Local strain and damage mapping in single trabeculae during three-point bending tests

The use of bone mineral density as a surrogate to diagnose bone fracture risk in individuals is of limited value. However, there is growing evidence that information on trabecular microarchitecture can improve the assessment of fracture risk. One current strategy is to exploit finite element analysis (FEA) applied to 3D image data of several mm-sized trabecular bone structures obtained from non-invasive imaging modalities for the prediction of apparent mechanical properties. However, there is a lack of FE damage models, based on solid experimental facts, which are needed to validate such approaches and to provide criteria marking elastic-plastic deformation transitions as well as microdamage initiation and accumulation. In this communication, we present a strategy that could elegantly lead to future damage models for FEA: direct measurements of local strains involved in microdamage initiation and plastic deformation in single trabeculae. We use digital image correlation to link stress whitening in bone, reported to be correlated to microdamage, to quantitative local strain values. Our results show that the whitening zones, i.e. damage formation, in the presented loading case of a three-point bending test correlate best with areas of elevated tensile strains oriented parallel to the long axis of the samples. The average local strains along this axis were determined to be (1.6±0.9)% at whitening onset and (12±4)% just prior to failure. Overall, our data suggest that damage initiation in trabecular bone is asymmetric in tension and compression, with failure originating and propagating over a large range of tensile strains.     

Clinical outcome of nutrition-oriented intervention for primary intestinal lymphangiectasia

Background  

Primary intestinal lymphangiectasia (PIL) is a rare digestive disease and few studies have focused on the therapeutic effect in PIL patients. This study was undertaken to evaluate nutrition-oriented intervention in children with PIL.     

Severe feeding disorder and malnutrition in 2 children with autism

Leanna, a 10-year-old girl with autism, was hospitalized for severe malnutrition and 20 pound weight loss secondary to reduced intake over 4 months. Her food choices became increasingly restrictive to the point where she only ate certain types and brands of foods. She gradually stopped drinking and developed severe constipation and encopresis. A new behavior of collecting saliva in her mouth and spitting onto napkins also emerged. Vital signs and electrolytes were normal on admission. A nasogastric tube was placed because she refused to eat. A behavior modification plan was implemented that awarded points for completing specific tasks related to feeding, which could later be redeemed for specific rewards, such as computer time. Although her ideal body weight increased from 68% to 75% (due to continuous nasogastric tube feeds), her refusal to eat persisted. Upon further data gathering, the staff learned that she moved and changed schools 5 months ago. She was cared for by either a family friend or paid caregiver while her mother worked. Although she could conduct basic self-care activities without assistance and write and draw at a third-grade level, she functioned cognitively at a 4-year-old level. The behavior plan was modified, breaking the tasks into shorter components with immediate and tangible rewards. She soon began eating small portions of food and spitting less frequently. Toileting was later incorporated into this plan. She was referred to a behavioral therapist in the community to work with her at home and school. Weekly visits with her pediatrician and appointments with a child psychiatrist and dietician were made. Orlando, a 3-year-old boy with autism, was evaluated in the emergency room for lethargy and generalized edema for 6 weeks. The history revealed a restrictive diet of commercial pureed fruit and coconut juice for 2 years. He only ate a particular brand and with specific containers; the limited food intake occurred only with his favorite blanket. He refused to eat other types of food. Outpatient treatments were unsuccessful. On physical examination, he was irritable with an erythematous, scaly rash throughout his body. His hair was thin, coarse, and blonde. He had nonpitting edema in his arms, legs, and periorbital region. The laboratory evaluation was significant for anemia, hypoalbuminemia, and hypoproteinemia. He was admitted to the pediatric service where nutritional formula feedings were initiated through a nasogastric tube. Weight gain was adequate, and the hemoglobin, serum albumen, and protein became normal. The rash improved with zinc supplementation. He was transferred to an inpatient feeding disorders unit where a team of occupational therapists implemented a behavioral modification program to overcome his severe food aversion.     

Comparison of the effect of two different doses of recombinant gonadotropin for ovarian stimulation on the outcome of intrauterine insemination

ObjectiveThe aim of this study was to identify an optimal stimulation protocol for intrauterine insemination (IUI) to obtain an acceptable pregnancy rate and low frequency of multiple pregnancies.Materials and MethodsIn total, 340 patients, who received intrauterine insemination because of ovulation dysfunction, were enrolled in this study. Group I consisted of 203 patients who received recombinant FSH (r-FSH) 150 U every other day as an ovulation induction agent. Group II consisted of 137 patients who received r-FSH 100 U every other day as an ovulation induction agent. All patients in both groups also received clomiphene citrate 100 mg/day for consecutive five days from the fifth day of the cycle. Only patients with at least two follicles >18 mm on the human chorionic gonadotropin injection days were included in this study.ResultsThe clinical pregnancy rate was 14.8% (30/203) in Group I compared with 20.4% (28/137) in Group II, p > 0.05. The incidence of multiple pregnancy was 41.7% (10/24) in Group I compared with 12.5% (3/24) in Group II, p < 0.05.ConclusionsThe concurrent use of low-dose r-FSH and clomiphene citrate would seem not only to be cost-effective but also highly satisfactory in that it prevents high-order multiple pregnancies.     

Johanson-Blizzard综合征一例及文献复习

目的 提高对Johanson-Blizzard综合征(JBS)的临床和诊断特点的认识.方法 讨论1例患儿的临床表现及诊断过程,运用基因检测的结果对诊断加以明确.并综合其他28例有详细临床资料的病例进行分析.结果 本例为女性,1岁9个月,以"脂肪泻"收治入院,出生后伴有肛门闭锁、鼻翼发育不全.现生长发育落后,智力发育落后,伴有头发稀疏及少牙畸形;便常规镜检脂肪球(++),血脂肪酶、淀粉酶及胰岛素、C肽水平偏低;腹部CT扫描见胰腺组织为脂肪组织替代;UBRI基因检测发现杂合错义突变,确诊JBS.在包括本例共计29例病例分析中,胰腺外分泌功能不全和鼻翼发育不全最为常见,分别为21例(72.4%)和27例(93%);18例(62%)伴有生长发育异常;17例(59%)伴有神经性听觉减退或丧失;头皮缺损和头发稀疏或异常卷曲分别有20例(69%)和13例(44.8%);甲状腺功能低下13例(44.8%);牙齿畸形13例(44.8%);肛门闭锁6例(21%).但是近亲结婚并不常见(3/29,10.3%).结论 JBS是一种罕见的、伴有独特先天性多发畸形的遗传性疾病,其特征表现是先天性胰腺外分泌不足伴有鼻翼发育不全或缺失,可以通过典型临床表现及UBRI基因检测加以明确.

Abstract：

Objective To study the clinical characteristics and diagnosis of the Johanson-Blizzard syndrome. Method The clinical characteristics and diagnosing procedure of 1 case with Johanson-Blizzard syndrome were analyzed, and genetic analysis was made in diagnosing procedure, and 28 cases of JohansonBlizzard syndrome with detailed clinical data were reviewed and analized. Result A one year and nine months old girl, who was initially admitted to the hospital because of fatty diarrhea and increased frequency of defecation. Imperforate anus, and aplastic alae nasi was noticed after birth. On physical examination,short stature, mental retardation, tooth abnormalities and scalp defects were observed. Fat globule was found by routine stool test. Serum biochemistry showed an exocrine and endocrine pancreatic insufficiency, CT scan of the abdomen demonstrated fatty replacement of the pancreas, UBRI gene analysis showed heterozygous for two missense changes. In all 29 cases, exocrine pancreatic insufficiency ( 72. 4% ) and hypoplasia of the alae nasi ( 93% ) were the most common clinical manifestations, and sensorineural hearing 1oss(59% ), scalp defects (69%) and hair thinning or upsweep of the hair (44. 8% ), hypothyroidism (44. 8% ), absence of permanent teeth (44. 8% )and imperforate anus(21% ) were also very common, but did not include consanguineous marriage of paerents( 10. 3% ). Conclusion Johanson-Blizzard syndrome is a rare autosomal recessive multisystem disorder, it is characterized by the association of congenital exocrine pancreatic insufficiency and hypoplasia or aplasia of the nasal wings, and can be diagnosed by clinical characteristics and UBRI gene analysis.     

喉部分切除术后复发癌的外科挽救治疗

目的 分析喉部分切除术后喉复发癌的外科治疗方法、预后及影响预后的因素.方法 回顾分析中国医学科学院肿瘤医院头颈外科77例喉部分切除患者术后喉复发癌再行外科挽救治疗的临床资料.其中51例行喉全切除术,26例行喉部分切除术,其中19例无放疗史者行手术加放疗的综合治疗.Kaplan-Meier法统计生存率,Cox多因素分析影...