RESUMO
BACKGROUND AND PURPOSE: The Systolic Blood Pressure Intervention (SPRINT) randomized trial demonstrated that intensive blood pressure management resulted in slower progression of cerebral white matter hyperintensities, compared with standard therapy. We assessed longitudinal changes in brain functional connectivity to determine whether intensive treatment results in less decline in functional connectivity and how changes in brain functional connectivity relate to changes in brain structure. MATERIALS AND METHODS: Five hundred forty-eight participants completed longitudinal brain MR imaging, including resting-state fMRI, during a median follow-up of 3.84 years. Functional brain networks were identified using independent component analysis, and a mean connectivity score was calculated for each network. Longitudinal changes in mean connectivity score were compared between treatment groups using a 2-sample t test, followed by a voxelwise t test. In the full cohort, adjusted linear regression analysis was performed between changes in the mean connectivity score and changes in structural MR imaging metrics. RESULTS: Four hundred six participants had longitudinal imaging that passed quality control. The auditory-salience-language network demonstrated a significantly larger decline in the mean connectivity score in the standard treatment group relative to the intensive treatment group (P = .014), with regions of significant difference between treatment groups in the cingulate and right temporal/insular regions. There was no treatment group difference in other networks. Longitudinal changes in mean connectivity score of the default mode network but not the auditory-salience-language network demonstrated a significant correlation with longitudinal changes in white matter hyperintensities (P = .013). CONCLUSIONS: Intensive treatment was associated with preservation of functional connectivity of the auditory-salience-language network, while mean network connectivity in other networks was not significantly different between intensive and standard therapy. A longitudinal increase in the white matter hyperintensity burden is associated with a decline in mean connectivity of the default mode network.
Assuntos
Encéfalo , Hipertensão , Humanos , Pressão Sanguínea , Encéfalo/diagnóstico por imagem , Imageamento por Ressonância Magnética , Hipertensão/diagnóstico por imagem , Hipertensão/tratamento farmacológico , Mapeamento Encefálico/métodosRESUMO
BACKGROUND AND PURPOSE: Rates of type 2 diabetes are higher among African Americans compared with individuals of European ancestry. The purpose of this investigation was to determine the relationship between MR imaging measures of brain structure (volume of GM, WM, WM lesions) and cognitive function in a population of African Americans with type 2 diabetes. These MR imaging measures of brain structure are affected by type 2 diabetes-associated macrovascular and microvascular disease and may be associated with performance on tasks of cognitive function in the understudied African American population. MATERIALS AND METHODS: African Americans with type 2 diabetes enrolled in the African American-Diabetes Heart Study MIND study (n = 263) were evaluated across a broad range of cognitive domains and imaged with brain MR imaging. Associations between cognitive parameters and MR imaging measures of whole-brain GM, WM, and WM lesion volumes were assessed by using adjusted multivariate models. RESULTS: Lower GM volume was associated with poorer performance on measures of general cognitive function, working memory, and executive function. Higher WM lesion volume was associated with poorer performance on a smaller subset of cognitive domains compared with GM volume but included aspects of working memory and executive function. There were no statistically significant associations with WM volume. CONCLUSIONS: Markers of cortical atrophy and WM lesion volume are associated with cognitive function in African Americans with type 2 diabetes. These associations are described in an African American cohort with disease control similar to that of individuals of European ancestry, rather than underserved African Americans with poor access to health care. Interventions to reduce cortical atrophy and WM disease may improve cognitive outcomes in this understudied population.
Assuntos
Encéfalo/patologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Negro ou Afro-Americano , Atrofia/patologia , Cognição , Humanos , Imageamento por Ressonância Magnética/métodos , MasculinoRESUMO
PURPOSE: Report the radiographic and magnetic resonance imaging (MRI) structural outcomes of an 18-month study of diet-induced weight loss, with or without exercise, compared to exercise alone in older, overweight and obese adults with symptomatic knee osteoarthritis (OA). METHODS: Prospective, single-blind, randomized controlled trial that enrolled 454 overweight and obese (body mass index, BMI = 27-41 kg m(-2)) older (age ≥ 55 yrs) adults with knee pain and radiographic evidence of femorotibial OA. Participants were randomized to one of three 18-month interventions: diet-induced weight loss only (D); diet-induced weight loss plus exercise (D + E); or exercise-only control (E). X-rays (N = 325) and MRIs (N = 105) were acquired at baseline and 18 months follow-up. X-ray and MRI (cartilage thickness and semi-quantitative (SQ)) results were analyzed to compare change between groups at 18-month follow-up using analysis of covariance (ANCOVA) adjusted for baseline values, baseline BMI, and gender. RESULTS: Mean baseline descriptive characteristics of the cohort included: age, 65.6 yrs; BMI 33.6 kg m(-2); 72% female; 81% white. There was no significant difference between groups in joint space width (JSW) loss; D -0.07 (SE 0.22) mm, D + E -0.27 (SE 0.22) mm and E -0.16 (SE 0.24) mm (P = 0.79). There was also no significant difference in MRI cartilage loss between groups; D -0.10(0.05) mm, D + E -0.13(0.04) mm and E -0.05(0.04) mm (P = 0.42). CONCLUSION: Despite the potent effects of weight loss in this study on symptoms as well as mechanistic outcomes (such as joint compressive force and markers of inflammation), there was no statistically significant difference between the three active interventions on the rate of structural progression either on X-ray or MRI over 18-months.
Assuntos
Dieta Redutora , Terapia por Exercício/métodos , Osteoartrite do Joelho/terapia , Idoso , Índice de Massa Corporal , Terapia Combinada , Progressão da Doença , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/dietoterapia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/etiologia , Radiografia , Índice de Gravidade de Doença , Método Simples-Cego , Resultado do Tratamento , Redução de PesoRESUMO
Oxygen delivery requires that Red Blood Cells (RBCs) must be deformable to pass through the microcirculation. Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by abnormal extracellular deposition of beta-amyloid peptide (Abeta) and neuronal loss. We have analyzed RBC morphology in blood from subjects with AD and found that > 15% of the RBCs are elongated as compared to 5.9% in normal controls (p < 0.0001). To determine whether these morphology changes can be associated with the greater exposure of RBCs to AP in AD subjects, we investigated the in vitro effect of Abeta fibrils on blood. Morphological analysis of RBCs treated with Abeta1-40 or Abeta1-42 fibrils show 8.6% or 11.1% elongated cells, respectively. In contrast, only 2.9% or 1.3% of RBCs are elongated when blood is treated with buffer or mock fibrils generated from Abeta42-1. Elongated RBCs are expected to be less deformable. This prediction is consistent with our earlier studies showing impaired deformability of RBCs treated with Abeta fibrils. An additional factor previously reported by us, expected to impair the flow of RBCs through the microcirculation is their adherence to endothelial cells (ECs) when Abeta1-40 fibrils are bound to either RBCs or ECs. This factor would be more pronounced in AD subjects with elevated levels of Abeta on the vasculature. These results suggest that Abeta interactions with RBCs in AD subjects can result in impaired oxygen transport and delivery, which will have important implications for AD.
Assuntos
Doença de Alzheimer/fisiopatologia , Peptídeos beta-Amiloides/metabolismo , Eritrócitos/fisiologia , Oxigênio/metabolismo , Doença de Alzheimer/patologia , Estudos de Casos e Controles , Eritrócitos/citologia , HumanosRESUMO
The epidemic of late life dementia, prominence of use of alternative medications and supplements, and initiation of efforts to determine how to prevent dementia have led to efforts to conduct studies aimed at prevention of dementia. The GEM (Ginkgo Evaluation of Memory) and GuidAge studies are ongoing randomized double-blind, placebo-controlled trials of Ginkgo biloba, administered in a dose of 120 mg twice per day as EGb761, to test whether Ginkgo biloba is effective in the prevention of dementia (and especially Alzheimer's disease) in normal elderly or those early cognitive impairment. Both GEM and GuidAge will also add substantial knowledge to the growing need for expertise in designing and implementing clinical trials to test the efficacy of putative disease-modifying agents for the dementias. While there are many similarities between GEM and Guidage, there are also significant differences. We present here the first comparative design and baseline data fromGEM and Guidage, two of the largest dementia primary prevention trials to date.
Assuntos
Demência/prevenção & controle , Demência/terapia , Ginkgo biloba , Fitoterapia , Extratos Vegetais/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: This preliminary study sought to determine whether using 1500/1200mg of glucosamine hydrochloride and chondroitin sulfate (GH/CS) is effective, both separately and combined with exercise, compared to a placebo plus exercise program in improving physical function, pain, strength, balance, and mobility in older adults with knee osteoarthritis (OA). METHODS: This double-blind, placebo-controlled, randomized clinical trial lasted 12 months. Participants included 89 older adults (age>/=50 years) with knee OA randomized to either GH/CS or placebo group. Phase I was a 6-month trial comparing the effects of assignment to either GH/CS or placebo. Phase II added 6 months of exercise for both groups. The primary outcome measure was Western Ontario and McMaster University Osteoarthritis Index (WOMAC) function, and secondary outcome measures included WOMAC pain, 6-min walk, balance, and knee strength. RESULTS: Of the 89 randomized participants, 72 (81%) completed the study. The median pill compliance was 94% and 95% in Phase I, and, in Phase II, 97% and 91% for the GH/CS and placebo groups, respectively. Median exercise compliance during Phase II was 77% for the GH/CS group and 78% for the placebo group. WOMAC function and pain did not differ significantly between the groups at 6- or 12-month follow-up. There were also no significant differences between the groups in 6-min walk or knee strength; however, balance was better in the placebo group with approximately a 10% difference compared to the GH/CS group. CONCLUSIONS: The GH/CS group was not superior to the placebo group in function, pain, or mobility after both phases of the intervention (pill only and pill plus exercise).
Assuntos
Analgésicos não Narcóticos/uso terapêutico , Condroitina/uso terapêutico , Terapia por Exercício , Glucosamina/uso terapêutico , Osteoartrite do Joelho/terapia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Cooperação do Paciente , Índice de Gravidade de DoençaRESUMO
The purpose of this study was to conduct a pilot clinical trial to test the feasibility and efficacy of an exercise program and anti-depressant treatment compared with usual care in improving the emotional and physical functioning of older adults with minor depression. Participants were 37 older adults with minor depression who were randomized to exercise, sertraline, or usual care; 32 participants completed the 16-week study. Outcomes included measures of both emotional (clinician and self-report) and physical (observed and self-report) functioning. There were trends for the superiority of the exercise and sertraline conditions over usual care in improving SF-36 mental health scores and clinician-rated depression scores. Individuals in the exercise condition showed greater improvements in physical functioning than individuals in the usual care condition. Both sertraline and exercise show promise as treatments for late-life minor depression. However, exercise has the added benefit of improving physical functioning as well.
Assuntos
Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Exercício Físico/psicologia , Sertralina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Projetos Piloto , Inquéritos e Questionários , Estados UnidosRESUMO
AIMS/HYPOTHESIS: We systematically reviewed and summarised prospective data relating diabetes status to changes in cognitive function over time. METHODS: Published reports of longitudinal studies that described assessment of cognitive function in people with diabetes were sought. Studies were included if they assessed cognitive function in participants with diabetes at the beginning and at follow-up. Studies were excluded if they had (1) a follow-up period of less than 1 year, (2) a rate of loss to follow-up in excess of 30%, or (3) described selected subgroups. Change in cognitive function was recorded as either the mean change in score and/or the proportion of individuals developing various degrees of change in cognitive function. A pooled estimate was calculated for the latter. RESULTS: Of 1,165 abstracts and titles initially identified, 25 articles met the inclusion and exclusion criteria. Individuals with diabetes had a 1.2- to 1.5-fold greater change over time in measures of cognitive function than those without diabetes. When assessed by the Mini-Mental State Exam and the Digit Symbol Span tests, a diagnosis of diabetes increased the odds of cognitive decline 1.2-fold (95% CI 1.05-1.4) and 1.7-fold (95% CI 1.3-2.3), respectively . The odds of future dementia increased 1.6-fold (95% CI 1.4-1.8). CONCLUSIONS/INTERPRETATION: Compared to people without diabetes, people with diabetes have a greater rate of decline in cognitive function and a greater risk of cognitive decline. Cognitive dysfunction should therefore be added to the list of chronic complications of diabetes.
Assuntos
Transtornos Cognitivos/complicações , Transtornos Cognitivos/epidemiologia , Cognição , Demência/complicações , Demência/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/psicologia , Diabetes Mellitus/fisiopatologia , Seguimentos , Humanos , Testes de Inteligência , Estudos Longitudinais , Testes Neuropsicológicos , Razão de Chances , Estudos Prospectivos , Fatores de RiscoRESUMO
Of the growing list of promising genes for plant improvement, some of the most versatile appear to be those involved in sugar alcohol metabolism. Mannitol, one of the best characterized sugar alcohols, is a significant photosynthetic product in many higher plants. The roles of mannitol as both a metabolite and an osmoprotectant in celery (Apium graveolens) are well documented. However, there is growing evidence that 'metabolites' can also have key roles in other environmental and developmental responses in plants. For instance, in addition to its other properties, mannitol is an antioxidant and may have significant roles in plant-pathogen interactions. The mannitol catabolic enzyme mannitol dehydrogenase (MTD) is a prime modulator of mannitol accumulation in plants. Because the complex regulation of MTD is central to the balanced integration of mannitol metabolism in celery, its study is crucial in clarifying the physiological role(s) of mannitol metabolism in environmental and metabolic responses. In this study we used transformed Arabidopsis to analyze the multiple environmental and metabolic responses of the Mtd promoter. Our data show that all previously described changes in Mtd RNA accumulation in celery cells mirrored changes in Mtd transcription in Arabidopsis. These include up-regulation by salicylic acid, hexokinase-mediated sugar down-regulation, and down-regulation by salt, osmotic stress and ABA. In contrast, the massive up-regulation of Mtd expression in the vascular tissues of salt-stressed Arabidopsis roots suggests a possible role for MTD in mannitol translocation and unloading and its interrelation with sugar metabolism.
Assuntos
Apium/enzimologia , Arabidopsis/genética , Manitol Desidrogenases/genética , Regiões Promotoras Genéticas/genética , 3-O-Metilglucose/farmacologia , Ácido Abscísico/farmacologia , Acetatos/farmacologia , Apium/genética , Arabidopsis/citologia , Arabidopsis/metabolismo , Divisão Celular/efeitos dos fármacos , Ciclopentanos/farmacologia , Desoxiglucose/farmacologia , Relação Dose-Resposta a Droga , Regulação da Expressão Gênica/efeitos dos fármacos , Glucose/farmacologia , Proteínas de Fluorescência Verde , Proteínas Luminescentes/genética , Proteínas Luminescentes/metabolismo , Manitol/farmacologia , Oxilipinas , Plantas/efeitos dos fármacos , Plantas/enzimologia , Plantas/genética , Plantas Geneticamente Modificadas/citologia , Plantas Geneticamente Modificadas/genética , Plantas Geneticamente Modificadas/metabolismo , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/metabolismo , Ácido Salicílico/farmacologia , Cloreto de Sódio/farmacologiaRESUMO
BACKGROUND: The prevention of disability in activities of daily living (ADL) may prolong older persons' autonomy (older persons are defined in this study as those aged > or =60 years). However, proved preventive strategies for ADL disability are lacking. A sedentary lifestyle is an important cause of disability. This study examines whether an exercise program can prevent ADL disability. METHODS: A 2-center, randomized, single-blind, controlled trial was conducted in which participants were assigned to an aerobic exercise program, a resistance exercise program, or an attention control group. Of the 439 community-dwelling persons aged 60 years or older with knee osteoarthritis originally recruited, the 250 participants initially free of ADL disability were used for this study. Incident ADL disability, defined as developing difficulty in transferring from a bed to a chair, eating, dressing, using the toilet, or bathing, was assessed quarterly during 18 months of follow-up. RESULTS: The cumulative incidence of ADL disability was lower in the exercise groups (37.1%) than in the attention control group (52.5%) (P =.02). After adjustment for demographics and baseline physical function, the relative risk of incident ADL disability for assignment to exercise was 0.57 (95% confidence interval, 0.38-0.85; P =.006). Both exercise programs prevented ADL disability; the relative risks were 0.60 (95% confidence interval, 0.38-0.97; P =.04) for resistance exercise and 0.53 (95% confidence interval, 0.33-0.85; P =.009) for aerobic exercise. The lowest ADL disability risks were found for participants with the highest compliance to exercise. CONCLUSIONS: Aerobic and resistance exercise may reduce the incidence of ADL disability in older persons with knee osteoarthritis. Exercise may be an effective strategy for preventing ADL disability and, consequently, may prolong older persons' autonomy.
Assuntos
Atividades Cotidianas , Pessoas com Deficiência/reabilitação , Exercício Físico , Osteoartrite do Joelho/reabilitação , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Qualidade de Vida , Índice de Gravidade de Doença , Método Simples-CegoRESUMO
BACKGROUND: Although present guidelines suggest that treatment of hypertension is more effective in patients with multiple risk factors and higher risk of cardiovascular events, this hypothesis was never verified in older patients with systolic hypertension. METHODS AND RESULTS: Using data from the Systolic Hypertension in the Elderly Program, we calculated the global cardiovascular risk score according to the American Heart Association Multiple Risk Factor Assessment Equation in 4,189 participants free of cardiovascular disease (CVD) and in 264 participants with CVD at baseline. In the placebo group, rates of cardiovascular events over 4.5 years were progressively higher according to higher quartiles of CVD risk. The protection conferred by treatment was similar across quartiles of risk. However, the numbers needed to treat (NNTs) to prevent one cardiovascular event were progressively smaller according to higher cardiovascular risk quartiles. In participants with baseline CVD, the NNTs to prevent one cardiovascular event were similar to those estimated for CVD-free participants in the highest-risk quartile. CONCLUSIONS: Treatment of systolic hypertension is most effective in older patients who, because of additional risk factors or prevalent CVD, are at higher risk of developing a cardiovascular event. These patients are prime candidates for antihypertensive treatment.
Assuntos
Anti-Hipertensivos/administração & dosagem , Atenolol/administração & dosagem , Clortalidona/administração & dosagem , Hipertensão/tratamento farmacológico , Reserpina/administração & dosagem , Fatores Etários , Idoso , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Distribuição por Sexo , Sístole , Resultado do TratamentoRESUMO
OBJECTIVES: This study described the prevalence and characteristics of financial difficulty acquiring food and its relation to nutritional biomarkers in older disabled women. METHODS: Baseline data were analyzed from the Women's Health and Aging Study, a population-based survey of 1002 community-dwelling, disabled women 65 years and older from Baltimore, Md. RESULTS: Minority women (49.5%) were more likely than White women (13.4%) to report financial difficulty acquiring food (odds ratio [OR] = 6.2, 95% confidence interval [CI] = 4.5, 8.6). Of the women reporting financial difficulty acquiring food, only 19.3% received food stamps and fewer than 7% participated in food assistance programs. Women reporting financial difficulty acquiring food had higher levels of psychologic depression than women not reporting such difficulty. Greater likelihood of financial difficulty acquiring food was associated with poorer quality of life and physical performance among White women and with more medical conditions among minority women. Finally, anemia (hemoglobin < 120 g/L) was associated with financial difficulty acquiring food (age-adjusted OR = 2.9, 95% CI = 1.9, 4.3). CONCLUSIONS: Financial difficulty acquiring food was common, and receipt of nutritional services was rare, in community-dwelling, older disabled women. Nutrition assistance programs for the elderly should reexamine their effectiveness in preventing nutritional deficits in older disabled women.
Assuntos
Pessoas com Deficiência , Abastecimento de Alimentos/economia , Estado Nutricional , Pobreza , Idoso , Idoso de 80 Anos ou mais , Baltimore/epidemiologia , Biomarcadores , Estudos Transversais , Feminino , Serviços de Alimentação , Necessidades e Demandas de Serviços de Saúde , Humanos , Modelos Logísticos , Análise Multivariada , Distúrbios Nutricionais/sangue , Distúrbios Nutricionais/epidemiologia , Razão de Chances , Fatores de RiscoRESUMO
BACKGROUND: Several observational studies and individual randomised trials in hypertension have suggested that, compared with other drugs, calcium antagonists may be associated with a higher risk of coronary events, despite similar blood-pressure control. The aim of this meta-analysis was to compare the effects of calcium antagonists and other antihypertensive drugs on major cardiovascular events. METHODS: We undertook a meta-analysis of trials in hypertension that assessed cardiovascular events and included at least 100 patients, who were randomly assigned intermediate-acting or long-acting calcium antagonists or other antihypertensive drugs and who were followed up for at least 2 years. FINDINGS: The nine eligible trials included 27,743 participants. Calcium antagonists and other drugs achieved similar control of both systolic and diastolic blood pressure. Compared with patients assigned diuretics, beta-blockers, angiotensin-converting-enzyme inhibitors, or clonidine (n=15,044), those assigned calcium antagonists (n=12,699) had a significantly higher risk of acute myocardial infarction (odds ratio 1.26 [95% CI 1.11-1.43], p=0.0003), congestive heart failure (1.25 [1.07-1.46], p=0.005), and major cardiovascular events (1.10 [1.02-1.18], p=0.018). The treatment differences were within the play of chance for the outcomes of stroke (0.90 [0.80-1.02], p=0.10) and all-cause mortality (1.03 [0.94-1.13], p=0.54). INTERPRETATION: In randomised controlled trials, the large available database suggests that calcium antagonists are inferior to other types of antihypertensive drugs as first-line agents in reducing the risks of several major complications of hypertension. On the basis of these data, the longer-acting calcium antagonists cannot be recommended as first-line therapy for hypertension.
Assuntos
Anti-Hipertensivos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Hipertensão/tratamento farmacológico , Idoso , Pressão Sanguínea/efeitos dos fármacos , Doença das Coronárias/prevenção & controle , Diástole , Feminino , Insuficiência Cardíaca/prevenção & controle , Humanos , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/prevenção & controle , Sístole , Resultado do TratamentoRESUMO
The authors evaluated subjective estimates of the relationship between freedom and responsibility under predictions made in accordance with cognitive-experiential self-theory (CEST; V. Denes-Raj & S. Epstein, 1994; S. Epstein, A. Lipson, C. Holstein, & E. Huh, 1992; S. Epstein, R. Pacini, V. Denes-Raj, & H. Meier, 1996; L. A. Kirkpatrick & S. Epstein, 1992). Half of the participants viewed sexually stimulating primes before making judgments. The other participants viewed neutral stimuli before making judgments. Two dependent measures were used: A set of alternate-forms propositions measured perceived relationships between the variables, and response latencies were used to evaluate the hypothesis that persons operating experientially would make judgments faster than persons operating rationally. Results indicated a significant effect for the priming condition with respect to the within-subject dependent variable. In accordance with predictions, further analysis indicated that positive contingency items were endorsed less often by primed participants, and negative contingency items were endorsed more often by primed participants. Results are in line with predictions afforded by the CEST model. Implications are discussed.
Assuntos
Liberdade , Imaginação , Julgamento , Personalidade , Comportamento Sexual/psicologia , Responsabilidade Social , Adulto , Análise de Variância , Ciência Cognitiva , Sinais (Psicologia) , Análise Fatorial , Feminino , Humanos , Masculino , Modelos Psicológicos , Psicanálise , PsicometriaRESUMO
We describe 5 cases of mucoepidermoid carcinoma (MEC) involving Warthin tumor (WT) of the parotid gland. The WT size ranged from 1.7 to 6.0 cm. The MECs were much smaller, 0.3 to 1.7 cm. In 3 cases, the WT completely surrounded the MEC, and in 2 cases neither WT nor MEC surrounded the other. Each MEC was low grade, 3 grade I and 2 grade II. One MEC had evidence of vascular invasion. All patients underwent partial or subtotal parotidectomy with negative resection margins. Clinical follow-up (range, 8-52 months) for 3 patients showed no evidence of recurrence. The pathogenetic relationship between WT and MEC in these cases is uncertain. In 4 cases, foci of squamous or mucous metaplasia were found in the WT component, associated with mild cytologic atypia in 3 tumors. However, a direct transition from WT to MEC was not identified. In 1 case, MEC was present 45 months before WT, suggesting that the recurrent MEC involved WT coincidentally. The small size and low grade of the MEC and the negative resection margins most likely explain the good outcome for the 3 patients with clinical follow-up data available.
Assuntos
Adenolinfoma/patologia , Carcinoma Mucoepidermoide/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Parotídeas/patologia , Adenolinfoma/cirurgia , Adulto , Idoso , Carcinoma Mucoepidermoide/classificação , Carcinoma Mucoepidermoide/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas/classificação , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Parotídeas/classificação , Neoplasias Parotídeas/cirurgiaRESUMO
In a complete between-subjects design, 576 respondents judged covariations of problems framed around height, weight, and body fat. A verbal measure was used, consisting of propositional statements representing relationships between two of the variables, as well as two types of response options: true or false, and a 7-point, bipolar, Likert-type scale. Consistent with previous findings, weight and body fat were unambiguously judged as if positively correlated; there were indications of a perceived negative correlation of height and body fat; and there was no evidence that participants regarded height and weight as positively correlated. Furthermore, there was no reliable evidence in support of framing effects. However, there were indications of influence for conditional format. These findings are discussed relative to previous and ongoing research efforts, and it is concluded that it may be inappropriate to regard variations in conditional format as parallel items. Measures involving all possible variations are considered fundamentally unbiased and consistent with I. Ajzen's (1988) principle of aggregation.
Assuntos
Composição Corporal , Estatura , Peso Corporal , Julgamento , Adulto , Análise de Variância , Feminino , Humanos , Masculino , Resolução de Problemas , Estudantes/psicologiaRESUMO
OBJECTIVE: To assess whether ACE inhibitors are superior to alternative agents for the prevention of cardiovascular events in patients with hypertension and type 2 diabetes. RESEARCH DESIGN AND METHODS: This study is a review and meta-analysis of randomized controlled trials that included patients with type 2 diabetes and hypertension who were randomized to an ACE inhibitor or an alternative drug, were followed for > or =2 years, and had adjudicated cardiovascular events. RESULTS: A total of 4 trials were eligible. The Appropriate Blood Pressure Control in Diabetes (ABCD) trial (n = 470) compared enalapril with nisoldipine, the Captopril Prevention Project (CAPPP) (n = 572) compared captopril with diuretics or beta-blockers, the Fosinopril Versus Amlodipine Cardiovascular Events Trial (FACET) (n = 380) compared fosinopril with amlodipine, and the U.K. Prospective Diabetes Study (UKPDS) (n = 758) compared captopril with atenolol. The cumulative results of the first 3 trials showed a significant benefit of ACE inhibitors compared with alternative treatments on the outcomes of acute myocardial infarction (63% reduction, P < 0.001), cardiovascular events (51% reduction, P < 0.001), and all-cause mortality (62% reduction, P = 0.010). These findings were not observed in the UKPDS. The ACE inhibitors did not appear to be superior to other agents for the outcome of stroke in any of the trials. None of the findings were explained by differences in blood pressure control. CONCLUSIONS: Compared with the alternative agents tested, ACE inhibitors may provide a special advantage in addition to blood pressure control. The question of whether atenolol is equivalent to captopril remains open. Conclusive evidence on the comparative effects of antihypertensive treatments will come from large prospective randomized trials.
Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Captopril/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/tratamento farmacológico , Angiopatias Diabéticas/prevenção & controle , Hipertensão/tratamento farmacológico , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Angiopatias Diabéticas/fisiopatologia , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Bowen disease is a variant of squamous cell carcinoma in situ. In some cases a pagetoid growth pattern can be observed with cytologically atypical clear cells arranged singly and in nests. The differential diagnosis of pagetoid Bowen disease includes primarily Paget disease and malignant melanoma in situ, as well as other less common entities. Two cases of pagetoid Bowen disease are described, one in a 65-year-old man with a thigh lesion and the other in a 25-year-old man with a lesion in the penile/scrotal region. Neither patient had clinical evidence of an internal malignant neoplasm. In both cases, the neoplastic cells were positive for cytokeratin (CK) 7 and CK 19 and were negative for CK 18, CK 20, carcinoembryonic antigen, GCDFP-15, c-erbB2, S100, and HMB-45. In aggregate, these findings support the diagnosis of pagetoid Bowen disease. Previously, others have shown that CK 7 is an almost invariable marker of Paget disease. Thus, we report these two cases to illustrate that CK 7 can be expressed by pagetoid Bowen disease and should not be a cause of confusion in the differential diagnosis.
Assuntos
Doença de Bowen/patologia , Queratinas/análise , Doença de Paget Extramamária/patologia , Neoplasias Cutâneas/patologia , Adulto , Idoso , Biomarcadores Tumorais/análise , Doença de Bowen/química , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Queratina-7 , Masculino , Proteínas de Neoplasias/análise , Doença de Paget Extramamária/química , Neoplasias Cutâneas/químicaRESUMO
Most of the research concerned with the illusory correlation is modeled after the seminal work of D. L. Hamilton and R. K. Gifford (1976). However, S. A. Haslam and C. McGarty (1994) have voiced concerns over the dependent measures used within this paradigm. Therefore, in this study, the authors tested a new dependent variable that has high face validity. This measure was modeled after the work of J. R. McGahan and R. Wight (1989) and consisted of a set of propositional statements representing either the illusory correlation, the contingency opposite the illusory correlation, or the noncontingency. A second purpose of this study was to validate other studies that have used dependent measures modeled after the work of J. R. McGahan and R. Wight (1989). Demonstrating that this measure can be used to detect a well-documented phenomenon (i.e., the illusory correlation) would strengthen the results and conclusions from other studies. To this end, results from 2 experiments indicate that this measure does provide a valid alternative to those measures that are commonly used in illusory correlation studies. The results thereby give credence to other studies that have used similar dependent measures.