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Results for “multiple linear regression”

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PubMed2004

[Bioavailabilities of manganese sources based on heart manganese-containing superoxide dismutase gene expression for broilers].

OBJECTIVE: Two experiments were conducted to determine whether heart manganese-containing superoxide dismutase (MnSOD) gene expression could detect the differences in bioavailabilities of Mn sources more quickly, sensitively and constantly than other indices. METHODS: In experiment 1, a total of 546 day-old commercial male Arbor Acres (AA) broilers were randomly assign to each of thirteen treatments with six cage replicates according to a completely randomized design involving a 4 x 4 factorial arrangement. Each group of birds was fed Mn-unsupplemented corn-soybean meal basal diets (Control) or basal diets supplemented with 60, 120 or 180 mg/kg Mn as either Mn sulfate, Mn-Met E, Mn-AA B or Mn-AA C for 21 days. At 21 days of age, three birds from each cage were selected according to average bodyweight of the cage and killed. Heart and left leg were excised immediately. Mn concentrations in tissues, MnSOD activity and gene expression of MnSOD in heart were analyzed. In experiment 2, two hundred and seventy day-old AA commercial male broilers were randomly allotted to one of five treatments with six cage replicates in a completely randomized design, and fed a Mn-unsupplemented corn-soybean meal basal diet (Control) or the basal diet supplemented with 120 mg/kg Mn as each of the four Mn sources in experiment 1 for 21 days. The methods in experiment 1 were used to select and slaughter birds from each cage on the 7th, 14th or 21st day. The tissues were collected and analyzed as well. RESULTS: (1) In experiment 1, ash Mn content, heart Mn content, and MnSOD activity in heart mitochondria on the 21st day were affected (P = 0.0001) by dietary added Mn level. Based on slope ratios from multiple linear regressions of these three indices on dietary added Mn intake, the relative bioavailabilities of organic Mn sources did not differ from that of MnSO4 (P > 0.14). Heart MoSOD mRNA level on the 21st day was affected by both Mn source (P < 0.10) and Mn level (P = 0.0001). Based on slope ratios from the multiple linear regression of heart MnSOD mRNA level on dietary added Mn intake, if 100% was set for Mn sulfate, the relative bioavailabilities of organic Mn sources with weak, moderate, and strong chelation strengths were 99.0%, 132.3% and 112.7%, respectively. The organic Mn source with the moderate chelation strength was more available (P < 0.05) than Mn sulfate and organic Mn sources with the weak or strong chelation strengths; (2) In experiment 2, the seven day-old chicks fed on the diet supplemented with the organic Mn source with the moderate chelation strength showed a higher (P < 0.02) MnSOD mRNA level than those fed on the diets supplemented with Mn sulfate and the organic Mn source with the weak chelation strength, and the same tendency was observed on the 14th day or 21st day (P < 0.05). Ash Mn content and heart MnSOD activity were less sensitive in detecting the differences among Mn sources in bioavailability than MnSOD mRNA level. CONCLUSION: The results indicate that dietary Mn significantly affected heart MnSOD gene expression pretranslationally, and heart MnSOD mRNA level as early as on the 7th day could detect differences in bioavailabilities of Mn sources more quickly, sensitively and constantly than all other indices. There was a close correlativity between chelation strengths of these organic Mn sources and their relative bioavailabilities for broilers, in which the organic Mn source with the moderate chelation strength was the most available. The estimation of relative bioavailabilities of Mn sources based on heart MnSOD mRNA level could request a shorter time of experimental period and smaller number of animals, and thus could be a new method for a quick and effective assessment in bioassays of Mn sources for broilers.

Animal Feed↗

PubMed2003

Maternal fish consumption and infant birth size and gestation: New York State Angler Cohort Study.

BACKGROUND: The scientific literature poses a perplexing dilemma for pregnant women with respect to the consumption of fish from natural bodies of water. On one hand, fish is a good source of protein, low in fat and a rich source of other nutrients all of which have presumably beneficial effects on developing embryos and fetuses. On the other hand, consumption of fish contaminated with environmental toxicants such as polychlorinated biphenyls (PCBs) has been associated with decrements in gestation and birth size. METHODS: 2,716 infants born between 1986-1991 to participants of the New York State Angler Cohort Study were studied with respect to duration of maternal consumption of contaminated fish from Lake Ontario and its tributaries and gestation and birth size. Hospital delivery records (maternal and newborn) were obtained for 92% of infants for the ascertainment of gestation (weeks), birth size (weight, length, chest, and head circumference) and other known determinants of fetal growth (i.e., maternal parity, history of placental infarction, uterine bleeding, pregnancy loss or cigarette smoking and infant's race, sex and presence of birth defect). Duration of maternal fish consumption prior to the index infant's birth was categorized as: none; 1-2, 3-7, 8+ years, while birth weight (in grams), birth length (in centimeters), and head and chest circumference (in centimeters) were left as continuous variables in multiple linear regression models. Birth size percentiles, ponderal indices and head to chest circumference ratios were computed to further assess proportionality and birth size in relation to gestational age. RESULTS: Analysis of variance failed to identify significant mean differences in gestation or any measure of birth size in relation to duration of maternal lifetime fish consumption. Multiple linear regressions identified gestational age, male sex, number of daily cigarettes, parity and placental infarction, as significant determinants of birth size. CONCLUSIONS: The results support the absence of an adverse relation between Lake Ontario fish consumption and reduced birth size as measured by weight, length and head circumference. Biological determinants and maternal cigarette smoking during pregnancy remain important determinants of birth size.

Birth Weight↗

PubMed2006

Polymorphisms of phase II xenobiotic-metabolizing and DNA repair genes and in vitro N-ethyl-N-nitrosourea-induced O6-ethylguanine levels in human lymphocytes.

This study tested the hypothesis that genetic variants of phase II detoxification enzymes and DNA repair proteins affect individual response to DNA damage from alkylating agents. In 171 healthy individuals, an immunoslot blot assay was used to measure O6-ethylguanosine (O6-EtGua) adduct levels in peripheral blood lymphocytes treated with N-ethyl-N-nitrosourea (ENU) in vitro. The genotypes of GSTM1, GSTT1, GSTP1 I(105)V and A(114)V, MGMT L(84)F and I(143)V, XPD D(312)N and K(751)Q, and XRCC3 T(241)M were determined. Demographic and exposure information was collected by in-person interview. Student's t-test, analysis of (co)variance, and multiple linear regression models were used in statistical analyses. The mean and median (range) O6-EtGua levels were 94.6 and 84.8 (3.2-508.1)fmol/g DNA, respectively. The adduct level was significantly lower in people who smoked >or=25 years than that in never-smokers (square-root transformed mean values 8.20 versus 9.37, P=0.03). Multiple linear regression models revealed that GSTT1 (beta=-2.36, P=0.009) polymorphism was a significant predictor of the level of adducts in 82 never-smokers, whereas the number of years smoked (beta=-0.08, P=0.005) and XRCC3 T(241)M (beta=2.22, P=0.007) in 89 ever-smokers. The association between GSTP1 I(105)V, MGMT I(143)V, and XPD D(312)N with the level of adducts was not conclusive. Each polymorphism could explain 2-10% of the variation of the adduct level. These observations suggest that GSTT1 null and XRCC3 T(241)M polymorphism may have some functional significance in modulating the level of ENU-induced DNA damage and these effects are smoking-dependent. Results from this exploratory study need to be confirmed in other experimental systems.

Aged↗

PubMed1998

Prediction of percutaneous absorption from physicochemical data: a model based on data of in vitro experiments.

Correlations between in vitro percutaneous absorption data and physicochemical properties of industrial chemicals are evaluated in order to develop predictive mathematical models based on said properties. Percutaneous diffusion of 16 pounds of occupational interest, eight of which were polycyclic aromatic hydrocarbons (acenaphthene, anthracene, benzo(a)anthracene, chrysene, phenanthrene, fluorene, naphthalene, pyrene), six organophosphorus insecticides (acephate, chlorpyrifos, dimethoate, fenitrothion, methamidophos, omethoate) and two phenoxycarboxylic herbicides (2,4-D, MCPA), were tested in vitro using monkey (Cercopithecus aetiops) skin. The test apparatus consisted of nine static diffusion cells with normal saline, gentamycin sulphate and 4% bovine serum albumin as receiving solution. Test compounds were applied at various concentrations in 30 microliters of acetone solution and determined, in the receiving phase, by chemical analysis. Values for ln Kow (octanol/water partition coefficient) were correlated with experimentally determined values of the permeability constant Kp (r = 0.90, P < 0.001) and lag time (r = 0.81, P < 0.01). Analysis of variance in a model of multiple linear regression between Kp, ln Kow and water solubility [water] of the compounds, showed that the data had a highly significant fit (P < 0.0001). A more general model which also included molecular weight (MW) and vapour pressure was evaluated as well, but the two variables made no substantial difference. Multiple regression analysis between lag time, ln Kow and [water] was significant (P < 0.0001), whereas introduction of vapour pressure and MW as independent variables did not significantly improve the predictive effect on lag time. Our experimental system, therefore, enables the values of Kp and lag time to be predicted with reasonable precision on the basis of ln Kow and [water] values, using the algorithm derived from the multiple linear regression equation.

Animals↗

PubMed1999

Effects of gender and age on plasma levels of clozapine and its metabolites: analyzed by critical statistics.

BACKGROUND: Previous reports concerning the effects of gender and age on steady-state plasma concentrations of clozapine and its major metabolites, norclozapine and clozapine-N-oxide, have been controversial. Since the frequency distribution of the plasma levels is asymmetrical and skewed to the right, the statistical methods (such as analysis of variance and regression analysis) used earlier are actually inappropriate for analyzing the effects of the variables on the concentrations and might contribute to the inconsistent results. The goal of the present study, with befitting statistics, is to measure the potential effect of dose, gender, age, and body weight on plasma levels of clozapine and its 2 major metabolites. METHOD: We retrospectively analyzed data from a therapeutic drug monitoring study for steady-state plasma clozapine, norclozapine, and clozapine-N-oxide levels that was conducted in a large group of Chinese schizophrenic inpatients (male:female ratio = 83:79; age range, 33.8 +/- 9.3 years). The daily doses of clozapine had ranged from 100 to 900 mg, with a mean +/- SD value of 379.5 +/- 142.2 mg. Plasma concentrations had been measured using high-performance liquid chromatography with ultraviolet detection. Multiple linear regression was adopted to quantify the effects of various factors on the plasma levels. The natural logarithm of the plasma level was used as the dependent variable to overcome the skewness problem. RESULTS: After adjusting the effects of gender, age, and body weight by multiple linear regression, each 1-mg increment in the daily dose could raise the clozapine level by 0.31%, norclozapine by 0.27%, and clozapine-N-oxide by 0.16%. Female patients had 34.9% higher clozapine levels and 36.3% higher norclozapine, with other variables being controlled. No sex differences were demonstrated for clozapine-N-oxide levels. Each 1-year increment in age would elevate the clozapine level by 1.1%, norclozapine by 1.0%, and clozapine-N-oxide by 1.0%. Body weight could not influence the levels of these compounds. CONCLUSION: The present results suggest that women possess higher plasma levels (about one third higher) of clozapine and norclozapine, but not the N-oxide metabolite. Each addition of 1 year in age elevated clozapine and either metabolite's levels by about 1%. Furthermore, every 1-mg increase in the daily dose raised clozapine and norclozapine concentrations by approximately 0.3%. These findings could assist clinicians in optimizing clozapine dosing strategies.

Adult↗

PubMed2002

Clinical and demographic predictors of exercise capacity in end-stage renal disease.

Patients on maintenance hemodialysis therapy for end-stage renal disease have reduced exercise tolerance. Multiple processes related to uremia and hemodialysis have been implicated in the pathophysiology of this impairment. However, limited data are available to identify the separate and combined effects of clinical factors on the degree of impairment for individuals within this population. For this purpose, data from 193 patients who had undergone exercise testing for two clinical trials were retrospectively analyzed. Univariate and multiple linear regression analyses were used to identify demographic and clinical correlates of peak exercise oxygen uptake (VO2). Peak VO2 averaged 18.5 +/- 6.4 mL/min/kg. On univariate analysis, peak VO2 correlated positively with male sex and hemoglobin, serum albumin, and serum creatinine concentrations and correlated negatively with dialytic age and diagnosis of diabetes or chronic heart failure. In a multiple linear regression model, sex, hemoglobin concentration, age, and diagnosis of diabetes each remained statistically significant. Together, factors included in the model accounted for 41% of the variability in peak VO2 (P = 0.0001). Among factors not correlating significantly with peak VO2 were resting blood pressure, serum carnitine level, and urea clearance assessed by Kt/V. Findings show the range of exercise impairment among clinically stable ambulatory hemodialysis patients, which may be sufficient to interfere with normal daily activities for many of these patients. Although this impairment may be broadly attributable to physiological consequences of uremia, the degree of impairment for individual patients is predicted by demographic factors, coexistent disease, and factors potentially modified by medical therapeutics.

Adult↗

PubMed1996

The role of melatonin in the pathogenesis of adolescent idiopathic scoliosis.

STUDY DESIGN: A matched, case-control study comparing melatonin production in female patients with and without adolescent idiopathic scoliosis. OBJECTIVES: To determine whether melatonin production is decreased in adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: A central etiology for idiopathic scoliosis has never been established. Previous authors have produced experimental scoliosis in chickens after pinealectomy, preventable by administration of melatonin. They suggested that a defect in melatonin synthesis might be involved in the pathogenesis of human idiopathic scoliosis. METHODS: Nine female adolescents with no medical problems, normal neurologic examinations, radiographic idiopathic scoliosis of 15-40 degrees, and Risser Stage I-III were in the patient group. Eighteen healthy adolescent girls with no medical problems, a negative school screening, and no family history of scoliosis were control subjects. Patients and control subjects were matched for age, weight, Tanner stage, sleep duration, and light exposure by multiple linear regression. Nighttime and daytime urine samples were analyzed for melatonin by high-performance liquid chromatography. RESULTS: Although nighttime melatonin levels were significantly higher than daytime levels in all volunteers (P < 0.00002), there were no significant differences in nighttime (P > 0.63) or daytime (P > 0.78) melatonin levels between patients and control subjects, even after matching by multiple linear regression analysis. A statistical analysis demonstrated that if a melatonin deficiency of 25% or more did exist in patients with scoliosis compared with control subjects, the likelihood that it would have been detected in this study was more than 98%. CONCLUSION: Although melatonin deficiency may cause scoliosis in the chicken, this study suggests that it is not a mechanism in the pathogenesis of adolescent idiopathic scoliosis in humans.

Adolescent↗

PubMed2001

Reference data and predictive diagnostic models for calcaneus bone mineral density measured with single-energy X-ray absorptiometry in 7428 Chinese.

Calcaneus bone mineral density (BMD) of 7428 Chinese (4126 women, 3302 men; aged 22-94 years) was measured using single-energy X-ray absorptiometry (SXA). A reference range of calcaneus BMD values for healthy Chinese men and women was established and the usefulness of this method for screening and diagnosis in osteoporosis was evaluated. The peak BMD occurred at 20-24 years old and peak BMD in women was significantly lower than in men. BMD loss in the calcaneus started at the age of 35 years for women, and at 63 years in men. BMD loss rate was 1.2%/year for women and 0.56%/year for men after 50 years. The young normal reference for calcaneus BMD was 442.1+/-69.6 mg/cm2 for men and 388.3+/-61.7 mg/cm2 for women calculated from the mean BMD value of subjects whose age ranged from 20 to 49 years. The accumulated BMD loss in the calcaneus is similar to that of Ward's triangle. Multiple linear regression showed that both age and weight were important factors. The incidence of osteoporosis in older men and women (> or = 60 years) is 6.6% and 32.1% respectively. We conclude that calcaneus BMD measurement is useful and sensitive for the screening and diagnosis of osteoporosis. A predictive diagnostic model for osteoporosis based on the calcaneus was constructed using multiple linear regression and the WHO criteria for diagnosing osteoporosis can be applied to calcaneus BMD.

Absorptiometry, Photon↗

PubMed2004

Use of systematic reviews in the development of new provincial public health policies in Ontario.

OBJECTIVES: The study determined whether the results of recently completed systematic reviews evaluating the effectiveness of public health interventions were used in the development of new provincial policies for public health practice. METHODS: This telephone survey included all members from five review groups who updated the Ontario Mandatory Health Programs and Services guidelines for Public Health in 2000. Independent variables included characteristics of the systematic reviews, organization, and the individual. Outcomes included the use of the reviews in developing new policies and the extent to which the reviews led to new recommendations for practice. Descriptive summaries as well as multiple linear regression were conducted. RESULTS: Eighty-five percent of decision-makers agreed to participate in the study. Ninety-six percent of respondents reported that the systematic reviews played a part in developing the new guidelines, while 47 percent indicated that the reviews contributed a great deal to the development of new recommendations for practice. The multiple linear regression model explained 42 percent of the variation in use of the reviews for developing new recommendations for practice. Significant predictor variables included the importance of the reviews in comparison to other sources of information and relevance of the reviews to the policy decisions. CONCLUSION: Public health decision-makers in Ontario have very positive perceptions of the usefulness of systematic reviews in policy development. Therefore, ongoing efforts to promote the usefulness and relevance of systematic reviews to public health decision-makers should remain a priority for health services researchers.

Cross-Sectional Studies↗

PubMed2004

The effect of a forearm/hand splint compared with an elbow band as a treatment for lateral epicondylitis.

The aim of the present study was to compare the effect of a new prefabricated Thämert forearm/hand splint with the effect of a simple elbow band as a treatment for lateral epicondylitis. Forty-three (43) patients that met the inclusion criteria were randomly assigned to the elbow band group and the splint group. They wore the orthotic devices for 6 weeks. Outcome measures were obtained at baseline and directly after the intervention. These outcome measures were maximal grip strength on the involved side with a pain scale from 1 to 10 to determine the extent of pain during gripping, and the Patient-Rated Forearm Evaluation Questionnaire (PRFEQ). Analysis of variances with repeated measures, a Mann Whitney test and multiple linear regression analysis were used to compare the two groups. Main effect for time was significant for maximal grip strength and sum scores on the PRFEQ, but no differences between groups were found, even when a distinction between acute and chronic symptoms was made. Change in pain score during gripping did not differ significantly between the groups. A multiple linear regression analysis showed that the use of the splint did not significantly contribute to the prediction of change in maximal grip strength and in overall PRFEQ. The conclusion is that the forearm/hand splint is not more effective than the elbow band as a treatment for lateral epicondylitis.

Adult↗

PubMed2000

The influence of menopause and body mass index on serum leptin concentrations.

OBJECTIVE: The aim of this study was to evaluate the influence of menopausal status, serum estradiol and body mass index (BMI) on serum leptin concentration in a large sample of pre- and postmenopausal women. DESIGN: 434 healthy women (mean age +/-s.d., 52.2 +/- 10.3 years) were recruited at the University of Marburg on the occasion of a routine gynecological visit. Two hundred and eighteen (50.2%) women were premenopausal (mean age, 36.5 +/- 10.4 years) and not on oral contraceptives or hormone replacement therapy (HRT) and 216 (49.8%) women were postmenopausal (mean age 61.8 +/- 8.9 years) not on HRT. To evaluate the influence of menopausal status, estradiol level and BMI on serum leptin concentrations, women were allocated to one of the four groups: (a) premenopausal women BMI <25 kg/m(2) (n=137), (b) premenopausal women BMI >25 kg/m(2) (n=81), (c) postmenopausal women BMI <25 kg/m(2) (n=94) and (d) postmenopausal women BMI >25 kg/m(2) (n=122). RESULTS: Irrespective of the menopausal status, women with a BMI >25 kg/m(2) had significantly higher leptin concentrations in all age groups compared with women with a BMI <25 kg/m(2) (P<0.001). The multiple linear regression analyses showed that BMI was the only statistically significant independent predictor for leptin. In comparison to postmenopausal women, premenopausal women showed a significantly lower mean age, weight, BMI and FSH concentration (P<0. 001), a higher mean height and serum estradiol (P<0.01 and P<0.001 respectively) but significantly lower serum leptin concentration (P<0.01). The multiple linear regression model showed no significant influence of menopausal status or serum estradiol on serum leptin concentration, even after controlling for BMI. CONCLUSIONS: Serum leptin concentrations are significantly higher in pre- and postmenopausal obese women, compared with normal weight controls. Serum leptin concentrations are not influenced by menopausal status or serum estradiol level.

Adult↗

PubMed2003

[Body mass index and triceps skinfold correlation in children from Paulínia city, São Paulo, SP].

UNLABELLED: Body mass index (BMI) has been considered a criterion to define and analyse obesity in adults and children. BACKGROUND: the purpose of this study was to evaluate the correlation between BMI and triceps skinfold (TSF). METHODS: there were studied 4,236 children (3.1-10.9y); 48.3%M:51.6%F, from four studies made in Paul nia, SP-Brazil. Height, weight and TSF (Holtain caliper) were measured. For each children BMI was calculated and transformed in SDS, according to North American data (Frisancho, 1993). Multiple linear regression analysis (stepwise) was used for the whole population and in three groups according to BMI: A) SDS < or = -1.0; B) -1.0 < SDS< 1.0) SDS(3) 1.0. Data were processed with SPSS software. RESULTS: in group A, the TSF (7.8 +/- 2.3) variability was lower when compared with the groups B (10.1 +/- 4.0) and C (17.8 +/- 6.2). In multiple linear regression with the whole population, R = 0.478 for TSF. In groups B and C, R = 0.364 and 0.368 respectively for TSF, and in group A it was only 0.032. CONCLUSIONS: these observations demonstrated a height correlation between BMI and TSF in children with obesity risk (group C). Therefore, we conclude that, in Brazil BMI can be used for children's research of obesity in population studies, instead of TSF.

Body Mass Index↗

PubMed2000

Direct impact of non-fatal occupational injuries.

OBJECTIVE: The objectives of this study were to describe the pattern of certain direct impacts of non-fatal injuries among workers insured by the General Organization of Social Insurance, admitted to hospitals in Al-Khobar City, and to determine factors influencing these direct impacts. METHODS: This cohort study consisted of 65, 915 insured male workers in various industries, followed to determine those who were admitted to 2 private hospitals selected randomly in Al-Khobar City. A data-collection sheet was used to collect the necessary data from patients and their medical records on admission to the hospital. RESULTS: The majority of admissions (78%) were for periods of less than a week. Absence from work was longer than 3 weeks in 35.5% and shorter than 1 week in 25% of admissions. The majority of the cases (65%) visited clinics from 2 to 7 times. Direct medical cost per admission was less than SR2,000 in 64% of the cases in one of the hospitals (one United States dollar = 3.75 Saudi Riyals). Multiple linear regression analysis for period of absence from work, length of hospitalization, and number of clinic visits showed these direct impact variables to be inter-related. Injury outside the work place (road traffic accidents), and the hospital which the injured worker was referred to, were the other main risk factors determining the direct impact of the injury. Multiple linear regression for direct medical cost was positively associated and predicted by the younger age of the worker. CONCLUSIONS: The direct impact of occupational injuries in this study, though less than the same reported from Western countries, were responsible for significant medical charges, human suffering and loss of productivity. Efforts made by different industries to prevent occupational injuries should be encouraged and continued, and the General Organization of Social Insurance may monitor their success by conducting similar studies.

Absenteeism↗

PubMedDate not supplied

A computerized method for measuring respiratory mechanics during mechanical ventilation.

In order to monitor respiratory mechanics in anesthetized ventilated subjects, an automated method was developed and tested on a physical model. The model was composed of an endotracheal tube (curvilinear resistance) coupled to a rigid air-filled box (elastance). Theoretical resistance was determined during steady-state flow experiments and theoretical elastance was estimated from the dimensions of the box. The physical model was connected to a volume-cycled ventilator. Pressure (P) and air flow (V) were measured at the outlet of the tube, and the time integral V of V was calculated. Elastance (E) and curvilinear resistance (R + K/V/) were identified by multiple linear regression analysis, for each ventilatory cycle, according to equation P = EV + RV + K/V/V. When linear regression analysis of P on V, V and /V/V was performed over the entire ventilatory cycle, E was found equal to its estimate, whereas R and K appeared different from their theoretical values. In order to improve determination of R and K, resistive pressure (Pr = P - EV) was calculated using the previously obtained value of E, and multiple linear regression of Pr on V and /V/V was performed over different fractions of the ventilatory cycle. When determined over the expiratory phase corresponding to decreasing flows, R and K were found close to their expected values. Such a method to calculate elastance and curvilinear resistance should prove convenient and efficient in measuring respiratory mechanics during mechanical ventilation.

Computers↗

PubMedDate not supplied

The use of midazolam for prehospital rapid-sequence intubation may be associated with a dose-related increase in hypotension.

OBJECTIVE: To investigate the incidence of hypotension associated with the use of midazolam for prehospital rapid-sequence intubation (RSI). METHODS: A retrospective review was performed using charts from the two aeromedical agencies servicing the authors' region. The RSI protocols used by crews from the northern (north) and the southern (south) parts of the region were identical, with the exception of midazolam dosing. The north crews used 0.1 mg/kg for all patients, while the south crews used 0.1 mg/kg up to a maximum of 5 mg. All patients receiving midazolam for prehospital RSI were pooled, with multiple linear regression used to investigate the relationship between midazolam dose and both hypotension and a decrease in systolic blood pressure (SBP) following RSI. Patients weighing >50 kg and patients with traumatic brain injury (TBI) were evaluated separately to determine differences between north and south with regard to midazolam dosing and incidence of hypotension. Multivariate logistical regression was used to test for these differences and for potential confounders such as age, initial SBP, and Glasgow Coma Scale score (GCS). RESULTS: A total of 219 patients were identified from the north (n = 75) and the south (n = 144). Multiple linear regression revealed a statistically significant relationship between midazolam dose and both hypotension and an SBP decrease following RSI. There was no difference between north and south with regard to age, sex, incidence of TBI, initial SBP, or GCS. In patients >50 kg, those from the north received higher doses of midazolam and had a higher incidence of hypotension than those from the south. This relationship was also present in 184 patients with TBI. CONCLUSION: The use of midazolam with prehospital RSI is associated with a dose-related incidence of hypotension.

Adult↗

PubMed2005

Changes in disease specific and generic quality of life related to changes in lower urinary tract symptoms: the Krimpen study.

PURPOSE: We determined if and to what extent longitudinal changes in lower urinary tract symptoms are related to disease specific and generic quality of life in men. MATERIAL AND METHODS: A longitudinal, population based study with a followup of 4.2 years was done in 1,688 who were 50 to 79 years old. Data were collected through self-administered questionnaires, including the Sickness Impact Profile (3 domains), Inventory of Subjective Health, International Prostate Symptom Score (I-PSS) and Benign Prostatic Hyperplasia Impact Index. Moreover, they completed various physical and urological measurements. Mean I-PSS and quality of life scores at baseline and followup were analyzed for certain subgroups. Multiple linear regression was used to determine the change in quality of life in relation to baseline I-PSS, I-PSS changes between baseline and followup, and age. RESULTS: Although mean I-PSS increased with time, the average generic quality of life improved and almost a third of the men reported better disease specific quality of life. Multiple linear regression revealed that disease specific quality of life was associated with I-PSS at baseline, changes in I-PSS between baseline and followup, and age. However, generic quality of life scores were not associated with these parameters. CONCLUSIONS: Changes in lower urinary tract symptoms severity had little impact on disease specific quality of life in 50 to 79-year-old men or on generic quality of life during the 4.2-year followup.

Activities of Daily Living↗

PubMed2006

[Relationship between obstructive sleep apnea/hypopnea syndrome and insulin resistance].

OBJECTIVE: To investigate whether obstructive sleep apnea/hypopnea syndrome (OSAHS) is independently associated with insulin resistance (IR). METHODS: We recruited 60 male obese patients with OSAHS [OSAHS group, age (42.3 +/- 2.6) years, body mass index (BMI) (28.3 +/- 2.1) kg/m2, waist/hip ratio (WHR) 0.95 +/- 0.05], 60 male weight-matched obese patients without OSAHS [OB group, age (41.5 +/- 3.1) years, BMI (27.7 +/- 1.5) kg/m2, WHR 0.94 +/- 0.04] and 60 male normal weight subjects [NW group, age (41.8 +/- 2.4) years, BMI (22.6 +/- 1.9) kg/m2, WHR 0.86 +/- 0.05]. The subjects underwent polysomnography and OSAHS was defined as an apnea-hypopnea index (AHI) > or = 5. The systolic blood pressure and diastolic blood pressure were measured. IR was evaluated by fasting serum true insulin (TI) level and IR index based on the homeostasis model assessment method (HOMA-IR). In the OSAHS group, multiple linear regression was used with either TI or HOMA-IR as the dependent variable, and the corresponding set of independent variables included age, BMI, WHR, AHI and minimum oxygen saturation (MSpO2). RESULTS: After adjustment for age, BMI, and WHR, the OSAHS group was more insulin resistant, as indicated by the higher levels of TI and HOMA-IR. Multiple linear regression showed that the central obesity parameter (WHR) was the major determinant of IR of the OSAHS group, while sleep-disordered breathing parameters (AHI and MSpO2) were also independent determinants of IR of the group (TI: AHI P = 0.017, TI: MSpO2 P = 0.005; HOMA-IR: AHI P = 0.008, HOMA-IR: MSpO2 P = 0.003). CONCLUSION: OSAHS may be independently associated with IR.

Adult↗

PubMed1990

Amphotericin B revisited: reassessment of toxicity.

PURPOSE: Although amphotericin B remains the mainstay of therapy for serious fungal infections, numerous acute and chronic toxicities make clinical usage difficult. Nevertheless, utilization of amphotericin B has increased dramatically in recent years. Accordingly, a study to reassess toxicity associated with the use of amphotericin in the modern era and to determine the aggregate impact toxicities have on the overall therapeutic course of patients was undertaken. PATIENTS AND METHODS: The charts of 50 patients at our institution who had received amphotericin B were retrospectively reviewed for the occurrence of drug-related acute and chronic toxicities and their impact on therapy. Patients evaluated were at least 21 years of age, had received at least 100 mg of amphotericin B, and were treated for at least 3 days. An analysis to investigate associations between drug administration variables and toxicities was also undertaken. RESULTS: The mean age of study subjects were 54 years, the average duration of therapy was 19 days, and the mean cumulative dose of amphotericin B was 582 mg. Acute toxicities accompanying infusion occurred in 66% of all patients. Fever was experienced by 34% of study subjects and chills by 56%, with rates of 2.6 and 3.5 mean episodes per patient per treatment course, respectively. Other acute toxicities including hypotension were rare, and no patients exhibited bronchospasm or anaphylaxis. Nephrotoxicity occurred in 30 patients (60%). Baseline creatinine values in these patients rose by a mean of 1.55 mg/dL (137 mumol/L), with increases in creatinine ranging from 0.2 to 5.2 mg/dL (18 to 460 mumol/L). Analysis of six drug administration parameters by stepwise multiple linear regression failed to reveal any significant associations with nephrotoxicity. The mean nadir potassium value was 3.1 mEq/L (3.1 mmol/L) (range: 2.3 to 4.8 mEq/L [2.3 mmol/L]), with 45 of 50 patients (90%) receiving potassium supplementation (average daily supplement = 69 mEq). Only increasing amphotericin B concentration was correlated with an increased requirement for potassium supplementation (p less than 0.01, stepwise multiple linear regression). CONCLUSION: Although clinically important toxicities continue to occur with usage of amphotericin B despite current methods of infusion and premedication, these are usually manageable and rarely limit the course of therapy.

Adult↗