Screening for hypertension in young people with obesity: Feasibility in the real life

Background and aimScreening for pediatric hypertension (HTN) is based on several measurements of blood pressure (BP) in different visits. We aimed to assess its feasibility in outpatient youths with overweight/obesity (OW/OB) in terms of adherence to two-repeated measurements of BP and to show the features of youths who missed the follow-up and the predictive role of clinical and/or anamnestic features on confirmed HTN.Methods and resultsSix hundred, eighty-eight youths (9–17 years) with OW/OB, consecutively recruited, underwent a first measurement of BP. Those exhibiting BP levels within the hypertensive range were invited to repeat a second measurement within 1–2 weeks. Confirmed HTN was diagnosed when BP in the hypertensive range was confirmed at the second measurement. At entry, 174 youths (25.1%) were classified as hypertensive. At the second visit, 66 youths (37.9%) were lost to follow-up. In the remaining 108 participants, HTN was confirmed in 59, so that the prevalence of confirmed HTN was 9.5% in the overall sample; it was higher in adolescents than children (15.9% vs 6.8%, P = 0.001). HTN at first visit showed the best sensitivity (100%) and a good specificity (91%) for confirmed HTN. The association of HTN at first visit plus familial HTN showed high specificity (98%) and positive predictive value of 70%.ConclusionThe high drop-out rate confirms the real difficulty to obtain a complete diagnostic follow up in the obese population. Information about family history of HTN may assist pediatricians in identifying those children who are at higher risk of confirmed HTN.     

妊娠高血压综合征性心脏病29例临床分析

目的探讨妊娠高血压综合征性心脏病的诱因及防治措施。方法对7年来我院收治的29例妊娠高血压综合征性心脏病患者的临床资料进行回顾性分析。结果29例患者均为重度妊高征,其中合并低蛋白血症19例（65.5%）、中重度贫血10例（34.5%）、肺部感染7例（24.2%）、双胎妊娠2例（6.9%）。所有孕妇均剖宫产终止妊娠,无孕产妇死亡,围生儿死亡2例（6.4%）。结论重度妊高征合并低蛋白血症、中重度贫血、肺部感染、双胎妊娠是妊高征性心脏病的重要原因。对妊高征性心脏病的诱发因素应引起重视,心衰控制后应立即终止妊娠,以减少母婴死亡。     

高级迭代重建技术在心血管低剂量螺旋CT成像中的动物研究

目的：探讨高级迭代重建技术（iDose）在心血管低剂量螺旋CT成像中的应用价值。方法：选取家猪10只,本组实验动物均进行以体重为基础的常规X线剂量（A组）及降低X线剂量30％（B组）、50％（C组）、70％（D组）128层前瞻性门控CT扫描,所有数据分别采用滤波反投影（FBP）、iDose-2、iDose-4、iDose-6重建,测量主动脉根部噪声、信噪比（SNR）、对比噪声比（CNR）,对图像质量进行评分（5分法评分）,3分及以上为图像质量可满足诊断,并对4种重建方法进行比较。结果：A、B、C、D各组内FBP、iDose-2、iDose-4、iDose-6重建后图像的噪声依次降低而SNR、CNR依次升高,且用iDose-6重建与用其余3种方法重建后图像噪声、SNR、CNR的差异均有统计学意义（P〈0．05）。用FBP重建,A、B、C3组病例的图像质量均能满足诊断,D组所有病例的图像质量均不能满足诊断;而经iDose重建后所有病例的图像质量均满足诊断,其中用iDose-6重建后除D组6例病例外,其余病例的主观评分均在4分或以上。各组中iDose-6与FBP重建比较的主观评分的差异均有统计学意义（P〈0．05）。结论：在心血管CT成像中,应用迭代重建技术（iDose）较FBP可明显降低图像噪声,提高SNR、CNR,提高图像质量,其中iDose-6重建效果最好;在满足诊断的前提下,用iDose-6重建可以降低70％的辐射剂量进行扫描。