沙库巴曲缬沙坦治疗老年心力衰竭患者的预后列线图建立及验证

目的 对沙库巴曲缬沙坦治疗的心力衰竭(HF)患者建立列线图并验证,准确预测其1年内HF再入院的风险。方法 回顾性分析2018年6月至2021年12月山西医科大学第一医院HF患者的病历资料,对最小绝对收缩和选择算子回归筛选的变量进行多因素Cox回归分析,并建立列线图。使用一致性指数、受试者工作特征(ROC)曲线和校准曲线评估列线图的预测准确性。采用SPSS 26.0、R 4.1.3软件进行数据分析。根据数据类型,组间比较分别采用t检验、Mann-Whitney U检验及χ²检验。结果 多因素Cox回归分析示白细胞(HR=1.125,95%CI 1.016~1.245;P=0.023)、血清总胆固醇(HR=1.522,95%CI 1.080~2.144;P=0.016)、甘油三酯(HR=1.619,95%CI 1.109~2.363;P=0.013)和高密度脂蛋白胆固醇(HR=0.273,95%CI 0.125~0.598;P=0.001)是HF患者的预后预测因子,以此建立列线图模型。训练集C-index为0.749(0.678~0.820),6个月曲线下面积(AUC)=0.821(0.700~0.893),12个月AUC=0.771(0.575~0.836);测试集C-index为0.851(0.641~0.809),6个月AUC=0.851(0.692~0.940),12个月AUC=0.847(0.679~0.995),提示模型具有中等预测价值,校准图呈现出较好的一致性。结论 基于临床电子病历,本研究得出白细胞、血清总胆固醇、甘油三酯和高密度脂蛋白胆固醇是沙库巴曲缬沙坦治疗HF患者的预后影响因素,构建的列线图具有良好的预测价值和临床实用性,利于评估患者短期预后。     

倾向性评分匹配法分析达格列净和沙库巴曲缬沙坦对心力衰竭预后的影响

目的 基于倾向性评分匹配法分析达格列净和沙库巴曲缬沙坦对心力衰竭患者预后的影响。方法 回顾性分析2018年6月至2021年12月山西医科大学第一医院收治的369例心力衰竭患者的临床资料,根据治疗方法不同将患者分为达格列净组和沙库巴曲缬沙坦组。倾向性评分匹配后比较2组患者的预后并分析其影响因素。采用SPSS 26.0和R Studio(4.1.2版本)进行数据分析。根据数据类型,组间比较分别采用t检验、秩和检验、χ²或Fisher精确概率法。采用Cox回归模型分析2组患者预后的影响因素并绘制Kaplan-Meier曲线。结果 倾向性评分匹配后每组70例,Kaplan-Meier曲线示2组患者出院后首次心力衰竭再住院情况差异无统计学意义(P=0.190)。Cox多因素分析显示,达格列净组纽约心脏病学会(NYHA)分级(HR=6.923,95%CI=1.032~46.426;P=0.046)、左室舒张末期内径(LVEDD)(HR=1.139,95%CI=1.004~1.293;P=0.044)、标准化Z值的N端-B型钠尿肽前体(NT-proBNP)(HR=1.825,95%CI=1.075~3.097;P=0.026)是影响心力衰竭患者预后的危险因素;饮酒(HR=0.086,95%CI=0.018~0.413;P=0.002)和HDL-C(HR=0.012,95%CI=0.000~0.642;P=0.029)是保护因素。沙库巴曲缬沙坦组吸烟(HR=14.376,95%CI=1.657~124.748;P=0.016)是影响心力衰竭患者预后的危险因素;饮酒(HR=0.082,95%CI=0.012~0.578;P=0.012)和血红蛋白(HR=0.953,95%CI=0.912~0.995;P=0.030)是保护因素。结论 倾向性评分匹配后,达格列净组NYHA分级、LVEDD、标准化Z值的NT-proBNP、HDL-C和饮酒是患者预后的影响因素;沙库巴曲缬沙坦组吸烟、Hb和饮酒是患者预后的影响因素。达格列净和沙库巴曲缬沙坦对患者预后的影响无显著差异。     

老年肺间质纤维化患者生存现状调查

目的 调查老年肺间质纤维化患者生存现状并分析其相关因素。方法 将2020年6月到2022年6月新疆医科大学第一附属医院收治的246例老年肺间质纤维化患者纳为老年组,同期收治的160例非老年肺间质纤维化患者纳为非老年组。采用中文版特发性肺纤维化患者生活质量特异性量表(cATAQ-IPF)调查患者生活质量,中文版死亡态度描绘(DAP-R)量表调查患者死亡态度,对比老年组与非老年组临床特征。采用二元logistic回归模型分析影响老年组患者生活质量的相关因素;采用Pearson相关分析老年组患者生活质量与死亡态度之间的相关性。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ²检验。结果 老年组及非老年组中分别有220例及150例患者完成相关调查,对比发现,老年组年龄,合并高血压、糖尿病、冠心病比例,病程以及肺间质性纤维化-年龄-肺功能(ILD-GAP)指数高于非老年组,文化程度及cATAQ-IPF量表总得分均低于非老年组,差异均有统计学意义(P<0.05)。老年肺间质纤维化患者cATAQ-IPF量表总得分(264.64±36.78)分,其中受损最严重的三个维度分别是呼吸困难、死亡敏感、社交活动,受损相对最轻的维度是人际关系。二元logistic回归分析提示,病程(OR=2.323,95%CI 1.382~3.906)、ILD-GAP指数(OR=3.725,95%CI 1.285~10.797)、用力肺活量(OR=2.404,95%CI 1.514~3.817)、医学研究委员会呼吸困难量表(OR=2.102,95%CI 1.555~2.843)、焦虑(OR=1.774,95%CI 1.143~2.751)、抑郁(OR=1.610,95%CI 1.124~2.304)是影响老年肺间质纤维化患者生活质量的危险因素,而有配偶(OR=0.619,95%CI 0.474~0.809)及医学应对方式(OR=0.489,95%CI 0.355~0.673)是其生活质量的保护因素(P<0.05)。Pearson相关性分析提示,患者生活质量得分与其死亡恐惧及死亡逃避之间呈正相关(r=0.246、0.233; P=0.036、0.043),与自然接受之间呈负相关(r=-0.278; P=0.021)。结论 与非老年组患者相比,老年肺间质纤维化患者合并基础性疾病更多,肺间质纤维化病程更长,病情更为严重,生活质量更低;除疾病相关因素外,心理因素对其生活质量均有影响,建议临床增加对老年肺间质纤维化患者心理健康的关注与干预。     

社区老年2型糖尿病患者合并肌肉减少症的影响因素分析

目的 调查新疆乌鲁木齐市社区老年2型糖尿病(T2DM)患者合并肌肉减少症的影响因素,为未来制定个体化的切实可行的干预措施提供参考。方法 选取2022年5月至8月新疆乌鲁木齐市社区老年T2DM患者408例为研究对象,采用问卷调查患者一般资料及临床资料,并测定患者身体功能。依据纳入T2DM患者是否合并肌肉减少症分为肌肉减少症组和非肌肉减少症组。采用单因素和多因素二元logistic回归分析T2DM合并肌肉减少症患者的影响因素。采用SPSS 25.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Mann-Whitney U检验及χ²检验。结果 T2DM合并肌肉减少症发生率20.6%(84/408)。两组患者在年龄段、体质量指数(BMI)、文化程度、月收入、空腹血糖、餐后2h血糖、糖尿病病程、静坐时间、睡眠时间等方面的分布比较,差异均有统计学意义(P<0.05);两组患者骨骼肌质量指数、基础代谢率、身体总水分、蛋白质、无机盐、骨骼肌含量、体脂肪、体脂百分比、右上肢脂肪量、右下肢脂肪量、左下肢脂肪量、左上肢肌肉量、右上肢肌肉量、左下肢肌肉量、右下肢肌肉量、握力(左、右)明显低于非肌肉减少症组(P<0.05);肌肉减少症组患者5次坐立试验、6m步速等方面显著高于非肌肉减少症组患者(P<0.05)。多因素分析结果显示:BMI=18.5-<23.9kg/m²(OR=0.201,95%CI 0.03~1.338)、BMI≥27.9kg/m²(OR=0.019,95%CI 0.002~0.208)、T2DM病程(OR=1.095,95%CI 1.025~1.171)、每日静坐时间(OR=1.704,95%CI 1.299~2.235)、睡眠时间(OR=0.682,95%CI 0.48~0.969)、餐后血糖(OR=1.261,95%CI 1.056~1.506)、6m步速(OR=1.224,95%CI 1.072~1.398)、5次坐立试验(OR=1.377,95%CI 1.204~1.576)、右下肢肌肉量(OR=0.369,95%CI 0.253~0.583)均是老年T2DM伴肌肉减少症的影响因素(P<0.05)。结论 T2DM病程、餐后血糖、每日静坐时间、6m步速、5次坐立试验、BMI增高、右下肢肌肉量、睡眠时间均与老年T2DM伴肌肉减少症密切相关。     

社区老年高血压患者基线血压水平对远期衰弱发生的影响

目的 探究社区老年高血压患者基线血压水平对远期衰弱发生的影响,为老年高血压患者的科学化血压管理提供依据。方法 纳入2019年1月至6月在北京市某社区接受老年综合评估且资料完整的老年非衰弱高血压患者,并于2023年1月1日至2月14日期间进行电话随访,最终共有372例老年高血压患者纳入本研究。随访时采用FRAIL量表评估衰弱,评分≥3分为衰弱。采用二项logistic回归分析(输入法)计算基线血压水平与远期衰弱发生的OR和95%CI;使用广义相加模型对基线血压水平与远期衰弱发生的剂量反应关系进行平滑曲线拟合和阈值效应分析。采用Empower Stats软件和SPSS 25.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Mann-Whitney U检验及χ²检验。结果 多因素调整的logistic回归分析结果显示,基线收缩压、舒张压水平与衰弱发生无显著相关;基线脉压水平与衰弱发生呈负相关(OR=0.983,95%CI 0.968~0.998;P＜0.05);平滑曲线拟合和阈值效应分析结果显示,基线收缩压水平与衰弱发生呈U型曲线关系,U型曲线的拐点在140mmHg(1mmHg=0.133kPa);当收缩压＜140mmHg时,基线收缩压与衰弱发生呈负相关(OR=0.957,95%CI 0.925~0.990,P=0.012);当收缩压>140mmHg时,呈正相关趋势,但不显著(OR=1.006,95%CI 0.985~1.028,P=0.578)。结论 社区老年高血压患者中,基线收缩压水平对远期衰弱发生存在影响,呈U型曲线关系,U型曲线的拐点为140mmHg。     

老年共病住院患者生活质量及其影响因素

目的 分析老年共病住院患者的生活质量及其影响因素。方法 回顾性分析2022年2月至2023年2月于协和武汉红十字会医院老年病科住院治疗的150例老年共病患者的临床资料。记录患者慢性疾病患病情况,并通过简明生活质量量表评估患者生活质量。比较不同性别、年龄、婚姻情况、文化程度、月收入、居住地区、共病严重程度、共病数量及认知功能的老年共病患者生活质量差异。采用SPSS 22.0统计软件对数据进行处理。根据数据类型,组间比较分别采用独立样本t检验、单因素方差分析或χ²检验。采用非条件logistic逐步回归分析影响老年共病患者生活质量的危险因素。结果 150例老年患者常见的慢性疾病共病类型为高血压、糖尿病及呼吸系统疾病。其中,同时合并2种慢性疾病者44例(29.33%)、合并3种慢性疾病者77例(51.33%)、合并＞3种慢性疾病者29例(19.33%)。年龄≥70岁、月收入＜3000元、独居、共病严重程度重度、共病数量＞3种、存在认知功能障碍的老年共病患者生活质量评分分别显著低于年龄＜70岁、月收入≥3000元、非独居、共病严重程度轻中度、共病数量2种或3种、非认知功能障碍者,差异均有统计学意义(t=6.276,2.785,2.599,19.519,233.834,4.254;P＜0.05)。多因素logistic回归分析显示,年龄≥70岁(OR=5.245,95%CI 1.667~16.483)、月收入＜3000元(OR=1.975,95%CI 1.307~2.984)、独居(OR=4.881,95%CI 1.526~15.612)、共病严重程度重度(OR=3.748,95%CI 1.600~8.780)、共病数量＞3种(OR=1.997,95%CI 1.371~2.909)、认知功能障碍(OR=1.520,95%CI 1.136~2.034)是影响老年共病患者生活质量的危险因素。结论 老年共病患者生活质量较低,且生活质量受到认知功能以及慢性病患病情况等因素的影响。     

老年住院患者口腔健康与衰弱的相关性

目的 了解老年住院患者衰弱及口腔健康现状,分析口腔健康对衰弱的影响,为针对性干预提供依据。方法 采用便利抽样法,抽取2022年5月至11月陕西省人民医院老年病院700例老年住院患者为研究对象,使用一般资料调查表、老年口腔健康评价指数和Tilburg衰弱评估量表进行调查,其中685例患者的调查问卷为有效问卷。依据Tilburg衰弱评估量表得分将患者分为非衰弱组(n=347)和衰弱组(n=338),比较2组患者一般资料与口腔健康状况的差异。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用Mann-Whitney U检验或χ²检验进行组间比较。采用Spearman相关分析衰弱与口腔健康及各维度的相关性。采用多因素logistic回归分析衰弱的影响因素。结果 老年住院患者合并衰弱占比为49.3%(338/685),口腔健康得分为54(48,57)分,处于中等水平,衰弱组患者的口腔健康总分及各维度得分均显著低于非衰弱组患者(P<0.01)。Spearman相关分析显示,口腔健康与衰弱呈显著负相关(r=-0.599,P<0.01)。Logistic回归分析显示,年龄更大(OR=1.043,95%CI 1.009~1.079)、未/离婚或丧偶(OR=2.226,95%CI 1.176~4.211)、多重用药(OR=1.986,95%CI 1.329~2.968)、牙齿掉落个数越多(OR=1.054,95%CI 1.016~1.093)、近1年有口腔溃疡(OR=1.930,95%CI 1.111~3.351)、口腔健康中等水平(OR=4.345,95%CI 2.437~7.747)和低等水平(OR=9.149,95%CI 4.454~18.795)为老年住院患者衰弱的危险因素;体育锻炼(OR=0.596,95%CI 0.403~0.881)为其保护因素。结论 老年住院患者口腔健康与衰弱密切相关,口腔健康水平越低其衰弱发生率越高。医护人员应重视对老年人口腔健康的识别和筛查,将口腔健康纳入衰弱老年人健康管理的工作范畴,通过积极的早期干预,延缓衰弱的进展。     

慢性呼吸系统疾病患者膳食习惯对肌少症的影响及风险模型构建

目的 探讨慢性呼吸系统疾病患者膳食习惯对肌少症的影响并建立风险模型,为未来干预方案的制定提供参考。方法 选择2021年5月至9月新疆医科大学第一附属医院呼吸科门诊与住院部收治的328例慢性呼吸系统疾病患者(年龄≥45岁)为研究对象。应用SPSS 25.0与R 4.0.5软件中的glm和rms软件包分别进行数据分析。根据数据类型,分别采用χ²检验或Fisher确切概率法进行组间比较。采用logistic回归分析慢性呼吸系统疾病患者并发肌少症的影响因素。采用受试者工作特征(ROC)曲线分析各危险因素对慢性呼吸系统疾病合并肌少症的预测价值,用Nomogram绘制列线图进行可视化分析。结果 肌少症患病率为25.0%。logistic回归分析结果显示,女性(OR=18.44,95%CI 8.05~42.24)、高龄(≥70岁;OR=6.26,95%CI 2.51~15.61)、体质量指数(BMI)<18.5kg/m²(偏瘦;OR=6.26,95%CI 2.51~15.61)、纯果汁/蔬菜汁每周摄入1~3次(OR=13.34,95%CI 2.16~82.60)、坚果每个月摄入1~3次(OR=0.25,95%CI 0.09~0.70)、坚果每日摄入1次(OR=0.16,95%CI 0.03~0.80)均是慢性呼吸系统疾病患者并发肌少症的影响因素。结论 女性、高龄、低BMI(偏瘦),蔬果汁/纯果汁、坚果均与肌少症的发生密切相关,这将为呼吸系统疾病合并肌少症患者的精准评估及合理膳食干预提供科学依据。     

老年心肌梗死患者后期心脏康复依从性的影响因素

目的 探讨老年心肌梗死患者后期心脏康复(CR)依从性的影响因素。方法 纳入琼海市人民医院2019年6月至2021年6月收治的178例老年心肌梗死患者为研究对象,对患者一般资料、CR相关信息知晓度、社会支持、焦虑、抑郁及一般自我效能进行问卷调查,并统计其院外早期(Ⅱ期)CR依从性。根据Ⅱ期CR依从性将患者分为依从性良好组(19例)和依从性不佳组(159例)。采用SPSS 19.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。采用二元logistic回归模型分析老年心肌梗死患者Ⅱ期CR依从性的影响因素。结果 178例患者Ⅱ期CR依从性良好者共19例(10.67%)。二元logistic回归分析结果显示,CR相关信息知晓度(OR=0.460,95%CI 0.339~0.625;P<0.05)、社会支持程度(OR=0.498,95%CI 0.318~0.778;P<0.05)及患者心脏自我效能(OR=0.294,95%CI 0.096~0.894;P<0.05)是老年心肌梗死患者Ⅱ期CR依从性的保护因素,而焦虑(OR=1.455,95%CI 1.299~1.630;P<0.05)是其危险因素。结论 老年心肌梗死患者Ⅱ期CR依从性整体处于较低水平,建议从提高患者自身疾病效能感、CR康复相关知识知晓度及社会支持力度、缓解患者焦虑情绪几个方面入手,提高其CR依从性。     

老年急性缺血性脑卒中偏瘫患者出院后生活质量现状及其影响因素

目的 分析老年急性缺血性脑卒中(AIS)偏瘫患者出院后生活质量现状及其影响因素。方法 收集2022年1月至12月江苏省人民医院神经内科收治的408例老年AIS偏瘫患者的临床资料。使用卒中专门生存质量量表(SSQOL)评估患者出院后1个月的生活质量。根据SSQOL评分结果,将患者分为生活质量良好组(SSQOL评分≥123分,n=225)及生活质量不良组(SSQOL评分＜123分,n=183)。使用SPSS 23.0统计软件进行数据分析。根据数据类型,组间比较分别采用独立样本t检验或χ²检验。采用多因素logistic回归分析影响老年AIS偏瘫患者出院后生活质量的危险因素。结果 408例老年AIS偏瘫患者出院后1个月SSQOL评分为(136.35±5.38)分,标准化得分为(56.30±5.21)%,生活质量处于中等水平。生活质量不良组与生活质量良好组医疗费用支付方式、婚姻状况、主要照护者、患侧Ashworth痉挛分级、日常生活能力及抑郁症状方面比较,差异均有统计学意义(均P＜0.05)。多因素logistic回归分析显示,医疗费用自费(OR=2.573,95%CI 1.550~4.271)、患侧Ashworth痉挛分级为Ⅱ级(OR=2.085,95%CI 1.030~4.223)、日常生活重度依赖(OR=3.435,95%CI 2.285~5.163)、抑郁症状(OR=3.114,95%CI 1.919~5.054)是老年AIS偏瘫患者出院后生活质量不良的危险因素(均P＜0.05);已婚(OR=0.573,95%CI 0.031~0.892)、主要照护者为配偶(OR=0.642,95%CI 0.109~0.980)则为保护因素(均P＜0.05)。结论 医疗经济负担、患侧肌张力较高、日常生活能力受限以及抑郁是老年AIS偏瘫患者出院后生活质量的重要影响因素,而配偶陪伴及照护对改善患者生活质量有利。     

Pancreatic invasion is a prognostic indicator after radical resection for carcinoma of the ampulla of Vater

Sixty-three patients who had undergone pancreatoduodenectomy for carcinoma of the ampulla of Vater were analyzed with respect to tumor extent and prognosis. The postoperative mortality rate was 3% and overall survival rates 3 and 5 years after surgery were 55% and 46%, respectively. pTNM stage did not reflect prognosis after resection in patients at stages 2 and 3, while pancreatic invasion and regional lymph node metastasis clearly reflected prognosis after resection. Of the 26 patients who had no pancreatic invasion, regional lymph node metastasis was seen in only 19%, whereas of the 37 patients with pancreatic invasion, 62% exhibited lymph node metastasis. These factors were significantly correlated (P<0.001). Pancreatic invasion appeared to be an indirect indicator of regional lymph node metastasis. We conclude that, to improve prognosis for patients with pancreatic invasion, extended resection including extended lymphadenectomy, is a preferable additional procedure.     

Japanese guidelines for adult asthma 2017

Adult bronchial asthma is characterized by chronic airway inflammation, and presents clinically with variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma induces airway remodeling, leading to intractable asthma. The number of patients with asthma has increased; however, the number of patients who die of asthma has decreased (1.2 per 100,000 patients in 2015). The goal of asthma treatment is to enable patients with asthma to attain normal pulmonary function and lead a normal life, without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management by therapeutic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high levels. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonist are recommended as add-on drugs, while anti-immunoglobulin E antibody and oral steroids are considered for the most severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by choosing treatment steps for asthma in accordance with the severity of exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-induced asthma, and pregnancy are also important issues that need to be considered in asthma therapy.     

Japanese guidelines for adult asthma 2020

Bronchial asthma is characterized by chronic airway inflammation, which manifests clinically as variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma may induce airway remodeling and become intractable. The prevalence of asthma has increased; however, the number of patients who die from it has decreased (1.3 per 100,000 patients in 2018). The goal of asthma treatment is to control symptoms and prevent future risks. A good partnership between physicians and patients is indispensable for effective treatment. Long-term management with therapeutic agents and the elimination of the triggers and risk factors of asthma are fundamental to its treatment. Asthma is managed by four steps of pharmacotherapy, ranging from mild to intensive treatments, depending on the severity of disease; each step includes an appropriate daily dose of an inhaled corticosteroid, which may vary from low to high. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonists are recommended as add-on drugs, while anti-immunoglobulin E antibodies and other biologics, and oral steroids are reserved for very severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by selecting treatment steps for asthma based on the severity of the exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-exacerbated respiratory disease, and pregnancy are also important conditions to be considered in asthma therapy.     

Regenerative therapies in electrophysiology and pacing

The prevention and treatment of cardiac arrhythmias conferring major morbidity and mortality is far from optimal, and relies heavily on devices and drugs for the partial successes that have been seen. The greatest success has been in the use of electronic pacemakers to drive the hearts of patients having high degree heart block. Recent years have seen the beginnings of attempts to use novel approaches available through gene and cell therapies to treat both brady- and tachyarrhythmias. By far the most successful approaches to date have been seen in the development of biological pacemakers. However, the far more difficult problems posed by atrial fibrillation and ventricular tachycardia are now being addressed. In the following pages we review the approaches now in progress as well as the specific methodologic demands that must be met if these therapies are to be successful.     

A long-term surviving patient with cancer of papilla of Vater after local resection

We report successful local resection for cancer of papilla of Vater in an 86-year-old woman. She was referred to our hospital because of right hypochondralgia. Abdominal ultrasonography and computed tomography showed marked dilatation of the common bile duct (CBD). Endoscopic retrograde cholangiography disclosed a small shadow defect in the terminal of the dilated CBD. Biopsy of the papilla revealed well-to-moderately differentiated adenocarcinoma. Considering her extreme old age and keeping in mind her quality of life after the operation, and the finding that the tumor was localized within the papilla and highly differentiated, we performed local resection. In addition, the intrapancreatic portion of the CBD and part of the main pancreatic duct (MPD) were further resected to secure a negative margin, confirmed by frozen section. The MPD was reapproximated to the duodenal mucosa and a choledocho-duodenostomy was performed for CBD reconstruction. Histopathological examination showed the tumor was papillary adenocarcinoma, 10 × 15 mm in size; there was no invasion beyond the sphincter of Oddi, it had partly infiltrated the CBD, but had not invaded to the pancreas or duodenum. The patient's postoperative course was not eventful and she has had good quality of life for the past 6 years since the operation, without any evidence of recurrence. Although radical pancreaticoduodenectomy is now the standard procedure in patients with malignant tumor of the papilla of Vater, local resection is a reasonable alternative for high-risk patients with highly differentiated, apparently localized carcinomas.     

贮存式自体输血开展对优化妇科手术用血结构的影响

目的:总结本院2011-2013年贮存式自体输血开展前后,妇科手术用血异体少白细胞红细胞和自身贮血的应用情况。方法:对本院妇科手术台次,异体少白细胞红细胞及贮存式自体血液的使用人数、量及比例分别进行统计。结果:最近3年妇科手术台次逐年上升,异体少白细胞红细胞用量从463.5U下降至320.5U,自体输血量上升至161U。异体输血比例由手术人次的33.61%下降至19.80%,自体输血比例由0上升至22.61%。人均异体少白细胞红细胞使用量由0.783U下降至0.450U,人均自体全血用量由0上升至0.226U。结论:贮存式自体输血开展,使妇科手术用血结构得到优化,其对临床节约用血的影响,得到了规模性,量化体现。     

改水、服硒、食用蓬灰防治大骨节病的效果观察

本实验应用改水、服硒、食用蓬灰等措施在大骨节病区对3～13岁儿童进行现场防治实验。用现患率、健康儿童新发率、X线痊愈率作为其判定指标。 通过四年的实验观察,现患率由1980年的46.40％下降到1984年的20.30％,有非常显著的差异。36名健康儿童连续四年观察未有新发病人,而对照组出现新发病例,取得了较好的防治效果。本文还对防治措施的作用进行了分析讨论。     

Recent results: biomarkers of aging

This communication reviews recent papers attempting to identify Biomarkers of Aging (BoA). A BoA is a biological parameter that will predict functional capability at some later age. Few, if any, BoA have been found and this review describes the recent search for BoA. Among others that have been put forward are IL6 and other markers of inflammation, allostatic load, and corticosterone, which have been described primarily in humans. Work in model systems as well as theoretical work are also reviewed.     

Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation

This paper considers the argument for obesity as a chronic relapsing disease process. Obesity is viewed from an epidemiological model, with an agent affecting the host and producing disease. Food is the primary agent, particularly foods that are high in energy density such as fat, or in sugar‐sweetened beverages. An abundance of food, low physical activity and several other environmental factors interact with the genetic susceptibility of the host to produce positive energy balance. The majority of this excess energy is stored as fat in enlarged, and often more numerous fat cells, but some lipid may infiltrate other organs such as the liver (ectopic fat). The enlarged fat cells and ectopic fat produce and secrete a variety of metabolic, hormonal and inflammatory products that produce damage in organs such as the arteries, heart, liver, muscle and pancreas. The magnitude of the obesity and its adverse effects in individuals may relate to the virulence or toxicity of the environment and its interaction with the host. Thus, obesity fits the epidemiological model of a disease process except that the toxic or pathological agent is food rather than a microbe. Reversing obesity will prevent most of its detrimental effects.