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S Sandra Carvalho-Bos Rixt F Riemersma-van der Lek Jim Waterhouse Thomas Reilly Eus J W Van Someren 《The American journal of geriatric psychiatry》2007,15(2):92-100
OBJECTIVE: The objective of this study is to investigate the association between actigraphic estimates of the sleep-wake rhythm and a range of functional domains that contribute to well-being in demented elderly patients. METHOD: Eighty-seven women aged 85.5 +/- 5.9 years (mean +/- standard deviation) wore an actigraph for two weeks. Activity profiles were analyzed using nonparametric variables, including dichotomy indices, interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA). The associations between these variables and cognitive, functional, behavioral, and emotional states (obtained from standardized neuropsychologic assessments and questionnaires administered to caregivers) were investigated by partial correlations and stepwise regressions. RESULTS: Cognitive, functional, behavioral, and emotional states showed medium to strong correlations with multiple rhythm variables. Partial correlations indicated that this could not be attributed to a uniform worsening with advancing cognitive decline. Stepwise regressions indicated three most distinctive rhythm variables: 1) the interdaily stability of the 24-hour rhythm was most strongly, negatively, related to cognitive decline and depression; 2) the median level of daytime activity was most strongly, negatively, related to impairments of function, of activities of daily living, and of social interaction; and 3) nocturnal restlessness was secondarily, positively, related to impairments of function and social interaction. CONCLUSION: Especially the interdaily stability and median daytime activity level, and secondarily nocturnal restlessness, showed a strong relationship with the functional status and well-being of demented elderly. This raises the possibility that treatments that enhance daytime activity and the stability of the rest-activity rhythm may improve well-being. 相似文献
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Ralph Madeb Dragan Golijanin Joy Knopf Craig Nicholson Stuart Cramer Frederick Tonetti Kelly Piccone John R. Valvo Louis Eichel 《Journal of robotic surgery》2007,1(2):145-149
Several recent studies have suggested that thought leaders in radical prostatectomy have decreased their own positive margin
rates by switching from open to robot-assisted radical prostatectomy. Theoretically, this improvement is largely attributed
to enhanced visualization of the deep pelvis and precision of dissection afforded by the instrumentation. To date, it has
not been determined if this phenomenon exists amongst non-fellowship-trained urologists in private practice. Herein, we describe
the positive margin rates of two non-fellowship-trained private-practice urologists who converted from open radical retropubic
prostatectomy to robot-assisted radical prostatectomy. The margin positivity data from two non-fellowship-trained private-practice
urologists (surgeon 1 and surgeon 2) were reviewed retrospectively. The last 50 cases of open radical retropubic prostatectomy
from each surgeon were compared with the first 50 robotic prostatectomy cases of surgeons 1 and 2, respectively. A positive
surgical margin was defined as tumor present at the inked margin of the prostate. There was a significant decrease in the
overall and pT2 positive margin rates for both surgeons. The overall positive margin rate and pT2 positive margin rate for
surgeon 1 dropped from 44 to 20% and from 37 to 5.7%, respectively, after changing from open to robotic prostatectomy. For
surgeon 2, the overall positive margin rate changed from 26 to 18% and the pT2 positive margin rate changed from 27.5 to 7%
after converting. Changing from open to robotic-assisted radical prostatectomy may improve the ability of urologists to obtain
negative surgical margins. With proper training this phenomenon does seem to apply to non-fellowship-trained urologists in
private practice and can be realized within the first 50 cases performed. 相似文献
197.
BACKGROUND: We assessed suicide and suicide attempt risk as well as symptom reduction among 3,282 depressed patients participating in duloxetine and escitalopram clinical trials assigned to either an antidepressant or placebo. METHODS: We reviewed the FDA Summary Basis of Approval reports for data regarding safety and efficacy for duloxetine and escitalopram. Furthermore, we compared suicide risk among antidepressant clinical trials in this study with our two previous analyses on seven antidepressant clinical trials. RESULTS: Suicide and suicide attempt risk varied considerably among the three analyses, showing up to ten fold differences. Interestingly, the variability exists across the three reports, rather than between treatments (antidepressants versus placebo). CONCLUSIONS: These findings suggest caution in generalizing suicide risk even from a relatively large number of participants and thus, firm conclusions can only be drawn if the number of participants is overwhelmingly large (approximately two million patients). We also noted similar magnitude of response to placebo and antidepressants among the three studies. 相似文献
198.
Edward D Moloney Jim J Egan Peter Kelly Alfred E Wood Leslie T Cooper 《The Journal of heart and lung transplantation》2005,24(8):1103-1110
Myocarditis is a major cause of end-stage heart failure and is responsible for up to 10% of cases of idiopathic dilated cardiomyopathy (IDC). Worldwide, approximately 45% of all heart transplants are performed for IDC and up to 8% for myocarditis. Early reports suggested that survival after transplantation for myocarditis was poor and patients had an increased risk of rejection. More recently, larger case series suggest that overall survival after transplantation for myocarditis is similar to survival after transplantation for other causes. However, certain disorders, including cardiac sarcoidosis and giant cell myocarditis (GCM), require heightened surveillance for post-transplantation disease recurrence. We present the case of a 42-year-old man with recurrence of GCM 8 years after transplantation and review the literature on the role of cardiac transplantation for patients with myocarditis. 相似文献
199.
Sandra Harris 《Clinical & experimental optometry》2003,86(1):51-56
Age‐related macular degeneration is a major cause of serious vision loss. The earliest stages of age‐related maculopathy may be defined by the size of the drusen present in the macula and the effects on vision. Further manifestations may include soft drusen, choroidal neovascularisation, macular haemorrhage and cicatricial or disciform degeneration of the macula. This report describes a patient with a macular haemorrhage, a choroidal neovascular membrane and serious loss of vision. In addition, the pathogenesis, diagnosis and treat‐ment options of macular degeneration are reviewed. 相似文献
200.
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