高血压病合并冠心病24小时动态血压监测

本文观察68例高血压病合并冠心病患者动态血压,探讨冠心病心肌缺血,心律失常与血压升高的关系,所有患者均同时进行24小时动态血压及动态心电图监测,结果显示日间血压明显高于夜间(P<0.05),其中以上午6—12小时血压为高,且此时心电监测心肌缺血及心律失常发生率明显高于其他时间。     

The nonrecurrent inferior laryngeal nerve: review of 33 cases, including two on the left side

In 6307 cervicotomies for thyroid and parathyroid excision, 33 cases of nonrecurrent inferior laryngeal nerve were identified (0.52%). The anomaly was observed in 31 cases from 4921 dissections on the right side (0.63%) and in two cases from 4673 dissections on the left side (0.04%). Of the 31 patients who were initially seen with this anomaly on the right side, no innominate (brachiocephalic) artery was found; the right common carotid artery was arising directly from the aortic arch. The aberrant subclavian artery could always be felt against the vertebral column behind the esophagus. The two patients with the anomaly on the left side had a right aortic arch associated with situs inversus viscerum. In one case of invasive thyroid carcinoma, the nerve had to be sacrificed. In all of the other patients, postoperative laryngoscopic findings were normal. The nervous anomaly was of vascular anomaly origin in all cases. Predisposing factors for its onset during aortic arch development are discussed. Before surgical treatment, the diagnosis may only be made if vascular anomaly is suspected. Impairment of swallowing is the only clinical symptom to be looked for. The retroesophageal subclavian artery may be detected on chest x-ray films (20%) or by the compression and distortion of the esophagus shown during barium swallow tests (97%). Although rare on the right side and exceptional on the left, an aberrant nonrecurrent pathway for the inferior laryngeal nerve represents a major surgical risk. This is an additional argument in favor of systematic dissection of the inferior laryngeal nerve during thyroid or parathyroid excision.     

Improved Utilization of ADAS-Cog Assessment Data Through Item Response Theory Based Pharmacometric Modeling

Purpose

This work investigates improved utilization of ADAS-cog data (the primary outcome in Alzheimer’s disease (AD) trials of mild and moderate AD) by combining pharmacometric modeling and item response theory (IRT).

Methods

A baseline IRT model characterizing the ADAS-cog was built based on data from 2,744 individuals. Pharmacometric methods were used to extend the baseline IRT model to describe longitudinal ADAS-cog scores from an 18-month clinical study with 322 patients. Sensitivity of the ADAS-cog items in different patient populations as well as the power to detect a drug effect in relation to total score based methods were assessed with the IRT based model.

Results

IRT analysis was able to describe both total and item level baseline ADAS-cog data. Longitudinal data were also well described. Differences in the information content of the item level components could be quantitatively characterized and ranked for mild cognitively impairment and mild AD populations. Based on clinical trial simulations with a theoretical drug effect, the IRT method demonstrated a significantly higher power to detect drug effect compared to the traditional method of analysis.

Conclusion

A combined framework of IRT and pharmacometric modeling permits a more effective and precise analysis than total score based methods and therefore increases the value of ADAS-cog data.     

“十四五”大型医用设备规划编制基础研究放射治疗组地区调查研究

目的 对中国内地放疗人员及设备现状进行调研,为“十四五”期间放疗设备科学配置和安全有效使用提供数据依据。方法 2020年10月至12月,中国医学装备协会组织专家组以线上问卷的形式开展中国内地放射治疗工作开展情况调研,调研内容包括2020年度全国放疗行业单位、专业人员、设备、技术、设备利用率、未来5年人员及设备增长预估等。数据经过各省级医学会/协会再次确认。结果 中国内地放疗单位1538家,从事放疗专业人员32978人,其中放疗医师18966人、物理师4475人、技术人员9537人;共有直线加速器2139台、⁶⁰Co机57台、近距离治疗机457台、质子重离子机6台、常规模拟机1034台、CT模拟机1208台、MR模拟机89台;能开展三维适形放疗单位1459家、固定野调强1256家、容积调强514家、近距离治疗422家;根据参与调研单位填报的预估数据汇总后,预估未来5年新增放疗医师4868人、物理师2078人、技术人员3796人;预估未来5年新增设备加速器994台、CT定位机896台、MR定位机313台、质子重离子机54台。结论 我国放疗行业发展迅速,在“十四五”期间,放疗行业还有强大的市场需求以及人员与设备增长的需求。增强国产放疗企业的市场竞争力,提高基层医院的设备利用率,提供完善系统的培训,促进标准化、规范化地临床应用等措施,有助于解决放疗资源欠缺、分布不均衡等问题,促进我国放疗事业健康快速发展。     

Likert pain score modeling: a Markov integer model and an autoregressive continuous model

Pain intensity is principally assessed using rating scales such as the 11-point Likert scale. In general, frequent pain assessments are serially correlated and underdispersed. The aim of this investigation was to develop population models adapted to fit the 11-point pain scale. Daily Likert scores were recorded over 18 weeks by 231 patients with neuropathic pain from a clinical trial placebo group. An integer model consisting of a truncated generalized Poisson (GP) distribution with Markovian transition probability inflation was implemented in NONMEM 7.1.0. It was compared to a logit-transformed autoregressive continuous model with correlated residual errors. In both models, the score baseline was estimated to be 6.2 and the placebo effect to be 19%. Developed models similarly retrieved consistent underlying features of the data and therefore correspond to platform models for drug effect detection. The integer model was complex but flexible, whereas the continuous model can more easily be developed, although requires longer runtimes.     

Predictive value of dental readiness and psychological dimensions for oral health-related quality of life in Croatian soldiers: a cross-sectional study

Aim

To determine the predictive value of dental readiness and psychological dimensions for oral health-related quality of life (OHRQoL) in Croatian soldiers.

Methods

The sample consisted of 402 consecutive soldiers aged 21 to 54 years classified into the following groups according to dental readiness: Class 1 – not requiring dental treatment (N = 54), Class 2 – unlikely to need emergency treatment within 12 months (N = 205), and Class 3 – very likely to need treatment within 12 months (N = 143). OHRQoL was assessed by the Oral Health Impact Profile and psychological dimensions by the Brief Symptom Inventory and Dental Anxiety Scale.

Results

Multivariate analysis showed that Class 3 soldiers had higher frequency of psychological discomfort, psychological disability, and physical pain and handicap than Class 1 soldiers (P = 0.019). Multiple linear regression showed that longer military experience, higher level of dental anxiety, and dental unreadiness were significant predictors of lower OHRQoL (P < 0.050) but accounted for low variability. None of the single psychological symptomatic dimensions was a significant predictor of OHRQoL.

Conclusion

Although this study found a moderate association between OHRQoL and clinical, military, demographic, and psychological variables, the significant predictors could be used as a basis for further research of clinical and psychosocial factors of OHRQoL.General and oral health have multiple effects on the quality of life (QoL), which can be decreased by pain, discomfort, and difficulties in everyday physical activities, chewing, speech, hygiene, relaxation, and social contact (1-3). Oral health is an often neglected dimension of health, especially among soldiers, although it affects their QoL and combat readiness (4). An inadequately assessed combat readiness may reduce the effectiveness of the military unit and cause human risks and financial expenses due to transportation of soldiers to health facilities (5). Acute dental conditions may cause losses of over 18 000 man-days per division per year (6,7). Dental non-battle injury emergency rates averaged 16% during Vietnam War (8), and in US military units in peacekeeping missions in Bosnia and Herzegovina the rate of emergency dental conditions was 156-170 per 1000 soldiers per year (9).Psychological personality dimensions might influence self-perceived QoL, thus potentially affecting the reported health impairment and combat disability. We hypothesized that the psychological dimensions that may affect the self-perception of OHRQoL were somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideas, psychoticism, and dental anxiety.The studies of HRQoL in soldiers have so far been sporadic (10,11). There were studies that assessed the impact of oral health on combat readiness or the consequences of wartime events on oral health, but often overlooked the QoL assessment (6,12-14). To the best of our knowledge, no studies so far have assessed the effect of psychological dimensions on the self-perceived OHRQoL.The aim of the research was to explore the predictive value of dental readiness and psychological dimensions for OHRQoL. The hypothesis was that OHRQoL was a specific dimension of combat readiness that was significantly correlated with clinically assessed dental readiness and psychological symptomatic dimensions.     

Acquired brain injury: a proposal for its definition, diagnostic criteria and classification

Acquired brain injury is a heterogeneous clinical concept that goes beyond the limits of the classical medical view, which tends to define processes and diseases on the grounds of a single causation. Although in the medical literature it appears fundamentally associated to traumatic brain injury, there are many other causes and management is similar in all of them, during the post-acute and chronic phases, as regards the measures to be taken concerning rehabilitation and attention to dependence. Yet, despite being an important health issue, today we do not have a set of diagnostic criteria or a classification for this condition. This is a serious handicap when it comes to carrying out epidemiological studies, designing specific care programmes and comparing results among different programmes and centres. Accordingly, the Extremadura Acquired Brain Injury Health Care Plan working group has drawn up these proposed diagnostic criteria, definition and classification. The proposal is intended to be essentially practical, its main purpose being to allow correct identification of the cases that must be attended to and to optimise the use of neurorehabilitation and attention to dependence resources, thereby ensuring attention is provided on a fair basis.