Investigation of childhood central nervous system vasculitis: magnetic resonance angiography versus catheter cerebral angiography

Aim We compared the clinical utility of magnetic resonance angiography (MRA) to catheter cerebral angiography (CA) in the investigation of children with suspected central nervous system (CNS) vasculitis. Method Single‐centre retrospective review of children with a suspected diagnosis of CNS vasculitis studied with both MRA and CA. MRA and CA‐detected abnormalities (location, multiplicity, and morphology) were compared; sensitivity and specificity were calculated on a per lesion and per patient basis for MRA, with CA as the reference standard. Results Findings in fourteen patients (median age at presentation of 5y 10mo [range 1y 5mo–14y 5mo]; eight males, six females) relating to sixteen paired studies of MRA and CA were reviewed. CA‐detected lesions were commonly bilateral (13/16 studies, p<0.05), and likely to be proximally distributed (15/16 studies, p<0.05).The sensitivity and specificity of MRA for CA lesion detection was 63% (95% confidence interval [CI] 48–78) and 89% (95% CI 81–93), respectively with moderate agreement between the two modalities (κ=0.51, 95% CI 0.37–0.66). The majority of the false negative observations involved the posterior circulation (9/14). The overall sensitivity for MRA diagnosis of vasculitis per patient was 94% (95% CI 67–99). Interpretation MRA failed to identify all lesions detected on CA, particularly those in the posterior circulation. MRA is a reasonable initial modality in the investigation of suspected CNS vasculitis but in cases of abnormal parenchymal MRI and normal MRA, CA should be considered.     

糖心康对糖尿病大鼠心肌NF-κB表达的影响

目的探讨糖心康对糖尿病性心肌病的治疗作用及其作用机制。方法通过腹腔小剂量多次注射链脲佐菌素(STZ)加高热量饮食建立糖尿病大鼠心肌损伤模型,采用全自动生化分析仪测定空腹血糖、糖化血红蛋白,放免法测定胰岛素含量观察糖心康对糖尿病大鼠糖代谢及胰岛素水平的影响;采用免疫组织化学法观察糖心康对糖尿病大鼠心肌NF-κB表达的影响。结果糖心康有明显降低血糖、糖化血红蛋白及提高胰岛素水平的作用(P<0.05);糖心康对糖尿病大鼠心肌NF-κB的过度表达有显著抑制作用(P<0.01)。结论糖心康对糖尿病性心肌病有显著治疗作用,其作用机制之一是通过抑制心肌NF-κB过度表达实现的。     

Modifications of the urethral rest and stress profiles after different types of surgery for urinary stress incontinence

Summary. Full urodynamic assessment, including urethral profiles at rest and under stress, using microtransducers, was made before and at least 6 months after surgery for urinary stress incontinence in 86 patients. Cure was assessed objectively. Procedures compared were Burch colposus-pension, Pereyra urethrovesical suspension and anterior colporrhaphy. The Burch colposuspension increased the pressure transmission ratio more efficiently than the vaginal operations and the cure rate was 91%. Only 50% of Pereyra operations were successful and success was related to an increase in the functional urethral length and in the pressure transmission ratio. The success rate for anterior colporrhaphy was 57% and was associated with a significant decrease in the maximal urethral closure pressure and the continence area. The prognostic value of the urethral profiles at rest and under stress and the therapeutic implications are discussed.     

Medication compliance in children with asthma

A questionnaire to assess compliance with prescribed therapy was completed by 200 children with asthma. The validity of the questionnaire was assessed objectively by measuring plasma theophylline concentrations in 37 subjects and by weighing metered dose aerosol canisters before and after use in 19 subjects. The average compliance was 67.9%. The close agreement between answers to the questionnaire and the objective measurements of compliance indicated that most participants recalled the drug regimens accurately. Good compliance was related to whether Australia was the parents' country of origin, to knowledge of the disorder and to comprehension of medication but was not related to perception of the severity of the illness. This study demonstrates that compliance is relatively poor even in a clinic population which attends regularly and appears well-motivated.     

Tinnitus in pregnancy

The presence of tinnitus in pregnancy was investigated by a postal questionnaire survey. A group of pregnant women attending the ante-natal clinic and a control group of non-pregnant members of the nursing staff at the Royal United Hospital in Bath were studied. The prevalence of tinnitus in the pregnant and non-pregnant women was compared. Both groups were similar in age, previous noise exposure and the presence of ear disease or operations. Twenty-five per cent of the pregnant women reported tinnitus compared with 11% of the control group. Chi-square analysis of this data gives a value of χ²= 4.07, d.f. = 1, P < 0.05. The result of our survey shows that there is a significantly increased prevalence of tinnitus in pregnant women compared with a similar non-pregnant control group. This association has not been previously reported.     

A communications seminar series for general practice residents

This article describes a seminar series for general practice residents dealing with communication, interpersonal relations, self-image, and patient-dentist interactions. Objectives, content, and methods of evaluation are presented.     

Maudsley Hospital Survey: prevalence of alcohol problems and other psychiatric disorders in a hospital population

This study, the first of its kind in the United Kingdom, reports on the prevalence of alcohol problems and other psychiatric disorders in the Joint Maudsley and Bethlem Royal Hospital population over a 12 year period. The steady 9–11% of the total number of diagnoses that are alcoholic, forces home the realization of the significant contribution of drinking problems to the work load of the hospital. The consistency of the percentage of alcoholics who receive an additional diagnosis, 30–40%, has considerable implications for treatment, treatment service planning and the understanding of aetiological factors.     

Optimal digital filters for long-latency components of the event-related brain potential

A fundamentally important problem for cognitive psychophysiologists is selection of the appropriate off-line digital filter to extract signal from noise in the event-related brain potential (ERP) recorded at the scalp. Investigators in the field typically use a type of finite impulse response (FIR) filter known as moving average or boxcar filter to achieve this end. However, this type of filter can produce significant amplitude diminution and distortion of the shape of the ERP waveform. Thus, there is a need to identify more appropriate filters. In this paper, we compare the performance of another type of FIR filter that, unlike the boxcar filler, is designed with an optimizing algorithm that reduces signal distortion and maximizes signal extraction (referred to here as an optimal FIR filter). We applied several different filters of both types to ERP data containing the P300 component. This comparison revealed that boxcar filters reduced the contribution of high-frequency noise to the ERP but in so doing produced a substantial attenuation of P300 amplitude and, in some cases, substantial distortions of the shape of the waveform, resulting in significant errors in latency estimation. In contrast, the optimal FIR filters preserved P300 amplitude, morphology, and latency and also eliminated high-frequency noise more effectively than did the boxcar filters. The implications of these results for data acquisition and analysis are discussed.