《中国胰腺癌新辅助治疗指南(2020版)》解读

胰腺癌是高度恶性的消化系统肿瘤,预后极差。随着对胰腺癌生物学行为认识的不断深入及综合治疗理念的普及,新辅助治疗在胰腺癌治疗中的作用日益凸显。中华医学会外科学分会胰腺外科学组、中国研究型医院学会胰腺疾病专业委员会联合制定了《中国胰腺癌新辅助治疗指南(2020版)》,就胰腺癌新辅助治疗中的关键问题进行系统全面的阐述,为胰腺癌新辅助治疗的临床实践提供了参考依据。本文对指南中的新辅助治疗前准备、指征把握、方案选择、新辅助治疗后的再评估及手术策略等方面的内容进行解读,进一步探讨胰腺癌新辅助治疗存在的争议。     

美国血管外科学会2018年腹主动脉瘤诊治指南解读

根据循证医学的基本原则,美国血管外科学会（SVS）在系统性回顾的基础上,于2018年1月发布了腹主动脉瘤（AAA）治疗指南,针对AAA的诊断评估、治疗方式、麻醉及围术期处理、术后管理及随访、经济效益学分析5个方面做了重点阐述,并给出111条具体的推荐建议,并按GRADE法给出了推荐强度及证据级别。笔者对该指南中涉及的新观点或推荐意见、以及与临床诊疗过程中的密切相关点作一解读,以期读者更好的理解该指南。     

Radiologist Use of and Perceived Need for Patient Data Access

Given the increasing volume of radiological exams, the decreasing frequency of direct communication with the referring provider, and the distribution of patient data over many clinical systems, radiologists often do not have adequate clinical information at the time of interpretation. We have performed a survey of radiologists to determine the need and actual utilization of patient data at the time of image interpretation. Our findings demonstrate that most radiologists want more clinical information when interpreting images and that this information would impact their report, but they are discouraged by the time it takes to access this information. In addition, current mechanisms for monitoring necessary patient follow-up are inadequate.     

Analyzing the eye movement of dentists during their reading of CT images

In order to evaluate the eye movements of dentists when they were interpreting radiographs, ten normal computed tomography (CT) images and ten images with pathologic lesions were shown to eight dentists, and the pattern of their eye movement was qualitatively analyzed. Six fixation point parameters were calculated, including the time required to discriminate between normal and pathologic images (X₁), the total fixation point count (X₂), the total travel distance between fixation points (X₃), the average time spent on each fixation point (X₄), the total gaze fixation time (X₅), and the maximum gaze fixation time spent on each image (X₆). When the subjects were interpreting pathologic images, X₂ and X₄ were shorter; however, when they were viewing normal images, time was spent on observing multiple fixation points before the completion of the interpretive process. While pathologic images were recognized through top-down processing, there was a tendency for normal images to be recognized through bottom-up processing. The results of discriminant analysis, using a linear discriminant function, indicated that the independent variables X₂ and X₄ and the dependent variable X₅ were the only variables that contributed significantly to differentiating between normal and pathologic images. The linear discriminant function was Z = 9.0 × 10⁻² × X₂ + 3.0 × X₄ − 2.1 (discriminant score: Z < 0, pathologic image; Z ≧ 0, normal image). When the mean value of each individual's gaze fixation data was substituted into the discriminant formula, the hit rate for normal and pathologic images was discriminated at 94% (15 of 16). Received: September 27, 2000 / Accepted: July 26, 2001     

Minimally important change determined by a visual method integrating an anchor-based and a distribution-based approach

Background: Minimally important changes (MIC) in scores help interpret results from health status instruments. Various distribution-based and anchor-based approaches have been proposed to assess MIC. Objectives: To describe and apply a visual method, called the anchor-based MIC distribution method, which integrates both approaches. Method: Using an anchor, patients are categorized as persons with an important improvement, an important deterioration, or without important change. For these three groups the distribution of the change scores on the health status instrument are depicted in a graph. We present two cut-off points for an MIC: the ROC cut-off point and the 95% limit cut-off point. Results: We illustrate our anchor-based MIC distribution method determining the MIC for the Pain Intensity Numerical Rating Scale in patients with low back pain, using two conceivable definitions of minimal important change on the anchor. The graph shows the distribution of the scores of the health status instrument for the relevant categories on the anchor, and also the consequences of choosing the ROC cut-off point or the 95% limit cut-off point. Discussion: The anchor-based MIC distribution method provides a general framework, applicable to all kind of anchors. This method forces researchers to choose and justify their choice of an appropriate anchor and to define minimal importance on that anchor. The MIC is not an invariable characteristic of a measurement instrument, but may depend, among other things, on the perspective from which minimal importance is considered and the baseline values on the measurement instrument under study. A balance needs to be struck between the practicality of a single MIC value and the validity of a range of MIC values.     

小金县饮茶型地方性氟中毒调查及结果分析

目的:了解小金县饮茶型地方性氟中毒的病情危害程度。为制定防治规划和措施提供科学依据。掌握砖茶氟摄入量同氟中毒病情的剂量-效应关系。方法:按照《四川省饮茶型地方性氟中毒流行现状调查方案(草案)》要求,采用氟离子选择电极法。结果:400份砖茶水样氟浓度范围为0.13~11.30 mg/L,氟浓度的均值为3.85 mg/L,氟含量偏高,生活饮用水中氟浓度符合国家标准要求。400份儿童尿样氟浓度范围为0.14~7.90 mg/L,氟浓度的均值为0.90 mg/L。400份成人尿样氟浓度范围为0.16~18.18 mg/L,氟浓度的均值为1.65 mg/L。结论:我县群众饮用砖茶水氟浓度偏高,饮茶型地方性氟中毒较严重。     

Cognitive bias modification - Priming with an ambiguous homograph is necessary to detect an interpretation training effect

Biases in the interpretation of ambiguous information may have a causal role in producing and maintaining anxiety. Training with repeated exposure to emotionally valenced meanings has been found to produce such a bias, as measured by lexical decisions for targets primed with related emotionally ambiguous homographs. Interpretation bias is thought to occur only when ambiguity causes competition for processing resources, but similar results might occur if valenced training causes a response bias. Twenty participants underwent training, followed by a lexical decision task with no ambiguous primes preceding the target stimuli. No training effect was found, supporting the resource competition explanation for the previous findings.     

药品黑框警示信息解读

简要介绍药品黑框警示信息的概念与发展,并通过对其内容要求、来源、依据及表现形式的解读,希望为国内医药学专业人员及广大患者在药品使用中正确认识药品黑框警示信息的意义和作用、规避用药风险提供一些参考。     

文化视阈下的医学语言解读

在现代医学模式确立过程中,对医学语言的研究不断推进,其价值和地位日显重要和突出。医学语言具有丰厚的文化意义,在最为明显的层面上,它决定了临床实践的价值,奠定了医学科学的发展根基,拓展了语言和文学的覆盖面,推动了哲学反思的终极化;在间接或衍生层面上,医学语言承载着负面的致病作用,体现着自然科学的美学意蕴,打通了医学与军事兵法的思想渊源。     

Emotion Recognition in Children and Adolescents with Autism Spectrum Disorders

We examined upper facial basic emotion recognition in 57 subjects with autism spectrum disorders (ASD) (M = 13.5 years) and 33 typically developing controls (M = 14.3 years) by using a standardized computer-aided measure (The Frankfurt Test and Training of Facial Affect Recognition, FEFA). The ASD group scored lower than controls on the total scores of FEFA and perceived ambiguous stimuli more often as a negative emotion. The older ASD group (≥12 years) performed better than the younger ASD group (<12 years) on the blended emotions of FEFA. The results support the findings that individuals with ASD have difficulties in emotion recognition. However, older subjects with ASD seem to have better skills than younger subjects with ASD.