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PubMedDate not supplied

[Protease-antiprotease balance in patients with invasive carcinoma of the cervix and uterus before and after radiotherapy].

Malignant cells have the ability to invade and metastasize in great part because they secrete proteolytic enzymes. In order to investigate if the abnormal proteinase/antiproteinase balance of cancer bearing patients changes when the malignant tumor is destroyed, we studied 50 patients with invasive carcinoma of the cervix and 33 healthy women as a control group. Patients with cancer were treated with radiation according to the protocols of our hospital. The following serum determinations were performed: plasminogen activators (PA), cathepsin B (CB), antiproteinase alpha-1-antitrypsin (A1AT), trypsin inhibitory capacity (TIC) and antiproteolitic activity ratio (AAR), all of them before and after treatment. Serum proteolytic activity was elevated manyfold in all patients with invasive tumor as well A1AT. The antiproteolytic activity however, was significantly reduced to about 50% of its normal value in the same group of patients. In patients with good response to radiotherapy (tumor necrosis) a great reduction of proteinase activity as well as a recovery to normal of the AAR was observed. Contrary, in those with a poor response after radiation, proteolytic activity remained elevated and AAR diminished. It is concluded that serum PA, CB, A1AT and AAR values can be precise indicators of the presence of malignancy. These tests might be also of help for improving follow-up studies and for better prognostic estimates.

Adult↗
PubMed1983

Relationships between measures of feed efficiency and transmitting ability for milk of Holstein cows.

Feed efficiency measures, gross energy (solids-corrected milk/estimated energy intake) and nitrogen (milk nitrogen/nitrogen intake) utilization, and apparent digestibilities of ration dry matter, nitrogen, acid detergent fiber, and starch were calculated for 134 samples of 75 daughters of 31 Holstein sires. Cows were in 5- to 9-day nitrogen balance trials in first and second trimesters of lactation and were fed for ad libitum consumption corn silage-based complete rations formulated to meet average nutrient requirements. The objective was to test the hypothesis that feed efficiency diminishes as milk increases from selection. The sample of cows closely approximated the distribution of genetic ability for milk of the Holstein breed. Nonsiblings of same parity (one, two, three or more), calving within 2 wk of each other and differing by at least 140 kg estimated transmitting ability, were paired in nitrogen balance trials. Evidence for diminishing returns to increased transmitting ability for milk was nil for any measure of feed efficiency. Energy efficiency showed linear increases when regressed on cow transmitting ability for fat-corrected milk, but other measures of dietary utilization were unrelated to milk yield.

Animals↗
PubMed1994

Jugular bulb oxygen saturation monitoring for evaluating cerebral ischemia.

Traumatic brain injury challenges the health care team to employ treatment modalities to prevent secondary brain damage. Initially, the focus was on controlling intracranial pressure and maintaining cerebral perfusion pressure. It is now known it is more critical to determine whether flow matches the brain's metabolic needs as indicated by the cerebral metabolic rate of oxygen. Measuring cerebral metabolic rate of oxygen, the brain's oxygen consumption, is not attained easily due to technical reasons; therefore, it is calculated from more easily attained values (cerebral blood flow x arteriovenous oxygen content difference [AVDO2]). Continuous monitoring of cerebral venous O2 saturation is accomplished via the jugular vein. In most incidences where arterial O2 saturation is stable, then AVDO2 is inversely proportional to the jugular bulb O2 saturation. Jugular bulb O2 saturation, and therefore AVDO2, can be used to evaluate cerebral O2 supply and demand balance as it correlates with cerebral blood flow, with important exceptions as discussed. The most immediate value of jugular bulb O2 saturation monitoring lies in its ability to guide the effects of therapy on O2 supply and demand balance.

Blood Gas Analysis↗
PubMed1995

Preparing for and competing in the heat: the human perspective.

This review provides an overview of the challenges that face man and horses when exercising in the heat. Some of the strategies that are used and are being developed for human athletes exercising in the heat are reviewed. There are many similarities between human and equine physiological responses to exercise in the heat; and equine exercise science may gain some useful insights from the training, fluid replacement and heat acclimatisation strategies used by human athletes. There are, however, some important differences that impact on the ability of horses to thermoregulate and to regulate fluid and electrolyte balance. The major differences are the low surface area to body mass ratio in horses compared to man; and the high metabolic capacity of equine skeletal muscle. These 2 factors may limit the ability of horses to dissipate heat when exercise is performed under hot conditions. Some of the more important equine differences are highlighted within the context of the "human perspective'.

Acclimatization↗
PubMed2004

Aging and vestibular system: specific tests and role of melatonin in cognitive involvement.

Balance disorders are frequent with aging. They are particularly important because they decrease social autonomy of the aged subjects and they often provoke falls. The cause is always multifactorial. There is evidence that aging affects multiple sensory inputs, as well as the muscoloskeletal system and central nervous system ability to perform sensorimotor integration. For the evaluation of decreased balance skills in elderly, a specific questionnaire has been prepared, in order to identify high risk of falling called falling risk inventory (FRI) questionnaire, and a complex psycho-sensory-motor test has been studied by means of posturography, in order to detect specific vestibular impairment. Regarding ethiopathogenesis of balance disorders in aged subjects, because the decline of behavioral and cognitive performances are due also to decline of biological rhythm control, the role of melatonin (the hormone regulating circadian rhythms, being strictly connected with cerebellar function, and it is well known that cerebellum acts in elderly both at motor and cognitive regulation. The goals of the present paper are: (i) To present a self-administered FRI questionnaire aimed at identifying possible causes of falls and quantifying falling risk in aged. (ii) To validate posturography as a specific test to investigate vestibular involvement in elderly in correlation with FRI. (iii) To present a complex behavioral test (NT) aimed at evaluating both spatial orientation and spatial memory in elderly, factors involved into the genesis of complex dizziness and unsteadiness. (iv) To evaluate the role of melatonin in cognitive involvement in dizzy, old subjects due to the functional correlations between circadian rhythms, cerebellum balance disturbances and cognitive disorders. General conclusions are: FRI correlates with falling risk. Posturography identifies specific vestibular impairments correlated to balance disorders and elderly falls. Spatial orientation is altered in about 40% of dizzy patients but no significant differences are revealed in melatonin rhythm. Spatial memory is highly altered only in subjects with inversion of circadian melatonin rhythm it is possible to hypothesize that the alteration of the normal circadian melatonin rhythm plays some role in the genesis of dizziness in a subpopulation of patients.

Accidental Falls↗
PubMed1989

Atrial natriuretic peptide: water and electrolyte homeostasis.

In the few years since its identification, a clear role for ANP in the regulation of water and electrolyte balance has emerged (Figure 3). The peptide is released in response to blood volume expansion, both acutely and gradually during changes in dietary sodium intake. Similarly, plasma levels are elevated in pathophysiological conditions such as cardiac and renal failure. It has become apparent that ANP has natriuretic, diuretic and vasorelaxant properties. Many of the original studies employed what we now know to be pharmacological doses of the peptide. However, recent reports have confirmed that small, sustained elevations in plasma ANP within or marginally above the 'normal' physiological range produce similar effects. A number of recent studies have tried to specifically address the physiological relevance of ANP. Although undoubtedly release by atrial distension and effective when infused to similar concentrations, atrial distension also has other effects via neural pathways. Thus, the demonstration that excretion of saline is impaired by atrial appendectomy (Benjamin et al, 1988) does not imply that this is only due to the absence of an atrial hormone. Goetz et al (1986) demonstrated that in the denervated heart, although ANP is still released, the excretion of a saline load is impaired. Similarly, in man, Richards et al (1988a) needed to infuse ANP to much higher plasma levels than those achieved by a saline load in order to reproduce the natriuresis. Although these experiments can be criticized, they confirm that ANP is not the sole mechanism for excreting a volume load, or for the natriuresis following atrial distension, but that these effects are likely to reflect the balance between ANP, AVP, the renin-angiotensin and autonomic nervous systems. In rats immunized against ANP (Greenwald et al, 1988), although the ability to excrete an acute saline load was impaired, long-term sodium balance was normal, suggesting that the rats were able to compensate for the absence of ANP. Many of the actions of ANP can be explained by antagonism of the renin-angiotensin-aldosterone system. Teleologically, it seems appropriate that a natriuretic hormone should counterbalance the major pressor and antinatriuretic hormones within the body. There is good evidence for cellular interactions between angiotensin, AVP, aldosterone and ANP at a number of discrete sites which are additional to the straightforward physiological antagonism of systems with opposing actions. ANP inhibits aldosterone secretion directly and may also reduce renal renin release. In the vascular tree there is evidence that ANP specifically blocks the vasoconstrictor actions of angiotensin II and possibly AVP.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1996

Postural control in the older adult.

Age-related changes in the neural, sensory, and musculoskeletal systems can lead to balance impairments that have a tremendous impact on the ability to move about safely. The many complex substrates of the posture control system subserve a common functional goal: regulation of the relationship between the center of mass and the base of support. Traditional approaches, which have focused on the control of the center-of-mass displacement, have documented age-related changes in "feet-in-place" responses: during quiet standing, during volitional movement, or in response to applied perturbation. Recently, increasing attention has been directed toward the control of the base of support, that is, compensatory leg and arm movement, as an important element of the postural repertoire, and early results suggest profound age-related impairment in the control of compensatory stepping movements. For both feet-in-place and stepping responses, control of lateral stability appears to be a major problem associated with increased risk of falling. In view of age-related differences in ability to adapt postural responses under predictable task conditions, future work will likely benefit by mimicking, as much as possible, the varied and unpredictable nature of the events that often precipitate falls in daily life, in order to draw connections between the laboratory or clinic and "real-life" stability.

Accidental Falls↗
PubMed1998

A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke.

BACKGROUND AND PURPOSE: Many stroke survivors have minimal to moderate neurological deficits but are physically deconditioned and have a high prevalence of cardiovascular problems; all of these are potentially modifiable with exercise. The purposes of this randomized, controlled pilot study were (1) to develop a home-based balance, strength, and endurance program; (2) to evaluate the ability to recruit and retain stroke subjects; and (3) to assess the effects of the interventions used. METHODS: Twenty minimally and moderately impaired stroke patients who had completed inpatient rehabilitation and who were 30 to 90 days after stroke onset were randomized to a control group or to an experimental group that received a therapist-supervised, 8-week, 3-times-per-week, home-based exercise program. The control group received usual care as prescribed by the patients' physicians. Baseline and postintervention assessments included the Fugl-Meyer Motor Assessment, the Barthel Index of Activities of Daily Living (ADL), the Lawton Scale of Instrumental ADL, and the Medical Outcomes Study-36 Health Status Measurement. Functional assessments of balance and gait included a 10-m walk, 6-Minute Walk, and the Berg Balance Scale. Upper extremity function was evaluated by the Jebsen Test of Hand Function. RESULTS: Of 22 patients who met study criteria, 20 completed the study and 2 refused to participate. The experimental group tended to improve more than the control group in motor function (Fugl-Meyer Upper Extremity: mean change in score, 8. 4 versus 2.2; Fugl-Meyer Lower Extremity: 4.7 versus -0.9; gait velocity: median change, 0.25 versus .09 m/s; 6-Minute Walk: 195 versus 114 ft; Berg Balance Score: 7.8 versus 5; and Medical Outcomes Study-36 Health Status Measurement of Physical Function: 15. 5 versus 9). There were no trends in differences in change scores by the Jebsen Test of Hand Function, Barthel Index, and Lawton Instrumental ADL Scale. CONCLUSIONS: This study demonstrated that a randomized, controlled clinical trial of a poststroke exercise program is feasible. Measures of neurological impairments and lower extremity function showed the most benefit. Effects of the intervention on upper extremity dexterity and functional health status were equivocal. The lasting effects of the intervention were not assessed.

Activities of Daily Living↗
PubMed1985

Cost-effective selection of fire fighter recruits.

To discriminate suitable fire fighters from recurring large groups of applicants, an objective test battery was developed which screened applicants on the basis of physical, psychomotor, and mental abilities. The physical and psychomotor selection procedures first involved fundamental tests of general aerobic endurance, upper body strength, and anaerobic endurance. Successful candidates progressed to more specific tests. Measurements were made of height, weight, hamstring flexibility, balance, strength, upper body flexibility, hand-eye coordination, and the ability to negotiate a fire fighting simulation course. Results of these tests were weighted, allocating 25% to physical tests, 20% to psychomotor tests, and 39% to the simulation course. These scores were then combined with scores of several knowledge tests weighted to be 16% of the whole. This provided a computer-generated ability profile of the top applicants which was considered at their interview before a final selection board of fire service officers. Selected candidates were then required to pass a medical examination. Pearson correlation coefficient analysis of 1984 test results demonstrated general independence of the tests (R = -0.34 to R = 0.52), with the exception of bilateral grip strength (R = 0.77). The first four trials of the selection procedure screened 3,172 applicants, 16.4% of whom were finally selected for interview. City officials estimated that based on a comparison of new and previously used selection procedures, cost savings of +92,500 were being achieved by 1984.

British Columbia↗
PubMed1997

Arthrogryposis multiplex congenita: perinatal and electromyographic findings, disability, and psychosocial outcome.

Fifty-two patients with arthrogryposis multiplex congenita were followed up for 1 to 36 years. There were six twin pregnancies, and delivery was complicated by breech position in 16 cases. In 19 cases the cause was atrophy of the alpha motoneurons of the spinal cord, detected by electromyography. Six patients did not achieve walking ability. Severe disability for other reasons was noted in two patients who had bilateral rigid extension contractures of the elbows and in six patients whose spinal deformities interfered with the balance of the trunk. Treatment of flexion contractures of the hips and knees seemed to be important in case it promotes the walking ability. Spinal deformities interfering with the balance of the trunk should be treated operatively. Restoration of elbow flexion was the main goal in operative treatment of the upper extremities. The intelligence of the patients was slightly above normal. The psychological analysis revealed significant diverging features compared with average population in testing situation. Socially the patients seemed to cope well.

Adolescent↗
PubMed1991

Stance duration under sensory conflict conditions in patients with hemiplegia.

Standing balance was evaluated in ten subjects with hemiplegia using a sensory organization balance test (SOT). The SOT is a timed balance test which evaluates somatosensory, visual, and vestibular function for maintenance of upright posture. The duration of bilateral stance was assessed using combinations of three visual and two support surface conditions. Stance time was measured with eyes open, eyes closed, and with each patient wearing a visual dome to produce inaccurate visual information. The support surface conditions involved stance on a hard flat floor followed by attempted stance on a compliant foam surface. Visual deprivation or visual conflict conditions did not cause a loss of balance when stance was performed on a stable surface. However, a lower stance duration was found when patients stood on a compliant surface (p less than .05). Visual compensation was evident during the compliant-surface condition because stance duration showed the greatest reductions with eyes closed and with the visual dome. These findings suggest that the ability to integrate somatosensory information from the lower extremities for balance is compromised after cerebrovascular disease. The implications for diagnosing the specific cause of balance dysfunction and for developing sensory-specific therapeutic interventions are discussed.

Adult↗
PubMed1982

European Association of Neurosurgical Societies. Third European Lecture. Naples, 23 April, 1982. Some aspects of personality of the neurosurgeon.

Possibility of personality shaping: Hippokrates said: "Balance is essential to health, and imbalance creates, or is, disease." Psychological balance is essential for developing our personality and professional ability. However, growth is also dependent on a sound community spirit in the profession. Hindu psychology lists joy, success, duty and understanding as personality-shaping forces which significantly-and positively-affect our actions from childhood until old age. Of these, success and duty are the most relevant during a neurosurgeon's creative period. The majority of our operations are not routine surgery: they aim to preserve and protect vital functions. But, for the same reason, vital functions may be put in jeopardy by an operation. The question is what sort of character it takes to live up to the challenge. Self-knowledge is for this a most important trait. We must know the present limitations of operating technology and be aware of the weak points of our own personality. Self-knowledge is the clue for self-improvement. In possession of self-knowledge there are relatively simple methods to enhance concentration, to develop our will, set our emotional balance, and to temper our emotional responses by self-control. One must strive for a rich, a full personality to achieve professional excellence. Work that is of a really high standard takes more than professional skill and knowledge. It is not sufficient to have great knowledge in your own field and to totter as if blindfolded as soon as you have left its narrow confines. Appreciation of literature, art, and music, interest in other sciences than our professional knowledge enrich the personality. The EANS Administrative Council have asked me to speak about general problems of concern to our profession rather than any single concrete professional question. My choice fell on personality because I regard it as an immensely exciting problem and one to which regrettably little attention has been given and is therefore-the reports of cosmonauts notwithstanding-still very much like the Moon: one half is obscured. (The simile was borrowed from Mark Twain).

Attitude of Health Personnel↗
PubMedDate not supplied

Evaluating progress toward closed forest models based on fluxes of carbon, water and nutrients.

Closed system models are defined as mathematical models of systems having specified boundaries within which all flows into and out of the system are accounted for. Closure is obtained experimentally when we can measure all the flows and do not depend on residuals. The meeting on which this volume is based discussed a range of models and approaches to modeling, and the possibility of achieving closure. There was general agreement that we can develop closed system models of the water balance, carbon cycle and nutrient fluxes at the stand level. Confidence in our ability to account for all the flows is greatest for water, decreasing progressively for carbon and nutrients. The priority areas for research on the carbon balance are belowground processes, foliage dynamics and respiration. The problems requiring particular attention in relation to the water balance are the measurement of interception losses, lateral flow in the soil and evaporation from snow. Areas warranting particular research attention in relation to nutrient fluxes through forest stands are the rates, and the controls on rates, of nutrient uptake by trees, and rates of mineralization with emphasis on the importance of microbial processes at the ecosystem level. Most models are written for uniform conditions. Forests are not uniform so the problem of heterogeneity, and how to deal with it in models, requires considerable attention, as does the question of how to scale up, to deal with large areas. There are a great many forest models of all types and the continual development of new ones may not be an effective use of research resources. There is a need for some assessment of the range of models currently existing, or under development, and for moves toward a directed strategy of model structure and development.

Journal Article↗
PubMed1996

Standing balance during internally produced perturbations in subjects with hemiplegia: validation of the balance scale.

OBJECTIVE: To examine the concurrent validity of the Berg Balance Scale (BBS) in subjects with hemiparesis after stroke by correlating functional balance performance on the BBS with laboratory measures of balance (center of pressure [CP] and electromyographic [EMG] activity of leg musculature during rapid arm flexion and during quiet stance). DESIGN: Concurrent validation study. Consistency of performance was determined through repeat measures obtained from 13 subjects. SETTING: Laboratory. PATIENTS: Twenty-four volunteers with longstanding hemiparesis from cerebrovascular accident (CVA) were tested. MAIN OUTCOME MEASURES: BBS scores were compared with CP excursion speed during (1) self-initiated rapid unilateral arm flexion with the nonhemiplegic arm and (2) quiet stance. The peak tangential arm acceleration and the sequence of EMG events in the posterior leg muscles were monitored during the arm flexion movement. RESULTS: In the arm flexion condition, BBS performance was significantly correlated with arm acceleration and CP excursion speed (multiple regression R = .81). BBS performance was also related to the presence of anticipatory activation of ipsilateral hamstrings during the rapid arm flexion movement. BBS performance and CP excursion speed during quiet stance were also significantly related (r = .76). The initial and repeat measures were not significantly different in magnitude (paired tests of difference, p < .01). CONCLUSION: The BBS appears to reflect differing abilities to tolerate the internally produced perturbation to standing balance associated with forward arm flexion in individuals with hemiparesis from CVA.

Aged↗
PubMed2001

Task-specific resistance training to improve the ability of activities of daily living-impaired older adults to rise from a bed and from a chair.

OBJECTIVES: To determine the effect of a 12-week intervention to improve the ability of disabled older adults to rise from a bed and from a chair. DESIGN: Subjects were randomly allocated to either a 12-week task-specific resistance-training intervention (training in bed- and chair-rise subtasks, such as sliding forward to the edge of a chair with the addition of weights) or a control flexibility intervention. SETTING: Seven congregate housing facilities. PARTICIPANTS: Congregate housing residents age 65 and older (n = 161, mean age 82) who reported requiring assistance (such as from a person, equipment, or device) in performing at least one of the following mobility-related activities of daily living: transferring, walking, bathing, and toileting. MEASUREMENTS: At baseline, 6 weeks, and 12 weeks, subjects performed a series of bed- and chair-rise tasks where the rise task demand varied according to height of the head of the bed, chair seat height, and use of hands. Outcomes were able or unable to rise and, if able, the time taken to rise. Logistic regression for repeated measures was used to test for differences between tasks in the ability to rise. Following log transformation of rise time, a linear effects model was used to compare rise time between tasks. RESULTS: Regarding the maximum total number of bed- and chair-rise tasks that could be successfully completed, a significant training effect was seen at 12 weeks (P = .03); the training effect decreased as the total number of tasks increased. No statistically significant training effects were noted for rise ability according to individual tasks. Bed- and chair-rise time showed a significant training effect for each rise task, with analytic models suggesting a range of approximately 11% to 20% rise-time (up to 1.5 seconds) improvement in the training group over controls. Training effects were also noted in musculoskeletal capacities, particularly in trunk range of motion, strength, and balance. CONCLUSIONS: Task-specific resistance training increased the overall ability and decreased the rise time required to perform a series of bed- and chair-rise tasks. The actual rise-time improvement was clinically small but may be useful over the long term. Future studies might consider adapting this exercise program and the focus on trunk function to a frailer cohort, such as in rehabilitation settings. In these settings, the less challenging rise tasks (such as rising from an elevated chair) and the ability to perform intermediate tasks (such as hip bridging) may become important intermediate rehabilitation goals.

Activities of Daily Living↗
PubMed2005

Balance between pro and anti-inflammatory cytokines in patients with acute alcoholic hepatitis.

UNLABELLED: The ability of endogenous IL-10 to modulate inflammatory response and to limit hepatotoxicity has been shown in several models of liver injury. AIMS: The objectives of this study were to evaluate the relationship between liver disease and the balance between pro and anti-inflammatory cytokines in acute alcoholic hepatitis. METHODS: Twenty-five patients with pure steatosis, 17 with cirrhosis and mild acute alcoholic hepatitis (discriminant function value<32) and 41 patients with cirrhosis and severe acute alcoholic hepatitis (discriminant function value >=32) were studied. Plasma levels of interleukin 10 (IL-10) and soluble TNF receptors (TNFsRp75 and 55) were analyzed using ELISA assays. Hepatocyte proliferative activity was assessed with proliferating cell nuclear antigen labeling index (PCNA-LI) on formalin-fixed paraffin embedded liver biopsy specimens. RESULTS: In patients with steatosis, cirrhosis with mild and severe acute alcoholic hepatitis, the plasma levels of IL-10 were higher (P<0.05) than in healthy controls. Between day 1 and day 8, the TNFsRp55/IL-10 ratio increased by 137 +/- 47 in the 10 patients with severe acute alcoholic hepatitis treated with prednisolone who died within 2 months and by 9.3 +/- 14 in the 19 patients still alive at 2 months (P=0.031). In patients with severe acute alcoholic hepatitis, PCNA-LI on liver biopsy was negatively correlated with the TNFsRp55/IL-10 ratio increase from day 1 to day 8 (r=- 0.42, P=0.11). PCNA-LI was positively correlated with TNFsRp75/TNFsRp 55 ratio increase from day 1 to day 15 (r=0.52; p<0.05). CONCLUSION: Our data suggest the anti-inflammatory system is up-regulated in patients with alcoholic liver disease. Nevertheless, in patients with severe acute alcoholic hepatitis, IL-10 production seems insufficient to modulate TNF-alpha cytotoxicity mediated by TNFRp55.

Acute Disease↗
PubMed1998

The reliability of the star-excursion test in assessing dynamic balance.

Quantification of dynamic balance is often necessary to assess a patient's level of injury or ability to function in order to initiate an appropriate plan of care. Some therapists use the star-excursion test in an attempt to quantify dynamic balance. This test requires the patient to balance on one leg while reaching with the other leg. For the purpose of this study, the reach was performed in four directions. No previous researchers have attempted to evaluate the reliability of this test. Twenty healthy subjects between the ages of 18 and 35 years participated in this study. During two testing sessions, each subject was required to perform five reaching trials in four directions. Reliability estimates, calculated using the intraclass correlation coefficient (2, 1), ranged from 0.67 to 0.87. Six duplicate practice sessions were suggested to increase this range above 0.86. Task complexity may account for the moderate reliability estimates. Subjects should engage in a learning period before being evaluated on the star-excursion test.

Adolescent↗