BACKGROUND & AIMS: STUDY OBJECTIVE:The aim was to examine whether a high intake of aluminium containing antacids is a risk for Alzheimer's disease. DESIGN:The mortality from dementia (1970-87), coded from death certificates as underlying or contributory cause of death, was compared with national rates in a cohort of patients who had surgery for gastroduodenal ulcer disease between 1911 and 1978. SETTING:Patient data were obtained from patient records from major hospitals in western Norway. PARTICIPANTS:4179 patients were identified who met the study criteria, which included having had a documented stomach operation, having a reliably identifiable personal number, and being alive on Jan 1, 1970. MEASUREMENTS AND MAIN RESULTS:The standardised mortality ratio for dementia was 1.10 (95% CI 0.85-1.40, n = 64) for all patients, while for patients operated on in the period 1967-78 it was 1.25 (95% CI 0.66-2.13, n = 13). CONCLUSIONS:As the majority of patients operated on after 1963 have probably been heavy consumers of aluminium containing antacids, the study provides meager evidence that a high intake of aluminium is an important risk factor for Alzheimer's disease, the major cause of dementia. However, the possibility of a raised mortality from Alzheimer's disease cannot be ruled out due to probable misclassification both in diagnosis and exposure. In addition, the observation period may have been too short to detect an effect since the latent period for Alzheimer's disease may be very long.

背景与目标：

BACKGROUND & AIMS: Stress ulcer prophylaxis protects against clinically important gastrointestinal bleeding and has gained widespread use. This study compares the efficacy of omeprazole to ranitidine for this indication. This was a prospective, randomized clinical trial. Sixty-seven high-risk patients were randomized to receive either ranitidine 150 mg (N = 35) intravenously daily or omeprazole 40 mg (N = 32) daily orally or by nasogastric route. Patients were monitored for clinically important bleeding. There was no statistically significant difference between treatment groups in the number of patients enrolled, gender, race, or age. The study groups were comparable in regard to the severity of illness based on their similar APACHE II score, duration of ICU stay, duration of ventilator dependence, and mortality rate. A significant difference was found only in regard to the number of risk factors per patient. The ranitidine-treated group had 2.7 risk factors per patient while the omeprazole-treated group had 1.9 (P < 0.05). Eleven patients (31%) given ranitidine and two patients (6%) given omeprazole developed clinically important bleeding (P < 0.05). Nosocomial pneumonia developed in five patients (14%) receiving ranitidine and one patient (3%) receiving omeprazole (P > 0.05). We conclude that oral omeprazole is safe, effective, and clinically feasible for stress ulcer prophylaxis.

背景与目标： 预防应激性溃疡可预防临床上重要的胃肠道出血，并已获得广泛应用。本研究比较了奥美拉唑与雷尼替丁对该适应症的疗效。这是一项前瞻性随机临床试验。67名高危患者被随机分配，每天静脉注射雷尼替丁150 mg (N = 35) 或每天口服奥美拉唑40 mg (N = 32) 或通过鼻饲途径。监测患者的临床重要出血情况。治疗组在入组患者人数，性别，种族或年龄方面没有统计学上的显着差异。基于相似的APACHE II评分，ICU停留时间，呼吸机依赖持续时间和死亡率，研究组在疾病严重程度方面具有可比性。仅在每位患者的危险因素数量方面发现显着差异。雷尼替丁治疗组每个患者有2.7危险因素，而奥美拉唑治疗组有1.9 (P <0.05)。11名患者 (31%) 接受雷尼替丁治疗，2名患者 (6%) 接受奥美拉唑治疗，出现临床上重要的出血 (P <0.05)。5例接受雷尼替丁治疗的患者 (14% 例) 和1例接受奥美拉唑治疗的患者 (3% 例) 发生院内肺炎 (P> 0.05)。我们得出的结论是，口服奥美拉唑对预防应激性溃疡是安全，有效且临床上可行的。

BACKGROUND & AIMS: AIM:Varicose veins of the legs are a common condition affecting 10-15% of men and 20-25% of women in the western world. This high prevalence is responsible of high medical and social costs. Most primary varices are associated with greater saphenous vein (GSV) incompetence. A new method, radiofrequency (RF) endovenous obliteration (VNUS-Closure'' procedure), recently has been described as a less invasive and cost-saving alternative to stripping for the treatment of refluxing GSV. METHODS:Twenty-four patients with varicose veins underwent endovenous obliteration of the above knee GSV by VNUS Closure'' procedure. The vein diameters were from 5 to 10 mm. The RF catheter was inserted via percutaneous puncture or through a small skin incision. All operations were performed in local, tumescent anesthesia, under ultrasound guidance. All patients were discharged 2 h after operation. Clinical and ultrasound follow-up was performed at 1 week, and at 1, 6, 12, 24 months. RESULTS:The complete or partial occlusion of the treated segment of the GSV has been achieved in 23 cases. In only one patient persisting patency of the GSV was immediately detected after the procedure. That was successfully treated by ultrasound guided foam sclerotherapy. All patients could resume all normal activities within 3-5 days. Every patient had reduction of varicosities, leg pain, fatigue and oedema. Adverse sequelae were minimal: 2 patients had transient thigh paresthesias. We didn't report deep venous thrombosis or pulmonary embolism (mean follow-up 26.7 months, range 15-33 months). CONCLUSION:A literature review and the authors'experience reveal that, in absence of significant complications, such as deep vein thrombosis and pulmonary embolism, there are significant advantages in the RF endovascular obliteration of the GSV. In effect, the Closure'' procedure, in selected patients, offers reduced postoperative pain, shorter sick leaves, faster return to normal activities compared with vein stripping, and it appears to be cost-saving for society. The mid-term (36 months) recurrence rates after RF obliteration seem to be similar to the results of the conventional surgical management.

背景与目标：

BACKGROUND & AIMS: :Marjolin's ulcer is the malignant transformation of a scar, usually as a squamous cell carcinoma. An uncommon presentation form is from a laparostomy scar. A 49-year-old patient that had a laparostomy during the treatment of a necrohemorrhagic pancreatitis in 1987 complained 13 years later of a 20-cm ulcer on the laparostomy scar. A resection of the abdominal wall including the ulcer and a segmental transverse colectomy were performed because of infiltration by an invasive squamous cell carcinoma. Ten months later, axillary lymphadenectomy was performed because of lymph node metastasis. Currently, the patient is free of disease. Lymph node infiltration is frequent in squamous cell carcinoma on Marjolin's ulcer and survival is not good. Prophylaxis of this disease includes meticulous care of wounds, with early skin grafts when required and treatment of infections.

背景与目标： : Marjolin溃疡是疤痕的恶性转化，通常是鳞状细胞癌。一种不常见的表现形式来自腹腔镜造口疤痕。一名49岁的患者在治疗坏死性出血性胰腺炎期间进行了剖腹造口术，1987年在13年后抱怨剖腹造口术疤痕上出现20厘米溃疡。由于浸润性鳞状细胞癌的浸润，进行了包括溃疡在内的腹壁切除术和节段性横向结肠切除术。10个月后，由于淋巴结转移，进行了腋窝淋巴结清扫术。目前，患者没有疾病。在Marjolin溃疡的鳞状细胞癌中，淋巴结浸润频繁，生存率不佳。这种疾病的预防包括伤口的精心护理，在需要时进行早期皮肤移植和治疗感染。

BACKGROUND & AIMS: :Omeprazole (OME) is a representative of proton pump inhibitors and widely used in anti-ulcer treatment. However, OME may cause some inevitable side effects and the long-term consequences of OME could increase the risk of diarrhea. Patchouli Alcohol (PA), the main extract of Pogostemonis Herba, have demonstrated benefits in treating gastric ulcer (GU) with low toxicity. The present study aimed to investigate the synergistically protective effects of OME and PA against ethanol-induced GU in rats to study the involvement of antioxidant and anti-inflammatory activities. Moreover, the anti-apoptosis, anti-oxidant and anti-inflammatory effects in H2O2-induced gastric epithelial cells (GES-1) and LPS-induced RAW264.7 cells were determined, as well as the modulation of signaling proteins. The results demonstrated that PA alone or combined with OME provided remarkable benefits by reducing ulcer areas, modulating oxidant stress and inflammatory factors and the therapeutic efficacy was showed to be dose-dependent, which were partly superior to that of high-dose OME only. Additionally, co-treated regimen could superiorly down-regulate cell apoptosis and regulate the levels of oxidant activities and inflammatory cytokines on H2O2-induced GES-1 cells and LPS-induced RAW264.7 cells, which involved with cleaved caspase 3, Bcl-2 and BAX protein expressions and MAPK pathway. We provided a new understanding that the combination of OME and PA possessed gastroprotective effects on modulating cell apoptosis, antioxidant stress and anti-inflammatory responses against GU. Therefore, PA was inferred to take a potential and critic role in gastric mucosa protection.

背景与目标： 奥美拉唑 (OME) 是质子泵抑制剂的代表，广泛用于抗溃疡治疗。然而，OME可能会导致一些不可避免的副作用，OME的长期后果可能会增加腹泻的风险。广藿香醇 (PA) 是草本药材的主要提取物，已证明在低毒性治疗胃溃疡 (GU) 方面具有益处。本研究旨在研究OME和PA对乙醇诱导的大鼠GU的协同保护作用，以研究抗氧化和抗炎活性的参与。此外，还确定了H2O2-induced胃上皮细胞 (GES-1) 和LPS诱导的RAW264.7细胞的抗凋亡，抗氧化和抗炎作用，以及信号蛋白的调节。结果表明，单独使用或与OME联合使用可通过减少溃疡面积，调节氧化应激和炎症因子而提供显着的益处，并且治疗效果显示为剂量依赖性，部分优于仅高剂量OME。此外，联合治疗方案可以进一步下调细胞凋亡，并调节H2O2-induced GES-1细胞和LPS诱导的RAW264.7细胞的氧化活性和炎性细胞因子水平，这与切割的caspase 3，Bcl-2和BAX蛋白表达以及MAPK途径有关。我们提供了一个新的认识，即OME和PA的组合对调节细胞凋亡，抗氧化应激和抗GU的抗炎反应具有胃保护作用。因此，可以推断PA在胃粘膜保护中具有潜在的批评作用。

BACKGROUND & AIMS: OBJECTIVES:To investigate the incidence, clinical significance, anatomical variation and physiology of non-saphenofemoral venous reflux (non-SF reflux) in the groin. DESIGN:Prospective study. MATERIALS:A total of 1072 vascular diagnostic workups in 680 patients with possible venous diseases to the legs were included. METHODS:Duplex scanning and air plethysmography. RESULTS:A total of 1022 legs had venous diseases. Of these, 101 (9.9%) had non-SF reflux in the groin. Such reflux occurred in recurrent varicose veins (RVV) in 16.3%, in primary varicose veins (PVV) in 6.1% and in deep venous thrombosis (DVT) in 8.0%. Two patterns of reflux were distinguished: epigastric reflux from lower abdominal wall veins (71 legs) and pudendal reflux from perineal and/or gluteal veins (30 legs). Pudendal reflux was almost exclusive to women and did not occur with DVT. If there was only non-SF reflux at the groin the venous filling indices (VFI) were close to normal (1.7+/-1.0 ml/s for RVV, 1.9+/-1.2 for PVV, 1.7+/-1.0 for DVT) and no active ulcers were observed. However, if non-SF reflux was associated with saphenofemoral or other reflux the VFIs (3.3+/-2.3 ml/s for RVV, 3.8+/-1.5 ml/s for PVV) were abnormal (p <0.05) and ulcers occurred in 11/32. CONCLUSION:Non-SF reflux in the groin is common. Such reflux may be missed at initial surgery and lead to recurrence of varicose veins. However, the venous physiological disturbance of such reflux is mild and it is not associated with ulcers unless combined with reflux at other sites in the leg.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:The venous clinical severity score (VCSS) and the Aberdeen varicose vein questionnaire (AVVQ) improve after treating chronic venous insufficiency (CVI). The aim was to examine how and why they improve by evaluating the change in each individual question. METHODS:This was an analysis on prospectively collected data from a clinical study on 100 patients (58% female) with CVI (C2 = 34, C3 = 14, C4a = 29, C4b = 9, C5 = 7, C6 = 7) who were randomized to endovenous laser ablation (n = 50) or foam sclerotherapy (n = 50). The change scores (performance) of each question of the VCSS (questions 1-10) and the AVVQ (questions 1-13) were calculated by subtracting the score at three weeks, and three months, from the pre-treatment score. RESULTS:Both the median, interquartile range (IQR), VCSS and the AVVQ scores improved from 6 (4) and 21.4 (15.1) at baseline to 3 (4) and 18.6 (12.1) at three weeks (P < 0.0005, P = 0.031) to 2 (3) and 8.8 (13.6) at three months, (P < 0.0005, P < 0.0005), respectively. The performance of the first three questions of the VCSS (pain, extent of varicosities, oedema) were the most contributory to the overall score. Questions 5, 7, 8, 9 on ulceration improved the most individually but did not contribute significantly to the overall score. Questions 5, 9 of the AVVQ on stocking use and ulceration failed to contribute statistically to the overall improvement at three months. CONCLUSION:The majority of the individual questions of the VCSS and AVVQ responded to change. However, the cause of a poor response was multifactorial with statistical dilution playing a significant role. Stratification of patients according to ulceration may allow better comparisons.

背景与目标：

BACKGROUND & AIMS: :Recurrent aphthous stomatitis (RAS), are common inflammatory lesions of the oral mucous, usually round or ovoid, circumscribed by erythematous haloes with a yellow-grey floor and mostly painful. The RAS has reached an incidence about 20% in general population, present on any aged group, especially adolescents and young adults. Etiopathogenesis of RAS is not entirely understood. Some factors involved include immune system anomalies, infections, nutritional deficiency, mucous traumatism, food or contact allergy, autoimmunity illness and cancer; together with psychiatric, genetic and environment agents. In this article, main clinical features, etiology related factors, differential diagnosis and initial study of patients consulting for RAS are presented.

背景与目标： : 复发性口疮性口炎 (RAS) 是口腔粘液常见的炎性病变，通常为圆形或卵形，周围有红斑晕，地板呈黄灰色，大部分疼痛。在一般人群中，RAS的发病率约为20%，存在于任何老年人群，尤其是青少年和年轻人中。RAS的病因尚不完全清楚。涉及的一些因素包括免疫系统异常，感染，营养不足，粘液创伤，食物或接触过敏，自身免疫性疾病和癌症; 以及精神病，遗传和环境因素。本文介绍了RAS患者的主要临床特征，病因相关因素，鉴别诊断疾病和初步研究。

BACKGROUND & AIMS: BACKGROUND:Short (or small) saphenous vein (SSV) varices occur as a result of an incompetent sapheno-popliteal junction, where the SSV joins the popliteal vein, resulting in reflux in the SSV; they account for about 15% of varicose veins. Untreated varicose veins may sometimes lead to ulceration of the leg, which is difficult to manage. Traditionally, treatment was restricted to surgery or conservative management. Since the 1990s, however, a number of minimally invasive techniques have been developed; these do not normally require a general anaesthetic, are day-case procedures with a quicker return to normal activities and avoid the risk of wound infection which may occur following surgery. Nerve injury remains a risk with thermal ablation, but in cases where it does occur, the injury tends to be transient. OBJECTIVES:To compare the effectiveness of endovenous laser ablation (EVLA), radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS) versus conventional surgery in the treatment of SSV varices. SEARCH METHODS:The Cochrane Vascular Information Specialist searched the Specialised Register (last searched 17 March 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2). We searched clinical trials databases for details of ongoing or unpublished studies. SELECTION CRITERIA:We considered all randomised controlled trials (RCTs) comparing EVLA, endovenous RFA or UGFS with conventional surgery in the treatment of SSV varices for inclusion. DATA COLLECTION AND ANALYSIS:We independently reviewed, assessed and selected trials that met the inclusion criteria; any disagreements were resolved by discussion. We extracted data and used the Cochrane's tool for assessing risk of bias. When the data permitted, we performed either fixed-effect meta-analyses with odds ratios (ORs) and 95% confidence intervals (CIs) or random-effects meta-analyses where there was moderate to significant heterogeneity. MAIN RESULTS:We identified three RCTs, all of which compared EVLA with surgery; one also compared UGFS with surgery. There were no trials comparing RFA with surgery. The EVLA versus surgery comparison included 311 participants: 185 received EVLA and 126 received surgery. In the UGFS comparison, each treatment group contained 21 people. For several outcomes in the EVLA comparison, only a single study provided relevant data; as a result, the current review is limited in its ability to demonstrate meaningful results for some planned outcomes. The quality of evidence according to GRADE was moderate to low for the outcome measures in the EVLA versus surgery comparison, but low for the UGFS versus surgery comparison. Reasons for downgrading in the EVLA versus surgery comparison were risk of bias (for some outcomes, the outcome assessors were not blinded; and in one study the EVLA-surgery allocation of 2:1 did not appear to be prespecified); imprecision (data were only available from a single small study and the CIs were relatively wide); indirectness (one trial reported results at six months rather than one year and was inadequately powered for SSV varices-only analysis). Reasons for downgrading in the UGFS versus surgery comparison were imprecision (only one trial offered UGFS and several participants were missing from the analysis) and a limitation in design (the study was inadequately powered for SSV participants alone).For the EVLA versus surgery comparison, recanalisation or persistence of reflux at six weeks occurred less frequently in the EVLA group than in the surgery group (OR 0.07, 95% CI 0.02 to 0.22; I2 = 51%; 289 participants, 3 studies, moderate-quality evidence). Recurrence of reflux at one year was also less frequent in the EVLA group than in the surgery group (OR 0.24, 95% CI 0.07 to 0.77; I2 = 0%; 119 participants, 2 studies, low-quality evidence). For the outcome clinical evidence of recurrence (i.e. presence of new visible varicose veins) at one year, there was no difference between the two treatment groups (OR 0.54, 95% CI 0.17 to 1.75; 99 participants, 1 study, low-quality evidence). Four participants each in the EVLA and surgery groups required reintervention due to technical failure (99 participants, 1 study, moderate-quality evidence). There was no difference between the two treatment groups for disease-specific quality of life (QoL) (Aberdeen Varicose Veins Questionnaire) either at six weeks (mean difference (MD) 0.15, 95% CI -1.65 to 1.95; I2 = 0%; 265 participants, 2 studies, moderate-quality evidence), or at one year (MD -1.08, 95% CI -3.39 to 1.23; 99 participants, 1 study, low-quality evidence). Main complications reported at six weeks were sural nerve injury, wound infection and deep venous thrombosis (DVT) (one DVT case in each treatment group; EVLA: 1/161, 0.6%; surgery 1/104, 1%; 265 participants, 2 studies, moderate-quality evidence).For the UGFS versus surgery comparison, there were insufficient data to detect clear differences between the two treatment groups for the two outcomes recanalisation or persistence of reflux at six weeks (OR 0.34, 95% CI 0.06 to 2.10; 33 participants, 1 study, low-quality evidence), and recurrence of reflux at one year (OR 1.19, 95% CI 0.29 to 4.92; 31 participants, 1 study, low-quality evidence). No other outcomes could be reported for this comparison because the study data were not stratified according to saphenous vein. AUTHORS' CONCLUSIONS:Moderate- to low-quality evidence exists to suggest that recanalisation or persistence of reflux at six weeks and recurrence of reflux at one year are less frequent when EVLA is performed, compared with conventional surgery. For the UGFS versus conventional surgery comparison, the quality of evidence is assessed to be low; consequently, the effectiveness of UGFS compared with conventional surgery in the treatment of SSV varices is uncertain. Further RCTs for all comparisons are required with longer follow-up (at least five years). In addition, measurement of outcomes such as recurrence of reflux, time taken to return to work, duration of procedure, pain, etc., and choice of time points during follow-up should be standardised such that future trials evaluating newer technologies can be compared efficiently.

背景与目标：

BACKGROUND & AIMS: AIM:This paper is a report of an evaluation of the effectiveness of a newly developed dressing for preventing persistent erythema and pressure ulcer development and improving the water-holding capacity without increasing the skin pH in bedridden older patients. BACKGROUND:Shear forces and skin dryness play important roles in persistent erythema and pressure ulcer development. To eliminate these risks, we developed a dressing to reduce shear forces and improve the water-holding capacity. However, the effects of this dressing in clinical settings remain unknown. METHOD:An experimental bilateral comparison study was conducted at a hospital in Japan in 2004 with 37 bedridden older patients at risk of pressure ulcer development. The dressing was randomly applied to the right or left greater trochanter for 3 weeks. No dressing was applied to the opposite side as a control. The skin was monitored weekly during the 3-week application for persistent erythema and pressure ulcer development. Skin hydration and pH were also assessed during the intervention and for 1 week after dressing removal. FINDINGS:The incidence of persistent erythema was significantly lower in the intervention area than the control area [P = 0.007, RR 0.18 (95% CI: 0.05-0.73) and NNT 4.11 (2.50-11.63) ]. No pressure ulcers occurred in either the intervention or control area. Skin hydration increased significantly during dressing application and remained high after removal (P < 0.001) relative to the control area. Skin pH decreased significantly during the application (P < 0.001) but returned to control levels after removal (P = 0.38). CONCLUSION:This safe and effective dressing can be used for patients with highly prominent bones and dry skin to prevent pressure ulcers.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:The rate of rebleeding from peptic ulcers could differ between Asian and Western populations. This study aimed to determine whether the observed twofold difference in rebleeding rates in two similarly designed clinical trials (one in Hong Kong [n = 240], the other in a predominantly Western population [n = 764, ClinicalTrials.gov identifier: NCT00251979]) can be explained by differences in baseline patient characteristics. METHODS:Two-factor and multifactor analyses (adjusted by demographics, established risk factors for peptic ulcer and peptic ulcer bleeding, and disease severity variables) were performed using pooled data from the two studies. Cox regression analysis was used to predict the rebleeding risk at 3 days. RESULTS:In the two-factor analysis (placebo vs esomeprazole/omeprazole and Western study vs Hong Kong study), data trended towards a reduced risk of rebleeding in the Western study (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.44-1.07, P = 0.094). The risk of rebleeding was similar in both studies after adjusted for multiple factors (HR 1.10, 95% CI 0.60-1.99, P = 0.767). The strongest predictor of rebleeding (apart from study drug) was a classification of American Society of Anesthesiologists (ASA) grade IV (HR 4.15, 95% CI 1.49-11.56, P = 0.006). When such patients were excluded, the difference in rebleeding rates between the studies reduced. CONCLUSION:The difference in rebleeding rates between the two studies is explained by the factors in our analysis, most importantly a classification of ASA grade IV, suggesting that other differences, including ethnicity, did not influence the rebleeding rate.

背景与目标：

BACKGROUND & AIMS: :To examine the correlations of miR-24 expression in peripheral plasma with the onset of diabetic foot ulcer (DFU) and diabetic foot osteomyelitis (DFO) in type 2 diabetes mellitus (T2DM) patients and explore the clinical value of miR-24 as a potential biomarker for the diagnosis and treatment outcomes of DFU and DFO, a total of 60 newly diagnosed T2DM patients without DFU (T2DM group), 112 T2DM patients with DFU (DFU group), and 60 healthy controls (NC group) were included. DFU group were further divided into DFO group (n = 64) and non-DFO group (n = 48). MiR-24 levels were determined by quantitative real-time PCR, while clinical features and risk factors of DFU and DFO were explored. The expression level of miR-24 in T2DM and DFU group was significantly lower than in NC group (P < .05), and that in DFU group was significantly lower than in T2DM group (P < .01). Additionally, the level of miR-24 significantly decreased in DFO group compared to non-DFO group (P < .01). Moreover, it was negatively correlated with the amputation rate in DFU group (P = .043) and positively correlated with healing rate after 8 weeks (P = .036). The multivariate logistic regression analysis confirmed that a low expression of miR-24 was an independent risk factor for DFU and DFO. The ROC curve analysis indicated that the AUC of miR-24 for the diagnosis of DFU and DFO was 0.849 (95% CI, 0.618-0.879, P < .001) and 0.782 (95% CI, 0.595-0.813, P < .001). Thus, a decreased expression of miR-24 of T2DM patients was closely related to the occurrence, development and prognosis of DFU and DFO, suggesting the use of miR-24 as a potential biomarker for the prediction of DFU and DFO.

背景与目标： 目的: 研究2型糖尿病 (T2DM) 患者外周血浆miR-24表达与糖尿病足溃疡 (DFU) 和糖尿病足骨髓炎 (DFO) 发病的相关性，探讨miR-24作为潜在生物标志物对DFU和DFO的诊断和治疗结果的临床价值。纳入60例无DFU的新诊断T2DM患者 (T2DM组) 、112例伴有DFU的T2DM患者 (DFU组) 和60例健康对照者 (NC组)。DFU组分为DFO组 (n = 64) 和非DFO组 (n = 48)。采用实时荧光定量PCR检测MiR-24水平，探讨DFU和DFO的临床特征及危险因素。T2DM组和DFU组miR-24表达水平显著低于NC组 (p  < .05)，DFU组表达水平显著低于T2DM组 (p  < .01)。此外，与非DFO组相比，DFO组的miR-24水平显著降低 (p  < .01)。DFU组与截肢率呈负相关 (P = .043)，与术后8周愈合率呈正相关 (P = .036)。多因素logistic回归分析证实，miR-24低表达是DFU和DFO的独立危险因素。ROC曲线分析表明，miR-24诊断DFU和DFO的AUC为0.849 (95% CI，0.618-0.879，p  < .001) 和0.782 (95% CI，0.595-0.813，p  < .001)。因此，T2DM患者miR-24表达下降与DFU和DFO的发生、发展及预后密切相关，提示miR-24作为预测DFU和DFO的潜在生物标志物。

BACKGROUND & AIMS: :This study was performed to determine the effects of zinc supplementation on wound healing and metabolic status in patients with diabetic foot ulcer. The current randomized, double-blind, placebo-controlled trial was conducted among 60 patients (aged 40-85 years old) with grade 3 diabetic foot ulcer. Participants were randomly divided into two groups (30 participants in each group) to take either 220 mg zinc sulfate supplements containing 50 mg elemental zinc or placebo daily for 12 weeks. After the 12-week intervention, compared with the placebo, zinc supplementation was associated with significant reductions in ulcer length (-1.5 ± 0.7 vs. -0.9 ± 1.2 cm, p = 0.02) and width (-1.4 ± 0.8 vs. -0.8 ± 1.0 cm, p = 0.02). In addition, changes in fasting plasma glucose (-40.5 ± 71.0 vs. -3.9 ± 48.5 mg/dl, p = 0.02), serum insulin concentration (-8.0 ± 15.4 vs. +1.1 ± 10.3 µIU/ml, p = 0.009), homeostasis model of assessment-estimated insulin resistance (-3.9 ± 7.1 vs. +0.8 ± 5.9, p = 0.007), the quantitative insulin sensitivity check index (+0.01 ± 0.03 vs. -0.002 ± 0.02, p = 0.04) and HbA1c (-0.5 ± 0.8 vs. -0.1 ± 0.5%, p = 0.01) in the supplemented group were significantly different from the changes in these indicators in the placebo group. Additionally, significant increases in serum HDL-cholesterol (+4.1 ± 4.3 vs. +1.1 ± 5.1 mg/dl, p = 0.01), plasma total antioxidant capacity (+91.7 ± 213.9 vs. -111.9 ± 188.7 mmol/L, p < 0.01) and total glutathione (+68.1 ± 140.8 vs. -35.0 ± 136.1 µmol/L, p = 0.006), and significant decreases in high sensitivity C-reactive protein (-20.4 ± 24.6 vs. -6.8 ± 21.3 µg/ml, p = 0.02) and plasma malondialdehyde concentrations (-0.6 ± 0.9 vs. -0.2 ± 0.7 µmol/L, p = 0.03) were seen following supplementation with zinc compared with the placebo. Zinc supplementation for 12 weeks among diabetic foot ulcer patients had beneficial effects on parameters of ulcer size and metabolic profiles.

背景与目标： : 本研究旨在确定补充锌对糖尿病足溃疡患者伤口愈合和代谢状态的影响。目前的随机，双盲，安慰剂对照试验是在60例3级糖尿病足溃疡患者 (年龄40-85岁) 中进行的。参与者被随机分为两组 (每组30名参与者)，每天服用含有50 mg元素锌的220 mg硫酸锌补充剂或安慰剂，持续12周。干预12周后，与安慰剂相比，补锌与溃疡长度的显着减少相关 (-1.5   ±   0.7 vs. -0.9   ±   1.2厘米，P   =   0.02) 和宽度 (-1.4   ±   0.8 vs. -0.8   ±   1.0厘米，p   =   0.02)。另外，空腹血糖 (-40.5   ±   71.0对-3.9   ±   48.5 mg/dl，p   =   0.02) 、血清胰岛素浓度 (-8.0   ±   15.4对 + 1.1   ±   10.3 µ iu/ml) 的变化，P   =   0.009)，评估胰岛素抵抗的稳态模型 (-3.9   ±   7.1 vs. + 0.8   ±   5.9，p   =   0.007)，定量胰岛素敏感性检查指标 (+ 0.01   ±   0.03 vs. -0.002   ±   0.02，P   =   0.04) 和HbA1c (-0.5   ±   0.8 vs. -0.1   ±   0.5%，p   =   0.01) 与安慰剂组这些指标的变化有显著差异。此外，血清HDL-胆固醇显著升高 (+ 4.1   ±   4.3 vs + 1.1   ±   5.1 mg/dl，p   =   0.01)，血浆总抗氧化能力 (+ 91.7   ±   213.9 vs. -111.9   ±   188.7 mmol/L，P  <  0.01) 和总谷胱甘肽 (+ 68.1   ±   140.8 vs. -35.0   ±   136.1 µ mol/L，p   =   0.006)，高敏C反应蛋白 (-20.4   ±   24.6对-6.8   ±   21.3 µ g/ml，p   =   0.02) 和血浆丙二醛浓度 (-0.6   ±   0.9对-0.2   ±   0.7 µ mol/L) 显著降低，与安慰剂相比，在补充锌后观察到p   =   0.03)。在糖尿病足溃疡患者中补充锌12周对溃疡大小和代谢特征参数有有益的影响。

BACKGROUND & AIMS: We prospectively examined 137 limbs in 112 consecutive patients with clinical evidence of severe varicosis by color coded duplex sonography and ascending venography (including varicography in 48 limbs) to evaluate the diagnostic capabilities of color coded duplex sonography in the assessment of venous anatomy, variant varicosis, postthrombotic changes, and incompetence of the superficial and perforating venous system. Additionally, descending venography was performed in the first 52 limbs and compared to color coded duplex sonography in the diagnosis of deep and superficial venous reflux. Variant venous anatomy (21 cases) was missed in two limbs and misinterpreted in one limb by ascending venography compared to surgery. Color coded duplex sonography was inconclusive in two cases. Variant varicosis (59 cases) was missed in seven surgically proved cases by venography and in one case by color coded duplex sonography. Color coded duplex sonography was inconclusive in five cases. Ascending venography was slightly superior to color coded duplex sonography in the detection of postphlebitic changes. Good agreement was found between color coded duplex sonography and descending venography in the grading of superficial (k = 0.75) and deep venous reflux (k = 0.79). Excellent agreement was found between ascending venography in the grading of long (k = 0.96) and short (k = 0.94) saphenous vein reflux. More incompetent perforating veins were detected by ascending venography, (and varicography) than by color coded duplex sonography, but the latter technique allows direct preoperative marking of the skin, which is beneficial for the surgeon. We conclude that color coded duplex sonography is a valuable imaging tool before venous stripping and is capable of replacing invasive ascending and descending venography. Only patients with inconclusive color coded duplex sonographic results (e.g., complex variant venous anatomy) should proceed to venography.

背景与目标： 我们通过彩色编码双工超声和上行静脉造影 (包括48条肢体的静脉曲张) 前瞻性检查了112例具有严重静脉曲张临床证据的连续患者的137个肢体，以评估彩色编码双工超声在评估静脉解剖，变异性静脉曲张，血栓后变化，以及浅表和穿孔静脉系统的无能。此外，在前52个肢体中进行了下行静脉造影，并将其与彩色编码的双工超声检查进行了比较，以诊断深静脉和浅静脉反流。与手术相比，两个肢体的静脉解剖变异 (21例) 被遗漏，而一个肢体的静脉造影被误解。在两种情况下，彩色编码的双工超声检查尚无定论。在7例经静脉造影手术证实的病例和1例经彩色编码的双工超声检查中，遗漏了变异性静脉曲张 (59例)。在五例中，彩色编码的双工超声检查尚无定论。在检测静脉曲张后变化方面，上升静脉造影略优于彩色双工超声检查。在浅表 (k = 0.75) 和深静脉反流 (k = 0.79) 的分级中，彩色编码的双工超声检查和下行静脉造影之间发现了良好的一致性。在长 (k = 0.96) 和短 (k = 0.94) 大隐静脉反流的分级中，在上升静脉造影之间发现了极好的一致性。与通过彩色编码的双工超声检查相比，通过上行静脉造影 (和静脉曲张造影) 检测到的不功能的穿孔静脉更多，但是后一种技术可以直接对皮肤进行术前标记，这对外科医生是有益的。我们得出的结论是，彩色编码的双工超声检查在静脉剥离之前是一种有价值的成像工具，并且能够替代侵入性的上升和下降静脉造影。只有具有不确定的彩色编码双工超声检查结果 (例如，复杂的静脉解剖结构) 的患者才应进行静脉造影。

BACKGROUND & AIMS: :The study was performed to examine whether indomethacin administered during the initial period of acetic acid-induced gastric ulcer healing affects future ulcer recurrence. Gastric ulcers were produced in rats by subserosal injection of acetic acid. Indomethacin (1 mg/kg/day, orally) administered either alone or concomitant with ornoprostil (50 micrograms/kg/day, orally) was started on the fourth day and continued for 56 days. In rats whose ulcer healed at the 90th day after production of ulcer, endoscopy was done every 30 days to examine recurrence of ulcer. Gastric specimens were obtained 10, 30, 60, 90, and 240 days after ulcer production for histology, to quantitate the height of regenerated mucosa, thickness of fibrous tissue, degree of polymorphonuclear cell infiltration, and PAS-positive cells. Cumulative ulcer recurrence rate was significantly higher in rats initially treated with indomethacin than in controls. Increased polymorphonuclear cell infiltration was the major histologic abnormality persisting after cessation of indomethacin. Ornoprostil reversed these abnormalities caused by indomethacin. In conclusion, the administration of indomethacin during the initial period of the ulcer healing promoted persistent polymorphonuclear cell infiltration and increased ulcer recurrence rates, possibly via a prostaglandin-dependent mechanism.

背景与目标： : 进行这项研究是为了检查在乙酸引起的胃溃疡愈合的初期服用消炎痛是否会影响未来的溃疡复发。通过浆膜下注射乙酸在大鼠中产生胃溃疡。从第4天开始单独或与ornoprostil (50微克/千克/天，口服) 联合给药吲哚美辛 (1 mg/kg/天，口服)，并持续56天。在溃疡产生后第90天溃疡愈合的大鼠中，每30天进行一次内窥镜检查以检查溃疡的复发。在溃疡产生后10、30、60、90和240天获得胃标本进行组织学检查，以定量再生粘膜的高度，纤维组织的厚度，多形核细胞浸润的程度和PAS阳性细胞。最初用吲哚美辛治疗的大鼠的累积溃疡复发率显着高于对照组。多形核细胞浸润增加是吲哚美辛停止后持续存在的主要组织学异常。Ornoprostil扭转了吲哚美辛引起的这些异常。总之，在溃疡愈合初期给予吲哚美辛可能通过前列腺素依赖性机制促进了持续性多形核细胞浸润并增加了溃疡复发率。