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Medical Management of Gestational Diabetes

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Open Journal of Obstetrics and Gynecology 2018年第4期8卷 400-407页

作者： Ayesha Anwar Kashif Ahmad Evdokia Karagianni Stephen Lindow north cumbria university hospitals NHS Trust Carlisle UK Sidra Medical and Research Center Weill Cornell Medical College in Qatar Doha Qatar

Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. The prevalence of GDM is on the rise due to increasing trends of obesity in females of child bearing age as well as due to increasing maternal age. Women at higher risk should be routinely screened of the condition and offered appropriate management in order to avoid fetal and maternal complications. GDM is associated with higher incidence of maternal and fetal complications during pregnancy and labour. There is a significant relationship between GDM and prediabetic states as well as high risk of developing type 2 diabetes mellitus. The aim of management is to keep glycaemic levels within specific targets to avoid adverse outcomes. Improved health related quality of life has been linked with treatment of gestational diabetes with active lifestyle, glucose monitoring and use of insulin. Historically, non pharmacological intervention and insulin have been the main approaches in management of GDM, though recently there is an emerging evidence of use of oral hypoglycemic agents. In this article we have reviewed the existing evidence and recommendations in management of GDM.

关键词： Gestational Diabetes Pregnancy Management

Evolution of transanal total mesorectal excision for rectal cancer:From top to bottom

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World Journal of Gastrointestinal Surgery 2018年第3期10卷 28-39页

作者： Sameh Hany Emile F Borja de Lacy Deborah Susan Keller Beatriz Martin-Perez Sadir Alrawi Antonio M Lacy Manish Chand Department of General Surgery Mansoura Faculty of Medicine Department of Surgery Hospital Clinic University of Barcelona GENIE Centre University College London Department of Surgery and Interventional Sciences University College London Hospitals NHS Trusts Department of Surgical Oncology Alzahra Cancer Center Al Zahra Hospital

The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are *** evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.

关键词： Rectal cancer Total mesorectal excision Transanal total mesorectal excision Transanal total mesorectal excision Sphincter sparing surgery Colorectal surgery

Biomechanical analysis of tension band wiring （TBW） of transverse fractures of patella

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Chinese Journal of Traumatology 2016年第5期19卷 255-258页

作者： Mohammed Ali Jan Kuiper Joby John Trauma and Orthopaedics North Cumbria NHS Trust UK The Robert Jones and Agnes Hunt Orthopaedics Hospital Oswestry UK university hospitals of Nottinghamshire UK

Purpose： Tension band wiring is commonly used for fixation of simple transverse fractures. The popular configuration is parallel Kirschner wires （K-wires） and a stainless steel wire loop placed in a vertically oriented figure-of-8. Methods： We used a wooden model of a patella with a midway transverse fracture and compared four different types of fixation. The first construct had a vertical figure-of-8 with one twist of wire. The second contained a vertical figure-of-8 with two twists of wire. The third was a vertical figure-of-8 with two twists of wire placed at adjacent corners while the last one had a horizontal figure-of-8 with two twists of wire placed at adjacent corners, lnterfragmentary compression at the point of wire breakage was measured for each construct as well as permanent displacement on cyclic loading. Results： Placement of the figure-of-eight in a horizontal orientation with two wire twists at the corner improved interfragmentary compression by 63% （p 〈 0.05, Tukey post ]hoc test）. On cyclic loading, all the constructs with vertical figure-of-eight but none with a horizontal construct failed （p = 0.01; Fisher＇s exact test）. Permanent fracture displacement after cyclic loading was ,57% lower with horizontal figure- of-eight constructs （p 〈 0.05; t test）. Conclusion： Placing wire twists at the corner and a horizontal placement of figure-of-8 improves stability of the construct.

关键词： Patella transverse fractures Tension band wiring Biomechanical analysis

婴儿期日间护理与儿童期急性淋巴细胞性白血病发病风险的研究:在英国开展的病例对照研究

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世界核心医学期刊文摘（儿科学分册） 2005年第11期1卷 6-6页

作者： Gilham C. Peto J. Simpson J. T.O.B. Eden 张振 Academic Unit of Paediatric Oncology Christie Hospital and Central Manchester Manchester Children's University Hospitals NHS Trusts Manchester M20 4BX United Kingdom

Objective: To test the hypothesis that reduced exposure to common infections in the first year of life increases the risk of developing acute lymphoblastic leukaemia. Design and setting: The United Kingdom childhood cancer study (UKCCS) is a large population based case-control study of childhood cancer across 10 regions of the UK Participants 6305 children (aged 2-14 years) without cancer; 3140 children with cancer (diagnosed 1991-6), of whom 1286 had acute lymphoblastic leukaemia (ALL). Main outcome measure: Day care and social activity during the first year of life were used as proxies for potential exposure to infection in infancy. Results: Increasing levels of social activity were associated with consistent reductions in risk of ALL; a dose-response trend was seen. When children whose mothers reported no regular activity outside the family were used as the reference group, odds ratios for increasing levels of activity were 0.73 (95%confidence interval 0.62 to 0.87) for any social activity, 0.62 (0.51 to 0.75) for regular day care outside the home, and 0.48 (0.37 to 0.62) for formal day care (attendance at facility with at least four children at least twice a week) (P value for trend < 0.001). Although not as striking, results for non-ALL malignancies showed a similar pattern (P value for trend < 0.001). When children with non-ALL malignancies were taken as the reference group, a significant protective effect for ALL was seen only for formal day care (odds ratio = 0.69, 0.51 to 0.93; P = 0.02). Similar results were obtained for B cell precursor common ALL and other subgroups, as well as for cases diagnosed above and below age 5 years. Conclusion: These results support the hypothesis that reduced exposure to infection in the first few months of life increases the risk of developing acute lymphoblastic leukaemia.

关键词：发病风险婴儿期病例对照研究儿童癌症儿童期癌症出生后潜在感染验证研究感染性疾病感染源

PRESSURE(减压支持表面)试验:成本效益分析

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世界核心医学期刊文摘（皮肤病学分册） 2006年第12期2卷 1-2页

作者： Iglesias C. Nixon J. Cranny G. N. Redd Cullum 朱国兴 Department of Health Sciences University of York York YO10 5DD United Kingdom Prof.

Objective: To assess the cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital. Design: Cost effectiveness analysis carried out alongside the pressure relieving support surfaces (PRESSURE) trial; a multicentre UK based pragmatic randomised controlled trial. Setting: 11 hospitals in six UK nhs trusts. Participants: Intention to treat population comprising 1971 participants. Main outcome measures: Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital. Results: Alternating pressure mattresses were associated with lower overall costs (￡283.6 per patient on average, 95%confidence interval -￡377.59 to ￡976.79) mainly due to reduced length of stay in hospital, and greater benefits (a delay in time to ulceration of 10.64 days on average, -24.40 to 3.09). The differences in health benefits and total costs for hospital stay between alternating pressure mattresses and alternating pressure overlays were not statistically significant; however, a cost effectiveness acceptability curve indicated that on average alternating pressure mattresses compared with alternating pressure overlays were associated with an 80%probability of being cost saving. Conclusion: Alternating pressure mattresses for the prevention of pressure ulcers are more likely to be cost effective and are more acceptable to patients than alternating pressure overlays.

关键词：气垫床垫压力性溃疡床罩床上用品 PRESSURE

气垫床垫与气垫床罩预防压力性溃疡的随机、对照试验:PRESSURE(减压支持表面)试验

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世界核心医学期刊文摘（皮肤病学分册） 2006年第12期2卷 48-页

作者： Nixon J. Cranny G. Iglesias C. N. Redd 朱国兴 Cullum Department of Health Sciences University of York York YO10 5DD United Kingdom Prof.

Objective: To compare whether differences exist between alternating pressure overlays and alternating pressure mattresses in the development of new pressure ulcers, healing of existing pressure ulcers, and patient acceptability. Design: Pragmatic, open, multicentre, randomized controlled trial. Setting: 11 hospitals in six nhs trusts. Participants: 1972 people admitted to hospital as acute or elective patients. Interventions: Participants were randomized to an alternating pressure mattress (n = 982) or an alternating pressure overlay (n = 990). Main outcome measures: The proportion of participants developing a new pressure ulcer of grade 2 or worse; time to development of new pressure ulcers; proportions of participants developing a new ulcer within 30 days; healing of existing pressure ulcers; and patient acceptability. Results: Intention to treat analysis found no difference in the proportions of participants developing a new pressure ulcer of grade 2 or worse (10.7%overlay patients, 10.3%mattress patients; difference 0.4%, 95%confidence interval -2.3%to 3.1%, P = 0.75). More overlay patients requested change owing to dissatisfaction (23.3%) than mattress patients (18.9%, P = 0.02). Conclusion: No difference was found between alternating pressure mattresses and alternating pressure overlays in the proportion of people who develop a pressure ulcer.

关键词：压力性溃疡床罩床上用品气垫 PRESSURE 床垫