We have measured cellular and humoral immune responses to short synthetic peptides representing epitopes of the malaria vaccine candidate antigen Pf155/RESA in a longitudinal, prospective study of clinical immunity to Plasmodium falciparum malaria in a cohort of 354 Gambian children aged 3-8 years. A significant association was observed between presence of antibodies to the 3' repeat region peptide (EENV)6 and resistance to clinical malaria. The prevalence of protective antipeptide antibodies varied significantly between different ethnic groups, suggesting that immune recognition of some Pf155/RESA epitopes may be genetically regulated. There was no obvious association between proliferative or interferon gamma responses to T cell epitopes of Pf155/RESA and resistance to malaria infection or disease. At an individual level, the presence of peptide-binding antibodies was associated with the induction of interleukin 4 messenger ribonucleic acid expression in T cells activated with the overlapping T cell epitope EENVEHDA(EENV)2. This suggests that measurement of interleukin 4 production by T cells may represent a functional assay for T helper activity.

Animals↗

PubMedDate not supplied

The shape of the proximal isovelocity surface area varies with regurgitant orifice size and distance from orifice: computer simulation and model experiments with color M-mode technique.

The hemispheric proximal isovelocity surface area method for quantification of mitral regurgitant flow (i.e., Qc = 2 pi r2v), where 2 pi r2 is the surface area and v is the velocity at radius r, was investigated as distance from the orifice was increased. Computer simulations and steady flow model experiments were performed for orifices of 4, 6, and 8 mm. Flow rates derived from the centerline velocity and hemispheric assumption were compared with true flow rates. Proximal isovelocity surface area shape varied as distance from each orifice was increased and could only be approximated from the hemispheric equation when a certain distance was exceeded: > 7, > 10, and > 12 mm for the 4, 6, and 8 mm orifices, respectively. Prediction of relative error showed that the best radial zone at which to make measurements was 5 to 9, 6 to 14 and 7 to 17 mm for the 4, 6, and 8 mm orifices, respectively. Although effects of a nonhemispheric shape could be compensated for by use of a correction factor, a radius of 8 to 9 mm can be recommended without the use of a correction factor over all orifices studied if a deviation in calculated as compared with true flow of 15% is considered acceptable. These measurements therefore have implications for the technique in clinical practice.

Blood Flow Velocity↗

PubMedDate not supplied

Voluntary strengths of male adults with acute low back syndromes.

Hand forces exerted in 120 different combinations of foot positions, hand positions, and force directions were measured in a group of 15 male adults with acute low-back syndromes. The performances of these patients were contrasted with those of 29 healthy male adults who had been tested earlier. The major findings were: acute back syndrome patients, sometimes even including those with very severe pain, have considerable physical ability in many of the situations examined, often fully comparable to that of healthy subjects; generally, either patients were unable even to assume a given position, or else their performances were close to normal in all exercises in each position; the positions which a significant number of patients could not assume were those involving substantial trunk twisting, or combinations of bending and twisting.

Adult↗

PubMedDate not supplied

Trunk strengths in attempted flexion, extension, and lateral bending in healthy subjects and patients with low-back disorders.

Trunk strengths were measured in 27 health males and 30 health females, and in 25 male and 15 female patients with low-back pain and/or sciatica. Maximum voluntary isometric strengths were measured during attempted flexion, extension, and lateral bending from an upright standing position. Both male and female patients had approximately 60% of the absolute trunk strengths of the corresponding healthy subjects. Intra-individual trunk strength ratios were used to interpret the results. Use of these ratios tends to avoid interpretational problems created by the general weakness of the patients and any lack of motivation of either patients or healthy subjects. The ratios showed that the patients had attempted extension strengths that were significantly less than their strengths in the other types of movements tested. The strength ratios for attempted extension were particularly low for patients with sciatica.

Adult↗

PubMedDate not supplied

Tinnitus and translabyrinthine acoustic neuroma surgery.

The purpose of this investigation was to study the effects of translabyrinthine acoustic neuroma surgery on tinnitus in a consecutive sample of patients operated on between 1988 and 1994 in Uppsala (Sweden). A postal questionnaire was returned by 141 patients, yielding a 90% response rate without reminder. The results showed that tinnitus was experienced by 70% of the patients before surgery and 60% after surgery. In general, low degrees of tinnitus distress were found, which was confirmed by the questionnaire results. Ratings of tinnitus distress after surgery, using the Klockhoff and Lindblom grading system, showed that 48% had tinnitus of grade I, 46% of grade II, and 6% of grade III. Pre- and postsurgery grading of distress did not change significantly. There was a 35% risk for developing tinnitus when no preoperative tinnitus was present and a 15% chance that tinnitus disappears when present preoperatively.

Adult↗

PubMedDate not supplied

Monitoring 24-hour blood pressure in a drug trial. Evaluation of a noninvasive device.

To test the usefulness of noninvasive ambulatory 24-hour blood pressure recording, the Del Mar Avionics system was used in a double-blind clinical trial in which 31 hypertensive patients were randomly allocated to receive placebo or pafenolol (25 mg or 50 mg), a novel, long-acting, highly selective beta-blocker, once daily. The results of 24-hour blood pressure and heart rate recording after 4 weeks of treatment were compared with a previous 24-hour recording performed after a 4-week placebo run-in period using the 3-hour mean of recordings performed every 7.5 minutes both day and night. Furthermore, 24-hour means were analyzed in each patient before and after 4 weeks. The system was easy to use and, judging from two placebo periods in the same patients, the reproducibility was good. The 24-hour blood pressure and heart rate recordings showed a clear dose-response relationship for pafenolol that could not be detected by ordinary casual readings. A daily dose of 25 mg of pafenolol significantly reduced blood pressure during the 9 hours after tablet intake (p less than 0.01), while 50 mg per day of pafenolol resulted in a significant reduction throughout the 24-hour period (p less than 0.01). The same pattern was seen for heart rate, which indicates a greater degree of beta-blockade during treatment with the higher dose. These results indicate that the tested noninvasive equipment is a useful tool for monitoring ambulatory 24-hour blood pressure. It gives important information impossible to obtain from single casual readings. This noninvasive method should be further evaluated to define its place in clinical work and as a research tool.

Adult↗

PubMedDate not supplied

Dispositional optimism, dysphoria, health, and coping with hearing impairment in elderly adults.

Sixty-eight elderly hearing impaired subjects were interviewed and completed self-report measures on hearing disability, dispositional optimism, dysphoria, and general health. The measures used were the Hearing Coping Assessment (HCA), the Hearing Questions (HQ), the Life Orientation Test (LOT), The Beck Depression Inventory (BDI), and a subscale from the Göteborg Quality of Life (GQL). Psychometric analyses of HCA, HQ, LOT, BDI, and GQL revealed high reliability in terms of Cronbach's Alpha and split-half r's. Significant intercorrelations were found between several measures, but not with pure-tone audiometry (0.5, 1, 2, and 3 kHz). Cluster analysis was used to identify subgroups in the sample. As a result three clusters were identified interpreted as 'high copers', 'copers with moderate psychological and somatic complaints', and 'low copers'. Results from the cluster analyses were confirmed by using two different clustering methods and by between-cluster comparisons on the HQ, which had not been used to obtain the clusters.

Adaptation, Psychological↗

PubMedDate not supplied

Tinnitus masking and depression.

In this pilot study 30 patients with annoying tinnitus completed tinnitus matching and the Beck Depression Inventory (BDI). A cluster analysis revealed three clusters of patients. Cluster one had relatively low depression and average results on tinnitus parameters. Cluster two displayed high depression scores and lower results on tinnitus parameters. The last small cluster had high depression scores and high results on tinnitus and hearing parameters. A curvilinear regression showed a U-shaped relation between the BDI and minimal masking level. The results are interpreted according to a diathesis stress model, in which a vulnerable person might develop tinnitus distress following a comparatively low degree of tinnitus and a more stress-tolerant person might bear higher degrees of tinnitus before seeking help. As a conclusion this may have implications for what treatment to recommend and most certainly should be accounted for in the assessment of patients.

Adult↗

PubMedDate not supplied

Quality decision making in dialysis.

A patient approaching the final stage of his renal disease is faced with many difficult questions. Should he opt for a transplant or start on dialysis? In the case of dialysis, can he manage his treatment at home or will he need to be cared for in a clinic? Should be choose peritoneal dialysis or haemodialysis? Is the freedom of being independent from a machine, given by CAPD, as valuable as the freedom of having days without treatment, given by HD? The issues are complex and do not have a given answer. To make the proper decisions about his treatment the patient needs extensive information and support from the caregivers. Likewise, the caregivers need to know the patient well in order to give appropriate advice. In this exchange of information, the renal nurse has a very important role. Some patients may need to be dialysed in a hospital but most can get an equally good or even better dialysis treatment in a less stressful environment. A high degree of self-care is preferred by people who value independence and freedom of movement. Self-care also improves the self-confidence and increases the chances of maintaining employment and a rich social life. Self-care could mean both PD and HD, sometimes with the assistance of a spouse or a nurse. But a certain degree of self-care can also be maintained in limited-care centres and satellites, where the presence of nursing staff gives the feeling of security. For everybody involved, not least the purchasers of health care, it is desirable to keep the patients out of the costly hospital environment for as long as possible.

Decision Making↗

PubMedDate not supplied

Oral implant rehabilitation in irradiated patients without adjunctive hyperbaric oxygen.

In 15 patients treated for malignant tumors in the maxillofacial region, 90 Brånemark implants have been placed in irradiated alveolar bone without adjunctive hyperbaric oxygen therapy. Seventy-eight implants were placed in the mandible and 12 in the maxilla. After a follow-up period of 1 to 8 years, 88 implants are still stable, 27 after 6 to 8 years, 44 after 3 to 4 years, and 17 after 1 to 2 years. Two patients lost 1 implant each, both at an early stage. The success rate is 97.8% according to remaining implants, and prosthesis stability is 100%. Implant treatment for oral rehabilitation can be carried out as a safe and successful procedure in the irradiated patient without adjunctive hyperbaric oxygen therapy.

Aged↗