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BACKGROUND: The purpose of this study was to determine cost of care for leg ulcers in sickle cell patients and suggest an improved modality in ulcer care. STUDY DESIGN: We performed a retrospective study of a group of sickle cell disease patients with leg ulcers. RESULTS: Eighteen patients with a leg ulcer (duration: mean, 53.7 months), sickle cell disease, and a mean of 20.7 years of age had various modalities of treatment with the only consistency in healing being a commercial moist-wound dressing. CONCLUSIONS: There is no consistency in the treatment of the sickle cell patient with a leg ulcer. Treatment with a moist dressing had the best results.  相似文献   

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OBJECTIVE: To determine if a risk prediction model for patients with unstable angina would predict resource utilization. METHODS AND RESULTS: Four hundred sixty-five consecutive patients admitted for unstable angina to a tertiary care university-based medical center were prospectively evaluated from June 1, 1992, to June 30, 1995. The proportion of patients receiving coronary angiography, coronary angioplasty, and coronary artery bypass grafting were analyzed according to four risk groups on the basis of a previously published model: Group 1, <2% risk of major complication; Group 2, 2.1% to 5% risk; Group 3, 5.1 % to 15% risk; and Group 4, >15.1 % risk. Hospital length of stay and estimated cost of hospitalization based on DRG and specific payer ratio of cost-to-charge were also compared between groups. Multiple linear regression analysis was used to determine the influence of estimated risk and procedures on hospital costs. The four groups were well matched for gender, hypertension, tobacco history, and previous percutaneous transluminal coronary angioplasty and myocardial infarction. Group 4 had a higher incidence of previous coronary bypass grafting (35% vs 10%, p=0.001) and triple vessel or left main coronary artery disease compared with Group 1 (44% vs 13%, p=0.041). Group 4 patients were more likely to be admitted to the coronary care unit compared with Group 2 or Group 1 patients (80% vs Group 1: 51% [p= 0.001]; and vs Group 2: 53% [p=0.001]), more likely to receive heparin (87% vs 71%, p=0.007), and more likely to receive a beta-blocker or calcium channel blocker (89% vs 74%, p=0.008) than Group 1. Coronary angioplasty rates were similar for all groups, but Group 4 patients were more likely to receive coronary bypass grafting than Group 2 or Group 1 (27% vs Group 2: 12%, p=0.004 and vs Group 1: 8%, p=0.002). Hospital length of stay was highest in Group 4 and lowest for Group 1. Average hospital costs were significantly less in Group 3 than in Group 4, but higher than in Group 1. Multivariate analysis determined a dependency of costs on risk group with Group 2 having costs 31.4% (95% CI=9.8 to 57.2), Group 3 46.7% (24, 3 to 73.1), and Group 4 75% (46.9 to 110.7) higher than Group 1. The use of procedures also significantly increased costs, with PTCA-treated patients having a 44.9% (26.7 to 65.7) increase in costs compared with medically treated patients, and surgically treated patients having a 204.7% increase in costs. CONCLUSION: Resource utilization as assessed by the use of revascularization procedures, length of stay, and hospital costs are influenced by patient acuity estimated from a prediction model on the basis of estimated risk of cardiac complications. The model exerts independent influence on cost even after adjustment for various procedures. The use of revascularization procedures, especially coronary artery surgery, remains a large determinant of hospital cost.  相似文献   

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In tests with newborn and one-week-old Daphnia magna, 48-h EC50 values of 21-24 microg/L and 16 microg/L pirimicarb, respectively, were found. Older animals thus were as sensitive to pirimicarb as newborn animals. In an experiment with sediment included in the test system, all mother animals survived for 72 h at 20 microg/L, and the number of offspring was not reduced relatively to the control. Addition of sediment thus reduced the toxicity of pirimicarb toward Daphnia magna. Pirimicarb was accumulated 12-16 times (5-7% of total) in the sediment, but the water concentrations of pirimicarb were not reduced significantly during the experiment, due to the small amount of sediment used. Accumulation in the sediment was found independent of the water concentration used. This was also the case with bioaccumulation in Daphnia magna, where a bioaccumulation factor of 31-37 was found on a dry weight basis. In water without sediment a BCF of 50 was found. Addition of sediment also reduced the accumulation of pirimicarb in the daphnids. The reduced bioavailability of pirimicarb may derive from humic acid and related compounds released from the sediment.  相似文献   

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In the Porsolt swimming test intact rats acquire and retain the immobile response indistinguishably at 25 and 30 degrees C; at both temperatures retention is abolished by administration of the glucocorticoid antagonist RU38486 and the kappa-selective opiate receptor antagonist MR2266 when given together, but not when either is given alone. At 20 degrees C, however, the animals do not acquire the response, and have levels of retention significantly lower than at the higher temperature. This deficit is not restored by administration of glucocorticoids, kappa-opioid receptor-selective agonists, thyroid hormone or glucose.  相似文献   

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选择性絮凝分选是微细粒矿物高效分选的重要手段之一.为了强化絮凝剂在亲水、疏水矿物表面的絮凝选择性,将疏水基团十六烷基二甲基烯丙基氯化铵(C16DMAAC)引入聚丙烯酰胺(PAM)分子链中合成了疏水改性聚丙烯酰胺(HMPAM),采用耗散型石英晶体微天平(QCM-D)研究了不同浓度K+和Ca2+对分散剂六偏磷酸钠(SHMP)和HMPAM在亲水和疏水化表面原位吸附行为的影响,并使用激光粒度分析仪分析了不同盐度下SHMP和HMPAM对硅微粉及疏水改性硅微粉粒径分布的影响.结果表明,不同盐度环境下HMP AM均呈现了较好的絮凝选择性.背景溶液分别为10 mmol·L-1、100 mmol·L-1KCl及1 mmol·L-1 CaCl2时,QCM-D结果表明SHMP在疏水化表面均未形成吸附层,随后HMPAM在疏水化表面发生吸附,且随着盐度的增加,HMPAM的吸附量增大且吸附层的耗散性降低;背景溶液为10 mmol·L-1 C...  相似文献   

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38 male hooded rats were subjected either to posterior hypothalamic cathodal lesions or sham operations. Postoperatively, lesioned Ss were somnolent for 3-5 days. Ss could groom, scratch, or facewash but did not engage in spontaneous locomotor behavior. The Ss recovered from somnolence but remained akinetic, lacking spontaneous movement throughout testing. In swimming tests at different water temperatures, lesioned Ss sank in 37. C water, but as water temperature deviated from body temperature, swimming improved, as measured by time the S's nose remained above water and appearance of mature swimming patterns. Similar results were obtained in both hypothermic (27. C) and hyperthermic (41.5. C) Ss. Results suggest that the lesions damage a system responsible for linking and integrating motor and sensory systems and for triggering voluntary movement. (French summary) (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)  相似文献   

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Data concerning operative treatment of 227 patients with lithiasis of the extrahepatic biliary ducts, covering an eleven-year period (1985 to 1995 inclusive), are presented. In all cases diagnosis and operation are done in the Second Surgical Clinic at the Medical University--State University Hospital "Alexandrovska"--Sofia. By type the surgical interventions are distributed as follows: external drainage of hepaticocholedochus--122 cases (53.74 per cent), choledochoduodenostomy 69 (30.39 per cent) and transduodenal papillosphincterotomy 36 (15.85 per cent). Fifteen patients develop postoperative complications (6.60 per cent), and in five patients the outcome is fatal with postoperative lethality amounting to 2.20 per cent. The basic indications for the various types of surgical interventions are established.  相似文献   

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The current study was undertaken to investigate the effect of swimming training on the antioxidant enzyme system in kidney of young and old mice. Both young and old mice, aged 2 and 26 months old, respectively, were divided into the sedentary and swimming-trained groups. The trained mice underwent a 6-week swimming program (1 h/day, 5 days/week) in water at 35-36 degrees C. Cu,Zn-superoxide dismutase (Cu,Zn-SOD) activity was significantly decreased with aging but was not influenced by swimming training, such changes being similar to those noted for catalase activity rather than for glutathione peroxidase activity. After swimming training Mn-SOD activity increased significantly only in old mice but was unaffected by aging. Although neither aging nor swimming training had overt effect on the expression of Cu,Zn-SOD mRNA, the immunoreactive Cu,Zn-SOD content in young mice decreased significantly after the training. Meanwhile, Mn-SOD mRNA expression in old mice was reduced by half after swimming training, accompanied by a significant decrease in its immunoreactive content; unexpectedly, however, Mn-SOD content in young mice did not parallel its mRNA expression. These findings suggest that the antioxidant enzyme system in mouse kidney trends to be down-regulated with aging, and that swimming training fails to attenuate such reduced levels of the antioxidant enzymes.  相似文献   

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The effect of estrogen on collateral circulation has not been previously investigated. We assessed the acute effect of estradiol on collateral blood flow velocity with the Flowire during percutaneous transluminal coronary angioplasty and found that intracoronary estradiol decreased collateral blood flow velocity compared with controls.  相似文献   

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通过建立结晶器内钢液和水的二维对流-传热耦合模型过程,研究了小方坯结晶器冷却水入口温度和流速对铜管温度和结晶器内平均热流的影响.该模型使用Fluent进行求解,模拟了钢液和冷却水的流动和传热,凝固坯壳的生长,以及热量以辐射和导热两种通过保护渣和气隙.通过将坯壳厚度和铜管温度与其他研究的结果进行对比来验证模型准确性.研究结果表明,结晶器冷却水的温度显著影响铜管的冷面温度,水温超过313 K会导致铜管冷面最高温度超过水的沸点.水流速升高0.49 m·s-1能够消除水温升高4 K带来的不利影响.  相似文献   

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转炉炼钢利用供氧枪位的改变实现前期化渣、中期脱碳升温以及后期强化搅拌的目的.本文基于100t炼钢转炉,研究了四孔超音速氧枪喷吹时枪位变化对熔池流动状况的影响.研究发现:低枪位有利于增加射流冲击深度,加速熔池表层钢液;高枪位有利于增大射流冲击面积,促进钢液速度在径向方向上均匀分布,增加熔池底部钢液速度.随着枪位从1.2m提高至1.8m,冲开渣层的直径从2.119m增加为2.645m,射流的冲击深度显著降低.  相似文献   

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An ideal, hydrated, nondilute pseudobinary salt-protein-water solution model of the RBC intracellular solution has been developed to describe the osmotic behavior of human erythrocytes during freezing and thawing. Because of the hydration of intracellular solutes (mostly cell proteins), our analytical results predict that at least 16.65% of the isotonic cell water content will be retained within RBCs placed in hypertonic solutions. These findings are consistent not only with the experimental measurements of the amount of isotonic cell water retained within RBCs subjected to nonisotonic extracellular solutions (20-32%) but also with the experimental evidence that all of the water within RBCs is solvent water. By modeling the RBC intracellular solution as a hydrated salt-protein-water solution, no anomalous osmotic behavior is apparent.  相似文献   

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