MRI随访观察鼻咽癌放疗前后腮腺及颌下腺体积变化

目的基于鼻咽癌放疗前后的MRI图像,观察放疗后腮腺及颌下腺体积变化。方法回顾性分析43例鼻咽癌放疗患者,基于轴位T2W压脂图像,逐层手动勾画各唾液腺边界,以面积求和法获得各腺体体积,计算放疗后首次随访(3个月)、1年及2年的唾液腺萎缩率。采用配对t检验对放疗后3个月患、健侧腮腺及颌下腺萎缩率进行比较。患、健侧腮腺及颌下腺萎缩率随时间变化(3个月、1年、2年)的比较采用重复测量检验。结果 1放疗后3个月患、健侧腮腺及颌下腺萎缩率的差异均无统计学意义(P均0.05)。患侧及健侧腮腺萎缩率均明显大于颌下腺(P均0.05)。2放疗后3个月、1年及2年患、健侧腮腺萎缩率均逐渐减小,两两比较差异均有统计学意义(P均0.05),而患、健侧颌下腺萎缩率差异均无明显统计学意义(P均0.05)。结论鼻咽癌放疗后腮腺体积下降较颌下腺更加明显,患、健侧唾液腺体积变化无明显差异;长期随访显示腮腺体积呈恢复趋势,而颌下腺体积无明显变化。     

自贡市0~1岁儿童身长变化情况研究

目的：随访自贡市儿童身长在0～1岁发生“追赶生长”或者“生长减速”的情况。方法收集分析四川省自贡市妇幼保健院儿童保健门诊中儿童健康体检资料。体格生长状况依据2000年美国疾病预防控制中心（CDC）儿童生长资料进行评价。结果547例儿童中1岁内177例（32.37％）的儿童身长发生追赶生长,244例（44.61％）的儿童身长发生生长减速。结论1岁内约2／3的儿童发生身长百分位线变化;儿童出生时的身长水平不完全决定生后生长状况。     

回访5462人次出院患者的护理体会及对临床管理工作的启示

目的探索护理临床管理和患者健康教育工作的新思路。方法统计2011年6月~2013年12月份出院患者回访记录资料,从患者对自我疾病的管理、患者或家属对回访工作的认识、患者对医疗护理工作的意见或建议等三方面进行汇总分析。结果患者对自我疾病的管理方面:能对自身病情进行出院后自我疾病管理者2531人次(占46.3%);执行治疗方案依从性差者有354人次(占6.4%);能定期门诊随访2089人次(占38.2%);日常生活管理差434人次(占7.9%)。患者或家属对回访工作的认识方面:患者或家属对回访的专科护士态度友好,对其健康教育欣然接受,并表示感谢。患者对医疗护理工作的意见或建议方面:医生与患者沟通的时间少。结论专科护士的专业回访受到患者或家属的认可,能增进患者和医护人员之间的信任感,延伸健康教育工作个体化指导,增加患者或家属的被尊重感,有利于临床管理工作的改进。     

永久起搏器和埋藏式心脏复律除颤器（ICD）在遗传性长QT综合征患者中的应用

目的总结合并窦性心动过缓的遗传性长QT综合征（以下简称遗传性LQTS）患者植入永久起搏器和埋藏式心脏复律除颤器（以下简称ICD）的治疗效果,对比分析这两种治疗在预防患者猝死中的差异。方法对我院从2003年6月到2013年6月出院诊断为遗传性LQTS合并窦性心动过缓、植入了永久起搏器或ICD的全部21例患者,结合门诊、电话和程控随访了解患者的生存状况、手术并发症以及晕厥、室性恶性心律失常的发作情况。结果起搏器组男性2例,女性9例,年龄39.3±14.3岁,随访时间50.6±26.3个月,1例患者猝死,2例患者再发晕厥前兆,其中1例最终更换为ICD。ICD组男性2例,女性8例,年龄34.5±11.9岁,随访时间61.4±43.5个月,3例患者接受了ICD的适当治疗,另2例患者接受了ICD的不适当治疗,1例患者术后出现囊袋感染,1例患者更换为永久起搏器。治疗有效率在起搏器组及ICD组分别为72.7%（8/11）和100.0%（10/10）,未达到统计学差异（p=0.21）。不良事件发生率在起搏器组及ICD组分别为27.3%（3/11）和30.0%（3/10）,也未达到统计学差异（p=0.63）。结论对于不能植入ICD的合并窦性心动过缓的遗传性LQTS患者,植入永久起搏器可能是一个较好的替代方法,但对于QTc≥539ms的患者,只有植入ICD才能预防猝死。植入ICD后长期无心脏事件发生的患者,根据患者意愿,可考虑更换为永久起搏器。     

Onyx闭塞载瘤动脉治疗颅内远端动脉瘤的随访分析

目的探讨液态栓塞剂Onyx闭塞载瘤动脉治疗颅内远端动脉瘤的效果。方法回顾性分析27例破裂动脉瘤患者(共29个颅内远端动脉瘤)的临床资料。动脉瘤位于小脑后下动脉17个,小脑前下动脉3个,小脑上动脉2个,大脑后动脉2个,大脑前动脉1个,大脑中动脉4个。对28个动脉瘤采用Onyx闭塞近端载瘤动脉及动脉瘤的方式治疗,1个大脑中动脉远端动脉瘤自行闭塞。结果所有治疗动脉瘤均完全闭塞。1例患者因术中出血死亡,其余患者术后随访8~67个月。23例患者最终格拉斯哥预后评分(GOS)为5分,3例为4分;17例患者术后DSA随访,5例患者术后CTA随访,动脉瘤均无复发;4例患者临床随访。所有幸存患者未见新的神经功能异常,无再出血。结论中-长期随访结果显示,Onyx闭塞载瘤动脉及动脉瘤治疗颅内远端动脉瘤临床疗效满意,复发率低。     

B型胰岛素抵抗的临床特点分析

目的　了解我国B型胰岛素抵抗（B-IR）患者的临床特点,提高诊治水平。方法　以“B型胰岛素抵抗”为关键词,检索中国知网和万方数据知识服务平台;以“type B insulin resistance”为关键词,检索PubMed数据库,检索2000年1月-2019年1月公开发表的文献,其中PubMed数据库中所检索文献筛选出报道中国患者的文献。根据筛选标准,共纳入13篇文献,15例患者。对其临床表现、实验室检查、治疗及随访情况进行归纳总结。结果　15例患者中男3例,平均年龄（46.3±17.0）岁;女12例,平均年龄（45.3±11.4）岁;年龄24~63岁,平均年龄（45.6±11.6）岁。15例患者均合并自身免疫性疾病,其中12例（12/15）合并1种疾病,3例（3/15）合并两种及以上疾病;9例（9/15）合并系统性红斑狼疮。15例患者中14例以高血糖起病者糖化血红蛋白为（11.9±2.7）%,1例以低血糖起病者糖化血红蛋白为7.6%。11例（11/15）患者空腹血清胰岛素>300 μU/ml,5例（5/15）有高睾酮血症。15例患者中7例（7/15）进行胰岛素受体抗体（AIRA）检测,结果均为阳性;6例（6/15）行13C呼气试验,其中4例阳性,2例阴性。糖皮质激素联合免疫抑制剂作为治疗该病的主要方案,其中4例（4/15）采用起始大剂量糖皮质激素冲击治疗（甲泼尼龙≥250 mg/d,共3 d）,其余11例（11/15）起始剂量为甲泼尼龙20~40 mg/d或醋酸泼尼松40~60 mg/d。12例（12/15）患者应用小剂量糖皮质激素（甲泼尼龙4~8 mg/d,醋酸泼尼松片2.5~10.0 mg/d）维持治疗。关于起始应用免疫抑制剂的方案,8例（8/15）患者起始选用环磷酰胺治疗,0.4~0.6 g/周起始应用,一般应用1~3周。血糖得以控制的时限为2周~1年。1例患者无随访记录,其余患者均进行随访,时间为2个月~7年。结论　B-IR临床罕见,有比较典型的血糖紊乱、高胰岛素血症和合并自身免疫性疾病,治疗方案主要包括糖皮质激素联合免疫抑制剂,需密切随访,改善预后。     

Vegetarian vs. conventional diabetic diet – A 1-year follow-up

ObjectiveOur previous 6-month, randomized study demonstrated the beneficial effect of a vegetarian (V) compared to a conventional diet (C) with similar caloric restriction on cardiovascular risk factors for patients with type 2 diabetes (T2D), namely increased insulin sensitivity, reduced body weight, reduced volume of visceral and subcutaneous fat, decreased LDL-cholesterol and improved oxidative stress markers and chosen adipokines. We conducted post-trial monitoring to determine whether the improved outcomes persisted 1 year after the end of the study.Methods62 subjects with T2D who completed the study were asked to come for a 1-year follow-up to measure weight, waist circumference, HbA1c and blood lipids. No attempts were made to maintain their previously assigned diets.Results44 patients (71%) attended the post-trial monitoring. Hypoglycemic agents were increased by 14% in V and by 26% in C; insulin therapy was introduced in 5% in V and in 13% in C one year after the end of the intervention. Neither weight nor waist circumference changed significantly in either group. HbA1c increased (p ≤ 0.05) similarly in both groups (+0.49 ± 1.04% in V vs. +0.42 ± 0.8% in C). Blood lipids did not change in either group.ConclusionOne year after the end of the intervention, the positive effects of a vegetarian diet on cardiovascular risk factors compared to a conventional diet were partially maintained.     

Five-year follow-up of left ventricular diastolic function in systemic sclerosis patients: Determinants of mortality and disease progression

Objectives

In systemic sclerosis (SSc), left ventricular diastolic dysfunction reflects primary myocardial involvement of the disease. We aimed to assess the abnormalities of the diastolic function, analyze the characteristics of the disease progression, and investigate the prognostic value of diastolic dysfunction in SSc patients.

Patients and methods

A total of 34 SSc patients (57 ± 12 years, 31 female) were involved in the study. The following traditional or tissue Doppler parameters of left ventricular diastolic function were obtained: E/A, lateral E?, E/E?, left ventricular mass index (LVM index), and maximal left atrial (LA) volume index. Measurements were repeated after 5.5 years.

Results

At baseline, diastolic dysfunction was found in 62% of the SSc patients. Follow-up time was 5.4 ± 1.2 years. A total of 6 patients died of heart failure. In univariate Cox regression analysis, age (HR = 1.08, p < 0.05), LVM index (HR = 1.07, p < 0.01), lateral E? (HR = 1.57, p = 0.05), and LA volume index (HR = 1.11, p < 0.01) were predictors of survival. During the follow-up, significant increase in LA volume index (27.5 ± 9.7 vs. 35.4 ± 10.6 cm³/m², p < 0.001) and E/E? was found (7.6 ± 2.5 vs. 8.7 ± 3.8, p < 0.05) while E? did not change (9.6 ± 2.6 vs. 9.2 ± 1.9 cm/s, NS). The increase in LA volume index showed positive correlation (r = 0.46, p < 0.05) while the decrease in E? values showed negative correlation (r = −0.54, p < 0.01) with the duration of the SSc.

Conclusion

In SSc patients, left ventricular diastolic dysfunction is highly prevalent and is associated with increased risk of mortality. Our data suggest that in the advanced phase of the disease, the myocardial fibrotic processes burns out while the increase of the filling pressure progresses continuously.     

Longitudinal study of variation in body mass index in middle-aged UK females

The importance of changing patterns of obesity in society and its implications for public health are well recognized. However, the adult life course of body mass index (BMI) changes in individuals over time is largely unknown and has mostly been extrapolated from cross-sectional studies. The present study examines individual specific variation of BMI during a 15-year follow-up period in a community-based sample of UK females. We attempted to establish whether there is a common, generalized pattern which captures variation in BMI over time. The participants of this study belong to a prospective population cohort of British women studied intensively since 1989: the Chingford Study. The sample originally consisted of 1,003 women aged 45-68 years, who were assessed annually for BMI during follow-up period. Polynomial regression models were used to assess longitudinal BMI variation. We observed a great stability in individual BMI variation during the follow-up period, reflected by high correlations between the baseline BMI and follow-up BMI 10 and 15 years later (r = 0.876, N = 810, and r = 0.824, N = 638, respectively). We also found that three different major age-related patterns in BMI could be clearly identified: no change in 30.6% in 58% it increased and in 11.4% it decreased with age. Thus, our data suggest that individual age-related changes in BMI are very different. Therefore, simply combining all individuals into groups by any other criteria (age, sex, etc.) and overlooking the distinctive patterns of BMI change may lead to biased inferences in epidemiologic and etiologic research of the future.     

根除幽门螺杆菌对慢性阻塞性肺病患者临床特征的影响

目的 比较不同治疗方案对慢性阻塞性肺病(COPD)患者Hp感染的根除率,探讨成功根除Hp对COPD患者临床特征的影响.方法 选取2006年12月至2009年12月吉林大学中日联谊医院Hp感染的稳定期COPD患者89例并分为根除组和不根除组,其中根除组又分为克拉霉素组和莫西沙星组.三组皆接受常规COPD治疗.克拉霉素组联用埃索美拉唑、阿莫西林、克拉霉素、胶体次枸橼酸铋.莫西沙星组联用埃索美拉唑、阿莫西林、胶体次枸橼酸铋、莫西沙星.患者分别在入组时及随访12个月时接受肺功能检测、运动耐力评价、呼吸困难评分、健康相关生活质量评分,并统计1年内COPD急性发作的次数.统计学处理采用x2检验和t检验.结果 克拉霉素组Hp根除率[48.4％(15/31)]低于莫西沙星组[87.1％(27/31)],差异有统计学意义(x2=4.22,P=0.032).27例不根除组患者第1秒用力呼气容积占预计值百分比的下降程度与53例成功根除Hp者比较差异无统计学意义(t=0.677,P=0.265).入组时与随访12个月时比较,53例成功根除Hp者6 min步行距离、Borg呼吸困难评分、圣乔治呼吸问题调查问卷总评分均获有统计学意义的改善(t=1.884、1.877、1.773,P=0.032、0.025、0.034),27例不根除组患者则皆未获改善.53例成功根除Hp者1年内平均COPD急性发作次数(1.2次)与不根除组(1.9次)比较差异有统计学意义(t=1.812,P=0.034).结论 COPD患者接受含莫西沙星的Hp根除方案或可获较高的Hp根除率.Hp感染的COPD患者根除Hp可在一定程度上提高运动耐力,减轻呼吸困难,提高生活质量,减少急性发作次数.