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The paper objectively analyzes the opportunities and challenges of Internet + medical,and puts forward relevant strategies and recommendations for deeply integratingInternet +into the traditional medical industry in several aspects,including strengthening the construction of Internet infrastructure in the medical industry,regulating the market access and improving the industry standards,as well as establishing and improving relevant supporting laws,regulations and policies.
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Patients with chronic thromboembolic pulmonary arterial hypertension,aged＞ 18 yr,scheduled for primary pulmonary thromboendarterectomy from May 2014 to October 2016 in our hospital,were selected.The site and degree of thrombus obstruction,pulmonary hypertension and degree of right heart insufficiency were assessed on 1 day before surgery.Anesthesia was induced with midazolam,etomidate,rocuronium or cisatracurium,and the Swan-Ganz catheter was placed.Anesthesia was maintained with Ⅳ propofol,dexmedetomidine,cisatracurium or rocuronium,and intermittent Ⅳ large boluses of sufentanil.Deep hypothermia circulatory arrest was used for cardiopulmonary bypass.The bispectral index value was maintained between 40 and 60 during surgery.The systemic blood pressure was maintained above 90/60 mmHg during the non-cardiopulmonary bypass period,and pulmonary arterial pressure was maintained not higher than the preoperative baseline level.The vasoactive drugs such as lyophilized recombinant human brain natriuretic peptide,norepinephrine and dopamine were intravenously injected after cardiopulmonary bypass.A total of 53 patients were included in the study and completed surgery successfully,vital signs were stable during surgery,and the patients returned to the recovery room safely.The mean pulmonary arterial pressure was reduced from the preoperative (38±13) mmHg to (26±12) mmHg at the end of the operation,the incidence of reperfusion pulmonary edema after surgery was 8％,incidence of pulmonary hypertensive crisis was 4％,and no patients died in the perioperative period.There were two improvements in the method of anesthetic management of pulmonary thromboendarterectomy in the perioperative period:(1) Lyophilized recombinant human brain natriuretic peptide in combination with norepinephrine was used;(2) The aortic pressure was guaranteed to ensure oxygen supply for the heart and body.This method can maintain the intraoperative circulation stable and reduce postoperative complications and is a suitable anesthetic management method for pulmonary thromboendarterectomy.
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It is one of the important tasks to promote the development of traditional Chinese medicine culture crea-tive industry in constructing the culture-rich Shandong Province. The major factors that influence the development of traditional Chinese medicine culture creative industry in Shandong Province and the ranks of their importance were thus analyzed by questionnaire survey and hierarchy analysis, respectively. Certain suggestions were put for-ward for the development of traditional Chinese medicine culture creative industry in Shandong Province.
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Hierarchical diagnosis and treatment system has become one of the strategies for overcoming the diffi-culties in medical reform in our country. The important role of health information and its application in hierarchical diagnosis and treatment were thus elaborated in this paper in order to provide reference for the health information construction in establishing hierarchical diagnosis and treatment system at different levels in our country.
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The distribution of authors, institutions that published papers, and key words in CNKI-covered papers on library information service model was analyzed, which showed that there are a number of high production authors in China engaged in studies on library information service model but the number of cooperative studies is few, aca-demic libraries are active in performing related studies but public libraries seldom participate in such studies, the related studies are focused on the application of information technologies and the personal demands of users.
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The key words, social network and author cooperation network in papers ( published in 2003-2014 ) on reform in domestic public hospitals were analyzed using Ucinet and CiteSpace visual softwares with CNKI as the data source.The current situation in reform in domestic public hospitals was revealed by mining its research hotspots, progress and author cooperation .Some suggestions were put forward for strengthening the reform in domestic public hospitals .
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Mobile service in libraries of domestic medical colleges and universities was investigated.The specific characteristics of specialized courses offered in medical colleges and universities, the special nature of medical sub-jects, and the unique features of medical library users were described with suggestions put forward for expanding the mobile service in libraries of domestic medical colleges and universities.
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Social network analysis has been a study hot spot in academic circle in recent years and is applied in several fields.After a brief description of its basic theories and study methods, its application in domestic medical and health field were analyzed with its key study hot spots summarized and its problems pointed out, in order to provide the methods that can learned in domestic medical and health studies.
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The functional framework of information management system for regional medical and health institutions was established according to the 5 application systems (public health, medical service, medical support, drug supply support and general management ) and the target to develop 2 databases ( a resident electronic health records data-base and a resident electronic medical records database ) and an operational network put forward in the overall framework of health information construction during The National Twelfth-5 Year Plan Period, based on the functional position of health institutions at different levels.The difficulties to realize the target of the national 3521 project and its prospects were pointed out.
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Objective To analyze Chinese oncology papers included by Chinese biomedical literature database (CBM) and science citation index (SCI),and to comprehensively and objectively reflect the current situation of Chinese oncology literatures published in domestic and international journals.Methods Chinese oncology papers were retrieved by using CBM and SCI.A comparison analysis was made from the respects of subject distribution,district distribution,organization distribution and high citation situation.Results 67 071 papers of 2012 were retrieved from CBM database,while 9226 papers were indexed by SCI.In terms of district distribution,the first three districts were Jiangsu (6707),Guangdong (4897) and Beijing (2214) in CBM database,while in SCI database,they were Beijing (2214),Shanghai (2008) and Guangdong (1393).The institute with the most amount of literature is university,respectively 9725 and 5755.Moreover,the mostly funded project is National Natural Science Foundation (4710,35.38％ ; 3290,35.68％).Conclusion The 2012 Chinese oncology literatures published in domestic journals has advantage with respect to quantity,compared with the international published journals.However,there exists a bigger difference in terms of quality.Through the comparative analysis,the medical researchers in our country will have some implications in the research orientation.
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Two hundred and thirty-five patients of both sexes (123 male,112 female) aged 18-54 yr,weighing 35-62 kg underwent repair of tetralogy of Fallot from January 1996 to July 2009 in Fuwai hospital.Direct BP, ECG,CVP,SpO2,naso-pharyngeal temperature and TEE were continuously monitored during operation.Anesthesia was induced with midazolam and/or etomidate, fentanyl and pipecuronium and maintained with isoflurane/sevoflurane inhalation and intermittent iv boluses of fentanyl and pipecuronium. The total amount of fentanyl administered ranged from 30-50 μg/kg. Cardiac function was supported and hemodynamic stability was maintained with vasoactive and inotropic drugs. Measures were taken to strengthen blood conservation and respiratory function support.Seven patients(2.9%) needed urgent CPB during operation because of serious cyanotic spells. Perfusion-induced lung injury occurred in 18 patients (7.6%). Circulation was assisted by ECMO in 2 patients (0.9%). Three patients (1.3%) died of serious low cardiac output and perfusion-induced lung injury.
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Objective To evaluate the effects of inhaled iloprost on pulmonary hypertension after cardiopulmonary bypass in patients with congenital heart disease undergoing surgical correction of anomaly. Methods Fifty-eight patients with congenital heart disease aged 14-60 yr undergoing surgical correction of anomaly under cardiopulmonary bypass (CPB) were enrolled in this study. Radial artery was cannulated before induction of anesthesia. A 6-lumen pulmonary catheter was placed via right internal jugular vein after tracheal intubation. Their mean pulmonary arterial pressure was still > 25 mm Hg after operation. ECG, HR, BP, CO, PAP and SpO_2 were continuously monitored. Aerosolized iloprost 10 fig was inhaled via nebulizer after CPB. Hemodynamics were measured before iloprost inhalation (baseline) and at 0, 5, 15, 30 and 60 min after the end of iloprost inhalation. Results There were 28 patients with pulmonary hypertension after CPB among the 58 patients with congenital heart disease. Inhalation of iloprost 10μg significantly decreased mPAP, pulmonary vascular resistance and intrapulmonary shunt as compared with the baseline. Iloprost inhalation could also improve significantly CO and the mixed venous oxygen saturation (SvO_2 ). Conclusion Iloprost inhaled after CPB can effectively reduce pulmonary arterial pressure and pulmonary vascular resistance in patients with congenital heart disease undergoing surgical correction of anomaly and help them wean from CPB.