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121.
122.
Activities of daily living in patients with dementia: clinical relevance, methods of assessment and effects of treatment 总被引:1,自引:0,他引:1
Disability, characterised by the loss of ability to perform activities of daily living (ADL), is a defining feature of dementia that results in growing caregiver burden and the eventual need for alternative care or nursing home placement. Functional decline in patients with dementia can also result from causes other than dementia, such as comorbid medical and psychiatric illnesses and sensory impairment. ADL consists of instrumental ADL (IADL) [complex higher order skills, such as managing finances] and basic ADL (BADL) [self-maintenance skills, such as bathing]. Assessment of IADL and BADL is recommended to establish a diagnosis of dementia. Functional assessment also helps the healthcare provider to offer appropriate counselling regarding safety concerns and need for custodial care. Functional capacity measures have been used increasingly in pharmacological trials of patients with Alzheimer's disease (AD) and related dementias, although at the present time these measures are generally not primary outcome measures. Functional impairment is not a uniform construct; rather, it is multifaceted and can be measured with various clinical instruments. Many scales have been validated for use in patients with AD for characterising functional impairment and evaluating the efficacy of treatment. Research to date indicates that cholinesterase inhibitors have the potential for modest but meaningful beneficial effects on ADL in patients with mild-to-moderate AD. Memantine also has promising beneficial effects on functional abilities in persons with moderate-to-severe AD. Assessment of ADL as a primary efficacy measure using a validated scale that is non-gender biased and cross-nationally relevant is recommended in new treatment trials of patients with AD and related dementias. 相似文献
123.
Ghoshal AA Agrawal SD Sheth SS 《The Journal of the American Association of Gynecologic Laparoscopists》2003,10(2):169-171
STUDY OBJECTIVE: To determine the safety of laparoscopic tubal sterilization in women who have had two or more cesarean sections. DESIGN: Retrospective study (Canadian Task Force classification III). SETTING: Private clinic and hospitals. PATIENTS: Two hundred ten consecutive women. INTERVENTION: Laparoscopic tubal sterilization. MEASUREMENTS AND MAIN RESULTS: The procedures were done with no difficulty in all but two women. In addition to the two failures, one woman experienced bladder trauma. CONCLUSION: Laparoscopic sterilization after several cesarean sections is possible and is associated with low morbidity. Scarring from cesarean sections should not be a contraindication if extra care is taken. 相似文献
124.
Sheth A 《Journal of postgraduate medicine》2003,49(3):287-288
125.
In the present article we describe two cases with Morquio-B syndrome characterized by β-galactosidase deficiency in a Muslim
family. They were found to have skeletal dysplasia, short stature and short trunk dwarfism with undetectable level of β-galactosidase
in leucpcytes. Probands1 sister who had no clinical signs of mucopolysaccharidosis was investigated and found to have normal levels of the enzyme.
Mother was found to have a deficient activity of β-galactosidase and father was not available for the study. Since mother
was pregnant, prenatal study from chorionic cells was carried out to investigate βgalactosidase activity in the chorionic
villus. An intermediate level of β-galactosidase activity was found in the chorionic villus cells suggesting a carrier status.
The diversity and rarity of the study makes it worth presenting.
An erratum to this article is available at . 相似文献
126.
Collins RF Haugh C Casavant D Sheth N Brown L Hook B 《Pacing and clinical electrophysiology : PACE》2002,25(1):112-114
A case is reported of far-field R wave (FFRW) oversensing resulting in inappropriate atrial tachycardia (AT) detection by a dual chamber pacemaker incorporating atrial autoadjusting sensitivity (AAS). FFRW oversensing occurred during periods of functional atrial undersensing (FAU) with PR interval prolongation. Limitations of the pacemaker's ability to reject FFRWs and programming considerations for addressing this unique behavior are discussed. 相似文献
127.
128.
129.
Multicenter randomized trial of the spiral Z-stent compared with the Wallstent for malignant biliary obstruction 总被引:3,自引:0,他引:3
Shah RJ Howell DA Desilets DJ Sheth SG Parsons WG Okolo P Lehman GA Sherman S Baillie J Branch MS Pleskow D Chuttani R Bosco JJ 《Gastrointestinal endoscopy》2003,57(7):830-836
BACKGROUND: The industry standard since 1990 for self-expanding biliary metallic stents has been the Wallstent. In 1998 the Spiral Z-stent was released. This randomized trial compared the Z-stent with the Wallstent in the treatment of malignant biliary obstruction. METHODS: Patients with unresectable malignant biliary obstruction distal to the bile duct bifurcation were randomized to receive a 10-mm diameter Wallstent or a 10-mm diameter Z-stent. RESULTS: A total of 145 patients were randomized; 13 were excluded. Sixty-four patients who received a Z-stent and 68 who had a Wallstent are included in the analysis. Tumors responsible for bile duct obstruction were pancreatic cancer (108), cholangiocarcinoma (15), metastatic cancer (6), and papillary cancer (3). Metallic stents were successfully placed in all patients. Seven technical problems were encountered during placement of the Z-stent and 5 with the Wallstent. There were 21 occlusions requiring reintervention (8 Z-stent, 13 Wallstent; p = 0.30). Median time to reintervention was the following: Z-stent, 162 days; Wallstent, 150 days (p = 0.22). A total of 104 patients died of progressive disease or other cause; 7 patients remain alive with patent stents. The overall calculated median patency rates were: Z-stent, 152 days; Wallstent, 154 days (p = 0.90). CONCLUSIONS: The Spiral Z-stent is comparable with the Wallstent in terms of placement, occlusion rates, and overall patency. Occasional early occlusion of both stents suggests tumor characteristics instead of the size of the mesh openings in the stents as important factors. 相似文献
130.
BACKGROUND: Prolonged polymorphonuclear neutrophil (PMN) survival has been implicated in tissue injury after sepsis. Previously we reported that lipopolysaccharide (LPS) inhibits PMN apoptosis via the activation of the extracellular signal-regulated kinase (ERK). Conversely, the p38 mitogen activated protein kinase (MAPK) pathway is involved in the spontaneous apoptosis of PMNs. The interaction between these 2 pathways and their ability to regulate apoptosis during sepsis remain largely undefined. We hypothesize that there is interaction between the ERK and p38 pathways during sepsis. METHODS: PMNs were isolated from healthy volunteers by Ficoll gradient centrifugation and red blood cell sedimentation. Cells were then pretreated for 1 hour with the ERK inhibitor (PD98059, 10 micromol/L), p38 inhibitor (SB203580, 1 micromol/L), or vehicle. After treatment with LPS, apoptosis and MAPK activity were correlated. RESULTS: LPS stimulation significantly inhibits PMN apoptosis compared with unstimulated cells. Furthermore, inhibition of ERK significantly abrogates this effect, whereas inhibition of p38 augments LPS induced inhibition of apoptosis. Elk-1 phosphorylation (ERK target) is significantly increased by LPS alone and by inhibition of the p38 pathway during LPS stimulation. This correlates with ERK phosphorylation by Western blot. CONCLUSIONS: These data show that p38 inhibition enhances ERK activity during endotoxemia. Furthermore, these data suggest that cooperation between ERK and p38 MAPK pathways dictates the apoptotic potential of PMNs during inflammatory states. 相似文献