涂阳肺结核患者诊断延误及影响因素分析

目的对2009年10~12月武汉市结核病防治所住院的痰标本直接涂片抗酸杆菌镜检阳性(涂阳)肺结核患者诊断延误及其影响因素进行研究。方法采用自行设计的问卷,对224例涂阳肺结核患者进行面访式调查。采用Wilcoxon符号秩和检验对首诊延误、卫生系统延误及诊断延误分别进行单因素分析,用逐步logistic回归法对3种延误分别进行多因素分析。结果首诊延误、卫生系统延误及诊断延误中位数分别为8、12及35 d;首诊延误的危险因素为:男性(OR=2.134,95%可信区间1.115~4.083),初中及以下文化(OR=1.879,95%可信区间1.048~3.368),无咯血(OR=2.194,95%可信区间1.056~4.559)及结核知识得分低(OR=4.060,95%可信区间2.232~7.385);卫生系统延误危险因素为:首诊为区以下医疗单位(OR=2.938,95%可信区间1.339~6.446),保护因素为:就诊次数≤1次(OR=0.056,95%可信区间0.025~0.126);诊断延误危险因素为结核知识得分低(OR=3.036,95%可信区间1.654~5.572),自卑及自我羞耻感水平高(OR=2.012,95%可信区间1.103~3.676),保护因素为:就诊次数≤1次(OR=0.216,95%可信区间0.117~0.396)。结论武汉市住院涂阳肺结核患者存在一定的诊断延误,但延误水平不高。应加强对人群特别是文化程度低的人群的结核相关知识宣教;加强基层医务人员对结核病的警觉性并提高诊断能力;应避免患者反复多次就诊于同一水平医疗机构,从而缩短诊断延误时间。     

Optofluidic wavelength division multiplexing for single-virus detection

Optical waveguides simultaneously transport light at different colors, forming the basis of fiber-optic telecommunication networks that shuttle data in dozens of spectrally separated channels. Here, we reimagine this wavelength division multiplexing (WDM) paradigm in a novel context––the differentiated detection and identification of single influenza viruses on a chip. We use a single multimode interference (MMI) waveguide to create wavelength-dependent spot patterns across the entire visible spectrum and enable multiplexed single biomolecule detection on an optofluidic chip. Each target is identified by its time-dependent fluorescence signal without the need for spectral demultiplexing upon detection. We demonstrate detection of individual fluorescently labeled virus particles of three influenza A subtypes in two implementations: labeling of each virus using three different colors and two-color combinatorial labeling. By extending combinatorial multiplexing to three or more colors, MMI-based WDM provides the multiplexing power required for differentiated clinical tests and the growing field of personalized medicine.The ability to overlay multiple electromagnetic waves in the same physical space by virtue of linear superposition is arguably at the root of modern communication as we know it. Originally implemented in the radiofrequency regime, this wavelength division multiplexing (WDM) principle was transferred to optical wavelengths in the visible and near-infrared range, which can be carried by a single, low-loss silica fiber (1). Available in both coarse and dense varieties, terabits of data are now shuttled between a source and their destination using anywhere from 4 to over 100 wavelengths (2, 3). Here, we transfer the WDM principle from data communications into a different realm, that of chip-based biomedical analysis, where much can be gained by superimposing multiple colors in an optical waveguide, albeit for different reasons.First, one of the key requirements for diagnostic test panels, aside from high sensitivity and specificity, is the ability to multiplex, i.e., detect and identify multiple biomarkers simultaneously. A standard influenza test, for example, simultaneously screens for eight pathogen types, enabling differential diagnosis of diseases with similar early symptoms (www.questdiagnostics.com/testcenter/testguide.action?dc=TS_RespVirusPanel). Current gold-standard techniques for nucleic acid and protein detection such as PCR and ELISA use fluorescent organic dyes as a means of signal reporting (4). Optical detection, by fluorescence or “label-free,” is extremely sensitive, allowing for single-molecule and even single-dye detection under appropriate conditions (5–11). The availability of over a dozen dyes across the visible spectrum opens the door to implementing the desired multiplexing capability with multiple dyes, i.e., spectral channels (12–14). Secondly, diagnostic tests are rapidly transitioning toward integrated laboratory-on-chip platforms on which small volumes of biological or chemical samples can be rapidly analyzed. The WDM principle of routing all spectral channels through the same physical space is, therefore, ideal for increasing compactness of an analytic device. Finally, chip-scale integration has recently been advanced by the advent of optofluidic devices in which both fluidic and optical components are miniaturized in the same system (15–17).Here, we implement WDM on an optofluidic platform for on-chip analysis of single influenza viruses. In place of silica fiber as the physical carrier, we create a single waveguide structure that combines multiple spectral channels for fluorescence excitation of biological targets. Instead of temporally modulating each channel to transport information, we use this waveguide to produce wavelength-dependent spatial patterns in an intersecting fluidic channel. The spatial encoding of spectral information then allows for direct identification of multiple labeled targets with extremely high sensitivity and fidelity. The technique is demonstrated in two implementations for direct counting and identification of individual virus particles from three different influenza A subtypes––H1N1, H2N2, and H3N2––at clinically relevant concentrations.     

Protective effect of chitosan treatment against acetaminophen-induced hepatotoxicity

Acetaminophen (APAP) is the most commonly reported toxic ingestion in the world. Severe liver injury resulting from overdose or chronic use of APAP remains a significant clinical problem. In recent years, the mechanisms underlying liver injury caused by APAP have become much better understood. We have studied the protective effect of chitosan supplementation against APAP-induced hepatotoxicity with respect to changes in the levels of total and lipid-bound sialic acid in the serum and in the liver tissue and changes in the activity of diagnostic marker enzymes, lipid peroxidation, and ceruloplasmin oxidase enzyme in normal and experimental groups of rats. During the experimental period, chitosan (200 mg/kg body weight per day) was administered to APAP + chitosan-treated rats by oral gavage. Results showed that treatment with APAP induced a significant increase in the serum alanine aminotransferase and alkaline phosphatase activities, in total and lipid-bound sialic acids levels, and in the liver lipid peroxide content. The administration of chitosan significantly prevented APAP-induced alterations in the levels of diagnostic marker enzymes, total sialic acid, lipid-bound sialic acid, and malondialdehyde in the experimental groups of rats. Furthermore, chitosan administration increased the activity of ceruloplasmin oxidase. In conclusion, our results suggest that chitosan has a protective effect on APAP-induced hepatic injury in rats. The study sheds light on the therapeutic potential of chitosan in an APAP-induced hepatotoxicity model.     

生殖腺及生殖腺外畸胎瘤的超声诊断

目的；探讨超声对各部位畸胎瘤的诊断价值。方法：对42例经手术及病理证实的畸胎瘤与超声检查结果对照，并回顾分析其声像特征。结果：畸胎瘤具有一些特征性声像图表现，其肿块检出率100％，诊断符合率89．8％，其中生殖腺畸瘤诊断符合率96．8％，生殖腺外畸胎瘤诊断符合率82．0％。结论：畸胎瘤的超声诊断符合率较高，应为目前首选检查方法。少见部位畸胎瘤因认识不足易造成误诊，良恶性的鉴别亦存在误差。     

Modified docetaxel,cisplatin and fluorouracil therapy as the first-line treatment for patients with recurrent/metastatic squamous cell carcinoma of the head and neck cancer: a retrospective study

Aim: Modified docetaxel, cisplatin, and 5-fluorouracil (mDCF) therapy has been shown to be a well tolerated and highly effective regimen for metastatic gastric carcinoma. Herein we investigated the effectiveness of the mDCF combination as the first-line treatment in patients with recurrent/metastatic squamous cell carcinoma of the head and neck (HNSCC).

Methods: A total of 80 patients with recurrent/metastatic HNSCC who were treated with mDCF between 2009 and 2015 were enrolled into this study. All patients were treated in the first-line with 2–6 cycles of mDCF chemotherapy which consisted of docetaxel 60?mg/m² intravenously (IV) on day 1, cisplatin 60?mg/m² IV on day 1, and 5-fluorouracil 600?mg/m² IV for 5 days of continuous infusion, with cycles repeated every 21 days.

Results: The most common grade 3–4 toxicities were neutropenia (22.5%), anemia (10%), thrombocytopenia (7.5%), nephrotoxicity (1.3%), hepatotoxicity (1.3%), and diarrhea (2.5%). Twelve patients (15%) experienced a febrile neutropenic episode. Dose modification was required in 22 (27.5%) of the patients due to drug toxicity. Complete response was achieved in 2.5% of all patients, while partial and stable responses were reported to be 43.8% and 25%, respectively, with a disease control rate of 71.3%. The median progression-free and overall survival was 7 (95% CI: 5.3–8.6) and 11.5 (95% CI: 9.4–13.7) months, respectively.

Conclusions: The efficiency of the mDCF combination for induction chemotherapy has been well established previously. To our knowledge, this is one of the largest studies evaluating the survival and safety significance of mDCF chemotherapy as a first-line treatment in patients with recurrent/metastatic HNSCC.     

Comparison of efficacy and safety of three different chemotherapy regimens delivered with concomitant radiotherapy in inoperable stage III non-small cell lung cancer patients

Tumor Biology - Concomitant administration of chemotherapy and radiotherapy is currently recognized as the standard of treatment in locally advanced inoperable non-small cell lung cancer (NSCLC)....     

Retrospective multicenter evaluation of patients diagnosed with mucosal melanoma: a study of Anatolian Society of Medical Oncology

Tumor Biology - Mucosal melanoma (MM) is a rare type of cancer that differs significantly from cutaneous melanoma. In this study, we aimed to evaluate clinical and demographical characteristics,...     

Simple Mobile Application for Calculating “Ergotrauma” Made Using an Excel Sheet

How to cite this article: Anand A, Saigal S, Panda R, Kodamanchili S, Shrivastava P, Das A, et al. Simple Mobile Application for Calculating “Ergotrauma” Made Using an Excel Sheet. Indian J Crit Care Med 2021;25(9):1081.     

复治肺结核病人的成因分析

目的　探讨复治肺结核病人形成原因。方法　使用调查表的方法 ,对前来诊治的复治涂阳肺结核病人的首次诊疗 ,管理情况进行问卷调查。结果　综合医院仍然为大多数患者的首次诊疗单位 ,因此部分肺结核患者未能得到正确的诊断、治疗和化疗管理。导致 67.2 %病人“中断”或“间断”治疗 ;另外结核病健康教育宣传做得不够 ,60 .3 %的患者诊断前未接受过防痨宣教 ,3 4.5 %的患者接受初次化疗时仍未得到宣教。这些均在导致复治病人的产生中起了重要作用。结论　加大DOTS覆盖面 ,加强归口管理力度 ,做好防治结核病教育工作是防止复治肺结核病人产生的重要环节。