Evaluación del proceso de transición de adolescentes con infección por VIH/Sida / Evaluation of the transition process of adolescents with HIV infection/AIDS

El desarrollo de nuevas opciones terapéuticas para el manejo de la infección VIH ha mejorado la sobrevida de los niños con infección perinatal. Estos avances llevaron a preparar a los adolescentes para la transición desde una institución pediátrica hacia un centro de adultos. Población: Se incluyeron pacientes con infección por VIH de 16 años o mayores. Fueron excluidos aquellos pacientes con infecciones oportunistas activas que requerían internación y ante ausencia de consentimiento/asentimiento informado. Objetivo, material y método: Evaluar el proceso de transición de adolescentes con infección VIH/SIDA desde un hospital pediátrico a centros de atención de adultos. Se realizó un estudio de intervención que incluyó la aplicación y análisis del proceso de transición interinstitucional. La transición incluyó la preparación y evaluación del paciente con asistencia a una serie de talleres, prevenir conductas de riesgo y favorecer el bienestar físico-social-emocional. Se analizó el estado de preparación del paciente en una etapa inicial y en el transcurso del programa, el cumplimiento del plan establecido y el tiempo requerido para la transición exitosa. Los objetivos centrales del proyecto fueron: preparación del paciente, concretar etapas del programa de transición, establecer indicadores clínicos y psicosociales que permitieron realizar una transición exitosa. Resultados: De un total de 50 pacientes, sexo femenino 52%. Escolarizados 92%. La mediana de carga viral fue de 289 y de recuento de CD4 de 23.35. En el 52% de la población el diagnóstico fue develado antes de los 13 años de edad. Este grupo presentó en un 48% autonomía adecuada. El 54% realizó adecuado seguimiento clínico. Durante el periodo del estudio, 17 pacientes lograron la transición. La edad promedio de los pacientes transicionados fue de 18 años, en su mayoría mujeres (59%). Conclusiones: La transición es un proceso multifacético, que involucra al paciente, su familia y al equipo de salud tratante de niños y de adultos. Para que sea exitosa hay que conocer todos los aspectos propios del paciente y la situación (AU)

The development of new treatment options for the management of HIV infection has increased survival of perinatally infected children. These advances have led to the need to prepare adolescents for the transition from a pediatric institution to a center for adult care. Population: Patients 16 years or older with HIV infection were included in the study. Patients with active opportunistic infections that required hospital admission and those who did not provide written informed consent/assent were excluded. Aim, material, and method: To evaluate the process of transition of adolescents with HIV infection/AIDS from a pediatric hospital to an adult care center. An intervention was performed including application and analysis of the process of interinstitutional transition. The transition included the preparation and evaluation of the patient through the participation in a series of workshops, prevention of risk behaviors, and encouragement of physical-social-emotional well-being. The state of preparation of the patient in the initial stage and throughout the program, compliance with the established plan, and the time needed for successful transition were analyzed. The main aims of the project were: preparation of the patient, carry out the stages of the transition program, establish clinical and psychosocial markers for a successful transition. Results: Of a total of 50 patients, 52% were female; 92% was attending school. Median viral load was 289 and CD4 count was 23.35. In 52% of the cohort, the diagnosis was disclosed before 13 years of age. Autonomy was adequate in 48% of the children. Overall, 54% complied with the clinical follow-up. Over the study period, 17 patients successfully transitioned. Mean age of the transitioned patients was 18 years, with a majority of girls (59%). Conclusions: Transition is a multifaceted process involving the patient, their family, and the health-care teams for children and adults. For a successful transition, all patient- and situation-related aspects should be known (AU)

Caracterización de la interconsulta médico-psicológica en un hospital pediátrico de alta complejidad / Characterization of the medical-psychological consultation at a tertiary pediatric hospital

Durante los meses de febrero a mayo de 2014 se caracterizaron las interconsultas de pacientes del área de internación que no eran atendidos por equipos interdisciplinarios y por los que se consultaba por primera vez, realizadas por los becarios del Servicio de Salud Mental (SSM). Se analizaron los datos ociobiodemográficos de los pacientes, las categorías de los pedidos y los diagnósticos e intervenciones por parte del servicio de salud mental. También se analizó la coincidencia de los diagnósticos realizados por los pediatras solicitantes con los realizados por los especialistas. La muestra total quedó constituida por 62 pacientes, 53% de sexo masculino, 70% proveniente del conurbano. Los pediatras consideraron que el 94% de las consultas debían realizarse en el día. El pedido más frecuente fue el requerimiento de atención por síntomas psicopatológicos en el niño (45%), seguidos por el malestar en el niño inherente a la situación de enfermar (21%). De los síntomas psicopatológicos, los conversivos fueron los más frecuentes. En el 8% de los casos el especialista consideró luego de la evaluación que la interconsulta no era pertinente. En el 41% de los casos existió total coincidencia en el diagnóstico realizado por el pediatra y por el especialista. Los especialistas diagnosticaron 6% menos síntomas psicopatológicos que los pediatras en los niños, y 5% más en los padres. La intervención más utilizada fue la psicoterapéutica (90%). Solo requirieron farmacoterapia el 10% de los pacientes. El 86% de las consultas requirieron seguimiento durante la internación y el 26%, continuar de manera ambulatoria tras el alta (AU)

Between February and May 2014 consultations from the inpatient area for children who were not managed by multidisciplinary teams and who were consulted for the first time were evaluated by fellows from the Department of Mental Health. Sociodemographic data of the patients, consultation categories, diagnoses, and interventions by the Mental Health team were analyzed. Coincidence between the diagnosis made by the pediatricians who requested the consultation and that made by the specialists was also assessed. The total sample consisted of 62 patients; 53% were male and 70% came from Greater Buenos Aires. The pediatricians considered that 94% of the children needed consultation on the same day. The most common request for consultation was because of psychopathological symptoms in the child (45%), followed by disease-related discomfort in the child (21%). Conversion symptoms were the most common psychopathological symptoms observed. In 8% of the cases, after evaluation the specialist did not consider the consultation necessary. In 41% of the cases the diagnosis of the specialist coincided with that of the pediatrician. Specialists diagnosed 6% less psychopathological symptoms in children and 5% more in parents compared to pediatricians. The most commonly used intervention was psychotherapy (90%). Only 10% of the patients required pharmacotherapy. Overall, 86% of the consultations required follow-up during hospital stay and in 26% of the patients, follow-up in an outpatient setting was necessary (AU)

The presence of Microlobius foetidus cause changes in the antioxidant defense of Urochloa decumbens?

Urochloa decumbens (Stapf) R. D. Webster (Poaceae) is an exotic species with has spread rapidly through the Cerrado area of Pantanal, Mato Grosso do Sul, Brazil. It has covered the soil aggressively turning it into cultivated pastures. Thus, it has become a challenge to protect native areas due its capacity of exclusion of native species. It has been observed that Microlobius foetidus (Jacq.) M.Sousa & G.Andrade species (Fabaceae) shows a dominant pattern over the development of U. decumbens. This work shows that M. foetidus interfere on the natural growth of U. decumbens within 10 m ratio. Between 15 and 20 m, it was observed an increase of Importance Value index (IVI) and Relative cover (RC) values. It was also observed a variation on the antioxidant defense system of U. decumbens within 10m ratio from M. foetidus. The enzymes superoxide dismutase, catalase and peroxidase present higher levels of activity then those found for glutathione reductase. This data indicates that M. foetidus may have an effect on U. decumbens, increase the activity of antioxidant enzymes. This effect probably happens as means to neutralize the toxic effects of the oxygen generated due to the presence of allelochemicals, which increases oxidative stress.

Análise fitoquímica, potencial antioxidante e toxicidade do extrato bruto etanólico e das frações da espécie Senecio westermaniiDusén frente à Artemia salina / Phytochemical analysis, antioxidant potential and toxicity of crude ethanol extract and fractions of the species Senecio westermanii Dusén against Artemia salina

RESUMO A espécie Senecio westermanii Dusén pertencente à família Asteraceae é planta endêmica e nativa do Brasil encontrada na região da Floresta Atlântica, nos estados do Paraná e São Paulo. O objetivo deste trabalho foi avaliar a composição fitoquímica do extrato bruto etanólico e frações das partes aéreas (folha e caule) de S. westermanii utilizando-se a análise fitoquímica qualitativa e cromatografia líquida de alta eficiência com detector de arranjo de diodos (CLAE-DAD), avaliar in vitro a toxicidade preliminar utilizando Artemia salina e o potencial antioxidante. O estudo fitoquímico qualitativo revelou a presença de alcaloides, flavonoides, iridoides, esteroides/triterpenos, heterosídeos saponínicos e aminogrupos. Através da análise realizada por CLAE-DAD obteve-se o fingerprint característico de cada amostra. No ensaio frente à A. salina houve ausência de toxicidade das amostras, o resultado da DL50 para todas as amostras foi superior a 1000 μg/mL. Todas as amostras apresentaram atividade antioxidante pela redução do complexo fosfomolibdênio, com destaque para a fração clorofórmio que apresentou atividade antioxidante de 92,51% em relação ao padrão rutina. Com relação ao ensaio de redução do radical DPPH•, a fração acetato de etila apresentou IC50 de 26,98 μg/mL. Pelo ensaio do ácido tiobarbitúrico (TBARS) a fração hexano apresentou o melhor índice antioxidante em relação ao padrão rutina. Os resultados obtidos demonstram evidências de que a espécie é fonte potencial de antioxidantes naturais, estimulando assim novos estudos que viabilizam sua utilização no tratamento de patologias associadas aos radicais livres. Além disso, a espécie não apresentou atividade tóxica preliminar, assegurando sua aplicabilidade.

ABSTRACT The species Senecio westermanii Dusén, which belongs to the Asteraceae family, is an endemic and native plant from Brazil. It is found mainly in the Atlantic Forest region, in Paraná and São Paulo states. This study aimed to evaluate the phytochemical composition using a qualitative phytochemical analysis and high performance liquid chromatography with diode array detector (HPLC-DAD), to evaluate preliminary toxicity in vitro using Artemia salina and antioxidant potential. Qualitative phytochemical analysis revealed the presence of alkaloids, flavonoids, iridoids, steroids, triterpenes, saponinic glycosides and aminogroups. The analysis by HPLC-DAD provided the characteristic fingerprint of each sample. In the A. salina assay, the results of LD50 over 1000 μg/mL for all samples did not indicate toxicity of the evaluated extracts. All samples demonstrated antioxidant activity by reducing phosphomolybdenum complex. The highest activity was detected in the chloroform fraction, which presented activity of 92.51% compared to the standard rutin. Regarding the trial to reduce the radical DPPH•, the ethyl acetate fraction showed an IC50 of 26.98 µg/mL. In the thiobarbituric acid assay (TBARS), the hexane fraction showed the highest antioxidant activity compared to the standard rutin. These findings indicate that the Senecio westermanii is a potential source of natural antioxidants, stimulating new studies that enable their use in the treatment of disorders associated with free radicals. In addition, the species did not present toxicity in its evaluation, ensuring its applicability.

Presence of t(14;18) positive cells in blood and bone marrow does not predict outcome in follicular lymphoma.

Follicular Lymphoma International Prognostic Index-FLIPI is an established clinical predictor for outcome in follicular lymphoma. The role of molecular abnormalities in blood and bone marrow of follicular lymphoma patients including t(14;18) is less clear. Seventy-five patients from a single institution diagnosed with follicular lymphoma between1999 and 2005 were included into the study. Diagnosis was based on lymph node biopsy in 62 cases (83%). Thirty-nine patients (52%) had G1 histological grade and 47 (63%) had entirely follicular growth pattern, as well as 9 patients (12%) had systemic symptoms and 33 (44%) were assigned to a good risk according to FLIPI. Median age of patients was 53 years. During a median observation time of 3 years 63 patients (84%) required initiating anti-lymphoma treatment. Seventy-five samples of peripheral blood and 65 samples of bone marrow were collected at the diagnosis. Bcl2 rearrangements including major breakpoint region and minor breakpoint cluster region were investigated using nested polymerase chain reaction technique. The primary end points of the study were time to first line lymphoma treatment and progression-free survival. Cells carrying t(14;18) were found in 31 cases (41%) including 29 samples of peripheral blood and 26 samples of bone marrow. Detection of t(14;18) in blood and bone marrow at diagnosis had no influence on clinical outcome. Age, follicular growth pattern systemic symptoms, and FLIPI score above 1 were predictive for initiation of the first lymphoma therapy. Follicular growth pattern, initial nodal involvement, serum LDH level, and FLIPI score above 1 were predictive for longer progression-free survival.

Molecular and biochemical testing in stage III melanoma: multimarker reverse transcriptase-polymerase chain reaction assay of lymph fluid after lymph node dissection and preoperative serum lactate dehydrogenase level.

BACKGROUND: There is a need for biomarkers to identify patients at risk for disease progression after resection of melanoma regional lymph node metastasis. OBJECTIVES: This study assessed the prognostic value of multimarker reverse transcriptase-polymerase chain reaction (RT-PCR) assay in lymphatic drainage (LY) after lymph node dissection (LND) and of preoperative serum lactate dehydrogenase (LDH) levels in American Joint Committee on Cancer (AJCC) stage III melanoma patients. METHODS: We collected 24-h LY from 255 stage III melanoma patients after radical LND [114, completion LND after positive sentinel node biopsy (CLND); 141, therapeutic LND for clinically/cytologically detected regional nodal metastases (TLND)]. For detection of melanoma cells, RT-PCR assays with primers specific for tyrosinase, MART1 (MelanA) and uMAGE mRNA were conducted. The LY sample was deemed positive if at least one marker was detected. In 244 patients, the preoperative serum LDH level was available. Median follow-up time was 25 months (range 5-60). RESULTS: The LY multimarker RT-PCR assay results were positive in 82 of 255 patients (32%). A significantly higher rate of melanoma recurrence was observed in patients with positive LY multimarker RT-PCR results (P = 0.01). Significant relationships were observed between positive LY multimarker RT-PCR results and shorter 3-year overall survival (OS) and disease-free survival (DFS), both in univariate and multivariate analyses (P = 0.007). Preoperative serum LDH level was increased in 79 of 244 patients (32%) [40.5% in TLND group and 23.0% in CLND group (P = 0.003)]. There were significant differences in OS between patients with normal and high preoperative LDH levels (P = 0.007), and these differences were seen mainly in patients in the TLND group. CONCLUSIONS: The multimarker RT-PCR assay detected melanoma cells in approximately 32% of LY after LND, which correlated significantly with early melanoma recurrence and shorter survival. Increased pre-LND serum LDH level had an additional negative impact on OS of melanoma patients with palpable nodal metastases after TLND.

[To a margin reduction in the dermatofibrosarcoma protuberans? Retrospective study of 34 cases]. / Vers une réduction des marges latérales dans les dermatofibrosarcomes de Darier et Ferrand ? Etude rétrospective de 34 cas.

INTRODUCTION: The dermatofibrosarcoma protuberans (DFSP) is a rare but not exceptional tumour. Surgical treatment should contain a wide excision to avoid local recurrence. MATERIAL AND METHOD: We report a retrospective study of 34 cases treated by the same team from 1994 to 1999. In this series, only 4 cases (12%) presented recurrences after previous treatment by the other teams. In all cases, surgical resection was performed with 3 cm lateral margin and a disease free anatomic layer removed with the tumour. RESULTS: The mean of follow up was 60 months. There was no recurrence case in our 34 patients during this period. We compare our results with those, from others teams described in international literature since 1951. Margins and results are similar with some teams who practice the Mohs surgery. CONCLUSION: These data are in favour of a reduction of the lateral margins in classical surgical procedure of DFSP. They should be consolidated by a follow-up in longer term with a prospective study.

Modified GFAP promoter auto-regulates tet-activator expression for increased transactivation and reduced tTA-associated toxicity.

Transactivator tTA is a necessary component of the tetracycline-regulated inducible gene system. While several transgenic animals have been described that express tTA in the central nervous system (CNS), their tTA levels are often limited, presumably due to toxic effects. We evaluated methods for auto-regulating tTA levels in astrocytes by modifying the transgenic promoter human GFAP (hGFAP). The hGFAP promoter carrying a single copy of the tet-operon in place of a native enhancer element (GFAPtetO1) drove expression of tTA at low levels during un-stimulated, basal condition. However the same promoter auto-induced expression of tTA to significant levels after tetracycline withdrawal. Glial cell-specificity of the promoter remained uncompromised during both basal and induced conditions. Transgenic rats were developed using the auto-inducible GFAPtetO1 promoter that expressed tTA mRNA to high levels in the brain. Expression was widespread within the CNS but enriched in astrocyte-rich regions including the cerebellum. Primary cerebellar astrocytes from GFAPtetO1 rats transfected with 07LacZ produced substantially greater inducibility of reporter gene compared to GFAP-tTA transgenic rats. Finally, GFAPtetO1 rats exhibited severe motor/gait deficit when bred to homozygosity. This phenotype was attributable to developmental abnormalities of the cerebellum and was completely abrogated by doxycycline administration. These results suggest that developmental toxicity resulting from tTA expression can be circumvented and tTA transgenics with high transactivation potential can be developed using the auto-activation strategy. Promoter modification presented here may be useful in developing highly inducible transgenic strategies without loss in tissue-specificity.

Detection of circulating melanoma cells in peripheral blood by a two-marker RT-PCR assay.

The aim of this study was to develop a highly sensitive two-marker assay for the detection of circulating melanoma cells in patients' blood using a reverse transcriptase-polymerase chain reaction (RT-PCR). We analysed the usefulness of two different sets of markers: tyrosinase and MUC-18 (TYR/MUC-18), and tyrosinase and MART 1 (TYR/MART 1). Total cellular RNA was isolated from 337 blood samples from 80 melanoma patients at different stages of the disease. All patients had undergone primary surgery. Assay sensitivity and specificity were confirmed using three different melanoma cell lines and two different fibroblast lines. In addition, blood from 47 healthy subjects and 10 patients with non-melanoma cancer was used as a negative control. We found that two-marker analysis is more accurate than the single tyrosinase assay. The frequency of melanoma cell detection in patients' blood was about 10% higher when the TYR/MART 1 two-marker assay was used. Using this assay we did not find any statistical correlation between the molecular markers and the UICC stage of disease or the Breslow thickness or Clark level of the primary melanoma. The frequency of melanoma cell detection with the TYR/MUC-18 two-marker assay was even higher than the TYR/MART 1 assay, but unfortunately the MUC-18 transcript was also present in about 20% of healthy subjects. Therefore we do not recommend the use of MUC-18 as a standard value marker.

Postnatal expression in hyaline cartilage of constitutively active human collagenase-3 (MMP-13) induces osteoarthritis in mice.

It has been suggested that increased collagenase-3 (MMP-13) activity plays a pivotal role in the pathogenesis of osteoarthritis (OA). We have used tetracycline-regulated transcription in conjunction with a cartilage-specific promoter to target a constitutively active human MMP-13 to the hyaline cartilages and joints of transgenic mice. Postnatal expression of this transgene resulted in pathological changes in articular cartilage of the mouse joints similar to those observed in human OA. These included characteristic erosion of the articular cartilage associated with loss of proteoglycan and excessive cleavage of type II collagen by collagenase, as well as synovial hyperplasia. These results demonstrate that excessive MMP-13 activity can result in articular cartilage degradation and joint pathology of the kind observed in OA, suggesting that excessive activity of this proteinase can lead to this disease.

The effects of fellow patients on the emotional well-being and satisfaction with care of postoperative cosmetic surgery patients.

This article reports the findings of a quasi-experimental study that represents the first attempt to systematically examine the possibility that contact with fellow patients after cosmetic surgery significantly influences a patient's postoperative emotional well-being and satisfaction with care. Patients were assigned to rooms that either facilitated ample postoperative contact with other patients (n = 70) or to rooms that were physically located in a manner that afforded little inter-patient contact (n = 9). The results indicate that whereas postoperative depression levels did not differ, patients in the high-patient-contact condition experienced less postoperative anxiety and greater overall satisfaction with their quality of care than did patients in the low-patient-contact condition. Analyses of patients' reported postoperative affiliations suggest several additional benefits of inter-patient contact, such as added emotional support, reduction of uncertainty about what to expect, and the opportunity to compare progress and emotional reactions. The results are consistent with a growing literature that suggests fellow patients can and do serve a useful, adjunctive role in health care. Questions for future research are considered.

High prevalence of sleep-disordered breathing in patients with primary open-angle glaucoma.

PURPOSE: Elevated intraocular pressure and systemic hemodynamic changes are main risk factors in primary open-angle glaucoma (POAG). Sleep-disordered breathing (SDB) characterized by snoring, excessive daytime sleepiness and insomnia is accompanied by large swings in blood pressure and repetitive hypoxic periods during sleep. The aim of this study was to evaluate whether there is any relationship between SDB and POAG. METHODS: Consecutively, 212 outpatients with POAG and 218 outpatients without POAG were recruited. Both eyes were examined. An interviewer-administered semi-structured questionnaire was used to collect SDB-related symptoms. RESULTS: After controlling for age, relative to control group, POAG patients showed a high prevalence of snoring (47.6%, p=0.04), snoring plus, excessive daytime sleepiness (27.3%, p=0.01) and snoring plus, excessive daytime sleepiness, plus insomnia (14.6%, p=0.01). CONCLUSION: We found a high prevalence of SDB in patients with POAG. Chronic hemodynamic changes and recurrent severe hypoxia resulting from SDB may contribute to anoxic optic nerve damage, implicated in glaucoma.

Professional communication for coordination of care: inter-mediation for a better management of patients.

The communication of data through telecommunication networks between Healthcare professionals and particularly Hospitals and family doctors is a fundamental challenge for the next decade. Some experiences are demonstrating the feasibility of this approach and give clear insight of the potentials, difficulties and constraints of the problem. Different technical solutions are proposed following a centralised or a distributed architecture, security and confidentiality obligations, and the users requirements. We propose an original solutions based on the principle of inter-mediation to provide intelligent treatments and services on the messages that are exchanged between the network participants. This approach proved to be successful in the experimental field of Armentières (France) where more than 30,000 messages were exchanged between the hospital and the General Practitioners during 1999. Following this experimental phase, the prototype is currently customised and industrialised to fulfil the requirements and needs of an healthcare sector.

[Teleradiographic analysis of velopharyngeal insufficiency in CATCH 22 association]. / Analyse téléradiographique de l'insuffisance vélo-pharyngée dans l'association CATCH 22.

The CATCH 22 association (Cardiac defect, Abnormal facies, Thymic hypoplasia, Cleft palate, Hypocalcemia) combines certain signs common to various syndromes (Di-George syndrome, velocardiofacial syndrome, etc.) in combination with a 22q11 chromosomal microdeletion. Velopharyngeal insufficiency can be a complementary sign, or even a presenting sign of this chromosomal anomaly. After clinical examination of these patients, velopharyngeal insufficiency appeared to be due to a deep nasopharynx rather than to a short soft palate. We therefore reviewed 11 patients with teleradiography. We studied the length of the soft palate, the depth of the nasopharynx, the ratio of the depth of the nasopharynx over the length of the soft palate, and we compared our results with those observed in reference populations. The results demonstrate nasopharyngeal disproportion with a normal length of the soft palate and increased depth of the nasopharynx. This anatomical finding therefore encourages us to propose sphincteroplasty rather than velopharyngoplasty.

Effects of a videotape information intervention at discharge on diet and exercise compliance after coronary bypass surgery.

BACKGROUND: This study evaluated the relative effects on compliance with recommended lifestyle changes of two experimental videotapes that involved different approaches for preparing coronary artery bypass graft (CABG) patients for the posthospital recovery period. The tapes differed in the extent to which they portrayed the recovery period as a steady, forward progression versus a series of "ups and downs." METHODS: Two hundred sixteen male and female CABG patients were assigned randomly either to view one of the two videotapes before discharge from the hospital or to receive only the standard discharge preparation provided by the hospital. All patients completed measures of anxiety and self-efficacy at discharge, 1 month and 3 months after discharge from the hospital. Patients also completed measures of dietary fat consumption and activity level 1 and 3 months after discharge. RESULTS: Relative to controls, patients who viewed either of the videotapes before hospital release reported higher self-efficacy for adhering to the recommended low-fat diet both at discharge and 1 month after surgery. Viewing either of the videotapes also resulted in significantly less dietary fat intake 1 month after hospital release compared with controls. Patients who viewed the tape that portrayed the recovery period as consisting of ups and downs also reported significantly more frequent moderate exercise at 1 month and more frequent strenuous exercise 3 months after discharge. CONCLUSIONS: The experimental videotapes proved to be an effective method for increasing dietary and exercise compliance during the first 3 months after CABG.

Effects of preparatory videotapes on self-efficacy beliefs and recovery from coronary bypass surgery.

This study evaluated the relative effects of three experimental videotapes that involved different approaches for preparing coronary artery bypass graft (CABG) patients for surgery and the inhospital recovery period. One of the tapes conveyed information via a health care expert only. The other two featured the same health care expert and also included clips of interviews with patient models. These latter two tapes differed in the extent to which they portrayed the recovery period as a steady, forward progression or as consisting of "ups and downs". Two hundred fifty-eight male CABG patients were randomly assigned to view one of the three videotapes on the evening prior to surgery or to a control condition. Overall, patients who viewed any of the videotapes felt significantly better prepared for the recovery period, reported higher self-efficacy for using the incentive spirometer and for speeding their recovery, performed more repetitions with their incentive spirometer each time they used it postoperatively, had shorter intensive care unit stays, and were released from the hospital more quickly than patients in the control condition. There was also evidence that patients' self-efficacy beliefs for speeding recovery directly mediated the effects of the videotapes on length of stay both in the intensive care unit and in the hospital.

Inhibition of cardiac delayed rectifier K+ current by overexpression of the long-QT syndrome HERG G628S mutation in transgenic mice.

Mutations in the HERG gene are linked to the LQT2 form of the inherited long-QT syndrome. Transgenic mice were generated expressing high myocardial levels of a particularly severe form of LQT2-associated HERG mutation (G628S). Hearts from G628S mice appeared normal except for a modest enlargement seen only in females. Ventricular myocytes isolated from adult wild-type hearts consistently exhibited an inwardly rectifying E-4031-sensitive K+ current resembling the rapidly activating cardiac delayed rectifier K+ current (Ikr) in its time and voltage dependence; this current was not found in cells isolated from G628S mice. Action potential duration was significantly prolonged in single myocytes from G628S ventricle (cycle length=1 second, 26 degrees C) but not in recordings from intact ventricular strips studied at more physiological rates and temperature (200 to 400 bpm, 37 degrees C). ECG intervals, including QT duration, were unchanged, although minor aberrancies were noted in 20% (16/80) of the G628S mice studied, primarily involving the QRS complex and, more rarely, T-wave morphology. The aberrations were more commonly observed in females than males but could not be correlated with sex-based differences in action potential duration. These results establish the presence of IKr in the adult mouse ventricle and demonstrate the ability of the G628S mutation to exert a dominant negative effect on endogenous IKr in vivo, leading to the expected LQT2 phenotype of prolonged repolarization at the single cell level but not QT prolongation in the intact animal. The model may be useful in dissecting repolarization currents in the mouse heart and as a means of examining the mechanism(s) by which the G628S mutation exerts its dominant negative effect on native cardiac cells in vivo.

The social construction of cardiovascular reactivity.

One can view the "reactivity hypothesis" as having two basic forms: the individual difference or personality approach, which suggests that people who show exaggerated cardiovascular responses to stress are at increased risk of developing cardiovascular disease, and the situational or social psychological approach, which suggests that circumstances which give rise to unusually large responses are those that put people at risk of disease. Both versions rely on the generality of cardiovascular responses across situations. Evidence is presented from two studies which indicate that such generality may, however, be hard to come by. In the first study, examining the personality approach, we show that a simple change in setting dramatically attenuates the consistency of reactivity. In the second study, from the social psychological perspective, we show that subtle alterations in the situation have profound effects on group mean responses. In both cases, reactivity proved extremely sensitive to the context, suggesting that testing in arbitrary and artificial settings cannot be expected to generalize well to the real world. Instead, we argue, careful attention to psychological naturalism is essential, with the testing carefully matched to specific real-world phenomena of interest.

Bioimpedance cardiac output measurements in patients with presumed congestive heart failure.

OBJECTIVE: To describe preliminary ED experience with thoracic electrical bioimpedance (TEB) for evaluation of patients with complaints suggestive of congestive heart failure (CHF). METHODS: A 6-month, prospective, observational study was performed using a convenience sample of patients with signs and symptoms consistent with CHF. Patients were excluded if they had received medication prior to arrival in the ED, if they were obese, and if they had unstable vital signs. They also were excluded if they were combative, refused to sign consent, or had invasive lines that did not allow for TEB lead placement. Patients also were excluded if the study could not be completed because the patient was taken from the department for a diagnostic test, or if there were no good follow-up records available 6-12 months after the patient's visit. The patient's physician was blinded to the output of the TEB monitor. Cardiac output (CO), stroke volume (SV), end-diastolic volume (EDV), thoracic fluid index (TFI), and acceleration index (ACI) were recorded at 5-minute intervals. Results were evaluated for the time intervals 0-5 minutes, 30-35 minutes, and 60-65 minutes. RESULTS: Seven patients were included in the study. The echocardiographic diagnoses were hypertrophic cardiomyopathy (2 cases), dilated cardiomyopathy (2 cases), ischemic cardiomyopathy (1 case), right ventricular hypertrophy (1 case), and pericardial effusion (1 case). Significant changes were seen in all cardiac parameters, with variance from individual to individual. CONCLUSIONS: Significant differences in TEB variables exist between patients who appear similar on initial examination in the ED. Changes noted on TEB may help to further elucidate physiologic differences. The clinical use of TEB-based hemodynamic measurements to guide presumed CHF patient management remains speculative.