结直肠癌诊断模式的若干思考

结直肠癌是常见的消化道恶性肿瘤,然而在临床上得到诊断时大多已经到了中晚期,错过了最佳的治疗时机。近年来,随着基因相关技术及生物信息技术的迅猛发展,结直肠癌诊断方法得到不断改进,但早期诊断仍不尽如人意。因此现有的诊断模式值得我们去深思,从哲学意义上探索更为完善的诊断模式。     

结直肠癌诊断模式的若干思考

结直肠癌是常见的消化道恶性肿瘤,然而在临床上得到诊断时大多已经到了中晚期,错过了最佳的治疗时机.近年来,随着基因相关技术及生物信息技术的迅猛发展,结直肠癌诊断方法得到不断改进,但早期诊断仍不尽如人意.因此现有的诊断模式值得我们去深思,从哲学意义上探索更为完善的诊断模式.     

小学四、五年级数学诊断性测验的编制——基于规则空间模型的方法

基于规则空间模型, 以小学四、五年级数学诊断性测验的编制为例, 探索了认知诊断理论背景下诊断性测验的编制方法。研究发现, 基于规则空间模型编制的诊断性测验具备优良的信效度, 尤其在结构效度上具有突出优势。应用该测验对1059名四、五年级学生进行诊断测验的结果显示:在整体上, 学生对整数、初级运算与应用掌握得较为巩固, 对量、统计、规律、高级运算掌握较差;在发展趋势上, 量、统计、规律、高级运算是四、五年级之间进步最快的属性。     

关于多发性骨髓瘤的诊断

多发性骨髓瘤是浆细胞克隆性增生的恶性肿瘤,起病隐匿,临床表现复杂多样,且无特异性,诊断上依赖实验室检查.临床上对该病足够的认识,正确诊断尤为重要.在诊断中,科学地应用哲学思维,有助于减少误诊和漏诊.     

B超与X线影像诊断肾积水的比较

通过结合临床实践与数据,以临床上常见的肾积水为例,用哲学的观点比较分析B超诊断与X线医学影像诊断的各自特点,有其共同之处,又有其各自突出的特点,在超声诊断的学习中要合理综合应用之,为临床诊断提供更多有价值的诊断信息,并能让病患了解和理解医学影像诊断学。     

盆腔炎性疾病的诊断和治疗

盆腔炎性疾病（pelvic inflammatory disease,PID）是指女性上生殖道的一组感染性疾病,由于临床不典型和致病微生物的多样性,导致目前临床上PID的诊断和治疗有一定的难度。本文介绍PID发病机制、高危因素、后遗症和并发症等方面的研究进展,推荐其诊断和治疗的最新规范。     

当代体外诊断的技术特征与演化趋势

体外诊断技术的发展经历了从经典手工、作坊式设备,到标准化、智能化、自动化管理的全过程。体外诊断在学科理念上也从"医学检验"到"检验医学"发生着重大转变,并为临床提供重要的病理、生理信息,是患者诊疗过程中的主要组成部分。论文通过梳理当代体外诊断(IVD)技术特征和演化趋势,从体外诊断的兴起和发展,分子诊断、精准医疗和POCT即时诊断的演变,产业的全球监管这几个方面,阐明体外诊断发展与应用的全过程及其价值,并对体外诊断前景分析展望。     

肺功能检查对婴幼儿哮喘诊断的价值

如何对婴幼儿哮喘进行早期诊断和进行早期干预已成为目前儿童哮喘防治的主要话题。随着肺功能检测技术的进步,临床上已有多项肺功能检测技术可应用于婴幼儿。正确地理解和掌握这些检测技术可为婴幼儿哮喘的诊断和鉴别诊断提供重要依据。本文对这些不同检测技术的原理、参数及其临床意义进行了阐述。     

多发性硬化诊疗指南评析

我国无统一的多发性硬化（MS）诊断标准,MS的诊断依据Poser标准和McDonald标准。McDonald标准是建立在Poser标准基础上,但更注意利用包括MRI在内的相关实验室检查来证明多发性硬化在时间和空间上的多发性,有利于MS的早期诊断及治疗。对于没有MRI仪器的地方或不能承担MRI检查费用者,可用Poser标准进行诊断,但要注意行视觉诱发电位检查及脑脊液寡克隆IgG区带测定。     

肠道溃疡性病变的诊断策略

目前在临床上以肠道溃疡性病变为首发的疾病很常见,对于临床上诊断和鉴别诊断应给予高度重视。肠道溃疡性病变主要包括肠道感染性疾病,肠道免疫相关性疾病,肿瘤相关性疾病,肠道解剖和血管异常相关性疾病,基因遗传性疾病,以及少见的药物性或放疗等因素引起的相关性疾病。本文根据当前分子生物学、免疫学、遗传学和病理学等新技术的发展和临床应用,对肠道溃疡性疾病的诊断和鉴别诊断给予详细阐述,旨在帮助临床医生和医学研究人员对该类疾病的认识,提高诊断率,便于精准医学治疗。     

Foundations of clinical praxiology part II: Categorical and conjectural diagnoses

The concepts of categorical diagnosis and conjectural diagnosis are introduced. It is argued that in diagnostic reasoning conjectural diagnosis plays a more important role than categorical diagnosis. Attention is called to the inevitable vagueness of clinical language and to the suitability of epistemic logic and fuzzy logic for diagnostic reasoning.     

实验诊断临床思维程序的必要性及其内容

为提高临床实验诊断的效率和准确性,提出编写“实验诊断临床思维程序”的观点。从实验诊断学的特性及发展趋势方面论述了该程序的必要性,并初步拟定了包括项目选择、结果判断和结果应用三个部分的实验诊断临床思维程序。     

The neuropsychological assessment of dementia

It has become standard practice to base the diagnosis of dementia on the combination of neuropsychological and non-behavioral findings. The present article provides a short, clinically oriented synopsis of the targets, investigational procedures, and difficulties of the modern neuropsychological approach to the diagnosis of dementia. Over the years, neuropsychology has developed assessment tools to evaluate the cognitive and behavioral abnormalities of many dementias. Validated tests of memory, language, executive, and other cognitive functions are used to screen for dementia and identifying certain dementia profiles. Behavioral assessment procedures are available for non-cognitive neurodegenerative alterations. At present, problems arise mainly with the behavioral heterogeneity of certain dementia syndromes. Especially problematic are discrimination of age-associated or mild cognitive impairments from incipient dementia and the impact of psychiatric symptoms on cognitive functions. It is concluded that neuropsychology offers a valuable contribution to the diagnosis and differential diagnosis of dementia.     

急腹症2例误诊分析

急腹症是外科常见病和多发病,它是一种以急性腹痛为主要表现的临床急症,临床上常有误诊发生,最终造成严重后果。因而在诊疗过程中,必须对急性腹痛尽快作出定位、定性及病因诊断,以防误诊误治。现将我科收治的子宫穿孔误诊为消化道穿孔和输卵管卵巢脓肿误诊为阑尾周围脓肿的2例以急腹症表现为首发症状的患者在我科室的诊治过程及经验进行总结并进行分析,为临床能够提高急腹症的诊率断,降低误诊率提供借鉴,提高临床医生的鉴别能力,保证患者的身心健康。     

医学影像诊断中的辩证思维

辩证思维是最普遍适用、最重要的科学思维方法之一,医学影像诊断的各个方面均适用及应用着辩证思维。运用辩证思维能帮助分析疾病繁杂的外在表现,从而深刻认识疾病的本质,使影像诊断的结论更为准确和合理。     

Retrospective diagnosis of a famous historical figure: ontological,epistemic, and ethical considerations

The aim of this essay is to elaborate philosophical and ethical underpinnings of posthumous diagnosis of famous historical figures based on literary and artistic products, or commonly called retrospective diagnosis. It discusses ontological and epistemic challenges raised in the humanities and social sciences, and attempts to systematically reply to their criticisms from the viewpoint of clinical medicine, philosophy of medicine, particularly the ontology of disease and the epistemology of diagnosis, and medical ethics. The ontological challenge focuses on the doubt about the persistence of a disease over historical time, whereas the epistemic challenge disputes the inaccessibility of scientific verification of a diagnosis in the past. I argue that the critics are in error in conflating the taxonomy of disease (nosology) and the act of diagnosing a patient. Medical diagnosis is fundamentally a hypothesis-construction and an explanatory device that can be generated under various degrees of uncertainty and limited amount of information. It is not an apodictic judgment (true or false) as the critics presuppose, but a probabilistic (Bayesian) judgment with varying degrees of plausibility under uncertainty. In order to avoid this confusion, I propose that retrospective diagnosis of a historical figure be syndromic without identifying underlying disease, unless there is justifiable reason for such specification. Moreover it should be evaluated not only from the viewpoint of medical science but also in a larger context of the scholarship of the humanities and social sciences by its overall plausibility and consistency. On the other hand, I will endorse their concerns regarding the ethics and professionalism of retrospective diagnosis, and call for the need for situating such a diagnosis in an interdisciplinary scope and the context of the scholarship of the historical figure. I will then enumerate several important caveats for interdisciplinary retrospective diagnosis using an example of the retrospective diagnosis of Socrates for his life-long intermittent neurologic symptoms. Finally, I will situate the present argument in a larger context of the major debate among the historians of medicine and paleopathologists, and discuss the similarities and differences.     

On assessing the validity of the main diagnosis in patient data bases: The impact of aims for making diagnosis

Computerized medical personal registers are created for administrative purposes but are frequently used in research. It can be shown that this divergence of aims deeply affects the validity of the diagnosis in register research. The diagnostic process is embedded within the process of creating the data base. This process is guided by the aims for making diagnosis. Five different aims for making diagnosis in clinical practice have been analysed and eight suggestions for validity control are proposed on the basis of the study.     

产前诊断中的伦理学问题

探讨我国产前诊断技术开展的现状,阐述产前诊断面临的伦理道德问题及其相应的伦理学处理原则,建议开创一个伦理学评价体系,使产前诊断向着合理、完善的方向发展,从而达到提高人口出生质量、确保母婴健康的社会共同目标。     

Reliability of headache diagnosis

The literature on diagnosis of head pain associated with psychological factors indicates that these diagnoses rely almost exclusively on self-report criteria. The reliability of self-report criteria for diagnosis of headache has not been previously reported. The present study investigated the reliability of headache diagnosis based on the criteria suggested by the Ad Hoc Committee on Classification of Headache. The results indicated modest rater agreement. It was concluded that the headache literature may be confounded by unreliable diagnostic procedures. Improved methods of classifying headache types using self-report, behavioral, and physiological measures during pain-free and headache states are required before adequate reliability of headache classification can be achieved. It is suggested that reliable and valid measurement and classification would eliminate much of the confusion currently existing in the headache literature.     

结直肠癌诊断技术述评

结直肠癌是消化道最常见的恶性肿瘤之一。目前结直肠癌诊断技术的研究涵盖了分子生物学、肿瘤学、影像学等多个学科,得到不断发展。在以往的诊断技术的基础上,结合新的理论和方法,采用正确的诊断策略及早发现结直肠癌对控制其发病率和病死率起着重要作用。