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1.
Int J Stroke ; 17(2): 163-171, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33538655

RESUMEN

BACKGROUND: Inflammation driven by pro-inflammatory cytokines is a new therapeutic target in coronary disease. Few data exist on the association of key upstream cytokines and post-stroke recurrence. In a prospective cohort study, we investigated the association between pivotal cytokines, high-sensitivity C-reactive protein (hsCRP) and one-year outcomes. METHODS: BIO-STROKETIA is a multi-center prospective cohort study of non-severe ischemic stroke (modified Rankin score ≤ 3) and transient ischemic attack. Controls were patients with transient symptoms attending transient ischemic attack clinics with non-ischemic final diagnosis. Exclusion criteria were severe stroke, infection, and other pro-inflammatory disease; hsCRP and cytokines (interleukin (IL) 6, IL-1ß, IL-8, IL-10, IL-12, interferon-γ (IFN-γ), tumor-necrosis factor-α (TNF-α)) were measured. The primary outcome was one-year recurrent stroke/coronary events (fatal and non-fatal). RESULTS: In this study, 680 patients (439 stroke, 241 transient ischemic attack) and 68 controls were included. IL-6, IL-1ß, IL-8, IFN-γ, TNF-α, and hsCRP were higher in stroke/transient ischemic attack cases (p ≤ 0.01 for all). On multivariable Cox regression, IL-6, IL-8, and hsCRP independently predicted one-year recurrent vascular events (adjusted hazard ratios (aHR) per-quartile increase IL-6 1.31, confidence interval (CI) 1.02-1.68, p = 0.03; IL-8 1.47, CI 1.15-1.89, p = 0.002; hsCRP 1.28, CI 1.01-1.62, p = 0.04). IL-6 (aHR 1.98, CI 1.26-3.14, p = 0.003) and hsCRP (aHR 1.81, CI 1.20-2.74, p = 0.005) independently predicted one-year fatality. IL-6 and hsCRP (adjusted odds ratio per-unit increase 1.02, CI 1.01-1.04) predicted poor functional outcome, with a trend for IL-1ß (p = 0.054). CONCLUSION: Baseline inflammatory cytokines independently predicted late recurrence, supporting a rationale for randomized trials of anti-inflammatory agents for prevention after stroke and suggesting that targeted therapy to high-risk patients with high baseline inflammation may be beneficial.


Asunto(s)
Proteína C-Reactiva , Citocinas , Ataque Isquémico Transitorio , Accidente Cerebrovascular , Proteína C-Reactiva/metabolismo , Humanos , Ataque Isquémico Transitorio/complicaciones , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/complicaciones
2.
Syst Rev ; 9(1): 291, 2020 12 12.
Artículo en Inglés | MEDLINE | ID: mdl-33308281

RESUMEN

BACKGROUND: Bone is a plastic tissue that is responsive to its physical environment. As a result, exercise interventions represent a potential means to influence the bone. However, little is currently known about how various exercise and participant characteristics interact to influence bone metabolism. Acute, controlled, interventions provide an in vivo model through which the acute bone response to exercise can be investigated, typically by monitoring circulating bone biomarkers. Currently, substantial heterogeneity in factors such as study design, quality, exercise, and participant characteristics render it difficult to synthesize and evaluate the available evidence. Using a systematic review and meta-analytic approach, the aim of this investigation is to quantify the effect of an acute exercise bout on circulating bone biomarkers as well as examine the potential factors that may moderate this response, e.g., variation in participant, exercise, and sampling characteristics. METHODS: This protocol was designed in accordance with the PRISMA-P guidelines. Seven databases (MEDLINE, Embase, Sport Discus, Cochrane CENTRAL, PEDro, LILACS, and Ibec) will be systematically searched and supplemented by a secondary screening of the reference lists of all included articles. The PICOS (Population, Intervention, Comparator, Outcomes and Study Design) approach was used to guide the determination of the eligibility criteria. Participants of any age, sex, training, or health status will be considered for inclusion. We will select studies that have measured the bone biomarker response before and after an acute exercise session. All biomarkers considered to represent the bone metabolism will be considered for inclusion, and sensitivity analyses will be conducted using reference biomarkers for the measurement of bone resorption and formation (namely ß-CTX-1 and P1NP). Multi-level, meta-regression models within a Bayesian framework will be used to explore the main effect of acute exercise on bone biomarkers as well as potential moderating factors. The risk of bias for each individual study will be evaluated using a modified version of the Downs and Black checklist while certainty in resultant outcomes will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. DISCUSSION: A better understanding of the bone metabolic response to an acute bout of exercise has the potential to advance our understanding of the mechanisms through which this stimulus impacts bone metabolism, including factors that may moderate this response. Additionally, we will identify current gaps in the evidence base and provide recommendations to inform future research. SYSTEMATIC REVIEW REGISTRATION: This protocol was prospectively registered in the Open Science Framework Registry ( https://osf.io/6f8dz ).


Asunto(s)
Ejercicio Físico , Deportes , Teorema de Bayes , Biomarcadores , Estado de Salud , Humanos , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto
3.
Ir Med J ; 112(9): 1006, 2019 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-31651135

RESUMEN

Decreased life expectancy (LE) has historically been found among people with intellectual disability (ID) compared to the general population. Several recent studies have looked into ageing and cause of death in ID. Results of many of these studies suggest that, although LE in ID remains lower than the general population, it has increased across many Western societies in recent decades. Increases in LE in the general and ID populations appear to follow similar trends. Some major causes of mortality in ID are similar to the general population, and therefore may be amenable to similar preventative healthcare interventions. In this article, we have outlined possible reasons for improved LE in ID, and potential areas that may require further intervention. However, more detailed studies on mortality in ID may provide more accurate insight into areas requiring intervention in ID populations.


Asunto(s)
Discapacidad Intelectual , Esperanza de Vida/tendencias , Humanos
4.
Sci Robot ; 4(33)2019 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-33137787

RESUMEN

The performance of indwelling medical devices that depend on an interface with soft tissue is plagued by complex, unpredictable foreign body responses. Such devices-including breast implants, biosensors, and drug delivery devices-are often subject to a collection of biological host responses, including fibrosis, which can impair device functionality. This work describes a milliscale dynamic soft reservoir (DSR) that actively modulates the biomechanics of the biotic-abiotic interface by altering strain, fluid flow, and cellular activity in the peri-implant tissue. We performed cyclical actuation of the DSR in a preclinical rodent model. Evaluation of the resulting host response showed a significant reduction in fibrous capsule thickness (P = 0.0005) in the actuated DSR compared with non-actuated controls, whereas the collagen density and orientation were not changed. We also show a significant reduction in myofibroblasts (P = 0.0036) in the actuated group and propose that actuation-mediated strain reduces differentiation and proliferation of myofibroblasts and therefore extracellular matrix production. Computational models quantified the effect of actuation on the reservoir and surrounding fluid. By adding a porous membrane and a therapy reservoir to the DSR, we demonstrate that, with actuation, we could (i) increase transport of a therapy analog and (ii) enhance pharmacokinetics and time to functional effect of an inotropic agent. The dynamic reservoirs presented here may act as a versatile tool to further understand, and ultimately to ameliorate, the host response to implantable biomaterials.

5.
Sci Rep ; 8(1): 14788, 2018 10 03.
Artículo en Inglés | MEDLINE | ID: mdl-30283073

RESUMEN

Histidine containing dipeptides (HCDs) have numerous ergogenic and therapeutic properties, but their primary role in skeletal muscle remains unclear. Potential functions include pH regulation, protection against reactive oxygen/nitrogen species, or Ca2+ regulation. In recognition of the challenge of isolating physiological processes in-vivo, we employed a comparative physiology approach to investigate the primary mechanism of HCD action in skeletal muscle. We selected two avian species (i.e., hummingbirds and chickens), who represented the extremes of the physiological processes in which HCDs are likely to function. Our findings indicate that HCDs are non-essential to the development of highly oxidative and contractile muscle, given their very low content in hummingbird skeletal tissue. In contrast, their abundance in the glycolytic chicken muscle, indicate that they are important in anaerobic bioenergetics as pH regulators. This evidence provides new insights on the HCD role in skeletal muscle, which could inform widespread interventions, from health to elite performance.


Asunto(s)
Pollos/fisiología , Histidina/metabolismo , Contracción Muscular/genética , Músculo Esquelético/metabolismo , Animales , Carnosina/metabolismo , Pollos/metabolismo , Dipéptidos/metabolismo , Metabolismo Energético , Contracción Muscular/fisiología , Músculo Esquelético/fisiología , Oxígeno/metabolismo
6.
Public Health ; 150: 26-33, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28622568

RESUMEN

OBJECTIVES: To investigate the effects of an exercise referral scheme (ERS) aligned to the UK best practice guidelines on a range of outcomes including those associated with key health concerns of the Scottish population. STUDY DESIGN: A longitudinal design with data collection at three time points (baseline, midway and post) during a 12-week ERS intervention was employed. METHODS: Health-related physical fitness was assessed through measurement of resting heart rate, blood pressure, FEV1:FEV6 (ratio of forced expiratory volume over one [FEV1] and six [FEV6] seconds), body mass and peak oxygen uptake (VO2 peak), whilst functional capacity was assessed through the five times sit to stand test. Psychosocial well-being and quality of life were measured using the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and the Profile of Mood State questionnaires. Growth curve analyses were used to model each outcome variable across the three time periods. RESULTS: A range of effects were obtained with significant linear improvements in physical performance tests (P < 0.001) and psychosocial assessments (P ≤ 0.002). Additionally, significant quadratic effects of time were obtained for body composition variables and physical activity levels (P < 0.001) with the greatest improvements obtained between baseline and midway assessments. CONCLUSIONS: An ERS aligned to the UK best practice guidelines can positively influence a range of health outcomes including those associated with lung function and cardiovascular fitness which are prevalent medical conditions in Scotland. In addition, results indicate that ERS can positively affect outcomes related to functional capacity as well as mental well-being and perceptions of health. The findings of the study identify the need for further investigation including consideration of the initial health status of referred clients.


Asunto(s)
Práctica Clínica Basada en la Evidencia , Ejercicio Físico , Aptitud Física/fisiología , Derivación y Consulta , Adolescente , Adulto , Anciano , Protocolos Clínicos , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Evaluación de Programas y Proyectos de Salud , Calidad de Vida , Escocia , Encuestas y Cuestionarios , Reino Unido , Adulto Joven
7.
Ir J Med Sci ; 186(4): 895-902, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28050806

RESUMEN

BACKGROUND: Dietary nitrate has been shown to increase nitrate/nitrite levels in multiple populations, with potential blood pressure lowering effects. However, there are few reports among hypertensives. AIMS: We aimed to assess the effect of daily nitrate in subjects with controlled hypertension vs. uncontrolled hypertension. METHODS: On day 0, hypertensives wore an ambulatory BP monitor (ABPM) for 24 h and fasting blood was taken. Subjects then consumed concentrated beetroot juice (12.9 mmol nitrate) for 14 consecutive days. On day 14 subjects consumed their last nitrate dose after fasting blood was drawn and again had an ABPM for 24 h. RESULTS: According to baseline ABPM, 11 subjects had controlled BP while 8 had uncontrolled BP. There were similar, significant increases in serum nitrate/nitrite in both groups. We observed little change in BP variables among controlled hypertensives. However, there were reductions in BP variables in uncontrolled hypertensives where decreases in nighttime DBP (-6 ± 4.8 mmHg), arterial stiffness (-0.08 ± 0.03 ambulatory arterial stiffness index) and LDL (-0.36 ± 0.42 mmol/L) reached significance (p = 003, 0.05 and 0.046, respectively). CONCLUSIONS: Our results support the existing data suggesting an anti-hypertensive effect of nitrate-containing beetroot juice, but only among those with uncontrolled hypertension.


Asunto(s)
Beta vulgaris/química , Monitoreo Ambulatorio de la Presión Arterial/métodos , Presión Sanguínea/efectos de los fármacos , LDL-Colesterol/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Nitratos/química , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto
8.
CBE Life Sci Educ ; 15(2)2016.
Artículo en Inglés | MEDLINE | ID: mdl-27174582

RESUMEN

Relationships with colleagues have the potential to be a source of support for faculty to make meaningful change in how they teach, but the impact of these relationships is poorly understood. We used a mixed-methods approach to investigate the characteristics of faculty who provide colleagues with teaching resources and facilitate change in teaching, how faculty influence one another. Our exploratory investigation was informed by social network theory and research on the impact of opinion leaders within organizations. We used surveys and interviews to examine collegial interactions about undergraduate teaching in life sciences departments at one research university. Each department included discipline-based education researchers (DBERs). Quantitative and qualitative analyses indicate that DBERs promote changes in teaching to a greater degree than other departmental colleagues. The influence of DBERs derives, at least partly, from a perception that they have unique professional expertise in education. DBERs facilitated change through coteaching, offering ready and approachable access to education research, and providing teaching training and mentoring. Faculty who had participated in a team based-teaching professional development program were also credited with providing more support for teaching than nonparticipants. Further research will be necessary to determine whether these results generalize beyond the studied institution.


Asunto(s)
Docentes/educación , Investigación/educación , Universidades , Humanos , Modelos Lineales , Investigadores , Apoyo Social
9.
Extrem Physiol Med ; 5: 1, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26744625

RESUMEN

Saturation diving is an occupation that involves prolonged exposure to a confined, hyperoxic, hyperbaric environment. The unique and extreme environment is thought to result in disruption to physiological and metabolic homeostasis, which may impact human health and performance. Appropriate nutritional intake has the potential to alleviate and/or support many of these physiological and metabolic concerns, whilst enhancing health and performance in saturation divers. Therefore, the purpose of this review is to identify the physiological and practical challenges of saturation diving and consequently provide evidence-based nutritional recommendations for saturation divers to promote health and performance within this challenging environment. Saturation diving has a high-energy demand, with an energy intake of between 44 and 52 kcal/kg body mass per day recommended, dependent on intensity and duration of underwater activity. The macronutrient composition of dietary intake is in accordance with the current Institute of Medicine guidelines at 45-65 % and 20-35 % of total energy intake for carbohydrate and fat intake, respectively. A minimum daily protein intake of 1.3 g/kg body mass is recommended to facilitate body composition maintenance. Macronutrient intake between individuals should, however, be dictated by personal preference to support the attainment of an energy balance. A varied diet high in fruit and vegetables is highly recommended for the provision of sufficient micronutrients to support physiological processes, such as vitamin B12 and folate intake to facilitate red blood cell production. Antioxidants, such as vitamin C and E, are also recommended to reduce oxidised molecules, e.g. free radicals, whilst selenium and zinc intake may be beneficial to reinforce endogenous antioxidant reserves. In addition, tailored hydration and carbohydrate fueling strategies for underwater work are also advised.

10.
Clin Radiol ; 70(12): 1408-13, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26385204

RESUMEN

AIM: To report the experience of a regional stroke referral service with endovascular treatment for patients with acute ischaemic stroke (AIS) and large vessel occlusion. MATERIALS AND METHODS: A prospective review was undertaken of 93 consecutive cases receiving endovascular treatment for AIS over a 42-month period (January 2010 to June 2013). The National Institutes of Health Stroke Scale (NIHSS), location of large vessel occlusion, details of endovascular procedure, and degree of reperfusion achieved (Thrombolysis In Cerebral Infarction [TICI] score) were recorded. Mortality and functional outcome (modified Rankin Scale [mRS]) were measured at 90 days. RESULTS: The mean patient age was 62 years (range 26-87 years). The mean NIHSS at presentation was 16 (range 6-29). All patients had confirmed proximal large-artery occlusion on computed tomography (CT) angiography: 87 in the anterior circulation, six in the posterior circulation. Of the 93 patients treated, 64 (69%) received intravenous thrombolysis. Successful reperfusion (TICI grade 2a to 3) was achieved in 80 (86%) cases. There were 13 (14%) cases of failed vessel recanalisation (TICI grade 0). Good functional outcome (mRS ≤2) was achieved in 51 (55%) cases. The 90-day mortality was 20 (22%) cases. Fifty-seven (61%) cases were transferred from outside centres. There was no significant increase in morbidity or mortality for transferred patients. CONCLUSION: Successful endovascular recanalisation can result in good functional outcomes for patients with AIS and large vessel occlusion. Our interventional neuroradiology service provides endovascular treatment as part of a regional stroke service without increase in morbidity or mortality for patients transferred from outside institutions.


Asunto(s)
Arteriopatías Oclusivas/cirugía , Isquemia Encefálica/cirugía , Procedimientos Endovasculares , Stents , Accidente Cerebrovascular/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/diagnóstico por imagen , Isquemia Encefálica/complicaciones , Isquemia Encefálica/diagnóstico por imagen , Angiografía Cerebral , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
11.
Age Ageing ; 44(5): 882-6, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26271048

RESUMEN

BACKGROUND: Stroke patients are at increased risk of falls and fractures. The aim of this study was to determine the rate, predictors and consequences of falls within 2 years after stroke in a prospective population-based study in North Dublin, Ireland. DESIGN: Prospective population-based cohort study. SUBJECTS: 567 adults aged >18 years from the North Dublin Population Stroke Study. METHODS: Participants were enrolled from an Irish urban population of 294,592 individuals, according to recommended criteria. Patients were followed for 2 years. Outcome measures included death, modified Rankin Scale (mRS), fall and fracture rate. RESULTS: At 2 years, 23.5% (124/522) had fallen at least once since their stroke, 14.2% (74/522) had 2 or more falls and 5.4% (28/522) had a fracture. Of 332 survivors at 2 years, 107 (32.2%) had fallen, of whom 60.7% (65/107) had 2 or more falls and 23.4% (25/107) had fractured. In a multivariable model controlling for age and gender, independent risk factors for falling within the first 2 years of stroke included use of alpha-blocker medications for treatment of hypertension (P = 0.02). When mobility measured at Day 90 was included in the model, patients who were mobility impaired (mRS 2-3) were at the highest risk of falling within 2 years of stroke [odds ratio (OR) 2.30, P = 0.003] and those functionally dependent (mRS 4-5) displayed intermediate risk (OR 2.02, P = 0.03) when compared with independently mobile patients. CONCLUSION: Greater attention to falls risk, fall prevention strategies and bone health in the stroke population are required.


Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Fracturas Óseas/epidemiología , Accidente Cerebrovascular/epidemiología , Accidentes por Caídas/mortalidad , Antagonistas Adrenérgicos alfa/uso terapéutico , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Distribución de Chi-Cuadrado , Comorbilidad , Evaluación de la Discapacidad , Femenino , Fracturas Óseas/diagnóstico , Fracturas Óseas/mortalidad , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Irlanda/epidemiología , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Limitación de la Movilidad , Análisis Multivariante , Oportunidad Relativa , Prevalencia , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Salud Urbana
12.
J Hum Hypertens ; 29(12): 719-25, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25787777

RESUMEN

Blood pressure variability (BPV) has been associated with cardiovascular events; however, the prognostic significance of short-term BPV remains uncertain. As uncertainty also remains as to which measure of variability most accurately describes short-term BPV, this study explores different indices and investigates their relationship with subclinical target organ damage (TOD). We used data from the Mitchelstown Study, a cross-sectional study of Irish adults aged 47-73 years (n=2047). A subsample (1207) underwent 24-h ambulatory BP monitoring (ABPM). As measures of short-term BPV, we estimated the s.d., weighted s.d. (wSD), coefficient of variation (CV) and average real variability (ARV). TOD was documented by microalbuminuria and electrocardiogram (ECG) left ventricular hypertrophy (LVH). There was no association found between any measure of BPV and LVH in both unadjusted and fully adjusted logistic regression models. Similar analysis found that ARV (24 h, day and night), s.d. (day and night) and wSD were all univariately associated with microalbuminuria and remained associated after adjustment for age, gender, smoking, body mass index (BMI), diabetes and antihypertensive treatment. However, when the models were further adjusted for the mean BP the association did not persist for all indices. Our findings illustrate choosing the appropriate summary measure, which accurately captures that short-term BPV is difficult. Despite discrepancies in values between the different measures, there was no association between any indexes of variability with TOD measures after adjustment for the mean BP.


Asunto(s)
Albuminuria/etiología , Presión Sanguínea , Hipertrofia Ventricular Izquierda/etiología , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad
13.
Ann Biomed Eng ; 43(4): 1036-50, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25281407

RESUMEN

Low magnitude high frequency (LMHF) loading has been shown to have an anabolic effect on trabecular bone in vivo. However, the precise mechanical signal imposed on the bone marrow cells by LMHF loading, which induces a cellular response, remains unclear. This study investigates the influence of LMHF loading, applied using a custom designed bioreactor, on bone adaptation in an explanted trabecular bone model, which isolated the bone and marrow. Bone adaptation was investigated by performing micro CT scans pre and post experimental LMHF loading, using image registration techniques. Computational fluids dynamic models were generated using the pre-experiment scans to characterise the mechanical stimuli imposed by the loading regime prior to adaptation. Results here demonstrate a significant increase in bone formation in the LMHF loaded group compared to static controls and media flow groups. The calculated shear stress in the marrow was between 0.575 and 0.7 Pa, which is within the range of stimuli known to induce osteogenesis by bone marrow mesenchymal stem cells in vitro. Interestingly, a correlation was found between the bone formation balance (bone formation/resorption), trabecular number, trabecular spacing, mineral resorption rate, bone resorption rate and mean shear stresses. The results of this study suggest that the magnitude of the shear stresses generated due to LMHF loading in the explanted bone cores has a contributory role in the formation of trabecular bone and improvement in bone architecture parameters.


Asunto(s)
Reactores Biológicos , Células de la Médula Ósea/metabolismo , Simulación por Computador , Modelos Biológicos , Osteogénesis , Estrés Mecánico , Animales , Células de la Médula Ósea/citología , Células Cultivadas , Porcinos
14.
J Hum Hypertens ; 28(9): 535-42, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24430701

RESUMEN

Overweight clusters with high blood pressure (BP), but the independent contribution of both risk factors remains insufficiently documented. In a prospective population study involving 8467 participants (mean age 54.6 years; 47.0% women) randomly recruited from 10 populations, we studied the contribution of body mass index (BMI) to risk over and beyond BP, taking advantage of the superiority of ambulatory over conventional BP. Over 10.6 years (median), 1271 participants (15.0%) died and 1092 (12.9%), 637 (7.5%) and 443 (5.2%) experienced a fatal or nonfatal cardiovascular, cardiac or cerebrovascular event. Adjusted for sex and age, low BMI (<20.7 kg m(-2)) predicted death (hazard ratio (HR) vs average risk, 1.52; P<0.0001) and high BMI (> or = 30.9 kg m(-2)) predicted the cardiovascular end point (HR, 1.27; P=0.006). With adjustments including 24-h systolic BP, these HRs were 1.50 (P<0.001) and 0.98 (P=0.91), respectively. Across quartiles of the BMI distribution, 24-h and nighttime systolic BP predicted every end point (1.13 < or = standardized HR < or = 1.67; 0.046 < or = P<0.0001). The interaction between systolic BP and BMI was nonsignificant (P > or = .22). Excluding smokers removed the contribution of BMI categories to the prediction of mortality. In conclusion, BMI only adds to BP in risk stratification for mortality but not for cardiovascular outcomes. Smoking probably explains the association between increased mortality and low BMI.


Asunto(s)
Monitoreo Ambulatorio de la Presión Arterial , Presión Sanguínea , Índice de Masa Corporal , Hipertensión/diagnóstico , Hipertensión/etnología , Obesidad/diagnóstico , Obesidad/etnología , Adulto , Anciano , Antihipertensivos/uso terapéutico , Asia/epidemiología , Presión Sanguínea/efectos de los fármacos , Europa (Continente)/epidemiología , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/mortalidad , Hipertensión/fisiopatología , Incidencia , Masculino , Persona de Mediana Edad , Obesidad/mortalidad , Obesidad/fisiopatología , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Fumar/efectos adversos , Fumar/mortalidad , América del Sur/epidemiología , Factores de Tiempo
15.
J R Soc Interface ; 9(77): 3503-13, 2012 Dec 07.
Artículo en Inglés | MEDLINE | ID: mdl-22915633

RESUMEN

Severe heat-shock to bone cells caused during orthopaedic procedures can result in thermal damage, leading to cell death and initiating bone resorption. By contrast, mild heat-shock has been proposed to induce bone regeneration. In this study, bone cells are exposed to heat-shock for short durations occurring during surgical cutting. Cellular viability, necrosis and apoptosis are investigated immediately after heat-shock and following recovery of 12, 24 h and 4 days, in osteocyte-like MLO-Y4 and osteoblast-like MC3T3-E1 cells, using flow cytometry. The regeneration capacity of heat-shocked Balb/c mesenchymal stem cells (MSCs) and MC3T3-E1s has been investigated following 7 and 14 day's recovery, by quantifying proliferation, differentiation and mineralization. An immediate necrotic response to heat-shock was shown in cells exposed to elevated temperatures (45°C, 47°C and most severe at 60°C). A longer-term apoptotic response is induced in MLO-Y4s and, to a lesser extent, in MC3T3-E1s. Heat-shock-induced differentiation and mineralization by MSCs. These findings indicate that heat-shock is more likely to induce apoptosis in osteocytes than osteoblasts, which might reflect their role as sensors detecting and communicating damage within bone. Furthermore, it is shown for the first time that mild heat-shock (less than equal to 47°C) for durations occurring during surgical cutting can positively enhance osseointegration by osteoprogenitors.


Asunto(s)
Respuesta al Choque Térmico , Células Madre Mesenquimatosas/fisiología , Procedimientos Ortopédicos/efectos adversos , Temperatura , Células 3T3 , Animales , Apoptosis , Resorción Ósea , Calcificación Fisiológica , Calcio/metabolismo , Diferenciación Celular , Línea Celular , Proliferación Celular , Ratones , Ratones Endogámicos BALB C , Necrosis , Osteoblastos/citología , Osteoblastos/fisiología , Osteocitos/citología , Osteocitos/fisiología , Factores de Tiempo
16.
Neurology ; 77(8): 738-43, 2011 Aug 23.
Artículo en Inglés | MEDLINE | ID: mdl-21849640

RESUMEN

OBJECTIVE: In the North Dublin Population Stroke Study, we investigated the risk of recurrent stroke within the 14-day time window recommended for endarterectomy. METHODS: In a population-based prospective cohort study, all ischemic stroke patients were identified over 1 year and categorized into those with (CS-positive) and without (CS-negative) ipsilateral carotid stenosis (CS) (≥50% lumen narrowing). Nonprocedural stroke recurrence was determined at 72 hours and 7 and 14 days. RESULTS: Of 365 ischemic stroke patients with carotid imaging, 51 were excluded due to posterior circulation or nonlateralizing stroke, ipsilateral carotid occlusion, or intracranial stenosis, leaving 314 included for analysis (36 CS-positive and 278 CS-negative). Recurrent stroke occurred in 5.6% (2/36) CS-positive and 0.4% (1/278) CS-negative patients by 72 hours of symptom onset (p =0.003), 5.6% (2/36) CS-positive and 0.7% (2/278) CS-negative patients (p =0.01) by 7 days, and in 8.3% (3/36) CS-positive and 1.8% (5/278) CS-negative patients by 14 days (p =0.02). On multivariable Cox regression analysis, CS was the only independent predictor of recurrence at 72 hours (adjusted hazard ratio [HR] 36.1, 95% confidence interval [CI] 1.6-837.5, p =0.03), and 7 days (HR 9.1, 1.1-79.2, p =0.05), with a trend at 14 days (HR 4.6, 0.9-22.8, p =0.06). CONCLUSIONS: Although only a minority of patients with symptomatic CS had a recurrent stroke within 14 days, early recurrent stroke risk was high, particularly within the first 72 hours. Earlier carotid revascularization or improved acute medical treatment may reduce recurrence in this high-risk group.


Asunto(s)
Endarterectomía Carotidea/métodos , Accidente Cerebrovascular/cirugía , Anciano , Anciano de 80 o más Años , Estenosis Carotídea/complicaciones , Estenosis Carotídea/cirugía , Estudios de Cohortes , Femenino , Lateralidad Funcional , Humanos , Irlanda/epidemiología , Angiografía por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Recurrencia , Análisis de Regresión , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodos
17.
Blood Press Monit ; 9(6): 307-9, 2004 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-15564985

RESUMEN

BACKGROUND: The prevalence of white-coat hypertension (WCH) is considerable in patients referred with elevated office blood pressure. Failure to recognise this phenomenon can lead to the inappropriate use of antihypertensive medications. We undertook this study to determine the profile of patients with WCH. METHODS: Baseline clinic and daytime ambulatory blood pressures were available from 5716 patients referred over a 22-year period. Individuals were considered to have WCH if they had an elevated clinic blood pressure measurement greater than 140/90 mmHg and normal daytime mean ambulatory blood pressure. Mean age was 53.6 years and 53.2% were female. RESULTS: The overall prevalence of white-coat hypertension was 15.4%. A higher prevalence was seen amongst older adults, females, and non-smokers. CONCLUSION: Multivariate logistic regression analysis confirmed these characteristics as independent predictors of WCH.


Asunto(s)
Determinación de la Presión Sanguínea , Hipertensión/diagnóstico , Hipertensión/epidemiología , Consultorios Médicos , Humanos , Análisis Multivariante , Prevalencia , Análisis de Regresión
18.
Environ Pollut ; 111(1): 21-7, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-11202712

RESUMEN

The dechlorination of atrazine (2-chloro-4-ethylamino-6-isopropylamino-1,3,5-triazine) via reaction with metallic iron under low-oxygen conditions was studied using reaction mixture pH values of 2.0, 3.0, and 3.8. The pH control was achieved through addition of sulfuric acid throughout the duration of the reaction. The lower the pH of the reaction mixture, the faster the degradation of atrazine. The surface area of the sulfuric acid-treated iron particles was 0.31 (+/- 0.01) m2 g-1 and the surface area normalized initial pseudo-first order rate constants (kSA, where rate = kSA x (surface area/l) x [Atrazine]) at pH values of 2.0, 3.0, and 3.8 were equal to, respectively, 3.0 (+/- 0.4) x 10(-3) min-1 m-2 l, 5 (+/- 3) x 10(-4) min-1 m-2 l, and 1 (+/- 1) x 10(-4) min-1 m-2 l. The observed products of the degradation reaction were dechlorinated atrazine (2-ethylamino-4-isopropylamino-1,3,5-triazine) and possibly hydroxyatrazine (2-ethylamino-4-isopropylamino-6-hydroxy-s-triazine). Triazine ring protonation may account, at least in part, for the observed effect of pH on atrazine dechlorination via metallic iron.


Asunto(s)
Atrazina/química , Herbicidas/química , Hierro , Contaminantes Químicos del Agua , Ácidos , Contaminación Ambiental , Humanos , Concentración de Iones de Hidrógeno
19.
Cancer Res ; 57(14): 2933-6, 1997 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-9230204

RESUMEN

A methylator-resistant human glioblastoma multiforme xenograft, D-245 MG (PR), in athymic nude mice was established by serially treating the parent xenograft D-245 MG with procarbazine. D-245 MG xenografts were sensitive to procarbazine, temozolomide, N-methyl-N-nitrosourea, 1,3-bis(2-chloroethyl)-1-nitrosourea, 9-aminocamptothecin, topotecan, CPT-11, cyclophosphamide, and busulfan. D-245 MG (PR) xenografts were resistant to procarbazine, temozolomide, N-methyl-N-nitrosourea, and busulfan, but they were sensitive to the other agents. Both D-245 MG and D-245 MG (PR) xenografts displayed no O6-alkylguanine-DNA alkyltransferase activity, and their levels of glutathione and glutathione-S-transferase were similar. D-245 MG xenografts expressed the human mismatch repair proteins hMSH2 and hMLH1, whereas D-245 MG (PR) expressed hMLH1 but not hMSH2.


Asunto(s)
Metilación de ADN , Reparación del ADN , Glioblastoma/tratamiento farmacológico , Animales , Resistencia a Medicamentos , Glioblastoma/genética , Humanos , Hormonas Estimuladoras de los Melanocitos/análisis , Metiltransferasas/metabolismo , Ratones , Ratones Endogámicos BALB C , Repeticiones de Microsatélite , Trasplante de Neoplasias , O(6)-Metilguanina-ADN Metiltransferasa , Trasplante Heterólogo , Células Tumorales Cultivadas
20.
Cytotechnology ; 19(3): 237-42, 1996.
Artículo en Inglés | MEDLINE | ID: mdl-8862012

RESUMEN

The correlation between cellular resistance to radiation and to chemotherapeutic drugs has been investigated in a number of solid tumour cell lines, and preliminary results indicate no direct relationship. The acquisition of a multidrug resistance (MDR) profile by adriamycin-selected variants of a human squamous lung carcinoma, an ovarian carcinoma, a cervical carcinoma and by a colchicine-selected variant of a Chinese hamster ovarian carcinoma resulted in alterations to their radiosensitivity. However, the degree of change in the radiosensitivity of the MDR cell lines could not be predicted from their level of resistance to adriamycin. Clonal populations derived from DLKP-A, an adriamycin-selected MDR variant of the human lung carcinoma cell line DLKP, exhibited individual radiosensitivity profiles, which did not correlate with their chemoresistance. Exposure of DLKP to consecutive increasing doses of radiation did not confer cross-resistance to chemotherapeutic drugs.


Asunto(s)
Resistencia a Múltiples Medicamentos , Resistencia a Antineoplásicos , Neoplasias/patología , Tolerancia a Radiación , Animales , Antibióticos Antineoplásicos/farmacología , Antineoplásicos Fitogénicos/farmacología , Carcinoma/patología , Carcinoma de Células Escamosas/patología , División Celular/efectos de los fármacos , División Celular/efectos de la radiación , Cisplatino/farmacología , Células Clonales/patología , Cricetinae , Cricetulus , Relación Dosis-Respuesta a Droga , Relación Dosis-Respuesta en la Radiación , Doxorrubicina/farmacología , Etopósido/farmacología , Femenino , Células HeLa/efectos de los fármacos , Células HeLa/efectos de la radiación , Humanos , Neoplasias Laríngeas/patología , Neoplasias Pulmonares/patología , Neoplasias Ováricas/patología , Selección Genética , Células Tumorales Cultivadas/efectos de los fármacos , Células Tumorales Cultivadas/efectos de la radiación , Neoplasias del Cuello Uterino/patología , Vincristina/farmacología
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