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Care management monitors the variances of the entire patient population in a given area versus specific cases as demonstrated in case management. It includes CQI principles, variance analysis and regulatory standards. Care management serves as a conduit for continuing education, involves a multidisciplinary team approach, which involves the family and assists managed care and utilization review.
In this study, naftidrofuryl's action on vascular network regeneration is evaluated after cortical lesion produced by suction. The vascular reaction was analyzed in the region of the damaged cortex and the corresponding contralateral cortex. Comparison of results by variance analysis confirms that the effect of treatment is highly significant (p = 0.008). The results thus obtained show that post-lesion angiogenesis is facilitated and that capacities of post-lesion cerebral function regeneration could also be improved.
In cultured embryonic chick motoneurons, glutamate-activated currents rise quickly and then decay rapidly to relatively small steady-state current levels. Dopaminergic modulation of these receptors was studied using patch-clamp recording techniques. At concentrations > or = 10 nM, dopamine enhanced glutamate-activated currents by about 200%. This enhancement was diminished by the nonspecific dopamine receptor antagonist S(+)-apomorphine and the more specific D1 receptor antagonist SCH23390, and it was mimicked by the D1 partial agonist SKF38393. Glutamate receptor desensitization rate was not altered in the presence of dopamine. Enhancement was specific to the kainate component. Current-variance analysis indicated that in the presence of dopamine the conductances of glutamate-activated channels were not altered but that the relative fraction of kainate-type channels activated by glutamate increased. Intracellular cAMP levels increased by 33% following exposure to 100 microM dopamine. The effects of elevated cAMP or protein kinase A (PKA) were tested by including 100 microM cAMP or PKA, respectively, in the recording pipette solution. This increased the kainate-activated currents specifically. Dopaminergic enhancement was not observed when a PKA inhibitor was in the pipette. mRNA encoding D1 was detected in the spinal cord by a reverse transcription, polymerase chain-reaction amplification procedure. Thus, dopamine is acting most probably on an avian homolog of the D1 receptor family. We conclude that dopamine causes cAMP to increase, which results in increased activation of kainate-gated channels during glutamate-mediated transmission.
The bactericidal and sporicidal activities of six disinfectants (Acétoper, Cidex, Phagoseptyl, Pyosynthène, Bétadine, Sterlane) were studied against 21 bacterial strains recovered from hemodialysis machines, and against two bacterial spores. AFNOR methods were used (NF T. 72-151, NF T. 72-171 et NF T. 72-231). Only Acétoper presented a bactericidal and sporicidal activity. A disparity in bactericidal concentrations was observed among Gram negative bacteria. Phenolic compound (Phagoseptyl) was not influenced by interfering substances. pH have a clear effect upon Cidex and Bétadine activities. Statistical analysis (variance and multiple comparisons test of Ryan-Einot) showed the significant role of the type of bacteria and the nature of disinfectants. These compounds were classified according to their increasing activity as following: Cidex, Sterlane, Phagoseptyl, Bétadine, Pyosynthène, Acétoper.
OBJECTIVE: To evaluate the effects of the calcium channel blocker diltiazem and its chloride derivative clentiazem on coronary vasoregulation of isolated rat hearts exposed to ischemia-reperfusion. Diltiazem has been reported to prevent postreperfusion myocardial damage but its beneficial effects on coronary blood-flow regulation remain uncertain. METHODS: Two groups of hearts were pretreated with a 10 min infusion of either diltiazem (10(-9) to 10(-6) mol/L) or clentiazem (10(-9) to 10(-7) mol/L) (n = 6 for each concentration) and exposed to 30 mins of no-flow ischemia. Another group (n = 6) received no pretreatment and was used as control. Endothelium-dependent and -independent relaxation were tested by assessing coronary flow increase to 5-hydroxytriptamine (10(-6) mol/L) and sodium nitroprusside (10(-5) mol/L) infusions, respectively, and were assessed before and after ischemia-reperfusion. Left ventricular pressure, dP/dt and coronary basal flow were also recorded. Postreperfusion results are expressed as a percentage of pre-ischemic value. Dunnet variance analysis was used to compare means of pretreated groups with the control group. RESULTS: Endothelium-dependent relaxation was significantly improved with both drugs. Optimal preservation was obtained with diltiazem 10(-6) mol/L (66 +/- 4%) and clentiazem 10(-7) mol/L (83 +/- 4%), whereas endothelial response was almost abolished in control hearts (6 +/- 11%, P < 0.01). Clentiazem was found to be more potent than diltiazem at low concentration (10(-9) mol/L, clentiazem 89 +/- 13% versus diltiazem 3 +/- 16%, P < 0.05). Optimal endothelium-independent relaxation preservation was achieved at 10(-8) mol/L in both groups (diltiazem 86 +/- 4%, clentiazem 82 +/- 8%, control 47 +/- 10%, P < 0.05). Left ventricular pressure and dP/dt were not affected by any pretreatment. However, postreperfusion coronary basal flow was significantly increased in control hearts. CONCLUSION: This study indicated that pre-ischemic infusion of diltiazem and clentiazem enhances endothelium-dependent and -independent coronary artery relaxation following reperfusion in the isolated rat heart model, without affective ventricular hemodynamics, and contributes to preservation of coronary artery autoregulation.
Several and different solutions have been used for lung preservation but, at present, fluids and solutions are quite alike. In the last years extracellular type solutions have been progressively tested in experimental researches and have shown a better protection vs intracellular one. In this research we have studied the effect of a low-potassium solution normally used as plasma expander (Haemmaccel, HM) on isolated foetal human fibroblasts (WI-38). HM has been compared with Belzer solution (UWS) after 16 hrs incubation at 10 degrees C and low-potassium solutions with dextran 2% and 5% after 6 hrs and 16 hrs incubation at 10 degrees C. Wi-38 cells have been seeded at the density of 9x10(4)/cm2 onto plastic well plates. Cellular viability was measuring using the rate of protein synthesis through the incorporation of 3H leucine in growth medium during a 1 hr incubation at 37 degrees C. The results were expressed as nmol 3 H leu/mg of proteins/minute and presented as means +/- SD; the comparison has been performed by the one way variance analysis test. After 16 hrs incubation at 10 degrees C HM preserves WI-38 cells significantly better than UWS. Comparing HM with LPD 2% and 5% a significant difference both at 6 hrs and at 16 hrs was observed. Our preliminary in vitro results confirm that low-potassium solutions are less toxic on isolated lung cells than intracellular one. Polygelin contained in HM could be considered a suitable colloidal substance that determine a better preservation if compared with Low-Potassium Dextran solutions.
Previous studies have indicated that a G to A substitution at position -76 in the gene encoding apolipoprotein A-I (apoA-I) confers increased plasma high density lipoprotein cholesterol (HDL-C). Increased HDL-C may be a direct consequence of the A allele, or may reflect the action of a locus in linkage disequilibrium with the A allele. To elucidate this question, we examined the effect of this polymorphism in a large sample (n = 409) of unrelated Caucasians and their nuclear families (n = 22). To eliminate the confounding effects of hypertriglyceridemia, individuals with triglyceride levels greater than 150 mg/dl were excluded from the study. ApoA-I genotype was determined by polymerase chain reaction (PCR) amplification of genomic DNA and restriction digestion with Msp I. Individuals were grouped by genotype (GG, GA or AA) and mean adjusted HDL levels of the three groups were compared by one-way analysis of variance. Our analysis indicates that HDL-C levels do not vary by genotype, and no gene dosage effect is apparent in men or in women. Analysis of 22 informative Caucasian nuclear families showed no significant difference between individuals with the A allele and their GG siblings. These data suggest that polymorphism at -76 in the apoA-I gene does not directly affect HDL levels. Therefore, the increased HDL-C levels reported in other populations must reflect linkage disequilibrium between the A allele and a putative HDL-raising allele. As we find no evidence for association between the A allele and high HDL levels, this putative allele must occur at a low frequency in the population sampled in this study.
PURPOSE: To check out the reproducibility and costs of prothrombin time (PT) determination as a control of oral anticoagulant therapy (OAT) in plasma and capillary blood. PATIENTS AND METHODS: The study was carried out in two phases: along two years, 1,700 patients with OAT were controlled, 700 of them in the hospital outpatient clinic. In 149 patients INR was simultaneously determined in both capillary and venous blood. The 700 patients receiving acenocoumarin who had been controlled in 1991 according to the conventional plasma-sample fashion, were controlled in the second year (i.e., 1992) by means of capillary blood testing, a comparison of the costs of each method and the need for anticoagulant drugs being undertaken. Venous blood PT was assessed with reagent thromboplastin (Tromborel S) in an Electra-1000 (MLA) system. An automated Trombotrack system was used for the capillary blood tests using Thrombotest as current procedure. The results were expressed as INR in both methods. The statistical evaluation of the results was carried out by means of Student's t, variance analysis, and correlation study. RESULTS: No significant differences were found in the anticoagulation intervals attained from venous or capillary blood samples. No significant differences were seen in 87 patients on whom the test was repeated in two samples drawn from a single capillary puncture. The weekly OAT doses of 30 patients along six months were analysed. The need for anticoagulant drugs was similar (17.4 vs 17.2 mg/patient/week). The mean INR in 1991 was 2.82 and the mean drug-need was 15.24 mg/week, whereas in 1992 the mean INR was 2.86 and the need for anticoagulant was 15.49 mg/week. The costs of the conventional method were 103.6 Pta, this being 70 Pta for capillary blood, which means a 32% savings. CONCLUSIONS: OAT control by means of PT performed on capillary blood must be considered a substitutive method for the venous blood assay due to its efficacy, simplicity and lower costs.
OBJECTIVE: To assess the reliability of 29 prediction models for vital capacity when these are applied as reference for young females, natives and residents in Mexico City (altitude = 2,240 m). DESIGN: Transversal, prospective and comparative study. SETTING: Metropolitan Autonomous University, Mexico. SUBJECTS: Sixty females clinically healthy, 17 to 29 years old, non-smokers. PROCEDURE: Vital capacity was predicted from 29 models and measured with a bell spirometer (Collins 9 L) according to the American Thoracic Society guidelines. Statistical comparison was done between measured and predicted values by linear regression, analysis of variance and analysis of residuals. RESULTS: Mean of measured vital capacity was 3,625 mL while mean values of predicted vital capacities varied from 2,644 mL to 3,962 mL. Actual and reference values showed a small but significative correlation (r = 0.40 to 0.49). By Dunnett's test, means from six of the 29 models showed non-significant differences (p > 0.05) with the mean of the measured vital capacity; however, all 29 models presented significative bias in the regression line between actual values and the residuals of predicted values (correlation coefficient, slope and intercept statistically different from zero, p < 0.05). CONCLUSION: Due to the large bias found, models tested in the present study have limitations to predict accurate reference values for young mexican females.
OBJECTIVE: Prader-Willi syndrome (PWS) is a complex multisystem genetic disorder in which many cardinal features may have a neurologically based pathophysiology involving both the central and peripheral components of the autonomic nervous system. Autonomic nervous system function was studied noninvasively in a group of subjects with PWS and control subjects to determine whether autonomic nervous system dysfunction exists as part of the PWS. DESIGN/SETTING: This cross-sectional study was performed in the neurophysiology laboratory at a tertiary care facility. METHODS: Evaluation included anthropometric measurements and calculation of a body mass index (BMI). Simultaneous electrocardiography and serial recordings of pulse rate and systolic/diastolic mean arterial blood pressures during orthostatic maneuvers were taken. Pupillary response to the instillation of dilute pilocarpine and measurements of plasma norepinephrine at rest and after standing were also obtained. Results were analyzed using two-tailed t tests, Fisher exact test, analysis of variance, and analysis of covariance adjusting for age, gender, and BMI. PATIENTS: There were 14 subjects with PWS (8 female, 6 male; aged 4 to 40 years, mean age 16 years) and 8 control subjects (4 female, 4 male; aged 5 to 37 years, mean age 19 years). RESULTS: Abnormal findings were obtained only in subjects with PWS. Analysis of covariance adjusting for age, gender, and BMI revealed a trend for subjects with PWS to have lower resting diastolic blood pressure (P < .09) and significantly less change in diastolic blood pressure after standing (P < .02). Subjects with PWS had significantly greater BMI than did control subjects (P < .001), which correlated significantly with all pulse rate measurements where the greater the BMI the higher the pulse rate at rest (r = .25, P < .04) and the lower the pulse rate after arising from lying to standing at both 15 and 30 seconds (r = .17, P < .1; r = .55, P < .08 respectively). Pupillary constriction of 2 mm or more was seen in 7 of 14 subjects with PWS and in no control subjects (P < .004). The 30:15 R-R interval ratio was abnormal in 6 of 14 subjects with PWS and in no control subjects (P < .03). CONCLUSIONS: These results suggest that patients with PWS have a detectable underlying autonomic dysfunction characterized principally by diminished parasympathetic nervous system activity.
In previous works our group has demonstrated that intracellular concentration of calcium ionized is greater in patients with pre-eclampsia than in normotense pregnant patients, and that these figures correlate with arterial pressure. Both indicators become normal six weeks after delivery. With the idea of searching the possible participation of soluble factors in the plasma, in increasing free, intracellular calcium, eight pre-eclamptic patients, were studied; the patients were diagnosed by the criteria of the American College of Gynecologists and Obstetricians. As a control group, eight normotense pregnant patients, were included; they were paired by age, chronological and gestational. To measure transmembrane calcium flow, platelets from healthy males, were used. The platelets were incubated during 0, 15, 30 and 60 minutes in sera of pre-eclamptic patients, or of normotensive pregnant patients, marked with Ca. The differences in calcium transportation, were evaluated with variance analysis of Kruskall Wallis. Calcium transportation was greater when the platelets were incubated in pre-eclamptic patients sera, Md = 1.475 +/- 0.311 nanomoles than when were incubated in normotensive women sera, Md = 0.9725 +/- 0.58 nanomoles, p < 0.02. This finding suggests that in pre-eclamptic patients serum, exists some factor that facilitates the entrance of calcium to the cell, that provokes an increase in free calcium concentration, and it participates in the gestational hypertension.
Conflicting results have been reported about the absorption of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) either as an ethyl ester (EE) or in a triglyceride (TG) formula. We decided to conduct a randomized double-blind study to compare the effects of EE and TG on plasma fatty acids, platelet function and haemostasis. Thirty-one healthy normolipaemic men were allocated to receive fish oil concentrate either as EE or TG with equal amounts of EPA (2.2 g and 2.2 g, respectively) and DHA (1.2 g and 1.4 g, respectively) or placebo daily for 7 weeks. Total cholesterol and the triglyceride level were not influenced differently by the two compounds. Repeated measurement ANOVA revealed a difference between TG and EE regarding incorporation of arachidonic acid (P = 0.034) and EPA (P = 0.007) into plasma cholesteryl esters. A discrimination not observed within plasma phospholipids. Both formulas had equal inhibitory effects on collagen-induced platelet aggregation and thromboxane B2 (TxB2) production in whole blood. Fibrinogen decreased 16% in EE (P = 0.034) and 12% in the placebo group (P = 0.11), but variance analysis of delta change during intervention did not indicate differences between groups. It is concluded that TG and EE fish oils are well incorporated into plasma lipids and have similarly beneficial influence one platelet function in men.
Of a greater number of biochemical tests in hepatobiliary diseases by means of methematico-statistical methods (calculation of specificity and sensitiveness, variance analysis, discrimination analysis with following discrimination experiments) the parameters should be established which in a step programme with multivariate observation and non-discriminated approach give the best possible information. The recognition of patients with liver diseases (preliminary diagnostics) is at nearly 94% possible with a scale comprising GOT, AAP, some relevant clinical data (touch findings, jaundice, hepatic skin signs) and the hepatitis B-antigen. In non-discriminated approach according to our findings the following scale should not be trangressed: GPT, GOT (compare preliminary diagnostics), LAP, AP, AAP (compare preliminary diagnostics), cholesterol, TTT, bilirubin, beta-GC. As to aimed questionings the bromsulphalein test belongs to the enlarged basic scale.
Calcium and gla-protein content are increased in the calcifications of cardiac bioprostheses. Such calcifications are more frequent during growth, pregnancy and renal failure when bone gla-protein levels are elevated. We investigated whether bone gla-protein and other markers of calcium metabolism play a role in bioprostheses calcifications. Forty-seven patients were separated into 2 groups according to the presence (group A, n = 9) or absence (group B, n = 38) of bioprostheses calcifications, as assessed by echo-doppler and surgery. Plasma levels of calcium, phosphorus, magnesium, creatinine and alkaline phosphatases were measured by standard laboratory methods, parathormone and those of bone gla-protein by specific radioimmunoassays. Results (mean +/- SEM) were compared (group A versus group B, P < 0.01) using Student's test and one-factor variance analysis (ANOVA). Age was similar in both group (53 +/- 12.9 vs 50 +/- 12.3 yrs), whereas duration of implant was greater in group A (104 +/- 12.4 vs 66 +/- 6.5 months, P < 0.01). No statistically significant difference was found between group A and B concerning biochemical and/or hormonal markers of calcium metabolism. These negative results merit to be discussed, and further studies will be needed to explore the potential role of circulating bone gla-protein in bioprostheses calcifications.
It is mandatory to preserve the vascular tone regulation of the saphenous vein in order to optimize its performance as a vascular conduit. To determine the optimal preservation solution, human saphenous vein segments (3-4 cm) were harvested, stored for 60 minutes in different preservation solutions and studied in organ chambers for endothelial and smooth muscle assessment. A 1st group (n = 10) was stored in the heparinized blood of the patient (SH), a 2nd group (n = 10) in physiologic saline solution (NaCl) and a 3rd group (n = 10) in Krebs Ringer (KR) solution. All solutions were maintained at room temperature (21 degrees C). Each preserved segment was paired to a control segment, harvested in the same patient, and studied before storage. Following 60 minutes of preservation decreased endothelial-dependent relaxation to acetylcholine and histamine was observed among the group stored in KR (p = 0.06 and p < 0.02 respectively) compared to the other groups. Endothelium-independent relaxation to sodium nitroprusside was not affected regardless of the solution used. However, veins stored in SH disclosed an increased contractility to norepinephrine (p < 0.04). When intergroup variability was considered (by variance analysis), no significant difference was seen between each group. This study suggests that KR and SH were not as efficient as NaCl in preserving saphenous endothelial function. Furthermore, storage in SH increased smooth muscle response to catecholamine. In this experimental setup, 0.9% NaCl solution is an acceptable preservation solution of the saphenous vein.
Minor potential cardioembolic sources of stroke such as atrial septal aneurysms (ASA) or patent foramen ovale (PFO) are important risk factors for cryptogenic stroke. We aim to determine the prevalence of these abnormalities through an exhaustive etiological workup including transesophageal echocardiography and cervical arteries assessment in stroke patients younger than 60 years of age who had no evidence of a significant source of embolism. We classified 118 stroke patients into four groups according to transesophageal echocardiography (TEE) and cervical arteries assessment findings. Group A, consisted of 30 (25.4%) patients who had an arteriopathy likely related to stroke without any cardiac abnormality; Group B, 49 (41%) patients who had only a potential cardiac source; Group C, 9 (7.6%) patients who had an obvious arterial source of stroke and incidental cardiac abnormalities, and Group D, 30 (25.4%) patients who had neither cardiac nor arterial source. Data were analysed with X2 test for the comparison of risk factors between groups. Variance analysis was used to compare age between groups. Significance was assessed as p < 0.05. ASA represented 56.8% of the cardiac abnormalities and was diagnosed in 35.4% of the 79 patients who had an unexplained stroke (B and D). A PFO was found in 34.1% of the patients who had a cryptogenic stroke (B and D). According to Fisher's exact test, ASA was significantly associated to PFO (p << 0.001). According to this selection one fourth of the patients might have a truly cryptogenic stroke as the etiological workup failed to demonstrate any source of stroke. Comparison between groups showed that the patients in whom an arterial source was detected also had a potential cardioembolic source in 23% of the cases (C), versus 62% in patients who had no arterial source (B and D) (p = 0.0007). Our study confirmed the strong association between ASA, PFO and stroke. Although there was a lower incidence of minor potential cardioembolic sources in patients who had a cervical artery disease, we suggest a systematic TEE screening in all patients with stroke without major cardiac source, in order to ensure a better prevention.
The erectil dysfunction is a common disorder in diabetic patients resulting from neurological, arterial and endocrine factors. This paper presents an eco-doppler evaluation of the arterial factor in 88 diabetics: 17 controlled with diet, 38 with oral anti-diabetic agents and 33 with insulin. Age, ranging from 23 to 70 years old, was similar in subjects controlled with diet (55.6 +/- 6.4) or anti-diabetic agents (57.6 +/- 7.9), but greater in insulin-treated subjects (46.8 +/- 10.5) (p < 0.01). Fifty-six subjects (63.6%) has nocturnal and 43 (48.9%) diurnal erections, 45 (51.1%) achieving penetration. There was 65 (73.9%) smokers, 28 (31.8%) hypertensives, and 24 (27.3%) reported stress. A baseline evaluation was performed in all cases, in 87 after I.I.C (papaverin 26 and PgL1 61), full erection being achieved in 18 cases, non-rigid erection in 15, tumescence in 50 and with no response in 4. No differences were seen by type of diabetes. The variance analysis showed no differences in the flow speed indicators among the three groups, both at rest and after I.I.C., the sample being therefore homogeneous, superposable to arterial dysfunctions and significantly lower than those of the control group (p < 0.01). We conclude that diabetes induces arterial changes which are superposable to those caused by other vascular risk factors and independent for the type of diabetes.
The object of this work was to test the efficacy of ornidazole in patients with active Crohn's disease. Twenty-five patients with active Crohn's disease (Crohn's disease activity index greater than 150 points) participated in this open study. The analysis of results was based on changes in the severity of the Crohn's disease activity index measured at entry and at the end of the first, second, and third and fourth week. Analysis of variance, correlation analysis, multiple regression analyses and chi-square test were used for statistical evaluation of results. The results showed that the Crohn's disease activity index fell gradually from week 0 to week 4 (p < 0.001), while the number of patients going into remission increased gradually from week 0 to week 4 (18/25 patients, 75%). Sex, location of disease, age at onset, first attack or recurrence and duration of disease were not statistically related to response to treatment. Presence and severity of abdominal pain both decreased and bowel movements were also reduced. General well-being improved significantly, the loss of weight stopped and an increase in body weight was noted at the end of the fourth week. Side effects were minimal. It is concluded that ornidazole is an effective and safe drug for the treatment of active Crohn's disease.