U.S. experience with the AddVent VDD(R) pacing system. AddVent Phase I Investigators

The AddVent pacemaker generator and model 1328C AV single-pass lead is a new pacemaker system capable of VDD or VDDR modes. The purpose of this study was to present the initial experience with AddVent in the United States and Canada. Between May 10, 1995 and May 3, 1996, 53 devices were implanted in 52 patients and followed for a mean of 217 (+/- 39) days. At the predischarge, 1-, 3-, and 6-month follow-up evaluations, atrial sensing thresholds and ventricular sensing and capture thresholds were measured in the supine, sitting, and standing positions to evaluate stability of atrial sensing with respect to body posture at rest. At the 1-month follow-up, a treadmill exercise test was performed to evaluate atrial sensing during exercise and to evaluate two new features of the AddVent called "sensor-mediated rate smoothing" and "preferential P wave sensing." Atrial sensing thresholds were not significantly different (P > 0.05) among body postures for any follow-up period or among follow-up periods for each posture. At rest, the percentage of appropriately tracked P waves observed was > 99% at each follow-up period. During treadmill exercise, the percentage of appropriately tracked P waves was > 98.7%. Appropriate preferential P wave sensing and sensor-mediated rate smoothing (VDDR mode) was observed. The AddVent pacing system provides safe and effective pacing therapy. Several features of VDDR pacing offer advantages over standard VDD pacing.

Changes in R-R variability before and after endurance training measured by power spectral analysis and by the effect of isometric muscle contraction

The long-term conditioning effects of physical training on cardiorespiratory interaction in 11 young healthy males were studied. Significant increases in maximum oxygen uptake (VO2max) (P < 0.05) and decreases in heart rate (P < 0.05) were achieved in all subjects following a 6-week training programme consisting of cycling for 25 min each day at a work level that increased heart rate to 85% of maximum. Heart rate variability, measured as the differences between the maximum and minimum R-R interval in a respiratory cycle, increased in nine of the subjects and decreased in two. The respiratory-cycle-related high-frequency peak in the power spectral plot of R-R variability also showed significant increases in the same nine subjects and decreases in two. The latter result was similar after normalisation of the data for changes in heart rate by calculating the common coefficient of variance [symbol: see text], where HF is the high-frequency component of the power spectral plots, using a further measure of vagal tone it was shown that, for all subjects, the R-R interval change in response to isometric contractions of the arm flexors in one respiratory cycle were significantly greater after training. These data suggest that cardiac vagal tone is increased by aerobic training for all subjects and that this is accompanied by a respiratory sinus arrhythmia (RSA) in most, but may be associated with a decrease in RSA in subjects with a very low (< 50 beats.min-1 heart rate.

Interactions of recombinant human pulmonary surfactant protein D and SP-D multimers with influenza A

To further study the structure and function of surfactant protein D (SP-D), recombinant human SP-D (rhSP-D) was isolated from the culture medium of Chinese hamster ovary (CHO)-K1 cells stably transfected with a full-length hSP-D cDNA. Although a significant fraction of the secreted rhSP-D was recovered as dodecamers similar to recombinant rat SP-D (rrSP-D), a major fraction accumulated as multimers of dodecamers indistinguishable from human proteinosis SP-D. As previously shown for the rat protein, rhSP-D agglutinated specific strains of influenza A virus (IAV), inhibited viral hemagglutinin activity, and protected neutrophils (PMN) from deactivation by IAV. However, the potency of rhSP-D multimers was severalfold greater than for purified dodecamers, comparable to natural, proteinosis hSP-D. Although rhSP-D multimers were also more potent than the serum collectins in mediating viral aggregation and protection of PMN, they were less potent than conglutinin in inhibiting infectivity in vitro. These studies establish that the propensity of hSP-D to form multimers of dodecamers is determined by its primary structure and demonstrate carbohydrate recognition domain valency-dependent interactions of SP-D with IAV.

Expression of insulin-like growth factor II (IGF-II), IGF binding protein-2 and myogenin during differentiation of myogenic satellite cells derived from the turkey

Myogenic satellite cells are essential for the development of postnatal skeletal muscle. The proliferation and differentiation of these cells are, in part, regulated by the insulin-like growth factors (IGFs), and it has been shown that the IGF binding proteins (IGFBPs) are capable of modulating the actions of IGFs. We have examined the endogenous expression of IGF-II, IGFBP-2 and the myogenic regulatory factor, myogenin, during differentiation of clonally derived turkey muscle satellite cells. Cells were harvested at approximately 80% of confluent density. Additional cultures were rinsed, fed differentiation medium and harvested when approximately 20%, 60% and 80% differentiated (fused). Northern blot analyses were performed using total cellular RNA and labeled rat cDNAs specific for IGF-II, IGFBP-2 and myogenin. A single IGF-II mRNA transcript of approximately 4.0 kb was observed. The relative mRNA abundance was highest in proliferating cultures and decreased with the onset of differentiation, to approximately 60% of initial levels where it remained throughout differentiation. Use of the IGFBP-2 cDNA probe indicated a single mRNA transcript of approximately 2.0 kb. The level of expression of IGFBP-2 mRNA was highest in proliferating cells and decreased to 25%, 16% and 11% of initial levels as differentiation progressed. A single 1.8 kb mRNA transcript was detected with the myogenin probe. Expression of myogenin was undetectable in proliferating cultures and increased significantly as differentiation progressed. Serum-free medium was conditioned for 24 h (CM) at each time point and collected from similar cultures. An IGFBP species of M(r) approximately 30,000 was detected in CM by probing western blots with [125I] IGF-I (ligand blot analysis). The intensity of this band decreased with differentiation to 35%, 24% and 18% of the level for proliferating cultures. Western blots were also probed with an antibody raised against the M(r)-34,000 bovine IGFBP-2. This antibody specifically bound to the M(r)-30,000 IGFBP, and the level of antibody binding decreased as differentiation progressed. It therefore appears that IGF-II, IGFBP-2 and myogenin are expressed in a differentiation-dependent manner by turkey myogenic satellite cells and may thus be involved in the process of differentiation of avian muscle cells.

Second malignancies after Ewing's sarcoma: radiation dose-dependency of secondary sarcomas

BACKGROUND

An excess risk of second malignancies has been reported in survivors of Ewing's sarcoma. We examined a multiinstitutional data base to reevaluate the risk among survivors of Ewing's sarcoma and to identify possible causal factors.

METHODS

Information was derived from a data base that included 266 survivors of Ewing's sarcoma. Cumulative incidence rates of second malignancies were calculated. Contributions of clinical features, type and dose of chemotherapy, and cumulative radiation dose to the risk of second malignancies were evaluated.

RESULTS

After a median follow-up duration of 9.5 years (range, 3.0 to 30), 16 patients have developed second malignancies, which included 10 sarcomas (five osteosarcomas, three fibrosarcomas, and two malignant fibrous histiocytomas) and six other malignancies (acute myeloblastic leukemia, acute lymphoblastic leukemia, meningioma, bronchioalveolar carcinoma, basal cell carcinoma, and carcinoma-in-situ of the cervix). The median latency to the diagnosis of the second malignancy was 7.6 years (range, 3.5 to 25.7). The estimated cumulative incidence rates at 20 years for any second malignancy and for secondary sarcoma were 9.2% (SD = 2.7%) and 6.5% (SD = 2.4%), respectively. The cumulative incidence rate of secondary sarcoma was radiation dose-dependent (P = .002). No secondary sarcomas developed among patients who had received less than 48 Gy, while the absolute risk of secondary sarcoma was 130 cases per 10,000 person-years of observation among patients who had received > or = 60 Gy.

CONCLUSION

The overall risk of second malignancies after Ewing's sarcomas is similar to that associated with treatment for other childhood cancers. The radiation dose-dependency of secondary sarcomas justifies modification in therapy to reduce radiation doses.

Function changes in spinal muscular atrophy II and III. The DCN/SMA Group

The course of spinal muscular atrophy (SMA) is not well established except for those patients whose age of onset is before 6 months and who achieve only "sit with support" as their maximum function (Werdnig-Hoffmann disease or SMA I). This study shows that there is another group of SMA patients whose age of onset and maximum function achieved can be used as prognostic guides. Fifty percent of SMA patients who could walk without assistance and whose onset was prior to age 2 years lost the ability to walk independently by age 12. Fifty percent of SMA patients who walked and whose onset was between 2 and 6 years of age lost walking ability by age 44 years. Fifty percent of SMA patients who could walk with assistance as their best function ever achieved lost this ability by age 7 years, unrelated to age of onset; none could walk with assistance after age 14 years. Seventy-five percent of SMA patients who developed the ability to sit independently as their best function were still sitting after age 7 years independent of age of onset; 50% of this group could sit independently after age 14 years. Eighty-five percent of SMA patients who could walk could not negotiate stairs without holding onto a rail. They could raise their hands above the head; however, as they lost walking ability, they lost this function as well. Only one SMA patient whose maximum function was sitting independently could get to the sitting position on his own. Only two of these patients could hold their hands above their heads. All patients with SMA lose function over time. This function loss occurs slowly and is related primarily to maximum function achieved; knowledge of age of onset provides helpful information, especially for predicting the loss of independent walking.

Effect of concentrate source and amount in diets on plasma hormone concentrations of prepubertal heifers

Effects of concentrate source (corn or soybean hulls) and amount (40 or 80% of DMI) on plasma hormone concentrations were evaluated for 32 prepubertal Holstein heifers in a 2 x 2 factorial design. Blood samples were collected every other day from d -4 through d 28 of the experiment and were analyzed for growth hormone, prolactin, IGF-1, and glucose. Ruminal samples were collected by esophageal tube on d 0, 7, 14, 21, and 28 and were analyzed for VFA content. Serial blood samples were collected on either d 25 or 26 at 20-min intervals for 8 h and were used for profile analysis of growth hormone and prolactin. Heifers fed 80% concentrate had higher IGF-1 concentrations in serum (158.1 vs. 131.9 ng/ml) than did heifers fed 40% concentrate, and heifers fed corn tended to have higher IGF-1 concentrations than heifers fed soybean hulls. Prolactin concentrations in samples that were collected every other day were higher for heifers fed the 80% soybean hull diet than for those fed 40% concentrate diets or the 80% corn diet. Effects of source and amount of concentrate on plasma prolactin concentrations were not evident in serial samples. Concentrate source or amount had no effect on plasma growth hormone or glucose. At high concentrate intakes, the source (soybean hulls vs. corn) affected intake parameters, ruminal VFA content, and prolactin concentrations.

Serum insulin-like growth factor I (IGF-I) concentrations are increased in pigs fed antimicrobials

The effect of antimicrobial supplementation on the sera concentrations of IGF-I was determined in crossbred weanling pigs. Pigs were allotted by weight, litter, and sex to either a control diet or a diet supplemented with ASP-250 (22.7 ppm of chlortetracycline, 22.7 ppm of sulfamethazine, and 11.4 ppm of penicillin) for 5 wk. The diets contained 21.8% crude protein and 1.15% lysine. Growth performance data were collected weekly. Insulin-like growth factor I and insulin-like growth factor binding protein (IGFBP) analyses were performed on blood samples that were drawn during the final week of the trial. Feeding ASP-250 to young pigs increased their sera IGF-I concentrations by 24.8% (P < .001). A 59% increase in sera IGFBP-3 levels also was observed. The pigs fed ASP-250 had a 26% increase in average daily gain (P < .01), a 6.7% improvement in gain:feed ratio (P < .05), and a 18.5% increase in feed consumption (P < .01) compared with pigs fed the control diet. Increased serum IGF-I concentrations with antimicrobial feeding may be involved in the enhanced growth performance observed.

Hormonal regulation of IGF-binding protein-2 expression in proliferating C2C12 myoblasts

No studies have investigated the hormonal regulation of IGF-binding protein-2 (IGFBP-2) secretion and mRNA expression in myoblasts. In this study, cells of the C2C12 mouse myoblast cell line were used to examine the effects of various agents on the hormonal regulation of IGFBP-2. Conditioned medium (CM) was collected and cells were harvested at 2, 4, 6, 15 and 24 h after exposure to treatment media containing porcine insulin (pINS) or recombinant human IGF-I (rhIGF-I), and at 6, 15 and 24 h after exposure to treatment media containing dexamethasone (DEX) or prostaglandin E2 (PGE2). Relative abundance of a single 1.8 kb IGFBP-2 mRNA transcript was determined by Northern analysis using total cellular RNA and a labeled cDNA specific for rat IGFBP-2. IGFBP-2 was detected in CM by probing Western blots with 125I-IGF-I (ligand blot analysis). We have previously shown by immunoblot analysis that the predominant 32,000 M(r) protein on ligand blots is IGFBP-2. Treatment with 10(-9) or 10(-6) M pINS led to a rapid reduction (P < 0.01) in relative IGFBP-2 mRNA abundance and protein secretion relative to controls. Treatment with 7 x 10(-10) or 7 x 10(-9) M (5 or 50 ng/ml) rhIGF-I increased IGFBP-2 mRNA abundance and protein secretion (P < 0.01). Cultures treated with 10(-8) M DEX exhibited significantly increased (P < 0.001) IGFBP-2 mRNA and protein. IGFBP-2 secretion was not affected by 10(-6) M PGE2 but mRNA levels were higher than controls at 24 h (P < 0.01). These findings suggest that multiple factors, including growth factors and metabolic hormones, are involved in regulating IGFBP-2 expression in C2C12 myoblasts.

Screening for patients at risk of diabetic foot ulceration in a general diabetic outpatient clinic

An examination of the reproducibility of three tests for identifying patients at risk of diabetic foot complications is reported. One thousand and one patients attending a general diabetic outpatient clinic at the Royal Liverpool University Hospital underwent screening using the Semmes-Weinstein monofilaments, the biothesiometer, and palpation of pedal pulses. Two hundred and fifty-nine patients who were found to have a deficit on at least one of these tests were given a second appointment where the tests were repeated. Two hundred and twenty-nine patients attended for their second appointment. The expected range of variation in readings for the biothesiometer was 5 log hertz, sufficient variation to make the biothesiometer unacceptable as a screening instrument. The range of reproducibility for the four pedal pulses was from 68% to 81%, also an unacceptable level of variation. Over 85% of the results for the Semmes-Weinstein monofilaments were the same on the first and second measurement. Of the three instruments examined in this study, only the Semmes-Weinstein monofilaments have sufficient reproducibility in the clinical setting for them to be recommended for general use as a screening test for risk of diabetic foot complications.

European Nosocomial Infection Survey: analysis of Irish data. Irish Intensive Care Nosocomial Pneumonia Survey Group

The European Nosocomial Infection Survey enrolled 9127 patients in 14 countries providing epidemiological data on pneumonia in 325 Intensive Care Units (ICU). Ten ICUs took part in Ireland recruiting 205 patients. Using strict diagnostic criteria, the pneumonia rate for the Irish group was 11.7%; European-wide it was of 11.8%. The ICU mortality Ireland was 14.2%, in the overall survey it was 14.3%. The pneumonia mortality rate in the overall survey was 30%.

Mild posttraumatic hypothermia reduces mortality after severe controlled cortical impact in rats

The effect of posttraumatic hypothermia (brain temperature controlled at 32 degrees C for 4 h) on mortality after severe controlled cortical impact (CCI) was studied in rats. Four posttraumatic brain temperatures were compared: 37 degrees C (n = 10), 36 degrees C (n = 4), 32 degrees C (n = 10), and uncontrolled (UC; n = 6). Rats were anesthetized and subjected to severe CCI (4.0-m/s velocity, 3.0-mm depth) to the exposed left parietal cortex. At 10 min posttrauma the rats were cooled or maintained at their target brain temperature, using external cooling or warming. Brain temperature in the UC group was recorded but not regulated, and rectal temperature was maintained at 37 +/- 0.5 degrees C. After 4 h, rats were rewarmed over a 1-h period to 37 degrees C, extubated, and observed for 24 h. In the 37 and 36 degree C groups, 24-h mortality was 50% (37 degrees C = 5/10, 36 degrees C = 2/4). In the 32 degree C group, 24-h mortality was 10% (1/10). In the UC group, brain temperature was 35.4 +/- 0.6 degrees C during the 4-h treatment period and 24-h mortality was 0% (0/6). Mortality was higher in groups with brain temperatures > or = 36 degrees C versus those with brain temperatures < 36 degrees C (50 vs. 6%, respectively; p < 0.05). Additionally, electroencephalograms (EEG) were recorded in subsets of each temperature group and the percentage of time that the EEG was suppressed (isoelectric) was determined. Percentage of EEG suppression was greater in the hypothermic (32 degrees C, n = 6; UC, n = 4) groups than in the normothermic (36 degrees C, n = 3; 37 degrees C, n = 6) groups (23.3 +/- 14.3 vs. 1.2 +/- 3.1%, respectively; p < 0.05). Posttraumatic hypothermia suppressed EEG during treatment and reduced mortality after severe CCI. The threshold for this protective effect appears to be a brain temperature < 36 degrees C. Thus, even mild hypothermia may be beneficial after severe brain trauma.

Porcine reproductive and respiratory syndrome (PRRS): a review, with emphasis on pathological, virological and diagnostic aspects

Despite early attempts to control the spread of the disease, porcine reproductive and respiratory syndrome (PRRS) has now become endemic in many countries including Britain. The occurrence of subclinical herd infections, the prolonged circulation of virus within herds and probable aerogenic virus spread all mitigated against the success of control measures. The origin of the disease is unknown but the causative agent has been shown to be an arterivirus with shared features to lactate dehydrogenase virus of mice. There is evidence of extreme genetic and antigenic variability between American and European isolates. PRRS virus has a predilection for alveolar macrophages and does not grow in most cell lines. In infected pigs, viraemia can persist for many weeks in the face of circulating antibodies and little is known about the mechanisms by which immunity to infection develops. A wide spectrum of disease has been reported from the field, accompanied in some cases by heavy economic losses. Reproductive and perinatal losses were most prominent when the disease first appeared. In the endemic phase, PRRS may be more significant as a contributory factor to a post-weaning respiratory syndrome of young pigs of 3-8 weeks. On-farm techniques have been developed to reduce the recycling of PRRS virus from older infected nursery pigs to the younger newly weaned pig. Vaccines are now marketed for the control of PRRS, but are not licensed for use in Britain. Improvements in knowledge of virion composition and antigenic stability and in the nature of the immune response of the pig should result in genetically engineered subunit vaccines becoming available. Diagnosis of PRRS is still difficult as many animals do not show clinical signs and may only be detected by serology and often only when other respiratory diseases are being investigated. Now that the infection is widespread, serological testing must be properly targeted and interpreted to give meaningful results about virus circulation. An increasing arsenal of diagnostic methods are becoming available to detect virus in both fresh and fixed specimens. The pathogenic mechanisms of PRRS remain poorly defined and more work is needed to reveal the nature of the interaction between PRRS virus and other factors in disease.

Pattern of nasal secretions during experimental influenza virus infection

To define the pattern of secretion production during influenza virus infection, 28 adult subjects were inoculated with influenza-A virus (H1N1) and cloistered for a period of 8 days. On each day, symptoms associated with virus infection were scored, nasal secretions were collected and nasal lavages were performed. Recovered lavage fluids were submitted for virus culture and assayed for proteins, histamine, and bradykinin. Twenty-one subjects were infected with influenza-A virus and had significant increases in daily secretion weights and symptom scores extending from day 2 to 7, post-inoculation. Plasma-derived proteins in the nasal lavage fluids showed an early increase to peak at day 4 and then decreased. Glandular proteins showed a later increase to peak at day 5. Bradykinin but not histamine was significantly elevated and tracked the changes in the glandular proteins. In contrast, a shallow increase in symptoms confined to day 2 post-inoculation, but no increase in daily secretion weights was documented in the seven uninfected subjects. There, an increase in plasma proteins was observed on days 1 and 2, but no change in glandular proteins was obvious. These results support a biphasic secretory response during influenza-virus infection with transudation dominating the early period and glandular secretions contributing later.

Initial experience with 1.5-mm2 high impedance, steroid-eluting pacing electrodes

In this human study, 21 atrial and 62 ventricular 1.5-mm2 unipolar steroid-eluting pacing electrodes were implanted in 64 patients. Pacing thresholds, lead impedance, and sensing measurements were measured via pacemaker telemetry within 24 hours postimplant, and at 1, 2, 3, 4, 6, 12, 24, and 52 weeks. Acute pacing impedances measured via a pacing systems analyzer were 1,039 +/- 292 (atrial) and 1,268 +/- 313 ohms (ventricular). A 10%-15% decline in the mean telemetered atrial and ventricular pacing impedances was observed at 1 week, but thereafter remained stable. Acute pacing thresholds at 0.5 ms were 0.5 +/- 0.3 V (atrial) and 0.4 +/- 0.1 V (ventricular). Filtered P and R wave amplitudes were 3.7 +/- 2.3 mV and 14.9 +/- 5.9 mV, respectively. In 21 patients, no complications related to the atrial electrode were observed. Of 62 patients with ventricular electrodes, 4 patients (6%) experienced complications and required surgical intervention. On these, causative factors included micro-dislodgment (1 patient), and perforation (1 patient). Sudden unexplained exit block occurred late (> 6 weeks) in two patients. In the remainder of patients, pacing thresholds and sensed electrogram amplitudes remained stable throughout the 52-week follow-up period.

CONCLUSIONS

The present study validates that smaller surface (i.e., 1.5 mm2) steroid-eluting electrode designs offer excellent pacing and sensing performance with significantly higher pacing impedances. Although questions remain as to the cause of late exit block in two patients in this series, this relatively small surface electrode design offers promise toward achieving greater pacing efficiency and a theoretical 13%-16% (minimum) enhancement in permanent pacemaker longevity.

Polar body diagnosis of common aneuploidies by FISH

PURPOSE

The purpose of this work was to investigate the reliability and accuracy of polar body analysis for preimplantation diagnosis of common aneuploidies in IVF patients of advanced maternal age.

DESIGN

We have previously introduced polar body analysis as an approach for nondestractive evaluation of the genotype of human oocytes. The method has recently been applied in a clinical trial involving 45 infertile patients, demonstrating the feasibility of preconception diagnosis of common aneuploidies by fluorescent in situ hybridization (FISH). The present paper describes the experience of polar body diagnosis in 135 IVF patients (161 cycles) of advanced maternal age.

RESULTS

FISH results of the first and/or second polar bodies were available in 648 (72.4%) of 895 biopsied oocytes subjected to FISH analysis. Of 648 oocytes with FISH results, 208 demonstrated chromosomal abnormalities. Of 440 oocytes predicted to be free from monosomy or trisomy of chromosomes X, 18, and/or 13/21, 314 were normally fertilized, cleaved, and transferred in 122 treatment cycles, resulting in 6 healthy deliveries and 12 ongoing pregnancies following confirmation of the polar body diagnosis by CVS or amniocentesis.

CONCLUSIONS

The method may be useful for detection of oocytes with common chromosomal trisomies in IVF patients of advanced maternal age.

Molecular cloning and sequence analysis of the porcine insulin-like growth factor binding protein-5 complementary deoxyribonucleic acid

We report here for the first time the isolation of a cDNA clone containing the open reading frame sequence for porcine insulin-like growth factor binding protein-5 (pIGFBP-5) and the complete deduced amino acid sequence for this porcine IGFBP. The cDNA sequence shares 94%, 90% and 91% identity to its human, mouse and rat counterparts, respectively. The deduced amino acid sequence consists of 252 amino acids and a putative 19 amino acid signal and shares 97%, 96%, and 96% identity to the human, mouse and rat peptides, respectively. The mature peptide contains the 18 conserved cysteines found in all of the IGFBPs. Northern blot analysis of total RNA isolated from porcine heart, muscle and spleen using a 315 base pair cDNA insert derived from the pIGFBP-5 open reading frame sequence revealed a single mRNA transcript of 6.0 kilobases.

Flow cytometric crossmatching in renal transplantation--outcome after five years

The association of a positive flow cytometric crossmatch between recipient IgG directed against donor T lymphocytes and poor outcome is well described in renal transplantation. Until now, no long-term follow-up on such patients has been available. A total of 117 renal transplant patients were followed up for a period of 5 years. Of these, 21 were known to have donor T cell-directed IgG and 5 had B lymphocyte-directed IgG. Both groups of patients with these antibodies had a significantly poorer outcome at 5 years than did the group of patients without IgG (P < 0.0001 Handel Maenzel test). Patients with antibody detected preoperatively were tested again, either at the time of graft failure or at 5 years posttransplantation. The sera were tested against stored donor cells and the intensity of surface IgG compared with the preoperative levels. In those recipients who lost their grafts, the levels increased in 60% of cases but those that retained their grafts also had an increase in levels of donor-directed antibody in 50% of cases. The changing levels of antibody therefore appeared to have little relevance to outcome. However, when IgG isotypes were considered, for those who experienced graft failure and also had a gamma 3 isotype, a rise in IgG was demonstrated in all cases. Conversely, successful grafts with gamma 3 had a decline in levels between preoperative and 5-year samples in three of the four cases (p not significant).

Effects of strength training on cardiovascular responses during a submaximal walk and a weight-loaded walking test in older females

PURPOSE

The purpose of this study was to examine the effects of a total body strength training program on oxygen uptake (VO2), heart rate (HR), systolic blood pressure (SBP), and rate pressure product (RPP) during a submaximal walk and a weight-loaded walking test in healthy women 60-77 years old.

METHODS

The submaximal walk (2 mph and 3.5% grade) took place during stage 3 of a graded exercise test. The weight-loaded walking task consisted of treadmill walking at 2 mph while carrying a box weighing 40% of maximum isometric elbow flexion strength. The women strength trained three times per week for approximately 1 hour per session for 16 weeks.

RESULTS

Paired t tests determined that strength increased by 57% on six isotonic strength tests (one repetition maximum) and by 29% on two isometric strength tests. A repeated measures analysis of variance (ANOVA) was used to determine the pre- to post-differences between and within the two tests (alpha = 0.05). There was no change in VO2 but HR, SBP, and RPP decreased significantly during the submaximal walk and the weight-loaded walking test. However, average HR (135 to 120 bpm) and RPP (23.3 x 10(3) to 19.3 x 10(3)) decreased more during the weight-loaded walking test than during the submaximal walk (HR: 108 to 104 bpm; RPP 18.3 x 10(3) to 17.0 x 10(3)).

CONCLUSIONS

In conclusion, the reduced HR, SBP, and RPP indicates that strength training may reduce cardiovascular stress during daily tasks in healthy older women.

Ambulatory elderly patients of primary care physicians: functional, psychosocial and environmental predictors of need for social work care management

With increasing numbers of elderly people, and the escalating costs of health care, screening becomes increasingly important for identifying those older people with social health care needs who appear in their primary care physicians' offices. Many people are not aware of available social services. Families with serious social problems are not finding the help they need. The aim of this study was to develop and refine a questionnaire as a screening tool to identify elderly outpatients in primary care settings who are at high risk for psychological, social or environmental needs. This study identified those ten factors at each site which were most indicative that further intervention was needed. There were consistencies among the coordinators across sites in terms of what factors triggered intervention. Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) were more likely to be predictive of the coordinator's intervention than were other factors.