Health-Related Quality of Life in Amyotrophic Lateral Sclerosis: Determining a Meaningful Deterioration

This paper uses the standard error of measurement (SEM) and the standard error of the difference (S(diff)) in relation to data on individuals with amyotrophic lateral sclerosis (ALS) to calculate the minimum change scores required by statistical criteria for each dimension of the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40). Data collected from a longitudinal study was used to evaluate the usefulness of SEM and S(diff) criteria and to compare these criteria with an anchor-based approach in determining meaningful change. Questionnaires were completed on two occasions, 3 months apart. 764 questionnaires were returned. Questionnaires included the ALSAQ-40 and dimension specific transition items. The ALSAQ-40 is a disease specific health-related quality of life instrument for use in studies of patients with ALS or other motor neuron diseases. For all dimensions of the ALSAQ-40 the patterns of SEMs were similar over time. The results suggest that, for example, six points change on a 0-100 transformed scoring of the physical mobility dimension may be considered on distributional grounds a minimum meaningful change. The demonstrated consistency of SEMs for the dimensions of the ALSAQ-40 is empirical evidence of the theoretically claimed advantage of this measure of sample independence, and supports use of this distributional approach to calculate meaningful change.     

血浆C型钠尿肽在急性冠脉综合征患者的变化及其意义

目的观察急性冠脉综合征(ACS)患者不同情况下血浆C型钠尿肽(CNP)水平,探讨CNP在ACS发病过程中的意义。方法用放射免疫分析法检测35例ACS患者经皮冠脉介入治疗(PC I)术前、术后24 h血浆CNP水平,并与20例正常对照组血浆CNP进行对比。观察并分析ACS患者PC I前血浆CNP水平与心功能及冠脉狭窄积分间的关系。结果ACS患者入院时血浆CNP水平高于正常对照组[(6.8±1.4)pg.m l-1vs(5.1±1.6)pg.m l-1,P<0.01],且PC I后24 h血浆CNP的水平较术前明显增高[(10.9±2.9)pg.m l-1vs(6.8±1.4)pg.m l-1,P<0.001]。PC I前左室射血分数(LVEF)<50%的患者血浆CNP水平明显高于LVEF>50%的患者[(7.8±1.1)pg.m l-1vs(6.1±1.2)pg.m l-1,P<0.001],但是血浆CNP水平与心功能分级(NYHA)未见相关性。冠脉Gensin i积分与PC I前血浆CNP水平呈高度正相关(r=0.76,P<0.001)。结论ACS患者血浆CNP水平明显增高,介入治疗后ACS患者血浆CNP水平继续增高,CNP在ACS发病中的意义值得进一步研究。     

硬膜外自控镇痛技术在脊柱内镜手术中的应用研究

探讨硬膜外自控镇痛在脊柱内镜手术应用的临床效果。选择120例脊柱内镜手术治疗腰椎间盘突出症患者,随机分为对照组(0.2%罗哌卡因+0.2%利多卡因局麻),0.1%罗哌卡因+舒芬太尼组(0.1%罗哌卡因+0.3 μg/mL舒芬太尼硬膜外自控镇痛),0.2%罗哌卡因+舒芬太尼组(0.2%罗哌卡因+0.3 μg/mL舒芬太尼硬膜外自控镇痛),采用视觉模拟(VAS)评分法评估手术中镇痛效果,采用改良Bromage 评分评估术毕运动神经阻滞程度,统计0.1%罗哌卡因+舒芬太尼组和0.2%罗哌卡因+舒芬太尼组自控镇痛泵(PCA)按压次数和用药量。结果显示0.2%罗哌卡因和0.3 μg/mL舒芬太尼硬膜外自控镇痛应用于脊柱内镜手术,可以达到明显的镇痛效果,满足手术需要,又同时保留患者双下肢运动功能,即有“感觉和运动阻滞分离”现象,从而避免脊柱内镜下马尾神经损伤的可能,值得在临床上推广。     

提上睑肌缩短术联合 Mustarde 双 Z 形切除术矫正儿童小睑裂综合征

目的探讨提上睑肌缩短术联合 Mustarde 双 Z 形切除术矫正儿童小睑裂综合征（blepharophimosis-ptosis-epicanthus inversus syndrome，BPES）的疗效。方法2015 年 3 月—2017 年 6 月，采用提上睑肌缩短术联合 Mustarde 双 Z 形切除术一期矫正 26 例儿童双眼 BPES。其中，男 16 例，女 10 例；年龄 4～14 岁，平均 7 岁。均有典型的小睑裂四联征。7 例伴有鼻梁低平，20 例伴有弱视和斜视。睑裂长度（19.5±4.5）mm，睑裂宽度（2.5±1.6）mm，内眦间距（42.1±6.5）mm，提上睑肌肌力（5.5±1.3）mm。结果术后切口均Ⅰ期愈合。23 例获随访，随访时间 2～12 个月，平均 10 个月。其中 2 例矫正不足、3 例过度矫正，6 例眼睑线弧度欠佳，均无眼睑内外翻和角膜炎发生。其余患儿均成功矫正上睑下垂和内眦赘皮，眼睑线弧度自然。术后 7 d 测量睑裂长度（27.2±1.9）mm，睑裂宽度（12.5±1.3）mm，内眦间距（29.4±2.6）mm；以上指标均较术前显著改善，差异有统计学意义（t=0.127，P=0.042；t=0.341，P=0.029；t=0.258，P=0.038）。术后无因睑裂宽度、长度回退导致的成角畸形发生。 结论提上睑肌缩短术联合 Mustarde 双 Z 形切除术能达到一期矫正儿童 BPES 目的，可获得较好临床疗效。     

Developing an Improved Home-Level Technology for the Production of a Protein-Enriched Nigerian Local Snack,Tofu Pie

Abstract

Maize flours and dough were variously prepared from whole, decorticated, and alkaline-cooked maize grains. Other flour types include soycorn milk residue and wheat flours. All the flour types were made into base for pie-type preparations. Tofu (soybean curd) cubes were mixed with local pepper and onion condiments, fried, and were used for pie filling. The various pie types namely WFTP, DMFTP, WMFTP, WMADTP, DMADTP, SRFTP and MPI-MPVI (MPs) represent pie types made from base using wheat, decorticated, whole maize flours, wet and dry masa doughs, soycorn residue flour, and market pies 1 to VI, respectively. MP1 was used as control for sensory evaluation. The protein content of the maize-based pies ranged from 19.54 to 34.13% and was significantly higher (P < 0.01) than the range of protein content 11.67–15.53% for the MPs. Except for WMFTP, all other experimental pie types gave higher in vitro digestibility (IVD) percent than the MPs. The sensory evaluation scores showed that none of the experimental pies were rejected but their scores were significantly lower (P < 0.05) than those for the MPs in all the parameters measured. Pie types WFTP, DMFTP, and WMFTP were significantly higher (P < 0.05) than the other experimental pies in all the sensory attributes measured. The consumption of tofu pies developed in this study, using the improved home-level technology described, will help to reduce malnutrition consequent to the high protein content and nutritional attributes of the improved local snack. doi:10.1300/J385v05n02_07     

Can We Eliminate Low-Density Lipoprotein Cholesterol-Related Cardiovascular Events Through More Aggressive Primary Prevention Therapy?

Intravascular levels of low-density lipoprotein cholesterol (LDL-C) at approximately ≤ 0.6 mmol/L are likely to minimize, and perhaps eliminate, LDL-C-related vascular toxicity while having no effect on essential, intracellular cholesterol homeostatic pathways, according to accumulated knowledge from basic science. Randomized clinical trials, observational reports, and Mendelian randomization trials are also forcing a reconsideration of what “normal” LDL-C means. Recent trials of secondary prevention have substantiated that such levels are safe and associated with a decreased risk of cardiovascular events (CVEs) compared with patients with higher levels of LDL-C. Similarly, treatment to this low range is associated with regression and stabilization of established atherosclerosis. Primary prevention trials also show that low levels of LDL-C are safe and associated with decreased risk of CVEs through cholesterol-lowering in adults with LDL-C ≥ 3.5 mmol/L or when levels are < 3.5 mmol/L in association with other cardiovascular risks. Although there are no randomized clinical outcome trials of familial hypercholesterolemia patients, such patients have very high, lifetime risk of CVE, and registry studies show that LDL-C reduction has nearly normalized their CVE rates. The possibility of familial hypercholesterolemia should be considered if LDL-C is > 4.5 and > 4.0 mmol/L at ages 18-39 years and younger than 18 years, respectively. On the basis of these convergent and internally consistent lines of evidence, in this article we speculate on a translational paradigm aimed at eliminating LDL-C-related CVEs through aggressive primary prevention strategies that are already proven and well accepted in principle.     

Correlation between the extent of smoking,salivary protein profiles,and dental caries in young adult smokers

Context.Proteins in the saliva are one of the defense mechanism factors that can protect the oral cavity from disease. However, smoking might affect the properties of saliva.AimTo determine the differences in salivary protein profiles and total concentrations in smokers and non-smokers and their correlation with dental caries severity as indicated by the Decayed, Missing, Filled-Teeth (DMF-T) scores.Methods and materialThis cross-sectional study included 25 smokers and 25 non-smokers. The DMF-T scores were recorded. The total salivary protein was measured by the Bradford method, and the profile proteins were determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE).ResultsThe average of salivary protein concentration in smokers was lower than that in non-smokers (551.486 µg/mL versus 765.361 µg/mL), but the difference was not statistically significant (P > 0.05). Further correlation analyses showed a negative correlation between the concentration of proteins based on the extent of smoking. A weak negative correlation was found between protein concentration and DMF-T scores (r = −0.239). Dominant salivary protein bands of 11.6 kDa and 54.5 kDa were found in smokers and 27 kDa, 60 kDa, and 94.5 kDa were found in non-smokers.ConclusionDifferent protein bands appeared in smokers and non-smokers. There was a weak correlation between protein concentration, DMF-T scores, and the extent of smoking.     

Personalized Blood Flow Restriction Therapy: How,When and Where Can It Accelerate Rehabilitation After Surgery?

Personalized (based on a percentage of a patient's limb occlusion pressure) blood flow restriction is emerging as a potential advancement in orthopaedic surgery. Safe application of the technology requires the use of medical devices capable of customizing the pressures applied to individual patients. In those circumstances, it is a low risk and noninvasive technique. By limiting muscle atrophy and aiding in the recovery of strength and function, it has the potential to significantly reduce the morbidity from limb trauma and surgery, and aid in achieving a substantially earlier return to full activity.