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101.
102.
Rheumatoid arthritis (RA) is a joint-specific disease with complex pathogenesis. It is characterized by synovial inflammation,
cartilage loss, and joint destruction. The reasons why joint damage recurs when therapy is discontinued are not clearly understood.
Several lines of evidence suggest that cartilage damage is promoted by the transformed and invasive fibroblast-like synoviocytes
(FLS) of the rheumatoid joint. It has been demonstrated in several systems that aberrant wnt-mediated signaling causes blockade
of cartilage differentiation and malformation of joints. In this review, we have discussed the importance of wnt–frizzled-mediated
signaling in the autonomous activation of FLS in patients with RA. Anti-wnt/anti-frizzled antibodies, frizzled receptor antagonists,
or small molecule inhibitors of wnt–frizzled signaling might be useful for therapeutic interventions in RA.
Received: May 15, 2001/Accepted: September 28, 2001 相似文献
103.
Carson P Giles T Higginbotham M Hollenberg N Kannel W Siragy HM 《Clinical cardiology》2001,24(3):183-190
Hypertension is a major problem throughout the developed world. Although current antihypertensive treatment regimens reduce morbidity and mortality, patients are often noncompliant, and medications may not completely normalize blood pressure. As a result, current therapy frequently does not prevent or reverse the cardiovascular remodeling that often occurs when blood pressure is chronically elevated. Blockade of the renin-angiotensin system (RAS) is effective in controlling hypertension and treating congestive heart failure. Both angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) inhibit the activity of the RAS, but these two classes of antihypertensive medications have different mechanisms of action and different pharmacologic profiles. Angiotensin-converting enzyme inhibitors block a single pathway in the production of angiotensin II (Ang II). In addition, angiotensin I is not the only substrate for ACE. The ACE inhibitors also block the degradation of bradykinin that may have potential benefits in cardiovascular disease. Bradykinin is, however, the presumed cause of cough associated with ACE inhibitor therapy. Data from clinical trials on ACE inhibitors serve to support the involvement of the RAS in the development of cardiovascular disease. Angiotensin receptor blockers act distally in the RAS to block the Ang II type 1 (AT1) receptor selectively. Thus, ARBs are more specific agents and avoid many side effects. Experimental and clinical trials have documented the efficacy of ARBs in preserving target-organ function and reversing cardiovascular remodeling. In some instances, maximal benefit may be obtained with Ang II blockade using both ARBs and ACE inhibitors. This review describes clinical trials that document the efficacy of ARBs in protecting the myocardium, blood vessels, and renal vasculature. 相似文献
104.
Ratanawongsa N Roter D Beach MC Laird SL Larson SM Carson KA Cooper LA 《Journal of general internal medicine》2008,23(10):1581-1588
Background Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies
relate physician burnout to observed patient-physician communication behaviors.
Objective To investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician
encounters.
Design Longitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment.
Setting Fifteen urban community-based clinics in Baltimore, MD.
Participants Forty physicians and 235 of their adult hypertensive patients, with oversampling of ethnic minorities and poor persons. Fifty-three
percent of physicians were women, and the average practice experience was 11.2 years. Among the 235 patients, 66% were women,
60% were African-American, and 90% were insured.
Measurements Audiotape analysis of communication during outpatient encounters (one per patient) using the Roter Interaction Analysis System
and patients’ ratings of satisfaction with and trust and confidence in the physician.
Results The median time between the physician burnout assessment and the patient encounter was 15.1 months (range 5.6–30). Multivariate
analyses revealed no significant differences in physician communication based on physician burnout. However, compared with
patients of low-burnout physicians, patients of high-burnout physicians gave twice as many negative rapport-building statements
(incident risk ratio 2.06, 95% CI 1.58 – 2.86, p < 0.001). Physician burnout was not significantly associated with physician
or patient affect, patient-centeredness, verbal dominance, or length of the encounter. Physician burnout was also not significantly
associated with patients’ ratings of their satisfaction, confidence, or trust.
Conclusions Physician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication.
However, patients engaged in more rapport-building behaviors. These findings suggest a complex relationship between physician
burnout and patient-physician communication, which should be investigated and linked to patient outcomes in future research. 相似文献
105.
Charles A. Austin Summer Choudhury Taylor Lincoln Lydia H. Chang Christopher E. Cox Mark A. Weaver Laura C. Hanson Judith E. Nelson Shannon S. Carson 《Journal of pain and symptom management》2018,55(3):946-952
Context
Patients triggering rapid response team (RRT) intervention are at high risk for adverse outcomes. Data on symptom burden of these patients do not currently exist, and current symptom management and communication practices of RRT clinicians are unknown.Objectives
We sought to identify the symptom experience of RRT patients and observe how RRT clinicians communicate with patients and their families.Methods
We conducted a prospective observational study from August to December 2015. Investigators attending RRT events measured frequencies of symptom assessment, communication, and supportive behaviors by RRT clinicians. As the rapid response event concluded, investigators measured patient-reported pain, dyspnea, and anxiety using a numeric rating scale of 0 (none) to 10 (most severe), with uncontrolled symptoms defined as numeric rating scale score of ≥4.Results
We observed a total of 52 RRT events. RRT clinicians assessed for pain during the event in 62% of alert patients, dyspnea in 38%, and anxiety in 21%. Goals of care were discussed during 3% of events and within 24 hours in 13%. For the primary outcome measure, at the RRT event conclusion, 44% of alert patients had uncontrolled pain, 39% had uncontrolled dyspnea, and 35% had uncontrolled anxiety.Conclusion
Hospitalized patients triggering RRT events have a high degree of uncontrolled symptoms that are infrequently assessed and treated. Although these patients experience an acute change in medical status and are at high risk for adverse outcomes, goals-of-care discussions with RRT patients or families are rarely documented in the period after the events. 相似文献106.
107.
108.
Development and steroidogenic activity of preantral follicles in the neonatal rat ovary 总被引:1,自引:0,他引:1
The neonatal rat ovary is completely devoid of antral follicles until the twelfth day of age. During this period the ovary becomes steroidogenically active and responsive to gonadotrophins. The aim of this study was to correlate the onset of ovarian androgen and oestrogen production in vitro with the first appearance of distinct granulosa and theca cells. Although ovarian aromatase activity increased significantly on day 7 of age, ovarian oestrogen production was limited by low progesterone and testosterone production until day 12 of age. Increased aromatase activity on day 7 and androgen production on day 12 were coincident with the first appearance of granulosa and theca cells respectively. These functional and morphological changes were not associated with significant alterations in ovarian weight or concentrations of LH or FSH in serum. 相似文献
109.
M I Taragin A P Wilczek M E Karns R Trout J L Carson 《The American journal of medicine》1992,93(5):537-542
PURPOSE: This study was undertaken to clarify which, if any, physician demographic characteristics are associated with an increased rate of medical malpractice claims. METHODS: We analyzed the malpractice experience of 9,250 physicians insured for at least 2 years from 1977 to 1987 in the state of New Jersey. After adjusting for years at risk, physician claims per year was categorized into low, medium, and high. RESULTS: Male physicians were three times as likely to be in the high-claims group as female physicians, even after adjusting for other demographic variables (relative risk, 3.1; 99% confidence interval, 2.2 to 4.4). Specialty was strongly associated with claims rate, with neurosurgery, orthopedics, and obstetrics/gynecology having 7 to 12 times the number of claims per year as psychiatry, the specialty with the fewest claims. The rate of claims varied with age (p < 0.001) and peaked at approximately age 40. No association was evident between claims rate and a physician's site of training or type of degree. CONCLUSION: Male physicians are three times as likely to be in a high-claims category as female physicians. We suspect that the most likely explanation for this finding is that women interact more effectively with patients. Understanding the reasons for the variation in claim rates between physicians may lead to the development of methods to reduce the overall rate of malpractice claims. 相似文献
110.
Gary W. Cline Mika Naganawa Laigao Chen Kristin Chidsey Santos Carvajal-Gonzalez Sylvester Pawlak Michelle Rossulek Yanwei Zhang Jason Bini Timothy J. McCarthy Richard E. Carson Roberto A. Calle 《Diabetologia》2018,61(12):2598-2607