基于运营数据中心的诊位与床位资源效率及配比研究

目的:基于医院运营数据中心,分析2019—2021年医院临床科室门诊人次与出院人次的配比关系,建立诊位与床位的资源配置模型,为合理配置诊位与床位资源提供参考。方法:采用每诊位门诊人次与每床位出院人次配比关系建立诊位和床位的合理配置模型,对临床科室诊位与床位配置合理性进行评价。结果:本研究33个临床科室中6个科室床位与诊位配置合理,24个科室床位配置过剩(或诊位配置不足),3个科室床位配置不足(或诊位配置过剩)。结论:对27个诊位床位配置不合理的科室,提出调整建议。

Preoperative Localization of Insulinoma by Intra-arterial Spiral CT

Objective To evaluate the value of intra-arterial dynamic spiral CT on preoperative localization of insulinoma. Methods Two patients with insulinoma proved by operative pathology were preoperatively localized by intra-arterial dynamic spiral CT. Results In intra-arterial spiral CT, two small insulinomas (1.5–2.0 cm in diameter) demonstrated as a significantly high dense nodule 20 s later after initiation of injection of contrast medium. The course of high density lasted nearly 4 min. Conclusion Intra-arterial dynamic spiral CT could clearly detect small insulinoma, and might be one of most effective preoperative localization methods for small insulinoma. Key words insulinoma - anteriography - CT

Genetic predisposition to inflammation:a new risk factor of Alzheimer's disease

Inflammation has been shown to play an important role in the progression of Alzheimer＇s disease （AD）. Recent epidemical study indicates that the incidence of AD in some populations is substantially influenced by the gene polymorphisms of the inflammation mediators. Meanwhile, an ensured risk factor, the ApoE ε4 allele is also reported to directly promote inflammation. Accordingly, it appears that an individual genetic background has partly determined his predisposition for AD by the extent of the inflammation response to the chronic stimulus by β-amyloid peptide （Aβ） deposits and other antigen stressor in the elderly. Hence we present a hypothesis that the inflammation genotypes may contribute to AD susceptibility. This may provide a new orientation both for future identification of individuals at risk and for personalized medication.

A MISDIAGNOSED CASE OF SACROILIAC JOINT INJURY AND MALPOSITION

Sacroiliac joint malposition is one of the main causes evoking lumbocrural pain. Because its clinical symptoms are similar to those induced either by lumbar intervertebral disc protrusion or by ankylosing spondylitis （AS） at the early stage, and because X-ray results taken at its early stage were not evident for differentiating the diseases,

Diagnosis and management of postural orthostatic tachycardia syndrome：A brief review

Postural orthostatic tachycardia syndrome （POTS） has been recognized since at least 1940.A review of the literature identifies differences in the definition for this condition and wide variations in treatment and outcomes.This syndrome appears to describe a group of conditions with differing pathophysiology,which requires treatment tailored to the true underlying disorder.Patients need to be fully evaluated to guide treatment.Further research is required to effectively classify the range of underlying pathophysioiogy that can produce this syndrome and to guide optimal management.

EUS diagnosis of ectopic opening of the common bile duct in the duodenal bulb: A case report

Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery.As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.

Sigmoid colon endometriosis treated with laparoscopy-assisted sigmoidectomy:Significance of preoperative diagnosis

We present a female patient with sigmoid colon endometriosis who was diagnosed correctly preoperatively and underwent minimally invasive surgery. She was admitted to our hospital with rectal bleeding and constipation. We performed several workups. Colonoscopy and endoscopic ultrasonography showed sigmoid colon stenosis caused by submucosal tumor, and magnetic resonance imaging revealed a sigmoid colon tumor displaying signal hy- pointensity on both T1- and T2-weighted imaging. However, colonoscopic ultrasonography-assisted needle aspiration biopsy could not specify tumor characteristics. From these examinations, the lesion was diagnosed as sigmoid colon endometriosis and laparoscopy-assisted sigmoidectomy was performed. Pathological diagnosis from the resected specimen was identical to preoperative diagnosis, i.e., colonic endometriosis. Since differential diagnosis of intestinal endometriosis seems difficult, a cautious preoperative diagnosis is required to select treatments including minimally invasive surgery.

Clinical role and importance of fluorescence in situ hybridization method in diagnosis of H pylori infection and determination of clarithromycin resistance in H pylori eradication therapy

H pylori is etiologically associated with gastritis, gas-tric and duodenal ulcers, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. Eradicating H pylori may convert rapidly the outcome of related diseases with the use of more accurate diagnostic molecular tests. Indeed some of the tests cannot give the evidence of current infection; H pylori can be detected by noninvasive and invasive methods, the latter requiring an endoscopy. Eradication failure is a big problem in H pylori infection. Recently, clarithromycin resistance in H pylori strains is increasing and eradicati-on therapy of this bacterium is becoming more difficult. Molecular methods have frequently been applied besides phenotypic methods for susceptibility testing to detect clarithromycin resistance due to mutations in the 2143 and 2144 positions of 23S rRNA gene. Fluorescence in situ hybridization (FISH) method on paraffin embedded tissue is a rapid, accurate and cost-effective method for the detection of H pylori infection and to determine clarithromycin resistance within three hours according to the gold standards as a non-culture method. This method can also be applied to fresh biopsy samples and the isolated colonies from a culture of H pylori, detecting both the culturable bacillary forms and the coccoid forms of H pylori, besides the paraffin embedded tissue secti-ons. This technique is helpful for determining the bac-terial density and the results of treatment where clarith-romycin has been widely used in populations to increase the efficacy of the treatment and to clarify the treatment failure in vitro.

A new approach for on-line open-circuit fault diagnosis of inverters based on current trajectory

Security and reliability of inverter are an indispensable part in power electronic system. Faults of inverter are usually caused by switch elements’ operating fault. Taking the inverter with hysteresis current control as the research object, a universal open-circuit fault location method which can be applied to multiple control strategies is proposed in the paper. If the switch open-circuit fault happens in inverter, the output phase current will inevitably change, which can be used as a characteristic for diagnosis, combined with the comparison of phase-current direction before and after the fault occurrence, to diagnose and locate the open-circuit fault in a half cycle. Moreover, this method requires neither system control signals nor sensor. The validity, reliability and limitation of the fault location method in the paper are verified and analyzed through dSPACE-based experiment platform.

Imaging of the Extra-axial Tumors and Tumor-like Lesions Involving both Middle and Posterior Cranial Fossae: Classification and Diagnosis

Objective: To study the imaging features of extra-axial tumors and tumor-likelesions involving both middle and posterior cranial fossae and to make a classification. Methods:Sixty cases of pathologically confirmed extra-axil tumors and tumor-like lesions involving bothmiddle and posterior cranial fossae were analyzed. They were divided into central and lateral types,the latter of which were subdivided into three types: middle cranial fossae type, posterior cranialfossae type and the over-riding type. The constitution and imaging features of each type wereanalyzed. Results: There were 12 cases of central type, including chordoma (n=5), pituitary adenoma(n=3), nasopharyngeal carcinoma (n=2), craniopharyn-gioma (n=1) and meningioma (n=l). 48 cases oflateral type including trigeminal nerve tumors (n=14), meningioma (n=12), epidermoid cyst (n=11),dural cavernous hemangioma (n=4), dermoid cyst (n=2), metastasis (n=2), hemangiopericytoma (n=1),paraganglioma of glonius jugular (n=1) and nasopharyngeal carcinoma (n=1). Each type of the lesionshad its own shape features, some of which were characteristic for some specific tumors. Most of thetumors and tumor-like lesions could be qualitatively diagnosed according to their imagingcharacteristics and the extent of the lesions could be defined definitely. Conclusion: It is helpfulto categorize extra-axial tumors and tumor-like lesions involving both middle and posterior cranialfossae according to their location for qualitative diagnosis and description of the extent of theselesions. It is of great clinical value in providing more precise and thorough imaging informationfor planning therapeutic methods and route of operation.

CLINICAL STUDY ON MANIPULATIVE TREATMENT OF DERANGEMENT OF THE ATLANTOAXIAL JOINT

The derangement of the atlantoaxial joint is one of main cervical sources of dizziness and headache, which were based on the observation on the anatomy of the upper cervical vertebrae, analysis of X-ray film of the atlantoaxial joint, and the manipulative treatment in 35 patients with cervical spondylosis. The clinical diagnosis of derangement consists of: dizziness, headache, prominence and tenderness on one side of the affected vertebra, deviation of the dens for 1 mm-4 mm on the open-mouth X-ray film, abnormal movement of the atlantoaxial joint on head-rotated open-mouth X-ray film. An accurate and delicate adjustment is the most effective treatment.

PRELIMINARY STUDY OF THREE- TONE PARADIGM AUDITORY P300 ON AGING DEMENTIA

Objective. To explore the changes of three- tone paradigm P300 and observe the improvement of the diagnostic sensitivity of P300 in aging dementia. Methods. Thirty- four patients of aging dementia underwent traditional P300 (2t- P300) and three- tone paradigm auditory P300 (3t- P300). The results of these two methods were compared. Results. Abnormal P300 was found in 18 of 34 dementia cases (52.9％ ) by 2t- P300, and in 26 of 30 patients who finished the 3t- P300 tests (86.7％ ). In 2t- P300, 9 of 24 mild cases, 7 of 8 moderate cases and 2 severe cases showed abnormal results. In 3t- P300, 20 of 24 mild cases and all 6 moderate cases showed abnormal results. Abnormal 3t- P300 was found in 13 of 16 cases which showed normal 2t- P300. Besides prolonged and bad- shaped P300, no certain response of P300 to rare non- target stimulus (r- nT) was found in 10 mild cases by 3t- P300. Conclusion. Three- tone paradigm auditory P300 had higher sensitivity in early diagnosis of aging dementia than traditional auditory P300. No P300 response to r- nT in 3t- P300 is an important index in early diagnosis of mild dementia.

DIAGNOSIS AND TREATMENT OF THE PITUITARY METASTASES

Three cases of pituitary metastases were reported. They all had operations and the pathological exami-nation confirming the diagnosis. The clinical features of diabetes insipidus and extraocular nerve palsy were presented. In two cases, the original tumors were bronchioloalveolar carcinoma; in the other one, the original tumor was unknown. All three cases had poor outcome. These cases illustrate the fact that a pituitary metastasis can closely mimic a pituitary benign tumor, such as pituitary adenoma. Especially in the presence of suggestive symptoms such as diabetes insipidus and/or cranical nerve paralysis, the possibility of metastatic disease in the differential diagnosis of a pituitary mass should always be considered.

Optimizing prostate biopsy for repeat transrectal prostate biopsies patients

Objective： Diagnosis of patients with negative prostate biopsy and persistent suspicion of prostate cancer re- mains a serious problem. In this study, we investigated the application of optimizing prostate biopsy for patients who need repeat prostate biopsy. Methods： In this prospective, non-randomized phase-I clinical trial, the prostate cancer detection rate of initial detection scheme was compared with optimizing prostate biopsy scheme. The number of punctures of initial detection scheme was the same as that of optimizing prostate biopsy scheme. The puncture direction of optimizing prostate biopsy was a 45~ angle to the sagittal plane from front, middle, and back. The two cores from each lateral lobe were horizontally inwardly inclined 45~. Results： A total of 45 patients with initial negative biopsy for cancer were received the optimizing prostate biopsy scheme. The cancer detection rate was 17.8% （8/45）, and prostate intraepithelial neoplasm （PIN） was 6.7% （3/45）. The pa- tients receiving repeat transrectal prostate biopsies were pathologically diagnosed as lower Gleason grade prostate cancers. Conclusion： The cancer detection rate of repeat biopsy prostate cancer is lower than that of initial biopsy. Our study showed that the optimizing prostate biopsy is important to improve the detection rate of repeat transrecta~ prostate biopsies patients.

THE THEORY OF MOIST POTENTIAL VORTICITY AND ITS APPLICATION IN THE DIAGNOSIS OF TYPHOON RAINFALL AND INTENSITY

This paper tests the impacts of cloud-induced mass forcing on the moist potential vorticity （MPV） anomaly associated with torrential rains caused by Typhoon No.9914 （Dan） by using fine model simulation data outputted by the Fifth-Generation NCAR / Penn State Mesoscale Model （MMS）. The diagnostic results show that the positive MPV anomaly region, which is obtained by integrating the MPV from 600 hPa to 300 hPa in the vertical, roughly coincides with the precipitation at their synchronous stages either in position or in the distribution pattem, and the maximum positive MPV area of Dan is located mainly between 600 hPa and 300 hPa, which is much higher than torrential rain cases. Further analyses also showed that the value of positive MPV anomaly increased or decreased with the development of Dan, and the positive MPV anomaly may also be served as a tracer to indicate the evolution of tropical cyclone intensity.

SIX KEY POINTS FOR ACUPUNCTURE THERAPY

In the present paper, the author puts forward six key points for acupuncture treatment of diseases, namely, (1) careful examination, (2) definite diagnosis, (3) precise and appropriate identification of syndromes, (4) accurate location of the acupoint, (5) flexible application of needling manipulations, and (6) 'Deqi'. The first three aspects are the foundation, accurate location and flexible needling manipulations are also the prerequisite for effective treatment of diseases. In addition, sound theoretical basic knowledge of both traditional Chinese medicine (TCM) and modern medicine, and flexibly applying suitable needling maneuvers, stimulating quantity and duration of needle retaining in accordance with the concrete state of disease and the patient's conditions are also very important in clinical practice of acupuncture.

A CASE-CONTROL EPIDEMIOLOGIC STUDY OF ENDOMETRIOSIS

A case-control study involving 203 cases of pelvic endometriosis seen from 1987- 1989 , and 406 randomly selected and age-matched community controls was conducted in order to provide information relevant to effective prophylxais of the disease. The diagnosis was confirmed by pathology from laparotomy and/or laparoscopy. A questionnaire focused on menstrual, marital and reproductive status , professional exposure and physical activities ,and the results were analyzed by a conditional logistic regression model. Women characterized by earlier menarche(≤ 12 years) and longer period(≥8 days) were found to be associated with an elevated incurring risk, and a trend of increasing risk associated with primary dysmenorrhea (RR =2. 1 for mild to moderate and RR= 5. 2 for severe dysmenorrhea), energetic physical activity during menstruation (RR =2. 1) , and allergic diathesis(RR=1 . 8) was seen. An inverse relationship was observed between the number of pregnancies and risk of endometriosis,and the protective effect was most significant when only the number of full-term pregnancies was counted.The risk factors of endometriosis are discussed, and intensive treatment of primary dysmenorrhea and avoidance of strenuous exercise during menstruation are identified as important measures in the prevention of endometriosis.

Recent Developments of Beam Diagnostics

The paper introduces some of the recent developments in beam diagnostics,which include the beam position measurement techniques with sub-micrometer resolution,the beam size measurement techniques with sub-micrometer resolution,and the bunch length measurement techniques with sub-picosecond resolution.The cavity beam position monitor and the digital BPM signal processing technique are introduced for the beam position measurement techniques. The laser wire beam profile monitor,and the optical transition radiation/optical diffraction radiation beam size monitor are introduced for the beam size measurement techniques.The spectral techniques of coherent radiation,the transverse deflecting cavity,the rf zero-phasing technique,and the electro-optic techniques are introduced for the bunch length measurement techniques.