Objective: To explore effectiveness of clinical application of the patch type dynamic ecg recorder by comparing with conventional dynamic ecg recorder Holter. And the clinical ecg teaching models is discussed in this paper. Methods: Using parallel controlled trial method, 60 patients in two hospitals received Holter examination, and patch heart testing at the same time. A comparative analysis of two kinds of inspection methods on testing the average heart rate, supraventricular premature beats and ventricular premature beat was made. Results: The average heart rate of patch type ECG and Holter were 71.87±9.28 and 72.55±9.06 ( P = 0.0879). Two kinds of detection methods, chamber on the coincidence rate of premature beat (PPS) was 98.33%, 95% CI (91.06, 99.96), Kappa = 0.9462, 95% CI (0.84, 1.00), good consistency. The accuracy of ventricular premature beat (PPS) was 98.33%, 95% CI (91.06, 99.63), Kappa = 0.9850, 95% CI (0.90, 1.00), good consistency. Patch type heart all platform is suitable for self-study and clinical care study, and professional skill assessment,etc. Conclusion: The effectiveness of patch type heart all on testing the average heart rate, supraventricular premature beat is the same as Holter. it is also suitable for to carry out clinical ECG teaching at the same time.

本文介绍基于新媒体－无线服务器的肾脏患者应知应会健康科普教育。该系统适用于患者在医院门诊、血液透析和住院病房等候时用智能手机或Ipad等移动终端进行实时健康教育。系统的功能有对医院、科室、医师的介绍性内容；有健康教育视频；有专科健康教育的应知应会内容；有自助挂号、检验报告查询等服务性内容；有影视片、游戏等娱乐内容。该系统构架由医院、患者、服务公司三方面组成，软件通过建立专科数据模块，硬件通过智能手机、无线服务器、互联网等实现，并有云计算和大数据功能。该系统适合健康教育，并有利于提高医疗服务水平。

This paper introduces the kidney health education mobile platform based on mobile terminals like the smart phone or iPad .This system is applicable to real-time health education for patients waiting at hospital outpatient department or at home .The functions of the system include introducing hospitals , departments and physicians; playing health education videos; providing necessary content of specialized health education;providing service in self-service registration and lab test report query;and providing entertainment such as games , TV programs and movies .The platform is constructed jointly by the hospital, patients'families, and the service company.Software can be realized with establishment of specialized APP while hardware can be realized with smart phones , wireless routers , servers and the Internet.The platform also has the functions of cloud computing and big data .All in all, the system is suitable for health education and conducive to the improvement of medical services .

This paper first introduces cloud computing and its characteristics.Then in view of the problems of doctor-patient interaction in the traditional Internet,it puts forward the project of applying cloud computing in doctor-patient interaction platform,analyzes the structure and characteristics of doctor-patient interaction information platform of kidney specialty,and points out the direction of its development.

Objective:To explore the method for bacterial detection and antibacterial solution in recurrent urinary tract infection.Methods:A total of 86 patients with recurrent urinary tract infection were randomly divided into two groups,43 in Chinese and Western medicine group while 43 in Western medicine group.Long-course treatment was carried out by different stages which were treatment stage,consolidation stage(reducing drug dose),maintenance stage(once every night) and observation stage(drug suspension).According to urine germiculture,susceptibility test and clinical verification,antibiotics were selected.For Western medicine group,a variety of antibiotics were used alternatively,while patients in Chinese and Western medicine group were given Ningmitai as a plus.Results: Among 86 patients,77 cases(89.5%)were cured.The cure rates of the two groups had no significant difference.The consolidation stage and the overall treatment time in medicine group were significantly shorter than those in Western medicine group(P0.05).In both groups,there were no significant changes in the result of blood routine tests,liver and renal functions before and after the treatment.Conclusions: Treatment according to different stages,combination of traditional Chinese and Western medicine,alternative medicine have good curative effects for recurrent urinary tract infection.

复发性尿路感染反复发作,不容易控制和彻底治愈,长期应用抗生素又会产生不良反应和耐药性.为了更好地控制复发性尿路感染,我们设计了一种规则的分期抗菌疗法,前瞻性地观察其疗效来评判其实用性. 一、对象与方法 1.对象:2006年5月-2008年12月的门诊慢性尿路感染患者,符合复发性尿路感染的诊断标准[1](病史2年以上,每年发作多于3次),且前期抗生素、中成药等治疗未能控制反复发作,近期感染治疗2周以上未治愈,除外严重心、肝疾病,严重感染和妇科感染疾病者,共入组68例.

Objective To observe the therapeutic effects of the drugs alternation multiple stages and long term therapy in elderly patients with recurrent urinary tract infection.Methods The patients were divided into elderly group (age≥65 years,n=30) and non-elderly group (n=48).The multiple effective antibiotics were selected for alternate use.The treatment included four periods as follows:(1)Treatment period:the regular dose of antibiotic was maintained until the urine routine test result became normal;(2)Consolidation period:the dosage of antibiotic was reduced;(3)Maintenance period:the dosage of antibiotic was reduced to once every night and the treatment should be kept for three months;(4)Observation period:the patients were observed for six months after withdrawal of antibiotics.During the treatment,if the urine routine test became abnormal repeatedly,the patient should return to the previous treatment period.During the treatment and consolidation period,each medication should be applied for one week alternatively.Results Among 78 patients,69 cases (88.5%) were cured,7 cases (8.9%) were effective,and two cases (2.56%) were invalid.There were 28 cured cases,1 effective case and 1 invalid case in elderly group.The corresponding data were 41,6 and 1 in non-elderly group,respectively.There was no difference in cure rate between the two groups (F= 0.469).Compared with non-elderly group,the overall treatment time [(54.8± 16.2)weeks vs.(44.5± 13.7) weeks,t= 2.8467,P＜0.01],treatment period [( 34.3± 15.2) weeks vs.(26.2±14.8) weeks,t=2.2081,P＜0.05] and consolidation period [(5.7±2.6) weeks vs.(4.1±0.2) weeks,t=3.9369,P＜0.01] were all prolonged in elderly group.But there was no difference in maintenance period [(14.8±4.6) weeks vs.(14.2±3.1) weeks,t=0.6480,P＞0.05].There were no markedly changes in blood routine,liver and kidney function during the course of treatment.Conclusions For the elderly patients with recurrent urinary tract infection,the drugs alternation,multiple stages and long-term treatment has a high cure rate and no adverse effect on blood routine,liver and renal function.

Objective:To investigate the efficacy and safe on recurrent urinary tract infection of combining traditional Chinese and western medicine treatment.Methods:78 cases of recurrent urinary tract infections were randomly divided into two groups,Combining traditional and western medicine group of 38 cases Combined with Chinese medicine NingBi tai,and western medicine group of 40 cases.Using the method of NingBi Tai is three goals each time.three times a day During the treatment period,and two times a day in the consolidation period,and once daily in the maintenance period,continuous use,discontinuation in the Observation period.Results:Among 78 patients,69 cases were cured,7 cases were effective,and two cases were the opposite.Western medicine group 35/40、4/40、and1/40respectively,traditional and western medicine group 34/38、3/38、and 1/38 respectively.The cure rate and middle urine germiculture positive of Traditional Chinese and Western medicine group and Western medicine group are no difference.The total treatment time was from 22 weeks to 118 weeks in the cured 60 cases,including treatment period(6 to 75 weeks),consolidation period(4 to 13 weeks),and maintenance period(12 to 30 weeks).The average period of each four stages was(50.1±20.6)weeks,(30.48±15.23)weeks,(5.28±2.34)weeks,(14.33±3.7)weeks.The time of treatment,consolidation,maintain period and total duration,in the traditional and western medicine group were respectively(28.2±10.2)weeks,and(4.3±3.6)weeks,and(14.2±4.6)weeks,and(46.7±10.2)weeks,in the western medicine group were respectively(32.4±12.8),and(5.5±2.2)weeks,and(14.8±3.1)weeks,and(52.7±11.7)weeks.Compared with western medicine group,the time of the period of total treatment in chinese and western medicine group are statistically distinguishable shortened in statistical differences(P<0.05),without treatment,consolidate and maintenance period.There were no significant changes in blood routine,liver and renal functions among,before and after the treatment.No adverse effect on blood routine,liver and renal function.Conclusion:For recurrent urinary tract infection,the use of the method of stage treatment with several antibiotics has a high cure rate and Combined with the traditional and western medicine with NingBi tai than western medicine,the total treatment is shorter.

The paper first analyzes the basic functions of the specialty information platform.Then it introduces the basic functions,information sources,key information technology,functional module requirements,and the platform management of kidney disease specialty information platform.It points out that establishing this information platform can meet the development of network information and clinicians' needs.

Clinical pathway is a standard issued by the Ministry of Health to guide physicians in providing patients with diagnosis and treatment.Clinical pathway must be realized by the clinical pathway physicians' workstation.This paper discusses the nature and characteristics of clinical pathways as well as the functions of the clinical pathway physicians' workstation.

Objective:The aim of study was to design a method of stage treatment,and to investigate its efficacy on recurrent urinary tract infection.Methods:The method of stage treatment includes four periods as follows: ①Treatment period: The regular dose of antibiotics was maintained until the urine routine test result became normal. Then the antibiotics should still be prescribed for four weeks.② Consolidation period: The dosage of antibiotics was reduced to maintain the urine routine test normal for 4 weeks.③ Maintenance period: The dosage of antibiotics was reduced to quaque nocte(once every night) and the treatment should be kept for three months. If result of the urine routine test kept normal,the medicine should be stopped. ④ Observation period: We observed the patients for six months after withdrawal of antibiotics. During the treatment if the result of urine test became abnormal repeatedly,the patient should return to the previous treatment period. Several effective medicines were chosen. During the treatment and consolidation period,each medicine should be prescribed for one week alternatively. And during the maintenance period,each should be used for one or two weeks. Results: Among 68 patients,60 cases were cured,6 cases were effective,and two cases were the opposite.The total treatment time was from 22 weeks to 118 weeks in the cured group,including treatment period(6 to 75 weeks),consolidation period(4 to 13 weeks),and maintenance period(12 to 30 weeks). The average period of each four stages was 50.1±20.6 weeks,30.48±15.23 weeks,5.28±2.34 weeks,14.33±3.7 weeks. There are 38 cases in the refractory urinary tract infections group,and the period of consolidation,treatment and the total treatment were longer(P<0.01)than the ordinary-type treatment group. There were no significant changes in blood routine,liver and renal functions among,before and after the treatment. Conclusion:For recurrent urinary tract infection,the use of the method of stage treatment with several antibiotics has a high cure rate and no adverse effect on blood routine,liver and renal function.

By relating to the application of our hospitals' continuing medical teleeducation technology in the past 10 years,this paper analyzes and compares the characteristics,functions and application of various technological modes.It points out that each mode has its own characteristics and scope of application,which indicates that comprehensive consideration should be taken.

The paper first introduces the trend that network video is the development direction of construction of continuing medical education platform at hospitals.Then it discusses principles,functions and basic framework of the platform construction.

The paper analyzes and compares the three pathological negatoscopies with experiments.It points out that the accuracy rate of telepathological negatoscopy basically accords with diagnostic and teaching requirements and has good operatability.Suggestions are proposed for technical parameters of telepathological negatoscopy based on our practice.

目的:探讨彩色多普勒超声、核素动态显像在肾移植术后早期并发症诊断与鉴别诊断中的应用价值.方法:收集肾移植术后肾功能恢复不佳且行彩色多普勒超声和核素肾动态显像检查的患者59例,分为3组:急性排斥反应组18例,加速性排斥反应组12例、急性肾小管坏死组29例,同时收集术后肾功能恢复良好的正常组20例,分剐统计上述4组彩色多普勒的阻力指数(RI)、移植肾体积、血流分布,分析彩色多普勒在鉴别诊断中的价值.计算核素肾动态显像的指标:灌注相内1 min时腹主动脉放射性计数与移植肾放射性计数比值(K1 minA1 min),功能相20 min时膀胱/移植肾放射性计数比值(B/K),分析其诊断价值.结果:彩色多普勒检查指标中,当移植肾体积增大、血流减少、阻力指数升高均提示移植肾病变,以阻力指数较敏感,但特异性不高.根据核素肾动态显像指标的计算数据,K1 min/A1 min比值联合B/K比值在诊断排斥反应与肾小管坏死方面准确性较高,分别达到96.7%和89.7%;K1 min/A1 min<4和B/K<1提示排斥反应,K1 min/A1 min≥4和B/K<1提示肾小管坏死.结论:彩色多普勒联合核素动态显像对于肾移植术后排异、急性肾小管坏死、移植肾功能延迟恢复的诊断与鉴别诊断具有很好的临床价值,二者联合应用,互补长短.

目的 探讨99Tcm-Ec肾动态显像检查在诊断和鉴别移植肾加速性排斥反应和急性肾小管坏死中的应用价值.方法 41例肾移植术后尿量减少患者,根据病理及临床资料最初拟诊分为加速性排斥反应组和急性肾小管坏死组.分别静脉弹丸式注射99Tcm-EC185MBq后立即以SPECT扫描获得主动脉放射性高峰时间(AMT)、高峰计数(AMC)、移植肾高峰时间(KMT)和高峰计数(KMC).计算K/A、B/K比值,并行诊断性试验.结果 加速性排斥反应组与急性肾小管坏死组K/A比值差异有统计学意义(P<0.01),B/K比值比较差异无统计学意义(P0.05).当K/A比值为2.8,用于诊断加速性排斥反应时其灵敏度为89.5%.特异度94.7%.用于诊断急性肾小管坏死时其灵敏度为94.7%,特异度89.5%.结论 K/A比值对诊断和鉴剐诊断肾移植术后加速性排斥反应和急性肾小管坏死有重要参考意义,且K/A比值为2.8时.可作为两者鉴别诊断的参考值。

目的:比较硫唑嘌呤(azathioprine,Aza)或霉酚酸酯(mycophenolate mofetil,MMF)联合环孢素+激素两种免疫抑制方案的肾移植患者,在术后并发症方面的差异,探讨较理想的免疫抑制方案。方法:收集两组肾移植患者249例:Aza组(即应用Aza+CsA+激素)、MMF组(MMF+CsA+激素),统计两组患者在术后1年内各种并发症(包括排斥反应、各种感染、肝损害、白细胞减少等)的发生。结果:Aza组与MMF组术后1年急性排斥反应的发生率差异显著;两组总的感染率、肺部感染率相近,但发生急性呼吸窘迫综合征(ARDS)及肺部感染病死率后者明显高于前者。在肝损害、白细胞减少、糖尿病等方面,两组也无统计学差异。结论:MMF组在减少急性排异方面优于Aza组,但增加重症肺部感染机会,肺部感染的病死率升高,且费用贵,故临床上应根据具体情况选择。

Objective The aim of this study was to investigate which parameter used in radionu- clide renography would benefit in early detecting and differentiating complications after renal transplantation. Methods Seventy-nine patients who had radionuclide renography within 72 h after renal transplantation were included.Of the 79 patients,20 were normal(control),18 were acute rejection(AR),12 were ac- celerated acute rejection(AAR)and 29 were acute tubular necrosis(ATN).Factors including changes of peffusion and(or)function of the kidney allograft and outcome after AR,AAR and ATN were evaluated u- sing the parameters of the ratio of graft maximal count in perfusion scintigraphy to that of lilac artery(K_(max)/ A_(max))and the ratio of graft count at 1 min to that of iliac artery(K_(1min)/A_(1 min)).Results Among the pa- rameters used in this study,K_(1 min)/A_(1 min)was significant lower in AR and AAR(2.54±1.59 and 2.04± 0.94)than in control(9.29±1.63,P<0.01)and ATN(5.74±2.35,P<0.01)groups.The diagnos- tic accuracy of ATN with K_(1 min)/A_(1 min)was higher than with K_(max)/A_(max)(89.7% vs 55.2% ).Moreover,the results showed that K_(1 min)/A_(1 min)<4 and the ratio of bladder count to that of graft at 20 min(B/K)<1 sug- gested rejection.For those with≥4,B/K<1 suggested ATN and>1 indicated to be normal.Conclusion Combination of parameters including K_(1 min)/A_(1 min)and B/K,diuretic renography would be helpful in early detecting and differentiating AR,AAR and ATN after renal transplantation.