pubMedId
stringlengths 3
2.44k
| title
stringlengths 1
1.85k
⌀ | abstract
stringlengths 1
14.5k
⌀ |
|---|---|---|
9451576 | Computerized monitoring of potentially interfering medication in thyroid function diagnostics. | Many drugs are known to affect the results of laboratory tests. This may cause problems in the interpretation of clinical laboratory data and lead to wrong diagnoses, unnecessary further tests and additional costs. puterized monitoring system of potential drug effects on laboratory tests was developed in Turku University Central Hospital. In the present study the incidence and nature of potentially interfering drug effects in thyroid function diagnostics was examined in order to ease the clinical implementation of the system. |
9451575 | Retest-reliability and convergent validity of noninvasive blood pressure determination: arm sphygmomanometry vs. Peñaz-method. | Blood pressure is usually determined by arm sphygmomanometry. However, this technique does not allow continuous blood pressure monitoring. Over the last years, a technique introduced by Peñaz makes it feasible to determine blood pressure noninvasively and continuously from the finger artery. Study on 46 normotensives showed that both methods have high retest-reliabilities for systolic blood pressure while for diastolic blood pressure, arm sphygmomanometry resulted in lower reliabilities than the Peñaz-method. parisons showed only small correlations. Diastolic blood pressure levels were significantly lower in the Peñaz-method than in arm sphygmomanometry. In conclusion, blood pressure levels determined by arm sphygmomanometry and the Peñaz-method differ systematically because of different methodologies. If blood pressure or blood pressure changes are determined, the method and the circumstances of its application need to be carefully reported. |
9451577 | Cognitive difficulty of a peripherally presented visual task affects head movements during gaze displacement. | The maintenance and adjustment of visual gaze are functions both of eye and of head movement. Compared to the factors that affect eye movement during gaze displacement, the factors that affect head movement have received relatively little attention. Most experimenters have restricted head movements to determine how the eye acquires information. Information monly acquired without head movements (e.g., it is likely you are moving your eyes without moving your head as you read the words on this page). However, when visual information beyond the written page is acquired head movements in addition to eye movements are likely to occur. The purpose of this experiment was to study gaze displacement under more natural conditions in which the eyes and head were both free to move. Specifically, the purpose of this experiment was to identify the pattern of gaze displacement as a function of cognitive task difficulty. Visual information was presented at an eccentricity of 40 degrees of visual angle either to the left or to the right of a center fixation point (0 degree eccentricity) to 24 undergraduate subjects (12 male). On each trial, five integers were presented in rapid succession; subjects were asked to count the number of odd integers or to arithmetically manipulate the integers. When subjects expected to perform the more difficult task of arithmetic manipulation, they were more likely to make head movements in the direction of the stimuli, F1,16 = 9.34, P < 0.05. Those subjects who made head movements to acquire the peripherally presented visual information made significantly more errors than the 'non-movers', F1,24 = 6.03, P < 0.05. These results suggest subjects who moved their head to acquire peripheral information may have found the task to be more difficult than subjects who did not make head movements. The results confirm that head movements play a critical role in the intake of information even in structured laboratory tasks and suggest mon method of restricting head movements to study eye movements may not be a natural method of information intake. |
9451578 | Cortical activity of good and poor spatial test performers during spatial and verbal processing studied with Slow Potential Topography. | Whether essential processing of spatial information is lateralized asymmetrically in the human cortex is still a matter of debate. In this study, items of an Item Response Theory calibrated test for spatial ability were used to ensure stimulus homogeneity and validity. Subjects were preselected as extreme groups of good and poor spatializers. Mapping of true DC-recorded slow potential shifts (SPSs) resulted in distinctly discriminable topographies with spatial and verbal-analytic material as well as with spatial performance groups within the spatial block. Left fronto-central negativity maxima in the verbal condition clearly contrasted with occipito-parietal peak activity in the spatial condition. Poor spatializers showed higher amplitudes as well as a tendency to asymmetric activity in right parietal (parieto-temporal) areas, whereas in good spatializers the activity was localized symmetrically in occipital and occipito-parietal regions. The findings emphasize the importance of the right posterior cortex for spatial processing (negativity maxima at occipital and right parietal sites) and suggest a task-specific lower cortical efficiency or, seen from a processing perspective, a higher Investment of Cortical Effort (ICE) on the part of poor spatializers. |
9451579 | ERP assessment of semantic memory in Alzheimer's disease. | This study used the technique of Event-Related Potentials (ERPs), specifically ponent N400, to evaluate semantic functions in Alzheimer's disease (AD). ERPs of 10 patients with probable AD and 10 asymptomatic elderly control subjects were recorded during a semantic categorization task using pictures as stimuli, 50% of the stimuli were congruent and the other 50% were incongruent. Significant differences for the incongruent ERPs, with a diminished ponent, was observed in the patients group whereas the amplitude of the congruent ERPs was similar in both groups. The characteristics of the N400 in the patients with probable AD suggest that there is a lack of efficiency in accessing information and shows that there are deficient associative connections within the semantic network. |
9451580 | Hypnosis and event-related potential correlates of error processing in a stroop-type paradigm: a test of the frontal hypothesis. | A model of frontal inhibition in hypnosis was elucidated by examining with cortical evoked potentials error negativity and positivity in 23 low versus medium/high hypnotisables during a perceptual task which included trials with conflicting stimulus information. In susceptible subjects the number of correct responses was found to be smaller for trials with incongruent stimulus information with hypnosis pared with baseline. While the early negative wave to incorrect responses tended to be higher in susceptible subjects, this wave was no longer followed by a late positivity, posited to reflect a failure to process further the error-related information. The results with hypnosis are interpreted as a failure of context updating without a global deficit in supervisory attention. |
9451581 | Human and monkey P3-like responses in a mixed modality paradigm: effects of context and context-dependent noradrenergic influences. | Previous studies in non-human primates have reported that noradrenergic agents, such as the alpha 2 agonist clonidine, affect auditory but not visual P3 responses. One explanation for these effects may be that distinct modalities are differentially susceptible to noradrenergic influences--a modality-dependent effect. Another possibility is that noradrenergic effects are modality-independent but context-dependent. Two separate experiments, in humans and monkeys, examined the role of stimulus modality, context and noradrenergic activity in an attempt to elucidate the nature of the relationship between P3 and the action of this catecholamine neurotransmitter. In Experiment 1, human subjects were exposed to two versions of a mixed modality oddball paradigm. In one version, the context or background activity was auditory, while in the other it was visual. In both versions of the paradigm, the same auditory and visual rare targets occurred. The results indicated that N2 and P3 to visual targets were more sensitive to changes in context than those to auditory targets. In both cases, N2 and P3 amplitudes to targets were enhanced when the eliciting event and context differed. A modality-specific N2b, on the other hand, was enhanced when the context matched the modality of the eliciting event. In Experiment 2, monkeys received systemic injections of a saline placebo or one of three doses of the adrenergic antagonist L657,743 prior to presentation of a mixed modality oddball paradigm in a visual context. Drug effects were observed on ponents such as N1, P2 and N2 but not on later P3-like responses. bined plement previous ones from our laboratory and suggest that P3 reflects context-dependent processes and specifically context-dependent, not modality-specific, noradrenergic activity. |
9451582 | Conditioned emotional cueing of spatial attentional shifts in a go/no-go RT task. | The influence of conditioned emotional arousal on selective attention was evaluated in a go/no-go version of Posner's covert attention spatial orienting task (Posner et al., 1982). Ten males and 10 females participated in the study, which consisted of two phases; an initial conditioning phase and a subsequent attention phase. In the conditioning phase, the Conditioning group received a 90-dB white noise unconditioned stimulus (UCS) contingent with presentations of a frame-lit rectangle, which thus became a conditioned stimulus (CS+), while pletely-lit rectangle was never paired with the noise and became a CS-. The Control group received non-contingent presentations of the noise and the two rectangles. In the attention phase, both groups participated in a go/no-go version of the attention orienting task, where targets were cued by both the CS+ and the CS-. Half of the subjects in both the Conditioning and the Control group were instructed to respond only to targets cued by the CS+ (go cue) and ignore targets cued by the CS- (no-go cue). The other half of the subjects responded to targets cued by the CS- and ignored targets cued by CS+. The Conditioning group identified targets at the opposite location of the CS+ significantly faster than targets at the same location. The emotional salience of the cue thus reversed the typical cost of shifting attention to targets outside the cued location. |
9451583 | Possible role of sweating in the pathophysiology of panic attacks. | In recent years the role of hyperventilation in the generation of panic attacks has attracted a considerable amount of interest. According to these studies hyperventilation can elicit the somatic symptoms of panic due to systemic alkalosis. We suggest that since in the case of panic, sweating might cause alkalosis, it could also contribute to the generation of panic attacks. In light of this hypothesis we made a statistical analysis of the panic symptoms of 111 panic patients diagnosed according to DSM-III criteria. The analysis revealed that: (1) there was a well identified group of panic patients who had minor breathing difficulties with heavy sweating; and (2) that all the patients sampled had either severe breathing, or sweating symptoms, or both. We conclude that in the absence of the intensive physical activity of the 'flight or fight' reaction, sweating as well as hyperventilation can cause alkalosis, which in turn might generate panic attacks. |
9451584 | Therapists' anxiety and attitudes toward computerized documentation in the clinical setting. | Many hospitals are converting to electronic records and allied health professionals are required to modify their traditional documentation practices to modate this new technology. This paper discusses a study conducted to determine puter anxiety and attitudes of physical, occupational, and speech therapists in a large urban teaching hospital before and after the implementation of puterized documentation system. Fifty-three therapists surveyed with a preinstallation questionnaire reported puter anxiety and generally good attitudes about the puter system. A greater amount of puter use and better puter skills were consistent with puter anxiety. Seven of the original sample became the first to use puter system. After their six month trial period, surveys revealed a reduction puter anxieties. Manual time pleted before and after the system implementation revealed a significant decrease in total documentation time when puters. |
9451585 | Integration of an Internet anatomy review of the knee joint in a rehabilitation sciences curriculum: "http:/(/)www.musc.edu/chp-rehab/anatomy/ kneedemo.htm". | The cost and difficulty of obtaining cadavers to teach anatomy in allied health programs and in medical schools have led to the development of new interactive technology plement cadaver dissection. However, the price of puter software packages often limits the schools from purchasing these products. The advantages of the Internet in the academic setting (easy and global accessibility associated with low cost) enticed us to develop an Internet site to study the anatomy of the knee. This article describes the process of developing an Internet site, the procedure for accessing an Internet site, and the contribution of Internet sites to the teaching of anatomy to students. Finally, this article provides addresses on the Internet for other anatomy sites related to the anatomy of the knee. In conclusion, our Internet site allows the students to study anatomy at a low cost while utilizing a new and exciting educational medium. |
9451586 | Respiratory care education goes the distance. | The availability of interactive videoconferencing technology has ignited interest in distance learning programs. Interactive courses can be offered via various technologies as dictated by the needs of educational programs. Allied health programs are employing interactive systems to increase accessibility of quality education to remote, isolated, and underserved areas. A model program in the Central Texas area is meeting the educational needs of respiratory care professionals in a Mexican-American border town. The interactive infrastructure of this project is also being used to offer college courses and continuing education classes in other programs, including Health Information Management and Health Administration. |
9451588 | Communication skill development in health professional education: the use of standardised patients in combination with a peer assessment strategy. | The purpose of this paper is to describe an approach to developing munication skills in health professional students. The course which was structured for this research project was experiential in nature and included self-directed student tutorials, dramatisations and theatrical improvisation with actors, videotape, and the use of standardised patients. Students ed the opportunity to experience 'communication' as part of their interpersonal skill development. Peer assessment was used to evaluate the student interviews with simulated patients which were recorded on videotape. There was a significant difference between the mean mark scores of the peer and unit coordinators. Reasons for this discrepancy are proposed as are methods for controlling this phenomenon. Literature describing peer assessment and the use of standardised patients is reviewed and discussed in the context munication skill training. |
9451587 | Strategic planning in a school of health related professions: organizational transformation for the future. | The School of Health Related Professions (SHRP) at The University of Alabama at Birmingham (UAB) has been in existence for over a quarter of a century. During this time, it expanded and grew to offering 34 individual programs at the time of its silver anniversary. A concerted strategic planning process over two years has resulted in the School pursuing major organizational transformations to better align itself with the rest of the University's academic health center, to maximize its resources, and to refine its niche in academia. The strategic planning process used and major es are described for the potential benefit of other schools of health related professions desiring to pursue introspection for future survival. |
9451589 | Health science graduates: preparation for the workplace. | The research reported in this article was undertaken to assess the perceptions of health science graduates in the fields of health information management, occupational therapy, orthoptics, physiotherapy, and speech pathology regarding their perceptions of the adequacy of undergraduate preparation in meeting the demands of a changing health care environment. An instrument was devised for use by graduates on the basis of the skills and workplace behaviours specified by experienced practitioners in the above fields as necessary in newly recruited graduates. A total of 527 health science pleted the 52 item instrument. The statistical analyses indicated that 11 factors define the adequacy of graduates' preparation for the workplace. Health science graduates perceived themselves to have been more thoroughly prepared on certain workplace dimensions than on others. Specifically, graduates perceived themselves to be ill-equipped on dimensions concerned with workplace management, knowledge of the health industry, and coping in the workplace. Graduates also perceived themselves to be inadequately prepared in terms municating with clients, health professionals, and the general public. The strengths of their courses were perceived to be pleting essential tasks, having confidence in the clinical role, in ethical practice, in pursuit and application of knowledge, and having a realistic expectation of the workplace role. The results are discussed in terms of the need to address curriculum changes. |
9451590 | B-cell deficiency does not abrogate development of cutaneous hyperplasia in mice inheriting the defective fibrillin-1 gene. | Tight-skin (TSK) mouse, the experimental model for scleroderma, develops cutaneous hyperplasia, cardiac hypertrophy, pulmonary emphysema and autoimmunity against scleroderma target autoantigens. The cutaneous hyperplasia is associated with the accumulation of microfibrils and elastic fibers in the middle and deep dermis. Fibrillin-1 (Fbn-1) is a ponent of the 10-12 nm microfibrils found in the extracellular matrix. In this study we report the identification of a genetic marker in the Fbn-1 gene that can distinguish the mutant phenotype. TSK mice exhibit an unique polymorphism in the Fbn-1 gene. RNA analysis, PCR analysis and sequence determination of the mutant gene showed that the Fbn-1 gene polymorphism is due to intragenic duplication of a segment of the gene coding for 3.0 Kb of mRNA sequence (10 Kb of the genome). Histological analysis of skin samples from F1 progeny obtained by crossing TSK mice with JH-/-, RAG2-/- or vit/vit showed a significant correlation between the inheritance of the defective Fbn-1 gene and the development of cutaneous hyperplasia. Further, our results also show that in mice deficient in mature B cells inheriting the defective Fbn-1 gene, development of cutaneous hyperplasia is not abrogated. Thus, production of autoantibodies or the presence of mature B lymphocytes do not play an integral role in the pathogenesis of cutaneous hyperplasia. |
9451591 | Propentofylline and iloprost suppress the production of TNF-alpha by macrophages but fail to ameliorate experimental autoimmune encephalomyelitis in Lewis rats. | Intracellular cAMP levels can be elevated by activation of cAMP-generating adenylate cyclase (AC) or inhibition of cAMP-cleavage by phosphodiesterases. Elevation of intracellular cAMP levels in immune cells inhibits production of some Th1-cytokines, particularly TNF-alpha, and results mainly in downregulation of the immune response. Experimental autoimmune encephalomyelitis (EAE) of Lewis rats is a disease mediated by type 1 T helper lymphocytes and macrophages and serves as a model of multiple sclerosis. In EAE we therefore tested the immunomodulatory potency of an AC-activating, stable prostacyclin analogue, iloprost, and of a potent and non-selective inhibitor of phosphodiesterases, propentofylline, which also has neuroprotective properties. Preventive treatment of Lewis rats with propentofylline (2 x 10 or 12.5 mg/ kg/d), iloprost (2 x 10 or 12.5 micrograms/kg/d), or both did not significantly ameliorate clinical or histological signs of EAE actively induced by immunization with myelin basic protein (MBP) plete Freund's adjuvant. Furthermore, adoptive transfer EAE (AT-EAE), passively induced by injection of encephalitogenic MBP-specific Th1 lymphocytes, was not altered in its course by bined application of iloprost (2 x 10 micrograms/kg/d) and propentofylline (2 x 20 mg/kg/d) starting on the day of cell transfer. In vitro assays demonstrated that iloprost strongly and propentofylline moderately inhibited the production of TNF-alpha by macrophages and that iloprost in vivo similarly suppressed TNF-alpha secretion, although this effect was limited to a few hours after a single injection. In contrast to macrophages, TNF-alpha production by antigen-activated encephalitogenic T helper line cells in vitro pletely resistant to modulation by these agents. In addition, the presence of iloprost, propentofylline, or both drugs during activation of the line cells in vitro did not impair their encephalitogenicity in vivo. The findings delineate immunomodulatory effects of both substances, particularly of iloprost, but fail to support a possible therapeutic role of these agents in autoimmune inflammation of the central nervous system. |
9451592 | A thyroxine-containing thyroglobulin peptide induces both lymphocytic and granulomatous forms of experimental autoimmune thyroiditis. | Mouse thyroglobulin (MTg)-sensitized spleen cells activated in vitro with MTg can induce two histologically distinct forms of experimental autoimmune thyroiditis (EAT). MTg-sensitized cells activated with MTg alone induce a mild chronic form of EAT in which the thyroid infiltrate consists primarily of lymphocytes and other mononuclear cells (lymphocytic EAT). The same donor cells activated with MTg and anti-IL2R mAb induce a more severe and acute form of EAT with a thyroid inflammatory lesion having granulomatous histopathological features. A thyroxine-containing (T4) peptide, corresponding to positions 2549-2560 of human Tg, was shown by others to activate spleen cells of mouse thyroglobulin (MTg)-sensitized CBA/J mice to induce lymphocytic EAT. To determine if the CD4+ effector T cells that induce granulomatous EAT can respond to the same T-cell epitope, the present study was undertaken to determine if both forms of EAT could be induced by the 2549-2560 thyroxine (T4)-containing peptide. This peptide was very effective for activation of T cells from MTg-primed CBA/J donors to induce granulomatous EAT but, in contrast to MTg, did not activate T cells from AKR/J or DBA/1 mice to induce granulomatous EAT. The T4 peptide did not apparently activate peptide-specific B cells in vivo but did activate MTg-primed B cells in vitro to produce anti-MTg autoantibody in recipient mice. These results demonstrate that a single 12-amino-acid thyroxine-containing peptide can activate T cells from CBA/J mice to induce both lymphocytic and granulomatous EAT. However, this peptide does not activate T cells from some other EAT-susceptible strains of mice, suggesting that MTg contains multiple epitopes able to activate T cells to induce granulomatous EAT. |
9451593 | Preference for IgG mAb binding insulin in solution or on surfaces is related to immunoglobulin variable region structures. | Studies on insulin autoantibodies often show a lack of correlation between enzyme-linked immunosorbent assays (ELISAs) and fluid phase radioimmunoassays (RIAs). Similarly, a set of IgG anti-insulin monoclonal antibodies (mAb) from BALB/c mice are found to differ in their binding in ELISAs and RIAs. To understand the structural basis for differential insulin binding, soluble plexed biotinylated insulin is used to confirm binding properties independent of insulin-coated plastic and radioiodination. The binding properties of intact mAb are also present in Fab fragments, indicating ligand preference is not related to valence or to the Fc portion of Ig. Analysis of binding to soluble or bound ligand in relationship to antibody variable (V) region structures indicates that differential binding in the two assays is a property of heavy chain variable region structure. Studies also show that limited amino acid replacements arising during maturation of the immune response may change the binding preference for an individual mAb. These findings indicate that differences in detection of insulin binding in solid phase and fluid phase are not artefactual but reflect intrinsic structural features of immunoglobulin interaction with insulin. |
9451594 | Titin transcripts in thymomas. | More than 90% of myasthenia gravis (MG) patients with a thymoma have antibodies against titin. We have identified titin mRNA transcripts in thymomas by RT-PCR and Southern blotting. The transcripts cover the main immunogenic region (MIR) and a central I-band epitope reactive with some MG patients' antibodies. The presence of the central I-band epitope was confirmed by immunohistochemistry as a titin antibody reactive with this part of titin, stained thymoma epithelial cells and a thymoma extract in Western blots. Our findings suggest that the initiation of paraneoplastic titin reactivity is correlated with the expression of titin sequences within the thymoma. |
9451595 | Autoepitope-mapping of the U1-70K protein with human-Drosophila chimeric proteins. | The 70K protein is the major autoantigen for anti-RNP autoantibodies directed against the U1 small nuclear plex particle. The U1-70K protein has been epitope-mapped by various groups, and a major antigenic region of about 70 amino acids has been found which overlaps with the RNA binding motif. Attempts to map the major antigenic region further with smaller cloned fragments or with peptides have been hampered by total loss of, or strongly reduced, antigenicity. Thus the major antigenic region posed of conformational epitopes and a detailed analysis of particular epitopes has not been possible. In the present work, we examine the antigenicity of chimeric proteins assembled from the highly conserved Drosophila melanogaster 70K proteins grafted with human 70K segments. With this approach, the effects on antigenicity of exchanging particular segments can be assayed with the overall structure of the major antigenic domain kept relatively constant. Our results, supported by depletion experiments, show that residues 99-128 from the human protein are essential for recognition by both human and canine anti-RNP autoantibodies. These residues have to be presented in a manner that allows correct conformational interaction between the different protein domains. |
9451596 | Selection of self-reactive peptides within human aggrecan by use of a HLA-DRB1*0401 peptide binding motif. | The pathogenesis of joint destruction in rheumatoid arthritis remains ill-defined. Joint destruction is thought to be the result of tissue damage mediated by T cells. The mere presence of articular cartilage appears responsible for sustaining chronic synovitis and thereby forwards a role for cartilage-responsive T cells in RA. Taking advantage of the positive DRB1*0401 association with RA susceptibility, we reasoned that T-cell recognition of autoantigens in RA would be restricted by DRB1*0401-encoded molecules. A DR4 (B1*0401) peptide binding motif was used for the identification of putative T-cell epitopes within human aggrecan, a candidate autoantigen. Thirteen peptides were synthesized and tested for binding DRB1*0401 or 0404-encoded molecules. Selected binders were tested for induction of proliferative responses in peripheral blood mononuclear cells from donors carrying the DR4 or DR1 specificity. Both healthy and RA donors responded to human aggrecan-derived peptides, thereby identifying these sequences as T-cell epitopes. Interestingly, responses to aggrecan-derived epitopes were significantly decreased in RA pared to controls. This was not due to an overall hyporesponsiveness of RA patients since responses to a recall antigen or mitogen did not differ from controls. The data suggest that in RA, aggrecan-specific T cells may exist in a different stage of activation or may have left the periphery to home to the joint. |
9451597 | HLA-DR7 in association with chlorpromazine-induced lupus anticoagulant (LA). | The presence of anti-phospholipid antibodies (aPL) has been associated with the major plex (MHC) genes. These autoantibodies occur in individuals with infections such as that produced by the human immunodeficiency virus 1 (HIV-1) or with syphilis, but they can also occur in drug-induced lupus-like syndromes. In the present study, we analysed the presence of aPL (detected as lupus anti-coagulant) and its relationship with the MHC markers in 93 Caucasian psychiatric patients chronically treated with chlorpromazine. Forty-one out of 93 patients were positive for LA, and the HLA-DR7 antigen was significantly increased in LA-positive patients pared to normal controls or LA-negative patients (PC = 0.024, RR = 2.12 and P = 0.05, RR = 1.57, respectively). Likewise, we noted a significantly increased frequency of HLA-B44 in LA-positive patients pared to normal controls (PC = 0.024, RR = 2.12), but not pared to aPL-negative patients. No significant differences were found among any other class I, II or III MHC antigens. Haplotype analysis showed that DR7 was mostly part of the HLA-B44-DR7-FC31 and B7-DR7-SC31 haplotypes. These results suggest that the HLA-DR7 antigen might be playing a role in the production of aPL in chlorpromazine-treated patients. |
9451598 | Autoantibodies to the GM2-1 islet ganglioside and to GAD-65 at type 1 diabetes onset. | The GM2-1 islet ganglioside has been sequenced, found to be a novel ganglioside structure with a sialic acid moiety in the terminal position and two residues of non-acetylated galactosamine and also shown to be a target of autoantibodies in a subset of ICA+ relatives of type 1 diabetic patients who subsequently progressed to the overt disease. In the present study we determined whether antibodies to GM2-1 or to other pancreatic gangliosides (a) are also expressed at disease onset and (b) are correlated with other diabetes-associated autoantibodies. Pancreatic gangliosides were extracted from human pancreas and purified by thin layer chromatography (TLC). Anti-ganglioside autoantibodies were determined using an indirect immunoperoxidase technique performed directly on TLC plates in the following groups of patients: (a) newly diagnosed type 1 diabetic subjects before insulin therapy (n = 45); all were tested for GAD65 autoantibodies in a fluid-phase RIA using 35S-methionine-labelled binant human GAD65. Of these patients, 24 were also tested for insulin autoantibodies (IAA) by petitive fluid phase radioimmunoassay and 21 were tested for GAD67 reactivity. (b) Forty-two age- and sex-matched normal control subjects. Autoantibodies to GM2-1, but not to other pancreatic gangliosides (GM3, GD3, GD1a), were expressed in 31 of 45 new-onset type 1 diabetic subjects and in one of 42 normal controls (P < 0.01), while anti-GAD65, IAA and anti-GAD67 were found in 31 of 45, 12 of 24 and three of 21 patients respectively, but not in the control group of subjects. Interestingly, occurrence of GM2-1 autoantibodies was significantly correlated (P < 0.005) with positivity for GAD65 autoantibodies, but not for IAA or GAD67 autoantibodies. It is of note that both GAD and gangliosides are mainly expressed in islets and in neuronal tissues and, therefore, type 1 diabetes may be regarded as a neuroendocrine autoimmune disease. |
9451599 | Th1-like cytokine production profile and individual specific alterations in TCRBV-gene usage of T cells from newly diagnosed type 1 diabetes patients after stimulation with beta-cell antigens. | In order to study cytokine production profile (IFN-gamma, IL-4 and TNF-alpha) and TCRBV-gene usage of peripheral autoreactive T cells from IDDM patients, we have generated antigen-specific T cell lines with either tetanus toxoid, insulinoma membranes or a single beta-cell protein, binant ICA69, which has been shown to be a target of both autoantibodies and T cells in IDDM. By semi-quantitative polymerase chain reaction (PCR) analysis, we have determined position of the T cell receptor repertoire of these T cell lines pared this with the general peripheral repertoire. T cell responses against beta-cell antigens and tetanus toxoid (TT) were shown to be associated with IFN-gamma and TNF-alpha production, suggestive of a Th1-like phenotype of the T-cell lines. The production of IFN-gamma was significantly higher in T-cell lines generated with pared to those generated with TT. The cytokine production profiles of the T-cell lines generated with ICA69 did not provide an obvious explanation for the inverse relation between cellular and humoral responses to this protein observed earlier. Upon stimulation with beta-cell antigens, outgrowth of T cells using a restricted set of TCRBV elements was observed in newly diagnosed IDDM patients. However, this skewing in TCRBV-gene expression was patient-specific rather than antigen-associated, since the T-cell repertoire that is used for the recognition of these antigens was, overall, heterogeneous. |
9451602 | Defending commercial surrogate motherhood against Van Niekerk and Van Zyl. | The arguments of Van Niekerk and Van Zyl that, on the grounds that it involves an modification and alienation of women's mercial surrogate motherhood (CSM) is morally suspect are discussed and considered to be defective. In addition, doubt is cast on the notion that CSM should be illegal. |
9451604 | "Goodbye Dolly?" The ethics of human cloning. | The ethical implications of human clones have been much alluded to, but have seldom been examined with any rigour. This paper examines the possible uses and abuses of human cloning and draws out the principal ethical dimensions, both of what might be done and its meaning. The paper examines some of the major public and official responses to cloning by authorities such as President Clinton, the World Health Organisation, the European parliament, UNESCO, and others and reveals their inadequacies as foundations for a coherent public policy on human cloning. The paper ends by defending a conception of reproductive rights of "procreative autonomy" which shows human cloning to be not inconsistent with human rights and dignity. |
9451606 | Causing death or allowing to die? Developments in the law. | Several cases which have been considered by the courts in recent years have highlighted the legal dilemmas facing doctors whose decisions result in the ending of a patient's life. This paper considers the case of Dr Cox, who was convicted of attempting to murder one of his patients, and explores the roles of motive, diminished responsibility and consent in cases of "mercy killing". The Cox decision pared to that of Tony Bland and Janet Johnstone, in which the patients were in a persistent vegetative state. In all three cases, the doctors believed that their patients' quality of life was so poor that their continued existence was of no benefit to them, and decided that their lives should not be unduly prolonged, yet the doctor who was prosecuted was the one whose dying patient had requested that her death be hastened. The paper examines the law's seemingly contradictory approaches to such cases. |
9451605 | Marginally effective medical care: ethical analysis of issues in cardiopulmonary resuscitation (CPR) | es from cardiopulmonary resuscitation (CPR) remain distressingly poor. Overuse of CPR is attributable to unrealistic expectations, unintended consequences of existing policies and failure to honour patient refusal of CPR. We analyzed the CPR es literature using the bioethical principles of beneficence, non-maleficence, autonomy and justice and developed a proposal for selective use of CPR. Beneficence supports use of CPR when most effective. Non-maleficence argues against performing CPR when the es are harmful or usage inappropriate. Additionally, policies which usurp good clinical judgment and moral responsibility, thereby contributing to inappropriate CPR usage, should be considered maleficent. Autonomy restricts CPR use when refused but cannot create a right to CPR. Justice requires that we define which medical interventions contribute sufficiently to health and happiness that they should be made universally available. This ordering is necessary whether one believes in the utilitarian standard or wishes medical care to be universally available on fairness grounds. Low-yield CPR fails justice criteria. Cardiopulmonary resuscitation should be performed when justified by the extensive es literature; not performed when not desired by the patient or not indicated; and performed infrequently when relatively contraindicated. |
9451607 | At the coalface--medical ethics in practice. First, do no harm. | When a physician acts as both doctor and researcher conflicts can develop. When a doctor does not know whether a patient is taking active drug or placebo, any new medical problems can result in a dilemma. Is the patient's suffering a side effect of the medication or is this a new medical problem? Mrs W's case demonstrates the problem that can occur when the physician is blinded in the name of research. |
9451608 | Local Research Ethics Committees can audit ethical standards in research. | To show that a Local Research Ethics Committee (LREC) can carry out an audit of ethical standards in research. To find out if a researcher met certain ethical standards in recruiting subjects for clinical trials and in obtaining their consent. |
9451609 | Questionable ethics--whistle-blowing or tale-telling? | Renal biopsy is a potentially hazardous procedure, generally performed for therapeutic reasons. An open renal biopsy was performed when there appeared to be no accepted clinical indication and its results published in a specialty journal, whose editors declined publication of subsequent correspondence, questioning the ethical propriety of such a procedure. The implications for clinical practice, authors, editors and readers are discussed. |
9451611 | Control of breathing during sleep assessed by proportional assist ventilation. | We used proportional assist ventilation (PAV) to evaluate the sources of respiratory drive during sleep. PAV increases the slope of the relation between tidal volume (VT) and respiratory muscle pressure output (Pmus). We reasoned that if respiratory drive is dominated by chemical factors, progressive increase of PAV gain should result in only a small increase in VT because Pmus would be downregulated substantially as a result of small decreases in PCO2. In the presence of substantial nonchemical sources of drive [believed to be the case in rapid-eye-movement (REM) sleep] PAV should result in a substantial increase in minute ventilation and reduction in PCO2 as the output related to the chemically insensitive drive source is amplified severalfold. Twelve normal subjects underwent polysomnography while connected to a PAV ventilator. Continuous positive air pressure (5.2 +/- 2.0 cmH2O) was administered to stabilize the upper airway. PAV was increased in 2-min steps from 0 to 20, 40, 60, 80, and 90% of the subject's elastance and resistance. VT, respiratory rate, minute ventilation, and end-tidal CO2 pressure were measured at the different levels, and Pmus was calculated. Observations were obtained in stage 2 sleep (n = 12), slow-wave sleep (n = 11), and REM sleep (n = 7). In all cases, Pmus was substantially downregulated with increase in assist so that the increase in VT, although significant (P < 0.05), was small 0.08 liter at the highest assist). There was no difference in response between REM and non-REM sleep. We conclude that respiratory drive during sleep is dominated by chemical control and that there is no fundamental difference between REM and non-REM sleep in this regard. REM sleep appears to simply add bidirectional noise to what is basically a chemically controlled respiratory output. |
9451612 | Effect of selective phosphodiesterase inhibitors on response of ovine pulmonary arteries to prostaglandin E2. | Several adenosine 3',5'-cyclic monophosphate (cAMP)-hydrolyzing phosphodiesterase isozymes are present in the pulmonary vasculature. The present study was designed to determine the effect of selective inhibitors of phosphodiesterase subtypes on prostaglandin E2 (PGE2)-induced relaxation of isolated fourth-generation pulmonary arteries of newborn lambs. PGE2 and forskolin caused pulmonary arteries to relax and induced an increase in the intracellular cAMP content in the vessels. The relaxation and change in cAMP content were augmented by milrinone and rolipram, inhibitors of phosphodiesterase type 3 (PDE3) and type 4 (PDE4), respectively. The augmentation in relaxation and the increase in cAMP content caused by milrinone plus rolipram was greater than the sum of the responses caused by either of the inhibitors alone. 8-Methoxymethyl-1-methyl-3-(2-methylpropyl)xanthine, an inhibitor of phosphodiesterase type 1, had no effect on relaxation and change in cAMP induced by PGE2 and forskolin. Acetylcholine alone had no effect on cAMP content in the vessels but augmented the relaxation and the increase in cAMP induced by PGE2 and forskolin in arteries with endothelium. This effect was not observed in arteries without endothelium or in arteries with endothelium treated with NG-nitro-L-arginine. These results suggest that PDE3 and PDE4 are the primary enzymes hydrolyzing cAMP of pulmonary arteries of newborn lambs and that an inhibition of both PDE3 and PDE4 would result in a greater effect than that caused by inhibition of either one of the subtype isozymes alone. Furthermore, endothelium-derived nitric oxide may enhance cAMP-mediated relaxation by inhibition of PDE3. |
9451613 | Choroidal readaptation to gravity in rats after spaceflight and head-down tilt. | To determine when choroidal structures were restored after readaptation to Earth gravity or orthostatic position, fine structure and protein distribution were studied in rat choroid plexus dissected either 6 h [Space Life Sciences-2 (SLS-2) experiments] or 2 days [National Institutes of Health-Rodent 1 (NIH-R1) experiments] after a spaceflight, or 6 h after head-down tilt (HDT) experiments. Apical alterations were noted in choroidal cells from SLS-2 and HDT animals, confirming that weightlessness impaired choroidal structures and functions. However, the presence of small apical microvilli and kinocilia and the absence of vesicle accumulations showed that the apical organization began to be restored rapidly after landing. Very enlarged apical microvilli appeared after 2 days on Earth, suggesting increased choroidal activity. However, as distributions of ezrin and carbonic anhydrase II remained altered in both flight and suspended animals after readaptation to Earth gravity, it was concluded that choroidal structures and functions were pletely restored, even after 2 days in Earth's gravity. |
9451614 | Stimulation of vagal pulmonary C fibers by inhaled wood smoke in rats. | This study investigated the stimulation of vagal pulmonary C fibers (PCs) by wood smoke. We recorded impulses from PCs in 58 anesthetized, open-chest, and artificially ventilated rats and delivered 6 ml of wood smoke into the lungs. Within 1 or 2 s after the smoke delivery, an intense and nonphasic burst of discharge [delta = +7.4 +/- 0.7 (SE) impulses/s, n = 68] was evoked in 60 of the 68 PCs studied and lasted for 4-8 s. This immediate stimulation was usually followed by a delayed and more sustained increase in C-fiber activity (delta = +2.0 +/- 0.4 impulses/s). The overall stimulation was not influenced by removal of smoke particulates (n = 15) or by pretreatment with vehicle (n = 8) for dimethylthiourea (DMTU; a hydroxyl radical scavenger) or indomethacin (Indo; a cyclooxygenase inhibitor). The immediate-phase stimulation was not affected by pretreatment with Indo (n = 8) but was largely attenuated by pretreatment with DMTU (n = 12) or by bined treatment with DMTU and Indo (DMTU + Indo; n = 8). Conversely, the delayed-phase stimulation was partially suppressed either by DMTU or by Indo but was totally abolished by DMTU + Indo. These results suggest that 1) the stimulation of PCs is linked to the gas phase of wood smoke and 2) hydroxyl radical, but not cyclooxygenase products, is involved in the immediate-phase stimulation, whereas both metabolites are responsible for evoking the delayed-phase stimulation. |
9451615 | Low energy availability, not stress of exercise, alters LH pulsatility in exercising women. | We tested two hypotheses about the disruption of luteinizing hormone (LH) pulsatility in exercising women by assaying LH in blood samples drawn at 10-min intervals over 24 h from nine young, habitually sedentary, regularly menstruating women on days 8, 9, or 10 of two menstrual cycles after 4 days of intense exercise [E = 30 kcal.kg lean body mass (LBM)-1.day-1 at 70% of aerobic capacity]. To test the hypothesis that LH pulsatility is disrupted by low energy availability, we controlled the subjects' dietary energy intakes (I) to set their energy availabilities (A = I - E) at 45 and 10 kcal.kg LBM-1.day-1 during the two trials. To test the hypothesis that LH pulsatility is disrupted by the stress of exercise, pared the resulting LH pulsatilities to those previously reported in women with similar controlled energy availability who had not exercised. In the exercising women, low energy availability reduced LH pulse frequency by 10% (P < 0.01) during the waking hours and increased LH pulse amplitude by 36% (P = 0.05) during waking and sleeping hours, but this reduction in LH pulse frequency was blunted by 60% (P = pared with that in the previously studied nonexercising women whose low energy availability was caused by dietary restriction. The stress of exercise neither reduced LH pulse frequency nor increased LH pulse amplitude (all P > 0.4). During exercise, the proportion of energy derived from carbohydrate oxidation was reduced from 73% while A = 45 kcal.kg LBM-1.day-1 to 49% while A = 10 kcal.kg LBM-1.day-1 (P < 0.0001). These results contradict the hypothesis that LH pulsatility is disrupted by exercise stress and suggest that LH pulsatility in women depends on energy availability. |
9451616 | Stop-flow studies of distribution of filtration in rat lungs. | The stop-flow approach was used to investigate where filtration occurs in the pulmonary vasculature after elevation of left atrial pressure and aspiration of HCl. Rat lungs were perfused for 11 min at zero left atrial pressures, and then flow was stopped for 10 min and left atrial pressures were increased to 20 cmH2O. Thereafter, 3HOH was instilled into the air spaces, and the pulmonary vasculature was flushed by perfusing it from the pulmonary artery to left atrium (anterograde flush) or in the opposite direction (retrograde flush). Increases in fluorescein isothiocyanate (FITC)-dextran (molecular weight 2,000,000) indicated filtration, and these preceded increases in 3HOH after anterograde but not retrograde flushes. This suggests that some filtration occurred through vessels that were relatively pared with those through which 3HOH exchange had occurred. Filtration increased fivefold after instillation of 0.1 N HCl in isotonic saline into the air spaces before perfusion. Increases in Evans blue-labeled albumin concentrations were < 40% those of FITC-dextran, indicating loss from the vasculature, but increases in unlabeled albumin and FITC-albumin parable. |
9451617 | A moderate glycemic meal before endurance exercise can enhance performance. | The purpose of this study was to determine whether presweetened breakfast cereals with various fiber contents and a moderate glycemic index optimize glucose availability and improve endurance exercise performance. Six recreationally active women ate 75 g of available carbohydrate in the form of breakfast cereals: sweetened whole-grain rolled oats (SRO, 7 g of dietary fiber) or sweetened whole-oat flour (SOF, 3 g of dietary fiber) and 300 ml of water or water alone (Con). The meals were provided 45 min before semirecumbent cycle ergometer exercise to exhaustion at 60% of peak O2 consumption (VO2peak). Diet and physical activity were controlled by having the subjects reside in the General Clinical Research Center for 2 days before each trial. Blood samples were drawn from an antecubital vein for glucose, free fatty acid (FFA), glycerol, insulin, epinephrine, and norepinephrine determination. Breath samples were obtained at 15-min intervals after meal ingestion and at 30-min intervals during exercise. Muscle glycogen concentration was determined from biopsies taken from the vastus lateralis muscle before the meal and immediately after exercise. Plasma FFA concentrations were lower (P < 0.05) during the SRO and SOF trials for the first 60 and 90 min of exercise, respectively, than during the Con trial. Respiratory exchange ratios were higher (P < 0.05) at 90 and 120 min of exercise for the SRO and SOF trials, respectively, than for the Con trial. At exhaustion, glucose, insulin, FFA, glycerol, epinephrine, and norepinephrine concentrations, respiratory exchange ratio, and muscle glycogen use in the vastus lateralis muscle were similar for all trials. Exercise time to exhaustion was 16% longer (P < 0.05) during the SRO than during the Con trial: 266.5 +/- 13 and 225.1 +/- 8 min, respectively. There was no difference in exercise time for the SOF (250.8 +/- 12) and Con trials. We conclude that eating a meal with a high dietary fiber content and moderate glycemic index 45 min before prolonged moderately intense exercise significantly enhances exercise capacity. |
9451618 | Effects of CO2-HCO3- on catecholamine efflux from cat carotid body. | Using a chronoamperometric technique with carbon-fiber microelectrodes and neural recordings, we simultaneously measured the effects of the following procedures on catecholamine efflux (delta CA) and frequency of chemosensory discharges (fx) from superfused cat carotid body: 1) the addition of CO2-HCO3- to Tyrode solution previously buffered with N-2-hydroxyethylpiperazine-N'-2-ethane-sulfonic acid, maintaining pH at 7.40; 2) hypercapnia (10% CO2, pH 7.10); 3) hypoxia (PO2 h approximately 40 Torr) with and without CO2-HCO3-; and 4) the impact of several boluses of dopamine (DA; 10-100 micrograms) on hypoxic and hypercapnic challenges. With CO2-HCO3-, hypoxia increased fx which preceded delta CA increases, whereas hypercapnia raised fx but did not consistently increase delta CA. Repeated stimuli induced similar fx increases, but attenuated delta CA. After DA, hypoxia produced larger delta CA, which preceded chemosensory responses. Without CO2-HCO3-, hypoxia produced a similar pattern of delta CA and fx responses. Switching to Tyrode solution with CO2-HCO3- at pH 7.40 raised fx but did not increase delta CA. With CO2-HCO3- and after DA, hypoxic-induced delta CAs were larger than in its absence. Results suggest that DA release is not essential for chemosensory excitation. |
9451619 | Effects of voluntary activity and genetic selection on aerobic capacity in house mice (Mus domesticus). | An animal model was developed to study effects ponents of exercise physiology of both "nature" (10 generations of genetic selection for high voluntary activity on running wheels) and "nurture" (7-8 wk of access or no access to running wheels, beginning at weaning). At the end of the experiment, mice from both wheel-access groups were significantly lighter in body mass than mice from sedentary groups. Within the wheel-access group, a statistically significant, negative relationship existed between activity and final body mass. In measurements of maximum oxygen consumption during forced treadmill exercise (VO2max), mice with wheel access were significantly more cooperative than sedentary mice; however, trial quality was not a significant predictor of individual variation in VO2max. Nested two-way analysis of covariance demonstrated that both genetic selection history and access to wheels had significant positive effects on VO2max. A 12% difference in VO2max existed between wheel-access selected mice, which had the highest mass-corrected VO2max, and sedentary control mice, which had the lowest. The respiratory exchange ratio at VO2max was also significantly lower in the wheel-access group. Our results suggest the existence of a possible genetic correlation between voluntary activity levels (behavior) and aerobic capacity (physiology). |
9451620 | Relationship between airway microvascular leakage, edema, and baseline airway functions. | This study was designed to examine the relationship among microvascular leakage, edema, and baseline airway function. Microvascular leakage was induced in the airways of anesthetized, tracheostomized New Zealand White rabbits (n = 22) by using nebulized N-formyl-methionyl-leucyl-phenylalanine (10 mg) and was measured in the trachea by using the Evans blue dye technique. Airway wall thickness was assessed morphometrically in the right main bronchus after Formalin fixation at a pressure of 25 cmH2O. Areas calculated included the mucosal wall area, the adventitial wall area, the total wall area, and the percentage of total wall area consisting of blood vessels. A neutrophil count was also performed by analyzing numbers of cells in both the mucosal wall area and the adventitial wall area. Airway function was assessed before and 30 min after challenge with N-formyl-methionyl-leucyl-phenylalanine by determining airway resistance, functional residual capacity, specific airway resistance, and flow-volume and pressure-volume curves (after paralysis of the animals with suxamethonium). The concentration of Evans blue dye in tracheal tissue ranged from 31.3 to 131.2 micrograms. There was a significant correlation between this concentration and both the adventitial wall area (P < 0.01) and mucosal neutrophil numbers (P < 0.005). There was no correlation between Evans blue concentration and either blood vessel area or changes in respiratory physiology parameters before and after challenge. There was no significant difference between any respiratory physiology measurements before and after challenge. We conclude that an increase in microvascular leakage correlates with airway edema in the adventitia; however, these airway changes have no significant effect on airway elastic or resistive properties. |
9451621 | Fetal sheep adrenal blood flow responses to hypoxemia after splanchnicotomy using fluorescent microspheres. | Adrenal gland blood flow (ABF) increases during hypoxemia in fetal sheep, but regulation of ABF is poorly understood. The purpose of this study was to determine the effects of splanchnic nerve section on fetal ABF responses to hypoxemia using the fluorescent microsphere (FM) technique. At 125 days of gestation, 14 unanesthetized fetal sheep [bilateral splanchnicotomy (Splx, n = 6) and control (Cont, n = 8)] were injected with FM before and at 60 min of N2-induced hypoxemia (approximately 40% decrease in fetal arterial PO2). Adrenal tissue and reference blood samples were digested and filtered, and FM dye was extracted for spectrometer analysis. Baseline whole, medullary, and cortical ABF for the Cont group were similar to published values using radioactive microspheres and did not differ from Splx values. Hypoxemia increased whole, medullary, and cortical ABF (mean +/- SE) from baseline for the Cont group by 281 +/- 35, 258 +/- 31, and 496 +/- 81% (P < 0.05). The increase for the Splx group was pared with the Cont group (P < 0.05) for whole and medullary ABF (139 +/- 27 and 43 +/- 27%) but not cortical ABF (326 +/- 91%). We conclude that 1) the FM technique is valid for measuring fetal ABF and 2) in fetal sheep the splanchnic nerve is not necessary to maintain basal ABF but plays an important role in regulating the hypoxemia-induced increase in ABF through the medullary, but not cortical, ABF response. |
9451622 | Skeletal muscle ECF pH error signal for exercise ventilatory control. | An autonomic reflex linking exercising skeletal muscle metabolism to central ventilatory control is thought to be mediated by neural afferents having free endings that terminate in the interstitial fluid of muscle. To determine whether changes in muscle extracellular fluid pH (pHe) can provide an error signal for exercise ventilatory control, pHe was measured during electrically induced contraction by 31P-magnetic resonance spectroscopy and the chemical shift of a phosphorylated, pH-sensitive marker that distributes to the extracellular fluid (phenylphosphonic acid). Seven lightly anesthetized rats underwent unilateral continuous 5-Hz sciatic nerve stimulation in an 8.45-T nuclear magnetic resonance magnet, which resulted in a mixed lactic acidosis and respiratory alkalosis, with no net change in arterial pH. Skeletal muscle intracellular pH fell from 7.30 +/- 0.03 units at rest to 6.72 +/- 0.05 units at 2.4 min of stimulation and then rose to 7.05 +/- 0.01 units (P < 0.05), despite ongoing stimulation and muscle contraction. Despite arterial hypocapnia, pHe showed an immediate drop from its resting baseline of 7.40 +/- 0.01 to 7.16 +/- 0.04 units (P < 0.05) and remained acidic throughout the stimulation protocol. During the on- and off-transients for 5-Hz stimulation, changes in the pH gradient between intracellular and partments suggested time-dependent recruitment of sarcolemmal ion-transport mechanisms. pHe of exercising skeletal muscle meets temporal and qualitative criteria necessary for a ventilatory metaboreflex mediator in a setting where arterial pH does not. |
9451623 | Stretch-shorten cycle compared with isometric preload: contributions to enhanced muscular performance. | To isolate any difference muscular contraction history may have on concentric work output, 40 trained male subjects performed three separate isokinetic concentric squats that involved differing contraction histories, 1) a concentric-only (CO) squat, 2) a concentric squat preceded by an isometric preload (IS), and 3) a stretch-shorten cycle (SSC) squat. Over the first 300 ms of the concentric movement, work output for both the SSC and IS conditions was significantly greater (154.8 +/- 39.8 and 147.9 +/- 34.7 J, respectively; P < pared with the CO squat (129.7 +/- 34.4 J). In addition, work output after the SSC test over the first 300 ms was also significantly larger than that for the corresponding period after the IS protocol (P < 0.05). There was no difference in normalized, integrated electromyogram among any of the conditions. It was concluded that concentric performance enhancement derived from a preceding stretch of the plex was largely due to the attainment of a higher active muscle state before the start of the concentric movement. However, it was also hypothesized that contractile element potentiation was a significant contributor to stretch-induced muscular performance under these conditions. |
9451625 | Cardiovascular and humoral responses to sustained muscle metaboreflex activation in humans. | The cardiovascular and humoral responses to sustained muscle metaboreflex activation were examined in eight male volunteers while they performed two 24-min exercise protocols. Each of these consisted of six 1-min bouts of isometric handgrip exercise (the left and right hands being used alternately) at 50% of maximal voluntary contraction; after each bout, there was either 3-min postexercise occlusion (occlusion protocol) or 3-min rest (control protocol). In the occlusion protocol, mean arterial blood pressure was approximately 25 mmHg higher than during the control protocol, indicating that the muscle metaboreflex was activated during occlusion. During the control protocol, plasma renin activity, plasma vasopressin, and adrenocorticotropic hormone values were not significantly different from the values at rest. During the occlusion protocol, however, plasma renin activity, plasma vasopressin, and adrenocorticotropic hormone were all significantly increased at 25 min. These data demonstrate that, in humans, the sustained activation of the muscle metaboreflex causes the secretion of several hormones originating from different regions. |
9451624 | Cardiopulmonary effects of inhaled nitric oxide in normal dogs and during E. coli pneumonia and sepsis. | We investigated the effect of inhaled nitric oxide (NO) at increasing fractional inspired O2 concentrations (FIO2) on hemodynamic and pulmonary function during Escherichia coli pneumonia. Thirty-eight conscious, spontaneously breathing, tracheotomized 2-yr-old beagles had intrabronchial inoculation with either 0.75 or 1.5 x 10(10) colony-forming units/kg of E. coli 0111:B4 (infected) or 0.9% saline (noninfected) in one or four pulmonary lobes. We found that neither the severity nor distribution (lobar vs. diffuse) of bacterial pneumonia altered the effects of NO. However, in infected animals, with increasing FIO2 (0.08, 0.21, 0.50, and 0.85), NO (80 parts/million) progressively increased arterial PO2 [-0.3 +/- 0.6, 3 +/- 1, 13 +/- 4, 10 +/- 9 (mean +/- SE) Torr, respectively] and decreased the mean arterial-alveolar O2 gradient (0.5 +/- 0.3, 4 +/- 2, -8 +/- 7, -10 +/- 9 Torr, respectively). In contrast, in noninfected animals, the effect of NO was significantly different and opposite; NO progressively decreased mean PO2 with increasing FIO2 (2 +/- 1, -5 +/- 3, -2 +/- 3, and -12 +/- 5 Torr, respectively; P < pared with infected animals) and increased mean arterial-alveolar O2 gradient (0.3 +/- 0.04, 2 +/- 2, 1 +/- 3, 11 +/- 5 Torr; P < pared with infected animals). In normal and infected animals alike, only at FIO2 < or = 0.21 did NO significantly lower mean pulmonary artery pressure, pulmonary artery occlusion pressure, and pulmonary vascular resistance index (all P < 0.01). However, inhaled NO had no significant effect on increases in mean pulmonary artery pressure associated with bacterial pneumonia. Thus, during bacterial pneumonia, inhaled NO had only modest effects on oxygenation dependent on high FIO2 and did not affect sepsis-induced pulmonary hypertension. These data do not support a role for inhaled NO in bacterial pneumonia. Further studies are necessary to determine whether, bination with ventilatory support, NO may have more pronounced effects. |
9451626 | Is urodilatin the missing link in exercise-dependent renal sodium retention? | The purpose of the present study was to investigate the behavior of plasma atrial natriuretic peptide [ANP-(99-126)] concentration ([ANP]) and renal urodilatin [Uro; ANP-(95-126)] excretion during and after exercise and their possible effects on renal Na+ retention. Ten male subjects performed a cycle ergometer test for 60 min at 60% of maximum workload. Blood and urine samples were collected before, during, and up to 24 h after exercise. During exercise, plasma [ANP] and renal Uro excretion were oppositely affected: whereas [ANP] increased from 46.5 +/- 5.1 to 124.1 +/- 10.6 pg/ml, urinary Uro excretion decreased from 120.8 +/- 16.0 to 49.5 +/- 9.8 fmol/min and remained at a lower level until 1 h after exercise. Glomerular filtration rate showed lowest values during exercise (from 164.9 +/- 15.3 to 75.8 +/- 10.1 ml/min), and urine flow and the fractional excretion rate of Na+ (FENa+) and Cl- (FECl-) had their nadir during the first hour after exercise. Positive relationships were observed between Uro excretion and FENa+ (P < 0.05) and FECl-, whereas a tendency toward a negative correlation was obtained between [ANP] and FENa+. It seems possible that Uro may be, among other factors, involved in the exercise-related regulation of renal Na+ retention. The specific roles Uro and ANP play during exercise, however, remain to be investigated. |
9451627 | Breathing of awake goats during prolonged dysfunction of caudal M ventrolateral medullary neurons. | Cooling the caudal M ventrolateral medullary (VLM) surface for 30 s results in a sustained apnea in anesthetized goats but only a 30% decrease in breathing in awake goats. The purpose of the present study was to determine, in the awake state, the effect of prolonged (minutes, hours) caudal M neuronal dysfunction on eupneic breathing and CO2 sensitivity. Dysfunction was created by ejecting excitatory amino acid receptor antagonists or a neurotoxin on the VLM surface through guide tubes chronically implanted bilaterally on a 10- to 12-mm2 portion of the caudal M VLM surface of 12 goats. Unilateral and bilateral ejections (1 microliter) of selective antagonists for N-methyl-D-aspartic acid or non-N-methyl-D-aspartic acid receptors had no significant effect on eupneic breathing or CO2 sensitivity. Unilateral ejection of a nonselective excitatory amino acid receptor antagonist generally had no effect on eupneic breathing or CO2 sensitivity. However, bilateral ejection of this antagonist resulted in a significant 2-Torr hypoventilation during eupnea and a significant reduction in CO2 sensitivity to 60 +/- 9% of control. Unilateral ejection of the neurotoxin kainic acid initially stimulated breathing; however, breathing then returned to near control with no incidence of apnea. After the kainic acid ejection, CO2 sensitivity was reduced significantly to 60 +/- 7% of control. We conclude that in the awake state a prolonged dysfunction of caudal M VLM neurons results pensation by other mechanisms (e.g., carotid chemoreceptors, wakefulness) to maintain near-normal eupneic breathing, pensation is more limited for maintaining CO2 sensitivity. |
9451628 | Effects of gender on resting leg blood flow: implications for measurement of regional substrate oxidation. | These studies were designed to examine whether the respiratory quotient (RQ) of leg tissue (primarily skeletal muscle) would increase to a greater degree in women than in men during meal ingestion. We found that mean leg and systemic RQ values were similar in men under both basal and fed conditions, whereas the agreement was poor in women. In women, leg RQ values tended to be greater than the systemic RQ, whereas splanchnic RQ values tended to be lower than the systemic RQ. The possibility that measurement imprecision accounted for the different findings in women could not be excluded because the arteriovenous blood O2 differences were almost twice as great in men as in women (53.7 +/- 5.4 vs. 28.6 +/- 2.9 ml of O2/l, respectively; P < 0.01), as were venoarterial blood CO2 differences. The smaller arteriovenous differences in women appeared to limit our ability to accurately measure their leg RQ values. O2 uptake relative to leg fat-free mass (FFM) was not different between men and women, whereas leg blood flow relative to leg FFM was greater in women than in men (55 +/- 3 vs. 39 +/- 2 ml.kg FFM-1.min-1, respectively; P < 0.001). These findings were confirmed by examining data from other studies conducted in our laboratory to create a larger data set. We conclude that resting leg blood flow in women is greater (relative to FFM) than in men, making it more difficult to accurately measure leg RQ in women. |
9451629 | Alterations in the surface properties of lung surfactant in the torpid marsupial Sminthopsis crassicaudata. | Torpor changes position of pulmonary surfactant (PS) in the dunnart Sminthopsis crassicaudata [C. Langman, S. Orgeig, and C. B. Daniels. Am. J. Physiol. 271 (Regulatory Integrative Comp. Physiol, 40): R437-R445, 1996]. Here we investigated the surface activity of PS in vitro. Five micrograms of phospholipid per centimeter squared surface area of whole lavage (from mice or from warm-active, 4-, or 8-h torpid dunnarts) were applied dropwise onto the sub-phase of a Wilhelmy-Langmuir balance at 20 degrees C and stabilized for 20 min. After 4 h of torpor, the adsorption rate increased, and equilibrium surface tension (STeq), minimal surface tension (STmin), and the pression required to achieve STmin pared with the warm-active group. After 8 h of torpor, STmin decreased [from 5.2 +/- 0.3 to 4.1 +/- 0.3 (SE) mN/m]; pression required to achieve STmin decreased (from 43.4 +/- 1.0 to 27.4 +/- 0.8); the rate of adsorption decreased; and STeq increased (from 26.3 +/- 0.5 to 38.6 +/- 1.3 mN/m). ST-area isotherms of warm-active dunnarts and mice at 20 degrees C had a shoulder pression and a plateau on expansion. These disappeared on the isotherms of torpid dunnarts. Samples of whole lavage (from warm-active and 8-h torpor groups) containing 100 micrograms phospholipid/ml were studied by using a captive-bubble surfactometer at 37 degrees C. After 8 h of torpor, STmin increased (from 6.4 +/- 0.3 to 9.1 +/- 0.3 mN/m) and pression decreased in the 2nd (from 88.6 +/- 1.7 to 82.1 +/- 2.0) and 3rd (from 89.1 +/- 0.8 to 84.9 +/- pression-expansion pared with warm-active dunnarts. ST-area isotherms of warm-active dunnarts at 37 degrees C did not have a shoulder pression. This shoulder appeared on the isotherms of torpid dunnarts. In conclusion, there is a strong correlation between in vitro changes in surface activity and in vivo changes in position of PS during torpor, although static pliance remained unchanged (see Langman et al. cited above). Surfactant from torpid animals is more active at 20 degrees C and less active at 37 degrees C than that of warm-active animals, which may represent a respiratory adaptation to low body temperatures of torpid dunnarts. |
9451630 | Impact of resistance exercise during bed rest on skeletal muscle sarcopenia and myosin isoform distribution. | Because resistance exercise (REx) and bed-rest unloading (BRU) are associated with opposing adaptations, our purpose was to test the efficacy of REx against the effects of 14 days of BRU on the knee-extensor muscle group. Sixteen healthy men were randomly assigned to no exercise (NoEx; n = 8) or REx (n = 8). REx performed five sets of leg press exercise with 80-85% of one repetition maximum (1 RM) every other day during BRU. Muscle samples were removed from the vastus lateralis muscle by percutaneous needle biopsy. Myofiber distribution was determined immunohistochemically with three monoclonal antibodies against myosin heavy chain (MHC) isoforms (I, IIa, IIx). MHC distribution was further assessed by quantitative gel electrophoresis. Dynamic 1-RM leg press and unilateral maximum voluntary isometric contraction (MVC) were determined. Maximal neural activation (root mean squared electromyogram) and rate of torque development (RTD) were measured during MVC. Reductions (P < 0.05) in type I (15%) and type II (17%) myofiber cross-sectional areas were found in NoEx but not in REx. Electrophoresis revealed no changes in MHC isoform distribution. The percentage of type IIx myofibers decreased (P < 0.05) in REx from 9 to 2% and did not change in NoEx. 1 RM was reduced (P < 0.05) by 9% in NoEx but was unchanged in REx. MVC fell by 15 and 13% in NoEx and REx, respectively. The agonist-to-antagonist root mean squared electromyogram ratio decreased (P < 0.05) 19% in REx. RTD slowed (P < 0.05) by 54% in NoEx only. Results indicate that REx prevented BRU-induced myofiber atrophy and also maintained training-specific strength. Unlike spaceflight, BRU did not induce shifts in myosin phenotype. The reported benefits of REx may prove useful in prescribing exercise for astronauts in microgravity. |
9451631 | Increasing maximal heart rate increases maximal O2 uptake in rats acclimatized to simulated altitude. | Maximal exercise heart rate (HRmax) is reduced after acclimatization to hypobaric hypoxia. The low HRmax contributes to reduce maximal cardiac output (Qmax) and may limit maximal O2 uptake (VO2max). The objective of these experiments was to test the hypothesis that the reduction in Qmax after acclimatization to hypoxia, due, in part, to the low HRmax, limits VO2max. If this hypothesis is correct, an increase in Qmax would result in a proportionate increase in VO2max. Rats acclimatized to hypobaric hypoxia [inspired PO2 (PIO2) = 69.8 +/- 3 Torr for 3 wk] exercised on a treadmill in hypoxic (PIO2 = 71.7 +/- 1.1 Torr) or normoxic conditions (PIO2 = 142.1 +/- 1.1 Torr). Each rat ran twice: in one bout the rat was allowed to reach its spontaneous HRmax, which was 505 +/- 7 and 501 +/- 5 beats/min in hypoxic and normoxic exercise, respectively; in the other exercise bout, HRmax was increased by 20% to the preacclimatization value of 600 beats/min by atrial pacing. This resulted in an approximately 10% increase in Qmax, since the increase in HRmax was offset by a 10% decrease in stroke volume, probably due to shortening of diastolic filling time. The increase in Qmax was panied by a proportionate increase in maximal rate of convective O2 delivery (Qmax x arterial O2 content), maximal work rate, and VO2max in hypoxic and normoxic exercise. The data show that increasing HRmax to preacclimatization levels increases VO2max, supporting the hypothesis that the low HRmax tends to limit VO2max after acclimatization to hypoxia. |
9451632 | Ovalbumin increases macromolecular efflux from the in situ nasal mucosa of allergic hamsters. | The purpose of this study was to determine whether bradykinin mediates ovalbumin-induced increase in macromolecular efflux from the nasal mucosa of ovalbumin-sensitized hamsters in vivo and, if so, whether the L-arginine/nitric oxide biosynthetic pathway transduces, in part, this response. We found that suffusion of ovalbumin onto the in situ nasal mucosa of ovalbumin-sensitized hamsters, but not of controls, elicited a significant time- and concentration-dependent increase in clearance of fluorescein isothiocyanate-labeled dextran (mol mass, 70 kDa; P < 0.05). HOE-140, but not des-Arg9,[Leu8]-bradykinin, and NG-L-arginine methyl ester (L-NAME), but not NG-D-arginine methyl ester, significantly attenuated ovalbumin-induced responses. L-Arginine, but not D-arginine, abolished the effects of L-NAME. L-NAME also significantly attenuated bradykinin-, but not adenosine-induced increase in macromolecular efflux from the in situ nasal mucosa. Overall, these data suggest that ovalbumin increases macromolecular efflux from the in situ nasal mucosa of ovalbumin-sensitized hamsters, in part, by producing bradykinin with subsequent activation of the L-arginine/ nitric oxide biosynthetic pathway. |
9451633 | Alterations in myocardial signal transduction due to aging and chronic dynamic exercise. | Normal aging without disease leads to diminished chronotropic and inotropic responses to catecholamine stimulation, resulting in depressed cardiac function with stress. The purpose of this study was to determine molecular mechanisms for decrements in adrenergic responsiveness of the left ventricle (LV) due to aging and to study the effects of chronic dynamic exercise on signal transduction. We measured beta-adrenergic receptor (beta-AR) density, adenylyl cyclase (AC) activity, and G-protein content and distribution in LV from 66 male Fischer 344 rats from three age groups that were either sedentary or treadmill trained (60 min/days, 5 days/wk, 10 wk at 75% of the maximal capacity). Final ages were 7 mo (young), 15 mo (middle-age), and 25 mo (old). There was no significant difference in beta-AR density among groups as a function of age or training. AC production of adenosine 3',5'-cyclic monophosphate (cAMP) with the use of five pharmacological stimulations revealed that old sedentary myocardium had depressed basal, receptor-dependent, G-protein-dependent, and AC catalyst stimulation pared with hearts from young and middle-age sedentary rats. Training did not alter AC activity in either middle-age or old groups but did increase G-protein-dependent cAMP production in young myocardium (12-34%). Immunodetectable concentrations of stimulatory and inhibitory G proteins (Gs and Gi, respectively) showed 43% less total Gs with similar Gi content in hearts from old pared with middle-age sedentary rats. pared with young sedentary animals, Gi content was 39 and 50% higher in middle-age sedentary and old sedentary myocardium, respectively. With age, there was a significant shift in the alpha-subunit of Gs distribution from cytosolic fractions of LV homogenates to membrane-bound fractions (8-12% redistribution in middle-age sedentary vs. old sedentary). The most significant training effect was a decrease in Gi content in hearts from old trained rats (23%), which resulted in parable with young sedentary rats and reduced the Gi/Gs ratio by 27% in old-rat LV. We report that age-associated reductions in cardiovascular beta-adrenergic responsiveness correspond with alterations in postreceptor adrenergic signaling rather than with a decrease in receptor number. Chronic dynamic exercise partially attenuates these reductions through alterations in postreceptor elements of cardiac signal transduction. |
9451634 | Hypohydration and thermoregulation in cold air. | This study examined the effects of hypohydration on thermoregulation during cold exposure. In addition, the independent influences of hypohydration-associated hypertonicity and hypovolemia were investigated. Nine male volunteers were monitored for 30 min at 25 degrees C, then for 120 min at 7 degrees C, under three counterbalanced conditions: euhydration (Eu), hypertonic hypohydration (HH), and isotonic hypohydration (IH). Hypohydration was achieved 12 h before cold exposure by inducing sweating (HH) or by ingestion of furosemide (IH). Body weight decrease (4.1 +/- 0.2%) caused by hypohydration was similar for HH and IH, but differences (P < 0.05) were found between HH and IH in plasma osmolality (292 +/- 1 vs. 284 +/- 1 mosmol/kgH2O) and plasma volume reduction (-8 +/- 2 vs. -18 +/- 3%). Heat debt (349 +/- 14 among) did not differ (P > 0.05) among trials. Mean skin temperature decreased throughout cold exposure during Eu but plateaued after 90 min during HH and IH. Forearm-finger temperature gradient tended (P = 0.06) to be greater during Eu (10.0 +/- 0.7 degrees C) than during HH or IH (8.9 +/- 0.7 degrees C). This suggests weaker vasoconstrictor tone during hypohydration than during Eu. Final mean skin temperature was higher for HH than for Eu or IH (23.5 +/- 0.3, 22.6 +/- 0.4, and 22.9 +/- 0.3 degrees C, respectively), and insulation was lower on HH than on IH (0.13 +/- 0.01 vs. 0.15 +/- 0.01 degree C.W-1.m-2, respectively), but not with Eu (0.14 +/- 0.01 degree C.W-1.m-2). This provides some evidence that hypertonicity impairs the vasoconstrictor response to cold. Although mild hypohydration did not affect body heat balance during 2-h whole body exposure to moderate cold, hypohydration-associated hypertonicity may have subtle effects on vasoconstriction that could e important during a more severe cold exposure. |
9451636 | Neuromuscular drive and force production are not altered during bilateral contractions. | Several investigators have studied the deficit in maximal voluntary force that is said to occur when bilateral muscle groups contract simultaneously. A true bilateral deficit (BLD) would suggest a significant limitation of neuromuscular control; however, some of the data from studies in the literature are equivocal. Our purpose was to determine whether there is a BLD in the knee extensors of untrained young male subjects during isometric contractions and whether this deficit is associated with a decreased activation of the quadriceps, increased activation of the antagonist muscle, or an alteration in motor unit firing rates. Twenty subjects performed unilateral (UL) and bilateral (BL) isometric knee extensions at 25, 50, 75, and 100% maximal voluntary contraction. Total UL and BL force (delta 3%) and maximal rate of force generation (delta 2.5%) were not significantly different. Total UL and BL maximal vastus lateralis electromyographic activity (EMG; 2.7 +/- 0.28 vs. 2.6 +/- 0.24 mV) and coactivation (0.17 +/- 0.02 vs. 0.20 +/- 0.02 mV) were also not different. Similarly, the ratio of force to EMG during submaximal UL and BL contractions was not different. Analysis of force production by each leg in UL and BL conditions showed no differences in force, rate of force generation, EMG, motor unit firing rates, and coactivation. Finally, assessment of quadriceps activity with the twitch interpolation technique indicated no differences in the degree of voluntary muscle activation (UL: 93.6 +/- 2.51 Hz, BL: 90.1 +/- 2.43 Hz). These results provide no evidence of a significant limitation in neuromuscular control between BL and UL isometric contractions of the knee extensor muscles in young male subjects. |
9451637 | A role for gastrointestinal endotoxins in enhancement of heat tolerance by physical fitness. | To further elucidate mechanisms underlying the higher heat tolerance of physically pared with sedentary people, we have investigated the possibility that endotoxins (of gastrointestinal origin) act, as in the normal development of fever, to raise body temperature and therefore reduce heat tolerance. In an initial series of experiments, five physically fit and four sedentary sheep were exposed twice at rest to an environment of 42/35 degrees C (dry/wet bulb temperature). When animals were given normal saline i.v., rectal temperature (Tre) rose at a significantly higher rate in sedentary than in fit animals; this confirms that heat tolerance is improved by physical fitness. Treatment with i.v. indomethacin did not affect the rate of rise of Tre in fit animals. In sedentary animals, however, Tre was lowered to approximate that of fit animals. Because indomethacin blocks prostaglandin pathways involved in endotoxin-induced fever, the indomethacin-induced improvement of heat tolerance of sedentary but not fit animals supports the contention that endotoxins play a role in determining that difference in heat tolerance. In a second series of experiments, quantitative cardiovascular measurements were made by using radioactive microspheres. Under normothermic conditions, blood flows in the brain, ileum, and diaphragm were higher in fit than in sedentary animals. During hyperthermia up to Tre of 42 degrees C (in a 42/39 degrees C environment), pared with sedentary animals exhibited 1) a greater increase in cardiac output, 2) an increase in blood flow through arteriovenous anastomoses to higher and better maintained levels, 3) less reduction in blood flow to the ileum, and 4) greater increase in blood flows to the myocardium, turbinates, nasal mucosa, and respiratory muscles. Endotoxins are likely e from the gut lumen, because reduction of gut blood flow forms part of the normal response to heat stress. We suggest that improvement of heat tolerance by physical fitness is caused by a greater cardiovascular capacity that permits not only greater perfusion of heat-loss tissues but the maintenance of a better gastrointestinal tract blood supply, thereby better maintaining the normal barrier to movement of endotoxins from gut lumen to plasma. Sedentary people, with their lower cardiovascular capacity, redistribute more blood flow away from the gut during environmentally induced hyperthermia, thus allowing endotoxin-induced fever to aggravate hyperthermia. |
9451638 | Non-cAMP-mediated bronchial arterial vasodilation in response to inhaled beta-agonists. | We studied the dose-dependent effects of inhaled isoetharine HCl, a beta-adrenergic bronchodilator (2.5, 5.0, 10.0, and 20.0 mg), on bronchial blood flow (Qbr) in anesthetized sheep. Isoetharine resulted in a dose-dependent increase in Qbr. With a total dose of 17.5 mg, Qbr increased from baseline values of 22 +/- 3.4 (SE) to 60 +/- 16 ml/min (P < 0.001), an effect independent of changes in cardiac output and systemic arterial pressure. To further study whether synthesis of endogenous nitric oxide (NO) affects beta-agonist-induced increases in Qbr, we administered isoetharine (20 mg) by inhalation before and after the NO-synthase inhibitor N omega-nitro-L-arginine methyl ester (L-NAME). Intravenous L-NAME (30 mg/kg) rapidly decreased Qbr by approximately 80% of baseline, whereas L-NAME via inhalation (10 mg/kg) resulted in a delayed and smaller (approximately 22%) decrease. Pretreatment with L-NAME via both routes of administration attenuated bronchial arterial vasodilation after subsequent challenge with isoetharine. We conclude that isoetharine via inhalation increases Qbr in a dose-dependent manner and that beta-agonist-induced relaxation of vascular smooth muscle in the bronchial vasculature is partially mediated via synthesis of NO. |
9451635 | Effects of NREM sleep on dynamic within-breath changes in upper airway patency in humans. | The purpose of our study was pare inspiratory- and expiratory-related changes in retropalatal cross-sectional area (CSA) during wakefulness to those during non-rapid-eye-movement (NREM) sleep. We studied 18 subjects in whom the severity of sleep-disordered breathing varied. Relative changes in CSA were visualized by using fiber-optic endoscopy. For each breath analyzed (wakefulness n = 4-13; sleep n = 7-16), the CSA was measured at fixed points within inspiration and expiration (0, 25, 50, and 100% of the inspiratory and expiratory duration); these measurements were expressed as a percentage of the CSA that occurred at the start of inspiration. During wakefulness, there was a statistically significant increase in the retropalatal CSA (compared with the start of inspiration) only during early expiration (group mean: expiration, 0% = 112.6 +/- 3.2 (SE) %; 25% = 122.8 +/- 6.2%; 50% = 110.6 +/- 3.8%). In contrast, during sleep, significant changes in CSA occurred during both inspiration and expiration (group mean: inspiration, 25% = 75.3 +/- 6.0%; 50% = 66.7 +/- 7.7%; 75% = 64.6 +/- 8.1%; expiration, 0% = 126.8 +/- 11.8%; 25% = 125.3 +/- 6.9%). The expiratory-related increase in CSA was followed by narrowing such that at end expiration the caliber of the airway was returned to that occurring at the beginning of inspiration (group mean at end expiration = 98.6 +/- 3.1%). The largest changes in CSA occurred in the subjects with an increased body mass index (BMI). We conclude that, during NREM sleep, significant changes in CSA occur during both inspiration and expiration and that the magnitude of these changes is significantly influenced by BMI. |
9451639 | Inhibition of allergic airway responses by inhaled low-molecular-weight heparins: molecular-weight dependence. | Inhaled heparin prevents antigen-induced bronchoconstriction and inhibits anti-immunoglobulin E-mediated mast cell degranulation. We hypothesized that the antiallergic action of heparin may be molecular weight dependent. Therefore, we studied the effects of three different low-molecular-weight fractions of heparin [medium-, low-, and ultralow-molecular-weight heparin (MMWH, LMWH, ULMWH, respectively)] on the antigen-induced acute bronchoconstrictor response (ABR) and airway hyperresponsiveness (AHR) in allergic sheep. Specific lung resistance was measured in 22 sheep before and after airway challenge with Ascaris suum antigen, without and after pretreatment with inhaled fractionated heparins at doses of 0.31-5.0 mg/kg. Airway responsiveness was estimated before and 2 h postantigen as the cumulative provocating dose of carbachol in breath units that increased specific lung resistance by 400%. All fractionated heparins caused a dose-dependent inhibition of ABR and AHR. ULMWH was the most effective fraction, with the inhibitory dose causing 50% protection (ID50) against ABR of 0.5 mg/kg, whereas ID50 values of LMWH and MMWH were 1.25 and 1.8 mg/kg, respectively. ULMWH was also the most effective fraction in attenuating AHR; the ID50 values for ULMWH, LMWH, and MMWH were 0.5, 2.5, and 4.7 mg/kg, respectively. These data suggest that 1) fractionated low-molecular-weight heparins attenuate antigen-induced ABR and AHR; 2) there is an inverse relationship between the antiallergic activity of heparin fractions and molecular weight; and 3) ULMWH is the most effective fraction preventing allergic bronchoconstriction and airway hyperresponsiveness. |
9451640 | Contractile function of single muscle fibers after hindlimb unweighting in aged rats. | This investigation determined how muscle atrophy produced by hindlimb unweighting (HU) alters the contractile function of single muscle fibers from older animals (30 mo). After 1 wk of HU, small bundles of fibers were isolated from the soleus muscles and the deep region of the lateral head of the gastrocnemius muscles. Single glycerinated fibers were suspended between a motor lever and force transducer, functional properties were studied, and the myosin heavy chain position was determined electrophoretically. After HU, the diameter of type I MHC fibers of the soleus declined (88 +/- 2 vs. 80 +/- 4 microns) and reductions were observed in peak active force (47 +/- 3 vs. 28 +/- 3 mg) and peak specific tension (Po; 80 +/- 5 vs. 56 +/- 5 kN/m2). The maximal unloaded shortening velocity increased. The type I MHC fibers from the gastrocnemius showed reductions in diameter (14%), peak active force (41%), and Po (24%), whereas the type IIa MHC fibers showed reductions in peak active force and Po. Thus 1 wk of inactivity has a significant effect on the force-generating capacity of single skeletal muscle fibers from older animals in a fiber type-specific manner (type I MHC > type IIa MHC > type I-IIa MHC). The decline in the functional properties of single skeletal muscle fibers in the older animals appears to be more pronounced than what has been reported in younger animal populations. |
9451641 | Potentiation of in vitro concentric work in mouse fast muscle. | Phosphorylation of myosin regulatory light chain (R-LC) is associated with potentiated work and power during twitch afterloaded contractions in mouse extensor digitorum longus muscle [R. W. Grange, C. R. Cory, R. Vandenboom, and M. E. Houston. Am. J. Physiol. 269 (Cell Physiol. 38): C713-C724, 1995]. We now describe the association between R-LC phosphorylation and potentiated concentric work when the extensor digitorum longus muscle is rhythmically shortened and lengthened to simulate contractions in vivo. Work output (at 25 degrees C) was characterized at sine frequencies of 3, 5, 7, 10, and 15 Hz at excursions of 0.6, 1.2, and 1.6 mm (approximately 5, 9, and 13% optimal muscle length) at a low level of R-LC phosphorylation. Muscles stimulated during the sine function with a single twitch at specific times before or after the longest muscle length yielded maximal concentric work near the longest muscle length at a sine frequency of 7 Hz (e.g., excursion approximately 9% optimal muscle length = 1.6 J/kg). Power increased linearly between sine frequencies of 3 and 15 Hz at all excursions (maximum approximately 29 W). After a 5-Hz 20-s conditioning stimulus and coincident with a 3.7-fold increase in R-LC phosphate content (e.g., from 0.19 to 0.70 mol phosphate/mol R-LC), work at the three excursions and a sine frequency of 7 Hz was potentiated a mean of 25, 44, and 50% (P < 0.05), respectively. The potentiated work during rhythmic contractions is consistent with enhanced interaction between actin and myosin in the force-generating states. On the basis of observations in skinned skeletal muscle fibers (H. L. Sweeney and J. T. Stull. Proc. Natl. Acad. Sci. USA 87:414-418, 1990), this enhancement could result from increased phosphate incorporation by the myosin R-LC. Under the assumption that the predominant effect of the conditioning stimulus was to increase R-LC phosphate content, our data suggest that a similar mechanism may be evident in intact muscle. |
9451642 | Multiple-breath washin of helium and sulfur hexafluoride in sustained microgravity. | We performed multiple-breath washouts of N2 and simultaneous washins of He and SF6 with fixed tidal volume (approximately 1,250 ml) and preinspiratory lung volume (approximately the subject's functional residual capacity in the standing position) in four normal subjects (mean age 40 yr) standing and supine in normal gravity (1 G) and during exposure to sustained microgravity (microG). The primary objective was to examine the influence of diffusive processes on the residual, nongravitational ventilatory inhomogeneity in the lung in microG. We calculated several indexes of convective ventilatory inhomogeneity from each gas species. A normal degree of ventilatory inhomogeneity was seen in the standing position at 1 G that was largely unaltered in the supine position. When pared the standing position in 1 G with microG, there were reductions in phase III slope in all gases, consistent with a reduction in convection-dependent inhomogeneity in the lung in microG, although considerable convective inhomogeneity persisted in microG. The reductions in the indexes of convection-dependent inhomogeneity were greater for He than for SF6, suggesting that the distances between remaining nonuniformly partments in microG were short enough for diffusion of He to be an effective mechanism to reduce gas concentration differences between them. |
9451643 | Mechanism controlling sleep organization of the obese Zucker rats. | We tested the hypothesis that the obese (fa/fa) Zucker rat has a sleep organization that differs from that of lean Zucker rats. We used the polygraphic technique to identify and to quantify the distribution of the three main states of the rat: wakefulness (W), non-rapid-eye-movement (NREM), and rapid-eye movement (REM) sleep states. Assessment of states was made with light present (1000-1600), at the rats thermoneutral temperature of 29 degrees C. Obese pared with lean ones, did not show significant differences in the total time spent in the three main states. Whereas the mean durations of W and REM states did not differ statistically, that of NREM did (P = 0.046). However, in the obese rats, the frequencies of switching from NREM sleep to W, which increased, and from NREM to REM sleep, which decreased, were statistically significantly different (P = 0.019). Frequency of switching from either REM or W state was not significantly different. We conclude that sleep organization differs between lean and obese Zucker rats and that it is due to a disparity in switching from NREM sleep to either W or REM sleep and the mean duration of NREM sleep. |
9451644 | Does adipose tissue influence bioelectric impedance in obese men and women? | Bioelectric-impedance analysis overestimates fat-free mass in obese people. No clear hypotheses have been presented or tested that explain this effect. This study tested the hypothesis that adipose tissue affects measurements of resistance by using data for whole body and body segment resistance and by using muscle, adipose tissue, and bone volumes from magnetic resonance imaging for 86 overweight and obese men and women (body mass index > 27 kg/m2; age 38.5 +/- 10.2 yr). In multiple-regression analysis, muscle volumes had strong associations with resistance, confirming that the electric currents are conducted primarily in the lean soft tissues. Subcutaneous adipose tissue had a slight but statistically significant effect in women, primarily for the leg, suggesting that adipose tissue can affect measured resistance when the volume of adipose tissue is greater than muscle volume, as may occur in obese women in particular. This resulted in a slight overestimation of fat-free mass (e.g., +3 kg) when a bioelectric-impedance-analysis equation calibrated for nonobese female subjects was applied. |
9451646 | An induced blood pressure rise does not alter upper airway resistance in sleeping humans. | Sleep apnea is associated with episodic increases in systemic blood pressure. We investigated whether transient increases in arterial pressure altered upper airway resistance and/or breathing pattern in nine sleeping humans (snorers and nonsnorers). A pressure-tipped catheter was placed below the base of the tongue, and flow was measured from a nose or face mask. During non-rapid-eye-movement sleep, we injected 40- to 200-microgram i.v. boluses of phenylephrine. Parasympathetic blockade was used if bradycardia was excessive. Mean arterial pressure (MAP) rose by 20 +/- 5 (mean +/- SD) mmHg (range 12-37 mmHg) within 12 s and remained elevated for 105 s. There were no significant changes in inspiratory or expiratory pharyngeal resistance (measured at peak flow, peak pressure, 0.2 l/s or by evaluating the dynamic pressure-flow relationship). At peak MAP, end-tidal CO2 pressure fell by 1.5 Torr and remained low for 20-25 s. At 26 s after peak MAP, tidal volume fell by 19%, consistent with hypocapnic ventilatory inhibition. We conclude that transient increases in MAP of a monly observed during non-rapid-eye-movement sleep-disordered breathing do not increase upper airway resistance and, therefore, will not perpetuate subsequent obstructive events. |
9451648 | Older adults can maximally activate the biceps brachii muscle by voluntary command. | Because some of the decline in strength with age may be explained by an impairment of muscle activation, the purpose of this study was to determine the activation level achieved in biceps brachii by older adults during a maximum voluntary contraction (MVC). This capability was assessed with two superimposition techniques: one calculated the activation level that was achieved during an MVC, and the other provided an estimate of the expected MVC force based on extrapolation with submaximal forces. The activation level in biceps brachii was plete (< 100%) for the young (n = 16) and elderly (n = 16) subjects, with the elderly subjects exhibiting the greater deficit. In contrast, there was no difference between the measured and expected MVC forces for either group of subjects, whether the extrapolation involved a third-order polynomial or linearization of the data. Because of the lower signal-to-noise ratio associated with the measurement of activation level and the greater number of measurements that contributed to the estimate of the expected MVC force, we conclude that the older adults were able to plete activation of the biceps brachii muscle during an MVC. |
9451645 | Supercritical fluid-aerosolized vitamin E pretreatment decreases leak in isolated oxidant-perfused rat lungs. | We hypothesized that direct pulmonary administration of supercritical fluid-aerosolized (SFA) vitamin E would decrease acute oxidative lung injury. We previously reported that rapid expansion of supercritical CO2 formed respirable particles of vitamin E and that administering SFA vitamin E to rats increased lung vitamin E levels and decreased neutrophil-mediated lung leak. In the present investigation, we found that pretreatment with SFA vitamin E protected isolated rat lungs against the oxidant-induced lung leak caused by perfusion with xanthine oxidase (XO) and purine, an enzyme system that generates superoxide union (O2-.) and hydrogen peroxide. SFA vitamin E droplets were 0.7-3 microns in diameter, and inhalation of the airborne droplets for 30 min deposited approximately 55 micrograms of vitamin E in rat lungs. Isolated rat lungs perfused with XO (0.02 U/ml) and purine (10 mM) gained more weight (1.75 +/- 0.12 g, n = 8), retained more Ficoll (11.5 +/- 1.2 mg/left lung, n = 7), and accumulated more Ficoll in their lung lavages (700 +/- 146 micrograms/ml, n = 8) than control lungs [0.25 +/- 0.06 g (n = 10), 6.2 +/- 1.2 mg/left lung (n = 9), and 141 +/- 31 micrograms/ml (n = 8), respectively, P < 0.05]. In contrast, isolated lungs from rats that were pretreated with SFA vitamin E had decreased (P < 0.05) weight gains (0.32 +/- 0.06 g, n = 7), Ficoll retentions (3.3 +/- 1.1 mg/left lung, n = 7), and lung lavage Ficoll concentrations (91 +/- 26 micrograms/ml, n = 6) after perfusion with XO and pared with isolated lungs from control rats perfused with XO and purine. This protective effect was not observed in rat lungs given sham treatments (CO2 alone or vitamin E acetate aerosolized with supercritical CO2). Our results suggest that direct pulmonary supplementation of vitamin E decreases susceptibility to vascular leakage caused by XO-derived oxidants. |
9451647 | Forearm training reduces the exercise pressor reflex during ischemic rhythmic handgrip. | We examined the effects of unilateral, nondominant forearm training (4 wk) on blood pressure and forearm metabolites during ischemic and nonischemic rhythmic handgrip (30 1-s contractions/min at 25% maximal voluntary contraction). Contractions were performed by 10 subjects with the forearm enclosed in a pressurized Plexiglas tank to induce ischemic conditions. Training increased the endurance time in the nondominant arm by 102% (protocol 1). In protocol 2, tank pressure was increased in increments of 10 mmHg/min to +50 mmHg. Training raised the positive-pressure threshold necessary to engage the pressor response. In protocol 3, handgrip was performed at +50 mmHg and venous blood samples were analyzed. Training attenuated mean arterial pressure (109 +/- 5 and 98 +/- 4 mmHg pre- and posttraining, respectively, P < 0.01), venous lactate (2.9 +/- 0.4 and 1.8 +/- 0.3 mmol/l pre- and posttraining, respectively, P < 0.01), and the pH response (7.21 +/- 0.02 and 7.25 +/- 0.01, pre- and posttraining, respectively, P < 0.01). However, deep venous O2 saturation was unchanged. Training increased the positive-pressure threshold for metaboreceptor engagement, reduced metabolite concentrations, and reduced mean arterial pressure during ischemic exercise. |
9451649 | Hypoxic ventilatory sensitivity in men is not reduced by prolonged hyperoxia (Predictive Studies V and VI). | Potential adverse effects on the O2-sensing function of the carotid body when its cells are exposed to toxic O2 pressures were assessed during investigations of human organ tolerance to prolonged continuous and intermittent hyperoxia (Predictive Studies V and VI). Isocapnic hypoxic ventilatory responses (HVR) were determined at 1.0 ATA before and after severe hyperoxic exposures: 1) continuous O2 breathing at 1.5, 2.0, and 2.5 ATA for 17.7, 9.0, and 5.7 h and 2) intermittent O2 breathing at 2.0 ATA (30 min O2-30 min normoxia) for 14.3 O2 h within 30-h total time. Postexposure curvature of HVR hyperbolas was not pared with preexposure controls. The hyperbolas were temporarily elevated to higher ventilations than controls due to increments in respiratory frequency that were proportional to O2 exposure time, not O2 pressure. In humans, prolonged hyperoxia does not attenuate the hypoxia-sensing function of the peripheral chemoreceptors, even after exposures that approach limits of human pulmonary and central nervous system O2 tolerance. Current applications of hyperoxia in hyperbaric O2 therapy and in subsea- and aerospace-related operations are guided by and are well within these exposure limits. |
9451650 | Anatomic distribution of pulmonary vascular compliance. | Previously, the pressure changes after arterial and venous occlusion have been used to characterize the longitudinal distribution of pulmonary vascular resistance with respect to pliance partmental models. However, partments have not been defined anatomically. Using video microscopy of the subpleural microcirculation, we have measured the flow changes in approximately 40-micron arterioles and venules after venous, arterial, and double occlusion maneuvers. The quasi-steady flows through these vessels after venous occlusion permitted an estimation of pliance in three anatomic segments: arteries > 40 microns, veins > 40 microns, and vessels < 40 microns in diameter. We found that approximately 65% of the total pulmonary pliance was in vessels < 40 microns, presumably mostly capillaries. The transient portions of the pressure and flow data after venous, arterial, and double occlusion were consistent with most of the pliance being upstream from most of the arterial resistance and most of the pliance being downstream from most of the venous resistance. |
9451651 | Exercise training restores decreased cellular immune functions in obese Zucker rats. | This study investigated whether exercise training had a beneficial effect on the decreased mitogen response and improved a decreased expression of glucose transporter 1 (GLUT-1) in splenocytes from obese Zucker rats. Experimental groups were lean and sedentary and exercise-trained obese Zucker rats. Exercise training, running on a motor-driven treadmill for 5 days/wk for 40 wk, did not induce a significant decrease in body weight in obese Zucker rats. The plasma insulin concentration, showing a significant pared with lean Zucker rats, was unaffected by exercise training. However, the plasma triglyceride concentration in obese Zucker rats was significantly depressed by exercise training, whereas it was still higher than that in lean Zucker rats. In addition, natural killer cell activity and concanavalin A-induced mitogenesis of splenic lymphocytes of obese Zucker rats were significantly restored. In these splenic lymphocytes, glucose uptake was significantly pared with that in lean Zucker rats, which was also improved by exercise training. Although the expression of GLUT-1, the major glucose transporter in immune cells, was depressed in splenic lymphocytes of obese Zucker rats, exercise training induced a significant improvement. These results suggest that exercise training has a beneficial effect on the decreased cellular immune functions in obese Zucker rats, which is associated, in part, with the improvement in GLUT-1 expression. |
9451653 | High-frequency partial liquid ventilation in respiratory distress syndrome: hemodynamics and gas exchange. | Partial liquid ventilation using conventional ventilatory schemes improves lung function in animal models of respiratory failure. We examined the feasibility of high-frequency partial liquid ventilation in the preterm lamb with respiratory distress syndrome and evaluated its effect on pulmonary and systemic hemodynamics. Seventeen lambs were studied in three groups: high-frequency gas ventilation (Gas group), high-frequency partial liquid ventilation (Liquid group), and high-frequency partial liquid ventilation with hypoxia-hypercarbia (Liquid-Hypoxia group). High-frequency partial liquid ventilation increased pared with high-frequency gas ventilation over 5 h (arterial oxygen tension 253 +/- 21.3 vs. 17 +/- 1.8 Torr; P < 0.001). Pulmonary vascular resistance decreased 78% (P < 0.001), pulmonary blood flow increased fivefold (P < 0.001), and aortic pressure was maintained (P < 0.01) in the Liquid group, in contrast to progressive hypoxemia, hypercarbia, and shock in the Gas group. Central venous pressure did not change. The Liquid-Hypoxia group was similar to the Gas group. We conclude that high-frequency partial liquid ventilation improves gas exchange and stabilizes pulmonary and systemic pared with high-frequency gas ventilation. The stabilization appears to be due in large part to improvement in gas exchange. |
9451654 | Design and calibration of unicapillary pneumotachographs. | This study presents a method for design and calibration of unicapillary pneumotachographs for small-animal experiments. The design, based on Poiseuille's law, defines a set of internal radius and length values that allows for laminar flow, measurable pressure differences, and minimal interference with animal's respiratory mechanics and gas exchange. A third-order polynomial calibration (Pol) of the pressure-flow relationship was employed pared with linear calibration (Lin). Tests were done for conditions of ambient pressure (Pam) and positive pressure (Ppos) ventilation at different flow ranges. A physical model designed to match normal and pliance in rats was used. At pliance, Pol provided lower errors than Lin for mixed (1-12 ml/s), mean (4-10 ml/s), and high (8-12 ml/s) flow rate calibrations for both Pam and Ppos inspiratory tests (P < 0.001 for all conditions) and expiratory tests (P < 0.001 for all conditions). At pliance, they differed significantly with 8.6 +/- 4.1% underestimation when Lin at Pam was used in Ppos tests. Ppos calibration, preferably bination with Pol, should be used in this case to minimize errors (Pol = 0.8 +/- 0.5%, Lin = 6.5 +/- 4.0%, P < 0.0005). Nonlinear calibration may be useful for improvement of flow and volume measurements in small animals during both Pam and Ppos ventilation. |
9451652 | Muscle fiber architecture of the dog diaphragm. | Previous measurements of muscle thickness and length ratio of costal diaphragm insertions in the dog (A. M. Boriek and J. R. Rodarte. J. Appl. Physiol. 77: 2065-2070, 1994) suggested, but did not prove, discontinuous muscle fiber architecture. We examined diaphragmatic muscle fiber architecture using morphological and histochemical methods. In 15 mongrel dogs, transverse sections along the length of the muscle fibers were analyzed morphometrically at x20, by using the BioQuant System IV software. We measured fiber diameters, cross-sectional fiber shapes, and cross-sectional area distributions of fibers. We also determined numbers of muscle fibers per cross-sectional area and ratio of connective tissue to muscle fibers along a course of the muscle from near the chest wall (CW) to near the central tendon (CT) for midcostal left and right hemidiaphragms, as well as ventral, middle, and dorsal regions of the left costal hemidiaphragm. In six other mongrel dogs, the macroscopic distribution of neuromuscular junctions (NMJ) on thoracic and abdominal diaphragm surfaces was determined by staining the intact diaphragmatic muscle for acetylcholinesterase activity. The average major diameter of muscle fibers was significantly smaller, and the number of fibers was significantly larger midspan between CT and CW than near the insertions. The ratio of connective tissues to muscle fibers was largest at pared with other regions along the length of the muscle. The diaphragm is transversely crossed by multiple scattered NMJ bands with fairly regular intervals offset in adjacent strips. Muscle fascicles traverse two to five NMJ, consistent with fibers that do not span the entire fascicle from CT to CW. These results suggest that the diaphragm has a discontinuous fiber architecture in which contractile forces may be transmitted among the muscle fibers through the connective tissue adjacent to the fibers. |
9451655 | Neuromuscular fatigue after maximal stretch-shortening cycle exercise. | To examine some possible sites of fatigue during short-lasting maximally intensive stretch-shortening cycle exercise, drop jumps on an inclined sledge apparatus were analyzed. Twelve healthy volunteers performed jumps until they were unable to maintain jumping height > 90% of their maximum. After the workout, the increases in the blood lactate concentration and serum creatine kinase activation were statistically significant (P < 0.001 and P < 0.05, respectively) but rather small in physiological terms. The major changes after the workout were as follows: the single twitch was characterized by smaller peak torque (P < 0.05) and shorter time to peak (P < 0.05) and half-relaxation time (P < 0.01). The double-twitch torque remained at the same level (P > 0.05), but with a steeper maximal slope of torque rise (P < 0.05); during 20- and 100-Hz stimulation the torque declined (both P < 0.01) and the maximal voluntary torque changed nonsignificantly but with a smaller maximal slope of torque rise (P < 0.01) and a higher activation level (P < 0.05), panied by an increased electromyogram amplitude. These findings indicate that the muscle response after the short-lasting consecutive maximum jumps on the sledge apparatus may involve two distinct mechanisms acting in opposite directions: 1) The contractile mechanism seems to be potentiated through a shorter Ca2+ transient and faster cross-bridge cycling, as implied by twitch changes. 2) High-frequency action potential propagation shows an impairment, which is suggested as the possible dominant reason for fatigue in exercise of this type. |
9451656 | Effect of oxygen tension and rate of pressure reduction during decompression on central gas bubbles. | Reduction in ascent speed and an increase in the O2 tension in the inspired air have been used to reduce the risk for pression sickness. It has previously been reported that pression speed and O2 partial pressure are linearly related for human pressions from saturation hyperbaric exposures. The constant of proportionality K (K = rate/partial pressure of inspired O2) indicates the incidence of pression sickness. The present study investigated the relationship among pression rate, partial pressure of inspired O2, and the number of central gas bubbles after a 3-h dive to 500 kPa while breathing nitrox with an O2 content of 35 kPa. We used transesophageal ultrasonic scanning to determine the number of bubbles in the pulmonary artery of pigs. The results show that, for a given level of pression stress, pression rate and O2 tension in the inspired air can be traded off against each other by using pulmonary artery bubbles as an end point. The results also seem to confirm that pressions that have a high K value are more stressful. |
9451657 | Prediction of hemorrhagic blood loss with a genetic algorithm neural network. | There is no established method for accurately predicting how much blood loss has occurred during hemorrhage. In the present study, we examine whether a genetic algorithm neural network (GANN) can predict volume of hemorrhage in an experimental model in rats and pare its accuracy to stepwise linear regression (SLR). Serial measurements of heart period; diastolic, systolic, and mean blood pressures; hemoglobin; pH; arterial PO2; arterial PCO2; bicarbonate; base deficit; and blood loss as percent of total estimated blood volume were made in 33 male Wistar rats during a stepwise hemorrhage. The GANN and SLR used a randomly assigned training set to predict actual volume of hemorrhage in a test set. Diastolic blood pressure, arterial PO2, and base deficit were selected by the GANN as the optimal predictors set. Root mean square error in prediction of estimated blood volume by GANN was significantly lower than by SLR (2.63%, SD 1.44, and 4.22%, SD 3.48, respectively; P < 0.001). A GANN can predict highly accurately and significantly better than SLR volume of hemorrhage without knowledge of prehemorrhage status, rate of blood loss, or trend in physiological variables. |
9451658 | Validity of heart rate, pedometry, and accelerometry for predicting the energy cost of children's activities. | Heart rate telemetry is frequently used to estimate daily activity in children and to validate other methods. This pared the accuracy of heart rate monitoring, pedometry, triaxial accelerometry, and uniaxial accelerometry for estimating oxygen consumption during typical children's activities. Thirty Welsh children (mean age 9.2 +/- 0.8 yr) walked (4 and 6 km/h) and ran (8 and 10 km/h) on a treadmill, played catch, played hopscotch, and sat and crayoned. Heart rate, body accelerations in three axes, pedometry counts, and oxygen uptake were measured continuously during each 4-min activity. Oxygen uptake was expressed as a ratio of body mass raised to the power of 0.75 [scaled oxygen uptake (sVO2)]. All measures correlated significantly (P < 0.001) with sVO2. A multiple-regression equation that included triaxial accelerometry counts and heart rate predicted sVO2 better than any measure alone (R2 = 0.85, standard error of the estimate = 9.7 ml.kg-0.75.min-1). The best of the single measures was triaxial accelerometry (R2 = 0.83, standard error of the estimate = 10.3 ml.kg-0.75.min-1). It is concluded that a triaxial accelerometer provides the best assessment of activity. Pedometry offers potential for large population studies. |
9451659 | Preliminary evidence that DEXA provides an accurate assessment of body composition. | It was previously found that dual-energy X-ray absorptiometry (DEXA) underestimated central body fat. The purposes of this study were to determine whether an updated version (enhanced version 5.64) of the analysis program corrected this problem (experiment 1) and pare position assessed by DEXA and hydrodensitometry (HD) in women (n = 225) and men (n = 110) across a 21- to 81-yr age range (experiment 2). For experiment 1, 10 subjects underwent DEXA procedures in a control condition and with packets of lard positioned over either the thighs or the truncal region. DEXA accurately quantified the additional mass as approximately 96% fat, regardless of position. For experiment 2, DEXA yielded higher (P < 0.001) estimates of fatness than did HD (32.1 +/- 12.0 vs. 31.2 +/- 10.1%). The mean difference between the two methods was similar in young, middle-aged, and older subjects, but was different in men (HD-DEXA, 1.6 +/- 3.4% of body wt) than in women (-2.1 +/- 3.8% of body wt). Correcting the density of fat-free mass for variance in the bone mineral fraction of fat-free mass reduced the difference between the methods in men from 1.6 +/- 3.4 to -0.7 +/- 2.9% but widened it in women from -2.1 +/- 3.8 to -3.5 +/- 3.4%. A second correction procedure that adjusted for variance in water, protein, and mineral fractions of fat-free mass eliminated the differences in estimates of fat content by DEXA and HD in both men (21.1 +/- 9.3 vs. 20.6 +/- 8.4%, respectively) and women (37.5 +/- 9.3 vs. 36.8 +/- 8.0%, respectively). These results provide encouraging, but not definitive, evidence that the assessment of position by DEXA is accurate under the specified conditions. |
9451660 | A modified Bessel filter for amplitude demodulation of respiratory electromyograms. | We studied a device that monly used for amplitude demodulation of respiratory muscle electromyograms (EMG). This device contains a rectifier and a low-pass filter called a modified third-order Paynter filter. We characterized this filter and found that it has good transient characteristics that suit its task as an EMG demodulator, but it has poor high-frequency attenuation that passes interfering, higher ponents to the output waveform. Therefore, we designed and constructed a new filter with transient characteristics that parable to those of the modified Paynter filter but with superior high-frequency attenuation. This new filter is a modified seventh-order Bessel filter. We also identified a simple technique to convert an existing modified Paynter filter back to an original Paynter filter. The original Paynter filter has a wider pass band than the modified Paynter filter but superior stop-band attenuation. |
9451661 | A comprehensive equation for the pulmonary pressure-volume curve. | Quantification of pulmonary pressure-volume (P-V) curves is often limited to calculation of pliance at a given pressure or the recoil pressure (P) at a given volume (V). These parameters can be substantially different depending on the arbitrary pressure or volume used in parison and may lead to erroneous conclusions. We evaluated a sigmoidal equation of the form, V = a + b[1 - e-(P-c)/d]-1, for its ability to characterize lung and respiratory system P-V curves obtained under a variety of conditions including normal and hypocapnic pneumoconstricted dog lungs (n = 9), oleic acid-induced acute respiratory distress syndrome (n = 2), and mechanically ventilated patients with acute respiratory distress syndrome (n = 10). In this equation, a corresponds to the V of a lower asymptote, b to the V difference between upper and lower asymptotes, c to the P at the true inflection point of the curve, and d to a width parameter proportional to the P range within which most of the V change occurs. The equation fitted equally well inflation and deflation limbs of P-V curves with a mean goodness-of-fit coefficient (R2) of 0.997 +/- 0.02 (SD). When the data from all analyzed P-V curves were normalized by the best-fit parameters and plotted as (V-a)/b vs. (P-c)/d, they collapsed into a single and tight relationship (R2 = 0.997). These results demonstrate that this sigmoidal equation can fit with excellent precision inflation and deflation P-V curves of normal lungs and of lungs with alveolar derecruitment and/or a region of gas trapping while yielding robust and physiologically useful parameters. |
9451663 | Management in general practice of patients with persistent dyspepsia. A decision analysis. | To determine whether an empirical drug treatment strategy (empirical group) instead of upper gastrointestinal endoscopy followed by treatment (conventional group) in patients with persistent dyspepsia increases appropriate use of endoscopy facilities, we did a decision analysis based on data found in the literature. We estimated the percentage of patients having an upper gastrointestinal endoscopy in 1 year, the percentage of patients with symptom relief, and the average medical costs per patient for both groups. In the empirical group, fewer patients (38%) had upper gastrointestinal pared with the conventional group. Furthermore, an additional 5% of patients in the empirical group experienced symptom relief, and the average medical costs per patient were estimated to be 8% less in this group pared with the patients in the conventional treatment group. The proposed empirical drug treatment strategy for patients with persistent dyspepsia results in the performance of fewer diagnostic upper gastrointestinal endoscopies per year with greater pared with upper gastrointestinal endoscopy followed by treatment. |
9451664 | Genetic polymorphisms of tobacco- and alcohol-related metabolizing enzymes and human esophageal squamous cell carcinoma susceptibility. | Many human cancers are caused by synthetic or natural pounds in the environment. Esophageal squamous cell carcinoma has been reported to be epidemiologically associated with tobacco and alcohol consumption. We studied the association between genetic polymorphisms of tobacco- and alcohol-related metabolizing enzymes and esophageal squamous cell carcinoma susceptibility. We examined genetic polymorphisms of the CYPIA1, GSTM1, CYPIIE1, ADH2, and ALDH2 genes in 94 Japanese patients with esophageal squamous cell carcinoma and 70 unrelated healthy Japanese persons. There were no significant differences between healthy controls and patients with esophageal cancer in the polymorphisms of the CYPIA1, GSTM1, and CYPIIE1 genes. On the other hand, there were significant differences in the ADH2 and ALDH2 polymorphisms between healthy controls and esophageal cancer patients. The ADH2(1)/ADH2(1) and ALDH2(1)/ALDH2(2) genotypes were independently and significantly higher in esophageal cancer patients than in healthy controls. Furthermore, persons with bined genotypes ADH2(1)/ADH2(1) and ALDH2(1)/ALDH2(2) were at extraordinarily high risk for esophageal squamous cell carcinoma, with an odds ratio of 17.9 (p < 0.001). Thus polymorphisms of alcohol-metabolizing enzymes, that is, ADH2 and ALDH2, may be useful for screening patients at high risk for esophageal cancer, which might facilitate clarification of esophageal tumorigenesis and prevention of esophageal cancer. |
9451665 | Seasonality in the prevalence of acute upper gastrointestinal bleeding. | The seasonal fluctuations of acute upper gastrointestinal bleeding treated from 1991 to 1996 in Patras, Greece, were analyzed retrospectively. During that period, 1992 patients with acute upper gastrointestinal bleeding were admitted to our hospital. After patients who were not residents of the region served by our hospital were excluded, the remaining 1879 cases were reviewed. We observed seasonal fluctuation with low prevalence in winter and an increase in spring and autumn with two peaks in April and October (p < 0.00001). The seasonal prevalence parallels that of duodenal ulcer bleeding, which follows a similar fluctuation (p < 0.00001). Bleeding due to gastric ulcers or other causes presented no periodicity. Seasonal fluctuation, both in total numbers of upper gastrointestinal bleeding and in duodenal ulcer bleeding, was statistically significant only in patients not receiving nonsteroidal anti-inflammatory drugs (p < 0.00001). We conclude that upper gastrointestinal bleeding shows a seasonal fluctuation parallel to duodenal ulcer bleeding and is not related to nonsteroidal anti-inflammatory drugs. The seasonal pattern supports the traditional view of duodenal ulcer exacerbations. |
9451666 | Is a history of tonsillectomy associated with a decreased risk of Helicobacter pylori infection? | To determine the relation between a history of tonsillectomy and the prevalence of colonization by Helicobacter pylori (HP), we conducted an observational, cohort study at the University of Oklahoma Hospital over a 13-month period. Subjects under-going upper endoscopic evaluation and antral biopsies for HP at the University of Oklahoma Hospital formed the database. The indication of the endoscopy and biopsies was determined by the endoscopist. The antral biopsy specimens were tested for HP using a rapid urease test. We recorded the patient's name, age, gender, race, history of smoking, and history of appendectomy or tonsillectomy. One hundred nine subjects constituted our database. There was no difference in age, gender, or smoking between the HP+ (n = 37) and HP- (n = 72) groups. The ability to pay for healthcare through a third-payor party also was similar. The prevalence of prior tonsillectomy was 30.6% in HP- group versus 5.4% in HP+ group (p < 0.01). In contrast, the prevalence of prior appendectomy was 21.6% in HP+ group versus 23.6% in HP- group (p = not significant). Multiple regression was carried out to account for confounding variables. The model showed that only white race and tonsillectomy were significantly related to the presence of HP colonization. Both appendectomy and health insurance, which were the surrogate markers for access to healthcare and socioeconomic status, were insignificant. We conclude that a history of tonsillectomy is associated with decreased prevalence of HP colonization. |
9451667 | Reduced incidence of Helicobacter pylori infection in young Japanese persons between the 1970s and the 1990s. | Although the incidence of gastric carcinoma in Japan has declined in the past several decades, there is no information about trends in helicobacter pylori infection. The purpose of the study was to clarify trends in H. pylori infection and in histologic gastritis in young Japanese subjects evaluated between 1975 and 1978 (the 1970s) versus 1991 and 1994 (the 1990s). The prevalence of H. pylori infection and the grade of gastritis in biopsy specimens were evaluated in 173 young Japanese without localized lesions in the upper gastrointestinal tract. Findings in 75 specimens obtained from subjects in the 1970s pared with those of 98 specimens obtained from subjects in the 1990s. The prevalence of H. pylori infection in the 1970s (54.7%) was significantly higher than that in the 1990s (28.6%) (p < 0.01). The grade of inflammation and the prevalence of both mucosal atrophy and intestinal metaplasia also were significantly higher in the 1970s than in the 1990s (p < 0.01 and p < 0.05). Our data thus show a trend toward a reduced prevalence of H. pylori infection and of histologically apparent gastritis (especially atrophic gastritis). This decrease may be linked to the reported decline of gastric carcinoma in Japan. |
9451668 | Correlation of serum immunoglobulin G Helicobacter pylori antibody titers with histologic and endoscopic findings in patients with dyspepsia. | Serum immunoglobulin G (IgG) antibody tests are used extensively. We attempted to find out whether the titers of anti-Helicobacter pylori IgG antibody correlated with the degree of macroscopic gastrointestinal damage, the severity of antral gastritis, and the density of antral H. pylori colonization in symptomatic patients. Peripyloric antral biopsy specimens were obtained from 50 consecutive patients with dyspepsia undergoing upper gastrointestinal endoscopy. The macroscopic gastrointestinal damage and the histologic grades of antral gastritis were scored by a modified Lanza scale and Sydney system, respectively. In addition, the densities of antral H. pylori colonization were graded semiquantitatively. Serum IgG antibodies to H. pylori were measured by enzyme-linked immunosorbent assay. Thirty-six (M/F = 29/7) of the 50 patients had H. pylori infection documented by histologic examination or rapid urease test or both. Among the subjects, the IgG antibody titers to H. pylori correlated significantly with the grades of antral polymorphonuclear cell infiltration (p = 0.002) and antral bacterial density (p = 0.01) but not with endoscopic scores, the grades of mononuclear cell infiltration, mucosal atrophy, or intestinal metaplasia (p > 0.05). In addition, endoscopic scores also were found to be significantly correlated with antral bacterial density (p = 0.049) and the grade of polymorphonuclear cell infiltration (p = 0.012). We therefore conclude that high titers of IgG antibody to H. pylori in patients with dyspepsia indicate dense H. pylori colonization and severe antral polymorphonuclear cell infiltration. However, it cannot replace endoscopic examination to evaluate the degree of macroscopic gastrointestinal damage. |
9451669 | Intragastric distribution of nonsteroidal anti-inflammatory drug-related ulcers in patients without collagen diseases. | During the long-term administration of nonsteroidal anti-inflammatory drugs (NSAIDs), approximately 3% of patients have gastric ulcers develop in each year. Although much is known about the endoscopic characteristics of NSAID-induced gastric ulcers in patients with rheumatoid arthritis (RA), it is not clear where in the stomach NSAIDs induce ulcers in patients without RA. We looked at that question. During the 1-year study period, 29 patients with gastric ulcer, who had been taking NSAIDs regularly for more than 4 weeks mainly for osteoarthritis, were identified. Seventy-five patients with gastric ulcers who had not taken NSAID also were found. The sites of gastric ulcers of these two groups were quite different. The NSAID-induced ulcers mainly were found in the gastric antrum, whereas the majority of NSAID-unrelated ulcers were in the gastric corpus. We conclude that NSAID-induced ulcers in non-RA patients mainly are formed in the gastric antrum. |
9451670 | Diarrheal epidemics among Rwandan refugees in 1994. Management and outcome in a field hospital. | We describe the clinical course and e of Rwandan refugees with cholera-like illness (n = 567) and clinical dysentery (n = 1,062) treated at the Israeli Army field hospital in the disaster region of Goma, Zaire, during the summer of 1994. Vigorous fluid administration was the primary plemented with antibiotics for patients with presumed Shigella infection. Recovery rates were 94% and 96% for patients with cholera and dysentery, respectively. Mortality was substantially affected orbid conditions such as pneumonia and meningitis, which occurred in one-quarter of these patients. Infective, metabolic, and plications (including three cases of intussusception) may have contributed to the deaths. The e of patients during diarrheal epidemics of cholera or bacillary dysentery may be favorable, even in disaster settings, if patients are evacuated promptly to medical facilities and appropriate therapy is instituted. We close with general observations on procedures to be followed in future epidemics of diarrheal diseases. |
9451671 | Cholelithiasis and pancreatic cancer. A case-control study. | To study the possible association between pancreatic cancer and cholelithiasis, we conducted a retrospective case-control study. Abdominal ultrasound of 100 consecutive cases of pancreatic cancer and that of 140 age- and gender-matched control subjects were examined by 2 observers who did not know the diagnosis. Thirty-seven patients with pancreatic cancer had cholelithiasis (37%), pared with 23 (16%) of the control group (p < 0.001). The increased prevalence of gallstones in patients with pancreatic carcinoma remained significant when either male or female patients pared (p < 0.02), as well as in the various age groups studied. For example, 30 (43.5%) of 69 patients 65 years of age and older had cholelithiasis versus 21 (22%) of 95 control subjects (p < 0.005). Thus, patients with pancreatic cancer were found to have a higher prevalence of gallstone disease than expected in a matched control population (relative risk, 2.2; 95% confidence interval, 1.2-4.3). This finding does not establish a causal link; however, the possibility should be pursued, more so because gallstones have been identified previously as likely risk factors for cancer in other parts of the biliary-pancreatic tract. |
9451672 | High prevalence of Helicobacter pylori infection in patients with colonic adenomas and carcinomas. | In some uncontrolled studies, a high prevalence of Helicobacter pylori infection unexpectedly has been found in patients with colorectal cancer. The purpose of the study was to investigate the prevalence of H. pylori infection in patients with colonic polyps or cancer. We reviewed 50 consecutive patients with either colonic adenomas or cancer who entered a preliminary case-control study. For each patient, 2 age- and gender-matched control subjects were selected (72 males; mean age, 63.1 years). A further 44 consecutive patients (30 with polyps and 14 with cancer) subsequently were enrolled. The H. pylori prevalence in patients with either polyps or cancer pared with that in control subjects. Anti-H. pylori immunoglobulin G antibodies were assayed by an immunoenzymatic method. The prevalence of H. pylori antibodies was 49 (49%) of 100 in control subjects, 40 (71.4%) of 56 in patients with polyps (p < 0.006 vs. control subjects), and 21 (55%) of 38 in patients with cancer (not significant). Among patients with colorectal cancer, H. pylori prevalence was 9 (69.2%) of 13 for patients evaluated at the time of diagnosis and 12 (48%) of 25 for patients evaluated 1 to 9 years after surgery. We conclude that colonic neoplastic lesions, especially adenomas, are associated with an increased prevalence of H. pylori infection. The mechanisms underlying this association need to be elucidated. |
9451673 | Bile duct hamartomas. A report of two cases. | Bile duct hamartomas (von plexes) of the liver are usually detected at laparotomy or autopsy as an incidental finding, and usually they are multiple. We report two cases of proved bile duct hamartomas of the liver. The first was in a 65-year-old man whose initial sepsis and many hepatic lesions were interpreted as microabscess of the liver. The second patient was a 39-year-old man, a hepatitis B surface antigen carrier, in whom an incidental hepatic tumor was found. We suggest that liver biopsy be done in hepatic lesions with uncertain clinical features, because the histologic findings may change the treatment plan. |
9451674 | Prevalence of cryoglobulinemia in chronic hepatitis C virus infection and response to treatment with interferon-alpha. | Chronic hepatitis C virus (HCV) infection is associated with a variety of clinically important extrahepatic abnormalities. We have assessed the prevalence of cryoglobulinemia and of the clinical syndrome associated with it in patients with chronic HCV infection. We also have evaluated the clinical, serologic, and biochemical response to antiviral treatment with interferon-alpha (IFN-alpha). Eighty-one patients with chronic liver disease associated with HCV infection were included. Cryoglobulins were sought in the serum. All patients were examined carefully for clinical manifestations of cryoglobulinemia (e.g., palpable purpura, Raynaud's syndrome, arthritis, peripheral neuropathy, Sjögren's syndrome, glomerulonephritis). Antiviral treatment with IFN-alpha, at a dose of 3 to 5 million units, 3 times weekly, was given to 20 patients with cryoglobulinemia. Cryoglobulins were detected in 45.7% of patients. Signs and symptoms of the clinical syndrome associated with cryoglobulinemia were present in 12.3% of the entire group of patients (27% of the subgroup with detectable cryoglobulins). Patients with cryoglobulinemia were older (mean age, 56 +/- 15 vs. 44 +/- 16 years; p = 0.002) and had a higher rate of cirrhosis (48.6% vs. 18.2%, rate ratio = 4.26, 95% confidence interval = 2.11 to 8.58, p = pared to patients without cryoglobulinemia. Cryoglobulins disappeared from the serum in 13 (65%) of the 20 patients who were treated for 6 to 12 months with IFN-alpha. This effect was affiliated in most patients with resolution of the clinical findings associated with cryoglobulinemia and return of transaminases to normal levels. Recurrence of cryoglobulinemia was observed in two thirds of the patients who were observed after treatment with IFN-alpha. We conclude that cryoglobulins are present in 45.7% of patients with chronic HCV infection. Symptoms or signs or both associated with the presence of cryoglobulins develop in a high proportion (27%) of these patients. Antiviral treatment with IFN-alpha leads to resolution of both cryoglobulinemia and the symptoms associated with it in most patients who also show a biochemical response to antiviral treatment. Recurrence is frequent after treatment withdrawal. |
9451675 | Evaluation of pleural fluid in patients with cirrhosis. | Although fluid analysis usually is the first step toward identifying the cause of pleural effusion in patients with cirrhosis and ascites, there are no available data on the reliability of this approach, therefore, we retrospectively evaluated hematologic and biochemical parameters from pleural fluid analysis in 21 patients with hepatic hydrothorax (with proven munication) and 6 patients with primary pleural disease (2 with tuberculosis, 3 with parapneumonic effusion, and 1 with empyema). The criteria developed by Light were diagnostic of pleural "exudate" in only one of six patients with primary pleural disease, concentrations of leukocytes, total protein (TP), albumin, and lactic dehydrogenase (LDH) in both fluids were measured and pleural fluid-to-ascites ratios of these measurements were calculated. Only ratio values for leukocytes and TP were higher in the group of patients with primary pleural pared with those with hepatic hydrothorax. Ratio values for leukocytes and TP overlapped between both groups during baseline conditions and during episodes of spontaneous bacterial peritonitis and pleuritis. We conclude that pleural fluid analysis has limited diagnostic efficacy in the patient with cirrhosis. Data collected by other methods--clinical and radiologic--should assist in arriving at the correct diagnosis. |
9451676 | Clinicopathologic features of resected primary adenosquamous carcinomas of the liver. | Four cases of resected adenosquamous carcinoma of the liver were clinicopathologically reviewed, together with immunohistochemical findings. Although no lymph node metastases were seen and a curative resection was achieved in all cases, two patients had recurrences in the peritoneum and distant organs such as the pericardium and pleura relatively soon after the operation. Of the remaining two cases, one patient died during the postoperative period and the other died of coexistent hilar cholangiocarcinoma. Together these findings suggest that this disease tends to spread locally and distantly in the early phase of tumor growth and shows aggressive biological behavior. In an immunohistochemical study, involucrin was a specific marker for the ponent and CA19-9 was a marker for the ponent. |
9451677 | Homeopathy for postoperative ileus? A meta-analysis. | Homeopathic remedies are advocated for the treatment of postoperative ileus, yet data from clinical trials are inconclusive. We therefore performed meta-analyses of existing clinical trials to determine whether homeopathic treatment has any greater effect than placebo administration on the restoration of intestinal peristalsis in patients after abdominal or gynecologic surgery. We conducted systematic literature searches to identify relevant clinical trials. Meta-analyses were conducted using RevMan software. Separate meta-analyses were conducted for any homeopathic treatment versus placebo; homeopathic remedies of < 12C potency versus placebo; homeopathic remedies of > or = 12C potency versus placebo. A "sensitivity analysis" was performed to test the effect of excluding studies of low methodologic quality. Our endpoint was time to first flatus. Meta-analyses indicated a statistically significant (p < 0.05) weighted mean difference (WMD) in favor of homeopathy (compared with placebo) on the time to first flatus. Meta-analyses of the three studies pared homeopathic remedies > or = 12C versus placebo showed no significant difference (p > 0.05). Meta-analyses of paring homeopathic remedies < 12C with placebo indicated a statistically significant (p < 0.05) WMD in favor of homeopathy on the time to first flatus. Excluding methodologically weak trials did not substantially change any of the results. There is evidence that homeopathic treatment can reduce the duration of ileus after abdominal or gynecologic surgery. However, several caveats preclude a definitive judgment. These results should form the basis of a randomized controlled trial to resolve the issue. |
9451678 | Diffuse cystic malformation and neoplasia-associated cystic formation in the stomach. Endosonographic features and diagnosis of tumor depth. | We have evaluated the endoscopic ultrasonography (EUS) features of cystic malformation of the stomach and the depth of associated neoplasia. We included 15 patients with multiple ponents identified on EUS: 6 patients with multiple cysts restricted focally to gastric neoplasia and 9 patients with diffusely distributed cysts. We categorized the former findings as focal cystic malformation (FCM), and the latter as diffuse cystic malformation (DCM) of the stomach and reviewed the endosonographic features. Both FCM and DCM tended to show male preponderance and develop in older patients. Cystic changes in FCM extended from the neoplastic lesion to the submucosa regardless of the location in the stomach. Diffuse cystic malformation was located predominantly in the gastric body and mainly was shown as the thickened submucosa and/or deep mucosa with multiple ponents. The boundary between the mucosal layer or the tumor echo and the submucosal layer was indistinct in eight patients, which led to a lower accuracy in EUS diagnosis of tumor depth. Diffuse cystic malformation has characteristic EUS features and occasionally is panied by gastric neoplasia. Endoscopic ultrasonography is inaccurate in determining tumor depth when multiple submucosal cysts are present. |
9451679 | Acute pancreatitis. A fatal complication of AIDS therapy. | Pancreatic disease in patients with AIDS often is so mild that the diagnosis may be missed. The pancreas can be affected by systemic illness caused by opportunistic infections, Kaposi's a, or lymphoma. monly, drugs used to treat patients infected with human immunodeficiency virus can cause pancreatitis and result in significant morbidity and, rarely, mortality. We report one such case in a 47-year-old patient with AIDS in whom pancreatitis developed while taking 2',3'-dideoxyinosine (ddI). His condition improved on ddI withdrawal, but he suffered a fatal relapse while receiving 2',3'-dideoxycytidine and trimethoprim-sulfamethoxazole. This case gives me the opportunity to review the literature regarding the incidence, causes, and diagnosis of human immunodeficiency virus-associated pancreatitis. |