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Biomedical subjects

C Hall

Publications and source records attributed to C Hall.

At least 73 records · Page 4Linked to original sources

Unusual presentation of polyarteritis nodosa.

We describe an unusual presentation of a localized form of polyarteritis nodosa (PAN) manifested by acute onset of severe calf pain. Biopsies of the gastrocnemius muscle and fascia revealed an acute necrotizing arteritis with fasciitis. The lumens of affected vessels were occluded by thrombi. PAN localized to calf muscles is extremely rare. To our knowledge this is the first report of evidence of fascial involvement believed to contribute to the severity of the clinical features of PAN. The occurrence of multiple intraluminal thrombi in conjunction with anticardiolipin antibodies suggested the possibility of a coexisting coagulopathy, and they were also likely contributors to the severity of the pain.

Antibodies, Anticardiolipin↗

Immuno-PET of human colon xenograft- bearing BALB/c nude mice using 124I-CDR-grafted humanized A33 monoclonal antibody.

UNLABELLED: Radiolabeling monoclonal antibodies (mAbs) allows the evaluation of biodistribution of constructs in vivo through gamma camera imaging and also permits quantitation of mAb uptake in tumors through biopsy-based counting techniques. The quantitation of radiolabeled mAb uptake in cancer patients is complicated by the attenuation of gamma emissions of routinely used isotopes (e.g., 131I and 111In) and the spatial resolution and sensitivity of gamma cameras. METHODS: We used the positron-emitting isotope 124I (half-life [T1/2] = 4.2 d) to label the recombinant humanized anti-colorectal cancer A33 antibody (huA33) and evaluated its biodistribution properties and PET imaging characteristics in BALB/c nude mice bearing SW1222 colorectal xenografts and control colon tumors. RESULTS: The immunoreactivity of radioconjugate was 78% as determined using the cell-binding Lindmo assay. The apparent association constant was found to be 2.2 x 10(9) M(-1), and the number of antibody binding sites per cell was 371,000. The radioconjugate was found to be stable in serum obtained from mice at various times after injection. Assuming a two-compartment model with a four-parameter fit of mean blood levels, the T1/2alpha was 1.5 h and the T1/2beta was 38.2 h. Excellent tumor uptake was obtained, with maximal uptake reaching 50.0 +/- 7.0 percentage injected dose per gram of tumor by 4 d after injection. Specificity of localization was shown by lack of uptake in control tumor. PET imaging detected antigen-positive tumor by 4 h after injection, and high-resolution images were obtained by 24 h after injection. CONCLUSION: In clinical trials using PET, huA33 labeled with 124I has potential for imaging and staging colon tumors and quantifying antibody uptake in colon tumors in vivo.

Animals↗

Postural sway of subjects wearing the U.S. Army chemical protective ensemble after functional activity.

BACKGROUND: This study assessed the effects of wearing the chemical protective clothing ensemble (CPE) vs. the battle dress uniform (BDU) on postural sway after 18 min of simulated field activity. Postural sway is a measure of static balance where a person maintains his/her center of gravity over his/her base of support by swaying fore to aft usually around the ankle joint axis. HYPOTHESES: Subjects' postural sway would increase more post-exercise while wearing the CPE vs. the BDU. The increase in postural sway while wearing the CPE would be due to decreased visual and somatosensory inputs. METHODS: Static balance was measured on 25 subjects pre- and post-exercise on the NeuroCom SMART Balance Master using the Sensory Organization Test protocol. Following a test-retest, repeated measures design, each subject completed the protocol twice, once while wearing only the BDU and once while wearing the CPE. RESULTS: A 2 x 2 repeated measures, multivariate analysis of variance revealed no significant difference between the static balance of subjects wearing the CPE vs. wearing the BDU pre- or post-exercise. CONCLUSIONS: The authors suggest that the wearing of the CPE does not affect static balance, even after completing 18 min of functional tasks. Future research should objectively quantify the amount of fatigue postexercise and employ a protocol that has been previously shown to increase postural sway.

Adult↗

Postexercise ischemia is associated with increased neuropeptide Y in patients with coronary artery disease.

BACKGROUND: Neurohormones may influence vascular tone both during and after exercise. Neuropeptide Y (NPY), which is costored and released with norepinephrine (NE) during sympathetic activity, is a potent vasoconstrictor with a relatively long half-life. We therefore examined its possible association with the ischemic response to exercise in patients with coronary artery disease. METHODS AND RESULTS: Twenty-nine male patients with effort-induced angina pectoris underwent a symptom-limited exercise test. In addition to conventional ST-segment analysis, we examined ischemia on the basis of heart rate (HR)-adjusted ST-segment changes through calculation of the ST/HR slope during the final 4 minutes of exercise and of the ST/HR recovery loop after exercise. Blood samples were taken before, during, and after exercise for an analysis of several neurohormones. Mean ST-segment depression was -223+/-20.2 microV (P:<0.0001) just before the termination of exercise, followed by a gradual normalization, but it remained significant after 10 minutes (-49+/-8.9 microV, P:<0.0001). At the end of exercise, the ST/HR slope, which reflects myocardial ischemia, was -6.0+/-0.77 microV/HR. In most patients, ST-segment levels at a given HR were lower during recovery than during exercise, here referred to as ST "deficit." Exercise increased the plasma levels of NPY, NE, epinephrine, and N-terminal proatrial natriuretic peptide, but big endothelin remained unchanged. Although NE and epinephrine peaked at maximal exercise, the highest levels of NPY and N-terminal proatrial natriuretic peptide were observed 4 minutes after exercise. The maximal increase in the NPY correlated significantly with ST-segment depression at 3 minutes after exercise (r=-0.61, P:= 0.0005), the ST deficit at the corresponding time point (r=-0.66, P:= 0.0001), and the duration of ST-segment depression after exercise (r= 0.42, P:=0.02). In contrast, no such correlations were found for NE. CONCLUSIONS: The present study has for the first time demonstrated a correlation between plasma NPY levels and the degree and duration of ST-segment depression after exercise in patients with coronary artery disease, which suggests that NPY may contribute to myocardial ischemia in these patients.

Analysis of Variance↗

Time- and space-resolved dynamic studies on ceramic and cementitious materials.

A review is given of the results and lessons arising from a sustained in situ diffraction study of the structure and performance of functional ceramic/cementitious materials in which synchrotron-based energy-dispersive diffraction has been the central under-pinning technique. Five particular points of discussion emerge: the demands on time resolution; the use of penetrating radiation for the in situ mode; the need for complementary techniques; re-analysing of data; spatially resolved diffraction: a new tomography. These aspects are discussed in turn using illustrative examples taken from the fields of cement hydration, clay intercalation, cation-exchanged zeolites, and particulate/fluid invasion into building and archaeological objects.

Journal Article↗

Partial Wetting in Capillary Liquid Absorption by Limestones.

We report measurements of the capillary absorption (imbibition) of water, n-heptane, n-decane, n-dodecane, methanol, ethanol, propan-2-ol, and ethanol-water mixtures into a number of dry calcitic limestones. The data are analyzed on the basis of unsaturated flow theory to give values of sorptivity S for water and for each organic liquid at different temperatures. The results show that for the organic liquids S varies as (surface tension/viscosity)(1/2) but that for the water S is anomalously low, indicating partial wetting. The wettability of these limestones is discussed in relation to natural contamination of the pore surface. Copyright 2000 Academic Press.

Journal Article↗

Exotic pets.

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Animals↗

Memory impairment on free and cued selective reminding predicts dementia.

OBJECTIVE: To estimate the relative rates of dementia in initially nondemented subjects with and without memory impairment defined by baseline free recall from the Free and Cued Selective Reminding (FCSR) test. BACKGROUND: Our approach to identifying persons at high risk for future dementia is to show the presence of memory impairment not caused by other cognitive deficits by using a memory test that controls attention and cognitive processing. When the conditions of testing are not adequately controlled, prediction is reduced because age-associated memory deficits due to other cognitive deficits are confused with dementia-associated memory deficits. METHODS: Longitudinal evaluation of 264 initially nondemented, elderly community volunteers from the Einstein Aging Study with clinical and psychometric examinations every 12 to 18 months for up to 10 years. MAIN OUTCOME MEASURES: Dementia was defined by an algorithmic definition that required a Blessed Information Memory and Concentration score >8 and clinical evidence of functional decline. RESULTS: Thirty-two incident cases of dementia developed during follow-up. Survival analyses indicated that subjects with impaired free recall at baseline had dementia develop (relative risk = 75.2, 95% CI = 9.9 to 567) over 5 years of follow-up at dramatically higher rates than subjects with intact free recall after adjusting for age, gender, and education. CONCLUSION: Poor performance on free recall from FCSR predicts future dementia. These findings support the existence of a preclinical phase of dementia characterized by memory impairment, which is present for at least 5 years before diagnosis.

Aged↗

Neurohormonal activation in severe heart failure: relations to patient death and the effect of treatment with flosequinan.

BACKGROUND: Flosequinan is a direct-acting vasodilator that exerts beneficial hemodynamic effects and improves the exercise tolerance of patients with heart failure. However, a multicenter trial has demonstrated that long-term administration of flosequinan is associated with increased mortality rate. To explore a possible role of neurohormonal activation on this adverse outcome, we conducted a substudy to examine the plasma levels of 3 neurohormonal systems known to have prognostic implications in heart failure. METHODS: At 20 participating Canadian centers, paired plasma samples at baseline and 1 month after randomization for the measurement of N-terminal atrial natriuretic peptide (N-ANP), angiotensin II, and norepinephrine were obtained in 234 patients (114 receiving flosequinan and 120 receiving placebo). RESULTS: Treatment with flosequinan was associated with a decline in median plasma N-ANP levels (2139 pmol/L at baseline to 1625 pmol/L at 1 month [P =. 0001]), unchanged plasma angiotensin II levels (40 to 50 pmol/L [P =. 2700]), and a modest increase in plasma norepinephrine levels (391 to 439 pg/mL [P =.002]). These changes were not observed in the placebo group. Multivariate analysis of baseline variables revealed that plasma norepinephrine level predicted patients' death whereas analysis incorporating both baseline and 1-month variables indicated that plasma N-ANP level predicted patients' death. Furthermore, in the flosequinan group, a significant decline in plasma N-ANP level was observed in the survivors only. On multivariate analysis of baseline and 1-month data, the increase in plasma norepinephrine level did not predict the increase in heart rate associated with the use of flosequinan, suggesting that the 2 effects might be mediated by separate mechanisms. CONCLUSIONS: Results of our study demonstrate that in patients with severe heart failure, baseline norepinephrine level predicts death. Flosequinan increases plasma norepinephrine level and heart rate in these patients through mechanisms that override its beneficial hemodynamic effects. Our study reinforces the concept that the direct actions of a pharmacologic agent may have a more profound impact on the prognosis of these patients than the hemodynamic effects.

Aged↗

The 2-piece Le Fort I osteotomy for cranial base access: an evaluation of 9 patients.

PURPOSE: This article discusses the use of the 2-piece Le Fort I osteotomy to gain access to the cranial base and the authors' experiences with this technique. METHODS: Medical records of patients who required surgical access to the cranial base were retrospectively reviewed, and demographic data, procedures done, postoperative results, and complications were recorded. RESULTS: Nine patients underwent a 2-piece Le Fort I osteotomy. Complications included development of a pseudoaneurysm of the internal carotid artery in 1 patient, 2 cerebrospinal fluid leaks, both of which resolved, and 1 patient who lost 2 teeth and some associated bone. CONCLUSION: The 2-piece Le Fort I osteotomy provides excellent access to the clival region of the cranial base with minimal complications.

Adolescent↗

Prism adaptation in normal aging: slower adaptation rate and larger aftereffect.

The effect of aging on prism adaptation, a motor learning paradigm, was evaluated. Different measures were obtained from a task consisting of throwing clay balls to a target in front of the subjects before, during, and after wearing prisms that deviate the visual field by several degrees. When performing the task without wearing the prisms, the aged subjects showed a larger hit variance, whereas the young subjects hit closer to the target. When donning the prisms, the aged group adapted more slowly than the controls, although after throwing all the balls both groups showed the same adaptation levels. After removing the prisms, the aged group showed a larger aftereffect. These findings suggest that the aftereffect requires the involvement of non-cognitive and cognitive processes and indicate that both adaptation and aftereffect are influenced by aging.

Adaptation, Physiological↗

Biomechanical, psychosocial, and organizational risk factors for WRMSD: population-based estimates from the Connecticut upper-extremity surveillance project (CUSP).

In a case-control study of a population-based telephone survey of 3,798 working adults, symptoms of work-related musculoskeletal disorder (WRMSD) were associated with biomechanical, psychosocial, and organizational factors. In several models, biomechanical exposures with strong associations were static postures (odds ratios [ORs] = 2.00-5.45); repeated pushing, pulling, lifting (ORs = 1.86-12.75); and repeated neck bending (ORs = 1.07-12.8). Psychosocial and organizational factors consistently retained in these models were demands (ORs = 1.26-1.59) and organizational support (ORs = 0.53-0.79). Decision latitude entered less frequently (ORs = 0.30-0.49). This research may have implications for intervention strategies. First, reducing both biomechanical and psychosocial risk may be more effective than focusing solely on engineering controls. Second, organizational culture and policy may have strong implications for WRMSD prevalence and control.

Adult↗

Cardiac natriuretic peptides and continuously monitored atrial pressures during chronic rapid pacing in pigs.

Changes in atrial natriuretic peptide (ANP), N-terminal proatrial natriuretic peptide and brain natriuretic peptide (BNP) were evaluated in relation to continuously monitored atrial pressures in a pacing model of heart failure. Pigs were subjected to rapid atrial pacing (225 beats min-1) for 3 weeks with adjustments of pacing frequencies if the pigs showed overt signs of cardiac decompensation. Atrial pressures were monitored by a telemetry system with the animals unsedated and freely moving. Left atrial pressure responded stronger and more rapidly to the initiation of pacing and to alterations in the rate of pacing than right atrial pressure. Plasma natriuretic peptide levels were measured by radioimmunoassay and all increased during pacing with BNP exhibiting the largest relative increase (2.9-fold increase relative to sham pigs). Multiple regression analysis with dummy variables was used to evaluate the relative changes in natriuretic peptides and atrial pressures and the strongest correlation was found between BNP and left atrial pressure with R 2=0.81. Termination of pacing resulted in rapid normalization of ANP values in spite of persistent elevations in atrial pressures. This may reflect an increased metabolism or an attenuated secretory response of ANP to atrial stretch with established heart failure. In conclusion, 3 weeks of rapid pacing induced significant increases in atrial pressures and natriuretic peptide levels. All the natriuretic peptides correlated with atrial pressures with BNP appearing as a more sensitive marker of cardiac filling pressures than ANP and N-terminal proatrial natriuretic peptide.

Animals↗

Hereditary non-polyposis colorectal cancer: an updated review.

INTRODUCTION: Colorectal cancer is the commonest cause of death due to malignancy in non-smokers in the western countries. The two main hereditary types of colorectal cancer are familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC), constituting approximately 10% of all cases of colorectal cancer. The main aim of this review is to reappraise the current advances in the genetics and diagnosis of HNPCC. METHODS: A Medline search was carried out to identify papers published from 1970 to 1999 on HNPCC. Embase and Cochrane databases were also searched. Reference lists of retrieved articles were carefully searched for additional articles. RESULTS AND CONCLUSIONS: Recent technological advances in the genetics of HNPCC have refined the criteria for diagnosis and management of HNPCC, however current policies regarding the testing of pedigrees are not clearly established. We believe that with the rapid development in this area definitive clinical guidelines will need to be available in future for the management of HNPCC.

Colorectal Neoplasms, Hereditary Nonpolyposis↗

N-terminal proatrial natriuretic peptide and prognosis in patients with heart failure and preserved systolic function.

BACKGROUND: Congestive heart failure and preserved left ventricular systolic function is a common clinical condition. Although the prognosis in this type of heart failure is better in comparison to systolic dysfunction, prognostic markers to evaluate long-term outcome are lacking. The atrial peptide, N-terminal proatrial natriuretic peptide (proANP), has been shown to predict survival in patients with systolic dysfunction. We intended to evaluate the predictive capability of N-terminal proANP in patients with preserved systolic function (ejection fraction [EF] > or = 0.40). METHODS AND RESULTS: A clinical and echocardiographic examination was performed in 149 patients with idiopathic heart failure from a population-based cohort, and 84 patients were identified to have preserved systolic function, with an EF of 0.40 or greater. The patients were followed up during 7 years with regard to symptoms, treatment, hospitalization, and survival. The patients with normal EFs had greater plasma concentrations of N-terminal proANP compared with a control group, and N-terminal proANP level was an independent predictor of mortality (risk ratio, 2.44; 95% confidence interval, 1.28 to 4.67; P = .007). In addition, a high concentration of N-terminal proANP predicted an increased rate of hospitalization (50% for a level > 1,200 pmol/L versus 19% for a level < or = 1,200 pmol/L; P = .046) and a greater future dosage of diuretic (127+/-102 vs 51+/-39 mg; P = .007). CONCLUSION: N-terminal proANP level was an independent marker of increased mortality and morbidity in patients with preserved systolic function, whereas EF was not usable in this regard. It is suggested that this peptide could be used to identify clinically relevant left ventricular dysfunction in patients with EFs within the normal range.

Aged↗

Plasma levels of N-terminal proatrial natriuretic peptide in children are dependent on renal function and age.

Plasma levels of natriuretic peptides are used as diagnostic markers of heart failure. The aim of this study was to analyse the relation between plasma levels of N-terminal proatrial natriuretic peptide (Nt-proANP) and renal function, and to develop reference values in children. Nt-proANP was measured in the plasma of 86 patients whose glomerular filtration rate (GFR) was determined by use of the X-ray contrast medium iohexol and a fluorescence technique. Blood samples for Nt-proANP were also collected in 399 reference children, aged 0 - 15 years. The relationship between Nt-proANP and GFR was examined using a multiple regression analysis. The mean value of Nt-proANP was markedly higher in children with heart failure than in children with malignant or urologic diseases (p<0.001). The variability in plasma levels of Nt-proANP was mainly (adjusted R2=0.81) explained by the following four variables: presence of heart failure, GFR, age and previous treatment with anthracyclins. Plasma levels of the peptide are raised at birth, but fall rapidly to adult levels. We conclude that the plasma levels of Nt-proANP are age-dependent. Moderately elevated values were registered in children with severe renal impairment. Heart failure is regularly associated with excessive elevation of Nt-proANP in plasma. Our findings suggest that the influence of heart failure on levels of this peptide in children greatly exceeds the influence of renal dysfunction.

Adolescent↗