体力活动、IGF-1、IGFBP-3与直肠癌患者存活率的关系

Background: Recent reports have shown that physical activity improves the outcome of patients with colorectal cancer as well as breast and prostate cancer. However, the mechanisms whereby physical activity reduces cancer mortality are not well established. Methods: Incident cases of colorectal cancer were identified among participants of the Melbourne Collaborative Cohort Study, a prospective cohort study of 41 528 Australians recruited from 1990 to 1994. Information on tumour site and stage, treatments given, recurrences, and deaths were obtained from systematic review of the medical records. Baseline assessments of physical activity and body size were made, and cases with available plasma had pre-diagnosis insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) levels measured. We assessed associations between these hormones and colorectal cancer specific deaths with respect to physical activity. Results: A total of 526 cases of colorectal cancer were identified, of which 443 had IGF-1/IGFBP-3 levels measured. Median follow up among survivors was 5.6 years. For the physically active, increasing IGFBP-3 by 26.2 nmol/l was associated with a 48%reduction in colorectal cancer specific deaths (adjusted hazard ratio (HR) 0.52 (0.33-0.83); p = 0.006). No association was seen for IGF-1 (adjusted HR 0.90 (0.55-1.45); p = 0.65). For the physically inactive, neither IGF-1 nor IGFBP-3 was associated with disease specific survival. Conclusions: This study supports the hypothesis that the beneficial effects of physical activity in reducing colorectal cancer mortality may occur through interactions with the insulin-like growth factor axis and in particular IGFBP-3.

荟萃分析:类固醇激素剂量对脓毒症患者存活率和休克的影响

Background: Previous meta analyses demonstrated that high dose glucoc orticoi ds were not beneficial in sepsis.Recently, lower dose glucocorticoids have been studied. Purpose: To compare recent trials of glucocorticoids for sepsis with p revious glucocorticoid trials. Data Sources: Systematic MEDLINE search for studi es published between 1988 and 2003. Study Selection: Randomized,controlled trial s of sepsis that examined the effects of glucocorticoids on survival or vasopres sor requirements. Data Extraction: Two investigators independently collected dat a on patient and study characteristics, treatment interventions, and outcomes. D ata Synthesis: The 5 included trials revealed a consistent and beneficial effect of glucocorticoids on survival (12=0%; relative benefit, 1.23, <<95%CI, 1.01 t o 1.50>>; P=0.036) and shock reversal (12=0%; relative benefit, 1.71 <<CI, 1.29 t o 2.26>>; P< 0.001). These effects were the same regardless of adrenal function. In contrast, 8 trials published before 1989 demonstrated a survival disadvantage with steroid treatment (12=14%; relative benefit, 0.89 <<CI, 0.82 to 0.97>>; P=0 .008). In comparison with the earlier trials, the more recent trials administere d steroids later after patients met enrollment criteria (median, 23 hours vs. < 2 hours; P=0.02), for longer courses (6 days vs. 1 day; P=0.01), and in lower to tal dosages (hydrocort isone equivalents,1209 mg vs. 23 975 mg; P=0.01) to patie nts with higher control group mortality rates (mean, 57%vs. 34%; P=0.06) who w ere more likely to be vasopressor dependent (100%vs. 65%; P=0.03). The relati onship between steroid dose and survival was linear, characterized by benefit at low doses and increasing harm at higher doses (P=0.02). Limitations: We could n ot analyze time related improvements in medical care and potential bias seconda ry to nonreporting of negative study results. Conclusions: Although short course s of high dose glucocorticoids decreased survival during sepsis, a 5-to 7-day course of physiologic hydrocortisone doses with subsequent tapering increases s urvival rate and shock reversal in patients with vasopressor dependent septic shock.

论心理治疗对提高癌症患者存活率的作用

“心理治疗”也叫精神治疗,指用心理学方法治疗精神和情绪障碍,是依据心理学的原则,通过医生、护士、家属与精神病和各种心身疾病患者之间的交往,以语言、表情、姿势态度和行为影响、改变病人的感觉、认识、情绪、性格、态度和行为,减轻或消除使病人痛苦的各种情绪和行为,恢复大脑神经系统的正常机能。

散发性克雅病及其他人类遗传性海绵状脑病患者存活率的预测因素

A collaborative study of human transmissible spongiform encephalopathies has b een carried out from 1993 to 2000 and includes data from 10 national registries, the majority in Western Europe. In this study, we present analyses of predictor s of survival in sporadic (n = 2304), iatrogenic (n = 106) and variant Creutzfel dt Jakob disease (n = 86) and in cases associated with mutations of the prion p rotein gene (n=278), including Gerstmann Strussler Scheinker syndrome (n = 24) and fat al familial insomnia (n = 41). Overall survival for each disease type was assess ed by the .Kaplan Meier method and the multivariate analyses by the Cox proport ional hazards model. In sporadic disease, longer survival was correlated with yo unger age at onset of illness, female gender, codon 129 heterozygosity, presence of CSF 14-3-3 protein and type 2a prion protein type. The ability to predict survival based on patient covariates is important for diagnosis and counselling, and the characterization of the survival distributions, in the absence of thera py, will be an important starting point for the assessment of potential therapeu tic agents in the future.

肝静脉压力梯度对预测终末期肝病的肝硬化患者存活率的影响

Measurements of portal pressure, usually obtained via the hepatic venous pressure gradient (HVPG) may be a prognostic marker in cirrhosis. The aim of this study was to evaluate the impact of HVPG on survival in patients with cirrhosis in addition to the Model for End-Stage Liver Disease (MELD) score. We also examined whether inclusion of HVPG in a model with MELD variables improves its prognostic ability. Retrospective analyses of all patients who had HVPG measurements between January 1998 and December 2002 were considered. Proportional hazards Cox models were developed. Prognostic calibrative and discriminative ability of the model was evaluated. In this period, 693 patients had a hepatic hemodynamic study, and 393 patients were included. Survival was significantly worse in those patients with greater HVPG value (univariate HR, 1.05; 95%CI, 1.02-1.08; P = .001). HVPG remained as an independent variable in a model adjusted by MELD, ascites, encephalopathy, and age (multivariate HR, 1.03; 95%CI, 1.00-1.06; P = .05) so that each 1 mmHg increase in HVPG had a 3%increase in death risk. In addition, HVPG as well as MELD score variables and age, significantly contributes to the calibrative predictive capacity of the prognostic model; however, discriminative ability improved only slightly (overall C statistic [95%CI]; MELD score variables: 0.71 [0.62-0.80], MELD score variables, age, and HVPG 0.76: [0.69-0.83]). In conclusion, HVPG has an independent effect on survival in addition to the MELD score. Although inclusion of HVPG and age in a survival predicting model would improve the calibrative ability of MELD, its discriminative ability is not significantly improved.

伊朗南部Kerman省天疱疮患者存活率和风险函数测定

Pemphigus has in the past been associated with a high mortality rate.However,with the discovery of corticosteroids,patient median survival has improved.Our purpose was to assess median survival after confirmed diagnosis of pemphigus in patients in Kerman,a southern province of Iran.Methods:All patients who were either admitted to the hospital or treated as outpatientsin Kerman from 22 September 1987 to 22 September 1999 and who had confirmed pemphigus were included in the study.Survival was estimated using the Kaplan-Meier method,and the following variables were evaluated in a univariate analysis for an association with survival:age,sex,type of pemphigus,and type of therapy.Results:A total of 55 patients(38 female and 17 male)were identified.No significant differences were found between genders.The mean age at the time of diagnosis was 46.0 years.Older groups had a lower survival rate than younger groups(P < 0.001).The majority(82%)of cases were vulgaris/vegetans,and no significant differences were foundin 10-year survival for type of pemphigus.The patients who had been treated with corticosteroid(P > 0.05)s alone had longer median survival times than those who had been treated with corticosteroids plus azathioprine(P < 0.001).A total of 11 patients died;the median follow-up time for those still a live was 5.9 years(range 2-12 years).Estimated survival at 2,6 and 10 years was 92.7,86.8 and 61.5%,respectively.Conclusion:Overall median survival rate in patients with pemphigus was 10 years,regardless of gender or subtype of pemphigus.Survival was adversely affected by late onset.Those patients treated with immunosuppressives and corticosteroids also appeared to have reduced survival times when compared to those treated with corticosteroids alone.

ICU存活患者心理障碍的危险因素及随访调查分析

目的分析急诊重症监护室(EICU)存活患者发生心理障碍的危险因素。方法选取收治于本院EICU且存活的92例患者,进行1个月的随访调查。分析其发生心理障碍的危险因素。结果92例经ICU救治存活患者发生心理障碍63例,占68.48%;单因素分析显示:婚姻状况、体重指数与ICU存活患者发生心理障碍无关,差异无统计学意义(P>0.05);性别、年龄、文化程度、入住ICU时间、ICU环境、家属关心、人际关系、疾病严重程度、接受有创操作与ICU存活患者发生心理障碍有关,差异有统计学意义(P<0.05);多因素分析显示:女性、年龄≤35岁、文化程度低,入住ICU≥7d;ICU环境嘈杂,家属关心缺乏,新的人际关系、急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)高、接受有创操作次数多是ICU存活患者发生心理障碍的独立危险因素(P<0.05)。结论女性、年龄≤35岁、文化程度低,入住ICU时间长、ICU环境嘈杂、家属关心缺乏、新的人际关系、APACHEⅡ评分高、接受有创操作次数多是ICU存活患者发生心理障碍的主要影响因素。

维持性血液透析患者治疗慢性肾脏病相关性瘙痒症的研究进展

现阶段维持性血液透析(maintenance hemodialysis,MHD)患者存活率提高,但同时与透析相关的并发症也日益增多。慢性肾脏病最常见并发症为皮肤瘙痒症,主要表现就是伴随着皮肤干燥、色素沉着或是难以忍受的皮肤瘙痒等。这种皮肤瘙痒也可能会伴随着皮肤苔藓样改变、尿素结晶析出等非特异性改变。慢性肾脏相关性皮肤瘙痒症患者严重者还可能导致情绪和睡眠障碍,甚至出现自杀倾向。

原发性脑出血患者短期存活和入院时血糖水平的关系:基于人群的研究

Background: The role of admission blood glucose level on the prognosis of pati ents with intracerebral haemorrhage has not been elucidated. Objective: To exami ne this association on the basis of an epidemiologically representative patient material.Methods: 249 500 people living in the catchment area of the Central Hos pital of Central Finland. The diagnosis of ICH was established if verified by cr anial computed tomography(CT) or autopsy. Results: Of the 416 patients who fulfi lled the diagnostic criteria, 30 died before admission and 386 were admitted to the Central Hospital. All 329 patients (290 nondiabetics and 39 diabetics) with both admission blood glucose and cranial CT data were included in the study. The mean blood glucose level was 10.6 mmol/l for nondiabetics who died on the day o f onset, 8.6 mmol/l for those dying during days 1 to 28, and 6.8 mmol/l for the 28 day survivors. The corresponding figures for diabetics were 13.9 mmol/l, 12.5 mmol/l,and 9.3 mmol/l. In both nondiabetics and diabetics, patients who died ha d significantly higher mean glucose than the 28 day survivors (p < 0.0001 versus p=0.029). However, blood glucose of the surviving diabetics was as high as that of the deceased nondiabetics (9.3 mmol/l versus 9.1 mmol/l). In nondiabetics,ad mission blood glucose was associated with parameters signifying severe stroke; d isturbed consciousness, large haematoma volume and shift of cerebral midline str uctures, and high admission mean arterial pressure. In logistic regression analy sis, high admission blood glucose in nondiabetics was a significant predictor of death during the first 28 days of onset(odds ratio 1.22, 95%CI 1.07 to 1.40). Conclusions: High admission blood glucose predicts increased 28 day case fatalit y rate in both nondiabetic and diabetic patients with ICH. Because high admissio n blood glucose was associated with markers of severe stroke, we are inclined to support the stress theory; high admission blood glucose is the result of a seri ous ICH.

关于乳腺癌存活患者需要开始激素替代治疗的想法

There is not only a need for scientific data regarding the risk of recurrence of breast cancer by starting hormone replacement therapy (HRT) but also regarding the patients’ needs for HRT. Objectives: To examine the severity of climacteric complaints in breast cancer patients and to examine if they are willing to take HRT. Methods: In November 2003, a questionnaire was sent to 469 breast cancer survivors. The survey examined on a scale base the severity of climacteric complaints and the patient’s opinion on starting HRT. Results: More than 76% of the patients complained that they experience or had experienced hot flushes or night sweating. More than half (53% ) of this group found the inconvenience severe to extreme, affecting the patient’s quality of life. A majority (80.5% ) patients who had already taken HRT, found that it improved their quality of life substantially. When the results of observational studies were explained regarding HRT in breast cancer survivors, a majority said they would take or would consider taking HRT (57.9% ). Conclusion: While physicians are more reserved in prescribing HRT in breast cancer survivors, a combination of severe symptomatic climacteric complaints and the willingness of the patient to be treated should at least result in a “ consideration” of prescribing HRT.

临床护理路径对重型颅脑损伤患者发生应激性溃疡的干预效果

颅脑损伤是创伤引起的脑损伤,据统计资料显示[1],重症颅脑损伤的死亡率高达66.7%。随着医学技术不断提高,患者存活率也逐渐提高。临床护理路径是根据患者的护理病情进展情况,制定全程护理计划,在规范医疗行为、提高护理质量中具有积极的应用价值。

医师对乳腺癌存活患者是否需要开始激素替代治疗的看法

To investigate how physicians felt about HRT use in breast cancer survivors a half year after the WHI trial. Methods: In December 2002, a questionnaire was conducted in Flanders (Belgium). The survey contained a presentation of a 35- year-old breast cancer survivor who presented with climacteric symptoms after treatment with tamoxifen. Results: With a response rate of 33.65% , a majority of the physicians did not prescribe classical oral HRT (5.40% ) in this patient. Physicians prefer to prescribe tibolone (30.68% ) or other alternative treatment (50.00% ). The main reason was the fear for increased recurrence of breast cancer. Furthermore the WHI oestrogen plus progestin trial and its attention in the media, a half year prior to the survey, influenced one-third of the physician’s prescribing attitude. Conclusions: Two-thirds of the physicians did not change prescribing attitude after the WHI oestrogen plus progestin trial. HRT is a well proven effective treatment in breast cancer survivors with severe climacteric complaints, but a majority of physicians is not convinced of its safety in breast cancer survivors. Therefore, a majority of physicians do not find the need to prescribe HRT in breast cancer survivors.

动脉瘤蛛网膜下腔出血后长期存活患者内分泌机能障碍的高发生率

Background and Purpose -To investigate the incidence, pattern, and magnitud e of neuroendocrine changes in long-term survivors of aneurysmal subarachnoid hemorrhage (SAH)-. Methods -Thirty patients (16 women) with a mean age of 50 ± 13 years underwent endocrine assessment between 12 and 24 months after aneury smal SAH. SAH severity was graded clinically by the Hunt & Hess scale (median, II) and ra diologically by the Fisher classification (median, II). Patients underwent measu rement of basal hormone levels and dynamic assessment by the low-dose (1 μ g) corticotropin stimulation test. Functional outcome was examined concurrently wi th endocrine testing by the modified Rankin Scale and the Barthel Index. Results -Of the 30 patients tested, 14 patients (47% ) showed isolated or combined e ndocrine abnormalities. These included low insulin-like growth factor 1 levels compatible with growth hormone deficiency in 37% , hypogonadism in 13% , and cortisol hyporesponsiveness to the low-dose corticotropin stimulation test in 10% ; thyroid dysfunction in the form of subclinical hypothyroidism was observe d in 7% of patients. Median modified Rankin Scale and Barthel Index at the tim e of endocrine testing were 1 and 100, respectively. There was no correlation be tween the presence of endocrine dysfunction and SAH severity indices or function al outcome scores. Conclusions -Long-term survivors of aneurysmal SAH freque ntly exhibit endocrine changes, with growth hormone and gonadal deficiencies pre dominating. Thus, screening of pituitary function is recommended in patients sur viving SAH. The relationship between late hormonal alterations and functional ou tcome in patients with SAH warrants further study.

肝素与低分子量肝素对血液透析患者β_2微球蛋白影响

随着现代血液透析技术的发展及提高,透析患者存活时间越来越长,但随之而来的问题即长期血液透析远期并发症的发生,其中透析相关性淀粉样变（DRA）是最普遍及最严重并发症之一。淀粉样变的主要原因是β_2-微球蛋白（β_2-MG）沉积,高通量血液透析及血液滤过可有效清除β_2-MG,但高通量血液透析费用高,对于经济条件差的长期血液透析患者来说很难实现。然而,进行血液透析治疗离不开抗凝剂,

依达拉奉联合医护一体化护理对急性脑梗死患者血液流变学及神经元特异性烯醇化酶白细胞介素-8水平的影响

急性脑梗死是脑卒中主要类型之一,主要病因为动脉系统病变导致血管痉挛、闭塞或破裂,可造成以偏瘫为主的肢体功能障碍[1]。临床上对于急性脑梗死通常采用阿司匹林等抗凝药物进行治疗,可显著提高患者存活率,但对于降低患者致残率改善患者预后效果并不显著[2]。医护一体化护理是以患者为中心,医护同时参与患者的治疗和护理,旨在提高患者预后,降低患者致残、致死率。依达拉奉是近年来新上市的药物,是一种自由基清除剂,可作用于急性脑梗死所致脑损伤的多个病理环节,应用效果良好[3]。本研究在基础治疗和医护一体化护理的基础上采用依达拉奉治疗,探究其对急性脑梗死患者血清白细胞介素(IL)-8和神经元特异性烯醇化酶(NSE)水平的影响。

高血压住院患者下肢外周动脉病及其危险因素分析

下肢外周动脉病（peripheral arterial disease,PAD）是系统动脉粥样硬化疾病的一种表现。虽然大多数PAD患者没有症状,但他们发生心肌梗死和脑卒中的危险明显增高,并且10年内的死亡危险为非PAD患者的6倍。15年后,间歇性跛行患者的存活率大约为22%,而非间歇性跛行患者存活率为78%,现已被美国心脏病学会（ACC）/美国心脏协会（AHA）列为冠心病的等危症。

镜像疗法在脑卒中偏瘫患者上肢运动功能康复中应用的研究进展

脑卒中,是目前世界上导致成年人残疾的主要原因[1]。据统计我国每年新发脑卒中近200万人,现存活患者有600万—700万,而存活者约75%致残[2]。针对脑卒中后上肢运动功能障碍这一难题,众多学者研究探索了多种康复措施,其中镜像疗法（Mirror therapy,MT）是近年来国内外学者研究的热点,成为了一种具有良好应用前景的脑卒中康复治疗新方法。本文将对镜像疗法在脑卒中偏瘫患者上肢运动功能康复中的应用做简要论述。

急性白血病150例长期生存患者的临床分析

目的 :总结上海市近 10年来急性白血病 15 0例长期生存患者的临床资料。方法 :采用病例分析方法。结果 :15 0例 5年以上长期生存者中 ,急性粒细胞白血病 (AML) 6 5例 ,急性淋巴细胞白血病 (AL L) 81例 ,其它类型 4例。M3和 L1 的病例数较多。长期生存组患者发病时较年轻 ,2～ 10岁儿童占 33.3% ,青壮年约占 5 0 %。与非长期生存组患者比较 ,长期生存患者白细胞数较低 ,血小板数较高 (均为 P <0 .0 5 )。AML总化疗时间 >3年或≤ 3年中位生存时间无差别 ,AL L化疗时间≤ 3年者中位生存时间较短。结论 :白血病类型、年龄、白血病负荷指标 WBC及血小板数是影响急性白血病患者长期生存的重要因素。

18F-FDG PET/CT与MRI在宫颈癌患者淋巴结转移诊断中的对比分析

宫颈癌发病率在女性生殖器官肿瘤中占首位,临床普遍采用MRI通过FIGO分类法对宫颈癌进行分期[1]。但缺点是FIGO分期未提及淋巴结转移及淋巴管间隙浸润相关问题,导致分期准确性下降,从而直接引起医生制定的治疗方案存在偏差[2]。因此,早期明确病变复发灶和转移灶,及时制定准确的治疗方案,有利于提高患者存活率。18F-FDG PETCT作为一种新型分子影像技术,可先期得出肿瘤的功能和代谢数据,对疾病的诊断、分期、治疗方案制定产生积极地影响[3]。