Assessing Documentation of Critical Imaging Result Follow-up Recommendations in Emergency Department Discharge Instructions

To facilitate follow-up of critical test results across transitions in patient care settings, we implemented an electronic discharge module that enabled care providers to include follow-up recommendations in the discharge instructions. We assessed the impact of this module on documentation of follow-up recommendations for critical imaging findings in Emergency Department (ED) discharge instructions. We studied 240 patients with critical imaging findings discharged from the ED before (n?=?80) and after (n?=?160) implementation of the module. We manually reviewed hand-written forms and electronic discharge instructions to determine if follow-up recommendations were documented. Follow-up recommendations in ED discharge instructions increased from 60.0% (48/80) to 73.8% (118/160) post-module implementation (p?=?0.03), a relative increase of 23%. There was no significant change in the rate of documented critical imaging findings in the discharge instructions (77.5% [62/80] before the intervention and 76.9% [123/160] after the intervention; p?=?0.91). Implementation of a discharge module was associated with increased documentation of critical imaging finding follow-up recommendations in ED discharge instructions. However, one in four patients still did not receive adequate follow-up recommendations, suggesting further opportunities for performance improvement exist.     

免疫酶法与ELISA法检测EB病毒VCA-IgA的比较

为探讨免疫酶法与ELISA在鼻咽癌诊断中的临床价值,检测鼻咽癌组患者与健康对照组血清EB病毒壳抗原抗体,并对两种检测方法的结果进行分析。结果表明：177例鼻咽癌患者中,免疫酶法检测EB-VCA-IgA阳性率高92．1％（163／177）,而国产试剂和进口试剂ELISA法检测结果阳性率都较低,分别为65．0％（115／177）和67．2％（119／177）,有显著性差异（P〈0．005）;在90名对照组血清EB-VCA-IgA,免疫酶法的阴性率为100％（90／90）,ELISA法中的国产和进口试剂的阴性率分别为：98．9％（89／90）和95．6％（86／90）,无显著性差异（P〉0．05）。为此免疫酶法检测EB-VCA-IgA的灵敏度较高,更适合用于鼻咽癌的普查、协助诊断等,具有实际临床意义。     

腹腔镜联合罗氏内异方治疗中、重度子宫内膜异位症 相关不孕的疗效观察

目的 探讨腹腔镜联合罗氏内异方在治疗中、重度子宫内膜异位症中的价值。方法 收集2015年1月~2016年5月我院收治的中、重度子宫内膜异位症患者34例,根据腹腔镜手术后接受的不同治疗,将患者分为LSF组与GnRH-a组,每组17例。两组患者均在行腹腔镜保守性手术后接受治疗,LSF组给予口服罗氏内异方治疗,GnRH-a组给予皮下注射诺雷得治疗,观察两组患者临床疗效、不孕症疗效、妊娠时段、妊娠情况、不良反应发生率等指标。结果 LSF组有效率为76.47%,GnRH-a组有效率为82.35%,两组相比差异无统计学意义（P＞0.05）。LSF组患者中未见明显不良反应,GnRH-a组的不良反应发生率为23.52%,两组比较差异有统计学意义（P＜0.05）。治疗后的3个月内,LST组复发率为17.65%,GnRH-a组复发率为5.88%,差异有统计学意义（P＜0.05）。与未妊娠组相比,妊娠组患者LF、EFI评分均较高,r-AFS较低,差异有统计学意义（P＜0.05）。且r-AFS、LF、EFI两两之间呈显著的正相关关系（均r＞0.3,P＜0.05）。结论 罗氏内异方与GnRH-a在短期疗效、提高妊娠率、改善症状方面效果相当,但罗氏内异方在缩短术后妊娠时间,减少不良反应发生率方面优于GnRH-a。     

Needle-tissue interactive mechanism and steering control in image-guided robot-assisted minimally invasive surgery: a review

Image-guided robot-assisted minimally invasive surgery is an important medicine procedure used for biopsy or local target therapy. In order to reach the target region not accessible using traditional techniques, long and thin flexible needles are inserted into the soft tissue which has large deformation and nonlinear characteristics. However, the detection results and therapeutic effect are directly influenced by the targeting accuracy of needle steering. For this reason, the needle-tissue interactive mechanism, path planning, and steering control are investigated in this review by searching literatures in the last 10 years, which results in a comprehensive overview of the existing techniques with the main accomplishments, limitations, and recommendations. Through comprehensive analyses, surgical simulation for insertion into multi-layer inhomogeneous tissue is verified as a primary and propositional aspect to be explored, which accurately predicts the nonlinear needle deflection and tissue deformation. Investigation of the path planning of flexible needles is recommended to an anatomical or a deformable environment which has characteristics of the tissue deformation. Nonholonomic modeling combined with duty-cycled spinning for needle steering, which tracks the tip position in real time and compensates for the deviation error, is recommended as a future research focus in the steering control in anatomical and deformable environments.

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Graphical abstract a Insertion force when the needle is inserted into soft tissue. b Needle deflection model when the needle is inserted into soft tissue [68]. c Path planning in anatomical environments [92]. d Duty-cycled spinning incorporated in nonholonomic needle steering [64]

     

<Emphasis Type="Italic">Angiostrongylus cantonensis</Emphasis>: morphological and behavioral investigation within the freshwater snail <Emphasis Type="Italic">Pomacea canaliculata</Emphasis>

An infection with Angiostrongylus cantonensis, the main causative agent for human eosinophilic encephalitis, can be acquired through the consumption of the freshwater snail Pomacea canaliculata. This snail also provides a suitable model to study the developmental morphology and behavior of A. cantonensis larvae, facilitated by the snail’s distinct lung structure. We used microanatomy for studying the natural appearance and behavior of A. cantonensis larvae while developing within P. canaliculata. The distribution of refractile granules in the larval body and characteristic head structures changed during the developmental cycle. Two well-developed, rod-like structures with expanded knob-like tips at the anterior part were observed under the buccal cavity as early as the late second developmental stage. A “T”-shaped structure at the anterior end and its tenacity distinguished the outer sheath from that shed during the second molting. Early first-stage larvae obtained from fresh rat feces are free moving and characterized by a coiled tail, whereas a mellifluous “Q”-movement was the behavioral trait of third-stage A. cantonensis larvae outside the host tissue. In combination, the distribution of refractive granules, distinct head features, variations in sheaths, and behavioral characteristics can be utilized for differentiation of larval stages, and for distinguishing A. cantonensis larvae from those of other free-living nematodes.     

自噬在结核分枝杆菌感染中的作用及相关基因的表达

目的:探讨自噬在结核分枝杆菌(MTB)感染中的作用及相关基因的表达.方法:透射电镜观察在雷帕霉素诱导下自噬体的形成,通过克隆形成单位(CFU)检测自噬形成后对胞内感染的MTB H37Rv菌株的清除作用,以实时定量PCR方法检测自噬相关基因atg5、atS7、atg8、atg12 mRNA表达水平.结果:在宙帕霉素诱导下,RAW264.7细胞可形成自噬体,自噬体产牛后对胞内感染的H37Rv菌株具有一定的清除作用.在MTB感染过程中参与自噬形成的atg5、atg8、atg12 mRNA表达量上调,而atg7表达量无变化.结论:自噬参与抗MTB免疫应答过程,而ats5、atg8、atg12是MTB感染形成自噬体的重要调控分子.     

Experimental study on the effects of chronic iodine excess on thyroid function, structure, and autoimmunity in autoimmune-prone NOD.H-2h4 mice

Iodine is an essential component of thyroid hormones; high intake may lead to thyroid disease. Epidemiologic researches have shown that exposure to iodine may be involved in the onset and development of autoimmune thyroiditis. Iodine may induce hypothyroidism in patients with autoimmune thyroiditis in a dose-dependent manner. The aim of the present study was to investigate the effects of dosages of iodine on thyroid autoimmunity, morphology, structure, and function in autoimmune-prone animals. NOD.H-2h4 mice were randomly divided into normal iodine, 5-fold, 10-fold, 100-fold, 1,000-fold iodine excess group, anesthetized by diethyl ether and bleed from eye socket vein at 4, 8, 16, and 24 weeks after the commencement of experiment. Iodine and thyroid hormone levels in the thyroid tissue and sera, serum thyroglobulin antibody levels, as well as thyroid gland histological appearance were measured. Excessive iodine caused thyroid goiter, and there was a positive correlation between the thyroid weight and the dosage of iodine (r = 0.64–0.92, P < 0.01). Iodine overdose ultrastructurally damaged thyroid epithelial cells in a dose-dependent manner. The incidence of thyroiditis, as well as the degree of lymphocytic infiltration in the thyroid gradually increased as the dosage increased (r = 0.87–0.98, P ≤ 0.05). Excessive iodine intake might induce goiter, lead to thyroiditis, worsen lymphocytic infiltration, as well as damage to the thyroid follicular structure in a dose-dependent manner in autoimmune-prone NOD.H-2h4 mice.     

神经病理性痛大鼠脊髓背角缝隙连接蛋白表达变化及鞘内注射甘珀酸的镇痛作用

目的 研究慢性神经病理性痛大鼠脊髓背角内缝隙连接蛋白家族(Cx)中Cx43和Cx32的表达变化,以及鞘内注射缝隙连接阻断剂甘珀酸（CBX）的镇痛作用。 方法 成年SD大鼠50只,分为正常对照组、假手术组和坐骨神经分支选择性损伤组(SNI)。手术前1d、术后3d、5d、10d、20d和30d,观察大鼠行为并检测机械刺激缩足反射阈值(PWMT)。15只大鼠于术后10d、20d、30d取脊髓腰段进行免疫印迹检测,另15只大鼠于术后10d、20d、30d取脊髓腰段进行免疫荧光染色,检测腰段脊髓背角内Cx43和Cx32表达的变化。有10只大鼠先进行鞘内插管,后行SNI手术,术后20d向鞘内注射生理盐水或CBX,观察大鼠PWMT的变化。 结果 SNI大鼠手术侧PWMT阈值较非手术侧或假手术组明显降低,术后20d达最低值。SNI大鼠手术侧脊髓背角内Cx43、32表达增多,明显高于非手术侧和假手术组背角。鞘内注射CBX 3h后,PWMT平均阈值由(2.5±1.0)g上升到(20.0±3.2)g,有抑制效应, 而生理盐水组则无抑制效应。 结论 脊髓背角内的缝隙连接在因外周神经损伤引起的神经病理性痛中起重要作用。     

胃复康对人SGC-7901胃癌细胞株p53、bcl-2基因表达的影响

目的探讨中药胃复康对人SGC-7901胃癌细胞株p53、bcl-2基因表达的影响。方法PRMI1640血清培养的人SGC-7901胃癌细胞株分为胃复康实验组、生理盐水对照组和顺铂(DDP)化疗组。利用血清药理学方法制备药物血清,作用48h后,应用免疫细胞化学方法和图像分析方法观察胃复康、DDP对人SGC-7901胃癌细胞株p53、bcl-2基因表达影响。结果免疫细胞化学法显示抑癌基因p53和癌基因bcl-2主要定位在细胞质内。胃复康、DDP药物血清作用后,p53表达明显增强,bcl-2表达明显降低;随着作用时间延长,两种基因表达改变更明显。胃复康、DDP药物血清组p53和bcl-2表达的光密度值(AOD)与对照组差异显著(P<0.01)。结论中药胃复康药物血清上调p53和下调bcl-2的表达可能是其抑制胃癌细胞株SGC-7901的作用机制之一。     

盆底功能障碍性疾病患者阴道壁成纤维细胞受力后生物学功能的变化

目的:研究盆底功能障碍性疾病(PFD)阴道壁成纤维细胞在受力情况下,Ⅰ型胶原(colⅠ)、Ⅲ型胶原(colⅢ)、转化生长因子β1(TGF-β1)和基质金属蛋白酶-1(MMP-1)基因表达水平的变化,探讨其与PFD发病的关系。方法:选取2009年10月至2010年5月在河北医科大学第二医院妇产科接受手术治疗的12例PFD患者的阴道壁组织,用组织块法对阴道壁成纤维细胞进行原代培养,取2～5代稳定的传代阴道壁成纤维细胞,采用Flexcell-4000细胞柔性基底拉伸系统进行0.3Hz、12%、正弦波的拉伸应变加载实验,以未加载力的静态细胞作为对照组。用RT-PCR反应检测对照组及受力后4h、15h、24h colⅠ、colⅢ、TGF-β1、MMP-1基因的表达水平。结果:对照组colⅠmRNA的表达水平为1.178±0.071,受力后4h、15h、24h表达分别为1.092±0.038、1.198±0.031、1.120±0.098,不同时间colⅠmRNA水平比较,差异有统计学意义(P=0.035);对照组colⅢ表达为0.673±0.029,受力后4h、15h、24h分别为0.313±0.019、0.504±0.033、0.853±0.210,不同时间colⅢmRNA水平比较,差异有统计学意义(P=0.015);对照组TGF-β1表达为0.852±0.039,受力后4h、15h、24h分别为0.673±0.052、0.897±0.051、0.895±0.015,不同时间TGF-β1 mRNA水平比较,差异有统计学意义(P=0.0001)。对照组MMP-1表达为1.167±0.036,受力后4h、15h、24h表达分别为0.669±0.109、1.085±0.176、1.325±0.048,不同时间MMP-1 mRNA水平比较,差异有统计学意义(P=0.017)。随着加力时间的延长,目的基因的表达水平呈现先下降,再上升的趋势。结论:阴道壁成纤维细胞受到机械拉伸刺激后,其细胞外基质的合成代谢和分解代谢均呈旺盛状态,细胞外基质发生了重塑,这可能是导致PFD发生的重要原因。