海口市老年牙周炎患者牙齿缺失情况及影响因素

目的调查海口市老年牙周炎患者的牙齿缺失情况及其影响因素。方法选择在海南省人民医院牙周科因牙周炎导致牙齿缺失而就诊的268例老年患者进行问卷调查。结果共调查268人,男138人,女130人,共计缺牙数2 237颗,其中前牙522颗,后牙1 715颗,平均缺牙数为(8.35±6.42)颗。老年牙周炎缺失牙数与年龄、居住地、经济收入、学历、口腔卫生状况(吸烟、刷牙次数、刷牙时间、是否使用菌斑控制器及定期进行口腔卫生检查)、自身因素等因素有一定的相关性。结论海口市老年牙周炎患者牙齿缺失较多,需要针对不同的老年患者制定个性化预防措施。     

甘肃省老年居民的口腔健康行为

目的了解甘肃省城乡老年居民口腔卫生健康行为现况,分析影响老年人口腔健康的相关因素。方法按照第三次全国口腔健康流行病学调查标准和方法,采用多阶段分层等容量随机抽样方法,对甘肃省429名城乡65～74岁老年居民进行问卷调查。结果被调查者中,每天刷牙率达到64.8%,农村明显低于城市(P=0.000),每天2次以上刷牙率仅有16.1%,几乎没有人使用牙线,含氟牙膏率为使用42.4%,城乡差异无统计学意义(P=0.403),吃甜食城市居民比例明显高于农村(P<0.05),吸烟饮酒比例为27.5%和8.6%,25.2%老年居民从未有过口腔就医行为,农村明显高于城市(P=0.000)。结论被调查者对自身口腔健康状况和认知不够重视,口腔自我保健行为不理想,就医行为不积极主动。应加大老年人群口腔健康保健知识宣传,指导其建立良好的口腔卫生保健行为,同时改善社区特别是农村地区口腔医疗服务设施,为老年人多提供方便快捷的社区口腔服务。     

海口市老年糖尿病患者牙周病患病情况及相关因素

目的调查分析海口市老年糖尿病(DM)患者牙周病患病情况及相关影响因素。方法对该市3家三甲医院的564例老年2型糖尿病(T2DM)患者的年龄、病程、吸烟情况、DM家族史、体重指数(BMI)、空腹血糖(FPG)水平、血糖控制状况及刷牙情况进行调查分析,同时根据世界卫生组织(WHO)制定的口腔健康调查基本方法,对DM患者进行口腔健康的检查。结果 564例老年T2DM患者中患有牙周病345例(61.2%),其中牙龈炎154例(44.6%),牙周炎191例(55.4%),牙周炎中早期牙周炎128例(67.0%),晚期牙周炎63例(33.0%)。多因素的Logistic回归分析发现,年龄较大、病程较长、吸烟、血糖控制不好及FPG水平较高均是老年T2DM患者并发牙周病的危险因素。结论老年T2DM患者中牙周病患病率高达61.2%,年龄较大、病程较长、吸烟、血糖控制不好及FPG水平较高均会增加DM患者牙周病的患病风险,临床上应加强口腔检查,注意口腔卫生,以降低牙周病的患病率。     

门诊与住院老年乙型病毒性肝炎患者生命质量及影响因素

目的老年乙型病毒性肝炎(乙肝)患者的生命质量及相关影响因素。方法采取随机整群抽样方法,使用SF-36量表对123例老年乙肝患者进行调查,采用多元线性回归等方法对有效调查信息进行分析。结果门诊乙肝患者除了情感职能(RE)领域,其他维度得分与中国常模比较差异均有统计学意义(P<0.05);住院乙肝患者各维度得分与中国常模比较差异均有统计学意义(P<0.05);多元线性回归分析结果显示,年龄、本年度医疗费用、是否患有其他慢性病是门诊和住院患者生命质量的共同影响因素;此外,住院患者生命质量还受到家庭人均年收入的影响。结论老年乙肝患者生命质量低于一般人群且受到多种因素影响,应采取综合干预措施改善生命质量。     

老年前列腺增生患者衰弱状况及影响因素

目的评估并分析住院老年前列腺增生患者衰弱状况及影响因素。方法 510例接受外科手术治疗的前列腺增生(BPH)老年患者,使用Tilburg衰弱评估(TFI)量表进行老年衰弱评估。结果 510例老年BPH患者中有77.6%(396例)的患者TFI量表得分≥5分,存在不同程度的衰弱状况;22.4%(114例)患者得分5分,无衰弱状况。经过单因素分析及Logistic回归分析,衰弱的发生与年龄、病程、前列腺症状评分、收入、吸烟及基础疾病等因素相关(P0.05)。结论年龄、病程、前列腺症状评分、收入、吸烟及基础疾病是BPH患者发生衰弱的主要影响因素。因此,为患者进行手术时要考虑个体差异。     

老年缺血性脑卒中患者生活质量及其影响因素

目的 评价老年缺血性脑卒中患者的生活质量,并分析其相关影响因素.方法 采用神经功能缺损评分量表(NIHSS)、功能独立量表(FIM)、生活质量调查量表等对320例老年缺血性脑卒中患者的生活质量进行评价和单因素分析及多元逐步回归分析.结果 躯体疼痛得分高于对照组,生活质量调查量表中的其他项目得分均明显低于健康对照组.除情感职能和躯体疼痛外,NIHSS与生活质量调查量表中各项呈现明显正相关;除躯体疼痛和精神健康外,FIM中的认知功能与生活质量调查量表各项呈明显正相关.结论 脑卒中患者的生存质量普遍下降,影响老年脑卒中患者生活质量的最重要因素是患者躯体功能障碍、日常生活活动能力和认知障碍.     

老年腰椎间盘突出症患者自我效能水平及其影响因素

目的了解老年腰椎间盘突出症(LDH)患者慢性疼痛自我效能状况,探讨其影响因素。方法选取2018年3月至2018年12月西安市3所医院收治的拟进行髓核摘除、植骨融合内固定手术治疗的老年LDH患者231例。应用慢性疼痛自我效能感量表、焦虑自评量表、患病行为问卷、视觉模拟评分表为研究工具进行调查。采用SPSS 17.0软件进行统计分析。采用多元线性逐步回归分析筛选自我效能感的影响因素。结果老年LDH患者慢性疼痛自我效能得分为41～74(60.33±8.88)分;在3个维度的条目均分中,疼痛管理自我效能感维度得分最高(3.05±0.46)分,躯体功能自我效能维度得分最低(2.63±0.35)分。多元线性逐步回归分析显示,焦虑、患病行为水平、腰腿疼痛程度、合并慢性病、文化程度与老年LDH患者自我效能水平密切相关(P0.05)。结论老年LDH患者的慢性疼痛自我效能感整体处于中等水平,疼痛管理自我效能感水平最高,躯体功能自我效能感最低;焦虑、患病行为、腰腿疼痛、合并慢性病是老年LDH患者慢行疼痛自我效能感的危险因素,而高文化水平是其保护因素。     

甘肃临夏回族自治州回族老年人口腔健康状况的调查与分析

目的了解并分析甘肃省临夏回族自治州回族老年人口腔健康状况,为临夏回族老年人口腔预防保健工作提供信息支持。方法按照第三次全国口腔健康流行病学调查标准和方法,采用多阶段分层等容量随机抽样方法对436名临夏回族65～74岁老年人进行问卷调查,对刷牙、漱口、吸烟等习惯以及就医行为进行现场询问。结果临夏市65～74岁老年人每天刷牙≥2次的人数占69%,城市(75%)高于农村(61%);每天漱口≥3次的人数占86%,城市(88%)略高于农村(83%);含氟牙膏使用率为62%,城乡老年人几乎都不使用牙线。回族老人吸烟、饮酒人群的比例分别为7%和1%,远远低于1995年第二次全国流调结果。结论临夏市回族城乡老年人群刷牙率高,漱口习惯良好,口腔不良习惯较少,但对回族老年人仍需进行口腔健康指导,指导其建立良好的口腔卫生习惯和正确的就医行为,提高回族老年人生活质量。     

高于病房老年患者孤独、焦虑、抑郁情绪及其相关因素探讨

目的调查高干病房老年患者孤独、焦虑、抑郁情绪的发生情况,并分析其相关因素。方法调查并分析北京市某三级医院高干病房60例老年慢性疾病患者UCLA孤独量表、医院焦虑抑郁量表(HAD)、日常生活能力量表(ADL)得分。结果96.7%的老年患者有不同程度的孤独感,有焦虑状态者占23.3%,有抑郁状态者占13.3%;相关影响因素有住院天数、家庭月收入、文化程度、日常生活能力(ADL)、健康自评得分、人际关系、婚姻状况。结论应重视高干病房老年患者伴发的孤独、焦虑、抑郁情绪,并针对相关因素加强心理护理。     

老年2型糖尿病患者平静心境现状调查及其影响因素分析

目的了解老年2型糖尿病(T2DM)患者平静心境的现状及其影响因素。方法选取2018年1月至2019年1月本院内分泌科收治的老年T2DM患者278例为研究对象,采用自制基本情况调查问卷对患者进行调查,采用平静心境量表对患者的平静心境现状进行评估,对老年T2DM患者平静心境的影响因素进行多元线性回归分析。结果老年T2DM患者平静心境得分为(14.86±2.11)分。单因素分析结果显示,不同性别、年龄、病程、宗教信仰、结婚状况、子女状况、并发症情况的老年T2DM患者的平静心境得分比较,差异有统计学意义(P0.05)。多元线性回归分析结果显示,性别、年龄、病程、宗教信仰以及并发症是影响老年T2DM患者平静心境的重要因素(P0.05)。结论老年T2DM患者内心平静状况不理想,不利于健康生活,性别、年龄、病程、宗教信仰和并发症是影响老年T2DM患者平静心境的重要因素。     

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.