Efficacy of short‐course lansoprazole with clarithromycin and amoxicillin in the eradication of Helicobacter pylori in South‐East Asian patients: 5‐day t.d.s. versus 7‐day b.d. treatment regimens

OBJECTIVE : To determine and compare the efficacy of 5‐day t.d.s and 7‐day b.d. treatment regimens comprising lansoprazole, clarithromycin and amoxicillin in the eradication of Helicobacter pylori. METHODS : Patients with unequivocal evidence of H. pylori infection based on histology and rapid urease tests of both antrum and corpus biopsies were recruited for the study. The study was a randomized, investigator‐blind, comparative study. Patients received either 500 mg clarithromycin t.d.s. and 500 mg amoxicillin t.d.s. for 5 days (LAC5) or 500 mg clarithromycin b.d. and 500 mg amoxicillin b.d. for 7 days (LAC7) together with 30 mg lansoprazole (both groups) daily for either 5 or 7 days, depending on the treatment group. Patients were assessed for the successful eradication of H. pylori, defined as the absence of bacteria based on histology and urease tests on both antral and corporeal biopsies, carried out at least 4 weeks after completion of the therapy. RESULTS : One hundred and eight patients were recruited for the study. In the LAC5 treatment group, four patients failed to return for follow up and in the LAC7 group, two failed to return for follow up and two were not compliant with medications. Eradication rates based on an intention‐to‐treat analysis were: 46/54 for LAC5 (85.2%; 95% CI = 72.9–93.4) and 47/54 for LAC7 (87.0%; 95% CI = 75.1–94.6). Based on a per protocol analysis, the rates were: 46/50 for LAC5 (92.0%; 95% CI = 80.8–97.8) and 47/50 for LAC7 (94.0%; 95% CI = 83.5–98.7). Both treatment regimens were convenient for patients and except for two patients in the LAC7 group, all patients reported taking 100% of all prescribed medications. The side‐effects encountered were uniformly mild and no patient discontinued treatment because of intolerance to medications. The most common side‐effects were altered taste (LAC5 64.7%; LAC7 78.8%). Diarrhea, nausea and anorexia were reported in a minority of patients. CONCLUSIONS : Both the LAC5 t.d.s. and the LAC7 b.d. treatment regimens were well tolerated by patients and were highly effective in the eradication of H. pylori.     

Social relationships and physiological determinants of longevity across the human life span

Two decades of research indicate causal associations between social relationships and mortality, but important questions remain as to how social relationships affect health, when effects emerge, and how long they last. Drawing on data from four nationally representative longitudinal samples of the US population, we implemented an innovative life course design to assess the prospective association of both structural and functional dimensions of social relationships (social integration, social support, and social strain) with objectively measured biomarkers of physical health (C-reactive protein, systolic and diastolic blood pressure, waist circumference, and body mass index) within each life stage, including adolescence and young, middle, and late adulthood, and compare such associations across life stages. We found that a higher degree of social integration was associated with lower risk of physiological dysregulation in a dose–response manner in both early and later life. Conversely, lack of social connections was associated with vastly elevated risk in specific life stages. For example, social isolation increased the risk of inflammation by the same magnitude as physical inactivity in adolescence, and the effect of social isolation on hypertension exceeded that of clinical risk factors such as diabetes in old age. Analyses of multiple dimensions of social relationships within multiple samples across the life course produced consistent and robust associations with health. Physiological impacts of structural and functional dimensions of social relationships emerge uniquely in adolescence and midlife and persist into old age.A defining characteristic of human society is that individual lives are intertwined through social relationships. Full social participation is such a fundamental human need that research since the 1900s has found the lack of social connections increases the odds of death by at least 50% (1, 2). When multidimensional assessments of social relationships were considered, the odds of mortality increased by 91% among the socially isolated (2). The magnitude of this effect is comparable to that of smoking and exceeds those of many other known risk factors of mortality, such as obesity or physical inactivity (2, 3). Although much evidence has accrued on the strong causal associations between social relationships and mortality as well as other health outcomes (4–7), important questions remain as to how social relationships affect health, when these effects emerge, and how long they last (8).Studies of social, psychological, and behavioral mechanisms underlying the social relationship gradient in health have shed light on the first question (9–11). It is less clear, however, what biological mechanisms may be at play. Recent research on the biology of aging emphasizes the essential role of physiological stress response and regulation across multiple bodily systems in shaping longevity (12, 13). Although social relationship gradients in health and longevity (Fig. 1, path A) and physiological determinants of mortality (Fig. 1, path B) have been widely documented, these separate bodies of research have yet to be fully integrated. We have yet to determine whether social relationship differentials in longevity arise from a biological process in which social experiences “get under the skin” to alter physiological regulatory systems (Fig. 1, path C) (4).Open in a separate windowFig. 1.A life course model of social relationship gradient in physical health: Mechanism and process. Empirical tests of the link represented in path C were applied in each stage of the life course trajectory D.Laboratory research on rats using experimental designs demonstrated that social isolation and hypervigilance increase the incidence of mammary tumors (14, 15) and compromise innate immune response to stress (16). In humans, deficits in social relationships such as social isolation or low social support can similarly lead to chronic activation of immune, neuroendocrine, and metabolic systems that lie in the pathways, leading to cardiovascular, neoplastic, and other common aging-related diseases (5, 8, 17, 18). Previous nonexperimental studies using observational data from human subjects tentatively support this proposition by documenting associations between social relationship measures such as social integration and support with biomarkers of inflammation (5, 8, 18), metabolic syndrome (18, 19), and cumulative dysregulation indicated by allostatic load (20). However, because these associations are largely based on cross-sectional data, they cannot be assumed to represent underlying causal relationships. Additional prospective longitudinal studies are needed to better address bias due to potential confounding factors and reverse causality, further explaining path C.Examining how social and biological processes unfold and interact as individuals age is a critical step in advancing scientific explanations of the emergence and progression of diseases. A life course perspective, represented by the horizontal arrow D as a developmental trajectory, has not been fully brought to bear on this question. This perspective may offer considerable leverage by linking physical risks to social exposures that occur over time across multiple developmental stages from early to late life. The vast majority of biosocial research to date on this association has focused on older adults for whom morbidity and mortality rates are high (8, 21, 22). However, early life social experiences may be biologically embedded at that time, shown by an increasing body of research linking childhood disadvantage and maltreatment to increased likelihood of exaggerated biological stress response and, in turn, higher risks of inflammation and cardiovascular disease throughout adulthood (23–26).Relationship deficits—such as social isolation, lack of support, or high strain—are alternative forms of social adversity that can create chronic stress by continuous exposure to chains of risk that accumulate over the life course (27, 28). Individuals who experienced early adversity are subject to multiple and longer durations of stress exposures and more prone to inflammatory and stress-related diseases as they age. At the same time, the emergence of chronic diseases usually takes many decades due to the long latency after the initial risk exposures (29). Therefore, extensive longitudinal data and analyses are imperative to understanding how the connection of social relationships and longevity unfolds over the human life span. Little empirical research exists that depicts this lifelong process partly because data that extend sufficiently over long periods of the life course, as depicted in trajectory D, are exceedingly rare.This study addresses the aforementioned questions, integrates previous research on social relationships and health across disciplines, and tests a new longitudinal model of how social relationships matter for physiological health across the human life span. We make three unique contributions that shed new light on path C across trajectory D. First, using data from an array of nationally representative longitudinal samples of the US population, we implement an innovative life course design that begins at the earliest developmental stage (adolescence) in which physiological consequences of key social relationship patterns begin to manifest and traces subsequent life stages (young, middle, late adulthood) to depict the life-long process of stress response cascades that such relationship patterns initiate. The data come from The National Longitudinal Study of Adolescent to Adult Health (Add Health) to capture adolescence and young adulthood, the National Survey of Midlife Development in the United States (MIDUS) for middle adulthood, and both the Health and Retirement Study (HRS) and the National Social Life, Health, and Aging Project (NSHAP) for late adulthood. The use of multiple large, population-based samples in an integrative design allows us to assess linkages between social relationships and health for each life stage. It also offers an unprecedented fuller view of age variations in such linkages than any previous study of a particular sample or single life stage alone. Second, this study uses comprehensive and refined measurements of social relationships that encompass two primary dimensions that may differentially influence physical health at different stages of the life course. It assesses measures of social integration to capture the structural–quantitative dimension and measures of social support and strain to capture the functional–qualitative dimension, using age-appropriate conceptualizations of these domains for each life stage. Third, the study examines multiple objectively measured biomarkers or endophenotypes including inflammation (C-reactive protein, CRP), cardiovascular function (hypertension), and energy metabolism (overall obesity and abdominal obesity) to capture key physiological mechanisms underlying common diseases of aging and longevity (12).     

红带锥蝽实验条件下发育特征研究

目的研究红带锥蝽的发育历程,为其调查和防制提供参考依据。方法以福建省漳州市华安县湖坪村采集的红带锥蝽为研究对象,于2018年5月-2019年9月在温度26℃、相对湿度60%的实验室环境条件下进行饲养。以ICR小鼠为唯一供血源(供血3 d),观察并记录红带锥蝽各个发育阶段的孵化、吸血、蜕皮等情况。结果在设定的实验条件下,红带锥蝽可完成整个生活史,包括卵、Ⅰ~Ⅴ龄若虫和成虫等7个阶段,平均历时117.7 d。卵的孵化率为92.2%(391/424)。若虫和成虫均吸血,且每一龄若虫均需饱血才能蜕皮,雌性成虫需吸血才能产卵。Ⅰ~Ⅴ龄若虫的吸血率和蜕皮率分别为86.4%(338/391)和72.4%(283/391)、76.7%(217/283)和58.3%(165/283)、71.5%(118/165)和52.1%(86/165)、91.9%(79/86)和64.0%(55/86)、96.4%(53/55)和56.4%(31/55)。若虫的吸血量随龄期增长而逐渐增大,Ⅰ~Ⅴ龄若虫的平均吸血量分别为(2.9±11.0)、(8.0±3.0)、(14.9±8.8)、(85.4±17.8)、(101.6±54.2)mg,吸血后的平均体质量增重倍数分别为5.4±1.8、3.8±1.2、2.8±1.1、5.1±1.4、2.6±1.1。Ⅴ龄若虫平均吸血量最大,Ⅰ龄若虫吸血后平均体质量增重倍数最大。结论红带锥蝽在实验条件下通过动物饲血能完成生活史,可为相关研究提供实验平台。     

心理健康课程教学改善大学生心理健康水平的效果

目的:考查心理健康课程教学改善大学生心理困扰和心理品质的效果,为同类高校心理健康相关课程建设提供参考。方法:将选修心理健康课程的116名大学生作为实验组,同时选取同级、相似专业的100名学生作为对照组。实验组被试接受连续17周(1.5小时/周)的教学干预,对照组被试不接受任何处理。使用症状自评量表(SCL-90)和心理品质量表对两组被试进行前测和后测。结果:实验组和对照组被试在前测的各指标上差异不显著(P0.05)。实验组后测SCL-90总分及除偏执外的其它各因子得分均显著低于对照组(t=-4.85~-1.99,P0.05),而好学、社会智力、勇敢、自控和感恩等心理品质得分显著高于对照组(t=2.50~4.79,P0.05);实验组后测SCL-90总分及各因子得分均显著低于前测(t=2.03~3.39,P0.05),而心理品质得分显著高于前测(t=-2.74~2.03,P0.05);对照组后测SCL-90总分及各因子得分和心理品质得分与前测结果差异不显著(P0.05)。结论:心理健康课程教学能显著提升大学生的心理健康水平,不仅能够减少心理困扰程度,还可以提高积极心理品质。     

医学生灾难管理认知现状的调查及思考

目的调查现今中国医学院校灾难医学课程的开展情况以及医学生对灾难管理的认知情况。方法采用调查问卷的形式,让来自全国14所医学院校的医学生就灾难管理的能力进行自我评估,并调查其所在医学院校灾难医学课程的开展情况以及其对灾难管理的学习兴趣。结果目前国内开设灾难医学课程的学校很少,已开设的相关课程的授课质量也不高,医学生普遍缺乏对灾难管理的系统认识,但对于学习灾难管理知识很感兴趣。结论需设计高质量的灾难医学教育课程,并在国内医学院校推广,这既符合医学生的需求,又能切实提高医学生及医务工作者在面对灾难事件时的应对能力。     

老年食管鳞癌淋巴结累及野放射治疗的回顾性资料分析

目的 比较根治性单纯放疗的老年食管鳞癌患者行淋巴结累及野照射(IFI)和预防性照射(ENI)的治疗效果,探讨老年患者单纯放疗行淋巴结累及野照射的可行性.方法 收集分析年龄＞70岁,并经病理证实食管鳞癌且行单纯根治性调强放射治疗的老年患者共79例.其中48例进行IFI放疗,31例进行ENI放疗.中位随访时间为24个月,比较两组的疾病无进展生存率、总生存率、治疗失败模式及肺照射剂量及放射性肺炎发生率.结果 1、2、3年疾病无进展生存率,IFI组为60.4％、34.9％、29.7％,ENI组为64.5％、54.0％、35.0％,两者疾病无进展生存率比较差异无统计学意义(P＞0.05);1、2、3年总生存率IFI组为72.9％、43.4％、31.5％,ENI组为73.0％、53.0％、38.3％,中位生存期两组分别为25和28个月,ENI组有生存提高趋势,但两者差异无统计学意义(P＞0.05).两组的失败模式类似,远处转移、局部复发、非受累野淋巴结复发率IFI组及ENI组分别为22.9％、27.0％、4.2％和25.8％、0％、19.4％,两组比较差异均无统计学意义(P＞0.05).在治疗相关不良反应方面,ENI组中肺V5、V20、肺平均剂量等指标均大于IFI组,比较差异均有统计学意义(=4.66、29.90、15.63,P＜0.05);放射性肺炎的发生率ENI组明显高于IFI组,1～2级分别为22％和13％,3级分别为19％和4％,两组比较差异有统计学意义(x2=4.55、4.77,P＜0.05).结论 在老年食管鳞癌单纯放疗患者中,IFI与ENI的疾病无进展生存率和生存率相似,IFI的肺受照射剂量明显减少,使肺的损伤更小,对老年患者更为适合.     

Effect of an independent-sector treatment centre on provision of elective orthopaedic surgery in east and north hertfordshire

Introduction

Independent Sector Treatment Centres (ISTCs) were created to relieve pressure from Acute Hospital Trusts. In October 2011, an ISTC opened on the grounds of a hospital within the East and North Hertfordshire NHS Trust. Most elective orthopaedic procedures were transferred there. We investigated the effect on productivity of operating theatres working in the ISTC compared with those working in the Acute Hospital Trust (AHT).

Methods

A 3-month period of working at the AHT was compared with the same period 9-months later in the ISTC, which were termed ‘pre-’ and ‘post-ISTC’ opening, respectively. Data for upper limb (UL) as well as foot and ankle (F&A) surgery were collected. Differences in the number of lists and patients per list constituted usage analyses. Financial productivity was calculated from the latest Payment by Results (PbR) data. A two-tailed Mann–Whitney U-test at a confidence level of 95% was employed to compare costs between groups.

Results

The UL surgeon undertook 18 lists in both years with 66 patients (pre-ISTC) and 32 (post-ISTC), eliciting a reduction in productivity of 51.5%. There were 13 lists for F&A surgery pre-ISTC with 67 procedures, and 20 lists with 49 patients post-ISTC. Allowing for the difference in the number of lists, a reduction of 52.5% was noted. PbR analyses confirmed productivity of £169,695 (pre-ISTC) and £95,760 (post-ISTC) at a loss of £73,935 for the UL surgeon. F&A data revealed £97,801 (pre-ISTC) and £91,960 (post-ISTC) at a loss of £54,742 when correcting for the difference in the number of lists. There was a combined reduction in potential financial productivity of £128,677 over 3 months or £514,708 over 1 year.

Discussion

Implementation of the ISTC was detrimental to departmental efficiency, with <50% of the number of patients being treated and a marked reduction in financial productivity.     

FASTING IN ELECTIVE SURGICAL PATIENTS: COMPARISON AMONG THE TIME PRESCRIBED,PERFORMED AND RECOMMENDED ON PERIOPERATIVE CARE PROTOCOLS

Background:

Prolonged preoperative fasting may impair nutritional status of the patient and their recovery. In contrast, some studies show that fasting abbreviation can improve the response to trauma and decrease the length of hospital stay.

Aim:

Investigate whether the prescribed perioperative fasting time and practiced by patients is in compliance with current multimodal protocols and identify the main factors associated.

Methods:

Cross-sectional study with 65 patients undergoing elective surgery of the digestive tract or abdominal wall. We investigated the fasting time in the perioperative period, hunger and thirst reports, physical status, diabetes diagnosis, type of surgery and anesthesia.

Results:

The patients were between 19 and 87 years, mostly female (73.8%). The most performed procedure was cholecystectomy (47.69%) and general anesthesia the most used (89.23%). The most common approach was to start fasting from midnight for liquids and solids, and most of the patients received grade II (64.6%) to the physical state. The real fasting average time was 16 h (9.5-41.58) was higher than prescribed (11 h, 6.58 -26.75). The patients submitted to surgery in the afternoon were in more fasting time than those who did in the morning (p<0.001). The intensity of hunger and thirst increased in postoperative fasting period (p=0.010 and 0.027). The average period of postoperative fasting was 18.25 h (3.33-91.83) and only 23.07% restarted feeding on the same day.

Conclusion:

Patients were fasted for prolonged time, higher even than the prescribed time and intensity of the signs of discomfort such as hunger and thirst increased over time. To better recovery and the patient''s well-being, it is necessary to establish a preoperative fasting abbreviation protocol.     

基于MOOC的医学教育改革思考

通过分析MOOC的内涵和实质,结合高等医学教育的课程特点,论述了MOOC与医学课程的融合应分为三个阶段:校本MOOC建立阶段、校际MOOC建立阶段以及国际合作MOOC联盟形成阶段,并对MOOC下未来医学高等教育的发展方向和应用策略进行展望。