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At least 811 records · Page 45Linked to original sources

PubMed1988

Early natural history of regional left ventricular dysfunction after experimental myocardial infarction.

Existing studies provide conflicting information concerning the natural history of regional dysfunction after subacute myocardial infarction. The purpose of this study was to use quantitative computer-assisted two-dimensional echocardiography to define the natural history of abnormal wall motion in a subacute canine infarct model within individual short-axis echocardiographic planes, and in the entire ventricle as well. Serial short-axis echocardiograms were obtained from 10 closed-chest dogs before occlusion and at 0.5, 6, 24, 48, and 72 hours after ligation of the circumflex (six dogs) or left anterior descending (four dogs) coronary artery. The circumferential extent of abnormal wall motion was quantified by two different computer-assisted methods: the first, a derived correlation method, examined wall motion throughout the systolic contraction sequence; the second method examined the fractional radial change in endocardial ray length from end-diastole to end-systole. The study shows that for individual planes there is a slight but not statistically significant increase in the circumferential extent of abnormal wall motion from 0.5 to 72 hours after coronary artery occlusion; however, when the total extent of left ventricular asynergy was used to define a global functional infarct size, we observed a small (3.6% to 5.4%) but significant increase in the circumferential extent of abnormal wall motion.

Analysis of Variance↗

PubMed1995

Relationship between smooth pursuit eye-tracking and cognitive performance in schizophrenia.

The relationship between measures of smooth pursuit and neuropsychological performance was assessed in 20 unmedicated schizophrenics. Eye-tracking measures included gain, catch-up saccade parameters, and rate of saccadic intrusions. Neuropsychological measures included tests generally considered as "frontal": Wisconsin Card Sorting Test (WCST), Consonant Trigram Test (CTT), and Controlled Oral Word Association Test (COWAT). The Digit Symbol Test (DST), which is generally considered to be a measure of global functioning, was also included. Gain and other pursuit measures were significantly correlated with the DST and the COWAT, but were not correlated with the WCST or the CTT.

Adult↗

PubMedDate not supplied

Predicting outcome for borderline personality disorder.

The purpose of this study is to identify variables predictive of the psychosocial outcomes of borderline patients 2 years following an acute psychiatric hospitalization. Of the initial 88 inpatients scoring positive for the Diagnostic Interview for Borderlines (DIB), 65 (73.8%) were reinterviewed, 14 (15.9%) refused, five (5.7%) were unable to be located, and four (4.6%) suicided. The dropouts (n = 19) were significantly more likely to be single, separated, or divorced, to be male, and to be diagnosed as having co-existing antisocial personality disorder than the followed-up probands (n = 69). In terms of global functioning, over the 2-year follow-up period, 61 (87.7%) of the 69 probands were judged to be functioning normally less than 50% of the follow-up interval. Using logistic regression, two variables, initial impulse action scores and poor premorbid functioning, predicted poor versus good outcome. This study supports the literature, which indicates that the early course of borderline personality disorder (BPD) is stormy. Impulsivity and poor premorbid functioning may be predictive of poor short-term outcome in borderline patients.

Adult↗

PubMed1975

Beta-adrenergic blockade and atrio--ventricular conduction impairment.

Atrio--ventricular conduction and its modifications induced by six Beta-adrenergic blocking agents have been investigated in the dog. Premature atrial stimuli (St2) were applied at variable intervals following regular stimuli (St1) ensuring atrial pacing; atrial (AERP), nodoventricular (NERP) and global (GERP) effective refractory periods as well as global functional refractory period (GFRP) were determined before and after administration of each of the six drugs. When Beta-blockade was produced with d,1-propranolol which hwas membrane stabilizing effects (MSE) but no intrinsic sympathomimetic activity (ISA) or with sotalol, which has neither MSE nor ISA, all parameters were significantly increased. When Beta-blockade was achieved with pindolol or practolol, which have only a poor Beta-adrenolytic potency and no ISA. Alprenolol showed intermediate effects. Thus, it appears that Beta-blockade and not MSE, is responsible for the onset of A-V conduction impairment but that ISA, probably through a metabolic mechanism, affords protection against this impairment. On the other hand, measurement of ventricular effective refractory period (VERP) has shown that at the Purkinje-free junction, it is MSE which is mainly involved in conduction impairment.

Adrenergic beta-Antagonists↗

PubMed1976

Isoprenaline and canine cardiac refractory periods.

Atrioventricular refractory periods and their modifications induced by variable doses of sioprenaline have been investigated in dogs. Premature atrial stimuli (St2) were applied at variable intervals following regular stimuli (St1) which ensured atrial pacing. Atrial (AERP), nodoventricular (NERP) and global (GERP) effective refractory periods, as well as the global functional refractory period (GFRP) were determined before, during and after infusion of the drug. In low doses, isoprenaline did not significantly alter these various parameters. This confirms its lack of dromotropic effect on the healthy heart. In contrast, high doses of the drug significantly reduced the refractory periods, probably by simple correction of the negative dromotropic effects resulting from overstimulation. Also when the infusion was stopped, marked but reversible conduction depression was observed. It would appear that this reflects 'exhaustion' of cell metabolism induced by the drug.

Animals↗

PubMed1989

Multivariable optimization of cycling biomechanics.

Relying on a biomechanical model of the lower limb which treats the leg-bicycle system as a five-bar linkage constrained to plane motion, a cost function derived from the joint moments developed during cycling is computed. At constant average power of 200 W, the effect of five variables on the cost function is studied. The five variables are pedalling rate, crank arm length, seat tube angle, seat height, and longitudinal foot position on the pedal. A sensitivity analysis of each of the five variables shows that pedalling rate is the most sensitive, followed by the crank arm length, seat tube angle, seat height, and longitudinal foot position on the pedal (the least sensitive). Based on Powell's method, a multivariable optimization search is made for the combination of variable values which minimize the cost function. For a rider of average anthropometry (height 1.78 m, weight 72.5 kg), a pedalling rate of 115 rev min-1, crank arm length of 0.140 m, seat tube angle of 76 degrees, seat height plus crank arm length equal to 97% of trochanteric leg length, and longitudinal foot position on the pedal equal to 54% of foot length correspond to the cost function global minimum. The effect of anthropometric parameter variations is also examined and these variations influence the results significantly. The optimal crank arm length, seat height, and longitudinal foot position on the pedal increase as the size of rider increases whereas the optimal cadence and seat tube angle decrease as the rider's size increases. The dependence of optimization results on anthropometric parameters emphasizes the importance of tailoring bicycle equipment to the anthropometry of the individual.

Anthropometry↗

PubMedDate not supplied

Patterns of substance use in schizophrenia: a Markov modeling approach.

Markov models were used to examine patterns of substance use and global functioning in a sample of 100 schizophrenic outpatients over an 18 month period. Patterns of changes in substance use and functional status were stable across the evaluation period. Persons remaining in any substance use or functional state for two evaluation periods were highly likely to continue in the same state. Tests of two common causal hypotheses about relationships between substance use and functional status yielded partial support for the hypothesis that substance use leads to functional impairment, but did not support the hypothesis that functional impairment leads to substance use. Furthermore, there was no evidence of any increase in overall substance use or of substance use leading to treatment dropout. These analyses illustrate a promising approach to key questions about substance use in schizophrenia.

Adult↗

PubMed1991

Effects of occupational therapy home service on patients with rheumatoid arthritis.

Because there is little information about the efficacy of home occupational therapy, we decided to assess the effects of a home service on patients with rheumatoid arthritis. 105 patients aged 18-70 years, on stable medical therapy, were randomised to receive a 6-week comprehensive programme of occupational therapy (experimental group, 53 patients) or to receive no such treatment (control group, 52). At 6 weeks, control patients received the experimental regimen, and experimental patients were continued on treatment as needed up to 12 weeks. Outcomes were measured at baseline, 6, and 12 weeks with a global functional capacity score (functional score). At 6 weeks the functional score for the experimental group was significantly higher than that for the control group (mean difference = 8.1, 95% Cl 1.7 to 15.8, p = 0.012). Control patients at 12 weeks showed a similar improvement to experimental patients at 6 weeks, and between 6 and 12 weeks the experimental patients were stable. Occupational therapy leads to a statistically significant and clinically important improvement in function in patients with rheumatoid arthritis.

Activities of Daily Living↗

PubMed1988

Neglect contributing to tertiary hospitalization in childhood asthma.

Clinical experience demonstrates that many chronically ill children have an unstable course of illness ending in tertiary care, not because of extraordinary disease, but because they come from dysfunctional and neglectful households. Families frequently cannot or will not adapt to the demands of their chronically ill child. This study substantiates the extent to which neglect and family dysfunction have contributed to the need for hospitalization of asthmatic children at National Jewish. Neglect accelerates the cycle of morbidity and stress associated with illness. Using a measure of global functioning, we demonstrate a psychologic morbidity associated with medical neglect. We discuss children at imminent risk in their home environment and the process of seeking alternative placements. We acknowledge gaps in delivery of health care to this difficult, treatment-resistant population and encourage development of day treatment and home outreach programs.

Asthma↗

PubMed1994

The prognostic importance of delusions in depression: a 6-year prospective follow-up study.

The authors followed 32 delusional and 41 unipolar non-delusional depressed patients 6 years after hospital discharge. Long-term outcome, as determined by the frequency of the relapses, number of hospitalizations, chronic course of illness as well as clinical status and global functioning at the end of the 6-year period, failed to differentiate the two patient groups. Discontinuation of maintenance medication in both groups or of antipsychotics in the delusional group was associated with a high rate of relapses. Our findings indicate that delusional depression has a similar clinical course to that of non-delusional depression, underline the importance of psychoprophylactic treatment and question the efficacy of monotherapy with antidepressants in the prevention of relapses of delusional depression.

Adult↗

PubMed1992

Yeast SNF/SWI transcriptional activators and the SPT/SIN chromatin connection.

Genetic studies of many diversely regulated genes in the yeast Saccharomyces cerevisiae have identified two groups of genes with global functions in transcription. The first group comprises five SNF and SWI genes required for transcriptional activation. The other group, containing SPT and SIN genes, was identified by suppressor analysis and includes genes that encode histones. Recent evidence suggests that these SNF/SWI and SPT/SIN genes control transcription via effects on chromatin. SNF2/SWI2 sequence homologues have been identified in many organisms, suggesting that the SNF/SWI and SPT/SIN functions are conserved throughout eukaryotes.

Biological Evolution↗

PubMedDate not supplied

Acetylcholinesterase and NADH-diaphorase chemoarchitectonic subdivisions in the rabbit medial geniculate body.

The distribution of acetylcholinesterase and NADH-diaphorase activities was studied histochemically in the rabbit medial geniculate body, yielding new data useful for the definition of the common structural pattern of this thalamic complex in mammals. Four chemoarchitectonic subdivisions could be detected in transversal, horizontal and sagittal sections that corresponded to the previously described ventral, dorsal and internal nuclei, and to a fourth subdivision, defined as the mediorostral nucleus of the medial geniculate complex in the rabbit. The topography and cellular typology of the mediorostral nucleus suggest its homology with the so-called magnocellular nucleus of other mammals, an identity that was previously assigned to the internal nucleus. The relative position of the rabbit internal and dorsal nuclei and comparative connectional data are combined to suggest their correspondence with the anterodorsal and posterodorsal subnuclei, respectively, of the cat and the monkey. Global functional interpretations of these nuclei as sites of visuoacoustic and somatoacoustic polymodal integration support the notion of a shell region of the medial geniculate, surrounding the principal cochleotopic ventral nucleus and interconnected to the cortical acoustic belt around the primary auditory area. Acetylcholinesterase and NADH-diaphorase chemoarchitectony may be useful for the detection of similar partitions in species where cytoarchitectonic differentiation of the medial geniculate is less clear.

Acetylcholinesterase↗

PubMed1994

Prognostic value of initial subtype in schizophrenic disorders.

The prognostic value of the subtype diagnosis at the initial episode was investigated in 148 narrowly defined schizophrenic patients. Every initial episode was classified according to multiple criteria: DSM-III-R, ICD-10, the positive/negative dichotomy, and Schneider's first rank symptoms. Patients were followed up on average 23 years later (range 10-50 years). Different aspects of long-term outcome were evaluated (global functioning, social adjustment, negative social consequences). In 93% of the patients persisting alterations were found at the end of the observation time. The influence of the predominant clinical features at the initial episode on various aspects of long-term outcome was found to differ depending on which of the four diagnostic systems was used. The highest power for discrimination was found for the subtypes of DSM-III-R, while the presence of first rank symptoms had no prognostic value. It was found that patients with an initial paranoid or positive episode had a significantly better long-term outcome than patients initially having a disorganised/hebephrenic or catatonic episode. The frequency of negative social consequences was not influenced by the initial subtype, with the exception of permanent hospitalisation.

Adolescent↗

PubMed1996

Biological predictors of 1-year outcome in schizophrenia in males and females.

This paper describes a prospective study designed to ascertain the predictive value of biological factors associated with schizophrenia in males and females. In a sample of 59 medication-free schizophrenic inpatients (41 males; 18 females), we assessed the correlation of four factors--rapid eye movement (REM) sleep latency, delta (slow-wave) sleep, dexamethasone suppression test (DST) cortisol levels, and ventricle-brain ratio (VBR)--with several dimensions of outcome at 1-year post-discharge. In the total sample, shorter REM latency was associated with poor outcome on all dimensions measured: rehospitalization, employment, social activity, symptomatology, and global functioning. However, none of the other biological factors were associated with any measure of outcome. The predictive value of REM latency appeared to be gender-specific; in general, the relationships between reduced REM latency and poor outcome were consistently noted in females, but were not significant in males. These results suggest that a common, possibly gender-related, pathophysiological mechanism might underlie both abnormal REM latency and poor outcome. The findings underscore the importance of considering gender differences in studies of schizophrenia.

Electroencephalography↗

PubMed2005

Is donepezil therapy associated with reduced mortality in nursing home residents with dementia?

BACKGROUND: Since cholinesterase inhibitors (CEIs) were approved for use in mild to moderate Alzheimer's disease, the therapeutic efficacy of this class of medications has largely centered on demonstration of short-term improvement in cognition and global function. Later evidence suggested that the beneficial effects of CEIs might be sustainable for at least 3 years and that CEIs may have a disease-modifying effect on Alzheimer's disease. These broad-ranging, long-term effects may explain the recent finding that the use of a CEI among nursing home residents with dementia was associated with lower mortality. OBJECTIVE: The goal of this study was to investigate whether donepezil treatment is associated with reduced mortality in nursing home residents who have dementia. METHODS: We performed a retrospective matched cohort study using the Systematic Assessment of Geriatric Drug Use via Epidemiology database, which contains data collected with the Minimum Data Set on a cross section of 915,469 nursing home residents aged > 65 years between 1998 and 2000 in 6 US states. We identified users of donepezil (5 and 10 mg) and an equal number of matched nonusers in the same facility, date of donepezil use, level of cognitive function, and dementia diagnosis. Comparisons of the 2 groups were made for sociodemographic variables, dementia severity, number of medications, and major comorbid illnesses (heart disease, cancer, diabetes mellitus, chronic obstructive pulmonary disease, and malnutrition), as well as survival over the 2-year study period. RESULTS: A total of 5423 users and 5423 nonusers of donepezil were identified. Based on Cox proportional hazards models, donepezil users showed a lower mortality rate than nonusers. The hazard rate ratio was 0.89 (95% CI, 0.83-0.95). After adjusting for the confounding variables, sociodemographic factors, other psychotropic drugs, and comorbid conditions, this survival advantage remained (hazard rate ratio, 0.90; 95% CI, 0.84-0.96). CONCLUSIONS: A relationship was observed between treatment of nursing home residents with donepezil and lower mortality. If the relationship was due to a direct effect of donepezil use, then this observation has implications for the socioeconomic impact of CEI therapy in those with advanced dementia in the nursing home. These implications deserve future investigation.

Aged↗

PubMed2005

Duloxetine hydrochloride: a new dual-acting medication for the treatment of major depressive disorder.

BACKGROUND: Duloxetine hydrochloride has recently been approved by the US Food and Drug Administration for the treatment of major depressive disorder (MDD). Duloxetine is a potent inhibitor of serotonin and norepinephrine reuptake, with weak effects on dopamine reuptake. OBJECTIVE: This article reviews the literature on duloxetine with regard to its pharmacodynamics, pharmacokinetics, clinical efficacy, and tolerability. METHODS: A comprehensive search of MEDLINE was performed using the terms duloxetine, Cymbalta, and major depressive disorder, with no restriction on year. The Eli Lilly and Company clinical trial registry, and abstracts and posters from recent American Psychiatric Association meetings were also reviewed. RESULTS: Duloxetine exhibits linear, dose-dependent pharmacokinetics across the approved oral dosage range of 40 to 60 mg/d. No dose adjustment appears to be needed based on age. Duloxetine has shown efficacy in reducing depressive symptoms compared with placebo, and duloxetine recipients have shown significant improvements in global functioning compared with placebo (both, P < 0.05). Response and remission rates have been comparable to or greater than those seen with fluoxetine or paroxetine. Duloxetine is generally well tolerated, with nausea, dry mouth, and fatigue being the most common treatment-emergent adverse effects. Cardiovascular adverse effects do not appear to result in sustained blood pressure elevations, QTc-interval prolongation, or other electrocardiographic changes. CONCLUSIONS: Based on the available evidence, duloxetine is a well-tolerated and effective treatment for MDD in adults. Randomized head-to-head comparisons against established antidepressants are needed to determine the relative safety and efficacy of duloxetine.

Adult↗

PubMed2004

Imaging techniques for the assessment of myocardial hibernation. Report of a Study Group of the European Society of Cardiology.

This report of an ESC Study Group reviews current knowledge on myocardial hibernation and relevant imaging techniques, and provides an algorithm for investigation and management when a patient presents with ischaemic left ventricular dysfunction. It covers the definitions of myocardial viability, stunning and hibernation, it reviews the morphological findings in hibernation and it describes relevant clinical settings. The imaging and other techniques that are reviewed are electrocardiography, positron-emitting and single photon-emitting scintigraphic imaging, echocardiography, radionuclide angiocardiography, magnetic resonance imaging, X-ray transmission tomography, invasive X-ray angiocardiography and electromechanical mapping. The evidence for the techniques to predict improvement of regional and global function after revascularisation is summarised and patient symptoms and clinical outcome are also considered. Each technique is classified in its ability to assess myocardial viability, function and perfusion and also for their roles in the assessment of the patient with ischaemic left ventricular dysfunction who is asymptomatic or who has angina or heart failure. A simplified clinical algorithm describes the initial assessment of left ventricular function, then viability and then perfusion reserve allowing regions of myocardium to be characterised as transmural scar, intramural scar, hibernation or ischaemia.

Echocardiography↗

PubMed2005

Prediction of repeated parasuicide after 1-12 months.

UNLABELLED: To investigate predictors for repetition of suicide attempts 1-12 months after a suicide attempt. SUBJECTS AND METHODS: Two hundred and sixteen patients who had made a suicide attempt were investigated after 1 month, and 178 were followed up again after 12 months. RESULTS: During 1-12 months after the suicide attempt, 30 patients reattempted suicide (repeaters). During 0-1 month 13 patients had reattempted suicide (early repeaters), and nine of them also repeated between 1 and 12 months. Repeaters had more often made three or more attempts before index attempt, they more often were in treatment at the index attempt and at 1 month they had lower global functioning and higher suicide ideation. In a Cox Regression analysis two predictors for repetition between 1 and 12 months remained significant; early repetition (OR 6.7, 95% CI, 3.0-14.9) and having GAF-scores below 49 (median cut-off) (OR 3.4 (95% CI, 1.5-7.5). CONCLUSION: Our findings suggest that repetitive behaviour in itself is a strong predictor of future attempts. Strategies focusing on the repetitive behaviour are warranted.

Adolescent↗