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81.
BACKGROUND: Parallel comparison studies of cognitive therapy and antidepressant medication have suggested that both treatments are effective. However, we cannot determine from these studies whether cognitive therapy and antidepressant medication are effective for the same populations of depressives. A sequential study in which nonresponders to the first treatment are then treated with the second can address this issue. METHOD: Twenty-seven patients meeting DSM-III criteria for major depression or dysthymic disorder and Columbia criteria for atypical depression received cognitive therapy followed by antidepressant medication for cognitive therapy nonresponders. A response rate with the second treatment equal to that expected with placebo would suggest both treatments target the same depressive population. RESULTS: Of the 25 completers of the study, 14 (56%) were judged responders to cognitive therapy alone. Sixty-nine percent (9/13) of the responders maintained their benefits for 6 months or more. Seven of the 11 cognitive therapy nonresponders (63%) responded to antidepressant medication. These results were compared with those of a concurrent double-blind medication study; both its sample and ours were drawn from the same population at the same time: cognitive therapy and antidepressant medication response rates were higher than expected with placebo (28%). CONCLUSION: The results suggest that (1) cognitive therapy and antidepressant medication are effective treatments for differing populations of depressed patients, as the antidepressant medication response of cognitive therapy nonresponders was greater than expected with placebo, and (2) cognitive therapy has a lasting effect. 相似文献
82.
Cardiac conduction abnormalities and rhythm changes after neonatal anatomical correction of transposition of the great arteries. 下载免费PDF全文
S Menahem M S Ranjit C Stewart W J Brawn R B Mee J L Wilkinson 《Heart (British Cardiac Society)》1992,67(3):246-249
Seventy three infants who underwent neonatal anatomical correction for transposition of the great arteries with or without a ventricular septal defect were reviewed for evidence of conduction and rhythm abnormalities on preoperative and postoperative 12 lead electrocardiograms and during 24 hour Holter monitoring. There was a partial right bundle branch block pattern in 47% (29/62) of all patients and in 60% (24/40) of those with simple transposition. Complete right bundle branch block was noted in 21% including 5% with simple transposition. Holter monitoring showed sinus rhythm in all patients except three: one had episodes of supraventricular tachycardia, another an intermittent second degree heart block, and a third a complete heart block. Atrial extrasystoles were noted in 47% (29/62) of patients but were frequent in only three patients. Occasional unifocal ventricular extrasystoles were encountered in 37% (23/62) of patients and were frequent in a further 3% (2/62). Only one patient (2%) developed multifocal ventricular extrasystoles. The frequency of important cardiac arrhythmias after neonatal anatomical correction of transposition of the great arteries was 5%, significantly less than that reported after atrial inflow diversion for the same malformation. 相似文献
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84.
Lygia Stewart J. McLeod Griffiss Gary A. Jarvis Lawrence W. Way 《Journal of gastrointestinal surgery》2007,11(8):977-984
Objective Gallstone bacteria provide a reservoir for biliary infections. Slime production facilitates adherence, whereas β-glucuronidase
and phospholipase generate colonization surface. These factors facilitate gallstone formation, but their influence on infection
severity is unknown.
Methods Two hundred ninety-two patients were studied. Gallstones, bile, and blood (as applicable) were cultured. Bacteria were tested
for β-glucuronidase/phospholipase production and quantitative slime production. Infection severity was correlated with bacterial
factors.
Results Bacteria were present in 43% of cases, 13% with bacteremia. Severe infections correlated directly with β-glucuronidase/phospholipase
(55% with vs 13% without, P < 0.0001), but inversely with slime production (55 vs 8%, slime <75 or >75, P = 0.008). Low slime production and β-glucuronidase/phospholipase production were additive: Severe infections were present
in 76% with both, but 10% with either or none (P < 0.0001). β-Glucuronidase/phospholipase production facilitated bactibilia (86% with vs 62% without, P = 0.03). Slime production was 19 (±8) vs 50 (±10) for bacteria that did or did not cause bacteremia (P = 0.004). No bacteria with slime >75 demonstrated bacteremia.
Conclusions Bacteria-laden gallstones are biofilms whose characteristics influence illness severity. Factors creating colonization surface
(β-glucuronidase/phospholipase) facilitated bacteremia and severe infections; but abundant slime production, while facilitating
colonization, inhibited detachment and cholangiovenous reflux. This shows how properties of the gallstone biofilm determine
the severity of the associated illness.
Presented at the annual meeting of the Society for Surgery of the Alimentary Tract, held May 20–24, 2006 in Los Angeles, California. 相似文献
85.
86.
87.
Screening for osteoporotic vertebral fractures traditionally involves X-ray of the thoracic and lumbar spine. We evaluated use of dual energy X-ray technology in patients with osteoporosis. We found this technology useful in the clinic setting and it has advantages in that less radiation is delivered to the patient. 相似文献
88.
89.
Asai T.; McBeth C.; Stewart JIM.; Williams J.; Vaughan R. S.; Power I. 《British journal of anaesthesia》1997,78(1):28-33
We have investigated the effects of clonidine on gastric emptying of
liquids in 30 patients. In a double-blind, randomized design, clonidine 150
micrograms, morphine 10 mg or saline in 1 ml was given i.m. One hour later,
the patient drank a paracetamol solution (1.5 g in 50 ml water). Venous
blood samples were obtained every 15 min for 90 min thereafter. Plasma
paracetamol concentrations were measured using high- pressure liquid
chromatography and the area under the concentration- time curve was
calculated. The degree of sedation and complications were recorded. The
area under the curve for 0-60 min was significantly smaller in the morphine
group than in the saline group (P = 0.002; 95% confidence interval (CI) for
difference -1237 to -502 micrograms min ml- 1), whereas it was greater in
the clonidine group compared with the saline group, although this was not
significant (95% CI for difference - 423 to 1264 micrograms min ml-1).
Arterial pressure was significantly lower in the clonidine group compared
with the saline group. Both clonidine and morphine appeared to cause mild
sedation. We conclude that clonidine 150 micrograms i.m. does not delay
gastric emptying of liquids in a similar manner to morphine.
相似文献
90.
L E Davis K E Rarey J A Stewart L C McLaren 《The Annals of otology, rhinology, and laryngology》1987,96(4):380-383
Cytomegalovirus (CMV) was recovered from a 5-month-old infant with probable congenital infection. In life, no hearing impairment had been observed. Auditory brain stem evoked responses were bilaterally intact. At necropsy, both temporal bones were morphologically normal, as demonstrated by light and electron microscopy. Sensory hair cells of the organ of Corti appeared intact. Cytomegalovirus was recovered from a mixture of perilymph and endolymph, but not the brain, CSF, or vitreous humor. This appears to be the first report of an individual with an inner ear CMV infection in which neither structural nor functional alterations of the inner ear were apparent. This case also suggests that CMV can persist within the inner ear for prolonged periods following congenital infection. 相似文献