Web-Based Learning Versus Standardized Patients For Teaching Clinical Diagnosis: A Randomized,Controlled, Crossover Trial

Background: Little evidence exists to guide the selection of methods for teaching clinical diagnosis. Purpose: To compare the efficacy, student preference, and cost of a Web-based (WB) program versus a standardized patient (SP) encounter for teaching clinical diagnosis skills to 2nd-year medical students. Methods: Randomized, controlled, crossover study comparing WB versus SP-based teaching for the clinical diagnosis of abdominal pain and headache. Outcome measures were performance on a 2-case SP examination (scored on the basis of a checklist completed by a faculty observer and an objective score on a postencounter subjective-objective assessment plan [SOAP] note), format preferences as assessed by end-of-course evaluations, and cost. Results: Thirty students consented to participate. WB and SP training produced similar scores on both the Abdominal Pain checklist (66% vs. 62%; p =. 17) and Headache checklist (56% vs. 63%; p =. 07). WB training produced a higher score on the Abdominal Pain SOAP note (69% vs. 47%; p =. 006), but not the Headache SOAP note (69% vs. 67%; p =. 85). Students rated the SP format higher than the WB format on all 7 preference measures. Start-up costs were estimated at $2,190 for the SP format and $2,250 for the WB format. Ongoing costs per case per student were estimated to be $45 for the SP format and $30 for the WB format. Conclusions: WB and SP learning outcomes were comparable, but students preferred the SP format. Start-up costs were comparable, but the ongoing costs of the WB format were less expensive, suggesting that WB teaching may be a viable strategy.     

罕见病实验室诊断技术的进展

罕见病是一类单病种发病率很低、病情严重、进展迅速的疾病,对其早期诊断能够有效延缓病程,提高患儿生存质量.随着高通量测序技术的普及、第3代测序技术的逐步完善以及多组学研究技术的进步,罕见病的实验室诊断方法不断多样化、高效化,通过整合高速更新的大数据,选择性结合细胞遗传学及分子遗传学方法,同时灵活运用生化检测指标等,将有效...     

Efficiency analysis of two written short-answer student evaluation formats

The purpose of this study was to compare the efficiency of two written short-answer student evaluation formats. Efficiency was defined in this study as reliability per unit of examination time. Twenty second-year physical therapy students enrolled in the soft tissue injuries portion of the orthopedic course completed a 12-item quiz consisting of two formats (diagnosis and response set) with six parallel content items per format. The outcome measures of interest were 1) students' score, 2) amount of time required to complete each item, and 3) amount of time required by the faculty members to grade each item. The results indicated that a greater reliability per unit of examination time was achieved for the diagnosis format than for the response set format and that the diagnosis format could be graded more rapidly and with a higher level of interrater agreement than the response set format. Students' grades on the diagnosis format items tended to be higher (although not statistically significant) than the grades on the response set format items, suggesting that when a criterion-referenced system is used, the minimal acceptable baseline score should be raised when using the diagnosis format. Further study is required to evaluate the validity of the diagnosis format.     

DNA芯片检测分枝杆菌的临床应用价值

目的：比较DNA-微阵列芯片法和改良罗氏法检测结核分枝杆菌和非结核分枝杆菌的一致性,探讨DNA-微阵列芯片法在临床上的应用价值。方法应用DNA-微阵列芯片法检测64例改良罗氏法阳性的分枝杆菌核酸,比较两种方法检测结果的一致率;两种方法检测结果不一致样本进行测序验证,以测序结果作为金标准,分析两种方法检测结果的正确率及不一致的可能原因。结果两种方法检测总一致率为93.8%,结核分枝杆菌检测一致率为87.5%,非结核分枝杆菌检测一致率为95.8%。DNA-微阵列芯片法和改良罗氏法共有4例检测结果不一致,与测序结果比对后,改良罗氏法区分结核和非结核的正确率为96.9%;DNA-微阵列芯片法正确率为93.8%,且能鉴定出7种常见分枝杆菌。结论 DNA-微阵列芯片法与作为传统金标准的改良罗氏法检测结核分枝杆菌和非结核分枝杆菌的一致性好、正确率高。操作简单、快速、灵敏、并且能鉴定出常见分枝杆菌,DNA-微阵列芯片法可作为临床分枝杆菌感染诊断的重要检测手段。     

siRNA therapy for cancer and non-lethal diseases such as arthritis and osteoporosis

Importance of the field: Gene silencing mediated by siRNA has been widely investigated as a potential therapeutic approach. The success of these therapies depends on effective systems capable of selectively and efficiently conveying siRNA to targeted cells/organs with minimal toxicity.

Areas covered in this review: This review discusses current experimental approaches to siRNA delivery strategies available for arthritis treatment and the management of other musculoskeletal disorders. The review covers literature on the subject from 2000 to 2010.

What the reader will gain: In the last decade, extensive improvements have been made to optimize siRNA-based gene therapy and have been tested on several arthritis and orthopedic conditions. However, except for Phase I – II DNA-based gene therapy trials on arthritis, no clinical studies have reported siRNA application in these domains.

Take home message: Most musculoskeletal disorders, such as rheumatoid arthritis, osteoarthritis, fracture, aseptic loosening, cartilage and intervertebral disc degeneration are non-fatal and age-related chronic inflammatory conditions, but represent significant morbidity and a socio-economic burden. siRNA-based gene therapy offers treatment opportunities that are less invasive, more effective and less expensive than existing modalities. Future directions for siRNA therapy include the development of safe and more efficient delivery systems and the selection of optimal gene targets for disease control.     

MRI、CT与乳腺X线钼靶摄影诊断乳腺疾病的价值比较

目的:探究MRI、CT与乳腺X线钼靶摄影三种检查方式对乳腺疾病的诊断价值,为临床治疗乳腺疾病提供理论参考。方法:选择2018年1月—2019年1月期间在我院接受治疗的96例乳腺疾病患者作为本次实验探究的研究对象,所有患者均进行MRI检查、CT扫描与乳腺X线钼靶摄影检查,比较三种检查方式对乳腺疾病的诊断准确率。结果:MRI的诊断准确率显著高于CT扫描和乳腺X线钼靶摄影,CT扫描的诊断准确率显著高于乳腺X线钼靶摄影,具有统计学意义(P<0.05)。结论:相对而言,乳腺X线钼靶摄影更适用于早期乳腺疾病的检查,MRI检查和CT扫描可有效提高乳腺疾病的诊断准确率,三种检查方法各有利弊,建议根据患者病情和个人情况,选择恰当的检查方法,或多种联合使用,能够有效提高患者的诊断准确率,对后期治疗方法的选择具有较高的参考意义,有利于提升预后效果。     

广西地区纯合子血红蛋白Constant Spring的研究

目的　分析广西地区纯合子血红蛋白ConstantSpring(HbCS)的表现型与基因型的相互关系 ,探讨临床上可能的漏诊原因及其筛查和确诊方法。方法　醋酸纤维薄膜电泳后联苯胺染色法筛选HbCS ,用PCR方法和DNA测序确诊纯合子HbCS基因突变。结果　 9例患者中 ,4例完全无临床症状 ,2例有轻度贫血、脾肿大 ,3例有轻度至中度巩膜黄染。血红蛋白正常或有轻度贫血 ,MCV正常或降低。全部病例外周血涂片呈红细胞大小不等 ,中央浅染 ,有靶形红细胞。血红蛋白分析HbA2 HbCS 4 .3%～ 6 .7% ,HbA2 <2 .0 % ,多数为 1.4 % ,基因分析确诊为纯合子HbCS。结论　纯合子HbCS的临床表现、血液学改变和血红蛋白分析方面差异很大 ,可以完全无症状 ,血液学资料正常或仅有轻度黄疸 ,亦可类似于HbH病。此病在临床上较易漏诊、误诊。确诊依赖基因分析。     

抗心磷脂抗体IgG时间分辨荧光免疫分析法的建立

目的建立高灵敏度、宽量程的定量检测患者血清中的抗心磷脂抗体(anticardiolipin antibody,ACA)IgG的时间分辨荧光免疫分析方法。方法采用ACA抗原(心磷脂+β2糖蛋白I)和鼠抗人IgG抗体分别作为固相抗原和铕标记抗体,如果样本中存在ACA抗体,则形成ACA抗原-ACA抗体-铕标记鼠抗人IgG抗体复合物,加入解离增强液解离铕离子,检测荧光强度,样本中ACA-IgG抗体含量与荧光强度成正比;对建立的时间分辨荧光免疫(time-resolved fluoroimmunoassay,TRFIA)法检测ACA抗体的线性范围、精密度、检测范围进行分析;对25例ACA-IgG抗体阳性血清标本分别利用TRFIA及ELISA法检测ACA-IgG抗体,分析其相关性;收集50例健康献血者,利用TR-FIA检测其血清中的ACA-IgG抗体,计算临床特异度。结果 利用SPSS 13.0统计软件进行统计学分析,TRFIA法检测高、中、低3种浓度混合血清的批内(n=20)精密度分别为2.34%、3.25%和3.87%,批间(n=8)精密度分别为2.89%、3.67%和4.50%;方法的灵敏度为0.1GPL U/ml;TRFIA法检测健康献血者,临床特异度为98%;TRFIA与ELISA 2种方法检测结果的一致性检验采用相关性分析,相关系数为0.987;TRFIA比ELISA的检测范围更宽,稳定性能好。结论首次建立稳定的高灵敏度和宽检测范围的TRFIA法检测人血清中的ACA-IgG抗体,对早期诊断自身免疫性疾病及监测疗效具有重要意义,该方法以其优势有望在各检验科室得以普遍应用。     

周边型肺部病变的内镜诊断

周边型肺部病变是临床上常见的疾病,支气管肺癌、肺转移瘤、肺结核等多种疾病均可表现为相似的影像学表现。周边型肺部病变常规支气管镜难以探及,对于距离胸壁较远或周围有大血管等重要脏器的病灶经皮穿刺也难以实施。合理利用细（或超细）支气管镜、经支气管镜肺活检、径向气道内超声引导肺活检术、支气管肺泡灌洗以及支气管镜导航等新技术可以提高周边型肺部病变的确诊率,便于指导临床早期治疗,以期获得较好的预后。     

伴有钙化的肝占位性病变的超声诊断分析

目的 探讨肝占位内钙化灶的出现对肝占位诊断和鉴别诊断的临床意义。方法 应用二维超声常规扫查肝脏，发现肝占位璀为时特别注意肝占位内有无钙化灶及其分布，并和ＣＴ及Ｘ线显示结果比较。结果 （１）超声和ＣＴ对肝占位内钙化灶的显示率极高，分别为１００％和９６％。二者比较无显著性差异。但优于Ｘ线显示率４７％。（２）良恶性病变均可出现钙化灶，恶性病变中以转移性肝癌多见。结论 肝占位内钙化中出现于多种病变，对诊断     

飞行时间质谱技术在糖尿病肾病患者尿蛋白成分分析中的研究进展

飞行时间质谱技术(time of flight mass spectrometry,TOF-MS)由于其快速易操作等优点,已经越来越广泛的应用于临床和科研。糖尿病肾病是糖尿病最常见的并发症,但临床现有的检测方法在一定程度上具有一定的滞后性,飞行时间质谱等蛋白组学相关技术的应用和发展,为糖尿病肾病的早期诊断及预后等方面提供了新的方法和思路。该文就近几年国内外应用TOF-MS在糖尿病肾病方面取得的最新研究成果进行综述。     

先天性子宫畸形的磁共振诊断价值

目的：探讨磁共振对先天性子宫畸形的诊断价值。方法：回顾性分析34例先天性子宫畸形的MRI、超声及临床资料,结果与宫腔镜和/或腹腔镜检查结果对照。结果：以宫腔镜和/或腹腔镜检查结果为金标准,MRI、超声诊断子宫畸形的准确率为97.1%和85.3%。结论：MRI能清楚显示宫底外形轮廓和宫腔结构,是诊断先天性子宫畸形的最佳无创性检查方法之一。     

3种检测方法在诊断自身免疫性疾病中的价值

目的通过对抗核抗体、可提取性核抗原(ENA)及抗核抗体谱3检测方法的分析比较,探讨有益于临床诊断的检测组合。方法采用人喉癌上皮细胞及猴肝作为基质的间接免疫荧光法检测抗核抗体;应用欧蒙斑点法检测可提取性核抗原中的如下抗原:nRNP/Sm、Sm、SSA、SSB、Scl-70、Jo-1;以绿蝇短膜虫为基质,应用间接免疫荧光法检测抗双链DNA抗体;通过欧蒙印迹法检测15种自身抗体。结果将3种稀释度(1:10、1:80、1:100)抗核抗体检测的阳性率进行比较,1:10及1:80稀释的血清抗核抗体阳性率差异有统计学意义(P0.01),其余2种比较差异无统计学意义;在核点型、胞浆颗粒型及均质型等多种核型的检测中抗核抗体谱3的阳性检出率高于ENA谱;在抗双链DNA抗体的检测中间接免疫荧光法的阳性检出率略高于欧蒙印迹法。结论在应用间接免疫荧光法的抗核抗体检测中,使用1:80的稀释度更有利于提高检出率,而且涵盖15种抗原的抗核抗体谱3也为临床诊断提供了有利的依据。     

MR半傅立叶单次激发快速自旋回波序列与超声检查在胎儿颅脑疾病的对比分析

目的探讨MR半傅立叶单次激发快速自旋回波序列(half-Fourier acquisition single-shot turbo spin-echo,HASTE)在胎儿颅脑疾病的应用价值。材料与方法选取超声诊断或疑诊胎儿颅脑发育异常孕妇46例,应用HASTE序列对胎儿头颅行轴面、冠状及矢状面扫描,对两种方法诊断结果进行对比分析。结果超声提出诊断34例,疑诊病变12例。HASTE共发现病变35例,检出病变45个。超声在液性病变诊断方面,在测量异常值≥3 mm时,诊断侧脑室扩张及枕大池增宽与HASTE符合率达96%(26/27);在超声测量异常值3 mm时,诊断侧脑室扩张及枕大池增宽与HASTE符合率为25%(3/12)。在诊断中线结构病变及复杂颅内病变方面,HASTE序列显示病变数明显多于超声检查。结论 HASTE序列在胎儿颅脑产前诊断中可进一步验证或修正超声诊断,且在颅脑中线结构及脑实质病变方面诊断明显优于超声检查。     

Diagnosis of tuberculosis: available technologies,limitations, and possibilities

Rapid diagnosis and treatment are important for preventing transmission of Mycobacterium tuberculosis. However, the diagnosis of tuberculosis continues to pose serious problems, mainly because of difficulties in differentiating between patients with active tuberculosis and those with healed lesions, normal mycobacterium boris BCG (Bacillus Calmette Guerin) vaccinated individuals, and unvaccinated Manteux positives. Physicians still rely on conventional methods such as Ziehl-Neelsen (ZN) staining, fluorochrome staining, sputum culture, gastric lavage, and other non-traditional methods. Although the tuberculin test has aided in the diagnosis of tuberculosis for more than 85 years, its interpretation is difficult because sensitization with nontuberculous mycobacteria leads to false-positive tests. There have been numerous unsuccessful attempts to develop clinically useful serodiagnostic kits for tuberculosis. A number of proteinaceous and nonprotein antigens (such as acyltrehaloses and phenolglycolipids) have been explored from time to time for the development of such assays but they have not proved to be clinically useful. It has been difficult to develop an ELISA utilizing a suitable antigen because M. tuberculosis shares a large number of antigenic proteins with other microorganisms that may or may not be pathogenic. With the advent of molecular biology techniques, there have been significant advances in nucleic acid-based amplification and hybridization, which are helping to rectify existing flaws in the diagnosis of tuberculosis. The detection of mycobacterial DNA in clinical samples by polymerase chain reaction (PCR) is a promising approach for the rapid diagnosis of tuberculous infection. However, the PCR results must be corrected for the presence of inhibitors as well as for DNA contamination. In the modern era of genetics, marked by proteomics and genomics, the day is not far off when DNA chip-based hybridization assays will instantly reveal mycobacterial infections.     

高频超声在浅表器官病变中的应用价值

目的　探讨对比运用 2 0 .0MHz和 7.5MHz高频超声对眼、甲状腺、乳腺、男性生殖器、浅表淋巴结及皮肤等组织器官病变进行诊断的临床应用价值。方法　运用 2 0 .0MHz与 7.5MHz的探头分别检查 92例浅表器官病变的形态、大小及血流状况。结果　 2 0 .0MHz超高频超声对乳腺、甲状腺肿块内沙粒状钙化灶的检出率明显高于 7.5MHz高频超声 (P <0 .0 5 ) ,明显提高了恶性病变的诊断率 ;2 0 .0MHz超高频超声可以明确显示小的病灶及细小管状结构的病变 ,如晶状体浑浊、乳腺导管内乳头状瘤及乳头状癌伴乳腺导管扩张、输精管扩张、腮腺导管结石伴导管扩张、阴茎硬结病变以及皮肤弥漫性或结节性病灶。结论　 2 0 .0MHz超高频超声对于浅表器官及皮肤等组织病变的检查具有重要价值。     

2015慢性肺曲霉菌病诊断和治疗临床指南解读

慢性肺曲霉菌病(CPA)是一种罕见的肺部疾病,指慢性肺部曲霉菌感染,病程超过3个月。CPA常继发于其他呼吸系统疾病,如肺结核、变应性支气管肺曲霉菌病、结节病等,如不积极治疗,5年病死率较高 (75%~80%),因此需提高临床医师对CPA的全面认识,以期尽早明确诊断,并给予恰当治疗,以降低其病死率。近年来,随着CPA患病人数的逐渐增多,临床医师对该病的认识不断提高,关于CPA诊治的研究成果日益增多。近期,欧洲临床微生物学和感染性疾病联合会(ESCMID)、欧洲呼吸学会(ERS)合作,总结了关于CPA的前期研究成果,发布了CPA临床诊治指南,对CPA的定义、临床分型、实验室检查、影像学检查、诊断标准、治疗和随访等进行了系统性阐述,本文对其进行解读,旨在学习并分享关于CPA领域的最新成果,以指导临床治疗。     

Oncolytic adenoviruses for treatment of brain tumours

Standard therapies are not capable of curing patients with malignant glioma; more than 90% of patients die within 2 years after diagnosis. Gene therapy appeared as a promising new approach for this disease. However, results of clinical trials with replication deficient viral vectors were disappointing. The main reasons being poor transduction efficiency of adenovirus towards glioma cells and limited spread and distribution of the vector in the tumour. With the increasing knowledge of viral genetics and its functions, an attractive alternative tool to kill malignant glioma cells has been developed: Replicating adenovirus as an oncolytic agent. This type of therapy, also referred to as virotherapy, has the potential to overcome some of the limitations connected with replication deficient adenoviral vectors. In this review the authors describe the latest developments in strategies that are being used to create a tumour- or glioma- selective replicating adenovirus. Special attention is given to the methods of viral delivery to an infiltrating tumour in the brain, regarding optimal dose and toxicity. Furthermore, the role of conventional antitumour treatments, such as irradiation and chemotherapy, in enhancing the effect of virotherapy is being emphasised.     

Oncolytic adenoviruses for treatment of brain tumours

Standard therapies are not capable of curing patients with malignant glioma; more than 90% of patients die within 2 years after diagnosis. Gene therapy appeared as a promising new approach for this disease. However, results of clinical trials with replication deficient viral vectors were disappointing. The main reasons being poor transduction efficiency of adenovirus towards glioma cells and limited spread and distribution of the vector in the tumour. With the increasing knowledge of viral genetics and its functions, an attractive alternative tool to kill malignant glioma cells has been developed: Replicating adenovirus as an oncolytic agent. This type of therapy, also referred to as virotherapy, has the potential to overcome some of the limitations connected with replication deficient adenoviral vectors. In this review the authors describe the latest developments in strategies that are being used to create a tumour- or glioma-selective replicating adenovirus. Special attention is given to the methods of viral delivery to an infiltrating tumour in the brain, regarding optimal dose and toxicity. Furthermore, the role of conventional antitumour treatments, such as irradiation and chemotherapy, in enhancing the effect of virotherapy is being emphasised.