Risk prediction of common bile duct stone recurrence based on new common bile duct morphological subtypes

Stones in the common bile duct (CBD) are reported worldwide, and this condition is majorly managed through endoscopic retrograde cholangiopancreatography (ERCP). CBD stone recurrence is an important issue after endoscopic stone removal. Therefore, it is essential to identify its risk factors to determine the necessity of regular follow-up in patients who underwent endoscopic removal of CBD stones. The authors identified that the S and polyline morphological subtypes of CBD were associated with increased stone recurrence. New morphological subtypes of CBD presented by the authors can be important risk predictors of recurrence after endoscopic stone removal. Furthermore, the new morphological subtypes of CBD may predict the risk of residual CBD stones or technical difficulty in CBD stone removal. Further studies with a large sample size and longer follow-up durations are warranted to examine the usefulness of the newly identified morphological subtypes of CBD in predicting the outcomes of ERCP for CBD stone removal.     

取环致宫腔化脓性感染引发腰椎间盘炎一例报道并文献复习

宫腔化脓性感染是一种严重的盆腔炎性疾病（PID），主要表现为发热、腹痛、阴道分泌物增多等症状。椎间盘炎是发生于椎间盘间隙和邻近椎体或软骨板的感染性病变，其症状及体征缺乏特异性，临床上容易诊断延迟直至出现椎体骨质破坏及下肢肌力减弱。本文报道了1例因取环手术引发宫腔化脓性感染进而引发腰椎间盘炎，出现腰痛伴行走障碍的患者，并进行了文献复习，加深了对PID的病原体、感染传播途径、诊断标准、治疗原则及其严重不良后果的认识。对于非特异性椎间隙感染，临床医生除实验室检查及影像学检查之外，还应仔细询问病史并了解病情的演变过程，及时诊断并进行手术治疗。     

Comparison of quantitative susceptibility mapping methods on evaluating radiation-induced cerebral microbleeds and basal ganglia at 3T and 7T

Quantitative susceptibility mapping (QSM) has the potential for being a biomarker for various diseases because of its ability to measure tissue susceptibility related to iron deposition, myelin, and hemorrhage from the phase signal of a T₂*-weighted MRI. Despite its promise as a quantitative marker, QSM is faced with many challenges, including its dependence on preprocessing of the raw phase data, the relatively weak tissue signal, and the inherently ill posed relationship between the magnetic dipole and measured phase. The goal of this study was to evaluate the effects of background field removal and dipole inversion algorithms on noise characteristics, image uniformity, and structural contrast for cerebral microbleed (CMB) quantification at both 3T and 7T. We selected four widely used background phase removal and five dipole field inversion algorithms for QSM and applied them to volunteers and patients with CMBs, who were scanned at two different field strengths, with ground truth QSM reference calculated using multiple orientation scans. 7T MRI provided QSM images with lower noise than did 3T MRI. QSIP and VSHARP + iLSQR achieved the highest white matter homogeneity and vein contrast, with QSIP also providing the highest CMB contrast. Compared with ground truth COSMOS QSM images, overall good correlations between susceptibility values of dipole inversion algorithms and the COSMOS reference were observed in basal ganglia regions, with VSHARP + iLSQR achieving the susceptibility values most similar to COSMOS across all regions. This study can provide guidance for selecting the most appropriate QSM processing pipeline based on the application of interest and scanner field strength.     

Novel Extracorporeal Dialysis Circuit to Improve the Removal Efficiency of High and Middle Molecular Weight Toxins

A new extracorporeal circuit for hemodialysis was designed with the goal of improving the middle and high molecular weight toxins removal. A recirculation pathway was added to the hemodialysis circuit and relevant pressure regulation was performed along the circuit in order to keep the ultrafiltration rate as zero. The influence of increasing the recirculation to dialysate flow rate ratio on the removal of urea, vitamin B12, and hemoglobin was investigated. This removal was also modeled by an analytical method and solved by MATLAB software. A significant increase in removal of vitamin B12 (34%) and especially hemoglobin (228%) was achieved using the recirculation flow in an adjusted hemodialysis circuit. The model showed an acceptable agreement with the experimental results which shows its applicability for prediction of different toxin removal in this circuit.     

子痫前期孕妇血清代谢组学分析

目的 比较妊娠子痫前期（PE）患者分娩前后血清代谢轮廓的变化，建立疾病区分模型并筛选出具有潜在临床应用价值的特征代谢物。方法 收集2017年9月至2018年3月于天津市第三中心医院住院的孕妇共45例，其中PE孕妇（PE组）20例（44.4%），正常孕妇（对照组）25例（55.6%），应用超高效液相色谱与质谱联用仪（UPLC-MS）分别检测PE组分娩前、分娩后以及对照组的血清标本，筛选出差异性特征代谢物并进行分析。 结果 构建了妊娠PE组血清代谢轮廓模型，共筛选出溶血磷脂酰胆碱类物质LPC 18:0、LPC 22:6、14-甲基十六烷酸、二十二酸和1,25-二羟基维生素D3-26，23内酯共5种差异性代谢产物，且溶血磷脂酰胆碱类物质LPC 18:0、LPC 22:6和14-甲基十六烷酸3种物质在PE分娩前与分娩后的差异有显著性统计学意义（P＜0.05）。结论 构建代谢轮廓模型具有很强的区分PE患者分娩前后及正常孕妇的能力，筛选出特征代谢物能够反映患者代谢水平的变化趋势，为PE的预测、诊治提供参考和帮助。     

Proteomic genotyping of fingermark donors with genetically variant peptides

Proteomic genotyping detects single amino acid polymorphisms to infer the genotype of corresponding non-synonymous SNPs. Like any DNA genotype, these inferences can be used to estimate random match probability. Fingermarks are a common source of biological evidence that is sample limited and a highly variable source of identifying DNA. Genetically variant peptides from fingermarks, that contain single amino acid polymorphisms, are an additional source of identifying genetic information. To discover these peptide biomarkers epidermal corneocytes from 9 subjects were isolated, processed, digested with trypsin and applied to mass spectrometry. The resulting proteomic and matching exome datasets were used to discover, characterize and validate 60 genetically variant peptides. An average of 28.8 ± 4.4 genetically variant peptides were detected from each subject resulting in a total of 264 SNP allele inferences with 260 true and 4 false positives, a false discovery rate of 1.5%. Random match probabilities were estimated using the genotype frequencies from the matching major populations in the 1000 Genomes Project. Estimates ranged up to a value of 1 in 1.7 × 10⁸, with a median probability of 1 in 2.4 × 10⁶. Furthermore, the proteomically-inferred genotypes are likely to be compatible with the STR-based random match probability estimates since the closest STR locus was 2.2 Mb from the nearest GVP-inferred SNP. This project represents a novel mode of genetic information that can be obtained from fingermarks and has the potential to complement other methods of human identification including analysis of ridge patterns or touch DNA.     

Disaster preparedness: A concept analysis and its application to the intensive care unit

ObjectivesThe aim of the study is to understand the concept of disaster preparedness in relation to the intensive care unit through the review and critique of the peer-reviewed literature.Review method usedRodgers' method of evolutionary concept analysis was used in the study.Data sourcesHealthcare databases included in the review were Cumulative Index to Nursing and Allied Health Literature, Public MEDLINE, Scopus, and ProQuest.Review methodsElectronic data bases were searched using terms such as “intensive care unit” OR “critical care” AND prep1 OR readiness OR plan1 AND disaster1 OR “mass casualty incidents” OR “natural disaster” OR “disaster planning” NOT paed1 OR ped1 OR neonat1. Peer-reviewed articles published in English between January 2000 and April 2020 that focused on intensive care unit disaster preparedness or included intensive care unit disaster preparedness as part of a facility-wide strategy were included in the analysis.ResultsEighteen articles were included in the concept analysis. Fourteen different terms were used to describe disaster preparedness in intensive care. Space, physical resources, and human resources were attributes that relied on each other and were required in sufficient quantities to generate an adequate response to patient surges from disasters. When one attribute is extended beyond normal operational capacities, the effectiveness and capacity of the other attributes will likely be limited.ConclusionThis concept analysis has shown the varied language used when referring to disaster preparedness relating to the intensive care unit within the research literature. Attributes including space, physical resources, and human resources were all found to be integral to a disaster response. Future research into what is required of these attributes to generate an all-hazards approach in disaster preparedness in intensive care units will contribute to optimising standards of care.