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??Food protein-induced enterocolitis syndrome??FPIES??is a non-IgE mediated gastrointestinal allergic disorder??and the pathogenesis is still unknown. The clinical manifestations include repetitive severe vomiting and diarrhea. Acute FPIES can result in dehydration??lethargy and even shock. Chronic FPIES is mainly characterized by weight loss and growth retardation. FPIES mainly affects infants and toddlers. Common allergen includes milk??soybean??oats??fish and eggs. The diagnosis is based on typical clinical manifestations and the fact that avoiding possible food source can alleviate the symptoms. If necessary??oral food challenge??OFC?? is required to confirm the diagnosis or to find out the food allergy sources. The key treatment measures are to avoid allergen food and to carry out symptomatic treatment during acute phase.     

The study techniques of Asian, American, and European medical students during gross anatomy and neuroanatomy courses in Poland

Background  

Past research in medical education has addressed the study of gross anatomy, including the most effective learning techniques, comparing the use of cadavers, dissection, anatomy atlases, and multimedia tools. The aim of this study was to demonstrate similarities and differences among American, Asian, and European medical students (MS) regarding different study methods and to see how these methods affected their clinical skills.     

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??Abstract?? Objective??To evaluate the value of biochemical markers in the diagnosis of biliary atresia ??BA?? and neonatal intrahepatic cholestasis caused by citrin deficiency ??NICCD??. Methods??Totally 77 infants in hospital with infantile hepatitis syndrome ??IHS?? were enrolled from December 1?? 2008 to March 31?? 2009. Totally 27 patients were diagnosed as having BA and 11 with NICCD. Biochemical markers were compared between groups including alanine transaminase ALT?? aspartate transaminase AST ?? alkaline phosphatase ALP?? γ-glutamyl transpeptidase γ-GT?? total bilirubin TB?? direct bilirubin DB?? total bile acid TBA?? total cholesterol TC??to compute ALT/AST??ALP/γ-GT and glucose GLU?? lactic acid LAC?? total protein TP?? albumin ALB in the NICCD group. The data were analyzed by T test and ROC curve with SPSS10.0. Results??γ-GT was significantly elevated in the infants with BA when compared to non-BA group ??P = 0.003???? cut-off point was 332.5U/L. ALP/γ-GT was significantly lower in the patients with BA??and cut-off point was 1.93. The infants with NICCD had significantly different biochemical markers including GLU?? LAC?? TP?? ALB?? ALT/AST and γ-GT. Conclusion??Biochemical markers could be considered as complementary diagnosis of BA and NICCD for differentiating infants with IHS.     

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??Abstract??Objective??To investigate antibiotic resistance and mechanism of antibiotic resistance of Haemophilus influenzae ??HI?? in children with acute respiratory tract infection in Suzhou. To determine beta-lactamase genes of Haemophilus influenzae?? possible genetic mutation and the possible relationship between minimal inhibitory concentrations??MICs?? of beta-lactamases antibiotic and genetic mutation. Methods??The susceptibility of 135 clinical isolates of Haemophilus influenzae were calculated using E-tests?? and beta-lactamases of these stratins were detected. Besides?? the beta-lactamases genes were detected by net-polymerase chain reaction ??n-PCR?? followed by DNA sequencing. The sequences of drug resistance genes were compared with the published sequence in GeneBank. Results??The beta-lactamase positive rate of HI was 31.1%. The MIC90 and MIC50 of HI to ampicillin??ampicillin/sulbactam??cefaclor and chloramphenicol were??32 μg/mL??1 μg/mL??????2 μg/mL?? 0.75 μg/mL??????24 μg/mL??3 μg/mL?? and ??8 μg/mL??0.5 μg/mL?? respectively. Among the isolated 135?? TEM genes were detected in 53 HI. Beta-lactamase geneTEM was detected in 39.3%of HI??No ROB gene was detected. About 28.3% of TEM gene had been mutated. The mean minimal inhibitory concentration of beta-lactamases antibiotic in HI that had mutant TEM genes was higher than that of no-mutant TEM gene. Conclusion Ampicillin resistance in HI influenzae isolates from children in this region is challenging??The resistance mechanism of beta-lactamase antibiotics is of production beta-lactamase TEM and 28.3% of TEM gene has been mutated. The production of TEM and its mutation is one of the most important factors that leads to the high resistance to beta-lactamase antibiotics.     

Comparison of a Multiple Daily Insulin Injection Regimen (Basal Once-Daily Glargine Plus Mealtime Lispro) and Continuous Subcutaneous Insulin Infusion (Lispro) in Type 1 Diabetes: A randomized open parallel multicenter study

OBJECTIVE

Insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) and multiple daily injections (MDIs) with insulin glargine as basal insulin and mealtime insulin lispro have not been prospectively compared in people naïve to either regimen in a multicenter study. We aimed to help close that deficiency.

RESEARCH DESIGN AND METHODS

People with type 1 diabetes on NPH-based insulin therapy were randomized to CSII or glargine-based MDI (both otherwise using lispro) and followed for 24 weeks in an equivalence design. Fifty people were correctly randomized, and 43 completed the study.

RESULTS

Total insulin requirement (mean ± SD) at end point was 36.2 ± 11.5 units/day on CSII and 42.6 ± 15.5 units/day on MDI. Mean A1C fell similarly in the two groups (CSII −0.7 ± 0.7%; MDI −0.6 ± 0.8%) with a baseline-adjusted difference of −0.1% (95% CI −0.5 to 0.3). Similarly, fasting blood glucose and other preprandial, postprandial, and nighttime self-monitored plasma glucose levels did not differ between the regimens, nor did measures of plasma glucose variability. On CSII, 1,152 hypoglycemia events were recorded by 23 of 28 participants (82%) and 1,022 in the MDI group by 27 of 29 patients (93%) (all hypoglycemia differences were nonsignificant). Treatment satisfaction score increased more with CSII; however, the change in score was similar for the groups. Costs were ∼3.9 times higher for CSII.

CONCLUSIONS

In unselected people with type 1 diabetes naïve to CSII or insulin glargine, glycemic control is no better with the more expensive CSII therapy compared with glargine-based MDI therapy.Insulin substitution in type 1 diabetes is based on mealtime rapid-acting and basal insulin, using multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) (1,2). In meta-analyses of studies, two small trials (3,4) with the long-acting insulin analog insulin glargine suggested superiority of CSII over MDI in terms of A1C lowering. Lower A1C levels and less hypoglycemia with CSII were also recently reported by Hoogma et al. (5) in a large type 1 diabetes population (272 people) comparing CSII with MDI using NPH insulin. A more recent meta-analysis (6) proposed that CSII is beneficial to “selected” people (people with recurrent and frequent severe hypoglycemia on MDI using NPH insulin) with type 1 diabetes.Since 2000, the long-acting insulin analogs, insulin glargine and insulin detemir, have become available (2). These are progressively replacing NPH insulin as basal insulin in type 1 diabetes due to favorable pharmacokinetics and pharmacodynamics, namely, a less pronounced peak concentration and longer duration of action (7,8) resulting in lower A1C levels and less hypoglycemia (9,10). Additionally, the long-acting analogs may give more reproducible effects compared with NPH insulin (11,12).This better glycemic control with the new analogs has reopened the question of comparisons between CSII and MDI based on long-acting analogs, rather than NPH insulin. A number of studies have attempted to compare CSII with MDI using insulin glargine, but not insulin detemir, as basal insulin (13–17). However, these studies are small, nonrandomized, or of short duration.The aim of the present prospective, randomized, multicenter, international study was to assess the difference in glycemic control when people with type 1 diabetes using NPH insulin-based MDIs are randomized either to an MDI regimen with insulin glargine as basal insulin and mealtime insulin lispro or to continuous subcutaneous infusion of insulin lispro and managed on either regimen for 6 months.     

Prevalence and Predictors of Breast and Cervical Cancer Screening Among Spanish Women With Diabetes

OBJECTIVE

To examine the use of mammography and Papanicolaou (Pap) smear among women with diabetes and to identify predictors of adherence to these tests.

RESEARCH DESIGN AND METHODS

We analyzed data of a nationally representative sample of Spanish women. Diabetes status was self-reported. Screenings were assessed asking whether they had a mammography (≥40 years) and a Pap smear (18–69 years) within the previous 2 and 3 years, respectively.

RESULTS

Women with diabetes were less likely to receive mammography (57.9%) or have a Pap smear (61.5%) than women without diabetes (mammography 61.9%, P < 0.05; Pap smear 65.6%, P < 0.05). After adjusting for age, educational level, income, comorbidity, tobacco use, obesity, and physician visits, the corresponding odds ratios remained significant (0.84, 95% CI 0.72–0.97) and (0.82, 95% CI 0.66–0.98). Higher educational level was a positive predictor for both tests among diabetic women.

CONCLUSIONS

Spanish women with diabetes underuse breast and cervical cancer screening tests.Women with diabetes have an increased incidence of breast cancer, and women diagnosed with this cancer who have preexisting diabetes are at increased risk of breast cancer mortality compared with those without diabetes (1,2).The relationship between diabetes and risk of cervical cancer remains to be evaluated, but cervical cancer mortality is higher in obese women, being these conditions are strongly associated with diabetes (3,4).Spanish preventive practice guides recommend mammography for women aged 50–69 years every 1–2 years and beginning at 40 years if any condition that increases risk exists (5). For cervical carcinoma, recommendations include screening with Papanicolaou (Pap) smear for 2 years starting 3 years after women become sexually active, and if both yield normal results, repeat every 3 years (6). In Spain, population-based programs for breast and cervical cancer prevention are established by the Public Health System and provide free mammography and Pap smears to target populations (5,6). However, adherence to the cancer screening guidelines is not known among Spanish women with diabetes.Studies conducted in the U.S. and Canada have shown that women with diabetes undergo mammography and Pap smear less frequently than women without diabetes (7–10). We aimed to examine and compare the prevalence of receiving breast and cervical cancer screenings among women with and without diabetes and to identify predictors of adherence to these recommendations among women with diabetes.     

Evaluation of cryopreserved donor skin viability: the experience of the regional tissue bank of Verona

Background

Allogeneic human skin removed from cadaveric donors is the covering of choice for deep burns, since it accelerates the re-epithelialisation of autologous skin. In this study we evaluated the cellular viability of cryopreserved skin at the regional tissue bank of Verona (Italy).

Methods

From 1^st June 2007 to 30^th September 2007, tests of cutaneous cell viability were carried out on 21 consecutive skin donors using the MTT (tetrazolium salt) method on samples prior to freezing and on thawed samples after a period of cryopreservation.

Results

The mean percentage viability was 45.1% (±20.1%), which is similar to results obtained in other tissue banks. It was noted that viability decreased with increasing age of the donor.

Conclusions

The results of the evaluation of cutaneous cell viability document the validity of the skin cryopreservation procedure in use at the tissue bank in Verona.     

Can Technology Improve Adherence to Long-Term Therapies?

Background

Therapeutic nonadherence is defined as the lack of equivalence between the behavior of the patients and their prescribed medical treatment. Consequences of nonadherence include not only health outcomes, but also cost saving. Thus, this issue gets paramount importance in contemporary medicine.

Method

The aim of this article is to discuss the relationships between technology and adherence by asking the following three questions. (1) How can technology be used to monitor patient adherence? (2) Considering the mechanisms of nonadherence in chronic diseases, is there room for technology in interventions aimed to improve patient adherence? (3) What about adherence to technology in diabetes care?

Results and Conclusion

Technology may help improve adherence to long-term therapies by (1) giving a concrete representation of adherence rewards, (2) overcoming immediate obstacles to adherence, such as the fear of hypoglycemia, and (3) providing an opportunity for patient–doctor conversations. This assumes, however, that both the patient and the doctor are convinced that technologies are useful.