The natural course of peripheral and autonomic neural function during the first two years after diagnosis of type 1 diabetes

Summary Motor and sensory nerve conduction velocities (MNCV, SNCV), beat-to-beat variation (BBV) at rest, speed of pupillary dilation (SPD), and pupillary latency time (PLT) were measured in 32 patients aged 12–36 years after 19±2 (mean±SEM) days and again after 3, 12, and 24 months of insulin treatment. Moreover, BBV under deep respiration was determined after 12 and 24 months, and thermal discrimination thresholds (TDT) as well as pain and vibration perception thresholds (PPT, VPT) were evaluated after 24 months. Mean HbA₁ levels during months 3–24 within the normal range (7.2±0.2%; mean±SEM) were observed in 20 patients (group 1), while in 12 patients (group 2) mean HbA₁ of months 3–24 was elevated (10.1±0.4%). There were no significant differences between both groups with regard to the nerve function tests at baseline and after 3 months. After 12 months mean median MNCV and median, ulnar, and sural SNCV were significantly lower in group 2 than in group 1 (p<0.05). After 24 months mean median MNCV, peroneal MNCV, median SNCV, and sural SNCV as well as both BBV tests and PLT were significantly impaired in group 2 as compared to group 1 (p<0.05). In addition, mean malleolar VPT and PPT to heat and cold stimuli on the thenar and the foot were significantly elevated in group 2 as compared to group 1 (p<0.05). These findings suggest that early deterioration of somatic nerve function after one year and of autonomic function after 2 years of diabetes may be prevented by effective glycemic control initiated immediately after diagnosis of the disease.Abbreviations BBV beat-to-beat variation - CSII continuous subcutaneous insulin infusion - IDDM insulin-dependent diabetes mellitus - MNCV motor nerve conduction velocity - NS not significant - PLT pupillary latency time - PPT pain perception threshold - SNCV sensory nerve conduction velocity - SPD speed of pupillary dilation - TDT thermal discrimination threshold - VPT vibration perception threshold     

氟脲嘧啶脂质体注射液取代5-氟脲嘧啶注射液联合化疗治疗转移性胃癌近期疗效的评价

目的:探讨氟脲嘧啶脂质体注射液(139-3)取代5-氟脲嘧啶注射液(5-FU)的联合化疗方案治疗转移性胃癌的近期疗效、不良反应及对宿主免疫系统的影响.方法:选择根治术后转移的胃癌患者148例,随机分成氟脲嘧啶脂质体组(139-3组)及5-氟脲嘧啶组(5-FU组),以HDLF方案进行全身静脉化疗,28天为1个周期,每例均完成至少4个周期的化疗.结果:两组均无完全缓解的病例,139-3组总有效率为60.4%,5-FU组总有效率为45.6%,主要不良反应为轻度的消化道反应和骨髓抑制.治疗后,139-3组T淋巴细胞亚群CD3 、CD4 、CD4 /CD8 均不同程度高于5-FU组,CD8 则低于5-FU组.结论:氟脲嘧啶脂质体注射液在HDLF联合化疗方案中可取代5-氟脲嘧啶注射液而获得更好的疗效,对宿主的免疫功能有激发作用.     

Primacy and recency effects in rhesus monkeys (Macaca mulatta) using a serial probe recognition task III. A developmental analysis

In children, the recency effect emerges prior to the primacy effect. To determine whether this dissociation is also seen in nonhuman primates, we evaluated the development of the primacy and recency effect in 3 young adult (35 months) and 4 adolescent (21 months) male rhesus monkeys (Macaca mulatta) using a six-item serial probe recognition (SPR) task. As predicted, the young adult monkeys displayed both effects, while the adolescent monkeys only displayed the recency effect. Not until after 26 months of training on the SPR task did the adolescent monkeys exhibit both the primacy and recency effect. Interference and strategy differences are discussed in terms of the results along with an interpretation of Rudy's (1992) configural association theory of cognitive development. Additional possible explanations for this developmental dissociation include the delayed maturation of the neocortical, hippocampal, and/or cholinergic systems, the latter two having been shown to be important in the expression of the primacy but not the recency effect. © 1998 John Wiley & Sons, Inc. Dev Psychobiol 32: 215–224, 1998     

Clinical and resource-use outcomes of risperidone long-acting injection in recent and long-term diagnosed schizophrenia patients: results from a multinational electronic registry

ABSTRACT

Background: Non-adherence to pharmacological treatment leading to frequent relapses and rehospitalizations is a major issue of concern among schizophrenia patients, especially those who are recently diagnosed. Risperidone long-acting injection (RLAI) has been shown to be efficacious, improve compliance, and increase long-term retention rate on therapy.

Objective: To determine clinical outcomes and hospitalizations before and after the initiation of RLAI among schizophrenia patients with recent (≤2 years) diagnosis relative to those who had long-term (> 2 years) diagnosis.

Research design and methods: The electronic Schizophrenia Treatment Adherence Registry (e-STAR) is an observational study of patients with schizophrenia who start treatment with RLAI. Data were recorded at baseline, retrospectively for the 12 months prior to baseline, and prospectively every 3 months for 24 months. Data on patients with a defined length of diagnosis were pooled from eight countries.

Main outcome measures: Clinical Global Impression of Illness Severity (CGI-S), Global Assessment of Functioning (GAF) scores, and hospitalization data were key outcomes.

Results: The magnitude of improvement in CGI-S scores was greater in the recent versus long-term diagnosis group [Δ ?1.48 vs. Δ ?0.95 (12 months); Δ ?1.6 vs. Δ ?1.09 (24 months)]. There were parallel improvements in GAF scores [Δ 19.4 vs. Δ 13.7 (12 months); Δ 22.3 vs. Δ 16.8 (24 months)]. The decline in the proportion of patients hospitalized from the retrospective to the prospective period was greater in the recent versus long-term diagnosis group (Δ ?36.0 vs. Δ ?19%, respectively) at 12 months. This was also true for the number of hospital stays (Δ ?0.6 vs. Δ ?0.3, respectively) and length of stay (days) (Δ ?20.9 vs. Δ ?6.9, respectively) at 12 months. Common adverse events in both groups included psychiatric, gastrointestinal, musculoskeletal and reproductive system and breast disorders.

Conclusions: Treatment with RLAI is associated with improved outcomes in recently diagnosed and chronic patients. However, the magnitude of improvement was higher in recently diagnosed patients.     

Icodextrine : quels arguments pour et contre son utilisation comme agent osmotique en dialyse péritonéale ?

Icodextrin is a glucose polymer derived from starch that is used as an osmotic agent in peritoneal dialysis. Its high molecular weight limits blood absorption and is useful for long dwell since there is few osmotic gradient dispersal. Its benefits are numerous: ltrafiltration optimization and better salt and water control especially in anuric patients with a high peritoneal permeability and also in case of infectious peritonitis, glucose sparing with less metabolic complications and a better preservation of peritoneal membrane, better biocompatibility. However it should not be forgotten that icodextrin has also side effects that must be known: allergies, cases of aseptic peritonitis, overintense water and salt depletion, lymphatic absorption of icodextrin and its metabolites (including maltose) with a risk of false capillary glucose rate estimation and a moderate increase in plasma osmolality. That is why it is not recommended now to use more than one daily icodextrin dwell. Nevertheless, several dialysis units use icodextrin in more than one daily dwell, especially in patients with an important ultrafiltration loss or in those in whom glucose sparing is essential. It seems to profit them with no more side effects. A large multicenter trial is in progress to test the efficacy and safety of icodextrin dwell twice a day in elder incident patients in peritoneal dialysis (DIDo). Moreover, icodextrin is also used combined with glucose in a long dwell (bimodal ultrafiltration) with encouraging results in terms of ultrafiltration and glucose sparing.     

腹腔镜结直肠癌根治术的可行性及近期疗效分析

目的:探讨腹腔镜结直肠癌根治术的可行性及近期临床疗效。方法:回顾分析2010年3月至2013年10月92例结直肠癌患者的临床资料,其中28例行腹腔镜手术,64例行传统开腹手术,对比分析两组患者术中出血量、切口总长度、肛门首次排气时间、人均止痛次数、术后下床活动时间、住院时间、手术时间、术后并发症等指标。结果:腹腔镜组术中出血量、切口总长度、肛门首次排气时间、人均止痛次数、术后下床活动时间、住院时间优于开腹组,差异有统计学意义(P<0.05)。清除淋巴结数量、术后并发症两组差异无统计学意义(P>0.05),但腹腔镜组术后并发症发生率低于开腹组,腹腔镜手术时间长于开腹手术。结论:腹腔镜结直肠癌根治术具有患者创伤小、康复快、住院时间短等优点,其手术疗效与开腹手术相当,值得临床推广应用。其适应证的掌握是循序渐进的过程,随着学习曲线的完成、技术水平的完善、手术经验的积累及腔镜设备的改进,手术适应证会逐步扩大。     

恶性淋巴瘤中西医结合临床治疗进展

叙述了中西医结合治疗恶性淋巴瘤的临床疗效,反映了恶性淋巴瘤治疗研究的概况,并对未来传统中医药治疗恶性淋巴瘤的前景进行了展望.     

初发SLE住院患者的护理

目的探讨初次发病住院的SLE患者的整体护理和健康教育模式。方法对40例初发SLE住院患者进行系统性整体护理，实施合理的健康教育。结果提高了他（她）们遵医行为，减少了药物的不良反应和疾病复发的因素。结论加强心理护理、用药护理及预防感染，减少诱发因素，使患者恢复正常的生活和工作，这是护理初发SLE患者的关键所在。     

低分子肝素治疗不稳定型心绞痛临床研究

目的 探讨低分子肝素治疗不稳定型心绞痛的临床疗效及安全性。方法 观察低分子肝素治疗前后，患者心绞痛日均发作次数、每次发作持续时间、消心痛含服日均用药量及血液流变学变化。结果 142例患者应用低分子肝素治疗后，临床症状及血液流变学指标均明显改善，无出血等并发症。结论 低分子肝素治疗不稳定型心绞痛安全、疗效确切。     

糖化血红蛋白水平与晚期胃癌FOLFOX方案化疗的近期有效率相关性研究

目的：研究晚期胃癌患者不同的糖化血红蛋白水平与化疗的近期有效率的相关性。方法对52例晚期胃癌患者进行回顾性分析,测定化疗前后的患者糖化血红蛋白水平的变化,观察该指标与近期有效率（ RR）的相关性。结果全组52例患者均完成至少3个周期化疗,并行疗效评价。该组患者FOLFOX方案化疗的近期有效率为32．7％,晚期胃癌患者化疗后糖化血红蛋白水平与患者不同的病灶数目的差异有统计学意义（P＝0．039）。晚期胃癌患者糖化血红蛋白的低、中、高水平组RR分别为9、6、2例,3组患者化疗的近期有效率比较,差异有统计学意义（ P＜0．05）;低、中、高糖化血红蛋白水平组疾病控制率分别为89．4％（17／19）、76．1％（16／21）、41．6％（5／12）,组间比较,差异均有统计学意义（P＜0．05）。结论糖化血红蛋白水平较高的晚期胃癌患者近期有效率较差,糖化血红蛋白水平可能是潜在的化疗近期疗效预测指标之一。