在不卧床急性下呼吸道感染儿童中胸X线摄片后临床结局的随机对照试验

胸部Ｘ线摄片常被用于儿童患不卧床急性下呼吸道感染时的治疗，但这种胸透对临床结局有无益处并不清楚。方法　５２２例儿童，年龄２～５９个月，符合世界卫生组织疾病诊断标准的肺炎患者，随机分配为胸Ｘ线摄片组与不胸透组。主要判定结果是恢复痊愈时间，２９５例患者通过电话联络，其次判定结果包括诊断、治疗以及随后采用的医疗设备等。结果　在Ｘ线摄片组和对照组平均痊愈时间均为７ｄ，９５％可信区间分别为６～８ｄ和６～９ｄ，痊愈危险比数值为１．０８，９５％可信区间为０．８５～１．３４。在Ｘ线摄片组中诊断为肺炎和上呼吸道感…     

X线平片与螺旋CT扫描在肋骨骨折诊断中的应用比较

目的 探讨X线平片与螺旋CT检查肋骨骨折的优缺点与价值比较。方法 对50例胸外伤病例，其中男43人，女7人，年龄22—48岁，对比分析其常规X线胸片和胸部螺旋CT资料。结果 50例患者，总计86处肋骨骨折。普通平片显示64处，诊断符合率为74.4％，胸部螺旋CT扫描显示86处，诊断符合率100．0％。结论 螺旋CT扫描对肋骨骨折的诊断有重要价值。     

高频心电图最大肢体导联诊断慢性缺血性心脏病的价值

本文应用高频心电图最大肢体导联研究了２２例正常人和２７例慢性缺血性心脏病患者的高频心电图，结果表明：６导及１２导组合导联的高频切迹数，正常人分别为１．８６±１．７０和７．０５±２．７９；慢性缺血性心脏病患者分别为４．４４±２．８１和１５．００±４．６１，与正常人比较有显著性差异（Ｐ＜０．０１和Ｐ＜０．００１）。６导及１２导组合导联对慢性缺血性心脏病的诊断敏感性、特异性及符合率分别为６３．０％、１．８％、８０．０％和９２．６％、６１．６％、０．６％；最大肢体导联为Ⅰ，Ⅱ、ａＶＲ和Ⅰ、ａＶＲ的诊断敏感性、特异性及符合率分别为６３．０％、１００％。１００％和８５．２％、９０．９％、９２．０％。这说明最大肢体导联在高频心电图诊断慢性缺血性心脏病中，也是一个重要价值的指标。     

胃液中肿瘤相关抗原（MG—Ag）IRMA对胃癌的诊断价值

本文报告我院１９９４年１１月～１９９５年１１月应用放射免疫分析法测定了２４６例胃液胃癌抗原。结果显示对胃癌诊断的敏感性为８２％，特异性７０％，胃癌的胃液胃癌抗原测定与非胃癌，癌前病变及良性病变比较，有明显差异，经卡方检验分别为Ｘ＾２＝６２．４４６，Ｐ〈０．０１，Ｘ＾２＝４４．３７５，Ｐ〈０．０１及Ｘ＾２＝７８．０５５，Ｐ〈０．０１，提示胃液胃癌抗原的检测对胃癌诊断有重要价值。     

CIDI对神经症诊断的现场测试

使用复合性国际诊断问卷（ＣＩＤＩ）对临床诊断为神经症的病人１００例及其他组２０９例进行了测试，并用ＷＨＯ提供的ＣＩＤＩ计算机诊断程序分别做出ＤＳＭ－Ⅲ－Ｒ和ＩＣＤ－１０诊断。结果，检查者间的信度为０．９３５：ＣＩＤＩ／ＩＣＤ－１０与神经症临床诊断的符合率为８９．００％，ＫＡＰＰＡ－０．７３，敏感性为６７．００％，特异性为９９．５２％；ＣＩＤＩ／ＤＳＭ－Ⅲ－Ｒ与神经症临床诊断的符合率为９０．６１％，ＫａＰＰａ＝０．７７，敏感性为７４．００％，特异性为９８．５６％；ＣＩＤＩ／ＩＣＤ－１０与ＣＩＤＩ／ＤＳＭ－Ⅲ－Ｒ之间神经症诊断的符合率为９２．２３％，Ｋａｐｐａ＝０．７８。文章最后讨论了ＣＩＤＩ在实际应用中存在的一些问题。     

真彩图像处理跟骨X线片诊断骨质疏松

目的探讨以真彩图像处理系统对１９２张规范后的跟骨侧位Ｘ线片进行“骨密度”值测定,从而诊断骨质疏松。方法用双盲法对每张Ｘ线原片行Ｊｈａｍａｒｉａ’ｓ分度以及对图像处理后测得的“骨密度”值按ＷＨＯ提出的骨矿物质密度（ＢＭＤ）诊断法进行分级。受试者为９６名健康人。男５７名．女３９名。以骨峰值年龄划分为青年组２７名,中年组２１名,老年男性组３１名,老年女性组１７名,其平均绝经期１１年。结果（１）各区“骨密度”值－中年组＞青年组＞老年组（Ｐ＜０．０１）、说明中年组处于最佳骨峰值期,青年组骨矿物质储备不足,老年组则骨量减少以至骨质疏松。（２）老年女性组各区“骨密度’值明显低于老年男性组（Ｐ＜０．０５）。（３）各组数据在跟骨左右侧之间以及青年组、中年组在男女性别之间均无显著差异（Ｐ＞０．０５）。（４）在老年组按Ｊｈａｍａｒｉａ’ｓ分度法对踉骨Ｘ线原片诊断骨质疏松有２１例（４３．８％）,其中男性１０例（３２．２６％）;女性１１例（６４．７１％）。（５）按ＷＨＯ的ＢＭＤ分级法对计算机图像处理后各组“骨密度”值诊断骨质疏松,在老年组有１７例（３５．４％）,其中男性８例（２５． ８％）;女性９例（５２．９５％）。此法要求较严格,要     

原因不明的长期发热常见疾病鉴别诊断专家系统

本文报告用模糊数学和概率统计评分法模拟人的思维建立原因不明的长期发热常见疾病鉴别诊断专家系统，用ＦＯＸＢＡＳＥ＋语言编程并在微型电子计算机上实现，回顾性检测正确率９４．４％，用２５０例确诊病例验证诊断正确率为９０．３％，与专家诊断比较符合率＞８７％。     

日本血吸虫循环抗原与抗独特型抗体的检测及其比较

以日本血吸虫肠相关ＭｃＡｂ－Ｇ３及单克隆抗独特型抗体ＮＰ３０致敏红细胞，建立ＲＩＨＡ诊断血吸虫病。结果是正常人、急、慢性及晚期血吸虫病人Ｇ３－ＲＩＨＡ阳性率分别为２．１７％、９８．７９％、８４．０％、３２．１４％；ＮＰ３０－ＲＩＨＡ阳性率各为１．４５％、９７．５８％、８１．３％、２８．５７％。７５例慢性感染人群中，两者与Ｋａｔｏ阳性符合率分别为８４．０％、８１．３％；而阴性符合率各是３１．５％、３７．０％轻、中、重感染度人群循环抗原／抗独特型抗体阳性率：Ｇ３－ＲＩＨＡ分别为８０．３３％、１００．０％、１００．０％；ＮＰ３０－ＲＩＨＡ为８０．３３％、８８．８９％、８０．０％，显示慢血病人血清中循环抗原及／或抗独特型抗体与ＥＰＧ无相关性。本文提示循环抗原、抗独特型抗体在免疫调变及／或免疫网络系统中呈竞争与抑制状态。     

CT检查在粉尘肺职业监护中的应用价值

目的探析CT检查在粉尘肺职业护理监护中的应用价值。方法选择120例粉尘肺患者与60例健康者,均给予胸部X线检查及相同条件下进行胸部CT检查,比较X线检查与CT检查在粉尘肺职业监护中诊断敏感度、特异度及准确度。结果 X线检查诊断尘肺108例(假阳性11例),CT增强扫描诊断尘肺113例(假阳性3例)。CT增强扫描检查诊断尘肺敏感性、特异性、诊断符合率分别为91.67%、95.00%、92.78%,显著高X线检查的80.83%、81.67%、81.11%(P0.05)。结论相较于X线检查,CT检查能够提高诊断尘肺病诊断效能,在尘肺职业病监护中效果更好,值得推广     

双排螺旋 CT 联合 X 线平片检查诊断在 腰椎间盘突出症诊断中的应用价值

目的 分析双排螺旋 CT 联合 X 线平片用于腰椎间盘突出症的诊断效果和应用价值。方法 收集 40 例腰椎间盘突出症手术患者,行双排螺旋 CT、X 线平片检查,分析两种检查方法的影像学特征,并以手术病理结果为标准,比较单一检查、联合检查的符合率。结果 以手术结果为标准,腰椎间盘突出单一 X 线平片检查符合率为 47.5%;单一双排螺旋 CT检查符合率为 90%;X 线平片联合 CT 检查符合率为 100%。联合检查与单一 X 线平片检查、单一 CT 检查比较差异均有统计学意义（P＜0.05）。双排螺旋 CT 腰椎间盘突出症诊断分型符合率为 95%,与手术病理结果比较差异无统计学意义（P＞0.05）。X 线平片提示,腰椎间隙宽度和长度明显异常,腰椎生理弯曲,呈弓状、后翘状态。CT 检查提示,椎体边缘可见椎间盘突出,密度稍低于椎间盘,小关节突增生,结节不规则,侧隐窝狭窄,突出块较大时,可见软组织密度影,硬膜囊、神经根表现为变形、移位,甚至消失。结论 X 线平片、CT 检查在腰椎间盘突出症诊断中各具优势,但若单一检查,容易发生误诊、漏诊等不良事件,两者联合诊断,可有效提高诊断符合率,为临床治疗提供可靠的影像学依据,具有重要的研究价值。     

Observer variation in the assessment of dysplasia in ulcerative colitis

Six histopathologists allocated 100 sections from patients with long-standing ulcerative colitis into four diagnostic categories, regular hyperplasia, reactive atypia, low-grade and high-grade dysplasia. Their allocations were analysed using kappa statistics, including Fleiss's multiple kappa for groups of observers, and agreement on specific diagnoses was explored by constructing a conditional probability matrix. The nature of their disagreements was investigated using coefficients for systematic and haphazard errors. Over the four diagnostic categories there was a wide range of pairwise agreement from a low of 49% up to 72% and kappa values were only 'fair' or 'moderate'. As expected, agreement over the two categories 'dysplasia' vs 'no dysplasia' was better, ranging from 68% to 84%, and for 'atypia present' (reactive atypia, low- and high-grade dysplasia) vs "no atypia' two pairings achieved over 90% and 11 pairings over 80% agreement. In view of its clinical importance, conditional agreement on high-grade dysplasia, pairwise agreement on this diagnosis ranged from 100% down to as low as 33%. However, most of these disagreements fell into the low-grade dysplasia category so that closer follow-up and further biopsies would still have been indicated. It is a truism that the basis for safe management is careful co-operation between clinicians and pathologists who have all the relevant facts and who know and trust one another's judgement. Thus, several aspects of the ideal diagnostic process cannot be evaluated in inter-observer studies and the element of artificiality should be borne in mind when applying the findings to diagnostic practice. Nevertheless, the low level of agreement on the diagnosis of high-grade dysplasia achieved by certain pairings of specialist pathologists is a disturbing outcome of this study. Inaccuracies should be minimized by a concensus approach and we therefore recommend referral of putative cases of dysplasia to interested pathologists for further opinions. We would also advocate that pathologists faced with appearances which are indefinite between reactive atypia and dysplasia, would do better to describe them in terms of "atypia, significance uncertain', so that closer surveillance is undertaken, rather than force them into more precise diagnostic categories which may be incorrect.     

Prostatic pathology reporting in the UK: development of a national external quality assurance scheme

Aims:  To develop a baseline picture of prostatic pathology reporting in the UK, identify areas of particular difficulty and assess the feasibility of a national external quality assurance scheme based on prostatic biopsy specimens using the same format as the National Health Service breast pathology scheme, as recommended by the National Institute for Clinical Excellence.
Methods and results:  Eight expert uropathologists and 32 randomly selected pathologists participated in four circulations each of 12 cases of prostatic biopsy specimens. A fixed text proforma was developed and responses were analysed for interobserver agreement using κ statistics. Consistency of reporting the main diagnostic categories of benign and invasive carcinoma was good (κ values 0.77 and 0.88, respectively), but only after excluding 19% of cases for which the experts did not reach 75% agreement. Areas of difficulty included the diagnosis of high-grade prostatic intraepithelial neoplasia and small foci of cancer. Prognostic factor reporting was more variable, with lower overall κs for the assessment of Gleason grading (experts 0.55, others 0.50), perineural invasion (experts 0.64, others 0.50) and number of positive cores (experts 0.74, others 0.61).
Conclusions:  Given the difficulties in diagnosis of prostatic biopsy specimens and the assessment of prognostic factors, the expansion of the scheme could deliver important educational benefits.     

Computerized Classification of Pneumoconiosis on Digital Chest Radiography Artificial Neural Network with Three Stages

It is difficult for radiologists to classify pneumoconiosis from category 0 to category 3 on chest radiographs. Therefore, we have developed a computer-aided diagnosis (CAD) system based on a three-stage artificial neural network (ANN) method for classification based on four texture features. The image database consists of 36 chest radiographs classified as category 0 to category 3. Regions of interest (ROIs) with a matrix size of 32 × 32 were selected from chest radiographs. We obtained a gray-level histogram, histogram of gray-level difference, gray-level run-length matrix (GLRLM) feature image, and gray-level co-occurrence matrix (GLCOM) feature image in each ROI. For ROI-based classification, the first ANN was trained with each texture feature. Next, the second ANN was trained with output patterns obtained from the first ANN. Finally, we obtained a case-based classification for distinguishing among four categories with the third ANN method. We determined the performance of the third ANN by receiver operating characteristic (ROC) analysis. The areas under the ROC curve (AUC) of the highest category (severe pneumoconiosis) case and the lowest category (early pneumoconiosis) case were 0.89 ± 0.09 and 0.84 ± 0.12, respectively. The three-stage ANN with four texture features showed the highest performance for classification among the four categories. Our CAD system would be useful for assisting radiologists in classification of pneumoconiosis from category 0 to category 3.     

Observer agreement in the diagnosis of serrated polyps of the large bowel

Aims:  To assess observer agreement in the diagnosis of colorectal serrated polyps, in particular, serrated adenomas and admixed polyps (i.e. 'polyps with admixed hyperplastic and adenomatous glands').
Methods and results:  Sixty cases of large bowel polyps were assessed by four specialist gastrointestinal histopathologists and allocated into one of five categories: serrated adenoma, hyperplastic polyp, conventional adenoma, admixed polyp, and other polyps with serration. Complete agreement amongst all four assessors was seen with only two-fifths of the cases. The overall κ value for all the assessors distinguishing between all five categories was 0.49. The κ values for diagnosing serrated adenoma versus all other polyps, and admixed polyp versus all other polyps were 0.38 and 0.3, respectively.
Conclusions:  Specialist gastrointestinal histopathologists show only moderate concordance when distinguishing between serrated colorectal polyps. There is only fair interobserver agreement in the diagnosis of serrated adenomas and admixed polyps of the large bowel.     

颈部淋巴结超声图像特征提取的评价研究

对颈部淋巴结超声图像特征的计算机提取进行研究,将所提取的外形特征、边界特征、皮髓质比例、皮髓质分布、长/短径比率、血流密度和血流分布等7类超声特征参数与医生的分级判断结果相比较,以评价各特征参数的有效性.对106个颈部淋巴结的分析结果显示,所提取的参数中归一化径向长度的过零率、凸包深度、长/短比率、血流密度和血流信号的轮廓投影分布熵等参数,具有较好的相关性.     

Prospective study of necropsy audit of geriatric inpatient deaths.

AIMS: To evaluate the accuracy of clinical diagnosis by specialists in geriatric medicine and to compare this with a previous study involving non-specialists. METHOD: Clinical and necropsy diagnoses from consecutive hospital inpatient deaths from the University Department of Geriatric Medicine were analysed for discrepancies at regular audit meetings. Three main categories of diagnosis were considered and any therapeutic implications discussed. RESULTS: Between 1987 and 1989 necropsies were performed on 100 patients (38 men, 62 women, aged 63 to 99 years) from a total of 207 deaths, a necropsy rate of 50%. There was complete agreement between necropsy and clinical diagnoses in 32% of cases. Disagreement involved the main diagnosis in 28%, contributory conditions in 32%, and cause of death in 34%. In 10% of cases the diagnostic discrepancy was considered therapeutically important. Specialist geriatricians correctly diagnosed the main diagnosis in 72% of cases; non-specialists in the previous study were correct in only 47% of cases. CONCLUSION: Specialist geriatricians diagnose elderly people more accurately than non-specialists. But rates of misdiagnosis are still significant and necropsies continue to be a useful form of audit.     

Interobserver and intraobserver variation among experts in the diagnosis of thyroid follicular lesions with borderline nuclear features of papillary carcinoma

Distinguishing follicular variant of papillary carcinoma (FVPC) from follicular adenoma and follicular carcinoma can be difficult if nuclear features of papillary carcinoma are not well developed or only focally present. We assessed interobserver and intraobserver agreement among 6 thyroid experts by using 15 cases in which original pathologists suspected FVPC. There was unanimous expert agreement in diagnosing FVPC in only 2 cases (13%) and majority agreement in 6 cases (40%). Unanimous agreement on benign and malignant diagnoses was seen in 4 cases (27%) and majority agreement on malignancy in 8 cases (53%). Intraobserver agreement ranged from 17% to 100%. Histologic features considered most helpful in diagnosing FVPC were nuclear clearing, nuclear grooves, nuclear overlapping and crowding, nuclear membrane irregularity, and nuclear enlargement. This considerable interobserver and intraobserver variability in the diagnosis of FVPC seems to result from lack of agreement on the minimal criteria needed to diagnose FVPC, even among experts.     

基于神经网络的VEP波形自动识别方法

目的：研究基于神经网络的视觉诱发电位波形的自动识别方法,实现Ｐ１００波的自动识别。方法：从历年来临床闪光ＶＥＰ检查记录中选择出经专家用视觉方法判断有Ｐ１００波存在的记录文件,记录专家判别的Ｐ１００波和比较波的数据,以此记录材料作为神经网络的学习样本,建立采用反向回归算法的神经网络。选取波形特征参数作为神经网络的输入参数,用具有不同隐层结点数的神经网络对相同样本进行学习和检验。结果：神经网络对学习样本的判别一致率为：Ａ组９８８％,Ｂ组９８８％;对检验样本的判别一致率为：Ａ组平均９２２％,Ｂ组平均９６０％。以全体材料为学习样本时网络的判别一致率为９７６％～９８２％,其中不同隐结点数的网络判别一致率差异极显著（χ２检验,χ２＝９．６３＞６．６３,Ｐ＜０．０１）。结论：专家的判断原则可以为神经网络所阐明     

Detecting drug resistant genetic mutation among pneumoconiosis patients complicated with tuberculosis in Mycobacterium tuberculosis L-forms application of PCR-SSCP technique in Huainan mining district

Objective: To study the relationship between drug resistant genetic mutation and drug resistance in Mycobacterium tuberculosis L-form, discuss the internal relationship between drug resistances and drug-resistant related genes and explore the value of PCRSSCP to clinical application. Methods: A total of 52 clinically isolated strains of tuberculosis L-form were collected among 97pneumoconiosis patients complicated with tuberculosis. The gene mutations of katG, rpoB and rpsL were detected by PCR-SSCP,and the results were compared with those analyzed by traditional antimicrobial susceptibility test(AST). Results: The gene mutation rates of katG, rpoB and rpsL by PCR-SSCP were respectively 57.70% (30/52), 65.38% (32/52) and 40.38% (21/52). The rate of reversion was 78.85%(41/52) and the result of drug-resistant genes was invariable. The results of AST showed that there were 40 (76.92%) multi-drug resistant strains in 52 clinically isolated strains. The number for three-drug resistant strain was 21(40.38%) and that of two-drug resistant was 19(36.54%), but only 12 (23.08%) strains were one drug resistant. The rate of total drug-resistance was 100%, but there were 15 strains of allied mutation of three genes, 16 of two mutations and 6 of only one by PCR-SSCP. The coincidences were respectively 71.43%, 84.12% and 50.00%. Then there was no significant difference between the allied mutations of multi-drug resistant gene and the mutations of only one drug resistant gene (P ＞ 0.05). Conclusion: PCRSSCP technique has a higher sensibility and specificity to detect the genes of katG, rpoB and rpsL in tuberculosis L-form among pneumoconiosis complicated with tuberculosis,and the detecting rate of two drug resistant strains and three drug resistant strains was higher. The combined application of PCR-SSCP and AST has advantages at earlier diagnosis and guidance of clinical medications.     

Immunofluorescent examination of the skin of rabies-infected animals as a means of early detection of rabies virus antigen.

Correlations were made on immunofluorescence positivity to antirabies conjugate between cranium-derived nerve fibers in skin and traditional samplings of brain tissue from several species and illness categories of animals with naturally acquired rabies. The overall correlation of results from all categories was about 98% (n, 104) for those that were brain positive and 100% (n, 99) for those that were brain negative. Some animals that ultimately developed rabies were found to have immunofluorescence-positive results 2 or more days before the onset of clinical signs in both natural and experimental infections. The percentage of those with positive skin immunofluorescence results increased as the onset of symptoms approached. From the midcourse period of illness to death, the correlation between skin and brain approached 100%. Different vaccines, commonly given to prevent rabies and other diseases of dogs and cats, were administered to groups of mice and were found to not produce false-positive results when their skin was examined by immunofluorescence for rabies virus antigen. These data suggest that examination of surgical biopsy specimens by immunofluorescence for rabies virus antigen is a useful and reliable diagnostic tool to evaluate the rabies status of biting dogs or cats, or to confirm a clinical diagnosis of rabies in the species tested. The biopsy evaluation of any other species as a means of assessing bite risk is not suggested by these data.