立足微检技术 强化医检生“岗前训练”

本文通过对聊城卫校235名结束实习返校同学的调查,阐述了"岗前训练"的必要性,并就如何进行"岗前训练"的具体措施作了初步探讨.

Patient and physician perception of natural orifice transluminal endoscopic appendectomy

AIM:To investigate perception of natural orifice transluminal endoscopic surgery(NOTES)as a potential technique for appendectomy.METHODS:One hundred patients undergoing endoscopy and 100 physicians were given a questionnaire describing in detail the techniques of NOTES and laparoscopic appendectomy.They were asked about the reasons for their preference,choice of orifice,and extent of complication risk they were willing to accept.RESULTS:Fifty patients(50%)and only 21 physicians(21%)preferred NOTES(P<0.001).Patients had previously heard of NOTES less frequently(7%vs73%,P<0.001)and had undergone endoscopy more frequently(88%vs 36%,P<0.001)than physicians.Absence of hernia was the most common reason for NOTES preference in physicians(80%vs 44%,P= 0.003),whereas reduced pain was the most common reason in patients(66%vs 52%).Physicians were more likely to refuse NOTES as a novel and unsure technique(P<0.001)and having an increased risk of infection(P<0.001).The preferred access site in both groups was colon followed by stomach,with vagina being rarely preferred.In multivariable modeling,those with high-school education[odds ratio(OR):2.68,95% confidence interval(CI):1.23-5.83]and prior colonoscopy(OR:2.10,95%CI:1.05-4.19)were more likely to prefer NOTES over laparoscopic appendectomy.There was a steep decline in NOTES preference with increased rate of procedural complications.Male patients were more likely to consent to their wives vaginal NOTES appendectomy than male physicians(P=0.02).CONCLUSION:The preference of NOTES for appendectomy was greater in patients than physicians and was related to reduced pain and absence of hernia rather than lack of scarring.

Endoscopic Classification of Esophagic Eosinophilia

Introduction： EoE （eosinophilic esophagitis） is an inflammatory condition characterized by a dense eosinophilic infiltrate in the esophageal epithelium. In Brazil, it remains a poorly diagnosed disease due to the lack of interaction between the clinician, the endoscopist, and the pathologist. The diagnosis is performed by histological study of esophageal biopsies, with at least fifteen eosinophils per high-power field （EOS/HPF）. Some doubts remain with respect to patients with a clinical picture and symptoms compatible with the disease （EoE）, but who have a lower number of eosinophils than established. The main objective of this study was to create an endoscopic classification for EsEo （esophageal eosinophilia）, which pointed the way to the endoscopist towards the diagnosis. Methods： This study was a prospective, two-year study, at a gastrointestinal endoscopy center where all patients with endoscopic symptoms and/or endoscopic findings suggestive of EsEo were biopsied for histological examination of EOS/HPF. After the study and compilation of the results, a retrospective study was performed, based on a review of electronic medical records, where the same diagnosis was searched, although at a period when this classification was not adopted. Results： A total of 4,251 endoscopies were performed between September 2011 and September 2013. Two biopsies were performed, aimed at lesions, in 133 patients with clinical picture or imaging suggestive of EsEo. Eosinophils were found in 55 patients, corresponding to an incidence of 1.29% of the total population studied and 41.35% of the suspected cases of the disease. EoE was diagnosed in 24 patients during the period of this study. In the two-year retrospective study, only two cases of EoE were found. Conclusions： The results of this study demonstrate that the endoscopic standardization of esophageal lesions, suggestive of eosinophilia, in this case by classification, alerts the endoscopist for the diagnosis of EoE, prompting him to perform targeted biopsies. Further, it was observed that two samples of esophageal tissue were sufficient for the diagnosis. The relationship between the clinical picture, endoscopy, and histology was not evident in this study.

Trends in Glaucoma Disability in Ukraine

The article represents the glaucoma disability rates in Ukraine and touches upon medical and social aspects of the problem We have screened a data from source medical documents and analyzed the MSEK （Physical Disability Board of Review） statistical reporting data, further used as a basis for calculation of live indices of general and primary disabilities caused by eye diseases, including the ones caused by primary open-angle glaucoma （7.05% and 9.99%, respectively）, the extensive distribution indices of disability by gender （75.74% male）, age （59.29% of II maturity patients）, and a disability group （56% of patients recognized disabled persons of groups I and II）. Our findings indicate a lack of modern science-based approaches to diagnosis, rehabilitation, and socio-medical examination of patients with ophthalmologic pathologies, thus requiring deeper study of this problem.

Submicroscopic Plasmodial Infection May Lead to Severe Malaria in Children

Malaria is one of the leading causes of consultation in African pediatric hospitals. In Gabon, malaria transmission is perennial. Plasmodium falciparum, responsible for the most severe form of the disease, represents more than 95% of all species. In P. falciparum infection, the hyperparasitemia accounts among the main criteria of disease severity. However, in many endemic countries, a significant decrease of malaria burden accompanying with the diminution of parasite load in infected individuals has been demonstrated. The objective of the study was to analyze the occurrence of febrile syndrome in childhood and investigate whether the acute febrile illness could be associated with P. falciparum submicroscopic infection. A cross-sectional study was carried out during January to March 2013 in Franceville. A total of 203 acute febrile children were enrolled. A clinical examination and biomedical analysis including parasitological diagnosis by microscope were carried out in all the patients and PCR on microscope negative ones. Of 203 children recruited for febrile syndrome, 111 have been diagnosed positive for P. falciparum infection, 73 （35.9%） by microscope （ME） and 38 （18.71%） by PCR （submicroscopic infection = SM1） with an overall prevalence of 54.68%. Of the 11 1 P. falciparum infected individuals and according to the WHO criteria, 35 （31.53%） children showed a clinical picture of severe malaria against 76 （68.47%） others classified as uncomplicated malaria. The overall prevalence rates were therefore estimated as 17.24 （35/203） for severe cases and 37.43% （76/203） for uncomplicated ones. Clinically, these severe malaria cases （27 ME＋ and 8 PCR＋） were mainly composed of 85.71% of anaemic patients （30/35）, 71.14% of prostrated individuals （25/35） and 57.14% of children with clinical icterus （20/35）. However, only two cases of severe anaemia were observed, the remaining others cases were moderate （10） and mild anaemia （18）. More interestingly, eight submicroscopic infected patients （22.85%） were found with neurological manifestations （prostration） and all were experiencing thrombocytopenia. Lastly, 1 hyperparasitemia, 6 hypoglycemia and 2 respiratory distresses were also observed among these severe malaria cases. P. falciparum submicroscopic infection may lead to severe malaria in perennial transmission area.

Pharmaceuticalization and Biomedicalization： An Examination of Problems Relating to Depression in Japan

The growing number of people suffering from depression has become a social problem in Japan. The problems associated with depression in Japan have been influenced by the pharmaceuticalization of mental health. Since selective serotonin reuptake inhibitors were introduced to Japan＇s pharmaceutical market in 1999, demand for anti-depressant medications has rapidly expanded. It seems likely then that the efforts of pharmaceutical companies, as part of their marketing strategies, to increase people＇s awareness of mental illness have led people who are not actually depressed to have medical consultations and drug treatments for it. This phenomenon is known as ＂disease mongering＂ and has been reported on. Problems exist from the medical perspective also and include the following： expansion of the diagnostic criteria for depression as formulated in the American Psychiatric Association＇s Diagnostic and Statistical Manual of Mental Disorders; treatments that rely heavily on drugs; and biomedicalization. Another reason for the increase in medical consultations is the declining function of communal bodies. This has resulted in individuals struggling psychologically, for example, with anxiety, worry, and depression. In summary, this sociological research analyzed the problems of depression in ｜apan and revealed how the pharmaceuticalization of mental health accelerates the individualization of social problem.

Nanoprobes in biomedical detection

Environmental problems caused by the development of nanotechnology have threatened human health. Investigating the biomedical effects of nanomaterials can help to solve these environmental safety issues. In studies on the biomedical effects of nanomaterials, several types of novel nanoscale probes that allow reliable, sensitive, accurate and rapid biomedical detection have emerged. We summarize recent developments in three categories of these nanoprobes, including noble metal nanocluster probes, carbon-based nanostructured probes, and unnatural amino acid-based probes. Besides reviewing the utility of different nanoprobes in cell imaging and protein detection, we also discuss the molecular mechanism of nanoprobe detection. Perspectives of novel nanoprobe design based on molecular details of biomedical detection are presented.

SUMMATION OF ABSOLUTE VALUE TEST FOR MULTIPLE OUTCOME COMPARISON WITH MODERATE EFFECT

In biomedical research,in order to evaluate the effect of a drug,investigators often need to compare the differences between one treatment group and another one by using multiple outcomes.The rank-sum tests can handle the case where the outcome differences between two groups are in the same direction.If they are not,MAX can handle it and is very useful when one/some of the differences is/are relatively larger than the others.When the individual outcome difference between two groups is moderate,a new method,summation of the absolute value of rank-based test for each outcome,is proposed in this work.Power comparison with the existing methods based on simulation studies and a real example show that the proposed test is a robust test,and works well when the difference for each outcome is moderate.The authors also derive some theoretical results for comparing the power between MAX and the the proposed method.

Progress in the development of techniques based on light scattering for single nanoparticle detection

Nanoparticles have recendy attracted extensive attention in view of their great potential in biomedicine and bioanalytical applications. Single particle detection via light scattering offers a simple and efficient approach for the size, size distribution, and concentration analysis of nanoparticles. In particular, intrinsic heterogeneity or rare events masked by ensemble averaging can be revealed. However, the sixth power dependence of Rayleigh scattering on particle size makes it very challenging to detect individual nanoparficles of small sizes. This article is intended to provide an overview of recent progress in the development of techniques based on light scattering for the detection of single nanoparticles.

Inflammatory bowel disease-and Barrett’s esophagus-associated neoplasia:the old,the new,and the persistent struggles

Early diagnosis of and adequate therapy for premalignant lesions in patients with inflammatory bowel disease(IBD)and Barrett’s esophagus(BE)has been shown to decrease mortality.Endoscopic examination with histologic evaluation of random and targeted biopsies remains the gold standard for early detection and adequate treatment of neoplasia in both these diseases.Although eventual patient management(including surveillance and treatment)depends upon a precise histologic assessment of the initial biopsy,accurately diagnosing and grading IBD-and BE-associated dysplasia is still considered challenging by many general as well as subspecialized pathologists.Additionally,there are continuing updates in the literature regarding the diagnosis,surveillance,and treatment of these disease entities.This comprehensive review discusses the cancer risk,detailed histopathological features,diagnostic challenges,and updates as well as the latest surveillance and treatment recommendations in IBD-and BE-associated dysplasia.