前列腺癌诊断方法比较

目的：了解前列腺癌各种检查方法在诊断中的作用。方法：本文回顾分析了近5年所收治的168例可疑前列腺癌病例,对其进行了直肠指诊（DRE）、前列腺特异性抗原（PSA）、经直肠B超（TURS）、MRI（或CT）等项检查,最后全部在B超引导下经直肠前列腺活检,其中87例病理证实前列腺癌（其中包括3例肉瘤）。结果：DRE检出率为55．9％,敏感度为93．1％,PSA检出率为58．3％,敏感度为84．3％;TURS检出率为55．7％,敏感度为60．7％;MRI（或CT）检出率为56．3％,敏感度为95．5％。DRE＋PSA检出率为64．4％,DRE＋PSA＋TURS检出率为71．9％,DRE＋PSA＋MRI／CT检出率为69．7％。结论：DRE是一种简单,无痛苦的检查,在前列腺癌筛选检查中十分重要,必不可少,而联合检查可明显提高检出率,降低假阳性率。     

中医药治疗药物难治性癫痫的思考与对策

癫痫是神经科常见疾病,在我国癫痫终身患病率高达4‰～7‰。药物治疗一直是控制癫痫发作的主要手段,但约有25%～30%的癫痫患者因对抗癫痫药物（Antiepileptic Drugs,AEDs）产生耐药而发展成为药物难治性癫痫（Drug Resistant Epilepsy,DRE）,给患者个人、家庭和社会带来沉重负担。中医药治疗DRE有一定的特点与优势,为药物控制DRE提供新希望。文章以DRE中医药证候研究、临床研究和基础研究三方面为切入点,介绍相关现状与问题,提出应对对策,旨在借助多学科融合提高中医DRE诊治水平。     

DR E2基因参与酵母内质网应激调控机制的初步研究

目的：初步研究 DRE2基因在抗肿瘤药物衣霉素诱导的内质网应激中的作用机制。方法以质粒pRS306为模板,通过 PCR 扩增含有 URA3开放阅读框的 DRE2基因破坏元件 der2：URA3,然后利用基因重组原理,构建 DRE2基因杂合缺失酵母菌株,并进一步检测其对衣霉素的抗性和复制寿命。结果相对于野生型菌株,DRE2基因杂合缺失酵母菌株对衣霉素的抗性增高,复制寿命缩短（P＜0．05）。结论 DRE2基因可能参与了酵母内质网应激和衰老的调控。     

迷走神经刺激对难治性癫痫脑功能连接的即时效应

目的：研究迷走神经刺激（vagal nerve stimulation，VNS）对药物难治性癫痫（drug-resistant epilepsy，DRE）患者脑功能连接的即时效应，探讨VNS抑制癫痫发作的作用机制。方法：采集14例正常被试静息态和14例DRE患者静息态和刺激态的脑磁图数据，分6个频段分析即时VNS引起的DRE患者脑功能连接的改变。结果：在静息态，DRE患者相对正常被试，功能连接显著增强。当VNS发生时，DRE患者有显著降低的功能连接，包括theta频段的左侧额中回-右侧嗅皮质和左侧丘脑-右侧距状裂周围皮层，alpha频段的左侧丘脑-左侧颞极颞中回之间的连接。结论：即时VNS可以降低DRE患者脑功能连接，即降低患者脑网络对发作的易损性，这可能是VNS调节DRE患者神经系统抑制癫痫发作的重要机制。     

直肠超声引导下前列腺活检对前列腺癌患者PSA、PSAD的影响

目的探讨直肠超声引导下前列腺活检诊断前列腺癌的效果,并与同期人选的非前列腺癌组织作对照,进一步探讨二者对前列腺特异性抗原（PSA）、PSAD（PSA密度）的影响。方法将前列腺特异性抗原（PSA）水平在2．5ng/mL以上并经直肠超声引导10孔法前列腺活组织检查的70例患者根据检查结果随机分为前列腺癌组44例及非前列腺癌组26例,应用统计学方法比较分析两组的PSA、DRE（直肠指诊）、TRUS（经直肠超声）、PSAD（PSA密度）及前列腺大小、超声表现、活检并发症情况、各项检查的敏感性。结果70例中44例证实患有前列腺癌,26例非癌病例;前列腺癌组与非前列腺癌组在PSA、异常DRE表现比率及异常TRUS表现比率、前列腺大小、PSAD均有统计学差异（P〈0．05）。前列腺癌组织的超声表现与非前列腺癌组织比较,差异有显著性（P〈0．05）。前列腺癌组与非前列腺癌组上述并发症的发生率比较,差异无显著性（P〉0．05）。前列腺癌组的DRE及TRUS的敏感性均明显高于非前列腺癌组,两组比较差异有显著性（P〈0．05）。但前列腺癌组的DRE与TRUS的敏感性对比,差异不显著（P〉0．05）,而非前列腺癌组的DRE与TRUS的敏感性对比差异也不显著（P〉0．05）。结论经直肠超声引导下活检穿刺联合应用血清PSA、肛门指诊及经直肠超声检查及PSAD检测,可以更有效指导经直肠超声引导下活检穿刺,具有很高的临床应用价值,能提高诊断率。     

前列腺炎研究近况（二）

4．2体格检查 检查主要了解患者的一般情况,进行鉴别诊断,或对伴发疾病进行诊断。局部检查主要是进行前列腺触诊的直肠指诊检查（DRE）（图2）。进行DRE时应该注意前列腺的大小、质地或硬度、温度,中央沟有无变浅或消失,表面是否光滑,有无结节,波动感,触痛及其程度,表面充血情况等。     

经直肠超声引导前列腺穿刺活检的临床价值

目的：初步探讨直肠指检（DRE）、经直肠超声检查（TRUS）、前列腺特异性抗原（PSA）指标对前列腺穿刺活检病例的意义，并评价经直肠超声引导前列腺穿刺活检的安全性。方法：对2006年8月～2007年7月临床疑似前列腺癌的31例患者行经直肠超声引导前列腺穿刺活检，根据诊断资料分析DRE、TRUS、PSA指标的灵敏度、特异度，并随访穿刺活检术后并发症情况。结果：①31例患者术后前列腺增生15例，前列腺癌13例，前列腺炎2例，前列腺结核1例。DRE、TRUS、PSA三者中，PSA的灵敏度最高（92．3％），TRUS的特异度最高（44．4％），本组穿刺活检对前列腺癌的检出率41．9％，敏感度、特异度100％。②术中无明显疼痛，术后血尿8例（25、8％），血便2例，发热2例，尿痛11例。结论：经直肠超声引导前列腺穿刺活检安全可靠，操作简单，痛苦小，是诊断前列腺癌的有效方法。     

前列腺周围神经阻滞麻醉对缓解经直肠超声引导下前列腺穿刺活检术疼痛的效果

目的评估前列腺周围神经阻滞麻醉（PPNB）对缓解经直肠超声引导下前列腺穿刺活检术时疼痛的效果。方法回顾性分 析我院2013年11月~2015年1月经直肠超声引导下前列腺12针系统穿刺患者111例,根据是否采用PPNB,将患者分成PPNB 组（52例）和非PPNB组（59例）。PPNB组在经直肠超声引导下注射1％利多卡因阻滞麻醉前列腺周围神经,然后行穿刺活检; 非PPNB组未采用任何麻醉方法。穿刺结束后采用视觉模拟评分法对直肠指检(DRE)、经直肠超声检查、穿刺过程进行疼痛评 分;穿刺结束后7天随访患者穿刺并发症。结果两组患者的年龄、前列腺体积、总前列腺特异性抗原（TPSA）、游离前列腺特异 性抗原（FPSA）、DRE异常比例差异无统计学意义。两组患者DRE疼痛评分（1.40∶1.39,P=0.997）、经直肠超声检查疼痛评分 （2.10∶2.07,P=0.834）差异无统计学意义;然而,PPNB组穿刺疼痛评分更低（2.54∶3.07,P=0.033）。两组患者穿刺并发症差异无 统计学意义。结论相对于无麻醉,采用前列腺周围神经阻滞麻醉可减轻经直肠超声引导下前列腺穿刺活检术时疼痛不适。     

立体定向脑电图在药物难治性癫术前侵袭性评估中的应用价值和安全性

目的 探讨立体定向脑电图（SEEG）在药物难治性癫（DRE）术前侵袭性评估中的应用价值和安全性。方法 回顾性分析2016年8月至2018年11月在深圳市第二人民医院和深圳大学总医院开展SEEG置入的DRE患者的临床资料。根据患者无创的评估检查,提出可疑致灶位置和传播路径的假设,制定SEEG置入方案,最后根据SEEG和电刺激结果,制定最终手术切除或射频热凝方案,完成外科手术。结果 31例DRE患者共成功置入电极359根电极,平均11.58根/人,电极置入失败13根（3.62%）,无追加电极置入情况。术后出现迟发性颅内出血1例,未出现颅内感染、脑脊液漏等并发症。SEEG置入后,20例患者行致灶切除,8例患者行致网络射频热凝术,1例致灶位于功能区行迷走神经刺激术,2例患者未行手术治疗。31例患者随访时间为6~30个月,平均为（11.68±7.46）个月。20例行致灶切除术患者术后国际抗癫联盟（ILAE）分级Ⅰ级17例（85.00%,17/20）、Ⅱ级2例（10.00%,2/20）、Ⅲ级1例（5.00%,1/20）,8例行致网络射频热凝术患者术后ILAE Ⅰ级6例（75.00%,6/8）、Ⅲ级2例（25.00%,2/8）,2种不同治疗手段间的疗效差异无统计学意义（P=0.61）。13例磁共振成像（MRI）阴性患者中术后ILAE Ⅰ级10例（76.92%,10/13）、Ⅱ级2例（15.38%,2/13）、Ⅲ级1例（7.69%,1/13）,15例MRI阳性患者中术后ILAE Ⅰ级13例（86.67%,13/15）、Ⅲ级2例（13.33%,2/15）,两者间疗效差异无统计学意义（P=0.64）。结论 无论是MRI阳性还是MRI阴性的DRE病例,SEEG均可以提高致灶定位的精准性,SEEG指导下外科治疗DRE是安全、有效的。     

前列腺癌诊断与分析(附46例报告)

目的分析我院前列腺癌诊断现状,提高我院前列腺癌的早期诊断水平。指导治疗。方法分析我院1999年1月～2008年1月共46例前列腺癌患者资料。46例患者分别通过直肠指检（DRE）、前列腺特异抗原（PSA）、经直肠B超（TRUS）、前列腺穿刺活检、CT、MRI、同位素骨扫描（ECT）等检查明确诊断。结果 DRE提示前列腺增大、质地坚硬或触及结节37例（80%）,PSA〈4×10-3ng/L者2例（6%）,PSA（4～10）×10-3ng/L8例（18%）,PSA〉10×10-3ng/L36例（78%）,前列腺穿刺活检阳性82.6%（38/46）,TRUS诊断符合率91.3%（42/46）,CT、MRI诊断符合率41.3%（19/46）,ECT诊断符合率65.2%（30/46）。结论前列腺癌早期诊断、预防、干预、教育,是提高患者生存率的保障。     

Digital rectal examination: national survey of undergraduate medical training in Ireland

Objective

To assess the experience gained in digital rectal examination (DRE) by medical students in the Republic of Ireland by the completion of undergraduate training.

Methods

A national survey was conducted targeting all 582 final year students from the five medical schools completing their undergraduate studies in the summer of 2005. Format was anonymous questionnaire. Experience of DRE was defined as the student having performed at least one examination on either patient or teaching mannequin.

Results

In total, 396 (68%) of 582 students responded. No experience of DRE was reported in 97 (24%), with mannequin‐only experience in a further 78 (20%). Of the remaining 221 (56%) who performed DRE on at least one patient, one third (74) reported no confidence in their ability to interpret their findings properly.

Conclusion

Undergraduate training in DRE is limited. Training in DRE can no longer be reasonably considered part of the core curriculum taught in Irish medical schools.Digital rectal examination (DRE) has been considered an essential skill for the trained medical doctor, with traditional undergraduate training always emphasising the need for familiarity with this simple diagnostic examination.¹ DRE is required in all patients where a possible diagnosis may be facilitated.² Traditionally a cornerstone of prostate cancer diagnosis, recent reports suggest the positive predictive value and sensitivity of DRE in the screening for prostate cancer is strongly dependent on serum prostate specific antigen (PSA) value. Indeed, DRE alone performs poorly as a screening modality at low PSA values.³ Despite this limitation, few dispute the need for DRE to remain in the diagnostic armamentarium of specialists in urology and coloproctology. Up to a third of rectal cancers are palpable and failure to perform DRE in these instances may clearly delay diagnosis.⁴ General physicians, however, acquire far less experience of DRE in routine practice. Outside the specialised areas already described, increasing numbers may no longer view this intrusive examination as part of a routine general physical examination.The balance between the patient''s right to be examined by competent trained personnel and the student''s need to practise DRE before being considered trained is a difficult one. The General Medical Council has stated that medical students during training should acquire and become proficient in comprehensive physical examination, but no clear guidance is provided on how this is to be achieved.⁵ The Irish Medical Council''s Guide to ethical conduct makes no direct reference to undergraduate training in DRE despite the intimate and intrusive nature of this examination.⁶ With an increasing medico‐legal awareness, proper procedures for medical students must be constructed and failure to comply may be considered criminal.⁷In studies based in general practice within the UK, it has been found that confidence in performing and interpreting DRE was associated with the perception of having been well taught to do rectal examination while at medical school.⁸ This study has analysed the current practices in relation to undergraduate training of DRE on a national level within the Republic of Ireland. It involved the cooperation of all medical schools within the state.     

基于虫孔直通交换片上网络的共享优先级机制

基于传统虫孔直通交换（Conventional Wormhole Cut-Through Switching,Con-WCTS）的片上网络系统（Network-on-Chip,NoC）无法直接实现基于优先级的仲裁逻辑,不适用于对信息传输实时性要求较高的多核片上系统。引入虚拟通道技术,提出了共享优先级虫孔直通交换（Shared Priority Wormhole Cut-Through Switching,SP-WCTS）的网络结构,并给出了该网络信息最坏传输时间的计算方法。通过实验对比了Con-WCT网络、共享优先级虫孔交换（Shared Priority Wormhole Switching,SP-WS）网络、SP-WCTS网络以及轮询虫孔交换（Round Robin Wormhole Switching,RR-WS）网络的可调度性,并探究了虚拟通道数量和总网络利用率对网络可调度性的影响。实验结果表明：SP-WCTS的可调度性要明显优于另外3种网络;虚拟通道数量和总网络利用率对SP-WS网络可调度性的影响大于共享优先级SP-WCTS网络。     

基于BA无标度网络的WSNs拓扑优化模型

由于无线传感器能量受限,最大化网络生命周期成为优化网络拓扑首要考虑的问题。基于BA无标度理论,提出了一种WSNs拓扑优化模型（WTOM）。在网络中引入超级节点,结合粒子群算法合理地划分整个网络;在节点间建立多因素为导向的虚拟力场,利用虚拟力调整超级节点的部署位置,实现网络能量的均衡消耗,通过对关键节点的保护,提高网络的抗毁鲁棒性。经理论分析和实验证明,该网络不仅继承了BA无标度网络的特征还具有小世界特性;同时该动态拓扑延长了网络的生命周期,提高了网络面向数据收集的节能性。     

前列腺癌穿刺活组织检查阳性率影响因素的分析及前列腺癌预测模型的建立

目的：建立前列腺癌logistic回归预测模型,为决策前列腺穿刺提供更充分的指征。方法：回顾性分析117 例行前列腺穿刺活组织检查术的病例资料,按照病例收集的时间先后顺序分为两组,前2/3(78例)分入建模组,后 1/3(39例)分入验证组,建立logistic回归预测模型,并通过受试者工作特征(receiver operating characteristic,ROC)曲线下 面积来评估该模型的预测价值。结果：直肠指诊(digital rectal examination ,DRE)、经直肠超声(transrectal ultrasound, TRUS)、MRI、前列腺特异性抗原密度(prostate-specifi c antigen density,PSAD)以及前列腺特异性抗原游离比值(free PSA/ total PSA,fPSA/tPSA)是前列腺穿刺的影响因素(P<0.01)。根据各影响因素的回归系数值,建立前列腺癌logistic回归预 测模型：logit P=−2.362+2.561×DRE+1.747×TRUS+2.901×MRI+1.126×PSAD−2.569×fPSA/tPSA。ROC曲线下面积为0.907, 当P的临界值取值0.12时,其敏感度、特异度分别为81.80%,89.30%。结论：利用logistic回归分析建立预测模型可以为 前列腺穿刺提供更充分的指征。当该模型预测概率P>0.12时建议行前列腺穿刺活组织检查。     

基于多参数建立前列腺癌列线图预测模型及验证的研究

目的 基于单中心数据探讨前列腺癌相关预测因素,建立并验证前列腺癌列线图预测模型.方法 回顾性收集2014年1月至2020年1月邯郸市中心医院行前列腺穿刺活检患者的临床资料,包括年龄(Age)、总PSA(tPSA)、游离PSA(fPSA)和前列腺体积(PV)等.资料完整者纳入研究,共697例,中位年龄71岁(40～95岁),中位tPSA 13.6 ng/mL(0.2～100 ng/mL).随机选取495例(70％)为建模组,余202例(30％)为验证组.在建模组中利用单因素和多因素logistic回归分析,构建多参数列线图预测模型,利用ROC曲线下面积(AUC)评估该模型对前列腺癌的诊断价值,与tPSA、％fPSA和PSAD相比较,并进行内部人群验证.结果 697例中非前列腺癌组504例,前列腺癌组193例.两组患者的Age、tPSA、fPSA、PV、％fPSA、PSAD、直肠指检(DRE)结节、TRUS低回声和体质指数(BMI)差异有统计学意义(P＜0.05).单因素和多因素logistic回归分析显示建模组的年龄(OR=1.043)、tPSA(OR=1.025)、fPSA(OR=1.198)、PV(OR=0.971)、DRE结节(OR=3.195)、TRUS低回声(OR=4.288)及BMI(OR=1.703)是预测前列腺癌的独立预测变量(P＜0.05),据此建立列线图预测模型.建模组模型最佳临界值为0.36时ROC曲线下面积(AUC)为0.855,显著高于tPSA、％fPSA、PSAD;验证组模型AUC为0.810,显著高于国内模型.结论 本研究建立的前列腺癌列线图预测模型对前列腺癌具有较高的预测价值,预测概率＞0.36时,建议行前列腺穿刺活检.     

磁共振波谱成像联合直肠指检及血清PSA在前列腺癌诊断中的价值

目的初步探讨磁共振波谱成像(MRS)联合直肠指检(DRE)与血清前列腺特异抗原(PSA)在前列腺癌诊断中的应用。方法选取血清PSA异常84例男性患者行前列腺MRS和DRE并与病理结果对照。再分析MRS联合DRE及不同水平PSA(低危组4 ng/ml20 ng/ml)诊断前列腺癌的灵敏度(Se)、特异度(Sp)和准确度(AR)。结果病理证实前列腺癌41例、非前列腺癌43例(良性增生41例,炎症1例,结核1例)。单纯MRS诊断前列腺癌的Se、Sp和AR分别为85.4%、83.7%和84.5%,与病理诊断有统计学一致性(K=0.69,P<0.05);MRS联合PSA低危组、中危组和高危组诊断的Se、Sp和AR分别为75.0%、90.0%和84.4%,66.7%、73.3%和71.4%,95.7%、87.5%和93.5%;MRS联合DRE诊断Se、Sp和AR分别为88.9%、87.5%和88.6%;MRS同时联合PSA高危组及DRE诊断Se、Sp和AR分别增加至95.7%、100%和95.8%,差异均有统计学意义(P<0.05)。结论 MRS诊断前列腺癌具有无创和简便优点,其联合直肠指检及PSA有助于提高诊断的准确性。     

脊柱侧凸常用步态特征评估参数应用及研究进展

脊柱侧凸是一种脊柱的三维畸形,其导致一系列健康问题,如疼痛、姿势异常、步行模式异常等。步态评估有助于评估脊柱畸形改变对患者生活质量和日常活动能力障碍。三维步态分析系统包含时空参数、运动学和动力学评估方法,为脊柱侧凸患者提供客观的、量化的步态分析方法。其中,表面肌电和能量监测反映脊柱侧凸患者与健康人相比步行时肌肉生理学和能量变化。本综述对脊柱侧凸的三维步态分析、表面肌电和能量监测的研究进行总结,以全面客观的反映脊柱侧凸患者步行的生物力学改变     

Experience and attitudes of final-year medical students to digital rectal examination

OBJECTIVE: To assess the attitudes of final-year medical students to digital rectal examination (DRE) and their experience of performing DRE during clinical training. DESIGN: Questionnaire-based survey. SETTING AND PARTICIPANTS: All students in the final year of medical school at the University of Melbourne in 2003. OUTCOME MEASURES: Agreement with statements about attitude to DRE; number of DREs performed and abnormalities palpated; and ratings of frequency of supervision and perceived barriers to performing DRE. RESULTS: 222 of 256 students (87%) responded. Almost all (97%) believed that DRE is an essential requirement for a medical practitioner, and 94% that they should have the skill before graduating, while 92% said they had been taught how to perform it. The median number of DREs performed was two, with 17% of students performing none. Sixty-three per cent had palpated a prostate, 24% a prostate cancer, 19% a rectal tumour, and 11% faecal constipation. Half the students (52%) felt they could give a reasonable or confident opinion based on their DRE findings. The most often cited reason for not performing DREs was the lack of a doctor to act as a supervisor. CONCLUSIONS: A concerted effort is needed from academics, supervising doctors and students to improve medical students' proficiency in performing DRE and confidence about their findings.     

能源化工新材料热致变色水凝胶在智能窗上的应用

智能窗作为一种利用太阳能的有效手段受到广泛的关注。热致变色水凝胶材料是指当环境温度变化时其在水中的聚集形态可逆改变,从而导致光学透过率显著变化的材料。热致变色水凝胶材料在能源化工领域应用的典型实例就是智能窗。本文综述了热致变色水凝胶作为能源化工领域的新材料在智能窗领域应用的最新研究进展,并展望了其未来的发展方向。     

Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness

Objective

Fatal errors can occur in intensive care units (ICUs). Researchers claim that information integration at the bedside may improve nurses'' situation awareness (SA) of patients and decrease errors. However, it is unclear which information should be integrated and in what form. Our research uses the theory of SA to analyze the type of tasks, and their associated information gaps. We aimed to provide recommendations for integrated, consolidated information displays to improve nurses'' SA.

Materials and Methods

Systematic observations methods were used to follow 19 ICU nurses for 38 hours in 3 clinical practice settings. Storyboard methods and concept mapping helped to categorize the observed tasks, the associated information needs, and the information gaps of the most frequent tasks by SA level. Consensus and discussion of the research team was used to propose recommendations to improve information displays at the bedside based on information deficits.

Results

Nurses performed 46 different tasks at a rate of 23.4 tasks per hour. The information needed to perform the most common tasks was often inaccessible, difficult to see at a distance or located on multiple monitoring devices. Current devices at the ICU bedside do not adequately support a nurse''s information-gathering activities. Medication management was the most frequent category of tasks.

Discussion

Information gaps were present at all levels of SA and across most of the tasks. Using a theoretical model to understand information gaps can aid in designing functional requirements.

Conclusion

Integrated information that enhances nurses'' Situation Awareness may decrease errors and improve patient safety in the future.