Biomedical subjects

C Cox

Publications and source records attributed to C Cox.

At least 109 records · Page 6Linked to original sources

PubMed1999

Cerebrovascular risk factors and depression in older primary care patients: testing a vascular brain disease model of depression.

The authors examined whether cerebrovascular risk factors (CVRFs) are associated with depressive diagnoses and symptoms in 303 primary-care patients age >/=60 years, as would be consistent with a small-vessel brain disease model of later-life depression. CVRFs were not significantly independently associated with major, minor, or subsyndromal depression, late-onset major depression, or overall depressive symptom severity. These data did not support the notion that a small-vessel brain disease model of depression might apply to the majority of older persons with depressive symptoms and syndromes in primary-care settings. Future work should include longitudinal study with larger sample sizes.

Aged↗

PubMed1999

The importance of subsyndromal depression in older primary care patients: prevalence and associated functional disability.

OBJECTIVE: Existing diagnostic categories for depression may not encompass the majority of older people suffering clinically significant depressive symptoms. We have described the prevalence of subsyndromal depressive symptoms and tested the hypothesis that patients with subsyndromal depression have greater functional disability and general medical burden than nondepressed subjects but less than patients with diagnosable depressions. METHODS: Subjects were 224 patients, aged 60 years and older, recruited from private internal medicine offices or a family medicine clinic. Validated measures of psychopathology, medical burden, and functional status were used. The subsyndromal depression group was defined by a score of more than 10 on the Hamilton Rating Scale for Depression and by the absence of major or minor depressive disorder. Analyses included multiple regression techniques to determine the presence of group differences adjusted for demographic covariates. RESULTS: Subsyndromal depression was common (estimated point prevalence of 9.9% compared with 6.5% for major depression, 5.2% for minor depression, and .9% for dysthymic disorder), associated with functional disability and medical comorbidity to a degree similar to major or minor depression, and often treated with antidepressant medications. CONCLUSIONS: Although depressive conditions are common and are associated with considerable functional and medical morbidity in older primary care patients, many patients with clinically significant depressive symptoms are not captured by criteria-based syndromic diagnostic categories. Future work should include intervention studies of subsyndromally depressed older persons as well as attention to the course and biopsychosocial concomitants of diagnosable and subsyndromal depressions in this population.

Aged↗

PubMed1999

Diabetes and dementia in long-term care.

OBJECTIVES: To examine the presence or absence of dementia, and the prevalence rates for different dementias, in patients with and without adult onset diabetes (AODM). DESIGN: Chart survey. SETTING: A public long-term care facility in Rochester, New York, chosen to provide an enriched sample with respect to the diseases and demographic variables of interest. PARTICIPANTS: All long-term care residents in the facility aged 50 years or older (n = 476), mean age 74.8 years. Thirty-six (7.6%) had probable Alzheimer's disease (AD), 49 (10.3%) had possible AD, 38 (8.0%) had clinically diagnosed vascular dementia, 84 (17.6%) had unspecified dementias, and 269 (56.5%) were not demented. MEASUREMENTS: Demographic data, dementia and diabetes determined on the basis of extraction of chart data, and hypertension, myocardial infarction, congestive heart failure, and hypercholesterolemia determined on the basis of chart diagnoses. RESULTS: There were 99 residents with AODM in the sample, a prevalence rate of about 21%. The rates of both dementia and AODM were as expected for this age group and setting. Patients with probable or possible AD had the lowest rates of AODM (0 and 6.1%, respectively), and patients with vascular dementia had the highest rates of AODM (47.4%). Age, sex, and race influenced both the risk of having a dementia and the type of dementia. When these variables were adjusted for in multiple logistic regression, however, AODM remained a robust predictive factor because of its significant negative association with AD. Patients with unspecified dementias and no dementia showed rates of AODM (about 20%) that were roughly comparable and intermediate between vascular dementia and AD. CONCLUSIONS: In our study, AD diagnosed clinically and AODM did not co-occur, whereas AODM was associated with vascular dementia diagnosed clinically. Conversely, in non-Alzheimer, nonvascular dementias diagnosed clinically, the rates of AODM were equivalent to those in nondemented patients. These findings are in agreement with some, but not all, previous studies.

Age Distribution↗

PubMed1999

Ozone exposure increases aldehydes in epithelial lining fluid in human lung.

We hypothesized that exposure of healthy humans to ozone causes both ozonation and peroxidation of lipids in lung epithelial lining fluid. Twelve smokers and 15 nonsmokers (eight lung function "responders" and seven "nonresponders") were exposed once to air and twice to 0. 22 ppm ozone for 4 h with exercise in an environmental chamber, with each exposure separated by at least 3 wk. Bronchoalveolar lavage (BAL) was performed immediately after one ozone exposure and 18 h after the other ozone exposure. BAL fluid was analyzed for the aldehyde products of ozonation and lipid peroxidation, nonanal (C9) and hexanal (C6), as well as total protein, albumin, and immunoglobulin M as markers of changes in epithelial permeability. Ozone exposure resulted in a significant early increase in C9 (p = 0. 0001), with no statistically significant relationship between increases in C9 and lung function changes, airway inflammation, or changes in epithelial permeability. Increases in C6 levels were not statistically significant (p = 0.16). Both C9 and C6 levels returned to baseline by 18 h after exposure. These studies confirm that exposure to ozone with exercise, at concentrations relevant to urban outdoor air, results in ozonation of lipids in the airway epithelial lining fluid of humans.

Adolescent↗

PubMed1999

Effects of group treatment for women with a history of childhood sexual abuse.

OBJECTIVE: Empirical support for the effectiveness of group therapies for women with a history of childhood sexual abuse is scant. This study examined the feasibility of conducting abuse-focused research and group treatment on a short-term unit and evaluated the effectiveness of the Women's Safety in Recovery group. METHODS: Eighty-six women with a history of childhood sexual abuse participated in treatment as usual (N=38) or in the Women's Safety in Recovery group (N=48). The latter group met three times weekly for one hour, focusing on patients' current safety and self-care. Participants completed the Symptom Checklist-Revised at baseline, discharge, and six-month follow-up. Patients rated their experience in treatment at discharge and six-month follow-up, and therapists rated patients' treatment experiences at discharge. The feasibility of the treatment group was measured by enrollment rates, group attendance, and attrition. RESULTS: Eighty-two percent of eligible patients agreed to enroll in the study. Women's Safety in Recovery participants attended an average of ten group meetings. Seventy percent of enrollees completed discharge assessments, and of these, 82 percent completed the six-month follow-up. Compared with treatment-as-usual patients, Women's Safety in Recovery participants reported greater symptom improvement and reported that their childhood sexual abuse issues had been more thoroughly addressed. These differences were present at discharge and at six-month follow-up. Therapists also perceived that abuse issues of these participants had been more thoroughly addressed. CONCLUSIONS: Women's Safety in Recovery participants reported significant reductions in distress compared with those receiving treatment as usual. The abuse-focused research program and the Women's Safety in Recovery group proved feasible, despite attrition.

Adaptation, Psychological↗

PubMed1999

Withdrawal from controlled carbamazepine therapy followed by further carbamazepine treatment in patients with dementia.

BACKGROUND: The aim of this study was to assess the effects of withdrawal from placebo and carbamazepine administered for agitation associated with dementia and to assess safety, tolerability, and efficacy of subsequent ongoing carbamazepine therapy. METHOD: We previously reported the results of a 6-week, randomized, parallel-group study of placebo versus carbamazepine in 51 nursing home patients with dementia who were agitated; 47 subjects completed that study. This report first presents the results of withdrawal from that experimental treatment assessed by (blinded) observations 3 weeks later (N = 45 remaining). The primary outcome measure was the Brief Psychiatric Rating Scale. Secondary outcome measures addressed other aspects of behavior, cognition, function, safety, and tolerability. Patients were then treated with carbamazepine for an additional 6 weeks (N = 32 remaining) or 12 weeks (N = 25 remaining), with the same assessments performed. RESULTS: Patients who had previously shown behavioral improvement with carbamazepine therapy reverted to their baseline state after washout, whereas there was no change in the patients previously treated with placebo. There were no other significant effects of washout. During subsequent therapy with carbamazepine at a modal dose of 300 mg/day, there were 2 deaths and 4 other adverse events resulting in dropout. Neither of the deaths, and only 1 serious adverse experience, was judged to be related to carbamazepine. There were a variety of nonserious adverse experiences during the trial. Behavior ratings showed ongoing improvement in agitation and aggression, as well as in other aspects of psychopathology. CONCLUSION: The washout data provided independent confirmation of efficacy found in the prior placebo-controlled phase of this trial. Ongoing treatment was not associated with unexpected toxicity and was associated with improvement in measures of agitation and aggression that appeared to continue for up to 12 weeks. These findings confirm and extend results from earlier placebo-controlled studies.

Aggression↗

PubMed1999

Age and suicidal ideation in older depressed inpatients.

Age-related patterns of symptom presentation may complicate the recognition of suicide risk. The authors sought to determine whether there is a relationship between age and reported suicidal ideation in depressed suicide attempters (DSAs) and depressed nonattempters (DNs) 50 years of age and over. Regression analyses revealed that increasing age is significantly associated with the absence of suicidal ideation in both DSAs and DNs. Because of their lower rates of depressed mood and suicidal ideation, the depressions of older adults may more readily escape detection. Preventive or treatment measures initiated after the onset of the suicidal state may be insufficient, and other preventive strategies ought to be considered.

Age Factors↗

PubMed1999

Attempted suicide in older depressed patients: effect of cognitive functioning.

The authors explored cognitive functioning and suicidal behavior in older depressed patients. Inpatients age 50 years or older (N=103) with major depression, 45 of whom had attempted suicide, were evaluated within 1 week of their hospital admission. Measures of suicidal behavior included suicide attempter status, the Suicide Intent Scale (SIS), ratings of method used (violent/nonviolent), and seriousness of injuries sustained (lethality). The Mini-Mental State Exam (MMSE) score measured cognitive impairment; covariates were age, gender, and living arrangement. The MMSE score was not associated with suicide attempter status, but for attempters, MMSE score showed a positive association with SIS score, but not method or lethality. Findings suggest that although cognitive disturbance may be associated with less-deliberate acts among older depressed suicide attempters, it does not appear to influence the potential lethality of their behavior.

Aged↗

PubMed1999

Association between prenatal exposure to methylmercury and developmental outcomes in Seychellois children: effect modification by social and environmental factors.

UNLABELLED: The Seychelles Child Development Study (SCDS) is testing the hypothesis that prenatal exposure to low doses of MeHg from maternal consumption of fish is associated with the child's developmental outcomes. No deleterious relationships between exposure to MeHg and cognitive functions have been identified in the primary analysis of the main cohort through 66 months of age. We performed secondary analyses to determine if effect modification (EM) from social and environmental factors was affecting associations between MeHg and outcomes. METHODS: MeHg exposure was determined by analysis of maternal hair growing during pregnancy. Children in our Main Study cohort were evaluated at 6.5 months (N = 740) for visual recognition memory and visual attention using the Fagan Infantest, at 19 months (N = 738) and 29 months (N = 736) with the Bayley Scales of Infant Development (BSID). Interactions between MeHg and Caregiver Intelligence, Family Income and Home Environment were examined by multiple regression analysis. RESULTS: The median prenatal MeHg exposure was 5.9 ppm (Range 0.5-26.7 ppm). No EM occurred for preferential looking or visual attention at 6.5 months, for the BSID Psychomotor Scale at either 19 or 29 months, or for activity level at 29 months as measured by the BSID Infant Behavior Record. Interactions between MeHg level and both caregiver intelligence and family income were statistically significant for the BSID Mental Scale at 19 months but not at 29 months. These showed enhancement of MDI scores with increasing maternal MeHg in higher caregiver IQ groups at several levels of family income. CONCLUSIONS: In Seychellois children, consistent major EM by social or environmental factors were not identified. The small EM by caregiver intelligence and social factors at 19 months is consistent with the enhanced performance we reported when this cohort was examined at 66 months.

Attention↗

PubMed1999

Aldehydes (nonanal and hexanal) in rat and human bronchoalveolar lavage fluid after ozone exposure.

We hypothesized that exposure of healthy humans to ozone at concentrations found in ambient air causes both ozonation and peroxidation of lipids in lung epithelial lining fluid. Smokers (12) and nonsmokers (15) were exposed once to air and twice to 0.22 ppm ozone for four hours with exercise in an environmental chamber; each exposure was separated by at least three weeks. Bronchoalveolar lavage (BAL) was performed immediately after one ozone exposure and 18 hours after the other ozone exposure. Lavage fluid was analyzed for two aldehyde products of ozonation and lipid peroxidation, nonanal and hexanal, as well as for total protein, albumin, and immunoglobulin M (IgM) as markers of changes in epithelial permeability. Ozone exposure resulted in a significant early increase in nonanal (p < 0.0001), with no statistically significant relationship between increases in nonanal and lung function changes, airway inflammation, or changes in epithelial permeability. Increases in hexanal levels were not statistically significant (p = 0.16). Both nonanal and hexanal levels returned to baseline by 18 hours after exposure. These studies confirm that exposure to ozone with exercise at concentrations relevant to urban outdoor air results in ozonation of lipids in the airway epithelial lining fluid of humans.

Adult↗

PubMed1998

Thermodynamic parameters for an expanded nearest-neighbor model for formation of RNA duplexes with Watson-Crick base pairs.

Improved thermodynamic parameters for prediction of RNA duplex formation are derived from optical melting studies of 90 oligoribonucleotide duplexes containing only Watson-Crick base pairs. To test end or base composition effects, new sets of duplexes are included that have identical nearest neighbors, but different base compositions and therefore different ends. Duplexes with terminal GC pairs are more stable than duplexes with the same nearest neighbors but terminal AU pairs. Penalizing terminal AU base pairs by 0.45 kcal/mol relative to terminal GC base pairs significantly improves predictions of DeltaG degrees37 from a nearest-neighbor model. A physical model is suggested in which the differential treatment of AU and GC ends accounts for the dependence of the total number of Watson-Crick hydrogen bonds on the base composition of a duplex. On average, the new parameters predict DeltaG degrees37, DeltaH degrees, DeltaS degrees, and TM within 3.2%, 6.0%, 6.8%, and 1.3 degreesC, respectively. These predictions are within the limit of the model, based on experimental results for duplexes predicted to have identical thermodynamic parameters.

Base Pairing↗

PubMed1998

Effects of prenatal and postnatal methylmercury exposure from fish consumption on neurodevelopment: outcomes at 66 months of age in the Seychelles Child Development Study.

CONTEXT: Human neurodevelopmental consequences of exposure to methyl-mercury (MeHg) from eating fish remain a question of public health concern. OBJECTIVE: To study the association between MeHg exposure and the developmental outcomes of children in the Republic of Seychelles at 66 months of age. DESIGN: A prospective longitudinal cohort study. PARTICIPANTS: A total of 711 of 779 cohort mother-child pairs initially enrolled in the Seychelles Child Development Study in 1989. SETTING: The Republic of Seychelles, an archipelago in the Indian Ocean where 85% of the population consumes ocean fish daily. MAIN OUTCOME MEASURES: Prenatal and postnatal MeHg exposure and 6 age-appropriate neurodevelopmental tests: the McCarthy Scales of Children's Abilities, the Preschool Language Scale, the Woodcock-Johnson Applied Problems and Letter and Word Recognition Tests of Achievement, the Bender Gestalt test, and the Child Behavior Checklist. RESULTS: The mean maternal hair total mercury level was 6.8 ppm and the mean child hair total mercury level at age 66 months was 6.5 ppm. No adverse outcomes at 66 months were associated with either prenatal or postnatal MeHg exposure. CONCLUSION: In the population studied, consumption of a diet high in ocean fish appears to pose no threat to developmental outcomes through 66 months of age.

Central Nervous System Diseases↗

PubMed1998

Expression profiles of multiple genes in single neurons of Alzheimer's disease.

Many changes have been described in the brains of Alzheimer's disease (AD) patients, including loss of neurons and formation of senile plaques and neurofibrillary tangles. The molecular mechanisms underlying these pathologies are unclear. Northern blot, dot-blot, and reverse transcription-coupled PCR analyses have demonstrated altered expression levels of multiple messages in AD brain. Because not all cells are equally affected by the disease, these methods obviously cannot study the changes in relation to disease states of individual cells. We address this problem by using antisense RNA profiling of single cells. We present expression profiles of single neurons at early and late stages of AD and describe statistical tools for data analysis. With multivariate canonical analysis, we were able to distinguish the disease state on the basis of altered expression of multiple messages. To validate this approach, we compared results obtained by this approach with results obtained by in situ hybridization analysis. When the neurofilament medium subunit was used as a marker, our results from an antisense RNA profiling revealed no change in neurofilament medium subunit expression between early- and late-stage AD, consistent with findings obtained with in situ hybridization. However, our results obtained by either analysis at the single-cell level differed from the reported decrease in AD neocortex obtained by Northern blot analysis [Kittur, S., Hoh, J., Endo, H., Tourtellotte, W., Weeks, B. S., Markesbery, W. & Adler, W. (1994) J. Geriatr. Psychiatry Neurol. 7, 153-158]. Thus, the strategy of using the single-cell antisense RNA approach to identify altered gene expression in postmortem AD brain, followed by detailed in situ hybridization studies for genes of interest, is valuable in the study of the molecular mechanisms underlying AD neuropathology.

Aged↗

PubMed1998

The semi-quantitative assessment of menstrual flow in relation to clinical and hematological parameters.

The hemostasis of menstruation has not been extensively studied particularly since the development of laboratory tests for von Willebrand factor, a glycoprotein that plays a critical role platelet aggregation.Objective: To determine the relationship of menstrual flow to clinical and hematological parameters.Methods: We studied 155 (56 blood type O/99 blood type non-O) normal female volunteers that met the following criteria: age 12-50; not taking an oral contraceptive, estrogen, or Coumadin; not pregnant; regular periods. A questionnaire was administered regarding the patient's medical history. A pictorial chart score of menstrual blood flow was obtained using standard tampons/pads for all participants; this semi-objective measure has previously been validated to be diagnostic of menorrhagia at a score of >185. Menstrual coagulation sampling was within the first 3 days of the cycle. We then analyzed by multiple linear regression analysis the pictorial chart score assuming a log-normal distribution as a dependent variable with the following clinical and laboratory parameters as independent variables.Results: The mean age was 35.7 +/- 7.4 years. The mean pictorial chart score was 119.1 +/- 76.3.Conclusion: A history of prior births and laboratory evidence of a low von Willebrand factor antigen appear to predict for increased menstrual flow; studies are ongoing in applying these parameters in women presenting with menorrhagia.

Journal Article↗

PubMed1998

The substantial impact of von Willebrand disease on menstruation.

von Willebrand disease (vWd) is the most common of all congenital bleeding disorders with an estimated prevalence of 1-3% in the general population. However, the gynecological complications have not been thoroughly described.Objective: To compare the clinical and quality of life aspects of vWd in menstruating women in relation to a cohort of menstruating women in the general population.Methods: A patient questionnaire and provider survey of the medical and quality of life aspects of menstruation was administered to 81 menstruating vWd patients registered at four geographically linked Hemophilia Treatment Centers. The questionnaire was also administered to 150 menstruating women volunteers that comprised a control group used to determine normal coagulation levels in menstruating women. We assessed the impact on quality of life of menses in both of the cohorts by a Likert scale of 1-10 with 10 being "most significant impact" using 7 quality of life parameters with those comparisons by Wilcoxon rank sum test.Results: 88% of the vWd patients (pts) had type I vWd, the remaining Type II or unknown. The mean age of the vWd patients was 31.6 +/- 10.3; the mean age of the control group was 35.5 +/- 7.6. The following comparisons were made using chi(2) and Wilcoxon rank sum test:Conclusions: vWd markedly diminishes the quality of life during menses. This observation warrants efforts to reduce the attendant morbidities of vWd in menstruating women.

Journal Article↗

PubMed1998

Lack of prenatal care increases the rate of recurrent preterm delivery and health care costs when compared to university hospital-based prenatal care.

Objective: To compare perinatal outcomes and total health care costs for patients with a previous history of preterm delivery (PTD) cared for in an inner-city university hospital house staff (HS) clinic vs pregnant patients who have not received any prenatal care (NPC).Study Design: We conducted a retrospective review of pregnant women with a history of PTD delivered at our institution between January 1994 and December 1996. Inclusion criteria were a history of at least one previous PTD. Prenatal care was given in a comprehensive setting in a teaching hospital. Exclusion criteria were infants with major malformations and multiple gestations. Data were obtained on maternal demographics and history of prenatal visits.Results: The study groups consisted of 96 HS and 53 NPC patients. There were no differences in maternal demographics, however, the number of prior preterm births was greater in the NPC group (1.59 vs 1.23, P =.003). The incidence of recurrent PTD (<34 weeks) was greater in the NPC group (49% vs 13%, P = <.001). The mean gestational age at time of delivery was decreased in the NPC group (33 weeks vs 37.2 weeks, P = <.001). The length of NICU stay was greater in the NPC group (15.6 vs 3.1 days, P =.001). The mean birth weight was less in the NPC group (2172 g vs 2786 g, P = <.001). The mean total mother-infant costs were significantly less in the HS group ($7,127 vs $18,047, P =.003). Even HS patients with only one prenatal visit had a significantly lower incidence of PTD (16% vs 75%, P =.04).Conclusions: Inner-city patients with a history of PTD who received even minimal prenatal care in a university HS clinic had a significantly lower incidence of recurrent PTD than those who had no prenatal care. Prenatal care also lowers total health care costs in women with a history of PTD. The coordinated multidisciplinary aspect of care provided at academic centers may have a positive impact on the problem of PTD.

Journal Article↗

PubMed1998

A study of the impact of influenza on the functional status of frail older people.

BACKGROUND: Excess hospitalization and death are well-known impacts of influenza on older people; however, little is known regarding the impact of influenza on functional status. We hypothesized that frail older people are at risk of functional decline as an outcome of influenza. OBJECTIVE: To measure the effect of acute influenza on the physical and mental status of older patients residing in nursing homes. METHODS: Our study was conducted in 6 nursing homes that participated in the Medicare Influenza Vaccine Demonstration and experienced laboratory-confirmed outbreaks of influenza in 1991 and 1992. A case-comparison design was used. One hundred sixteen of 131 residents who developed influenza-like illness and survived at least 4 months served as the case subjects; 127 of 132 residents without influenza-like illness who survived served as the comparison subjects. Measures of functional status 1 to 2 months before outbreak and 1 to 2 months and 3 to 4 months after outbreak were collected from medical records. Matched pairs analyses were conducted to ascertain changes in selected measures of functional status within each of the study groups. Wilcoxon signed rank tests for statistical significance were used. RESULTS: Among surviving case subjects and comparison subjects, 25% and 15.7%, respectively, experienced decline in at least 1 major function (P=.04). Case subjects experienced significant decline in independence in bathing, dressing, and mobility while comparison subjects experienced decline in mental status. CONCLUSIONS: Within the limitations of this study, influenza is observed to cause decline in major physical functions in more than 9% of survivors. Such disabling outcomes constitute an important new measure of impact of influenza on the frail elderly.

Activities of Daily Living↗

PubMed1998

Binding of tissue-plasminogen activator to fibrin: effect of ultrasound.

Ultrasound reversibly alters the structure of polymerized fibrin, an effect that could influence tissue-plasminogen activator (t-PA) binding. We have, therefore, characterized the effects of ultrasound on binding of t-PA to fibrin using a novel system in which radiolabeled, active-site blocked, single chain tissue-plasminogen activator flowed through a fibrin gel at constant rate, and specific binding was determined by monitoring incorporation of radiolabel. Results using polymerized fibrin were compared with those using a surface of fibrin immobilized on Sepharose beads in a similar system. Interaction of t-PA with surface-immobilized fibrin involved two classes of binding sites (Kd = 31 nmol/L and 244 nmol/L) and a maximum binding ratio of 3.8 mol t-PA/mol fibrin. Ultrasound increased Kd for the high affinity site to 46 nmol/L (P < .0001), but it had no significant effects on the Kd 244 nmol/L site nor on Bmax. Tissue-plasminogen activator binding to noncrosslinked fibrin involved two sites with Kds of 267 nmol/L and 952 nmol/L, while a single Kd 405 nmol/L site was identified for crosslinked fibrin. Ultrasound had no significant effect on the binding affinity for noncrosslinked fibrin, but Bmax was increased in the presence of ultrasound, from 31 mumol/L to 43 mumol/L (P < .0001). Ultrasound decreased the Kd for crosslinked fibrin to 343 nmol/L (P = .026) and also increased Bmax from 22 mumol/L to 25 mumol/L (P = .015). Ultrasound also affected the kinetics of t-PA binding to fibrin, significantly accelerating the rate of dissociation by 77% +/- 5% for noncrosslinked fibrin and by 69% +/- 3% for crosslinked fibrin (P < .001 for each). These results indicate that ultrasound exposure accelerates t-PA binding, alters binding affinity, and increases maximum binding to polymerized fibrin, effects that may result from ultrasound-induced changes in fibrin structure.

Binding Sites↗