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Biomedical subjects

Eugene S Smith

Publications and source records attributed to Eugene S Smith.

10 recordsLinked to original sources
PubMed2007

Effects of muscle strength training and megestrol acetate on strength, muscle mass, and function in frail older people.

OBJECTIVES: To determine the independent and combined effects of progressive resistance muscle strength training (PRMST) and megestrol acetate (MA) on strength, muscle mass, and function in older recuperative care patients. DESIGN: Double-blind, randomized, controlled intervention using a two-by-two factorial design and conducted between 1999 and 2001. SETTING: University-affiliated Department of Veterans Affairs hospital. PARTICIPANTS: Twenty-nine patients (mean age 79.4 +/- 7.4, 90% white) aged 65 and older and had recent functional decline. INTERVENTIONS: After randomization to one of four treatment groups (low-resistance exercises plus 800 mg per day of MA or a placebo or high-intensity PRMST plus 800 mg/d of MA or placebo), subjects received training and the drug or placebo for 12 weeks. MEASUREMENTS: Change in muscle strength, mid-thigh muscle area, and aggregate functional performance score as assessed using analysis of covariance. RESULTS: Five subjects withdrew from the study before its completion. Based on intent-to-treat analyses, subjects who received high-intensity PRMST and placebo experienced the greatest strength gains. The addition of MA was associated with worse outcomes than with high-intensity exercise training alone, especially with regard to the leg exercises. Post hoc analysis demonstrated that subjects who received high-intensity PRMST and placebo experienced significantly greater percentage increases in leg strength than subjects in either of the MA treatment groups (P<.05 for each comparison). There was also a significant negative effect of MA on physical function. In general, subjects who received MA experienced a deterioration in aggregate physical function scores, whereas the remaining subjects improved (-0.80+/-0.40 vs 0.48+/-0.41, P=.04). There was not a significant interaction between exercise and MA for any outcome. CONCLUSION: High-intensity PRMST is a safe and well-tolerated exercise regimen for frail elderly patients. The addition of MA appears to blunt the beneficial effects of PRMST, resulting in less muscle strength and functional performance gains.

Aged↗
PubMed2006

Safety and effectiveness of granulocyte-colony stimulating factor in mobilizing stem cells and improving cytokine profile in advanced chronic heart failure.

The objective of this study was to determine a safe and effective dose of granulocyte-colony stimulating factor (G-CSF) to mobilize hematopoietic stem cells in patients with advanced heart failure and to determine its effects on the cytokine profile. Patients with advanced heart failure (n = 6) and implantable defibrillators in situ were administered G-CSF after baseline echocardiographic and laboratory evaluation, using an escalating dose schedule designed to ensure safety. The peripheral CD34+ hematopoietic stem cell count increased from 3.6 +/- 0.5/microl to 38.7 +/- 13/microl (p= 0.022) after 5 days of 5 microg/kg/day G-CSF therapy. The baseline or peak white blood cell count did not predict the stem cell response. G-CSF increased plasma levels of interleukin-10. Left ventricular ejection fraction increased significantly in the 4 patients with ischemic cardiomyopathy 9 months after treatment. No major adverse effects attributable to the drug occurred during administration or 9 months of follow-up. Our results have shown that low-dose G-CSF significantly mobilized hematopoietic stem cells in advanced heart failure and improved left ventricular function in the ischemic subset of patients. G-CSF significantly increased plasma levels of the anti-inflammatory cytokine interleukin-10, without changing pro-inflammatory cytokine levels. In conclusion, these results indicate a novel mechanism of action for the potential therapeutic benefit of G-CSF in advanced ischemic cardiomyopathy.

Aged↗
PubMed2006

Prevention of heart failure.

PURPOSE OF REVIEW: Chronic heart failure imposes a significant health burden and remains a substantial and increasing problem despite advances in therapy. Hence, prevention of heart failure is a priority. RECENT FINDINGS: Various risk factors have been identified that contribute to the development of heart failure. In this review, we will discuss the various recently reported clinical trials, epidemiological studies, meta-analyses, and subanalyses that have identified these risk factors and have provided evidence regarding the strategies to prevent heart failure. SUMMARY: Heart failure is a costly, disabling, and potentially fatal disease. It is therefore important to incorporate the strategies for prevention of heart failure on the basis of the current available evidence into routine clinical practice.

Atherosclerosis↗
PubMed2005

Trends in the care of patients with acute myocardial infarction at a university-affiliated Veterans Affairs Medical Center.

BACKGROUND: Acute cardiac care of the veterans at Veterans Administration (VA) hospitals has been thought of as poor in quality. We examined the use of life-saving, evidence-based medical therapy in patients admitted with acute myocardial infarction to the University of Arkansas for Medical Sciences-affiliated VA Medical Center in Little Rock and compared the use of this therapy with other hospitals in Arkansas and in the rest of the nation. METHODS: Use of life-saving medical therapy in 117 patients admitted with acute myocardial infarction from January 2002 to December 2002 was compared with the National Registry of Myocardial Infarction database for the identical period. RESULTS: Heparin/low-molecular-weight heparin and glycoprotein IIb/IIIa inhibitors were used in 88% and 66% of patients, respectively. Aspirin, beta adrenergic-blocking agents, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) were used in 92%, 93%, 62%, and 79% of the patients, respectively. The use of these therapies was better than in similar patients in Arkansas (P < .001) and the United States as a whole (P < .01). Calcium-channel blockers were used in 16% of the patients. At a mean follow-up period of 1.5 years, use of beta blockers and aspirin had decreased, whereas the use of statins and ACE inhibitors/ARBs was unchanged. CONCLUSION: This study shows that patients with acute myocardial infarction admitted to this university-affiliated VA Medical Center receive evidence-based life-saving medical therapy more often than in the rest Arkansas or in the entire United States. More important, patients at this federal institution continue to receive life-saving medical therapy during follow-up. Better use of evidence-based therapy may be related to affiliation of this VA Medical Center with a teaching institution where board certified cardiologists are involved in short- and long-term care of these patients.

Adrenergic beta-Antagonists↗
PubMed2005

Effects of muscle strength training and testosterone in frail elderly males.

PURPOSE: Determine the independent and combined effects of progressive resistance muscle strength training (PRMST) and testosterone on strength, muscle mass, and function in hypogonadal elderly male recuperative care patients. METHODS: Between 1999 and 2004, 71 subjects (mean age 78.2 +/- 6.4 yr, 86% white) were enrolled. After baseline one-repetition maximum (1RM) strength testing and then randomization to one of four treatment groups (low-resistance (20% of the 1RM) exercises and weekly injections of either 100 mg of testosterone enanthate or placebo or high-intensity PRMST (> or =80% 1RM) and weekly injections), each subject received training and injections for 12 wk. RESULTS: Ten subjects withdrew from the study before its completion. Based on intent-to-treat analyses, strength improved in all groups, but was greater with high-intensity PRMST compared with low-resistance exercise (e.g., leg press, (mean +/- SE), 28 +/- 4 vs 13 +/- 4%, P = 0.009). Although testosterone led to significantly greater increases in midthigh cross-sectional muscle area compared with placebo (7.9 +/- 1.3 vs 2.4 +/- 1.4%, P = 0.005), it produced only a nonsignificant trend toward greater strength gains (e.g., leg press 25 +/- 4 vs 16 +/- 4%, P = 0.144). Change in aggregate functional performance score (the sum of 4 functional performance test scores) did not differ between the four intervention groups nor with high-intensity PRMST compared with low-resistance exercise (7 +/- 5 vs 15 +/- 5%, P = 0.263). There was not a significant interaction between exercise and testosterone for any outcome. CONCLUSION: High-intensity PRMST is as safe and well tolerated as a similarly structured low-resistance exercise regimen for very frail elderly patients, but produces greater muscle strength improvements. The addition of testosterone leads to greater muscle size and a trend toward greater strength but did not produce a synergistic interaction with exercise. Neither intervention had a significant effect on functional performance.

Aged↗
PubMed2003

Forearm endothelial response in smokeless tobacco users compared with cigarette smokers and nonusers of tobacco.

STUDY OBJECTIVE: To compare brachial artery flow-mediated dilation (FMD) in subjects who use smokeless tobacco, smoke cigarettes, or do not use any tobacco product. DESIGN: Cross-sectional study. SETTING: University-affiliated outpatient clinic. SUBJECTS: Seventeen apparently healthy volunteers who for more than 1 year smoked at least 10 cigarettes/day, used at least two containers of smokeless tobacco/week, or did not use any tobacco product. MEASUREMENTS AND MAIN RESULTS: Baseline characteristics of subjects were similar among the three groups except for mean age and serum cotinine level. Baseline brachial artery diameter, endothelium-dependent FMD induced by reactive hyperemia, and endothelium-independent dilation induced by administration of sublingual nitroglycerin were measured. Mean FMD over baseline was 4.1% +/- 0.7% in subjects who used smokeless tobacco, 3.9% +/- 5.1% in cigarettes smokers, and 12.2% +/- 5.7% in nonusers of tobacco (p=0.01). Endothelium-independent dilation induced by nitroglycerin was not statistically different among the three groups. CONCLUSION: Brachial artery FMD, a surrogate for endothelial dysfunction, was significantly impaired in smokeless tobacco users and cigarette smokers compared with nonusers of tobacco.

Adolescent↗
PubMed2002

Prevention of heart failure.

Heart failure carries a sizeable health burden. Efforts to prevent this condition are not generally well studied. Most of the interventions that have demonstrated benefit address cardiac risk factors such as hypertension and hyperlipidemia. The results of the HOPE study have recently expanded the indications for angiotensin converting enzyme inhibitors in the prevention of heart failure. Once heart failure occurs, a variety of interventions can prevent recurrent episodes of congestion. Biventricular pacing, left ventricular assist devices, and disease-specific management clinics join more standard medical therapies such as angiotensin converting enzyme inhibitors, beta-blockers, diuretics, digoxin, and spironolactone in improving outcomes for patients with this disorder.

Angiotensin-Converting Enzyme Inhibitors↗