Predictive capacity, comparison and clinic consequences of the Framingham-Wilson and REGICOR tables in persons for whom care has been provided at a health care center, Badajoz, Spain

BACKGROUND: Framingham's original equation modified by Wilson and the REGICOR calibration are widely recommended in coronary risk stratification. This study is aimed at: (1) Analyzing the ten-year predictiveness of the Framingham-Wilson and REGICOR tables among a population for which care has been provided at an urban health care center (2) Evaluating the concordance use of hypolipemiant and antihypertensive drugs resulting from these tables. METHODS: Observational, longitudinal, retrospective study of a cohort of patients for whom care was provided at a primary care center. A total of 1011 patients ages 35-74 (mean age 55.7, 56.0% females) without any evidence of cardiovascular disease. Those patients having a > or =20% risk in Wilson and > or =10% in REGICOR were considered high-risk. RESULTS: The actual coronary risk of the population was 10.7%, whilst the mean coronary risk estimated with the functions was 17.0% in Wilson and 6.6% in REGICOR. A total 29.6% was classified high-risk in Wilson as compared to the 18.2% in RECIGOR (p < 0.05). The percentage of high-risk males was significantly higher in Wilson than in REGICOR (49.0% vs. 29.4%, p < 0.01). The Kappa index was 0.70 (95 CI: 0.67, 0.73). A total of 39.5% of the patients (as per Wilson) and 31.4% (as per REGICOR) were candidates for taking hypolipemiant drugs (p < 0.001). The validity criteria of both of these functions are quite discreet: sensitivity, specificity and odds ratio diagnosed at 50.9%, 73.1% and 2.11 in Wilson and 28.7%, 83.1% and 1.98 in REGICOR, respectively. CONCLUSIONS: The Wilson and REGICOR tables show an acceptable degree of concordance, but their validity parameters are discreet. The Framingham-Wilson function screens a higher percentage of patients as being candidates for hypolipemiant drugs.     

同种异体骨髓基质细胞修复大鼠股骨缺损

目的：评估腺病毒介导的转BMP-2基因的同种异体骨髓基质干细胞的成骨潜能和免疫原性，探索骨缺损修复新途径。方法：将编码骨髓基质干细胞的基因，通过腺病毒介导转染同种异体骨髓基质干细胞后复合藻酸钙凝胶植入骨缺损部位并应用免疫抑制剂FK506。结果：术后8周检查，Adv—hBMP-2转染的同系骨髓基质干细胞-藻酸钙复合体组、Adv—hBMP-2转染的同种异体骨髓基质干细胞-藻酸钙-FK506复合体组以板层骨为主；Adv—hBMP-2转染的同种异体骨髓基质干细胞-藻酸钙复合体组以编织骨和类骨质为主，内有炎症细胞浸润；Adv-βgal转染的同系骨髓基质干细胞一藻酸钙复合体组、Adv-βgal转染的同种异体骨髓基质干细胞-藻酸钙-FK506复合体组、Adv-βgal转染的同种异体骨髓基质干细胞一藻酸钙复合体组无明显新骨形成．缺损区内为纤维结缔组织。结论：Adv—hBMP-2转染同种异体骨髓基质干细胞-藻酸钙一-FK506复合体可促进长骨干节段性骨缺损的修复。     

应用平衡功能检测训练系统改善脑卒中患者平衡功能的疗效观察

目的 观察应用PH—A型平衡功能检测训练系统对脑卒中偏瘫患者进行平衡功能训练的疗效。方法 将108例脑卒中偏瘫患者分为治疗组（68例）和对照组（40例）。对照组给予常规药物治疗和物理因子治疗，治疗组在常规治疗的基础上同时应用PH—A型平衡功能检测训练系统对患者进行平衡功能训练，2组患者在治疗前、后分别应用该系统检测和Berg平衡功能评定表（BBS）进行评定。平衡检测分别在坐位、双足站立位（睁眼和闭眼状态下）进行，取摆幅指数、重心分布区域、摆动的轨迹长、外周面积4个指标进行分析。结果 2组患者治疗后BBS评定和平衡检测均有明显改善，其中治疗组的坐位分布区域好转，但无统计学意义（P〉0．05），BBS评定和平衡检测站立位各指标均有显著好转（P〈0．001）；治疗后2组比较差异有统计学意义（P（0、05～P〈0、01），治疗组临床疗效明显优于对照组。结论 运用PH—A型平衡功能检测训练系统对偏瘫患者进行平衡功能训练，可以显著提高患者的站立平衡功能。     

不同吸痰方式对急性呼吸窘迫综合征血流动力学影响的实验研究

目的研究更适宜急性呼吸窘迫综合征(ARDS)机械通气气管内吸痰的方式。方法采用静脉注射油酸制备动物ARDS模型;每只犬随机选择使用开放式气管内吸痰(OS)和密闭式气管内吸痰(CS)2种吸痰方式。于吸痰前后记录血流动力学等监测指标的数据。结果OS和CS后,犬平均肺动脉压(MPAP)与吸痰前比较均明显升高(P<0.05);OS后平均动脉压(MAP)显著升高(P<0.05)。结论OS、CS均可影响血流动力学的稳定。本研究提示,在护理工作中,对ARDS机械通气者应重视吸痰引起的继发性损害,加强吸痰前后血流动力学等监测。     

High-dose therapy and peripheral blood progenitor cell transplantation: effects of recombinant human granulocyte-macrophage colony-stimulating factor on the autograft

Between June 1989 and June 1992, 144 patients participated in sequential clinical trials using peripheral blood progenitor cells (PBC) as their sole source of hematopoietic rescue following high-dose chemotherapy. All patients had received prior extensive combination chemotherapy and had marrow defects that precluded autologous bone marrow transplantation (ABMT). PBC were collected according to a single apheresis protocol. The initial 86 patients (group 1) had PBC collected without mobilization. Beginning in April 1991, PBC were mobilized solely with recombinant human granulocyte-macrophage colony-stimulating factor (rHuGM-CSF). Thirty-four patients (group 2) received rHuGM-CSF at a dose of 125 micrograms/m2/d by continuous intravenous infusion, and 24 patients (group 3) received rHuGM-CSF at a dose of 250 micrograms/m2/d by continuous intravenous infusion. Patients underwent at least six aphereses and had a minimum of 6.5 x 10(8) mononuclear cells (MNC)/kg collected. Cytokines were not routinely administered immediately after transplantation. A median of nine aphereses were required to collect PBC in group 1 and seven aphereses for groups 2 and 3 (P = .03). The time required to recover 0.5 x 10(9)/L granulocytes after transplant was significantly shorter (P = .0004) for the mobilized groups; the median time to recovery was 26 days for group 1, 23 days for group 2, and 18 days for group 3. Transplantation of PBC mobilized with rHuGM-CSF resulted in a shorter time to platelet (P = .04) and red blood cell (P = .01) transfusion independence. Mobilization with rHuGM-CSF alone resulted in efficient collection of PBC, that provided rapid and sustained restoration of hematopoietic function following high-dose chemotherapy. Mobilization of PBC with rHuGM-CSF alone is an effective method for patients who have received prior chemotherapy and have bone marrow abnormalities.     

Improved Measurement of Elastic Properties of Cells by Micropipette Aspiration and Its Application to Lymphocytes

Mechanical deformability of cells is an important property for their function and development, as well as a useful marker of cell state. The classical technique of micropipette aspiration allows single-cell studies and we provide here a method to measure the two basic mechanical parameters, elastic modulus and Poisson’s ratio. The proposed method, developed from finite-element analysis of micropipette aspiration experiments, may be implemented in future technologies for the automated measurement of mechanical properties of cells, based on the micropipette aspiration technique or on the cell transit through flow constrictions. We applied this method to measure the elastic parameters of lymphocytes, in which the mechanical properties depend on their activation state. Additionally, we discuss in this work the accuracy of previous models to estimate the elastic modulus of cells, in particular the analytical model by Theret et al., widely used in the field. We show the necessity of using an improved model, taking into account the finite size of the cells, to obtain new insights that may remain hidden otherwise.     

呼吸频率检测技术研究现状

在机体代谢中,呼吸是至关重要的。定期监测呼吸情况,能尽早发现并预防呼吸系统以及心脑血管等方面的病变。目前,呼吸检测技术主要分为接触式和非接触式两大类。这两种检测技术各有优缺点,其中接触式检测方法能简单并快捷地测量数据,而非接触式检测方法则是利用某些技术手段通过无创测量获取人体的数据。本文对呼吸检测技术的研究现状进行了阐述,并结合各个新技术的现有产品,分析了呼吸检测技术的适用范围及未来的研究方向。     

Increasing incidence of HIV‐ associated tuberculosis in Romanian injecting drug users

Background

A high prevalence of tuberculosis (TB) among HIV‐positive injecting drug users (IDUs) may fuel the TB epidemic in the general population of Romania. We determined the frequency and characteristics of TB in HIV‐infected IDUs referred to a national centre.

Methods

Prospective observational cohort study of all newly‐diagnosed HIV‐positive IDUs admitted to Victor Babes Hospital, Bucharest, between January 2009 and December 2014. Socio‐demographics, clinical characteristics and outcomes of HIV/TB co‐infected IDUs were compared to HIV‐positive IDUs without TB.

Results

170/598 (28.5%) HIV‐infected IDUs were diagnosed with TB. The prevalence increased from 12.5% in 2009 to 32.1% in 2014 (P < 0.001). HIV/TB co‐infected individuals had lower median CD4 cell counts 75 (vs. 450/mm³, P < 0.0001) and higher median HIV viral loads 5.6 log₁₀ (vs. 4.9 log₁₀, P < 0.0001) when presenting to healthcare services. 103/170 (60.6%) HIV/TB co‐infected IDUs were diagnosed with pulmonary TB. Resistant Mycobacterium tuberculosis strains were common, with 18/105 (17.1%) of patients having Multi‐Drug Resistant (MDR) disease. Higher mortality rate was associated with TB co‐infection (P < 0.0001), extra‐pulmonary TB (P = 0.0026) and extensively drug resistant TB (P = 0.024).

Conclusions

Tuberculosis (TB) is an increasing problem in HIV‐infected IDUs in Romania. Presentation is often with advanced HIV, significant TB drug resistance and consequent outcomes are poor.

     

腹膜透析结合血液透析治疗终末期肾脏病3例长期疗效并文献复习

目的探讨腹膜透析结合血液透析(Combined therapy with Peritoneal Dialysis and Hemodialysis,PHD)治疗终末期肾病(End stage renal disease ESRD)患者的长期临床疗效。方法对3例长期行PHD治疗的患者临床资料进行分析并复习相关文献。结果 3例患者经过PHD治疗后临床症状改善。例1周尿素清除指数[Kt/(V?W)]1.46增至1.90,周肌酐清除率(Weekly creatinine clearance WCC)36.52增至60.72L/1.73m2,血浆白蛋白、血红蛋白升高,左室肥厚(Left ventricle hypertrophy LVH)改善。例2[Kt/(V?W)]1.43增至1.81,WCC 35.34增至55.79 L/1.73m2,血浆白蛋白、血红蛋白升高。例3[Kt/(V?W)]1.55增至1.82,WCC 46.0增至56.53 L/1.73m2,血浆白蛋白、血红蛋白升高,LVH改善。结论 PHD能有效改善ESRD患者临床症状,提高透析充分性,可作为补充的肾脏替代治疗模式在临床应用。