bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydrocortisone Preserves the Vascular Barrier by Protecting the Endothelial Glycocalyx
Authors: Chappell Daniel , Jacob Matthias , Hofmann-Kiefer Klaus , Bruegger Dirk , Rehm Markus , Conzen Peter , Welsch Ulrich , Becker Bernhard F.
Published: March 2009

Background

Hydrocortisone protects against ischemia-reperfusion injury, reduces paracellular permeability for macromolecules, and is routinely applied in the prevention of interstitial edema. Healthy vascular endothelium is coated by the endothelial glycocalyx, diminution of which increases capillary permeability, suggesting that the glycocalyx is a target for hydrocortisone action.

Methods

Isolated guinea pig hearts were perfused with Krebs-Henseleit buffer. Hydrocortisone was applied in a stress dose (10 microg/ml) before inducing 20 min of ischemia (37 degrees C). Hearts were reperfused for 20 min at constant flow (baseline perfusion pressure, 70 cm H2O) with Krebs-Henseleit buffer or Krebs-Henseleit buffer plus 2 g% hydroxyethyl starch (130 kd). Coronary net fluid filtration was assessed directly by measuring transudate formation on the epicardial surface. Hearts were perfusion fixed to visualize the glycocalyx.

Results

Ischemia-induced degradation of the glycocalyx enhanced coronary perfusion pressure (118.8 +/- 17.3 cm H2O) and increased vascular permeability (8 +/- 0.2 microl x min(-1) x cm H2O(-1) at baseline vs. 34 +/- 3.3 microl x min(-1) x cm H2O(-1) after reperfusion). Enzymatic digestion of the glycocalyx (heparinase) elicited similar effects. Hydrocortisone reduced postischemic oxidative stress, perfusion pressure (86.3 +/- 6.4 cm H2O), and transudate formation (11 +/- 0.6 microl x min(-1) x cm H2O(-1)). Applying colloid augmented this (70.6 +/- 5.6 cm H2O and 9 +/- 0.5 microl x min(-1) x cm H2O(-1)). Postischemic shedding of syndecan-1, heparan sulfate, and hyaluronan was inhibited by hydrocortisone, as was release of histamine from resident mast cells. Electron microscopy revealed a mostly intact glycocalyx after hydrocortisone treatment, but not after heparinase treatment.

Conclusions

Hydrocortisone preserves the endothelial glycocalyx, sustaining the vascular barrier and reducing interstitial edema. The effect of colloids suggests that prevention of postischemic rise in coronary resistance by hydrocortisone could also be based on alleviation of endothelial swelling. Stabilization of myocardial mast cells by hydrocortisone may account for the mitigated inflammatory affect of ischemia-reperfusion.
Differential Presynaptic Effects of Opioid Agonists on Aδ- and C-afferent Glutamatergic Transmission to the Spinal Dorsal Horn
Authors: Ikoma Miho , Kohno Tatsuro , Baba Hiroshi
Published: March 2009

Background

Although intrathecal administration of opioids produces antinociceptive effects in the spinal cord, it has not been established whether intrathecal opioid application more effectively terminates C fiber-mediated pain than A fiber-mediated pain. Here, the authors focus on the differences in opioid actions on Adelta- and C-afferent responses.

Methods

Using the whole cell patch clamp technique, the authors investigated the presynaptic inhibitory actions of micro-, delta-, and kappa-opioid receptor agonists on primary afferent-evoked excitatory postsynaptic currents (EPSCs) in substantia gelatinosa neurons of adult rat spinal cord slices.

Results

The micro agonist DAMGO (0.1, 1 microM) reduced the amplitude of glutamatergic monosynaptic Adelta- or C fiber-evoked EPSCs. C fiber-evoked EPSCs were inhibited to a greater extent than Adelta fiber-evoked EPSCs. The delta agonist DPDPE (1, 10 microM) produced modest inhibition of Adelta- or C fiber-evoked EPSCs. In contrast, the kappa agonist U69593 (1 microM) did not affect the amplitude of either Adelta or C fiber-evoked EPSCs.

Conclusions

These results indicate that opioids suppress excitatory synaptic transmission mainly through activation of micro receptors on primary afferent C fibers. Given that the substantia gelatinosa is the main termination of Adelta and C fibers transmitting nociceptive information, the current findings may partially explain the different potency of opioid agonists.
Dose-dependent Effects of Smoked Cannabis on Capsaicin-induced Pain and Hyperalgesia in Healthy Volunteers
Authors: Wallace Mark , Schulteis Gery , Atkinson J Hampton , Wolfson Tanya , Lazzaretto Deborah , Bentley Heather , Gouaux Ben , Abramson Ian
Published: March 2009

Background

Although the preclinical literature suggests that cannabinoids produce antinociception and antihyperalgesic effects, efficacy in the human pain state remains unclear. Using a human experimental pain model, the authors hypothesized that inhaled cannabis would reduce the pain and hyperalgesia induced by intradermal capsaicin.

Methods

In a randomized, double-blinded, placebo-controlled, crossover trial in 15 healthy volunteers, the authors evaluated concentration-response effects of low-, medium-, and high-dose smoked cannabis (respectively 2%, 4%, and 8% 9-delta-tetrahydrocannabinol by weight) on pain and cutaneous hyperalgesia induced by intradermal capsaicin. Capsaicin was injected into opposite forearms 5 and 45 min after drug exposure, and pain, hyperalgesia, tetrahydrocannabinol plasma levels, and side effects were assessed.

Results

Five minutes after cannabis exposure, there was no effect on capsaicin-induced pain at any dose. By 45 min after cannabis exposure, however, there was a significant decrease in capsaicin-induced pain with the medium dose and a significant increase in capsaicin-induced pain with the high dose. There was no effect seen with the low dose, nor was there an effect on the area of hyperalgesia at any dose. Significant negative correlations between pain perception and plasma delta-9-tetrahydrocannabinol levels were found after adjusting for the overall dose effects. There was no significant difference in performance on the neuropsychological tests.

Conclusions

This study suggests that there is a window of modest analgesia for smoked cannabis, with lower doses decreasing pain and higher doses increasing pain.
Cerebral Air Emboli Differentially Alter Outcome after Cardiopulmonary Bypass in Rats Compared with Normal Circulation
Authors: Jungwirth Bettina , Kellermann Kristine , Blobner Manfred , Schmehl Wolfgang , Kochs Eberhard F. , Mackensen G Burkhard
Published: March 2009

Background

Cerebral air emboli (CAE) are thought to contribute to adverse cerebral outcomes following cardiac surgery with cardiopulmonary bypass (CPB). This study was designed to investigate the effect of escalating volumes of CAE on survival and neurologic and histologic outcomes. In addition, the effect of xenon administration during CAE on these outcomes was determined.

Methods

With institutional review board approval, four groups were studied (n = 15). In two CPB-CAE groups, rats were subjected to 90 min CPB with 10 repetitively administered CAE. Rats in two sham-CAE groups were also exposed to CAE but not to CPB. Rats were randomly assigned to sequential dose cohorts receiving CAE ranging from 0.2 to 10 microl in a dose-escalating fashion. Groups were further subdivided into xenon (56%) and nitrogen groups. Rats with severe neurologic damage were killed; others were neurologically tested until postoperative day 7, when infarct volumes were determined. Survival and neurologic and histologic outcomes were tested with logistic regression analyses (P < 0.05).

Results

This study demonstrates a dose-dependent relation between CAE volumes and survival, neurologic outcome, and histologic outcome. For all outcomes, CPB adversely affected the dose-effect curves compared with sham-CAE groups (P < 0.05). Xenon demonstrated no impact on either outcome.

Conclusions

This study describes the successful incorporation of CAE in a rodent CPB model and allows identifying suitable CAE volumes for subsequent studies. CAE exhibit a differential effect on outcome in rats undergoing CPB versus those not exposed to CPB. Perioperative administration of xenon remained without any effect on outcome.
Cerebral Cortex Activation during Experimentally Induced Ventilator Fighting in Normal Humans Receiving Noninvasive Mechanical Ventilation
Authors: Raux Mathieu , Ray Patrick , Prella Maura , Duguet Alexandre , Demoule Alexandre , Similowski Thomas
Published: March 2009

Background

Mechanical ventilation is delivered to sedated patients during anesthesia, but also to nonsedated patients (ventilator weaning, noninvasive ventilation). In these circumstances, patient-ventilator asynchrony may occur, provoking discomfort and unduly increasing work of breathing. In certain cases, it is associated with an increased inspiratory load. Inspiratory loading in awake humans activates the premotor cortical regions, as illustrated by the occurrence of electroencephalographic premotor potentials. In normal humans during noninvasive ventilation, the authors used an experimental model of patient-ventilator asynchrony to determine whether premotor cortical activation occurs in this setting.

Methods

Noninvasive pressure support ventilation was administered to seven healthy volunteers aged 22-27 yr with continuous electroencephalographic recordings in Cz. The ventilator settings were first adjusted to make the subjects feel comfortable ("comfort"), and then modified to induce respiratory "discomfort" (evaluated on a 10-cm visual analog scale). This was achieved by setting the ventilator to a higher trigger level, reducing the slope of the pressure support rise, and reducing the level of pressure support. The settings were finally brought back to their initial values. To identify a respiratory-related premotor activity, a minimum of 80 preinspiratory electroencephalographic epochs were averaged.

Results

Altering ventilator settings induced respiratory discomfort (average visual scale 4 [1.5-6.0] vs. 0 [0-1.0] cm during "comfort"; P < 0.0001). This was associated with premotor potentials in all cases, which disappeared upon return to "comfort."

Conclusions

This study indicates that "ventilator fighting" in healthy humans is associated with an activation of higher cerebral areas. Premotor potentials could thus be markers of patient-ventilator asynchrony at the brain level. Both corroboration in patients and the elucidation of the causative or reactive nature of the association are needed before determining clinical implications.
A Single Dose of Propofol at the End of Surgery for the Prevention of Emergence Agitation in Children Undergoing Strabismus Surgery during Sevoflurane Anesthesia
Authors: Aouad Marie T. , Yazbeck-Karam Vanda G. , Nasr Viviane G. , El-Khatib Mohamad F. , Kanazi Ghassan E. , Bleik Jamal H.
Published: March 2009

Background

Emergence agitation in children after sevoflurane is common. Different drugs have been used to decrease its occurrence with variable efficacy. The authors compared the incidence and severity of emergence agitation in children who received a single dose of propofol at the end of strabismus surgery versus children who received saline.

Methods

In this prospective, randomized, double-blind study, the authors enrolled 80 healthy children aged 2-6 yr. The children were randomly allocated to the propofol group (n = 41), which received 1 mg/kg propofol at the end of surgery, or to the saline group (n = 39), which received saline.

Results

The mean scores on the Pediatric Anesthesia Emergence Delirium scale were significantly lower in the propofol group compared with the saline group (8.6 +/- 3.9 vs. 11.5 +/- 4.5; P = 0.004). Also, the incidence of agitation was significantly lower in the propofol group compared with the saline group (19.5% vs. 47.2%; P = 0.01). A threshold score greater than 10 on the Pediatric Anesthesia Emergence Delirium scale was the best discriminator between presence and absence of emergence agitation. Times to removal of the laryngeal mask airway (10.6 +/- 1.5 vs. 9.4 +/- 1.9 min; P = 0.004) and emergence times (23.4 +/- 5.7 vs. 19.7 +/- 5 min; P = 0.004) were significantly longer in the propofol group. However, discharge times were similar between the two groups (propofol: 34.1 +/- 8.4 min; saline: 34.9 +/- 8.6 min). More parents in the propofol group were satisfied.

Conclusions

In children undergoing strabismus surgery, 1 mg/kg propofol at the end of surgery after discontinuation of sevoflurane decreases the incidence of agitation and improves parents' satisfaction without delaying discharge from the postanesthesia care unit.
Nitric Oxide
Authors: Toda Noboru , Toda Hiroshi , Hatano Yoshio , Warltier David C.
Published: March 2009

There has been an explosive increase in the amount of interesting information about the physiologic and pathophysiologic roles of nitric oxide in cardiovascular, nervous, and immune systems. The possible involvement of the nitric oxide-cyclic guanosine monophosphate pathway in the effects of anesthetic agents has been the focus of many investigators. Relaxations of cerebral and peripheral arterial smooth muscle as well as increases in cerebral and other regional blood flows induced by anesthetic agents are mediated mainly via nitric oxide released from the endothelium and/or the nitrergic nerve and also via prostaglandin I2 or endothelium-derived hyperpolarizing factor. Preconditioning with volatile anesthetics protects against ischemia-reperfusion-induced myocardial dysfunction and cell death or neurotoxicity, possibly through nitric oxide release. Inhibition of nitric oxide synthase decreases the anesthetic requirement. Involvement of nitric oxide in the effects of volatile, intravenous, and local anesthetics differs. This review article includes a summary of information about the sites and mechanisms by which various anesthetic agents interact with the nitric oxide-cyclic guanosine monophosphate system.
Endovascular Treatment of a Blunt Thoracic Aortic Laceration Due to Thoracolumbar Spine Fracture
Authors: Dagenais François , Nadeau Geneviève , Normand Jean-Pierre , Turcotte Roc , Mathieu Patrick , Voisine Pierre
Published: March 2009

A 36-year-old woman sustained an aortic laceration at the level of the diaphragmatic hiatus owing to a displaced thoracolumbar spine fracture (TLS). We herein report the first case of aortic trauma secondary to a TLS fracture treated with a thoracic stent-graft.
Comparison of Bispectral Index and Composite Auditory Evoked Potential Index for Monitoring Depth of Hypnosis in Children
Authors: van Oud-Alblas Heleen J. Blussé , Peters Jeroen W. B. , de Leeuw Tom G. , Tibboel Dick , Klein Jan , Weber Frank
Published: March 2009

Background

In pediatric patients, the Bispectral Index (BIS), derived from the electroencephalogram, and the composite A-Line autoregressive index (cAAI), derived from auditory evoked potentials and the electroencephalogram, have been used as measurements of depth of hypnosis during anesthesia. The performance and reliability of BIS and cAAI in distinguishing different hypnotic states in children, as evaluated with the University of Michigan Sedation Scale, were compared.

Methods

Thirty-nine children (aged 2-16 yr) scheduled to undergo elective inguinal hernia surgery were studied. For all patients, standardized anesthesia was used. Prediction probabilities of BIS and cAAI versus the University of Michigan Sedation Scale and sensitivity/specificity were calculated.

Results

Prediction probabilities for BIS and cAAI during induction were 0.84 for both and during emergence were 0.75 and 0.74, respectively. At loss of consciousness, the median BIS remained unaltered (94 to 90; not significant), whereas cAAI values decreased (60 to 43; P < 0.001). During emergence, median BIS and cAAI increased from 51 to 74 (P < 0.003) and from 46 to 58 (P < 0.001), respectively. With respect to indicate consciousness or unconsciousness, 100% sensitivity was reached at cutoff values of 17 for BIS and 12 for cAAI. One hundred percent specificity was associated with a BIS of 71 and a cAAI of 60. To ascertain consciousness, BIS values greater than 78 and cAAI values above 52 were required.

Conclusions

BIS and cAAI were comparable indicators of depth of hypnosis in children. Both indices, however, showed considerable overlap for different clinical conditions.
Willingness of Health Care Personnel to Work in a Disaster: An Integrative Review of the Literature
Authors: Chaffee Mary
Published: March 2009

Effective hospital surge response in disaster depends largely on an adequate number of personnel to provide care. Studies appearing since 1991 indicate health care personnel may not be willing to work in all disaster situations—and if so, this could degrade surge response. A systematic review of the literature was conducted to determine the state of the evidence concerning the willingness of health care personnel to work in disaster. The aims of this review are to collate and assess the literature concerning willingness of health care personnel to work during a disaster, to identify gaps in the literature as areas for future investigation, and to facilitate evidence-based disaster planning. Twenty-seven studies met inclusion criteria (25 quantitative and 2 qualitative studies). The current evidence indicates there may be certain factors related to willingness to work (or lack of willingness) in disaster including the type of disaster, concern for family, and concerns about personal safety. Barriers to willingness to work have been identified including pet care needs and the lack of personal protective equipment. This review describes the state of an emerging area of science. These findings have significant implications for community and organizational emergency planning and policymaking in an environment defined by limited resources. (Disaster Med Public Health Preparedness. 2009;3:42–56)
Increased Gender-based Violence Among Women Internally Displaced in Mississippi 2 Years Post–Hurricane Katrina
Authors: Anastario Michael , Shehab Nadine , Lawry Lynn
Published: March 2009

Objectives:Although different types of gender-based violence (GBV) have been documented in disaster-affected populations, no studies have documented a quantitative increase in rates of GBV among populations living in protracted displacement after a disaster. We aimed to assess the change in rates of GBV after Hurricane Katrina among internally displaced people (IDPs) living in travel trailer parks in Mississippi.

Methods:The study design included successive cross-sectional randomized surveys, conducted in 2006 and 2007, among IDPs in Mississippi using a structured questionnaire. We sampled 50 travel trailer parks in 9 counties in Mississippi in 2006, and 69 parks in 20 counties in 2007. A total of 420 female respondents comprised the final sample. We measured respondent demographics, forms of GBV including sexual and physical violence further subtyped by perpetrator, suicidal ideation, suicide attempt, and Patient Health Questionnaire-9–assessed depression.

Results:Respondents had a mean age of 42.7 years. The crude rate of new cases of GBV among women increased from 4.6/100,000 per day to 16.3/100,000 per day in 2006, and remained elevated at 10.1/100,000 per day in 2007. The increase was primarily driven by the increase in intimate partner violence. GBV experience was significantly associated with increased risk for poor mental health outcomes.

Conclusions:Overall, the rate of GBV, particularly intimate partner violence, increased within the year following Hurricane Katrina and did not return to baseline during the protracted phase of displacement. Disaster planning efforts should incorporate plans to decrease the incidence of GBV following a disaster, and to ensure adequate services to people with postdisaster GBV experience. (Disaster Med Public Health Preparedness. 2009;3:18–26)
The association of opium with coronary artery disease
Authors: Sadeghian Saeed , Darvish Soodabeh , Davoodi Gholamreza , Salarifar Mojtaba , Mahmoodian Mehran , Fallah Nader , Karimi Abbas Ali
Published: March 2009

Background

The effects of opium consumption on coronary artery disease are still unknown.

Methods

A cross-sectional study was conducted on 2405 patients admitted to the Angiographic Ward at Tehran Heart Center from 7 May 2005 to 13 August 2005.

Results

After adjusting for conventional cardiovascular risk factors, opium consumption was a significant risk factor for coronary artery disease ( P=0.01 and odds ratio = 1.8). Moreover, the amount of opium consumption was associated significantly with the severity of coronary atherosclerosis, as measured by clinical vessel score ( r=0.2, P=0.002).

Conclusions

To our knowledge, this is the first time that the adverse effects of opium consumption on coronary arteries was defined. Eur J Cardiovasc Prev Rehabil14:715-717 © 2007 The European Society of Cardiology
Associations of von Willebrand factor, fibrin D-dimer and tissue plasminogen activator with incident coronary heart disease: British Women's Heart and Health cohort study
Authors: May Margaret , Lawlor Debbie A. , Patel Rita , Rumley Ann , Lowe Gordon , Ebrahim Shah
Published: March 2009

Background

Associations of three markers of thrombotic tendency, von Willebrand factor, tissue plasminogen activator antigen and fibrin D-dimer, with coronary heart disease have been reported in meta-analyses. It is not known, however, whether findings are generalizable to older women.

Design

Prospective cohort of 3582 women aged 60-79 years randomly selected from 23 towns without evidence of cardiovascular disease at entry into the British Women's Heart and Health Study.

Methods

Women were followed for 4.7 years for incident coronary heart disease. Cox proportional hazard models were used to compare the hazard ratio of coronary heart disease per doubling for each thrombotic factor.

Results

In models adjusting for age and town only there was no association between von Willebrand factor or D-dimer and incidence of coronary heart disease, but there was a positive association of tissue plasminogen activator: coronary heart disease hazard ratio per doubling was 1.37 (95% confidence interval: 1.08-1.75). Adjustment for potential confounders (socio-economic position, smoking, lung function, physical activity, alcohol consumption, body mass index, waist-to-hip ratio) attenuated association to 1.20 (0.92-1.58). Further adjustment for risk factors that may be part of the same pathophysiological process linking tissue plasminogen activator to coronary heart disease (high density lipoprotein cholesterol, triglycerides, blood pressure, fasting glucose, insulin, C-reactive protein, fibrinogen) attenuated the hazard ratio to 1.05 (0.79-1.40).

Conclusion

In older women, tissue plasminogen activator was associated with incident coronary heart disease, but does not appear to be an independent risk factor for coronary heart disease as the association was attenuated by adjustment for confounding and other metabolic and vascular risk factors. Eur J Cardiovasc Prev Rehabil 14:638-645 © 2007 The European Society of Cardiology
Development and validation of a very brief questionnaire measure of physical activity in adults with coronary heart disease
Authors: Orrell Alison , Doherty Patrick , Miles Jeremy , Lewin Robert
Published: March 2009

Background

The aim of this study was to validate the Total Activity Measure, a brief questionnaire, to measure physical activity in an older adult population with heart disease.

Methods

Two versions of the Total Activity Measure were administered twice, 7 days apart. The Total Activity Measure 1 asked respondents for the frequency and average duration of bouts of physical activity at three different intensity levels per week, whereas the Total Activity Measure 2 asked respondents for the total time spent in activity at each activity level per week. Questionnaire accuracy was studied in 62 men and 15 women aged 47-84 years, by repeatability and comparison of both administrations of the Total Activity Measure 1 and Total Activity Measure 2 with 7-day RT3 accelerometer data.

Results

Seventy-three adults (58 men, 15 women) were used for all statistical analyses. Intraclass correlation coefficients for the Total Activity Measure 1 and Total Activity Measure 2 total activity scores (metabolic equivalent per minute) were r = 0.73 (95% confidence intervals, 0.56-0.83) and r = 0.82 (95% confidence intervals, 0.71-0.88), respectively. Correlations between the Total Activity Measure 1 and RT3 accelerometer for total activity score (metabolic equivalent per minute) were significant, r = 0.26 at time 1 and r = 0.27 at time 2 for moderate intensity activities. Correlations between the Total Activity Measure 2 and RT3 accelerometer for total activity score (metabolic equivalent per minute) were also significant, r = 0.38 at time 1 and r = 0.36 at time 2, r = 0.31 at time 2 for strenuous intensity activities and r = 0.29 at time 1 and r = 0.25 at time 2 for moderate intensity activities. Participants overestimated the amount of physical activity on both questionnaires as compared with the RT3 accelerometer.

Conclusions

The Total Activity Measure 2 was reasonably accurate in assessing total and moderate intensity activity over a 7-day period and demonstrated good test-retest reliability. The Total Activity Measure 1 was less accurate. The Total Activity Measure 2 is a suitable measure of total or moderate intensity physical activity for surveys and audits in an adult cardiac population. Eur J Cardiovasc Prev Rehabil 14:615-623 © 2007 The European Society of Cardiology
Immune response to inspiratory muscle training in patients with chronic heart failure
Authors: Laoutaris Ioannis D. , Dritsas Athanasios , Brown Margaret D. , Manginas Athanassios , Kallistratos Manolis S. , Degiannis Dimitrios , Chaidaroglou Antigoni , Panagiotakos Demosthenes B. , Alivizatos Peter A. , Cokkinos Dennis V.
Published: March 2009

Background

The effects of inspiratory muscle training on plasma cytokines, C-reactive protein and the soluble apoptosis mediators Fas and Fas ligand in chronic heart failure are unknown.

Design and methods

Thirty-eight patients with chronic heart failure, age 57 ± 2 years, New York Heart Association classification II-III, were assigned to either a high intensity training group ( n = 15, age 53±2 years) exercised at 60% of sustained maximal inspiratory pressure, or a low intensity training group ( n = 23, age 59 ± 2 years), exercised at 15% of sustained maximal inspiratory pressure, three times per week for 10 weeks. Patients in the high intensity training group and low intensity training group were matched for age, sex and New York Heart Association functional class. Plasma levels of tumor necrosis factor (TNF)-α, soluble TNF receptor I, interleukin-6, C-reactive protein, soluble apoptosis mediators Fas and Fas ligand were measured at baseline and at post-inspiratory muscle training. Pulmonary function was assessed by spirometry, exercise capacity by a cardiopulmonary exercise test and the 6 min walk test, whereas dyspnea by the Borg scale after the 6 min walk test.

Results

High intensity training group improved inspiratory muscle strength (105.1 ± 4.9 vs. 79.8 ± 4.7 cmH2O, P < 0.001), sustained maximal inspiratory pressure (504.5 ± 39.7 vs. 312.5 ± 26.5cmH2O/s/103, P<0.001), forced vital capacity (98.9 ± 3.9 vs. 96 ± 3.3%, P<0.05), peak Vo2 (19.4 ± 1.2 vs. 17.3 ± 0.9 ml/kg per min, P<0.01), 6 min walk test distance (404.3 ± 11.9 vs. 378.2 ± 10.4 m, P<0.01) and dyspnea (8.0 ± 0.4 vs. 9.2 ± 0.4, P<0.01). Circulating TNF-α, soluble TNF receptor I, interleukin-6, C-reactive protein, soluble apoptosis mediators Fas and Fas ligand were not significantly altered. Low intensity training group increased only the inspiratory muscle strength (90.3 ± 5.9 vs. 80.2 ± 5cmH2O, P<0.01). Comparison between groups was significant for soluble TNF receptor I change (high intensity training group, 5.8 ± 0.49 vs. 6.1 ± 0.42; low intensity training group, 8.4 ± 0.6 vs. 7.8 ± 0.6, P<0.01).

Conclusion

A high intensity inspiratory muscle training program resulted in improvement in functional status of chronic heart failure patients compared with low intensity inspiratory muscle training. Improvement in exercise capacity was not associated with an anti-inflammatory effect, although a beneficial influence on soluble TNF receptor I was recorded. Possible reasons include inadequate level of muscle mass exercise and the low pretraining New York Heart Association class. Eur J Cardiovasc Prev Rehabil14:679-685 © 2007 The European Society of Cardiology
Towards risk factor assessment in inflammatory dilated cardiomyopathy: the SFB/TR 19 study
Authors: Angelow Aniela , Schmidt Matthias , Hoffmann Wolfgang
Published: March 2009

Background

Patients with idiopathic dilated cardiomyopathy (DCMid) account for about one-third of patients with heart failure. Recent studies found a myocardial viral genomic persistence in up to 67% of DCMid patients, indicating a possible inflammatory etiology (DCMi). Considering the importance of DCMi, we aimed to study the present knowledge on risk factors in DCMi.

Methods

Review of published literature on risk factors for DCMi/DCMid from 1989 through 2005 in Medline database and the Cochrane library (search terms ‘epidemiology’, ‘risk factors’, ‘inflammatory dilated cardiomyopathy’ and ‘idiopathic dilated cardiomyopathy’).

Results

An extended array of risk factors in DCMid has been investigated in 11 studies. No studies addressing specifically DCMi, however, were found. Consistent associations with DCMid were reported only for diabetes mellitus, black race, male sex and estimated low income. Inconsistent results were observed for the presence of asthma, hypertension and smoking. Few studies addressed potential risk factors such as low education level, infectious diseases and environmental factors.

Conclusions

Considering the high number of potential DCMi patients among patients with DCMid, results on risk factors for DCMid are likely relevant to at least a number of patients with DCMi. Future studies of risk factors in DCMi should include specific case classification and the application of standardized instruments for risk-factor assessment. The four-center SFB/TR 19 study aims to establish a prospective cohort of DCMi patients validated by endomyocardial biopsy. Eur J Cardiovasc Prev Rehabil14:686-693 © 2007 The European Society of Cardiology
The effects of cigarette smoking on C-reactive protein concentrations in men and women and its modification by exogenous oral hormones in women
Authors: Dietrich Thomas , Garcia Raul I. , Pablo Paola de , Schulze Paul Christian , Hoffmann Kurt
Published: March 2009

Background

Previous studies have shown dose-dependent and time-dependent effects of cigarette smoking and smoking cessation on C-reactive protein (CRP) concentrations in men, but results were inconsistent for women. The aim of this study was to evaluate the dose-dependent and time-dependent association of smoking and smoking cessation with CRP concentrations in men and women using a novel comprehensive smoking index (CSI).

Design

Cross-sectional study of representative US survey data (National Health and Nutrition Examination Survey 1999-2002).

Methods

The CSI simultaneously accounts for intensity, duration and time since cessation of smoking. We analyzed data of 3505 men and 3896 women using sex-specific multiple linear regression models adjusting for other determinants of CRP concentrations, including age, race/ethnicity, body mass index, alcohol intake, diabetes, physical activity, oral hormone use among women, and history of coronary heart disease, stroke, chronic obstructive pulmonary disease and arthritis.

Results

A positive association of similar strength was found between smoking and CRP concentrations in both men and women who did not use exogenous oral hormones. Among women who used exogenous oral hormones, no association with smoking was found. In older men and women it took several years after smoking cessation for CRP concentrations to return to that of individuals who never smoked.

Conclusion

Smoking is associated with dose-dependent and time-dependent increases in CRP concentrations in both men and women. Furthermore, the effect of exogenous oral hormones on CRP concentrations in women is affected by smoking in a dose-dependent fashion. Eur J Cardiovasc Prev Rehabil14:694-700 © 2007 The European Society of Cardiology
Estimating the incidence of the acute coronary syndrome: data from a Danish cohort of 138290 persons
Authors: Nielsen Kirsten M. , Foldspang Anders , Larsen Mogens L. , Gerdes Lars U. , Rasmussen Soeren , Faergeman Ole
Published: March 2009

Background

Estimates of incidence are crucial to the planning of public health measures, but most studies of incidence of, for example, acute myocardial infarction (MI) are troubled by methodological problems such as; (i) selection biases of the patients being included for study, (ii) lack of identification and control of the cohort under observation, (iii) inconsistencies in the use of diagnostic criteria, and (iv) missing data. We aimed to measure directly the incidence of the entire spectrum of the acute coronary syndrome (ACS), consisting of unstable angina pectoris, MI and sudden cardiac death (SCD), by use of the new criteria for MI as proposed in 2000. Design Cohort study.

Methods

From a cohort of 138 290 residents of the municipality of Aarhus, Denmark, aged 30-69 years, with a demographic structure known at the individual population member level, we prospectively identified all consecutive ACS patients from 1 April 2000 to 31 March 2002. The population was identified from Danish Population Registers.

Results

A total of 189 victims of SCD and 457 ACS patients who survived until admission to hospital were present. Consequently, crude incidence rate of ACS was 234 per 100000 person-years. Unstable angina pectoris constituted for 16.9%, MI for 53.8% and SCD for 29.3% of ACS patients.

Conclusions

Crude incidence rates of ACS were 137 and 331 per 100 000 person years for women and men, respectively. The incidence rate of ACS, as measured directly, was insignificantly 6% higher than expected from Danish administrative databases. Eur J Cardiovasc Prev Rehabil 14:608-614 © 2007 The European Society of Cardiology
Nasal Mucosa Expression of Lactoferrin in Patients With Chronic Rhinosinusitis
Authors: Psaltis Alkis J. , Bruhn Maressa A. , Ooi Eng Hooi , Tan Lor Wai , Wormald Peter‐John
Published: March 2009

Objective/Hypothesis: Antimicrobial peptides, such as lactoferrin, are an important component of the innate immune system. They offer the body a first line defense against a wide range of invading pathogens. The diverse antipathogenic action of lactoferrin has been well characterized; however, the role that this peptide plays in chronic conditions such as rhinosinusitis remains largely unknown. This study aims to examine the level of lactoferrin expression in the nasal mucosa of patients with chronic rhinosinusitis (CRS).

Study Design/Methods: Nasal biopsies of 85 chronic rhinosinusitis patients, subclassified into allergic fungal sinusitis (AFS), nonallergic fungal eosinophilic sinusitis (NAFES), nonallergic, nonfungal eosinophilic sinusitis (NANFES), and CRS were studied by quantitative real‐time reverse‐transcriptase polymerase chain reaction and enzyme‐linked immunosorbent assay for their expression of lactoferrin at an mRNA and protein level, respectively.

Results: All groups of patients with CRS showed a decrease in lactoferrin mRNA expression relative to controls (median fold‐change of CRS relative to controls, 0.1550; AFS, 0.1800; NANFES, 0.1900; and NAFES, 0.2100). All groups also showed a decreased expression of lactoferrin protein (controls, 163.3 ng/mL; CRS, 82.19 ng/mL; AFS, 104.1 ng/mL; NANFES, 118.9 ng/mL; and NAFES, 74.33 ng/mL). The most significant reduction was evident in the CRS subgroup as well as in patients with nasal polyposis at the time of surgery.

Conclusions: This is the first study of its kind to objectively examine lactoferrin expression in the nasal mucosa of CRS patients. We report a reduction in the expression of this important antimicrobial peptide at both the mRNA and protein level. Such a defect in the innate immune system may explain the predisposition of certain individuals to develop CRS and nasal polyposis, providing further insight into the pathogenesis of such conditions.
Diagnosis of Food Allergy in Children: Toward a Standardization of Food Challenge
Authors: Niggemann Bodo , Beyer Kirsten
Published: March 2009

Adverse reactions to food represent a common complaint in childhood; however, only a small proportion of children have proven clinically relevant food allergy. The foods most commonly involved in food allergy are cow's milk, hen's eggs, peanuts, tree nuts, seeds, soy, wheat, fish, and crustaceans. The diagnostic workup of suspected food allergy includes the patient's history, skin prick testing, the measurement of food‐specific immunoglobulin E antibodies, and, more recently, the atopy patch test. Because none of these parameters can accurately predict tolerance, the gold standard for diagnosing food allergy is still the double‐blind, placebo‐controlled food challenge. Although numerous efforts have been made to standardize the procedure, there is a need for improvement. This review presents the current status of the indication and performance of controlled oral food challenges in children with suspected food‐related symptoms. It covers aspects of indications and contraindications, blinding, diet before the challenge, the practical performance, the handling of medication, the interpretation of test results, suitable locations for testing, safety considerations, and the procedure after a period of avoidance. Efforts to standardize oral food challenges to achieve the best possible decision on a diet are important to avoid an unnecessary diet that may be harmful to the child.
Decline of Lactase Activity and C/T‐13910 Variant in Sardinian Childhood
Authors: Schirru Enrico , Corona Valeria , Usai‐Satta Paolo , Scarpa Maria , Cucca Francesco , De Virgiliis Stefano , Rossino Rossano , Frau Fulvia , Macis Maria Doloretta , Jores Rita‐Désirée , Congia Mauro
Published: March 2009

Objectives:

Our study aims to determine the age of onset of adult‐type hypolactasia in Sardinians, and to establish the age at which genotyping of the C/T‐13910 variant can be used reliably in the diagnosis of lactose malabsorption.

Patients and Methods:

A lactose breath hydrogen test was given to 383 randomly selected patients, from 3 to 19 years old.

Results:

The C/C‐13910 genotype was found in 90% of patients; the frequency of the positive lactose breath hydrogen test increased with age and reached a prevalence of 85% at 9 years.

Conclusions:

In Sardinians, adult‐type hypolactasia becomes phenotypically evident in all individuals older than 9 years, suggesting that this should be considered the minimum age at which the genetic test for lactase nonpersistence should be applied.
Dramatic Changes in the Prevalence of Helicobacter pylori Infection During Childhood: A 10‐year Follow‐up Study in Russia
Authors: Tkachenko Mikhail A , Zhannat Nurgalieva Z , Erman Lev V , Blashenkova Elena L , Isachenko Sergey V , Isachenko Olga B , Graham David Y , Malaty Hoda M
Published: March 2009

Background:

The prevalence and rate of acquisition of Helicobacter pylori infection in children from developing countries is higher than in developed countries. This phenomenon has been related to differences in socioeconomic status, sanitation, and household hygiene. Russia is in the process of transforming from an underdeveloped to a developed country.

Aim:

To examine the effect of recent improvements in standards of living on the prevalence of H pylori in Russian children.

Patients and Methods:

We conducted 2 cross‐sectional studies among children in St Petersburg, Russia. The first study was conducted in 1995 and the second was conducted a decade later. H pylori status was evaluated by the same enzyme‐linked immunoassay method for anti‐H pylori immunoglobulin G. Demographic data were obtained from each individual, and socioeconomic class was assessed by the education level of the mother and family income.

Results:

In 1995 the overall prevalence of H pylori infection was 44%; 10 years later it had decreased to 13%. In both studies, the prevalence increased with age. In 1995 the prevalence was 30% among children younger than 5 years. A decade later the prevalence in the same age group was 2% (P = 0.001). The age‐specific prevalence of H pylori infection increased significantly with age in both study periods. During 1995 the prevalence of the infection increased from 30% at age <5 years to 48% in the age group 15 to 19 years (P = 0.001). In the 2005 study the prevalence of the infection increased from 2% at age <5 years to 25% in the age group 15 to 19 years (P = 0.001). The crude and the age‐adjusted odds ratio risk of infection in children showed an inverse correlation between the mothers' and fathers' educational levels and H pylori seropositivity (OR 1.8, 95% CI 1–3.2; P = 0.06). No associations were found between the prevalence of H pylori and any factor tested, including sex, type of dwelling, income, or the number of people living in the home.

Conclusions:

Improvements in standards of living in Russia have resulted in a marked reduction in H pylori transmission. Different rates of acquisition of H pylori form the basis for the differences in prevalence of infection between and among populations. The change in the prevalence of H pylori within 10 years among the Russian population is an example of how sensitive H pylori acquisition is to improvement in standards of living. Increased use of anti‐H pylori eradication therapy played an important role in the reduction of the prevalence of H pylori infection.
Immunogenicity of Helicobacter pylori Urease B Protein and DNA Vaccines in a Mouse Model
Authors: Bégué Rodolfo E , Cruz Alma R , Ramgoolam Andres , Breslin Mary B
Published: March 2009

A vaccine could alleviate major morbidity and mortality associated with Helicobacter pylori infection. We immunized BALB/c mice with 3 doses of a protein or DNA vaccine based on H pylori urease B. Protein alone was immunogenic even after the first dose, whereas DNA did not elicit antibodies after 3 doses. DNA preceding protein (D‐P‐P) appeared to blunt the response to protein, whereas DNA following protein (P‐D‐D) shifted from a predominantly T helper 2 (Th2) profile to a balanced Th1:Th2 profile. These preliminary findings may have important implications for the development of an H pylori vaccine.
Accuracy and Tolerability of the Bravo Catheter‐free pH Capsule in Patients Between the Ages of 4 and 18 Years
Authors: Croffie Joseph M , Fitzgerald Joseph F , Molleston Jean P , Gupta Sandeep K , Corkins Mark R , Pfefferkorn Marian D , Lim Joel R , Steiner Steven J , Dadzie Steven K
Published: March 2009

Objective:

The aim of this study was to determine if the Bravo pH capsule is comparable to the nasally placed pH catheter in terms of pH‐metry, safety, and tolerability in children.

Methods:

Ten patients each in the age ranges of 4 to 6 years, 7 to 10 years, and >10 years were tested simultaneously with the catheter and the capsule. Six each were tested with the catheter alone or the capsule alone. Subjects recorded adverse events and graded tolerance (in terms of activity, appetite, and satisfaction) on a scale of 1 to 5, with a score of 5 indicating that the device was well tolerated. A 24‐hour reflux index and 24‐ and 48‐hour reflux indices were generated from the catheter and capsule, respectively. Student t test, Mann‐Whitney U test, and Fisher exact test were used to compare reflux index, tolerability, and adverse events between the catheter and capsule.

Results:

Sixty‐six patients 4 to 16 years of age (mean, 9.4 years) were enrolled. There was no statistically significant difference between the mean reflux indices (RIs) obtained simultaneously with the catheter and capsule in all patients combined on day 1 (P = 0.0665). There was a significant difference between day 2 and days 1 and 2 combined with the capsule versus the catheter (P = 0.007 and P = 0.0107); however, a discordant result of normal RI on day 1 and pathological RI on day 2 was seen in only 1 patient. The capsule was better tolerated than the catheter in terms of appetite (P = 0.029), activity (P = 0.001), and satisfaction (P = 0.003). There were no significant complications.

Conclusions:

The Bravo pH capsule was as accurate and safe and better tolerated than the conventional pH catheter in children 4 years of age and older.
Fecal Calprotectin: A Quantitative Marker of Colonic Inflammation in Children With Inflammatory Bowel Disease
Authors: Fagerberg Ulrika Lorentzon , Lööf Lars , Lindholm Johan , Hansson Lars‐Olof , Finkel Yigael
Published: March 2009

Objectives:

The protein calprotectin (S100 A8/A9) is present in neutrophils, monocytes, and macrophages. Colorectal inflammation can be detected by increased excretion of fecal calprotectin (FC). The aim of this study was to evaluate FC as a quantitative marker of inflammatory activity in children with inflammatory bowel disease (IBD).

Patients and Methods:

Thirty‐nine children with IBD delivered a fecal spot sample and underwent colonoscopy. The samples were examined with an enzyme‐linked immunosorbent assay for FC (Calprest, Eurospital, Trieste, Italy). The concentrations were correlated to macroscopic and microscopic assessments of extent and severity of inflammation in 8 colonic segments for each patient.

Results:

FC correlated significantly to the macroscopic extent (Spearman ρ = 0.61) and the severity (Spearman ρ = 0.52) of colonic inflammation and to a macroscopic, combined extent and severity score (Spearman ρ = 0.65). Significant correlations also were found to the microscopic extent (Spearman ρ = 0.71) and severity (Spearman ρ = 0.72) of colonic inflammation and to a microscopic, combined extent and severity score (Spearman ρ = 0.75). The median FC was 392 μg/g (95% confidence interval [CI], 278–440) in children with clinical IBD symptoms (n = 23) and 32.9 μg/g (95% CI, 9.4–237) in asymptomatic IBD patients (n = 16). Of the asymptomatic children, 56% had a complete microscopic mucosal healing, and their median FC was 9.9 μg/g (95% CI, 5.9–41.9).

Conclusions:

FC can be used as a surrogate marker for estimation of colonic inflammation in pediatric IBD. Normalized FC concentration seems to indicate complete mucosal healing. FC is simple to obtain and analyze; this should facilitate objective assessment and monitoring of IBD activity.
Iron Deficiency Among Children of Asylum Seekers in The Netherlands
Authors: Stellinga‐Boelen AAM , Storm H , Wiegersma PA , Bijleveld CMA , Verkade HJ
Published: March 2009

Objectives:

To investigate, in asylum seekers' children in the Netherlands, biochemical iron status and the prevalence of iron deficiency (ID) and anemia in relation to age, region of origin, length of stay in the Netherlands, body mass index (BMI), and dietary iron intake.

Patients and Methods:

Hemoglobin (Hb) and plasma ferritin concentrations were determined in 122 asylum seekers' children (median age, 7.1 years; range, 2–12 y). ID was defined by plasma ferritin levels <15 μg/L. Anemia was defined by Hb levels <6.8 mmol/L (11 g/dL) for children <6 years of age and Hb levels <7.1 mmol/L (11.5 g/dL) for children between 6 and 12 years of age. Nutritional status of the children was assessed by BMI and dietary intake of iron was estimated by 24‐hour recall.

Results:

Twenty percent of the children had compromised iron status (16% with ID, 4% with ID anemia [IDA]). Another 6% of the children had anemia caused by thalassemia. ID was significantly more prevalent in children <6 years of age and in children of African origin. The iron status was not significantly correlated with the length of stay in the Netherlands (r = 0.6; P = 0.48). Higher BMI z scores were positively correlated with iron status. Adequate or marginal dietary iron intake was not significantly related to the presence of ID (r = 0.02; P = 0.9) or anemia (IDA and thalassemia; r = 0.15; P = 0.9).

Conclusions:

Iron deficiency is highly prevalent among the children of asylum seekers in the Netherlands. Our data indicate that systematic biochemical screening for ID is warranted in asylum seekers' children.