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PubMed2003

[Influential factors in anastomosis healing].

Anastomotic leakage after visceral surgery is one of the most important and feared complication. According to the literature the rate of clinically apparent anastomotic leakage ranges from 3.4% to as high as 12% and at least one third of the mortality after colorectal surgery is attributed to leaks at the anastomotic site. Within this context, knowledge of factors influencing anastomotic healing appears even more important. Beside surgical-technical (suture technique, suture material) and surgical-tactical factors (primary anastomosis vs. discontinuity resection or formation of protective diverting stomas) knowledge of the various endogenous (diabetes, sepsis, infection, malnutrition) and exogenous factors (steroids, radiation, preoperative bowel preparation) influencing anastomotic healing is essential. Recently, it has been demonstrated that Mycophenolate mofetil, an immunosuppressive drug that is currently used in transplantation and in chronic inflammatory diseases significantly impairs mechanical stability of the healing anastomosis. In contrary, local application of keratinocyte growth factor (KGF) as well as insulin-like growth factor-I (IGF-I) have been shown to accelerate and improve anastomotic healing and mechanical stability in an animal model. Studies that will identify further factors and drugs influencing anastomotic healing are of great importance since the use of such drugs could have enormous clinical implications. The traditional use of temporary diverting stomas following operations such as coloanal anastomosis or ileopouch anastomosis as well as Hartmann's discontinuity resection could be eliminated even in immunocompromised or other high risk patients.

Anastomosis, Surgical↗
PubMed1983

Effects of conformational selectivity and of overlapping kinetically influential ionizations on the characteristics of pH-dependent enzyme kinetics. Implications of free-enzyme pKa variability in reactions of papain for its catalytic mechanism.

The effects of selection by a small molecule, when binding to a protein, of a particular conformation from an equilibrium stereopopulation on the characteristics of the pH-dependence of reaction with a reactivity probe or substrate were determined by analysis of an appropriate kinetic model. For reaction in one protonic state containing an equilibrium mixture of two conformational isomers, the pH-second-order rate constant (k) profile is of conventional sigmoidal form. The apparent pKa value is a composite of the pKa values of the two conformational states. The value of pKapp. for a given enzyme under given experimental conditions will always be the same (provided that the site-specificity assumed in the model is maintained) irrespective of whether only one conformation reacts or both react, with the same or with different rate constants. The experimentally determined pH-independent rate constant (kapp.) is an average of the reactivities of the two conformational states weighted in favour of the predominant form. The presence of an additional but unreactive conformational state also affects the value of kapp. The possibility that overlapping acid dissociations that affect the reactivity of the enzyme might provide pH-k profiles often indistinguishable in practice from simple sigmoidal dissociation curves and subject to variability in apparent pKa values was evaluated by a simulation study. If two reactive protonic states of the enzyme respond differently to changes in the structure of the substrate or site-specific reactivity probe, differences in apparent pKa values of up to approx. 1 unit can be exhibited without deviation from sigmoidal behaviour being reliably observed. Differences in apparent pKa values observed in some site-specific reactions of papain and their possible consequences for its catalytic mechanism are discussed.

Hydrogen-Ion Concentration↗
PubMed1990

Patients' perception of distress due to symptoms and effects of asthma on daily living and an investigation of possible influential factors.

1. Distress ratings for questions relating to the symptoms and impacts of asthma on daily living have been examined in 40 adult asthmatic outpatients. 2. The patients responded to each item in a 76-item questionnaire by marking a 10 cm visual analogue scale to indicate the degree of distress associated with the symptoms or state described in the question. The resulting score (as a percentage of 10 cm) was interpreted as the degree of distress associated with a particular item. 3. The possible influence on these distress scores of five factors, age, duration (time in years from diagnosis to interview), variability [recorded variability of forced expiratory volume in 1 s (FEV1) expressed as amplitude per cent mean], sex and FEV1 (current and worst recorded in the clinic, expressed as per cent of predicted) was investigated. 4. From correlations of each item with age, 11/76 items were significant at P less than 0.05. Taking the results from all 76 items in a repeated measures analysis of variance, there was a small significant relationship between age and distress score (P = 0.048). The direction of the association was negative, suggesting that younger patients were less tolerant of asthma; however, the effect of age only explained 1.5% of the total variance in scores of the 76 items. 5. From correlations of visual analogue scale score for each item against duration, 10/76 items were significant at P less than 0.05, but taking the 76 items overall there was no significant association (P = 0.2). 6. The remaining factors, sex, variability and FEV1, only showed a significant effect in 1/76, 1/76 and 5/76 items, respectively (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1998

The quality of alcohol treatment research: an examination of influential controlled trials and development of a quality rating system.

BACKGROUND: The importance of evidence-based practice has stimulated interest in the methodology of clinical trials. Various weaknesses of evaluation research in the alcohol field have been indicated previously. This study set out to develop a comprehensive system for the assessment of the methodological quality of outcome research for treatment of alcohol misuse and to apply the system to well-known trials in the area. METHODOLOGY: A sample of the most highly cited controlled trials of interventions for alcohol misuse was selected using the Science Citation Index. Thirty methodological criteria were formulated and a scoring system devised. Two raters applied this system to the sample of trials. Reliability testing was performed and used to refine the criteria. RESULTS: Inter-rater reliability of the overall quality score was initially 0.85 and 0.92 after review and re-rating. Internal consistency was also high (0.87). Quality score correlated with year of publication. Certain areas of methodology were poorly addressed in the sample, including specification of main outcomes, documentation of recruitment and selection procedures, testing of blinding, analysis of withdrawals and reporting of results. DISCUSSION: The methodology of this sample of trials was frequently deficient in ways which might bias results or compromise generalizability. It is recommended that the system of quality assessment described here is used to evaluate existing research and to inform the design of future studies.

Alcoholism↗
PubMed1996

[Psychological coping with stillbirth. Course of grief response, influential factors, treatment satisfaction, patient management needs].

Course of Grief Response, influencing Factors, Satisfaction with treatment, Need for Psychotherapeutic Support: The emotional response to a late miscarriage or a stillbirth was examined retrospectively in a systematic study involving 51 patients. The women had lost a child either by stillbirth (beyond the 20th week of gestation) or shortly after delivery. We assessed the long-term course of possible determinants of grief, a complicated grief response, as well as the patients' satisfaction with the treatment and their need for further psychotherapeutic support. The mourning response was complicated by a depressive reaction in 22%. Major risk factors were individual disposition, lack of partner and professional support. The findings reveal that the course of the grief response is positively influenced by: 1. open discussion (thematisation) with the skilled personnel and the patients' families, 2. direct or indirect contact with the deceased child (concretisation) and 3. the patients concerned being extensively informed as to place and circumstances of the funeral (whereabouts of the child).

Adaptation, Psychological↗
PubMed2000

Evaluation of testosterone/epitestosterone ratio influential factors as determined in doping analysis.

The ratio of the concentration of testosterone glucuronide to the concentration of epitestosterone glucuronide (T/E ratio) as determined in urine is the most frequently used method to prove testosterone abuse by athletes. A T/E ratio higher than 6 has been considered as proof of abuse in the past; however, cases of naturally occurring higher T/E ratios have been described. Since the introduction of the T/E ratio in doping analysis, the parameters that may or may not influence the T/E ratio, possibly leading to false-positive results, have been debated. To achieve more insight on the influencing circumstances, an overview is given to obtain an objective view on the merits of the urinary T/E ratio. Relevant analytical aspects of the T/E ratio, potential parameters of endogenous and exogenous origins, as well as some alternative methods to determine testosterone abuse, such as the urinary testosterone/luteinizing hormone ratio, gas chromatography-combustion-isotope-ratio mass spectrometry, hair analysis, and high-performance liquid chromatography-mass spectrometry, are discussed.

Chromatography, High Pressure Liquid↗
PubMed1998

Is physical activity or aerobic power more influential on reducing cardiovascular disease risk factors?

PURPOSE: This study determined the relationship between aerobic power (VO2max), physical activity (PA), and cardiovascular disease (CVD) risk factors. The study also determined how increased VO2max and increased PA levels influence CVD risk factors of 576 low-fit adults (VO2max < 30 mL.kg-1.min-1). METHODS: PA (Baeke questionnaire) and VO2max (submaximal cycle test) of 1664 law enforcement trainees were evaluated with respect to the CVD risk factors of total cholesterol, blood pressure (BP) [BP], smoking, and obesity using separate logistic regression, adjusting for age, gender, and the other major CVD risk factors. RESULTS: Compared with the lowest tertile of VO2max, the highest tertile had a reduced relative risk (RR) for elevated cholesterol (RR, 0.56; CI, 0.36-0.43), BP (RR, 0.32; CI, 0.15-0.62) and obesity (RR, 0.09; CI, 0.06-0.12). The middle tertile of VO2max compared with the lowest had reduced RR for elevated diastolic BP (RR, 0.44; CI, 0.23-0.66) and obesity (RR: 0.38; CI 0.28-0.50). High PA tertile, compared with low PA tertile, only had lower RR for high systolic BP (RR, 0.48; CI, 0.23-0.95). Compared with the low PA tertile, moderate or high PA had no reduction in any of the RR (P > 0.05). Participation in a 9-wk exercise program by low-fit individuals resulted in a 9% increase in PA levels (P < 0.02); however, only those subjects who increased VO2max (> 3 mL.kg-1.min-1; N = 345) had a reduction in RR for high cholesterol (RR: 0.62; CI 0.42-0.92) and systolic BP (RR: 0.57; CI 0.40-0.80). No reduction in RR were noted for diastolic BP or obesity. CONCLUSIONS: Aerobic power appears to have more of an influence on CVD risk factors than PA levels. Further, in low-fit persons, it appears that PA resulting in an increased aerobic power is associated with a reduction in CVD risk factors of cholesterol and BP in as little as 9 wk.

Adult↗
PubMed1999

Model choice and influential cases for survival studies.

Deletion diagnostics are developed for identifying observations that influence the estimates of regression parameters and the mixture parameter in the families of relative risk functions for failure time data. The diagnostic for the regression parameters is a generalization of Cain and Lange's (1984, Biometrics 40, 493-499) measure of individual influence. The generalizations of martingale residuals, Schoenfeld's partial residuals (1982, Biometrika 69, 239-241), and score residuals by Therneau, Grambsch, and Fleming (1990, Biometrika 77, 147-160) are also obtained. The influence of some observations on regression parameters can be drastically modified as the mixture parameter changes, even for a very small change. In addition, adding or deleting some observations might result in choosing different models. The diagnostics are applied to a family proposed by Guerrero and Johnson (1982, Biometrika 69, 309-314). One illustrative example is presented.

Biometry↗
PubMed1997

Training as an influential factor on the locomotor pattern in Andalusian horses.

The physiological and metabolic adaptations to exercise of the Andalusian horse seem to differ slightly from those found in other breeds. The authors studied the locomotor adaptation of 18 Andalusian horses to a training programme in relation to anaerobic energy metabolism, efficacy of the training programme, and changes associated with the onset of fatigue. They also tried to find out if these changes had become diminished by training. Several locomotor variables during trotting and galloping were determined and plasma lactate concentrations were measured before training and after two training periods of different lengths. While trotting after training, an increase in the duration of the restraint phase, a reduction in the propulsion phase and a decrease in the duration and length of step were observed. During galloping, training caused a reduction in stride length but an increase in stride frequency. Significant correlations were obtained between stride duration, frequency and length of step and lactate concentrations. The training might have caused a shift in metabolism from anaerobic to aerobic predominance. This reduction was coupled with a decrease in stride duration, in response to a shorter stance phase duration and an increase in stride frequency. A reduction in the fatigue level was not observed. The study concludes that this training programme was not sufficient for improving the physical capacity of Andalusian horses.

Adaptation, Physiological↗