Avoiding misdiagnosis of multilocular thymic cysts as malignant tumors on computer tomography

This editorial provides insights from a case report by Sun et al published in the World Journal of Clinical Cases.The case report focuses on a case where a multilocular thymic cyst(MTC)was misdiagnosed as a thymic tumor,resulting in an unnecessary surgical procedure.Both MTCs and thymic tumors are rare conditions that heavily rely on radiological imaging for accurate diagnosis.However,the similarity in their imaging presentations can lead to misinterpretation,resulting in unnecessary surgical procedures.Due to the ongoing lack of comprehensive knowledge about MTCs and thymic tumors,we offer a summary of diagnostic techniques documented in recent literature and examine potential causes of misdiagnosis.When computer tomography(CT)values surpass 20 Hounsfield units and display comparable morphology,there is a risk of misdiagnosing MTCs as thymic tumors.Employing various differential diagnostic methods like biopsy,molecular biology,multi-slice CT,CT functional imaging,positron emission tomography/CT molecular functional imaging,magnetic resonance imaging and radiomics,proves advantageous in reducing clinical misdiagnosis.A deeper understanding of these conditions requires increased attention and exploration by healthcare providers.Moreover,the continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.

Multi-scale Modeling and Finite Element Analyses of Thermal Conductivity of 3D C/SiC Composites Fabricating by Flexible-Oriented Woven Process

Thermal conductivity is one of the most significant criterion of three-dimensional carbon fiber-reinforced SiC matrix composites(3D C/SiC).Represent volume element(RVE)models of microscale,void/matrix and mesoscale proposed in this work are used to simulate the thermal conductivity behaviors of the 3D C/SiC composites.An entirely new process is introduced to weave the preform with three-dimensional orthogonal architecture.The 3D steady-state analysis step is created for assessing the thermal conductivity behaviors of the composites by applying periodic temperature boundary conditions.Three RVE models of cuboid,hexagonal and fiber random distribution are respectively developed to comparatively study the influence of fiber package pattern on the thermal conductivities at the microscale.Besides,the effect of void morphology on the thermal conductivity of the matrix is analyzed by the void/matrix models.The prediction results at the mesoscale correspond closely to the experimental values.The effect of the porosities and fiber volume fractions on the thermal conductivities is also taken into consideration.The multi-scale models mentioned in this paper can be used to predict the thermal conductivity behaviors of other composites with complex structures.

Design,preparation,application of advanced array structured materials and their action mechanism analyses for high performance lithium-sulfur batteries

Lithium-sulfur battery(LSB)has brought much attention and concern because of high theoretical specific capacity and energy density as one of main competitors for next-generation energy storage systems.The widely commercial application and development of LSB is mainly hindered by serious“shuttle effect”of lithium polysulfides(Li PSs),slow reaction kinetics,notorious lithium dendrites,etc.In various structures of LSB materials,array structured materials,possessing the composition of ordered micro units with the same or similar characteristics of each unit,present excellent application potential for various secondary cells due to some merits such as immobilization of active substances,high specific surface area,appropriate pore sizes,easy modification of functional material surface,accommodated huge volume change,enough facilitated transportation for electrons/lithium ions,and special functional groups strongly adsorbing Li PSs.Thus many novel array structured materials are applied to battery for tackling thorny problems mentioned above.In this review,recent progresses and developments on array structured materials applied in LSBs including preparation ways,collaborative structural designs based on array structures,and action mechanism analyses in improving electrochemical performance and safety are summarized.Meanwhile,we also have detailed discussion for array structured materials in LSBs and constructed the structure-function relationships between array structured materials and battery performances.Lastly,some directions and prospects about preparation ways,functional modifications,and practical applications of array structured materials in LSBs are generalized.We hope the review can attract more researchers'attention and bring more studying on array structured materials for other secondary batteries including LSB.

Misdiagnosis of Sexually Transmitted Diseases in Hong Kong Outpatient Private Healthcare

Background and objective: Early and accurate diagnosis is one of the critical requirements for successful management of all diseases. Yet, delayed diagnosis and misdiagnosis remain as vital problems, consequently impose adverse effects on patient treatment. Sexually transmitted disease (STD) is one of the most common infectious diseases, and more than one million of STD cases are acquired every day globally. Misdiagnosis of STD inevitably exists, therefore should not be overlooked. Being a medical diagnostic laboratory providing various STDs diagnosing service in Hong Kong, we aimed to determine the misdiagnosis rate of STDs and investigate the possible underlying cause. Methods: Specimens were collected for STD diagnosis from multiple clinics during 1 June 2021 to 20 October 2021 from different clinics and hospitals were included in the study. DNA extraction was performed using magnetic bead based method;then the extracted DNA was tested using the DiagCor GenoFlowTM STD Array kit to detect the existence of any targeted pathogens. Results: 1459 specimens were collected and included during the designated time period, with 643 specimens found to be positive with at least one targeted STD pathogen. 494 of these were found to be aligned with test ordered by physicians, and the remaining 149 positive cases had at least one pathogen detected but not requested to be tested by the physicians resulting in misdiagnosis. The overall misdiagnosis rate was determined to be 23.2% (149/643), with high frequency of misdiagnosis occurred to tests ordered for one to three pathogens detection. Also, Ureaplasma urealyticum and/or Ureaplasma parvum (UU/UP) was the commonest pathogen detected in this study. Conclusion: The findings suggested incorrect test selection made by physicians was one of the major reasons of STDs misdiagnosis in outpatient settings. To reduce diagnostic errors in STD diagnosis, physicians are encouraged to select and request test that allow detection of multiple pathogens, as co-infection of multiple pathogens in STD patients is commonly observed. The correct selection of test would not only benefit the patient, but also the public health.

The need to develop tailored tools for improving the quality of thematic bibliometric analyses: Evidence from papers published in Sustainability and Scientometrics

Purpose: The aim of this article is to explore up to seven parameters related to the methodological quality and reproducibility of thematic bibliometric research published in the two most productive journals in bibliometrics, Sustainability(a journal outside the discipline) and Scientometrics, the flagship journal in the field.Design/methodology/approach: The study identifies the need for developing tailored tools for improving the quality of thematic bibliometric analyses, and presents a framework that can guide the development of such tools. A total of 508 papers are analysed, 77% of Sustainability, and 23% published in Scientometrics, for the 2019-2021 period.Findings: An average of 2.6 shortcomings per paper was found for the whole sample, with an almost identical number of flaws in both journals. Sustainability has more flaws than Scientometrics in four of the seven parameters studied, while Scientometrics has more shortcomings in the remaining three variables.Research limitations: The first limitation of this work is that it is a study of two scientific journals, so the results cannot be directly extrapolated to the set of thematic bibliometric analyses published in journals from all fields.Practical implications: We propose the adoption of protocols, guidelines, and other similar tools, adapted to bibliometric practice, which could increase the thoroughness, transparency, and reproducibility of this type of research.Originality/value: These results show considerable room for improvement in terms of the adequate use and breakdown of methodological procedures in thematic bibliometric research, both in journals in the Information Science area and journals outside the discipline.

Mechanical stress and deformation analyses of pressurized cylindrical shells based on a higher-order modeling

In this research,mechanical stress,static strain and deformation analyses of a cylindrical pressure vessel subjected to mechanical loads are presented.The kinematic relations are developed based on higherorder sinusoidal shear deformation theory.Thickness stretching formulation is accounted for more accurate analysis.The total transverse deflection is divided into bending,shear and thickness stretching parts in which the third term is responsible for change of deflection along the thickness direction.The axisymmetric formulations are derived through principle of virtual work.A parametric study is presented to investigate variation of stress and strain components along the thickness and longitudinal directions.To explore effect of thickness stretching model on the static results,a comparison between the present results with the available results of literature is presented.As an important output,effect of micro-scale parameter is studied on the static stress and strain distribution.

手指鲍恩病误诊3例

报告3例手指鲍恩病。例1.患者男,80岁。右手无名指红斑、丘疹及脱屑2余年,疼痛2个月,误诊为乳房外Paget病。例2.患者男,88岁。左手中指红斑、斑块及糜烂10余年,误诊为基底细胞癌。例3.患者男,37岁。右手示指红斑、斑块、糜烂伴瘙痒2年,误诊为湿疹。3例患者皮损组织病理检查均表现为表皮角化过度伴角化不全,表皮全层细胞极性紊乱,可见核大深染的细胞,病理性核分裂象增多;真皮浅层可见不等量淋巴细胞及组织细胞浸润。3例患者均诊断为手指鲍恩病。

急诊猝死相关疑难病诊治的新近认识

本文介绍11种急诊猝死相关的疑难疾病,有心脏震荡、胸腺淋巴体质、青壮年猝死综合征、小心脏综合征、浅水昏迷、小麦依赖运动诱发的严重过敏反应、Kounis综合征、双相过敏反应、血液净化过滤器过敏、McKittrick-Wheelock综合征和Mendelson综合征等。急诊临床医师应认识这些比较疑难、实际上并不少见的疾病,以提高急诊临床诊治水平,最大限度地避免误诊误治。

误诊为炎性脊髓病的硬脊膜动静脉瘘临床分析

目的 探讨硬脊膜动静脉瘘(SDAVF)的临床表现、影像学特点、诊治方法和误诊原因、防范措施。方法 对2016年3月-2018年3月收治的被误诊为炎性脊髓病的SDAVF 2例的临床资料进行回顾性分析。结果 2例分别因渐进性双下肢麻木、力弱伴尿便障碍5月余,以及行走不稳50 d、加重伴颈痛、呕吐45 d入院。均误诊为炎性脊髓病,误诊时间分别为5月余及50 d。后经仔细阅片发现磁共振影像上可见髓周流空信号影,完善脊髓血管造影后确诊为SDAVF。1例于等待院外介入治疗过程中死亡,1例行介入治疗后院外死亡。结论 SDAVF临床表现不典型,易误诊,仔细询问病史、查体,认真阅影像片,必要时行脊髓血管造影是避免该病误诊的关键。

前列腺癌多参数MRI诊断及误诊原因分析

目的 探讨前列腺癌临床特点、多参数MRI表现,总结其误诊原因及防范措施。方法 对2020年4月—2022年2月收治的多参数MRI检查后误诊为膀胱癌、前列腺增生的前列腺癌10例的临床资料进行回顾性分析。结果 10例年龄54~73岁。6例因尿急、尿频、尿潴留、排尿困难就诊,直肠指诊示前列腺肥大,查血清前列腺特异性抗原升高,多参数MRI及前列腺穿刺活组织病理检查未发现前列腺肿瘤证据,误诊为前列腺增生,后经术后病理检查确诊T1期前列腺癌。4例以尿痛、血尿、排尿困难就诊,经多参数MRI检查误诊为膀胱癌,查血清前列腺特异性抗原升高,直肠指诊发现前列腺肥大,再次行多参数MRI和前列腺组织穿刺活组织病理检查证实为前列腺癌累及膀胱。误诊时间4~10 d。误诊为前列腺增生6例接受根治性手术,误诊为膀胱癌4例予内分泌和放射治疗,随访至今病情控制尚可。结论 临床接诊以尿急、尿频、尿潴留、排尿困难等症状就诊的中老年男性患者时应考虑到前列腺癌可能。加强对前列腺癌影像学特征认识,行多参数MRI检查时重点观察前列腺结构、包膜完整与否、膀胱壁连续性等重要特征,必要时可行前列腺穿刺活组织病理检查,以提高该病术前诊断正确率。

化学链氧解耦燃煤发电系统过程模拟

当前煤的化学链燃烧中煤主要通过以下3步进行转化:煤的热解、煤焦的气化以及煤热解和气化产物与氧载体的反应。由于煤焦的气化反应速率较低,燃烧转化全过程受限于较慢速的煤焦气化过程,导致燃烧效率和CO_(2)捕集效率的下降。化学链氧解耦燃烧采用具有吸释氧能力的氧载体,煤焦可以与氧载体释放的气态氧直接反应而转化,避免较慢速的煤焦气化过程,显著提高燃料的转化速率。运用Aspen Plus软件构建了以CuO/Cu_(2)O为氧载体的600 MW化学链氧解耦燃煤发电系统。基于系统仿真结果,分别进行了能量、[火用]和[火用]成本分析。结果表明:化学链氧解耦燃煤发电系统的净热效率为37.66%;系统中内部[火用]损失最大的组件为燃烧反应器,占子系统总内部[火用]损失的44.23%。仅以发电量为产品时,化学链氧解耦燃煤发电系统的[火用]效率为36.27%;如果将高浓度CO_(2)也作为产品,系统的[火用]效率为40.47%;化学链氧解耦燃煤发电系统中单位[火用]成本最大的组件为第7台给水加热器,其次为第5个低压汽轮机、凝汽器、第1个高压汽轮机和空气预热器。

基于多维度分析的浙江共同富裕示范区建设政策文本研究

分析浙江省共同富裕示范区建设的政策文本,揭示其推进工作的目标、路径、手段和措施,以期从顶层设计视角为其他区域推动共同富裕提供有益借鉴。基于政策工具、政策目标、政策主题以及交叉分析等多个维度,分析22份从不同层面推进浙江省共同富裕示范区建设的政策文本内容,深入剖析政策文本的特点与存在的问题。结果表明:(1)从政策工具的使用情况来看,环境型政策工具占比最大,供给型政策工具占比居中,需求型政策工具占比最小,且各大类政策工具内部结构存在差异;(2)从政策的发展目标来看,实施有效占主导地位,共建共享和产业兴旺次之,而风险防范、绿色发展和文化兴盛则占比最低;(3)从政策主题的内容来看,与项目政策推进、实施、共同建设以及文化发扬相关的主题词频次较高,频次居中的是旅游、乡村、共同富裕和示范等,而频次较低的则是全面、协同、数字和管理等;(4)从政策工具—政策目标的交叉对比结果来看,实施有效和共建共享是共同富裕示范区建设最本质的目标,与之对应的政策工具(具体类别)的频次也处于较高的位置,且对政策目标有着相对集中的支持力度;政策目标—政策主题的交叉分析证实,政策主题更倾向于实施有效这一政策目标。为此,要通过补充政策工具短板内容,加大对风险防范的政策工具支撑,提高政策的聚集度,增强政策工具、政策目标与政策主题的匹配度,扩大政策工具支持范围等途径,促进政策文件更好地支撑共同富裕示范区建设。

子宫假性动脉瘤误诊分析

目的 探讨子宫假性动脉瘤(uterine artery pseudoaneurysm, UAP)超声特征并分析误诊原因。方法 回顾性选取2016年1月至2023年4月首都医科大学附属北京妇产医院UAP患者35例,收集其超声图像及临床资料,分析其误诊原因。结果 UAP灰阶超声呈肌层或同时累及宫腔及肌层的含有液性无回声区团块状病变,彩色多普勒超声可见一条或多条载瘤动脉血流射入假腔,频谱多普勒超声呈高速低阻血流;部分可伴发动静脉瘘(uterine arteriovenous fistula,UAVF),表现为与子宫静脉同方向的粗大血流,频谱呈与心动周期一致的搏动性频谱。UAP误诊率为71.4%(25/35),被误诊的疾病包括与滋养细胞相关疾病的富血供征象(12例)、UAVF(9例)、滋养细胞疾病(3例)、胚物残留(1例)。结论减少UAP误诊首先需提高对该病的认识,超声检查过程中要注意调节仪器的条件设置以获得更佳图像帮助诊断。

蕈样肉芽肿误诊为寻常型银屑病临床分析

目的探讨蕈样肉芽肿的临床特点及误诊为银屑病原因、防范措施。方法对误诊40年蕈样肉芽肿1例的临床资料进行回顾性分析,并复习相关文献。结果患者主因全身红斑鳞屑40年,躯干红色丘疹伴瘙痒4年就诊。40年前双下肢出现皮疹,逐渐增大为斑块,长期诊断为银屑病,治疗效果差。4年前躯干出现粟粒样丘疹伴瘙痒,外院经病理检查考虑蕈样肉芽肿,后因皮疹反复,更换部位病理检查再次诊断为寻常型银屑病,对症治疗效果差。入院后完善相关检查,明确诊断为蕈样肉芽肿(ⅣB期),调整治疗方案,目前病情稳定。结论蕈样肉芽肿早期临床及病理表现不典型,易误诊。对于非典型的或常规治疗无反应的银屑病患者,特别是在开始使用免疫抑制剂之前,建议进行组织病理及其他特异性检查以明确诊断并排除蕈样肉芽肿,降低误诊率,改善患者预后。

不典型急性心肌梗死心电图误诊分析

目的探讨不典型急性心肌梗死(AMI)早期心电图误诊原因及防范措施。方法回顾分析2022年1月—2023年2月收治的曾误诊的不典型AMI 2例的临床资料。结果1例因发热、胸闷、心悸、咳嗽和全身乏力1 d就诊,心电图检查示Ⅱ、Ⅲ、aVF导联ST段压低,T波低平,窦性心律不齐,误诊为心肌炎,予对症治疗无好转,复查心电图及心肌酶等后诊断为AMI。1例因胸痛、晕厥倒地2 h入院,心电图无ST-T及异常Q波改变,提示右心室肥大,诊断为右心室肥大,后经心肌酶、心脏超声及冠状动脉造影检查明确诊断AMI。误诊时间3 d和6 h。1例行药物保守治疗,1例行经皮冠状动脉介入术治疗,随访均预后良好。结论不典型AMI患者或因无明显胸痛症状,或因早期心电图表现不典型或正常,导致初期极易误诊。加强对不典型AMI认识,对伴有高危因素者提高警惕性,熟知其心电图动态变化特点,注重动态心电图监测,并结合临床症状及心肌酶情况综合分析病情,有助于早期确诊并治疗。

妊娠期宫颈癌临床误诊分析

目的探讨妊娠期宫颈癌临床误诊的原因及防范措施。方法回顾性分析2020年1月—2021年12月收治的曾有误诊经过的妊娠期宫颈癌3例临床资料。结果3例均因妊娠期阴道出血、腹痛或阴道分泌物异常就诊。1例考虑为先兆早产,剖宫产术后行MRI检查发现宫颈明显不规则增厚伴异常信号,经增厚组织病理检查确诊为宫颈低分化鳞状细胞癌(鳞癌);1例考虑为先兆流产,妇科检查发现宫颈有一赘生物,经宫颈活检确诊为宫颈中分化鳞癌;1例考虑为前置胎盘,剖宫产术后宫颈内口触及胎盘样组织,腹部超声示宫颈与宫体结合部占位性病变,病理活检示宫颈鳞癌。误诊时间2 d~4个月。3例确诊后予宫颈癌根治术联合术后放疗,随访半年情况良好。结论妊娠期宫颈癌临床少见,临床对以妊娠期出现不规则阴道出血、腹痛及分泌物异常增多就诊者提高警惕,以减少误诊。

误诊为毛母细胞瘤的结节型黑色素瘤一例

本文报道一例误诊为毛母细胞瘤的结节型黑色素瘤。患者,女,53岁。头皮孤立的半球形肤色质硬结节2年,临床诊断为毛母细胞瘤。经组织病理及免疫组化检查,最终诊断为结节型黑色素瘤。

“双减”背景下河北省中小学生焦虑抑郁症状现状

目的:调查“双减”背景下河北省中小学生焦虑抑郁症状的影响因素、关键症状及容易导致共病的症状,为制定中小学生焦虑抑郁症状预防与干预工作提供参考依据。方法:使用一般资料调查表、抑郁症状群量表(PHQ-9)、广泛性焦虑量表(GAD-7)对河北省6个地区48所的4413名中小学进行问卷调查。结果:中小学生焦虑和抑郁症状检出率分别为13.7%、10.4%,共病检出率为6.3%。二元Logistic回归结果显示,焦虑和抑郁症状的共同危险因素为女生、住宿、感到学习压力大、受过欺凌和睡不着觉(P<0.05),其中焦虑症状的危险因素为初中和独生子女(P<0.01),抑郁症状的危险因素为城镇、双亲家庭、每日上网时间>2小时和对学校感到不适应(P<0.05)。网络结构中预期影响较高的症状为GAD4“很难放松”(Z=1.09)、PHQ6“感觉自己糟糕或让其他人失望”(Z=1.06)、PHQ1“兴趣下降”(Z=1.05);桥梁预期影响较高的3个症状分别为PHQ9“存在消极观念”(Z=0.54)、PHQ1“兴趣下降”(Z=0.53)、GAD7“害怕将有可怕的事发生”(Z=0.46)。结论:“双减”背景下河北省焦虑和抑郁症状的检出率较低,但仍有待进一步降低。二者共同危险因素为女生、住宿、感到学习压力大、受过欺凌和睡不着觉,其中焦虑症状的危险因素为初中和独生子女,抑郁症状的危险因素城镇、双亲家庭、每日上网时间>2小时和对学校感到不适应。焦虑抑郁症状网络中的关键症状为GAD4、PHQ6、PHQ1,传递风险较高的桥梁症状为PHQ9、PHQ1、GAD7。

存在肺外表现的成人肺炎支原体肺炎临床特征及误诊分析

目的分析存在肺外表现的成人肺炎支原体肺炎(AMP)患者的临床特征及误诊情况。方法回顾性分析2022年1月至2023年6月经肺炎支原体DNA检测阳性的AMP 60例临床资料,根据是否存在肺外表现分为无肺外表现组(n=29)和存在肺外表现组(n=31)。比较2组凝血功能、生化指标、院外病程、住院时间、误诊占比、误诊时间。结果60例AMP中存在肺外表现31例(51.67%),常见肺外表现有乏力18例(30.00%),关节肌肉痛16例(26.67%),头痛、纳差、腹泻各7例(11.67%),嗜睡4例(6.67%),皮疹3例(5.00%),恶心2例(3.33%),腰痛、黑便各1例(1.67%)。存在肺外表现组C反应蛋白、天冬氨酸转氨酶、乳酸脱氢酶、α-羟丁酸脱氢酶、纤维蛋白原水平均高于无肺外表现组(P<0.05)。存在肺外表现组住院时间以及误诊时间均长于无肺外表现组(P<0.05)。2组院外病程比较差异无统计学意义(P>0.05)。存在肺外表现组误诊占比高于无肺外表现组(P<0.05)。结论AMP存在较高的肺外表现发生率。存在肺外表现的AMP炎症反应程度更高,住院时间更长,误诊占比更高,临床应注意对这部分人群生化指标、凝血功能的监测,及时发现病情变化,避免误诊漏诊发生,延误治疗。

甲状腺癌冰冻切片病理不能明确诊断的临床因素分析

目的探讨术中冰冻切片(frozen section,FS)病理检查不能明确诊断甲状腺癌的发生情况,探寻影响FS病理检查准确率的临床因素。方法回顾性分析2016年8月至2019年12月在北京市大兴区人民医院行手术治疗的甲状腺癌患者。根据FS与石蜡切片病理检查结果,将目标结节分为FS明确诊断组与不能明确诊断组(包括延迟诊断组、误诊断组、意外诊断组)。比较FS明确诊断组与不能明确诊断组之间患者的一般情况、实验室检查、彩超、病理类型。结果共纳入癌结节336个,其中明确诊断组、延迟诊断组、误诊断组、意外诊断组癌结节数量及占比分别为266个(79.17%)、28个(8.33%)、21个(6.25%)、21个(6.25%)。延迟诊断组中,“不除外”甲状腺癌使用频率最高。与明确诊断组相比,延迟诊断组、误诊断组、意外诊断组癌结节最大径均更小(P<0.05);延迟诊断组纵横比>1的比例更多(P=0.017)、微钙化比例更低(P=0.002);误诊断组甲状腺过氧化物酶抗体水平更高(P=0.002)。结论临床医生应熟悉延迟诊断、误诊断常用的诊断用语。在治疗决策时应充分考虑难以明确诊断的可能,尤其是较小结节、合并慢性淋巴细胞性甲状腺炎患者。