藏毛窦发病率和远期复发率现况及其影响因素分析

目的 调查德国部队中藏毛窦的发病率和术后远期复发率的现状及其发展变化趋势,分析不同手术治疗方法、体格状况和吸烟量等因素对藏毛窦的发病率和术后远期复发率的影响.方法 对德国三家部队医院1980至1996年收治的所有藏毛窦患者的资料进行统计,随机抽取其中500例患者进行随访.结果 德国部队中藏毛窦的发病率由1985年的0.3/1000上升到2007年的2.4/1000.随机抽取的500例患者中2例死亡,498例接受了随访.其术后复发率从1981年的33%,到1986年的23%,再到1996年的12%,呈明显下降趋势(P=0.01).藏毛窦切除后行开放愈合的复发率为16.8%,显著低于行一期缝合的复发率31.0%(P＜0.01).部队中人均体质量每十年增加1 kg,德国国民人均体质量每十年增加1.9kg,但是体质量的增加与藏毛窦复发率之间无显著相关性(P=0.72).每天吸烟20支以上者藏毛窦的复发率比吸烟≤20支者显著升高(P=0.015).结论 在藏毛窦的术后复发率下降,特别是切除后开放愈合的术后复发率下降的同时,藏毛窦的发病率上升了近十倍.

Abstract：

Objectives To investigate the trends in incidence and long-term recurrence rate of pilonidal sinus disease (PSD) within the German Armed Forces, and analyse the influence of variable factors, such as different surgical methods, body constitution and smoking amount, to incidence and long-term recurrence rate of PSD. Methods Information of all the patients being admitted with primary PSD to the surgical departments of three hospitals of the German Armed Forces between 1980 and 1996 was collected and analyzed ,500 patients of which were interviewed. Results Two of the 500 patients were dead, and every one of the rest 498 patients agreed to take part in the interview. The incidence of PSD rose from 0. 3/ 1000 in 1985 to 2. 4/1000 in 2007. The recurrence rates were decreasing within 16 years of treatment from 33% in 1981 via 23% in 1986 to 12% in 1996 (P = 0. 01). Recurrence rates of primary open wound healing (16. 8%) compared to primary suture (31.0%) differ significantly (P ＜ 0. 01). While the mean body weight within the army rose 1 kg per decade, population shows an increase of 1.9 kg per decade though not being an influencing factor on the recurrence rate (P = 0. 72). Smoking of more than 20 cigarettes per day proved to be a significant factor on the recurrence rate of PSD (P = 0. 015). Conclusion While the recurrence rates-especially of primary open wound treatment-decreased, the incidence of PSD rose nearly tenfold.     

血流动力学相关直立性头晕/眩晕诊断标准： Bárány协会前庭疾病分类委员会共识文件

本文《血流动力学相关直立性头晕/眩晕（hemodynamic orthostatic dizziness/vertigo,HOD/V）诊断标准》被纳入国际前庭疾病 分类（International Classification of Vestibular Disorders,ICVD）。定义HOD/V诊断标准的目的是帮助临床医生能够更好地理解直立 性头晕/眩晕相关的术语以鉴别直立性头晕/眩晕是由脑低灌注因素还是由其他病因所致。HOD/V诊断标准：（A）至少5次由起身引 发或直立体位时出现的头晕、不稳或眩晕,坐下或躺下后缓解;（B）站立或直立倾斜试验时记录到直立性低血压、体位性心动过速综 合征或晕厥;（C）不能归因于其他疾病。很可能的HOD/V诊断标准：（A）至少5次由起身引发或直立体位时出现的头晕、不稳或眩 晕,坐下或躺下后缓解;（B）至少有一项伴随症状：全身乏力或疲劳感、思维迟缓或注意力难以集中、视物模糊、心动过速或心悸;（C） 不能归因于其他疾病。这些诊断标准是基于广泛回顾近九十年来关于HOD/V、体位性低血压或心动过速及自主神经性头晕的相关 研究达成的专家共识。进一步测量直立位血压和心率对于筛查和记录直立性低血压、体位性心动过速综合征以确立HOD/V的诊 断具有重要意义。     

ERCC1基因多态性与胰腺导管腺癌易感性的Meta分析

目的：探讨切除修复交叉互补基因1（excision repair cross complementing 1,ERCC1）2种最常见的基因多态性（rs3212986、rs11615）与胰腺导管腺癌（pancreatic ductal adenocarcinoma,PDAC）患病风险的相关性。方法：检索PubMed、EMBASE、Web of Science、中国知网文献数据库,查找国内外关于ERCC1多态性（rs3212986、rs11615）与PDAC易感性关系的病例对照研究。由2名评价者根据纳入标准分别独立筛选文献并提取数据后,采用Stata12.0软件进行Meta分析。结果：共纳入8项病例对照研究,其中ERCC1 rs3212986纳入4项研究共1 934例患者,rs11615纳入4项研究共2 547例患者。结果显示,ERCC1 rs3212986可显著提高人群PDAC的患病风险（CA vs. AA：OR=1.34,95% CI：1.11~1.63;CC vs. AA：OR=2.33,95% CI：1.73~3.14;AC+CC vs. AA：OR=1.50,95% CI：1.25~1.80;CC vs. CA+AA：OR=1.98,95% CI：1.50~2.62;C vs. A：OR=1.45,95% CI：1.27~1.66）;而ERCC1 rs11615则与PDAC患病风险无关（CT vs. TT：OR=1.02,95% CI：0.87~1.21;CC vs. TT：OR=1.21;95% CI：0.93~1.56;TC+CC vs. TT：OR=1.06,95% CI：0.91~1.24;CC vs. CT+TT：OR=1.20,95% CI：0.94~1.53;C vs. T：OR=1.08,95% CI：0.96~1.21）。结论：ERCC1 rs3212986可明显增加PDAC发病风险,rs11615则与PDAC易感性无关。