Is dietary counselling effective in increasing dietary calcium,protein and energy intake in patients with osteoporotic fractures? A randomized controlled clinical trial

To determine the feasibility of increasing the calcium, protein and calorie intake of osteoporotic fracture patients by repeated dietary counselling delivered by a dietitian, a randomized controlled trial was conducted. Among 189 patients presenting with osteoporotic fractures to an Orthopaedics and Traumatology Department of a large regional hospital, 98 patients were randomized to the intervention group and 91 were randomized to the control group (with usual care). Intervention group received three sessions of dietary counselling with tailored made recommendations over a period of 4 months, while the control group only received dietary assessment and pamphlets on the prevention of osteoporosis. Almost all subjects in both intervention and control groups had calcium intake below the recommended level of 1000 mg at baseline. Half and 60% of subjects in both groups had total energy and protein intake below recommended levels respectively. The mean weights of control and intervention groups at baseline were 51.5 and 50.9 kg respectively, while the body mass index (BMI) were 22.6 (kg m(-2)) and 22.6 (kg m(-2)) respectively. After dietary intervention, significant increase of intake was seen in calcium intake (P = 0.0095 by t-test) in the intervention group. No significant increase was seen in protein or calorie intake. No significant change was observed in the body weight or BMI although there was a positive trend in the intervention group for all these parameters. We concluded that there was general malnutrition in Chinese elderly who presented with osteoporotic fractures. Dietary calcium could be increased by repeated professional dietary counselling. Future studies with longer duration and more objective clinical outcomes will be helpful to further demonstrate the long-term effects of dietary intervention on osteoporosis and other chronic diseases.     

桡骨远端关节内骨折的手术治疗(附12例临床报告)

目的 探讨桡骨远端关节内骨折手术治疗的效果。方法 对12例桡骨远端关节内骨折按通用分类法分类，Ⅲ型1例，ⅣA型3例，ⅣB型2例，ⅣC型5例，ⅣD型1例，5例术前行螺旋CT和三维重建检查。手术治疗的方法：外固定支架，外固定支架加克氏针，掌侧或背侧支持钢板，或支持钢板加克氏针，以及以单纯克氏针固定。结果 随访8-20个月，平均12个月，优9例，良2例，优良率为91.7％。结论 桡骨远端的关节内骨折在闭合复位欠佳时，应该考虑手术治疗，螺旋CT和三维重建技术在术前准备中可提供充分的骨折资料，术式的选择对不同类型的骨折应有所选择。     

中药结合心理干预治疗不安障碍40例

[目的]探索不安障碍治疗的有效途径。[方法]采用中药结合心理干预治疗不安障碍患者40例。[结果]显效31例(77·5%)、有效7例(17·5%)无效2例(5·0%)。SDS、CMI有显著性差异。[结论]中药结合心理干预治疗不安障碍疗效显著。     

婴儿脑损伤早期诊断和早期医学干预探讨

目的探讨婴儿脑损伤筛查专科门诊在早期发现婴儿脑损伤的作用以及神经发育疗法治疗脑损伤的效果。方法采用专科门诊筛查，早期发现脑损伤忠儿。对婴儿脑损伤进行早期诊断和早期综合康复治疗，以临床疗效评估。结果专科门诊对早期发现婴儿脑损伤有意义，88．1％的患儿由门诊筛查发现而被诊断，筛查中应着重注意小婴儿肌张力改变（48％）和运动发育落后（35％），脑损伤中不明原因占18％，1岁以内脑损伤诊断以中枢性发育障碍（89％）、运动落后（11％）为主，治疗以神经发育疗法为主的综合方法，20d一疗程，108例1岁以下脑损伤忠儿治疗效果：显效46．2％，好转47．2％，无效6．6％，总有效率为93.4％，6mo以下疗效显著高于6mo以上脑损伤忠儿。结论婴儿脑损伤专科门诊定期筛查能够早期发现患儿，CDD和MD作为婴儿脑损伤早期诊断的名称是可取的，治疗以神经发育疗法为主，治疗愈早，效果愈好，婴儿脑损伤早期诊断和早期医学干预方法可以在医疗保健机构推广和应用。     

枢星联合方案预防顺铂(DDP)致恶心呕吐的观察及护理

目的:研究枢星联合方案(枢星联合地塞米松及胃复安)预防顺铂联合化疗所致恶心呕吐的疗效及护理干预。方法:将93例接受以顺铂为主联合化疗的患者随机分为两组,实验组53例接受70周期化疗并给予护理干预;对照组40例接受57周期常规化疗,观察1~5d,对两组恶心、呕吐控制率进行比较。结果:实验组对急性恶心、呕吐控制率分别为90%及94.3%,均较对照组(77.2%和80.87%)明显提高(P<0.05)。结论:枢星联合方案结合护理干预可较好地预防顺铂所致的急性恶心、呕吐,使患者以更为舒适的状态接受化疗。     

轻、中度精神发育迟滞儿童的中药和行为干预综合治疗探讨

采用中药与行为干预综合治疗的方法对１４０名轻、中度精神发育迟滞的儿童进行分组康复观察。结果发现中药加行为干预组治疗后智力商数（ＩＱ）及能力的变化最大，明显优于单用中药组和单纯行为干预组（Ｐ＜０．０１）；与对照组相比有非常显著的差异（Ｐ＜０．００１）。从而为精神发育迟滞儿童的康复治疗提供了新的途径。     

Interventions to promote optimal health outcomes in children with Type 1 diabetes—are they effective?

The incidence of Type 1 diabetes is increasing worldwide, imposing enormous public health costs, as well as profoundly affecting individual quality of life. There is evidence that psychological problems are increased in children with diabetes and this morbidity is often associated with poor metabolic control. Specific risk factors for this dual morbidity are emerging from empirical studies. The next challenge is to identify effective interventions for use with children at risk for adverse mental and physical health outcomes. The intervention literature is reviewed. It is noted that most studies have used diabetes-specific, unstandardized interventions in groups of adolescents, with few interventions trialled with younger children. No study has targeted a specific psychological disorder such as behaviour problems or depression, both of which are known to be increased in children with diabetes and for which effective standardized interventions are available. Attention is drawn to methodological limitations in many of the studies conducted to date and suggestions made to reduce these in future interventions attempting to reduce the burden of illness in children with diabetes.     

A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST (Which Early ST-elevation myocardial infarction Therapy) study.

AIMS: Uncertainty exists as to which reperfusion strategy for ST-elevation myocardial infarction (MI) is optimal. We evaluated whether optimal pharmacologic therapy at the earliest point of care, emphasizing pre-hospital randomization and treatment was non-inferior to expeditious primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: Which Early ST-elevation myocardial infarction Therapy (WEST) was a four-city Canadian, open-label, randomized, feasibility study of 304 STEMI patients (> 4 mm ST-elevation/deviation) within 6 h of symptom onset, emphasizing pre-hospital ambulance treatment and participation of community and tertiary care centres. All received aspirin, subcutaneous enoxaparin (1 mg/kg), and were randomized to one of three groups: (A) tenecteplase (TNK) and usual care, (B) TNK and mandatory invasive study < or = 24 h, including rescue PCI for reperfusion failure, and (C) primary PCI with 300 mg loading dose of clopidogrel. Time from symptom onset to treatment was rapid (to TNK for A = 113 and B = 130 min and for PCI in C = 176 min). The primary outcome, a composite of 30-day death, re-infarction, refractory ischaemia, congestive heart failure, cardiogenic shock, and major ventricular arrhythmia, was 25% (Group A), 24% (Group B), and 23% (Group C), respectively. However, there was a higher frequency of the combination of death and recurrent MI in Group A vs. Group C (13.0 vs. 4.0%, respectively, P-logrank = 0.021), yet no difference between Group B (6.7%, P-logrank = 0.378) and C. CONCLUSION: These data suggest that a contemporary pharmacologic regimen rapidly delivered, coupled with a strategy of regimented rescue and routine coronary intervention within 24 h of initial treatment, may not be different from timely expert PCI.     

A "grapple hook" technique using a deflectable tip catheter to facilitate complex proximal circumflex interventions.

We present two patients with angulated, proximal left circumflex lesions, one a chronic total occlusion and one an acute subtotal occlusion. In both cases, use of the deflectable tip Venture Catheter (Velocimed, Minneapolis, MN) facilitated guide wire passage and successful percutaneous coronary intervention (PCI) after prior attempts at guide wire passage with standard wires were unsuccessful.