General and specific mortality among the elderly during the 2003 heat wave in Genoa (Italy)

The effects of heat waves on health can be serious for elderly persons, especially those in urban areas. We investigated in-depth the mortality excess during the 2003 heat wave among elderly persons (>74 years) in the City of Genoa (Italy). The excess in general mortality was calculated for the period July 16-August 31, as the ratio of observed to expected deaths. To evaluate "harvesting", we compared observed and expected mortality in the period September 2003-April 2004. We also studied the relationship between mortality and climatic conditions considering daily maximum temperature and Humidex discomfort degrees, as well as "lag-time". For cause-specific mortality, we considered all pathologies reported on the death certificate. The excess in general mortality was significant and was greatest in the first half of August. During Summer 2003, in Genoa the climatic conditions (described in terms of maximum temperature and Humidex Index) were extremely hot; regarding lag-time, the greatest correlation between the number of observed deaths and the maximum temperature values was observed for the three preceding days (rho=0.568; significance level<0.01). The prominent causes of death, for which an excess was observed, were cerebrovascular diseases, severe respiratory diseases, severe renal diseases, dementia; moreover, certain pathologic conditions and symptoms, usually not lethal, were also frequent causes of death (e.g., hypovolemia, hyperpyrexia, decubitus ulcers and immobilization syndrome). The results of this study confirm the relationship between the heat waves and death among elderly, stressing that, because of their poorer physical health and the prevalence of cognitive disturbances that hinder risk perception, it is necessary to properly care for them during heat waves.     

拉力螺钉1/3管状钢板在三踝骨折合并下胫腓联合分离治疗中的应用

目的：探讨三踝骨折合并下胫腓联合分离的手术治疗。方法：回顾分析25例三踝骨折合并下胫腓联合分离采用拉力螺钉1／3管状钢板治疗的临床资料。结果：25例患者随访1～3年，优17例，良4例，可4例，其中3例患者复诊时拉力螺钉断裂，但功能均优。结论：拉力螺钉1／3管状钢板固定牢固，有利于早期功能锻炼。     

调节与辐辏因素导致视疲劳的诊断和治疗

视疲劳的临床表现复杂,因其症状的非特异性给临床诊断和病因治疗带来一定的困难.随着对该病的认识深入,发现其病因甚为复杂,并且往往是多因素混合导致发病.如果只是单纯的对症治疗效果并不理想,探寻病因进行对因治疗才是根本的治疗策略.目前已经明确多种因素可导致视疲劳,通过必要的眼科及视光学检查可确保明确且全面的病因诊断.目前针对视疲劳的病因治疗难易不同.一些病因只要去除和矫正就能避免视疲劳,而另一些就显得相对困难,调节和辐辏因素导致的视疲劳即属于后者.另一方面由于调节和辐辏检查的专科性,使得它们在视疲劳中的诊断和治疗具有一定的难度和特殊性.我们对目前调节和辐辏在视疲劳中的诊断和治疗现状进行总结,以期为临床诊治带来帮助.     

大气细颗粒物浓度与急性冠脉综合征急诊人次的相关性分析

目的 探讨大气细颗粒物(fine particulate matter,PM2.5)浓度与居民急性冠脉综合征(acute coronary syndrome,ACS)急诊人次之间的相关性.方法 收集2013年12月1日至2014年11月30日期间北京大学第三医院急诊科每日ACS就诊病例,患者均为北京市海淀区常住居民.收集同期北京市海淀区大气污染物和气象因素的监测数据.采用广义相加模型,在控制时间长期趋势、节假日效应、星期几效应以及气象因素等混杂因素的基础上,定量评估大气PM2.5浓度与急性冠脉综合征急诊人次的相关性.结果 研究期间北京市PM2.5年平均浓度为85.44 μg/m3,北京大学第三医院急诊科共确诊ACS患者619例.大气PM25浓度与PM10、SO2、NO2浓度呈正相关,相关系数分别为0.88、0.48和0.67,均有统计学意义(P＜0.05),与日均气温呈负相关,相关系数为-0.04 (P ＜0.05).污染模型中,PM2.5浓度与ACS急诊人次呈正相关,PM2.5浓度每上升10μg/m,ACS急诊相对危险度Rn为1.019(95％CI:1.000～ 1.038).此外,大气PM25浓度对ACS急诊人次的影响具有滞后效应,滞后1 d(lag1)的PM2.5浓度对急诊人次的相对危险度最大.结论 大气PM2.5浓度升高引起ACS急诊人次的增加,并且具有滞后效应.     

内隐斜视青少年近视眼矫正时个体化下加的确立方法

目的 探讨在青少年近视眼矫正时不同视近下加条件下,调节滞后及隐斜的变化,并构建下加与调节滞后、隐斜间关系的数学公式,以期得到使调节滞后与隐斜量同时最小的最适视近下加范围.方法 招募110例单纯性近视眼的内隐斜视青少年患者,据MPMVA原则验光配镜后依次予以佩戴5种不同下加试镜片(OD、+0.75D、+1.50D、+2.00D、+2.50D)后测量双眼视近33 cm的调节反应(Shin-Nippon,日本)以及遮盖试验+排棱镜测量视近隐斜度;采用线性回归统计学分析视近下加与调节滞后、隐斜度间关系.结果 随着下加度数增加,视近调节滞后量逐渐减少,而内隐斜量逐渐变小并向外隐斜方向变化;不同下加条件下调节滞后量[F(262.76,4),P＜0.01]以及隐斜度[F(223.45,4),P＜0.01]都存在统计学差异;内隐斜患者的最适下加与初始调节滞后存在线性相关性(r=0.526,P＜0.01),且最适下加与初始隐斜状态也存在线性相关性(r=0.523,P＜0.01).结论 根据青少年近视眼患者个体的初始近调节滞后量和近隐斜度,可获得适合该患者的视近下加范围,从而为青少年内隐斜近视眼确立个体化视近下加提供参考策略.     

褪黑激素镇痛和镇静的某些研究进展

褪黑激素不仅能使入睡容易、改善睡眠质量,减轻术前焦虑、产生镇静,调节昼夜节律,抗衰老,免疫调节,以及产生抗惊厥和抗炎作用,而且对疼痛的调节也起重要作用。研究表明,在急性疼痛、炎性痛及神经性疼痛等多种疼痛类型中,褪黑激素能预防、减轻伤害性疼痛,可用于治疗纤维肌痛、外科手术相关疼痛,以及防治术后谵妄或时差综合征等。     

Differences of percutaneous retrograde screw fixation of anterior column acetabular fractures between male and female: A study of 164 virtual three-dimensional models

Introduction

Percutaneous retrograde screw fixation of the anterior column has been recommended for the treatment of minimally displaced acetabular fractures. However, proper placement of the screw in anterior column is challenging because of its unique anatomy. There are few anatomic studies on this technique, and the differences between male and female have never been reported.

Methods

We created virtual three-dimensional reconstruction models of the pelvis from CT scan data obtained from 82 adult patients without any bony problems. Virtual cylindrical implants were placed intraosseously both in left and right anterior column. The maximum diameter, length and optimal direction of the virtual cylindrical implant were determined for the screw. The perpendicular distance from the insertion point (P) of virtual cylindrical implant to the pubic symphysis (A) and the rim of superior ramus of pubis (B) were measured respectively. In the same model, cross-sections of the anterior column were created and the diameters of them were measured.

Results

164 (80 males and 84 females) hemipelvis models were obtained. The mean maximum diameter and length of virtual cylindrical implant were 8.16 ± 1.21 mm (range: 5.60-10.80 mm) and 109.39 ± 8.95 mm respectively. The angles of the virtual cylindrical implant to transverse, coronal and sagittal planes were 39.66 ± 3.92°, 20.81 ± 4.58° and 42.66 ± 3.23° respectively. The distance of PA and PB were 18.42 ± 4.82 mm and 17.76 ± 2.63 mm. Both the differences of the diameter and length of the virtual cylindrical implant, and the distance of PA between the male and female were of statistical significance (p < 0.00001). The mean minimum cross-sectional diameter of anterior column was larger than the mean diameter of the virtual cylindrical implant.

Conclusions

The anterior column of a male will accommodate a 6.5 mm lag screw very well, but it does not fit all the females. The same direction of screw can be used in both male and female, but the insertion points of the screw are different. In addition, the determination of the size of the screw used for the anterior column cannot be based solely on the measurement of cross-sectional diameter and the virtual three-dimensional reconstruction model might be useful in preoperative planning.     

Removal of a broken trigen intertan intertrochanteric antegrade nail

Implant breakage is a serious complication after cephalomedullary nailing for unstable intertrochanteric fracture. Failure usually occurs at the lag screw hole in the nail body. On the other hand, lag screw failure is extremely rare and occurs around the nail-lag screw junction. We experienced rare mechanical failure of the Intertan nail, which showed breakage at the lag screw hole and failure of the integrated compression screw underneath the main lag screw.     

Changes in dynamics of accommodation after accommodative facility training in myopes and emmetropes

This study evaluates the effect of accommodative facility training in myopes and emmetropes. Monocular accommodative facility was measured in nine myopes and nine emmetropes for distance and near. Subjective facility was recorded with automated flippers and objective measurements were simultaneously taken with a PowerRefractor. Accommodative facility training (a sequence of 5 min monocular right eye, 5 min monocular left eye, 5 min binocular) was given on three consecutive days and facility was re-assessed on the fifth day. The results showed that training improved the facility rate in both groups. The improvement in facility rates were linked to the time constants and peak velocity of accommodation. Some changes in amplitude seen in emmetropes indicate an improvement in facility rate at the expense of an accurate accommodation response.     

2009-2019年中国4省农村重点地区肝癌死亡相关行为危险因素及其滞后效应分析

目的分析2009-2019年我国江苏省、安徽省、山东省、河南省(4省)农村重点地区肝癌死亡率变化趋势, 探讨行为危险因素对肝癌死亡的影响及其滞后效应, 为我国肝癌防治工作提供参考。方法基于2009-2019年全国死因监测数据库及3次4省农村重点地区居民肿瘤及危险因素调查数据, 采用Joinpoint 4.2软件计算平均年度变化百分比(AAPC), 分析肝癌标化死亡率的时间变化趋势;采用χ2检验与趋势χ2检验分析行为习惯因素的地区分布差异和时间变化趋势;采用Stata 16软件建立面板数据模型, 分析行为危险因素与肝癌死亡的相关性及其滞后效应。结果 2009-2019年4省金湖县、射阳县、灵璧县、寿县、蒙城县、汶上县、巨野县、罗山县、沈丘县、西平县农村重点地区肝癌标化死亡率呈下降趋势(AAPC<0, P<0.05)。4省农村重点地区咸菜/咸鱼类、红肉类、水产品类食物摄入频率呈下降趋势, 新鲜蔬菜、新鲜水果、乳制品等健康食品的摄入频率呈上升趋势, 油炸类食物、泡菜、烟熏类食物、霉变食物、咖啡、豆制品摄入频率一直处于较低水平(P<0.05);豆制品、乳制品的摄入频率<...