腓肠豆骨的形态学特点及其临床意义研究进展

目的：总结腓肠豆骨的形态学特点及其临床意义.方法：广泛查阅近几年关于腓肠豆骨的解剖学以及临床研究相关文献,归纳总结其形态特点及临床意义.结果：腓肠豆骨为膝关节不恒定出现的籽骨,以往其临床意义常被忽视.但由于其能引起腓肠豆综合征、腓总神经麻痹,且与膝关节炎发生有关,逐渐受到重视.结论：腓肠豆骨病变可造成膝关节疼痛,但常被误诊为其他常见疾病.医生应充分认识腓肠豆骨可能造成病变,并且对此引起重视.     

从历史的观点谈我国医学遗传学的出路

通过对医学遗传学的发展史进行回顾,可知医学遗传学是一门临床学科,临床遗传学是它的临床部分。它的飞速发展是由于基础学科与临床遗传工作的密切互动。不幸的是,在我国,临床遗传工作没有受到应有的重视。迄今,医学遗传学及其临床部分还不是一门医学专业。这种情况与发达国家相距甚远。目前应立即确认医学遗传学及其临床部分是一门医学专业,并在有条件的大医院内,积极推动临床遗传学服务工作。     

手足口病病原体实时荧光RT-PCR反应体系的建立与临床应用

目的 建立一种快速、准确、特异件高的方法 检测手足口病病原体.方法 根据引起手足口病常见致病原肠道病毒71(EV71)、柯萨奇病毒A16(CA16)及肠道病毒(EV),设计相应的引物、探针对35例临床诊断的手足口病患儿及20例正常健康婴儿的粪便进行EV、EV71、CA16三种病原体实时荧光RT-PCR检测,同时对55分标本进行EV71病毒培养分离.结果 35例临床诊断手足口病患儿粪便中EV全部阳性,EV71阳性25例,CA16阳性8例,其中3例为EV71、CA16同时阳性,与临床诊断符合率为85.71%,20例健康体检婴儿粪便中EV病毒5例阳性,EV71、CA16均阴性.结论 荧光RT-PCR对手足口病病原体检测准确性高、特异性强,具有快速、廉价等特点,适合于手足口病的早期诊断.     

儿童哮喘临床护理路径变异相关因素的Logstic回归分析

目的 研究Logstic回归分析儿童哮喘临床护理路径变异相关因素。方法 回顾分析2016年5月~2017年10月在我院诊治采用临床护理路径护理的80例哮喘儿童,采用Logstic回归方法分析临床护理路径变异相关因素。结果 21例患者发生变异,病例数达26.25%,其中正性变异发生率为3.75%,负性变异发生率为22.50%;临床护理路径负性变异相关因素包括疾病转归因素、医院系统、医护人员、病人需求,其发生率分别为14.16%、1.67%、2.81%、4.16%。结论 分析儿童哮喘临床护理路径变异相关因素,可及早发现患儿病情变化趋势,从而改善临床护理路径,使临床护理更具有针对性,形成一个良好的临床护理过程。     

Translational Applications of Personality Science for the Conceptualization and Treatment of Psychopathology

Utilizing personality science within clinical assessment and intervention can aid in treatment planning. General personality constructs also are related to clinically relevant areas of dysfunction. However, personality continues to be underutilized in clinical settings. This article reviews current literature pertaining to the clinical applications of personality with a focus on dimensional models such as the Five‐Factor Model. With the advent of a dimensional personality model in DSM‐5, the clinical use of traits is an important topic of exploration. This review discusses the clinical significance of personality and personality pathology in various aspects of living (i.e., functioning, physical health, mental health), clinical applications and utility within clinical and treatment settings, and future research directions, as well as suggestions for further utilization of personality traits.     

Association of phenotypic and genotypic characteristics of invasive Streptococcus pyogenes isolates with clinical components of streptococcal toxic shock syndrome.

Sixty-two invasive Streptococcus pyogenes strains, including 32 strains isolated from patients with streptococcal toxic shock syndrome (STSS), were analyzed for the following phenotypic and genotypic characteristics: M-protein type, serum opacity factor production, protease production, the presence of streptococcal pyrogenic exotoxin (Spe) genes A, B, and C, and in vitro production of SpeA and SpeB. These characteristics were analyzed for possible associations with each other as well as with clinical components of STSS. M-type 1, the most commonly isolated M-type, was significantly associated with protease production. Protease activity was significantly associated with the clinical sign of soft tissue necrosis. M-type 1 and 3 strains from STSS patients were significantly associated with the clinical signs of shock and organ involvement as well as with SpeA production in vitro. Finally, the production of SpeA was significantly associated with the clinical component of shock and organ involvement as well as with rash. These data suggest that STSS does not make up a single syndrome but, rather, that the multiple STSS clinical criteria probably reflect different phenotypic characteristics of individual S. pyogenes isolates.     

Current and future applications of mass spectrometry to the clinical laboratory

Mass spectrometry is an analytic technique with high specificity and a growing presence in laboratory medicine. Various types of mass spectrometers are being used in an increasing number of clinical laboratories around the world, and, as a result, significant improvements in assay performance are occurring rapidly in areas such as toxicology, endocrinology, and biochemical genetics. This review serves as a basic introduction to mass spectrometry, its uses, and associated challenges in the clinical laboratory and ends with a brief discussion of newer methods with the greatest potential for clinical diagnostics.     

教学医院内临床解剖实验室建设及意义——以唐山市第二医院为例

人体解剖学是一门基础医学学科,是医学生的必修课程;而医学生毕业从事临床工作后,很少再有机会回到解剖室,没有条件带着临床中遇到的问题再次学习解剖。在教学医院内建设临床解剖实验室能为临床医生提供根据临床需要进行解剖研究的场所和条件,也能促进临床手术技术和诊疗水平的提高,意义重大,值得推广。     

Behavioral Treatment of Insomnia: A Clinical Case Series Study

There is substantial experimental evidence that behavioral treatment of insomnia produces significant clinical improvement and that treatment gains tend to be maintained over time. Less clear is whether behavioral treatment is effective as it is plied in clinical settings. In this clinical case series study, we evaluated 47 patients with primary insomnia. It was found that patients were, on average, 43% improved. This average corresponded to a 65% reduction in sleep latency, a 46% decrease in number of awakenings per night, a 48% reduction in wake time after sleep onset, and a 13% increase in total sleep time. These results suggest that behavioral treatment for insomnia is as effective in clinical settings as it is as under clinical trial conditions.     

ELISA and indirect immunofluorescence in the diagnosis of LCM virus infections.

Thirty-seven matched samples of patient sera with the clinical diagnosis of a lymphocytic choriomeningitis (LCM) infection, as well as 56 matched samples of patient sera with the clinical diagnosis of a CNS infection of vague etiology were examined. Two serological techniques, indirect immunofluorescence (IF) and ELISA were used. They revealed 16.2% of positive sera confirming the clinical diagnosis of the disease; in the cases of clinical diagnosis of CNS infection of vague etiology 8.9% of positive sera were found, which points to an LCM virus-caused infection.     

Consulting work of local hospital--participation in department without expert physician, and clinical training

All of the newly graduated doctors must undergo training in basic clinical abilities in the new clinical training system for physicians. The trainee receives basic laboratory training in the department of laboratory medicine. This training provides an opportunity for the doctor to develop a close relationship with the department of laboratory medicine. As an expert in laboratory medicine, the clinical laboratory technician on staff in the department of laboratory medicine as well as the clinical laboratory physician should be participate in providing this training. Specifically, in a field where there are no available experts, the primary consultation function is important. Moreover, clinical laboratory physicians, as members of a central clinical department, must participate in other hospital activities, for example, auditing hospital infections, blood supply.     

Guideline-based modeling of therapeutic strategies in the special case of chronic diseases

Despite the availability of evidence-based clinical practice guidelines in most countries, patients with chronic diseases are still generally inadequately managed. One difficulty lies in the optimal synchronization of a patient with the guideline therapeutic strategy, especially when the history of her past treatments does not follow the recommended sequence of therapies. We propose a formal model to represent guideline-based therapeutic strategies as a two-level decision tree. The clinical level is used to identify a patient-specific clinical situation, on the basis of key elements of clinical examination (complication of hypertension, associated diseases). The therapeutic level is derived from the formalization of guideline-based strategies first represented as bidimensional matrices structured in lines of therapy and levels of therapeutic intention. A revised version based on the ordering of levels of therapeutic combination is then developed. The aim is to dynamically provide the best next step of treatment from the patient's therapeutic-history-based customization of the general therapeutic sequence established in the guideline for the corresponding clinical situation. A preliminary in vitro evaluation of the system on actual clinical cases showed a positive impact on physician compliance with a significant increase from 16 to 57%.     

腰椎板截骨原位再植临床应用的远期效果

目的 观察椎板截骨再植这一术式在治疗腰椎病变的远期效果。方法通过对采用腰椎截骨再植术后5年以上24例病人临床疗效的信访和12例病人回访临床疗效、X线、CT检查观察椎板截骨再植骨愈合情况。结果临床疗效：优28例，良6例，可2例。截骨再植愈合情况：愈合10例，未愈合2例。结论腰椎椎板截骨原位再植作为治疗腰椎疾患进入椎管的一个途径，从临床疗效、植骨愈合和恢复脊柱正常序列结构上都是一个良好的术式。     

On the controversies about clinical use of EEG Brain Mapping

Summary Quantitative EEG analysis, often called EEG Brain Mapping, consists of a large variety of separate techniques. Most of these techniques have demonstrated research uses, but few have been shown to have clinical applications that actually impact patient care. Substantial problems exist that can interfere with routine clinical applications. These include a variety of artifacts, confounding clinical problems, diversity of techniques and statistical issues. Existing medical literature suggests several areas where there are clinical uses at this time. EEG Brain Mapping can be used as a testing technique to determine abnormality and perhaps as a monitoring tool, too. It should be viewed as complementary to neuroimaging techniques, rather than a competitor. Those who introduce costly new technology bear the burden of proof for demonstrating its usefulness and cost-effectiveness. Evaluation of new tests should be based on several principles outlined here. EEG Brain Mapping, when used for clinical purposes, should be read together with the accompanying traditional polygraph EEG record. Reproducibility of results should be demonstrated, and artifacts, normal variants and other problems must be identified or avoided. The reader must recognize that features noted on statistical tests do not necessarily imply that pathology exists. Reporting results and clinical implications should be done carefully, thoroughly and with appropriate caution. Results are often quite nonspecific. The user must have skills, knowledge and abilities for reading polygraph EEG as well as additional experience and knowledge about quantitative EEG techniques and problems. Experts must remain careful and responsible about introducing EEG Brain Mapping into routine clinical practice.     

Targeting the Vascular Endothelial Growth Factor Pathway in the Treatment of Human Malignancy

Over 30 years ago, it was proposed that blocking new blood vessel formation would significantly inhibit solid tumor growth and hence, limit cancer progression. Efforts guided by this philosophy have resulted in a better understanding of the molecular basis of tumor angiogenesis. The first successful therapeutic to emerge from this work, an antibody (bevacizumab) targeting the vascular endothelial growth factor (VEGF), was recently approved for the treatment of colorectal cancer. Additional positive clinical data with bevacizumab in the treatment of breast and lung carcinoma have also been reported. These clinical achievements have validated the approach of anti-angiogenesis therapy for cancer and provided further confirmation for antibodies as a therapeutic class in this disease. Nevertheless, important unanswered questions with regard to preclinical and clinical results of VEGF pathway inhibitors remain. For example, preclinical models with a number of VEGF pathway inhibitors suggest that these agents would have significant clinical activity on their own; yet, clinical activity in patients with bevacizumab or other VEGF pathway inhibitors as monotherapy have been disappointing. Moreover, while bevacizumab is approved for the treatment of colorectal cancer in combination with cytotoxics, the mechanism for the benefits of this combination are still poorly understood, with a number of viable mechanisms under active experimental evaluation. The 3–8-month survival benefit in colorectal cancer patients treated with bevacizumab is a positive step forward. However, improving our understanding of the mechanism for these effects, as well as the mechanism underlying the inability as yet to achieve greater effects, is needed in order to follow up on the positive clinical results with improved strategies. This review discusses the experimental results surrounding the current status of our understanding of the mechanism of action of VEGF signaling inhibitors, and the potential for utilizing these agents in the future so that clinical benefits will be measured in years rather than months.     

Accuracy of bedside antigen tests in the diagnosis of new influenza A/H1N1v infection

To evaluate the clinical reliability of two rapid influenza detection tests (RIDTs), we analyzed 107 specimens from patients with clinically suspected pandemic influenza A/H1N1v by these tests as well as by real-time PCR as a standard. Both RIDTs had a moderate sensitivity (28–32%), a high specificity (93–99%) and a negative predictive value of 80%. These results will impact on the clinical management and isolation precautions in patients with suspected infection. Although a positive RITD is mostly confirmatory, a negative result in the presence of high clinical likelihood of infection should be interpreted with caution and be re-evaluated by PCR.     

Evaluating diagnostic performance of clinical tests by spreadsheet modeling. Bayesian analysis using Ri/Cj ratio as a unifying concept

We present a general spreadsheet model for evaluating diagnostic performance of clinical tests. Our model depicts test results as an r X c matrix, with r possible test results and c possible clinical states. Analysis of this matrix is based on the Ri/Cj ratio, calculated as a number of subjects having a specified result Ri within a given clinical state Cj, divided by total subjects within this clinical state. From this model, we can identify three special cases: (1) a 2 X c matrix, with two possible test results of T+ or T-, over c possible clinical states; (2) an r X 2 matrix, with r possible test results, over two possible clinical states of D+ or D-; and (3) a 2 X 2 matrix, with two possible test results over two possible clinical states. Application of the Ri/Cj ratio to the r X c matrix provides a useful approach to graphic analysis of multiple test results over multiple clinical states. The Ri/Cj ratio also provides a general approach to Bayesian analysis, in which likelihood ratio, relative operating characteristic analysis, sensitivity, and specificity represent special cases or special applications.     

Cerebro-facio-articular syndrome of Van Maldergem: confirmation of a new MR/MCA syndrome

Van Maldergem et al. (1992) described a new syndrome in an 11-year-old girl, characterized by: mental retardation, hypotonia, dysmorphic facies with telecanthus, epicanthus, broad flattened nose, large inverted W-shaped mouth, malformed ears, finger camptodactyly, and joint hyperlaxity. In this report we present a 5-year-old girl with very similar clinical findings. We confirm the existence of this condition as an independent clinical entity, and we propose that, based on the major clinical manifestations, it should be defined as "cerebro-facio-articular" syndrome.     

Targeting the vascular endothelial growth factor pathway in the treatment of human malignancy

Over 30 years ago, it was proposed that blocking new blood vessel formation would significantly inhibit solid tumor growth and hence, limit cancer progression. Efforts guided by this philosophy have resulted in a better understanding of the molecular basis of tumor angiogenesis. The first successful therapeutic to emerge from this work, an antibody (bevacizumab) targeting the vascular endothelial growth factor (VEGF), was recently approved for the treatment of colorectal cancer. Additional positive clinical data with bevacizumab in the treatment of breast and lung carcinoma have also been reported. These clinical achievements have validated the approach of anti-angiogenesis therapy for cancer and provided further confirmation for antibodies as a therapeutic class in this disease. Nevertheless, important unanswered questions with regard to preclinical and clinical results of VEGF pathway inhibitors remain. For example, preclinical models with a number of VEGF pathway inhibitors suggest that these agents would have significant clinical activity on their own; yet, clinical activity in patients with bevacizumab or other VEGF pathway inhibitors as monotherapy have been disappointing. Moreover, while bevacizumab is approved for the treatment of colorectal cancer in combination with cytotoxics, the mechanism for the benefits of this combination are still poorly understood, with a number of viable mechanisms under active experimental evaluation. The 3-8-month survival benefit in colorectal cancer patients treated with bevacizumab is a positive step forward. However, improving our understanding of the mechanism for these effects, as well as the mechanism underlying the inability as yet to achieve greater effects, is needed in order to follow up on the positive clinical results with improved strategies. This review discusses the experimental results surrounding the current status of our understanding of the mechanism of action of VEGF signaling inhibitors, and the potential for utilizing these agents in the future so that clinical benefits will be measured in years rather than months.     

Delineation of dermatan 4-O-sulfotransferase 1 deficient Ehlers-Danlos syndrome: observation of two additional patients and comprehensive review of 20 reported patients

Loss-of-function mutations in CHST14, dermatan 4-O-sulfotransferase 1 (D4ST1) deficiency, have recently been found to cause adducted thumb-clubfoot syndrome (ATCS; OMIM#601776) and a new type of Ehlers-Danlos syndrome (EDS) coined as EDS Kosho Type (EDSKT) [Miyake et al., 2010], as well as a subset of kyphoscoliosis type EDS without lysyl hydroxylase deficiency (EDS VIB) coined as musculocontractural EDS (MCEDS) [Malfait et al., 2010]. Lack of detailed clinical information from later childhood to adulthood in ATCS and lack of detailed clinical information from birth to early childhood in EDSKT and MCEDS have made it difficult to determine whether these disorders would be distinct clinical entities or a single clinical entity with variable expressions and with different presentations depending on the patients' ages at diagnosis. We present detailed clinical findings and courses of two additional unrelated patients, aged 2 years and 6 years, with EDSKT with a comprehensive review of 20 reported patients with D4ST1 deficiency, which supports the notion that these disorders constitute a clinically recognizable form of EDS. The disorder, preferably termed D4ST1-deficient EDS, is characterized by progressive multisystem fragility-related manifestations (joint dislocations and deformities, skin hyperextensibility, bruisability, and fragility; recurrent large subcutaneous hematomas, and other cardiac valvular, respiratory, gastrointestinal, and ophthalmological complications) resulting from impaired assembly of collagen fibrils, as well as various malformations (distinct craniofacial features, multiple congenital contractures, and congenital defects in cardiovascular, gastrointestinal, renal, ocular, and central nervous systems) resulting from inborn errors of development.