Circadian growth hormone and prolactin blood concentration during a self-limited viral infection and artificial hyperthermia in man

Growth hormone and prolactin blood concentrations were measured in five human volunteers over 28-hour periods including 24 hourly samples (0800 to 0800 hours) followed by an oral glucose tolerance test (0800 to 1100 hours) both preexposure and during the peak febrile phase of a self-limited viral infection, Sandfly fever. Several months after recovery, three of the subjects were studied for 24-hour periods while they sat in a tub of water at 41 degrees C for 2 hours from 1300 to 1500 hours. During all studies, mealtimes (0800 hours, 1130 hours, 1630 hours) and dark phase (2300 to 700 hours) were fixed. Growth-hormone concentrations were strikingly elevated throughout the 24-hour study done during the febrile period of Sandfly fever infection (P less than .01) except for the period of normal nocturnal release when they were not significantly different from the baseline study. No additional nocturnal surge was noted the already elevated growth-hormone values during the viral-induced fever. Growth-hormone values tended to decline slowly during the night but increased considerably during the glucose-tolerance test the following morning. These changes were similar to responses previously reported in patients with cases of malnutrition. A clear-cut increase in growth-hormone concentrations (P less than .001) was also seen during a brief 2-hour period of artificial hyperthermia, suggesting that elevated body temperature alone may explain part of the increase in growth-hormone values seen during the fever of infection. A nocturnal surge of growth hormone was still seen in the artificial hyperthermia study, albeit somewhat delayed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Restriction fragment length polymorphism (RFLP) of the human insulin receptor gene in Japanese: its possible usefulness as a genetic marker

Summary Restriction fragment length polymorphism of the human insulin receptor gene was analyzed with a 4.2 Kb cDNA probe in Japanese normal subjects and Type 2 (nonsulin-dependent) diabetic patients. Restriction endonuclease Rsa I digestion showed polymorphism of the human insulin receptor gene, with a band at 6.7 Kb, 6.2 Kb or 3.6 Kb. The frequency of the 6.7 Kb band was less than that in Caucasians. the Japanese subjects examined lacked a 3.6 Kb band, which is commonly found in Caucasians. We have also detected restriction fragment length polymorphism in the human insulin receptor gene by Pvu II or Stu I digestion. Although no significant association of restriction fragment length polymorphism with Type 2 diabetes was found in the present study, our results suggest that the restriction fragment length polymorphism in the human insulin receptor gene varies among ethnic groups, and that the restriction fragment length polymorphism linked to the human insulin receptor gene might be a useful marker for the linkage study of the genes located close to the human insulin receptor gene on chromosome 19.     

Graves' ophthalmopathy. An unusual course

A patient with an unusual course of Graves' ophthalmopathy is presented; serial computed tomographic scanning of the orbits was used to follow the course of the eye disease. Right-sided unilateral ophthalmopathy first developed two years after thyroid ablation with radioactive iodine and was followed by complete resolution two years later. The remission of this patient's eye disease was short-lived; within eight months, unilateral ophthalmopathy affected the left eye, and ophthalmopathy recurred in the right eye a few months later. Current hypotheses do not readily explain the course of this patient's ophthalmopathy.     

Monitoring recovery from diaphragm paralysis with ultrasound

BACKGROUND: Diaphragmatic paralysis is an uncommon, yet underdiagnosed cause of dyspnea. Data regarding the time course and potential for recovery has come from a few small case series. The methods that have been traditionally employed to diagnose diaphragmatic weakness or paralysis are either invasive or limited in sensitivity and specificity. A new technique utilizing two-dimensional, B-mode ultrasound (US) measurements of diaphragm muscle thickening during inspiration (Deltatdi%) has been validated in the diagnosis of diaphragm paralysis (DP). The purpose of this study was to assess whether serial US evaluation might be utilized to monitor the potential recovery of diaphragm function. METHODS: Twenty-one consecutive patients with clinically suspected DP were referred to the pulmonary physiology laboratory. Sixteen patients were found to have DP by US (unilateral, 10 patients; bilateral, 6 patients). Subjects were followed up for up to 60 months. On initial and subsequent visits, Deltatdi% was measured by US. Additional measurements included upright and supine vital capacity (VC), maximal inspiratory pressure (Pimax), and maximal expiratory pressure. RESULTS: Eleven of 16 patients functionally recovered from DP. The mean (+/- SD) recovery time was 14.9 +/- 6.1 months. No diaphragm thickening was noted in those patients who did not recover. Positive correlations were found between improvement in Deltatdi% and interval changes in VC, Pimax, and end-expiratory measurements of diaphragm thickness. CONCLUSIONS: US may be used to assess for potential functional recovery from diaphragm weakness or DP. As in previous series, recovery occurs in a substantial number of individuals, but recovery time may be prolonged.     

美国药品安全治理模式初探

探究美国药品安全治理模式的演变路径,并在此基础上总结了其当前治理模式的现状特点,最后从完善药品安全治理信息共享、优化药品安全治理公私合作以及促进药品安全决策公众参与三个方面为我国构建多元主体协同参与的药品安全治理模式提供经验及借鉴.     

Physician communication styles in initial consultations for hematological cancer

Objective

To characterize practices in subspecialist physicians’ communication styles, and their potential effects on shared decision-making, in second-opinion consultations.

Methods

Theme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists.

Results

Physicians frequently “broadcasted” information about the disease, treatment options, relevant research, and prognostic information in extended, often-uninterrupted monologs. Their communicative styles had one of two implications: conveying options without offering specific recommendations, or recommending one without incorporating patients’ goals and values into the decision. Some physicians, however, used techniques that encouraged patient participation.

Conclusions

Broadcasting may be a suboptimal method of conveying complex treatment information in order to support shared decision-making. Interventions could teach techniques that encourage patient participation.

Practice implications

Techniques such as open-ended questions, affirmations of patients’ expressions, and pauses to check for patient understanding can mitigate the effects of broadcasting and could be used to promote shared decision-making in information-dense subspecialist consultations.