Association between the risk of tuberculosis outbreak in schools and the visit interval of index cases / 中国学校卫生

Objective@#To analyze the relationship between the risk of tuberculosis outbreaks in schools and the visit interval of index cases, so as to provide a scientific reference for predicting the risks of tuberculosis outbreak and making preventive measures.@*Methods@#A total of 630 index cases from school tuberculosis outbreaks were studied during January, 2015 to December, 2022. Data on demographics, consultation history, etiological diagnosis, and methods of detection were collected. Restricted Cubic Splines (RCS), unconditional Logistic regression, and the receiver operating characteristic curve (ROC curve) were used for analysis.@*Results@#The RCS fitted curve showed that the risk of a tuberculosis outbreak linearly increased when the consultation interval for etiologically negative patients exceeded 5.79 days, or for etiologically positive patients exceeded 8.37 days. After multi factor adjustment, for every additional day in the visit interval of the index case, the odds ratio ( OR ) value for a high risk outbreak was 1.10 (95% CI =1.07-1.13)( P <0.05). When analyzed by tertiles of visit intervals, compared to an interval of <14 days, the OR values (95% CI ) for high risk outbreaks in schools with intervals of 14-<28 days and ≥28 days were 10.32(3.04-35.10) and 82.58( 28.42 -239.95), respectively( P <0.01), indicating a trend of increasing outbreak risk with longer visit intervals. Based on the ROC curve analysis, the optimal threshold for predicting a high risk school tuberculosis outbreak was 23.5 days, with an area under the curve ( AUC ) of 0.93 (95% CI =0.89-0.98).@*Conclusion@#An extended visit interval of index cases is a good early warning indicator for high risk tuberculosis outbreaks in schools and could be considered a key factor in early intervention and risk control strategies.

Bone protective effect of sinomenine against monosodium iodoacetate induced knee and hip injury in rat model: an inflammatory pathway

Purpose: Osteoarthritis (OA) is a degenerative joint disease which is categorized via destruction of joint cartilage and it also affects the various joints, especially knees and hips. Sinomenine active phytoconstituents isolated from the stem of Sinomenium acutum and already proof anti-inflammatory effect against the arthritis model of rodent. In this experimental protocol, we scrutinized the anti-osteoarthritis effect of sinomenine against monosodium iodoacetate (MIA) induced OA in rats. Methods: MIA (3 mg/50 µL) was used for inducing the OA in the rats, and rats received the oral administration of sinomenine (2.5, 5 and 7.5 mg/kg body weight) up to the end of the experimental study (four weeks). The body and organs weight were estimated. Aggrecan, C-terminal cross-linked telopeptide of type II collagen (CTX-II), glycosaminoglycans (GCGs), monocyte chemoattractant protein-1 (MCP-1), Interferon gamma (IFN-γ), antioxidant, inflammatory cytokines, inflammatory mediators and matrix metalloproteinases (MMP) were analyzed. Results: Sinomenine significantly (P < 0.001) boosted the body weight and reduced the heart weight, but the weight of spleen and kidney remain unchanged. Sinomenine significantly (P < 0.001) reduced the level of nitric oxide, MCP-1 and improved the level of aggrecan, IFN-γ and GCGs. Sinomenine remarkably upregulated the level of glutathione, superoxide dismutase and suppressed the level of malonaldehyde. It effectually modulated the level of inflammatory cytokines and inflammatory mediators and significantly (P < 0.001) reduced the level of MMPs, like MMP-1, 2, 3, 9 and 13. Conclusions: Sinomenine is a beneficial active agent for the treatment of OA disease.

Maxent modeling for predicting the global potential distribution of talaromycosis marneffei / 中国热带医学

@#Abstract: Objective　To predict the potential distribution of talaromycosis marneffei (TSM) and analyze its driving factors, so as to provide evidence for the surveillance and prevention of this disease. Methods　The data of all laboratory-confirmed, non-duplicating TSM published in the English and Chinese literature from the first case in January 1964 to December 2018 was collected. A Maxent ecology model using environmental variables, Rhizomys distribution and HIV/AIDS epidemic was developed to forecast ecological niche of TSM worldwide, as well as identify the driving factors. Results　A total of 705 articles (477 in Chinese and 228 in English) were obtained during the study period. After excluding imported cases, a total of 100 foci information were included in the model. The area under the receiver operating characteristic (ROC) curve (AUC) of the model was 0.997 for the training set and 0.991 for the test set. Maxent model revealed that Rhizomys distribution, mean temperature of warmest quarter, precipitation of wettest month, HIV/AIDS epidemic and mean temperature of driest quarter were the top 5 important variables affecting TSM distribution. In addition to identifying traditional TSM endemic areas (South of the Yangtze River in China, Southeast Asian, North and Northeast India), other potential endemic areas were also identified, including parts of the North of the Yangtze River, Central America, West Coast of Africa, East Coast of South America, the Korean Peninsula and Japan. Conclusion　Our finding has discovered hidden high-risk areas and provided insights about driving factors of TSM distribution, which will help inform surveillance strategies and improve the effectiveness of public health interventions against TM infections.

SWOT analysis of HIV control strategy in key areas of Zhejiang Province / 预防医学

Objective @#To analyze the problems in the AIDS control strategy in key areas of Zhejiang Province, so as to provide insights into the improvement of the control strategy.@*Methods @#The AIDS control data were collected from 10 key counties (districts) in Zhejiang Province, and the AIDS control strategy was comprehensively evaluated using a SWOT analysis.@*Results @#The strengths of the AIDS control strategy in key counties (districts) of Zhejiang Province included distinct working objectives, well-organized leadership, and effective control measures, the weaknesses included large number of HIV-infected cases, high burden of disease, difficulty in management of AIDS transmission and insufficient AIDS control capability, and the opportunities included the AIDS control in key counties (districts) conforming to the current status of AIDS control, strong support of innovative strategies and technical support from professional teams, while the threats included insufficient working mechanisms for AIDS control, the gap between the effectiveness of AIDS control and the target goal and unverified scientific evidence of the control strategy. Supported policies should be fully used, working mechanisms need to be improved, control strategies need to be innovated, and assessments need to be implemented for AIDS control in key counties (districts). @*Conclusions @#There are both opportunities and challenges for AIDS control in key counties (districts) of Zhejiang Province. Optimization of the working mechanisms, promotion of precision interventions, and search for repeatable control strategy in other disease-affected regions are required for AIDS control.

Delay in student pulmonary tuberculosis case finding and associated factors in Suzhou during 2011 to 2020 / 中国学校卫生

Objective@#To analyze delay in student pulmonary tuberculosis(PTB) case finding and associated factors in Suzhou, and to provide a reference for tuberculosis outbreak prevention and control in schools.@*Methods@#A total of 1 148 students with PTB who registered and were treated in Suzhou from 2011 to 2020 were included. Kruskal Wallis H test, 2 test and Cochran Armitage trend test were used to analyze the time trend of case finding delay. Logistic regression was used to analyze the correlation between admission characteristics and case finding delay.@*Results@#Among the students with PTB, a total of 569 cases were found to be delayed. The rate of delay was 49.6%, and the median delay time was 26(11-49) days. From 2011 to 2020, the difference in case finding interval of students with PTB was statistically significant( Hc=54.62, P <0.05), and the difference in case finding rate was also statistically significant( χ 2=53.69, P <0.05). The rate of delay fluctuated, with an overall upward trend over time( Z=-3.67, P < 0.05). Clinical consultation( OR=5.57, 95%CI =1.91-16.27), positive etiology ( OR=1.46, 95%CI =1.14-1.86) were positively correlated with case finding delay(all P <0.05).@*Conclusion@#There are significant delays in case finding among students with PTB in Suzhou. Clinical consultation and positive etiology are associated with case finding delay. In response to the growing problems in daily school tuberculosis prevention and control, multiple departments should cooperate to implement relevant measures and to reduce the occurrence of case finding delay.

Assessment on the third round of Zhejiang Comprehensive AIDS Response program / 预防医学

Objective@#To evaluate the third round of Zhejiang Comprehensive AIDS Response (CARES) program (nine national areas and three provincial areas) and the control effect of AIDS, so as to provide reference for AIDS prevention and control. @*Methods@#According to the final assessment protocol of the third round of China CARES, the data of 23 assessment items which were collected from online database and field investigation for 12 response areas of Zhejiang in 2014 and 2018 were evaluated. The endemic situation and detection of AIDS in CARES areas was compared with those in non-CARES areas, in order to evaluate the achievement of Zhejiang CARES areas.@*Results@#The rates of reaching the standard ranged from 91.30% to 100.00% in 12 CARES areas. Six indexes in leadership and innovation, fifteen (seventeen in total) indexes in HIV/AIDS control and prevention reached the standard. The items that failed included the awareness rates of AIDS and indicators in “prevention and intervention”. The rates of of reaching the standard in “publicity and education”, “monitoring and testing”, “prevention and intervention”, and “treatment and follow-up” increased from 55.56%, 79.17%, 79.76% and 65.00% in 2014 to 91.67%, 100.00%, 90.48% and 100.00% in 2018, respectively. The proportion of HIV testing people in permanent residents was 30.94% in CARES areas in 2018, which was significantly higher than 20.70% in non-CARES areas (P<0.05). The proportion of new reported HIV/AIDS in CARES areas was 50.87%, and the average increase was 4.48%, which was lower than 9.95% in non-CARES areas.@*Conclusion@#The third round of Zhejiang CARES program has remarkable achievement and plays a positive role in the prevention and control of AIDS.

Characteristics and influencing factors of the newly diagnosed cases locally infected with HIV through sexual contact in Jinhua / 预防医学

Objective@#To analyze the characteristics and influencing factors of the newly diagnosed cases locally infected with HIV through sexual contact in Jinhua,so as to provide reference for AIDS prevention and control.@*Methods@#An epidemiological survey was conducted among the HIV/AIDS cases diagnosed in 2017 in Jinhua to collect the information about demographic characteristics,local infection and sexual behaviors. The logistic regression model was used to analyze the related factors for local HIV infection. @*Results@#A total of 438 HIV/AIDS cases infected through sexual contact were recruited,with 272（62.10%）cases infected in Jinhua. The proportion of local infection was 86.67%,79.47%,63.04%,69.09%,77.46% and 77.97%,respectively,among those people aged 60 years or over,permanent residents in Jinhua,employees / students,farmers,those who had lived in Jinhua for more than five years,and those who had a HIV testing in one year. The Results of the multivariate logistic regression analysis showed that heterosexual transmission cases who were permanent residents in Jinhua（OR=3.437,95%CI：1.250-9.451）,who had lived in Jinhua for more than five years（OR=3.609,95%CI：1.403-9.284）,who had commercial heterosexual behaviors in Jinhua（OR=5.463,95%CI：2.529-11.803）were more likely to be infected with HIV in Jinhua;homosexual transmission cases who were permanent residents in Jinhua（OR=4.812,95%CI：1.744-13.275）and who had non-commercial,temporary homosexual behaviors in Jinhua（OR=10.641,95%CI：4.369-25.916）were more likely to be infected with HIV in Jinhua. @* Conclusion@#Among the HIV/AIDS cases diagnosed in 2017 infected through sexual contact in Jinhua,having permanent residence,long-term residence,commercial heterosexual behaviors and non-commercial,temporary homosexual behaviors were risk factors for local infection.

Epidemiological characteristics of newly diagnosed HIV/AIDS cases aged50 years or over in Zhejiang Province from 2015 to 2019 / 预防医学

Objective@#To analyze the epidemiological characteristics of newly diagnosed HIV/AIDS cases aged 50 years or over in Zhejiang Province from 2015 to 2019, so as to provide reference for the development of prevention and control strategies.@*Methods @#The data of newly diagnosed HIV/AIDS cases in Zhejiang Province were collected through the China HIV/AIDS Comprehensive Response Information Management System, and the demographic characteristics, infection routes,regional distribution and time distribution of the cases were analyzed. @*Results@#A total of 6 726 HIV/AIDS patients were recruited in this study, and the number of new patients from 2015 to 2019 showed an increasing trend ( P <0.05 ) . The number of participants diagnosed at the age of 50-59, 60-69 and 70-91 years old were 3 433( 51.04% ), 2 242 ( 33.33% ) and 1 051 ( 15.63% ). The majority of them were males ( 5 180, 77.01% ) , married ( 4 286, 63.72% ) , Zhejiang residents ( 5 304, 78.86% ) , and lived in rural areas ( 4 095, 60.88% ) . In terms of exposure history,6 586 cases ( 97.92% ) were infected by sexual contact. Among the 5 083 males infected by sexual contact, 82.63% were through heterosexual contact, 94.79% had extramarital sex partners, among whom 76.61% were commercial sex partners. The married women patients who confirmed HIV positive accounted for 75.44%. There were increasing trends in the proportion of the cases living in rural areas, male cases infected through heterosexual contact and those with extramarital and commercial sex partners, and female cases with their husbands positive along with age ( P <0.05 ) . @*Conclusions@#The number of newly diagnosed HIV/AIDS cases aged ≥50 years is increasing in Zhejiang Province. Many of them live in rural areas. Commercial sexual contact is the main route of HIV transmission among males and further lead to HIV transmission within couples.

PPD results after 3-6 years of BCG vaccination and its effect on latent tuberculosis infection in children / 中国学校卫生

Objective@#To understand the results of tuberculin skin test (PPD) in preschool children after the vaccination of BCG, and to analyze the effect of BCG vaccination on latent tuberculosis infection in children.@*Methods@#From January to November 2018, a total of 1 359 preschool children from 14 kindergartens in 8 districts and cities of Jiangsu Province were selected for tuberculin test(PPD), and chest X-ray examination was performed on children with strong PPD results.@*Results@#The positive rate of PPD in preschool children in Jiangsu Province was 23.33%, of which strong positive and moderate positive (PPD≥10 mm) were totaled 6.47%. There were 149 boys (21.29%) with PPD positive reactions and 168 girls(25.50%) with PPD positive reactions, and differences of PPD positive reactions with different genders were of no statistical significance (χ2=3.36, P>0.05) And there were 201 children (25.35%) with PPD positive reactions in northern Jiangsu, 116 children (20.50%) with PPD positive reactions in southern Jiangsu. There were significant differences in the results of PPD positive and negative reactions between different regions(χ2=4.35, P<0.05). There was 1 case of PPD positive reactions among 3-year-old children(0.71%), 19 cases among 4-year-old children(3.89%), 31 cases among 5-year-old children(8.96%), and 37 cases among 6-year-old children(9.63%), and the differences of PPD positive reactions of different age groups were of statistical significance(χ2=21.69, P<0.01).@*Conclusion@#The positive rate of PPD in preschool children in Jiangsu Province is very low, indicating that PPD can be used as a detection method for latent infection in children. The overall positive rate of PPD in preschool children in Jiangsu Province is also low, and appropriate measures should be taken to protect susceptible children and effectively prevent and control childhood tuberculosis.

Effect on pedicle screw stability of polymethylmethacrylate volume and distribution in synthetic bone block for patients with osteoporosis / 解放军医学杂志

Objective To compare the stability of injectable pedicle screw with different lateral holes augmented with different volume of polymethylmethacrylate (PMMA) in synthetic bone block used for patients with osteoporosis,and analyze the relationship between screw stability and injected volume and distribution pattern of PMMA.Methods The synthetic bone blocks used for patients with osteoporosis were randomly divided into groups A,B,C and D according to the screw difference,and the blocks in each group were then randomly divided again into subgroups 0,1,2 and 3 according to the difference of PMMA volume.A pilot hole was prepared in advance using the same method in all samples.Pedicle screws of type A-C were directly inserted into vertebrae of groups A-C respectively,and then different volumes of PMMA (0,1.0,1.5 and 2.0ml) were injected through screw into the blocks of subgroups 0,1,2 and 3 respectively.The pilot hole was filled with different volumes of PMMA (0,1.0,1.5 and 2.0ml) followed by insertion of screw in groups D0,D1,D2 and D3 respectively.X-ray examination was performed to evaluate the screw position and PMMA distribution,and axial pull-out test was performed to measure the maximum axial pullout strength (Fmax).Results X-ray examination revealed that PMMA wrapt the anterior 1/3 part of screw in groups A1-A3,wrapt the middle 1/3 part of screw in groups B1-B3 and groups C1-C3,and evenly wrapt the full length of screw in groups D1-D3.Two factor ANOVA showed that both volume and distribution of PMMA significantly influenced Fmax (P＜0.05),but no marked interaction existed between the two factors (P=0.877).Among groups with the same screw,no significant difference of Fmax was found between the groups injected of 1.0ml and 1.5ml PMMA and those of 1.5ml and 2.0ml PMMA (P＞0.05),but the Fmax was significantly higher in groups with injection of 2.0ml PMMA than that in groups with injection of 1.0ml PMMA (P＜0.05).Among the groups injected with same volume of PMMA,no significant differences on Fmax were found among the groups A0-D0,A2-D2 and A3-D3 (P＞0.05).The Fmax was significantly lower in group A1 than in group DI (P=0.026),and no significant differences existed between the other two groups injected with the same volume of PMMA (P＞0.05).Conclusion PMMA can significantly enhance the stability of different injectable pedicle screws in synthetic bone block used for patients with osteoporosis,and the stability is significantly correlated with injected volume and distribution pattern of PMMA.

Danggui Shaoyao Powder combined with trabeculectomy and bevacizumab on neovascular glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?AlM: To study the effect of Danggui Shaoyao Powder combined with trabeculectomy and bevacizumab on neovascular glaucoma? METHODS: Neovascular glaucoma patients were enrolled from January 2011 to February 2014 in our hospital, according to the different methods of treatment were divided into observation group given traditional Chinese medicine and Western medicine combined with trabeculectomy, and control group received Western medicine combined with trabeculectomy. Visual acuity, intraocular pressure, retinal thickness were compared.?RESULTS: Visual acuity level : 1wk; 6, 12mo after treatment, visual acuity in observation group were significantly higher than that in control group (0. 41±0. 07 vs 0. 27±0. 04, 0. 52±0. 08 vs 0. 38±0. 06, 0. 72±0. 14 vs 0. 54± 0. 08 ); lntraocular pressure: 1wk; 6, 12mo after treatment, intraocular pressure in observation group were significantly lower than that in control group (15. 11±3. 22 vs 22.32±5.34, 18.64±5.08 vs 26.67±6.22, 17.18±3.76 vs 22. 42 ± 4. 32 ) mmHg; Retinal nerve fiber layer thickness:12mo after treatment, nerve fiber layer thickness in observation group was significantly higher than that in control group (90. 41±10. 52 vs 78. 64±8. 24, 88. 38±12. 12 vs 72. 37± 8. 82, 73. 21 ± 8. 46 vs 60. 25 ± 7. 23, 75. 35 ± 8. 13 vs 62. 63±7. 29)μm.?CONCLUSlON:Danggui Shaoyao Powder combined with trabeculectomy and bevacizumab on neovascular glaucoma can promote visual acuity recovery, control intraocular pressure, and improve the retinal nerve fiber layer thickness.

Finite element analysis of a bone healing model: 1-year follow-up after internal fixation surgery for femoral fracture

Finite element analysis was used to compare preoperative and postoperative stress distribution of a bone healing model of femur fracture, to identify whether broken ends of fractured bone would break or not after fixation dislodgement one year after intramedullary nailing. Using fast, personalized imaging, bone healing models of femur fracture were constructed based on data from multi-slice spiral computed tomography using Mimics, Geomagic Studio, and Abaqus software packages. The intramedullary pin was removed by Boolean operations before fixation was dislodged. Loads were applied on each model to simulate a person standing on one leg. The von Mises stress distribution, maximum stress, and its location was observed. According to 10 kinds of display groups based on material assignment, the nodes of maximum and minimum von Mises stress were the same before and after dislodgement, and all nodes of maximum von Mises stress were outside the fracture line. The maximum von Mises stress node was situated at the bottom quarter of the femur. The von Mises stress distribution was identical before and after surgery. Fast, personalized model establishment can simulate fixation dislodgement before operation, and personalized finite element analysis was performed to successfully predict whether nail dislodgement would disrupt femur fracture or not

Thin slice three dimentional (3D) reconstruction versus CT 3D reconstruction of human breast cancer.

Background & objectives: With improvement in the early diagnosis of breast cancer, breast conserving therapy (BCT) is being increasingly used. Precise preoperative evaluation of the incision margin is, therefore, very important. Utilizing three dimentional (3D) images in a preoperative evaluation for breast conserving surgery has considerable significance, but the currently 3D CT scan reconstruction commonly used has problems in accurately displaying breast cancer. Thin slice 3D reconstruction is also widely used now to delineate organs and tissues of breast cancers. This study was aimed to compare 3D CT with thin slice 3D reconstruction in breast cancer patients to find a better technique for accurate evaluation of breast cancer. Methods: A total of 16-slice spiral CT scans and 3D reconstructions were performed on 15 breast cancer patients. All patients had been treated with modified radical mastectomy; 2D and 3D images of breast and tumours were obtained. The specimens were fixed and sliced at 2 mm thickness to obtain serial thin slice images, and reconstructed using 3D DOCTOR software to gain 3D images. Results: Compared with 2D CT images, thin slice images showed more clearly the morphological characteristics of tumour, breast tissues and the margins of different tissues in each slice. After 3D reconstruction, the tumour shapes obtained by the two reconstruction methods were basically the same, but the thin slice 3D reconstruction showed the tumour margins more clearly. Interpretation & conclusions: Compared with 3D CT reconstruction, thin slice 3D reconstruction of breast tumour gave clearer images, which could provide guidance for the observation and application of CT 3D reconstructed images and contribute to the accurate evaluation of tumours using CT imaging technology.

Single implant in the mandibular molar region of edentulous patient

Implant-retained overdentures are a valid treatment option for edentulous patients, especially for patients with severe alveolar ridge atrophy. A central single implant is considered adequate to retain an overdenture in the edentulous mandible. However, for some patients, there is no sufficient bone height, or width in the interforaminal region of the mandible for insertion of the implant. This case report illustrates that the insertion of a single implant in the mandibular molar region might stabilize the prosthesis, and might improve the oral health-related quality of life and chewing function. A Locator attachment was used in this case to retain the overdenture. The one-year clinical results are promising. However, long-term clinical results and randomized clinical trials are needed before this method can be widely used in clinical application

Curcumin exerts antinociceptive effects by inhibiting the activation of astrocytes in spinal dorsal horn and the intracellular extracellular signal-regulated kinase signaling pathway in rat model of chronic constriction injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Activation of glial cells and the extracellular signal-regulated kinase (ERK) signaling pathway play an important role in the development and maintenance of neuropathic pain. Curcumin can alleviate the symptom of inflammatory pain by inhibiting the production and release of interleukin and tumor necrosis factor. However, whether curcumin affects neuropathic pain induced by nerve injury and the possible mechanism involved are still unknown. This study investigated the effects of tolerable doses of curcumin on the activation of astrocytes and ERK signaling in the spinal dorsal horn in rat model of neuropathic pain.</p><p><b>METHODS</b>Adult male Sprague-Dawley rats were randomly divided into three groups: a control (sham operated) group, and chronic constriction injury groups (to induce neuropathic pain) that were either untreated or treated with curcumin. Thermal and mechanical hyperalgesia thresholds were measured. The distribution and morphological changes of astrocytes were observed by immunofluorescence. Western blotting was used to detect changes in the expression of glial fibrillary acid protein (GFAP) and phosphorylated ERK.</p><p><b>RESULTS</b>Injured rats showed obvious mechanical allodynia and thermal hyperalgesia. The number of GFAP-positive astrocytes, and the fluorescence intensity of GFAP were significantly increased in the spinal dorsal horn of injured compared with control rats. The soma of astrocytes also appeared hypertrophied in injured animals. Expression of GFAP and phosphorylated ERK was also significantly increased in the spinal dorsal horn of injured compared with control rats. Curcumin reduced the injury-induced thermal and mechanical hyperalgesia, the increase in the fluorescence intensity of GFAP and the hypertrophy of astrocytic soma, activation of GFAP and phosphorylation of ERK in the spinal dorsal horn.</p><p><b>CONCLUSIONS</b>Curcumin can markedly alleviate nerve injury-induced neuropathic pain in rats. The analgesic effect of curcumin may be attributed to its inhibition of astrocyte hypertrophy in the spinal dorsal horn and phosphorylation of the ERK signaling pathway.</p>

Optimal design of ball socket on artificial cervical joint complexity by finite element analysis / 医用生物力学

Objective To optimize the design of ball socket of artificial cervical joint complexity. Method A three dimension model of the artificial cervical joint complexity was constructed by the finite element method. The height range of the ball socket handle in the model was set. A simulation was manipulated to optimize the height under the physical load. The stress and strain of the joint complexity with different sizes was analyzed and the systematic safety factor was also evaluated. Results The simulation showed that the maximum Von mises stress appeared at the joint of handle and bottom in the anteflexion position. As the height of the handle increased, the maximum strain increased, and the graph of minimum safety factor was Parabola curve. Conclusions Considering the systematic stability and mobility, when the height of handle is 6 mm, the design of ball socket is considered to be optimal.

Population pharmacokinetics of phenytoin in pediatric patients / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To study population pharmacokinetics of phenytoin in pediatric patients by using sparse data.</p><p><b>METHODS</b>We used routinely collected therapeutic drug monitoring data, derived from the steady state serum concentrations of phenytoin in 42 pediatric outpatients with epilepsy. Depending on whether the patients were administered with phenytoin alone or coadministered with phenobabital or clonazepam, the subjects were divided into two groups: phenytoin group and coadministration group. The population parameter and individual parameter of phenytoin in children were estimated using Monte Carlo method.</p><p><b>RESULTS</b>The children's phenytoin population pharmacokinetic parameters Vm and Km were 9.8 mg.kg(-1).d(-1) and 2.73 mg/L in phenytoin group; and 9.2 mg.kg(-1).d(-1) and 3.24 mg/L in coadministration group. There were good relationship between predicted and determined concentrations with correlation coefficient of 0.999 and 0.984, respectively.</p><p><b>CONCLUSION</b>The coadministration of phenobarbital or clonazepam obviously affected the pharmacokinetics of phenytoin. The population pharmacokinetics of phenytoin in children may provide a usefull index for individualization of dosage regimen.</p>