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1.
The aim of this study was to examine whether esophageal dysphagia can be described as a handicap and to grade the severity
of handicap as the discrepancy between the subject's own eating goals and his or her eating disability. The severity of the
disability-goal-handicap (DGH) regarding dysphagia was expressed on a scale ranging from 0 to 48 points. Nineteen patients
with dysphagia of differing causes were selected from a patient register at a laboratory for diagnostic procedures of the
esophagus. The severity of handicap for the 19 patients was, on average, 33 points (range, 20–44). The DGH score correlated
significantly with the patients' own evaluation of the severity of their dysphagia (p=0.008). The DGH scores did not differ markedly based on patient's sex, age, or cause of dysphagia. Patients who were operated
upon because of dysphagia had significantly more points on the DGH scale prior to operation than patients who were not (p=0.001). Denial of dysphagia (N=18), concealment of dysphagia (N=18), and lack of confirmation by the patient's physician
(N=15) were common but did not influence the severity of handicap as assessed by the DGH scale. It was shown that dysphagia
affects all aspects of life as expressed by reduction in self-esteem (N=13), security (N=16), work capacity (N=8), exercise
(N=7), and leisure time (N=6). Esophageal dysphagia may therefore be regarded as a handicap when assessed using the DGH code
described in this study. 相似文献
2.
Lita Tibbling MD PhD Francesca Maria Gibellino MD PhD Karl-Erik Johansson MD PhD 《Dysphagia》1995,10(2):113-116
Respiratory symptoms were studied in 119 patients operated on for fundoplication and crural repair because of gastroesophageal reflux disease (GERD). The effect of antireflux surgery and of smoking habits on their respiratory symptoms was evaluated. A questionnaire was completed before and after surgery in connection with esophageal investigations. Chronic bronchitis was present in 20% of the patients, 38% of whom were smokers. In the rest of the patients, 18% were smokers. Cough was reported by 34% and expectoration by 21%. After surgery the number of patients with cough and chronic bronchitis was reduced significantly in nonsmokers and to some extent in smokers. It is believed that fundoplication with distal anchoring of the longitudinal esophageal muscle will improve pharyngoesophageal function and thereby decrease aspiration and respiratory symptoms due to mis-swallowing. 相似文献
3.
A GCH1 haplotype confers sex‐specific susceptibility to pain crises and altered endothelial function in adults with sickle cell anemia
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Zhengyuan Wang Lena Diaw Lita Freeman Krupa Desai Michael Dizon Darlene Allen Colin Cunnington Keith M. Channon Jacqueline Milton Stephen W. Hartley Vikki Nolan Gregory J. Kato Martin H. Steinberg David Goldman James G. Taylor VI 《American journal of hematology》2014,89(2):187-193
GTP cyclohydrolase (GCH1) is rate limiting for tetrahydrobiopterin (BH4) synthesis, where BH4 is a cofactor for nitric oxide (NO) synthases and aromatic hydroxylases. GCH1 polymorphisms are implicated in the pathophysiology of pain, but have not been investigated in African populations. We examined GCH1 and pain in sickle cell anemia where GCH1 rs8007267 was a risk factor for pain crises in discovery (n = 228; odds ratio [OR] 2.26; P = 0.009) and replication (n = 513; OR 2.23; P = 0.004) cohorts. In vitro, cells from sickle cell anemia subjects homozygous for the risk allele produced higher BH4. In vivo physiological studies of traits likely to be modulated by GCH1 showed rs8007267 is associated with altered endothelial dependent blood flow in females with SCA (8.42% of variation; P = 0.002). The GCH1 pain association is attributable to an African haplotype with where its sickle cell anemia pain association is limited to females (OR 2.69; 95% CI 1.21–5.94; P = 0.01) and has the opposite directional association described in Europeans independent of global admixture. The presence of a GCH1 haplotype with high BH4 in populations of African ancestry could explain the association of rs8007267 with sickle cell anemia pain crises. The vascular effects of GCH1 and BH4 may also have broader implications for cardiovascular disease in populations of African ancestry. Am. J. Hematol. 89:187–193, 2014. © 2013 Wiley Periodicals, Inc. 相似文献
4.
Clinical, hormonal and cytogenetic evaluation of 46,XX males and review of the literature 总被引:3,自引:0,他引:3
Ergun-Longmire B Vinci G Alonso L Matthew S Tansil S Lin-Su K McElreavey K New MI 《Journal of pediatric endocrinology & metabolism : JPEM》2005,18(8):739-748
The main factor influencing the sex determination of an embryo is the genetic sex determined by the presence or absence of the Y chromosome. However, some individuals carry a Y chromosome but are phenotypically female (46,XY females) or have a female karyotype but are phenotypically male (46,XX males). 46,XX maleness is a rare sex reversal syndrome affecting 1 in 20,000 newborn males. Molecular analysis of sex-reversed patients led to the discovery of the SRY gene (sex-determining region on Y). The presence of SRY causes the bipotential gonad to develop into a testis. The majority of 46, SRY-positive XX males have normal genitalia; in contrast SRY-negative XX males usually have genital ambiguity. A small number of SRY-positive XX males also present with ambiguous genitalia. Phenotypic variability observed in 46,XX sex reversed patients cannot be explained only by the presence or absence of SRY despite the fact that SRY is considered to be the major regulatory factor for testis determination. There must be some other genes either in the Y or other autosomal chromosomes involved in the definition of phenotype. In this article, we evaluate four patients with 46,XX male syndrome with various phenotypes. Two of these cases are among the first reported to be diagnosed prenatally. 相似文献
5.
6.
Suzanne R. Thibodeaux Yvette C. Tanhehco Leah Irwin Lita Jamensky Kevin Schell Una O’Doherty 《Transfusion and apheresis science》2019,58(1):100-106
Background
In sickle cell disease (SCD), red blood cells (RBCs) containing hemoglobin S can be denser than RBCs containing wild-type hemoglobin, especially when dehydrated. We hypothesize that targeting denser RBCs during red blood cell (RBC) exchange for SCD could result in more efficient removal of dehydrated, sickled RBCs and preservation of non-sickled RBCs.Study design and methods
Waste products from RBC exchanges for SCD were used as “simulated patients”. One RBC volume was exchanged using ABO-compatible blood. The apheresis instrument was programmed to exchange the entire RBC layer by indicating the hematocrit (control), or the bottom half by indicating the hematocrit was half the hematocrit (experimental), with or without subsequent transfusion. Hemoglobin S levels, and complete blood counts were measured.Results
Hemoglobin S levels were lower after the modified versus control RBC exchange (post-RBC exchange mean 4.96% and 11.27%); total hemoglobin S amounts were also lower (mean 19.27 and 58.29?mL of RBCs). Mean RBC density decreased after the modified RBC exchange by 8.86%. Hematocrit decreased in the modified RBC exchange by 36.37%, with partial correction by direct transfusion following a truncated RBC exchange.Conclusions
Targeting denser RBCs in RBC exchange enhanced hemoglobin S removal and decreased RBC density. Further development of this ex vivo model could potentially allow for: 1) improved reduction in hemoglobin S levels (allowing for longer periods between RBC exchange or maintained lower levels), or 2) achievement of previous goal hemoglobin S levels with fewer donor units (reducing alloimmunization risk and improving blood utilization). 相似文献7.
为全面系统地了解国内外丙型肝炎病毒NS3/4A蛋白酶抑制剂的研发现状,笔者调研了国内外处于临床研究阶段和已上市的蛋白酶抑制剂.目前仅有2种丙型肝炎病毒NS3/4A蛋白酶抑制剂上市,即2011年美国食品和药物管理局批准的Vertex公司研发的药物Telaprevir和默克公司研发的药物Boceprevir.Telaprevir和Boceprevir需与目前的丙型病毒性肝炎标准疗法联合使用,临床治愈率高于标准疗法,Telaprevir的临床效果略微优于Boceprevir.部分处于临床开发状态的第2代蛋白酶抑制剂与Telaprevir和Boceprevir相比,在安全性、耐受性、服用便利性、疗效上更胜一筹. 相似文献
8.
OBJECTIVE: This brief report presents a staff training program based on psychiatric rehabilitation principles used in a hospital setting. The training program intervention significantly promoted the belief that mental illness does not necessarily limit functioning and also improved awareness of research findings, evidence-based practices and community services. METHODS: A randomized controlled study assessed the impact of the program on the staff's attitudes regarding psychiatric rehabilitation and recovery. RESULTS: Findings suggest that in-service training programs within a hospital setting can change staff attitudes in order to support psychiatric rehabilitation. CONCLUSIONS: A psychiatric rehabilitation forum, made up of representatives from all disciplines, including the medical directors of every ward, was set up in the hospital following the training program and has become the main avenue to disseminate information, messages, and goals to the staff at large and to the hospital administration. It is the forum that creates the shared vision about psychiatric rehabilitation within the hospital and has the task of facilitating implementation of services according to that vision. 相似文献
9.
10.
Two hundred and twenty-nine patients were studied in an attempt to determine the main causative factors behind their having
a residual foreign body in the esophagus. Strictures were present in 13%. Fifty-two percent of the patients with stricture
had been hospitalized more than once for treatment of foreign body impaction; this was the case in only 8.5% of the rest of
the patients (p<0.001). More than half of the patients aged 15 years or younger had a foreign body in the hypopharynx. This location was
extremely uncommon in adults (p<0.001). The hypothesis of spasm distal to an esophageal foreign body as the cause for obstruction in patients without esophageal
stricture was supported by the following findings: spontaneous disimpaction occurred in more than one-third of the patients
and became more frequent as time progressed; 63% of 16 patients given spasmolytic drugs experienced spontaneous disimpaction
of the foreign body; half of the patients had the foreign body in the proximal esophagus distal to the narrower passage of
the upper esophageal sphincter; foreign body impaction in the esophagus turned out to be a once-only event in 86% of the patients;
and 21% of the patients had a disorder of the central nervous system and had been hospitalized significantly more often because
of food impaction than the other patients. The findings indicate that adults with a history of impaction of foodstuff lacking
sharp bones and who do not have stricture suffer food impaction because of spasm of the esophageal smooth muscle, and can
be treated accordingly. 相似文献