Type 1 (insulin-dependent) diabetes mellitus diagnosed during pregnancy: a clinical and prognostic study

Summary The study concerns the clinical outcome and later prognosis (regarding permanent insulin treatment) of patients who develop insulin-dependent diabetes mellitus during pregnancy (which is different from gestational diabetes). Sixty-three such patients (27±1 (SEM) years old) were delivered at the Copenhagen Centre for Diabetes and Pregnancy during the years 1966–1980. Obstetric complications such as toxaemia were seen in 9.5% of these study patients and the perinatal mortality was 6.3%, both percentages being higher than in the general population (1.1%,p<10^–7 and 1.0%,p<10^–3, respectively), but similar to those observed in patients with Type 1 diabetes diagnosed before pregnancy. In contrast, the frequency of malformations was 1.6%, the same as in the general population (1.4%), but lowerthan that seen in patients with long-standing diabetes (8.3%,p<0.05). At follow-up examination 8±1 years after diagnosis all patients were diabetic; 77% were insulin treated, having no or virtually no residual B-cell function, and were clearly Type 1 diabetic patients. After delivery 80% of the patients had a remission period (median 256 days) without insulin treatment. This remission period was absent or shortest in patients with the following characteristics (p0.03): low age, first parity, not overweight, and high blood glucose level at diagnosis. These prognostic parameters should be considered in obligatory, clinical follow-up plans for such patients.     

Prospective randomized clinical study in general surgery comparing a new low molecular weight heparin with unfractionated heparin in the prevention of thrombosis

A prospective, randomized, controlled clinical trial was performed comparing the antithrombotic efficacy of the low molecular weight heparin LMWH 21–23, (Braun) with an unfractionated heparin in elective general surgical patients over an observation period of 7 postoperative days. A total of 230 patients were admitted: 103 (group I) received low molecular weight heparin and 100 (group II) low-dose unfractionated heparin treatment given subcutaneously. In group I 41 patients (46%) were operated on for malignant disease and in group II 54 patients (54%). Due to the large amount of great abdominal procedures the intra- and perioperative application of hydroxyethyl starch was allowed for volume substitution. None of the patients died due to fatal pulmonary embolism. In group I four patients revealed positive ¹²⁵I-labeled fibrinogen uptake (3.9%); two patients belonged to the hydroxyethyl starch subgroup. In group II five patients displayed a positive fibrinogen uptake (5%); two belonged to the hydroxyethyl starch subgroup. The results of the hemostaseological investigations (e.g., prothrombin time, activated partial thromboplastin time, thrombin clotting time, fibrinogen, antithrombin III, protein C, plasminogen, ₂-antiplasmin , tissue-type plasminogen activator, plasminogen activator inhibitor) revealed no statistically significant differences between groups I and II or their subgroups, although a tendency to prolonged clotting times was observed. The antifactor Xa activity values, however, displayed a statistically significant difference between the two groups (P < 0.05). The antifactor Xa activity measured up to 0.16 U/ml for the low molecular weight heparin (group I) and 0.05 U/ml for the unfractionated heparin (group II) in the postoperative period. Major bleeding complications were not encountered in this study. Fundamental for the low incidence of thrombosis, the additive administration of hydroxyethyl starch appeared in almost one-third of the patients in both study groups.Abbreviations APTT activated partial thromboplastin time - aXa anti-factor Xa - DVT deep venous thrombosis - FUT ¹²⁵I-labeled fibrinogen uptake test - HES hydroxyethyl starch - LMWH low molecular weight heparin - PE pulmonary embolism - UFH unfractioned heparin     

Valid parameters for investigation of the pupillary light reflex in normal and diabetic subjects shown by factor analysis and partial correlation

Summary Pupillary test data of 103 normal and 119 diabetic subjects (47 IDDM, 72 NIDDM) were evaluated by factor analysis. From a total of nine pupillary parameters three factors were extracted in the analysis. Factor 1 represents maximal pupillary area, contraction velocity at 1 s, dilation velocity at 6 s and minimal pupillary area — static and simple dynamic parameters; factor 2 amplitude of pupillary unrest, area under the detrended curve of pupillary unrest and period of pupillary unrest — parameters of pupillary unrest; factor 3 fusion frequency of pupillary response following flicker stimuli and latency time of pupillary light reflex — second order dynamic parameters. Factor analysis was then applied to investigate diabetic patients with a high percentage of autonomic neuropathic participants (about 39 % had pupillary and about 35 % had cardio-respiratory function disorders), which revealed the same three factors as those identified in normal subjects. Furthermore, an age-related database of parameters of pupillary unrest is given. It demonstrates that normal subjects and diabetic patients did not differ in the period of pupillary unrest (normal vs diabetic (mean±SEM): 1550±29 vs 1536±27 ms; 2p>0.5). The difference in amplitude (47.8±2.8 vs 41.0±2.6 % percentile; 2p=0.071) and area under the detrended curve of pupillary unrest (47.9±2.8 vs 40.8±2.6 % percentile, 2p=0.062) seems to show a trend but was not significant. In conclusion, factor analysis revealed three different pupillary test factors. From the comparison of normal and diabetic subjects factor 1 which accounts for the highest percentage of variance (43 %) and factor 3(12 %) appear to be useful for investigating the pupillary light reflex. Factor 2 is not useful because of the insignificant differences between the normal and diabetic group. From factor analysis and partial correlation we believe that pupillary autonomic function in diabetic patients can be best assessed by using only two parameters, maximal pupillary area and latency time.Abbreviations IDDM Insulin-dependent diabetes mellitus - NIDDM non-insulin-dependent diabetes mellitus - lx lux - lm lumen     

Kümmell病伴脊柱后凸畸形对脊柱-骨盆矢状面参数的影响

目的：探讨Kümmell病伴脊柱后凸畸形对脊柱-骨盆矢状面形态的影响。方法：回顾性分析2015年8月至2022年9月收治的34例Kümmell病伴脊柱后凸畸形的患者（Kümmell病组）,其中男10例,女24例,年龄（71.1±8.5）岁,以37例年龄（69.3±6.7）岁匹配的无症状人群为对照组。在站立位全脊柱正侧位X线片上测量脊柱-骨盆矢状面参数,包括节段性后凸角（segmental kyphosis,SK）或胸腰椎后凸（thoracolumbar kyphosis,TLK）、胸椎后凸角（thoracic kyphosis,TK）、腰椎前凸角（lumbar lordosis,LL）,骨盆入射角（pelvic incidence,PI）、骨盆倾斜角（pelvic tilt,PT）、骶骨倾斜角（sacral slope,SS）、矢状面平衡（sagittal vertical axis,SVA）、T₁骨盆角（T₁ pelvic angle,TPA）以及骨盆入射角与腰椎前凸的匹配关系（PI-LL）。同时测量Kümmell病患者患椎椎体楔变角（wedge angle,WA）,并分析WA、SK等与脊柱-骨盆矢状面参数的相关性。结果：Kümmell病组TK、SK、PT、SVA、TPA、PI-LL均高于对照组（P<0.05）,Kümmell病组LL、SS低于对照组（P<0.05）;两组PI比较,差异无统计学意义（P>0.05）。Kümmell病组患椎WA为（30.8±5.9）°,并与SK、TK有相关性（r=0.366,0.597,P<0.05）,SK与LL、SS有相关性（r=0.539,-0.591,P<0.05）,LL与PI、SS、SVA、TPA、PI-LL有相关性（r=0.559,0.741,-0.273,-0.356,-0.882,P<0.05）。结论：Kümmell病伴脊柱后凸不仅存在节段性后凸畸形,而且整体脊柱-骨盆矢状面参数亦发生改变,包括腰椎前凸丢失、骨盆后旋、躯干前倾等。Kümmell病的手术治疗不仅要重视塌陷椎体高度的恢复,对于合并脊柱后凸患者还要着眼于脊柱-骨盆矢状面的整体平衡。     

Feasibility,acceptability and effects of dance therapy in stroke patients: A systematic review

IntroductionStroke is the leading cause of non-traumatic disability in adults, with balance and gait disturbances representing the main limitations of body functions. Dance therapy (DT) has shown positive effects in older adults and in patients with neurological pathologies. This systematic review aims to examine the feasibility, acceptability and effects of DT in stroke rehabilitation, specifically on functional gains of gait and balance.MethodsA systematic search was carried out for articles published in the MEDLINE, PEDro, Web of Science, Scopus and CINHAL in February 2021 and updated in April 2021. Results: Eight studies were included (2 clinical cases, 5 case series and 1 randomized controlled trial), 7 of them in patients with chronic stroke and only 1 in subacute stroke phase. The most widely used dance modality was tango and ballet, with sessions ranging from 30 to 110 min. DT seems to show positive effects on post-stroke body functions and activities such as gait and balance. Reported dropout rates are inconsistent, no adverse effects were reported, and participant satisfaction was high.ConclusionGiven the heterogeneity and uneven quality of the included studies, strong conclusions cannot be put forward on the effectiveness of DT in post-stroke body function and activities. Nevertheless, DT seems to be safe and acceptable therapy for patients, and no adverse effects have been reported. More studies with a high level of evidence and feasibility are needed to determine the patient profile, the characteristics of the intervention, the participation rate and the role of the rehabilitation professional most likely to generate optimal benefit.     

Meiotic abnormalities and spermatogenic parameters in severe oligoasthenozoospermia

The incidence of meiotic abnormalities and their relationship with different spermatogenic parameters was assessed in 103 male patients with presumably idiopathic severe oligoasthenozoospermia (motile sperm concentration < or = 1.5 x 10(6)/ml). Meiosis on testicular biopsies was independently evaluated by two observers. Meiotic patterns included normal meiosis and two meiotic abnormalities, i.e. severe arrest and synaptic anomalies. A normal pattern was found in 64 (62.1%), severe arrest in 21 (20.4%) and synaptic anomalies in 18 (17.5%). The overall rate of meiotic abnormalities was 37.9%. Most (66.7%) meiotic abnormalities occurred in patients with a sperm concentration < or = 1 x 10(6)/ml. In this group, total meiotic abnormalities were found in 57.8% of the patients; of these, 26.7% had synaptic anomalies. When the sperm concentration was < or = 0.5 x 10(6)/ml, synaptic anomalies were detected in 40% of the patients. In patients with increased follicle stimulating hormone (FSH) concentrations, total meiotic abnormalities occurred in 54.8% (synaptic anomalies in 22.6%). There were statistically significant differences among the three meiotic patterns in relation to sperm concentration (P < 0.001) and serum FSH concentration (P < 0.05). In the multivariate analysis, sperm concentration < or = 1 x 10(6)/ml and/or FSH concentration > 10 IU/l were the only predictors of meiotic abnormalities.     

计算机在固定床传热参数测定中的应用

开发了固定床传热参数测定的通用计算机处理系统,并给出了国产新型环柱状醋酸乙烯合成催化床的径向导热系数及壁给热系数的测定实例。     

普拉西坦在动物体内的药物代谢动力学

为研究普拉西坦在犬和大鼠体内药代动力学规律,给犬灌服普拉西坦后,抽取不同时间的血液,分离血浆,用ＨＰＬＣ测定血浆中药物浓度,采用３ｐ８７ 程序计算药代参数;应用ＨＰＬＣ测定大鼠灌服普拉西坦后各组织和胆汁、尿、粪中药物浓度。结果显示：血药浓度－时间曲线符合一室开放模型,其体内的Ｔ１／２为２．３～３．９ 小时;大鼠灌服普拉西坦后３ 小时各组织中有较高的浓度,以肾脏为最高,肝脏次之,依序为肠、肺、肌、心、生殖腺、脾、脂肪;脑组织也能测到一定的量。２４小时从胆汁排泄原形药物占给药量的０．７％ ,７２小时从尿和粪中排出原形药物量分别占给药量的２８．２６％ 和６．３５％ 。用平衡透析法测定普拉西坦的血浆蛋白结合率约为２０．１％ ～２２．２％ 。以上结果表明,普拉西坦吸收快,分布广,消除也快。