The effect of two different 18-week walking programmes on aerobic fitness, selected blood lipids and factor XIIa

Forty-nine previously sedentary or low active individuals aged 40-71 years were allocated to three groups. The long walking group participated in an 18-week walking programme which consisted of walks lasting 20-40 min; the repetitive short walking group completed walks of between 10 and 15 min, up to three times a day, with no less than 120 min between each walk; and the control group maintained their low level of activity. Both walking programmes began at a prescribed 60 min x week(-1), which increased steadily up to 200 min x week(-1) by week 12. During the study, the long walking group walked for an estimated 2514 min (139 min x week(-1)), expending an estimated 67.5 MJ (3.72 MJ x week(-1)) at an estimated 73% of their age-predicted maximum heart rate and 68% of their estimated VO2max. The repetitive short walking group walked for an estimated 2476 min (135 min x week(-1)), expending an estimated 58.5 MJ (3.17 MJ x week(-1)) at an estimated 71% of their age-predicted maximum heart rate and 65% of their estimated VO2max. The results showed a statistically significant reduction in heart rate during a standardized step test (pre- vs post-intervention) in both walking groups, indicating an improvement in aerobic fitness, although the control group showed a higher average heart rate during the post-intervention test, indicating reduced fitness. When compared with the male subjects pre-intervention, the females possessed more favourable levels of high-density lipoprotein (HDL) cholesterol (P< 0.001), apolipoprotein (apo) AI (P < 0.001) and ratios of total cholesterol:HDL cholesterol (P< 0.02) and low-density lipoprotein (LDL) cholesterol: HDL cholesterol (P< 0.02). Compared with the controls post-intervention, the walking groups showed no statistically significant changes in total cholesterol, LDL cholesterol, HDL cholesterol, apo AI, apo AII, apo B, or the ratios of total cholesterol: HDL cholesterol, LDL cholesterol: HDL cholesterol, apo AI: apo B or apo AI: apo AII (P > 0.05). Relative to the walking groups, factor XIIa increased in the control group (P < 0.05). We conclude that, although both walking programmes appeared to improve aerobic fitness, there was no evidence of improvements in the blood lipids or associated apolipoproteins of the walking groups. Further analysis indicated that this apparent lack of change may have been related to the subjects' relatively good pre-intervention blood lipid profiles, which restricted the potential for change. The implications of the observed changes in the coagulation/fibrinolytic factors remain unclear.

Effects of candesartan cilexetil in patients with severe systemic hypertension. Candesartan Cilexetil Study Investigators

The efficacy, tolerability, and safety of the potent angiotensin II receptor blocker candesartan cilexetil were evaluated in 217 adult patients (68% men, 41% black) with severe systemic hypertension on background therapy with hydrochlorothiazide (HCTZ) in a 4-week, multicenter, randomized, double-blind, placebo-controlled study. Patients with sitting diastolic blood pressure (BP) > or =110 mm Hg during the placebo run-in received HCTZ 12.5 mg once daily for 1 week. Those with sitting diastolic BP >95 mm Hg after the HCTZ run-in were randomized (2:1) to receive candesartan cilexetil 8 mg once daily (n = 141) or placebo (n = 76), plus HCTZ 12.5 mg. After 1 week of double-blind treatment, patients with sitting diastolic BP > or =90 mm Hg were uptitrated to candesartan cilexetil 16 mg once daily or matching placebo, plus HCTZ 12.5 mg; 84% required uptitration. Primary efficacy measurement was a change in trough (24+/-3 hours after treatment) sitting diastolic BP from the end of the HCTZ run-in to double-blind week 4. Mean changes in systolic and diastolic BP were significantly greater with candesartan cilexetil than with placebo, -11.3/-9.1 mm Hg versus -4.1/-3.1 mm Hg, p <0.001/p <0.001, respectively. Patients with higher sitting diastolic BP at the end of the HCTZ run-in tended to have greater decreases in BP (p <0.05). Most patients (53%) receiving candesartan cilexetil were responders (diastolic BP <90 mm Hg or > or =10 mm Hg decrease) and 32% were controlled (diastolic BP <90 mm Hg). Tolerability and safety profiles were similar in the candesartan and placebo groups. In conclusion, candesartan cilexetil 8 to 16 mg once daily was an effective and well-tolerated therapy for lowering BP when added to HCTZ 12.5 mg in a diverse population of patients with severe systemic hypertension in the United States.

Renal abnormalities in ankylosing spondylitis

The incidence of renal abnormalities is increased in patients with ankylosing spondylitis (AS). Possible mechanisms include the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), an increased incidence of glomerulonephritis and the deposition of amyloid. We assessed renal function in 51 patients with AS randomly selected from those attending routine rheumatology clinics. Five patients were found to have a definite renal abnormality and three of them underwent renal biopsy. These showed one case each of IgA glomerulonephritis, focal segmental glomerulosclerosis and nonspecific tubulo-interstitial damage. A sixth patient had recurrent haematuria and borderline renal functional impairment but refused further investigation. The urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) was elevated in four patients; two had other biochemical evidence of renal damage while the other two patients appeared normal, although they had both received spinal irradiation in the past. The finding of a significant renal abnormality in 10% of AS patients suggests that evidence of renal involvement should be actively sought in this disease.

Clinical implications of resilient denture lining material research. Part I: Flexibility and elasticity

The clinical use of resilient denture liners is based on their flexibility and elasticity. The nine commercial resilient denture liners measured were less flexible during and after simulated chewing and clenching test sequences. The elasticity of the intraoral-cure liners reached maximal values at 24 hours. Although interpretations require caution, the results imply that the dentist should (1) use maximum liner thickness in the denture base when conditioning abused supporting tissues because of the material's tendency to stiffen under function, and (2) leave a functional impression in the mouth for at least 24 hours before pouring the cast.

In vitro crevice corrosion behavior of implant materials

The crevice corrosion susceptibility of cold-worked Type 316LVM stainless steel, cast Co-Cr-Mo, wrought Co-Cr-W-Ni, non-nitrided and nitrided Ti-6Al-4V ELI, and c.p. Ti, Grades 1 and 4, was studied in vitro by means of a crevice cell. Occlusion was created by interfacing a disc specimen and a Teflon bar. Specimens were mechanically prepared through 2-4 micron Al2O3 and passivated in 30% HNO3, followed by steam sterilization. Tests were performed in a deaerated Ringer's solution, maintained at pH = 7 and 37 degrees C. Anodic polarization was conducted potentiostatically at pre-selected levels, and resultant currents were monitored: stainless steel, 50 and 100 mV (S.C.E.), 450 min; non-stainless materials, 600 mV, 1000 min. Results for the stainless steel demonstrated that a HNO3 passivation treatment reduced its crevice corrosion susceptibility. For the non-stainless steel materials, no crevice corrosion susceptibility was observed, although a dulling and discoloration of c.p. Ti was evident. Recognizing that 600 mV is in excess of the O2 reduction potential in vivo, it was concluded that, in the absence of fretting, implants of these non-stainless steel materials would not experience significant corrosion loss under crevice conditions.

The response of dental amalgam to dynamic loading

A conventional (gamma 2-containing) dental amalgam was fatigue-tested at 1800 and 80 cycles/min, employing uni-axial, sinusoidal loading, with R = -8. Compressive, tensile, and creep tests were conducted to characterize the alloy's static mechanical behavior. Tests were performed at 37 degrees C on specimens which were aged for seven days, at 37 degrees C. Fatigue-tested specimens were microscopically examined for fracture surface appearance and crack path. The amalgam demonstrated a frequency dependence and a significant reduction in fracture strength due to fatigue loading. The fatigue crack path was primarily intergranular in the gamma 1 phase and inclined at approximately 45 degrees to the principal stress axis. These observations are characteristic of some metals when subjected to low-frequency, elevated temperature testing where significant grain boundary sliding occurs, and therefore suggest a creep-fatigue interaction for this alloy.

Hamster cheek-pouch testing of dental soft polymers

The hamster cheek pouch provides a suitable model system for the mucous-membrane irritation testing of dental materials. Poor retention of materials or difficulties in histopathological interpretation caused by surgical artifacts have been reported in published techniques. We describe a new "pouch-in-pouch" technique for mucous membrane irritation tests. The retention rate of polymer discs was 97% and 87% at 14 and 35 days, respectively. Clear differentiation was obtained between the tissue reaction to the test materials and the surgical procedure. Polymer discs containing dibutyltin diacetate (DBTD) or dibutyl phthalate (DBP) as plasticizer resulted in epithelial changes, including epithelial atypia, early papillomas, and areas resembling dysplasia. The potentially pre-malignant nature of these changes requires further investigation.

Neuropharmacological studies with SPECT in neuropsychiatric disorders

The last decade saw a rapid development of single photon emission computed tomography (SPECT) from a tool to assess cerebral blood flow to the study of specific neurotransmitter systems. Because of the relatively long half-life of SPECT radioisotopes, it is practical to measure the availability of neuroreceptors and transporters in conditions approaching equilibrium. The cost-efficiency of SPECT allowed studies in relatively large samples of patients with various neuropsychiatric disorders. We have applied this approach in studies of dopaminergic, serotonergic, and muscarinergic neurotransmission in patients with dementia, extrapyramidal disorders, schizophrenia, and alcoholism. No simple associations were observed between a single defect in one neurotransmitter system and a certain neuropsychiatric disease. Instead, complex dysfunction of several neurotransmitter systems in multiple, partially connected brain circuits have been implicated. Treatment effects also have been characterized. Microdialysis and neurotransmitter depletion studies showed that most radioligands and endogenous neurotransmitters compete for binding at receptors and transporters. Future research directions include the assessment of endogenous neurotransmitter concentrations measured by depletion studies and of genetic effects on neuroreceptor and transporter expression.

Clinical compliance of two resilient denture liners

Although intra-oral-setting resilient denture liners have been used for 30 years to treat the severely resorbed residual ridges of elderly patients, their clinical physical properties are not well understood. The effect of clinical usage on the compliance (compressibility, flexibility) of two intra-oral-setting resilient denture liners was measured in 10 patients, for up to 30 days. The clinical compliance of Material B (Coe-Comfort) was found to be significantly greater than Material A (Veltec) for up to 14 days. At 24 h both materials had significant compliance reductions from the original 1 h measurement. These compliance reductions continued throughout the testing period. For up to 14 days of clinical usage there were no significant differences between the compliance reductions of the two materials. The study suggests that (i) Material B would provide more effective tissue conditioning of abused residual ridge mucosa than Material A; and (ii) a functional impression made with these materials should be left in the mouth for at least 24 h before the cast is poured.

Crevice corrosion products of dental amalgam

The objective of this study was to determine the in vitro corrosion products that resulted from crevice corrosion of low- and high-copper dental amalgams. Specimens were potentiostatically polarized in a chloride-containing electrolyte while set against a PTFE surface to form a crevice. After 16 h, corrosion products were examined by light microscopy, SEM, EDS, and XRD. Analysis showed the presence of three previously reported products [Sn4(OH)6Cl2, SnO, and Cu2O] and a new product, CuCl, which formed on high-copper, gamma 2-free amalgams. Thermodynamic considerations show that CuCl is stable for the reported in vivo potentials of amalgam restorations and the high acidity and high chloride ion concentration associated with crevice corrosion.

A novel hemoglobin-binding peptide reduces cell-free hemoglobin in murine hemolytic anemia

Hemolysis can saturate the hemoglobin (Hb)/heme scavenging system, resulting in increased circulating cell-free Hb (CF-Hb) in hereditary and acquired hemolytic disease. While recent studies have suggested a central role for intravascular hemolysis and CF-Hb in the development of vascular dysfunction, this concept has stimulated considerable debate. This highlights the importance of determining the contribution of CF-Hb to vascular complications associated with hemolysis. Therefore, a novel Hb-binding peptide was synthesized and linked to a small fragment of apolipoprotein E (amino acids 141-150) to facilitate endocytic clearance. Plasma clearance of hE-Hb-b10 displayed a rapid phase t(1/2) of 16 min and slow phase t(1/2) of 10 h, trafficking primarily through the liver. Peptide hE-Hb-B10 decreased CF-Hb in mice treated with phenylhydrazine, a model of acute hemolysis. Administration of hE-Hb-B10 also attenuated CF-Hb in two models of chronic hemolysis: Berkeley sickle cell disease (SS) mice and mice with severe hereditary spherocytosis (HS). The hemolytic rate was unaltered in either chronic hemolysis model, supporting the conclusion that hE-Hb-B10 promotes CF-Hb clearance without affecting erythrocyte lysis. Interestingly, hE-Hb-B10 also decreased plasma ALT activity in SS and HS mice. Although acetylcholine-mediated facialis artery vasodilation was not improved by hE-Hb-B10 treatment, the peptide shifted vascular response in favor of NO-dependent vasodilation in SS mice. Taken together, these data demonstrate that hE-Hb-B10 decreases CF-Hb with a concomitant reduction in liver injury and changes in vascular response. Therefore, hE-Hb-B10 can be used to investigate the different roles of CF-Hb in hemolytic pathology and may have therapeutic benefit in the treatment of CF-Hb-mediated tissue damage.

Intrarenal abscess. Report of 14 cases

Six of 14 patients with renal abscess had prior history of urinary tract infection; initial symptoms included fever and flank pain in 12. A drip-infusion intravenous pyelogram was the most sensitive radiologic test, but selective renal arteriography was most specific. Urine cultures were positive in all 14 patients; blood cultures were positive in nine. Six patients were treated with antibiotics alone and eight required surgery. Of the eight, five had pus-filled cavities, one had multiple stones, one had a renal infarct, and one had a resolving abscess. Of six treated with antibiotics alone, one died of unrelated complications and five have demonstrated no pathological renal condition after three to six years.

4F decreases IRF5 expression and activation in hearts of tight skin mice

The apoAI mimetic 4F was designed to inhibit atherosclerosis by improving HDL. We reported that treating tight skin (Tsk^−/+) mice, a model of systemic sclerosis (SSc), with 4F decreases inflammation and restores angiogenic potential in Tsk^−/+ hearts. Interferon regulating factor 5 (IRF5) is important in autoimmunity and apoptosis in immune cells. However, no studies were performed investigating IRF5 in myocardium. We hypothesize that 4F differentially modulates IRF5 expression and activation in Tsk^−/+ hearts. Posterior wall thickness was significantly increased in Tsk^−/+ compared to C57Bl/6J (control) and Tsk^−/+ mice with 4F treatment assessed by echoradiography highlighting reduction of fibrosis in 4F treated Tsk^−/+ mice. IRF5 in heart lysates from control and Tsk/+ with and without 4F treatment (sc, 1 mg/kg/d, 6–8 weeks) was determined. Phosphoserine, ubiquitin, ubiquitin K⁶³ on IRF5 were determined on immunoprecipitates of IRF5. Immunofluorescence and TUNEL assays in heart sections were used to determine positive nuclei for IRF5 and apoptosis, respectively. Fluorescence-labeled streptavidin (SA) was used to determine endothelial cell uptake of biotinylated 4F. SA-agarose pulldown and immunoblotting for IRF5 were used to determine 4F binding IRF5 in endothelial cell cytosolic fractions and to confirm biolayer interferometry studies. IRF5 levels in Tsk^−/+ hearts were similar to control. 4F treatments decrease IRF5 in Tsk^−/+ hearts and decrease phosphoserine and ubiquitin K⁶³ but increase total ubiquitin on IRF5 in Tsk^−/+ compared with levels on IRF5 in control hearts. 4F binds IRF5 by mechanisms favoring association over dissociation strong enough to pull down IRF5 from a mixture of endothelial cell cytosolic proteins. IRF5 positive nuclei and apoptotic cells in Tsk^−/+ hearts were increased compared with controls. 4F treatments decreased both measurements in Tsk^−/+ hearts. IRF5 activation in Tsk^−/+ hearts is increased. 4F treatments decrease IRF5 expression and activation in Tsk^−/+ hearts by a mechanism related to 4F’s ability to bind IRF5.

The usefulness of echocardiography in the surgical management of infants with congenital heart disease

Between January 1988 and August 1991, at The Children's Heart Center, Atlanta, 83 infants with congenital heart defects were diagnosed by echocardiography and underwent surgery without cardiac catheterization. The diagnostic categories included 46 infants with left heart obstructive lesions, 19 infants with cyanotic heart lesions, and 18 infants with miscellaneous lesions. Forty-five infants (55%) underwent surgery under cardiopulmonary bypass. There were three errors in diagnosis, yielding a diagnostic accuracy of 95%. Many infants with congenital heart disease can be accurately and completely diagnosed by echocardiography and can safely undergo surgery without cardiac catheterization.