晋黔贫困地区暴力管教现状及影响因素研究

目的 通过在晋黔两省的调查,了解贫困地区暴力管教的发生情况,探讨暴力管教的影响因素。方法 数据来源于2013年在贫困山区开展的针对3岁以下儿童及其看护人的横断面调查;内容包括儿童、看护人及家庭的一般信息,管教态度及行为;用χ²检验和Logistic回归分析进行因素分析。结果 2 953名看护人中44.9%在过去的一个月内对儿童采用过暴力管教方式,其中情感暴力、轻度身体暴力和重度身体暴力分别为25.5%、39.6%、3.8%。儿童月龄增加(OR=1.07)、留守儿童(OR=1.17)、女性看护人(OR=1.44)、少数民族(OR=1.60)、教育程度低(OR=1.41) 会增加暴力管教的风险。结论 贫困地区婴幼儿遭受暴力管教的比例很高,需针对高危儿童进行家庭干预。     

Quantitative assessment of hepatic fibrosis in chronic hepatitis B and C: T1 mapping on Gd-EOB-DTPA-enhanced liver magnetic resonance imaging

AIM To assess the accuracy of Look-Locker on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(GdEOB-DTPA)-enhanced magnetic resonance imaging(MRI) for staging liver fibrosis in chronic hepatitis B/C(CHB/C).METHODS We prospectively included 109 patients with CHB or CHC who underwent a 3.0-Tesla MRI examination, including T1-weighted and Look-Locker sequences for T1 mapping. Hepatocyte fractions(He F) and relaxation time reduction rate(RE) were measured for staging liver fibrosis. A receiver operating characteristic analysis using the area under the receiver operating characteristic curve(AUC) was used to compare thediagnostic performance in predicting liver fibrosis between He F and RE.RESULTS A total of 73 patients had both pathological results and MRI information. The number of patients in each fibrosis stage was evaluated semiquantitatively according to the METAVIR scoring system: F0, n = 23(31.5%); F1, n = 19(26.0%); F2, n = 13(17.8%); F3, n = 6(8.2%), and F4, n = 12(16.4%). He F by EOB enhancement imaging was significantly correlated with fibrosis stage(r =-0.808, P 0.05). AUC values for diagnosis of any(≥ F1), significant(≥ F2) or advanced(≥ F3) fibrosis, and cirrhosis(F4) using He F were 0.837(0.733-0.913), 0.890(0.795-0.951), 0.957(0.881-0.990), and 0.957(0.882-0.991), respectively. He F measurement was more accurate than use of RE in establishing liver fibrosis staging, suggesting that calculation of He F is a superior noninvasive liver fibrosis staging method.CONCLUSION A T1 mapping-based He F method is an efficient diagnostic tool for the staging of liver fibrosis.     

流动儿童2 055例婴幼儿喂养现状研究

目的 了解研究地区流动儿童婴幼儿喂养现状,以发现存在的主要喂养问题。 方法 采用横断面调查设计,两阶段随机整群抽样方法,以及联合国儿童基金会标准问卷,分别对广东和浙江两省各一个流动人口密集的区市的2 055名2岁以下儿童看护人进行问卷调查,对8个婴幼儿喂养指标进行了描述与分析。结果 调查地区流动儿童婴幼儿早开奶率为18.0%、纯母乳喂养率为13.6%、1岁时持续母乳喂养率为17.0%、2岁时持续母乳喂养率为5.2%、辅食及时添加率为81.1%、辅食添加种类合格率53.9%、辅食添加频率合格率为26.9%、辅食合理添加率为16.9%。 结论研究地区流动儿童母乳喂养和辅食添加的情况水平差,提示流入地应加强对流动人口中婴幼儿喂养的健康促进,改善保健服务利用。     

不同b值表观弥散系数直方图参数鉴别甲状腺良、恶性结节

目的 观察以不同b值获得的表观弥散系数（ADC）直方图参数鉴别甲状腺良、恶性结节的效能。方法 回顾性分析43例单发甲状腺结节患者,术后病理确诊良性22例（良性组）、恶性21例（恶性组）;将其术前5个b值（0、200、400、600和990 s/mm²）弥散加权成像（DWI）图导入ITK-snap软件,于b值为990 s/mm²的DWI上手动勾画ROI,利用自编程序分别计算ROI内不同b值的ADC百分位数（ADC 5%、25%、50%、75%、95%）、平均值、偏度及峰度,绘制直方图曲线;以受试者工作特征（ROC）曲线分析ADC直方图参数鉴别甲状腺良、恶性结节的效能。结果 b值为400、600、990 s/mm²时,良性组ADC 5%、50%、75%及平均值均高于恶性组（P均<0.05）;b值为200、400、600、990 s/mm²时,良性组ADC 25%高于恶性组（P均<0.05）;b值为600、990 s/mm²时,良性组ADC 95%高于恶性组（P均<0.05）;其余参数组间差异均无统计学意义（P均>0.05）。上述组间差异具有统计学意义的ADC直方图参数中,b值为990 s/mm²时的ADC平均值鉴别良、恶性结节的曲线下面积（AUC）最大,为0.751;b值为990 s/mm²时的ADC平均值、ADC 95%的诊断敏感度最高,均为81.04%;b值为990 s/mm²时的ADC 50%诊断特异度最高,为86.43%。结论 b值为200、400、600尤其990 s/mm²获得的ADC直方图参数可用于鉴别甲状腺良、恶性结节。     

经直肠前列腺穿刺活检156例分析

目的 对2009年1月-2010年1月进行的超声引导经直肠前列腺穿刺活检的156例检查者结果进行统计、比较和分析.方法 直肠指诊前列腺占位、血清PSA＞ 4ng/ml及经直肠前列腺超声或MRI提示怀疑前列腺占位病变的156例进行超声引导经直肠前列腺穿刺活检.结果 156例活检病理结果显示:良性前列腺增生(BPH)81例,占51.9％,前列腺癌(PCa) 58例,占37.2％,前列腺炎7例,占4.5％,前列腺结核1例,占0.6％,非典型性腺瘤样增生9例,占5.8％.结论 在一定条件的病例筛选下,通过超声引导经直肠前列腺穿刺活检(13针活检),诊断准确率较高,在PCa和前列腺其他疾病的诊断和鉴别诊断中具有明显的临床意义,对患者的进一步治疗具有重要临床指导作用.     

3.0T无对比剂MR冠状动脉造影图像质量的影响因素

目的 分析影响3.0T无对比剂MR冠状动脉造影（MRCA）图像质量的因素。方法 前瞻性对170例疑诊冠状动脉疾病患者行3.0T全心无对比剂MRCA检查，针对冠状动脉主要分支包括左前降支（LAD）、左回旋支（LCX）及右冠状动脉（RCA）进行主观评分，计算其信噪比（SNR）；根据3支总得分将图像分为优、良、中或差；采用单因素分析及有序logistic回归分析筛选MRCA图像质量的影响因素。观察回归分析结果显示差异有统计学意义的参数与MRCA图像质量的相关性，并以受试者工作特征（ROC）曲线分析其评估图像质量的效能。结果 MRCA主观评分结果为优、良、中（以上可用于诊断）及差者（不可用于诊断）分别为36、46、57及31例；其间LAD、LCX及RCA的SNR总体差异具有统计学意义（P均<0.01）。患者体质量指数（BMI）（OR=0.64）、心率（OR=0.96），以及采集效率（OR=1.06）和体位（OR=0.33）均为MRCA图像质量的影响因素（P均<0.05），且均与图像质量评分相关（r=－0.604、－0.250、0.500、0.407，P均<0.001）；分别以≤25.5 kg/m²、≤70次/分、≥37%及手下摆为阈值，BMI、心率、采集效率及手上举或下摆判断MRCA图像可否用于诊断的曲线下面积（AUC）为0.802、0.704、0.955及0.686。结论 患者BMI、心率，以及采集效率和体位为3.0T无对比剂MRCA图像质量的影响因素。     

ACOD frente a AVK en pacientes con fibrilación auricular y bioprótesis: revisión sistemática y metanálisis

Introduction and objectivesDirect oral anticoagulant (DOAC) therapy has been shown to be safe and effective in patients with atrial fibrillation (AF). However, outcomes in AF patients with bioprosthetic valves are unclear, as this population has been underrepresented in clinical trials. The aim of this study was to assess the safety and efficacy of DOACs in this population based on the existing published literature.MethodsA systematic search and review were conducted to identify randomized clinical trials and comparative observational studies published from 2017 to January 2022 that compared DOACs and vitamin K antagonists (VKAs) in AF patients with bioprosthetic valves. Hazard ratios (HR) were collected to compare the 2 treatments in terms of cardiovascular and all-cause mortality, stroke/systemic embolism, and major bleeding. A meta-analysis combining the results was performed.ResultsWe included 12 studies (30 283 patients). DOACs and VKAs were compared based on HRs at the 95% confidence interval. DOAC therapy was associated with a significant 9% reduction in all-cause mortality (HR, 0.91; 95%CI, 0.85-0.97; P = .0068; I² = 8%), with no significant differences in the risk of stroke/systemic embolism (HR, 0.87; 95%CI, 0.67-1.14; P = .29; I² = 45%) or major bleeding (HR, 0.82; 95%CI, 0.67-1.00; P = .054; I² = 48.7%).ConclusionsDOAC therapy in AF patients with bioprosthetic valves may be associated with a significant reduction in all-cause mortality, with no reduction in the efficacy of stroke/systemic embolism prevention or increase in major bleeding risk.