Pelvic haemophilic pseudotumour occurring in a patient with mild haemophilia: a brief report

Haemophilic pseudotumour is a rare but well-recognized complication of moderate and severe haemophilia, particularly in patients who have developed a factor VIII inhibitor. It has only been reported in haemophiliacs with factor VIII or IX levels less than 5%. We report a patient with mild haemophilia (factor VIII 11%, factor IX 78%) who developed a pelvic pseudotumour that was successfully treated with a novel surgical technique and who has no evidence of recurrence five years after operation.     

Symptoms of depression prospectively predict poorer self‐care in patients with Type 2 diabetes

Aims To examine prospectively the association of depression symptoms with subsequent self‐care and medication adherence in patients with Type 2 diabetes mellitus. Methods Two hundred and eight primary care patients with Type 2 diabetes completed the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS) and the Summary of Diabetes Self‐Care Activities (SDSCA) at baseline and at follow‐up, an average of 9 months later. They also self‐reported medication adherence at baseline and at a follow‐up. Results Baseline HANDS scores ranged from 0 to 27, with a mean score of 5.15 ± 4.99. In separate linear regression models that adjusted for baseline self‐care, patients with higher levels of depressive symptoms at baseline reported significantly lower adherence to general diet recommendations and specific recommendations for consumption of fruits and vegetables and spacing of carbohydrates; less exercise; and poorer foot care at follow‐up (β ranging from ?0.12 to ?0.23; P < 0.05). Similarly, each one‐point increase in baseline HANDS score was associated with a 1.08‐fold increase in the odds of non‐adherence to prescribed medication at follow‐up (95% confidence interval 1.001, 1.158, P = 0.047). Increases in depression scores over time also predicted poorer adherence to aspects of diet and exercise. Conclusions Depressive symptoms predict subsequent non‐adherence to important aspects of self‐care in patients with Type 2 diabetes, even after controlling for baseline self‐care. Although the relationship between symptoms of depression and poorer diabetes self‐care is consistent, it is not large, and interventions may need to address depression and self‐care skills simultaneously in order to maximize effects on diabetes outcomes.     

伏尔泰《谈种痘》及蒙塔古夫人传种人痘于英国史料辨误

伏尔泰<哲学通信>中的第11封信是<谈种痘>,信中关于种痘史实细节的表述不够准确,原因在于其本人并未亲临现场,没有引征文献,多是得于传闻,甚或出于自己的想象.一些不够准确的表述,虽似无伤大雅,但容易对人痘起源和传播途径方面的研究产生误导,应当加以纠正.关于蒙塔古夫人将人痘接种术带回英国的过程,因国内罕能读到原始文献,有不少以讹传讹,更有必要于此加以澄清.     

Estimating the relative stability of polymorphs and hydrates from heats of solution and solubility data.

The transition temperature, T(t), of polymorphs is estimated from both their heats of solution and solubilities (or intrinsic dissolution rates) determined at any one temperature (e.g., ambient). At a given temperature, T, the enthalpy difference, DeltaH, between polymorphs, I and II, is equal to the difference between their heats of solution, whereas the free energy difference, DeltaG, can be estimated by the equation, DeltaG = -RTln (c(I)/c(II)) or DeltaG = -RTln (J(I)/J(II)), where c is the solubility and J is the intrinsic dissolution rate. The entropy difference, DeltaS, is evaluated as (DeltaH - DeltaG)/T. Because the heat capacity difference,DeltaC(p) between polymorphs is small enough to be neglected, the transition temperature may be estimated by the equation, T(t) = DeltaH/DeltaS. The thermodynamic stability relationships of the polymorphs (i.e., whether they are enantiotropes or monotropes) are predicted from the value of T(t) and the melting temperature. The T(t) values for auranofin, carbamazepine, chloramphenicol palmitate, cyclopenthiazide, gepirone hydrochloride, lamivudine, MK571, premafloxacin, sulfamerazine, sulfamethoxazole, sulfathiazole, and urapidil, were calculated from reported values of the heats of solution and solubilities (or dissolution rates). The stability relationships deduced from the calculated values of T(t) are in good agreement with those reported using other methods, such as differential scanning calorimetry and interpretation of melting data.     

Treatment of complex limb deformities in children with the Ilizarov technique

Twenty-nine children underwent 36 Ilizarov procedures for a variety of limb deformities. We present the results in 11 patients, six with leg length discrepancies and five with achondroplasia, who underwent lengthening procedures using the Ilizarov method. Lengthening was accomplished in 15 of the 16 procedures (93%). Average increase in femur length was 10 cm (32%), in tibial length 7.5 cm (30%), in humerus length 11 cm (40%). Eleven complications occurred. The most common were pin tract infections (4), joint contractures (2), transient nerve injury (4), premature consolidation (5), and three fractures of the regenerated bone. The complication rate was as high as in other methods, but with the Ilizarov apparatus longer segments of bone were lengthened and more complex deformities were treated. The number of complications were lessened as experience was gained.