Cataract is a very common eye disease and the most significant cause of blindness.In consideration of its burden on society,the focus was put on testing the risk factors of cataract and building robust machine learnin...Cataract is a very common eye disease and the most significant cause of blindness.In consideration of its burden on society,the focus was put on testing the risk factors of cataract and building robust machine learning models in which these factors can be utilized to predict the risk of cataract.The data used herein was collected by a Chinese physical examination center located in Shanghai.It contains more than 120,000 examinees and about 500 physical examination metrics.Firstly,association rules were adopted to filter 39 abnormalities which are more likely to incur the risk of cataract,and the significance of these abnormalities was tested with univariate analysis and multivariate analysis.The test results indicate that age,diabetes,refractive error,retinal arteriosclerosis,thyroid nodules,and incomplete mammary gland degeneration significantly increase the possibility of cataract.Various machine learning models were compared in terms of their performance in predicting the risk of cataract based on these six factors,among which the logistic regression model and the decision-tree based ensemble methods outperform others.The test set A U C of these models can reach 0.84.展开更多
AIM:To explore the correlation between diabetic retinopathy(DR)and Helicobacter pylori(Hp)infection,based on data from a physical examination population.METHODS:This cross-sectional retrospective analysis included dat...AIM:To explore the correlation between diabetic retinopathy(DR)and Helicobacter pylori(Hp)infection,based on data from a physical examination population.METHODS:This cross-sectional retrospective analysis included data of 73824 health examination participants from December 2018 to December 2019.Participants were divided into the diabetic group and non-diabetic group,nondiabetic retinopathy(NDR)group,non-proliferative diabetic retinopathy(NPDR)group,proliferative diabetic retinopathy(PDR)group,and Hp infection group.Gender,age,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),glycated hemoglobin A1c(HbA1c),triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),and Hp data were recorded to compare the degree of DR lesions and Hp infection.Logistic regression analysis was used to evaluate the correlation between DR and Hp infection.RESULTS:There was a statistically significant difference between the diabetic and non-diabetic group(χ2=94.17,P<0.0001).Logistic regression analysis showed that male sex,age,BMI,SBP,TG,LDL-C,and Hp infection were independent risk factors for DR.There was no correlation between the degree of DR lesions and Hp infection(ρ=-0.00339,P=0.7753).Age[odds ratio(OR)=1.035,95%CI:1.024,1.046,P<0.0001]and SBP(OR=1.009,95%CI:1.004,1.015,P=0.0013)were independent risk factors for the degree of DR.CONCLUSION:There is a significant correlation between DR and Hp infection in the physical examination population.Hp infection is a risk factor for DR,and there is no significant difference between Hp infection and DR of different pathological degrees.Actively eradicating Hp may be of help to prevent DR.展开更多
The study investigated the distribution of Epstein-Barr virus(EBV)EA-IgA,VCAIgA,and EBVNA-IgG antibodies in a local population of Wuhan,China.Chemiluminescence immunoassay(CL1A)was used to detect EBV EA-IgA,VCA-IgA,an...The study investigated the distribution of Epstein-Barr virus(EBV)EA-IgA,VCAIgA,and EBVNA-IgG antibodies in a local population of Wuhan,China.Chemiluminescence immunoassay(CL1A)was used to detect EBV EA-IgA,VCA-IgA,and EBVNA-IgG antibodies in 972 subjects undergoing physical examination in Wuhan,and the results were analyzed.The detection rate of EBV was positively correlated with age.In the 972 cases,there was significant difference between different genders in the positive rate of VCA-IgA and EBVNA-IgG.Moreover,the positive rate of VCA-IgA and EBVNA-IgG was higher in men>60 years old than in those<60 but no significant differences were found in three antibodies among various age groups.Our results suggested that the EBV infection should be intensively monitored in elderly people in Wuhan.展开更多
BACKGROUND: Diagnosing pericardial effusion is critical for optimal patient care. Typically, clinicians use physical examination ? ndings and historical features suggesting pericardial effusion to determine which pati...BACKGROUND: Diagnosing pericardial effusion is critical for optimal patient care. Typically, clinicians use physical examination ? ndings and historical features suggesting pericardial effusion to determine which patients require echocardiography. The diagnostic characteristics of these tools are not well described. The objective of this study is to determine the prevalence of historical features and sensitivity of clinical signs to inform clinicians when to proceed with echocardiogram.METHODS: A retrospective review of point-of-care echocardiograms performed over a two and a half year period in two emergency departments were reviewed for the presence of a pericardial effusion. Patient charts were reviewed and abstracted for presenting symptoms, historical features and clinical findings. The prevalence of presenting symptoms and historical features and the sensitivity of classic physical examination ? ndings associated with pericardial effusion and tamponade were determined.RESULTS: One hundred and fifty-three patients with pericardial effusion were identified. Of these patients, the most common presenting complaint was chest pain and shortness of breath. Patients had no historical features that would suggest pericardial effusion in 37.5% of cases. None of the patients with pericardial effusion or pericardial tamponade had all of the elements of Beck's triad. The sensitivity of Beck's triad was found to be 0(0%–19.4%). The sensitivity for one ? nding of Beck's triad to diagnose pericardial tamponade was 50%(28.0%–72.0%).CONCLUSION: History and physical examination findings perform poorly as tests for the diagnosis of pericardial effusion or pericardial tamponade. Clinicians must liberally evaluate patients suspected of having a pericardial effusion with echocardiography.展开更多
Objectives:This study aimed to describe cardiovascular risk and cardiovascular disease(CVD)knowledge among older adults,and further explore the association between knowledge and risk.Methods:In this cross-sectional st...Objectives:This study aimed to describe cardiovascular risk and cardiovascular disease(CVD)knowledge among older adults,and further explore the association between knowledge and risk.Methods:In this cross-sectional study,we enrolled 1120 older adults who received physical examination in health centers.The participants were interviewed to obtain their behavioral risk factors related to CVD and clinical characteristics.A risk prediction chart was used to predict participants'cardiovascular risk based on clinical characteristics and behavioral risk factors.Participants'CVD knowledge was collected with a pretested knowledge questionnaire.Results:Among the 1120 participants,240(21.4%)had low cardiovascular risk,353(31.5%)had moderate cardiovascular risk,527(47%)had high and very high cardiovascular risk.The knowledge level about CVD among 0.8%of the 1120 participants was good while that of 56.9%was poor.Lower CVD knowledge level,older age,lower income,and lower educational level were the independent factors of higher cardiovascular risk level.Conclusions:This study highlights the need to reduce the cardiovascular risk among older adults.CVD knowledge should be considered when developing health interventions.展开更多
AIM:To assess the prevalence of meibomian gland dysfunction(MGD)in staffs and faculty members of Sichuan University,China.METHODS:The records of the annually systemic physical examination of 4404 consecutive staffs an...AIM:To assess the prevalence of meibomian gland dysfunction(MGD)in staffs and faculty members of Sichuan University,China.METHODS:The records of the annually systemic physical examination of 4404 consecutive staffs and faculty members of Sichuan University were analyzed retrospectively.Ocular symptoms and signs of ocular surface were evaluated.RESULTS:MGD was diagnosed in 1424 participants(32.3%),with a mean age of 43.0±9.6 y.Of these,718(50.4%)were females and no significant difference was found between males and females.The highest prevalence was found in the age 50-59 y(36.0%).Logistic regression analysis showed that age is an impact factor of MGD(P<0.001,odds ratio=1.014).CONCLUSION:The prevalence of MGD in staffs and faculty members of a Chinese university is 32.3%,and increases with age.展开更多
BACKGROUND Shoulder maneuvers and magnetic resonance imaging(MRI)are performed to diagnose supraspinatus tendon tears regardless of arthroscopy exam.Although there are many studies on this subject,there is a lack of s...BACKGROUND Shoulder maneuvers and magnetic resonance imaging(MRI)are performed to diagnose supraspinatus tendon tears regardless of arthroscopy exam.Although there are many studies on this subject,there is a lack of studies comparing the sensitivity(Se)and specificity(Sp)of shoulder maneuvers and MRI to arthroscopic findings(intact,partial,or full thickness supraspinatus tendon tear).AIM To compare the diagnostic values of shoulder maneuvers with MRI for supraspinatus tendon tears in patients undergoing shoulder arthroscopy.METHODS A total of 199 consecutive patients from four orthopedic centers met the eligibility criteria of shoulder pain persisting for at least four weeks.They were prospectively enrolled in this study from April 2017 to April 2019.Seven clinical tests(full can,empty can,drop arm,Hawkins’,painful arc,Neer’s sign and resisted external rotation)and MRI were performed,and all were compared with surgical findings.Full can,empty can and resisted external rotation tests were interpreted as positive in the case of pain and/or weakness.We assessed the Se,Sp,accuracy,positive predictive value(PPV)and negative predictive value(NPV),positive and negative likelihood ratio and diagnostic odds ratio for overall,partial and fullthickness supraspinatus tears.RESULTS MRI had the highest Se for overall(0.97),partial(0.91)and full-thickness(0.99)tears;moreover,MRI had the highest NPV:0.90,0.88 and 0.98 for overall,partial and full-thickness tears,respectively.For overall supraspinatus tears,the Se and PPV were:Painful arc(Se=0.85/PPV=0.91),empty can(pain)(Se=0.80/PPV=0.89),full can(pain)(Se=0.78/PPV=0.90),resisted external rotation(pain)(Se=0.48/PPV=0.87),drop arm(Se=0.19/PPV=0.97),Neer’s sign(Se=0.78/PPV=0.93)and Hawkins’(Se=0.80/PPV=0.88).MRI had the highest PPV(0.99).The Hawkin’s test had the highest false positive rate in patients with intact tendons(0.36).The Sp of the empty can and full can(both tests positive for pain and weakness),drop arm and MRI were:0.93,0.91,0.98 and 0.96,respectively.For partial and full-thickness tears,the empty can test(positive for pain and weakness)had a Sp of 0.93,and the drop arm and MRI had the same Sp(0.98).CONCLUSION Physical examination demonstrated good diagnostic value,the drop arm test had a Sp as good as MRI for supraspinatus tears;however,MRI was more accurate in ruling out tears.The Hawkins’test had high false-positive findings in patients with intact tendons.展开更多
Objective: To compare the two skeletal muscle mass index (SMI) algorithms. One is SMM [SMM(%) = total skeletal muscle mass (kg)/body weight mass (kg) × 100%];and the other is SMH [SMH (kg/m<sup>2</sup>...Objective: To compare the two skeletal muscle mass index (SMI) algorithms. One is SMM [SMM(%) = total skeletal muscle mass (kg)/body weight mass (kg) × 100%];and the other is SMH [SMH (kg/m<sup>2</sup>) = total skeletal muscle mass (kg)/height (m)<sup>2</sup>]. Methods: Body composition, body mass index (BMI) and body fat percentage (BFP) were estimated using a bioelectrical impedance analyzer. SMI was calculated by the two algorithms described above, and measurement parameters were stratified by age, BMI and levels of physical activity. Results: Levels of BMI, BFP, SMM and SMH differed significantly between the sexes. BMI and BFP were positively associated with age, while SMM was negatively associated with age (β = −0.2294, P < 0.001). Furthermore, SMM was determined to have a negative association with BMI (β = −0.5340, P < 0.001), while a positive association between SMH and BMI (β = 0.7930, P β = −0.9849, P β = −0.0642, P < 0.001) were negatively associated with BFP. In both men and women, SMM maintained the analogous correlation with other indicators. In the general population, SMM showed a gradual downward trend from low body weight to grade III obesity (F = 9528.32, P < 0.001), but SMH (F = 34395.46, P F = 9706.20, P < 0.001) had a reciprocal association. BMI, BFP and SMM differences were observed based on levels of physical activity (P < 0.001). However, there was no significant difference in SMH based on exercise (P > 0.05). Conclusions: SMM may be a more ideal and accurate clinical algorithm for SMI because it is more tightly associated with other body composition indices, as compared with SMH.展开更多
BACKGROUND Acute scrotal pain and swelling are common presentations in the emergency department.Urgent surgical intervention is justified in up to one-third of cases,whereas two-thirds of them should be treated conser...BACKGROUND Acute scrotal pain and swelling are common presentations in the emergency department.Urgent surgical intervention is justified in up to one-third of cases,whereas two-thirds of them should be treated conservatively.CASE SUMMARY We report a case of scrotal only strangulation in a child and review the available literature.CONCLUSION Due to its rarity,scrotal strangulation can be a diagnostic challenge.Skin ulceration and edema may well indicate the presence of a strangulation object.A high index of suspicion and appropriate physical examination,especially in patients with a mental disability or behavioral disorder,are key to early diagnosis and treatment.展开更多
<strong>Objective:</strong> The clinical examination is the basis for the diagnosis and rational choice of complementary tests. The aim of the study was to evaluate the performance of auscultation of the c...<strong>Objective:</strong> The clinical examination is the basis for the diagnosis and rational choice of complementary tests. The aim of the study was to evaluate the performance of auscultation of the chest for screening of disease and for predicting the presence of abnormalities in the other domains of the chest examination. <strong>Methods:</strong> Patients with COPD, atelectasis, pleural effusion, pneumonia and controls were evaluated by two examiners in the absence of any clinical information, initially only with pulmonary auscultation, and then in the other domains of chest examination. <strong>Results:</strong> 192 physical examinations were performed in 104 patients. An abnormal pulmonary auscultation had a sensitivity of 85.2%, positive predictive value (PPV) of 84.1%, positive likelihood reason (LR) of 1.53 (95% CI;1.16 to 2.01) and negative LR of 0.33 (95% CI;0.2 to 0.56) to identify the presence of any disease, and also a positive LR of 2.23 (95% CI;1.02 to 4.9) and a negative LR of 0.3 (95% CI;0.17 to 0.51) to predict additional abnormalities. A normal auscultation showed low accuracy to identify healthy individuals, with sensitivity, specificity, NPV and PPV, respectively, of 44%, 43%, 41% and 46%. The agreement between the examiners considering normal versus abnormal findings showed kappa = 0.76 for any changes in the physical examination present (p < 0.0001). <strong>Conclusions:</strong> Auscultation of the chest alone, may not be a sufficient strategy to track diseases or establish whether continuity of the examination is necessary or not.展开更多
Poor adherence to standard protocols of blood pressure(BP)measurement in routine clinical practice leads to higher readings than“research-quality”measurements.Whether this phenomenon exists in periodic health examin...Poor adherence to standard protocols of blood pressure(BP)measurement in routine clinical practice leads to higher readings than“research-quality”measurements.Whether this phenomenon exists in periodic health examinations was unknown.We aimed to explore the concordance between BP measurements in periodic health examinations and those measured following a standard measurement protocol.We used data from the Kailuan Study,an ongoing longitudinal cohort study in China,of which participants received biennial health examinations in health management centers.In addition,BPs were measured following standard protocols in a workplace-based hypertension management program nested in the Kailuan Study.We compared BP readings of the same person between the two settings using generalized linear mixed-effects models.A total of 3988 men(the mean age was 44.9 years)had at least two BP measurements both in health examinations and management program with a time interval between the two settings that less than 90 days.The mean systolic blood pressures(SBP)and diastolic blood pressures(DBP)in health examinations were 4.2(95%CI 3.9–4.5)mm Hg and 3.3(95%CI 3.1–3.5)mm Hg higher than those in the management program,respectively.Bland–Altman analyses showed the wide agreement inter-vals ranging from-27.7-to 36.5-mm Hg for SBP and-18.3-to 24.7-mm Hg for DBP.In conclusion,BP measurements in periodic health examinations were generally higher than BPs measured following a standard protocol.Our findings highlight the importance of standard BP measurement to avoid overestimation of hypertension prevalence and treatment initiation.展开更多
Clinical forensic imaging encompasses the diverse application of imaging procedures that serve the same purpose:to enable the analysis and investigation of criminal activities and consequences of a crime.All kinds of ...Clinical forensic imaging encompasses the diverse application of imaging procedures that serve the same purpose:to enable the analysis and investigation of criminal activities and consequences of a crime.All kinds of imaging techniques and their corresponding images can be subsumed under“forensigraphy”,a more comprehensive term for forensic imaging created by the Ludwig Boltzmann Institute for Clinical Forensic Imaging in Graz,Austria.As the word forensigraphy suggests,criminal imaging material should be of use in forensic investigations.Ideally,this can lead to new findings that would not have been revealed without the application of imaging techniques and are moreover admissible as evidence in criminal proceedings.However,the admissibility of evidence can only be facilitated through the implementation of clinical forensic imaging techniques into the forensic routine case work,which requires a precise pre-analysis of the corresponding legal framework.Because taking and displaying internal images of a person’s body touches upon various aspects of one’s physical and psychological integrity,imaging methods in general and clinical forensic imaging methods especially have a strong impact on and interfere regularly with the fundamental rights of the concerned person.Particularly with regard to a possible medical context,certain legal regulations have to be taken into account.Therefore,this paper examines forensic imaging in the field of radiological forensigraphy,specifically its in vivo(i.e.clinical)application.It is designed to enlighten readers as to the great significance of legal barriers that emerge from fundamental rights,as laid down in the European Convention on Human Rights(ECHR),when dealing with clinical forensic imaging.As a result,the legal framework of clinical forensic imaging procedures are comprehensively described,the relevant fundamental rights,especially the right to respect for private and family life,the right to data protection and certain procedural guarantees,are concisely presented to further raise awareness regarding the importance of fundamental rights.展开更多
Introduction:A comprehensive scene reconstruction requires forensic investigators to examine the impact marks left on various surfaces to identify whether a projectile produces a specific hole.Subsequently,it is furth...Introduction:A comprehensive scene reconstruction requires forensic investigators to examine the impact marks left on various surfaces to identify whether a projectile produces a specific hole.Subsequently,it is further necessary to determine whether a particular ammunition has caused the impact.Throughout history,designs of ammunition have evolved with the intended effects,which could leave different impact marks on a target surface,especially by ammunition with a nonconventional design.Careful examination on impact marks and determination of their specific characteristics on sheet metal of vehicle would provide crucialforensic information.Aim:This study was aimed to physically characterize bullet impact holes made by 11 types of 9-mm caliber ammunitions.Materials and Methods:Two automotive doors were shot with different ammunitionsfrom the same firearm,and the morphological features of bullet impact holes were observed and compared.Results:Bullet impact holes produced by the various ammunitions could be differentiated through careful observation of bullet hole circumferences,presence of petalling effect,metallic ring and triangular peak at the edge,and deposition of residue at the peripheral area of bullet impact holes.Ammunitions with nonconventional design such as Inceptor‑Polycase and GECO Hexagon showed observable morphological differences and discriminated them from bullet impact holes made by conventional ammunitions.Conclusion:A thorough physical examination could aid in distinguishing bullet impact holes and predicting the possible types of ammunition that had made an impact hole on a surface.展开更多
Infertility is a pervasive issue affecting a considerable proportion of couples in their reproductive years,with a projected 10%-15% prevalence.It is characterized by the incapability to achieve conception following a...Infertility is a pervasive issue affecting a considerable proportion of couples in their reproductive years,with a projected 10%-15% prevalence.It is characterized by the incapability to achieve conception following a year of consistent,unprotected intercourse,and its far-reaching consequences can take a profound emotional,psychological,and social toll on couples,inducing feelings of melancholy,exasperation,and anxiety.The appraisal of infertile couples'cases is a multifaceted and daunting process,necessitating a holistic understanding of the intricate underlying factors contributing to their infertility.Consequently,an individualized evaluation should be conducted,considering diverse parameters,such as the couple's medical history,age,infertility duration,and other relevant criteria.This paper will provide an in-depth overview of the current approaches utilized in the evaluation of men with infertility,including the commonly employed diagnostic tools and procedures.Enhancing our comprehension of infertility assessment and management holds the promise of helping couples achieve their ultimate desire of conceiving and enriching their overall quality of life.展开更多
基金the National Key R&D Program of China under Grant No.2020AAA0103800.
文摘Cataract is a very common eye disease and the most significant cause of blindness.In consideration of its burden on society,the focus was put on testing the risk factors of cataract and building robust machine learning models in which these factors can be utilized to predict the risk of cataract.The data used herein was collected by a Chinese physical examination center located in Shanghai.It contains more than 120,000 examinees and about 500 physical examination metrics.Firstly,association rules were adopted to filter 39 abnormalities which are more likely to incur the risk of cataract,and the significance of these abnormalities was tested with univariate analysis and multivariate analysis.The test results indicate that age,diabetes,refractive error,retinal arteriosclerosis,thyroid nodules,and incomplete mammary gland degeneration significantly increase the possibility of cataract.Various machine learning models were compared in terms of their performance in predicting the risk of cataract based on these six factors,among which the logistic regression model and the decision-tree based ensemble methods outperform others.The test set A U C of these models can reach 0.84.
基金Supported by The Project of National Key Research and Development(No.2018YFC1106103)。
文摘AIM:To explore the correlation between diabetic retinopathy(DR)and Helicobacter pylori(Hp)infection,based on data from a physical examination population.METHODS:This cross-sectional retrospective analysis included data of 73824 health examination participants from December 2018 to December 2019.Participants were divided into the diabetic group and non-diabetic group,nondiabetic retinopathy(NDR)group,non-proliferative diabetic retinopathy(NPDR)group,proliferative diabetic retinopathy(PDR)group,and Hp infection group.Gender,age,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),glycated hemoglobin A1c(HbA1c),triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),and Hp data were recorded to compare the degree of DR lesions and Hp infection.Logistic regression analysis was used to evaluate the correlation between DR and Hp infection.RESULTS:There was a statistically significant difference between the diabetic and non-diabetic group(χ2=94.17,P<0.0001).Logistic regression analysis showed that male sex,age,BMI,SBP,TG,LDL-C,and Hp infection were independent risk factors for DR.There was no correlation between the degree of DR lesions and Hp infection(ρ=-0.00339,P=0.7753).Age[odds ratio(OR)=1.035,95%CI:1.024,1.046,P<0.0001]and SBP(OR=1.009,95%CI:1.004,1.015,P=0.0013)were independent risk factors for the degree of DR.CONCLUSION:There is a significant correlation between DR and Hp infection in the physical examination population.Hp infection is a risk factor for DR,and there is no significant difference between Hp infection and DR of different pathological degrees.Actively eradicating Hp may be of help to prevent DR.
基金grants from the Natural Science Foundation of Hubei Province(No.2018CFB749 and No.2018ADC073)the Scientific Research Fund of Union Hospital,Tongji Medical College,Huazhong University of Science and Technology(No.02.03.2017-292 and No.02.03.2017-327)General Project of Hubei Health Committee(No.02.07.19030018).
文摘The study investigated the distribution of Epstein-Barr virus(EBV)EA-IgA,VCAIgA,and EBVNA-IgG antibodies in a local population of Wuhan,China.Chemiluminescence immunoassay(CL1A)was used to detect EBV EA-IgA,VCA-IgA,and EBVNA-IgG antibodies in 972 subjects undergoing physical examination in Wuhan,and the results were analyzed.The detection rate of EBV was positively correlated with age.In the 972 cases,there was significant difference between different genders in the positive rate of VCA-IgA and EBVNA-IgG.Moreover,the positive rate of VCA-IgA and EBVNA-IgG was higher in men>60 years old than in those<60 but no significant differences were found in three antibodies among various age groups.Our results suggested that the EBV infection should be intensively monitored in elderly people in Wuhan.
文摘BACKGROUND: Diagnosing pericardial effusion is critical for optimal patient care. Typically, clinicians use physical examination ? ndings and historical features suggesting pericardial effusion to determine which patients require echocardiography. The diagnostic characteristics of these tools are not well described. The objective of this study is to determine the prevalence of historical features and sensitivity of clinical signs to inform clinicians when to proceed with echocardiogram.METHODS: A retrospective review of point-of-care echocardiograms performed over a two and a half year period in two emergency departments were reviewed for the presence of a pericardial effusion. Patient charts were reviewed and abstracted for presenting symptoms, historical features and clinical findings. The prevalence of presenting symptoms and historical features and the sensitivity of classic physical examination ? ndings associated with pericardial effusion and tamponade were determined.RESULTS: One hundred and fifty-three patients with pericardial effusion were identified. Of these patients, the most common presenting complaint was chest pain and shortness of breath. Patients had no historical features that would suggest pericardial effusion in 37.5% of cases. None of the patients with pericardial effusion or pericardial tamponade had all of the elements of Beck's triad. The sensitivity of Beck's triad was found to be 0(0%–19.4%). The sensitivity for one ? nding of Beck's triad to diagnose pericardial tamponade was 50%(28.0%–72.0%).CONCLUSION: History and physical examination findings perform poorly as tests for the diagnosis of pericardial effusion or pericardial tamponade. Clinicians must liberally evaluate patients suspected of having a pericardial effusion with echocardiography.
基金The study was funded by a grant from the National Natural Science Foundation of China(NSFC,contract grant number:81641112)Hunan Excellent Young Teachers Fund(contract grant number:2018191RQG010).
文摘Objectives:This study aimed to describe cardiovascular risk and cardiovascular disease(CVD)knowledge among older adults,and further explore the association between knowledge and risk.Methods:In this cross-sectional study,we enrolled 1120 older adults who received physical examination in health centers.The participants were interviewed to obtain their behavioral risk factors related to CVD and clinical characteristics.A risk prediction chart was used to predict participants'cardiovascular risk based on clinical characteristics and behavioral risk factors.Participants'CVD knowledge was collected with a pretested knowledge questionnaire.Results:Among the 1120 participants,240(21.4%)had low cardiovascular risk,353(31.5%)had moderate cardiovascular risk,527(47%)had high and very high cardiovascular risk.The knowledge level about CVD among 0.8%of the 1120 participants was good while that of 56.9%was poor.Lower CVD knowledge level,older age,lower income,and lower educational level were the independent factors of higher cardiovascular risk level.Conclusions:This study highlights the need to reduce the cardiovascular risk among older adults.CVD knowledge should be considered when developing health interventions.
基金Supported by the National Natural Science Foundation of China(No.81870665)。
文摘AIM:To assess the prevalence of meibomian gland dysfunction(MGD)in staffs and faculty members of Sichuan University,China.METHODS:The records of the annually systemic physical examination of 4404 consecutive staffs and faculty members of Sichuan University were analyzed retrospectively.Ocular symptoms and signs of ocular surface were evaluated.RESULTS:MGD was diagnosed in 1424 participants(32.3%),with a mean age of 43.0±9.6 y.Of these,718(50.4%)were females and no significant difference was found between males and females.The highest prevalence was found in the age 50-59 y(36.0%).Logistic regression analysis showed that age is an impact factor of MGD(P<0.001,odds ratio=1.014).CONCLUSION:The prevalence of MGD in staffs and faculty members of a Chinese university is 32.3%,and increases with age.
文摘BACKGROUND Shoulder maneuvers and magnetic resonance imaging(MRI)are performed to diagnose supraspinatus tendon tears regardless of arthroscopy exam.Although there are many studies on this subject,there is a lack of studies comparing the sensitivity(Se)and specificity(Sp)of shoulder maneuvers and MRI to arthroscopic findings(intact,partial,or full thickness supraspinatus tendon tear).AIM To compare the diagnostic values of shoulder maneuvers with MRI for supraspinatus tendon tears in patients undergoing shoulder arthroscopy.METHODS A total of 199 consecutive patients from four orthopedic centers met the eligibility criteria of shoulder pain persisting for at least four weeks.They were prospectively enrolled in this study from April 2017 to April 2019.Seven clinical tests(full can,empty can,drop arm,Hawkins’,painful arc,Neer’s sign and resisted external rotation)and MRI were performed,and all were compared with surgical findings.Full can,empty can and resisted external rotation tests were interpreted as positive in the case of pain and/or weakness.We assessed the Se,Sp,accuracy,positive predictive value(PPV)and negative predictive value(NPV),positive and negative likelihood ratio and diagnostic odds ratio for overall,partial and fullthickness supraspinatus tears.RESULTS MRI had the highest Se for overall(0.97),partial(0.91)and full-thickness(0.99)tears;moreover,MRI had the highest NPV:0.90,0.88 and 0.98 for overall,partial and full-thickness tears,respectively.For overall supraspinatus tears,the Se and PPV were:Painful arc(Se=0.85/PPV=0.91),empty can(pain)(Se=0.80/PPV=0.89),full can(pain)(Se=0.78/PPV=0.90),resisted external rotation(pain)(Se=0.48/PPV=0.87),drop arm(Se=0.19/PPV=0.97),Neer’s sign(Se=0.78/PPV=0.93)and Hawkins’(Se=0.80/PPV=0.88).MRI had the highest PPV(0.99).The Hawkin’s test had the highest false positive rate in patients with intact tendons(0.36).The Sp of the empty can and full can(both tests positive for pain and weakness),drop arm and MRI were:0.93,0.91,0.98 and 0.96,respectively.For partial and full-thickness tears,the empty can test(positive for pain and weakness)had a Sp of 0.93,and the drop arm and MRI had the same Sp(0.98).CONCLUSION Physical examination demonstrated good diagnostic value,the drop arm test had a Sp as good as MRI for supraspinatus tears;however,MRI was more accurate in ruling out tears.The Hawkins’test had high false-positive findings in patients with intact tendons.
文摘Objective: To compare the two skeletal muscle mass index (SMI) algorithms. One is SMM [SMM(%) = total skeletal muscle mass (kg)/body weight mass (kg) × 100%];and the other is SMH [SMH (kg/m<sup>2</sup>) = total skeletal muscle mass (kg)/height (m)<sup>2</sup>]. Methods: Body composition, body mass index (BMI) and body fat percentage (BFP) were estimated using a bioelectrical impedance analyzer. SMI was calculated by the two algorithms described above, and measurement parameters were stratified by age, BMI and levels of physical activity. Results: Levels of BMI, BFP, SMM and SMH differed significantly between the sexes. BMI and BFP were positively associated with age, while SMM was negatively associated with age (β = −0.2294, P < 0.001). Furthermore, SMM was determined to have a negative association with BMI (β = −0.5340, P < 0.001), while a positive association between SMH and BMI (β = 0.7930, P β = −0.9849, P β = −0.0642, P < 0.001) were negatively associated with BFP. In both men and women, SMM maintained the analogous correlation with other indicators. In the general population, SMM showed a gradual downward trend from low body weight to grade III obesity (F = 9528.32, P < 0.001), but SMH (F = 34395.46, P F = 9706.20, P < 0.001) had a reciprocal association. BMI, BFP and SMM differences were observed based on levels of physical activity (P < 0.001). However, there was no significant difference in SMH based on exercise (P > 0.05). Conclusions: SMM may be a more ideal and accurate clinical algorithm for SMI because it is more tightly associated with other body composition indices, as compared with SMH.
文摘BACKGROUND Acute scrotal pain and swelling are common presentations in the emergency department.Urgent surgical intervention is justified in up to one-third of cases,whereas two-thirds of them should be treated conservatively.CASE SUMMARY We report a case of scrotal only strangulation in a child and review the available literature.CONCLUSION Due to its rarity,scrotal strangulation can be a diagnostic challenge.Skin ulceration and edema may well indicate the presence of a strangulation object.A high index of suspicion and appropriate physical examination,especially in patients with a mental disability or behavioral disorder,are key to early diagnosis and treatment.
文摘<strong>Objective:</strong> The clinical examination is the basis for the diagnosis and rational choice of complementary tests. The aim of the study was to evaluate the performance of auscultation of the chest for screening of disease and for predicting the presence of abnormalities in the other domains of the chest examination. <strong>Methods:</strong> Patients with COPD, atelectasis, pleural effusion, pneumonia and controls were evaluated by two examiners in the absence of any clinical information, initially only with pulmonary auscultation, and then in the other domains of chest examination. <strong>Results:</strong> 192 physical examinations were performed in 104 patients. An abnormal pulmonary auscultation had a sensitivity of 85.2%, positive predictive value (PPV) of 84.1%, positive likelihood reason (LR) of 1.53 (95% CI;1.16 to 2.01) and negative LR of 0.33 (95% CI;0.2 to 0.56) to identify the presence of any disease, and also a positive LR of 2.23 (95% CI;1.02 to 4.9) and a negative LR of 0.3 (95% CI;0.17 to 0.51) to predict additional abnormalities. A normal auscultation showed low accuracy to identify healthy individuals, with sensitivity, specificity, NPV and PPV, respectively, of 44%, 43%, 41% and 46%. The agreement between the examiners considering normal versus abnormal findings showed kappa = 0.76 for any changes in the physical examination present (p < 0.0001). <strong>Conclusions:</strong> Auscultation of the chest alone, may not be a sufficient strategy to track diseases or establish whether continuity of the examination is necessary or not.
基金supported by National Natural Science Foundation of China(81930124 and 82021005)Shanghai Municipal Science and Technology Major Project(Grant No.2017SHZDZX01).
文摘Poor adherence to standard protocols of blood pressure(BP)measurement in routine clinical practice leads to higher readings than“research-quality”measurements.Whether this phenomenon exists in periodic health examinations was unknown.We aimed to explore the concordance between BP measurements in periodic health examinations and those measured following a standard measurement protocol.We used data from the Kailuan Study,an ongoing longitudinal cohort study in China,of which participants received biennial health examinations in health management centers.In addition,BPs were measured following standard protocols in a workplace-based hypertension management program nested in the Kailuan Study.We compared BP readings of the same person between the two settings using generalized linear mixed-effects models.A total of 3988 men(the mean age was 44.9 years)had at least two BP measurements both in health examinations and management program with a time interval between the two settings that less than 90 days.The mean systolic blood pressures(SBP)and diastolic blood pressures(DBP)in health examinations were 4.2(95%CI 3.9–4.5)mm Hg and 3.3(95%CI 3.1–3.5)mm Hg higher than those in the management program,respectively.Bland–Altman analyses showed the wide agreement inter-vals ranging from-27.7-to 36.5-mm Hg for SBP and-18.3-to 24.7-mm Hg for DBP.In conclusion,BP measurements in periodic health examinations were generally higher than BPs measured following a standard protocol.Our findings highlight the importance of standard BP measurement to avoid overestimation of hypertension prevalence and treatment initiation.
文摘Clinical forensic imaging encompasses the diverse application of imaging procedures that serve the same purpose:to enable the analysis and investigation of criminal activities and consequences of a crime.All kinds of imaging techniques and their corresponding images can be subsumed under“forensigraphy”,a more comprehensive term for forensic imaging created by the Ludwig Boltzmann Institute for Clinical Forensic Imaging in Graz,Austria.As the word forensigraphy suggests,criminal imaging material should be of use in forensic investigations.Ideally,this can lead to new findings that would not have been revealed without the application of imaging techniques and are moreover admissible as evidence in criminal proceedings.However,the admissibility of evidence can only be facilitated through the implementation of clinical forensic imaging techniques into the forensic routine case work,which requires a precise pre-analysis of the corresponding legal framework.Because taking and displaying internal images of a person’s body touches upon various aspects of one’s physical and psychological integrity,imaging methods in general and clinical forensic imaging methods especially have a strong impact on and interfere regularly with the fundamental rights of the concerned person.Particularly with regard to a possible medical context,certain legal regulations have to be taken into account.Therefore,this paper examines forensic imaging in the field of radiological forensigraphy,specifically its in vivo(i.e.clinical)application.It is designed to enlighten readers as to the great significance of legal barriers that emerge from fundamental rights,as laid down in the European Convention on Human Rights(ECHR),when dealing with clinical forensic imaging.As a result,the legal framework of clinical forensic imaging procedures are comprehensively described,the relevant fundamental rights,especially the right to respect for private and family life,the right to data protection and certain procedural guarantees,are concisely presented to further raise awareness regarding the importance of fundamental rights.
基金financially supported by the Universiti Sains Malaysia Short-Term Grant(304/PPSK/6315250).
文摘Introduction:A comprehensive scene reconstruction requires forensic investigators to examine the impact marks left on various surfaces to identify whether a projectile produces a specific hole.Subsequently,it is further necessary to determine whether a particular ammunition has caused the impact.Throughout history,designs of ammunition have evolved with the intended effects,which could leave different impact marks on a target surface,especially by ammunition with a nonconventional design.Careful examination on impact marks and determination of their specific characteristics on sheet metal of vehicle would provide crucialforensic information.Aim:This study was aimed to physically characterize bullet impact holes made by 11 types of 9-mm caliber ammunitions.Materials and Methods:Two automotive doors were shot with different ammunitionsfrom the same firearm,and the morphological features of bullet impact holes were observed and compared.Results:Bullet impact holes produced by the various ammunitions could be differentiated through careful observation of bullet hole circumferences,presence of petalling effect,metallic ring and triangular peak at the edge,and deposition of residue at the peripheral area of bullet impact holes.Ammunitions with nonconventional design such as Inceptor‑Polycase and GECO Hexagon showed observable morphological differences and discriminated them from bullet impact holes made by conventional ammunitions.Conclusion:A thorough physical examination could aid in distinguishing bullet impact holes and predicting the possible types of ammunition that had made an impact hole on a surface.
文摘Infertility is a pervasive issue affecting a considerable proportion of couples in their reproductive years,with a projected 10%-15% prevalence.It is characterized by the incapability to achieve conception following a year of consistent,unprotected intercourse,and its far-reaching consequences can take a profound emotional,psychological,and social toll on couples,inducing feelings of melancholy,exasperation,and anxiety.The appraisal of infertile couples'cases is a multifaceted and daunting process,necessitating a holistic understanding of the intricate underlying factors contributing to their infertility.Consequently,an individualized evaluation should be conducted,considering diverse parameters,such as the couple's medical history,age,infertility duration,and other relevant criteria.This paper will provide an in-depth overview of the current approaches utilized in the evaluation of men with infertility,including the commonly employed diagnostic tools and procedures.Enhancing our comprehension of infertility assessment and management holds the promise of helping couples achieve their ultimate desire of conceiving and enriching their overall quality of life.
