RESUMEN
OBJECTIVE: Bisphosphonate treatment does not increase bone mineral density (BMD) in all subjects particularly at the femoral neck (FN). Our aim was to evaluate the relationship between response to oral bisphosphonate (oBP) at the FN and change in BMD following discontinuation. METHODS: Data were collected retrospectively from postmenopausal women on oBP for ≥3 years, attending a real-world metabolic clinic at initiation of oBP, discontinuation, and 1 to 2 years post discontinuation. Improvement in BMD ≥4% in the FN and ≥5% for the lumbar spine (LS) were deemed clinically meaningful and used as least significant change (LSC) values. We divided subjects based on FN BMD response and compared outcomes between responders and non-responders after oBP discontinuation. RESULTS: Of the 213 subjects, 32.1% showed an increase ≥LSC at the FN compared to 57.1% at the LS on treatment (P < .0001). FN responders had lower BMD levels at pretreatment baseline than non-responders both at the FN (0.58 vs 0.62 g/cm2; P = .003) and LS (0.76 vs 0.79 g/cm2; P = .044). Off-treatment, more subjects lost BMD ≥LSC at FN in the responder group than in the non-responder group (37.5% vs 14.2%; P < .001). BMD remained above pre-treatment levels in responders after a median follow-up of 1.52 years. CONCLUSION: BMD response at FN is suboptimal in patients on oBP and is much less common than LS response. FN responders tend to lose the accumulated bone quickly off-treatment, though BMD remains above pretreatment levels. These observations suggest that new approaches may be needed to optimize osteoporosis management in real-world patients.
Asunto(s)
Conservadores de la Densidad Ósea , Osteoporosis Posmenopáusica , Humanos , Femenino , Densidad Ósea , Difosfonatos/uso terapéutico , Estudios Retrospectivos , Conservadores de la Densidad Ósea/uso terapéutico , Huesos , Vértebras Lumbares/diagnóstico por imagen , Osteoporosis Posmenopáusica/tratamiento farmacológicoRESUMEN
Aberrations in spinal glycinergic signaling are a feature of pain chronification. Normalizing these changes by inhibiting glycine transporter (GlyT)-2 is a promising treatment strategy. However, existing GlyT2 inhibitors (e.g., ORG25543) are limited by narrow therapeutic windows and severe dose-limiting side effects, such as convulsions, and are therefore poor candidates for clinical development. Here, intraperitoneally administered oleoyl-D-lysine, a lipid-based GlyT2 inhibitor, was characterized in mouse models of acute (hot plate), inflammatory (complete Freund's adjuvant), and chronic neuropathic (chronic constriction injury) pain. Side effects were also assessed on a numerical rating score, convulsions score, for motor incoordination (rotarod), and for respiratory depression (whole body plethysmography). Oleoyl-D-lysine produced near complete antiallodynia for chronic neuropathic pain, but no antiallodynia/analgesia in inflammatory or acute pain. No side effects were seen at the peak analgesic dose, 30 mg/kg. Mild side effects were observed at the highest dose, 100 mg/kg, on the numerical rating score, but no convulsions. These results contrasted markedly with ORG25543, which reached less than 50% reduction in allodynia score only at the lethal/near-lethal dose of 50 mg/kg. At this dose, ORG25543 caused maximal side effects on the numerical rating score and severe convulsions. Oleoyl-D-lysine (30 mg/kg) did not cause any respiratory depression, a problematic side effect of opiates. These results show the safe and effective reversal of neuropathic pain in mice by oleoyl-D-lysine and provide evidence for a distinct role of glycine in chronic pain over acute or short-term pain conditions. SIGNIFICANCE STATEMENT: Partially inhibiting glycine transporter (GlyT)-2 can alleviate chronic pain by restoring lost glycinergic function. Novel lipid-based GlyT2 inhibitor ol-D-lys is safe and effective in alleviating neuropathic pain, but not inflammatory or acute pain. Clinical application of GlyT2 inhibitors may be better suited to chronic neuropathic pain over other pain aetiologies.
Asunto(s)
Dolor Agudo , Dolor Crónico , Neuralgia , Insuficiencia Respiratoria , Animales , Modelos Animales de Enfermedad , Proteínas de Transporte de Glicina en la Membrana Plasmática , Hiperalgesia/tratamiento farmacológico , Lípidos , Lisina/farmacología , Lisina/uso terapéutico , Masculino , Ratones , Neuralgia/tratamiento farmacológico , Insuficiencia Respiratoria/inducido químicamente , Insuficiencia Respiratoria/tratamiento farmacológicoAsunto(s)
Medicina Aeroespacial/métodos , Aviación/métodos , Enfermedades del Sistema Nervioso/terapia , Neurología/métodos , Medicina Aeroespacial/tendencias , Aviación/tendencias , Humanos , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/epidemiología , Neurología/tendencias , Pilotos/tendencias , Reino Unido/epidemiologíaRESUMEN
Flight crew are occupationally exposed to several potentially carcinogenic hazards; however, previous investigations have been hampered by lack of information on lifestyle exposures. The authors identified, through the United Kingdom Civil Aviation Authority medical records, a cohort of 16,329 flight crew and 3,165 air traffic control officers (ATCOs) and assembled data on their occupational and lifestyle exposures. Standardised incidence ratios (SIRs) were estimated to compare cancer incidence in each occupation to that of the general population; internal analyses were conducted by fitting Cox regression models. All-cancer incidence was 20-29% lower in each occupation than in the general population, mainly due to a lower incidence of smoking-related cancers [SIR (95% CI) = 0.33 (0.27-0.38) and 0.42 (0.28-0.60) for flight crew and ATCOs, respectively], consistent with their much lower prevalence of smoking. Skin melanoma rates were increased in both flight crew (SIR = 1.87; 95% CI = 1.45-2.38) and ATCOs (2.66; 1.55-4.25), with rates among the former increasing with increasing number of flight hours (p-trend = 0.02). However, internal analyses revealed no differences in skin melanoma rates between flight crew and ATCOs (hazard ratio: 0.78, 95% CI = 0.37-1.66) and identified skin that burns easily when exposed to sunlight (p = 0.001) and sunbathing to get a tan (p = 0.07) as the strongest risk predictors of skin melanoma in both occupations. The similar site-specific cancer risks between the two occupational groups argue against risks among flight crew being driven by occupation-specific exposures. The skin melanoma excess reflects sun-related behaviour rather than cosmic radiation exposure.
Asunto(s)
Melanoma/epidemiología , Exposición Profesional , Neoplasias Cutáneas/epidemiología , Viaje , Adulto , Medicina Aeroespacial , Aeronaves , Aviación , Femenino , Conductas Relacionadas con la Salud , Humanos , Incidencia , Estilo de Vida , Masculino , Encuestas y Cuestionarios , Reino Unido/epidemiologíaRESUMEN
Introduction: Studies show that physicians and medical trainees who identify as underrepresented in medicine or as women experience higher rates of microaggressions during patient encounters. We designed, implemented, and evaluated an active bystander training workshop focused on mitigating microaggressions using standardized patient (SP) methodology. Methods: Internal medicine faculty members and chief residents led the workshop. Participants included 31 PGY 1 categorical and preliminary internal medicine residents. They participated in three case simulations with SPs involving microaggressions from patients toward a member of the health care team. Prior to the case simulations, a brief presentation outlined examples of microaggressions and reviewed the behavioral response framework WAKE (work with who you are, ask questions/make direct statements, involve key people, and employ distraction techniques). After each encounter, residents debriefed with an internal medicine faculty member and discussed questions related to each scenario. Results: All 31 residents participated in the workshop and, before and after the activity, completed a survey that asked them to rank their agreement with statements via a Likert scale. Participants reported statistically significant improvement in recognizing microaggressions (12% reported increase, p = .002), the ability to respond to patients who exhibit microaggressions (23% reported increase, p < .001), andâ¯the ability to debrief with team membersâ¯(20% reported increase, p < .001). Discussion: SP simulations can be an effective teaching modality for microaggression response strategies during patient encounters. Additional studies are needed to further characterize the workshop's effect on other medical workforce trainees and retention of skills over time.
Asunto(s)
Internado y Residencia , Microagresión , Humanos , Femenino , Educación de Postgrado en Medicina/métodos , Medicina Interna/educación , Docentes MédicosRESUMEN
Archaeological faunal remains provide key insights into human societies in the past, alongside information on previous resource utilisation and exploitation of wildlife populations. The great whales (Mysticete and sperm whales) were hunted unsustainably throughout the 16th - 20th centuries (herein defined as the modern period) leading to large population declines and variable recovery patterns among species. Humans have utilised whales as a resource through carcass scavenging for millennia; however, increasing local and regional ethnographic and archaeological evidence suggests that, prior to the modern period, hunting of the great whales was more common than previously thought; impacts of earlier hunting pressures on the population ecology of many whale species remains relatively unknown. Hunting guided by traditional ecological knowledge may have been sustainable and likely originated in societies that also incorporated opportunistic use of stranded individuals. The collation of georeferenced zooarchaeological data of the great whales between the 1st - 20th centuries CE worldwide will provide insight into the timescale and distribution of resource utilisation of the great whales and how this varied within and between societies, and may have changed over time. By comparing regions of known resource utilisation and breeding and feeding grounds of current-day whale populations, this information will subsequently be used to infer regions where whale populations were possibly lost or extirpated prior to detailed historical records. This systematic review protocol also provides a template for archaeologists, ecologists, and historians interested in using faunal remains to infer historical ecology and resource use of wild animal populations. The transparency of our data collection approach provides opportunities for reproducibility and comparability with future datasets.
Asunto(s)
Cachalote , Ballenas , Animales , Humanos , Reproducibilidad de los Resultados , Revisiones Sistemáticas como Asunto , Recolección de Datos , Animales SalvajesRESUMEN
OBJECTIVE: Flight crew are exposed to several potential occupational hazards. This study compares mortality rates in UK flight crew to those in air traffic control officers (ATCOs) and the general population. METHODS: A total of 19,489 flight crew and ATCOs were identified from the UK Civil Aviation Authority medical records and followed to the end of 2006. Consented access to medical records and questionnaire data provided information on demographic, behavioral, clinical, and occupational variables. Standardized mortality ratios (SMR) were estimated for these two occupational groups using the UK general population. Adjusted mortality hazard ratios (HR) for flight crew versus ATCOs were estimated via Cox regression models. RESULTS: A total of 577 deaths occurred during follow-up. Relative to the general population, both flight crew (SMR 0.32; 95% CI 0.30, 0.35) and ATCOs (0.39; 0.32, 0.47) had lower all-cause mortality, mainly due to marked reductions in mortality from neoplasms and cardiovascular diseases, although flight crew had higher mortality from aircraft accidents (SMR 42.8; 27.9, 65.6). There were no differences in all-cause mortality (HR 0.99; 95% CI 0.79, 1.25), or in mortality from any major cause, between the two occupational groups after adjustment for health-related variables, again except for those from aircraft accidents. The latter ratios, however, declined with increasing number of hours. CONCLUSIONS: The low all-cause mortality observed in both occupational groups relative to the general population is consistent with a strong "healthy worker effect" and their low prevalence of smoking and other risk factors. Mortality among flight crew did not appear to be influenced by occupational exposures, except for a rise in mortality from aircraft accidents.
Asunto(s)
Accidentes de Aviación/mortalidad , Aeronaves , Aviación , Enfermedades Profesionales/mortalidad , Adulto , Medicina Aeroespacial , Causas de Muerte , Estudios de Cohortes , Estudios Transversales , Femenino , Efecto del Trabajador Sano , Humanos , Masculino , Persona de Mediana Edad , Exposición Profesional , Tasa de Supervivencia , Reino Unido/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: Scant data are available on the annual incapacitation rate of aircrew. This study analyzes all incapacitations occurring among UK commercial pilots, in flight and off duty, in 2004 to derive a baseline minimum annual incapacitation rate for the UK commercial pilot population. METHOD: The study cohort was all professional pilots holding a valid UK/JAR (Joint Aviation Requirements) Class 1 medical certificate and license in 2004. Three data sources were used to identify episodes of incapacitation: the statutory notification of prolonged illness, personal injury, or pregnancy to the UK Civil Aviation Authority; Mandatory Occurrence Reports (MORs) for in-flight medical incidents; and death certificates. The total number of incapacitations was expressed as a proportion of the number of professional pilots to give an incapacitation rate. RESULTS: In 2004 there were 16,145 UK/JAR professional pilot license holders. Of the notified medical events, 36 presented as incapacitations; half were cardiac or cerebrovascular. In-flight incapacitations were predominantly of psychiatric cause. There were four sudden deaths. The type of incapacitation varied with age. A male pilot in his 60s had 5 times the risk of incapacitation of a male pilot in his 40s. The annual incapacitation rate was 40/16,145 = 0.25%. DISCUSSION: Aeromedical emphasis on minimizing cardiovascular risk and monitoring the mental health of pilots remains appropriate. Age should influence the content and periodicity of regulatory aeromedical assessments. The demonstrated annual incapacitation rate of 0.25% may provide a basis for quantifying the acceptable risk for a pilot undertaking single pilot commercial air transport operations.
Asunto(s)
Accidentes/estadística & datos numéricos , Medicina Aeroespacial , Enfermedades Cardiovasculares/epidemiología , Enfermedades Musculoesqueléticas/epidemiología , Salud Laboral , Inhabilitación Profesional/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Embarazo , Accidente Cerebrovascular/epidemiología , Reino Unido/epidemiología , Adulto JovenRESUMEN
Animal models of human pain conditions allow for detailed interrogation of known and hypothesized mechanisms of pain physiology in awake, behaving organisms. The importance of the glycinergic system for pain modulation is well known; however, manipulation of this system to treat and alleviate pain has not yet reached the sophistication required for the clinic. Here, we review the current literature on what animal behavioral studies have allowed us to elucidate about glycinergic pain modulation, and the progress toward clinical treatments so far. First, we outline the animal pain models that have been used, such as nerve injury models for neuropathic pain, chemogenic pain models for acute and inflammatory pain, and other models that mimic painful human pathologies such as diabetic neuropathy. We then discuss the genetic approaches to animal models that have identified the crucial glycinergic machinery involved in neuropathic and inflammatory pain. Specifically, two glycine receptor (GlyR) subtypes, GlyRα1(ß) and GlyRα3(ß), and the two glycine transporters (GlyT), GlyT1 and GlyT2. Finally, we review the different pharmacological approaches to manipulating the glycinergic system for pain management in animal models, such as partial vs. full agonism, reversibility, and multi-target approaches. We discuss the benefits and pitfalls of using animal models in drug development broadly, as well as the progress of glycinergic treatments from preclinical to clinical trials.
RESUMEN
AIM: This study is one of the largest ever completed to examine the prevalence of cardiovascular disease (CVD) risk factors among commercial aircrew. METHOD AND RESULTS: A retrospective cross-sectional study comparing prevalence of CVD risk factors age, body mass index (BMI), overweight and obesity, current smoking status, hypertension, and diabetes among commercial aircrew and the UK general population. A total of 14,379 subject records were eligible for the study. The age-sex group mean BMI was significantly lower in almost all pilot age groups compared to the general population. Overweight age-sex group prevalence was significantly higher in the <25, 35-44, 45-54, 55-64 age groups for male pilots, and lower for female pilots in the 25-34 and 45-54 age groups. Male and female pilots had significantly lower age-sex-group prevalence of obesity and current smoking compared to the general population. For hypertension, the male <25 and 35-44 year age groups had significantly higher prevalence, and the 45-54 and 55-64 year age groups had significantly lower prevalence than the general population. Age-standardised mean BMI and prevalence of overweight and hypertension were not significantly different from the highest income quintile of the general population. Age-standardised obesity and current smoking prevalence were significantly lower in pilots compared to the highest socio-economic quintile of the general population. CONCLUSION: Even when comparisons were made with the highest income quintile of the general population to control for socio-economic status, pilots had a significantly lower prevalence of obesity and smoking. This finding is consistent with a strong 'healthy worker effect'.
Asunto(s)
Aviación , Enfermedades Cardiovasculares/epidemiología , Obesidad/complicaciones , Sobrepeso/complicaciones , Fumar/efectos adversos , Adulto , Factores de Edad , Anciano , Presión Sanguínea , Índice de Masa Corporal , Enfermedades Cardiovasculares/etiología , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Sobrepeso/epidemiología , Prevalencia , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Fumar/epidemiología , Reino Unido/epidemiologíaRESUMEN
Spinal muscular atrophy is one of the most common fatal autosomal recessive disorders. Children diagnosed with SMA Type 1 (SMAT1) demonstrate severe oral motor weakness and flaccid dysarthria progressing to complete anarthria. A review of literature illustrates that little has been described regarding augmentative and alternative communication (AAC) use among these children, although communication has a critical impact on quality of life and participation in daily activities. Responses to an investigator-developed parent survey were obtained to appraise communication skills and opportunities among children diagnosed with SMA1. Results illustrate parent perception of greater receptive than expressive language ability and highlight the benefits of implementing speech-generating devices (SGD). Barriers to SGD acquisition and implementation, including access and funding, are reported and described. Overall, families indicated that SGD increases quality of life and provides valued improvements through expanded functional communication.
Asunto(s)
Equipos de Comunicación para Personas con Discapacidad , Atrofia Muscular Espinal , Niño , Comunicación , Humanos , Padres , Calidad de VidaRESUMEN
INTRODUCTION: It has been suggested that integrated cardiovascular risk management guidelines and absolute cardiovascular risk prediction scores should be used routinely in aeromedical risk assessment. In this study a cardiovascular disease (CVD) risk prediction model has been applied to UK commercial pilots as an occupational group. METHOD: This retrospective cross-sectional study measured the variables age, sex, body mass index (BMI), blood pressure, use of antihypertensive medication, current smoking, and diabetes status of commercial pilots. Individual 10-yr absolute CVD risk scores (also referred to as 10-yr global CVD risk) were calculated using a non-laboratory based Framingham Heart Study developed model. RESULTS: Of the 14,379 subjects eligible for the study, none had missing values for risk factors. None of the female pilots and 9.7% of all male pilots were found to be high risk. The mean 10-yr absolute CVD risk for the entire pilot population was 8.41% (median 5.6). High-risk pilots are concentrated around 60 yr of age, (mean 59, median 60 yr) with an age range of 40-81 yr. A sub-analysis of high-risk pilots younger than 65 revealed 1137 pilots in this group. CONCLUSION: The application of a 10-yr absolute CVD risk prediction model identified a group of pilots, previously unidentified, who may require a more comprehensive risk assessment. Pilots are continuing to fly commercially beyond the age of 60, which results in substantial increase in the CVD risk burden of the pilot population as a whole.
Asunto(s)
Medicina Aeroespacial , Enfermedades Cardiovasculares/diagnóstico , Hipertensión/diagnóstico , Adulto , Factores de Edad , Anciano , Antihipertensivos/uso terapéutico , Comercio , Estudios Transversales , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , Distribución por Sexo , Reino Unido/epidemiologíaRESUMEN
The different interpretations by States (countries) of the aeromedical standards established by the International Civil Aviation Organization has resulted in a variety of approaches to the development of national aeromedical policy, and consequently a relative lack of harmonization. However, in many areas of aviation, safety management systems have been recently introduced and may represent a way forward. A safety management system can be defined as "A systematic approach to managing safety, including the necessary organizational structures, accountabilities, policies, and procedures" (1). There are four main areas where, by applying safety management principles, it may be possible to better use aeromedical data to enhance flight safety. These are: 1) adjustment of the periodicity and content of routine medical examinations to more accurately reflect aeromedical risk; 2) improvement in reporting and analysis of routine medical examination data; 3) improvement in reporting and analysis of in-flight medical events; and 4) support for improved reporting of relevant aeromedical events through the promotion of an appropriate culture by companies and regulatory authorities. This paper explores how the principles of safety management may be applied to aeromedical systems to improve their contribution to safety.
Asunto(s)
Medicina Aeroespacial/normas , Administración de la Seguridad , Medicina Aeroespacial/legislación & jurisprudencia , Certificación , Toma de Decisiones , Estado de Salud , Humanos , Cooperación Internacional , Cultura Organizacional , Examen FísicoRESUMEN
INTRODUCTION: Commercial aircrews are exposed to potential occupational hazards and, recently, epidemiological studies have examined their morbidity and mortality relative to the general population. Aircrews are, however, likely to differ from the general population in several respects which may affect the validity of such comparisons. METHODS: A cohort of 17,990 commercial aircrews was identified through the United Kingdom (UK) Civil Aviation Authority medical records and is being followed for morbidity and mortality. Demographic, lifestyle, reproductive, and medical characteristics of commercial aircrews were compared with those of: 1) UK air traffic control officers (ATCOs; N = 3386) identified in a similar way as aircrews; and 2) estimates for the UK general population. RESULTS: Aircrews and ATCOs had similar characteristics, except that sex-age-adjusted prevalences for current smoking, obesity, and hypertension were statistically significantly higher in the latter. Both aircrews and ATCOs differed considerably from the general population with, for instance, much lower sex-age-adjusted prevalences of current smoking, obesity, and hypertension but higher levels of regular physical exercise. Age-adjusted fertility rates among female aircrews and ATCOs were only one-third of those in the general population. These differences were slightly attenuated when comparisons with the general population were restricted to its highest socio-economic stratum. DISCUSSION: The differences between aircrews and the general population are consistent with a strong "healthy worker effect." Aircrews and ATCOs undergo a similar employment selection process and thus taking the latter as the reference population, in addition to the general population, will help to minimize the "healthy worker effect" and gain insight into its biases.
Asunto(s)
Medicina Aeroespacial , Conductas Relacionadas con la Salud , Estilo de Vida , Adulto , Enfermedades Cardiovasculares/epidemiología , Ejercicio Físico , Femenino , Estado de Salud , Efecto del Trabajador Sano , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Factores de Riesgo , Fumar/epidemiología , Reino Unido/epidemiologíaRESUMEN
Aims. To investigate regional lower limb bone density and associations with weight, PTH, and bone breakdown in coeliac men. Methods. From whole body DXA scans bone mineral density (BMD) was measured in 28 coeliac men, in the lower limb (subdivided into 6 regions, 3 being metaphyseal (mainly trabecular) and 2 diaphyseal (mainly cortical)). BMD at femoral neck (FN) and lumbar spine L2-4, body weight, height, serum calcium, alkaline phosphatase, parathyroid hormone (PTH), and urinary calcium and NTx/Cr, a measure of bone breakdown, were also measured. Age matched healthy men provided values for BMD calculation of z and T scores and for biochemical measurements. Results. Low BMD z scores were found at metaphyseal regions in the leg (p < 0.001) and in the FN (p < 0.05). The distal metaphyseal region BMD in the leg was lower than spine or FN (p < 0.05). PTH, urinary calcium/creatinine, and urinary NTx/Cr were similar to controls. Both metaphyseal and diaphyseal BMD z scores were associated with body weight (p < 0.02), but not with either PTH or urinary NTx/Cr. Conclusions. Low BMD lower limb regions comprising mostly trabecular bone occur early in CD and in the absence of elevated PTH or increased bone resorption. Low BMD is associated with low body weight.
RESUMEN
The question of how meaningful associations between verbal and spatial information might be utilized to facilitate working memory performance is potentially highly instructive for models of memory function. The present study explored how separable processing capacities within specialized domains might each contribute to this, by examining the disruptive impacts of simple verbal and spatial concurrent tasks on young adults' recall of visually presented digit sequences encountered either in a single location or within a meaningful spatial "keypad" configuration. The previously observed advantage for recall in the latter condition (the "visuospatial bootstrapping effect") consistently emerged across 3 experiments, indicating use of familiar spatial information in boosting verbal memory. The magnitude of this effect interacted with concurrent activity; articulatory suppression during encoding disrupted recall to a greater extent when digits were presented in single locations (Experiment 1), while spatial tapping during encoding had a larger impact on the keypad condition and abolished the visuospatial bootstrapping advantage (Experiment 2). When spatial tapping was performed during recall (Experiment 3), no task by display interaction was observed. Outcomes are discussed within the context of the multicomponent model of working memory, with a particular emphasis on cross-domain storage in the episodic buffer (Baddeley, 2000).
Asunto(s)
Memoria a Corto Plazo , Desempeño Psicomotor , Percepción del Habla , Percepción Visual , Adolescente , Adulto , Aprendizaje por Asociación , Femenino , Humanos , Masculino , Recuerdo Mental , Persona de Mediana Edad , Modelos Psicológicos , Pruebas Psicológicas , Aprendizaje Verbal , Adulto JovenRESUMEN
An overweight 56-year-old type II diabetic on peritoneal dialysis (body mass index 35 kg/m(2)) was taking Orlistat for some months up until live-unrelated renal transplantation. Despite oral cyclosporin A (CyA) for 48 hours pretransplantation, it was very difficult to achieve adequate CyA blood levels for the first week postengraftment despite the use of much larger oral CyA doses. After opening his bowels on day 7, and the use of 3 days intravenous CyA, good CyA blood levels were achieved then maintained with conventional oral doses. The authors believe that this case shows important interactions between CyA and Orlistat.
Asunto(s)
Ciclosporina/sangre , Trasplante de Riñón/efectos adversos , Lactonas/metabolismo , Administración Oral , Fármacos Antiobesidad/metabolismo , Fármacos Antiobesidad/uso terapéutico , Ciclosporina/administración & dosificación , Ciclosporina/uso terapéutico , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Interacciones Farmacológicas , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/sangre , Inmunosupresores/uso terapéutico , Inyecciones Intravenosas , Fallo Renal Crónico/etiología , Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Lactonas/uso terapéutico , Masculino , Persona de Mediana Edad , Obesidad/sangre , Obesidad/tratamiento farmacológico , OrlistatRESUMEN
INTRODUCTION: In 1997 an autopsy on a professional pilot killed in an aircraft accident demonstrated myocardial fibrosis, thought to be the result of previous anthracycline treatment. The United Kingdom (UK) Civil Aviation Authority (CAA) was tasked with investigating the possible dangers to flight safety of treatment with this type of chemotherapy. METHODS: From CAA computer records of 18,319 professional license holders, 14 were identified as having received anthracycline treatment. These subjects underwent clinical cardiological examination, exercise and 24 h ambulatory electrocardiography, and echocardiography. Other studies were performed as needed. RESULTS: Of the 14 subjects, 9 demonstrated arrhythmias on ambulatory electrocardiography, including 4 with ventricular tachycardia and 5 with supraventricular tachycardia, a much higher incidence than expected. One pilot had evidence of left ventricular dysfunction and another developed symptomatic sinus arrest at first follow-up. Another died shortly after completing the investigations from acute lymphatic leukemia, probably a complication of his original chemotherapy for Hodgkin's disease. In this small cohort there seemed to be no correlation of abnormal findings with anthracycline dose nor with time since completion of treatment. CONCLUSIONS: The results presented strongly suggest the need for cardiological review of individuals who have received anthracycline treatment and who are seeking initial certification or recertification for professional aviation licensing.
Asunto(s)
Medicina Aeroespacial/normas , Antraciclinas/efectos adversos , Arritmias Cardíacas/inducido químicamente , Adulto , Ambulancias Aéreas/normas , Arritmias Cardíacas/diagnóstico , Sistema Cardiovascular/efectos de los fármacos , Certificación , Relación Dosis-Respuesta a Droga , Ecocardiografía , Prueba de Esfuerzo , Femenino , Bloqueo Cardíaco/inducido químicamente , Bloqueo Cardíaco/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Reino Unido , Disfunción Ventricular Izquierda/inducido químicamente , Disfunción Ventricular Izquierda/diagnósticoRESUMEN
OBJECTIVE: To determine the effect of 6 years of routine management on body composition, physical functioning, and quality of life, and their interrelationships, in men with idiopathic vertebral fracture. METHODS: Twenty men with idiopathic vertebral fracture (patients: mean ± SD age 58 ± 6 years) were age and height matched to 28 healthy controls with no known disease. The primary outcome was skeletal muscle mass (appendicular lean mass by dual x-ray absorptiometry) assessed at 2 visits (0 and 6 years). Physical functioning and quality of life domains were assessed by the Senior Fitness Test and Short Form 36 (SF-36) questionnaire at visit 2 only. Data were analyzed by repeated-measures analysis of variance, independent t-tests, and correlation. RESULTS: At visit 1, appendicular lean mass was 9% lower in patients than controls. Although patients better maintained appendicular lean mass between visits (interaction P = 0.016), at visit 2 appendicular lean mass remained 5% lower in patients than controls. Furthermore, patients' appendicular lean mass change was correlated with femoral neck bone density change (r = 0.507, P = 0.023). Physical function tests were 13-27% lower in patients compared with controls (P = 0.056 to 0.003), as were SF-36 quality of life physical domains (13-26% lower; P = 0.028 to <0.001). CONCLUSION: Despite an association between changes in muscle mass and bone density, routine management of men with idiopathic vertebral fracture does not address muscle loss. Combined with the observation of reduced physical functioning and quality of life, this study identifies novel targets for intervention in men with idiopathic vertebral fracture.