根据日本乡村绝经后妇女腰椎骨密度的随访研究制定骨质疏松的护理卫生方针

为了检测妇女绝经后发生骨量减少的相关指标进而倡导依据生活方式的特点对绝经后妇女骨质疏松的发生采取相应的预防和护理方针，我们对日本乡村的绝经后妇女（末次月经后六个月或更长时间算起）进行了为期4a的随访。我们运用双能X线骨密度仪（DXA）对腰椎骨密度（BMD）进行检测并对各种变量，包括年龄、绝经时的年龄、骨折史、日常摄奶量以及吸烟习惯进行多元分析，结果表明这些因素对于腰椎骨密度（BMD）的恢复是不相关联的。 在这些变量中，骨折史被证明对于相关人群是最具危险性的，这些对象有高比例的骨量减少（6．6％），其次是不规律的摄奶（13．6％）和吸烟（9．3％）。在护理中使用的作用于足跟骨的检测骨密度的设备被证实与作用于腰椎的DXA设备可以相互替代。依据这些结果，针对居住在日本乡村的绝经后妇女制订了相应的预防骨质疏松的方针。这些卫生指导方针依据特定区域的生活方式而制定并可适用于其他的人群和区域。在本文中，作者列出了不同的有助于预防绝经后妇女出现骨质疏松的方法并进行了调查。     

盐城市县乡级医院内科医生《中国高血压防治指南》知晓情况调查

[目的]了解内科医生对《中国高血压防治指南》的知晓情况，提高《中国高血压防治指南》实施效果。[方法]2004年，抽取盐城市各县（市、区）部分县乡级医院具有执业医师资格的内科医生，调查对《指南》的知晓情况。[结果]调查114家县级医院、27家乡级卫生院的165名内科医生，对高血压的诊断标准能全面正确了解的占58．18%，21．82％的知道测量血压的正确部位，只有43．64％的能正确读取血压值，33．33％的知道要对所有就诊的患者测量血压。20．61％的知晓奶油中含有较高的胆固醇，41．21％的知晓番茄、香蕉有降压作用，75．76％的知道每人每天食盐的标准摄入量。[结论]县乡级医疗机构内科医生对《中国高血压防治指南》的知晓率比较低。     

Impact of corneal parameters on intraocular pressure measurements in different tonometry methods

AIM: To evaluate the impact of central corneal thickness (CCT) and corneal curvature on intraocular pressure (IOP) measurements performed by three different tonometers. METHODS: IOP in 132 healthy eyes of 66 participants was measured using three different tonometry techniques: Goldmann applanation tonometer (GAT), Pascal dynamic contour tonometer (DCT), and ICare rebound tonometer (RT). CCT and corneal curvature were assessed. RESULTS: In healthy eyes, DCT presents significantly higher values of IOP than GAT (17.34±3.69 and 15.27±4.06 mm Hg, P<0.0001). RT measurements are significantly lower than GAT (13.56±4.33 mm Hg, P<0.0001). Compared with GAT, DCT presented on average 2.51 mm Hg higher values in eyes with CCT<600 μm and 0.99 mm Hg higher results in eyes with CCT≥600 μm. The RT results were lower on average by 1.61 and 1.95 mm Hg than those obtained by GAT, respectively. Positive correlations between CCT in eyes with CCT<600 μm were detected for all IOP measurement techniques, whereas a similar relationship was not observed in eyes with thicker corneas. A correlation between IOP values and keratometry in the group with CCT<600 μm was not detected with any of the tonometry methods. In thicker corneas, a positive correlation was found for GAT and mean keratometry values (R=0.369, P=0.005). CONCLUSION: The same method should always be chosen for routine IOP control, and measurements obtained by different methods cannot be compared. All analysed tonometry methods are dependent on CCT; thus, CCT should be taken into consideration for both diagnostics and monitoring.     

Assessing guideline adherence in patients with non-variceal upper gastrointestinal bleeding receiving antiplatelet and anticoagulant therapy

Abstract

Background & aims: Non-variceal upper gastrointestinal bleeding (NVUGIB) occurs frequently and is associated with a significant morbidity and mortality, especially in patients receiving antiplatelet or anticoagulant therapy (APT and ACT, respectively). We aimed to evaluate adherence to guideline recommendations published by European Society of Gastrointestinal Endoscopy (ESGE).

Methods: Retrospective analysis of patients with NVUGIB und prior exposition to APT or ACT at a single university hospital between 01 January 2016 and 31 December 2017.

Results: 270 patients were identified (70.4% male, median age 72?years). 6/17 (35.3%) patients receiving APT for primary cardiovascular prophylaxis, 39/71 (54.9%) and 35 (49.3%) patients receiving APT for secondary cardiovascular prophylaxis (using strict and liberal definition, respectively) and 13/25 (52%) patients receiving dual antiplatelet therapy (DAPT) were not managed according to current recommendations. Management of ACT for secondary thromboembolic prophylaxis did not follow guideline recommendations in 59/93 (63.4%) and 34/93 (36.6%) patients (using strict and liberal definition, respectively). 23.7% of patients with NVUGIB were exposed to combined APT and ACT for whom no guideline recommendations exist. Mortality for any reason was twice as high in patients who were not managed according to guideline recommendations (18.8% vs. 8% using strict definition, 20.5% vs. 10.2% using liberal definition), which did not remain significant after adjusting for comorbidities, whereas cardiovascular events were observed at similar rates.

Conclusion: A significant number of patients with NVUGIB receiving APT or ACT is not managed according to current ESGE guideline recommendations. Strategies to implement these guidelines into daily practice need to be developed.     

中国胰腺癌诊治指南（2021）

正胰腺癌的发病率在世界范围内呈持续上升态势。2021年统计数据显示,在美国所有恶性肿瘤中,胰腺癌新发病例男性居第10位,女性居第9位,占恶性肿瘤相关病死率的第4位~([1])。中国国家癌症中心2017年统计数据显示,胰腺癌位列我国男性恶性肿瘤发病率的第7位,女性第11位,占恶性肿瘤相关病死率的第6位~([2])。作为预后极差的消化道肿瘤,胰腺癌具有早期诊断困难、手术切除率低、术后易复发转移等临床特点,临床诊治极具挑战性。     

Automated Delineation of the Normal Urinary Bladder on Planning CT and Cone Beam CT

PurposeTo quantify the volumetric effect of delineation variability when using manual versus semiautomated tools to contour the normal bladder on planning computed tomography (CT) and cone beam CT.MethodsFollowing research ethics board approval, 10 prostate cancer patients were selected. For each patient, one pretreatment cone beam CT (CBCT) was randomly selected from the first treatment week and registered to the planning CT (planCT). Model-based auto adaptation was used to delineate the outer bladder (OB) surface for the planCT. That contour was then propagated and manually adapted onto the CBCT. A second observer delineated OB for the planCT and CBCT using typical manual methods. These delineation procedures were repeated four times on each image set, with observers blinded to the previous contours. Metrics of volumetric, geometric, and overlap concordance were used to compare the manual and automated OB contours.ResultsThe mean pairwise difference between the manual and model-based planCT volumes was 4 cm³ (2%), and the model-based contours exhibited approximately half the observer variation of the manual ones (3 cm³, 2%). The mean of pairwise differences between the manual and propagated CBCT volumes was 13 cm³ (8%), but the propagated contours exhibited approximately half the observer related volume variation (11 cm³, 6%). Small CBCT bladder volumes displayed larger observer variation with manual methods (r², −0.640). Variability between the automated contours was significantly smaller than for the corresponding manual observations (P = .004 and .002, respectively). Metrics of three-dimensional overlap concordance indicated excellent agreement within and between the delineation methods. Automated CBCT contours were significantly smoother than the manual ones (surface sphericity index, 1.29 vs. 1.35; P = .03).ConclusionsVolumetric, geometric, and overlap metrics all indicated that planCT and CBCT automated OB contours fell within the range of manually delineated contours. The CBCT propagated contours were significantly smoother and associated with smaller intraobserver variability, compared with manual contours. Importantly, the findings from this research suggest that contour propagation may be more robust than manual delineation, especially in the presence of poor image quality.