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个性化信息检索系统中文本聚类的研究_硕士学位论文（pdf格式可编辑）
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首都医科大学宣武医院神经内科重症监护病房,北京,100053; 首都医科大学宣武医院神经内科重症监护病房,北京,100053; 首都医科大学宣武医院神经内科重症监护病房,北京,100053; 首都医科大学宣武医院神经内科重症监护病房,北京,100053; 首都医科大学宣武医院神经内科重症监护病房,北京,100053
[目的 探讨血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)预测恶性大脑中动脉供血区梗死(malignant middle cerebral artery infarction,mMCAI)的准确性.方法 纳入40例发病24 h内的急性大面积脑梗死患者,在发病后24、36和48 h抽取血液样本,采用罗氏全自动电化学发光仪测定血清NSE浓度.mMCAI定义为临床出现脑疝征象且CT和(或)MRI显示占位效应.采用受试者工作特征曲线分析3个时间点血清NSE水平预测mMCAI的准确性.结果 16例患者发生mMCAI(40%).发病后24 h血清NSE水平预测mMCAI的准确性较差;36 h血清NSE浓度预测mMCAI的特异性很高(96%),但敏感性较低(69%);48 h血清NSE浓度预测mMCAI的特异性(92%)和敏感性(88%)均很高.结论 血清NSE浓度及其动态变化可预测mMCAI的发生,预测时间点以发病后36～48 h为宜.]
071051,河北省保定市第二医院神经内科; 071051,河北省保定市第二医院神经内科; 071051,河北省保定市第二医院神经内科
[短暂性脑缺血发作(transient ischemic attack,TIA)短期内发生卒中的风险很高.对TIA的近期卒中风险做出预测,快速筛选高危患者,并采取有效治疗措施,可以减少卒中的发生.文章对目前TIA后近期卒中风险预测的相关研究进行了综述.]
南方医科大学南方医院神经内科,广州,510515; 南方医科大学南方医院神经内科,广州,510515; 南方医科大学南方医院神经内科,广州,510515; 南方医科大学南方医院神经内科,广州,510515; 南方医科大学南方医院神经内科,广州,510515; 南方医科大学南方医院神经内科,广州,510515; 南方医科大学南方医院神经内科,广州,510515; 南方医科大学南方医院神经内科,广州,510515
[目的 探讨40 Hz听性稳态反应(40 Hz auditory steady-state response,40 Hz ASSR)对大脑中动脉供血区梗死患者恶性过程的预测价值.方法 收入神经重症监护病房(neuro-intensive care unite,NICU)的大脑中动脉供血区梗死患者入院后72 h内行40Hz ASSR以及脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)检查,同时行美国国立卫生研究院卒中量表(Naional Institutes of Health Stroke Scale,NIHSS)评分.采用多变量logistic回归分析确定恶性过程的影响因素.对恶性过程相关指标进行接受者操作特征(receiver operating characteristic,ROC)曲线分析,明确40Hz ASSR对大脑中动脉供血区梗死恶性过程的预测价值.结果 共纳入104例大脑中动脉供血区梗死患者,其中恶性过程组59例,非恶性过程组45例,两组基线NIHSS评分[(17.25±7.23)分对(20.40±8.09)分；t=-2.055,P=0.043)、梗死体积[(105.85±73.37)mm3对( 179.15±144.38)mm3；t=-3.011,P=O.004]、白细胞计数[(10.26±3.14)×109/L对(13.45±5.42)×109/L;t=-3.336,P=0.001]、40 Hz ASSR(Z=-3.237,P =0.001)和短潜伏期体感诱发电位(Z=-3.130,P=0.002)分级存在显著差异.多变量logistic回归分析显示,40 Hz ASSR[优势比(odds ratio,OR)3.347,95％可信区间(confidence interval,CI)1.630～6.872,P=0.014]、梗死体积(OR 1.006,95％ CI 1.001 ～1.012,P=0.003)和白细胞计数(OR 1.277,95％CI 1.074～1.402,P=0.001)为大脑中动脉供血区梗死患者出现恶性过程的独立预测因素.40 Hz ASSR为3级时预测恶性过程的敏感性为39.5％,特异性为94.4％.结论 40 Hz ASSR对大脑中动脉供血区梗死患者的恶性过程具有重要的预测价值.]
广东省人民医院急危重症医学部ICU,广东省医学科学院,广州,510080; 广东省人民医院急危重症医学部ICU,广东省医学科学院,广州,510080; 广东省人民医院急危重症医学部ICU,广东省医学科学院,广州,510080; 广东省人民医院急危重症医学部ICU,广东省医学科学院,广州,510080; 广东省人民医院急危重症医学部ICU,广东省医学科学院,广州,510080; 广东省人民医院急危重症医学部ICU,广东省医学科学院,广州,510080
[目的 应用受试者工作特征(ROC)曲线评价血浆氨基末端脑钠肽前体(NT-proBNP)对机械通气患者撤机结局的预测价值.方法 回顾性分析广东省人民医院ICU 2008年6月至2010年1月达到撤机标准并行撤机的患者.依撤机结局分为撤机成功组和失败组,以成组t检验及x2检验比较两组间年龄、性别及撤机前NT-proBNP对数值(Lg NT-proBNP);绘制ROC曲线,评价撤机前NT-proB-NP水平对撤机结局的预测价值.结果 共入选160例患者,成功组106例,失败组54例.撤机成功组年龄(岁)相对较轻[(63.17±17.00)vs.(71.28±12.56),t=2.063,P=0.024],两组性别差异无统计学意义(χ2=0.06,P＞0.05).撤机失败组NT-proBNP水平明显高于成功组(Lg NT-proBNP:2.80±0.72,3.75±0.56,t=2.351,P=0.014);NT-proBNP预测撤机失败的ROC曲线下面积为0.855±0.036(95%CI=0.784～0.925),其预测撤机失败的截点值为3635.5 pg/mL,此值下的Youden指数为0.60,正确百分率为82.5%,敏感性为75%,特异性为84.7%,阳性似然比4.90,阴性似然比0.295,Kappa 值为0.62.结论 撤机前NT-proBNP值对撤机结局有一定的预测价值,可作为撤机筛查指标之一.]
浙江大学医学院附属第二医院老年病科,杭州,310009; 浙江大学医学院附属第二医院老年病科,杭州,310009; 浙江大学医学院附属第二医院老年病科,杭州,310009
[目的 研究分析血清肌碱酯酶对老年全身炎症反应综合征患者病情发展转归的预测作用.方法 将124例入住浙江大学医学院附属第二医院中心监护室(ICU)的老年SIRS患者根据预后情况分为存活组和死亡组.检测所有入院患者24 h内的血清胆碱酯酶、白蛋白、D-二聚体、乳酸、C反应蛋白(CRP),并进行APACHEⅡ和GCS评分.结果 生存组和死亡组之间比较,在年龄、性别、APACHEⅡ评分、GCS评分方面差异无统计学意义(P＞0.05).血乳酸、血D-二聚体、白蛋白、CRP、ChE在两组间比较差异具有统计学意义(P值=0.011,0.011,0.007,0.008,0.000.).预后多因素回归分析结果显示性别、年龄、白蛋白、CRP、GCS评分、APACHEⅡ评分、乳酸、D-二聚体不是决定患者预后的独立危险因素(P值分别为0.401,0.165,0.446,0.841,0.615,0.120,0.502,0.184),但ChE有显著性相关(P=0.000).ROC曲线图分析显示血清ChE对老年SIRS患者预后的ROC曲线下面积(AUC)为0.797,SE=0.04,P=0.000;ChE=103.00U/L时,敏感度为:0.793;1-特异度为0.258,可作为诊断的切点.Kendall相关分析ChE与APACHEⅡ评分、CRP、白蛋白相关性非常弱,相关系数分别为0.061,0.231,-0.090,P值分别为0.161,0.000,0.069.结论 ChE可能参与了老年SIRS的发生和发展过程,对这类患者的病情发展转归有一定的预测作用,且指标稳定,受干扰因素少.]
广州医学院第二附属医院急诊科,广州,510260; 广州医学院第二附属医院急诊科,广州,510260; 广州医学院第二附属医院急诊科,广州,510260; 广州医学院第二附属医院急诊科,广州,510260; 广州医学院第二附属医院急诊科,广州,510260; 广州医学院第二附属医院急诊科,广州,510260
[目的 通过检测急性心肌梗死( AMI)患者静脉溶栓前、后2小时内血浆凝血酶激活的纤溶抑制物(TAFI)和纤溶酶原激活物抑制剂-1(PAI-1)的含量,探讨两者的变化是否对溶栓后血管再通具有预测价值.方法2007年1月至2009年3月期间收集广州医学院第二附属医院急诊科16例急性ST段抬高心肌梗死(STEMI)患者溶栓前、后0.5,1,1.5,2h的血浆标本,并以16名健康人作为健康对照组,用ELISA法测定血浆中TAFI和PAI-1的含量.结果 (1)与健康对照组相比,STEMI患者溶栓前的血浆PAI-1水平显著升高(P＜0.01)；而TAFI活性与对照组相比差异无统计学意义.(2)与溶栓前相比,溶栓后0.5,1,1.5,2h的血浆TAFI活性较溶栓前比较,差异无统计学意义(P＞0.05)；溶栓后1.5,2h的血浆PAI-1显著升高(P＜0.01).(3)溶栓后2h冠脉未通组PAI-1水平显著高于再通组(P＜0.05)；而冠脉未通组和再通组TAFI活性差异无统计学意义(P＞0.05).结论 升高的血浆PAI-1在溶栓后2h下降可能对溶栓后血管再通具预测价值,TAFI对血管冉通不具预测价值.]
518104,广州医学院附属深圳沙井医院急诊科; 518104,广州医学院附属深圳沙井医院急诊科; 518104,广州医学院附属深圳沙井医院急诊科
[目的 探讨完善后的预警评分(MEWS)分析法预测急诊潜在危重症患者的可行性研究.方法 对急诊科与抢救室298例患者进行MEWS评分法评测,对MEWS不同分值的急诊心肺复苏、重症监护室与专科普通病房所收住的患者、门诊治疗、出院＜1个月、出院≥1个月、转上级医院、死亡的构成比进行分析,并对所有患者进行预后追访.结果 MEWS不同分值患者接受不同处置方式的概率比较差异有统计学意义(x2=258.697,P＜0.001);预后情况比较差异有统计学意义(x2=115.938,P＜0.001);患者病情与MEWS的分值成正相关(r=0.848,P＜0.001).结论 MEWS于急诊潜在危重症患者的预测上具有可行性,可作为急诊评估专用系统进行推广.]
华南肿瘤学国家重点实验室中山大学肿瘤医院放疗科,广州,510060; 华南肿瘤学国家重点实验室中山大学肿瘤医院放疗科,广州,510060; 华南肿瘤学国家重点实验室中山大学肿瘤医院放疗科,广州,510060; 华南肿瘤学国家重点实验室中山大学肿瘤医院放疗科,广州,510060; 华南肿瘤学国家重点实验室中山大学肿瘤医院放疗科,广州,510060; 华南肿瘤学国家重点实验室中山大学肿瘤医院放疗科,广州,510060; 华南肿瘤学国家重点实验室中山大学肿瘤医院放疗科,广州,510060; 华南肿瘤学国家重点实验室中山大学肿瘤医院放疗科,广州,510060; 华南肿瘤学国家重点实验室中山大学肿瘤医院放疗科,广州,510060
[目的 评价疗前PE-CT FDG最大标准摄取值(SUVmax)预测局部晚期鼻咽癌调强放疗(IMRT)预后的价值.方法 140例疗前行全身或头颈部FDG PET-CT并接受根治性IMRT的Ⅲ～Ⅳb期(UICC/AJCC-6th分期)鼻咽癌病例被纳入研究.分别分析鼻咽原发灶SUVmax(SUVmax-P)、颈部转移淋巴结SUVmax(SUVmax-N)与临床各因素和临床疗效的关系.结果 全组SUVmax-P中位数为10.4,SUVmax-N为6.2.SUVmax-P与T分期(R=0.279,P=0.001)、SUVmax-N与N分期(R=0.334,P=0.000)均相关.局部复发与无复发患者SUVmax-P中位数为9.2与10.4(U=560.50,P=0.805),SUVmax-N中位数为4.0与5.0(U=576.00,P=0.908).远处转移与无转移患者SUVmax-P中位数为11.9与9.8(U=987.50,P=0.014),SUVmax-N中位数为5.0与5.0(U=1266.00,P=0.348).与5年无远处转移生存(DMFS)和5年总生存(OS)相关最佳截断点SUVmax-P均为10.2.SUVmax-P≤10.2与＞10.2患者5年DMFS和OS分别为95.5％与69.1％(x2=15.88,P=0.000)和94.0％与68.4％(x2=15.56,P=0.000).多因素分析显示SUVmax-P是5年DMFS及OS的预后因素(HR=7.87,P=0.001及HR=5.14,P=0.003).结论 疗前原发灶FDG SUVmax可能是预测局部晚期鼻咽癌IMRT后远处转移和生存的有效生物学指标.]
广东省医学科学院广东省人民医院检验科,广州,510080; 广东省医学科学院广东省临床检验中心,广州,510080; 广东省医学科学院广东省人民医院检验科,广州,510080; 广东省医学科学院广东省人民医院检验科,广州,510080; 广东省医学科学院广东省人民医院检验科,广州,510080; 广东省医学科学院广东省人民医院检验科,广州,510080; 广州医学院检验系
[目的 通过对比分析艾滋病病毒(HIV)抗体筛查阳性结果与免疫印迹试验(WB)结果,评价4种HIV抗体筛查试剂检测性能.方法 2004年1月至2009年6月,分别用中山生物工程有限公司、荷兰生物梅里埃有限公司、珠海丽珠有限公司生产的3种酶联免疫吸附试验(enzyme linked immunasorbent assay,ELISA)试剂初筛血清HIV抗体,用美国雅培Determine HIV-1/2胶体硒标试剂、原试剂复检.筛查阳性样本用WB法进行确认.结果 共检测206 151例患者血清HIV抗体,确认HIV抗体阳性193例(0.094%).3种ELISA试剂敏感度、阴性预期值均为100%;雅培试剂分别为93.93%、91.67%,其漏检的样本均为WB不确定.中山、梅里埃、丽珠、雅培试剂的特异度分别为99.88%、99.89%、99.96%、89.38%;阳性预期值(study predictive value of a positive test result,PVP)分别为35.58%、46.46%、76.61%、92.20%;功效分别为99.88%、99.89%、99.96%、91.98%;3种ELISA试剂ROC曲线下面积分别为0.93、0.99、0.95.丽珠的PVP明显高于中山(X~2=45.804,P=0.000)、梅里埃(X~2=25.231,P=0.000);梅里埃的PVP比中山高,但无统计学意义(X~2=2.488,P=0.115);雅培PVP最高(与丽珠相比,X~2=18.633,P=0.000).在WB确认阳性、不确定、阴性组,均存在S/CO值[样本(sample)吸光度值/临界值(cut off)]＜6或≥6的样本.中山试剂确认阳性组S/CO值(14.29±2.63)明显高于阳性-阴性组(2.80±3.25)(t=17.652,P=0.000).梅里埃试剂确认阳性组S/CO值(16.09±2.35)明显高于阳性-阴性组(2.14±1.91)(t=31.622,P=0.000).丽珠试剂确认阳性组S/CO值(11.54±1.95)明显高于阳性-不确定组(5.54±3.57)(t=6.386,P=0.000)、阳性-阴性组(3.25±2.41)(t=21.772,P=0.000);阳性-不确定组S/CO值则高于阳性-阴性组(t=2.301,P=0.033).结论 4种筛查试剂性能良好,根据S/CO值不能准确估计WB确认结果,筛查阳性后必须进行确认.]
Research Center for Gastroenterology and Liver Diseases,Shahid Beheshti University of Medical Sciences,Taleghani H Arad General Hospital
[BACKGROUND:The major issue with intraoperative cholangiography (IOC) is whether its diagnostic accuracy for common bile duct (CBD) stones matches that of other diagnostic procedures,and thus,whether it will become a routine diagnostic procedure.The current study aimed to address the main determinants of CBD stone diagnosis in IOC among an Iranian population.METHODS:In a retrospective review database-based study conducted in Taleghani Hospital in Tehran between 2006 and 2008,baseline data and perioperative information of 2060 patients (male to female ratio 542:1518,mean age 53.7 years) who were candidates for cholecystectomy and underwent concomitant IOC for confirming CBD stones were reviewed.The predictive power of this procedure for diagnosis of abnormal biliary ducts with the focus on biliary stones was determined.RESULTS:Overall mortality and morbidity following cholecystectomy in the study population were 0.6% and 2.6%,respectively.Both early mortality and morbidity due to cholecystectomy were higher in male than female.The prevalence of CBD stones in IOC was 3.4% (5.2% in male and 2.8% in female,P=0.008).Among those without gallstones,8.7% had CBD stones and only 3.1% had concomitant gallstones and CBD stones.The main predictors of stone appearance as an abnormal feature of IOC during cholecystectomy were:advanced age (OR=1.022,P=0.001),male gender (OR=1.498,P=0.050),history of abdominal surgery (OR=1.543,P=0.040) and preoperative endoscopic retrograde cholangiopancreatography (OR=5.400,P&0.001).CONCLUSIONS:IOC is a safe and accurate method for the assessment of bile duct anatomy and stones.Therefore,the routine use of IOC within cholecystectomy seems reasonable and is recommended.]
Discipline of Medical Imaging,Department of Imaging and Applied Physics,Curtin University,GPO Box U1987 Perth,Western Australia 6845,Australia
[Coronary artery disease is the leading cause of death in advanced countries and its prevalence is increasing among the developing countries.Cardiac computed tomography(CT) has been increasingly used in the diagnosis of coronary artery disease due to its rapid improvements in multislice CT scanners over the last decade,and this less-invasive technique has become a potentially effective alternative to invasive coronary angiography.Quantifying the amount of coronary artery calcium with cardiac CT has been widely accepted as a reliable non-invasive technique for predicting risk of future cardiovascular events.However,the main question that remains uncertain is whether routine,widespread coronary artery calcium scoring in an individual patient will result in an overall improvement in quality of care and clinical outcomes.In this commentary,we discuss a current issue of the clinical value of coronary artery calcium scoring with regard to its value of predicting adverse cardiac events.We also discuss the applications of coronary artery calcium scores in patients with different risk groups.]
[Background Some studies found that cholinesterase (ChE) can be an independent risk factor for patients with multiple organ dysfunction syndrome.To assess aged patients with systemic inflammatory response syndrome (SIRS) early and predict their prognosis,the predictive value of ChE for the prognosis of aged patients with SIRS was analyzed.Methods From September 2009 to September 2010,all aged patients with SIRS in the ICU of the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed if they met inclusion criteria:patients aged ＞65 years and met American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference criteria for SIRS.Serum ChE,albumin,D-dimer,lactic acid and C-reactive protein (CRP) were measured,and the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ and Glasgow Coma Scale (GCS) scores were evaluated within the first 24 hours in the ICU.Fisher's exact test was used for comparison of the primary disease between the deceased group and surviving group.For comparison of study variables between the two groups,the Student's t test or Mann-Whitney U test was used.Multivariate significance was tested with binary Logistic regression analysis.Results The clinical data of 124 aged patients with SIRS were collected and analyzed.Sixty-six patients (46 male,20female,mean age (78.70±8.08) years) who died were included in the deceased group and 58 patients (34 male,24female,mean age (76.02±6.57) years) who survived were included in the surviving group.There were no significant differences in age,gender,APACHE Ⅱ score and GCS score between the deceased group and surviving group (all P＞0.05),but there were significant differences in lactic acid (P=0.011),D-dimer (P=0.011),albumin (P=0.007),CRP (P=0.008),and ChE (P ＜0.0001).The correlation analysis showed that the APACHE Ⅱ score and CRP were not correlated with ChE (both P ＜0.05).D-dimer and albumin were correlated with ChE (Spearman's rho correlation coefficients were-0.206 and 0.324,the corresponding P values were 0.022 and ＜0.0001).Multiple Logistic regression analysis showed that age,gender,lactic acid,D-dimer,albumin,CRP,APACHE Ⅱ score,and GCS score were not independent risk factors for prognosis of aged patients with SIRS,but that ChE was (P ＜0.0001).The receiver operating characteristic curve of ChE had an area under the curve of 0.797 (standard error=0.04;P ＜0.0001),and a ChE of 103.00U/L was the cut-off value with sensitivity=0.793,specificity=0.742.Conclusion Serum ChE might be a predictive marker for the prognosis of aged patients with SIRS,with low serum ChE levels indicating poor prognosis.]
烟台龙矿中心医院内一科,山东烟台,265700
[目的探讨介入术后 D-二聚体(DD)变化及其起对血栓性疾病的预测价值。方法180例行心血管介入治疗的患者在术前及术后第1、2、3天对 DD 进行定量地测定，若测定 DD 的值＞正常值的2倍（即≥1000μg/L），则应在第7天、14天再次对 DD 值加以测定。结果①本组患者术后第3天 DD 值较术前出现显著性升高术前为（311.32±22.31）μg/L，术后为（489.82±33.17）μg/L，（P ＜0.01）；②各组患者术后1、2、3d DD 均较术前有了显著性的升高（P ＜0.01）；③本组患者有29例患者 DD 显著升高，其中6例为持续性升高，3例为冠状动脉支架内急性闭塞，2例未深静脉血栓形成，1例未肺栓塞。结论心血管介入诊疗术后患者的血液中的 DD 会升高，DD 值持续性升高则显示血栓性疾病的发生，因此 DD 值能对血栓性疾病的预测具有一定的价值与意义。]
中山大学孙逸仙纪念医院妇产科,广州,510120; 中山大学孙逸仙纪念医院妇产科,广州,510120; 中山大学孙逸仙纪念医院妇产科,广州,510120; 中山大学孙逸仙纪念医院妇产科,广州,510120; 中山大学中山医学院临床医学系,广州,510120; 中山大学中山医学院临床医学系,广州,510120; 中山大学中山医学院临床医学系,广州,510120; 中山大学孙逸仙纪念医院妇产科,广州,510120
[目的 了解广东省育龄期汉族妇女体毛生长状况,探讨年龄、月经紊乱以及多囊卵巢对终毛生长状况的影响,并提出改良Ferriman-Gallwey (mFG)评分系统对多毛症的评分诊断界值.方法 2008年6月至2009年7月采用四级系统随机抽样的方法,抽取广东省两个城市和两个农村共16个社区的育龄期(20 ～ 45岁)妇女2988例,采用mFG评分系统对体毛分布进行评价,并用K-聚类分析法计算多毛症的诊断界值.按照不同的年龄分组(20～岁组982例、26～岁组765例、31～岁组597例、36～岁组384例、41～45岁组260例)；因部分数据记录错误或缺失,导致部分病例从组别中删除,最终根据有、无月经紊乱,有、无多囊卵巢分为月经紊乱组488例、月经正常组2413例,多囊卵巢组568例、非多囊卵巢组2207例,比较各组多毛症mFG评分系统诊断界值,以及各组多毛症妇女痤疮、月经紊乱、黑棘皮症和多囊卵巢的发生率.结果 (1)在2988例妇女中,mFG评分系统≥7分149例(5.0％),≥5分314例(10.5％),≥2分747例(25.0％).(2)在总人群中,多毛症mFG评分系统诊断界值为≥5分；月经紊乱组和多囊卵巢组mFG评分系统评分第90、95百分位数均分别低于月经正常组、非多囊卵巢组(P均＜0.05).(3)年龄分组结果显示:mFG评分系统相应百分位数和多毛症诊断界值均随着年龄增加而下降(P＜0.05)；多毛症mFG评分系统诊断界值在20～岁组为≥6分,26～岁组为≥5分,而31～岁组、36～岁组、41 ～45岁组则均为≥4分.(4)总人群中多毛症妇女痤疮、月经紊乱、多囊卵巢发生率分别为45.5％ (143/314)、73.6％ (231/314)、25.8％ (81/314),正常毛发妇女分别为25.1％(671/2674)、16.1％ (431/2674)、19.8％(529/2674),两者分别比较,差异均有统计学意义(P＜0.05)；各年龄组多毛症妇女痤疮、月经紊乱、黑棘皮症发生率分别为44.4％(130/293)、23.2％(68/293)、4.1％(12/293),正常毛发妇女分别为25.3％(681/2695)、16.2％(437/2695)、1.9％ (51/2695),两者分别比较,差异均有统计学意义(P＜0.05).结论 (1) mFG评分系统评价广东省育龄期汉族妇女的体毛生长程度随着年龄增加而降低.(2)mFG≥5分为多毛症诊断界值.(3)多毛症妇女痤疮、月经紊乱及多囊卵巢发生率明显升高.]
Division of Gastroenterology and Hepatology, University of Illinois Peoria Campus, OSF Saint Francis Medical Center,Peoria, IL 61637, United S Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center,Peoria, IL 61637, United S Division of Gastroenterology and Hepatology, University of Missouri-Columbia,Columbia, MS 65212, United S Department of Surgery,University of Illinois Peoria Campus, OSF Saint Francis Medical Center,Peoria, IL 61637, United S Interventional Endoscopy Services, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School,Boston, MA 02114, United States
[AIM: To detect pancreatic neuroendocrine tumors (PNETs) has been varied. This study is undertaken to evaluate the accuracy of endoscopic ultrasound (EUS) in detecting PNETs.METHODS: Only EUS studies confirmed by surgery or appropriate follow-up were selected. Articles were searched in Medline, Ovid journals, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Pooling was conducted by both fixed and random effects model). RESULTS: Initial search identified 2610 reference articles, of these 140 relevant articles were selected and reviewed. Data was extracted from 13 studies (n = 456) which met the inclusion criteria. Pooled sensitivity of EUS in detecting a PNETs was 87.2% (95%CI: 82.2-91.2). EUS had a pooled specificity of 98.0% (95%CI: 94.3-99.6). The positive likelihood ratio of EUS was 11.1 (95%CI: 5.34-22.8) and negative likelihood ratio was 0.17 (95%CI: 0.13-0.24). The diagnostic odds ratio, the odds of having anatomic PNETs in positive as compared to negative EUS studies was 94.7 (95%CI: 37.9-236.1). Begg-Mazumdar bias indicator for publication bias gave a Kendall’s tau value of 0.31 (P = 0.16), indication no publication bias. The P for χ2 heterogeneity for all the pooled accuracy estimates was & 0.10. CONCLUSION: EUS has excellent sensitivity and specificity to detect PNETs. EUS should be strongly considered for evaluation of PNETs.]
Department of Gastroenterology,the Second Affiliated Hospital,Zhejiang University School of M Department of Surgery,the Second Affiliated Hospital,Zhejiang University School of M Binjiang Hospital,the Second Affiliated Hospital(Binjiang Branch),Zhejiang University School of M Department of Ultrasonography,the Second Affiliated Hospital,Zhejiang University School of M Department of Radiology,the Second Affiliated Hospital,Zhejiang University School of Medicine
[AIM:To quantitatively assess the ability of double contrast-enhanced ultrasound(DCUS) to detect tumor early response to pre-operative chemotherapy.METHODS:Forty-three patients with gastric cancer treated with neoadjuvant chemotherapy followed by curative resection between September 2011 and February 2012 were analyzed.Pre-operative chemotherapy regimens of fluorouracil + oxaliplatin or S-1 + oxaliplatin were administered in 2-4 cycles over 6-12 wk periods.All patients underwent contrast-enhanced computed tomography(CT) scan and DCUS before and after two courses of pre-operative chemotherapy.The therapeutic response was assessed by CT using the response evaluation criteria in solid tumors(RECIST 1.1) criteria.Tumor area was assessed by DCUS as enhanced appearance of gastric carcinoma due to tumor vascularity during the contrast phase as compared to the normal gastric wall.Histopathologic analysis was carried out according to the Mandard tumor regression grade criteria and used as the reference standard.Receiver operating characteristic(ROC) analysis was used to evaluate the efficacy of DCUS parameters in differentiating histopathological responders from non-responders.RESULTS:The study population consisted of 32 men and 11 women,with mean age of 59.7 ± 11.4 years.Neither age,sex,histologic type,tumor site,T stage,nor N stage was associated with pathological response.The responders had significantly smaller mean tumor size than the non-responders(15.7 ± 7.4 cm vs 33.3 ± 14.1 cm,P & 0.01).According to Mandard’s criteria,27 patients were classified as responders,with 11(40.7%) showing decreased tumor size by DCUS.In contrast,only three(18.8%) of the 16 non-responders showed decreased tumor size by DCUS(P & 0.01).The area under the ROC curve was 0.64,with a 95%CI of 0.46-0.81.The effects of several cut-off points on diagnostic parameters were calculated in the ROC curve analysis.By maximizing Youden’s index(sensitivity + specificity-1),the best cut-off point for distinguishing responders from non-responders was determined,which had optimal sensitivity of 62.9% and specificity of 56.3%.Using this cut-off point,the positive and negative predictive values of DCUS for distinguishing responders from non-responders were 70.8% and 47.4%,respectively.The overall accuracy of DCUS for therapeutic response assessment was 60.5%,slightly higher than the 53.5% for CT response assessment with RECIST criteria(P = 0.663).Although the advantage was not statistically significant,likely due to the small number of cases assessed.DCUS was able to identify decreased perfusion in responders who showed no morphological change by CT imaging,which can be occluded by such treatment effects as fibrosis and edema.CONCLUSION:DCUS may represent an innovative tool for more accurately predicting histopathological response to neoadjuvant chemotherapy before surgical resection in patients with locally-advanced gastric cancer.]
Supported by National Science Foundation of China,No. ; Projects of the Health Bureau of Zhejiang Province, No. and 2011KYB037
100029,首都医科大学附属北京安贞医院超声科; 100029,首都医科大学附属北京安贞医院全科医学科; 100029,首都医科大学附属北京安贞医院超声科; 100029,首都医科大学附属北京安贞医院心内科十五病房; 100029,首都医科大学附属北京安贞医院全科医学科
756-757,760
[目的 应用超声观察临床疑诊冠心病患者的颈动脉斑块稳定性及斑块的病理性质,探讨其对冠心病发生发展的预测价值.方法 对92例疑诊冠心病的住院患者行冠状动脉造影及颈动脉超声检查,根据颈动脉斑块的稳定性不同分为斑块稳定组(41例)及斑块不稳定组(51例),比较2组患者冠心病发病率,评估颈动脉稳定性检查对冠心病的预测价值；根据斑块的病理性质分为硬斑组(12例)、软斑组(27例)、混合斑组(53例),比较三组患者冠状动脉病变的严重程度,评估颈动脉斑块病理性质检查对冠心病进展的预测价值.结果 斑块不稳定组较斑块稳定组冠心病比较明显较多[74.5％(38/51)比31.7％(13/41)],混合斑组冠状动脉重度狭窄的患者比例较硬斑组明显较多[73.6％ (39/53)比16.7％ (2/12)],软斑组非冠心病的患者比例较混合斑组明显较多[81.5％(22/27)比9.4％(5/53)],差异有统计学意义(P＜0.05).结论 应用超声检查颈动脉斑块的稳定性并判断斑块的病理性质对提示心血管疾病患者冠心病的发生发展有着良好的预测价值.]
首都医科大学基础临床合作课题(项目编号：12JL58)安贞医院院长基金(项目编号：2012Z05)
Department of Surgery,Institute of Clinical Sciences,Sahlgrenska University Hospital/?stra,41685 Gothenburg,S Sahlgrenska Academy,Department of Radiology,Sahlgrenska University Hospital/?stra,41685 Gothenburg,Sweden
[AIM: To assess the stage and size of rectal tumours using 1.5 Tesla (1.5T) magnetic resonance imaging (MRI) and three-dimensional (3D) endosonography (ERUS). METHODS: In this study, patients were recruited in a phaseⅠ/Ⅱ trial of neoadjuvant chemotherapy for biopsy-proven rectal cancer planned for surgical resection with or without preoperative radiotherapy. The feasibility and accuracy of 1.5T MRI and 3D ERUS were compared with the histopathology of the fixed surgical specimen (pathology) to determine the stage and size of the rectal cancer before and after neoadjuvant chemotherapy. A Philips Intera 1.5T with a cardiac 5-channel synergy surface coil was used for the MRI, and a B-K Medical Falcon 2101 EXL 3D-Probe was used at 13 MHz for the ERUS. Our hypothesis was that the staging accuracy would be the same when using MRI, ERUS and a combination of MRI and ERUS. For the combination, MRI was chosen for the assessment of the lymph nodes, and ERUS was chosen for the assessment of perirectal tissue penetration. The stage was dichotomised into stageⅠ and stage Ⅱ or greater. The size was measured as the supero-inferior length and the maximal transaxial area of the tumour. RESULTS: The staging feasibility was 37 of 37 for the MRI and 29 of 36 for the ERUS, with stenosis as a limiting factor. Complete sets of investigations were available in 18 patients for size and 23 patients for stage. The stage accuracy by MRI, ERUS and the combination of MRI and ERUS was 0.65, 0.70 and 0.74, respectively, before chemotherapy and 0.65, 0.78 and 0.83, respectively, after chemotherapy. The improvement of the post-chemotherapy staging using the combination of MRI and ERUS compared with the staging using MRI alone was significant (P = 0.046). The post-chemotherapy understaging frequency by MRI, ERUS and the combination of MRI and ERUS was 0.18, 0.14 and 0.045, respectively, and these differences were non-significant. The measurements of the supero-inferior length by ERUS compared with MRI were within 1.96 standard deviations of the difference between the methods (18 mm) for tumours smaller than 50 mm. The agreement with pathology was within 1.96 standard deviations of the difference between imaging and pathology for all tumours with MRI (15 mm) and for tumours that did not exceed 50 mm with ERUS (22 mm). Tumours exceeding 50 mm in length could not be reliably measured by ERUS due to the limit in the length of each recording. CONCLUSION: MRI is preferable to use when assessing the size of large or stenotic rectal tumours. However, staging accuracy is improved by combining MRI with ERUS.]
Supported by The Gothenburg Medical Association,the Lions Cancerfond V?st and the Bj?rnsson Foundation
[AIM: To analyze the performance value of high risk factors in population-based colorectal cancer (CRC) screening in China. METHODS: We compared the performance value of the immunochemical fecal occult blood test (iFOBT) and other high risk factors questionnaire in a population sample of 13 214 community residents who completed both the iFOBT and questionnaire investigation. Patients with either a positive iFOBT and/or questionnaire were regarded as a high risk population and those eligible were asked to undergo colonoscopy. RESULTS: The iFOBT had the highest positive predictive value and negative predictive value in screening for advanced neoplasia. The iFOBT had the highest sensitivity, lowest number of extra false positive results associated with the detection of one extra abnormality for screening advanced neoplasias and adenomas. A history of chronic cholecystitis or cholecystectomy, chronic appendicitis or appendectomy, and chronic diarrhea also had a higher sensitivity than a history of adenomatous polyps in screening for advanced neoplasias and adenomas. The sensitivity of a history of chronic cholecystitis or cholecystectomy was highest among the 10 high risk factors in screening for nonadenomatous polyps. A history of chronic appendicitis or appendectomy, chronic constipation, chronic diarrhea, mucous and bloody stool, CRC in first degree relatives, malignant tumor and a positive iFOBT also had higher sensitivities than a history of adenomas polyps in screening for non-adenomatous polyps. Except for a history of malignant tumor in screening for non-adenomatous polyps, the gain in sensitivity was associated with an increase in extra false positive results associated with the detection of one extra abnormality. CONCLUSION: The iFOBT may be the best marker for screening for advanced neoplasias and adenomas. Some unique high risk factors may play an important role in CRC screening in China.]
Department of Gastroenterology,Royal Cornwall Hospital,Truro,Cornwall TR1 3LJ,United K Research and Development,Knowledge Spa,Royal Cornwall Hospital,Truro,Cornwall TR1 3LJ,United Kingdom
[AIM:To determine which features of history and demographics predict a diagnosis of malignancy or peptic stricture in patients presenting with dysphagia.METHODS:A prospective case-control study of 2000 consecutive referrals(1031 female,age range:17-103 years) to a rapid access service for dysphagia,based in a teaching hospital within the United Kingdom,over 7 years.The service consists of a nurse-led telephone triage followed by investigation(barium swallow or gastroscopy),if appropriate,within 2 wk.Logistic regression analysis of demographic and clinical variables was performed.This includes age,sex,duration of dysphagia,whether to liquids or solids,and whether there are associated features(reflux,odynophagia,weight loss,regurgitation).We determined odds ratio(OR) for these variables for the diagnoses of malignancy and peptic stricture.We determined the value of the Edinburgh Dysphagia Score(EDS) in predicting cancer in our cohort.Multivariate logistic regression was performed and P & 0.05 considered significant.The local ethics committee confirmed ethics approval was not required(audit).RESULTS:The commonest diagnosis is gastro-esophageal reflux disease(41.3%).Malignancy(11.0%) and peptic stricture(10.0%) were also relatively common.Malignancies were diagnosed by histology(97%) or on radiological criteria,either sequential barium swallows showing progression of disease or unequivocal evidence of malignancy on computed tomography.The majority of malignancies were esophago-gastric in origin but ear,nose and throat tumors,pancreatic cancer and extrinsic compression from lung or mediastinal metastatic cancer were also found.Malignancy was statistically more frequent in older patients(aged &73 years,OR 1.1-3.3,age & 60 years 6.5%,60-73 years 11.2%,& 73 years 11.8%,P & 0.05),males(OR 2.2-4.8,males 14.5%,females 5.6%,P & 0.0005),short duration of dysphagia(≤ 8 wk,OR 4.5-20.7,16.6%,8-26 wk 14.5%,& 26 wk 2.5%,P & 0.0005),progressive symptoms(OR 1.3-2.6:progressive 14.8%,intermittent 9.3%,P & 0.001),with weight loss of ≥ 2 kg(OR 2.5-5.1,weight loss 22.1%,without weight loss 6.4%,P & 0.0005) and without reflux(OR 1.2-2.5,reflux 7.2%,no reflux 15.5%,P & 0.0005).The likelihood of malignancy was greater in those who described true dysphagia(food or drink sticking within 5 s of swallowing than those who did not(15.1%vs 5.2% respectively,P & 0.001).The sensitivity,specificity,positive predictive value and negative predictive value of the EDS were 98.4%,9.3%,11.8% and 98.0% respectively.Three patients with an EDS of 3(high risk EDS ≥ 3.5) had malignancy.Unlike the original validation cohort,there was no difference in likelihood of malignancy based on level of dysphagia(pharyngeal level dysphagia 11.9% vs mid sternal or lower sternal dysphagia 12.4%).Peptic stricture was statistically more frequent in those with longer duration of symptoms(& 6 mo,OR 1.2-2.9,≤ 8 wk 9.8%,8-26 wk 10.6%,& 26 wk 15.7%,P & 0.05) and over 60 s(OR 1.2-3.0,age & 60 years 6.2%,60-73 years 10.2%,& 73 years 10.6%,P & 0.05).CONCLUSION:Malignancy and peptic stricture are frequent findings in those referred with dysphagia.The predictive value for associated features could help determine need for fast track investigation whilst reducing service pressures.]
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