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Effect of physical activity on bone mineralization in premature infants.

OBJECTIVE: A 4-week pilot study was done with 26 preterm infants to evaluate whether a physical activity program would result in greater bone mineralization. DESIGN: Subjects were matched by birth weight, gender, and gestational age, and randomly assigned to the physical activity program (group EX; n = 13) or to the control group (group C; n = 13). Physical activity consisted of range of motion with passive resistance to all extremities for 5 to 10 minutes daily. Baseline and 4-week values were determined for both bone mineral analyses and serum levels of calcium, phosphate, alkaline phosphatase, parathyroid hormone, and 25-hydroxy-vitamin D. RESULTS: Despite similar nutrient intake at advised levels for preterm infants, EX infants gained more weight than control subjects (17.8 vs 13.4 gm/kg body weight per day; p = 0.01). A difference in radial bone mass and density change as determined by single-beam photon absorptiometry (+/- 2% error) was found between groups (p = 0.006 by analysis of covariance). Changes in bone width and in bone mineral content and density were enhanced by physical activity. Group EX infants had 12%, 18%, and 34% gains in bone width and in bone mineral density and content, respectively; group C infants had only a 2% gain in bone width and 11% and 14% losses from baseline in bone mineral content and density, respectively, during the 4-week study. Serum biochemical values were similar in the groups except for lower alkaline phosphatase levels in group EX. There was a negative association between bone mineral content and parathyroid hormone values: r = -0.83, p = 0.01. CONCLUSIONS: A physical activity program may increase the effects of adequate nutrition in healthy preterm very low birth weight infants by promoting weight gain and bone mass and by decreasing the risk of osteopenia.

Absorptiometry, Photon

Energy expenditure during leg exercise programs.

Comparisons of the effects of three exercise programs (active, passive, and isometric) and a rest program (control) on energy expenditure (oxygen consumption), heart rate, respiratory rate, and blood pressure were made. Thirty-six volunteers (18 men and 18 women) between the ages of 25 and 35 participated. Repeated measures ANOVAs (sex by program by time) were used to analyze the data. Significant program by time effects were obtained on oxygen consumption, heart rate, respiratory rate, and systolic blood pressure. In general, pair-wise comparisons indicate that for oxygen consumption and heart rate the isometric and active programs were comparable and significantly more demanding than either the passive or rest programs.

Adult

The Veterans Administration Northwest Regional Health Services Research and Development Field Program: organization, activities, and early outcomes.

In 1982, the Veterans Administration established Health Services Research field programs in each of the six VA regions. Herein, we describe the historical origins, organization, responsibilities, activities, and early accomplishments of one of these programs--the Northwest Regional HSR&D field program. Special reference is made to this program's commitment to health services research relevant to geriatrics and gerontology, including the development of a system-wide agenda for research, information syntheses in geriatrics-relevant health services research topics, and the conduct of funded projects pertinent to care of the elderly. The importance of a medical center location for the field programs is discussed, and early indications of institutional impact are described.

Aged

Inhibition of activation-induced programmed cell death and restoration of defective immune responses of HIV+ donors by cysteine protease inhibitors.

In vitro activation of PBLs from HIV+ individuals resulted in programmed cell death (PCD) within 2 days in 58 of 95 HIV+ blood donors, in contrast to only two of 30 control HIV- donors. CD4+ and CD8+ T cells from HIV+ donors died under these conditions, and these cells showed apoptotic nuclear morphology and DNA fragmentation. To test the hypothesis that this cell death shares a common biochemical pathway with that induced by TCR cross-linking in normal dividing T cells, inhibitors of the calcium-activated cysteine protease calpain were tested for their ability to block the activation-induced PCD of HIV+ donors. The E-64 (epoxysuccinyl) class of cysteine protease inhibitors gave 40% to 60% inhibition of HIV+ PCD responses, while the aldehyde inhibitors, leupeptin and calpain inhibitor II, gave 60% to 67% inhibition. The involvement of this calpain-dependent death pathway in HIV-induced functional T helper cell deficiency was tested by examining the effect of calpain inhibitors on the defective Ag- and mitogen-dependent proliferative responses of HIV+ donors. Twenty to fifty percent of such defective responses were significantly restored toward normal levels by calpain inhibitors, whereas control responses by normal donors were largely unaffected. These data suggest that a calpain-dependent PCD pathway contributes to HIV-associated immunodeficiency and suggest the use of calpain inhibitors as a possible route to therapy of HIV infection.

Apoptosis

Activation of programmed cell death in the rat ventral prostate after castration.

The rapid involution of the rat ventral prostate after castration is an active process initiated by removal of the inhibitory effects of androgen on prostatic cell death. The present studies demonstrate that after castration-induced androgen deprivation a series of temporally discrete biochemical events are activated which result in the rapid programmed death of the subset of androgen-dependent cells within the rat ventral prostate. These biochemical steps involve 1) rapid loss of nuclear androgen receptor retention; by 12 h after castration, androgen receptors are no longer detectable in ventral prostatic nuclei; 2) an initial fragmentation of nuclear DNA into low mol wt (less than 1000 basepairs) nucleosomal oligomers which lack intranucleosomal break points; and 3) eventual complete digestion of these nucleosomal oligomers into component nucleotides. Additional studies demonstrate that activation of a Ca2+-Mg2+-dependent endonuclease is associated with this DNA fragmentation. By 4 days after castration, maximal DNA fragmentation is obtained, with 15% of the total nuclear DNA extractable as low mol wt fragments. Proteolytic enzymes are apparently not involved initially in this process, suggesting that DNA fragmentation is a discrete event in, rather than a result of, cell death. Flow cytometric analysis of nuclear DNA content demonstrated that each day after castration, a subpopulation of androgen-dependent cells in rat ventral prostate fragmented all of their genomic DNA, as opposed to the whole population of cells fragmenting an increasing portion of their DNA daily.

Animals

Sequential organizing activities of engrailed, hedgehog and decapentaplegic in the Drosophila wing.

The Drosophila wing is formed by two cell populations, the anterior and posterior compartments, which are distinguished by the activity of the selector gene engrailed (en) in posterior cells. Here, we show that en governs growth and patterning in both compartments by controlling the expression of the secreted proteins hedgehog (hh) and decapentaplegic (dpp) as well as the response of cells to these signaling molecules. First, we demonstrate that en activity programs wing cells to express hh whereas the absence of en activity programs them to respond to hh by expressing dpp. As a consequence, posterior cells secrete hh and induce a stripe of neighboring anterior cells across the compartment boundary to secrete dpp. Second, we demonstrate that dpp can exert a long-range organizing influence on surrounding wing tissue, specifying anterior or posterior pattern depending on the compartmental provenance, and hence the state of en activity, of the responding cells. Thus, dpp secreted by anterior cells along the compartment boundary has the capacity to organize the development of both compartments. Finally, we report evidence suggesting that dpp may exert its organizing influence by acting as a gradient morphogen in contrast to hh which appears to act principally as a short range inducer of dpp.

Animals

Gerontic occupational therapy--psychological and social predictors of participation and therapeutic benefits.

The purpose of this study was to assess what role psychological and social factors play in predicting the participation of elderly people in a social activation program. Furthermore, the study evaluated the importance of such factors in improving subjects' moods and decreasing feelings of loneliness. Over a six-month period, a social activation program was conducted in a senior citizen apartment building in Stockholm, Sweden. A group of 30 residents from one floor of the building, the experimental group, received the program while a control group of 30 residents from another floor did not. Medical, social, psychological, and behavioral assessments were made immediately before, three months after, and six months after the beginning of the program. Results were that the activity level had increased threefold in the experimental group. Experimental group subjects who initially had a low social activity level and higher scores on the internal-locus-of-control scale had the highest rate of increase in their social activity level. Subjects in the experimental group who initially had a low social activity level, were single or bereaved, scored low on the neuroticism scale, or desired a low level of internal control showed the greatest improvement in mood. Feelings of loneliness decreased the most among those in the experimental group who had a stronger internal locus of control and scored high on pessimistic feelings. Because the program benefited those subjects who initially were the most passive and isolated, it is concluded that gerontic occupational therapy plays an important role in preventing unnecessary social isolation in institutional living.

Aged

Matching services to needs. Vocational services for substance abusers.

Problems with employment are common among individuals with substance use disorders, yet comprehensive vocational services are not generally available to them, and vocational interventions are often not matched to their specific needs. This article describes the wide range of vocational problems found among individuals with substance use disorders and the elements of a recently funded vocational program for patients in outpatient and residential drug and alcohol treatment programs. Data are presented describing program activity and documenting program effectiveness for the first 2 years of operation of the program. Three case histories are presented to illustrate the types of services delivered and the matching of services delivered to specific, identified client needs (see Case Histories).

Adult

Tyrosine phosphorylation participates in peripheral T-cell activation and programmed cell death in vivo.

T-cell antigen receptor (TCR), which is not itself a protein tyrosine kinase (PTK), is thought to be associated with at least two SRC-like PTKs, P59fyn and ZAP-70. Activation of these PTKs is required for T-cell signal transduction. The aim of the present study was to determine the roles of PTKs in peripheral T-cell activation, induced by in vivo bacterial superantigen administration. We demonstrated that in vivo staphylococcal enterotoxin B (SEB) administration induced an enhanced tyrosine phosphorylation in peripheral spleen T cells undergoing a programmed cell death. In vitro immunecomplex kinase assay using antibody against P59fyn showed increased fyn kinase activity in SEB-stimulated spleen T cells. We examined the effect of PTK-specific inhibitors on DNA fragmentation and programmed cell death of V beta 8 positive T cells following in vitro culture of SEB-primed spleen T cells. Our results indicated that pretreatment of SEB-activated T cells with PTK inhibitors reduced DNA fragmentation and programmed cell death of V beta 8 positive T cells. These findings suggest that PTK plays an important role in activation and apoptosis of peripheral T cells induced by in vivo SEB administration.

Animals

Influence of lidocaine on human muscle sympathetic nerve activity during programmed electrical stimulation and ventricular tachycardia.

Lidocaine directly affects conduction and refractoriness of ventricular myocardium, and may also indirectly affect these electrophysiologic properties by inhibition of cardiac sympathetic nerve traffic. Both effects may play important roles in preventing ventricular arrhythmias in humans. To determine if lidocaine has a direct effect on sympathetic nerve activity, the effects of a 100 mg lidocaine bolus followed by a 2 mg/min infusion of lidocaine on muscle sympathetic nerve activity was assessed in seven patients during programmed ventricular stimulation with single extrastimuli (premature ventricular contractions [PVCs]) in sinus rhythm, and in seven patients during induced hemodynamically stable monomorphic ventricular tachycardia. During single extrastimuli, the mean (+/- SEM) area of PVC-associated bursts of sympathetic nerve activity was unaffected by lidocaine (1101 +/- 16 units pre-lidocaine versus 1075 +/- 19 units following lidocaine; p = 0.30). Likewise, the transient decrease in blood pressure with induced PVCs was similar before and after lidocaine infusion (p = 0.46). In seven patients with induced monomorphic ventricular tachycardia, tachycardia cycle length did not change after the lidocaine bolus (393 +/- 18 versus 399 +/- 17 msec; p = 0.34) but increased during lidocaine maintenance infusion (428 +/- 17 msec; p = 0.01). After induction of ventricular tachycardia, systolic pressure decreased from 150 +/- 6 to 117 +/- 9 mm Hg at 1 minute of tachycardia, to 109 +/- 6 mm Hg during the lidocaine bolus, and rebounded to 126 +/- 8 mm Hg during the lidocaine maintenance infusion (p = 0.04, bolus versus infusion).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure

An experimental study of social isolation of elderly people: psychoendocrine and metabolic effects.

Psychoendocrine and metabolic effects of social isolation and understimulation in real life were examined in a controlled study of 60 elderly people representative of their age group. Together with the staff and the elderly, a social activation program was formed at a senior citizen apartment building. Half of the elderly were part of this activation program (experimental group). The other half constituted the control group. Blood sampling and psychosocial testing were performed immediately before and after 3 and 6 months of social activation. Social activation increased threefold in the experimental group. Height decreased in the control group compared to the experimental subjects. Plasma levels of testosterone, dehydroepiandrosterone, and estradiol increased significantly in the experimental group over the 6-month period compared to the control group. The most pronounced increase took place during the initial 3 months. Hemoglobin A1c decreased significantly in the experimental group over the 6-month period compared to the control group. In this preliminary study it is concluded that social isolation and understimulation may be associated with a wide range of psychophysiologic effects in elderly people.

Aged

Tuftsin (an Ig-associated tetrapeptide) triggers the immunogenic function of macrophages: implications for activation of programmed cells.

The immunoglobulin heavy-chain-associated tetrapeptide, tuftsin (Thr-Lys-Pro-Arg), known for its phagocytosis-stimulating activity, was found to augment the antigen-specific, macrophage-dependent education of T lymphocytes. The investigation of stereospecific characteristics of the tetrapeptide, by use of structural analogs with different modifications, revealed strict structural requirements for eliciting the immunogenic activity of macrophages. It was found that the most important moiety for its activity is the dipeptide Pro-Arg. This finding is of interest in view of the appearance of this particular dipeptide in other bioregulatory peptides, including many of the peptide hormones. The significance of the appearance of a common structure in such molecules, which may act through specific receptors on different target cells, is discussed.

Amino Acid Sequence

A community outreach training program for pediatric residents and medical students.

In 1982 the Division of Community Pediatrics of the University of North Carolina at Chapel Hill began a new training program for all first-year pediatrics residents and fourth-year medical students taking an ambulatory pediatrics elective. The program was designed to introduce the trainees to community resources for children and increase their knowledge of the factors affecting children's development. During their regular hospital clinic rotations, the trainees spend approximately one-third of their time in program activities that involve 25 community agencies. Educational packets (consisting of books, journal articles, films, slides, videotapes, self-instruction materials, manuals for developmental tests, and/or agency materials) are provided for each program component. At the end of each one-month rotation of program activities, the trainees meet individually with the program director and coordinator to discuss the trainee's experiences and reactions and to identify strengths and weaknesses of the program components.

Child

Development and impact of the Gene-Tox-Program, genetic activity profiles, and their computerized data bases.

This invited historical review traces the development and impact of two major data bases in the field of genetic toxicology. Discussed from a personal perspective are the Environmental Protection Agency (EPA) Gene-Tox Program and the EPA/International Agency for Research on Cancer Genetic Activity Profiles (GAPs) and their respective data bases. Whereas Gene-Tox was focused on the assessment of short-term tests and their role in predicting carcinogens and mutagens, GAPs and the GAP data base were designed specifically to aid in the evaluation of individual chemicals. Both data bases have been computerized. Gene-Tox is available on TOXNET and GAP is available in a personal computer format from the author. The Gene-Tox and GAP data bases appear to have had substantial impact, particularly on hazard identification activities in cancer risk assessment.

Carcinogenicity Tests

[Lateral instability of the ankle joint (2). Active training programs can prevent surgery].

One hundred consecutive patients with chronic lateral functional instability of the ankle were treated non-operatively with physiotherapy (active range-of-motion training, strengthening exercises and co-ordination training with a tilt-board). All patients were evaluated functionally with a special rating scale, and radiologically with standardised stress radiographs measuring anterior talar translation (ATT) and talar tilt (TT). Excellent or good functional results were obtained in 49 of the patients, fair or poor in the remainder. The outcome was better in those with painful functional instability or mild mechanical instability, while those with more pronounced mechanical instability required further treatment (i e, reconstructive surgery). Of 10 patients with generalised joint laxity, only fair or poor results were obtained in seven, all of whom had mechanical instability.

Adult

HLA class II signaling mediates cellular activation and programmed cell death.

The class II human leucocyte antigens (HLA class II) are principally peptide presentation molecules. Signal transduction by these molecules has also been shown to transmit activation signals in both B and T lymphocytes by a pathway including protein tyrosine kinase activation, an intracellular calcium flux, and both the activation and transcriptional regulation of protein kinase C (PKC) isoforms. Apoptosis can also result from human leukocyte antigen class II stimulation. Inhibitors of gene transcription were used to inhibit activation and, therefore, to distinguish the signal transduction pathways important for apoptosis. This approach provided evidence that cellular activation and apoptosis undertook separate signaling pathways, and that PKC and intracellular calcium were shared between the two pathways, while tyrosine kinase activity was essential for cell activation. Further studies using cord blood B cells showed that these cells were incapable of generating a calcium flux after HLA class II ligation and were not subject to cell death. The importance of sustained levels of calcium for programmed cell death (PCD) was underlined since the restoration of a calcium flux enabled PCD of cord blood B cells via HLA class II. These results demonstrate that HLA class II stimulation initiates two distinct signal transduction pathways.

Adult