Consideration of connective tissue dysfunction in the fragile X syndrome

Eleven cytogenetically documented patients with the fragile X syndrome were evaluated for hyperextensibility of the finger joints and the presence of other manifestations of connective tissue dysfunction. All of the patients had hyperextensibility of several finger joints and many had features such as flat feet, highly arched palate and the ability to voluntarily dislocate finger joints. These traits, particularly hyperextensibility of the joints, are a useful aid in the clinical diagnosis of the fragile X syndrome.     

胃十二指肠溃疡大出血的外科手术疗效

目的观察外科手术治疗胃十二指肠溃疡大出血的临床疗效。方法根据58例胃十二指肠溃疡大出血患者的临床表现及身体状况选择适宜的时机行急诊手术或择期手术治疗。结果本组58例患者中行急诊胃大部切除术治疗者37例,行择期胃大部切除术者21例。术后57例患者痊愈出院,痊愈率达98.28%;死亡1例,占1.72%。有3出例患者术后出现了并发症,并发症发生率5.26%。结论对于胃十二指肠溃疡大出血患者在手术治疗时应严格把握手术适应证,并选择适宜的手术时机和手术方式进行治疗能迅速止血,提高其痊愈率。     

Evaluation of diabetic foot care knowledge,determinants of self-care practices and the efficacy of health education

To evaluate the risk factors connected with diabetic foot care and investigate the impact of health education on promoting proper diabetic foot care practices. An explanatory and mixed-method study was performed. We administered a structured pretest questionnaire to patients diagnosed with Type 2 diabetes who frequented our health examination center and community health clinics. The survey encompassed patient demographics, basic knowledge concerning diabetic foot care, and self-care practices pertaining to diabetic foot care. Concurrent assessments and scoring were carried out. Following the survey, patients underwent health education sessions focusing on foot self-care behaviours. Their progress was reevaluated after 2 weeks to gauge its effectiveness. We identified educational attainment, diabetes duration, regular follow-up, and blood sugar control as critical factors influencing knowledge about foot care and self-care practices related to it. Pearson correlation analysis demonstrated a positive relationship between scores for diabetic foot care knowledge and scores for self-care behaviours (r = 0.32, p < 0.001). Health education led to a significant improvement in the self-care behaviours of diabetic patients. A variety of factors affect the occurrence of diabetic foot complications and the self-care behaviours associated with diabetic foot care. Health education proves to be an effective means of enhancing diabetic foot care behaviours.     

A Cognitive Training Program Based on Principles of Brain Plasticity: Results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) Study

OBJECTIVES: To investigate the efficacy of a novel brain plasticity–based computerized cognitive training program in older adults and to evaluate the effect on untrained measures of memory and attention and participant‐reported outcomes. DESIGN: Multisite randomized controlled double‐blind trial with two treatment groups. SETTING: Communities in northern and southern California and Minnesota. PARTICIPANTS: Community‐dwelling adults aged 65 and older (N=487) without a diagnosis of clinically significant cognitive impairment. INTERVENTION: Participants were randomized to receive a broadly‐available brain plasticity–based computerized cognitive training program (intervention) or a novelty‐ and intensity‐matched general cognitive stimulation program modeling treatment as usual (active control). Duration of training was 1 hour per day, 5 days per week, for 8 weeks, for a total of 40 hours. MEASUREMENTS: The primary outcome was a composite score calculated from six subtests of the Repeatable Battery for the Assessment of Neuropsychological Status that use the auditory modality (RBANS Auditory Memory/Attention). Secondary measures were derived from performance on the experimental program, standardized neuropsychological assessments of memory and attention, and participant‐reported outcomes. RESULTS: RBANS Auditory Memory/Attention improvement was significantly greater (P=.02) in the experimental group (3.9 points, 95% confidence interval (CI)=2.7–5.1) than in the control group (1.8 points, 95% CI=0.6–3.0). Multiple secondary measures of memory and attention showed significantly greater improvements in the experimental group (word list total score, word list delayed recall, digits backwards, letter–number sequencing; P<.05), as did the participant‐reported outcome measure (P=.001). No advantage for the experimental group was seen in narrative memory. CONCLUSION: The experimental program improved generalized measures of memory and attention more than an active control program.     

Lessons from the Trenches: Adopting Medication Technology Within Agencies Serving Older Adults

In 2009, a California-based technology and aging-focused non-profit implemented a medication optimization diffusion grants program, awarding grants to five health service organizations to develop technology-based projects to improve medication use by older adults. The project looked at the diffusion of innovation, in this case the technologies used, within the five organizations. “Diffusion of innovation” refers to the spread or dissemination of an idea, concept, or product throughout a group, such as a society or organization (Rogers 2003). The purpose of this study was two-fold. The first aim was to determine factors that served as challenges and facilitators in implementing and adopting medication optimization technology by community-based programs serving older adults. The second aim was to gather information to inform grant makers of how their grant making structure could better support agencies adopting new medication technologies. A semi-structured questionnaire was administered to the project investigators at each of the five organizations and one clinical site in late 2010 to identify the challenges and facilitators encountered when implementing medication management technology for older adults. Qualitative analysis revealed specific challenges, including time, funding, staff, licensing, scope of practice, reimbursement, and technology issues. Facilitators included presence of a site champion, information technology and other staff, organization mission and structure, and technology. In addition, project investigators discussed implementation and policy issues and lessons learned. Outreach, education, and hands-on training were considered essential to prepare staff to ensure their buy-in and project success. An on-site champion was particularly important. Most clinicians and their older patients—including those with severe chronic conditions—found the technology simple and easy to use. Reimbursement for the technology was inconsistent and licensure issues, problematic. Some providers believe licensure issues can be resolved through a cooperative regional approach (Cwiek et al. Telemedicine and e-Health 13(2):141–147, 2007). This study provides new information for agencies aiming to implement or adapt new medication technologies as well as grant makers seeking to fund the development of these technologies.     

低旋转点逆行腓肠神经营养血管皮瓣的临床应用

目的 探讨应用低旋转点腓肠神经营养血管逆行皮瓣修复踝足部软组织缺损的临床效果.方法 2006年5月至2008年2月根据损伤的部位、形状、面积设计腓肠神经营养血管修复22例22处损伤创面.结果 术后22例22处皮瓣全部成活,所有患者均获6～12个月随访,皮瓣外形满意,患肢正常步态行走,皮瓣耐磨,无溃疡发生,有痛觉,两点辨别觉为6～10 mm. 结论低旋转点腓肠神经营养血管逆行皮瓣皮肤质量较好,切取简便,供皮面积较大,成活率高且不牺牲主干血管,是修复足踝部较大面积皮肤缺损的一种理想供区.     

Videodensitometric estimation of the protective effect of hyperbaric oxygen in the ischemic gerbil brain

To verify its protective effect on the ischemic mammalian brain, hyperbaric oxygen was administered to six groups of carotid-ligated gerbils. The outcome was evaluated clinically and by a colorimetric videodensitometry technique by comparing differences in the interhemispheric color density through the translucent intact cranium. It was found that there was a graded decrease in interhemispheric differences with increasing exposure to hyperbaric oxygen (the appearance of the ischemic hemisphere increasingly approached that of normal brain). This correlated with the incidence of ischemia in each group.