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1.
medRxiv ; 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38946941

RESUMO

Background: Older adults with mild cognitive impairment (MCI) exhibit deficits in cerebrovascular reactivity (CVR), suggesting CVR is a biomarker for vascular contributions to MCI. This study examined if spontaneous CVR is associated with MCI and memory impairment. Methods: 161 older adults free of dementia or major neurological/psychiatric disorders were recruited. Participants underwent clinical interviews, cognitive testing, venipuncture for Alzheimer's biomarkers, and brain MRI. Spontaneous CVR was quantified during 5 minutes of rest. Results: Whole brain CVR was negatively associated with age, but not MCI. Lower CVR in the parahippocampal gyrus (PHG) was found in participants with MCI and was linked to worse memory performance on memory tests. Results remained significant after adjusting for Alzheimer's biomarkers and vascular risk factors. Conclusion: Spontaneous CVR deficits in the PHG are observed in older adults with MCI and memory impairment, indicating medial temporal microvascular dysfunction's role in cognitive decline.

2.
Alzheimers Res Ther ; 16(1): 124, 2024 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-38851772

RESUMO

BACKGROUND: Higher order regulation of autonomic function is maintained by the coordinated activity of specific cortical and subcortical brain regions, collectively referred to as the central autonomic network (CAN). Autonomic changes are frequently observed in Alzheimer's disease (AD) and dementia, but no studies to date have investigated whether plasma AD biomarkers are associated with CAN functional connectivity changes in at risk older adults. METHODS: Independently living older adults (N = 122) without major neurological or psychiatric disorder were recruited from the community. Participants underwent resting-state brain fMRI and a CAN network derived from a voxel-based meta-analysis was applied for overall, sympathetic, and parasympathetic CAN connectivity using the CONN Functional Toolbox. Sensorimotor network connectivity was studied as a negative control. Plasma levels of amyloid (Aß42, Aß40), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP) were assessed using digital immunoassay. The relationship between plasma AD biomarkers and within-network functional connectivity was studied using multiple linear regression adjusted for demographic covariates and Apolipoprotein E (APOE) genotype. Interactive effects with APOE4 carrier status were also assessed. RESULTS: All autonomic networks were positively associated with Aß42/40 ratio and remained so after adjustment for age, sex, and APOE4 carrier status. Overall and parasympathetic networks were negatively associated with GFAP. The relationship between the parasympathetic CAN and GFAP was moderated by APOE4 carrier status, wherein APOE4 carriers with low parasympathetic CAN connectivity displayed the highest plasma GFAP concentrations (B = 910.00, P = .004). Sensorimotor connectivity was not associated with any plasma AD biomarkers, as expected. CONCLUSION: The present study findings suggest that CAN function is associated with plasma AD biomarker levels. Specifically, lower CAN functional connectivity is associated with decreased plasma Aß42/40, indicative of cerebral amyloidosis, and increased plasma GFAP in APOE4 carriers at risk for AD. These findings could suggest higher order autonomic and parasympathetic dysfunction in very early-stage AD, which may have clinical implications.


Assuntos
Doença de Alzheimer , Peptídeos beta-Amiloides , Biomarcadores , Imageamento por Ressonância Magnética , Humanos , Feminino , Doença de Alzheimer/sangue , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/diagnóstico por imagem , Idoso , Masculino , Biomarcadores/sangue , Peptídeos beta-Amiloides/sangue , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Fragmentos de Peptídeos/sangue , Sistema Nervoso Autônomo/fisiopatologia , Proteína Glial Fibrilar Ácida/sangue , Idoso de 80 Anos ou mais , Proteínas de Neurofilamentos/sangue , Doenças do Sistema Nervoso Autônomo/sangue , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Doenças do Sistema Nervoso Autônomo/etiologia
3.
Front Neurosci ; 18: 1401706, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38846716

RESUMO

Amyotrophic lateral sclerosis (ALS) continues to pose a significant challenge due to the disease complexity and heterogeneous manifestations. Despite recent drug approvals, there remains a critical need for the development of more effective therapies. This review explores the underlying mechanisms involved; including neuroinflammation, glutamate mediated excitotoxicity, mitochondrial dysfunction, and hypermetabolism, and how researchers are trying to develop novel drugs to target these pathways. While progress has been made, the unmet need of ALS patients highlights the urgency for continued research and resource allocation in the pursuit of effective treatments.

4.
Neuroimage Rep ; 4(1)2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38699510

RESUMO

Background: Blood pressure variability is increasingly linked with cerebrovascular disease and Alzheimer's disease, independent of mean blood pressure levels. Elevated blood pressure variability is also associated with attenuated cerebrovascular reactivity, which may have implications for functional hyperemia underpinning brain network connectivity. It remains unclear whether blood pressure variability is related to functional network connectivity. We examined relationships between beat-to-beat blood pressure variability and functional connectivity in brain networks vulnerable to aging and Alzheimer's disease. Methods: 53 community-dwelling older adults (mean [SD] age = 69.9 [7.5] years, 62.3% female) without history of dementia or clinical stroke underwent continuous blood pressure monitoring and resting state fMRI scan. Blood pressure variability was calculated as variability independent of mean. Functional connectivity was determined by resting state fMRI for several brain networks: default, salience, dorsal attention, fronto-parietal, and language. Multiple linear regression examined relationships between short-term blood pressure variability and functional network connectivity. Results: Elevated short-term blood pressure variability was associated with lower functional connectivity in the default network (systolic: standardized ß = -0.30 [95% CI -0.59, -0.01], p = .04). There were no significant associations between blood pressure variability and connectivity in other functional networks or between mean blood pressure and functional connectivity in any network. Discussion: Older adults with elevated short-term blood pressure variability exhibit lower resting state functional connectivity in the default network. Findings support the role of blood pressure variability in neurovascular dysfunction and Alzheimer's disease. Blood pressure variability may represent an understudied early vascular risk factor for neurovascular dysfunction relevant to Alzheimer's disease, with potential therapeutic implications.

6.
Neurobiol Aging ; 139: 5-10, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38579393

RESUMO

Cerebrovascular reactivity (CVR) deficits may contribute to small vessel disease, such as white matter hyperintensities (WMH). Moreover, apolipoprotein-e4 (APOE4) carriers at genetic risk for Alzheimer's disease exhibit cerebrovascular dysfunction relative to non-carriers. We examined whether older adults, and APOE4 carriers specifically, with diminished CVR would exhibit higher WMH burden. Independently living older adults (N = 125, mean age = 69.2 years; SD = 7.6; 31.2% male) free of dementia or clinical stroke underwent brain MRI to quantify cerebral perfusion during CVR to hypercapnia and hypocapnia and determine WMH volume. Adjusting for age, sex and intracranial volume, hierarchical regression analysis revealed a significant association between whole brain CVR to hypercapnia and WMH overall [B = -.02, 95% CI (-.04, -.008), p =.003] and in APOE4 carriers [B = -.03, 95% CI (-.06, -.009), p =.009]. Findings suggest deficits in cerebral vasodilatory capacity are associated with WMH burden in older adults and future studies are warranted to further delineate the effect of APOE4 on precipitating WMH.


Assuntos
Apolipoproteína E4 , Circulação Cerebrovascular , Imageamento por Ressonância Magnética , Substância Branca , Humanos , Masculino , Feminino , Idoso , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Apolipoproteína E4/genética , Pessoa de Meia-Idade , Envelhecimento/patologia , Envelhecimento/fisiologia , Heterozigoto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/fisiopatologia , Encéfalo/irrigação sanguínea , Hipercapnia/fisiopatologia , Hipercapnia/diagnóstico por imagem , Risco , Doença de Alzheimer/diagnóstico por imagem , Doença de Alzheimer/genética , Doença de Alzheimer/patologia
7.
medRxiv ; 2023 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-38168394

RESUMO

Background: Increased blood pressure variability (BPV) is a risk factor for cerebral small vessel disease (CSVD) and neurodegeneration, independent of age and average blood pressure, particularly in apolipoprotein E4 (APOE4) carriers. However, it remains uncertain whether BPV elevation is a cause or a consequence of vascular brain injury, or to what degree injury to the central autonomic network (CAN) may contribute to BPV-associated risk in APOE4 carriers. Methods: Independently living older adults (n=70) with no history of stroke or dementia were recruited from the community and underwent 5 minutes of resting beat-to-beat blood pressure monitoring, genetic testing, and brain MRI. Resting BPV, APOE genotype, CSVD burden on brain MRI, and resting state CAN connectivity by fMRI were analyzed. Causal mediation and moderation analysis evaluated BPV and CAN effects on CSVD in APOE4 carriers (n=37) and non-carriers (n=33). Results: Higher BPV was associated with the presence and extent of CSVD in APOE4 carriers, but not non-carriers, independent of CAN connectivity (B= 18.92, P= .02), and CAN connectivity did not mediate the relationship between BPV and CSVD. In APOE4 carriers, CAN connectivity moderated the relationship between BPV and CSVD, whereby BPV effects on CSVD were greater in those with lower CAN connectivity (B= 36.43, P= .02). Conclusions: Older APOE4 carriers with higher beat-to-beat BPV exhibit more extensive CSVD, independent of average blood pressure, and the strength of CAN connectivity does not mediate these effects. Findings suggest increased BPV is more likely a cause, not a consequence, of CSVD. BPV is more strongly associated with CSVD in APOE4 carriers with lower rsCAN connectivity, suggesting CAN dysfunction and BPV elevation may have synergistic effects on CSVD. Further studies are warranted to understand the interplay between BPV and CAN function in APOE4 carriers.

8.
Front Aging Neurosci ; 14: 1006089, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36523957

RESUMO

In this review, the relationship between bioenergetics, mitochondrial dysfunction, and inflammation will be and how they contribute to neurodegeneration, specifically in Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS) will be reviewed. Long-term changes in mitochondrial function, autophagy dysfunction, and immune activation are commonalities shared across these age-related disorders. Genetic risk factors for these diseases support an autophagy-immune connection in the underlying pathophysiology. Critical areas of deeper evaluation in these bioenergetic processes may lead to potential therapeutics with efficacy across multiple neurodegenerative diseases.

9.
Neurology ; 99(3): e245-e257, 2022 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-35450967

RESUMO

BACKGROUND AND OBJECTIVES: To evaluate whether plasma biomarkers of amyloid (Aß42/Aß40), tau (p-tau181 and p-tau231), and neuroaxonal injury (neurofilament light chain [NfL]) detect brain amyloidosis consistently across racial groups. METHODS: Individuals enrolled in studies of memory and aging who self-identified as African American (AA) were matched 1:1 to self-identified non-Hispanic White (NHW) individuals by age, APOE ε4 carrier status, and cognitive status. Each participant underwent blood and CSF collection, and amyloid PET was performed in 103 participants (68%). Plasma Aß42/Aß40 was measured by a high-performance immunoprecipitation-mass spectrometry assay. Plasma p-tau181, p-tau231, and NfL were measured by Simoa immunoassays. CSF Aß42/Aß40 and amyloid PET status were used as primary and secondary reference standards of brain amyloidosis, respectively. RESULTS: There were 76 matched pairs of AA and NHW participants (n = 152 total). For both AA and NHW groups, the median age was 68.4 years, 42% were APOE ε4 carriers, and 91% were cognitively normal. AA were less likely than NHW participants to have brain amyloidosis by CSF Aß42/Aß40 (22% vs 43% positive; p = 0.003). The receiver operating characteristic area under the curve of CSF Aß42/Aß40 status with the plasma biomarkers was as follows: Aß42/Aß40, 0.86 (95% CI 0.79-0.92); p-tau181, 0.76 (0.68-0.84); p-tau231, 0.69 (0.60-0.78); and NfL, 0.64 (0.55-0.73). In models predicting CSF Aß42/Aß40 status with plasma Aß42/Aß40 that included covariates (age, sex, APOE ε4 carrier status, race, and cognitive status), race did not affect the probability of CSF Aß42/Aß40 positivity. In similar models based on plasma p-tau181, p-tau231, or NfL, AA participants had a lower probability of CSF Aß42/Aß40 positivity (odds ratio 0.31 [95% CI 0.13-0.73], 0.30 [0.13-0.71], and 0.27 [0.12-0.64], respectively). Models of amyloid PET status yielded similar findings. DISCUSSION: Models predicting brain amyloidosis using a high-performance plasma Aß42/Aß40 assay may provide an accurate and consistent measure of brain amyloidosis across AA and NHW groups, but models based on plasma p-tau181, p-tau231, and NfL may perform inconsistently and could result in disproportionate misdiagnosis of AA individuals.


Assuntos
Doença de Alzheimer , Amiloidose , Idoso , Doença de Alzheimer/diagnóstico , Amiloide , Peptídeos beta-Amiloides/metabolismo , Amiloidose/diagnóstico , Apolipoproteína E4 , Biomarcadores , Encéfalo/diagnóstico por imagem , Humanos , Filamentos Intermediários , Fragmentos de Peptídeos/metabolismo , Fosforilação , Proteínas tau
10.
Am J Hypertens ; 34(9): 895-909, 2021 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-33693474

RESUMO

Interventions targeting traditional barriers to antihypertensive medication adherence have been developed and evaluated, with evidence of modest improvements in adherence. Translation of these interventions into population-level improvements in adherence and clinical outcomes among older adults remains suboptimal. From the Cohort Study of Medication Adherence among Older adults (CoSMO), we evaluated traditional barriers to antihypertensive medication adherence among older adults with established hypertension (N = 1,544; mean age = 76.2 years, 59.5% women, 27.9% Black, 24.1% and 38.9% low adherence by proportion of days covered (i.e., PDC <0.80) and the 4-item Krousel-Wood Medication Adherence Scale (i.e., K-Wood-MAS-4 ≥1), respectively), finding that they explained 6.4% and 14.8% of variance in pharmacy refill and self-reported adherence, respectively. Persistent low adherence rates, coupled with low explanatory power of traditional barriers, suggest that other factors warrant attention. Prior research has investigated explicit attitudes toward medications as a driver of adherence; the roles of implicit attitudes and time preferences (e.g., immediate vs. delayed gratification) as mechanisms underlying adherence behavior are emerging. Similarly, while associations of individual-level social determinants of health (SDOH) and medication adherence are well reported, there is growing evidence about structural SDOH and specific pathways of effect. Building on published conceptual models and recent evidence, we propose an expanded conceptual framework that incorporates implicit attitudes, time preferences, and structural SDOH, as emerging determinants that may explain additional variation in objectively and subjectively measured adherence. This model provides guidance for design, implementation, and assessment of interventions targeting sustained improvement in implementation medication adherence and clinical outcomes among older women and men with hypertension.


Assuntos
Anti-Hipertensivos , Hipertensão , Adesão à Medicação , Idoso , Anti-Hipertensivos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Hipertensão/tratamento farmacológico , Masculino , Autorrelato
11.
J Subst Abuse Treat ; 110: 49-58, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31952628

RESUMO

BACKGROUND: Opioid use disorder (OUD) has become an increasingly consequential public health concern, especially in the United States where 47,600 opioid overdose deaths occurred in 2017 (Scholl, Seth, Kariisa, Wilson, & Baldwin, 2019). Medications for OUD (MOUD) are effective for decreasing opioid-related morbidity and mortality, including within the criminal justice system (Hedrich et al., 2012; Medications for Opioid Use Disorder Save Lives, 2019; Moore et al., 2019).While a stronger evidence base exists for agonist MOUD than for antagonist MOUD, a national study of drug courts found that half prohibited agonist MOUD (Matusow et al., 2013).Furthermore, recent media reports suggest that the pharmaceutical manufacturer of an antagonist MOUD has marketed its product towards drug court judges (Goodnough & Zernike, 2017; Harper, 2017). However, no study to date has systematically examined the relationship between MOUD marketing practices and drug courts. This ecological study examines the association at the county level between MOUD manufacturer payments to prescribers and drug court locations. METHOD: We extracted provider-directed payments from Centers for Medicare and Medicaid Services (CMS)'s Sunshine Act Open Payments data 2014-2017, isolating those records mentioning any MOUD. We compared provider-directed payments for two major MOUDs: buprenorphine and extended-release naltrexone, in counties with and without drug courts. RESULTS: The presence of any adult drug courts in the county is associated with a 7.86 percentage-point increase in the likelihood of providers in that county receiving any MOUD-related payments (about 22.46% of the sample mean, p<0.001) and with a 10.70% increase in the amount of these payments per 1000 county residents (p<0.001). The association between other forms of drug courts such as juvenile drug courts and Driving-Under-the-Influence courts (DUI) courts are less significant and slightly smaller in magnitude compared to those of adult drug courts. We did not find significant difference between payments by the manufacturer of Vivitrol and manufacturers of Zubsolv, Bunavail, and Suboxone (oral forms of buprenorphine). CONCLUSIONS: Our results show an ecological association at the county level between MOUD manufacturer payments to prescribers and drug court presence. However, we did not examine a causal association between these variables.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Adulto , Idoso , Combinação Buprenorfina e Naloxona , Humanos , Marketing , Medicare , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estados Unidos
12.
Environ Toxicol Chem ; 32(3): 517-25, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23233353

RESUMO

Contaminants used at low elevation, such as pesticides on crops, can be transported tens of kilometers and deposited in adjacent mountains in many parts of the world. Atmospherically deposited organic contaminants in the Sierra Nevada Mountains of California, USA, have exceeded some thresholds of concern, but the spatial and temporal distributions of contaminants in the mountains are not well known. The authors sampled shallow-water sediment and tadpoles (Pseudacris sierra) for pesticides, polycyclic aromatic hydrocarbons (PAHs), and polychlorinated biphenyls in four high-elevation sites in Yosemite National Park in the central Sierra Nevada twice during the summers of 2006, 2007, and 2008. Both historic- and current-use pesticides showed a striking pattern of lower concentrations in both sediment and tadpoles in Yosemite than was observed previously in Sequoia-Kings Canyon National Parks in the southern Sierra Nevada. By contrast, PAH concentrations in sediment were generally greater in Yosemite than in Sequoia-Kings Canyon. The authors suggest that pesticide concentrations tend to be greater in Sequoia-Kings Canyon because of a longer air flow path over agricultural lands for this park along with greater pesticide use near this park. Concentrations for DDT-related compounds in some sediment samples exceeded guidelines or critical thresholds in both parks. A general pattern of difference between Yosemite and Sequoia-Kings Canyon was not evident for total tadpole cholinesterase activity, an indicator of harmful exposure to organophosphorus and carbamate pesticides. Variability of chemical concentrations among sites, between sampling periods within each year, and among years, contributed significantly to total variation, although the relative contributions differed between sediment and tadpoles.


Assuntos
Atmosfera/química , Praguicidas/análise , Bifenilos Policlorados/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Poluentes Químicos da Água/análise , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/metabolismo , Poluição do Ar/estatística & dados numéricos , Altitude , Animais , Anuros/metabolismo , California , Monitoramento Ambiental , Água Doce/química , Larva/metabolismo , Praguicidas/metabolismo , Bifenilos Policlorados/metabolismo , Hidrocarbonetos Policíclicos Aromáticos/metabolismo , Análise Espaço-Temporal , Poluentes Químicos da Água/metabolismo
13.
J Pastoral Care Counsel ; 67(3-4): 3, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24720234

RESUMO

The group practice called "sacramental meditation" relies on sacred objects and spontaneous imagination to prepare its participants for spiritual experience. The meditation object is likened to an icon. The practice is compared with Loyola's "spiritual exercises" and the therapeutic technique of "active imagination'. Fowler's theory of faith development is used to show the forms of symbolic awareness that occur during a meditation. The theory, the method, and the effects of sacramental meditation are reviewed.


Assuntos
Processos Grupais , Meditação/métodos , Religião e Psicologia , Espiritualidade , Estresse Psicológico/prevenção & controle , Adaptação Psicológica , Humanos , Terapias Espirituais/métodos
14.
Arch Environ Contam Toxicol ; 62(1): 135-40, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21505867

RESUMO

Amphibians in alpine wetlands of the Sierra Nevada mountains comprise key components of an aquatic-terrestrial food chain, and mercury contamination is a concern because concentrations in fish from this region exceed thresholds of risk to piscivorous wildlife. Total mercury concentrations were measured in whole tadpoles of the Sierra chorus frog, Pseudacris sierra, two times at 27 sites from high elevations (2786-3375 m) in the southern Sierra Nevada. Median mercury concentrations were 14 ng/g wet weight (154 ng/g dry weight), which were generally low in comparison to tadpoles of 15 other species/location combinations from studies that represented both highly contaminated and minimally contaminated sites. Mercury concentrations in P. sierra were below concentrations known to be harmful in premetamorphic tadpoles of another species and below threshold concentrations for risk to predaceous wildlife. Concentrations in tadpoles were also lower than those observed in predaceous fish in the study region presumably because tadpoles in the present study were much younger (1-2 months) than fish in the other study (3-10 years), and tadpoles represent a lower trophic level than these fish. Mercury concentrations were not related to distance from the adjacent San Joaquin Valley, a source of agricultural and industrial pollutants.


Assuntos
Anuros , Monitoramento Ambiental , Larva/química , Mercúrio/análise , Poluentes Químicos da Água/análise , Poluição Química da Água/análise , Animais , California , Áreas Alagadas
15.
Environ Toxicol Chem ; 30(3): 682-91, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21298712

RESUMO

Atmospherically deposited pesticides from the intensively cultivated Central Valley of California, USA, have been implicated as a cause for population declines of several amphibian species, with the strongest evidence for the frogs Rana muscosa and Rana sierrae at high elevation in the Sierra Nevada mountains. Previous studies on these species have relied on correlations between frog population status and either a metric for amount of upwind pesticide use or limited measurements of pesticide concentrations in the field. The present study tested the hypothesis that pesticide concentrations are negatively correlated with frog population status (i.e., fraction of suitable water bodies occupied within 2 km of a site) by measuring pesticide concentrations in multiple media twice at 28 sites at high elevation in the southern Sierra Nevada. Media represented were air, sediment, and Pseudacris sierra tadpoles. Total cholinesterase (ChE), which has been used as an indicator for organophosphorus and carbamate pesticide exposure, was also measured in P. sierra tadpoles. Results do not support the pesticide-site occupancy hypothesis. Among 46 pesticide compounds analyzed, nine were detected with ≥ 30% frequency, representing both historically and currently used pesticides. In stepwise regressions with a chemical metric and linear distance from the Central Valley as predictor variables, no negative association was found between frog population status and the concentration of any pesticide or tadpole ChE activity level. By contrast, frog population status showed a strong positive relationship with linear distance from the Valley, a pattern that is consistent with a general west-to-east spread across central California of the amphibian disease chytridiomycosis observed by other researchers.


Assuntos
Poluentes Ambientais/análise , Praguicidas/análise , Ranidae , Animais , California , Exposição Ambiental/análise , Exposição Ambiental/estatística & dados numéricos , Monitoramento Ambiental , Poluição Ambiental/estatística & dados numéricos , Dinâmica Populacional
16.
Spine (Phila Pa 1976) ; 36(7): E492-7, 2011 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-21252827

RESUMO

STUDY DESIGN: Report of four collected cases. OBJECTIVE: The purpose of this report is to describe the presentation, diagnostic workup, treatment, and pathologic findings in four cases of lymphocytic reaction in patients receiving a metal-on-metal total disc replacement (TDR). SUMMARY OF BACKGROUND DATA: Metal-on-metal designs in hip arthroplasty have gained popularity because of decreased volumetric wear rates and theoretically increased implant longevity. Systemic metal ions produced have not been associated with adverse clinical sequelae, although there have been reports of local soft-tissue reactions leading to early prosthetic failure. Histologic evaluation in these cases suggested a cell-mediated delayed-type hypersensitivity reaction. Metal-on-metal bearings have also emerged in lumbar and cervical TDR. METHODS: This report is on four patients, from three centers, who underwent TDR, using a metal-on-metal implant, and later presented with symptoms that were determined to be due to lymphocytic reaction. Details of their symptoms, diagnostic work-up, treatment, and outcomes were compiled. RESULTS: All four patients initially had a good surgical outcome, followed by the onset and worsening of axial pain, and/or radicular symptoms months later. All patients had imaging findings of a mass lesion with neurologic impingement. All three of the lumbar patients underwent a decompressive posterior procedure before the eventual device removal and fusion. Intraoperatively, in all the lumbar cases, a thick, yellowish, avascular soft-tissue mass was found to be responsible for an epidural-mass effect on the thecal sac. In the cervical case, there was a gray-tinged soft-tissue response around the implant, suggestive of metallosis. Independent laboratory analysis confirmed a lymphocytic reaction to the implant. Three of the patients had a good outcome after the explant and revision surgery. The remaining patient continued to have residual symptoms related to the neural compression caused by the mass. CONCLUSIONS: In this group of patients from three centers, a metal-on-metal TDR resulted in a lymphocytic reaction causing subsequent failure of the surgery. This phenomenon has previously been recognized with metal bearings in hip arthroplasty. Surgeons using metal-on-metal TDRs should be aware of this possible occurrence.


Assuntos
Hipersensibilidade Imediata/imunologia , Disco Intervertebral/cirurgia , Linfócitos/imunologia , Complicações Pós-Operatórias/imunologia , Próteses e Implantes/efeitos adversos , Falha de Prótese/efeitos adversos , Adulto , Remoção de Dispositivo/métodos , Feminino , Humanos , Hipersensibilidade Imediata/patologia , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/imunologia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/imunologia , Deslocamento do Disco Intervertebral/cirurgia , Linfócitos/patologia , Masculino , Metais/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Próteses e Implantes/normas , Radiografia , Fatores de Tempo , Resultado do Tratamento
17.
Psychol Rep ; 109(2): 461-520, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22238853

RESUMO

This study is an 11-part investigation of the psychology and neuropsychology of early Christian asceticism as represented by Evagrius Ponticus (AD 345-399), the tradition's first ascetical theologian and possibly its mosfinfluential. Evagrius's biography is reviewed in the first section. The living circuinstaii and perceptual consequences of desert asceticism are considered in the second. Penitence, dispassion, and the mysticism of "pure prayer" are discussed in the third. Austerities are addressed in the fourth section, particularly fasting, prostrations, and prolonged standing. Ascetical perspectives on sleep, dreams, and the hypnogogic state are analyzed in the fifth. The depressive syndrome of acedia is discussed in the sixth. Evagrius's reports of auditory, olfactory, and visual hallucinations are analyzed in the seventh. Multiple complementary interpretations of demonic phenoniena are developed in the eighth section. Evagrius's psychotherapy for anger is reviewed in the ninth. Interpersonal relations among ascetics are considered in the tenth section. The study concludes with a summary.


Assuntos
Encéfalo/fisiologia , Cristianismo/história , Processos Mentais/fisiologia , Neuropsicologia/história , Psicologia/história , Religião e Medicina , Religião e Psicologia , Espiritualidade , Antigo Egito , História Antiga , Humanos , Turquia
18.
Environ Toxicol Chem ; 29(5): 1056-66, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20821540

RESUMO

Atmospherically deposited contaminants in the Sierra Nevada mountains of California, USA have been implicated as adversely affecting amphibians and fish, yet little is known about the distributions of contaminants within the mountains, particularly at high elevation. The hypothesis that contaminant concentrations in a high-elevation portion of the Sierra Nevada decrease with distance from the adjacent San Joaquin Valley was tested. Air, sediment, and tadpoles were sampled twice at 28 water bodies in 14 dispersed areas in Sequoia and Kings Canyon National Parks (2,785-3,375 m elevation; 43-82 km from Valley edge). Up to 15 chemicals were detected frequently in sediment and tadpoles, including current- and historic-use pesticides, polychlorinated biphenyls, and polycyclic aromatic hydrocarbons. Only beta-endosulfan was found frequently in air. Concentrations of all chemicals detected were very low, averaging in the parts-per-billion range or less in sediment and tadpoles, and on the order of 10 pg/m3 for beta-endosulfan in air. Principal components analysis indicated that chemical compositions were generally similar among sites, suggesting that chemical transport patterns were likewise similar among sites. In contrast, transport processes did not appear to strongly influence concentration differences among sites, because variation in concentrations among nearby sites was high relative to sites far from each other. Moreover, a general relationship for concentrations as a function of distance from the valley was not evident across chemical, medium, and time. Nevertheless, concentrations for some chemical/medium/time combinations showed significant negative relationships with metrics for distance from the Valley. However, the magnitude of these distance effects among high-elevation sites was small relative to differences found in other studies between the valley edge and the nearest high-elevation sites.


Assuntos
Poluentes Atmosféricos/química , Altitude , Poluentes Atmosféricos/metabolismo , Animais , Anuros/metabolismo , Atmosfera , California , Monitoramento Ambiental , Larva/metabolismo
19.
Environ Sci Technol ; 44(12): 4609-14, 2010 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-20496891

RESUMO

Agricultural pesticides are being transported by air large distances to remote mountain areas and have been implicated as a cause for recent population declines of several amphibian species in such locations. Largely unmeasured, however, are the magnitude and temporal variation of pesticide concentrations in these areas, and the relationship between pesticide use and pesticide appearance in the montane environment. We addressed these topics in the southern Sierra Nevada mountains, California, by sampling water weekly or monthly from four alpine lakes from mid-June to mid-October 2003. The lakes were 46-83 km from the nearest pesticide sources in the intensively cultivated San Joaquin Valley. Four of 41 target pesticide analytes were evaluated for temporal patterns: endosulfan, propargite, dacthal, and simazine. Concentrations were very low, approximately 1 ng/L or less, at all times. The temporal patterns in concentrations differed among the four pesticides, whereas the temporal pattern for each pesticide was similar among the four lakes. For the two pesticides applied abundantly in the San Joaquin Valley during the sampling period, endosulfan and propargite, temporal variation in concentrations corresponded strikingly with application rates in the Valley with lag times of 1-2 weeks. A finer-scale analysis suggests that a large fraction of these two pesticides reaching the lakes originated in localized upwind areas within the Valley.


Assuntos
Atmosfera/química , Ecossistema , Água Doce/química , Resíduos de Praguicidas/análise , California , Cicloexanos/análise , Endossulfano/análise , Geografia , Ácidos Ftálicos/análise , Simazina/análise , Propriedades de Superfície , Fatores de Tempo , Estados Unidos
20.
Talanta ; 81(4-5): 1380-6, 2010 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-20441911

RESUMO

An analytical method using solid phase extraction (SPE) and analysis by gas chromatography/mass spectrometry (GC-MS) was developed to determine trace levels of a variety of 41 agricultural pesticides and selected transformation products in high-elevation surface waters. Large-volume water sampling (up to 100L) was employed because it was anticipated that pesticide contamination, if present, would be at very low levels. The target compounds comprise pesticides (and selected oxygen transformation products) known to have been extensively used in agriculture in the San Joaquin Valley, CA, USA. Solid phase extraction using the polymeric resin Abselut Nexus was optimized to extract the pesticide analytes from water samples. A single determinative method using GC-MS with electron ionization was used for all the analytes. Recoveries from 100L of reagent water at 100pg/L and 1ng/L concentrations were generally greater than 75%, although dimethoate, disulfoton, and phorate were not recovered. Analysis of the extracts without cleanup yielded detection limits for the remaining 38 analytes between 0.1 and 30ng/L. A silica cleanup with separate analysis of 3 eluant fractions improved detection limits for 37 of the compounds to between 6 and 600pg/L in high-elevation surface waters.


Assuntos
Técnicas de Química Analítica , Resíduos de Praguicidas/análise , Praguicidas/análise , Extração em Fase Sólida/métodos , Purificação da Água/métodos , Água/química , Absorção , Agricultura/métodos , Dimetoato/análise , Dissulfóton/análise , Cromatografia Gasosa-Espectrometria de Massas/métodos , Resíduos de Praguicidas/isolamento & purificação , Praguicidas/isolamento & purificação , Forato/análise , Dióxido de Silício/química , Temperatura , Poluentes da Água/análise
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