肺结节CT随访中的生长特性评估

对肺结节行计算机断层扫描(computed tomography,CT)随访并确定结节生长特性是临床针对不定性肺结节常采用的策略.依据肿瘤生长指数模型,常采用体积或质量倍增时间量化结节的生长速率.本文拟对肺癌的指数生长模型、肺结节生长量化评价的方法学、不同类型肺结节的生长特性进行综述.     

基于精益六西格玛的随访再住院患者入院检查流程改造研究

目的：探讨应用精益六西格玛对随访再住院患者入院检查流程改造的效果。方法选取肿瘤中心二区随访再住院患者为对照组，按照改造前入院检查流程进行入院检查；选取肿瘤中心一区随访再住院患者为观察组，应用精益六西格DMAIC模型进行流程改造，比较两组入院检查时间、住院时间、患者满意度等指标。结果改进后观察组与对照组患者入院检查时间、住院时间、患者满意度比较，差异均有统计学意义( P<0.05)。结论运用精益六西格玛法可有效缩短随访再住院患者入院检查时间和住院时间，提高患者满意度。     

Documento nacional de recomendaciones sobre el seguimiento del paciente con carcinoma de células renales

Objectives

This document was developed to establish directives for the follow-up of patients with renal cell carcinoma (RCC) based on the best available scientific evidence and on expert opinions, which can help urologists in the decision-making process and standardise the criteria at the national level.

椎基底动脉狭窄血管内支架成形术效果分析

目的 探讨症状性椎基底动脉血管内支架成形术的远期效果.方法 选取症状性椎动脉狭窄接受血管内支架治疗的33例患者,对临床症状和支架内再狭窄情况进行随访观察分析.结果 33例患者支架成形术后临床症状均明显改善,术前平均狭窄率为（92.36±3.23）％,术后即刻平均残余狭窄率为（9.13±2.57）％.术后23例临床症状完全消失,10例明显改善.1例基底动脉重度狭窄患者术后出现一侧肢体麻木的并发症,1例术后出现脑栓塞表现,3d后恢复正常.随访6～24个月,9例出现头晕、头昏等不适症状,其中29例获得数字减影血管造影检查,残余狭窄率为（19.27±5.62）％,3例椎动脉开口支架内再狭窄＞50％,再次给予支架内成形术,症状消失.结论 症状性椎基底动脉狭窄血管内支架成形术能够明显缓解脑缺血症状,提高患者生存质量,同时有一定的再狭窄率.     

心脏永久性起搏器植入患者门诊随访依从性分析

目的：分析心脏永久性起搏器植入患者门诊随访依从性的现状、影响因素及探讨提高随访依从性的方法。方法：回顾性分析2006-01至2013-01在我院住院植入心脏永久性起搏器的患者817例，对术后1年内的门诊随访情况进行依从性评判，并分析其影响因素。实际随访790例（96.70%），1年内未进行门诊随访者入电话随访组（n=350例），至少进行过1次门诊随访者入门诊随访组（n=440例）。结果：研究对象中，失访26例，失访率3.18%；非起搏器相关死亡1例，实际随访790例，实际随访率96.7%，其中门诊随访者440例（55.70％），电话随访者350例（44.30％）。两组在文化程度、医疗费用、居住地、对心律失常的了解、固定陪护人员方面的差异有统计学意义（P<0.05）。高中以上文化程度、医疗费用可报销、本地居住、对心律失常知识了解、有固定陪护人员的患者门诊随访率高。1年内总体并发症发生率1.8%，均未造成严重后果。随访时进行优化参数设置者占59.5%。结论：心脏永久性起搏器植入患者门诊随访率较低。影响因素较多，包括文化程度、医保制度、居住地、对心律失常的认知程度、有无陪护人员。     

新生儿听力与聋病易感基因联合筛查及干预管理系统在听力筛查中的应用价值

目的 探讨新生儿听力与聋病易感基因联合筛查及干预管理系统在听力筛查中的应用价值.方法 2005～ 2015年使用新生儿听力与聋病易感基因联合筛查及干预管理系统前后进行听力筛查的新生儿分别为25 805例、3 106例,比较使用该系统前后新生儿听力筛查的初筛率、复筛率、初筛通过率、复筛通过率、转诊率的差异.结果 应用该系统后,新生儿听力筛查的初筛率、复筛率明显提高(P＜0.05).结论 新生儿听力与聋病易感基因联合筛查及干预管理系统的应用显著提高了新生儿听力筛查的复筛率,减少了失访人数,提高了听力筛查的工作效率,有利于聋病患儿进行早期预防和干预治疗.     

永久起搏器和埋藏式心脏复律除颤器（ICD）在遗传性长QT综合征患者中的应用

目的总结合并窦性心动过缓的遗传性长QT综合征（以下简称遗传性LQTS）患者植入永久起搏器和埋藏式心脏复律除颤器（以下简称ICD）的治疗效果,对比分析这两种治疗在预防患者猝死中的差异。方法对我院从2003年6月到2013年6月出院诊断为遗传性LQTS合并窦性心动过缓、植入了永久起搏器或ICD的全部21例患者,结合门诊、电话和程控随访了解患者的生存状况、手术并发症以及晕厥、室性恶性心律失常的发作情况。结果起搏器组男性2例,女性9例,年龄39.3±14.3岁,随访时间50.6±26.3个月,1例患者猝死,2例患者再发晕厥前兆,其中1例最终更换为ICD。ICD组男性2例,女性8例,年龄34.5±11.9岁,随访时间61.4±43.5个月,3例患者接受了ICD的适当治疗,另2例患者接受了ICD的不适当治疗,1例患者术后出现囊袋感染,1例患者更换为永久起搏器。治疗有效率在起搏器组及ICD组分别为72.7%（8/11）和100.0%（10/10）,未达到统计学差异（p=0.21）。不良事件发生率在起搏器组及ICD组分别为27.3%（3/11）和30.0%（3/10）,也未达到统计学差异（p=0.63）。结论对于不能植入ICD的合并窦性心动过缓的遗传性LQTS患者,植入永久起搏器可能是一个较好的替代方法,但对于QTc≥539ms的患者,只有植入ICD才能预防猝死。植入ICD后长期无心脏事件发生的患者,根据患者意愿,可考虑更换为永久起搏器。     

社区老年期痴呆患者的随访研究

痴呆是一类高死亡率疾病 ,和心脏病、癌症及中风一起已成为威胁老年健康和生命的主要因素。本研究随访调查原有社区老年期痴呆患者 12 9例十年后的生存状况 ,现将资料报告如下。1　对象和方法1.1　对象1991年长沙市社区流调发现的 12 9例老年期痴呆患者[1] ,其中AD 116例 ,VD 13例。1.2　方法自编调查表 ,包括人口学资料 ,躯体疾病情况等。采用简易智力状态检查 (MMSE)、日常生活能力量表 (ADL)及功能活动调查表 (POD) [2 ] 对存活者进行功能评定。对于死者进一步了解死亡原因。2　结　　果2 .1　AD组和VD组生存时间频度分布病程≤ …     

Endoanal Ultrasound is of Little Value in Follow-Up of Anal Carcinomas

PURPOSE: The treatment of anal carcinoma has a vigorous follow-up regimen, and several authors have stated that endoanal ultrasound is a useful and necessary part of this regimen. This study was designed to evaluate the value of endoanal ultrasound in follow-up of anal carcinoma.METHODS: In this retrospective study, 82 patients were treated between 1983 and 1999. Main outcome measures were five-year survival and local recurrence rates, and in particular, it was focused on how local recurrences have been detected.RESULTS: Overall five-year survival was 68 percent. Fourteen patients (17 percent) developed local recurrence. Despite an estimated number of 780 scheduled endoanal ultrasound examinations, all the local recurrences were detected by digital and visual examination before the ultrasound procedures.CONCLUSIONS: In this study, all the local recurrences of anal carcinoma were detected by digital and visual examination. Thus, the addition of endoanal ultrasound was costly and unnecessary.Supported by a grant from the Norwegian Cancer Society.Presented at the meeting of the Norwegian Surgical Association, Oslo, Norway, October 20 to 24, 2003.     

Detection of Lymphatic Micrometastases in Patients With Stages I and II Colorectal Cancer: Impact on Five-Year Survival

PURPOSE: Despite having removed the whole macroscopic disease (curative intent surgery), one of five patients with Stages I and II colorectal cancer will develop recurrence. Lymphatic micrometastases detected by immunohistochemistry could be one of explanation for recurrence and cancer-related death in patients without lymph node involvement at light microscopy. However, the biologic importance of micrometastases remains unclear. This study was designed to determine the impact of micrometastases in five-year survival in patients with Stages I and II colorectal cancer.METHODS: This retrospective study included patients operated on between May 1989 and January 1999 for colorectal cancer without histopathologic lymph node involvement. Patients who received any adjuvant therapy were excluded. Immunohistochemical staining of the lymph nodes was performed with antipancytokeratin antibodies. Follow-up data were obtained from the clinical database and death certificates. Survival was estimated by the Kaplan-Meier method and compared by the log-rank test.RESULTS: Micrometastases were observed in 26 of 90 patients (28.9 percent). The mean follow-up time was 90.7 (range, 11–160) months. Seventeen cancer-related deaths occurred during follow-up (18.9 percent), 6 of them in patients with micrometastases (23.1 percent) and 11 in patients without micrometastases (17.2 percent; P = 0.559). Cancer-specific five-year survival was 87 percent in the whole group and 81 percent in patients positive for micrometastases vs. 90 percent in negative patients (P = 0.489).CONCLUSIONS: The presence of micrometastases in patients with Stages I and II colorectal cancer seems not to have any impact on cancer-specific survival.Supported by the Apertus Research Program (Andromaco Pharmaceutical Company) and by The National Public Grant (FONDECYT #1000556).