模拟教学法可改善成人糖尿病患者的血糖控制

初级保健医师(primary care physicians,PCPs)对继续医学教育的需求很大.为了评估以病例为基础的模拟教学法是否可以提高初级保健医师对糖尿病的诊疗水平,美国明尼苏达州健康合作者研究基金会和医疗集团进行了相关的研究. 研究选择了美国明尼苏达州健康合作者研究基金会和医疗集团旗下的11个诊所的41名初级保健医师,随机分为参与模拟教学组和不参与模拟教学组.在模拟教学组中,给每位初级保健医师派发了1 2个2型糖尿病的模拟病例,这些病例都是针对研究人员在电子病历中观察到的初级保健医师诊疗水平的不足之处所专门设计的,每个模拟病例都需要初级保健医师在15分钟内完成诊疗过程.     

Implementation of a multidisciplinary guideline‐driven approach to the care of the extremely premature infant improved hospital outcomes

Aim: To test the hypothesis that implementing guidelines for the standardized care of the extremely premature infant (<27 weeks) in the first week of life would improve patient outcomes in an all referral NICU. Methods: Data were collected on all infants <27 weeks gestational age and <7 days of age on admission cared for using these small baby guidelines (SBG), as well as on all age‐matched infants admitted the year prior (comparison). Results: Thirty‐seven patients were cared for utilizing the SBG and 40 patients were in the comparison group. There were no differences between the groups in gestational age, birthweight or age on admission. There was no difference in survival to discharge (73% SBG, 70% comparison). The mean length of stay for survivors was 112 ± 38 days SBG and 145 ± 76 days (p < 0.05) comparison group. Survival without BPD was greater in the SBG group (24%) than in the comparison group (9%; p < 0.05), and survival without severe IVH was greater in the SBG group (65%) than in the comparison group (38%; p < 0.01). Conclusions: These data demonstrate that applying a unified approach to the care of the extremely premature infant in the first week of life resulted in a decrease in the length of hospitalization and improved patient outcomes.     

Anthropometric correlates of lipoprotein profile and blood pressure in high BMI African American children

Objective: To explore the association of anthropometric indices with lipoprotein profile and blood pressure as risk factors of cardiovascular disease, in African American (AA) children. Methods: A cross‐sectional analysis was carried out on children aged 9–13 years with BMI >85th percentile. Height, weight, waist and hip circumferences, % body fat and blood pressure [systolic (sBP) and diastolic (dBP)] were measured. Fasting plasma levels of triglycerides (TG), total cholesterol (TC), high‐density lipoprotein cholesterol (HDL‐C), low‐density lipoprotein cholesterol (LDL‐C), intermediate density lipoprotein cholesterol (IDL‐C) and very low‐density lipoprotein cholesterol (VLDL‐C) were analysed. Results: After accounting for age, gender and pubertal status of the child, multiple linear regression models showed that waist circumference and BMIz were strong predictors for lipoprotein variables. In independent analysis, waist circumference and BMI z‐scores were found to be interdependently associated with TG, LDL‐C:HDL‐C ratio, VLDL‐C and sBPz. However, for HDL‐C, TG:HDL‐C ratio and dBPz, waist circumference was independently and more strongly associated with these risk factors than BMI. Conclusion: Waist circumference was a stronger predictor for lipoprotein variables and blood pressure in high BMI AA children than other anthropometric indices, and may be adequate as a screening test to identify children who are at increased risk for cardiovascular disease.     

Bioengineering strategies for regeneration of craniofacial bone: a review of emerging technologies

Oral Diseases (2010) 16 , 709–716 Although advances in surgical techniques and bone grafting have significantly improved the functional and cosmetic restoration of craniofacial structures lost because of trauma or disease, there are still significant limitations in our ability to regenerate these tissues. The regeneration of oral and craniofacial tissues presents a formidable challenge that requires synthesis of basic science, clinical science, and engineering technology. Tissue engineering is an interdisciplinary field of study that addresses this challenge by applying the principles of engineering to biology and medicine toward the development of biological substitutes that restore, maintain, and improve normal function. This review will explore the impact of biomaterials design, stem cell biology and gene therapy on craniofacial tissue engineering.     

散偏汤联合针刺治疗偏头痛的临床疗效

目的 观察散偏汤联合针刺治疗偏头痛的临床疗效.方法 选取2019年8月至2020年11月沈阳市中医院收治的100例偏头痛患者作为为研究对象,根据随机数字表分为观察组与对照组,每组各50例,对照组采用口服盐酸氟桂利嗪胶囊进行治疗,观察组采用针刺联合口服散偏汤治疗,4周为1个疗程,治疗1个疗程后,比较两组视觉模拟量表(VA...     

黄芩苷下调NF-κB表达抑制高糖环境下肾小球系膜细胞增殖的作用

目的研究黄芩苷对高糖环境下肾小球系膜细胞（GMC）增殖的抑制作用及对NF-κB表达的影响。方法将体外培养的大鼠GMC分为六组：低糖组,高糖组,黄芩苷低、中、高剂量组、氯沙坦组,培养24、48、72 h。实验结束后根据MTT法检测结果,收集细胞并提取核蛋白,用Western blot方法检测各组NF-κB表达情况。结果高糖组在24、48、72 h时间段的吸光值均较低糖组增高,且随培养时间延长而增高明显（P〈0.05）;黄芩苷低、中、高剂量组,氯沙坦组在24 h时间段吸光值均较高糖组高,48、72 h时间段较高糖组低（P〈0.05）。Western blot结果显示,高糖组NF-κB表达量较低糖组增加。而用黄芩苷干预后,GMC中NF-κB表达量较高糖组减少,且随着浓度增加,表达量逐渐减少。结论高糖环境下体外培养的GMC存在异常增殖现象,黄芩苷能抑制高糖诱导的GMC异常增殖,且呈时间、剂量依赖关系,其机制可能与黄芩苷下调NF-κB表达有关。     

Hangman's fracture: radiologic assessment in 27 cases

Traumatic spondylolisthesis of C-2, frequently referred to as the hangman's fracture, is typically regarded as a hyperextension injury with rare neurologic sequelae by virtue of decompression of the neural canal. The authors retrospectively evaluated their radiographic experience with this injury in 27 patients over a 24-month period. Lateral cervical spine studies and computed tomography (CT) scans (21 patients) were analyzed. CT studies provided better delineation of the fracture in all 21 patients and significant additional information in five patients (24%). Seven patients (26%) suffered initial neurologic sequelae in association with the C-2 injury. Nine patients had additional sites of fracture, including seven with associated C-1 ring disruption (26%). Extension of the fracture line into the transverse vertebral artery foramen led to vertebral artery injury and cerebellar embolization in one patient. Angiography may be necessary to detect intimal injury to the vertebral arteries when the fracture extends through the transverse foramina and to indicate the need for anticoagulation when clinically feasible.