三维可视化在远程诊断系统中的实现

目的：将三维可视化技术引入医学图像远程诊断系统,实现网页嵌入式医学影像三维可视化系统。方法：在基于浏览器/服务器（Brower/Server,B/S）构架实现的医学图像远程诊断系统的基础上,使用ASP.NET技术完成系统设计与实现,利用VTK工具包及Volume Render X控件开发嵌入网页的图像三维可视化控件,并将其部署到远程诊断系统中。结果：系统无需安装,具有较友好的用户界面和操作环境,能够初步实现医学图像的三维重建以及较完整的分割、优化等后处理。结论：该系统无需影像工作站,在网页中便可实现对DICOM影像资料的三维可视化处理,且可与任何基于网络的远程诊断系统整合,具有较强的网络通用性。     

遥控自动涎腺造影术装置的研制和临床应用

目的利用遥控的原理达到自动控制注射造影剂的目的。方法采用遥控自动涎腺造影装置,对３０例涎腺疾病的患者进行造影,并与直接手推涎腺造影法６７例进行对比。结果利用遥控自动涎腺造影装置,实现了注射涎腺造影剂的远距离控制和自动注射,简化了工作程序,避免了医生在工作中受到Ｘ光辐射。结论遥控自动涎腺造影术装置不仅在操作上给医务人员带来很大的方便,而且能提高临床诊断符合率。     

Improving chronic lung disease management in rural and remote Australia: The Breathe Easy Walk Easy programme

Background and objective: To evaluate the impact of a chronic lung disease management training programme, Breathe Easy Walk Easy (BEWE), for rural and remote health‐care practitioners. Methods: Quasi‐experimental, before and after repeated measures design. Health‐care practitioners (n = 33) from various professional backgrounds who attended the BEWE training workshop were eligible to participate. Breathe Easy Walk Easy, an interactive educational programme, consisted of a training workshop, access to online resources, provision of community awareness‐raising materials and ongoing telephone/email support. Participant confidence, knowledge and attitudes were assessed via anonymous questionnaire before, immediately after and at 3 and 12 months following the BEWE workshop. At 12 months, local provision of pulmonary rehabilitation services and patient outcome data (6‐min walk test results before and after pulmonary rehabilitation) were also recorded. Results: Measured knowledge (score out of 19) improved significantly after the workshop (mean difference 7.6 correct answers, 95% confidence interval: 5.8–9.3). Participants' self‐rated confidence and knowledge also increased. At 12‐month follow up, three locally run pulmonary rehabilitation programmes had been established. For completing patients, there was a significant increase in 6‐min walk distance following rehabilitation of 48 m (95% confidence interval: 18–70 m). Conclusions: The BEWE programme increased rural and remote health‐care practitioner knowledge and confidence in delivering management for people living with chronic lung disease and facilitated the establishment of effective pulmonary rehabilitation programmes in regional and remote Australian settings where access to such programmes is limited.     

网络远程管理联合无创通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床研究

目的研究网络远程管理(NRM)联合无创通气(NPPV)治疗慢性阻塞性肺病(COPD)合并呼吸衰竭(RF)的临床效果。方法选取延安市人民医院呼吸内科2018年1月~2018年12月收治的CDPD^RF患者100例,依据随机数字表法分为研究组(n=50)、对照组(n=50)。出院后研究组行NRM联合NPPV治疗,出院后对照组行传统家庭氧疗(LTOT)。观察两组出院前及出院前6个月第1秒用力呼气容积(FEV1)、用力肺活量(FVC)及FEV1/FVC等肺功能指标,mMRC评分、CAT评分,血清脂质过氧化物(LPO)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)等氧化应激因子。两组生存质量及再次住院及急性加重情况。结果出院6个月,研究组FEV1、FVC及FEV1/FVC均大于对照组,mMRC、CAT评分均小于对照组(P<0.05)。研究组SOD、GSH-Px水平均高于对照组,LPO、MDA水平均均低于对照组(P<0.05)。研究组生存质量各分项评分及总分均高于对照组(P<0.05)。实验组再次住院率、急性加重率均低于对照组(P<0.05)。结论 NRM联合NPPV治疗CDPD^RF可及时对患者做出诊断并进行远程指导,提高治疗效率,改善患者肺功能及机体氧化应激状态,提高其生存质量,降低再次住院率、急性加重率,促进患者康复。     

The role of cytokine-induced neutrophil chemoattractant-1 in neutrophil-mediated remote lung injury after intestinal ischaemia/reperfusion in rats

OBJECTIVE: Remote lung injury is induced by ischaemia/reperfusion (I/R) of the gastrointestinal tract and the liver following hypovolaemic shock. In the present study, the role of cytokine-induced neutrophil chemoattractant (CINC), a member of the interleukin (IL)-8 family, in neutrophil-mediated remote lung injury following intestinal I/R was investigated in anaesthetized rats. METHODOLOGY: The I/R group was subjected to 60 min of occlusion of the superior mesenteric artery with laparotomy, followed by 240 min of intestinal reperfusion. The sham-operated (sham) group was subjected to the same procedures with the exception of intestinal I/R. RESULTS: In the I/R group, the permeability index of the lung, the neutrophil count in pulmonary vascular lavage fluid and bronchoalveolar lavage fluid (BALF), lung myeloperoxidase activity and neutrophil oxidative production were all significantly greater than those in the sham group. Cytokine-induced neutrophil chemoattractant-1 levels in blood and BALF were significantly increased at 240 min after intestinal reperfusion. There was a significant relationship between neutrophils in BALF and CINC-1 level in BALE CONCLUSION: These findings suggest that intestinal reperfusion was associated with activation and accumulation of neutrophils in the lung and resulted in remote lung injury with increased microvascular permeability. Thus, CINC-1 in BALF may induce neutrophil migration from the pulmonary vessels to the interstitium and alveolar spaces in remote lung injury after intestinal I/R.     

慢性心力衰竭远程监测的临床应用

近年来,在运用药物和植入式心脏电器械治疗慢性心力衰竭的同时,心脏远程监测已经成为其治疗的一个新方向。研究证明心脏远程监测的应用明显降低了慢性心力衰竭患者的病死率和住院率,同时又有利于患者生活质量的改善。现主要介绍心脏远程监测系统的监测范围和实用技术以及其在普通慢性心力衰竭患者和植入心脏电器械患者中的临床应用和研究现状。     

便携式远程多参数监护仪的临床应用价值及准确性评估

目的：评估远程多参数监护仪在心血管疾病患者临床应用中的准确性,初步探讨其临床应用价值。方法选取我院住院患者160例为研究对象,根据血压、血氧饱和度、心电图对其进行评估。分为高血压组、低血压组、血压正常组、低血氧饱和度组、正常血氧饱和度组、心律失常组、ST-T 改变组、心电图正常组各20例。所有患者均进行便携式远程多参数监护仪、常规12导联心电图机、水银血压计及血氧饱和度仪监测。将所有患者采用病房常规12导联心电图机、水银血压计、血氧饱和度仪测得的心电、血压、血氧饱和度等数据作为“参照标准”,对远程多参数监护仪测得的心电图结果如心律失常的检出及 ST 段的改变、血压的测得值及血氧饱和度所得数值等进行相关性分析,评估多参数监护仪与“参照标准”的诊断符合率。结果远程多参数监护仪的血压、血氧饱和度测量结果与“参照标准”有高度的相关性,两组数据比较,差异无统计学意义（P ＞0．05）,心电监测对于心律失常及 ST-T 改变的识别与常规导联心电图完全一致。结论远程多参数监护仪与临床常用的监测仪器测得的结果有高度的相关性,且可以通过实时观察及时发现异常并通知医生,及早给予有效的干预措施,因此有较高的临床应用价值。     

Evolving telehealth reimbursement in Australia

Video‐based consultation is the only telehealth service reimbursed by the Medicare Benefits Schedule in Australia, but the uptake of telehealth is still low and inconsistent. There is a clear need for the development of appropriate medical evidence to support implementation of telehealth services. With the ubiquitous use of mobile phones, mobile health becomes important in facilitating health services and impacting clinical outcomes anywhere.     

Integration of Administrative,Clinical, and Environmental Data to Support the Management of Type 2 Diabetes Mellitus: From Satellites to Clinical Care

A very interesting perspective of “big data” in diabetes management stands in the integration of environmental information with data gathered for clinical and administrative purposes, to increase the capability of understanding spatial and temporal patterns of diseases. Within the MOSAIC project, funded by the European Union with the goal to design new diabetes analytics, we have jointly analyzed a clinical-administrative dataset of nearly 1.000 type 2 diabetes patients with environmental information derived from air quality maps acquired from remote sensing (satellite) data. Within this context we have adopted a general analysis framework able to deal with a large variety of temporal, geo-localized data. Thanks to the exploitation of time series analysis and satellite images processing, we studied whether glycemic control showed seasonal variations and if they have a spatiotemporal correlation with air pollution maps. We observed a link between the seasonal trends of glycated hemoglobin and air pollution in some of the considered geographic areas. Such findings will need future investigations for further confirmation. This work shows that it is possible to successfully deal with big data by implementing new analytics and how their exploration may provide new scenarios to better understand clinical phenomena.     

Effect of remote ischemic preconditioning on hepatic microcirculation and function in a rat model of hepatic ischemia reperfusion injury

Background:

Liver transplantation involves a period of ischemia and reperfusion to the graft which leads to primary non-function and dysfunction of the liver in 5–10% of cases. Remote ischemic preconditioning (RIPC) has been shown to reduce ischemia reperfusion injury (IRI) injury to the liver and increase hepatic blood flow. We hypothesized that RIPC may directly modulate hepatic microcirculation and have investigated this using intravital microscopy.

Methods:

A rat model of liver IRI was used with 45 min of partial hepatic ischemia (70%) followed by 3 h of reperfusion. Four groups of animals (Sham, IRI, RIPC+IRI, RIPC+Sham) were studied (n= 6, each group). Intravital microscopy was used to measure red blood cell (RBC) velocity, sinusoidal perfusion, sinusoidal flow and sinusoidal diameter. Neutrophil adhesion was assessed by rhodamine labeling of neutrophils and cell death using propidium iodide.

Results:

RIPC reduced the effects of IRI by significantly increasing red blood cell velocity, sinusoidal flow and sinusoidal perfusion along with decreased neutrophil adhesion and cell death.

Conclusions:

Using intravital microscopy, this study demonstrates that RIPC modulates hepatic microcirculation to reduce the effects of IRI. HO-1 may have a key role in the modulation of hepatic microcirculation and endothelial function.