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PubMed2005

REM sleep behavior disorder and REM sleep without atonia in patients with progressive supranuclear palsy.

STUDY OBJECTIVE: To compare sleep characteristics, rapid eye movement (REM) sleep without atonia, and REM sleep behavior disorder (RBD) in patients with progressive supranuclear palsy (tauopathy), patients with Parkinson's disease (a synucleinopathy), and control subjects. DESIGN: Sleep interview, overnight polysomnography, and Multiple Sleep Latency Tests. PATIENTS: Forty-five age- and sex-matched patients with probable progressive supranuclear palsy, (n=15, aged 68 +/- 8 years, 7 men), patients with Parkinson disease (n=15), and control subjects (n=15). SETTINGS: Tertiary-care academic hospital. INTERVENTION: N/A. RESULTS: Compared to the 2 other groups, patients with progressive supranuclear palsy had a longer duration of wakefulness after sleep onset and twice as much sleep fragmentation and percentage of stage 1 sleep but had similar apnea-hypopnea indexes, periodic leg movements indexes, and mean daytime sleep latencies. REM sleep percentage was as low in patients with progressive supranuclear palsy (8% +/- 6% of total sleep time) as in patients with Parkinson disease (10% +/- 4%), versus 20% +/- 6% in controls (analysis of variance, P < .0001). Interestingly, patients with progressive supranuclear palsy had percentages of REM sleep without atonia (chin muscle activity: 33% +/- 36% of REM sleep) similar to those of patients with Parkinson disease (28% +/- 35%) and dramatically higher than those of controls (0.5% +/- 1%, analysis of variance, P = .008). Four (27%) patients with progressive supranuclear palsy had more than 50% REM sleep without atonia (as did a similar number of patients with Parkinson disease), and 2 of them (13%, vs 20% of patients with Parkinson disease) had clinical RBD. The four patients with progressive supranuclear palsy with excessive daytime sleepiness slept longer at night than the 11 patients with progressive supranuclear palsy who were alert (442 +/- 14 minutes vs 312 +/- 74 minutes, student t tests, P = .004), suggesting a primary nonnarcoleptic hypersomnia. CONCLUSION: REM sleep without atonia and RBD were as frequent in patients with progressive supranuclear palsy as in patients with Parkinson disease. It suggests that the downstream cause of parkinsonism, rather than its primary neuropathology (synucleinopathy vs tauopathy), is a key factor for REM sleep behavior disorder.

Aged↗
PubMed1979

[The applicability of systolic time intervals in patients before and after aortic valve replacement (author's transl)].

In order to evaluate the systolic time intervals (STI) for characterizing the left ventricular pump function and the clinical course in patients with aortic valve disease, 35 patients with aortic stenosis (AS) and 25 patients with aortic insufficiency (AI class III or IV (NYHA) were studied before and 1 year after valve replacement either with Björk-Shiley, Lillehie-Kaster or Starr-Edwards aortic prostheses. Left ventricular ejection time index (LVETI), preejection period index (PEPI) and PEP/LVET were determined and compared with cardiac index (CI), stroke volume index (SVI) and ejection fraction (EF). Prosthetic valve replacement leads to a high significant decrease of LVETI from preop. 468 +/- 31 ms to postop. 394 +/- 26 ms (mean normal values 415 ms) and an increase of PEPI from 100 +/- 26 ms to 136 +/- 25 ms (normal 132 ms) as of PEP/LVET from 0.21 +/- 0.09 to 0.41 +/- 0.12 (normal 0.31). Pre- as well as postop. there is no difference in STI between AS and AI. Also the groups with the three prosthetic valve types do not differ significantly. LVETI and PEPI correlate only postop. with CI and SVI, but PEP/LVET correlates well with EF (r = -0.73) before and after operation. The comparison of STI with the hemodynamic data suggest that preop. values of STI near normal and postop. LVETI below, PEPI and PEP/LVET above the mean values of the whole group with aortic valve replacement indicate left ventricular pump dysfunction. The STI are helpful in the pre-/postop. follow-op of patients with severe aortic valve disease to characterize the clinical and hemodynamic course.

Aortic Valve↗
PubMed1981

Periodicity of microfilariae of human filariasis analysed by a trigonometric method (Aikat and Das).

The microfilarial periodicity of human filariae was characterized statistically by fitting the observed change of microfilaria (mf) counts to the formula of a simple harmonic wave using two parameters, the peak hour (K) and periodicity index (D) (Sasa & Tanaka, 1972, 1974). Later Aikat and Das (1976) proposed a simple calculation method using trigonometry (A-D method) to determine the peak hour (K) and periodicity index (P). All data of microfilarial periodicity analysed previously by the method of Sasa and Tanaka (S-T method) were calculated again by the A-D method in the present study to evaluate the latter method. The results of calculations showed that P was not proportional to D and the ratios of P/D were mostly smaller than expected, especially when P or D was small in less periodic forms. The peak hour calculated by the A-D method did not differ much from that calculated by the S-T method. Goodness of fit was improved slightly by the A-K method in two thirds of analysed data. The classification of human filariae in respect of the type of periodicity was, however, changed little by the results calculated by the A-D method.

Animals↗
PubMed1986

Noninvasive evaluation of systolic and diastolic function in severe congestive heart failure secondary to coronary artery disease or idiopathic dilated cardiomyopathy.

The usefulness of systolic time intervals, diastolic time intervals and echocardiography in evaluating left ventricular (LV) function was determined in 69 patients with severe congestive heart failure. All systolic time intervals were markedly abnormal (preejection period/LV ejection time 0.59 +/- 0.18 vs 0.30 +/- 0.04, preejection period index 170 +/- 37 vs 117 +/- 11, LV ejection time index 372 +/- 26 vs 410 +/- 17; patients vs control subjects, p less than 0.05). Diastolic time intervals in patients were not different from those in control subjects. Echocardiographic measurements were all markedly abnormal (LV end-diastolic dimension 6.9 +/- 1.0 vs 4.8 +/- 0.4 cm, patients vs control subjects, p less than 0.05). No pattern of abnormalities distinguished ischemic cardiomyopathies from idiopathic dilated cardiomyopathies. The presence of LV conduction delay did not substantially alter results, except that exclusion of patients with LV conduction delay normalized the total time of systole (QA2) index (from 542 +/- 40 to 531 +/- 31 ms) and reduced but did not normalize prolongation in the preejection period index (from 170 +/- 37 to 162 +/- 29 ms). No systolic or diastolic interval strongly correlated with any hemodynamic or other independent measure of LV performance. Twenty-four patients were given inotropic or unloading agents, which significantly improved hemodynamic values. Systolic and diastolic intervals were measured at baseline and at maximal hemodynamic effect. The correlation of changes in hemodynamics with changes in systolic and diastolic intervals was only modest. Thus, although systolic time intervals and associated echocardiographic measurements can detect abnormal LV function, they cannot reliably detect a change in LV function or distinguish gradations of abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

Outcomes of patients treated with fluticasone propionate or montelukast sodium.

The authors conducted a retrospective database study of patients with asthma (age range, 6-55 yr) who initiated fluticasone propionate or montelukast sodium treatment between an index period of July 1998 and June 1999. All patients were observed for 12 months before and after the index period. Changes in asthma-related hospitalizations, emergency department visits, oral corticosteroid use, and short-acting beta-agonist use were analyzed. The odds of postindex asthma-related events were estimated. In multivariate analysis, use of a short-acting beta agonist (SABA) was significantly associated with fluticasone treatment (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.21-2.26) and preindex use of SABAs (OR, 1.84; 95% CI, 1.34-2.53). In this managed care population, fluticasone and montelukast provided similar effectiveness.

Acetates↗
PubMed2006

The impact of unrecognized bipolar disorders among patients treated for depression with antidepressants in the fee-for-services California Medicaid (Medi-Cal) program: a 6-year retrospective analysis.

INTRODUCTION: The cost of unrecognized bipolar disorders over time is unknown. METHODS: Ten years of data from the California Medicaid program were used to identify depressed patients initiating new episodes of antidepressant therapy and with 6+ years of post-treatment data. Recognized bipolar (RBP) patients received a BP diagnosis or used mood stabilizers in the pre-index period. Unrecognized bipolar (UBP) patients received an initial BP diagnosis or used a mood stabilizer in the post-index period. Depression-only (MDD) patients had no BP diagnosis or mood stabilizer use. Three analyses were conducted: (1) regression models of cost per year, (2) a regression model of aggregate cost over 6 years and (3) a time trend analysis of the costs for UBP patients. RESULTS: 14,809 patients were identified: RBP 14.5%, UBP 28.2% and MDD 57.3%. The growth in costs per month for UBP patients over 6 years (171%) far exceeds the growth for RBP and MDD patients (82% and 95%, respectively). RBP and MDD patients cost 2316 dollars and 1681 dollars less per year in the 6th year relative to UBP patients (p<0.0001 for both estimates). The cost per month increased by 91 dollars for each month of delayed diagnosis (p=0.011). Costs for UBP patients increased by 10 dollars per month prior to their initial BP diagnosis (p<0.001) and by -1.01 dollars thereafter (p=0.006 for the change in slope). LIMITATIONS: Classification of patients based on diagnosis or mood stabilizer use using paid claims data is inexact. CONCLUSIONS: Early diagnosis of bipolar disorders may significantly reduce health care cost.

Adult↗
PubMed2006

[A brief introduction to MEDLINE and a guide for authors].

Medical literature analysis and retrieval system online (MEDLINE) established by National Library of Medicine, USA (NLM) is the most important biomedical database all over the world. This article introduces the database of MEDLINE and Chinese periodicals indexed in MEDLINE in 2006. Several suggestions are made as well, with the aim of providing a guide for authors to contribute to periodicals indexed in MEDLINE so as to extend the international influence of the articles, authors and related hospitals.

China↗
PubMed1981

Effects of thyroid hormone on left ventricular function in patients treated for thyrotoxicosis.

Systolic time intervals, echocardiographic indexes of left ventricular contractile function and serum triiodothyronine and thyroxine levels were measured before treatment in nine patients with hyperthyroidism, and again every 2 weeks for the first 2 months after therapy and then every 4 weeks until the subjects were clinically and chemically euthyroid. Six of the nine became transiently hypothyroid. Although the preejection period corrected for heart rate (preejection period index) increased as the patients became euthyroid, the change was not significant. Preejection period index increased dramatically in the patients becoming hypothyroid (p less than 0.005). Corrected left ventricular ejection time (left ventricular ejection time index) also increased as the patients became euthyroid (p less than 0.001), and increased again with the appearance of hypothyroidism (p less than 0.05). There was a linear correlation between velocity of circumferential fiber shortening and serum triiodothyronine level (r - 0.77) and between velocity of circumferential fiber shortening and serum thyroxine level (r = 0.70) at all stages of thyroid function. Thus thyroid hormone definitely enhances left ventricular function in human beings, and both excess and deficiency cause predictable reversible changes in myocardial contractile function. Thus thyroid hormone definitely enhances left ventricular function in human beings, and both excess and deficiency cause predictable reversible changes in myocardial contractile function. Furthermore echocardiographic measurements of velocity of circumferential fiber shortening provide rapid estimates of the chemical status of thyrotoxic patients before and after treatment.

Adult↗
PubMed1987

Haemodynamic effects of disopyramide using a new model of intravenous administration.

Intravenous treatment with disopyramide is usually performed by administration of a bolus injection of 150 mg given over 5 min. followed by a continuous infusion of 18-24 mg hour-1. A decrease in cardiac output is associated with this rapid bolus injection. Seven patients with ischaemic heart disease entered an open randomised cross-over trial to elucidate if an extension of the bolus injection time to 20 min. resulted in a smaller decrease in cardiac output. Cardiac index decreased significantly (P less than 0.001) in both situations, with maximum decrease observed at time 5 and 20 min., respectively (equivalent to the ending of the administration of 150 mg disopyramide). The decrease in Cardiac index (mean +/- S.E.M.) was identical in the two situations (2.56 +/- 0.23 to 1.78 +/- 0.21 l/min. X m2 (30%) and 2.66 +/- 0.17 to 1.94 +/- 0.19 l/min. X m2 (27%], respectively. Blood pressure was unchanged, while heart-rate (P less than 0.025) and preejection period index (P less than 0.005) increased significantly and to the same extent in the two situations. Significant correlations between the log free and log total serum concentration of disopyramide and the relative change in preejection period index of r = 0.840 (P less than 0.01) and 0.919 (P less than 0.01), respectively, were observed giving disopyramide over 5 min. A significant anticlockwise hysteresis was observed extending the time of administration to 20 min. As no haemodynamic advantages are achieved by the slower way of administration we would still recommend the bolus injection to be given over 5 min.

Disopyramide↗
PubMed1983

A comparative study on the effects of pindolol and propranolol on systemic and cardiac haemodynamics in hypertensive patients.

Eight out-patients with essential hypertension participated in a comparative, placebo-controlled study with a cross-over design. Pindolol and propranolol were administered orally in doses of 20.0 +/- 3.13 mg/d (mean +/- SEM) and 125.0 +/- 19.17 mg/d respectively. Pindolol reduced mean blood pressure by 11.9 mmHg; pre-ejection period index by 8.1 msec; total peripheral resistance by 3.1 mmHg min/L; and limb vascular resistance by 3.28 mmHg min 100 g/ml. Heart rate, cardiac output, plasma renin activity and urinary norepinephrine excretion rate were not altered by pindolol. Propranolol reduced mean blood pressure by 14.0 mmHg; heart rate by 9.1 beats/min; cardiac output by 0.57 L/min; limb blood flow by 1.06 ml/100 g.min; and plasma renin activity by 1.44 ng/ml/h; and increased pre-ejection period index by 8.7 msec. Total peripheral resistance, limb vascular resistance and urinary norepinephrine excretion rate were not altered by propranolol. It was concluded that: (1) the drugs, pindolol and propranolol, are equally effective as antihypertensive agents; (2) heart function and plasma renin activity are decreased by propranolol and unaltered by pindolol; (3) total peripheral resistance is decreased by pindolol and unaltered by propranolol; and (4) these findings may be explained by the intrinsic sympathomimetic activity exhibited by pindolol only.

Adult↗
PubMed1980

Correlation between changes in systolic time intervals and left ventricular end-diastolic diameter after preload reduction. Non-invasive monitoring of pharmacological intervention.

In order to measure the effect of a decrease in preload on systolic time intervals and left ventricular end-diastolic diameter (LVEDD) measured by echocardiography, eight healthy young subjects were given 40 mg frusemide intravenously. The pre-ejection period index (PEPI) increased and the left ventricular end-diastolic diameter decreased. A correlation between delta PEPI and delta LVEDD was shown. Using changes in systolic time intervals in the evaluation of changes in contractility it is important to correct for changes in preload. For normal subjects it is suggested that the relation between delta PEPI and delta LVEDD as a percentage of the mean values should be used for this correction. A method is suggested for estimating the changes in pre-ejection period index induced by changes in left ventricular end-diastolic diameter.

Adult↗
PubMed1985

Immediate central and regional haemodynamic effects of a new beta 1-adrenergic stimulating drug, xamoterol (Corwin) in healthy volunteers.

Dose-response curves for heart rate, arterial blood pressure, cardiac output, total peripheral resistance, systolic time intervals, forearm blood flow and forearm vascular resistance were obtained after i.v. administration of seven logarithmically increasing doses of xamoterol to 8 healthy volunteers. The total cumulative dose was 0.2 mg/kg b.w. At rest after the seventh dose of xamoterol heart rate, systolic blood, pressure, cardiac output and forearm blood flow were increased by 10%, 20%, 23% and 41%, respectively. Diastolic blood pressure was unchanged. Forearm vascular resistance was reduced by 21% and total peripheral resistance by 10%. Systolic time intervals were reduced: total electromechanical systole index (QS2I), left ventricular ejection time index (LVETI), pre ejection period index (PEPI) and PEP/LVET ratio by 4%, 2%, 12% and 14%, respectively. No side-effects were observed. During upright exercise after the seventh dose of xamoterol heart rate was reduced by 11% and systolic BP by 6%. Diastolic blood pressure was unchanged. Thus xamoterol increased the contractility of the heart with only a small increase in heart rate, increased systolic blood pressure and caused vasodilatation in resting skeletal muscle. During exercise the reduction in heart rate and blood pressure suggests beta-adrenoceptor blocking activity of the drug.

Adrenergic beta-Agonists↗
PubMed1997

Wuchereria bancrofti in Tanzania: microfilarial periodicity and effect of blood sampling time on microfilarial intensities.

The circadian periodicity of Wuchereria bancrofti microfilarial (mf) intensities in peripheral blood was analysed in a group of infected individuals from an endemic community in north-eastern Tanzania. The mf density was quantified at two-hourly intervals for 24 hours. A clear nocturnal periodic pattern was observed. Mathematical analysis of the data indicated a peak at 0152 h and a periodicity index of 117.5. A periodicity equation was developed describing the average relation between mf intensity and hour of the day for the study area. Based on the observed periodicity pattern, the effect of blood sampling before peak time is discussed, and the importance of taking sampling time into consideration when analysing data from epidemiological studies is emphasized. A simple method is devised which can be used to adjust for the influence of time on mf intensities, in studies where accurate information on mf intensities is necessary, and where it is impossible to obtain all samples at peak time.

Adult↗