Verringerung des plantaren Spitzendrucks beim Diabetiker durch Verkürzung der Schrittlänge

Plantar peak pressure is a diagnostically significant parameter for the evaluation of the risk of foot ulceration in patients with diabetic neuropathy. The prophylaxis and therapy of the diabetic foot therefore is to a large extent oriented on peak pressure, and is aimed at an extensive reduction in this parameter. This is mainly accomplished with protective footwear including shoe modifications and cushioning. In comparison, other approaches affecting the loading and motion pattern of the patient are of minor importance--as for example control of gait pattern. In this study we examined shortening of stride length as a possible measure in reducing plantar peak pressure during gait. In 17 diabetic patients without acute foot ulcerations, stride length was reduced to 33% of leg length using an elastic hobble. This led to a reduction in stride length of 23%. At the same time, the walking speed was significantly reduced by 27% and the cadence by 5.7%. As a consequence, the peak pressure was reduced in nearly all regions of the foot--except the small toes. In the metatarsal region peak pressure is reduced by 14.5%. Thus, a reduction in stride length offers the possibility of reducing plantar peak pressure as a supplementary measure in addition to orthopaedic footwear. However, at present clinical feasibility has not yet been established.     

Die fußentlastende Unterschenkelorthese und ihre klinische Anwendung bei Patienten mit diabetisch-neuropathischer Osteoarthropathie

Zusammenfassung Im täglichen Umgang mit Patienten mit diabetisch-neuropathischer Osteoathropathie (DNOAP) wird anamnestisch häufig über prolongierte Verläufe der therapeutischen Behandlung berichtet, die z. T. durch unrichtige Diagnosestellung, aber auch durch unzureichende orthopädietechnische Versorgungen bedingt sind. Klassisch ist die unerkannte Osteoarthropathie, die fälschlicherweise als Osteomyelitis gedeutet wird. Folglich werden den Patienten nach frustanen Therapieversuchen und bei Persistenz der klinischen Symptomatik nicht selten Amputationen angeboten, die zur Erhöhung der Sicherheit des Behandlungsergebnisses weit proximal der knöchernen Läsionen erfolgen. Dass bei Major-Amputationen sich statistisch signifikant die Lebensdauer der Patienten verkürzt, ist bei der Indikation zur Amputation in aller Regel nicht Bestandteil der Entscheidungsfindung. Beinerhaltende orthopädisch-chirurgische Verfahren müssen zum Erhalt der Lebensqualität, orthopädietechnische und orthopädieschuhtechnische Versorgungen zum Erhalt der Mobilität Vorrang haben, bevor die Indikation zur Amputation bei DNOAP-Patienten gestellt wird.Die dargestellten klinischen Beispiele sollen ermutigen, die in der Klinik und Poliklinik für Technische Orthopädie und Rehabilitation propagierten Behandlungskonzepte auch anderenorts zu etablieren, um dazu beizutragen, unnötige Amputationen zu vermeiden.     

Radiologische und klinische Aspekte der diabetisch-neuropathischen Osteoarthropathie

AIMS: The clinical and radiological observation of patients with neuroarthropathy was carried out with the aim of determining the most significant factors and risk factors involved. METHODS AND MATERIALS: From January 1998 to December 2000, 53 patients between 29 and 79 years of age were treated in the Clinic for Technical Orthopedics for diabetic-neuropathic osteoarthropathy (DNOAP) of the foot. A comparison was made between the retrospective data for conservative and surgical treatments. RESULTS: Almost 90% of the effected patients were of working age, which is an indication of the socioeconomic consequences of DNOAP. The mean age of the diabetics was 30.3 years for diabetes mellitus type 1 and 14.6 years for type 2. Overweight was a possible risk factor for the development of orthoarthropathic lesions, in particular at the rear of the foot. An additional risk factor was the presence of claw toes. Taking the radiological data into consideration, DNOAP of the foot can be seen as a dynamic illness that is not adequately dealt with in the commonly used Sanders' classification. In the case of proximal lesions, the number of additional DNOAP changes on the same foot was more than for distal lesions. A possible explanation is the microtrauma of neighbouring bones due to changes in the statics and biomechanics of the foot. Our results indicate that type 1 diabetes plays a particularly important role. Contrary to the other forms of DNOAP, Sanders type 1 is associated with atrophic-destructive changes to the bone. In our cohort, pAVK and ulcers were common with Sanders type 1 diabetes, and overweight appeared to be insignificant. CONCLUSIONS: Our results are a plea for an early, consequent and stage specific treatment of DNOAP in order to prevent the advance of bone destruction. The clinical and radiological course show that a lasting clearance of ulcers, the removal of necrosis and the repositioning of luxations by suitable stabilisation promote healing in DNOAP.     

进展期胃癌淋巴结转移与临床病理特征的关系

目的：探讨进展期胃癌淋巴结转移与临床病理特征的关系，为临床上进行合理的淋巴结清扫提供依据。方法：对55例进展期胃癌资料进行回顾性分析，术后常规解剖原发灶及各组淋巴结，并标记和计数，分析肿瘤部位、肿瘤大小、浸润深度、分化程度及Lauren分型与淋巴结转移率的关系。结果：进展期胃癌淋巴结转移率为74．5％；U、M、L区及全胃癌淋巴结转移率为85．7％、87．5％、67．6％和83．3％，各区和全胃癌淋巴结转移率差异无统计学意义（P〉0．05）；浆膜受侵的胃癌淋巴结转移率为82．5％，明显高于浆膜未受侵者（53．3％）（P〈0．05）；弥漫型胃癌淋巴结转移率为83．3％，明显高于肠型（64．0％）（P〈0．05）；直径〉5cm癌灶淋巴结转移率为90．0％，明显高于直径≤5cm的胃癌患者（65．7％）（P〈0．05）；浸润深度、Lauren分型和肿瘤大小是影响淋巴结转移率的主要因素，其中浸润深度为独立影响因素。结论：术中淋巴结清扫范围应结合肿瘤部位、肿瘤大小、浸润深度、分化程度及Lauren分型做出判断，并考虑患者的全身情况，合理选择淋巴结清扫范围。     

Synergism of atenoloi and nitrendipine on hemodynamic amelioration and organ protection in hypertensive rats

OBJECTIVE： This study was designed to investigate the possible synergism of atenolol and nitrendipine on blood pressure （BP） and blood pressure variability （BPV） reductions, baroreflex sensitivity （BRS） amelioration, and organ protection in hypertensive rats. METHOD： The dose was 20 mg/kg for atenolol, 10 mg/kg for nitrendipine and 20 ＋ 10 mg/kg for the combination of these two drugs. In an acute study, a single dose was given via a catheter previously inserted into the stomach in spontaneously hypertensive rats （SHR）.     

一阶导数光谱法测定复方红甲凝胶中乳糖酸红霉素的含量

建立测定复方红甲凝胶中乳糖酸红霉素的含量测定方法。方法：以一阶导数光谱的谷一零位值法测定乳糖酸红霉素的含量,测定波长λ谷=490±lnm。结果：回收率100.6％,RSD为3.1％,线性范围40～120μg／ml。结论：方法简便,结果准确,重现性好,适合于该制剂的含量测定。     

Altered metabolism of familial Alzheimer's disease-linked amyloid precursor protein variants in yeast artificial chromosome transgenic mice

Missense mutations in the beta-amyloid precursor protein gene (APP) co- segregate with a small subset of autosomal dominant familial Alzheimer's disease (FAD) cases wherein deposition of the 39-43 amino acid beta-amyloid (A beta) peptide and neurodegeneration are principal neuropathological hallmarks. To accurately examine the effect of missense mutations on APP metabolism and A beta production in vivo, we have introduced yeast artificial chromosomes (YACs) containing the entire approximately 400 kbp human APP gene encoding APP harboring either the asparagine for lysine and leucine for methionine FAD substitution at codons 670 and 671 (APP(K670N/M671L)), the isoleucine for valine FAD substitution at codon 717 (APP(V7171)) or a combination of both substitutions into transgenic mice. We demonstrate that, relative to YAC transgenic mice expressing wild-type APP, high levels of A beta peptides are detected in the brains of YAC transgenic mice expressing human APP(K670N/M671L) that is associated with a concomitant diminution in the levels of apha-secretase-generated soluble APP derivatives. Moreover, the levels of longer A beta peptides (species terminating at amino acids 42/43) are elevated in YAC transgenic mice expressing human APP(V7171). These mice should prove valuable for detailed analysis of the in vivo effects of the APP FAD mutations in a variety of tissues and throughout aging and for testing therapeutic agents that specifically alter APP metabolism and A beta production.      

Cloning and characterization of DXS6673E, a candidate gene for X-linked mental retardation in Xq13.1

In several families with non-specific X-linked mental retardation (XLMR) linkage analyses have assigned the underlying gene defect to the pericentromeric region of the X chromosome, but none of these genes have been isolated so far. Here, we report on the cloning and characterization of a novel gene, DXS6673E, that maps to Xq13.1, is subject to X-inactivation and is disrupted in the 5' untranslated region by a balanced X;13 translocation in a mentally retarded female. The DXS6673E gene is highly conserved among vertebrates and its expression is most abundant in brain. It encodes a hydrophilic protein of 1358 amino acids (aa) that does not show sequence homology to other known proteins. A segment of this protein consisting of neutral and hydrophobic aa with a proline residue in every second position may represent a transmembrane domain. Almost complete sequence identity was found between the 3' end of the DXS6673E gene and two expressed sequence tags (ESTs) and between the 5' end of the DXS6673E gene and a third EST. Moreover, weaker sequence similarity was observed between coding regions and two other ESTs.