胃肠癌患者术后生命质量现状及与焦虑、抑郁的相关性分析

目的 探讨胃肠癌患者生命质量现状及与焦虑、抑郁的相关性,为提高患者生命质量提供依据。 方法 采用医院焦虑抑郁量表(Hospital Anxiety and Depression Scale, HADS)和癌症患者生命质量测定量表(Functional Assessment of Cancer Therapy Generic Scale, FACT-G)评估198例胃肠癌术后住院患者焦虑、抑郁情绪障碍和生命质量情况,采用方差分析或t检验分析不同特征及焦虑、抑郁程度胃肠癌患者生命质量情况,并采用Pearson相关分析胃肠癌患者生命质量与焦虑、抑郁情绪障碍程度的相关性。 结果 198例研究对象均为胃肠癌术后患者,其中胃癌、结肠癌、直肠癌分别为84例、51例、63例。198例研究对象FACT-G总评分为(59.62±7.94)分,不同年龄段、不同肿瘤位置、不同术前TNM分期、不同确诊时间和不同化疗次数,FACT-G总评分差异有统计学意义(P<0.001)。其中,轻度、中度、重度焦虑患者分别为79例(39.90%)、66例(33.33%)、22例(11.11%)。轻度、中度、重度抑郁患者分别为82例(41.41%)、42例(21.21%)、16例(8.08%)。不同焦虑、抑郁程度患者间FACT-G总评分以及各维度评分差异均有统计学意义(P<0.05)。Pearson相关分析结果显示胃肠癌患者生命质量总分与抑郁、焦虑均呈较强相关,Pearson相关系数分别为-0.43和-0.46;生命质量各维度评分与焦虑、抑郁评分均呈显著负相关。 结论 胃肠癌术后患者年龄越大、术前TNM分期越高、确诊时间越长、放化疗次数越多患者术后整体生命质量越低;焦虑和抑郁发病率较高,术后生命质量总分及各维度评分均与焦虑、抑郁评分呈显著负相关。     

成都市某社区居民健康知识知晓率调查

目的了解成都市某社区常住居民基本健康知识知晓率现状,并分析相关影响因素,为提高居民健康知识知晓率、制定居民健康教育规划提供参考。方法采用自行设计的结构式问卷对成都市某社区抽取的1 533名居民进行入户面对面访谈调查。结果被调查的1 533名居民健康知识总知晓率为41.3%,对单项健康知识的认识不一,关于具体的量化指标和疾病的危险因素回答正确率偏低。结论被调查社区居民健康知识知晓率较低。应通过多种渠道并结合专业性指导开展健康教育,尤其应关注健康相关知识的细化和专业化教育。     

Clinical target volume delineation including elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer

ABSTRACT: BACKGROUND: Radiotherapy is widely used in the treatment of pancreatic cancer. Currently, recommendation has been given for the delineation of the clinical target volume (CTV) in adjuvant radiotherapy. Based on recently reviewed pathologic data, the aim of this study is to propose criteria for the CTV definition and delineation including elective nodal irradiation (ENI) in the preoperative and definitive treatment of pancreatic cancer. METHODS: The anatomical structures of interest, as well as the abdominal vasculature were identified on intravenous contrast-enhanced CT scans of two different patients with pancreatic cancer of the head and the body. To delineate the lymph node area, a margin of 10 mm was added to the arteries. RESULTS: We proposed a set of guidelines for elective treatment of high-risk nodal areas and CTV delineation. Reference CT images were provided. CONCLUSIONS: The proposed guidelines could be used for preoperative or definitive radiotherapy (RT) for carcinoma of the head and body of the pancreas. Further clinical investigations are needed to validate the defined CTVs.     

L����valuation du risque cardiaque avant l��utilisation de stimulants chez les enfants et les adolescents

Regulatory decisions and scientific statements regarding the management of attention-deficit hyperactivity disorder (ADHD) raise questions about the safety of medications and the appropriate pretreatment evaluation to determine suitability for treatment with medication. This is particularly true in the setting of known structural or functional heart disease. The present paper reviews the available data, including peer-reviewed literature, data from the United States Food and Drug Administration Web site on reported adverse reactions in children using stimulant medication, and Health Canada data on the same problem. A consensus-based guideline on appropriate assessment is provided, based on input from members of the Canadian Paediatric Society, the Canadian Cardiovascular Society and the Canadian Academy of Child and Adolescent Psychiatry, with specific expertise and knowledge in the areas of both ADHD and paediatric cardiology. The present statement advocates a thorough history and physical examination before starting stimulant medications, with an emphasis on the identification of risk factors for sudden death, but does not routinely recommend electrocardiographic screening or cardiac subspecialist consultation unless indicated by history or physical examination findings. A checklist for identifying children who are potentially at risk of sudden death (independent of ADHD or medications used to treat it) is provided. Although recommendations are based on the best evidence currently available, the committee further agrees that more research on this subject is necessary to optimize the approach to this common clinical scenario.Il est démontré que le traitement pharmacologique par des stimulants réduit les symptômes associés au trouble de déficit de l’attention avec hyperactivité (TDAH), et ce traitement fait partie des recommandations thérapeutiques de l’American Academy of Pediatrics pour les enfants présentant ce trouble (1,2). Cependant, de récentes décisions en matière de réglementation sur l’homologation et l’étiquetage des médicaments contre le TDAH (3,4), ainsi qu’un récent document de principes de l’American Heart Association (5), une correction et une réponse (clarification) de l’American Academy of Pediatrics (6,7), ont soulevé des questions sur l’évaluation et la thérapie du TDAH que préconisent les praticiens canadiens. La pratique canadienne actuelle dans le domaine de la pharmacothérapie du TDAH et du dépistage cardiovasculaire est mixte, et il y a peu de consensus quant à l’évaluation pertinente des enfants avant d’instaurer la pharmacothérapie du TDAH (8). Les avis sont encore plus partagés au sujet de l’innocuité du traitement des enfants ayant subi une réfection ou une palliation de leur cardiopathie congénitale (CPC) et qui prennent des médicaments contre le TDAH (8).Afin d’orienter les médecins canadiens qui soignent les enfants ayant un TDAH et de clarifier la situation, la Société canadienne de pédiatrie, la Société canadienne de cardiologie et l’Académie canadienne de psychiatrie de l’enfant et de l’adolescent ont préparé conjointement le présent document de principes. Il contient des recommandations consensuelles sur l’évaluation du risque cardiaque chez les enfants ayant un TDAH à qui on envisage d’administrer des stimulants. Il ne s’attarde pas au diagnostic de TDAH, ni aux bienfaits thérapeutiques des stimulants. De même, il n’aborde pas le bien-fondé ou les risques relatifs d’un médicament par rapport à un autre au sein de cette population de patients. Enfin, les médicaments non stimulants utilisés dans le traitement du TDAH, y compris l’atomoxétine, les antidépresseurs et les agonistes alpha-adrénergiques, ne font pas l’objet d’une analyse particulière.     

Analgesia for circumcision in a paediatric population: comparison of caudal bupivacaine alone with bupivacaine plus two doses of clonidine

BACKGROUND: Clonidine is often used to improve the duration and quality of analgesia produced by caudal epidural blockade, although the optimum dose of clonidine with bupivacaine remains uncertain. Methods: We compared the effect of clonidine, 1 and 2 microg x kg(-1), added to bupivacaine (1.25 mg x kg(-1)) with that of bupivacaine alone in 75 male children undergoing elective circumcision. RESULTS: There was a trend towards increasing duration of analgesia with increasing dose of clonidine [group B (bupivacaine) 280.7 (171.6) min, C1 (bupivacaine + clonidine 1 microg x kg(-1)) 327.8 (188.3) min and C2 (bupivacaine + clonidine 2 microg x kg(-1)) 382.0 (200.6) min], although this difference was not statistically significant. Mean time to arousal from anaesthesia was significantly prolonged with clonidine 2 microg kg(-1) (group C2 21.3 (13-36) min, group C1 14.0 (6-25) min and group B 14.4 (2-32) min. Supplementary analgesic requirements and incidence of adverse effects were low, with no differences between the groups. Conclusions: For paediatric circumcision, under general anaesthesia, the addition of clonidine 2 microg x kg(-1) to low volume (0.5 ml x kg(-1)) caudal anaesthetics has a limited clinical benefit for children undergoing circumcision.     

西藏农牧民吸食鼻烟行为流行病学调查

目的：了解西藏地区农牧民吸食鼻烟情况,探讨控烟对策。方法：以西藏农村疾病监测点常住藏族人群为调查对象,采用分阶段随机抽样调查15－70岁计1200例,有效样本1084例。结果：调查表明,在西藏地区农牧民中吸食鼻烟的现象还普遍存在,鼻烟吸食率达26．57％,结论：结果初步描述了西藏地区农牧民中鼻烟吸食的流行病学现状,为以后在西藏地区开展控烟工作提供了一些基础数据和背景资料。     

胃癌COX-2 的表达与微血管密度及相关临床病理因素的关系

目的 :探讨胃癌COX - 2的表达与微血管密度及相关临床病理因素的关系。方法 :采用免疫组化S -P法检测 4 6例胃癌的COX - 2表达 ,采用CD34单克隆抗体进行微血管内皮细胞染色 ,计算微血管密度 (MVD)分析与相关临床病理因素的相关性。结果 :COX - 2在胃癌组织表达的阳性率为 71 6 %。COX - 2的高表达与胃癌淋巴结转移、浸润深度、分化程度和临床分期有关 ,与肿瘤大小、腹膜转移、血行转移无显著相关性。COX - 2表达阳性、淋巴转移阳性、浸润程度深者MVD值明显增高。结论 :COX - 2的表达对胃癌细胞的演进和血管形成可能起重要作用 ,是判断预后和指导治疗的有效指标。