食管癌调强放疗靶区与肺体积比和处方剂量的关系

目的 研究食管癌调强放射治疗中能够做出既定目标的放疗计划时,靶区体积与肺体积比值和处方剂量的关系,从而帮助临床医生根据靶区情况,选择适合的处方剂量。方法 随机选取临床上已进行放射治疗的食管癌患者80例;其中病变范围包括全部食管癌类型,靶区根据ICRU（International Commission Radiological Units）50、62号文件进行勾画;设定统计参数及计划目标。根据参数的统计结果进行统计学分析;通过拟合计算求出满足既定目标的体积比临界值。结果 体积比与肺V₅、V₂₀、V₃₀以及肺平均受量具有线性正相关关系。给予60 Gy的处方剂量时,体积比的临界值为10%;给予50 Gy的处方剂量时,体积比的临界值为13%。结论 根据研究结果可以预见：食管癌调强放疗中当靶区体积与肺体积比值超过10%时,考虑给予的处方剂量不高于60 Gy;当靶区体积与肺体积比值超过13%时,给予处方剂量时应谨慎选择,但对于各段食管癌靶区超出肺段的患者可适当放宽。这为临床医生勾画靶区期间在处方剂量和靶区范围的选择上提供了参照。     

Changes in patterns of left ventricular hypertrophy after aortic valve replacement for aortic stenosis and regurgitation with St. Jude Medical cardiac valves

In this study, we analyzed the extent and pattern of regression of left ventricular (LV) hypertrophy after aortic valve replacement in patients with aortic stenosis (AS) and compared the results with those of another group of patients with aortic regurgitation (AR). Seventy patients who underwent isolated aortic valve replacement were divided into 2 groups. Group 1 was comprised of 29 patients who underwent aortic valve replacement for aortic stenosis, and Group 2 of 41 patients who underwent aortic valve replacement for aortic regurgitation. A third group of 10 healthy subjects served as a healthy control group. Echocardiographic studies were done before the operation and 5 years postoperatively. At follow-up, a significant reduction in the left ventricular mass was found in both groups, but it remained significantly greater than in the healthy control group. The ratio of LV wall thickness to radius (th/r) in Group 1 decreased significantly, and at follow-up it was within the normal value. In Group 2, the th/r ratio increased, and at follow-up it was within the normal value. After aortic valve replacement, the wall thickness remained significantly greater than normal for patients with AS, and the chamber radius remained significantly greater than normal for patients with AR. For these reasons, LV hypertrophy still existed in both groups at postoperative follow-up. The actuarial survival rate was 85.3% at 16 years for Group 1 and 83.4% at 18 years for Group 2. There was no significant difference in the long-term survival rates between the 2 groups. Actuarial freedom from valve-related events was 91.9% at 16 years for Group 1 and 82% at 18 years for Group 2. There was no significant difference in the valve-related event free curves between groups. After 5 years of follow-up, th/r reached normal for both groups, indicating remodeling of the LV geometry after aortic valve replacement.     

医疗保险风险因素的相对风险度分析

目的 :探讨医疗保险风险因素的相对风险度及其分析方法。方法 :借鉴流行病学研究方法 ,用 logistic回归模型产生比值比 (OR)来刻画风险因素与医疗保险赔付 (损失 )之间的定量关系。结果 :实例拟合单因素及多元 logistic回归模型 ,得到各风险因素的 OR值并能合理地解释。结论 :相对风险度分析为医疗保险风险控制提供了新的分析思路和定量依据     

An Analysis for the Comprehensive Evaluation of Health Resources Allocation in Shenzhen

INCREASING HEALTH COSTS are a dilemmafaced by the health administration. In order to en-hance the productivity, we must invest in healthservices. Meanwhile, limited health resources shouldbe properly allocated to obtain maximal socioeco-nomic benefits at lowest input. Thus, it is especiallyimportant to comprehensively assess the allocationof health resources from the perspectives of theInput and Output. The comprehensive evaluation ofhealth resources is a topic of interest for multi-objective assessment, wh...     

阻力指数比率对梗阻性积水肾功能的评估

目的:探讨多普勒超声肾内阻力指数比率在诊断单侧梗阻性肾积水及对积水肾功能的可复性评估的临床应用价值。方法:用多普勒超声检测53例单侧梗阻性肾积水患者主肾动脉、肾段动脉及叶间动脉的多普勒频谱,检测指标为收缩期最大峰值流速(Vmax)、舒张末最低流速(Vmin)、阻力指数(RI)和阻力指数比率(RIR),并且进行术前、术后3月和6月的动态观察,同时静脉尿路造影(IVU)对比,正常对照组36例。结果:53例单侧梗阻性肾积水患者中,中度肾积水和重度肾积水的RI及RIR均升高,但以RIR更为显著(P<0.01),轻度肾积水RIR升高(P<0.05)比RI(P>0.05)显著;梗阻解除术后动态观察RIR比RI恢复更为明显、迅速。结论:肾内阻力指数比率(RIR)为单侧梗阻性肾积水的诊断及积水肾功能的可复性评估提供了一种简便有效的方法。     

黑龙江省11个边境口岸蜱类调查

〔目的〕调查黑龙江省11个边境口岸蜱的种群组成。〔方法〕采用人工小时布旗法采集蜱。〔结果〕在黑龙江省11个边境口岸采获蜱3926只,计3属4种。林缘的优势种群为森林革蜱(95.9%);针阔混交林为全沟硬蜱(46.1%)和森林革蜱(31.8%)。不同口岸的蜱种组成有所不同。绥芬河口岸蜱密度指数最高(93.1%只/人工小时)。不同生境蜱密度指数有所不同。4种蜱的雌雄比:日本血蜱2.7:1,森林革蜱1.7:1,嗜群血蜱1.3:1,全沟硬蜱1.1:1。〔结论〕本次调查为黑龙江省边境口岸地区的蜱种群组成研究提供了依据。     

球瓣比和球囊长度与儿童经皮球囊肺动脉瓣成形术疗效的关系

目的通过分析不同的球瓣比和球囊长度对儿童经皮球囊肺动脉瓣成形术(PBPV)近期及中远期疗效的影响，探讨最适宜的球瓣比和球囊长度。 方法1987~2005年山东省立医院儿科诊治119例肺动脉瓣狭窄患儿，使用不同球瓣比和长度的扩张球囊行PBPV术，扩张前后测量右室与肺动脉间的峰值压力阶差，并行左侧位右室造影，测量瓣环大小并观察有无右室流出道激惹。术前、术后定期行经胸超声心动图检查，估测最大跨肺动脉瓣压力阶差，并观察肺动脉瓣形态及其反流情况。 结果超大球囊法行PBPV术后，患儿的近期及中远期跨肺动脉瓣压差持续下降，且压差下降率不随球瓣比的增加而增大；术后未发现有肺动脉瓣再狭窄者，所有患儿均有不同程度的肺动脉瓣反流，且反流的程度随时间的延长而加重，并与球瓣比成正相关。对于年龄较小(≤6岁)的儿童，球瓣比大且长度≥40mm的球囊较易引起右室流出道痉挛及三尖瓣反流。中远期三尖瓣反流的发生可能间接继发于肺动脉瓣反流所引起的右室容量负荷过重。 结论PBPV治疗肺动脉瓣狭窄，最佳的球瓣比为1.0~1.2，疗效满意且并发症少；6岁以下儿童宜使用长度<40mm的球囊，可减少右室流出道痉挛及近期三尖瓣反流的发生。     

Starch digestibility modulation significantly improves glycemic variability in type 2 diabetic subjects: A pilot study

Background and aimsIn type 2 diabetes (T2D) patients, the reduction of glycemic variability and postprandial glucose excursions is essential to limit diabetes complications, beyond HbA1c level. This study aimed at determining whether increasing the content of Slowly Digestible Starch (SDS) in T2D patients’ diet could reduce postprandial hyperglycemia and glycemic variability compared with a conventional low-SDS diet.Methods and resultsFor this randomized cross-over pilot study, 8 subjects with T2D consumed a controlled diet for one week, containing starchy products high or low in SDS. Glycemic variability parameters were evaluated using a Continuous Glucose Monitoring System.Glycemic variability was significantly lower during High-SDS diet compared to Low-SDS diet for MAGE (Mean Amplitude of Glycemic Excursions, p < 0.01), SD (Standard Deviation, p < 0.05), and CV (Coefficient of Variation, p < 0.01). The TIR (Time In Range) [140–180 mg/dL[ was significantly higher during High-SDS diet (p < 0.0001) whereas TIRs ≥180 mg/dL were significantly lower during High-SDS diet. Post-meals tAUC (total Area Under the Curve) were significantly lower during High-SDS diet.ConclusionOne week of High-SDS Diet in T2D patients significantly improves glycemic variability and reduces postprandial glycemic excursions. Modulation of starch digestibility in the diet could be used as a simple nutritional tool in T2D patients to improve daily glycemic control.Registration numberin clinicaltrials.gov: NCT 03289494.     

Hepatotoxicity reports in the FDA adverse event reporting system database: A comparison of drugs that cause injury via mitochondrial or other mechanisms

Drug-induced liver injury (DILI) is a leading reason for preclinical safety attrition and post-market drug withdrawals. Drug-induced mitochondrial toxicity has been shown to play an essential role in various forms of DILI, especially in idiosyncratic liver injury. This study examined liver injury reports submitted to the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) for drugs associated with hepatotoxicity via mitochondrial mechanisms compared with non-mitochondrial mechanisms of toxicity. The frequency of hepatotoxicity was determined at a group level and individual drug level. A reporting odds ratio (ROR) was calculated as the measure of effect. Between the two DILI groups, reports for DILI involving mitochondrial mechanisms of toxicity had a 1.43 (95% CI 1.42–1.45; P < 0.0001) times higher odds compared to drugs associated with non-mitochondrial mechanisms of toxicity. Antineoplastic, antiviral, analgesic, antibiotic, and antimycobacterial drugs were the top five drug classes with the highest ROR values. Although the top 20 drugs with the highest ROR values included drugs with both mitochondrial and non-mitochondrial injury mechanisms, the top four drugs (ROR values > 18: benzbromarone, troglitazone, isoniazid, rifampin) were associated with mitochondrial mechanisms of toxicity. The major demographic influence for DILI risk was also examined. There was a higher mean patient age among reports for drugs that were associated with mitochondrial mechanisms of toxicity [56.1 ± 18.33 (SD)] compared to non-mitochondrial mechanisms [48 ± 19.53 (SD)] (P < 0.0001), suggesting that age may play a role in susceptibility to DILI via mitochondrial mechanisms of toxicity. Univariate logistic regression analysis showed that reports of liver injury were 2.2 (odds ratio: 2.2, 95% CI 2.12–2.26) times more likely to be associated with older patient age, as compared with reports involving patients less than 65 years of age. Compared to males, female patients were 37% less likely (odds ratio: 0.63, 95% CI 0.61–0.64) to be subjects of liver injury reports for drugs associated with mitochondrial toxicity mechanisms. Given the higher proportion of severe liver injury reports among drugs associated with mitochondrial mechanisms of toxicity, it is essential to understand if a drug causes mitochondrial toxicity during preclinical drug development when drug design alternatives, more clinically relevant animal models, and better clinical biomarkers may provide a better translation of drug-induced mitochondrial toxicity risk assessment from animals to humans. Our findings from this study align with mitochondrial mechanisms of toxicity being an important cause of DILI, and this should be further investigated in real-world studies with robust designs.