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PubMed1993

Doppler studies of deteriorating growth-retarded fetuses.

Intrauterine growth retardation continues to be one of the major problems in obstetrics and still greatly contributes to perinatal mortality and morbidity. This paper reviews the role of Doppler ultrasonography in the antenatal assessment of fetuses with intrauterine growth retardation. Recent developments in this field are described with particular emphasis on the pathophysiologic background of the hemodynamic modification of fetuses with intrauterine growth retardation. Doppler ultrasonography allows the prediction of the development of intrauterine growth retardation in selected populations and the identification among a population of small-for-gestational-age fetuses, those really at risk of unfavorable outcome. Finally, the modifications occurring after the establishment of the growth retardation with the progression of fetal deterioration are described in an attempt to clarify the natural history of this condition. To this end, the longitudinal changes of Doppler indices of placental vessels, fetal arterial vessels, fetal heart, and venous circulation are described, and their complex interrelationship is analyzed. The knowledge of these mechanisms may be useful in deciding the timing of delivery.

Cardiac Output↗
PubMed1995

Long-term use of cyclosporine A does not adversely impact on clinical outcomes following renal transplantation.

The present review summarizes thirteen selected studies addressing the impact of cyclosporin A (CsA) on long-term outcomes following successful renal transplantation. Together, the data reflect the clinical courses of over 4,000 CsA-treated renal allograft recipients followed from one to ten years from the time of transplantation. Seven of the studies provided historical control data from more than 10,000 patients treated with azathioprine and prednisone. Graft survival beyond one year in CsA-treated recipients was consistently as good as or better than that achieved in the pre-CsA era. Underscoring the graft survival data, severe forms of the afferent arteriolopathy described as pathognomonic for 'CsA nephropathy' have become very uncommon and highly unlikely to be a cause of early or late graft loss. Retrospective analyses of longitudinal changes in aggregate serum creatinine concentrations did not demonstrate any differences in the long-term rate of attrition of allograft function between CsA- and non-CsA-treated patients. Similarly, prospective studies of serial glomerular filtrate rates did not reflect accelerating loss of function in association with long-term CsA use. CsA may be used for up to 10 years following successful renal transplantation without jeopardizing clinical outcomes. Graft arteriopathy (that is, chronic rejection), not progressive nephrotoxicity, is the dominant obstacle to achieving more uniformly successful long-term graft survival in the CsA era.

Animals↗
PubMed1996

HIV-1 gp120-specific antibody-dependent cell-mediated cytotoxicity correlates with rate of disease progression.

The Ab-dependent cell-mediated cytotoxicity (ADCC) activity of anti-gp120 Abs in serum from four groups of HIV-1-positive individuals in the Multicenter AIDS Cohort Study was evaluated at several time points over a 10-yr period. HIV-1-positive individuals who progressed to AIDS within 3 yr of seroconversion (rapid progressors) were compared with seroconverters who did not progress to AIDS within 6 yr (nonrapid progressors) and individuals who were seropositive when they entered the study and did not progress to AIDS within 9-10 yr (nonprogressors). At the visit closest to AIDS, rapid progressors had significantly lower titers of Abs that mediate ADCC against HIV-1 gp120 than those of nonrapid progressors at corresponding visits or those of nonprogressors at any visit. Nonprogressors generally had high titers of ADCC Abs at all visits. Differences between ADCC titers of rapid progressors and nonrapid progressors or nonprogressors remained when longitudinal changes within individuals were compared. Among seroconverters who were nonrapid progressors, those with low or declining ADCC titers lost significantly more CD4+ cells during the study than those whose ADCC titers were stable or increasing, even though both groups had similar serum virion RNA levels. This demonstrates that high titers of Abs that mediate ADCC correlate with a successful host defense against AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Overweight and leanness in adulthood: prospective study of male participants in the Normative Aging Study.

OBJECTIVE: Our objective was to examine the stability of body habitus over 15 years in Boston area adult males enrolled in the Normative Aging Study (NAS) and to examine stability as a function of initial leanness or obesity, age and reported body habitus at age 18. DESIGN: Prospective observational study of anthropometric/clinical measures initiated in 1961-1970, follow-up examinations at regular three and five year intervals. Subjects with complete data at entry, 5, 10 and 15 years. SUBJECTS: The 2280 Boston area subjects were aged 21-80 years (mean = 42 y) at entry. A subset (n = 350) with complete data for weight (WT) and height (HT) at four points over 15 years provided estimates of body habitus continuity. The prevalence of obesity and age of those studied were comparable to the complete sample of enrolled men (n = 1403) with any missing follow-up measures. MEASUREMENTS: Obesity was defined as body mass index (BMI) (weight in kg/height in m2) > or = 27.8 and leanness as BMI < 24.0. Three age categories at baseline (young = 25-39 y; middle = 40-49 y and old = 50-74 y) were used to examine secular and longitudinal changes. Obesity prevalence rates during late adolescence, based on self-reported weights at age 18, were compared with measured prevalence rates at entry and follow-up. Individual changes in BMI over time for each subject were estimated by linear regression and were combined to measure change in age and BMI groups. RESULTS: Weights and BMI at entry were highly correlated with 18 year values and 15 year follow-up values. New cases of obesity, defined on the basis of BMI, increased over time while the numbers of subjects classified as lean and intermediate decreased. Among oldest subjects both the lean and obese had slight but significant decreases in mean BMI. Among the lean, only the young showed consistent increments. DISCUSSION: Our results suggest consistency in body habitus among young and middle-aged obese subjects. There was little evidence of long-term reduction. In agreement with previous observations, the current findings of long-term duration in obesity suggest that preventive efforts should be focused on early years.

Adult↗
PubMed1997

Prospective longitudinal evaluation of men with initial prostate specific antigen levels of 4.0 ng./ml. or less.

PURPOSE: We evaluated the 3-year longitudinal changes in serial serum prostate specific antigen (PSA) levels in men with an initial PSA of 4.0 ng./ml. or less and no suspicion of prostate cancer. MATERIALS AND METHODS: A total of 760 men with an initial PSA of 4.0 ng./ml. or less plus a normal or suspicious digital rectal examination and a benign prostate biopsy was enrolled into an every 4-month PSA monitoring study. RESULTS: Of the 559 men with an initial PSA of 2.0 ng./ml. or less only 3 (0.5%) had a persistently abnormal PSA for 3 years and 1 cancer (0.2%) was detected, and 48 men had a PSA velocity of 0.8 ng./ml. per year or more at year 1 but only 1 (2%) had a persistent rate of increase (2.4 ng./ml. per year) at 3 years. Of the 201 men with a PSA of 2.1 to 4.0 ng./ml. 85 had an abnormal PSA but only 37 (43%) met the criteria for biopsy. Only 8 of 23 biopsies (35%) revealed cancer. Of the 201 men 24 had a PSA velocity of 0.8 ng./ml. per year or more at year 1 but only 4 had persistence for 3 years. All 4 men had cancer but they were identified as at high risk by PSA criteria. CONCLUSIONS: Men with a PSA of 2.0 ng./ml. or less are at low risk for an abnormal PSA or cancer within 3 years and annual monitoring may not be necessary. However, annual monitoring is clinically useful in men with an initial PSA of 2.1 to 4.0 ng./ml. Also, serial monitoring with interval testing in men whose PSA becomes greater than 4.0 ng./ml. is beneficial in identifying a high risk group requiring biopsy. Finally, PSA velocity did not add further to cancer detection in this population.

Adult↗
PubMed1997

Insulin-like growth factor-binding protein-2 in patients with prostate carcinoma and benign prostatic hyperplasia.

OBJECTIVE: Insulin-like growth factor-binding protein (IGFBP)-2 is a major prostatic IGFBP and may be involved in regulating prostate growth. Patients with prostate carcinoma (PC) have elevated serum IGFBP-2 levels which correlate with the specific PC marker, prostate-specific antigen (PSA). The aims of this study were to investigate whether elevated serum IGFBP-2 is unique to PC or also occurs in benign prostatic hyperplasia (BPH), to examine the relations among age, PSA and IGFBP-2 levels, and to examine longitudinal changes in serum IGFBP-2 with PSA in prostate carcinoma. DESIGN AND PATIENTS: Sixteen patients (61-83 years) with inoperable PC attending the oncology unit at a tertiary referral hospital were studied. Some serum samples were obtained retrospectively while the majority were collected prospectively over 13 months of treatment. The patients with PC were compared to 8 patients (66-73 years) with histologically proven BPH and 7 male control subjects (61-82 years) with no known prostate abnormality. MEASUREMENTS: A new IGFBP-2 RIA was developed. Serum PSA (by EIA), and IGFBP-2, IGFBP-3, IGF-I and IGF-II (by RIA) were measured in all subjects, and serially in patients with PC. RESULTS: Serum IGFBP-2 was significantly higher in PC with high PSA (560 +/- 66 micrograms/l, n = 12) than PC with normal PSA (292 +/- 65 micrograms/l, n = 4, P = 0.02), BPH (364 +/- 61 micrograms/l, P = 0.03) and controls (367 +/- 44 micrograms/l, P = 0.04). Mean IGFBP-2 in BPH was not different from controls. IGFBP-2 and PSA were significantly correlated with age (r = 0.543 and r = 0.433 respectively) and with each other even when the age effect was removed. Serum IGFBP-2 and PSA levels changed concordantly in all 7 PC patients who had serial sampling. Serum IGF-II but not IGF-I or IGFBP-3 was higher in PC and BPH than in controls (PC 332 +/- 23 micrograms/l), BPH 359 +/- 26 micrograms/l vs controls 241 +/- 37 micrograms/l; P = 0.03 and 0.02 respectively). CONCLUSIONS: Serum IGFBP-2 levels are uniquely elevated in active prostate carcinoma but not in benign prostatic hypertrophy. In PC, serum IGFBP-2 levels closely parallel those of PSA and probably reflect tumour burden. The relation between PSA and IGFBP-2 is partially independent of their individual relations with age. Although serum IGFBP-2 is less sensitive than PSA in PC, it may have adjunctive value in the management of prostate carcinoma.

Age Factors↗
PubMed1997

The continuation of family caregiving in Japan.

The purpose of this study was to develop concepts that facilitate our understanding of why family caregivers of demented elderly persons can continue caregiving despite various difficulties of care. Twenty-six Japanese daughter or daughter-in-law caregivers of elderly parents with dementia who lived at home or in long-term care facilities were recruited through various senior service organizations in Japan. The caregivers underwent unstructured interviews, and the interview data were analyzed using the constant comparative method. Three categories emerged as reasons for care continuation: value of care, maintainers of value, and reinforcers of care continuation. Value of care came from societal norms and attachment, and was the basis of caregivers' motivation to continue care. Several maintainers of value and reinforcers of care continuation also emerged from the analysis. The contents and some longitudinal changes in these categories were explained. The findings highlight the need to assess these categories separately in order to develop appropriate interventions and they have implications for future research and policy development.

Adolescent↗
PubMed1998

Pre-clinical cardiovascular disease and surrogate end-points in hypertension: does race influence target organ damage independent of blood pressure?

OBJECTIVES: To examine the adequacy of available evidence that: 1) left ventricular hypertrophy (LVH) and its regression influence the rate of cardiovascular events in hypertension; 2) carotid artery wall thickening and discrete plaque have comparable significance to LVH; and 3) black hypertensive patients have greater target organ damage than white hypertensives, independent of blood pressure and other relevant covariates. DESIGN AND METHODS: Statistical, epidemiologic, and treatment trial literature concerning ECG and echocardiographic LVH and carotid ultrasound findings was reviewed to address the above three questions. RESULTS: Results of seven electrocardiographic and ten echocardiographic studies (total of 20,000 subjects) show consistently higher risks of morbid events in individuals with LVH as compared to those without (odds ratios 1.4 to 5.4). Available data (five studies, 1544 subjects) suggest that morbid events occur in a greater proportion of individuals in whom LVH progresses (13% to 59%) than in whom it regresses (7% to 12%). Results of four studies using carotid ultrasound (n = 9570) show consistently higher rates of subsequent cardiovascular events in individuals with carotid wall thickening, discrete atherosclerotic plaque or arterial stenosis than those without; however, data are only available from one study regarding the relation between longitudinal change in carotid ultrasound findings and subsequent events. Of the available echocardiographic studies comparing black and white hypertensive patients, most (7 out of 9) show higher LV wall thickness in blacks, with no consistent difference with regard to LV mass. CONCLUSIONS: LVH satisfies strict criteria to establish a fully adequate surrogate endpoint for morbid events in hypertension more fully than do carotid arterial findings. It has not yet been fully established whether black-white differences in hypertensive target organ damage are independent of blood pressure or other factors.

Arteriosclerosis↗
PubMedDate not supplied

Modified rapid ventricular pacing: a chronic model of heart failure for evaluation of new surgical therapies.

Rapid ventricular pacing (RVP) in dogs creates a well characterized model of dilated cardiomyopathy. Standard pacing protocols use RVP at 240-260 beats/min for 2-4 weeks, and result in high mortality rates if continued longer. The authors describe a modification of RVP that results in significant heart failure by 4 weeks, but can be continued for up to 10 weeks with low mortality. Nineteen mongrels underwent RVP at 215 beats/min for 10 weeks. Serial pressure-volume analysis and echocardiography were performed in this model to assess longitudinally changes in left ventricular (LV) function and volumes. The mortality rate was 10%. Significant progressive LV dysfunction with concomitant LV enlargement was observed throughout the pacing period. Finally, norepinephrine levels were elevated at the end of pacing, consistent with an activated sympathetic system. This modified RVP protocol permits long-term pacing with a low mortality rate and results in progressive heart failure throughout the pacing period. This model would be useful in the long-term evaluation of newer surgical and medical therapies of the failing heart.

Animals↗
PubMed1993

A longitudinal study of changes in children's thought content in response to frustration on the Children's Picture-Frustration Study.

A longitudinal design examined changes in the 11 response types on the Children's Form of the Picture-Frustration (P-F) Study. Eighty-six children were retested on the instrument after a 5-year interim. Children showed changes reflecting an increase in verbal aggression and an increase in making amends for wrongdoing. They showed decreases in unfocused emotional outbursts and apologies. The findings add to the literature on children's emotional development of aggression and guilt and on the validity of the instrument.

Adolescent↗
PubMed1992

The changing needs of patients with cancer at home. A longitudinal view.

Changes in the daily living needs of 629 patients with advanced cancer were investigated (1) during and (2) 3 to 6 months after a course of outpatient chemotherapy and/or radiation treatment. The analytic sample consisted of patients completing both baseline and follow-up interviews (n = 434). At both times, the point prevalence of need and unmet need for assistance with personal care, instrumental activities, transportation, and home health tasks was calculated. In addition, the prevalence of new need and unmet need at follow-up was determined as were the rates of resolution of baseline need. The prevalence of need for assistance with personal care increased from 7% at baseline to 16% at follow-up; the dynamic of need acquisition and resolution resulted in relatively constant prevalence rates in other task areas. Acquisition of need at follow-up was associated primarily with disease and treatment-related characteristics. Approximately one third of patients reporting need for assistance during at least one interview did not have enough help. New unmet need at follow-up was associated most strongly with patients' mobility and the ability of their informal support system to provide care. The apparently rapid fluctuation in patients' experience of need and unmet need suggests the necessity for ongoing appraisal of patients' physical condition and social situation.

Adult↗
PubMed2005

Longitudinal study of changes in hip bone mineral density in Caucasian and African-American women.

OBJECTIVES: To determine whether changes in hip bone mineral density (BMD) differ in Caucasian and African American women. DESIGN: Longitudinal study of changes in hip BMD. SETTING: Four U.S. clinical centers. PARTICIPANTS: Six thousand seven Caucasian (mean age 73) and 482 African-American (mean age 75) women enrolled in the Study of Osteoporotic Fractures. MEASUREMENTS: Total hip and femoral neck BMD were measured an average of 3.5 years apart (Caucasian) and 2.0 years apart (African American). Annual absolute and percentage changes in BMD and bone mineral apparent density (BMAD) were calculated. RESULTS: The multivariate adjusted annual percentage change in BMD was greater in Caucasian than African-American women at the total hip (-0.574%/y vs -0.334%/y) and femoral neck (-0.515%/y vs -0.203%/y) (both, P<.001). Similar findings were observed for BMAD. The average annualized rate of BMD loss was twice as high in women aged 75 and older as in women younger than 75 in both ethnic groups. The annual percentage loss in femoral neck BMD in nonusers versus hormone therapy users was (-0.57% vs -0.22%) in Caucasians and (-0.35% vs 0.64%) in African Americans (interaction P=.03). CONCLUSION: The average rate of hip BMD loss is approximately twice as great in Caucasian as African-American women and increases with age in both groups. The hormonal and biochemical factors that contribute to ethnic differences and the increase in bone loss with advancing age need to be identified.

Absorptiometry, Photon↗
PubMed1997

Sixteen-year longitudinal and time lag changes in memory and cognition in older adults.

The authors describe assessment of 16-year changes in memory and intellectual abilities in a sample of 106 adults ages 30-36 and 55-81 at baseline. Results suggest that there are reliable 16-year declines in list and test recall but not in recognition after age 55. Comparisons of predictions of change from the cross-sectional baseline sample indicated that longitudinal changes were either similar to or greater than predicted for those participants over the age of 60. Despite age differences in initial scores, a comparison of 2 cohorts in a time lag analysis showed that they did not differ in performance when they were in their 70s. These results suggest that age changes in list and text recall in older adults are due to age-related declines rather than to cohort differences and that age declines in recognition are not reliable.

Adult↗
PubMed1982

A longitudinal study of changes in motor units in motor neuron disease.

In a longitudinal investigation of 14 patients with motor neuron disease motor units were studied in the biceps and first dorsal interosseous muscles in both arms, using single fibre EMG. The fibre density usually increased initially and this was occasionally accompanied by temporary improvement in strength. Later, as the fibre density decreased, increasing weakness and atrophy developed. The fibre density was rarely as high at any stage of the disease as in other chronic neurogenic disorders. Marked asymmetry was observed in individual patients at all stages of the disease.

Adult↗
PubMed1989

Studies in the distribution of body fat. II. Longitudinal effects of change in weight.

Information on the effects of age, sex, obesity and weight change on the fat distribution pattern has not been systematically reported. As an index of body fat distribution, the waist hip circumference ratio (WHR) was computed in 370 men and 177 women aged 22-86 years, participants of the Baltimore Longitudinal Study of Aging. For cross-sectional analysis, initial data on the participants were analyzed; for longitudinal study, the changes in the measurements related to weight change during a 5-year follow-up were analyzed. From cross-sectional analysis: (1) waist circumference is larger in men than in women and increases progressively with age; (2) hip circumference shows no consistent age or sex differences; (3) thus, the well known sex differences in WHR are totally attributable to differences in waist circumference; (4) increases in WHR with age occur in both men and women. From longitudinal analysis of weight change: (1) changes in waist and hip circumferences are correlated directly with changes in weight in both sexes, but there are large differential sex effects; (2) in men, waist changes dominate; (3) in women, waist and hip changes are nearly the same; (4) thus, weight changes in men have large effects on the WHR, while in women changes in WHR are very small. Men, as a group, have a more dangerous fat distribution pattern than women, but men as a group will show a more beneficial pattern of change in WHR with weight control than women.

Adipose Tissue↗
PubMed2003

Importance of smoking habits for longitudinal and age-matched changes in body mass index: a cohort study of Swedish men and women.

BACKGROUND: Previous longitudinal studies of smoking and BMI have focused on smoking cessation. The aim of the present study was to disentangle the effects of long-term smoking on longitudinal changes and age-matched BMI differences (time period effects) in a nation-wide Swedish cohort. METHODS: Men and women (n = 4349) ages 18-73 years reported height, weight, and smoking status for a baseline survey in 1980-1981. Eight and 16 years after baseline, follow-up surveys were conducted for 3244 (75%) of the 4349 subjects. Long-term smokers and long-term nonsmokers were compared with respect to longitudinal changes and age-matched BMI differences. RESULTS: For middle-age adults, the longitudinal increases in BMI were smaller among long-term smokers than long-term nonsmokers regardless of gender. Among the elderly, the longitudinal decrease in BMI was greatest among long-term smokers. Among men, age-matched BMI differences between surveys were smaller for long-term smokers than for nonsmokers. Among women, however, age-matched BMI differences were greater for long-term smokers than for nonsmokers. CONCLUSIONS: In middle-age subjects, longitudinal BMI increases are smaller among smokers than nonsmokers. During old age, the BMI of smokers decreases more than that of nonsmokers. Unknown factors related to gender contribute to larger time period effects of smoking in women than in men.

Adult↗
PubMed1993

Porter's generic strategies, discontinuous environments, and performance: a longitudinal study of changing strategies in the hospital industry.

OBJECTIVE: Changes in generic strategies in response to discontinuous environments have been relatively ignored in the management literature. This study reports an examination of the relationships between Porter's (1980) generic strategies, discontinuous environments, and performance. DATA SOURCES: Archival data for 1984 and 1988 were collected for 172 acute care hospitals in Florida in order to test these relationships. STUDY DESIGN: To examine fully the performance impact of changes in strategy in a discontinuous environment, a longitudinal research design that identified a firm's strategy at two points in time, 1984 and 1988, was used. PRINCIPAL FINDINGS: Results indicate that firms with a proper strategy environment fit performed the highest, firms that did not change their strategy had no change in performance, and firms that changed their strategy toward a proper strategy environment showed an increase in performance. CONCLUSION: Findings support the notion that hospitals with appropriate strategy-environment combinations will exhibit higher performance.

Analysis of Variance↗
PubMed2005

Longitudinal thalamic diffusion changes after middle cerebral artery infarcts.

BACKGROUND: Cerebral infarcts are responsible for functional alterations and microscopic tissue damage at distance from the ischaemic area. Such remote effects have been involved in stroke recovery. Thalamic hypometabolism is related to motor recovery in middle cerebral artery (MCA) infarcts but little is known concerning the tissue changes underlying these metabolic changes. Diffusion tensor imaging (DTI) is highly sensitive to microstructural tissue alterations and can be used to quantify in vivo the longitudinal microscopic tissue changes occurring in the thalamus after MCA infarcts in humans. METHODS: Nine patients underwent DTI after an isolated MCA infarct. Mean diffusivity (MD), fractional anisotropy (FA), and thalamic region volume were measured from the first week to the sixth month after stroke onset in these patients and in 10 age matched controls. RESULTS: MD significantly increased in the ipsilateral thalamus between the first and the sixth month (0.766 x 10(-3) mm(2)/s first month; 0.792 x 10(-3) mm(2)/s third month; 0.806 x 10(-3) mm(2)/s sixth month). No significant modification of FA was detected. In six patients, the ipsilateral/contralateral index of MD was higher than the upper limit of the 95% CI calculated in 10 age matched controls. An early decrease of MD preceded the increase of ipsilateral thalamic diffusion in one patient at the first week and in two other patients at the first month. CONCLUSION: After MCA infarcts, an increase in diffusion is observed with DTI in the ipsilateral thalamus later than 1 month after the stroke onset. This is presumably because of the progressive loss of neurons and/or glial cells. In some patients, this increase is preceded by a transient decrease in diffusion possibly related to an early swelling of these cells or to microglial activation. Further studies in larger series are needed to assess the clinical correlates of these findings.

Adult↗