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PubMed1996

Cognitive and emotional deficits in early stages of HIV infection: an event-related potentials study.

1. In order to inventory different Event-Related Potentials (ERP) modifications in HIV-infection the authors have evaluated 23 HIV-positive subjects and 12 HIV-negative subjects. ERP were recorded during an auditory oddball task. 2. Electrophysiological results showed that the latency of the N100 component of the ERP was significantly increased in HIV-positive subjects compared to the HIV-negative subjects. The latency of the N200 component of the ERP showed a similar tendency which just failed to reach significance when considering HIV-positive subjects vs HIV negative subjects. This result was in agreement with the literature which reported increased latencies in HIV infection. 3. Considering all subjects the authors have observed a correlation between the amplitude of the P300 and the emotional deficit. This correlation was stronger in subjects who presented an emotional deficit and was independent of any other psychopathological symptom. 4. The use of ERP appeared to be a sensitive technique to detect subclinical manifestations in HIV asymptomatic subjects and therefore would help to identify subjects at higher risk for developing cognitive impairments.

Adult↗
PubMedDate not supplied

Experiences with diabetes mellitus and implantable insulin pump therapy: a summary of interview data.

A semistructured interview was used to elicit information from 23 implantable insulin pump recipients regarding their concerns about having diabetes mellitus, their decision to receive an implantable insulin pump, and their experiences with the pump. Findings indicated that subjects had present and future concerns about having diabetes mellitus and that they wanted an implantable insulin pump primarily to achieve better control of their diabetes. Subjects said their health generally improved after pump implantation and that the pump had minimal interference with their social lives. Although 16 subjects identified concerns about the pump, all subjects said they would decide again for pump implantation.

Adult↗
PubMed1999

Eversion strength analysis of uninjured and functionally unstable ankles.

OBJECTIVE: Functional ankle instability (FAI) afflicts many athletes. Several causes of FAI have been implicated, including peroneal muscle weakness. Traditional musculoskeletal rehabilitation programs have focused on concentric muscle strength. The purpose of our study was to compare concentric and eccentric isokinetic and isometric eversion ankle strength measurements between subjects identified as having unilateral FAI and subjects having no history of inversion ankle sprain. DESIGN AND SETTING: Employing a matched-pairs technique, subjects with no history of ankle injury were compared with subjects with unilateral FAI using isokinetic and isometric measures of eversion ankle strength. Strength testing was performed in a sports medicine clinic setting. SUBJECTS: Forty-two subjects volunteered for this study: 21 subjects suffered from unilateral FAI (age = 19.3 +/- 1.1 years, wt = 84.0 +/- 9.5 kg, ht = 181.5 +/- 9.2 cm), while 21 subjects served as matched-paired controls (age = 19.5 +/- 1.2 years, wt = 82.5 +/- 10.9 kg, ht = 179.5 +/- 7.9 cm). MEASUREMENTS: Ankle eversion concentric and eccentric strength (peak torque) was assessed at 0 degrees /s, 30 degrees /s, 60 degrees /s, 90 degrees /s, 120 degrees /s, 150 degrees /s, and 180 degrees /s using an isokinetic dynamometer. RESULTS: We found no significant differences in concentric, eccentric, or isometric eversion ankle strength between the 2 groups of subjects. CONCLUSIONS: The exact cause of FAI remains elusive. Based on our results, those who suffer from unilateral FAI do not appear to have eversion strength deficits. Unless clear evidence of weakness exists, clinicians may find that eversion strength training exercises are unnecessary. Future research should examine other causes of FAI, including reciprocal muscle group strength ratios and proprioception deficits.

Journal Article↗
PubMed2002

Post-Traumatic Stress Disorder in subjects with schizophrenia and bipolar disorder.

The purpose of this study was to identify subjects with Post-traumatic Stress Disorder (PTSD) consequent to hallucinations and delusions and the experiences related to psychosis in schizophrenic and bipolar subjects. Schizophrenic and bipolar subjects were given questionnaires in order to evaluate PTSD incidence and symptoms. Subjects with classical types of trauma were excluded. Depression and stress scales were also answered. About one-third of schizophrenic subjects and one-half of bipolar subjects met PTSD criteria on the Penn PTSD Inventory. Hallucinations and delusions were identified as traumatic events in 60% of subjects with schizophrenia, but in only 15% of the subjects with bipolar disorder. Also, childhood abuse and various present stressors may contribute to the current PTSD symptomatology. Increases in PTSD scale scores were paralleled by increases in Beck depression scale scores. This study underscores the need for mental health clinicians to be sensitive to patients' illness experiences and to be aware of the therapeutic implications in treating PTSD in subjects with schizophrenia and bipolar illnesses.

Adult↗
PubMed1997

Heart rate adjustment of exercise-induced ST-segment depression identifies men who benefit from a risk factor reduction program.

BACKGROUND: Whether subjects identified as being at increased risk of coronary heart disease (CHD) death by heart rate adjustment of exercise-induced ST-segment depression will benefit from therapy aimed at reducing risk factors has not been examined. METHODS AND RESULTS: Exercise ECGs were performed in 11,880 men from the Usual Care (UC) and Special Intervention (SI) groups of the Multiple Risk Factor Intervention Trial. UC men were referred to customary sources of care in the community; SI men received counseling on smoking cessation and dietary reduction of cholesterol, and stepped-care therapy for hypertension. An abnormal ST-segment response to exercise was defined according to standard criteria as > or = 100 microV of additional horizontal or downsloping ST-segment depression and by an ST-segment/heart rate (ST/HR) index >1.60 microV/bpm. After 7 years of follow-up, CHD mortality was significantly lower in SI than UC men with an abnormal ST/HR index (2.4%, 19/786 versus 5.3%, 39/729, P=.005) but was comparable in SI and UC men with a normal ST/HR index (1.6%, 84/5154 versus 1.3%, 70/5211, P=NS). Risk reduction in SI men with an abnormal ST/HR index was independent of age and other cardiac risk factors. In contrast, there was no significant difference in CHD death rate between the smaller groups of SI and UC men with an abnormal test by standard criteria (3.6%, 7/192 versus 2.7%, 5/186, P=NS). CONCLUSIONS: An abnormal ST/HR index identifies men in whom therapy aimed at reducing CHD risk factors reduces the risk of CHD death by 61%. These findings support the application of heart rate adjustment of ST depression for screening of asymptomatic subjects at increased risk of CHD to identify those who will benefit most from risk factor-reduction programs.

Adult↗
PubMed1997

Oral sensory discrimination of fluid viscosity.

This study was designed to investigate the ability of normal young adult volunteers to sensorially identify Newtonian fluids of specified viscosities. Twenty subjects, 10 men and 10 women between the ages of 18 and 29 years participated. Seven stimuli, consisting of combinations of corn syrup and water, with viscosities ranging from 2 to 2,240 centipoise (cP) were prepared and characterized using a coaxial rotational viscometer. Subjects were presented with two anchor stimuli representing the extremes of the range of viscosities as a basis from which the experimental stimuli were judged. The seven experimental stimuli were randomly presented to each subject 10 times. The accuracy with which the subjects identified the viscosity of the fluid was significant at p < 0.01. The pattern of response was not significantly different across subjects nor gender. There were no differences in performance throughout the duration of the study. The repeat presentation of the anchor points did not significantly affect performance. Further research on oral perception of viscosity, and the processes that mediate changes in swallow physiology resulting from changes in viscosity is required.

Adult↗
PubMed1985

Detection of early arterial disease: a study using Doppler waveform analysis.

Laplace transform analysis of arterial Doppler waveforms was examined for its potential in identifying subjects with early, pre-symptomatic arterial disease. Ninety men, aged 45 to 62, and with no history of cardiovascular disease, were selected from a population of 2300 involved in a longitudinal study of risk factors for cardiovascular disease. Forty-nine were selected on the basis of high values of Laplace delta, omega o, or both, and 41 were selected with "normal" values. Three years after initial screening examination, each was examined clinically and by exercise testing for evidence of arterial disease, and the waveform recordings were repeated. In the group with high waveform analysis values initially, 11 of 49 (22%) were found to have signs of arterial disease 3 years later, while among those with lower values only 2 of 41 (5%) had evidence of disease (p less than 0.05). Although variability of results obviates their use in monitoring the progress of individual subjects, this study supports the potential of Doppler waveform analysis for identifying a group of subjects with a high incidence of early arterial disease.

Arteriosclerosis↗
PubMed1991

Holding death at bay: the experience of the spouses of patients undergoing cardiovascular surgery.

This study utilized a grounded theory design to investigate the experiences related to being the spouse of a cardiovascular surgical patient during five subject-identified phases: a) finding out the surgery was necessary, b) waiting for surgery, c) waiting during surgery, d) the intensive care unit (ICU) experience, and e) the recovery period before hospital discharge. Data were collected from each of eight subjects via three unstructured, tape-recorded interviews conducted a) on the day of the patients' hospital admission, b) during the first 48 hours of the patients' ICU stay and c) just before the patients' hospital discharge. Holding Death at Bay was identified as the core category. Three main categories: uncertainty, helping commitment and reorganization emerged from the data and were apparent in each of the five subject-identified phases of the spouses' experience. Main categories and subcategories of the core category emerging from the data are described. Implications of this research for nursing practice and further nursing research are discussed.

Adaptation, Psychological↗
PubMed1990

Screening for thyroid disease in children with IDDM.

The aim of this study was to evaluate the usefulness of screening for thyroid disease by performing thyroid function tests and measuring thyroid autoantibodies in 371 children and adolescents with insulin-dependent diabetes mellitus (IDDM). We analyzed clinical data and results of serum thyroxine, triiodothyronine uptake, thyroid-stimulating hormone, and antibodies to thyroid microsomal antigen and thyroglobulin. Goiter was noted in 20% of subjects. Thyroid-specific autoantibody was positive in 19% of subjects. Twenty-seven subjects (7%) had thyroid dysfunction. Autoantibody testing identified subjects with thyroid dysfunction with a sensitivity of 50%, a specificity of 84%, a degree of misclassification of 17%, a positive predictive value of 13%, and a negative predictive value of 97%. We recommend that all children and adolescents be screened shortly after diagnosis of IDDM by determination of thyroid-stimulating hormone (measured by high-sensitivity assay) to identify thyroid dysfunction and by testing for antibody to thyroid microsomal antigen to characterize both risk of future thyroid dysfunction and the need for future testing.

Adolescent↗
PubMed1998

Are voice endurance tests able to assess vocal fatigue?

Voice endurance tests are often used to evaluate vocal fatigue or to test the suitability of an individual for voice demands. It is assumed that these tests help to identify subjects with laryngeal or vocal fatigue out of a population of persons with complaints of discomfort in the throat, recurrent hoarseness and decreased voice power. In this study we evaluated the Voice Interval Test with respect to its discriminative power by comparison of voice performances in 20 patients with a history of vocal fatigue with that in 12 healthy subjects. Voice performance was studied during the Voice Interval Test as well as during regular use of the voice on a working day by electroglottography (EGG), acoustic analysis and a self-rating scale for pain and fatigue. Despite the number of tests the data did not reveal any significant difference between the patients and the healthy subjects. Voice fatigue could therefore not be identified and the clinical relevance of the Voice Interval Test appears to be questionable.

Adult↗
PubMed1989

The comparability of solicited versus clinic subjects in alcohol treatment research.

The increasing use of media advertisements to recruit subjects in alcohol treatment research has raised concerns about the comparability of such solicited subjects and subjects drawn from more traditional clinic populations. This paper, based on a study that involved both solicited and clinic subjects, identifies differences between the two types of subjects in terms of sociodemographic variables; pre-treatment drinking and marital adjustment; several dimensions of 'self-definition'; and three outcome measures. These findings suggest that there may be significant differences between solicited and clinic subjects and that these differences should be taken into account in the design of studies utilizing solicited subjects in order to determine the generalizability of the results.

Adult↗
PubMed2000

Increased levels of soluble vascular cell adhesion molecule 1 are associated with risk of cardiovascular mortality in type 2 diabetes: the Hoorn study.

Membrane-bound vascular cell adhesion molecule 1 (VCAM-1) allows the tethering and rolling of monocytes and lymphocytes as well as firm attachment and transendothelial migration of leukocytes. Soluble forms of VCAM (sVCAM-1) may serve as monitors of increased expression of membrane-bound VCAM-1 and thus may reflect progressive formation of atherosclerotic lesions. Levels of sVCAM-1 have been found to be increased among type 2 diabetic as compared with nondiabetic subjects. To study the association of plasma sVCAM-1 concentration and risk of cardiovascular and all-cause mortality among nondiabetic and diabetic subjects, we investigated an age-, sex-, and glucose-tolerance-stratified sample (n = 631) of a population-based cohort aged 50-75 years that was followed prospectively. Plasma levels of sVCAM-1 were determined in frozen -70 degrees C baseline samples. After 7.4 years (mean) of follow-up, 107 (17%) subjects had died (42 of cardiovascular causes). In the entire group, increased sVCAM-1 levels were significantly associated with increased risk of cardiovascular mortality (relative risks [RRs] per 100 ng/ml sVCAM-1 increase, 1.10 [1.05-1.15] after adjustment for age, sex, and glucose tolerance status). This RR was somewhat diminished by further adjustment for the presence of hypertension and cardiovascular disease; levels of total, HDL, and LDL cholesterol and homocysteine; the presence of microalbuminuria (a putative marker of endothelial dysfunction); levels of von Willebrand factor (a marker of endothelial dysfunction) and C-reactive protein (a marker of low-grade inflammation); and estimates of glomerular filtration rate. However, the RR remained statistically significant. The RR among type 2 diabetic subjects was 1.13 (1.07-1.20) per 100 ng/ml sVCAM-1 increase after adjustment for age and sex, which was somewhat higher but not significantly different from the RR in nondiabetic subjects (P value for interaction term, 0.12). Further adjustment for other risk factors gave similar results. In conclusion, levels of sVCAM-1 are independently associated with the risk of cardiovascular mortality in type 2 diabetic subjects and therefore might be useful for identifying subjects at increased cardiovascular risk. Increased plasma sVCAM-1 levels may reflect progressive formation of atherosclerotic lesions, or sVCAM-1 itself may have bioactive properties related to cardiovascular risk. Our data, however, argue against the hypotheses of sVCAM-1 levels simply being a marker of endothelial dysfunction, of low-grade inflammation, or of an impaired renal function.

Aged↗
PubMed1992

Discrimination of agonist-antagonist opioids in humans trained on a two-choice saline-hydromorphone discrimination.

The stimulus properties of four opioid agonist-antagonists were assessed in postaddict volunteers trained in a two-choice drug discrimination procedure to discriminate between the effects of i.m. saline and hydromorphone (3 mg/70 kg). Behavioral, subjective and physiological measures were concurrently collected. After training, generalization curves were determined for hydromorphone, pentazocine, butorphanol, nalbuphine and buprenorphine. In generalization testing, hydromorphone produced dose-related increases in hydromorphone-appropriate responses and in characteristic opioid agonist-like subjective effects measures. In general, each of the study drugs produced a profile of subjective and physiological effects similar to that reported in other human studies. These subjective indices showed the study drugs to be heterogeneous. However, in this two-choice drug discrimination procedure, they were discriminated as homogeneous (i.e., all were discriminated as hydromorphone-like). The present study also found that all test drugs were subjectively identified as being opiates, and all were subjectively rated as similar to the hydromorphone training condition. A previous three-choice discrimination was sensitive to the heterogeneity among these drugs on both the discrimination measures and subjective ratings of similarity to the hydromorphone training condition. Thus, the specific procedures of drug discrimination studies may have an effect on some subjective indices, although this interaction is not apparent for the majority of subjective effect measures. Also, the characterization of opioids in drug discrimination testing appears to depend upon the specific training subjects receive; this is most clear with discrimination measures, and to a more limited extent, with subjective measures.

Adult↗
PubMed1996

p53 protein accumulation and gene mutations in multifocal esophageal precancerous lesions from symptom free subjects in a high incidence area for esophageal carcinoma in Henan, China.

BACKGROUND: Multifocal occurrence of precancerous lesions of the esophagus has been observed among individuals in a high incidence area for esophageal carcinoma in Henan Province, China. Results from recent studies suggest that p53 protein accumulation and mutation occur early in the pathogenesis of esophageal carcinoma. Discordant p53 gene mutations have been observed in invasive carcinoma and preinvasive lesions from a patient with esophageal carcinoma. The p53 alterations in the multifocal precancerous lesions from symptom-free subjects, however, have not been investigated. METHOD: Two biopsy samples, one each from the middle-third and the lower-third of the esophagus, from each subject, were taken from 55 symptom-free subjects in a high incidence area for esophageal cancer in Huixian, Henan Province, China. p53 protein accumulation and p53 gene mutation were analyzed in the multifocal esophageal precancerous lesions from these subjects. RESULTS: Histopathologic examination showed that among the 110 biopsies, 20 had dysplasia, 72 had basal cell hyperplasia, and 18 had normal epithelia. Concurrent lesions at the middle- and lower-third biopsy occurred in 2 subjects with dysplasia (2 of 55 subjects, 4%) and 26 subjects with basal cell hyperplasia (26 of 55 subjects, 47%). Analysis by immunohistochemistry showed high concurrent rates of p53 protein accumulation (51 of 55 subjects, 93%). p53 sequence analysis of 32 samples from 16 subjects identified missense mutations in 5. In one subject, there were three different mutations in the middle-third biopsy (codon 161, GCC-->GAC) and the lower-third biopsy (codon 159, GCC-->CCC). A single mutation was detected in the other four subjects in either the middle- or lower-third biopsy. CONCLUSIONS: The present findings indicate that p53 protein accumulation and mutations occur in the early stages of human esophageal carcinogenesis. Independent somatic mutations of the p53 tumor suppressor gene and protein accumulation in different regions of the esophageal "field" might be key molecular events in multifocal esophageal carcinogenesis.

Adult↗
PubMed1995

[Identification of subjects at high risk of coronary disease in a working population using a prediction model].

Identification of subjects at high risk of coronary morbidity is of major interest in the prevention of cardiovascular disease. This report describes the use of a multifactorial prediction model for the identification of high risk subjects in a French male population. The PCV-METRA study (Prévention Cardiovasculaire en Médecine du Travail) monitors risk factors of cardiovascular morbidity in a population of men and women employed in big companies in the Paris region. A model adapted from a prediction model conceived by K.M. Anderson et al. in the Framingham study was used. The modified model enables an estimation of individual coronary risk based on 7 factors: age, total cholesterol, HDL-cholesterol, systolic blood pressure, smoking, diabetes and presence of left ventricular hypertrophy, taking into account the relatively low prevalence of coronary heart disease in France. The population comprised 4,131 active men aged 30 to 65 years. The average risk at 5 years was estimated to be 1.6%. Subjects at high risk (over the 80th percentile of the risk distribution curve) usually had high blood pressures and cholesterol levels. However, nearly 30% of these subjects were neither hypertensive nor hypercholesteraemic. It is important to note that 3/4 of these smoked. Moreover, they also had low HDL-cholesterol levels. A risk table, derived from the Framingham model, is presented. This table allows estimation of individual risk at 5 years in men aged 30 to 65 years. In each age group, the comparison of individual risk with the percentiles of risk distribution in the PCV-METRA population allows identification of high-risk subjects. This study proposes a tool for identifying subjects at high risk of coronary morbidity in a French male population. This multifactorial model is particularly useful for detecting subjects with several borderline factors none of which overstep the usually accepted limits.

Adult↗
PubMed2000

Detection of apoptotic T lymphocytes in peripheral blood of human immunodeficiency virus (HIV)-infected subjects by apostain.

Apoptosis has been indicated as a mechanism of T cell depletion in HIV-infected subjects and useful in monitoring disease progression. We investigated for the presence of apoptotic T lymphocytes in 130 HIV subjects in various stages of disease by the newly developed cell permeant DNA dye Apostain. Blood was collected in EDTA, lysed in buffered ammonium chloride, fixed in freshly prepared 1% paraformaldehyde and stored in aliquots at -80 degrees C. Samples were thawed and double stained with FITC conjugated-CD3 monoclonal antibody and Apostain. Flow cytometry was then performed and T cells gated on a CD3 versus side scatter dot plot. Normal samples treated in the same manner served to establish the boundary separating non-apoptotic from apoptotic cells. There was no statistically significant association between the proportion of subjects with detectable apoptotic cells and CDC clinical categories A, B and C at the time of admission to the study, although a trend toward a lower apoptotic rate in category A (A= 29%, B=40% and C=41%) was noticed. Conversely, CDC T cell categories 2 and 3 contained significantly higher proportions of Apostain positive patients (1=6%, 2=32% and 3=49%, P=0.072, by chi(2) test). Most importantly, Apostain test identified subjects at risk of disease progression during a 3.5-7 months follow-up in CDC category B and 2 (P=0.008 and P=0.0003, by Fisher's exact test, respectively). A similar, albeit not statistically significant trend was observed also in the other categories. Not requiring extensive manipulation of fresh samples nor cumbersome culture techniques, Apostain test appears suitable for identifying HIV subjects at higher risk of disease progression in clinical settings.

Adult↗
PubMed2001

Medical care from childhood to adulthood in type 1 and type 2 diabetes.

Diabetes mellitus comprises a heterogeneous group of diseases that have in common the development of macro- and microvascular complications. It is now possible to identify subjects at high risk of Type 1 or Type 2 diabetes, especially in the patient's family members. Preventive interventions are quickly becoming available, and can help delay the onset of the disease and thereby reduce complications in these subjects. Furthermore the correct etiological diagnosis of diabetes is fundamental in providing the best treatment for the patient. Maturity-onset diabetes of the young (MODY) syndrome should be suspected in cases of a subtle onset of diabetes and autosomal dominant inheritance. Mitochondrial DNA mutations should be considered when a diabetic patient also suffers from deafness or if there is a family history of this combination in the mother side of the family. Atypical diabetes has to be identified by the physician to avoid mistakes when the patient enters the non-insulin-dependent phase. In the case of Wolfram's syndrome a gene analysis for each family member should be performed to identify heterozygote subjects. Recently, many discoveries in genetics help us better understand the pathogenesis of the diseases and diagnose the monogenic form of diabetes more easily. If all family members are followed in the same center, clues from the family history are readily available for differential diagnosis and preventive interventions can be established more effectively.

Adolescent↗
PubMed2000

Recovery time dispersion measured from 87-lead body surface potential mapping as a predictor of sustained ventricular tachycardia in patients with idiopathic dilated cardiomyopathy.

INTRODUCTION: The clinical usefulness of QT dispersion in 12-lead ECG has been controversial in identifying subjects at risk for sustained ventricular tachycardia (VT) in patients with idiopathic dilated cardiomyopathy (DCM). We hypothesized that increasing the spatial resolution of the ECG improves the accuracy of risk stratification. The purpose of this study was to test the ability of recovery time dispersion measured from 87-lead body surface potential mapping (BSPM) to identify patients at risk for sustained VT in idiopathic DCM. METHODS AND RESULTS: We obtained 87-lead BSPM and 12-lead ECG in 33 patients with idiopathic DCM (15 patients with a history of sustained VT [VT(+) group] and 18 patients without a history of sustained VT [VT(-) group]) and in 20 normal control subjects. We measured the corrected QT dispersion and corrected recovery time dispersion from 12-lead ECG (QTc-12 dispersion and RTc-12 dispersion, respectively) and 87-lead BSPM (QTc-87 dispersion and RTc-87 dispersion, respectively). Signal-averaged ECG also was recorded in 25 patients. Neither the QTc-12 nor QTc-87 dispersion discriminated between the VT(+) and VT(-) groups patients. The VT(+) group patients had a larger but insignificant RTc-12 dispersion than the VT(-) group patients. In contrast, the RTc-87 dispersion was significantly larger in the VT(+) group patients than in the VT(-) group patients (236 +/- 39 msec vs 184 +/- 28 msec, P < 0.001). Receiver operating curve analysis indicated that the RTc-87 dispersion was as good as late potentials in predicting susceptibility to sustained VT; its sensitivity, specificity, and negative predictive value were 73%, 76%, and 76%, respectively (cutoff value 200 msec). RTc-87 dispersion >200 msec combined with positive late potentials provide high sensitivity (92%) and high negative predictive value (88%) for sustained VT. CONCLUSION: The RTc-87 dispersion is a useful tool to identify subjects at risk for sustained VT in patients with idiopathic DCM.

Body Surface Potential Mapping↗