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Levels Greater (level + greater)

Distribution by Scientific Domains

Medical Sciences	76%
Life Sciences	8%
Chemistry	8%
2 Other Domains	8%

Distribution within Medical Sciences

Surgery & Surgical Specialties	15%
Diabetes	10%
11 Other Subdomains	55%

Selected Abstracts

Predictors of glycaemic control in indigent patients presenting with diabetic ketoacidosis

DIABETES OBESITY & METABOLISM, Issue 3 2005
M. Maldonado
Aim:, To derive predictors of good glycaemic control in patients presenting with diabetic ketoacidosis (DKA) followed prospectively in a specialized clinic. Methods:, One hundred and sixty-one adult patients were admitted during a 31-month period and followed for at least 12 months. After 1 year, the patients were classified into three groups: good control (GC) (HbA1c , 7%), intermediate control (IC) (HbA1c 7,9%) and poor control (PC) (HbA1c > 9%). Characteristics of patients in the three groups were compared both at baseline and during follow-up. Results:, At 12 months, 36% of the patients were classified as GC, 27% as IC and 37% as PC. GC patients had higher fasting serum C-peptide levels 0.7 ± 0.54 compared to 0.38 ± 0.29 and 0.16 ± 0.21 nmol/l, respectively, for the IC and PC patients (p < 0.0001). A higher proportion GC patient had a C-peptide level greater than 0.33 nmol/l than that for IC and PC patients (86, 61 and 19%, respectively; p < 0.0001). Exogenous insulin was safely discontinued in 50, 30 and 3% of patients, respectively, in the GC, IC and PC groups (p < 0.0001). Compliance with life-style interventions was higher in the GC than that in IC and PC patients (87, 41 and 5%, respectively; p < 0.0001). In the logistic regression analysis, predictors of good glycaemic control were having baseline fasting serum C-peptide value ,0.33 mmol/l, OR: 3.01 (95% CI 1.07,8.55, p = 0.03) and compliance with life-style interventions OR 12.66 (95% CI 3.73,51.57, p = 0.0001). Conclusion:, Among adult patients with DKA, significant predictors of good glycaemic control are preserved ,-cell function and compliance with life-style modifications. [source]

Comparison of pharyngoesophageal segment pressure in total laryngectomy patients with and without pharyngeal neurectomy

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2003
Ahmet Köyba, lu MD
Abstract Background. To compare pharyngoesophageal segment (PES) pressure values in total laryngectomy patients with and without pharyngeal neurectomy (PN) in the early postoperative period. Methods. Forty-five previously untreated laryngeal carcinoma patients were enrolled into this prospective randomized study. Twenty of them underwent total laryngectomy with PN, and 25 underwent total laryngectomy without PN. PES pressures were measured on the tenth postoperative day with a four-channel catheter. Results. Average PES pressures in patients with and without pharyngeal neurectomy were 12.82 ± 6.11 mmHg and 17.40 ± .72 mmHg respectively (p < .05). When compared with the critical point of 20 mmHg that is closely related to voice attainment in the group without pharyngeal neurectomy, 10 (40%) patients had pressure levels greater than 20 mmHg and in the other group only 1 (5%) patient had a pressure level greater than 20 mmHg. The difference between the groups with pressure levels greater than 20 mmHg was found to be statistically significant (p < .05). Conclusions. Pharyngeal neurectomy results in a statistically significant decrease of PES pressures in total laryngectomy patients. © 2003 Wiley Periodicals, Inc. Head Neck 25: 617,623, 2003 [source]

Cardiovascular and Metabolic Effects of High-dose Insulin in a Porcine Septic Shock Model

ACADEMIC EMERGENCY MEDICINE, Issue 4 2010
Joel S. Holger MD
Abstract Objectives:, High-dose insulin (HDI) has inotropic and vasodilatory properties in various clinical conditions associated with myocardial depression. The authors hypothesized that HDI will improve the myocardial depression produced by severe septic shock and have beneficial effects on metabolic parameters. In an animal model of severe septic shock, this study compared the effects of HDI treatment to normal saline (NS) resuscitation alone. Methods:, Ten pigs were randomized to an insulin (HDI) or NS group. All were anesthetized and instrumented to monitor cardiovascular function. In both arms, Escherichia coli endotoxin lipopolysaccharide (LPS) and NS infusions were begun. LPS was titrated to 20 ,g/kg/hour over 30 minutes and continued for 5 hours, and saline was infused at 20 mL/kg/hour throughout the protocol. Dextrose (50%) was infused to maintain glucose in the 60,150 mg/dL range, and potassium was infused to maintain a level greater than 2.8 mmol/L. At 60 minutes, the HDI group received an insulin infusion titrated from 2 to 10 units/kg/hour over 40 minutes and continued at that rate throughout the protocol. Survival, heart rate (HR), mean arterial pressure (MAP), pulmonary artery and central venous pressure, cardiac output, central venous oxygen saturation (SVO2), and lactate were monitored for 5 hours (three pigs each arm) or 7 hours (two pigs each arm) or until death. Cardiac index, systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), O2 delivery, and O2 consumption were derived from measured data. Outcomes from the repeated-measures analysis were modeled using a mixed-effects linear model that assumed normally distributed errors and a random effect at the subject level. Results:, No significant baseline differences existed between arms at time 0 or 60 minutes. Survival was 100% in the HDI arm and 60% in the NS arm. Cardiovascular variables were significantly better in the HDI arm: cardiac index (p < 0.001), SVR (p < 0.003), and PVR (p < 0.01). The metabolic parameters were also significantly better in the HDI arm: SVO2 (p < 0.01), O2 delivery (p < 0.001), and O2 consumption (p < 0.001). No differences in MAP, HR, or lactate were found. Conclusions:, In this animal model of endotoxemic-induced septic shock that results in severe myocardial depression, HDI is associated with improved cardiac function compared to NS resuscitation alone. HDI also demonstrated favorable metabolic, pulmonary, and peripheral vascular effects. Further studies may define a potential role for the use of HDI in the resuscitation of septic shock. ACADEMIC EMERGENCY MEDICINE 2010; 17:429,435 © 2010 by the Society for Academic Emergency Medicine [source]

Synthesis and characterization of poly(butylene terephthalate)/mica nanocomposite fibers via in situ interlayer polymerization

JOURNAL OF APPLIED POLYMER SCIENCE, Issue 2 2007
Jin-Hae Chang
Abstract Intercalated nanocomposites consisting of poly(butylene terephthalate) (PBT) incorporated between mica layers were synthesized from dimethyl terephthalate (DMT) and 1,4-butanediol (BD) by in situ interlayer polymerization. PBT nanocomposites of varying organoclay content were melt-spun to produce monofilaments. The samples were characterized using wide angle X-ray diffraction, electron microscopy, thermal analysis, and tensile testing. Some of the clay particles were found to be well dispersed in the PBT matrix, but other clay particles were agglomerated at a size level greater than approximately 20 nm. The glass transition temperatures (Tg) and the thermal degradation properties (TDi) of undrawn PBT hybrid fibers were found to improve with increases in the clay content. At draw ratio (DR) = 1, the ultimate tensile strengths of the hybrid fibers increased with the addition of clay up to a critical content and then decreased. However, the initial moduli monotonically increased with increases in the amount of organoclay in the PBT matrix. The ultimate strengths were found to decrease linearly with increases in DR from 1 to 18. In contrast to the trend for the tensile strengths, the initial moduli of the hybrid fibers increased only slightly with increases in DR up to 18. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 2007 [source]

Survey of the management of neonatal hyperglycaemia in Australasia

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2007
Jane M Alsweiler
Aim: Hyperglycaemia is a common problem in very low birthweight (VLBW) preterm neonates and has been associated with an increase in intraventricular haemorrhage and mortality. There are few data to guide clinicians on the best range of blood glucose levels to aim for when treating hyperglycaemic preterm babies with insulin. The aim of this study was to survey all Australasian tertiary neonatal intensive care units for their current practice in the definition and management of neonatal hyperglycaemia to aid in the design of a randomised controlled trial of the effect of tight glycaemic control on long-term outcome in VLBW babies. Methods: An online survey was sent to the 27 tertiary neonatal units in Australasia asking the respondents for details of their unit's definition and management of hyperglycaemia in VLBW infants. Results: Twenty-three tertiary neonatal units responded to the questionnaire. There were six different definitions of hyperglycaemia, with most units defining neonatal hyperglycaemia as a blood glucose level greater than 10 mM. There were large variations in the criteria for commencing insulin (blood glucose level 8,15 mM ± glycosuria) and target blood glucose ranges for babies on insulin (ranging from 2.5,8 mM to 8,15 mM). Conclusions: There is a wide variation in the management of neonatal hyperglycaemia between tertiary neonatal units in Australasia. This reflects the paucity of data available in this area. Further research on the management of neonatal hyperglycaemia is needed. [source]

The survival outcome and prognostic factors for middle and distal bile duct cancer following surgical resection

JOURNAL OF SURGICAL ONCOLOGY, Issue 6 2009
Sae Byeol Choi MD
Abstract Background and Objectives The objective of this study was to analyze the survival outcome and the clinicopathological factors that influence survival and recurrence of middle and distal bile duct cancer after surgical resection. Methods From January 2000 to June 2007, 125 patients underwent surgical resection for middle and distal bile duct cancer. The clinicopathological characteristics and survival outcomes were reviewed retrospectively. Results Of the 125 patients, 31 patients underwent segmental resection of the bile duct, and 94 patients underwent pancreaticoduodenectomy (PD). Overall survival rates were 85.8% at 1 year and 38.3% at 5 years. Lymph node metastasis, noncurative resection, poorly differentiated tumor, and preoperative bilirubin level greater than 5.0 mg/dl were significant independent predictors of poor prognosis by multivariate analysis. The number of metastatic lymph nodes did not significantly affect survival. Recurrence occurred in 72 patients (61.0%). Disease-free survival rates were 74.1% at 1 year and 42.0% at 3 years. Lymph node and distant metastases and poorly differentiated tumors were found to be significant independent predictors of recurrence by multivariate analysis. Conclusions R0 resection confers a survival benefit, thus the surgeon should make an effort to achieve R0 resection. The presence of lymph node metastasis was a significant prognostic factor. J. Surg. Oncol. 2009;99:335,342. © 2009 Wiley-Liss, Inc. [source]

Successful use of short-term mechanical ventilation to manage respiratory failure secondary to profound hypokalemia in a cat with hyperaldosteronism

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 5 2008
Tara N. Hammond DVM
Abstract Objective , To report successful management of respiratory failure due to severe hypokalemia in a cat with hyperaldosteronism, including short-term mechanical ventilation strategies and aspects of medical and surgical treatment. Case Summary , A cat presented with bilateral pelvic limb weakness that rapidly progressed to tetraparesis and respiratory muscle failure. Point-of-care testing revealed severe hypokalemia (1.9 mmol/L) and mild azotemia. Initial management included endotracheal intubation, mechanical ventilation, and aggressive potassium supplementation. Spironolactone was started due to a high index of suspicion for hyperaldosteronism. A right adrenal mass visualized during abdominal ultrasonographic examination and a serum aldosterone level greater than 3329 pmol/L confirmed the diagnosis. The cat made a full recovery following surgical removal of a right adrenal adenoma. New or Unique Information Provided , We report successful management of respiratory failure in a cat with hyperaldosteronism using short-term mechanical ventilation. Respiratory failure due to severe hypokalemia should be considered a complication of hyperaldosteronism in cats and may require mechanical ventilation. However, full recovery is possible. [source]

Retransplantation for late liver graft failure: Predictors of mortality

LIVER TRANSPLANTATION, Issue 2 2000
Marcelo Facciuto
As patient survival after orthotopic liver transplantation (OLT) improves, late complications, including late graft failure, more commonly occur and retransplantation (re-OLT) is required more often. Survival after re-OLT is poorer than after primary OLT, and given the organ shortage, it is essential that we optimize our use of scarce donor livers. We sought to identify variables that predict poor outcome after late re-OLT. Among adults who underwent OLT between September 1989 and October 1997, we identified transplant recipients who survived greater than 6 months (n = 964) and analyzed those who required late re-OLT (,6 months after primary OLT). We recorded the indication for the initial OLT and interval from OLT to re-OLT. We also analyzed data collected at the time of re-OLT, including age, sex, indications for primary OLT and re-OLT, United Network for Organ Sharing status, preoperative laboratory values (white blood cells, platelets, hemoglobin, albumin, bilirubin, creatinine, and prothrombin time), Child-Pugh-Turcotte score, number of rejection episodes before re-OLT, and interval between OLT and re-OLT. In addition, we analyzed surgical factors (including procedure performed and use of packed red blood cells, fresh frozen plasma, and platelets), postoperative immunosuppression, and donor factors (age, ischemic time). Forty-eight patients (5%) underwent late re-OLT at a median of 557 days (range, 195 to 2,559 days) post-OLT. Survival rates after re-OLT at 90 days, 1 year, and 5 years were 71%, 60%, and 42%, respectively. Patients surviving 90 days or greater after re-OLT had an 85% chance of surviving to 1 year. Sepsis was the leading cause of death (15 of 25 deaths; 60%). Recipient age older than 50 years (P = .04), preoperative creatinine level greater than 2 mg/dL (P = .004), and use of intraoperative blood products (packed red blood cells, P = .001; fresh frozen plasma, P = .002; platelets, P = .004) had significant impacts on survival. Late re-OLT was associated with increased mortality. Careful patient selection, with particular attention to recipient age and renal function, may help improve results and optimize our use of scarce donor livers. [source]

Insulin glargine improves hemoglobin A1c in children and adolescents with poorly controlled type 1 diabetes

PEDIATRIC DIABETES, Issue 2 2003
Anne Jackson
Abstract:, The pediatric diabetes team at the University of Minnesota made a clinical decision to switch patients with type 1 diabetes with a hemoglobin A1c level greater than 8.0% to insulin glargine in an effort to improve glycemic control. Retrospective chart analysis was performed on 37 patients 6 months after the switch to insulin glargine therapy. Results:, After 6 months, the average hemoglobin A1c level in the entire cohort dropped from 10.1 ± 2.0 to 8.9 ± 1.6% (p = 0.001). Thirty patients responded with an average hemoglobin A1c drop of 1.7 ± 1.5%, from 10.3 ± 2.2 to 8.6 ± 1.5% (p < 0.001). Seven patients did not respond to insulin glargine therapy, with an average hemoglobin A1c rise of 1.0 ± 0.8% from a baseline of 9.5 ± 1.0% to 10.4 ± 1.4% (p = 0.01). The greatest response was seen in children with an A1c > 12.0%, who dropped their hemoglobin A1c by 3.5 ± 1.9%. Compared with responders, non-responders had significantly less contact with the diabetes team in the form of clinic visits and telephone conversations both before and after initiation of glargine therapy. Sixty-two per cent of patients received insulin glargine at lunchtime, when injections could be supervised at school. Three episodes of severe hypoglycemia occurred after initiation of insulin glargine therapy. Conclusions:, Insulin glargine substantially improved glycemic control in children and adolescents with poorly controlled type 1 diabetes. This response was most remarkable in those with a baseline hemoglobin A1c level > 12.0%, and may have been related to increased supervision of injections. [source]

Elevated IRT levels in African-American infants: Implications for newborn screening in an ethnically diverse population

PEDIATRIC PULMONOLOGY, Issue 7 2008
Robert Giusti MD
Abstract During the first 4 years of newborn screening (NBS) for Cystic Fibrosis (CF) in New York there was a statistically significant, twofold greater relative risk of an Immunoreactive Trypsinogen (IRT) level greater than 95% in African-American infants. The reason for this previously reported increase in IRT level in African-American infants is unclear. The positive predictive value of a screen positive result in this population was only 0.3%. The bulk of screen-positive African-American infants were in the top 0.2% (IRT) group, with no CF mutations isolated. Repeat IRT testing at 2,3 weeks of age may represent a suitable approach to decrease the false-positive rate in this population. Pediatr Pulmonol. 2008; 43:638,641. © 2008 Wiley-Liss, Inc. [source]

Liver function testing in patients on HMG-CoA reductase inhibitors,

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2003
Susan E. Andrade ScD
Abstract Purpose The Food and Drug Administration currently requires the labeling of HMG-CoA reductase inhibitors to recommend liver function tests (LFTs) before the start of therapy and at various intervals during therapy, depending on the specific agent. We sought to determine the frequency and patterns of LFT screening in patients receiving HMG-CoA reductase inhibitors. Methods A retrospective study was conducted at a staff-model health maintenance organization among 4178 new users of HMG-CoA reductase inhibitors during the period 1 January 1991 through 31 December 1996. The number and proportions of HMG-CoA reductase inhibitor therapy courses with baseline LFTs (within 180 days prior to dispensing), follow-up LFTs and LFT abnormalities were calculated. Results For the initial HMG-CoA reductase inhibitor dispensed, 1947 patients (47%) had at least one screening LFT at baseline and 3063 (73%) had at least one follow-up LFT. Twenty-seven (0.9%) patients with at least one follow-up LFT performed had a level greater than 3 times the upper limit of normal. In a random sample of 100 discontinued patients, none discontinued due to elevated LFTs or liver disease. Conclusions A large proportion of patients dispensed HMG-CoA reductase inhibitors in this managed care setting did not have baseline and follow-up LFTs performed. Modest LFT abnormalities were common among users of HMG-CoA reductase inhibitors; however, in this population, serious abnormalities were rare. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Intraoperative decay profile of intact (1,84) parathyroid hormone in surgery for secondary hyperparathyroidism in a consecutive series of 50 patients on haemodialysis

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2000
J. Lokey
Background The usefulness of rapid intraoperative monitoring of intact (1,84) parathyroid hormone (PTH) is not clearly defined in the surgical management of secondary HPT in the patients on haemodialysis. The aim of this study was to define the normal pattern of decay during surgery for secondary HPT using the rapid intact (1,84) PTH assay during operation. Methods Fifty patients on haemodialysis underwent neck exploration for secondary HPT. The therapeutic goal in all patients was the subtotal resection of four or more glands and bilateral transcervical thymectomy. PTH levels were monitored using a rapid immunochemiluminometric assay. Peripheral blood samples were assayed at induction of anaesthesia, after dissection but before resection, and 20 and 40 min after resection in all patients. All patients were followed up for at least 6 months. PTH levels were expressed as absolute values, as multiples of the upper limit of normal and as the percentage decline from pre-excision values. Results Forty-eight patients (96 per cent) were considered cured after surgery. Twenty patients (40 per cent) had a PTH level less than twice normal and 20 patients (40 per cent) had a PTH level between two and four times normal at 20 min. At late follow-up, all these patients were cured. Ten patients (20 per cent) had a PTH level greater than four times normal at 20 min. Eight of these patients were cured. Seven of these eight had a PTH level at 20 min, while not less than four times normal, less than 40 per cent of the original value. In contrast, the two failures had neither a decline to less than four times normal nor a decay to less than 40 per cent of the original value. One has been reoperated with resection of a fifth gland and one awaits reoperation. Conclusion The intraoperative decay of PTH during surgery for secondary HPT in patients on haemodialysis is slower than that in patients with normal renal function. However, 20 min after resection, a decline to less than four times the upper limit of normal is predictive of cure. Variability of decay slopes in individual patients may reflect molecular heterogeneity or biphasic metabolism of the hormone. © 2000 British Journal of Surgery Society Ltd [source]

Influence of contamination by organochlorine pesticides and polychlorinated biphenyls on the breeding of the Spanish Imperial Eagle (Aquila adalberti)

ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 2 2008
Mauro Hernández
Abstract We evaluated temporal and regional trends of organochlorine (OC) pesticide (including polychlorinated biphenyl [PCB]) levels in eggs of the Spanish Imperial Eagle (Aquila adalberti) collected in Spain between 1972 and 2003. Levels of p,p,-dichlorodiphenyldichloroethylene (DDE) and PCBs varied significantly (p = 0.022) among regions (central, western, and Doñana), being higher in Doñana than in the central and western populations (DDE: 1.64 ± 5.56, 0.816 ± 1.70, and 1.1 ± 2.66 ,g/g, respectively; PCBs: 1.189 ± 5.0, 0.517 ± 1.55, and 0.578 ± 1.75 ,g/g, respectively). Levels of DDE decreased with time, but a significant interaction was observed between region and time. In Doñana, egg volume and breadth as well as Ratcliffe Index were significantly lower after DDT use (p = 0.0018) than during the pre-DDT period (p = 0.0018); eggs were significantly smaller overall than in the other two regions (p = 0.04) and were smaller when DDE levels increased, even when controlling for regional differences (p = 0.04). Productivity in Doñana was significantly lower than in the other regions (p < 0.001). Clutch size in Doñana varied according to DDE concentrations (p = 0.01), with the highest DDE concentrations found in clutches consisting of one egg. When considering eggs with DDE levels greater than 3.5 ,g/g, a significant effect of DDE on fertility was found (p = 0.03). Clutches with DDE levels greater than 4.0 ,g/g had a higher probability of hatching failure (p = 0.07) and produced fewer fledglings (p = 0.03). If we consider 3.5 ,g/g as the lowest-observable-adverse-effect level, the proportion of sampled clutches that exceeded that level in Doñana (29%) was significantly higher than in other regions (p < 0.001). These eggs showed a mean percentage of thinning of 16.72%. Contamination by OCs, mainly DDE, could explain, at least in part, the low productivity of the Spanish Imperial Eagles in Doñana. [source]

Elevated sweat sodium associated with pulmonary oedema in meningococcal sepsis

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 8 2004
M. Eisenhut
Abstract Background, We observed a temporary positive sweat test with sodium and chloride levels greater than 60 mmol L,1 following meningococcal septicaemia. Objective was to investigate whether this finding is reproducible and whether this disturbance in epithelial sodium transport is related to sepsis-induced pulmonary oedema. Materials and methods, Twenty-four children with a diagnosis of meningococcal septicaemia and 10 controls with noninfectious critical illness admitted to the Royal Liverpool Children's Hospital were included. Sweat collection was by pilocarpine iontophoresis in the acute phase of the illness (days 1,5) and on follow up. Sodium and chloride concentrations were determined by flame photometry. Results, In patients with meningococcal septicaemia, sweat sodium and chloride concentrations were significantly higher in the acute compared with the recovery phase, with a mean (SD) of 31·0 (14·6) mmol L,1 in the acute vs. 19·6 (10·2) mmol L,1 on recovery for sodium and 21·0 (12·1) mmol L,1 in the acute vs. 11·8 (4·9) mmol L,1 on recovery for chloride (P < 0·01, t -test, for sodium and chloride). Sweat sodium and chloride were significantly higher in patients with meningococcal disease compared with controls and in the acute phase in patients with septicaemia-related pulmonary oedema [mean (SD) sodium: 41·0 (15·4) mmol L,1 and chloride: 28·8 (14·3) mmol L,1] compared with septic patients without [mean (SD) sodium: 24·5 (10·1) mmol L,1 and chloride: 15·3 (7·9) mmol L,1] (P < 0·01 for sodium and chloride). Conclusions, This is the first study to provide in vivo evidence of reduced epithelial sodium transport in children with septicaemia and of its association with pulmonary oedema. [source]

Comparison of pharyngoesophageal segment pressure in total laryngectomy patients with and without pharyngeal neurectomy

10W CW broadband balanced limiter/LNA fabricated using MSAG MESFET process

INTERNATIONAL JOURNAL OF RF AND MICROWAVE COMPUTER-AIDED ENGINEERING, Issue 2 2003
Inder J. Bahl
Abstract This article presents the design and test data for a 10W broadband balanced limiter/LNA MMIC fabricated using MSAG MESFET process. The limiter is based on Schottky diodes and the two-stage LNA is designed using high-performance MESFETs. The typical measured performance for the limiter/LNA circuit includes gain greater than 14 dB, NF less than 2.7 dB, and return loss better than 20 dB over the 8.5,11.5 GHz frequency range. The CW power handling for the packaged limiter/LNA circuits was greater than 10W. The packaged devices were also exposed to power levels greater than 10W, and no catastrophic failures were observed up to 18W. © 2003 Wiley Periodicals, Inc. Int J RF and Microwave CAE 13: 118,127, 2003. [source]

Serum Calcium and Cognitive Function in Old Age

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2007
Miranda T. Schram PhD
OBJECTIVES: To determine whether serum calcium is associated with cognitive function in elderly individuals in the general population. DESIGN: Prospective follow-up study of two independent, population-based cohorts. SETTING: The Rotterdam Study (median follow-up 11 years) and the Leiden 85-plus Study (median follow-up 5 years). PARTICIPANTS: Three thousand nine hundred ninety-four individuals, mean age 71, from the Rotterdam Study and 560 individuals, all aged 85, from the Leiden 85-plus Study. MEASUREMENTS: Global cognitive function was assessed in both cohorts using the Mini-Mental State Examination; attention, psychomotor speed, and memory function were assessed in the Leiden 85-plus Study only. Linear regression and linear mixed models were used for statistical analyses. RESULTS: In the Rotterdam Study, high serum calcium was associated with worse global cognitive function at baseline (P<.05) and a faster rate of decline in cognitive function during follow-up (P=.005) in individuals aged 75 and older but not in younger individuals. In the Leiden 85-plus Study, high serum calcium was associated with worse global cognitive function from age 85 through 90 (P<.001). This observation also held for the specific cognitive domains tested (all P<.01). These results did not change when individuals with serum calcium levels greater than normal (>2.55 mmol/L) were excluded from the analyses. CONCLUSION: In the general population, high serum calcium levels are associated with faster decline in cognitive function over the age of 75. [source]

Gender divergent expression of Nqo1 in Sprague Dawley and August Copenhagen x Irish rats

JOURNAL OF BIOCHEMICAL AND MOLECULAR TOXICOLOGY, Issue 2 2008
Lisa M. Augustine
In the mammalian liver, there is an abundance of enzymes that function to enable the safe and efficient elimination of potentially harmful xenobiotics that are encountered through environmental exposure. A variety of factors, including gender and genetic polymorphisms, contribute to the variation between an individual system's detoxification capacity and thus its ability to protect itself against oxidative stress, cellular damage, cell death, etc. NAD(P)H:quinone oxidoreducatase 1 (Nqo1) is an antioxidant enzyme that plays a major role in reducing reactive electrophiles, thereby protecting cells from free-radical damage and oxidative stress. The goal of this study was to determine the gender-specific expression and inducibility of Nqo1 in the Sprague Dawley (SD) and August Copenhagen x Irish (ACI) rat strains, two strains that are commonly used in drug metabolism and drug-induced enzyme induction, toxicity, and carcinogenesis studies. Nqo1 mRNA, protein, and activity levels were determined through 96 h in SD and ACI males and females following treatment with known Nqo1 inducers oltipraz and butylated hydroxyanisole. In the SD strain, gender dimorphic expression of Nqo1 was observed with female mRNA, protein, and activity levels being significantly higher than in males. In contrast, there were minimal differences in Nqo1 mRNA, protein, and activity levels between ACI males and females. The gender dimorphic expression of Nqo1 in the SD rats was maintained through the course of induction, with female-induced levels greater than male-induced levels indicating that SD females may have a greater capacity to protect against oxidative stress and thus a decreased susceptibility to carcinogens. © 2008 Wiley Periodicals, Inc. J Biochem Mol Toxicol 22:93,100, 2008; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/jbt.20224 [source]

The Role of the Kidneys in Hypertension

JOURNAL OF CLINICAL HYPERTENSION, Issue 9 2005
L. Gabriel Navar PhD
The devastating long-term consequences of high blood pressure include stroke, heart disease, atherosclerosis, renal disease, and other end-organ damage. From a physiologic perspective, it is not apparent why the propensity for hypertension is so widespread in the general population. Clearly, an adequate arterial pressure is essential for perfusion of the tissues to provide adequate oxygenation and nutrition to the brain and other critical organs. Although the various microcirculatory beds have the capability to adjust vascular resistance to autoregulate blood flow, systemic arterial pressure is usually maintained at levels greater than required for requisite tissue perfusion. The myriad of neurohumoral mechanisms designed to protect against decreases in systemic arterial pressure provide a reserve capacity for increased perfusion when there are increased tissue demands. The unfortunate consequence of having these powerful physiologic control mechanisms is that they may be inappropriately activated in certain circumstances or by genetically determined traits, leading to hypertension and cardiovascular injury. Evidence continues to accumulate indicating that the kidney not only is victim to hypertension-related injury, but also contributes as a villain to the hypertensinogenic process. [source]

Influence of Pressing Method on Juice Stilbene Content in Muscadine and Bunch Grapes

JOURNAL OF FOOD SCIENCE, Issue 4 2008
M.R. Leblanc
ABSTRACT:, Juice stilbene contents of 2 muscadine (Vitis rotundifolia) cultivars, Noble and Carlos, and 2 bunch grape (Vitis labrusca) cultivars, Mid South and Miss Blanc were evaluated after crushing and pressing. Four commercial pressing methods were used to produce juice: (1) cold press of fresh berries (CP); (2) hot press of fresh berries (HP); (3) cold press of frozen and thawed berries (FCP); and (4) cold press of pectolytic enzyme treated berries (ECP). Free run juice (FRJ) from the crusher without pressing was also tested. An HPLC with a UV detector was used to verify the presence and quantity of resveratrol, piceid, and their isomers. For the muscadine juices, total stilbenes were greater for HP and FCP than for FRJ and CP treatments. Trans -resveratrol was only detected in HP juices of the muscadines at levels near the detection limits. The bunch grape cultivars behaved similar to the muscadines in the processing treatments. HP juice had the greatest total stilbene levels and was significantly greater than FRJ, CP, and FCP. Total stilbene levels in juices from the 2 bunch grape cultivars, were higher (up to 5 times greater depending on pressing method) than for the muscadine grape cultivars. Total stilbene levels in muscadine juices treated with pectinase before pressing (ECP) were similar to those of the FCP samples. Juice from FCP and ECP treated Noble muscadine had total stilbene levels greater than FRJ and CP but less than HP levels. Juices from HP-, ECP-, and FCP-treated Carlos muscadine had total stilbene levels greater than for FRJ and CP juices. [source]

High D-dimer levels increase the likelihood of pulmonary embolism

JOURNAL OF INTERNAL MEDICINE, Issue 2 2008
L. W. Tick
Abstract. Objective., To determine the utility of high quantitative D-dimer levels in the diagnosis of pulmonary embolism. Methods., D-dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous thromboembolism, i.e. hospitalized patients, patients older than 80 years, with malignancy or previous surgery. Presence of pulmonary embolism was based on a diagnostic management strategy using a clinical decision rule (CDR), D-dimer testing and computed tomography. Results., A total of 1515 patients were included with an overall pulmonary embolism prevalence of 21%. The pulmonary embolism prevalence was strongly associated with the height of the D-dimer level, and increased fourfold with D-dimer levels greater than 4000 ng mL,1 compared to levels between 500 and 1000 ng mL,1. Patients with D-dimer levels higher than 2000 ng mL,1 and an unlikely CDR had a pulmonary embolism prevalence of 36%. This prevalence is comparable to the pulmonary embolism likely CDR group. When D-dimer levels were above 4000 ng mL,1, the observed pulmonary embolism prevalence was very high, independent of CDR score. Conclusion., Strongly elevated D-dimer levels substantially increase the likelihood of pulmonary embolism. Whether this should translate into more intensive diagnostic and therapeutic measures in patients with high D-dimer levels irrespective of CDR remains to be studied. [source]

Original Article: Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010
Christopher R.H. WHITE
Background:, Current evidence suggests that umbilical arterial pH analysis provides the most sensitive reflection of birth asphyxia. However, there's debate whether umbilical cord blood gas analysis (UC-BGA) should be conducted on some or all deliveries. Aim:, The aim of this study was to evaluate the impact of introducing universal UC-BGA at delivery on perinatal outcome. Methods:, An observational study of all deliveries ,20 weeks' gestation at a tertiary obstetric unit between January 2003 and December 2006. Paired UC-BGA was performed on 97% of deliveries (n = 19,646). Univariate and adjusted analysis assessed inter-year UC-BGA differences and the likelihood of metabolic acidosis and nursery admission. Results:, There was a progressive improvement in umbilical artery pH, pO2, pCO2, base excess and lactate values in univariate and adjusted analyses (P < 0.001). There was a significant reduction in the newborns with an arterial pH <7.10 (OR = 0.71; 95%CI 0.53,0.95) and lactate >6.1 mmol/L (OR = 0.37; 95%CI 0.30,0.46). Utilising population specific 5th and 95th percentiles, there was a reduction in newborns with arterial pH less than 5th percentile (pH 7.12; OR = 0.75; 95%CI 0.59,0.96) and lactate levels greater than 95th percentile (6.7 mmol/L; OR = 0.37; 95%CI 0.29,0.49). There was a reduction in term (OR = 0.65; 95%CI 0.54,0.78), and overall (OR = 0.75; 95%CI 0.64,0.87) nursery admissions. These improved perinatal outcomes were independent of intervention rates. Conclusions:, These data suggest that introduction of universal UC-BGA may result in improved perinatal outcomes, which were observed to be independent of obstetric intervention. We suggest that these improvements might be attributed to provision of biochemical data relating to fetal acid-base status at delivery influencing intrapartum care in subsequent cases. [source]

Hepatotoxicity Despite Early Administration of Intravenous N -Acetylcysteine for Acute Acetaminophen Overdose

ACADEMIC EMERGENCY MEDICINE, Issue 1 2009
Suzanne Doyon MD
Abstract Objectives:, The objective was to evaluate the effectiveness of intravenous N -acetylcysteine (IV NAC; 300 mg/kg over 21 hours) in early acute acetaminophen (APAP) overdose patients. Methods:, This observational case series included patients hospitalized between 2004 and 2007 for acute APAP overdoses and who were reported to a regional poison center. Inclusion criteria were plasma APAP concentrations on or above the treatment line on the Rumack-Matthew nomogram, administration of IV NAC within 8 hours of ingestion, and follow-up to known outcome. The hospital chart of each patient who received IV NAC for longer than the standard 21 hours was reviewed. Hepatotoxicity was defined as hepatic aminotransferase levels greater than 1,000 IU/L. Results:, Seventy-seven patients met inclusion criteria and received at least 21 hours of IV NAC for an acute APAP overdose. Seven patients received antidotal therapy for greater than 21 hours. These patients tended to have ingested combination preparations, have very high initial plasma APAP concentrations, and had persistently elevated plasma concentrations during their hospital stay. Hepatotoxicity occurred in 4 patients (5.2%, 95% confidence interval [CI] = 0.2% to 10.1%), including 1 death and 1 liver transplantation. Conclusions:, Hepatotoxicity developed in 5.2% of cases, suggesting that the 21-hour IV NAC regimen is suboptimal in some patients. In addition to high initial plasma APAP concentrations, APAP product formulation and persistently elevated plasma APAP concentrations were identified as factors possibly associated with developing hepatotoxicity. The authors propose a tailored approach to the discontinuation of IV NAC and point out the need for reevaluation of optimal doses and duration of therapy. [source]

Environmental constraints on life histories in Antarctic ecosystems: tempos, timings and predictability

BIOLOGICAL REVIEWS, Issue 1 2006
Lloyd S. Peck
ABSTRACT Knowledge of Antarctic biotas and environments has increased dramatically in recent years. There has also been a rapid increase in the use of novel technologies. Despite this, some fundamental aspects of environmental control that structure physiological, ecological and life-history traits in Antarctic organisms have received little attention. Possibly the most important of these is the timing and availability of resources, and the way in which this dictates the tempo or pace of life. The clearest view of this effect comes from comparisons of species living in different habitats. Here, we (i) show that the timing and extent of resource availability, from nutrients to colonisable space, differ across Antarctic marine, intertidal and terrestrial habitats, and (ii) illustrate that these differences affect the rate at which organisms function. Consequently, there are many dramatic biological differences between organisms that live as little as 10 m apart, but have gaping voids between them ecologically. Identifying the effects of environmental timing and predictability requires detailed analysis in a wide context, where Antarctic terrestrial and marine ecosystems are at one extreme of the continuum of available environments for many characteristics including temperature, ice cover and seasonality. Anthropocentrically, Antarctica is harsh and as might be expected terrestrial animal and plant diversity and biomass are restricted. By contrast, Antarctic marine biotas are rich and diverse, and several phyla are represented at levels greater than global averages. There has been much debate on the relative importance of various physical factors that structure the characteristics of Antarctic biotas. This is especially so for temperature and seasonality, and their effects on physiology, life history and biodiversity. More recently, habitat age and persistence through previous ice maxima have been identified as key factors dictating biodiversity and endemism. Modern molecular methods have also recently been incorporated into many traditional areas of polar biology. Environmental predictability dictates many of the biological characters seen in all of these areas of Antarctic research. [source]

Survey of neonatal respiratory support strategies

ACTA PAEDIATRICA, Issue 8 2007
Atul Sharma
Abstract Aim: To survey current practice regarding neonatal respiratory support strategies to determine whether it reflected evidence from randomised trials. Methods: A questionnaire (in Supplementary Material online) survey of all U.K. neonatal units was undertaken to determine what modes of ventilation, types of endotracheal tube, lung function monitoring and oxygen saturation levels were used. Results: There was an 80% response rate. Most (73%) units used in prematurely born infants (in the first 24 h) the intermittent positive pressure ventilation, and other respiratory modes included: CPAP (2%), triggered ventilation with or without volume guarantee (22%) and high frequency oscillation (2%). Only 15% of units used assist control mode for weaning; the preferred weaning mode was synchronous intermittent mandatory ventilation (73%). Few units used shouldered endotracheal tubes (3%) or lung function measurements (25%) to aid choice of ventilator settings. Oxygen saturation levels from 80% to 98% were used, levels greater or equal to 95% were used by 11% of units for infants with acute respiratory disease but by 34% of units for BPD infants (p < 0.001). Conclusion: Many practitioners do not base their choice of neonatal respiratory support strategies on the results of large randomised trials; more effective methods are required to ensure evidence-based practice. [source]