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Nicolas N. Abourizk MD Chaula K. Vora MD Parveen K. Verma DO 《Journal of general internal medicine》2004,19(5P1):466-471
Tight glycemic control is now an imperative of outpatient diabetes care. The inpatient arena remains under the influence of an ineffective paradigm characterized by tolerance for hyperglycemia and a reluctance to use insulin intensively. This article is a call to action against the lip service paid to inpatient diabetes care. The compelling in vitro and in vivo evidence for the benefit of intensive insulin-mediated glycemic control is summarized. The linchpin of current inpatient care is a commonly used insulin sliding scale. This autopilot approach as the sole mode of treatment for inpatient hyperglycemia has been strongly condemned. Nevertheless, it continues to survive. The evidence supports the compelling argument that the adverse effect of hyperglycemia on hospital length of stay, morbidity, and mortality is substantial. Clinicians, nurses, administrators, and insurers ought to look critically at the prevailing paradigm and spearhead the much-needed revolution in inpatient diabetology. The issue of glycemic targets, the need for noninvasive blood glucose monitoring, and the role of nursing staff in this revolution are raised. We call for the banning of the insulin sliding scale use as the sole diabetes order. Also, the use of basal insulin via continuous intravenous insulin infusion or subcutaneous insulin analogs should be embraced. Educating nurses, house staff, and other frontline professionals in the adverse consequences of the current paradigm is essential. Inpatient glycemic control matters; clinical and financial outcomes are at stake. It behooves the health care system and the diabetic public to address the contemporary state of inpatient diabetology as soon as possible. 相似文献
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滑动加压螺纹钉的力学研究及疗效评价 总被引:2,自引:0,他引:2
对滑动加压螺纹钉(Richards钉)进行了力学测试,结果显示,滑动加压螺纹钉的力学性能较可靠。31例临床资料分析发现,滑动加压螺纹钉的临床效果理想。作者认为,滑动加压螺纹钉有动力性和静力性加压作用,它结构牢固,固定效果可靠,病人可早期下地活动,是当今治疗股骨转子间骨折比较理想的内固定物。其不足之处是无有效的抗旋转作用。 相似文献
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The pin-on-disc test is a standard sliding wear test used to analyse sliding properties, including wear contour and wear volume. In this study, long-term laboratory test performance is compared with a short-term numerical model. A discrete element method (DEM) approach combined with an Archard wear model and a deformable geometry technique is used. The effect of mesh size on wear results is evaluated, and a scaling factor is defined to relate the number of revolutions between the experiment and the numerical model. The simulation results indicate that the mesh size of the disc has a significant effect on the wear contour. The wear depth and wear width follow a normal distribution after experiencing a run-in phase, while the wear volume has a quadratic relation with the number of revolutions. For the studied material combination, the calibration of the wear coefficient shows that the wear volume of the pin-on-disc test accurately matches the simulation results for a minimum of eight revolutions with a wear coefficient lower than 2 × 10−11 Pa−1. 相似文献
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目的 探讨微种植体支抗钉结合改良滑动杆近中移动上颌前磨牙关闭缺牙间隙的可行性及有效性。方法 选取上颌侧切牙或尖牙缺失的患者5例(男2例,女3例),年龄14~25岁。缺失侧磨牙关系均为安氏Ⅱ类。在上颌第二前磨牙及第一磨牙间植入微种植体支抗钉,结合改良滑动杆近中移动前磨牙。前磨牙移动到位后更换支抗钉位置,利用支抗钉拉磨牙近中移动,关闭剩余间隙。前磨牙移动疗程6~10个月。通过矫治前后石膏模型测量前磨牙近中移动有效性。结果 5例患者均得到有效治疗,上颌前磨牙及磨牙近中移动,缺牙间隙关闭,缺牙侧磨牙关系完全远中,治疗效果均令人满意。上颌前磨牙近中平均移动4.1 mm,平均移动速度0.96 mm/月。结论 对于上颌侧切牙或尖牙缺失的患者,微种植体支抗钉结合改良滑动杆可简单高效实现前磨牙近中移动,并最终关闭缺牙间隙,临床上可作为一种备选治疗方案。 相似文献
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In larval frogs the retina and tectum grow in topologically dissimilar patterns: new cells are added as peripheral annuli in the retina and as caudal crescents in the tectum. Retinotopy is maintained by the continual caudalward shifting of the terminals of the optic axons. After metamorphosis the pattern of growth changes. The retina continues to add new ganglion cells peripherally, but there is no neurogenesis in the tectum. To maintain retinotopy in postmetamorphic frogs, the terminals of the optic axons must continually shift toward the central tectum. We tested the proposal of centripetally shifting axons by making punctate injections of horseradish peroxidase (HRP) in the tectum of adult Rana pipiens and observing the patterns of filled cells in the contralateral retina, as was done in the goldfish (Easter and Stuermer, '84). Punctate applications of HRP in the tectum should be taken up: 1) by fascicles, and label a partial anulus of cells, 2) by terminals, and label a cluster of cells in the corresponding retinotopic site, and 3) by the extrafascicular axonal segments, and label a band of cells connecting the partial annulus to the cluster. If the terminals have shifted centripetally, the band of cells labeled through their extrafascicular segments should have a spoke-like orientation, with the center of the retina as the hub. As the tectal site moves from rostral to caudal, this band of cells should move, pendulum-like, from temporal to nasal retina. In general, the patterns of HRP-filled retinal cells we observed were consistent with our predictions. In addition, HRP taken up by the oldest (rostral) tectal axons produced more complex patterns of filled cells that indicated that these axons had shifted both caudally before metamorphosis and centripetally after. 相似文献
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目的:探讨直丝弓矫治器治疗安氏Ⅱ类1分类错[牙合]畸形过程中,采用主动结扎关闭间隙时,两种施力方式关闭拔牙间隙对牙齿移动的影响。方法:采用前瞻性配对设计,对30例拔除4个第一双尖牙的安氏Ⅱ类1分类病例进行配对,共配成15对,分为A、B两组,两组均采用主动结扎法关闭间隙,A组施力于弓丝上(弓丝法),B组施力于牙上(牙列法),对两组患者进行上颌牙齿移动的测量研究。结果:两种方法关闭间隙时,在所耗时间、前牙后移比率和消耗支抗方面无显著性差异(P〉0.05),在垂直方向上,弓丝法压低前牙0.5mm,牙列法压低前牙0.25mm,差异有显著性(P〈0.05)。结论:主动结扎关闭拔牙间隙时,采用施力于牙列上或施力于弓丝上的方式都可以,两种方法都能有效的关闭间隙。 相似文献
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