Dimensional structure of bodily panic attack symptoms and their specific connections to panic cognitions, anxiety sensitivity and claustrophobic fears.

BACKGROUND: Previous studies of the dimensional structure of panic attack symptoms have mostly identified a respiratory and a vestibular/mixed somatic dimension. Evidence for additional dimensions such as a cardiac dimension and the allocation of several of the panic attack symptom criteria is less consistent. Clarifying the dimensional structure of the panic attack symptoms should help to specify the relationship of potential risk factors like anxiety sensitivity and fear of suffocation to the experience of panic attacks and the development of panic disorder. METHOD: In an outpatient multicentre study 350 panic patients with agoraphobia rated the intensity of each of the ten DSM-IV bodily symptoms during a typical panic attack. The factor structure of these data was investigated with nonlinear confirmatory factor analysis (CFA). The identified bodily symptom dimensions were related to panic cognitions, anxiety sensitivity and fear of suffocation by means of nonlinear structural equation modelling (SEM). RESULTS: CFA indicated a respiratory, a vestibular/mixed somatic and a cardiac dimension of the bodily symptom criteria. These three factors were differentially associated with specific panic cognitions, different anxiety sensitivity facets and suffocation fear. CONCLUSIONS: Taking into account the dimensional structure of panic attack symptoms may help to increase the specificity of the associations between the experience of panic attack symptoms and various panic related constructs.

Introducing dental hygienists in general practice to research - an in-practice evaluation programme in the United Kingdom.

AIM: To introduce dental hygienists (DHs) in the UK to the principles of research through a practice-based product evaluation programme. METHODS: The programme consisted of an initial training and orientation day with presentations on evidence-based practice, research methods and the structure of research papers. The programme and its aims were explained in detail, and participants were briefed on the methods to be used. Participants then recruited seven to ten patients from their practices (offices), carried out a baseline assessment of: plaque, gingival health, calculus and staining at anterior teeth, and gave the patients a questionnaire asking about their teeth and then provided a 3-month supply of a test toothpaste. About 10 weeks later, a follow-up assessment of the same variables was performed and the questionnaire was repeated. A second training day followed during which the DHs provided feedback of their experiences and received training in literature searching and critical appraisal of literature including interpretation of results. RESULTS: Sixty-five DHs attended the first training day; 31 were able to recruit sufficient patients and attend the second training day. The DHs recruited 168 patients who received baseline and follow-up assessments. All the variables improved overall. Feedback from the DHs was very positive, and patients expressed delight with the care they had received. CONCLUSIONS: Qualitative feedback for participating DHs suggests the programme met its aim and could be used in the future as a mechanism for helping DHs who want to increase their understanding of research methodology.

Talking heads: Morphological variation in the human mandible over the last 500 years in the Netherlands.

The primary aim of this paper is to assess patterns of morphological variation in the mandible to investigate changes during the last 500 years in the Netherlands. Three-dimensional geometric morphometrics is used on data collected from adults from three populations living in the Netherlands during three time-periods. Two of these samples come from Dutch archaeological sites (Alkmaar, 1484-1574, n=37; and Middenbeemster, 1829-1866, n=51) and were digitized using a 3D laser scanner. The third is a modern sample obtained from MRI scans of 34 modern Dutch individuals. Differences between mandibles are dominated by size. Significant differences in size are found among samples, with on average, males from Alkmaar having the largest mandibles and females from Middenbeemster having the smallest. The results are possibly linked to a softening of the diet, due to a combination of differences in food types and food processing that occurred between these time-periods. Differences in shape are most noticeable between males from Alkmaar and Middenbeemster. Shape differences between males and females are concentrated in the symphysis and ramus, which is mostly the consequence of sexual dimorphism. The relevance of this research is a better understanding of the anatomical variation of the mandible that can occur over an evolutionarily short time, as well as supporting research that has shown plasticity of the mandibular form related to diet and food processing. This plasticity of form must be taken into account in phylogenetic research and when the mandible is used in sex estimation of skeletons.

["Manubriosternal Synchondrosis": A Rare Problem in Sports Medicine]. / "Synchrondritis manubriosternalis": Ein seltenes Problem in der Sportmedizin.

Non-traumatic, inflammatory and painful lesions of the manubriosternal joint are rare pathologies and, to our knowledge, have not been described in the literature of sports medicine. We report the case of a 30-year-old male strength athlete who developed chronic pain in the manubriosternal joint after exercise. Four-month abstinence from exercise combined with a conservative rehabilitation program performed after clinical and radiological tests did not bring any symptomatic relief. After a local ultrasound-guided single-shot sclerotherapy procedure performed in our clinic, the patient was free of symptoms and quickly regained his ability to exercise.

A suspected case of intranasal inverted Schneiderian papilloma in an adult male from post-Medieval Holland.

During the routine assessment of skeletal material unearthed from Middenbeemster, a post-Medieval (AD 17-19th century) cemetery in Northern Holland, an adult male with an unidentified choanal lesion was discovered. The affected individual was analysed macroscopically and via computer tomography. Based on the phenotypic and radiographic characteristics of the lesion, and after a comprehensive review of clinical literature, it was determined that the lesion was likely caused by an inverted Schneiderian papilloma (ISP), a benign but locally aggressive endophytic neoplasm histopathologically characterized by the inversion of the epithelium into the lamina propria (Schneiderian membrane) of the respiratory nasal mucosa. This study presents a detailed description of the pathophysiology and aetiology of ISPs, using both bioarchaeological and biomedical frameworks. Several differential diagnoses are discussed, with emphasis on the reasons for their rejection as the primary pathogenic mechanism(s). To the best of the authors' knowledge, this research is the first reported case of ISP within palaeopathology, which highlights the need to consider ISPs whenever slow-growing sinonasal neoplasms are suspected, as well as in cases that exhibit focal rhinitis.

The mechanism of inhibition by acidosis of gluconeogenesis from lactate in rat liver.

1. Gluconeogenesis from lactate or pyruvate was studied in perfused livers from starved rats at perfusate pH7.4 or under conditions simulating uncompensated metabolic acidosis (perfusate pH6.7-6.8). 2. In 'acidotic' perfusions gluconeogenesis and uptake of lactate or pyruvate were decreased. 3. Measurement of hepatic intermediate metabolites suggested that the effect of acidosis was exerted at a stage preceding phosphoenolpyruvate. 4. Total intracellular oxaloacetate concentration was significantly decreased in the acidotic livers perfused with lactate. 5. It is suggested that decreased gluconeogenesis in acidosis is due to substrate limitation of phosphoenolypyruvate carboxykinase. 6. The possible reasons for the fall in oxaloacetate concentration in acidotic livers are discussed; two of the more likely mechanisms are inhibition of the pyruvate carboxylase system and a change in the [malate]/[oxaloacetate] ratio due to the fall in intracellular pH.

Recognition of random shapes in brain-damaged patients.

In two experiments the hypothesis was tested that left hemisphere-damaged patients and especially those with aphasia are impaired in the recognition of meaningless random shapes because they fail to attribute a meaning to the shapes. In a multiple choice recognition task, left hemisphere-damaged patients with aphasia and left and right hemisphere-damaged patients without aphasia were shown complex random shapes together with either a pictorial cue (experiment I and II) or a dotted drawing of its outline on which more or less outstanding parts were specially marked (experiment I). In experiment I no difference between conditions or groups emerged. In experiment II aphasics and left hemisphere-damaged patients without aphasia were generally inferior to right hemisphere-damaged controls and performed significantly better when a pictorial cue was given than when it was absent, however only when the conditions were given in a certain order.

Cognitive impairments of aphasics in picture sorting and matching tasks.

On the basis of earlier experiments showing a differential deficit of aphasics in picture sorting and matching tasks, two experiments were conducted to test the conjecture of a specific deficit of aphasics in the analytical appraisal of individual features. Broca's and Wernicke's aphasics--according to clinical diagnoses and the Aachener Aphasie Test--were compared with patients having right-hemisphere lesions or left-hemisphere lesions without aphasia. Both groups of aphasics differed from the control groups in the sorting task, irrespective of the sorting criterion, but the differences were small. The picture matching task did not discriminate between groups. Obviously, the basic assumption has to be modified with respect to specific conditions of task requirements. The experimental literature is reviewed.