心房颤动与脑卒中

脑卒中是心房颤动（房颤）患者常见且最严重的并发症，其年发生率平均为5％，不同亚组间差异很大0．5％～12％。房颤占所有脑卒中原因的15％-20％，在房颤基础卜发生的卒中与无房颤患者相比导致严重功能障碍和致死的比例更高。应根据危险分层合理选择抗栓治疗的适应证，在有效预防血栓栓塞事件的同时，减少不适当抗凝造成的出血危险和经济负担。     

心房颤动的抗栓治疗

心房颤动（atrial fibrillation，房颤）是最常见的一种心律失常，它也是脑卒中一个非常重要的独立危险因素。在美国有近250万房颤患者。房颤的发生受年龄因素影响，50岁以下人群发病率很低．从60岁开始房颤的发病率迅速增高．80岁发上发病率可接近10％。房颤的平均发病年龄在72岁左右。在所有年龄段中，男性房颤的发病率均明显高于女性。随着美国人口的老龄化，在未来数十年中房颤病例数可能会显著增多。     

心房颤动与缺血性脑卒中的关系

心房颤动(房颤)是临床最常见的心律失常,对患者的生活质量影响及大,主要反映在缺血性脑卒中方面,极大地影响了患者的生存质量,严重者可危及生命。因此,对房颤患者给予积极抗凝治疗,对预防缺血性脑卒中,尤为重要。     

阿尔茨海默病的流行病学

1　概述阿尔茨海默病 (Ａｌｚｈｅｉｍｅｒｄｉｓｅａｓｅ,ＡＤ) ,又称老年性痴呆 ,作为老龄化社会重要的卫生保健和社会问题之一 ,已日益引起人们的关注。国际上ＡＤ的流行病学研究始于 2 0世纪 60年代 ,当时大部分为横断面调查 ,主要是了解ＡＤ的分布特征 ;直至 80年代 ,流行病学方法才用于痴呆的病因学和痴呆诊断方法效度的评价研究 ;90年代始 ,在以往研究的基础上又开始了对ＡＤ的纵向前瞻性研究。我国自80年代始进行了老年期痴呆的流行病学研究工作 ,并取得一定的成绩 ,目前已有近 10 0篇文献报道 ,部分报道在国际上也引起较大反响。2…     

肥厚型心肌病合并心房颤动的流行病学、机制及危险因素

肥厚型心肌病(HCM)是在无异常负荷的情况下,以心室不对称性肥厚为特征的心肌疾病,通常累及室间隔.作为一种常见的遗传性心脏病,HCM的发病率约为0.2％,是心力衰竭以及青少年非暴力性猝死的重要原因.然而,房颤是HCM中最常见的持续性心律失常,特别是在流出道梗阻、50岁以上或发展为慢性持续性房颤的患者中,与心力衰竭相关的...     

心房颤动发生缺血性脑卒中的危险因素研究进展

心房颤动是临床上常见的一种快速性房性心律失常。缺血性脑卒中作为其主要的并发症之一,极大地增加了患者的致残及死亡风险。因此,积极探寻心房颤动患者发生脑卒中的危险因素,对预防脑卒中的发生、帮助临床医生更好地制定个体化的诊疗和管理方案至关重要。研究表明,一些血清生物标志物及影像学参数可能与心房颤动相关脑卒中的发生关系密切。本文将对近几年预测心房颤动发生缺血性脑卒中的危险因素进展做一综述。     

心房颤动的抗栓治疗(上)

心房颤动(atrial fibrillation,AF)是临床常见的心律失常,在心电图上表现为P波被大小、形状、时限不等的快速震荡波或纤维颤动波所取代.其发病率随着年龄的增长而增长.Framingham研究显示[1],年龄每增长10岁其发病率约增加1倍,在50～59岁为0.5%,60～69岁为1.8%,70～79岁为4.8%,而到了80～89岁为8.8%,男性高于女性.高血压和糖尿病是主要的独立危险因素.房颤可引起一系列的临床症状和并发症,其中血栓栓塞是其最主要的并发症,尤其是脑栓塞,严重影响患者的生活质量,使致残率和致死率增加,给患者、患者家庭和社会带来沉重的经济负担.在北美洲,每年至少75000例缺血性脑卒中的发生与房颤有关[2].随着社会的老龄化,老年人口比例的增加,高血压、糖尿病发病率的增高,非瓣膜性房颤(nonvalvular atrial fibrillation,NVAF,不伴风湿性二尖瓣狭窄或人工瓣膜置换的房颤[3])将会越来越多.Brannwald[4]指出,房颤将成为21世纪的一种流行性疾病.因此,通过抗栓治疗来预防房颤血栓栓塞事件的发生,越来越受到人们的重视.     

心房颤动的抗凝治疗现状调查分析

目的了解临床实践中房颤患者抗凝治疗的现状及分析。方法采用回顾性观察了近2年间205例房颤患者接受抗凝治疗的情况。组I:2003年125例有血栓栓塞高危因素的房颤患者;组II:2004年80例有血栓栓塞高危因素的房颤患者。结果临床实践中房颤接受抗凝治疗达到标准的比例很低。接受阿司匹林治疗者较多,但剂量偏少,接受华法令治疗者很少。结论提高广大医务人员和房颤患者对房颤并发栓塞的危害性的认识及正确的抗凝治疗观念刻不容缓。     

孤立性心房颤动研究进展

孤立性心房颤动(lone atrial fibrillation,LAF)在心房颤动中所占比例较小,无心脏器质性病变,故对孤立性心房颤动的研究较少。文中从流行病学、危险因素、发病机制及病理生理及治疗等方面对LAF的研究进展作一综述。     

Staphylococcal pyomyositis in a temperate region: epidemiology and modern management

OBJECTIVES: To describe all cases of staphylococcal pyomyositis in the Geelong region of Victoria over 110 months, to estimate the incidence of this disease, and to describe the clinical outcomes and identify any predisposing factors. DESIGN, PARTICIPANTS AND SETTING: A prospective case series identified by clinical features (local pain and fever) and magnetic resonance imaging (MRI) findings (hyperintense signal on T2-weighted scan), among patients presenting to Geelong Hospital, Victoria between 1 April 1998 and 1 June 2007. MAIN OUTCOME MEASURES: Estimation of incidence, clinical course and identification of predisposing factors. RESULTS: We estimate an annual incidence of 0.5 cases per 100 000 person-years, and propose a recent history of vigorous exercise (six of 11 patients) and underlying skin condition (five of 11 patients) as possible predisposing factors. MRI showed eight patients had osteomyelitis and one had septic arthritis. All patients had bacteraemia and one had mitral valve endocarditis. The duration of intravenous antibiotic therapy varied between 4 and 12 weeks, and all patients were completely cured. CONCLUSION: Pyomyositis should be considered in patients presenting with local pain, fever, muscle tenderness, and a recent history of vigorous exercise or underlying skin condition. MRI may guide non-surgical management.     

Diabetes and atherosclerosis: epidemiology,pathophysiology, and management

CONTEXT: Complications of atherosclerosis cause most morbidity and mortality in patients with diabetes mellitus. Despite the frequency and severity of disease, proven medical therapy remains incompletely understood and underused. OBJECTIVE: To review the epidemiology, pathophysiology, and medical and invasive treatment of atherosclerosis in patients with diabetes mellitus. DATA SOURCES: Using the index terms diabetes mellitus, myocardial infarction, peripheral vascular diseases, cerebrovascular accident, endothelium, vascular smooth muscle, platelets, thrombosis, cholesterol, hypertension, hyperglycemia, insulin, angioplasty, and coronary artery bypass, we searched the MEDLINE and EMBASE databases from 1976 to 2001. Additional data sources included bibliographies of identified articles and preliminary data presented at recent cardiology conferences. STUDY SELECTION: We selected original investigations and reviews of the epidemiology, pathophysiology, and therapy of atherosclerosis in diabetes. We selected randomized, double-blind, controlled studies, when available, to support therapeutic recommendations. Criteria for data inclusion (168 of 396) included publication in a peer-reviewed journal or presentation at a national cardiovascular society-sponsored meeting. DATA EXTRACTION: Data quality was determined by publication in peer-reviewed literature. Data extraction was performed by one of the authors. DATA SYNTHESIS: Diabetes mellitus markedly increases the risk of myocardial infarction, stroke, amputation, and death. The metabolic abnormalities caused by diabetes induce vascular dysfunction that predisposes this patient population to atherosclerosis. Blood pressure control, lipid-lowering therapy, angiotensin-converting enzyme inhibition, and antiplatelet drugs significantly reduce the risk of cardiovascular events. Although diabetic patients undergo revascularization procedures because of acute coronary syndromes or critical limb ischemia, the outcomes are less favorable than in nondiabetic cohorts. CONCLUSIONS: Since most patients with diabetes die from complications of atherosclerosis, they should receive intensive preventive interventions proven to reduce their cardiovascular risk.     

Atrial myxoma: National incidence,diagnosis and surgical management

Despite being the most common benign intracardiac tumour with an excellent prognosis after surgical excision the incidence of atrial myxoma (except at autopsy) is unknown. We reviewed all patients admitted to the National Cardiac Surgery Unit (n=26) with an atrial myxoma over a fifteen year period (1977–1991) to compile national incidence data and assess pre-operative diagnosis, management, surgical technique, and outcome. Preoperative symptoms were: congestive cardiac failure (12 patients), embolism (8 patients), constitutional (3 patients), asymptomatic (2 patients) and tachyarrhythmia (1 patient). The diagnosis was confirmed by 2D echocardiography alone in thirteen patients and by a combination of echocardiography and angiography in thirteen patients. At operation the site of the tumour was left atrial in 24 patients and bi-atrial in two patients. All cases were confirmed by histology. All patients made a good post-operative recovery, although one patient survived a pulmonary embolus and one patient developed a deep venous thrombosis. There has been one late death (five months after surgery) from a cerebrovascular accident. Serial echocardiography has revealed one recurrence to date (8 years after surgery). The surgical incidence of these tumours in the Republic of Ireland over the study period was 0.5 atrial myxomas/million population/year. Although rare atrial myxomas are the most important cardiac tumours to diagnose as the results from surgery are excellent.     

Opioid-induced hyperalgesia: a review of epidemiology, mechanisms and management

There has been a growing interest in opioid-induced hyperalgesia (OIH), which is an increased sensitivity to pain caused by opioid exposure. Multiple underlying pathways may contribute to the development of OIH, and the mechanism may vary with the duration of opioid exposure, dose, type and route of administration. In addition, the distinction between OIH, tolerance and withdrawal should be made in both the basic and clinical science literature so as to help translate findings to the clinical phenomenon and to help determine the best strategies to prevent or treat OIH.     

Herpes simplex virus type 2: epidemiology and management options in developing countries

Genital herpes simplex virus type 2 (HSV2) is highly prevalent worldwide and an increasingly important cause of genital ulcer disease (GUD). Continued HSV2 transmission is facilitated by the large number of undiagnosed cases, the frequency of atypical disease and the occurrence of asymptomatic shedding. The lack of easy, affordable diagnostic methods and specific antiviral treatment in countries with low and middle income is of great concern, given the ability of GUD to enhance HIV transmission and acquisition. With rising HSV2 prevalence contributing to an increase in the proportion of GUD attributed to genital herpes in high-HIV prevalence settings, a safe and effective HSV vaccine is urgently needed. Meanwhile, multifaceted interventions are required to improve recognition of genital herpes, to prevent its spread and also to prevent its potential to promote HIV transmission in developing countries.     

Amotivational syndrome: The real management problem of schizophrenia

Impaired insight is a prominent feature of the schizophrenic syndrome, and failure to take major tranquillizers by the oral route has resulted in many relapses. The introduction of the long-acting phenothiazine fluphenazine enanthate (Moditen Enanthate) has greatly facilitated the control of the florid symptoms of this disorder by transferring most of the responsibility for phenothiazine administration from the patients to the clinic or family physician. The educational maturing process, to enable these patients to cope with the challenges of adult life and the reality of their condition, can be handled more effectively through a therapeutic team approach, operating within the framework of a structured program, than by the traditional psychiatrist/patient relationship alone.     

基于USGS生命周期模型的肿瘤流行病学数据管理研究

随着科研数据的增长,对海量数据进行有效的管理和利用成为科学数据共享的研究重点之一。基于USGS数据生命周期模型,以国际癌症研究中心（IARC）发布的肿瘤流行病学发病数据和相应的人口数据为分析对象,介绍了数据的整合与管理方法,为科研人员提供整合和管理科学数据的具体案例和可行性方法,为制定宏观政策提供基础数据和知识支撑。通过使用USGS数据生命周期模型,实现了对不同类型数据的对比分析,验证了数据生命周期模型在数据管理方面的有效性。