山东省临朐县1993～2004年恶性肿瘤发病与死亡资料分析

目的 探讨临朐县恶性肿瘤发病与死亡规律，为卫生决策提供依据。方法 对1993～2004年临朐县恶性肿瘤登记资料进行统计分析，利用1998～2004年资料计算发病率、标化发病率、死亡率和标化死亡率，利用1993～1999年肿瘤登记资料计算发病时间中位数和平均病程。结果 临朐县恶性肿瘤年平均发病率152．18／10万（国标率158．07／10万、世标率174．68／10万），年平均死亡率133．35／10万（国标率138．32／10万、世标率155．14／10万）；男性发病率和死亡率分别为女性的1．9倍和1．8倍，超过80％的发病和死亡发生在45—79岁人群；胃癌居临朐县恶性肿瘤发病和死亡首位，其次为肺癌和肝癌，三大肿瘤分别占男性发病和死亡70％以上、女性60％以上；1998～2004年肿瘤发病率和死亡率呈现上升趋势，其中肺癌发病率和死亡率分别上升了52．7％和22．4％；恶性肿瘤发病年龄中住数65岁，平均病程1．04年，结论 恶性肿瘤的性别年龄分布提示了防治工作的重点人群，胃癌、肺癌的防治地位十分突出。     

2007年浙江省台州市居民恶性肿瘤发病和死亡分析

目的　了解2007年浙江省台州市居民恶性肿瘤的发病和死亡情况，为防治工作提供基础信息。方法　对台州市2007年居民死因数据库采用2002版《死亡医学登记系统》和Excel进行恶性肿瘤死亡分析。结果2007年全市肿瘤报告发病率为134.33/10万，校正发病率为259.22/10万。男性发病率是女性的1.50倍。发病率居前5位的恶性肿瘤为肺癌、胃癌、肝癌、肠癌和食管癌。2007年肿瘤报告死亡率为170.57/10万，校正死亡率为198.27 /10万。死亡率居前5位的恶性肿瘤为肺癌，肝癌，胃癌，结肠、直肠和肛门癌以及食管癌。除了乳腺癌和宫颈癌，主要恶性肿瘤死亡率男性均高于女性。结论　肺癌是台州市居民发病和死亡均居首位的恶性肿瘤，其次是消化系统肿瘤。肺癌已成为危害台州市居民健康和生命的主要因素。恶性肿瘤男性发病率较女性高。     

2003～2005年金华市婺城区城市居民恶性肿瘤监测分析

目的分析2003～2005年婺城区城市居民恶性肿瘤发病与死亡分布特征,为制定肿瘤防治规划提供依据。方法对2003～2005年该区城市居民恶性肿瘤发病与死亡进行流行病学分析。结果2003～2005年恶性肿瘤发病854例,死亡828例。2003年发病率最高(202.73/10万),2004年最低(186.54/10万),年标化发病率均高于180/10万。年死亡率约170/10万～200/10万,标化死亡率约180/10万～190/10万。发病率和死亡率男性均高于女性。年龄别发病率和年龄别死亡率均随着年龄增长而升高。发病和死亡主要集中在40岁以上年龄组。男性恶性肿瘤以肺癌和消化系统肿瘤为主,女性以乳腺癌、肺癌和消化系统肿瘤为主,乳腺癌为女性首位发病肿瘤。结论婺城区城市居民恶性肿瘤发病和死亡均高,占死因首位。建议:制定肿瘤防制规划并由政府组织实施;开展恶性肿瘤等慢性病监测报告;对肺癌、乳腺癌、消化系统肿瘤予以重点防治;开展恶性肿瘤危险因素研究;普及防癌健康教育;开展社区恶性肿瘤综合预防工作。     

胃癌的治疗现状

胃癌是最常见的消化道恶性肿瘤，全世界每年胃癌发病率为17．6／10万。近30年来，在世界范围内的胃癌死亡率有一定程度的下降趋势。中国在20世纪70年代进行第一次全国范围内的居民死亡调查，1973～1975年又进行了恶性肿瘤死亡回顾调查，每年胃癌的死亡率总是占恶性肿瘤的第一位，为5．41／10万，占全部恶性肿瘤死亡的23．03％。1993年又进行了第二次全国肿瘤死亡抽样调查，在高死亡率的恶性肿瘤中胃癌仍占第一位。近10年来，通过国家对胃癌研究的投入胃癌防治研究工作者的努力，中国的胃癌发病率有下降趋势，男性退居第二位，女性则居第三位，但由于其每年死亡人数仍位居我国恶性肿瘤的首位，因此需继续加强对胃癌治疗的研究。     

2004～2005年珠海市成人肺癌死亡的流行病学特征

目的了解珠海市户籍人群肺癌死亡的流行病学特征，为肺癌防治提供决策依据。方法应用2004～2005年珠海市户籍居民病伤死亡原因监测资料，分析珠海市户籍人群肺癌死亡的流行病学特征。结果2004～2005年间珠海市成人平均肺癌死亡率为25．3／10万，标准化率为30．3／10万，是恶性肿瘤死亡的第一位原因；男性和女性标准化率分别为40．1／10万和19．2／10万，男性高于女性（u=7．23，P〈0．01）；平均肺癌死亡率随年龄增长而增加，60岁以上增加明显，且多为老年男性；香洲、斗门、金湾3个区标准化死亡率分别为30．5／10万、31．1／10万和27．3／10万，不同地区间肺癌死亡水平无显著性差异。结论肺癌是威胁珠海市居民健康的主要恶性肿瘤之一，随着人口老龄化的发展，其病死率将呈持续增长趋势；应针对肺癌主要危险因素采取控烟、改善环境等积极有效的预防控制措施。     

北京市海淀区1992年～1994年老年人口主要死因分析及防制对策

为预防和控制老年人口疾病，降低死亡率，对北京市海淀区1992年～1994年65岁以上老年人口死亡资料进行流行病学分析。结果表明：3年间共死亡9941人，占全人。死亡的63．17％，年均死亡率4881．97／1。万。其中男性死亡5127人，年均死亡率5542.22／10万；女性死亡4814人，年均死亡率4332．29／10万；前5位死因依次为脑血管病、呼吸系病、心脏病、恶性肿瘤、内分泌代谢病。男女性死因相同，只是位次有所区别。引起呼吸系病、心脏病、恶性肿瘤和内分泌代谢病死亡的主要疾病是支气管炎、肺气肿、哮喘（占85.01％）；冠心病（占86．51％）；肺癌、胃癌、食管癌（占56．27％）；糖尿病（占9774％）。针对主要死因采取加强社区保健等相应对策是一条防制老年人口死亡有效的途径。     

北京市海淀区1992年～1994年老年人口主要死因分析及防制对策

为预防和控制老年人口疾病，降低死亡率，对北京市海淀区1992年～1994年65岁以上老年人口死亡资料进行流行病学分析。结果表明：3年间共死亡9941人，占全人口死亡的63.17％，年均死亡率4881.97／10万。其中男性死亡5127人，年均死亡率5542.22／10万；女性死亡4814人,年均死亡率4332．29／10万；前5位死因依次为脑血管病、呼吸系病、心脏病、恶性肿瘤、内分泌代谢病。男女性死因相同，只是位次有所区别。引起呼吸系病、心脏病、恶性肿瘤和内分泌代谢病死亡的主要疾病是支气管炎、肺气肿、哮喘(占85.01％)；冠心病(占86.51％)；肺癌、胃癌、食管癌(占56．27％)；糖尿病(占97.74％)。针对主要死因采取加强社区保健等相应对策是一条防制老年人口死亡有效的途径。     

1990～2010年成都市前三位恶性肿瘤流行病学特征分析

目的回顾性分析1990～2010年成都市前三位恶性肿瘤的发病率、死亡率、流行病学趋势和分布特征,以了解成都市主要恶性肿瘤的发病危险因素、肿瘤类别及顺位情况,为制定地区肿瘤防治策略提供依据。方法收集成都市1990年以来恶性肿瘤发病和死亡的监测数据,采用ICD-10编码进行疾病分类,统计不同年龄、性别、地区、种类的恶性肿瘤发病和死亡情况。结果 1990～2010年成都市发病率报告前三位的恶性肿瘤分别是肺癌、肝癌、肠癌,与1990～2005年死亡率报告相同;但2005～2010年间,胃癌超过肠癌成为死亡率第三的恶性肿瘤。前三位恶性肿瘤的死亡率男性均高于女性,城市和农村地区恶性肿瘤死亡率差异无统计学意义,主要恶性肿瘤的死亡率均随年龄增加而增高。结论肺癌、肝癌和胃癌是危害成都市居民健康的主要恶性肿瘤,且发病率和死亡率逐年上升,应有针对性地开展几种主要肿瘤的早诊早治等防控措施。     

徐州市城区居民肺癌死亡情况及潜在寿命损失分析

背景：肺癌一直高居恶性肿瘤死因构成的首位，阐明居民肺癌死亡状况及趋势变化对于制定防治策略十分必要。 目的：分析徐州城区居民肺癌死亡特征、死亡趋势及造成的潜在寿命损失。 设计：回顾性描述流行病学分析。 单位：徐州市疾病预防控制中心。 对象：1990～2003年徐州市城区所有肺癌死亡病例3890例。 方法：用粗死亡率、标化死亡率、年龄别死亡专率、潜在寿命损失年等指标统计分析，描述1990～2003年徐州市城区居民肺癌死亡特征及潜在寿命损失情况。 主要观察指标：①肺癌的粗死亡率。②潜在寿命损失年。③减寿率。 结果：①14年间。肺癌总计死亡3890例，占恶性肿瘤总死亡数的27．43％，②年平均死亡率为28．31／10万，标化死亡率为24．88／10万，居民肺癌死亡潜在寿命损失年合计24230人年，③减寿率为1．19／1000，标化减寿率为lA5／1000，每例肺癌死亡造成潜在寿命损失6．23岁；男性死亡率高于女性（x^2=575．70，P〈0．01），男女性别比为2．31：1，20岁以后男女性年龄别死亡专率均呈指数关系递增。 结论：肺癌是威胁徐州市区居民生命健康最严重的恶性肿瘤之一，肺癌造成的潜在寿命损失较大，暴露于环境中致癌物量与肺癌的发生关系密切，故应积极启动对其预防和控制工作。     

2010年～2012年张家港市恶性肿瘤发病趋势分析

目的：分析张家港市2010年～2012年恶性肿瘤发病的特征和趋势。方法按照肿瘤登记规范,收集整理并分析2010年～2012年恶性肿瘤新发病例报告资料,统计和计算恶性肿瘤粗发病率、标化率、0~74岁累积率和35～64岁截缩率。结果2010年~2012年张家港市共报告新发恶性肿瘤9334人,粗发病率为343.40/10万,标化率192.04/10万,0~74岁累积率为21.77%,35~64岁截缩率为271.25/10万;男性发病前5位的恶性肿瘤依次为肺癌、胃癌、肝癌、结直肠癌和食管癌,女性发病前5位的恶性肿瘤依次为乳腺癌、肺癌、胃癌、结直肠癌和宫颈癌。结论与本市历史资料相比,恶性肿瘤的发病率呈上升趋势,肺癌成为本市发病率居首位的恶性肿瘤,肺癌、消化系统恶性肿瘤、乳腺癌仍是本市肿瘤防治工作的重点。     

Respiratory Rate as a Determinant of Optimal Pacing Rate

Des essais ont été faits dans ľutilisation des paramètres bialogiques pour déterminer la fréquence optimale de stimulation cardiaque. Dans cette étude, le rapport entre fréquence respiratoire et fréquence cordiaque a étéétabli chez 67 patients au cours de ľexercice. Ensuite, un système de stimulation cardiaque qui repondrait àľactivation radiotélémétrique a été posé chez onze patients. Dans deux cos un système automatique a été implanté avec succès. A present, les résultats de cette stimulation pilotée par la fréquence respiratoire sont satisfaisants.
Efforts have been made to utilize biologic parameters for determining optimal cardiac pacing rates. In this study of 67 patients, a significant relationship between heart rate and respiratory rate was observed during dynamic exercise. A system using a radiofrequency activator to modify pacing rate is described. Eleven patients have received VVI pacemakers with a similar implanted radioreceiver coil. In two patients the fully automatic system has been successfully implanted. The experience with respiratory rate as a determinant of pacing rate is encouraging.     

Trends in Pacemakers Which Physiologically Increase Rate: DDD and Rate Responsive

Exercise (rate) responsive pacemakers benefit patients by providing increased cardiac output when needed and permitting lower rate during rest. This paper briefly reviews trends in reported studies on rate responsive pacemakers. For patients with reliable atrial rhythms, atrial-triggered pacemakers (DDD) provide physiological ventricular rates unless complications arise. At low rates, A-V synchrony benefits patients with refractory cardiac decompensation; however, in patients with healthy myocardiums, achieving higher pacing rates is more significant than maintaining synchrony. If atrial rhythms are unreliable, an alternative sensor for determining pacing rate is indicated. Pacemakers that respond to changes in right ventricular blood temperature, respiratory rate, QT interval, body vibration (motion), and pH have been implanted in humans. Clinical evaluations have shown that increased pacing rate leads to increased exercise tolerance and cardiac output when needed, independent of the sensor type (DDD, QT, respiratory rate, etc.). The effectiveness of any sensor type to increase pacing rate appropriately requires reliable sensors that respond specifically to the need for increased pacing rate. Sensors for stroke volume, venous oxygen saturation, right atrial or ventricular pressure and catecholamines are also under preclinical investigation. The availability of a reliable, long-term sensor is a key limitation to several techniques including pH. stroke volume, oxygen saturation, pressure, and catecholamines. Sensor technology and clinical effectiveness are the keys to rate responsive pacing.     

Increasing Cardiac Rate by Tracking the Respiratory Rate

Un stimulateur asservi qui utilise la fréquence venlilatoire comme capteur a été implunté chez 22 patients, dont 19 pour la stimulation ventriculaire et 3 pour la stimulation auriculaire. Le niveau d'exercice atteint en utilisant ce système a été toiijours supérieur à celui de la stimulation ventriculaire à fréquence fixe. En plus, aucun capteur chimique ou mécanique n'était utilisé; le capteur même est simple, durable et utilise une faible énérgie. Done, ce système s'adapte facilement à chaque patient individuel.     

Changes in Heart Rate, Heart Rate Variability, and Heart Rate Turbulence during Evolving Reperfused Myocardial Infarction

Depressed cardiac parasympathetic activity is associated with electrical instability and adverse outcomes after myocardial infarction (MI). Heart rate turbulence (HRT), reflecting reflex vagal activity, and heart rate variability (HRV), reflecting tonic autonomic variations are both reduced in the subacute phase of MI. However, the evolution of these components of cardiac autonomic control between subacute and chronic phase of MI has not been defined. We prospectively studied 100 consecutive patients with a recent first MI with ST-segment elevation, who underwent successful direct percutaneous coronary interventions. Beta-adrenergic blockers and angiotensin-converting enzyme (ACE) inhibitors were administered according to the state-of-the-art medical practice guidelines. HRT and HRV were measured from 24-hour ambulatory electrocardiographic recordings 10 days and 12 months after the index MI. There was no significant difference in mean RR interval between the subacute and chronic phase of MI (875 ± 145 versus 859 ± 122 ms). Indices of HRV increased significantly during the observation period (SDNN: from 88.8 ± 26.8 to 116.0 ± 35.7 ms, P < 0.001; SDNNi: from 37.9 ± 15.9 to 46.0 ± 16.3 ms, P < 0.001; SDANN: from 79.6 ± 34.7 to 105.6 ± 35.4 ms, P < 0.001). In contrast, there were no significant changes in indices of HRT (turbulence onset: from −0.008 ± 0.022 to −0.012 ± 0.025%; turbulence slope: from 7.78 ± 5.9 to 8.06 ± 6.8 ms/beat). In contrast to reflex autonomic activity, there was a significant recovery of tonic autonomic activity within 12 months after MI. These different patterns of recovery of reflex versus tonic cardiac autonomic control after MI need to be considered when risk stratifying post-MI patients.     

Activity-Controlled Circadian Base Rate

The current pacing rates are clustered around a fixed base rate since pacemaker patients are usually sedentary, resting, or sleeping most of the time. This fixed base rate is either too low for daytime hemodynamic support or too high for nighttime rest and recovery. Multiple Holter studies involving normal individuals have suggested that the resting base rate fluctuates during the course of the day. The circadian base rate (CBR) algorithm was designed to provide patients with a circadian change in paced resting rate and a normal rate distribution. The CBR algorithm, using a sophisticated accelerometer sensor, was developed and tested using the downloaded activity data from patients implanted with Trilogy DR+ pacemakers. Twenty-five patients (19 men, 6 women, age 72 ± 9 years) were studied. Trilogy DR+ is able to record the detailed sensor and system behavior data for a week. During outpatient visits, the pacemaker was interrogated and the data accumulated in the pacemaker memory were downloaded. The CBR algorithm was applied to the activity variance histogram to calculate the base rate and to construct its histogram. The base rates in the CBR histogram are generally below 100 ppm with a distribution that mimics the natural sinus rate distribution of normal subjects. The CBR algorithm provides the highest daytime rates for hemodynamic support and the lowest nighttime rates for cardiac recovery, with a smoothly changing base rate modeling the normal circadian variation in heart rate.     

New Algorithms to Increase the Initial Rate Response in a Minute Volume Rate Adaptive Pacemaker

Background : Minute volume is a truly physiological sensor for rate adaptive pacing that correlates with metabolic expenditure throughout the range of physical activity. Criticism has centered on the slow initial response compared to less physiological sensors. A new algorithm, consisting of rate augmentation factor and programmable speed of response, has been incorporated in the 1206 META III pacemaker generator and was designed to improve the rate response at lower levels of exertions. Rate augmentation factor increases the programmed rate response factor by 3, 6, or 10 when set to low, medium, or high, respectively; this augmentation lasting to 50% of the maximum programmed rate. Response time can be programmed to medium or fast. Methods : Nine patients were studied during the first 3 minutes of an exercise test (Bruce protocol) in a single blind manner. The pacemaker generator was randomly programmed with rate augmentation factor at off, low, or high and speed of response to medium or fast, giving six possible combinations. Heart rates were recorded continuously for the duration of the test and until resting heart rate was achieved during recovery. The test was repeated until all six combinations had been tested. Results : During exercise significant differences appeared in response time from 30 seconds onward. Fast response and rate augmentation factor contributed to an improved rate response with greatest speed of response seen with fast response time and high rate augmentation factor. During recovery decreases in recovery time were seen with fast response time but rate augmentation factor prolonged recovery. Conclusions : Rate augmentation factor improves initial rate response in the early stages of exercise. Fast response gives an improved time to initial rate increase and shortens the duration of inappropriate postexercise tachycardia. These features improve the pattern of response of the minute ventilation sensor.     

Variable Effects of Physical Training of Heart Rate Variability, Heart Rate Recovery, and Heart Rate Turbulence in Chronic Heart Failure

Background: Heart rate variability (HRV), heart rate turbulence (HRT), and heart rate recovery (HRR), indices that reflect autonomic nervous system (ANS) activity, are outcome predictors in patients with chronic heart failure (CHF). It is not clear, however, whether they reflect the same components of ANS activity. No study has examined the effects of physical training (PT) training on HRV, HRT, and HRR in CHF.
Study Objective: To examine the responses of HRV, HRT, and HRR to a PT program in patients presenting with CHF.
Methods: In 41 patients (mean age = 58.7 ± 10.2 years) in New York Heart Association CHF functional classes II or III, and with a left ventricular ejection fraction <40%, HRV, HRT, and HRR were measured before and after 8 weeks of PT.
Results: The training was clinically effective in all patients. Before versus after PT, standard deviation of all normal RR intervals increased from 107 ± 30 to 114 ± 32 ms (P = 0.047), high frequency increased from 210 ± 227 to 414 ± 586 ms²/Hz (P = 0.02), and the low/high frequency ratio decreased from 1.8 ± 1.55 to 1.1 ± 1.2 (P = 0.002). HRT and HRR did not change significantly after PT.
Conclusions: In patients with CHF, the positive effects of PT were limited to HRV indices, which reflect parasympathetic activity, without significantly changing HRR and HRT. These observations indicate that different mechanisms modulate HRV, HRR, and HRT, which provide complementary information regarding ANS activity. The 8-week PT program failed to completely normalize ANS function.     

Upper Rate Pacing After Radiofrequency Catheter Ablation in a Minute Ventilation Rate Adaptive DDD Pacemaker

A 58-year-old man with an implanted minute ventilation rate adaptive DDD pacemaker underwent RF ablation of the AV junction because of symptomatic supraventricular tachyarrhythmias. Immediately after ablation, while the pacemaker was programmed in the DDDR mode, AV sequential pacing at upper rate was observed. After programming the pacing system to the DDD mode and repeated ablation, no abnormalities were observed. It was concluded that AV sequential upper rate pacing was caused by false interpretation of the RF current by the sensor measuring transthoracic impedance as an indicator for minute ventilation.     

Pure Atrial-Based Lower Rate Timing of Dual Chamber Pacemakers: Implications for Upper Rate Limitation

The release of dual chamber pulse generators with atrial-based lower rate timing has added a new dimension to the complexity of pacemaker function and electrocardiography. This discussion focuses on the concept that in pulse generators with pure atrial-based lower rate timing, preservation of the atrial lower rate interval takes hierarchial precedence over all other timing intervals including the ventricular-based upper rate interval. Under certain circumstances whenever upper rate limitation requires extension of the programmed AV interval, a DDD pulse generator with pure atrialbased lower rate timing can violate its atrial-driven upper rate interval to provide constancy of the lower rate interval. Such behavior also has important implications for upper rate control in devices that function in the DDI(DDIR) or DDDR mode with pure atrial-based lower rate timing.     

Heart Rate Turbulence in Chagas Disease

RIBEIRO, A.L.P., et al. : Heart Rate Turbulence in Chagas Disease. Heart rate turbulence (HRT) quantifies the biphasic response of the sinus node to ventricular premature complexes (VPCs) and is a powerful electrocardiogram related risk predictor. VPCs are frequent in Chagas disease, a potentially lethal illness, and can hamper the analysis by conventional methods of autonomic heart control. The aim of the study was to examine HRT in patients with Chagas disease. Chagas disease patients and healthy controls (group   0, n = 11   ) without other diseases were submitted to a standardized protocol, including electrocardiogram, echocardiography, and 24-hour Holter monitoring. Chagas disease patients were divided according to their left ventricular systolic function: normal (group   1, n = 103   ) and reduced ejection fraction (group   2, n = 23   ). Two HRT indices, turbulence onset (TO) and turbulence slope (TS), were calculated and compared among groups after adjustment for covariates like the prevalence of VPCs and the mean heart rate. Chagas disease patients had significantly altered TO (group 1: −0.0186, group 2: −0.0126) and TS (group 1: 10.844, group 2: 7.870) values in comparison with controls (TO − 0.0256, TS 19.829);   P < 0.001   for both comparisons. In conclusion, HRT data may be useful in the electrocardiographic analysis of autonomic heart control in Chagas disease. Its prognostic value remains to be determined. (PACE 2003; 26[Pt. II]:406–410)