Analysis of speech-based measures for detecting and monitoring Alzheimer's disease.

Automatic diagnosis of the Alzheimer's disease as well as monitoring of the diagnosed patients can make significant economic impact on societies. We investigated an automatic diagnosis approach through the use of speech based features. As opposed to standard tests, spontaneous conversations are carried and recorded with the subjects. Speech features could discriminate between healthy people and the patients with high reliability. Although the patients were in later stages of Alzheimer's disease, results indicate the potential of speech-based automated solutions for Alzheimer's disease diagnosis. Moreover, the data collection process employed here can be done inexpensively by call center agents in a real-life application. Thus, the investigated techniques hold the potential to significantly reduce the financial burden on governments and Alzheimer's patients.

The interrelationship between insulin secretion and action in type 2 diabetes mellitus with different degrees of obesity: evidence supporting central obesity.

This paper investigates the relative role of the impairment of insulin secretion and action in the pathogenesis of Type 2 diabetes mellitus (T2DM). The parameters indicating insulin secretion and action were calculated from the data obtained during oral glucose tolerance test (OGTT), in 156 age- and sex-matched T2DM patients divided in 4 groups according to their body mass index (BMI, I = 20.0-24.9, II = 25.0-29.9, III = 30.0-39.9 and IV > 40.0 kg/m2). After obtaining baseline biomedical parameters (plasma glucose, serum insulin, cholesterol, HDL-cholesterol, triglycerides, BMI, and amount of fat tissue), the rates of insulin secretory capacity and insulin action were obtained from OGTT and compared between the T2DM patients with normal body weight and different grades of obesity. Beta-cell secretory capacity of the participants was found to be proportionally and significantly higher in graded obese than that of the normal body weight patients. The rates of hepatic as well as peripheral insulin resistance in obese groups proportionally and significantly rise in comparison with that of non-obese diabetics. In addition, these parameters are shown to be related to the body fat, presumably visceral in origin. In conclusion, hyperglycemia-hyperinsulinemia observed in obese and T2DM patients might be due, in part, to increased capacity of insulin secretion, and to exaggerated hepatic glucose production because of hepatic insulin resistance, respectively.

Association of lipoprotein(a) concentration and apo(a) isoform size with restenosis after percutaneous transluminal coronary angioplasty.

Lp(a) is a unique class of lipoprotein particles that exhibits a considerable size heterogeneity resulting from the size polymorphism of apo(a), its unique protein component. An elevated level of Lp(a) in plasma has been proposed to be a risk factor for premature development of coronary artery disease. To evaluate the relationship between Lp(a) concentration and apo(a) isoform size with restenosis after percutaneous transluminal coronary angioplasty, Lp(a) levels and apo(a) phenotypes were determined in 204 patients who underwent a successful coronary angioplasty procedure and stent implantation. The patients were followed with clinical examinations and exercise tests at 1, 3, and 6 months, and a control coronary angiography was performed after 6 months to evaluate restenosis. Lp(a) levels were determined with an ELISA that is insensitive to the size heterogeneity of Lp(a), and the apo(a) isoforms were determined by a high-resolution agarose gel electrophoresis method followed by immunoblotting with a specific monoclonal antibody. Of the 146 patients who underwent angiographic evaluation, 57 (39%) had restenosis, whereas 89 (61%) did not. Lp(a) levels and the distribution of the expressed apo(a) phenotypes were compared in these two groups of patients. Although the mean and median Lp(a) levels were higher in the restenosed group, the difference was not statistically significant. However, a significant difference in Lp(a) values was found in women (P=0.043), even though, because of the small number of women in the study (n=35), no sound conclusions can be reached on the predictive role of Lp(a) in restenosis. There also was no difference in the distribution of apo(a) phenotypes between the two groups. Because of their wide distribution, Lp(a) values and apo(a) isoforms do not seem to be a useful indicator of risk of restenosis after percutaneous transluminal coronary angioplasty in our study cohort.

The use of the 5-HT3-receptor antagonist ondansetron for the treatment of postcardiotomy delirium.

OBJECTIVE: To evaluate the effect of the 5-HT3-receptor antagonist ondansetron in patients with postcardiotomy delirium. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Thirty-five patients who had undergone coronary artery bypass graft surgery. INTERVENTIONS: Thirty-five patients, 23 men and 12 women, who developed delirium in the intensive care unit after coronary artery bypass graft surgery were included. Mean patient age was 51.3 years (range, 36 to 79 years). A mental status scoring scale was developed, and patients were scored 0 to 4 according to their delirium status after confirming that there were no correctable metabolic abnormalities as an underlying cause for delirium. Normal behavior was scored as 0, and severe verbal and physical agitation was scored as 4. Patients received a single dose of ondansetron, 8 mg, intravenously and were reevaluated 10 minutes later. MEASUREMENTS AND MAIN RESULTS: Before the treatment, 7 patients had a score of 2 (20%); 10 patients (28.6%), 3; and 18 patients (51.4%), 4. After the treatment, 28 patients (80%) dropped their score to 0; 6 patients (17.1%) dropped to a score of 1, and 1 patient (2.9%) remained at a score of 4. The mean score dropped from 3.20 + 1.01 to 0.29 + 0.75 after treatment. Wilcoxon signed ranks test was used for statistical evaluation, and the fall in delirium score after ondansetron treatment was found to be statistically significant (p < 0.001). CONCLUSIONS: The use of ondansetron was effective and safe and without important side effects. This positive effect of the 5-HT3-receptor antagonist ondansetron led to speculation that impaired serotonin metabolism may play a role in postcardiotomy delirium.

Transaortic coronary patchplasty for isolated main left coronary ostial stenosis: a report of five cases.

The incidence of isolated ostial stenosis of the left main coronary artery varies between 0.13% and 2.7%. We performed surgical ostial angioplasty in five patients who had isolated left coronary ostial stenosis. One patient had low systemic blood pressure and, after the procedure, manifested myocardial ischaemia: conventional aortocoronary bypass was performed. The outcome of the four others was uneventful. They remained free of symptoms and resumed normal activities. Transaortic patch angioplasty might be useful operative method for the isolated coronary ostial stenosis, since it restores a more physiologic perfusion of the coronary arteries.

Long-term prognosis after a first myocardial infarction in Turkey: determinants of mortality and reinfarction.

Long-term prognosis of a first myocardial infarction and factors associated with late cardiac mortality and reinfarction were studied in 718 survivors. Patients have been followed up for 1-10 years (mean 57.6 +/- 39.6 months). None of the patients underwent coronary bypass surgery in the follow-up period. Cumulative mortality rates were 8.6% in the first year, 17.9% in 3 years, 26.4% in 5 years and 36.5% in 10 years. The type and site of myocardial infarction (Q-wave versus non-Q-wave and anterior versus infero-posterior) were found to have no independent prognostic importance. The cardiac mortality was best predicted by the occurrence of congestive heart failure in the coronary care unit. Other determinants of late outcome were the presence of ventricular arrhythmias, left bundle branch block, and the occurrence of stable or unstable angina pectoris or reinfarction during the follow-up period. Usage of antiplatelet or anticoagulant drugs was not found to affect mortality. Reinfarction rates were 4, 9.9, 15.5 and 28% in 1, 3, 5 and 10 years, respectively, and no relation was found between the type and location of myocardial infarction and reinfarction rate. Reinfarction was higher in patients receiving anticoagulants and in patients with postmyocardial infarction angina. Our findings suggest that the prognosis of patients with a first acute myocardial infarction in Turkey is not different from that in Western populations and factors influencing prognosis are similar to those previously reported.

A case of ventricular tachycardia refractory to medical treatment related to a cystic mass in left ventricle--a case report.

This is a case report of a twenty-two-year-old woman who had attacks of ventricular tachycardia that could be prevented by the use of various antiarrhythmic drugs for three months. Electrophysiologic study showed that the mechanism of the tachycardia was "reentry." In cardiac catheterization a non-contractile mass having calcification was seen on the apical portion of the left ventricle. Angiographically, the mass resembled a diverticulum. Recurrence of attacks was terminated by resection of this mass, which had a cystic appearance.

Suppression of atherogenesis by n-3 fatty acids in the cholesterol-fed rabbit.

The effects of n-3 fatty-acid supplementation on serum lipids, platelet aggregation, and the development of atherosclerotic lesions were studied in the cholesterol-fed rabbit. Serum total cholesterol and LDL cholesterol values were significantly reduced in comparison with those of the nonsupplemented cholesterol-fed group (p less than 0.005, p less than 0.0025, respectively), though still higher than those of the control group (p less than 0.0025, p less than 0.0125 respectively). Platelet aggregation was reduced below that of the cholesterol-fed and the control levels (p less than 0.0005, p less than 0.0025, respectively). The endothelial injury encountered in cholesterol-fed rabbits was inhibited in the supplemented group. It is concluded that n-3 fatty acids suppress atherogenesis in this animal model by interfering with platelet aggregation and lipid metabolism.

Combined internal mammary artery graft for coronary artery revascularization.

Five patients with multiple-vessel coronary artery disease underwent isolated coronary artery bypass grafting with a technique involving both internal mammary arteries and a small piece of interposed saphenous vein. The combined internal mammary artery grafts were used for sequential grafting. A total of 20 anastomoses were performed (average number, 4 anastomoses per patient). There were no operative deaths. Postoperative complications included reoperation for bleeding in 1 patient and diaphragmatic dysfunction in another. Postoperative coronary angiography 2 days before discharge (mean time, 10 days postoperatively) revealed that all the sequential anastomoses with the combined IMA graft were patent. Exercise tolerance tests performed 3 and 11 months postoperatively indicated excellent results and no ischemia. Based on this experience, we conclude that this method appears promising for multivessel coronary artery bypass grafting.

Sustained-release verapamil as a first-step drug in the treatment of mild to moderate hypertension.

The efficacy of sustained-release verapamil as a first-stage treatment for mild to moderate, uncomplicated essential hypertension was studied. Nineteen patients aged 36-70 years (mean +/- SD 55 +/- 10 years) entered the study. Treatment with 240 mg sustained-release verapamil, once daily for 8 weeks, caused systolic and diastolic blood pressures to decline significantly during the first 2 weeks and this lower level was maintained until week 8. Heart rate decreased gradually during the treatment period reaching significance at week 8. After 2 weeks maximum systolic and diastolic blood pressures during isometric exercise were significantly reduced compared with pre-treatment values; there was no difference in the percentage increase occurring pre- and post-treatment. These measures for heart rate did not change significantly. Except for a significant reduction in cardiac index after 8 weeks left ventricular function and left ventricular mass were unchanged. The 24-h urinary Na+ excretion increased significantly after 2 and 8 weeks' treatment. Plasma renin activity, serum lipid concentrations and routine blood chemistries were not affected. Side-effects were transient and did not require discontinuation of therapy. In conclusion, sustained-release verapamil is an efficacious and well tolerated first-stage drug in the treatment of essential hypertension.

Acute and sustained antianginal effects of nitroglycerin patches: objective evaluation with training-effect-eliminated exercise performance index.

A randomized within-patient double-blind acute and sustained study was performed to compare transdermal nitroglycerin (NTG) patches (5 and 10 mg) and matching placebo in 10 patients with chronic stable angina pectoris confirmed on exercise thallium scintigraphy or coronary angiography, or both. Patients performed treadmill tests 2 and 24 hours after application of patches on the first and last days of each of the 3 treatment periods. Effects caused by sequence of treatments and training with serial testing were prominent so the changes in the well-known parameters did not favor either of the active doses over placebo. Quantification of training effects and its subtraction from performance index disclosed that 10 mg of transdermal NTG caused significant increase in performance in both the acute and sustained stages of therapy in comparison to pretreatment performance. This was not observed with 5 mg and placebo treatments. To our knowledge, this is the first trial to study the efficacy of transdermal NTG with a more objective parameter that permitted elimination of training effects of serial exercise testing.

Erythrocyte and plasma lipid peroxides in chronic alcoholic patients.

Erythrocytes from alcoholics without liver cirrhosis and control subjects were examined for the susceptibility to lipid peroxidation. Erythrocytes of patients were found to be sensitive to H2O2-induced peroxidation as compared to controls. In addition, chronic alcoholics showed a high level of plasma lipid peroxide levels. These results suggest the stimulation of lipid peroxidation in chronic alcoholics.

Alternating sinus rhythm and intermittent sinoatrial block induced by propranolol.

Alternating sinus rhythm and intermittent sinoatrial (S-A) block was observed in a 57-year-old woman, under treatment for angina with 80 mg propranolol daily. The electrocardiogram showed alternation of long and short P-P intervals and occasional pauses. These pauses were always preceded by the short P-P intervals and were usually followed by one or two P-P intervals of 0.92-0.95 s representing the basic sinus cycle. Following these basic sinus cycles, alternating rhythm started with the longer P-P interval. The long P-P intervals ranged between 1.04-1.12 s and the short P-P intervals between 0.80-0.84 s, respectively. The duration of the pauses were equal or almost equal to one short plus one long P-P interval or to twice the basic sinus cycle. In one recording a short period of regular sinus rhythm with intermittent 2/1 S-A block was observed. This short period of sinus rhythm was interrupted by sudden prolongation of the P-P interval starting the alternative rhythm. There were small changes in the shape of the P waves and P-R intervals. S-A conduction through two pathways, the first with 2/1 block the second having 0.12-0.14 s longer conduction time and with occasional 2/1 block was proposed for the explanation of the alternating P-P interval and other electrocardiographic features seen. Atropine 1 mg given intravenously resulted in shortening of all P-P intervals without changing the rhythm. The abnormal rhythm disappeared with the withdrawal of propranolol and when the drug was restarted a 2/1 S-A block was seen. This was accepted as evidence for propranolol being the cause of this conduction disorder.