HbA1c variability and long-term glycemic control are linked to diabetic retinopathy and glomerular filtration rate in patients with type 1 diabetes and multiethnic background

AimTo evaluate the associations between HbA1c variability and long-term glycemic control with microvascular complications in type 1 diabetes (T1D) patients and multiethnic background.MethodsT1D adults with ≥ 10 years of follow-up and ≥ 2 HbA1c measurements were included. Glycemic variability was evaluated by the standard deviation (HbA1c-SD), and coefficient of variation (HbA1c-CV), and glycemic control by mean HbA1c over 10 years. Diabetic retinopathy (DR), increased urinary albumin excretion rate (UAER) and reduced glomerular filtration rate (eGFR) were diagnosed. Cardiac autonomic neuropathy (CAN) was diagnosed by cardiac reflex tests. Associations between glycemic parameters with complications were assessed by multivariate logistic regressions.Results220 patients were included. Simultaneously adjusted for each other, mean HbA1c was independently associated with DR (OR: 2.82; 95%CI: 1.45-5.50), increased UAER (OR: 1.97; 95%CI: 1.14-3.09) and CAN (OR: 4.42; 95%CI: 1.45-13.51); whereas HbA1c-CV was independently associated with DR (OR: 8.93; 95%CI: 1.86-42.87) and reduced eGFR (OR: 7.02; 95%CI: 1.47-35.55).ConclusionsLong-term glycemic control was associated with DR, increased UAER and CAN, while glycemic variability was additionally associated with DR and impaired renal function; suggesting that both good and stable glycemic status might be important to prevent microvascular complications in T1D patients and multiethnic background.     

ARRAY 360特种蛋白分析仪故障检修五例

本文总结、分析了ARRAY360特种蛋白分析仪五例比较典型故障维修过程。希望能对各位同行提供有益的参考。     

360度绩效反馈法在护士长考评中的效用分析

目的运用360度绩效反馈法者评估护士长的个体职业发展和绩效情况,有利于护士长的针对性培养及岗位合理聘用.方法选择评估对象;对评估者进行分级测评,并给予不同的权重系数;编制量表,其内容包括品德、智力、能力、绩效、服务指标5个因子共25个条目,采用主客观结合的赋权法,确定各指标的权重值.运用360度绩效反馈法,对本院的31名护士长进行绩效考评,对2004年护士长的考评结果进行分层分析,并及时反馈.结果 2004年护士长绩效考评总均分为91.82±8.87,下属对护士长的评价几乎不同程度地高于同级、上级和顾客(患者)的评价(P<0.05),尤其在智力指标和能力指标因子方面,护理部对护士长的因子得分从高到低依次为品德指标、绩效指标、智力指标、能力指标、服务指标(P<0.05),其中绩效指标因子对考评总分影响最大,护士长的年限对各种指标有不同程度的影响;服务指标因子的增加及顾客(患者)导入,决定了护士长绩效考评的成败.结论 360度绩效反馈法能从多角度反映护士长的综合情况,有利于护士长的职业个体发展和正确的绩效评价.     

MRI辅助下膝关节骨关节炎伴内翻畸形患者股骨远端3种旋转轴线与外科经股骨上髁轴的准确性比较

目的 在磁共振(magnetic resonance imaging,MRI)上测量膝关节重度骨关节炎(osteoarthritis)伴内翻畸形患者股骨远端不同旋转轴线,评估各参照轴线相对于外科经股骨上髁轴(surgical transepicondylar axis,STEA)的准确性.方法 回顾性分析2013年6月至2014年1月在我中心明确诊断为膝关节重度骨关节炎伴内翻畸形患者(内翻≤15°)86例(86膝)的临床资料,其中男性34例,女性52例;年龄51 ～70(63.7±8.7)岁,由2位医师在MRI横断面图像上定位STEA、临床经股骨上髁轴(clinical transepicondylar axis,CTEA)、后踝轴(posterior condylar line,PCL)外旋3°线(3°extorsion against PCL,3°PCL)、前后轴(anterior posterior line,APL)的垂线,测量各轴线相对于STEA偏差的角度,并用方差分析比较各角度接近STEA的精确性.结果 3°PCL相对于STEA外旋(0.63°±1.82°)、CTEA相对于STEA外旋(3.78°±0.75°),APL垂线相对于STEA外旋(5.38°±3.17°),精确度:A角(3° PCL相对于STEA旋转的角度)＞CSA(CTEA相对于STEA旋转的角度)＞ASA(APL垂线相对于STEA旋转的角度),各角度两两比较差异具有统计学意义(P＜0.01).结论 膝关节重度骨关节炎伴轻度内翻人群中,股骨远端截骨轴线除STEA外,3°PCL准确性最高;术中STEA定位困难时,参照3°PCL进行截骨可获得较好的股骨旋转准确度.     

Is Airway Smooth Muscle the “Missing Link” Modulating Airway Inflammation in Asthma?

Airway smooth muscle (ASM) plays a central role in regulating bronchomotor tone in patients with asthma. New evidence, however, suggests that ASM may also orchestrate and perpetuate airway inflammation by promoting the recruitment, activation, and trafficking of inflammatory cells in the airways. This review addresses the immunomodulatory function of ASM and highlights how such function may have therapeutic implications in the management of asthma.     

股静脉采血30°角斜刺在1～3个月婴儿静脉采血中的应用效果

目的探讨股静脉采血30°角斜刺在1~3个月婴儿静脉采血中的应用效果。方法将需要静脉采血的160例1~3个月婴儿随机分为观察组和对照组,对照组采用直刺股静脉采血,观察组采用30°斜刺股静脉采血,比较2组的采血情况以及家长的护理满意度。结果观察组的一次采血成功率高于对照组,疼痛程度轻于对照组,舒适度高于对照组,采血时间、压迫时间短于对照组,标本溶血率低于对照组,差异均有统计学意义(P0.05)。观察组家长对采血的护理满意度高于对照组,差异有统计学意义(P0.05)。结论股静脉采血30°角斜刺的穿刺成功率高,操作时间短,有利于减轻1~3个月婴儿静脉采血时的疼痛,提高患儿的舒适度,减少皮下血肿。     

排便体位的改进对胸腰椎术后患者舒适的影响

目的:对胸腰椎术后患者排便体位进行改进,促进患者生理和心理舒适。方法:将胸腰椎术后120例患者随机分为观察组、对照组各60例。对照组排便时采取常规侧卧位排便,即90°侧卧屈膝,臀下放置一次性尿垫,抬高床头15°～30°。观察组采取45°侧卧位排便法,即侧卧45°屈膝,背部垫45°三角枕支撑,双下肢自然屈膝,两腿间垫一软枕,臀下放置便盆,抬高床头15°～30°。结果:两组排便时间及排便舒适度比较,差异有统计学意义(P0.01)。结论:胸腰椎术后患者采取45°侧卧位排便法,缓解患者的心理压力,增加排便的舒适感,缩短排便时间,利于疾病康复。     

Open reduction and internal fixation of comminuted patellar fractures with headless compression screws and wiring technique

Background

Management of a displaced comminuted patellar fractures is challenging, and various surgical fixation methods have been suggested. However, issues of loss of reduction and breakage of fixatives have not yet been resolved. In the current study, we describe a new technique for exposure and stabilization of comminuted patellar fractures and evaluate the clinical and radiologic outcomes of this new treatment.