高龄直肠癌患者腹会阴联合切除术后会阴切口并发症发生的相关危险因素

探讨高龄直肠癌患者腹会阴联合切除术(APR)后会阴切口并发症发生的相关危险因素。方法采用回顾性病例对照研究的方法,分析中国医学科学院肿瘤医院结直肠外科2007年1月至2018年9月行APR的72例高龄(≥80岁)直肠癌患者的临床病理资料。采用单因素和多因素分析确定影响高龄直肠癌患者APR后会阴切口并发症发生的危险因素。结果72例患者中,男47例,女25例,年龄为(81.8±1.8)岁。术后会阴切口并发症发生率为23.6%(17/72),其中切口感染5例,切口脂肪液化4例,切口延迟愈合8例。所有患者均顺利出院,无围手术期死亡病例。单因素分析显示,术前血清白蛋白<35 g/L、术中置入氟尿嘧啶缓释剂/洛铂冲洗液、盆底修复、糖尿病和冠心病与高龄患者APR术后会阴切口并发症的发生均有关(均P<0.05)。多因素分析显示,未行盆底修复(OR=0.17,95%CI为0.04~0.82;P=0.027)和糖尿病(OR=4.32,95%CI为1.05~17.81;P=0.043)为高龄直肠癌患者APR后会阴切口发生的独立危险因素。结论行APR的高龄直肠癌患者应尽可能保留盆底腹膜,并予以关闭。围手术期血糖监测也是预防会阴切口并发症发生的有力保障。     

女性难治性膀胱过度活动症患者心理弹性及保护性因素研究

目的探讨女性难治性膀胱过度活动症患者心理弹性状况及保护性因素，为改善其身心健康提供依据。方法采用心理弹性量表、症状自评量表、艾森克人格问卷、社会支持量表、焦虑及抑郁量表对80例女性难治性膀胱过度活动症患者进行问卷调查。结果女性难治性膀胱过度活动症患者心理弹性得分为（54.10±8.27）分，显著低于国内常模（P＜0.05）。患者的一般情况（病程、年龄、文化程度）对心理弹性的预测作用不明显（R2=0.14，F=18.10），当社会支持、SCL-90、人格特质、SAS、SDS进入方程后，对患者的心理弹性具有较明显的预测作用（R2=0.67，△R2=0.46，F=115.22）。结论女性难治性膀胱过度活动症患者心理弹性较差，社会支持、SCL-90、人格特质、焦虑抑郁情绪是其重要的影响因素，应重视患者存在的心理问题，发掘心理弹性的保护性因素并积极干预，促进其身心健康。     

Infecciones de transmisión sexual en hombres internos en prisión: riesgo de desarrollo de nuevas infecciones

ObjectiveTo measure incidence and main risk factors related to sexually transmitted infections (STIs) in Daroca Prison (Zaragoza, Spain).MethodA retrospective cohort study (2005-2013) to measure the incidence of STI and a cross-sectional study to measure risk factors.ResultsOf the 203 inmates, 79 developed an STI, 37 had a previous STI, 55.2% lacked knowledge on STI prevention, and 28.9% showed behaviours unfavourable for STI prevention. The incidence rate was 6.5 STIs per 1,000 inmates-year. The most frequent STIs were hepatitis B (39.7%), Ureaplasma urealyticum (19.1%), herpes simplex (16.2%) and HIV (8.8%). The risk (hazard ratio, HR) of acquiring a new STI was significantly higher in inmates with a history of previous STI (HR = 2.61; 95%CI: 1.01 to 6.69), and was at the limit of significance for non-preventive behaviour (HR = 2.10; 95%CI: 0.98 to 4.53), but not in knowledge related to STIs (HR = 1.33; 95%CI: 0.58 to 3.07).ConclusionThe most important risk factors in prison are behaviours related to STIs and previous history of STIs. Other factors are being a repeat offender, injecting drug use, or being in a methadone programme. Health personnel and peer education can facilitate prevention and control.     

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Diagnoses and Surgical Results in 12 Pediatric Patients

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital condition. It responds well to early diagnosis and treatment, but otherwise the prognosis is poor. We present our case series of 12 patients (mean age, 2 ± 2.58 yr; age range, 2 mo–8 yr), emphasizing the diagnostic process and discussing our surgical results. The diagnosis of ALCAPA should be suspected in infants who have dilated cardiomyopathy with electrocardiographic changes that suggest ischemia, and in older children who have isolated mitral regurgitation. When clinical suspicion is high, the results of 2-dimensional echocardiography combined with color-flow Doppler studies in expert hands can establish the diagnosis, thus avoiding angiography in critically ill infants. The treatment of choice in our patients was transfer and reimplantation of the left coronary artery onto the ascending aorta. There were 2 deaths: both were infants in extremis who underwent emergency surgery. An older child with severe ventricular dysfunction was given mechanical ventricular assistance and then heart transplantation. As of this report, all 10 survivors remained well and asymptomatic.     

Lysophosphatidylcholine‐induced cytotoxicity and protection by heparin in mouse brain bEND.3 endothelial cells

A pathological feature in atherosclerosis is the dysfunction and death of vascular endothelial cells (EC). Oxidized low‐density lipoprotein (LDL), known to accumulate in the atherosclerotic arterial walls, impairs endothelium‐dependent relaxation and causes EC apoptosis. A major bioactive ingredient of the oxidized LDL is lysophosphatidylcholine (LPC), which at higher concentrations causes apoptosis and necrosis in various EC. There is hitherto no report on LPC‐induced cytotoxicity in brain EC. In this work, we found that LPC caused cytosolic Ca²⁺ overload, mitochondrial membrane potential decrease, p38 activation, caspase 3 activation and eventually apoptotic death in mouse cerebral bEND.3 EC. In contrast to reported reactive oxygen species (ROS) generation by LPC in other EC, LPC did not trigger ROS formation in bEND.3 cells. Pharmacological inhibition of p38 alleviated LPC‐inflicted cell death. We examined whether heparin could be cytoprotective: although it could not suppress LPC‐triggered Ca²⁺ signal, p38 activation and mitochondrial membrane potential drop, it did suppress LPC‐induced caspase 3 activation and alleviate LPC‐inflicted cytotoxicity. Our data suggest LPC apoptotic death mechanisms in bEND.3 might involve mitochondrial membrane potential decrease and p38 activation. Heparin is protective against LPC cytotoxicity and might intervene steps between mitochondrial membrane potential drop/p38 activation and caspase 3 activation.     

膝关节镜术后结合活血祛瘀汤内服对膝关节炎患者骨代谢指标及炎性指标的影响

目的:研究膝关节镜术后结合活血祛瘀汤内服对膝关节炎患者骨代谢指标及炎性指标的影响。方法:选取2013年6月至2016年5月抚顺市中医院骨科住院部收治的进行关节镜清理术的膝骨关节炎患者68例进行回顾性分析,按照术后治疗方法的不同分为观察组和对照组,每组34例。观察组内服活血祛瘀汤(58膝),对照组行单纯关节镜清理术(62膝)。将2组患者术后6个月随访疗效结果进行比较。结果:6个月治疗结束后,观察组总有效率81. 02%,显著高于对照组的48. 55%,差异有统计学意义(P 0. 05),观察组治疗后夜间卧床休息时疼痛、晨僵或起床后疼痛加重、绞锁、肿胀以及跛行优于对照组,差异有统计学意义(P 0. 05)。观察组治疗后TNF-α、IL-6改善显著,与对照组比较,差异有统计学意义(P 0. 05),观察组与对照组治疗后COMP、CTX-Ⅱ、CTX-Ⅰ、MMP-3治疗后效果显著,且观察组优于对照组,差异有统计学意义(P 0. 05)。结论:活血祛瘀汤可明显降低膝关节术后患者炎性反应递质水平,患者COMP,CTX-Ⅱ,CTX-Ⅰ和MMP-3指标亦有显著改善,患者综合治疗疗效优于患者单纯使用关节镜下清理术疗效。     

The influence of environmental and health indicators on premature mortality: An empirical analysis of the City of Toronto's 140 neighborhoods

The objective of this paper was to assess the link between premature mortality and a combination of neighbourhood contextual (environmental and health) and compositional (socioeconomic and demographic) characteristics. We statistically and spatially examined six environmental variables (ultrafine particles, carcinogenic and non-carcinogenic pollutants, pollution released to air, tree cover, and walkability index), six health service indicators (number health providers, breast, colorectal and cervical cancer screening uptake rates, student nutrition program uptake rates, and healthy food index), and eight socioeconomic indicators (total income, Gini coefficient, two age categories – below and above 40 years, proportion of females to males, visible minorities, Indigenous peoples, education, less than grade 9) among 140 neighbourhoods of the City of Toronto in Ontario (Canada). We applied principal component analysis to identify patterns and to reduce the number of explanatory variables into combined component axes that represent unique variation in these confounded and overlapping factors. We then applied regression analysis to model the relationship between the indices of enviro-health and socioeconomics and their potential relationship with premature mortality. Residual spatial analysis was used to investigate any remaining spatial structure (such as neighbourhoods with higher residual premature mortality rates). Neighbourhood Equity Index was correlated with our enviro-health and socioeconomic indices. Premature mortality within neighbourhoods was predicted by poor cancer screenings, pollution, lack of tree canopy, increased uptake of student nutrition programs and high walkability index. A negative association between premature mortality and pollution was associated low walkability index and presence of visible minorities within neighbourhoods. There was some unexplained residual spatial variation in our model of premature mortality - especially along the shores of Lake Ontario and in neighbourhoods with major highways or road corridors: premature mortality in Toronto neighbourhoods was higher than expected along highway-corridor neighbourhoods and shorelines. Our analysis revealed a significant relationship between neighbourhood contextual features – both environmental and health – and premature mortality, suggesting that these contextual components of neighbourhoods can predict rates of urban premature mortality in Toronto.