老年人心脏瓣膜反流与心功能及年龄的关系

目的探讨老年人心脏瓣膜反流的发生对心功能的影响。方法选择住院患者477例,根据NYHA心功能分级标准分为心功能代偿组(290例)及心力衰竭组(187例),再将两组患者按年龄分为45～59岁、60～69岁、70～79岁。≥80岁4个年龄段,比较心功能代偿组、心力衰竭组及其各年龄段患者的瓣膜反流检出率。结果心力衰竭组60岁以上患者瓣膜反流检出率高于心功能代偿组;心功能代偿组及心力衰竭组45～59岁年龄段患者的单纯主动脉瓣反流及主动脉瓣反流合并二尖瓣反流的检出率均低于3个老年年龄段(P<0.05,P<0.01),有随年龄增长而增加的趋势;45～59岁年龄段患者的单纯二尖瓣反流的检出率与3个老年年龄段比较,差异无统计学意义(P>0.05)。结论心脏瓣膜反流影响老年人的心功能,年龄是独立于心功能而影响老年人主动脉瓣反流的因素。     

内源分泌型高级糖基化终末产物受体与冠心病危险因素对动脉弹性的影响

目的探讨冠心病患者内源分泌型高级糖基化终末产物受体(esRAGE)与冠心病危险因素对动脉弹性的影响。方法选择180例冠心病患者,检测颈-股动脉脉搏波传导速度(cf-PWV)、肱-踝动脉脉搏波传导速度(ba-PWV)和血esRAGE,分析与冠心病相关的危险因素。结果与未合并高血压、糖尿病、腰围正常和≤3个异常代谢组分患者比较,合并高血压、糖尿病、腰围异常和3个异常代谢组分患者的cf-PWV、ba-PWV明显增高,血esRAGE降低(P0.05)。log cf-PWV与年龄、收缩压、舒张压、稳态模式评估法胰岛素抵抗指数呈正相关,与esRAGE呈负相关(P0.05)。ba-PWV与年龄、收缩压、舒张压呈正相关,与esRAGE呈负相关(P0.05)。log cf-PWV与年龄、收缩压、esRAGE独立相关;ba-PWV与年龄、收缩压独立相关。结论合并危险因素的冠心病患者的动脉弹性功能明显减低,冠心病患者esRAGE水平下降在动脉弹性减低方面起着重要作用。     

UMOD 基因启动子区单核苷酸多态性与 CKD 患者发病年龄的关系

目的：探讨UMOD基因启动子区多态性与慢性肾脏病患者发病年龄的关系。方法选取89例CKD患者作为病例组,选择与病例组年龄、性别相匹配的体检健康者104例作为对照组。采用PCR法检测两组UMOD基因启动子区进行扩增并测序,分析其多态性与CKD患者发病年龄的关系;分析性别、吸烟史、体重指数（ BMI）、平均动脉压等与CKD患者发病年龄的关系。结果病例组－1617（ rs13333226） G等位基因的频率高于对照组（χ^2＝4．737,P＝0．030）;携带rs13333226A者发病年龄早于携带rs13333228G患者（χ^2＝7．902,P＝0．005）。单因素分析结果显示,BMI≥22的CKD患者发病年龄＜45岁者的比例高于BMI ＜22者,吸烟者发病年龄＜45岁者的比例高于非吸烟者（P均＜0．05）。多因素分析示UMOD基因rs13333226的多态性是CKD患者发病年龄的独立影响因素（OR＝0．494,95％CI：0．268-0．913,P＜0．05）。结论 CKD患者UMOD基因rs13333226等位基因的频率增高,携带rs13333226 A的CKD患者发病年龄较小。 UMOD基因rs13333226的多态性是CKD患者发病年龄的独立影响因素。     

老年重症甲型 H1N1流感的临床特征分析

目的：分析老年重症甲型 H1N1流感病例的临床特征和疾病转归,以提高临床救治水平。方法收集2009年9月至12月中国426家医院确诊的重症甲型 H1N1流感住院患者中≥65岁的217例作为研究对象。确诊病例定义为甲型 H1N1流感病毒核酸检测阳性,并符合甲型 H1N1流感重症诊断标准。基于各变量有完整记录的病例数来计算各变量数据百分比。结果入选患者平均年龄(72.9±6.2)岁。82.0%的患者合并1种或以上基础疾病。患者发病到首次就诊的中位时间是24 h,到实验室确诊中位时间是102 h。发热(87.6%)和咳嗽(91.7%)是突出的临床表现,91.6%的患者影像学检查存在肺炎,56.4%的患者氧合指数≤300。入组患者中,死亡34例(15.7%),其中15例死于呼吸衰竭。死亡患者与存活者相比,在合并重要基础疾病、入院时的呼吸频率、心率、血小板计数、谷丙转氨酶、胆红素、氧合指数等方面存在显著性差异。结论老年甲型 H1N1流感患者多合并基础疾病,出现呼吸、心率增快、肝功能异常、血小板下降等情况提示患者预后不良。     

Epidemiology of achondroplasia: A population‐based study in Europe

Achondroplasia is a rare genetic disorder resulting in short‐limb skeletal dysplasia. We present the largest European population‐based epidemiological study to date using data provided by the European Surveillance of Congenital Anomalies (EUROCAT) network. All cases of achondroplasia notified to 28 EUROCAT registries (1991–2015) were included in the study. Prevalence, birth outcomes, prenatal diagnosis, associated anomalies, and the impact of paternal and maternal age on de novo achondroplasia were presented. The study population consisted of 434 achondroplasia cases with a prevalence of 3.72 per 100,000 births (95%CIs: 3.14–4.39). There were 350 live births, 82 terminations of pregnancy after prenatal diagnosis, and two fetal deaths. The prenatal detection rate was significantly higher in recent years (71% in 2011–2015 vs. 36% in 1991–1995). Major associated congenital anomalies were present in 10% of cases. About 20% of cases were familial. After adjusting for maternal age, fathers >34 years had a significantly higher risk of having infants with de novo achondroplasia than younger fathers. Prevalence was stable over time, but regional differences were observed. All pregnancy outcomes were included in the prevalence estimate with 80.6% being live born. The study confirmed the increased risk for older fathers of having infants with de novo achondroplasia.     

奈达铂联合多西他赛治疗晚期食道癌的临床观察

目的：观察奈达铂联合多西他赛治疗晚期食道癌的近期疗效及不良反应。方法：将80例晚期食道癌患者随机分为治疗组和对照组,每组40例,治疗组：采用奈达铂联合多西他赛治疗,其中奈达铂25mg／（m2·d）第1～3天给予;对照组：采用顺铂联合多西他赛治疗,其中顺铂25mg／（m2·d）第1～3天给予,两组均在第1天给予多西他赛75mg／m2,21天为1个周期。化疗2个周期后按WHO标准评价疗效及毒副作用。结果：治疗组完全缓解2例,部分缓解14例,稳定18例,进展6例,有效率为40．0％（16／40）;对照组完全缓解2例,部分缓解16例,稳定16例,进展6例,有效率45．0％（18／40）,两组有效率比较差异无统计学意义（P〉0．05）。治疗组和对照组消化道不良反应分别为10．0％和30．0％;肾毒性分别为0和15．0％,血小板下降分别为30．0％和5．0％,差异有统计学意义（P〈0．05）;白细胞减少分别为70．0％和65．0％,差异无统计学意义（P〉0．05）。结论：奈达铂联合多西他赛方案与顺铂联合多西他赛方案治疗晚期食道癌的疗效相近,在毒副作用方面多西他赛联合奈达铂方案耐受性良好,具有优势。     

Secular changes in the relation between social factors and depression: A study of two birth cohorts of Swedish septuagenarians followed for 5 years

Background

Rapid societal changes occurred in the Western world during the 20^th century. It is not clear whether this has changed the relation between social factors and depression in older people.

Methods

Representative samples of 70-year-olds from Gothenburg, Sweden, were examined with identical psychiatric examinations in 1971–72 (N=392; 226 women and 166 men) and 2000–01 (N=499; 270 women and 229 men). Follow-up studies were conducted after five years. Social factors were obtained by self-report and depression was diagnosed according to DSM-IV-TR.

Results

Feelings of loneliness were related to both concurrent depression at baseline and new depression at follow-up in both birth cohorts. Visits with others than children and neighbours once per month or less, compared to having more visits, and the perception of having too little contact with others, were related to both concurrent and new depression in 70-year-olds examined 1971–72, but not in those examined 30 years later.

Limitations

The response rate declined from 85.2% in 1971–72 to 65.8% in 2000–01. Participation bias may have resulted in an underestimation of depression in the later-born cohort.

Conclusions

Social contacts with others were related to depression in 70-year-olds examined in the 1970s, but not in those examined in the 2000s. This may reflect period changes in the ways of socialising, communicating and entertaining, e.g. due to technological development and expansion of mass media. Findings may be useful when developing modern and effective programs for the prevention of mental ill-health in older people.     

单药替吉奥胶囊治疗老年晚期胃癌的临床观察

目的：观察单药替吉奥胶囊治疗晚期胃癌的临床疗效及毒副反应。方法：选择50例经病理证实的老年晚期胃癌患者,随机分为治疗组32例及对照组18例。治疗组根据体表面积给予替吉奥胶囊治疗,对照组给予营养等最佳支持治疗。每2周期后行影像学检查评价疗效、记录不良反应及随访情况。结果：治疗组32例患者CR(完全缓解)0例,PR(部分缓解)10例,SD(病情稳定)12例,PD(病情进展)10例,临床总缓解率31.3%,临床获益率68.8%。治疗组中位无疾病进展时间及中位生存期分别为5.7及11.5个月,对照组分别为3.1及7.6个月。毒副反应主要为I-III度骨髓抑制、消化道反应、肝功能损伤及手足综合症。结论：单药替吉奥胶囊治疗老年晚期胃癌效果肯定,生活质量高、毒副作用小。     

AGEs介导的糖尿病肾损伤机制及二甲双胍的干预作用

糖尿病肾病(diabetic nephropathy,DN)是糖尿病(diabetes mellitus,DM)的常见的慢性微血管并发症之一。慢性高糖状态下糖基化终末产物(AGEs)形成增加,诱导肾脏氧化应激和内质网应激,参与糖尿病肾病的发生与发展。二甲双胍是目前临床治疗糖尿病的最常用药物之一。越来越多的研究表明,二甲双胍除了最主要的降糖作用外,其尚可抑制AGEs形成和具有抗氧化作用,深入研究AGEs与DN的关系,有助于进一步了解DN的发病机制并对干预其发生和发展具有重要的指导意义。     

3640例育龄产妇TORCH筛查回顾性分析

目的对育龄妇女产前TORCH筛查,并对结果进行回顾性分析。方法采用ELISA法,对2009年1月至2011年5月在暨南大学附属第一医院做产前筛查的3640名育龄妇女进行孕妇致畸八项（TORCH-IgM及IgG抗体）或优生四项（TORCH-IgM抗体）的检测。结果孕妇致畸八项中TORCH-IgM阳性率为2.29%,优生四项中TORCH-IgM阳性率为1.59%,TORCH-IgM总阳性率为2.03%。孕妇致畸八项中Tox-IgG、RV-IgG、CMV-IgG及HSV-II-IgG分别为3.49%、69.60%、83.30%和71.00%。结论广州地区育龄妇女TORCH-IgG阳性率较低,而相应的IgM水平也较文献报道低,表明产妇TORCH既往感染和当前感染率均较低,可能与当前卫生条件的改善有关。