试论门诊管理

结合门诊管理的实践,对如何加强门诊管理进行了论述。主要为:①掌握门诊特点,确定门诊管理重点;②做好工作计划,实施目标管理;③充分发挥门诊部办公室的作用,承上启下,及时协调;④健全门诊管理组织,完善门诊管理规定;⑤抓好服务质量,方便病人就医;⑥加强质量考核,确保门诊工作质量。     

Theoretical basis for camera control in teleoperating

Background: The triangle paralaxis method for camera control in teleoperating is presented. Methods: For orientation in the 3D space of the corporic cavity there are three points necessary for the creation of the paralaxis triangle. This triangle is then imagined and compared with topography during surgery. The first and second points are created in one's mind at the locus of the entry of the instruments into the viewing field of the camera. The third apex of the triangle is the area of dissection—the point in which the instruments converge. The fourth point to be viewed determines the course of dissection. Triangle paralaxis may be applied in dissection with only one instrument as well as in the zooming technique, closely viewing a part of the dissecting instrument. Results: Using this technique a 7.78% rate of conversion and 2.15% rate of reoperation could be achieved in 334 evaluated laparoscopic cholecystectomies performed in a small public hospital. Conclusions: Triangle paralaxis seems to be a simple method for ensuring an optimal camera view during laparoscopic surgery.     

血压自动控制系统应用于抗失血性休克的实验研究

本文设计的８模型血压自适应控制系统，试用于造成失血休克模型的家兔的血压自控治疗，２２只休克家兔中１８只能控制血压于预置水平。根据血压控制期间药物输注速率变化规律，可将２２只家兔分为三类，剂量上升型、剂量下降型和迟钝型。实验表明多模型血压自适应控制系统应用于失血性休克家兔的血压控制治疗是可行的，能做到剂量个体化，按需给药。在血压控制期间显示的药物输注速率变化能在一定程度上反映机体休克状况，有可能为及     

Responses of human primary sensorimotor and supplementary motor areas to internally triggered unilateral and simultaneous bilateral one‐digit movements. A high‐resolution EEG study

We modelled the responses of human primary sensorimotor areas and supplementary motor area to simple, self-initiated unilateral and simultaneous bilateral middle finger movements using a novel high-resolution electroencephalography technology. The results support the view that these cortical motor areas are involved in parallel and present similar activity in the preparation, initiation, and execution of the contralateral and bilateral movements. Furthermore, the left primary sensorimotor area (dominant hemisphere) appears to be activated more than the right primary sensorimotor area during the preparation and performance of the ipsilateral movements.     

Modification of DiFrancesco-Noble equations to simulate the effects of vagal stimulation onin vivo mammalian sinoatrial node electrical activity

We present a new mathematical model for vagal control of rabbit sinoatrial (SA) node electrical activity based on the DiFrancesco-Noble equations. The original equations were found to be unstable, resulting in progressive cycle by cycle depletion or accumulation of ions in intra- and extracellular compartments. This problem was overcome by modifying the maximum Na−K pump current and the time constant for uptake of intracellular calcium. We also included a formulation for the acetylcholine (ACh)-activated potassium current which was consistent with experimental data. This formulation was based on kinetics first proposed by Osterrieder and later modified by Yanagihara. The resulting model exhibits cycle-cycle ionic stability, and includes an ACh-activated potassium current which accurately reproduces experimentally observed effects of vagal stimulation on both the membrane potential and its timederivative. Simulations were performed for both brief-burst and prolonged vagal stimulation using simplified square wave profiles for the concentration of ACh in the synaptic cleft space. This protocol permits the isolation of cardiac period dynamics caused by changes in membrane potential and intra- and extracellular ionic concentrations from those caused by other mechanisms including the dynamics of ACh release, diffusion, hydrolysis and washout. Simulation results for the effects of brief-burst single cycle stimulation on the cardiac period agree closely with experimental data reported in the literature, accurately reproducing changes in membrane potential and the phasic dependency of the response to the position of vagal stimulus bursts within the cycle. Simulation of the effects of prolonged vagal stimulation accurately reproduced the steady-state characteristics of heart period response, but did not yield the complex multimodal dynamics of the recovery phase, or the pronounced post vagal tachycardia observed experimentally at the termination of the stimulus. Our results show that the major chronotropic effects of vagal stimulation on the SA cell membrane can be explained in terms of the ACh-activated potassium current. The effects of this membrane current however are generally fast acting and cannot contribute to any long lasting dynamics of the cardiac period response. The modified DiFrancesco-Noble model presented in this article provides a valuable theoretical tool for further analysis of the dynamics of vagal control of the cardiac pacemaker.     

等速离心训练对肩关节内外旋肌的肌力平衡及神经肌肉控制能力的影响

背景 肩关节内外旋肌肌力失衡会增加肩部运动损伤的风险,研究等速离心训练(IET)能否提高肌力平衡并改善神经肌肉控制能力具有重要的损伤预防意义。目的 探讨IET对健康青年人肩关节内外旋肌的肌力平衡及神经肌肉控制能力的影响。方法 2020年12月至2021年11月在复旦大学附属中山医院招募32例健康青年志愿者为研究对象,随机将其分为试验组(n=16)和对照组(n=16)。试验组接受4周IET,对照组接受4周连续被动运动训练(2次/周)。采用Biodex System 4 Pro多关节等速肌力测试与训练系统(美国Biodex公司)对两组研究对象的优势侧肩关节内、外旋肌群进行训练干预,分别在60(°)/s、120(°)/s速度下进行,干预前1周、干预结束后1周对两组肩关节内外旋肌的功能性比率(FR)、加速时间(AT)和达峰力矩时间(TPT)进行评估并比较。结果 试验组全部完成了4周的训练干预和评估,对照组2例中途退出。最终共30例研究对象数据纳入统计学分析。在60(°)/s和120(°)/s速度下,试验组干预后FR高于对照组(P<0.001),试验组干预后FR高于干预前(配对t检验：t<...     

新型冠状病毒感染疫情防控与慢性病管理

新型冠状病毒感染疫情防控期间,各国出现了不同程度的常规医疗服务减少情况,慢性病管理工作也相应受到影响。2022年12月,中国调整了新型冠状病毒感染疫情防控相关政策和方案,医疗卫生系统面临挑战,基层医疗压力增加。在此情况下,本文基于其他国家经验,建议中国基层医疗应注重开展慢性病患者的自我管理,并为复杂和高需求的慢性病患者提供主动服务,加强对远程医疗的应用与研究,强化基层服务的社区连接,重点完善医疗服务的补偿机制。     

Effects of sodium nitroprusside (MR7S1) and nitroglycerin on the systemic,renal, cerebral,and coronary circulation of dogs anesthetized with enflurane

Summary In beagle dogs anesthetized with enfluranenitrous oxide, effects of sodium nitroprusside (SNP; MR7S1) and nitroglycerin (NTG) on hemodynamics and main organ circulation were studied to evaluate their effectiveness and safety as hypotensive agents during anesthesia. SNP (MR7S1) infusion (1–10 g/kg/min) decreased arterial blood pressure in a dose-dependent manner. The hypotension was stable during the infusion. After discontinuation of infusion, the blood pressure rapidly returned to the initial level. The hypotension was associated with decreases in cardiac output and total peripheral resistance. NTG infusion (3–10 g/kg/min) decreased arterial blood pressure, too, but the hypotension was less marked and not dose dependent, and the recovery was slower. Neither drug changed the heart rate. Infusion of SNP (MR7S1) and NTG did not change the hypotension induced by the injection of adenosine, SNP, and NTG. Furthermore, cerebral blood flow, cerebral oxygen consumption, and renal blood flow were unchanged during the hypotension produced by either drug. Coronary blood flow was decreased, but this was due to decreases in cardiac oxygen consumption. In conclusion, SNP (MR7S1) is superior to NTG as a hypotensive agent during anesthesia in efficacy, clear dose dependency, and rapid recovery. The hypotension induced by NTG as well as SNP (MR7S1) seems to have no undesirable effects on the circulation of important organs.     

Fluorescence spectroscopy guidance of laser ablation of atherosclerotic plague

Laser-induced fluorescence (LIF) spectroscopy can only be used for laser angioplasty guidance if high-power laser ablation does not significantly alter the pattern of tissue fluorescence. Although the spectra of normal and atherosclerotic arteries differ, the change in fluorescence spectra following laser angioplasty has not been well studied. Therefore, the purpose of this study was to assess whether laser-induced fluorescence spectroscopy could guide selective laser ablation of atherosclerotic plaque and, if so, to develop a quantitative LIF score that could be used to control a "smart" laser angioplasty system. Baseline LIF spectroscopy of 50 normal and 50 atherosclerotic human aortic specimens was performed using an optical fiber coupled to a He-Cd laser and optical multichannel analyzer. LIF was then serially recorded during erbium:YAG laser ablation of 27 atherosclerotic specimens. Laser ablation was terminated when the arterial LIF spectrum visually appeared normal. Histologic analysis revealed a mean initial plaque thickness of 1,228 +/- 54 microns and mean residual plaque thickness of 198 +/- 27 microns. Ablation of the media occurred in only three specimens. A discriminant function was derived to discriminate atherosclerotic from normal tissue for computer guidance of laser angioplasty. The LIF score, derived from stepwise multivariate linear regression analysis of the LIF spectra, correctly classified 93% of aortic specimens. The spectra obtained from the atherosclerotic specimens subjected to fluorescence-guided laser revealed a change in score from "atherosclerotic" to "normal" following plaque ablation. Seven atherosclerotic specimens were subjected to laser angioplasty with on-line computer control using the LIF score. Mean initial plaque thickness was 1,014 +/- 86 microns, and mean residual plaque thickness was 78 +/- 29 microns. There was no evidence of ablation of the media. Therefore, LIF guidance of laser ablation resulted in minimal residual plaque without arterial perforation. These findings support the feasibility of an LIF-guided laser angioplasty system for selective atherosclerotic plaque ablation.