BPD treatments: The never-ending smorgasbord

Despite important advances in neonatal care, rates of bronchopulmonary dysplasia (BPD) have remained persistently high. Numerous drugs and ventilator strategies are used for the prevention and treatment of BPD. Some, such as exogenous surfactant, volume targeted ventilation, caffeine, and non-invasive respiratory support, are associated with modest but important reductions in rates of BPD and long-term respiratory morbidities. Many other therapies, such as corticosteroids, diuretics, nitric oxide, bronchodilators and anti-reflux medications, are widely used despite conflicting, limited or no evidence of efficacy and safety.This paper examines the range of therapies used for the prevention or treatment of BPD. They are classified into those supported by evidence of effectiveness, and those which are widely used despite limited evidence or unclear risk to benefit ratios. Finally, the paper explores emerging therapies and approaches which aim to prevent or reduce BPD and long-term respiratory morbidity.     

基于专利分析的输液泵在战创伤救治中应用的研究进展

静脉输液技术是战创伤救治中最常用的技术之一。我军现在仍配备普通的静脉输液装置,无法满足战场救治需要。输液泵作为一种临床常用的医疗器械,为患者给药创造了有利条件,有效的提高了医护人员的工作效率。目前较多专利针对急救、战创伤快速补液研发设计新型输液泵。作者在国家知识产权局、欧洲专利局及美国专利商标局的专利库进行关于便携式输液泵的专利检索,分析总结归纳该类输液泵在国内外专利布局、专利申请量及关键研发技术要点,以期为产品的选用和进一步研发提供参考,促进便携式输液泵在战创伤救治中应用,提高战创伤救治的成功率,更好地挽救伤员的生命。     

Decline in mean platelet volume in patients with patent foramen ovale undergoing percutaneous closure

Patent foramen ovale (PFO) is a haemodynamically insignificant communication that is present in 24% of the general population.1 In 1988 Lechat et al. performed transthoracic echocardiography (TTE) with contrast injection and showed that patients with stroke of unknown cause had PFOs more frequently than the controls.2 Since then, many studies have confirmed this association. In 2000, a meta-analysis summarised the evidence that PFO was more likely to be found in stroke patients than in stroke-free individuals.3In about 50 to 60% of patients younger than 55 years, the cause of acute ischaemic stroke remains undefined.4 In this group, interatrial septal abnormalities are found in 55 to 60% of cases, which is higher than in the normal population.In another meta-analysis, Mattle et al. reported a higher prevelance of PFO in patients with cryptogenic stroke than in patients with a stroke of known causes.1 The postulated possible mechanisms underlying the stroke in the presence of PFO are: paradoxycal embolism, thrombus formation within the conduit of the PFO, or susceptibility of patients with PFO to atrial arrhythmias with possible intra-atrial thrombus formation.4-8Although paradoxycal embolism, which is associated with deep-vein thrombosis (DVT), is the favoured hypothesis, DVT in patients with PFO is usually undetectable.9 Therefore, increased platelet activity as well as disorders in the coagulation cascade may contribute to the association between PFO and stroke.Mean platelet volume (MPV) is a measure of platelet size and is a potential marker of platelet reactivity. It has been shown that larger platelets are metabolically and enzymatically more active and have greater prothombotic potential.10,11The aim of this study was (1) to compare MPVs of PFO patients with and without a history of cryptogenic stroke, and (2) to determine the effect of percutaneous PFO closure on MPV.     

3-dimensional Analysis and Literature Review of the Root Canal Morphology and Physiological Foramen Geometry of 125 Mandibular Incisors by Means of Micro–Computed Tomography in a German Population

IntroductionThe aim of this study was to examine the root canal system morphology of mandibular incisors by means of micro–computed tomographic imaging.MethodsThe root canal configuration, physiological foramina, frequency of accessory and connecting canals, and the size and shape of the physiological foramina of 125 mandibular incisors were investigated by means of micro-CT and 3-dimensional imaging software. Root canal configuration of the coronal, middle, and apical thirds and the physiological foramina number are described by a 4-digit system code.ResultsThe most frequent root canal configurations were 1-1-1/1 (56%), 1-2-1/1 (17.6%), and 1-1-1/2 (10.4%); 9 additional different root canal configurations were observed. Single-rooted incisors showed in 80% 1, in 16% 2, and in 4% 3 physiological foramina, respectively. Accessory canals were found in only 13.6% of the investigated teeth. Connecting canals were observed in 36% of the sample, most often in root canal configurations 1-2-1/1 (12.8%) and 2-2-1/1 (7.2%). The morphologic dimensions of a total of 146 physiological foramina were measured. Their mean wide and narrow diameters were 0.24 mm (standard deviation = 0.1 mm) and 0.23 mm (standard deviation = 0.08 mm) when only 1 physiological foramen was present. The physiological foramen shapes observed were oval (56%), round (28.8%), and irregular (15.2%).ConclusionsThe study provides detailed information about the root canal morphology of anterior teeth in a German population. Within the limitations of the study, the authors recommend according to results obtained in this investigation a final physiological foramen preparation size of ISO 30-35; yet, such a decision should be carefully considered on an individual basis.