Peak Endocardial Acceleration-Based Clinical Testing of the "BEST" DDDR Pacemaker

The peak endocardial acceleration (PEA, unit g) shows a near correlation with myocardial contractility during the isometric systolic contraction of the heart (dP/dtmax), with sympathetic activity and, thus, with physiological heart rate modulation. The (Biomechanical Endocardial Sorin Transducer (BEST) sensor is incorporated in the tip of a pacing lead and measures PEA directly near the myocardium. In an international study, the lead was implanted with the dual chamber pacemaker Living-1 (Sorin) in 105 patients. The behavior of the PEA signal was tested under conditions of physical and mental stress and during daily life activities by 24-hour recordings of PEA (PEA Holter) at 1 to 2 months and approximately 1 year after implantation. Implantation of the BEST lead was performed without complications in all patients. The sensor functioned properly in the short- and long-term in 98% of patients. Although PEA values differed from patient to patient, the values closely reflected the variations in sympathetic activity due to physical and mental stress in each patient. During exercise and during daily life activities a close correlation between PEA and heart rate was observed among patients with normal sinus rhythm. Peak endocardial acceleration allows a nearly physiological control of the pacing rate.     

Randomized factorial trial of high-dose intravenous streptokinase, of oral aspirin and of intravenous heparin in acute myocardial infarction

619 patients with suspected acute myocardial infarction (MI)were randomized to receive either a high-dose short-term intravenousinfusion of streptokinase (1.5 MU over one hour) or placebo.Using a '2 x 2 x 2 factorial' design, patients were also randomizedto receive either oral aspirin (325 mg on alternate days for28 days) or placebo and separately randomized to receive eitherintravenous heparin (1000 1U h-1 for 48 hours) or no heparin.Streptokinase (SK) was associated with a nonsignificant (NS)increase in non-fatal reinfarc–tion (3.9% SKvs 2.9% placebo)and decrease in mortality (7.5%vs9.7% in hospital plus 6.1%vs8.7% after discharge). After SK, there were significantly fewerstrokes (0.5% vs 2.4%; 2P<0.05), but significantly more minoradverse events (e.g. hypotension and bradycardial, allergies,bruises or minor bleeds, nausea). Aspirin was associated withfewer non-fatal reinfarctions (3.2% aspirin vs 39% placebo;NS), deaths (in hospital: 61% vs 10.5%; 2P<0.05, and afterdischarge: 7.0% vs 6.9%; NS), and strokes (0.3% vs 2.0%; NS).Heparin was associated with a decrease in reinfarction (2.2%heparin vs 4.9% no heparin; NS), though not in mortality (inhospital: 8.0% vs 8.5%; NS, and after discharge: 7.0% vs 6.9%;NS), and with a trend towards more strokes (1.6% vs 0.7%; NS)and more bruising and bleeding (14% vs 12%; NS). To assess morereliability the effects of aspirin and of this SK regimen onmortality, about 400 hospitals worldwide are now collaboratingin a large (about 20 000 patients planned ) randomized trial( ISIS-2). for which the present study was a pilot.     

Cost of diseases in international perspective

This study compares the health care costs of The Netherlandswith the United States and Sweden and estimates the impact ofdemographic change on costs. Total health care costs were allocatedto disease, age, sex and specific subsectors. For The Netherlands75% of the costs in 1988 were assigned to specific diseases.Costs of mental disorders and other chronic non-fatal diseasesdominate, followed by cardiovascular diseases. The effect ofage is strong from age 70 years onwards. The effect of sex,adjusting for age, is small, except for elderly women, who aremore expensive. Both total and disease-specific costs are similarin The Netherlands and Sweden, but differ from those in theUS. The available data suggest that the differences in medicalpractice and health care systems may explain a substantial partof the divergent results; demographic or epidemiologic aspectsseem less important. Ageing induces, in the Dutch case, a modest0.7% annual increase in costs. The contribution of other forcesin the increase of costs is probably more important. A structuralupward pressure on costs also prevails in The Netherlands andSweden, but it is more prominent in the US, due to a large amountof expensive surgery and high administration costs.     

Efficacy of mitemcinal, a motilin agonist, on gastrointestinal symptoms in patients with symptoms suggesting diabetic gastropathy: a randomized, multi-center, placebo-controlled trial

BACKGROUND: Mitemcinal, an oral motilin agonist, accelerates gastric emptying. AIM: To investigate if mitemcinal was superior to placebo in relief of symptoms attributed to gastroparesis. METHODS: In a randomized, double-blind design, 392 insulin-requiring diabetics with symptoms attributable to gastroparesis were treated for 3 months with placebo, mitemcinal 5 or 10 mg bid. On a weekly basis, patients assessed whether there was adequate relief of their gastroparesis symptoms. Patients were classified as Complete Responders (CR) if there were three consecutive positive monthly responses, which required at least 50% of their weekly responses in a month being positive. An Overall Responder (OR) had at least 75% positive weekly responses for the whole treatment period. RESULTS: Mitemcinal 10 mg produced a significantly better response rate than placebo with a 10.6% increase in the OR (P < 0.05 vs. placebo). Mitemcinal 10 mg also produced statistically significant increases in the CR and OR in the subgroup identified by baseline body mass index (<35 kg/m(2)) and haemoglobin A(1c) (<10%) (P < 0.01 vs. placebo). Adverse events did not differ from placebo frequency levels. CONCLUSIONS: Mitemcinal can induce a statistically significant response to treatment in a subset of diabetic gastroparesis where future prokinetic clinical trials should be focused.     

The attribution of blame for criminal acts: relationship with personality disorders and mood

Attribution of blame for criminal acts and its relationship to DSM-IIIR (APA, 1987) personality disorder diagnosis and psychological variables was investigated in 52 men referred to an intensive probation programme. Self-report questionnaires revealed a high rate of personality disorder psychopathology in the subjects with 73% meeting criteria for one personality disorder and 63.5% meeting criteria for anti-social personality disorder. However, there was high multiple morbidity of personality disorder diagnosis with an average of 3.6 diagnoses for each subject. Blame attribution was measured with the Gudjonsson Blame Attribution Inventory (Gudjonsson & Singh, 1989) . External attribution of blame was found to correlate significantly positively with scores for five personality disorder categories (schizoid, avoidant, obsessive compulsive, passive-aggressive and borderline), whilst mental element attribution was associated with avoidant personality disorder, high depression, anxiety and inward direction of irritability. Guilt feelings were positively associated with scores for schizotypal, avoidant and dependent personality disorder categories and with irritability directed inwards.     

某两省医院管理年活动督导中发现的问题

论述了对某两省6所三级医院开展医院管理年活动情况进行督导检查工作中发现的管理、医疗、护理、医院感染管理、检验、药事、物价、财务管理等方面存在的问题。     

Early parental and child predictors of recurrent abdominal pain at school age: results of a large population-based study

OBJECTIVE: To assess whether parental psychological and physical factors and child factors measured in the first year of life were associated with recurrent abdominal pain (RAP) in children at age 6(3/4) years. METHOD: A longitudinal cohort study (the Avon Longitudinal Study of Parents and Children), followed 8,272 children from pregnancy to age 6(3/4) years. Parental reports of child and parent functioning were gathered. Associations between parental and child functioning assessed at 6 to 8 months postpartum, and RAP measured at age 6(3/4) years were investigated. RESULTS: The prevalence of RAP in this sample was 11.8%. Both maternal anxiety (adjusted odds ratio = 1.53; 95% confidence interval 1.24-1.89) and paternal anxiety (adjusted odds ratio = 1.38; 95% confidence interval 1.12-1.71) in the first year of a child's life were associated with later childhood RAP. Parent reports of child temperament features such as irregular feeding and sleeping were also associated with later RAP. CONCLUSIONS: This is the first evidence from a prospective study that anxiety in both mothers and fathers and child temperament features predate the occurrence of RAP in children. These findings highlight the potential importance of addressing parental anxiety in families in which children present with RAP, although some caution should be exercised in their interpretation because of possible reporting bias.     

Prevalence of hay fever and allergic sensitization in farmer's children and their peers living in the same rural community

INTRODUCTION: Lower prevalence rates of allergic diseases in rural as compared with urban populations have been interpreted as indicating an effect of air pollution. However, little is known about other factors of the rural environment which may determine the development of atopic sensitization and related diseases. OBJECTIVE: The authors tested the hypothesis that children growing up on a farm were less likely to be sensitized to common aerollergens and to suffer from allergic diseases than children living in the same villages but in nonfarming families. MATERIALS AND METHODS: Three age groups of schoolchildren (6-7 years, 9-11 years, 13-15 years) living in three rural communities were included in the analyses. An exhaustive questionnaire was filled in by 1620 (86.0%) parents. A blood sample was provided by 404 (69.3%) of the 13-15 year olds to determine specific IgE antibodies against six common aeroallergens. RESULTS: Farming as parental occupation was reported for 307 children (19.0%). After adjustment for potential covariates such as family history of asthma and allergies, parental education, number of siblings, maternal smoking, pet ownership, indoor humidity and heating fuels, farming as parental occupation was significantly associated with lower rates of sneezing attacks during pollen season (adjusted OR 0.34, 95% CI 0.12-0.89) and atopic sensitization (adjusted OR 0.31, 95% CI 0.13-0.73) whereas the association with wheeze (adjusted OR 0.77 95% CI 0.38-1.58) and itchy skin rash (adjusted OR 0.86, 95% CI 0.49-1.50) was not statistically significant. The risk of atopic sensitization was lower in children from full-time farmers (adjusted OR 0.24, 95% CI 0.09-0.66) than from part-time farmers (adjusted OR 0.54, 95% CI 0.15-1.96). CONCLUSION: Factors directly or indirectly related to farming as parental occupation decrease the risk of children becoming atopic and developing symptoms of allergic rhinitis.