Musculoskeletal manifestations of diabetes mellitus

Rheumatic complaints are common in patients with diabetes. Maintaining good glycaemic control by exercise, diet, and medication improves or prevents the development of rheumatic conditions.     

Low-level chronic mercury exposure in children and adolescents: Meta-analysis

BACKGROUND: Mercury is a well-known neurotoxin. There are three kinds of mercury exposure: elemental mercury poisoning, inorganic mercury poisoning and organomercury poisoning. Organomercury is the most toxic. Twenty-four hour urine for mercury and blood mercury are the gold standards for diagnosis of mercury poisoning, including low-level chronic mercury exposure. Other tests for mercury level are discussed. The purpose of the present paper was to review recent data on the nature, pathophysiology, pharmacokinetics, diagnostic methods, treatment and the linkage to neurodevelopmental disabilities of mercury exposure in children. METHODS: A literature search was undertaken of MEDLINE (1980-2003), and American Academy of Pediatrics, American Medical Association, American Dental Association, World Health Organization and Center for Disease Control websites. The search string 'mercury' was used in MEDLINE and articles were selected as appropriate by two independent reviewers. All relevant information was reviewed and data were extracted by two independent reviewers. RESULTS: Based on the meta-analysis of the accuracy of hair mercury, hair mercury levels correlated with mercury level in blood (sample size weighted correlation coefficient, r w = 0.61), with 24 h urine ( r w = 0.46) and with cord blood ( r w = 0.64). However, the correlation for hair mercury level with 24 h urine level and blood level was not high enough to replace them in clinical decision-making of individual patient. Epidemiological evidence has shown that low-level mercury poisoning is not a cause of autism (relative risk = 0.49, 95%CI = 0.36-0.66). The risk of neurodevelopmental disabilities from low-level exposure to methylmercury from the regular consumption of fish is still controversial even after combining results from different epidemiological studies worldwide. There is a lack of data in the literature about the effect of chelation therapy in children with neurodevelopmental disabilities. CONCLUSION: Mercury poisoning should be diagnosed only with validated methods. There is no evidence to support the association between mercury poisoning and autism.     

Angiographic and Clinical Outcomes of Everolimus‐Eluting Stent in the Treatment of Extra Long Stenoses (AEETES)

Objectives

The purpose of this study was to examine the angiographic and clinical results of stent full metal jacket in treating long lesions using everolimus‐eluting stents (EES).

Background

Data are lacking regarding the use of EES for this lesion subgroup.

Methods

From 2007 to 2011, 77 symptomatic patients who had severe coronary stenoses necessitating implantation of stents with total length longer than 60 mm were treated with overlapping EES.

Results

The mean age of patient was 61 ± 11 years with male predominance (66%). Diabetes mellitus was seen in 35 (45.5%) patients. Majority of patients had class III angina with normal heart function. On average, 3.1 stents were implanted per lesion; the mean stent size and length were 2.70 ± 0.28 mm and 82 ± 16 mm. Restudy angiography was performed on 71 patients (72 lesions) at 8.9 ± 2.5 months. Angiographic restenosis was seen in 9 (12.5%) lesions; the lesion length and late loss were 67 ± 15 mm and 0.4 ± 0.6 mm, respectively. The use of intravascular ultrasound has been found to be a predictor of less restenosis (P = 0.02; HR: 0.02; CI: 0.01–0.59). The in‐hospital and 1 year major adverse cardiac event rates were 7.8% and 13%. The annual cardiac death rates were 2.6%, 3.4%, and 5.3% in the first 3 years.

Conclusions

The use of EES full metal jacket for long lesions is only associated with good short‐term clinical and angiographic outcomes. Long‐term follow‐up has revealed a high cardiac death rate which may necessitate prolongation of dual antiplatelet therapy. (J Interven Cardiol 2013;26:22–28)

     

Serum soluble interleukin-2 receptors and tumor necrosis factor-α in hematological malignancies of childhood

The levels of soluble interleukin-2 receptors (sIL-2R) and tumor necrosis factor (TNF) were determined in the serum of 61 children with hematological malignancy, including 20 patients with leukemia and 16 with lymphoma in active state of malignancy, and 20 patients with leukemia and 5 with lymphoma in complete remission. In addition, serum samples from 15 healthy children were used as controls. It was found that the mean serum levels of sIL-2R and TNF were significantly increased in active malignancy (207.0±17.1 pmol/L for sIL-2R; 209.7±35.0 pg/mL for TNF) compared to the remission status and normal controls (P<0.001). No such difference was observed between leukemia and lymphoma groups. It was concluded that serum sIL-2R and TNF are of potential value in the diagnosis and follow up of patients with neoplastic diseases.     

Fractionated conformal radiotherapy in vestibular schwannoma: early results from a single centre

AimsTo assess the local control and cranial nerve toxicity in vestibular schwannoma patients treated with fractionated conformal radiotherapy delivered using a linear accelerator.Materials and methodsNinety-five patients were referred for consultation to the Oncology Department in Addenbrookes Hospital between 1996 and 2005. The 42 cases who received fractionated conformal radiotherapy are the subject of this analysis. All patients had radiological or symptomatic progression. Conformal radiotherapy was prescribed at 50 Gy in 30 fractions over 6 weeks, delivered using a linear accelerator. Patients were immobilised using either a beam direction shell or a Gill Thomas Cosman relocatable stereotactic head frame.ResultsThe median age was 63 years (range 28–81) with 57% men. The average tumour size was 21.5 mm on magnetic resonance imaging. Before treatment, 20 (48%) patients were deemed to have useful hearing on the affected side. The median follow-up was 18.6 months (range 0.3–6.5 years) and the actuarial local control rate at 2.5 years was 96.9% (one patient progressed after treatment). In previously hearing patients, the actuarial rate of useful hearing preservation was 100%, and the rate of mild hearing loss was 20% at 1 year and 26.7% at 2.5 years of follow-up. There were five neurofibromatosis type 2 patients treated, two of whom had useful hearing before radiotherapy. In one patient this was affected, with a 20 dB loss, although he still has useful hearing. In those with normal facial nerve function before radiotherapy (n = 40), this was preserved in 96.8% at 2.5 years. Trigeminal nerve function was preserved in all patients (n = 38) who had normal nerve function before radiotherapy.ConclusionAlthough follow-up was relatively short in this single institution series, fractionated linear accelerator radiotherapy gave excellent local control, useful hearing preservation and retained cranial nerve function in vestibular schwannoma.     

健康教育在控制糖尿病预防并发症发生中的积极作用

目的 探讨健康教育在控制及预防糖尿病,防止并发症发生中的积极作用.方法 将2009年6月至2010年6月入院治疗的96例糖尿病患者随机分为观察组与对照组各48例,对照组给予常规的治疗与发放糖尿病健康教育宣传手册,观察组在常规治疗的基础上,对患者实施健康教育,并对其进行认知、营养、行为等干预.对2组教育前、教育6个月后的疾病及并发症发生的总体控制情况及教育效果进行对比分析.结果 观察组患者的空腹血糖、餐后2h血糖值、糖化血红蛋白、体重指数以及并发症的发生率与对照组比较显著改善.结论 加强健康教育,可以提高患者的自护能力,有效地改善糖尿病的总体控制水平,更是减少糖尿病急、慢性并发症以及致残、致死率的重要途径.     

Left ventricular volumes measured by MR imaging

We assessed the potential of proton magnetic resonance (MR) imaging for accurately measuring left ventricular volumes using 15 latex casts of excised human left ventricles. The casts were submerged in water to stimulate the endocardial left ventricular cavity interface in in vivo imaging conditions. Tomographic image sections perpendicular to the long axis of the cast were obtained, spanning each cast from apex to base. Simpson's rule was used to calculate the cast volumes. Correlation between the actual cast volumes (as measured by the displacement method) and the calculated volumes using MR imaging for the 15 casts was excellent. Our data demonstrate that MR imaging accurately measures cardiac chamber volumes in this in vitro model.     

解淀粉芽孢杆菌对婴幼儿潜在致病性的研究

解淀粉芽孢杆菌属革兰阳性芽孢杆菌,可污染医院75%酒精消毒液、潮湿损害的房屋、食品,造成新生儿、婴幼儿等免疫力低下的特殊人群感染和房屋污染健康综合征。文章从细菌对环境、食品的污染、院内感染三个方面来阐述其流行状况,从细胞毒素对哺乳动物细胞的毒性来描述其毒理作用,从细菌的芽孢结构特点来证明其特殊的理、化特性,从国外同类菌属的疾病动物模型来进一步探讨其致病性,以期引起临床上的重视。     

中国人口婚姻挤压状况及对生育保健的挑战

目的分析中国1985-1999年的婚姻挤压方向、程度及变化趋势，为生育保健策略的制定提供依据。方法利用中国2000年第五次人口普查资料，计算男女终身不婚率及婚姻挤压指数。结果中国人口在19851999年15年间一直呈现为男性婚姻挤压，且挤压程度从1991年开始有所升高。结论应重视不能成婚的男性这一弱势群体，开展可行、有效的男性保健；同时，应针对女性开展防范性暴力的健康教育。     

高三酰甘油腰围表型与糖尿病前期及2型糖尿病发病风险的关系

摘要：目的探讨高三酰甘油（TG）腰围表型与糖尿病前期及2型糖尿病（T2DM）发病风险的关系。方法从参与2011年4—11月四川省泸州地区2型糖尿病患者肿瘤发生风险流行病学调查研究的基线调查者中筛选出1 722例糖耐量正常者,以血TG≥1.7 mmol/L、男性腰围≥90 cm或女性腰围≥80 cm为切点,分为TG和腰围正常组（856例）、单纯高三酰甘油血症组（133例）、单纯腹型肥胖组（518例）、高三酰甘油血症-腰围表型（HTWC）组（215例）,行5年随访观察,比较各组间糖尿病前期及T2DM发病情况。结果随访5年后,1 722例糖耐量正常者中共445例发展为糖尿病前期,67例发展为T2DM。TG和腰围正常组、单纯高三酰甘油血症组、单纯腹型肥胖组、HTWC组糖尿病前期发病率分别为20.7%（177/856）、21.1%（28/133）、30.5%（158/518）、38.1%（82/215）,T2DM发病率分别为2.9%（25/856）、3.8%（5/133）、4.4%（23/518）、6.5%（14/215）。在调整了年龄、性别、空腹血糖、餐后2 h血糖、收缩压、糖化血红蛋白后,多分类无序Logistic回归分析结果显示,HTGW表型人群的糖尿病前期及T2DM发病风险较正常组升高,其OR（95%CI）分别为1.961（1.387～2.773）与2.638（1.279～5.441）。结论HTWC表型是糖尿病前期及T2DM患病的危险因素,可作为筛选两者高风险人群的简便指标。