Increased circulating magnesium concentrations after Roux-en-Y gastric bypass surgery in patients with type 2 diabetes

Background

Low circulating magnesium concentrations predict cardiovascular and all-cause mortality in patients with type 2 diabetes (T2D). Epidemiologic and clinical studies have indicated lower extra- and intracellular magnesium concentrations in patients with diabetes.

Why do doctors in Norway choose general practice and remain there? A qualitative study about motivational experiences

Objective: To explore experiences motivating doctors to become and remain GPs.Design and contributors: Qualitative analysis of written responses from an open-ended question about motivational experiences posted on an internet discussion list for GPs in Norway. Texts from 25 contributors were analysed with Systematic Text Condensation, supported by theories about calling as motivation.Results: Analysis revealed numerous aspects of motivation to become and remain a general practitioner. Inspirations from early experiences and skilled role models had conveyed values and offered insight into a fascinating world of care, gratitude and respect. Close and continuous relationships with patients provided GPs with humbling experiences and learning moments. Contributors described how these encounters became rewarding sources of insight and mutual trust, improving interpersonal skills. Also, the extensive variety of tasks during the workday and the space for autonomy and independence was emphasised.Implications: Understanding motivational experiences influencing GPs’ choice of medical career is necessary to develop strategies for recruitment and stability and contribute to prevention of burn-out and improper work-life balance. GPs’ professional identities and commitments should be recognized and developed in dialogues between authorities and GPs to enhance communication, improve the structural frames of work environment and thereby sustainable recruitment.

Key points

• GPs regard their choice of medical career as strongly influenced by motivational experiences in childhood, adolescence and as medical students
• Role models, diversity of work, feelings of being able to contribute and rewarding and continuous relationships with patients were mentioned to activate and maintain general practice commitment
• Knowledge about motivational influences, professional identities and commitment for GPs is crucial for medical education and dialogue to promote general practice as a career choice and prevent dangers of work overload and burnout

     

Pediatric Cardiac Arrest Due to Trauma

Survival from pediatric cardiac arrest due to trauma has been reported to be 0.0%–8.8%. Some argue that resuscitation efforts in the case of trauma-related cardiac arrests are futile. We describe a successful outcome in the case of a child who suffered cardiac arrest caused by external traumatic airway obstruction. Our case illustrates how to deal with pediatric traumatic cardiac arrests in an out-of-hospital environment. It also illustrates how good clinical treatment in these situations may be supported by correct treatment after hospital admission when it is impossible to ventilate the patient to provide sufficient oxygen delivery to vital organs. This case relates to a lifeless child of 3–5 years, blue, and trapped by an electrically operated garage door. The first ambulance arrived to find several men trying to bend the frame and the door apart in order to extricate the child, who was hanging in the air with head and neck squeezed between the horizontally-moving garage door and the vertical door frame. One paramedic found a car jack and used it to push the door and the frame apart, allowing the lifeless child to be extricated. Basic life support was then initiated. Intubation was performed by the anesthesiologist without drugs. With FiO2 1.0 the first documented SaO2 was <50%. Restoration of Spontaneous Circulation was achieved after thirty minutes, and she was transported to the hospital. After a few hours she was put on venous-arterial ECMO for 5.5 days and discharged home after two months. Outpatient examinations during the rest of 2013 were positive, and the child found not to be suffering from any injuries, either physical or mental. The last follow-up in October 2014 demonstrated she had made a 100% recovery and she started school in August 2014.     

肝胆外科临床见习教学探讨

为适应培养现代高素质医学人才的需要,从加强理论联系实践、培养学员自主学习和解决问题的能力、全面提高学员综合素质等方面进行了积极的探索,并总结了改善肝胆外科见习教学质量和临床实践能力的具体做法。     

肺、结肠和直肠癌患者血清瘦素的表达及意义

目的研究肺癌、结肠癌和直肠癌患者血清瘦素（Leptin）的表达变化,探讨其与患者预后的关系。方法采集肺癌、结肠癌、直肠癌患者及正常对照者的血清样品,采用相应试剂盒检测血清Leptin、癌胚抗原的水平,采用全自动生化分析仪检测反映脏器功能、代谢功能的相关生化指标变化。结果与正常对照者相比,三种肿瘤患者血清Leptin显著升高,癌胚抗原、脏器功能指标和代谢指标均有不同程度变化。结论Leptin可能作为评价恶性肿瘤患者状况的新指标。     

联合疗法治疗女性外阴上皮内非瘤样病变临床观察

目的探讨高强度聚焦超声（HIFU）配合专用药物治疗女性外阴上皮内非瘤样病变的效果。方法将2006年1月～2011年1月在济南军区总医院妇产科就诊的女性外阴上皮内非瘤样病变376例分为两组,HIFU组75例,单独应用HIFU治疗,联合疗法组301例,采用HIFU联合局部专用药物治疗。以同期56例单纯应用传统药物治疗的同类疾病患者为对照组。设立＂外阴瘙痒评分法＂、＂外阴白色病变面积计算法＂、＂四象限比较法＂和＂四度皮肤弹性评估法＂判定疗效。结果①HIFU组与联合疗法组对控制各类外阴上皮内非瘤样病变瘙痒症状的疗效显著优于对照组（P〈0.05）,联合疗法组疗效更佳（P〈0.05）。②HIFU组与联合疗法组控制白色病变的总有效率均高于对照组（P〈0.05）。HIFU组、联合疗法组治疗后白色病变面积与本组治疗前比较显著减小（P〈0.01）。③HIFU组、联合疗法组符合外阴皮肤弹性不良标准的患者治疗后外阴局部皮肤弹性评分与治疗前比较差异均有统计学意义（P〈0.05,P〈0.01）,HIFU组、联合疗法组外阴局部皮肤弹性改善总有效率均显著高于对照组（P〈0.05）,联合疗法组疗效更佳（P〈0.05）。结论 HIFU联合局部专用药物治疗女性外阴上皮内非瘤样病变,对瘙痒症状、外阴局部皮肤弹性的改善及减小白色病变面积效果满意,并具有治疗方便、安全无创的优势。     

Parkinson's disease and nursing home placement: the economic impact of the need for care

Background and Purpose:  To examine the relative risk (RR) for living in nursing homes for patients with Parkinson's disease (PD) compared with the general population and to ascertain society's costs related to nursing home placement for this patient group.
Methods:  We evaluated the frequency of admission to nursing homes in a cross-sectional study and during a 12-year follow-up study of 108 patients with PD and 864 controls who were matched for age and sex. The RR for living in a nursing home was calculated at baseline and during follow-up. On the basis of 2007 prices, we estimated the costs per person year of survival for patients with PD and controls.
Results:  The RR for living in a nursing home at baseline was 5.0 for patients with PD and 4.8 during follow-up. Patients with PD caused 4.8 times higher costs for nursing home placement with euro 18 875 versus euro 3978 per individual and year. The annual costs for institutional care of patients with PD in Norway were euro 132 million.
Conclusion:  Patients with PD have a substantially higher risk for living in nursing homes than the general population. This causes high costs to society. Therapeutic interventions to prevent or delay nursing home admissions are therefore important.     

Leptin and leptin receptor genes in Atlantic salmon: Cloning, phylogeny, tissue distribution and expression correlated to long-term feeding status

The present study reports the complete coding sequences for two paralogues for leptin (sLepA1 and sLepA2) and leptin receptor (sLepR) in Atlantic salmon. The deduced 171-amino acid (aa) sequence of sLepA1 and 175 aa sequence for sLepA2 shows 71.6% identity to each other and clusters phylogenetically with teleost Lep type A, with 22.4% and 24.1% identity to human Lep. Both sLep proteins are predicted to consist of four helixes showing strong conservation of tertiary structure with other vertebrates. The highest mRNA levels for sLepA1 in fed fish (satiation ration = 100%) were observed in the brain, white muscle, liver, and ovaries. In most tissues sLepA2 generally had a lower expression than sLepA1 except for the gastrointestinal tract (stomach and mid-gut) and kidney. Only one leptin receptor ortholog was identified and it shares 24.2% aa sequence similarity with human LepR, with stretches of highest sequence similarity corresponding to domains considered important for LepR signaling. The sLepR was abundantly expressed in the ovary, and was also high in the brain, pituitary, eye, gill, skin, visceral adipose tissue, belly flap, red muscle, kidney, and testis. Fish reared on a rationed feeding regime (60% of satiation) for 10 months grew less than control (100%) and tended to have a lower sLepA1 mRNA expression in the fat-depositing tissues visceral adipose tissue (p < 0.05) and white muscle (n.s.). sLepA2 mRNA levels was very low in these tissues and feeding regime tended to affect its expression in an opposite manner. Expression in liver differed from that of the other tissues with a higher sLepA2 mRNA in the feed-rationed group (p < 0.01). Plasma levels of sLep did not differ between fish fed restricted and full feeding regimes. No difference in brain sLepR mRNA levels was observed between fish fed reduced and full feeding regimes. This study in part supports that sLepA1 is involved in signaling the energy status in fat-depositing tissues in line with the mammalian model, whereas sLepA2 may possibly play important roles in the digestive tract and liver. At present, data on Lep in teleosts are too scarce to allow generalization about how the Lep system is influenced by tissue-specific energy status and, in turn, may regulate functions related to feed intake, growth, and adiposity in fish. In tetraploid species like Atlantic salmon, different Lep paralogues seems to serve different physiological roles.