Screening for a frequent cardiac disorder: mitral valve prolapse]

Mitral valve prolapse (MVP) screening using bidimensional echocardiography was performed on 171 healthy subjects from Lorraine of both sexes, aged 20 to 60 years. Six men and seven women presented this valvular disease. In the Lorraine population, the estimated prevalence of MVP was 7.6% (95% confidence interval: 3.6-11.6%). In this study, only seven cases of MVP had a cardiac auscultation suggestive of MVP. As compared with echocardiography, clinical screening of MVP had a low validity (sensibility 54%, specificity 69%) and a poor positive predictive value (12.5%). Because MVP has severe complications, and because clinical screening has a low performance, a strategy of screening with bidimensional echocardiography could be interesting.     

Quality of life of children with mitral valve prolapse

Objective  

The aim of our prospective study was to assess the health-related quality of life (HRQOL) of children with mitral valve prolapse (MVP) and the impact of clinical symptoms on HRQOL.     

Experiences with and Perception of a Web-Based Mindfulness,Nutrition, and Fitness Platform Reported by First-Year University Students: A Qualitative Study

BackgroundMy Viva Plan (MVP) (https://www.myvivainc.com/) is a web-based application developed by a dietitian that aims to support healthy living by providing resources and self-monitoring tools to help promote a healthy diet, healthy mind, and physical fitness. First-year university students have the potential to benefit because poor dietary choices, limited physical activity, and high stress are prevalent in this population. In addition, they are also active technology users.ObjectiveThis study aims to understand experiences and perception of MVP by first-year university students using this tool as part of a 12-week randomized controlled trial.DesignOne-on-one semistructured interviews were conducted following a 12-week intervention involving use of MVP.Participants/settingFirst-year university students from the University of Alberta, Edmonton, Canada (n = 32).InterventionParticipants were instructed to use MVP as much as possible for 12 weeks in either the fall/2018 or winter/2019 semesters.Qualitative data analysisInterviews were audio-recorded, transcribed verbatim, and analyzed abductively using content analysis.ResultsParticipants reported varied use of MVP across the 12-week period. Data were categorized using the HealthChange Methodology (Behaviors, Emotions, 37 Situations, Thinking) framework. Participants provided various examples of emotions (eg, motivation, stress), situations (eg, time, living arrangements, finances), and thinking (eg, self-awareness, level of satisfaction with MVP, and how MVP was or could be better tailored for students) that acted as either facilitators or barriers to MVP use and explained their behaviors associated with this tool.ConclusionsOverall, participant behaviors regarding MVP varied and were influenced by several factors, including their emotions, situations, and thinking. The Behaviors, Emotions, Situations, Thinking framework may be helpful for dietitians to identify barriers and facilitators affecting their client’s use of ehealth tools for lifestyle behavior change. This information can be used to optimize client support when using these tools.     

Noncardiac chest pain in adolescents and children with mitral valve prolapse

Chest pain in adolescents and children is usually not of cardiac origin. Of cardiac conditions commonly linked to chest pain in childhood, mitral valve prolapse (MVP) is the most prevalent, but this association has recently been questioned. In light of recent reports of gastroesophageal sources of chest pain in adults with MVP, we performed a comprehensive gastroesophageal evaluation of 17 preadolescents and adolescents with mitral valve prolapse who had chest pain as their presenting symptom. Evaluation consisted of esophageal manometry, Bernstein test, esophageal pH probe, and/or esophagogastroscopy. Fourteen of the 17 patients had at least one abnormal finding. Five patients had esophagitis, five had gastritis, one had high-amplitude esophageal contractions, one had abnormal esophageal manometry with positive Bernstein test, one had esophageal reflux and positive Bernstein test, and one had abnormal manometry with esophageal reflux. The 13 patients with esophagitis, gastritis, reflux, or positive Bernstein test were treated with antacid, with resolution of chest pain in 12 patients. Two of these patients underwent follow-up endoscopy with documentation of improvement. The patient with high-amplitude esophageal contractions was treated with dicyclomine, which resulted in resolution of chest pain. The observation that the chest pain was not related to mitral valve prolapse is important in clinical practice and raises further questions as to whether mitral valve prolapse causes chest pain.     

二尖瓣成形术治疗二尖瓣关闭不全的疗效分析

目的分析二尖瓣瓣膜成形术(MVP)治疗中重度二尖瓣关闭不全(MR)患者的临床疗效。 方法以2013年6月至2017年6月徐州医科大学附属沭阳医院心胸外科收治的28例行MVP的MR患者为研究对象行回顾性分析,其中男性17例,女性11例;年龄50～72岁,平均(61.5±10.6)岁。所有患者术前均存在中重度MR。术前根据患者的合并症、病变部位的定位和合并腱索断裂与否,评估选择可行的MVP术式及合并手术：所有患者均采用正中切口、体外循环下手术治疗,术中行二尖瓣楔形切除、矩形切除及缘对缘缝合方法修补二尖瓣,合并腱索断裂或腱索冗长的行e-PTFE线人工腱索植入,常规行二尖瓣成型环植入,术中注水观察评估瓣膜成行效果。术中采取的二尖瓣成形方法统计：7例(25.0%)植入1～3根腱索,行二尖瓣矩切除术9例(32.1%),二尖瓣楔形切除术8例(28.6%),二尖瓣缘对缘缝合4例(14.3%),所有患者均置入鞍形二尖瓣成形环。对于合并心房颤动的患者同期行单纯左心耳切除术(LAA),或心房颤动射频消融术(AB)＋LAA;合并冠心病,则同期行冠状动脉搭桥术(CABG);合并中度及以上的三尖瓣关闭不全,则同期行三尖瓣成形环植入手术(TVP)。1例(3.6%)患者行MVP＋CABG,1例(3.6%)行MVP＋TVP＋LAA;3例(10.7%)行MVP＋TVP＋AB＋LAA;5例(17.9%)行MVP＋TVP;18例(64.3%)行单纯MVP。术后予华法林抗凝治疗3～6个月,合并心房颤动者终身抗凝治疗。统计所有患者采取的手术方式,包括合并手术、二尖瓣成形方法;对比患者术前及术后2年的返流、心功能改善情况以及LAD、左心室舒张末内径(LVEDD)、左心室射血分数(LVEF)水平的差异。 结果所有患者术前均为中重度返流,术后2年复查心脏彩超：21例(75.0%)无明显二尖瓣返流,6例(21.4%)二尖瓣轻度返流,1例(3.6%)二尖瓣中度返流。且所有患者的心功能较术前均提升1 ～ 2级。术前LAD[(49.42±12.58)mm],术后2年LAD[(38.17±9.84)mm],术前LVEDD[(50.91±7.93)mm],术后LVEDD[(44.37±7.42)mm],术后均较术前明显缩小;术前LVEF(51.69±9.71)%,术后LVEF(62.79±8.53)%,术后LVEF较术前明显增加。 结论MVP治疗MR安全有效、疗效显著,但远期效果还待进一步研究随访。     

乙肝肝硬化患者血小板参数检测及其临床意义

目的通过检测比较乙肝肝硬化患者和健康人血小板参数,了解乙肝肝硬化患者血小板参数变化及其临床意义。方法采用血细胞分析仪对81例乙肝肝硬化患者血小板计数（PLT）、平均血小板体积（MPV）、血小板分布宽度（PDW）进行检测。并进一步检测肝硬化出血组与非出血组以及肝硬化Child分级A级、B级、C级组的PLT、MPV、PWD。结果发现乙肝肝硬化患者PLT、MPV显著降低,PDW显著升高（P〈0.01和P〈0.05）。肝硬化出血组与非出血组其PLT、MPV、PWD亦有明显差异（P〈0.01）,随着肝功能的下降,PLT、MPV随之下降。结论乙肝肝硬化患者血小板参数检测可以间接反映血小板的功能变化,判断有无出血倾向,对指导临床治疗及判断预后都有重要意义。     

Mitral valve prolapse in eating and panic disorder: A pilot study

The prevalence of echocardiographic mitral valve prolapse (MVP) and arrhythmias was studied in controls (n = 23) and patients with panic disorder (n = 14), bulimia nervosa (n = 14), and anorexia nervosa (n = 21). There was approximately twice the rate of MVP in patient groups compared to controls, a statistically insignificant difference. Importantly, the presence of prolapse was not associated with measures of weight or depression but there was a trend for MVP to be associated with anxiety disorder in bulimic patients. There were no significant arrhythmias found. These results raise the possibility that MVP may not be a state weight-related phenomenon as has been proported, but rather a trait phenomenon reflecting comorbidity with anxiety disorder.     

Complex syndromes, ambivalent diagnosis, and existential uncertainty: the case of Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus (SLE), also known as lupus, is an autoimmune disorder which is difficult to diagnose due to its manifold symptoms. Its complexity is part and parcel of the epistemological changes that scientific biomedicine is undergoing which in turn influence clinical practice. These changes lead to the well known and often-discussed frustration of patients who suffer from elusive disorders, long-term or chronic illnesses, and medically unexplained symptoms. Using ethnographic observations in combination with grounded theory methods this study explores SLE as one example of complex syndromes that the clinical practice of late modernity seems to bring about. It concentrates on the difficulties of diagnosing complex disorders from a medical point of view, then goes on to describe the impact this has on patients' lives, and their reaction to this situation. I argue that ambivalent diagnosis leads to existential uncertainty amongst patients which in turn influence the doctor-patient relationship. In concluding, I suggest that medical sociology has to move from merely describing and analysing this emerging situation to suggesting strategies for integrating experiential knowledge into clinical practice, especially when it comes to medical and personal management of chronic disorders such as SLE.     

Cholinergic deficiency syndrome as an indicator for the cholinesterase inhibitors

Cholinesterase inhibitors are licensed for the treatment of dementia in Alzheimer's disease. In clinical practice, these drugs have little effect on the cognitive symptoms of dementia. Several studies report a beneficial effect of cholinesterase inhibitors on neuropsychiatric symptoms. We hypothesise that symptoms such as the impairment of attention and concentration, anxiety, restlessness and hallucinations, delineate a specific central cholinergic deficiency syndrome. It is postulated that this syndrome crosses boundaries of nosological entities and occurs in various neurodegenerative diseases. Symptoms resulting from cholinergic deficiency might be a much better target for treatment than cognitive deficits.     

Clinical judgment predicts culture results in upper respiratory tract infections

BACKGROUND: We wanted to describe the natural history, familial transmission, microbiology, and accuracy of clinical judgment of potential pathogens of respiratory tract infections in a community family practice. METHODS: The study was a prospective case series in which consecutive patients requesting treatment for respiratory tract infections were evaluated after nurse triage during 3 fall-spring months in a solo family practice in suburban Cleveland, Ohio. According to the physician's usual practice, patients were classified into high-, medium-, and low-risk groups for bacterial illness based on their clinical signs and symptoms. Cultures were performed and sensitivities were determined for pathogens from the infected throat, nasopharynx, conjunctiva, or other sites. Patient symptoms and well-being were scored at the initial visit and at 3, 7 and 14 days later. RESULTS: There were 111 illness episodes in 86 patients; 94% had cultures taken, of which 38% grew a potentially pathogenic bacteria, most commonly group A streptococci, Branhamella catarrhalis or Staphylococcus aureus. The physician's judgment of bacterial infection was associated (P < .001) with having a positive culture (sensitivity 53%, specificity 78%, positive and negative predictive values 60% and 73%, respectively). A positive culture was associated with 2 of 16 signs or symptoms: purulent discharge from any site or a red swollen eye. There was no association of treatment status with clinical outcomes during 2 weeks of follow-up observation. CONCLUSION: Infection with a potentially pathogenic bacteria is difficult to determine solely by clinical signs and symptoms, but clinical judgment is associated with positive culture results. The effect of selective treatment of upper respiratory tract infection based on clinical signs and symptoms and patient and family culture results remains to be determined, but using clinical judgment could result in more selective antibiotic use than found in current practice patterns.     

Mitral valve prolapse and sudden death: a case report

Mitral valve prolapse (MVP) is a common disorder that, in general, has a good prognosis. Rare occasions of sudden death have been reported in patients with MVP and it is presumed that the basis of sudden death is arrhythmias. We report a case of a 47 years old men affected by MVP complicated by ventricular arrhythmias and sinoatrial block; who died suddenly from ventricular tachycardia. The pathophysiology and risk factors of sudden cardiac death in MVP are discussed.     

Educational objectives and requirements of an undergraduate clerkship in general practice. The outcome of a consensus procedure

OBJECTIVES: The main aim of this study was to reach consensus between students, faculty and general practice teachers on the educational objectives and requirements of the clerkship in general practice. METHOD: The consensus procedure consisted of four steps and all active general practice teachers (n = 116) were asked to participate in the study. RESULTS: We identified 189 educational objectives: 127 complaints (problems, symptoms, syndromes), 29 clinical skills and 37 objectives concerning the theoretical dimensions of general practice. Educational requirements crystallized to 16 essential preconditions of a teaching practice and 35 didactic activities to be performed by the general practice teachers. CONCLUSIONS: These consensus results will be used to structure the medical curriculum and as guidelines for the educational process during the clerkship.      

The mode of delivery of parenteral multivitamins influences nutrient handling in an animal model of total parenteral nutrition

BACKGROUND: Very low birthweight preterm infants receive early total parenteral nutrition (TPN) to optimize protein balance. Adding multivitamins (MVP) to the lipid emulsion (MVP+LIP) rather than to the amino acid+dextrose moiety of TPN (AA+MVP) limits the effects of light exposure on lipid peroxidation and vitamin loss. AIM: Compare the effects of the mode of delivery of MVP on nutrient handling and indices of oxidant stress. METHODS: Three-day old guinea pig pups were assigned to TPN containing MVP+amino acids+dextrose+heparin and electrolytes, with lipids provided separately (AA+MVP). Solutions were light exposed (LE, n = 8) or light protected (LP, n = 9). In a further group (n = 7), MVP was co-administered with the lipid moiety and light exposed (LIP+MVP). Variables measured in urine (creatinine, nitrogen, vitamin C) and in liver (protein, glutathione, isoprostane, vitamins A, E, C) were compared by ANOVA. RESULTS: Urinary nitrogen and vitamin C were higher (P<0.05) during LE, while hepatic levels of vitamin C were higher (P<0.05) with LIP+MVP. These results were not related to total peroxide levels in TPN or to markers of oxidant stress. CONCLUSION. Co-administration of MVP with lipid or light protected amino acids offers comparable beneficial effects on nitrogen and vitamin C metabolism.     

Plasma gamma-hexachlorocyclohexane concentrations in forestry workers exposed to lindane

Plasma gamma-hexachlorocyclohexane (gamma-HCH) and three urinary trichlorophenols were measured in forestry workers who were engaged in planting seedlings treated with gamma-HCH. These two procedures were assessed as potential biological monitoring methods and the data were compared with reported clinical symptoms. The measurement of plasma gamma-HCH was considered to be a feasible and valid monitoring method for use in routine practice and is a useful indicator of gamma-HCH absorption. The data were used to illustrate the need to be vigilant about personal hygiene and the efficacy of protective clothing. Plasma gamma-HCH concentrations above 70 nmol/l were measured in two workers which coincided with persistent non-specific clinical symptoms. Trichlorophenols were identified in urine but the extensive and variable metabolism of gamma-HCH makes this approach less suitable for biological monitoring.     

Plasma gamma-hexachlorocyclohexane concentrations in forestry workers exposed to lindane.

Plasma gamma-hexachlorocyclohexane (gamma-HCH) and three urinary trichlorophenols were measured in forestry workers who were engaged in planting seedlings treated with gamma-HCH. These two procedures were assessed as potential biological monitoring methods and the data were compared with reported clinical symptoms. The measurement of plasma gamma-HCH was considered to be a feasible and valid monitoring method for use in routine practice and is a useful indicator of gamma-HCH absorption. The data were used to illustrate the need to be vigilant about personal hygiene and the efficacy of protective clothing. Plasma gamma-HCH concentrations above 70 nmol/l were measured in two workers which coincided with persistent non-specific clinical symptoms. Trichlorophenols were identified in urine but the extensive and variable metabolism of gamma-HCH makes this approach less suitable for biological monitoring.     

Unexplained illness: the mind versus the environment.

Every doctor in clinical practice is familiar with the patient who presents with multiple 'soft' symptoms. Where organic pathology cannot be demonstrated, there is a tendency to apply psychiatric labels. Indeed, it has been suggested that the risk of psychiatric disorder increases linearly with the number of presented symptoms. In psychiatric practice, the mere absence of an organic cause of disease is often regarded as adequate reason to invoke a psychological mechanism. However, this action precludes the possibility of any other diagnosis, and thus constricts therapeutic management to the psychiatric realm. Such psychologization of illness is commonplace, overworked and infrequently challenged. This highlights the longstanding controversy over multiple allergy and the role of psychiatric disorder.     

Shielding parenteral multivitamins from light increases vitamin A and E concentration in lung of newborn guinea pigs

BACKGROUND & AIMS: Exposure of parenteral multivitamin preparation (MVP) to light generates peroxides. Light-exposed MVP induces an oxidant stress in lung but not in liver. This discrepancy suggests differences in handling of infused antioxidant vitamins between the two organs. Hypothesis: antioxidant capacity of lung depends on the MVP concentration and light protection of infused solutions. METHODS: Protocol 1: four groups of three-day old guinea pigs received the base solution (5% dextrose + 0.45% NaCl) enriched with 0%, 1%, 2% and 3% MVP. Protocol 2: three further groups received the base solution + 2% MVP either light-exposed or light-protected or light-protected + 300 microM H2O2. After 4 days, lung and liver were sampled for vitamin determinations. Data were analyzed by ANOVA. RESULTS: In lung, vitamins A-C-E reached a plateau with 1% MVP. In liver, vitamin A and E increased according to their concentration in solutions. Light exposure and added-H2O2 were associated with lower vitamin E in lung and liver. Retinol was higher in lung and lower in liver of animals receiving light-protected compared to light-exposed solutions. CONCLUSIONS: Light protection of 1% MVP is a better way to improve the pulmonary oxidant-antioxidant balance than to increase MVP (>1%) in parenteral nutrition.     

猪囊尾蚴病免疫学诊断方法的研究进展(综述)

猪囊尾蚴病又名猪囊虫病,是由猪带绦虫的幼虫引起的一种常见的人畜共患疾病,可累及全身多个器官,引起严重的临床症状。由于科学技术的发展,猪囊尾蚴病的免疫诊断检测方法有了很大的进展,该文就近年猪囊尾蚴病的免疫学诊断方法的进展进行综述,希望为该病的临床诊治提供参考。     

晚期非小细胞肺癌化疗效果与费用分析

目的：分析非小细胞肺癌3种化疗方案的疗效和费用的关系,控制医疗费用,以减轻病人住院经济负担。方法：回顾性调查68例晚期非小细胞肺癌采用MVP方案、NP和TP方案的疗效和平均费用。结果：MVP方案、NP方案和TP方案对于晚期非小细胞肺癌的疗效分别是28.6%、40.9%和38.8%,三者之间未见到明显差异,对于复治的病人NP方案和TP方案比MVP方案疗效高,但NP方案和TP方案之间未见明显差异。MVP方案、NP方案和TP方案平均费用分别为3487.26元、12450.21元和38499.43元。结论：3种化疗方案对于晚期非小细胞肺癌的治疗效果无明显差别,建议对于初治的晚期非小细胞肺癌病人选择MVP方案,对于复治的病人选择NP方案。     

Non-Celiac Gluten Sensitivity in the Context of Functional Gastrointestinal Disorders

Gluten-free diets are increasingly chosen in the Western world, even in the absence of a diagnosis of celiac disease. Around 10% of people worldwide self-report gluten-related complaints, including intestinal and extra-intestinal symptoms. In most cases, these subjects would be labeled as patients suffering from irritable bowel syndrome (IBS) who place themselves on a gluten-free diet even in the absence of celiac disease. In some instances, patients report a clear benefit by avoiding gluten from their diet and/or symptom worsening upon gluten reintroduction. This clinical entity has been termed non-celiac gluten sensitivity (NCGS). The symptoms referred by these patients are both intestinal and extra-intestinal, suggesting that similarly to functional gastrointestinal disorders, NCGS is a disorder of gut–brain interaction. It remains unclear if gluten is the only wheat component involved in NCGS. The mechanisms underlying symptom generation in NCGS remain to be fully clarified, although in the past few years, the research has significantly moved forward with new data linking NCGS to changes in gut motility, permeability and innate immunity. The diagnosis is largely based on the self-reported reaction to gluten by the patient, as there are no available biomarkers, and confirmatory double-blind challenge protocols are unfeasible in daily clinical practice. Some studies suggest that a small proportion of patients with IBS have an intolerance to gluten. However, the benefits of gluten-free or low-gluten diets in non-celiac disease-related conditions are limited, and the long-term consequences of this practice may include nutritional and gut microbiota unbalance. Here, we summarize the role of gluten in the clinical features, pathophysiology, and management of NCGS and disorders of gut–brain interaction.