The clinical course ofchronic liver diseases is significantly dependent on the progression rate and the extent offibrosis, i.e. the non-structured replacement of necrotic parenchyma by extracellular matrix. Fibrogenes...The clinical course ofchronic liver diseases is significantly dependent on the progression rate and the extent offibrosis, i.e. the non-structured replacement of necrotic parenchyma by extracellular matrix. Fibrogenesis, i.e. the development offibrosis can be regarded as an unlimited wound healing process, which is based on matrix (connective tissue) synthesis in activated hepatic stellate cells, fibroblasts (fibrocytes), hepatocytes and biliary epithelial cells, which are converted to matrix-producing (myo-)fibroblasts by a process defined as epithelial-mesenchymal transition. Blood (noninvasive) biomarkers offibrogenesis and fibrosis can be divided into class and class analytes. Class biomarkers are those single tests, which are based on the pathophysiology offibrosis, whereas class biomarkers aremostly multiparametric algorithms, which have been statistically evaluated with regard to the detection and activity ofongoing fibrosis. Currently available markers fulfil the criteria ofideal clinical-chemical tests only partially, but increased understanding ofthe complex pathogenesis offibrosis offers additional ways for pathophysiologically well based serum (plasma) biomarkers. They include TGF-β-driven marker proteins, bone marrow-derived cells (fibrocytes), and cytokines, which govern proand anti-fibrotic activities. Proteomic and glycomic approaches ofserum are under investigation to set up specific protein or carbohydrate profiles in patients with liver fibrosis. These and other novel parameters will supplement or eventually replaceliver biopsy/histology, high resolution imaging analysis, and elastography for the detection and monitoring of patients at risk ofdeveloping liver fibrosis.展开更多
Objective To determine the validity of the diagnostic evidence for deceased cases in hospitals. Methods All information collected from medical records of the deceased cases in tertiary care health facilities was input...Objective To determine the validity of the diagnostic evidence for deceased cases in hospitals. Methods All information collected from medical records of the deceased cases in tertiary care health facilities was input into ottr database. Four diagnosis levels were determined based on level of diagnostic evidence： level Ⅰ was based on autopsy, pathology or operative exploration, level Ⅱ on physical and laboratory tests plus expert clinical judgment, level Ⅲ on expert clinical judgment, level Ⅳ on postmortem assumptions. After the diagnostic evidence of each deceased case was reviewed by a panel of three experts, the diagnostic level of each diagnosis was determined. Results Among the 2102 medical cases for verbal autopsy study, only 26 （1.24%） afforded diagnostic evidence for level Ⅲ Among the level Ⅲ evidence-based cases of death, the major causes of death were cardiovascular diseases, respiratory diseases, and gastroenterological diseases. According to some special symptoms and medical histories, these cases could be diagnosed by comprehensive clinical judgment. Only one case met the criteria for level Ⅳ. Conclusion Level Ⅰ diagnostic evidence is hard to attain in China because of the traditional concept and economic restriction. The causes for 2101 deaths can be validated by level Ⅱ or Ⅲ diagnostic evidence.展开更多
BACKGROUND Dissociation,which is defined as the failure to associate consciousness,memory,identity,emotion,perception,body representation,motor control,and behavior into an integrated whole,has long been assumed to be...BACKGROUND Dissociation,which is defined as the failure to associate consciousness,memory,identity,emotion,perception,body representation,motor control,and behavior into an integrated whole,has long been assumed to be generated by trauma.If dissociation is a product of trauma exposure,then dissociation would be a major mental health outcome observed in studies of disaster survivors.Although some studies have examined dissociation in disasters,no systematic literature reviews have been conducted to date on the topic.AIM To systematically evaluate the literature on the association between disaster and dissociation to determine the prevalence and incidence of dissociation after exposure to disaster and further examine their relationship.METHODS EMBASE,Medline,and PsychINFO were searched from inception to January 1,2019 to identify studies examining dissociative disorders or symptoms related to a disaster in adult or child disaster survivors and disaster responders.Studies of military conflicts and war,articles not in English,and those with samples of 30 or more participants were excluded.Search terms used were“disaster*”and dissociation(“dissociat*,”“multiple personality,”“fugue,”“psychogenic amnesia,”“derealization,”and“depersonalization”).Reference lists of identified articles were scrutinized to identify studies for additional articles.RESULTS The final number of articles in the review was 53,including 36 articles with samples of adults aged 18 and above,5 of children/adolescents under age 18,and 12 of disaster workers.Included articles studied several types of disasters that occurred between 1989 and 2017,more than one-third(38%)from the United States.Only two studies had a primary aim to investigate dissociation in relation to disaster and none reported data on dissociative disorders.All of the studies used self-report symptom scales;none used structured interviews providing full diagnostic assessment of dissociative disorders or other psychopathology.Several studies mixed exposed an展开更多
Background: Detection of extended spectrum beta lactamase producing bacteria is an important issue in the clinical settings. Objective: The purpose of the present study was to validate the Cica Beta Test 1 for detecti...Background: Detection of extended spectrum beta lactamase producing bacteria is an important issue in the clinical settings. Objective: The purpose of the present study was to validate the Cica Beta Test 1 for detection of extended spectrum beta-lactamase (ESBL) producing bacteria. Method: This analytical type of cross-sectional study was carried out in the Department of Microbiology and Immunology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2006 to December 2006 for a period of one (01) year. All the patients presented with the clinical features of urinary tract infection and surgical as well as burn wound infection at any age with both sexes were selected as study population. All bacteria were isolated and identified by their colony morphology, staining characters, pigment production, motility and other relevant biochemical tests. Phenotypic confirmation of ESBLs producing isolates were done by inhibitor potentiated disc diffusion test according to CLSI recommendation. The Cica Beta Test 1 was performed according to the manufacturer’s instructions. Result: A total number of 288 Gram negative bacteria were isolated. Among these isolates Cica Beta test 1 was positive in 97 strains and phenotypic confirmatory test was positive in 89 strains. The test sensitivity of Cica Beta Test 1 was 100% (95% CI 95.9% to 100.0%). Specificity of the test was 96.0% (95% CI 92.2% to 98.2%). The positive predictive value (PPV) and negative predictive value (NPV) were 92.7% (95% CI 84.5% to 95.7%) and 100.0% (95% CI 98.0% to 100.0%) respectively. The accuracy of the test was 97.2% (95% CI 95.1% to 99.1%). Area under ROC curve = 0.980 (95% CI 0.964 to 0.996);p value 0.0001. Conclusion: In conclusion, Cica Beta Test 1 is very high sensitivity and specificity for the detection of ESBL from Gram negative bacteria.展开更多
文摘The clinical course ofchronic liver diseases is significantly dependent on the progression rate and the extent offibrosis, i.e. the non-structured replacement of necrotic parenchyma by extracellular matrix. Fibrogenesis, i.e. the development offibrosis can be regarded as an unlimited wound healing process, which is based on matrix (connective tissue) synthesis in activated hepatic stellate cells, fibroblasts (fibrocytes), hepatocytes and biliary epithelial cells, which are converted to matrix-producing (myo-)fibroblasts by a process defined as epithelial-mesenchymal transition. Blood (noninvasive) biomarkers offibrogenesis and fibrosis can be divided into class and class analytes. Class biomarkers are those single tests, which are based on the pathophysiology offibrosis, whereas class biomarkers aremostly multiparametric algorithms, which have been statistically evaluated with regard to the detection and activity ofongoing fibrosis. Currently available markers fulfil the criteria ofideal clinical-chemical tests only partially, but increased understanding ofthe complex pathogenesis offibrosis offers additional ways for pathophysiologically well based serum (plasma) biomarkers. They include TGF-β-driven marker proteins, bone marrow-derived cells (fibrocytes), and cytokines, which govern proand anti-fibrotic activities. Proteomic and glycomic approaches ofserum are under investigation to set up specific protein or carbohydrate profiles in patients with liver fibrosis. These and other novel parameters will supplement or eventually replaceliver biopsy/histology, high resolution imaging analysis, and elastography for the detection and monitoring of patients at risk ofdeveloping liver fibrosis.
基金This work was sponsored by the National Institute of Aging Grant (No. 1-PO1-AG17625)
文摘Objective To determine the validity of the diagnostic evidence for deceased cases in hospitals. Methods All information collected from medical records of the deceased cases in tertiary care health facilities was input into ottr database. Four diagnosis levels were determined based on level of diagnostic evidence： level Ⅰ was based on autopsy, pathology or operative exploration, level Ⅱ on physical and laboratory tests plus expert clinical judgment, level Ⅲ on expert clinical judgment, level Ⅳ on postmortem assumptions. After the diagnostic evidence of each deceased case was reviewed by a panel of three experts, the diagnostic level of each diagnosis was determined. Results Among the 2102 medical cases for verbal autopsy study, only 26 （1.24%） afforded diagnostic evidence for level Ⅲ Among the level Ⅲ evidence-based cases of death, the major causes of death were cardiovascular diseases, respiratory diseases, and gastroenterological diseases. According to some special symptoms and medical histories, these cases could be diagnosed by comprehensive clinical judgment. Only one case met the criteria for level Ⅳ. Conclusion Level Ⅰ diagnostic evidence is hard to attain in China because of the traditional concept and economic restriction. The causes for 2101 deaths can be validated by level Ⅱ or Ⅲ diagnostic evidence.
文摘BACKGROUND Dissociation,which is defined as the failure to associate consciousness,memory,identity,emotion,perception,body representation,motor control,and behavior into an integrated whole,has long been assumed to be generated by trauma.If dissociation is a product of trauma exposure,then dissociation would be a major mental health outcome observed in studies of disaster survivors.Although some studies have examined dissociation in disasters,no systematic literature reviews have been conducted to date on the topic.AIM To systematically evaluate the literature on the association between disaster and dissociation to determine the prevalence and incidence of dissociation after exposure to disaster and further examine their relationship.METHODS EMBASE,Medline,and PsychINFO were searched from inception to January 1,2019 to identify studies examining dissociative disorders or symptoms related to a disaster in adult or child disaster survivors and disaster responders.Studies of military conflicts and war,articles not in English,and those with samples of 30 or more participants were excluded.Search terms used were“disaster*”and dissociation(“dissociat*,”“multiple personality,”“fugue,”“psychogenic amnesia,”“derealization,”and“depersonalization”).Reference lists of identified articles were scrutinized to identify studies for additional articles.RESULTS The final number of articles in the review was 53,including 36 articles with samples of adults aged 18 and above,5 of children/adolescents under age 18,and 12 of disaster workers.Included articles studied several types of disasters that occurred between 1989 and 2017,more than one-third(38%)from the United States.Only two studies had a primary aim to investigate dissociation in relation to disaster and none reported data on dissociative disorders.All of the studies used self-report symptom scales;none used structured interviews providing full diagnostic assessment of dissociative disorders or other psychopathology.Several studies mixed exposed an
文摘Background: Detection of extended spectrum beta lactamase producing bacteria is an important issue in the clinical settings. Objective: The purpose of the present study was to validate the Cica Beta Test 1 for detection of extended spectrum beta-lactamase (ESBL) producing bacteria. Method: This analytical type of cross-sectional study was carried out in the Department of Microbiology and Immunology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2006 to December 2006 for a period of one (01) year. All the patients presented with the clinical features of urinary tract infection and surgical as well as burn wound infection at any age with both sexes were selected as study population. All bacteria were isolated and identified by their colony morphology, staining characters, pigment production, motility and other relevant biochemical tests. Phenotypic confirmation of ESBLs producing isolates were done by inhibitor potentiated disc diffusion test according to CLSI recommendation. The Cica Beta Test 1 was performed according to the manufacturer’s instructions. Result: A total number of 288 Gram negative bacteria were isolated. Among these isolates Cica Beta test 1 was positive in 97 strains and phenotypic confirmatory test was positive in 89 strains. The test sensitivity of Cica Beta Test 1 was 100% (95% CI 95.9% to 100.0%). Specificity of the test was 96.0% (95% CI 92.2% to 98.2%). The positive predictive value (PPV) and negative predictive value (NPV) were 92.7% (95% CI 84.5% to 95.7%) and 100.0% (95% CI 98.0% to 100.0%) respectively. The accuracy of the test was 97.2% (95% CI 95.1% to 99.1%). Area under ROC curve = 0.980 (95% CI 0.964 to 0.996);p value 0.0001. Conclusion: In conclusion, Cica Beta Test 1 is very high sensitivity and specificity for the detection of ESBL from Gram negative bacteria.
