前列腺素E1治疗老年糖尿病合并下肢血管病变的疗效观察

[目的]观察不同方式小壶静脉输注高浓度前列腺素E1治疗老年糖尿病合并下肢血管病变病人的疗效及不良反应。[方法]将40例老年糖尿病合并下肢血管病变住院病人,随机分为两组,观察组前5d分别以5 μg、5 μg、10 μg、10 μg、15 μg前列腺素E1加入小壶静脉输注生理盐水10 0mL ,以后每天以2 0 μg前列腺素E1至疗程结束,2 0d为1疗程;对照组2 0例给予前列腺素E1每天2 0 μg加入小壶静脉输注生理盐水10 0mL完成1个疗程。应用超声血流检知器检测治疗前及疗程第10天、第2 0天患肢足背动脉同一部位平均血流速度、血流峰值的变化并进行自身对照;并比较治疗前后病人自觉症状,记录不良反应出现时间。[结果]前列腺素E1治疗后10d、2 0d两组平均血流速度、血流峰值与治疗前比较均有增加(P <0 .0 1) ,而且治疗2 0d的效果明显优于治疗10d(P <0 .0 1、P <0 .0 5 )。两组间治疗前和治疗10d、2 0d的平均血流速度、血流峰值比较无统计学意义。注射部位类静脉炎反应对照组发生率明显高于观察组(χ2 =9.3 8,P <0 .0 5 )。[结论]高浓度前列腺素E1对糖尿病合并下肢血管病变病人具有显著扩张血管、疏通微循环的作用;逐渐增大药物浓度的治疗方法可降低不良反应,治疗第1周是最佳护理契机。     

Prevalence,impact and specialised treatment of urinary incontinence in women with chronic lung disease

Objectives

To determine in women with clinically stable chronic lung disease (CLD) and healthy women; (1) prevalence of urinary incontinence; (2) risk factors for urinary incontinence; (3) effects of a standard course of specialised physiotherapy treatment (PT) in women with CLD.

Ⅱ型糖尿病患者下肢血管病变超声检查的临床指导意义

目的 Ⅱ型糖尿病下肢血管病变是糖尿病致残的主要原因。探讨 Ⅱ型糖尿病患者下肢动脉血管病变的危险因素,了解糖尿病外周血管病变的形态学特征[1],寻找早期诊断方法。方法应用多普勒超声检查对2004～2005年我院住院86例确诊为型糖尿病患者和30例同期住院无糖尿病的患者下肢血管形态、血管壁内膜-中层厚度(IMT)、有无斑块、管腔狭窄或闭塞及血流动力学改变进行比较。结果(1)糖尿病患者下肢血管管腔的硬化斑块、狭窄、闭塞的发生率明显高于对照组;(2)硬化斑块的发生率以股动脉最常见,而管腔狭窄、闭塞率以累及动脉以下侧的远端动脉血管胫前动脉受累最为明显[2]。结论彩色多普勒超声成像对糖尿病患者下肢血管的早期诊断、预防及治疗有重要的临床指导意义。     

Identifying non-pharmacological risk factors for falling in older adults with type 2 diabetes mellitus: a systematic review

Purpose: To identify the non-pharmacological risk factors for falling in older adults with type 2 diabetes mellitus (DM2).

Methods: A systematic review of randomized controlled trials, prospective cohort studies, cross-sectional studies and before/after studies was conducted. Eligible studies identified non-pharmacological risk factors for falling in older adults with DM2. Medline, Embase, Pubmed and CINAHL were searched for relevant studies published through December 2015. Reference lists were also searched for relevant studies. Search terms were DM2, risk factors, falls and falling, older adults, aging, non-insulin dependent diabetes mellitus, accidental falls and trip. Publication language was restricted to English.

Results: Thirteen studies met the inclusion criteria: four cross-sectional, six prospective cohorts, two randomized controlled trials and one before/after study. These studies included a total of 13,104 participants, ≥50 years. The most common risk factors for falling were impaired balance, reduced walking velocity, peripheral neuropathy and comorbid conditions. However, lower extremity pain, being overweight and comorbid conditions had the greatest impact on fall risk.

Conclusion: Interventions to reduce falling in older adults with type 2 diabetes mellitus should focus on reducing lower extremity pain, reducing body weight and managing comorbid conditions.

• Implications for Rehabilitation

• Diabetes mellitus:

• ??Older adults with type 2 diabetes mellitus (DM2) have a higher risk for falling than older adults without.

• ??Older adults with DM2 are more likely to suffer serious injuries when they fall.

• ??Comprehensive risk factor identification is necessary for rehabilitation professionals to accurately determine whether their clients are at risk for falling.

• ??Rehabilitation professionals also need to tailor interventions based on the client’s risk factors in order to effectively reduce falls and fall-related injuries.

     

Prevalence of β-lactamase-nonproducing ampicillin-resistant <Emphasis Type="Italic">Haemophilus influenzae</Emphasis> and <Emphasis Type="Italic">Haemophilus influenzae</Emphasis> type b strains obtained from children with lower respiratory tract infections

The prevalence of strains with ampicillin (ABPC) resistance among Haemophilus influenzae strains isolated from the nasopharynx of children with lower respiratory tract infections has increased significantly during the 6 years from 2000, when it was 41.9%, to 2005, when it reached 60.1%. From 2002, the prevalence exceeded 50%, and the prevalence of β-lactamase-nonproducing ABPC-resistant (BLNAR) strains with a minimum inhibitory concentration (MIC) of ABPC of over 4 μg/ml doubled, from 28.2% in 2002 to 54.7% in 2005. In H. influenzae strains obtained from the nasopharynx of children with lower respiratory tract infections between April 2004 and March 2006, identification of serotype b was defined, using the slide agglutination method. The frequency of isolation of H. influenzae type b (Hib) strains was then measured and the ABPC resistance conditions of the Hib strains were also evaluated. The frequency of the Hib strains was found to be 30 out of 479 strains, 6.3%. Of these 30 strains, BLNAR accounted for 53.3% (16 strains), approximately the same frequency of isolation as that of the BLNAR isolated from all H. influenzae strains during the same period. In Japan, the prevalence of BLNAR strains among clinically isolated H. influenzae strains has continued to increase, and the frequency of isolation of BLNAR strains among Hib strains has also continued to rise. As a countermeasure, attempts at improving resistance have been made through judicious antibiotic use, but concern that the choice of antibiotics for Hib meningitis may become complicated has sparked a keen interest in the introduction of Hib conjugate vaccine. Part of this report was presented at the fifty-fourth general meeting of the Japanese Society of Chemotherapy (Kyoto, May 2006).     

Pixantrone plus rituximab versus gemcitabine plus rituximab in patients with relapsed aggressive B-cell non-Hodgkin lymphoma not eligible for stem cell transplantation: a phase 3, randomized,multicentre trial (PIX306)

PIX306 was a phase 3, randomised, single-blind, multicentre trial conducted in adult patients with diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma (FL) grade 3 who relapsed after ≥1 rituximab-containing regimen and were not eligible for a stem cell transplant. Patients were randomised 1:1 to pixantrone 50 mg/m² or gemcitabine 1000 mg/m² on days 1, 8 and 15 of a 28-day cycle, combined with rituximab 375 mg/m² on day 1, for up to six cycles. Patients were followed for up to 96 weeks. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), complete response (CR) rate, overall response rate (ORR) and safety. Overall, 312 patients were randomised (median age 73·0 years). The study did not meet its primary endpoint. Median PFS [95% confidence interval (CI)] was 7·3 months (5·2–8·4) with pixantrone + rituximab (PIX + R) and 6·3 months (4·4–8·1) with gemcitabine + rituximab [GEM + R; hazard ratio (HR): 0·85; 95% CI 0·64–1·14; P = 0·28]. Median OS was 13·3 (10·1–19·8) months with PIX + R and 19·6 (12·4–31·9) months with GEM + R (HR: 1·13; 95% CI 0·83–1·53). ORR was 61·9% and 43·9% respectively and CR rate 35·5% and 21·7%. The incidence of adverse events, including cardiac events, was not statistically significant different between PIX + R and GEM + R.     

Orthodontic management of a dilacerated central incisor and partially impacted canine with unilateral extraction – A case report

Aim

To align a dilacerated maxillary central incisor and partially impacted canine with unilateral extraction in a young patient with skeletal deep bite.

生长板材料属性对6岁儿童乘员膝关节损伤影响分析

目的构建较高仿真度的6岁儿童乘员下肢有限元模型,验证6岁儿童乘员膝关节的有效性;分析在前碰撞载荷下生长板对儿童膝关节的生物力学响应及损伤机制。方法基于儿童生理结构及CT影像构建包含生长板的6岁儿童乘员下肢有限元模型,赋予相应的材料属性;参照Kerrigan等及Haut等的生物力学实验,验证模型的有效性,分析不同生长板材料属性对膝关节损伤的影响。结果通过模型仿真实验与生物力学实验曲线对比验证了模型的有效性;在膝关节区域,生长板的存在可以改变儿童乘员下肢骨折的损伤模式;不同生长板的材料属性,可以影响股骨轴向损伤力的阈值及达到损伤阈值而发生骨折的相对位置。结论所建模型得到有效验证,可用于6儿童乘员膝关节损伤生物力学响应及损伤机制的相关研究及应用。     

From the Cover: Montsechia,an ancient aquatic angiosperm

The early diversification of angiosperms in diverse ecological niches is poorly understood. Some have proposed an origin in a darkened forest habitat and others an open aquatic or near aquatic habitat. The research presented here centers on Montsechia vidalii, first recovered from lithographic limestone deposits in the Pyrenees of Spain more than 100 y ago. This fossil material has been poorly understood and misinterpreted in the past. Now, based upon the study of more than 1,000 carefully prepared specimens, a detailed analysis of Montsechia is presented. The morphology and anatomy of the plant, including aspects of its reproduction, suggest that Montsechia is sister to Ceratophyllum (whenever cladistic analyses are made with or without a backbone). Montsechia was an aquatic angiosperm living and reproducing below the surface of the water, similar to Ceratophyllum. Montsechia is Barremian in age, raising questions about the very early divergence of the Ceratophyllum clade compared with its position as sister to eudicots in many cladistic analyses. Lower Cretaceous aquatic angiosperms, such as Archaefructus and Montsechia, open the possibility that aquatic plants were locally common at a very early stage of angiosperm evolution and that aquatic habitats may have played a major role in the diversification of some early angiosperm lineages.When did early angiosperms begin to diversify ecologically? This question is currently unanswered. Age estimates of the divergence of crown-group angiosperms using molecular clock data vary considerably, although it is in the range of (max. 210–) often accepted, 150–140 (min. 130) million years (1–7). Parsimony reconstruction of early angiosperm habit suggests that they may have been shrubs living in “damp, dark, and disturbed” habitats (8). In contrast, many living aquatic angiosperms are basal in angiosperm phylogenies [e.g., Nymphaeales in Amborella, Nymphaeales and Illiciales, Trimeniaceae-Austrobaileya (ANITA) or Ceratophyllales with the eudicots as commonly understood]. In the fossil record, we have found an aquatic angiosperm, Montsechia vidalii (Zeiller) Teixeira, which is an atypical plant fossil found in the Barremian (130–125 million years ago) freshwater limestone in the Pyrenees and Iberian Range in Spain. Montsechia (Fig. 1) lacks roots (no proximal or adventitious roots were found in more than 1,000 shoots examined) and shows flexible axes and two types of phyllotaxy and leaf morphology. The cuticle is very thin with rare stomata. The fruit is closed with a pore near the distal tip, indehiscent, and contains one unitegmic seed developed from an orthotropous and pendent ovule (Figs. 2 and ​and3).3). Cladistic analysis of these characters places Montsechia on the stem lineage basal to extant Ceratophyllum or a clade formed by Ceratophyllum and Chloranthaceae (Fig. 4) suggesting that mesangiosperms (non-ANITA angiosperms) existed 125 million years ago, as indicated by the tricolpate pollen record. Montsechia is well-adapted to a submerged aquatic habit. Montsechia is contemporaneous with another aquatic plant fossil, Archaefructus, indicating that some of the earliest angiosperms were fully aquatic very early in their ecological diversification.Open in a separate windowFig. 1.Long- and short-leaved forms of Montsechia vidalii. (A) The long-leaved specimen shows very flexuous branches and opposite, long leaves. LH02556. (Scale bar, 10 mm.) (B) The short-leaved specimen shows regularly developed lateral branches and tiny leaf rosettes. LH07198. (Scale bar, 10 mm.)Open in a separate windowFig. 2.Fruit and seed of Montsechia vidalii. The fruit shows a small apical pore (po). The funicle (f) of the single, upside-down seed (orthotropous pendent) is attached from the hilum (h) to the placenta (pl). (Scale bar, 500 µm.)Open in a separate windowFig. 3.Reconstructions of Montsechia vidalii. (A) The long-leaved form shows the opposite leaves and branches. (B) The short-leaved form shows the alternate phyllotaxy of leaves and branches bearing pairs of ascidiate, nonornamented fruits. (C and D) The fruit shows a small apical pore and a single seed developed from an orthotropous pendent ovule. The funicle arises from the placenta (near the micropyle) to the hilum (near the pollination pore). (C) Lateral view. (D) Front view. Diagram by O. Sanisidro, B.G., and V.D.-G.Open in a separate windowFig. 4.Most parsimonious position of Montsechia in a simplified tree derived from the matrix by Endress and Doyle (26) using the J & M backbone. Taxa in blue are considered ancestrally water-related (27). Diagram by C.C. and B.G.