2004～2005年珠海市成人肺癌死亡的流行病学特征

目的了解珠海市户籍人群肺癌死亡的流行病学特征，为肺癌防治提供决策依据。方法应用2004～2005年珠海市户籍居民病伤死亡原因监测资料，分析珠海市户籍人群肺癌死亡的流行病学特征。结果2004～2005年间珠海市成人平均肺癌死亡率为25．3／10万，标准化率为30．3／10万，是恶性肿瘤死亡的第一位原因；男性和女性标准化率分别为40．1／10万和19．2／10万，男性高于女性（u=7．23，P〈0．01）；平均肺癌死亡率随年龄增长而增加，60岁以上增加明显，且多为老年男性；香洲、斗门、金湾3个区标准化死亡率分别为30．5／10万、31．1／10万和27．3／10万，不同地区间肺癌死亡水平无显著性差异。结论肺癌是威胁珠海市居民健康的主要恶性肿瘤之一，随着人口老龄化的发展，其病死率将呈持续增长趋势；应针对肺癌主要危险因素采取控烟、改善环境等积极有效的预防控制措施。     

1992-2006年浙江省武义县梅毒流行特征分析

目的 分析武义县1992-2006年梅毒流行趋势和病例特征,为制订防治策略提供依据.方法 收集全县性病疫情报表及个案资料,采用流行病学方法分析.结果 1992-2006年武义县梅毒报告发病率从0.31/10万上升至62.59/10万,目前处于高发态势;病例以Ⅰ期、Ⅱ期梅毒为主,隐性梅毒和胎传梅毒增速较快;男女性别比为1:1.42,发病年龄集中在20-49岁,占总数的84.79%;职业以农民为主,占49.27%,地区分布以本地居民为主,外地居民的构成比例呈逐年上升趋势.结论 武义县梅毒流行从零星散发进入高发态势,由高危人群向一般人群扩散、从城市蔓延至广大农村,若梅毒得不到有效控制,预示着艾滋病流行的危险,需加大防治力度.     

Antidepressant Use in Canada Has Stopped Increasing

Objective:

Large increases in the use of antidepressants (ADs) were reported in the past 2 decades in many countries, including Canada. Our objective was to determine whether this pattern of increasing use has continued, using data from a 2012 national mental health survey.

Method:

During the past 2 decades, a series of Canadian national health surveys have evaluated AD use in the household population. Some of these surveys have assessed past 2-day use whereas others have assessed self-reported past-month use. We applied meta-regression methods as a methodological strategy to address this heterogeneity and to examine long-term trends, incorporating 2012 data.

Results:

In keeping with prior reports, AD use rapidly increased in the 1990s and early 2000s. However, the 2012 data suggest that these increases have slowed or perhaps even stopped in recent years. A post hoc examination of longitudinal data from the National Population Health Survey reinforced the impression of a levelling off in the use of these medications.

Conclusion:

The frequency of AD use may now be stabilizing in the Canadian population. This emerging steady state may reflect a contemporary balance between the perceived need, perceived effectiveness, and acceptability of these medications in the general population.     

Clinico-radiological spectrum of reversible splenial lesions in children

Recently, many cases of children presenting reversible splenial lesions during febrile illness (RESLEF) have been reported; however, their overall clinico-radiological features are unclear.     

Mitochondrial myopathy with dystrophic features due to a novel mutation in the MTTM gene

Introduction: A 61‐year‐old woman with a 5‐year history of progressive muscle weakness and atrophy had a muscle biopsy characterized by a combination of dystrophic features (necrotic fibers and endomysial fibrosis) and mitochondrial alterations [ragged‐red, cytochrome c oxidase (COX)‐negative fibers]. Methods: Sequencing of the whole mtDNA, assessment of the mutation load in muscle and accessible nonmuscle tissues, and single fiber polymerase chain reaction. Results: Muscle mitochondrial DNA (mtDNA) sequencing revealed a novel heteroplasmic mutation (m.4403G>A) in the gene (MTTM) that encodes tRNA^Met. The mutation was not present in accessible nonmuscle tissues from the patient or 2 asymptomatic sisters. Conclusions: The clinical features and muscle morphology in this patient are very similar to those described in a previous patient with a different mutation, also in MTTM, which suggests that mutations in this gene confer a distinctive “dystrophic” quality. This may be a diagnostic clue in patients with isolated mitochondrial myopathy. Muscle Nerve 50:292–295, 2014     

Sibling concordance for clinical features of Duchenne and Becker muscular dystrophies

Introduction: The correlation of markers of disease severity among brothers with Duchenne or Becker muscular dystrophy has implications for clinical guidance and clinical trials. Methods: Sibling pairs with Duchenne or Becker muscular dystrophy (n = 60) were compared for ages when they reached clinical milestones of disease progression, including ceased ambulation, scoliosis of ≥ 20°, and development of cardiomyopathy. Results: The median age at which younger brothers reached each milestone, compared with their older brothers ranged from 25 months younger for development of cardiomyopathy to 2 months older for ceased ambulation. For each additional month of ambulation by the older brother, the hazard of ceased ambulation by the younger brother decreased by 4%. Conclusions: The ages when siblings reach clinical milestones of disease vary widely between siblings. However, the time to ceased ambulation for older brothers predicts the time to ceased ambulation for their younger brothers. Muscle Nerve 49 : 814–821, 2014     

275例急性肾损伤的临床资料及预后分析

目的 分析急性肾损伤（acute kidney injury,AKI）的病因,探讨影响其预后的危险因素,为临床更好的认识和预防AKI、改善预后提供依据.方法 回顾性分析275例AKI患者的一般资料、病因、临床特点、实验室检查及治疗情况,分析其与预后的关系.结果 纳入本研究的AKI患者275例,男181例,女94例,中位年龄为57岁,其中青年组（≤40岁）54例（占 19.6%）,中年组（40～60岁）97例（占 35.3%）,老年组（≥61岁）124例（占 45.1%）.275例患者的AKI分期中1期88例（占32%）,2期83例（占 30.2%）,3期104例（占 37.8%）.肾前性病因最常见,153例（占 55.6%）,其中感染相关性疾病最多,其次为心脑血管疾病.肾性病因中以药物性因素最多,其次为肿瘤相关性肾病.肾后性因素以尿路结石最常见,其次为肿瘤转移或浸润.多因素非条件Logistic回归分析示机械通气、血管活性药物、多器官功能障碍综合征（multiple organ dysfunction syndrome,MODS）、低蛋白血症是AKI患者死亡的独立危险因素,OR值分别为 2.445、43.530、2.801和3.118（均P＜0.01）.结论 AKI患者中,感染、心脑血管疾病等肾前性病因引起的AKI较常见,要及早诊断并积极干预.机械通气、血管活性药物、MODS、低蛋白血症是AKI患者死亡的独立危险因素.     

阑尾黏液性肿瘤病理学特征及预后分析

目的探讨基于2010版WHO分类的各类阑尾黏液性肿瘤的病理学特征及预后。方法收集并复习2003年1月至2012年6月间在南京大学医学院附属鼓楼医院接受手术切除的70例阑尾黏液性肿瘤术后病理切片,按照2010年消化系统肿瘤WHO新分类,将阑尾黏液性肿瘤分为5种类型：阑尾黏液性腺瘤／囊腺瘤（MA）、低级别黏液性肿瘤（LAMN）、起源于阑尾的低级别腹膜假黏液瘤（PMP．L）、浸润性黏液腺癌（MAC）以及起源于阑尾的高级别腹膜假黏液瘤（PMP．H）。结果11例MA肿瘤上皮和黏液仅局限于黏膜肌层以内;术后无复发或死亡病例。41例LAMN黏液均可出现于黏膜肌层外阑尾壁或阑尾表面,其中39黏液湖内没有或仅见少数黏液上皮,上皮具有轻度异型性;有3例复发或进展,元死亡病例。7例PMP—L上皮具有轻度异型性,其中有4例黏液湖内上皮数量稀少或缺乏,其余3例上皮数量中等至较多：术后复发和死亡各1例。7例MAC和4例PMP—H均为浸润性肿瘤,至少局部出现高级别细胞学特征;术后复发4例,死亡3例（含2例复发后死亡）。MA和LAMN在组织学上表现为非浸润性肿瘤。而PMP-L、MAC和PMP-H则在生物学行为上表现为腺癌特征。结论阑尾黏液性肿瘤是一系列肿瘤谱系,其生物学行为取决于肿瘤性质和类型,统一、规范而准确的病理诊断对于治疗至关重要。