White coat effect and reactivity to stress: cardiovascular and autonomic nervous system responses

The aim of this study was to elucidate further the precise nature of the so-called "white coat" (WC) effect. We enrolled 88 hypertensive (46 men, 42 women) and 18 normotensive (4 men, 14 women) subjects in whom beat-to-beat blood pressure (BP) and heart rate (HR) were measured with a Finapres device at rest (R period) and during conventional BP measurement (WC period). The WC effect was defined as WC period minus R period values of Finapres systolic BP. Using the same method, we also measured the BP and HR variations induced by mental stress (MS period) and by assuming the standing position (S period). Variability was estimated in the frequency domain for BP (BPV) and HR (HRV) and gave indices of the autonomic nervous system. Pulse wave velocity was taken as an index of arterial distensibility. In hypertensive subjects, the WC effect was significantly and positively correlated with the BP response to stress (0.51, P<.0001) and standing (0.63, P<.0001). An increased BPV was observed in the low-frequency band (0 to 0.150 Hz) during WC, MS, and S periods. In normotensive subjects, the WC effect was very slight and not correlated with the responses to stress and standing. In this group, the WC period was not accompanied with an increased BPV, unlike the stress and standing periods. HRV was similar in normotensives and in hypertensives: decreased, unchanged, and increased during MS, S, and WC periods, respectively. The PWV was significantly increased in the hypertensives relative to the normotensives, even in the quartile of those with the lowest BP (on average similar to that of the normotensives). This work shows that the WC effect is associated with an enhanced BP response to standing and mental stress; these three situations are characterized by an increased BPV in the low frequencies, suggesting a similar modification of the sympathovagal balance. The WC effect may entail an increased risk because it is associated with impaired arterial distensibility.     

Opioid requirements and responses in Asians

BACKGROUND: There is a relationship between stressful situations and the susceptibility towards certain diseases, probably mediated by immune system modifications. AIM: To study T lymphocyte proliferation in medical students during periods of differing academic stress. SUBJECTS AND METHODS: Blood samples were obtained from 42 medical students during a period of moderate academic stress, immediately before a final examination and after their summer vacations. T lymphocyte proliferation in response to 5, 10 and 20 mg/ml phytohemagglutinin was measured by the incorporation of 3H-thymidine, and plasma cortisol was measured by RIA. RESULTS: T lymphocyte stimulation index in response to all phytohemagglutinin concentrations was significatively lower in the period before examination than in the other two periods. There were no differences in the index between the period of moderate stress and after summer vacations. Plasma cortisol levels were 15.6 +/- 4.3, 18.6 +/- 5.8 and 16.7 +/- 5.1 mg/dl during the periods of moderate stress, before the examination and after vacations, respectively (p < 0.05 for the difference between examination and the other two periods). CONCLUSIONS: There is a decrease in lymphocyte proliferation and an increase in cortisol levels during a period of acute academic stress in medical students, suggesting that, the exposure of the healthy subjects to common stressful stimuli, may affect their immunocompetance.     

Morphologic and cytochemical characteristics of blood cells from Hawaiian green turtles

Previous studies have shown that hypoglycemia may reduce counterregulatory responses to subsequent hypoglycemia in healthy subjects and in patients with diabetes. The effect of hypoglycemia on the hormonal response to a nonhypoglycemic stimulus is uncertain. To test the hypothesis that the cortisol response to corticotropin (ACTH) infusion is independent of antecedent hypoglycemia, 10 healthy subjects received a standard ACTH infusion (0.25 mg Cosyntropin [Organon, West Orange, NJ] intravenously over 240 minutes) at 8:00 AM on day 1 and day 3 and a hypoglycemic insulin clamp study (1 mU/kg/min) at 8:00 AM on day 2. During the hypoglycemic clamp, plasma glucose decreased from 5.0 mmol/L to 2.8 mmol/L for two periods of 120 minutes (mean glucose, 2.9 +/- 0.03 and 2.8 +/- 0.02 mmol/L, respectively) separated by a 60-minute interval of euglycemia (mean glucose, 4.7 +/- 0.01 mmol/L). Seven subjects also had paired control studies in random order during which a 330-minute euglycemic clamp (mean glucose, 5.0 +/- 0.11 mmol/L) instead of a hypoglycemic clamp was performed on day 2. Basal ACTH (4.6 +/- 0.7 v 2.6 +/- 0.4 pmol/L, P < .02) and basal cortisol (435 +/- 46 v 317 +/- 40 nmol/L, P < .02) both decreased from day 1 to day 3 following intervening hypoglycemia. In contrast, with intervening euglycemia, neither basal ACTH (5.9 +/- 1.5 v 4.5 +/- 1.0 pmol/L) nor basal cortisol (340 +/- 38 v 318 +/- 60 nmol/L) were reduced significantly on day 3 compared with day 1. Following interval hypoglycemia, the area under the curve (AUC) for the cortisol response to successive ACTH infusions was increased (4,734 +/- 428 nmol/L over 240 minutes [day 3] v 3,526 +/- 434 nmol/L over 240 minutes [day 1], P < .01). The maximum incremental cortisol response was also significantly increased (805 +/- 63 nmol/L (day 3) v 583 +/- 58 nmol/L (day 1), P < .05). In contrast, the AUC for the cortisol response to successive ACTH infusions with interval euglycemia (3,402 +/- 345 nmol/L over 240 minutes [day 3] v 3,709 +/- 391 nmol/L over 240 minutes [day 1] and the incremental cortisol response (702 +/- 62 nmol/L [day 3] v 592 +/- 85 nmol/L [day 1] were unchanged. Following exposure to intermittent hypoglycemia in healthy humans, fasting morning ACTH and cortisol levels are reduced and the incremental cortisol response to an infusion of ACTH is enhanced. The enhanced cortisol response to exogenous ACTH infusion after intervening hypoglycemia (but not intervening euglycemia) may reflect priming of the adrenal gland by endogenous ACTH produced during the hypoglycemia. These data suggest that adrenal function testing by exogenous ACTH administration is not impaired by prior exposure to hypoglycemia. Moreover, the reduced cortisol response to recurrent hypoglycemia in patients with well-controlled diabetes is not likely the result of impaired adrenal responsiveness.     

Effects of intermittent reperfusion on brain pHi, rCBF, and NADH during rabbit focal cerebral ischemia

BACKGROUND AND PURPOSE: The use of intermittent reperfusion versus straight occlusion during neurovascular procedures is controversial. This experiment studied the effects of intermittent reperfusion and single occlusion on intracellular brain pH (pHi), regional cerebral or cortical blood flow, and nicotinamide adenine dinucleotide (NADH) fluorescence during temporary focal ischemia. METHODS: Twenty fasted rabbits under 1.0% halothane anesthesia were divided into four groups: (1) nonischemic controls, (2) 60 minutes of uninterrupted focal ischemia, (3) 2 x 30-minute periods of focal ischemia separated by a 5-minute reperfusion, and (4) 4 x 15-minute periods of focal ischemia separated by three 5-minute reperfusion periods. Focal ischemia was produced by occlusion of both the middle cerebral and ipsilateral anterior cerebral arteries. After the final occlusion, there was a 3-hour reperfusion period in all groups. Regional cerebral and cortical blood flow, brain pHi, and NADH fluorescence were measured with in vivo panoramic fluorescence imaging. RESULTS: During occlusion, regional cerebral and cortical blood flows and NADH fluorescence values were not different among the groups. Brain pHi was significantly lower in the 4 x 15-minute group compared with the 1 x 60-minute group (6.57 +/- 0.02 versus 6.73 +/- 0.06; P < .03) but not significant when compared with the 2 x 30-minute group. During the short reperfusion periods, all parameters returned to normal except for NADH fluorescence levels, which remained elevated. During the postischemic final reperfusion period, there was a mild brain alkalosis of approximately 7.1 in all groups. There were no significant differences in NADH fluorescence among groups during the final reperfusion. Regional cerebral and cortical blood flow returned to near normal values in all groups. CONCLUSIONS: This study demonstrates that intermittent reperfusion during temporary focal ischemia has different effects on the intracytoplasmic and the intramitochondrial compartments: worsening of brain cytoplasmic pHi but no significant differences in the oxidation/reduction level of mitochondrial NADH.     

Weight change and glycemic control in a population-based sample of adults with older-onset diabetes

BACKGROUND: Numerous clinic-based studies have observed improved glycemic control with even moderate weight reductions, for periods up to 1 year, in obese subjects with noninsulin-dependent diabetes mellitus (NIDDM). Similar benefits of weight loss have not been well documented in free-living populations, particularly in older persons with NIDDM of long duration. METHODS: Relations between weight change and glycosylated hemoglobin were evaluated in a population-based sample of persons with older-onset diabetes. Persons participating in baseline (1980-1982, n = 1370) and two follow-up examinations (1984-1986, n = 987; 1990-1992, n = 550) were included. Mean glycosylated hemoglobin levels among those losing, gaining, or remaining within 5 kg were compared in all subjects combined and stratified by insulin use, using ordinary least-squares regression to adjust for confounding variables. RESULTS: Subjects who lost weight had higher mean glycosylated hemoglobin compared to those who gained weight (baseline to second exam only). This pattern remained in those not using insulin. Weight change was not related to glycosylated hemoglobin in persons using insulin. CONCLUSIONS: Associations suggest that in older persons not using insulin, moderate weight loss over periods of 4-6 years has little beneficial impact on glycosylated hemoglobin. Weight loss may be reflecting disease processes that also result in poor glycemic control. Intentional weight loss achieved over a shorter time period and maintained through the later years in older diabetic persons remains to be evaluated.     

Electrode discrimination and speech recognition in postlingually deafened adult cochlear implant subjects

This study investigated the relationship between electrode discrimination and speech recognition in 11 postlingually deafened adult cochlear implant subjects who were implanted with the Nucleus/Cochlear Corporation multichannel device. The discriminability of each electrode included in a subject's clinical map was measured using adaptive and fixed-level discrimination tasks. Considerable variability in electrode discriminability was observed across subjects. Two subjects could discriminate all electrodes, and discrimination performance by the remaining nine subjects varied from near perfect to very poor. In these nine subjects, the results obtained from the discrimination tasks were used to create a map that contained only discriminable electrodes, and subjects' performance on speech recognition tasks using this experimental map was measured. Four different speech recognition tests were administered: a nine-choice closed-set medial vowel recognition task, a 14-choice closed-set medial consonant recognition task, the NU6 Monosyllabic Words Test [T. W. Tillman and T. Carhart, Tech. Rep. No. SAM-TR-66-55, USAF School of Aerospace Medicine, Brooks Air Force Base, Texas (1966)] scored for both words and phonemes correct, and the Central Institute for the Deaf (CID) Everyday Sentences test [H. Davis and S. R. Silverman, Hearing and Deafness (Holt, Rinehart, and Winston, New York, 1978)]. Seven of the nine subjects tested with the experimental map showed significant improvement on at least one speech recognition measure, even though the experimental map contained fewer electrodes than the original map. Three subjects' scores improved significantly on the CID Everyday Sentences test, three subjects' scores improved significantly on the NU6 Monosyllabic Words test, and five subjects' scores improved significantly on the NU6 Monosyllabic Words test scored for phonemes correct. None of the subjects' scores improved significantly on either the vowel or consonant tests. No significant correlation was observed between electrode discrimination ability and speech recognition scores or between electrode discrimination ability and improvement in speech recognition scores when programmed with the experimental map. The results of this study suggest that electrode discrimination tasks may be used to improve speech recognition of some cochlear implant subjects, and that each electrode site does not necessarily provide perceptually distinct information.     

Use of dynamic two-dimensional transesophageal echocardiography for renal cell carcinoma with cavoatrial tumor thrombus

Previous investigations involving continuous blood pressure (BP) monitoring have shown an important alteration of the 24-hour BP profile in patients with obstructive sleep apnea syndrome (OSAS). We investigated the impact of REM sleep on the 24-hour BP cycle in 16 severe OSAS male patients (mean respiratory disturbance index = 66 +/- 16 events/hour of sleep), with hypertension (mean BP 162 +/- 21/105 +/- 11 mmHg World Health Organization (WHO) protocol). Two successive nights of polysomnography were performed, and arterial BP was monitored continuously during the second 24-hour period after brachial artery cannulation. During the daytime, subjects were kept awake and supine. At 3 p.m. BP was continuously monitored during quiet supine wakefulness for 20 minutes. Systolic, diastolic and mean BP and heart rate (HR) were analyzed and tabulated in mean values of 5 minute segments. Sleep/wake information were correlated with cardiovascular variables. Each uninterrupted REM sleep period was identified and comparison between the period of quiet supine wakefulness and REM sleep HR and BP values was performed. 8 OSAS patients presented a normal drop of the mean arterial BP during the nocturnal REM sleep periods compared to quiet supine wakefulness (mean value = -10.8 +/- 7.3 mmHg) ("dippers") while the other 8 subjects ("REM sleep non dippers"), revealed an elevated mean arterial BP during REM sleep (mean value = 18.9 +/- 10.9 mm Hg). The absence of the normal circadian BP dip seen during the nocturnal sleep period is considered as an indication of vascular risk. The REM sleep non dipping may play a role in this risk.     

Reflex sympathetic function in cortisol-induced hypertension in humans

Nine healthy male subjects underwent measurement of reflex sympathetic function, pressor responsiveness and baroreflex sensitivity to phenylephrine (PE) and glyceryltrinitrate (GTN) before (C1) and following six days of treatment (E6) with cortisol (F), 200 mg/day. Seven subjects had washout studies (W) performed at least two weeks following the end of treatment. The BP responses to head tilt, isometric exercise and mental arithmetic were unaltered by F, however, there was a significant diminution of the diastolic BP response to cold pressor stimulus (delta DBP: 19 +/- 3 vs 25 +/- 5 vs 27 +/- 5 mmHg; E6 vs C1 vs W, p < 0.05 C1 vs E6 and W). Baroreflex sensitivity to PE was increased (28 +/- 3 vs 19 +/- 2 ms/mmHg, E6 vs C1, p = 0.03). These data demonstrate that increased BP during F treatment is not attributable to increased SNS activity, and suggest that SNS activity may be decreased by F.     

Antiischemic effects of CP-060S, an inhibitor of pathologically modified sodium channels, assessed in the canine experimental model of angina pectoris

BACKGROUND: A fast, proton echo-planar spectroscopic imaging (PEPSI) technique, capable of simultaneously measuring metabolites from multiple brain regions, was used to investigate the anatomical distribution and magnitude of brain lactate responses to intravenous lactate infusion among subjects with panic disorder and control subjects. METHODS: Fifteen subjects with panic disorder and 10 control subjects were studied. All subjects were medication free and met DSM-IV criteria for panic disorder, or, for controls, no Axis I psychiatric disorder. Two-dimensional axial metabolite images having 1-cm3 spatial resolution were acquired at 61/2-minute intervals during 3 conditions: a 20-minute baseline, 20-minute 0.5-mol/L sodium lactate infusion, and 15-minute postinfusion period. RESULTS: Intravenous lactate infusion increased brain lactate levels throughout the axial brain section studied in all subjects. Panic-disordered subjects had significantly greater global brain lactate increases in response to lactate infusion. Lateralization of brain lactate response did not occur, nor were discrete regional loci of elevated lactate observed. Cerebrospinal fluid lactate changes corresponded to lactate changes in brain tissue. Severity of symptoms provoked by lactate infusion did not directly correlate with brain lactate response. CONCLUSIONS: Greater overall rises in brain lactate among subjects with panic disorder compared with controls occurred in response to lactate infusion. We were unable to detect a distinct regional pattern for magnitude differences in brain lactate rise by which to identify a specific neuroanatomical substrate underlying a lactate-induced panic response. The wide anatomical distribution of these brain lactate increases suggest metabolic and/or neurovascular mechanisms for the abnormal rise in subjects with panic disorder.     

Treatment system for drug-dependence syndrome

OBJECTIVE: There is emerging evidence that women with visceral obesity may have hyper-responsiveness of the hypothalamic-pituitary-adrenal axis. There are no studies on basal daily secretory pattern of ACTH and cortisol in subjects with different obesity phenotypes. DESIGN AND PATIENTS: In this study we examined daytime pulsatile secretion of ACTH and cortisol in two groups of premenopausal obese women with visceral (V-BFD) (BMI 37.1 +/- 1.7) and subcutaneous (S-BFD) (BMI 38.8 +/- 1.5) body fat distribution (measured by CT scan) and in a group of normal weight healthy controls (BMI 21.1 +/- 0.5). After an overnight fast, blood samples were taken at 15-minute intervals for 12 h (49 samples, from 0800 h until 2000 h). All women avoided breakfast but had a normal lunch and dinner, both containing similar food, energy and nutrient composition. ACTH and cortisol responses to mixed meals at noon and in the evening were also investigated. RESULTS: Mean values of ACTH and cortisol did not differ between the groups. However, ACTH pulse frequency was significantly higher in V-BFD (P < 0.06) and S-BFD (P < 0.02) obese women than in controls, without any significant differences between the two obese subgroups. Mean ACTH pulse amplitude was lower in the V-BFD than in S-BFD obese (P < 0.02) and control (P < 0.05) groups. Cortisol episodic characteristics did not differ between V-BFD and S-BFD obese and controls. All differences in ACTH pulsatile parameters between obese and controls and between the two obese subgroups were evident only in the morning, with no further significant differences during the early and late afternoon. There were no significant differences in cortisol parameters during the three periods of the day between the various groups, apart from late afternoon cortisol pulse frequencies, which were significantly lower in V-BFD than in controls. After lunch, ACTH and cortisol levels significantly increased in all groups, but the cortisol increase tended to be more rapid in V-BFD than in the other two groups. After dinner, ACTH significantly increased in V-BFD and controls but not in the S-BFD group, whereas cortisol rose significantly in all groups, but significantly less in S-BFD than in V-BFD and controls. CortisolAUC (but not ACTHAUC) after lunch was significantly higher than after dinner in all groups. ACTH response after each meal was similar in all groups, but cortisolAUC after dinner was significantly lower in S-BFD than in V-BFD women. CONCLUSION: This study demonstrates that in premenopausal women, obesity, particularly the visceral phenotype, is associated with several abnormalities of ACTH pulsatile secretion, particularly in the morning. On the contrary, no major differences were present in either blood concentrations, diurnal rhythm or secretory pattern of cortisol between obese and controls. The responses to meals seem to indicate a much more rapid cortisol response after lunch in women with visceral obesity and a reduced activation of the hypothalamic-pituitary-adrenal axis after dinner in women with subcutaneous obesity.     

Speech outcomes of a prolonged-speech treatment for stuttering

It has been shown that people who stutter can speak with greatly reduced stuttering after treatments that use variations of Goldiamond's (1965) prolonged-speech (PS). However, outcome research to date has not taken account of several important issues. In particular, speech outcome measures in that research have been insufficient to show that lasting relief from stuttering has been achieved by clients outside the clinic for meaningful periods. The present study used extensive speech outcome measures across a variety of situations in evaluating the outcome of an intensive PS treatment (Ingham, 1987). The speech of 12 clients in this treatment was assessed on three occasions prior to treatment and frequently-on eight occasions-after discharge from the residential setting. For 7 clients, a further assessment occurred at 3 years posttreatment. Concurrent dependent measures were percent syllables stuttered, syllables per minute, and speech naturalness. The dependent measures were collected in many speaking situations within and beyond the clinic. Dependent measures were based on speech samples of substantive duration, and covert assessments were included in the study. Detailed data were presented for individual subjects. Results showed that 12 subjects who remained with the entire 2-3-year program achieved zero or near-zero stuttering. The majority of subjects did not show a regression trend in %SS or speech naturalness scores during the posttreatment period, either within or beyond the clinic. Some subjects showed higher posttreatment %SS scores during covert assessment than during overt assessment. Results also showed that stuttering was eliminated without using unusually slow and unnatural speech patterns. This treatment program does not specify a target speech rate range, and many clients maintained stutter-free speech using speech rates that were higher than the range typically specified in intensive PS programs. A significant correlation was found between speech rate and perceived posttreatment speech naturalness.     

Hemagglutinating properties of apolipophorin III from the hemolymph of Galleria mellonella larvae

PURPOSE: Continuous lateral rotational therapy (CLRT) <40 degrees is a method of altering the position of the ventilated patient to help clear secretions from the lung. CLRT has not been shown to reduce the incidence of atelectasis or pneumonia but potentially offers a way to maximize positional drainage in these patients without producing adverse effects. Treatment intervention, bracketed by two (nonrotational) control periods. The purpose of this study was to determine if CLRT alters mucus transport in critically ill, intubated patients in the intensive care unit of a teaching hospital. MATERIALS AND METHODS: Thirteen critically ill, but stable, mechanically ventilated patients, mean age 74 years, were enrolled. They were placed supine on a Biodyne bed (KCI, San Antonio, Texas) and pressures in the cushions adjusted to patient's weight. A radiolabeled aerosol was delivered by bagging for 2 to 3 minutes and repeated measurements of lung radioactivity were obtained by imaging of the thorax over the following 3 hours. A 90-minute period of rotation of the bed, 30 degrees to either side was preceded and followed by two 45-minute control periods during which the patient remained supine and stationary on the bed. Coughs and suctions were recorded and blood gases obtained pre and post study. RESULTS: (1) The mucous clearance was slower than that reported in normal subjects and in ambulatory patients with COPD; (2) there was a slight, but not significant, increase in clearance during CLRT; (3) clearance reverted to pre-oscillation levels following therapy. Lack of significant effect may be attributed to too shallow an angle for rotation or too short an intervention period. CONCLUSION: Positional drainage effected by short duration CLRT did not appear to stimulate significant mucous removal from the lung in critically ill patients but also did not cause any adverse effects.     

Relaxation training and cardiovascular response to experimental stressors.

Blood pressure (BP) and heart rate were measured in 36 Ss (mean age 33 yrs) during periods of rest, intentional relaxation, unsignaled reaction time (RT), cold pressor tasks, and recovery periods, both before and after 4 wks of progressive relaxation training, transcendental meditation analog treatment, or an assessment control condition. Both types of relaxation training resulted in significant reductions in BP, but not heart rate, levels across all posttreatment assessment intervals (baseline, stress periods, and stress recovery). Relaxation training did not reduce cardiovascular response during stress periods, but did result in more rapid BP reductions in stress recovery periods. Scores on the Jenkins Activity Survey were related to posttreatment BP level during the RT task, with high scorers showing higher BPs than low scorers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stage I ovarian cancer by transvaginal color Doppler sonography: a report of 18 cases

PURPOSE: To evaluate the tolerability and 24 hours efficacy of a new anti-hypertensive drug: cilazapril. METHODS: In an open non comparative study 20 hypertensive patients (16 females, age from 30 to 60 years, average = 49.4) were followed for 6 weeks: 2 wash out and 4 treatment (5 mg OD). Blood pressure (BP) was measured by casual and ambulatory blood pressure monitoring (ABPM) readings. RESULTS: Comparing washout and treatment periods, ABPM averages both for systolic and diastolic BP (mmHg) showed significant decrease in 24 hours, during day and night sub periods. The decrease was not significant between averages considering the "early morning rising pressure" sub period. Heart rate averages showed significant reduction at all sub periods except during night. Adverse effects were mild and resolved spontaneously (n = 3, 15%). CONCLUSION: Cilazapril seems to be efficacious as antihypertensive. Tolerability is excellent. It preserved circadian rhythm despite significantly reducing blood pressure at all periods evaluated except early morning. A bradycardic effect observed mostly during day period should be better evaluated.     

Major depressive disorder is associated with attenuated cardiovascular reactivity and impaired recovery among those free of cardiovascular disease.

Objective: To examine cardiovascular reactivity and recovery to laboratory stress among a naturalistic sample of individuals diagnosed with major depressive disorder (MDD) and healthy control participants. Prospective evidence suggests that MDD confers risk for cardiovascular disease equal to or greater than the risk associated with depressed mood. Enhanced cardiovascular reactivity has been proposed as a mechanism explaining increased risk, but data are inconsistent as to whether depressed individuals exhibit enhanced or attenuated reactivity. Further, few studies have examined appraisal and recovery differences. Design: Participants diagnosed with MDD (N = 25) and healthy control participants (N = 25) engaged in a cardiovascular reactivity protocol including 2 tasks, each followed by a brief recovery period. Main outcome measures: Blood pressure, heart rate, pre-ejection period, cardiac output and total peripheral resistance were assessed. Appraisals of tasks were assessed prior to each task. Results: Depressed participants exhibited significantly less systolic blood pressure, heart rate, and cardiac output reactivity during speech, less heart rate reactivity during mirror tracing, and less heart rate recovery after speech and mirror tracing than controls. Depressed participants appraised the tasks as more demanding, threatening, and stressful and reported being less able to cope than controls. Appraisals were related to heart rate reactivity, but appraisals did not mediate the relationship between depression group and reactivity. Conclusion: Impaired recovery rather than exaggerated cardiovascular reactivity may partially explain the increased prospective cardiovascular disease risk in depressed individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlation of CT with histopathological findings in patients with gastric and gastro-oesophageal carcinomas following neoadjuvant chemotherapy

The aim of this investigation was to study the effect of the interproximal use of fluoride (F)-impregnated and non-impregnated birch toothpicks on the degree of de- and remineralization of enamel and dentine in situ. Ten volunteers with complete dentures in the upper jaw participated. Each subject had four specimens: (1) sound enamel, (2) demineralized enamel, (3) sound dentine and (4) demineralized dentine; placed pairwise at two approximal sites (15/16 and 25/26) of the maxillary prosthesis. The study involved three test periods (A, B and C), each lasting 4 weeks. In A, the subjects used F toothpicks (impregnated in 4% NaF) and, in B, nonimpregnated toothpicks 3 times daily. During period C, no toothpicks were used. Dentifrice or other F-containing products were not allowed during the 4-week periods. Transversal microradiography was used to determine lesion depth (ld) and mineral loss (DeltaZ). The results revealed that all the sound samples lost mineral during the three experimental periods; DeltaZ for both enamel and dentine was less for A and B compared with C (p<0.01) and less for A compared with B and C for dentine (p<0.05, p<0.01). The demineralized samples also lost mineral, apart from dentine, during periods A and B, i.e. when F-impregnated and non-impregnated toothpicks were used; ld for enamel and DeltaZ for dentine were less for A compared with C (p<0.05). Four weeks' use of toothpicks, especially F-impregnated toothpicks, thus reduces the demineralization of enamel and dentine at approximal sites in situ.     

Ten-year blood pressure trends in nonhypertensive inhabitants of La Plata, Argentina

OBJECTIVES: To compare, according to blood pressure (BP) categories, 10-year trends in BP measurements in nonhypertensive subjects and the relative risk of developing hypertension. DESIGN: Population study. BP was recorded as the average of two measures taken on a single occasion with a mercury sphygmomanometer and the auscultation method. SETTING: Residents of La Plata, aged 15 to 64 years. PARTICIPANTS: The study was based on randomly chosen individuals who, during a previous survey in 1985, were 15 to 64 years old and whose BP was below 140/90 mmHg. They were grouped according to sex and BP categories. Random age- and sex-stratified sampling of 151 men and 193 women was performed. Categories were high normal BP, optimal BP (as defined by the fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure) and normal but not optimal BP defined as BP 120 to 129/80 to 84 mmHg. RESULTS: BP increased in all categories; this increase was significant (P < 0.01) except for diastolic BP in women with high normal BP. BP increases were higher in optimal BP subjects and lower in high normal BP subjects (P < 0.01 for women and not significant for men). The relative risk of developing hypertension in high normal BP subjects was triple that in optimal BP subjects (P < 0.01). CONCLUSIONS: Increases in BP observed in optimal BP subjects stress the importance of monitoring BP changes and recommending primary prevention in the whole population.     

Levator veli palatini muscle activity in relation to intraoral air pressure variation in cleft palate subjects

A comparison of the ranges of levator veli palatini EMG activity for speech versus a nonspeech task for subjects with cleft palate was the focus of this study. EMG values are also compared with subjects without cleft palate obtained in a previous study. Hooked-wire electrodes were inserted into the levator muscle of five adult subjects with cleft palate exhibiting mild hypernasality. Intraoral air pressure was measured concurrently. A blowing task was used to determine the subject's operating range for the levator muscle. Both the nonspeech and speech tasks were designed to sample the widest possible ranges of levator EMG activity. It was found that the subjects with cleft palate used a relatively high activation level for the levator muscle during speech, in relation to their total activation range, compared with the subjects without cleft palate. Implications are discussed in relation to possible anatomic and physiologic differences for cleft palate subjects compared to normal.     

The positive effect of pretreatment with serotonin and gangliosides on the development of early mouse embryos after cryopreservation

Blood pressure (BP) during siesta declines to levels similar to those of night time sleep. The objective of the study was to assess the effect of siesta on 24-h ambulatory BP (ABP) data. Two different approaches were employed for the definition of day and night periods: (1) actual patient reported day and night intervals (ACT) with siesta period analysed as a third time period; and (2) arbitrary day and night time intervals (ARB) with the presence of siesta being ignored. A total of 203 24-h ABP recordings were analysed, with a siesta during ABP monitoring reported in 154 of them. Mean siesta BP was very close to ACT night time BP. Among recordings with a siesta, ACT daytime BP was higher and night time BP lower than the corresponding ARB BPs (P < 0.001). The magnitude of night time BP drop was greater with ACT intervals, resulting in a lower percentage of non-dippers (P < 0.001). Among 49 recordings without a siesta, differences between ACT and ARB BPs were less pronounced for daytime but not for night time. Differences in the magnitude of nocturnal BP drop between ACT and ARB periods, although statistically significant, did not affect the prevalence of non-dippers. In conclusion, analysis of 24-h BP profiles by using ARB instead of ACT day and night intervals results in underestimation of the nocturnal BP drop and overestimation of the proportion of non-dippers. This bias is more pronounced in patients who take a siesta during ABP monitoring.     

5-Hydroxytryptamine1D-like receptors mediate contraction of partially depolarized rabbit renal arteries

OBJECTIVE: Our purpose was to correlate measures of Doppler-detected fetal movements with standard fetal heart rate parameters and perinatal outcomes. STUDY DESIGN: This prospective, multiinstitutional trial used the Hewlett-Packard M1350A monitor to record simultaneous fetal heart rate baseline, variability, accelerations, decelerations, and number of fetal movements, and duration and percent of total time. These data were compared at 10- and 30-minute intervals during nonstress tests and were correlated with fetal heart rate baseline parameters and maternally perceived fetal movements and with outcomes of infants delivered within 7 days of the last test. RESULTS: At six centers 1704 actocardiograms from 884 third-trimester patients were analyzed. Doppler-detected fetal movement counts, durations, and percent of total time correlated weakly with all baseline fetal heart rate parameters (all values < 0.20). All fetal movement parameters increased significantly in successive 10-minute blocks and in periods of increased or normal fetal heart rate variability compared with those with fetal heart rate variability. The sensitivity, specificity, and predictive values of the percent of total movement time were comparable to those of standard nonstress test parameters. The risk of poor perinatal outcomes after nonreactive nonstress tests was lower in cases with fetal movements than in those without. CONCLUSIONS: Doppler actocardiography may help to discriminate fetal states during antepartum testing. It may prevent inappropriate diagnosis of fetal compromise when the nonstress test is nonreactive or nonreassuring.