兔膝关节软骨表面形态在短时非周期大强度运动训练后的变化

目的:观察正常软骨表面的形态结构以及短时非周期大强度运动训练对关节软骨的影响。方法:实验于2001-01/09在四川省骨科医院完成。①实验动物:10～12个月龄日本大耳白兔8只,雌雄各半,体质量(3.5±0.2)kg。②实验分组:将动物分为对照组2只,训练组6只,其中训练1,2,3周各2只。③实验干预:训练组兔在电刺激笼中进行训练,训练量为20s刺激1次,刺激时间为0.2～0.5s,动物受刺激后沿刺激笼跑跳数步并转弯。训练120min/d,每组训练60min后休息20min,训练6d/周,星期日休息,分别训练1,2,3周。对照组不放在电刺激笼中,也不进行训练。④实验评估:扫描电子显微镜下观察训练前后兔股骨和胫骨髁软骨表面形态结构的变化;MIAS99图形处理软件计算浅坑(pits)的直径和面积。结果:8只兔均进入结果分析。①正常兔膝关节软骨的表面形态结构:正常软骨表面低倍镜下显示为均匀排列的浅坑,在高倍镜下呈现一种均匀多孔状结构。②运动训练后软骨表面结构的变化:训练后浅坑形态不规则,边缘粗糙,胶原纤维增粗,孔隙不均匀增大。结论:软骨表面正常的形态结构是浅坑,短时非周期大强度训练,未引起纤维断裂和碎屑,说明不会损伤软骨表面形态结构。     

正常兔膝关节表面结构的扫描电镜观察

目的:扫描电镜观察正常兔膝关节表面的结构,为研究关节软骨表面结构提供正常参照。方法:实验于2001-01/09在四川省骨科医院完成。日本大耳白兔8只,10～12个月龄,雌雄各半,体质量(3.5±0.2)kg。通过扫描电镜对8只实验兔股骨髁、胫骨髁的软骨表面进行观察,其中4个髁用锐器划伤。结果:纳入日本大耳白兔8只,均进入结果分析。每个正常髁的表面都显示有大量的浅坑,有锐器划伤的髁则出现了垄沟及隆突。软骨表面在高倍镜下呈现一种均匀多孔状结构。结论:软骨表面唯一呈现的结构是浅坑,垄沟和隆突可能是标本的采集、制作过程中形成的赝象。     

Black-white disparity in disability: the role of medical conditions

OBJECTIVES: To describe the independent contributions of selected medical conditions to the disparity between black and white people in disability rates, controlling for demographic and socioeconomic factors. DESIGN: Cross‐sectional analysis of a community‐based cohort. SETTING: Urban and rural counties of central North Carolina. PARTICIPANTS: Two thousand nine hundred sixty‐six adults aged 68 and older participating in the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE). MEASUREMENTS: Self‐reported data on sociodemographic characteristics and medical conditions, Short Portable Mental Status Questionnaire, activities of daily living (ADLs). RESULTS: Fifty‐five percent of the cohort was black. Blacks were more likely than whites to report disability (odds ratio=1.39, 95% confidence interval= 1.15–1.68). Controlling for age, sex, marital status, and socioeconomic status, blacks were more likely to be obese and have diabetes mellitus, and less likely to report vision problems, fractures, and heart attacks. The higher prevalence of obesity and diabetes mellitus in blacks, after adjustment for sociodemographic factors, accounted for more than 30% of the black–white difference in disability. Conversely, the black–white disability gap would be approximately 45% wider if whites had a lower prevalence of fractures and vision impairment, similar to their black peers. CONCLUSION: Higher rates of obesity and diabetes mellitus in older black Americans account for a large amount of the racial disparity in disability, even after controlling for socioeconomic differences. Culturally appropriate interventions that lower the prevalence or the functional consequences of obesity and diabetes mellitus in blacks could substantially decrease this racial health disparity.     

Trajectory classes of depressive symptoms in a community sample of older adults

Kuchibhatla MN, Fillenbaum GG, Hybels CF, Blazer DG. Trajectory classes of depressive symptoms in a community sample of older adults. Objective: To identify trajectories of depressive symptoms in older community residents. Method: Depressive symptomatology, based on a modified Center for Epidemiological Studies–Depression scale, was obtained at years 0, 3, 6, and 10, in the Duke Established Populations for Epidemiologic Studies of the Elderly (n = 4162). Generalized growth mixture models identified the latent class trajectories present. Baseline demographic, health, and social characteristics distinguishing the classes were identified using multinomial logistic regression. Results: Four latent class trajectories were identified. Class 1 – stable low depressive symptomatology (76.6% of the sample); class 2 – initially low depressive symptomatology, increasing to the subsyndromal level (10.0%); class 3 – stable high depressive symptomatology (5.4%); class 4 – high depressive symptomatology improving over 6 years before reverting somewhat (8.0%). Class 1 was younger, male gender, with better education, health, and social resources, in contrast to class 3. Class 2 had poorer cognitive functioning and higher death rate. Class 4 had better health and social resources. Conclusion: Reduction in high depressive symptomatology is associated with more education, better health, fewer stressful events, and a larger social network. Increasing depressive symptomatology is accompanied by poorer physical and cognitive health, more stressful life events, and greater risk of death.     

Metabolic syndrome predicts mobility decline in a community-based sample of older adults

OBJECTIVES: To determine whether metabolic syndrome is an independent predictor of decline in mobility in an elderly community sample. DESIGN: Biracial community-based prospective cohort study. SETTING: Urban and rural areas of central North Carolina. PARTICIPANTS: One thousand two hundred twenty-nine older African Americans and whites, mean age 77.0, who were participants in the Duke Established Populations for Epidemiologic Studies of the Elderly. MEASUREMENTS: Sociodemographic data and data on mobility (a subset of items from the Rosow-Breslau scale), depression (Center for Epidemiological Studies Depression Scale), self-report of medical conditions, body mass index, cognitive function (Short Portable Mental Status Questionnaire), blood pressure, height, and waist circumference. High-density lipoprotein cholesterol, triglycerides, and blood glucose were available from blood samples. Metabolic syndrome was calculated for subjects with complete data. RESULTS: Twenty-nine percent of the sample met criteria for metabolic syndrome. In bivariate analyses, age, sex, race, education, cognitive impairment, depression, impairment in mobility, history of stroke and heart disease, and metabolic syndrome at baseline were associated with a decline in mobility 4 years later. Regression analysis controlling for the above variables demonstrated that metabolic syndrome persisted as an independent and highly significant predictor of decline in mobility. CONCLUSION: These findings suggest that metabolic syndrome may be a distinct risk factor for mobility decline in community-dwelling older people.     

Identifying frailty in hospitalized older adults with significant coronary artery disease

OBJECTIVES: To characterize physiological variation in hospitalized older adults with severe coronary artery disease (CAD) and evaluate the prevalence of frailty in this sample, to determine whether single-item performance measures are good indicators of multidimensional frailty, and to estimate the association between frailty and 6-month mortality. DESIGN: Observational cohort study. SETTING: Inpatient hospital cardiology ward. PARTICIPANTS: Three hundred nine consecutive inpatients aged 70 and older admitted to a cardiology service (n = 309; 70% male, 84% white) with minimum two-vessel CAD determined using cardiac catheterization. MEASUREMENTS: Two standard frailty phenotypes (Composite A and Composite B), usual gait speed, grip strength, chair stands, cardiology clinical variables, and 6-month mortality. RESULTS: Prevalence of frailty was 27% for Composite A versus 63% for Composite B. Utility of single-item measures for identifying frailty was greatest for gait speed (receiver operating characteristic curve c statistic = 0.89 for Composite A, 0.70 for Composite B) followed by chair-stands (c = 0.83, 0.66) and grip strength (c = 0.78, 0.57). After adjustment, composite scores and single-item measures were individually associated with higher mortality at 6 months. Slow gait speed (< or =0.65 m/s) and poor grip strength (< or =25 kg) were stronger predictors of 6-month mortality than either composite score (gait speed odds ratio (OR)=3.8, 95% confidence interval (CI) = 1.1-13.1; grip strength OR = 2.7, 95% CI = 0.7-10.0; Composite A OR = 1.9, 95% CI = 0.60-6.1; chair-stand OR = 1.5, 95% CI = 0.5-5.1; Composite B OR = 1.3, 95% CI = 0.3-5.2). CONCLUSION: Gait speed frailty was the strongest predictor of mortality in a population with CAD and may add to traditional risk assessments when predicting outcomes in this population.     

Intraarterial digital subtraction arteriographic evaluation of extremity tumors: comparison with conventional arteriography

Conventional arteriography and intraarterial digital subtraction arteriography (IADSA) were compared in 36 patients with primary bone or soft-tissue tumors of the extremities. The sensitivity of IADSA was at least equal to conventional arteriography for demonstrating normal or abnormal major arteries and feeding arteries, equal to or superior for depicting tumor stains or draining veins, but slightly inferior for revealing minute tumor vessels. An increase of the matrix size from 256 X 256 to 512 X 512 improved these sensitivities. IADSA with 15% diatrizoate contrast material eliminated the contrast material-induced pain in all patients. With a computer-controlled iris setting, an average of 5 minutes of procedure time and 1.7 R of radiation (0.44 mC kg) per examination could be saved. IADSA reduced the cost of an examination by an average of $67. The results indicate that IADSA was diagnostic in all instances and can replace conventional arteriography for the evaluation of extremity tumors.     

Improved outcome for high-risk acute myeloid leukemia patients using autologous bone marrow transplantation and monoclonal antibody-purged bone marrow

We have conducted a 9-year multicenter trial of autologous bone marrow transplantation (ABMT) for acute myeloid leukemia (AML). Remission BM was purged in vitro using monoclonal antibodies (MoAbs; PM-81, AML-2- 23) and complement targeting myeloid differentiation antigens (CD15, CD14). In 1988, the preparative regimen changed from 60 mg/kg/d cyclophosphamide x 2 and fractionated total body irradiation (TBI) total dose, 1,200 cGy (Cy/fTBI), to 4 mg/kg/d busulfan x 4 and 60 mg/kg/d Cy x 2 (Bu/Cy2). Recent analysis (October 1, 1993) shows that the Bu/Cy2 regimen along with the same MoAb purging method yields an improved outcome. Seven first complete-remission (CR) (CR1), 45 second- or third-CR (CR2/3), and 11 first-relapse (R1) patients were treated with chemotherapy and TBI or chemotherapy alone followed by ABMT with MoAb-purged BM. Median age at ABMT for those patients in CR 2/3 and R1 patients was 36 years. Twenty-nine CR 2/3 and R1 patients were conditioned with Cy/fTBI, and 27 CR2/3 and R1 patients were conditioned with Bu/CY. Using the Kaplan-Meier method, the CY/fTBI, CR2/3, and R1 patients have a 3-year disease-free survival (DFS) of 21%. On the other hand, the Bu/Cy2, CR2/3, and R1 patients have a 3-year DFS of 48%. Nineteen CR2/3 and R1 patients relapsed post-ABMT. On analysis by conditioning regimen, those treated with Cy/fTBI have a 3-year relapse rate (RR) of 58%, whereas the patients conditioned with Bu/Cy2 have a 39% 3-year RR. Long-term DFS can be achieved in about 50% of patients with advanced remissions and relapsed AML using Bu/Cy2 with MoAb-purged BM.     

Estimated prevalence of dementia among elderly black and white community residents

A stratified random sample of 83 black and 81 white community residents aged 65 years and older in a five-county area in the Piedmont region of North Carolina was evaluated for dementia, using the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, and the National Institute of Neurological Disorders and Stroke--Alzheimer's Disease and Related Disorders Association criteria. Of 164 subjects, 26 were found to be demented, resulting in an estimated prevalence rate of dementia in the five-county area of 16% (95% confidence interval, 7.92 to 24.08) for blacks and 3.05% (95% confidence interval, 0 to 6.91) for whites. The estimated prevalence of dementia for white women (2.9%) was similar to that for white men (3.3%), but the rate for black women was distinctly higher than for black men (19.9% and 8.9%, respectively). Blacks were more likely than whites to have a history of stroke, hypertension, and other chronic disorders that might have contributed to the development of dementia. Apart from differences in rates of institutionalization, no other relevant factors were identified that might explain the difference in the prevalence of dementia in these black and white community residents.