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。     

建立现代化诊断学模拟实验中心的实践

目的探讨诊断学教学改革新方法的效果。方法建立现代化诊断学模拟实验中心:检体诊断模拟实验室、器械诊断模拟实验室、实验诊断示教室的教学新方法与传统的教学方法进行比较。结果改革后学生学习兴趣增加、考试成绩明显提高,与改革前比较差异有显著性(P<0.05)。结论建立现代化诊断学模拟实验中心,加强学生实际操作技能,势在必行。     

In vivo fluorescence spectroscopy and imaging of human skin tumours

The feasibility of using in vivo autofluorescence for the diagnosis of skin cancer was evaluated. In vivo fluorescence measurements were performed on healthy human volunteers, and patients with different types of benign and malignant skin tumours. Fluorescence spectra as well as fluorescence images were acquired. The excitation-emission matrix of normal skin (n=3) showed a broad peak at the shortest excitation wavelength (365 nm) and at 440 nm fluorescence wavelength, smoothly decreasing towards longer excitation and fluorescence wavelengths. Non-melanoma skin tumours (n=31) and control skin excited with 375 nm showed a broad fluorescence band from 400 to 700 nm, peaking around 436 nm. No significant differences in measurements between tumours and the corresponding control sites were found. A large spatial variation in the fluorescence intensity was observed both in the tumours and in the control sites. Standard deviations found ranged from 0.15 to 1.5 times the mean fluorescence. Fluorescence images, excited with 375 nm and taken with an image intensified CCD camera, on eight malignant melanomas and eight benign pigmented lesions did not indicate any fluorescence intensity distribution specific to the malignancy of the lesion. Neither the shape of the fluorescence spectra, nor the spatial distribution of the fluorescence intensity showed any signature specific to the histopathological nature of the lesions investigated. Optical diagnostics of skin tumours using the autofluorescence does not seem to be feasible at the present time.     

The impact of early information concerning the surgical operations on anxiety in patients with burns

AimsStress has been linked to poor coping with health-related issues, poor adaptation, a decrease of quality of life, poor recovery and poor wound healing. Therefore, it is important to address patients’ uncertainty and feelings of anxiety. The aim of this study was to examine the effect of providing early treatment information based on an LDI-scan to patients with burns on their feelings of anxiety.DesignAn observational prospective pre-test post-test study.MethodsPatients with intermediate burns (n = 59) admitted to our burn centre in 2016 were evaluated for anxiety using a visual analogue scale (VAS-A) before and after an LDI-scan was made. Two groups were compared: a group that heard whether surgery would or would not be recommended for wound closure (certain group) versus a group that heard to wait and see whether an operation was determined to be helpful (uncertain group).ResultsBefore the LDI-scan was made, both groups showed clinically high levels of anxiety (median VAS scores above 5). After the information gathered with the LDI was discussed with the patient, anxiety dropped significantly (median VAS below 3; p = .001). No significant differences between the groups were observed (p > .05).ConclusionIn contrast to other studies, anxiety was significantly reduced in all our study groups after information was shared. Early communication of knowledge by health care professionals is important regardless whether it includes treatment uncertainty.     

Indicators of Complex Care During the Consultation-Liaison Psychiatry Activity at the Transplant Center of the Policlinico Hospital,Modena

Objective

The objective of this study was to identify possible biopsychosocial predictors of organizational complexity in patients referred to the consultant psychiatrist for assessment before liver transplantation.

Semiautomatic quantification of carotid plaque volume with three-dimensional ultrasound imaging

Objective

Vessel wall volume (VWV) assessed by three-dimensional duplex ultrasound (3DUS) imaging provides a more comprehensive measure of plaque burden than conventional two-dimensional measures of diameter stenosis. We previously demonstrated that manual outlining of the arterial lumen-intima boundary and outer wall boundary can be performed reliably on images obtained with a commercially available 3D-DUS transducer. Manual segmentation, however, is time consuming (～45 minutes), limiting its clinical translation. We have developed a semiautomatic algorithm (manual selection of the carotid bifurcation image with subsequent automatic plaque outlining) to outline carotid plaques on 3DUS data sets. In this study, we investigated the accuracy, reproducibility, reliability, and time taken by this algorithm.

Medical diagnostics for indoor mold exposure

In April 2016, the German Society of Hygiene, Environmental Medicine and Preventative Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin (GHUP)) together with other scientific medical societies, German and Austrian medical societies, physician unions and experts has provided an AWMF (Association of the Scientific Medical Societies) guideline ‘Medical diagnostics for indoor mold exposure’. This guideline shall help physicians to advise and treat patients exposed indoors to mold. Indoor mold growth is a potential health risk, even without a quantitative and/or causal association between the occurrence of individual mold species and health effects. Apart from the allergic bronchopulmonary aspergillosis (ABPA) and the mycoses caused by mold, there is only sufficient evidence for the following associations between moisture/mold damages and different health effects: Allergic respiratory diseases, asthma (manifestation, progression, exacerbation), allergic rhinitis, exogenous allergic alveolitis and respiratory tract infections/bronchitis. In comparison to other environmental allergens, the sensitizing potential of molds is estimated to be low. Recent studies show a prevalence of sensitization of 3–10% in the total population of Europe. The evidence for associations to mucous membrane irritation and atopic eczema (manifestation, progression, exacerbation) is classified as limited or suspected. Inadequate or insufficient evidence for an association is given for COPD, acute idiopathic pulmonary hemorrhage in children, rheumatism/arthritis, sarcoidosis, and cancer. The risk of infections from indoor molds is low for healthy individuals. Only molds that are capable to form toxins can cause intoxications. The environmental and growth conditions and especially the substrate determine whether toxin formation occurs, but indoor air concentrations are always very low. In the case of indoor moisture/mold damages, everyone can be affected by odor effects and/or impairment of well-being. Predisposing factors for odor effects can be given by genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for impairment of well-being are environmental concerns, anxieties, conditioning and attributions as well as a variety of diseases. Risk groups that must be protected are patients with immunosuppression and with mucoviscidosis (cystic fibrosis) with regard to infections and individuals with mucoviscidosis and asthma with regard to allergies. If an association between mold exposure and health effects is suspected, the medical diagnosis includes medical history, physical examination, conventional allergy diagnosis, and if indicated, provocation tests. For the treatment of mold infections, it is referred to the AWMF guidelines for diagnosis and treatment of invasive Aspergillus infections. Regarding mycotoxins, there are currently no validated test methods that could be used in clinical diagnostics. From the perspective of preventive medicine, it is important that mold damages cannot be tolerated in indoor environments.     

Magnetoencephalography using high temperature rf SQUIDs

Summary We have developed high-critical-temperature radio-frequency Super conducting QUantum Interference Devices (SQUIDs) with step-edge grain-boundary Josephson junctions and large flux focusers. These planar devices were fabricated from epitaxial YBa₂Cu₃O₇ films and operated in the magnetometer and first-order gradiometer configurations while immersed in liquid nitrogen. At the temperature of 77K, we have attained a magnetic field resolution for the magnetometer better than 200 fT/Hz^1/2 down to less than 1 Hz, i.e., over the low signal frequency range important for medical diagnostics. The results to date show a high promise for biomagnetic diagnostics. For the first time, we recorded the evoked responses from human brains using a high-temperature magnetometer and a first-order electronic gradiometer channel simultaneously. These results were obtained in a magnetically shielded room. An improvement in the magnetic field resolution by another order of magnitude is possible and probable.We are grateful to Prof. Dr. med. M. Hoke, Director of the Institute for Experimental Audiology for his support and the encouragement offered to us. We also thank Dr. J. Schubert and W. Zander, KFA-ISI, who fabricated the YBCO films by pulsed laser deposition. Work at KFA was supported, in part, by the German Minister of Research and Technology (BMFT), the Consortium on "First Applications of HTS in Microelectronics".     

Molecular lipid species in urinary exosomes as potential prostate cancer biomarkers

BackgroundExosomes have recently appeared as a novel source of noninvasive cancer biomarkers, since these nanovesicles contain molecules from cancer cells and can be detected in biofluids. We have here investigated the potential use of lipids in urinary exosomes as prostate cancer biomarkers.MethodsA high-throughput mass spectrometry quantitative lipidomic analysis was performed to reveal the lipid composition of urinary exosomes in prostate cancer patients and healthy controls.ResultsControl samples were first analysed to characterise the lipidome of urinary exosomes and test the reproducibility of the method. In total, 107 lipid species were quantified in urinary exosomes. Several differences, for example, in cholesterol and phosphatidylcholine, were found between urinary exosomes and exosomes derived from cell lines, thus showing the importance of in vivo studies for biomarker analysis. The 36 most abundant lipid species in urinary exosomes were then quantified in 15 prostate cancer patients and 13 healthy controls. Interestingly, the levels of nine lipids species were found to be significantly different when the two groups were compared. The highest significance was shown for phosphatidylserine (PS) 18:1/18:1 and lactosylceramide (d18:1/16:0), the latter also showed the highest patient-to-control ratio. Furthermore, combinations of these lipid species and PS 18:0-18:2 distinguished the two groups with 93% sensitivity and 100% specificity. Finally, in agreement with the reported dysregulation of sphingolipid metabolism in cancer cells, alteration in specific sphingolipid lipid classes were observed.ConclusionThis study shows for the first time the potential use of exosomal lipid species in urine as prostate cancer biomarkers.     

信息化环境下《中医诊断学》的教学模式实施初探

从对教师素质的要求、教师素质的培养及信息化教学模式的实施几方面对如何运用现代信息技术,开发教学资源,优化教学过程,促进中医诊断学教学质量的提高进行探讨,提示信息环境下中医诊断教学模式需各环节配合才能达到最佳效果。