Comparison of the clinical significance of serum HE4, CA125 and ROMA in the differential diagnosis of ovarian tumor / 中国基层医药

Objective To compare the clinical significance of human epididymis protein 4(HE4),CA125, ROMA in the differential diagnosis of ovarian cancer.Methods From May 2016 to October 2017,240 patients with ovarian tumor in Xuzhou Cancer Hospital were selected .According to the result of postoperative pathology ,the patients were divided into benign ovarian disease group ( n =120 ) and ovarian cancer group ( n =120 ) .And 100 healthy women from medical examination center were selected as control group .The electrochemiluminescence ( ECLIA ) technique was used to assess the serum levels of CA 125,HE4,and ROMA was calculated .The clinical significance of HE4,CA125,ROMA in the differential diagnosis of ovarian cancer was analyzed by statistic methods .Results The CA125,HE4 concentrations and ROMA in the ovarian cancer group [(370.9 ±213.2) U/mL,(364.4 ±227.0) pmpl/L, (80.2 ±26.1)％] were higher than those in the benign ovarian disease group and the health control group ( all P<0.01),there were no statistically significant differences between the benign ovarian disease group and the healthy control group(P=0.356,P=0.321,P=0.292).The sensitivity,specificity,positive and negative predictive values , accuracy of ROMA were higher than those of HE 4 and CA125.By using the ROC analysis ,the AUC for CA125,HE4, ROMA were 0.832,0.888,0.960,respectively,AUC(CA125) <AUC(HE4) <AUC(ROMA).Conclusion CA125 and HE4 have important value in the diagnosis of ovarian cancer ,but the ROMA shows the best diagnostic performance and actual value .

Diagnosis and treatment of periprosthetic femoral fractures of Vancouver type B2 / 中华创伤骨科杂志

Incidence of periprosthetic femoral fracture is increasing. Vancouver classification has been widely accepted and used in clinical practice and consensus reached on the treatment principles for various types of such fractures. However, controversy exists concerning the diagnosis and treatment of periprosthetic femoral fractures of Vancouver type B2. To enhance understanding of such fractures, we have summarized the advances in their diagnosis and treatment after literature review.

Validación de la puntuación de apendicitis pediátrica (pas) frente a la escala de alvarado, para el diagnóstico de apendicitis en niños de 4 a 15 años de edad / Validation of pediatric appendicitis score (SBP) versus the Alvarado scale, for the diagnosis of appendicitis in children 4 to 15 years of age

ANTECEDENTES: La apendicitis es la patología quirúrgi-ca más común en la infancia. Es necesario un método ágil y preciso para evitar el exceso de exámenes para-clínicos, errores diagnósticos y apendicectomías inne-cesarias. Las puntuaciones sistemáticas son los mejores procesos para ordenar manifestaciones clínicas y llegar al diagnóstico. ObjETIVO: Validar simultáneamente las puntuaciones PAS y Alvarado para el diagnóstico de apendicitis agu-da en niños de 4 a 15 años de edad, con abdomen agudo en urgencias pediátricas de un hospital de ter-cer nivel del sistema nacional de salud. MATERIALES y MéTODO: Se incluyeron 161 pacientes de 4 a 15 años de edad atendidos en el servicio de emer-gencia pediátrica del Hospital Vicente Corral Moscoso, con sospecha clínica de apendicitis aguda a los que se aplicó las dos puntuaciones antes de ser operados. El diagnóstico se confirmó con histología. Se comparó la capacidad diagnóstica de PAS y Alvarado y la propor-ción de acuerdos entre las pruebas con respecto del gold estándar.RESULTADOS: La muestra tuvo un predominio de varo-nes. Mediana de edad 12 años, peso 37.5 ± 12.2 kg, es-tatura 138.5 ± 15.4 cm y un 42% de malnutridos entre los que hubo: emaciación, sobrepeso y obesidad. La sen-sibilidad de PAS fue más alta (97.1 vs 79.8) aunque con especificidad más baja (50 vs 59). El valor predictivo negativo de PAS fue superior (73.1 vs 31.7). Los acuer-dos entre histología y pruebas en estudio fueron supe-riores para PAS (90.7% vs 74.5%). El 99% de apendicitis flegmonosa perteneció a PAS y el 84% a Alvarado. Se produjeron más falsos negativos con la puntuación de Alvarado (P< 0.001). CONCLUSIÓN: La puntuación PAS es una herramienta diagnóstica de uso fácil y confiable para decidir la ciru-gía de apendicitis aguda sospechada en niños. Hasta que se disponga de evidencia concluyente, el uso de ambas puntuaciones debe ser considerado como una buena práctica clínica.

bACkGROUND: The appendicitis is the most common surgical pathology in childhood. It is necessary an agi-le and accurate method to avoid excessive paraclini-cal examinations, diagnostic errors and unnecessary appendectomies. The systematic scores are the best processes for ordering clinical manifestations and reach the diagnosis.ObjECTIVE: To validate simultaneously the pediatric appendicitis score (PAS) and Alvarado scales for the diagnosis of acute appendicitis in children aged from 4 to 15 years old with acute abdomen in pediatric emer-gencies of a third level hospital in the national health system. MATERIALS AND METhODS: A total of 161 patients aged from 4 to 15 years old were treated at the Vicente Co-rral Moscoso Hospital in the pediatric emergency ser-vice with clinical suspicion of acute appendicitis. They were applied the two scores before the surgery. The diagnosis was confirmed with histology. We compared the diagnostic capacity of PAS and Alvarado, and the proportion of agreement between tests with respect to the gold standard. RESULTS: The sample had a predominance of males. The median age was 12 years, weight 37.5 ± 12.2 kg, height 138.5 ± 15.4 cm and 42% of malnutrition among those that were: emaciation, overweight and obesity. The sensitivity of PAS was higher (97.1 vs 79.8) although with lower specificity (50 vs 59). The negative predictive value of PAS was higher (73.1 vs 31.7). The agreements between histology and tests were higher for PAS (90.7% vs 74.5%). The 99% of phlegmonous appendicitis belon-ged to PAS and the 84% to Alvarado. More false negati-ves were produced with the Alvarado score (P <0.001). CONCLUSION: The PAS score is a reliable and easy diagnostic tool to use for deciding on acute appendi-citis surgery suspected in children. Until the conclusive evidence is available, the use of both scores should be considered as a good clinical practice.

The research development of congenital central hypoventilation syndrome / 中国小儿急救医学

Congenital central hypoventilation syndrome,also known as “Ondine′s curse”,is charac-terized by hypoventilation during sleep and impaired ventilatory responses to hypercapnia and hypoxemia. This disorder is associated with a malfunction of the nerves that control involuntary body functions and abnor-mal development of early embryonic cells that form the spinal cord. This review summarized the latest pro-gression in the pathogenesis,clinical symptoms,diagnosis,treatment and prognosis.

Progress of the cardiac injury in patients with duchenne muscular dystrophy / 国际儿科学杂志

Duchenne muscular dystrophy(DMD)is a fatal muscular wasting disease in children.Because of various factors such as DMDˊs low incidence,quick progression,limited knowledge of this disease,and treat-ment outcomes of respiratory failure,heart failure has become the leading cause of death in these patients.Early diagnosis and treatment is essential for prolonging the survival time and improving the quality of life.This review describes recent progress in the study of epidemiology,pathogenesis,early diagnosis,prevention and treatment of cardiac injury in patients with DMD.

Multilocular cystic renal cell carcinoma:a clinicopathological analysis of 18 cases / 临床与实验病理学杂志

Purpose To exp1ore the c1inicopatho1ogica1 features,diagnosis and differentia1 diagnosis of mu1ti1ocu1ar cystic rena1 ce11 carcinoma( MCRCC). Methods 18 cases of MCRCC were reported by microscopy,immunohistochemistry,differentia1 diagnosis and were fo11owed-up. Results A11 patients were adu1ts inc1uding twe1ve ma1es and six fema1es who aged from 26 to 68 years(mean 55. 6 years). Imaging studies revea1ed a po1ycystic mass,with c1ear boundary. Gross1y,the cut surface of the tumors had more cysts of va-rying sizes,containing serous or b1oody f1uid. Microscopica11y,the cyst wa11s of tumors were often covered with a few simp1e c1ear ce11s,stratified epithe1ium or devoid of epithe1ium. The septa contained aggregates of epithe1ia1 ce11s with transparent cytop1asm which showed gradeⅠ nuc1ear features,these characteristics were diagnostic c1ues of MCRCC. Immunohistochemica11y the c1ear ce11 was positive for CD10,vimentin,EMA and Ki-67 showed 1ow pro1iferative activity. 18 case were fo11owed up,mean fo11ow-up 43 months, no case recurred or with metastasis. Conclusion MCRCC is a rare histo1ogica1 subtype of rena1 ce11 carcinoma with more favorab1e prognosis. It shou1d be distinguished from cystic change of c1ear ce11 rena1 carcinoma and cysts of kidney 1esion.

A comparative study on diagnostic value of endoscopic retrograde cholangiopancreatographyand MR cholangiopancreatography in malignant biliary obstraction / 介入放射学杂志

Objective Comparing the diagnostic values for the malignant obstruction diseases of biliary tract between endoscopic retrograde cholangiopancreatography(ERCP)and MR cholangiopancreatography (MRCP). Methods Parallel analysis for the ERCP and MRCP data of 142 malignancies confirmed by surgery and/or ERCP among 383 biliary tract patients was retrospectively carried out. Results MRCP and ERCP were performed with exploration of 137 cases,showing the total conformity of 96.4%; together with localization conformities of 92.3% and 87.3%,qualitative conformities of 78.5% and 89.8% respectively. Conclusions In diagnosing the malignant obstructing disease of biliary tract,MRCP has the advantages in convenience,safety and low false negative,but with higher false positive than ERCP; however,if combined with ERCP can get higher positive conformity.(J Intervent Radiol,2007,16: 673-675)

Síndrome serotoninérgico / Serotonin syndrome

El síndrome serotoninérgico (SS) es una condición clínica asociada al uso de medicamentos agonistas de la serotonina, prescritos para el manejo de enfermedades psiquiátricas y no psiquiátricas como trastornos afectivos, de ansiedad, por dolor, etcétera. Se presenta por una excesiva estimulación de los receptores centrales y perifé-ricos de serotonina produciendo cambios mentales, autonómicos y neuromusculares. Usualmente se resuelve en las primeras 24 horas de iniciados los síntomas con tan solo la suspensión de los medica-mentos y medidas de soporte, sin embargo puede progresar a falla multisistémica y a la muerte de los pacientes. El presente artículo es una revisión teórica de los aspectos fundamentales del SS, iniciando con una breve revisión del sistema de serotonina en cuanto a su anatomía y fisiología para luego revisar los aspectos históricos, de diagnóstico, clínicos y de tratamiento más relevantes.[Muñoz H, Vargas A. Síndrome serotoninérgico. MedUNAB 2004; 7:144-50]

Serotonin syndrome. The serotonin syndrome is a clinical condi-tion associated with serotonin agonists, prescribed to treat some psychiatric and non psychiatric diseases like affective, anxiety and pain disorders. Is due to an excessive stimulation of central and peripheral serotonin receptors that leads to mental, autonomic and neuromuscular changes. Usually the disorder resolves within the first 24 hours after the medications are discontinued, however some patients progress to a multiple organ failure and die. This paper is a theoretical review of the fundamental aspects of the serotonin syndrome, beginning with a brief review of the anatomic and phy-siologic features of serotonin system, to continue to examine the most relevant historic, diagnosis, clinical and treatment aspects of the syndrome

THE COMPARISON BETWEEN PALPATION OF LIVER AND SPLEEN AND B ULTRASOUND IN THE SCREENING OF SCHISTOSOMIASIS JAPONICA / 中国血吸虫病防治杂志

After analyzing the correlation coefficient (r) of mid-clavicular liver size (MCL) and mid-sternal liver size (MSL), and the rate of correspond once between palpation and B Ultrasound of spleen, it was found that the "r" of MCL and MSL is 0. 6476 and 0. 5623 respectively, the correspond once rate of spleen is 76. 23%, This result shows that the examiner must master the palpation technique well and B Ultrasound should be used in the screening of schistosomiasis japonica if possible.