目的:探索2002-2021年公立医院对口支援领域相关研究热点,为开展学术研究和管理实践提供借鉴.方法:在中国知网、维普网、万方数据知识服务平台及中国生物医学文献数据库中检索2002年1月～2021年12月发表的公立医院对口支援相关文献,统计论文发表年份、第一作者、第一作者所在机构、高被引文献的分布情况.结果:按规则进行数据清洗合并后,纳入研究文献868篇.对高频主题词共现矩阵进行聚类分析,揭示研究热点及其演变趋势.结论:公立医院对口支援研究热点主要集中在5个方面,即对口支援落实载体、对口支援人才策略、对口支援相关政策研究、对口支援现状分析和对口支援案例思考.研究主题演变与政策及基层发展需求高度相关.

根据新冠肺炎疫情期间封控区和管控区人群特点、就医需求和存在的困难,提出"关口前移""分区救治""多学科诊疗"的综合应对方案并验证实施效果.诊疗关口前移有利于合理分配医疗资源,使诊疗更加高效;专区救治有助于对风险人群进行分区管控,减少院感风险;结合疫情防控实际研判非急危重症患者转诊的必要性,应用互联网医疗等创新模式可以进一步满足封控区和管控区人群的就医需求.

Objective:To evaluate the consistency on digital lung sounds between artificial intelligence (AI) analysis and clinician judgment.Methods:This is a diagnostic experimental study.By non-random sampling method, totally 2 737 pieces of real clinical digital lung sound data were enrolled from National Telemedicine and Internet Medical Center Digital Auscultation System.Luntech ? digital lung sound artificial intelligence analysis system was used to analyze this results and judgment.The AI analysis results database is established based on roughness of lung sound, whether there is rale, the intensity of rale, whether there is dry rale and wet rale.Meanwhile, a unified classification definition was formulated, clinicians judged the digital lung sound in the above five aspects, aiming to compare the consistency between AI analysis of digital auscultation and auscultation results on lung sounds form clinicians, the change characteristics of phonopneumography as a whole were performed by descriptive methods.Clinician′s judgment results as " gold standard" , the consistency of the two were evaluated by using confusion matrix calculating the classification accuracy, recall rate, false alarm rate, accuracy and kappa value. Results:The application of digital auscultation AI analysis (Luntech ?) judged whether it was abnormal lung sound, whether there was rough breath sound, whether there was rale, whether there was dry rale and whether there was wet rale, the results were as follows: the accuracy were 98.39%, 95.14%, 96.60%, 97.84% and 96.97% respectively; the recall rates were 96.60%, 88.34%, 91.65%, 92.70% and 86.68% respectively; the false alarm rates were 3.48%, 2.43%, 1.03%, 0.92% and 0.63% respectively, and the accuracy was 97.00%, 92.86%, 97.71%, 97.08% and 96.98% respectively; and good consistency (the kappa values were 0.931, 0.873, 0.921, 0.941 and 0.898 respectively); the judgment results of rales intensity had a good consistency (wet rale kappa value=0.790, dry rale kappa value=0.889). Morphological characteristics were obvious in phonopneumography, lung sound index of AI analysis of lung sounds, and phonopneumography was sensitively capabling reflecting the changes of lung sound properties. Conclusions:There is a good consistency on digital lung sound between AI analysis, phonopneumography and clinician′s judgment.

目的:探索医药卫生体制改革启动以来公立医院文化领域研究热点及演变趋势,为国内医院文化建设实践提供借鉴.方法:在中国知网、维普网、万方数据知识服务平台及中国生物医学文献数据库中,以"公立医院"和"文化"为主要检索词,检索2009年3月～2021年12月发表的文献,统计论文发表年份、第一作者、第一作者所在机构、高被引文献、主题共现矩阵和突现词的分布情况,揭示热点主题及演变趋势.结果:公立医院文化研究热点主要集中在4个方面,即医院文化与党建、医院文化与人本管理、医院文化与医疗服务、公立医院文化现状评价.结论:公立医院文化建设领域研究数量不断增加;研究内容与政策关联度较高;研究聚焦不足,协同研究和持续研究较少;研究科学性有待加强.

"互联网+"医疗服务的兴起带来了药品供应和医保报销支付形式的新需求.2020年11月,国家医疗保障局印发了《关于积极推进"互联网+"医疗服务医保支付工作的指导意见》,《指导意见》对"互联网+"医疗服务的医保协议管理、总额预算方式、支付路径和分期发展作出了明确的规定,为实现线上业务的脱卡支付和跨域支付奠定了基础,对各省级医保经办机构具有实质性的、可操作的指导意义.新的医保支付政策集中体现了"互联网+"医疗服务体系与医保体系的衔接,为推动"互联网+"医疗健康新业态提供了驱动力.

Objective:To explore a new model of scientific research courses in standardized training of resident doctors guided by National Telemedicine and Connected Health Center(NTCHC).Methods:The "Clinical Research Design and Article Writing skill Enhancement Courses" were jointly organized by the Education Department, the Department of Ultrasound of the China-Japan Friendship Hospital and NTCHC from June 7 to December 12, 2019. Students who participated in the courses ( n=44) were divided into three groups: Group A ( n=14) joined online courses; Group B ( n=16) joined on-the-spot courses; Group C ( n=14) joined both online and on-the-spot courses. Questionnaires survey were used to evaluate learning effectiveness and learning satisfaction after the courses. The reliability was analysed by the satisfaction scale. Results:All 44 students believed a signficant knowledge gain and improvement of research capacity, and 88.6%(39/44) students thought that the gain was great. There was no statistical difference in the satisfaction of the three groups of students on the content of the course, the teachers and the course organization (all P> 0.05). Conclusions:Based on guidance from NTCHC, the learning outcomes of resident research courses through a remote online pathway is impressive.

新型冠状病毒肺炎突如其来,传播迅猛.控制疾病传播的最佳策略是减少人口流动,减少人与人之间的密切接触.对很大一部分患者群体来说,"互联网+医疗"远距离、非接触性的优势是非常实用和急需的新医疗形式.在抗击新冠疫情期间,互联网+医疗服务模式解决了很多工作难点,并加速推进了多项工作的进展.

2019年在国家卫生健康委指导下,由中日友好医院、国家远程医疗与互联网医学中心、国家基层远程医疗发展指导中心牵头,召集全国30余家省部级医院、中国医学装备协会、中国电信、中国移动、中国联通、华为,联合在中日友好医院联合启动《基于5G技术的医院网络建设标准》.作者就《基于5G技术的医院网络建设标准》制定的背景、核心价值和关键内容进行解读,为本标准的尽快推广及应用提供支持.

2020年,突如其来的新冠肺炎疫情给重大公共卫生应急管理体系带来严峻考验.而融合5G、边缘计算、人工智能、云计算等ICT技术的智慧医疗在此次疫情防控中发挥了重要作用. 5G加速“互联网+医疗”进程 “互联网+医疗”是国家战略发展的一项国策,是综合医改的重要举措之一.早在2018年,国务院办公厅就印发《关于促进“互联网+医疗健康”发展的意见》,以鼓励创新、包容审慎的原则,推动互联网与医疗、公共卫生、药品供应保障等深度融合,多措并举完善支撑体系、加强行业监管,满足民众医疗卫生健康需求.

The key role of telemedicine is to integrate the advantages of medical resources,help doctors in primary institute improving their clinical skills and promote the hierarchical medical system implementation.This article introduced the practical experiences of how "Internet Plus" enhances the capacity of primary care comprehensively by promoting the discipline development of primary hospitals.The first measure is to help the doctors from primary hospitals to pursue the right treatments and standard protocols on clinic.The second one is to enhance the quality and efficiency of specialist medical training through the development of specialist medical cluster.The last one is to develop targeted specialized assistance system to help people lift their life out of poverty.

耿女士在中日友好医院呼吸与危重症医学科住院一段时间后病情好转,即将出院.耿女士是既高兴又发愁.原来耿女士出院以后还需要治疗一段时间再回来复诊,可是她家在河北省高邑县,离北京400多公里,来回旅途劳顿,还要提前请假、安排住宿、现场挂号等,一想到这些耿女士感到十分焦虑.

The teleconsultation model of the National Telemedicine and Connected Health Center is cited as an example, to study the pricing formulation of video teleconsultation. This refers to the pricing composed of such four parties as the inviter′s hospital, invitee′s hospital, technical support, and business operation. Based on such pricing standard, teleconsultation charges can be collected. From 2015 to 2017, the annual applications of teleconsultation is on the rise year by year. Such pricing has been accepted by patients at large, as it embodies the value of each party, and ensures the long-term running of telemedicine system. Therefore, this pricing formulation could be a referable model for the localities to formulate their teleconsultation pricing.

Previous studies have shown that the secondary degeneration of retinal ganglion cells (RGCs) occurs commonly in glaucoma. Partial optic nerve transection is considered a useful and reproducible model. Compared with other optic nerve injury models used commonly for assessing secondary degeneration, e.g. complete optic nerve transection and optic nerve crush models, the partial optic nerve transection model is superior as it distinguishes primary from secondary degeneration in situ. Therefore, it serves as an excellent tool for evaluating secondary degeneration. This study describes a novel operative approach of partial optic nerve transection by directly accessing the area of the retrobulbar optic nerve through the orbital lateral wall of the eyeball. Moreover, we present a newly designed, low cost surgical instrument to assist with transection. As demonstrated by the representative results in distinguishing the boundary of primary and secondary injury areas, the new approach and instrument ensures high efficiency and stability of the model by providing adequate space for surgical operation. This in turn makes it easy to separate the meningeal sheath and ophthalmic vessels from the optic nerve before transection. An additional benefit is that this space-saving operative approach improves the investigators' ability to administer drugs, carriers, or selective RGC tracers to the stump of the partially transected optic nerve, allowing the exploration of mechanisms behind secondary injury in RGCs, in a new way.

The method of using telemedicine to solve the problem of long distance medical alliance is explored to provide health care for patients of long distance.Specialized disease medical alliance,and provided medical service based on telemedicine of a hospital is founded.Health care practice experience based on precision referral and long-distance medicinethrough telemedicine is summed up.With the aid of telemedicine,the hospital formulates the rules and regulations of the precise referral for long-distance medical patients to provide more convenient and quick service,reduce the medical cost,and save the fund of medical expenses.The practice effect is remarkable.With the aid of telemedicine,specialized disease medical alliance is founded to better realize patients' precision referral and medicine.In this way,"too difficult and too expensive to see doctors"can be solved to provide medical insurance for doctors and patients.And great health strategy of telemedicine around the country can be realized.

The construction of the biomedical laboratory needs to rely on a dominant discipline. As an ophthalmological laboratory in the process from the specialized research platform to the multi-discipline and new technology transformation,an open platform with the specialized characteristics has been gradually established,and some experience in the sharing operational mechanism and management has been accumulated. According to the near,medium and long term plan of the construction of the discipline platform, the construction process of the open platform is elaborated,and the management mechanism of such platform is introduced.

“互联网+”迅速成为信息时代的风潮.互联网企业首先看到了互联网与医疗领域的价值,凭借站在风口上的优势,率先推出了关于互联网医疗的系列概念,并受到了互联网业界的热捧,各路信息产业人士蜂拥而至,舆论界加紧制造互联网医疗的各类热点,并迅速演变成了一阵浪潮,席卷而来.在所谓互联网思维的催化下,热炒新闻让人们似乎相信了凭着烧钱就能烧出一个“互联网医疗”的市场.风险投资者争先恐后地投下天使基金或A轮风险基金,“天使散金”催化了互联网医疗创业者们的梦想,期待着“颠覆医疗”……

PURPOSE:To investigate the mechanism of chitosan promoting corneal wound healing though evaluating its effect on extracellular signal-regulated kinases (ERK) and p38 pathway activity in a rabbit animal model.METHODS:Cell proliferation and migration assay were performed 24 hours after chitosan treatment. The activity of ERK and p38 pathways was detected by using immunofluorescence and Western blotting in the presence of chitosan and an ERK inhibitor. In vivo study of epithelial debridement wounds was performed on 8 mm rabbit corneas in the presence of chitosan and an ERK pathway inhibitor.RESULTS:Immunostaining with Ki67 and migrating assay showed that chitosan could upregulate the cell proliferation and promote the cell migration. Chitosan activated the ERK pathway in 5 min to 30 min after treatment but did not affect the p38 pathway. ERK inhibitor PD98059 can inhibit the chitosan-stimulated ERK phosphorylation. Chitosan increased the corneal epithelial wound closure in organ culture and ERK inhibition with PD98059 blocked the effect of chitosan on wound healing.CONCLUSIONS:Chitosan promoted corneal epithelial proliferation and migration during the wound healing in rabbits' eye. Chitosan-stimulated epithelial wound healing is partially mediated through the activation of the ERK pathway but not the p38 pathway.

目的 观察“益阳坚阴”中药复方对豚鼠实验性近视眼球活体参数的影响.设计 实验性研究.研究对象 50只花豚鼠.方法 随机分为正常对照组(A组)、空白对照组(B组)、“益阳坚阴”中药干预组(C组)、“养阴”中药干预组(D组).A组双眼无缝合,B、C、D三组缝合豚鼠右眼,诱导建立形觉剥夺性近视模型;B组无药物干预,C组“益阳坚阴”中药复方干预(代水饮),D组养阴中药干预(代水饮).实验前及实验6周后A超测量眼球活体参数指标.主要指标 玻璃体腔深度、眼轴长度.结果 组间对比:各组豚鼠右眼(缝合眼)比较,C组玻璃体腔深度(3.262±0.208)mm、眼轴(7.687±0.256)mm,明显低于B组(3.499±0.098)mm、(8.049±0.257)mm(P均＜0.05);各组豚鼠右眼玻璃体腔深度、眼轴长度两两比较发现,A组与C组比较差异无统计学意义(P均＞0.05),表明C组在右眼睑缝合下,剥夺性近视眼的发生不明显.组内对比:C组左、右眼眼轴长度(7.664±0.076 mm,7.687±0.256 mm)比较无统计学意义(P＞0.05).结论 “益阳坚阴”中药复方可抑制豚鼠形觉剥夺性近视眼的发展,主要表现在延缓了玻璃体腔的加深和眼轴的增长.

Background The pathogenesis of age-related macular degeneration (AMD) is complex. It has been shown that vitreomacular traction (VMT) plays a role in the pathogenesis of AMD. We speculate that the continuous stretch induced by VMT might impair the function of retinal pigment epithelium (RPE) cells and it might also be involved in the progression of AMD. Methods Cultured ARPE-19 cells were subjected to cyclic stretch on the Flexcell Strain system at a level of 25% increment on the surface area for 8 h, 14 h, 20 h, 24 h. In another group, the stretch was withdrawn at 14 h and the cell cultured for another 6 h. Then, we observed the changes in morphology, apoptosis and expression of interleukin 6 (IL6) and vascular endothelial growth factor (VEGF) in RPE cells under stretch. Results We found that stretch induced the RPE cells to change from a spreading shape into a rounded shape, and that the morphological changes were positively correlated with the duration of the stretch. The expression of pFAK397 and pRac1/cdc42 were elevated in a time-dependent fashion. The stretch resulted in an increase in the apoptosis ratio, with Bcl2, Bax and p53 also showing time-dependent changes. In addition, up-regulation of IL6 and VEGF expression levels was also observed. After withdrawal of the stretch, all of these changes were significantly diminished. Conclusion Stretch may induce morphological, cell apoptosis, and up-regulation of cytokines changes in RPE cells, indicating that cyclic stretching may participate in the progression of AMD by impeding the functions of the RPE.

我国的医药卫生体制改革迎来了新一轮的重要发展时期。目前我们面临的医疗现状存在四大共性问题：①量不足，医疗资源总量不足，优质医疗资源尤其紧缺；②碎片化，医疗资源没有形成科学的协同体系，碎片化运行的现状无法发挥其应有的效率；③不均衡，医疗资源在地区之间分布不均衡，基本医疗在不发达地区和边远地区的普及程度不够；④非同质，突出表现在医生的素养缺乏同质性，这与我们的医学教育和培训机制没有形成统一标准有关。为了有效利用现有的资源，尽快发挥其应有的效率，国家连续出台了系列政策和指导意见，来推动医疗体制和机制的改革。其核心原则是保基本、强基层、建机制。推动“互联网+医疗健康”是带动国家医疗体制改革、引导健康产业链的重要战略规划。在如此强力政策推动的医改大潮中，大型公立医院如何正确定位，如何利用其资源优势发挥更大的效力，如何合理利用现代信息技术促进分级诊疗新业态的形成等问题，值得思考。