Long-term follow-up and the role of surgery in adolescents with morbid obesity

PURPOSE: Obesity has become a health-care crisis in the United States. Adolescent obesity is now one of the most common childhood disorders, with 4.7 million American adolescents having a body mass index (BMI) greater than the 95th percentile. Most patients do not respond to diet modification or exercise programs and attention is now turning toward surgery as a source of weight loss in adolescents. Few studies have looked at the overall morbidity and mortality of weight loss surgery in this patient population. METHODS: This is a retrospective study of medical charts of 15 bariatric surgical procedures performed on 14 adolescents without known genetic syndromes associated with severe childhood obesity from 1971 to 2001 at the University of Minnesota. Procedures performed on these patients included vertical banded gastroplasty (n = 7), Roux-en-Y gastric bypass (n = 5), and jejunoileal bypass (n = 3). Jejunoileal bypass procedures were performed from 1971 to 1977, after which time this procedure was abandoned. Patient age ranged from 13 to 17 years (mean, 15.7 years). Mean follow-up time was 6 years, with 9 patients available for long-term follow-up. RESULTS: All procedures were performed using an open technique by 1 surgeon. There were no perioperative deaths; complications included 1 case of wound infection, 2 episodes of dumping syndrome that resolved without revision, 1 episode of hypoglycemia, and 1 case of short-term electrolyte imbalance in a patient who underwent jejunoileal bypass. The average BMI dropped from 58.5 +/- 13.7 to 32.1 +/- 9.7 kg/m(2) (P < .01)--a 45% reduction. CONCLUSIONS: Surgery for morbid obesity is safe and results in significant weight loss in adolescents who fail medical therapy.     

Establishing the Cost-Effectiveness of New Pharmaceuticals under Conditions of Uncertainty—When Is There Sufficient Evidence?

Decisions about which health-care interventions represent adequate value to collectively funded health-care systems are as widespread as they are unavoidable. In the case of new pharmaceuticals, many countries now require formal cost-effectiveness analysis to inform this decision-making process. This requires evidence on parameters associated with health-related utilities, treatment effects, resource use, and costs, for which data from available regulatory trials are invariably absent or highly uncertain. This uncertainty results from a number of factors including the predominance of intermediate end points in the clinical evidence-base and the limited period of follow-up of patients in clinical studies. Despite these imperfections in the evidence base, decisions about whether new pharmaceuticals are sufficiently cost-effective for reimbursement cannot be side-stepped. Data limitations do, however, require the use of rigorous analytical methods to support decision making. Probabilistic decision models and value of information analysis offer a means of structuring decision problems, synthesizing all available data, characterizing the uncertainty in the decision, quantifying the cost of uncertainty, and establishing the expected value of perfect information. This analytical framework is important because it addresses two fundamental questions about new pharmaceuticals. First, is the product expected to be cost-effective on the basis of existing evidence? Second, is additional research concerning the product itself cost-effective? In addressing these questions, the analytical framework can establish when sufficient evidence exists to sustain a claim for a new pharmaceutical to be cost-effective.     

兔视网膜方向选择性神经节细胞树突的独特分枝模式及其生理意义

本实验研究了兔视网膜中的方向选择性神经节细胞 (direction selective retinal ganglion cells,DS cells)树突野的分枝模式。测量了视网膜中方向选择性神经节细胞和作为经典分枝模式神经元代表的α神经节细胞的树突直径。发现 ,方向选择性神经节细胞的树突在分枝后直径达到 0 .5 μm,进一步分枝树突直径仍保持在 0 .5 μm左右 ,这样 ,在方向选择性神经节细胞树突野中大多数树突直径在 0 .5μm左右。而作为经典分枝模式神经元代表的α神经元的树突每次分枝后都逐级变细 ,最终直径达到 0 .5μm左右 ,这样 ,α神经节细胞的树突直径大部分都大于 0 .5μm。我们应用程序“NEU RON”对在两种神经元模型中 ,抑制点落于兴奋点与胞体之间 (proximal)和抑制点不落于兴奋点与胞体之间 (distal)这两种情况进行模拟。我们发现 ,当抑制点不落于兴奋点与胞体之间时 ,在方向选择性神经节细胞的树突分枝模型中 ,抑制效果更强。那么 ,将使得方向选择性神经节细胞对抑制点落于兴奋点和胞体之间的要求变得不是那么迫切。所以 ,方向选择性神经节细胞的这种独特分枝模式 ,也许可以避免或至少减轻其在发育中可能会产生的连线的复杂性。并且 ,我们对得出的结论进行了电路分析 ,对方向选择性神经节细胞这种独特的分枝模式具有的?     

某地13所医院1997-2001年门诊费用的基本分析与评价

采用回顾性调查分析方法,对某地13所医院1997-2001年门诊费用变动情况进行分析。统计学处理结果提示样本医院5年来门诊费用平均发展速度和平均增长速度加快明显。作者对此提出借鉴国外教训、避免浪费的建议,以应对医疗费飞涨给全局工作带来的各种冲击。     

An imaging routine for assessing the efficacy of instruments used for scaling and root planning

Deposits of dental plaque or calculus are typically quantified using planimetric techniques. However, error is introduced into a quantitative analysis of plaque deposits using these methods, since they require a significant amount of human intervention. The purpose of this study is to describe and validate a computerized imaging routine which has the potential to objectively identify material on dental roots and measure the area covered by these deposits. Dentiform teeth with simulated plaque were videorecorded. A computer routine was developed based on a flood-fill algorithm which analyzed images of the dentiform teeth and determined the amount of simulated plaque on their root surfaces. Results showed that the dentiform teeth and their simulated plaque patterns are duplicated by the imaging routine in a rapid and reliable fashion. The system shows a high degree of accuracy with an average error factor of only 0.58%. As well, the system enables precise reproducibility with an average error factor of only 0.71%.     

子宫颈癌226例临床病理分析

目的：探讨宫颈癌的临床、病理特点、诊治方法及预后因素。方法：收集1996年1月至2001年1月226例宫颈癌患者进行回顾性分析。结果：平均患病年龄为48．18岁。130例患者为阴道流血，70例为阴道流液，25例下腹疼痛，l例精神减退、贫血、浮肿。病理分期：Ⅰ期病例数为169例(75％)；Ⅱ期病例数为3l例(13．72％)；Ⅲ期病例数为23例(10．18％)；Ⅳ期病例数为3例(1．1％)。比较2l例宫颈鳞癌与宫颈腺癌的转移，显示后者的腹主动脉旁淋巴结转移、肾上腺转移、子宫转移、胸水形成明显高于前者。结论：重视宫颈癌发病相关因素及临床症状，争取早期诊断，严格手术病理分期，选择适当治疗方案。     

6186例脑卒中患者发病时间的季节性分析

目的探讨青岛市区脑出血(CH)、脑梗死(CI)、蛛网膜下腔出血(SAH)发病时间的季节规律。方法收集青岛市1998年～2002年脑卒中患者6186例,其中CH1179人,CI4821人,SAH186人。圆分布分析探讨脑卒中患者发病时间的季节规律。结果CH冬季高发,平均角在1月份(P<0.05),男性患者的平均角在2月份(P<0.05),女性患者的平均角在1月份(P<0.05);CI秋季高发,男、女间无差别,平均角在10月份(P<0.05);SAH秋季高发,平均角在10月份(P<0.05),男性患者的平均角在9月份(P<0.05),女性患者的平均角在10月份(P<0.05)。结论青岛市的脑卒中发病具有季节性,在脑卒中预防工作中要充分考虑其发病的季节特点,并采取相应的措施。     

Non-invasive estimation of the diastolic elastic and viscoelastic properties of the left ventricle

The present study applies a non-invasive method to the quantitative evaluation of left ventricular stiffness in normal subjects and in patients with ischaemic heart disease (IHD). We have studied 20 patients with IHD and 25 healthy subjects. The third heart sound (S3) was detectable in all patients. We have correlated the energy spectrum of S3, divided into 15 Hz bands, with a series of echocardiographic parameters. The existence of a significant correlation between the spectrum energy and the diameter and thickness of the left ventricle at the moment of S3 allowed us to explore the possibility of interpreting the origin of S3 based on a mathematical model. Our hypothesis has been that, once the left ventricle starts vibrating, it behaves as a simple physical model composed of a mass and an elastic element. To this purely elastic model one can add a factor accounting for viscosity, with a damping effect, to obtain a more complex viscoelastic model. The stiffness coefficient 'k' was computed in both models from the peak frequency of S3 and the left ventricular mass at the moment of S3. Furthermore, in the viscoelastic model, the damping element 'c' was also computed. Both parameters--k and c--were significantly increased in the group with IHD compared with the control group. Although a simplification of the vibrating system, these models make it possible to obtain non-invasively information on the characteristics of the left ventricle through the combined use of echocardiography and spectral analysis of S3.