Long-term changes in dietary intake and its association with eating-related problems after gastric bypass in adolescents

BackgroundRoux-en-Y gastric bypass (RYGB) surgery is an established, effective treatment for severe adolescent obesity. Long-term dietary intake and the relationship to eating-related problems are scarcely evaluated in this population.ObjectivesAssess changes in dietary intake in adolescents after RYGB and explore associations between dietary intake and eating-related problems.Setting: Multicenter study in Swedish university hospitals.MethodDiet history, binge eating scale (BES), and Three-Factor Eating Questionnaire were assessed preoperatively and 1, 2, and 5 years after RYGB in 85 adolescents (67% female) aged 16.5 ± 1.2 years with a body mass index (BMI) of 45.5 ± 6.0 kg/m² and compared with control individuals at 5 years.ResultsFive-year BMI change was –28.6% ± 12.7% versus +9.9% ± 18.9% in RYGB patients versus control individuals (P < .001). Through 5 years, RYGB adolescents reported reduced energy intake, portion size of cooked meals at dinner, and milk/yoghurt consumption (P < .01). The BES scores were 9.3 ± 8.3 versus 13.4 ± 10.5 in RYGB patients versus control individuals (P = .04). Association between BES score and energy intake was stronger in control individuals (r = .27 versus r = .62 in RYGB patients versus control individuals, P < .001). At 5 years, lower energy intake was associated with greater BMI loss in all adolescents (r = .33, P < .001). Higher scores in BES and uncontrolled and emotional eating were associated with higher energy intake, cooked meals, candies/chocolates, cakes/cookies, desserts, and sugary drinks (r > .23, P < .04) and lower intake of fruits/berries (r = –.32, P = .044). A higher score in cognitive restraint was associated with a higher intake of cereals and fruits/berries (r > .22, P < .05) and a lower intake of sugary drinks (r = –.24, P < .03).ConclusionTo support optimization of long-term outcomes in adolescent RYGB patients, it is important to provide management strategies to reduce energy intake. Monitoring eating-related problems could identify potential individuals at risk of poor weight loss and to initiate treatment interventions.     

V-EMF treatment of facial scar: First results

Aim of studyThis is a retrospective study aimed at evaluating the effectiveness of the use of electromagnetic fields and negative pressure treatment (V-EMF) for facial scars, from an aesthetic and functional point of view, and considering the variations in the levels of hydration.Material and methods25 subjects with facial scarring were re-evaluated after being treated with the V-EMF method. The hydration levels of the scars before and after treatment were compared. The results were evaluated considering the satisfaction levels of the patients with the VAS, and of the medical specialists who performed the treatment, and of 3 independent dermatologists with the Likert scale.ResultsMean hydration levels of scars went from 41.8 to 53.3, with mean hydration levels of healthy reference points equal to 54.6. The minimum patient satisfaction level was 2 in the VAS. The minimum level of satisfaction of specialists and dermatologists was equal to IV on the Likert scale for all patients, except for 1 subject in which it was III for the specialist who had treated him. Anti-aging and re-pigmentation effects were also noted as secondary results.ConclusionsFrom an aesthetic and functional point of view, and for the overall anti-aging effect of the treated area, V-EMF applied to facial scars has shown extremely promising results.     

耳甲电针治疗功能性消化不良的临床效果

目的:观察耳甲电针治疗功能性消化不良的疗效。方法:选取2018年6月至2019年5月北京同仁医院收治的功能性消化不良患者90例作为研究对象,按照随机数字表法分为对照组和观察组,每组45例,对照组采用对照刺激,观察组采用耳甲电针刺激,所有患者治疗前后均使用功能性消化不良主要症状评分表、功能性消化不良生命质量量表(FDDQL)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)评估患者症状的严重程度,并参照功能性消化不良中医诊疗专家共识意见和功能性消化不良中西医结合诊疗共识意见的疗效评估方法,对比分析观察组与对照组治疗功能性消化不良的疗效。结果:观察组和对照组治疗前主要症状评分表、功能性消化不良生命质量量表(FDDQL)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)差异无统计学意义(P>0.05),治疗后观察组症状及量表评分与对照组差异有统计学意义(P<0.05)。观察组治疗有效率82.22%,对照组治疗有效率57.78%,差异有统计学意义(P<0.05)。结论:耳甲电针对于功能性消化不良的各项症状具有较好的疗效。     

伞骨草利尿抗炎活性及急性毒性研究＊

目的 研究伞骨草水提物的利尿和抗炎作用，以及利尿后对电解质平衡、糖代谢及肾脏功能的影响，并对伞骨草水提物安全性进行初步评价。方法 采用小鼠代谢笼法，检测盐水负荷小鼠在给药6 h后的排尿量，并分析小鼠尿液中离子浓度、血清中糖原、尿素氮和肌酐的变化；采用二甲苯致小鼠耳廓肿胀法，计算耳廓肿胀度及肿胀抑制率，角叉菜胶致大鼠足趾肿胀法，计算足趾肿胀率，小鼠急性毒性试验初步评价伞骨草水提物的安全性。结果 与对照组比较，伞骨草水提物能明显增加小鼠的排尿量，尿液中K⁺、Cl^-的浓度明显增加，高剂量组Na⁺、Ca²⁺浓度明显增加；伞骨草对小鼠血清中的糖原、尿素氮和肌酐均无明显影响；伞骨草中、高剂量对二甲苯所致小鼠耳廓肿胀和角叉菜胶所致大鼠足趾肿胀具有明显的抑制作用；伞骨草水提物24 h内小鼠单次灌胃给药急性毒性试验的LD₅₀为：12.33 g·kg^-1（相当于生药82.15 g·kg^-1），动物在4 h内出现毒性反应，主要表现为主要表现为腹泻、俯卧、竖毛、运动失调、死亡，腹泻至给药第2天恢复。结论 伞骨草水提物具有明显的利尿和抗炎作用，并且对机体的血糖水平和肾脏功能无明显影响。     

超脉冲CO2点阵激光联合PRP治疗面部痤疮凹陷性瘢痕疗效分析

目的:探究超脉冲CO2点阵激光联合富血小板血浆(PRP)治疗面部痤疮凹陷性瘢痕的疗效。方法:72例面部痤疮凹陷性瘢痕患者,随机分为观察组(36例)和对照组(36例)。对照组采用超脉冲CO2点阵激光治疗,观察组采用超脉冲CO2点阵激光联合PRP治疗。比较两组患者的灰度差异、时间指标、瘢痕程度、疼痛、不良反应及视觉评估。结果:观察组的并发症发生率为11.11%,低于对照组的36.11%,差异具有统计学意义(P<0.05)。治疗后,两组患者的灰度差异率均减小,且观察组患者的灰度差异率显著低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的炎性渗出时间、红肿时间、愈合时间、停工时间及瘢痕程度评分均低于对照组,差异均具有统计学意义(P<0.05);但疼痛度评分组间比较,差异无统计学意义(P>0.05)。结论:超脉冲CO2点阵激光联合PRP治疗面部痤疮凹陷性瘢痕效果较好,可有效降低瘢痕程度,减少治疗时间及并发症的发生,帮助患者迅速回归正常工作与生活,值得临床推广使用。     

英国价值定价理念对我国医保药品报销政策的启示

本文在梳理英国医保药品报销政策的基础上,通过对价值定价理念的深入研究和理解,系统探讨其在报销政策制定过程中对药品目录遴选、价值测算、支付标准确定、医保基金平衡和报销效益评估的作用机制,并深入思考通过价值定价理念建立起的药物警戒体系与药品报销政策间的衔接机制。在此基础上总结价值定价理念的特点、应用阶段和具体操作方法,以期为我国提供借鉴。     

Comparison of Gap Balancing vs Measured Resection Technique in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee

BackgroundTotal knee arthroplasty requires careful surgical technique to attain the goal of a well-aligned and symmetrically balanced knee. Soft tissue balance and correct femoral component rotation are paramount in achieving these goals. The two competing techniques to select femoral component rotation and soft tissue balance are the gap balance technique and the measured resection technique.MethodsWe performed a randomized, prospective study to compare the two techniques in patients undergoing simultaneous bilateral total knee arthroplasty, whereby one technique was performed in each knee. Fifty (50) subjects were enrolled into the study. The inclusion criteria were osteoarthritic varus knee deformities with similar deformities in both knees. Subjects were followed up for a minimum of two years.ResultsThe knees balanced via the gap balance technique had significantly more posterior medial bone removed from the femur than those knees balanced via the measured resection technique (P < .001). Knees in the gap balance group tended to require more medial knee releases in extension and tended to have smaller sized femoral components as a result of cutting more bone from the femur in flexion. The modular tibial polyethylene bearing tended to be thicker in the gap balance group. Despite these differences, average knee flexion and functional revised Oxford Knee Scores at 2-year follow-up were not statistically different.ConclusionAt 2-year follow-up, there were no differences between the function and scores using the two techniques. Long-term follow-up will be necessary to evaluate any differences in long-term durability.     

冠心病稳定型心绞痛痰瘀互结证中医证候量表评价研究

[目的]探索冠心病稳定型心绞痛痰瘀互结证患者、气阴两虚证患者与健康人中医证候评价量表异同。[方法]通过多中心、小样本、精细化临床研究,纳入7家临床单位124例受试者,因未完成访视脱失7例,最终纳入受试者117例,其中冠心病痰瘀互结证患者38例,在西医常规治疗的基础上加服丹蒌片治疗,气阴两虚证患者39例,在西医常规治疗的基础上加服通脉养心丸治疗,健康人40例不予干预。比较冠心病患者0、4、8、12周、健康人第0周《冠心病痰瘀互结证中医证候评价量表》评分情况。[结果] 1)冠心病痰瘀互结证患者第4、8、12周时,各症状评分及舌下脉络青紫情况较0周不同程度降低(P0.05或P0.01)。2)冠心病气阴两虚证患者第4、8、12周时,各症状评分较0周有所下降(P0.05或P0.01)。3)与健康人比较,冠心病痰瘀互结证患者各项评分具有统计学差异(P0.01),冠心病气阴两虚证患者各症状评分及舌质紫暗、舌下脉络青紫、脉弦、脉涩情况具有统计学差异(P0.05或P0.01),冠心病两组患者各时点比较,部分指标及舌脉情况存在不同程度差异。4)冠心病痰瘀互结证患者0、8周时,身重、口黏腻、苔腻、脉滑、舌有瘀斑瘀点聚为一类,脉弦、舌质紫暗、舌下脉络青紫、脉涩、口唇青紫、面色晦暗聚为一类;冠心病气阴两虚证患者0、8周时,胸闷、胸痛、身重、口黏腻、口唇青紫、面色晦暗聚为一类,舌有瘀斑瘀点、舌质紫暗、脉涩聚为一类。[结论]冠心病稳定型心绞痛痰瘀互结证与气阴两虚证患者经治疗后,《冠心病痰瘀互结证中医证候评价量表》中相关症状表现均有所改善,且不同证型的表现不同。《冠心病痰瘀互结证中医证候评价量表》可以为进一步临床诊断冠心病稳定型心绞痛痰瘀互结证提供一定参考。     

肌内效贴技术结合针刀治疗卒中后肩痛的临床研究及安全性分析

目的:评定运用肌内效贴技术结合针刀治疗卒中后肩痛的临床疗效及安全性。方法:选取2018年1月~2019年9月东莞市滨海湾中心医院中医康复科和神经内科的脑卒中后肩痛患者120例,随机分为治疗组和对照组各60例。对照组运用常规康复治疗训练,治疗组在此基础上配合运用肌内效贴技术及针刀治疗。分别记录两组患者在治疗前、治疗2周后及治疗4周后的肩痛VAS评分、上肢简化Fugl-Meyer运动功能评分及Constant-murley评分,并分析其疗效。结果:治疗2周、4周后,两组患者的VAS评分、FAM评分、CMS评分均较治疗前显著改善(P<0.05),且治疗组组治疗后的各评分显著优于对照组(P<0.05)。结论:运用肌内效贴结合针刀治疗卒中后肩痛临床疗效满意,安全性高。