Using Interrupted Time Series Design to Analyze Changes in Hand, Foot, and Mouth Disease Incidence during the Declining Incidence Periods of 2008-2010 in China

ObjectiveTo identify patterns of hand, foot and mouth disease (HFMD) incidence in China during declining incidence periods of 2008, 2009, and 2010.MethodsReported HFMD cases over a period of 25 months were extracted from the National Disease Reporting System (NDRS) and analyzed. An interrupted time series (ITS) technique was used to detect changes in HFMD incidence rates in terms of level and slope between declining incidence periods of the three years.ResultsOver 3.58 million HFMD cases younger than 5 years were reported to the NDRS between May 1, 2008, and May 31, 2011. Males comprised 63.4% of the cases. ITS analyses demonstrated a significant increase in incidence rate level (P<0.0001) when comparing the current period with the previous period. There were significant changes in declining slopes when comparing 2010 to 2009, and 2010 to 2008 (all P<0.005), but not 2009 to 2008.ConclusionIncremental changes in incidence rate level during the declining incidence periods of 2009 and 2010 can potentially be attributed to a few factors. The more steeply declining slope in 2010 compared with previous years could be ascribed to the implementation of more effective interventions and preventive strategies in 2010. Further investigation is required to examine this possibility.     

补肾中药对骨质疏松大鼠性激素影响的实验研究

目的　探讨补肾中药骨康对去势所造成骨质疏松大鼠性激素及骨密度的影响及性激素水平在骨质疏松发病中的作用。方法　通过切除大鼠睾丸和卵巢造成骨质疏松模型,观察中药骨康不同剂量对骨质疏松大鼠血睾酮（Ｔ）、血清雌二醇（Ｅ２）、ＢＭＤ 和ＢＭＣ的影响,并与特乐定、尼尔雌醇作阳性对照。结果　中药骨康高、中剂量防治的去势大鼠Ｔ 含量高于模型组（Ｐ＜ ０．０５ 和０．０１）,高、中、低剂量组的Ｅ２、全身及左、右股骨ＢＭＤ、ＢＭＣ高于模型组（Ｐ＜ ０．０５）。结论　骨康能提高去势大鼠血性激素含量、骨的骨矿含量及骨密度,其提高骨矿含量及骨密度的作用可能与其提高性激素水平有关。     

SPIR扫描在诊断骨胳肌肉系统疾病中的应用

目的：探讨SPIR脂肪抑制技术在骨胳肌肉系统疾病MRI检查中的诊断价值。材料与方法：对36例骨、关节软组织疾病患者行T1W／SE、T2W／FSE及T2W／SPIR序列扫描，并对后两者进行比较。结果：各种病理性积液呈高信号；损伤性骨髓水肿呈高信号；骨折线呈低信号，如骨折断端出血则呈线状高信号；软组织肿瘤囊性部分呈高信号，实质部分呈中等强度信号；软组织炎症性病变为弥漫性高信号；骨病成骨性改变为低信号；骨髓病变为高信号或混杂等高信号；椎管内占位性病变及半月板损伤SPIR显示不清。结论：SPIR能提高正常组织与病变组织间的对比度，清晰地显示病变组织，作为T1W／SE、T2W／FSE序列的辅助检查，有助于提高骨胳肌肉系统疾病的诊断水平。     

Outcomes and poor prognostic factors in endovascular thrombectomy for octo- and nonagenarians with large vessel occlusion: A real-world experience

Endovascular thrombectomy (EVT) is the preferred treatment for eligible patients with acute large vessel occlusions (LVOs). However, its role in very elderly patients remains uncertain. This study retrospectively analysed EVT outcomes, including successful reperfusion, change in National Institutes of Health Stroke Scale (NIHSS) score at 24 h after EVT, inpatient haemorrhagic transformation and favourable functional outcomes and mortality at 90 days after EVT in patients aged over 80 years. The primary outcome of the study was risk factors significantly associated with poorer functional outcomes at 90 days after EVT. The secondary outcomes were risk factors associated with higher NIHSS scores at 24 h after EVT and higher mortality rates at 90 days after EVT. Among the 73 octo- and nonagenarians, successful reperfusion was achieved in 86.3%, and up to 35.6% maintained functional independence at 90 days. Poorer outcomes were associated with internal carotid artery occlusion; risk factors such as hypertension, diabetes mellitus and atrial fibrillation; higher admission NIHSS score; longer time between symptom onset and successful reperfusion and unsuccessful reperfusion. EVT is both safe and effective in our elderly population, with over one-third of very elderly patients achieving satisfactory functional outcomes after EVT. Therefore, age alone should not be the sole criterion for excluding very elderly LVO patients from EVT. Instead, each patient should undergo individual assessment based on their premorbid condition, clinical presentation and LVO characteristics before making a treatment decision.     

Use of a corrected standardized uptake value based on the lesion size on CT permits accurate characterization of lung nodules on FDG-PET

The purpose of this study was to determine the actual standardized uptake value (SUV) by using the lesion size from computer tomography (CT) scan to correct for resolution and partial volume effects in positron emission tomography (PET) imaging. This retrospective study included 47 patients with lung lesions seen on CT scan whose diagnoses were confirmed by biopsy or by follow up CT scan when the PET result was considered negative for malignancy. Each lesion's FDG uptake was quantified by the SUV using two methods: by measuring the maximum voxel SUV (maxSUV) and by using the lesion's size on CT to calculate the actual SUV (corSUV). Among small lesions (2.0 cm or smaller on CT scan), ten were benign and 17 were malignant. The average maxSUV was 1.43+/-0.77 and 3.02+/-1.74 for benign and malignant lesions respectively. When using an SUV of 2.0 as the cutoff to differentiate benignity and malignancy, the sensitivity, specificity, and accuracy were 65%, 70%, and 67% respectively. When an SUV of 2.5 was used for cutoff, the sensitivity, specificity, and accuracy were 47%, 80%, and 59% respectively. The average corSUV was 1.65+/-1.09 and 5.28+/-2.71 for benign and malignant lesions respectively. Whether an SUV of either 2.0 or 2.5 was used for cutoff, the sensitivity, specificity, and accuracy remained 94%, 70%, and 85% respectively. The only malignant lesion that was falsely considered benign with both methods was a bronchioalveolar carcinoma which did not reveal any elevated uptake of fluorine-18 fluorodeoxyglucose (FDG). Of the large lesions (more than 2.0 cm and less than 6.0 cm), one was benign and 19 were malignant and the corSUV technique did not significantly change the accuracy. It is concluded that measuring the SUV by using the CT size to correct for resolution and partial volume effects offers potential value in differentiating malignant from benign lesions in this population. This approach appears to improve the accuracy of FDG-PET for optimal characterization of small lung nodules.     

短期加用替罗非班在支架辅助弹簧圈栓塞梭形动脉瘤中的安全性与有效性研究

目的评估支架辅助弹簧圈栓塞梭形动脉瘤术中及术后24 h内,在标准双抗血小板治疗的基础上,短期应用小剂量替罗非班在降低缺血并发症方面的安全性及有效性。 方法回顾分析我中心2015年1月至2020年12月颅内未破裂梭形动脉瘤接受支架辅助弹簧圈栓塞治疗,并在手术过程中及术后24 h内静脉接受替罗非班（0.1 μg/kg/min）预防血小板聚集的患者资料。记录并分析围手术期并发症,动脉瘤栓塞程度及术后3个月随访时的mRS评分。 结果本研究共纳入38例患者,39枚动脉瘤,动脉瘤平均直径（6.4±2.1）mm。其中,26枚动脉瘤接受了单支架辅助弹簧圈栓塞治疗,13枚动脉瘤接受了双支架辅助弹簧圈栓塞治疗。术后即刻78.9%（30/38）的动脉瘤实现完全栓塞;在26例接受脑血管造影复查的患者中,92.3%（24/26）的患者动脉瘤实现完全闭塞。围手术期缺血并发症发生率为7.9%（3/38）;无出血并发症发生。3个月随访的良好预后率为97.4%（37/38） （mRS评分为0~1分）。 结论支架辅助弹簧圈栓塞梭形动脉瘤术中及术后24 h内,静脉加用小剂量替罗非班未增加出血并发症。但是,由于样本量偏少,缺少对比,在降低缺血并发症方面的有效性尚需进一步证实。     

家属培训对长期住院慢性精神分裂症患者康复的影响

目的探讨家属心理护理、生活技能培训在长期住院的慢性精神分裂症患者康复治疗中的作用。方法选取有家庭监护条件的长期住院的精神分裂症患者126例,将其随机分为干预组(66例)和对照组(60例)。干预组由心理咨询师对患者家属进行心理护理、生活技能培训,然后对患者实施假出院3个月。对照组患者仍住院治疗。实施前后采用护士用住院患者观察量表(NOS-IE)、自尊量表(SES)进行测试。结果干预后干预组NOSIE及SES评分显著优于对照组(P<0.01,P<0.05)。结论家属心理护理、生活技能培训用于长期住院的慢性精神分裂症患者,可使其社会能力、生活技能提高,激惹、抑郁等消极情绪减少;自尊水平提升。     

再次或多次手术治疗复发性腹膜后 脂肪肉瘤的临床意义

目的 探讨再次手术或多次手术治疗复发性腹膜后脂肪肉瘤的治疗策略和临床意义。方法 回 顾性分析2013 年1 月—2017 年8 月北京大学第一医院普通外科收治的16 例腹膜后脂肪肉瘤术后复发患者（复 发组）行再次或多次手术的临床资料,随访时间12 ～ 62 个月,平均30 个月;观察其术后效果。结果 16 例 腹膜后肿瘤术后复发患者共行手术30 例次,手术时间60 ～ 840 min,平均360 min ;中位手术时间270 min, 术中出血50 ～ 33 100 ml,平均3 755 ml ;中位出血量800 ml。其中,28 例次手术为联合脏器切除。原发性腹 膜后脂肪肉瘤行手术治疗患者（原发组）与复发组在肿瘤最大径、是否多灶等指标比较,差异无统计学意义 （P >0.05）,而手术时间、出血量及是否联合脏器切除比较,差异有统计学意义（P <0.05）。随访期间无瘤存 活率为25%（4/16）,带瘤生存8 例,死亡4 例。结论 对于复发性腹膜后脂肪肉瘤患者,经多学科评估和完 善的术前准备,可行再次或多次手术治疗。     

试论岳甫嘉医案中不育的诊治思维

岳甫嘉诊病重视脉症合参,尤以诊脉见长;处方多用中和之剂,收固真阴,反对过用热药,耗散精血。诊治思维贯穿其著作《妙一斋医学正印种子编》上卷所载验案。此卷专门论述男性不育的诊治,虽仅载验案八则,但八者皆奇,诊治结合,涵盖多法,可归纳为“先清热毒,再施温补”“药用滑涩,当辨标本”“先治脾,后治肾”“脾肾同治”“先祛痰火,再滋肾阴”及“交通心肾”6类,诸法之中的诊治思维,蕴含奥妙,颇具特色,特作探析。