地中海贫血高发地区的贫血性疾病诊断思维

广西地中海贫血(thalassemia,地贫)携带率高达24.51%,是本地区最常见的贫血性疾病,易影响其他类型贫血的临床表现.地贫高发区诊断贫血性疾病时需注意:诊断时需想到地贫;诊断困惑时需考虑合并地贫;确诊地贫者需反思能否解释临床症状.从而提高诊断准确率、减少误诊.     

心肾贫血综合征的系统思维

心肾贫血综合征在慢性肾脏疾病患者和慢性心衰患者中大有人在,并日益受到医生重视,对其的正确认识及治疗直接影响患者的疾病预后.因此我们深入认识心肾贫血综合征及研究新的临床防治策略时,有必要着眼于心肾贫血综合征的内在特征并运用系统学方法原理分析其特点,为临床防治提供科学指导。     

心肾贫血综合征的系统思维

心肾贫血综合征在慢性肾脏疾病患者和慢性心衰患者中大有人在,并日益受到医生重视,对其的正确认识及治疗直接影响患者的疾病预后,因此我们深入认识心肾贫血综合征及研究新的临床防治策略时,有必要着眼于心肾贫血综合征的内在特征并运用系统学方法原理分析其特点,为临床防治提供科学指导.     

再生障碍性贫血发病机制的探讨

目前再生障碍性贫血发病机制有如下解释造血干(祖)细胞缺陷;造血微环境功能缺陷;免疫功能紊乱。这些解释显示着深刻的哲学意义,正确地应用哲学思维将有助于对再生障碍性贫血发病机制的进一步深入研究。     

再生障碍性贫血发病机制的探讨

目前再生障碍性贫血发病机制有如下解释:造血干(祖)细胞缺陷;造血微环境功能缺陷;免疫功能紊乱.这些解释显示着深刻的哲学意义,正确地应用哲学思维将有助于对再生障碍性贫血发病机制的进一步深入研究.     

流式细胞术在骨髓增生异常综合征及再生障碍性贫血诊断中的应用

为探讨骨髓增生异常综合征患者与再生障碍性贫血患者骨髓髓系细胞的免疫表型变化,用流式细胞术检测骨髓增生异常综合征、再生障碍性贫血及正常对照髓系细胞的表面抗原。结果显示骨髓增生异常综合征组髓系细胞较正常对照组及再生障碍性贫血组表面抗原表达明显不同。因此,流式细胞术有助于二者的诊断及鉴别诊断。     

流式细胞术在骨髓增生异常综合征及再生障碍性贫血诊断中的应用

为探讨骨髓增生异常综合征患者与再生障碍性贫血患者骨髓髓系细胞的免疫表型变化,用流式细胞术检测骨髓增生异常综合征、再生障碍性贫血及正常对照髓系细胞的表面抗原。结果显示骨髓增生异常综合征组髓系细胞较正常对照组及再生障碍性贫血组表面抗原表达明显不同。因此,流式细胞术有助于二者的诊断及鉴别诊断。     

流式细胞术在骨髓增生异常综合征及再生障碍性贫血诊断中的应用

为探讨骨髓增生异常综合征患者与再生障碍性贫血患者骨髓髓系细胞的免疫表型变化,用流式细胞术检测骨髓增生异常综合征、再生障碍性贫血及正常对照髓系细胞的表面抗原.结果显示骨髓增生异常综合征组髓系细胞较正常对照组及再生障碍性贫血组表面抗原表达明显不同.因此,流式细胞术有助于二者的诊断及鉴别诊断.     

综合分析基础上重新认识再生障碍性贫血——从“综合征”到“自身免疫性疾病”

此前认为再生障碍性贫血是以多种机制导致骨髓造血功能衰竭以外周血细胞减少为特征的一组异质性疾病群,研究发现此类患者体内,CD3＋CD8＋T淋巴细胞数目增加、CD4＋／CD8＋T淋巴细胞比值降低、T细胞功能亢进、Th1型细胞因子分泌增多。综合分析认为再生障碍性贫血是以Th1细胞异常活化导致自身反应性T淋巴细胞功能亢进导致造血干祖细胞损伤的一种自身免疫性疾病。     

再生障碍性贫血发病机制认识的发展与启示

再生障碍性贫血的发病机制已经突破了“种子”、“土壤”、“虫子”学说,并沿着“免疫异常”理论进入“自身免疫病”理论。同时这是一个科学思维付诸实践不断探索的过程。大量证据表明再生障碍性贫血是一种自身免疫病,它应该符合自身免疫病的共性,这一认识开阔了人们的视野,使人们能在更高的层面上考察原来的事物。     

The problem of apparent schizophrenic symptoms in juveniles]

In the clinic we frequently come across cases of indistinct accentuated schizophrenic behaviour in youth. We mention here a casuistry which can be considered as a juvenile asthenic denial syndrome with coenaesthetic symptoms. This picture can be differentiated from coenaesthetic schizophrenia, hebephrenia, neurotic symptoms and physical psychoses which can be proven. The problem of differential diagnosis is considered with particular regard to progressive diagnosis.     

Psychopathology in Children with Thalassemia Major

The present work investigated the prevalence and spectrum of psychopathology in children with thalassemia. Childhood psychopathology measurement schedule (CPMS), adapted from Child Behavior Checklist was administered on children with thalassemia major receiving regular blood transfusion. Age and sex matched children with other chronic illness (bronchial asthma) served as controls. 46.7% of children with thalassemia had a CPMS score of > 10 as against 17.1% in the control group. Children with thalassemia had higher scores in factors of conduct problems, special symptoms and somatization. This study highlights the significantly higher psychopathology in children with thalassemia major and emphasizes the need for psychosocial support during treatment.     

外科疾病的发热

发热是临床上的一种常见症状,引起发热的原因很多,只有找到发热的原因才能做出正确的处理。启动临床思维必须掌握充分的临床资料,然后进行周密的鉴别诊断思维程序,首先排除引起发热的其他科疾病,再考虑外科原因。感染是外科发热最主要的原因,如果是手术病人,特别应该想到和手术有关的各种感染问题。思维惯性、思维顺性和思维惰性的误导是误诊的思维原因。     

Even in correctable search, some types of rare targets are frequently missed

Socially important visual search tasks, such as airport baggage screening and tumor detection, place observers in situations where the targets are rare and the consequences of failed detection are substantial. Recent laboratory studies have demonstrated that low target prevalence yields substantially higher miss errors than do high-prevalence conditions, in which the same targets appear frequently (Wolfe, Horowitz, & Kenner, 2005; Wolfe et al., 2007). Under some circumstances, this \ldprevalence effect\rd can be eliminated simply by allowing observers to correct their last response (Fleck & Mitroff, 2007). However, in three experiments involving search of realistic X-ray luggage images, we found that the prevalence effect is eliminated neither by giving observers the choice to correct a previous response nor by requiring observers to confirm their responses. This prevalence effect, obtained when no trial-by-trial feedback was given, was smaller than the effect obtained when observers searched through the same stimuli but were given trial-by-trial feedback about accuracy. We suggest that low prevalence puts pressure on observers in any search task, and that the diverse symptoms of that pressure manifest themselves differently in different situations. In some relatively simple search tasks, misses may result from motor or response errors. In other, more complex tasks, shifts in decision criteria appear to be an important contributor.     

早孕期诊断及其相关问题分析

早孕期诊断是早期诊断的一部分。将新方法应用于早孕期诊断时,应考虑其成本效益问题。早孕期咨询应注意孕妇的年龄特征、个体化诊断和社会伦理学问题,正确诠释诊断结果,让孕妇及其配偶共同参与诊断。     

A short note on the maximal point‐biserial correlation under non‐normality

The aim of this paper is to derive the maximal point‐biserial correlation under non‐normality. Several widely used non‐normal distributions are considered, namely the uniform distribution, t‐distribution, exponential distribution, and a mixture of two normal distributions. Results show that the maximal point‐biserial correlation, depending on the non‐normal continuous variable underlying the binary manifest variable, may not be a function of p (the probability that the dichotomous variable takes the value 1), can be symmetric or non‐symmetric around p = .5, and may still lie in the range from ?1.0 to 1.0. Therefore researchers should exercise caution when they interpret their sample point‐biserial correlation coefficients based on popular beliefs that the maximal point‐biserial correlation is always smaller than 1, and that the size of the correlation is always further restricted as p deviates from .5.     

Testing Manifest Monotonicity Using Order-Constrained Statistical Inference

Most dichotomous item response models share the assumption of latent monotonicity, which states that the probability of a positive response to an item is a nondecreasing function of a latent variable intended to be measured. Latent monotonicity cannot be evaluated directly, but it implies manifest monotonicity across a variety of observed scores, such as the restscore, a single item score, and in some cases the total score. In this study, we show that manifest monotonicity can be tested by means of the order-constrained statistical inference framework. We propose a procedure that uses this framework to determine whether manifest monotonicity should be rejected for specific items. This approach provides a likelihood ratio test for which the p-value can be approximated through simulation. A simulation study is presented that evaluates the Type I error rate and power of the test, and the procedure is applied to empirical data.     

Psychosocial Functioning in Children and Adolescents with Gastrointestinal Complaints and Disorders

The current study examined the prevalence and presentation of psychosocial symptoms in pediatric patients and their parents presenting for first time appointments at a gastroenterology (GI) clinic compared to healthy controls (HC). One hundred GI patients, aged 8-17 years, and their mothers were compared to 100 age- and gender-matched HC on measures of child and parental behavioral/psychosocial functioning, depression, and anxiety. Results revealed significant correlations between mother- and child-reported internalizing behaviors and psychological symptoms. Significant group differences were observed in internalizing problems, adaptive and social skills, and leadership competency, as well as parental interpersonal sensitivity, depression, phobic anxiety, and number of psychological symptoms. GI patients are at increased risk for psychosocial and social dysfunction compared to healthy peers. Psychosocial factors should be considered when assessing patients in GI clinics. Patients might benefit from treatment plans that involve adjunctive behavioral intervention to assist patients in managing their conditions.     

浅谈现代医学模式在影像诊断实践中的应用

医学模式由传统的生物型向生物心理社会医学模式转变需要全社会共同努力,影像诊断虽然＂见病不见病人＂,但通过影像诊断报告同样会向患者传递出对他们健康、疾病诊疗的指导和人文关怀,并能在化解医疗纠纷改善医患关系方面起到关键作用.因此影像诊断同样需要现代医学模式的指导,达到这一目标的必要途径,就要树立＂以人为中心＂的医学理念,把病人作为一个统一整体来考虑疾病的诊断,同时影像与临床资料相联系;加强影像报告的书写,描述既要客观,又要有目的性,结论尽量明晰,措词准确,通过字里行间的表达增加医患之间的信任.