人工智能在医疗领域的应用和准入

人工智能自1956年确立为独立的研究领域以来,先后经历过三次发展浪潮,实现了从理论到场景的应用,逐渐上升为多国的国家战略。当前在医疗领域的应用主要有9大类,分别是虚拟助手、疾病诊断与预测、医疗影像、病历/文献分析、医院管理、智能器械、新药研发、健康管理和基因。但是,在数据隐私、数据标准、医保支付、责任风险等方面还存在许多问题。在准入管理方面,美国已在数据隐私保护、缩短审批流程等方面做出了应对,并组建了专门致力于数字化医疗和人工智能技术审评的新部门。鉴于人工智能能够弥补人力资源不足、提高医疗准确性等优点,我国应在法治、监管、技术、标准等方面做好规范。     

脑导纳微分环及频谱分析在偏头痛诊断中的价值

目的:探讨脑导纳微分环及频谱分析在偏头痛患者诊断中的价值。方法:运用导纳式双侧脑血流自动检测仪,对偏头痛患者进行脑导纳微分环及频谱检测并与正常组比较。结果:研究结果显示偏头痛患者的脑导纳微分环及频谱与正常组差异有显著性(P<0.05)。结论:脑导纳微分环及频谱分析指标可客观反映出偏头痛患者的脑血管扩张、痉挛及供血情况,在临床诊断中有重要价值。     

The admittance of the interface between a metal electrode and an aqueous electrolyte solution: Some problems and pitfalls

Electrochemical admittance measurements have become popular as a convenient, non-invasive method for the study of interfacial properties of the metal-solution interface. However, uncritical use of this technique (as of any other) can lead one astray. Here, then, some of the complicating factors and common problems will be discussed.     

社区脑卒中患者各级康复准入及准出标准建立研究

背景　康复是社区卫生服务机构职能的一个重要组成部分,康复网络体系的不健全,加剧了社区的脑卒中康复需求。构建社区脑卒中康复服务体系,符合社区居民的卫生服务需求,也是基层医疗卫生机构在医疗卫生体系中功能定位的体现。目的　构建上海市社区脑卒中各级康复准入及准出标准,以指导社区筛选真正属于脑卒中康复范畴并亟须照护的人群,规范各级脑卒中患者的准入及准出。方法　于2018年4—7月,邀请18位综合医院心脑血管和康复领域专家、社区卫生服务中心脑卒中康复相关管理者和执行人代表,通过两轮Delphi专家咨询,采集各位专家对社区中心病房康复、养老机构康复、社区中心门诊康复和居家康复的脑卒中康复服务对象的准入及准出标准的意见。结果　两轮咨询专家的积极系数均为100.0%,且最后一轮专家权威程度为0.74。根据服务对象准入及准出标准的界定原则,从介入时间点、神经功能、运动功能障碍、触觉及本体感觉障碍、认知障碍、情绪障碍、语言和交流障碍、吞咽障碍、尿便障碍、日常生活活动能力和生活质量、社会支持度等方面梳理出了社区脑卒中患者各级康复的准入及准出标准。结论　本研究构建的社区中心病房、养老机构、社区中心门诊、居家四级康复服务对象的准入及准出标准可信度较高,可供社区开展脑卒中康复工作时借鉴及实际应用,同时为社区各级脑卒中康复转介机制的有序运行奠定了基础。     

Voltage clamp analysis of lamprey neurons — role of N-methyl-d-aspartate receptors in fictive locomotion

Spinal neurons in the lamprey have been subjected to a voltage clamp analysis of the excitatory currents generated during fictive locomotion with particular reference to the phasic activation of voltage dependent N-methyl-D-aspartate (NMDA) receptors. Voltage-clamped neurons observed during NMDA-induced fictive swimming show excitatory and inhibitory synaptic currents in phase with the ipsilateral and contralateral ventral root discharges, respectively. The excitatory synaptic currents showed a marked voltage dependence suggesting that potential sensitive conductances such as the NMDA ionophore are involved in the synaptic events underlying rhythmic locomotor activity. The effect of NMDA receptor activation during application of tetrodotoxin has also been analyzed during NMDA-induced pacemaker-like oscillations. Such NMDA-induced oscillations are essentially abolished during the voltage clamp. In the presence of NMDA current voltage plots reveal a negative slope conductance in the potential range of the inherent oscillations. The addition of tetraethyl ammonium (TEA) to NMDA solution enhanced a net steady state inward current by more than 10-fold due to a partial block of the outward currents. A kinetic analysis was done with a frequency domain technique using a white noise stimulus to linearly perturb the membrane potential over a wide range of frequencies. The analysis revealed that the induced negative conductance leads to a response which is nearly 180 degrees out of phase with the stimulus at low frequencies. This is an unstable condition which leads to the depolarizing phase of the induced oscillations.     

应用心导纳微分图评价小儿先心病左室功能

对100例TF、VSD、ASD和PDA等先心病患儿,用心导纳一阶微分图与心机械图同步测定的收缩时间间期各指标都有非常密切相关,实测数值十分接近。心导纳图测定的左心功能诸指标的改变与临床心功能分级相符。本文还用电子计算机作多因素逐步回归初步探讨了TF血流动力学变化和病理畸形对左心功能诸参数的影响程度和相互关系。     

Three-channel telemetry system for monitoring e.c.g. cardiac output,rate of respiration and basal transthoracic admittance

A three-channel frequency-modulation telemetry system for the noninvasive measurement of cardiac output, rate of respiration, e.c.g. and basal transthoracic admittance of the unconstrained human subject is described. Tetrapolar admittance plethysmography has been employed to obtain the transthoracic admittance and its variations corresponding to the cardiac cycle and respiratory changes. Pulse duration modulation has been used in the transmitter system. The nonlinearity of the system is less than ±2·0%. The telemetry transmitter has a range of about 100 m, it weights approximately 200 g and is contained in a box measuring 150×100×50 mm. The batteries used provide a continuous life of 20 h. The system has been used to obtain data from normal subjects in different postures with breath hold and during normal respiration.     

上海市医疗技术准入配置特征追踪研究

目的：探索上海市医疗技术准入的配置特征,为政府卫生行政部门科学管理提供决策依据。方法：描述性分析准入技术的基本情况、空间分布、机构分布、类别及应用病种等。结果：共准入第二类及本市首次开展技术917项,技术种类为101种,涉及医院166家。准入技术主要为本市首次开展的医疗技术,占82．2％。准入技术的空间分布不均衡,中心区域技术配置数量明显高于郊区;三级医院申请的医疗次数和种类均较二级、一级医院多,但三级医院平均中请次数低于二级医院。主要准入技术种类为手术治疗、实验室诊断和物理治疗,共占准入总数的90．1％。主要技术方法为微创、快速定量诊断及超声等先进技术方案,诊疗病种主要为心血管疾病和肿瘤等慢性疾病。准入的前三位技术分别为妇科内镜诊疗技术、白内障超声乳化和髋膝关节置换技术。结论：上海市医疗技术准入主要为本市首次开展的医疗技术,技术配置空间分布不合理,建议加强准入技术在郊区及基层医院的推广应用,并进一步加强准入技术的监管和跟踪评估。