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101.
Myles T. Taffel Lyndon Luk Justin M. Ream Andrew B. Rosenkrantz 《Journal l'Association canadienne des radiologistes》2019,70(4):416-423
PurposeTo evaluate whole-lesion 3D-histogram apparent diffusion coefficient (ADC) metrics for assessment of pancreatic malignancy.MethodsForty-two pancreatic malignancies (36 pancreatic adenocarcinoma [PDAC], 6 pancreatic neuroendocrine [PanNET]) underwent abdominal magnetic resonance imaging (MRI) with diffusion-weighted imaging before endoscopic ultrasound biopsy or surgical resection. Two radiologists independently placed 3D volumes of interest to derive whole-lesion histogram ADC metrics. Mann-Whitney tests and receiver operating characteristic analyses were used to assess metrics’ diagnostic performance for lesion histology, T-stage, N-stage, and grade.ResultsWhole-lesion ADC histogram metrics lower in PDACs than PanNETs for both readers (P ≤ .026) were mean ADC (area under the curve [AUC] = 0.787-0.792), mean of the bottom 10th percentile (mean0-10) (AUC = 0.787-0.880), mean of the 10th-25th percentile (mean10-25) (AUC = 0.884-0.917) and mean of the 25th-50th percentile (mean25-50) (AUC = 0.829-0.829). For mean10-25 (metric with highest AUC for identifying PDAC), for reader 1 a threshold > 0.94 × 10?3 mm2/s achieved sensitivity 94% and specificity 83%, and for reader 2 a threshold > 0.82 achieved sensitivity 97% and specificity 67%. Metrics lower in nodal status ≥ N1 than N0 for both readers (P ≤ .043) were mean0-10 (AUC = 0.789-0.822) and mean10-25 (AUC = 0.800-0.822). For mean10-25 (metric with highest AUC for identifying N0), for reader 1 a threshold <1.17 achieved sensitivity 87% and specificity 67%, and for reader 2 a threshold <1.04 achieved sensitivity 87% and specificity 83%. No metric was associated with T-stage (P > .195) or grade (P > .215).ConclusionVolumetric ADC histogram metrics may serve as non-invasive biomarkers of pancreatic malignancy. Mean10-25 outperformed standard mean for lesion histology and nodal status, supporting the role of histogram analysis. 相似文献
102.
Byron J. Good Carla Raymondalexas Marchira M. A. Subandi Fiddina Mediola Tri Hayuning Tyas Mary-Jo DelVecchio Good 《International review of psychiatry (Abingdon, England)》2019,31(5-6):510-522
AbstractThis paper provides an overview of more than 22?years of research conducted in the central Javanese province of Yogyakarta, Indonesia, by teams of researchers associated with Gadjah Mada University and Harvard University, led by the authors of this essay. This work is placed in the context of the very limited literature on early psychosis and mental health services in Indonesia. It provides an overview of mental health services in Indonesia and of this team’s research trajectory, then addresses four key domains: the cultural phenomenology of early experiences of psychotic illness; patterns of onset, with a particular focus on extremely rapid onset psychoses; patterns of care-seeking for first episode illness; and mental health services and patterns of utilization. It then discusses the importance of rapid onset psychosis for research on early psychosis, and the question of whether collinearity of rapidity of onset and rapidity of care-seeking raises questions about the long-standing finding that a short duration of untreated psychosis leads to better outcomes. It concludes by discussing difficulties of prioritizing early intervention models in settings with very low mental health resources. 相似文献
103.
David L. Murphy Thomas D. Rea Andrew M. McCoy Michael R. Sayre Carol E. Fahrenbruch Lihua Yin Benjamin A. Tonelli Aaron M. Joffe Steven H. Mitchell 《The American journal of emergency medicine》2019,37(5):937-941
Purpose
In hospital-based studies, patients intubated by physicians while in an inclined position compared to supine position had a higher rate of first pass success and lower rate of peri-intubation complications. We evaluated the impact of patient positioning on prehospital endotracheal intubation in an EMS system with rapid sequence induction capability. We hypothesized that patients in the inclined position would have a higher first-pass success rate.Methods
Prehospital endotracheal intubation cases performed by paramedics between 2012 and 2017 were prospectively collected in airway registries maintained by a metropolitan EMS system. We included all adult (age?≥?18?years) non-traumatic, non-arrest patients who received any attempt at intubation. Patients were categorized according to initial positioning: supine or inclined. The primary outcome measure was first pass success with secondary outcomes of laryngoscopic view and challenges to intubation.Results
Of the 13,353 patients with endotracheal intubation attempted by paramedics during the study period, 4879 were included for analysis. Of these, 1924 (39.4%) were intubated in the inclined position. First pass success was 86.3% among the inclined group versus 82.5% for the supine group (difference 3.8%, 95% CI: 1.5%–6.1%). First attempt laryngeal grade I view was 62.9% in the inclined group versus 57.1% for the supine group (difference 5.8%, 2.0–9.6). Challenges to intubation were more frequent in the supine group (42.3% versus 38.8%, difference 3.5%, 0.6–6.3).Conclusion
Inclined positioning was associated with a better grade view and higher rate of first pass success. The technique should be considered as a viable approach for prehospital airway management. 相似文献104.
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107.
目的 探讨维持性血液透析治疗(MHD)患者首次使用综合征(FUS)的有效护理方法.方法 对143例MHD患者在常规透析治疗期间,采取加强生命体征观察、动-静脉瘘保护及心理疏导等综合护理措施,并分析FUS的发生情况.结果 143例MHD患者透析治疗期间,其中发生FUS 4例,发生率为2.8%.结论采取全方位、立体式护理措施,可有效降低FUS发生率,提高患者透析治疗效果. 相似文献
108.
109.
Wanzhen Li Meng Zhang Caojuan Huang Jalin Meng Xingxu Yin Gengyun Sun 《Pathology, research and practice》2019,215(10):152548
As is commonly perceived, polymorphisms in genes of deoxyribonucleic acid (DNA) repair pathway plays a fundamental role in defective DNA repair and mutagenesis prevention and serves to contribute to the individual susceptibility to the development of a variety of cancers. Recently, an increasing number of studies have been dedicated to the contentious and ambiguous links between polymorphisms in genes of DNA repair pathway and lung cancer (LC) risk. In response, a comprehensive updated meta-analysis has been proposed herein to assess the correlation between polymorphisms of DNA repair pathway genes and susceptibility to LC. This paper has identified and retrieved eligible articles from PubMed, Google Scholar, Web of Science, and CNKI databases till February 20, 2019. Finally, 295 case-control studies as to the fourteen polymorphisms of DNA repair pathway genes were enrolled. When the results have been pooled, we have brought to light the conclusion that ERCC2-rs13181 polymorphism has an elevated association with LC risk under allele, heterozygote, and dominant comparisons. In the subgroup analysis by ethnicity, we have found that the Caucasian individuals with “B” variant possess risk of LC which was more than twice as much as allele, homozygote, and recessive models. In comparison, Asian carriers of rs13181 polymorphism in ERCC2 gene are more susceptible to LC in heterozygote, dominant models. To sum up, ERCC2-rs13181 polymorphism could be a critical factor in stimulating LC evolvement. Future studies with a larger sample size and multivariate factors are needed to vindicate these findings. 相似文献
110.
Nicholas Whitfield 《Medical history》2015,59(3):421-442
During the Great War, the French surgeon Alexis Carrel, in collaboration with the English
chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper
focuses on Carrel’s attempt to standardise knowledge of infected wounds and their
treatment, and looks closely at the vision of surgical skill he espoused and its
difference from those associated with the doctrines of scientific management. Examining
contemporary claims that the Carrel–Dakin method increased rather than diminished demands
on surgical work, this paper further shows how debates about antiseptic wound treatment
opened up a critical space for considering the nature of skill as a vital dynamic in
surgical innovation and practice. 相似文献