Twin embolization syndrome: prenatal sonographic detection and significance

Twin embolization syndrome (TES) is a complication of monozygotic twinning following in utero demise of the co-twin. Passage of thromboplastic material into the circulation of the surviving twin results in ischemic structural defects of the central nervous system, gastrointestinal tract, and genitourinary system. In six cases of this rare abnormality, sonographically normal fetuses subsequently demonstrated ventriculomegaly, porencephaly, cerebral atrophy, or microcephaly following demise of the co-twin. Extracranial abnormalities included small bowel atresia (two cases) and renal cortical necrosis (one case). Surviving twins all had neurodevelopmental delay at follow-up. Two fetuses were aborted because of sonographically apparent, progressively severe brain abnormality. The lone survivor of a dizygotic triplet gestation was normal, despite sonographic findings of TES in the co-triplets. Because of poor outcome, prenatal sonographic diagnosis of TES may influence antenatal or neonatal management of the surviving monozygous twin. Recognition of TES may permit accurate postnatal counseling of prognosis and recurrence risks.     

SMALL JOINT SYNOVTTIS IN RHEUMATOID ARTHRITIS: SHOULD IT BE ASSESSED SEPARATELY?

In the assessment of disease activity in rheumatoid arthritis(RA) small joint synovitis is traditionally included only asa component of active, tender or swollen joint counts. By contrast,in the assessment of disease damage in RA, the X-ray score ofhands and feet represents one of the most common parametersused and is regarded as a major indicator of outcome. Data presentedin this study lead us to hypothesize that the small joints requireseparate assessment in any study of disease activity or outcomein RA: (i) there is clear evidence that small joint synovitisoften occurs in the absence of an abnormal acute phase response(ESR or C-reactive protein) and (ii) measured synovitis is anindividual (PIP) joint has been shown to be reliable and tobe related to subsequent X-ray changes in the same joint. Ourfindings show that, in a study of a treatment of RA, it is quitepossible for disease activity measures to appear controlledwhile inflammation continues in the small joints causing radiologicaldamage. This radiological damage is reflected as an adverseoutcome. Hence the paradox of improving disease activity butnot outcome. We argue that small joint inflammation and damageshould be recognized as one aspect of the RA disease processoffering unique information and as such should be assessed independently. KEY WORDS: Rheumatoid arthritis, Disease activity, Small joint synovitis, X-ray     

Neurological "hard" signs and family history of psychosis in schizophrenia.

Previous research found schizophrenics to have significantly more neurological signs than normal controls, even when signs were screened to exclude possible artifacts, and limited to "hard" signs of localizing significance. Schizophrenics with a family history of psychosis also tended to have more neurological signs than those without such a history. The present study examined whether these findings could be confirmed in new samples of schizophrenics and controls, using interview-based DSM-III and DSM-III-R diagnoses. Schizophrenics had significantly more hard signs than controls, and schizophrenics with a family history for psychosis again had more signs than those without this history. When present study data were analyzed alone, as well as when pooled with data from previous research using similar methods, hard signs were significantly greater in both (a) schizophrenics versus controls and (b) schizophrenics with versus without a family history of psychosis, supporting the hypothesis that neurological signs reflect a significant etiologic factor in schizophrenia.     

周期性机械牵张刺激对C_2C_(12)小鼠成肌细胞增殖和有氧代谢能力的影响

目的探讨不同频率牵张刺激对C_2C_(12)小鼠成肌细胞增殖及细胞有氧代谢能力的影响。方法采用Flexercell细胞应力加载装置对体外培养的C_2C_(12)成肌细胞分别加载1、2 Hz不同频率的牵张刺激,牵张幅度为15%,牵张时长为2 h/d,连续进行4 d。以静置培养的C_2C_(12)成肌细胞作为对照组。实验期间通过倒置相差显微镜观察细胞生长状态,利用CCK-8试剂盒测定细胞增殖情况。实验结束后,分别收取各组细胞,经胰酶消化处理,然后利用荧光探针,通过能量代谢设备检测细胞耗氧量比率。结果细胞经机械牵张刺激后,显微镜下细胞形态为典型的长梭形,排列呈现一定方向性,与牵张刺激方向平行,生长状况良好;与对照组细胞相比,1、2 Hz频率牵张刺激均可显著促进细胞增殖(P0.05),且在第3、4 d,1 Hz实验组的增殖情况优于2 Hz实验组;实验组与对照组细胞耗氧量比率均有增加,但各组之间并无显著差异(P0.05)。结论周期性机械牵张刺激能有效促进C_2C_(12)小鼠成肌细胞增殖,且与牵张刺激的频率有关,其中1 Hz的牵张频率最佳,但牵张刺激对C_2C_(12)小鼠成肌细胞的有氧代谢能力无明显影响。     

南京市7岁以下儿童上臂围及上臂围与身高比值调查分析

目的 对2015年南京市7岁以下儿童上臂围及上臂围/身高比值 (AHtR) 进行调查分析,探讨上臂围及上臂围/身高比值在儿童生长发育监测中的意义。方法 采用分层随机整群抽样方法,分男、女各21个年龄组,共测量8 682名7岁以下儿童的上臂围,与体格相关指标进行分析。结果 上臂围在1~3月龄间增长速度较快,3月龄后增长逐渐缓慢;不同年龄组男童上臂围平均值均大于女童组,其中1月~、3~21月、2~<2.5岁、3~<4.5岁及5.5~<7岁组上臂围在性别上差异有统计学意义(P＜0.05);前3个月,AHtR呈现随月龄增加上升趋势,此后随月龄增加逐渐下降。1月~<3岁各年龄组AHtR平均值范围为男童0.169~0.237,女童0.169~0.230;3~<7岁各年龄组AHtR中位数范围为男童0.150~0.160;女童0.140~0.160。上臂围均与体重、身长/高存在正相关性,与体重指数 (BMI)无相关性。结论 南京市7岁以下儿童上臂围存在年龄和性别上的差异,AHtR存在年龄差异,上臂围与其体重相关。     

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.