节段性足趾移植在拇手指部分组织缺损修复中的应用

目的探讨节段性足趾游离移植修复拇、手指部分组织缺损的临床应用。方法应用吻合血管的游离节段性第2足趾对11例拇、手指部分复合组织缺损进行修复,并对其解剖基础、操作要点及优缺点进行阐述。结果本组11例节段性游离移植指体及伤指全部成活,创面及时治愈,感觉功能恢复良好。结论应用节段性足趾游离移植修复再造拇、手指部分缺损可恢复良好的感觉、功能与外形,是当前拇、手指部分缺损修复较好的方法。     

Patterns and predictors of older adult Medicare Part D beneficiaries’ receipt of medication therapy management

BackgroundMedicare Part D medication therapy management (MTM) includes an annual comprehensive medication review (CMR) as a strategy to mitigate suboptimal medication use in older adults.ObjectivesTo describe the characteristics of Medicare beneficiaries who were eligible, offered, and received a CMR in 2013 and 2014 and identify potential disparities.MethodsThis nationally representative cross-sectional study used a 20% random sample of Medicare Part A, B, and D data linked with Part D MTM files. A total of 5,487,343 and 5,822,188 continuously enrolled beneficiaries were included in 2013 and 2014, respectively. CMR use was examined among a subset of 620,164 and 669,254 of these beneficiaries enrolled in the MTM program in 2013 and 2014. Main measures were MTM eligibility, CMR offer, and CMR receipt. The Andersen Behavioral Model of Health Services Use informed covariates selected.ResultsIn 2013 and 2014, 505,658 (82%) and 649,201 (97%) MTM eligible beneficiaries were offered a CMR, respectively. Among those, CMR receipt increased from 81,089 (16%) in 2013 to 119,181 (18%) in 2014. The mean age of CMR recipients was 75 years (±7) and the majority were women, White, and without low-income status. In 2014, lower odds of CMR receipt were associated with increasing age (adjusted odds ratio (OR) = 0.99 (95% confidence interval (CI) = 0.994–0.995), male sex (OR = 0.93, 95% CI = 0.926–0.951), being any non-White race/ethnicity except Black, dual-Medicaid status (OR = 0.64, 95% CI = 0.626–0.650), having a hospitalization (OR = 0.87, 95% CI = 0.839–0.893) or emergency department visit (OR = 0.67, 95% CI = 0.658–0.686), and number of comorbidities (OR = 0.90, 95% CI = 0.896–0.905).ConclusionsCMR offers and completion rates have increased, but disparities in CMR receipt by age, sex, race, and dual-Medicaid status were evident. Changes to MTM targeting criteria and CMR offer strategies may be warranted to address disparities.     

切应力作用下脐静脉内皮细胞的流变特性

用流室法研究人工培养脐静脉内皮细胞在切应力作用下的变形特性。对脐静脉内皮细胞分别施加０．６、３．８及７．５Ｐａ的切应力，作用１２小时。通过实时显微观测和计算机图象分析，结果证明切应力为３．８或７．５Ｐａ，作用１２小时后内皮细胞被拉长，长轴与流场方向一致；并且内皮细胞的拉长与定向程度、切应力大小及其作用时间的长短有关。     

Cognition Predicts Mobility Change in Lower Extremity Amputees Between Discharge From Rehabilitation and 4-Month Follow-up: A Prospective Cohort Study

ObjectivesTo assess (1) the effect of task (single and dual task), time (discharge and 4mo), and their interaction for mobility; (2) task prioritization during dual-task testing; and (3) the association between cognition on change in mobility between discharge from rehabilitation and 4 months’ follow-up.DesignProspective cohort study.SettingRehabilitation hospital.ParticipantsPeople with lower extremity amputations (N=22) were consecutively recruited at discharge from an inpatient prosthetic rehabilitation program.InterventionsNot applicable.Main Outcome MeasuresGait velocity and the L Test of Functional Mobility, single and dual task (serial subtractions by 3), were the primary outcomes. Montreal Cognitive Assessment and Trail Making Test quantified cognition as secondary outcomes. Repeated measures analysis of variance evaluated the effects of task (single task and dual task) and time (at discharge and 4 months’ follow-up) and their interaction on each outcome. A performance-resource operating characteristic graph evaluated gait and cognitive task prioritization. Multivariable linear regression evaluated the association between cognition and change in mobility over time.ResultsNo significant interactions between task and time were found (all P>.121) for L Test and gait velocity. The L Test single task (P=.001) and dual task (P=.004) improved over time. Gait velocity improved over time for both single task and dual task (P<.001). Dual-task performance was slower than single-task performances at each time point. The Trail Making Test B was independently associated with the change in dual-task L Test (P=.012), and single-task (P=.003) and dual-task (P=.006) gait velocity at follow-up.ConclusionsGait velocity and L Test single and dual task improved over time. No significant interactions indicated that cognitive task did not differentially affect performance over time. Lower executive function scores at discharge were independently associated with lower gains in all gait velocity and dual-task L Test outcomes at follow-up.     

A cross-cultural analysis of Jammu,Kashmir and Ladakh (India) medicinal plant use

Ethnopharmacological relevance

Jammu & Kashmir (J&K) is a predominantly Himalayan state in the north-western part of India. It has three geographically distinct divisions viz., Jammu, Kashmir and Ladakh, which are immensely rich in their biological and cultural diversity. Medicinal plants are an important element of indigenous medical system of the region. The main goal of the present article is to examine the use of ethnomedicinal plants in three divisions of J&K and to discuss cross-cultural consensus on the use of medicinal plants in these divisions. The article also discusses the gaps in the current state of knowledge on ethnomedicinal plants of the region and gives recommendations for the future studies.

Materials and Methods

Scientific literature on ethnomedicinal field studies conducted in J&K state of India available in the journals, edited books and other scientific databases viz., CAB international, DOAJ, Google Scholar, PubMed, Science direct, SciFinder, Scopus and Web of Science were searched. Only field based ethnomedicinal surveys from last four decades up to December 2013 reporting first hand information on the medicinal plants used to treat human health related ailments by indigenous communities of J&K were included in this study. Venn diagram was used to analyze the cross-cultural consensus on the use of ethnomedicinal plants in the three divisions of J&K.

Results

A total of 948 plant taxa (923 angiosperms, 12 gymnosperms and 13 pteridophytes) belonging to 129 families, 509 genera, 937 species and 11 varieties have so far been reported to have a traditional medicinal use by indigenous communities of J&K. Asteraceae (60 genera, 132 spp.) was the most frequently used family followed by Fabaceae (32 genera, 50 spp.) and Lamiaceae (27 genera, 55 spp.). 514, 415 and 397 medicinal plants were used in Jammu, Kashmir and Ladakh divisions, respectively. Sixty eight plant taxa were used in all the three divisions, whereas 95 plants were common between Ladakh and Jammu, 127 plants between Ladakh and Kashmir, and 216 plants between Jammu and Kashmir. Maximum numbers of plant taxa were used for treating dermatological problems (321), followed by cold, cough and throat related ailments (250), fever (224), joint and muscle related ailments (215), gastrointestinal disorders (210), urogenital ailments (199), respiratory ailments (151), body pain (135) and gynecological disorders (127).

Conclusions

This is the first study from the J&K state, which has examined the medicinal plant use in three divisions of J&K and discussed the promising medicinal plant species with cross-cultural consensus. The analysis of the data suggested that while large numbers of plants are used medicinally in each division, there is a low interregional consensus and high variation between medicinal plants used in these divisions, which is due to both cultural divergence as well as biological distinctness. The issues related to current status of knowledge on medicinal plants used by indigenous communities of J&K have been discussed and some recommendations have been made for future studies on medicinal plants in J&K region.