Neutrophil Bactericidal Function in Diabetes Mellitus: Evidence for Association with Blood Glucose Control

Neutrophil bactericidal activity was assessed in patients with type 1 (n=45) and Type 2 diabetes mellitus (n=68) and non-diabetic control subjects (n=40) by measurement of whole blood chemiluminescence. Though chemiluminescence values tended to be highest in the non-diabetic subjects these differences were not statistically significant (mean ± SD) (2.73 ± 1.65 mV (controls), 2.33 ± 1.41 mV (Type 1 diabetes) and 2.38 ± 1.12 mV (Type 2 diabetes), F=1.12, p=0.33). Significant negative correlations were evident, however, in patients with both Type 1 and Type 2 diabetes between chemiluminescence and glycated haemoglobin (r_s=-0.35, p=0.005 (Type 1), r_s=-0.45, p=0.002 (Type 2), fructosamine (r_s=-0.36, p=0.003 (Type 1), r_s=-0.42, p=0.004 (Type 2)), and random blood glucose (r_s=-0.25, p=0.04 (Type 1), r_s=-0.48, p=0.001 (Type 2)). Changes in whole blood chemiluminescence in a further group of 10 patients with Type 2 diabetes mellitus commenced on insulin therapy were followed for 21 days. Serum fructosamine concentrations fell significantly over this time (524 ± 58 μmol l^?1 to 405 ± 47 μmol l^?1, p<0.001), however, although chemiluminescence values tended to rise these changes were not statistically significant (1.01 ± 0.38 mV to 1.60 ± 0.91 mV, S=4.24, df=5, p=0.52). These results suggest that impaired neutrophil bactericidal function is associated with poor blood glucose control. While it is likely that neutrophil bactericidal function will improve as blood glucose control improves, further studies are required both to confirm this and to demonstrate a reduction in the incidence of clinical bacterial infection.     

Modulation of infection-induced inflammation and locomotive deficit and longevity in senescence-accelerated mice-prone (SAMP8) model by the oligomerized polyphenol Oligonol.

Oligonol is produced from the oligomerization of polyphenols (typically proanthocyanidin from a variety of fruits such as lychees, grapes, apples, persimmons, etc.) and contains catechin-type monomers and oligomers of proanthocyanidins. The ability of Oligonol to affect infection-dependent eye inflammation, locomotion and longevity in senescence-accelerated prone mice (SAMP8) (a model of senescence acceleration and geriatric disorders with increased oxidative stress and neuronal deficit) was investigated. Oligonol (60mg/kg) significantly modulated the extent of inflammation scores in the eye of SAMP8 mice. Examination of the mice indicated infection with mouse hepatitis virus and pinworm (Syphacia obvelata) in both males and females and with the intestinal protozoa (trichomonad) in males. A comparison of the two groups (using log-rank test) and the difference in the mean life span between groups (using Student's t-test) indicated significant differences in survival (p=0.043) and the mean life span (p=0.033) in male SAMP8 mice. Oligonol increased the mean life span and this was statistically significant. In the open-field locomotive test, the 7-week-old SAMP8 mice crossed more than 40 partitioned lines in 1min. At 48-week-old control untreated male SAMP8 crossed 2 lines. The Oligonol-treated 48-week-old male SAMP8 mice crossed 17 lines however. The improved locomotive activity was statistically significant even after 36weeks in the Oligonol-treated male SAMP8 but this was not the case throughout the time course of the study in the Oligonol-treated female SAMP8. Thus Oligonol treatment to SAMP8 mice modulated the severity of infection-dependent inflammation, prolonged life-span and significantly improved locomotive activity indicating potential benefit to aging-associated diseases such as Alzheimer's or Parkinson's diseases. This presents potential for further research to define infection-dependent inflammation associated with degenerative conditions and the molecular mechanism of dietary antioxidant protection.     

Klinische und funktionelle Ergebnisse der abdominalen Rektopexie unter Verwendung verschiedener Fixierungsgrundlagen

Zusammenfassung 63 Patienten wurden wegen eines Rektumprolaps durch eine abdominale Rektopexie (Operationsverfahren nach Ripstein-Corman) therapiert. Als Rektopexienahtlagermaterial wurden lyophylisierte Dura-Streifen, ein Vicryl-Netz oder ein Dexon-Netz verwendet. 71,4% (n = 45 von 63) des Kollektivs konnten nachuntersucht wurden, der Nachbeobachtungszeitraum betrug im Mittel 52,5 Monate. Die postoperative verfahrensbedingte Mortalität betrug 0%, im 30-Tage-Intervall nur 1,6% wegen kardialer Komplikationen. Intraoperative Komplikationen traten in 4,7% der Fälle auf. Die postoperative Morbiditätsrate betrug 25,4% (n = 16 von 63), infektbedingte Komplikationen wurden in 12.7% (n = 8 von 63) der Fälle beschrieben, davon 1 Fall mit einer spontan ausgeheilten pelvikutanen Fistel. Ein Rektumprolapsrezidiv zeigte sich in 4,4% (n = 2 von 45) der Fälle (nur Dura-Rektopexie), ein Schleimhautprolaps trat bei 15,5% (n = 7 von 45) der Fälle auf. Postoperativ reduzierten sich Obstipationsbeschwerden um 28,6% (n = 18 von 63) auf 22,2%. Bei Patienten mit einer präoperativen Inkontinenz wurde eine Verbesserung in 60,7% (n = 17 von 28) der Fälle erreicht, 35,7% (n = 10 von 28) waren vollständig kontinent. Die Steigerung der Kontinenzgrade durch eine abdominale Rektopexie ist statistisch signifikant (Wilcoxon-Test, p = 0,05). Die Einflußgrößen hohes Lebensalter, Prolapsanamnesedauer, Geburtenzahl und präoperative Inkontinenzdauer

---

Clinical and functional results after abdominal rectopexy: a comparison of dura strips. Vicryl and Dexon gauze as fixation material and suture placement (Ripstein-Corman procedure)

We report our results with abdominal rectopexy (modified Ripstein procedure, Ripstein/Corman) without resection of the colon in 63 patients using lyophylized dura-strips, Vicryl gauze or Dexon gauze, as the underlying fixation material for the mobilized rectum, presacral fascia and fixation suture material. Forty-five of 64 patients (71.4%) were reevaluated by proctoscopic examination and questioning; the mean follow-up time was 52.5 months (range 3–136 months). Postoperative mortality due to the method was 0%; the mortality was 1.6% (n = 1/63) in general for the first postoperative 30-day period as a result of cardiac complications. There were three complications (4.7%) the durating operation. Postoperative morbidity was 25.4% (16/63); infectious complications occurred in 12.7% (8/63) of cases, with one case of spontaneous closure of a pelvicutaneous fistula after intraoperative injury to the rectal wall. Full-thickness rectal prolapse appeared after rectopexy in 4.4% (2/45) (dura material alone) and mucosal prolapse was seen in 15.5% (7/45) of the follow-up group. Constipation was reduced by 28.6% (18/63) to 22.2% during the follow-up. Seventeen of 28 patients (60.7 %) with incontinence showed an improvement; total continence was registered in 35.7% (10/28). The increase in continence as a result of abdominal rectopexy was significant (Wilcoxon, P = 0.05). The special aspects of being in an older age group, having a long history of procidentia, the number of deliveries, the length of the preoperative incontinence period all showed no influence on the postoperative degree of continence (Spearman's rank correlation). In 7/15 cases with persisting incontinence after rectopexy, postanal repair (Parks) was efficient in 7/7 cases leading to total or partial continence. Abdominal rectopexy with the Ripstein-Corman procedure is generally recommended for the treatment of procidentia. Absorbable material for the Ripstein sling is preferred because of the low prolapse recurrency rate and the low infection rate; the absorbability of Vicryl or Dexon gauze might be of advantage in cases of pelvic sepsis after rectopexy, as removal of the gauze is not necessary. Resection of the colon as a treatment for severe constipation is not generally recommended.

     

Risk infection factors in the total hip replacement

Infection is a complication that occurs in a considerable percentage of hip prostheses replacements, being in many cases necessary to retire them, which generates important health and economical problems. Objectives: To know the distribution of infection and its risk factors in total hip replacement. Material and methods: A four year prospective study was developed in the rehabilitation and orthopedic center of La Paz Hospital. A total of 873 patients were included. Patients were controlled by means of active epidemiological surveillance until the day of discharge, listing up their characteristics at admission and risk factors during their stay. A multivariant study was carried out to determine risk factors. Results: Patients, average age was 63 years, 3.4% of them suffered from diabetes and there were no inmunocompromised patients. The percentage of wound infection during the four years was 6%, being reduced to 1.2% in the last year. The risk factors found in the multivariant study were: incorrect prophylaxis (OR: 3.85), wrong scaring (OR: 14.06), suffering more than one intervention (OR: 7.31) and a hospitalization period longer than 30 days (OR: 2.84). Conclusion: We think that special attention in the care of the surgical wound, as well as the correct use of prophylaxis, can significantly collaborate to the reduction of infection.     

Labelling of leucocytes with colloidal tech netium-99m-SnF2: an investigation of the labelling process by autoradiography

Autoradiography of smears and frozen sections of labelled cell suspensions was used to study the distribution of radioactivity in and among blood cells labelled in either whole blood or leucocyte-rich plasma (LRP) with technetium-99m-SnF₂ colloid. The tracer proved selective for neutrophils: the labelling probability (relative to that for erythrocytes) for each cell type in LRP (mean of five samples) was: neutrophils, 9.4; lymphocytes, 3.7; monocytes, 3.0; eosinophils 1.4; erythrocytes, 1.0. When labelling was carried out in whole blood (five samples), 74.5%±8.3% of the cell-bound radioactivity was bound to erythrocytes, 13.6%±6.5% to neutrophils, and 11.9%±2.1% to lymphocytes, whereas in LRP (in which the leucocytes were only slightly out-numbered by erythrocytes), 76.5%±14.9% of radioactivity was neutrophil bound. Labelled cells in smear autoradiographs exhibited two distinct silver grain patterns, diffuse, consistent with an intracellular radioactive particle (in neutrophils), and focal, consistent with a cell surface-adhering particle in direct contact with the emulsion (in other leucocyte types and erythrocytes). The phagocytic inhibitor cytochalasin B neither reduced the proportion of labelled neutrophils nor altered the labelling pattern. Neutrophils were able to scavenge radioactivity from the surface of erythrocytes. It is concluded that neutrophils bind^99mTc-SnF₂ intracellularly by phagocytosis, with high affinity; other cells become labelled at the cell surface reversibly and with lower affinity. This selectivity is high enough to permit predominantly leucocyte labelling in LRP but not in whole blood.     

生化检查对人工髋关节感染的诊断价值

目的评价翻修术前生化检查对人工髋关节感染的诊断价值。方法对145例人工髋关节翻修患者进行回顾性分析,分别以血沉(ESR)和C-反应蛋白(CRP)作为诊断标准对人工髋关节感染进行诊断,并与“金标准”的诊断结果进行比较分析。结果血沉和CRP诊断人工髋关节感染的灵敏度分别为57.89%、68.42%,特异度分别为85.71%、88.89%,阳性预测值分别为37.93%、48.15%,阴性预测值分别为93.10%、94.92%,准确度分别为20.00、18.62,Youden指数分别为0.44、0.57。结论血沉和CRP作为人工髋关节翻修术前的常规检查,对人工髋关节感染的诊断具有筛选价值;两者结合起互补作用,可以增加诊断的准确性。     

居家治疗的患者家庭中医疗废弃物处理问题的探讨与研究

目的 了解目前居家治疗的患者对医疗废弃物的认识及医疗废弃物的处理情况,并通过正确的指导和鼓励进一步规范居家治疗的患者家庭中医疗废弃物的管理.方法 发放问卷对居家治疗的120名糖尿病患者进行调查,调查他们对医疗废弃物的认识,目前所采取的处理方法,有无被废弃物损伤的经历等.通过知识讲解,电话回访,并和社区、当地基层医院建立联系,借助社区医院、基层医院为载体,在广泛宣传的基础上,按照就近、方便的原则,利用废弃的广口硬质塑料瓶,将居家治疗中产生的医疗垃圾有效收集并集中处理.为患者提供恰当的容器和地点进行医疗废弃物回收,对按要求回收者给予一定的奖励.结果 通过12个月的跟踪调查指导,居家治疗的患者对医疗废弃物的危害、正确处理的途径的认识有了较大提高;针刺伤发生率明显下降(P<0.01).结论 通过正确的指导和鼓励,能够提高人们对医疗废弃物认识,逐步做到规范处理.     

人工流产与早产关系的妇产科学前瞻性研究

目的研究妇女人工流产次数对再孕后发生早产几概率的关系。方法对我院2010年1月至2012年12月分娩的产妇其早产儿的发生率与其既往人工流产史的关系进行了回顾性分析研究。采用卡方检验进行统计学分析。结果有3次或3次以上人工流产的产妇组与无人工流产史的产妇组其再孕后早产儿发生率χ2=7．3279,P=0．01-0．005呈显著性差异,而有1次或2次人工流产史组的产妇与无人工流产史的产妇再孕后发生早产几的概率χ2=1．41844,P=0．25-0．01．χ2=0.9148,P=0．5—0．25无明显差异。结论有1次或2次人工流产史对再孕后发生早产儿的概率虽无显明影响但人工流产次数过多可引起早产儿发生概率明显增加。