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Bone Mineral “Quality”: Differing Characteristics of Calcified Microsphere Populations at the Osteoporotic and Osteoarthritic Femoral Articulation Front

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Journal of Biomedical Science and Engineering 2014年第9期7卷 739-755页

作者： Kathryn M. Linton Lesley D. Hordon Roger C. Shore Jean E. Aaron Institute of Membrane and Systems Biology Faculty of Biological Sciences University of Leeds Leeds UK Oral Biology Department Leeds Dental Institute University of Leeds Leeds UK

The mineral front consists of large populations of organically enshrouded calcified microspheres (filamentous clusters) about 1 micron in diameter and associated smaller numbers of variably dense nanospheres, 30 - 40 nm in diameter. The discrete objects persist and modulate in maturity, and may constitute a variable “qualitative” factor in the skeletal inorganic phase, exemplified by the biomechanically contrasting pathologies of osteoporosis (OP;fracture, low stress condition) and osteoarthritis (OA;non fracture, high stress condition). The aim was to compare the articulation front material for morphological and trace element diversity using fresh female femoral head discards (from Dewsbury District Hospital nhs Mid-Yorkshire trust). These were prepared for histology of the cartilage/bone interface region by immersion in hydrazine hydrate to expose the anorganic mineral topography for microscopy and FEGSEM microanalysis. 1) Mineral microsphere morphology (compared to animals as arbitrary controls) suggested that calcified microspheres from OP (n = 19) tended to be small (0.5 - 0.7 microns), smooth and compacted;those from OA (n = 19) were large (0.5 - 4.0 microns), uneven and irregularly dispersed. Respective calcified nanospheres from OP were similarly smaller (30 - 50 nm) than those from OA (>100 nm). In subchondral bone a proportion of the filamentous microspheres had fused into a fine-textured phase in OP and a coarse-textured phase in OA. 2) Trace element analysis (compared to positive porcine Si and Mg and other peaks) suggested a diminution with mineral maturity, and also with age effecting OP and OA similarly, with minor differences detected between them. It was concluded that calcified objects constituting the inorganic phase vary regionally with age and in fracture and nonfracture, being diminished in size (not number) in weak OP and enlarged (compared to porcine control) in stronger OA, with Si or Mg “doping” diminishing with time, perhaps influencing th

关键词： Bone Mineral Quality Calcified Microspheres Si Mg Trace Elements Osteoporosis Osteoarthritis

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合理的影像学检查妊娠期疑诊肺栓塞的研究

英国医学杂志中文版 2007年第3期10卷 182-183页

作者： Andrew Frederick Scarsbrook Fergus Vincent Gleeson 王（洋译）代华平（校） Department of Radiology St James＇s University Hospital Leeds Teaching Hospitals NHS Trust Leeds LS9 7TF Radiology Department Churchill Hospital Oxford Radcliffe Hospitals NHS Trust Headington Oxford OX3 7LJ 不详

知识点妊娠期的生理变化可以产生类似肺栓塞的症状,从而使临床诊断不可靠影像学检查可以避免不恰当的治疗,并且不增加胎儿任何的特殊风险。均应接受 X 线胸片检查以排除其他病因半剂量的肺灌注显像检查可以应用于大多数患者由于 CTPA ... 详细信息

知识点妊娠期的生理变化可以产生类似肺栓塞的症状,从而使临床诊断不可靠影像学检查可以避免不恰当的治疗,并且不增加胎儿任何的特殊风险。均应接受 X 线胸片检查以排除其他病因半剂量的肺灌注显像检查可以应用于大多数患者由于 CTPA 可使母亲乳房组织暴露于高剂量照射,因此,此项检查应该仅用于合并肺部疾病如哮喘的患者,肺灌注显像对这些患者的诊断价值不大。

关键词：影像学检查妊娠期肺栓塞疑诊症状评分临床观察生理变化发生概率

Quality Assuring a Ring Vortex Flow Phantom in Real-Time

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Open Journal of Medical Imaging 2023年第1期13卷 11-29页

作者： Alana S. Matthews Kelvin Simatwo Andrew Narracott Simone Ambrogio Adrian Walker John W. Fenner Department of Infection Immunity and Cardiovascular Disease Mathematical Modelling in Medicine Group University of Sheffield Sheffield UK Insigneo Institute for In Silico Medicine University of Sheffield Sheffield UK Department of Electronic and Electrical Engineering University of Sheffield Sheffield UK Medical Physics Department Guy’s and St Thomas’ NHS Foundation Trust London UK leeds Test Objects Boroughbridge UK

Introduction: The ring vortex phantom is a novel, cost-effective prototype which generates complex and well-characterised reference flows in the form of the ring vortex. Although its reproducibility has been demonstrated, with ring speeds routinely behaving within 10% tolerances at speeds of approximately 10 - 70 cm/s, a form of real-time QA of the device at the time of imaging is needed to confirm correct function on demand in any environment. Methods: The technology described here achieves real-time QA, comprising a linear encoder, laser-photodiode array, and Doppler probe, measuring piston motion, ring speed and intra-ring velocity respectively. This instrumentation does not interfere with imaging system QA, but allows QA to be performed on both the ring vortex and the device in real-time. Results: The encoder reports the reliability of the piston velocity profile, whilst ring speed is measured by laser behaviour. Incorporation of a calibrated Doppler probe offers a consistency check that confirms behaviour of the central axial flow. For purposes of gold-standard measurement, all elements can be related to previous Laser PIV acquisitions with the same device settings. Conclusion: Consequently, ring vortex production within tolerances is confirmed by this instrumentation, delivering accurate QA in real-time. This implementation offers a phantom QA procedure that exceeds anything seen in the literature, providing the technology to enhance quantitative assessment of flow imaging modalities.

关键词： Flow Phantom Ring Vortex Quality Assurance Imaging

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合理检查多尿的检查

英国医学杂志中文版 2014年第2期17卷 124-127页

作者： Adam D Jakes Sunil Bhandari 任倩(译) leeds Teaching Hospitals nhs trust Beckett Street Leeds LS9 7TF UK Renal Unit Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School Kingston upon Hull HU3 2JZ UK 北京大学人民医院内分泌科

多尿是一级医院门诊的常见症状，鉴别诊断困难，需要仔细斟酌。本文为此提供了结构化的、逻辑性的鉴别诊断思路，强调了各项相关检查的重要性，并且对何时进行专科转诊给出了建议。

关键词：合理检查多尿鉴别诊断常见症状医院门诊相关检查结构化逻辑性

Global Strategies to Combat Antimicrobial Resistance: A One Health Perspective

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Pharmacology & Pharmacy 2023年第8期14卷 271-328页

作者： Steward Mudenda Billy Chabalenge Victor Daka Ruth Lindizyani Mfune Kyembe Ignitius Salachi Shafiq Mohamed Webrod Mufwambi Maisa Kasanga Scott Kaba Matafwali Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Medicines Control Zambia Medicines Regulatory Authority Lusaka Zambia Department of Public Health Michael Chilufya Sata School of Medicine Copperbelt University Ndola Zambia Medicines Management and Pharmacy Services St James University Hospital Leeds Teaching Hospitals NHS Trust Leeds UK Department of Epidemiology and Biostatistics School of Public Health Zhengzhou University Zhengzhou China Clinical Research Department Faculty of Infectious and Tropical Diseases London School of Hygiene & Tropical Medicine London UK

Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies to reduce and combat AMR is critical. Purpose: This study aimed to highlight some global strategies that can be implemented to address AMR using a One Health approach. Methods: This study employed a narrative review design that included studies published from January 2002 to July 2023. The study searched for literature on AMR and antimicrobial stewardship (AMS) in PubMed and Google Scholar using the 2020 PRISMA guidelines. Results: This study reveals that AMR remains a significant global public health problem. Its severity has been markedly exacerbated by inappropriate use of antimicrobials in humans, animals, and the broader ecological environment. Several strategies have been developed to address AMR, including the Global Action Plan (GAP), National Action Plans (NAPs), AMS programs, and implementation of the AWaRe classification of antimicrobials. These strategies also involve strengthening surveillance of antimicrobial consumption and resistance, encouraging the development of new antimicrobials, and enhancing regulations around antimicrobial prescribing, dispensing, and usage. Additional measures include promoting global partnerships, combating substandard and falsified antimicrobials, advocating for vaccinations, sanitation, hygiene and biosecurity, as well as exploring alternatives to antimicrobials. However, the implementation of these strategies faces various challenges. These challenges include low awareness and knowledge of AMR, a shortage of human resources and capacity building for AMR and AMS, in adequate funding for AMR and AMS initiatives, limited laboratory capacities for surveillance, behavioural change issues, and ineffective leadership and multidisciplinary teams. Conclusion: In conclusion, this study established that AMR is prevale

关键词： Antimicrobial Resistance Antimicrobial Stewardship AWaRe Classification One Health Approach One Health Perspective Strategies Surveillance

The Ring Vortex: Concepts for a Novel Complex Flow Phantom for Medical Imaging

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Open Journal of Medical Imaging 2017年第1期7卷 28-41页

作者： Simone Ferrari Simone Ambrogio Adrian Walker Prashant Verma Andrew J. Narracott Iain Wilkinson John W. Fenner Medical Physics Mathematical Modelling in Medicine Group Department of Infection Immunity and Cardiovascular Disease University of Sheffield Sheffield UK Insigneo Institute for In Silico Medicine University of Sheffield Sheffield UK leeds Test Objects Ltd. Boroughbridge UK Medical Imaging & Medical Physics Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK Academic Unit of Radiology Department of Infection Immunity and Cardiovascular Disease University of Sheffield Sheffield UK

Calibration of medical imaging systems that provide quantitative measures relating to complex physiological flows is challenging. Physical test objects available for the purpose either offer a known simple flow far removed from the complexity of pathology (e.g. parabolic flow in a straight pipe) or complex relevant flows in which the details of the flow behaviour are unknown. This paper presents the ring vortex as a candidate for a complex flow phantom, since it is marked by inherently complex flow features that are controllable, predictable, reproducible and stable. These characteristics are demonstrated by a combination of analytical, numerical (CFD) and experimental methods. Together they provide a consistent perspective on ring vortex behaviour and highlight qualities relevant to phantom design. Discussion of the results indicates that a liquid phantom based on the ring vortex may have merit as a complex flow phantom for multimodal imaging. Furthermore, availability of such a flow reference may also serve as a benchmark for quality assurance of simulation methodologies.

关键词： Imaging Phantom Flow Vortex

Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

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World Journal of Cardiology 2014年第8期6卷 865-872页

作者： Richard A Brogan Christopher J Malkin Philip D Batin Alexander D Simms James M McLenachan Christopher P Gale leeds Institute of Cardiovascular and Metabolic Medicine Division of Epidemiology and BiostatisticsUniversity of LeedsLeeds LS2 9JTUnited Kingdom York and Hull Medical School University of YorkYorkYO10 5DDUnited Kingdom Department of Cardiology Leeds Teaching Hospital NHS TrustLeeds LS2 9JTUnited Kingdom Department of Cardiology Pinderfields General HospitalMid Yorkshire NHS TrustWakefield WF5 9LZUnited Kingdom Department of Cardiology York Teaching Hospital NHS Foundation TrustYork YO10 5DDUnited Kingdom

Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.

关键词： ST segment elevation myocardial infarction Risk stratification Primary percutaneous coronary intervention Harm Risk scores

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感染、炎症、修复 2023年第3期24卷 158-172页

作者： Matilde Monteiro-Soares Emma J.Hamilton David A.Russel Gulapar Srisawasdi Ed J.Boyko Joseph L.Mills William Jeffcoate Fran Game on behalf of the International Working Group on the Diabetic Foot 薛婧(译) 王爱红(审校) Higher School of Health of the Portuguese Red Cross LisbonPortugal Department of Community Medicine Information and Health Decision Sciences(MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal RISE@CINTESIS Faculty of MedicineOporto UniversityPortoPortugal Department of Endocrinology and Diabetes Fiona Stanley Hospi-talMurdochAustralia University of Western Australia Medical SchoolFiona Stanley HospitalMurdochAustralia leeds Institute of Clinical Trials Research University of LeedsLeedsUK leeds Vascular Institute Leeds Teaching Hospitals NHS TrustLeedsUK Department of Rehabilitation Medicine Sirindhorn School of Prosthetics OrthoticsBangkokThailand Faculty of Medicine Siriraj Hospital Mahidol UniversityBangkokThailand Department of Medicine University of WashingtonSeattleWashingtonUSA Veterans Affairs Puget Sound Health Care System SeattleWashingtonUSA Baylor College of Medicine Michael E.DeBakey Department of SurgeryHoustonTexasUSA Nottingham University Hospitals trust UK University Hospitals of Derby and Burton nhs Foundation trust 不详战略支援部队特色医学中心北京100101

本文是对国际糖尿病足工作组(IWGDF)2019年指南的更新,针对在日常临床工作中使用的糖尿病伴足溃疡的分类提出了新指南。本指南基于对现有文献的系统综述,确定了149篇文献中涉及的28种分类,随后使用推荐、评估、发展和评价分级(GRADE)方... 详细信息

本文是对国际糖尿病足工作组(IWGDF)2019年指南的更新,针对在日常临床工作中使用的糖尿病伴足溃疡的分类提出了新指南。本指南基于对现有文献的系统综述,确定了149篇文献中涉及的28种分类,随后使用推荐、评估、发展和评价分级(GRADE)方法获取了专家意见。首先,我们通过对诊断试验的判断总结,制定了一份可能适合在临床实践中使用的分类系统的清单,重点关注每个系统在预测溃疡相关并发症的可用性、准确性和可靠性以及资源可及性。其次,经过小组讨论和共识研讨,我们确定了哪些分类系统应该用于特定的临床场景。总之,对于糖尿病合并足溃疡患者,我们推荐:①医务人员之间的沟通:使用部位、缺血、神经病变、细菌感染、溃疡面积、溃疡深度(SINBAD)分类(第一选择)或考虑使用创面、缺血、足感染(WIfI)分类系统(替代选择,当具备所需的设备和专业水平,并且具有可行性时),针对每例患者,应具体描述组成分类系统的每个变量而不是仅仅报告总分;②不推荐任何现有分类系统用以预测特定个体的具体的溃疡结局;③对于描述有感染的溃疡患者的特征:使用美国感染性疾病学会(IDSA)/IWGDF(第一选择)分类或考虑使用WIfI系统(替代选择,当具备所需的设备和专业水平,并且具有可行性时);④对于描述周围动脉病变患者的特征:考虑使用WIfI系统作为对愈合可能性和截肢风险进行分层的手段;⑤对于人群结果的稽查:使用SINBAD评分。基于GRADE分级,本文提出的所有推荐,证据的可信度是低的。然而,基于对当前数据的合理应用,本文的推荐具有临床应用价值。

关键词：糖尿病相关的足病糖尿病相关的足溃疡分类指南国际糖尿病足工作组

Tenascin C upregulates interleukin-6 expression in human cardiac myofibroblasts via toll-like receptor 4

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World Journal of Cardiology 2016年第5期8卷 340-350页

作者： Azhar Maqbool Emma J Spary Iain W Manfield Michaela Ruhmann Lorena Zuliani-Alvarez Filomena O Gamboa-Esteves Karen E Porter Mark J Drinkhill Kim S Midwood Neil A Turner Division of Cardiovascular and Diabetes Research Leeds Institute of Cardiovascular and Meta-bolic Medicine School of Medicine University of Leeds Astbury Centre for Structural Molecular Biology Faculty of Biological Sciences University of Leeds Kennedy Institute of Rheumatology Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford leeds Institute of Cancer and Pathology Leeds Teaching Hospitals NHS Trust

AIM:To investigate the effect of Tenascin C(TNC)on the expression of pro-inflammatory cytokines and matrixmetalloproteinases in human cardiac myofibroblasts(CMF).METHODS:CMF were isolated and cultured from patients undergoing coronary artery bypass *** cells were treated with either TNC(0.1μmol/L,24 h)or a recombinant protein corresponding to different domains of the TNC protein;fibrinogen-like globe(FBG)and fibronectin typeⅢ-like repeats(TNⅢ5-7)(both 1μmol/L,24 h).The expression of the proinflammatory cytokines;interleukin(IL)-6,IL-1β,TNFαand the matrix metalloproteinases;MMPs(MMP1,2,3,9,10,MT1-MMP)was assessed using real time RT-PCR and western blot ***:TNC increased both IL-6 and MMP3(P<0.01)mR NA levels in cultured human CMF but had no significant effect on the other markers *** increase in IL-6 mR NA expression was mirrored by an increase in protein secretion as assessed by enzymelinked immunosorbant assay(P<0.01).Treating CMF with the recombinant protein FBG increased IL-6mR NA and protein(P<0.01)whereas the recombinant protein TNⅢ5-7 had no *** FBG nor TNⅢ5-7 had any significant effect on MMP3 *** expression of toll-like receptor 4(TLR4)in human CMF was confirmed by real time RT-PCR,western blot and ***-incubation of cells with TLR4neutralising antisera attenuated the effect of both TNC and FBG on IL-6 mR NA and protein ***:TNC up-regulates IL-6 expression in human CMF,an effect mediated through the FBG domain of TNC and via the TLR4 receptor.

关键词： Tenascin C Matrix metalloproteinase Tolllike receptor Interleukin-6 Cardiac fibroblasts