Biomedical subjects
Publications and source records attributed to M T Kearney.
Data from recent clinical trials suggest digoxin is now widely used in patients with chronic heart failure in sinus rhythm. We present data from a heart failure registry that reiterates concerns about the safety of digoxin in this population.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
An eight-year study was conducted to define the epidemiology of gastrointestinal nematode infection in Suffolk and Gulf Coast Native (Native) breeds of sheep, and to determine if the Native sheep is more resistant to infection. For the initial three years, each breed grazed separate pastures where anthelmintic treatments were administered to individual animals on a salvage basis. For the last five years, both breeds grazed concurrently; anthelmintic treatments were administered to individual animals on a salvage basis for the first three years, and to all animals, when treatment criteria were met, for the last two years. The fecal egg count (FEC) and blood packed cell volume (PCV) were monitored, and tracer lamb nematode burdens were determined. Overall, FEC for both breeds increased in the spring (periparturient rise) for most years and in the summer for all years. Under separate grazing conditions, Native ewes and lambs had consistently lower infection levels than Suffolk ewes and lambs. During the haemonchosis season (June-September) each year, Suffolk ewe and lamb PCV decreased, and Native ewe and lamb PCV remained relatively stable. The salvage treatment protocol resulted in 27 treatments for Suffolk and one for Native ewes; similarly for lambs, 13 for Suffolk and zero for Native. Tracer lambs grazed with their respective breed, and the FEC and mean total nematode burden corresponded with the pattern of infection for their respective breed. The predominant nematodes found in Suffolk and Native tracer lambs were Haemonchus contortus and Trichostrongylus spp., respectively. Under concurrent grazing conditions, the same seasonal repeatable pattern of infection was present and was exhibited by both breeds, with the Native ewes and lambs being consistently and significantly (p < or = 0.05) lower for FEC and higher for PCV. The salvage treatment protocol resulted in 57 and zero treatments for Suffolk and Native ewes, respectively; for lambs, 46 and 11. Tracer lamb nematode burdens again corresponded to their respective breed pattern of infection, with H. contortus and Trichostrongylus spp. being predominant in Suffolk and Native lambs, respectively. Data from all tracer lambs showed a relatively low level of hypobiosis (H. contortus only), and, although there was no consistent hypobiosis season, the tendency was for a higher level to occur in the fall. These results showed that the classic repeatable seasonal pattern of gastrointestinal nematode infection occurred in both breeds of sheep, and that Native sheep were more resistant to infection (specifically H. contortus) than Suffolk sheep.
OBJECTIVES: We sought to assess the role of insulin in postprandial blood pressure regulation in the elderly. BACKGROUND: Insulin is both a positive inotropic and chronotropic hormone that also vasodilates skeletal muscle vasculature. Insulin may thus mediate aspects of postprandial cardiovascular homeostasis. METHODS: Ten healthy elderly subjects were studied in the fasting state on three separate days. After baseline supine hemodynamic and neurohumoral measurements were taken (cardiac output and superior mesenteric artery blood flow were measured using Doppler ultrasound, and calf blood flow was measured using venous occlusion plethysmography), subjects ate on one occasion a 2.5-MJ high carbohydrate meal and on the other two occasions, an isoenergetic high fat meal. One high fat meal was accompanied by an insulin infusion reproducing the plasma insulin profile seen after a high carbohydrate meal while maintaining the glycemic profile seen after a high fat meal alone. After meal ingestion, measurements were repeated every 20 min for 2 h. RESULTS: After the three meals, there were similar increments in cardiac output and heart rate. After the high carbohydrate meal and high fat meal with insulin, mean arterial blood pressure fell by between 8 to 10 mm Hg, but did not change after the high fat meal. After the high carbohydrate meal and the high fat meal with insulin, calf vascular resistance did not change, whereas after the high fat meal, it increased by 15.5 +/- 4.4 U (mean +/- SEM). CONCLUSIONS: Insulin contributes to the failure of calf vasoconstriction seen after a high carbohydrate meal. By this vasodepressor action, insulin is at least in part responsible for the fall in blood pressure after a high carbohydrate meal.
OBJECTIVE: To determine the relationship between prediction errors of a regression model of racing finish times and earnings or finish position; the relationship between standardized finish times, determined by use of this model, and earnings or finish position; and whether this model was valid when applied to data for horses that underwent surgical treatment. DESIGN: Survey. SAMPLE POPULATION: Records of 6,700 healthy Thoroughbreds racing in Louisiana and of 31 Thoroughbreds with idiopathic left laryngeal hemiplegia that underwent surgical treatment. PROCEDURE: Predicted and standardized finish times were calculated by use of the regression model for healthy horses, and the relationships between prediction error (actual--predicted finish time) and standardized finish times, and earnings and finish position, were examined. Then, the regression model was applied to data for horses with hemiplegia to determine whether the model was valid when used to calculate predicted and standardized finish times for lifetime performance data. RESULTS: Prediction error and standardized finish times were negatively correlated with earnings and positively correlated with finish position and, thus, appeared to be reliable measures of racing performance. The regression model was found to be valid when applied to lifetime performance records of horses with laryngeal hemiplegia. CLINICAL IMPLICATIONS: Prediction error and standardized finish times are measures of racing performance that can be used to compare performances among Thoroughbred racehorses across a variety of circumstances that would otherwise confound comparison.
The cardiovascular (CV) responses to meal ingestion and orthostasis are well established. The effect of meal ingestion and meal composition on the CV responses to orthostasis are unknown. The effect of high carbohydrate (HC) and high fat (HF) meal ingestion on the CV responses to simulated orthostatic stress (using graded lower body subatmospheric pressure (LBSP)) was assessed in nine healthy young volunteers. Cardiac output (CO), forearm blood flow (FABF) heart rate (HR) and blood pressure (BP) were measured before and during LBSP while fasted and after eating HC and HF meals. Ingestion of both meals led to an increase in CO and HR. Both meals resulted in a fall in total peripheral resistance but only HC led to a significant fall in BP (p < 0.05). HF had no effect on the CV responses to LBSP, whereas HC resulted in attenuated FABF and forearm vascular resistance responses (p < 0.05). Thus, ingestion of an HC meal significantly attenuates the forearm vascular response to orthostatic stress and the hypotensive effect of orthostasis is additive to that occurring after an HC meal.
OBJECTIVES: This study aimed to explore the hemodynamic responses to ingestion of meals of different composition in patients with chronic stable angina and to assess the effect of these meals on time to onset of > 1-mm ST segment depression and limiting angina pectoris during exercise. BACKGROUND: To our knowledge, no study has assessed the effect of meal composition and timing of exercise in patients with coronary artery disease. METHODS: Fifteen patients with chronic stable angina visited our laboratory in the fasted state on three occasions. Measurements of cardiac output, heart rate and blood pressure were taken while patients were standing. A modified Bruce exercise test was then carried out, during which time to onset of > 1-mm ST segment depression and limiting chest pain were recorded. Patients then ate a 2.5-MJ high fat or high carbohydrate meal; on the third occasion, no meal was taken. At 30 min and 1 h after eating the meals, rest hemodynamic measurements and exercise tests were repeated. RESULTS: The high fat meal did not affect exercise variables, whereas the high carbohydrate meal resulted in a reduction in time to onset of ST segment depression of 74.4 +/- 22.2 s (mean +/- SEM) during exercise at 30 min (p < 0.01), and at both 30 and 60 min after the high carbohydrate meal, limiting chest pain occurred 50 to 90 s earlier than when patients fasted (p < 0.01). CONCLUSIONS: One hour after a high carbohydrate meal, the onset of angina during exercise occurs earlier than in the fasted state. Despite similar hemodynamic adjustments, a high fat meal does not affect exercise time.
When aspirating ovarian follicles in pregnant mares to obtain oocytes for in vitro fertilisation (IVF), the effect of the manipulation on circulating concentrations of progesterone may be an important consideration in terms of the maintenance of pregnancy. The object of this study was to compare the effects of 3 different forms of transvaginal ultrasound-guided follicle aspiration (Treatment 1, no aspiration, n = 4; Treatment 2, aspirate only follicles > or =20 mm in diameter, n = 7; Treatment 3, aspirate all visible follicles, n = 7) on peripheral plasma progesterone concentrations between Days 21 and 150 of gestation in 9 mares carrying intraspecies horse and 9 mares carrying interspecies mule conceptuses. The 3 follicle aspiration treatments were applied at the peak of each follicular wave as determined by follicular mapping by means of transrectal ultrasonography on alternate days. The plasma progesterone profile in mares undergoing Treatment 1 was in close agreement with those reported previously in pregnant mares. A decline in plasma progesterone levels occurred after Day 53 of gestation in Treatments 2 and 3 mares, indicating that the follicular aspiration procedures did interfere with the formation of secondary corpora lutea. However, the levels in individual mares never dropped low enough to endanger the pregnancy. Mares carrying mule pregnancies exhibited higher mean plasma progesterone concentrations between Days 39 and 45 of gestation than mares carrying horse pregnancies, equivalent levels between Days 46 and 66 despite the lower circulating concentrations of chorionic gonadotrophin (mule CG) in their blood during this period and lower progesterone levels between Days 67 and 150 of gestation. The results indicate that the primary corpus luteum in the pregnant mare may be more sensitive to mule CG than horse CG. Furthermore, the earlier disappearance of CG from the circulation in mares carrying mule fetuses is reflected by an earlier decline in plasma progesterone concentrations in this type of equine pregnancy.
OBJECTIVE: To develop a statistical model to evaluate the influence of specific parameters on racing performance in Thoroughbreds. DESIGN: Survey. SAMPLE POPULATION: Racing records of Thoroughbreds performing in Louisiana from 1981 to 1985. PROCEDURE: Race results for 20 randomly selected days from 5 racetracks during 5 years were analyzed, using regression analysis. RESULTS: The most influential parameter was distance raced. There were significant differences in racing performance among horses at different tracks. At the tracks examined, fast racing surfaces resulted in significantly faster finish times than good racing surfaces, and good racing surfaces resulted in significantly faster finish times than muddy racing surfaces. Finish times also were significantly faster as a function of increasing purse amount and age of horse. Finish times were significantly faster during quarter 4 (summer) and significantly slower during quarter 1 (fall). Races were run at significantly faster times as the number of the race progressed during the day. The finish times were significantly slower as the number of horses competing in the race increased, as the weight carried by the horse increased, and as the starting position away from the rail increased. CLINICAL IMPLICATIONS: The coefficients used in the statistical model of this report may be used by researchers to compare before injury and after treatment finish times. The coefficients can be used to standardize past racing performances to uniform conditions, thus permitting comparison from 1 race to another to determine success of treatments and to inform owners of prognosis.
Three trials compared responses to naturally-acquired strongylate nematode infection between suckling Suffolk and Gulf Coast Native (Native) lambs which grazed together. In Trial 1 (1992), infection in 14 lambs of each breed was monitored from birth to 12 weeks of age using fecal egg count (FEC) and blood packed cell volume (PCV). In Trial 2 (1993), two age-matched lambs of each breed were sacrificed at seven and ten weeks of age to estimate nematode burdens. In Trial 3 (1994), infection in 18 lambs of each breed was monitored (FEC, PCV, white blood cell count, differential leukocyte count, and anti-Haemonchus contortus immunoglobulin level) from birth to 8 weeks of age, at which time six age-matched lambs of each breed were sacrificed to estimate nematode burdens. The remaining 24 lambs were monitored until 12 weeks of age. In both Trials 1 and 3, infection in Native lambs peaked and then declined between 6-10 weeks of age. Infection in Suffolk lambs continued to increase as evidenced by increasing FEC with concomitant reduction in PCV, higher morbidity and mortality (Trial 1), and number of anthelmintic treatments required (Trial 3). In Trials 2 and 3, the principal nematode found at necropsy was H. contortus, and infection level was consistently lower (> 64%) in Native compared with Suffolk lambs. In Trial 3, there was no difference between breeds for WBC, any leukocyte type, or anti-H. contortus immunoglobulin level. These results demonstrated that suckling Native lambs developed resistance to H. contortus infection during their first exposure to infection at an age when they are considered immune incompetent and colostrally transferred anti-H. contortus immunoglobulin did not appear to be involved in the resistance.
Immunoglobulin E (IgE) has been regarded as an antibody isotype important in the host response to helminth infection and allergic conditions. Level of parasitic infection has been associated with serum total IgE level and the highest levels have been observed during the spring when environmental allergen levels are also high. Two groups of five parasite-native calves were maintained in a barn and one of the groups received an experimental gastrointestinal nematode infection. One group of five parasite-native calves was placed on clean pasture and another group of five was placed on a nematode-contaminated pasture. The contaminated pasture group acquired an acute gastrointestinal nematode infection, compared with a relatively low infection in the experimentally infected group. The only difference between the groups was a significant change (increase) in IgE level in calves on contaminated pasture, compared with the other three groups. This suggested that the infection acquired on pasture and not the experimental infection or environmental allergens encountered while grazing or in the barn stimulated an IgE response.
1. Patients with autonomic dysfunction and elderly people with an age-related decline in autonomic function can suffer from a fall in blood pressure after eating. While the cardiovascular changes after eating and the effect of meal composition on these changes are well established, the underlying mechanisms are less clear. 2. This study assessed the cardiac, circulatory and humoral responses to ingestion of isoenergetic (2.5 MJ) high carbohydrate and high fat meals in nine orthotopic cardiac transplant recipients, who before transplantation had significant circulatory, metabolic and autonomic abnormalities and after transplantation had complete or partial extrinsic cardiac denervation, and compared them to the responses seen in nine healthy age-matched control subjects. 3. All variables were measured non-invasively. Cardiac transplant recipients, despite cardiac denervation, showed a normal heart rate response to high carbohydrate and high fat meals (maximal increase at 30 min postprandially + 7.8 +/- 1.1 and + 63 +/- 1.4 beats/min respectively), a normal cardiac output response to the high carbohydrate meal (maximal increase at 30 min + 1.16 +/- 0.25 l/min), but a significantly attenuated cardiac output response to the high fat meal. Cardiac transplant recipients had attenuated superior mesenteric artery blood flow responses after both meals (P < 0.05) and an attenuated calf vascular resistance response after the high fat meal (P < 0.01). Throughout the study after both meals, cardiac transplant recipients maintained blood pressure. 4. This study demonstrates that cardiac transplant recipients, despite partial or complete cardiac denervation, have a normal chronotropic response to food and a normal cardiac output response to a high carbohydrate meal. The attenuated cardiac output response to a high fat meal did not compromise blood pressure, due at least in part to decreased splanchnic vasodilatation.
1. While the haemodynamic adjustments occurring after meal ingestion and the different effects of meals of different composition on these changes are well established, the mechanisms underlying these changes are less clear. Insulin, which has been shown to be both a positive inotrope and to stimulate vasodilatation in the skeletal muscle vascular bed, may account for the different cardiac and regional haemodynamic responses to high fat and high carbohydrate meals. 2. This study assessed the effect of an insulin infusion reproducing the plasma insulin profile seen after a high carbohydrate meal on the cardiovascular and regional haemodynamic response to a high fat meal. All measurements were carried out non-invasively in nine healthy lean subjects (mean age 24.5 +/- 1.3 years). 3. The high fat meal resulted in increases in cardiac output (0.7 +/- 0.32 l/min, P < 0.001), heart rate (7.8 +/- 2.1 beats/min, P < 0.001) and insulin (25.1 +/- 4.2 m-units/l, P < 0.001), and a decline in systemic vascular resistance (-1.9 +/- 0.9 units, P < 0.05) and superior mesenteric artery vascular resistance (-45 +/- 9 units, P < 0.01). After the high fat meal alone, calf vascular resistance and blood pressure did not change. After the high fat meal accompanied by insulin (peak insulin 86.1 +/- 10.1 m-units/l) there were greater cardiac responses [(P < 0.001); cardiac output, 1.17 +/- 0.36 l/min, and heart rate, 13.4 +/- 2.1 beats/min], and a larger fall in systemic vascular resistance and superior mesenteric artery vascular resistance. Unlike the high fat meal alone, the high fat meal with insulin was accompanied by a fall in calf vascular resistance (8.3 +/- 3.3 units) and blood pressure (3.8 +/- 1.6 mmHg). 4. The results of this study support a role for insulin in modulating postprandial cardiovascular homoeostasis; in particular, by its depressor action on skeletal muscle vasculature, insulin may in part contribute to the fall in blood pressure seen in the elderly, who have an inadequate cardiac response to the fall in systemic vascular resistance occurring after meal ingestion.
To determine the prevalence and nature of difficulties elderly subjects experience using home nebulizers we have studied all patients in the Leeds Health District aged 70 years and older loaned a nebulizer from the hospital for at least 6 months. Of 42 subjects with a nebulizer, 40 (95%) agreed to assessment. They had a mean age of 79 years (range 70-84 years) and mean duration of nebulizer use of 38 months (range 6-120 months). Twenty subjects had one or more problems with 14/40 (35%) rated as moderate or severe; difficulties with cleaning 16/40 (40%) and filling 7/40 (18%) were the most frequent; 13/40 (33%) were sometimes or always dependent on their carers to administer their nebulizers. Elderly subjects often experience practical difficulties, or require help from a carer, when using a home nebulizer.
Explore the source record for details and available documents.
A study was done to determine whether intra-articular pressure is increased in equine metacarpophalangeal joints with increasing degrees of synovial distention, and to correlate elastance of the soft tissue forming the dorsal pouch of the metacarpophalangeal joint to maximal range of motion in flexion. Sixty seven metacarpophalangeal joints in 36 horses were categorized by palpation and visual inspection of the palmar pouch into 1 of 4 increasing grades of distention. Intra-articular pressures were then measured, using 2 pressure transducers attached to 22 gauge needles, from the dorsal and palmar pouches simultaneously while horses stood squarely under mild sedation. Intra-articular pressure ranged from -13 to +78 mm of Hg. Mean (+/- SEM) palmar pouch pressure was subatmospheric (-2.53 +/- 2.78 mm of Hg) in joints in which the palmar pouch was not discernible (grade 0), and was markedly increased (+37.13 +/- 2.775 mm of Hg) in joints in which the palmar pouch was distended laterally beyond the lateral branch of the suspensory ligament (grade 3). Grade of distention was positively correlated with intra articular pressure (r = 0.758; P < 0.001). Significant compartmentation (P < 0.002) was observed between the dorsal and palmar pouches in all horses. In 25 of the aforementioned horses, (42 joints), which were active or retired Thoroughbred racehorses with variable degree of metacarpophalangeal joint injury/disease, a third needle was inserted into the dorsal pouch, and 0.5-ml increments of saline solution were added every 10 seconds to perform a pressure/volume (elastance) study of the dorsal pouch. The elastance study for each joint ended when leakage into the palmar pouch was detected by the pressure transducer placed in that region. A flexed lateral radio graphic view was taken of each metacarpophalangeal joint in maximal flexion. The maximal angle of flexion was measured from the radiograph, and this angle was subtracted from 180 degrees to acquire the range of motion in flexion. Range of motion in flexion has strong negative correlation (r= -0.68; P < 0.0001) with elastance (stiffness) of the dorsal pouch, and moderate pouches (r= -0.48; P < 0.0001). To adjust for the possible correlations resulting from repeated measures on limbs within horses, a normal linear mixed model was used to assess the effect of limb (right vs left), range of motion in flexion, and volume of saline solution added on the dependent variable (delta mm of Hg) in the elastance study. There was no significant limb effect, but a highly significant effect regarding volume of saline solution added (P < 0.00001) and range of motion in flexion (P < 0.00001). Loss of range of motion in flexion of this joint is associated with shortening or loss of the initial low elastance (flat) phase of the elastance profile. Measuring the elastance of the dorsal pouch or measuring maximal range of motion in flexion provides an objective measure of the degree of metacarpophalangeal joint stiffness secondary to joint disease.
Explore the source record for details and available documents.