Analysis of the causes of primary revision after unicompartmental knee arthroplasty: A case series

BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.

Effects of time-restricted eating with different eating duration on anthropometrics and cardiometabolic health:A systematic review and meta-analysis

BACKGROUND Time-restricted eating(TRE)is a dietary approach that limits eating to a set number of hours per day.Human studies on the effects of TRE intervention on cardiometabolic health have been contradictory.Heterogeneity in subjects and TRE interventions have led to inconsistency in results.Furthermore,the impact of the duration of eating/fasting in the TRE approach has yet to be fully explored.AIM To analyze the existing literature on the effects of TRE with different eating durations on anthropometrics and cardiometabolic health markers in adults with excessive weight and obesity-related metabolic diseases.METHODS We reviewed a series of prominent scientific databases,including Medline,Scopus,Web of Science,Academic Search Complete,and Cochrane Library articles to identify published clinical trials on daily TRE in adults with excessive weight and obesity-related metabolic diseases.Randomized controlled trials were assessed for methodological rigor and risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials(RoB-2).Outcomes of interest include body weight,waist circumference,fat mass,lean body mass,fasting glucose,insulin,HbA1c,homeostasis model assessment for insulin resistance(HOMA-IR),lipid profiles,C-reactive protein,blood pressure,and heart rate.RESULTS Fifteen studies were included in our systematic review.TRE significantly reduces body weight,waist circumference,fat mass,lean body mass,blood glucose,insulin,and triglyceride.However,no significant changes were observed in HbA1c,HOMA-IR,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,heart rate,systolic and diastolic blood pressure.Furthermore,subgroup analyses based on the duration of the eating window revealed significant variation in the effects of TRE intervention depending on the length of the eating window.CONCLUSION TRE is a promising chrononutrition-based dietary approach for improving anthropometric and cardiometabolic health.However,further clinical trials are needed to determine the optimal eating duration in TRE intervention for cardiovascular disease prevention.

Nomogram based on multimodal magnetic resonance combined with B7-H3mRNA for preoperative lymph node prediction in esophagus cancer

Accurate preoperative prediction of lymph node metastasis(LNM)in esophageal cancer(EC)patients is of crucial clinical significance for treatment planning and prognosis.AIM To develop a clinical radiomics nomogram that can predict the preoperative lymph node(LN)status in EC patients.METHODS A total of 32 EC patients confirmed by clinical pathology(who underwent surgical treatment)were included.Real-time fluorescent quantitative reverse transcription-polymerase chain reaction was used to detect the expression of B7-H3 mRNA in EC tissue obtained during preoperative gastroscopy,and its correlation with LNM was analyzed.Radiomics features were extracted from multi-modal magnetic resonance imaging of EC using Pyradiomics in Python.Feature extraction,data dimensionality reduction,and feature selection were performed using XGBoost model and leave-one-out cross-validation.Multivariable logistic regression analysis was used to establish the prediction model,which included radiomics features,LN status from computed tomography(CT)reports,and B7-H3 mRNA expression,represented by a radiomics nomogram.Receiver operating characteristic area under the curve(AUC)and decision curve analysis(DCA)were used to evaluate the predictive performance and clinical application value of the model.RESULTS The relative expression of B7-H3 mRNA in EC patients with LNM was higher than in those without metastasis,and the difference was statistically significant(P<0.05).The AUC value in the receiver operating characteristic(ROC)curve was 0.718(95%CI:0.528-0.907),with a sensitivity of 0.733 and specificity of 0.706,indicating good diagnostic performance.The individualized clinical prediction nomogram included radiomics features,LN status from CT reports,and B7-H3 mRNA expression.The ROC curve demonstrated good diagnostic value,with an AUC value of 0.765(95%CI:0.598-0.931),sensitivity of 0.800,and specificity of 0.706.DCA indicated the practical value of the radiomics nomogram in clinical practice.CONCLUSION This study developed a radiomics nomogram that includes radiomics features,LN status from CT reports,and B7-H3 mRNA expression,enabling convenient preoperative individualized prediction of LNM in EC patients.

Importance of gastrin in the pathogenesis and treatment of gastric tumors

In addition to regulating acid secretion, the gastric antral hormone gastrin regulates several important cellular processes in the gastric epithelium including proliferation, apoptosis, migration, invasion, tissue remodelling and angiogenesis. Elevated serum concentrations of this hormone are caused by many conditions, particularly hypochlorhydria (as a result of autoimmune or Helicobacter pylori (H pylori)-induced chronic atrophic gastritis or acid suppressing drugs) and gastrin producing tumors (gastrinomas). There is now accumulating evidence that altered local and plasma concentrations of gastrin may play a role during the development of various gastric tumors. In the absence of H pylori infection, marked hypergastrinemia frequently results in the development of gastric enterochromaffi n cell-like neuroendocrine tumors and surgery to remove the cause of hypergastrinemia may lead to tumor resolution in this condition. In animal models such as transgenic INS-GAS mice, hypergastrinemia has also been shown to act as a cofactor with Helicobacter infection during gastric adenocarcinoma development. However, it is currently unclear as to what extent gastrin also modulates human gastric adenocarcinoma development. Therapeutic approaches targeting hypergastrinemia,such as immunization with G17DT, have been evaluated for the treatment of gastric adenocarcinoma, with some promising results. Although the mild hypergastrinemia associated with proton pump inhibitor drug use has been shown to cause ECL-cell hyperplasia and to increase H pylori-induced gastric atrophy, there is currently no convincing evidence that this class of agents contributes towards the development of gastric neuroendocrine tumors or gastric adenocarcinomas in human subjects.

The development and role of microbialhost interactions in gut mucosal immune development

At birth the piglet's immune system is immature and it is dependent upon passive maternal protection until weaning.The piglet's mucosal immune system develops over the first few weeks but has not reached maturity at weaning ages which are common on commercial farms. At weaning piglets are presented with a vast and diverse range of microbial and dietary/environmental antigens. Their ability to distinguish between antigens and mount a protective response to potential pathogens and to develop tolerance to dietary antigens is critical to their survival and failure to do so is reflected in the high incidence of morbidity and mortality in the post-weaning period. A growing recognition that the widespread use of antibiotics to control infection during this critical period should be controlled has led to detailed studies of those factors which drive the development of the mucosal immune system, the role of gut microbiota in driving this process, the origin of the bacteria that colonise the young piglet's intestine and the impact of rearing environment. This review briefly describes how the mucosal immune system is equipped to respond "appropriately" to antigenic challenge and the programmed sequence by which it develops. The results of studies on the critical interplay between the host immune system and gut microbiota are discussed along with the effects of rearing environment. By comparing these with results from human studies on the development of allergies in children, an approach to promote an earlier maturation of the piglet immune system to resist the challenges of weaning are outlined.

Molecular targets in the treatment of alcoholic hepatitis

Alcohol related costs to health and society are high. One of the most serious complications of alcohol misuse to the individual is the development of alcoholic hepatitis (AH), a clinical syndrome of jaundice and progressive inflammatory liver injury in patients with a history of recent heavy alcohol use. It has a poor outcome and few existing successful therapies. The use of glucocorticoids in patients with severe AH is still controversial and there remains a group of patients with glucocorticoid-resistant disease. However, as our understanding of the pathogenesis of the condition improves there are opportunities to develop new targeted therapies with specific actions to control liver inflammation without having a detrimental effect on the immune system as a whole. In this article we review the molecular mechanisms of AH concentrating on the activation of the innate and adaptive immune response. We consider existing treatments including glucocorticoids, anti-tumor necrosis factor therapy and pentoxifylline and their limitations. Using our knowledge of the disease pathogenesis we discuss possible novel therapeutic approaches. New targets include pro-inflammatory cytokines such as interleukin (IL)-17, chemokines and their receptors (for example IL-8, CXCL9 and CXCR3) and augmentation of anti-inflam- matory molecules such as IL-10 and IL-22. And there is also future potential to consider combination therapy to selectively modulate the immune response and gain control of disease.

Is liver biopsy necessary in the management of alcoholic hepatitis?

Acute alcoholic hepatitis(AAH)is characterised by deep jaundice in patients with a history of heavy alcohol use,which can progress to liver failure.A clinical diagnosis of AAH can be challenging to make in patients without a clear alcohol history or in the presence of risk factors for other causes of acute liver failure.Other causes of acute on chronic liver failure such as sepsis or variceal haemorrhage should be considered.Liver biopsy remains the only reliable method to make an accurate diagnosis.However,there is controversy surrounding the use of liver biopsy in patients with AAH because of the risks of performing a percutaneous biopsy and limitations in access to transjugular biopsy.We review the existing literature and find there are few studies directly comparing clinical and histological diagnosis of AAH.In the small number of studies that have been conducted the correlation between a clinical and histological diagnosis of AAH is poor.Due to this lack of agreement together with difficulties in accessing transjugular liver biopsy outside tertiary referral centres and research institutions,we cannot advocate universal biopsy for AAH but there remains a definite role for liver biopsy where there is clinical diagnostic doubt or dual pathology.Italso adds value in a clinical trial context to ensure a homogeneous trial population and to further our understanding of the disease pathology.Further prospective studies are required to determine whether non-invasive markers can be used to accurately diagnose AAH.

Diet,ageing and genetic factors in the pathogenesis of diverticular disease

Diverticular disease(DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK.This high prevalence ranks it as one of the most common bowel disorders in western nations.The majority of patients remain asymptomatic but there are associated life-threatening co-morbidities, which, given the large numbers of people with DD, translates into a considerable number of deaths per annum.Despite this public health burden, relatively little seems to be known about either the mechanisms of development or causality.In the 1970s, a model of DD formulated the concept that diverticula occur as a consequence of pressureinduced damage to the colon wall amongst those with a low intake of dietary fiber.In this review, we have examined the evidence regarding the influence of ageing, diet, inflammation and genetics on DD development.We argue that the evidence supporting the barotrauma hypothesis is largely anecdotal.We have also identified several gaps in the knowledge base which need to be filled before we can complete a model for the etiology of diverticular disease.

Recovery of saturated signal waveform acquired from high-energy particles with artificial neural networks

Artificial neural networks(ANNs)are a core component of artificial intelligence and are frequently used in machine learning.In this report,we investigate the use of ANNs to recover the saturated signals acquired in highenergy particle and nuclear physics experiments.The inherent properties of the detector and hardware imply that particles with relatively high energies probably often generate saturated signals.Usually,these saturated signals are discarded during data processing,and therefore,some useful information is lost.Thus,it is worth restoring the saturated signals to their normal form.The mapping from a saturated signal waveform to a normal signal waveform constitutes a regression problem.Given that the scintillator and collection usually do not form a linear system,typical regression methods such as multi-parameter fitting are not immediately applicable.One important advantage of ANNs is their capability to process nonlinear regression problems.To recover the saturated signal,three typical ANNs were tested including backpropagation(BP),simple recurrent(Elman),and generalized radial basis function(GRBF)neural networks(NNs).They represent a basic network structure,a network structure with feedback,and a network structure with a kernel function,respectively.The saturated waveforms were produced mainly by the environmental gamma in a liquid scintillation detector for the China Dark Matter Detection Experiment(CDEX).The training and test data sets consisted of 6000 and 3000 recordings of background radiation,respectively,in which saturation was simulated by truncating each waveform at 40%of the maximum signal.The results show that the GBRF-NN performed best as measured using a Chi-squared test to compare the original and reconstructed signals in the region in which saturation was simulated.A comparison of the original and reconstructed signals in this region shows that the GBRF neural network produced the best performance.This ANN demonstrates a powerful efficacy in terms of solving the saturation recovery problem.The proposed method outlines new ideas and possibilities for the recovery of saturated signals in high-energy particle and nuclear physics experiments.This study also illustrates an innovative application of machine learning in the analysis of experimental data in particle physics.

Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care

BACKGROUND Hepatic encephalopathy(HE)is a reversible neuropsychiatric complication of liver cirrhosis and occurs in up to 50%of cirrhotic patients.Studies examining the prognostic significance of HE are limited despite the high prevalence in cirrhosis.AIM To define the clinical outcomes of patients after an episode of HE treated with current standards-of-care.METHODS All patients hospitalised with HE requiring Rifaximin to 3 tertiary centres over46-mo(2012–2016)were identified via pharmacy dispensing records.Patients with hepatocellular carcinoma and those prescribed Rifaximin prior to admission were excluded.Medical records were reviewed to determine baseline characteristics and survival.The Kaplan-Meier method was used to calculate survival probability.Univariate survival analysis was performed with variables reaching statistical significance included in a multivariate analysis.The primary outcome was 12-mo mortality following commencement of Rifaximin.RESULTS188 patients were included.Median age was 57 years(IQR 50-65),71%were male and median model for end stage liver disease and Child Pugh scores were 25(IQR 18-31)and 11(IQR 9-12)respectively.The most common causes of cirrhosis were alcohol(62%),hepatitis C(31%)and non-alcoholic fatty liver disease(20%).A precipitating cause for HE was found in 92%patients with infection(43%),GI bleeding(16%),medication non-compliance(15%)and electrolyte imbalance(14%)the most common.During a mean follow up period of 12±13 mo 107(57%)patients died and 32(17%)received orthotopic liver transplantation.Themost common causes of death were decompensated chronic liver disease(57%)and sepsis(19%).The probability of survival was 44%and 35%at 12-and 24-mo respectively.At multivariate analysis a model for end stage liver disease>15 and international normalised ratio reached statistical significance in predicting mortality.CONCLUSION Despite advances made in the management of HE patients continue to have poor survival.Thus,in all patients presenting with HE the appropriateness of orthotopic liver transplantation should be considered.

cytoplasmic domain of tissue factor promotes liver fibrosis in mice

AIM To evaluate the role of tissue factor(TF) and protease activated receptor(PAR)-2 in liver fibrosis.METHODS Using CCl4 administration for eight weeks, we induced hepatic fibrosis in wild-type C57BL/6 mice and in mice with deletion of the cytoplasmic signalling domain of TF(TF§CT/§CT), deletion of PAR-2(PAR-2-/-) and combined deletion of TF signalling domain and PAR-2(TF§CT/§CT/PAR-2-/-). Hepatic fibrosis area was assessed by quantitative imaging of picrosirius red staining. Hepatic collagen content was assessed by hydroxyproline levels. Hepatic stellate cells(αSMA positive) and hepatic macrophages(CD68 positive) were identified by immunohistochemistry. Hepatic gene expression was determined by PCR and liver TGFβ1 content by ELISA.RESULTS CCl4 treated mice with deletion of the PAR-2 gene(PAR-2-/-) and the cytoplasmic domain of TF(TF§CT/§CT) developed significantly less hepatic fibrosis, characterised by reduced liver fibrosis area and hydroxyproline content, compared to control wildtype mice treated with CCl4. The observed reduction in histological fibrosis was accompanied by a significant decrease in the hepatic content of TGFβ, the prototypic fibrogenic cytokine, as well as fewer activated hepatic stellate cells and hepatic macrophages. Deletion of the TF cytoplasmic signalling domain reduced hepatic fibrosis to levels similar to thoseobserved in mice lacking PAR-2 signalling but combined deletion provided no added protection against fibrosis indicating a lack of mutual modulating effects that have been observed in other contexts such as angiogenic responses.CONCLUSION Tissue factor cytoplasmic domain is involved in TF-PAR-2 signalling initiating hepatic fibrosis and is a potential therapeutic target, as its deletion would not impact coagulation.

Outcome of Assisted Reproduction Treatment in Women with Extremely Low Antimullerian Hormone (AMH) Levels

Purpose: To evaluate age related ovarian response to controlled ovarian hyperstimulation, clinical pregnancy and ongoing pregnancy rates beyond 20 weeks in women undergoing assisted reproduction treatment (ART) with antimullerian hormone (AMH) levels of <5 pmol/l. Methods: Retrospective analysis of data from 63 women with AMH of In-vitro?fertilization, IVF and intracytoplasmic sperm injection, ICSI) cycle. Results were analyzed after dividing patients in two groups, group 1 included women of ≤38 years and group 2 > 38 years of age. Non parametric variables were expressed as median (Interquartile range) and compared by Kruskal-Wallis test. Categorical variables were expressed as numbers with proportions (%) and compared by Fisher’s exact test. Results: There was no statistical difference in body max index, level of antimullerian hormone (AMH), follicle stimulating hormone (FSH), dose of gonadotrophins used and cycles cancellation rate in two groups. Although number of oocytes retrieved (median 5), clinical pregnancy (18.4%) and ongoing pregnancy rate beyond 20 weeks (18.4%) was higher in group 1, there was no statistical difference between the two groups. There was one miscarriage in group 2. Conclusion: Women with extremely low-serum AMH levels can still have clinical pregnancy and ongoing pregnancies beyond 20 weeks after ART, though chances will be lower than women with normal ovarian reserve.

Natural history and outcomes of patients with liver cirrhosis complicated by hepatic hydrothorax

BACKGROUNDHepatic hydrothorax (HH) is an uncommon and difficult-to-manage complicationof cirrhosis with limited treatment options.AIMTo define the clinical outcomes of patients presenting with HH managed withcurrent standards-of-care and to identify factors associated with mortality.METHODSCirrhotic patients with HH presenting to 3 tertiary centres from 2010 to 2018 wereretrospectively identified. HH was defined as pleural effusion in the absence ofcardiopulmonary disease. The primary outcomes were overall and transplant-freesurvival at 12-mo after the index admission. Cox proportional hazards analysiswas used to determine factors associated with the primary outcomes.RESULTSOverall, 84 patients were included (mean age, 58 years) with a mean model forend-stage liver disease score of 29. Management with diuretics alone achievedlong-term resolution of HH in only 12% patients. At least one thoracocentesis wasperformed in 73.8% patients, transjugular intrahepatic portosystemic shuntinsertion in 11.9% patients and 33% patients received liver transplantation within12-mo of index admission. Overall patient survival and transplant-free survival at12 mo were 68% and 41% respectively. At multivariable analysis, current smoking [hazard ratio (HR) = 8.65, 95% confidence interval (CI): 3.43-21.9, P < 0.001) and acute kidneyinjury (AKI) (HR = 2.91, 95%CI: 1.21-6.97, P = 0.017) were associated with a significantly increasedrisk of mortality.CONCLUSIONCirrhotic patients with HH are a challenging population with a poor 12-mo survival despitecurrent treatments. Current smoking and episodes of AKI are potential modifiable factors affectingsurvival. HH is often refractory of diuretic therapy and transplant assessment should beconsidered in all cases.

Important Newborn Cardiac Diagnostic Dilemmas for the Neonatologist and Cardiologist-A Clinical Perspective

Most congenital heart disease(CHD)is readily recognisable in the newborn.Forewarned by previous fetal scanning,the presence of a murmur,tachypnoea,cyanosis and/or differential pulses and saturations all point to a cardiac abnormality.Yet serious heart disease may be missed on a fetal scan.There may be no murmur or clinical cyanosis,and tachypneoa may be attributed to non-cardiac causes.Tachypnoea on day 1 is usually non-cardiac except arising from ventricular failure or a large systemic arteriovenous fistula.A patent ductus arteriosus(PDA)may support either pulmonary or systemic duct dependent circulations.The initially high pulmonary vascular resistance(PVR)limits shunts so that murmurs even from large communications between the systemic and pulmonary circulations take days/weeks to develop.At times despite expert input,serious CHD maybe difficult to diagnose and warrants close interaction between the neonatologist and cardiologist to reach a timely diagnosis.Such conditions include obstructed total anomalous pulmonary venous connections(TAPVC)and the need to distinguish it from persistent pulmonary hypertension in the newborn(PPHN)–the treatment of the former is surgical the latter medical.A large duct shunting right to left may overshadow a suspected hypoplastic aortic isthmus and/or coarctation.Is the right to left shunting because of severe aortic obstruction or resulting from a high PVR with little obstruction.The diagnosis of pulmonary vein stenosis(PVS)remains problematic often developing in premature infants with ongoing bronchopulmonary dysplasia(BPD),still being cared for by the neonatologist.While there are other diagnostic dilemmas including deciding the contribution of a recognised CHD in a sick neonate,this paper will focus on the above-mentioned conditions with suggestions on what may be done to arrive at a timely diagnosis to achieve optimal outcomes.

Does type of instrument influence colonoscopy performance and sedation practice?

In the UK, clear guidelines exist as to the expected level of competence an individual endoscopist should achieve.This is of utmost importance given the variance in practice among endoscopic departments as

Associations of accelerometer-determined physical activity and sedentary behavior with sarcopenia and incident falls over 12 months in community-dwelling Swedish older adults

Purpose:This study was aimed to determine associations of accelerometer-determined time and bouts of sedentary behavior,light physical activity(LPA),and moderate-to-vigorous PA(MVPA)with sarcopenia and incident falls over 12 months.Methods:A total of 3334 Swedish 70-year-olds were assessed for sarcopenia,as defined by the revised definition of the European Working Group on Sarcopenia in Older People.Assessments were based on low scores for appendicular lean mass(dual-energy X-ray absorptiometry),hand grip strength,and the Timed Up and Go test.For 7 days after baseline,total time and total number of bouts(≥10 min of continuous activity at a given intensity)of activity performed at sedentary,LPA,and MVPA intensities were assessed by accelerometer.Incident falls were self-reported 6 months and 12 months after baseline.Results:Only 1.8%of participants had probable or confirmed sarcopenia.After multivariable adjustment for other levels of activity,only greater MVPA time was associated with a decreased likelihood of having low appendicular lean mass,low hand grip strength,and slow Timed Up and Go time as defined by the European Working Group on Sarcopenia in Older People criteria(all p<0.05),and only MVPA time was associated with lower likelihood of probable or confirmed sarcopenia(odds ratio=0.80,95%confidence interval:0.71-0.91 h/week).Similar associations were identified for total number of bouts,with no evidence of threshold effects for longer duration of bouts of MVPA.A total of 14%of participants reported-1 fall,but neither total time nor bouts of activity was associated with incident falls(all p>0.05).Conclusion:Higher amounts of accelerometer-determined MVPA are consistently associated with a decreased likelihood of sarcopenia and its components,regardless of the length of bouts or amounts of sedentary behavior.

Understanding the Experiences of Anxiety in Community Dwelling Older Adults—Understanding Anxiety in Older Adults

Objectives: Anxiety is commonly reported as being experienced by older adult patients. However most of the theories on anxiety in older adults are developed from clinical measures rather than open-ended questionnaires. Consequently, little is known about the day to day experiences of anxiety in the lives of older adults, and the functional impairment that may result. Method: Community dwelling older adults (n = 135) were administered an open-ended questionnaire eliciting their experiences of anxiety using a cognitive behavioural framework. Directed content analysis was applied to discover the shared experiences of anxiety in older adults. Results: Although 64% of older adults reported avoidance behaviour that appeared anxiety driven, they generally denied experiencing anxiety themselves. Thought content and processes were idiosyncratic however commonalities were thinking positively (34%), problem solving (31%), rumination (31%) and difficulty concentrating (19%). A broad range of physical symptoms including those that may relate to medical conditions and depression were reported as resulting from anxiety, most commonly headaches (26%) and gastrointestinal disturbances (26%). Conclusion: Anxiety driven behaviours were common and appeared to negatively impact their quality of life through avoidance behaviours. Older adults may benefit from education to destigmatise the experiences of anxiety and improve reporting of functional impairment due to anxiety.

Respiratory Symptoms and Spirometry Profile of Plastic Factory Workers in Ogun State, Southwest Nigeria

Background: Exposure to plastic fumes can lead to severe occupational hazards due to inhalation, ingestion or direct contact wide variety of potentially harmful by-products during the manufacturing and burning of plastics. Objectives: To determine the prevalence of respiratory symptoms in plastic factory workers, evaluate the respiratory function of plastic factory workers and the association between respiratory symptoms and the duration of employment. Methods: This was a cross-sectional study done among plastic factory workers. Using a random sampling technique, 190 individuals (95 subjects and 95 control) above 18 years of age were recruited. Data were obtained with a validated questionnaire and Spirometry was done. Result: The mean age of the study group and control were 30.27 ± 7.38 and 25.92 ± 4.63 respectively (t = 4.877;p Conclusion: Workplace exposure to plastic fumes can lead to development of respiratory symptoms and impaired pulmonary function.

国际糖尿病足工作组:糖尿病足防治实践指南——《国际糖尿病足工作组:糖尿病足防治国际指南(2019)》的一部分

糖尿病足给全球糖尿病患者以及卫生保健系统带来沉重的负担。国际糖尿病足工作组(The International Working Group on the Diabetic Foot,IWGDF)自1999年起一直致力于制定基于循证的糖尿病足防治指南。2019年,在文献系统综述以及全球多学科领域专家推荐意见的基础上,对IWGDF的所有指南进行了更新。本实践指南在IWGDF指南第六部分的基础上阐述了糖尿病足的预防、分类和治疗的基本原则。同时,阐述了如何基于这些原则从组织层面成功地预防与治疗糖尿病足,并提供了用于辅助糖尿病足筛查的附录(见附录1和附表1)。本实践指南针对的是全球参与糖尿病患者医疗照护的医务人员。全球大量的研究证实,实施这些防治原则与降低糖尿病相关的下肢截肢发生率有关。我们希望这些更新的实践指南能继续作为有效参考文件以帮助卫生保健人员减轻全球糖尿病足的负担。

Male circumcision： towards a World Health Organisation normative practice in resource limited settings

现在有等级 1 证据，男割礼(MC ) 减少获得 HIV 的一个人的风险。建模研究显示 MC 能与高 HIV 流行在那些非洲的国家在下一 10 年里节省 200 万生活。几个非洲的国家现在在公共健康 MC 计划上面正在可伸缩。在非洲的最有效的立即的公共健康 MC 计划将需要 0 个岁人到目标 18 鈥 ? 。从长远的观点看对婴儿割礼计划有需要。以便在那里实现更普遍的 MC 是需要使外科的过程尽可能简单以便安全手术能被 paramedical 职员动。在局部麻醉下面的男割礼的 WHO 手册在头脑与这些目的被写。在手册包括了是三种成年技术和四个儿科学的过程。成年过程是背面的裂缝，指导的钳和袖子切除术方法。包括的儿科学的方法是 plastibell 技术， Mogen 和 Gomco 盾方法和一个标准外科的背面的裂缝过程。每个方法被描述在一一步一步地举止与摄影并且线绘画插图。除了外科的技术的 WHO 手册，一堂教学功课被开发了，用这堂功课，训练不有的一位割礼外科医生在一个星期内是可能的或最小以前的外科的经验。进一步的可伸缩将要求割礼外科医生训练，监视性能，训练在公民的训练员专题讨论会以及倡导，国际并且政府会议。除了继续 standardised 方法，工作在进行中在戒指设备和政策上在象停留那样的成年人估计新奇技术至于怎么估计新设备被提出。另外工作在进行中在由任务分享的外科的处理探索效率。当在非洲的计划扩大规模，合适的知情同意和首要的安全遗体和大照顾不得不被订。在 HIV 流行病在一个早得多的阶段的大陆人中国，可以为考虑婴儿割礼有一个盒子，但是大照顾将被需要保证没有伤害。