Isolation, stabilization, and molecular weight estimation of thyroid hormone receptors of tadpole and chick embryo erythrocytes. Typical procedures for the isolation of triiodothyronine (T3) receptors from mammalian nuclei involve extraction of nuclei with buffers containing divalent cations and 0.40M KCl. However, when applied to tadpole erythrocyte (RBC) nuclei, this method gave low yields of relatively unstable T3 receptors. The use of EDTA (10 mM) and 0.4M KCl in a sucrose-Tris buffer resulted in the extraction of 90% of the specifically bound [125I]-T3 from RBC nuclei. It was also found that 5 mM thiol reagent (DTT, GSH, or beta-mercaptoethanol) was required for maximal stability of the receptor. Fractionation of labeled RBC nuclear extracts on a Sephadex G-100 column yielded only one peak of specific T3 binding activity. The T3 receptor peak eluted at the same position as bovine serum albumin (BSA), with an estimated mol wt of 68 kDa. Specific T3 binding activity was destroyed by protease digestion but not by DNAse or RNAse. Scatchard analysis of the fractions from the receptor peak supported the existence of one class of T3 binding sites, with an estimated Kd (about 7 pM) comparable to the Kd reported for the intact RBC. Using the same methods, T3 receptors from the nuclei of chick embryo RBCs were also isolated, again with a Kd (7 pM) similar to that for the intact RBC. The chick receptor also eluted from the Sephadex G-100 column at the same position as BSA. The estimated mol wt of the T3 receptors from both sources is comparable to those reported for T3 receptors from other sources. The results show that T3 receptors derived from both tadpole and chick RBC nuclei could be isolated in a soluble and stable form with no apparent change in Kd.


A novel, highly conserved structural motif is present in all members of the steroid receptor superfamily. Steroid and thyroid hormone receptor superfamily members are ligand potentiated transcription factors. Recent evidence indicates that one aspect of steroid receptor action is an interaction with other trans-acting factors, such as the glucocorticoid receptor with the AP1 transcription factor, for example. Using a structural approach to identify domains of the glucocorticoid receptor responsible for interactions with affiliated transacting factors and DNA, we have identified a putative helix-turn-zipper motif that is conserved in all steroid, thyroid hormone, retinoic acid, and vitamin-D3 receptors. This structural motif is also conserved among new members of the family, the peroxisome proliferator-activated receptors and the retinoid-X receptors. This structural domain is characterized by a pair of amino acids (I,L,V)P that is conserved in all superfamily members. Additional characteristics include six heptad repeats of hydrophobic amino acids, four of which form a canonical leucine zipper in the rat glucocorticoid receptor. Although this leucine repeat is not absolutely conserved among superfamily members, the periodicity of hydrophobic residues is conserved throughout. Based on sequence analyses from the GenEMBL and SwissProt databases using the Genetics Computer Group and MacVector sequence analysis software packages, and the Brookhaven structural database, we present evidence for a novel structural domain, a helix-turn-zipper that is conserved in all superfamily members, and may function in transactivation of cognate genes.


Angiotensin II receptor subtypes in rat renal preglomerular vessels. A simple technique to isolate rat renal preglomerular vessels is described. Kidneys were pressed against a 0.3 mm stainless steel grid. The whole vascular tree, including the interlobar, arcuate, and interlobular arteries, as well as the afferent arterioles, remained on the grid surface from where they were recovered. Extensive washing yielded a highly pure preparation of renal microvessels. Radioligand binding experiments were performed to characterize 125I-[Sar1,Ile8]-ANG II binding sites in preglomerular microvessel membranes. Equilibrium saturation binding experiments revealed the presence of one group of high affinity receptors (Kd = 1.22 +/- 0.171 nM; Bmax = 209 +/- 14 fmol/mg protein). Competitive inhibition experiments with two highly specific nonpeptide ANG II antagonists, losartan (DuP 753), which is specific for the AT1 receptor subtype, and PD123319, which is specific for the AT2 subtype, demonstrated that the large majority of, if not all, ANG II receptors in rat renal preglomerular vessels correspond to the AT1 subtype.


[The evolution and structure of morbidity from extrarespiratory tuberculosis in the last 15 years in Romania]. Though in comparison with the overall lethality of tuberculosis the extra-respiratory localizations of the disease showed a markedly less weight than the respiratory ones during the past 15 years (12.8% in 1975 and 6.7% in 1989), this pathology chapter is still essential due to the diversity of Tb forms and localizations. The annual average rate of the decrease in extra-respiratory tuberculosis incidence was of 4.8% between 1975-1989, so the incidence value reached 4.2%000 at the end of the last year of study. Just like 15 years ago, in 1989 the extra-respiratory tuberculosis incidence was dominated by the localizations on the peripheral lymph nodes (1.2%000), on bones and joints (1.0%000), urogenital apparatus (0.7%000), meninges and central nervous system (0.5%000). The prevalence of patients with extra-respiratory Tb localizations was gradually diminished so that only 3415 cases were registered in the IIIrd group of the active case-index in 1989 (13,524 in 1975). More than half of the number of deaths through extra-respiratory tuberculosis were still due to tuberculous meningitis, particularly in children aged 0-4 years (82% of deaths in 1989). A further diminution up to a total elimination of extra-respiratory Tb localizations (still about 1,000 new cases a year) can be reached only by a restriction and liquidation at the same time of both primary and secondary pulmonary tuberculoses.


The double life of the IGF-1 receptor.

The double life of the IGF-1 receptor. The IGF-1 receptor is expressed in many cell types, and its activation by its ligands is a required step for the proliferation of many cells in vivo and in vitro. In most cells in culture, requiring more than one growth factor for growth, the IGF-1 receptor can be found in one of two different modes: in the first mode, although it is autophosphorylated by its ligands and induces the expression of specific genes, it does not transmit a mitogenic signal. In the alternative mode, i.e., after priming with an unrelated growth factor, the IGF-1 receptor responds to its ligands with a mitogenic stimulus. This review examines briefly the possible alternatives to explain this different behavior, which is crucial to our understanding of the control of cellular proliferation.


Reflux nephropathy in adults.

Reflux nephropathy in adults. Reflux nephropathy (RN), the main complication of the vesico-ureteral reflux (VUR), relatively frequent in adults, is often the consequence of recurrent urinary infections in the child, hood or during pregnancy. Unilateral RN has generally a benign course but the bilateral one, with important nephron destruction, leads to focal and segmental glomerulosclerosis, manifested by high levels of proteinuria. A certain degree of cicatrization and renal failure are followed by progressive impairment of the remaining renal function, even if VUR is cured. An early diagnosis, treatment of the acute bacterial infection, adequate ingestion of liquids, regulation of the intestinal transit and complete bladder voiding by miction, associated with hypotensive and antiinfectious drug therapy lead to VUR disappearance in 80% of the cases, avoiding renal failure. Surgery is indicated only in the patients with severe reflux and with congenital or obstructive anomalies, as well as in the case of recurrent infection resistant to antibiotherapy.


Myocardial involvement in systemic lupus erythematosus and systemic sclerosis--pulsed Doppler echocardiographic evaluation of left ventricular diastolic function. Myocardial involvement (MI) in connective tissue diseases is commonly found at autopsy but seldom recognized clinically. To assess the subclinical MI, the left ventricular (LV) diastolic function was studied in 16 patients with systemic lupus erythematosus (SLE) and 15 patients with systemic sclerosis (SSc) by means of pulsed Doppler echocardiography. Patients with abnormal LV systolic function were not included. A control group (C) included 16 sex and age-matched healthy subjects. The parameters analyzed were: peak early diastolic flow velocity (E), peak late diastolic flow velocity (A), E/A ratio, isovolumic relaxation time (IRT). LV diastolic function was found impaired in SLE and SSc patients even when systolic function was normal as could be demonstrated by pulsed Doppler echocardiography.


Contribution of the high amplitude electrocardiography to the detection of ventricular late potentials in several cardiovascular diseases. The criteria for detection of ventricular late potentials (VLP) by high amplitude electrocardiography (ECG) in the frequency domain were evaluated in 75 patients with cardiovascular diseases, mostly men (85%), with a mean age of 57 years, distributed by disease type into three subgroups: (1) with a history of myocardial infarction (MI)--53 cases; (2) with syncopes, episodes of prolonged ventricular arrhythmias--18 cases; (3) with unobstructive, primary cardiomyopathies--4 cases. Complete clinical examination, standard ECG, continuous 24 hr Holter ECG, high amplitude ECG (Corazonix system) for detection of VLP by analyses in the time domain (TD) and in the frequency one (FD) were performed in all the cases. The VLP incidence was evidently high in all the cases. By association of the analyses in TD and FD, the accuracy of VLP detection increased by 17.3% in the whole group (from 64% to 81.3%). The incidence of severe ventricular arrhythmias (class 4-5 Lown, i.e., doubled and/or trebled ventricular extrasystoles, salvos of unsustained ventricular tachycardia) was evidently higher in the patients with VLP (88% compared with 77% in the absence of VLP), thus demonstrating the presence, in most of the patients studied, of an arrhythmogenic mechanism by ventricular reentry.


The prognostic value of late ventricular potentials for sudden death. Sixty patients of whom 51 with old myocardial infarction--30 with late ventricular potentials and 30 without--were followed up for 5 years. The late ventricular potentials were recorded using an original method. During the follow-up period, in the group, with late ventricular potentials, sudden death was recorded in 6 patients and episodes of ventricular tachycardia in 2. No sudden death occurred in the patients without late ventricular potentials. The prognostic value of this simple, noninvasive technique is emphasized.


Serum cholesterol and apoprotein B levels and serum cholinesterase activity in selected hematologic malignancies. As compared to values recorded in 10 healthy normal-weight normolipidemic control subjects, serum cholesterol and apoprotein B levels as well as serum cholinesterase activity were found to be obviously decreased in the 28 patients with acute leukemia, the lowest levels being associated with the worst prognosis. The values of the above-mentioned biochemical variables in the 21 patients with chronic disorders (13 with chronic myeloproliferative disease and 8 with chronic lymphocytic leukemia) were not as low as in patients with acute leukemia. It should however be mentioned that in patients with chronic myelogenous leukemia, the lowest levels of serum cholesterol were correlated with a large tumor burden as assessed by a score taking into account for clinical and hematologic parameters. It is concluded that hypocholesterolemia could be regarded as a factor of adverse prognosis in hematologic malignancies, being probably the result of both enhanced catabolism of low density lipoproteins and impaired hepatic lipoprotein synthesis.


Pattern of antigens A and B distribution on the surface of AB group red blood cells--an argument in support of the concept of "genetic oscillation". Using a mixture of mouse monoclonal antibodies anti red blood cell (RBC) AgA and human antibodies anti RBC AgB coupled to fluorescein isothiocyanate (FITC) conjugated goat antimouse monoclonal antibodies and to phycoerythrin (PE) conjugated goat antihuman monoclonal antibodies, we obtained the distribution of these antigens on the AB RBC surface. The analysis of 30 samples of 30,000-100,000 RBCs each was carried out using flow cytometry and revealed three kinds of AB RBC populations: (1) a population characterized by maximum concentration of AgA and minimum concentration of AgB; (2) a complementary population characterized by minimum concentration of AgA and maximum concentration of AgB; (3) an intermediary equilibrated population with about equal concentrations of the A and B antigens. This pattern corresponds to the pattern of oscillating genetic activity defined as "genetic oscillation", a concept amply discussed in the paper.


Hypertrophic osteoarthropathy secondary to bronchopulmonary cancer (our experience). During 5 years (1986-1990), 81 of the patients under our care showed bronchopulmonary cancer diagnosed by clinical, x-ray and bronchoscopic examinations. Of these, 69 (85.2) were men and 12 (14.8%) women, with a mean age of 62 years; 72 patients (90%) were moderate or heavy smokers. Four of them (4.9%) presented the classical hypertrophic osteoarthropathy (HOA) described by Bamberger and Pierre Marie, i.e., finger clubbing, ossifying periostitis of the long bones, joint pains and swelling. Other 3 patients showed only finger clubbing, while 7 of 30 cases studied by systematic x-ray examinations of the long bones presented ossifying periostitis (5 cases) or hyperostosis (2 cases). It results that almost one third (31.6%) of the patients with bronchopulmonary cancer had a complete or incomplete Bamberger-Pierre Marie syndrome. It is concluded that HOA identification before the clinical and x-ray manifestations of bronchopulmonary cancer could contribute to an early diagnosis of this malignant disease.


Age-dependent variations of the plasma peroxides and total antioxidants in women with obesity and hypothyroidism. The concentrations of peroxides, total antioxidants and free sulfhydryl (SH) groups in the plasma of normal persons vary depending on age and sex. The most significant differences for peroxides were found between young and old people over 60 years in both sexes. For the SH groups, significant differences were observed only between young and older women, while in men, similar differences were found only for total antioxidants. In women, the association of obesity with hypothyroidism induces a significant increase of peroxides even at the age of 35 years. This significant increase goes in parallel with a increase of uric acid and a decrease of the total antioxidants. Considering the inclusion of uric acid and of free SH groups among the natural antioxidants, the changes observed in obesity associated with hypothyroidism may suggest a tendency of an adaptation of the organism since hypothyroidism favors the peroxidation of lipids. Up to a certain age, varying according to the individuals, the rise of lipid peroxides is compensated by the increase of certain antioxidants, especially of uric acid.


Highly active effect of alpha interferon in blocking the cutaneous delayed hypersensitivity. A group of 13 patients with contact dermatitis to various chemical compounds such as potassium dichromate, nickel sulphate, formaldehyde and balsam of Peru, was investigated by patch test and by the agreement between the history of disease and the patch test, the specific allergen involved in each special case could be demonstrated. Two-three days after the first patch test three normal skin areas were chosen. The first area was intradermally infiltrated with alpha-2a Interferon (IFN) (100,000 I.U. in 1 ml), the second area was infiltrated with saline and the third area, considered as control, did not receive any treatment. Once more the corresponding allergen was applied into the skin in a second patch-test. After 48 hours in the IFN infiltrated area, only the delayed contact hypersensitivity become negative thus proving that alpha-2a IFN behaves as an efficient inhibitor of these immune effector reactions. Since the lymphocytes involved in the delayed type hypersensitivity reactions (in our case contact dermatitis) belong to the T helper line, i.e., are CD-4 positive cells we conclude that alpha-2a IFN in vivo is an efficient inhibitor of the activation of these cells. This effect achieved by any CD-4(+) DTH clones does not depend on their antigenic specificity. Some clinical trials are now in progress in our laboratory to turn to account this important biological effect in the clinical practice as an efficient inhibitor in skin contact dermatitis.


Therapeutic modalities in severe infections. Theoretic considerations. The advantages of discontinuous versus continuous antibiotherapy are discussed as a therapeutic method in severe infections. The main scientific achievements related to the criteria of discontinuous antibiotherapy are discussed as a therapeutic modality consisting in administration of moderate doses of usual antibiotics every 12th hours. The advantages and disadvantages of the classical continuous and discontinuous antibiotherapies are presented and amply discussed.


Effect of calcium blocking agents of the verapamil series on the myocardium mitochondrial activity in experimentally induced arterial hypertension. Some mitochondrial biochemical parameters were determined in Wistar rats with experimentally induced arterial hypertension (AHT) treated with calcium blocking agents of the Verapamil series. The results obtained showed that succinic dehydrogenase (SDH) activity increased, in the group with AHT, by 23.4% as compared with the control group while in the group with AHT treated with Verapamil the activity of this enzyme increased by 46.7%. The NAD+ dehydrogenase activity showed a moderate increase (15.7%) in the group with AHT and an increase by 22.3% after administration of Verapamil. The mitochondrial content in thiolic groups presented an increase of 12.5% in the group with AHT and of 24.4% in the treated group. The kinetics of the mitochondrial swelling-contraction also presented changes in as much as the cycle period, first increased then partially returned to normal values after Verapamil treatment. The strongly stimulating effect of Verapamil on the enzymatic activity in the Krebs cycle was also demonstrated.


A survey of invasive Haemophilus influenzae infections--England and Wales. A survey of invasive H. influenzae infections has been underway in 6 regions of England and Wales since September 1990. In the first year, there were 433 cases of which 362 (84%) were due to H. influenzae type b (Hib). The majority of Hib infections were in children aged less than 5 years (annual incidence in this age group is 26.4/100,000). Meningitis occurred in 56% of cases of Hib infection. The results confirm previous evidence of the need to incorporate Hib vaccination into the childhood immunization schedule. The ongoing survey data will provide useful information to assess the impact of an Hib immunization program.


[The characteristics of the extreme actions on the bodies of deep-sea divers during saturation dives and the basic task of medical support for these descents]. A novel dive method, namely, saturation diving is presented. Extreme factors affecting the deep divers during such saturation dives are listed. The physiologic parameters of early adaptation, stable adaptation, early disadaptation and readaptation periods of a man during prolonged staying in a hyperbaric artificial gaseous environment are evaluated. The key task of medical monitoring of saturation dives is discussed.


[The late sequelae of the systematic action of a complex of real diving factors on the pulmonary ventilatory function of deep-sea divers]. Parameters which characterize lung volumes, absolute and relative flow rates, breathing reserve, were found unchanged with increasing age and record of active dive service, and in some deep-divers these parameters were growing up. This was disclosed due to comparative analysis of lung ventilatory function changes in divers through certain amount of years of professional occupation. At the same time a significant decrease in small to middle calibre bronchi patency was noted. In 30% of experienced deep-divers the mean maximal forced expiratory flow at 75% forced vital capacity (FEF75) decreased to 39% of predicted value at one-second forced expiratory volume (FEV1) being normal. Maximal expiratory flow at 50% forced vital capacity (FEF50) were in inferior normal limit (52% of predicted value).


[The dynamics of functional heart volumes in the descents of divers to depths of up to 15 m]. In an underwater environment at a depth up to 15 m the cardiodynamic parameters of resting and exercising man were recorded echocardiographically. Increased functional volumes of the heart and decreased ejection fraction (EF) have been noted. Underwater reactions of the cardiac functional volumes in response to exercise were characterized by: a maximum rise in systolic volume on exposure to low level loading; decreases of end diastolic and end systolic blood volumes; an elevation of EF lower than on the surface. With an increase in diving depth the functional reserves of the heart of exercising man are exhausted more rapidly.


[The readaptation of the respiration, blood circulation and body oxygen regimen in aquanauts after saturation dives to depths of up to 450 m]. Main trace posthyperbaric and postdecompression responses to respiration, circulation and oxygen profiles, dynamics of their reduction in 99 aquanauts at pressure of 46 kgs/cm2 (0.46 mPa) during 14-30 day period have been studied. The respiratory changes were found to be characterized by: ventilatory function disorders which followed the obstructive-restrictive pattern; discoordination of ventilation regulation and slowing down of respiratory gas transport through aerohematic barrier. The hemodynamic shifts have been manifested as cardiac rhythm instability, heart pump function followed by decreased cardiac contractions on exercise exposures. The economy and efficiency of body oxygen profiles in a respiration loop become lower than that in hemodynamic loop. The rate of the alveolar oxygen supply is decreased to the levels lower than the rates of oxygen supply by arterial and mixed venous blood. The long-term functional rearrangement of respiratory gas transport followed by the phase changes combined with the specific and nonspecific reactions persisting over a period of 30-60 days and more longer after decompression, is existed.


[The effect of 2- and 3-component hyperbaric breathing mixtures on the self-stimulation reaction and on the skeletal muscle electromyogram of rabbits]. The effects of two- and three-component normoxic mixtures on self-stimulation and total bioelectrical activity of the skeletal muscles were evaluated in six test runs with 37 male rabbits. The increased partial pressures of He and N2 are found to affect differently intensity of self-stimulation which is enhanced in an O2-N2 environment and suppressed in that one consisting of He-O2. The He-N2-O2 mixture in which N2 amounts to 6% under pressure of 40 kgs/cm2 does not cause significant changes in self-stimulation as compared to that exposed by He-O2 breathing mixture. In contrast, trimix breathing (N2 amounts to 6%) under the same pressure did not result in an elevation in amplitude of muscular electric activity observed when used hyperbaric He-O2 breathing mixture. The experimental results may be indicative of an involvement of different mechanisms in genesis of the nervous syndrome of high pressure as well as of the fact that adding of N2 to He-O2 mixture does not allow this pathologic state to be completely prevented.


[Oxygen and hydrogen dynamics in the skin of aquanauts under a prolonged hyperbaric exposure]. Polarographic measurements of the dynamics of partial pressures and diffusion parameters of O2 and H2 in the skin of aquanauts during prolonged hyperbaric exposure to He-O2 breathing to 3, 3.6 mPa were performed. It was indicated that at an early exposure stage there occur the distinct changes in cutaneous oxygen profiles manifested as: increased rate of local blood flow, decreased intensity of O2 utilization and due to this as elevated cutaneous PO2 levels. It is also noted that at the same exposure time an abrupt transient decline in diffusion rates of H2 and O2 through tissue and cell membrane of the skin of aquanauts is occurred.


[The effect of the simulation of a prolonged dive to 100 m in a helium-oxygen environment on human erythrocytes]. Three volunteers participated in the experiments to study the osmotic resistance and elemental composition of the erythrocytes during a 100-meter simulated saturation dive in He-O2 environment. The 15-day hyperbaric exposure resulted in a significant increase of erythrocytes resistance in response to a changed osmotic environment which was also maintained at an early stage of readaptation. The X-ray spectral local microanalysis revealed a decrease in chlorine, potassium and sodium level's on the 2nd postdecompression day. On a prolonged hyperbaric exposure at the expense of phospholipid exchange between plasma erythrocytes and lipoproteins, the erythrocyte membrane changes which may cause disturbances in ionic permeability of the cells are expected to occur.


[Water-salt metabolism and its hormonal regulation studied in the 2nd joint Soviet-French space flight]. During a 25-day space mission of French cosmonaut on board Mir station, the joint Soviet-French Czecho-Slovak experiment "Minilab" has been conducted in order to evaluate a fluid-electrolyte metabolism status and its hormonal control at different flight stages and early postflight. In cosmonaut venous blood was drawn twice, and 24-hour urine samples were collected on mission Days 5 and 19. With the aid of Plasma-02 equipment the blood plasma and urinary samples were treated, frozen and maintained aboard the station. Postflight, frozen samples were delivered to the laboratory for further analyses. In-flight, urinary excretion of fluid and sodium decreased by 25-35%. On mission Day 9, the blood plasma levels of vasopressin increased by 450% and on Day 20 by 700% as opposed to the baseline levels, blood aldosterone content was also elevated with an increased renal excretion of both hormones. Blood plasma renin activity elevated two-fold, and atrio-natriuretic factor (ANF) content practically did not differ from a baseline value. In-flight circulating plasma volume (CPV) decreased by 20%. Postflight, there occurred the body hypohydration and activation of the hormonal systems providing a retention of body fluids and electrolytes to restore an adequate CPV and fluid-electrolyte homeostatic as a whole.


[The electrical and contractile responses during hyperbarism in the frog neuromuscular preparation]. The well-known phenomenon of incrementing muscular contraction intensity induced by an increased ambient pressure is still unclear (P. Regnard, 1891). This study was done in order to establish whether an increased contraction intensity is the result of enhanced effect of triggering stimuli in response to pressure elevation to 100 atm or a rise in muscle contraction intensity depends on other reasons. When studying the nerve stimulation electric response (muscle action potential, MAP) at increased pressure, the MAP amplitude significantly decreased about two-fold whereas the contraction intensity increased two-fold. The response duration was also elevated. Since electric stimulation was supramaximal in an intensity throughout the experiment the contraction-generating nervous impulse was sufficient for stimulating all the muscle fibers. No significant changes in other parameters of electric potentials occurring during neuromuscular transmission under pressure have been found which agrees with available neurophysiologic data. Thus, the causes responsible for an increased contraction intensity appear to depend on an altered muscle fiber contractility. This phenomenon provides the basis for understanding the changes in peripheric structures of the body and the periphery contribution to the genesis of hyperbaric nervous syndrome.


[Cardiac bioelectrical activity in healthy men during 370-day head-down tilt hypokinesia]. Nine men, aged 27-42 yrs, have been examined during a 370-day head-down tilt (HDT) experiment. The group A test subjects (4 persons) used the countermeasures involving exercises, pharmacological means to correct metabolism, bone tissue and digestive function. The group B test subjects (5 individuals) have embarked on exercising only in 120 days of bedrest. The electrocardiographic changes in the group A test subjects were insignificant, manifested mainly as a moderately decreased T-wave amplitudes in the most leads. In the group B test subjects at early HDT stages there was a negative dynamics: an elevated heart rate (HR) at rest, an increased time of atrioventricular transmission, decreased T-wave amplitudes followed in some cases by its widening and deformations. After the onset of physical training there appeared a tendency toward normalizing the values although T-wave amplitudes till terminating a bedrest period never reached baseline levels. In a rehabilitation period, both groups displayed the dynamics similarity: initially the HR lability and certain decrease in T-wave amplitudes were noted. By the end of 2nd month of rehabilitation the ECGs in all the test subjects of both groups practically normalized, but in Group B this process developed more slower. Thus, a year-long HDT experiment exerted a moderately adverse effect on myocardium metabolism and HR control mainly in the Group B test subjects. The observed changes are reversible and can be regarded as functional.


[The hemodynamics and activity of the sympathetic-adrenal system in air traffic controllers during their professional duties]. A functional status of the circulation and catecholamines excretion in air traffic controllers operating in two shifts (morning and daytime duties) and attending a Start air traffic control system have been assessed. It is shown that a correlations pattern between parameters under study is significantly altered depending on an occupational activity time. The dependence of hemodynamic shifts on an activity of hormonal and mediator components of sympathetic-adrenal system, an accomplishment of the catecholamine effects on cardiovascular activity with an involvement of alpha- and beta-adrenoreceptor system are shown.


[Lipid peroxidation and the system of antioxidant protection in rats following a 13-day space flight on the Kosmos-1887 biosatellite]. After a 13-day space mission, in the rats flown on Cosmos-1887 biosatellite the parameters of lipid peroxidation and antioxidant defense system--the contents of diene conjugates, malonic dialdehyde, Schiff bases, tocopherol, total antioxidant activity (in blood plasma only), antioxidant enzyme activity (in tissues only)--superoxide dismutase, catalase, glutathio peroxidase, glutathio reductase have been measured in the blood plasma, myocardium, skeletal muscles and liver. The liver level of diene conjugates, Schiff bases and tocopherol decreased, and an activity of superoxide dismutase and catalase increased. In the skeletal muscles there was an elevation of diene conjugate contents followed by the decreases in malonic dialdehyde and superoxide dismutase activity. In rat myocardium, superoxide dismutase activity and tocopherol levels increased significantly. In the blood plasma the levels of tocopherol, malonic dialdehyde and total antioxidant activity were elevated. It is concluded that the observed changes in lipid peroxidation developed probably in response to an effect of the last dynamic stage of space flight and during re-adapting to the Earth environments.


[The spontaneous and evoked neuronal activity of the parietal associative cortex in cats during motion sickness]. In the experiments with the cats a spontaneous and induced activity of the neurons (57) of parietal associated cortex during motion sickness was studied. It was found that after a 15 min motion sickness 54 percent of the examined neurons displayed suppression, 20 percent of neurons did an increase of spontaneous activity. Twenty-six percent of neurons did not respond to motion sickness. The dynamics of induced neuronal responses under motion sickness effect was complex, a direction of the changes in induced responses frequently did not agree with that of alterations in a spontaneous cellular activity. The more stable changes of induced responses have been in the neurons with phase responses to the fight and electrocutaneous stimulation. After 45-min effect of motion sickness, the light-stimulated responses were characterized by an increase of early and suppression of late components of a response, and the responses to electrocutaneous stimulation displayed mainly a suppression of the early components of the responses.


[The hematological status of rats born and raised under increased gravitational force]. Blood and bone marrow morphology of the rats the pre- and postnatal development of which up to the ages of 60 and 75 days took place under 2g environments induced by a continuous centrifuge rotation. The response to a reduced gravity was studied in 60-day-old rats on post-rotation days 2 and 15. Immediately post-rotation, these animals exhibited: an intensified erythropoiesis resulting in an elevated erythroid cell counts, an activated eosinophilopoiesis and decreased level of neutrophilopoiesis. Return of the animals to a terrestrial environment during a 2-week period has caused a greater increase of erythroid production and the tendency toward normalizing granulocytopoiesis. In the 75-day-old rats developed under 2g, erythro- and granulocytopoiesis have tended to be recovered and bone marrow population of lymphoid and plasma cells was significantly decreased. The results point to the fact that hemopoiesis adaptation to an increased gravity during the studied period of time is not accomplished and this hematologic status depends on a changed status, of the controlling systems.


[The comparative characteristics of the bone marrow cellular composition in rats after the prolonged continuous or interrupted action of a low geomagnetic field]. Bone marrow cell composition in male Wistar rats exposed to long-term continuous (Run 1) or interrupted (Run 2) hypo-geomagnetic field (HGMF) with an attenuation coefficient of 172.5 generating in a permalloic chamber has been studied. When comparing the rat myelograms of the two test runs, a significant increase of lymphoid cell content, less pronounced during an interrupted exposure to HGMF by 10.1 and 6.5%, respectively, was noted. Analysis of myeloid cell response indicated that on a continuous exposure to HGMF the percentage of neutrophilic promyelocytes and myelocytes is somewhat declined. The levels of mature relating to stab and nuclear-segmental neutrophils in bone marrow during both modes of HGMF exposures practically remained unchanged. A certain decrease in cell fractions of erythroblastic shoot (chiefly at the cost of polychromatophilic normocytes), to a lesser extent manifested during an interrupted exposure to HGMF (by 5.8 and 2.4%, respectively) was noted. Long-term exposure of the animals to a weak terrestrial magnetic field causes a particular eosinophilia of bone marrow due to an increased fraction of mature eosinophils approximately similar on both HGMF profiles (by 2.1 and 2.0% respectively). On an interrupted HGMF exposure there was a significant myelogram elevation of the mast cell counts by 1.4%.


[The characteristics of lipid ligand binding by serum albumin in athletes]. The ability of serum albumin to bind lipids, fatty acids and products of their peroxidation was studied in well trained sportsmen during a competitive period. Detected quantitative and qualitative alterations point to a protein involvement in metabolic changes in an adaptation to work loads.


[Evoked potentials of the human brain during prolonged fasting]. Dynamics of the visual evoked potentials of human brain during a long-term alimentary starvation is studied. During a 14-day fasting in healthy male volunteers abrupt changes are found in an amplitude and shape of the evoked potentials in the site of occipital leads: increase of time and maximum amplitude of the response; level of residual murmur; duration and square of slow negative wave; integrated spectral densities (ISDs), ranged 0.1-1; 1-4 and 4-8 Hz; decrease of ISDs ranged 8-13 Hz. On a 14th day of food consumption, the measurements of all the evoke potential parameters are somewhat declined but significantly exceed the baseline levels. Also, fasting results in changing a pattern of spatial sequence of the evoked potentials: an increase of the mean values of response time in all the lead sites; a rise of maximum amplitude of response in occipital lead sites, and a slight statistically insignificant trend to a diminished amplitude of response in temporal lead sites.


Social support and stressful life events: age differences in their effects on health-related quality of life among the chronically ill. There is substantial evidence of individual variation in health-related quality of life measures that is not accounted for by age or disease condition. An understanding of factors that determine good health is necessary for maintained function and improved quality of life. This study examines the extent to which social support and stressful life events were more or less beneficial for the long-term physical functioning and emotional well-being of 1,402 chronically ill patients. Analyses, conducted separately in three age groups, showed that social support was beneficial for health over time regardless of age. In addition, low levels of support were particularly damaging for the physical functioning of older patients. Stressful life events impacted differentially on health-related quality of life; relationship events had an immediate effect on well-being which diminished with time; financial events had an immediate negative effect on functioning and well-being which persisted over time for middle-aged patients; bereavement had a delayed impact on quality of life, with the youngest patients especially vulnerable to its negative effects; work-related events had both negative and positive effects, depending on age group. Results reinforce the importance of identifying and dealing with psychosocial problems among patients with chronic disease.


Do the pictures influence scores on the Dartmouth COOP Charts? To determine the effect of illustrations on COOP Chart responses. Randomized split-half design of 177 patients discharged from a medical centre during a 3 month interval. Patient responses were obtained. However, there are benefits from the use of illustrations. Further research measures. Demographic characteristics and health status. No response differences were observed between patients who received COOP Chart illustrations and those who did not receive illustrations. Pictures do not appear to affect responses to COOP Charts. However there are benefits of the use of illustrations. Also, further research should be conducted with other patient populations and other COOP Charts before conclusive statements can be made regarding the use of illustrations with the COOP Charts.


[The righting reaction in the free fall of rats after a flight on the Kosmos-936 biosatellite]. The free fall turning over reaction has been studied in the weightless and centrifuged rats flown on board Cosmos 936. There occur particular changes of the reaction in the weightless rats after landing and its complete absence in eyes-closed centrifuged rats. The possible mechanisms responsible for the observed alterations are discussed.


Does changing the heart mean changing personality? A retrospective inquiry on 47 heart transplant patients. Heart transplantation is not simply a question of replacing an organ that no longer functions. The heart is often seen as source of love, emotions, and focus of personality traits. To gain insight into the problem of whether transplant patients themselves feel a change in personality after having received a donor heart, 47 patients who were transplanted over a period of 2 years in Vienna, Austria, were asked for an interview. Three groups of patients could be identified: 79% stated that their personality had not changed at all postoperatively. In this group, patients showed massive defense and denial reactions, mainly by rapidly changing the subject or making the question ridiculous. Fifteen per cent stated that their personality had indeed changed, but not because of the donor organ, but due to the life-threatening event. Six per cent (three patients) reported a distinct change of personality due to their new hearts. These incorporation fantasies forced them to change feelings and reactions and accept those of the donor. Verbatim statements of these heart transplant recipients show that there seem to be severe problems regarding graft incorporation, which are based on the age-old idea of the heart as a centre that houses feelings and forms the personality.


Reliability and validity of a health-related quality of life battery for evaluating outpatient antidepressant treatment. This study was designed to evaluate the reproducibility, validity and responsiveness of a health-related quality of life (HRQOL) battery that was assembled for the evaluation of antidepressant therapy. The Montgomery-Asberg Depression Rating Scale was used to measure severity of depression. The HRQOL battery contained measures of energy and fatigue, social behaviour, cognitive function, home and work role function, and general well-being (i.e., health perceptions, life satisfaction) selected from previously developed and validated instruments. The clinical investigators and research nurses reported on difficulty in using the HRQOL battery. Most patients were able to complete the questionnaire without problems within 10 min. Reproducibility was very good with intraclass correlation coefficients ranging from 0.74 to 0.97. The HRQOL scales showed evidence of good concurrent validity. The scales were moderately correlated with MADRS scores (r = 0.30-0.62). The magnitude of these correlations indicate that HRQOL scales are related to depression measures, but they are not alternative measures of depression. Changes in MADRS scores were associated with changes in all scales, except for work behaviour, indicating that improvements in depression ratings also resulted in improvements in health status and well-being. The HRQOL scales included in this study were found to be reliable, reproducible, and valid and no appreciable burden was placed on patients or investigators participating in the study. With the exception of the Work Behaviour scale, the HRQOL scales were very responsive to changes in depression severity. This brief HRQOL instrument can provide a comprehensive assessment of the outcomes of antidepressant treatment.


A reformulation of quality of life for medical science. Current quality of life measuring tools are suited for economic decision making, not to investigate causal processes which lead to patients making evaluations of their lives. An alternative approach is presented based on research into positive versus negative life-satisfaction. Quality of life is a causal sequence of psychological states where perceived symptoms cause problems and the problems and symptoms cause evaluations, and where the causal sequence is a complex interaction between morbidity and psychological factors. Different types of medical intervention affect different stages in the causal sequence and so different types of quality of life instrument are needed for different kinds of medical research.


Measurement of quality of life in patients: psychometric analyses of the Functional Living Index-Cancer (FLIC). Biomedical advances in medical care and treatment have highlighted potential trade-offs between the length and quality of a patient's life. There is increasing need for psychometrically sound measurement of quality of life in medical patients. Psychometric analyses of the Functional Living Index-Cancer (FLIC) were conducted on data from 530 consecutive patients with histologically confirmed cancer. To examine construct validity, a principal components analysis was conducted that revealed a five-factor solution accounting for 70% of the variance in a random half of the original sample and 68% in a cross-replication sample. Content analysis indicated that domains of physical, psychological and social functioning are assessed along with the patient's view of their current well-being and disease symptoms. Convergent-discriminant validity was shown with independent measures of symptoms and anxiety. Most, but not all expected differences in quality of life by demographic and psychological variables were found. Within the limitations imposed by the study and its sample, the FLIC appears to be a conceptually sound, internally consistent instrument worthy of use and further study in other health care samples.


Change and status in quality of life in patients with rheumatoid arthritis. Current status in quality of life and deterioration retrospectively attributed to the disease by patients with rheumatoid arthritis (RA) were examined. The study group included 169 female and 53 male patients with probable (n = 70), definite (n = 127) and classical RA (n = 25). In a cross-sectional postal survey the participants self-rated their quality of life according to a generic self-assessment package tailored in part for this study. Shortened parallel ratings by significant others were also performed. The impact of RA on quality of life was pervasive. Heaviest intrusion emerged within the physical life sphere and the behavioural and activity domain, followed by the impact on global life satisfaction and habits. Material, psychological and social life domains were less disrupted. In spite of the pervasive discomfort attributed to the illness, quality of life status was mostly rated as being 'rather good' to 'good'. There was a consistent pattern: the better off currently, the less disturbance from the disease perceived. Higher age and longer duration of RA were significantly correlated to a lower status. In addition, individuals still working rated a higher quality of life and less intrusion of the disease. Self-ratings were corroborated by ratings of significant others. While there was an agreement on the level of the negative impact of the disease, the patients rated their current situation more positively than did significant others. The dual assessment of quality of life status and change appears reasonable and informative as regards rheumatoid arthritis.


Psychosocial problems of donor heart recipients adversely affecting quality of life. Heart transplantation has become an accepted therapy for patients suffering from terminal heart disease for whom neither standard forms of medication nor the usual surgery are of any benefit. Although results regarding postoperative quantity and quality of life are encouraging, it must not be overlooked that the patient and his family face, and have to overcome, profound psychosocial problems. The main stressors were identified in interviews with 47 heart transplant patients. The main preoperative problems were: the way of being informed about the diagnosis, the waiting period for transplantation, anguishing doubts about the decision to have a transplant, being a body without heart ('zombie'), guilt and shame regarding the donor, the reactions of others. Postoperatively the patients have to cope with: re-entering social systems, reactions of friends, neighbours and colleagues, rejection episodes, death of a fellow patient, the need to redesign family life. All the problems reported by the patients interviewed are discussed regarding their psychosocial implications, and hints are given on how to minimize them.


The distinction between affect and cognition in the quality of life of cancer patients--sensitivity and stability. The distinction between affect and cognition has been put forward to clarify the lack of differences found in studies describing quality of life under deteriorated circumstances, such as serious illness. In the study reported here, cancer patients under treatment (n = 201) were compared with a random sample from the normal population (n = 200). As hypothesized, the affective component of life quality turned out to be more severely impaired than the cognitive component. Besides, it was investigated which factors contribute to the affective and the cognitive component of the quality of life of cancer patients under treatment. In cancer patients affect proved more strongly related to the physical domain. Cognition on the other hand was more strongly related to coping resources, especially personality characteristics like the level of self-esteem. It is concluded that an affective measure of quality of life is more sensitive to change in patients. The stability of life quality is attributed to the rather strong relation the affective and the cognitive component both have to coping resources.


Quality of life and psychosocial status in stage D prostate cancer. Zoladex Prostate Cancer Study Group. Inasmuch as treatments for advanced prostate cancer may have identical clinical outcomes but very different meanings to patients, we sought to compare the impact of surgical and medical castration (orchiectomy versus injected goserelin acetate Zoladex) on quality of life and psychosocial status. A total of 147 men with Stage D prostate cancer participated in the study: 115 selected treatment with goserelin acetate, and 32 chose orchiectomy. Quality of life, as measured by the Functional Living Index: Cancer (FLIC), improved at both the 3 and the 6 month follow-up in the goserelin acetate group (p = 0.0001), but did not change from baseline at 6 months in the orchiectomy group (p = 0.54). These findings were paralleled by improvement from baseline in psychosocial status, as measured by the Profile of Mood States (POMS), at 6 month follow-up (p = 0.01 in the goserelin acetate group versus p = 0.60 in the orchiectomy group). This investigation, which is among the first to evaluate patients' appraisals of their lives following treatment choices for advanced prostatic cancer, argues compellingly for including quality of life in assessments of therapy.


Quality of life consequences of chemotherapy-induced emesis. Nausea and vomiting following chemotherapy administration are common and often overlooked causes of impairment in cancer patients. The goal of this study was to explore the broad range of consequences associated with this specific acute toxicity of chemotherapy. Specific objectives were: (1) create and test scales specifically designed to assess the impact of chemotherapy-induced nausea and vomiting or patients' daily function; (2) examine changes in quality of life of cancer patients 3 days following chemotherapy administration; (3) assess the impact of chemotherapy-induced emesis on quality of life and patients' daily function; (4) identify medical and non-medical cost-related consequences associated with chemotherapy-induced emesis. Patients receiving intermittent bolus chemotherapy regimens on an outpatient basis were eligible for this survey. Four instruments were used: a patient maintained diary, the Functional Living Index-Cancer (FLIC), a newly created Functional Living Index-Emesis (FLIE) and an Item Check list for cost-related consequences. On Day 1, before chemotherapy, patients completed the FLIC and FLIE. Patients recorded episodes on vomiting, severity of nausea, anxiety, sedation, antiemetics self-administered, and adverse effects in diaries for 3 days following chemotherapy. The FLIC and FLIE were completed at the end of Day 3. The Item Check list of cost-related consequences was administered as a telephone survey on Day 5. Approximately 56% of 122 patients reported chemotherapy-induced emesis (CIE). A change in mean FLIC score indicating a decline in quality of life was observed for the CIE group (119 to 101) but not in the group who did not report emesis (124 to 122). Decline in FLIC and FLIE from before to after chemotherapy administration was greater for CIE patients (p = 0.001). FLIE scores indicated that CIE patients perceived that vomiting, and to a slightly lesser extent, nausea substantively influenced their ability to complete household tasks, enjoy meals, spend time with family and friends, and maintain daily function and recreation. Effect size calculations supported a significant negative relationship between occurrence of CIE and the direction and magnitude of functional living index change. An exploratory analysis (principal component followed by regression analysis) supported the hypothesis that side-effects produced by chemotherapy and antiemetic therapy significantly contributed to changes in quality of life observed.(ABSTRACT TRUNCATED AT 400 WORDS)


Nursing research into quality of life.

Nursing research into quality of life. This report describes the scope of nursing research in the area of quality of life. The strategy used to identify research reports relied heavily on nursing publications included in the Cumulative Index for Nursing and Allied Health Literature (CINAHL) from 1983 (when the database first included the subject, quality of life) to December, 1991. During this period, over 1,000 references concerning quality of life can be identified through a key-word search of the data set. Nursing investigators defined quality of life in terms of psychological, physical, social/interpersonal, and financial/material well-being. Nursing instruments have been developed to measure one or more of these dimensions of the concept. Nursing journals like Advances in Nursing Science (1985), Seminars in Oncology Nursing (1990), and Progress in Cardiovascular Nursing (1992) dedicated whole issues to the topic. Major nursing associations have supported conferences/talks (American Heart Association Council on Cardiovascular Nursing, Santa Fe, NM, 1991; Oncology Nursing Society, Fall Institute, Annual Quality of Life Lectureship) and provided awards on the subject (Oncology Nursing Society Annual Quality of Life Research Award). The National Center for Nursing Research is launching an intramural programme to address quality of life questions.


International Quality of Life Assessment (IQOLA) Project. The International Quality of Life Assessment (IQOLA) Project is a 4-year project to translate and adapt the widely used MOS SF-36 Health Survey Questionnaire in up to 15 countries and validate, norm, and document the new translations as required for their use in international studies of health outcomes. In addition to the eight-scale SF-36 health profile, the project will also validate psychometrically based physical and mental health summary scores, as well as health utility indexes incorporating SF-36 scales for use in cost-utility studies.


Changes in quality of life among persons with HIV infection. Health-related quality of life (QOL) is an important component of the evaluation of patient outcome in HIV infection where disease is progressive and debilitating. This paper compares patient-reported QOL obtained from questionnaires which cover functional ability, social functioning, cognition, mental health, disability days, disease symptoms, and overall health in the previous 3 months. These scales have been validated on HIV populations. We compared changes in health status over 12 months for 669 patients with varying HIV disease severity: 134 asymptomatic, 416 symptomatic (previously termed ARC), and 119 AIDS. Groups were evaluated at baseline for demographic and health status differences (i.e., age, CD4+). Declines in health status and psychosocial status were found over the year for all persons. Individuals with symptomatic disease or AIDS had significant declines of 10-20% (p < 0.001) in all aspects of role functioning (social, daily activities, energy, and global health) and increased disease symptoms, but no significant declines in cognition or mental health. Persons with AIDS had greater declines than those with symptomatic disease. AIDS and symptomatic patients also reported significantly fewer hours at work and more disability days than asymptomatic patients. The impact that HIV disease has on the health status of non-AIDS symptomatic patients is especially striking.


Assessment of quality of life in the elderly assisted at home through a Tele-Check service. This study evaluates the effects of a Tele-check/Tele-emergency service on the quality of life in the elderly. Through telephone interviews a questionnaire has been repeatedly administered to explore various psychological, somatic, and social aspects in a random sample of 574 subjects aged 65 years and over (mean = 76.8 years). The findings suggest that the elderly helped by the service (in its 'control' functioning) make less demands on health facilities (GPs visits, number of days in hospital) as compared to controls. Implications are presented and discussed.


Measurement of quality of life in bone marrow transplantation survivors. This study was designed to assess the reliability and validity of a Quality of Life (QOL) instrument on a sample of 179 allogeneic Bone Marrow Transplant (BMT) survivors. The QOL-BMT tool was developed specifically for this population and was based on the investigators' prior research and a conceptual model of Quality of Life. Patients who were at least 100 days post BMT completed the 30 item visual analogue questionnaire. The instrument measured physical symptoms (e.g., weight loss, frequent colds, skin changes, cataracts, sexual problems), psychological symptoms (e.g., worry about recurrence, adjustment to illness), social concerns (e.g., relationship adjustment, return to work), and spiritual well-being (e.g., sense of control, future goals). Psychometric analysis of the instrument included measures of reliability and validity. The study findings demonstrate the unique aspects of QOL dimensions in BMT survivors and the value of QOL assessment in clinical practice and research.


The SmithKline Beecham 'quality of life' scale: a validation and reliability study in patients with affective disorder. The rationale for the development of Repertory-Grid based quality of life assessment (QOL) is described. The emergent scale, the SmithKline Beecham Quality of Life Scale (SBQOL) utilizes 23 predetermined constructs and three fixed elements: self now, ideal self and sick self. Inclusion of the latter two elements provides a personal frame of reference for the individual and recognizes the highly idiosyncratic and subjective nature of the experience which constitutes quality of life. A study of the validity and reliability of the SBQOL was conducted in 129 patients presenting to their GP with either major depression or generalized anxiety disorder, as defined by DSM III R. Patients were treated at the discretion of their GP and followed over a period of 12 weeks with assessments of treatment efficacy being performed at 6 weeks and 12 weeks in parallel with administration of the SBQOL. The results from co-administration of standard efficacy measures such as the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Scale (HAMA) with the SBQOL, provided good evidence of construct validity. Evidence in support of the concurrent validity of the SBQOL was provided by co-administration of the Sickness Impact Profile and General Health Questionnaire (external criteria) with the SBQOL scale. Test-retest reliability and internal consistency were high. No obvious advantage was conferred by the use of principal components analysis from the Flexigrid software package in contrast to a simple arithmetical procedure for computing interelement distances. It is concluded that the SBQOL provides a valid, reliable and practicable approach to the assessment of quality of life in patients with affective disorder.


Assessing the needs and quality of life of patients with HIV infection: development of the HIV Overview of Problems-Evaluation System (HOPES). To develop and evaluate the psychometric properties (reliability, validity etc.) of a comprehensive Quality of Life (QOL) tool, for patients infected with the human immunodeficiency virus (HIV), that was adapted from a previously validated cancer tool. Cross-sectional, patient completed written surveys and interviews. The Medical Centers serving HIV infected patients in the Los Angeles community including UCLA, community physicians, Veterans Affairs Medical Centers, and a County hospital: and additional data contributed from Johns Hopkins University Medical Center CMV Retinitis Clinic. Patients (n = 318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%) and AIDS with Cancer (18%) receiving health services at one of the above sites. The patients self-administered the newly developed instrument, the HOPES (HIV Overview of Problems-Evaluation System), other QOL related tools including the Medical Outcomes Study instrument adapted for HIV (MOS-HIV) the Profile of Mood States (POMS), the Perceived Adjustment to Chronic Illness Scale (PACIS), and the Physical Activity Scale (PAS). Brief interview to assess the Karnofsky Performance Status Score (KPS). Measured sociodemographic characteristics included age, sex, race, HIV risk factor, education etc. Assessed medical history, current medications, HIV clinical classification. The sociodemographic and medical characteristics of the sample resemble those of the general population with HIV infection in this geographic area: 96% male, 28% nonwhite, 84% homosexual contact as risk factor, 75% receiving antiretroviral therapy. The adaptation of the cancer QOL instrument to HIV appears to have face and content validity according to patients and health professionals who care for HIV infected patients. Analyses of the psychometric properties found that the HOPES has a similar structure to its parent instrument following factor analyses which results in five summary scales representing the Physical, Psychosocial, Medical Interaction, Sexual and Significant Other/Partners domains in addition to a Global Score. Internal consistency of 35 subscales is high with a mean alpha coefficient of 0.82. Correlations of the HOPES summary scales with other QOL instruments are in the predicted directions. Comparing patients within the HIV clinical diagnostic categories on the HOPES Global, Physical, and Psychosocial Summary Scales indicates that Asymptomatic Patients have better QOL than symptomatic patients. This finding is also found in the other QOL instruments which provides evidence of construct validity. The HOPES is an excellent tool for identifying the problems and needs of patients with HIV infection and for assessing their quality of life. It is reliable, valid and acceptable to patients. The tool may be especially useful in developing a normative data base.


Crossroads in ambulatory surgery.

Crossroads in ambulatory surgery. In its short history, same-day surgery has encountered several major decision points or crossroads: during its inception, and when facing the decision to expand to meet the needs of radiology, cardiology, and neurology. Changes in surgery toward less invasive procedures, such as laparoscopic, laser, and stapling procedures influence institutions to make major decisions involving same-day surgery. Perioperative nurses in ambulatory services are being compelled to look at efficiencies regarding patient contact and interaction. Major decisions regarding these nursing approaches must be made, just as major decisions have been required in ambulatory services in the past.


Development of a freestanding health care facility. The development of a freestanding ambulatory health care facility requires careful planning by the investors before starting the project. A corporate strategic plan should be developed well in advance of hiring a developer or acquiring property for the facility. This strategic plan will serve as a guide for all activities involved in the development and opening of the facility.


Integrated preadmission services and case management: the foundation for achievable patient outcomes in a hospital-based ambulatory surgery setting. The forces of technology and changing payor requirements continue to move many surgical procedures to the ambulatory setting. The American Hospital Association's Hospital Statistics, 1991-92 indicates that more than half of all surgeries are now performed on an ambulatory or outpatient basis. Hospital-based ambulatory surgery programs must learn to fully integrate many of their traditional inpatient hospital services with the needs of the ambulatory surgery patient by developing preadmission services, as well as by adopting case management theory to continue to deliver quality ambulatory care.


Staff selection for an ambulatory surgery unit. Major changes in the care delivery system affect the selection of the professional nursing staff for an ambulatory surgery unit. The skills required are diverse and dynamic. Selecting the right applicant requires not only knowledge of the interview process, but also acute observation and communication skills. The use of a matrix system helps to organize the process as well as to quantify and qualify the information gained.


Cross-training: a staffing alternative in ambulatory surgery. Content plateauing, which occurs when one's work becomes too routine, may be prevented by the cross-training and cross-utilization of staff. This article tracks the process of cross-training and cross-utilization from its inception at Lutheran Medical Center in Denver, Colorado.


Managing quality and reducing risks in ambulatory surgery. This article reviews the evolution of quality assurance and continuous quality improvement (QA/CQI) in ambulatory surgery centers. As an example, The QA/CQI Plan of the Gumenick Ambulatory Care Center is examined in detail.


Marketing ambulatory services in the 1990s. The ability to predict, to adapt to change, and to develop strategic low cost marketing plans are the components essential to remaining financially solvent in today's health care environment. The marketing process is analogous to the nursing process and should support the institution's mission statement, philosophy, and goals. Managers who are able to empower their personnel to become the sales force and implement the marketing plan will be the survivors in the 1990s.


Influence of diet and exercise on energy expenditure--a review. Maintenance of a healthy body weight results from equating total energy intake to total energy expenditure (resting metabolic rate, RMR; the thermic effect of feeding, TEF; the thermic effect of activity, TEA; and adaptive thermogenesis, AT). Dietary quantity and composition and acute and chronic exercise have been shown to influence all components of total energy expenditure. This paper reviews the effects of exercise and diet on energy expenditure and, ultimately, energy balance. Overnutrition increases RMR and TEF while undernutrition decreases them. Carbohydrate and protein oxidation is closely tied to intake whereas fat oxidation does not closely parallel fat intake. Thus excess fat intake is likely to lead to fat storage. Acute endurance exercise at > 70% VO2max increases postexercise RMR and TEF. Chronic exercise training may increase RMR while also increasing TEF. Review of the research indicates that energy balance may best be achieved by consuming an energy appropriate, low fat diet complemented by endurance exercise.


Effects of phosphate loading on metabolic and myocardial responses to maximal and endurance exercise. Six trained male cyclists and triathletes participated in a double blind study to determine the effects of phosphate loading on maximal and endurance exercise performance. Subjects ingested either 1 gm of tribasic sodium phosphate or a glucose placebo four times daily for 3 days prior to performing either an incremental maximal cycling test or a simulated 40-km time trial on a computerized race simulator. They continued the supplementation protocol for an additional day and then performed the remaining maximal or performance exercise test. Subjects observed a 17-day washout period between testing sessions and repeated the experiment with the alternate supplement regimen in identical fashion. Metabolic data were collected at 15-sec intervals while venous blood samples and 2D-echocardiographic data were collected during each stage of exercise during the maximal exercise test and at 8-km intervals during the 40-km time trial. Results indicate that phosphate loading attenuated anaerobic threshold, increased myocardial ejection fraction and fractional shortening, increased maximal oxidative capacity, and enhanced endurance performance in competitive cyclists and triathletes.


Comparison of four methods to assess body composition in black and white athletes. Four methods of assessing body composition were compared in 55 black and 35 white, Division I, American football players. Percent body fat (%BF) was estimated with hydrostatic weighing at residual volume, corrected for race; seven-site skinfolds (7 SF), corrected for race; bioelectrical impedance analysis (BIA); and near-infrared spectrophotometry (NIR). Percent body fat with HW in blacks (mean = 14.7%) and whites (19.7%) did not differ (P > .05) from %BF with 7 SF (blacks, 14.7%; whites, 19.0%). In relation to HW, BIA significantly (P < .05) overpredicted (blacks: 20.1%, SEE = 3.2%; whites: 22.3%, SEE = 4.3%) and NIR underpredicted %BF (blacks: 12.6%, SEE = 3.9%; whites: 17.7%, SEE = 3.6%). The contribution of BIA variables (resistance, phase angle, conductance) and NIR optical density to predict %BF was trivial compared to body mass index. It appears that race may not substantially influence %BF prediction by NIR and BIA. It was concluded that when considering the cost and expertise required with NIR and BIA, SF measurements appear to be a superior alternative for rapid and accurate body composition assessment of athletes, independent of race.


Predictive accuracy of three field methods for estimating relative body fatness of nonobese and obese women. Three methods of body composition assessment were used to estimate percent body fat (%BF) in nonobese (n = 77) and obese (n = 71) women, 20-72 yrs of age. Skinfolds (SKF), bioelectrical impedance (BIA), and near-infrared interactance (NIR) methods were compared to criterion-derived %BF from hydrostatic weighing (%BFHW). Nonobese subjects had < 30% BFHW and obese subjects had > or = 30% BFHW. The Jackson, Pollock, and Ward SKF equation and the manufacturer's equations for BIA (Valhalla) and NIR (Futrex-5000) were used. For nonobese women there were no significant differences between mean %BFHW and %BFSKF, %BFBIA, and %BFNIR. The rs and SEEs were 0.65 and 3.4% BF for SKF, 0.61 and 3.6% BF for BIA, and 0.58 and 3.7% BF for NIR for nonobese subjects. For obese women, mean %BFHW was significantly underestimated by the SKF, BIA, and NIR methods. The rs and SEEs for the obese group were 0.59 and 3.4% BF for SKF, 0.56 and 3.5% BF for BIA, and 0.36 and 3.9% BF for NIR. The total errors of the equations ranged from 5.6 to 8.0% BF in the obese group. It is concluded that all three field methods accurately estimate %BF for nonobese women; however, none of the methods is suitable for estimating %BF for obese women.


Exercise intensity and the thermic effect of food. This study investigated the effect of varying exercise intensity on the thermic effect of food (TEF). Sixteen lean male subjects were matched for VO2 max and randomly assigned to either a high or low intensity group for 30 min of treadmill exercise. Caloric expenditure was measured using indirect calorimetry at rest and at 30-min intervals over 3 hrs following each of three conditions: a 750-kcal liquid meal, high or low intensity exercise, and a 750-kcal liquid meal followed by high or low intensity exercise. Low intensity exercise enhanced the TEF during recovery at 60 and 90 min while high intensity enhanced it only at 180 min but depressed it at 30 min. Total metabolic expense for a 3-hr postmeal period was not differently affected by the two exercise intensities. Exercise following a meal had a synergistic effect on metabolism; however, this effect was delayed until 180 min postmeal when exercise intensity was high. The circulatory demands of high intensity exercise may have initially blunted the TEF, but ultimately the TEF measured over the 3-hr period was at least equal to that experienced following low intensity exercise.


Efficacy of chromium supplementation in athletes: emphasis on anabolism. As the biologically active component of glucose tolerance factor (GTF), the essential trace mineral chromium is now being marked to athletes. GTF potentiates insulin activity and is responsible for normal insulin function. Thus, insulin's effects on carbohydrate, fat, and protein metabolism are dependent upon the maintenance of adequate chromium stores. Due to excessive chromium loss and marginal chromium intake, athletes may have an increased requirement for chromium. Therefore, in some circumstances the dietary supplementation of a chromium compound may be efficacious. The restoration and maintenance of chromium stores via supplementation would promote optimal insulin efficiency, necessary for high-level athletic performance. However, potential anabolic effects of enhanced insulin function would likely be marginal, and reports of short-term anabolic increases from the supplementation of an organic chromium compound need to be confirmed.


The effect of 7 to 8 months of vitamin/mineral supplementation on the vitamin and mineral status of athletes. Blood indicators of eight vitamins (B1, B2, B6, C, E, A, B12, folate) and six minerals (Cu, Mg, Zn, Ca, P, Al) were measured in 86 athletes before and after a 7- to 8-month period of training. During this period half consumed a multivitamin/mineral supplement and a matched group took a placebo. Following the supplementation period, blood biochemical indicators of B1, B6, B12, and folate status all increased but there were no significant effects of supplementation on B2, C, E, and A, or on the blood levels of any of the minerals. The supplementation had no effect on red or white cell counts or on hemoglobin levels. Irrespective of the supplementation, some blood measures varied according to sex, females evidencing significantly higher values than males for vitamins C, E, copper, magnesium, and aluminium, with B2 being higher in males. It is concluded that 7 to 8 months of multivitamin/mineral supplementation increased the blood nutritional status of some vitamins but did not affect any blood mineral levels, and that some blood nutritional indicators may vary according to sex.


The effect of 7 to 8 months of vitamin/mineral supplementation on athletic performance. The effect of vitamin and mineral supplementation was studied over 7 to 8 months of training and competition in 82 athletes from four sports: basketball, gymnastics, rowing, and swimming. Matched subgroups were formed and a double-blind design used, with subgroups being given either the supplementation or a placebo. All athletes were monitored to ensure that the recommended daily intakes (RDI) of vitamins and minerals were provided by diet alone. Sport-specific and some common tests of strength as well as aerobic and anaerobic fitness were performed. Coaches' assessment of improvement was also obtained. The only significant effect of supplementation was observed in the female basketball players, in which the supplementation was associated with increased body weight, skinfold sum, and jumping ability. A significant increase in skinfold sum was also demonstrated over the whole group as a result of supplementation. In general, however, this study provided little evidence of any effect of supplementation to athletic performance for athletes consuming the dietary RDIs.


Failure of magnesium supplementation to influence marathon running performance or recovery in magnesium-replete subjects. This study examined the effect of magnesium supplementation on muscle magnesium content, on running performance during a 42-km marathon footrace, and on muscle damage and the rate of recovery of muscle function following the race. Twenty athletes were divided equally into two matched groups and were studied for 4 weeks before and 6 weeks after a marathon in a double-blind trial; the experimental group received magnesium supplement (365 mg per day) and the control group, placebo. Magnesium supplementation did not increase either muscle or serum magnesium concentrations and had no measurable effect on 42-km marathon running performance. Extra magnesium ingestion also had no influence on the extent of muscle damage or the rate of recovery of muscle function. The latter was significantly reduced immediately after the marathon but returned to normal within 1 week. Thus, magnesium supplementation in magnesium-replete subjects did not enhance performance or increase resistance to muscle damage during the race, or the rate of recovery of muscle function following the race.


Does calcium supplementation prevent bone stress injuries? A clinical trial. This study investigated the effect of calcium supplementation in preventing bone stress injuries. Healthy male military recruits (N = 1,398) served as subjects, of which 247 were randomly allocated to an experimental group (E) while 1,151 served as a control group (C). For 9 weeks both groups wore the same footwear and had the same physical training program. The baseline dietary intake of calcium in 50 randomly selected subjects of each group was assessed using a 24-hr dietary record. The E group received a daily calcium supplement while the C group did not. Injuries were monitored in all subjects by a panel of doctors who followed specific diagnostic criteria. The mean weekly injury incidence for all overuse injuries, but specifically tibial stress syndrome and stress fractures, was similar in both groups. Mean baseline daily dietary calcium intake was above 800 mg in both subgroups. This study demonstrated that large-scale calcium supplementation (500 mg/day) beyond usual dietary intake did not influence the risk of developing bone stress injuries during a 9-wk physical training program in these young military recruits.


Changes in plasma zinc following high force eccentric exercise. This study was done to determine whether eccentric exercise that causes muscle damage will produce an increase in plasma levels of zinc. Changes in total plasma zinc concentration (Zn) were examined following an eccentric and concentric exercise of the forearm flexors. Eight female subjects performed 24 maximal concentric actions (CON) with one arm and 10-14 days later performed 24 maximal eccentric actions (ECC) with the other arm. Maximal isometric force, elbow joint angles at a relaxed (RANG) and flexed position (FANG), muscle soreness, and plasma creatine kinase activity (CK) were measured as indicators of muscle damage. Zn levels were determined at the same time as CK. Maximal isometric force, RANG, FANG, and muscle soreness showed large changes after ECC but little if any change after CON. CK increased significantly after ECC but did not change after CON. Neither ECC nor CON showed significant changes in Zn following exercise. It is concluded that exercise-induced muscle damage does not appear to produce an increase in plasma zinc levels.


The hyponatremia of exercise.

The hyponatremia of exercise. The hyponatremia of exercise may exist in symptomatic and asymptomatic forms. Symptomatic hyponatremia is usually characterized by severe alterations in cerebral function including coma and grand mal seizures; it develops especially in less competitive athletes who have maintained high rates of fluid intake during endurance events lasting at least 5 hours. The hyponatremia becomes symptomatic when the volume of excess fluid retained exceeds 2 to 3 liters. The etiology of the condition is unknown. Possibly as many as three or more pathologies (abnormal fluid retention possibly due to inappropriate ADH secretion, abnormal regulation of the extracellular fluid volume, translocation of sodium into a "third space") must be present for symptomatic hyponatremia to develop. The avoidance of overhydration would appear to be the only certain way that susceptible individuals can prevent symptomatic hyponatremia. Sodium chloride containing solutions ingested in physiologically significant concentrations would likely prevent a possible "third space" effect.


Rationale for upper limits of electrolyte replacement during exercise. The addition of carbohydrate and sodium to sport drinks has been recommended to enhance fluid intake and absorption and to delay fatigue. Other electrolytes (E) which are lost through sweating are also commonly added. However, too many E may lead to increased serum E and osmolality levels, which may negatively influence thermoregulation, depress sweating, and cause gastrointestinal distress. On the other hand, drinking large amounts of plain water to compensate sweat loss may induce hyponatremia. Therefore, literature describing sweat E losses was examined in order to estimate average whole-body E loss and to determine an upper limit for replacement of E with sport drinks. Mean E loss was determined from 13 studies, with +/- 1 SD resulting in a hypothetical range for E losses. Correction for net absorption resulted in an upper limit fo electrolyte replacement. It is suggested that the E levels in sport rehydration drinks should not exceed the upper limit of the range given.


The effects of a carbonated carbohydrate drink on gastric emptying, gastrointestinal distress, and exercise performance. To determine the effect of a carbonated carbohydrate (CHO) drink on gastric function and exercise performance, eight male cyclists completed four 120-min bouts of cycling. Each bout consisted of a 105-min ride at 70% VO2max followed by a 15-min self-paced performance ride. During each trial, one of four test solutions was ingested: carbonated CHO (C-10%), noncarbonated CHO (NC-10%), carbonated non-CHO (C), and noncarbonated non-CHO (NC). Following the performance ride, the subjects had their stomach contents removed by aspiration. There were no significant differences in gastric emptying (GE) except for Trial C-10%, which averaged 13.3% less than NC. However, there was no difference in the perception of gastrointestinal comfort between this trial and any other. Average power output during the performance ride was not significantly different between carbonated and noncarbonated trials, or between CHO-fed and no-CHO trials; however, the subjects worked at a greater intensity when fed CHO. Finally, acid base status did not change when a carbonated drink was ingested. This indicates that adding carbonation to a sport drink does not significantly alter gastric function, the perception of GI comfort, or exercise performance.


Effects of downhill running on the responses to an oral glucose challenge. Because muscle damage from eccentric exercise has been associated with alterations in muscle glycogen metabolism, this study determined the effects of exercise on the insulin and glucose responses to an oral glucose tolerance test (OGTT). In a repeated-measures design, 11 subjects undertook either no exercise, 2 min of isokinetic leg exercise, or 50 min of level or downhill running. No exercise was performed and diet was controlled during the 48 hrs after the treatments and before the OGTT. Ratings of muscle soreness and CK activity were significantly elevated 48 hrs after downhill running. Level running also increased CK activity but did not induce muscle soreness. Isokinetic exercise did not affect either one. Blood glucose responses to the OGTT were similar among the treatments. In contrast, the insulin responses to the OGTT following downhill running were significantly increased. These results suggest that eccentric exercise associated with downhill running that results in delayed muscle soreness is associated with the development of a mild insulin-resistant condition.


Vitamin C intake and lipid profiles of competitive male and female bodybuilders. This research compared nutrient intake data with blood lipids and anthropometric data. Height, weight, and seven skinfolds were collected 3 days prior to competition at the official weigh-in. The lipids measured were total cholesterol (TC), HDL-cholesterol (HDL-C), and the HDL2 and HDL3 cholesterol subfractions. The subjects were 17 males and 17 females. Descriptive data are presented as means and standard deviations of the means. Protein, fat, and carbohydrate provided about 40, 12, and 48%, respectively, of total energy intake; vitamin C was > 200 mg/day. Only dietary fat was significantly (p < 0.05) associated with TC for females. Fiber was significantly associated with HDL-C and HDL2-C for males and with HDL-C for females. Vitamin C was significantly associated with HDL-C,HDL2-C, and HDL3-C for males, and with HDL-C and HDL3-C for females. These findings are consistent with those reported by Bazzarre et al. in farmers and suggest that vitamin C may favorably influence HDL-C metabolism.


Ornithine supplementation and insulin release in bodybuilders. Ornithine supplementation has gained popularity with athletes because of its alleged potential to release anabolic hormones, factors governing skeletal muscle hypertrophy. Three female and nine male bodybuilders served as subjects in a study to test the effectiveness of oral ornithine in bringing about the release of insulin, an anabolic hormone. After an overnight fast, subjects were administered 40, 100, or 170 mg.kg-1 L-ornithine.HCl by mouth in a random fashion on three consecutive Saturday mornings. Blood samples were drawn at baseline (T = 0), 45, and 90 min afterward. Serum ornithine levels were elevated (p < 0.01) at T = 45 and 90 min for all three dosage levels. However, serum insulin did not change from baseline levels at any dose of ornithine. The present findings show that ornithine is not an insulin secretagogue.


The effect of protein supplementation on lactate accumulation during submaximal and maximal exercise. Eleven subjects performed a graded exercise test after 1 week of protein supplementation (PRO) or glucose polymer placebo (CON), randomly assigned in a double blind fashion. The exercise consisted of 3-min graded exercise bouts separated by 10 min of active recovery at zero pedal resistance. Subjects then performed a 30-sec Wingate test (WIN) to assess performance during supramaximal exercise. Blood samples were obtained in the last 15 sec of each exercise and recovery period. PRO resulted in a decrease in blood lactate following 120% VO2max and WIN, an increase in blood alanine at all time points, and lower postexercise muscle lactate and glycogen. Resting muscle GPT activity was 47% higher during the PRO trial. Mean power output during the WIN did not differ between PRO and CON. The WIN fatigue index was not significantly different between PRO and CON. The increased alanine may reflect increased transamination of pyruvate, thereby reducing the accumulation of lactate, which in turn had a marginal effect on performance during supramaximal exercise.


Influence of carbohydrate ingestion on blood glucose and performance in runners. Ten trained male runners performed a treadmill exercise test at 80% VO2max under two experimental conditions, carbohydrate (CHO, 7% carbohydrate) and placebo (P), to determine the effect of carbohydrate ingestion on endurance performance (treadmill run time), blood glucose concentration, respiratory exchange ratio (RER), and subjective ratings of perceived exertion (RPE). Treatment order was randomized and counterbalanced and test solutions were administered double-blind. Ingestion took place 5 min preexercise (250 ml) and at 15-min intervals during exercise (125 ml). Performance was enhanced by 29.4% (p < 0.05) during CHO (115 +/- 25 min) compared to P (92 +/- 27 min). Blood glucose concentration was significantly greater during CHO (5.6 +/- 0.9 mM) relative to P (5.0 +/- 0.7 mM). There was a significant increase in mean RER following CHO ingestion (.94 +/- .01) compared to P (.90 +/- .01). Average RPE was significantly less during CHO (14.5 +/- 2.3) relative to P (15.4 +/- 2.4). These data suggest that time to exhaustion of high-intensity treadmill exercise is delayed as a result of carbohydrate ingestion and that this effect is mediated by favorable alterations in blood glucose concentration and substrate utilization.


Effects of carbohydrate loading and weight-lifting on muscle girth. Bodybuilders have used different carbohydrate loading regimens in conjunction with resistance exercise prior to competition in the belief that this would result in increased muscle size. To investigate this possibility, muscle girth measurements were obtained from nine weight-trained males before and after a control (standard isocaloric diet) and an experimental trial (carbohydrate loading). The latter regimen consisted of 3 days of intense weight-lifting while the subjects ingested a diet of 10% carbohydrate (CHO), 57% fat (F), and 33% protein (P), followed by 3 days of light weight-lifting and a day of rest while ingesting a diet of 80% CHO, 5% F, and 15% P. The control trial consisted of an identical weight-lifting regimen while subjects ingested an isocaloric (45 kcal/kg BW/day) diet. Body weight and girths (forearm, upper arm, chest, thigh, waist, and calf) were obtained before and after each trial in a relaxed and flexed state. The results indicate that an exercise/carbohydrate loading regimen had no significant effect on muscle girth as compared to the control trial. It is concluded that CHO loading has no additional advantage to enhancing muscle girth in bodybuilders over weight-lifting alone.


Plasma ferritin concentration and physical work capacity in athletes. This investigation aimed to determine whether the physical work capacity of nonanemic athletes could be improved when plasma ferritin concentrations of below 30 ng/ml were raised at least 15 ng/ml. The experimental group consisted of 15 training athletes, each of whose plasma ferritin concentration was less than 30 ng/ml (mean and SD of 19.8 +/- 8.4 ng/ml). In a control group of 16, each was measured with a plasma ferritin concentration of more than 40 ng/ml (mean and SD of 83.3 +/- 37.6 ng/ml). All participated in submaximal and maximal tests for aerobic and anaerobic power. Following iron supplementation, plasma ferritin concentration in each experimental subject increased by at least 15 ng/ml to more than 30 ng/ml, to a new mean of 46.3 +/- 15.5 ng/ml. The performance measures were also repeated, but no significant overall effects were associated with the increased plasma ferritin concentrations. These data provide no sound evidence that physical work capacity of athletes is enhanced when plasma ferritin concentrations of around 20 ng/ml are increased by at least 15 ng/ml.


Effects of chromium picolinate on beginning weight training students. Changes in body weight (BW), a sum of three body circumferences (sigma C), a sum of three skinfolds (sigma SF), and the one-repetition maximum (1RM) for the squat (SQ) and bench press (BP) were examined in 59 college-age students (37 males [M], 22 females [F]) over a 12-week weight lifting program. Using a double-blind protocol, half of the students were given 200 micrograms/day chromium (Cr) in the form of chromium picolinate (CrPic) while the other half received a placebo (P). Therefore four groups were randomly formed: F-CrPic (n = 12), F-P (n = 10), M-CrPic (n = 18), and M-P (n = 19). All groups had significant increases in sigma C and significant decreases in sigma SF. No treatment effects were seen for the strength measurements, although the males experienced greater absolute increases. The only significant treatment effect found was due to the F-CrPic group gaining more BW (p = 0.0048) than the other three groups. It was concluded that CrPic supplementation had a greater effect on the females than on the males.


Dietary intake and thiamin, iron, and zinc status in elite Nordic skiers during different training periods. This study evaluated how different training periods affect dietary intake and biochemical indices of thiamin, iron, and zinc status in elite Nordic skiers. Subjects were 17 skiers and 39 controls, ages 18-38 yrs. Dietary data were collected by 7-day food records at 3-month intervals. Coefficient of variation (CV) was used to indicate magnitude of seasonal changes. Energy intake for the year (28 food record days) was 3,802 kcal/day (CV 19.1%) in male skiers, 2,754 kcal/day (CV 3.7%) in male controls, 2,812 kcal/day (CV 9.1%) in female skiers, and 2,013 kcal/day (CV 5.9%) in female controls. CVs for thiamin, riboflavin, vitamin C, calcium, magnesium, iron, and zinc intake were 14.1-23.9% (male skiers), 2.9-15.0% (male controls), 4.8-24.5% (female skiers), and 4.3-11.5% (female controls). Seasonal changes in energy, carbohydrate, and micronutrient intakes reflected energy expenditure in male endurance athletes particularly. Erythrocyte transketolase activation coefficients and serum ferritin and zinc concentrations did not differ between skiers and controls. Seasonal variations in these biochemical indices of nutritional status were of the same magnitude in skiers and controls, despite large changes in skiers' physical activity.


Hematological status of male runners in relation to the extent of physical training. Blood biochemical indices of iron status were measured in venous blood from 20 runners and 6 control subjects. All subjects were male, ages 20 to 40 years, and stable with regard to body weight and degree of physical activity. Dietary analysis was undertaken using a 7-day weighed food intake. There was no evidence of iron deficiency: hemoglobin concentrations and serum ferritin levels were within the normal population range for all individuals. However, serum ferritin was negatively correlated with the amount of training. Daily iron intake appeared to be adequate; iron intake was correlated with protein intake but not related to training or energy intake. Serum ferritin, an indicator of iron status, was significantly correlated with vitamin C intake but not iron intake. Serum transferrin concentration was higher in the group of athletes undertaking a high weekly training load compared with the control subjects, suggesting an alteration in iron metabolism although there was no evidence of increased erythropoiesis. The biological significance of this is unclear.


Effects of low ferritin concentration on endurance performance. To determine the effects of depleted iron stores on endurance performance and blood lactate concentration, eight active women with normal (> 26 ng/ml) and eight with low (< 12 ng/ml) plasma ferritin concentrations were studied while performing a VO2max and an endurance test (80% VO2max) on a cycle ergometer. The low ferritin group had significantly lower serum iron concentration and transferrin saturation and higher TIBC than the normal ferritin group. Mean VO2max was not significantly different between groups. No significant difference was found in total time to exhaustion during the endurance test for low (23.2 min) and normal (27.0 min) ferritin groups; however, the normal ferritin group exercised 14% longer. Blood lactate concentrations following the VO2max and endurance test did not differ significantly between groups. Food diaries revealed lower daily absorbable iron intake by the low ferritin group compared to the normal ferritin group. Ferritin concentration was significantly related to absorbable iron (r = .72) and total iron (r = .70) intake. The results suggest that women with depleted iron stores who are not anemic may have less endurance, but do not have higher blood lactate during exercise than women with normal iron stores.


Effects of caffeine ingestion on metabolic responses to prolonged walking in sedentary males. This study examined the effects of a single dose of caffeine (5 mg.kg-1) on energy metabolism during 60-min treadmill walking at light (30% VO2max) and moderate (50% VO2max) aerobic intensities in eight sedentary (VO2max) 39.6 +/- 3.1 ml.kg-1 x min-1) males. Caffeine intake 60 min prior to walking exercise increased pre- and postexercise FFA, glycerol, and lactate concentrations (p < 0.05). Blood glucose levels following walking trials were lower than preexercise values (p < 0.05). Gas exchange indicated that caffeine did not change exercise oxygen uptake, RER values, and carbon dioxide production (p > 0.05). In contrast, a small but statistically significant effect of caffeine on exercise minute ventilation was noted (p < 0.01). It is concluded that ingestion of 5 mg.kg-1 caffeine increases the mobilization of energy substrate from fat sources; however, the present data do not provide evidence of a caffeine-induced shift in energy substrate usage. Caffeine is not an effective means for enhancing the energy cost of prolonged walking.


[Isolated and unilateral malacoplakia of the upper urinary tract. Apropos of a case]. Malakoplakia, strictly unilateral and localised to the upper urinary tract, is a rare presentation of this uncommon inflammatory disease. In this 53 year old woman, the disease presented in the form of a tumour of the left upper urinary tract. Radical nephroureterectomy was performed and histological examination of the resection specimen revealed the diagnosis.


[Protection of male fertility during anticancer treatment: animal experiments]. One of the best known iatrogenic effects of anticancer treatments is the sterility of young patients with a good prognosis, hence the necessity to develop a protocol enabling us to preserve male reproductive function. This review of the literature summarises the various approaches investigated in order to obtain protection of spermatogenesis prior to radiotherapy and/or chemotherapy. Most of these pathways involve hormone therapy based on regulation of the hypothalamo-hypophyso-testicular axis. Animal models are generally used in these experiments. The various applications in man are described and discussed.