Foot orthoses: a review focusing on kinematics

Orthoses have been broadly used by clinicians to treat mechanical misalignments, such as abnormal foot pronation. As such, the influences of orthoses on lower-limb kinematics have been studied numerous times, with many articles reporting nonsystematic results; the aim of this review, therefore, was to examine the recognized effects of foot orthoses on lower-limb kinematics. The findings from this review suggest that foot orthoses seem to have certain generic and common effects on the lower limb when designed to control rearfoot pronation. We also discuss the possible reasons behind the lack of consistent results between studies. Based on the findings, a list of recommendations is presented for future research on foot orthoses to facilitate comparisons between studies and enable the scientific and clinical communities to better comprehend the effects that these variables might have on the kinematics and, possibly, the treatment outcomes.     

Congenital absence of the pericardium presenting as acute myocardial necrosis

Congenital absence of the pericardium is a rare defect of which recognition is critical because it can be associated with catastrophic outcomes. While some carriers of this condition may present with a lethal complication, most are asymptomatic, and the defect is found incidentally. The case of a 49-year-old woman is described who presented with acute myocardial necrosis and absence of obstructive coronary artery disease, and in whom a complete left pericardial defect was found. An investigation was undertaken to determine the role of the defect in this patient's presentation and to recommend the best possible therapy. Finally, a review of literature focusing on congenital absence of the pericardium, as well as a discussion of clinical presentation, imaging techniques and therapeutic options, is also presented.     

Predictors of aorto-saphenous vein bypass narrowing late after coronary artery bypass grafting

The objective of this study was to evaluate the clinical and angiographic factors associated with significant saphenous vein graft (SVG) atherosclerosis progression at mid-term follow-up in a series of unselected coronary patients who had previously received a coronary artery bypass graft (CABG). A total of 123 SVGs from 86 patients who underwent cardiac catheterization twice, 15 +/- 12 months apart, were included in the study. None of the SVGs presented any > or =50% diameter stenosis (DS) lesion or underwent any intervention at baseline. All SVGs were divided into 3 segments and each SVG segment was scored from 0 to 3 depending on the presence of lesions, with percent DS ranging from 0% to 19% (score 0), 20% to 29% (score 1), 30% to 39% (score 2), and > or =40% (score 3). The SVG atherosclerotic burden score (ABS) was calculated by adding the score obtained for each of the 3 SVG segments. Significant progression was defined as > or =10% increase in lesion percent DS or > or =0.6 mm decrease in minimal lumen diameter between baseline and follow-up studies. Mean age of the study population was 66 +/- 9 years, and most of the patients were receiving statin therapy with mean low-density lipoprotein cholesterol of 85 +/- 26 mg/dl. Significant angiographic progression occurred in > or =1 SVG in 41 patients (48%). On multivariate analysis, the variables associated with SVG atherosclerosis progression were SVG ABS (odds ratio [OR], 1.52 for each increase of 1 point in SVG ABS; 95% confidence interval [CI] 1.1 to 2.29) and high-density lipoprotein (HDL) cholesterol (OR 1.38 for each decrease of 5 mg/dl in HDL cholesterol levels, 95% CI 1.09 to 1.85). Twenty-two patients (26%) had a cardiac event at follow-up related to SVG disease progression. The percent DS of the SVG segment at baseline was associated with SVG disease progression leading to a cardiac event (OR 3.67 for each increase of 5% in percent DS, 95% CI 2.11 to 6.38). In conclusion, simple clinical and angiographic variables such as HDL cholesterol, ABS, and lesion severity remain independent predictors of significant SVG atherosclerosis progression in mild to moderately diseased SVGs despite mean low-density lipoprotein levels <90 mg/dl.     

Hyperlipidaemia induced by a high-cholesterol diet leads to the deterioration of guanosine-3′,5′-cyclic monophosphate/protein kinase G-dependent cardioprotection in rats

Background and purpose:

Hyperlipidaemia interferes with cardioprotective mechanisms, but the cause of this phenomenon is largely unknown, although hyperlipidaemia impairs the cardioprotective NO–cGMP system. However, it is not known if natriuretic peptide–cGMP–protein kinase G (PKG) signalling is affected by hyperlipidaemia. Therefore, we investigated the cardioprotective efficacy of cGMP-elevating agents in hearts from normal and hyperlipidaemic rats.

Experimental approach:

Male Wistar rats were rendered hyperlipidaemic by feeding with 2% cholesterol-enriched chow for 12 weeks. Hearts isolated from normal and hyperlipidaemic rats were perfused (Langendorff mode) and subjected to 30 min occlusion of the left main coronary artery, followed by 120 min reperfusion. 8-Br-cGMP (CG, 10 nM), B-type natriuretic peptide-32 (BNP, 10 nM), S-nitroso-N-acetyl-penicillamine (SNAP, 1 µM) were perfused from 10 min prior to coronary occlusion until the 15th min of reperfusion. Infarct size (% of ischaemic risk zone) was determined by triphenyltetrazolium staining.

Key results:

Treatment with CG, SNAP or BNP decreased infarct size significantly in normal hearts from its control value of 41.6 ± 2.9% to 15.5 ± 2.4%, 23.3 ± 3.0% and 25.3 ± 4.6%, respectively (P < 0.05). Protection by BNP was abolished by co-perfusion of PKG inhibitors KT5823 (600 nM) or Rp-8pCPT-PET-cGMPs (1 µM), confirming its PKG dependence. In hearts from hyperlipidaemic rats, CG, SNAP or BNP failed to decrease infarct size. Hyperlipidaemia did not alter basal myocardial PKG content, but decreased its activity as assessed by phosphorylation of cardiac troponin I.

Conclusions and implications:

This is the first demonstration that defects in the cardioprotective cGMP–PKG system could be a critical biochemical anomaly in hyperlipidaemia.     

盐酸维拉帕米渗透泵片溶出度与人体生物利用度研究

溶出度按Weibull's分布处理得T_d=5.76 h,T₅₀=3.9 h,零级溶出速度常数K_t=9.9450,平均体外溶解时间MDT=5.391 h。测定8名健康受试者,单剂量口服,得C_max=76.2±16.7 ng/ml,T_amx=8.0 h,t_1/2=9.75 h,MRT=19.41 h,MAT=5.34 h,与Knoll公司SR片相比,F_rel=101.71%;与市售普通片相比,F_rel=96.16%。多剂量口服,得C_max=121.47±34.5 ng/ml,T_max=7.14 h。按Loo-Riegelman方程处理表明体内外显著相关。理论值与实测值基本相符。     

沙尘天气大气颗粒物对学龄儿童最大呼气流速的影响

目的 研究沙尘天气颗粒物浓度与学龄儿童最大呼气流速(PEFR)之间的关系.探讨沙尘天气颗粒物对儿童肺功能的影响.方法 于2006年4月27日-6月5日连续40d对内蒙古包头市1所小学107名四年级小学生进行每日3次PEFR的测定,同时监测和收集每日大气PM2.5、PM1O、NO2和SO2浓度以及气温和相对湿度,通过问卷调查了解儿童年龄、性别、身高、体重、哮喘病史、慢性呼吸系统疾病家族史、被动吸烟等情况.应用线性混合效应模型,在控制了个体特征、气象因素的情况下估计PM2.5和PM10对儿童PEFR的影响.结果 单污染物模型和多污染物模型均显示,PM2.5和PM10的日均浓度与沙尘天气当日及之后3 d内儿童的PEFR日均值都存在明显的负相关(P<0.01),其中以滞后1 d的效应最强.在多污染物模型中调整了NO2和SO2的影响之后,PM2.5和PM10的日均浓度每增加10μg/m3,儿童PEFR在沙尘天气1 d之后的日均值就分别降低0.245和0.121 L/min,有统计学意义(P<0.01).结论 学龄儿童PEFR日均值下降与包头市沙尘天气颗粒物浓度的升高有关.     

Long-acting insulin analogues and the risk of diabetic retinopathy among patients with type 2 diabetes: A population-based cohort study

Aim

To determine whether the use of long-acting insulin analogues is associated with an increased risk of incident diabetic retinopathy (DR) among patients with type 2 diabetes.

Methods

Using data from the Clinical Practice Research Datalink Aurum, this retrospective, population-based cohort study included patients with type 2 diabetes who initiated a long-acting insulin analogue (glargine, detemir, degludec) or Neutral Protamine Hagedorn (NPH) insulin. The primary outcome was incident DR. We used Cox proportional hazards models with inverse probability of treatment weighting to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident DR with insulin analogues versus NPH insulin.

Results

There were 66 280 new users of long-acting insulin analogues and 66 173 new users of NPH insulin. The incidence rate of DR was 101.7 per 1000 person-years (95% CI, 98.7-104.8) for insulin analogues and 93.2 (95% CI, 90.0-96.5) per 1000 person-years for NPH insulin. Compared with the current use of NPH insulin, insulin analogues were not associated with the risk of incident DR (HR 1.04, 95% CI, 0.99-1.09). The adjusted HRs were 0.84 (95% CI, 0.66-1.07) for proliferative DR and 1.02 (95% CI, 0.97-1.08) for non-proliferative DR.

Conclusions

Compared with NPH insulin, long-acting insulin analogues were not associated with the risk of incident DR among patients with type 2 diabetes. This finding provides important reassurance regarding the safety of long-acting insulin analogues with respect to incident DR.