A novel method for measuring and monitoring monobloc distraction osteogenesis using three-dimensional computed tomography rendered images with the 'biporion-dorsum sellae' plane. Part I: Precision and reproducibility

The results of craniofacial and orthognathic surgery have traditionally been monitored using lateral cephalometry. In the age of computed tomography (CT) and magnetic resonance imaging (MRI), newer methods of measuring surgical outcome have arisen. This has been further enhanced by the use of computer software to render CT images in a three-dimensional format. The authors present a novel method of measuring the outcome of monobloc distraction osteogenesis advancement using the biporion-dorsum sellae plane. The perpendicular distance of eight facial skeletal points to this plane were made automatically using the Vworks 4.0 program. A total of 10 measurements were made against six planes of reference. Planes 1, 2, 3, 1+2 degrees, and 1-2 degrees were constructed, and measurements were made by observer 1. Plane 6 was constructed and measurements were made by observer 2. Plane 1 was used as the denominator on which calculations were made. The results revealed a mean intra- and interobserver percentage difference from plane 1 of less than 5%. In addition, the overall mean intraobserver variance of all eight points from observer 1 was 0.91%, and the mean interobserver variance between observer 1 and 2 was 0.73%. In summary, based on the authors' method, repeated measurements made from the biporion-dorsum sellae plane have proven precision and reproducibility.     

Obstetric and nonmalignant gynecologic bleeding: treatment with angiographic embolization

Eight patients (seven post partum, one post abortion) with massive pelvic hemorrhage related to pregnancy and one patient with uncontrollable bleeding following a cervical biopsy underwent angiography to facilitate the identification and treatment of bleeding sites. In all nine patients pelvic hemorrhage was successfully controlled with embolization under angiographic guidance. Angiographic embolization allowed preservation of the uterus in six patients referred prior to hysterectomy, and one patient subsequently became pregnant. When conservative measures and minor surgical repairs have failed, embolization should be the next step in the treatment of postpartum hemorrhage to avoid major surgery in an unstable patient and to maintain reproductive function.     

Comparison of methods for the detection of penicillinase-producing Neisseria gonorrhoeae

In an evaluation of four methods for detecting penicillinase-producing Neisseria gonorrhoeae the chromogenic cephalosporin, rapid iodometric, and penicillin disc diffusion methods gave complete agreement for all the 202 strains of gonococci tested. No false-positive or false-negative results occurred. The filter paper iodometric method detected 99% of the penicillinase-producing strains without any false-positive result.     

MGB1 Poor Adherence to Hypertension Treatment Guidelines: An Analysis of Therapeutic Choices

The recent Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) reiterated long-standing recommendations that Stage 1 hypertension (BP ≥ 140/90 mm Hg) without comorbidity should be treated initially with diuretics (DI) or beta blockers (BB). Yet market research suggests that many physicians prefer to use other drug classes, such as calcium channel blockers and ACE inhibitors.
OBJECTIVES: To explore the determinants of therapeutic choice in hypertension.
METHODS: We surveyed by mail a stratified random sample of 10,000 U.S. cardiologists, internists, and family/general practitioners. Physicians were queried about their practice environment and their knowledge, attitudes, and practices regarding antihypertensive therapy, including their choice of drugs to treat patients with specified clinical profiles. The probability that physicians would follow JNC guidelines Stage 1 hypertension was analyzed using multiple logistic regression with stepwise backward elimination to select variable with p < 0.001.
RESULTS: Completed surveys were received from 1,023 physicians. 86.7% prescribe drug therapy for Stage 1 hypertension, and 19.5% (22.5% of drug prescribers) limit their choices to DI and BB. Guideline conformity was higher among physicians who: practice in academic medical centrers; are older; are general practitioners (versus general internists); have smaller caseloads; have fewer hypertensive patients; have higher proportions of HMO, Medicaid, and uninsured patients; and experience more formulary restrictions. Cardiologists and family practitioners were less likely than internists to follow guidelines.
CONCLUSION: JNC guidelines are better accepted by academic physicians, older physicians who have more expenence using DI and BB, physicians with smaller caseloads and hence more time for follow-up and therapy adjustment, and physicians who face drug reimbursement constraints.     

肝炎肝硬变患者血清层粘连蛋白水平与食管静脉曲张的关系

0引言食管静脉曲张破裂出血是肝硬变的严重并发症之一．近年研究表明,血清LN水平与食管静脉曲张关系密切．我们分析了108例肝炎肝硬变病例,就LN水平与食管静脉曲张程度的关系做一分析．回对象和方法1．l对象选择肝炎肝硬变连续住院患者108（男gi,女17）例,年龄43．75岁士16．92岁,慢性肝炎患者62（男sl,女11）例,年龄38．20岁士13．20岁,均测定血清1。N水平,并行电子胃镜检查．诊断标准均符合1995－05月北京第五届全国传染病和寄生虫病学术会议修订的病毒性肝炎诊断标准．1．2方法采用放射免疫法测定I。N水平;用电子胃镜确定食…     

Developing a spatial-statistical model and map of historical malaria prevalence in Botswana using a staged variable selection procedure

Background  

Several malaria risk maps have been developed in recent years, many from the prevalence of infection data collated by the MARA (Mapping Malaria Risk in Africa) project, and using various environmental data sets as predictors. Variable selection is a major obstacle due to analytical problems caused by over-fitting, confounding and non-independence in the data. Testing and comparing every combination of explanatory variables in a Bayesian spatial framework remains unfeasible for most researchers. The aim of this study was to develop a malaria risk map using a systematic and practicable variable selection process for spatial analysis and mapping of historical malaria risk in Botswana.     

胆碱能M受体拮抗剂：2α－（2＇，2＇－二取代基－2＇－羟基乙氧基）托品烷光学异构体合成

胆碱能Ｍ受体拮抗剂：２α－（２＇，２＇－二取代基－２＇－羟基乙氧基）托品烷光学异构体合成王林，恽榴红，张其楷（军事医学科学院毒物药物研究所，北京１００８５０）目前临床所用托品类抗胆碱药一般为３位取代托品酯类衍生物，这类药物作用较广泛，但选择性不高。Ａ...     

XEN‐45 collagen implant for the treatment of uveitic glaucoma

Importance

The XEN‐45 implant, a hydrophilic collagen implant which drains aqueous to the subconjunctival space, has not been investigated in the context of uveitic glaucoma.

Background

To determine the safety and efficacy of the XEN‐45 collagen implant in eyes with uveitic glaucoma.

Design

Exploratory prospective case series.

Participants

patients with medically uncontrolled uveitic glaucoma.

Methods

Twenty‐four consecutive patients (mean age ± standard deviation [SD] = 45.3 ± 18.1 years) were implanted with the XEN‐45 implant.

Main Outcome Measures

The primary outcome measure was intraocular pressure (IOP) reduction at 12 months as compared to baseline. Secondary outcome measures included ocular hypotensive medication use at 12 months, the requirement for further glaucoma surgery and failure. Intraoperative and postoperative complications were documented.

Results

The baseline mean ± SD IOP was 30.5 ± 9.8 mmHg and the mean ± SD number of glaucoma medications required was 3.3 ± 0.8. In 20 eyes (83.3%) in whom conventional glaucoma surgery was originally perceived to be inevitable, further surgery was not required after XEN‐45 implantation. The mean IOP was reduced by 60.2% from baseline to 12.2 ± 3.1 mmHg and mean medication usage was reduced to 0.4 ± 0.9 at 12 months (both P < 0.001). One patient had hypotony persisting beyond 2 months that required surgical revision and one patient developed blebitis. The 12‐month cumulative Kaplan–Meier survival probability was 79.2%.

Conclusions and Relevance

The XEN‐45 implant is effective for the treatment of patients with medically uncontrolled uveitic glaucoma. Potentially sight‐threatening complications, including bleb‐related ocular infection and persistent hypotony, may occur.     

Influence of diabetes on macular thickness measured using optical coherence tomography: the Singapore Indian Eye Study

Purpose

To determine the influence of diabetes, diabetic retinopathy (DR), and other factors on macular thickness, measured using optical coherence tomography (OCT), in a population-based sample.

Methods

Data from the population-based Singapore Indian Eye Study were analyzed. We measured macular thickness using Stratus OCT Fast Macular Thickness scan protocol in 228 participants with diabetes mellitus (including 167 without DR, 44 with mild DR, 17 with moderate or severe DR) and 72 non-diabetic controls without macular oedema or other macular lesions. Analysis was done on right eyes.

Results

The mean age of participants was 60.1±10.1 years, with 53.8% men. Macular thickness measurements did not differ significantly between diabetic participants with no or mild DR and non-diabetic participants. Diabetic participants with moderate or severe DR had greater foveal and temporal outer macula thickness compared with those with no or mild DR (P=0.003). In a multivariate linear regression model, older age (P=0.009), male gender (P=0.005), and lower spherical equivalent (P=0.001) were other factors associated with greater foveal thickness in all participants after controlling for body mass index, glycosylated haemoglobin, total cholesterol, and mean systolic blood pressure.

Conclusion

This population-based study showed that diabetic participants with moderate or severe DR had thicker foveal measurements, even in the absence of diabetic macula oedema, than non-diabetic controls. Other factors that influenced macular thickness measurements were age, gender, and spherical equivalent. These data may aid the interpretation of OCT findings in persons with diabetes and DR.