中国儿童心脏移植操作规范(2019版)

儿童心脏移植是治疗年龄18岁终末期心力衰竭患者的有效手段。1967年美国Adrian Katrowitz实施第一例儿童心脏移植,近五年全球80家单位每年开展500例左右。中国儿童心脏移植起步晚、发展慢。自1995年开展第一例儿童心脏移植以来,目前国内已登记病例超过130例。中华医学会器官移植学分会组织心脏移植专家,总结国内外相关研究最新进展,结合国际指南和临床实践,针对儿童心脏移植受者选择及常用术式的操作要点、程序和方法,以及各类复杂先天性心脏病心脏移植的特殊操作,制订《中国儿童心脏移植适操作规范(2019版)》。     

Impact of overweight and obesity on US renal cell carcinoma incidence trends (1995-2018)

In the United States, renal cell carcinoma (RCC) incidence and the prevalence of obesity, an established risk factor for RCC, have been increasing for several decades. RCC is more common among older individuals. We sought to quantify the contribution of excess adiposity to the rising incidence of RCC among individuals 60 years or older. National Institutes of Health-American Association of Retired Persons Diet and Health Study data (n = 453 859 participants, enrolled in 1995-1996, age at enrollment 50-71 years) were used to estimate multivariable-adjusted hazard ratios (HRs) for RCC across body mass index categories and HRs associated with smoking. Population attributable fractions (PAFs) were calculated using estimated HRs and annual overweight/obesity prevalence from the National Health Interview Survey (1985-2008). PAF estimates were combined with RCC incidence from Surveillance, Epidemiology and End Results-13 to calculate annual percent changes in RCC incidence attributable (and unrelated) to overweight/obesity. We found that between 1995 and 2018, among individuals aged 60 years and older, PAF for overweight/obesity increased from 18% to 29% for all RCCs. In comparison, the PAF for smoking declined from 12% to 9%. RCC incidence increased 1.8% per year (95% confidence interval [CI] 1.5%-2.1%) overall, while RCC incidence attributable to overweight/obesity increased 3.8% per year (95%CI 3.5%-4.2%) and RCC incidence unrelated to overweight/obesity increased 1.2% per year (95% CI 0.9%-1.4%). In conclusion, overweight/obesity appears to have contributed importantly to the rising incidence of RCC in the United States since the mid-1990s. Public health interventions focused on reducing overweight and obesity could help substantially in curbing this trend.     

166Ho-DOTMP radiation-absorbed dose estimation for skeletal targeted radiotherapy.

166Ho-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylene-phosphonate (DOTMP) is a tetraphosphonate molecule radiolabeled with 166Ho that localizes to bone surfaces. This study evaluated pharmacokinetics and radiation-absorbed dose to all organs from this beta-emitting radiopharmaceutical. METHODS: After two 1.1-GBq administrations of 166Ho-DOTMP, data from whole-body counting using a gamma-camera or uptake probe were assessed for reproducibility of whole-body retention in 12 patients with multiple myeloma. The radiation-absorbed dose to normal organs was estimated using MIRD methodology, applying residence times and S values for 166Ho. Marrow dose was estimated from measured activity retained after 18 h. The activity to deliver a therapeutic dose of 25 Gy to the marrow was determined. Methods based on region-of-interest (ROI) and whole-body clearance were evaluated to estimate kidney activity, because the radiotracer is rapidly excreted in the urine. The dose to the surface of the bladder wall was estimated using a dynamic bladder model. RESULTS: In clinical practice, gamma-camera methods were more reliable than uptake probe-based methods for whole-body counting. The intrapatient variability of dose calculations was less than 10% between the 2 tracer studies. Skeletal uptake of 166Ho-DOTMP varied from 19% to 39% (mean, 28%). The activity of 166Ho prescribed for therapy ranged from 38 to 67 GBq (1,030-1,810 mCi). After high-dose therapy, the estimates of absorbed dose to the kidney varied from 1.6 to 4 Gy using the whole-body clearance-based method and from 8.3 to 17.3 Gy using the ROI-based method. Bladder dose ranged from 10 to 20 Gy, bone surface dose ranged from 39 to 57 Gy, and doses to other organs were less than 2 Gy for all patients. Repetitive administration had no impact on tracer biodistribution, pharmacokinetics, or organ dose. CONCLUSION: Pharmacokinetics analysis validated gamma-camera whole-body counting of 166Ho as an appropriate approach to assess clearance and to estimate radiation-absorbed dose to normal organs except the kidneys. Quantitative gamma-camera imaging is difficult and requires scatter subtraction because of the multiple energy emissions of 166Ho. Kidney dose estimates were approximately 5-fold higher when the ROI-based method was used rather than the clearance-based model, and neither appeared reliable. In future clinical trials with 166Ho-DOTMP, we recommend that dose estimation based on the methods described here be used for all organs except the kidneys. Assumptions for the kidney dose require further evaluation.     

The Framingham Disability Study: physical disability among community-dwelling survivors of stroke

The relationship between stroke and physical disability was examined in a cohort of adult, Framingham, Massachusetts, residents who, between 1948 and 1951, were assembled for a longitudinal examination of cardiovascular disease. Multivariate analyses examined the amount of residual disability attributable to stroke among 2540 community-dwelling survivors, 27 years after their initial examination, after controlling for age, cardiovascular risk factors, other cardiovascular diseases, and eight general health conditions related to physical disability. Among men living in the community, a history of stroke explained 12% of the variance in physical disability. Suffering a stroke, however, was not as strongly related to physical disability among women living in the community, accounting for only 3% of the variance. Results suggest that although older men and women die from the same major causes, they may not be disabled by the same conditions.     

The combination of prazosin and verapamil in the treatment of essential hypertension

An exaggerated fall in blood pressure has been reported with the combination of an alpha 1-blocker and a calcium antagonist. This study investigated, in a placebo-controlled, randomized crossover trial, the clinical usefulness of the combination of prazosin (2 mg b.i.d.) and verapamil (160 mg b.i.d.). Therapeutic efficacy was monitored at regular outpatient visits: average supine and erect blood pressures were, respectively, 175/99 and 176/103 mm Hg with placebo, 160/91 and 164/96 mm Hg with single drug treatment, and 152/84 and 152/89 mm Hg with combination therapy. This significant and clinically useful reduction in blood pressure had an overall magnitude of approximately 28/18 mm Hg (supine) and 29/19 mm Hg (erect). Further measurements were made during a series of intensive study days, and the most important additional finding was a pharmacokinetic interaction that resulted in increased peak concentrations and bioavailability of prazosin. In conclusion, the combination of prazosin and verapamil proved effective in the treatment of 12 patients with essential hypertension who had been poorly responsive to conventional treatment with a beta-blocker and thiazide diuretic.     

Effects of sensory and motor functioning on adult intellectual performance

This study examined longitudinal health and intelligence data to determine whether sensory or motor deficits account for some of the age-related intellectual changes that are commonly seen from midlife onward. Although sensory and motor functioning did not account for the age-related decrements in performance on speeded, visual perceptual tasks found for this sample in previous work, we did find that hearing deficits added error variance to performance estimates on two verbal subtests of the Wechsler scales.     

pH值对IFN-α2b、rIL-2、ADM合用维拉帕米对人肝癌细胞杀伤作用的影响

目的　观察培养液在 pH值为 6 .8、7.3、7.6条件下rIL - 2、IFN -α2b、ADM及合用维拉帕米对人肝癌细胞 74 0 4杀伤作用的影响。方法　MTT法于 96孔培养板上进行杀伤实验 ,测定培养液pH值分别为 6 .8、7.3、7.6状态下 ,rIL - 2、IFN -α2b、ADM、及与维拉帕米联合杀伤人肝癌细胞 70 4 0的差异。结果　pH值为 7.6状态下rIL - 2、IFN -α2b、ADM及合用维拉帕米杀伤效果最佳。pH值为 6 .8、7.3、7.6时 ,IFN -α2b都能增加ADM抗肿瘤作用 ,但pH值为 7.6时 ,IFN -α2b +ADM杀伤效果最佳。结论　在偏硷性环境下 ,rIL - 2、IFN -α2b、ADM及合用维拉帕米对肿瘤细胞杀伤效果最佳     

FACTORS AFFECTING THE SELECTION OF PRIMARY MEDICAL CARE AGENCY IN THE WESTERN REGION OF MELBOURNE: AN INTERVIEW STUDY OF ADULT PATIENTS

An interview study investigating attitudinal and other factors influencing the selection of primary medical care (PMC) agency is described. It focuses on adult patients excluding those with trauma of medical/surgical emergencies and was conducted in part of the Western Region of Melbourne in late 1983, the period immediately prior to the introduction of Medicare. It is based on a cross-sectional survey of in-hours attenders of eight general practices (GP), the Western Region (Community) Health Centre (WRCHC) and the general clinic of the casualty department at the Western General Hospital (WGH). Attenders of these different services differed significantly in their socio-demographic characteristics. WGH attenders were significantly younger and had migrated from non-English speaking countries significantly more often. Male attenders at the WGH had significantly lower socioeconomic status. 71 per cent being not in the workforce. The most commonly stated reasons for attendance at particular services generally were “closeness to home, work”, “recommendation” and “good service”. Reasons given by attenders at the different clinics generally were similar. However GP attenders offered “good service” significantly more often as a reason for choice; WGH attenders offered “cheap/economic reasons” significantly more often and “recommendation” significantly less so. WRCHC attenders offered “workers' compensation” significantly more often. Thirty per cent of attenders overall had attended other than their current clinic during their past three to four illness episodes. While a large majority of patients still attend GP for PMC it is concluded that a pluralist model recognising the legitimacy of different PMC arrangements and multiple use of them by individuals best meets community need. This is likely to be even more true under Medicare. It is concluded that instrumental factors and social networks are important in the selection of PMC, particularly given the limited knowledge of respondents about health services. It is also concluded that cost and economic factors have been given undue weight in selection of primary medical care agency. The use of the WGH casualty department by groups not in the work force, given no real financial advantage in doing so, requires further study.