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[Lipid profile and alteration of body composition in growth hormone deficient adults].

BACKGROUND: The growth hormone deficiency (GHD) syndrome in adults and the increased associated cardiovascular risk have been extensively studied in recent years. Abnormal body composition with excess of visceral adiposity and adverse lipid profile are important features of this syndrome. Abnormal lipid profile has been described with increased levels of total cholesterol (C), LDL-cholesterol (LDL-C), triglycerides, decreased levels of HDL-cholesterol (HDL-C) and apolipoproteins abnormalities. METHODS: Lipid profile and the amount of visceral adipose tissue were studied in 31 GHD adults compared with a control group of healthy subjects matched for age, gender and body mass index (BMI). Visceral adipose tissue was evaluated by abdominal computed tomography and anthropometric measurements--BMI (kg/m2) and waist circumference (cm). The lipid profile was studied by measurement of C, LDL-C, HDL-C, triglycerides, apolipoproteins A and B, and Lipoprotein (a). RESULTS: The GHD adults showed increased visceral adipose tissue (156.66 +/- 72.72 vs. 113.51 +/- 32.97 cm2, p = 0.049), higher levels of triglycerides (158.58 +/- 80.29 vs. 97.17 +/- 12.37 mg/dl; p = 0.007) and lower HDL- cholesterol (45.41 +/- 13.30 vs. 55.34 +/- 14.31 mg/dl; p = 0.002). There were no differences in others aspects of lipid profile and anthropometric measurements. CONCLUSION: Growth Hormone Deficient adults showed increased visceral adipose tissue, higher levels of triglycerides and lower HDL- cholesterol levels.

Adult↗

Modeling surface water critical loads with PROFILE: possibilities and challenges.

The critical load concept has become a valuable tool for policymakers in the European negotiations on emission reductions. Despite the international acceptance, ongoing validation of critical load methodology is of the utmost importance to avoid a situation where the calculation results are difficult to defend. In this paper we explore the potential of using the steady state soil chemistry model PROFILE as an alternative to the Steady State Water Chemistry (SSWC) method for calculating critical loads of acidity. The hypothesis is that the uncertainty in prediction of preindustrial leaching of base cations is reduced when soil properties instead of lake chemistry are used as input data. Paleolimnological reconstructions of preindustrial lake chemistry are used to test PROFILE. As PROFILE requires soil data that are not generally available on a catchment level, we used distributions of crucial parameters from soil survey data within the vicinity of five lakes for which paleoecological pH reconstructions were available. An important concern is the characterization of catchment hydrology. A calibration of the "effective" soil depth, needed to give PROFILE predictions that coincided with paleolimnology, suggested that approximately 0.6 m of the total soil depth was hydrologically active in supplying acid neutralizing capacity (ANC) to runoff through weathering. At present, there is insufficient evidence to either recommend or reject the PROFILE model for surface water critical loads. Before such a judgement can be made, the approach presented here has to be tested for other regions, and the definition of catchment hydrology needs to be investigated further.

Acid Rain↗

The effect of aerobic exercise training on the lipid-lipoprotein profile of children and adolescents.

Longitudinal paediatric population studies have provided evidence that the risk factor theory may be extended to children and adolescents. These studies could assist in identifying individuals at increased coronary risk. Numerous studies have focused on the effects of regular exercise on the paediatric lipoprotein profile, a recognised primary risk factor, with equivocal results. Cross-sectional comparisons of dichotomised groups provide the strongest evidence of an exercise effect. 'Trained' or 'active' children and adolescents demonstrate 'favourable' levels of high density lipoprotein-cholesterol (HDL-C), triacylglycerol, total cholesterol (TC)/HDL-C and low density lipoprotein-cholesterol (LDL-C)/HDL-C, whilst TC is generally unaffected. The evidence regarding LDL-C in these studies is equivocal. A possible self-selection bias means that a cause-effect relationship between exercise and the lipoprotein profile cannot be readily established from this design. Correlational studies are difficult to interpret because of differences in participant characteristics, methods employed to assess peak oxygen uptake and habitual physical activity (HPA), and the statistical techniques used to analyse multivariate data. Directly measured cardiorespiratory fitness does not appear to be related to lipoprotein profiles in the children and adolescents studied to date, although there are data to the contrary. The relationship with HPA is more difficult to decipher. The evidence suggests that a 'favourable' lipoprotein profile may be related to higher levels of HPA, although differences in assessment methods preclude a definitive answer. While few prospective studies exist, the majority of these longitudinal investigations suggest that imposed regular exercise has little, if any, influence on the lipoprotein levels of children and adolescents. However, most prospective studies have several serious methodological design weaknesses, including low sample size, inadequate exercise training volume and a lack of control individuals. Recent studies have suggested that increases in HDL-C and reductions in LDL-C may be possible with regular exercise. The identification of a dose-response relationship between exercise training and the lipoprotein profile during the paediatric years remains elusive.

Adolescent↗

Good safety profile and efficacy of leucocyte interferon-alpha in combination with oral ribavirin in treatment-naive patients with chronic hepatitis C: a multicentre, randomised, controlled study.

BACKGROUND: The differential tolerability profile of various interferon (IFN)-alpha preparations used in combination with ribavirin for the treatment of chronic hepatitis C needs to be elucidated. Approximately 8% of patients receiving recombinant IFNalpha-2b plus ribavirin discontinue treatment because of adverse events. Human leucocyte IFNalpha is deemed to have a better safety profile than recombinant IFNalpha. We therefore compared the safety profile and efficacy of ribavirin combined with leucocyte IFNalpha or with recombinant IFNalpha-2b in treatment-naive patients with chronic hepatitis C. STUDY DESIGN: We randomised 423 patients to either leucocyte IFNalpha 3MU three times weekly plus ribavirin (210 patients) or the same dose of recombinant IFNalpha-2b plus ribavirin (213 patients). Patients were treated for 24 weeks and followed-up for a further 48 weeks. The primary endpoint was the safety profile of the two therapies; the secondary endpoint was the rate of sustained response. RESULTS: In patients receiving leucocyte IFNalpha, the total number of adverse events was lower than in the group receiving recombinant IFNalpha (259 vs 441 patients), and the percentage of patients discontinuing treatment because of adverse events or laboratory abnormalities was significantly reduced (4% vs 11%; p = 0.013). Sustained response was observed in 47% of patients receiving leucocyte IFNalpha plus ribavirin and in 44% of patients receiving IFNalpha-2b plus ribavirin. CONCLUSIONS: Both therapeutic regimens were effective in inducing a sustained response in naive patients. However, the safety profile of leucocyte IFNalpha plus ribavirin was more favourable than that observed with the administration of recombinant IFNalpha-2b plus ribavirin, suggesting that leucocyte IFNalpha may be an alternative option in patients with reduced tolerability to other IFNs.

Adult↗

The effect of diet and insulin on metabolic profiles of women with gestational diabetes mellitus.

Twenty women with abnormal glucose tolerance, detected from a routine program of antenatal screening for gestational diabetes mellitus (GDM) at 28 wk, were admitted for 24-h metabolic profiles. They were then alternately allocated to either insulin and dietary restriction or dietary restriction alone and then retested 4 wk later while on therapy. Ten normal controls were assessed twice at similar gestations to the study group. Before treatment, the 20 gestational diabetic subjects had higher mean concentrations of plasma glucose and 3-hydroxybutyrate than the controls for most of the profile, but mean insulin values were similar. Insulin therapy was associated with a reduction in mean glucose concentrations so that the profile was similar to the controls, while in the diet-alone group the reduction was less. The 3-hydroxybutyrate concentrations rose between profiles in the normal group and also rose in those treated by diet alone, but still remained within the upper range of normal even at night. Insulin therapy resulted in a similar 3-hydroxybutyrate profile to the controls. The C-peptide response to breakfast was reduced in both groups to levels below that of the controls. Neonatal outcome indices were similar in the two treatment groups, despite the differences in maternal metabolites, but because of the size of this study, conclusions about the neonate must be tentative.

3-Hydroxybutyric Acid↗

Impact of two common polymorphisms in the PPARgamma gene on glucose tolerance and plasma insulin profiles in monozygotic and dizygotic twins: thrifty genotype, thrifty phenotype, or both?

The Pro12Ala polymorphism in the PPARgamma2 gene has been associated with reduced risk of type 2 diabetes and insulin resistance. Recently, an association between dizygotic twinning and PPARgamma gene polymorphisms has been proposed. We investigated the phenotypic appearance of the two polymorphisms (Pro12Ala and exon 6 C-->T) in PPARgamma among elderly twins (207 monozygotic [MZ] and 342 dizygotic [DZ]) and evaluated whether they could explain previously reported differences in plasma glucose and insulin profiles among MZ and DZ twins. We demonstrated a significant impact of the Pro12Ala polymorphism on glucose tolerance, diabetic status, homeostasis model assessment for insulin resistance, and plasma insulin profiles in twins. No impact of the silent exon 6 polymorphism on glucose homeostasis or plasma insulin profiles was found. Independent of the polymorphisms, we observed a significant impact of zygosity status per se on the plasma insulin profile after oral glucose ingestion, with the MZ twins being more hyperinsulinemic, indicating insulin resistance, than the DZ twins. Nonsignificantly higher glucose concentrations were observed among MZ compared with DZ twins. We demonstrated an association between the Ala allele and reduced risk of diabetes and insulin resistance in twins. However, the differences in metabolic profiles among MZ and DZ twins were not explained by differences in frequencies of the genetic variants and may be due to intrauterine environmental factors operating in twins independent of genotype. Accordingly, our study simultaneously supports a role for both the intrauterine environment (thrifty phenotype) and for genetics (thrifty genotype) in the etiology of insulin resistance and perhaps glucose intolerance in twins.

Aged↗

The glucose area under the profiles obtained with continuous glucose monitoring system relationships with HbA(lc) in pediatric type 1 diabetic patients.

OBJECTIVE: The purpose of this study was to determine whether the continuous glucose monitoring system (CGMS) (MiniMed, Sylmar, CA) 1) is sufficiently representative of the overall metabolic control as assessed by HbA(1c), 2) could be used to identify a particular blood glucose threshold value affecting hemoglobin glycation; and 3) is able to show any relationship between particular glycemic profiles and HbA(1c) levels. RESEARCH DESIGN AND METHODS: Of 44 pediatric patients with type 1 diabetes who wore CGMS devices, 28 subjects were selected for the study. Criteria for inclusion were high levels of HbA(1c) (> or =8%) for more than 1 year or a history of frequent hypoglycemic episodes and a complete CGMS registration for 72 h. Age of the subjects ranged from 5.7 to 24.8 years, the mean duration of disease was 7.63 +/- 4.75 years, and the mean HbA(1c) value was 8.7 +/- 1.3%. CGMS data were downloaded and glucose profiles were analyzed. The area under each glucose profile was calculated by means of a professional digital planimeter. RESULTS: The glucose profiles showed a high frequency of prolonged hyperglycemic periods (80% of subjects) and a low frequency of postmeal glycemic peaks (29% of subjects). Postlunch values were significantly correlated with HbA(1c) levels, but the correlation disappeared when controlling for glucose area values. Glucose area values significantly correlated with HbA(1c) levels both when considered as a whole (40-400 mg/dl; r = 0.53, P = 0.002) and when considered fractioned (40-150, 40-200, 40-250, 40-300 mg/dl), apart from the 40-90 mg/dl partial area. HbA(1c) levels were significantly decreased 3 and 6 months after use of CGMS (P = 0.05 and 0.03, respectively, paired Student's t test). CONCLUSIONS: HbA(1c) levels may be decreased by using the information obtained with the CGMS. Three-day glucose profiles are representative of the overall glucose control, because glucose area values correlate with HbA(1c) levels. The only glucose threshold below which there seems to be no correlation with HbA(1c) is 90 mg/dl. Only glucose area, and not postprandial glucose values, are directly and independently correlated with HbA(1c). Therefore, to improve metabolic control, it is necessary to lower the whole mean 24-h glycemia and not just the postprandial glucose values.

Adolescent↗

Incidence of the half-left profile pose in single-subject portraits.

The present work recorded frequencies of five poses (left profile, half-left profile, full-face view, half-right profile, and right profile) by examining 4,180 single-subject portraits of various media. Statistically significant differences were found between the incidence of half-left and half-right profiles. These differences found across media, authorship, and five centuries of portrait work are consistent with right-hemisphere activation models in attentional bias and perception of emotion.

Adult↗

WASI profile variability in a sample of psychiatric inpatients.

This study examined the variability of Wechsler Abbreviated Scale of Intelligence profiles using the subtest range and profile variability index in a sample of 70 psychiatric inpatients. The subtest range and profile variability index were correlated .93 (p<.001), indicating that either measure may be used to assess profile variance. Comparison of profile variability on this abbreviated scale with other Wechsler intelligence scales in similar populations suggests that variability measures are not comparable across the tests.

Female↗

Age-related differences of blood pressure profile in essential hypertension.

The purpose was to assess age-related circadian changes of blood pressure profile (BPP) employing a truncated Fourier series with four harmonics (tFs) in patients with essential hypertension. The study was performed on 32 patients with essential hypertension divided in two groups: (A) 15 patients younger than 55 years and (B) 17 patients older than 60 years. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were monitored every 20 minutes for 24 h with a noninvasive portable device (SpaceLabs 90202). To evaluate the existence of SBP and DBP circadian rhythms a one-sample runs-test was performed and the mesor, amplitude, and acrophase from the overall curve of each patient were obtained by tFs. In both groups, SBP and DBP profiles showed a first peak in the late morning and a second peak in the early evening around the same hours. The two peaks in the SBP profile were higher and the two peaks in the DBP profile were lower in older patients than in younger ones (p < .01, p < .05, p < .3, p < .05). The truncated Fourier series with four harmonics evidences different age-related BP profiles characterized by two peaks with higher SBP and lower DBP in elderly patients. These changes of BPP are in accordance with the reported higher risk of cardiovascular events observed around the same hours.

Adult↗

The 'PRESTON Profile'--the first disease-specific tool for assessing quality of life in patients with malignant glioma.

This study seeks to assess the quality of life in patients with malignant glioma, using as its measuring tool the disease-specific "PRESTON Profile' designed by the author. Twenty patients took part in the project. Following completion of the questionnaire, semi-structured interviews were conducted with each subject to further explore issues raised by their responses to the "PRESTON Profile'. Results showed that the "PRESTON Profile' was perceived as a most pertinent tool for ascertaining quality of life in patients with malignant glioma. However, it was apparent that a questionnaire alone is not the ideal way of assessing quality of life in these patients, as the concentration required to reach each statement, and then to make a considered decision, sometimes proved too demanding. Interviewing patients (alone or with their spouse/carer)- utilizing information gained from their responses to the "PRESTON Profile' elicited considerably more information. Thus the "PRESTON Profile' can be used successfully as both an assessment of quality of life, and as a "launching pad' for more in-depth counselling, for patients with malignant glioma.

Adult↗

Amino acid profile and intestinal digestibility in dairy cows of rumen-undegradable protein from various feedstuffs.

Three lactating cows fitted with rumen cannulas and three cows fitted with proximal duodenal cannulas were used to determine the effect of in situ rumen degradation on the AA profile of rumen-undegraded protein of 12 feedstuffs. Intestinal digestibility of rumen-undegraded protein was determined using the mobile bag technique. The absorbable AA profile of rumen-undegraded protein for each feedstuff was compared with profiles of the original feedstuff and the rumen-exposed undegraded protein. Branched-chain AA in particular seemed to be rather resistant to degradation in the rumen, as was Phe. Lysine concentrations decreased in the undegraded protein fraction in 9 of 12 feedstuffs; the degradation of Met depended on the feedstuff. The absorbable AA profiles of undegraded protein, in general, closely reflected the AA profiles of the rumen-exposed residues, which suggests that rumen degradation had a greater influence than postruminal digestion on the postruminal provision of specific absorbable AA. Intestinal digestibility of undegraded protein varied from 37.8% for Eragrostis curvula hay to 98% for soybean meal; the constant digestibility factor used by most protein systems should be reconsidered.

Amino Acids↗

Hemodynamic clinical profiles.

Hemodynamic profiling provides valuable information about cardiac output and its determinants: preload, afterload, and contractility. The direct and derived parameters of these determinants are used by expert critical care nurses in collaboration with medical directives for intervention to enhance clinical assessment, decisionmaking, and evaluation. This article reviews the basic and advanced aspects of hemodynamic profiling. The parameters that must be included in a complete hemodynamic profile are discussed with emphasis on the importance of index values. An algorithm is included as a guideline for use of the hemodynamic profile. A variety of clinical examples are discussed to illustrate the importance of hemodynamic profiling as an adjunct to expert critical care nursing practice.

Cardiovascular Diseases↗

The Adult Sensory Profile: measuring patterns of sensory processing.

OBJECTIVE: This article describes a series of studies designed to evaluate the reliability and validity of the Adult Sensory Profile. METHOD: Expert judges evaluated the construct validity of the items. Coefficient alpha, factor analysis, and correlations of items with subscales determined item reliability, using data from 615 adult sensory profiles. A subsample of 20 adults furnished skin conductance data. A heterogeneous group of 93 adults completed the revised Adult Sensory Profile, and item reliability was reexamined. RESULTS: Expert judgment indicated that items could be categorized according to Dunn's Model of Sensory Processing. Results suggested reasonable item reliability for all subscales except for the Sensation Avoiding subscale. Skin conductance measures detected distinct patterns of physiological responses consistent with the four-quadrant model. Revision of the Adult Sensory Profile resulted in improved reliability of the Sensation Avoiding subscale. CONCLUSION: The series of studies provides evidence to support the four subscales of the Adult Sensory Profile as distinct constructs of sensory processing preferences.

Adolescent↗

[Reusable imaging plate (IP) for swift and automatic measurement of X-ray CT dose profiles].

PURPOSE: In multi-slice CT, over beaming by penumbra effect has been reported, and measurements of X-ray CT beam profiles are very important for accurate performance assessment. This study was conducted in order to facilitate and economize on the measurement of CT dose profiles. METHODS: The imaging plate (IP: HR-V type, Fuji) was placed in its case, X-rayed, and then read with a digital IP reader, which then erased the data in preparation for reuse. The values were then compared with the values obtained with the standard one-use imaging film. The CT scanner used was a Toshiba Aquilion Multi (4 rows). RESULTS: The shape of the beam profile obtained using the IP method was for all practical purposes identical to that obtained using the film method. The FWHM values for 2.0, 4.0, 8.0, 12.0, 16.0, 20.0 and 32-mm beam were 4.88, 6.61, 10.2, 14.9, 18.2, 22.4 and 35.0 mm for the IP method and 4.81, 6.66, 10.2, 14.7, 18.1, 22.3 and 34.8 mm for the film method. In addition, in the IP method, the results obtained for the shape of the beam profile and the FWHM were found to be extremely similar irrespective of the X-ray tube used or individual differences between IPs. CONCLUSION: We have developed a new X-ray CT beam profile measurement system using an IP. This IP method permits data processing to be performed entirely in the digital domain, allowing high-precision measurements to be obtained with ease.

Equipment Reuse↗

Provider profiling: advancing to episodes of care.

Judging by the interest expressed by managed care organizations, provider profiling has arrived. Surveys indicate that most organizations have adopted, or plan to adopt in the near future, a means to describe provider practice patterns. A further vote of confidence came from providers: In 1994, the American College of Physicians, the largest national specialty organization, issued a position paper supporting provider profiling and questioning the value of other approaches to utilization management, such as preauthorization of individual services. Also, an article and an editorial in the New England Journal of Medicine cautiously supported the concept of profiling. Provider profiling has great promise as a means to promote cost-effective care without the limitations of case-by-case preauthorization. The combination of a sophisticated episode of care methodology and a set of validated practice benchmarks offers the opportunity to perform true clinical profiling and to supply providers with data to review and alter practice patterns.

Cost-Benefit Analysis↗

Physician profiling: trends and implications.

In the October 1995 issue of Physician Executive, the author discussed the general notions of profiling of professionals, comparing the emerging methods of profiling of physicians to methods already in place for profiling professional athletes, investment bankers, and others. In this issue, the author provides details on specific methodologies in place for profiling physicians. While the science of profiling may be in its infancy, managed care organizations and third-party payers are clearly demanding more precise and useful information on the practice patterns of the physicians they hire or contract with.

Databases, Factual↗

Recognizing very distant sequence relationships among proteins by family profile analysis.

Family profile analysis (FPA), described in this paper, compares all available homologous amino acid sequences of a target family with the profile of a probe family while conventional sequence profile analysis (Gribskov M, Lüthy R, Eisenberg D. Meth Enzymol 1990;183:146-159) considers only a single target sequence in comparison with the probe family. The increased input of sequence information in FPA expands the range for sequence-based recognition of structural relationships. In the FPA algorithm, Zscores of each of the target sequences, obtained from a probe profile search over all known amino acid sequences, are averaged and then compared with the scores for sequences of 100 reference families in the same probe family search. The resulting F-Zscore of the target family, expressed in "effective standard deviations" of the mean Zscores of the reference families, with value above a threshold of 3.5 indicates a statistically significant evolutionary relationship between the target and probe families. The sensitivity of FPA to sequence information was tested with several protein families where distant relationships have been verified from known tertiary protein architectures, which included vitamin B6-dependent enzymes, (beta/alpha)8-barrel proteins, beta-trefoil proteins, and globins. In comparison to other methods, FPA proved to be significantly more sensitive, finding numerous new homologies. The FPA technique is not only useful to test a suspected relationship between probe and target families but also identifies possible target families in profile searches over all known primary structures.

Algorithms↗