胫骨Pilon骨折采用有限切开锁定钢板内固定治疗的临床价值分析

目的对有限切开锁定钢板内固定在胫骨Pilon骨折治疗中的临床应用价值进行分析。方法选取胫骨Pilon骨折患者66例,随机分为两组,分别给予交锁髓内钉内固定术和有限切开锁定钢板内固定治疗,对比两组手术情况。结果观察组手术用时显著短于对照组,两组患者切口Ⅰ期愈合率、下地负重时间与骨折愈合时间无显著差异;经随访,观察组踝-后足功能评分显著高于对照组。结论有限切开锁定钢板内固定可促进胫骨Pilon骨折患者骨愈合,早期及中期预后良好,具有较高临床应用价值。     

不同液体复苏对重症急性胰腺炎患者预后的影响分析

目的探讨不同液体复苏对重症急性胰腺炎患者预后的影响。方法回顾性分析2009年3月-2012年10月我院SICU 172例重症急性胰腺炎患者的临床资料,根据患者入院后24h内液体复苏量将患者分成A组与B组,各86例。A患者给予充分性液体复苏治疗,B组患者给予限制性液体复苏治疗,比较两组患者的临床治疗效果和预后。结果 A组患者的急性肾损伤（AKI）发生率、AKI持续时间、肌酐峰值及连续肾脏替代疗法（CRRT）使用率均较B组有明显升高,两组比较具有统计学意义（P〈0.05）;A组患者与B组患者在多器官功能衰竭综合征（MODS）发生率、CRRT使用时间、机械通气率、开腹手术率、住院时间及死亡率等方面无统计学意义（P〉0.05）。结论对于重症急性胰腺炎患者给予限制性液体复苏能够显著降低患者的AKI发生率和持续时间以及肌酐峰值,减少CRRT的使用率,减少并发症的发生,较充分性液体复苏具有更好的临床疗效,对于重症胰腺炎患者疾病的治疗和预后具有重要的意义。     

Computational Fluid Dynamics Reveals a Unique Net Unidirectional Pattern of Pulmonary Airflow in the Savannah Monitor Lizard (Varanus exanthematicus)

This report models pulmonary airflow in the savannah monitor (Varanus exanthematicus) using computational fluid dynamics simulations, which are based on computed tomography data. Simulations were validated by visualizing the flow of aerosolized lipids in excised lungs with good but not perfect agreement. The lung of this lizard has numerous successive bronchi branching off a long intrapulmonary bronchus, which are interconnected by intercameral perforations. Unidirectional flow has been documented in the lateral secondary bronchi of the savannah monitor, but patterns of airflow in the rest of the lung remain unknown, hindering our understanding of the evolution of pulmonary patterns of airflow in tetrapods. These results indicate that the lung contains a unique net unidirectional flow, where the overall flow scheme is similar during expiration and late inspiration, but dissimilar during early inspiration. Air is transported net caudally through the intrapulmonary bronchus and net craniad through secondary bronchi, much like the pattern of flow in birds. The simulations show that many chambers feature flow in multiple directions during parts of the respiratory cycle, but some regions also show robust unidirectional airflow. Air moves craniad through secondary bronchi and between adjacent secondary bronchi through intercameral perforations. The first secondary bronchus, the hilar-cranial bronchus, contains tidal flow that may improve ventilation of the central and dorsal lung parenchyma. These results expand our understanding of flow patterns in varanid lungs and suggest lungs with net unidirectional flow as an evolutionary pathway between tidal flow and complete unidirectional flow in multicameral lungs. Anat Rec, 2020. © 2019 American Association for Anatomy Anat Rec, 303:1768–1791, 2020. © 2019 American Association for Anatomy     

Treatment of myogenic temporomandibular disorder: a prospective randomized clinical trial,comparing a mechanical stretching device (TheraBite®) with standard physical therapy exercise

Aims:

To compare in a randomized controlled clinical trial (RCT) the application of the TheraBite® (TB) Jaw Motion Rehabilitation System with a standard physical therapy (PT) exercise regimen for the treatment of myogenic temporomandibular disorder (TMD).

Methodology:

Myogenic TMD patients were randomized for the use of the TB device or for standard PT. Mandibular function was assessed with the mandibular function impairment questionnaire (MFIQ). Pain was evaluated using a visual analog scale, and maximum inter-incisor (mouth) opening (MIO) was measured using the disposable TB range of motion scale.

Results:

Of the 96 patients randomized (46 TB, 50 standard PT exercises), 38 actually started with the TB device and 41 with the standard PT exercises. After six-week follow-up, patients using the TB device reported a significantly greater functional improvement (MFIQ score) than the patients receiving regular PT exercises (P?=?0·0050). At 6 weeks, no significant differences in pain, and active or passive MIO were found between the two groups. At 3 months, patients in both treatment groups did equally well, and showed a significant improvement in all parameters assessed.

Conclusions:

This RCT on myogenic TMD treatment, comparing standard PT with passive jaw mobilization using the TheraBite Jaw Motion Rehabilitation System®, shows that both treatment modalities are equally effective in relieving myogenic TMD symptoms, but that the use of the TB device has the benefit of achieving a significantly greater functional improvement within the first week of treatment.     

Asthma Severity,Exacerbation Risk,and Controller Treatment Burden in Underweight and Obese Children

Objective. The relationship between weight status and asthma characteristics in children remains inadequately defined. Very little has been published on the risk of exacerbation, physician perception of severity, and the level controller treatment prescribed to underweight and obese children with asthma in a real-world setting. Methods. We assessed the diagnostic severity, pulmonary function, exacerbation prevalence, and controller treatment level in 10,559 new asthma patients seen at one of four pediatric asthma subspecialty clinics among three BMI groups. Participants were analyzed by body mass index (BMI)-percentile based on Centers for Disease Control & Prevention classification. Multivariable logistic regression models were used to assess the associations between BMI-percentile cohort group and asthma outcomes. Results. Underweight asthmatics were rare (2.5%) relative to obese asthmatics but appeared to have the greatest impairment in forced vital capacity and had the greatest controller treatment burden. Obese asthmatic children made up 26.2% of our cohort and were more likely to have severe disease (odds ratio (OR) 1.40, 95% confidence interval (CI) 1.06–1.85) and airflow obstruction (OR 1.36, 95% CI 1.16–1.59) compared to normal weight asthmatics. Obese asthmatics were not at greater risk for exacerbation (OR 1.41, 95% CI 0.64–3.11) or high treatment burden (OR 1.03, 95% CI 0.83–1.28). Conclusions. Obesity is more common than underweight status among children with asthma. Both underweight and obese children with asthma have worse lung function and asthma-related outcomes compared to similar normal weight children, though the phenotypic characteristics of underweight and obese asthmatics differed considerably.     

Allergy,total serum immunoglobulin E,and airflow in children and adolescents in TENOR

Haselkorn T, Szefler SJ, Simons FER, Zeiger RS, Mink DR, Chipps BE, Borish L, Wong DA, for the TENOR Study Group. Allergy, total serum immunoglobulin E, and airflow in children and adolescents in TENOR.
Pediatr Allergy Immunol 2010: 21: 1157–1165.
© 2010 John Wiley & Sons A/S In children and adolescents with difficult‐to‐treat asthma, few data exist characterizing the relationships between basic patient characteristics (e.g., age, sex) and atopic indicators in asthma. These associations were examined in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR), an observational study of a large cohort of patients with severe or difficult‐to‐treat asthma. To characterize allergy patterns and the relationship between total serum immunoglobulin E (IgE) and airflow in young patients with severe or difficult‐to‐treat asthma. A total of 1261 patients from the TENOR study were stratified into four age groups at baseline (6–8, 9–11, 12–14, and 15–17 yr). The objective was to characterize allergy patterns and the relationship between total serum immunoglobulin E (IgE) and ratio of pre‐bronchodilator forced expiratory volume in 1 second to forced vital capacity (FEV₁/FVC) in young patients with severe or difficult‐to‐treat asthma. The chi‐square test for categorical variables and analysis of variance for continuous variables were used to identify significant differences among age groups. Multivariable linear regression was used to evaluate the association between IgE and FEV₁/FVC. Allergic rhinitis was reported in approximately two‐thirds of patients. Up to 25% of patients had atopic dermatitis, which differed across age groups in boys (p < 0.05). Positive allergen skin test rate differed across age groups in boys (p < 0.05). Rates of asthma triggers were higher and differed across age groups in girls (p < 0.05), particularly around menarche (12–14 yr). IgE levels were higher in boys and differed across age groups in boys (p < 0.01) and girls (p < 0.05). IgE was associated with a lower FEV₁/FVC after adjusting for age and sex (p < 0.01). Severe or difficult‐to‐treat asthma in children and adolescents is characterized by high frequencies of comorbid allergic diseases, allergen sensitization, and high IgE levels. This burden is amplified by the association of more airflow limitation with higher IgE levels, suggesting the need for allergy evaluations.     

Practical model description of peripheral neural excitation in cochlear implant recipients: 3. ECAP during bursts and loudness as function of burst duration

In this, the third paper of the series, the loudness of low-rate bursts of electrical pulses was measured as a function of the burst duration, in subjects implanted with the Nucleus^® 24 cochlear implant system (three with straight and two with Contour™ electrode arrays). In order to help distinguish between the contributions of peripheral and more central effects, the ECAP was recorded to the individual pulses comprising the bursts, using the Neural Response Telemetry™ (NRT™) system. At a pulse rate of 250 pulses/s, the ECAP amplitude did not decrease greatly during the bursts: the mean reduction factor was 0.89. The time-constant for summation of the loudness contributions from the pulses comprising a burst was found to be larger than that associated with normal hearing. In addition, the first pulse of a pulse train was found to contribute much more to the overall loudness than did the subsequent pulses, although a corresponding difference was not observed in the ECAP recordings. These results establish a necessary connection between the essentially single-pulse model, developed in the fourth and fifth papers of the series, and the psychophysical data for pulse bursts, but they also have broader implications.     

Two‐stage estimation of limited dependent variable models with errors‐in‐variables

Summary This paper deals with censored or truncated regression models where the explanatory variables are measured with additive errors. We propose a two‐stage estimation procedure that combines the instrumental variable method and the minimum distance estimation. This approach produces consistent and asymptotically normally distributed estimators for model parameters. When the predictor and instrumental variables are normally distributed, we also propose a maximum likelihood based estimator and a two‐stage moment estimator. Simulation studies show that all proposed estimators perform satisfactorily for relatively small samples and relatively high degree of censoring. In addition, the maximum likelihood based estimators are fairly robust against non‐normal and /or heteroskedastic random errors in our simulations. The method can be generalized to panel data models.