肺癌早期诊断的研究进展

大多数肺癌患者在确诊时已属中晚期,5年生存率极低,早期诊断是改善其预后和提高生存率的关键。目前常用的肺癌早期诊断方法包括影像学、内镜和分子生物学技术等。除传统的X线胸片、磁共振（Magnetic Resonance Imaging,MRI）、正电子发射断层显像（Positron Emission Tomography-Computed Tomography,PET-CT）等方法外,近年来逐步应用的高分辨CT（High-ResolutionComputed Tomography,HRCT）、低剂量CT（Low Dose Computed Tomography,LDCT）、自荧光纤维支气管镜（AutomaticFluorescence Bronchoscopy,AFB）、超声支气管内镜（Endo-Bronchial Ultra-Sound,EBUS）、荧光共聚焦显微镜支气管镜（FiberedConfocal Fluorescence Microscopy,FCFM）、细胞内镜（Endocytoscopy,EC）、电磁导航支气管镜（Electromagnetic NavigationBronchoscopy,ENB）、经支气管针吸活检术（Transbronchial Needle Aspiration,TBNA）、呼出气体分析和肿瘤标记物联合检测等,对于肺癌的早期诊断起到了重要作用,明显改善预后。本文就肺癌早期诊断的研究进展进行综述。     

血液或无菌体液培养阳性标本中病原菌检测结果分析

目的：了解血培养（包括血液、无菌体液培养,下同）阳性标本中病原菌的分布及阳性报警时间,为临床及时明确病原菌和正确用药提供参考依据。方法：无菌条件下采集血培养标本注人相应的培养瓶,经仪器扫描后放入血培养仪进行检测,报警后及时进行菌种鉴定和药敏试验。结果：364例阳性报警标本中真阳性标本为176例,其中革兰阳性菌占61．7％,革兰阴性菌占35．0％,真菌占3．3％;188例为假阳性标本,其中革兰阳性菌占54％,革兰阴性菌占41．9％,真菌占4．0％;新生儿科的感染阳性率最高;不同种类病原菌的阳性报警时间多重叠;临床医生经验用药正确或根据药敏结果更换用药的百分比为78．2％。结论：本院引起血液、无菌体液感染的病原菌以革兰阳性细菌为主,病原菌种类较多,存在一定的污染;当新生儿有局部感染时要警惕脓毒血症;单独靠血培养仪报警时间来鉴定区分病原菌与污染菌不一定可靠,及时了解血培养结果及标准药敏结果可以辅助找出感染性疾病的病因,尽早正确合理的使用抗菌药物,从而优化抗菌治疗。     

三维CT血管造影在颅内动脉瘤夹闭术后复查中的应用

目的:评价三维CT血管造影(3D-CTA)在颅内动脉瘤夹闭术后复查中的应用价值.方法:选取我院神经外科2010年8月至2012年1月间,共42例颅内动脉瘤夹闭术后患者(45个动脉瘤),分别于动脉瘤夹闭术后5-7天,5-6个月,12个月接受三维CT血管造影(3D-CTA)和数字减影血管造影(DSA)检查,以DSA为金标准,判断CTA对动脉瘤术后残留、血管闭塞狭窄等检出的灵敏度和特异度.结果:3D-CTA发现4例瘤颈残留,1例吻合血管闭塞,28例载瘤动脉通畅,6例术中阻断的载瘤动脉不显影,61个动脉瘤夹均可清晰辨识,与DSA结果一致.3D-CTA评价瘤颈残留与载瘤动脉、吻合血管通畅的灵敏度和特异度均为100％,一致性为1.0.结论:3D-CTA检查操作简便,结果真实可靠,临床应用价值极高,能够很好的显示动脉瘤夹闭术后改变,可作为颅内动脉瘤夹闭术后长期多次随访的主要方法.     

The Breivik case and what psychiatrists can learn from it

In the afternoon of July 22, 2011, Norwegian Anders Behring Breivik killed 77 persons, many of them children and youths, in two separate events. On August 24, 2012, he was sentenced to 21 years in prison. Breivik went through two forensic evaluations: the first concluded that he had a psychotic disorder, thus being legally unaccountable, whereas the second concluded that he had a personality disorder, thus being legally accountable. This article first describes Breivik's background and his crimes. This is followed by an overview of the two forensic evaluations, their methods, contents and disagreements, and how these issues were handled by the court in the verdict. Finally, the article focuses on some lessons psychiatrists can take from the case.     

Senescence evasion in melanoma progression: uncoupling of DNA‐damage signaling from p53 activation and p21 expression

The best‐established function of the melanoma‐suppressor p16 is mediation of cell senescence, a permanent arrest following cell proliferation or certain stresses. The importance of p16 in melanoma suggests indolence of the other major senescence pathway through p53. Little or no p53 is expressed in senescent normal human melanocytes, but p16‐deficient melanocytes can undergo p53‐mediated senescence. As p16 expression occurs in nevi but falls with progression toward melanoma, we here investigated whether p53‐dependent senescence occurs at some stage and, if not, what defects were detectable in this pathway, using immunohistochemistry. Phosphorylated checkpoint kinase 2 (CHEK2) can mediate DNA‐damage signaling, and under some conditions senescence, by phosphorylating and activating p53. Remarkably, we detected no prevalent p53‐mediated senescence in any of six classes of lesions. Two separate defects in p53 signaling appeared common: in nevi, lack of p53 phosphorylation by activated CHEK2, and in melanomas, defective p21 upregulation by p53 even when phosphorylated.     

Perfectly registered multiphoton and reflectance confocal video rate imaging of in vivo human skin

We present a multimodal in vivo skin imaging instrument that is capable of simultaneously acquiring multiphoton and reflectance confocal images at up to 27 frames per second with 256 × 256 pixel resolution without the use of exogenous contrast agents. A single femtosecond laser excitation source is used for all channels ensuring perfect image registration between the two‐photon fluorescence (TPF), second harmonic generation (SHG), and reflectance confocal microscopy (RCM) images. Images and videos acquired with the system show that the three imaging channels provide complementary information in in vivo human skin measurements. In the epidermis, cell boundaries are clearly seen in the RCM channel, while cytoplasm is better seen in the TPF imaging channel, whereas in the dermis, SHG and TPF channels show collagen bundles and elastin fibers, respectively. The demonstrated fast imaging speed and multimodal imaging capabilities of this MPM/RCM instrument are essential features for future clinical application of this technique. (© 2013 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

宝石能谱CT 冠脉成像在隐匿型冠心病冠状动脉粥样斑块性质判断中的价值

目的:探讨宝石能谱CT冠脉成像在隐匿型冠心病冠状动脉粥样斑块性质判断中的价值,为临床隐匿型冠心病的诊断和治疗提供影像学参考依据。方法:选择2014年6月~2015年6月在我院诊断为心肌缺血且无临床症状的隐匿型冠心病患者共360例,所有入选患者均行宝石能谱CT冠脉成像检查,其中155例有冠状动脉狭窄,且伴有不同性质的粥样斑块。分析冠状动脉不同血管狭窄情况、斑块分型和斑块数目。结果:所有冠脉动脉狭窄均为轻度狭窄和中度狭窄,主要集中在左主干和左前降支,分别占35.48%和37.42%。硬斑块数目最多,占75.43%,其次为混合斑块和软斑块,分别占16.19%和8.38%。冠状动脉4支血管粥样斑块均为硬斑块者最多(29.03%)、硬斑块与软斑块同时存在者占29.03%、硬斑块与软斑块、混合斑块同时存在者占14.84%,未见单纯混合斑块或软斑块的患者。结论:隐匿型冠心病患者冠状动脉狭窄主要为轻、中度狭窄,冠状动脉斑块以硬斑块为主。宝石能谱CT冠脉成像能准确的判断隐匿型冠心病冠状动脉粥样斑块性质,值得临床推广借鉴。     

LBL结合PBL在物理诊断教学过程中的初步探索

目的:比较传统教学模式和问题教学法及二者结合教学法的不同优劣势,找出物理诊断学最佳教学方法。传统教学模式采用授课为主的教学法(lecture based learning,LBL),单单强调了教师的重要性,而忽视学生的主观能动性,不利于调动和培养学生自学和灵活运用所学知识的能力。问题教学法(Problem-based learning,PBL),其强调学生自身的主观能动性,弱化了教师在教学中的主体地位,学生有偏离教学主线的风险。因而如果将LBL与PBL有机结合在一起,将可能有利于提高学生的学习效率和学习效果。方法:选取97名全科医学本科学员,在物理诊断课程教学过程中,采用完全随机的方法分为2组,采用LBL教学方法组48人,采用LBL结合PBL教学方法组49人,通过分别对理论、实践分层打分,确定优秀、合格、不合格的比率,采用Mann-Whitney U检验最终评定2组教学方法的授课效果。结果:在理论考试中,2组学员在优秀、合格、不合格的分层评定上均无明显差异(P0.05),而在实践考核中,LBL+PBL组学员成绩在优秀这一分层评定中,优于LBL组,差异具有统计学意义(P0.05)。结论:LBL和PBL教学方法结合应用于物理诊断教学中,符合物理诊断教学的特点,更容易被学生接受,对于知识的识记和应用更有好处,从而更利于培养高素质医学人才,值得在物理诊断教学中进一步推广。     

能谱CT在去除腰椎术后金属伪影中的应用进展

多层计算机断层扫描(Multi-slice computed tomography,MSCT)具有时间及空间分辨率高的特点已经被广泛应用于脊柱术后评价,然而,因为术中植入金属植入物,CT图像由于其成像原理的限制,其图像质量受到金属植入物的严重影响,金属伪影大多来源于量子噪声、散射线和射束硬化效应,降低图像的对比度,使细微解剖结构显示不清,从而使得感兴趣区域的检测能力降低,其图像质量明显下降,甚至使临床医师做出错误的诊断,因此,为了做出更准确的腰椎术后并发症诊断和术后评估,使金属伪影最小化成为关键。能谱CT及其扫描及重建技术可以有效的去除腰椎术后产生的金属伪影,改善图像质量,本文能谱CT在腰椎术后金属伪影去除方面的应用进行综述。