Arts activity and well-being for visually impaired military veterans: a narrative discussion of current knowledge.

OBJECTIVES: The objective of this study was to offer an overview of literature relating to the topic of arts as activity within the context of military and veteran health and to consider the implications of current knowledge on future research with visually impaired veterans. STUDY DESIGN: A search for literature addressing the topic of visual art activities with visually impaired veterans was undertaken. No research addressing this topic was identified. A review of literature on the related topics of mental health and well-being in military veterans, visual impairment and mental health and well-being, and art therapy for veteran populations was carried out to offer an overview of current knowledge. RESULTS: While there is growing evidence of the benefits of arts engagement among both general and military populations, the role of the visual arts in the everyday lives of broader veteran samples, and the impact of these activities on holistic well-being, remains underexplored. The current article highlights the need for art as activity to be differentiated from art as therapy and argues that the former might offer a tool to positively impact the holistic well-being of visually impaired veterans. CONCLUSIONS: Future research relating to the use of visual art activities in the context of veteran health and well-being should endeavour to explore the potential impacts of engagement on holistic well-being. Research is needed to build on anecdotal evidence of the positive impact of arts engagement on visually impaired veterans by systematically exploring if, and how, holistic well-being in this population may be impacted by engagement with visual art activities.

Platelet-Rich Plasma Improves Strength and Speed of Recovery in an Active-Duty Soldier with Isolated Injury to the Lateral Collateral Ligament of the Knee: A Case Report.

Ligamentous injuries of the knee occur in the military, but constitute an overwhelmingly disproportionate number of medical discharges, which can be due to prolonged recovery through traditional use of physical therapy (PT) and other non-operative modalities. The use of platelet-rich plasma (PRP) may substantially increase the speed of recovery and patient outcomes but is little explored for less common isolated ligamentous injuries, such as the lateral collateral ligament, especially in active-duty populations. We describe the use of PRP in a young, otherwise healthy active-duty male to treat an isolated LCL injury with significant positive outcomes. These findings support consideration for early use of PRP in similar cases to improve recovery timelines and aid in return to duty.

Expression of apolipoprotein E by cultured vascular smooth muscle cells is controlled by growth state.

Rat vascular smooth muscle cells (SMC) in culture synthesize and secrete a approximately 38,000-Mr protein doublet or triplet that, as previously described (Majack and Bornstein. 1984. J. Cell Biol. 99:1688-1695), rapidly and reversibly accumulates in the SMC culture medium upon addition of heparin. In the present study, we show that this approximately 38,000-Mr heparin-regulated protein is electrophoretically and immunologically identical to apolipoprotein E (apo-E), a major plasma apolipoprotein involved in cholesterol transport. In addition, we show that expression of apo-E by cultured SMC varies according to growth state: while proliferating SMC produced little apo-E and expressed low levels of apo-E mRNA, quiescent SMC produced significantly more apo-E (relative to other proteins) and expressed markedly increased levels of apo-E mRNA. Northern analysis of RNA extracted from aortic tissue revealed that fully differentiated, quiescent SMC contain significant quantities of apo-E mRNA. These data establish aortic SMC as a vascular source for apo-E and suggest new functional roles for this apolipoprotein, possibly unrelated to traditional concepts of lipid metabolism.

Comparison of the lipid and apolipoprotein composition of skeletal muscle and peripheral lymph in control dogs and in dogs fed a high fat, high cholesterol, hypothyroid-inducing diet.

Most studies of peripheral interstitial fluid lipoprotein composition have been made on interstitial fluid-derived from skin and connective tissue. We developed techniques which allowed simultaneous comparison of lymph (a model of interstitial fluid) from skeletal muscle and skin in control (C) and cholesterol-fed (CF) dogs. Lipoprotein fractions were separated by ultracentrifugation. Skeletal muscle interstitial fluid HDL concentrations were approximately twice those of skin. However, the concentration of VLDL-LDL particles was similar in both interstitial spaces. HDL particles from both microvascular beds showed evidence of extensive remodelling when compared to plasma HDL from the same animal. Relative to apo A-I, skeletal muscle HDL was enriched in free cholesterol and apo E (C and CF dogs) and apo A-IV (CF dogs). Skin-derived HDL was consistently enriched in free cholesterol, apo E and A-IV in both C and CF dogs. These studies indicate that similar remodeling of plasma HDL occurs in widely different tissues which together constitute approximately 70% of the total interstitial space. The relatively high concentration of plasma-derived and remodeled HDL within the interstitial space of skeletal muscle is consistent with that tissue's importance in reverse cholesterol transport.

Apo A-I metabolism in cynomolgus monkeys: male-female differences.

Female cynomolgus monkeys have significantly higher plasma apo A-I concentrations than males (P = 0.04) and are able to maintain higher levels than the males even after consuming a high-cholesterol diet that severely depresses the apo A-I concentration in primates (P less than 0.05). The mechanism responsible for this difference was investigated by comparing apo A-I turnover (synthesis and catabolism) in males and females consuming monkey chow and in a separate group of males and females that had consumed the high-cholesterol diet for several weeks. The average length of time an apo A-I molecule remained in the plasma compartment of chow-fed monkeys was 2.62 days but decreased to 1.52 days (P less than 0.01) in animals fed the HC diet. There were no male-female differences in the residence times. The absolute turnover rate (mg/day) of apo A-I was not statistically affected by diet or sex; however, the females were substantially smaller than the males (3.8 vs. 4.8 kg; P less than 0.01) and their plasma volumes were significantly smaller than those of the males, even after correction for differences in body wt. (32.6 vs. 37.0 ml/kg, respectively; P less than 0.01). Taken together, the data indicate that females cynomolgus monkeys have higher apo A-I synthesis rates than males of comparable plasma volume (P = 0.03), which we would propose accounts for the higher plasma apo A-I concentrations evident in females.

Apo B metabolism in the cynomolgus monkey: evidence for post-transcriptional regulation.

Previous studies have shown that hepatic apo B mRNA levels do not increase in animals fed high cholesterol diets, even though plasma apo B concentrations increase markedly. As a result, it has been suggested that the diet-induced increase in plasma apo B levels was due solely to an inhibited clearance of those lipoproteins. The present study was undertaken to test that hypothesis. Hepatic apo B mRNA levels were measured in liver biopsies taken from five male cynomolgus monkeys before and twice after, they began to consume a high cholesterol diet. The diet had no effect on hepatic apo B mRNA levels, even though it caused a 7-fold increase in the plasma apo B levels. However, measurements of the apo B secretion rate in eight separate monkeys (four chow-fed and four cholesterol-fed) by isotope dilution showed that apo B secretion by the liver was increased 4-fold in the cholesterol-fed monkeys. These data, taken together, indicate that apo B secretion is not regulated by the rate at which the apo B gene is transcribed, but at some point further along in the secretion pathway.

Sudden death in the late hospital phase of acute myocardial infarction.

Forty-seven patients died suddenly during the late hospital phase of acute myocardial infarction. Risk factors associated with late in-hospital sudden death included prior cardiovascular disease, circulatory failure while in the coronary care unit, and certain arrhythmias and conduction disturbances while in the coronary care unit. These were associated with a twofold to sixfold increase in late in-hospital phase sudden death. The most prevalent risk factor occured in 62% of the sudden-death patients; the highest incidence of sudden death with a single risk factor was 2.6%, and the greatest relative risk was 6.0. Relative risks were uniformly greater for males than females. Multiple factors were associated with a greater risk than single factors. These risk factors characterize the group of sudden-death patients as a whole but do not allow precise identification of individual patients at high risk.

Effects of withdrawing diuretic therapy on blood pressure in mild hypertension.

A 1-year double-blind placebo-controlled study on the effects of diuretic withdrawal was conducted on a group of 62 previously well-controlled, mildly hypertensive patients. Data were collected on blood pressure (BP), biochemical laboratory values, and subjective reports of side-effects. Twenty-six percent of placebo subjects and 3% of the active treatment subjects reached preset criteria for the return of hypertension (reverters). The average systolic and diastolic pressures of all placebo-treated patients who did not revert showed statistically significant increases. BP control was quickly reestablished in reverters by restarting diuretic therapy. No substantial differences in side-effects were reported between the groups, and laboratory changes were those consistent with known metabolic effects of thiazide and thiazide-like diuretics. This study showed a much lower reversion rate after treatment withdrawal than previously reported by other investigators. It also showed significant increases in BP of placebo patients who did not revert. Long-term diuretic therapy retains its effectiveness in responsive mild hypertensive patients, potentially offering protection against the increased risks of mortality and morbidity associated with even slight elevations of BP. Withdrawal of diuretics cannot be recommended for patients with mild hypertension without use of other equally effective interventions to maintain optimum BP control.

The primary structure of cynomolgus monkey apolipoprotein A-1 deduced from the cDNA sequence: comparison to the human sequence.

We have cloned and analyzed a cDNA containing the complete coding sequence for cynomolgus monkey apolipoprotein A-1 (apoA-1). This cDNA clone was found to share approx. 97% nucleotide sequence identity with the published human apoA-1 and encodes a protein of the same size as the human protein. Paired proline residues are present at positions 3 and 4 in the mature protein as has been reported for other primate species and the propeptide sequence is identical to the human propeptide. The amino acid content derived from the nucleotide sequence predicts a more basic protein than human apoA-1 and this was confirmed by isoelectric focusing analysis. In addition, we present evidence for two different transcriptional initiation sites for the cynomolgus monkey gene in contrast to only one for human.

Lipoproteins and apolipoproteins in peripheral lymph of normal and cholesterol-fed dogs.

Prenodal peripheral lymph was used as a model of interstitial fluid to obtain information on the composition of lipoproteins and apolipoproteins which are in direct contact with peripheral cells. Lipoproteins resembling plasma lipoproteins in size and electrophoretic mobility were present in the prenodal peripheral lymph of control as well as cholesterol-fed dogs. Most of the lipoproteins in control dogs were high density lipoproteins, both in the plasma and in the lymph. Cholesterol feeding resulted in an increased concentration of lipoprotein particles with decreased electrophoretic mobility (beta-VLDL and, in plasma, HDLc) and decreased concentration of HDL, both in plasma and in lymph. Size distribution of lipoproteins was also markedly altered by cholesterol feeding; most of the lipoproteins were present as IDL and VLDL both in plasma and in lymph. Judged by agarose gel chromatography, the size of the lymph HDL as consistently larger than plasma HDL in both groups of dogs. Furthermore, it appears that cholesterol feeding increased the size of an HDL subfraction, partially resolved by agarose chromatography, both in lymph and plasma. All apolipoproteins present in plasma were also present in lymph. Cholesterol feeding resulted in 3-10-fold increases in plasma apo B, E, and A-IV while apo A-I was drastically decreased. These changes were reflected in lymph to different degrees depending on the size of the lipoprotein fraction containing the individual apolipoproteins. Our findings provide direct evidence that the large, cholesterol-rich, 'atherogenic' lipoproteins found in the plasma of cholesterol-fed dogs (beta-VLDL) are also present in the interstitial fluid and presumably interact with peripheral cells. Our studies furthermore suggest modification of plasma HDL by peripheral cells and/or de novo assembly of an HDL subfraction. The utilization of this animal model may thus provide a direct approach to the study of the interaction of lipoproteins with peripheral cells.

The effect of population density on the development of experimental atherosclerosis in female mice.

The effect of cage population density on plasma lipids and the development of atherosclerosis was examined in female C57BL/6 mice. Mice were housed at a density of one, two or five animals per cage and fed an atherogenic diet for 28 weeks. Subsequently, the animals were bled, sacrificed, the hearts removed and the extent of fatty lesion development in the aorta examined and quantified. As the population density increased, there was a statistically significant increase in total cholesterol levels, VLDL+LDL cholesterol levels, the VLDL+LDL/HDL ratio and lesion severity. These differences are due to the psychosocial stress associated with living within a confined space with high population density over an extended period of time.

Long-term systemic arterial blood pressure control with nicardipine.

Nicardipine was administered orally for up to 1 year to 250 patients with essential hypertension. Phase I, a 2- to 4-week placebo washout to establish baseline supine diastolic blood pressure (BP), was followed by 4 weeks of open-label nicardipine dose titration (phase II) to establish optimal dosage on a 3-times-daily regimen for each patient. After nicardipine administration, approximately 79% of the patients had supine diastolic BP less than 90 mm Hg or greater than or equal to 10 mm Hg below baseline. The reduction in systolic and diastolic BPs was somewhat greater in patients older than 60 years. After phase III--an 8-week double-blind comparison of dosage regimens of 2- and 3-times-daily--all patients returned to a 3-times-daily regimen at their optimal daily dosage for 40 weeks of open treatment (phase IV). Supplemental treatment with a diuretic or a beta blocker was required by 67 patients. By the end of phase IV, more than 100 patients had completed 1 year of nicardipine monotherapy (mean supine diastolic BP = 85 mm Hg, approximately 14 mm Hg below baseline). Finally, patients were randomly assigned to continue nicardipine on a double-blind basis or take a matching placebo for 6 weeks (phase V, n = 101). The nicardipine group had only a slight change in supine diastolic BP, whereas those receiving placebo had statistically significant increases in supine diastolic BP toward baseline values. Adverse experiences, attributed to the vasodilatory effects of nicardipine, tended to occur in the first few months of the study and resulted in early withdrawal of 30 patients. Overall, these results show that nicardipine is a well-tolerated antihypertensive agent with efficacy sustained during 1 year of treatment.

Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function.

To define normal criteria of size and dynamics of the inferior vena cava (IVC) and its clinical value in assessing right-sided cardiac function, 2-dimensional (2-D) and M-mode echocardiography (echo) were performed in 175 subjects, who were classified into 3 groups: group 1-80 normal subjects; group IIA--65 patients with documented right-sided cardiac disease, and group IIB--30 patients with cardiac disease but no right-sided abnormality. The IVC was adequately imaged in 175 of 185 subjects (95%). There was good correlation between M-mode and 2-D echo (r = 0.84) and long- and short-axis (r = 0.88) measurements. The IVC diameter during expiration was: group 1-9 to 28 mm (mean 18.2 +/- 4.6); group IIA--15 to 40 mm (mean 23.1 +/- 4.8) and group IIB-8-24 mm (mean 15.6 +/- 3.7). Collapsibility index (inspiratory decrease in diameter) was: group I-37 to 100% (mean 55.8 +/- 15.9); group IIA--0 to 39% (mean 13.5 +/- 10.5); and group IIB--44 to 100% (mean 60.4 +/- 13.1). A and V waves could be measured in 120 of 151 cases (79%). Both A and V waves were less than 125% of its diameter in group I. The A wave was absent in 34 patients; 30 (88%) were in atrial fibrillation. Among 8 patients with tricuspid regurgitation, 5 (63%) had V waves greater than 125%. There was no correlation between diameter or collapsibility index and age, sex, rhythm or body surface area.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of hypertension on myocardial rupture after acute myocardial infarction.

Fifty-three of 4,369 patients with acute myocardial infarction died of myocardial rupture. The incidence of rupture varied directly, among men, with the systolic blood pressure on admission to the coronary care unit (CCU), and the highest systolic pressure while in the CCU. Rupture occurred in 0.3% of the men with systolic pressures on admission to the CCU between 110-129 mm Hg, increasing to 2.0% of men with pressures between 170-189 mm Hg. Similarly, 0.3% of the men with a highest systolic pressure less than 150 mm Hg had a rupture, while 1.6% of those with pressures between 170-189 mm Hg ruptured. Diastolic blood pressure, past history of hypertension, and sustained hypertension after infarction were not related to the occurrence of rupture. Eighteen of the 53 patients who sustained rupture had systolic hypertension (greater than or equal to 150 mm Hg) sometime during the 24 hours before rupture, and 14 had diastolic hypertension (greater than or equal to 95 mm Hg). Hypertension appears to be one of several variables interacting to influence the occurrence of myocardial rupture.

Grouping and detection of group B streptococci by immunofluorescence.

Forty-nine clinical isolates of group B streptococci (GBS) were correctly grouped from broth culture by the Fluoro-Kit immunofluorescence test. A further 82 beta-haemolytic streptococci of groups A, C, D, F, and G were tested and gave no cross-reactions. The test was simple to perform and gave clear results. The Fluoro-Kit reagents, however, failed to detect GBS in 21 (51%) of 41 smears of rectal or vaginal swabs from pregnant women from which GBS were subsequently grown. Thirty-two (20%) of 159 culture-negative swabs gave positive immunofluorescent reactions.

Successful modification of medical students' cardiovascular risk factors.

Modifying identified risk factors for cardiovascular disease should change an individual's risk. Educational interventions might change behavior to modify some risk factors. To evaluate this possibility, we evaluated the health and fitness status of freshman medical students at the University of Utah (n = 89) in 1983 and determined their cardiovascular risk factors. During a preventive cardiology course later that year, students received their results. We reevaluated the students during their senior year using the same method. For both years, we obtained complete data on 77 (87%) of the eligible students. As freshmen 83% of these students had at least one modifiable risk factor, compared with 62% with a risk as seniors. The number of reevaluated students with low levels of high-density lipoprotein cholesterol, low estimations of aerobic capacity, or both, decreased significantly (P = .009 and P = .0008, respectively). The preventive cardiology educational intervention may have changed behavior and improved cardiovascular risk factors.

Risk factors for cardiovascular disease in U.S. medical students: the Preventive Cardiology Academic Award Collaborative Data Project.

Risk factors for cardiovascular disease are commonly obtained in freshman medical students for the purpose of increasing interest and awareness in preventive cardiology. What would be a normal range of values for this select group? This paper describes the major cardiovascular risk factors for 3,811 male and female freshman medical students from eight U.S. medical schools that were obtained in a standardized fashion as part of the Preventive Cardiology Academic Award (PCAA) programs at these institutions. The distributions of height, weight, Quetelet index, systolic and diastolic blood pressures, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and calculated low-density lipoprotein cholesterol are presented for male and female medical students stratified by race into white, black, Asian, and Hispanic groups. The sex and race distributions of cardiovascular risk factors such as previously diagnosed hypertension, diabetes mellitus, smoking, lack of regular exercise (three times a week or more), oral contraceptive use in women, and family history of coronary heart disease are presented. The cardiovascular risk of freshman medical students is compared to other epidemiologic studies of young adults. The use and limitations of these race- and sex-specific data on cardiovascular risk, including physiologic measurements, are discussed in the context of educational programs for medical students and house staff in preventive cardiology.

Method for measuring the activities of cholesteryl ester transfer protein (lipid transfer protein).

A continuous recording fluorescence assay was developed for cholesteryl ester transfer protein (CETP). The assay measures the increase in fluorescence accompanying the relocation of fluorescent lipids, cholesteryl esters and triglycerides, from a donor emulsion to an acceptor emulsion. In the absence of CETP, the quantum yields of the fluorescent lipids is low because their high concentrations in the donor emulsions result in self-quenching. CETP catalyzes the redistribution of the fluorescent lipids from the donor to the acceptor emulsions and fluorescence increases substantially. Efficient sonication and incorporation of apolipoproteins from human HDL into the emulsions significantly increased the transfer rates. Under optimal conditions, the redistribution of fluorescent compounds reaches equilibrium within < 30 min and the kinetics of this process are consistent with a simple, first-order reaction pathway. The redistribution kinetics support a mechanism of adsorption --> exchange --> desorption --> diffusion.

Urinary tract evaluation of diethylstilbestrol-exposed female progeny followed in a colposcopy clinic.

Structural abnormalities of the upper genital tract in diethylstilbestrol-exposed (DES-exposed) female progeny have been noted. Since upper genital tract anomalies are often associated with upper urinary tract anomalies, intravenous pyelography was obtained in 102 DES-exposed patients at our institution to determine the incidence of upper urinary tract anomalies. Only two patients had duplication of the ureter. Since this incidence is not greater than that expected in an unexposed population, intravenous pyelogram studies are not routinely recommended for DES-exposed patients.

Chronic peripheral lymphatic cannulation in the dog.

Peripheral lymph collected acutely has been commonly sampled as representative of non-visceral interstitial fluid. By developing a prenodal lymphatic-lymphatic (L-L) shunt, we were able to collect peripheral lymph for 3-5 days in unanesthetized dogs. The L-L shunt was constructed entirely of medical grade silicone rubber tubing designed with a slip of coupling which allowed the shunt to be disconnected for lymph collection and reconnected at night. Average peripheral lymph flow (4.9 ml/hr leg) in unanesthetized dogs was almost twice the flow rate previously observed in anesthetized dogs. The average lymph/plasma total protein concentration ratio (0.16), however, was similar to that previously found in anesthetized dogs. Lymph protein concentration fell with the collection during the day and became more concentrated at night. Lymph flow did not change greatly during daytime collection. Average peripheral lymph collection volume was greater than 200 ml/dog. The L-L shunt allows collection of prenodal-lymph in experiments where unanesthetized dogs are required (e.g., feeding studies). They also are useful when multiple protocols are conducted on the same dog or when large volumes of peripheral lymph are required.