射频消融术治疗晚期胰腺癌的中远期疗效分析

目的 探讨射频消融术在晚期胰腺癌患者治疗中的效果及中远期随访情况.方法 回顾性分析304医院2008年1月-2012年12月行射频消融术治疗晚期胰腺癌28例患者的围手术期临床资料,并将该组资料与同期行姑息性手术治疗的140例晚期胰腺癌患者的临床资料进行对比分析,并对两组患者术后中远期的随访情况进行对比分析.结果 28例行射频消融术的晚期胰腺癌患者,肿瘤的平均最大直径为(4.8±1.6) cm,术中平均射频消融时间为(17.7±4.3) min,术后无胰瘘患者,无围手术期死亡患者,围手术期疼痛缓解率为88.9％.23例患者获得随访,随访率为82.1％,其1个月、6个月、1年的生存率分别为95.7％、65.2％、38.2％,平均生存时间为(14.6±2.2)个月,优于同期行姑息性手术治疗的晚期胰腺癌患者(97.4％、45.3％、19.1％,P=0.0306).结论 对于不能行根治性切除的晚期胰腺癌患者,射频消融术是一种有效的治疗手段,能相对延长患者的生存时间.     

Why Don’t Neurosurgery Patients Return for Neuropsychological Follow-Up? Predictors for Voluntary Appointment Keeping and Reasons for Cancellation

Neuropsychological follow-up appointments are important for patients who have had intracranial surgery because cognitive deficits are common in this population and prognosis is not always optimistic. Unfortunately some patients cancel or do not show up. The current study attempted to identify predictors of non-attendance in this population. A total of 428 patients recruited over 2 years with a scheduled neuropsychological follow-up appointment after intracranial surgery in the St. Elisabeth Hospital, Tilburg, The Netherlands were included. Demographic, clinical, and other miscellaneous variables were extracted from medical records. Of this total population, 42% were non-attenders. The predictors of non-attendance were as follows: patients who had subdural hematomas and/or malignant tumors (compared to those who had other diagnoses prior to intracranial surgery); those who had been transferred to another hospital (compared to those sent home); those who had been referred for further medical treatment before the appointment; a shorter time interval between discharge and follow-up appointment; and finally, if the patient’s home was further away from the hospital. Patients who undergo intracranial surgery are a very heterogeneous group with different needs. Neuropsychological follow-up after surgery may be important for some patients (the better-functioning and/or those with cognitive complaints) but perhaps not for others (those with more severe prognoses and/or no complaints). We provide suggestions which should increase attendance in those who could benefit from follow-up neuropsychological assessment.     

Long-term changes in heart rate variability in elementary school–aged children with sleep-disordered breathing

ObjectiveSleep-disordered breathing (SDB) in adults and children has been associated with reduced heart rate variability (HRV) indicative of autonomic dysfunction, which in turn is associated with an increased risk for cardiovascular morbidity. However, the long-term effects of pediatric SDB that has either resolved or remains unresolved on HRV are unknown.MethodsForty Children with previously diagnosed SDB and 20 non snoring controls underwent repeat overnight polysomnography (PSG) four years after the original diagnosis. At follow-up, children aged 11 to 16 years were categorized into resolved (absence of snoring and obstructive apnea hypopnea index [OAHI] ⩽ 1) or unresolved (continued to snore or had an OAHI > 1) groups. HRV was assessed using power spectral analysis for each sleep stage.ResultsThere were no group differences in age, sex or body mass index (BMI) z score. Both the resolved and unresolved SDB groups showed significant improvement in OAHI. The control, resolved, and unresolved groups all showed a significant reduction in total power (P < .001), low-frequency (LF) power (P < .05), high-frequency (HF) power (P < .001), and an increase in the LF/HF ratio (P < .001) from baseline to follow-up in all sleep stages.ConclusionsHRV did not differ between non snoring children and children with resolved and unresolved SDB four years after initial diagnosis, concomitant with a significant reduction in OAHI in both SDB groups. All groups demonstrated a decrease in HRV from baseline to follow-up which may reflect an age-related phenomenon in these children.     

The impact of weight reduction in the prevention of the progression of obstructive sleep apnea: an explanatory analysis of a 5-year observational follow-up trial

BackgroundObstructive sleep apnea (OSA) is a chronic progressive disease, and it is well-documented that severe OSA is associated with an increased cardiovascular morbidity and mortality. Weight reduction has been shown to improve OSA; however, we need further evidence to determine if it may prevent the progression of OSA in the long term. The aim of our study was to assess the impact of weight change during a 5-year observational follow-up of an original 1-year randomized controlled trial.MethodsThe participants were divided into the two groups according to the weight change at 5-year follow-up using the 5% weight loss as a cutoff point, which was later referred to as the successful (n = 20) or unsuccessful groups (n = 27). The change in apnea–hypopnea index (AHI) was the main objective outcome variable.ResultsFifty-seven patients participated in the 5-year follow-up. At 5 years from the baseline, the change in AHI between the groups was significant in the successful group (−3.5 [95% confidence interval {CI}, −6.1 to −0.9]) compared with the unsuccessful group (5.0 [95% CI, 2.0–8.5]) (P = .002). Successful weight reduction achieved an 80% reduction in the incidence of progression of OSA compared to the unsuccessful group (log-rank test, P = .016).ConclusionsA moderate but sustained weight reduction can prevent the progression of the disease or even cure mild OSA in obese patients.     

EEG network connectivity changes in mild cognitive impairment — Preliminary results

Resting state EEGs were compared between patients with amnestic subtype of mild cognitive impairment (aMCI) and matched elderly controls at two times over a one year period. The study aimed at investigating the role of functional connectivity between and within different brain regions in relation to the progression of cognitive deficit in MCI. The EEG was recorded in two sessions during eyes closed and eyes open resting conditions. Functional brain connectivity was investigated based on the measurement of phase synchronization in different frequency bands. Delta and theta synchronization characteristics indicated decreased level of local and large-scale connectivity in the patients within the frontal, between the frontal and temporal, and frontal and parietal brain areas which was more pronounced 1 year later. As a consequence of opening the eyes connectivity in the alpha1 band within the parietal lobe decreased compared to the eyes closed condition but only in the control group. The lack of alpha1 band reactivity following eye opening could reliably differentiate patients from controls. Our preliminary results support the notion that the functional disconnection between distant brain areas is a characteristic feature of MCI, and may prove to be predictive in terms of the progression of this condition.     

Outpatient follow-up appointments for patients having curative treatment for cancer of the head and neck: are the current arrangements in need of change?

Although there are recommendations, there is little evidence about the rationale for the frequency and duration of review appointments for patients with cancer of the head and neck. We have recorded the pattern of follow-up in a tertiary cancer centre and its association with survival and recurrent disease. We used clinical letters and a prospectively maintained database to obtain details on 297 patients who were treated curatively for squamous cell carcinoma (SCC) of the oral cavity between 2005 and 2008. Mean (SD) age was 63 (12) years and 58% (n = 171) were male. Most patients were seen about 6 times in year one, 3 times in year 2, twice in year 3, twice in year 4, once or twice in year 5, and once yearly beyond year 5. Fewer clinics were scheduled for and attended by patients over 75 years of age, those with overall clinical grades 0-1, and those treated by operation alone in contrast to those who also had adjuvant radiotherapy. Patients were usually seen about 15 times over the 5 years. Taking into account the stage of the tumour and overall mortality, the number and timing of follow-up visits is adequate for the needs of patients with stage II-IV disease. Those with stage I disease may be considered for discharge after the third year if they are told about the risk factors, and signs and symptoms of recurrent disease, and surveillance in primary care.     

A national survey of intensive care follow-up clinics in Australia

BackgroundIntensive care follow-up clinics (ICFCs) have been implemented internationally with the aim to address the growing number of patients living with sequalae of critical illness and intensive care. However, data on Australian intensive care follow-up practice are rare.ObjectivesThe primary objective was to determine the proportion of Australian intensive care units (ICUs) that offer a dedicated ICFC to ICU survivors, with the intention of improving long-term outcomes of critical illness. Secondary objectives were to identify models of ICU follow-up and barriers to the implementation of ICFCs.MethodsA custom-designed, pilot-tested 12-question online survey was sent to the nurse unit managers and medical directors of all 167 Australian ICUs listed in the database of the Australian and New Zealand Intensive Care Society. Outcome measures included proportion of ICUs offering ICFCs, details on types of follow-up services with staffing, funding source, and reasons for not providing ICU follow-up.ResultsOne hundred seven of the 167 ICUs contacted responded to the survey. Of these, two (2%) operated a dedicated ICFC. Both ICFCs were nursing-led, with one receiving dedicated funding and the other being unfunded. Three units (3%) conducted routine outpatient follow-up by telephone; one of these services was doctor-led, and two were nurse-led. Four units (4%) were performing outpatient follow-up as part of research studies only. Among the units not operating an ICFC, the main reason given for not doing so were financial constraints (58%), followed by lack of clinical need (19%) and perceived lack of evidence (11%).ConclusionIn Australia, only two ICUs operated an ICFC. Only one outpatient follow-up service received dedicated funding, and financial constraints were the main reason given for units not offering outpatient follow-up services.     

免疫印迹法检测HIV抗体条带常见模式分析及在随访中的价值

目的了解免疫印迹法检测人类免疫缺陷病毒(HIV)抗体阳性的常见条带模式及在随访中的价值。方法回顾分析免疫印迹法检测HIV抗体为阳性的460例患者和结果为不确定的16例患者的免疫印迹法检测结果及临床资料。结果在3个基因编码的3组HIV特异性抗体中,env基因编码的包膜蛋白抗体gp160、gp120和gp41的检出率分别为100.00%、99.35%和96.30%;pol基因编码的核酸内切酶及聚合酶抗体p66、p51和p31的检出率分别为92.61%、86.96%和91.96%;gag基因编码的核心蛋白抗体p55、p39、p24和p17的检出率分别为56.30%、13.26%、100.00%、87.17%。采用免疫印迹法检测HIV抗体,共检测到34种条带模式,最常见的条带模式为gp160/gp120/p66/p55/p51/gp41/p31/p24/p17(p39缺失,占41.74%),其次为gp160/gp120/p66/p51/gp41/p31/p24/p17(p55和p39缺失,占23.70%),全条带模式占11.30%。对16例免疫印迹法结果为不确定的患者进行随访,其中首次检测含包膜蛋白抗体条带的4例患者在随访期间HIV抗体均转为阳性。HIV感染者首诊科室共涉及到28个临床科室,其中有66.31%就诊于内科相关科室。结论 HIV感染者的免疫印迹法条带检出率存在一定的差异,患者首诊的临床科室众多,医疗机构应重视HIV检测,避免获得性免疫缺陷综合征(AIDS)被误诊和漏诊。     

Primary breast cancer patient with poliomyelitis: A case report

BACKGROUNDPoliomyelitis is an acute infection caused by an enterovirus, which primarily infects the human gastrointestinal tract. In general, patients with polio have no association with the occurrence of cancer. The present case study presents a rare case of poliomyelitis combined with primary breast cancer.CASE SUMMARYA 61-year-old woman who was diagnosed with poliomyelitis at 5 years old and confirmed invasive breast cancer by core needle biopsy (CNB) after hospitalization. The patient received a modified radical mastectomy and four cycles of chemotherapy with the TC (docetaxel and cyclophosphamide) regimen. The patient was also prescribed endocrine therapy without radiotherapy after chemotherapy. The patient had no evidence of lymphedema in the right upper extremities and no evidence of either regression or distant metastasis at the 1-year follow-up.CONCLUSIONThe pectoral muscles of patients with polio are easily damaged in traumatic procedures, such as CNB, local anesthesia for tumor excision, and general anesthesia for surgery. A CNB, modified radical mastectomy, and four cycles of TC chemotherapy were successfully completed for the present case and the adverse reactions were found to be tolerable. This case may indicate the relationship between breast cancer and polio, and the examination and treatment methods used could be used as a guide for similar cases in the future.     

118例心向量图横面T环原发性顺钟向运行者长期随访分析

目的弄清心向量图(VCG)横面T环原发性顺钟向运行(顺转)与心肌缺血的关系。方法对118例VCG横向T环原发性顺转者随访10～20年,观察其横面T环转向变化、临床症状及心电图、超声心动图、心脏X线片、心脏负荷试验、冠状动脉造影等检查。结果原发性T环顺转者中34．8％由顺转变为逆转。98．3％无器质性心血管疾患。结论VCG横面T环顺转与心肌缺血无关,可能同发育有关。T环顺转者易于发生心脏神经官能症。