携氧液对心脏停搏后脑复苏作用的观察

研讨携氧液对脑复苏的作用。方法用１２－１６ｋｇ杂种犬１６只,分实验组和对照组各８只,用低压直流电诱发心室颤动１０分钟实验组静滴携带液５０ｍｌ／ｋｇ;对照组静滴非携氧液。结论携氧液有助于提高脑复苏的成功率,减少缺氧性脑损伤致残率。     

Telematics-based online client–server/client collaborative environment for radiotherapy planning simulations

Customized cancer radiation treatment planning for each patient is very useful for both a patient and a doctor because it provides the ability to deliver higher doses to a more accurately defined tumor and at the same time lower doses to organs at risk and normal tissues. This can be realized by building an accurate planning simulation system to provide better treatment strategies based on each patient’s tomographic data such as CT, MRI, PET, or SPECT. In this study, we develop a real-time online client–server/client collaborative environment between the client (health care professionals or hospitals) and the server/client under a secure network using telematics (the integrated use of telecommunications and medical informatics). The implementation is based on a point-to-point communication scheme between client and server/client following the WYSIWIS (what you see is what I see) paradigm. After uploading the patient tomographic data, the client is able to collaborate with the server/client for treatment planning. Consequently, the level of health care services can be improved, specifically for small radiotherapy clinics in rural/remote-country areas that do not possess much experience or equipment such as a treatment planning simulator. The telematics service of the system can also be used to provide continued medical education in radiotherapy. Moreover, the system is easy to use. A client can use the system if s/he is familiar with the Windows^TM operating system because it is designed and built based on a user-friendly concept. This system does not require the client to continue hardware and software maintenance and updates. These are performed automatically by the server.     

Responses of Purkinje cells in the cerebellar anterior vermis to off-vertical axis rotation

Responses of 67 Purkinje cells (P-cells) and 44 unidentified neurons (U-cells) located in the cerebellar anterior vermis were recorded in decerebrate cats during off-vertical axis rotation (OVAR). This stimulus consisted of a slow constant velocity (9.4°/s) rotation in the clockwise (CW) and counterclockwise (CCW) directions around an axis inclined by 5° with respect to the vertical. OVAR imposes on the animal head a 5° tilt, whose direction changes continuously over the horizontal plane, thus eliciting a selective stimulation of macular receptors. A total of 27/67 P-cells (40%) and 24/44 U-cells (55%) responded to both CW and CCW rotations. For these bidirectional units, the direction of maximum sensitivity to tilt (S_max) could be identified. S_max directions were distributed over the whole horizontal plane of stimulation. Among bidirectional neurons, 48% of the P-cells and 33% of the U-cells displayed an equal amplitude of modulation during CW and CCW rotations, indicating a cosinetuned behaviour. In these instances, the temporal phase of the unit response to a given direction of tilt remained constant, while the sensitivity was maximal along the S_max direction and declined with the cosine of the angle between S_max and the tilt direction. The remaining bidirectional units displayed unequal amplitudes of modulation during CW and CCW rotations. For these neurons, a nonzero sensitivity along the null direction was expected and the response phase varied as a function of stimulus direction. Finally, 31% and 23% of P-cells and U-cells, respectively, responded during OVAR in one direction only (unidirectional units). This behaviour predicts equal sensitivities along any tilt direction in the horizontal plane and a response phase that changes linearly with the stimulus direction. The possibility that the tested neurons formed a population which coded the direction of head tilt in space was also investigated. The data from the whole population of cells were analysed using a modified version of vectorial analysis. This model assumes that for a particular tilt each cell makes vectorial contributions; the vectorial sum of these contributions represent the outcome of the population code and points in the direction of head tilt in space. Thus, a dynamic head tilt along four representative directions was simulated. For each of the four directions, 12 population vectors were calculated at regular time intervals so as to cover an entire cycle of head tilt. The results indicate that for each selected time in the cycle the direction of the population vector closely corresponded to that of the head tilt, while its amplitude was related to the amount of head tilt. These data were particularly obtained for the P-cells. In view of their efferent connections, the cerebellar anterior vermis may provide a framework for the spatial organization of vestibulospinal reflexes induced by stimulation of otolith receptors.     

Three Dimensional Transient Multifield Analysis of a Piezoelectric Micropump for Drug Delivery System for Treatment of Hemodynamic Dysfunctions

In this paper, we present design of a transdermal drug delivery system for treatment of cardiovascular or hemodynamic disorders such as hypertension. The system comprises of integrated control electronics and microelectromechanical system devices such as micropump, micro blood pressure sensor and microneedle array. The objective is to overcome the limitations of oral therapy such as variable absorption profile and the need for frequent dosing, by fabricating a safe, reliable and cost effective transdermal drug delivery system to dispense various pharmacological agents through the skin for treatment of hemodynamic dysfunction such as hypertension. Moreover, design optimization of a piezoelectrically actuated valveless micropump is presented for the drug delivery system. Because of the complexity in analysis of piezoelectric micropump, which involves structural and fluid field couplings in a complicated geometrical arrangement, finite element (FE) numerical simulation rather than an analytical system has been used. The behavior of the piezoelectric actuator with biocompatible polydimethylsiloxane membrane is first studied by conducting piezoelectric analysis. Then the performance of the valveless micropump is analyzed by building a three dimensional electric-solid-fluid model of the micropump. The effect of geometrical dimensions on micropump characteristics and efficiency of nozzle/diffuser elements of a valveless micropump is investigated in the transient analysis using multiple code coupling method. The deformation results of the membrane using multifield code coupling analysis are in good agreement with analytical as well as results of single code coupling analysis of a piezoelectric micropump. The analysis predicts that to enhance the performance of the micropump, diffuser geometrical dimensions such as diffuser length, diffuser neck width and diffuser angle need to be optimized. Micropump flow rate is not strongly affected at low excitation frequencies from 10 to 200 Hz. The excitation voltage is the more dominant factor that affects the flow rate of the micropump as compared with the excitation frequency. However, at extremely high excitation frequencies beyond 8,000 Hz, the flow rate drops as the membrane exhibits multiple bending peaks which is not desirable for fluid flow. Following the extensive numerical analysis, actual fabrication and performance characterization of the micropump is presented. The performance of the micropump is characterized in terms of piezoelectric actuator deflection and micropump flow rate at different operational parameters. The set of multifield simulations and experimental measurement of deflection and flow rate at varying voltage and excitation frequency is a significant advance in the study of the electric-solid-fluid coupled field effects as it allows transient, three dimensional piezoelectric and fluid analysis of the micropump thereby facilitating a more realistic multifield analysis. The results of the present study will also help to conduct relevant strength duration tests of integrated drug delivery device with micropump and microneedle array in future.     

组蛋白密码

遗传信息的传递是从核酸序列三联密码子的转录和翻译,到合成具有完整结构的功能蛋白质的全过程。随着对遗传信息库的认识越来越深入,人们发现基因组DNA是非遗传信息库的唯一决定因素。晚近,有作者提出“组蛋白密码”学说,使组蛋白的研究倍受瞩目。该学说表明,组蛋白氨基末端的多样化修饰扩充了遗传密码的信息库。     

Osteotomy around the knee: Assessment of quality,content and readability of online information

BackgroundAs knee osteotomy surgery becomes increasingly accessible, more patients may turn to the Internet for information. This study examined the source, quality, content and readability of online information regarding osteotomy around the knee.MethodsThe first 70 websites returned by the top four search engines were identified using the key words: “knee osteotomy” and “high tibial osteotomy.” The websites were categorised by type and assessed using the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria and a novel Knee Osteotomy-Specific Score (KOSS). The presence of the Health On the Net (HON) code accreditation seal was noted. Readability of each website was assessed using eight readability formulae. The mean reading grade level (RGL) was compared to the 6th and 8th grade reading levels. The mean RGL of each category was also compared.ResultsOf the 45 unique websites analysed, the majority were Physician (33%) and Journal websites (31%). The mean DISCERN score was 36.7 (±8.9) which is classified as ‘poor.’ The mean JAMA benchmark criteria score was 2.04 (±1.5) and Physician websites were most likely to be scored zero. The mean KOSS was 15.4 (±5.7). The highest scoring website was a Commercial site but, overall, Journal category sites provided the best quality information. Websites that bore the HONcode seal obtained higher DISCERN, JAMA benchmark criteria and Knee Osteotomy - Specific Scores.The cumulative mean RGL was 13.2 (±2.2) which exceeded the 6th grade level by an average of 7.2 grade levels and the 8th grade level by an average of 5.2 grade levels. No website (0%) was written at or below either the 6th or the 8th grade reading levels. The mean Flesch Reading Ease Score of all websites was 41.13 (±14.7) which is classified as ‘difficult.’ Journal websites had the highest RGL.ConclusionThe information available online regarding osteotomy around the knee varies tremendously in quality and completeness. Physician sites predominate, but these were among the lowest scoring of all websites. Even where high quality information is available, it is set at too high a level to be easily understood.Level of evidenceSurvey of materials – Internet.     

Conceptual-driven classification for coding advise in health insurance reimbursement

Objective

With the non-stop increases in medical treatment fees, the economic survival of a hospital in Taiwan relies on the reimbursements received from the Bureau of National Health Insurance, which in turn depend on the accuracy and completeness of the content of the discharge summaries as well as the correctness of their International Classification of Diseases (ICD) codes. The purpose of this research is to enforce the entire disease classification framework by supporting disease classification specialists in the coding process.

Methodology

This study developed an ICD code advisory system (ICD-AS) that performed knowledge discovery from discharge summaries and suggested ICD codes. Natural language processing and information retrieval techniques based on Zipf's Law were applied to process the content of discharge summaries, and fuzzy formal concept analysis was used to analyze and represent the relationships between the medical terms identified by MeSH. In addition, a certainty factor used as reference during the coding process was calculated to account for uncertainty and strengthen the credibility of the outcome.

Results

Two sets of 360 and 2579 textual discharge summaries of patients suffering from cerebrovascular disease was processed to build up ICD-AS and to evaluate the prediction performance. A number of experiments were conducted to investigate the impact of system parameters on accuracy and compare the proposed model to traditional classification techniques including linear-kernel support vector machines. The comparison results showed that the proposed system achieves the better overall performance in terms of several measures. In addition, some useful implication rules were obtained, which improve comprehension of the field of cerebrovascular disease and give insights to the relationships between relevant medical terms.

Conclusion

Our system contributes valuable guidance to disease classification specialists in the process of coding discharge summaries, which consequently brings benefits in aspects of patient, hospital, and healthcare system.     

微生物鉴定分析系统基于IHE LBL的集成研究

基于医学信息标准化集成架构,实现系统互联与数据采集,并生成规范的微生物检测标本标签。运用IHE LBL技术框架设计并实现微生物鉴定系统与客户端组成的集成平台。结合Windows Socket消息机制,使标签信息以HL7消息的形式进行流转,实现标签信息采集,最终生成QR Code通用标签。完成了IHE LBL集成模式中各角色和事务的通讯,以及HL7消息的构造与解析、QR Code标签的构造,并对HL7消息进行了验证。通过系统集成获取到的标签信息有更高的准确性和安全性,并可提高微生物实验室的工作效率,方便标本标签的管理,有助于微生物实验室实现信息化、区域化集成与共享。