睡眠呼吸暂停低通气综合征( SAHS) 是一种常见病症,临床上以阻塞性睡眠呼吸暂停低通气综合征( OSAHS) 最为常见[1] 。1993 年一项基于社区人群的研究中, Young 等[2] 发现年龄介于30 ～60 岁的人群中, 以睡眠呼吸暂停低通气指数( AHI) ≥5 次/h 定义的OSAHS在女性的患病率为9% ,在男性为24% , 2% 的女性和4% 的男性同时存在嗜睡症状。越来越多的证据表明睡眠呼吸暂停可导致许多并发症, 包括行为和躯体两方面。行为并发症包括日间嗜睡、注意力下降和神经心理异常, 而躯体并发症主要包括心脑血管疾病, 尤其是高血压[3, 4] 。OSAHS 是全身多个脏器功能损害的独立危险因素, 其中心血管并发症是主要死因[5] 。如何评价OSAHS 病情严重程度, 对患者的诊断、治疗及预后判断具有非常重要的意义。目前AHI 仍然是诊断OSAHS 的金标准,但其与靶器官损害的相关性存在诸多争议。
In recent years, photon-counting computed tomography (PCD-CT) based on photon-counting detectors (PCDs) has become increasingly utilized in clinical practice. Compared with conventional CT, PCD-CT has the potential to achieve micron-level spatial resolution, lower radiation dose, negligible electronic noise, multi-energy imaging, and material identification, etc. This advancement facilitates the promotion of ultra-low dose scans in clinical scenarios, potentially detecting minimal and hidden lesions, thus significantly improving image quality. However, the current state of the art is limited and issues such as charge sharing, pulse pileup, K-escape and count rate drift remain unresolved. These issues could lead to a decrease in image resolution and energy resolution, while an increasing in image noise and ring artifact and so on. This article systematically reviewed the physical principles of PCD-CT, and outlined the structural differences between PCDs and energy integration detectors (EIDs), and the current challenges in the development of PCD-CT. In addition, the advantages and disadvantages of three detector materials were analysed. Then, the clinical benefits of PCD-CT were presented through the clinical application of PCD-CT in the three diseases with the highest mortality rate in China (cardiovascular disease, tumour and respiratory disease). The overall aim of the article is to comprehensively assist medical professionals in understanding the technological innovations and current technical limitations of PCD-CT, while highlighting the urgent problems that PCD-CT needs to address in the coming years.
目的：分析汶川地震致脊髓损伤患者的病情特点。方法：对35例地震致脊髓损伤患者进行回顾性调查。结果：地震造成的这35例脊髓损伤患者在性别、年龄无明显差异，完全性损伤占42.86%，不完全损伤占57.14%。主要致伤原因为压榨伤（68.57%）。骨折部位依次为腰椎（57.14%）、胸椎（28.57%）、颈椎（11.43%）。受伤时体位60%为屈曲位。31.43%的完全性损伤患者由非专业救援人员救出。结论：35例患者脊髓损伤程度普遍较重，主要是与地震当时巨大冲击力有关，也与受灾现场救援条件严重受限，错过最佳治疗时机有关。现场的急救、救援方式对患者的伤情和预后有重要影响，因此需要大力宣传和普及灾害后抢救伤员的基本知识。
ObjectivesTo systematically review the efficacy and safety of palifermin on oral mucositis (OM) and acute graft versus host disease (aGVHD) for hematological malignancy patients undergoing hematopoietic stem cell transplantation (HSCT).MethodsPubMed, The Cochrane Library, Web of Science, EMbase, Clinicaltrials.gov, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy of palifermin on OM and aGVHD for hematological malignancy patients undergoing HSCT from inception to September 30th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 7 RCTs involving 904 patients were included. The results of meta-analysis showed that: palifermin could reduce the duration of OM grade 2 to 4 (MD=−4.21, 95%CI −7.83 to −0.58, P=0.02), OM grade 3 to 4 (MD=−2.54, 95%CI −4.61 to −0.46, P=0.02) significantly for hematological malignancy patients undergoing HSCT. However, no significant difference was found in the prevalence of aGVHD grade 2 to 4 (RR=1.29, 95%CI 0.95 to 1.75, P=0.11), aGVHD grade 3 to 4 (RR=0.99, 95%CI 0.55 to 1.77, P=0.97), OM grade 2 to 4 (RR=0.86, 95%CI 0.72 to 1.03, P=0.11) and OM grade 3 to 4 (RR=0.82, 95%CI 0.65 to 1.03, P=0.08) between palifermin group and placebo group. The prevalence of paresthesia (RR=4.24, 95%CI 1.24 to 14.56, P=0.02) and erythema (RR=1.49, 95%CI 1.06 to 2.09, P=0.02) were significantly higher in palifermin group.ConclusionsThe durations of OM grade 2 to 4, 3 to 4 are significantly reduce in patients receiving palifermin compared with those receiving a placebo, however, no statistically significant difference are found in the incidence of aGVHD grade 2 to 4, 3 to 4, OM grade 2 to 4, 3 to 4. Parethesia and erythema are more prevalent among patients using palifermin. Therefore, advantages and disadvantages of palifermin should be considered when used in clinical.
Objective To systematically review the prevalence of osteoporosis (OP) in Chinese postmenopausal females. Methods The CNKI, VIP, CBM, WanFang Data, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect studies on the prevalence of OP in Chinese postmenopausal females from inception to March 17th, 2022. Two reviewers independently screened the literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed using Stata 14.0 software. Results A total of 54 studies involving 96 391 cases and 41 651 confirmed OP patients were included. The meta-analysis results showed that the prevalence of OP in Chinese postmenopausal females was 38.8% (95%CI 34.1% to 43.5%). Subgroup analysis showed that the prevalence of OP was 31.7% (95%CI 16.6% to 48.6%) in females who had been menopausal for less than 5 years, 47.4% (95%CI 32.2% to 62.5%) for 5-9 years, 52.7% (95%CI 37.1% to 68.3%) for 10-14 years, 77.5% (95%CI 69.5% to 85.4%) for 15-19 years, and 78.3% (95%CI 56.3% to 100.0%) for more than 20 years. The rate was 16.2% (95%CI 28.8% to 37.2%) in under 50 years age group, 28.8% (95%CI 34.4% to 47.9%) for 50- years group, 41.1% (95%CI 34.4% to 47.9%) for 60- years group, 55.3% (95%CI 45.8% to 64.8%) for 70- years group, 82.0% (95%CI 76.1% to 87.9%) for 80- years group. The prevalence in different regions was between 31.0% and 43.5%, which was lowest in the northeast (31.0%, 95%CI 26.3% to 51.4%) and highest in the northwest (43.5%, 95%CI 22.3% to 64.7%). According to the year of publication, the rate was 43.9% (95%CI 15.7% to 72.0%) from 1997 to 2009 and 38.2% (95%CI 33.8% to 42.5%) from 2010 to 2021. The prevalence of OP was 24.9% (95%CI 20.5% to 29.3%) in postmenopausal females with no birth or 1 birth, and 45.0% (95%CI 37.0% to 53.0%) in females with 2 or more births. Conclusion The prevalence of OP in Chinese postmenopausal females is relatively high. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
目的：探讨5·12汶川地震致脊髓损伤患者神经源膀胱的康复治疗方法。方法：通过对35例脊髓损伤患者神经源膀胱康复治疗的总结回顾，观察采用制定饮水计划，间歇性导尿，药物治疗，膀胱功能训练，手术治疗等方法治疗神经源膀胱的疗效。结果：经过综合治疗，35例患者的神经源膀胱都得到了不同程度的改善。结论：地震致脊髓损伤发生率高，而神经源膀胱是其重大并发症之一，危害患者生命，重建脊髓损伤后患者的膀胱功能对于提高截瘫患者的生活质量，降低死亡率具有十分重要的意义。
ObjectiveTo compare the clinical effects of pulsed electromagnetic fields (PEMFs) with oral alendronate in the treatment of postmenopausal osteoporosis. MethodsFourty patients diagnosed to have postmenopausal osteoporosis (OP) from September 2009 to September 2010 were included in our study. They were randomly divided into the experimental group and the control group. All patients were administered the same basic drugs:Caltrate 600 mg and Alfacalcidol 0.5 μg per day. For the experimental group, PEMFs were offered 6 times per week for 5 weeks (30 times in total), and patients in this group were followed up for 12 weeks. For the control group, alendronate was given at a dose of 70 mg per week for 12 weeks. Bone mineral density (BMD), visual analogue scale, and manual muscle testing (MMT) scale were evaluated before, 1 week, 5 weeks, and 12 weeks after intervention. ResultsIncreasing of BMD, pain relieving, and improvement of MMT had a trend of increasing values after 5 weeks of treatment in the experimental group (P<0.05), but there was no significant difference between the two groups (P>0.05). However, there was a significant difference between the two groups in patients' lower back muscle strength after treatment (P<0.05). ConclusionPEMFs have the same effect as alendronate in pain relief, and bone mass and muscle strength improvement, and are even advantageous in increasing back muscle strength compared with alendronate.