Coronary artery fistula; coronary computed topography – The diagnostic modality of choice

Coronary artery fistulae (CAF) are rare anomalies. They are vascular communications between the coronary arteries and other cardiac structures, either cardiac chambers or great vessels. There can be considerable variation in the course of a coronary artery fistula. We report a case of a coronary artery fistula between the left circumflex coronary artery and the right and left atria. CAF are often diagnosed by coronary angiogram, however with the advent of new technologies such as Coronary Computed Tomography Angiography (Coronary CTA) the course and communications of these fistulae can be delineated non-invasively and with greater accuracy.     

Breast-feeding and a subsequent diagnosis of measles

Background: Breast-feeding protects against many infectious diseases and may also influence immunization outcomes.
Aim: This study investigated if breast-feeding protects against clinical measles and if it modified the effect of immunization.
Methods: We used logistic regression with data for 10 207 individuals from the 1970 British Cohort study (BCS70). Breast-feeding data were collected at five years of age, and information on clinical measles infection, as well as socio-economic measures was collected at the age of ten years. Breast feeding was categorized as: breast-fed <1 month (n = 1611), breast-fed for 1–3 months (n = 1016), breast-fed for more than three months (n = 1108), breast-feeding of uncertain duration (n = 21) and never breast-fed (n = 6451).
Results: Breast-feeding for more than three months was negatively associated with a diagnosis of clinical measles infection after adjustment for crowding, social class, measles vaccination, parity and sex with an odds ratio (95% confidence interval) of 0.69 (0.60–0.81) compared with those who never breast-fed. Measles vaccination was highly associated with low risk for measles with: 0.14 (0.13–0.16). Age at acute measles infection was not associated with breastfeeding. Breast-feeding did not notably alter measles immunization efficacy.
Conclusion: Immunization against measles provides effective protection against the disease. A more modest reduction in the risk of a measles diagnosis is associated with breast-feeding. The associations with a diagnosis of measles for breast-feeding and measles immunization are independent of each other.     

累及距下跟骰关节损伤跟骨骨折术后远期疗效

[目的] 探讨应用跟骨钢板内固定的方法治疗累及距下、跟骰关节损伤的跟骨骨折的远期临床效果.[方法] 采用钢板内固定的方法治疗跟骨关节内骨折61例63足,男58例,女3例;年龄19～68岁,平均42岁.按Sanders分型:Ⅱ型16足,Ⅲ型30足,Ⅳ型17足.其中急诊手术13足,亚急诊手术50足.[结果] 术后随访时间3～5年,平均4年3个月.术中无重要神经、肌腱损伤.术后有2足切口延迟愈合,1足发生切口皮缘坏死感染;无骨折不愈合和内固定松动及再骨折发生;2足于久走后出现距下关节痛,尚能忍受.按张铁良百分评分法进行评定:优36例,良24例,可3例,总优良率为95.2%.[结论] 选择适当的手术时机,并采用钢板内固定治疗距下、跟彀关节损伤的各型跟骨骨折,可有效恢复Bohlers角和Gissane角,具有固定坚强.并有利于早期踝关节功能锻炼.可以取得较好的远期疗效.     

"Ethnic" variation in childhood lung function may relate to preventable nutritional deficiency

This study aimed to define the differences in lung function between British Caucasian and rural eastern Indian children, and to test the hypothesis that nutrition could account for such "ethnic" variation. To exclude confounders, a rural Indian setting was identified and children were screened for respiratory illness before lung function and nutritional characteristics were measured. Regression equations for this population have already been published. In this study, the lung function differences between rural eastern Indian ( n = 391) and mean predicted lung function for Caucasian children were characterized, matched for height and sex. In addition, stepwise multiple regression models were fitted to investigate the relative associations of lung function differences with body mass index (BMI), occipitofrontal circumference and age. Although the largest differences in the forced expiratory volume in 1 s (FEV 1 ) [girls 28.7 (27.3-30.1), boys 23.4 (22.2-24.6)] and forced vital capacity [girls 27.9 (26.4-29.4), boys 30.7 (29.6-31.9)] [values as mean difference in % predicted (95% confidence intervals)] ever reported between two populations were observed, differences in peak expiratory flow rate (PEFR) were small. BMI was strongly associated with inter-racial differences for FEV 1 for both sexes (boys β= -0.227, girls β= -0.353, p ≤0.001) and PEFR for girls ( β= -0.200, p ≤0.05) ( β= standardized coefficient).

Conclusion: Preventable nutritional factors may play a causal role in determining the FEV 1 differences between rural Indian and Caucasian children. As peak FEV 1 in youth influences respiratory morbidity in later life, it is important to define specific nutrient 1 deficiencies that may relate to poor FEV growth in these children.     

超声引导下经会阴穿刺活检在前列腺癌诊断中的价值

目的：探讨超声引导下经会阴道前列腺穿刺活检诊断前列腺癌的价值。方法：对376例临床怀疑前列腺癌患者行直肠腔内超声引导下经会阴前列腺穿刺活检。分3组。A组：184例,为指检前列腺触及结节或前列腺增大、质硬怀疑前列腺癌者;B组：84例,为因前列腺增生行直肠腔内超声检查发现有异常回声区域者;C组：108例,为指检未及明显硬节而血中PSA＞10ng/ml者。结果：3组穿刺活检阳性率分别为44．5％（82／184）,29．8％（25／84）,57．4％（62／108）。结论：直肠腔内超声引导下经会阴穿刺活检取材准确,能清楚显示穿刺针的径路和深度,避免损伤邻近脏器,可重复操作,明显提高穿刺活检的阳性率。     

少数民族地区双语导医在妇产科门诊的应用

目的：满足少数民族病人的就医需求,提高病人满意度。方法：创造温馨舒适的就医环境,简化服务流程,配备具有双语导医语言能力的护士,通过病人满意度来评估双语导医的有效性。结果：妇产科门诊护理工作的综合满意度达95%,妇产科门诊年门诊量比前一年有所增加,护理纠纷和投诉现象明显减少。结论：双语导医以人为本,满足了少数民族病人的需求,取得了良好效果。     

Are treatments for cervical precancerous lesions in less-developed countries safe enough to promote scaling-up of cervical screening programs? A systematic review

Background  

Since the mid-1990s, there have been growing efforts to prevent cervical cancer in less-developed countries through the development of innovative screening approaches such as visual inspection of the cervix associated with same day management of cervical lesions with cryotherapy or loop electrosurgical excision procedure (LEEP). In the past, promising cancer screening interventions have been widely promoted despite incomplete evidence, only to become the subject of intense controversies about ensuing net health benefit. Because the efficacy and effectiveness of the new protocols for global cervical cancer screening have not been well characterized yet, and as a contribution to the evaluation of the balance between the benefits and risks of these protocols, we reviewed the literature on the safety of cryotherapy and LEEP for cervical intraepithelial neoplasia (CIN) in low- and middle-income countries.     

18F-FDG PET/CT在弥漫性大B细胞淋巴瘤疗效评价中的临床价值

目的 探讨18F-FDG PET/CT在弥漫性大B细胞淋巴瘤（DLBCL）化疗早期及化疗后疗效评价中的临床价值。 方法 回顾性分析采用美罗华联合环磷酰胺+多柔比星+长春新碱+泼尼松方案或环磷酰胺+多柔比星+长春新碱+泼尼松方案化疗的34例DLBCL患者的PET/CT结果。所有患者分别在化疗前、化疗6疗程后行PET/CT,比较化疗前后病灶最大标准化摄取值（SUV_max）及病灶最大直径（D_max）;其中12例患者于化疗前、第2疗程结束后、第4疗程结束后行PET/CT,比较3组间的SUV_max与D_max。对在化疗6疗程后行PET/CT显像已达到完全缓解的8例和部分缓解的10例患者进行临床随访,观察1年无进展生存期（PFS）。 结果 ①34例患者化疗前和6疗程化疗后,SUV_max之间和D_max之间的差异均有统计学意义（t=3.58和2.96,P均 < 0.05）。② 12例患者在化疗前、第2疗程结束后、第4疗程结束后,SUV_max之间和D_max之间的差异均有统计学意义（F=18.64和4.33,P均 < 0.05）;第2疗程结束后与化疗前相比,病灶D_max未见显著变化（t=1.05,P > 0.05）,SUV_max显著降低（t=5.37,P < 0.05）;第4疗程结束后与化疗前相比,SUV_max之间和D_max之间的差异均具有统计学意义（t=8.56和3.90,P均 < 0.05）。③对18例患者进行的随访发现,完全缓解的8例中,PFS > 1年者6例,PFS < 1年者2例;部分缓解的10例中,PFS > 1年者2例,PFS < 1年者8例。 结论 在DLBCL化疗早期及化疗后的疗效评价上,PET比CT更灵敏,以两种显像方法相结合的PET/CT在淋巴瘤疗效评价上具有较高的临床价值。