Small and large fiber sensory polyneuropathy in type 2 diabetes: Influence of diagnostic criteria on neuropathy subtypes

Diabetic polyneuropathy (DPN) can be classified based on fiber diameter into three subtypes: small fiber neuropathy (SFN), large fiber neuropathy (LFN), and mixed fiber neuropathy (MFN). We examined the effect of different diagnostic models on the frequency of polyneuropathy subtypes in type 2 diabetes patients with DPN. This study was based on patients from the Danish Center for Strategic Research in Type 2 Diabetes cohort. We defined DPN as probable or definite DPN according to the Toronto Consensus Criteria. DPN was then subtyped according to four distinct diagnostic models. A total of 277 diabetes patients (214 with DPN and 63 with no DPN) were included in the study. We found a considerable variation in polyneuropathy subtypes by applying different diagnostic models independent of the degree of certainty of DPN diagnosis. For probable and definite DPN, the frequency of subtypes across diagnostic models varied from: 1.4% to 13.1% for SFN, 9.3% to 21.5% for LFN, 51.4% to 83.2% for MFN, and 0.5% to 14.5% for non‐classifiable neuropathy (NCN). For the definite DPN group, the frequency of subtypes varied from: 1.6% to 13.5% for SFN, 5.6% to 20.6% for LFN, 61.9% to 89.7% for MFN, and 0.0% to 6.3% for NCN. The frequency of polyneuropathy subtypes depends on the type and number of criteria applied in a diagnostic model. Future consensus criteria should clearly define sensory functions to be tested, methods of testing, and how findings should be interpreted for both clinical practice and research purpose.     

摆幅可调型足部康复机器人的生物力学特性分析

目的基于人机工程学和生物力学仿真技术,对人体肌肉进行生物学评价,研究摆幅可调型足部康复机器人的康复策略。方法在Any Body中建立人体和摆幅可调型足部康复机器人的人机耦合模型,并对耦合模型进行运动学仿真,将仿真结果与理论计算结果相比,验证耦合模型的可靠性;再利用Any Body中的参数研究机制对验证后的耦合模型进行生物力学仿真,以足部康复机器人的运动速度和摆幅为变量,分析在不同变量组合下的肌肉活动度和肌肉力。结果在康复运动中足部相关肌肉的拉伸性能得到有效训练,不同的运动速度和摆幅对肌肉的影响不同,并得出运动速度和摆幅调节的安全范围。结论实现了不同运动速度和摆幅下肌肉活动度和肌肉力的组合分析,研究结果对足部康复机器人的临床应用和被动康复模式下康复策略的制订具有一定指导意义。     

中药热奄包联合耳穴压豆及针刺对急性胃肠炎患者症状的影响

目的 探讨中药热奄包联合耳穴压豆及针刺对急性胃肠炎患者症状的影响.方法 选取2018年12月—2020年11月就诊于某院的86例急性胃肠炎患者,根据不同干预方法分为对照组与观察组各43例.对照组给予常规护理干预,观察组在对照组基础上实施中药热奄包联合耳穴压豆及针刺等中医护理干预.对比两组患者症状改善时间、视觉模拟评分法(VAS)疼痛评分与康复效果.结果 观察组腹泻、呕吐、腹痛症状改善时间为(16.68±4.22)h、(14.28±3.50)h、(21.39±5.63)h,短于对照组的(20.87±5.01)h、(19.97±5.77)h、(28.49±6.11)h;干预3 d后,观察组VAS疼痛评分(1.62±0.47)分,低于对照组的(2.28±0.49)分;干预3 d后,观察组康复总有效率97.67％,高于对照组的81.40％,有统计学差异(P<0.05).结论 中药热奄包联合耳穴压豆及针刺干预可促进急性胃肠炎患者腹泻、呕吐等症状的改善,减轻疼痛症状,增强其身心康复效果.     

大黄素-8-O-β-D-葡萄糖苷的体内外遗传毒性评价

目的:评价大黄素-8-O-β-D-葡萄糖苷(EG)的体内外遗传毒性,并比较体外细胞试验及大鼠体内实验评价结果的差异。方法:采用体外二维(2D)、三维(3D)细胞培养法分别构建2D、3D HepaRG细胞模型,造模成功后,分别将2D、3D HepaRG细胞分为空白对照组[0.5%二甲基亚砜(DMSO)]、丝裂霉素C组(阳性对照,0.1μg/mL)和EG低、中、高剂量组(10、50、200μg/mL),然后检测各组HepaRG细胞的微核形成率和尾DNA百分含量。将SD大鼠分为空白对照组(0.5%羧甲基纤维素钠)、甲磺酸乙酯组(阳性对照,200 mg/kg)和EG低、中、高剂量组(100、300、1 000 mg/kg),每组6只,连续灌胃给药15 d,每天1次;15 d后检测各组大鼠骨髓嗜多染红细胞、肝细胞的微核形成率及外周血淋巴细胞、肝细胞的尾DNA百分含量、尾距。结果:在体外2D HepaRG细胞模型中,与空白对照组比较,丝裂霉素C组HepaRG细胞的微核形成率和尾DNA百分含量均显著升高(P<0.01),EG各剂量组HepaRG细胞的微核形成率和尾DNA百分含量差异无统计学意义(P>0.05);在3D HepaRG细胞模型中,与空白对照组比较,丝裂霉素C组HepaRG细胞的微核形成率和尾DNA百分含量均显著升高(P<0.01或P<0.001),EG高剂量组HepaRG细胞的尾DNA百分含量显著升高(P<0.01)。在大鼠体内实验中,与空白对照组比较,甲磺酸乙酯组大鼠骨髓嗜多染红细胞、肝细胞的微核形成率和外周血淋巴细胞、肝细胞的尾DNA百分含量、尾距均显著升高(P<0.01),EG高剂量组大鼠外周血淋巴细胞尾DNA百分含量显著升高(P<0.01),EG各剂量组大鼠骨髓嗜多染红细胞、肝细胞的微核形成率和肝细胞尾DNA百分含量、尾距差异无统计学意义(P>0.05),但随剂量增加有升高趋势。结论:本研究结果提示在2D细胞模型中,EG未导致染色体断裂及DNA损伤,但3D细胞模型长期给药和体内重复给药结果均显示EG存在一定DNA损伤风险,故3D HepaRG细胞模型的评价结果更接近大鼠体内实验结果。     

植入式心律转复除颤器手术前后患者确定感、焦虑与性格乐观状态的研究

目的研究比较植入式心律转复除颤器(ICD)作为心源性猝死的一级预防(primary prevention,PP)和二级预防(secondary prevention,SP),在植入前、植入后1周以及植入后1个月对患者情绪的不同影响。方法选择15例患者应用植入式心律转复除颤器作为心源性猝死的PP,15例患者应用植入式心律转复除颤器作为心源性猝死的SP,应用描述性横断面调查法,利用Mishel-疾病不确定感量表(Mishel’s Uncertainty in Illness Scale,MUIS-C),特质状态焦虑量表(State-Trait Anxiety Inventory,STAI)和生活目标量表(the Life Orientation Test,LOT-R),通过晤谈行半结构访问。结果在植入式心律转复除颤器植入前,两组患者的MUIS-C分值都较高(PP=67.67±13.36;SP=70.27±6.80,P=0.507);LOT-R分值为PP=15.67±3.8,SP=16.47±3.6,P=0.557;STAI分值为PP=37.40±10.0,SP=37.73±13.6,P=0.940。在植入式心律转复除颤器植入后1个月,PP患者的MUIS-C分值明显低于SP患者(PP=62.33±4.17,SP=67.87±4.61,P=0.002)。结论利用植入式心律转复除颤器作为SP的患者护理时更应该引起护士的重视。     

Pulmonary artery aneurysms in Behçet's disease: contribution of imaging in 5 cases

Pulmonary involvement in Beh?et's disease is an uncommon condition (12%). Thromboembolism of the superior vena cava and/or other mediastinal veins, aneurysms of the aorta and pulmonary arteries are the main vascular manifestations in addition to pulmonary infarct and intrathoracic hemorrhage. Despite their scarcity, respiratory symptoms may be life-threatening. The aim of this study was to assess the contribution of thoracic imaging for one of the most serious aspects of the disease: pulmonary artery aneurysm. We report five patients with pulmonary artery aneurysms (mean age: 39.5 years). Hemoptysia revealed Beh?et's disease in three. Initially explored by conventional radiography, computed tomography and angiography, pulmonary artery aneurysms are currently investigated well with helicoidal computed tomography, digital angiography, magnetic resonance imaging (MRI) and angio-MRI. These imaging techniques provide helpful information for the diagnosis of Beh?et's disease.     

维生素E微胶囊的制备工艺研究

目的:通过正交实验优化包合工艺参数,研究超声法制备维生素E油β-环糊精包合物的最佳工艺条件。方法:采用β-环糊精为壁材,运用包结络合法对维生素E进行微胶囊化。结果:得到超声法制备最佳工艺条件为:包合时间20 min、包合温度30℃、超声功率150 W、m(VE)∶m(β-CD)=1∶9。在优选的条件下包合得包合率为83.5%,产物收率达到71.3%。结论:在此条件下维生素E油β-环糊精包合物成功解决了维生素E易氧化、遇光和热不稳定的难题,提高了其稳定性。     

Outcomes of patients with acute respiratory failure after abdominal surgery treated with noninvasive positive pressure ventilation

OBJECTIVES: Little is known about the physiologic and clinical effects of noninvasive positive pressure ventilation (NPPV) in patients who have acute respiratory failure (ARF) after abdominal surgery. We evaluated our clinical experience with the use of NPPV in the treatment of ARF after abdominal surgery. METHODS: We prospectively evaluated NPPV use during a 2-year period in a medical-surgical ICU of a university hospital. We documented demographic and diagnostic data, gas exchange, and clinical outcomes. We compared patients who were not intubated to those who were intubated after a trial of NPPV. RESULTS: Of 72 patients with ARF after abdominal surgery who were treated with NPPV, 48 patients avoided intubation (67%). Patients in the intubated and nonintubated groups had similar demographic characteristics, and similar American Society of Anesthesiologists physical status and simplified acute physiology score II scores at admission. The intubated group had a significantly lower Pa(O2)/fraction of inspired oxygen (Fi(O2)) ratio (123 +/- 62 mm Hg vs 194 +/- 76 mm Hg, p < 0.01) and more extended bilateral alveolar infiltrates (67% vs 31%, p < 0.01) than the non-intubated group. Within the first NPPV observation period, the Pa(O2)/Fi(O2) increased (+ 36 +/- 29% [+/- SD], p = 0.04) and the respiratory rate decreased (28.2 +/- 3.4 breaths/min vs 23.1 +/- 3.8 breaths/min, p < 0.01) significantly only in the non-intubated group. The non-intubated group had significantly lower length of ICU stay (17.3 +/- 10.9 days vs 34.1 +/- 28.5 days, p < 0.01) and mortality rate (6% vs 29%, p < 0.01). CONCLUSION: NPPV may be an alternative to conventional ventilation in selected patients with ARF after abdominal surgery who require ventilatory support.