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肝外胆管癌的临床病理与预后分析 被引量:6
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作者 陶连元 何小东 +4 位作者 高飞 王磊 张锋良 龙志华 徐青 《肝胆外科杂志》 2011年第4期251-253,共3页
目的手术目前仍是肝外胆管癌(ECC)的唯一有效治疗手段。本研究通过研究ECC病人的各项临床病理特点,分析其与手术后病人预后的联系。方法分析2005年3月至2008年3月期间进行手术治疗的31例ECC病人。回顾性统计各项临床病理特点并用采用Kap... 目的手术目前仍是肝外胆管癌(ECC)的唯一有效治疗手段。本研究通过研究ECC病人的各项临床病理特点,分析其与手术后病人预后的联系。方法分析2005年3月至2008年3月期间进行手术治疗的31例ECC病人。回顾性统计各项临床病理特点并用采用Kaplan-Meier分析其与病人预后联系。结果 ECC病人1、3、5年生存率分别为71.0%、18.5%、4.0%,平均生存时间为19.0个月。经根治性手术切除与姑息性手术切除治疗肝外胆管癌患者之间的生存率有显著性差异(P=0.049)。胆管周围组织浸润阴性者较胆管周围组织浸润阳性者的预后好(P=0.044),肿瘤分化程度越好的病人其预后越好(P=0.000)。结论我们的结果表明根治性手术、肿瘤有无浸润以及肿瘤的分化程度是ECC病人主要术后预后因素。 展开更多
关键词 肝外胆管癌 外科治疗 病理 生存率
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A Survey of Surgical Patient’s Perception about Anesthesiologist in a Large Scale Comprehensive Hospital in China 被引量:1
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作者 李敏娜 马璐璐 +1 位作者 虞雪融 黄宇光 《Chinese Medical Sciences Journal》 CAS CSCD 2019年第2期140-146,共7页
Objectives This study aim to evaluate patient’s perception about anesthesiologists’ job roles and investigate their expectations for anesthesia care.Methods We designed a self-administered questionnaire for this cro... Objectives This study aim to evaluate patient’s perception about anesthesiologists’ job roles and investigate their expectations for anesthesia care.Methods We designed a self-administered questionnaire for this cross-sectional survey study and delivered questionnaire forms to adult in-patients who were scheduled for elective surgery before pre-operative anesthetic visit the day before surgery.We collected information of respondents’ demographic data,education background,health literacy and previous experience of anesthesia,perception of anesthesiologist’s job,the expectation on anesthesia care.Descriptive analyses,χ^2 test and multiple linear regression analysis were used for data analysis.Results Of 550 participants,521(94.7%)completed the questionnaire.In these respondents,335 (64.3%) considered anesthesiology as an independent medical discipline,225 (43.2%) believed that anesthesiology department was an independent clinical department,and 243 (46.6%) recognized anesthesiologists as qualified doctors.Only 21.5% of them knew that anesthesiologists also work in the intensive care unit and 26.9% of them knew that anesthesiologists also work in pain clinic as well.Younger patients (β=-0.044,P<0.001),those with higher education (β=1.200,P<0.001),or with better health literacy (β=0.781,P=0.005) had significant more knowledge about the job roles of anesthesiologists.Most patients demanded pre-anesthetic visit (80.5%),expected availability of preoperative anesthetic clinic (74.1%),wished to receive more information about anesthesia (91.3%) and anesthesiologist (77.4%).Conclusions Patients’ perception about anesthesiologists might be limited.Efforts should be made on education about anesthesia,especially for elderly patients and those under-educated patients.Preoperative anesthetic clinic is expected by most in-patients. 展开更多
关键词 patients' PERCEPTION ANESTHESIOLOGY ANESTHESIOLOGIST PREOPERATIVE CLINIC
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炎症性肠病合并艰难梭菌感染的研究进展 被引量:2
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作者 李玥 钱家鸣 《临床荟萃》 CAS 2018年第5期394-397,共4页
艰难梭菌感染(Clostridium difficileinfection,CDI)在炎症性肠病(inflammatory bowel disease,IBD)患者中的发生率不断上升。CDI明显增加IBD患者预后不良如死亡和结肠切除手术率。有关IBD合并CDI的相关研究显示,肠道微生态、免疫和遗... 艰难梭菌感染(Clostridium difficileinfection,CDI)在炎症性肠病(inflammatory bowel disease,IBD)患者中的发生率不断上升。CDI明显增加IBD患者预后不良如死亡和结肠切除手术率。有关IBD合并CDI的相关研究显示,肠道微生态、免疫和遗传因素共同决定了IBD发生CDI的风险。进一步的机制研究将有助于CDI的预防和治疗。 展开更多
关键词 炎性肠疾病 梭菌感染 肠道微生态 遗传易感性
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胆管癌相关肿瘤抗原标记物的研究现状 被引量:2
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作者 陶连元 何小东 蔡磊 《肝胆外科杂志》 2010年第4期311-314,共4页
关键词 胆管癌 肿瘤抗原标记物
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以皮肤表现为主的原发性系统性淀粉样变病1例 被引量:2
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作者 张心瑜 陈典 孙秋宁 《皮肤性病诊疗学杂志》 2016年第1期40-42,共3页
报道1例皮肤受累较突出的原发性系统性淀粉样变病。患者男,60岁,主要表现为头面部及肛周散在紫癜,近期出现心慌、气短。查体可见面部、颈部、腹部、肛周及口腔黏膜多发紫癜、紫红色瘀斑,部分融合,舌红肿大,可见齿痕。辅助检查:血清蛋白... 报道1例皮肤受累较突出的原发性系统性淀粉样变病。患者男,60岁,主要表现为头面部及肛周散在紫癜,近期出现心慌、气短。查体可见面部、颈部、腹部、肛周及口腔黏膜多发紫癜、紫红色瘀斑,部分融合,舌红肿大,可见齿痕。辅助检查:血清蛋白电泳可见M蛋白,24 h尿蛋白1.07 g,超声心动图示左房扩大,室间隔及左室后壁心肌厚度正常高限,左室舒张功能减退。皮肤镜表现为紫红色不规则斑块,边缘模糊,部分融合。皮肤病理:表皮轻度角化过度,棘层萎缩变薄,基底层色素增加。真皮浅中层可见淡红色淀粉样物质沉积,刚果红染色阳性。根据临床表现及皮肤组织病理结果,考虑原发性系统性淀粉样变。目前予泼尼松30 mg 1天1次口服,完善系统评估中,建议其转诊血液科。 展开更多
关键词 原发性系统性淀粉样变 皮肤镜
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光动力疗法治疗外阴鲍文氏病1例
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作者 张心瑜 刘秀荣 孙秋宁 《皮肤性病诊疗学杂志》 2015年第6期446-448,共3页
患者女,35岁,患者自7年前起无明显诱因于右侧大阴唇内侧出现皮肤红斑,直径约5 mm,偶瘙痒。后皮损逐渐增大至2-3 cm,皮肤逐渐变硬、粗糙,偶有刺痛感,月经期间瘙痒、疼痛加重。1年前起皮损处出现糜烂、破溃,有黄色渗出物。曾于外院就诊,... 患者女,35岁,患者自7年前起无明显诱因于右侧大阴唇内侧出现皮肤红斑,直径约5 mm,偶瘙痒。后皮损逐渐增大至2-3 cm,皮肤逐渐变硬、粗糙,偶有刺痛感,月经期间瘙痒、疼痛加重。1年前起皮损处出现糜烂、破溃,有黄色渗出物。曾于外院就诊,予外用“重组牛碱性成纤维细胞生长因子外用溶液”、“聚维酮碘溶液”,效果不明显。查体示右侧大阴唇内侧见蚕豆大小红色丘疹,伴糜烂、渗液,渗出物为黄色透明。触之发硬、粗糙,余未见明显异常。皮肤镜表现可见典型的小球状血管。皮肤组织病理示:角化不全,棘细胞层增厚,皮突延长,棘细胞排列紊乱,明显异型性,基底膜完整,真皮层淋巴、组织细胞浸润。结合临床表现、皮肤镜及病理,诊断为鲍文氏病。采用光动力治疗3次后皮损已基本消退,仅残留散在色素脱失。 展开更多
关键词 鲍文氏病 光动力疗法
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Artificial Intelligence in Healthcare and Medicine:Promises,Ethical Challenges and Governance 被引量:10
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作者 关健 《Chinese Medical Sciences Journal》 CAS CSCD 2019年第2期76-83,共8页
Artificial intelligence (AI) is rapidly being applied to a wide range of fields,including medicine,and has been considered as an approach that may augment or substitute human professionals in primary healthcare.Howeve... Artificial intelligence (AI) is rapidly being applied to a wide range of fields,including medicine,and has been considered as an approach that may augment or substitute human professionals in primary healthcare.However,AI also raises several challenges and ethical concerns.In this article,the author investigates and discusses three aspects of AI in medicine and healthcare:the application and promises of AI,special ethical concerns pertaining to AI in some frontier fields,and suggestive ethical governance systems.Despite great potentials of frontier AI research and development in the field of medical care,the ethical challenges induced by its applications has put forward new requirements for governance.To ensure “trustworthy” AI applications in healthcare and medicine,the creation of an ethical global governance framework and system as well as special guidelines for frontier AI applications in medicine are suggested.The most important aspects include the roles of governments in ethical auditing and the responsibilities of stakeholders in the ethical governance system. 展开更多
关键词 artificial INTELLIGENCE medical ETHICS ETHICAL GOVERNANCE machine learning brain-computer interaction brain-inspired computer ROBOTS biohybrids
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Association between Air Pollution and Type 2 Diabetes Mellitus in Developing Countries:A Systematic Review and Meta-Analysis 被引量:3
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作者 Zihan Chen Zhou Zhao +1 位作者 Chuiwen Deng Naishi Li 《Chinese Medical Sciences Journal》 CAS CSCD 2022年第3期218-227,I0007,共11页
Objective In recent years,many studies have reported that air pollution is a risk factor for type 2 diabetes mellitus(T2DM).The aim of this systematic review and meta・analysis is to summarize the evidence about the as... Objective In recent years,many studies have reported that air pollution is a risk factor for type 2 diabetes mellitus(T2DM).The aim of this systematic review and meta・analysis is to summarize the evidence about the association between exposure to air pollution andT2DM in developing countries.Methods The databases,including PubMed,EMBASE and Web of Science,were systematically searched for studies published up to 31 March 2022.Studies about the association between air pollution andT2DM prevalence or incidence in developing countries were included.The odds ratio(OR)was used as effect estimate.We synthesized the included studies in the meta-analysis.Results We included 8 cross-sectional studies and 8 cohort studies,all conducted in developing countries.Meta-analysis of 8 studies on PM_(2.5)(particulate matter ≤2.5 μm in diameter)showed that T2DM prevalence was significantly associated with PM_(2.5)exposure(OR=1.12;95%CI:1.07,1.17;P<0.001).The association between air pollutants andT2DM incidence was not estimated due to the limited relevant studies.Conclusions The exposure to PM_(2.5)would be positively associated with an increased prevalence of T2DM in developing countries.Some effective measures should be taken to reduce air pollutant exposure in people who are vulnerable to diabetes. 展开更多
关键词 Air pollutants PM_(2.5) type 2 diabetes mellitus
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Reliability and Validity of the Chinese Version of the Lymphedema Quality of Life Questionnaire 被引量:3
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作者 Zhengyun Liang Xiao Long +6 位作者 Elan Yang Yunzhu Li Zhujun Li Min Xu Bifen Zhang Nanze Yu Jiuzuo Huang 《Chinese Medical Sciences Journal》 CAS CSCD 2021年第4期295-306,共12页
Objective To study the reliability and validity of the Chinese version of the Lymphedema Quality of Life Questionnaire(LYMQOL)in lymphedema patients.Methods LYMQOL was translated into Chinese.The Chinese version of th... Objective To study the reliability and validity of the Chinese version of the Lymphedema Quality of Life Questionnaire(LYMQOL)in lymphedema patients.Methods LYMQOL was translated into Chinese.The Chinese version of the LYMQOL was distributed with the official Wechat account"Lymphedema Channel"to lymphedema patients who were recruited from October 28^(th),2020 to February 23^(rd),2021.Patients with upper limb lymphedema and lower limb lymphedema completed the LYMQOL-ARM subscale and the LYMQOL-LEG subscale separately,at enrollment,1 week later,and 1 month later.Reliability,validity,feasibility,responsiveness and average time required for completing the questionnaire were assessed.Results A total of 195 patients participated in the study.The Chinese questionnaire showed high reliability with Cronbach’sαcoefficients of 0.849-0.902 for the LYMQOL-ARM and intraclass correlation coefficient(ICC)of 0.848-0.884 and Cronbach’sαcoefficients of 0.726-0.902 for the LYMQOL-LEG and ICC of 0.863-0.900.The LYMQOL showed moderate to good correlations with the EQ-5 D(0.4<r<0.6,P<0.01;for the LYMQOLARM,n=95,for the LYMQOL-LEG,n=102).Responsiveness analysis suggested that quality of life of upper limb lymphedema patients decreased after 1 month(P<0.05).The average time of patients to finish the questionnaire was approximately 12 minutes.Conclusions The Chinese version of the LYMQOL is easy to answer,comprehensive and appropriate in length,and has good reliability and validity.It may be utilized to assist treatment decision-making and track changes in clinical setting or research for lymphedema. 展开更多
关键词 lymphedema quality of life questionnaire RELIABILITY validity
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Effect of Focused Cardiac Ultrasound in Combination with Lung Ultrasound on Critically Ill Patients: A Multicenter Observational Study in China 被引量:2
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作者 Hongmin Zhang Lina Zhang +9 位作者 Lixia Liu Ying Zhu Wanhong Yin Wei He Xiuling Shang Yangong Chao Liwen Lv Xiaoting Wang Dawei Liu 《Chinese Medical Sciences Journal》 CAS CSCD 2021年第4期257-264,共8页
Objective Focused cardiac ultrasound(FCU)and lung ultrasound(LU)are increasingly being used in critically ill patients.This study aimed to investigate the effect of FCU in combination with LU on these patients and to ... Objective Focused cardiac ultrasound(FCU)and lung ultrasound(LU)are increasingly being used in critically ill patients.This study aimed to investigate the effect of FCU in combination with LU on these patients and to determine if the timing of ultrasound examination was associated with treatment change.Methods This is a multicenter cross-sectional observational study.Consecutive patients admitted to the intensive care unit(ICU)were screened for enrollment.FCU and LU were performed within the first 24 h,and treatment change was proposed by the performer based on the ultrasound results and other clinical conditions.Results Among the 992 patients included,502 were examined within 6 h of ICU admission(early phase group),and 490 were examined after 6 h of admission(later phase group).The early phase group and the later phase group had similar proportions of treatment change(48.8%vs.49.0%,χ^(2)=0.003,P=0.956).In the multivariable analysis,admission for respiratory failure was an independent variable associated with treatment change,with an odds ratio(OR)of 2.357[95%confidence interval(CI):1.284-4.326,P=0.006];the timing of examination was not associated with treatment change(OR=0.725,95%CI:0.407-1.291,P=0.275).Conclusions FCU in combination with LU,whether performed during the early phase or later phase,had a significant impact on the treatment of critically ill patients.Patients with respiratory failure were more likely to experience treatment change after the ultrasound examination. 展开更多
关键词 cardiac ultrasound lung ultrasound critically ill POINT-OF-CARE
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External and Internal Validation of a Computer Assisted Diagnostic Model for Detecting Multi-Organ Mass Lesions in CT images 被引量:1
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作者 Lianyan Xu Ke Yan +4 位作者 Le Lu Weihong Zhang Xu Chen Xiaofei Huo Jingjing Lu 《Chinese Medical Sciences Journal》 CAS CSCD 2021年第3期210-217,共8页
Objective We developed a universal lesion detector(ULDor)which showed good performance in in-lab experiments.The study aims to evaluate the performance and its ability to generalize in clinical setting via both extern... Objective We developed a universal lesion detector(ULDor)which showed good performance in in-lab experiments.The study aims to evaluate the performance and its ability to generalize in clinical setting via both external and internal validation.Methods The ULDor system consists of a convolutional neural network(CNN)trained on around 80 K lesion annotations from about 12 K CT studies in the DeepLesion dataset and 5 other public organ-specific datasets.During the validation process,the test sets include two parts:the external validation dataset which was comprised of 164 sets of non-contrasted chest and upper abdomen CT scans from a comprehensive hospital,and the internal validation dataset which was comprised of 187 sets of low-dose helical CT scans from the National Lung Screening Trial(NLST).We ran the model on the two test sets to output lesion detection.Three board-certified radiologists read the CT scans and verified the detection results of ULDor.We used positive predictive value(PPV)and sensitivity to evaluate the performance of the model in detecting space-occupying lesions at all extra-pulmonary organs visualized on CT images,including liver,kidney,pancreas,adrenal,spleen,esophagus,thyroid,lymph nodes,body wall,thoracic spine,etc.Results In the external validation,the lesion-level PPV and sensitivity of the model were 57.9%and 67.0%,respectively.On average,the model detected 2.1 findings per set,and among them,0.9 were false positives.ULDor worked well for detecting liver lesions,with a PPV of 78.9%and a sensitivity of 92.7%,followed by kidney,with a PPV of 70.0%and a sensitivity of 58.3%.In internal validation with NLST test set,ULDor obtained a PPV of 75.3%and a sensitivity of 52.0%despite the relatively high noise level of soft tissue on images.Conclusions The performance tests of ULDor with the external real-world data have shown its high effectiveness in multiple-purposed detection for lesions in certain organs.With further optimisation and iterative upgrades,ULDor may be well suited for extensive application to external data. 展开更多
关键词 lesion detection computer-aided diagnosis convolutional neural network deep learning
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BAG3-Related Myofibrillar Myopathy Presenting as Hypercapnia:A Case Report and Literature Review
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作者 Yan Xu Shixuan Liu +7 位作者 Wenbing Xu Jinmei Luo Jingwen Niu Zhi Liu Jinming Gao Jinglan Wang Yi Dai Mengzhao Wang 《Chinese Medical Sciences Journal》 CAS CSCD 2021年第4期265-278,共14页
Objective BAG3-related myopathy is a rare condition so far reported in twenty patients worldwide.The purpose of this study was to draw attention to this rare disease and to the fact that BAG3-related myopathy should b... Objective BAG3-related myopathy is a rare condition so far reported in twenty patients worldwide.The purpose of this study was to draw attention to this rare disease and to the fact that BAG3-related myopathy should be considered as a rare differential diagnosis of hypercapnia.Methods We report a sporadic case of a 14-year-old Chinese girl with a de novo p.Pro209 Leu mutation in BAG3 and reviewed the literatures for reported cases related to this mutation.Results We described a 14-year-old Chinese girl who presented with gradually appearing symptoms of hypercapnia that required assisted ventilation.The muscle biopsy and the blood whole-exome sequencing results confirmed the diagnosis of myofibrillar myopathy with a de novo p.Pro209 Leu mutation in BAG3.Totally twentyone patients from twenty families with a confirmed diagnosis of BAG3-related myopathy were reported to date,including this patient and literature review.The male to female ratio was 11:10 and most showed initial symptoms in the first decade of life.Most patients presented toe/clumsy walking or running as the onset symptom,followed by muscle weakness or atrophy.Creatine kinase levels were elevated in fourteen patients and were normal in three.Eighteen patients developed respiratory insufficiency during the disease course and thirteen(one could not tolerate non-invasive assisted ventilation)required non-invasive assisted ventilation for treatment.Except for one not reported,heart involvement was found in seventeen patients during the disease course and seven underwent heart transplantation.Z-disk streaming and aggregation could be observed in most of the patients’muscle histology.In the long-term follow-up,five patients died of cardiac or respiratory failure.Conclusion BAG3-associated myopathy is a rare type of myofibrillar myopathy.It should be considered as a rare differential diagnosis of hypercapnia. 展开更多
关键词 myofibrillar myopathy BAG3 respiratory insufficiency HYPERCAPNIA
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Government Provides Vigorous Supports to the Improvement of Health Care in Qinghai Province,China
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作者 Yi Wang Airong Yang Quanren Su 《Chinese Medical Sciences Journal》 CAS CSCD 2021年第4期346-350,共5页
Qinghai province is located in the northeastern part of the Tibetan Plateau,and is an underdeveloped province of inland China.Chinese government gives high priority to the improvement of the wellbeing of Qinghai peopl... Qinghai province is located in the northeastern part of the Tibetan Plateau,and is an underdeveloped province of inland China.Chinese government gives high priority to the improvement of the wellbeing of Qinghai people,and have provided great supports in aspects of policy,funding,and professional resource to the development of health care and medical system in Qinghai.Great progress has been made,and wellness of residents in Qinghai has been significantly improved.This article reviews the strategies and measures from central and provincial government in improving health care of Qinghai province under the leadership of the Communist Party of China. 展开更多
关键词 QINGHAI healthcare system POLICY governmental support
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The Great Imitator:Atypical Cutaneous Manifestations of Primary Syphilitic Chancre
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作者 Huizi Gong Mengyin Wu +1 位作者 Jun Li Heyi Zheng 《Chinese Medical Sciences Journal》 CAS CSCD 2021年第4期279-283,共5页
Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease.Methods A case series of twenty-seven challenging primary syphilis p... Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease.Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study.The clinical data including the patients’age,sex,skin lesions,HIV status,syphilis serologic test results,treatment,and follow-up results were collected.Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed.Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget’s disease or eczema.The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum.Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed.Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre,at atypical locations,or with a nonreactive nontreponemal test result,tends to be missed or misdiagnosed. 展开更多
关键词 primary syphilis CHANCRE MISDIAGNOSIS
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