DCE data yielded the most consistent results and was used for the generation of the value set. The predicted values for all 3125 health states ranged from ?0.923 to 1. The preference values were most affected by the pain/discomfort dimension.ConclusionsThis is the largest EQ-5D-5L valuation study conducted so far in the world. The Indian EQ-5D-5L value set will promote the effective conduct of health technology assessment studies in India, thereby generating credible evidence for efficient resource use in healthcare.