The association between smoking and the prevalence of intermittent claudication

The objective of this study was to investigate the association between smoking and the prevalence of intermittent claudication (IC). Between 1995 and 1997, all residents aged 20 years or older in Nord-Tr?ndelag County, Norway, were invited to take part in the Nord-Tr?ndelag Health Study (Helseunders?kelsen i Nord-Tr?ndelag: HUNT 2). A total of 19748 participants aged 40-69 years attended. Responses to 12 questions on IC (including a Norwegian translation of the Edinburgh Claudication Questionnaire) had been previously tested against the ankle-brachial pressure index (ABPI < 0.9), and an algorithm of the best test properties was used to identify people with IC. Using logistic regression analysis we computed age-adjusted prevalence odds ratios (OR) for the association between smoking and IC. Both current (ORmen = 3.8, confidence interval (CI) 2.1-6.7, ORwomen = 2.2, CI 1.4-3.4) and former smokers (ORmen = 1.7, CI 0.9-3.2, ORwomen = 1.7, CI 1.1-2.7) had a higher prevalence of IC compared with those who had never smoked, and individuals who had stopped smoking more than 20 years previously had a substantially lower prevalence of IC (ORmen = 0.2, CI 0.1-0.5, ORwomen = 0.4, CI 0.2-0.8) than current smokers. We found no association between passive smoking and IC in either men or women. Current and previous smoking habits were positively associated with the prevalence of IC, and smoking cessation was negatively associated in men and women. Passive smoking was not associated with IC in this study.     

Fatigue in patients with lupus is not associated with disturbances in cerebral blood flow as detected by SPECT

Abstract Objectives Fatigue is a common complaint in patients with systemic lupus erythematosus (SLE). We investigated whether focal or general disturbances of cerebral blood flow (CBF), as assessed by SPECT, were associated with the presence of fatigue in an unselected group of SLE patients. Methods Fifty-six patients were included. Mean age was 47.5 years (±12.7), mean disease duration 14.7 years (±8.9), and disease activity measured by SLE disease activity index (SLEDAI) was 5.7 (±5.4). Fatigue was assessed by the Fatigue Severity Scale (FSS) and CBF by Tc-99m-hexamethyl propylamine oxime (HMPAO)-SPECT. The images were read and processed quantitatively by a computer program using the primary visual cortex as reference region and > 15% CBF deviation as definition of abnormality. Results The mean FSS score was 4.6 (±1.8). SPECT revealed focal CBF disturbances in 17 patients (30.4 %). Generalized symmetrical CBF reductions were present in 32 patients (57.1 %). There were no significant associations between CBF disturbances in any region of the brain and the degree of fatigue. Conclusions Fatigue in SLE patients is not related to focal or general CBF disturbances. Therefore, factors that do not influence blood flow seem responsible for the fatigue phenomenon.     

Levetiracetam concentrations in serum and in breast milk at birth and during lactation

PURPOSE: To study the pharmacokinetics of levetiracetam (LEV) at birth, during lactation, and in the nursed infant. METHODS: Eight consecutive breast-feeding women with epilepsy treated with LEV twice daily and their infants were studied. RESULTS: The mean umbilical cord serum/maternal serum ratio was 1.14 (range, 0.97-1.45) (n = 4). The mean milk/maternal serum concentration ratio was 1.00 (range, 0.76-1.33) at 3 to 5 days after delivery (n = 7). At sampling 2 weeks to 10 months after delivery (n = 5), it was similar (range, 0.85-1.38). At 3 to 5 days after delivery, the infants had very low LEV serum concentrations (<10-15 microM), a finding that persisted during continued breast-feeding. No malformations were detected, and in none of the infants did signs of adverse effects develop. CONCLUSIONS: Our data indicate an extensive transfer of LEV from mother to fetus and into breast milk. However, breast-fed infants had very low LEV serum concentrations, suggesting a rapid elimination of LEV.     

Reducing atrial tachycardia and atrial fibrillation episodes with a prevention and treatment device and tailored treatment

BACKGROUND: Pacemaker treatment of known trigger mechanisms for atrial tachyarrhythmias (AT) and atrial fibrillation (AF) has shown reduction in the incidence of AF. A new arrhythmia management device, which included storage of AT/AF (for tailoring treatment) and three prevention algorithms and one for treatment, was examined in order to identify the influence on arrhythmia episodes over a 12-month follow-up (FU) period. METHODS: Twenty-three consecutive patients with known tachybradyarrhythmias were examined. Seven patients had to be excluded (two outliers, four developed permanent AF, one had no detection algorithm turned on at implantation). The remaining 16 patients showed 2723 episodes (675 treated episodes) for evaluation of the effect on episodes/month/patient (e/m/p), treatment success, duration of episodes, circadian distribution and quality of life. RESULTS: The AT/AF e/m/p were reduced from 37 +/- 102 e/m/p at 1-month FU to 16 +/- 48 e/m/p at 3-month FU, 15 +/- 48 e/m/p at 6-month FU and 10 +/- 28 e/m/p at 12-month FU (p < 0.05), according to fewer subjective symptoms. Treatment success remained stable during the observation period (29-40%). Only minor changes in the duration of episodes and the distribution of start times were observed. CONCLUSION: Tailoring treatment by the pacemaker examined with several prevention and treatment algorithms reduces e/m/p and might be a promising supplement in the treatment of selected patients with known AT/AF and bradycardia.     

Color Doppler tissue velocity imaging can disclose systolic left ventricular asynchrony independent of the QRS morphology in patients with severe heart failure

A QRS width greater than 120 ms is assumed to be a marker of inter- and intraventricular asynchrony in severe heart failure (HF) patients. Color Doppler tissue velocity imaging (c-TVI) with a time resolution of 10 ms was used to study regional left ventricular (LV) longitudinal systolic contraction pattern in HF patients with left and right bundle branch block (LBBB and RBBB) and in patients with normal QRS width. We studied 12 women and 23 men with severe HF, with a mean age of 66 +/- 11 years in New York Heart Association functional Class 2.9 +/- 0.6. Twenty patients had LBBB and 10 of those were accepted for cardiac resynchronization therapy by biventricular pacing (CRT). Ten patients had normal QRS width, and five had RBBB. In the echocardiographic apical four chamber view, regional peak LV tissue velocities and regional LV time differences of peak tissue velocities were compared at basal and mid-LV segments. There were no significant differences in regional mean peak tissue velocities among the patient groups. In patients with LBBB accepted for CRT, the LV lateral free-wall movement at basal LV was 29 ms delayed during main systole, almost significantly different from LBBB patients not accepted for CRT (P = 0.075). Even in HF patients with normal QRS width or RBBB, significant asynchronous longitudinal LV contraction was observed. Conclusions: For the detection of regional longitudinal LV contraction asynchrony in patients with severe HF, supplementary methods to the surface ECG, such as c-TVI, are strongly recommended.     

Feasibility of color doppler tissue velocity imaging for assessment of regional timing of left ventricular longitudinal movement

OBJECTIVE--The feasibility of color Doppler tissue velocity imaging (c-TVI) with a high time resolution of 10 ms for simultaneous measurement of the temporal characteristics of regional left ventricular (LV) tissue velocities at different LV sites was examined. Methods and results--In 20 subjects with structurally normal hearts, inter- and intraobserver agreement and the beat-to-beat variation were tested in c-TVI profiles from basal and mid-LV segments of the interventricular septum (IS) and of the lateral free wall (LFW). For peak tissue velocities a mean error of less than 1 cm/s was demonstrated. For systolic regional LV velocity time difference, the mean error was +/- 5 ms, with the best agreement when sampling from basal LV sites. For diastolic regional LV velocity time differences, the mean error was +/- 12 ms. The longitudinal LV movement pattern demonstrated a pattern of incremental tissue velocity from basal to mid-LV, and from IS to LFW sites. Conclusion--The c-TVI method has acceptable inter- and intraobserver agreement and is sufficiently accurate to disclose regional time aspects of LV contraction and relaxation.     

In vitro uptake of a new cholesteryl carborane ester compound by human glioma cell lines

The cellular uptake and retention of a new cholesteryl carborane ester compound, cholesteryl 1,12-dicarba-closo-dodecaboranel-carboxylate (BCH), by two human glioma cell lines, glioblastoma multiforme SF-763 and SF-767, was evaluated. BCH, which is an extremely hydrophobic compound, was formulated into liposomes and incubated with two human glioma tumor cell lines and one human normal neuron cell line. The amount of BCH uptake by the cells was measured by high performance liquid chromatography. The effects of BCH concentration in the culture medium and the incubation time on the cellular uptake of BCH were studied. In addition, BCH uptake by tumor cells was examined in the presence and absence of lipoprotein in the culture medium. It was found that the amount of BCH taken by the glioma cell lines was much more (up to 14 times) than that by the normal neuron cell line. The cellular uptake of BCH was related to the amount of BCH in the medium as well as the incubation time. The cellular uptake of BCH by SF-763 and SF-767 cells after 16 h of incubation was 283.3 +/- 38.9 and 264.0 +/- 36.5 microg boron/g cells, respectively. The majority of BCH taken up in tumor cells was retained after the subsequent incubation. In the presence of lipoprotein, the cellular uptake of BCH by SF-767 tumor cells was about four times as much as that in the absence of lipoprotein. In conclusion, the cellular uptake of BCH by glioma cells was about 14 times higher than by normal neuron cells. The uptake in glioma cells was up to 10 times higher than that required for successful cancer treatment and BCH was well retained in the tumor cells. Lipoprotein seemed to have an important role in the BCH uptake by glioma cells.     

Reducing the duration of untreated first-episode psychosis: effects on clinical presentation

CONTEXT: Most studies on first-episode psychosis show an association between a long duration of untreated psychosis (DUP) and poorer short-term outcome, but the mechanisms of this relationship are poorly understood. OBJECTIVE: To determine whether it is possible to reduce the DUP for first-episode patients in a defined health care area through the introduction of an early detection (ED) program, compared with parallel health care areas without an ED program (No-ED). SETTING AND PATIENTS: We included consecutive patients with a DSM-IV diagnosis of nonorganic, nonaffective psychosis coming to their first treatment in the study health care areas between January 1, 1997, and December 31, 2000. A total of 281 patients (76% of the total) gave informed consent. INTERVENTIONS: The ED and No-ED health care areas offered an equivalent assessment and treatment program for first-episode psychosis. The ED area also carried out an intensive ED program. RESULTS: The DUP was significantly shorter for the group of patients coming from the ED area, compared with patients from the No-ED areas (median, 5 weeks [range, 0-1196 weeks] vs 16 weeks [range, 0-966 weeks]). Clinical status measured by the Positive and Negative Syndrome Scale and the Global Assessment of Functioning Scale was significantly better for patients from the ED area at start of treatment and, with the exception of Positive and Negative Syndrome Scale positive subscale, at 3 months. Multiple linear regression analyses gave no indication that confounders were responsible for these differences. CONCLUSIONS: It is possible to reduce the DUP through an ED program. The reduction in DUP is associated with better clinical status at baseline that is maintained after 3 months.     

Unveiling the foveal blue scotoma through an afterimage

The absence of short-wave-sensitive (S-) cones in the human foveola normally goes unnoticed, but the resulting foveal S-cone, or blue, scotoma can be visualized as the negative afterimage of a short-wavelength adapting field on a larger white background. The afterimage has an annular shape with a lighter inner region that corresponds to Maxwell's spot, and a small bright spot in the center corresponding to the foveal blue scotoma. We have shown that the visibility of the center spot in the afterimage approximately follows the spectral sensitivity curve of the S-cones. We further demonstrate that the central bright spot subtends a retinal area that is coincident with the tritanopic region of the foveola. The macular pigment distribution measured for the same observers also peaks in the central fovea, but has a relatively high density over a broader retinal region than the bright spot in the negative afterimage, and more closely corresponds to the lighter annular region of the afterimage. The results support the hypothesis of an active post-receptoral process for filling-in of chromatic scotomas.