Comparison of pneumatic retinopexy and scleral buckling in the management of primary rhegmatogenous retinal detachment. Southern Wisconsin Pneumatic Retinopexy Study Group

PURPOSE: To compare pneumatic retinopexy and scleral buckling for repair of primary rhegmatogenous retinal detachment with respect to visual outcome, single-procedure reattachment rate, and development of proliferative vitreoretinopathy. METHODS: A consecutive series of eyes initially treated with pneumatic retinopexy (n = 56) between March 1986 and February 1996 were compared with a selected group of eyes treated with scleral buckling (n = 86) with similar location and distribution of retinal breaks and absence of proliferative vitreoretinopathy. A regression model was developed to adjust for underlying differences between treatment groups, resulting in a cohort of 50 eyes in each group for final comparison. A minimum follow-up of 6 months was obtained. RESULTS: Single-procedure reattachment rate was significantly higher for scleral buckle eyes (42 of 50 eyes, 84%) than for pneumatic retinopexy eyes (31 of 50 eyes, 62%; P < or = .01). Correspondingly, reoperation rate was significantly higher for pneumatic retinopexy eyes (19 of 50 eyes, 38%) than for scleral buckle eyes (7 of 50 eyes, 14%; P < or = .01). Multiple regression analysis evaluating perioperative factors demonstrated that the use of pneumatic retinopexy was the sole factor predictive of retinal detachment after a single procedure (relative odds = 2.20, P = .02). Final reattachment rate, after reoperations, was 98% (49 of 50 eyes) in each group. Except for nonphakic eyes, final visual outcome and rate of postoperative proliferative vitreoretinopathy development did not differ significantly between the two procedures. CONCLUSIONS: In phakic eyes, pneumatic retinopexy was associated with a significantly higher reoperation rate than scleral buckling, but resulted in equivalent final visual outcome and reattachment rate after reoperations. If used, it must be incorporated into a strategy in which patient and physician are prepared for a greater chance of reoperation compared to initial management with scleral buckling.     

ACE inhibitor-induced angioedema. Incidence, prevention and management

Increased consumer awareness and concern about microbial foodborne diseases has resulted in intensified efforts to reduce contamination of raw meat, as evidenced by new meat and poultry inspection regulations being implemented in the United States. In addition to requiring operation of meat and poultry slaughtering and processing plants under the principles of the hazard analysis critical control point (HACCP) system, the new regulations have established microbiological testing criteria for Escherichia coli and Salmonella, as a means of evaluating plant performance. These developments have renewed and intensified interest in the development and commercial application of meat and poultry decontamination procedures. Technologies developed and evaluated for decontamination include live animal cleaning/washing, chemical dehairing, carcass knife-trimming to remove physical contaminants, steam/hot water-vacuuming for spot-cleaning/decontamination of carcasses, spray washing/rinsing of carcasses with water of low or high pressures and temperatures or chemical solutions, and exposure of carcass sides to pressurized steam. Under appropriate conditions, the technologies applied to carcasses may reduce mean microbiological counts by approximately one-three log colony forming units (cfu)/cm2, and some of them have been approved and are employed in commercial applications (i.e., steam-vacuuming; carcass spray-washing with water, chlorine, organic acid or trisodium phosphate solutions; hot water deluging/spraying/rinsing, and pressurized steam). The contribution of these decontamination technologies to the enhancement of food safety will be determined over the long term, as surveillance data on microbial foodborne illness are collected. This review examines carcass decontamination technologies, other than organic acids, with emphasis placed on recent advances and commercial applications.     

Number and timing failures among legitimate births in the United States: 1968, 1969 and 1972

More than one in 10 legitimate births that occurred in the United States during 1968, 1969, and 1972 were not wanted at all, and more than one-quarter of the births were timing failures. A substantial reduction in unwanted childbearing took place between 1968 and 1972. The proportion of legitimate births reported by their mothers to be unwanted ever declined from 13 percent in 1968 to eight percent in 1972. If, as reported in a number of cross-sectional surveys taken during this approximate period, there was a sharp reduction in wanted family size reported by married women, then these women would have remained at risk of having an unwanted birth for a longer period than when their wanted family size had been higher. Thus, these estimates of a decline in unwanted childbearing may be understated (although there was the countervailing trend of later age at marriage during these years). The decline in unwanted childbearing between 1968 and 1972 is only partially attributable to the shift toward lower birth orders that occurred. Declines in unwanted births occurred for almost all birth orders. There was no significant reduction in mistimed births. Because the decline in unwanted fertility during the study period was much greater for nonwhites than whites, the traditional racial differential in unwanted childbearing narrowed considerably between 1968 and 1972. In 1968, 12 percent of the white legitimate births were classified as not wanted, compared to 21 percent of the legitimate births to nonwhites. However, between 1968 and 1972, nonwhites experienced extremely sharp declines in unwanted childbearing. Thus, in 1972 only 9.5 percent of the legitimate births to nonwhites were reported as unwanted, compared to 8.1 percent of the white births. Mothers of higher parity were much more likely to report a birth as unwanted than those of lower parity. Mothers who had completed more schooling were less likely than poorly educated mothers to report births as unwanted. Income level seems unrelated to whether the birth is unwanted, but is inversely related to whether it is a timing failure. Births that resulted from premarital conceptions tended to be reported as timing failures. Viewed from the cross-sectional perspective of period rates of population change, the elimination of unwanted legitimate childbearing would have had a substantial effect on population growth in each of the study years even without decreasing marital mistimed births or illegitimate fertility. The data also suggest that eliminating unwanted marital childbearing could significantly reduce completed family size. However, this conclusion must be viewed with great caution, since we do not know the future variations in timing and spacing of births, and the extent to which the childbearing experience of the sampled mothers is representative of their birth cohorts.     

Sleep and cognitive failures improved by a three-month stress management intervention.

Work-related stress is a major occupational health problem. Prominent symptoms are impaired sleep and cognitive ability. Participants (N=102) were randomized to either an intervention or a wait-list control group. Outcomes, measured at baseline, 3, 6, and 9 months, were the Basic Nordic Sleep Questionnaire, Cognitive Failures Questionnaire, and Digit Span test. Data were analyzed using repeated measures analyses of variance. Self-reported quality of sleep improved in the intervention group. Relative to the control group, an effect size of d=?0.64, CI [?1.05, –0.24], was found. For cognitive failures, an effect size of d=?0.57, CI [?0.90, –0.24], was found, favoring the intervention. Gains were maintained at follow-up. Digit Span scores did not differ between groups. In conclusion, the intervention had medium effects on self-reported sleep and cognitive errors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

气动蝶阀故障原因分析及防范措施

从结构和原理入手分析了气动蝶阀故障原因并提出了防范措施。     

Bronchiolitis obliterans: pathogenesis, prevention, and management

Increasing early success-post lung transplant has been tempered by the long-term development of histologic bronchiolitis obliterans (OB) or of the progressive airway obstruction which is called bronchiolitis obliterans syndrome (BOS). Multiple lines of evidence suggest that OB/BOS is due to an injury directed against the epithelial cells in the airways of the donor lung by the immune system of the recipient. Acute rejection is the strongest risk factor for the subsequent development of this process. Efforts to prevent or minimize acute rejection may reduce the prevalence of OB/BOS. Results of treatment with augmented immunosuppression have been disappointing but the treatment of complicating infections in the allograft can be beneficial. Multicenter studies are needed to assess the efficacy of new immunosuppressive agents in preventing or treating OB/BOS.     

Failed total wrist arthroplasty. Analysis of failures and results of operative management

Nine metal on polyethylene total wrist arthroplasties were revised for failure, including eight trispherical devices and one Volz implant. Causes of failure include sepsis in one patient, progressive wrist flexion contracture in two patients, and mechanical failure in six patients. The most common mode of mechanical failure was metacarpal loosening with dorsal perforation of the stem. This was associated with an intact articulation between the third metacarpal and the capitate, with a proximal position of the metacarpal component in the shaft, and with poor cement fill of the metacarpal shaft. The one infected wrist was managed with resection arthroplasty. Five patients had conversion to a wrist arthrodesis and three patients underwent revision total wrist arthroplasty with custom trispherical components. Followup averaged 3.3 years. All patients undergoing arthrodesis attained a solid painless fusion after a single operation at an average of 4.8 months. The three patients treated with revision arthroplasty had wrists that were pain free, functional, and had no evidence of loosening at latest followup. Failed total wrist arthroplasties can be salvaged successfully to either a fusion or a revision arthroplasty in most patients.     

Osteoporosis in men. New insights into aetiology, pathogenesis, prevention and management

Osteoporosis is increasingly recognised in men. Low bone mass, risk factors for falling and factors causing fractures in women are likely to cause fractures in men. Bone mass is largely genetically determined, but environmental factors also contribute. Greater muscle strength and physical activity are associated with higher bone mass, while radial bone loss is greater in cigarette smokers or those with a moderate alcohol intake. Sex hormones have important effects on bone physiology. In men, there is no abrupt cessation of testicular function or 'andropause' comparable with the menopause in women; however, both total and free testosterone levels decline with age. A common secondary cause of osteoporosis in men is hypogonadism. There is increasing evidence that estrogens are important in skeletal maintenance in men as well as women. Peripheral aromatisation of androgens to estrogens occurs and osteoblast-like cells can aromatise androgens into estrogens. Human models exist for the effects of estrogens on the male skeleton. In men aged > 65 years, there is a positive association between bone mineral density (BMD) and greater serum estradiol levels at all skeletal sites and a negative association between BMD and testosterone at some sites. It is crucial to exclude pathological causes of osteoporosis, because 30 to 60% of men with vertebral fractures have another illness contributing to bone disease. Glucocorticoid excess (predominantly exogenous) is common. Gastrointestinal disease predisposes patients to bone disease as a result of intestinal malabsorption of calcium and colecalciferol (vitamin D). Hypercalciuria and nephrolithiasis, anticonvulsant drug use, thyrotoxicosis, immobilisation, liver and renal disease, multiple myeloma and systemic mastocytosis have all been associated with osteoporosis in men. It is possible that low-dose estrogen therapy or specific estrogen receptor-modulating drugs might increase BMD in men as well as in women. In the future, parathyroid hormone peptides may be an effective treatment for osteoporosis, particularly in patients in whom other treatments, such as bisphosphonates, have failed. Men with idiopathic osteoporosis have low circulating insulin-like growth factor-1 (IGF-1; somatomedin-1) concentrations, and IGF-1 administration to these men increases bone formation markers more than resorption markers. Studies of changes in BMD with IGF-1 treatment in osteoporotic men and women are underway. Osteoporosis in men will become an increasing worldwide public health problem over the next 20 years, so it is vital that safe and effective therapies for this disabling condition become available. Effective public health measures also need to be established and targeted to men at risk of developing the disease.     

The hippocampus, collateral behavior, and timing.

Male Sprague-Dawley rats with hippocampal (HC) lesions, cortical control lesions, or sham operations were trained to leverpress on a DRL schedule requiring 12 sec between responses. In 4 experiments, factors affecting performance efficiency in this paradigm were manipulated. Providing extra opportunities for collateral mediating behavior (Exp I) aided all groups nondifferentially. Adding a limited hold (Exp II) or administering chlordiazepoxide HCl (Exp III) reduced DRL efficiency in all groups nondifferentially. However, adding an auditory stimulus marking the halfway point in the DRL requirement (Exp IV) differentially aided the HC group. Implications for theories of HC function are discussed. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cause of leaf yellowing of Amomum villosum Lour. from Yunnan and its prevention

The results of the experiment showed that manganese deficiency in soil is one of the main causes of leaf yellowing of Amomum villosum and applying trace element fertilizer can make up deficiency. Manganese sulphate can effectively prevent the leaf yellowing.     

The role of psychologists in the treatment, management, and prevention of chronic mental illness.

In addition to suffering from the severe psychiatric symptoms of chronic mental illness (CMI), people with this type of disorder suffer from a variety of secondary disabilities and face societal obstacles that interfere with their ability to maximize their personal, social, and vocational potentials. Following the deinstitutionalization of long-term psychiatric patients in recent decades, many different understandings of the etiology, treatment, and management of CMI have evolved, including those derived from the biological, vulnerability, cognitive, case management, rehabilitation, and psychoeducational models. Because psychologists are trained in a wide range of psychological theories and a broad repertoire of applications, they have unique contributions to make within each model, particularly, as discussed here, to prevent, treat, and manage CMI through research, assessment, and intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologist as ethics educator: Successes, failures, and unanswered questions.

Critically analyzes the literature documenting ethics education over the last 35 yrs, discussing changes in instructional methodology, current course content, and the empirical literature relevant to the outcomes of ethics education. This analysis reveals several gaps in the ethics competencies of students. The article next describes the results of a national survey of the views of 101 internship directors on the ethical capabilities of predoctoral interns in psychology. In contrast to ethics researchers, internship directors rate the ethics knowledge of psychology interns highly. It ends with a discussion of strengths and weaknesses of current knowledge and directions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathophysiology, prevention, and management of prosthetic infections in hernia surgery

Because hernias are repaired increasingly with mesh and plugs, surgeons performing these operations should make an extended effort to prevent infection, and, when infections occur, to treat them expeditiously. This article discusses bacterial binding, infection reduction, the patient-doctor relationship during the care of an infected wound, and other related topics.     

Time-on-task: Issues of timing, sampling, and definition.

Analyzed the extent to which variations in methodological characteristics of time-on-task observations alter the substantive importance of time-on-task for student achievements. Using an existing observational data set, different observational decisions were simulated to assess their effects. 108 2nd–5th graders served as Ss. Five issues were examined: definitions of off-task behavior, duration of observation time during a class period, number of days of observation, schedule of observation in the school year, and number of students sampled. Results show that variations in observational characteristics affected the substantive conclusions in all 5 areas examined, and the largest differences were due to changes in the duration and number of days of observation. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

预制板楼面板缝开裂的原因及预防

使用预应力空心楼板的房屋,经常出现楼面、天棚沿着板缝开裂的现象,直接影响到室内的美观和使用功能.通过对施工中多项工程的实践和分析,找出预制板楼面板缝开裂的原因,并提出了预防措施.     

Complications of laparoscopic pelvic surgery: recognition, management and prevention

Laparoscopic surgery has many advantages but it is not without complications. The complexity of the surgery significantly influences the complication rate. Laparoscopic surgeons ought to be aware of the possible complications and how they could be prevented, recognized without delay, and managed safely and efficiently. Important complications include injuries to the vessels, bowel and urinary tract. Incisional hernia ought to be reduced by careful closure of the fascia whenever a trocar > or =10 mm is used at the extraumbilical site. Gas embolism is a rare but potentially life threatening complication. Shoulder pain is a minor complication but is exceedingly common; it is less likely to occur if as much gas as possible is removed at the end of the operation while the patient is still in head down Trendelenburg position. Rare complications include pneumothorax, subcutaneous and pre-peritoneal emphysema, cardiac arrhythmia, nerve injury and venous thrombosis. Laparoscopic surgeons should also understand the principles of electrosurgery and how to avoid complications arising from the use of electrical energy including capacitative coupling, direct coupling and insulation failure.