The Relationship Between Psychogenic Cough and the Diagnosis and Misdiagnosis of Asthma: A Review

The differential diagnoses of persistent nonproductive cough include numerous pulmonary and nonpulmonary organic disorders as well as functional illnesses. Many diseases can cause cough, and several studies have shown asthma among the most common etiologies associated with chronic cough in adult nonsmokers, as well as children. Psychogenic cough and its relationship to asthma and other asthma-like illnesses is complex since distinct maladies with similar features may coexist individually or in combination in any given patient. While chronic cough may occur as a sole presenting manifestation of bronchial asthma in all age groups, recent findings suggest that most children with persistent cough without other respiratory symptoms do not have asthma. Since several organic, as well as functional diseases, may present with persistent cough as their sole manifestation in either adults or children, cough should not be used as a single or major determinant to diagnose and treat asthma, especially when empirically focused therapy trials fail. Given the range of illnesses causing cough, no single management guideline can be expected to be universally effective.     

加强质量体系建设,提高技术监督水平

本文对药品检验机构建立和完善质量体系的重要性，质量体系的内涵，建立和完善质量体系应注意的主要问题进行了分析并提出了建议。     

Optimal pole assignment into specified regions and its application to rotating mechanical systems

This paper considers a pole assignment problem to cluster all poles of a closed-loop system into some specified regions by introducing the complex state for systems having an isotropic property and by using the Riccati equation. The algebraic relations for the distribution of the eigenvalues of a complex matrix are used in order to cluster the poles into specified regions, which guarantees the relative stability margin, e.g. uniform damping or uniform damping ratio. The proposed scheme is essentially a combination of the pole assignment approach and linear quadratic design, taking the advantages of both. A block modal control method—an extension of recursive pole assignment—is also developed for the vibration control of rotating systems by clustering the forward and backward modes in order. Vibration control simulations with an isotropic rotor—bearing system, a magnetic bearing system and a rotating circular disc are treated in order to demonstrate the advantages of the proposed method.     

Effects of the antimigraine compound zolmitriptan ('Zomig') on psychomotor performance alone and in combination with diazepam in healthy volunteers

Zolmitriptan (Zomig^TM) is a 5HT_1B/1D agonist which has the ability to cross the intact blood-brain barrier to access central as well as peripheral receptors. Because of the potential for central nervous system side effects, this randomized, double-blind, placebo-controlled, 6-period crossover study evaluated the effects of 2.5 and 5 mg doses of zolmitriptan on psychomotor performance and investigated any pharmacodynamic or pharmacokinetic interaction with diazepam. Twelve healthy volunteers received the following "treatments" as single doses: zolmitriptan 2.5 mg, zolmitriptan 5 mg, diazepam 10 mg, zolmitriptan 2.5 mg+diazepam 10 mg, zolmitriptan 5 mg+diazepam 10 mg and placebo. Pre-dose and at 1, 4, 8, and 24 h post-dose, the following validated battery of psychomotor tests was performed: Bond-Lader visual analogue scales (calmness, contentedness, and alertness factors), critical flicker fusion test, choice reaction time (recognition, motor, and total reaction times), finger-tapping test, number cancellation test and digit symbol substitution test. Plasma concentrations of zolmitriptan, its active metabolite, and diazepam and its active metabolites were measured at the same timepoints. Zolmitriptan 2.5 and 5 mg had no effect on psychomotor function when given alone. In contrast, diazepam 10 mg had profound effects, consistent with its sedative properties, but there was no synergism on concomitant administration of either dose of zolmitriptan. Plasma concentrations of zolmitriptan, diazepam, and their respective active metabolites were similar when the two drugs were given alone or in combination.     

双相气道内正压呼吸机在老年慢性阻塞性肺疾病康复期和急性肺水肿患者中的临床应用

应用双相气道内正压呼吸机（ＢｉＰＡＰ）对９例慢性阻塞性肺疾病（ＣＯＰＤ）康复期和呼吸衰竭稳定期进行临床观察发现，治疗后动脉血氧分压与治疗前相比显著升高（Ｐ＜０．０１）；肺活量及用力肺活量轻度升高；１例３次发生急性左心衰、急性肺水肿致急性呼衰患者治疗后，病情很快改善；１例阻塞性夜间睡眠呼吸暂停综合征者应用效果满意。该机应用简便、安全，对心率血压无明显影响，为ＣＯＰＤ康复期、急性左心衰兼肺水肿的治疗提供了新途径。     

Predictive testing for Huntington's disease: I. Predictors of uptake in South Wales

In Wales, predictive testing for Huntington's disease (HD) has not been offered proactively to families and uptake of testing is low in comparison to other centres. Little is known of those not requesting testing, particularly those not in direct contact with the genetics service. This study examined differences between a cohort of 22 test applicants and a random group of 32 'non-requesters', drawn from the South Wales HD register. Respondents were interviewed by means of a semi-structured schedule in their own homes. The study groups differed significantly on a number of variables including: knowledge of the availability of testing; perceived attitudes of family members and significant others to testing; length of knowledge and perceived stressfulness of being at risk; and perceived ability to cope with an unfavourable result. Overall, knowledge of testing procedures was poor and at-risk individuals' understanding of genetic terminology was at odds with scientific distinctions. Discussion focuses on the organisational and psychological factors associated with lack of knowledge of the availability of testing and the interpretation of reported coping capacities.     

ADJUSTABLE SUTURES IN STRABISMUS SURGERY: A PERSONAL SERIES OF CASES

A personal series of 77 separate primary adjustable suture procedures performed on 69 patients is analysed. Adjustable suture surgery was performed on patients over ten years of age undergoing rectus muscle surgery, and a few selected younger patients. The ages ranged from 7 to 74 years. A 24-month-old infant who had a two-stage-anaesthesia is included in the series.
Thirty-eight of the 69 patients were reoperations. Of the 77 primary procedures, 48 (62.3%) required postoperative adjustment; 29 (37.7%) were tied down without adjustment.
Sixty-two of the 69 patients (89.8%) achieved a "cure". A further four patients (5.8%) were initially in desired alignment, but deteriorated within the follow-up period. Three of these were successfully reoperated. Of the three primary failures (4.4 %) two were reoperated with one achieving orthophoria.
Apart from alignment failure in the primary procedure, complications were minimal. Current follow-up periods range from one to 24 months.     

Quantitative MRI of the brain in children with sickle cell disease reveals abnormalities unseen by conventional MRI

Conventional MRI (cMRI) has shown that brain abnormalities without clinical stroke can manifest in patients with sickle cell disease (SCD). We used quantitative MRI (qMRI) and psychometric testing to determine whether brain abnormalities can also be present in patients with SCD who appear normal on cMRI. Patients 4 years of age and older with no clinical evidence of stroke were stratified by cMRI as normal (n = 17) or abnormal (n = 13). Spin-lattice relaxation time (T1) of gray and white matter structures was measured by the precise and accurate inversion recovery (PAIR) qMRI method. Patient cognitive ability was assessed with a standard psychometric instrument (WISC-III or WISC-R). In all 30 patients with SCD, qMRI T1 was lower than in 24 age- and race-matched controls, in cortical gray matter (P < .0006) and caudate (P < .0009), as well as in the ratio of gray-to-white matter T1 (P < .008). In the 17 patients who were shown to be normal by cMRI, qMRI T1 was still lower than in controls, in both cortical gray matter (P < .02) and caudate (P < .004). Histograms of voxel T1 show that the proportion of voxels with T1 values intermediate between gray and white matter (ie, consistent with encephalomalacia) was 9% higher than controls in patients shown to be normal by cMRI (P < .05) and 15% higher than controls in patients shown to be abnormal by cMRI (P < .0005). The full scale intelligence quotient (FSIQ) of all patients with SCD was 75, compared to the FSIQ of 88 in a historical control group of patient siblings (P < .001). The FSIQ of patients shown to be normal by cMRI was 79, significantly lower than the FSIQ of patient siblings (P < .04). The FSIQ of 71 in patients shown to be abnormal by cMRI was significantly lower than both the patient siblings (P < .005) and the patients shown to be normal by cMRI (P < .04). Patients shown to be abnormal by cMRI scored lower than patients shown to be normal by cMRI, specifically on the subtests of vocabulary (P = .003) and information (P = .03). Cognitive impairment is thus significant, even in patients with SCD who were shown to be normal by cMRI, suggesting that cMRI may be insensitive to subtle neurologic damage that can be detected by qMRI. Because cognitive impairment can occur in children normal by cMRI, our findings imply that prophylactic therapy may be needed earlier in the course of SCD to mitigate neurologic damage.