The influence of age, sex and cardiorespiratory fitness on maximal fat oxidation rate.

Fat oxidation decreases with age, yet no studies have previously investigated if aging affects the maximal fat oxidation rate (MFO) during exercise in men and women differently. We hypothesized that increased age would be associated with a decline in MFO and this would be more pronounced in women due to menopause, compared with men. In this cross-sectional study design, 435 (247/188, male/female) subjects of varying ages performed a DXA scan, a submaximal graded exercise test and a maximal oxygen uptake test, to measure MFO and cardiorespiratory fitness (CRF) by indirect calorimetry. Subjects were stratified into 12 groups according to sex (male/female), age (<45, 45-55 and >55 years), CRF (below average and above average). Women aged <45 years had a higher MFO relative to fat free mass (FFM) (mg/min/kg) compared with men, regardless of CRF. However, there were no differences in MFO (mg/min/kg FFM) between men and women, in the groups aged between 45-55 and >55 years. In summary, we found that women aged <45 years display a higher MFO (mg/min/kg FFM) compared with men and that this sexual divergence is abolished after the age of 45 years. Novelty: Maximal fat oxidation rate is higher in young women compared with men. This sex-related difference is attenuated after the age of 45 years. Cardiorespiratory fitness does not influence this sex-related difference.

Validation of the Danish version of the Critical Care Pain Observation Tool.

BACKGROUND: Assessing pain in critically ill patients is a challenge even in an intensive care unit (ICU) with a no sedation protocol. The aim of this study was to validate the Danish version of the pain assessment method; Critical Care Pain Observation Tool (CPOT) in an ICU with a no sedation protocol. METHODS: Seventy patients were included in this study. The patients were observed during a non-nociceptive procedure (wash of an arm) and a nociceptive procedure (turning). Patients were observed before, during, and 15 min after the two interventions (six assessments). Two observers participated in the data collection and CPOT scores were blinded to each other. Calculations of interrater reliability, criterion validity and discriminant validity were performed to validate the Danish version of CPOT. RESULTS: The results indicated a good correlation between the two raters (all scores > 0.9 and P < 0.05). About 48 (68.6%) of the included patients were able to self-report pain. We found a significantly higher mean CPOT score at the nociceptive procedure than at rest or the non-nociceptive procedure (P < 0.05). No correlation was found between CPOT scores and physiological indicators. Patients self-reported pain and CPOT showed a significant correlation (P < 0.05). A CPOT score of ≥ 3 correlated with patients' self-reported pain (ROC AUC 0.83). CONCLUSION: The Danish version of CPOT can be used to assess pain in critically ill patients, also when the ICU has a no sedation protocol. CPOT scores showed a good interrater reliability and correlates well with patient's self-reported pain.

Plasma brain-derived neurotrophic factor and prefrontal white matter integrity in late-onset depression and normal aging.

OBJECTIVE: To explore the relationship between brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF), cerebral deep white matter lesions (DWMLs), and measures of white matter integrity in patients with late-onset depression, with respect to vascular risk factors. METHOD: We examined 22 patients with late-onset depression and 22 matched controls. Quantification of plasma BDNF and VEGF levels were performed with enzyme-linked immunosorbent assay (ELISA) kits. Measures of white matter integrity comprised apparent diffusion coefficient (ADC) and fractional anisotropy (FA), obtained by diffusion tensor imaging (DTI). Effects of DWMLs, FA, ADC, and vascular risk factors on BDNF and VEGF were assessed using multiple linear regression. RESULTS: The BDNF and VEGF levels did not differ significantly between groups. With pooled data for patients and controls, the BDNF level was positively associated with both number (t = 2.14, P = 0.039) and volume (t = 2.04, P = 0.048) of prefrontal DWMLs and negatively associated with FA in prefrontal normal-appearing white matter (t = -2.40, P = 0.02), adjusted for age and gender. Smoking and hypercholesterolemia was positively associated with the BDNF (t = 2.36, P = 0.023) and VEGF levels (t = 2.28, P = 0.028), respectively. CONCLUSION: Our results suggest a role for BDNF in the complex pathophysiologic mechanisms underlying DWMLs in both normal aging and late-onset depression.

Localization of white-matter lesions and effect of vascular risk factors in late-onset major depression.

BACKGROUND: Several studies suggest that patients with late-onset major depression (MD) have an increased load of cerebral white-matter lesions (WMLs) compared with age-matched controls. Vascular risk factors such as hypertension and smoking may confound such findings. Our aim was to investigate the association between the localization and load of WMLs in late-onset MD with respect to vascular risk factors. METHOD: We examined 22 consecutive patients with late-onset first-episode MD and 22 age- and gender-matched controls using whole-brain magnetic resonance imaging (MRI). The localization, number and volume of WMLs were compared between patients and controls, while testing the effect of vascular risk factors. RESULTS: Among subjects with one or more WMLs, patients displayed a significantly higher WML density in two white-matter tracts: the left superior longitudinal fasciculus and the right frontal projections of the corpus callosum. These tracts are part of circuitries essential for cognitive and emotional functions. Analyses revealed no significant difference in the total number and volume of WMLs between groups. Patients and controls showed no difference in vascular risk factors, except for smoking. Lesion load was highly correlated with smoking. CONCLUSIONS: Our results indicate that lesion localization rather than lesion load differs between patients with late-onset MD and controls. Increased lesion density in regions associated with cognitive and emotional functions may be crucial in late-onset MD, and vascular risk factors such as smoking may play an important role in the pathophysiology of late-onset MD, consistent with the vascular depression hypothesis.

Dynamic changes in corticospinal tracts after stroke detected by fibretracking.

BACKGROUND AND AIMS: The integrity of motor pathways and functional connectivity patterns are important in assessing plastic changes related to successful recovery, to obtain prognostic information and to monitor future therapeutic strategies of stroke patients. We tested the following hypotheses: (1) that changes in axonal integrity along the corticospinal tract after stroke can be detected as a reduction in fractional anisotropy; and (2) that sustained low fractional anisotropy is indicative of axonal loss and therefore is correlated with poor motor outcome, as measured by specific neurological motor scores. METHODS: We developed a segmentation tool based on magnetic resonance diffusion tensor imaging in conjunction with three dimensional fibretracking for longitudinal studies of the corticospinal tract, and used specific neurological motor scores to test the hypotheses in five stroke patients within the first week and 30 and 90 days after the stroke. RESULTS: Reduction in fractional anisotropy within the first weeks after stroke reflected a decline in axonal integrity, leading to Wallerian degeneration, and demonstrated a correlation between the temporal evolution of fractional anisotropy and motor function in patients with poor motor outcome. CONCLUSION: The study demonstrated the feasibility of fibretracking as a segmentation tool for mapping distal parts of the corticospinal motor pathways and showed that fractional anisotropy in the segmented corticospinal tract is a sensitive measure of structural changes after stroke.

Clinical outcome of patients with suspected pulmonary embolism. A follow-up study of 588 consecutive patients.

OBJECTIVE: To investigate the clinical outcome in patients with clinically suspected pulmonary embolism (PE). Design and setting. In a retrospective design we studied 588 consecutive patients with suspected PE and referred for lung scintigraphy from 1995 to 1998. The mean follow-up time was 653 +/- 424 days. RESULTS: The diagnosis of PE was confirmed in 194 and excluded in 394 patients, respectively. The overall prevalence of PE was 33%. Amongst clinical and paraclinical variables, age, chronic obstructive pulmonary disease (COPD), heart rate, pleuritic pain, presence of deep venous thrombosis (DVT), electrocardiographic signs of right ventricular (RV) strain were identified as independent predictors of the diagnosis of PE. Amongst patients with PE anticoagulation was given in 96% for at least 3 months and 13% received thrombolytic therapy. Recurrent PE was seen in 6% of patients with PE whereas none of the patients with no diagnosis of PE suffered PE during follow-up. The 1 year mortality was 18% amongst patients with PE and 15% in patients with excluded PE (P=NS). The cause of death amongst patients with PE was cancer (49%) and PE (28%), whereas patients without PE had an excess mortality because of cancer, COPD, acute myocardial infarction and heart failure. CONCLUSION: Patients admitted to hospital on suspicion of PE have increased risk of adverse clinical outcome whether the diagnosis of PE is confirmed or not. This indicates that the patients where the diagnosis is excluded often suffer from other serious illness that warrants further investigations.

[Characteristics and treatment of acute pulmonary embolism. A study of 183 consecutive patients treated during the period 1995 to 1998]. / Karakteristik og behandling af akut lungeemboli. En undersøgelse af 183 konsekutive patienter behandlet i perioden 1995 til 1998.

The aim of the present study was to evaluate the clinical characteristics and mortality in patients with pulmonary embolism during 1995-1998. The diagnosis of pulmonary embolism in 183 patients was confirmed based on the clinical and lung scan findings. Compared to previous studies fewer cases with pulmonary embolism after surgery, immobilisation and history of trauma to lower extremity were noted. Deep vein thrombosis and electrocardiographic signs of acute right ventricular strains were found frequently, and should support the suspicion of pulmonary embolism. A normal plasma fibrin D-dimer was noted in several patients. When using the D-dimer for the diagnosis of pulmonary embolism the result given depends on the assay method used, the assay specific discriminatory level and duration of symptoms. The total one year mortality was 16% whereas the mortality due to pulmonary embolism was 6%.

Steroid reversibility test followed by inhaled budesonide or placebo in outpatients with stable chronic obstructive pulmonary disease. The Danish Society of Respiratory Medicine.

The aim of this study was evaluate the predictive value of a 2 week course of prednisolone on the effect of 6 months treatment with inhaled budesonide in patients with stable chronic obstructive pulmonary disease (COPD). Forty patients with stable COPD entered the study, and received prednisolone (37.5 mg o.d.) for 2 weeks. They were subsequently divided into steroid-irreversible and steroid-irreversible, using 15% of baseline as a dividing point. In each group patients were randomized to receive budesonide 400 micrograms b.i.d. or placebo for 6 months. During treatment with prednisolone, three patients dropped out because of side effects. Of the remaining 37, only two patients (5%) were reversible with prednisolone forced expiratory volume in 1s [(FEV1) > 15% of baseline], and among the steroid-irreversible, 26 patients were evaluated after 6 months treatment with either placebo or budesonide. No significant differences in spirometry values, symptoms, or number of exacerbations were found between these two groups. Reversibility with prednisolone is rarely seen in COPD. In outpatients with stable COPD and no signs of asthma or atopy, 2 weeks treatment with prednisolone seems to be of no value in choosing subsequent long-term therapy.

Long term follow up of patients who underwent jejunoileal bypass for morbid obesity.

OBJECTIVE: To describe our long term results after jejunoileal (JI) bypass for morbid obesity. DESIGN: Retrospective study. SETTING: Teaching hospital, Denmark SUBJECTS: All 57 patients who underwent JI bypass for morbid obesity between January 1973 and December 1988. INTERVENTIONS: Type A and type B JI bypass. MAIN OUTCOME MEASURES: Weight loss, operative morbidity and mortality, and subjective evaluation of the results. RESULTS: Mean duration of follow up was 15.9 years (range 8-22). There were no operative or early postoperative deaths, but there were 7 late deaths (12%). 5 patients developed postoperative complications (9%), and 11 patients (19%) required reoperation for side effects or complications. The mean body mass index (BMI, kg/m2) was reduced from 47.5 (range 40-60) to 32 (range 22-49) during the follow up period which corresponded to a weight loss of about 42 kg. Of the 39 patients who still had a JI bypass in 1994, nearly two thirds said that they were satisfied with the operation, though they nearly all had some side effects such as diarrhoea or intermittent abdominal pain. CONCLUSION: As complications of JI bypass can develop at any time, we suggest that all patients who have had the operation should be regularly followed up at special clinics so that complications can be diagnosed and treated as soon as possible.

The use of computers in cancer pain management.

OBJECTIVES: To provide an overview of the present use of computer technology in cancer pain management. DATA SOURCES: Review articles, research studies, and books pertaining to the use of computers in cancer pain management. CONCLUSIONS: The availability of computer resources for cancer pain and nursing are limited. However, the application of computer technology to cancer pain management has the potential to improve our delivery of care, educate both health care professionals and consumers, and improve outcome measures. IMPLICATIONS FOR NURSING PRACTICE: Computers can assist our efforts to improve quality of care, teaching, research, and communication with patients. It is essential for nurses to be knowledgeable about available computer resources and the application of new technology.

Anesthesia alternatives for ophthalmic surgery.

1. Traditionally, local anesthesia has only been used in patients with coexisting diseases that jeopardize the safety of general anesthesia. Local anesthesia, however, provides a number of advantages that make it suitable for ophthalmic surgery of both the anterior and posterior segment. 2. Preoperative emotional and physical assessment and patient counseling is essential to the successful use of local anesthesia. 3. Anxiety that exists intraoperatively can be relieved by sedentary social diversions such as listening to music, handholding, and other holistic approaches. 4. Discomfort caused by draping can be eliminated by using a drapeholder that lifts the drapes away, providing the patient with a high flow of air.

Mineral content of the free-living nematode Turbatrix aceti and ruminant parasite Trichostrongylus colubriformis.

1. The parasitic nematode Trichostrongylus colubriformis and free-living nematode Turbatrix aceti were examined for element content. 2. T. colubriformis contained significantly less phosphorus, potassium, manganese and boron than T. aceti. 3. T. colubriformis contained significantly more nitrogen and copper than T. aceti. 4. Comparative study of the chemical composition of parasitic vs free-living nematodes may facilitate in vitro cultivation of the parasitic forms.