不同腹腔镜剥离术式对子宫内膜异位症患者性激素、窦卵泡数及卵巢体积的影响

目的探讨腹腔镜下常规钝性剔除与改良锐性剥离术式对子宫内膜异位症(EMs)患者性激素、窦卵泡数(AFC)及卵巢体积的影响。方法选取该院2013年1月-2016年4月收治EMs患者共100例,按随机数字表法分为对照组(50例)和观察组(50例),分别给予腹腔镜下常规钝性剔除与改良锐性剥离术式治疗;比较两组患者剥除病灶厚度、卵巢皮质剥除率、卵巢皮质剥除厚度、手术前后血清性激素水平、患侧卵巢AFC及卵巢体积。结果两组患者卵巢窝部位剥除病灶厚度、卵巢皮质剥除率及卵巢皮质剥除厚度比较差异无统计学意义(P0.05);观察组患者中间部位剥除病灶厚度和卵巢皮质剥除厚度均明显低于对照组(P0.05);观察组患者卵巢门剥除病灶厚度、卵巢皮质剥除厚度和卵巢皮质剥除率均明显低于对照组(P0.05);两组患者手术前后性激素水平比较差异无统计学意义(P0.05);观察组患者手术前后患侧卵巢AFC水平比较差异无统计学意义(P0.05);对照组患者术后患侧卵巢AFC水平明显低于术前(P0.05);两组患者术后卵巢体积均明显小于术前(P0.05);观察组患者术后卵巢体积明显大于对照组(P0.05)。结论腹腔镜下改良锐性剥离术式治疗EMs患者可有效减少卵巢门皮质剥除量,降低初级和次级卵泡丢失程度,价值优于常规钝性剥离术式。     

不同术式对早期乳腺癌病人术后生活质量的影响

[目的]寻找提高早期乳腺癌病人生活质量的手术方式。[方法]从乳腺癌生活质量的各个维度,比较了保乳手术和改良根治术对早期乳腺癌病人生活质量的影响。[结果]保乳手术在提高体形和改善上肢症状方面优于改良根治术,在情绪功能方面两种手术无明显差异。[结论]从早期乳腺癌病人术后生活质量方面看,保乳手术优于改良根治术。     

Impact and Prevention of Far-Field Sensing in Fallback Mode Switches

BORDACHAR, P., et al.: Impact and Prevention of Far-Field Sensing in Fallback Mode Switches. Far-field oversensing (FFOS) promoted by high atrial sensitivity and short atrial refractory periods induces false positive mode switches. We evaluated the incidence of ventricular FFOS in a population of DDD paced patients. Methods: One hundred thirty-seven patients (   71 ± 10   years, 76 men) implanted with a Talent DR pacemaker were studied. Before discharge, an analysis of internal data stored in the memories of the PM was performed by the specific software incorporated in the programmer in parallel with a 24-hour Holter recording. Data were validated by a panel of experts. One and 4 months follow-up was based only on the data stored in the PM memories. Results: Pacing indications were atrioventricular block   (n = 75)   , sinus node dysfunction   (n = 57)   , and other   (n = 5)   . Sustained far-field oversensing was observed in 12/137 patients (9%). Out of a total of 3,511 triggered mode switch episodes, FFOS accounted for 20% and 7% of a 311 days cumulative time in mode switch. Inappropriate mode switch episodes induced by far-field were more numerous but shorter than episodes prompted by atrial arrhythmias. Atrial sensitivity was increased in eight patients, successfully in four. Reprogramming of the atrial refractory period   (156 ± 11 ms)   was successful in five of six patients. Conclusions: A 9% rate of ventricular FFOS was observed in an unselected population, easily and automatically diagnosed using the internal memory function and the automatic analysis provided by the programmer. Prolongation of the atrial refractory period was more effective than resetting of the atrial sensitivity in eliminating FFOS. (PACE 2003; 26[Pt. II]:206–209)     

组织多普勒成像与全方位M-型超声评价左心室舒张功能的临床研究

目的:探讨组织多普勒成像(TDI)与全方位M-型超声心动图对左心室舒张功能诊断的价值。方法:将29例结合常规超声和左心导管证实的左心室舒张功能障碍患者,分为A组:松弛延迟组(11例);B组:“假性正常化”组(12例);C组:限制性充盈组(6例)及15例左心室舒张功能正常对照组;使用TDI于心尖四腔心切面、左心室两腔心切面和心尖三腔心切面测定二尖瓣环运动Ea峰及Aa峰,并计算Ea/Aa。全方位M-型超声测定收缩期最大运动速度(VS)和舒张早期运动速度(VD),计算VD/VS比值。并比较二者的特异性及敏感性。结果:TDI与全方位M-型超声对左心室舒张功能减低诊断的特异性分别为96.7%和94.4%。TDI评价各阶段左心室舒张功能障碍的敏感性,分别为71.2%,90.3%,97.7%。全方位M-型超声对左心室舒张功能评价(将标准定为VD/DS≤1)时,对各阶段左心室舒张功能减低的敏感性分别为56.1%,65.3%,96.5%。结论:二者均可作为评价左心室舒张功能障碍的指标,而TDI有较高的敏感性。     

新疆地区HBV感染者的血清学模式与HDV的关系

目的了解新疆地区乙乙肝炎病毒(HBV)感染者的血清学模式与丁型肝炎病毒(HDV)的关系,为新疆乙型肝炎病毒指标阳性病例的各民族(汉族162例、维族93例、哈族53例、回族32例、蒙古族28例)病毒性肝炎诊断、治疗提供可靠的流行病学资料。方法应用国产酶联免疫法(ELISA)和荧光定量聚合酶链反应(FQ-PCR),检测了新疆各地区不同民族HBV的血清学模式、HBV DNA和HDAg、抗-HD。结果在368例各族患者血清中,48例HDV血清标志物阳性,HBV血清学模式为HBsAg+、HBeAg+、抗-HBc+22例;HBsAg+、抗-HBe+、抗-HBc+18例;HBsAg+、抗-HBc+8例。结论新疆地区各民族HBV感染者中,HDV阳性标志物与HBV血清学模式、HBV DNA之间比较,P>0.05,并无显著性差异。     

不同感染途径的丙型肝炎患者血清HCV RNA及抗-HCV与ALT水平的分析

目的:探讨丙型肝炎(丙肝)患者感染途径与其肝脏病变程度的关系。方法:根据感染途径的不同将210例丙肝患者分输血后丙肝(PTHC组)102例和散发性丙肝(SHC组)108例,应用荧光定量聚合酶链反应(FQ-PCR)技术、酶联免疫吸附方法(ELISA)和自动生化速率法分别检测两组患者血清中HCV RNA含量、抗-HCV及ALT水平。结果:PTHC组HCV RNA阳性率和ALT的异常率均显著高于SHC组(χ2=23.39,P<0.01和χ2=13.73,P<0.01);HCV RNA阳性患者中,PTHC组的HCV DNA含量均值显著高于SHC组(t=4.29,P<0.01);ALT异常患者中,PTHC组的ALT水平均值显著高于SHC组(t=4.30,P<0.01)。HCV RNA的含量与ALT水平呈正相关(r=0.794,P<0.01)。结论:PTHC组患者病毒血症水平和肝脏功能损害的程度均显著高于SHC组,HCV不同的感染途径可导致患者不同的感染结果。     

Is elective cesarean section associated with a higher risk of asthma? A meta-analysis

Abstract

Background: Recent meta-analyses indicate that children delivered by cesarean section have increased risk for asthma. However, the studies included in these previous meta-analyses showed significant heterogeneity. Furthermore, no previous meta-analysis has distinguished the association of elective and emergency CS, spontaneous and instrumental vaginal deliveries (VD) with the odds of asthma. Objective: To examine the association between specific mode of delivery and the prevalence of asthma. Methods: PUBMED, Google Scholar, EMBASE, and MEDLINE were searched to identify relevant studies. Odds ratio (OR) and 95% confidence interval (CI) were calculated from the prevalence of asthma in children born by elective CS, emergent CS, instrumental VD and spontaneous VD. Meta-analysis was then used to derive a combined OR. Heterogeneity between studies was also tested in the findings. Results: A total of 26 studies were identified. The overall meta-analysis revealed an increase in the risk of asthma in children delivered by CS (OR?=?1.16, 95% CI 1.14, 1.29), and no evidence of heterogeneity was found (I²?=?24.6%). Elective and emergency CS moderately increased the risk of asthma (OR?=?1.21, 95% CI 1.17, 1.25; I²?=?39.9%; OR?=?1.23, 95% CI 1.19–1.26). The risk of asthma was also higher in the children born by instrumental VD (OR?=?1.07, 95% CI, 1.04–1.11) but with evidence of heterogeneity (I²?=?54.9%). Conclusion: About 20% increase in the subsequent risk of asthma was both found in children delivered by elective and emergency CS. The increasing rates of CS worldwide might partly explain the concomitant rise in asthma during the same time period.     

Blue Mode Imaging may Improve the Detection and Visualization of Small-Bowel Lesions: A Capsule Endoscopy Study

Background/Aims:Diagnostic miss rate and time consumption are the two challenging limitations of small-bowel capsule endoscopy (SBCE). In this study, we aimed to know whether using of the blue mode (BM) combined with QuickView (QV) at a high reviewing speed could influence SBCE interpretation and accuracy.Results:In study A, the total number of the vascular (P < 0.001) and the inflammatory lesions (P = 0.005) detected by BM was significantly higher than that detected by the white light. No lesion was found using the white light that was not detected by the BM. Moreover, the BM highly improved the image quality of all the vascular lesions and the erythematous ones from the nonvascular lesions. In study B, the total number of only the vascular lesions, detected by the BM on a rapid speed of viewing at 20 fps was significantly higher than that detected by the white light (P = 0.035). However, the true miss rate for the BM was 4%.Conclusion:BM imaging is a new method that improved the detection and visualization of the vascular and erythematous nonvascular lesions of SB as compared with the conventional white light imaging. Using of the BM at a slow viewing speed, markedly reduced the diagnostic miss rate of CE.     

Association between caesarean section and childhood obesity: a systematic review and meta‐analysis

Birth by caesarean section has been recently implicated in the aetiology of childhood obesity, but studies examining the association have varied with regard to their settings, designs, and adjustment for potential confounders. We conducted a systematic review and meta‐analysis to summarize the available evidence and to explore study characteristics as sources of heterogeneity. A search of Medline, EMBASE, and Web of Science identified 28 studies. Random effects meta‐analysis was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Caesarean section had a RR of 1.34 (CI 1.18–1.51) for obesity in the child compared with vaginal birth. The RR was lower for studies that adjusted for maternal pre‐pregnancy weight than for studies that did not (1.29, CI 1.16–1.44 vs. 1.55, CI 1.11–2.17). Studies that examined multiple early life factors reported lower RRs than studies that specifically examined caesarean section (1.39, CI 1.23–1.57 vs. 1.23, CI 0.97–1.56). Effect estimates did not vary by child's age at obesity assessment, study design or country income. Children born by caesarean section are at higher risk of developing obesity in childhood. Findings are limited by a moderate heterogeneity among studies and the potential for residual confounding and publication bias.     

Hearing voices in the resting brain: A review of intrinsic functional connectivity research on auditory verbal hallucinations

Resting state networks (RSNs) are thought to reflect the intrinsic functional connectivity of brain regions. Alterations to RSNs have been proposed to underpin various kinds of psychopathology, including the occurrence of auditory verbal hallucinations (AVH). This review outlines the main hypotheses linking AVH and the resting state, and assesses the evidence for alterations to intrinsic connectivity provided by studies of resting fMRI in AVH. The influence of hallucinations during data acquisition, medication confounds, and movement are also considered. Despite a large variety of analytic methods and designs being deployed, it is possible to conclude that resting connectivity in the left temporal lobe in general and left superior temporal gyrus in particular are disrupted in AVH. There is also preliminary evidence of atypical connectivity in the default mode network and its interaction with other RSNs. Recommendations for future research include the adoption of a common analysis protocol to allow for more overlapping datasets and replication of intrinsic functional connectivity alterations.