Manifestations of Peripheral Autonomic Insufficiency in Patients Suffering from Acute Inflammatory Demyelinating Neuropathies

We tried to characterize the frequency and significance of manifestations of peripheral autonomic insufficiency (PAI) in clinical cases of acute inflammatory demyelinating neuropathies (AIDN). Forty patients with the above diagnosis (21 men and 19 women, 16 to 72 years old) were examined. To detect symptoms attributable to PAI, we used Birkmayer–Vein tables; these data were compared with the results of electroneuromyographic (ENMG) examinations. In 38 and 2 cases, clinical manifestations of AIDN corresponded to the Guillain–Barre and Miller–Fisher syndromes, respectively. According to ENMG data, changes in the peripheral nerves and neuromuscular junctions corresponded to axonopathy, myelinopathy, and a mixed damage (myelinoaxonopathy) in 18 (45%), 14 (35%), and 8 (20%) patients, respectively. The following disturbances in the sphere of autonomic control were observed: orthostatic hypotension, in 28 cases (70%); tachycardia in the resting state, in 24 cases (60%); hypertension in the reclining position, in 16 cases (40%); hypohydrosis of the skin on the limbs, in 18 cases (45%); dyspepsia, in 8 cases (20%), and enuresis, in 3 cases (7.5%). Manifestations of PAI began to be observed in the earliest stage of the disease and were preserved within the period of recovery of the motor functions; they were more intensive in the cases of a severe clinical course of polyneuropathies. The severity of autonomic disorders strictly correlated with the level of axonal degeneration (characterized according to the ENMG data). The treatment used (i.v. injections of immunoglobulin, plasmapheresis, use of vasoactive and neurometabolic drugs) not only improved the state of the motor sphere but also decreased the intensity of PAI symptoms. Thus, in the cases of AIDN not only thick myelinated fibers of the peripheral nerves but also a significant proportion of thin fibers responsible for the control of automatic functions are subjected to damage. PAI is rather frequently observed in patients suffering from AIDN, and the level of its manifestation reflects the severity of the disease and intensity of damage to the peripheral nerves.     

Current treatment options for penile fractures

The diagnosis of "penile fracture" describes the traumatic rupture of the tunica albuginea of an erect penis. Penile fractures typically occur when the engorged penile corpora are forced to buckle and literally "pop" under the pressure of a blunt sexual trauma. Patients typically describe immediate detumescence, severe pain, and swelling as a result of the injury. Prompt surgical exploration and corporal repair is the most efficacious therapy. Although a majority of cases can be diagnosed from the history and physical examination alone, radiographic studies, including retrograde urethrography and corporal cavernosography can aid in the diagnosis of unusual cases.     

Current therapeutic options for gastric adenocarcinoma

Gastric cancer inflicts significant health issues globally despite its declining incidence. The disease is known to be diagnosed at its advanced stages also corresponding with a poor prognosis for patients. The integral therapeutic choices to cure advanced gastric cancer have progressed swiftly in modern days. The preface of molecularly targeted therapeutic techniques would potentiate the personalized approach depending on patient-specific and tumor-specific features, exasperating the advantages of chemotherapy. Here we have reviewed the modern therapeutics such as immune therapy, chemotherapy, m-RNA based therapeutics, alongside evaluating the influence of age, sex and comorbidities-like factors on the occurrence of gastric cancer. Gastric cancer therapy consolidated target agents comprising inhibitors of programmed death-1(PD-1), human epidermal growth factor receptor 2 (HER2), mRNA, and epidermal growth factor receptor (EPGF). A combination of trastuzumab to platinum-mediated chemotherapy evolved has a typical front-line therapy in advanced gastric cancer. An attempt has been made to epitomize the contemporary-modern research on targeted therapy for advanced gastric cancer.     

Treatment options for extended-spectrum beta-lactamase-producers

A review of antibiotic options for the treatment of infections caused by extended-spectrum beta-lactamase-producing isolates is presented. The use of the third-generation cephalosporin, cefotaxime, for infections caused by isolates producing ceftazidimase-type extended-spectrum beta-lactamases is controversial, despite in vitro susceptibility to the antibiotic in many instances. The fourth-generation cephalosporin, cefipime, although active against most extended-spectrum beta-lactamases, is reported to show a marked inoculum effect. The cephamycins, such as cefoxitin. are generally effective against Enterobacteriaceae producing TEM- and SHV-derived extended-spectrum beta-lactamases, but Klebsella pneumoniae strains are prone to cephamycin resistance as a result of porin loss. The use of beta-lactamase inhibitor combinations is variable. Sulbactam is less effective than clavulanate for the inhibition of SHV-derived extended-spectrum beta-lactamases and a marked inoculum effect has been noted, while the efficacy of tazobactam against SHV-derived extended-spectrum beta-lactamase producers is controversial. Furthermore, extended-spectrum beta-lactamases are often encoded by multi-resistant plasmids carrying genes conferring resistance to aminoglycosides, chloramphenicol, sulfonamides, trimethoprim and other antimicrobials, severely limiting even alternative therapies. Extensive susceptibility testing before the institution of antibiotic therapy is thus vital.     

Glycemic Control and Radiographic Manifestations of Tuberculosis in Diabetic Patients

Background

Radiographic manifestations of pulmonary tuberculosis (TB) in patients with diabetes mellitus (DM) have previously been reported, with inconsistent results. We conducted a study to investigate whether glycemic control has an impact on radiographic manifestations of pulmonary TB.

Methods

Consecutive patients with culture-positive pulmonary TB who had DM in three tertiary care hospitals from 2005–2010 were selected for review and compared with a similar number without DM. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C). A pre-treatment chest radiograph was read independently by two qualified pulmonologists blinded to patients’ diabetic status. Films with any discordant reading were read by a third reader.

Results

1209 culture positive pulmonary TB patients (581 with DM and 628 without DM) were enrolled. Compared with those without DM, TB patients with DM were significantly more likely to have opacity over lower lung fields, extensive parenchymal lesions, any cavity, multiple cavities and large cavities (>3 cm). The relative risk of lower lung field opacities was 0.80 (95% CI 0.46–1.42) for those with DM with A1C<7%, 2.32 (95% CI 1.36 - 3.98) for A1C 7%–9%, and 1.62 (95% CI 1.12–2.36) for A1C>9%; and that of any cavity over no cavity was 0.87 (95% CI 0.46–1.62) for patients with DM with A1C<7%, 1.84 (95% CI 1.20–2.84) for A1C 7%–9%, and 3.71 (95% CI 2.64–5.22) for A1C>9%, relative to patients without DM.

Conclusions

Glycemic control significantly influenced radiographic manifestations of pulmonary TB in patients with DM.     

Treatment options for stress urinary incontinence

Treatment options for stress urinary incontinence (SUI) in women are designed to prevent the involuntary loss of urine from the urethra during increases in intraabdominal pressure that occur during physical activity, coughing, or sneezing. Effective nonsurgical therapies include behavioral therapy (eg, bladder training, fluid and dietary modification) and drug therapy. Surgical therapy for this condition has existed for well over 100 years. Currently, approximately 200 different surgical procedures have been described. Because of the physiologic risks inherent in surgical procedures, the cost of hospitalization, and the loss of productivity during convalescence, surgeons continue to modify their techniques to improve efficacy, safety, and cost-effectiveness, and to minimize invasiveness. No single procedure or intervention is optimal for all patients. Having a variety of treatment options offers the possibility of tailoring therapy to the desires and needs of the individual patient. The key to an optimal therapeutic outcome is an accurate diagnosis combined with the selection of an appropriate intervention that is acceptable to the patient after balancing multiple factors.     

Treatment options for hormone-refractory prostate cancer

Hormone-refractory prostate cancer is a disease that includes a variety of patients and represents a treatment dilemma for the practicing physician. Because of the diversity of this group, management strategies must be targeted to the clinical situations of the individual patients and their wishes. This article outlines a logical progression of treatment choices that currently exist in this rapidly evolving field, and the landmark chemotherapy trials involving docetaxel (SWOG 9916 and TAX 327) are reviewed. Although significant progress has been made in understanding and treating hormone-refractory prostate cancer, current treatments do not yet provide a cure, and important clinical trials continue to recruit patients.     

Current pharmacologic options for patients with Alzheimer's disease

BACKGROUND: The aim of the current study was to provide general practitioners with an overview of the available treatment options for Alzheimer's disease (AD). Since general practitioners provide the majority of medical care for AD patients, they should be well versed in treatment options that can improve function and slow the progression of symptoms. DESIGN: Biomedical literature related to acetylcholinesterase inhibitors (AChEIs) was surveyed. In the United States, there are four AChEIs approved for the treatment of AD: tacrine, donepezil, rivastigmine, and galantamine. There are other agents under investigation, but at present, AChEIs are the only approved drug category for AD treatment. MEASUREMENTS AND MAIN RESULTS: AD is becoming a major public health concern and underdiagnosis is a significant problem (with only about half of AD patients being diagnosed and only half of those diagnosed actually being treated). Clinical trials have demonstrated that patients with AD who do not receive active treatment decline at more rapid rates than those who do. CONCLUSIONS: Given that untreated AD patients show decline in three major areas (cognition, behavior, and functional ability), if drug treatment is able to improve performance, maintain baseline performance over the long term, or allow for a slower rate of decline in performance, each of these outcomes should be viewed a treatment success.     

前列地尔联合丹红注射液治疗糖尿病周围神经病变的疗效分析

目的：探讨前列地尔联合丹红注射液治疗糖尿病周围神经病变的效果,为治疗糖尿病周围神经病变提供临床依据。方法：采用回顾性调查的方法,选取我院2011年1月-2012年12月收治的糖尿病周围神经病变150例,分为前列地尔联合丹红注射液组（联合治疗组）,前列地尔组和丹红组,每组各50例。结果：联合治疗组总有效率为94．00％（47／50）,高于丹红组86．00％（43／50）和前列地尔组88．00％（44／50）（P〈0．05）;联合治疗组显效率为68．00％（34／50）,高于丹红组60．00％（30／50）和前列地尔组60．00％（30／50）;联合治疗组无效率为9．00％（3／50）,低于丹红组14．00％（7／50）和前列地尔组12．00％（6／50）（P〈0．05）;三组治疗后正中神经和腓总神经MNCV和SNCV均高于治疗前,差异有统计学意义（P〈0．05）;联合治疗组治疗后均高于丹红组和前列地尔组治疗后,差异有统计学意义（P〈0．05）。结论：前列地尔联合丹红注射液可有效提高正中神经和腓总神经MNCV和SNCV,对改善糖尿病周围神经病变效果较好。     

多重耐药和广泛耐药鲍曼不动杆菌感染治疗的药物选择

鲍曼不动杆菌是医院内感染的重要病原体,其基于内在性和获得性的耐药机制,导致全球抗感染领域面临巨大挑战。目前,针对多重耐药和广泛耐药鲍曼不动杆菌引起的感染尚无有效治疗方案,本文对其可选用的治疗药物及最新进展进行综述。     

Current options for cereal improvement: Double haploids,mutants and heterosis

Book reviews

Current options for cereal improvement: Double haploids, mutants and heterosisM. Maluszynski (Ed.), (Advances in Agricultural Biotechnology, Seris 24). Dordrecht: Kluwer Academic Publishers, Guelph, Canada Proceedings of the first FAO/IAEA research co-ordination meeting on the use of induced mutations in connection with haploids and heterosis in creals, 8–12 December 1986, 19. vii + 214 pages. £32.50 ISBN 0-7923-0064-5     

Long-Term Low Carbohydrate Diet Leads to Deleterious Metabolic Manifestations in Diabetic Mice

We investigated long-term effects of low carbohydrate diets on wild type mice, streptozotocin-injected and KKAy obese diabetic mice. These mice were pair-fed three different types of diets, standard chow (SC, C∶P∶F = 63∶15∶22), a low carbohydrate (LC, C∶P∶F = 38∶25∶37) diet and a severely carbohydrate restricted (SR, C∶P∶F = 18∶45∶37) diet for 16 weeks. Despite comparable body weights and serum lipid profiles, wild type and diabetic mice fed the low carbohydrate diets exhibited lower insulin sensitivity and this reduction was dependent on the amount of carbohydrate in the diet. When serum fatty acid compositions were investigated, monounsaturation capacity, i.e. C16:1/C16:0 and C18:1/C18:0, was impaired in all murine models fed the low carbohydrate diets, consistent with the decreased expression of hepatic stearoyl-CoA desaturase-1 (SCD1). Interestingly, both the hepatic expressions and serum levels of fibroblast growth factor 21 (FGF21), which might be related to longevity, were markedly decreased in both wild type and KKAy mice fed the SR diet. Taking into consideration that fat compositions did not differ between the LC and SR diets, we conclude that low carbohydrate diets have deleterious metabolic effects in both wild type and diabetic mice, which may explain the association between diets relatively low in carbohydrate and the elevated risk of cardiovascular events observed in clinical studies.