高海拔地区不同民族脑梗死病因及危险因素分析

目的探讨高海拔地区不同民族脑梗死的病因及危险因素。方法收集并分析四川省阿坝藏族羌族自治州人民医院神经内科2012年3月-2014年3月所有诊断为脑梗死的患者资料,对藏族和汉族患者的危险因素及TOAST分型进行比较。结果藏族组的高脂血症、肥胖、嗜酒所占比例显著高于汉族组,差异有统计学意义（P〈0.05）。汉族组的继发性红细胞增多症所占比例显著高于藏族组,差异有统计学意义（P〈0.05）。两民族均以大动脉粥样硬化型及小动脉闭塞型为主,藏族组的大动脉粥样硬化所占比例显著高于汉族组,差异有统计学意义（P〈0.05）。藏族组的未确定病因所占比例显著低于汉族组,差异有统计学意义（P〈0.05）。结论阿坝地区藏族和汉族脑梗死的发病原因及危险因素有着明显不同。

院前死亡患者病因及危险因素分析探讨

目的:对院前死亡患者的病因及危险因素进行临床分析探讨与预防。方法:对2000年6月—2005年10月间院前死亡374例患者进行了病因及危险因素与预防的回顾性临床分析与探讨。结果:心源性猝死148例占39.5%,位列第一,脑座中131例占35%,位列第二。结论:心源性猝死及脑卒中是院前死亡的主要疾病病因。高龄、高心病、高血压、高脂血症、糖尿病、动脉粥样硬化是心源性猝死及脑卒中的主要危险因素。

慢性失眠症病因及相关危险因素分析

目的:调查分析失眠常见病因及危险因素。方法:临床调查分析1000例慢性失眠症患者常见病因和或相关危险因素。结果:失眠症常见病因和或者危险因素有卧床时间过多、心理因素、围绝经期综合征、夜间进食、抽烟、饮酒、咖啡、茶、共病、镇静催眠药物及其他干扰睡眠药物等多种病因和或危险因素。慢性失眠病因单因素不足15%,多因素85%以上。结论:慢性失眠症有多种危险因素引起,不同失眠患者危险因素不同,多种危险因素常见。

急性出血性脑血管疾病的病因及临床危险因素分析

目的：分析急性出血性脑血管疾病的病因及临床危险因素,针对病因及危险因素制定防治措施.方法：选取我院70例经影像学检查证实为脑出血的患者,分析其病因、危险因素及出血部位.结果：脑出血的主要病因为高血压,主要危险因素是高血压、高血脂、糖尿病、吸烟、饮酒,主要出血部位以基底节区为主. 结论：找出了脑出血的病因及危险因素,可以对一些危险因素进行干预.

浅析心脑血管疾病的病因及其预防

心脑血管疾病严重威胁了人类的健康，特别是五十岁以上的中老年朋友，因“三高症”（高血压、高血糖、高血脂）导致的心脑血管疾病的发病率和死亡率逐年上升，各医疗研究机构纷纷展开其病因分析，本文针对肥胖、吸烟、酗酒、运动减少、情绪应激等危险因素，普及预防知识。

Re-searching nasopharyngeal carcinoma

Nasopharyngeal carcinoma(NPC)has been a focus of medical research for more than 100 years,with significant interest emerging over the last 58 years following the identification of the link between the disease and Epstein-Barr virus(EBV)infection.NPC possesses several distinctive characteristics among human cancers,notably its well-documented global epidemiology,which reveals localized high-incidence regions primarily in Southeast Asia,particularly in the Southern provinces of China near the Pearl river,as well as in Greenland and North Africa.Epidemiological data indicate a marked male predominance,early disease onset,and a nearly 100%prevalence of latent EBV infection in the tumors.Due to lack of consistent pattern of cancer-related mutations in NPC genomes and excessive DNA-methylation in the tumor cells,NPC can be considered"an epigenetic cancer".Despite extensive researches,convincing biological explanations for these unique characteristics remain elusive.Recently,suggestive evidence has been published that specific local variants of EBV may represent major high risk factors.In spite of tumor and virus specific immunity,it has not been possible to use this for improved treatment.Ongoing studies on the role of the local microflora and tumor microenvironment are essential for a comprehensive understanding of host-EBV-tumor interactions.Ultimately,this knowledge aims to enhance diagnosis,disease fractionation,treatment strategies,and potentially prevention of NPC.

2073例小儿意外损伤的分析

目的 探讨本地区小儿意外损伤原因及危险因素。方法 对我院 1989～ 1998年 10年间 2 0 73例 0～ 14岁意外损伤住院患儿进行临床回顾性分析。结果 小儿意外损伤中农村多于城市 (3∶1) ,男孩多于女孩 (2 2∶1) ;损伤发生的高峰年龄是 1～ 4岁组 (5 0 1% ) ,损伤的类型依次为外伤(79 3 % )、窒息 (16 6 % )、中毒 (3 3 % )、电击 (0 44 % )、溺水(0 2 9% )。结论 损伤的主要原因是跌伤、车祸、误食、故意伤害 ;损伤的危险因素有照顾儿童不周、交通管理不严、健康教育未普及、安全措施不健全。

酗酒致酒精性心肌病67例相关因素分析

目的:探讨酒精中毒导致酒精性心肌病(ACM)的相关因素。方法:以67例ACM患者作为研究组;并采用分层随机的方法,对同期3011例酒精中毒患者按年龄、性别、饮酒量、年限相匹配抽取了89例作为对照组。对酒精浓度、饮酒频数、饮酒方式、体重指数、酒后心率、血压、意识、心电图、超声心动图、肝功等监测进行分析。结果酒精浓度、酗酒频数、体重指数、酒后血压增高或休克、心肌损害、肝功检测两组间有显著差异。而饮酒方式、意识障碍的程度在两组间无显著差异。ACM患者的肝功异常及血压异常波动与心肌损害的程度有密切相关性。结论摄入大量高浓度乙醇,较大量低度乙醇更易造成血压异常,并直接损害肝脏、心肌。长期酒精中毒,肝脏解毒能力下降,血压异常波动对心肌损害起到叠加效应,导致ACM。

孔源性视网膜脱离的诊断与治疗进展

孔源性视网膜脱离（RRD）是严重的致盲性眼底病，随着对病因与危险因素认识的深入，及先进的辅助检查技术如三维超声、彩色多普勒血流显像技术、光相干断层扫描（OCT）的广泛应用，使RRD得以早期诊断。在以往RRD术式的基础上结合新技术新材料使手术的成功率提高，眼内并发症降低，视力的明显改善成为可能。

Crohn's disease and risk of fracture: does thyroid disease play a role?

AIM: To assess the role of thyroid disease as a risk for fractures in Crohn's patients.METHODS: A cross-sectional study was conducted from 1998 to 2000. The study group consisted of 210 patients with Crohn's disease. A group of 206 patients without inflammatory bowel disease served as controls. Primary outcome was thyroid disorder. Secondary outcomes included use of steroids, immunosuppressive medications, surgery and incidence of fracture.RESULTS: The prevalence of hyperthyroidism was similar in both groups. However, the prevalence of hypothyroidism was lower in Crohn's patients (3.8 % vs 8.2 %, P=0.05).Within the Crohn's group, the use of immunosuppressive agents (0 % vs11 %), steroid usage (12.5 % vs37 %), small bowel surgery (12.5 % vs 28 %) and large bowel surgery (12.5 % vs27 %) were lower in the hypothyroid subset as compared to the euthyroid subset. Seven (3.4 %) Crohn'spatients suffered fracture, all of whom were euthyroid.CONCLUSION: Thyroid disorder was not found to be associated with Crohn's disease and was not found to increase the risk for fractures. Therefore, screening for thyroid disease is not a necessary component in the management of Crohn's disease.

Etiology of chronic pancreatitis:Has it changed in the last decade?

The evidence from recent surveys on chronic pancreatitis carried out around the world shows that alcohol remains the main factor associated with chronic pancreatitis, even if at a frequency lower than that reported previously. It has further conf irmed that heavy alcohol consumption and smoking are independent risk factors for chronic pancreatitis. Autoimmune pancreatitis accounts for 2%-4% of all forms of chronic pancreatitis, but this frequency will probably increase over the next few years. The rise in idiopathic chronic pancreatitis, especially in India, represents a black hole in recently published surveys. Despite the progress made so far regarding the possibility of establishing the hereditary forms of chronic pancreatitis and the recognition of autoimmune pancreatitis, it is possible that we are more inaccurate today than in the past in identifying the factors associated with chronic pancreatitis in our patients.

Multicausality in fatty liver disease:Is there a rationale to distinguish between alcoholic and non-alcoholic origin?

Apart from alcohol,there are other factors that may induce complications,which resemble alcohol-related liver disorders.In particular,obesity has been brought into focus as a risk factor for fatty liver disease.The term "non-alcoholic" fatty liver disease is commonly used to distinguish between obesity-related and alcohol-related hepatic steatosis.This review uses the epidemiological perspective to critically assess whether it is necessary and useful to differentiate between alcoholic and "nonalcoholic" fatty liver disease.The MEDLINE database was searched using the PubMed search engine,and a review of reference lists from original research and review articles was conducted.The concept to distinguish between alcoholic and "non-alcoholic" fatty liver disease is mainly based on specific pathomechanisms.This concept has,however,several limitations including the common overlap between alcohol misuse and obesityrelated metabolic disorders and the non-consideration of additional causal factors.Both entities share similar histopathological patterns.Studies demonstrating differences in clinical presentation and outcome are often biased by selection.Risk factor reduction is the main principle of prevention and treatment of both disease forms.In conclusion,alcoholic and "non-alcoholic" fatty liver diseases are one and the same disease caused by different risk factors.A shift from artificial categories to a more general approach to fatty liver disease as a multicausal disorder may optimize preventive strategies and help clinicians more effectively treat patients at the individual level.

Predictors and in-hospital prognosis of recurrent acute myocardial infarction

Objective To investigate the contributing factors and in-hospital prognosis of patients with or without recurrent acute myocardial infarction （AMI）. Methods A total of 1686 consecutive AMI patients admitted to Peking University People＇s Hospital from January 2010 to December 2015 were recruited. Their clinical characteristics were retrospectively compared between patients with or without a recurrent AMI. Then multivariable logistic regression was used to estimate the predictors of recurrent myocardial infarction. Results Recurrent AMI patients were older （69.3 ± 11.5 vs. 64.7 ± 12.8 years, P 〈 0.001） and had a higher prevalence of diabetes mellitus （DM） （52.2% vs. 35.0%, P 〈 0.001） compared with incident AMI patients, they also had worse heart function at admission, more severe coronary disease and lower reperfusion therapy. Age （OR = 1.03, 95% CI： 1.02-1.05; P 〈 0.001）, DM （OR = 1.86, 95% CI： 1.37-2.52; P 〈 0.001） and reperfusion therapy （OR = 0.74; 95% CI： 0.52-0.89; P 〈 0.001） were independent risk factors for recurrent AMI Recurrent AMI patients had a higher in-hospital death rate （12.1% vs. 7.8%, P = 0.039） than incident AMI patients. Conclusions Recurrent AMI patients presented with more severe coronary artery conditions. Age, DM and reperfusion therapy were independent risk factors for recurrent AMI, and recurrent AM1 was related with a high risk of in-hospital death.

Sex Hormones and Androgen Receptor:Risk Factors of Coronary Heart Disease in Elderly Men

Objective To investigate the variation of sex hormone and its receptor level in elderly male patients with coronary heart disease (CHD) and to evaluate the correlations between CHD and sex hormone as well as sex hormone receptor. Methods Altogether 139 male CHD patients (CHD group) aged 60-92 years and 400 healthy men (control group) aged 60-90 years were included in this cross sectional study. The plasma concentrations of dehydroepiandrosterone sulfate (DHEAS),total testosterone (TT),free testosterone (FT),estradiol (E2),sex hormone binding globulin (SHBG),luteinizing hormone (LH),and follicle-stimulating hormone (FSH) were measured. The androgen receptor (AR) was tested by flow cytometry. Correlations between CHD and levels of sex hormones and AR were analyzed. Results Compared with the control group,the levels of DHEAS,TT,FT,SHBG,and the fluorescence intensity of AR in the CHD group significantly reduced (P<0.05),while the levels of FSH and E2 significantly increased (P<0.01). Age was negatively correlated with TT (r=-0.28,P=0.00) and FT (r=-0.17,P=0.01),while it was positively correlated with SHBG (r=0.14,P=0.04) and E2 (r=0.33,P=0.00). AR fluorescence intensity was negatively correlated with systolic blood pressure (r=-0.12,P=0.01). Binary logistic regression analysis showed that TT,SHBG,and AR were all negatively correlated with CHD (P<0.05). Conclusions Elderly male patients with CHD are found to have low levels of DHEAS,TT,FT,SHBG,and AR,while high concentrations of E2 and FSH. Low levels of TT and SHBG may be the potential risk factors of CHD in elderly men.

Etiology for Degenerative Disc Disease

Degenerative disc disease is a multifaceted progressive irreversible condition and an inevitable part of aging,which has been found to be a contributing factor for low back pain and might cause radiculopathy,myelopathy,spinal stenosis,degenerative spondylolisthesis,and herniations.Its etiology is complex and multifactorial.Although genetics influence more dominant,the occupational and mechanical influences still persist as a major risk factor.This review emphasizes up-to-date knowledge regarding etiology of disc degeneration with special consideration on occupational,lifestyle factors,and genetic polymorphisms.

Association between serum homocysteine and arterial stiffness：role of anti-hypertensive drugs

To the Editor I read the article of Zhang, et al. with great interest. They investigated the association of homocysteine with arterial stiffness in Chinese community-based elderly persons. The carotid-femoral pulse wave velocity （PWV） was significantly higher in the high homocyteine group than in the normal one, however, there was no differences in carotid-radial PWV between the high homocyteine group and the normal one. Homocysteine levels were strongly associated with the carotidfemoral PWV even after adjustment for classical risk factors of cardiovascular disease. I congratulate the authors for this important study. However, I want to make minor criticism for this study from the methodological aspect.

Risk factors for hilar cholangiocarcinoma:A case-control study in China

AIM:To study the association between hilar cholangiocarcinoma(HC) and pre-existing medical conditions. METHODS:Three hundred and thirteen HC patients admitted to the Eastern Hepatobiliary Surgery Hospital(Shanghai,China) in 2000-2005 and 608 healthy controls were enrolled in this study.Association between HC and pre-existing medical conditions was studied with their adjusted odds ratio(OR) calculated by logistic regression analysis. RESULTS:The prevalence of choledocholithiasis(adjusted OR=2.704,P=0.039) ,hepatolithiasis(adjusted OR=3.278,P=0.018) ,cholecystolithiasis(adjusted OR =4.499,P<0.0001) ,cholecystectomy(adjusted OR =7.012,P=0.004) ,biliary ascariasis(adjusted OR= 7.188,P=0.001) ,liver fluke(adjusted OR=10.088,P =0.042) and liver schistosomiasis(adjusted OR=9.913,P=0.001) was higher in HC patients than in healthy controls. CONCLUSION:Biliary tract stone disease(choledocho-lithiasis,hepatolithiasis,cholecystolithiasis) and parasitic liver disease(biliary ascariasis,liver fluke,liver schistosomiasis) are the risk factors for HC in Chinese population.

Extracapsular invasion as a risk factor for disease recurrence in colorectal cancer

AIM: To evaluate the presence of extracapsular invasion (ECI) in positive nodes as a predictor of disease recurrence disease in colorectal cancer. METHODS: Two hundred and twenty-eight consecutive patients who underwent colorectal resection were identified for inclusion in this study, of which 46 had positive lymph nodes. Among 46 cases with stage Ⅲcolorectal cancer, 16 had ECI at positive nodes and 8 had disease recurrence. The clinical and pathological features of these cases were reviewed. RESULTS: In the univariate analysis, the number of positive lymph nodes and depth of tumor invasion were significantly associated with the presence of ECI at positive nodes. Multivariate analysis demonstrated that only ECI was a predictor of recurrence. The recurrence-free interval differed significantly among patients with ECI at positive nodes.CONCLUSION: Our results suggest that ECI at metastatic nodes can identify which cases are at high risk of short-term disease recurrence in colorectal cancer.

Prevalence and risk factors of gastroesophageal reflux disease in Qashqai migrating nomads, southern Iran

AIM： To investigate the prevalence and risk factors of gastroesophageal reflux disease （GERD） symptoms in Qashqai migrating nomads with a different life style in Fars province, southern Iran. METHODS： In summer 2006, 748 Qashqai migrating nomads aged 25 years or more were enrolled using a multiple-stage stratified cluster random sampling method. A questionnaire consisting of demographic characteristics, lifestyle and GERD symptoms （heartburn, regurgitation, chest pain, dysphagia, hoarseness and cough） as completed for each subject. RESULTS： The questionnaire was completed in 717 subjects. The prevalence rate of GERD, defined as reflux occurring at least one time per week in the preceding year, was 33% （237 subjects）. The prevalence was higher in older individuals （36.0% vs 28.9%, P 〈 0.05） and in those with other gastrointestinal complaints （51.0% vs 27.8%, P 〈 0.001）, but not different in obese and non-obese subjects. It was also higher in those consuming fruits and vegetables more than once a week （36.2% vs 17.3%, P 〈 0.001）. GERD had a positive correlation with smoking （42.1% vs 27.8%, P 〈 0.001）, but a negative relation with non-alcoholic beverages. The association between GERD and non-steroidal antiinflammatory drugs （NSAIDs） consumption was also significant （40.2% vs 25.4%, P 〈 0.001）. CONCLUSION： The prevalence of GERD （33%） is very high in Qashqai migrating nomads which may be due to a lower socioeconomic and educational level of these people and difference in the life style. Older age, frequent consumption of fruits and vegetables, smoking and NSAIDs are risk factors for GERD in this population.

Dyslipidemia： evidence of efficacy of the pharmacological and non-pharmacological treatment in the elderly

The clinical decision to control risk factors for cardiovascular disease （CVD） in the elderly takes the followings into consideration： （1） the elderly life expectancy; （2） the elderly biological age and functional capacity; （3） the role of cardiovascular disease in the elderly group; （4） the prevalence of risk factors in the elderly; and （5） The effectiveness of treatment of risk factors in the elderly. A large number of studies showed the efficacy of secondary and primary prevention of dyslipidemia in the elderly. However, the only trial that included patients over 80 years was the Heart Protection Study （HPS）. Statins are considered the first line therapy for lowering low-density lipoprotein cholesterol （LDL-C）. Because lifestyle changes are very difficult to achieve, doctors in general tend to prescribe many drugs to control cardiovascular risk factors. However, healthy food consumption remains a cornerstone in primary and secondary cardiovascular prevention and should be implemented by everyone.