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PubMed1999

Independent frontal-system deficits in schizophrenia: cognitive, clinical, and adaptive implications.

This study examined whether frontal-system impairments in schizophrenia occur independently of one another and whether they have distinct implications for information processing, symptom severity, and adaptive functioning. We assessed 26 medication-free schizophrenic outpatients and 18 normal control subjects on eight frontally mediated tasks, semantic information processing, IQ, the BPRS, and long-term psychosocial adaptation. Schizophrenic subjects showed three types of deficits, which were uncorrelated with one another: (1) Executive dysfunction (inflexible problem solving) was related to decreased use of expectancy during controlled semantic priming, lower intelligence, more severe negative symptoms and stereotyped mannerisms. (2) Disinhibition of responses (to irrelevant stimuli) was associated with increased automatic priming, a trend for more severe hallucinations, and was unrelated to intelligence. (3) Motor dyscoordination (inaccurate, dysfluent motor sequencing) was not related to semantic processing, intelligence, or symptoms. Furthermore, all three impairments were unrelated to generalized slowness, age, sex, illness length, or pre-washout neuroleptic dose. Two deficits accounted for aspects of long-term psychosocial adaptation, even after statistical correction for IQ: Executive dysfunction was associated with younger illness onset, poor purposefulness and planning, impaired social relations, and lower global functioning. Motor dyscoordination was associated with poor treatment outcome and restricted educational advancement. Furthermore, executive and motor deficits interacted significantly; subjects who had both deficits showed the least favorable treatment outcome. These findings are neither consistent with generalized impairment nor with a unitary 'frontal syndrome' in schizophrenia. They provide preliminary evidence for at least three frontal-system deficits (dorsolateral, orbital, and premotor), which are dissociable from one another, can occur without general intellectual impairment, and have distinct implications for long-term adaptive functioning.

Adaptation, Psychological↗

PubMed2005

Cardiac functional analysis with multi-detector row CT and segmental reconstruction algorithm: comparison with echocardiography, SPECT, and MR imaging.

PURPOSE: To evaluate accuracy of cardiac functional analysis with multi-detector row computed tomography (CT) and segmental reconstruction algorithm over a range of heart rates. MATERIALS AND METHODS: Institutional review board approval was obtained. Informed consent was not required. Multi-detector row CT (500-msec rotation time, 8 x 1-mm detector collimation) and magnetic resonance (MR) imaging were performed in 50 patients (28 men, 22 women; age range, 46-84 years; mean age, 67 years). Two-dimensional echocardiography was performed in 41 patients, and electrocardiographically (ECG)-gated single photon emission computed tomography (SPECT) was performed in 27. End-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and left ventricular (LV) mass were estimated with multi-detector row CT and compared with values estimated with MR imaging, which served as the reference standard. Additionally, EF values estimated with multi-detector row CT, echocardiography, and SPECT were compared with those estimated with MR imaging. Systemic error and degree of agreement of global functional parameters measured with MR imaging and other modalities were assessed. In a second analysis, linear regression analysis was added. RESULTS: EF estimated with multi-detector row CT agreed and correlated well with EF estimated with MR imaging (bias +/- standard deviation, -1.2% +/- 4.6; r = 0.96). Agreement and correlation were similar for EDV (-0.35 mL +/- 15.2; r = 0.97), ESV (1.1 mL +/- 8.6; r = 0.99), and LV mass (2.5 mL +/- 15.0; r = 0.96). Standard deviation of EF difference between multi-detector row CT and MR imaging was significantly less than that between echocardiography and MR imaging (P < .001) or that between SPECT and MR imaging (P < .001). CONCLUSION: Various LV functional parameters were measured with multi-detector row CT with a segmental approach, and measurements correlated and agreed with those obtained with MR imaging. Moreover, functional analysis with multi-detector row CT was more accurate than that with two-dimensional echocardiography or ECG-gated SPECT.

Aged↗

PubMed2004

Depot bromperidol decanoate for schizophrenia.

BACKGROUND: Antipsychotic drugs are the mainstay treatment for schizophrenia. Long-acting depot injections of drugs such as bromperidol decanoate are extensively used as a means of long-term maintenance treatment. OBJECTIVES: To assess the effects of depot bromperidol versus placebo, oral antipsychotics and other depot antipsychotic preparations for people with schizophrenia in terms of clinical, social and economic outcomes. SEARCH STRATEGY: Relevant trials were identified by searching Biological Abstracts (1982-1999), Cochrane Library (Issue 2, 1999), Cochrane Schizophrenia Group's Register (May 1999), EMBASE (1980-1999), MEDLINE (1966-1999) and PsycLIT (1974-1999). References of all identified trials were inspected and Janssen-Cilag was contacted in order to identify more trials. An update search was undertaken in October 2003. The Schizophrenia Groups trials register is based on regular searches of BIOSIS Inside; CENTRAL; CINAHL; EMBASE; MEDLINE and PsycINFO; the hand searching of relevant journals and conference proceedings, and searches of several key grey literature sources. A full description is given in the Group's module. SELECTION CRITERIA: All randomised trials focusing on people with schizophrenia where depot bromperidol, oral antipsychotics or other depot preparations were sought. Primary outcomes were death, clinically significant change in global function, mental state, relapse, hospital admission, adverse effects and acceptability of treatment. DATA COLLECTION AND ANALYSIS: Data were extracted independently by two reviewers and cross-checked. Fixed effects relative risks (RR) and 95% confidence intervals (CI) were calculated for dichotomous data. Weighted or standardised means were calculated for continuous data. Where possible, the number needed to treat statistic (NNT) was calculated. Analysis was by intention-to-treat. MAIN RESULTS: Four controlled clinical trials were included (total n=117). We identified a single small study of six months duration comparing bromperidol decanoate with placebo injection. Similar numbers left the study before completion (n=20, 1 RCT, RR 0.4 CI 0.1 to 1.6) and there was no clear differences between bromperidol decanoate and placebo for a list of adverse effects (n=20, 1 RCT, RR akathisia 2.0 CI 0.21 to 18.69, RR increased weight 3.0 CI 0.14 to 65.9, RR tremor 0.33 CI 0.04 to 2.69). When bromperidol decanoate was compared with fluphenazine depot we found no important change on global outcome (n=30, RR no clinical important improvement 1.50 CI 0.29 to 7.73). People allocated to fluphenazine decanoate and haloperidol decanoate had less relapses than those given bromperidol decanoate (n=77, RR 3.92 Cl 1.05 to 14.60, NNH 6 CI 2 to 341). People allocated bromperidol decanoate required additional antipsychotic medication somewhat more frequently than those taking fluphenazine decanoate and haloperidol decanoate but the results did not reach conventional levels of statistical significance (n=77, 2 RCTs, RR 1.72 CI 0.7 to 4.2). The use of benzodiazepine drugs was very similar in both groups (n=77, 2 RCTs, RR 1.08 CI 0.68 to 1.70). People left the bromperidol decanoate group with the same frequency as those allocated other depots (n=97, 3 RCTs, RR 1.92 CI 0.8 to 4.6). Anticholinergic adverse effects were equally common between bromperidol and other depots (n=47, RR 3.13 CI 0.7 to 14.0) and additional anticholinergic medication was needed with equal frequency in both depot groups, although results did tend to favour the bromperidol decanoate group (n=97, 3 RCTs, RR 0.80 CI 0.64 to 1.01). The incidence of movement disorders was similar in both depot groups (n=77, 2 RCTs, RR 0.74 CI 0.47 to 1.17). REVIEWERS' CONCLUSIONS: Currently, minimal poorly reported trial data suggests that bromperidol decanoate may be better than placebo injection but less valuable than fluphenazine or haloperidol decanoate. If bromperidol decanoate is available it may be a viable choice, especially when there are reasons not to use fluphenazine or haloperidol decanoate. Well-conducted and reported randomised trials are needed to inform practice in Belgium, Germany, Italy and the Netherlands.

Antipsychotic Agents↗

PubMed1997

Significance of morphological abnormalities detected by MRI in patients undergoing successful ablation of right ventricular outflow tract tachycardia.

BACKGROUND: MRI can demonstrate subtle morphological changes of the right ventricle in patients with idiopathic right ventricular outflow tract tachycardia (RVOT). The present study examines the incidence and significance of right ventricular (RV) abnormalities detected by MRI with respect to the site of successful radiofrequency catheter ablation of the clinical tachycardia. METHODS AND RESULTS: The study population comprised 20 patients (mean age, 40+/-12 years) undergoing elimination of recurrent RVOT by radiofrequency catheter ablation. MRI studies were performed before ablation to assess RV volumes and function, as well as structural abnormalities of the RV myocardium. Ten healthy age- and sex-matched subjects served as control subjects. The successful ablation sites, as documented by radiographs of the catheter position, were compared with MRI findings. Patients with RVOT showed no difference in respect to RV volumes and ejection fractions compared with control subjects. Whereas RV abnormalities were limited to prominent fatty deposits of the right atrioventricular groove extending into the inlet portion of the RV wall in 2 of 10 control subjects, MRI studies demonstrated morphological changes of the RV free wall in 13 (65%) of 20 patients with RVOT, including presence of fatty tissue (n=5), wall thinning (n=9), and dyskinetic wall segments (n=4). Eight of these patients had additional fat deposits, thinning, or a saccular aneurysm in the RV outflow tract, corresponding with the ablation site in 6 patients. CONCLUSIONS: In RVOT, structural abnormalities of the right ventricle can be detected in a substantial number of patients despite normal RV volumes and global function. MRI abnormalities within the RV outflow tract are significantly associated with the origin of tachycardia.

Adult↗

PubMed2002

Cerebrolysin in Alzheimer's disease: a randomized, double-blind, placebo-controlled trial with a neurotrophic agent.

UNLABELLED: Cerebrolysin (Cere) is a compound with neurotrophic activity. It has been shown to be effective in the treatment of Alzheimer's disease (AD) in earlier trials. In this multicenter, randomized, double-blind, placebo-controlled, parallel-group study, patients were injected intravenously with placebo or 30 mL Cere five days per week for four weeks. Effects on cognition and global function were evaluated with the Alzheimer Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and the Clinicians Interview-based Impression of Change with Caregiver Input scale (CIBIC+) 4, 12, 24 weeks after the beginning of the injections. 192 patients were enrolled, 95 were randomized to placebo, and 97 to Cere. At baseline, there was a significant difference between groups for age, age of onset of dementia, and the number of patients with hallucinations. At week 12 there was a significant difference on the CIBIC+ (p = 0.033) in favor of Cere. The number of CIBIC+ responders (score < or = 4), was significantly higher (p = 0.007), with 68 (76%) in the Cere group and 51 (57%) in the placebo group. Trends were noted in the Disability Assessment in Dementia scale and the Cornell Depression Scale. Adverse events were recorded in 73% of placebo and 64% of Cere patients. Most common adverse events were headaches, dizziness, weight loss and anxiety. CONCLUSIONS: Cere treatment was well tolerated and resulted in significant improvements in the global score two months after the end of active treatment.

Aged↗

PubMed1999

Use of technetium-99m sestamibi ECG-gated single-photon emission tomography for the evaluation of left ventricular function following coronary artery bypass graft: comparison with three-dimensional magnetic resonance imaging.

In patients who had undergone cardiac surgery (coronary artery bypass graft) and whose hearts showed abnormal movement during the cardiac cycle, we studied the accuracy of functional assessment using ECG-gated single-photon emission tomography (SPET) and the automated software developed by Germano et al. by comparing the findings with magnetic resonance (MR) images acquired three-dimensionally. Sixteen patients who had undergone cardiac surgery underwent 99mTc-sestamibi gated SPET (MIBI-g-SPET) and MRI on the same day. Left ventricular end-diastolic and end-systolic volumes (EDV, ESV) and ejection fraction (LVEF) were measured using MIBI-g-SPET and the aforementioned algorithm. Regional wall thickening was assessed using a four-point scale on MIBI-g-SPET and cine MRI. There was a good correlation between MIBI-g-SPET and MRI in respect of EDV (r=0.89), ESV (r=0.93) and LVEF (r=0.89). A high degree of agreement was found between the wall thickening scores obtained by MIBI-g-SPET and MRI in total segments (kappa=0.62) and in septal segments (kappa=0.67). It is concluded that ECG-gated perfusion SPET can provide regional and global functional information, including absolute volumes, in patients following cardiac surgery.

Aged↗

PubMed2003

Dynamic stress echocardiography in asymptomatic patients who received chemotherapy in childhood because of a malignant disease.

BACKGROUND: Introducing anthracycline antibiotics into the treatment of children's malignancies contributed enormously to the excellent outcome in children and adolescents. Nevertheless, the cardiotoxicity of such was discovered as early as in the 1970's. Only recently stress tests have been used to detect late cardiotoxic effects of anti-neoplastic drugs. AIM: To determine the function of the left ventricle (LV) in asymptomatic patients who were treated with chemotherapy containing anthracyclines in childhood or adolescence. METHODS: We examined 137 patients (81 men, 56 women), aged 16.6+/-4.8 years, in whom a malignant disease was diagnosed at the age of 9.1+/-4.8 years and who were treated with a cumulative dose of anthracyclines of 242+/-110 mg/m(2). The control group comprised 30 subjects (14 men, 16 women, mean age 19.5+/-5.2 years). The echocardiographic examination was carried out at rest and also immediately after a dynamic stress test. RESULTS: A decrease in the fractional shortening (FS) <30% was found in 11 (8%) patients. The values of ejection fraction (EF), mean velocity circumferential fibre shortening, end-systolic wall stress, excursion and systolic thickening of the LV posterior wall were significantly impaired in comparison with the group who had the FS > or =30% as well as with the control group. The maximal decrease in EF was reduced to 40% and FS - to 20%. The values of the index of the global function of LV were, in comparison with the control group, impaired in both subgroups of the patients. We did not find any differences in the exercise tolerance between the groups. The EF values both at rest and at stress were significantly lower in the group with FS <30% when compared with other groups. The values of percentage EF stress increment were increased in all the groups. A decrease in EF after exercise was not observed. CONCLUSIONS: Anthracycline chemotherapy leads to a late impairment of LV function. Asymptomatic patients with a decrease of EF to 40% or FS to 20% show preserved exercise tolerance as well as contractile reserve of the LV. These findings represent a better prognosis for the patient. Echocardiography at rest should be carried out repeatedly after the termination of the treatment and in the case of a pathological finding it is necessary to perform stress tests to evaluate the contractile reserve.

Adolescent↗

PubMed2000

Depot haloperidol decanoate for schizophrenia.

BACKGROUND: The mainstay of treatment for schizophrenia is the antipsychotic group of drugs. These are usually given orally but compliance with medication given by this route may be difficult to quantify. Problems with treatment adherence are common. The development of depot injections in the 1960s gave rise to their extensive use as a means of long-term maintenance treatment. Haloperidol decanoate is one depot drug available in clinical practice. OBJECTIVES: To assess the effects of haloperidol decanoate versus oral anti-psychotics and other depot antipsychotic preparations for people with schizophrenia in terms of clinical, social and economic outcomes. SEARCH STRATEGY: Relevant trials were identified by searching Biological Abstracts (1982-1998), Cochrane Library (Issue 2, 1998), Cochrane Schizophrenia Group's Register (June 1998), EMBASE (1980-1998), MEDLINE (1966-1998) and PsycLIT (1974-1998). References of all identified trials were also inspected for more studies. SELECTION CRITERIA: All relevant randomised trials focusing on people with schizophrenia where haloperidol decanoate, oral anti-psychotics or other depot preparations were compared. Outcomes such as death, clinically significant change in global function, mental state, relapse, hospital admission, adverse effects and acceptability of treatment were sought. DATA COLLECTION AND ANALYSIS: Studies were reliably selected, quality rated and data extracted. For dichotomous data Mantel-Haenszel odds ratios (OR) with the 95% confidence intervals (CI) were estimated. Where possible, the number needed to treat statistic (NNT) was calculated. Analysis was by intention-to-treat. Normal continuous data were summated using the weighted mean difference (WMD). Scale data were presented only for those tools that had attained pre-specified levels of quality. MAIN RESULTS: In a haloperidol decanoate versus placebo comparison, two small studies reported that significantly fewer people on depot left early (OR 0.09 CI 0.03-0.21, NNT 2 CI 1-3) or experienced no important improvement in mental state (OR 0. 04 CI 0.01-0.15). Zississ (1982) suggested that those taking haloperidol decanoate would need less additional antipsychotic medication (OR 0.14 Cl 0.04-0.55, NNT 2 CI 1-5). Haloperidol decanoate was compared to oral haloperidol in a single trial that showed no differences in global impression, mental state or side effects ( approximately approximately Zuardi 1983 approximately approximately , n=22). Compliance with medication was not reported in this study. Eight trials compared haloperidol decanoate to other depot neuroleptics and again no differences were found for the outcomes of death, global impression, mental state, behaviour, or side effects. REVIEWER'S CONCLUSIONS: Haloperidol decanoate may have a substantial effect in improving the symptoms and behaviour associated with schizophrenia in comparison to placebo, but data are remarkably sparse. There are no discernible differences between the depot form of haloperidol and its oral equivalent. For those needing and willing to take the drug, the means of administration is then a matter of individual choice and clinical judgement. As there are no clear differences between haloperidol decanoate and other depots, the choice of depot medication could also be individually tailored and patient preference exercised. Well-conducted and reported randomised trials are needed comparing haloperidol decanoate with other depots but the comparison of haloperidol decanoate to oral antipsychotics is a priority.

Antipsychotic Agents↗

PubMed1999

Three-dimensional echocardiographic assessment of left ventricular wall motion abnormalities in mouse myocardial infarction.

We applied 3-dimensional echocardiographic reconstruction to assess left ventricular (LV) volumes, function, and the extent of wall motion abnormalities in a murine model of myocardial infarction (MI). Consecutive parasternal short-axis planes were obtained at 1-mm intervals with a 13-MHz linear array probe. End-diastolic and end-systolic LV volumes were calculated by Simpson's rule, and the ejection fraction and cardiac output were derived. Echocardiography-derived cardiac output was validated by an aortic flow probe in 6 mice. Echocardiography was then performed in 9 mice before and after the left anterior descending coronary artery was ligated. Wall motion was assessed, and the ratio of the abnormally to normally contracting myocardium was calculated. After MI occurred, LV end-diastolic volume and LV end-systolic volume increased (33 +/- 10 vs 24 +/- 6 microL, P <.05 and 24 +/- 9 vs 10 +/- 4 microL, P <.001), whereas cardiac output decreased (4.2 +/- 1.5 mL/min vs 6.6 +/- 2.3 mL/min, P <.01). Forty percent of the myocardium was normokinetic, 24% was hypokinetic, and 36% was akinetic. Echocardiography can measure LV volumes and regional and global function in a murine model of myocardial infarction, thereby providing the potential to quantitate and compare the responses of various transgenic mice to MI and its therapies.

Animals↗

PubMedDate not supplied

Comparison of electron beam computed tomography with magnetic resonance imaging in assessment of right ventricular volumes and function.

OBJECTIVE: Intraindividual comparison of right ventricular volumes and function using electron beam computed tomography (EBT) and magnetic resonance imaging (MRI). METHODS: Twenty-seven patients with a known cardiac history were referred for evaluation of ventricular function parameters. The following standardized protocols were used: contrast-enhanced multislice mode EBT and gradient echo sequence MRI. Right ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) were calculated using a slice summation method. Interobserver variability was calculated. RESULTS: The correlation between the 2 methods was: r = 0.901 for EDV, r = 0.938 for ESV, r = 0.823 for SV, and r = 0.953 for EF. Electron beam computed tomography overestimated EDV and ESV slightly when compared with MRI (P < 0.05). No significant differences (P > 0.05) were found between SV and EF. Mean values determined by EBT and MRI were as follows: 168.6 +/- 62.3 mL and 153.7 +/- 59.1 mL for EDV, 104.7 +/- 60.4 mL and 95.1 +/- 54.8 mL for ESV, 63.2 +/- 19.3 mL and 58.7 +/- 19.8 mL for SV, and 40.2% +/- 14.1% and 40.2% +/- 13.6% for EF, respectively. Interobserver variability ranged between 1.0% and 3.2%. CONCLUSION: Electron beam computed tomography shows good agreement with a close correlation and an acceptable interobserver variability for right ventricular volumes and global function, with a small but significant overestimation of EDV and ESV when compared with MRI.

Adult↗

PubMed1996

[Noninvasive electrocardiographic monitoring and ventricular arrhythmias in patients after myocardial infarct].

It is generally accepted that ventricular arrhythmias represent a predictor of prognosis after myocardial infarction, and that their impact on the increase of risk is especially unfavourable when associated with myocardial ischaemia or reduced left ventricular function. The aim of the study was to assess the significance and contribution of noninvasive ECG methods in detection of risk due to sudden cardiac death in Q postmyocardial infarction patients. Two-hundred and seventy patients were examined by exercise testing which in 5.2% of cases revealed couplet ventricular extrasystoles and 0.8% yielded non-sustained ventricular tachycardia. 24-hour-Holter ECG recording was performed in 168 patients (19.0% of couplet ventricular extrasystoles, 9.0% of non-sustained and 0.6% of sustained ventricular tachycardia respectively), and 300 patients were examined by late ventricular potentials analysis with a result of 25% positive cases. During 3 years of follow-up, 20 out of 300 patients (6.7%) died suddenly; in this group late ventricular potentials occurred significantly more frequently than in survivors. Exercise testing plays a major role in the detection of myocardial ischaemia, while Holter recording and signal averaging for detection of late ventricular potentials are important in noninvasive diagnosis of ventricular arrhythmias. Their combination with other ECG techniques (heart rate variability, QT dispersion) and determination of global function of the left ventricle may help to identify the group of patients in whom subsequent electrophysiological study is indicated in order to determine the optimal therapy for mortality reduction after myocardial infarction. (Fig. 5, Tab. 3, Ref. 20.)

Adult↗

PubMed1991

[Residual stenosis after intracoronary thrombolysis: its clinical significance].

The effects of residual stenosis after intracoronary thrombolysis (ICT) on the hospital course and on left ventricular function were investigated in 94 patients with acute myocardial infarction. The in-patient hospital events including death, post-infarction angina, and re-infarction occurred in 6 of 24 (25%) patients with 100-99% residual stenosis (Group I), 18 of 55 (32.7%) patients with 95-90% stenosis (Group II) and one of 15 (7%) patients with 75% or less stenosis (Group III), suggesting that the presence of severe residual stenosis could be associated with the occurrence of in-patient hospital events. However, re-infarction occurred in only 3.6% of Group II patients. In an analysis of left ventricular function, global and regional wall motion was significantly improved in this group of patients, compared with patients who had no reperfusion (Group I). What is more, the degree of the improvement in wall motion in Group II, despite the severe stenosis, was the same as that in Group III with 75% or less stenosis. It was concluded that further intervention following thrombolysis may not be necessarily required for patients who underwent reperfusion without filling delay, even if the residual stenosis is greater than 90%.

Aged↗

PubMed2006

Selective serotonin reuptake inhibitors in autism: a review of efficacy and tolerability.

BACKGROUND: Awareness of the impact and prevalence of autism spectrum disorders has significantly increased in recent years. Given the dearth of reliable interventions, there is great interest in demonstrating efficacy of the various treatment options. A growing body of evidence links autism spectrum disorders to abnormalities in serotonin function, and the selective serotonin reuptake inhibitors (SSRIs) have been utilized to target various symptoms of the disorders. This article reviews the available data on the efficacy and tolerability of SSRIs in individuals with autism spectrum disorders. Objectives for future research in this area will also be suggested. DATA SOURCES AND STUDY SELECTION: The entire PubMed database including MEDLINE (1966-July 2005) was searched for English-language biomedical articles. Search terms included autism, autism spectrum disorder, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, pervasive developmental disorder, selective serotonin reuptake inhibitors, and sertraline. All clinical trials evaluating treatment outcomes associated with the use of SSRIs in managing symptoms of autism that were identified in the search were reviewed. All randomized controlled trials and open-label trials were included in this review. Case reports and case series were excluded. DATA SYNTHESIS: We identified 3 randomized controlled trials and 10 open-label trials or retrospective chart reviews on the use of SSRIs in autism and autism spectrum disorders. The SSRIs that have been studied in autism spectrum disorders are citalopram, escitalopram, fluoxetine, fluvoxamine, and sertraline. Most studies demonstrate significant improvement in global functioning and in symptoms associated with anxiety and repetitive behaviors. While side effects were generally considered to be mild, increased activation and agitation occurred in some subjects. CONCLUSIONS: Although SSRIs may demonstrate therapeutic benefit in autism spectrum disorders, methodological weaknesses of many of the clinical trials suggest the need for additional randomized controlled trials. Furthermore, given the increased awareness of the dangers associated with SSRI-induced activation and agitation, the presence of these side effects in the autistic population warrants closer attention to dosage, titration, and subject selection issues.

Adolescent↗

PubMed2003

Tissue Doppler echocardiography in patients with thalassaemia detects early myocardial dysfunction related to myocardial iron overload.

AIMS: To compare an echocardiographic method for detecting abnormal cardiac function before development of overt cardiomyopathy with a recently validated technique of quantifying myocardial iron load. METHODS AND RESULTS: We examined thalassaemia patients whose myocardial iron load had been evaluated with magnetic resonance imaging (MRI). By tissue Doppler echocardiography, myocardial velocities were sampled continuously from base to apex in the RV and LV free wall, and the septum in 52 patients aged 29.2 (14.2-43.1) years and 52 age-matched controls. Ninety-six percent of patients had normal LV ejection fraction by MRI. Thirty-eight (73%) had abnormal iron loading of the myocardium, and 33 of those had regional wall motion abnormalities detected in the septum (n=29), LV (n=2), RV (n=1), and septum plus LV (n=1). The incidence of wall motion abnormalities was significantly higher (P<0.04) in patients with myocardial iron overload (87%) than in the 14 without (35%). Furthermore, myocardial iron overload was suggested by a low T2(*)(15.1+/-15.8 ms) in patients with wall motion abnormalities vs those with normal wall motion (T2(*): 30+/-19 ms) (P<0.007). CONCLUSIONS: Wall motion abnormalities may represent an early sign of cardiac disease despite preserved global function. The regional abnormalities are related to iron overload and easily detectable with tissue Doppler echocardiography.

Adolescent↗

PubMed1995

Respiratory muscle strength during continuous ambulatory peritoneal dialysis (CAPD).

The purpose of this study was to investigate the effect of chronic renal failure (CRF) and continuous ambulatory peritoneal dialysis (CAPD) on respiratory muscle function. Global respiratory muscle strength was assessed by measuring mouth pressures during maximum static inspiration (PIMAX) near residual volume (RV) and expiration (PEMAX) near total lung capacity (TLC), in 26 patients. Maximum pressures, spirometry and lung volumes were measured before dialysis, 4 h after the administration of 2 l of dialysate into the peritoneal cavity, and just after the next drainage. In addition, biochemical indices (urea, creatinine, sodium, potassium, calcium and phosphorus) and haematological indices (haemoglobin (Hb) and haematocrit (Hct)) were measured once before the treatment. The results showed that mean PIMAX and PEMAX were normal, with a very wide range between patients, before CAPD. However, seven patients (27%) showed a PIMAX of < 75% predicted (pred) and eight (31%) a PEMAX < 75% pred. Maximal pressures decreased significantly during CAPD and increased again after the drainage of fluid. Similarly, lung volumes were within the normal range before and decreased significantly during CAPD. The forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio did not change. We conclude that respiratory muscle strength was preserved in the majority of the patients with chronic renal failure treated with CAPD. During CAPD, lung volumes and respiratory muscle function were decreased, demonstrating an effect of the abdominal cavity on the mechanics of the respiratory system. However, the decrease in the maximum pressures was less than 20%, indicating that CAPD is a safe procedure in patients without pre-existing pulmonary disease or uraemic pulmonary complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMedDate not supplied

[A new method of global search for functional DNA segments using a fractal representation of nucleotide texts].

New global method for computer prediction of functional sites in nucleotide sequences, based on the fractal representation, is presented. Fractal representation of set of sequences (FRS) provides simple way for generating recognitions matrix of functionally similar sequences and simple estimations of its efficiency for searching homologous regions in new sequences. Other advantages of the method are absence of the necessity of sequences alignment during generating based set and searching new homologous regions and small CPU time. Usage of the method illustrated for searching globin and histone genes, for ALU repeats in human genome and long terminal repeats in virus genome.

Computer Simulation↗

PubMedDate not supplied

Effect of changes in load carriage while walking on the left ventricular function in highly trained elderly subjects.

BACKGROUND: In previous studies, the effect of isometric stress on the dynamic performance of a graded exercise test in normal subjects augmented afterload and brought about changes in left ventricular function more often than did results from physical exercise. OBJECTIVE: This study used the metabolic charts and echocardiography to examine the influence of two different types of load carriage during 30 min of treadmill walking on left ventricular function, hemodynamics, and cardiovascular responses. METHODS: Fifteen elderly (age 66.1 +/- 3.5 years) aerobically well-trained male subjects (VO(2 peak) 44.2 +/- 5.0 ml x kg(-1) x min(-1)) volunteered in this study. The subjects walked on a treadmill (at a speed of 4.5 km x h(-1)), carrying a load of 20 kg during one session and a load of 30 kg during a second session. RESULTS: Following the 30-min exercise in each session, significant (p < 0.05) differences were noted between the 20-kg and the 30-kg work loads with regard to cardiac output (6.8 +/- 0.5 and 7.8 +/- 0.4 l.min(-1)), heart rate (114.0 +/- 11.0 and 126.0 +/- 10.0 beats.min(-1)), diastolic blood pressure (79.4 +/- 5.0 and 84.3 +/- 5.0 mm Hg, mean arterial blood pressure (104.0 +/- 4.0 and 109.2 +/- 3.0 mm Hg), and left ventricular contractility ratio (3.3 +/- 0.4 and 3.6 +/- 0.3). No significant differences were noted between the work loads with regard to systolic blood pressure, cardiac output, left ventricular volumes, and ejection fraction. CONCLUSIONS: This study suggests that in the highly trained elderly, the influence of the autoregulation mechanism dominates during combined dynamic and isometric exercises, thus the opposing force to the left ventricular ejection is reduced which in turn does not change left ventricular global function.

Aged↗

PubMed1997

Redefining AIDS: towards a modification of the current AIDS case definition.

AIDS is defined by the occurrence of an opportunistic infection or tumor considered indicative of advanced infection with human immunodeficiency virus (HIV). Even though recent modifications have improved the widely used AIDS case definition issued by the World Health Organization and the Centers for Disease Control and Prevention, the modified version has fallen short of generating a globally functional instrument for the surveillance of HIV-related infections. The clinical AIDS case definition should be as comprehensive as possible. In many countries, only the diagnosis of an AIDS-defining illness will grant the affected patient social benefits or access to medical care. An expanded AIDS case definition is also likely to improve surveillance of HIV-associated morbidity and mortality; increase the awareness of emerging infections; increase the number of clinical endpoints in clinical trials; and facilitate the introduction of diagnostic tests, screening programs, and preventive measures. Examples of opportunistic infections and tumors that could be considered in future modifications of the AIDS case definition are discussed in detail.

AIDS-Related Opportunistic Infections↗