Target setting in intensive insulin management is associated with metabolic control: the Hvidoere Childhood Diabetes Study Group Centre Differences Study 2005

Swift PGF, Skinner TC, de Beaufort CE, Cameron FJ, Åman J, Aanstoot H‐J, Castaño L, Chiarelli F, Daneman D, Danne T, Dorchy H, Hoey H, Kaprio EA, Kaufman F, Kocova M, Mortensen HB, Njølstad PR, Phillip M, Robertson KJ, Schoenle EJ, Urakami T, Vanelli M, Ackermann RW, Skovlund SE for the Hvidoere Study Group on Childhood Diabetes. Target setting in intensive insulin management is associated with metabolic control: the Hvidoere Childhood Diabetes Study Group Centre Differences Study 2005. Objective: To evaluate glycaemic targets set by diabetes teams, their perception by adolescents and parents, and their influence on metabolic control. Methods: Clinical data and questionnaires were completed by adolescents, parents/carers and diabetes teams in 21 international centres. HbA1c was measured centrally. Results: A total of 2062 adolescents completed questionnaires (age 14.4 ± 2.3 yr; diabetes duration 6.1 ± 3.5 yr). Mean HbA 1c = 8.2 ± 1.4% with significant differences between centres (F = 12.3; p < 0.001) range from 7.4 to 9.1%. There was a significant correlation between parent (r = 0.20) and adolescent (r = 0.21) reports of their perceived ideal HbA1c and their actual HbA1c result (p < 0.001), and a stronger association between parents' (r = 0.39) and adolescents' (r = 0.4) reports of the HbA1c they would be happy with and their actual HbA1c result. There were significant differences between centres on parent and adolescent reports of ideal and happy with HbA1c (8.1 < F > 17.4;p < 0.001). A lower target HbA1c and greater consistency between members of teams within centres were associated with lower centre HbA1c (F = 16.0; df = 15; p < 0.001). Conclusions: Clear and consistent setting of glycaemic targets by diabetes teams is strongly associated with HbA1c outcome in adolescents. Target setting appears to play a significant role in explaining the differences in metabolic outcomes between centres.     

新型植骨与内固定方法治疗上肢骨不连93例

1临床资料1990-01/2003-12采用新型植骨方法结合天鹅型记忆接骨器[1]治疗上肢骨干骨不连93(男60,女33)例,107(肱骨50,尺桡骨28,尺骨14,桡骨11,锁骨4)根,年龄10～80(平均37.6)岁.所有病例入我院前已行1～5(平均1.7)次手术.植骨以自体髂骨为主,必要时辅以同种异体骨植骨.内固定采用我院张春才发明,以镍钛记忆合金制成,由鹅体、鹅颈、鹅翼组成的天鹅型记忆接骨器[1](Swan-like Memorablycompressive Connector , SMC).     

Transcultural adaptation of the Liver Disease Quality of Life instrument (LDQOL 1.0) for its use in the Spanish population

Instruments of health-related quality of life (HRQOL) help us to interpret the results of treatments and health interventions. In Spain there is no HRQOL instrument specifically designed for use in patients with liver disease or to measure the effect of interventions such as liver transplantation. The Liver Disease Quality of Life (LDQOL 1.0) questionnaire is an American instrument developed for use in these patients. The aim of this study was to produce an appropriate version of this questionnaire for use in Spain. Cultural adaptation was performed in 3 phases: a) modification for use in Spain of a Hispanic version of this questionnaire supplied by the original authors; b) back-translation to English of a new version of the questionnaire and comparison with the original version in English, and c) a pilot test in a small sample of patients. In the first phase consisting of revision of the Hispanic version, the changes were mainly linguistic due to cultural and idiomatic differences. The validated Spanish version of the SF-36 was directly incorporated and items that could be of interest to local investigators were added. Few changes were made in the second phase of the process: changes involved an item on the appearance of feces and another item on taking naps. In the final phase, various changes suggested by the patients were introduced. Before applying the new version of the LDQOL 1.0 in clinical studies in Spain, its psychometric properties (its reliability, validity and sensitivity to change) must be verified in a subsequent validation study.     

Young Malaysian children with lower respiratory tract infections show low incidence of chlamydial infection

Objective: The incidence of Chlamydia pneumoniae and Chlamydia trachomatis infection was studied among infants and young children admitted to hospital for the management of lower respiratory tract infections, over a 12 month period.
Methodology: Respiratory secretions were examined for chlamydiae by cell culture, enzyme-linked immunosorbent assay and polymerase chain reaction-enzyme immunoassay. Sera were tested by micro-immunofluorescence for chlamydial IgG, IgM and IgA. Other bacterial and viral pathogens were also looked for by standard cultural and serological methods.
Results: Of 87 patients aged 2 months-3 years, an aetiologic diagnosis was made in 41 (47.1%). C. pneumoniae and C. trachomatis were each detected in 1 (1.2%) of the patients. Among common bacterial pathogens, Haemophilus influenzae (13.8%) and Streptococcus pneumoniae (8.1%) were the most frequently identified. Respiratory viruses and elevated Mycoplasma pneumoniae antibodies were found in 10.3% and 9.1% of patients, respectively.
Conclusion: Chlamydiae are infrequent causes of community-acquired acute lower respiratory tract infections in infants and very young children in Malaysia.     

Sphincter of Oddi stenosis: diagnosis using hepatobiliary scintigraphy and endoscopic manometry

To determine the role of radionuclide imaging in diagnosing sphincter of Oddi stenosis, 21 patients with symptoms suggesting this disorder underwent endoscopic retrograde cholangiopancreatography, cholescintigraphy, and, when possible, endoscopic manometry. Those patients with abnormal hepatobiliary scintigraphy results--based on our criteria of delayed biliary intestinal transit, abnormal duct size, and abnormal time-activity dynamics and obstruction--had a mean basal sphincter pressure of 38.5 mm Hg. Sphincter pressures could not be measured in six patients with sphincters too tight to cannulate. Ten patients who underwent hepatobiliary scanning both before and after sphincter surgery had normal scan results on the repeat study. Hepatobiliary imaging appears useful for diagnosis of sphincter of Oddi stenosis in selected patients in whom manometry cannot be performed and for objective assessment of response to therapy.     

Vascular trauma to the extremities and lower neck: initial assessment with intravenous digital subtraction angiography

Rapid assessment of a patient with possible major peripheral vascular injury is essential to preserve limb function. Intravenous digital subtraction angiography (IV DSA) allows rapid evaluation of these patients without the need for intraarterial examination. We report our experience in 295 vessels studied by IV DSA for the evaluation of possible traumatic arterial injury to the extremities or neck. Of our study population requiring angiography (469 patients), 63.4% were appropriate candidates for IV DSA. Of the vessels studied by IV DSA, 93.6% required no further radiologic evaluation. A normal appearance on IV DSA study indicates no major vascular injury; patients with positive studies may proceed to surgery without further interventional assessment.