Feeding and neuroendocrine responses after recurrent insulin-induced hypoglycemia

Prior exposure to hypoglycemia impairs neuroendocrine counterregulatory responses (CRR) during subsequent hypoglycemia. Defective CRR to hypoglycemia is a component of the clinical syndrome hypoglycemia-associated autonomic failure (HAAF). Hypoglycemia also potently stimulates food intake, an important behavioral CRR. Because the increased feeding response to hypoglycemia is behavioral and not hormonal, we hypothesized that it may be regulated differently with recurrent bouts of hypoglycemia. To test this hypothesis, we simultaneously evaluated neuroendocrine CRR and food intake in rats experiencing one or three episodes of insulin-induced hypoglycemia. As expected, recurrent hypoglycemia significantly reduced neuroendocrine hypoglycemic CRR. Epinephrine (E), norepinephrine (NE) and glucagon responses 120 min after insulin injection were significantly reduced in recurrent hypoglycemic rats, relative to rats experiencing hypoglycemia for the first time. Despite these neuroendocrine impairments, food intake was significantly elevated above baseline saline intake whether rats were experiencing a first (hypoglycemia: 3.4+/-0.4 g vs. saline: 0.94+/-0.3 g, P<0.05) or third hypoglycemic episode (hypoglycemia: 3.8+/-0.3 g vs. saline: 1.2+/-0.3 g, P<0.05). These findings demonstrate that food intake elicited in response to hypoglycemia is not impaired as a result of recurrent hypoglycemia. Thus, neuroendocrine and behavioral (stimulation of food intake) CRR are differentially regulated by recurrent hypoglycemia experience.     

大前庭水管综合征患者鼓膜吸收率特征初探

目的 探讨大前庭水管综合征(Large Vestibular Aqueduct Syndrome,LVAS)患者宽频声导抗(Wideband Acoustic Immittance,WAI)测试中的声导抗峰压值的鼓膜吸收率特征.方法 选取40例经CT确诊大前庭水管综合征患者,进行声导抗峰压值的鼓膜吸收率测试,并收集相同...     

完美主义与自尊、应对方式的关系研究

目的探讨大学生完美主义与自尊和应对方式的关系。方法以南京3所大学的496名大学生为研究对象,采用大学生完美主义量表修订版、自尊量表(SES)以及应付方式问卷施测,用SPSS与AMOS进行统计分析。结果相关分析与结构方程模型检验显示完美主义与自尊呈显著负相关,自尊与消极应对方式呈显著负相关,以自尊为中介变量的部分中介模型的拟合指数:χ2=135.146、df=33、χ2/df=4.095、RMSEA=0.079、CFI=0.937、NFI=0.920。各项指标比较理想,较准确的反映了三者之间的关系。结论自尊在完美主义与消极应对之间起部分中介作用。自尊较好地缓解了完美主义者高标准没有达到时的负性心理,使其向积极的情绪转化,从而采取积极的应对方式。     

Concordance of Patient-Physician Obesity Diagnosis and Treatment Beliefs in Rural Practice Settings

CONTEXT: Although clinical guidelines recommend routine screening and treatment for obesity in primary care, lack of agreement between physicians and patients about the need for obesity treatment in the primary care setting may be an unexplored factor contributing to the obesity epidemic. PURPOSE AND METHODS: To better understand this dynamic, we surveyed 439 obese patients (body mass index >or=30) at the time of clinic visits in 2003 at diverse primary care settings in rural Kansas and conducted same-day interviews with their physicians (N = 28). We used Spearman's correlation to describe and compare patient and physician responses. FINDINGS: Most patients were women (66%). Their mean age was 55.8 years, and mean body mass index was 37.7. Half (51%) reported discussing their weight on that visit date. Overall, 51% of patients wanted to discuss weight more often with their physician and 54% wanted to discuss weight sooner. Patients and physicians gave similar assessments of the patient's preference for discussing weight loss, how often weight was discussed at visits, and the patient's motivation for weight loss. Spearman's correlations on these variables were .33, .54, and .25, respectively (all P < .001). CONCLUSIONS: These patients and their physicians demonstrated a weak to moderate agreement on several variables crucial to initiating and continuing obesity care. Understanding patient and provider beliefs and preferences regarding obesity diagnosis and treatment is essential in designing obesity interventions for primary care.     

An exploration of emotional response to erotic stimulation in men with premature ejaculation: effects of treatment with clomipramine

Emotions presumably play an important role in sexual response and dysfunction in men. Yet, few studies have investigated differences in affect between sexually dysfunctional and functional men or changes in dysfunctional men resulting from successful treatment. We compared men having premature ejaculation (PE) with sexually functional counterparts on positive and negative affects, and examined changes in their affective response to pharmacotherapeutic treatment with clomipramine, an ejaculation-retarding agent. Results indicated higher levels of specific negative affects in PE men than controls. Positive affect also differed among groups, and showed variation in response to erotic stimulation and drug treatment. When specific positive affects were analyzed, they diverged in their response to stimulus and drug manipulations. For example, all groups exhibited a decrease in arousal/sensual during clomipramine treatment, but only PE men who responded positively to pharmacological treatment exhibited significant elevation in their enjoyment of the sexual experience. The fact that alleviation of the dysfunction improved positive affect in PE men responsive to clomipramine argues for the efficacy of pharmacotherapy in promoting positive emotional experiences associated with sexual response. But the failure of negative affects to approximate the low levels typical of sexually functional men also suggests the need to consider nonpharmacological methods to ensure complete reinstatement of healthy sexual response.     

Ecologic correlates of obesity in rural obese adults

OBJECTIVE: We examined relationships of individual and environmental factors with obesity and trying to lose weight in rural residents. METHODS: The joint contributions of individual and environmental factors on obesity status (obese vs. morbidly obese) and trying to lose weight (yes vs. no) were evaluated using generalized estimating equations. Patients at 29 clinics in rural areas (N = 414, M age 55.0 years (SD = 15.4), 66.3% female) completed anthropometric assessments of weight and height along with survey assessments of individual sociodemographics and trying to lose weight. Rural environments were assessed on aggregated physician access, and sociodemographic context. RESULTS: Most participants (70%, M BMI = 38.3) were obese and 30% morbidly obese. A majority (73%, n = 302) of the sample was trying to lose weight. Compared to obese, morbidly obese participants were more likely to be younger, disproportionately female, not have private insurance, have more comorbid conditions, and rate themselves in worse health in comparison to their obese peers. Compared to not trying to lose weight, trying to lose weight participants were more likely to be younger, disproportionately female, have fewer comorbid conditions, and have attempted to lose weight more times through exercise. Few relationships were seen between environmental variables and obesity or trying to lose weight. CONCLUSIONS: There was no consistent pattern of relationships between environment factors and obesity or trying to lose weight was seen. Unique aspects of rural living may not be captured by traditionally available neighborhood measures.     

1 702 例食管鳞状上皮癌家族史与发病及预后关系的研究*

目的:通过研究家族史阳性或阴性与食管鳞癌发病年龄、多原发癌灶以及预后的关系,揭示遗传易感性在食管鳞癌发生发展过程中的作用。方法:对河北医科大学第四医院1985 年1 月至 1994 年12 月手术切除的来自高发区的476 例家族史阳性和 1 226例家族史阴性食管鳞癌的发病年龄、原发癌灶数量和生存曲线进行比较。结果:全组病例家族性食管鳞癌比散发鳞癌发生年龄显著提前（51 .9±8.2 vs 53 .4±8.0,P t-test=0.00 ）,双灶鳞癌发生率显著升高（2.7% vs 1.2%,adjusted with TNM:χ2MH=4.029,P=0.045）;生存时间显著降低（Pwald =0.04 ）。亚组分析多数显示家族性食管鳞癌与散发鳞癌之间发病年龄和生存曲线具有差别,发病年龄差别较大的亚组,生存率的差别较明显;发病年龄和预后的关系密切,如在Tis 、T1N0M0、T2,3N0M0 和T2-4N1M0 组发病年龄差别的t 检验、P 值分别为0.01 、0.01 和0.09 ;生存曲线的 ward 检验 P 值分别为 0.01 、0.52 和0.18 。结论:本文用临床病理和生存资料证实,高发区食管鳞癌的发生存在遗传易感性,该遗传易感性可理解为肿瘤二次突变学说中的第一次突变,对食管鳞癌的发生和预后都有影响。      

Predictors of Mortality in Patients with Delirium Tremens

Objectives:  The objectives were to identify factors that may help predict mortality for patients with delirium tremens (DT).
Methods:  The authors conducted a 1:1 gender- and age-matched case–control study of patients hospitalized for DT. Using McNemar chi-square tests and conditional logistic regression (CLR), risk factors for death, including demographics, location of diagnosis, vital sign derangements, treatment methods, and comorbid conditions, were evaluated. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported.
Results:  Thirty-five patients with DT died between January 2000 and June 2006. The majority (31; 88.6%) were male with a mean (±standard deviation [SD]) age of 51.7 (±7.6) years. Hyperthermia in the first 24 hours of DT diagnosis (OR = 10.0, 95% CI = 2.3 to 42.7), persistent tachycardia (OR = 24.0, 95% CI = 3.3 to 177.4), and use of restraints (OR = 7.50, 95% CI = 1.7 to 32.8) were associated with increased mortality by univariate analysis, while an emergency department (ED) diagnosis of DT (OR = 0.18, 95% CI = 0.05 to 0.6) and use of clonidine (OR = 0.10, 95% CI = 0.01 to 0.78) were associated with decreased mortality. In the CLR model, restraint use and hyperthermia were the only variables that remained significant (OR = 5.8, 95% CI = 1.0 to 32.2; and OR = 6.1, 95% CI = 1.2 to 30.4, respectively).
Conclusions:  The use of restraints and hyperthermia is associated with increased odds of death for patients with DT. This study highlights the need for further research into modifiable factors influencing mortality from DT.