眼手术后干眼症的临床观察

目的 探讨眼手术后干眼症的病因,诊断和治疗.方法 对眼部手术后有干眼症状的132例(149只眼),就诊前所行手术,眼局部用药情况、治疗前后,停止治疗前后基础泪液分泌实验(Schirmertest)、泪膜破裂时间(BUT)实验和荧光苏染色的变化情况进行分析.根据病情停用原来的眼药水,辅以不含防腐剂的人工泪液(透明质酸钠)和促上皮生长的滴眼液(碱性成纤维细胞生长因子basic fibroblast growth factor,bFGF)滴眼液.结果 分别对治疗前、治疗后、有效者停止治疗一周后的基础泪液分泌、泪膜破裂时间(BUT)进行比较,差异显著有统计学意义(P<0.01).结论 眼科手术易诱发干眼症,早期明确诊断,选择正确的治疗方法,可以取得较好的疗效.     

2007年度北京地区血液透析患者透析龄调查分析

目的分析北京地区109个血液透析单位2007年度血液透析患者的登记资料,了解血液透析患者的流行病学规律。方法根据该年度北京地区109个血液透析单位5065例透析龄资料完整的病例,按照患者透析龄及相应的性别、年龄、原发病进行分层分析。结果随着透析龄延长,坚持血液透析的患者逐渐减少。透析龄在1～2年的患者数仅为透析龄0～1年的46.0%,其后透析龄每增加1年,剩余患者数是前一透析龄的75.0%左右。男女患者逐年退出的比例都与总体患者的退出规律相类似,但女性患者坚持透析的时间明显长于男性。50～80岁的患者在各个透析龄段人数均最多;30岁以下和80岁以上的患者在0～1年的透析龄中所占比例偏高（分别为59.5%和41.0%）,而至透析龄1～2年时其下滑的幅度大于其它年龄段患者。原发病以原发和继发肾小球疾病所占比例最高,透析龄均数也最长。结论随着透析龄增长,坚持血液透析的人数减少,透析第1年前后退出的人数最多,以后退出人数似乎遵循着一定的比例。女性的平均透析龄长于男性。30～80岁患者人数在各个透析龄段均高于其它年龄段。不同原发病透析龄存在着差异。     

Lifetime Risk and Trends in Lung Cancer Incidence in Greater Mumbai

Objective: To estimate the probability of developing lung cancer in the entire life span of the people ofGreater Mumbai and variation according to age and sex. Information on cancer incidence trends in a communityforms the scientific basis for planning and organising prevention, diagnosis and treatment. During the last 24year period, a total of 11,458 lung cancer cases were registered (9,052 male and 2,406 female) by the BombayCancer Registry. Lung cancer accounts for 9.4% of all male cancers and 2.7% of those in females (6.2% of allcancers) in Greater Mumbai. The probability of developing cancer in the entire life span of the people of GreaterMumbai was estimated. Methods: A method based on the cumulative risk of cancer was used to estimate theprobabilities using lung cancer data collected by the population-based Bombay Cancer Registry from the years1982 to 2005. For evaluation of trends, a linear regression model based on the logarithm of the observed incidencerates was applied. The annual percentage change was also computed for the evaluation. The cumulative incidencerate percentage was calculated by adding up the age-specific incidence rates at single ages and then expressed asa percentage. Results: The results show that age-adjusted incidence rates of lung cancer during the period 1982to 2005 showed a statistically significant decreasing trend in males and a statistically significant increasingtrend among females. When these trends were examined across different age-groups (0-39, 40-64 and 65 orolder), the rates showed a statistically significant decreasing trend from 0-64 years in males and a statisticallysignificant increasing trend in females aged 65 years and older. The rates proved stable across the other agegroups.The probability estimates indicate that one out of every 74 men and one out of every 242 women willcontract lung cancer at some time in their whole life in the absence of other causes of death, assuming that thecurrent trends prevail over the time period. Most of them will acquire the disease after the age of 40 years, afterwhich risk increases with time. Conclusions: The variation in age-adjusted incidence rate across different agegroupsin both sexes clearly indicate that there has been a change in the etiology of lung cancer in GreaterMumbai over time. The most important reason for this would be decrease in smoking prevalence among males.The other reasons for this have to be explored through risk assessment studies, but these findings may be ofgeneral interest because changes in diagnostic practices are confounders in time trends of lung cancer in manydeveloped countries, preventing inferences on changes in risk factors.     

中国中医药资源配置水平及影响因素探讨＊

目的 分析2013-2019年中国31省市中医药资源配置水平及区域差异，探讨影响资源配置水平的主要因素，为优化中国中医药资源配置提供依据。方法 选取具有代表性的每万人口中医药机构数、每万人口中医药技术人员以及每万人口中医药床位数作为中医药资源配置水平的指标，利用统计年鉴2013-2019年的面板数据，综合运用熵权法、可分解的泰尔指数以及面板时间固定效应模型，分析各省份中医药资源配置水平及区域公平性差异和影响因素。结果 中国中医药资源配置水平均值为0.165，整体呈现递增趋势，不同省份间配置水平有差异；按人口配置的总体泰尔指数优于按面积配置的指数；公平性差异主要来自于四大经济区区域内差异；经济发展水平、城镇化水平和财政自主度是影响中医药资源配置的主要因素（P<0.05）。结论 中医药资源配置整体水平呈增长趋势，资源配置的公平性有待于进一步提高，应重点关注区域内的不公平性。经济发展水平、城镇化水平和财政自主度是影响中医药资源配置水平的主要因素，建议各地区根据当地不同现状精准施策。     

Time-restricted feeding (TRF) for prevention of age-related vascular cognitive impairment and dementia

Aging is the most significant risk factor for vascular cognitive impairment (VCI), and the number of individuals affected by VCI is expected to exponentially increase in the upcoming decades. Yet, there are no current preventative or therapeutic treatments available against the development and progression of VCI. Therefore, there is a pressing need to better understand the pathophysiology underlying these conditions, for the development of novel tools and interventions to improve cerebrovascular health and delay the onset of VCI. There is strong epidemiological and experimental evidence that lifestyle factors, including nutrition and dietary habits, significantly affect cerebrovascular health and thereby influence the pathogenesis of VCI. Here, recent evidence is presented discussing the effects of lifestyle interventions against age-related diseases which in turn, inspired novel research aimed at investigating the possible beneficial effects of dietary interventions for the prevention of cognitive decline in older adults.     

Ventilatory Support Use in Hospitalized Patients With Community-Acquired Pneumonia. Fifteen-year Trends in Spain (2001–2015)

AimWe examined fifteen years trends (2001–2015) in the use of non-invasive ventilation (NIV), invasive mechanical ventilation (IMV) or both (NIV + IMV) among patients hospitalized for community acquired pneumonia (CAP). We also analyzed trends overtime and the influence of patient factors in the in-hospital mortality (IHM) after receiving NIV, IMV or NIV + IMV.MethodsObservational retrospective epidemiological study. Our data source was the Spanish National Hospital Discharge Database.ResultsOver a total of 1,486,240 hospitalized patients with CAP, we identified 56,158 who had received ventilator support in Spain over the study period. Of them, 54.82% received NIV, 37.04% IMV and 8.14% both procedures. The use of NIV and NIV + IMV increased significantly (p < 0.001) over time (from 0.91 to 12.84 per 100.000 inhabitant and from 0.23 to 1.19 per 100.000 inhabitants, respectively), while the IMV utilization decreased (from 3.55 to 2.79 per 100,000 inhabitants; p < 0.001). Patients receiving NIV were the oldest and had the highest mean value in the Charlson comorbidity index (CCI) score and readmission rate. Patients who received only IMV had the highest IHM. Factors associated with IHM for all groups analyzed included age, comorbidities and readmission. IHM decreased significantly over time in patients with CAP who received NIV, IMV and NIV + IMV.ConclusionsWe found an increase in NIV use and a decline in IMV utilization in patients hospitalized for CAP over the study period. Patients receiving NIV were the oldest and had the highest CCI score and readmission rate. IHM decreased significantly over time in patients with CAP who received NIV, IMV and NIV + IMV.     

Characterizing Sunflower syndrome: a clinical series

Aims. To characterize the clinical phenotype of Sunflower syndrome. Sunflower syndrome is a rare photosensitive epilepsy syndrome characterized by highly stereotyped seizures, photosensitivity, and heliotropism. Methods. We retrospectively reviewed the medical records of patients seen in the Massachusetts General Hospital for Children (MGHfC) pediatric epilepsy program with a history of Sunflower syndrome. Results. Twenty‐four patients were identified; 18 were female. At the time of initial MGHfC evaluation, patients’ ages ranged from 6.4 to 25 years, with a median age of 11.5 years. All patients presented with hand‐waving episodes (HWEs), although one patient no longer demonstrates this, but now has eye blinking episodes on exposure to light. Four have associated eye fluttering as a component of their most prevalent light‐induced seizures. The average age at onset of HWEs was six years. Seventeen developed other symptoms prior to the onset of HWEs. The most prevalent symptom was an attraction to light and possible absence seizures. Light‐induced seizures were generally refractory to broad‐spectrum antiepileptic drugs (AEDs). Only three patients had a reduction of HWEs with the use of AEDs. Several non‐pharmacological strategies reduced seizure frequency, however, efficacy varied. These non‐pharmacological strategies included avoiding stimulus, focusing on other tasks, and occupying or restraining the hand that was involved in hand‐waving. The use of tinted glasses reduced seizure frequency in 17 patients, however, no patient achieved seizure freedom. Twenty‐two patients had available EEGs, 20 of which showed interictal epileptiform discharges. Additionally, many of the patients experienced a negative impact on their self‐concept due to anxiety, depression, or negative interactions with peers. Conclusion. Sunflower syndrome is a generalized, pharmacoresistant epilepsy with childhood onset and remains poorly understood. To improve clinical care and scientific understanding, long‐term prospective research exploring the natural history, etiology, and effective treatments for Sunflower syndrome should be conducted. [Published with video sequence].