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PubMed2001

The efficacy of a universal school-based program to prevent adolescent depression.

Evaluated whether a universal school-based program, designed to prevent depression in adolescents, could be effectively implemented within the constraints of the school environment. Participants were 260 Year 9 secondary school students. Students completed measures of depressive symptoms and hopelessness and were then assigned to 1 of 3 groups: (a) Resourceful Adolescent Program-Adolescents (RAP-A), an 11-session school-based resilience building program, as part of the school curriculum; (b) Resourceful Adolescent Program-Family (RAP-F), the same program as in RAP-A, but in which each student's parents were also invited to participate in a 3-session parent program; and (c) Adolescent Watch, a comparison group in which adolescents simply completed the measures. The program was implemented with a high recruitment (88%), low attrition rate (5.8%), and satisfactory adherence to program protocol. Adolescents in either of the RAP programs reported significantly lower levels of depressive symptomatology and hopelessness at post-intervention and 10-month follow-up, compared with those in the comparison group. Adolescents also reported high satisfaction with the program. The study provides evidence for the efficacy of a school-based universal program designed to prevent depression in adolescence.

Adolescent↗

PubMed1992

Effect of L-NG-nitro-arginine, inhibitor of nitric oxide synthesis, on autoregulation of renal blood flow in dogs.

The present experiments were designed to evaluate the importance of nitric oxide in the regulation of renal hemodynamics and the autoregulation of renal blood flow (RBF) in anesthetized dogs. RBF was measured by an electromagnetic flowmeter, and renal arterial pressure (RAP) was varied by an adjustable aortic clamp. The RAP-RBF relations were examined during the intrarenal infusion of saline or agents. The intrarenal infusion of L-NG-nitro-arginine (L-NNA, 40 micrograms/kg.min) at normal RAP decreased RBF and urine flow (UF), while the infusion of L-arginine.HCI (1 mg/kg.min) increased RBF and UF. Both agents did not affect the glomerular filtration rate and mean arterial pressure. The autoregulation of RBF was impaired during the L-NNA infusion. The L-arginine infusion did not affect autoregulatory efficiency. When L-NNA (40 micrograms/kg.min) and L-arginine were infused simultaneously into the renal artery, the autoregulation of RBF was maintained. However, a higher dose of L-NNA (200 micrograms/kg.min) impaired the autoregulation of RBF. These results suggest that the basal production and/or the release of nitric oxide contributes to the regulation of renal hemodynamics and urine formation. During the reduction of RAP, nitric oxide may play an important role in the autoregulation of RBF.

Animals↗

PubMed2000

Hyperuricemia in severe pulmonary hypertension.

STUDY OBJECTIVE: Hyperuricemia occurs frequently in patients with myeloproliferative and lymphoproliferative disorders and in patients with congenital heart disease associated with polycythemia. Whether hyperuricemia is common in patients with severe pulmonary hypertension is not known. DESIGN, PATIENTS, MEASUREMENTS: In the Pulmonary Hypertension Center at the University of Colorado Health Sciences Center between September 1991 and August 1997, 442 consecutive patients were evaluated with right heart catheterization; 191 patients also had a measurement of the serum uric acid (UA) in close temporal proximity to the hemodynamic evaluation. RESULTS: Of the 191 patients with a complete data set, 99 patients had primary pulmonary hypertension (PPH) and 92 had secondary pulmonary hypertension. For the entire cohort with severe pulmonary hypertension (n = 191), there was a positive correlation between the natural logarithm of the serum UA (lnUA) and the mean right atrial pressure (RAP; r = 0.47; p < 0.001). When analyzed separately, the correlation between lnUA and RAP was stronger in the patients with PPH (r = 0.642; p < 0.001). This correlation cannot be explained by diuretic use or impaired hepatocellular function. Neither mean pulmonary artery pressure nor cardiac output was as well correlated with the RAP when compared with the lnUA. Some patients with PPH had serum UA measurements repeated during treatment with chronic IV prostacyclin infusion. Eleven of these 18 patients (61%) demonstrated a decrease in serum UA during prostacyclin treatment. CONCLUSION: There is a positive correlation between the RAP elevation and the serum UA levels in patients with PPH. Serum UA levels drop in some, but not all PPH patients during chronic prostacyclin infusion therapy.

Adult↗

PubMedDate not supplied

A minimal binding domain of the low density lipoprotein receptor family.

As more relatives of the low density lipoprotein receptor (LDLR) are discovered, defining their minimal binding domain(s) becomes a challenge. Here we have chosen the multifunctional chicken oocyte receptor for yolk deposition (termed LR8), and the pan-receptor ligand, receptor associated protein (RAP), as model systems to characterize a minireceptor using the phage display approach. Displayed fragments derived from the entire 819 residue LR8 molecule, followed by selection via panning on RAP, led to the definition of an 80 residue stretch LR8 minireceptor. It contains 12 cysteines, and represents parts of the second, the entire third, and parts of the fourth, of the eight clustered 'ligand binding repeats' in LR8; only two of the eight stretches of negatively charged residues of LR8, i.e., EDGSDE and DSGEDEE, are present. The latter sequence is reminiscent of that in the fifth repeat of the human LDLR, thought to be most critical for interaction with positive charge clusters in ligands. Baculovirus-mediated expression of the soluble minireceptor in insect cells showed it to fold as a monomer, and sulfhydryl-reduction-sensitive interaction with RAP was demonstrated for immobilized as well as soluble minireceptor. Furthermore, the LR8-derived minireceptor provided a RAP-responsive surface when covalently coupled to the surface of a gold electrode. In addition to its use in defining minimal binding domains, the phage display approach provides powerful tools for dissection, and consequently, manipulation, of the function of receptors so as to direct their binding activity toward ligands of diagnostic and/or therapeutic interest.

Amino Acid Sequence↗

PubMed2006

Diurnal salivary cortisol concentration in school-aged children: increased morning cortisol concentration and total cortisol concentration negatively correlated to body mass index in children with recurrent abdominal pain of psychosomatic origin.

INTRODUCTION: The sampling method for salivary cortisol is sensitive, specific and pain-free. Our knowledge about cortisol concentration in saliva and plasma in school-aged children is sparse and contradictory. AIM: To estimate diurnal variation in salivary cortisol concentration in children with and without psychosomatic recurrent abdominal pain (RAP), and to compare groups and relate the concentrations to age, sex, puberty, body mass index (BMI), allergy, headache and ethnicity. CHILDREN AND METHOD: Saliva was collected in 'Salivette' tubes from 159 healthy girls and 147 healthy boys, aged 5-15 years, and from 25 girls and 6 boys, aged 6-18 years, with RAP of psychosomatic origin, at 08.00 h, 13.00 h and 20.00 h. Saliva was analysed using a commercial RIA-cortisol kit. RESULTS: The median concentrations in healthy girls and boys were 8.8/8.3 nmol/l at 08.00 h, 5.5/5.3 nmol/l at 13.00 h, and 2.1/2.3 nmol/l at 20.00 h, respectively. Cortisol concentrations differed between 6-7 year-old and 9 year-old children (higher in the former). Age-matched post-menarcheal girls had higher cortisol concentrations in the evening, 2.2 vs 1.7 nmol/l (p = 0.03). The results were independent of BMI, headache and allergy. In the RAP group, diurnal cortisol concentrations in girls/boys at the different time-points were 14.8/12.9, 5.2/5.8, and 2.4/2.7 nmol/l, respectively, and were negatively correlated to BMI. Total secretion of cortisol was higher than in healthy children. Cortisol concentration was independent of allergy, headache and ethnicity, CONCLUSION: In healthy children, salivary cortisol concentration was dependent on time, age and menarche. In children with RAP of psychosomatic origin, morning and total secretion of cortisol were significantly higher than in healthy children and negatively correlated to BMI.

Abdominal Pain↗

PubMed2000

A brief screening instrument for problem drinking in the emergency room: the RAPS4. Rapid Alcohol Problems Screen.

OBJECTIVE: While a number of brief screening instruments for identifying problem drinkers have been tested in clinical settings, instruments have not been found to perform as well for women as for men, or to perform uniformly across ethnic groups. The purpose of this study was to evaluate a shortened version of the RAPS (Rapid Alcohol Problems Screen) in an emergency room (ER) sample (N = 1,429; 51% female) and to determine the most efficient ordering of the items. METHOD: The sensitivity and specificity of each of the RAPS items were examined against current ICD-10 and DSM-IV criteria for alcohol dependence, and separately for harmful drinking or abuse. A four-item version of the RAPS (the RAPS4) was analyzed separately for men and for women, and for blacks, Hispanics and whites/others. RESULTS: Among the five original RAPS items, four items were found to be most efficient, with the single item of feeling guilt or remorse after drinking identifying 83% of those with alcohol dependence and 44% of those meeting criteria for harmful drinking or abuse. A positive response to any one of the four items (RAPS4) gave a sensitivity of 93% and specificity of 87% for alcohol dependence, and sensitivity and specificity were consistently high across gender and ethnic subgroups. Sensitivity and specificity for harmful drinking or abuse were lower (55% and 79%, respectively). CONCLUSIONS: Because of its brevity and high performance across demographic subgroups, the RAPS4 may hold promise in screening for alcohol use disorders in patient populations, and its utility warrants further evaluation in clinical settings.

Adolescent↗

PubMed1989

Atrial natriuretic peptide-induced stimulation of cyclic GMP formation by isolated bovine luteal cells.

Incubation of bovine luteal cells with an atrial natriuretic peptide (rat atriopeptin II, rAP-II) did not affect hCG-stimulated or basal cyclic AMP accumulation and progesterone production, but cyclic GMP formation was stimulated by rAP-II in a dose-dependent manner, being maximally stimulatory in the nanomolar range. This stimulatory influence of rAP-II on cyclic GMP formation results from a specific stimulation of particulate guanylate cyclase. We suggest that, although rAP-II mediated cyclic GMP formation can be demonstrated in bovine luteal cells, there appear to be no acute effects of the atrial peptide on the regulation of progesterone production by these cells.

Animals↗

PubMed1981

Effects of perhexiline on hemodynamics in anesthetized open-chest dogs.

Cardiohemodynamic effects of perhexiline were investigated in anesthetized open-chest dogs, measuring blood flow rates of the pulmonary artery (PAF), superior and inferior venae cavae (SVCF and IVCF), right atrial pressure (RAP), systemic blood pressure (SBP), and heart rate (HR). Sum of SVCF and IVCF was interpreted as venous return (VR). Perhexiline, 0.3-3 mg/Kg, injected intravenously over 2 min caused dose-dependent increases in PAF, VR, and RAP, followed by decreases in PAF and VR at higher doses. SBP and HR were depressed with perhexiline dose-dependently. Verapamil, 0.03-0.3 mg/Kg, also increased PAF, VR, and RAP to the lesser extent than perhexiline. Verapamil decreased these variables except RAP more markedly than perhexiline. Treatment with propranolol (1 mg/Kg) and phentolamine (1 mg/Kg) which completely blocked cardiohemodynamic effect of 1 microgram/Kg of norepinephrine, markedly attenuated the effects of perhexiline on VR and PAF but not completely. It is concluded that the effect of perhexiline to increase VR and PAF is in most part mediated through the cardiovascular reflex control for blood pressure reduction by the drug, though a direct effect on capacitance vessels may be included.

Anesthesia↗

PubMed2003

Importance of parental conceptual model of illness in severe recurrent abdominal pain.

OBJECTIVES: Recurrent abdominal pain (RAP) affects up to 15% of children. A biopsychosocial approach to the treatment of children with RAP has been proposed as an alternative to the traditional medical model. The aim of this study was to examine whether the parental conceptual model of illness is a factor in the long-term outcome of children with severe RAP. METHODS: The study was undertaken in 2 parts: 1) a review of the medical and psychiatric records (including Child Behavior Checklist [CBCL]) of all children with RAP of sufficient severity to necessitate hospitalization during a 5-year period and 2) a structured telephone interview to collect information on ongoing abdominal pain, other somatic symptoms, school attendance, and the parents' opinion as to the cause of the child's pain. RESULTS: Twenty-eight of 30 children who were identified were available for follow-up. Twenty-three (82%) were tertiary referrals from other pediatric services, and 20 had pain for >6 months. On admission 7 (25%) of 28 had a depressive disorder, and 8 (29%) had an anxiety/depressive disorder. Twenty-one of 28 parents completed the CBCL, and on analysis of the CBCL, 11 (52%) children had scores in the clinical range (>65). At follow-up (mean: 3.56 years; standard deviation: 1.59), 14 (50%) of 28 continued to complain of pain. These children also complained of multiple other somatic complaints and had repeated school absences. Only 1 (7%) of 14 parents of children with ongoing pain believed that there was a psychological cause for their child's pain, whereas 11 (78%) of 14 parents of the children who had recovered believed that the cause was attributable to psychological factors (odds ratio: 47.67; 95% confidence interval: 3.56-1511.6). CONCLUSIONS: The acceptance by parents of a biopsychosocial model of illness is important for the resolution of recurrent abdominal pain in children.

Abdominal Pain↗

PubMed2006

[Results of treatment of retinal angiomatous proliferation with photodynamic therapy].

PURPOSE: To determine the effects of phothodynamic therapy using verteporfin in the treatment of patients with retinal angiomatous proliferation (RAP) and the incidence of this retinal disease in our area. METHODS: We performed a retrospective study of 11 cases of RAP who were treated with photodynamic therapy using verteporfin (PDT). RESULTS: The incidence of RAP in the group of eyes with minimally classic or occult subfoveal choroidal neovascularization was 8%. The mean follow-up time after treatment was 15 months. The visual acuity improved in 3, remained the same in 4, and decreased in 4. In 4 patients, angiomatous lesions were observed in both eyes. CONCLUSIONS: There is no method proven to be effective for the treatment of retinal angiomatous proliferation. Our results suggest that PDT may be useful therapy in patients with RAP as it appeared to reduce the risk of visual loss.

Aged, 80 and over↗

PubMed1987

Developing a Role Activity Performance Scale.

This article describes the Role Activity Performance Scale (RAPS) and presents data from a study of its reliability and validity. The RAPS evaluates an individual's functional level, using 12 subscales that represent a range of life roles. It was developed as an instrument for evaluating the impact of occupational therapy and other treatment modalities on the functioning of psychiatric patients. It is also useful in the diagnostic, treatment, and discharge planning processes. Validity and interrater reliability testing involved a sample of 30 patients in two major diagnostic groups. Interrater correlations for subscales and total scores were above .80 and statistically significant. A comparison of the RAPS with other accepted psychosocial rating scales showed strong correlations in scores. The psychometric evidence from this preliminary study supports the continued development and use of the RAPS for both clinical and research purposes.

Adult↗

PubMed1993

Antilymphocytic activity of erythromycin distinct from that of FK506 or cyclosporin A.

Erythromycin (EM), a macrolide antibiotic has been recently reported to depress the extent of inflammation irrespective of its antimicrobial action. Our study was initiated to examine the effect of EM on T cell proliferation in vitro, since other macrolide antibiotics FK506 and rapamycin (RAP) have been well known to possess strong immunosuppressive or anti-inflammatory potential. EM had a suppressive effect on the proliferative response of human lymphocytes stimulated with mitogens and antigens, while EM had no effect on concanavalin A (Con A)-induced interleukin-2 (IL-2) production or IL-2R alpha (CD25) expression. Delayed addition of EM after the first 48 hours of mitogenic stimulation did suppress IL-2-dependent proliferation of Con A blasts, whereas pretreatment with EM for the first 48 hours of stimulation did not impede the subsequent IL-2-dependent proliferation of obtained blast cells. The results indicate that EM suppresses T cell proliferation at a late stage in the activation process by impairing their response to IL-2. This antilymphocytic action of EM was quite distinct from that of FK506 or cyclosporin A (CsA) but was similar to that of RAP. Unlike RAP, however, EM did not antagonize FK506-induced suppression but potentiated the action of FK506 and CsA. The addition of an enteric hormone motilin, a receptor of which was previously found to be occupied by EM, unaffected the lymphocyte proliferation and the subsequent EM-induced suppression. These data suggest that EM operates through an undefined mechanism probably distinct from that of FK506, CsA, RAP or motilin.

Antigens↗

PubMed2000

Involvement of low-density lipoprotein receptor-related protein (LRP) in the clearance of factor VIII in von Willebrand factor-deficient mice.

Factor VIII is tightly noncovalently linked to von Willebrand factor (vWF) in plasma with a stoichiometry of 1:50, and vWF deficiency results in secondary factor VIII deficiency, with accelerated clearance of factor VIII from the circulation. We used a murine model of severe von Willebrand disease (vWF knockout mice) to study the effect of a recombinant vWF/pro-vWF preparation (rpvWF) on factor VIII survival and to investigate whether low-density lipoprotein receptor-related protein (LRP) might be involved in the in vivo clearance of factor VIII in the absence of vWF. vWF-deficient mice received 70 U/kg rpvWF in the first series of experiments, and in a second series, 80 mg/kg receptor-associated protein (RAP) as a recombinant fusion protein to block the action of LRP. Factor VIII levels were measured at time 0, or 1 or 3 hours after administration of rpvWF or RAP. RAP induced a sustained rise in factor VIII levels comparable to that induced by rpvWF. In a third series, the preadministration of RAP resulted in a slower disappearance of factor VIII antigen (measured by an enzyme-linked immunosorbent assay specific for human factor VIII) after infusion of recombinant factor VIII. These findings suggest that the accelerated clearance of factor VIII seen in the absence of vWF may be a result of the involvement of LRP in factor VIII metabolism. (Blood. 2000;95:1703-1708)

Animals↗

PubMed2000

[Recurrent abdominal pain in children as a cause of hospitalization].

Recurrent abdominal pain (RAP) is a common disease that occurs in childhood and it seems to be a difficult clinical problem. In presented research the analysis of recurrent abdominal pain causes were considered. There were 175 hospitalized children in age of 4-16 that suffered from RAP. Reassuming the observation--it was confirmed that the most common causes of the RAP were both alimentary and urinary system diseases. Recurrent abdominal pain occurs mainly in a group of over 11 years old, mainly female children. There were 11% of cases which the causes of the RAP were unknown.

Abdominal Pain↗

PubMed2001

Recurrent abdominal pain, food allergy and endoscopy.

Gastrointestinal food allergy, a well-recognized clinical entity, has a wide spectrum of clinical features, including cutaneous, respiratory and gastrointestinal symptoms and objective abnormalities. The gastrointestinal alterations in food allergy have been described throughout the gastrointestinal tract. Recurrent abdominal pain (RAP) is a common complaint in school-age children. The findings among children with RAP of an underlying food allergy associated with mucosal pathology of the foregut may support a causal relationship between food allergy and RAP. Further studies are needed to elucidate whether well-documented food allergy (based on double-blind placebo-controlled food challenges) is a major cause of RAP.

Abdominal Pain↗

PubMedDate not supplied

Self-report assessment of recurrent abdominal pain.

UNLABELLED: Pain is the principal, and often the only symptom in cases of recurrent abdominal pain (RAP). The purpose of this study was to analyze the clinical background behind the pain symptom and the pain's capacity for differentiation in the diagnostic assessment of a group of 86 children suffering from RAP and observed at a pediatric gastroenterology service. The self-rating methods applied to the children included a verbal scale and a Visual Analogue Scale (VAS) for scoring the pain, and the Eland method, which is based on a graphic representation of the pain to enable its quantification and localization. Regardless of the pain assessment emerging from this study, the children were divided into 3 groups on the basis of a standardized diagnostic procedure, i.e. G1--upper gastrointestinal tract disease; G2--RAP with no apparent organic cause; G3--intestinal disease. RESULTS: The intensity of the pain fails to distinguish between the three groups, while other features seem more useful, e.g. variability in the pain's intensity, the number and location of painful sites, and the how the pain is graphically represented. Drawings typical of RAP with no apparent organic cause characteristically represent the pain more accurately and in greater detail, using more colors and a certain refinement in the performance of the drawing, with varying types of pain in subsequent episodes, and involving several abdominal and even extra-abdominal sites. In our experience, this method might contribute towards the completion and standardization of the child's clinical history and clinical evaluation. Such methods would have to be validated by further clinical studies, however.

Abdominal Pain↗

PubMed2001

Recurrent abdominal pain. A world-wide problem of organic, functional and psychosomatic aetiology.

This spring, Acta Paediatrica is publishing five original articles underlining the importance of recurrent abdominal pain (RAP) and illustrating the scientific and diagnostic difficulties involved in understanding it. Our knowledge of organic causes is increasing with improved instruments for investigation, including 24-h pH monitoring and endoscopy, but the difficulty in how to link findings of organic abnormalities conclusively to the symptom RAP has to be further elaborated and discussed. There is an old belief that many cases of RAP have a psychogenic aetiology. Psychometric tests in past decades, however, have not supported this belief, but if the reaction primarily is one of negative stress, than we should be looking for negative stress reactions, not for psychopathology. RAP of psychosomatic origin is not just a matter of excluding organic disease, but a diagnosis that must be built on firm positive diagnostic criteria, criteria that have not yet been elaborated for a broader public.

Abdominal Pain↗

PubMed2001

Recurrent abdominal and flank pain in children with idiopathic hypercalciuria.

OBJECTIVE: To evaluate the role of idiopathic hypercalciuria (IH) as a cause of recurrent abdominal pain (RAP) in children. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 124 children referred for various complaints who had 24-h urine calcium excretion greater than 2 mg/kg/d or random urine calcium-creatinine ratio greater than 0.18 mg/mg. RESULTS: Fifty-two children with various clinical complaints had RAP or flank pain. These comprised of 22 males and 30 females, 9 mo to 15.9 y of age, mean 6.7 +/- 3.5 y. A family history of urolithiasis was present in 50% of all the children. Only 6 of the 52 children with abdominal pain had renal stones. In addition to abdominal pain, 27 children had hematuria and 10 had urinary incontinence. Mild metabolic acidosis was present in three children, parathyroid hormone activity elevated in two and serum vitamin D activity was increased in nine. All children were treated with increased fluid intake and a reduction in dietary sodium and oxalate and some required treatment with thiazide and antispasmodics. Forty-five cases responded to treatment, 5 failed to improve from therapy, and 2, which were not followed up as patients, were not available. CONCLUSION: We describe 52 children with RAP or back pain due to IH and recommend that IH be considered in the differential diagnosis of RAP in childhood.

Abdominal Pain↗