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Immunological biomarkers in salt miners exposed to salt dust, diesel exhaust and nitrogen oxides.

OBJECTIVES: Air pollutants can affect lung function and also the immune system. In a study about lung function of salt miners in relation to the complex exposure in a salt mine, we also analysed selected immunological parameters and inflammation markers in the blood of miners. Effect of salt dust, diesel exhaust, nitrogen oxides (NOx) and smoking on the biomarkers was analysed. METHODS: Blood was drawn from 286 salt miners, and the soluble intercellular adhesion molecule-1 (s-ICAM), monocyte chemotactic protein (MCP-1) and clara cell protein (CC16) were analysed by an immunoassay, blood profile was done and lymphocyte subpopulations (CD3, CD3/CD4, CD3/CD8, CD19, NK-cells, CD3/HLA-DR) were determined by flow cytometry. Salt dust was measured by two-step gravimetry (personal sampling). Diesel exhaust was measured as elemental carbon concentration by coulometry. NOx were determined by an electrochemical cell method. Differences between non-smokers, former smokers and active smokers were analysed by analysis of variance. Linear regression analysis to describe exposure-response relationships was done with regard to confounding factors [smoking, inflammatory diseases, time of blood drawing, respiratory infection and body-mass index (BMI)]. RESULTS: Significant differences between non-smokers and active smokers were found for most of the leukocyte types (e.g. granulocytes P = 0.000, lymphocytes P = 0.002, T-cells P = 0.033) and for some soluble parameters (ICAM P = 0.000, IgM P = 0.007, IgE P = 0.035). Increasing numbers of total lymphocytes, T-cells and HLA-DR positive T-cells in relation to exposure were found by linear regression analysis (e.g. for inhalable dust:total lymphocytes P = 0.011, T-cells P = 0.061, HLA-DR positive T-cells P = 0.007). CONCLUSION. Comparison of immunological markers in non-smokers and active smokers confirms leukocytosis and inflammation following tobacco consumption. The combined exposure of salt dust, diesel exhaust and NOx seems to influence the immune system. Together, the results suggest that the analysis of leukocytes and their subsets can complete other investigations (lung function, questionnaire) to monitor exposure-response relationships in occupational studies investigating the effect of inhaled substances. Longitudinal studies will be necessary to determine the predictive value of the immunological changes.

Adult↗

The effects of a single bout of downhill running and ensuing delayed onset of muscle soreness on running economy performed 48 h later.

Delayed onset of muscle soreness (DOMS) is a common response to exercise involving significant eccentric loading. Symptoms of DOMS vary widely and may include reduced force generating capacity, significant alterations in biochemical indices of muscle and connective tissue health, alteration of neuromuscular function, and changes in mechanical performance. The purpose of the investigation was to examine the effects of downhill running and ensuing DOMS on running economy and stride mechanics. Nine, well-trained distance runners and triathletes participated in the study. Running economy was measured at three relative intensities [65, 75, and 85% of maximal aerobic capacity ( VO(2peak))] before (RE1) and 48 h after (RE2) a 30-min downhill run (-10%) at 70% VO(2peak). Dependent variables included leg muscle soreness, rate of oxygen consumption ( VO(2)), minute ventilation, respiratory exchange ratio, lactate, heart rate, and stride length. These measurements were entered into a two-factor multivariate analysis of variance (MANOVA). The analysis revealed a significant time effect for all variables and a significant interaction (time x intensity) for lactate. The energy cost of locomotion was elevated at RE2 by an average of 3.2%. This was coupled with a significant reduction in stride length. The change in VO(2) was inversely correlated with the change in stride length ( r= -0.535). Lactate was significantly elevated at RE2 for each run intensity, with a mean increase of 0.61 mmol l(-1). Based on these findings, it is suggested that muscle damage led to changes in stride mechanics and a greater reliance on anaerobic methods of energy production, contributing to the change in running economy during DOMS.

Adaptation, Physiological↗

Does aggressive hydration reverse the effects of pneumoperitoneum on renal perfusion?

BACKGROUND: Although pneumoperitoneum (PP) decreases renal blood flow, it remains unclear whether this impacts renal function. Our aim was to characterize the effects of PP on renal perfusion and function using two fluid strategies for intravenous fluid administration. METHODS: Twelve 30-kg pigs were randomized into two groups: maintenance (3 cc/kg/h of normal saline (NS)) and bolus (15 cc/kg/h + 20 cc/kg NaCl bolus prior to induction of PP). Pigs were studied in a blinded fashion for 30 min prior, 60 min during, and 30 min after release of 15 mmHg CO(2) PP. Cardiac output (CO) and stroke volume (SV) were measured using an esophageal Doppler probe, renal cortical perfusion (RCP) was measured with a laser Doppler probe on the right kidney, and renal function was measured using the fractional excretion of sodium (FeNa) and urine output. Statistical analysis was performed with area-under-the-curve (AUC) analysis and analysis of variance RESULTS: AUC analysis revealed moderate effect size for CO (0.416) and small effect size for SV (0.366) and RCP (0.363), with decreases seen in the control group but not the bolus group. During PP, urine output increased in the bolus group (p = 0.04) but not in the control group; there was no difference in FeNa in either group. CONCLUSION: Aggressive fluid hydration during CO(2) PP of 15 mmHg preserves CO, SV, and RCP while increasing urine output. No effect on renal function as measured by FeNa was observed in either group.

Animals↗

[Patient anxiety and satisfaction in coloproctological operations].

BACKGROUND: Patients' emotional internal views related to coloproctological operations were examined, especially the relation between anxieties and satisfaction with treatment, including possible moderator variables such as age, gender, and control beliefs. PATIENTS AND METHODS: For 328 patients with operations on the rectum versus colon operations, intensity of anxiety, quality of anxiety, and their course was assessed. Likewise, satisfaction with medical care, subjective success of treatment, as well as control beliefs regarding illness and health were measured. The data were analyzed by means of analysis of (co-)variance, regression analysis, and discriminatory analysis. RESULTS: The emotional internal view turned out to have a greater influence than the objective severity of the operation. This also concerns specific, coloproctology-related contents of anxiety (e.g., anxieties concerning an anus praeter). For coping with anxiety, variables of a "talking medicine" are relevant. For this purpose, engaged communicative nursing care is important, though it cannot compensate for deficiencies in doctor-patient-communication. The latter must take into account the higher intensity of anxiety among younger patients as well as feelings of insecurity related to the hospital dismissal. CONCLUSION: These findings suggest the following improvements: the information provided by the physician should be more sophisticated, the clarification of diagnosis should take place as soon as possible, and the communication of the diagnosis should be combined with the reinforcement of internal control beliefs. This should apply to the transition to outpatient treatment as well.

Adult↗

Assessment of Genetic Diversity and Population Structure on Azadirachta indica A. Juss. in an Urban Metropolitan: Ahmedabad, India.

Azadirachta indica (A. indica) A. Juss., commonly known as Neem, is a valuable multipurpose tree with profound medicinal properties and socioeconomic importance, widely recognized since ancient Ayurvedic times. Despite its prominence, knowledge about its genetic diversity within the metropolitan area of Ahmedabad is limited. This study marks the first in-depth exploration of the genetic diversity and population structure of A. indica in Ahmedabad. The authenticity of the species was validated through DNA barcoding, and a Geographical Information System (GIS) was used to collect the samples. A total of 35 A. indica accessions were analyzed using five Inter Simple Sequence Repeat (ISSR) primers. Genetic diversity and population structure were evaluated using Inter Simple Sequence Repeat (ISSR) markers through polymorphism assessment, clustering, ordination, and Bayesian population structure analyses. ISSRs revealed a high level of polymorphism (75.66%), indicating substantial genetic variability among accessions. An analysis of genetic diversity indices revealed low to moderate diversity (Hs = 0.14, Ht = 0.217, I = 0.217). Analysis of Molecular Variance (AMOVA) analysis depicted 81% variation within the population and 19% among the population. Low to moderate genetic differentiation (Gst = 0.319) and moderate gene flow (Nm = 1.06) indicated that urban development has not hindered gene flow among populations. Mantel's test revealed a weak but significant correlation between genetic and geographic distances, suggesting limited isolation by distance. The estimated ΔK using STRUCTURE exhibited two subpopulations, representing two gene pools for A. indica accessions (K = 2). Collectively, these patterns indicate that urbanization has not severely disrupted genetic connectivity in A. indica, reflecting its resilience and adaptive potential in a metropolitan environment. These findings provide pivotal knowledge for further understanding the genetic diversity and population structure of A. indica in one of the fastest-growing cities in India, which can be utilized for new breeding programmes, sustainable development and future conservation strategies around the globe.

India↗

Fibrinolytic parameters in women undergoing ovulation induction.

OBJECTIVE: The purpose of this study was to evaluate the effect of elevated levels of circulating estradiol on the clotting and fibrinolytic system in patients undergoing controlled ovarian hyperstimulation. STUDY DESIGN: Fifty-two patients undergoing controlled ovarian hyperstimulation with human menopausal gonadotropins or urofollotropin were asked to participate. Blood for hemostasis parameters was obtained on the days that patients returned for estradiol sampling. Sample days were identified as cycle days 1 to 5 (baseline), 6 to 9, and 10 to 14. Each factor was analyzed by repeated-measures analysis of variance and correlation analysis. RESULTS: A significant decline was observed for tissue plasminogen activator antigen and plasminogen activator inhibitor type 1 activity from baseline to cycle days 10 to 14. As serum estradiol levels increased throughout each phase (maximum mean estradiol 739.8 pg/ml), a significant linear decrease was observed for both tissue plasminogen activator antigen and plasminogen activator inhibitor type 1 activity, whereas thrombin-antithrombin III complexes did not change significantly. A significant positive correlation was also observed for plasminogen activator inhibitor activity and tissue plasminogen activator antigen level over all cycle days examined. CONCLUSION: Down-regulation of the fibrinolytic system was observed as estradiol levels increased. However, thrombin formation did not change, thus suggesting that elevated circulating estradiol alone does not predispose to a thromboembolic event.

Adult↗

Truncal flexibility exercise effects on musculoskeletal capability for manual handling operations.

The main purpose of this study was to investigate the effects of a truncal flexibility programme on manual material handling strength and endurance, low-back flexibility and truncal rotation. Two training groups (males and females) and one control group participated in the study. Multivariate analysis of variance and discriminant analysis suggested that it is possible to improve significantly dynamic muscular strength, low-back flexibility and truncal rotation during the course of the exercises described in this investigation. However, the effects of the programme on muscular endurance were mixed; females significantly improved and males did not. The response variables collected for the control group did not show any significant change over the study period. The implications of the results with respect to the industrial environment are discussed.

Journal Article↗

Rerandomization tests for analyzing correlated data from dental studies.

Dental research studies often produce relatively small data sets in which observations are serially or spatially correlated. Rerandomization tests are presented as alternatives to analysis of variance and multivariate analysis for assessing group differences using such data. Rerandomization tests are particularly useful when the investigator is unwilling to make strong assumptions about the nature of the serial correlation or the distribution of the data. Two examples are discussed that demonstrate these techniques.

Data Interpretation, Statistical↗

An improved data analysis method for interleukin 2 microassay.

Development of the interleukin 2(IL 2) microassay, coupled with the use of highly purified or recombinant factors has allowed a detailed examination of the mechanism of action of this important biological response modifier. However, probit analysis of the microassay data does not allow inherent error of the system to be approximated nor can units of activity be assessed for significance. A computer program was developed to analyze the validity of each regression line and to generate 95% confidence intervals around each line. This program employs analysis of variance, linear regression analysis and the parallel line assay to fix confidence intervals for each IL 2 unit value. The use of recombinant IL 2 as an immunomodulator in clinical settings warrants a more precise statistical method to evaluate normal fluctuations of this factor than currently in use. The development of such a method is presented here.

Biological Assay↗

Improved performance and student satisfaction after implementation of a problem-based preclinical obstetrics and gynecology curriculum.

OBJECTIVE: This study was undertaken to assess student performance and satisfaction as a preclinical obstetrics and gynecology course changed from a didactic to a problem-based format. STUDY DESIGN: We prospectively compared examination scores and course evaluations given to 162 second-year medical students over 4 years: 2 years before and 2 years after the curricular change, to assess student performance and satisfaction with learning. We used analysis of variance for the analysis of student performance and likelihood-ratio test for analysis of student satisfaction. RESULTS: Mean examination scores increased from 79.1% to 84% after implementation of the problem-based curriculum (P < .0001). The data showed statistically significant improvement in satisfaction with course content, learning objectives, learning resources, instructional methods, and course examinations. CONCLUSION: Students' satisfaction and performance in a preclinical obstetrics and gynecology course improved significantly when problem-based learning methods were introduced.

Curriculum↗

Obesity and retropubic surgery for stress incontinence: is there really an increased risk of intraoperative complications?

OBJECTIVE: The objective of the study was to evaluate the impact of obesity on length of surgery, blood loss, and intra- and postoperative complications in women who underwent retropubic surgery for stress urinary incontinence. STUDY DESIGN: Of 449 women participating in a multicenter, randomized trial evaluating antibiotic prophylaxis in women with suprapubic catheters, 250 women underwent retropubic anti-incontinence procedures. This is a prospective nested cohort study of these women, 79 (32%) of whom were obese (body mass index 30 or greater) and 171 (68%) overweight or normal weight (body mass index less than 30). Data collected included demographic variables, past medical history, physical examination, and intraoperative and postoperative complications. Data were analyzed with Fisher's exact for dichotomous variables, Student t tests for continuous variables, and analysis of variance for multivariate analysis. Significance was set at P < .05. RESULTS: Obese women undergoing stress urinary incontinence surgery were younger than nonobese women (48.7 versus 51.9 years, respectively, P < .019). The number and type of additional surgeries performed were similar between groups with the exception that obese women were less likely to undergo abdominal apical suspensions (P = .006) or abdominal paravaginal repairs (P = .001); therefore, estimated blood loss, change in hematocrit, length of stay, surgery, and suprapubic catheterization comparisons are adjusted for the performance of these procedures. Estimated surgical blood loss was greater for obese women (344 versus 284 P = .03); however, change in hematocrit was lower for obese than nonobese women (6.6 versus 7.3, P = .048). Mean length of surgery was 15 minutes longer in obese women (P = .02). Length of hospital stay did not vary between groups (P = NS). Major intraoperative complications were uncommon (14 [5.6%]), with no difference between weight groups. Incidence of postoperative urinary tract infection, wound infections, or postoperative major complications were likewise similar between groups (all P > .05). CONCLUSION: Surgery takes longer for obese patients, but blood loss as recorded by change in hematocrit is lower. Major complications were rare and similar between weight groups, as were infectious complications.

Adult↗

Reduced atrial fibrillation in patients immediately extubated after off-pump coronary artery bypass grafting.

BACKGROUND: We analyzed data from patients undergoing off-pump isolated coronary artery bypass grafting surgery (OPCABG) to determine if immediate extubation in the operating room affected the incidence of postoperative atrial fibrillation. METHODS: The study group comprised 2,376 consecutive OPCABG patients operated on between January 1, 2000, and December 31, 2004, by 22 surgeons at 18 hospitals. The data were subjected to univariate, multivariate analysis of variance, and logistic analysis. Logistic regression of matched groups was used to eliminate the effect of some confounding variables. RESULTS: Patients immediately extubated after surgery had a reduced incidence of atrial fibrillation (10.6% versus 18.5%; p < 0.001), shorter length of stay (4.8 +/- 3.5 versus 6.3 +/- 5.2 days; p < 0.001), and also reduced mortality (1.1% versus 2.4%; p = 0.04). Logistic analysis identified as significant factors for postoperative atrial fibrillation, postoperative ventilator usage (p < 0.001; odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.24 to 2.14), male sex (p = 0.002; OR = 1.51; 95% CI: 1.17 to 1.96), previous CABG (p = 0.005; OR = 0.43; 95% CI: 0.24 to 0.78). Congestive heart failure may also be a contributing factor. In patient groups matched for their risk of mortality, postoperative ventilator use (p < 0.001; OR = 1.80; 95% CI: 1.31 to 2.47), increasing age, and male sex were all statistically significant risk factors. When patient groups were matched on a combination of factors including preoperative beta-blocker usage, pulmonary disease, and smoking, postoperative ventilator use (p = 0.005; OR = 1.66; 95% CI: 1.16 to 2.38), along with increasing age, male sex, and previous CABG (reduced odds of atrial fibrillation developing) were statistically significant. CONCLUSIONS: Immediate extubation after OPCABG appears to reduce the incidence of postoperative atrial fibrillation independent of comorbidities.

Adrenergic beta-Antagonists↗

A randomized, open-label pharmacokinetic comparison of two oral formulations of fluconazole 150 mg in healthy adult volunteers.

BACKGROUND: Because of its systemic action, fluconazole is prescribed for a variety of fungal infections. However, therapeutic failure might result when a patient is switched between an innovator drug and a nonbioequivalent generic formulation. Pharmacokinetic (PK) studies investigating the bioequivalence of generic and innovator drugs can minimize such risks. OBJECTIVE: The aim of this study was to compare the PK profiles and relative bioavailabilities of 2 oral formulations of fluconazole: Diflucan (reference; Pfizer Corporation Austria GmbH, Wien, Austria) and Funzol (test; Bosnalijek d.d., Pharmaceutical and Chemical Industry, Sarajevo, Bosnia and Herzegovina), both prepared as capsules containing 150 mg of active drug. METHODS: A single oral dose of fluconazole was given under fasting conditions to healthy, white volunteers aged 18 to 55 years in this open-label, randomized, crossover study. A 3-week washout period was applied between each of the 2 doses. Serum samples were obtained before dosing and at various time points after dosing up to 144 hours and were analyzed for fluconazole concentration using a high-performance liquid chromatography-UV method. PK parameters representing the extent (AUC(0-infinity)) and rate (CmaX and T(max)) of absorption of fluconazole were obtained. An analysis of variance, a power analysis, 90% CI, and two 1-sided tests were used for statistical analysis of relative differences between the 2 drugs. Bioequivalence was concluded if the 90% CIs for the geometric mean ratios of AUC(0-infinity) and C(max) were between 0.80 and 1.25. A study investigator monitored the volunteers for adverse effects at 5 defined time points during the clinical part of the investigation. RESULTS: Thirteen men and 11 women (mean age, 33.3 years; mean weight, 73.6 kg) completed the study. The respective point estimates of the ratios of geometric means of log-transformed C(max) and AUC0(0-infinity) of fluconazole (test vs reference) were 0.985 and 1.047, with 90% CIs of 0.894 to 1.085 and 0.927 to 1.182, respectively. Differences in T(max) also did not reach statistical significance. No adverse effects were reported by the subjects or revealed by clinical or laboratory tests. CONCLUSIONS: The study failed to demonstrate any statistically significant differences in C(max) and AUCO(0-infinity) values between the test and reference formulations of oral fluconazole 150 mg in this small, select population of healthy volunteers. On that basis, and according to both the rate and extent of absorption, the test and reference formulations were considered bioequivalent.

Administration, Oral↗

Susceptibility of red blood cell lipids to in vitro oxidation and antioxidant status in preeclampsia.

OBJECTIVE: To investigate susceptibility of red blood cell (RBC) lipids to oxidation and antioxidant status in preeclampsia. STUDY DESIGN: Twenty-one women with mild preeclampsia, 21 women with severe preeclampsia, and 20 healthy pregnant women were included in this cross-sectional study. Susceptibility of RBC to oxidative stress was determined by measuring RBC-malondialdehyde levels after incubation with hydrogen peroxide. Vitamins E and C, total carotenoids and erythrocyte superoxide dismutase and glutathione peroxidase (GPx) activities and serum total antioxidant capacity (TAC) were determined spectrophotometrically. One-way analysis of variance and correlation analysis were used for statistical analyses. RESULTS: Compared with the normal pregnant women, susceptibility of RBC to oxidation was enhanced in the mild (p<0.05) and severe (p<0.01) preeclampsia groups, TAC was lower in the mild (p<0.01) and severe (p<0.001) preeclampsia groups. Vitamin C level was decreased in severe preeclampsia and total carotene level was decreased in mild and severe preeclampsia groups (p<0.05). GPx activity was also decreased in the mild (p<0.01) and severe (p<0.05) preeclampsia groups. CONCLUSION: The results of the present study supported the oxidative stress hypothesis of preeclampsia and it is possible that RBC play a role in the pathophysiology of the disease.

Adult↗

Comparison of two pain-management strategies during chest tube removal: relaxation exercise with opioids and opioids alone.

PURPOSE: The purpose of this study was to determine whether the use of a slow deep-breathing relaxation exercise, when used as an adjunct to opioid analgesia, decreases pain during chest tube removal (CTR) after coronary bypass surgery. DESIGN: A two-group quasi-experimental pretest/posttest design was used. SAMPLE: A convenience sample of 40 adults who had undergone coronary artery bypass graft surgery and met all inclusion criteria were recruited before CTR. SETTING: Data were collected in the Cardiothoracic Surgical Intensive Care Units of three acute care facilities in the Midwestern United States. METHOD: A 10-cm vertical Visual Analog Scale was used to measure pain at three points: before CTR, immediately after CTR, and 15 minutes after CTR. The experimental group received slow breathing relaxation exercises in addition to the usual opioid doses administered. FINDINGS: Data were analyzed using analysis of variance, and multivariate analysis of covariance yielded a significant difference in pain ratings immediately after CTR and 15 minutes after CTR for the group receiving relaxation exercise as an adjunct to opioid analgesic. CONCLUSIONS: This study supports the use of a slow deep-breathing relaxation exercise as an adjunct to the use of opioids for pain management during CTR among patients who have undergone coronary bypass surgery.

Adult↗

Food habits are associated with lipid peroxidation in an elderly population.

OBJECTIVE: The purpose of this study was to assess the association between dietary intake and lipid peroxidation. DESIGN: Cross-sectional population analysis from an ongoing prospective study. Malondialdehyde (MDA) was measured as a marker of lipid peroxidation. Diet was assessed through direct observation and food frequency questionnaire. SUBJECTS: Participants with no missing data were 162 nonsmoking elderly individuals residing in 7 institutions across Asturias (Spain). STATISTICAL ANALYSES PERFORMED: Comparisons of adjusted group means by tertiles of plasma MDA were made by analysis of variance. Stepwise regression analysis was done using MDA as a dependent variable and food intake as an independent variable. Food intakes were categorized into quartiles and logistic regression was applied to calculate the odds ratio for being in the highest tertile of plasma MDA. RESULTS: Consumption of potatoes had an independent direct effect and accounted for a sizeable proportion of the variation in plasma MDA levels (18%, P<.001). In addition to potatoes, other foods that had an apparently independent effect on plasma MDA were eggs, cooked vegetables, and red wine (R(2)=0.028, 0.023 and 0.018, respectively). In this study, dietary factors accounted for 25% of the variation in plasma MDA levels. CONCLUSION: Identifying nutritional determinants of oxidative stress is important because of its negative health effect. Consumption of cooked vegetables and moderate intake of wine has been shown to be appropriate for reducing the risk of oxidative damage. On the contrary, caution must be used with the intake of potatoes because we have found a positive association with MDA levels. Further studies are required to investigate the mechanism(s) of this association and whether it is related to the preparation method or to the potato itself.

Aged↗

Associations of decisional balance, processes of change, and self-efficacy with stages of change for increased fruit and vegetable intake among low-income, African-American mothers.

OBJECTIVE: To determine the relationship between stage of change and decisional balance, processes of change, and self-efficacy variables of the Transtheoretical Model to increase fruit and vegetable consumption by low-income, African-American mothers, and to assess the usefulness of the model for intervention efforts. DESIGN: We used a cross-sectional questionnaire design with a food frequency questionnaire and a staging algorithm to classify women by stage of change before enrollment. We used scaled questionnaire items based on think-aloud data to measure self-efficacy, processes of change, and pros and cons to increasing fruit and vegetable intake and variety. SUBJECTS/SETTING: We recruited a convenience sample of low-income, African-American mothers (n=420) aged 18 to 45 years with children <12 years of age to complete questionnaires at community-based sites. STATISTICAL ANALYSES PERFORMED: Analysis of variance, principal component analysis, chi(2) tests, correlation, and regression analyses were conducted. RESULTS: Perceptions of benefits for health and planning meals were stronger for women in later stages compared with earlier stages. The same relationship was observed for the use of processes of change related to becoming aware of health benefits and engaging in enabling behaviors, and variety of fruits and vegetables consumed. Self-efficacy based on eating fruits and vegetables for various eating occasions and in difficult situations was greater for women in later stages compared to earlier stages. CONCLUSIONS: Interventions for women in earlier stages should include making women aware of health benefits, increasing self-efficacy, and improving ability to make plans and engage in behaviors to increase intake.

Adolescent↗

Low prolactin response to fenfluramine in impulsive aggression.

To examine the prolactin (prl) response to d,l-fenfluramine in a large sample of personality disorder patients with impulsive aggression. Patients were screened from clinics at the Bronx VAMC and the Mount Sinai Medical Center and from press releases. One hundred and forty-six personality disorder patients (90M;56F) and 23 normal controls (15M;8F) underwent oral d,l-fenfluramine challenge. The peak change in prolactin(deltapkprl) was calculated by subtracting baseline prolactin from peak response following fenfluramine administration (3 h). Analysis of variance and regression analysis were used to detect group differences in deltapkprl. Deltapkprl in impulsive aggressive men, but not women, with personality disorders was blunted compared with controls. Men with suicide histories also had a blunted deltapkprl compared with those without, which was not accounted for by depression. This study represents a replication of previous studies, in a much larger sample, showing a blunted PRL response to fenfluramine of male patients with personality disorder in relation to impulsive aggression and to suicide attempts.

Adult↗