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PubMed2001

Prevalence of molecular mechanisms of resistance to azole antifungal agents in Candida albicans strains displaying high-level fluconazole resistance isolated from human immunodeficiency virus-infected patients.

Molecular mechanisms of azole resistance in Candida albicans, including alterations in the target enzyme and increased efflux of drug, have been described, but the epidemiology of the resistance mechanisms has not been established. We have investigated the molecular mechanisms of resistance to azoles in C. albicans strains displaying high-level fluconazole resistance (MICs, > or =64 microg/ml) isolated from human immunodeficiency virus (HIV)-infected patients with oropharyngeal candidiasis. The levels of expression of genes encoding lanosterol 14alpha-demethylase (ERG11) and efflux transporters (MDR1 and CDR) implicated in azole resistance were monitored in matched sets of susceptible and resistant isolates. In addition, ERG11 genes were amplified by PCR, and their nucleotide sequences were determined in order to detect point mutations with a possible effect in the affinity for azoles. The analysis confirmed the multifactorial nature of azole resistance and the prevalence of these mechanisms of resistance in C. albicans clinical isolates exhibiting frank fluconazole resistance, with a predominance of overexpression of genes encoding efflux pumps, detected in 85% of all resistant isolates, being found. Alterations in the target enzyme, including functional amino acid substitutions and overexpression of the gene that encodes the enzyme, were detected in 65 and 35% of the isolates, respectively. Overall, multiple mechanisms of resistance were combined in 75% of the isolates displaying high-level fluconazole resistance. These results may help in the development of new strategies to overcome the problem of resistance as well as new treatments for this condition.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed2006

Fine particulate matter (PM2.5) air pollution and selected causes of postneonatal infant mortality in California.

Studies suggest that airborne particulate matter (PM) may be associated with postneonatal infant mortality, particularly with respiratory causes and sudden infant death syndrome (SIDS). To further explore this issue, we examined the relationship between long-term exposure to fine PM air pollution and postneonatal infant mortality in California. We linked monitoring data for PM<or=2.5 microm in aerodynamic diameter (PM2.5) to infants born in California in 1999 and 2000 using maternal addresses for mothers who lived within 5 miles of a PM2.5 monitor. We matched each postneonatal infant death to four infants surviving to 1 year of age, by birth weight category and date of birth (within 2 weeks). For each matched set, we calculated exposure as the average PM2.5 concentration over the period of life for the infant who died. We used conditional logistic regression to estimate the odds of postneonatal all-cause, respiratory-related, SIDS, and external-cause (a control category) mortality by exposure to PM2.5, controlling for the matched sets and maternal demographic factors. We matched 788 postneonatal infant deaths to 3,089 infant survivors, with 51 and 120 postneonatal deaths due to respiratory causes and SIDS, respectively. We found an adjusted odds ratio for a 10-microg/m3 increase in PM2.5 of 1.07 [95% confidence interval (CI), 0.93-1.24] for overall postneonatal mortality, 2.13 (95% CI, 1.12-4.05) for respiratory-related postneonatal mortality, 0.82 (95% CI, 0.55-1.23) for SIDS, and 0.83 (95% CI, 0.50-1.39) for external causes. The California findings add further evidence of a PM air pollution effect on respiratory-related postneonatal infant mortality.

Air Pollutants↗

PubMed2000

[Azole resistance in Candida albicans].

The molecular mechanisms of azole resistance in Candida albicans include alterations in the target enzyme (lanosterol 14-demethylase) and overexpression of efflux transporters that decrease the intracellular concentration of the drug. Although the rate of azole resistance in systemic isolates of C. albicans remains very low, resistance to fluconazole appears as an important issue in the management of oropharyngeal candidiasis (OPC) in patients with AIDS. In order to establish the prevalence of resistance to azole antifungal agents in this setting, we investigated the molecular mechanisms of resistance to azoles in highly resistant C. albicans isolates (fluconazole MIC 64 mg/l) from HIV-infected patients with OPC. Antifungal susceptibility testing of serial C. albicans isolates was performed by NCCLS methodology. Strain identity was investigated by DNA-typing techniques. Overexpression of genes encoding lanosterol 14-demethylase (erg11) and efflux transporters (mdr1 and cdr) implicated in the development of resistance was monitored in matched sets of susceptible and resistant isolates. In addition, erg11 genes were PCR-amplified and their nucleotide sequences determined in order to detect point mutations. A combination of different mechanisms of resistance contributed to the development of resistance to fluconazole. The multifactorial character of the azole resistance in C. albicans makes necessary the development of approaches to overcome the problem. Accordingly, new triazoles have been developed; new classes of antifungals are being investigated; and combinations with inhibitors of efflux transporters are being studied.

Antifungal Agents↗

PubMed2005

[Spectral colorimetric correction of full view color images in a real scene measurement system].

In the three dimensional multiple modalities scanning real scene measurement system, a color linear CCD was used to obtain the one dimensional linear color information of the scene. Successive one dimensional color images of different angles were patched to constitute the full view color image. If the color image is displayed directly on the color cathode ray tube (CRT) monitor of a computer, colorimetric distortion will occur. Colorimetric correction is then needed. Through thespectral colorimetric correction, the colorimage displayed on the color CRT monitor is matched with the original scene in the colorimetric sense.

Colorimetry↗

PubMed2006

Physiological and technical aspects of ''6-a-side'' soccer drills.

AIM: The purposes of the present study were: 1) to evaluate heart rate and technical-tactical differences, if any, during ''6-a-side'' drills, played on 2 pitch dimensions (30x40 m and 50x40 m) and duration (3 min and 8 min); 2) to assess the variability of data between repeated experimental sessions; 3) to evaluate training intensities from heart rate at lactate threshold. METHODS: Laboratory measurements of maximal oxygen consumptions, maximum heart rates and lactate thresholds were performed on 9 soccer players who played at Regional level. For test and retest field sessions, the exercise intensities were calculated from heart rate monitoring and match analysis (number of actions, consecutive passes, players involved in a single action) was performed. RESULTS: No significant differences were found in heart rate frequency distributions between test and retest sessions. Statistically significant differences in frequency distributions of heart rate were found only between the 3 min and 8 min drills played on the 40x50 m pitch. Regarding exercise intensity, significant differences (P<0.01) were found for pitch dimension, with higher intensities shown during the 30x40 m pitch trials. When technical data were related to time units, no differences were found among experimental settings. CONCLUSIONS: These data indicate that coaches could better modulate the training intensity by varying the pitch dimension, with the smaller individual playing area (30x40 m) having a large impact on the metabolic demands of exercise.

Adult↗

PubMed1995

[Can obstructive sleep apnea syndrome be predicted based on anamnesis and clinical examination findings?].

The objective of this retrospective study was to determine the predictive value of a selfadministered questionnaire together with physical and laboratory examinations in establishing the diagnosis and severity of obstructive sleep apnea syndrome (OSAS). The apnea index (AI) and apnea/hypopnea index (AHI), measured by nocturnal respiratory monitoring, were matched with the 21 questions of the questionnaire as well as with physical and laboratory findings in 129 patients (average age 53 years, 80% males) referred to the sleep lab within a three-year period because of suspected OSAS. OSAS was diagnosed in 85 (66%) patients. Patients with OSAS had significantly higher body weight (BMI), but lower PaO2, lower total and vital lung capacity, as well as lower FEV1, than patients without OSAS. AI and AHI could be predicted from the BMI (R2 = 0.13) as well as the day time sleepiness (R2 = 0.11), less so by blood pressure and hemoglobin (R2 < 0.1); therefore, a predictability score could not be calculated. We conclude, that in addition to a specific questionnaire and physical and laboratory examinations, still a routine examination in a specialized sleep lab is necessary to establish the diagnosis of OSAS.

Adult↗

PubMedDate not supplied

Determination of native mixed venous saturation during venovenous extracorporeal circulation.

The ability to monitor the match between systemic oxygen delivery and consumption using mixed venous oxygen saturation is an important component of management of critically ill patients. Mixed venous oxygen saturation is a particularly useful parameter in circumstances where systemic oxygen delivery is significantly compromised, such as the acute respiratory distress syndrome. With the advent of venovenous extracorporeal life support (ECLS) in the treatment of this condition, however, accurate measurement of true mixed venous oxygen saturation has not been available, because of this artificial elevation of venous oxygen content. Using an algebraic solution, the authors developed an equation to calculate true patient mixed venous oxgen saturation during ECLS. This is accomplished using readily obtainable data such as cardiac output, ECLS flow, ECLS circuit pre and post oxygenator blood oxygen content, pulmonary arterial oxygen saturation, and patient hemoglobin. The formula has been used in an in vitro model, simulating venovenous ECLS and native venous saturation ranging from 20-72%, with a resulting correlation coefficient between calculated and measured saturation of 0.983 and a gamma intercept of 0.7. Using this new mathematical model, previously unobtainable information about the match of oxygen delivery and consumption in venovenous ECLS is now available. This information will facilitate optimal management of oxygen kinetics in patients during venovenous extracorporeal support.

Animals↗

PubMed1985

Automated ambulatory blood pressure monitoring: a study in age-matched normotensive and hypertensive men.

Noninvasive automated techniques have been used in this study in 29 ambulatory normotensive and hypertensive men to monitor blood pressure during a full 24-hour period. The two groups of men were carefully matched for age. The data were analyzed with respect to possible differences in the circadian pattern of blood pressure, in the variability of blood pressure, and differences in the prevalence of abnormal blood pressures between the two groups. The circadian pattern of blood pressure in hypertensive patients was displayed parallel to that in normotensive control subjects but at a significantly higher level. The difference between daytime and nighttime systolic blood pressure was greater in normotensive than in hypertensive men. However, variability of blood pressure was not different between the two subgroups. Hypertensive men showed on average a greater incidence of abnormal blood pressures than normotensive subjects. However, nine of the normotensive control subjects showed more than 25% of abnormal readings of systolic or diastolic blood pressures during a 24-hour recording period. In contrast, fewer than 25% of abnormal blood pressure readings were found in nine of the hypertensive patients. The data reported here may help to better define the use of ambulatory blood pressure monitoring techniques in the diagnosis of hypertension.

Adult↗

PubMed2007

Personal digital assistants are comparable to traditional diaries for dietary self-monitoring during a weight loss program.

Dietary self-monitoring is considered the core of behavioral weight control programs. As software for personal digital assistants (PDA) has become more available, this study investigated whether the use of a PDA would improve dietary self-monitoring frequency and subsequent weight loss over the use of traditional paper diaries. One-hundred-seventy-six adults (BMI 25-39.9) participated in a 6-month behavioral weight control program. Treatment subjects (n = 61) were provided with a PalmZire 21 with Calorie King's Diet Diary software installed. Their self-monitoring habits and weight loss were compared with the results from a previous program (n = 115) which followed the same protocol using paper diaries for self-monitoring. No significant differences in weight loss or dietary self-monitoring were found. More frequent self-monitoring correlated with weight loss in both groups (p<.001). People seeking to lose weight should be encouraged to self-monitor and be matched with a mode of self-monitoring that is fitting to their lifestyle and skills.

Adult↗

PubMed1992

Home apnea monitoring and disruptions in family life: a multidimensional controlled study.

We used data from telephone interviews and mailed questionnaires to examine 12 aspects of family life among 93 families with infants considered at high risk for sudden infant death syndrome and on home apnea monitors and a matched comparison group with infants not requiring monitoring. Using logistic regression to control confounding variables, we found that case mothers were at an increased risk of poor health, but we found no other significant differences in family life between the two groups.

Apnea↗

PubMed2006

The influence of old age and enzyme inducing comedication on the pharmacokinetics of valproic acid at steady-state: A case-matched evaluation based on therapeutic drug monitoring data.

PURPOSE: To evaluate the influence of aging on the pharmacokinetics of valproic acid (VPA) at steady-state and on the susceptibility of VPA metabolism to enzyme induction by antiepileptic comedication. METHODS: The database of the therapeutic drug monitoring service of a large neurological hospital was searched to identify patients aged > or = 65 years stabilized on VPA therapy. Apparent VPA oral clearance (CL/F) calculated for each elderly patient was compared with that determined in an equal number of VPA-treated controls aged 20-50 years and matched for gender, body weight and antiepileptic drug (AED) comedication. RESULTS: A total of 71 elderly patients aged 70.0+/-4.4 years, including 20 receiving enzyme inducing AEDs, was included in the main evaluation. In the absence of enzyme inducing comedication, VPA CL/F in the elderly was similar to that found in non-elderly controls (9.7+/-4.6 versus 10.2+/-4.6mlh(-1)kg(-1)). Elderly patients on enzyme inducing comedication, on the other hand, had lower CL/F values than enzyme induced younger controls (11.7+/-5.4 versus 16.0+/-6.3mlh(-1)kg(-1), p<0.05). Since VPA CL/F is known to increase with increasing dosage, a lower VPA dosage in elderly patients comedicated with enzyme inducers compared with controls may have contributed to differences in CL/F between the two groups. CONCLUSIONS: In the absence of enzyme inducing comedication, VPA clearance in the elderly was comparable to that observed in controls. VPA clearance in elderly patients receiving enzyme inducing AEDs was lower than in controls, the difference being probably due to an influence of age as well as to the fact that mean VPA dosage was lower in these patients than in controls. Since our measurements of clearance were based on total serum VPA concentrations and VPA binding to plasma proteins is known to be reduced in old age, it is likely that the clearance of unbound, pharmacologically active, VPA was decreased to an important extent in the elderly, presumably as a result of a decline in drug metabolizing capacity.

Adult↗

PubMed2005

Phenobarbital pharmacokinetics in old age: a case-matched evaluation based on therapeutic drug monitoring data.

PURPOSE: To assess the influence of aging on the pharmacokinetics of phenobarbital (PB) at steady state in patients receiving long-term therapy. METHODS: Serum PB concentrations from the database of the therapeutic drug monitoring service of a large neurological hospital were used to calculate apparent clearance values (CL/F) in 224 patients aged 65 years and older (mean, 73 +/- 6.1 years). CL/F values in these patients were compared with those determined in an equal number of controls aged 20 to 50 years (mean, 35.7 +/- 7.9 years) and matched for gender, body weight, and type of anticonvulsant comedication. Correlations of CL/F with age, body weight, gender, and comedication also were explored within each age group. RESULTS: PB CL/F values were significantly lower in elderly patients than in controls (3.2 +/- 0.8 vs. 4.1 +/- 1.2 ml/h/kg; p < 0.0001). Age was identified as a statistically significant predictor of CL/F at multiple regression analysis, but it accounted for only a modest component of the interindividual pharmacokinetic variation. Comedication with carbamazepine (CBZ) and phenytoin (PHT) was associated with a moderate decrease in PB CL/F, which reached statistical significance in the elderly group (p < 0.01 for CBZ comedication; p < 0.001 for PHT comedication). CONCLUSIONS: Aging is associated with a significant decrease in PB clearance, which might be related to a reduction in glomerular filtration rate or diminished drug-metabolizing capacity in the liver or both. Because of this, older patients will require lower dosages to achieve serum PB concentrations comparable with those found in nonelderly adults.

Adult↗

PubMed2003

Analysis of the characteristics of competitive badminton.

OBJECTIVE: To describe the characteristics of badminton in order to determine the energy requirements, temporal structure, and movements in the game that indicate performance level. To use the findings to plan training with greater precision. METHODS: Eleven badminton players (mean (SD) age 21.8 (3.26) years) with international experience from four different countries (France, Italy, Spain, and Portugal) were studied. Two of the Spanish players were monitored in several matches, giving a total of 14 samples, all during the 1999 Spanish International Tournament. Blood lactate concentration was measured with a reflective photometer. Maximum and average heart rates were recorded with a heart rate monitor. Temporal structure and actions during the matches were determined from video recordings. All variables were measured during and after the game and later analysed using a descriptive study. RESULTS: The results confirmed the high demands of the sport, with a maximum heart rate of 190.5 beats/min and an average of 173.5 beats/min during matches over 28 minutes long and performance intervals of 6.4 seconds and rest time of 12.9 seconds between exchanges. CONCLUSIONS: The results suggest that badminton is characterised by repetitive efforts of alactic nature and great intensity which are continuously performed throughout the match. An awareness of these characteristics, together with data on the correlations between certain actions such as unforced errors and winning shots and the final result of the match, will aid in more appropriate planning and monitoring of specific training.

Adult↗

PubMed2003

Activity profile of young soccer players during actual match play.

This study investigated the activity profile of young soccer players (mean age 11.8 +/- 0.6 years; N = 12) with the aim of providing information for the development of training strategies. Data for movements of each player were obtained using 2 cameras that aimed at the subject throughout the match (Play Controller, Phromos, Italy). Encoders transmitted camera movements to a computer. The collected signals were then converted into distances, times, and speed attained at arbitrarily selected match categories. Players were monitored during official 11 vs. 11 matches (N = 12), with each match consisting of 2 halves, each lasting 30 minutes played on a regular soccer pitch. Mean total match distance amounted to 6,175 +/- 318 m. During the second half, players covered 5.5% less distance (p > 0.05). At speeds between 13.1 and 18.0 km.h(-1), players covered 12% less distance during the second half (p < 0.05). Players stood still 11% of the total time played (3,789 +/- 109 seconds). At speeds faster than 18 km.h(-1), players performed 33 +/- 4 bouts during match play, with a mean time length of 2.3 +/- 0.6 seconds per bout. Mean time interval between two successive maximal sprint bouts was 118.5 +/- 20.5 seconds. Players stood still longer during the course of the second half (229 +/- 76 seconds vs. 173 +/- 61 seconds, p < 0.05). Players tended to play in small areas of the football pitch and spent 9% of the total match time at high intensity. In order to promote a more active space coverage of the young player, at least for the age considered in the present study, the dimensions of the football pitch and the number of players should be reduced.

Analysis of Variance↗

PubMed1981

Kidney transplantation by use of splenectomy and transfusions, cadaver haplotype matching, suppressor cell assays, and T-cell monitoring.

We attempted to modulate several determinants of the host immunologic profile to improve kidney transplant survival: (1) genotype matching of the cadaver donor with the recipient, (2) assessment in recipients of living related donors (LRD) for predisposition to generate suppressor cells in mixed lymphocyte culture (MLC), (3) pretransplant splenectomy and transfusions, and (4) posttransplant immunologic monitoring. Between January, 1979, and July, 1980, 48 primary renal transplants were performed and followed up between 6 and 24 months. Pretransplant splenectomy was performed, and transfusions were administered in 38 of 48 and 48 of 48 patients, respectively. Donors and recipients of 10 of 11 cadaveric transplants were genotyped and selected for one HLA haplotype identity. All 10 proved to also be one DR antigen matches. There were no cadaveric kidney losses, but one surgical antibody to T cell subtest were used to modulate rejection therapy. The LRD group (n = 37) included 13 HLA-identical, seven haploidentical low MLC reactors, and 17 haploidentical high MLC reactors. Three deaths occurred (diabetes and myocardial infarction, stroke, and pancreatitis). A three-component coculture assay was used in the LRD group before transplantation to determine the capacity to generate specific and nonspecific MLC suppressor cells. Suppressor cells were seen in 17 patients given standard immunosuppression postoperatively without rejection episodes. However, in 20 patients incapable of generating suppressor cells, seven biopsy-proved rejection episodes occurred. There were no kidney losses, with 44 of 48 surviving recipients demonstrating normal renal function.

Adolescent↗

PubMedDate not supplied

Obstetrical nurses' attitude toward fetal monitoring.

A 24-item tool, using a Likert attitudinal scale, was developed to measure labor and delivery nurses' attitudes toward fetal monitoring and was administered to 124 nurses. For each of the 24 attitude statements, cumulative responses were over 50% positive at least. Fifty-two percent of the nurses felt that routine continuous monitoring of all labor patients would be ideal, and 88% felt that the fetal surveillance achieved by monitoring cannot be matched by intermittent auscultation.

Attitude of Health Personnel↗

PubMed2004

Quantified measurement of activity provides insight into motor function and recovery in neurological disease.

BACKGROUND: A direct quantitative measurement of locomotor activity in an individual's own environment over an extended period may help in evaluating the impact of impairments in neurological disorders. OBJECTIVE: To investigate the reliability and validity of activity monitoring in neurological patients and healthy subjects. METHODS: Initial reliability studies were completed on 10 healthy subjects and 10 mobility restricted neurological patients. Validity was investigated using 7 days of ambulatory monitoring with the Step Watch( step activity monitor, laboratory based measures of gait and the Rivermead Mobility Index (RMI) in 10 patients with multiple sclerosis, 10 with Parkinson's disease, and 10 with a primary muscle disorder. Additionally, 30 healthy subjects participated in the study. Two clinical illustrations of ambulatory monitoring are provided. RESULTS: The mean (range) right step count of 7 days of monitoring in both healthy and neurological patients proved a reliable measure of activity (intra-class correlations 0.89 and 0.86 respectively). The 7 day mean (range) right step count was 5951 (2886-9955) in healthy subjects, 3818 (1611-5391) in patients with Parkinson's disease, 3003 (716-5302) in those with muscular disorders, and 2985 (689-5340) in those with multiple sclerosis. A moderate correlation was noted between 7 day mean step count and gait speed (r = 0.45, p = 0.01) in the grouped neurological patients but not the RMI (r(s) = 0.3, p = 0.11). CONCLUSION: Ambulatory monitoring provides a reliable and valid measure of activity levels. Neurological patients, living independently, demonstrate lower activity levels than healthy matched controls. Ambulatory monitoring as an outcome measure has potential for improving the evaluation of ambulation and providing insight into participation.

Adult↗

PubMedDate not supplied

The physiological requirements of Soccer refereeing.

The movement patterns and heart rate responses of Soccer referees during matches were examined. A movement analysis was performed using a grid method and subjects wore a PE 3000 heart rate monitor during the match. The mean distance (+/- SD) covered was 9,408 m (+/- 838m) which comprised: walking (18.9%), jogging (46.6%), running/striding (12.1%), sprinting (6.2%) and backwards movement (16.2%). If walking and jogging are pooled as low intensity activity and high intensity work is defined as running/striding and sprinting then the majority of distance was covered by low intensity activity (65.5%). No differences in the total distance covered during the two halves was evident. However, in the second half the subjects walked more than in the first half (p < 0.01), while they ran/strode more in the first when compared to the second half (p < 0.01). The subjects' mean heart rate during the first and second halves was not significantly different and were 163 and 162 beats per minute (b.min-1) respectively. If the theoretical maximum heart rate for each subject (220-age) is used, the major percentage of the time was spent at heart rates above 85% HRmax. Based upon the distance results of this study, the major energy source for Soccer refereeing would appear to be the aerobic system with the anaerobic system contributing to ATP production to a lesser extent. The results of this study suggest that refereeing at a high level places a significant physiological demand upon these athletes; they therefore require specialised assessment and training.

Adult↗