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41.
42.
The aim of our study was to observe the induction of panic attacks by hyperventilation in a group of panic disorder and social phobia patients (DSM-IV). We randomly selected 26 panic disorder patients, 22 social phobics and 25 normal volunteers. They were drug-free for 1 week. Hyperventilation (30 breaths/min) was induced for 3 min. Anxiety scales were taken before and after the test. 61.5% (n = 16) of panic disorder patients, 22.7% (n = 5) of social phobics and 4.0% (n = 1) of control subjects had a panic attack after hyperventilating (p < 0.01, panic disorder vs. control; p < 0.05, panic disorder vs. social phobia; p = n.s., social phobia vs. control). Both anxiety disorder groups were more sensitive to hyperventilation than normal volunteers. The induction of panic attacks by voluntary hyperventilation may be an easy and useful test for validating the diagnosis in some specific panic disorder patients. 相似文献
43.
44.
Mechanics of intercostal space and actions of external and internal intercostal muscles. 总被引:4,自引:0,他引:4 下载免费PDF全文
It is conventionally considered that because of their fiber orientations, the external intercostal muscles elevate the ribs, whereas the internal interosseous intercostals lower the ribs. The mechanical action of the intercostal muscles, however, has never been studied directly, and the electromyographic observations supporting this conventional thinking must be interpreted with caution. In the present studies, the external and internal interosseous intercostal muscles have been separately stimulated in different interspaces at, above, and below end-expiratory rib cage volume in anesthetized dogs. The axial (cephalo-caudal) displacements of the ribs were measured using linear displacement transducers. The results indicate that when contracting in a single interspace and other muscles are relaxed, both the external and internal intercostals have a net rib elevating action at end-expiratory rib cage volume. This action increases as rib cage volume decreases, but it progressively decreases as rib cage volume increases such that at high rib cage volumes, both the external and internal intercostals lower the ribs. Stimulating the intercostal muscles in three adjacent intercostal spaces simultaneously produced similar directional rib motion results. We conclude that (a) in contrast with the conventional thinking, the external and internal interosseous intercostals acting alone have by and large a similar effect on the ribs into which they insert; (b) this effect is very much dependent on rib cage (lung) volume; and (c) intercostal muscle action is primarily determined by the resistance of the upper ribs to caudad displacement relative to the resistance of the lower ribs to cephalad displacement. The lateral intercostals, however, might be more involved in postural movements than in respiration. Their primary involvement in rotations of the trunk might account for the presence of two differently oriented muscle layers between the ribs. 相似文献
45.
Segal I; Sharer NM; Kay PM; Gutteridge JM; Braganza JM 《QJM : monthly journal of the Association of Physicians》1996,89(1):45-53
Vitamin C can be used to overcome oxidative stress and ease pain in chronic
pancreatitis. But its use is deprecated in conditions of tissue iron
overload, because its bioactive form, ascorbate, can accelerate
free-radical reactions that are driven by transition metals. We measured
iron, ascorbate and copper in Sowetan Blacks (RSA) with chronic
pancreatitis, obtaining serum/plasma from 14 consecutive patients and 15
controls. Compared with data from corresponding groups in Manchester,
African samples had less ascorbate (p < 0.0001), but more caeruloplasmin
(p < 0.0001). African and British controls had comparable iron and
iron-binding capacity. Plasma from African patients had less ascorbate than
that from African controls (p < 0.005) and in six samples, ferritin
exceeded 300 micrograms/l (677 pmol/l). Low- molecular-mass iron or copper,
capable of participating in free radical reactions, was not detected.
British patients, had similar caeruloplasmin levels to African patients but
higher ascorbate levels. There is no evidence of iron overload in our
African samples. Outwardly healthy controls from Soweto have elevated
levels of caeruloplasmin, possibly to compensate for dietary deficiency of
ascorbate. Persistent oxidative stress is a unifying feature of chronic
pancreatitis, but its degree is higher in African than British patients.
Supplements of vitamin C should be safe in Blacks of southern Africa.
相似文献
46.
To determine the cause of a positive direct antiglobulin test (DAT), blood banks routinely perform serologic tests on eluates prepared from DAT-positive red cells. Negative eluates traditionally have been suspected to be associated with drug reactions. This report confirms that the most frequent cause of a positive DAT and a nonreactive eluate is hypergammaglobulinemia. The results of 74 patient samples with positive DATs were analyzed retrospectively. Eluates prepared from the red cells of 54 patients (72.9%) reacted; eluates from 20 patients (27.1%) did not react. This latter group had identical serologic and clinical findings, suggesting that they made up a homogeneous group. In particular, the patients had a positive DAT, a negative indirect antiglobulin test, and a negative eluate; an increased serum concentration of IgG; and no evidence of hemolysis. In a subsequent study, DATs were performed prospectively on red cells from 44 consecutive patients with elevated serum IgG levels. The serum IgG concentration was highest in the three patients whose red cells had a positive DAT. The DAT also became positive in two patients treated with high-dose intravenous gammaglobulin (IV IgG). These studies indicate that a negative eluate from red cells with a positive DAT, a common serologic finding, is often caused by hypergammaglobulinemia. The authors postulate that IgG binds nonspecifically to the red cells because of the hypergammaglobulinemia. 相似文献
47.
QUADAS评价:一种用于诊断性研究的质量评价工具(修订版) 总被引:2,自引:0,他引:2
背景 QUADAS是一种新近发展起来的诊断性研究的质量评价工具。虽然已有系统评价采用了QUADAS,但尚未得以正式确证。本研究的目的是评价QUADAS的有效性和实用性。方法3位评价者采用QUADAS独立评价30项研究的质量。比较每位评价者的评分与最终结论之间的意见一致度。这主要是通过比较所有QUADAS条目的总分和每个单项的得分来实现的。20位曾在其系统评价中使用过QUADAS的评价者就其使用经验完成一份简短的问卷。结果就所有条目而言,每位评价者的评分与最终结论之间的意见一致度分别达到了91%、90%和85%。就单项QUADAS条目而言,一致度在50%至100%之间,中位值是90%。与难以解释的试验结果和退出病例相关的条目,评分结果差异最大。有关QUADAS内容的反馈意见普遍较好,仅少数评价者提出了有关QUADAS涵盖面、使用便利性、评分说明的清晰度及有效性方面的问题。结论QUADAS内容本身无需作大的修改。评价过程的主要困难出现在难以解释的试验结果和退出病例这2个条目的评分上。对这些条目的评分指南提出了修改意见。评价者必需根据其系统评价制定相应的评分指南,并确保所有评价者都清楚如何评分。评价者还应考虑是否所有的QUADAS条目都与其系统评价相关,以及其他质量条目是否应作为其系统评价的评价部分。 相似文献
48.
Winning the battle but losing the war: methicillin-resistant Staphylococcus aureus (MRSA) infection at a teaching hospital 总被引:2,自引:0,他引:2
Farrington M; Redpath C; Trundle C; Coomber S; Brown NM 《QJM : monthly journal of the Association of Physicians》1998,91(8):539-548
A methicillin-resistant Staphylococcus aureus (MRSA) control policy, aimed
at eradication, was established at a 1000-bed hospital in 1985, applied
consistently for 10.5 years, and then relaxed. Its components included
screening of high-risk patients, transfer of carriers to exhaust-ventilated
isolation rooms, closure of wards to new admissions when local transmission
was detected, MRSA screening during outbreaks, and prospective collection
of clinical and epidemiological information. During the eradication policy
period, every 6 months, a mean of 5.1 patients (range 1-12) already
carrying MRSA were admitted, and a mean of 3.6 (range 0-16) acquired
carriage in the hospital. The largest outbreak comprised 11 patients
despite epidemic MRSA strain EMRSA-16 being introduced six times, and MRSA
did not become endemic. MRSA- positive admissions increased progressively
from 1993; nursing staff workload increased, areas available for
alternative patient accommodation were reduced, the resulting ward closures
interfered with clinical services, and hence the control policy was relaxed
in mid- 1995. Isolation facilities were overwhelmed with 622 new patient-
isolates in the next 18 months, and there were 67 clinical infections in
1996. The proportion of blood cultures positive for MRSA rose nearly
sevenfold by 1996 and 27-fold by 1997. Thus, repeated eradication of MRSA,
even epidemic strains, by use of a stringent policy, is possible given
sufficient resources, whereas flexible national guidelines designed to
control, but not eradicate, epidemic staphylococci, are currently unlikely
to be successful. The costs of eradication policies need to be weighed
against those of endemicity.
相似文献
49.
JM Ranson NM Pantelides D Gharpuray Pandit JKG Laitung 《Journal of plastic, reconstructive & aesthetic surgery》2018,71(9):1269-1273
Objectives
The ‘10% rule’ has become widely accepted by surgeons performing sentinel lymph node biopsy (SLNB) for melanoma. The purpose of this study was to compare the ‘10% rule’ with alternative node harvesting criteria. In particular, we were interested to see whether the use of blue dye had any impact on the sensitivity of the test and whether it is necessary to remove all hot nodes.Methods
We reviewed 537 SLNBs performed for primary melanoma from 2009–2015. SLNB was offered to all patients with 1–4?mm Breslow thickness melanoma and sentinel nodes were harvested according to the ‘10% rule’.Results
One hundred sixteen patients (22%) had at least one positive sentinel node and there were 45 positive nodal basins from which more than one sentinel node had been harvested. Excluding blue dye and sampling only hot nodes would have enabled a 5% reduction in nodes harvested, without any compromise in the sensitivity of the test. However, applying harvesting criteria whereby not all hot nodes are taken was associated with a loss of sensitivity, with positive sentinel nodes being missed and patients understaged.Conclusions
Our data do not support the continued use of blue dye in SLNB for melanoma, as it does not improve the sensitivity of the test. This series adds to growing evidence, suggesting that the ‘10% rule’ with the inclusion of blue nodes should be reconsidered and that radiocolloid tracer alone is sufficient for sentinel node localisation. 相似文献50.
Soulard V Amadoudji Zin M Fitting C Ibitokou S Oesterholt M Luty AJ Perrin RX Massougbodji A Deloron P Bandeira A Fievet N 《Infection and immunity》2011,79(7):2801-2809
In areas where Plasmodium falciparum is endemic, pregnancy is associated with accumulation of infected red blood cells (RBCs) in the placenta, a condition referred to as placental malaria (PM). Infants born to PM-positive mothers are at an increased risk of malaria, which is putatively related to the transplacental passage of parasite-derived antigens, with consequent tolerization of the fetal immune system. Here we addressed the impact of PM on the regulation of neonatal T cell responses. We found that the frequency of regulatory CD25(+) CD127(-/low) Foxp3(+) CD4(+) T cells was significantly decreased in neonates born to mothers with high levels of P. falciparum-induced placental inflammation, consisting mainly of primigravid mothers. However, at the individual level, the ratio between regulatory and effector (CD25(+) CD127(+) Foxp3(-)) CD4(+) T cells was unaffected by PM. In addition, parasite-induced CD4(+) T cell activation and production of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and IL-10 were strongly reduced in neonates born to PM-positive mothers. Thus, our results show that active PM at delivery is associated with a marked suppression of P. falciparum-specific cellular neonatal immune responses, affecting secretion of both pro- and anti-inflammatory cytokines. Additionally, our results suggest that, as in adults, effector and regulatory CD4(+) T cell populations are tightly coregulated in all neonates, irrespective of the maternal infection status. 相似文献