医用显示器的选择不容忽视

本文对数字化医学影像系统中的终端显示器从技术参数、性能特点等方面作了分析对比,阐述了医学影像诊断工作选用医用显示器的重要性.强调在医学影像数字化系统建设中,医用显示器和普通显示器在应用中的区别.并指出,在数字化医学影像系统中,如果终端显示器选择不当,将会带来医院整体医疗质量的下降.     

视网膜母细胞瘤的遗传学特征及临床筛查与治疗

视网膜母细胞瘤(RB)是儿童最常见的眼内恶性肿瘤,多发于婴幼儿,可损害患儿视力、眼球,甚至危及生命。其发生和发展与基因组和表观基因组有很大关系,遗传性RB占所有病例的45%。RB的治疗和预后取决于疾病的初始阶段,当疾病被早期诊断和治疗时,存活率超过95%,当RB在晚期发生眼外播散时,存活率低于50%。因此RB的治疗重点是通过早期肿瘤的监测和预防挽救患儿生命,其次要目标是保存眼球,并最大水平地保留视力。对RB遗传学的研究有助于通过基因筛查、监测查找特异性靶点,对提高患儿的生存率、研究RB靶向治疗十分必要。     

心电监护仪在新生儿经下肢静脉置入中心静脉导管中定位效果的随机对照研究

目的 探讨心电监护仪辅助定位法在新生儿通过下肢静脉进行经外周静脉穿刺的中心静脉导管(peripherally inserted central venous catheter,PICC)置管中的应用效果。方法 选取2020年1月至2022年1月入住新生儿重症监护室(neonatal intensive care unit,NICU)经下肢静脉行PICC置管患儿120例,按随机数字表法分为对照组和观察组,每组60例。对照组患儿行体表测量+术后胸部X线检查定位;观察组患儿行体表测量+心电定位+术后胸部X线检查定位。收集并比较2组患儿的一般资料、置管一次性到位率及置管耗时,并评估心电定位效率。结果 观察组置管一次性到位率高于对照组(92%vs 75%;P<0.05),且置管耗时短于对照组[26.5±3.0) min vs (31.8±2.8) min;P<0.05]。心电监护仪辅助定位技术在新生儿经下肢静脉行PICC置管中具有较高的灵敏度(90.9%)和特异度(100%)。结论 在新生儿经下肢静脉行PICC置管过程中,利用心电监护仪辅助判断导管尖端位置,可提高置管一次性到位率,减...     

清醒Beagle犬呼吸和循环系统功能监测模型建立及生物学特性分析

目的:应用植入式遥测技术,建立Beagle犬清醒动物呼吸和循环系统功能检测模型,应用遥测技术对Beagle犬生理参数进行长时程采集和分析,为临床前药物安全性评价试验提供重要的生理基础参考值。方法:通过外科手术,在Beagle犬体内埋植TL11M3-D70-PCTP遥测传感器,以DSI遥测生理信号采集系统连续记录并分析Beagle犬在无束缚条件下24 h生理信号,分析其昼夜节律,并以特非那定作为阳性药物进行验证。结果:成功建立了Beagle犬植入式清醒动物模型,Beagle犬的生理活动具有明显的昼夜节律性,早上09:00左右是多项生理指标的最高点,特非那定能够明显延长Beagle犬的QTc间期。结论:试验获得了本中心GLP试验室饲养条件下动物的基础值,可为其在药物临床前试验中的应用提供重要的参考数据。     

肥厚型心肌病磁共振钆剂延迟增强与心电图 QTe/RR的关系

摘要：目的 探讨肥厚型心肌病（HCM）磁共振钆剂延迟增强与动态心电图QTe/RR斜率的关系。方法 将本院 2016 年 1 月—2017 年 6 月接诊的 96 例 HCM 患者,根据心脏磁共振扫描（CMR）是否出现钆剂延迟增强（LGE）分为 LGE阳性组和LGE阴性组。采用评分法评估LGE阳性组患者LGE透壁程度。所有受试者行24 h动态心电图检查, 计算心率（HR）、QT间期及QTe/RR斜率。分析LGE阳性组总LGE评分与QTe/RR斜率之间的相关性,分析LGE透壁 程度和QTe/RR斜率与患者预后的关系。结果 CMR结果显示LGE阳性51例（53.13%）,LGE阴性45例（46.87%）; LGE阳性组与LGE阴性组左心室射血分数（LVEF：0.412±0.092 vs. 0.508±0.083）、左心室舒张末期容积［LVEDV（mL）： 173.91±43.68 vs.148.52±31.77］及左心室舒张末期后壁厚度［LVPWD（mm）：13.26±2.81 vs. 12.15±2.37］比较差异有统 计学意义（t分别为5.301、3.219、2.077,均P＜0.05）;LGE阳性组QT间期（ms：439.67±25.82 vs. 411.53±31.66）、QTe/RR 斜率（0.20±0.05 vs. 0.16±0.03）均高于 LGE 阴性组（t 分别为 4.794、4.674,均 P＜0.05）;LGE 阳性组总 LGE 评分为 （26.37±7.52）分,与QTe/RR斜率呈正相关（r=0.742,P＜0.001）;LGE阳性组室性心律失常、心源性猝死等不良反应发 生率高于LGE阴性组（17.65% vs. 4.44%,c2=4.107,P＜0.05）;总LGE评分、QTe/RR斜率与患者室性心律失常、心源性 猝死有关（P＜0.05）。结论 HCM患者LGE程度与QTe/RR斜率显著相关,综合评估两项指标可能更有助于HCM预 后判断     

Left Ventricular Abnormality and Covert Atrial Fibrillation in Embolic Stroke of Undetermined Source

Aims: The relationship between left ventricular (LV) function and AF detection in embolic stroke of undetermined source (ESUS) patients with insertable cardiac monitors (ICMs) remains unclear. We investigated the association between LV function and AF detection in patients with ESUS after ICMs implantation. Methods: We enrolled patients with ESUS who underwent ICMs implantation from September 2016 to September 2020 using a single-center, prospective registry. LV systolic and diastolic functions were assessed on precordial echocardiography by LV fractional shortening (LVFS) and average E/e’, respectively. Associations between characteristics of LV function and detection of AF by ICMs were analyzed. Results: Participants comprised 101 patients (median age, 74 years; male, 62%). During a median follow-up period of 442 days (interquartile range (IQR), 202–770 days), AF was detected in 24 patients (24%). Median duration from ICMs implantation to AF detection was 71 days (IQR, 13–150 days). When LVFS and E/e’ were dichotomized by cutoff value, each of low LVFS (＜35.5%; adjusted hazard ratio (HR), 4.77; 95% confidence interval (CI), 1.77–12.9) and high E/e’ (≥ 8.65; adjusted HR, 4.56; 95%CI, 1.17–17.7) were independently associated with AF detection after adjusting for age and sex. When patients were divided into four groups according to dichotomized LVFS and E/e’, the combination of low LVFS and high E/e’ was independently associated with AF. Conclusions: In patients with ESUS after ICMs implantation, the LV characteristics of low LVFS and high E/e’ were associated with AF detection.     

Combining CGM and an Online Peer Support Community for Hispanic Adults with T2D: A Feasibility Study

Background:Previous research has identified that people with type 2 diabetes (T2D) within the Hispanic community would benefit from an online peer support community (OPSC) and continuous glucose monitoring (CGM) data to facilitate diabetes self-management.Methods:A mixed-methods feasibility study enrolled Hispanic, Spanish-speaking adults with T2D, not on insulin. Participants were provided with CGM and access to an OPSC for 12 weeks. Feasibility was assessed by number of eligible participants who enrolled, attrition, quantity of CGM data, validated clinical measures of self-efficacy, quality of life and adverse events. Engagement in the OPSC was measured using objective metrics on the online platform. Qualitative interviews were conducted upon conclusion of the intervention to assess feasibility, acceptability, participant satisfaction, and key recommendations for improvement.Results:Of 46 participants screened, 39 were eligible and 26 completed the study. Participants significantly improved self-efficacy scores. Posts in the OPSC related to goal setting had the highest engagement followed by mid-week and end of week check-in posts respectively. Participant interviews described challenges accessing the OPSC platform as a barrier to engagement. Despite this, all participants were satisfied with the intervention. Key recommendations for improvement included providing greater variety of and individualized education and the use of a peer support platform that is easily accessible.Conclusions:The CGM + OPSC intervention tailored to the Hispanic community with T2D was feasible, acceptable and satisfactory and improved participant self-efficacy for diabetes management which may lead to improved clinical outcomes.     

糖尿病管理信息系统的建立及应用

目的应用分布式动态数据管理信息系统对糖尿病进行系统化、标准化管理,为糖尿病及其慢性并发症、合并症的临床监控、发病机制研究提供重要的科学依据和研究手段。方法利用美国微软公司公开发布的分布式关系型数据库查询语言系统[structured query language(SQL)Server 2000],结合流行病学的方法和要求,自行研究设计了分布式、动态的基于网络的糖尿病管理信息系统(DIMS系统)。结果DIMS系统以多种形式动态地显示了患者长期的临床指标变化,并动态地提醒医师注意周围疾病的发病风险。实现了患者个体病情的动态监控,做到及早、及时地采取相应的治疗方案,减少或延缓并发症的发生,使患者的病情控制达标率有了显著改观,糖化血红蛋白达标率由建档前的49.93%上升至77.94%(P<0.01),空腹血糖及体重指数的达标率均有不同程度改善(P值均<0.05)。DIMS系统可有效地解决病史管理紊乱的问题,实现病史资料的标准化管理,提高医疗质量和工作效率。结论DIMS系统可有效地解决糖尿病及其慢性并发症的计算机标准信息化管理,实现许多人工操作环节中较难完成的管理和分析工作,提高工作效率,使糖尿病患者的病情得到更好监控。     

人工耳蜗植入编程中NRT值和行为测试T值比较分析

目的:了解人工耳蜗植入编程中神经反应遥测(NRT)阈值与行为反应阈值的差别,寻找更好的编程方法。方法:对77例进行澳大利亚24型人工耳蜗植入的患儿在调试时对1、6、11、16、20号电极进行NRT值测试和行为T值测试,在能获得可靠的NRT和行为T值的时候收集数据,并进行统计学分析。结果:各个电极的vNRT值和行为T值的相关系数范围为0.40～0.54。各个电极vNRT的最小值为135μV,最大值为215μV。行为值的最小值为120CL,最大值为190CL。1,6,11,16,20号电极的vNRT和行为T差值的均值为27±14,24±13,31±14,26±13,20±13。vNRT和行为T值的最大差值为65,最小差值为-15。从20号电极到1号电极,平均T值幅度范围为148～159CL,平均vNRT值幅度范围为168～186μV,而且从低频电极到高频电极,vNRT值和行为T值呈上升趋势。结论:用vNRT阈值推测行为T值指导调机编程,个体差异较大,推测结果不是非常可靠,仅用于不能配合行为测试的患者。为了保证编程的准确性,最好对所有进行耳蜗编程的患者用行为T值来编程。     

用近红外光谱相似系数法监测市场药品的质量

 目的 用近红外相关系数法,通过药品检测车对药品在流通领域中的变化进行跟踪,对药品的真伪进行快速筛查。方法 将真品近红外光谱图作参照光谱,选择7 240～7 140 cm-1,6 200～5 500 cm-1及5 000～4 700 cm-1波长范围,光谱预处理方法为二阶导数（13点平滑）,测定待测样品光谱与参照光谱的相似系数,相似系数的阈值为95.0%,小于此值判为伪品。结果 以14种真品药品为参照光谱,检测市场上收集到的相应伪品,相似系数均低于95.0%。结论 该法简便、易行,通过药品检测车可对流通链中药品进行快速全程跟踪。