卡培他滨、奈达铂同步化疗联合放疗治疗老年食管癌临床研究

目的 评价同步放化疗在老年食管癌治疗中的应用价值。方法 87例老年食管癌患者随机分为同步放化疗组(42例)和单独放疗组(45例),随访2组临床疗效及毒副反应。结果 同步放化组和单放组的总有效率(CR+PR)分别为92.9%、77.8%,2组比较差异有统计学意义(P<0.05);同步放化组和单放组的1﹑2年生存率分别为85.7%、59.5%,66.7%、37.8%,生存率比较差异有统计学意义(P<0.05);同步放化疗组的毒副反应高于单独放疗组(P<0.05)。结论 同步放化疗能提高老年食管癌患者总有效率及1、2年生存率,但亦显著增加了放疗副反应。     

Effect of intensive counselling on the quality of dietary fats in pregnant women at high risk of gestational diabetes mellitus

As part of a feasibility study to prevent gestational diabetes mellitus (GDM), we evaluated the effect of an intensive dietary therapy on quality of diet, weight gain and birth weight in women at high risk of GDM. Women with risk factors for GDM (n 54) were randomly assigned from April 2005 to May 2006 to a lifestyle intervention group (n 27) including dietary advice six times during pregnancy or to a close follow-up group (n 27) in a community-based setting in Finland. Dietary intake was recorded three times during pregnancy using 4?d food records. The main outcome was the incidence of GDM. The secondary outcomes were the changes in nutrient intake, weight gain and birth weight. Overall, seventeen (65?%) women in the intervention group and eighteen (69?%) women in the close follow-up group returned all three food records. PUFA intake increased (P?=?0·008) during pregnancy in the intervention as compared to the close follow-up group. There were no clear differences in the changes of saturated fat or fibre intake between the groups. Intensive dietary education resulted in a somewhat lower weight gain during pregnancy (P?=?0·062) and higher birth weights of the infants (P?=?0·047) without an effect on macrosomia as compared to the close follow-up group. Individualised counselling by a clinical nutritionist as part of a lifestyle intervention improved the quality of dietary fat intake in pregnant women at high risk of GDM.     

Midterm outcome after rotator cuff reconstruction

Rotator cuff tear is a common degenerative shoulder disorder that often requires surgical treatment. However, the correlation between the size of the tear and the functional results is somewhat controversial, which generates inconsistency among orthopaedic surgeons about the indications for and methods of rotator cuff reconstruction. Aims: The aim of the authors was to evaluate the midterm functional outcome after rotator cuff reconstruction and the possible connection between the results and the surgical technique or the postoperative ultrasound examination. In addition, recently published corresponding studies are also reviewed by the authors. Methods: Twenty-seven patients with full thickness rotator cuff tear were enrolled into the study who were treated either by arthroscopic (14 patients) or by open repair (13 patients) technique. Functional results were assessed using clinical tests. Ultrasound examination was also performed. Results: The average postoperative Constant Score was 73, the average DASH (Disabilities of the arm, shoulder and hand score) was 14. The Constant scores averaged 80 for the arthroscopic and 70 for the open group. Ultrasound examination showed partial or full thickness retear of the cuff in 40% of the cases. Conclusion: More than 70% of the patients had excellent or good results two years after the reconstruction. The change in the acromiohumeral distance or partial retear failed to affect the results significantly, but full thickness tear had an effect on them.     

Spinal mechanisms contribute to differences in the time to failure of submaximal fatiguing contractions performed with different loads

This study compared the mechanisms that limit the time to failure of a sustained submaximal contraction at 20% of maximum when the elbow flexors either supported an inertial load (position task) or exerted an equivalent constant torque against a rigid restraint (force task). The surface electromyogram (EMG), the motor-evoked potential (MEP) in response to transcranial magnetic stimulation (TMS) of the motor cortex, and the Hoffmann reflex (H-reflex) and maximal M-wave (Mmax) elicited by electrical stimulation of the brachial plexus were recorded in biceps brachii during the two tasks. Although the time to failure for the position task was only 44% of that for the force task, the rate of increase of the average EMG (aEMG; % initial MVC) and MEP area (% Mmax) did not differ significantly during the two tasks. At task failure, however, the increases in normalized aEMG and MEP area were significantly (P < 0.05) greater for the force task (36.4 and 219.9%) than for the position task (22.4 and 141.7%). Furthermore, the superimposed mechanical twitch (% initial MVC), evoked by TMS during a brief MVC of the elbow flexors immediately after task failure, was increased similarly in both tasks. Although the normalized H-reflex area (% Mmax) decreased during the two fatiguing contractions, the reduction was more rapid and greater during the position task (59.8%) compared with the force task (34.7%). Taken together, the results suggest that spinal mechanisms were a major determinant of the briefer time to failure for the position task.     

电视胸腔镜治疗老年非小细胞肺癌的疗效分析

目的：探讨电视胸腔镜治疗老年非小细胞肺癌的疗效。方法：将我院收治的非小细胞肺癌患者60例随机分为观察组和对照组,每组30例,观察组实施电视胸腔镜治疗,对照组给予传统手术治疗,对比疗效。结果：观察组患者的治愈率显著高于对照组,差异具有显著性（P＜0.05）。结论：电视胸腔镜手术治疗非小细胞肺癌具有创伤小、痛苦少、恢复快、安全性大等优点,值得推荐。     

整合术前营养指标的列线图对中老年胸段食管鳞状细胞癌患者预后的影响

目的 利用营养风险筛查(NRS)-2002及血液营养指标在术前对中老年胸段食管鳞癌患者进行营养状态评估，并建立列线图，探索对长期生存预后的影响。方法 回顾性分析接受食管癌根治术的388例中老年患者，术前采集外周血进行营养标志物前白蛋白(PAB)、白蛋白(ALB)和血红蛋白(Hb)的检测，参照NRS-2002工具标准，进行营养风险评分，并根据最佳临界值将营养指标分为3组，与生存预后的关系采用Kaplan-Meier法计算生存率并Log-rank法检验，Cox模型单因素及多因素分析。然后，通过结合有意义的营养指标及临床病理参数建立列线图个体化预测中老年食管鳞癌患者的无进展生存率及总生存率，通过校准曲线图、一致性指数(C-index)和决策曲线图进一步验证结合营养指标的预后列线图预测食管鳞癌术后生存的准确性。结果 全组患者的中位总生存期(OS)为36个月，1、3、5年总生存率分别为96.6%、50.2%和33.0%。单因素分析的结果显示，T分期、N分期、TNM分期、分化程度、肿瘤位置、Hb、ALB、PAB和NRS-2002评分均与中老年胸段食管鳞癌患者的OS密切相关(均P<0.05);...