扩髓及髓腔内固定导致肺骨髓脂肪栓塞的大鼠模型

目的：建立以单纯扩髓及髓腔内固定导致肺骨髓脂肪栓塞的大鼠模型。方法：将20只大鼠随机分为实验组和对照组，各组10只。实验组除行双侧完整股骨转子窝处闭合扩髓及髓腔内固定外，均同对照组。两组术后均观察110min，处死大鼠并检查肺脏组织病理改变。按栓塞的肺小动脉及毛细血管数分为Ⅰ－Ⅳ级，结果：实验组行单纯扩髓及髓腔内固定后，全部大鼠的肺小动脉及毛细血管可见扩张，管腔内充满骨髓干细胞及脂肪球，呈现骨髓脂肪栓塞改变；栓塞的等级为Ⅰ级1只，Ⅱ级3只，Ⅲ级4只，Ⅳ级2只。对照组未见肺骨髓脂肪栓塞。结论：单纯扩髓及髓腔骨固定大鼠骨髓脂肪栓塞模型简便易行，经济实用，适于临床研究。     

Dietary fat plays a major role in obesity: no

The percentage of dietary energy from fat has been suggested to be an important determinant of body fat, and this presumed effect has been invoked to justify the general promotion of low‐fat diets. Dietary fat and the prevalence of obesity are lower in poor countries than in affluent countries. However, these contrasts are seriously confounded by differences in physical activity and food availability; within areas of similar economic development, per capita intake of fat and the prevalence of obesity have not been positively correlated. Randomized trials are the preferable method for evaluating the effect of dietary fat on adiposity because they avoid problems of confounding that are difficult to control in other studies. In short‐term trials, a small reduction in body weight is typically seen in individuals randomized to diets with a lower percentage of calories from fat. In a meta‐analysis of these trials, it was estimated that a decrease in 10% of energy from fat would reduce weight by 16 g d^–1, which would correspond to a 9‐kg weight loss by 18 months. However, compensatory mechanisms appear to operate because in trials lasting one year or longer, fat consumption within the range of 18–40% of energy has consistently had little, if any, effect on body fatness. Moreover, within the United States (US), a substantial decline in the percentage of energy from fat during the last two decades has corresponded with a massive increase in obesity, and similar trends are occurring in other affluent countries. Diets high in fat do not account for the high prevalence of excess body fat in Western countries; reductions in the percentage of energy from fat will have no important benefits and could further exacerbate this problem. The emphasis on total fat reduction has been a serious distraction in efforts to control obesity and improve health in general.     

Unusual finding in a water-logged corpse —hyperchylomicronemia or pulmonary fat embolism?

Summary During excavation work at the bank of the River Inn the corpse of a 32-year-old alcoholic male was recovered. Head injuries suggested a crime of violence. Postmortem examination demonstrated conspicuous milky turbidity of the blood, which was found by laboratory testing to be due to hyperchylomicronemia. The findings are interpreted and their relevance to the determination of postmortal head injuries is discussed. The inadequacy of double-edged knife specimens and frozen-section biopsies for the estimation of pulmonary fat embolism as a vital reaction is considered.     

Factors influencing compliance with dietary advice: the Diet And Reinfarction Trial (DART)

Factors influencing compliance with dietary advice were investigated in the Diet and Reinfarcation Trial (DART). In terms of achieved intakes, smokers had a lower mean P/S ratio and fibre intake than non-smokers; manual workers had a lower mean fibre intake than non-manual workers; and obese men had a higher percentage of energy from fat and lower P/S ratio than non-obese men. However the effect of the advice (difference in intakes of those advised and thosen not advised) was similar in smokers and non-smokers and was similar in all social classes. The effect of fat advice was less among obese men than among non-obese men, probably as a result of weight-reducing advice given to all overweight men. Fat advice tended to have a greater effect among those who gave up smoking after their heart attack than among non-smokers and those who continued to smoke but the difference was not statistically significant. This suggests that advice on diet and smoking can be given simultaneously and still be effective.     

Magnetic resonance imaging of cerebral fat embolism

Summary The cerebral fat embolism is a potentially serious complication of fractures but clinical cases often go undiagnosed. Two cases of clinically diagnosed cerebral fat embolism are reported, and MR images of these patients are described. While brain CT revealed no abnormality, MR imaging showed relative low-intensity areas on T1-weighted images and high-intensity areas on T2-weighted images. In one patient follow-up MR showed nearly complete resolution of the abnormal signal. MR imaging appears to be valuable for detecting the lesions in these patients.     

初诊T2DM短期胰岛素强化治疗40例分析

目的观察初诊T2DM短期胰岛素强化治疗的疗效。方法对40例初诊T2DM患者采用三餐前皮下注射短效胰岛素和睡前注射中效胰岛素2wk，并检测治疗2wk前后FPG、PPG、GHbA1C及血脂等值进行比较。结果两组治疗后FPG、PPG、GHbA1C及血脂各值均显著低于治疗前p〈0．05（x^2=4．940—11．544）。结论胰岛13细胞功能异常和（或）胰岛素抵抗是T2DM发病的基本环节，早期强化胰岛素治疗能获得血糖的有效控制，减少或延缓并发症的发生。     

Alternating repetition time balanced steady state free precession.

A novel balanced SSFP technique for the separation or suppression of different resonance frequencies (e.g., fat suppression) is presented. The method is based on applying two alternating and different repetition times, TR(1) and TR(2). This RF scheme manipulates the sensitivity of balanced SSFP to off-resonance effects by a modification of the frequency response profile. Starting from a general approach, an optimally broadened stopband within the frequency response function is designed. This is achieved with a TR(2) being one third of TR(1) and an RF-pulse phase increment of 90 degrees . With this approach TR(2) is too short ( approximately 1 ms) to switch imaging gradients and is only used to change the frequency sensitivity. Without a significant change of the spectral position of the stopband, TR(1) can be varied over a range of values ( approximately 2.5-4.5 ms) while TR(2) and phase cycling is kept constant. On-resonance spins show a magnetization behavior similar to balanced SSFP, but with maximal magnetization at flip angles about 10 degrees lower than in balanced SSFP. The total scan time is increased by about 30% compared to conventional balanced SSFP. The new technique was applied on phantoms and volunteers to produce rapid, fat suppressed images.     

膝关节骨性关节炎合并髌下脂肪垫劳损的B超诊断与治疗

膝关节骨性关节炎是一种常见病，是引起膝关节痛的主要原因之一。膝关节骨性关节炎与髌下脂肪垫劳损的研究甚少，我们从1995—2003年对106例膝关节骨性关节炎患者进行了髌下脂肪垫B超检查，同时与150例正常膝关节进行了对比。并对确诊为膝关节髌下脂肪垫劳损患者采用透明质酸钠关节腔注射，效果优良，现报告如下。     

Acute Oxalate Nephropathy Causing Late Renal Transplant Dysfunction Due to Enteric Hyperoxaluria

Calcium oxalate (CaOx) deposition in the renal allograft is an under recognized and important cause of acute tubular injury and early allograft dysfunction.
We present a case of late transplant dysfunction due to acute oxalate nephropathy. The patient presented with diarrhea and deteriorating graft function, and a diagnosis of enteric hyperoxaluria secondary to pancreatic insufficiency was made. This had occurred, as the patient had been noncompliant with his pancreatic enzyme replacement therapy. Treatment to reduce his circulating oxalate load was initiated, including twice-daily hemodialysis, low fat and oxalate diet and appropriate administration of pancreatic enzyme supplements. Graft function subsequently recovered.
The possibility of fat malabsorption leading to enteric hyperoxaluria should be considered in renal graft recipients presenting with loose stools and graft dysfunction.     

Individual and environmental correlates of dietary fat intake in rural communities: A structural equation model analysis

Total dietary fat and saturated fat intake are associated with obesity, elevated cholesterol, and heart disease. This study tested a multi-group structural equation model to explore differences in the relative influence of individual, social, and physical environment factors on dietary fat intake amongst adults aged 40–70 years. Participants from four rural Georgia, U.S., counties (n = 527) completed a cross-sectional survey that included questions about eating patterns and individual and social influences on healthy eating. Observational measures of nutrition environments in stores and restaurants in these counties also were completed. Models for both women and men found significant positive relationships between self-efficacy for healthy eating and perceived nutrition environments and family support for healthy eating. The association between self-efficacy for eating a low-fat diet and frequency of eating out and grocery shopping was negative for both genders. The home nutrition environment was associated with dietary fat intake for women but not men. The results indicate that the influence of individual and environmental factors on dietary fat intake differs for men and women, with the home environment playing a larger role for women in rural communities.