壶腹周围癌危险因素的病例对照研究

目的：探讨壶腹周围癌发病的相关危险因素,为有效预防和控制壶腹周围癌提供理论依据。 方法：采用1:1配对病例对照研究,收集湖南省人民医院肝胆外科2003—2014年间122例壶腹周围癌患者（病例组）和同期122例非肿瘤、非消化系统疾病患者（对照组）,对可能的危险因素进行条件Logistic回归分析。 结果：在控制了混杂因素后,壶腹周围癌的危险因素为吸烟、饮酒及乙肝感染。其结果为,随着每日吸烟量（支）的增加壶腹周围癌的患病率随之增加,其中现在不吸烟者、<20支/d、20~39支/d、≥40支/d者的优势比（OR）分别为0.450（95% CI=0.205~0.988）、0.500（95% CI=0.092~2.730）、 2.571（95% CI=1.074~6.156）、3.000（95% CI=0.312~28.841）;每日饮酒<40 g、40~99 g、≥100 g者患壶腹周围癌的OR值分别为3.000（95% CI=0.312~28.841）、65.289（95% CI=0.006~70.239）、4.50（95% CI=0.972~20.827）;乙肝感染者患壶腹周围癌的危险性是无乙肝病史者的3.25倍（95% CI= 1.060~9.967）。 结论：大量吸烟、饮酒以及乙肝感染是壶腹周围癌的危险因素。     

慢性胰腺炎138例分析

目的：探讨慢性胰腺炎（CP）的发病因素及诊治特征。方法：回顾性分析138例CP患者一般资料、临床表现、治疗方法,探讨主要危险因素与临床特征的关系,根据2012年中华医学会CP诊治指南对进行患者临床分型、分期,用M-ANNHEIM的评分系统分析患者治疗（手术治疗与保守治疗）前后CP病情变化。结果：138例CP患者中,116例（84.1%）以腹痛为主要表现;长期饮酒者44.2%（61/138）,长期吸烟42.8%（59/138）、高脂血症39.9%（55/138）、胆道疾病20.2%（28/138）;I型11例,II型58例,III型47例,IV型22例;1期69例,2期47例,3期22例。大量饮酒患者胰腺钙化比例高于非饮酒患者,而长期吸烟患者胰腺钙化比例与糖尿病比例均高于非吸烟患者（均P<0.05）。1期患者保守治疗与手术治疗效果差异无统计学意义（P=0.744）,2期患者手术治疗效果优于保守治疗（P<0.05）,3期患者保守治疗治疗效果优于手术治疗（P<0.05）。结论：饮酒、吸烟、高脂血症、胆道疾病依然是CP的主要致病危险因素,不同因素所致CP的特征有所不同,应该根据CP诊治指南并结合患者具体情况,制定合理的治疗方案。

     

老年腹部术后患者睡眠障碍的影响因素及护理对策

目的：分析老年腹部术后患者睡眠障碍的影响因素,探讨有针对性的护理干预措施以改善患者的睡眠质量。方法对2012年10月至2013年10月我院收住的62例老年腹部术后睡眠障碍患者采用匹兹堡睡眠质量表进行调查,并用自制调查表对患者进行问卷调查,分析影响因素。结果影响62例老年腹部术后患者睡眠质量的因素为：老龄化因素、手术创伤及麻醉因素、疼痛因素、环境因素、心理因素。对该类患者采取包括围术期护理、舒适护理、心理护理、药物治疗等护理措施,效果令人满意。结论明确老年腹部术后患者睡眠障碍的原因所在,采取针对性的护理对策,能改善患者睡眠质量促进早日康复。     

Obstructive Sleep Apnea Syndrome is Associated with Metabolic Syndrome among Adolescents and Youth in Beijing: Data from Beijing Child and Adolescent Metabolic Syndrome Study

Background:

Obstructive sleep apnea (OSA) syndrome has a negative impact on the health of millions of adolescents and youth. The aim of this study was to evaluate the associations of OSA syndrome with obesity and cardiometabolic risk factors among adolescents and youth at risk for metabolic syndrome (MS).

Methods:

A total of 558 subjects aged 14–28 years were recruited from the Beijing Child and Adolescent Metabolic Syndrome Study. Each underwent a 2-h oral glucose tolerance test (OGTT), echocardiography, and liver ultrasonography. Anthropometric measures, blood levels of glucose, lipids, and liver enzymes were assessed. Subjects with high or low risk for OSA were identified by Berlin Questionnaire (BQ).

Results:

Among the subjects in obesity, 33.7% of whom were likely to have OSA by BQ. Subjects with high risk for OSA had higher neck and waist circumference and fat mass percentage compared to those with low risk for OSA (P < 0.001). Moreover, significant differences in levels of lipids, glucose after OGTT, and liver enzymes, as well as echocardiographic parameters were found between the two groups with high or low risk for OSA (P < 0.05). The rates of nonalcoholic fatty liver disease (71.0% vs. 24.2%), MS (38.9% vs. 7.0%), and its components in high-risk group were significantly higher than in low-risk group.

Conclusions:

The prevalence of OSA by BQ was high in obese adolescents and youth. A high risk for OSA indicates a high cardiometabolic risk. Mechanisms mediating the observed associations require further investigation.     

Analyses of Potential Predictive Markers and Response to Targeted Therapy in Patients with Advanced Clear-cell Renal Cell Carcinoma

Background:Vascular endothelial growth factor-targeted agents are standard treatments in advanced clear-cell renal cell carcinoma (ccRCC),but biomarkers of activity are lacking.The aim of this study wa...     

Plantar Pressure Changes and Correlating Risk Factors in Chinese Patients with Type 2 Diabetes: Preliminary 2-year Results of a Prospective Study

Background:

Plantar pressure serves as a key factor for predicting ulceration in the feet of diabetes patients. We designed this study to analyze plantar pressure changes and correlating risk factors in Chinese patients with type 2 diabetes.

Methods:

We recruited 65 patients with type 2 diabetes. They were invited to participate in the second wave 2 years later. The patients completed identical examinations at the baseline point and 2 years later. We obtained maximum force, maximum pressure, impulse, pressure-time integral, and loading rate values from 10 foot regions. We collected data on six history-based variables, six anthropometric variables, and four metabolic variables of the patients.

Results:

Over the course of the study, significant plantar pressure increases in some forefoot portions were identified (P < 0.05), especially in the second to forth metatarsal heads. Decreases in heel impulse and pressure-time integral levels were also found (P < 0.05). Plantar pressure parameters increased with body mass index (BMI) levels. Hemoglobin A1c (HbA1c) changes were positively correlated with maximum force (β = 0.364, P = 0.001) and maximum pressure (β = 0.366, P = 0.002) changes in the first metatarsal head. Cholesterol changes were positively correlated with impulse changes in the lateral portion of the heel (β = 0.179, P = 0.072) and pressure-time integral changes in the second metatarsal head (β = 0.236, P = 0.020). Ankle-brachial index (ABI) changes were positively correlated with maximum force changes in the first metatarsal head (β = 0.137, P = 0.048). Neuropathy symptom score (NSS) and common peroneal nerve sensory nerve conduction velocity (SCV) changes were positively correlated with some plantar pressure changes. In addition, plantar pressure changes had a correlation with the appearance of infections, blisters (β = 0.244, P = 0.014), and calluses over the course of the study.

Conclusions:

We should pay attention to the BMI, HbA1c, cholesterol, ABI, SCV, and NSS changes in the process of preventing high plantar pressure and ulceration. Some associated precautions may be taken with the appearance of infections, blisters, and calluses.     

Alcohol Expectancies in a Native American Population

Native Americans, as a group, have a high prevalence of alcohol abuse and alcohol dependence, although specific risk factors for alcoholism among this population have yet to be clearly identified. One set of factors that may contribute to the development of alcoholism are expectations of alcohol's effects. Previous research has shown that heavy drinkers and alcoholics have higher alcohol-related expectancies. Some studies have also shown an association between alcohol expectancies and a positive familial history of alcoholism. To examine factors that are related to expectations of alcohol's effects in a Native American population, this study evaluated healthy, nonalcoholic Mission Indian men between the ages of 18 and 25 years using the short form of the Alcohol Expectancy Questionnaire (AEQ). The influence of recent drinking history, family history of alcoholism, and degree of Native American heritage on alcohol-related expectancies was determined using regression analyses for the total AEQ score and for each of the six AEQ subscales. Recent drinking history accounted for a significant proportion of the variance in the total score, as well as scale I (global positive changes) and scale VI (arousal and power) of the AEQ. Degree of Native American heritage and family history of alcoholism did not account for a significant amount of variability in alcohol expectancies. These results suggest that, consistent with findings in other populations, alcohol expectancies are related to drinking patterns in Mission Indians. However, no association with two other potential risk factors were found in this sample of Native Americans.     

伊伐布雷定对糖尿病伴冠心病患者的效果观察

目的 探讨伊伐布雷定对糖尿病伴冠心病患者的效果观察。方法 选择2018年1月至2019年1月本院收治的糖尿病伴冠心病患者90例,采用随机数字表法分为两组,各45例。对照组采用常规治疗,观察组在对照组基础上服用伊伐布雷定。对比两组临床疗效、心功能指标、炎性因子、血液流变学指标。结果 治疗后,观察组总有效率97.78%高于对照组80.00%,差异具有统计学意义（P<0.05）。观察组心率（71.63±3.21）次/min及氨基末端脑钠肽前体（NT-proBNP）（755.48±346.42）ng/L水平、空腹血糖( FPG)（6.55±1.14）mmol/L、糖化血红蛋白( HbA1c)（6.13±1.08）%、餐后2 h 血糖(2hPG)（7.14±0.52）mmol/L、肿瘤坏死因子-α（TNF-α）（0.81±0.21）ng/L、白介素-6（IL-6）（7.42±1.21）ng/L、血清超敏C反应蛋白（hs-CRP）（1.24±0.54）mg/L水平、全血黏度（33.92±1.13）mpa?s、血浆黏度（1.35±0.09）mpa?s、血浆纤维蛋白原（2.01±0.03）g/L低于对照组心率（84.06±3.54）次/min、NT-proBNP（1598.14±309.34）ng/L水平、FPG（7.95±1.02）mmol/L、HbA1c（7.12±1.23）%、2hPG（7.87±0.76）mmol/L、TNF-α（1.06±0.28）ng/L、IL-6（9.24±1.52）ng/L、hs-CRP（1.67±0.72）mg/L水平、全血黏度（38.10±1.18）mpa?s、血浆黏度（1.58±0.13）mpa?s、血浆纤维蛋白原（2.64±0.16）g/L;且观察组左心室射血分数（LVEF）（50.69±4.98）%、左心室收缩末期内径（LVESD）（45.70±4.70）mm、左心室舒张末期内径（LVEDD）（45.20±3.81）mm、6 min步行距离（422.67±70.54）m高于对照组LVEF（46.72±5.38）%、LVESD（50.52±5.20）mm、LVEDD（49.40±4.03）mm水平、6 min步行距离（322.04±53.12）m,差异具有统计学意义（P<0.05）。结论 伊伐布雷定有助于糖尿病伴冠心病患者降低NT-proBNP水平、改善心功能指标、降低炎性因子水平和血液流变学指标,改善患者临床疗效,提高患者生活质量,有助于患者转归。     

Breastfeeding and Helicobacter pylori Infection in Early Childhood: a Continuing Dilemma

Objective:

Helicobacter pylori (H. pylori) is the most common chronic bacterial infection in humans. Chronic colonization increases the risk of duodenal ulcer and gastric cancer. The risk factors for acquiring the infection have been extensively studied. However, there are conflicting results on the role of breastfeeding in the prevention of H. pylori infection. We conducted a study to evaluate the effects of breastfeeding on the H. Pylori infection in Kurdish children in Sanandaj, IR Iran.

Methods:

A historical cohort study was carried out from January 2011 through December 2012. Totally 221 children who were going to attain 2 years old during the study period were randomly enrolled. They were divided into two groups, i.e. breastfed and non-breastfed. We used H. pylori stool antigen test to detect infection in the selected group of children after age of 2 years and cessation of breastfeeding. Each group was subdivided into two subgroups, infected and non-infected. The associations of breastfeeding with H. pylori infection was assessed using statistical software.

Findings:

We found no difference in the odds of infection between breastfed and non-breastfed groups (OR=0.809, 95% CI [0.453–1.444]). An association between age and the prevalence of infection was found (P=0.008). There was an increase in the odds of infection as the family size grew (OR=1.93, 95% CI [1.04–3.6]) as well as increasing housing density (OR=2.12, 95% CI [1.10–4.10]).

Conclusion:

The data suggests that breastfeeding in infancy does not protect against H. pylori infection for long duration among studied children in Iran. The protective effects of breastfeeding, if any, are at most transient.     

Risk Factors of Germinal Matrix Intraventricular Hemorrhage in Premature Infants

Objective

To determine whether some clinical parameters can be used to predict the hemorrhage and whether the relationship between these clinical variables and the grades of hemorrhage is linear.

Methods

A total of 230 premature infants, born at a gestational age less than 34 weeks were retrospectively reviewed. Germinal matrix-intraventricular hemorrhage (GM-IVH), the grade of the hemorrhage, and clinical data were assessed with a checklist. Variables were analyzed by using Mann Whitney U and Fisher’s exact tests and then multiple logistic regression analysis was used to evaluate the independent risk factors.

Findings

Resuscitation, gestational age, hypotension, multiple birth, and birth weight were found to be independent risk factors. We determined non-linear relationship between the grades of hemorrhage and the clinical parameters. But when we classified hemorrhages as grade 1, grade 2-3 and grade 4, the relationships were found linear.

Conclusion

Premature infants who had resuscitation, low gestational age, hypotension, multiple birth, and low birth weight are more likely to have GM-IVH. The relationship between the clinical variables and the grades of GM-IVH does not seem to be linear.