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1.
目的比较飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK)、全飞秒激光小切口角膜基质透镜取出术(SMILE)和有晶状体眼后房型人工晶状体(ICL V4c)植入术三者矫正中低度近视的效果。方法采用回顾性研究。以惠州爱尔眼科医院2019年6月至2020年4月矫正中低度近视120例(120眼)作为研究对象,受术者分为FS-LASIK组、SMILE组及ICL组,每组40例(40眼),各组分别接受相应的手术,术后随访3个月比较其矫正效果。结果术后1个月及3个月,3组间视力及有效性指数对比差异无统计学意义(P>0.05);ICL组安全性指数高于SMILE组及FS-LASIK组(P<0.05)。术后3个月FS-LASIK组的三叶草像差、彗差和球差出现明显变化,而SMILE组的变化较小,ICL组变化最小(P<0.05)。结论对中低度近视FS-LASK、SMILE及ICL植入术三者均有确切疗效,而ICL V4c植入术的安全性最高,患者的视觉质量最好。  相似文献   
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ObjectiveTo determine the long-term cardiovascular disease risk of astronauts with spaceflight exposure compared with a well-matched cohort.MethodsNational Aeronautics and Space Administration (NASA) astronauts are selected into their profession based upon education, unique skills, and health and are exposed to cardiovascular disease risk factors during spaceflight. The Cooper Center Longitudinal Study (CCLS) is a generally healthy cohort from a preventive medicine clinic in Dallas, Texas. Using a matched cohort design, astronauts who were selected beginning April 1, 1959, (and each subsequent selection class through 2009) and exposed to spaceflight were matched to CCLS participants who met astronaut selection criteria; 1514 CCLS participants matched to 303 astronauts in a 5-to-1 ratio on sex, date of birth, and age. The outcome of cardiovascular mortality through December 31, 2016, was determined by death certificate or National Death Index.ResultsThere were 11 deaths caused by cardiovascular disease (CVD) among astronauts and 46 among CCLS participants. There was no evidence of increased mortality risk in astronauts (hazard ratio [HR]=1.10; 95% confidence interval [CI], 0.50 to 2.45) with adjustment for baseline cardiovascular covariates. However, the secondary outcome of CVD events showed an increased adjusted risk in astronauts (HR=2.41; 95% CI, 1.26 to 4.63).ConclusionNo increased risk of CVD mortality was observed in astronauts with spaceflight exposure compared with a well-matched cohort, but there was evidence of increased total CVD events. Given that the duration of spaceflight will increase, particularly on missions to Mars, continued surveillance and mitigation of CVD risk is needed to ensure the safety of those who venture into space.  相似文献   
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目的分析低分子肝素钙抗凝对多囊卵巢综合征(PCOS)所致不孕症患者来曲唑诱导排卵疗效的影响。方法选取2014年1月—2019年1月九江市第三人民医院和彭泽县妇幼保健院收治的156例PCOS所致不孕症患者,采用随机数字表分成两组,每组78例。对照组口服来曲唑治疗,观察组采取口服来曲唑联合低分子肝素钙注射液治疗。比较两组的疗效、子宫内膜容受性、凝血功能指标、促排卵结局及不良反应。结果观察组总有效率[94.87%(74/78)]显著高于对照组[80.77%(63/78)],差异有统计学意义(χ2=7.252,P=0.007)。治疗后,观察组子宫内膜厚度、子宫动脉搏动指数(PI)及阻力指数(RI)分别为(9.75±1.03)mm、(1.30±0.26)及(0.58±0.12),对照组子宫内膜厚度、PI及RI分别为(7.48±0.95)mm、(1.71±0.33)及(0.66±0.11),两组比较差异均有统计学意义(t=14.308,8.619,4.340,均P<0.05)。治疗后,两组凝血功能指标比较差异均有统计学意义(均P<0.05)。观察组妊娠率[52.56%(41/78)]显著高于对照组[32.05%(25/78)],自然流产率[2.44%(1/41)]显著低于对照组[16.00%(4/25)],差异均有统计学意义(均P<0.05)。观察组不良反应发生率[16.67%(13/78)]与对照组[12.82%(10/78)]比较差异无统计学意义(χ2=0.459,P=0.498)。结论PCOS所致不孕症患者在应用来曲唑诱导排卵的同时联合低分子肝素钙抗凝治疗能有效改善患者的凝血-纤溶状态,明显提高患者的子宫内膜容受性,改善促排卵结局。  相似文献   
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BackgroundThe patient acceptable symptom state (PASS) is a treatment-response criterion developed to determine the clinical relevance of a treatment effect. Its estimates for some patient-reported outcomes (PROs) in non-specific chronic low back pain (cLBP) are lacking and the stability of PRO estimates between independent cLBP populations is unknown. We hypothesized that these PRO estimates will be stable.ObjectivesTo estimate and compare the PASS for PROs between 2 independent cLBP populations.MethodsWe conducted a secondary analysis of a randomized controlled trial (PREDID) and a cohort of outpatients with non-specific cLBP. Using an anchoring question, participants who self-rated their health as “excellent”, “very good” or “good” at 1 month were considered to have an acceptable symptom state. PASS estimates for 5 PROs were calculated by using the 75th percentile method. Estimates were compared between the 2 populations with bootstrap resampling.ResultsA total of 256 participants with non-specific cLBP were included: 135 patients with cLBP and active discopathy from the PREDID trial and 121 outpatients with cLBP without active discopathy followed up in an independent cohort. Overall, 137/256 (54%) participants had an acceptable symptom state at 1 month. PASS estimates were 47.5 (95% confidence interval [CI] 40.0 to 50.0)/100 for lumbar pain (0, no pain and 100, maximal pain), 30.5 (30.0 to 40.0)/100 for radicular pain, 39.3 (33.6 to 45.3)/100 for Quebec Back Pain Disability score (0, no disability and 100, maximal disability), 10.0 (9.2 to 10.0)/21 for the Hospital Anxiety Depression anxiety subscale (0, no anxiety, and 21, maximal anxiety) and 6.7 (6.0 to 8.0)/21 for the depression subscale (0, no depression, and 21, maximal depression). PASS estimates did not differ between the 2 populations.ConclusionsOur study provides PASS estimates for 5 PROs commonly used in cLBP. Our estimates were stable between 2 independent populations of people with cLBP. The stability of our PASS estimates suggests that they are relevant for interpreting PRO values in clinical trials and practice. ClinicalTrials.gov no. (PREDID trial) NCT00804531.  相似文献   
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BackgroundWhile studies have demonstrated favorable outcomes in utilization of primary total shoulder arthroplasty (TSA) for the treatment of glenohumeral osteoarthritis (OA), adverse events such as infections can still occur. Periprosthetic joint infections (PJIs) are associated with worse outcomes and patient morbidity. The purpose of this study was to: (1) compare patient demographics amongst TSA patients with and without PJIs following primary TSA; and (2) identify patient-related risk factors for PJIs following primary TSA.MethodsPatients undergoing primary TSA for the treatment of glenohumeral OA were identified using the Mariner administrative claims database by CPT code 23,472. Laterality modifiers were utilized to ensure PJIs were developing in the correct laterality as those patients undergoing primary TSA. Inclusion for the study group consisted of patients who developed PJIs within 2-years after the index procedure, whereas patients who did not develop PJIs served as the comparison cohort. Primary outcomes analyzed included patient demographics and patient-related risk factors for PJIs following primary TSA. A stepwise backwards elimination multivariate binomial logistic regression analyses was performed to determine the odds (OR) of PJIs in patients undergoing primary TSA. A P value less than .05 was considered statistically significant.ResultsThe query yielded 15,396 patients who underwent primary TSA for glenohumeral OA, of which 191 patients developed PJIs and 15,205 did not develop PJIs. The study found statistically significant differences amongst patients who did and did not develop PJIs following primary TSA with respect to age, sex, and presence of comorbid conditions. Risk factors associated with developing PJIs following primary TSA included: pathologic weight loss (OR: 2.06, P < .0001), obesity (OR: 1.56, P = .0001), male sex (OR: 1.52, P = .007), and peripheral vascular disease (OR: 1.46, P = .022).ConclusionAs the number of primary TSAs for the treatment of glenohumeral OA increase worldwide, identifying modifiable risk-factors to reduce the incidence of infection is critical. The study found various modifiable and non-modifiable risk factors associated with developing PJIs following primary TSA. This study is valuable to orthopedists in order to identify and risk-stratify patients with regard to PJI in the setting of primary TSA for OA.Level of EvidenceLevel III; Case-Control Study  相似文献   
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Introduction and objectivesIonizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients.MethodsWe analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B).ResultsWe analyzed 120 catheter ablation procedures in 110 pediatric patients (11 ± 3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P = .53), complications (1.7% vs 1.6%; P = .23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1 minutes vs 12 minutes; P < .0005) and ablation time (median 96.5 seconds vs 133.5 seconds; P = .03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P = .03).ConclusionsThe use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation.  相似文献   
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《Vaccine》2022,40(6):904-911
BackgroundGSK initiated a Pregnancy Registry in the United States (US) for the reduced-antigen-content tetanus-diphtheria-acellular pertussis (Tdap; Boostrix, GSK) vaccine with the aim to detect and describe pregnancy outcomes in women vaccinated with Boostrix 28 days before estimated conception or during pregnancy.MethodsVoluntary reports of pregnancy exposure to Boostrix received from spontaneous and post-marketing surveillance sources in the US were assessed. Reports were classified as prospective or retrospective based on the knowledge of pregnancy outcomes at the time of reporting. For completeness, reports of exposure to Boostrix or to the Tdap-inactivated poliovirus vaccine (Boostrix-IPV, GSK) reported to the global safety database from countries outside the US were also evaluated.ResultsFrom May 2005 to August 2019, 1517 (1455 prospective and 62 retrospective) pregnancy reports were received in the Boostrix US Pregnancy Registry. Of the prospective reports, 250 had known outcomes: 244 live infants with no apparent birth defects (BDs), three live infants with BDs, and three spontaneous abortions with no apparent BDs. Of the retrospective reports, 55 had known outcomes: 33 live infants with no apparent BDs, 16 live infants with BDs, one spontaneous abortion with no apparent BDs, four stillbirths with no apparent BDs, and one stillbirth with BDs. Cumulatively, 1321 pregnancy reports (1006 for Boostrix; 315 for Boostrix-IPV) were received from countries outside the US. Of these, 163 prospective reports and 551 retrospective reports had known outcomes. Results were in line with those from the Boostrix US Pregnancy Registry.ConclusionsData currently available from the Boostrix US Pregnancy Registry and from countries outside the US suggested that exposure to Boostrix or Boostrix-IPV during pregnancy does not raise safety concerns related to adverse pregnancy outcomes or BDs.  相似文献   
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目的:通过对接受腹腔镜直肠癌根治(total mesorectal excision,TME)手术患者的术后随访,探究保留左半结肠血管对术后便秘及相关并发症的影响。方法:我院普外科2015年05月至2017年05月共收治的93例直肠肠癌根治手术患者进行回顾性分析。结果:对于病人的年龄、性别、BMI、术前CEA、术中出血量、吻合口瘘、术后肿瘤复发率,是否保留左半结肠血管方面无差异(P>0.05)。低位结扎组在术后肠道功能恢复、吻合口炎症以及术后便秘发生率中明显优于高位结扎组(P<0.05);高位结扎组在手术时间上优于低位结扎组(P<0.05)。结论:保留左半结肠的TME手术可以完成同样的淋巴结清扫,虽然术中用时较长但一定程度上保护了肠道的血运及神经,降低了术后便秘的发生率,值得临床进一步研究与推广。  相似文献   
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