Our pilot study showed good feasibility in terms of most of the procedures and assessments used. In subsequent larger research projects the schedule may be practicable for investigating the influence of skin type on the acute and long-term effects of UVB on VitD status, including 1,25(OH) 2 D assessments as well as questionnaires for affective state/well-being in the research program. For possible future application of UVR, for example, in patients suffering from rheumatoid arthritis, week appears more practical than several weeks of exposure a limited number of UVR exposures within one, and might ensure greater compliance. The six-week study of Bogh et al. (2012) with three UVR exposures per week reported a high rate of drop-outs [ 40 ].
Patients from the South Texas Ambulatory Research Network (STARNET) presenting with a new complaint of chest pain were asked to participate in the study. Before seeing their physician, subjects completed the panic disorder section of the Structured Clinical Interview (SCID) of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised.
A proportion of patients have psychiatric disease in combination or isolation with the above.Managementin primary care, an empirical trial of a four-week course of twice-daily proton pump inhibitor (PPI) is a useful diagnostic and therapeutic test. In case of response, maintenance dose PPI should be continued.
Further therapeutic measures (medication or surgery) should be given only following a specialist’s advice. Fig 4 , women with a large increase in 1,25(OH) 2 D were less vigorous. The interpretation of this finding is difficult. Most VitD and UV-B exposure studies only analyze changes in 25(OH)D, and not in 1,25(OH) 2 D [ 22 – 39 ]. Given the interaction of 1,25(OH) 2 D with membrane-based signaling pathways in different cell types [ 74 ], as well as the existence of numerous additional VitD metabolites with possible biological activity [ 2 – 4 ], a simple causal relationship should not be assumed.
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This diagnostic strategy globally is commonly used, primarily because of its availability, simplicity, and high sensitivity. The PPI test has been proven to be a sensitive tool for diagnosing GERD in noncardiac chest pain patients and in preliminary trials in extraesophageal manifestations of GERD.
A total of 42 patients with noncardiac chest pain (NCCP), 35 patients with cardiac chest pain, and 52 healthy controls were recruited. Heartbeat perception was assessed using the Schandry task and a modified Brener-Kluvitse task. Self-report measures assessed anxiety sensitivity, somatosensory amplification, heart-focused anxiety, and chest pain characteristics.
Chest pain in women warrants added attention because women underestimate their likelihood to have coronary heart disease. A factor that complicates the clinical assessment of patients with chest pain (both cardiac and noncardiac in origin) is the relatively common presence of psychological and psychiatric conditions such as depression or panic disorder.
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There is growing evidence about the value of psychological intervention in patients with NCCP in the form of cognitive behavioral therapy or hypnotherapy. Noncardiac chest pain (NCCP) affects approximately 1 quarter of the adult population in the United States. The pathophysiology of the disorder remains to be elucidated fully. Identified underlying mechanisms for esophageal pain include gastroesophageal reflux disease (GERD), esophageal dysmotility, and visceral hypersensitivity.
Nutcracker Esophagus (NE) is characterized by high amplitude peristaltic esophageal contractions and these patients often present with symptoms of “angina like” or non-cardiac chest pain (NCCP). Tissue ischemia is a known cause of visceral pain and the goal of our current study was to determine if esophageal wall blood perfusion (EWBP) is reduced in patients with NE.
Noncardiac chest pain (NCCP) is very common, affecting up to 25% of the adult population in the United States. Treatment for NCCP has markedly evolved in the past decade and is presently focused on gastroesophageal reflux disease (GERD) and visceral hypersensitivity.
GERD is the most common underlying mechanism for NCCP and thus should be excluded first when evaluating a patient with NCCP. Noncardiac chest pain (NCCP) is very prevalent in the community. Although mortality remains low, morbidity and the financial implications are high. Women, those of middle age especially, should be thoroughly investigated as per current guidelines for coronary artery disease before labeling their chest pain as NCCP. Gastroesophageal reflux disease is the most common cause of NCCP; other esophageal pathology including esophageal hypersensitivity however, neuromuscular disease and eosinophilic esophagitis may also cause NCCP.
We propose that low EWBP leads to hypoxia of the esophageal tissue, which may be a mechanism of esophageal pain in patients with NE. Fourteen normal subjects (mean age 51 yrs, 11 males) and 12 patients (mean age 53 year, 9 males) with NE and NCCP were investigated. The EWBP was measured continuously using a custom designed laser Doppler probe tethered to a Bravo capsule, which anchored it to the esophageal wall. The development and course of noncardiac chest pain are assumed to be influenced by interoceptive processes.
Pain modulators (e.g. low dose tricyclic antidepressants) are often the mainstay of therapy in refractory situations. Smooth muscle relaxants (sublingual nitroglycerine, phosphodiesterase-5 inhibitors, and calcium channel blockers) can be used in hypermotility states, although their efficacy has not been demonstrated in controlled trials. Hypnotherapy, biofeedback, transcutaneous nerve stimulation, and cognitive and behavioral therapy complement pharmacologic therapy, although additional -studies are needed; acupuncture may be of benefit.