RESUMO
AIMS: Lewy body diseases (LBD) are characterized by alpha-synuclein (SYN) pathology, but comorbid Alzheimer's disease (AD) pathology is common and the relationship between these pathologies in microanatomic hippocampal subfields is understudied. Here we use digital histological methods to test the association between hippocampal SYN pathology and the distribution of tau and amyloid-beta (Aß) pathology in LBD and contrast with AD subjects. We also correlate pathologic burden with antemortem episodic memory testing. METHODS: Hippocampal sections from 49 autopsy-confirmed LBD cases, 30 with no/low AD copathology (LBD - AD) and 19 with moderate/severe AD copathology (LBD + AD), and 30 AD patients were stained for SYN, tau, and Aß. Sections underwent digital histological analysis of subfield pathological burden which was correlated with antemortem memory testing. RESULTS: LBD - AD and LBD + AD had similar severity and distribution of SYN pathology (P > 0.05), CA2/3 being the most affected subfield (P < 0.02). In LBD, SYN correlated with tau across subfields (R = 0.49, P < 0.001). Tau burden was higher in AD than LBD + AD (P < 0.001), CA1/subiculum and entorhinal cortex (ERC) being most affected regions (P = 0.04 to <0.01). However, tau pathology in LBD - AD was greatest in CA2/3, which was equivalent to LBD + AD. Aß severity and distribution was similar between LBD + AD and AD. Total hippocampal tau and CA2/3 tau was inversely correlated with memory performance in LBD (R = -0.52, -0.69, P = 0.04, 0.009). CONCLUSIONS: Our findings suggest that tau burden in hippocampal subfields may map closely with the distribution of SYN pathology in subfield CA2/3 in LBD diverging from traditional AD and contribute to episodic memory dysfunction in LBD.
Assuntos
Doença de Alzheimer/patologia , Encéfalo/patologia , Hipocampo/patologia , Doença por Corpos de Lewy/patologia , Idoso , Idoso de 80 Anos ou mais , Peptídeos beta-Amiloides/metabolismo , Córtex Entorrinal/metabolismo , Feminino , Humanos , Masculino , Doença de Parkinson/patologia , alfa-Sinucleína/metabolismo , Proteínas tau/metabolismoRESUMO
BACKGROUND AND PURPOSE: Dementia in Parkinson's disease (PD) is common and disabling. Identification of modifiable risk factors for it is essential. Vascular risk factors (VRFs) may be associated with cognitive decline in early PD. Biomarkers that serve as surrogates of the long-term effect of VRFs on PD are needed. To that end, we aimed to quantitate white matter hyperintensities (WMH) in early PD, measure associations with VRFs and examine relationships between WMH and longitudinal cognition. METHODS: Participants in the Parkinson's Progression Markers Initiative study (141 patients with PD, 63 healthy controls) with adequate baseline structural brain magnetic resonance imaging data were included. Hypertension and diabetes history, and body mass index were combined to create a vascular risk score. WMH were quantitated via automated methods. Cognition was assessed annually with a comprehensive test battery. RESULTS: In the PD group, vascular risk score was associated with WMH for total brain (ß = 0.210; P = 0.021), total white matter (ß = 0.214; P = 0.013), frontal (ß = 0.220; P = 0.002) and temporal (ß = 0.212; P = 0.002) regions. Annual rate of change in global cognition was greater in those with higher vascular risk score (ß = -0.040; P = 0.007) and greater WMH (ß = -0.029; P = 0.049). Higher temporal WMH burden was associated with great decline over time in verbal memory (ß = -0.034; P = 0.031). CONCLUSIONS: In early PD, modifiable VRFs are associated with WMH on brain magnetic resonance imaging. Temporal WMH burden predicts decline in verbal memory. WMH may serve as a surrogate marker for the effect of VRFs on cognitive abilities in PD.
Assuntos
Encéfalo/patologia , Transtornos Cognitivos/etiologia , Cognição/fisiologia , Disfunção Cognitiva/etiologia , Leucoencefalopatias/etiologia , Doença de Parkinson/complicações , Substância Branca/patologia , Idoso , Transtornos Cognitivos/patologia , Transtornos Cognitivos/psicologia , Disfunção Cognitiva/patologia , Disfunção Cognitiva/psicologia , Progressão da Doença , Feminino , Humanos , Leucoencefalopatias/patologia , Leucoencefalopatias/psicologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Doença de Parkinson/patologia , Doença de Parkinson/psicologia , Fatores de RiscoRESUMO
BACKGROUND: Little is known about the heterogeneous etiology of suspected non-Alzheimer's pathophysiology (SNAP), a group of subjects with neurodegeneration in the absence of ß-amyloid. Using antemortem MRI and pathological data, we investigated the etiology of SNAP and the association of neurodegenerative pathologies with structural medial temporal lobe (MTL) measures in ß-amyloid-negative subjects. METHODS: Subjects with antemortem MRI and autopsy data were selected from ADNI (n=63) and the University of Pennsylvania (n=156). Pathological diagnoses and semi-quantitative scores of MTL tau, neuritic plaques, α-synuclein, and TDP-43 pathology and MTL structural MRI measures from antemortem T1-weighted MRI scans were obtained. ß-amyloid status (A+/A-) was determined by CERAD score and neurodegeneration status (N+/N-) by hippocampal volume. RESULTS: SNAP reflects a heterogeneous group of pathological diagnoses. In ADNI, SNAP (A-N+) had significantly more neuropathological diagnoses than A+N+. In the A- group, tau pathology was associated with hippocampal, entorhinal cortex, and Brodmann area 35 volume/thickness and TDP-43 pathology with hippocampal volume. CONCLUSION: SNAP had a heterogeneous profile with more mixed pathologies than A+N+. Moreover, a role for TDP-43 and tau pathology in driving MTL neurodegeneration in the absence of ß-amyloid was supported.
Assuntos
Doença de Alzheimer , Proteínas tau , Doença de Alzheimer/diagnóstico por imagem , Peptídeos beta-Amiloides/metabolismo , Córtex Entorrinal/metabolismo , Hipocampo/diagnóstico por imagem , Hipocampo/metabolismo , Humanos , Imageamento por Ressonância Magnética , Lobo Temporal/metabolismo , Proteínas tau/metabolismoRESUMO
Diverse photoperiodic responses were shown by three populations of Xanthium strumarium L. originating between 22 degrees and 25 degrees N on the western coast near Culiacán, Sinaloa; in the Chihuahuan Desert near Matehuala, San Luis Potos; and on the Gulf Coast near Ciudad Mante, Tamaulipas, respectively. A combination of differences in critical night length and in ripeness-to-flower response (maturity) appears to be the basis for reproductive adaptation of these populations to different climatic regimes that prevail at the same latitude (and photoperiodic regime).
RESUMO
North American populations of cocklebur Xanthium strumarium L. are diverse in form and show critical dark periods ranging from 7.75 to 10.75 hours (critical photoperiods of 13.25 to 16.25 hours). South American cockleburs also are diverse in form and response. American cockleburs are adapted to diverse ecosystems, which suggests that they are indigenous. In contrast, the widespread Australian populations known as Noogoora Burr are all of the chinense morphological complex and respond uniformly to photoperiod. Plants from southern Louisiana and Australia are nearly identical in external form and in critical dark period of 10.5 hours. Probably the Australian Noogoora Burr and the Indian monsoon form arrived in their present countries after 1800 as contaminants in cottonseed from the Mississippi Delta region.
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A hereditary, non-inflammatory myopathy occurring in young great Danes with distinctive histological features in muscle biopsy specimens is reviewed. Onset of clinical signs is usually before one year of age and both sexes are affected. Clinical signs are characterised by exercise intolerance, muscle wasting, and an exercise-induced tremor. Although most affected dogs have a severe form of the disease, occasional dogs may have a less pronounced form and survive into adulthood with an acceptable quality of life. Litters containing affected puppies are born to clinically unaffected parents, and an autosomal recessive pattern of inheritance is likely. All recorded cases have had fawn or brindle coat coloration. Elevated serum creatinine kinase concentrations and spontaneous electrical activity in skeletal muscles are frequently found. While originally reported (Targett and others 1994) as a central core myopathy in this breed, the histochemical characteristics of the distinct cytoarchitectural structures differ from those of the well-characterised central core myopathy in human beings. In fact, these structures differ from any known myopathy in human beings and likely represents a unique non-inflammatory myopathy affecting dogs. Until this myopathy is characterised further, the name inherited myopathy in great Danes is suggested.
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Doenças do Cão/genética , Doenças Musculares/veterinária , Animais , Animais Recém-Nascidos , Doenças do Cão/epidemiologia , Doenças do Cão/patologia , Cães , Feminino , Genes Recessivos , Predisposição Genética para Doença , Masculino , Músculo Esquelético/patologia , Doenças Musculares/epidemiologia , Doenças Musculares/genética , Doenças Musculares/patologiaRESUMO
Our objectives were to measure plasma concentrations of glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and peptide YY (PYY) in client-owned newly diagnosed diabetic cats and nondiabetic lean or overweight cats and to determine whether circulating concentrations of these hormones differed between study groups and if they increased postprandially as seen in other species. A total of 31 cats were recruited and placed into 1 of 3 study groups: lean (body condition score 4-5 on a scale of 1-9; n = 10), overweight (body condition score 6-8; n = 11), or diabetic (n = 10). Diabetics were newly diagnosed and had not had prior insulin therapy. Preprandial (fasting) and postprandial (60 min after meal) plasma hormone and glucose concentrations were measured at baseline and 2 and 4 wk. All cats were exclusively fed a commercially available high-protein and low-carbohydrate diet commonly prescribed to feline diabetic patients for 2 wk before the 2-wk assessment and continued through the 4-wk assessment. Results showed that plasma concentrations of GLP-1, GIP, PYY, and insulin increased in general after a meal in all study groups. Plasma PYY concentrations did not differ (P > 0.10) between study groups. Diabetics had greater plasma concentrations of GLP-1 and GIP compared with the other study groups at baseline (P < 0.05), and greater preprandial and postprandial GLP-1 concentrations than lean cats at 2 and 4 wk (P < 0.05). Preprandial plasma GIP concentrations were greater in diabetics than obese and lean (P < 0.05) cats at week 4. Postprandial plasma GIP concentrations in diabetics were greater than lean (P < 0.05) at week 2 and obese and lean cats (P < 0.05) at week 4. Together, our findings suggest that diabetic status is an important determinant of circulating concentrations of GLP-1 and GIP, but not PYY, in cats. The role of GLP-1, GIP, and PYY in the pathophysiology of feline obesity and diabetes remains to be determined.
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Doenças do Gato/sangue , Diabetes Mellitus/veterinária , Polipeptídeo Inibidor Gástrico/sangue , Peptídeo 1 Semelhante ao Glucagon/sangue , Insulina/sangue , Peptídeo YY/sangue , Animais , Gatos , Diabetes Mellitus/sangue , Jejum , Obesidade/sangue , Obesidade/veterinária , Sobrepeso/sangue , Sobrepeso/veterinária , Período Pós-PrandialRESUMO
Recordings of distortion product otoacoustic emissions (DPOAE) were taken from 28 geriatric dogs aged 12.2 ± 2.2 years and 15 control dogs aged 5.9 ± 3.0 years (mean ± standard deviation) to demonstrate frequency-specific changes in cochlear responses. Recordings were performed for primary frequencies of 2-12 kHz in 2 kHz increments. Brainstem auditory evoked response (BAER) recordings were also made from geriatric dogs for comparison with DPOAE responses. Significant decreases in DPOAE response amplitudes were observed at frequencies of 6-12 kHz in geriatric dogs compared to control dogs, reflecting loss of cochlear outer hair cells along the length of the cochlea. Significant decreases in response amplitudes were not seen at frequencies of 2 or 4 kHz. Decreases in BAER response amplitudes subjectively paralleled the depressed DPOAE amplitudes. No significant linear regression relationships were found for DPOAE response amplitude vs. age despite the progressive nature of age-related hearing loss. The reductions in response at all frequencies starting at the age where dogs are considered geriatric indicate that age-related hearing loss begins earlier in the life span. DPOAE recordings provide a means to assess cochlear function across different portions of the auditory spectrum for assessing hearing loss associated with aging, and potentially for losses from other causes of decreased auditory function.
Assuntos
Envelhecimento , Doenças do Cão/fisiopatologia , Perda Auditiva/veterinária , Emissões Otoacústicas Espontâneas , Animais , Limiar Auditivo , Doenças do Cão/etiologia , Cães , Potenciais Evocados Auditivos do Tronco Encefálico , Feminino , Perda Auditiva/etiologia , Perda Auditiva/fisiopatologia , MasculinoRESUMO
The response to a highly purified concentrate of porcine factor VIII was evaluated in 45 bleeding episodes in 38 patients with high responding inhibitor antibodies to factor VIII. A total of 437 infusions were given. The patients came from 25 hemophilia centers in the United States. The majority had a life- or limb-threatening hemorrhage for which other modalities had not been successful. In 32 of 45 episodes, a good to excellent response was obtained. Adverse reactions were minimal, occurring in 17 treatment episodes, and were mostly treated with antihistamines and/or hydrocortisone. No clear predictor of clinical response to porcine factor VIII concentrate was identified, including pretreatment human and porcine inhibitor levels, percentage of cross-reactivity between the human and porcine antibodies, and the presence of measurable levels of factor VIII after the porcine factor concentrate was given. Anamnesis to porcine factor VIII did occur in some instances. Porcine factor VIII is a valuable modality in the treatment of serious hemorrhages in patients with inhibitors to factor VIII. Its use should be considered early in the course of severe hemorrhage in these patients.
Assuntos
Anticorpos/análise , Fator VIII/uso terapêutico , Hemofilia A/terapia , Hemorragia/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Fator VIII/efeitos adversos , Fator VIII/imunologia , Hemofilia A/imunologia , Hemorragia/imunologia , Humanos , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Estados UnidosRESUMO
BACKGROUND: In the paediatric population careful attention needs to be made concerning techniques utilised for wound assessment to minimise discomfort and stress to the child. AIM: To investigate whether 3D photography is a valid measure of burn wound area in children compared to the current clinical gold standard method of digital planimetry using Visitrak™. METHOD: Twenty-five children presenting to the Stuart Pegg Paediatric Burn Centre for burn dressing change following acute burn injury were included in the study. Burn wound area measurement was undertaken using both digital planimetry (Visitrak™ system) and 3D camera analysis. Inter-rater reliability of the 3D camera software was determined by three investigators independently assessing the burn wound area. RESULTS: A comparison of wound area was assessed using intraclass correlation co-efficients (ICC) which demonstrated excellent agreement 0.994 (CI 0.986, 0.997). Inter-rater reliability measured using ICC 0.989 (95% CI 0.979, 0.995) demonstrated excellent inter-rater reliability. Time taken to map the wound was significantly quicker using the camera at bedside compared to Visitrak™ 14.68 (7.00)s versus 36.84 (23.51)s (p<0.001). In contrast, analysing wound area was significantly quicker using the Visitrak™ tablet compared to Dermapix(®) software for the 3D Images 31.36 (19.67)s versus 179.48 (56.86)s (p<0.001). CONCLUSION: This study demonstrates that images taken with the 3D LifeViz™ camera and assessed with Dermapix(®) software is a reliable method for wound area assessment in the acute paediatric burn setting.
Assuntos
Superfície Corporal , Queimaduras/diagnóstico , Imageamento Tridimensional/métodos , Fotografação/métodos , Queimaduras/patologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , SoftwareRESUMO
GH is an important regulator of fat metabolism at rest, but it is not known whether it regulates fat metabolism during exercise. To determine whether physiologic concentrations of GH influence fat metabolism during exercise, we randomized 16 GH-deficient adults, receiving long-term (mean duration, 5 yr) GH replacement, to either continue GH (n = 8) or receive identical placebo (n = 8) for a 3-month period. Metabolic studies, at rest, during and following exhaustive exercise were carried out at baseline and at the end of the 3 months. The rate of appearance of glycerol (glycerol Ra, an index of lipolysis) and free fatty acids (FFA, FFA Ra) and the rate of disappearance of FFA (FFA Rd) in the plasma were measured using infusions of (2)H(5)-glycerol and 1-(13)C-palmitic acid. Changes in body composition were assessed using dual-energy x-ray absorptiometry scanning and anthropometric measurements. In the baseline studies, exercise resulted in an increase in plasma glycerol and FFA concentrations, glycerol Ra, FFA Ra, and FFA Rd (P < 0.001). Three months of GH withdrawal resulted in reductions in plasma glycerol and FFA, glycerol Ra, FFA Ra, and FFA Rd at rest (P < 0.05 vs. baseline) and during exercise (P < 0.05 vs. baseline and vs. GH treated). Lean body mass decreased after 3 months of GH withdrawal, but total body fat, trunk fat, waist circumference, and the sum of skinfold thicknesses increased after 3 months of GH withdrawal (P < 0.05 vs. baseline and vs. GH treated). Fasting insulin and homeostasis model assessment of insulin resistance decreased after 3 months of GH withdrawal (P < 0.05 vs. baseline and vs. GH treated). In summary, GH withdrawal for 3 months resulted in reductions in release of glycerol and FFA into the circulation and uptake of FFA into the tissues during intense exercise. These changes were accompanied by reduced lean body mass and increased total body and trunk fat. Further studies are required to determine whether reduced mobilization of fat during exercise contributes to reduced exercise capacity and increased body fat in GH-deficient adults.
Assuntos
Exercício Físico/fisiologia , Ácidos Graxos não Esterificados/sangue , Glicerol/sangue , Hormônio do Crescimento Humano/administração & dosagem , Hormônio do Crescimento Humano/deficiência , Absorciometria de Fóton , Tecido Adiposo , Adulto , Aerobiose , Idoso , Composição Corporal , Constituição Corporal , Isótopos de Carbono , Deutério , Método Duplo-Cego , Jejum , Feminino , Homeostase , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Insulina/sangue , Resistência à Insulina , Fator de Crescimento Insulin-Like I/análise , Cinética , Lipólise , Masculino , Pessoa de Meia-Idade , Placebos , Dobras CutâneasRESUMO
Highly purified factor IX, produced by a monoclonal antibody immunoaffinity technique, contains a high concentration of factor IX with negligible amounts of other vitamin K-dependent coagulation factors. When infused in patients with hemophilia B, monoclonal factor IX concentrate yielded a mean half-life of 34.6 +/- 13.1 (+/- SD) hours and in vivo recovery of 0.67 +/- 0.14 U/dL rise per each U/kg of factor IX infused. Unlike prothrombin complex concentrate (PCC) infusion, monoclonal IX infusion was not associated with rises in factors II, VII, and X, but achieved in vivo recovery and half-life at least comparable to PCC. Long-term use of monoclonal IX as a home-care product provided excellent response in the control of bleeding episodes and was equivalent to previous patient experience with PCC. The results indicate that monoclonal IX concentrate raises factor IX levels effectively, while avoiding extraneous thrombogenic components.
Assuntos
Fator IX/uso terapêutico , Hemofilia B/tratamento farmacológico , Adulto , Anticorpos Monoclonais , Fatores de Coagulação Sanguínea/farmacologia , Fatores de Coagulação Sanguínea/uso terapêutico , Fator IX/efeitos adversos , Fator IX/farmacocinética , Fator VII/metabolismo , Fator X/metabolismo , Meia-Vida , Humanos , Masculino , Protrombina/metabolismoRESUMO
A survey of 11 hemophilia centers produced data concerning 28 females with extremely low levels of factor VIII or IX coagulant activity. Ten of the 28 have hemophilia A, six have hemophilia B, and 12 have severe von Willebrand's disease. The 16 females who have severe factor VIII or factor IX deficiency as an isolated defect exemplify several of the possible genetic explanations for the occurrence of hemophilia in females. All 16 bruise excessively, and several have had recurrent hemarthroses. Three of these girls, ages five, 10 and 23 years, have evidence of chronic hemophilic arthropathy. The 12 females with severe von Willebrand's disease are either homozygous for von Willebrand's disease or severely affected heterozygotes. All 12 have mucous membrane bleeding. In addition, five of the 12 have recurrent hemarthroses and three have evidence of chronic joint disease. However, the major problem in the adult females with von Willebrand's disease has been extreme menorrhagia. One of the seven adults underwent irradiation sterilization and another had a hysterectomy because of menorrhagia. The others have been managed with anovulatory drugs or plasma infusions and EACA. Despite menorrhagia, five pregnancies and deliveries have been uneventful in three of these women.
Assuntos
Hemofilia A/epidemiologia , Hemofilia B/epidemiologia , Doenças de von Willebrand/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Hemofilia A/diagnóstico , Hemofilia B/diagnóstico , Humanos , Pessoa de Meia-Idade , Doenças de von Willebrand/diagnósticoRESUMO
Bleeding episodes in patients with hemophilia A with anti-factor VII antibodies are frequently difficult to treat. Factor VIII concentrates administered by continuous infusion or prothrombin complex concentrates (PCC) have been used for treatment. Hemophilia A patients with inhibitors who respond to factor VIII concentrates generally have low to moderate inhibitor titers (generally less than 20 Bethesda units). Those patients who receive PCC are quite difficult to evaluate but promising clinical responses have clearly been observed. This paper describes our experience with both modalities of therapy and will offer specific guidelines for such therapy.
Assuntos
Anticorpos , Fator VIII/imunologia , Hemofilia A/terapia , Protrombina/uso terapêutico , Adulto , Anticorpos/análise , Criança , Pré-Escolar , Fator VIII/antagonistas & inibidores , Fator VIII/uso terapêutico , Glicina , Hemofilia A/imunologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To determine whether subjects with insomnia report greater reductions in quality of life (QoL) than subjects without insomnia when assessed with self-report instruments. METHODS: Questionnaires were completed by individuals recruited through media advertisements and screened with a structured telephone interview. Data obtained from 261 individuals with insomnia (INS group) were compared with those of 101 individuals with no sleep complaint, or controls (CTL group). RESULTS: Subjects in the INS group obtained lower mean sum scores on the Medical Outcomes Study Cognitive Scale than did subjects in the CTL group (25.34 +/- 0.34 vs 31.91 +/- 0.58, t = 9.53, p < 0.0001). The INS group also obtained lower mean scores on all subscales of the SF-36 Questionnaire compared with those in the CTL group (each, p < 0.0001 or lower), indicating impairments across multiple QoL domains. Psychiatric assessment revealed that subjects in the INS group obtained significantly higher mean item scores than subjects in the control group on the Zung Depression Scale (2.22 +/- 0.03 vs. 1.52 +/- 0.03, p < 0.0001) and the Zung Anxiety Scale (1.96 +/- 0.02 vs. 1.40 +/- 0.04, p < 0.0001). In addition, subjects in the INS group reported significantly greater impairments in specific QoL domains on the QoL inventory, and the Work and Daily Activities Inventory. No differences were observed between subjects in the INS group who were receiving treatment for insomnia versus those who were untreated. CONCLUSIONS: The results of this study indicate that significant QoL impairments are associated with insomnia.
Assuntos
Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono/psicologia , Atividades Cotidianas , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia , Inquéritos e QuestionáriosRESUMO
Fifteen anesthetized mechanically ventilated patients recovering from multiple trauma were studied to compare the effects of high-frequency jet ventilation (HFJV) and continuous positive-pressure ventilation (CPPV) on arterial baroreflex regulation of heart rate. Systolic arterial pressure and right atrial pressure were measured using indwelling catheters. Electrocardiogram (ECG) and mean airway pressure were continuously monitored. Lung volumes were measured using two linear differential transformers mounted on thoracic and abdominal belts. Baroreflex testing was performed by sequential intravenous bolus injections of phenylephrine (200 micrograms) and nitroglycerin (200 micrograms) to raise or lower systolic arterial pressure by 20-30 Torr. Baroreflex regulation of heart rate was expressed as the slope of the regression line between R-R interval of the ECG and systolic arterial pressure. In each mode of ventilation the ventilatory settings were chosen to control mean airway pressure and arterial PCO2 (PaCO2). In HFJV a tidal volume of 159 +/- 61 ml was administered at a frequency of 320 +/- 104 breaths/min, whereas in CPPV a tidal volume of 702 +/- 201 ml was administered at a frequency of 13 +/- 2 breaths/min. Control values of systolic arterial pressure, R-R interval, mean pulmonary volume above apneic functional residual capacity, end-expiratory pulmonary volume, right atrial pressure, mean airway pressure, PaCO2, pH, PaO2, and temperature before injection of phenylephrine or nitroglycerin were comparable in HFJV and CPPV. Baroreflex regulation of heart rate after nitroglycerin injection was significantly higher in HFJV (4.1 +/- 2.8 ms/Torr) than in CPPV (1.96 +/- 1.23 ms/Torr).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Frequência Cardíaca , Ventilação em Jatos de Alta Frequência , Pressorreceptores/fisiologia , Adolescente , Adulto , Gasometria , Pressão Sanguínea , Eletrocardiografia , Desenho de Equipamento , Feminino , Ventilação em Jatos de Alta Frequência/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva , Volume de Ventilação PulmonarRESUMO
Our research objective was to calculate and forecast the monthly increase in medical and prescription costs for Medicaid patients with acquired immunodeficiency syndrome (AIDS) and compare these values with costs for non-AIDS patients. A retrospective analysis of AIDS patients and a control group of Georgia Medicaid beneficiaries was conducted between January 1, 1988, and December 31, 1991. AIDS patients were defined using the Keyes algorithm of combinations of International Classification of Diseases, 9th Revision, Clinical Modification codes. The AIDS patient group was matched demographically to a group of non-AIDS patients. Data were adjusted to account for eligibility status, and the ratio of AIDS costs to non-AIDS costs was modeled with an econometric time series procedure. A total of 1966 AIDS patients were identified from 900,000 Medicaid recipients in the study period; 58.0% were male and 59.8% were black. Age was bimodal at < or = 1 year and 33 years. The best fit for the medical cost ratios produced a significant regression coefficient of .37. The initial ratio of AIDS to non-AIDS forecast was 4.25 in January 1992. The January 2000 forecast of this ratio increased to 42.56. This increase equates to an additional $8510.19 per AIDS patient-month for January 2000 in 1991 dollars. The outpatient prescription ratio for AIDS versus non-AIDS patients was not predictable. However, the greatest observed discrepancies were attributed to the expense for antihemophilia products. Overall, the most important finding was the accelerating medical costs for treating AIDS patients compared with costs for treating non-AIDS patients. These results may, in part, reflect additional costs for treating intravenous drug users and pediatric AIDS patients.
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Síndrome da Imunodeficiência Adquirida/economia , Efeitos Psicossociais da Doença , Honorários Farmacêuticos/tendências , Previsões , Medicaid/economia , Síndrome da Imunodeficiência Adquirida/terapia , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estados UnidosRESUMO
The US population is multiethnic in composition: many languages thrive, and Spanish is the second most frequently spoken language. The Hispanic population is one of the fastest growing ethnic groups in the United States. The majority of Hispanics speak Spanish at home (63%), and a significant proportion speak little or no English (25%). The purpose of this study was to translate the American Urological Association (AUA) symptom index into Spanish and to validate the final translation. To translate the AUA symptom index, a combination of four methods was used: forward- and back-translation, evaluation of the translated version by a committee, testing of the translated index with healthy bilingual subjects, and correlation of the scores of bilingual patients with benign prostatic hyperplasia (BPH) who were administered both the AUA symptom index and the Maine Medical Assessment Program (MMAP) symptom index. One-way analysis of variance was used to compare the scores of healthy bilinguals, and no significant differences were found between the English and Spanish versions. Multivariate analysis of variance revealed that none of the seven questions showed statistical differences between the Spanish and English versions. This provided further evidence that the questions were translated properly into Spanish and that they can be used to measure the same concepts as the English questions. After both indexes (AUA and MMAP) were administered to bilingual patients with BPH, the study found that the correlation between the Spanish version of the AUA symptom index and the MMAP was 0.85. This is further evidence that the Spanish version of the AUA symptom index is accurate and can be used to measure the symptoms of BPH as well as the English counterpart.
Assuntos
Doenças Urológicas/diagnóstico , Análise de Variância , Hispânico ou Latino , Humanos , Idioma , Inquéritos e Questionários , Terminologia como Assunto , Estados UnidosRESUMO
The estimates of migraine headache prevalence vary widely and fluctuate with the population examined and the methodologic factors used in studies examining this condition. As an alternative to survey techniques, a retrospective review of Medicaid claims data from 22 continuous months (January 1, 1989, to October 31, 1990) was used to detect medical episodes and physician-initiated pharmacologic therapy indicative of migraine headache. Specifically, the objectives of this study were to measure the prevalence of migraine headache in Georgia Medicaid recipients, estimate the prevalence in the US population, and describe the relationships between migraine and sociodemographic variables including sex, age, race, and rural versus urban residence. Logistic regression was used to isolate the independent effects of age, race, residence, and length of Medicaid eligibility on the presence or absence of migraine. The data consisted of adjudicated claims for 847,453 Georgia Medicaid recipients. Medicaid profiles for 678,079 recipients (468,448 female and 209,631 male) aged older than 4 years were analyzed as persons at risk of migraine. Migraine was identified in 6518 (1.39%) females and 991 (0.47%) males. Adjusting for eligibility, age, and race, the projected 22-month period prevalence for the United States was estimated as 3.83% (females) and 1.33% (males). Females, whites, and individuals residing in rural counties were more likely to suffer from migraine headache than their respective comparison groups. For both sexes, the peak prevalence was in the fourth and fifth decades of life. Migraine headache in the United States is estimated to afflict 4.5 million females and 1.4 million males. This prevalence is lower than previously reported and indicates that migraine headache may not be as common as previously believed. An alternative explanation is that many Medicaid recipients self-treat the condition, thus circumventing physician care and subsequent diagnosis and treatment.
Assuntos
Transtornos de Enxaqueca/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Georgia/epidemiologia , Humanos , Masculino , Medicaid , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/tratamento farmacológico , Grupos Raciais , Análise de Regressão , Estudos Retrospectivos , Risco , População Rural , Fatores Sexuais , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/epidemiologia , Estados Unidos , População UrbanaRESUMO
Ten phenolic compounds were examined for their effect on mung bean (Phaseolus aureus L.) hypocotyl growth and on respiration and coupling parameters of isolated mung bean hypocotyl mitochondria. Three compounds-tannic, gentisic, and p-coumaric acids-inhibited hypocotyl growth and when incubated with isolated hypocotyl mitochondria released respiratory control, inhibited respiration, and prevented substrate-supported Ca2+ and PO4 transport. Vanillic acid also inhibited hypocotyl growth and reduced mitochondrial Ca2+ uptake but did not affect respiration or respiratory control of isolated mitochondria. This is the first compound reported to selectively inhibit Ca2+ uptake in plant mitochondria. Two other phenolic compounds-α, 3,5-resorcylic and protocatechuic acids-showed no significant effect on hypocotyl growth and did not affect mitochondrial oxidative phosphorylation either separately or in various combinations. Four phenolic compounds-ferulic, caffeic, p-hydroxybenzoic, and syringic acids-showed a significant reduction in mung bean hypocotyl growth but did not inhibit any of the mitochondrial processes examined. The results show that phenolic compounds which alter respiration or coupling responses in isolated mitochondria also inhibit hypocotyl growth and may reflect a mechanism of action for these natural growth inhibitors.