Morphological imaging and CT histogram analysis to differentiate pancreatic neuroendocrine tumor grade 3 from neuroendocrine carcinoma

PurposeTo compare morphological imaging features and CT texture histogram parameters between grade 3 pancreatic neuroendocrine tumors (G3-NET) and neuroendocrine carcinomas (NEC).Materials and methodsPatients with pathologically proven G3-NET and NEC, according to the 2017 World Health Organization classification who had CT and MRI examinations between 2006-2017 were retrospectively included. CT and MRI examinations were reviewed by two radiologists in consensus and analyzed with respect to tumor size, enhancement patterns, hemorrhagic content, liver metastases and lymphadenopathies. Texture histogram analysis of tumors was performed on arterial and portal phase CT images. images. Morphological imaging features and CT texture histogram parameters of G3-NETs and NECs were compared.ResultsThirty-seven patients (21 men, 16 women; mean age, 56 ± 13 [SD] years [range: 28-82 years]) with 37 tumors (mean diameter, 60 ± 46 [SD] mm) were included (CT available for all, MRI for 16/37, 43%). Twenty-three patients (23/37; 62%) had NEC and 14 patients (14/37; 38%) had G3-NET. NECs were larger than G3-NETs (mean, 70 ± 51 [SD] mm [range: 18 - 196 mm] vs. 42 ± 24 [SD] mm [range: 8 - 94 mm], respectively; P = 0.039), with more tumor necrosis (75% vs. 33%, respectively; P = 0.030) and lower attenuation on precontrast (30 ± 4 [SD] HU [range: 25-39 HU] vs. 37 ± 6 [SD] [range: 25-45 HU], respectively; P = 0.002) and on portal venous phase CT images (75 ± 18 [SD] HU [range: 43 - 108 HU] vs. 92 ± 19 [SD] HU [range: 46 - 117 HU], respectively; P = 0.014). Hemorrhagic content on MRI was only observed in NEC (P = 0.007). The mean ADC value was lower in NEC ([1.1 ± 0.1 (SD)] × 10⁻³ mm²/s [range: (0.91 - 1.3) × 10⁻³ mm²/s] vs. [1.4 ± 0.2 (SD)] × 10⁻³ mm²/s [range: (1.1 - 1.6) × 10⁻³ mm²/s]; P = 0.005). CT histogram analysis showed that NEC were more heterogeneous on portal venous phase images (Entropy-0: 4.7 ± 0.2 [SD] [range: 4.2-5.1] vs. 4.5 ± 0.4 [SD] [range: 3.7-4.9]; P = 0.023).ConclusionPancreatic NECs are larger, more frequently hypoattenuating and more heterogeneous with hemorrhagic content than G3-NET on CT and MRI.     

核仁形成区嗜银蛋白定量对结肠癌分型、分级的诊断意义

对１１４例不同类型和级别的结肠癌进行银染核仁形成区嗜银蛋白（Ａｇ－ＮＯＲｓ）形态定量研究．结果表明，Ａｇ－ＮＯＲｓ数量、大小和分布在结肠未分化癌和印戒细胞癌组与管状腺癌和粘液腺癌组比较，有明显差异．管状腺癌随分化程度的降低，Ａｇ－ＮＯＲｓ的数量、形态、大小和分布也发生等级性变化．结果提示，Ａｇ－ＮＯＲｓ形态定量的数量、形态、大小和分布４项指标对结肠癌分型有一定意义，对管状腺癌分级有较好的诊断价值。     

海南省妇幼保健机构现状与创等达标的对策

根据《妇幼保健机构等级评审标准》（下称《标准》）要求，对全省２０个妇幼保健机构现状进行了调查。结果显示：我省妇幼卫生工作基础薄弱，离《标准》要求差距较大；各机构间的发展极不平衡；县（市）级机构整体水平偏低，业务用房、人员、设备、床位等建设滞后；服务项目单一，二级专业分科不完善等矛盾较为突出。据此提出，在创等达标工作中，要依靠各级政府，努力争取各方面的支持，抓住机遇，迎接挑战，重点抓好软件建设，加强在职培训，积极引进人才，拓宽服务范围，规范自我，依法服务。     

Osteotomy around the knee: Assessment of quality,content and readability of online information

BackgroundAs knee osteotomy surgery becomes increasingly accessible, more patients may turn to the Internet for information. This study examined the source, quality, content and readability of online information regarding osteotomy around the knee.MethodsThe first 70 websites returned by the top four search engines were identified using the key words: “knee osteotomy” and “high tibial osteotomy.” The websites were categorised by type and assessed using the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria and a novel Knee Osteotomy-Specific Score (KOSS). The presence of the Health On the Net (HON) code accreditation seal was noted. Readability of each website was assessed using eight readability formulae. The mean reading grade level (RGL) was compared to the 6th and 8th grade reading levels. The mean RGL of each category was also compared.ResultsOf the 45 unique websites analysed, the majority were Physician (33%) and Journal websites (31%). The mean DISCERN score was 36.7 (±8.9) which is classified as ‘poor.’ The mean JAMA benchmark criteria score was 2.04 (±1.5) and Physician websites were most likely to be scored zero. The mean KOSS was 15.4 (±5.7). The highest scoring website was a Commercial site but, overall, Journal category sites provided the best quality information. Websites that bore the HONcode seal obtained higher DISCERN, JAMA benchmark criteria and Knee Osteotomy - Specific Scores.The cumulative mean RGL was 13.2 (±2.2) which exceeded the 6th grade level by an average of 7.2 grade levels and the 8th grade level by an average of 5.2 grade levels. No website (0%) was written at or below either the 6th or the 8th grade reading levels. The mean Flesch Reading Ease Score of all websites was 41.13 (±14.7) which is classified as ‘difficult.’ Journal websites had the highest RGL.ConclusionThe information available online regarding osteotomy around the knee varies tremendously in quality and completeness. Physician sites predominate, but these were among the lowest scoring of all websites. Even where high quality information is available, it is set at too high a level to be easily understood.Level of evidenceSurvey of materials – Internet.     

高三学生时间管理倾向、自尊与成就动机的关系研究

目的探讨时间管理倾向、自尊与成就动机的关系。方法以青少年时间管理倾向量表（ATMD）、成就动机测量表（AMS）和自尊量表（SES）对高三151名文、理和艺术学生进行了研究。结果①高三学生在自尊上有显著性别差异（P〈0.05）;②高三文、理科和艺术学生在时间价值感（0.020）、自尊水平（0.017）上差异显著（P〈0.05）;③时间管理倾向各因子与自尊、自尊与成就动机两因子、时间管理倾向各因子与成就动机因子（时间价值感与避免失败动机除外）均有显著性相关（P〈0.05）。4时间管理总分和自尊对成就动机有显著的预测。结论高三学生时间管理倾向、自尊与成就动机三者密切相关。     

Intraductal papillary-mucinous tumours represent a distinct group of pancreatic neoplasms: an investigation of tumour cell differentiation and K-ras,p53 and c-erbB-2 abnormalities in 26 patients

Intraductal papillary growth of mucin producting hypersecreting, columnar cells characterizes a group of rare pancreatic exocrine neoplasms which we propose to call intraductal papillary-mucinous tumors (IPMT). We analysed the histopathology of 26 IPMT in relation to gastro-enteropancreatic marker expression, genetic changes and biology. Four IPMT showing only mild dysplasia were considered to be adenomas. Nine tumours displayed moderate dysplasia and were regarded as borderline. Severe dysplasia-carcinoma in situ changes were found in 13 IPMT which were therefore classified as intraductal carcinomas. Six of these carcinomas were frankly invasive and two of these had lymph node metastases. The invasive component resembled mucinous noncystic carcinoma in all but one tumour which showed a ductal invasion pattern. Immunohistochemically, an intestinal marker type was found in most carcinomas, while gastric type differentiation prevailed among adenomas or borderline tumours. K-ras mutations (seven at codon 12 and one at codon 13) were found in 31% of IPMT (2 adenomas, 1 borderline, 5 carcinomas). Nuclear p53 overexpression was detected in 31% of IPMT (6 carcinomas and 2 borderline IPMT) and correlated with p53 mutations (one at exon 8 and the other at exon 5) in two carcinomas. p53 abnormalities were unrelated to K-ras mutation. c-erbB-2 overexpression was observed in 65% of IPMT, with various grades of dysplasia. Twenty-two of 24 patients are alive and well after a mean post-operative follow-up of 41 months. Only two patients, both with invasive cancer at the time of surgery, died of tumour disease. It is concluded that pancreatic IPMT encompass neoplasms which, in general, have a favorable prognosis, but are heterogeneous in regard to grade of dysplasia and marker expression. Adenoma, borderline tumour, intraductal carcinoma and invasive carcinoma can be differentiated. p53 changes but not K-ras mutation or c-erbB-2 overexpression are related to the grade of malignancy. Most IPMT differ in histological structure, marker expression and behaviour from ductal adenocarcinoma.     

私立学校初三学生考试成败归因特点研究

目的 研究私立学校初三学生考试成败的归因特点，为实际教育工作提供依据。方法 采用中小学生考试成败归因量表和自尊量表对236名学生进行了调查。结果 ①“失败”是影响学生进行考试结果归因的主要因素。②学生在归因时存在“自利性归因偏差”，并且有“习得性无助感”。结论 需对学生进行积极的归因训练。     

足部穴位按摩护理0级糖尿病足患者有效性的系统评价

目的:对足部穴位按摩护理0级糖尿病足的相关文献进行系统评价,证实其应用效果,为临床实践提供参考。方法:计算机检索Cochrane Library、PubMed、Embase、Web of Science、Ebsco、中国知网(CNKI)、万方数据知识服务平台(WanFang Data)、维普期刊资源整合服务平台(VIP)和中国生物医学文献数据库(CBM)中有关足部按摩治疗0级糖尿病足的随机对照试验(RCT)和半随机对照试验(CCT),检索时间均从建库至2020年3月。由2名研究员进行文献筛选、资料提取及质量评价后,利用RevMan 5.3软件进行Meta分析。结果:筛选、资料提取及质量评价后,利用RevMan 5.3软件进行Meta分析。最终纳入10篇原始文献,包括11项研究,共计663例患者,根据不同干预措施分为4个亚组。文献质量评价结果均为B级。Meta分析结果显示:实施足部穴位按摩可提高患者护理有效率[RR=1.43, 95%CI(1.25, 1.63),P0.00001];提高患者踝肱比[MD=0.22,95%CI(0.15,0.30),P0.00001]。结论:对0级糖尿病足患者实施足部穴位按摩优于常规护理,但需继续开展多中心、大样本、高质量随机对照试验进一步证实,并分析联合不同中医护理技术的疗效差异。     

Evaluating Patient Education Materials for Grade Level

Patients are often given patient education documents to take home with them when they leave the hospital. It is important that these documents be at an appropriate grade level since some patients have low health literacy and may be unable to read the materials given to them. Evaluators can use readability tools to assess their patient education materials and make sure they are at a sixth- to eighth-grade reading level. The hospital librarian can play a large role in identifying the grade level of patient education materials.