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Medically unexplained dyspnea:psychophysiological characteristics and role of breathing therapy

Chinese Medical Journal 2004年第1期117卷 6-13页

作者：韩江娜朱元珏李舜伟雒冬梅胡征 van diest i De Peuter S van de Woestijne KP van den Bergh O Laboratory of Respiratory Psychophysiology Department of PneumologyPeking Union Medical College HospitalChinese Academy of Medical Sciences Department of Psychology University of Leuven Department of Pneumology UZ Gasthuisberg

Background Medically unexplained dyspnea occurs commonly in medical settings and remains poorly understood. This study was conducted to investigate the psychophysiological characteristics of medically unexplained dyspnea and the efficacy of breathing retraining for these patients. Methods A group of patients with medically unexplained dyspnea were compared to patients with a variety of organic lung diseases and healthy subjects. in another group of patients,the influence of breathing therapy on complaints,anxiety, and breath-holding was evaluated for an average of 1.5 years. Results Patients with medically unexplained dyspnea reported more intense dyspnea than patients with a variety of organic lung diseases. Additionally,they were anxious and presented a broad range of symptoms in daily life and under challenge,for instance voluntary hyperventilation. More than one third of them qualified for panic disorder. They had shorter breath-holding time at rest,less increase in breath-holding time and higher chances of showing a “paradoxical” decrease of breath-holding time after hyperventilation. A combination of PaO2,forced expiratory volume in one second (FEV_1),and anxiety measures distinguished them from organic dyspnea. Breathing retraining profoundly improved their symptoms and decreased the level of state and trait anxiety. Moreover,they better tolerated the voluntary hyperventilation and the symptoms induced were also markedly decreased after therapy. Breath-holding time was prolonged and PetCO2 in a representative group of patients increased. Conclusions Patients with medically unexplained dyspnea appear to have the feature of a “psychosomatic” patient: an anxious patient with a wide variety of symptoms of different organ systems that do not have an organic basis. They can be distinguished from organic dyspnea using a small set of physiological and psychological measures. Breathing retraining turns out to be an effective therapy for those “difficult to

关键词： dyspnea·somatization·anxiety·hyperventilation·breathing therapy

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Tumor-stroma ratio as prognostic factor for survival in rectal adenocarcinoma: A retrospective cohort study

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World Journal of Gastrointestinal Oncology 2017年第12期9卷 466-474页

作者： René Scheer Alexi Baidoshvili Shorena Zoidze Marloes AG Elferink Annefleur EM Berkel Joost M Klaase Paul J van diest Department of Surgery Medisch Spectrum Twente Laboratory for Pathology East-Netherlands Netherlands Comprehensive Cancer Organization Location Enschede Department of Pathology University Medical Center Utrecht

AiM To evaluate the prognostic value of the tumor-stroma ratio(TSR) in rectal *** TSR was determined on hematoxylin and eosin stained histological sections of 154 patients treated for rectal adenocarcinoma without prior neoadjuvant treatment in the period 1996-2006 by two observers to assessreproducibility. Patients were categorized into three categories: TSR-high [carcinoma percentage(CP) ≥ 70%], TSR-intermediate(CP 40%, 50% and 60%) and TSR-low(CP ≤ 30%). The relation between categorized TSR and survival was analyzed using Cox proportional hazards *** Thirty-six(23.4%) patients were scored as TSR-low, 70(45.4%) as TSR-intermediate and 48(31.2%) as TSRhigh. TSR had a good interobserver agreement(κ = 0.724, concordance 82.5%). Overall survival(OS) and disease free survival(DFS) were significantly better for patients with a high TSR(P = 0.01 and P = 0.02, respectively). A similar association existed for disease specific survival(P = 0.06). in multivariate analysis, patients without lymph node metastasis and an intermediate TSR had a higher risk of dying from rectal cancer(HR = 5.27, 95%Ci: 1.54-18.10), compared to lymph node metastasis negative patients with a high TSR. This group also had a worse DFS(HR = 6.41, 95%Ci: 1.84-22.28). An identical association was seen for OS. These relations were not seen in lymph node metastasis positive patients. CONCLUSiON The TSR has potential as a prognostic factor for survival in surgically treated rectal cancer patients, especially in lymph node negative cases.

关键词： Rectal cancer Adenocarcinoma Prognosis Recurrence Pathology Tumor-stroma ratio

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Fearful imagery induces hyperventilation and dyspnea in medically unexplained dyspnea

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Chinese Medical Journal 2008年第1期121卷 56-62页

作者： HAN Jiang-na ZHU Yuan-jue LUO Dong-mei Li Shun-wei ilse van diest Omer van den Bergh KarelP van de Woestijne Department of Pneumology Peking Union Medical CollegeHospital Chinese Academy of Medical Sciences Beijing 100730China Department of Psychology University of Leuven B-3000 LeuvenBelgium Department of Pneumology U Z Gasthuisberg B-3000 LeuvenBelgium

Background Medically unexplained dyspnea refers to a condition characterized by a sensation of dyspnea and is typically applied to patients presenting with anxiety and hyperventilation without underlying cardiopulmonary pathology. We were interested to know how anxiety triggers hyperventilation and elicits subjective symptoms in those patients. Using an imagery paradigm, we investigated the role of fearful imagery in provoking hyperventilation and in eliciting symptoms, specifically dyspnea. Methods Forty patients with medically unexplained dyspnea and 40 normal subjects matched for age and gender were exposed to scripts and asked to imagine both fearful and restful scenarios, while end-tidal PCO2 （PetCO2） and breathing frequency were recorded and subjective symptoms evaluated. The subject who had PetCO2 falling more than 5 mmHg from baseline and persisting at this low level for more than 15 seconds in the imagination was regarded as a hyperventilation responder. Results in patients with medically unexplained dyspnea, imagination of fearful scenarios, being blocked in an elevator in particular, induced anxious feelings, and provoked a significant fall in PetCO2 （P〈0.05）. Breathing frequency tended to increase. Eighteen out of 40 patients were identified as hyperventilation responders compared to 5 out of 40 normal subjects （P〈0.01）. The patients reported symptoms of dyspnea, palpitation or fast heart beat in the same fearful script imagery. Additionally, PetCO2 fall was significantly correlated with the intensity of dyspnea and palpitation experienced during the mental imagery on one hand, and with anxiety symptoms on the other. Conclusions Fearful imagery provokes hyperventilation and induces subjective symptoms of dyspnea and palpitation in patients with medically unexplained dyspnea.

关键词： medically unexplained dyspnea hyperventilation anxiety dyspnea mental imagery

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呼吸前反馈调节、情景想象和过度通气

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中华结核和呼吸杂志 2002年第5期25卷 299-301页

作者： ilse van diest 韩江娜 Karel P.vande Woestijne Stephan Devriese Winnie Winters Omer vanden Bergh Department of Psychology University of Leuven 中国医学科学院中国协和医科大学北京协和医院呼吸科 Faculty of Medicine University of Leuven Department

通过大量的科学证据,我们论述了代谢的负反馈调节不是呼吸调节的唯一机制.醒觉时呼吸的前反馈调节起了主导作用,前反馈调节可以在血气异常引起的负反馈调节之前,对将要发生的异常进行纠正,预见性地改变通气,而代谢的变化随后发生,避免... 详细信息

通过大量的科学证据,我们论述了代谢的负反馈调节不是呼吸调节的唯一机制.醒觉时呼吸的前反馈调节起了主导作用,前反馈调节可以在血气异常引起的负反馈调节之前,对将要发生的异常进行纠正,预见性地改变通气,而代谢的变化随后发生,避免了负反馈调节所具有的波动和滞后的缺点,使呼吸调节系统具有更大的灵活性和适应能力.在前反馈调节的形成过程中,经典的巴甫洛夫条件反射学说可能起了重要作用.尤其重要的是表象作为条件刺激形成的条件反射,研究表象作为条件刺激如何形成呼吸的前反馈调节对揭示高通气综合征的发病机制具有重要意义.

关键词：呼吸前反馈调节情景想象过度通气呼吸调节

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健康人腋窝淋巴结特征的高分辨率7TMRi的体外研究

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国际医学放射学杂志 2011年第2期 199-200页

作者： M.A.Korteweg J.J.M.Zwanenburg P.J.van diest M.A.A.J.van den Bosch P.R Luijten R.van Hillegersberg 唐光健 Department of Radiology University Medical Centre Utrecht

目的作为将来乳腺癌病人无创性分期的初步研究,利用7TMRi确定健康人腋窝淋巴结的特征,并与病理分析进行对照。方法共4个来自2例非癌病人活检的腋窝

关键词： MRi 乳腺肿瘤淋巴结肿瘤分期 7Tesla

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乳腺癌清扫的前哨淋巴结:高空间分辨力7 T MRi的特征

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国际医学放射学杂志 2011年第6期 588-589页

作者： M.A.Korteweg J.J.M.Zwanenburg J.M.Hoogduin M.A.A.J.van den Bosch P.J.van diest R.van Hillegersberg 李雪华 Department of Radiology University Medical Center UtrechtHP.E102Heidelberglaan 1003584 CX Utrechtthe Netherlands

目的探讨经组织病理学证实的乳腺癌病人被清扫的前哨转移淋巴结与7TMRi特征的相关性。材料与方法 2008年11月—2010年7月期间,33例女性乳腺癌病人(年龄31～80岁,平均57岁)被清扫的淋巴结共114个。采用3DT1Wi脂肪抑制快速场梯度回波(各... 详细信息

目的探讨经组织病理学证实的乳腺癌病人被清扫的前哨转移淋巴结与7TMRi特征的相关性。材料与方法 2008年11月—2010年7月期间,33例女性乳腺癌病人(年龄31～80岁,平均57岁)被清扫的淋巴结共114个。采用3DT1Wi脂肪抑制快速场梯度回波(各向同性,180μm)MR序列

关键词：乳腺癌 T MRi 病人乳腺肿瘤淋巴结门空间分辨力空间分辨率

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采用基于密度试验数据的预测模型降低致密型乳腺女性的MRi假阳性筛查率

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国际医学放射学杂志 2022年第1期 104-104页

作者： B.M.den Dekker M.F.Bakker S.V.de Lange W.B.Veldhuis P.J.van diest K.M.Duvivier 白雪

摘要高的乳腺密度会增加患乳腺癌的风险，降低乳腺X线检查的敏感度。MRi辅助筛查提高了癌症的检出率，但增加了筛查的假阳性率。因此，需要一些方法来鉴别真阳性

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