应用斑点追踪技术评价原发性干燥综合征患者右心室收缩功能

目的探讨应用斑点追踪技术(STI)评价原发性干燥综合征(pSS)患者右心室收缩功能的临床应用价值。方法将2014年12月至2015年10月中国医科大学附属盛京医院收治的30例pSS患者设为pSS组,并随机选取30例正常体检者作为对照组。应用常规超声心动图测量两组患者以下二维参数:右心室前后径(RVD)、右心室游离壁厚度(RVFW)、右心房横径(RATD)、右心室横径(RVTD)以及右心室面积变化分数(RVFAC)。应用STI技术对动态图像进行脱机分析,并测量两组患者右心室游离壁各节段(基底、中间、心尖)的收缩期纵向峰值速度(Vs)、峰值应变(Ss)及峰值应变率(SRs),比较两组患者各测值间的差异性。结果两组患者常规超声各项测值比较,差异均无统计学意义(P>0.05)。两组患者STI参数比较,pSS组右心室游离壁基底段的Vs、Ss、SRs及中间段的Ss、SRs较对照组减低,且差异均有统计学意义(P<0.05);而心尖段的Vs、Ss、SRs及中间段的Vs均值虽然较对照组减低,但差异无统计学意义(P>0.05)。结论应用STI能够早期发现pSS患者右心室收缩受损,是一种较为客观的新方法。     

失效模式与效应分析在床边监护仪报警管理的应用

目的降低床边监护仪使用过程中的潜在风险,提高护理质量,确保患者安全。方法对5个监护病区60张床位的床边监护仪报警管理,运用失效模式与效应分析(FMEA)对使用流程进行分析,查找每个环节中可能存在的风险,针对操作流程、规范培训、质量监管等关键环节实施改进措施。结果实施FMEA管理后,床边监护仪报警管理质量检查结果、护士监护仪使用相关知识掌握评分与实施前比较,差异有统计学意义(均P0.01)。结论对床边监护仪报警运用FMEA管理,能降低床边监护仪不报警的风险,保障患者安全。     

2018年安阳市农村饮水安全工程水质监测结果分析

目的 掌握安阳市农村饮水安全工程水质卫生现状,为政府制定相关政策提供科学依据,以保障农村饮水安全。方法 对204个农村饮水安全工程水质监测点进行枯水期和丰水期的出厂水、末梢水的水样采集、保存和检验工作,并对检测结果进行评价、统计分析和对比。结果 水质总体合格率为62%。枯水期和丰水期水质差异有统计学意义（P<0.05）,且枯水期合格率大于丰水期合格率;枯水期和丰水期微生物学指标差异有统计学意义(P<0.05),且枯水期微生物学指标合格率大于丰水期;枯水期和丰水期肉眼可见物指标差异有统计学意义(P<0.05),且丰水期肉眼可见物指标合格率低于枯水期;枯水期和丰水期浑浊度指标差异有统计学意义(P<0.05),且枯水期浑浊度指标合格率高于丰水期。结论 安阳市农村饮水安全工程水质总体合格率较低,主要影响指标包括微生物指标和浑浊度、肉眼可见物等感官性状指标,需要引起相关部门和村民的共同重视。应加强农村饮水安全工程管理,改善农村饮水现况。     

Inappropriate Discharges by the Implantable Cardioverter Defibrillator During Postoperative Testing: Implications for Intraoperative Assessment

Inappropriate shocks were delivered to a patient while in sinus rhythm by an implantable cardioverter defibrillator (ICD) during routine prehospital discharge testing. This was induced by the standard programmer when the "read" telemetry sequence was initiated. The ICD was removed and found to suffer from electrical artifact that was sensed as ventricular tachycardia during telemetry. To avoid inadvertent telemetry-induced shocks during routine testing, all ICDs should be interrogated, using a standard programmer, intraoperatively, with the unit in "defibrillation on" mode.     

Ambulatory Blood Pressure and Endothelial Dysfunction in Hematopoietic Cell Transplantation Recipients

Hematopoietic cell transplantation (HCT) is a common treatment for many disorders. Albuminuria post-HCT, which may represent endothelial injury or inflammation from graft- versus-host disease, increases the risk of chronic kidney disease and nonrelapse mortality at 1 year. HCT recipients also have abnormal blood pressure (BP) and increased rates of cardiovascular complications. We sought to determine the relationships among albuminuria, endothelial dysfunction, and BP in HCT recipients. Patients age ?≥12 years who underwent their first allogeneic HCT between 2012 and 2015 and survived through day 80 post-HCT were eligible. Peripheral endothelial function was assessed using the EndoPAT2000 device at day 80 along with 24-hour ambulatory BP monitoring (ABPM). Clinical and laboratory data were collected along with a urine sample for calculation of the albumin-to-creatinine ratio. Both logistic and linear regression analyses were used to identify associations between EndoPAT score and clinical variables. Sixty patients (median age, 48 years; range, 14 to 69 years) completed the study. The median EndoPAT score was 2.05 (range, 1.02 to 4.45), and 17 patients (28%) had abnormal endothelial function. Forty-two patients (72%) had ambulatory hypertension (HTN), and 38 (63%) had blunted nocturnal dipping. HTN on ABPM (P?=?.045) and blunted nocturnal dipping (P?=?.04) were associated with a lower EndoPAT score. Albuminuria was not associated with EndoPAT score. There was a lack of agreement between our clinical definition of HTN (office BP and/or use of medications) and ABPM results (P?=?.04). We did not find an association between lower EndoPAT scores and albuminuria, but did find an association between an abnormal nocturnal dip and HTN diagnosed by ABPM. This suggests that albuminuria may reflect local endothelial injury and inflammation rather than a systemic process. Office BP readings do not accurately reflect true BP, suggesting that 24-hour ABPM studies are needed to diagnose and treat HTN appropriately.     

子野小数机器跳数取整对鼻咽癌静态调强放射治疗计划剂量学的影响

目的:探讨Prowess5.1计划系统在鼻咽癌静态调强放疗（IMRT）计划设计时子野小数机器跳数（MU）的四舍五入取整对计划剂量学的影响。 方法:选择33例病理诊断明确的鼻咽癌患者的IMRT计划纳入研究,分为两组计划:计划系统优化完成的原始计划组为Porig;对原始计划组的子野小数机器跳数四舍五入取整,做最终剂量计算后生成新计划组Pnew。两组计划所有子野形状未改变,比较两组计划的MU变化及剂量学差异。 结果:两组计划所有靶区的CI和HI相近,差异均无统计学意义;Pnew组靶区覆盖率、PGTVnd的D98、D95、D2、Dmean及PTV2的D98、D95,Pnew组均低于Porig组（P<0.05）,PGTVnd、PTVnx和PTV1的V100%分别降低了1.807%、0.655%和1.258%;危及器官仅左颞叶的Dmean差异具有统计学意义（P<0.05）;对于P1计划,单次Pnew比Porig跳数增加了1.600,差异具有统计学意义（519.758±46.410 vs 518.158±46.693, P<0.05)。 结论:Prowess5.1计划系统在制定鼻咽癌静态调强IMRT计划时,子野小数MU的微小变化会引起剂量学的变化,临床实践中应引起重视。     

广西血吸虫病十年监测分析

目的探索近十年广西新发现的残存钉螺的分布特点及流动人口血吸虫病感染情况,为血吸虫病防治提供科学依据。方法根据查到残存钉螺年份长短将广西原血吸虫病钉螺孳生地分成三类,针对不同螺区分类,对原螺区及毗邻地区采用不同的监测方案。结合血清学方法及粪便检查方法,抽样检查当地居地、原血吸虫病人及流动人口的监测检查工作,对监测结果进行考核。结果近十年来,广西发现5处残存螺点,分别位于玉林、靖西、宜州、横县等地,其中隶属南宁市辖区的横县发现残存钉螺2处。广西未发现本地血吸虫病人,流动人口监测过程中发现输入性病例23例,病人分别来自湖北、湖南、江西和安徽4省,除2例为女性外,其余均为男性。职业则以干部、商人、民工（农民）、学生及武警新兵为主。结论广西虽然保持阻断传播标准的成果,但由于不断新发现残存钉螺及输入性血吸虫病例,广西仍然面临血吸虫病的威胁。     

Urinary bladder volume tracking using a Kalman filter

This study introduced the Kalman filter procedure for tracking urinary bladder filling from intermittent bladder volume measurements taken by an ultrasonic bladder volume monitor. The Kalman filter was based on a double integrator as a model for the bladder filling process between micturitions and included a procedure to reset the filter in the event of a micturition. The performance of the Kalman filter was evaluated experimentally using an ultrasonic bladder volume monitor on seven male urologic patients. During cystometry, saline was infused into the patient's bladder at a constant rate of 30 ml min⁻¹ until it was full, and the volume of the bladder was recorded every 30 s by the bladder volume monitor. The evaluation showed that the filter significantly improved the precision of the measured volumes in terms of mean absolute error by 4.2 ml (95% confidence interval: 0.7–7.7 ml) (p=0.025) without affecting the system accuracy, i.e slope (p=0.92) and intercept (p=0.32). Finally, the micturition reset procedure was verified using simulated data.     

振幅整合脑电图在新生儿缺氧缺血性脑病早期诊断中的意义

目的 探讨振幅整合脑电图(aEEG)在新生儿缺氧缺血性脑病(HIE)早期诊断中的意义.方法 选择HIE足月儿42例为研究对象,临床分为轻、中、重三度.选择同期健康足月儿10例为健康对照组.并对所有观察对象进行脑电图描记及振幅整合,按aEEG结果将其分为正常aEEG、轻度异常aEEG、重度异常aEEG 3种.采用SPSS 13.0软件进行统计学分析.结果 42例HIE患儿中,aEEG正常者18例,其中16例为轻度HIE( 88.9％),2例为中度HIE( 11.1％);aEEG轻度异常者15例,其中3例为轻度HIE (20.0％),9例为中度HIE( 60.0％),3例为重度HIE( 20.0％);aEEG重度异常者9例,其中2例为中度HIE (22.2％),7例为重度HIE( 77.8％).而10例健康对照组aEEG均为正常.aEEG监测结果与HIE临床分度密切相关(K=0.633,P＜0.001).结论 aEEG可作为一种简化的脑功能评价方法,用于HIE新生儿的早期诊断及病情预测.