基于光电传感器的多段脉搏波传播速度检测系统的研制

采用了一种以反射式和透射式红外光光电传感器和单片机为基础,用同步检测心电信号、桡动脉脉搏波、手指脉搏波信号来测定桡动脉和外周动脉脉搏波传播速度的方法,研制一种无创的多段脉搏波传播速度检测系统。在软件编程中脉搏波周期信号的识别是以心电R波峰值为基准,同时再根据它们之间的时延关系进一步确定脉搏波的波峰与波谷的范围,提高检测准确性及精度。该系统通过检测心电、桡动脉脉搏波和手指脉搏波信号可获得多段脉搏波传播速度参数,具有较高的检测精度和良好的应用前景。     

Relationship of brain and skull in pre- and postoperative sagittal synostosis

Models of vertebrate skull evolution stress the coordinated developmental relationship between the skull and the brain that it houses. This study investigates the relationship between altered skull morphology and brain morphology in premature fusion of the cranial sagittal suture (isolated sagittal synostosis; ISS), a condition associated with dysmorphology of both neurocranium and brain. Although the skull displays a more normal shape following reconstructive cranial vault surgery, effects of this surgery on the brain have not been investigated. Landmark coordinate data were collected from three-dimensional magnetic resonance imaging reconstructions of the brain in a sample of ISS patients and an age-matched unaffected cohort. These data were analysed using Euclidean distance matrix analysis (EDMA). Results show that the brain in ISS is dysmorphic preoperatively, displaying a posteriorly directed neural expansion that does not 'worsen' with growth. Postoperatively, the brain in ISS displays a more globular shape overall as compared with the preoperative morphology, but differs from normal in its subcortical morphology. These results show that the ISS brain is altered following neurocranial surgery, but does not more closely approximate that of unaffected individuals. This suggests that although the brain is affected by manipulation of the skull, it retains a growth pattern that is, at least in part, independent of the skull.     

Response to oral β-carotene supplementation in patients with cystic fibrosis: a 16-month follow-up study

The aim of this study was to determine the efficacy of long-term oral β -carotene supplementation for correcting impaired β -carotene status in cystic fibrosis patients. Thirty-five patients (2.3-30.5 years of age) with coefficients of fat absorption of 46-96% (median 88%) received β -carotene 0.5 mg/kg daily and were followed over a 16-month treatment period. Baseline plasma β -carotene concentrations in patients (meanSD, 0.090.06 μ mol/1) were significantly lower than those of age-matched controls (0.860.56 μ mol/1) ( p < 0.0001). Concentrations increased rapidly and reached a plateau at or before 3 weeks that was maintained throughout the study period. Values obtained at 3 weeks (0.890.64 μ mol/1) were significantly higher ( p < 0.0001) than those at baseline and did not differ from controls. Plasma retinol and α -tocopherol concentrations increased during the observation period, but remained within normal ranges. Plasma retinyl palmitate, which was below the detection limit in all but one patient at baseline, did not increase. Thus oral β -carotene supplementation is effective and normalizes β -carotene status of cystic fibrosis patients without evidence of significant side effects. β -Carotene, cystic fibrosis, LDL-cholesterol, oral supplementation, retinol, α-tocopherol     

Malignant granular cell tumour of the sciatic nerve

A case of malignant granular cell tumour of the sciatic nerve is presented. Computed tomography demonstrated iso-density with muscle and minimal enhancement. Magnetic resonance demonstrated T1 isointensity with muscle with marked enhancement, and isointensity with fat on proton and T2 images. Pathological evidence is presented for its probable Schwann cell histogenesis.     

Clinical incidence of lymphoedema in breast cancer patients in Jönköping County, Sweden

The clinical incidence of lymphoedema of the arm in breast cancer patients was studied before and after general mammography screening in the country of jönköping, Sweden. There was a significant decrease of incidence of lymphoedema from 15% in 1983 to 8% in 1988. Clinical and pathological therapy data have been analysed in relation to lymphoedema. Significant factors contributing to lymphoedema were the number of lymph nodes examined and the number of pathologically positive lymph nodes. A higher proportion of patients receiving post-operative radiotherapy to the axilla developed lymphoedema, compared with those with surgery alone.
A comparison between the two groups is impossible due to the fact that post-operative radiotherapy was prescribed only to patients with pathologically positive lymph nodes.     

Observing decision‐making in the general practice consultation: who makes which decisions?

OBJECTIVE: To investigate opportunities for, and types of decision making in the general practice (primary care) consultation, and examine differences in skills of those doctors who are successful at meeting their patients' preferences and those who are less successful. DESIGN: Observation study of doctor-patient consultations in general practice. PARTICIPANTS: Patients attending for routine appointments in 12 general practice surgeries across Oxfordshire. METHODS: A total of 212 doctor-patient consultations were video-recorded. The patients involved completed a questionnaire to elicit their perceptions of how decisions were made. The video-taped recordings were coded with a new instrument, the Evidence Based Patient Choice Instrument (EBPCI), to classify the number and type of decision-making opportunities arising during each consultation. A total of 149 recordings were coded using the Oxbridge Rating Scale to assess the doctors' consultation styles. RESULTS: There was a range of decision-making opportunities in addition to those involving medical treatment. With the exception of 'fitness for work', decisions were generally 'doctor led'. There was only moderate agreement between patient perceptions of their level of involvement in decision making and the objective ratings using the EBPCI. There was wide variation in the ability of doctors to meet their patients' preferences for involvement. CONCLUSIONS: There are many decisions made in primary care consultations, in addition to those about medical treatments, in which patients could be involved to a greater extent than they currently are. Some doctors are significantly better than others at meeting different patients' preferences for their decision-making role. Patients' perceptions of shared decision making appears to be influenced by the doctors' general consultation skills.     

Reliability of treadmill measures and criteria to determine VO2max in prepubertal girls

PURPOSE: The main objective of this study was to determine the reliability of measuring treadmill exercise economy (VO2submax) and the maximal oxygen uptake (VO2max) in prepubertal girls tested twice, 6 wk apart. We also wanted to examine the percentage of young girls who were able to reach the criteria for achieving VO2max and to describe methods that would allow a high proportion of young children to achieve criteria for reaching a true VO2max. METHODS: We studied 61 normal-weight, prepubertal girls with a mean (+/- SD) age 7.3+/-1.3 yr (range 4.8 to 10.3 yr). VO2submax was determined while walking for 4 min at 2.5 mph with 0% grade. VO2max was measured during a progressive, all-out, continuous treadmill test using standardized procedures and criteria. Heart rate (HR) was measured using a Polar monitor. Respiratory rate (RR), respiratory exchange ratio (RER), ventilation (V), and VO2 were measured using a Sensormedics metabolic monitor. RESULTS: There were no significant differences between visits I and 2 in mean HR, RR, RER, V, VO2submax (421 vs 422 mL x min(-1), respectively), and VO2max (1036 vs 1049 mL x min(-1), respectively). Intra-individual coefficients of variation (CV) between visits 1 and 2 for submaximal tests were: HR = 5.1%, RR = 12.4%, RER = 7.2%, V = 12.5%, and VO2 = 12.4%. Intra-individual CVs for the maximum tests were: HRmax = 2.1%, RRmax = 10.8%, RERmax = 5.3%, Vmax = 11.7%, and VO2max = 7.5%. A high proportion of the girls reached criteria for VO2max [RER> 1.00, HR>85% of age predicted maximum, and plateauing of VO2max] in both visits: 99% reached one of three criteria, 92% reached two of three criteria, and 70% reached all three criteria. Twenty girls [mean age 7.2+/-1.2 yr] reached at least two criteria in both visits, whereas 32 girls [mean (+/- SD) age 8.6+/-1.0 yr] reached three criteria in both visits. CONCLUSION: Exercise measurements using treadmill testing were reliable in healthy, normal-weight, prepubertal girls. Older girls when compared to the younger girls were able to reach criteria for VO2max more often. Thus, we recommend that one testing should give researchers an accurate measure of walking economy and aerobic capacity, and that two criteria are enough for determining VO2max.     

Elevated Serum Alpha Fetoprotein and Normal Liquor Alpha Fetoprotein Values in Association with an Abdominal Pregnancy

Summary: A case report is described in which abdominal pregnancy was misdiagnosed by ultrasound scanning as a pregnancy within a horn of a bicornuate uterus. Two serum alpha fetoprotein (SAFP) results were greatly elevated and an amniocentesis was performed, the liquor alpha fetoprotein (LAFP) and karyotype were normal. Elective Caesarean section was performed at 38 weeks for a persistent transverse lie and an abdominal pregnancy was found. The outcome was excellent for both the mother and child.
This is the first reported case of amniocentesis and measurement of LAFP in an abdominal pregnancy and confirms abdominal pregnancy as a rare cause of an elevated SAFP.     

Screening for a raised rectal temperature in Africa

The main purpose of this study was to compare rectal and axillary temperature measurements in African children. Altogether 573 sick children were seen in an outpatient setting in rural West Africa. Rectal and axillary temperatures were measured and the parent or guardian was asked if they thought that the child had a raised body temperature. Normal ranges were defined from an age matched population of 203 healthy children. A raised axillary temperature predicted a raised rectal temperature with a sensitivity of 98% and a specificity of 88%. The parents' impression that their child had a fever was a less sensitive (89%) and less specific (59%) indicator of raised rectal temperature. A raised axillary temperature is a good screening test for a raised rectal temperature in African children.