Biomedical subjects
Publications and source records attributed to A Ward.
The sunset review of 20 health agencies and a package of legislation addressing psychiatric, chemical dependency and rehabilitation hospitals were high profile issues during the 73rd Texas Legislature. However, funding for health and human services presented the greatest challenge to hospital advocates.
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N-Acetyltransferase activities associated with erythrocytes from 20 individuals have been determined with p-aminobenzoic acid as substrate. A three-fold variation in Vmax is found. The N-acetyltransferase genotype of the individuals has been determined and there is no correlation between the extent of acetylation measured in the individuals' erythrocytes and the inheritance of alleles at the polymorphic NAT locus. Folate is confirmed to be an inhibitor of arylamine N-acetyltransferase activity measured in erythrocytes. The content of folate in erythrocytes of individuals also varies. The individual with the maximum folate content has the minimum N-acetyltransferase activity. The monomorphic N-acetyltransferase gene from individuals spanning the range of N-acetyltransferase activity have been amplified, using the polymerase chain reaction. The pattern of restriction enzyme digestion of the monomorphic N-acetyltransferase gene with a series of eight restriction enzymes is the same for individuals spanning the activity range of arylamine N-acetyltransferase in their erythrocytes.
The purpose of this study was to determine whether a test developed to predict maximal oxygen consumption (VO2max) during over-ground walking, was similarly valid as a predictor of peak oxygen consumption (VO2) when administered during a 1-mile (1.61 km) treadmill walk. Treadmill walk time, mean heart rate over the last 2 full min of the walk test, age, and body mass were entered into both generalized (GEN Eq.) and gender-specific (GSP Eq.) prediction equations. Overall results indicated a highly significant linear relationship between observed peak VO2 and GEN Eq. predicted values (r = 0.91), a total error (TE) of 5.26 ml.kg-1.min-1 and no significant difference between observed and predicted peak VO2 mean values. The peak VO2 for women (n = 75) was predicted accurately by GSP Eq. (r = 0.85; TE = 4.5 ml.kg-1.min-1), but was slightly overpredicted by GEN Eq. (overall mean difference = 1.4 ml.kg-1.min-1; r = 0.86; TE = 4.56 ml.kg-1.min-1). No significant differences between observed peak VO2 and either GEN Eq. (r = 0.85; TE = 4.3 ml.kg-1.min-1) or GSP Eq. (r = 0.85; TE = 4.8 ml.kg-1.min-1) predicted values were noted for men (n = 48) with peak VO2 values less than or equal to 55 ml.kg-1.min-1. However, both equations significantly underpredicted peak VO2 for the remaining high peak VO2 men (n = 22). In conclusion, the over-ground walking test, when administered on a treadmill, is a valid method of predicting peak VO2 but underpredicts peak VO2 of subjects with observed high peak VO2 values.
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BACKGROUND: Oxygen therapy is effective in the prevention and treatment of oedematous exacerbations of cor pulmonale. As renal blood flow is reduced in cor pulmonale a study was designed to investigate whether one of the beneficial effects of oxygen was to increase renal blood flow. The effect of oxygen therapy on renal haemodynamics measured noninvasively was examined in patients with chronic obstructive airways disease and previous episodes of oedema. METHODS: Renal blood flow waveforms were recorded in a single vessel by colour flow Doppler ultrasound in nine hypoxaemic patients (PaO2) (arterial oxygen tension < 8 kPa while they were breathing air) with chronic obstructive airways disease and previous oedema and eight age matched normoxaemic volunteers (arterial oxygen saturation (SaO2) 97% or more when breathing air) while they were breathing air and oxygen. SaO2 and transcutaneous PaO2 (TcPO2) and PaCO2 (TcPCO2) were monitored. Five renal velocity profile recordings were made from the same segmental vessel with the patient breathing room air for one hour followed by oxygen titrated to achieve an oxygen saturation of 95% or more without a rise in TcPCO2 for 15 minutes. Control subjects breathed 35% oxygen. RESULTS: No significant change in the pulsatility index (a measure of distal vascular resistance) or mean height of the waveform (Tamx, a measure of renal blood flow) occurred in the control subjects while they were breathing air or oxygen. The pulsatility index of the patients with chronic obstructive airways disease was significantly greater than that in the control subjects breathing air (1.44 (SD 0.28) v 1.03 (0.14). Breathing oxygen was associated with an increase in TcPO2 in the patients (from 6.9 (1.9) to 11.5 (0.7) kPa), a fall in pulsatility index (from 1.44 (0.28) to 1.26 (0.14) and an increase in Tamx (from 0.187 (0.055) to 0.234 (0.087) m/s). CONCLUSIONS: The results suggest that renal vascular resistance is increased in patients with chronic obstructive airways disease and hypoxaemia and that short term oxygen therapy reduces renal vascular resistance and increases blood flow. Some of the benefits of oxygen therapy in cor pulmonale may be due to improvements in renal haemodynamics.
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AHS is a benign condition consisting of physiologic adaptations to the increased cardiac work load of exercise. Its primary features are biventricular hypertrophy and bradycardia associated with normal systolic and diastolic function. In addition, the alterations in cardiac structure are related to the type of training with dynamic training causing proportionally greater dilation and static training primarily increased wall thickness. AHS is associated with abnormalities in ECG, radiograph, and echocardiographic findings. It is important to be aware of these changes so that they are not misinterpreted to represent pathologic states. In particular, the distinction between AHS and HCM can be difficult, although certain historic and echocardiographic features can help differentiate the two.
Thirty-eight female subjects (M +/ SD = 33 +/- 3.0 years) had VO2max measured on the cycle ergometer (M +/- SD = 37.3 +/- 6.4 ml.kg-1.min-1) and on the treadmill (M +/- SD = 41.3 +/- 6.6 ml.kg-1.min-1). VO2max was estimated for each subject from heart rate (HR) at submaximal workloads on the cycle ergometer using the Astrand-Rhyming nomogram (A/R) and the extrapolation method (XTP). VO2max was also estimated from three field tests: 1.5-mile run (RUN) (independent variable [IV] = time), mile walk (WALK) (IV = time, age, HR, gender, body weight), and the Queens College Step Test (ST) (IV = HR during 5-20 s recovery). Repeated measure ANOVA revealed significant mean differences between the criterion cycle ergometer VO2max versus A/R and XTP (20 and 12% overestimation). The WALK, RUN, and ST VO2max values were not significantly different from the criterion treadmill VO2max. The correlation between criterion VO2max estimated from the WALK and RUN were r = .73 (SEE = 4.57 ml,kg-1.min-1) and r = .79 (SEE = 4.13 ml.kg-1.min-1), respectively. The ST, A/R, and XTP had higher SEEs (13-13.5% of the mean) and lower r s (r = .55 to r = .66). These results suggest both the WALK and RUN tests are satisfactory predictors of VO2max in 30 to 39-year-old females.
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An equation was developed to estimate maximal oxygen uptake (VO2max, ml.kg-1.min-1) based on a single submaximal stage of a treadmill walking test. Subjects (67 males, 72 females) aged 20-59 yr completed 4-min stages at 0, 5, and 10% grades walking at a constant speed (2.0-4.5 mph) and then performed a VO2max test. Heart rate and respiratory gas exchange variables were measured during the test. Multiple regression analysis (N = 117) to estimate VO2max from the 4-min stage at 5% grade yielded the following model (R2 = 0.86; SEE = 4.85 ml.kg-1.min-1): VO2max = 15.1 + 21.8*SPEED (mph) -0.327*HEART RATE (bpm) -0.263*SPEED*AGE (yr) + 0.00504*HEART RATE*AGE + 5.98*GENDER (0 = Female; 1 = Male). The constant and all coefficients were highly significant (P less than 0.01). To assess the accuracy of the model in a cross-validation group (N = 22), an estimated VO2max value was obtained using the above model. Estimated VO2max then was regressed on observed VO2max yielding the following equation (R2 = 0.92): ESTIMATED VO2max = 0.15 + 1.03*OBSERVED VO2max. The intercept and slope of this equation were not significantly different from 0 and 1, respectively. For 90.9% of the subjects in the cross-validation group, residual scores were within the range of +/- 5 ml.kg-1.min-1. In conclusion, this submaximal walking test based on a single stage of a treadmill protocol provides a valid and time-efficient method for estimating VO2max.
ST-segment depression was measured during submaximal dynamic (treadmill) and combined isometric-dynamic (isodynamic) exercise at comparable rate-pressure products in 11 patients (mean age 63 years) with stable coronary artery disease who were participating in an exercise training program. Each patient completed 3 separate trials. Trial 1 (baseline) was a submaximal treadmill exercise test to determine the threshold heart rate-systolic blood pressure (rate-pressure product) for ST-segment depression (greater than or equal to 1.0 mm). During trials 2 and 3, patients performed (in random order) dynamic treadmill exercise and isodynamic exercise (treadmill walking 1.5 to 2.0 mph carrying 15 to 25 kg) until threshold rate-pressure product was achieved. During trial 1, each patient showed significant ST depression (mean 1.7 mm) at target rate-pressure product (mean 18,200). Subsequent dynamic exercise trials 2 and 3 showed similar mean ST depression (1.5 mm) and rate-pressure product (18,000). During isodynamic exercise trials 2 and 3, subjects showed only minimal ST depression (mean 0.4 mm) at a rate-pressure product similar to dynamic exercise (mean 18,590). Heart rates were significantly lower (-10/min) and systolic (+20 mm Hg) and diastolic (+25 mm Hg) pressure was higher during isodynamic exercise (p less than 0.05). The rate-pressure product is not a valid index of ST response during isodynamic exercise in stable exercise-trained cardiac patients. Attenuation of ST depression during isodynamic exercise may be attributed to a combination of increased diastolic perfusion pressure, decreased heart rate and possibly to reductions in venous return and ventricular diastolic wall tension due to increased intrathoracic and abdominal pressure.
The aim of this study was to determine whether the non-steroidal anti-inflammatory drug, flurbiprofen, which has been shown to be an inhibitor of alveolar bone loss in human periodontal disease, is present in human crevicular fluid (CF) following oral dosing. A method is described whereby routine high-performance liquid chromatography is used to detect the drug in only 20 microliters of CF. 5 volunteers abstained from toothbrushing for 21 days to induce experimental gingivitis and increase the resting flow of CF. 100 mg of flurbiprofen was taken by each volunteer on d 21-28. On d 21 and 28, serum and CF samples were taken prior to dosing and afterwards at 1, 2, 4 and 6 hours. On d 21 the mean peak concentration of the drug in serum was about 11 micrograms/ml and was found between 1-2 h after dosing. The respective values for CF (d 21) were 0.32 micrograms/ml and 4 h. On d 28 flurbiprofen was detected in both fluids prior to dosing. The mean peak concentrations after dosing had increased to 13.13 micrograms/ml (serum) and 0.46 micrograms/ml (CF) although the levels of the drug in CF remained relatively constant throughout the observation period on d 28. The results indicate that flurbiprofen may be detected in human CF after oral administration and that the levels are in excess of the plasma level, which in beagles has been shown to inhibit alveolar bone loss in periodontal disease.
The gonadotrophin releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH); gonadorelin] agonist buserelin is a promising new agent in the treatment of a variety of disorders in gynaecology and andrology, paediatrics and oncology. While a single dose of buserelin stimulates the release of pituitary gonadotrophins, multiple doses produce reversible pituitary desensitisation, and this specific blockade of gonadotrophin support to the gonads provides the basis for the drug's efficacy in conditions dependent on sex hormone secretion. Thus, buserelin provides comparable efficacy to orchidectomy or high dose estrogens in the treatment of hormone-sensitive prostate cancer and exhibits a lower incidence of adverse effects. During the early phase of treatment it may be particularly useful in combination with antiandrogens. Buserelin also appears promising in hormone-sensitive premenopausal breast cancer. Extensive studies have proven the value of buserelin in endometriosis, where it produces a transient remission with gradual recurrence of the disease on cessation of treatment. Surgical intervention is necessary in severe disease after buserelin-induced involution of the lesions. In patients with uterine leiomyoma, preliminary data suggest that buserelin may be beneficial in rendering surgery more conservative by reducing fibroid size, although it appears unlikely to preclude surgical intervention. The use of buserelin to induce a state of reversible hypogonadotrophism before administration of exogenous gonadotrophins is a promising strategy in the treatment of infertility associated with polycystic ovary syndrome and other conditions of infertility with underlying ovarian dysfunction; such a strategy also clearly enhances the efficiency of in vitro fertilisation programmes. Initial studies suggest its potential usefulness as a female contraceptive when administered intermittently in conjunction with a progestogen. Buserelin represents a first-line treatment of central precocious puberty. In endometriosis the adverse effect profile of buserelin is generally favourable, with hypoestrogenic effects such as hot flushes and vaginal dryness, and decreased libido, predominating. There is no apparent detrimental effect on lipid metabolism. The potential for adverse hypoestrogenic effects on bone mineral content with long term administration remains to be clarified. Thus, the GnRH agonist buserelin represents an advance in the treatment of a variety of gynaecological and andrological as well as paediatric and oncological conditions, infertility and other sex-hormone dependent conditions, with a low incidence of adverse treatment effects.
Coronavirus-like particles have been detected by electron microscopy in fecal samples from naturally occurring cases of epizootic catarrhal gastroenteritis (ECG) of mink. Preliminary transmission trials with bacteria-free filtrates from mink with ECG suggested that a coronavirus plays a role in the disease syndrome.