4字位关节镜手术治疗60岁以上腘窝囊肿患者的临床疗效

目的：探讨4字位关节镜手术治疗60岁以上腘窝囊肿患者的临床疗效。方法：选择2013年6月至2015年6月36例膝关节疼痛、肿胀、活动受限的60岁以上腘窝囊肿患者作为研究对象。采用4字位关节镜切除腓肠肌内侧头与半膜肌肌腱之间的关节囊皱襞,扩大开口至1 cm,同时处理关节内疾病。术前和术后对患者进行Rauschning-Lindgren评分。结果：4字位进行镜下操作方便,建立通道无障碍。36例患者中有34例(94.4%)合并关节内疾病,内侧半月板损伤24例(66.7%),外侧半月板损伤10例(27.8%),关节软骨Ⅲ~Ⅳ级损伤12例(33.3%),关节游离体8例(22.2%)。随访时间为10~22个月,平均（16±4）个月。术后膝关节不适症状均较术前明显缓解。术后Rauschning-Lindgren评分明显低于术前水平(P＜0.01)。结论：4字位关节镜手术治疗60岁以上腘窝囊肿患者操作简便、安全、有效,可同时处理关节内疾病,短期疗效确切。     

Optimal treatment allocation for placebo‐treatment comparisons in trials with discrete‐time survival endpoints

In many randomized controlled trials, treatment groups are of equal size, but this is not necessarily the best choice. This paper provides a methodology to calculate optimal treatment allocations for longitudinal trials when we wish to compare multiple treatment groups with a placebo group, and the comparisons may have unequal importance. The focus is on trials with a survival endpoint measured in discrete time. We assume the underlying survival process is Weibull and show that values for the parameters in the Weibull distribution have an impact on the optimal treatment allocation scheme in an interesting way. Additionally, we incorporate different cost considerations at the subject and measurement levels and determine the optimal number of time periods. We also show that when many events occur at the beginning of the trial, fewer time periods are more efficient. As an application, we revisit a risperidone maintenance treatment trial in schizophrenia and use our proposed methodology to redesign it and compare merits of our optimal design. Copyright © 2015 John Wiley & Sons, Ltd.     

THE POVERTY EFFECTS OF A ‘FAT‐TAX’ IN IRELAND

To combat growing levels of obesity, health‐related taxes have been suggested with taxes on foods high in fat or sugar. Such taxes have been criticised on the basis of their regressivity and potentially adverse impact upon poverty. This paper analyses the effect of such taxes on a range of poverty measures and also examines the effect of a revenue‐neutral tax subsidy mixed with a tax on unhealthy food combined with a subsidy on more healthy food. Using Irish expenditure data, the results indicate that taxes on high fat/sugar goods on their own will be regressive but that a tax‐subsidy combination can be broadly neutral with respect to poverty. Copyright © 2013 John Wiley & Sons, Ltd.     

Ventilatory efficiency during ramp exercise in relation to age and sex in a healthy Japanese population

BackgroundThe current understanding of ventilator efficiency variables during ramp exercise testing in the normal Japanese population is insufficient, and the responses of tidal volume (VT) and minute ventilation (V?E) to the ramp exercise test in the normal Japanese population are not known.MethodsA total of 529 healthy Japanese subjects aged 20–78 years underwent cardiopulmonary exercise testing using a cycle ergometer with ramp protocols. VT and V?E at rest, at anaerobic threshold, and at peak exercise were determined. The slope of V?E versus carbon dioxide (V?CO₂) (V?E vs. V?CO₂ slope), minimum V?E/V?CO₂, and oxygen uptake efficiency slope (OUES) were determined.ResultsFor males and females in their 20 s, peak VT (VTpeak) was 2192 ± 376 and 1509 ± 260 mL (p < 0.001), peak V?E (V?Epeak) was 80.6 ± 18.7 and 57.7 ± 13.9 L/min (sex differences p < 0.001), the V?E vs. V?CO₂ slope was 24.4 ± 3.2 and 25.7 ± 3.2 (p = 0.035), the minimum V?E/V?CO₂ was 24.2 ± 2.3 and 27.0 ± 2.8 (p < 0.001), and the OUES was 2452 ± 519 and 1991 ± 315 (p < 0.001), respectively. VTpeak and V?Epeak decreased with age and increased with weight and height. The V?E vs. V?CO₂ slope and minimum V?E/V?CO₂ increased with age, while conversely, the OUES decreased with age.ConclusionsWe have established the normal range of VT and V?E responses, the V?E vs. V?CO₂ slope, the minimum V?E/V?CO₂, and the OUES for a healthy Japanese population. Some of these parameters were influenced by weight, height, sex, and age. These results provide useful reference values for interpreting the results of cardiopulmonary exercise testing in cardiac patients.     

Utilization of oxygen by the contractile apparatus is disturbed during reperfusion of post-ischaemic myocardium

Post-ischaemic ventricular function remains depressed ( = myocardialstunning) despite nearly normal coronary blood flow during reperfusion.In order to illuminate the causes of this phenomenon, we studiedthe relationship between ventricular function and myocardialoxygen consumption (MVO_2tot) in experiments on 15 isolated rabbithearts perfused with erythrocyte suspension (hct=30%). Leftventricular systolic function was assessed by measuring aorticflow (ml. min ^–1), peak systolic pressure (L VP_max), dPldt_max,and early relaxation in terms of dPldt_min during control and30 min after the onset of reperfusion, following 20 min globalno-flow ischaemia. The pressure-volume area was calculated asa measure of total mechanical energy. The external mechanicalefficiency (E_ext) was assessed from stroke work and MVO_2torBothcontractile efficiency (E_con= inverse slope of the MVO₂-PVArelationship) and MVO₂ of the unloaded contracting heart (MVO_2unl=basal MVO₂ + MVO₂ for excitation-contraction coupling) werecalculated using pressure-volume area and MVO_2tot Results: At matched heart rate (149 ± 30 vs 147 ±31 min ^–1; mean ± SD) and end-diastolic volume(1.3 ± 0.2 ml), the systolic variables were significantlydecreased in the stunned myocardium: aortic flow: 38 ±13 vs9 ± 11 ml. min ^–1, LVP_max: 112 ±19vs 74±18mmHg, and dP/dt_max: 1475 ±400 vs 1075±275 mmHg. s^–1. Likewise, dP/dt_min was significantlyimpaired (– 1275 ±250 vs – 975 ±250).The decrease in pressure-volume area (570 ±280 vs 270±200mmHg.ml. 100g^–1) was not statistically significant. In contrast,both E_ext (0.75±0.29 vs 0.18±0.26 arbitrary units)and E_con (31 ± 18 vs 14± 7%) were significantlydecreased, whereas MVO_2tot (40±9 vs 34±8µl.beat^–1. 100g^–1) and MVO_2unl (26±9 vs22±6µl.beat^–1. 100g^–1) were not. Summary: Ventricular function after brief episodes of ischaemiais decreased whereas MVO_2tot is maintained, i.e. external efficiencyis decreased. MVO₂ for the unloaded contraction remained unchanged,indicating that MVO₂for excitation-contraction coupling is inappropriatelyhigh for the depressed contractile state. The decreased contractileefficiency indicates further that O₂ utilization of the contractileapparatus is disturbed during reperfusion.     

Chemokine programming dendritic cell antigen response: part I – select chemokine programming of antigen uptake even after maturation

Here, we report on the successful programming of dendritic cells (DCs) using selectively applied mixtures of chemokines as a novel protocol for engineering vaccine efficiency. Antigen internalization by DCs is a pivotal step in antigen uptake/presentation for bridging innate and adaptive immunity and in exogenous gene delivery used in vaccine strategies. Contrary to most approaches to improve vaccine efficiency, active enhancement of antigen internalization by DCs as a vaccine strategy has been less studied because DCs naturally down‐regulate antigen internalization upon maturation. Whereas chemokines are mainly known as signal proteins that induce leucocyte chemotaxis, very little research has been carried out to identify any additional effects of chemokines on DCs following maturation. Here, immature DCs are pre‐treated with select chemokines before intentional maturation using lipopolysaccharide (LPS). When pre‐treated with a mixture of CCL3 and CCL19 in a 7 : 3 ratio, then matured with LPS, chemokine pre‐treated DCs exhibited 36% higher antigen uptake capacity than immature DCs and 27% higher antigen‐processing capacity than immature DCs treated only with LPS. Further, CCL3 : CCL19 (7 : 3) pre‐treatment of DCs modulated MHC molecule expression and secretion of various cytokines of DCs. Collectively, DC programming was feasible using a specific chemokine combination and these results provide a novel strategy for enhancing DC‐based vaccine efficiency. In Part II, we report on the phenotype changes and antigen presentation capacity of chemokine pre‐treated murine bone marrow‐derived DCs examined in long‐term co‐culture with antigen‐specific CD4⁺ T cells.     

Submaximal arm crank ergometry: Effects of crank axis positioning on mechanical efficiency,physiological strain and perceived discomfort

Purpose: To evaluate the effect of the spatial orientation of the crank axis on mechanical efficiency, physiological strain and perceived discomfort in submaximal synchronous arm crank ergometry.

Methods: Twelve able-bodied individuals performed 12 submaximal exercise bouts of 3 minutes (women: 20 W/25 W; men: 25 W/35 W). The crank axis position was defined by elbow and shoulder angle.

Results: The results showed that a crank set-up with an elbow angle of 30° was more efficient than 15°; oxygen consumption and minute ventilation were significantly lower. No significant effects were seen for shoulder angle. Power output and gender showed obvious effects.

Discussion and conclusion: The magnitude of this effect and the absence of any significant shoulder angle effects may be due to the relative low exertion levels that were evaluated. An elbow angle of 30° flexion in arm crank exercise is favourable compared to an elbow angle of 15° in able-bodied untrained subjects.     

Development of an instrument for the identification of frail older people as a target population for integrated care

Background

Primary care is increasingly interested in the identification of frailty, as it selects the target population for integrated care. However, instruments for the identification of frailty specifically validated for use in primary care are scarce. This study developed the Easycare Two-step Older persons Screening (Easycare-TOS), which provides a valid, efficient, and pragmatic screening procedure to identify frail older people.

Aim

This paper aims to describe the development of the Easycare-TOS and the data from the pilot studies.

Design and setting

Observational pilot study in seven academic GP practices in and around Nijmegen, The Netherlands.

Method

The Easycare-TOS was developed in a cyclic process with the input of stakeholders. In every cycle, the requirements were first defined, then translated into a prototype that was tested in a pilot study. The Easycare-TOS makes optimal use of prior knowledge of the GP, and the professionals’ appraisal is decisive in the frailty decision, instead of a cut-off score. Further, it considers aspects of frailty, as well as aspects of the care context of the patient.

Results

The pilot data have shown that after step 1, two-thirds of the patients do not need further assessment, because they are judged as not frail, based on prior knowledge of the GP. The overall prevalence of frailty in this pilot study is 24%. Most professionals who participated in the pilot studies considered the time investment acceptable and the method to be of added value.

Conclusion

The Easycare-TOS instrument meets the predefined efficiency, flexibility, and acceptability requirements for use as an identification instrument for frailty in primary care.     

深部埋置环形褥式缝合联合浅层X射线放射治疗胸背部瘢痕疙瘩的疗效分析

目的探讨深部埋置环形褥式缝合联合浅层X射线放射治疗胸背部瘢痕疙瘩的临床疗效。方法选取102例胸背部瘢痕疙瘩患者,采用深部埋置环形褥式缝合技术进行治疗,术后进行病理HE染色分析,于术后24 h内行第1次浅层X射线放射治疗,每隔5 d 1次,共4次。于术后1个月、3个月、6个月及1年观察患者的临床疗效,记录患者术后并发症发生率及满意率。结果瘢痕组织HE染色可见表皮萎缩变薄,真皮中上部成纤维细胞及胶原增生,增生的毛细血管周围可见稀疏的炎细胞浸润。术后1个月、3个月、6个月及1年,患者治疗有效率分别为100%、99.02%、96.08%及89.22%;术后总体并发症发生率为16.67%,总体满意率为97.06%。结论胸背部瘢痕疙瘩手术切除后采取深部埋置环形褥式缝合技术联合浅层X射线放射治疗,患者可取得较好的临床疗效,且具有复发率低、无严重并发症等优点。     

Optimization of Polymer Solar Cells Based on the Conjugated Copolymer of Poly(phenylenevinylene‐alt‐4,7‐diphenyl‐2,1,3‐benzothiadiazole) (PP‐DBT)

Polymer solar cells based on poly(phenylenevinylene‐alt‐4,7‐diphenyl‐2,1,3‐benzothiadiazole) (PP‐DBT):[6,6]‐phenyl C₇₁ butyric acid methyl‐ester (PC₇₁BM) blend films are optimized. The results show that the solar cell has a better performance at a 1:4 blend ratio than at 1:1, 1:2, 1:3, and 1:5 blend ratios, due to the higher hole mobility of active layer and the optimized morphology. The device prepared from chlorobenzene (CB) has a higher power conversion efficiency (PCE) than the devices prepared from chloroform and o‐dichlorobenzene, because the former has a much higher short‐circuit current density (J_sc) resulting from the morphology with proper phase separation. The solar cell modified with two layers of ZnO nanocrystals achieves the best performance with an open‐circuit voltage of 0.9 V, a J_sc of 7.46 mW cm^?2, fill factor (FF) of 0.50, and PCE of 3.36%.