A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. California Collaborative Treatment Group

BACKGROUND. Pneumocystis carinii pneumonia remains a common cause of serious morbidity and mortality in patients with the acquired immunodeficiency syndrome (AIDS). The extensive lung injury that accompanies pneumocystis-associated respiratory failure and the reports of clinical benefit from the use of adjunctive corticosteroids provided the rationale for this prospective multicenter trial. METHODS. A total of 333 patients with AIDS and pneumocystis pneumonia received standard treatment and were randomly assigned to receive either corticosteroids (beginning with the equivalent of 40 mg of prednisone twice daily) or no additional therapy. The primary end points in this unblinded trial were the occurrence of respiratory failure (hypoxemia ratio [partial pressure of arterial oxygen divided by fraction of inspired oxygen] less than 75, intubation, or death), death, and dose-limiting toxicity of the initial standard therapy. RESULTS. Of the patients with confirmed or presumed pneumocystis pneumonia (n = 225 and n = 26, respectively), those assigned to treatment with corticosteroids had a lower cumulative risk at 31 days of respiratory failure (0.14 vs. 0.30, P = 0.004) and of death (0.11 vs. 0.23, P = 0.009), as well as a lower risk of death within 84 days (0.16 vs. 0.26, P = 0.026). The frequency of dose-limiting toxicity of the standard therapy was similar in the two treatment groups. Intention-to-treat analyses of the entire cohort confirmed these findings. Clinical benefit could not be demonstrated, however, for patients with mild disease (hypoxemia ratio, greater than 350), equivalent to a partial pressure of oxygen greater than 75 torr on room air. The patients assigned to corticosteroid treatment had an excess of localized herpetic lesions (26 percent vs. 15 percent, P = 0.04) but not of other infections or of neoplasms. CONCLUSIONS. Early adjunctive treatment with corticosteroids reduces the risks of respiratory failure and death in patients with AIDS and moderate-to-severe pneumocystis pneumonia. Because the adverse effects are few, corticosteroids should be included as part of the initial treatment for persons with AIDS who have moderate-to-severe pneumocystis pneumonia.     

Effects of health information in youth on adult physical activity: 20‐Year study results from the Amsterdam growth and health longitudinal study

In the Amsterdam Growth and Health Longitudinal Study (AGAHLS), a group of apparently healthy males and females (n = 200) were interviewed about their physical activities on eight separate occasions over a period of 20 years between 13 and 33 years of age (multi‐measured group: MM). Information about their health was given based on their personally measured lifestyle (activity, diet, smoking) and biological risk characteristics for chronic diseases (medical check‐ups). A comparable group of boys and girls (n = 200) was only measured on two occasions (bi‐measured group: BM): at 13 and 33 years. Physical activity was estimated with a structured interview. Total physical activity and sports activity were estimated in three intensity levels (light, moderate, and heavy). It was hypothesized that the eight repeated medical check‐ups with health information in the MM group would result in a healthier lifestyle with respect to the determinants and levels of habitual physical activity compared to the BM group. Contrary to the hypothesis, males and females in the BM group showed a significantly higher increase or a lower decrease in physical activities compared to the MM group. This negative effect on the physical activity pattern at 33 years in the MM group may have been caused by more underreporting of physical activities than in the BM group. In conclusion, there does not appear to be a significant effect of long‐term (multi‐measured) health information with medical check‐ups during adolescence and young adulthood on level of physical activity in males and females at 33 years of age. Am. J. Hum. Biol. 14:448–456, 2002. © 2002 Wiley‐Liss, Inc.     

Longitudinal relationships between nutritional status, body composition, and physical fitness in rural children of South Africa: The Ellisras longitudinal study.

The objective of this study was to investigate the development and tracking of nutritional status, body composition and physical fitness, and the longitudinal relationship of changes in nutritional status, and body composition with changes in physical fitness over a 1-year period of follow-up. Studied were 380 boys and 322 girls aged 7-14 years from the Ellisras Longitudinal Study. Boys and girls were divided into two groups of pre-adolescence (<11 years) and adolescence (>10 years). High tracking coefficients (>8) were found for nutritional status, body mass index, and fat-free mass, while low tracking coefficients (<4) were found for the sum of skinfolds, fat mass, arm muscle area, and central fat distribution. Moderate and low tracking coefficients were found for the physical fitness items. Longitudinal regression analyses showed that physical fitness performances that require a high energy flux over a short period of time are affected by muscle wasting, whereas having a low body weight appears to be important for a good performance on other fitness items in these malnourished rural South African children.     

Immunocytochemical localization of dopamine-beta-hydroxylase in neurons of the human brain stem

The distribution of catecholaminergic cells in the human pons and medulla was illustrated by immunocytochemistry using a polyclonal antibody directed against the catecholamine synthetic enzyme, dopamine-beta-hydroxylase. The antibody specifically recognizes dopamine-beta-hydroxylase in putative adrenergic and noradrenergic neurons. The adrenergic and noradrenergic neurons are found in the brain stem from caudal levels of the medulla through the caudalmost levels of the midbrain. Large numbers of dopamine-beta-hydroxylase-positive cells were observed in cell groups of the medulla. Additionally, dopamine-beta-hydroxylase-positive cells were concentrated in the nucleus locus coeruleus and the nucleus subcoeruleus in the pons. These studies confirm that immunocytochemical localization of dopamine-beta-hydroxylase can be used to identify noradrenergic and adrenergic neurons and their terminal varicosities in the pons and medulla in routine autopsy material. These studies have also illustrated that the distribution of dopamine-beta-hydroxylase in the adult human brain is comparable to the distribution in other species.     

Anorexia nervosa and affective disorders: a controlled family history study

Analysis of family history information from a prospectively studied group of 40 young female patients with anorexia nervosa and 23 normal control female subjects of similar age showed more depression and substance use disorders in first- and second-degree relatives of anorexia nervosa patients. Further, the pedigrees of the patients differed significantly from those of the control subjects in the higher frequency of depression and substance use disorders in consecutive generations and in the family "loading" of these disorders. These findings, consistent with previous reports, add to the growing evidence of an association between anorexia nervosa and familial risk for affective and related disorders.     

病灶清除内固定植骨治疗胸椎结核

目的;探讨手术治疗胸椎结核的更好方法。方法;自１９９０年以来,对２１例胸椎结核导致椎柱不稳的患者,应用病灶清除,哈氏棒内固定,椎间及椎板植骨的手术方法。本组平均３３．２岁。胸７椎体６例,胸８椎体８例,胸１０椎体７例,椎体压缩〈１／２椎体高度１３例,〉１／２椎体高度８例,并不全瘫１４例。手术中先行病灶清除,然后哈氏棒内固一,撑开后再次清除病灶,取肋骨和髂骨行椎间及椎板上植骨。术后化疗１２～１５月。结