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Expected Increase (expected + increase)
Selected AbstractsProblematic internet use: Proposed classification and diagnostic criteriaDEPRESSION AND ANXIETY, Issue 4 2003Nathan A. Shapira M.D., Ph.D. Abstract Since the mid-1990s, there have been frequent reports of individuals whose use of the computer and internet is problematic. Given the recent expansion and the expected increase in internet availability and usage in the coming years, it is important that healthcare professionals be informed about this behavior and its associated problems. Recently, psychological and psychiatric literature has described individuals that exhibit problematic internet use who often suffer from other psychiatric disorders. In the face of this comorbidity, it is essential to evaluate whether these individuals represent a distinct class of disorder, or a manifestation/coping mechanism related to other underlying diagnosis. In either event, problematic internet use negatively impacts social and emotional functioning. Based on the current limited empirical evidence, problematic internet use may best be classified as an impulse control disorder. It is therefore imperative that problematic internet use be appropriately identified among symptomatic individuals. For these reasons, we propose specific diagnostic criteria that will allow for consistent identification and assist in further study of this behavior. Depression and Anxiety 17:207,216, 2003. © 2003 Wiley-Liss, Inc. [source] Surge Capacity Associated with Restrictions on Nonurgent Hospital Utilization and Expected Admissions during an Influenza Pandemic: Lessons from the Toronto Severe Acute Respiratory Syndrome OutbreakACADEMIC EMERGENCY MEDICINE, Issue 11 2006Michael J. Schull MD Background Current influenza pandemic models predict a surge in influenza-related hospitalizations in affected jurisdictions. One proposed strategy to increase hospital surge capacity is to restrict elective hospitalizations, yet the degree to which this measure would meet the anticipated is unknown. Objectives To compare the reduction in hospitalizations resulting from widespread nonurgent hospital admission restrictions during the Toronto severe acute respiratory syndrome (SARS) outbreak with the expected increase in admissions resulting from an influenza pandemic in Toronto. Methods The authors compared the expected influenza-related hospitalizations in the first eight weeks of a mild, moderate, or severe pandemic with the actual reduction in the number of hospital admissions in Toronto, Ontario, during the first eight weeks of the SARS-related restrictions. Results Influenza modeling for Toronto predicts that there will be 4,819, 8,032, or 11,245 influenza-related admissions in the first eight weeks of a mild, moderate, or severe pandemic, respectively. In the first eight weeks of SARS-related hospital admission restrictions, there were 3,654 fewer hospitalizations than expected in Toronto, representing a modest 12% decrease in the overall admission rate (a reduction of 1.40 admissions per 1,000 population). Therefore, influenza-related admissions could exceed the reduction in admissions resulting from restricted hospital utilization by 1,165 to 7,591 patient admissions, depending on pandemic severity, which corresponds to an excess of 0.44 to 2.91 influenza-related admissions per 1,000 population per eight weeks, and an increase of 4% to 25% in the overall number of admissions, when compared with nonpandemic conditions. Conclusions Pandemic modeling for Toronto suggests that influenza-related admissions would exceed the reduction in hospitalizations seen during SARS-related nonurgent hospital admission restrictions, even in a mild pandemic. Sufficient surge capacity in a pandemic will likely require the implementation of other measures, including possibly stricter implementation of hospital utilization restrictions. [source] Effects of Endotoxin Exposure on Cationic Amino Acid Transporter Function in Ovine Peripheral Blood Mononuclear CellsEXPERIMENTAL PHYSIOLOGY, Issue 2 2003Megan F. Clark Rodent models of sepsis differ from clinical human disease in that humans make substantially less whole-body nitric oxide and have different cellular responses to endotoxin. Sheep, when exposed to endotoxin, behave in a manner more similar to humans. Many studies of rodent peripheral blood mononuclear cells (PBMCs) exposed to endotoxin demonstrate increased cationic amino acid transporter function (particularly through the y+ transporter) to supply arginine substrate to upregulated nitric oxide synthase. Whether this is true in sheep is not known. We have studied cationic amino acid transport in sheep PBMCs stimulated with endotoxin, using labelled lysine. PBMCs stimulated both in vitro and in vivo show an initial reduction in total and y+ lysine transport (after 1-2 h exposure to endotoxin): a previously undescribed effect of endotoxin. In in vitro activated cells, the reduction in y+ transport was prevented by the lipoxygenase inhibitor, nordihydroguaretic acid (NDGA), and the phospholipase inhibitor 4-bromophenacyl bromide (4-BPAB), but not cyclohexamide or a number of other inhibitors of intracellular second-messenger pathways. In contrast after 14 h incubation, the expected increase in total and y+ lysine transport was seen. The increase in y+ transport could be prevented by cyclohexamide, dexamethasone, ibuprofen, the protein kinase C inhibitor sphingosine, NDGA and 4-BPAB. These results suggest that in response to endotoxin exposure there is an initial decrease in y+ activity mediated by a lipoxygenase product, followed by a substantial increase in y+ activity mediated by the products of either cyclo-oxygenase or lipoxygenase. Cyclo-oxygenase and/or lipoxygenase inhibition might be useful in reducing arginine transport, and hence nitric oxide production, in these cells. [source] Effects of climatic change on the phenology of butterflies in the northwest Mediterranean BasinGLOBAL CHANGE BIOLOGY, Issue 10 2003Constantí Stefanescu Abstract Phenological changes in response to climatic warming have been detected across a wide range of organisms. Butterflies stand out as one of the most popular groups of indicators of climatic change, given that, firstly, they are poikilothermic and, secondly, have been the subject of thorough monitoring programmes in several countries for a number of decades. Here we provide for the first time strong evidence of phenological change as a consequence of recent climatic warming in butterflies at a Spanish site in the northwest Mediterranean Basin. By means of the widely used Butterfly Monitoring Scheme methodology, three different phenological parameters were analysed for the most common species to test for trends over time and relationships with temperature and precipitation. Between 1988 and 2002, there was a tendency for earlier first appearance dates in all 17 butterfly species tested, and significant advances in mean flight dates in 8 out of 19 species. On the other hand, the shape of the curve of adult emergence did not show any regular pattern. These changes paralleled an increase of 1,1.5°C in mean February, March and June temperatures. Likewise, a correlation analysis indicated the strong negative effect of spring temperature on phenological parameters (i.e. higher temperatures tended to produce phenological advances), and the opposite effect of precipitation in certain months. In addition, there was some evidence to indicate that phenological responses may differ between taxonomic lineages or species with similar diets. We discuss the consequences that these changes may have on species' population abundances, especially given the expected increase in aridity in the Mediterranean Basin caused by current climatic warming. We predict that varying degrees of phenological flexibility may account for differences in species' responses and, for multivoltine species, predict strong selection favouring local seasonal adaptations such as diapause phenomena or migratory behaviour. [source] Roman Period fetal skeletons from the East Cemetery (Kellis 2) of Kellis, EgyptINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 5 2005M. W. Tocheri Abstract Much can be learned about the religious ideology and mortuary patterns as well as the demographic and health profiles of a population from archaeological human fetal skeletons. Fetal skeletons are rare, however, largely due to poor preservation and recovery, misidentification, or non-inclusion in general burial populations. We present an analysis of 82 fetal/perinatal skeletons recovered from Kellis 2, a Roman Period cemetery dated to the third and fourth centuries AD, located in the Dakhleh Oasis, Egypt. Most of the fetal remains were individually wrapped in linen and all were buried among the general cemetery population in a supine, east,west orientation with the head facing to the west. Gestational age estimates are calculated from diaphysis lengths using published regression and Bayesian methods. The overall similarity between the fetal age distributions calculated from the regression and Bayesian methods suggests that the correlation between diaphysis length and gestational age is typically strong enough to avoid the ,regression' problem of having the age structure of reference samples adversely affecting the age distribution of target samples. The inherent bias of the regression methods, however, is primarily reflected in the gestational age categories between 36 and 42 weeks corresponding with the expected increase in growth variation during the late third trimester. The results suggest that the fetal age distribution at Kellis 2 does not differ from the natural expected mortality distribution. Therefore, practices such as infanticide can be ruled out as having a significant effect on the observed mortality distribution. Moreover, the Kellis 2 sample is well represented in each gestational age category, suggesting that all premature stillbirths and neonatal deaths received similar burial rites. The age distribution of the Kellis 2 fetal remains suggests that emerging Christian concepts, such as the ,soul' and the ,afterlife', were being applied to everyone including fetuses of all gestational ages. Copyright © 2005 John Wiley & Sons, Ltd. [source] Impact of the post-World War II generation on intensive care needs in NorwayACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010J. H. LAAKE Background: A high birth rate during the first two decades following World War II has increased the proportion of elderly people in present-day society and, consequently, the demand for health-care services. The impact on intensive care services may become dramatic because the age distribution of critically ill patients is skewed towards the elderly. We have used registry data and population statistics to forecast the demand for intensive care services in Norway up until the year 2025. Methods: Data collected by the Norwegian intensive care registry (NIR), showing the age distribution in Norwegian intensive care units (ICU) during the years 2006 and 2007, were used with three different Norwegian prognostic models of population growth for the years 2008,2025 to compute the expected increase in intensive care unit bed-days (ICU bed-days). Results: The elderly were overrepresented in Norwegian ICUs in 2006,2007, with patients from 60 to 79 years of age occupying 44% of ICU bed-days. Population growth from 2008 to 2025 was estimated to be from 11.1 to 26.4%, depending on the model used. Growth will be much larger in the age group 60,79 years. Other factors kept unchanged, this will result in an increase in the need for intensive care (ICU bed-days) of between 26.1 and 36.9%. Conclusion: The demand for intensive care beds will increase markedly in Norwegian hospitals in the near future. This will have serious implications for the planning of infrastructure, education of health care personnel, as well as financing of our health care system. [source] Reduced Expression of the KATP Channel Subunit, Kir6.2, is Associated with Decreased Expression of Neuropeptide Y and Agouti-Related Protein in the Hypothalami of Zucker Diabetic Fatty RatsJOURNAL OF NEUROENDOCRINOLOGY, Issue 12 2007A. Gyte The link between obesity and diabetes is not fully understood but there is evidence to suggest that hypothalamic signalling pathways may be involved. The hypothalamic neuropeptides, pro-opiomelanocortin (POMC), neuropeptide Y (NPY) and agouti-related protein (AGRP) are central to the regulation of food intake and have been implicated in glucose homeostasis. Therefore, the expression of these genes was quantified in hypothalami from diabetic Zucker fatty (ZDF) rats and nondiabetic Zucker fatty (ZF) rats at 6, 8, 10 and 14 weeks of age. Although both strains are obese, only ZDF rats develop pancreatic degeneration and diabetes over this time period. In both ZF and ZDF rats, POMC gene expression was decreased in obese versus lean rats at all ages. By contrast, although there was the expected increase in both NPY and AGRP expression in obese 14-week-old ZF rats, the expression of NPY and AGRP was decreased in 6-week-old obese ZDF rats with hyperinsulinaemia and in 14-week-old rats with the additional hyperglycaemia. Therefore, candidate genes involved in glucose, and insulin signalling pathways were examined in obese ZDF rats over this age range. We found that expression of the ATP-sensitive potassium (KATP) channel component, Kir6.2, was decreased in obese ZDF rats and was lower compared to ZF rats in each age group tested. Furthermore, immunofluorescence analysis showed that Kir6.2 protein expression was reduced in the dorsomedial and ventromedial hypothalamic nuclei of 6-week-old prediabetic ZDF rats compared to ZF rats. The Kir6.2 immunofluorescence colocalised with NPY throughout the hypothalamus. The differences in Kir6.2 expression in ZF and ZDF rats mimic those of NPY and AGRP, which could infer that the changes occur in the same neurones. Overall, these data suggest that chronic changes in hypothalamic Kir6.2 expression may be associated with the development of hyperinsulinaemia and hyperglycaemia in ZDF rats. [source] Kinetics of the batch cationic emulsion polymerization of styrene: A comparative study with the anionic caseJOURNAL OF POLYMER SCIENCE (IN TWO SECTIONS), Issue 15 2006Jose Ramos Abstract An in-depth study on the kinetics of the cationic emulsion polymerization of styrene in a batch reactor is presented. This study is focused on the effect of the amount of the cationic surfactant dodecyltrimethylammonium bromide (DTAB), using two different cationic initiators: 2,2,-azobisisobutyramidine dihydrochloride (AIBA), 2,2,-azobis (N,N,-dimethyleneisobutyramidine) dihydrochloride (ADIBA), on kinetics and colloidal features such as conversion, number of particles, number average of radicals per particle, mean particle diameter, and particle size distribution (PSD) of the polystyrene latices obtained by emulsion polymerization in a batch reactor. Furthermore, the results of the cationic emulsion polymerization were compared with its homologous anionic case. Using DTAB as cationic surfactant an expected increase in the total rate of polymerization was observed when the DTAB concentration increased. However, the total number of particles increased much more than in the anionic system. On the other hand, a dependence on the particle size of the rate of polymerization per particle together with the average number of radicals per particle was found. These differences between cationic and anionic emulsion polymerizations were explained taking into account the limited particle coagulation observed with cationic surfactants, and the high rate of radical formation of cationic initiators. © 2006 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 44: 4461,4478, 2006 [source] Identification of Candidate Genes for Alcohol Preference by Expression Profiling of Congenic Rat StrainsALCOHOLISM, Issue 7 2007Lucinda G. Carr Background: A highly significant quantitative trait locus (QTL) on chromosome 4 that influenced alcohol preference was identified by analyzing crosses between the iP and iNP rats. Congenic strains in which the iP chromosome 4 QTL interval was transferred to the iNP (NP.P) exhibited the expected increase in alcohol consumption compared with the iNP background strain. This study was undertaken to identify genes in the chromosome 4 QTL interval that might contribute to the differences in alcohol consumption between the alcohol-naïve congenic and background strains. Methods: RNA from 5 brain regions from each of 6 NP.P and 6 iNP rats was labeled and analyzed separately on an Affymetrix Rat Genome 230 2.0 microarray to look for both cis -regulated and trans -regulated genes. Expression levels were normalized using robust multi-chip average (RMA). Differential gene expression was validated using quantitative real-time polymerase chain reaction. Five individual brain regions (nucleus accumbens, frontal cortex, amygdala, hippocampus, and striatum) were analyzed to detect differential expression of genes within the introgressed QTL interval, as well as genes outside that region. To increase the power to detect differentially expressed genes, combined analyses (averaging data from the 5 discrete brain regions of each animal) were also carried out. Results: Analyses within individual brain regions that focused on genes within the QTL interval detected differential expression in all 5 brain regions; a total of 35 genes were detected in at least 1 region, ranging from 6 genes in the nucleus accumbens to 22 in the frontal cortex. Analysis of the whole genome detected very few differentially expressed genes outside the QTL. Combined analysis across brain regions was more powerful. Analysis focused on the genes within the QTL interval confirmed 19 of the genes detected in individual regions and detected 15 additional genes. Whole genome analysis detected 1 differentially expressed gene outside the interval. Conclusions: Cis -regulated candidate genes for alcohol consumption were identified using microarray profiling of gene expression differences in congenic animals carrying a QTL for alcohol preference. [source] Evidence of Nearest-Neighbor Ordering in Wet-Processed Zirconia,Nickel CompositesJOURNAL OF THE AMERICAN CERAMIC SOCIETY, Issue 10 2001Carlos Pecharromán Monolithic zirconia,nickel (ZrO2/Ni) cermets have been prepared by a wet-processing method with nickel volume concentrations of 16%,40%. Microstructural analysis performed on scanning electron microscopy images has revealed evidence of a partial ordering of metallic particles inside the ceramic matrix. This ordering does not appear in mullite/molybdenum cermets. Complex impedance measurements have shown that the percolation threshold of ZrO2/Ni cermets appears at a filling factor (fc) of 0.34, exceeding the theoretical value (fc= 0.16), as a consequence of its microstructural order. Electrical measurements display the expected increase of capacity near the percolation threshold. These results open the possibility to design new devices with the appealing electric, magnetic, and mechanical properties that are predicted by the percolation theory. [source] Prediction of herb,drug metabolic interactions: a simulation studyPHYTOTHERAPY RESEARCH, Issue 6 2005Shufeng Zhou Abstract In vitro and in vivo studies have indicated that the induction or inhibition of cytochrome P450 (CYP) is one of the major mechanisms for some clinically important pharmacokinetic herb,drug interactions. An attempt was made to simulate the effects of herbal preparation with single or multiple CYP-inhibiting constituents on the area of the plasma concentration-time curve (AUC) of coadministered drug that was either a low clearance drug by intravenous (i.v.) injection or a high clearance drug by oral route. Our simulation studies indicated that the expected increase (Rc) in the AUC of the coadministered drug by inhibiting herbal constituent(s) was dependent on the route of administration. For low clearance drug by i.v. injection, Rc was generally determined by inhibition constant (Ki), unbound inhibitor concentration ([I]), hepatic fraction (fh), number of inhibitory herbal constituents (n) and metabolic pathway fraction in hepatic metabolism (fm), while Rc for a high clearance drug by oral route, Rc was determined by Ki, [I], n and fm. By varying these parameters, Rc changed accordingly. It appeared likely to predict a herb,drug metabolic interaction, if the inhibiting herbal constituents could be quantitatively determined. However, many herb- and drug-related factors may cause difficulties with the prediction, and thus in vivo animal and human studies are always necessary. Copyright © 2005 John Wiley & Sons, Ltd. [source] Heat opens axon initial segment sodium channels: A febrile seizure mechanism?,ANNALS OF NEUROLOGY, Issue 2 2009Evan A. Thomas PhD Objective A number of hypotheses have been put forward as to why humans respond to fever by seizing. The current leading hypotheses are that respiratory alkalosis produces an as yet unidentified change in neural excitability or that inflammatory mediators potentiate excitatory synaptic transmission. However, it is well known that ion channel gating rates increase with increased temperature. Furthermore, skeletal and cardiac sodium channel activation can be temperature sensitive in some situations. We measured the temperature sensitivity of the brain sodium channel, NaV1.2, to determine whether febrile temperatures might produce a direct increase in neuronal excitability. Methods The effect of temperature on NaV1.2 electrophysiological properties was measured in a transfected mammalian cell line. The subcellular location of NaV1.2 in the mouse brain was ascertained using antibodies against NaV1.2 and ankyrin-G. Computer simulation of a hippocampal granule cell model was used to predict the effect of temperature on action potential firing. Results As well as the expected increase in gating rates, the voltage dependence of activation became 7.6mV more negative when the temperature was increased from 37°C to 41°C. NaV1.2 was localized to the axon initial segment in hippocampal and cortical neurons. Computer simulation showed that increased gating rates and the more negative activation dramatically increase neuronal excitability. Interpretation The direct effect of heat on ion channels localized to the site of action potential initiation potentially causes a profound increase in neuronal excitability. This is likely to contribute to febrile seizure genesis. Ann Neurol 2009;66:219,226 [source] Heart Rate Variability in Patients with Essential Hyperhidrosis: Dynamic Influence of Sympathetic and Parasympathetic ManeuversANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2005Dayimi Kaya M.D. Background: Essential hyperhidrosis has been associated with an increased activity of the sympathetic system. In this study, we investigated cardiac autonomic function in patients with essential hyperhidrosis and healthy controls by time and frequency domain analysis of heart rate variability (HRV). Method: In this study, 12 subjects with essential hyperhidrosis and 20 healthy subjects were included. Time and frequency domain parameters of HRV were obtained from all of the participants after a 15-minute resting period in supine position, during controlled respiration (CR) and handgrip exercise (HGE) in sitting position over 5-minute periods in each stage. Results: Baseline values of HRV parameters including RR interval, SDNN and root mean square of successive R-R interval differences, low frequency (LF), high frequency (HF), normalized unit of high frequency (HFnu), normalized unit of low frequency (LFnu), and LF/HF ratio were identical in two groups. During CR, no difference was detected between the two groups with respect to HRV parameters. However, the expected increase in mean heart rate (mean R-R interval) did not occur in hyperhidrotic group, whereas it did occur in the control group (Friedman's P = 0.000). Handgrip exercise induced significant decrease in mean R-R interval in both groups and no difference was detected between the two groups with respect to the other HRV parameters. When repeated measurements were compared with two-way ANOVA, there was statistically significant difference only regarding mean heart rate in two groups (F = 6.5; P = 0.01). Conclusion: Our overall findings suggest that essential hyperhidrosis is a complex autonomic dysfunction rather than sympathetic overactivity, and parasympathetic system seems to be involved in pathogenesis of this disorder. [source] Capturing of cell culture-derived modified Vaccinia Ankara virus by ion exchange and pseudo-affinity membrane adsorbersBIOTECHNOLOGY & BIOENGINEERING, Issue 4 2010Michael W. Wolff Abstract Smallpox is an acute, highly infectious viral disease unique to humans, and responsible for an estimated 300,500 million deaths in the 20th century. Following successful vaccination campaigns through the 19th and 20th centuries, smallpox was declared eradicated by the World Health Organization in 1980. However, the threat of using smallpox as a biological weapon prompted efforts of some governments to produce smallpox vaccines for emergency preparedness. An additional aspect for the interest in smallpox virus is its potential use as a platform technology for vector vaccines. In particular, the latter requires a high safety level for routine applications. IMVAMUNE®, a third generation smallpox vaccine based on the attenuated Modified Vaccinia Ankara (MVA) virus, demonstrates superior safety compared to earlier generations and represents therefore an interesting choice as viral vector. Current downstream production processes of Vaccinia virus and MVA are mainly based on labor-intensive centrifugation and filtration methods, requiring expensive nuclease treatment in order to achieve sufficient low host-cell DNA levels for human vaccines. This study compares different ion exchange and pseudo-affinity membrane adsorbers (MA) to capture chicken embryo fibroblast cell-derived MVA-BN® after cell homogenization and clarification. In parallel, the overall performance of classical bead-based resin chromatography (Cellufine® sulfate and Toyopearl® AF-Heparin) was investigated. The two tested pseudo-affinity MA (i.e., sulfated cellulose and heparin) were superior over the applied ion exchange MA in terms of virus yield and contaminant depletion. Furthermore, studies confirmed an expected increase in productivity resulting from the increased volume throughput of MA compared to classical bead-based column chromatography methods. Overall virus recovery was ,60% for both pseudo-affinity MA and the Cellufine® sulfate resin. Depletion of total protein ranged between 86% and 102% for all tested matrices. Remaining dsDNA in the product fraction varied between 24% and 7% for the pseudo-affinity chromatography materials. Cellufine® sulfate and the reinforced sulfated cellulose MA achieved the lowest dsDNA product contamination. Finally, by a combination of pseudo-affinity with anion exchange MA a further reduction of host-cell DNA was achieved. Biotechnol. Bioeng. 2010. 105: 761,769. © 2009 Wiley Periodicals, Inc. [source] Hot and cold technologies for tissue ablation in urologyBJU INTERNATIONAL, Issue 6 2006Jennifer M. Burr Increasingly, technology plays an important role in urology, and with this greater use comes the expected increase in regulation. Authors from the UK present a review of the physical properties of ablative technologies, evaluating efficacy and safety, and summarising guidance issued by the National Institute of Health and Clinical Excellence (NICE) where available. There are also reviews from the UK on haematuria, and on the pathology of bladder cancer from an international group of European authors. [source] Acute treatment costs of intracerebral hemorrhage and ischemic stroke in ArgentinaACTA NEUROLOGICA SCANDINAVICA, Issue 4 2009M. C. Christensen Background and purpose,,, Stroke is the third leading cause of death in Argentina, yet little information exists on the acute treatment provided for stroke or its costs. This study estimates the national costs of the acute treatment of first-ever intracerebral hemorrhage (ICH) and ischemic stroke (IS) in Argentina. Methods,,, Retrospective hospital-based inception study design using data on resource use and costs from high-volume stroke centers in Argentina, and published population-based incidence data. Treatment provided at two large urban hospitals were evaluated in all patients admitted with a first-ever stroke between 1 January 2004 and 31 August 2006, and costs were assigned using appropriate unit cost data for all resource use. Cost estimates in Argentinian pesos were converted to US dollars ($) using the 2005 purchasing power parity index. National costs of acute treatment for incident strokes were estimated by extrapolation of average costs estimates to national incidence data. Assumptions of the average cost of stroke treatment on a national scale were examined in sensitivity analysis. Results,,, The acute care of 167 patients with stroke was thoroughly evaluated from hospital admission to hospital discharge. Mean length of hospital stay was 35.4 days for ICH and 13.0 days for IS. Ninety-one percent of the patients with ICH and 68% of the patients with IS were admitted to an ICU for a mean length of stay (LOS) of 12.9 ± 20.3 and 3.6 ± 5.9 days respectively. Mean total costs of initial hospitalization were $12,285 (SD ±14,336) for ICH and $3888 (SD ±4018) for IS. Costs differed significantly by Glasgow Coma Scale (GCS) score at admission, development of pneumonia and infections during hospitalization, and functional outcome at hospital discharge. Aggregate national healthcare expenditures for acute treatment of incident ICH were $194.2m (range 97.1,388.4) and $239.9m for IS (range 119.9,479.7). Conclusion,,, The direct hospital costs of incident ICH and IS in Argentina are substantial and primarily driven by stroke severity, in-hospital complications and clinical outcomes. With the expected increase in the incidence of stroke over the coming decades, these results emphasize the need for effective preventive and acute medical care. [source] Different effects of short- and long-term recombinant hGH administration on ghrelin and adiponectin levels in GH-deficient adultsCLINICAL ENDOCRINOLOGY, Issue 1 2004Claudia Giavoli Summary objective, To evaluate circulating levels of ghrelin and adiponectin (ApN) in GH-deficient (GHD) adults before and after short- and long-term recombinant human GH (rhGH) administration. patients and methods, Twenty-three patients were studied. Seventeen subjects (Group A, 12 men, five women) were evaluated at baseline and after 1 year rhGH therapy (dose mean ± SD: 0·3 ± 0·1 mg/day) with the assessment of serum IGF-I, ghrelin, ApN, leptin, insulin and glucose levels, percentage of body fat (BF%), HOMA-IR and QUICKI. Seventeen age-, sex- and body mass index (BMI)-matched healthy subjects were recruited for comparisons. Six patients (Group B, three men, three women) underwent IGF-I generation test (rhGH 0·025 mg/kg/day for 7 days), blood sampled at baseline and on day 8 for determination of IGF-I, ghrelin and ApN levels. results, Group,A: at baseline GHD patients showed low IGF-I levels and BF% significantly higher than controls (31·4 ± 2·5 vs. 26·4 ± 1·3, P < 0·05). Glucose, insulin, leptin, tryglicerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels, as well as HOMA-IR and QUICKI values were similar in the two series, while total cholesterol levels were higher in GHD. In GHD, ghrelin levels were significantly lower than in controls (193·9 ± 27·1 vs. 298·1 ± 32·5 pmol/l, respectively, P = 0·02), while ApN levels were similar (10·2 ± 1·1 and 9 ± 1 mg/l, respectively, P = ns). After 1 year of rhGH therapy, BF%, BMI, serum total and LDL cholesterol significantly decreased, serum leptin levels showed a trend to decrease, while HOMA-IR and QUICKI did not change. Ghrelin and ApN levels significantly increased from 193·9 ± 27·1 to 232·4 ± 26·3 pmol/l (P < 0·01) and from 8·6 ± 0·8 to 10·3 ± 1·1 mg/l (P < 0·05), respectively. In group B, the expected increase in IGF-I levels was associated with a significant decrease in ghrelin levels, while ApN did not change. conclusion, GHD patients showed serum ghrelin lower than controls, probably due to the higher BF%. No difference in ApN was observed. Ghrelin and ApN increments induced by long-term treatment may be related to the significant BMI and BF% reduction that is the predominant metabolic effect of rhGH therapy. Conversely, the decrease in ghrelin levels observed after short-term rhGH administration may be consistent with an inhibitory feedback of GH and/or IGF-I on ghrelin release. [source] | ||||||||||||||||