常规超声心动图对蒽环类化疗药物致心脏毒性的诊断价值

目的:探讨常规超声心动图对蒽环类化疗药物所致心脏毒性的诊断价值。方法:选取2014年2月至2017年6月在我院接受蒽环类药物化疗的乳腺癌术后患者136例,给予吡柔比星+环磷酰胺+多西他赛方案化疗6个周期。疗程结束后,根据患者是否发生心脏毒性分为心脏毒性组(N=48)和无心脏毒性组(N=76),对比患者化疗前后的超声心动图参数,分析常规超声心动图参数在早期心脏毒性诊断中的价值。结果:心脏毒性组TAPSE、E/A和E/a,值显著低于无心脏毒性组(P0.05)。ROC曲线分析,TAPSE、E/A和E/e'对应的曲线下面积分别为0.917(0.874,0.962)、0.902(0.853,0.957)、0.845(0.823,0.921)。TAPSE的截断值为20.78 mm、E/A的截断值为1.19、E/e'的截断值为8.59,Youden指数分别为0.842、0.761、0.712。结论:常规超声心动图在蒽环类药物心脏毒性诊断中具有一定价值。     

心肌致密化不全的超声心动图诊断

目的研究心肌致密化不全(noncompaction of ventricular myotacdium,NVM)的超声心动图诊断价值.方法采用Acuson 128 XP/10 C,HP 4500彩色超声诊断仪,探头频率2～4 MHz.主要观察左室长轴及短轴切面,四心腔切面.结果所有5例均可见心室内未致密化的肌小梁及其间深陷的隐窝.其中,2例为双心室型,3例为左心室型.5例中有1例合并其他先天性心脏畸形.4例出现心功能不全,3例出现心律失常.结论超声心动图是诊断本病的最佳选择.     

Consistency of Positron Emission Tomography and Myocardial Contrast Echocardiography in Diagnosing Mental Stress-Induced Myocardial Ischemia: Study Protocol of a Prospective Study—Background,Design and Method

Mental stress-induced myocardial ischemia (MSIMI) has attracted increasing attention in the last 30 y. Positron emission tomography/computed tomography (PET/CT) is among the most accurate methods for evaluating myocardial perfusion. Even so, echocardiography seems to be a more harmless option when the radiation exposure and high expense of PET/CT are considered. To date, no previous studies have compared the consistency between echocardiography and PET/CT in the diagnosis of MSIMI. The primary aim of this research was to compare the consistency of myocardial contrast echocardiography and PET/CT in diagnosing MSIMI in women with angina symptom/ischemia but no obstructive coronary artery disease (INOCA). Fifty adult female patients with INOCA were recruited for a 12-min-long mental stress test. Each patient underwent both echocardiography and PET/CT at baseline and during mental stress testing; the interval between the two examinations was 1–3 d and the sequence was assigned naturally. MSIMI is defined by a summed difference score (SDS) ≥3 on PET-CT during mental stress testing. It is also defined by new abnormal wall motion, ejection fraction reduction ≥5%, and/or development of ischemic ST change on the electrocardiogram during mental stress testing. This study examined the consistency of PET/CT and myocardial contrast echocardiography in diagnosing MSIMI.     

隐源性缺血性脑卒中患者的食管超声心动图解析

目的 探讨食管超声心动图（TEE）诊断隐源性缺血性脑卒中（CS）患者房间隔异常的特点。方法 收集我院CS患者181例,根据年龄分为＜30岁组、31~50岁组、＞51岁组。所有患者均行TEE检查,观察房间隔情况。结果 所有患者中,PFO患者63例,占34.81%,房间隔膨出瘤患者6例,占3.31%,房间隔膨出瘤并缺损患者19例,占10.50%,房间隔组织稀疏并分流患者24例,占13.26%;小于30岁组房间隔组织稀疏并分流患者4例,占44.44%;31~50岁组房间隔结构异常者以PFO居多,占33.33%;大于51岁组PFO最多,占37.36%。CS患者中房间隔异常的TEE超声特点:①卵圆孔未闭类型:卵圆瓣较长,与房间隔组织贴合欠佳,有明显裂隙,形似“隧道”样;卵圆瓣较短,与房间隔组织贴合处有间隙。②房间隔膨出瘤或合并房间隔缺损,即房间隔组织菲薄,随心脏舒缩活动膨向右房、左房或摆动于左右房之间,部分患者可合并房间隔小缺损。③房间隔组织薄弱、稀疏,形同“筛子”样,可合并心房水平多股细小分流信号。结论 PFO是CS的重要致病原因之一,TEE作为目前诊断PFO和房间隔病变的首选方法,可精准描述房间隔结构和准确判断心房水平的分流情况,为临床尽早识别和预防脑血管卒中提供客观依据。     

Insomnia in institutionalized older people in Cairo,Egypt: Prevalence and risk factors associated

Insomnia symptoms are highly prevalent among the elderly. Nearly half of the elderly population reported difficulty in initiation and maintaining sleep. The presence of insomnia affects the quality of life of elderly and increases the risk of falls. This study aims to measure the prevalence of insomnia among a group of elderly living in geriatric homes in Cairo and to assess the factors affecting it. A cross sectional study was conducted on 184 elderly living in two geriatric homes in Cairo. Athens insomnia scale was used to assess insomnia through an interview questionnaire. The prevalence of insomnia among the studied elderly in geriatric homes in Cairo was 36.4%. Higher prevalence of insomnia was found among males and married elderly. Also, insomnia was associated with longer stay in geriatric homes. Feeling sleepy during the day (59.2%) was the most prevalent symptom. Suffering pain (73.5%), nocturia (42.7%), and suffering from chronic diseases (40.4%) were significantly associated with insomnia. A significantly higher percentage of elderly with bad self-perception of owns health, suffered of insomnia (77.8%). This study reveals that changes in lifestyle, optimization of living environment and symptom control can reduce the burden of insomnia and improve quality of life of institutionalized elderly in Egypt.     

A scoping review identifies multiple emerging knowledge synthesis methods,but few studies operationalize the method

ObjectivesTo systematically identify, define, and classify emerging knowledge synthesis methods through a scoping review.Study Design and SettingMEDLINE, CINAHL, EMBASE, PsycINFO, the Cochrane Methodology Register, the Cochrane Database of Systematic Reviews, Social Sciences Abstracts, Library and Information Science Abstracts, Philosopher's Index, and Education Resources Information Center were searched to identify articles reporting emerging knowledge synthesis methods across the disciplines of health, education, sociology, and philosophy. Two reviewers independently selected studies and abstracted data for each article.ResultsIn total, 409 articles reporting on 25 knowledge synthesis methods were included after screening of 17,962 titles and abstracts and 1,010 potentially relevant full-text articles. Most of the included articles were an application of the method (83.9%); only 3.7% were seminal articles that fully described the method (i.e., operationalized the steps). Most of the included articles were published after 2005. The methods were most commonly used across the fields of nursing, health care science and services, and health policy.ConclusionWe found a lack of guidance on how to select a knowledge synthesis method. We propose convening an international group of leaders in the knowledge synthesis field to help clarify emerging approaches to knowledge synthesis.