下颌第三磨牙萌出状态与第二磨牙远中邻面龋坏的相关性研究

目的:研究下颌第三磨牙萌出状态与第二磨牙远中邻面龋坏的相关性。方法 :临床收集因下颌第三磨牙不适而就诊的患者204例,运用锥形束CT分析下颌第二磨牙远中邻面龋坏与第三磨牙阻生类型(高位、中位、低位)、阻生角度以及两磨牙的釉牙骨质界距离(cementoenamel junction,CEJ)等因素是否存在相关性。结果:在下颌第三磨牙存在的情况下,第二磨牙远中邻面龋坏发生率高达78.4%;性别差异无统计学意义(P=0.165);高位、中位和低位阻生的龋坏发生率差异无统计学意义(P=0.646);而当第三磨近中阻生角度为40~80°时,第二磨牙远中邻面最易发生龋坏,与其他阻生角度组的差异有统计学意义(P<0.001);当第二磨牙与第三磨CEJ距离在6~9 mm时,第二磨牙远中邻面龋坏高于其他组,差异有统计学意义(P<0.001)。结论:下颌第三磨牙近中阻生角度、第三磨牙与第二磨牙的CEJ距离与第二磨牙远中邻面龋坏的发生密切相关。当第三磨近中阻生角度在40~80°间,且两磨牙间的CEJ距离在6~9 mm时,第二磨牙远中邻面更容易发生龋坏,此类阻生齿建议尽早拔除。     

Peer educator vs. respiratory therapist support: Which form of support better maintains health and functional outcomes following pulmonary rehabilitation?

Objective

This study examined if ongoing support delivered by telephone following pulmonary rehabilitation (PR) assisted chronic obstructive pulmonary disease (COPD) patients to maintain health outcomes.

Methods

Phase one (n = 79) compared post-rehabilitation telephone-based support delivered by peers compared to usual care (UC). The second phase (n = 168) compared post-rehabilitation support from peer educators, respiratory therapists (RT), or UC. Primary outcome variables were St. George's Respiratory Questionnaire (SGRQ) total score and the six minute walk test (6MWT). Measures were obtained at baseline, immediately following PR, and six-months post PR.

Results

Six-month follow-up data for phase one was collected for 66 COPD patients (n = 35 peer support, n = 31 UC) and 142 for phase two (n = 42 peer support, n = 52 RT support, n = 48 UC). Per-protocol and intention to treat (ITT) analysis in both phases found no significant group by time differences for SGRQ or 6MWT.

Conclusion

Providing peer or RT support via telephone following PR was not more effective than UC for maintaining health outcomes.

Practice implications

There are concerns with using peers to provide ongoing support to COPD patients. Additionally, COPD patients require a higher level of care than telephone support can provide.     

中期妊娠胎盘前置状态引产剖宫产分娩影响因素分析

目的探讨中期妊娠胎盘前置状态引产分娩方式的相关影响因素。方法回顾性分析我院2012～2018年中期妊娠胎盘前置状态合并死胎或胎儿畸形的引产病例共51例,按分娩方式将其分为阴道分娩组和剖宫产组,比较两组间年龄、剖宫产史、孕次、产次、分娩孕周、胎盘覆盖宫颈内口范围、伴发胎盘植入、羊水量的差异。将单因素分析中具有统计学意义的变量(既往剖宫产史、胎盘覆盖宫颈内口范围、伴发胎盘植入)为自变量,拟合多因素Logistic回归方程,探讨胎盘前置状态引产剖宫产分娩的相关危险因素。结果 (1)阴道分娩组和剖宫产组比较,两组间既往剖宫产史、胎盘覆盖宫颈内口范围、伴发胎盘植入之间比较,差异均有统计学意义。(2)多因素Logistic回归分析显示,既往剖宫产史、伴发胎盘植入是剖宫产分娩的危险因素。与未植入比较,胎盘植入者剖宫产的危险度是其13.333倍;既往有剖宫产史者本次剖宫产的危险度是无剖宫产史者的8.727倍。结论胎盘前置状态中期妊娠引产,合并既往剖宫产史及胎盘植入者,其剖宫产分娩的危险度增加。     

Age‐time risk patterns of solid cancers in 60 901 non‐Hodgkin lymphoma survivors from Finland,Norway and Sweden

Survival after non‐Hodgkin lymphoma (NHL) has increased thanks to improved treatment but NHL survivors have an increased risk of second neoplasms. The assessment of cancer risk patterns after NHL may help to quantify the late side‐effects of therapy. Poisson regression was used to estimate relative risks (RRs) and absolute incidence rates for nine solid tumours based on a nationwide cohort of 60 901 NHL survivors from Finland, Norway and Sweden. Patients were diagnosed between 1980 and 2006 and developed 6815 s neoplasms. NHL patients showed an increased risk of each of the nine investigated cancer sites: prostate and pancreas (both RRs 1·28), breast (1·37), colorectum (1·48), urinary bladder (1·52), stomach and lung (both RRs 1·87), skin (melanoma 2·27) and kidney (2·56). The RRs showed a U‐shaped relationship with time after NHL for all nine‐second cancer types. NHL diagnosis early in life was a risk factor for the development of second cancers with the exception of melanoma, but a risk excess was even observed in patients diagnosed with NHL at age 80+ years. The present study provides accurate estimates on the adverse late effects of NHL therapy, which should guide the establishment of cancer prevention strategies in NHL survivors.     

Long‐term follow‐up and second malignancies in 487 patients with hairy cell leukaemia

A large, multicentre, retrospective survey of patients with hairy cell leukaemia (HCL) was conducted in France to determine the frequency of second malignancies and to analyse the long‐term effects of the established purine nucleoside analogues (PNAs), cladribine and pentostatin. The survey retrospectively reviewed the medical history of patients and their immediate family, clinical and biological presentation at the time of HCL diagnosis, treatment choice, response to treatment, time to relapse and cause of death. Data were collected for 487 patients with HCL. Of the patients included in the survey, 18% (88/487) had a familial history of cancers, 8% (41/487) presented with malignancies before HCL diagnosis and 10% (48/487) developed second malignancies after HCL was diagnosed. An excess incidence of second malignancies was observed, with a standardized incidence ratio (SIR) of 1·86 (95% confidence interval (CI): 1·34–2·51), with no significant difference between PNAs. For second haematological malignancies alone, the SIR was markedly increased at 5·32 (95% CI: 2·90–8·92). This study highlights the high frequency of cancers in HCL patients and their family members. The frequency of second malignancies is notably increased, particularly for haematological malignancies. The respective role of pentostatin and cladribine in the development of second malignancies is debatable.