中医腹诊的研究进展

腹诊是中医传统诊法之一,是"望、闻、问、切"四诊在胸腹部的综合运用。本文腹诊的概念、腹诊的源流、腹诊内容、腹诊的应用以及腹诊的现代研究等方面进行阐述,使腹诊得到更广泛地应用,以促进其发展。     

No benefit from combining HE4 and CA125 as ovarian tumor markers in a clinical setting

Objective

About 70% of epithelial ovarian cancer patients (EOC) are diagnosed at advanced stage with a five-year survival rate of only 30%. Whilst CA125 detects peritoneally-spread disease, it has limited sensitivity for early cancers, many of which are potentially curable.

Methods

We compared the new commercially available tumor marker HE4 with CA125 individually, in combination, within the risk of malignancy index (RMI) and the newly defined risk of malignancy algorithm (ROMA). Our prospectively-collected cohort of 160 patients consisted of healthy controls, benign diseases, and borderline tumors/adenocarcinomas of ovarian, tubal, peritoneal and endometrial origin. HE4 and CA125 were measured in serum using standardized ELISA.

Results

Both markers showed similar diagnostic performance in the detection of EOC at clinically defined thresholds (CA125 35 U/ml; HE4 70 pM) but HE4 was not elevated in endometriosis. Comparison of non-malignant diagnoses (n = 71) versus early stage ovarian and tubal cancers (n = 19) revealed that HE4 and ROMA displayed the best diagnostic performance (AUC 0.86/0.87, specificity 85.9%/87.3% and sensitivity 78.9%/78.9%, respectively). Whilst RMICA125 detects peritoneal cancer better than all other models (AUC 0.99, specificity 97.2%, sensitivity 80.0%), there is no other detection benefit from RMI compared to HE4 alone or included in ROMA.

Conclusions

The major advantage of HE4 lies in its specificity and improved detection of borderline tumors and early stage ovarian and tubal cancers. HE4 is superior to CA125 with or without RMI and ROMA indices. However, we see no benefit from combining both markers in clinical practice.     

中医诊断中相关性思维浅谈

随着中医师承教育的淡出,传统中医思维逐渐淡化。我们运用相关性思维在中医诊断方面做了一些初步的尝试,对中医思维框架的建立发挥了积极作用,提高了临床疗效。在此抛砖引玉,敬请同道指教。     

Ultrasound Backscatter Imaging Provides Frequency-Dependent Information on Structure,Composition and Mechanical Properties of Human Trabecular Bone

The strength as well as the acoustic properties of trabecular bone are determined by its structure and composition. Consequently, tissue structure and compositional properties also affect the ultrasound propagation in bone. The diagnostic potential of ultrasound has not been fully exploited in clinical quantitative ultrasound devices. The aim of this study was to investigate the ability of quantitative ultrasound pulse-echo imaging, conducted over a broad range of frequencies (1 to 5 MHz), to predict the mechanics, composition and microstructure of trabecular bone. Ultrasound reflection and backscatter parameters correlated significantly with the ultimate strength of the trabecular bone and the bone volume fraction (r = 0.76–0.90, n = 20, p < 0.01). Ultrasound backscatter associated significantly (independently of bone structure or mineral content) with the collagen content of the bone matrix (r = 0.75, r_adjusted = 0.66, p < 0.01). Interestingly, the applied ultrasound frequency seemed to relate the sensitivity of ultrasound backscatter to different properties of trabecular bone. At frequencies ranging from 1 to 3.5 MHz, the ultrasound backscatter associated significantly with the tissue mechanical and structural parameters. At 5 MHz, the composition of the bone matrix was a more significant determinant of the measured backscatter. This study provides useful information for optimizing the use of pulse-echo measurements, and thereby further emphasizes the diagnostic potential of the ultrasound backscatter measurements of trabecular bone.     

Detection and subtyping of influenza A virus based on a short oligonucleotide microarray

We report the design and characterization of a microarray with 46 short virus-specific oligonucleotides for detecting influenza A virus of 5 subtypes: H1N1, H1N2, H3N2, H5N1, and H9N2. A unique combination of 3 specific modifications was introduced into the microarray assay: (1) short probes of 19 to 27 nucleotides, (2) simple amplification of full-length hemagglutinin and neuraminidase cDNAs with universal primers, and (3) Klenow-mediated labeling and further amplification of the samples before hybridization. The assay correctly and specifically detected and subtyped 11 different influenza A isolates from human, avian, and swine species representing the 5 subtypes. When tested with 225 clinical samples, 20 were detected to be positive using our microarray-based assay, whereas only 10 were positive by the conventional culture method. The entire analysis was completed within 7 h. Thus, these modifications result in a specific, sensitive, and rapid microarray assay and may be used for constructing microarrays for the detection of all influenza subtypes and strains.     

浅谈诊断学教学中的人文素质教育

在医学教育中加强人文素质教育是促进医学生全面发展的必然要求,也是顺应医学模式转变和构建和谐社会的必然要求。诊断学实习是医学生踏上临床的第一步,通过构建合理的医患沟通能力培训体系以及在诊断学的具体教学环节中融入人文素质教育,使学生在接受专业知识的同时,潜移默化地接受人文精神的培养,对于全面提高医学生的人文素质,培养合格的医务工作者具有重要的现实意义。     

临床医学专业本科生诊断学学习成绩与毕业临床综合能力的相关研究

目的 研究五年制医学生诊断学学习成绩与毕业临床综合能力的相关性,为进一步提高诊断学课程的地位和重要性提供科学依据.方法 对徐州医学院临床医学本科专业2007届～2011届医学生诊断学学习成绩与毕业临床技能考试和临床理论考试成绩进行相关性分析.结果 毕业临床技能考试成绩与诊断学成绩明显相关（P＜0.01）,毕业临床理论考试成绩与诊断学成绩无明显相关性（P＞0.05）.诊断学成绩位于高分组和低分组的排名情况与毕业临床技能考试成绩的排名较为一致.结论 诊断学学习在医学本科生临床综合能力的培养上占据重要地位,应当进一步深化诊断学教学改革,尽快建立一套科学合理、系统有效的临床综合能力评价体系.     

浅析中医“见微知著”的深层含义

目的:通过古文献的分析来揭示中医"见微知著"的深层含义;方法:从渊源追溯、医案举例、临床应用等方面来阐述"见微知著"有异于通常的解释;结果:"见微知著"的确切含义并不能被"以小见大"所涵盖;结论:除"以小见大"的含义外,"见微知著"还蕴含着对未来疾病动态的预测。     

超声诊断胆总管结石假阳性原因分析(附54例报告)

目的分析超声诊断胆总管结石假阳性的原因及影响因素。方法回顾性分析住院治疗的胆石症患者1306例,其中经超声诊断为胆总管结石506例,占38.7%。对超声诊断为胆总管结石的506例患者成功进行了内镜逆行胰胆管造影(ERCP)、内镜下乳头括约肌切开术(EST)及经十二指肠镜网篮取石,机械碎石;对胆总管末端组织增生或占位者取组织病理检查;胆管狭窄者放置鼻胆管、胆道支架引流;部分病例行外科手术或肝内胆管穿刺引流等治疗。结果超声诊断胆总管结石假阳性54例,占10.67%(54/506),占总数的4.1%(54/306)。结论胆汁成份的改变、肝外胆管解剖特征的改变是造成假阳性的主要原因。     

标准化病人在诊断学教学中的运用

诊断学是关于疾病诊断基本理论、基本技能、基本方法的重要医学专业课程。标准化病人的引入,缓解了我国教学资源不足及医患关系紧张的矛盾,在学生基本技能及医患沟通能力培养方面显露优势。但标准化病人的应用在诊断学教学实践中存在诸多问题,对此进行分析,以寻求相关对策。