Dual-energy computed tomography imaging to determine atherosclerotic plaque composition: A prospective study with tissue validation

BackgroundIdentifying vulnerable coronary plaque with coronary CT angiography is limited by overlap between attenuation of necrotic core and fibrous plaque. Using x-rays with differing energies alters attenuation values of these components, depending on their material composition.ObjectivesWe sought to determine whether dual-energy CT (DECT) improves plaque component discrimination compared with single-energy CT (SECT).MethodsTwenty patients underwent DECT and virtual histology intravascular ultrasound (VH-IVUS). Attenuation changes at 100 and 140 kV for each plaque component were defined, using 1088 plaque areas co-registered with VH-IVUS. Hounsfield unit thresholds that best detected necrotic core were derived for SECT (conventional attenuation values) and for DECT (using dual-energy indices, defined as difference in Hounsfield unit values at the 2 voltages/their sum). Sensitivity of SECT and DECT to detect plaque components was determined in 77 segments from 7 postmortem coronary arteries. Finally, we examined 60 plaques in vivo to determine feasibility and sensitivity of clinical DECT to detect VH-IVUS–defined necrotic core.ResultsIn contrast to conventional SECT, mean dual-energy indices of necrotic core and fibrous tissue were significantly different with minimal overlap of ranges (necrotic core, 0.007 [95% CI, –0.001 to 0.016]; fibrous tissue, 0.028 [95% CI, 0.016–0.050]; P < .0001). DECT increased diagnostic accuracy to detect necrotic core in postmortem arteries (sensitivity, 64%; specificity, 98%) compared with SECT (sensitivity, 50%; specificity, 94%). DECT sensitivity to detect necrotic core was lower when analyzed in vivo, although still better than SECT (45% vs 39%).ConclusionsDECT improves the differentiation of necrotic core and fibrous plaque in ex vivo postmortem arteries. However, much of this improvement is lost when translated to in vivo imaging because of a reduction in image quality.     

局麻单孔腹腔镜双极电凝与经腹近端抽芯包埋两种输卵管绝育术对生殖激素近期影响的对比观察

目的:比较观察局麻单孔腹腔镜双极电凝输卵管绝育术与经腹近端抽芯包埋输卵管绝育术对卵巢功能的影响。方法:在贵州省内14个县随机抽取2014年10月~2015年10月行上述两种输卵管绝育术妇女各100例,测定卵巢基础激素(FSH、LH和E2)。结果:共133例研究对象进入观察,其中腹腔镜输卵管绝育术组82名,年龄28.84±4.02岁;开腹输卵管绝育术组51名,年龄27.61±4.20岁。两组术后1个月的卵巢基础性激素平均水平无统计学改变;术后1个月基础FSH≥10U/L、基础FSH/LH升高2的比例开腹组明显高于腹腔镜组。结论:腹腔镜输卵管绝育术近期对卵巢功能的影响小于开腹输卵管绝育术。     

Sanger sequencing versus INNO-LiPA® HBV PreCore assay for routine detection of precore and basal core promoter mutations in hepatitis virus B chronically infected patients

We compared the Sanger sequencing and the commercial INNO-LiPA® HBV assay for the routine detection of precore (PC) and basal core promoter (BCP) mutations of hepatitis B virus in chronically infected patients. The overall agreement rate between assays was 94.2% and 98.8% for the detection of PC and BCP mutations, respectively.     

竞赛驱动下医学专业“课程思政”的实践教学改革探索

当今医患矛盾日益突出、医患关系不断恶化的背景下,医学高等教育坚持用社会主义核心价值观引领意识形态的潮流,遵循社会主义核心价值观做导向,做到勤学、修德、立志、成才达到全方位育人目的。为落实立德树人根本任务,深度挖掘课程德育内涵,推动"课程思政"责任共同体,教师为主体,既可创新教学改革方法,有效充分发挥课程"育人"功能,将"课程思政"贯穿教育教学全过程,目的是医学专业基础课与思想政治理论同向同行,形成协同效应",以赛促教,增进实效"多元化竞赛,深入挖掘蕴含在专业知识里的德育元素,竞赛活动为载体促进"课程思政"与医学知识融合。在调研医学课程中专业课"课程思政"的现状基础上,不断充分挖掘医学专业课程中的思政元素,做到润物细无声,构建"竞赛驱动—课程思政融入-教学改革-学生批判能力培养"的教学改革实践模式,既将以竞赛为驱动力,并以医学专业知识为载体融入思政元素,提高医学生社会价值观的形成。坚持理论学习与实践教学相衔接,体会理论知识外化为实践能力,化知为行、知行合一。以赛促教、以赛促学"从专业角度发挥课堂主渠道,做好立德树人工作。     

A core syllabus for the teaching of neuroanatomy to medical students

There is increasingly a call for clinical relevance in the teaching of biomedical sciences within all health care courses. However, this presupposes that there is a clear understanding of what can be considered core material within the curricula. To date, the anatomical sciences have been relatively poorly served by the development of core syllabuses, particularly for specialized core syllabuses such as neuroanatomy. One of the aims of the International Federation of Associations of Anatomists (IFAA) and of the European Federation for Experimental Morphology (EFEM) is to formulate, on an international scale, core syllabuses for all branches of the anatomical sciences using Delphi Panels consisting of anatomists, scientists, and clinicians to initially evaluate syllabus content. In this article, the findings of a Delphi Panel for neuroanatomy are provided. These findings will subsequently be published on the IFAA website to enable anatomical (and other cognate learned) societies and individual anatomists, clinicians, and students to freely comment upon, and elaborate and amend, the syllabuses. The aim is to set internationally recognized standards and thus to provide guidelines concerning neuroanatomical knowledge when engaged in course development. Clin. Anat. 28:706–716, 2015. © 2015 Wiley Periodicals, Inc.     

Structural diversity of coiled coils in protein fibers of the bacterial cell envelope

The cell envelope of bacteria shows great diversity in architecture and composition, to a large extent due to its proteome. Proteins localized to the cell envelope, whether integrally embedded in the membrane, membrane-anchored, or peripherally associated as part of a macromolecular complex, often form elongated fibers, in which coiled coils represent a prominent structural element. These coiled-coil segments show a surprising degree of structural variability, despite being shaped by a small number of simple biophysical rules, foremost being their geometry of interaction referred to as 'knobs-into-holes'. Here we will review this diversity, particularly as it has emerged over the last decade.