全髋关节置换术中钴-铬股骨头不同磨损部位的摩擦学特性

 通过使用原子力显微镜检查(atomic force microscopy,AFM)计算表面粗糙度和摩擦系数的方法,对工程和生物材料的摩擦学特性进行研究。尽管之前的大量研究对全髋关节置换术中不同承重材料的摩擦系数进行了报告,但却没有关于全髋关节置换术术中轴承材料的表面粗糙度和摩擦系数的关系的报道。此外,钴-铬股骨头不同磨损部位的摩擦学特性尚不明确。因此,本研究对全髋关节置换术后 10年钴-铬股骨头发生严重磨损及轻微磨损部位的表面粗糙度、摩擦系数和硬度之间的关系进行研究。钴-铬股骨头的平均维氏硬度为(380.7±11.3) HV。在 AFM扫描的 25滋m伊25滋m面积内,严重磨损和轻微磨损部位的摩擦系数分别为 0.229±0.054和 0.243±0.059,两者差异无统计学意义(P=0.449)。严重磨损部位的表面粗糙度[Rq=(96.5±26.2) nm]与轻微磨损部位[Rq=(17.7±4.2) nm]的差异有统计学意义(P <0.0001)。本研究结果显示院钴-铬股骨头的摩擦特性与其表面粗糙度没有明显关系,为金属植入材料表面特性的改善提供了依据。     

Peculiarities of the Continuous Glucose Monitoring Data Stream and Their Impact on Developing Closed-Loop Control Technology

Therapeutic advances in type 1 diabetes (T1DM) are currently focused on developing a closed-loop control system using a continuous glucose monitor (CGM), subcutaneous insulin delivery, and a control algorithm. Because a CGM assesses blood glucose indirectly (and therefore often inaccurately), it limits the effectiveness of the controller. In order to improve the quality of CGM data, a series of analyses are suggested. These analyses evaluate and compensate for CGM errors, assess risks associated with glucose variability, predict glucose fluctuation, and forecast hypo- and hyperglycemia. These analyses are illustrated with data collected using the MiniMed CGMS® (Medtronic, Northridge, CA) and Freestyle Navigator^™ (Abbott Diabetes Care, Alameda, CA). It is important to remember that traditional statistics do not work with CGM data because consecutive CGM readings are highly interdependent.     

Biopsychobehavioral model of risk of severe hypoglycemia. Self-management behaviors

OBJECTIVE: To identify self-management antecedents of low blood glucose (BG) (< 3.9 mmol/l) that might be easily recognized, treated, or avoided altogether. RESEARCH DESIGN AND METHODS: Ninety-three adults with type 1 diabetes (age, 35.8 +/- 8 years [mean +/- SD]; duration of diabetes, 17.0 +/- 11 years; daily insulin dose, 0.58 +/- 0.18 U/kg; and HbAlc, 8.6 +/- 1.8%) were recruited to participate in the study. Of the 93 subjects, 42 had a history of severe hypoglycemia (SH), defined as two or more hypoglycemic episodes in the preceding 12 months, and 51 subjects had no history of SH (No-SH) in the same time period. Before each of 70 BG measurements obtained over a 3-week period, subjects used a handheld computer to record whether their most recent insulin, food, and exercise was more than, less than, or the same as usual. Associations among self-management behaviors preceding BG readings < 3.9 mmol/l versus those preceding BG readings of 5.6-7.8 mmol/l were determined using chi 2 tests, analyses of variance, and logistic regression analyses. RESULTS: Analysis of 6,425 self-management/self-monitoring of BG events revealed that the usual amounts of insulin, food, and exercise preceded the events 58.3% of the time. No significant differences were observed for changes in insulin before readings of BG < 3.9 mmol/l versus 7.8 < BG > 5.6 mmol/l, but significantly less food (P < 0.01) was eaten and more exercise (P < 0.001) was performed before the low BG measurement. No interactions between SH and No-SH groups and management behaviors were observed. However, each of the three management variables entered significantly in a logistic model that predicted 61% of all readings of BG < 3.9 mmol/l. CONCLUSIONS: Subjects with a history of SH did not report managing their diabetes differently from those with no such history. Specifically, when low BG occurred, the preceding management behaviors, although predictive of low BG, were not different in SH and No-SH subjects. Overall, self-management behaviors did not distinguish SH from No-SH subjects. Thus, even though it might be beneficial for all patients to review their food and exercise management decisions to reduce their frequency of low BG, an educational intervention whose content stresses insulin, food, and exercise would be unlikely by itself to be sufficient to reduce the frequency of SH.     

Biopsychobehavioral model of severe hypoglycemia. II. Understanding the risk of severe hypoglycemia

OBJECTIVE: To evaluate the clinical/research utility of the biopsycho-behavioral model of severe hypoglycemia in differentiating patients with and without a history of severe hypoglycemia and in predicting occurrence of future severe hypoglycemia. RESEARCH DESIGN AND METHODS: A total of 93 adults with type 1 diabetes (mean age 35.8 years, duration of diabetes 16 +/- 10 years, HbA1 8.6 +/- 1.8%), 42 of whom had a recent history of recurrent severe hypoglycemia (SH) and 51 who did not (NoSH), used a handheld computer for 70 trials during 1 month recording cognitive-motor functioning, symptoms, blood glucose (BG) estimates, judgments concerning self-treatment of BG, actual BG readings, and actual treatment of low BG. For the next 6 months, patients recorded occurrence of severe hypoglycemia. RESULTS: SH patients demonstrated significantly more frequent and extreme low BG readings (low BG index), greater cognitive-motor impairments during hypoglycemia, fewer perceived symptoms of hypoglycemia, and poorer detection of hypoglycemia. SH patients were also less likely to treat their hypoglycemia with glucose and more likely to treat with general foods. Low BG index, magnitude of hypoglycemia-impaired ability to do mental subtraction, and awareness of neuroglycopenia, neurogenic symptoms, and hypoglycemia correlated separately with number of SH episodes in the subsequent 6 months. However, only low BG index, hypoglycemia-impaired ability to do mental subtraction, and awareness of hypoglycemia entered into a regression model predicting future severe hypoglycemia (R2 = 0.25, P < 0.001). CONCLUSIONS: Patients with a history of severe hypoglycemia differed on five of the seven steps of the biopsychobehavioral model of severe hypoglycemia. Helping patients with a recent history of severe hypoglycemia to reduce the frequency of their low-BG events, become more sensitive to early signs of neuroglycopenia and neurogenic symptoms, better recognize occurrence of low BG, and use fast-acting glucose more frequently in the treatment of low BG, may reduce occurrence of future severe hypoglycemia.     

Methods for quantifying self-monitoring blood glucose profiles exemplified by an examination of blood glucose patterns in patients with type 1 and type 2 diabetes

The maintenance of glycemic control in patients with type 1 or type 2 diabetes mellitus (T1DM and T2DM, respectively) is commonly assisted by devices for self-monitoring of blood glucose (SMBG) that store multiple BG determinations. However, besides average BG, no other SMBG characteristics are routinely computed. We describe several SMBG-based measures that quantify the extent and rate of patients' BG excursions into hypoglycemia and hyperglycemia and can be used as markers for patients' vulnerability to hypoglycemia and BG irregularity. These markers are applied to analyze data from patients with T1DM (n = 277) and T2DM (n = 323), all of whom used insulin. T1DM and T2DM patients were matched by HbA(1c), gender, and number of SMBG readings/day. On average, 230 SMBG readings and three HbA(1c) assays were collected for each subject over 3 months. Compared with T2DM, patients with T1DM diabetes had (1) more extreme low and high BGs, (2) greater risk for severe hypoglycemia as quantified by the Low BG Index, (3) faster descent into hypoglycemia as quantified by the risk rate of change/hour, and (4) greater BG irregularity as computed by BG rate of change/hour and BG SD (all p levels < 0.0001). SMBG data allow for computing and frequent updating of various idiosyncratic diabetes characteristics and risk factors. The use of such computations may assist in optimizing patients' glycemic control.     

Hypoglycemia and the decision to drive a motor vehicle by persons with diabetes.

CONTEXT: Laboratory studies have shown impairments in driving performance among subjects with type 1 diabetes mellitus when their blood glucose (BG) level is between 2.6 and 3.6 mmol/L (47-65 mg/dL). However, to our knowledge, no data exist examining subjects' decisions to drive at various BG levels during their daily routine. OBJECTIVE: To examine type 1 diabetic subjects' decisions to drive during their daily routine based on perception of BG levels compared with actual measured BG levels. DESIGN AND SETTING: Two separate groups of patients were recruited 2 years apart from 4 academic medical centers. PARTICIPANTS: All subjects were adults with type 1 diabetes who were drivers and who performed at least 2 BG tests per day. Group 1 (initial) subjects (n = 65) had a mean (SD) age of 38.6 (8.9) years with a mean (SD) diabetes duration of 20.5 (10.6) years, were taking 38.8 (16.8) U/d of insulin, and had a mean (SD) glycosylated hemoglobin (HbA1) level of 10.0% (1.9%). Group 2 (replication) subjects (n = 93) were 35.8 (8.0) years old with a mean diabetes duration of 17.0 (10.6) years, were taking 40.0 (15.5) U/d of insulin, and had a mean (SD) HbA1 level of 8.5% (1.6%). Each subject used a handheld computer to record data on symptoms, cognitive function, insulin dosage, food, activity, estimated and actual BG levels, and whether he/she would drive. Data were entered 3 to 6 times per day for a total of 50 to 70 collections per subject during a 3- to 4-week period. MAIN OUTCOME MEASURES: Decisions to drive when subjects estimated their BG level to be less than 2.2 mmol/L (40 mg/dL), 2.2 to 2.8 mmol/L (40-50 mg/dL), 2.8 to 3.3 mmol/L (50-60 mg/dL), 3.3 to 3.9 mmol/L (60-70 mg/dL), 3.9 to 10 mmol/L (70-180 mg/dL), and more than 10 mmol/L (>180 mg/dL), and driving decisions when actual BG levels were in these ranges. RESULTS: Subjects stated they would drive 43% to 44% of the time when they estimated their BG level to be 3.3 to 3.9 mmol/L (60-70 mg/dL), and 38% to 47% of the time when their actual BG level was less than 2.2 mmol/L (40 mg/dL). Logistic regression analysis demonstrated that number of autonomic symptoms, degree of impairment on cognitive function tests, and BG level estimate predicted 76% to 80% of decisions to drive (P<.01 for all). Approximately 50% of subjects in each group decided to drive at least 50% of the time when their BG level was less than 3.9 mmol/L (70 mg/dL). CONCLUSIONS: Our data suggest that persons with type 1 diabetes may not judge correctly when their BG level is too low to permit safe driving and may consider driving with a low BG level even when they are aware of the low level. Health care professionals should counsel their patients about the risk of driving with hypoglycemia and the importance of measuring BG level before driving.     

MEASUREMENT OF ROOT CANAL LENGTH – USE OF AN ELECTROMETRIC DEVICE

The measurement of root canal length is a pre-requisite for successful pulpectomy. The conventional manual and radiographic methods are not very accurate. In the present study, odontometer was used [Group B) to assess its efficacy over the conventional methods (Group A) for recording root canal length. In group A, 36 teeth were treated with pulpectomy while in group B, 51 teeth were managed by the same treatment. It was observed that post operative complications in group B were significantly less (p < 0.05). The odontometer proved to be an excellent device for rapid and accurate measurement of root canal length.KEY WORDS: Pulpectomy, Root canal length, Odontometer     

Morphological features and apoptosis in the left internal thoracic artery grafts before implantation.

AIM: A small number of left internal thoracic artery (LITA) grafts are occluded at 3 years after the operation or show more than 50% stenosis of the lumen. The purpose of this study is to examine factors related to the morphology of the wall and to the function of the cell population of LITA grafts before implantation, in order to evaluate their quality and the viability, in a follow-up examination. METHODS: Fifteen LITA grafts were examined with light microscopy, for their morphology, endothelial cell coverage, apoptosis and cell proliferation, scanning electron microscopy and transmission electron microscopy. RESULTS: Increase of the thickness of the intima (14.21+/-1.28 mm), mean thickness of media 160.37+/-11.97 mm, detachment of intima from media, presence of foam cells in the media, low endothelial coverage (40.638+/-16.864), increase of apoptosis in intima (46.38+/-13.46), sub-intima (29.3+/-8.54), media (34.91+/-6.05) and adventitia (40.21+/-5.36), blood cells penetration of the intima through disruptions between endothelial cells are findings of LITA grafts before implantation. Cell proliferation was not detected in the wall of any graft. Follow-up examination 6 months and 2.5 years after the operation showed normal function of LITA grafts. CONCLUSIONS: Besides of the wall injury and the initiated atherosclerotic lesions, LITA grafts are well functioning at the time of the follow-up examination. Maybe our findings are related to the later occlusion of the referred in the literature small number of LITA grafts.