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PubMed1991

Effect of age on use of thrombolytic therapy and mortality in acute myocardial infarction. The MITI Project Group.

The findings in 3,256 consecutive patients hospitalized for acute myocardial infarction were tabulated to assess the history, treatments and outcome in the elderly; 1,848 patients (56%) were greater than 65 years of age, including 28% who were aged greater than or equal to 75 years. The incidence of prior angina, hypertension and heart failure (only 3% of patients less than 55 years of age had a history of heart failure compared with 24% greater than or equal to 75 years old) was found to increase with age. Twenty-nine percent of patients less than 75 years of age were treated with a systemic thrombolytic drug compared with only 5% of patients older than 75 years. Mortality rates increased strikingly with advanced age (less than 2% in patients less than or equal to 55, 4.6% in those 55 to 64, 12.3% in those 65 to 74 and 17.8% in those greater than or equal to 75 years). Both the incidence of complicating illness and a nondiagnostic electrocardiogram (ECG) increased with age. In a multivariate analysis of outcome in older patients (greater than or equal to 65 years), adverse events were related to both prior history of heart failure (odds ratio 3.9) and increasing age (odds ratio 1.4 per each decade of age). Outcome was not improved by treatment with thrombolytic drugs, but these agents were prescribed to only 12% of patients greater than 65 years of age, thereby reducing the power for detecting such an effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1984

Increased incidence of thromboembolism in stage IV breast cancer patients treated with a five-drug chemotherapy regimen. A study of 159 patients.

We report an incidence of thrombosis of 17.6% in 159 patients treated with a five-drug chemotherapy regimen (cyclophosphamide, methotrexate, 5-fluorouracil, vincristine, and prednisone) for Stage IV breast carcinoma. Chi-squared analysis of risk factors for thrombosis (ambulatory status, obesity, family history, smoking, diabetes mellitus, hypertension, liver dysfunction, thrombocytosis, and previous endocrine therapy) showed no difference between the patients who had a thromboembolic event and those who did not. Statistical analysis revealed that a significantly higher incidence of thrombosis occurred during the chemotherapy regimen than when off this regimen (P less than 0.05). Detailed coagulation studies done prospectively on 10 patients receiving the five-drug chemotherapy regimen compared with 10 control patients showed a significantly elevated Factor VIII antigen:activity ratio in the group receiving the chemotherapy regimen compared with the control group and normals. These results implicate the chemotherapeutic regimen in the pathogenesis of the increased incidence of thrombosis. The pathophysiology of thrombosis in settings such as this awaits better in vitro tests defining the "hypercoagulable state."

Adult↗
PubMed1984

Prediction of pregnancy complications: an application of the biopsychosocial model.

This paper describes a pilot study of biomedical and psychosocial risk and the outcome of pregnancy. Ninety-three pregnant women completed four instruments to identify three types of psychosocial risk: life events, family function and social support. Biomedical risk was identified through analysis of self-reported health histories and hospital records. Information on complications of pregnancy was obtained from hospital delivery records. Further complications data were obtained by a home interview at 6 weeks postpartum. In the sample studied, from an agricultural-university community in Eastern Washington, biomedical risk alone was not substantially related to complications. Psychosocial risk was related to both delivery and postpartum complications. Family function was the best single psychosocial predictor. The interaction between family function and biomedical risk also predicted complications reliability. A total of 11% of variance in postpartum complications could be explained jointly by biomedical and psychosocial risk. The results of the study suggest that psychosocial risk assessment alone and in interaction with biomedical risk assessment will offer significant improvement in the identification of women who may experience pregnancy complication.

Adult↗
PubMed2004

Evolutionary history of the northern leopard frog: reconstruction of phylogeny, phylogeography, and historical changes in population demography from mitochondrial DNA.

This study uses a combined methodological approach including phylogenetic, phylogeographic, and demographic analyses to understand the evolutionary history of the northern leopard frog, Rana pipiens. We tested hypotheses concerning how (or if) known geological events and key features of the species biology influenced the contemporary geographic and genetic distribution of R. pipiens. We assayed mitochondrial DNA variation from 389 individuals within 35 populations located throughout the species range. Our a priori expectations for patterns and processes influencing the current genetic structure of R. pipiens were supported by the data. However, our analyses revealed specific aspects of R. pipiens evolutionary history that were unexpected. The phylogenetic analysis indicated that R. pipiens is split into populations containing discrete eastern or western haplotypes, with the Mississippi River and Great Lakes region dividing the geographic ranges. Nested clade analysis indicated that the biological process most often invoked to explain the pattern of haplotype position is restricted gene flow with isolation by distance. Demographic analyses showed evidence of both historical bottlenecks and population expansions. Surprisingly, the genetic evidence indicated that the western haplotypes had significantly reduced levels of genetic diversity relative to the eastern haplotypes and that major range expansions occurred in both regions well before the most recent glacial retreat. This study provides a detailed history of how a widespread terrestrial vertebrate responded to episodic Pleistocene glacial events in North America. Moreover, this study illustrates how complementary methods of data analysis can be used to disentangle recent and ancient effects on the genetic structure of a species.

Animals↗
PubMedDate not supplied

Long-term follow-up results after plain balloon coronary angioplasty.

Between September 1987 and June 1992, 571 patients of coronary artery disease underwent percutaneous transluminal coronary angioplasty in our institute. Their ages ranged from 31-82 years (mean 51 +/- 9) and majority (88.3%) were males. At baseline, 318 (55.7%) patients had chronic stable angina, 184 (32.2%) unstable angina, and 57 (10%) underwent PTCA for recurrence of angina in the post-infarction period. Single vessel angioplasty was performed in 406 (71.1%), two-vessel angioplasty in 121 (21.2%) and three or more vessels were dilated in 44 (7.7%). The procedure was successful in 524 (91.8%) patients. Follow-up was available in 438 (83.6%) patients, and ranged from 78 to 135 months (mean 89 +/- 29) with all the patients completing at least 60 months of follow-up. Using Kaplan-Meier statistical analysis, event-free survival (freedom from repeat percutaneous transluminal coronary angioplasty, myocardial infarction, coronary artery bypass surgery, or death) was 72.5 percent at three, 68.0 percent at five, 61.8 percent at seven and 55.6 percent at 10 years of follow-up. Freedom from major adverse cardiac events (myocardial infarction, coronary artery bypass surgery or death) was 88.3, 85.8, 82.0 and 75.4 percent at 3, 5, 7 and 10 years, respectively. Overall survival was 97.4 and 95.2 percent, respectively at 5 and 10 years. Subgroup analysis for all major events was done between males and females, diabetics and non-diabetics, previous history or absence of myocardial infarction, stable versus unstable angina and single versus multivessel disease. Event-free survival rates were compared between the groups using log rank test. On follow-up, the need for surgical revascularisation was more in males compared to females although statistically insignificant, and in patients with unstable angina compared to stable angina (p < 0.02). Similarly, freedom from major adverse cardiac events was significantly better in females compared to males (p < 0.05) and in stable versus unstable angina (p < 0.01). Event-free survival (repeat percutaneous transluminal coronary angioplasty, myocardial infarction, coronary artery bypass surgery, death) was also significantly better in patients with stable angina (p < 0.02). The other outcomes were comparable in all the subgroups. In conclusion, plain balloon angioplasty provides excellent long-term results in patients with coronary artery disease in terms of reduction in major adverse cardiovascular events and need for subsequent revascularisation.

Adult↗
PubMed1994

Meta-analysis of P300 amplitude from males at risk for alcoholism.

The P3(00) event-related brain potential (ERP) is used to study the development of alcoholism by comparing males who have a positive family history of alcoholism with control Ss who have no such familial history. Meta-analysis indicated that overall, smaller P3 amplitudes were obtained from males with family histories of alcoholism compared to controls. Moderator analysis indicated that paradigms using difficult visual tasks yielded the most reliable effects. Furthermore, no differences in outcomes were obtained among studies that recruited positive family history Ss exclusively from among individuals whose father had received treatment for alcoholism as compared with other studies. These findings are discussed in the context of using ERPs as an evaluative tool in the study of psychopathology.

Adolescent↗
PubMed1996

Prognostic value of stress dobutamine technetium-99m sestamibi single-photon emission computed tomography (SPECT) in patients with suspected coronary artery disease.

Inotropic stress using graded dobutamine infusion has evolved as an alternative form of pharmacologic stress in conjunction with perfusion and functional imaging for evaluation of coronary heart disease. However, the prognostic value of technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) imaging in patients undergoing dobutamine stress testing for the detection of coronary artery disease is unclear. Accordingly, 61 patients undergoing coronary arteriography for the evaluation of chest pain on the basis of symptoms and treadmill exercise electrocardiography underwent SPECT imaging at rest and during stress. Patients were followed up for 19 +/- 11 months (2 to 33) during which 2 died, 2 had acute myocardial infarction, 13 developed unstable angina, and 3 had congestive heart failure. Univariate Cox regression analysis revealed that those with reversible defects (95%) and defects in multiple vascular territories (80%) on SPECT had a greater number of cardiac events compared to those without (59% [p = 0.02] and 34% [p = 0.002], respectively). The number of reversible (3.9 +/- 2.1) and fixed (2.3 +/- 2.0) segments (12-segment model) were greater in patients with cardiac events compared to those without, (2.3 +/- 2.5, p = 0.009 and 1.1 +/- 2.0, p = 0.02) respectively. When multivariate analysis was performed using clinical, exercise testing, and SPECT variables, the independent predictors of cardiac events were a history of myocardial infarction (p <0.001), number of reversible segments (p = 0.001), and presence of defects in multiple vascular territories (p = 0.01). In summary, dobutamine stress Tc-99m sestamibi SPECT is a powerful predictor of future cardiac events in patients undergoing coronary arteriography for evaluation of chest pain and may be used to stratify patients for further intervention.

Aged↗
PubMed2006

[Rational treatment of diabetes mellitus in Siauliai and Telsiai regions, Lithuania].

OBJECTIVE: The evaluation of adherence to guidelines on rationality in prescribing reimbursed medicines for the treatment of diabetes mellitus. MATERIAL AND METHODS: A retrospective evaluation of drug utilization in national public health insurance database and analysis of 906 case histories of diabetic patients in respect of nonadherence to guidelines. RESULTS: A total of 184 (20.3%) case histories with 370 events were found to be nonadherent to: a) national guidelines on prescription of medicines (66.49%); b) authorized indications and contraindications (13.24%); c) insufficient monitoring (4.32%); d) nonadherence to the recommendations for prescription writing (11.35%); and e) nonadherence to the requirements for service provisions (4.6%). The analysis of nonadherence to national guidelines revealed: 1) failure to assess patient's height, weight, and body mass index (30.1%); 2) poor glycemia control (26%); 3) failure in referring to an endocrinologist in case of noncontrolled glycemia (17.5%); 4) monotherapy with long-acting insulin or started combined oral therapy without monotherapy (10.2%); 5) noncompliance with the recommendations of endocrinologist (8.5%); 6) unsubstantiated changes in diabetes mellitus treatment (4.1%). Thiazolidinediones are often administered in case of liver failure or without investigation of its function (60.4%) or in case of heart failure (29.2%). CONCLUSIONS: 1) Nonadherence was observed in 20.3% of cases; 2) the most frequent cause was nonadherence to guidelines (66.5%) and to authorized indications and contraindications (13.2%); 3) thiazolidinediones were prescribed in the presence of the contraindications. The areas for intervention are: 1) more active monitoring of glycemia; 2) the assessment of height, weight, and body mass index; and 3) the prescription of thiazolidinediones according to authorized indications and contraindications.

Administration, Oral↗
PubMed1996

Predictive diagnostics for logistic models.

Novel methodology is implemented to assess the predictive power of covariate information associated with sequential binary events. Logistic models are first fitted on the basis of a subset of the observations and then evaluated sequentially on the rest. The probabilistic forecasts are compared to the outcomes via a scoring function, but as most validation samples are small, the usual reference distribution for the test statistics is inadequate. However, bootstrap-based distributions can easily be constructed. The first example pertains to the evaluation of screening tests for major depression. It illustrates that goodness-of-fit and predictive assessments lead to the selection of very different models. The second example deals with the prediction of a major event in the natural history of HIV-induced disease. It shows that this type of analysis can reveal features missed by other approaches.

Calibration↗
PubMedDate not supplied

Trends in smoking by birth cohort for births between 1940 and 1975: a reconstructed cohort analysis of the 1990 Ontario Health Survey.

BACKGROUND: Smoking patterns have changed markedly over the past 70 years. Previous studies have shown that examination of smoking patterns within birth cohorts can identify important changes in tobacco adoption and cessation. This paper examines temporal trends in the prevalence of smoking and the age of smoking adoption and cessation for birth cohorts born between 1940 and 1975. METHODS: The underlying data were obtained from the Ontario Health Survey (conducted in 1990), which used a multistage stratified area sampling strategy to obtain interviews on 29,843 people age 12 or older. Self-reported smoking histories were used as the basis for a reconstructed cohort analysis of prevalence rates. A life events methodology was employed to examine the age at starting smoking and the time of smoking cessation. RESULTS: There has been a steady drop in peak smoking prevalence for men. This trend appears to be continuing among the most recent cohorts. However, for women, peak smoking prevalence increased until the 1960 birth cohort, after which time the peak prevalence has been dropping. Prevalence of smoking was much higher for men then for women among the earlier birth cohorts but, by the 1960 cohort, the prevalence for men and women was essentially the same. Examination of the age of smoking onset reveals that there was a statistically significant interaction between sex and birth cohort on the relative risk of starting smoking. The rate of smoking cessation has increased uniformly across all birth cohorts among both men and women. CONCLUSIONS: This study confirms recent trends in smoking reduction and provides no evidence to suggest a diminution of the effect. Trends in recent birth cohorts of women are encouraging. There is a clear need for public health initiatives directed at older children and teenagers in order to further reduce the onset of smoking. Efforts to prohibit advertising directed toward minors, sponsorship of sporting and cultural events, and the sale of tobacco to minors should receive high priority.

Adolescent↗
PubMed1982

Etiological factors in tubal infertility.

An analysis was made of the history of 820 patients who underwent diagnostic laparoscopy for infertility reasons. Events in the patient's history related to abdominal surgery, infection of the genital tract, and endometriosis were compared with the incidence of tubal disease at laparoscopy. Salpingitis, puerperal endometritis, gynecologic operations such as ovarian cystectomy, wedge resection, and operative correction of uterine retroversion and appendicitis complicated by perforation of the appendix, inflammatory mass or appendiceal abscess, were all associated with a significantly higher incidence of tubal disease. In patients that had undergone an uncomplicated appendectomy, the occurrence of tubal abnormalities was not increased (42%), when they were compared with the group with a completely negative history (37%). Implications of these findings with relation to the prevention of tubal disease are discussed.

Adult↗
PubMedDate not supplied

Climate variability and the energetic pathways of evolution: the origin of endothermy in mammals and birds.

Large-scale climate oscillations in earth's history have influenced the directions of evolution, last but not least, through mass extinction events. This analysis tries to identify some unifying forces behind the course of evolution that favored an increase in organismic complexity and performance, paralleled by an increase in energy turnover, and finally led to endothermy. The analysis builds on the recent concept of oxygen-limited thermal tolerance and on the hypothesis that unifying principles exist in the temperature-dependent biochemical design of the eukaryotic cell in animals. The comparison of extant water-breathing and air-breathing animal species from various climates provides a cause-and-effect understanding of the trade-offs and constraints in thermal adaptation and their energetic consequences. It is hypothesized that the high costs of functional adaptation to fluctuating temperatures, especially in the cold (cold eurythermy), cause an increase in energy turnover and, at the same time, mobility and agility. These costs are associated with elevated mitochondrial capacities at minimized levels of activation enthalpies for proton leakage. Cold eurythermy is seen as a precondition for the survival of evolutionary crises elicited by repeated cooling events during extreme climate fluctuations. The costs of cold eurythermy appear as the single most important reason why metazoan evolution led to life forms with high energy turnover. They also explain why dinosaurs were able to live in subpolar climates. Finally, they give insight into the pathways, benefits, and trade-offs involved in the evolution of constant, elevated body temperature maintained by endothermy. Eurythermy, which encompasses cold tolerance, is thus hypothesized to be the "missing link" between ectothermy and endothermy. Body temperatures between 32 degrees and 42 degrees C in mammals and birds then result from trade-offs between the limiting capacities of ventilation and circulation and the evolutionary trend to maximize performance at the warm end of the thermal tolerance window.

Adaptation, Physiological↗
PubMed2025

Navigating Sampling Bias in Discrete Phylogeographic Analysis: Assessing the Performance of an Adjusted Bayes Factor.

Bayesian phylogeographic inference is widely used in molecular epidemiological studies to reconstruct the dispersal history of pathogens. Discrete phylogeographic analysis treats geographic locations as discrete traits and infers lineage transition events among them, and is typically followed by a Bayes factor (BF) test to assess the statistical support. In the standard BF (BFstd) test, the relative abundance of the involved trait states is not considered, which can be problematic in the case of unbalanced sampling. Existing methods to correct sampling bias in discrete phylogeographic analyses using continuous-time Markov chain (CTMC) model, often require additional epidemiological information to balance the sampling effort among locations. As such data is not necessarily available, alternative approaches that rely solely on available genomic data are needed. In this perspective, we assess the performance of a modification of the BFstd, the adjusted Bayes factor (BFadj), which incorporates information on the relative abundance of samples by location when inferring support for transition events and root location inference without requiring additional data. Using a simulation framework, we assess the statistical performance of BFstd and BFadj under varying levels of sampling bias, estimating their type I and type II error rates. Our results show that BFadj complements the BFstd by reducing type I errors at the cost increasing type II errors for inferred transition events, while improving type I and type II errors in root location inference. Our findings provide guidelines for implementing the complementary BFadj to detect and mitigate sampling bias in discrete phylogeographic inference using CTMC modeling.

Bayes Theorem↗
PubMed1999

Suicide in the Montreal subway system: characteristics of the victims, antecedents, and implications for prevention.

OBJECTIVE: To understand the characteristics of persons who commit suicide in the Montreal subway system (the Montreal Metro), their personal and psychiatric histories, and the nature of the event in order to develop better prevention strategies. METHOD: Systematic analysis of coroner's office investigations of the 129 suicides in the Montreal Metro from 1986 to 1996. RESULTS: Of the 129 people who committed suicide, 81% had expressed a prior suicidal intention, 66% had previously attempted suicide, and 9% had attempted suicide in the metro. One hundred and five of the victims had serious mental health problems, most frequently depression; 73% had had inpatient psychiatric treatment, and at the time of death, 27% resided in a mental health treatment institution. Recent adverse life events included failed relationships, work problems, and family difficulties. CONCLUSIONS: Suicide victims intentionally go to the metro to kill themselves, often tell others beforehand, and are generally in treatment for serious psychiatric problems. Possible prevention strategies include modification of the environment and procedures in the metro, changing public conceptions of metro suicides, and modifying practice in psychiatric facilities.

Adolescent↗
PubMed2005

Risk factors for myocardial infarction in HIV-positive patients.

We describe the clinical characteristics of 12 HIV-infected patients who suffered from myocardial infarction (MI) in our clinical cohort. They were compared with a control group matched (1:2) for factors related to cardiovascular risk (age, gender, smoking habit, risk factor for HIV acquisition, hypertension, family history for relevant cardiovascular events, and body mass index) by conditional (fixed-effect) logistic regression analysis. Among patients with MI, 6/12 had never used protease inhibitors (PIs) or were antiretroviral therapy naive. The only variables marginally associated with MI were nadir CD4+ T-cell count <50/mm(3) (odds ratio (OR): 7.2; 95% confidence interval (CI) 0.81-64.2; P: 0.077) and zenith >100,000 HIV RNA copies/mL (OR: 7; 95% CI 0.81-60.2; P: 0.076) at univariate analysis. Moreover, the use of PIs did not result in being associated with the risk of MI. Our data show that in HIV-infected patients, PI use does not seem to have any negative impact on MI while the possible impact of advanced HIV infection itself needs further investigations.

Adult↗
PubMed1993

[Semantic information. Internal language. Thinking].

Semantic information has reached an objective condition after a lengthy history of semantic inquiries that instrumental neurophysiological devices--such as event-related potentials, electroencephalographic spectral analysis, regional brain circulation, PET scan, deep brain electrodes, and other--have made easier. In turn, internal language, as screened according to Vigotsky's perspective, is considered a product of semantic information circulation understood as neurosemae interconnection. Finally, in normal adults, thinking processes are assumed to be made up by both sensoperceptive information (proprioceptive information included) and semantic information. Thus, an "extraverbal thinking" can be distinguished, whose activity is hardly describable in healthy adults but should be considered as a condition of non-educated deaf persons, and a "verbal thinking", or internal language, made up by semantic information.

Humans↗
PubMed2006

Plasma total homocysteine and cardiovascular risk in patients submitted to liver transplantation.

Patients submitted to orthotopic liver transplantation (OLT) show an increased rate of cardiovascular events. OLT subjects have high homocysteine (Hcy) levels, but no data are available on the association of Hcy with cardiovascular events. In a cross-sectional analysis, 230 subjects were studied at least 6 months after OLT (159 on cyclosporine, 71 on tacrolimus). Routine laboratory data and total Hcy were recorded, as well as the history of diabetes, hypertension, dyslipidemia, and overweight. Cardiovascular events occurring in a follow-up of 2-36 months were registered. OLT subjects had higher-than-normal Hcy (median 16.7 micromol/L, range 6.1-171.8) without difference between the 2 immunosuppressive agents. The prevalence of Hcy >15 micromol/L was also similar, and significantly correlated with creatinine levels. A total of 28 arterial events occurred in 25 patients during follow-up (11 in coronary arteries, 10 in peripheral arteries, and 7 in splanchnic arteries). Deep vein thromboses occurred in 2 patients, and splanchnic vein thromboses in 4 patients. Cardiovascular events were frequently associated to high Hcy and hypertension. Cox regression analysis showed that high Hcy was significantly associated with arterial events. The risk of any arterial event, coronary artery or peripheral artery event increased by nearly 10% for any increase in Hcy of 5 micromol/L. In conclusion, high Hcy may be involved in the pathogenesis of cardiovascular events in OLT patients. The usefulness of Hcy-lowering therapy remains to be verified.

Adult↗
PubMed2005

The JAK2(V617F) tyrosine kinase mutation in myelofibrosis with myeloid metaplasia: lineage specificity and clinical correlates.

An association between an activating JAK2 mutation (JAK2(V617F)) and BCR/ABL-negative myeloproliferative disorders was recently reported in multiple simultaneous publications. In the current study, mutation analysis for JAK2(V617F) was performed in peripheral blood mononuclear cells (PBMC) from 157 patients with myelofibrosis with myeloid metaplasia (MMM) including 117 with agnogenic (AMM), 22 with postpolycythaemic (PPMM), and 18 with post-thrombocythaemic (PTMM) myeloid metaplasia. The detection rate for JAK2(V617F) was significantly higher in PPMM (91%; homozygous in 18%) compared with either AMM (45.3%; homozygous in 2.6%) or PTMM (38.9%; homozygous in 11.1%). Concomitant analysis in granulocytes (n=57) and CD34(+) cells (n=25) disclosed a higher incidence of homozygous JAK2(V617F) mutation but the overall mutation rate was similar to that obtained from PBMC. JAK2(V617F) was not detected in DNA derived from T cells (n=19). In AMM, the presence of JAK2(V617F) was associated with an older age at diagnosis and a history of thrombosis or pruritus. Multivariate analysis identified only age and the Dupriez prognostic score as independent prognostic factors; JAK2(V617F) had no prognostic significance. In conclusion, JAK2(V617F) is a myeloid lineage-specific event, its incidence in MMM is significantly higher with an antecedent history of polycythaemia vera (PV), and its presence in AMM does not affect prognosis but is associated with PV-characteristic clinical features.

Adolescent↗