This study explored the effect of a moderate (90 g/d) low-carbohydrate diet (LCD) in type 2 diabetes patients over 18 months. Methods Ninety-two poorly controlled type 2 diabetes patients aged 20-80 years with HbA1c �7.5% (58 mmol/mol) in the previous three months were randomly assigned to a 90 g/d LCD r traditional diabetic diet (TDD). The primary outcomes were glycaemic control status and change in medication effect score (MES). The secondary outcomes were lipid profiles, small, dense low-density lipoprotein (sdLDL), serum creatinine, microalbuminuria and carotid intimamedia thickness (IMT). Results A total of 85 (92.4%) patients completed 18 months of the trial. At the end of the study, the LCD and TDD group consumed 88.0±29.9 g and 151.1±29.8 g of carbohydrates, respectively (p < 0.05). The 18-month mean change from baseline was statistically significant for the HbA1c (-1.6±0.3 vs.-1.0±0.3%), 2-h glucose (-94.4±20.8 vs.-18.7±25.7 mg/dl), MES (-0.42±0.32 vs.-0.05±0.24), weight (-2.8±1.8 vs.-0.7±0.7 kg), waist circumference (-5.7 ±2.7 vs.-1.9±1.4 cm), hip circumference (-6.1±1.8 vs.-2.9±1.7 cm) and blood pressure (-8.3±4.6/-5.0±3 vs. 1.6±0.5/2.5±1.6 mmHg) between the LCD and TDD groups (p<0.05). The 18-month mean change from baseline was not significantly different in lipid profiles,

In emergency medical services, portable ultrasound scanners have the potential to become new-age stethoscopes for emergency physicians. For trauma cases in particular, portable ultrasound scanners can scan the chest and abdomen of emergency patients both rapidly and conveniently. This study describes the development of tele-ultrasound for pre-diagnosis in a medical emergency setting as a part of the updated Mobile Hospital Emergency Medical System (MHEMS). An emergency medical technician can provide an emergency physician with a patient's ultrasound images and medical information during the patient's pre-hospitalization and transportation period using a combination of the MHEMS, the portable ultrasound scanner, and the onboard 3G communication capabilities. The MHEMS includes a Dispatch and Mission Control Center that facilitates the communication between the Emergency Department of a specified hospital, the systems aboard the ambulance. Early receipt of information relevant to the patient will enhance pre-diagnosis options for on-duty emergency physicians and allow for a hospital's emergency department to promptly prepare necessary surgical instruments or beds. Furthermore, emergency medical technicians can also obtain instructions from on-duty physicians to enhance damage and disaster control ability in critical moments.

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There is currently controversy on whether the insufficient response to penile venous surgery done in an attempt to restore erectile function is due to recurrent or residual veins. In order to elucidate this issue, we report a study on those patients who failed to respond to the first venous surgery and subsequently underwent or declined a second operation. From July 1996 to July 2003, a total of 83 patients, aged 25 to 83, who were dissatisfied with their first venous surgery and were later diagnosed with a persistent veno-occlusive dysfunction via our dual cavernosography, were recruited into our study. Subsequently, 45 men underwent penile venous stripping surgery for a second time and were assigned to the surgery group, whereas the remaining 38 men were subject to followup and routine management and were assigned to the control group. All were evaluated with the abridged 5-item version of the international index of erectile function (IIEF-5) every 6 months for 1 to 5 years and cavernosogram, if necessary. In the surgery group their preoperative IIEF-5 score was 10.1 6 3.7, which increased to 17.1 6 3.2 (P , .001) after the first surgery and further increased to 20.7 6 3.1 (P , .001) after a second venous stripping of the cavernosal vein that was consistently demonstrated on the cavernosogram. Overall, 41 men (91.1%) reported a positive response to further venous surgery, with more satisfactory coitus, after the residual veins were stripped thoroughly, although eventually 4, 3, and 3 men required additional oral sildenafil, penile implant, and intracavernosal injection, respectively. The follow-up period ranged from 12 months to 72 months, with an average of 37.0 6 11.5 months. In the control group, however, their corresponding IIEF-5 score changed from 17.4 6 2.9 to 16.9 6 3.2 (P . .05). Finally, 11, 7, and 8 men required additional oral sildenafil, penile implant, and intracavernosal injection, respectively. Although there was no statistical significance between the 2 groups in the first postoperative IIEF-5 scores, there was a significant difference in their IIEF-5 after further venous surgery. In this study, we propose that the clinical relapse of erectile dysfunction is a result of ''residual'' veins rather than ''recurrent'' ones. (Wespes et al, 1985;Bennett et al, 1986). The approach was extended from initial procedures involving singlevessel ligation of the deep dorsal vein to more elaborate techniques in which excision of the deep dorsal vein, cavernous vein, and crural vein were described (PuechLeao et al, 1987;Lewis, 1988;Lue, 1989). Current theories, however, seem to ascribe the veno-occlusive dysfunction (VOD) to a defect within the penis rather than the veins themselves (Wespes et al, 1993) and suggest that the major contributor of erectile dysfunction is corporeal fibrosis due to an abnormality in the regulation of collagen synthesis and suggest degradation as the most likely etiology, secondary to chronic ischemia (Nehra et al, 1996). Thereafter, venous surgery per se, regardless of ...

The human erectile mechanism is an intricate interplay of hormonal, vascular, neurological, sinusoidal, pharmacological, and psychological factors. However, the relative influence of each respective component remains somewhat unclear, and merits further study. We investigated the role of venous outflow in an attempt to isolate the key determinant of erectile function. Dynamic infusion cavernosometry and cavernosography was conducted on 15 defrosted human cadavers, both before and after the systematic removal and ligation of erection-related penile veins. Preoperatively, an infusion rate of more than 28.1 mL/min (from more than 14.0 to 85.0 mL/min) was required to induce a rigid erection (defined as intracavernosal pressure [ICP] exceeding 90 mmHg). Following surgery, we were able to obtain the same result at a rate of 7.3 mL/ min (from 3.1 to 13.5 mL/min) across the entire sample. Thus, we witnessed statistically significant postoperative differences (all P # .01), consistently elevated ICP, lower perfusion volumes, and a general reduction in time taken to attain rigidity. The cavernosograms provided further evidence substantiating the critical role played by erection-related veins, whereas histological samples confirmed the postoperative integrity of the corpora cavernosa. Given that our use of cadavers eliminated the influence of hormonal, arterial, neurological, sinusoidal, pharmacological, and psychological factors, we believe that our study demonstrates that the human erection is fundamentally a mechanical event contingent on venous competence.

Although topical anesthetic blockage for penile surgeries has been substantially reported in the medical literature, its methodology, reliability, and reproducibility have not been consistent. We report on several methods of topical blocks for local anesthesia in patients with indications for penile surgeries. From March 1993 to March 2003, a total of 1131 men, ages 19 to 87, underwent penile surgeries in which 165, 203, 708, 45, and 10 patients received penile implantation, modified Nesbit procedure, venous surgery, venous patches, and arterial revascularization respectively, under pure local anesthesia on an outpatient basis. They were categorized into the implant, Nesbit, venous, patch, and arterial groups respectively. Proximal dorsal nerve blockage, peripenile infiltration, and topical injection, although challenging, were sufficient local anesthesia for patients in the last 4 patient groups. A new method of crural blockade, however, was also required for optimal anesthesia of the cavernous nerve for implantation purposes.The anesthetic effects and postoperative results were satisfactory. Common immediate side effects included puncture of the corpus spongiosum or the deep dorsal vein as well as the innominate vessel, subcutaneous ecchymosis, transient palpitations, and acceptable low level of pain. There were no significant late complications. In the implant group, however, 6.1% of patients (10/165) had experienced pain over the perineum for 1 to 2 weeks postoperatively. Overall there were statistical differences in scoring between the 5 groups in which the implant group stood out when a visual analog scale of 100 mm was used. Topical nerve blockades proved to be reliable, simple, and safe, with minimal complications. They offer the advantages of less morbidity, reduced effects of anesthesia, protection of privacy, and a rapid return to preoperative daily activity.

The percentage of the elderly population grew rapidly in recent years, so the tremendous life and health care needs became an issue of focus in an aging society. The Elderly Nursing Home plays an important role and intends to provide a comfortable environment and living space and serve as safe and healthy place for the elderly. However, the frailty and fragility of the elderly in both physiologically and psychologically make it an uneasy task. To enhance the service and care quality of an Elderly Nursing Home, a ubiquitous monitor system integrated with biosensors and Radio Frequency Identification (RFID) technology was implemented as a prototyping system. The system was expected to improve the Activity of Daily Living (ADL) of the residents, to detect the emergencies or accidents such as stroke, falling down, fainting, and heart attack, in order to enhance the quality of care and promote efficiency at the same time.

Disappointing functional outcome and penile deformity are major concerns of penile venous surgery. Consequently, it has been abandoned by most urologists. To explore whether penile deformity is correctable and erectile function can be improved, we report our experience in patients who had undergone surgery elsewhere. From 1986 to 2008, 16 consecutive patients sought our assistance because of poorer erectile capability or/and penile deformity from previous venous surgery elsewhere. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) was used to score the patients when it became available in 1998. Accordingly, 3 and 13 patients were categorized into the non-IIEF and IIEF groups, respectively. A median longitudinal pubic incision and a circumferential or semicircumcision were made to relieve the fibrotic tissues for accessing the deep dorsal veins, which were stripped thoroughly and ligated with 6-0 nylon sutures. The cavernosal veins were managed in a similar manner. The paraarterial veins were ligated only segmentally. Finally, the wound was approximated while an assistant consistently stretched the penile shaft. The operation time was 5.2 to 8.5 hours. The follow-up period ranged from 0.6 to 23.0 years. Overall, all patients reported satisfactory penile morphology postoperatively. In the IIEF group, the difference in preoperative and postoperative scores was significant (P , .001). In the non-IIEF group, 2 of the 3 patients reported natural coitus. This series of salvaging venous surgeries, although technically challenging, are helpful in correcting penile deformity and restoring erectile function in some patients who had poorer outcomes from prior venous surgeries.