OBJECTIVE:In the treatment of uterine fibroids with ultrasound-guided high-intensity focused ultrasound (HIFU), water balloons are considered to be a valuable aid for improving safety and efficiency. However, the water balloons worsen the pathway for acoustic transmission, causing degraded performance both in ultrasound therapy and in ultrasound imaging. This study was aimed at establishing a protocol to evaluate the effects of the water balloon.METHODS:Simulations and experiments were carefully conducted to quantitatively investigate the effects of water ballons on the efficiency of HIFU energy delivery and on the quality of ultrasound guiding images. More specifically, HIFU-induced temperature increases in the focal region, together with spatial resolution, contrast and signal-to-noise ratio in the ultrasound guiding images, were compared under the conditions with and without the water balloon.RESULTS:Experiment results revealed that the use of water balloons led to decreases in temperature up to 10ºC within the focal region in some specific situations, but the quality of the guiding images was relatively less affected.CONCLUSION:The study provided knowledge on what influence the water balloon could have in ultrasound-guided HIFU treatment; it also established a practical and standardized evaluation scheme for further optimizing the water balloon, for example, its material and internal liquid compositions. This study can potentially help improve the efficiency and safety of treating uterine fibroids with ultrasound-guided HIFU systems.

In this paper, an ultrasound beamforming method for plane wave (PW) imaging based on modified sidelobe blanking (MSLB) is proposed to improve image resolution and contrast ratio (CR). In this framework, PWs from various angles were designed to create main and auxiliary beamformer signals. Specifically, the PW signals from all angles were first coherently combined to serve as the main beamformer output signals. To prevent excessive clutter and noise, output signals in the main beamformer were weighted by the generalized coherence factor. Subsequently, the PW signals were split into positive and negative angles to perform a subtraction, creating the auxiliary beamformer. Finally, signals in the main beamformer were compared with the signals in the auxiliary beamformer point by point to further eliminate the noises and clutters. Compared with the delay and sum, full width at half maximum of the MSLB for point targets was reduced by an average of 54.17% and 51.65% in simulations and experiments, respectively; and the corresponding CR was improved by 55.38% and 18.40% on average. The MSLB method provided better imaging quality in human carotid arteries. In conclusion, the proposed method can effectively improve image resolution and CR with low computational complexity.

BackgroundOne big challenge in the noninvasive high-intensity focused ultrasound (HIFU) surgery is that the location and shape of its focus is unpredictable at the preoperative stage due to the complexity of sound wave propagation. The Acoustic Radiation Force Impulse (ARFI) imaging is a potential solution to this problem, but artifacts resulting from shear wave propagation remain to be solved.PurposeIn this study, we proposed avoiding those artefacts by applying the ARFI technique at a high imaging frame rate within a very short time before the shear waves start to propagate.MethodsUsing single transmission with a convex imaging probe, two ultrafast imaging modalities (the diverging wave and the wide beam), were developed in the ARFI framework, and their reliabilities were validated on a nylon string phantom by the centroid tracking method borrowed from ultrasound localization microscopy (ULM). The proposed ARFI method was tested on a clinically equivalent HIFU system under different acoustic radiation intensities by in-vitro, ex-vivo and in-vivo experiments. In three experimental scenarios, we delivered short HIFU stimulation pulses at varying acoustic powers to induce tissue motion within the focal region. At each experimental site, both diverging wave and wide-beam imaging techniques were employed for motion estimation. Based on the focus prediction derived from the motion estimation, HIFU ablation treatment was performed. The treated samples were then incised to examine the damaged areas. Additionally, ultrasound B-mode images were acquired before and after the procedure and saved for analysis.ResultsQuantitative analysis showed that the ARFI with wide beam imaging was able to predict the HIFU focus preoperatively, only with 1 to 3 mm of errors in focal central location, and less than 23% of percentage errors in focal area in most cases. However, the diverging wave imaging failed to predict the HIFU focus due to its low signal-to-noise ratio.ConclusionsIn conclusion, the inherent shear wave artefacts in ARFI for predicting the HIFU focus can be successfully avoided by carefully designing the imaging strategy and its working sequence. This ARFI technique was validated through a series of experiments on a clinically equivalent HIFU system, which demonstrated its capability in assisting surgical planning.

BACKGROUND:The persistence of symptoms in patients with chronic neck pain is considered to be associated with variation in the neck muscle structure and associated neuromuscular control. Sling exercise therapy (SET) has been demonstrated to relieve the symptoms of chronic neck pain, whereas it is controversial whether this benefit is correlated to altered neck muscle structure and associated neuromuscular control in the patients. OBJECTIVE:To investigate the effect of SET on cervical muscle structure (thickness) and associated neuromuscular control in patients with chronic neck pain. METHODS:Twenty-five patients with chronic neck pain were randomly assigned to the SET group (n= 12) or the control group (n= 13). The SET group received the SET intervention for 4 weeks, while the control group maintained normal activities of daily living. At baseline and after 4 weeks of intervention, Visual analogue scale and neck disability index were measured in both groups, and changes in the thickness of the superficial cervical muscles were assessed using musculoskeletal ultrasound. Surface electromyography (EMG) was adapted to assess the neuromuscular control of the neck while the participant was performing the cranio-cervical flexion test. RESULTS:At 4 weeks, the SET group had a significant reduction of RMS in both UT and SCM of EMG compared to the control group (p< 0.05). Regarding ultrasound, the SET group had significantly lower muscle thickness compared to the control group in both the rest position and the MVIC position (p< 0.05). There were no within-group differences in the control group (p> 0.05), while the SET group showed significant reductions in both RMS and muscle thickness (p< 0.05). CONCLUSION:4-week SET was effective in reducing pain and dysfunction in patients with chronic neck pain, which may be related to improved neck muscle thickness and neuromuscular control of the neck.

Objective:To characterize the severe sports injuries related to alpine skiing during the 2022 Beijing Winter Olympics and Paralympics so as to provide information for the prevention and treatment of sports injuries in the Yanqing National Alpine Skiing Center tracks.Methods:The medical data were collected of all the alpine skiing athletes and related staff who had sought medical treatment in Peking University Third Hospital Yanqing Hospital during January 20, 2022 to March 26, 2022. Descriptive statistical analyses were conducted for body part, type, occurrence place, and severity of the injuries.Results:There were 49 patients who had suffered severe injuries related to alpine skiing events during this Olympic Games, with 68 injuries by body parts and 72 injuries by types. The most common injury part was the knee (25.0%, 17/68), followed by the head (14.7%, 10/68), and the shoulder (8.8%, 6/68). The most common types of injury were contusion (including hematoma and abrasion, 30.6%, 22/72), followed by sprain (including dislocation, subluxation, and ligament injury, 22.2%, 16/72), and fracture (20.8%, 15/72). The most common occurrence place in the tracks for athletes was the "Haituo Bowl" area (41.7%, 10/24). In terms of severity, the injuries led to an absence from training or competition in 48 athletes [98.0% (48/49)], of whom 33 were severely injured [67.3% (33/49)].Conclusions:The most vulnerable part for severe sports injuries in the alpine skiing events of the 2022 Beijing Winter Olympics and Paralympics was the knee, mostly with ligament injuries, which is consistent with the findings of previous events. The high proportion of severe injuries indicated the difficulty of this track. The place where injuries mostly occurred was the "Haituo Bowl" area of the racing track, also the most challenging part of this track, indicating a necessity of more medical resources in this area.

为高质量完成北京冬奥会各项医疗保障任务,北京大学第三医院延庆医院(以下简称北医三院延庆医院)按照《2022年冬奥会和冬残奥会医疗卫生保障工作规范(标准)》,以严格闭环方式开展冬奥定点医院专区建设工作,并在专区提供"一站式"医疗服务,圆满完成相约北京系列测试赛的服务保障.本文就冬奥定点医院医疗保障专区建设管理相关工作进行简要分析探讨,为北京冬奥会和今后突发公共卫生事件下的各类国际赛事定点医院医疗保障工作提供借鉴和参考.

"首都十大疾病科技成果推广项目"旨在促进科技成果在各级医疗卫生机构的转化与推广,提高北京临床诊疗水平和规范化程度,使科技研究成果真正"落地".延庆区某二级医院的科技成果推广项目通过原科技成果课题负责人及其团队的培训和指导、二级医院消化吸收再利用、再辐射到区域内多家社区卫生服务中心及社区卫生服务站,实现区域内科技成果知识的广覆盖.健康教育是医疗卫生事业的重要组成部分,延庆区某二级医院将健康教育应用在基层医院的科技成果推广工作,将科技成果推广知识应用于医护人员、门诊患者、住院患者、社区居民、大众普及及健康教育的个性化方面,惠及医、护、患、众各个层面,能够取得良好的经济效益和社会效益.

目的:为全面提升医疗技术和服务质量,切实提高医疗卫生行业服务能力,满足2019年世界园艺博览会园会区域医疗服务保障需求,增强卫生应急综合处理能力,使卫生应急队伍掌握卫生应急相关的基本方法和技能,制定心肺复苏培训方案,以提高全员心肺复苏急救技能.方法:采用PDCA循环法,建立一套完整的计划、实施、检查和新问题处理计划流程.建立师资队伍及院科两级培训机制.将理论和操作相结合,特别注重培养实际操作能力,使全体医务人员快速掌握心肺复苏技术.结果:培训结束后对考核成绩进行统计分析,全员心肺复苏技能从熟练程度到高质量复苏技能掌握情况都有了不同程度提高.结论:心肺复苏技术是每一位医务人员必须熟练掌握的基本急救,所以对全体医务人员定期进行心肺复苏培训,具有可行性和可持续性.利用PDCA循环管理法发现培训中的问题、进一步分析问题、解决问题,从而使心肺复苏技能不断提高,是行之有效且在基层医院可推广使用的方法.

目的 了解进行学籍制管理下乡村医生对区级医院组织乡村医生培训项目的满意度,并进一步了解对培训的需求,推进乡村医生医生培训工作更加规范化、合理化.方法 采用自制的乡村医生培训授课满意度调查表及培训需求调查表,选取在我院进行培训的15个社区卫生服务中心的153名乡村医生进行问卷调查.结果 乡村医生对培训的总体满意度为86.47％,较培训前有所提高.92.16％的人希望培训以理论结合实践的形式,42.48％的人希望能安排在门诊轮转2～4周,只有24.83％的希望在病房轮转.在培训内容的需求上关注农村常见病多发病、针灸、推拿等方面知识的培训占90.20％.结论 学籍制管理下的乡村医生培训顺应了广大乡医的迫切需求,能够促进乡村医生的医疗水平.

目的 探索"3+2"助理全科医师的培训模式,推进"3+2"助理全科医师的培训的规范化、标准化、统一化.方法 选取2017级"3+2"助理全科医师第一年轮转培训科室的32名带教医师,对出科技能考核给予工作量的量化,并分别在工作量考核实施前后进行工作满意度的问卷调查.结果 带教医师对出科技能考核工作满意度由之前的72.00%提高到85.30%,整体工作满意度、工作性质、工作薪酬、晋升机会、当前的工作情形在实施前后对比,差异有统计学意义(P<0.05).结论 对"3+2"助理全科医师规范化培训的出科技能考核进行合理的工作量量化,能够提高带教医师的工作满意度,从而调动带教医师的工作积极性,提高培训质量.

目的 通过回顾性分析采用外固定架联合克氏针撬拨闭合复位或有限切开复位固定治疗桡骨远端C3型骨折的临床疗效.方法 回顾性分析自2012年10月至2015年11月,共23例患者,23例复杂桡骨远端关节内骨折,AO C3型;通过外固定架联合克氏针闭合复位或者有限切开复位治疗,分别对患者的年龄、功能评分、相关病变、并发症、临床畸形和复位的质量进行了分析.进行独立和配对样本t检验.用线性回归分析确定连续参数变量之间的相关性.显著性差异设定在P<0.05.结果 所有患者平均随访20个月(14～26个月),末次随访,改良的Gartland和Werley评分系统:优5例,良12例,一般5例,差1例.总体结果满意.结论 通过外固定架联合克氏针固定闭合复位或有限切开复位治疗桡骨远端C3型骨折可以取得满意的临床效果,功能情况与关节面复位情况相关.

助理全科医师培养已成为北京郊县向农村基层医疗卫生机构输送人才的主要方式.介绍了国内外全科医师岗位胜任力的研究进展情况,指出了助理全科医师岗位胜任力特征分析的必要性,从基本医疗服务能力、公共卫生服务能力、职业素养3方面提出了助理全科医师岗位胜任力特征指标.

目的 评价三维人体解剖软件在骨科临床教学中的作用.方法选择两个骨科教学课题对18名实习学生进行授课,其中一个课题采用三维人体解剖软件对其中的解剖学知识进行讲授,另一课题采用传统二维图谱对其中的解剖学知识进行讲授,课后3天分别对两次讲课内容进行测验;以学生的两次考试成绩评价三维人体解剖软件的教学效果.同时对学生和老师进行调查问卷,比较他们对两种教学方法的满意度.结果三维人体解剖软件在骨科临床教学中效果较传统二维解剖图谱好,两次学生的考试成绩差异有统计学意义(t=5.24,P<0.01).调查问卷显示采用三维人体解剖软件教学更受学生和教师的欢迎.结论三维人体解剖软件为骨科临床教学提供了一种新的方法.它一方面便于学生对各部位组织解剖的理解和记忆;另一方面让学生对临床疾病和手术入路的理解更深入.因此三维人体解剖软件在骨科临床教学中有重要的价值.

外科基本操作的教学具有内容比较统一、实际操作依赖性强的特点,而传统的教学方式在课堂上很难让同学有足够的时间进行操作练习,更加依赖水平、态度参差不齐的临床单独带教.随着互联网的发展,慕课教学和翻转课堂的教学方式应运而生,这种教学方式的改革在优秀教学资源的共享和学生自学能力、交流能力、自控能力的培养上有着传统教学方式无法比拟的优势,并在本年度外科基本操作的教学中进行了实践性的探索,取得了良好的教学效果.这种教学方式有其独到的优势也有不能回避的缺点,更好的应用这种新生的教学方式提高外科基本操作等临床教学内容的教学质量,需要进一步的探索和总结.

Objective To evaluate the clinical curative effect of less invasive stabilization system(LISS)in treating type C fractures of the distal femur fractures. Methods From March 2010 to June 2015,using less invasive stabilization system(LISS)in treating distal femur type C fractures in 25 cases. Results Patients were all followed up for 6~18 months,according to the American hospital for special surgery knee score(HSS)standard:excellent 16,good 5,general 3,bad 1,fine rate 84%. Conclusions Less invasive stabilization system(LISS)treatment for distal femur type C fractures can achieve stable fixation,early postoperative functional exercises knee flexion and extension and obtain good clinical effect.

Objective To investigate the therapeutic effect of intramedullary nail for tibial shaft fractures via the supra-patellar approach. Methods 18 patients with supra-patellar approach on the clinical data of intramedullary nailing for tibial shaft fracture from June 2012 to December 2015 were retrospectively analyzed. Results All patients were followed up for 6~24 months,according to the Lysholm knee rating 75~93 points, 88 points average. Conclusion The supra-patellar approach on intramedullary nailing for tibial shaft fracture,which reset and the operation is convenient,postoperative knee pain rate is low,thus achieving good clinical effect.

Objective To investigate the therapeutic effect of dynamic hip screw(DHS)for femoral neck basal fracture. Methods Between January 2012 and August 2015,DHS in treatment of femoral neck basal fractures in 18 cases were adopted in our department,10 cases on the left side,8 cases on the right side,and the clinical therapeutic effect was observed. Results 18 cases all received follow-up 6~24 months,all fractures healed and no femoral head necrosis occurred,limb function was excellent 14,good 3,general 1. Conclusion DHS as the treatment for femoral neck basal fracture is fixed firmly,the effect is exact,it is an effective treatment for femoral neck fractures in base.

Objective To analyze the effect of intramedullary fixation system on femoral intertrochanteric fracture in the elderly.Methods Proximal femoral nail anti-rotation (PFNA),proximal femoral nail (PFN),pressure interlocking intramedullary nail (InterTan) and Asian PFNA(PFNA-Ⅱ) four intramedullary fixation system were used to treat 95 elderly patients with femoral fractures.The operation time,intraoperative blood volume,number of fluoroscopy,fracture healing time and the final follow-up of Harris scores were compared among four methods.Results All 95 cases were followed up for 7 ～ 20 months.Fracture healing time was 6 ～ 9 months.The femoral neck fracture occurred in 1 case of PFNA group at 5 months after the operation.1 case of postoperative 3 months spiral blade cut out in PFNA-Ⅱ group;deep venous thrombosis occurred in 2 cases of the PFN group at 1 week after operation.Operation time:PFN group was longer than other three groups,compared with PFNA group and PFNA-Ⅱ group,the difference was statistically significant (P ＜ 0.05).there was no statistically significant difference compared with InterTan group (P ＞ 0.05);lnterTan group was compared with PFNA group and PFNA-Ⅱ group,the differences were statistically significant (P ＜0.05).PFNA group was compared with PFNA-Ⅱ group,the difference was statistically significant (P ＜ 0.05).Intraoperative blood loss:PFN group was more than the other three groups,compared with PFNA group and PFNA-Ⅱ group,the differences were statistically significant (P ＜ 0.05),there was no statistically significant difference compared with InterTan group (P ＞ 0.05);InterTan group was compared with PFNA group and PFNA-Ⅱ group,the differences were statistically significant (P ＜ 0.05),PFNA group had no statistically significant difference compared with PFNA-Ⅱ group (P ＞ 0.05).Machine C-arm fluoroscopy times:PFN group was more than the other three groups,compared with PFNA group and PFNA-Ⅱ group,the differences were statistically significant (P ＜ 0.05),there was no statistically significant difference compared with InterTan group (P ＞0.05);InterTan group was compared with PFNA group and PFNA-Ⅱ group,the differences were statistically significant (P ＜ 0.05);PFNA group had no statistically significant difference compared with PFNA-Ⅱ group (P ＞ 0.05).There were not statistically significant difference among the four groups of fracture healing time and the last follow-up of Harris scores (P ＞ 0.05).Conclusions Femoral intertrochanteric fractures should be treated with proper methods as intramedullary fixation system which can obtain good curative effect,and PFNA-Ⅱ and PFNA are less trauma.

2008年1月~2016年1月，我科应用支撑钢板治疗35例三踝骨折患者，疗效满意，报道如下。

Objective To explore the effect of ACP cemented prosthesis for treatment of senile femoral neck fracture. Methods Eighty-four cases of senile patients with femoral neck fracture were treated with ACP cemented prosthesis bipolar artificial femoral head replacement. According to the Harris score and X-ray examination,the clinical efficacy was assessed. Results All 84 cases received follow-up time for 6~36 (18 ± 3. 5) months. Patients with hip joint function restored well, no hip varus and dislocation was found. Early infection occurred in 2 cases, they recovered well after through debridement and prosthesis replacement. Preoperative examination showed 4 cases of intermuscular veniplex thrombosis of lower limb, postoperative examination showed intermuscular veniplex thrombosis in 10 cases, posterior tibial vein thrombosis in 2 cases. No venous plexus thrombosis was found after anticoagulant treatment. Two cases of posterior tibial vein thrombosis review showed venous thrombosis absorption after treatment. Harris hip joint function scores were excellent in 63 cases, good in 16, and poor in 5. Conclusions ACP cemented prosthesis in the treatment of femoral neck fracture in the elderly can allow early weight bearing, recover heart and lung function, im-prove the quality of life. Perioperative aggressive anticoagulation therapy can reduce the incidence of venous thrombo-sis in the lower extremity.