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PubMed2006

Erectile function, sexual drive, and ejaculatory function after reconstructive surgery for anterior urethral stricture disease.

OBJECTIVE: To evaluate the effect of urethral reconstructive surgery on sexual drive, erectile function and ejaculation. PATIENTS AND METHODS: The study group consisted of 52 men with a median (range) age of 44 (18-79) years who underwent 59 urethral reconstructive procedures for anterior urethral stricture disease between 2001 and 2004. We evaluated sexual functioning using the O'Leary Brief Male Sexual Function Inventory (BMSFI) before and after surgery. RESULTS: The mean (sd) follow-up was 22.3 (14.8) months. The mean BMSFI scores were only statistically significantly different for an improvement in ejaculation after surgery (P = 0.04). When separated by age, only the men aged 50-59 years reported decreased erectile function after surgery (P < 0.001) and only those aged <40-49 years reported an improvement in ejaculatory function (P = 0.05). Men at <1 year after surgery reported lower sexual drive (P = 0.025) and erectile function (P = 0.05) than men with longer periods of recovery. CONCLUSIONS: The BMFSI is useful for evaluating sexual function after urethroplasty. Overall, the men did not report a decline in erectile function or sexual drive after surgery; however, older men might have a higher incidence of erectile dysfunction after surgery. Erectile function might recover with time. Younger men had the most pronounced improvement in ejaculatory function, but further studies are necessary to evaluate the clinical significance of this.

Adolescent↗

PubMed2005

Longitudinal membrane function in functionally anuric patients treated with APD: data from EAPOS on the effects of glucose and icodextrin prescription.

BACKGROUND: Peritoneal dialysis is associated with changes in membrane function that can lead eventually to ultrafiltration (UF) failure. Factors driving these changes are thought to include hypertonic glucose exposure, but previously reported associations are confounded by the presence of residual renal function. METHODS: Longitudinal membrane function (solute transport and UF capacity) were measured annually in a prospective cohort of 177 functionally anuric patients as part of the European Automated Peritoneal Dialysis Outcomes Study (EAPOS). Subgroup analysis was performed according to glucose exposure and icodextrin use at baseline. RESULTS: The whole cohort experienced an increase in solute transport and reduction in UF capacity at 12 and 24 months that could not be explained by informative censoring. These changes were accelerated and more severe in patients using either 2.27% or 3.86% glucose, or those not using icodextrin at baseline. These differences could not be explained by age, comorbidity score, previous time spent on renal replacement, differential dropout from the study, peritonitis rates, or, by definition, residual renal function. Patients using icodextrin at baseline had worse membrane function and were more likely to be diabetic. There was an association between membrane function changes and achieved 24-hour ultrafiltration over the 2-year study period. CONCLUSION: Anuric automated peritoneal dialysis (APD) patients experience significant detrimental changes in membrane function over a relatively short time period. Glucose appears to enhance these changes independent of residual renal function. Icodextrin use in these circumstances is associated with less deterioration in membrane function.

Anuria↗

PubMed2006

Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms.

OBJECTIVE: Impairments in adaptive life skills are a major source of disability in patients with schizophrenia. The relationship between adaptive life skills in real-world settings and performance on neuropsychological tests may be complicated by other factors that interfere with deployment of skills. Assessment of the ability to perform life skills under optimal conditions (i.e., assessment of functional capacity) has been proposed as a means to clarify these relationships. METHOD: The authors examined cross-sectional data from a study of the course of neuropsychological and adaptive life skills of older (age 50-85) schizophrenia patients (N=78). Functional capacity was examined with a performance-based measure (UCSD Performance-Based Skills Assessment), and case managers rated real-world adaptive functions (i.e., interpersonal skills, work skills, and community activities). Neuropsychological performance was assessed with a comprehensive battery, while symptoms were assessed with patient self-report and clinical ratings. RESULTS: Confirmatory path analyses were used to evaluate the effects of neuropsychological performance, functional capacity, and symptoms on the various domains of real-world functioning. Neuropsychological performance predicted functional capacity, which predicted all three domains of real-world functioning. Depression predicted interpersonal and work skills, while negative symptoms affected interpersonal skills independently of other predictors. CONCLUSIONS: Real-world adaptive life skills are predicted by neuropsychological performance, symptoms, and functional capacity. Neuropsychological performance contributes little to the prediction of real-world performance after accounting for functional capacity. In some domains, negative and depressive symptoms influenced real-world performance while not relating to functional capacity or neuropsychological performance.

Activities of Daily Living↗

PubMed2004

Sagittal plane translation during level walking in poor-functioning and well-functioning patients with anterior cruciate ligament deficiency.

BACKGROUND: Some patients with anterior cruciate ligament deficiency can function well and participate in high-level sports, whereas others have functional limitations even during activities of daily living. HYPOTHESIS: Patients who function well after an anterior cruciate ligament injury can stabilize the knee joint during gait by an anterior positioning of the tibia. STUDY DESIGN: Controlled laboratory study. METHODS: Sagittal tibial translation was registered with the CA-4000 electrogoniometer, during the Lachman test and walking, in 20 patients with a unilateral anterior cruciate ligament injury. Eleven patients functioned well (Lysholm score > or = 84), and 9 patients had poor knee function (Lysholm score < 84). RESULTS: During gait, the well-functioning group had 24% greater anterior translation in the injured leg compared to the noninjured leg. In the poor-functioning group, the anterior translation in the injured leg was 16% smaller compared to the noninjured leg (P = .0003). Tibial translation during the Lachman test was similar in the injured leg in the 2 groups. CONCLUSION: Patients who function well position their tibiae near the anterior border of the joint play. This position may encourage functional stability. CLINICAL RELEVANCE: Rehabilitation that emphasizes training to stabilize the tibia in an anterior position may improve functional stability of the anterior cruciate ligament-deficient knee.

Adaptation, Physiological↗

PubMed2004

Cerebral palsy: correlation of risk factors and functional performance using the Functional Independence Measure for Children (WeeFIM).

We studied the risk factors affecting the functional status of cerebral palsy. A cross-sectional study of 73 children with cerebral palsy was conducted with the Functional Independence Measure for Children (WeeFIM), which assesses functional skills in the domains of self-care, mobility, and cognition. The mean total Functional Independence Measure for Children quotient was 67.5%. The mean subquotients for self-care, mobility, and cognition were 68.3%, 62.7%, and 69.4%, respectively. The risk factors related to the degree of functional dependency were (1) mental retardation (P = .030), (2) epilepsy (P = .005), (3) type of cerebral palsy (P < .001), and (4) severity of cerebral palsy using the Gross Motor Function Classification System (P < .001) (using univariate analysis). However, when using multivariate analysis, only epilepsy (P = .02) and severity status according to the Gross Motor Function Classification System (P < .001) were significantly related. When the etiology was analyzed, only prematurity was significantly associated with better Functional Independence Measure for Children scores using both univariate (P = .022) and multivariate (P = .007) analyses. The functional status of children with cerebral palsy depends on the severity and the presence of epilepsy. Despite impairment, we found that most children with cerebral palsy could achieve functional independence.

Activities of Daily Living↗

PubMed2001

Trap a gene and find out its function: toward functional genomics in Drosophila.

Many declared aims of the genome projects have been achieved. The total genomic sequences of several relatively noncomplex/complex organisms (such as E. coli, yeast, Caenorhabditis, Drosophila) are being determined, and the nucleotide sequencing of the entire human genome will be complete in the near future. However, this achievement is not the end of the road but rather the first step toward the functional understanding of the genome of humans and other organisms. The determined linear nucleotide sequences remain only lists of A, C, G and T, unless they are given functional significance. The coding sequences of genes can be identified in a relatively reliable manner by computational methods, but the exact function of their protein products can rarely be determined without obtaining much additional information, e.g., by biochemical or cell biological methods. Thus, following sequencing, the next step must be to assign functions to the identified genes. The final goal of genome research today may look futuristic, but the knowledge of the function of every single gene and the interactions between them will finally allow us to understand the development and functioning of an organism as a whole. Gene-trapping methodology is a powerful strategy for cloning and identifying functional genes, as it marks a gene with a tag and simultaneously generates a corresponding genetic variation for that particular locus. Therefore, gene trapping is an extremely useful tool for functional genomics, establishing a correlation between the physical and genetic maps of the genome. The relative simplicity of its genome and the availability of huge bodies of genetic and molecular information make Drosophila melanogaster one of the most important model organisms. Its genome will serve as a "reference" for the in-depth analysis of the organization of more complex eukaryotic genomes. Multifaceted approaches to Drosophila functional genomics and the dual-tagging gene trap system newly developed for functional analysis of Drosophila genes are discussed in this review.

Animals↗

PubMed1989

Improving patient function: a randomized trial of functional disability screening.

STUDY OBJECTIVES: To test whether a 34-item functional status questionnaire measuring physical, psychological, and social function can be used by physicians in practice to help improve their patients' outcomes. DESIGN: Prospective randomized trial. SETTING: Community internal medicine practices. PATIENTS: Five hundred and ten continuing patients with functional disabilities who saw their physicians at least four times a year. PHYSICIANS: Seventy-six UCLA clinical volunteer faculty who are internists in community office practices. INTERVENTIONS: Physicians and their patients were randomly assigned to the experimental or the control group. Experimental group physicians attended a 2-hour multimedia educational session and received four functional status reports on each of their study patients over a 1-year period. Control group physicians received no education and no functional status feedback. Control group and experimental group patients were tested for functional status with the functional status questionnaire every 4 months for 1 year. Both groups also completed monthly diaries that measured use of health services. Experimental group physicians answered an anonymous evaluation questionnaire at 6 months after study entry. MEASUREMENTS AND MAIN RESULTS: Forty-three percent of experimental group physicians reported that they had used the functional status questionnaire to change therapy. Ninety-five percent reported that it was useful and accurate. Patient diaries did not show any difference between experimental group patients and control group patients in number of medications used, visits to physicians or other health professionals, equipment purchased, diet, or exercise programs. There were no significant differences between experimental and control group patients at exit from the study on any functional status or health outcome measure. CONCLUSION: A more powerful intervention than a 2-hour educational session and the regular provision of functional status information is needed to help office-based internists improve patient outcomes.

Activities of Daily Living↗

PubMed2001

Executive functioning in high-functioning children with autism.

Executive functioning was investigated in 34 children (24 boys and 10 girls) with developmental language disorder (DLD) and 21 children (18 boys and 3 girls) with high-functioning autistic disorder (HAD) matched on Full Scale IQ, Nonverbal IQ, age (mean age 9 year, 1 month), and SES. The DLD group had a Verbal IQ that was 10 points higher than the HAD group. These children were given the Wisconsin Card Sorting Test (WCST), the Mazes subtest from the WISC-R, the Underlining test, and the Rapid Automatized Naming test. In addition, these children were given the Vineland Scales of Adaptive Functioning and the Wing Diagnostic Symptom Checklist in order to assess severity of autistic symptomatology. Results indicated that the only significant difference between the two groups on the cognitive tasks was perseverative errors on the WCST; there was no significant difference on total number of categories achieved or total number of errors on the WCST or on the other executive function measures. There was also significant overlap in the scores between the two groups and the difference in perseverative errors was no longer significant when Verbal IQ was partialled out. Executive functioning was strongly related to all IQ variables in the DLD group and particularly related to Verbal IQ in the HAD group. Although there was a relationship in the HAD group between executive functioning and adaptive functioning, as well as between executive functioning and autistic symptomatology, these relationships were generally no longer significant in the HAD group after the variance due to Verbal IQ was accounted for. The results are interpreted to indicate that although impaired executive functioning is a commonly associated feature of autism, it is not universal in autism and is unlikely to cause autistic behaviors or deficits in adaptive function.

Autistic Disorder↗

PubMed2001

Evaluation of male sexual function by the International Index of Erectile Function after deep dorsal vein arterialization of the penis.

PURPOSE: The objective of vascular surgery for erectile dysfunction is to provide long-term improvement of erectile function. We evaluated that claim after deep dorsal vein arterialization by a cross-sectional study of multifaceted male sexual function with the validated International Index of Erectile Function (IIEF). MATERIALS AND METHODS: We performed a mail survey of male sexual function after deep dorsal vein arterialization in 68 consecutive literate men who underwent surgery between 1984 and 1998 for severe erectile dysfunction. The IIEF questionnaire and a questionnaire on patient characteristics were answered in a self-administered and nominative manner. Scores of the responders pertaining to the 5 domains of male sexuality were compared with those of the control groups used for the psychometric validation of the IIEF. RESULTS: Of the patients 38 (55.9%) with a mean age plus or minus standard deviation of 46.5 +/- 11.9 years responded. Mean followup was 61.2 +/- 34.7 months. Compared to controls with erectile dysfunction controls men who underwent deep dorsal vein penile arterialization had significantly higher scores for erectile function, sexual desire, orgasmic function, intercourse satisfaction and overall satisfaction. Conversely compared with normal controls these patients reported significantly lower erectile function, orgasmic function, intercourse satisfaction and overall satisfaction scores, whereas sexual desire scores were similar in the 2 groups. No correlations were noted of the 5 IIEF domains with the duration of followup after arterialization. When erectile function scores were graded, 25.0% and 28.1% of patients reported no and or mild dysfunction, respectively, while 15.6% still complained of severe erectile dysfunction. CONCLUSIONS: Long-term improvement in the various aspects of male sexual function was observed after deep dorsal vein penile arterialization in a significant proportion of patients.

Coitus↗

PubMed1990

[A reliable method for evaluating the masticatory function in complete denture wearers, concerning a masticatory function evaluation chart based on food hardness].

The purpose of this study was to construct an evaluation chart to objectively and simply determine the extent of the masticatory function of complete denture wearers in daily clinical practice, and to describe the chart's clinical application. 58 different types of food were selected according to two criteria: their frequency of ingestion by complete denture wearers, and their convenience for determining the masticatory function. Then an anatomical artificial porcelain set of dentures was used to bite each food item, using only bicuspids and molars. Dentures were installed on an Instron Universal Testing Instrument to compression-cut the food. Food requiring the highest pressure was considered the hardest food. Then the masticatory function evaluation chart was constructed by using the hardness of the food as an index of relative masticatory difficulty. Using this chart, 95 complete denture wearers were tested to determine the masticatory function of their dentures. The following results were obtained: 1. The mean hardness of the 58 food items tested was 7.85 +/- 11.29 kg. The mean hardness of the 38 food items frequently ingested by complete denture wearers was 5.24 +/- 5.41 kg. 2. The differences in hardness of the foods tested were statistically processed, and the 58 food items were classified into 5 groups (I-V). This five-fold classification was used as a range for determining masticatory function. 3. A correlation coefficient of -0.697 (p less than 0.01) was found between the hardness of the food and the ease of eating the food. 4. A correlation coefficient of 0.548 (p less than 0.01) was found between the hardness of the food and the frequency of ingestion. 5. The masticatory function was determined on a 5-point scale from A to E according to the total number of food types that the subjects said that they could eat easily. The masticatory function increased progressively from A to E. The results of determining the masticatory function of the 95 complete denture wearers were as follows: Rank A 1.1%, B 10.5%, C 34.7%, D 29.5% and E 24.2%. 6. Persons who evaluated their own dentures positively comprised 86.0% of ranks D and E. On the other hand, persons who evaluated their own denture negatively were widely distributed from rank A through E, indicating that there were considerable individual differences. 7. It was concluded that the masticatory function evaluation chart was a reliable means of objectively and simply determining the masticatory function of complete denture wearers.

Bite Force↗

PubMed2004

Right ventricular long-axis function in relation to left ventricular systolic function.

A decrease in left ventricular (LV) systolic function is accompanied by a decrease in maximal relaxation velocity in LV long-axis direction, but is it also accompanied by a decrease in right ventricular (RV) long-axis function? To study this 35 consecutive patients were examined by echocardiography. Ejection fraction (LVEF) and mitral annulus motion (MAM) were used as indices of LV systolic function and tricuspid annulus motion (TAM), that is the systolic shortening in RV long-axis direction, was used as an index of RV systolic long-axis function. In the same way the maximal relaxation velocity in LV long-axis direction, that is the maximal diastolic velocity of MAM (MDV MAM), has been suggested as an index of LV diastolic function the maximal diastolic velocity of TAM (MDV TAM) can be supposed to be an index of RV diastolic function measuring the maximal relaxation velocity in the RV long-axis direction. A significant positive correlation was found between MDV TAM and MAM (r = 0.64, P<0001) and LVEF (r = 0.54, P = 0.001) and between TAM and the two studied indices of LV systolic function, with the highest correlation to MAM (r = 0.68, P<0.001) and the lowest to LVEF (r = 0.57, P<0.001). Thus, a decrease in LV systolic function is accompanied by a decrease in both systolic and diastolic RV long-axis function, findings that probably are due to the close anatomical connection between the ventricles and to changes that occur in afterload of the RV secondary to LV systolic dysfunction.

Aged↗

PubMed2001

Relationships between heart rate variability, functional capacity, and left ventricular function following myocardial infarction: an evaluation after one week and six months.

BACKGROUND: Relationships between heart rate (HR) variability and different prognostic markers such as ejection fraction, functional capacity, and patency of the infarct-related artery, as well as the comparison of their time courses are not fully elucidated. HYPOTHESIS: The aim of study was to assess prospectively the early postinfarction changes in HR variability and its evolution over a period of 6 months: the relationships between HR variability and functional capacity in exercise testing; left ventricular function in cardiac catheterization: status of the infarct-related artery; and the comparison of their time courses. METHODS: In 42 patients with anterior myocardial infarction, a study was made of the early changes in HR variability analyzed by the complex demodulation method, its evolution over a period of 6 months. and the relationships between HR variability and (1) functional capacity in exercise testing, (2) left ventricular function in cardiac catheterization, and (3) status of the infarct-related artery. RESULTS: At 1 week HR variability parameters correlated directly with functional capacity indicators such as METS, percent change in HR from rest to peak exercise (%deltaHR), difference between initial and peak HR (HR range), percent peak theoretical HR (% peak HR), left ventricular ejection fraction (EF), and, inversely, with end-systolic volume (ESV). Stepwise multiple regression analysis to establish HR variability parameters (recorded at 1 week) as related to functional capacity and left ventricular function at 1 week and 6 months postinfarction established the following variables: (1) At 1 week: standard deviation (SD) of the RR cycles in relation to %deltaHR (r = 0.60, p <0.0001), HR range (r = 0.43, p < 0.01), and EF (r = 0.79, p < 0.0001). (2) At 6 months, the sole accepted HR variability parameter was the SD in relation to %deltaHR (r = 0.38, p < 0.05) and HR range (r = 0.45, p < 0.01). No variability parameter was accepted in relation to METS, % peak HR, or ESV. Relationship between EF or ESV and HR variability parameters was not significant when both were evaluated at 6 months. At that time, there was a significant increase in all HR variability parameters among all surviving patients (n = 39), with the exception of the LF/HF ratio and mean RR cycle. The percent increase in HR variability between the first week and 6 months was greater among those patients with the lowest basal EF. No relation was established between HR variability and patency of the infarct-related artery. CONCLUSION: The decrease in HR variability observed following myocardial infarction is associated with a diminished functional capacity and an increased alteration of the EF. This does not affect the recovery of HR variability, which was observed in all surviving patients.

Adult↗

PubMed2005

Determinants of functional capacity in patients with chronic heart failure: role of filling pressure and systolic and diastolic function.

BACKGROUND: Previous work suggesting a better correlation of diastolic than systolic function with exercise capacity in heart failure may reflect the relative insensitivity and load-dependence of ejection fraction (EF). We sought the correlation of new and more sensitive methods of quantifying systolic and diastolic function and filling pressure with functional capacity. METHODS: We studied 155 consecutive exercise tests on 95 patients with congestive heart failure (81 male, aged 62 +/- 10 years), who underwent resting 2-dimensional echocardiography and tissue Doppler imaging before and after measurement of maximum oxygen uptake (peak VO2). RESULTS: The resting EF was 31% +/- 10% and a peak VO2 was 13 +/- 5 mL/kg.min; the majority of these patients (80%) had an ischemic cardiomyopathy. Resting EF (r = 0.14, P = .09) correlated poorly with peak VO2 and mean systolic (r = 0.23, P = .004) and diastolic tissue velocities (r = 0.18, P = .02). Peak EF was weakly correlated with the mean systolic (r = 0.18, P = .02) and diastolic velocities (r = 0.16, P < .04). The mean sum of systolic and diastolic velocities in both annuli (r = 0.30, P < .001) and E/Ea ratio (r = -0.31, P < .001) were better correlated with peak VO2 . Prediction of peak VO2 was similar with models based on models of filling pressure (R = 0.61), systolic factors (R = 0.63), and diastolic factors (R = 0.59), although a composite model of filling pressure, systolic and diastolic function was a superior predictor of peak VO2 (R = 0.69; all P < .001). CONCLUSIONS: The reported association of diastolic rather than systolic function with functional capacity may have reflected the limitations of EF. Functional capacity appears related not only to diastolic function, but also to systolic function and filling pressure, and is most closely associated with a combination of these factors.

Aged↗

PubMed2005

The impact of anaemia and kidney function in congestive heart failure and preserved systolic function.

BACKGROUND: The importance of anaemia in chronic heart failure was highlighted recently by different cohort studies. The aim of this study was to assess the prevalence of anaemia and its relationship to renal function, left ventricular function and symptoms of heart failure. METHODS: We surveyed cases of patients admitted to the Department of Cardiology during 22 consecutive months. Laboratory measurements, blood pressure and echocardiographic parameters were obtained with standardized methods. RESULTS: Out of a total number of 2941 patients, 238 patients (8.1%) had haemoglobin values <11 g/dl. There was a positive association of anaemia with the symptoms of heart failure with a lowering of the median haemoglobin from 14.2 g/dl [New York Heart Association (NYHA) I] to 12.9 g/dl (NYHA IV, P<0.001). Interestingly, anaemia was not associated with left ventricular function or any left ventricular parameters. Symptoms of heart failure, however, were associated with kidney function. The estimated glomerular filtration rate (GFR) was 82 ml/min at NYHA I and 59 ml/min at NYHA IV, P<0.05. There was an association between impaired renal function and haemoglobin values. Haemoglobin was 14.2 g/dl in the group with normal renal function and 11.1 g/dl in the group with a GFR <25 ml/min (P<0.001). Even in patients with normal renal function (878 patients, GFR >85 ml/min), we still found an association of anaemia with the symptoms of heart failure. Haemoglobin was 14.5 g/dl at NYHA I and 13.4 g/dl at NYHA IV, P<0.0001. CONCLUSION: Anaemia is found in 8.1% of patients admitted to cardiology service. Anaemia was clearly associated with symptoms of congestive heart failure even in patients with normal renal function. Anaemia was not associated with left ventricular function.

Aged↗

PubMed2004

Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics.

A review of prospectively collected data was done to compare functional outcomes and mortality among patients with different hip fracture types. Five hundred thirty-seven elderly patients who sustained a hip fracture were followed up prospectively. Orthopaedists blinded to treatment and outcome radiographically classified the fractures as either: (1) nondisplaced or impacted femoral neck; (2) displaced femoral neck; (3) stable intertrochanteric; or (4) unstable intertrochanteric fracture. Functional independence measure scores were calculated for preinjury function and at 2- and 6- month follow-ups. Comorbidities, operative details, postoperative complications, and deaths were recorded. Six-month mortality was lowest for patients with nondisplaced femoral neck fractures (5.7%) and highest for patients with displaced femoral neck fractures (15.8%), but multivariate analysis only identified preinjury function as an independent predictor of mortality. All preinjury and followup functional independence measure scores were greatest for patients with nondisplaced femoral neck fractures and least for patients with unstable intertrochanteric fractures. However, multivariate analysis identified only patient age and preinjury functional independence measure scores as independent predictors of functional outcome. These data show differences in mortality and functional outcomes among fracture types that can be attributed to differences in functional status before injury.

Activities of Daily Living↗

PubMed2006

Effects of nebivolol versus carvedilol on left ventricular function in patients with chronic heart failure and reduced left ventricular systolic function.

BACKGROUND: Beta-adrenoceptor antagonist (beta-blocker) therapy results in a significant improvement in left ventricular (LV) systolic function and prognosis in patients with chronic heart failure. Both carvedilol and nebivolol produce hemodynamic and clinical benefits in chronic heart failure, but it is unknown whether their peculiar pharmacologic properties produce different effects on LV function. OBJECTIVE: To assess the effects on LV function of nebivolol compared with carvedilol in patients with chronic heart failure and reduced LV systolic function. METHODS: Seventy patients with a LV ejection fraction <or=40% and in New York Heart Association (NYHA) functional class II or III were randomly assigned to receive carvedilol or nebivolol therapy for 6 months. At baseline and after 6 months of treatment, all patients were assessed clinically and by biochemical and hematological investigation, ECG, 24-hour Holter monitoring, echocardiogram, measurement of ventilatory function, and a 6-minute walk test. RESULTS: Compared with baseline values LV end-systolic volume decreased and LV ejection fraction increased in both the carvedilol (from 79 +/- 38mL to 73 +/- 43mL and from 33% +/- 6% to 37% +/- 11%) and the nebivolol group (from 72 +/- 35mL to 66 +/- 32mL and from 34% +/- 7% to 38% +/- 10%), although the between-group differences were not statistically significant. ECG data showed a decrease in resting HR in both groups (from 83 +/- 20 bpm to 66 +/- 11 bpm for carvedilol and from 81 +/- 15 bpm to 65 +/- 11 bpm for nebivolol; p < 0.001 vs baseline for both groups) but no difference in the PQ, QRS, and QT intervals. Hematologic (in particular, N-terminal pro-brain natriuretic peptide), Holter monitoring (with the exception of HR), and respiratory functional data did not show any significant variation in either group after 6 months' therapy. SBP and DBP decreased in both groups. A small reduction in mean NYHA functional class from baseline was seen in both groups (from 2.5 +/- 0.5 to 2.2 +/- 0.5 for carvedilol [p < 0.05] and from 2.3 +/- 0.4 to 2.2 +/- 0.5 for nebivolol [not significant]). The 6-minute walk test showed a trend toward an increase in the walking distance in both groups. During 6 months of treatment no significant differences in adverse events were observed between the groups. CONCLUSION: Nebivolol is as effective as carvedilol in patients with symptomatic chronic heart failure and reduced LV systolic function.

Adrenergic beta-Antagonists↗

PubMed2000

[The preliminary analysis on the changes of the oral functional space in Class II division 1 malocclusion after triggered by functional appliance].

OBJECTIVE: The purpose of this paper is to study the area changes of the oral functional space in the patients with Angle's Class II division 1 malocclusion after triggered by FR-I functional appliances. METHODS: Twenty patients with Angle's Class II division 1 malocclusion were selected, and the patients were selected by the standards of an horizontal growth pattern with normal maxilla, retracted mandible and short lower facial height. All patients were triggered by FR-I functional appliances and achieved the Angle's Class I occlusion after treatments. The average periods of the treatments were about 9 months. The assessments were made from the lateral cephalograms taken in centric occlusion before and after treatments. The upper and behind borders of the oral functional space are hard palate and soft palate, the forward border is the lingual side of upper and lower incisors, the lower border is the line between apex of lower incisor and lower first molar. The graphics from the lateral cephalogram were painted and input into the computer by scaner, which were measured by special software. Self-controls of individuals before and after treatments were used in statistic analysis. RESULTS: The paired-samples t test confirmed the oral functional space was enlarged after triggered by FR-I functional appliance, which was induced by obviously increased mandibular body and ramus, anterior lower facial height and posterior facial height. At the same time, the angle of Y axis increased and the upper incisor inclined lingually, but the inclining angle of lower incisor was not obvious. CONCLUSION: Enlarged oral functional space facilitates the development of the maxilla, mandible and alveolar bones and consummates the functions of oral and jaw system. This study aids the design and application of FR-I functional appliance.

Adolescent↗

PubMed2000

Effects of nonsteroidal anti-inflammatory drugs on post-operative renal function in adults.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) can play a major role in the management of acute pain in the peri-operative period. However, there are conflicting views on whether NSAIDs are associated with adverse renal effects. OBJECTIVES: The primary objective of this review was to determine the effects of NSAIDs on post-operative renal function in adults. SEARCH STRATEGY: Electronic searches for relevant randomised and quasi-randomised controlled trials in Cochrane Controlled Trials Register, MEDLINE and EMBASE were performed. Attempts were also made to identify trials from citation lists of relevant trials, review articles and clinical practice guidelines. Hand-searching of conference abstracts published in major anaesthetic journals was also performed. SELECTION CRITERIA: The inclusion criteria were randomised or quasi-randomised comparisons of individual NSAIDs with either each other or placebo for treatment of post-operative pain, with relevant post-operative renal outcome measures, in adult surgical patients. DATA COLLECTION AND ANALYSIS: Of the 14 trials that fulfilled the selection criteria for this review, eight trials were relevant with sufficient data for meta-analysis. The data was extracted independently by two reviewers. The primary outcome measure was creatinine clearance within the first two days after surgery. Secondary outcome measures included serum creatinine, urine volume, urinary sodium level, urinary potassium level, fractional excretion of sodium, fractional excretion of potassium, need for dialysis and need for diuretic or dopamine treatment for renal insufficiency. Weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes were estimated. MAIN RESULTS: As a group, NSAIDs reduced creatinine clearance by 18ml/min (95%CI: 6 to 31) and potassium output by 38mmol/day (95%CI: 19 to 56) on the first day after surgery compared to placebo. Serum creatinine clearance increased on the second day after surgery by 15umol/L (95%CI: 2 to 28) compared to placebo. No significant reduction in urine volume during the early post-operative period was found. There was no significant difference in serum creatinine in the early post-operative period between patients receiving ketorolac and diclofenac in one trial. No cases of post-operative renal failure requiring dialysis were described. REVIEWER'S CONCLUSIONS: NSAIDs caused a clinically unimportant transient reduction in renal function in the early post-operative period. NSAIDs should not be withheld from adults with normal pre-operative renal function because of concerns about post-operative renal impairment.

Adult↗