Symptom Perception, Evaluation, Response to Symptom, and Delayed Care Seeking in Patients With Acute Heart Failure: An Observational Study.

BACKGROUND: Exacerbation of heart failure (HF) requires early intervention to prevent hospital admission and to reduce mortality. Early care seeking requires that patients perceive symptoms, accurately evaluate perceived symptoms, and respond appropriately. How perception, evaluation, and response to symptoms are associated with delay in seeking care for worsening symptoms has rarely been studied. OBJECTIVE: The aims of this study were to investigate the associations of perception of symptoms, evaluation of symptoms, and response to symptoms with delayed care seeking in patients with HF and to identify factors associated with delayed care seeking. METHODS: Patients admitted for acute exacerbation of HF were enrolled in this cross-sectional observational study. We used structured interviews, questionnaires, and medical record review to collect data. Factors related to delayed care seeking were identified using nonlinear regression. RESULTS: Analysis was performed in 109 patients with HF. The median delay time was 124 hours. Delayed care seeking was associated with younger age and perception of fatigue, whereas evaluation of and response to symptoms were not associated with delay. CONCLUSIONS: Few characteristics of the symptom experience are associated with delayed care seeking among patients with HF who experience an exacerbation of symptoms. Further research is needed to determine why early care seeking is difficult among patients with HF.

Synthesis and Biological Evaluation of Cyclopentaquinoline Derivatives as Nonsteroidal Glucocorticoid Receptor Antagonists.

The steroidal glucocorticoid antagonist mifepristone has been reported to improve the symptoms of depression. We report the discovery of 6-(3,5-dimethylisoxazol-4-yl)-2,2,4,4-tetramethyl-2,3,4,7,8,9-hexahydro-1H-cyclopenta[h]quinolin-3-one 3d (QCA-1093) as a novel nonsteroidal glucocorticoid receptor antagonist. The compound displayed potent in vitro activity, high selectivity over other steroid hormone receptors, and significant antidepressant-like activity in vivo.

Plasma dehydroepiandrosterone sulphate and insulin-like growth factor I levels in obstructive sleep apnoea syndrome.

CONTEXT: We aimed to assess whether obstructive sleep apnoea syndrome (OSAS) affects plasma IGF-1 and dehydroepiandrosterone sulphate (DHEA-S) levels in men, factors implicated in the development of age-related metabolic disorders. DESIGN: We conducted a cross-sectional and longitudinal clinical study. PATIENTS AND SETTING: We measured plasma IGF-1 and DHEA-S levels in 191 non-drug-treated Japanese men (34 primary snorers (PS), 88 patients with mild-to-moderate OSAS and 69 patients severe OSAS ). RESULTS: Plasma IGF-1 and DHEA-S were negatively correlated with age. Plasma IGF-1 was also negatively correlated with plasma glucose, HOMA-IR and systolic blood pressure and apnoea parameters such as the apnoea-hypopnea index, minimum oxygen saturation and slow-wave sleep (SWS) time. Plasma DHEA-S was associated with plasma glucose, HbA1c and free fatty acid and was negatively correlated with SWS time. To eliminate the influence of age, PS, patients with mild-to-moderate OSAS and severe OSAS were divided into three groups by age: young (<40 years), middle-aged (40-59 years) and elderly (≥ 60 years). Patients with severe OSAS aged <40 or <60 years had lower plasma IGF-1 or DHEA-S levels, respectively, than did the corresponding snorers and mild-to-moderate OSAS groups. Continuous positive airway pressure therapy for generally 16-18 months increased plasma IGF-1 levels in patients with severe OSAS aged <40 years (n = 18). Plasma DHEA-S levels were increased in patients with severe OSAS aged <60 years, whose DHEA-S level was below the mean value for that age (n = 23/41). CONCLUSION: Severe OSAS could reduce plasma IGF-1 and DHEA-S levels in younger, but not elderly Japanese men, which is potentially associated with the development of metabolic abnormalities.

Accurate enumeration and identification of Testacea (Protozoa, Rhizopoda) in forest soil using scanning electron microscopy.

A new procedure is used for separating Testacea from soil, based on dispersion, sequential centrifugation settling, and subsequent filtration of the soil suspension. Combined with scanning electron microscopy (SEM), this procedure allows accurate enumeration of Testacea, with a recovery rate of 90% and more precise counting (relative standard deviation, RSD: 5%) of Testacea than in previous works.