糖尿病患者行肱踝指数测定对糖尿病足相关健康教育依从性增高的报告

目的：了解糖尿病患者行四肢多普勒肱踝指数（ABI）检测后对足部护理知识的掌握和依从性是否提高,从而有效预防糖尿病足的发生.方法：自行设计调查问卷和方法,将140名患者随机分成两组,实验组和对照组各70人,实验组行ABI检测,对照组不进行ABI检测.都对其进行糖尿病足健康教育.进行ABI检测的患者,要同时告知其下肢病变的严重程度.6个月后采用自行设计的糖尿病患者足部情况及相关知识进行问卷调查.结论：通过对140例糖尿病患者的调查分析,其结果显示：患者行ABI检测后对糖尿病足的健康教育知识的依从性比不进行ABI检测的患者要高,在糖尿病教育中要重视用客观资料、检测方法对糖尿病患者进行糖尿病足的预防护理知识教育,增强患者对糖尿病足的认识和对足部的保护意识,同时ABI检测结果对观察糖尿病足的发生、发展有指导性意义.     

IL-2 pathway blocking in combination with anti-CD154 synergistically establishes mixed macrochimerism with limited dose of bone marrow cells and prolongs skin graft survival in mice

To facilitate the establishment of mixed chimerism with limited dose of bone marrow (BM) cells, and to achieve tolerance in skin graft model, combined blocking of costimulatory pathway and IL-2 pathway was used in minimally myeloablative model using busulfan. BM cells (2.5x10(7)) of BALB/c were injected into C57BL/6 mice at day 0 with full thickness skin graft after single dose injection of busulfan (25 mg/kg) on day-1. Recipients were grouped and injected the anti-CD154, CTLA4-Ig, anti-IL-2R at days 0, 2, 4, and 6 according to protocol. Mixed macrochimerism were induced in groups treated with anti-CD154+anti-CTLA4-Ig, anti-CD154+anti-IL-2R, and anti-CD154+anti-CTLA4 Ig+anti-IL-2R. Three groups having chimerism enjoyed prolonged graft survival more than 6 months. Superantigen deletion study revealed deletion of alloreactive T cells in combined blockade treated groups. In graft versus host disease model using CFSE staining, CD4+ T cell and CD8+ T cell proliferation were reduced in groups treated with CTLA4-Ig or anti-IL-2R or both in combination with anti-CD154. However, anti-IL-2R was not so strong as CTLA4-Ig in terms of inhibition of T cell proliferation. In conclusion, IL-2 pathway blocking combined with anti-CD154 can establish macrochimerism with limited dose of BM transplantation and induce specific tolerance to allograft.     

Qualitative score of systemic arteriosclerosis by vascular ultrasonography as a predictor of coronary artery disease in type 2 diabetes

Objective

Patients with type 2 diabetes mellitus (T2DM) are at risk of polyvascular comorbidities and poor prognosis. Non-invasive techniques for early prediction of coronary artery disease (CAD) are desirable to prevent cardiovascular events in these patients. The aim of the present study was to investigate the association between CAD and systemic arteriosclerosis by qualitative vascular ultrasonography.

Methods

The study subjects were 102 consecutive outpatients with T2DM [males/females = 60/42, age: mean ± SD 67 ± 9 (range, 40–85) years] evaluated by vascular ultrasonography for arteriosclerosis in the abdominal aorta, carotid, renal, and common iliac arteries. The total number of detected arteriosclerotic vascular lesions in the four arteries was determined. CAD was diagnosed by two cardiologists using either stress electrocardiography, myocardial scintigraphy, multi-detector row computed tomography or coronary angiography.

Results

Multiple arteriosclerotic vascular lesions (>1) were detected in 64 (63%) patients. The total systemic vascular score was significantly higher in patients with CAD than those without (average score 2.7 versus 1.0, p < 0.0001). None of the CAD patients had a total score of 0. Age- and sex-adjusted multiple logistic regression analysis identified total score of ≥2 as the only predictor of CAD (p < 0.001). The sensitivity, specificity, positive and negative predictive values for total systemic vascular score in the prediction of CAD were 98%, 77%, 83%, and 97%, respectively, which were better than those for carotid mean and maximum intima-media thickness.

Conclusion

Non-invasive qualitative evaluation of systemic arteriosclerosis by the total systemic vascular score is potentially useful for the early prediction of CAD in T2DM patients.     

Investigating air pollution and atherosclerosis in humans: concepts and outlook

Although ambient particulate matter contributes to atherosclerosis in animal models, its role in atherogenesis in humans needs to be established. This article discusses concepts, study design, and choice of health outcomes to efficiently investigate the atherogenic role of ambient air pollution, with an emphasis on early preclinical biomarkers of atherosclerosis that are unaffected by short-term exposure to air pollution (eg, carotid intima-media thickness [CIMT] and functional performance of the vessel). Air pollution studies using these end points are summarized. The CIMT is currently the most frequently used outcome in this field (6 studies). The continuous nature of CIMT, the lack of short-term variation, its relationship to atherosclerotic changes in the artery wall, its predictive value for coronary heart disease, and the noninvasiveness of the assessment make it a useful candidate for cross-sectional and longitudinal studies investigating the role of air pollution in atherogenesis.     

Nonverbal cognitive abilities and auditory performance in children fitted with auditory brainstem implants: preliminary report

Objectives/Hypothesis: Auditory brainstem implants (ABIs) can provide excellent open set speech recognition in adults without auditory tumors. These favorable results prompted us to extend ABI indications to children with profound hearing loss (HL) who are not candidates for a cochlear implant (CI). This article reports on the auditory performance and cognitive development measured in children with ABIs. Study Design: This study quantifies the development of auditory perceptual and nonverbal cognitive abilities of children with profound HL undergoing ABI. From 2000 to 2006, 17 children aged 14 months to 16 years received an ABI for different tumor and nontumor diseases in our department in Verona, and nine children were operated in other countries. Six of the children had been previously fitted elsewhere with a CI with no auditory results. Fourteen children had multiple associated psychomotor handicaps. Methods: The retrosigmoid approach was used in all children. Intraoperative and postoperative electrically evoked auditory brainstem responses were performed in all children. Perceptual auditory abilities were evaluated with the Evaluation of Auditory Responses to Speech battery and the Category of Auditory Performance test. Cognitive evaluation was performed on 10 children using the Leiter International Performance Scale—Revised test. Results: All children consistently use their devices for 8 h/d at average and have environmental sound awareness and utterance of words and simple sentences. Their category of auditory performance test scores increased significantly with ABI use. Scores on two of the four subtests considered for cognitive evaluation in this study increased significantly (P < .05) during the first year of ABI use. Postimplant cognitive outcomes were positively related to the auditory results. Conclusions: The present investigation clearly indicates that children who are not candidates for CI fitted with ABI obtain significant development of their hearing ability and a significant improvement in some cognitive parameters. The outcomes of the present study suggest that children with cochlear or cochlear nerve abnormalities with associated cognitive deficits should not be excluded from ABI implantation.     

动脉硬化早期检测患者临床资料分析

目的探讨臂踝脉搏波传导速度(baPWV)和踝臂血压指数(ABI)作为冠心病(CHD)、颈动脉粥样硬化斑块(CAS)等心血管疾病预测的临床价值。方法应用科林BP-203RPEⅡ(VP-1000)全自动动脉硬化检测仪,对1500例健康体检者及心血管科患者进行baPWV和ABI测量,其中150例疑为冠心病者行冠状动脉造影检查,154例行颈动脉超声多普勒检测颈动脉粥样硬化斑块情况。结果(1)baPWV在评估冠心病中的价值:冠状动脉造影阳性组与冠脉造影阴性组比较,baPWV>1700cm/s,敏感性83.33%,准确性84.00%,Kappa值0.61。(2)随着baPWV的升高,颈动脉粥样硬化斑块的OR值增加。结论baPWV>1700cm/s可能是冠心病、颈动脉粥样硬化斑块发生的独立预测因子。     

银杏达莫注射液对脑梗塞患者踝臂指数影响的临床观察

目的观察银杏达莫注射液对急性脑梗塞患者踝臂指数的影响。方法将40例脑梗塞患者随机分为两组(各20例),在常规治疗的基础上分别加用银杏达莫注射液(治疗组)和丹参注射液(对照组),疗程均为14d。治疗前后分别测量踝臂指数、血液流变学,以及神经功能评定。结果两组均能改善患者踝臂指数和血液流变学水平,治疗组疗效更为显著,(P<0.05);治疗组总有效率为85%,对照组则为55%(P<0.05)。结论银杏达莫注射液能提高患者踝臂指数水平。