Chronic venous leg ulcers benefit from surgery: long-term results from 173 legs

OBJECTIVE: The purpose of this retrospective study was to present 7 years of data from operations of currently active, chronic venous leg ulcers (CEAP: C6), focusing on the short- and long-term effects of healing and recurrence and considering concomitant risk factors. METHODS: Between January 1997 and March 2004, 173 patients (239 legs) with a currently active, chronic venous leg ulcer were surgically treated. The surgical procedures included two main steps: (1) the surgical interruption of reflux in the superficial and perforating veins to reduce venous hypertension in the entire leg and/or the affected area and (2) the surgical procedure involving the ulcer. A total of 123 patients (173 legs) who came to the follow-up were examined. The follow-up period ranged from 3 months to 7 years. The data collection integrated a preoperative examination that included medical history and clinical diagnoses and incorporated measurements such as body mass index, ankle-brachial pressure index, and the neutral position method at the follow-up. The function of the veins was measured with duplex ultrasonography. Finally, the data were analyzed by using various statistical methods, including Kaplan-Meier analysis, Cox regression analysis, and paired t tests. RESULTS: Initially, ulcer healing occurred in 87% of the cases (151 legs). A total of 13% (22 legs) of the venous ulcers never healed, and recurrent venous ulcers occurred in 5% (9 legs). The Kaplan-Meier analyses of ulcer healing showed a healing rate of 85% in 6 months for all legs. The mean time of healing was 1.5 months. Furthermore, the Kaplan-Meier analyses of ulcer recurrence showed a 1.7% rate of recurrence in 6 months for all legs. The 5-year ulcer recurrence rate was 4.6%. The mean time of recurrence was 70.4 months. CONCLUSIONS: On the basis of the results from the 7 years of data from functional surgery of venous leg ulcers and as a result of the outcomes of our study, we recommend surgical treatment of venous leg ulcers at any stage. We therefore conclude that surgery is indicated before an ulcer is intractable to treatment. In general, our findings are based on the understanding and identification of the causes and symptoms of venous ulceration and illustrate that standard surgical methods can be applied for the therapy of venous leg ulcers at any stage.     

中国女性轻度认知障碍的影响因素及其与绝经症状的关系

目的 调查中国女性轻度认知障碍(mild cognitive impairment, MCI)的影响因素及其与各种典型绝经症状之间的关系。方法 采用蒙特利尔认知评估量表(Montreal Cognitive Assessment , MoCA)评估150名志愿者的认知功能,将其中患有轻度认知障碍的61例患者作为病例组(MCI组),认知功能正常的89例患者作为对照组(Non-MCI组)。收集临床、社会人口学和人体测量学数据,用改良Kupperman评分表(Modified Kupperman Index, KMI)评估绝经症状。两组间比较应用t检验和χ²检验。采用二元Logistic回归模型筛选轻度认知功能障碍的危险因素。结果 单因素分析显示,两组患者间年龄(P=0.001)、教育水平(P=0.001)、KMI评分(P <0.001)、失眠(P=0.033)与轻度认知功能障碍有关。多因素分析显示,对于年龄不超过55岁的患者,失眠(P=0.032)、头痛(P=0.021)是MCI的独立危险因素,高教育水平(P=0.004)是MCI的独立保护性因素。结论 各种更年期症状与MCI之间明确关联,这可能为预防痴呆症提供了新的方向。     

Study of thymic factors. II. Failure of thymosin to alter the natural history of nzb and nzb/nzw mice

The effects of daily injections of thymosin, bovine fraction V, on the natural history of NZB and NZB/NZW F₁ mice were investigated. With the use of several dose schedules, no significant differences were discovered in treated versus control groups when survival, autoantibodies, and mitogen responsiveness were compared. These results provide further evidence that thymosin may have little or no role in the treatment of the autoimmune disease of New Zealand mice. More encouraging research in thymic extracts and their measurement is necessary before clinical trials in SLE are considered.     

Smoking and Carboxyhemoglobin in the St. Louis Metropolitan Population

The most important source of carbon monoxide (CO) exposure is smoking. If a person smokes and inhales, the carboxyhemoglobin (COHb) level in his blood is due primarily to smoking, and other sources of CO exposure are relatively unimportant. The COHb data for smokers are analyzed by type of smoking, sex, and whether or not the subject has an industrial occupation. Data indicate that men and women who smoke at the same rate reach the same equilibrium level of COHb, but women achieve lower COHb levels after ceasing smoking for the day. Restriction or elimination of cigarette smoking makes the most sense for protecting the atherosclerotic population from chronic CO exposure.     

Ultrasound can Modulate Neuronal Development: Impact on Neurite Growth and Cell Body Morphology

Neuronal development is known to be a dynamic process that can be modulated by presenting guidance cues to neuronal cells. We show that ultrasound, when applied at pulsed settings and with intensities slightly greater than clinical diagnosis levels, can potentially act as a repulsive cue for modulating neuronal growth dynamics. Using differentiated Neuro-2a cells as the model, we have examined in vitro how neuronal development can change during and after exposure to 1-MHz ultrasound for different acoustic settings. Neurite retraction and cell body shrinkage were found in neuronal cells over a 10-min exposure period with 1.168 W/cm² spatial-peak, time-averaged intensity (based on 0.84 MPa peak acoustic pressure, 100-cycle pulse duration, and 500-Hz pulse repetition frequency). These effects were found to result in instances of neuronal cell body displacement. The extent of the effects was dependent on acoustic intensity, with peak acoustic pressure being a more important contributing factor compared with pulse duration. The morphological changes were found to be non-destructive, in that post-exposure neurite outgrowth and neuritogenesis were respectively observed in neurite-bearing and neurite-less neuronal cells. Our results also showed that mechanotransduction might be involved in mediating ultrasound-neuron interactions, as the morphological changes were suppressed if stretch-activated ion channels were blocked or if calcium messenger ions were chelated. Overall, these findings suggest that ultrasound can potentially influence how neuronal cells develop through modifying their cytomechanical characteristics.