中医科主动服务模式构建探讨

本研究从患者主观观念转变、诊疗价格下降和中西医结合诊疗理念的发展3个方面，介绍了在中医科构建主动服务模式的可行性，重点从分配中医科医生的服务科室和建立服务制度两个方面论述了主动服务模式的构建方法，并对主动服务模式未来工作的开展提出了可行的建议。     

Investigation of Solid Dosage Form Components Interaction Using Orthogonal Techniques- Discovery of New Forms of Sodium Stearyl Fumarate

Physical or chemical interactions between drug product (DP) components can occur during manufacturing and/or upon storage; and may alter DP shelf life and performance. In this work a new Powder X-ray Diffraction (PXRD) peak was observed in DP under accelerated storage conditions. Due to the complex drug product matrix (including API, polymer, fillers, super disintegrant and lubricant), it was challenging to pinpoint the component(s) responsible for the new peak. In addition to PXRD, other orthogonal techniques including Differential Scanning Calorimetry (DSC), thermogravimetric analysis (TGA), dynamic vapor sorption (DVS), Solid State Nuclear Magnetic Resonance (SSNMR) and Infrared (IR) spectroscopy were employed in this investigation to understand the root cause mechanistically. Specifically, multi nuclei SSNMR (¹H, ²³Na, ¹³C) was instrumental in delineating the components of the matrix. We identified the root cause to be an acid base reaction occurring in the DP, whereby sodium ion in sodium stearyl fumarate (SSF) is replaced by proton leading to SSF form conversion. We also identified commercially available SSF to be a hydrate that can dehydrate to an anhydrous form upon heating. In general, the same techniques can be used to investigate interactions of any multi component solid dosage forms.     

库车坳陷东部迪北侏罗系致密砂岩气藏特征

岗位评价又称职位评价,是指在岗位分析的基础上,按照一定的标准,对各个岗位的工作性质、责任要素、复杂因素、任职要素、工作环境等方面进行综合性的评价,确定岗位相对价值的过程[1].岗位评价方案通过对一系列报酬要素的排序或评分,衡量工作的相对价值,明确各个岗位的分类、级别的高低,保证对每个岗位的工作人员进行考核、晋升、奖罚等管理时,具有统一的标准,是现代人力资源管理理论中的重要内容.本文对国内外岗位评价方法及应用现状综述如下.     

Pentobarbital overdose: A case of contract killing

Suicides by pentobarbital overdose have increased since about 2012, which appear to be influenced by technical information on active euthanasia that has spread over the Internet. We encountered a pentobarbital poisoning case of a patient with amyotrophic lateral sclerosis. A caregiver found the patient unconscious immediately after two visitors left the room. The patient was immediately transferred to the emergency hospital but eventually declared dead. A fatal concentration of pentobarbital was detected in peripheral blood samples collected in the emergency hospital and during autopsy (53.8 μg/mL and 29.4 μg/mL, respectively). Because the ratios of pentobarbital concentrations between the gastric contents and peripheral blood were 35 and 29 in the hospital and autopsy samples, respectively, it is likely that pentobarbital was administered via the gastrostomy tube. The patient had contacted the visitors through social media. Although the patient had requested the doctor perform active euthanasia and expressed a desire to end their life on social media, nobody had noticed the plan to commit suicide.     

A statistical assembled deformable model (SAMTUS) for vasculature reconstruction

Although many deformable models have been proposed in medical applications for segmenting isolated structures in the human anatomy, not much of such work had been done on tubular structures such as the vasculature. In this paper, we propose a statistical assembled model for tubular structures (SAMTUS) to segment entire tubular structure from three-dimensional (3D) volumetric data. To our knowledge, there is no literature about the statistical deformable model for entire tubular structures. Specifically, the statistical tubular model is composed of a statistical axis model (SAM) and a statistical surface model (SSM). Both of them are assembled from a set of branch segments through the control points. Instead of searching for fuzzy correspondence along tubular axes or surfaces, we build point matching between feature points along tubular segments, and train SAM and SSM independently to characterize, respectively, the axial and the cross-sectional variation of the entire structure. In this way, more accurate point correspondence can be established, and a larger number of deformation modes can be captured. Our SAMTUS-based segmentation process consists of three stages: initialization, model fitting and final refinement. The experimental results demonstrate that the algorithm obtains good quantifications on the morphology and volume of the vasculature of the zebrafish which is being used increasingly as a specimen for drug screening and genomic research.     

早期主动性康复训练对卒中偏瘫患者上肢功能恢复的疗效观察

目的观察早期主动性康复训练对卒中偏瘫患者上肢功能恢复的疗效。方法将45例卒中后7-45d的偏瘫患者,按照入院病例号单双顺序分为康复组（25例）和对照组（20例）。所有患者均接受神经内科常规药物治疗、传统物理疗法、作业治疗和理疗等治疗;另外,康复组接受早期上肢主动性康复训练和应用腕关节背伸矫形支具,对照组仍进行传统康复训练。两组训练时间为30min/次,2次/d,5d/周,治疗时间均为4个月。分别在治疗前及治疗后4个月时进行偏瘫上肢功能评分（manual function examination,MFS）和运动评定量表评分（the motor assessment scale,MAS）。康复治疗4个月后,第3、6、12个月进行随访,评价MFS和MAS。对出院后继续自我练习2个月的患者进行功能磁共振成像检查。结果治疗后4个月,康复组MFS、MAS评分较治疗前分别增加10.8±1.1和5.3±1.5,对照组增加4.4±0.4和1.9±0.8,两组增加值比较,差异均有统计学意义（P〈0.01）。②康复组第3、6、12个月MFS、MAS随访评分均高于对照组,两组比较差异均有统计学意义（P〈0.01）③头部功能磁共振成像显示,康复组患者患侧第一运动区和辅助运动区均有高信号显示;对照组患侧和健侧第一运动区有高信号显示,而患侧辅助运动区无高信号显示。结论早期主动性康复训练对提高上肢功能的恢复和降低上肢致残率有显著疗效。     

主动固定电极在右室流出道间隔部起搏中的应用研究

目的评价主动固定电极在右室流出道间隔部起搏应用中的可行性和稳定性。方法160例起搏适应证患者随机分为两组,每组80例,一组采用主动固定电极行右室流出道间隔部起搏(简称主动固定电极组),另一组应用被动固定电极行右室心尖起搏(简称被动固定电极组),观察电极置入时间和心电图QRS波宽度,电极置入后随访观察起搏阈值、感知、阻抗,电极脱位及相关并发症。结果主动固定电极组的置入时间和X线曝光时间均长于被动固定电极(26.34±6.54minvs20.86±4.32min,16.78±5.38minvs8.67±4.52min;P均<0.01)。主动固定电极组电极置入15min时较置入即刻的起搏阈值明显下降(0.76±0.21mVvs1.12±0.25mV,P<0.01)。主动固定电极组起搏的QRS波时限较被动固定电极组短(0.14±0.04msvs0.16±0.03ms,P<0.01)。术后随访1,3,6个月,两组的起搏阈值、感知、阻抗均无差异,未见电极脱位等并发症。结论主动固定电极在右室流出道间隔部起搏中的应用是可行和稳定的。     

主动固定螺旋电极在右室流出道间隔部起搏中的应用体会

目的探索采用主动固定螺旋电极行右室间隔部起搏的临床可行性。方法随机选择54例需要安装双腔起搏器的患者行右室流出道间隔部起搏,将心室起搏螺旋电极先后定位于右室心尖部及右室流出道间隔部并测试起搏参数。结果右室流出道间隔部电极定位成功率为98.15%,该部位起搏参数满足起搏要求,同时起搏的QRS波时限较心尖部变窄(130.45±18.24msvs153.11±20.10ms,P<0.001)。结论采用主动固定螺旋电极行右室流出道间隔部起搏安全性高、可行性好。     

活动性矫治器早期治疗牙齿反的临床研究

目的：探讨活动性矫治器治疗早期牙齿反的临床疗效,为矫治前牙反提供有效办法。方法对60例牙齿反患儿采用佩戴活动性矫治器的方法进行早期治疗,分别比较这60例患儿治疗前后X线投影测量结果,判断治疗效果。结果60例牙齿反患儿中,矫治时间为2-9个月,其中10例矫治时间2-3个月,37例矫治时间3-7个月,13例矫治时间7-9个月,平均矫治时间（5.8±2.7）个月,所有研究患儿均按照医师要求完成治疗周期;对60例患儿的SNA角、颌凸角、SNB角、ANB角、U1-SN、SN-UIN、CV值治疗前后X线测量显示治疗后较治疗前均显著改善且差异均具有显著的统计学意义（P<0.05）;60例患儿在治疗后结束后1年进行复查,发现有4例儿童复发,均与年龄偏大、存在前牙反的家族史或不良的口腔习惯未破除等原因有密切关系,复发率为6.67%。结论活动性矫治器治疗早期牙齿反具有明显的正畸效果,但同时应该注意对儿童不良习惯的纠正以保持治疗效果。