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991.
Dallago CM Abech DD Pereira-Lima JF Leães CG Batista RL Trarbach EB Oliveira Mda C 《Pituitary》2008,11(1):109-112
Kallmann syndrome (KS) is a developmental disease characterized by the association of isolated hypogonadotropic hypogonadism
and anosmia/hyposmia. We report an unusual presentation of two females with KS and empty sella. These females, aged at 20
and 29-year-old, presented primary amenorrhea with prepubertal estradiol and low gonadotropin levels. No other significant
clinical signs were observed. Empty sella was observed on MRI in both cases. Sequencing of FGFR1 gene, recently implicated in autosomal form of KS, was performed and one splicing mutation (IVS14 + 1G > A) was identified
in one patient. 相似文献
992.
Summary
Background Increasing physician case volumes are documented to reduce costs and improve outcomes for many surgical procedures but not
for medical conditions such as pneumonia that consume significant health care resources.
Objective This study explored the association between physicians’ inpatient pneumonia case volume and cost per discharge.
Design The design was a retrospective, population-based, cross-sectional study, using National Health Insurance administrative claims
data.
Setting The setting was Taiwan.
Participants The participants were a universal sample of 270,002 adult, acute pneumonia hospitalizations, during 2002–2004, excluding transferred
cases and readmissions.
Measurements Hierarchical linear regression modeling was used to examine the association of physician’s volume (three volume groups, designed
to classify patients into approximately equal sized groups) with cost, adjusting for hospital random effects, case severity,
physician demographics and specialty, hospital characteristics, and geographic location.
Results Mean cost was NT$2,255 (US$1 = NT$33 in 2004) for low-volume physicians (≤100 cases) and NT$1,707 for high-volume physicians
(≥316 cases). The adjusted patient costs for low-volume physicians were higher (US$264 and US$235 than high- and medium-volume
physicians, respectively; both P < .001), with no difference between high- and medium-volume physicians. High-volume physicians had lower in-hospital mortality
and 14-day readmission rates than low-volume physicians.
Conclusions Data support an inverse volume–cost relationship for pneumonia care. Decision processes and clinical care of high-volume physicians
versus low-volume physicians should be studied to develop effective care algorithms to improve pneumonia outcomes and reduce
costs. 相似文献
993.
A 21-year-old male patient with low back pain and marked forward bending was presented. The exaggerated lumbar flexion was
preventing him to stand in erect posture but disappeared while lying. The symptoms had begun after he had lifted a heavy object.
Straight-leg-raising test could not be performed properly because of the exaggerated pain. The light-touch sense was decreased
on L5 and S1 dermatomes. There was no loss of muscle strength. The deep-tendon reflexes were normal. Plain graph showed mild
narrowing in the L4–5 and L5–S1 intervertebral spaces. Lumbar magnetic resonance imaging revealed disc protrusions in L4–5
and L5–S1 levels. During his stay in the department, the patient was given tizanidine and tramadol, and physical therapy was
performed. A paravertebral intramuscular injection with lidocaine was applied. Moreover, the patient was referred to psychiatrist
for evaluation regarding his medical history of conversive seizures and possible efforts for secondary gain. No response was
obtained from all the treatments. The final diagnosis was camptocormia triggered by lumbar-disc herniation. He was applied
supportive psychotherapy, psychoeducation regarding secondary gain, strong suggestions to improve posture, positive reinforcement,
and behavioral therapy. His postural abnormality resolved and disappeared completely with mild pain.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
994.
Saito Y Guo YM Hirokawa M Saito K Komatsuda A Takahashi N Fujishima M Fujishima N Yamashita J Sawada K 《International journal of hematology》2008,88(1):64-72
Tumor necrosis factor-alpha (TNF-alpha) has been shown to induce the differentiation of CD34(+) cells toward dendritic cells (DCs). We have previously shown that DCs are co-generated from human CD34(+) cells during erythroid or megakaryocytic differentiation in the presence of TNF-alpha, and those DCs are able to stimulate autologous T cell proliferation. The aim of this study was to learn whether the co-stimulation of granulocyte colony-stimulating factor (G-CSF) and TNF-alpha would generate neutrophil progenitors and DCs together from human CD34(+) cells, and if this was the case, to clarify the phenotypic and functional characteristics of these DCs. When highly purified human CD34(+) cells were cultured for 7 days with G-CSF alone, the generated cells predominantly expressed a granulocyte marker, CD15, and then differentiated into neutrophils after 14 days of culture. The addition of TNF-alpha with G-CSF markedly decreased the number of CD15(+) cells without affecting the total number of cells during 7 days of culture. Almost one third of the generated cells were positive for CD11c and CD123. Furthermore, CD11c(+) cells were found to phagocytose CD15(+) cells and were able to induce allogeneic, but not autologous, T cell proliferation in the mixed lymphocyte reaction (MLR). On the other hand, the CD11c(+) cells generated by TNF-alpha and cytokines capable of inducing erythroid differentiation were able to stimulate autologous T cells. There was a difference in the expression of CD80, CD83 and CD86 among CD11c(+) cells induced by G-CSF plus TNF-alpha and those generated by interleukin-3, stem cell factor, and erythropoietin plus TNF-alpha. These results indicate that the co-stimulation of human CD34(+) cells with G-CSF and TNF-alpha induces the phagocytosis of co-developing neutrophil progenitors by DCs, and the stimulatory effects of these DCs on autologous T cells is different from that of DCs generated from CD34(+) cells during erythroid differentiation. 相似文献
995.
Charles J. Bruce Paul A. Friedman Om Narayan Thomas M. Munger Stephen C. Hammill Douglas L. Packer Samuel J. Asirvatham 《Journal of interventional cardiac electrophysiology》2008,22(3):211-219
INTRODUCTION: We reviewed our experience in managing intracardiac ultrasound-detected left atrial thrombus and analyzed the impact of the timing of heparin therapy on thrombus incidence. METHODS AND RESULTS: We identified 508 patients undergoing ablation procedures for atrial fibrillation in which intracardiac ultrasound was used. All patients received unfractionated heparin during the procedure: 31 patients before the first transseptal puncture (preTS1), 257 between the first and second transseptal punctures (TS1-TS2), and 220 following both punctures (postTS2). By using intracardiac echocardiography (ICE), thrombus was detected in 30 of these 508 patients (5.9%). Of these, 29 were in the left atrium and constituted our study group. In 21 patients, the thrombi were successfully aspirated from the left atrium using strong suction through the transseptal sheath. All patients in whom thrombi were aspirated did well without neurological event or death. When patients received heparin therapy either preTS1 or TS1-TS2, there was a significant decrease in the occurrence of ICE-detected left atrial thrombus compared with those who received heparin postTS2 (0 of 31 patients (0%) preTS, 9 of 257 (3.5%) TS1-TS2, and 20 of 220 (9.1%) postTS2; (preTS1 vs postTS2, p = 0.01; preTS2 [preTS1 and TS1-TS2] vs postTS2, p < 0.001). CONCLUSION: Early administration of intravenous heparin, specifically before transseptal puncture, decreases the incidence of left atrial thrombi. 相似文献
996.
Takenaka R Kawahara Y Okada H Tsuzuki T Yagi S Kato J Ohara N Yoshino T Imagawa A Fujiki S Takata R Nakagawa M Mizuno M Inaba T Toyokawa T Sakaguchi K 《Gastrointestinal endoscopy》2008,67(2):359-363
BACKGROUND: Endoscopic submucosal dissection (ESD) of early gastric cancer is less invasive than surgical resection, and if technically feasible, it may result in less long-term morbidity than does incisional surgery. However, ESD is technically difficult in patients who have had a previous distal gastrectomy. OBJECTIVE: Our purpose was to retrospectively assess the results of ESD of early gastric cancer in the remnant stomach. DESIGN: Case series. SETTING AND PATIENTS: A total of 31 lesions in 30 patients with early remnant gastric cancer were treated with ESD at Okayama University Hospital, Tsuyama Central Hospital, Hiroshima City Hospital, Kagawa Prefectural Central Hospital, and Mitoyo General Hospital from March 2001 to January 2007. INTERVENTION: ESD. MAIN OUTCOME MEASUREMENTS: En bloc resection rate, complete resection rate, operation time, and complications. RESULTS: En bloc resection and complete resection were achieved in 30 (97%) and in 23 (74%) lesions, respectively. The median operation time required for ESD in the remnant stomach was 113 minutes (range 45-450 minutes). Perforation occurred in 4 (13%). The incidence of delayed bleeding requiring blood transfusion was 0%. LIMITATION: Short duration of follow-up. CONCLUSIONS: ESD is feasible in the remnant stomach but has a relatively high complication rate and should only be performed by experienced endoscopists. 相似文献
997.
998.
999.
Lisa Armistead Nada Goodrum Marya Schulte William Marelich Rebecca LeCroix Debra A. Murphy 《AIDS and behavior》2018,22(12):3807-3814
Nondisclosure of maternal HIV status to young children can negatively impact child functioning; however, many mothers do not disclose due to lack of self-efficacy for the disclosure process. This study examines demographic variations in disclosure self-efficacy, regardless of intention to disclose, and assesses the relationship between self-efficacy and child adjustment via the parent–child relationship among a sample of HIV+ mothers and their healthy children (N = 181 pairs). Mothers completed demographic and self-efficacy measures; children completed measures assessing the parent–child relationship and child adjustment (i.e., worry, self-concept, depression). Across demographics, few mothers reported confidence in disclosure. Results from covariance structural modeling showed mothers endorsing higher self-efficacy had children who reported better relationship quality, and, in turn, reported fewer adjustment difficulties; higher levels of disclosure self-efficacy also directly predicted fewer adjustment problems. Findings offer support for interventions aimed at providing mothers with skills to enhance confidence for disclosing their HIV status. 相似文献
1000.
Kurt Kroenke Tasneem L. Talib Timothy E. Stump Jacob Kean David A. Haggstrom Paige DeChant Kittie R. Lake Madison Stout Patrick O. Monahan 《Journal of general internal medicine》2018,33(8):1245-1252