2017年湖南省学生常见病监测检出情况结果分析

目的 了解湖南省城乡学生常见病检出情况,为制订相关学生常见病预防控制措施提供参考。 方法 根据经济发展水平,随机抽取湖南省3个城区和3 个郊县共39所学校,调查小学四至六年级学生,初中、高中和大学一至三年级学生,每个年级随机选择1~3个班共80名学生,分别检测学生的视力、身高、体重、牙齿患病情况。 结果 学生视力不良检出率为66.58%,城区(68.67%)高于郊县(63.21%),女生(71.84%)高于男生(60.92%),高年级明显高于低年级学生,差异均有统计学意义(均P<0.05)。龋患检出率为49.26%,城区与郊县没有差异,但女生(53.26%)高于男生(44.97%),低年级高于高年级学生,差异均有统计学意义(均P<0.05);龋失检出率为7.24%,龋补检出率为5.29%,女生均高于男生,差异有统计学意义(P<0.05)。学生营养不良、肥胖检出率分别为4.29%、8.47%,均是男生高于女生,郊区高于城区(均P<0.05);学生超重检出率为12.50%,男生高于女生,城区高于郊县(均P<0.05)。 结论 湖南省学生常见病仍处于较高水平,学校卫生工作需要进一步加强     

Intimal sarcoma of the abdominal aorta and common iliac arteries presenting as epithelioid angiosarcoma of the skin: a case report

Intimal sarcoma (IS) is the most common type of sarcoma of the aorta. IS tumor emboli can involve various organs, including the skin. However, a limited number of IS cases with an initial presentation of skin metastasis has been reported. Cutaneous metastasis as a form of epithelioid angiosarcoma (EAS) has not been well described. Herein, we present a 61-year-old Japanese man with an initial presentation of EAS of the skin, followed by multiple metastases to the skin as a form of EAS prior to detection of IS of the infrarenal aorta and common iliac arteries. In our case, the IS was CD31 and cytokeratin positive but did not express CD34 and factor VIII-related antigen. The EASs in our case exhibited diffuse CD31 expression, and focal factor VIII-related antigen and cytokeratin expression were observed throughout the tumor, including the neoplastic vascular structure; CD34 expression was not identifiable. IS metastasis to the skin has been documented as a form of angiosarcoma. However, IS metastasis has not been well described as a form of EAS. Our case could prove a morphological change from IS to EAS. Given the rarity of primary cutaneous EAS, it is recommended that primary sites other than the skin should be thoroughly investigated when EAS of the skin is encountered.     

Type IV-A choledochal cysts: a challenge

Background/Purpose

Type IV-A choledochal cysts are characterized by congenital cystic dilatation of the biliary tree extending to involve the intrahepatic biliary channels also. A single-center experience of the management of type IV-A choledochal cysts is presented.

Methods

Thirty-five out of 105 (33%) patients with choledochal cysts, who underwent surgery at a tertiary care center in northern India from January 1989 to December 2002, were found to have a type IV-A (Todani’s classification) cyst. The mean age of the patients was 24 years (range, 3 months to 60 years); 17 patients in the group were adults and 22 were females. Presenting features were abdominal pain, jaundice, cholangitis, and abdominal lump, in various combinations.

Results

Excision of the extrahepatic part of the cyst and a wide bilio-enteric anastomosis was achieved in 32 (91%) patients, while internal drainage of the cyst was necessitated in 3 patients, for technical reasons: collaterals due to portal hypertension (1 patient) and dense adhesions (2 patients). Six (17%) patients developed postoperative complications: 3 had bilio-enteric anastomosis leaks, with 2 requiring a percutaneous proximal biliary diversion; 2 had intraabdominal bleeds requiring re-exploration, and 1 had external pancreatic fistula that closed spontaneously. Follow-up information was available for 28 (80%) patients. Mean duration of follow up was 25 months (median, 12 months; range, 6 months to 9 years). Three patients required re-operation, for anastomotic stricture (n = 2) and hepatolithiasis and recurrent cholangitis (n = 1) during follow up.

Conclusions

Excision of the extrahepatic part of the cyst and drainage of the intrahepatic part by a wide hilar or subhilar anastomosis gave satisfactory results in the majority of patients with type IV-A choledochal cysts. Close long-term follow up of these patients is essential, because they are likely to present with complications related to the residual intrahepatic part of the disease.     

A new modality for the estimation of corrected flow time via electrocardiography as an alternative to Doppler ultrasonography

Background

Evaluation of corrected flow time (FTc) via ultrasonography is one of the suggested modalities for the assessment of intravascular volume status. This study aimed to compare the results of FTc of carotid artery measured via ultrasonography, as a measure of mechanical outcome of the cardiac cycle, with the results of FTc estimation from a new modified formula via electrocardiography (ECG), as a measure of electrical function of the cardiac cycle.

Methods

Healthy volunteers were evaluated before and after a passive leg raising (PLR) maneuver. FTc was measured concurrently before and after PLR via a modified method from ECG and via ultrasonography of the carotid artery.

Results

A total number of 98 healthy volunteers (51 women and 47 men) with a mean age of 30.69 ± 6.28 years were included. There was a significant correlation between FTc measured by ultrasonography and estimated by ECG both before PLR and after PLR (r = .878, p < .0001 and r = .797, p < .0001, respectively). Changes in FTc were slightly higher in measurements by ultrasonography compared to estimations by ECG (22.33 ± 17.15 ms^0.5 vs. 15.86 ± 14.25 ms^0.5, p = .001).

Conclusion

Estimation of FTc via ECG is potentially an effective and feasible method for the assessment of volume status at the clinical settings. Further investigations should determine the significance of differences that may be observed between ultrasonography and ECG in patients with either dehydration or volume overload and in the need of real‐time volume status assessment.

     

1-Year Outcomes of Thromboendarterectomy vs Endovascular Therapy for Common Femoral Artery Lesions: CAULIFLOWER Study Results

BackgroundThromboendarterectomy (TEA) is the gold-standard treatment for common femoral artery (CFA). However, because of its low invasiveness and short hospitalization duration, CFA endovascular therapy (EVT) is performed in real-world practice. However, the clinical benefits and appropriate target population for CFA EVT remain unclear.ObjectivesThe aims of this study were to compare the clinical outcomes of TEA with those of EVT in patients with symptomatic CFA diseases and to identify the adequate target population for CFA EVT.MethodsA total of 1,193 consecutive patients who underwent EVT (n = 761) or TEA (n = 432) for CFA were identified and retrospectively reviewed from a registry of 66 institutions. The primary outcome was 1-year primary patency compared between EVT and TEA using propensity score matching. An interaction analysis was performed to explore the appropriate target population for CFA EVT.ResultsAfter propensity score matching, the 1-year primary patency rate was significantly higher in the TEA group (82.3% vs 96.6%; P < 0.001), whereas perioperative complications were more frequently observed in the TEA group (P = 0.047). Nonambulatory status attenuated the HR of EVT vs TEA for restenosis risk (P = 0.021), whereas the presence of nodular calcification significantly increased the HR (P = 0.040). In the EVT subgroup analysis for restenosis risk, stent use showed the lowest HR compared with plain balloon angioplasty and drug-coated balloon angioplasty (P < 0.001).ConclusionsTEA showed superior 1-year patency compared with EVT in a nationwide multicenter study. Nonambulatory status attenuated the superiority, whereas the presence of nodular calcification enhanced it.     

Targeting an epicardial‐endocardial breakthrough in a case with an intractable common atrial flutter using ultra–high‐resolution three‐dimensional mapping

The recent development of high‐density high‐spatial resolution three‐dimensional mapping has provided detailed information for understanding complicated atrial activation patterns at a level not previously possible. Using this technology, we report a case with recurrent common atrial flutter, demonstrating the presence of a bridging epicardial fiber that traveled across the previous cavotricuspid isthmus ablation lesion with apparent epicardial‐endocardial breakthrough (EEB) sites located on both sides of the ablation line. The entrainment study indicated that the EEB site, located adjacent to the coronary sinus ostium, was part of the recurrent circuit and a focal ablation targeting that site terminated the tachycardia.     

解读“睡眠呼吸暂停与心血管疾病专家共识”

本文简介了由中华医学会呼吸病分会睡眠学组与心血管病分会专家制订的睡眠呼吸暂停与心血管病专家共识,包括睡眠呼吸暂停与高血压、冠心病、心律失常、充血性心力衰竭的关系,旨在提高大家对这两类疾病关系的认识和诊断治疗水平。