Purpose To review evidence-based management of nephropathy in patients with type 2 diabetes.Data sources A literature search (MEDLINE 1966 to 2000) was performed using the key word 'diabetic nephropathy'. Re...Purpose To review evidence-based management of nephropathy in patients with type 2 diabetes.Data sources A literature search (MEDLINE 1966 to 2000) was performed using the key word 'diabetic nephropathy'. Relevant book chapters were also reviewed.Study selection Well-controlled, prospective landmark studies and expert review articles on diabetic nephropathy were selected.Data extraction Data and conclusions from the selected articles that provide solid evidence to the optimal management of diabetic nephropathy were extracted and interpreted in light of our clinical research experience with many thousands of Hong Kong Chinese patients.Results Hypertension, long diabetes duration, poor glycaemic control and central obesity are the most important risk factors. Microalbuminuria is a practical marker to predict overt nephropathy in type 2 diabetic patients. Risk factor modification, renal function monitoring and combined therapies are the current integrated approaches to manage patients with diabetic kidney disease. Optimal glycaemic control is the mainstay of treatment but effective antihypertensive therapy is also key to delaying the progression of diabetic nephropathy. Angiotensin-converting enzyme inhibitors and angiotensin Ⅱ receptor antagonists have important renoprotective actions independent of their blood pressure lowering actions. Conclusions Diabetic nephropathy is the leading cause of end-stage renal disease worldwide. Monitoring renal function and screening for microalbuminuria will allow the identification of patients with nephropathy at a very early stage for intervention. Tight glycaemic control and aggressive antihypertensive treatment as well as the use of renin-angiotensin system inhibitors should substantially delay the progression of nephropathy.展开更多
Objective：To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system （PHILOS） plate for proximal humerus fractures.Methods：We reviewed 51...Objective：To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system （PHILOS） plate for proximal humerus fractures.Methods：We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012.There were 35 men and 16 women with a mean age of 38 years （range 24-68）.There were 41 patients in the age group of ＜60 years and 10 patients in the age group of ＞60 years.According to Neer classification system,8,15 and 23 patients had 2-part,3-part,and 4-part fractures,respectively and 5 patients had 4-part fracture dislocation.All surgeries were carried out at our tertiary care trauma centre.Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score.Results：The mean follow-up period was 30 months （range 12-44 months）.Two patients were lost to followup.Of the remaining 49 patients,all fractures were united clinically and radiologically.The mean time for radiological union was 12 weeks （range 8-20 weeks）.At the final follow-up the mean Constant-Murley score was 79 （range 50-100）.The results were excellent in 25 patients,good in 13 patients,fair in 6 patients and poor in 5 patients.During the follow-up,four cases of varus malunion,one case of subacromial impingement,one case of deep infection,one case of intraarticular screw penetration and one case of failure of fixation were noted.No cases of avascular necrosis,hardware failure,locking screw loosening or nonunion were noted.Conclusion：PHILOS provides stable fixation in proximal humerus fractures.To prevent potential complications like avascular necrosis,meticulous surgical dissection to preserve vascularity of humeral head is necessary.展开更多
AIM:To perform a single-center analysis of all double balloon endoscopy (DBE) related cases of pancreatitis identified prospectively from a recorded DBE-complication database. METHODS:From November 2003 until January ...AIM:To perform a single-center analysis of all double balloon endoscopy (DBE) related cases of pancreatitis identified prospectively from a recorded DBE-complication database. METHODS:From November 2003 until January 2007, 603 DBE procedures were performed on 412 patients, with data on complications recorded in a database. The setting was a tertiary care center offering DBE. DBE was performed from the antegrade or retrograde route. Out-come measurements included age, gender, medication, indication, DBE-endoscope type, insertion depth, proce-dure duration, findings, interventions, post-procedural abdominal pain, and post-procedural hospitalization. RESULTS:This is the largest single-center study report-ing on post-DBE pancreatitis prospectively. Six patients (1.0%) developed post-DBE pancreatitis, all after antegrade DBE. There was no association with gender, duration of the procedure or type of endoscope. The mean age was 51.9 years (range 25-78). Four patients had severe pancreatitis. Of these, two had inflammatory signs in the body-tail region, one had pancreatitis in the tail region, and the total pancreas was involved in one. CONCLUSION:The incidence of post-DBE pancreatitis in our series is higher than previously reported. We found no relation with DBE-endoscope type. The inflammatory changes occurred in the body-tail region of the pancreas, suggesting that post-DBE pancreatitis is caused by repetitive mechanical strain on the pancreas.展开更多
THE formation periods,properties and initial elevations of Tibetan planation surfaces are keysto the issues ot the plateau uplift.Li et al.believed that the study on planation surfaces hasfar-reaching significance.Yan...THE formation periods,properties and initial elevations of Tibetan planation surfaces are keysto the issues ot the plateau uplift.Li et al.believed that the study on planation surfaces hasfar-reaching significance.Yang et al.indicated that the summit level and the basin level展开更多
The impact buckling of a laminated composite bar is investigated in case of one of its ends moving due to axial impact compression. The governing equations considering the first- order shear deformation effect are der...The impact buckling of a laminated composite bar is investigated in case of one of its ends moving due to axial impact compression. The governing equations considering the first- order shear deformation effect are derived by the Hamilton principle and solved by the finite difference method. The critical axial shortness is determined by the B - R cirterion. The given example is used to highlight the influences of initial imperfection, impact velocity, stress wave and coupled stiffness. It is found that the unsymmetrically laminated bar has a quite different dynamic buckling behaviour from that of the symmetrically laminated bar.展开更多
A new in situ method was realized by one step laser cladding to produce Ni-base alloy composite coating reinforced by in situ reacted and gradiently distributed TiCp particles. The submicron TiCp particles were formed...A new in situ method was realized by one step laser cladding to produce Ni-base alloy composite coating reinforced by in situ reacted and gradiently distributed TiCp particles. The submicron TiCp particles were formed and uniformly distributed because of the in situ reaction and trapping effect under the rapid solidification condition. And, TiCp particles were of gradient distribution on a macro scale and their volume fraction increased from 1.86% at the layer/substrate interface to a maximum 38.4% at the surface of the layer. Furthermore, the in situ generated TiCp/gamma-Ni interfaces were free from deleterious surface reactions. Additionally, the clad coating also revealed a high microhardness of gradient variation with the layer depth and the superior abrasive wear resistance.展开更多
The microstructural and compositional features of the laser-solidified microstructures and phase evolutions occurring during high temperature tempering were investigated by using analytical electron microscopy with en...The microstructural and compositional features of the laser-solidified microstructures and phase evolutions occurring during high temperature tempering were investigated by using analytical electron microscopy with energy dispersive X-ray analysis. The cladded alloy, a powder mixture of Fe, Cr, W, Ni and C with a weight ratio of 10:5: 1:1:1, was processed with a 3 kW continuous wave CO2 laser. The cladded coating possessed the hypoeutectic microstructure of the primary dendritic γ-austenite and interdendritic eutectic consisting of (γ+M7C3). The γ-austenite is a nonequilibrium phase with extended solid solution of alloying elements. And, a great deal of fine structures, i.e., a high density ofdislocations,twins,andstackingfaultsexistedinaustenite phase. During high temperature aging,the precipitation of M23C6, MC and M2C in austenite and in situ transformation of M7C3(+γ) → M23C6 and M7C3+7→ M6C occurred. The laserclad coating revealed an evident secondary hardening and superior impact wear resistance展开更多
文摘Purpose To review evidence-based management of nephropathy in patients with type 2 diabetes.Data sources A literature search (MEDLINE 1966 to 2000) was performed using the key word 'diabetic nephropathy'. Relevant book chapters were also reviewed.Study selection Well-controlled, prospective landmark studies and expert review articles on diabetic nephropathy were selected.Data extraction Data and conclusions from the selected articles that provide solid evidence to the optimal management of diabetic nephropathy were extracted and interpreted in light of our clinical research experience with many thousands of Hong Kong Chinese patients.Results Hypertension, long diabetes duration, poor glycaemic control and central obesity are the most important risk factors. Microalbuminuria is a practical marker to predict overt nephropathy in type 2 diabetic patients. Risk factor modification, renal function monitoring and combined therapies are the current integrated approaches to manage patients with diabetic kidney disease. Optimal glycaemic control is the mainstay of treatment but effective antihypertensive therapy is also key to delaying the progression of diabetic nephropathy. Angiotensin-converting enzyme inhibitors and angiotensin Ⅱ receptor antagonists have important renoprotective actions independent of their blood pressure lowering actions. Conclusions Diabetic nephropathy is the leading cause of end-stage renal disease worldwide. Monitoring renal function and screening for microalbuminuria will allow the identification of patients with nephropathy at a very early stage for intervention. Tight glycaemic control and aggressive antihypertensive treatment as well as the use of renin-angiotensin system inhibitors should substantially delay the progression of nephropathy.
文摘Objective：To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system （PHILOS） plate for proximal humerus fractures.Methods：We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012.There were 35 men and 16 women with a mean age of 38 years （range 24-68）.There were 41 patients in the age group of ＜60 years and 10 patients in the age group of ＞60 years.According to Neer classification system,8,15 and 23 patients had 2-part,3-part,and 4-part fractures,respectively and 5 patients had 4-part fracture dislocation.All surgeries were carried out at our tertiary care trauma centre.Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score.Results：The mean follow-up period was 30 months （range 12-44 months）.Two patients were lost to followup.Of the remaining 49 patients,all fractures were united clinically and radiologically.The mean time for radiological union was 12 weeks （range 8-20 weeks）.At the final follow-up the mean Constant-Murley score was 79 （range 50-100）.The results were excellent in 25 patients,good in 13 patients,fair in 6 patients and poor in 5 patients.During the follow-up,four cases of varus malunion,one case of subacromial impingement,one case of deep infection,one case of intraarticular screw penetration and one case of failure of fixation were noted.No cases of avascular necrosis,hardware failure,locking screw loosening or nonunion were noted.Conclusion：PHILOS provides stable fixation in proximal humerus fractures.To prevent potential complications like avascular necrosis,meticulous surgical dissection to preserve vascularity of humeral head is necessary.
文摘AIM:To perform a single-center analysis of all double balloon endoscopy (DBE) related cases of pancreatitis identified prospectively from a recorded DBE-complication database. METHODS:From November 2003 until January 2007, 603 DBE procedures were performed on 412 patients, with data on complications recorded in a database. The setting was a tertiary care center offering DBE. DBE was performed from the antegrade or retrograde route. Out-come measurements included age, gender, medication, indication, DBE-endoscope type, insertion depth, proce-dure duration, findings, interventions, post-procedural abdominal pain, and post-procedural hospitalization. RESULTS:This is the largest single-center study report-ing on post-DBE pancreatitis prospectively. Six patients (1.0%) developed post-DBE pancreatitis, all after antegrade DBE. There was no association with gender, duration of the procedure or type of endoscope. The mean age was 51.9 years (range 25-78). Four patients had severe pancreatitis. Of these, two had inflammatory signs in the body-tail region, one had pancreatitis in the tail region, and the total pancreas was involved in one. CONCLUSION:The incidence of post-DBE pancreatitis in our series is higher than previously reported. We found no relation with DBE-endoscope type. The inflammatory changes occurred in the body-tail region of the pancreas, suggesting that post-DBE pancreatitis is caused by repetitive mechanical strain on the pancreas.
文摘THE formation periods,properties and initial elevations of Tibetan planation surfaces are keysto the issues ot the plateau uplift.Li et al.believed that the study on planation surfaces hasfar-reaching significance.Yang et al.indicated that the summit level and the basin level
基金The present research work was financially supported by the National Natural Science Foundation of China.(No.19472042)
文摘The impact buckling of a laminated composite bar is investigated in case of one of its ends moving due to axial impact compression. The governing equations considering the first- order shear deformation effect are derived by the Hamilton principle and solved by the finite difference method. The critical axial shortness is determined by the B - R cirterion. The given example is used to highlight the influences of initial imperfection, impact velocity, stress wave and coupled stiffness. It is found that the unsymmetrically laminated bar has a quite different dynamic buckling behaviour from that of the symmetrically laminated bar.
文摘A new in situ method was realized by one step laser cladding to produce Ni-base alloy composite coating reinforced by in situ reacted and gradiently distributed TiCp particles. The submicron TiCp particles were formed and uniformly distributed because of the in situ reaction and trapping effect under the rapid solidification condition. And, TiCp particles were of gradient distribution on a macro scale and their volume fraction increased from 1.86% at the layer/substrate interface to a maximum 38.4% at the surface of the layer. Furthermore, the in situ generated TiCp/gamma-Ni interfaces were free from deleterious surface reactions. Additionally, the clad coating also revealed a high microhardness of gradient variation with the layer depth and the superior abrasive wear resistance.
文摘The microstructural and compositional features of the laser-solidified microstructures and phase evolutions occurring during high temperature tempering were investigated by using analytical electron microscopy with energy dispersive X-ray analysis. The cladded alloy, a powder mixture of Fe, Cr, W, Ni and C with a weight ratio of 10:5: 1:1:1, was processed with a 3 kW continuous wave CO2 laser. The cladded coating possessed the hypoeutectic microstructure of the primary dendritic γ-austenite and interdendritic eutectic consisting of (γ+M7C3). The γ-austenite is a nonequilibrium phase with extended solid solution of alloying elements. And, a great deal of fine structures, i.e., a high density ofdislocations,twins,andstackingfaultsexistedinaustenite phase. During high temperature aging,the precipitation of M23C6, MC and M2C in austenite and in situ transformation of M7C3(+γ) → M23C6 and M7C3+7→ M6C occurred. The laserclad coating revealed an evident secondary hardening and superior impact wear resistance
