Measures of adiposity in two cohorts of Hawaiian school children

Background: Native Hawaiians have high rates of obesity and obesity-related diseases compared with non-Hawaiians in Hawaii, and the relation between this ethnic disparity in adiposity and socioeconomic status (SES) in children is unclear.

Aim: The present study compared measures of adiposity in two cohorts of school children residing in the Hilo area of Hawaii and related these measures to parental reports of ethnicity, household income and parent educational attainment.

Subjects and methods: All children in either Kindergarten (mean age 5.6 years) or third grade (mean age 8.7 years) in eight elementary schools in the Hilo area were invited to participate. A total of 125 children had anthropometric, bioelectric impedance and air displacement plethysmography measurements taken and their parents answered questions about household income, parental educational attainment and genealogical background that included ethnicity of ancestors.

Results: Boys and girls in both cohorts had stature approximately at the 50^th percentile (Z-score = 0) of national samples (CDC data). Z-scores of BMI were elevated compared to the CDC reference curves, but were significantly higher in male Native Hawaiian children in the older cohort among whom nearly 50% had a BMI above the 95^th percentile for age. In the younger cohort, there was no significant ethnic difference in adiposity measures. In the older cohort, Native Hawaiian boys had significantly higher adiposity measures than their classmates. Adiposity in third grade girls was significantly and inversely related to their father's educational attainment. Percentage of Hawaiian ancestry was not significantly related to adiposity measures.

Conclusions: Ethnic disparity in adiposity among Native Hawaiians compared with non-Hawaiian age mates occurs after the age of 6 years, and is confined to males in this sample. For older girls, father's, but not mother's, educational attainment was inversely related to adiposity.     

颞下颌关节紊乱病关节造影—介入治疗

本研究通过造影操作同时完成对患者的治疗工作,提出“关节造影－介入治疗”的概念。方法随机选择ＴＭＤ行关节造影检查的３０例病人。其中滑膜炎表现并经关节造影诊断为不可复性盘前移位者１６例;临床上仅有开口受限或明显开口偏斜,经关节造影诊断为不可复性盘前移者１２例;     

Hemodynamic effects of a right lumbar-pelvic wedge during spinal anesthesia for cesarean section

Background

Aortocaval compression is a major cause of maternal hypotension. A randomized controlled trial was designed to determine the effectiveness of a mechanical intervention using a right lumbar–pelvic wedge in preventing hypotension after spinal anesthesia for cesarean delivery.

Methods

Eighty healthy women undergoing elective cesarean section were randomly allocated immediately after spinal blockade to either a lumbar–pelvic wedge positioned under the right posterior–superior iliac crest (Wedge group, n = 40) or the complete supine position (Supine group, n = 40). Hemodynamic values, vasopressor consumption and adverse effects were collected during the surgical procedure. Hypotension was defined as a reduction in systolic blood pressure of 25% from baseline. Patient allocation, management and data collection were performed by a single unblinded anesthetist.

Results

There was no difference in the incidence of hypotension between the two groups (42.5% vs. 50%, P = 0.51). During the first 5 min, blood pressure decreased less in the Wedge group. There were significant differences in median [interquartile range] vasopressor requirements between the Wedge group and the Supine group (1 [0–2] vs. 3 [1–4] mg, P < 0.01) and in nausea during the procedure (6 vs. 22 patients, P < 0.01).

Conclusion

In our study population the use of right lumbar–pelvic wedge was not effective in reducing the incidence of hypotension during spinal anesthesia for cesarean section. Patients in whom the wedge was used had higher systolic blood pressure values during the first 5 min of anesthesia and fewer episodes of nausea. The risk of hypotension remains substantial.     

后路椎体间植骨融合椎弓根钉内固定治疗复发性腰椎间盘突出症

目的 探讨后路椎体间植骨融合椎弓根钉内固定术治疗复发性腰椎间盘突出症的临床疗效.方法 回顾性分析本院2002年4月至2007年10月19例复发性腰椎间盘突出症患者的临床资料,包括临床表现、初次手术方式、再次手术方式、术后效果及其预后.结果 所有复发性腰椎间盘突出症患者经后路椎体间植骨融合椎弓根钉内固定术治疗,术后优良比例为84.2%(16/19),有效比例为94.7%(18/19);下腰痛JOA评分术前(10.0±1.9)分,术后(22.5±0.9)分(P<0.05).随访发现除1例患者外,其余患者腰背部疼痛明显缓解,植骨融合情况良好,未出现脊柱不稳定.结论 后路椎体间植骨融合椎弓根钉内固定术可明显缓解复发性腰椎间盘突出症患者下腰痛症状,促进相邻椎体达到骨性愈合,恢复脊柱稳定.     

Vestibular,optokinetic, and cognitive contribution to the guidance of passive self-rotation toward instructed targets

We ask how vestibular and optokinetic information is combined ("fused") when human subjects who are being passively rotated while viewing a stationary optokinetic pattern try to tell when they have reached a previously instructed angular displacement ("targeting task"). Inevitably such a task entices subjects to also draw on cognitive mechanisms such as past experience and contextual expectations. Specifically, because we used rotations of constant angular velocity, we suspected that they would resort, consciously or unconsciously, to extrapolation strategies even though they had no explicit knowledge of this fact. To study these issues, we presented the following six conditions to subjects standing on a rotatable platform inside an optokinetic drum: V, pure vestibular (passive rotation in darkness); O, pure optokinetic (observer motionless, drum rotating); VO, combined (passive rotation while viewing stationary drum); Oe, optokinetic extrapolation (similar to O, but drum visible only during first 90° of rotation; thereafter subjects extrapolate the further course in their minds); VOe, combined extrapolation (similar to VO, but drum visible only during first 90°); AI, auditory imagination (rotation presented only metaphorically; observers imagine a drum rotation using the rising pitch of a tone as cue). In all conditions, angular velocities (v _C) of 15, 30, or 60°/s were used (randomized presentation), and observers were to indicate when angular displacement (of the self in space or relative to the drum) had reached the instructed magnitude ("desired displacement", D _D; range 90–900°). Performance was analyzed in terms of the targeting gain (G _T = physical displacement at time of subjects' indication / D _D) and variability (%E _R = percentage absolute deviation from a subject's mean gain). In all six conditions, the global mean of G _T (across v _C and D _D) was remarkably close to veracity, ranging from 0.95 (V) to 1.06 (O). A more detailed analysis of the gain revealed a trend of G _T to be larger with fast than with slow rotations, reflecting an underestimation of fast and an overestimation of slow rotation. This effect varied significantly between conditions: it was smallest in VO, had intermediate values with the monomodal conditions V and O, and also with VOe, and was largest in Oe and AI. Variability was similar for all velocities, but depended significantly on the condition: it was smallest in VO, of intermediate magnitude in O, VOe, Oe, and largest in V and AI. Additional experiments with conditions V, O, and VO in which subjects repetitively indicated displacement increments of 90°, up to a subjective displacement of 1080°, yielded similar results and suggest, in addition, that the displacement perceptions measured at the beginning and during later phases of the rotation are correlated. With respect to the displacement perception during optokinetic stimulation, they also show that the gain and its variability are similar whether subjects feel stationary and see a rotating pattern, or feel rotated and see a stationary pattern (circular vection). We conclude that the vestibular and optokinetic information guiding the subjects' navigation toward an instructed target is not fused by straightforward averaging. Rather the subjects' internal velocity representation (which ultimately determines G _T) appears to be a weighted average of (1) whatever sensory information is available and of (2) a cognitive default value reflecting the subjects' experiences and expectations. The less secure the sensory information (only one source as in V or O, additional degrading as in Oe or AI), the larger the weight of the default value. Vice versa, the better the information (e.g., two independent sources as in VO), the more the actual velocity and not the default value determines displacement perception. Moreover, we suggest that subjects intuitively proceeded from the notion of a constant velocity rotation, and therefore tended to carry on the perception built up during the beginning of a rotation or, in the case of vestibular navigation, to compensate for the decaying vestibular cue by means of an internal recovery mechanism.     

硫酸镍对SD大鼠晶状体损伤的实验研究

背景流行病学调查表明,镍矿区人群中自内障的发病率高于其他人群,硫酸镍对人晶状体上皮细胞（LECs）的代谢和增生有抑制作用,但目前镍对晶状体损伤机制的研究较少。目的探讨硫酸镍对sD大鼠晶状体的损伤情况。方法出生7～14d的SPF级sD大鼠45只随机分为空白对照组、皮下注射组、腹腔注射组。腹腔注射组、皮下注射组分别腹腔注射或皮下注射2g／L的硫酸镍溶液10mg／kg,连续给药45d;空白对照组不用药。给药后每2周裂隙灯下观察sD大鼠晶状体的变化,给药后45d参考LOCSⅡ、LOCSⅢ的评价标准对晶状体的前囊、核区、皮质和后囊进行混浊指数评分,评价sD大鼠晶状体的混浊程度。45d后处死大鼠,取下完整晶状体行组织学观察。结果与空白对照组比较,皮下注射组大鼠晶状体前囊区混浊指数评分较高,差异有统计学意义（t=14．311,P〈0．05）,腹腔注射组大鼠晶状体前囊区混浊指数评分虽高于空白对照组,但差异无统计学意义（t=4．355,P〉0．05）。皮下注射组和腹腔注射组大鼠晶状体后囊混浊指数评分高于空白对照组,差异均有统计学意义（t=9．316,P=0．004;t=7．464,P=0．009）。皮下注射组和腹腔注射组大鼠晶状体前囊＋后囊晶状体混浊指数评分高于空白对照组,差异均有统计学意义（t=23．387,P=0．000;t=10．533,P=0．002）。各组大鼠晶状体皮质区和核区混浊指数评分比较差异均无统计学意义（P〉0．05）。皮下注射组、腹腔注射组大鼠晶状体混浊指数总评分高于空白对照组,差异均有统计学意义（t=12．358,P=0．001;t=10．188,P=0．003）;皮下注射组晶状体混浊的总评分高于腹腔注射组,但差异无统计学意义（t=0．527,P〉0．05）。皮下注射组和腹腔注射组大鼠晶状体胶原纤维变性均比空白对照组严重,皮下注射组大鼠的晶状体胶原纤维变性比腹腔注射组明显。结论硫酸镍皮下注射和腹腔注射均能对SD大鼠晶状体造成一定的损伤,晶状体损伤的部位主要集中在晶状体前囊和后囊下。     

增生性糖尿病视网膜病变手术方式的探讨

目的探讨玻璃体切除与晶状体乳化吸出联合手术治疗增生性糖尿病视网膜病变的效果。方法回顾性分析增生性糖尿病视网膜病变26例（26眼）联合手术与24例（24眼）单纯玻璃体切除手术,术后视力及术中术后并发症等临床资料。平均随访时间分别为20个月和21个月。结果两组患者手术后视力较术前均提高,两组之间差异无统计学意义（P〉0．05）;术后前房内纤维素渗出膜形成者两组分别有6眼和1眼（P〉0．05）;术后角膜水肿两组分别有10眼和3眼（P〈0．0）;术后发生新生血管性青光眼者两组分别有2眼和1眼（P〉005）;术后形成虹膜后粘连者两组分别有5眼和1眼（P〉0．05）;术后再行玻璃体切除术者两组分别有1眼和2眼（P〉0．05）;术后视网膜再次脱离者两组分别有1眼和3眼（P〉0．05）。结论联合手术治疗增生性糖尿病视网膜病变是安全有效的,可避免再次手术,对迅速恢复术后视力,有积极的作用。     

多聚赖氨酸-乙二胺四乙酸交联物抑制兔晶状体上皮细胞生长的研究

背景后囊膜混浊（PCO）是现代白内障囊外摘出术后引起视力下降的主要原因。研究证实多聚赖氨酸-乙二胺四乙酸（EDTA）交联物（PLE）能够降低兔PCO的发生率。目的研究PLE对体外培养的兔晶状体上皮细胞（LECs）生长的抑制作用及有效药物浓度。方法取3月龄新西兰白兔晶状体前囊膜进行体外植块培养获得兔LECs并进行传代,取第2～3代传代培养的LECs消化后按1×10^5个／ml密度接种于96孔培养板中。在培养皿中加入12．5、25．0、50．0、100．0μmol／L的PLE,培养皿中加入DMSO培养液作为对照组。PLE作用48h用MTT比色法测定PLE对兔LECs增生的抑制作用并计算各浓度PLE组的吸光度（A490）值及其抑制率。结果≤25．0μmol／LPLE组可见细胞生长及形态改变不明显。≥50．0μmol／LPLE各组可见细胞生长及形态有明显改变,增生缓慢,生长差,数量减少,贴壁能力减弱。12．5、25．0、50．0、100．0μmol／L的PLE组LECs的A490值分别为0．278±0．013、0．266±0．028、0．260±O．022和0．247±0．012,均明显低于DMSO对照组的O．311±0．038（P=0．035、0．011、0．009、0．013）,且呈明显的剂量一效应依赖关系。12．5、25．0、50．0、100．0μmol／LPLE组对兔LECs的抑制率分别为10．61％、14．47％、16．40％和20．58％。结论PLE可以浓度依赖的方式抑制兔LECs的生长,可为临床筛选出防治PCO的药物提供依据。     

玻璃体积血早期对兔眼晶状体上皮细胞超微结构的影响

背景长期的玻璃体积血会产生一些毒性物质。在白内障手术中发现,陈旧性玻璃体积血眼晶状体前囊膜薄且透明,研究玻璃体积血对晶状体的影响对玻璃体切割手术时机的选择有重要意义。目的观察玻璃体积血对兔眼晶状体上皮细胞（LECs）超微结构的影响。方法取8只普通级新西兰大白兔,左眼为实验眼,右眼为对照眼。实验眼玻璃体腔注射0．1ml自体耳缘静脉血,对照眼以同样的方法注射等体积的PBS（pH7．4）。于注射后1、3、5、9、15、20、25、30d用直接检眼镜检查玻璃体及眼底情况,注射后第30天取实验兔双眼晶状体前囊膜制备组织切片,透射电子显微镜下检测LECs的凋亡情况。结果玻璃体腔注射后检查实验组和对照组兔眼均未发现眼内炎症表现,对照组兔眼无玻璃体积血。术后第1天,实验眼玻璃体积血凝集,边界清晰;第5天可见玻璃体呈暗红色改变,眼底窥不清;第15天时可见积血块转变成灰白色,玻璃体液化;注射后第25天时,血液基本吸收;注射后第30天,可见玻璃体液化,无血液沉积,但玻璃体色泽较对照组深暗。透射电子显微镜下检查发现实验眼LECs间隙增大,与囊膜连接疏松,线粒体数量减少且呈空泡样改变,细胞中内质网扩张,核膜双层结构消失并呈皱缩样改变。对照组LECs结构无明显变化。结论玻璃体积血可能引起LECs凋亡的超微结构病理性改变。     

葡萄膜炎并发白内障术中植入肝素修饰人工晶状体

目的评价葡萄膜炎并发白内障术中植入肝素表面修饰的PMMA人工晶状体的效果。方法98例（146眼）葡萄膜炎并发白内障行超声乳化吸出术,术中分别植入肝素修饰的PMMA人工晶状体56例（98眼）（肝素组）和未修饰PMMA人工晶状体42例（48眼）（对照组）。对两组术后视力、眼前段反应、后囊浑浊情况进行回顾性对比分析。结果矫正视力≥0．5者,肝素组86眼（87．76％）,对照组27眼（56．25％）,（P〈0．05）。眼前段反应：人工晶状体表面纤维素样渗出、房水细胞,均在术后1周时差异最显著（P〈0．05）,虹膜后粘连在6个月后两组差异最显著（P〈0．05）。后囊浑浊发生率6个月后对照组明显高于肝素组,分别为54．17％和12。24％（P〈0．05）。结论葡萄膜炎并发白内障术中植入肝素修饰人工晶状体能显著减轻术后眼前段的炎症反应,降低后囊浑浊的发生率。