Addition of felodipine to metoprolol vs replacement of metoprolol by felodipine in patients with angina pectoris despite adequate beta-blockade: Results of the Felodipine ER and Metoprolol CR in Angina (FEMINA) Study

AIMS: The study aimed to compare the addition of felodipine to metoprolol,and of the replacement of metoprolol by felodipine, with continuationof metoprolol, in patients with angina pectoris despite optimalbeta-blockade. METHODS AND RESULTS: The study was double-blind, parallel, randomized and controlled,and comprised 363 patients from 27 outpatient cardiology clinicsin the Netherlands. The patients had angina and positive bicycleexercise tests despite optimal beta-blockade (resting heartrate <65 beats . min^–1). Randomization was to threetreatment groups: continuation of metoprolol (control), additionof felodipine to metoprolol, and replacement of metoprolol byfelodipine. Exercise tests were repeated after 2 and 5 weeks.The main outcome measure was: exercise result after 5 weeks,compared with baseline, between-group comparison of changesvs control. There were no significant differences in exerciseduration and onset of chest pain vs control. The addition offelodipine increased time until 1 mm ST depression (43 s, 95%confidence interval 20–65 s), and decreased both ST depressionat highest comparable work load (0·46 mm, 95% confidenceinterval 0·19–0·72), and maximal ST depression(0·49 mm, 95% confidence interval 0·23–0·74).Exercise results after replacement of metoprolol by felodipinewere not different from control, apart from a significant increasein rate pressure product. Significantly more patients experiencedadverse events in the felodipine monotherapy group. CONCLUSION: Combination of metoprolol and felodipine is to be preferredto felodipine monotherapy in patients who have signs and symptomsof myocardial ischaemia despite optimal beta-blockade.     

银屑病和日光性角化病皮损应用氨基-γ-酮戊酸荧光染色后肉眼荧光强度与原卟啉Ⅸ含量的相互关系

应用5-氨基-γ-酮戊酸（ALA）诱导的卟啉荧光诊断（FDAP）中，肉眼可观察到原卟啉IX（PpIX）沉积。因操作重复性低，且涉及PpIX肿瘤选择的机制知之甚少，所以解释荧光数据仍有些困难。本研究中，作者要研究FDAP后银屑病和日光性角化病（AK）患者皮损的PpIX沉积情况。基于此目的，将患者脱屑区皮损和无皮损正常皮肤用20％ALA油孵育3h，进行FDAP，取强荧光区皮损和无皮损处皮肤活检。从活检标本中提取PpIX、蛋白质和双链DNA行荧光分光光度法定量，用图像分析软件分析由FDAP获得的数字图像。     

Natural course and predicting self-reported improvement in patients with chronic fatigue syndrome with a relatively short illness duration

OBJECTIVE: To describe the course of fatigue in chronic fatigue syndrome (CFS) patients with a relatively short duration of complaints and to test which psychosocial factors predict spontaneous improvement 1 year later. METHODS: Seventy-nine patients with a complaint duration of less than 2 years were tested at baseline and 78 of the same group at 1-year follow-up. During this time period, no systematic intervention took place. Self-reported improvement and fatigue severity were the main outcome measures. RESULTS: Forty-six percent (95% confidence intervals, 95CI = 35-58%) of the patients with a short illness duration reported to be improved. This was a significantly (chi(2) = 20.3, P < .001) higher percentage compared to the 20% (95CI = 15-26%) self-reported improvement in a previously published natural-course study among 246 CFS patients with a longer illness duration. Persistence of complaints after 1-year follow-up was associated with high baseline levels of experienced concentration problems, less strong psychosocial causal explanations for the complaints, and higher levels of the experienced lack of social support. Baseline fatigue severity predicted fatigue severity at follow-up. CONCLUSION: The results showed that CFS patients with a relatively short duration of complaints had a more favourable outcome compared to patients with a long illness duration. The data also indicated that complete recovery only occurred in patients with a complaint duration of less than 15 months. This finding has important implications, since it suggests that after such a time period spontaneous recovery hardly occurs.     

Cohort patterns in mortality trends among the elderly in seven European countries, 1950-99

BACKGROUND: Secular trends in old-age mortality are of crucial importance to population ageing. For the understanding and prediction of these trends, it is important to determine whether birth cohort effects, i.e. long-lasting effects of exposures earlier in life, are important in determining mortality trends up to old age. This study aimed to identify and describe cohort patterns in trends in mortality among the elderly (>60 years of age) in seven European countries. METHODS: A standard age-period-cohort analysis was applied to all-cause and cause-specific mortality data by 5-year age groups and sex, for Denmark, England and Wales, Finland, France, The Netherlands, Norway, and Sweden, in the period 1950-99. RESULTS: Cohort patterns were identified in all countries, for both the sexes and virtually all causes of death. They strongly influenced the trends in all-cause mortality among Danish, Dutch, and Norwegian men, and the trends in mortality from infectious diseases, lung cancer (men only), prostate cancer, breast cancer, and chronic obstructive pulmonary disease (COPD). All-cause mortality decline stagnated among Danish, Dutch, and Norwegian male birth cohorts born between 1890 and 1915, among French men born after 1920, and among women from all countries born after 1920. Where all-cause mortality decline stagnated, cohort patterns in mortality from lung cancer, COPD, and to a lesser extent ischaemic heart diseases, were unfavourable as well. For infectious diseases, stomach cancer, and cerebrovascular diseases, mortality increased among cohorts born before 1890, and decreased strongly thereafter. CONCLUSIONS: Cohort effects related to factors such as living conditions in childhood and smoking in adulthood were important in determining the recent trends in mortality among the elderly in seven European countries.     

Cognitive behaviour group therapy for chronic fatigue syndrome: a non-randomised waiting list controlled study

BACKGROUND: It has been demonstrated that individual cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome (CFS). The aim of the present study was to investigate the effectiveness of cognitive behaviour group therapy (CBGT) in an unselected group of CFS patients. Additionally, pretreatment characteristics of CFS patients who improve after CBGT were explored. METHODS: In a non-randomised waiting list controlled design, 31 patients were allocated to CBGT and 36 to the waiting list condition. CBGT consisted of 12 two-hour sessions during 6 months. Main outcome measures were fatigue (Checklist Individual Strength) and functional impairment (Sickness Impact Profile). RESULTS: A moderate effect on fatigue in favour of CBGT was found. For functional impairment, the effect was opposite to what was expected. Patients who improved after CBGT had less complaints at baseline compared to patients who did not improve. CONCLUSIONS: An explanation for the moderate effect might be that during CBGT, rest and relaxation were too much emphasised. Furthermore, an unselected group of CFS patients and therapists inexperienced in CB(G)T for CFS participated. Suggestions to improve CBGT for future research are given.     

More than 10 years registration of continuing medical education as part of quality control by the Netherlands Society for Oto-Rhino-Laryngology and Cervico-Facial Surgery

After more than 10 years registration, 93% of ENT specialists in The Netherlands fulfil the requirements for continuing medical education in spite of the fact that sanctions (no re-registration) have not been implemented to date. Improvements have been made over the years. Information about how to set up a comparable system was supplied to 10 other scientific societies. A recurrent point for discussion is whether or not to award points for presentations, papers and (co)publications. On the one hand, it seems reasonable to reward the effort but, on the other hand, it creates practical problems. As a matter of fact, all members who give papers and write articles appear to attend more than enough postgraduate education. The process of accurate registration of continuing medical education, including accreditation and certification, is time-consuming. Moreover, it requires intensive and essential supervision by an experienced colleague who has a thorough knowledge of the specialist field.