The role of medical comorbidity in outcome of major depression in primary care: the PROSPECT study.

OBJECTIVE: The authors described the influence of specific medical conditions on clinical remission and response of major depression (MDD) in a clinical trial evaluating a care-management intervention among older primary-care patients. METHODS: Adults age 60 years and older were randomly selected and screened for depression. Participants were randomly assigned to Usual Care or to an Intervention with a depression care-manager offering algorithm-based care for MDD. In all, 324 adults meeting criteria for MDD were included in these analyses. Remission and response was defined by a score on the Hamilton Rating Scale for Depression <10 and by a decrease from baseline of > or =50%, respectively. Medical comorbidity was ascertained through self-report. Cognitive impairment was defined by a score <24 on the Mini-Mental State Exam (MMSE). RESULTS: In Usual Care, rates of remission were faster in persons who reported atrial fibrillation (AF) than in persons who did not report AF and slower in persons who reported chronic pulmonary disease than in persons who did not report chronic pulmonary disease; rates of response were less stable in persons with MMSE <24 than in those with MMSE > or =24. In the Intervention condition, none of the specific chronic medical conditions were significantly associated with outcomes for MDD. CONCLUSIONS: Because disease-specific findings were observed in persons who received Usual Care but not in persons who received more intensive treatment in the Intervention condition, our results suggest that the association of medical comorbidity and treatment outcomes for MDD may be determined by the intensity of treatment for depression.     

Phase II trials of fosquidone (GR63178A) in carcinoma of the breast, head and neck, ovary and melanoma.

A total of 91 eligible patients with metastatic cancer have been treated in a series of phase II trials of the novel pentacyclic pyrroloquinone, fosquidone. Tumour types were breast (24), ovary (25), head and neck (21) and melanoma (21). All patients, except those with melanoma had received prior chemotherapy. The drug was given intravenously as a 20 min infusion, at the dose of 120 mg/m2 on days 1 to 5 of a 3 week cycle. Treatment was well tolerated; the only significant side-effects being mild headaches and generalised musculo-skeletal pains. Response was assessed after 2 cycles of therapy. Only one patient (with head and neck cancer) achieved an objective partial response, lasting 6 weeks. A total of 12 patients demonstrated stable disease for a median duration of 15 to 20 weeks. Using this schedule of administration, fosquidone has no significant antitumour activity in this group of tumours.     

Technical factors of CT angiography studied with a carotid artery phantom.

PURPOSETo evaluate scanning parameters (conventional versus spiral CT, section thickness, and pitch) and vessel orientation in the performance of CT angiography.METHODSConventional CT and 1.0-, 1.5-, and 2.0-pitch spiral CT acquisitions of a carotid phantom designed with vessels oriented parallel to the z-axis, 45 degrees oblique, and perpendicular to the z-axis were obtained with section thicknesses of 2, 4, and 8 mm. The phantom contained 32 vessels with 0% to 100% stenoses. Normal and stenotic luminal diameters were measured and the number of artifacts was assessed.RESULTSNo overall difference was observed among conventional and spiral CT acquisitions obtained with pitches of 1.0, 1.5, and 2.0. With thicker sections, CT angiographic accuracy decreased and artifacts increased. The three-vessel orientations were relatively comparable in accuracy in terms of the percentage of stenosis measured. Vessels parallel to the z-axis suffered less artifactual degradation. Unique artifacts, such as luminal distortion and beam hardening, were observed in vessels oriented at 45 degrees and perpendicular to the z-axis.CONCLUSIONUse of thinner sections with vessels oriented parallel to the z-axis optimizes CT angiographic quality. There is no apparent degradation with the use of spiral CT, and a pitch of 1.5 or 2.0 provides results equivalent to 1.0-pitch spiral studies.     

FM sonography in diffuse liver disease: prospective assessment and blinded analysis

FM sonography - a signal-processing technique that uses frequency and phase information as well as amplitude data - shows promise in evaluation of patients with diffuse liver disease. In a prospective blinded review of 37 patients with biopsy-proved liver disease and 42 healthy volunteers, FM sonography was clearly superior to traditional amplitude-based (AM) sonography in distinguishing healthy from diseased subjects. Statistically significant differences were seen in accuracy (FM, 98.7%; AM, 84.8%), sensitivity (FM, 97.3%; AM, 70.3%), and negative predictive value (FM, 97.7%; AM, 78.8%). Our data also suggest that current FM sonographic techniques cannot differentiate among histologic findings associated with different hepatic parenchymal abnormalities. It is unclear, therefore, whether FM imaging can reduce the numbers of patients who require biopsy for diagnosis or the frequency of biopsy procedures in patients with known disease.     

用于筛选天然产物中脲酶抑制剂的脲酶活性测试方法的建立

抑制幽门螺杆菌产生的脲酶具有治疗胃炎和消化性溃疡的作用。用酚红指示剂和Ｂｅｒｔｈｅｌｏｔ试剂在９６孔培养板上检测重组脲酶活性，其灵敏度指标酚红法每ｍｇ酶蛋白引起的每分钟吸光度变化。△Ａ为６．９，而Ｂｅｒｔｈｅｌｏｔ法每ｍｇ酶蛋白引起的每分钟吸光度比值变化△Ａ为３１３。结果表明用Ｂｅｒｔｈｅｌｏｔ试剂检测重组脲酶活性适宜在９６孔培养板上大规模筛选天然产物中的脲酶抑制剂。     

The work of walking: a calorimetric study

Experiments were designed to test the traditional assumption that during level walking all of the energy from oxidation of fuel appears as heat and no work is done. Work is force expressed through distance, or energy transferred from a man to the environment, but not as heat. While wearing a suit calorimeter in a respiration chamber, five women and five men walked for 70 to 90 min on a level treadmill at 2.5, 4.6, and 6.7 km.h-1 and pedalled a cycle ergometer for 70 to 90 min against 53 and 92 W loads. They also walked with a weighted backpack and against a horizontal load. During cycling, energy from fuel matched heat loss plus the power measured by the ergometer. During walking, however, energy from fuel exceeded that which appeared as heat, meaning that work was done. The power increased with walking speed; values were 14, 29, and 63 W, which represented 11, 12, and 13% of the incremental cost of fuel above the resting level. Vertical and horizontal loads increased the fuel cost and heat loss of walking but did not alter the power output. This work energy did not re-appear as thermal energy during 18 h of recovery. The most likely explanation of the work done is in the inter-action between the foot and the ground, such as compressing the heel of the shoe and bending the sole. We conclude that work is done in level walking.