妊娠糖尿病妇女使用门冬胰岛素或常规人胰岛素在疗效、安全性方面的比较

在一项随机、平行分组的开放试验中，27例妊娠糖尿病妇女（年龄30．7±6．3岁，HbA1c〈7％）随机分为门冬胰岛素治疗组（餐前5分钟注射）和常规人胰岛素治疗组（餐前30分钟注射）。试验时间为从诊断妊娠糖尿病（18～28周）至产后6周。研究期间两组的总体血糖水平均控制良好（试验开始和结束时HbA1c≤6％）。进餐试验时，试验6周时的平均血糖水平（门冬胰岛素组4．2±0．57mmol／L，常规人胰岛素组4．8±0．86mmol／L）略低于试验0周时（门冬胰岛素组4．9±0．59mmol／L，常规人胰岛素组5．1±0．36mmol／L）。     

马兜铃酸的倍半萜的酯类化合物VI.绵毛马兜铃中马兜铃酸萜酯I的结构鉴定

从绵毛马兜铃(Aristolocha mannisima Hance)中分得一个马兜铃酸倍半萜的酯类化合物,经红外、紫外、高分辩质谱和多种一维和二维核磁共振谱鉴定,确定了其骨架结构及顺反构型,命名为马兜铃酸萜酯I。     

Detailed per-oral small bowel examination vs. enteroclysis. Part II: Radiographic accuracy

Accuracy of the detailed per-oral small bowel series and enteroclysis was compared in 134 patients known to have (or not have) disease of the small bowel. Overall sensitivity of the per-oral examination was 92% and specificity 94%, compared to 94% and 89%, respectively, for enteroclysis. There was no difference between the two in Crohn disease, adhesions, and metastatic disease; however, enteroclysis was thought to be more effective in delineating peritoneal adhesions in patients with obstruction. The authors conclude that while the per-oral study and enteroclysis are equally valid methods of examining the small bowel, the per-oral study is preferable as a screening examination because it requires less time, has fewer side effects, and involves a lower radiation exposure.     

Bacteremia during double-contrast barium enema examination

Forty-five patients undergoing double-contrast barium enema examinations were studied to identify the incidence of transient bacteremia associated with the examination. Blood cultures were obtained immediately prior to the examination and at 5, 10, and 20 minutes after the start of the examination. Blood samples were cultured in both aerobic and anaerobic media, and four of these cultures were positive for organisms that are common skin contaminants. No bacteremia was identified from enteric pathogens. The data herein suggest that patients with cardiac valvular disease are not at greater risk of bacteremia during double-contrast barium enema examinations.     

Thoracic wall involvement by Hodgkin disease and non-Hodgkin lymphoma: CT evaluation

Thoracic computed tomographic (CT) scans of 250 patients with newly diagnosed or recurrent lymphoma revealed thoracic wall involvement in 24 patients (11 with Hodgkin disease, 13 with non-Hodgkin lymphoma). Thoracic wall involvement occurred without contiguous mediastinal or parenchymal involvement in 17 patients. Of these, 13 patients had masses beneath the pectoralis muscles or within the breast, and four had masses arising from the ribs. Five additional patients had mediastinal masses with thymic involvement and parasternal extension through the thoracic wall. Pulmonary parenchymal lymphoma with thoracic wall invasion was noted in the remaining two patients. In five of nine patients receiving radiation therapy, treatment plans were modified by CT demonstration of thoracic wall lymphoma.     

Vertebral-body collapse in focal and diffuse disease: patterns of pathologic processes

The radiographic patterns of vertebral-body collapse and/or endplate deformity were examined in 99 autopsy specimens of the thoracolumbar spine with benign and malignant disease. Angling of endplates was found to be highly predictive of underlying malignancy, whereas concavity was more suggestive of benign disease, for both individual vertebral bodies and intact spines (P less than .001). Diffuse-concave, diffuse-angled, and focal-angled patterns were more useful (P less than .001) than the focal-concave pattern (P = .07) in distinguishing between benign and malignant disease for superior endplates, whereas all were equally useful (P less than .025) in inferior endplates. Condition of the adjacent disks, location within the spine, and position of the apex of collapse were not predictive. Although these results and subsequent blinded testing suggest that reliable distinction between benign and malignant vertebral collapse is possible, extrapolation to clinical practice may be inappropriate because of population bias in the study and differences in radiographic quality between autopsy specimens and live subjects.     

Does the perception of downloading speed influence the evaluation of web-based lectures?

Medical schools put little emphasis upon education on public health, even though public health has played an important role in this century. One way to harness its benefit in order to improve global health in the 21st century is to globally share lectures on public health through the Internet. We have developed the Supercourse comprising of web-based learning modules on epidemiology in a standardized format with the size of each web page less than 10 kilobytes. A cross-sectional observational study was conducted to investigate the association of the perception of the access speed to Web-based lectures by teachers with their perception of lecture quality. There were 223 teachers who rated the lectures: 72% were from North America or Western Europe, 40% had taught epidemiology, and 14% reported that the speed of access was slow. Odds ratio of above-average rating among those who reported that the speed of access was fast relative to those who reported that the speed of access was slow was 4.25 (2.03-8.91; P = 0.001). The odds ratios were similar and significant after taking into account several other factors, including the variation of rating across lectures, region, and experiences in teaching epidemiology. The results indicate that the perception of the quality of Web-based lectures is related to the speed of access to a web page. The speed of access may be as important, if not more important, as the content itself. This suggests that, to share educational materials on the Web globally for teachers, one must consider not only the content, but also how people at local sites gain access to the Internet.     

Non-invasive trigeminal evoked potentials: normative aging data

A mild electric shock applied to the lower lip was used to elicit reliable evoked potentials from the trigeminal nerve in 50 normal adults who ranged in age from 20 to 69 years. The waveforms were morphologically similar to those observed with invasive procedures. No substantial effects for subject age, side of stimulation, or recording electrode were obtained for any of the individual trigeminal evoked potential amplitudes or latencies. Female subjects tended to have somewhat larger amplitudes and shorter latencies than male subjects. The results suggest that non-invasive procedures produce reliable evoked potential measures of trigeminal nerve function for patients of all ages.     

Demographic characteristics and prevalence of serologic markers among donors who use the confidential unit exclusion process: the Retrovirus Epidemiology Donor Study

BACKGROUND: Most blood centers utilize a confidential unit exclusion (CUE) process, intended to reduce the risk of transfusion-associated infectious diseases by allowing high-risk donors confidentially to exclude their blood from use for transfusion. The effectiveness of this method remains controversial. STUDY DESIGN AND METHODS: Confirmatory or supplemental test results for antibodies to human immunodeficiency virus, human T-lymphotropic virus type I, and hepatitis C virus, as well as hepatitis B surface antigen and syphilis and screening test results for antibodies to hepatitis B core (antigen) and alanine aminotransferase levels were obtained for approximately 1.8 million units donated during 1991 and 1992 at five blood centers within the United States. The prevalences of these infectious disease markers in units that the donors confidentially excluded (CUE+) and units that the donors did not exclude (CUE-) were calculated and examined within demographic subgroups. RESULTS: Units that were CUE+ were 8 to 41 times more likely to be seropositive for antibodies to human immunodeficiency virus and hepatitis C virus, hepatitis B surface antigen, and syphilis and three to four times more likely to react for antibody to hepatitis B core (antigen) or to have elevated alanine aminotransferase levels than units that were CUE- (p < 0.001). The positive predictive value of CUE (the percentage of CUE+ units that were confirmed seropositive for any marker) was 3.5 percent, and the sensitivity of CUE (the percentage of confirmed-seropositive units that were CUE+) was 2.3 percent. CONCLUSION: The current CUE process has low sensitivity and apparently low positive predictive value, and in many cases, it appeared that donors misunderstood it. Yet, CUE was not a “random process,” as CUE+ units were more likely to be seropositive for any infectious disease marker than CUE- units. This suggests that efforts to improve the CUE system may be warranted. As risk factors for transfusion-transmitted infection become more difficult to identify by history-based screening, however, such efforts may have limited effect.