The changing diagnosis of gestational diabetes mellitus: Does anyone miss out?

Our aim was to identify women diagnosed with gestational diabetes mellitus (GDM) using 1999 WHO diagnostic criteria but who would be now classified as normal glucose tolerance (NGT) using updated criteria. We demonstrate that this category change affected 3.3% women and they have a limited increased risk of adverse outcomes.     

Autoimmune pancreatitis type-1 associated with intraduct papillary mucinous neoplasm: Report of two cases

Chronic pancreatitis lesions usually embrace both intraduct papillary mucinous neoplasm (IPMN) and pancreatic ductal adenocarcinoma (PDAC). Patients at genetically-determined high risk of PDAC often harbor IPMN and/or chronic pancreatitis, suggesting IPMN, chronic pancreatitis and PDAC may share pathogenetic mechanisms. Chronic autoimmune pancreatitis (AIP) may also herald PDAC. Concurrent IPMN and AIP have been reported in few patients. Here we describe two patients with IPMN who developed type-1 AIP fulfilling the Honolulu and Boston diagnostic criteria. AIP diffusively affected the whole pancreas, as well as peripancreatic lymph nodes and the gallbladder. Previous pancreatic resection of focal IPMN did not show features of AIP. One of the patients carried a CFTR class-I mutation. Of notice, serum IgG4 levels gradually decreased to normal values after IPMN excision. Common risk factors to IPMN and AIP may facilitate its coincidental generation.     

基于Excel的随机模拟在《医药数理统计》教学中的应用

随机模拟是统计学研究中的一种常用方法,将其运用到医药数理统计教学中,有很好的演示效果。以Excel软件里的随机数发生器为基础,进行简单的随机模拟。通过几个例子,说明了随机模拟在教学中可以起到模拟随机试验、验证重要结论和解释重要概念等作用。     

Polymyositis: Essential Information for Primary Care Providers

Polymyositis is one of a rare group of skeletal muscle diseases known as idiopathic inflammatory myopathies. The etiology is not fully understood, and its clinical presentation is often vague yet similar to more common neuromuscular diseases, making diagnosis difficult. A number of different tests are available to assist providers in making an accurate diagnosis. Once a diagnosis is made, there are a number of various treatment modalities available. Nurse practitioners must be familiar with treatment protocols and follow-up. The focus of this article is on polymyositis; its presentation, signs, and symptoms; the process of accurate diagnosis; and common treatment strategies.     

The role of response evaluation criteria in solid tumour in anticancer treatment evaluation: Results of a survey in the oncology community

PurposeWith the increasing use of novel targeted agents and the development of high imaging techniques, response evaluation criteria in solid tumour (RECIST) 1.1 developed primarily for cytotoxic agents and anatomic imaging, has demonstrated limitations. A survey was conducted of RECIST users to identify concerns and their suggestions for future RECIST criteria.Methods140 key partners of the RECIST collaboration were asked to complete a questionnaire. The 49 questions concerned (a) satisfaction and concerns with RECIST 1.1; (b) use of modified RECIST criteria and (c) suggestions for the next RECIST Version.ResultsSixty-five replies were received. 52.3% responders were satisfied with RECIST 1.1, while 10.8% indicated dissatisfaction. Areas of potential weakness included: (a) lack of incorporation of potential early indicators of response such as functional imaging, (b) lack of validation in rarer tumour types and (c) lack of validation for novel (targeted) agents. Suggestions were multiple, with highest numbers on two points: developing sub-criteria for certain disease types and including advanced imaging techniques for the evaluation.ConclusionsConstructive suggestions were received for optimising the next version. Ongoing data collection will make it possible to investigate the possible utilisation of fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging in tumour assessment, to verify whether RECIST is/can still be applicable in novel targeted therapy and to consider the need for criteria for specific disease types.     

老年高血压患者静息心率增加对靶器官损害的临床研究

目的探讨老年原发性高血压(EH)患者静息心率(RHR)与靶器官损害的关系。方法入选老年EH患者206例,按RHR水平分为RHR1组<70次/min(56例),RHR2组70次≤RHR<80次/min(84例),RHR3组RHR≥80次(66例)三组。对人选患者做以下检查心电图、超声心动图、颈动脉超声、肌酐清除率以及尿微量白蛋白。结果(1)RHR2组和RHR3组的颈动脉内膜厚度(IMT)、颈动脉内径(CAD)、左心室重量指数(LVMI)以及尿微量白蛋白定量(MAU)均高于RHR1组(P<0.01),而左室射血分数(LVEF)、肌酐清除率小于RHR1组(P<0.01)。(2)RHR与IMT、CAD、LVMI、MAU呈正相关(r分别为0.312、0.289、0.630、0.576,P<0.01),而与LVEF、肌酐清除率呈负相关(r分别为-0.563、-0.510,P<0.01)。(3)非条件Logistic回归分析显示,RHR、收缩压(SBP)、舒张压(DBP)、脉压(PP)对高血压性心脏病、冠心病、心力衰竭、脑血管意外和肾功能损害有不同程度的影响(P<0.05或P<0.01),其中SBP和RHR的作用更大。结论RHR可能是老年EH患者靶器官损害的独立危险因素。     

肝囊型包虫病药物治疗疗效标准的研究

目的　进一步研究和评价囊型包虫病药物治疗的疗效判定标准。　方法　采用前瞻性随机对照观察的研究方法。对 4 9例肝囊型包虫病病人进行了研究 ,其中治疗组 31例为经过不同时间阿苯达唑乳剂治疗的病人。对照组 18例为未经任何治疗的病人。以外科手术、粗针穿刺抽吸和常规细针穿刺的方法采集包虫囊内容物观察其性状。囊壁组织石腊切片观察组织学变化。收集原头节通过镜下形态及活动的观察、染料排斥试验、犬胆汁激活试验及接种小鼠腹腔 6个月后剖检观察有无包虫囊生长的方法判定囊内原头节的死活。结合 CT及 B超影像特征进行比较评价。　结果　治疗组病人中87.1% (2 1/ 31)的包虫囊 B超影像显示不同程度的退行变性 ,育囊率为 2 2 .6 %。对照组病人包虫囊的 B超影像显示退行变性的占 11.1% (2 / 18) ,育囊率为 6 1.1%。治疗组判定为痊愈的 15例病人的育囊率为 13.3% (2 / 15 )。疗效标准与 B超影像反映的包虫囊变性死亡的过程一致 ,与寄生虫学和囊壁组织学变化趋势相符。177例停药后随访 1～ 4年的肝囊型包虫病病人的转归证明了这一标准的可靠性。　结论　本研究提出的以 B超影像为基础的肝囊型包虫病药物治疗疗效指标反映了包虫囊在药物作用下从正常生长到变性死亡的过程 ,是一个比较客观、合理的疗效标     

Rendimiento diagnóstico de la secuenciación de genes de hipercolesterolemia familiar en sujetos con hipercolesterolemia primaria

Introduction and objectivesOur objective was to approximate the prevalence of mutations in candidate genes for familial hypercholesterolemia (FH) in a middle-aged Spanish population and to establish the predictive value of criteria for clinical suspicion in the detection of causative mutations.MethodsUnrelated individuals aged ≥ 18 years from the Aragon Workers’ Health Study (AWHS) with high low-density lipoprotein cholesterol (LDL-C) and clinical suspicion of FH (participants with LDL-C concentrations above the 95th percentile, participants with premature cardiovascular disease and/or participants with high LDL-C [130 mg/dL] under statin therapy), assuming that any participant with FH exhibits at leats 1 trait, were selected and the LDLR, APOB, PCSK9, APOE, STAP1 and LDLRAP1 genes were sequenced by next generation sequencing technology.ResultsOf 5400 individuals from the AWHS, 4514 had complete data on lipid levels and lipid-lowering drugs, 255 participants (5.65%) met the criteria for suspicion of FH, 24 of them (9.41%) were diagnosed with hyperlipoproteinemia(a), and 16 (6.27% of those sequenced) were found to carry causative mutations in candidate genes: 12 participants carried 11 different pathogenic LDLR alleles and 4 participants carried 1 pathogenic mutation in PCSK9. LDL-C concentrations > 220 mg/dL and LDL-C > 130 mg/dL despite statin therapy showed the strongest association with the presence of mutations (P = .011).ConclusionsOur results show that the prevalence of FH in Spain is 1:282 and suggest that the combination of high untreated LDL-C and high levels of LDL-C despite statin therapy are the best predictors of a positive FH genetic test.