Localising Structured Lifestyle Intervention for Dietary Management Success

@#The growing prevalence of type 2 diabetes mellitus (T2DM) and the parallel increase in the prevalence of obesity warrants for effective intervention strategies. Overweight/obese patients with T2DM who attempt weight reduction often face considerable challenges. A recent study in Malaysia conducted among overweight/obese patients with T2DM showed that weight reduction and improved glycaemic control could be achieved with structured lifestyle intervention and the incorporation of behavioural counselling. The structured lifestyle recommendations in this study consisted of 1) a fixed low-calorie diet plan of 1200 kcal/day for female and 1500 kcal/day for male patients; 2) incorporation of one or two servings/day of diabetes-specific formula as a meal replacement; 3) a 14-day structured meal plan consisting of the ingredients list, cooking methods and nutrition facts; and the 4) healthy low-calorie snack options. Exercise prescription of ≥150 min/week of moderate-intensity was also encouraged. Behavioural counselling such as motivational interviewing not only facilitated adherence to the lifestyle recommendations but also further enhanced weight loss and glycaemic control in these patients. This article outlines the localisation of the structured lifestyle recommendations and its effectiveness in achieving weight loss and good glycaemic control in overweight/obese patients with T2DM.

Revisión de la evidencia de estudios de supervivencia de pacientes con prótesis valvular biológica / Review of the evidence in survival studies of patients with a biological valve replacement

Resumen Introducción: las modificaciones en las características estructurales/funcionales de las prótesis valvulares han derivado en un aumento en las curvas de sobrevida/supervivencia de los pacientes, dada la reducción de las tasas de morbilidad y mortalidad posteriores a intervenciones quirúrgicas de las válvulas cardíacas y los cambios sustanciales en la relación costo-efectividad y costo-beneficio de estos procedimientos. Objetivo: conocer la supervivencia de pacientes mayores de 60 años de edad, con prótesis valvular biológica. Materiales y métodos: revisión de estudios de seguimiento publicados en los cuales se evaluó la supervivencia de los pacientes sometidos a reemplazo valvular. Se hizo una búsqueda de artículos científicos registrados en la base de datos PubMed, de acuerdo con los descriptores seleccionados como palabras clave − Prótesis Valvulares Cardíacas/Heart Valve Prosthesis, Bioprótesis/Bioprosthesis, Supervivencia/Survival − en el programa de gestión de referencias EndNote. Se valoró la fuerza de evidencia científica de cada uno de los artículos seleccionados con la escala de McMaster para estudios cuantitativos. Resultados: se obtuvieron 12 referencias y se descartaron 5 (41,7%); calificación global de "fuerte" con la escala de McMaster 7 (58,3%). El tiempo promedio de seguimiento fue de 13,7 años y la razón de masculinidad de 1:0,8. La edad promedio de los pacientes fue 67,2 (rango 60,0-78,5) años. La supervivencia promedio a diez años fue del 65%. Conclusiones: se observa mayor supervivencia entre los pacientes sometidos a reemplazo valvular mecánico versus biológico; sin embargo, la literatura plantea como opción razonable el uso de prótesis biológicas en pacientes mayores de 60 años. Se reconoce, así mismo, la necesidad de hacer más estudios que puedan corroborar los hallazgos.

Abstract Introduction: The modifications in the structural / functional features of replacement valves have led to an increase the survival curves of the patients. This can be seen in the reduction in morbidity and mortality rates after the surgical intervention of the cardiac valves, as well as the substantial changes in the cost-effectivity and cost-benefit ratio of these procedures. Objective: To determine the survival of patients over 60 years of age with a biological valve replacement. Materials and methods: A review of follow-up published studies that evaluated the survival of patients subjected to a valve replacement. A search was made of the scientific articles registered in the PubMed databases, using the selected descriptors as Key words: Heart Valve Prosthesis, Bioprosthesis, Survival, in the references management program-EndNote. The strength of the scientific evidence in each of the selected articles was assessed using the McMaster scale for quantitative studies. Results: A total of 12 references were found and 5 (41.7%) were discarded, and 7 (58.3%) had an overall "strong" score with the McMaster scale. The mean follow-up time was 13.7 years, and the male ratio was 1:0.8. The mean age of the patients was 67.2 (range: 60.0-78.5) years. The mean survival rate at 10 years was 65%. Conclusions: A higher survival was observed between the patients fitted with a mechanical versus a biological valve. However, the literature has established the use of a biological replacement valve as a reasonable option in patients over 60 years of age. It is also recognised that more studies are needed that can corroborate the findings.

Comparison of the effects of meal replacements and a standard food-based low calorie diet on weight loss and glycolipid metabolism / 中华内分泌代谢杂志

Objective To investigate the effects of a standard food-based low calorie diet and meal replacements on compliance,weight loss,and glycolipid metabolism in obese patients,and to provide an optimal nutritional weight reduction method for obese individuals in China.Methods Height,weight,waist circumference,body mass index (BMI),body fat,visceral fat in low calorie diet group (n =23) and meal replacements group (n =17) were assessed at baseline,4 and 8 weeks after the intervention.Fasting plasma glucose (FPG),triglyceride (TG),total cholesterol (TC),high density lipoprotein-cholesterol (HDL-C),low density lipoprotein-cholesterol (LDL-C),aspartate aminotransferase (AST),alanine transaminase (ALT),gamma-glutamyl transpeptidase (GGT),alkaline phosphatase (ALP),fasting insulin (FINS),and homeostasis model assessment for insulin resistance (HOMA-IR) were assessed at both baseline and 8 weeks after the intervention.Results Both low calorie diet and meal replacements led to significant decreases in body weight,waist circumference,BMI,body fat,and visceral fat(all P＜0.01) after 4 and 8 weeks.Body fat (P＜ 0.01) and total body water (P＜ 0.05) in low calorie diet group were decreased more obviously compared with those in meal replacements group at 4 weeks.However,there were no difference in all these parameters between two groups at 8 weeks (P＞0.05).Both groups experienced improvements in biochemical outcomes and metabolic indicators.TG,AST,ALT,GGT,ALP,FINS,and HOMA-IR levels were all decreased (P＜0.05 or P＜0.01) while HDL-C level was increased (P＜0.01) 8 weeks after standard food-based low calorie diet.FPG,TG,TC,LDL-C,AST,ALT,ALP,FINS,and HOMA-IR levels were declined 8 weeks after meal replacements(P＜0.05 or P＜0.01).TC,LDL-C,and ALT levels were more evidently to reduce in meal replacements group compared with low calorie diet group.Conclusions Present data suggest that meal replacements and low calorie diet may have a similar effect on weight loss,while meal replacements seems to obtain a better metabolic results.

Outcomes of Bilateral Shoulder Arthroplasties: A Comparison of Bilateral Total Shoulder Arthroplasties and Bilateral Reverse Shoulder Arthroplasties

BACKGROUND: The purpose of this study was to compare outcomes of patients who underwent bilateral total shoulder arthroplasties (TSAs) for osteoarthritis (OA) versus bilateral reverse shoulder arthroplasties (RSAs) for cuff tear arthropathy (CTA). METHODS: Inclusion criteria were patients who underwent bilateral TSAs for OA or bilateral RSAs for CTA with at least 2 years of follow-up. Twenty-six TSA patients (52 shoulders) were matched 2 to 1 with 13 RSA patients (26 shoulders) by sex, age at first surgery, and time between surgeries. Outcomes measured were shoulder range of motion (ROM), complications, and patient-reported scores. RESULTS: Preoperatively, TSA patients had significantly better forward elevation (FE) of both shoulders than RSA patients (dominant side [Dom]: 103° ± 32° vs. 81° ± 31°, p = 0.047; nondominant side [non-Dom]: 111° ± 28° vs. 70° ± 42°, p = 0.005) without significant differences in external (ER) or internal rotation (IR). Postoperatively, TSA patients had significantly better FE (Dom and non-Dom: 156° ± 12°, 156° ± 14° vs. 134° ± 24°, 137° ± 23°; p = 0.006, p = 0.019) and ER (42° ± 11°, 43° ± 10° vs. 24° ± 12°, 25° ± 10°; p < 0.001, p < 0.001) bilaterally and IR of their dominant arm (L1 vs. L4, p = 0.045). TSA patients had significantly better activities of daily living external and internal rotations (ADLEIR) scores (Dom and non-Dom: 35.3 ± 1.0, 35.5 ± 0.9 vs. 32.1 ± 2.4, 32.5 ± 2.2; p = 0.001, p = 0.001), American Shoulder and Elbow Surgeons scores (94.2 ± 8.4, 94.2 ± 8.2 vs. 84.7 ± 10.0, 84.5 ± 8.0; p = 0.015, p = 0.004), and Single Assessment Numerical Evaluation (SANE) scores (93.5 ± 7.6, 93.8 ± 11.8 vs. 80.5 ± 14.2, 82.3 ± 13.1; p = 0.014, p = 0.025), with no significant difference in visual analog scale pain scores (0.4 ± 1.0, 0.3 ± 1.0 vs. 0.7 ± 1.3, 0.8 ± 1.2) bilaterally. CONCLUSIONS: Overall, patients with bilateral TSAs and RSAs exhibited improved ROM and patient-reported outcomes. Those with bilateral TSAs had better functional outcomes than those with bilateral RSAs.

Nursing care of one pulmonary embolism patient after total knee arthroplasty easily misdiagnosed coronary heart disease / 中国实用护理杂志

Objective To summarize the reason and nursing experience of one pulmonary embolism patient after total knee arthroplasty easily misdiagnosed coronary heart disease. Methods For the patient to implement risk assessment of venous thromboembolism and develop prevention plan in preoperation, then carry out anticoagulation prevention and physical prophylaxis after operation. Nurse observe the patient changes of clinical symptom and signs,focus on the complain of patient and the changes of laboratory examination results, implement the diagnosis process of pulmonary thromboembolism. Pulmonary thromboembolism patient was definitely diagnosed and got standardized treatment. Results Through the treatment and nursing, the patient finely discharged from hospital. Conclusions To develop the system of VTE risk assessment and implement prevention measures.Nurses need to distinguish the high risk pulmonary thromboembolism patient according to the clinical observation, it is better for the pulmonary thromboembolism patient to be early diagnosed and treated, meanwhile, to implement the effective nursing measures will contribute to the prognosis of pulmonary thromboembolism patient.

Current application and prospects of 3D printing technology in thoracic surgery / 国际生物医学工程杂志

As a pioneering technology, 3D printing technology has good application prospects in the medical field. In thoracic surgery, 3D printing technology has been used clinically for preoperative evaluation, surgical design, disease treatment, etc. Some 3D printed tissue and organ replacements have been gradually applied in thoracic surgery. The current application status of 3D printing technology in the field of thoracic surgery was reviewed, and the existing problems and prospects of this technology were discussed.

A suplência perversa em sujeitos psicóticos como uma possível chave de leitura da psicopatia / La suppléance perverse chez les patients psychotiques comme un possible axe delecture de la psychopathie / The perverse replacement in psychotic individuals as a possible key for understanding psycopathy

O artigo busca defender a hipótese de que muitos casos diagnosticados como psicopatias podem na verdade ser casos em que psicóticos fazem uso de arranjos estabilizadores com matizes perversos. Para tanto, recorre ao texto do psicanalista francês Jean-Claude Maleval, intitulado “Suplência perversa em um sujeito psicótico”. A partir do esmiuçamento desse trabalho e do caso clínico que ele apresenta, coleta subsídios teóricos que demonstram como em algumas psicoses pode-se observar certa conivência com atos sadomasoquistas extremos, o que, não raro, leva a diagnósticos equivocados, como o de psicopatia

L'article cherche à défendre l'hypothèse que de nombreux cas classés comme des psychopaties ne sont en fait que des arrangements stabilisants à nuances perverses faits par des individus psychotiques. Pour ce faire, le texte du psychanalyste français Jean-Claude Maleval intitulé "Suppléance perverse chez un sujet psychotique." De l’analyse de ce travail et du cas clinique qu'il présente, sont prélevés des éléments théoriques qui montrent comment dans certaines psychoses il est possible d’observer une certaine connivence avec des actes sadomasochistes extrêmes, ce qui conduit souvent à des erreurs de diagnostic, tels que la psychopathie

The article aims to defend the hypothesis that many cases with psychopathic diagnoses may in fact be cases in which psychotics use stabilizing arrangements with perverse nuances. In order to do so, we resorted to an article from the French psychoanalyst Jean Claude Maleval called “Perverted replacement in a psychotic individual”. From the study of that work and the clinical case that it presents, we have collected the theoretical elements that show how in some psychoses we observe a certain collusion with extreme sadomasochistic acts, which leads, frequently, to flawed diagnosis such as psychopathy

Surgical treatment of severe mitral stenosis associated with small left ventricle / 中国医师进修杂志

Objective To summarize the experience of operation treatment of severe mitral stenosis associated with small left ventricle.Methods The clinical data of 115 patients with severe mitral stenosis received mitral valve replacement (MVR) were retrospectively analyzed.According to whether associated with small left ventricle,they were divided into small left ventricle group (61 cases) and non-small left ventricle group (54 cases).The postoperative early complication rate and mortality rate between two groups were compared.Results The postoperative early complication rate and mortality rate in small left ventricle group was higher than that in non-small left ventricle group [14.75％ (9/61) vs.7.41％ (4/54),55.74％ (34/61) vs.25.93％(14/54)],there was significant difference(P ＜ 0.05).Conclusions The positive and effective perioperative management and correct intraoperative decision is key to reduce the incidence of early postoperative complications and mortality after MVR surgical in patients with severe mitral stenosis associated with small left ventricle.

Contact mechanics performance of hip joint replacements with different material combinations / 医用生物力学

Objective To study the contact performance of hip joint replacements with different material combinations typically used in clinic. Methods The finite element model of spherical conformal contact of hip joint replacements was developed to analyze the different contact mechanics performance of hip joint replacements with different material combinations by simulation test under a vertical constant load within one normal walking gait. The corresponding wear prediction was also evaluated. Results The contact mechanics performances of hip joint replacements with the material combination of metal-on-metal (MOM), metal-on-ceramic (MOC), ceramic-on-ceramic (COC), metal-on-polyethylene (MOP) and ceramic-on-polythene (COP) were analyzed. The results obtained from the simulations showed that contact stress was decreased in the order of COC＞MOC＞MOM＞COP＞MOP, while contact area was decreased in the order of MOP＞COP＞MOM＞MOC＞COC. Conclusions Hip joint replacement with the material combination of high elastic modulus and low Poisson’s ratio has smaller deformation, but could induce larger local stress, while flexible material polythene of low elastic modulus and high Poisson’s ratio might have smaller concentrated contact stress, but cause larger deformation and edge contact phenomenon on the acetabulum cup of hip joint replacements. In addition, hip joint replacements with MOC and MOM material combination may have lower contact bearing performance, which provides references for material choices of typical artificial hip joints in clinic.

Relations between Long-term Glycemic Control and Postoperative Wound and Infectious Complications after Total Knee Arthroplasty in Type 2 Diabetics

BACKGROUND: The authors examined whether poor preoperative glucose control, as indicated by the hemoglobin A1c (HbA1c) level of more than 8%, is associated with postoperative wound and infectious complications in diabetic patients that have undergone total knee arthroplasty (TKA). METHODS: One hundred and sixty-seven TKAs performed in 115 patients with type 2 diabetes mellitus, from January 2001 through March 2007, were retrospectively reviewed. Logistic regression was used to identify the variables that had a significant effect on the risk of wound complications or early deep infection. The variables considered were age, gender, body mass index, comorbidities, operation time, antibiotic-impregnated cement use, amount of blood transfusion, close suction drain use, duration of diabetes, method of diabetes treatment, diabetes complications, and preoperative HbA1c level. RESULTS: The overall incidence of wound complications was 6.6% (n = 11) and there were seven cases (4.2%) of early postoperative deep infection. Logistic regression revealed that the independent risk factors of wound complications were preoperative HbA1C > or = 8% (odds ratio [OR], 6.07; 95% confidence interval [CI], 1.12 to 33.0) and operation time (OR, 1.01; 95% CI, 1.00 to 1.03). No variable examined was found to be significantly associated with the risk of early postoperative deep infection. CONCLUSIONS: Poorly controlled hyperglycemia before surgery may increase the incidence of wound complications among diabetic patients after TKA.

Growth response of clarias gariepinus fingerlings to different dietary protein levels of toadmeal inclusion.

A ten-week nutritional study was carried out to evaluate the practical replacement of fishmeal with toad meal in different protein levels in the diet of Clarias gariepinus fingerlings. One hundred and fifty (150) fingerlings with an average weight of 7.99 – 27.64g were stocked at the rate of ten (10) fish per experimental tank. The fingerlings were subjected to five different dietary feeds with varying levels of toad meal at 0%, 25%, 50%, 75%, and 100% respectively. Each treatment was replicated thrice. Feeding was done at 3% body weight per day and records of weekly weight increase were kept. The feed conversion ratio, weight gain, survival rate revealed that the control (0% toadmeal inclusion) and diet 5 (100% toadmeal inclusion) were best in growth performance, unlike the mixed fishmeal and toadmeal that showed adequate growth performance. Water quality parameters of the experiment measured constantly were within the normal optimum requirements that had no negative effects on the experimental fish. Finally based on biological and financial evaluation of the feeding trials diet 5 (100%) was recommended as the most economical and practically acceptable for large-scale intensive fish culture.

Vulnerabilidad de los implantes dentales y ortopédicos / Vulnerability of dental and orthopedic implant

La colocación de implantes en diferentes partes del cuerpo ha sido realizada desde hace muchotiempo atrás. Se ha identificado diferentes factores de riesgo y complicaciones que pueden alterarlos tejidos perimplantares posterior a la colocación de estos. No existe evidencia científica que realice la comparación entre diferentes implantes colocados en diferentes partes del cuerpo.

The placement of implants on different body parts has been practiced since long ago. Variousrisk factors and complications that can alter perimplant tissue after placement of these have beenidentified. There is no scientific evidence to make the comparison among different implants placed indifferent parts of the body.

Needs and demands of prosthetic treatment among two groups of individuals.

Objectives: The level of knowledge, awareness, and attitude about teeth-replacement options among a group of medical and paramedical subjects and to compare them with the general population. Materials and Methods: A self-administered questionnaires using simple Arabic language were distributed to two groups of subjects. Questions focused on the willingness to replace the missing teeth, the preferable methods of choice for replacement, and the reasons for these choices. The first group (G-I) was from the medical and paramedical staff who work in a military hospital at Jordan Royal medical services, the dental staff was excluded from the study. The other group (G-II) was from the general population who attended the dental department in the same hospital with comparable level of education. All the participants were partially edentulous excluding the third molars. Clinical examination was done by qualified prosthodontist to evaluate the possible prosthetic treatment options for replacement. A total of 612 questionnaires were distributed, of which 533 questionnaires were returned (response rate 87.09%). The results were analyzed and comparison was made between the two groups. Results: Responses to questions about awareness and attitude about prosthetic management of missing teeth revealed that G-I have more awareness than G-II to the probable causes for tooth/teeth replacement and limitation of the preferable method for replacement (P<0.05). More than 80% of the participants believed that replacement of anterior teeth is more important than the posterior teeth. Implants and fixed partial denture (FPD), respectively, were more preferable than removable prosthesis, although clinically was not indicated in cases (P<0.05). There was no clinical benefit from replacement of missing teeth in 33.4% while only 6% believe this. Conclusions: This study showed that the awareness and attitude between the medical and paramedical staff to prosthetic needs is better than between general populations. The demands for dental replacement by patients were significantly different when compared with the actual needs.

Preoperative Risk Factors for Deep Infection Following Total Knee Replacements

PURPOSE: The aim of this study was to investigate the overall rate of deep infection and the risk factors for infection after primary total knee arhroplasties. MATERIALS AND METHODS: We conducted a retrospective case-control study of 229 patients (376 knees) who underwent total knee replacement (TKR) between January 2006 and June 2007 and who were followed up for more than one year. The risk factors for deep infection were determined via univariate analyses. RESULTS: The overall rate for developing infection was 1.9% (7 of 376). The risk factors were an operating theatre other than the main room (odds ratio=33.2, 95% confidence interval=1.9, 583.6) and a preoperative hemoglobin level lower than 12 mg% (odds ratio=4.3, 95% confidence interval=1.9, 9.4). CONCLUSION: The deep infection rates after TKRs might vary depending on the preoperative level of hemoglobin and the operating-room environment. Successful strategies to overcome the host and environmental risk factors are needed with the goal of preventing infection of the prosthesis.

Effects of Very Low Calorie Diet using Meal Replacements on Weight Reduction and Health in the Obese Adult Women

This study was performed to investigate the effects of very low calorie diet (VLCD) using newly meal replacements that contain the wild grass extracts based on Samul-tang ingredients on weight reduction and health in the obese adult women (BMI > or = 25 kg/m2) for four weeks. Seventy five women participated in this experiment. Subjects were randomly classified three groups: 1) General Diet group (GD group, n = 25) consumed 3 regular meals within 600 kcal/day, 2) Meal replacements group (MR group, n = 25) consumed 1 regular meal and 2 meal replacements within 600 kcal/ day, 3) Herbal Meal replacements group (HMR group, n = 25) consumed 1 regular meal and 2 meal replacements within 600 kcal/day. Anthropometric measurements, body composition, biochemical measurements and body symptoms were assessed before (the initial) and after (the 4th week) the study. Anthropometry measurements such as weight, waist and hip circumference, and BMI and body composition such as body fat percent, fat mass significantly decreased in all groups after diet intervention. Anthropometric measurements and body composition of the HMR group significantly more than those of GD and MR groups. Serum Total cholesterol was significantly decreased in all groups. However, there was no significant difference among three groups during the experimental period. HMR group had significantly less felt a pain than GD and MR groups in body symptoms such as anemia, powerlessness, vomiting, constipation and dryness of skin during the experimental period. Therefore, very low calorie diet (VLCD) using meal replacements that contain the wild grass extracts based on Samul-tang ingredients was very effective on weight reduction and health in the obese adult women.

Comparison of Postoperative Epidural Analgesia in the Two Staged Bilateral Total Knee Replacements / 대한마취과학회지

BACKGROUND: Modern studies have confirmed that interindividual pain threshold variability greatly exceeds intraindividual pain threshold variability. The purpose of this investigation was to compare the efficacy and safety of postoperative pain control by patient controlled analgesia (PCA) of two staged bilateral total knee replacements in the same patient. METHODS: Forty patients had two total knee replacements in separate sessions of anesthesia (a bilateral two stage procedure). They received postoperative pain treatment with patient-controlled epidural analgesia during the first postoperative 48 hours after total knee replacement. The procedures were assigned to the first operation (early group) and the second operation (late group) in the same patient. Visual analog scale (VAS) scores whilst at rest or during movement were used to assess pain. Total bupivacaine volume delivered, number of PCA requests, supplemental analgesics, overall satisfaction score and adverse events were evaluated. RESULTS: No significant differences were found between the two (early and late) groups in terms of effects and adverse events of postoperative pain control. CONCLUSIONS: Two staged bilateral total knee replacement appears to be a means of comparing postoperative pain control, and which significantly reduces interindividual variability.