Rest and exercise hemodynamic effects of sequential alpha-1-adrenoceptor (trimazosin) and beta-adrenoceptor (propranolol) antagonism in essential hypertension

The efficacy of acute beta blockade in essential hypertension is limited by reflex vasoconstriction. The aim of this study was to determine whether the latter response was modified by prior selective alpha-1-adrenoceptor blockade. A single-blind, within-patient, placebo-controlled evaluation of the immediate hemodynamic effects of sequential alpha-1 (trimazosin)- and beta (propranolol)-adrenoceptor blockade was undertaken in 10 men (34 to 58 years) with previously untreated essential hypertension. The study commenced with a 4-minute control period of constant-load (600 to 900 kpm/min) upright bicycle exercise, and measurements were made before (control) and 30 minutes after intravenous trimazosin (2 mg/kg) and exercise was then repeated; measurements at rest were again made 4 minutes after intravenous propranolol (0.2 mg/kg) before a final exercise period. Trimazosin at rest reduced systolic and diastolic arterial pressure and systemic vascular resistance without change in heart rate, cardiac output, or left ventricular (LV) filling pressure. During upright bicycle exercise the reductions in blood pressure were sustained without change in their rest-to-exercise increments. Other circulatory variables did not differ from control values. At rest the addition of propranolol further reduced systolic arterial pressure. Heart rate and cardiac output fell and systemic vascular resistance increased to its pretreatment control value. During exercise the changes at rest were sustained and the rest-to-exercise increments in blood pressure, heart rate, and cardiac output were reduced. LV filling pressure was significantly increased. In conclusion, alpha-1-adrenoceptor blockade modified the adverse effects of acute beta blockade at rest but not during exercise.     

The effects of unimanual and bimanual massed practice on upper limb function in adults with cervical spinal cord injury: a systematic review

BackgroundIndividuals with cervical spinal cord injury (cSCI) have identified improving upper limb function as their most important rehabilitation goal. Unimanual massed practice (UMP) and bimanual massed practice (BMP) may help achieve this.ObjectivesTo evaluate and compare the effects of UMP and BMP on upper limb function in adults with cSCI.Data sourcesCochrane Central Register of Controlled Trials, PubMed, CINAHL, Web of Science and PEDro until April 2016.Study selectionStudies investigating the effects of UMP and/or BMP on upper limb function in adults with cSCI.Data extraction and synthesisData was extracted using a standardised form. Studies were appraised using a modified version of the Cochrane risk of bias tool. The findings were qualitatively synthesised.ResultsFive randomised controlled trials and two case studies were included. Six studies included UMP, three included BMP, and two compared these approaches. Overall the studies reported that UMP and BMP improved upper limb function, particularly when combined with electrical stimulation, with no clear differences between UMP and BMP. These findings should be interpreted with caution however, as six studies presented a high or unclear risk of bias for all functional upper limb outcome measures included, and the remaining study was a small pilot study with no control group.ConclusionAlthough the findings of the included studies support the use of UMP and BMP in adults with cSCI, only seven studies, all with significant limitations, were included; hence robust conclusions cannot be drawn and further research is warranted.PROSPERO registration number: CRD42016037365     

The two-film barium meal in the exclusion of coeliac disease

Prospective experience over five years is described in assessing the two-film barium meal as a test for the exclusion of untreated celiac disease in children in order to try to make jejunal biopsy unnecessary. 287 meals were examined in children between 3 months and 10 years of age with a variety of gastro-intestinal symptoms and signs that might be attributed to celiac disease. From the two-film barium meal the calibre and transverse mucosal folds of the upper small bowel were measured. In 48 children with untreated coeliace disease there were only three (6%) with negative two-film barium meals. In 45 children with malabsorption from causes other than coeliac disease, there were four (9%) with negative two-film barium meals. It is concluded that the two-film barium meal is a reasonably reliable test for the exclusion of untreated coeliac disease in children. It is simple, cheap, safe and economical of radiological time, and it compares favourably in accuracy with other screening tests, other than jejunal biopsy.     

Arteriosclerosis related deaths in severe neurosis

1,482 previous in-patients with the diagnosis of neurosis from three hospitals in Birmingham, U.K., were followed up after a mean of 10.9 years. 91% of the sample were traced and 139 patients were found to have died. When those causes of death from the International Classification of Diseases indicating arteriosclerosis were summed, there was a highly significant increase of death from arteriosclerosis in the sample compared with expected mortality. Death from accident, poisoning and violence was also highly significantly increased, especially self-inflicted death. There was also an increase in deaths from respiratory causes.     

英国补充替代医学研究的主要机构（二）——利兹大学、威斯敏斯特大学和约克大学

英国对非生物医学体系的补充替代医学（cornplementary and alternative medicine,CAM）持比较宽松的态度,属于欧洲使用CAM比较活跃的地区。但英国CAM的迅速发展也带来许多问题,英国卫生部等政府部门正着手就其使用和管理进行立法,并已于2008年4月成立了补充和自然保健委员会（Complementary and Natural Healthcare Council,CNHC）,开始进行英国补充治疗的管理工作,这是欧洲第一个正在对CAM立法的国家口一。随着CAM使用和管理的深入,英国研究机构也开展了大量CAM相关的科研工作。     

3种神经病理性疼痛筛查量表在中轴型脊柱关节炎患者中的评价

目的 比较3种神经病理性疼痛筛查量表在中轴型脊柱关节炎患者中的信度、效度和适用性。方法 采用painDETECT问卷、神经病理性疼痛4问卷和利兹神经病理性症状和体征评估疼痛量表对186例中轴型脊柱关节炎患者进行调查,评价量表的信度和效度。结果 painDETECT问卷、神经病理性疼痛4问卷和利兹神经病理性症状和体征评估疼痛量表的Cronbach α系数分别为0.807,0.697和0.623, Guttman分半系数分别为0.846、0.691和0.701。painDETECT问卷共提取2个公因子,累计方差贡献率55.171%。神经病理性疼痛4问卷共提取4个公因子,累计方差贡献率66.627%。利兹神经病理性症状和体征评估疼痛量表共提取2个公因子,累计方差贡献率50.836%。3种量表评估结果一致性Kappa值和相关性r值均大于0.500。患者对3种量表首选率分别为71.5%、3.2%和14.0%。结论 painDETECT问卷信度和效度良好,首选率最高。其余2种量表信度尚可,效度良好。3种量表一致性与相关性较强。