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931.
932.
933.
Failure of adequate gastric emptying frequently prevents successful, early enteral nutrition in the preterm infant. The effect on gastric emptying of adding breast milk fortifier is unknown, but clinical experience suggests that it is less well tolerated by some infants. We therefore compared gastric-emptying rates of breast milk and fortified breast milk within pre-term infants, using a previously described ultrasonic technique. Eleven infants were studied on 22 occasions. Median (range) gestation of the group was 28 weeks (25-31) with birth weight 1090 g (714-1360). The human milk fortifier FM-85 (Nestlé, Vevey, Switzerland) was used in all infants. Half-emptying time for unfortified breast milk was less than half that for fortified breast milk. Mean (±SEM) half emptying times were 21 min (±3.6) and 48 min (±4.0), respectively. Breast milk emptied faster than fortified breast milk in 10 out of 11 patients. These data demonstrate that the addition of human milk fortifier can significantly slow gastric emptying. This has important implications for the management of infants who have feed intolerance. 相似文献
934.
Thymocytes bearing autoreactive TCR are eliminated from the organism by a
process termed negative selection. The molecular basis of this deletion has
been recently shown to be a consequence of TCR-triggered activation of a
caspase by certain peptide-MHC ligands in the immature CD4+CD8+
double-positive (DP) thymocyte subpopulation. Of note, the numerically
minor TCRhigh DP thymocyte subpopulation, unlike the major TCRlow DP
subset, is resistant to negative selection. Despite exposure to cognate
peptide, TCRhigh DP thymocytes mature into single-positive thymocytes and
are exported into the periphery. Here we investigated the mechanism by
which these thymocytes escape negative selection. Using a cytochemical
assay in conjunction with a caspase-specific affinity ligand, we
demonstrate that the resistance of the TCRhigh DP thymocytes to negative
selection correlates with the disappearance of TCR-triggered caspase
activity in these cells. Thus thymocytes which have presumably begun the
positive selection process inactivate the thymic caspase pathway and are no
longer susceptible to negative selection.
相似文献
935.
Diseases of the gastrointestinal tract and liver are very common in Bangladesh. Gastroenterology as a dedicated specialty was initiated in 1977 at the Institute of Postgraduate Medicine and Research in Dhaka. One more centre was set up later and these centres are providing specialized diagnostic and therapeutic services. These centres are also imparting training in endoscopy and 49 endoscopists trained so far are providing services in 22 centres around the country. Clinical gastroenterologists are also being trained in a 3 year Master's degree course and three specialists have already completed this. A Gastroenterology Society was formed in 1988 and has held three national scientific conferences and 20 regional meetings. Research in special problems of the country has also been initiated and work on aspects of peptic ulcer disease, chronic calcific pancreatitis and chronic viral hepatitis has been conducted. The demand for gastrointestinal services is high and the specialty has attracted a good number of young doctors. Gastroenterology is likely to grow in size and quality in Bangladesh. 相似文献
936.
A Esmaeili AK Keinhorst T Schuster F Beske R Schlösser C Bastanier 《Acta paediatrica (Oslo, Norway : 1992)》2010,99(2):209-214
Aim: The objective of this retrospective study is to compare the medical treatment of neonatal narcotic abstinence syndrome with clonidine and chloral hydrate with the commonly used combination therapy of morphine and phenobarbital. Methods: From 1998 to 2008, a total of 133 newborns suffering from neonatal narcotic abstinence syndrome were treated at our clinic. All of these patients were born to mothers who had received methadone substitution for drug addiction during the course of pregnancy. Results: Twenty‐nine patients received clonidine and chloral hydrate, and 64 patients were treated with morphine and phenobarbital for abstinence syndrome. The duration of treatment was significantly shorter in the clonidine/chloral hydrate group (median: 14 days vs. 35 days). Correspondingly, the period of hospitalization was also considerably shorter in the clonidine/chloral hydrate group (median: 32 days vs. 44 days). In addition, patients in the clonidine/chloral hydrate group exhibited markedly reduced withdrawal symptoms. Conclusion: This study suggests that a treatment of neonatal abstinence syndrome with clonidine in omission of opiates is possible without causing short‐term adverse cardiovascular effects. Considering the retrospective design of the study, controlled and prospective trials are needed. 相似文献
937.
On the basis of reports that some calcium channel blockers impair the elimination of some drugs, the effect of nifedipine on the disposition of antipyrine and theophylline was assessed in healthy volunteers. Antipyrine half-life of 10.04 +/- 1.43 h (mean +/- SD) after a week intake of nifedipine (20 mg twice daily) was not significantly different from the control value of 10.64 +/- 2.15 h; nor was that of 10.02 +/- 1.49 h after 2 weeks pretreatment with the calcium channel blocker in eight healthy volunteers. Control antipyrine clearance (ml min-1) of 44.40 +/- 10.58 was not significantly different from that of 45.66 +/- 9.34 and 46.87 +/- 9.63 after nifedipine pretreatment of 1 and 2 weeks, respectively. Similarly volume of distribution was unaltered: 0.601 +/- 0.074, 0.591 +/- 0.078 and 0.602 +/- 0.051 l kg-1, respectively. A week pretreatment with nifedipine did not significantly alter either of theophylline half-life (7.32 +/- 0.81 h (control) to 7.50 +/- 0.80 h) or clearance (42.10 +/- 5.84 ml min-1 (control) to 43.77 +/- 4.00 ml min-1) in six volunteers. However the change in volume of distribution: 0.451 +/- 0.053 l kg-1 (control) to 0.483 +/- 0.062 l kg-1 was significant (p less than 0.025). Generally, theophylline plasma levels were lower after nifedipine pretreatment and the difference was significant at 2 and 4 h post-dosing (p less than 0.05). It is suggested that nifedipine, unlike diltiazem and verapamil, is unlikely to interfere with the functional integrity of the hepatic mixed-function oxygenase enzymes, but might displace theophylline from plasma protein. 相似文献
938.
939.
Attitudes of GPs to the care of people with epilepsy 总被引:3,自引:0,他引:3
BACKGROUND: Most individuals with current epilepsy are solely under the
care of the primary care team for follow-up care. Government working party
recommendations, expert epilepsy panels and patients have also stressed the
central role of the GP in follow-up care. Problems in the provision of care
in the community have, however, repeatedly been highlighted. The views of
GPs about service provision for people with epilepsy may be an important
barrier to providing care, but have not yet been studied in a systematic
manner. OBJECTIVES: We aimed to ascertain the views of GPs on service
provision for people with epilepsy in primary care and on specific
initiatives to improve care. METHOD: A specially designed postal
questionnaire was sent to all 262 GPs on the list of West Glamorgan FHSA.
It ascertained what GPs felt their role should be in providing care to
people with epilepsy, identified their views on the importance of
particular problems in providing this care, as well as obtaining their
opinions on possible future initiatives to improve epilepsy care in the
community. RESULTS: The overall response rate was 70%. Although a majority
of responding GPs (55%) agreed that the care of people with epilepsy should
be based in general practice, 23% disagreed. A lack of confidence about
knowledge of epilepsy (34% responders), unfamiliarity with new drugs (65%
responders) and a lack of time (41% responders) were identified as
important perceived barriers to providing epilepsy care. Nearly all
responding GPs would welcome guidelines for epilepsy care (93% felt they
would be very helpful) and an epilepsy liaison nurse in the community was
the most popular option in terms of preferred overall strategy for
improving care. CONCLUSIONS: Despite 40 years of official recommendations
regarding the central role of the GP in the follow-up care of people with
epilepsy, a number of GPs have difficulty in providing this care. Many feel
that they lack knowledge or are too time pressured to improve the
situation. Nearly all GPs say that they would find guidelines for epilepsy
care very helpful and over half would find epilepsy liaison nurses helpful.
There is scope for more innovative ideas for epilepsy care in the
community.
相似文献
940.