Advances in the treatment of distal radius fractures in the elderly / 中国综合临床

Distal radius fractures often occur in the elderly.At present,there has not yet reached a consensus on how to take effective measures for the treatment of such fractures in clinical.There are many different therapeutic methods for this fracture with different effect.Based on the summary of the relevant literature,the epidemiological characteristics of fractures of the distal radius,treatment,implant selection,surgical procedure,complications and prevention were summarized,in order to provide references for clinical treatment.

Advances in the selection of internal fixator for intertrochanteric fracture in the elderly / 中国综合临床

Objective In clinic, the elderly with femoral intertrochanteric fracture are suggested surgical treatment, with the continuous deepening of the research and technology innovation, the new type of internal fixator for treating this fracture are emerging?At present,a wide variety of internal fixators in clinic,but each has its advantages, disadvantages and indications, and considering?The right choice of internal fixator directly affects patient's prognosis?This article reviewed several common internal fixators in clinic, so as to provide a reference for the clinical selection.

Study on aminoglycoside antibiotics resistance of Pseudomonas aeruginosa isolated from diabetic foot infections / 天津医药

Objective To investigate the clinical features, phenotypes and genotypes of Pseudomonas aeruginosa (PA) strains isolated from patients with diabetic foot infection (DFI) resisting to aminoglycosides antibiotics (AmAn). Methods The clinical profiles of 209 DFI patients hospitalized in the Tianjin Metabolic Diseases Hospital were collected and ana?lyzed. Forty-one PA strains were identified, and their antibiotic resistance profiles were obtained. The DNAs of PA isolates were extracted and applied to amplifications for several aminoglycosides modifying enzyme genes, including aac(3′)-Ⅰ, aac (3′)-Ⅱ, aac(6′)-Ⅰb, aac(6′)-Ⅱ, ant(2′′)-Ⅰand ant(3′′)-Ⅰby PCR method. Combining with the clinical features and the antibiotic resistance profiles, the relationship between genotypes and phenotypes of the PA strains was analyzed. Results Gram positive bacteria (G+) were the majority of the pathogen with 51.67%detection rate. The total detection rate of PA was 19.62%, listed as the top one pathogenic bacterium among gram negative bacteria (47.67%). There was significant difference in the ratio of ulcer area≥4 cm2 between PA group and non-PA group and G+group. There were significantly higher inci?dence rate of ischemic ulcer and osteomyelitis in PA group than those of G+group. There were higher clinical characteristics and ulcer depth (SAD) score, and increased hypersensitive C-reactive protein in PA group than those of G+ group. There were 30 strains of PA being resistant to AmAn (73.17%). The predominant drug resistance gene to AmAn was ant(3′′)-Ⅰ(65.85%), and aac(3′)-Ⅰgene was not found from all PA isolates. Conclusion The detection rate of PA isolated from DFI patients was higher, and patients were with the characteristics of larger, deeper and severe ischemia of ulcer area. The phe?nomenon of PA resistant to AmAn was more serious, and ant(3′′)-Ⅰgene identified from PA isolates was the most common resistance gene identified to AmAn.

Interaction of sleep quality and sleep duration on glycemic control in patients with type 2 diabetes mellitus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Copious evidence from epidemiological and laboratory studies has revealed that sleep status is associated with glucose intolerance, insulin resistance, thus increasing the risk of developing type 2 diabetes. The aim of this study was to reveal the interaction of sleep quality and sleep quantity on glycemic control in patients with type 2 diabetes mellitus.</p><p><b>METHODS</b>From May 2013 to May 2014, a total of 551 type 2 diabetes patients in Tianjin Metabolic Diseases Hospital were enrolled. Blood samples were taken to measure glycosylated hemoglobin (HbA1c), and all the patients completed the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep status. "Good sleep quality" was defined as PQSI <5, "average sleep quality" was defined as PQSI 6-8, and "poor sleep quality" was defined as PQSI >8. Poor glycemic control was defined as HbA1c ≥7%. Sleep quantity was categorized as <6, 6-8, and >8 hours/night. Short sleep time was defined as sleep duration <6 hours/night.</p><p><b>RESULTS</b>In the poor glycemic control group, the rate of patients who had insufficient sleep was much higher than that in the other group (χ(2) = 11.16, P = 0.037). The rate of poor sleep quality in poor glycemic control group was much greater than that in the average control group (χ(2) = 9.79, P = 0.007). After adjusted by gender, age, body mass index, and disease duration, the adjusted PSQI score's OR was 1.048 (95% CI 1.007-1.092, P = 0.023) for HbA1c level. The sleep duration's OR was 0.464 (95% CI 0.236-0.912, P = 0.026) for HbA1c level. One-way analysis of variance showed that the poor sleep quality group had the highest homeostasis model assessment-insulin resistance (P < 0.01).</p><p><b>CONCLUSIONS</b>Inadequate sleep, in both quality and quantity, should be regarded as a plausible risk factor for glycemic control in type 2 diabetes. Poor sleep might bring much more serious insulin resistance and could be the reason for bad glycemic control. A good night's sleep should be seen as a critical health component tool in the prevention and treatment of type 2 diabetes. It is important for clinicians to target the root causes of short sleep duration and/or poor sleep quality.</p>

Correlation between psychological states and coping styles of primary caregivers of stroke patients / 现代临床护理

Objective To study the correlation between psychological state and coping styles of primary caregivers of stroke patients.Method 286 primary caregivers were screened out by the random sampling method for the investigation of their psychological states and coping styles using SCL-90 and the medical coping modes questionnaire(MCMQ).Results There were significant differences between primary caregivers and Chinese norm in terms of all factors(P<0.01).The major caregivers with higher education were scored significantly lower than those with less education on the factors of depression,anxiety,hostility,fear,psychoticism (P<0.01).There were significant different differences between primary caregivers and Chinese norm in coping style(P<0.01): the score on confrontation in the coping style lower than the norm while the score on avoidance in the coping style higher than in norm.The confrontation and avoidance in the primary caregivers were negatively correlated to the factors of SCL-90(P<0.05)and yielding in the coping style positively to the factors of SCL-90(P<0.05).Conclusions The primary caregivers of stroke patients are at the poor psychological states and they tend to take the passive and negative coping styles.The more they take active coping style,the better their mental states grow and vise versa.Therefore,the caregivers need professional training so that they can use the supports from their families and be encouraged to speak out their poor moods.Post-discharge visits to them,besides,are helpful for the improved psychological states for the improvement of their quality of life.