Perceived risk as a barrier to appropriate diagnosis of irritable bowel syndrome

AIM:To evaluate perceived risk,diagnostic testing,and acceptance of a diagnosis of irritable bowel syndrome(IBS)among the Korean laypersons.METHODS:We designed a conceptual framework to evaluate the health-seeking behavior of subjects based on a knowledge,attitude,and practice model.We developed a vignette-based questionnaire about IBS based on a literature review and focused group interviews.The vignette described a 40-year-old woman who meets the RomeⅢcriteria for IBS without red-flag signs.It was followed by questions about demographic characteristics,health behaviors,IBS symptoms,risk perception,perceived need for diagnostic tests,and acceptance of a positive diagnosis of IBS.Weplanned a nationwide survey targeting laypersons without IBS and between the ages of 20 and 69 years.Survey participants were selected by quota sampling stratified by gender,age,and nationwide location.A multivariate logistic model was constructed based on literature reviews,univariate analysis,and a stepwise selection method to investigate correlations between the perceived risk,need for diagnostic tests,and acceptance of a positive diagnosis.RESULTS:Of 2354 eligible households,1000 subjects completed the survey and 983 subjects were analyzed,excluding those who met symptom criteria for IBS.After reading the IBS vignette,the majority of subjects(86.8%)responded that the patient was at increased risk of severe disease.The most frequent concern was colon cancer(59.8%),followed by surgical condition(51.5%).Most subjects responded the patient needs diagnostic tests(97.2%).Colonoscopy was the most commonly required test(79.5%).Less than half of the respondents requested a stool examination(45.0%),blood test(40.7%),abdominal ultrasound(36.0%),or computed tomography(20.2%).The subjects who felt increased risk were more likely to see a need for colonoscopy[adjusted odds ratio(a OR)=2.10,95%CI:1.38-3.18].When asked about the positive diagnosis,the most frequent response was that"the patient would not be reassured"(65.7%).The increased risk perception group was less likely to be reassured by a positive diagnosis of IBS,compared to the other respondents(a OR=0.52,95%CI:0.34-0.78).CONCLUSION:For IBS diagnosis,increased risk perception is a possible barrier to the appropriate use of diagnostic tests and to the patient’s acceptance of a positive diagnosis.

Endoscopic ultrasound-guided deep and large biopsy for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies

AIM: To assess the diagnostic yield and safety of adeep and large biopsy technique under the guidance of endoscopic ultrasound(EUS) for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies.METHODS: From January 2009 to March 2014, 36 patients in whom gastric infiltrating tumors had been diagnosed by EUS received negative results for malignancy after endoscopic biopsies. The deep and large biopsy technique combined bite-on-bite technique with or without endoscopic mucosal resection(EMR) to obtain submucosal tissue from lesions. EUS was used to select the appropriate biopsy sites. If the lesion protruded into the cavity, EMR was performed for removal of the overlying mucosa and then bite-onbite technique was conducted in the resected area to obtain submucosal tissue. If the lesion appeared to be flat or was difficult to lift by injection, the bite-on-bite technique was directly used.RESULTS: Twenty-eight of the 36 patients were treated by EMR followed by bite-on-bite technique, while 8 patients only underwent bite-on-bite technique. Histological results showed 23 of the 36 lesions were poorly differentiated adenocarcinomas, 2 diffuse large B cell lymphomas, 4 mucosa-associated lymphoid tissue-type lymphomas, and 7 undiagnosed. The deep and large biopsy technique provided a definitive and conclusive diagnosis in 29(80.6%) of the 36 patients. The 12 gastric linitis plastica and 6 lymphoma patients received chemotherapy and avoided surgery. Minor oozing of blood in 2 mucosal resection wounds was managed by argon plasma coagulation and in 5 cases after deep biopsies by epinephrine(0.001%). Neither severe hemorrhage nor perforation occurred in any patient.CONCLUSION: The deep and large biopsy technique is superior to ordinary endoscopic biopsy for achieving an accurate diagnosis of gastric infiltrating tumors.This procedure guided by EUS is an effective and safe diagnostic method for gastric infiltrating tumors in which endoscopic biopsy results were negative for malignancy.

Transcription factor ERG is a specific and sensitive diagnostic marker for hepatic angiosarcoma

AIM:To investigate the expression of ERG,CD34,CD31(PECAM-1,platelet/endothelial cell adhesion molecule 1)and factorⅧ-related antigen(FⅧRAg)in the diagnosis of hepatic angiosarcoma patients.METHODS:Patient samples were collected from January 1986 to December 2012 from the People’s Liberation Army General Hospital in Beijing,China.We obtained twenty-four samples of hepatic angiosarcoma(HAS)that were confirmed by two pathologist.The samples were the result of three autopsy cases,eight biopsy cases and 13 patients who underwent surgical tumor removal.The HAS cases accounted for 2.23%(24/1075)of all hepatic vascular tumors at the hospital during the same time period.Patient histories including age,gender,clinical manifestations,medical treatments,laboratory tests,radiological images,histological observations and outcomes for each case were analyzed in detail.All samples were evaluated histologically with hematoxylin and eosinstaining.Using immunohistochemistry,the expression and localization of ERG was examined in all HAS specimens and compared to the known endothelial markers CD34,CD31 and FⅧRAg.The endothelial markers were also evaluated in a panel of non-HAS tumors.RESULTS:This cohort of 24 HAS cases is,to the best of our knowledge,currently the largest cohort in the world in the publicly available literature.Hepatic angiosarcoma tissue samples were obtained from 14 males and 10 females with a mean age of 50.6 years(range:7-86 years).The patients presented with the following clinical manifestations:abdominal pain(16/24),back pain(3/24),heart palpitations(1/20),cough(1/24)or no clinical symptoms(3/24).Tumors were predominantly localized in the right hepatic lobe(15/24)or left hepatic lobe(6/24),or a diffuse growth on the right and left hepatic lobes(3/24).Eleven patients underwent surgical resection(45.8%),two patients received a liver transplant(8.3%),eight patients received interventional therapy(33.3%)and three patients received no treatment(lesions discovered at autopsy,12.5%).Postoperative follow-up of patients revealed that 87.5%(21/24)of patients had died and three cases were not able to be tracked.In all cases,the mean survival time was 12.1 mo.While 100%of the HAS samples were positive for ERG expression,expression of the other markers was more variable.CD31 was expressed in79.2%(19/24)of samples,CD34 was expressed in87.5%(21/24)of samples and FⅧRAg was expressed in 41.7%(10/24)of samples.CONCLUSION:ERG is a more sensitive and specific diagnostic marker for hepatic angiosarcoma in comparison to CD31,CD34 and FⅧRAg.

Nonalcoholic fatty liver disease:Updates in noninvasive diagnosis and correlation with cardiovascular disease

Nonalcoholic fatty liver disease(NAFLD)refers to the accumulation of fat(mainly triglycerides)within hepatocytes.Approximately 20%-30%of adults in the general population in developed countries have NAFLD;this trend is increasing because of the pandemicity of obesity and diabetes,and is becoming a serious public health burden.Twenty percent of individuals with NAFLD develop chronic hepatic inflammation[nonalcoholic steatohepatitis(NASH)],which can be associated with the development of cirrhosis,portal hypertension,and hepatocellular carcinoma in a minority of patients.And thus,the detection and diagnosis of NAFLD is important for general practitioners.Liver biopsy is the gold standard for diagnosing NAFLD and confirming the presence of NASH.However,the invasiveness of this procedure limits its application to screening the general population or patients with contraindications for liver biopsy.The development of noninvasive diagnostic methods for NAFLD is of paramount importance.This review focuses on the updates of noninvasive diagnosis of NAFLD.Besides,we review clinical evidence supporting a strong association between NAFLD and the risk of cardiovascular disease because of the cross link between these two disorders.

Diagnostic challenges in alcohol use disorder and alcoholic liver disease

Alcohol use disorders represent a heterogeneous spectrum of clinical manifestations that have been defined by the Diagnostic and Statistical Manual of Mental Disorders-5. Excessive alcohol intake can lead to damage of various organs, including the liver. Alcoholic liver disease includes different injuries ranging from steatosis to cirrhosis and implicates a diagnostic assessment of the liver disease and of its possible complications. There is growing interest in the possible different tools for assessing previous alcohol consumption and for establishing the severity of liver injury, especially by noninvasive methods.

超声诊断先天性肌性斜颈的研究进展

先天性肌性斜颈(CMT)是儿童常见的先天性肌肉骨骼系统疾病,由胸锁乳突肌单侧挛缩而导致患儿出现典型的头部向患侧偏转,其发病机制尚未明确,可能与分娩过程有关。早诊断、早治疗对患儿畸形的矫正有重要意义。超声检查具有安全、实时、无创、无辐射等特点,可以对肌肉病变进行分型,同时反映肌肉纤维化程度,因此成为CMT诊断的首选方法。本文对超声诊断CMT患儿的研究进展进行综述。

乙型肝炎核心抗体对慢性乙型肝炎初治患者显著纤维化的预测价值

目的探讨乙型肝炎核心抗体(HBcAb)定量水平对慢性乙型肝炎(CHB)初次治疗患者显著纤维化阶段的预测价值。方法回顾性分析2018年4月至2022年4月于福建医科大学孟超肝胆医院感染科住院并行肝脏穿刺活检的157例CHB初治患者的资料和相关指标,根据Scheuer评分系统将91例S0-1期患者定义为轻度纤维化组,66例S2-4期患者定义为显著纤维化组,比较两组相关指标的差异,对差异有统计学意义的指标进行logistic回归分析,同时绘制相关指标预测显著纤维化的受试者工作特征曲线。结果HBcAb定量水平与CHB患者肝纤维化程度呈正相关(r=0.175,P=0.028),HBc Ab、丙氨酸转氨酶(ALT)、血小板(PLT)和乙型肝炎病毒脱氧核糖核酸(HBV DNA)是CHB患者进展至显著纤维化阶段的独立危险因素(OR=1.794、1.017、0.989、0.779,P<0.05),对显著纤维化阶段均有预测价值(曲线下面积=0.628、0.659、0.729、0.594,P<0.05)。HBcAb最佳截断值为3.65 log10 IU/ml,预测显著纤维化的敏感度为83.33%,特异度为41.76%(P=0.004)。结论HBcAb对CHB初治患者显著纤维化阶段有较好的预测价值,值得进一步研究。

鼻咽恶性淋巴瘤43例误诊分析

目的 分析鼻咽恶性淋巴瘤的误诊原因 ,探讨减少误诊的措施。方法 对我院 1990至 2 0 0 2年间住院治疗的 12 0例鼻咽恶性淋巴瘤病人进行回顾性分析。结果 12 0例鼻咽恶性淋巴瘤中有 4 3例误诊 ,误诊率高达 35 .8%。结论 鼻咽恶性淋巴瘤易发生临床误诊和病理误诊 ,全面掌握鼻咽恶性淋巴瘤的临床表现特点、重视鼻咽的检查和活检、注意影像学检查、结合实验室检查及免疫组化等是减少鼻咽恶性淋巴瘤误诊的有效措施。

端粒酶对良恶性腹水的鉴别诊断价值

目的探讨腹水端粒酶活性检测对良、恶性腹水鉴别诊断价值。方法采用ＴＲＡＰ－ＰＣＲ－ＳＬＩＳＡ法对４２例腹水进行端粒酶活性的分析。结果恶性腹水组端粒酶活性（平均Ａ值０．７４５）明显高于良性腹水组（平均Ａ值０．０６５）。端粒酶活在恶性腹水组阳件率为８８．９％，明显高于腹水找癌细胞的阳性率５５．６％、ＣＥＡ阳性率４４．４％、ＳＡ阳性率６１．１％、ＡＦＰ阳性率２２．２％。结论腹水端粒酶活性测定可作为诊断恶性腹水有效而敏感的方法。

^(99m)Tc-MIBI和^(18)F-FDG双核素同步显像在心肌梗死诊疗中的价值

目的:探讨双核素心肌同步显像(DISA)在心肌梗死患者治疗策略和疗效评估中的价值。方法:回顾性分析行DISA的87例心肌梗死患者,选择其中在治疗前后均成功进行DISA的63例患者进入本研究,所有患者均在术前2~3周、术后11~13周行DISA。根据治疗方法和有否存活心肌,分为A组:冠脉血运重建术(A1组:有存活心肌,A2组:无存活心肌);B组:冠脉血运重建术+干细胞移植(B1组:有存活心肌,B2组:无存活心肌);C组:干细胞移植(C1组:有存活心肌,C2组:无存活心肌)。采用SPSS13.0软件进行数据处理。结果:①63例患者中有存活心肌的30例,其中A1组16例,B1组6例,C1组8例;无存活心肌的33例,其中A2组9例,B2组7例,C2组17例。②A2组治疗前后,心肌梗死区心肌血流灌注和代谢均无明显改善,灌注显像或代谢显像的DF值比较,差异均无统计学意义(P值均>0.05),其余5组治疗后均有不同程度改善,DF值比较差异均有统计学意义(P值均<0.05);心肌存活组经治疗后血流灌注和代谢的改善程度,明显优于无心肌存活组,差异有显著统计学意义(P值均<0.05),同时B1组优于A1和C1组,B2优于A2和C2组,差异均有统计学意义(P值均<0.05或<0.01)。结论:①DISA显像能很好地评估心肌存活情况,有助于对心肌梗死患者治疗策略的选择;②DISA显像能较好地观察和评价梗死心肌治疗后的改善程度。

20例小儿膈疝的诊断与治疗

报道小儿膈疝２０例，其中男１３例，女７例，年龄１０ｄ～６岁，２岁以内者１６例，占８０％。先天性膈疝１７例，以心肺受压症状为主者１３例，消化道症状突出者４例。３例外伤性膈疝均有急性心肺功能不全表现。对右侧、病程长、缺损巨大的膈疝，主张经胸手术。术后死亡２例，病死率１０％（２／２０）。术后加强心肺功能的维护，应用ＨＦＪＶ可提高生存率。

利用ANSYS进行网架结构损伤诊断的数值模拟研究

利用结构动力参数的改变对空间钢网架进行损伤分析,其中许多指标对损伤并不敏感.文中通过结构有限元分析软件AN SY S得到网架结构位移模态分析数据,采用杆件轴向应变变化率的模态分析技术针对不同损伤状况的钢结构网架进行损伤识别,能够较为准确地诊断出网架杆件的损伤位置.

基于时间序列的电力系统故障诊断规则挖掘

介绍了利用Rough集理论进行数据挖掘技术在电力系统故障诊断中的应用。针对电力系统中与时间序列相关的数据集,提出了基于Rough集的时间序列相关的分类规则挖掘算法。利用该算法得到的分类规则,可以较好地反映条件属性集随时间动态变化对系统状态的影响。

^(99m)锝-亚甲基二膦酸盐三相骨显像对糖尿病足的诊断价值

目的 评估99m锝 亚甲基二膦酸盐 (Tc99m MDP)三相骨显像对糖尿病足 (DF)的诊断价值。 方法 对 4 5例DF患者和 36例对照者进行Tc99m MDP三相骨显像。每个单足单独进行资料处理。在足背 (楔骨和跖骨 )、胫骨粗隆各勾画感兴趣区 (ROI) ,计算各ROI放射性浓度 (千计数 /像素 ,counts/ pixel)以及足部 /胫骨放射性浓度比值 (Rm/t)。生成各ROI的时间 活度曲线 ,从曲线读取各部位的灌注时间 (Tp) ,并计算各部位摄取速率 (V)。患足与健足之间Rm/t、Tp、V等指标的比较采用t检验。计算各指标的诊断灵敏度、特异性、准确率。各指标对DF诊断效能的差异采用u检验。 结果 Tp、V、Rm/t比值在对照组分别为 (33± 9)s、(2 3± 0 8)counts/s、0 85± 0 2 9,在DF组分别为(36± 13)s、(1 5± 0 3)counts/s、0 72± 0 31。两组之间比较 ,除Tp差异无显著意义外 (t=1 80 2 4 ,P>0 0 5 ) ,V(t=7 736 0 ,P <0 0 0 1)及Rm/t比值 (t=2 7395 ,P <0 0 1)在两组间差异均有显著意义。V值诊断DF的灵敏度为 82 6 % ,特异性为 83 8% ,准确率为 83 3% ,Rm/t比值则分别为 6 5 2 %、6 8 8%、6 7 3%。V值的灵敏度 (u =2 32 74 ,P <0 0 5 )和特异性 (u =2 4 0 6 8,P <0 0 5 )均优于Rm/t比值。

DMD基因及其产物检测的临床价值

目的针对ＤＭＤ基因的突变特点以及由此而产生的编码产物的异常，探讨ＤＭＤ基因及其编码产物──抗肌营养个良蛋白的检测对于诊断疾病的意义。方法用多重ＰＣＲ技术和免疫印迹技术对ＤＭＤ或ＢＭＤ患者的ＤＭＤ基因和抗肌营养不良蛋白进行了检测。结果３３．３％的ＤＭＤ患者虽然未被检测出基因的片段性缺失，但他们的抗肌营养不良蛋白却完全丧失。结论多重ＰＣＲ技术是检测ＤＭＤ基因片段性缺失的有效方法，但却无法检测出点突变等微小突变。兔疫印迹技术能反映由于各种类型的基因突变所造成的编码产物的缺陷，更有利于ＤＭＤ和ＢＭＤ的确实诊断，应将其作为主要的实验室检测指标之一。

胰腺囊性肿瘤诊治中的常见问题(附25例报告)

目的 :分析和解决胰腺囊性肿瘤诊治中的常见问题。方法 :回顾分析了 1 984～ 2 0 0 2年中 2 5例胰腺囊性肿瘤的诊治资料。结果 :既往曾被误诊为假性囊肿而作囊肠或胃吻合 1 1例 ,误诊率 44 .0 % ;手术切除率 68.0 % ;除 3例浆液性囊腺瘤外 ,其余 2 2例中恶性占 68.2 % ;随访 2 2例 ,半数以上病人生存 3年多 ,其中 8例仍健在。结论 :提高对胰腺囊性肿瘤的认识 。

超声引导下经皮肾脏穿刺活检后大出血的诊治体会

大出血是超声引导下经皮肾脏穿刺活检后最严重的并发症之一,严重者可能导致患者单侧肾脏切除,甚至病死。临床通常认为,术前把握好肾穿刺活检指征,做好术前准备,术中规范操作,术后严格管理,可以降低肾脏出血发生概率,或减轻出血严重程度,但仍然不能完全避免穿刺后大出血的发生。本文通过回顾1例超声引导下经皮肾脏穿刺活检后大出血患者的诊治过程,以及相关文献复习,从患者自身因素、术前准备、穿刺方法、术后管理等方面,探讨肾脏穿刺活检出血的危险因素,并从出血判断、处理等方面,总结肾脏穿刺活检后大出血的诊治经验。

关于青少年网络成瘾的内涵、诊断和治疗

青少年网络成瘾一直是国内外学者研究的重点。作者在国内外有关研究的基础上,对青少年网络成瘾的原因、诊断和治疗进行了探讨,并针对这些问题提出思想政治教育法,认知行为疗法,解决焦点短期疗法,药物、心理干预综合疗法。

可溶性细胞间粘附分子-1与胃癌侵袭关系的研究

目的 探讨胃癌患者外周血中可溶性细胞间粘附分子－１（ｓＩＣＡＭ－１）与胃癌侵袭转移的关系。方法 通过采用流式细胞仪（ＦＣＭＳ）对胃癌患者外周血中ｓＩＣＡＭ－１的水平进行定量测定。结果ｓＩＣＡＭ－１在胃癌患者血清中的水平明显高于正常对照组（Ｐ＜０．０１），有肝脏转移癌组明显高于无转移癌组（Ｐ＜０．０１）。结论ｓＩＣＡＭ－１做为免疫抑制因子阻断了 ＩＣＡＭ－１／；ＦＡ－１系统功能，削弱了机体免疫监视能力和对肿瘤细胞的破坏作用，导致肿瘤细胞不断生长和发生远处转移。

乳头溢液脱落细胞端粒酶活性检测

目的探讨乳头溢液脱落细胞端粒酶活性检测在临床诊断中的应用。方法采用ＴＲＡＰ－ＰＣＲ银染定性法及ＴＲＡＰ－ＰＣＲ－ＥＬＩＳＡ定量法对５０例溢乳进行脱落细胞端粒酶活性分析。结果５０例溢乳脱落细胞端粒酶阳性率高达７８％（３９／５０），随着年龄的增大，端粒酶阳性率呈逐步下降趋势，而同期送检的细胞病理诊断则无１例找到癌细胞。结论溢乳脱落细胞端粒酶阳性检出率明显增高。随着疾病的发展，端粒酶阳性患者易发生恶变的可能性是否大于端粒酶阴性患者需进一步研究。