微型腹腔镜治疗小儿腹股沟斜疝62例体会

目的:探讨微型腹腔镜治疗小儿腹股沟斜疝的可行性。方法:应用微型腹腔镜,采用自行设计的带线针和En-doc lose与操作钳配合,运用提插式缝合方法,高位荷包缝扎内环口周边腹膜,治疗小儿腹股沟斜疝62例。结果:62例手术均成功,手术时间10~15m in,住院2~3d。术后随诊1~28月无复发。结论:微型腹腔镜下高位荷包缝扎内环口治疗小儿腹股沟斜疝具有损伤小、恢复快、住院时间短、对侧再发率低的优点。     

Weight gain in childhood and bone mass in female college students

The attainment of maximal peak bone mass early on in life is one of the most important strategies for the prevention of osteoporosis in women. The aim of this study was to clarify the correlation between gains in body size in all growth phases in childhood and adult bone mass in women. The subjects were 86 female first-year university students, aged 18–21 years. We measured the subjects bone mineral content (BMC) and bone mineral density (BMD) at the lumbar spine and the left hip, including the femoral neck, with dual energy X-ray absorptiometry. Each subject was measured for current height and weight. Height and weight at birth, and at 1.5, and 3 years were obtained from each maternity record book, and those between 6 and 18 years were obtained from their school health records. Other information, including physical activity and calcium intake, was obtained through an interview. Bivariate analysis showed that weight gains during the periods from birth to 1.5 years and from 9 to 12 years significantly correlated with both BMC and BMD values at any site. The stepwise method of multiple regression analysis showed that a weight gain during the period from birth to 1.5 years was significantly associated with BMC at the lumbar spine (P = 0.0001) and at the femoral neck (P = 0.0290) and with BMD at the lumbar spine (P = 0.0387). Birth weight was significantly associated with BMC at the lumbar spine (P = 0.0474) and the total hip (P = 0.0352), and weight gain during the period from 9 to 12 years was significantly associated with BMC at the femoral neck (P = 0.0376). In conclusion, birth weight and weight gain in infancy are important determinants of bone mass in young women. Additionally, a girls prepubertal growth spurt is likely to be a key phase for the acquisition of bone mass in relation to body weight. Our findings suggest that osteoporosis prevention programs may need to start very early in the life cycle.     

Determinants of peak bone mineral density and bone area in young women

Osteoporosis is a disease caused by compromised bone strength, and individuals with a high peak bone mass at a young age are likely to have a high bone mass in old age. To identify the clinical determinants of peak bone mass in young adult women, 418 southern Chinese women, aged 20–39 years, were studied. Low bone mass was defined as areal bone mineral density (aBMD) Z-score < −1 at either the spine or total hip. Within the cohort, 62 (19.0%) and 86 (26.4%) women had low aBMD at the spine and hip, respectively. Regression model analysis revealed that low body weight (<44 kg) was associated with an 8.3-fold (95% CI, 3.7–18.9) and a 6.8-fold (95% CI, 3.0–15.6) risk of having low aBMD at the spine and hip, respectively. Low body weight was also predictive of low volumetric BMD (vBMD) at the spine (odds ratio (OR) 7.8, 95% CI, 3.1–20.1) and femoral neck (OR 3.0, 95% CI, 1.3–7.1). A body height below 153 cm was associated with a 4.8-fold risk in the small L2–4 bone area (95% CI, 2.3–9.8) and a 3.9-fold risk in the small femoral neck area (95% CI, 1.9–8.1). Delayed puberty (onset of menstruation beyond 14 years) was associated with a 2.2-fold (95% CI, 1.0–4.9) increased risk of having low aBMD at the hip. Physical inactivity was associated with a 2.8-fold risk of low spine vBMD (OR 2.8, 95% CI, 1.1–6.7) and a 3.3-fold risk of low hip aBMD (95% CI, 1.0–10.0). Pregnancy protected against low spine aBMD (OR 0.4, 95% CI, 0.1–1.2) and spine vBMD (OR 0.1, 95% CI, 0.0–1.0), low femoral neck vBMD (OR 0.3, 95% CI, 0.1–1.1) and small L2–4 bone area vBMD (OR 0.3, 95% CI, 0.1–1.1). In conclusion, this study identified a number of modifiable determinants of low peak bone mass in young adult women. Maintaining an ideal body weight, engaging in an active lifestyle, and diagnosing late menarche may enable young women to maximize their peak bone mass and so reduce their risk of osteoporosis in later life.     

腹腔镜治疗青年十二指肠球溃疡穿孔的临床应用

目的 评价腹腔镜下修补治疗十二指肠球部前壁溃疡穿孔的临床应用价值。方法 对我院2003年1月～2004年12月收治的42例青年十二指肠溃疡穿孔病例随机分组，20例接受腹腔镜下修补治疗，22例接受传统开腹修补。结果 两组术后胃肠功能恢复情况、术后使用镇痛药、平均住院时间差异均有显著性（P〈0．05），两组术后均无出血、中转开腹、再穿孔等并发症。结论 腹腔镜下修补治疗青年十二指肠球部前壁溃疡穿孔临床安全可行，应该作为首选方法在临床上推广应用。     

COVID-19 vaccine effectiveness by HIV status and history of injection drug use: a test-negative analysis

Introduction

People living with HIV (PLWH) and/or who inject drugs may experience lower vaccine effectiveness (VE) against SARS-CoV-2 infection.

Methods

A validated algorithm was applied to population-based, linked administrative datasets in the British Columbia COVID-19 Cohort (BCC19C) to ascertain HIV status and create a population of PLWH and matched HIV-negative individuals. The study population was limited to individuals who received an RT-PCR laboratory test for SARS-CoV-2 between 15 December 2020 and 21 November 2021 in BC, Canada. Any history of injection drug use (IDU) was ascertained using a validated administrative algorithm. We used a test-negative study design (modified case−control analysis) and multivariable logistic regression to estimate adjusted VE by HIV status and history of IDU.

Results

Our analysis included 2700 PLWH and a matched population of 375,043 HIV-negative individuals, among whom there were 351 and 103,049 SARS-CoV-2 cases, respectively. The proportion of people with IDU history was much higher among PLWH compared to HIV-negative individuals (40.7% vs. 4.3%). Overall VE during the first 6 months after second dose was lower among PLWH with IDU history (65.8%, 95% CI = 43.5–79.3) than PLWH with no IDU history (80.3%, 95% CI = 62.7–89.6), and VE was particularly low at 4–6 months (42.4%, 95% CI = −17.8 to 71.8 with IDU history vs. 64.0%; 95% CI = 15.7–84.7 without), although confidence intervals were wide. In contrast, overall VE was 88.6% (95% CI = 88.2–89.0) in the matched HIV-negative population with no history of IDU and remained relatively high at 4–6 months after second dose (84.6%, 95% CI = 83.8–85.4). Despite different patterns of vaccine protection by HIV status and IDU history, peak estimates were similar (≥88%) across all populations.

Conclusions

PLWH with a history of IDU may experience lower VE against COVID-19 infection, although findings were limited by a small sample size. The lower VE at 4–6 months may have implications for booster dose prioritization for PLWH and people who inject drugs. The immunocompromising effect of HIV, substance use and/or co-occurring comorbidities may partly explain these findings.     

Outcomes according to treatment using an established protocol in patients with bilateral Wilms' tumor: A national Canadian population-based study

BackgroundBilateral Wilms tumor (BWT) is a rare entity. The goal of this study is to report outcomes (overall and event-free survival, OS/EFS) of BWT in a large cohort representative of the Canadian population since 2000. We focused on the occurrence of late events (relapse or death beyond 18 months), as well as outcomes of patients treated following the only protocol specifically designed for BWT to date, AREN0534, compared to patients treated following other therapeutic schemes.MethodsData was obtained for patients diagnosed with BWT between 2001 and 2018 from the Cancer in Young People in Canada (CYP-C) database. Demographics, treatment protocols, and dates for events were collected. Specifically, we examined outcomes of patients treated according to the Children's Oncology Group (COG) protocol AREN0534 since 2009. Survival analysis was performed.Results57/816 (7%) of patients with Wilms tumor had BWT during the study period. Median age at diagnosis was 2.74 years (IQR 1.37–4.48) and 35 (64%) were female; 8/57 (15%) had metastatic disease. After a median follow-up of 4.8 years (IQR 2.8–5.7 years, range 0.2–18 years), OS and EFS were 86% (CI 73–93%) and 80% (CI 66–89%), respectively. Less than 5 events were recorded after 18 months from diagnosis. Since 2009, patients treated according to the AREN0534 protocol had a statistically significant higher OS compared to patients treated with other protocols.ConclusionsIn this large Canadian cohort of patients with BWT, OS and EFS compared favorably to the published literature. Late events were rare. Patients treated according to a disease-specific protocol (AREN0534) had improved overall survival.Type of studyOriginal article.Level of evidenceLevel IV.     

85例青年乳腺癌临床病理特点及预后的回顾性分析

【摘要】 目的 回顾性研究85例青年乳腺癌的临床病理特点,探讨青年乳腺癌的临床病理特点,并分析其对临床预后的影响。方法〓本研究将收治的青年乳腺癌(≦35岁)85例作为青年组,将同时期收治的中老年乳腺癌(﹥35岁)98例作为中老年组,收集其临床病理类型,包括雌激素受体(ER)和孕激素受体(PR)、Her-2表达、P53表达方面、腋窝淋巴结转移情况和术后5年无病生存率等方面开展比较,进行统计学分析。结果〓青年组乳腺癌和中老年组乳腺癌在病理类型上、组织学分级及临床分期上均无显著差异(P>0.05);在ER、PR及Her-2的表达方面具有显著差异(P<0.05);而在P53的表达方面无显著差异(P>0.05);在腋窝淋巴结转移率方面具有显著差异(P<0.05);两组在术后5年无病生存率上的差异具有统计学意义(P<0.05)。结论〓青年乳腺癌的病理类型提示其较中老年乳腺癌有更强的侵袭性,淋巴结转移较早,5年无病生存率较低,所以在临床上改善其预后最好的办法是早期发现并早期接受规范化治疗。     

Diagnosis of breast cancer in women age 40 and younger: delays in diagnosis result from underuse of genetic testing and breast imaging

Background

The impact of newer breast imaging technologies and genetic testing on the detection of breast cancer in women age 40 and younger remains unknown.

Methods

A records review identified 628 women age 40 and younger diagnosed with breast cancer from 1996 to 2008. Patient and tumor characteristics, means of diagnosis, imaging results, and genetic testing were examined.

Results

Tumors were first detected by self-examination in 71%, with a median invasive tumor size of 2.0 cm. Imaging performed at or after diagnosis visualized most tumors; mammography visualized 86%, magnetic resonance imaging (MRI) visualized 96%, and mammography plus MRI visualized more than 98% of tumors. For 81% of patients, the mammogram at diagnosis was their first mammogram. Although 50% had a family history of breast or ovarian cancer, few underwent genetic testing before their cancer diagnosis; 61 of 247 (25%) ultimately tested had a BRCA mutation.

Conclusions

Better use of genetic testing, mammography, and MRI could improve breast cancer detection in young women.     

青年期下肢深静脉血栓形成的原因分析及处理对策

目的:探讨青年期(≤35岁)下肢深静脉血栓形成的危险因素及治疗措施。方法 :回顾性分析我科自2010年1月至2015年3月收治的47例青年期下肢深静脉血栓病人的临床资料,均以静脉造影检查诊断。结果:危险因素中遗传性10例(21.3%),免疫性6例(12.8%),恶性肿瘤5例(10.6%),妊娠相关6例(12.8%),术后卧床等其他因素20例(42.6%)。47例病人中,4例采用不抗凝、不止血的中性治疗,19例单纯抗凝。24例抗凝结合下腔静脉滤器置入,其中71例在滤器保护下溶栓,2例溶栓并置入髂静脉支架。结论:血液高凝状态是青年期静下肢深静脉血栓形成的最常见危险因素,治疗以抗凝为主,必要时结合滤器置入、导管溶栓等腔内微创综合治疗。     

失能老人家庭病床智慧管理研究的范围综述

目的 对失能老人家庭病床智慧管理研究进行范围综述,为相关研究与干预提供参考。方法 以主题词和自由词相结合的方式检索PubMed、Web of Science、中国知网、万方数据等国内外数据库中相关研究,检索时限为建库至2022年6月30日,对纳入文献进行提取与分析。结果 纳入8篇文献,智慧管理方案包括移动医疗和远程保健2种形式;内容要素涵盖临床诊疗、建立患者健康档案、设备使用指导、警报管理;策略要素涵盖组建多学科团队、明确团队成员职责、入床前综合评估、全程动态等级评估;评价要素主要包括患者健康结局、智慧医疗依赖性、患者满意度评价、管理方案依从性和可行性。结论 失能老人家庭病床智慧管理研究呈现多样性、有效性;缺乏规范统一的管理评价标准及高质量研究数据。需加强多中心、大样本、高质量研究,以提供高水平证据。