摘要：对急腹症诊断中,腹部16排CT的具体方法展开研究,评估其应用价值及精准度,对诊断结果等进行分析。方法 在进行实验设计时,通过样本计算公式,本次研究共纳入100例样本,均为疑似急腹症患者,均实施16排CT诊断,且以手术病理诊断结果为金标准,对CT诊断与金标准进行相关指标的对比分析,来间接了解16排CT对急腹症的诊断精确度及相关价值意义。结果 100例疑似患者经手术病理学诊断确诊的有60例,占比为60.00%,腹部16排CT诊断确诊58例,占比为58.00%,表明手术病理学诊断结果与腹部16排CT诊断结果差异小(P>0.05);腹部16排CT诊断灵敏度、准确性、阳性预测值、阴性预测值、特异度均较高,分别为95.00%(38/40)、96.55%(56/58)、93.33%(56/60)、94.00%(94/100)、90.48%(38/42);误诊及漏诊率较低,分别为5.00%(4/42)、6.67%(2/58)。结论 腹部16排CT诊断价值较高,具有较高的灵敏度、准确性,对指导后续有效治疗具有积极意义,因而适合普及使用。

摘要：背景:上消化道内镜检查时意外发现的胃息肉大多都是低风险的,但目前的指南推荐对所有的胃息肉都进行活检以进行组织病理学分析。我们设计了一个简单的窄带成像(NBI)分型,旨在减少对低危胃息肉的常规活检。方法:筛选出具有组织病理学诊断的73枚息肉,提取其NBI影像和白光影像,进行诊断性队列研究。两名并不清楚息肉性质的内镜医生对每枚息肉的NBI特征进行独立评估,包括颜色、血管模式和表面结构,并将这些特征进行各种组合,从而建立一个分型标准,以鉴别低危息肉(基底腺性或增生性息肉)与高危息肉(腺瘤或腺癌)以及基底腺性息肉(FGP)和非FGP。结果:孤立网状的血管模式和均质或缺失的表面结构可有效鉴别低危与高危胃息肉。将这两个特征相结合来诊断高危息肉,可获得100%的阴性预测值(95%CI:100%-100%),阳性预测值为13.7%(95%CI:2.6%-24.8%),灵敏度和特异度分别为100%(95%CI:100%-100%)和53.7%(95%CI:45.3%-62.0%);可将需要活检的息肉数量减少50%的同时,不会漏掉一例高危息肉。采用孤立网状的血管模式来判断无需活检的FGP,其阴性预测值高达94.9%(95%CI:89.2%-100%),阳性预测值为63.2%(95%CI:47.2%-79.2%),灵敏度和特异度分别为94.8%(95%CI:89.5%-100%)和63.6%(95%CI:51.3%-76.0%)。结论:这项推导性队列研究发现,NBI有助于高危与低危胃息肉的鉴别,从而对减少低危息肉的常规活检。这些结果需要在不同的研究人群中进行验证。

摘要：背景:人类白细胞抗原-B27与强直性脊柱炎等风湿病发病密切关联,对强直性脊柱炎有重要的辅助诊断价值。磁珠酶联免疫分析近来已应用于检测人类白细胞抗原-B27。目的:了解磁珠酶联免疫分析法检测人类白细胞抗原-B27的准确性、敏感性和特异性,探讨其在强直性脊柱炎辅助诊断中的价值。设计:金标准对照。单位:中山大学附属第三医院风湿科及检验科。对象:选择2002-12/2003-04首次于本院风湿科门诊或住院有腰痛和/或关节炎表现的86例患者。纳入标准:①有下腰痛和/或关节炎表现;②相关临床及辅助检查资料完整;③同意接受人类白细胞抗原-B27检测;④为首次在本院就诊或住院患者。排除临床或辅助检查资料不完整及患其他重大疾病者。86例患者中男56例,女30例,年龄12～65岁。方法:同时以磁珠酶联免疫分析和微量淋巴细胞毒试验法对入选患者血标本进行检测。以微量淋巴细胞毒试验法测定结果为金标准,统计两法结果的符合率,并计算磁珠酶联免疫分析检测人类白细胞抗原-B27的敏感度、特异度及阳性、阴性预测值。主要观察指标:①两种方法对人类白细胞抗原-B27检测结果的符合率。②磁珠酶联免疫分析检测人类白细胞抗原-B27的敏感度及特异度。结果:所有患者均进入结果分析。①对于33例强直性脊柱炎患者,磁珠酶联免疫分析检测人类白细胞抗原-B27的阳性率(90.9%)高于微量淋巴细胞毒试验法(87.9%),但差异无显著性意义(P>0.05)。②应用两法对33例强直性脊柱炎和53例有下腰痛和/或关节炎症状的其他患者测定人类白细胞抗原-B27,结果的总体符合率达93.0%。磁珠酶联免疫分析检测的敏感度为90.0%,特异度为95.7%,阳性预测值为94.7%,阴性预测值为91.7%。结论:对于强直性脊柱炎和其他风湿病患者,磁珠酶联免疫分析与微量淋巴细胞毒试验法均能可靠地检测人类白细胞抗原-B27,磁珠酶联免疫分析的敏感度和特异度均已达较高水平。

摘要：Objective: To compare digital and ultrasonographic cervical examination for the prediction of preterm delivery in patients hospitalized for preterm labor. Study design: Fiftynine patients were included. The Bishop score was evaluated upon admission, weeks gestational age. Ultrasonographic measurement of cervical length was done within 24 h after entry. Delivery before 37 weeks gestational age was the primary endpoint. Attending obstetricians were blinded to the results of echography. Results: Preterm delivery rate was 39%(23/59). The risk of preterm delivery was significantly increased when the Bishop score was greater than or equal to 6 (OR=4.45 [1.41-14.01]) or when ultrasonographic cervical length was less than or equal to 27 mm (OR=4.04 [1.32-12.3]), but digital examination was the only independent risk factor in multivariate analysis. Sensitivity, specificity, positive and negative predictive value for digital examination and ultrasonography were respectively 74, 61, 55 and 79%, 70, 64, 55 and 77%. Combination of digital examination and ultrasonography did not yield better results. Conclusion: In our series, prediction of preterm delivery was not improved by ultrasonography compared to digital examination. The size of the cervical shift observed in most patients hospitalized for preterm labor may render ultrasonography less relevant in identifying patients anticipated to deliver prematurely.

摘要：背景传染性软疣(molluscum contagiosum,MC)可根据其特征做出诊断。父母MC诊断可降低焦虑、减少初级保健咨询,尤其利于大规模的流行病学研究。然而截止到目前,尚无有关父母用MC诊断有效工具的文献发表。目的父母用MC诊断工具(molluscum contagiosum diagnostic tool for parents,MCDTP)的开发与验证。设计与场所开发MCDTP,将其诊断准确性与南威尔士全科医生的诊断进行比较。方法开发含3个阶段。父母在候诊室完成MCDTP(指标性测试),并且评估他们的诊断信心。之后由全科医生确定他们的孩子是否为MC(参考性测试)。对所有父母和那些表示对他们的诊断有信心或很有信心的测试特性做出评价。结果有203位儿童父母完成了MCDTP。所有父母MCDTP的灵敏度为91.5%〔95%CI(81.3%,97.2%)〕,特异度为88.2%〔95%CI(81.8%,93.0%)〕;对诊断有信心或很有信心的父母的灵敏度为95.8%〔95%CI(85.7%,99.5%)〕,特异度为90.9%〔95%CI(83.9%,95.6%)〕。所有父母的阳性预测值为76.1%〔95%CI(64.5%,85.4%)〕,阴性预测值为96.2%〔95%CI(91.4%,98.8%)〕。结论与全科医生诊断相比较,MCDTP效果良好,适合临床上儿童父母使用,也可用于人口学研究。

摘要：Objective: B- type natriuretic peptide (BNP) is synthesized in cardiac ventricles in response to volume expansion. This study evaluated BNP levels to determine trends during pregnancy, and to assess BNP as a diagnostic tool in preeclampsia. Study design: We studied 163 BNP levels in 118 pregnant women, ranging from first trimester to term. An additional 34 patients with preeclampsia were studied and compared to 25 normal control patients at term. Plasma BNP values were determined using a standard assay. Results: The median BNP levels during the 1st, 2nd, 3rd trimester, and at term were equivalent (18.4, 17.9, 15.5, and 17.8 pg/mL, respectively, P = .796). The median BNP levels in normal patients, mild preeclamptics, and severe preeclamptics were 17.8, 21.1, and 101 pg/mL, respectively, with the severe group being significantly higher than the mild group (P=.003) and any phase of normal pregnancy (P <.001 in each case). A BNP cut-off of < 40.6 pg/mL had a negative predictive value of 92% in excluding preeclampsia. Conclusion: In normal pregnancies, median BNP values are < 20 pg/mL, and stable throughout gestation. In severe preeclampsia BNP levels are elevated. This may reflect ventricular stress and/or subclinical cardiac dysfunction associated with preeclampsia.

摘要：Existing predictor systems of severe pancreatitis are cumbersome and can requ ire up to 48 hr to complete. This study aimed to determine whether useful likeli hood ratios exist for the prediction of severe pancreatitis, corresponding to va rious ranges of admission hematocrit. A retrospective cohort of 200 patients adm itted with acute pancreatitis was identified. Likelihood ratios were calculated for a priori defined hematocrit ranges. Using multivariate logistic regression, initial hematocrit was evaluated as a predictor of severe pancreatitis as define d a priori by local and/or systemic complications (Atlanta criteria, 1992). Plan ned subgroup analysis was performed on those with a hematocrit >50% , stratifie d by 24- hr hematocrit. Fourteen patients (7% ) developed severe pancreatitis. Likelihood ratios were 0.45, 0.70, and 7.5 for hematocrit ranges of≤ 45,45.1- 49.9, and ≥ 50% , respectively. Hematocrit (as increases by 5% ) was a signi ficant predictor of severe pancreatitis (odds ratio [OR] = 2.8; P = 0.001), leng th of stay (P < 0.0001), necrosis (OR = 3.9; P = 0.001), and need for intensive care (OR 4.5; P = 0.002). The negative predictive value of the lowest range and positive predictive value of the highest range were 97% (95% Cl: 92- 99% ) and 37% (16- 62% ), respectively. Lack of normalization of hematocrit by 24 hr did not predict severe pancreatitis. Initial hematocrit appears to be an ear ly, simple, and useful predictor of severe pancreatitis. A normal 24- hr hemato crit does not appear to alter the prediction made by the initial hematocrit.

摘要：背景:多探头CT(MDCT)已被推荐作为评估冠状动脉解剖结构的无创性方法。目的:在多中心研究中确定采用16层CT基于独特的定量分析方法检测阻塞性冠状动脉疾病的诊断准确度。设计、机构和患者:自11个参与地点前瞻性纳入2004年6月至2005年3月间临床转诊拟行非急诊冠状动脉造影的238例患者。