Concepción didáctica del proceso formativo interdisciplinar de la habilidad diagnosticar enfermedades para residentes de Dermatología / Didactic Concept of the Interdisciplinary Formation Process of the Diagnostic Ability of Dermatology Residents

Fundamento: El estudio teórico, el diagnóstico realizado y la experiencia de los investigadores, posibilitan formular como problema de la presente investigación: limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología del Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila. Objetivo: Elaborar una concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología, a partir de la caracterización del estado actual de esta habilidad. Metodología: Se realizó una investigación educativa con un componente descriptivo en el Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila, en los cursos escolares desde 2016 al 2020. La población de estudio fueron los 16 residentes de 1.er año que matricularon la especialidad de Dermatología en el período de estudio. Se emplearon métodos del nivel teórico y empírico. Resultados: La caracterización realizada reveló limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los laboratorios de Anatomía Patológica, Microbiología y Parasitología Médica, por los residentes (100 %). La concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar orienta el proceso desde las actividades docentes-atencionales y prácticas de laboratorio en una consecutividad lógica y sistematización desde las diferentes formas de enseñanza y tipologías de clase. Integra la interdisciplinariedad y la utilización del método investigativo establecido en las ideas rectoras. Conclusiones: La concepción didáctica como aporte de la investigación resuelve la contradicción dialéctica entre la aplicación del método clínico y los procedimientos en la práctica de laboratorio que se da en ese proceso formativo y constituye un soporte didáctico que respalda las actividades prácticas en los laboratorios para cumplir con los objetivos del Plan de estudio de la especialidad.

Background: The theoretical study, the diagnosis conducted and the experience of the researchers make possible to formulate the problem of the present research: limitations in the development of the ability to diagnose dermatological diseases in residents of the Specialty of Dermatology of the General Provincial Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila. Objective: To elaborate a didactic conception of the interdisciplinary training process of the ability to diagnose dermatological diseases in residents of the specialty of Dermatology, based on the characterization of the current state of that ability. Methodology: An educational research with a descriptive component was conducted at the Provincial General Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila, in the 2016-2020 school years. The study population consisted of the 16 first-year dermatology residents who enrolled in the specialty during the study period. Results: The characterization conducted showed limitations in the development of the ability to diagnose dermatological diseases in anatomic pathology laboratories, Microbiology and Medical Parasitology, by residents (100%). The didactic conception of the interdisciplinary training process of diagnostic ability focuses on teaching and learning activities and laboratory practices in a logical consecutiveness and systematization from the different forms of teaching and class typologies. It integrates the interdisciplinary and the use of the research method that is established in the guiding ideas. Conclusions: The didactic conception, as a research contribution, resolves the dialectic contradiction between the application of the clinical method and the procedures in laboratory practice that occurs in this formative process which is a didactic support that backs up the practical activities in the laboratories in order to achieve the objectives of the study plan of the specialty.

Application effect analysis of artificial intelligence automatic diagnosis system for diabetic retinopathy in elderly diabetic patients in community and hospital / 中华眼底病杂志

Objective:To study the efficiency and difference of the artificial intelligence (AI) system based on fundus-reading in community and hospital scenarios in screening/diagnosing diabetic retinopathy (DR) among aged population, and further evaluate its application value.Methods:A combination of retrospective and prospective study. The clinical data of 1 608 elderly patients with diabetes were continuously treated in Henan Eye Hospital & Henan Eye Institute from July 2018 to March 2021, were collected. Among them, there were 659 males and 949 females; median age was 64 years old. From December 2018 to April 2019, 496 elderly diabetes patients were prospectively recruited in the community. Among them, there were 202 males and 294 female; median age was 62 years old. An ophthalmologist or a trained endocrinologist performed a non-mydriatic fundus color photographic examination in both eyes, and a 45° frontal radiograph was taken with the central fovea as the central posterior pole. The AI system was developed based on the deep learning YOLO source code, AI system based on the deep learning algorithm was applied in final diagnosis reporting by the"AI+manual-check" method. The diagnosis of DR were classified into 0-4 stage. The 2-4 stage patients were classified into referral DR group.Results:A total of 1 989 cases (94.5%, 1 989/2 104) were read by AI, of which 437 (88.1%, 437/496) and 1 552 (96.5%, 1 552/1 608) from the community and hospital, respectively. The reading rate of AI films from community sources was lower than that from hospital sources, and the difference was statistically significant ( χ2=51.612, P<0.001). The main reasons for poor image quality in the community were small pupil (47.1%, 24/51), cataract (19.6%, 10/51), and cataract combined with small pupil (21.6%, 11/51). The total negative rate of DR was 62.4% (1 241/1 989); among them, the community and hospital sources were 84.2% and 56.3%, respectively, and the AI diagnosis negative rate of community source was higher than that of hospital, and the difference was statistically significant ( χ2=113.108, P<0.001). AI diagnosis required referral to DR 20.2% (401/1 989). Among them, community and hospital sources were 6.4% and 24.0%, respectively. The rate of referral for DR for AI diagnosis from community sources was lower than that of hospitals, and the difference was statistically significant ( χ2=65.655, P<0.001). There was a statistically significant difference in the composition ratio of patients with different stages of DR diagnosed by AI from different sources ( χ2=13.435, P=0.001). Among them, community-derived patients were mainly DR without referral (52.2%, 36/69); hospital-derived patients were mainly DR requiring referral (54.9%, 373/679), and the detection rate of treated DR was higher (14.3%). The first rank of the order of the fundus lesions number automatically identified by AI was drusen (68.4%) and intraretinal hemorrhage (48.5%) in the communities and hospitals respectively. Conclusions:It is more suitable for early and negative DR screening for its high non-referral DR detection rate in the community. Whilst referral DR were mainly found in hospital scenario.

Progress in monkeypox: basic and clinical aspects / 中华皮肤科杂志

Monkeypox is a zoonotic disease caused by monkeypox virus infection. This disease primarily occurs in tropical rainforest regions of central and western Africa, and is occasionally exported to other regions. Since May 2022, multinational monkeypox outbreak has become the largest monkeypox outbreak in history outside Africa. This review summarizes progress in the etiology, epidemiology, laboratory detection, clinical diagnosis and treatment of monkeypox.

Adenocarcinoma of the rete testis: a case report / 中华泌尿外科杂志

Adenocarcinoma of the rete testis is a rare testicular malignant tumor with high invasiveness and poor prognosis. Due to the lack of specific tumor marker and characteristic features in imaging, early diagnosis of testicular reticulum adenocarcinoma is difficult, and a final diagnosis depends on the pathological and immunohistological examination. At present, there is no systematic treatment guidance, and radical orchiectomy is preferred. This article reported a 66-year-old patient with right adenocarcinoma of the rete testis who underwent right radical orchiectomy. He refused adjuvant radiotherapy or chemotherapy after surgery, and developed lung, liver, and retroperitoneal lymph node metastasis 8 months afterwards. He was followed up at 15 months, when he was died of multiple metastases.

Full-information Force Sensor for Pulse Condition Diagnose / 中国医疗器械杂志

According to the collection principles and characteristics of the pulse physiological signals of traditional Chinese medicine, combined with the international standard requirements of the pulse graph force transducer (ISO 19614:2017-05), a special force sensor component that can be used for a complete and objective collection of pulse signals has been developed, this sensor meets the requirements of industrialization. The sensor can measure the pulse amplitude and width signals of the cunpart of the human body. In addition, three sensors can be placed at the cun, guan, chi part at the same time, so that the "three body parts and nine pulse-taking sites" can be realized synchronously. After the sensor has been verified, the results meet the relevant requirements of international standard. The consistency of the result can be reached to 92.3% compared with the diagnosis result of clinical TCM experts.

Diagnosis, treatment and prognosis of human major exocrine ductal carcinoma / 国际肿瘤学杂志

Exocrine ductal carcinoma is an important part of malignant tumors of exocrine glands, including invasive breast ductal carcinoma, salivary duct carcinoma, pancreatic ductal adenocarcinoma and cholangiocarcinoma. Most of these diseases are aggressive, highly malignant and endanger human health. Early detection and diagnosis are the key to a good prognosis for exocrine ductal carcinoma. Different exocrine ductal carcinomas also have certain connections, and their molecular biological characteristics, pathological characteristics and molecular mechanisms have similarities. Surgical resection combined with adjuvant radiotherapy and chemotherapy is currently a common treatment method for exocrine ductal carcinoma. At the same time, its related targeted therapy and immunotherapy sites can also learn from each other. Human epidermal growth factor receptor-2 (HER-2) and the family markers have become breast ductal carcinoma and salivary duct carcinoma targeted therapy sites, and immunotherapy at programmed death ligand 1 (PD-L1) sites has also been involved in many studies, but there is no clear conclusion yet.

Sarcopenia, definición y diagnóstico: ¿Necesitamos valores de referencia para adultos mayores de Latinoamérica? / Sarcopenia, definition and diagnosis: do we need reference values in older adults from latin america?

La sarcopenia es uno de los principales síndromes geriátricos que está asociada con limitación en las actividades de la vida diaria, discapacidad y mortalidad en la población adulta mayor. Sin embargo, su definición, criterios diagnósticos y puntos de corte son diversos en la literatura, lo que dificulta el diagnóstico de la sarcopenia. El objetivo de esta revisión narrativa fue detectar en la literatura todos los consensos internacionales relacionados con sarcopenia, comparar su definición, criterios diagnósticos y puntos de corte, con el propósito de identificar una definición y criterios que puedan ser utilizados en Latinoamérica. Fueron identificados 7 consensos internacionales que han definido la sarcopenia como un síndrome/enfermedad caracterizado por la pérdida de la masa y función muscular asociada al proceso de envejecimiento. A pesar de tener una definición similar, no hay una total concordancia entre los criterios y evaluaciones. La sarcopenia puede ser detectada utilizando evaluaciones funcionales de fuerza muscular, velocidad de la marcha y equilibrio, que son frecuentemente utilizados por profesionales del área de la rehabilitación. Adicionalmente, el riesgo de sarcopenia puede ser identificado utilizando los cuestionarios SARC-F y SARC-CalF. Debido a su impacto funcional, la sarcopenia debería ser diagnosticada precozmente en adultos mayores por terapeutas ocupacionales, kinesiólogos y fisioterapeutas, para prevenir y tratar futuras complicaciones clínicas y funcionales en esta población. Es necesario la creación de valores de referencia para favorecer el diagnóstico de la sarcopenia en población latinoamericana.

Sarcopenia is one of the main geriatric syndromes that has been associated with limitation in activities of daily living, disability, and mortality in the elderly population. However, the definition, diagnostic criteria and cut-off points are diverse in the literature, which makes the diagnosis of sarcopenia difficult. The aim of this narrative review was to detect in the literature all the international consensus related to sarcopenia, to compare their definition, diagnostic criteria and cut-off points, in order to identify a definition and criteria that can be used in Latin America. Seven international consensuses were identified that have defined sarcopenia as a syndrome / disease characterized by loss of muscle mass and function associated with the aging process. Despite having a similar definition, there is not a total concordance between the criteria and evaluations. Sarcopenia can be detected using functional assessments of muscle strength, gait speed, and balance, which are frequently used by professionals in the area of rehabilitation. Additionally, the risk of sarcopenia can be assessed using SARC-F and SARC-CaF. Due to its functional impact, sarcopenia should be diagnosed early in older adults by occupational therapists, physical therapists and physiotherapists, to prevent and treat future clinical and functional complications in this population. The creation of reference values is necessary to favor the diagnosis of sarcopenia in the Latin American population.

Robert’s uterus: a rare mullerian anomaly mystery unfolded

Anomalies of female genital tract may not be detected until after menarche when they present a cyclical pain due to outlet obstruction. Mullerian anomalies represent a vast array of structural abnormalities resulting from improper development and fusion of embryological mullerian ducts. 19-year-old girl attained menarche at the age of 14, had progressive dysmenorrhoea and diagnosed as right haemotosalphinx and ovarian endometrioma which were removed in 2008. As pain progressed, she underwent laparoscopic adhesiolysis in 2013. Since, pain persisted, diagnosed as right haematometra, and drainage done by laparotomy. Left adnexa were normal. She was given depot provera till she completed schooling. She developed recurrent dysmenorrhoea after stopping depot provera. USG and MRI revealed recurrent haematometra on right side with normal left horn. The possibility of atypical septum was thought about and hystero laparoscopy was done. It showed right side haemetometra with absent right adnexa. Left adnexa normal. Hysteroscopy showed normal left horn with septum with a bulge towards the left side. Hence, proceeded with hysteroscopic septostomy and haemetometra was drained to the left horn. Later patient was free from dysmenorrhea and repeat hysteroscopy was found to be normal. This case highlighting mullerian anomalies have to be considered when young girls present with severe progressive dysmenorrhoea and diagnosis remains a challenge most of the clinicians. This rare entity has to be kept in mind while evaluating such patients. Prompt diagnosis and early surgical correction are essential to avoid future morbidity in the form of repeated unnecessary surgeries.

Hemoplasma infection in wild captive carnivores / Infecção por hemoplasmas em carnívoros selvagens cativos

Hemoplasmas are bacteria able to adhere themselves loosely to the plasma membrane of erythrocytes and may parasitize several species of mammals. There are three known species of hemoplasmas that parasitize domestic and wild cats: Mycoplasma haemofelis, 'Candidatus Mycoplasma haemominutum' and 'Candidatus Mycoplasma turicensis'. Dogs are infected by at least two species of hemoplasmas: 'Candidatus Mycoplasma haematoparvum' and Mycoplasma haemocanis. The hemoplasmoses are very important in veterinary clinics, either because of its worldwide distribution and severity of clinical signs, depending on parasite species and host immune competence, or due to its zoonotic potential and capability of infecting endangered species. This study set out to investigate which hemoplasmas species parasitize different captive wild carnivores in order to clarify the epidemiology of hemoplasmoses in wild animals. Furthermore, the research intended to characterize the hematological changes caused by different species of hemotropic mycoplasmas infection in order to establish their clinical importance to wild species and the capacity of these species to become a reservoir of studied agents. Samples of 33 wild felids and 18 wild canids were investigated using polymerase chain reaction (PCR) to detect hemoplasmas DNA and it was observed that the occurrence of infection in these species is 45.5% and 83.3%, respectively. Factors such as age, gender or anaemia are not more frequent in animals positive for the infection. Therefore, it is concluded that infection caused by hemoplasmas in wild carnivores has high prevalence, and either agent pathogenicity is low, or chronic stage is more frequent, resulting in a low rate of diagnosis.(AU)

Hemoplasmas são bactérias capazes de aderir frouxamente à membrana plasmática de eritrócitos e que podem parasitar diversas espécies de mamíferos. São conhecidas três espécies de hemoplasmas que parasitam felídeos domésticos e selvagens: Mycoplasma haemofelis, 'Candidatus Mycoplasma haemominutum' and 'Candidatus Mycoplasma turicensis'. Cães são infectados por ao menos duas espécies de hemoplasmas: Candidatus Mycoplasma haematoparvum' and Mycoplasma haemocanis. As hemoplasmoses são de grande importância na clínica veterinária, tanto pela sua distribuição ubíqua e severidade dos sinais clínicos, a depender da espécie do parasita e imunocompetência do hospedeiro, quanto pelo seu potencial zoonótico e capacidade de infectar espécies ameaçadas. Este estudo visa investigar quais espécies de hemoplasmas parasitam diferentes carnívoros selvagens de cativeiro, a fim de esclarecer a epidemiologia das hemoplasmoses em animais selvagens. Além disso, o trabalho objetivou caracterizar as alterações hematológicas causadas pela infecção por diferentes espécies de micoplasmas hemotrópicos visando estabelecer sua importância clínica para espécies selvagens e a capacidade destas espécies de se tornar reservatórios dos agentes estudados. Amostras de 33 felídeos selvagens e de 18 canídeos selvagens foram investigadas por meio da reação em cadeia da polimerase (RCP) para detectar o DNA dos agentes e foi observado que a ocorrência da infecção por hemoplasmas nestas espécies é de 45,5% e 83,3%, respectivamente. Fatores como idade, sexo ou anemia não são mais frequentes em animais positivos para a infecção. Dessa forma, conclui-se que a infecção causada por hemoplasmas em carnívoros selvagens possui alta prevalência, no entanto ou a patogenicidade dos agentes é baixa ou o estágio crônico da infecção é mais frequente, resultando em uma baixa frequência diagnóstica.(AU)

Development of quantitative detection method for Meloidogyne incognita by qPCR / Desenvolvimento do método de detecção quantitativo para Meloidogyne incognita por qPCR

The root-knot nematode (Meloidogyne spp.) is the most important plant-parasitic nematode genus, they are the most common and destructive pathogens in this group. They produce some of the most drastic symptoms in plants and can significantly reduce the yield of crops. In order to achieve deploy an efficient method of plant-parasitic nematode management, is necessary an identification and quantification accurate and reliable of plant-parasitic nematodes. The aim of this study was to analyze samples in qPCR to detect and quantify M. incognita, in the field samples, comparing different methods of extraction of DNA and its efficacy in establishing the number of individuals. For this purpose the effectiveness of different DNA methods of extraction was compared through the values of CT intervals. For standard curve and method comparisons, we used nematodes multiplied in a greenhouse and carefully separated in the specific quantities of the experiments. For the number of individuals experiment field samples previously counted under an optical microscope were used. The DNA extraction was made from 100 nematodes by the methods: CTAB, Phenol: Chloroform and commercial kit (PureLink® Genomic DNA Kit, Invitrogen). In the comparative analysis using the three methods of DNA extracting from 100 nematodes, it was observed that commercial kit and CTAB methods obtained CT values similar. The CTAB method of extraction, showed less variation in the repeats and greater linearity of standard curve in comparison with other methods tested. So, it was possible to quantify the samples through the CT value intervals, established from different numbers of individuals (1, 10, 25, 100, 250, 500 and 750), in field samples. This study demonstrated that qPCR technique is an alternative sensitive and reliable for the quantification of M. incognita to support laboratories of diagnose and field survey.

Os nematoides-das-galhas (Meloidogyne spp.) é o gênero de fitonematoide mais importante, são os patógenos mais comuns e destrutivos deste grupo. Eles produzem alguns dos sintomas mais drásticos nas plantas e podem reduzir significativamente o rendimento das culturas. Para conseguir implantar um método eficiente de manejo de nematoides parasitas de plantas, é necessária a identificação e quantificação precisa e confiável dos fitonematoides. O objetivo deste estudo foi analisar amostras em qPCR para detectar e quantificar M. incognita, em amostras de campo, comparando diferentes métodos de extração do DNA e sua eficácia no estabelecimento do número de indivíduos. Para este propósito, a eficácia de diferentes métodos de extração de DNA foi comparada através dos valores dos intervalos de Ct. Para comparações padrão de curvas e métodos, usamos nematoides multiplicados em casa de vegetação e cuidadosamente separados nas quantidades específicas dos experimentos. Para o número de indivíduos, foram utilizadas amostras de campo previamente contadas sob um microscópio óptico. A extração de DNA foi realizada a partir de 100 nematoides, pelos métodos: CTAB, Phenol: Clorofórmio e kit comercial (PureLink® Genomic DNA Kit, Invitrogen). Na análise comparativa utilizando os três métodos de extração de DNA a partir de 100 nematoides, observou-se que o kit comercial e os métodos de CTAB obtiveram valores de CT semelhantes. O método de extração CTAB apresentou menor variação nas repetições e maior linearidade da curva padrão em comparação com os demais métodos testados. O coeficiente de correlação (R2) da curva padrão foi de 0,98 indicando uma relação linear entre o valor de Ct e a quantidade de padrões de DNA variando de 90 a 0,00009 ng.µL-1. Assim, foi possível quantificar as amostras através dos intervalos de valores de CT, estabelecidos a partir de diferentes números de indivíduos (1, 10, 25, 100, 250, 500 e 750), em amostras de campo. Este estudo demonstrou que a técnica de qPCR é uma alternativa sensível e confiável para a quantificação de M. incognita, para apoiar laboratórios de diagnóstico e levantamentos de campo.

El diagnóstico de trastorno del espectro autista (TEA) a temprana edad del niño y sus consecuencias en el encuentro-desencuentro entre los padres y su hijo / Le diagnostique trouble du spectre autistique (TSA), en bas âge et ses consequénces dans la rencontre o la divergence entre les parents et leur enfant / The autism spectrum disorder (ASD) at an early age and its consequences on the encounters and missed encounters between parents and their children / O diagnóstico de transtorno do espectro do autismo (TEA) em terna idade da criança e suas consequências no encontro-desencontro entre os pais e o filho

En los últimos años llegan a mi consulta niñas y niños entre los dos y los nueve años de edad diagnosticados tempranamente con TEA. Dicho diagnóstico es realizado, por otros profesionales, que desde la observación fenomenológica ubican en el niño alguna de las características presente en el cuadro clínico de autismo. A partir de tres viñetas clínicas con padres (de modalidades psíquicas e historias diferentes), reflexionaré qué les sucedió en el desencuentro con su bebé y de qué manera la enunciación de determinado tipo de diagnóstico imposibilitó que ese desencuentro inicial se transforme en un encuentro conjunto madre-hijo y padre-hijo. Cuando ocurre la posibilidad de este encuentro entre los padres y su hijo, el mismo se constituye en el punto de partida de un desarrollo más pleno de la subjetividad del niño(AU)

Ces dernières anneés, ils sont arrivés a mon cabinet des filles et fils entre les deux et les neuf ans qui portent le diagnostic TSA. Ce diagnostic a été fait par des professionels qui, du point de vue de l'observation phenomenologique, ont trouve dans l'enfant quelque charactéristiques du cadre autiste. A partir de trois vignettes cliniques (les parents ont de modalités psichiques et d'histoires differénts) je refléchirai sur la divergence entre eux et leur bébé et comment l'énunciation de ce diagnostic empêche la transformation de cette divergence initial dans une rencontre conjoint merè -fils et perè-fils. Quand cette rencontre entre les parents et leur fils est possible, elle se transforme en partie constituante d'une développement plus pleine de la subjectivité del' enfant(AU)

In recent years I came across consultations of children between two and nine years old who had been previously diagnosed with ASD at an early age. Such diagnose was made by other professionals who, from a phenomenological analysis, place the patient under some features of the clinical picture of autism. Taking into account three clinical vignettes with parents of diverse psychic modalities and stories, I will reflect over the past events that lead to a missed encounter with their babies and in which way the annunciation of a determined diagnose precludes the possibility of that missed encounter to transform into a joint meeting parent-child. When an encounter parent-child occurs, it represents the starting point of a fulfilled development of the child's subjectivity(AU)

Nos últimos anos, meninos e meninas com idades entre dois e nove anos diagnosticados com TEA chegam cedo ao meu consultório. Esse diagnóstico é feito por outros profissionais que, a partir da observação fenomenológica, localizam na criança algumas das características presentes no quadro clínico do autismo. A partir de três vinhetas clínicas com pais (de modalidades psíquicas e histórias diferentes), refletirei sobre o que aconteceu com eles no desencontro com seu bebê e como a enunciação de um certo tipo de diagnóstico torna impossível que esse desencontro inicial se torne um encontro conjunto mãe-filho e pai e filho. Quando a possibilidade desse encontro entre os pais e o filho ocorre, torna-se o ponto de partida para um desenvolvimento pleno da subjetividade da criança(AU)

Research progress of laboratory diagnostic methods of dengue virus / 中华疾病控制杂志

Dengue virus(DENV) has been identified by World Health Organization as a major public health problem in tropical and subtropical regions. In recent years, dengue outbreaks have become more and more frequent in the world. In 2019, dengue outbreaks of varying degrees have occurred in the Philippines, Thailand, Bangladesh, Myanmar and Chongqing City in China. The laboratory diagnostic method of DENV is of great significance to the prevention and control of dengue epidemic. Therefore, the methods and strategies of DENV laboratory diagnosis are reviewed in this paper. By reviewing the traditional diagnostic methods and looking forward to the emerging diagnostic strategies, this paper aims to provide a reference to select the appropriate laboratory diagnostic scheme for the outbreak of dengue.

Embarazo ectópico cervical / Cervical Ectopic Pregnancy

El embarazo ectópico cervical representa alrededor de 0,1 por ciento de todos los embarazos ectópicos. La incidencia se estima en 1: 2500 a 1: 98,000 embarazos. Es un fenómeno extraño; sin embargo, la morbilidad y la mortalidad por esta causa son elevadas, pero pueden disminuirse con el diagnóstico temprano. Es extremadamente peligroso porque el trofoblasto puede alcanzar los vasos uterinos a través de la delgada pared cervical y provocar una hemorragia grave e incoercible que aun en la actualidad suele terminar en cirugías mutilantes que limitarán la reproducción futura. En la actualidad, no existen criterios claros en la bibliografía que ayuden a la toma de decisiones. Se reporta un caso de embarazo cervical tratado exitosamente mediante histerectomía total abdominal y posterior seguimiento en la Unidad de Cuidados Intensivos. Se exponen algunos criterios que en el futuro podrían ayudar a diagnosticar esta entidad devastadora de forma oportuna para disminuir la morbimortalidad por esta causa y mejorar las posteriores posibilidades reproductivas de la mujer(AU)

Cervical ectopic pregnancy accounts for about 0.1 percent of all ectopic pregnancies. The incidence is estimated at 1: 2500 to 1: 98,000 pregnancies. It is a strange phenomenon; however, morbidity and mortality from this cause are high, but early diagnosis can help reducing. It is extremely dangerous because the trophoblast can reach the uterine vessels through the thin cervical wall and cause a severe and incoercible hemorrhage that, even today, usually ends in mutilating surgeries that will limit future reproduction. At present, no clear criteria in the literature help decision-making. We report a case of cervical pregnancy successfully treated by total abdominal hysterectomy and subsequent follow-up in the Intensive Care Unit. We present some criteria that could help timely diagnosing this devastating entity to reduce morbidity and mortality and improve the later reproductive possibilities of women(AU)

O analista em cena: uma clínica da transexualidade mais além do diagnóstico / The analyst on stage: for a transsexual clinic that goes beyond diagnosis / L'analyste en scène: une clinique de la transsexualité au-delà du diagnostic / El analista en escena: una clínica de la transexualidad más allá del diagnóstico

As produções psicanalíticas sobre a transexualidade têm crescido exponencialmente, entretanto, resta uma lacuna sobre o que orienta o fazer dos analistas que recebem sujeitos trans em seus consultórios. Partindo da análise crítica de um relato clínico, teceremos uma hipótese, com Butler e Laplanche, relativa ao por que das dificuldades encontradas em nosso fazer teórico e prático sobre a transexualidade. Concluiremos com uma reflexão sobre o potencial ético e político da psicanálise em uma clínica mais além do diagnóstico "trans".

Psychoanalytic writings on transsexuality have increased exponentially. However, a gap remains in terms of what guides analytical practice aimed at transsexuals. Based on Butler and Laplanche, we perform a critical analysis of a clinical report and propose a hypothesis on the difficulties that came up during our theoretical studies and practical work with transsexuality. The paper concludes with a reflection on the ethical and political potential of psychoanalysis, advocating a clinic that goes beyond the "trans" diagnosis.

Les productions psychanalytiques sur la transsexualité connaissent une croissance exponentielle. Cependant, une lacune existe par rapport à ce qui oriente la pratique des analystes qui traitent des sujets transsexuels. Partant de l'analyse critique d'un récit d'un cas médical, nous construisons une hypothèse, avec Butler et Laplanche, sur les difficultés qui se sont manifestées au cours de notre travail théorique et pratique sur la transsexualité. Nous concluons avec une réflexion sur le potentiel éthique et politique de la psychanalyse pour une clinique qui va au-delà du diagnostic «trans¼.

Las producciones psicoanalíticas sobre la transexualidad han crecido exponencialmente, sin embargo, queda una laguna sobre lo que orienta el hacer de los analistas que reciben sujetos trans en sus consultorios. A partir del análisis crítico de un relato clínico, se teje una hipótesis, con Butler y Laplanche, relacionada al por qué de las dificultades encontradas en nuestro hacer teórico y práctico sobre la transexualidad. Concluiremos con una reflexión sobre el potencial ético y político del psicoanálisis en una clínica más allá del diagnóstico "trans".

Die psychoanalytische Literatur zur Transsexualität hat exponentiell zugenommen, doch was die Praxis der Analytiker und ihre Behandlungsweise von transsexuellen Patienten orientiert bleibt nach wie vor offen. Ausgehend von der kritischen Analyse eines klinischen Berichts stellen wir eine Hypothese auf, welche die Probleme beschreibt, die bei unserer theoretischen und praktischen Arbeit zur Transsexualität aufkamen, basierend auf den Theorien von Butler und Laplanche. Wir schließen mit einer Betrachtung über das ethische und politische Potential der Psychoanalyse für eine Klinik, die über die „Trans"-Diagnose hinausgeht.

Diagnosis and treatment of congenital submandibular duct dilatation / 华西口腔医学杂志

OBJECTIVE@#To study the clinical features and treatments of congenital submandibular duct dilatation.@*METHODS@#Seven children with congenital submandibular duct dilatation from January 2008 to March 2018 were included in this study, whose average age was 5 months and 22 days. The clinical manifestations are unilateral swelling of the mouth floor. All seven children underwent sublingual gland resection, submandibular gland dilatation catheter resection, and catheter reroute under general anesthesia. Intraoperatively, the orifice of the submandibular gland was constricted and part of the catheter was dilated.@*RESULTS@#All seven patients had good healing without swelling or cyst formation.@*CONCLUSIONS@#Congenital submandibular duct dilatation occurs at a young age. Early diagnosis and treatment can help prevent further expansion of the catheter and avoid gland atrophy, feeding difficulty, and breathing obstruction. Simultaneous excision of the sublingual gland can avoid the formation of postoperative sublingual cyst.

Current advance of polypoidal choroidal vasculopathy in diagnosis and treatment / 中华实验眼科杂志

Polypoidal choroidal vasculopathy (PCV) is a kind of fundus disease characterized by choroidal anomalous branch vascular network and terminal polypoidal dilatation.The pathological basis of idiopathic choroidal neovascularization is similar to age-related macular degeneration (AMD).It is controversial that whether PCV and AMD is the same disease.Optical coherence tomography angiography (OCTA) is a new,noninvasive imaging technique that plays an important role in clinical practice.OCTA not only provides B-scans of the retina,but also offers rapid,high-resolution,repeated and accurate visualization of blood flow,which provides representation of the vascular morphology of the retina and choroid.OCTA is a noninvasive imaging modality capable of evaluating and assessing the morphology of PCV and their associated vascular patterns.The vascular endothelial growth factor (VEGF) participates in the pathophysiology of PCV,so anti-VEGF therapy has become the first-line treatment for PCV.Intravitreal injection of bevacizumab,ranibizumab,and aflibercept improves and stabilizes the vision of patients with PCV.In this article,we summarized the new progress of diagnosis and treatment associated with PCV.

Research progress of polypeptide in IgA nephropathy / 国际儿科学杂志

IgA nephropathy (IgAN) is one of the most common primary glomerular diseases.Kidney biopsy is the gold standard for diagnosing IgAN,however,its invasiveness,contraindications and the risk of complications limit its timely diagnosis of IgAN.Therefore,a non-invasive,sensitive and specific biomarker is urgently needed for early diagnosis and treatment of IgAN.Peptidomics is a new discipline between proteomics and metabolomics.The polypeptide spectrum of organisms is closely related to its pathological and physiological status.Peptidome has great potential in the exploration of biomarkers.Researchers have conducted some explorations on the IgAN peptidome biomarkers.These peptidome markers showed good sensitivity and specificity in a single-center,small-sample range.However,the application of IgAN peptidome markers to the clinic requires more in-depth and meticulous research,such as the verification in large and multi-center samples,the development of different markers for different pathological grades of IgAN,and the development of different markers for IgAN in adults and children.

Diagnosis and treatment of progressive familial intrahepatic cholestasis / 国际儿科学杂志

Progressive familial intrahepatic cholestasis ( PFIC) is a group of heterogenous autosomal recessive genetic diseases. PFIC resulted by genetic mutation which leading to bile metabolic disorder. The main manifestations are intrahepatic cholestasis, jaundice and pruritus. There are six subtype including PFIC1、PFIC2、 PFIC3 、PFIC4、 PFIC5 and PFIC6. PFIC4、 PFIC5 and PFIC6 are new subtypes. PFIC1、 PFIC2、PFIC3、PFIC4、 PFIC5 and PFIC6 caused by ATP8B1、 ABCB11、 ABCB4、 TJP2、 NR1H4 and MYO5B re-spectively. The diagnosis is mainly based on clinical manifestations, biochemical tests, liver histology and gene testing, etc. The treatment is divided into medical treatment of ursodeoxycholic acid, 4-phenylbutyrate acid, and surgical treatment of partial biliary diversion, liver transplantation, etc. This review summarizes the diagnosis and treatment of PFIC.

Analysis of clinical and electroencephalogram characteristics of ring chromosome 14 syndrome / 中华实用儿科临床杂志

Objective@#To investigate the clinical and electroencephalogram (EEG) characteristics and treatment of ring chromosome 14 syndrome, and to improve its early recognition and accurate diagnosis.@*Methods@#The cli-nical and EEG characteristics of 4 patients with ring chromosome 14 syndrome confirmed by genetic diagnosis were analyzed in the neurology outpatient department and ward of pediatrics in Peking University First Hospital from August 2012 to August 2018.The treatment and prognosis of the 4 patients were followed up.@*Results@#Of the 4 patients, there were 2 males and 2 females.All the patients had developmental delay, abnormal facial features such as wide eye spacing, low nasal bridge and microcephaly.Seizures occurred in all the patients with varying onset ages from 8 months to 1 year.Seizure types included focal seizure, tonic seizure and generalized tonic-clonic seizure.EEG monitoring ages varied from 9 months to 4 years and 4 months.The characteristic EEG pattern manifested as slow activity of background, unilateral or bilateral anterior, posterior or diffuse slow activity, with or without interposed multifocal epileptiform discharges.Cranial magnetic resonance imaging (MRI) showed non-specific abnormality in 1 patient and normal in 3 patients.The ages at the last follow-up ranged from 1 year and 8 months to 7 years and 1 month with intervals from 9 months to 6 years and 5 months.Valproic acid combined with other antiepileptic drugs was used to treat seizures.Seizure reduction instead of control was observed in all the 4 cases.At the last follow-up, the development of movement and language were all delayed in the 4 patients.One case could walk independently, three could walk unsteadily alone; two could speak 2-3 simple words, one could call only " baba, mama" , and one had no language development.@*Conclusions@#The ring chromosome 14 syndrome is a rare disease caused by chromosome abnormality.Its main clinical manifestations included facial abnormalities, microcephaly, epilepsy, developmental delay especially for language and cognitive disability.The types of seizures included both focal and generalized.EEG showed non-specific features with slow background activity, with the migratory slow waves mixing multi-focal discharges as the main common pattern.The epilepsy of this disease was often drug resistant.Valproic acid combined with other antiepileptic drugs could reduce seizures.Seizures without control could further affect development outcome.

The clinical study of character types of sentinel lymph nodes in patients with breast cancer in lymphatic contrast enhanced ultrasound / 中华超声影像学杂志

Objective@#To evaluate the diagnostic efficiency in differential diagnosis for breast sentinel lymph nodes, and to analyze the imaging characteristics of involved breast sentinel lymph node in lymphatic contrast enhanced ultrasound.@*Methods@#Sixty-one patients suspected with breast cancer from May 2017 to March 2019 in Shanghai General Hospital, Shanghai Jiao Tong University were included in the study. Ultrasound contrast agent was injected subcutaneously, and axillary lymph nodes were displayed under contrast enhanced ultrasound mode. The longitudinal diameter (anteroposterior diameter), transverse diameter, longitudinal/transverse ratio and the distance from skin surface were measured. Five types were concluded according to the imaging characteristics in lymphatic contrast enhanced ultrasound: typeⅠ, uniform enhancement; type Ⅱ, ring-shape enhancement; type Ⅲ, ununiform enhancement; type Ⅳ, regional filling defect; type Ⅴ, total filling defect. Sentinel lymph nodes were guided by wire guides and verified in pathology after excision in the operation.@*Results@#The detection rate of sentinel lymph nodes was 95.08% (58/61). Seventy-seven lymph nodes, including 21 involved nodes and 56 uninvolved nodes were detected by lymphatic contrast enhanced ultrasound in 58 patients. The longitudinal diameters and transverse diameters of involved lymph nodes were larger than those of uninvolved ones (P=0.001, 0.003). When type Ⅳ(regional filling defect) and type Ⅴ(total filling defect) were classified as involved, the sensitivity, specificity, positive-predictive value, negative-predictive value, accuracy and the area under ROC curve of predicting sentinel lymph node metastases were 85.71%, 96.43%, 90.00%, 94.70%, 93.51% and 0.911, respectively.@*Conclusions@#Lymphatic contrast enhanced ultrasound reaches a high diagnostic efficiency in qualitative analysis of breast sentinel lymph nodes. Regional filling defect and total filling defect are the imaging characteristics of involved sentinel lymph nodes in lymphatic contrast enhanced ultrasound.