AIM： To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with longstanding type 2 diabetes mellitus.METHODS： Proximal gastric motility was assessed （using a barostat...AIM： To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with longstanding type 2 diabetes mellitus.METHODS： Proximal gastric motility was assessed （using a barostat） in 10 critically ill patients with type 2 diabetes mellitus （59±3 years） during two 60-min duodenal infusions of Ensure （1 and 2 kcal/min）, in random order, separated by 2h fasting. Data were compared with 15 non-diabetic critically ill patients （48 ± 5 years） and 10 healthy volunteers （28 ±3 years）. RESULTS： Baseline proximal gastric volumes were similar between the three groups. In diabetic patients, proximal gastric relaxation during I kcal/min nutrient infusion was similar to non-diabetic patients and healthy controls. In contrast, relaxation during 2 kcal/ min infusion was initially reduced in diabetic patients （P 〈 0.05） but increased to a level similar to healthy humans, unlike non-diabetic patients where relaxation was impaired throughout the infusion. Duodenal nutrient stimulation reduced the fundic wave frequency in a dose-dependent fashion in both the critically ill diabetic patients and healthy subjects, but not in critically ill patients without diabetes. Fundic wave frequency in diabetic patients and healthy subjects was greater than in non-diabetic patients.CONCLUSION： In patients with diabetes mellitus, proximal gastric motility is less disturbed than nondiabetic patients during critical illness, suggesting that these patients may not be at greater risk of delayed gastric emptying.展开更多
背景:骨质疏松和骨折类型是影响股骨近端防旋髓内钉内固定后失效的两个重要原因。AO31-A3.3型股骨转子间骨折因其骨折累及内外侧壁,极大地增加了骨折不稳定性,加之老年人多为骨质疏松患者,故老年AO31-A3.3型股骨转子间骨折股骨近端防旋...背景:骨质疏松和骨折类型是影响股骨近端防旋髓内钉内固定后失效的两个重要原因。AO31-A3.3型股骨转子间骨折因其骨折累及内外侧壁,极大地增加了骨折不稳定性,加之老年人多为骨质疏松患者,故老年AO31-A3.3型股骨转子间骨折股骨近端防旋髓内钉内固定失败和术后并发症概率较高。目的:探讨钉道强化和普通股骨近端防旋髓内钉治疗AO31-A3.3型股骨转子间骨折的生物力学差异。方法:选取1例75岁女性AO31-A3.3型股骨转子间骨折志愿者的CT资料,导入Mimics 19.0和Geomagic studio 2017软件中进行提取、优化,得到右侧股骨三维模型。运用Solidworks 2017软件画出内固定模型并与股骨模型按照标准手术技术装配,以STEP格式导入Hypermesh14.0软件中截骨得到AO31-3.3型普通股骨近端防旋髓内钉股骨转子间骨折模型,将螺旋刀片近端周围松质骨重新定义为骨水泥,得到钉道强化股骨近端防旋髓内钉模型。设置材料属性参数、边界条件、施加载荷,分别储存为K文件导入LS-DYNA软件求解。结果与结论:(1)与普通股骨近端防旋髓内钉相比,骨水泥钉道强化股骨近端防旋髓内钉治疗老年AO31-A3.3型股骨转子间骨折的螺旋刀片切割程度更轻,股骨头颈骨块内翻和旋转角度、位移均更小,具有更好的生物力学效果;(2)完整的外侧壁可以有效支撑股骨头颈骨块,对抗头颈骨块的内翻和旋转倾向,并作为三点支撑的外侧作用点,有效防止头颈螺钉退出;(3)骨水泥强大的锚固力能稳定螺旋刀片,增强三点支撑的内侧作用点,并能传导、分散压力。展开更多
基金Supported by a project grant from the National Health and Medical Research Council of Australia.
文摘AIM： To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with longstanding type 2 diabetes mellitus.METHODS： Proximal gastric motility was assessed （using a barostat） in 10 critically ill patients with type 2 diabetes mellitus （59±3 years） during two 60-min duodenal infusions of Ensure （1 and 2 kcal/min）, in random order, separated by 2h fasting. Data were compared with 15 non-diabetic critically ill patients （48 ± 5 years） and 10 healthy volunteers （28 ±3 years）. RESULTS： Baseline proximal gastric volumes were similar between the three groups. In diabetic patients, proximal gastric relaxation during I kcal/min nutrient infusion was similar to non-diabetic patients and healthy controls. In contrast, relaxation during 2 kcal/ min infusion was initially reduced in diabetic patients （P 〈 0.05） but increased to a level similar to healthy humans, unlike non-diabetic patients where relaxation was impaired throughout the infusion. Duodenal nutrient stimulation reduced the fundic wave frequency in a dose-dependent fashion in both the critically ill diabetic patients and healthy subjects, but not in critically ill patients without diabetes. Fundic wave frequency in diabetic patients and healthy subjects was greater than in non-diabetic patients.CONCLUSION： In patients with diabetes mellitus, proximal gastric motility is less disturbed than nondiabetic patients during critical illness, suggesting that these patients may not be at greater risk of delayed gastric emptying.
文摘背景:骨质疏松和骨折类型是影响股骨近端防旋髓内钉内固定后失效的两个重要原因。AO31-A3.3型股骨转子间骨折因其骨折累及内外侧壁,极大地增加了骨折不稳定性,加之老年人多为骨质疏松患者,故老年AO31-A3.3型股骨转子间骨折股骨近端防旋髓内钉内固定失败和术后并发症概率较高。目的:探讨钉道强化和普通股骨近端防旋髓内钉治疗AO31-A3.3型股骨转子间骨折的生物力学差异。方法:选取1例75岁女性AO31-A3.3型股骨转子间骨折志愿者的CT资料,导入Mimics 19.0和Geomagic studio 2017软件中进行提取、优化,得到右侧股骨三维模型。运用Solidworks 2017软件画出内固定模型并与股骨模型按照标准手术技术装配,以STEP格式导入Hypermesh14.0软件中截骨得到AO31-3.3型普通股骨近端防旋髓内钉股骨转子间骨折模型,将螺旋刀片近端周围松质骨重新定义为骨水泥,得到钉道强化股骨近端防旋髓内钉模型。设置材料属性参数、边界条件、施加载荷,分别储存为K文件导入LS-DYNA软件求解。结果与结论:(1)与普通股骨近端防旋髓内钉相比,骨水泥钉道强化股骨近端防旋髓内钉治疗老年AO31-A3.3型股骨转子间骨折的螺旋刀片切割程度更轻,股骨头颈骨块内翻和旋转角度、位移均更小,具有更好的生物力学效果;(2)完整的外侧壁可以有效支撑股骨头颈骨块,对抗头颈骨块的内翻和旋转倾向,并作为三点支撑的外侧作用点,有效防止头颈螺钉退出;(3)骨水泥强大的锚固力能稳定螺旋刀片,增强三点支撑的内侧作用点,并能传导、分散压力。
