江苏省城乡人群高血压患病率10年对比研究

调查江苏省城乡人群高血压患病率10年的变化，结果显示高血压患病率较10年前明显增长。城市男女性高血压总患病率分别较前增长60．8％和21．9％；农村男女性分别增长86．8％和38．4％。发现高血压患病率有着明显的性别、年龄及城乡间的差异，同时发现临界高血压增长尤为明显。分析认为同外界环境因素造成的精神、心理紧张以及生活方式、膳食结构变化、人群中超重及肥胖者增多等因素有密切关系。提出应开展对高血压的原发预防。     

Undifferentiated Spondyloarthropathies: A 2-Year Follow-up Study

The aim of the study was to analyse the 2-year follow-up of a series of patients with the diagnosis of undifferentiated spondyloarthropathy (uSpA). A prospective study was carried out analysing 68 patients with symptomatic uSpA who fulfilled the European Spondylarthropathy Study Group (ESSG) criteria for seronegative spondyloarthropathies (SpA) and were aged between 18 and 50 years. Inclusion criteria included inflammatory low back pain (ILBP) (without radiographic sacroiliitis), asymmetric oligoarthritis (predominantly affecting large joints in the lower limbs) and heel enthesopathies (Achilles tendinitis and/or plantar fasciitis). Imaging methods included pelvic radiography (at study entry and after 2 years) and calcaneal radiography (at study entry). There was a predominance of male gender (78%), caucasoid race (72%) and positive HLA-B27 (54%), with a mean age of 31 years and mean disease duration of 5 years. The first disease manifestations were ILBP (49%), asymmetric oligoarthritis (35%) and heel enthesopathies (16%). A positive family history of a definite SpA was mentioned by 9% of the patients. Seventeen patients (25%) scored 5 points in the Amor set of SpA criteria; logistic regression analysis showed that HLA-B27, heel enthesopathy and asymmetric oligoarthritis were significantly associated with Amor criteria ≥6, whereas ILBP was associated with Amor criteria <6. Male sex was associated with heel enthesopathies (p = 0.041) and ankle involvement (p = 0.015). Caucasoid race was associated with ILBP (p = 0.015) and buttock pain (p = 0.047). Positive HLA-B27 was associated with wrist involvement (p = 0.019) and Amor criteria ≥6 (p = 0.001). After a 2-year follow-up the following outcomes were observed: uSpA 75%; disease remission 13%; ankylosing spondylitis 10%; psoriatic arthritis 2%. Logistic regression analysis showed that buttock pain and positive HLA-B27 (trend) were statistically associated with progression to a definite SpA. In conclusion, uSpA can represent a provisional diagnosis in the group of SpA and a systematic follow-up is necessary in order to better establish the different patterns of the disease. Received: 2 June 2000 / Accepted: 5 January 2001     

Mesothelioma incidence projections in South East England

We estimated the past and future age-standardised incidence rates of mesothelioma by birth cohort and by period of diagnosis in South East England. We extracted data on patients diagnosed with mesothelioma (International Classification of Diseases-10 C45) between 1960 and 2009 from the Thames Cancer Registry. We calculated the age-standardised incidence rates using the European standard population. We used age-cohort and age-period modelling to estimate the age-specific incidence rates for the 1900 to 1950 birth cohorts and the 1935 to 2034 calendar periods. A much more pronounced increase in mesothelioma incidence between 1972 and 2007 was observed in males than in females. In both sexes, the incidence rates increased in successive generations up to the 1945 birth cohort. Projection of rates in the future showed an increase in incidence in males until 2022 and a decrease thereafter. Among females, the incidence rate was predicted to increase gradually until reaching its maximum around 2027, and to remain stable thereafter. The occurrence of mesothelioma is closely linked to occupational exposure to asbestos in the 1960s and 1970s and, due to the long latency period, the incidence of mesothelioma is projected to increase until the 2020s.     

A 20-Year Follow-up Study of 64 Subjects with M-components

ABSTRACT. Sixty-four persons with M-components in serum were detected in a health survey of 6995 subjects in 1964. After 20 years, data could be obtained on all 64. The 45 who had died included two cases of myeloma and one of malignant lymphoma. One of the myeloma cases had started as chronic lymphatic leukemia. Three of the 19 persons alive had an increase in the size of the M-component and depression of the background immunoglobulin, but they could not be diagnosed as myeloma cases. One had a rather large but not increasing M-component and an excess of light chains. She could be a third case of myeloma in this series.     

Short- and Long-term Outcomes of Medically Treated Isolated Left-Sided Endocarditis: A Retrospective Study With 5-Year Longitudinal Follow-up

BackgroundA retrospective study of medically treated isolated left-sided infective endocarditis (LSIE) patients identifying predictors of outcomes with nonoperative management was undertaken.MethodsMedical records of 135 Manitoban medically managed LSIE patients from January 2004 to December 2016 were reviewed. Five-year survival for 135 patients and hospitalization data till March 2016 for 65 patients were collected from the Manitoba Centre for Health Policy.ResultsIn-hospital mortality was 44%. Patients with surgical indications were more likely to die in-hospital than those without (53% vs 24%; P = 0.002). Survival at 1 and 5 years was 43% and 23%, respectively. All-cause readmission at 1 and 5 years was 64% and 84%, respectively. At 1 and 5 years, readmission from major adverse events (heart failure, stroke, endocarditis) was 25% and 47%, and from recurrent endocarditis was 17% and 26%, respectively. Severe valvular regurgitation was a risk factor for in-hospital mortality (odds ratio, 3.52; P = 0.022), poor long-term survival (hazard ratio [HR], 2.57; P < 0.001), and recurrent endocarditis (HR, 5.93; P < 0.001). Prosthetic valve endocarditis was a risk factor for poor long-term survival (HR, 2.11; P = 0.002). Streptococcus viridans group was associated with better rates of in-hospital mortality (odds ratio, 0.28; P = 0.018) and long-term survival (HR, 0.34; P < 0.001).ConclusionsNonoperative management of LSIE carries a poor prognosis but may have a role in select cases. Surgical management remains the mainstay for patients with clear surgical indications, including severe regurgitation and prosthetic valve endocarditis. Further prospective analyses are required to better delineate appropriate patient selection for nonsurgical management.     

Pancreatic Abscess: 10-Year Experience at the University of South Florida

Pancreatic abscess is an uncommon but often catastrophic complication of acute pancreatitis. This study reviews the past 10 yr experience at the University of South Florida Teaching Hospitals involving patients diagnosed to have pancreatic abscess. The etiology, management, complications, and factors affecting mortality are discussed. The results indicate: the presentation of pancreatic abscess is variable; increased positive prognostic signs (by Ranson's criteria) on initial presentation correlate with increased mortality; complications are common (80%) and contribute significantly to morbidity and mortality; CT scan is more accurate than ultrasound in the diagnosis of pancreatic abscess; poorly localized phlegmonous pancreatic slough noted by CT scan, sonography, or exploratory laparotomy, carries a higher mortality than a well-localized purulent collection; negative blood cultures or abscess cultures do not rule out pancreatic abscess; infection of lesser sac fluid collections can occur in the hospital implying that strict attention must be paid to nosocomial infections; the timing of surgical drainage is critical, recurrent abscess requires repeat surgery, and resection is associated with a very high mortality (reflecting greater severity of underlying disease); there has been no change in mortality of pancreatic abscess in the last 10 yr.     

A 12-Year Follow-up Study of Chronic Gastritis and Helicobacter pylori in a Population-Based Random Sample

Background: The study is a 12-year endoscopic follow-up investigation on the course of chronic gastritis and Helicobacter pylori infection in a sample of 81 Estonian people. Methods: The series is a subset from a random sample of 227 subjects in whom a gastroduodenal endoscopy had been done. The grade of superficial gastritis (SG), atrophy, and colonization of the mucosa by H. pylori was evaluated in biopsy specimens from both antrum and corpus in accordance with the principles of the Sydney System. Resufrs: The healing rate of the H. pylori and gastritis was 0.3% (3 of 81); H. pylori colonization with gastritis developed in 5 of 81 during the follow-up. The mean prevalence of atrophic gastritis (AG) was three times more common in the corpus than in the antrum on the average. The formation of new cases of AG and the disappearance of AG were quite equal during the follow-up, and the overall changes in the grade of SG and atrophy were slow. The mean life span of corpus AG was nearly three times as long as that of antrum AG. In the antrum the grade of chronic inflammation correlated positively with the grade of H. pylori colonization. In cases of SG a low grade of colonization of H. pylori in the antral mucosa in connection with moderate inflammation predicted a reduction or even a healing of gastritis in the long term. Conclusions: New H. pylori infections with subsequent gastritis may occur in adulthood; a healing of gastritis occurs but is a quite rare event in the course of the 12-year follow-up. Further, in the present random sample of Estonian people atrophic corpus gastritis did not show an overall progression, in contrast to our earlier findings.     

Prediction of Posttreatment Drinking Outcome in a 2-Year Out-Patient Alcoholic Treatment Program. A Follow-up Study

Fifty alcoholics who attended a 2-year out-patient treatment program with standardized evaluations every third month were followed-up 2 years after completion of the program. One patient refused to be followed-up and four were dead. Corroboration was available in 78% of the cases. The number of abuse days from the second half-year of therapy and forward was strongly related to the number of abuse days during the follow-up period as were ratings both of drinking goal fulfillment and fulfillment of other treatment goals at termination of the treatment period. On the contrary initial characteristics and background data as well as the number of abuse days during the first half-year were not related to number of abuse days during the follow-up period. Our findings indicate that improvement during long term out-patient treatment for alcoholism is stable during the following 2 years with a socially stable sample.     

Patterns of Treatment of Gallstone Ileus over a 45-Year Period

All patients with gallstone ileus admitted to our institutions between 1938 and 1982 were retrospectively analyzed by grouping the patients into 10-year periods. Forty-five patients were studied, of whom 39 required operation. When hospital statistics for admissions, length of stay, and mortality rates from the Mount Sinai Hospital were compared to the gallstone ileus data, it was found that there has been no significant change in the admission rate for these patients. The mortality rate and length of stay of gallstone ileus patients has also remained constant over the past 25 years despite the general hospital decrease in both of these numbers. There has been no change in the complication rate, duration of symptoms prior to admission, or the preoperative diagnostic rate of gallstone ileus during the duration of this study.     

Gallstone Prevalence in Germany: The Ulm Gallbladder Stone Study

The Ulm Gallbladder Stone Study is the first ultrasound-based epidemiologic survey of cholecystolithiasis in the former West Germany. A study population of 1116 blood donors (656 men, age 38.0 ± 12.0 years; 460 women, age 34.1 ± 11.2 years) at the Central Blood Bank of the German Red Cross in Ulm was examined between April 1994 and February 1995. Based on age, subjects were assigned to one of four groups (18-30, 31-40, 41-50, and 51-65 years). Following a structured interview of each study subject, an ultrasound examination was carried out and a blood sample obtained for laboratory study. Overall, 6.0% (95% (95% CI: 4.8%-7.6%) of all study subjects (5.8% of the men and 6.3% of the women) exhibited evidence of current or past gallbladder disease (cholelithiasis or history of cholecystectomy). The prevalence of gallbladder disease correlated positively with age, reaching a maximum of 13.7% (9.5-20.0) in the 51- to 65-year-old age group, and also correlated as with body mass index (BMI). Female subjects with previous full-term pregnancies showed a higher prevalence of cholelithiasis, but this difference was not statistically significant for age-adjusted analysis. Subjects with a family history of cholelithiasis were found to suffer from gallstones in 11.5% (8.0-16.7) of cases compared with 4.6% (3.4%-6.3%) of subjects without such family history. Autopsy studies conducted in Germany have shown the prevalence of gallstones to be about 13.1% in men and 33.8% in women. Our sonographic data are relatively low in comparison. This may be due, in part, to the specific selection characteristics inherent in retrospective autopsy studies, such as age distribution and the presence of other pathologic factors associated with increased risk for cholelithiasis. The Ulm data rank in the lower third of the prevalence range reported for European sonographic studies to date. Age, positive family history, and increased BMI all correlated positively with the prevalence of gallbladder disease (P < 0.05). For the study population as a whole, there was no gender-specific increased risk for the development of gallstones.     

Automated Telecommunication to Obtain Longitudinal Follow-up in a Multicenter Cross-sectional COPD Study

Abstract

Background. It can be challenging to maintain longitudinal follow-up of subjects in clinical studies. COPDGene is a multicenter, observational study designed to identify genetic factors associated with COPD and to characterize COPD-related phenotypes. To obtain follow-up data on patient's vital status and outcomes, the COPDGene Longitudinal Follow-up (LFU) Program was developed to supplement its parent study. Methods/Results. We used a telecommunication system that employed automated telephone contact or web-based questions to obtain longitudinal follow-up data in our subjects. A branching questionnaire asked about exacerbations, new therapies, smoking status, development of co-morbid conditions, and general health status. Study coordinators contacted subjects who did not respond to one of the automated methods. We enrolled 10,383 subjects in the COPDGene study. As of August 29, 2011, 7,959 subjects completed 19,955 surveys. On the first survey, 68.8% of subjects who completed their survey did so by electronic means, while 31.3% required coordinator phone follow-up. On each subsequent survey the number of subjects who completed their survey by electronic means increased, while the number of subjects who required coordinator follow-up decreased. Despite many of the patients in the cohort being chronically ill and elderly, there was broad acceptance of the system with over half the cohort using electronic response methods. Conclusions. The COPDGene LFU Study demonstrated that telecommunications was an effective way to obtain longitudinal follow-up of subjects in a large multicenter study. Web-based and automated phone contacts are accepted by research subjects and could serve as a model for LFU in future studies.     

心脏起搏治疗肥厚型梗阻性心肌病5年随访

目的：观察右心室起搏对肥厚型梗阻性心肌病（ＨＣＭ）患者的远期临床、血液动力学及形态学变化,以确定右心室起搏对其治疗效果及预后影响。 方法：对３０例ＨＣＭ患者采用有创血液动力学监测及多普勒超声心动图方法观察右心室起搏前及５年后患者的血液动力学及形态变化。 结果：右心室起搏５年后临床症状、心功能、血液动力学及超声心动日均显著改变,尤其二尖瓣收缩期前向运动（ＳＡＭ）、左心室流出道宽度、左心室流出道压力阶差（ＬＶＯＴＧ）、左心室舒张末期压、心排血量及心脏指数改善更为显著（Ｐ＜０．００１）,肥厚的心室间隔显著变薄（Ｐ＜０．０５）。 结论：右心室起搏能显著地改善患者的临床症状,心功能及血液动力学,其远期疗效显著,并发现能逆转肥厚的心室间隔及左心室游离壁,改善左心室流出道梗阻。因此为ＨＣＭ的起搏治疗提供了客观依据、对药物治疗无效或疗效不满意的患者,起搏治疗可能成为较理想的治疗措施。     

Follow-up after colorectal cancer — current practice in Wales and South West England

The necessity for follow-up after curative resection of colorectal cancer remains controversial. Many studies have failed to demonstrate the increase in survival which might be anticipated when detailed follow-up methods are used. In the United Kingdom no single policy has evolved. This study has examined, therefore, the current follow-up practice of a large group of British surgeons. Six per cent carried out no routine postoperative follow-up and there was great variation in the methods used and the regularity of visits. There is a need for a rational policy based on controlled studies to determine whether follow-up is of benefit to the patient and to identify the most effective methods.     

Risk of Gastrointestinal Cancer in Patients with Unexplained Chest/Epigastric Pain and Normal Upper Endoscopy: A Danish 10-Year Follow-up Study

Unexplained chest/epigastric pain is a common symptom in the general population. However, it has not previously been studied whether such pain could be a marker of subsequent gastrointestinal cancer. We aimed to estimate the risk of gastrointestinal cancers in a Danish 10-year follow-up study among patients with chest/epigastric pain, normal upper endoscopy, and no prior discharge diagnosis of ischemic heart disease (N = 386), compared with population controls (N = 3860). The overall 10-year risk of gastrointestinal cancer (stomach, colorectal, liver, and pancreas) was 2.9% for patients with unexplained chest/epigastric pain vs. 1.5% for controls. The adjusted relative risks <1 year and ≥1 year after upper endoscopy were 8.4 (95% confidence interval [CI], 2.6–27.5) and 1.2 (95% CI, 0.5–2.9), respectively. We found that patients with unexplained chest/epigastric pain have an increased risk of gastrointestinal cancer within the first year after upper endoscopy. Consequently, unexplained chest/epigastric pain might be an early gastrointestinal cancer symptom.