Age and sex differences in the management of ischaemic heart disease

Objective

To investigate age and sex differences in the utilisation of hospital services for ischaemic heart disease.

Design

Analysis of routine mortality data and hospital activity data.

Setting

South West Thames Regional Health Authority.

Subjects

Residents of the South West Thames Regional Health Authority who in 1991 either died from ischaemic heart disease or were admitted to an NHS hospital in England and Wales with a main diagnosis of ischaemic heart disease.

Main outcome measures

Ratio of consultant episodes to deaths from ischaemic heart disease (as a proxymeasure of the utilisation of hospital care), and the percentages of consultant episodes in which further investigation (angiography or catheterisation) or revascularisation treatment (coronary artery bypass grafting or angioplasty) were carried out.

Results

The ratio of episodes to deaths was similar in men and women (odds ratio for men vs. women 0.96, 95% confidence intervals 0.90 to 1.03). The percentage of episodes in which further investigation was carried out was higher in men than women (odds ratio for men vs. women 1.46, 95% confidence intervals 1.25 to 1.70) as was the percentage of episodes in which revascularisation treatment was carried out (odds ratio for men vs. women 1.46, 95% confidence intervals 1.20 to 1.77). The ratio of episodes to deaths, the percentage of episodes in which further investigation was carried out, and the percentage of episodes in which revascularisation treatment was carried out all declined with age (all p values <0.001).

Conclusions

Women with ischaemic heart disease are as likely as men to be admitted to hospital, but afteradmission are less likely to undergo further investigation and revascularisation treatment. Elderly patients with ischaemic heart disease are less likely than younger patients to be admitted to hospital; after admission, they are also less likely to undergo further investigation and revascularisation treatment. Further research is needed to determine whether these age and sex differences in the use of hospital services are clinically justified.     

老年急性结石性胆囊炎手术治疗的临床分析

目的 探讨老年人急性胆囊炎的临床特点和手术治疗经验.方法 选取本院及常州市武进人民医院2009年1月～2012年12月收治的老年急性结石性胆囊炎患者52例,进行手术治疗后的回顾性分析.结果 手术治疗后并发症以水电解质紊乱、肺部感染、肾功能不全、切口裂开、切口感染为常见,共18例（13%）,所有患者都无脏器或胆道损伤.结论 应根据老年人急性胆囊炎特殊的临床特点,及时选择合适的手术时机及手术方式.早期手术可取得良好的治疗效果.     

体外循环下治疗布-加综合征合并下腔静脉血栓形成(附49例病例报告)

目的总结在体外循环辅助下,经右房切口治疗合并下腔静脉血栓形成的布-加氏综合征的治疗经验。方法回顾我院自2002年9月至2010年7月共计49例在体外循环辅助下,经右心房切口治疗合并下腔静脉血栓的布加氏综合征的临床病例和随访资料。结果全组病人均成功的在体外循环辅助下完成经右房切口下腔静脉狭窄段扩张及血栓取出术。术中在手指破膜后再使用3.0×4.0cm球囊进行扩张。围手术期病人无死亡,无急性肺栓塞等严重并发症的发生。术后随访0～36个月,所有病人术后症状明显缓解,腹水及下肢水肿减轻至消失。1例病人术后1年后出现再狭窄,经股静脉行下腔静脉球囊扩张后好转。全组病人术后随访未见有血栓形成。结论在体外循环下,经右房切口对于合并下腔静脉血栓的布-加氏综合征是一种安全有效的治疗方法。     

心脏瓣膜病合并感染性心内膜炎的外科治疗

目的探讨心脏瓣膜心内膜炎的临床特点、手术时机选择和围术期处理。方法回顾分析26例心脏瓣膜病合并感染性心内膜炎的临床表现、治疗经过和临床预后。结果术前死于恶性心力衰竭1例,术后随访25例,随访时间3个月～6年,无术后死亡,无再发感染。结论心脏瓣膜病合并感染性心内膜炎外科治疗风险大,死亡率高,正确掌握手术指征、术中彻底清除感染灶和围术期正确处理是治疗的关键。     

双切口套法预防开放性胃肠手术后切口感染的临床效果观察

目的：探讨双切口套法预防开放性胃肠手术后切口感染的临床效果。方法选取2013年3月~2014年8月在本院实施开放性胃肠手术的75例患者作为研究对象,随机分为观察组(38例)和对照组(37例)。观察组在开放性胃肠手术中采用双切口套法,对照组术中不使用任何切口保护套。比较两组的手术时间、术后首次排气时间、首次排便时间、住院时间及切口感染率。结果两组的手术时间比较,差异无统计学意义(P>0.05)。观察组的术后首次排气时间、首次排便时间及住院时间显著短于对照组,差异有统计学意义(P<0.05)。观察组的切口感染率为2.63%,显著低于对照组的16.22%,差异有统计学意义(P<0.05)。结论双切口套法可以明显降低开放性胃肠手术后的切口感染率,提高临床疗效。     

Resting energy expenditure and its determinants in hemodialysis patients

OBJECTIVE: Chronic kidney disease is associated with several metabolic disturbances that can affect energy metabolism. As resting energy expenditure (REE) is scarcely investigated in patients on hemodialysis (HD) therapy, we aimed to evaluate the REE and its determinants in HD patients. DESIGN: Cross-sectional study. SETTING: Dialysis Unit of the Nephrology Division, Federal University of S?o Paulo, Brazil. SUBJECTS: The study included 55 patients (28 male, 41.4+/-12.6 years old) undergoing HD therapy thrice weekly for at least 2 months, and 55 healthy individuals pair matched for age and gender. Subjects underwent fasting blood tests, as well as nutritional assessment, and the REE was assessed by indirect calorimetry. RESULTS: REE of HD patients was similar to that of pair-matched controls (1379+/-272 and 1440+/-259 kcal/day, respectively), even when adjusted for fat-free mass (P=0.24). REE of HD patients correlated positively with fat-free mass (r=0.74; P<0.001) and body mass index (r=0.37; P<0.01), and negatively with dialysis adequacy (r=-0.46; P<0.001). No significant univariate correlation was found between REE and age, dialysis vintage, serum creatinine, urea, albumin, bicarbonate, parathyroid hormone (PTH) or high-sensitivity C-reactive protein (CRP). In the multiple linear regression analysis, using REE as dependent variable, the final model showed that besides the well-recognized determinants of REE such as fat-free mass and age, PTH and CRP were the independent determinants of REE in HD patients (R (2)=0.64). CONCLUSIONS: In this study, the REE of HD patients was similar to that of healthy individuals, even with the positive effect of secondary hyperparathyroidism and inflammation on REE of these patients.     

肠缺血再灌流时肠内给予葡萄糖能增加肠粘膜血流量

目的探讨肠缺血再灌流损伤时肠内营养与肠粘膜血流改变的关系.方法SD大鼠分为三组,先制作空肠袋,然后将激光多谱勒探头和肠粘膜张力计放置在空肠袋两端,分别向袋内注射丙氨酸、葡萄糖及甘露醇.用动脉夹阻断肠系膜上动脉血流60分后,再恢复灌流60分.分别测定肠粘膜血流量和局部PCO2张力(PrCO2).结果缺血再灌流过程中,与甘露醇组比较,葡萄糖组粘膜血流量显著增加,PrCO2降低.结论缺血再灌流过程中,肠内给予葡萄糖能增加肠粘膜血流量,对缺血再灌流损伤的肠道提供保护作用.     

利用CRISPR-Cas9系统敲除小鼠黑色素瘤细胞系MATP基因的初步研究

目的利用CRISPR/Cas9系统,敲除小鼠黑色素瘤细胞系的MATP基因,为MATP基因的功能研究奠定基础。方法利用http://crispr.mit.edu/网站,设计针对MATP的特异性引物,并将引物链接到pCAS9/gRNA1载体。将阳性载体转染小鼠黑色素瘤细胞系B16F10,利用无限稀释的方法获得转染后的单克隆细胞株。提取不同细胞株的基因组,通过测序的方法进一步筛选出发生MATP基因切割的细胞株,并利用Western-blot的方法验证MATP的表达情况。结果成功获得了3株MATP基因敲除的细胞株,Western-blot结果表明,该细胞株不表达MATP蛋白。结论利用pCAS9/gRNA1载体,可以实现B16F10细胞系MATP基因的敲除。     

脾切除对结直肠癌切除术后的影响：一项多中心、嵌入式、配对队列研究

目的探讨医源性脾脏损伤脾切除对结直肠癌切除患者术后长期生存的影响。方法对1990年1月1日至1999年12月31日10年间行结直肠癌手术切除并附带脾切除患者进行病例配对回顾研究。分析患者年龄、性别、依据美国麻醉学医师协会（ASA）标准评估的身体状况、疾病分期、手术类型及预后等资料。配对病例来自同一医疗中心，性别、年龄、疾病分期及手术类型完全相同。手术附带脾切除患者为试验组，未切脾者为对照组。结果55例患者行医源性脾切除术，对照组在年龄、性别、身体状况、疾病分期及手术类型上与之匹配。随访时间（从手术开始到患者死亡或者最后一次随访1为2～205个月（中位随访时间为43个月）。Cox比例危险度模型进行Kaplan-Meier法生存分析发现两组间差异有显著性意义，不切除脾脏对患者生存有利（危险度1．8，95％可信区间为1-3．3，P=0．0399），未切脾组与切脾组5年生存率分别为70％和47％，10年生存率分别为55％和38％。结论结直肠癌患者在行结肠或直肠切除时，因医源性脾脏损伤而切除脾脏者，预后较差。