Motoric Cognitive Risk Syndrome and Risk for Falls,Their Recurrence,and Postfall Fractures: Results From a Prospective Observational Population-Based Cohort Study

ObjectiveMotoric cognitive risk syndrome (MCR) is a predementia stage associated with increased risk for falls. There are conflicting results regarding its association with recurrent falls and no information about its association with postfall fractures. The aim of the study was to examine the association of MCR and its components [ie, slow walking speed and subjective cognitive complaint (SCC)] with the occurrence of falls, their recurrence, and postfall fractures in older community-dwelling adults.DesignObservational prospective and longitudinal cohort study.Setting and participantsFrench community-dwelling older women (n = 5958) recruited in the EPIDémiologie de l'OStéoporose (EPIDOS) study.MeasuresMCR was defined as both the presence of SCC and slow walking speed in women free of major neurocognitive disorders. Falls (≥1), recurrent falls (≥2), and postfall fractures (any fractures and hip fractures) were prospectively recorded using mail and/or phone call questionnaires every 4 months over 4 years.ResultsAt baseline, the prevalence of SCC was 43.1% (n = 2569), slow walking speed 5.7% (n = 341), and MCR 9.9% (n = 591). Overall, 25.7% (n = 1533) of participants reported any fall during the follow-up. The incidence of postfall hip fractures was higher in participants with MCR compared to healthy participants and those with SCC (P ≤ .001). Cox regression models revealed that only participants with MCR had a significantly high risk for falls [hazard ratio (HR) = 1.22, P = .021], recurrent falls (HR = 1.46 with P = .030), and postfall hip fractures (HR = 2.54, P ≤ .001).Conclusions/ImplicationsThere is an increased risk for falls, their recurrence, and postfall hip fractures associated with MCR but not with its individual components. This finding underscores the clinical interest of MCR for the detection of older adults at risk for falls and their related adverse events in order to start early appropriate interventions for fall reduction.     

Keeping newborns warm: beliefs,practices and potential for behaviour change in rural Ghana

Objectives This study aimed to collect data on thermal care practices in rural Ghana to inform the design of a community newborn intervention. Methods All 635 women who delivered in six districts in Ghana in the first 2 weeks of December 2006 were interviewed about immediate newborn care. Qualitative data on thermal care practices and barriers and facilitators to behaviour change were collected from recently delivered/pregnant women, birth attendants/grandmothers, and husband through birth narratives, in‐depth interviews and focus group discussion. Results Respondents knew that keeping the baby warm was essential for health but 71% of babies born at home had delayed drying, 79% delayed wrapping, 93% early bathing and 10% were placed skin‐to‐skin. Birth attendants were usually in charge of mother and baby immediately after birth. Delays in drying/wrapping were linked to leaving the baby unattended until the placenta was delivered. Early bathing was linked to reducing body odour in later life, shaping the baby’s head, and helping the baby sleep and feel clean. Respondents thought that changing bathing behaviours would be difficult, especially as babies are bathed early in facilities. The concept of skin‐to‐skin care was easily understood and most women said they would try it if it was good for the baby. Conclusion Thermal care is a key component of community newborn interventions, the design of which should be based on an understanding of current behaviours and beliefs. Formative research can help select focus behaviours, decide who to include in interventions, ensure consistent messages and determine what messages and approaches are needed to overcome behaviour change barriers.     

Change in willingness to pay for normal delivery and caesarean section during pregnancy and after delivery in Kathmandu

Objectives To determine the change in willingness to pay (WTP) measured at pregnancy and at postpartum before and after knowing hospital costs among women who gave birth by normal delivery (NL) and caesarean section (CS) and to identify factors affecting the change in WTP. Methods A prospective study was conducted from May to August 2009 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. WTP for total costs was measured by double‐bound dichotomous contingent valuation and an open‐ended technique. The trend of WTP over time was tested using longitudinal analysis. Associated factors to the positive or negative change in WTP were analysed by logistic regression. Results Of 438 pregnant women followed up both at pregnancy and postpartum, two‐thirds were willing to pay for services at the initial bid of the double‐bound method by $60–$85 for NL and $110–$170 for CS. There were no significant differences in the median WTP measured during pregnancy between NL and CS. The WTP of both groups changed significantly over time (P < 0.001). Caesarean section, perception of good care, information provided on delivery costs and discussion with family about cost were significantly associated with changes from pregnancy to the postpartum period. Conclusions In low‐income countries such as Nepal, where out‐of‐pocket health care expenditures are common, women perceived the health benefit of delivery care in hospital, especially for emergency CS. Their WTP had changed substantially after delivery, and awareness of the associated factors is essential for further policy and planning to improve the services and utilization.     

Valores pretratamiento e inducidos por el tratamiento de enolasa específica de neurona en pacientes con cáncer de pulmón microcítico: estudio prospectivo,abierto

Background

Neuron-specific enolase (NSE) is the most sensitive tumor marker for small-cell lung carcinoma (SCLC) at the time of diagnosis. The main purpose of this study was to review the usefulness of serum NSE level as a prognostic factor in patients with SCLC and to determine the correlation between the NSE level and the stage of disease and response to chemotherapy.

Methods

In this prospective study, patients with SCLC were evaluated for response to chemotherapy, survival without disease progression, and overall survival. The end point was designated at patient death due to SCLC. NSE assays were performed before and after completion of chemotherapy.

Results

Sixty-five patients were included in study. NSE levels were significantly higher in patients who died of SCLC. The pre-treatment NSE levels in patients who responded to treatment were significantly lower. The post-treatment NSE levels were not significantly correlated with response to chemotherapy, progression-free survival, overall survival, and prognosis of patients. Change in the NSE level between the pre- and post-treatment periods was not significantly correlated with response to treatment, progression-free survival, and overall survival.

Conclusions

NSE levels might not be related with the stage of the disease. However, a low pre-treatment NSE level might be used in predicting good response to chemotherapy in patients with SCLC. The post-treatment serum NSE levels and the rate of change between pre- and post-treatment serum levels of NSE were not related with response to chemotherapy, progression-free survival, and overall survival.     

DNA adducts and oxidative DNA damage induced by organic extracts from PM2.5 in an acellular assay

The genotoxic activities of complex mixtures of organic extracts from the urban air particles collected in various localities of the Czech Republic, which differed in the extent and sources of air pollution, were compared. For this purpose, PM2.5 particles were collected by high volume samplers in the most polluted area of the Czech Republic - Ostrava region (localities Bartovice, Poruba and Karvina) and in the locality exhibiting a low level of air pollution - Trebon - a small town in the non-industrial region of Southern Bohemia. To prepare extractable organic matter (EOM), PM2.5 particles were extracted by dichloromethane and c-PAHs contents in the EOMs were determined. As markers of genotoxic potential, DNA adduct levels and oxidative DNA damage (8-oxo-7,8-dihydro-2′-deoxyguanosine, 8-oxodG, levels) induced by EOMs in an acellular assay of calf thymus DNA coupled with ³²P-postlabeling (DNA adducts) and ELISA (8-oxodG) in the presence and absence of microsomal S9 fraction were employed. Twofold higher DNA adduct levels (17.20 adducts/10⁸ nucleotides/m³ vs. 8.49 adducts/10⁸ nucleotides/m³) were induced by EOM from Ostrava-Bartovice (immediate proximity of heavy industry) compared with that from Ostrava-Poruba (mostly traffic emissions). Oxidative DNA damage induced by EOM from Ostrava-Bartovice was more than fourfold higher than damage induced by EOM from Trebon (8-oxodG/10⁸ dG/m³: 0.131 vs. 0.030 for Ostrava-Bartovice vs. Trebon, respectively). Since PM2.5 particles collected in various localities differ with respect to their c-PAHs content, and c-PAHs significantly contribute to genotoxicity (DNA adduct levels), we suggest that monitoring of PM2.5 levels is not a sufficient basis to assess genotoxicity of respirable aerosols. It seems likely that the industrial emissions prevailing in Ostrava-Bartovice represent a substantially higher genotoxic risk than mostly traffic-related emissions in Ostrava-Poruba. B[a]P and c-PAH contents in EOMs are the most important factors relating to their genotoxic potential.     

复式脉冲低能量体外冲击波碎石术联合新总攻法治疗输尿管结石206例疗效观察

目的 探讨采用复式脉冲低能量体外冲击波碎石术(EswL)联合新总攻法治疗输尿管结石的疗效.方法 本组选取206例输尿管结石病例,分3组分别采用复式脉冲低能量体外冲击波碎石、新总攻法排石、复式脉冲低能量体外冲击波碎石术联合新总攻法治疗,观察碎石排石疗效.结果 206例输尿管结石中,复式脉冲低能量体外冲击波碎石组一次碎石后排石率84.9%,二次碎石后排石率88.1%;新总攻疗法组排石率81.9%～85.5%;复式脉冲低能量体外冲击波碎石联合新总攻法组一次碎石后排石率达91.9%,二次碎石后排石率达98.2%.治疗中无一例并发剧烈绞痛、严重血尿、穿孔、石街形成、肾功能不全等并发症.复式脉冲低能量体外冲击波碎石联合新总攻法组其结石排净率与前两组相比较P<0.05差异有统计学意义.结论 复式脉冲低能量体外冲击波碎石联合新总攻法治疗输尿管结石优于单纯ESWL及总攻排石疗法,具有治疗效果佳、排石率高、安全、无严重并发症、副作用少、无创等优点.     

Il ruolo dell’igienista dentale nel trattamento laser dell’ipersensibilità dentinale

Objectives

The aim of the study is to assess and compare the desensitizing effects of Er:Yag laser and CO₂ laser with fluoride gel in the treatment of dentine hypersensitivity.

Materials and methods

The 15 patients selected are affected by hypersensitivity in the upper premolar; they have been treated randomly with Er:Yag laser, CO₂ laser, fluoride gel, and placebo. The pain was evaluated before the treatment by using the Visual Analogue Scale (VAS) and by air emission from a standard air-water syringe.

Results

There were statistically significant differences between the group treated with lasers and fluoride gel versus the group treated with placebo. There were no statistically significant differences between the groups treated with Er:Yag and CO₂ laser and the groups treated with fluoride gel and placebo.

Conclusions

Er:Yag and CO₂ lasers together with fluoride gel are useful in the treatment of dentine hypersensitivity.     

SMAD2／3蛋白在沙鼠脑缺血再灌注及氟桂利嗪干预后脑内表达的研究

目的研究smad2／3在沙鼠脑缺血再灌注脑内表达及氟桂利嗪干预后对其表达的影响。方法35只沙鼠随机分假手术组、缺血再灌注组和氟桂利嗪治疗组3组,采用夹闭双侧颈总动脉制作沙鼠脑缺血再灌注模型,于缺血10min再灌注1d、3d、7d各时间点处死动物,用免疫组化方法检测各组沙鼠脑内smad2／3的表达情况。结果假手术组沙鼠脑内smad2／3弱阳性表达,而缺血再灌注1d、3d、7d后沙鼠脑内呈阳性或强阳性表达,两者比较差异有统计学意义（P〈0．01）;氟桂利嗪治疗组smad2／3的表达低于缺血再灌注组,2组比较差异有统计学意义（P〈0．05）。结论沙鼠脑内有smad2／3表达,脑缺血再灌注后,脑内smad2／3表达上调;氟桂利嗪干预后,其表达下调。     

左金丸胃漂浮缓释片的制剂配方研究

目的 优选左金丸胃内漂浮缓释片的制剂配方。 方法 以辅料羟丙基甲基纤维素(HPMC K4MCR)、卡泊姆(Carbopol)934P、十八醇和NaHCO3为L9(34)正交试验4个因素,干法压片,优化左金丸体外漂浮性能,在此基础上设计F1～F5 5个方案,对处方体外释药性能进行优选;并研究左金丸胃漂浮缓释片体外评价方法。 结果 选择以A3B3C3D3和F4作为左金丸胃漂浮缓释片处方的最优制剂配方组合。初步建立了左金丸胃漂浮缓释片体外评价方法。结论 该剂型符合该药物药理作用特点,有助于延长药物在胃内的治疗作用时间,且制剂配方稳定可靠,可为左金丸新剂型的开发和应用提供参考。