Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat.It is a commonly encountered clinical condition that is usually long-lasting,difficult to treat,and has a tendency t...Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat.It is a commonly encountered clinical condition that is usually long-lasting,difficult to treat,and has a tendency to recur.Furthermore,due to the uncertain etiology of globus,it remains difficult to establish standard investigation and treatment strategies for affected patients. As a first step for managing globus,careful history taking and nasolaryngoscopy are essential.Given the benign nature of the condition and the recent notion that gastroesophageal reflux disease is a major cause of globus,empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical globus.If patients are nonresponsive to this therapy, definitive assessments such as endoscopy,multichannel intraluminal impedance/pH monitoring,and ma-nometry should be considered.Speech and language therapy,anti-depressants,and cognitive-behavioral therapy can be helpful in patients whose symptoms persist despite negative investigations.展开更多
Increased abdominal imaging has led to an increase in the detection of the incidental small renal mass(SRM). With increasing recognition that the malignant potential of SRMs is heterogeneous, ranging from benign(15%-2...Increased abdominal imaging has led to an increase in the detection of the incidental small renal mass(SRM). With increasing recognition that the malignant potential of SRMs is heterogeneous, ranging from benign(15%-20%) to aggressive(20%), enthusiasm for more conservative management strategies in the elderly and infirmed, such as active surveillance(AS), have grown considerably. As the management of the SRM evolves to incorporate ablative techniques and AS for low risk disease, the role of renal mass biopsy(RMB) to help guide individualized therapy is evolving. Historically, the role of RMB was limited to the evaluation of suspected metastatic disease, renal abscess, or lymphoma. However, in the contemporary era, the role of biopsy has grown, most notably to identify patients who harbor benign lesions and for whom treatment, particularly the elderly or frail, may be avoided. When performing a RMB to guide initial clinical decision making for small, localized tumors, the most relevant questions are often relegated to proof of malignancy and documentation(if possible) of grade. However, significant intratumoral heterogeneity has been identified in clear cell renal cell carcinoma(ccRCC) that may lead to an underestimation of the genetic complexity of a tumor when single-biopsy procedures are used. Heterogeneous genomic landscapes and branched parallel evolution of ccRCCs with spatially separated subclones creates an illusion of clonal dominance when assessed by single biopsies and raises important questions regarding how tumors can be optimally sampled and whether future evolutionary tumor branches might be predictable and ultimately targetable. This work raises profound questions concerning the genetic landscape of cancer and how tumor heterogeneity may affect, and possibly confound, targeted diagnostic and therapeutic interventions. In this review, we discuss the current role of RMB, the implications of tumor heterogeneity on diagnostic accuracy, and highlight promising future directions.展开更多
Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma,lymphoma,cystic neoplasia,retroperitoneal tumors,pancreatitis or pseudocysts.Here,I report the case of a 31-year-old immigrant Burmese...Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma,lymphoma,cystic neoplasia,retroperitoneal tumors,pancreatitis or pseudocysts.Here,I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia,fever,weight loss and an epigastric mass.The patient was diagnosed with pancreatic TB and acquired immunodeficiency syndrome,and was treated with antituberculous drugs and percutaneous catheter drainage without a laparotomy.The clinical presentation,radiographic investigation and management of pancreatic TB are summarized in this paper to emphasize the importance of considering this rare disease in the differential diagnosis of pancreatic masses concomitant with human immunodeficiency virus infection.I also emphasize the need for both histopathological and microbiological diagnosis via fineneedle aspiration.展开更多
As a newly developed theory, narrative ethics has its reasonability and advantages in that it can not only analyze either the contents or the forms of the texts, but also make an analysis of the combination of both co...As a newly developed theory, narrative ethics has its reasonability and advantages in that it can not only analyze either the contents or the forms of the texts, but also make an analysis of the combination of both contents and forms. This article, supported by James Phelan＇s rhetorical narrative theory as the theoretical base, attempts to explore and interpret narrative judgments and its implied ethics existing in The Child in Time by Ian McEwan so as to observe the hidden aesthetic orientation, the value judgments and the ethical intentions of the text and help to reveal the author＇s views of narrative ethics and aesthetics of the novel.展开更多
Our aim was to record pancreaticobiliary endoscopic ultrasound(EUS) literature of the past 3 decades and evaluate its role based on a critical appraisal of published studies according to levels of evidence(LE).Origina...Our aim was to record pancreaticobiliary endoscopic ultrasound(EUS) literature of the past 3 decades and evaluate its role based on a critical appraisal of published studies according to levels of evidence(LE).Original research articles(randomized controlled trials,prospective and retrospective studies),meta-analyses,reviews and surveys pertinent to gastrointestinal EUS were included.All articles published until September 2011 were retrieved from PubMed and classified according to specific disease entities,anatomical subdivisions and therapeutic applications of EUS.The North of England evidencebased guidelines were used to determine LE.A total of 1089 pertinent articles were reviewed.Published research focused primarily on solid pancreatic neoplasms,followed by disorders of the extrahepatic biliary tree,pancreatic cystic lesions,therapeutic-interventional EUS,chronic and acute pancreatitis.A uniform observation in all six categories of articles was the predominance of LE Ⅲ studies followed by LE Ⅳ,Ⅱb,Ⅱa,Ⅰb and Ⅰ a,in descending order.EUS remains the most accurate method for detecting small(< 3 cm) pancreatic tumors,ampullary neoplasms and small(< 4 mm) bile duct stones,and the best test to define vascular invasion in pancreatic and peri-ampullary neoplasms.Detailed EUS imaging,along with biochemical and molecular cyst fluid analysis,improve the differentiation of pancreatic cysts and help predict their malignant potential.Early diagnosis of chronic pancreatitis appears feasible and reliable.Novel imaging techniques(contrast-enhanced EUS,elastography) seem promising for the evaluation of pancreatic cancer and autoimmune pancreatitis.Therapeutic applications currently involve pancreaticobiliary drainage and targeted fine needle injection-guided antitumor therapy.Despite the ongoing development of extra-corporeal imaging modalities,such as computed tomography,magnetic resonance imaging,and positron emission tomography,EUS still holds a leading role in the investigation of the pancreaticobiliary area.The major challenge of EUS evolution is its expanding therapeutic potential towards an effective and minimally invasive management of complex pancreaticobiliary disorders.展开更多
An invasive electrical resistance tomographic sensor was proposed for production logging in vertical oil well.The sensor consists of 24 electrodes that are fixed to the logging tool,which can move in the pipeline to a...An invasive electrical resistance tomographic sensor was proposed for production logging in vertical oil well.The sensor consists of 24 electrodes that are fixed to the logging tool,which can move in the pipeline to acquire data on the conductivity distribution of oil/water mixture flow at different depths.A sensitivity-based algorithm was introduced to reconstruct the cross-sectional images.Analysis on the sensitivity of the sensor to the distribution of oil/water mixture flow was carried out to optimize the position of the imaging cross-section.The imaging results obtained using various boundary conditions at the pipe wall and the logging tool were compared.Eight typical models with various conductivity distributions were created and the measurement data were obtained by solving the forward problem of the sensor system.Image reconstruction was then implemented by using the simulation data for each model.Comparisons between the models and the reconstructed images show that the number and spatial distribution of the oil bubbles can be clearly identified.展开更多
基金Supported by A Pusan National University Hospital Clinical Research Grant(2011)a grant from the National R and D Program for Cancer Control,Ministry for Health,Welfare and Family Affairs,Republic of Korea,No.0920050
文摘Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat.It is a commonly encountered clinical condition that is usually long-lasting,difficult to treat,and has a tendency to recur.Furthermore,due to the uncertain etiology of globus,it remains difficult to establish standard investigation and treatment strategies for affected patients. As a first step for managing globus,careful history taking and nasolaryngoscopy are essential.Given the benign nature of the condition and the recent notion that gastroesophageal reflux disease is a major cause of globus,empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical globus.If patients are nonresponsive to this therapy, definitive assessments such as endoscopy,multichannel intraluminal impedance/pH monitoring,and ma-nometry should be considered.Speech and language therapy,anti-depressants,and cognitive-behavioral therapy can be helpful in patients whose symptoms persist despite negative investigations.
文摘Increased abdominal imaging has led to an increase in the detection of the incidental small renal mass(SRM). With increasing recognition that the malignant potential of SRMs is heterogeneous, ranging from benign(15%-20%) to aggressive(20%), enthusiasm for more conservative management strategies in the elderly and infirmed, such as active surveillance(AS), have grown considerably. As the management of the SRM evolves to incorporate ablative techniques and AS for low risk disease, the role of renal mass biopsy(RMB) to help guide individualized therapy is evolving. Historically, the role of RMB was limited to the evaluation of suspected metastatic disease, renal abscess, or lymphoma. However, in the contemporary era, the role of biopsy has grown, most notably to identify patients who harbor benign lesions and for whom treatment, particularly the elderly or frail, may be avoided. When performing a RMB to guide initial clinical decision making for small, localized tumors, the most relevant questions are often relegated to proof of malignancy and documentation(if possible) of grade. However, significant intratumoral heterogeneity has been identified in clear cell renal cell carcinoma(ccRCC) that may lead to an underestimation of the genetic complexity of a tumor when single-biopsy procedures are used. Heterogeneous genomic landscapes and branched parallel evolution of ccRCCs with spatially separated subclones creates an illusion of clonal dominance when assessed by single biopsies and raises important questions regarding how tumors can be optimally sampled and whether future evolutionary tumor branches might be predictable and ultimately targetable. This work raises profound questions concerning the genetic landscape of cancer and how tumor heterogeneity may affect, and possibly confound, targeted diagnostic and therapeutic interventions. In this review, we discuss the current role of RMB, the implications of tumor heterogeneity on diagnostic accuracy, and highlight promising future directions.
文摘Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma,lymphoma,cystic neoplasia,retroperitoneal tumors,pancreatitis or pseudocysts.Here,I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia,fever,weight loss and an epigastric mass.The patient was diagnosed with pancreatic TB and acquired immunodeficiency syndrome,and was treated with antituberculous drugs and percutaneous catheter drainage without a laparotomy.The clinical presentation,radiographic investigation and management of pancreatic TB are summarized in this paper to emphasize the importance of considering this rare disease in the differential diagnosis of pancreatic masses concomitant with human immunodeficiency virus infection.I also emphasize the need for both histopathological and microbiological diagnosis via fineneedle aspiration.
文摘As a newly developed theory, narrative ethics has its reasonability and advantages in that it can not only analyze either the contents or the forms of the texts, but also make an analysis of the combination of both contents and forms. This article, supported by James Phelan＇s rhetorical narrative theory as the theoretical base, attempts to explore and interpret narrative judgments and its implied ethics existing in The Child in Time by Ian McEwan so as to observe the hidden aesthetic orientation, the value judgments and the ethical intentions of the text and help to reveal the author＇s views of narrative ethics and aesthetics of the novel.
文摘Our aim was to record pancreaticobiliary endoscopic ultrasound(EUS) literature of the past 3 decades and evaluate its role based on a critical appraisal of published studies according to levels of evidence(LE).Original research articles(randomized controlled trials,prospective and retrospective studies),meta-analyses,reviews and surveys pertinent to gastrointestinal EUS were included.All articles published until September 2011 were retrieved from PubMed and classified according to specific disease entities,anatomical subdivisions and therapeutic applications of EUS.The North of England evidencebased guidelines were used to determine LE.A total of 1089 pertinent articles were reviewed.Published research focused primarily on solid pancreatic neoplasms,followed by disorders of the extrahepatic biliary tree,pancreatic cystic lesions,therapeutic-interventional EUS,chronic and acute pancreatitis.A uniform observation in all six categories of articles was the predominance of LE Ⅲ studies followed by LE Ⅳ,Ⅱb,Ⅱa,Ⅰb and Ⅰ a,in descending order.EUS remains the most accurate method for detecting small(< 3 cm) pancreatic tumors,ampullary neoplasms and small(< 4 mm) bile duct stones,and the best test to define vascular invasion in pancreatic and peri-ampullary neoplasms.Detailed EUS imaging,along with biochemical and molecular cyst fluid analysis,improve the differentiation of pancreatic cysts and help predict their malignant potential.Early diagnosis of chronic pancreatitis appears feasible and reliable.Novel imaging techniques(contrast-enhanced EUS,elastography) seem promising for the evaluation of pancreatic cancer and autoimmune pancreatitis.Therapeutic applications currently involve pancreaticobiliary drainage and targeted fine needle injection-guided antitumor therapy.Despite the ongoing development of extra-corporeal imaging modalities,such as computed tomography,magnetic resonance imaging,and positron emission tomography,EUS still holds a leading role in the investigation of the pancreaticobiliary area.The major challenge of EUS evolution is its expanding therapeutic potential towards an effective and minimally invasive management of complex pancreaticobiliary disorders.
基金Supported by the National Natural Science Foundation of China (61001135)the Fundamental Research Funds for the Central Universities (YWF-11-03-Q-072)
文摘An invasive electrical resistance tomographic sensor was proposed for production logging in vertical oil well.The sensor consists of 24 electrodes that are fixed to the logging tool,which can move in the pipeline to acquire data on the conductivity distribution of oil/water mixture flow at different depths.A sensitivity-based algorithm was introduced to reconstruct the cross-sectional images.Analysis on the sensitivity of the sensor to the distribution of oil/water mixture flow was carried out to optimize the position of the imaging cross-section.The imaging results obtained using various boundary conditions at the pipe wall and the logging tool were compared.Eight typical models with various conductivity distributions were created and the measurement data were obtained by solving the forward problem of the sensor system.Image reconstruction was then implemented by using the simulation data for each model.Comparisons between the models and the reconstructed images show that the number and spatial distribution of the oil bubbles can be clearly identified.
