输尿管软镜钬激光碎石术治疗肾下盏结石的护理体会

总结了输尿管软镜碎石术(钬激光)治疗45例肾下盏结石的围手术期护理经验。39例患者一次碎石成功,单次手术碎石总成功率达到86.67%(39/45),4例经输尿管软镜治疗失败者改体外冲击波碎石成功,2例改经皮肾镜钬激光碎石成功。经过围手术期积极护理配合治疗,本组患者未出现肾周感染、输尿管穿孔、发热、脓肾、输尿管撕脱等并发症。认为经尿道输尿管软镜碎石术(钬激光)治疗肾下盏结石具有操作简便、创伤小、并发症少和碎石高效等特点,可作为肾下盏结石一线治疗方案推荐临床应用。良好的围手术期护理配合,可减少术后并发症,有利于患者术后康复。     

Right ventricular septomarginal trabeculation hypertrophy is associated with disease severity in patients with pulmonary arterial hypertension

To characterize the morphological change in the right ventricle (RV) of patients with pulmonary artery hypertension (PAH) and further explore the correlation between septomarginal trabeculation (SMT) and right ventricular (RV) function, myocardial fibrosis, and exercise capacity in patients with PAH. Sixty untreated PAH patients were prospectively included from May 2016 to April 2017. All patients underwent comprehensive clinical evaluation and cardiac magnetic resonance (CMR). The area and diameter of the basal segment of SMT, and the mass of SMT were measured on cine SSFP images. Relationship between parameters of SMT and RV ejection fraction (RVEF), 6 min walking distance (6MWD), myocardial fibrosis and pulmonary vascular resistance (PVR) were evaluated by Pearson’s correlation and logistic regression. Predictive performance of SMT parameters for reduced RVEF or impaired 6MWD was evaluated by receiver operating characteristics (ROC) analysis. Compared with SMT diameter index and mass index, SMT area index (SMT Ai) in basal segment was the best parameter to show correlation with RVEF (r?=???0.496, P?<?0.001), 6MWD (r?=???0.619, P?<?0.001), and inferior insertion point (I IP) extracelluar volume (ECV) (r?=?0.365, P?=?0.008). ROC showed that SMT Ai had the strongest predictive value for reduced RVEF (AUC?=?0.756), and impaired 6MWD (AUC?=?0.813). SMT parameters were closely correlated with RV systolic function and 6MWD in patients with PAH. SMT Ai is a simple imaging indicator for the severity of PAH.     

Dietary Pattern Is Associated with Obesity in Older People in China: Data from China Health and Nutrition Survey (CHNS)

Background: No studies have been conducted to explore the associations between dietary patterns and obesity among older Chinese people, by considering gender and urbanization level differences. Methods: We analyzed data from the 2009 China Health and Nutrition Survey (2745 individuals, aged ≥ 60 years). Dietary data were obtained using 24 h-recall over three consecutive days. Height, Body Weight, and Waist Circumference were measured. Exploratory factor analysis was used to identify dietary patterns. Multinomial and Poisson regression models were used to examine the association between dietary patterns and Body Mass Index (BMI) status/central obesity. Results: The prevalence of general and central obesity was 9.5% and 53.4%. Traditional dietary pattern (high intake of rice, pork and vegetables) was inversely associated with general/central obesity; modern dietary pattern (high intake of fruit, fast food, and processed meat) was positively associated with general/central obesity. The highest quartile of traditional dietary pattern had a lower risk of general/central obesity compared with the lowest quartile, while an inverse picture was found for the modern dietary pattern. These associations were consistent by gender and urbanization levels. Conclusions: Dietary patterns are associated with general/central obesity in older Chinese. This study reinforces the importance of a healthy diet in promoting healthy ageing in China.     

Quantitative measurement of cartilage volume with automatic cartilage segmentation in knee osteoarthritis

Clinical Rheumatology - To determine the reproducibility of the automatic cartilage segmentation method using a prototype KneeCaP software (version 1.3; Siemens Healthcare, Erlangen, Germany) and...     

Successful management of lung adenocarcinoma with ALK/EGFR co-alterations and PD-L1 over-expression by bevacizumab combined with chemotherapy

Angiogenesis - Anaplastic lymphoma kinase (ALK)/epidermal growth factor receptor (EGFR) co-alterations in adenocarcinomas are rare and no therapeutic consensus is reached. The potentially negative...     

Risk of vertebral fractures: evaluation on vertebral trabecular attenuation value and hydroxyapatite concentration in patients by chest spectral CT

Objectives:To analyze vertebral fractures risk in patients with chest scans by evaluating vertebral hydroxyapatite concentration measured on spectral CT compared to trabecular attenuation value measured on conventional CT.Methods:Our retrospective study reviewed CT of 216 patients. Analysis of vertebral (T11 – L1) hydroxyapatite concentration by spectral imaging and trabecular attenuation value by conventional CT imaging were performed in patients with chest CT examinations. Specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) were performed by using receiver operating characteristic (ROC) curves in patients with and without vertebral fractures.Results:In male patients, vertebral hydroxyapatite concentration had high area under the ROC curve (0.916), by using the optimal threshold of 72.27 mg/cm³, specificity, sensitivity, NPV, and PPV were 91.7, 80.2, 36.7, and 98.7%, respectively. In female patients, vertebral hydroxyapatite concentration also had high area under the ROC curve (0.870), by using the optimal threshold of 74.79 mg/cm³, specificity, sensitivity, NPV, and PPV were 100.0, 77.8, 47.4, and 100.0%, respectively. Area under the ROC curve was significantly different between spectral CT-measured bone hydroxyapatite concentration and conventional CT-measured attenuation value in distinguishing vertebral fractures (p = 0.007 for males; p = 0.005 for females).Conclusions:Quantitative assessment with spectral CT may appear as higher accuracy than that of conventional CT imaging to analyze risk of vertebral fractures. Hydroxyapatite concentration measured with chest spectral CT may be used to evaluate risk of bone fractures.Advances in knowledge:Hydroxyapatite concentration measured with chest spectral CT may be used to evaluate risk of bone fractures.     

稳定期慢性阻塞性肺疾病的抗生素治疗进展

慢性阻塞性肺疾病(COPD)是一种呼吸系统常见的慢性疾病,炎症反应在其发生、发展过程中是导致一系列病理生理改变的重要机制.根据病程可分为稳定期和急性加重期,目前的研究表明对于易出现急性加重的患者,一年内长期使用阿奇霉素或红霉素可减少急性加重风险(A级证据),至于长期使用抗生素的安全性和有效性仍待更多的研究.现针对稳定期COPD的抗生素治疗作一综述,探讨不同给药方式及抗生素种类对COPD患者的益处、不良反应以及耐药性的影响,旨在为临床工作提供参考.     

我国食品来源金黄色葡萄球菌种群结构分析

目的了解我国食源性金黄色葡萄球菌(金葡菌)的种群结构。方法通过全基因组测序方法对2006-2020年我国16个省份收集的763株食源性金葡菌进行多位点序列分型、葡萄球菌蛋白A编码基因(spa)和葡萄球菌染色体mec基因盒(SCCmec)分型, 使用BioNumerics 7.5软件创建基于ST类型的最小生成树。国外进口食品分离到的金葡菌31株被纳入基因组系统发育树的构建。结果 763株金葡菌共鉴定出90个ST型和160个spa型别, 其中20种为新ST型别。72个(72/90, 80.0%)ST型属于22个克隆群, 其中主要型别为CC7、CC1、CC5、CC398、CC188、CC59、CC6、CC88、CC15和CC25, 占82.44%(629/763)。其中优势克隆群中ST型和spa型别随着时间的变化呈多态性变化。耐甲氧西林金葡菌(MRSA)的阳性率为7.60%, 共鉴定出7种SCCmec型别, 以ST59-t437-Ⅳa(17.24%, 10/58)、ST239-t030-Ⅲ(12.07%, 7/58)、ST59-t437-Ⅴb(8.62%, 5/58)、ST338-t437-...