The effects of multidimensional exercise treatment on community-dwelling elderly Japanese women with stress, urge, and mixed urinary incontinence: a randomized controlled trial

Background

Urinary incontinence is one of the most prevalent health problems and a significant cause of disability and dependence in the elderly. Pelvic floor exercise is effective in reducing stress urinary incontinence, but few studies have investigated the effect of behavioral management on urge and mixed incontinence.

Objectives

To determine the effects of multidimensional exercise treatment on reducing urine leakage in elderly Japanese women with stress, urge, and mixed urinary incontinence.

Design

Randomized controlled, follow-up trial.

Settings

Urban community-based study.

Participants

127 community-dwelling women aged 70 and older with stress, urge, and mixed urinary incontinence were randomly assigned to the intervention (n = 63) or the control group (n = 64).

Methods

Urine leakage and fitness data were collected at baseline, and after the intervention and follow-up. The intervention group received a multidimensional exercise treatment twice a week for 3-month. After treatment, the participants were followed for 7-month.

Results

There were significant differences in changes of functional fitness and incontinence variables between the intervention and control groups. The intervention group showed urine leakage cure rates of 44.1% after treatment and 39.3% after follow-up (χ² = 21.96, p < 0.001); whereas, the control group showed no significant improvement. The multidimensional exercise treatment was significantly effective in decreasing all three types of urinary incontinence. However, the effects of the exercise treatment were greater on stress urinary incontinence than on urge or mixed urinary incontinence. At the 7-month follow-up, while cure rates of all three types of urinary incontinence were significantly maintained, a slight reversal was seen only in the urge and mixed urinary incontinence (χ² = 10.28, p = 0.008). According to the logistic regression model, urine leakage volume (adjusted odds ratio OR = 0.69, 95% confidence interval CI = 0.39–0.98), compliance (OR = 1.03, 95%CI = 1.01–1.16), and BMI reduction (OR = 0.67, 95%CI = 0.48–0.89) were significantly associated with the cure of urine leakage after intervention. The cure rate of urine leakage after the follow-up was significantly associated with compliance (OR = 1.13, 95%CI = 1.02–1.29) and BMI reduction (OR = 0.78, 95%CI = 0.60–0.96).

Conclusions

The intervention group showed higher urine leakage cure rates than control group. This result suggests that multidimensional exercise strategies may be effective for all three types of urinary incontinence. BMI reduction and compliance to the intervention was the consistent predictor for the effectiveness of the exercise treatment.     

Gemcitabine cures metastatic hepatic carcinoma and bone metastasis

We report a case of a 59-year-old gentleman who had suffered from low back pain for several months. Abdominal sonogram showed multiple heteroechoic nodules in the bilateral liver and an enlarged pancreatic head. Abdominal computer tomography (CT) favored pancreas head tumor with liver and bone metastasis. Endoscopic retrograde cholangiopancreatography (ERCP) disclosed pancreatic duct invasion over the distal portion of the pancreatic duct with prestenotic dilatation. Liver biopsy showed undifferentiated carcinoma. As suggested by the pathologist, the nasopharyngeal area was checked by the ear, nose and throat doctor, was negative and nasopharyngeal carcinoma was excluded. Therefore, the patient was treated with Gemcitabine (1500 mg/wk), as the suggested treatment schedule, for 24 wk in opioid dependency program. Sequential abdominal CT during follow up showed the disappearance of liver metastasis and shrinkage of the pancreatic tumor. Repeated ERCP after treatment showed re-channelization of the pancreatic duct. During 11 years of follow up, 5 CT scans disclosed not only the disappearance of the hepatic tumor but also no cancer recurrence. Progressive shrinkage of pancreatic head was also noted. Therefore, we can say this malignant case was cured by monotherapy with gemcitabine.     

慢性粒细胞白血病治疗中关于停药及治愈问题的研究进展:第54届美国血液学会年会报道

 【摘要】　伊马替尼（IM）及其他酪氨酸激酶抑制剂（TKI）在临床应用中的巨大成功,使慢性粒细胞白血病（CML）的治疗走在肿瘤靶向治疗的前沿。尽管TKI的出现极大地改善了CML患者的预后,然而长期TKI治疗可能给患者带来耐药、严重不良反应、依从性差、沉重的经济负担等问题。近年来,关于CML患者在达到长期完全分子生物学缓解（CMR）后能否安全停药及停药后能否达到治愈是CML研究中的关注点。就2012年第54届美国血液学会（ASH）年会关于CML患者停药及治愈问题的研究进展进行报道。     

部分股骨粗隆间骨折疗效研究

目的:探讨股骨粗隆间骨折合理的治疗方法,比较DHS、LCP、PFN三种固定治疗方法的临床效果。方法:将临床70例患者随机分为三组分别采用动力髋螺钉(DHS)固定治疗、股骨近端解剖锁定加压钢板(LCP)固定治疗、股骨近端髓内钉(PFN)内固定治疗三种治疗方法进行治疗。结果:通过采用Harris评分表对所有的患者进行术后评分,通过进行计算发现本组70例患者中,行DHS固定29例患者优良率达到83.78%,行PFN固定17例的优良率达到93.10%,行LCP固定治疗24例,优良率达到85.29%。结论:临床治疗股骨粗隆间骨折的方法有很多种,但是在治疗的过程中根据患者的具体情况选择合适的治疗方案,即采用个性化治疗,从而可以提高治疗效果。     

CO2激光治疗宫颈上皮内瘤样病变后的随访结果分析

目的 探讨CO2激光气化治疗宫颈上皮内瘤样病变(cervical intraepithelial neoplasia,CIN)Ⅱ的有效性.方法 对2005年1月至2006年12月阴道镜活检病理诊断为CINⅡ的110例患者CO2激光气化治疗后术后3、6、9和24个月进行随诊;每次随诊均行宫颈细胞学检查(ThinPreP cytologic test,TCT)和高危型人乳头状瘤病毒(high-risk human papillomavirus,hrHPV)DNA检测;对检查异常的患者再行阴道镜和活检组织病理学检查;对术后各阶段随诊结果进行分析总结.结果 治疗后3、6个月病变持续存在率分别为8.2%(9/110)、1.8%(2/110);9个月及均值为24个月的复发率分别为2.7%(3/110)、1.9%(2/106).3、6、9均值为24个月的治愈率分别为91.8%(101/110)、98.2%(108/110),97.3%(107/110)和98.1%(104/106).随访中的HPV DNA检测优于TCT检查,二者结合可提高复发病例的检出率.本组110例患者术中及术后无并发症发生.结论 CO2激光气化治疗CINⅡ安全、有效,但治疗前对患者疾病状态的评估甚为重要;治疗后需长期随访,尤其在治疗后2年内.     

高龄直肠癌外科诊治特点分析

 目的探讨75岁以上老年性直肠癌的诊治特点.方法采用回顾性分析诊治的128例75岁以上老年性直肠癌,总结其临床特点.结果此类患者的临床特点是:入院前病史长,59.4%患者病史超过6个月;术前误诊率高(47.7%);合并症多(95.3%);手术根治率高(86%);低位直肠癌保肛率达61%,且多数(85.4%)患者对术后控便情况表示满意.结论高龄直肠癌患者经围手术期积极治疗,手术疗效明显;只要术前控便功能良好,年龄不应成为施行保肛手术的禁忌证.     

2002～2005年广西边境地区结核病防治效果分析

目的评价实施世界银行贷款项目后广西边境地区结核病防治效果。方法以病人登记和治疗转归等项指标作为评价的依据。结果2002~2005年广西边境地区初治涂阳肺结核病人比例逐年增加,复治涂阳肺结核病人比例逐年下降,从2002年的3.8:6.2上升到2005年的7.9:2.1。新涂阳和涂阳肺结核病人的登记率逐年增加,分别从2002年的9.06/10万和24.07/10万上升到2005年的30.38/10万和42.41/10万。新涂阳和涂阳肺结核病人的治愈率也逐年增加,分别从2002年的71.88%和60.00%上升到2005年的85.13%和80.57%,达到了WHO要求的新涂阳肺结核病人治愈率85%的目标。结论通过政府承诺实施世界银行贷款项目,并将现代结核病控制策略应用于结核病防治工作中,使得广西边境地区结核病防治工作取得很大成效。     

中西医结合治疗急性肾小球肾炎疗效分析

本文对中西医结合治疗急性肾小球肾炎50例作了疗效分析。临床治愈4例,占80％,显效8例,总有效率达96％。通过50例疗效观察,总结了在治疗过程中应吸取的经验教训。在正确的中医辨证与西医辨病相结合的基础上给予正确的辨证施治、恢复期坚持服中药及严防劳累、感冒等并发症,增加机体抗病能力是取得较好疗效的关键。     

Exceso de mortalidad en las pacientes con cáncer de mama en estadios precoces en Tarragona y Gerona (España)

ObjectiveTo analyze the population-based survival of breast cancer (CM) diagnosed in early stages estimating the time trends of excess mortality (EM) in the long term in annual and five-year time intervals, and to determine, if possible, a proportion of patients who can be considered cured.MethodWe included women diagnosed with BC under the age of 60 years in stages I and II in Girona and Tarragona (N = 2453). The observed (OS) and relative survival (RS) were calculated up to 20 years of follow-up. RS was also estimated at annual (RSI) and in five-year intervals (RS5) to graphically assess the EM. The results are presented by age groups (≤49 and 50-59), stage (I/II) and diagnostic period (1985-1994 and 1995-2004).ResultsIn stage I, OS and RS were higher during 1995-2004 compared to 1985-1994: 3.5% at 15 years of follow-up and 4.5% at 20-years of follow-up. In 1995-2004, the OS surpassed 80% in stage I patients whereas in stage II it remained below 70%. During 1995-2004, the long-term EM did not level off towards 0 (RSI <1) independently of age group, stage and period of diagnosis. After 15 years of follow-up, the 5-year EM oscillated between 1 and 5% in stage I (RS5 ≥0.95) and between 5 and 10% in stage II.ConclusionsIn our cohort, after 15 years of follow-up, it was detected that the annual EM did not disappear and the five-year EM remained between 1 and 10%. Therefore, it was not possible to determine a cure rate of BC during the study period.     

我国高校教职工高血压流行病学研究的Meta分析

目的:系统了解我国高校教职工高血压的流行病学状况,以便更好地开展高血压的预防保健工作。方法:全面检索我国高校教职工高血压流行病学研究的中英文文献,筛选文献,提取数据,使用Stata14.0对我国高校教职工高血压患病率、知晓率、治疗率和控制率进行Meta分析。结果:最终纳入73篇文献,高血压合并患病率为23.3%（95%CI=21.1%-25.6%）,男性教职工合并患病率为27.2%（95%CI=24.4%-30.0%）,女性教职工合并患病率为18.6%（95%CI=16.6%-20.6%）。高校教职工高血压患病率随年龄增加而升高,随调查年代的由远及近呈显著上升趋势,从我国东部、中部到西部患病率依次降低。高校教职工高血压合并知晓率为68.3%（95%CI=59.7%-76.8%）,合并治疗率为63.7%（95%CI=55.5%-71.9%）,合并控制率为37.7%（95%CI=28.0%-47.5%）。结论:我国高校教职工高血压的患病率存在性别、年龄和地域差异,知晓率接近国际一般水平,但治疗率和控制率低。