Limited knowledge of kidney disease in a survey of AusDiab study participants

OBJECTIVES: To explore awareness of the causes of kidney disease and recollection of kidney function testing in a cohort of Australian adults. DESIGN, SETTING AND PARTICIPANTS: An interviewer-administered cross-sectional survey, conducted from October to December 2004 as a nested study within the 5-year follow-up phase of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab); 852 subjects who attended a testing site in New South Wales were interviewed. MAIN OUTCOME MEASURES: Responses to the questions "What sort of things do you think may lead to a person developing kidney disease?" and "Has a doctor or health care worker ever tested your kidney function, outside of the AusDiab study?" RESULTS: Respondents most commonly believed that kidney disease was caused by alcohol misuse or poor diet, with few identifying diabetes or high blood pressure. Awareness of risk factors was no greater in respondents identified as having chronic kidney disease (CKD). A third of respondents with CKD recalled having undergone a test of kidney function within the previous 2 years, while another third replied they had never had their kidney function tested. Of participants with previously diagnosed diabetes or treated hypertension, 54.1% and 32.0%, respectively, reported having their kidney function tested within the previous 2 years. CONCLUSIONS: Knowledge of risk factors for kidney disease and recall of kidney function testing were both limited, even among subgroups of the cohort who were at greatest risk of CKD. Prevention efforts may benefit from public and patient education to improve recognition of risk factors for CKD.     

Can measurements from an anteroposterior radiograph predict pelvic sagittal inclination?

Pelvic sagittal inclination (PSI) is often evaluated in patients with hip pathology using lateral radiographs. However, it would be useful if PSI could be predicted from an anteroposterior radiograph since this film is ubiquitous in the evaluation of hip pathology. Herein, computer-modeling was applied to predict PSI from radiographic measurements assessed in the anteroposterior plane. Three-dimensional surface models of the pelvis, femur, and sacrum were reconstructed from computed tomography images of 50 women with hip dysplasia. This study cohort was selected as changes in PSI alter femoral head coverage, which is relevant to the diagnosis and treatment of hip dysplasia, a known cause of hip osteoarthritis. Five radiographic parameters commonly used to independently estimate PSI were evaluated after bone surfaces were projected to an anteroposterior plane, including the symphysis to sacrococcygeal joint distance (S-S distance), the pelvic foramen aspect ratio (PF ratio), the distance between the symphysis and a line connecting the femoral head centers (S-H distance), the sacro-femoral-pubic angle (SFP angle), and the pelvic vertical ratio (PVR). Regression models determined the ability of these parameters to predict PSI from −20° to 20° at 1° increment. All five parameters showed a strong correlation with the PSI (all r > 0.9). From the regression models, PSI was estimated with a median (maximum) absolute error of 3.6° (18.4°), 3.8° (17.7°), 5.2° (17.9°), 5.8° (28.8°), and 3.2° (23.5°) for the S-S distance, PF ratio, S-H distance, SFP angle, and PVR, respectively. The regression model for S-S distance had a mean slope of 2.18 that ranged from 1.98 to 2.41 when the sacrococcygeal joint was located superior to the symphysis. Results indicated that substantial errors occur when estimating the actual value of PSI from an anteroposterior radiograph. However, the change in PSI could be estimated from the S-S distance, which may aid surgeons to successfully increase head coverage through periacetabular osteotomy and to locate the acetabular cup in a functional position for total hip arthroplasty.     

不同胆道灌洗液对肝移植供体胆道冷保存损伤的影响

目的：冷保存/再灌注损伤是导致非外科性移植物胆管树损害最重要的始动因素。观察不同胆道灌洗液对大鼠肝移植供肝胆道保存的影响，以筛选出一种较为理想的胆道灌洗液，使胆道在冷保存期间获得器官水平上的最佳保护。方法：实验于2006-08／12在中国医科大学附属盛京医院动物实验中心完成。①实验设计及分组：实验因素包括胆道灌洗液与冷保存时间，不同的灌洗液分别为胆道灌洗液a（生理盐水、HCA液），胆道灌洗液b（HTK液、UW液）；冷保存时间为4h，8h，12h。采用正交设计方法，选用[L9（3^4）]正交表对实验因素随机分组，共分为9组。②实验方法：选择雄性Wistar大鼠45只，分为9组，每组5只。制作大鼠取供肝模型，按照实验设计分别选择不同的胆道灌洗液进行胆道灌洗，在相应的冷保存时间取胆管组织进行检测。③实验评估：采用原位末端标记法进行胆管上皮细胞凋亡检测，计算凋亡指数；在电镜下观察胆管细胞的病理形态变化，并利用图像分析系统求出每张照片中所有胆管上皮细胞的线粒体平均体积和数密度。结果：45只大鼠全部进入结果分析。通过正交设计的方差分析与直观分析得出下列结果。①胆管上皮细胞凋亡指数的正交设计结果：胆道灌洗液a、胆道灌洗液b及冷保存时间是决定大鼠供肝胆道冷保存损伤的主要因素（P均〈0．01）；其中HCA液、HTK液及4h冷保存时间较为理想，且三者结合效果更好。②胆道上皮细胞线粒体平均体积及数密度的正交设计结果：胆道灌洗液a、胆道灌洗液b及冷保存时间是决定大鼠供肝胆道冷保存损伤的主要因素（P均〈0．01）；其中HCA液、HTK液及4h冷保存时间较为理想，且三者结合效果更好。结论：①正确选择胆道灌洗液可以大幅度减轻肝移植供肝胆道的冷保存损伤，保护胆管上皮细胞。②胆道灌洗液以选择HCA液与HTK液结合灌洗的方式较为理想，冷保存时间越短越理想。     

Vision-based real-time position control of a semi-automated system for robot-assisted joint fracture surgery

Purpose

Joint fracture surgery quality can be improved by robotic system with high-accuracy and high-repeatability fracture fragment manipulation. A new real-time vision-based system for fragment manipulation during robot-assisted fracture surgery was developed and tested.

Methods

The control strategy was accomplished by merging fast open-loop control with vision-based control. This two-phase process is designed to eliminate the open-loop positioning errors by closing the control loop using visual feedback provided by an optical tracking system. Evaluation of the control system accuracy was performed using robot positioning trials, and fracture reduction accuracy was tested in trials on ex vivo porcine model.

Results

The system resulted in high fracture reduction reliability with a reduction accuracy of 0.09 mm (translations) and of \(0.15^{\circ }\) (rotations), maximum observed errors in the order of 0.12 mm (translations) and of \(0.18^{\circ }\) (rotations), and a reduction repeatability of 0.02 mm and \(0.03^{\circ }\).

Conclusions

The proposed vision-based system was shown to be effective and suitable for real joint fracture surgical procedures, contributing a potential improvement of their quality.

     

Early cellular events in a systemic graft-vs.-host reaction. I. The migration of responding and nonresponding donor lymphocytes

A systemic graft-vs.-host (GVH) reaction was initiated by the intravenous injection of parental strain thoracic duct lymphocytes (TDL) into irradiated F1 hybrid recipients with in-dwelling thoracic duct cannulae. The migration of the donor lymphocytes was followed by labeling them in vitro with either [3H] or [14C]uridine and measuring radioactivity by scintillation counting of the spleen and lymph nodes of the recipients removed 24 h after injection and in TDL collected throughout this period. The localization of labeled cells was always compared to that of a reference population of nonreactive lymphocytes, e.g. F1 hybrid, labeled with the alternative isotope (Fig. 1). A consistent surplus of the reactive label was found in the spleen which was balanced by a deficit of the reactive label in TDL; lymph nodes gave intermediate values. The same distribution pattern was noted when the reference population was a specifically unresponsive population of the parental strain. This differential distribution depends on recognition of the recipient's Ag-B antigens because when normal lymphocytes were injected together with specifically unresponsive lymphocytes into a "third party" F1 hybrid (against which both populations were reactive) there was no surplus of the normal cells in the spleen and no deficit in the lymph. Moreover in an Ag-B identical strain combination there was no detectable difference in the distribution of reactive and nonreactive populations. The distribution of a labeled reaction population can be accounted for if a substantial minority of cells are immobilized in the spleen and lymph nodes as a consequence of antigen recognition (Fig. 3). When the donor cells in the spleen were assayed 24 h after injection there was paradoxically a slight reduction in their specific GVH activity, which is at least partly because they are under-represented in a single cell suspension. The size of the splenic surplus (23%) and the thoracic duct deficit (12%) suggested that the minority of nonimmune lymphocytes which recognize each Ag-B complex carry 12% of the radioactive label in the original population. It is argued that this provides a near estimate of the frequency of T lymphocytes which can recognize each Ag-B antigenic complex.     

Reflection: a review of the literature

This paper is a review of the literature on reflection The purpose was to unravel and make sense of the complex literature, and to identify the skills required to engage in reflection An analysis of the literature revealed that differences between authors' accounts of reflective processes are largely those of terminology, detail and the extent to which these processes are arranged in a hierarchy Key stages of reflection are identified and represented by a model Skills required to engage in reflection were found to be implicit in the literature and these are identified Methodological issues related to empirical literature are discussed It is suggested that reflection is an important learning tool in professional education and that the skills required for reflection need to be developed in professional courses