47例原发性腹膜后肿瘤的临床诊治探讨

目的 探讨原发性腹膜后肿瘤(PRT)的诊治经验.方法 回顾性分析自2005年6月至2014年6月收治的47名腹膜后肿瘤患者一般临床资料、既往史、影像学检查、手术方式、术后病理、随访记录等资料.结果 B超诊断阳性率为85.0％,CT和MRI诊断阳性率为100％.开放手术组25例,肿瘤平均直径8.06cm,人平均手术时间为154.3min,人均术中出血量790.1 mL,人均术后住院天数11.8d.腔镜组22例,肿瘤平均直径6.84cm,人均手术时间153.9min,人均术中出血量289.2mL,人均术后住院天数9.0d.两组术中出血量和术后住院天数差异有统计学意义(P＜0.05).良性肿瘤27例(57.45％),恶性肿瘤20例(42.55％).恶性PRT完整切除组的5年生存率为40.0％ (4/10),姑息切除组为0(0/8),差异有统计学意义(P＜0.05).结论 影像学检查对PRT术前诊断至关重要,腹腔镜手术在术中出血以及术后恢复方面优于开放手术,完整切除肿瘤是治疗的关键和影响预后的重要因素.     

CT的肾血流重建3D影像在内生型肾癌保留肾单位手术中的应用

目的 探讨CT的肾血流重建3D影像在内生型肾癌保留肾单位手术(LNSS)中的应用.方法 术前通过肾肿瘤血流在CT增强中的“快进快退”表现,对患肾进行CT肾血流重建,旋转3D重建影像见肿瘤区域缺损.术中同轴旋转影像及肾脏,根据缺损部位定位肿瘤,并进行LNSS.结果 4例患者均完成LNSS,剥离出肿瘤均见包膜完整,肿瘤直径(2.2±0.5)cm.术中热缺血时间17～27min,平均21.7min.出血20 ～ 55mL,平均32mL.病理回示均为透明细胞癌.术后随访7个月～5年,患者血肌酐、尿素氮及碱性磷酸酶无明显变化,肾小球滤过率测定患肾功能无明显下降,CT均未见局部肿瘤复发.结论 采用CT的肾血流重建3D影像帮助内生型T1a期肾癌的LNSS进行精准定位,该技术是安全、有效的,并且方法简便易行,利于推广.     

18F-FDG SPECT/CT与64排CT异机融合在结直肠癌诊断中的应用

目的 对比氟18-脱氧葡萄糖单光子发射计算机断层成像术（¹⁸F-FDG SPECT/CT）与GE 64排CT异机融合前后图像质量,探讨异机融合¹⁸F-FDG SPECT/CT（简称异机融合）诊断结直肠癌及TNM分期的优势。方法 36例经病理证实的结直肠癌患者接受¹⁸F-FDG SPECT/CT和异机64排CT检查,图像传输至后处理工作站,完成¹⁸F-FDG SPECT图像分别与同机低能量CT及异机64排CT图像融合。36例患者中,共65枚病灶,其中原发灶36枚,淋巴结转移灶19枚,远处转移灶10枚,并依此分为三组;分别对三组同机融合及异机融合图像中病灶边界是否清晰、与邻近脏器关系是否清晰、是否有伪影进行主观评分,同机融合及异机融合图像质量得分的比较采用Wilcoxon检验。结果 三组图像质量得分异机融合均高于同机融合,差异有统计学意义（z=-5.303和-3.858和-2.844,均P<0.01）。结论 结直肠癌原发灶、淋巴结转移灶、远处转移灶异机融合图像均优于同机融合图像,异机融合值得临床推广应用。     

临床护理路径对核磁共振增强检查患者满意度的影响

目的：探讨如何将临床护理路径应用于核磁共振增强检查,使其形成模式化并确保更高的患者满意度。方法：将实施临床护理路径前后进行核磁共振增强检查的患者分别设为对照组和实验组。采用技术评价量表和患者满意度问卷调查,比较护士技术水平和患者满意度。结果：实施临床护理路径管理模式后,患者检查准备不足现象减少,护理投诉与纠纷明显减少（P < 0.05）。患者对MRI增强检查过程中护士主动沟通、健康教育、检查后处置、部门间协作的满意度提升明显（P < 0.05）。结论：在核磁共振增强检查过程中应用临床护理路径管理模式提升了患者满意度,对改进临床管理质量有一定借鉴。     

Human papillomavirus vaccination coverage among females and males,National Health and Nutrition Examination Survey,United States, 2007–2016

BackgroundHuman papillomavirus (HPV) vaccination has been routinely recommended at age 11–12 years in the United States for females since 2006 and males since 2011. Coverage can be estimated using self/parent-reported HPV vaccination collected in the National Health and Nutrition Examination Survey (NHANES) for a wider age range than other national surveys. We assessed vaccination coverage in 2015–2016, temporal trends by age, and the validity of self/parent-reported vaccination status.MethodsParticipants aged 9–59 years completed an interview collecting demographic and vaccination information. Weighted coverage was estimated for two-year NHANES cycles by age group for 2007–2008 to 2015–2016 for females (N = 14318) and 2011–2012 to 2015–2016 for males (N = 7847). Temporal trends in coverage were assessed from 2007–2008 to 2011–2012 for females and from 2011–2012 to 2015–2016 for both sexes. Sensitivity and specificity of self/parent-reported vaccination were assessed using provider-verified vaccination records from a pilot study in 14–29 year-olds.ResultsIn 2015–2016, ≥1 dose coverage among females was highest in 14–19 (54.7%) and 20–24 (56.0%) year-olds and lower in successively older age groups. Among males, ≥1 dose coverage was highest in 14–19 year-olds (39.5%) and lower at older ages. Coverage was similar in 9–13 year-old females and males. Between 2007–2008 and 2011–2012, there were increases among females younger than 30 years. Between 2011–2012 and 2015–2016, there were increases among female age groups including 20–39 year-olds; male coverage increased among ages 9–13, 14–19, and 20–24 years. Self/parent-reported receipt of ≥1 dose had a sensitivity and specificity of 87.0% and 83.3%. Performance was lower for 3 doses.ConclusionsWhile overall HPV vaccination coverage remains low, it is higher in females than males, except in 9–13 year-olds. There have been increases in coverage among many age groups, but coverage has stalled in younger females. Adequate validity was demonstrated for self/parent-reported vaccination of ≥1 dose, but not 3 doses, in a pilot study.     

Metabolic syndrome: pathogenesis, medical care and dental implications

BACKGROUND: The dental literature contains little information about metabolic syndrome (MetS) and its dental implications. TYPES OF STUDIES REVIEWED: The authors conducted a MEDLINE search for the period 2000 through 2005, using the term "metabolic syndrome" to define its pathophysiology, medical treatment and dental implications. RESULTS: MetS is the co-occurrence of abdominal obesity, hyper-triglyceridemia, reduced high-density lipoprotein cholesterol levels, hypertension and impaired fasting glucose, which results from consumption of a high-calorie diet and decreased levels of physical activity superimposed on the appropriate genetic setting. Components of MetS synergistically promote the development of atherosclerosis, resulting in myocardial infarction and stroke. CLINICAL IMPLICATIONS: Deteriorating oral health status is associated with worsening of the atherogenic profile. Tooth loss often results in chewing difficulties because of inadequate occlusive surfaces and may lead to alterations in food selection and dietary quality. This, in turn, adversely affects body composition and nutritional status, both of which are related to vascular health. Dentists should develop treatment plans that preserve and restore the dentition, thus ensuring maximum masticatory efficiency and affording patients the optimum opportunity to consume food that will not foster atherogenesis.     

Screening for cardiovascular risk factors in a dental setting

BACKGROUND: The authors assessed the utilization of oral health care professionals (OHCPs) as a resource for identifying patients who were unaware of their increased risk of developing cardiovascular disease (CVD). METHODS: OHCPs administered a CVD risk-screening questionnaire, measured blood pressure and tested cholesterol levels, high-density lipoprotein levels and hemoglobin A1c (HgA1c) levels using "finger-stick" blood testing in 100 patients treated in a dental school clinic who were unaware of their CVD risk status. The authors determined the prevalence of specific risk factors (that is, smoking and abnormal levels of systolic blood pressure, lipids, body mass index and HgA1c) and calculated Framingham 10-year coronary heart disease (CHD) risk scores. RESULTS: Seventeen percent of the 100 patients (35 percent of men, 5 percent of women) had an increased global risk of experiencing a CHD event within 10 years (Framingham risk score>10 percent). Seventy-three percent of participants had one or more risk factors and 31 percent had two or more risk factors present. More men than women had low levels of high-density lipoprotein (45 percent [18/40] of men versus 3.3 percent [2/60] of women; P<.0001). The mean Framingham CHD risk score increased with increasing risk factor burden. CONCLUSIONS: OHCPs identified patients with an increased CHD risk who could benefit from primary prevention activities. A substantial proportion of study patients who were unaware of their risk status were at an increased risk of experiencing a CHD event within 10 years. OHCPs could contribute to public health CHD control efforts.     

北京工业大学教职工健康体检结果分析

目的 了解北京工业大学教职工身体健康状况.方法 对北京工业大学2012年教职工健康体检结果进行统计分析.结果 参加体检的4 191例中共检出异常者3 687例,异常率达87.97％,共检出疾病36种,主要以咽炎、脂肪肝、高脂血症、高血压、乳腺增生症、糖尿病或空腹血糖≥7.0 mmol/L等多见,男教职工体检异常率明显高于女教职工（均P ＜0.05）.结论 北京工业大学教职工健康状况不容乐观,应重视教职工定期体检,加强教职工医疗保健、健康教育,落实各项预防措施.     

比较“法体系”视角下我国执业药师考试模式探讨

本文基于执业医师考试管理较为成熟,其管理依据为《执业医师法》体系较为完善的原因.两者同属人力资源管理领域,对比研究、探讨当前执业药师考试制度.     

Associations Between Adherence to the Physical Activity and Exercise Program Applied in the LAST Study and Functional Recovery After Stroke

ObjectiveTo investigate the associations between participants’ adherence to a physical activity and exercise program after stroke and functional recovery 18 months after inclusion.DesignSecondary analyses of the intervention arm in the multisite randomized controlled trial Life After Stroke (LAST).SettingPrimary health care services in 3 Norwegian municipalities.ParticipantsOf the participants enrolled (N=380), 186 (48.9%) were randomized to the intervention. The study sample comprised community dwelling individuals included 3 months after stroke, with mean age of 71.7 ± 11.9 years and 82 (44.1%) women. According to the National Institutes of Health Stroke Scale, 97.3% were diagnosed as having mild (National Institutes of Health Stroke Scale<8) and 2.7% with moderate (8-16 on the National Institutes of Health Stroke Scale) stroke.InterventionMonthly coaching by physiotherapists encouraging participants to adhere to 30 minutes of daily physical activity and 45-60 minutes of weekly exercise.Main Outcome MeasuresThe primary outcome was Motor Assessment Scale (MAS). Secondary outcome measures were 6-minute walk test, Timed Up and Go (TUG), Berg Balance Scale (BBS), and the physical domains of the Stroke Impact Scale (SIS). Adherence was assessed by combining participants’ training diaries and physiotherapists’ reports.ResultsThe relationship between adherence and functional recovery was analyzed with simple and multiple linear regression models. Adjusted for age, sex, dependency, and cognition, results showed statistically significant associations between adherence and functional outcomes after 18 months, as measured by MAS, TUG, BBS, and SIS (P≤.026).ConclusionsIncreased adherence to physical activity and exercise was associated with improved functional recovery after mild to moderate stroke. This emphasizes the importance of developing adherence-enhancing interventions. Dose-response studies are recommended for future research.