采用不同临床评分系统评估某医院狼疮激素用量的合理性分析

  目的  采用系统性红斑狼疮疾病活动指数2000（systemic lupus erythematosus disease activity index 2000，SLEDAI-2000）、英国狼疮评估组指数2004（revised british Isles lupus assessment group index 2004，BILAG-2004）、系统性红斑狼疮活动性测定（systemic lupus activity measure-revised，SLAM-R）三种评分系统评估糖皮质激素（glucocorticoid，GC）在系统性红斑狼疮治疗中的规范化用量。  方法  收集51例初诊的系统性红斑狼疮病人的临床资料，分别应用SLEDAI-2000、BILAG-2004、SLAM-R三种评分系统判断狼疮的活动度。进行三种评分和泼尼松用量（或转换后等同的泼尼松用量）的相关性分析。  结果  三种评分系统均与泼尼松的累计剂量和每日剂量成正相关，其中BILAG-2004评分与泼尼松用量的相关性最好（r=0.827，P<0.001），SLAM-R评分与泼尼松用量的相关系数最低（r=0.512，P<0.001），SLEDAI-2000评分与泼尼松用量相关系数（r=0.584，P<0.001）。泼尼松的不同用法与不同的器官/系统受累有关。  结论  三种评分系统均可为临床上泼尼松用量的选择提供参考，但BILAG-2004评估系统更全面可靠。     

腹腔镜手术体位对脑血管阻力及血流量的影响

目的 探讨腹腔镜手术体位对脑血管阻力及血流量的影响.方法 选取2020年1～7月在皖南医学院第一附属医院择期行腹腔镜手术的女性患者60例,按随机数字表法,分为试验组(T组)与对照组(R组),每组30例.试验组按术中体位需要调整为头低位(-30°),对照组为头高位并向左侧倾斜(30°).采用无创多普勒超声测量,比较T1(...     

Opportunistic Screening Using Low-Dose CT and the Prevalence of Osteoporosis in China: A Nationwide,Multicenter Study

Opportunistic screening for osteoporosis can be performed using low-dose computed tomography (LDCT) imaging obtained for other clinical indications. In this study we explored the CT-derived bone mineral density (BMD) and prevalence of osteoporosis from thoracic LDCT in a large population cohort of Chinese men and women. A total of 69,095 adults (40,733 men and 28,362 women) received a thoracic LDCT scan for the purpose of lung cancer screening between 2018 and 2019, and data were obtained for analysis from the China Biobank Project, a prospective nationwide multicenter population study. Lumbar spine (L₁–L₂) trabecular volumetric bone mineral density (vBMD) was derived from these scans using quantitative computed tomography (QCT) software and the American College of Radiology QCT diagnostic criteria for osteoporosis were applied. Geographic regional differences in the prevalence of osteoporosis were assessed and the age-standardized, population prevalence of osteoporosis in Chinese men and women was estimated from the 2010 China census. The prevalence of osteoporosis by QCT for the Chinese population aged >50 years was 29.0% for women and 13.5% for men, equating to 49.0 million and 22.8 million, respectively. In women, this rate is comparable to estimates from dual-energy X-ray absorptiometry (DXA), but in men, the prevalence is double. Prevalence varied geographically across China, with higher rates in the southwest and lower rates in the northeast. Trabecular vBMD decreased with age in both men and women. Women had higher peak trabecular vBMD (185.4 mg/cm³) than men (176.6 mg/cm³) at age 30 to 34 years, but older women had lower trabecular vBMD (62.4 mg/cm³) than men (92.1 mg/cm³) at age 80 years. We show that LDCT-based opportunistic screening could identify large numbers of patients with low lumbar vBMD, and that future cohort studies are now required to evaluate the clinical utility of such screening in terms of fracture prevention and supporting national health economic analyses. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)..     

PBL联合CBL教学法在胃肠外科临床实习教学中的应用研究

目的 探讨“以问题为基础”的教学模式(problem-based learning,PBL)联合“以病例为基础”(case-based learning,CBL)的教学模式在胃肠外科临床实习生教学中的实际应用成效。 方法 该课题选取2016年4—5月皖南医学院弋矶山医院2012级临床本科专业实习生96位,随机将其分为研究组和对照组,每组各48位,研究组采用PBL联合CBL教学模式,对照组按照传统的“填鸭式”教学法(lecture-based learning,LBL)授课模式,对比2种教学模式的教学效果,采用问卷调查形式和理论考试评估教学效果。采用SPSS 15.0统计学软件进行数据分析,计量资料以x±s表示,组间比较采用t检验;计数资料的组间比较采用χ2检验,P<0.05为差异有统计学意义。 结果 研究组理论知识成绩、综合能力成绩和总成绩均高于对照组,2组间比较差异均有统计学意义(均P<0.05)。研究组实习生在提高自身自学能力、临床思维能力、分析和解决问题能力、沟通表达能力、团队协作能力、资料查询效率等方面均高于对照组,2组间差异均具有统计学意义(均P<0.05)。 结论 PBL联合CBL教学模式可激发学生的学习兴趣,提高实习生的学习主动性,提升实习生分析、解决问题的能力,在胃肠外科的实际教学中能明显提高教学效果,学生的综合能力得以全方位的提升,值得在临床教学中推广。      

三角函数法计算套管安全活动角度在23G双通道硅油取出术的应用

目的：使用UBM在术前测量巩膜前表面到硅油泡的距离,利用三角函数的计算公式,从而计算出23G套管的安全活动角度,最大限度避免术中取油时损伤视网膜。

方法：从2017/03-2017/09,共选取15例硅油眼患者,年龄32～69岁,首次手术均为视网膜脱离,左眼10例,右眼5例,均采用23G套管通过23G灌注管连接5 mL注射器,直接取油的方法。术前均通过UBM测量角膜缘后4 mm,2：00和10：00位的巩膜壁前表面到硅油泡的距离,定义为 “A”; 23G套管的长度为4 mm,定义为 “C”; 将巩膜套管最大活动角度时的巩膜内壁的宽度定义为 “B”; “A”,“B”,“C”构成直角三角形。利用三角函数计算出最大活动角度时“A”和“C”的正弦值,参考三角函数表得出23G套管的安全活动角度。根据此角度指导术中硅油取出时23G套管的活动范围,同时观察取油时间和穿刺口视网膜情况。

结果：所有患者均顺利取出硅油,所用时间平均为4.78±0.13min。穿刺管口处视网膜未见任何新发视网膜裂孔和其他损伤。2：00位巩膜壁前表面到硅油泡的距离为0.82～2.81(1.62±0.41)mm,10：00位为0.98～2.19(1.71±0.34)mm,2：00位巩膜套管的安全活动角度(指套管和巩膜壁的角度)不能低于11～44(24.14±6.95)°,10：00巩膜套管的安全活动角度不能低于14～33(25.45±5.41)°。模拟图形构建,计算穿刺套管安全活动角度为不低于52°。

结论：利用三角函数的方法,结合UBM测量数据,计算套管安全活动角度可以有效的指导23G硅油取出术中套管针的活动范围,本研究建议套管移动角度不要低于50°,可以最大限度的避免医源性裂孔的发生。     

Pidotimod,an immunostimulant in pediatric recurrent respiratory tract infections: A meta-analysis of randomized controlled trials

ObjectivesRecurrent respiratory tract infections (RRTIs) remain a great challenge to pediatricians, because they can increase the risk of various complications and there is no confirmed effective treatment. In the present study, we aimed to assess the effectiveness and safety of pidotimod (PDT), an immunostimulant, in treatment of RRTIs in children aged 14 years and under.MethodsPubMed, EMBASE, Web of Science, Cochrane Library, ClinicalTrials.gov, CBM and CNKI were searched from their inception up to February 2018. All randomized controlled trials (RCTs) using PDT with various treatment durations and enrolling participants <14 years of age were included in the present review. The interventions were PDT plus conventional treatment (e.g. anti-bacterial and antiviral therapy) or PDT alone versus the conventional treatment plus placebo or conventional treatment alone.ResultsA total of 29 RCTs consisting of 4344 pediatric patients were included in this meta-analysis. Ten RCTs were published from Italy, Russia or Greece, and 19 RCTs were published by Chinese groups. However, appropriate randomization methods were only used in 15 trials. Only one study had explicit allocation concealment. Since only eight RCTs were double-blind and placebo controlled, the evidence was not assessed as high quality. The meta-analysis indicates that treatment with PDT resulted in a significant increase in the proportion of participants who had lower RTIs (RR 1.59; 95% CI 1.45–1.74, p < 0.00001) compared with the conventional treatment. PDT could significantly decrease the duration of cough and fever. The number of patients in using antibiotics was also remarkably decreased in the PDT treatment group. Moreover, PDT administration improved the levels of serum immunoglobulin (IgG, IgA, or IgM) and T-lymphocyte subtypes (CD3+, CD4+). Besides, PDT administration did not increase the risk of adverse events of any cause (RR = 1.05, 95% CI 0.72–1.54, p = 0.80).ConclusionsPDT showed a good efficacy and safety in treatment of pediatric RRTIs. Further high-quality and large-scale RCTs are still required to provide confirmatory evidence.Trial registration: The protocol of this study can be found at PROSPERO with the registration number of CRD42018093541.     

A Case Report of Double‐Chambered Right Ventricle Associated with Subaterial Ventricular Septal Defect and Rupture of Right Coronary Sinus Aneurysm

Double‐chambered right ventricle (DCRV) is a rare congenital heart disease in which the right ventricle (RV) is divided into two chambers by anomalous muscle bundles. Here, we report a case of DCRV associated with subarterial ventricular septal defect (VSD) and rupture of right coronary sinus aneurysm (RCSA); the patient was diagnosed by echocardiography and later confirmed by surgical operation.     

The Association Between Erectile Dysfunction and Sleep Parameters: Data from a Prospective,Controlled Cohort

BackgroundMany studies have reported a possible strong relationship between poor sleep quality, sleep disruption, sleep disorders, and erectile dysfunction (ED).AimThis study aimed to investigate the relationship between sleep quality and ED.MethodsPatients diagnosed with ED by the International Index of Erectile Function-5 (IIEF-5) questionnaire and 72 healthy adult men were included. Participants completed the questionnaire, underwent a detailed physical examination, and provided blood samples. All enrolled subjects then wore the Fitbit Charge 2 that monitored sleep throughout the night.OutcomesPrimary outcome measures included scores on the IIEF-5, General Anxiety Disorder-7 (GAD-7) scale, Patient Health Questionnaire-9 (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), and sleep monitoring parameters obtained from Fitbit Charge 2.ResultsFinally, a total of 107 ED patients and 72 healthy adult men were enrolled in this study. Univariate analysis indicated that the GAD-7 (P < .001), PHQ-9 (P < .001), and PSQI scores (P < .001) significantly differed according to the presence/absence of ED. Further multiple logistic regression analysis showed that the PHQ-9 (odds ratio [OR]: 1.227, 95% confidence interval [CI]: 1.070-1.407; P = .003) and PSQI scores (OR: 1.220, 95%CI: 1.116-1.334; P < .001) were independent risk factors for ED. Analysis of objective sleep monitoring parameters showed that total sleep time (TST) (P = .001), sleep onset latency (SOL) (P = .026), deep sleep (N3) duration (P = .011) and rapid eye movement (REM) sleep duration (P < .001) were significantly differed between the 2 groups, with durations in the ED group significantly lower than those in the non-ED group. In addition, receiver operating characteristic (ROC) curve analysis indicated that the REM sleep duration had the highest area under the curve (AUC: 0.728) of all sleep parameters, with a P value < .001, a sensitivity of 72.2% and a specificity of 73.8%.Clinical ImplicationsUrologists and andrologists should be aware of impacted sleep quality and depression in ED patients.Strengths & LimitationsThe strength of this study is that the relationship between sleep quality and ED was assessed with both a subjective scale and an objective sleep monitoring tool. However, our study only described an association between sleep quality and ED and did not establish a causal relationship.ConclusionSleep parameters are strongly associated with ED, indicating that poor sleep quality may increase the likelihood of ED.Wu X, Zhang Y, Zhang W, et al. The Association Between Erectile Dysfunction and Sleep Parameters: Data from a Prospective, Controlled Cohort. J Sex Med 2022;19:1387–1396.