Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis

Background  

The aim of this meta-analysis was to determine if severity assessment tools can be used to guide decisions regarding intensive care unit (ICU) admission of patients with community-acquired pneumonia.     

Is influenza A(H1N1) pneumonia more severe than other community-acquired pneumonias? Results of the GiViTI survey of 155 Italian ICUs

Purpose  

Uncertainty about the severity of the A(H1N1) pandemia persists. Information about disease severity can be obtained by investigating intensive care unit (ICU) admissions, especially when historical comparisons can be made with cases of community-acquired pneumonia (CAP).     

Electronic colon-cleansing for CT colonography: diagnostic performance

Background  The purpose of this study was to evaluate whether an electronic-colonic-cleansing (ECC) algorithm is beneficial for the diagnostic performance compared to a CT colonography (CTC) evaluation without electronic cleansing in tagged datasets. Methods  Two blinded readers evaluated CTC datasets from 79 patients with 153 colorectal polyps confirmed by optical colonoscopy. Cases were read in a randomized order with and without the use of electronic colon-cleansing software. Per-polyp sensitivity, per-polyp/per-patient specificity and reading times (with and without ECC) have been calculated and reported. Results  Per-polyp sensitivity for polyps >6 mm without using ECC was 60.4% (Reader 1: 59.7%, Reader 2: 61.1%), while polyps >10 mm were detected with a sensitivity of 58.3% (Reader 1: 66.7%, Reader 2: 50%). On electronically cleansed datasets, the sensitivity was 73.6% (Reader 1: 76.4%; Reader 2: 70.8%) for polyps >6 mm and 83.3% (Reader 1: 83.3%; Reader 2: 83.3%), respectively. Per-patient specificity was 75% without using cleansing (Reader 1: 68%, Reader 2: 82%) and 81.5% using ECC (Reader 1: 86%, Reader 2: 77%). Conclusion  Reading CTC cases using ECC software improves sensitivity in detecting clinically relevant colorectal polyps.     

大豆蛋白对肾脏疾病的影响

从大豆蛋白的生物化学特性、动物实验研究、临床研究方面,综述了大豆蛋白对肾脏疾病的影响,简述了大豆蛋白对肾脏保护作用的机制.     

应用八髎穴药物注射并膀胱功能训练改善脊髓损伤膀胱功能障碍的效果

目的:脊髓损伤膀胱功能障碍患者采用八穴药物注射配合膀胱功能训练与单纯膀胱功能训练进行疗效对比观察。方法:选择2001-10/2004-03在广州工伤康复医院住院的脊髓损伤膀胱功能障碍患者24例,随机分为两组,治疗组12例,对照组12例。治疗组采用膀胱功能训练配合八穴药物注射疗法。①八穴药物注射:将维生素B1200mg+维生素B12500μg+生理盐水3～5mL,注入上穴,次穴,中穴,下穴,每穴位注入2～2.5mL,1次/d,两侧穴位每天交替注射,10d为1个疗程,平均治疗2～4个疗程,每疗程间隔3～5d。②膀胱功能训练的方法:限制饮水量,24h总入水量控制在2500mL左右;依据残余尿量多少进行间歇导尿。③对照组仅行上述膀胱功能训练方法。④膀胱功能评定以自主性排尿节律,勿需导尿管排尿,残余尿量<100mL为显效;导尿次数减少,残余尿量100～150mL为有效;无明显改善为无效。结果:按意向处理分析,24例患者均进入结果分析。治疗组显效5例,有效5例,无效2例。对照组显效2例,有效2例,无效8例。治疗组总有效率显著高于对照组犤83%(10/12),33%(4/10),χ2=4.29,P<0.05犦。结论:采用八穴药物注射配合膀胱功能训练治疗脊髓损伤膀胱功能障碍患者,比单纯的膀胱功能训练方法疗效显著。说明八穴药物注射后,发挥了穴位和药物的综合治疗作用,能有效的改善脊髓损伤后的膀胱功能。     

Migraine genetics: An update

A growing interest in genetic research in migraine has resulted in the identification of several chromosomal regions that are involved in migraine. However, the identification of mutations in the genes for familial hemiplegic migraine (FHM) forms the only true molecular genetic knowledge of migraine thus far. The increased number of mutations in the FHM1 (CACNA1A) and the FHM2 (ATP1A2) genes allow studying the relationship between genetic findings in both genes and the clinical features in patients. A wide spectrum of symptoms is seen in patients. Additional cerebellar ataxia and (childhood) epilepsy can occur in FHM1 and FHM2. Functional studies show a dysfunction in ion transport as the key factor in the pathophysiology of (familial hemiplegic) migraine that predict an increased susceptibility to cortical spreading depression—the underlying mechanism of migraine aura.     

Post-triptan era for the treatment of acute migraine

There now is one realized and several attractive targets for the treatment of acute attacks of migraine that will follow and augment the use of serotonin 5-HT1B/1D receptor agonists, the triptans. Calcitonin gene-related peptide (CGRP) receptor blockade recently has been shown to be an effective acute antimigraine strategy; therefore, blockade of CGRP release by inhibition of trigeminal nerves would seem a logical approach. A number of targets are reviewed in this article including serotonin 5-HT1F and 5-HT1D receptors, adenosine A1 receptors, nociceptin, vanilloid TRPV1 receptors, and anandamide CB1 receptors. Development of one or more such compound offers the exciting prospect of new non-vasoconstrictor treatments for migraine and cluster headache.     

Relationship between Vitamin D Levels and Bone Tissue in Adolescents with and without Down Syndrome

Vitamin D (vitD) deficiency is a worldwide problem. Therefore, the main aims of this study were to compare 25-hydroxivitamin D levels (25(OH)D) in adolescents with and without Down syndrome (DS) and to study the relationship between 25(OH)D and bone. Eleven adolescents with DS (6 females) aged 15.5 ± 2.8 years and sixteen healthy controls (non-DS) (6 females) aged 14.3 ± 2.2 years were evaluated by bone imaging techniques. Blood samples were collected to determine vitD levels. Independent t-tests and analyses of covariance controlling for age, height, sex, sexual maturation, calcium intake and body mass index were performed to evaluate differences in 25(OH)D levels between groups. Pearson’s correlation test and multiple linear regression analyses were performed to examine the association between 25(OH)D and bone mass. Adolescents with DS had lower 25(OH)D (22.8 ± 8.0 vs. 36.0 ± 6.5 ng/ml) than non-DS (d = 1.81; p < 0.05). Only 18% of participants with DS reached the recommended level of 30 ng/ml of 25(OH)D. No significant group interactions were found for any bone variable (all p > 0.05) but linear regression analyses suggested that 25(OH)D influenced positively femoral neck bone mineral density (β = 0.477, p = 0.038) and content at the 4% of the length of the tibia (β = 0.453, p = 0.008) in the non-DS and cortical volumetric bone mineral density at the 38% (β = 0.841, p = 0.034) in the DS. Adolescents with DS had lower levels of 25(OH)D and higher prevalence of vitD deficiency compared with non-DS. Associations between 25(OH)D and bone parameters were not observed for adolescents with DS but medium and positive correlations were observed in the non-DS group.     

Planning of mandibular reconstructions based on statistical shape models

Purpose

The reconstruction of large continuity defects of the mandible is a challenging task, especially when the shape of the missing part is not known prior to operation. Today, the surgical planning is based mainly on visual judgment and the individual skills and experience of the surgeons. The objective of the current study was to develop a computer-based method that is capable of proposing a reconstruction shape from a known residual mandible part.

Methods

The volumetric data derived from 60 CT scans of mandibles were used as the basis for the novel numerical procedure. To find a standardized representation of the mandible shapes, a mesh was elaborated that follows the course of anatomical structures with a specially developed topology of quadrilaterals. These standard meshes were transformed with defined mesh modifications toward each individual mandible surface to allow for further statistical evaluations. The data were used to capture the inter-individual shape variations that were considered as random field variations and mathematically evaluated with principal component analysis. With this information of the mandibular shape variations, an algorithm was developed that proposes shapes for reconstruction planning based on given residual mandible geometry parts.

Results

The accuracy of the novel method was evaluated on six different virtually defined continuity defects that were each created on three mandibles that were not part of the initial database. Virtual reconstructions showed sufficient accuracy of the algorithm for the planning of surgical reconstructions, with average deviations toward the actual geometry of \(1.82 \pm 0.11\) mm for small missing parts and 5 mm for large hemi-lateral defects.

Conclusions

The presented algorithm may be a valuable tool for the planning of mandibular reconstructions. The proposed shapes can be used as templates for computer-aided manufacturing, e.g., with 3D printing devices that use biocompatible materials.