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Biomedical subjects

J Pool

Publications and source records attributed to J Pool.

At least 37 records · Page 2Linked to original sources
PubMed1991

QT interval prolongation predicts cardiovascular mortality in an apparently healthy population.

BACKGROUND: In myocardial infarction patients, heart rate-adjusted QT interval (QTc), an electrocardiographic indicator of sympathetic balance, is prognostic for survival. METHODS AND RESULTS: In a 28-year follow-up, the association between QTc and all-cause, cardiovascular, and ischemic heart disease mortality was studied in a population of 3,091 apparently healthy Dutch civil servants and their spouses, aged 40-65 years, who participated in a medical examination during 1953-1954. Moderate (QTc, 420-440 msec) and extensive (QTc, more than 440 msec) QTc prolongations significantly predict all-cause mortality during the first 15 years among men (adjusted respective relative risks [RRs], 1.5 and 1.7) and among women (RRs, 1.7 and 1.6). In men, cardiovascular (RRs, 1.6 and 1.8) and ischemic heart disease mortality (RRs, 1.8 and 2.1) mainly account for this association. In women, the association cannot be attributed specifically to cardiovascular and ischemic heart disease mortality. RRs for a subpopulation without any sign of heart disease at baseline are similar. The same is observed for QTc prolongation after light exercise, although in this situation most associations are not statistically significant, probably because of smaller numbers in the QTc prolongation categories. CONCLUSIONS: Our results suggest that QTc contributes independently to cardiovascular risk. If autonomic imbalance is an important mechanism, it might be speculated that changes in life-style (e.g., with regard to physical exercise and smoking) may have a preventive impact.

Autonomic Nervous System↗
PubMed1990

[Earlier treatment of acute myocardial infarction with administration of alteplase (rt-PA) before hospitalization].

The gain in survival by thrombolytic therapy in patients with myocardial infarction is determined by the delay between coronary occlusion and reperfusion. The REPAIR study was designed to examine the feasibility and safety of prehospital thrombolysis with alteplase (rt-PA, Actilyse). Indications and contraindications are verified by general practitioner or ambulance nurse with a short questionnaire. A small portable ECG computer system is used to confirm the presence of a large evolving myocardial infarction 'on the spot'. Between June 1988 and May 1990, 150 patients were treated by the ambulance service. Therapy could be initiated within an average of 91 (+/- 40) minutes (sd) after the onset of symptoms, and within 23 (+/- 9) minutes after ambulance arrival. Three patients were defibrillated during transportation, in one of these therapy had to be discontinued because of cardiac massage. No other complications were observed. Five patients (3%) died after arrival in the hospital. The time gained by prehospital treatment averaged 47 (+/- 2) minutes in comparison with 220 patients who received thrombolytic therapy after hospital admission. The procedure allows rapid and safe initiation of thrombolytic therapy in selected patients, even in the absence of a physician.

Acute Disease↗
PubMed1990

Psychic effects of physical training and relaxation therapy after myocardial infarction.

The psychological impact of exercise training and relaxation therapy was investigated in 156 myocardial infarction patients. They were randomly assigned to either exercise plus relaxation and breathing therapy (Treatment A: n = 76) or exercise training only (Treatment B: n = 80). Patients in Treatment A improved on three out of eight psychological measurements (anxiety, well-being, feelings of invalidity). No change was demonstrable in Treatment B. The difference between the treatments was significant for wellbeing (p less than 0.005). Physical outcome, measured by exercise testing was positive in about half of the patients (Treatment A: 55%, Treatment B: 46%). A negative outcome occurred less in Treatment A (p less than 0.05). Training success was not associated with psychic benefit. The association differed for the two treatments. It was concluded that exercise training was effective for some but not for all cardiac patients, and that a psychic effect of exercise could not be demonstrated. Relaxation therapy enhanced physical and psychic outcome of rehabilitation.

Adaptation, Psychological↗
PubMed1990

Success and failure of exercise training after myocardial infarction: is the outcome predictable?

One hundred fifty-six patients underwent a 5 week daily exercise training program after recovery from acute myocardial infarction. Outcome was assessed on the basis of exercise testing, integrating the measurements into a single outcome measure consisting of three categories (positive, n = 79; negative, n = 42; no change, n = 35). This composite criterion served as the end point for determining the predictability of a positive (training success) and negative (training failure) outcome. With use of logistic regression analysis, the baseline variables of clinical information, exercise data and psychosocial variables were able to identify patients with training success, as well as patients with failure (correct classification rates 81% and 85%, respectively). The characteristics of patients for whom training was beneficial differed from those of patients with a negative outcome. Work status before infarction was the single most important predictor of success, but it did not determine failure. Psychologic variables (type A behavior, well-being, depression) were important for predicting failure, but not for predicting success. Cardiac state and physical fitness largely determined training success. It is concluded that the physical benefit of exercise training in patients after myocardial infarction is highly predictable. Validation will make it possible to optimally apply exercise training as a therapeutic modality in these patients.

Aged↗
PubMed1989

[Consensus heart and vascular diseases and sports].

A consensus meeting on persons with a cardiovascular disease engaging in sports was held on 25 November 1988. The purpose was to arrive at uniformity in counselling and attendance. For these purposes, the exercise tolerance of the cardiovascular patients has to be weighed against the expected work load. The recommendations should be based on examinations suitable to the nature of the disorder. Guidelines for performance- and recreation-directed athletic activities are presented for a number of cardiovascular diseases. In counselling and attendance the medication used should also be taken into account. Expertise in counselling and attendance is of great importance for prevention of injuries. This is mostly achieved by team work with the sports physician coordinating.

Cardiovascular Agents↗
PubMed1989

Changes in functional residual capacity in response to bronchodilator therapy among young asthmatic children.

Measurements of functional residual capacity (FRC) by helium gas dilution and peak expiration flow rate (PEFR) were made in 63 young asthmatic children aged 2 and 7 years before and after bronchodilator therapy. All 63 children tolerated two measurements of FRC, but only 33 children were able to perform the peak flow maneuver. Bronchodilator therapy was associated with significant change in FRC in the majority (80%) of children; in some, however, this change was an increase rather than a decrease. The change in FRC was significantly correlated with both prebronchodilator FRC and the change in PEFR. An increase in FRC following bronchodilator therapy was more common in children with severe and symptomatic asthma. We suggest that changes in FRC may be used in asthmatic children to demonstrate bronchodilator responsiveness, particularly in those too young to perform other respiratory function tests.

Asthma↗
PubMed1989

Physical training and relaxation therapy in cardiac rehabilitation assessed through a composite criterion for training outcome.

One hundred fifty-six myocardial infarction patients were randomly assigned to either exercise plus relaxation and breathing therapy (treatment A, n = 76) or to exercise training only (treatment B, n = 80). Effects on exercise testing showed a more pronounced training bradycardia and a remarkable improvement in ST abnormalities in treatment A (p less than 0.005). A model was developed to integrate the various exercise parameters into a single measure for training benefit. Approximately half the patients showed a training success, with a more positive and less negative outcome in treatment A (p = 0.09). The odds for failure were 0.25 for treatment A and 0.51 for treatment B (odds ratio: 2.04; 95% confidence interval, 0.94 to 4.6). Thus the risk of failure was reduced by half when relaxation was added to exercise training. These results indicate that exercise training is not successful in all MI patients and that relaxation therapy enhances training benefit.

Breathing Exercises↗
PubMed1989

Blood lymphocytes from ankylosing spondylitis patients fail to induce disease-specific cytotoxic T lymphocytes.

The intriguing observation made by Geczy et al. (1) showing the possibility of generating specific ankylosing spondylitis--cytotoxic T lymphocytes by presenting HLA-B27+AS+ cells as antigen-specific stimulator cells prompted us (by using Geczy's approach) to identify cytotoxic T lymphocytes specific for this apparent B27+AS+ target structure. Peripheral blood mononuclear cells (PBMC) of 21 healthy B27+ individuals were stimulated in primary and in short-term cultures with PBMC of an HLA-identical sibling suffering from definite AS (n = 12). In addition, PBMC in vitro modified by "Geczy bacterial products" from two healthy B27+ individuals were used to stimulate B27+ AS- lymphocytes (either autologous or from a healthy HLA-identical sibling). Effector cells raised in primary AS- versus AS+ and AS- versus "modified B27" mixed lymphocyte culture combinations showed no proliferative nor cytotoxic activity at all. The scarcely observed cytotoxic reactivity of restimulated mixed lymphocyte culture was not restricted to AS+B27+ cells. These results demonstrate that PBMC from ankylosing spondylitis patients fail to induce disease-specific cytotoxic T lymphocytes and suggest that an ankylosing spondylitis--related "modified B27" structure does not exist, at least in the patient material tested.

Cells, Cultured↗
PubMed1989

Renal transplant patients monitored by the cell-mediated lympholysis assay. Evaluation of its clinical value.

Donor-specific cytotoxic T cell activity was measured over a period of 5 years after transplantation using the cell-mediated lympholysis (CML) test in 124 recipients of unrelated kidney allografts who received conventional immunosuppressive therapy consisting of azathioprine and prednisone. Since patients with a functioning transplant frequently display donor-specific CML non-responsiveness in vitro, we addressed the question of whether the CML status has a predictive value regarding the graft prognosis at any time interval until 5 years posttransplantation. From log-rank type analyses we conclude that the estimated relative risk calculated over the whole follow-up period of a CML-responder in the category of transplant rejectors is 1.25 with 95% confidence bounds between 0.94 and 1.65. Measurements of CML responder status during follow-up seem to have only limited prognostic value, although the relative risk is borderline significant when the analysis is restricted to the period between 2 weeks and 6 months posttransplantation.

Cytotoxicity Tests, Immunologic↗
PubMed1989

Randomised controlled trial of two methods of weaning from high frequency positive pressure ventilation.

Forty preterm infants suffering from respiratory distress syndrome were entered into a randomised controlled trial to assess the importance of the length of inspiratory time during weaning from high frequency positive pressure ventilation (HFPPV). Two weaning regimes were compared: in one (group A) inspiratory time was limited to 0.5 seconds throughout weaning, in the other (group B) ventilator rate was reduced by increasing both inspiratory and expiratory time (inspiration:expiration ratio constant) until inspiratory time reached 1.0 seconds. At ventilator rates of 20 and 40 breaths/minute an acute comparison was made in all 40 infants of the two inspiratory times; despite the lower mean airway pressure associated with the shorter inspiratory time blood gases were maintained. There was no difference in the incidence of pneumothoraces or need for reventilation between the two regimens but infants in group A had a shorter duration of weaning. We conclude limitation of inspiratory time to 0.5 seconds during weaning from HFPPV is advantageous to preterm infants with respiratory distress syndrome.

Carbon Dioxide↗
PubMed1988

T lymphocyte cloning from rejected human kidney allograft. Recognition repertoire of alloreactive T cell clones.

We analyzed the recognition repertoire of 16 human alloreactive T cell clones (ATLC) derived from cells invading an irreversibly rejected kidney allograft. These clones, which specifically proliferated against the kidney donor B lymphoblastoid cell line, fell into two classes: CD4+ killers and CD8+ killers. Cytotoxic and proliferative activities of the ATLC were studied by using a panel of allogeneic cells sharing HLA specificities with kidney donor cells. Moreover, mAb recognizing monomorphic parts of HLA class I and class II molecules were used in blocking experiments of ATLC cytotoxicity. The results obtained from proliferative and cytotoxic assays were concordant. All ATLC investigated were directed against HLA molecules, and some clones were found to recognize HLA-B, -C, -DP, -DQ, or -DR products. All anti-HLA class I ATLC were CD8+, whereas both CD4+ and CD8+ ATLC were committed against HLA class II specificities. Nine of 16 ATLC were shown to react against serologically defined donor HLA determinants. These data indicate the recognition of HLA determinants in the course of an in vivo alloimmune response and particularly emphasize the role of HLA-C and DP loci products so far ignored in clinical transplantation.

Antibodies, Monoclonal↗
PubMed1988

Catecholamine and blood pressure levels in paralysed preterm ventilated infants.

The effect of pancuronium administration on catecholamine levels and blood pressure was investigated. Noradrenaline levels prior to paralysis amongst infants fighting the ventilator were high, but were significantly reduced following treatment with pancuronium. There was no significant change in either blood pressure or adrenaline levels. Increasing peak inspiratory pressure (approx. 4 cmH2O) immediately prior to paralysis effectively prevented the hypoventilation previously associated with the administration of the first dose of pancuronium.

Blood Pressure↗
PubMed1988

Randomized trial of artificial surfactant (ALEC) given at birth to babies from 23 to 34 weeks gestation.

Artificial surfactant (ALEC) composed of dipalmitoylphosphatidylcholine and unsaturated phosphatidylglycerol in a ratio of 7:3 (w/w) and a dose of 50-100 mg was suspended in 1 ml of cold saline and used at birth as a prophylaxis against the respiratory distress syndrome and its complications in a two centre randomized prospective trial involving 341 babies from 23 to 34 weeks gestation regardless of their antenatal problems. The surfactant had little effect in babies above 29 weeks gestation and was most beneficial in babies under 30 weeks gestation (67 controls and 69 surfactant treated babies). In this subgroup the artificial surfactant significantly reduced the inspired oxygen and peak ventilator pressure requirements during the first 96 h, the incidence of intraventricular haemorrhages from 40% to 19% (P less than 0.01), the overall mortality from 36% to 17% (P less than 0.02), the mortality due to RDS from 31% to 9% (P less than 0.01), the need for more than 28 days oxygen from 37% to 21% (P = 0.05) and the use of pancuronium in ventilated babies from 52% to 27% (P less than 0.01). There were no apparent side effects. This protein free, artificial surfactant should be a useful addition to the therapy of babies under 30 weeks gestation to reduce the severity of their RDS and the incidence of serious complications.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1988

Neonatal patient triggered ventilation.

Patient triggered ventilation was assessed in 14 neonates (gestational age 24-40 weeks). Inspiratory changes in airflow, monitored by a pneumotachograph, were used to trigger the ventilator and this was not associated with complications. Patient triggered ventilation was maintained for up to eight hours (mean duration five hours). In 13 of 14 infants oxygenation improved and this was associated in most with an increase in rate of delivered positive pressure inflations and inflating volumes. A greater improvement in oxygenation was shown when trigger mode was used during the recovery phase of respiratory distress syndrome. Only one infant, who made very little respiratory effort, failed to improve. We conclude that patient triggered ventilation may be used as an effective form of neonatal ventilation.

Humans↗
PubMed1988

Functional residual capacity related to hepatic disease.

Functional residual capacity was measured in 20 children (aged 3.1-11.2 years) with liver disease. Children with severe liver disease, regardless of diagnosis, had reduced functional residual capacities (less than 80% of expected). Children with alpha-1 antitrypsin deficiency had higher functional residual capacities than those with other hepatic diagnoses. Three children had a functional residual capacity greater than 120% of expected, all had alpha-1 antitrypsin deficiency.

Child↗
PubMed1988

Effect of budesonide on pulmonary hyperinflation in young asthmatic children.

In 19 asthmatic children, aged 2-6 years, the effect of six weeks' treatment with inhaled budesonide or placebo on functional residual capacity (FRC--helium dilution) and bronchodilator responsiveness was assessed in a double blind, randomised crossover trial. FRC was increased in most children at the start of treatment. Treatment with budesonide was associated with a reduction in FRC by comparison with placebo (median change 9% v 0%; p less than 0.05). There was a trend towards a greater response to a bronchodilator after budesonide. The results suggest that inhaled corticosteroids reduce hyperinflation in young asthmatic children.

Airway Resistance↗