混合型生物人工肝治疗设备的研制

目的:结合临床应用需求,研制一种新式混合型生物人工肝治疗应用系统。方法:以2个可编程控制器(PLC)作为控制系统核心,辅以多种安全监测报警装置,具有密闭、洁净和恒温的生物反应治疗环境,为离线混合型生物人工肝治疗提供一体化集成解决方案。结果:该设备能实现对血液流量、流速、质量等参数的精确控制,并提供温度、气泡、漏血等参数的报警监测功能。控制系统操作简便,人机界面友好,并为封闭式生物反应离线治疗过程提供实时影像监控。结论:新型治疗设备实现了混合式生物反应人工肝的离线治疗,有效缩短了生物人工肝治疗时间,同时改善了生物治疗环境。     

Prognostic indicators of lenalidomide for multiple myeloma: consensus and controversy

The long-term outcome of multiple myeloma (MM) has been greatly improved through new agents, one being lenalidomide (LEN). Based upon the findings of in vitro experiments, its mode of action against MM occurs through a combination of direct tumoricidal effects on myeloma cells, modulatory effects on tumor immunity and tumor microenvironment-regulatory effects. However, it has not been clearly defined whether the clinical response and long-term outcome of MM with LEN treatment truly reflect the mechanisms of action of LEN proposed by in vitro studies. To ascertain what is known and what remains to be elucidated with LEN, we review the current literature on the mode of action of LEN in association with myeloma pathophysiology, and discuss the prognostic indicators in the treatment of MM with LEN.     

计算机三维动画技术在创伤骨科教学课件中的应用及优势

结合实践介绍了在创伤骨科临床课件制作中三维动画技术的具体应用,分析了该技术在临床教学中的诸多优势,并探讨了三维动画技术在骨科医学教育中的应用原则。     

Rethinking Normal: Benefits and Risks of Not Reporting Harmless Incidental Findings

The authors explore the benefits and risks of not reporting imaging findings that do not have clinical relevance, with the goal of developing recommendations to reduce their reporting. The authors review the example of incidentally detected, simple renal cysts (Bosniak category I), including medicolegal conditions required for such a shift in reporting practices to be acceptable. The authors propose four potential criteria for not reporting clinically unimportant findings and recommend that these criteria be debated in other contexts, so that they can be refined and implemented.     

When Artificial Intelligence Models Surpass Physician Performance: Medical Malpractice Liability in an Era of Advanced Artificial Intelligence

It seems inevitable that diagnostic and recommender artificial intelligence models will ultimately reach a point when they outperform human clinicians. Just as antibiotics displaced a host of medicinals for treating infections, the superior performance of such models will force their adoption. This article contemplates certain ethical and legal implications bearing on that adoption, especially because they involve a clinician’s exposure to allegations of malpractice. The article discusses four relevant considerations: (1) the imperative of using explainable artificial intelligence models in clinical care, (2) specific strategies for diminishing liability when a clinician agrees or disagrees with a model’s findings or recommendations but the patient nevertheless experiences a poor outcome, (3) relieving liability through legislation or regulation, and (4) comprehending such models as “persons” and therefore as potential defendants in legal proceedings. We conclude with observations on clinician–vendor relationships and argue that, although advanced artificial intelligence models have not yet arrived, clinicians must begin considering their implications now.     

小儿厌食症治验举隅

举例介绍了治疗小儿厌食症的临床经验，并取得了满意的临床疗效。     

Unveiling the masked native blood group following thalidomide therapy in a thalassemia patient: A 5 WHY analysis approach

Blood grouping discrepancy in patients with hematological disorders can occur due to red cell sensitization following transfusion, transplantation, and pregnancy or pre-analytical errors. Prompt initiation of root cause analysis is vital to avoid complications of wrong blood transfusion. We present an unusual case of Rh mismatched grouping report of 24 year old female thalassemia patient being managed in our hospital since 2015. Her current type and screen were observed as O Rh D negative with negative antibody screen while the historical blood group was O Rh D positive. The pre-analytical errors were ruled out and blood grouping performed from fresh sample also demonstrated as O Rh D negative despite antigen enhancement techniques and had no recent transfusion history. We sought to reason out the possibilities for discordant Rh grouping report, historical and present group through “Funnel based problem solving 5 WHY analysis” approach. The review of the past clinical history revealed that the patient had undergone Rh mismatch bone marrow transplant (Rh D positive donor and Rh D negative recipient) at 5 years of age which soon resulted in graft failure. Yet, she continued to receive Rh D positive blood thereafter with no development of anti-D which explains the historical blood group. Recently the patient was started on thalidomide, the Hb F inducer drug, which helped in maintaining her hemoglobin level between 9 and 10 g/dl without transfusion support for two months. This allowed unmasking of native Rh D negative blood and the review of clinical history played a significant role in resolution of grouping discrepancy.     

The impact of gross anatomy laboratory on first year medical students’ interest in a surgical career

This study sought to determine the impact of gross anatomy laboratory (GA) on first year medical students’ (M1) interest in a surgical career. Secondary objectives included identifying other influences in M1s’ career decision making. This prospective study included surveys before and after GA. All M1s enrolled in GA were invited to participate. Sixty students completed both the pre‐ and post‐test surveys. A 5‐point Likert‐type scale surveyed participants’ interests, specific personality traits, experience during the course of GA, and likelihood of pursuing a surgical career. Statistical analysis included Wilcoxon Signed Rank Test and (Polychotomous) Ordinal Logistic Regression Model. Students’ desire to work with their hands increased (50 vs. 33.3%) and enjoyment working with instruments and tools similarly increased (50 vs. 41.7%). Likelihood of pursuing a surgical career after gross anatomy increased in 31.7% of students, decreased in 16.7%, and was unchanged in 51.7%. Over 75% of students with a prior interest in surgery and 21% of those who previously felt neutral agreed that they were likely to pursue a career in surgery at the conclusion of the laboratory. Students with a surgeon family member were 0.1976 times as likely to exhibit a positive change in interest (P values 0.024). Gross anatomy may influence up to a third of the class to consider a surgical career, especially those with a prior interest in surgery and those previously feeling ambivalent. Students with a surgeon family member became less likely to enter a surgical career after gross anatomy. Clin. Anat. 29:691–695, 2016. © 2016 Wiley Periodicals, Inc.