Skeletal muscle effects of electrostimulation after COPD exacerbation: a pilot study.

Muscle dysfunction is a major problem in chronic obstructive pulmonary disease (COPD), particularly after exacerbations. We thus asked whether neuromuscular electrostimulation (NMES) might be directly useful following an acute exacerbation and if such a therapy decreases muscular oxidative stress and/or alters muscle fibre distribution. A pilot randomised controlled study of NMES lasting 6 weeks was carried out in 15 in-patients (n=9 NMES; n=6 sham) following a COPD exacerbation. Stimulation was delivered to the quadriceps and hamstring muscles (35 Hz). Primary outcomes were quadriceps force and muscle oxidative stress. At the end of the study, quadriceps force improvement was statistically different between groups (p=0.02), with a significant increase only in the NMES group (median (interquartile range) 10 (4.7-11.5) kg; p=0.01). Changes in the 6-min walking distance were statistically different between groups (p=0.008), with a significant increase in the NMES group (165 (125-203) m; p=0.003). NMES did not lead to higher muscle oxidative stress, as indicated by the decrease in total protein carbonylation (p=0.02) and myosin heavy chain carbonylation (p=0.01) levels. Finally, we observed a significant increase in type I fibre proportion in the NMES group. Our study shows that following COPD exacerbation, NMES is effective in counteracting muscle dysfunction and decreases muscle oxidative stress.

Long-term effects of aerobic exercise on psychological outcomes.

BACKGROUND: Although the literature on increased physical fitness and psychological outcomes has grown large, a number of methodological limitations remain unaddressed. The present study was designed to address a number of these limitations while examining the short- and long-term psychological effects following completion of a 12-week aerobic fitness program using bicycle ergometry (and confirmed increases in fitness). METHOD: Following completion of a 12-week aerobic fitness program (and through 12 months of follow-up), 82 adult participants completed the Beck Depression Inventory, Profile of Mood States, State-Trait Anxiety Inventory, and the Tennessee Self-Concept Scale. Physiological measures used to assess changes in aerobic fitness were maximal work load, submaximal heart rate at a standard work load, predicted maximum oxygen uptake, and resting heart rate. RESULTS: Exercise participants experienced a positive fitness change and psychological improvement over the initial 12-week program compared to a control group. At 1 year follow-up, physiological and psychological benefits remained significantly improved from baseline. CONCLUSIONS: Overall, results indicate that exercise-induced increases in aerobic fitness have beneficial short-term and long-term effects on psychological outcomes. We postulate that participants in the exercise group did not increase the amount of weekly exercise they performed over the 12-month follow-up period and thus the maintenance of the psychological improvements occurred concurrent with equal or lesser amounts of exercise.

Neoadjuvant etoposide, ifosfamide, and cisplatin followed by concomitant thoracic radiotherapy and continuous cisplatin infusion in stage IIIb non-small cell lung cancer.

OBJECTIVE: To determine the applicability and safety of an ifosfamide, cisplatin, and etoposide (VIP) regimen as a neoadjuvant chemotherapy to a concomitant thoracic radiotherapy and cisplatin continuous infusion in locally advanced non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Forty-four patients (stage IIIb in 43 and stage IIIa in 1) entered a study of VIP, followed by concomitant thoracic radiotherapy and cisplatin continuous infusion. Chemotherapy consisted of three courses of cisplatin 25 mg/m2, ifosfamide 1.5 g/m2 (with uroprotection), and etoposide 100 mg/m2 given on days 1 to 4 of a 21-day cycle with hematopoietic support using recombinant human methionyl granulocyte colony stimulating factor. Patients who achieved a response or a stabilization were planned to receive a split-course normofractionated thoracic radiotherapy (first course: 30 Gy/10; 4-week rest period; second course: 25 Gy/10). A continuous cisplatin infusion of 6 mg/m2 daily was administered using an autonomous chemotherapy delivery device. Total plasma platinum titration was performed daily during the two courses in five of the patients. Analyses were done on an intent-to-treat basis. RESULTS: Thirty-nine of the 44 patients received the three-cycle chemotherapy program. Received dose intensity was 82%. Thirty-eight patients received the radiotherapy and, among them, 35 received the complete concomitant continuous cisplatin infusion. Objective (complete) response rates were 48% (7%) at the end of chemotherapy and increased up to 61% (16%) by the end of radiotherapy. At the end of the first radiotherapy cycle, the mean total plasma platinum concentration was twice as high as that of the residual postinduction chemotherapy concentration. During induction chemotherapy, myelosuppression was the limiting toxicity requiring hospital readmission in 23 patients. During radiotherapy, the main toxicity was acute esophagitis. A relatively high rate of pulmonary fibrosis was observed using the subjective objective management analytic--late effects of normal tissue score without life-threatening pulmonary function impairment. None of the patients died from toxic reactions. Probability of survival at 1, 2, and 3 years was 49%, 19%, and 5%, respectively. Primary cause of failure was a local relapse in 63% of the patients, brain metastases in 24%, and hematogeneous metastases to other sites in 13%. CONCLUSION: Neoadjuvant VIP followed by concomitant radiotherapy-chemotherapy is feasible, but the split-course radiotherapy did not prevent a high rate of local recurrences. The high rate of toxic reactions requiring hospital readmission limits further development of such an aggressive regimen in NSCLC.

Evaluation of ligase chain reaction for direct detection of Mycobacterium tuberculosis in respiratory specimens.

A new automated amplification method, Ligase Chain Reaction (LCx MTB), was evaluated for direct detection of Mycobacterium tuberculosis in respiratory specimens from 208 patients and its performance was compared with culture and direct smears. Out of 226 specimens, 28 LCx MTB and 15 cultures were found positive for M. tuberculosis. After resolution of clinical history, the sensitivity of LCx MTB and culture was respectively 89.3% and 53.6% with a specificity of 98.5% and 100%. However, samples coming from untreated patients presented similar results between culture and LCx MTB (sensitivity 75% and 83.3% for culture and LCx MTB).

A new model for risk stratification and delivery of cardiovascular rehabilitation services in the long-term clinical management of patients with coronary artery disease.

This model for risk stratification includes variables that classify patients for Risk of Event similar to current models of risk stratification, as well as variables that stratify patients for Risk of Progression of Atherosclerosis by established risk factors. Categories of risk are established using accepted data from the literature for each risk factor that targets regression or plaque stabilization as the goal for Low Risk. A case-rate charging system and the proposed removal of time restrictions for length of cardiovascular rehabilitation fit neatly into the present climate for health care. Health maintenance organizations will be seeking programs that use similar models to address cost issues inherent in cardiovascular rehabilitation programs under current fee-for-service models. Improved outcomes will also be targets for these programs and case-management lends itself to disease management, thus, improved outcomes. Tracking outcomes becomes even more important to both the provider and the insurer because results drive referrals. Likewise, removal of the time restriction for cardiovascular rehabilitation allows programs to individualize care and to target risk factors that are not only most deleterious, but also where patients show readiness for change. The changing environment of health care virtually mandates change in cardiovascular rehabilitation. It is imperative that programs manage the disease process, are effective in achieving outcomes that affect both patient function and the disease process, and are cost effective. This model for risk stratification and delivery of services addresses these requirements and provides a beginning for implementing these changes in cardiovascular rehabilitation.

Influence of activity level on vitamin E status in healthy men and women and cardiac patients.

BACKGROUND: Plasma Vitamin E status may indicate protection against cholesterol oxidation. The purpose of this study was to determine if the plasma vitamin E status is influenced by exercise training status or a single session of submaximal exercise. METHODS: The 41 participants were categorized as sedentary, recreational endurance trained, competitive endurance trained, or cardiac rehabilitation patients. Subjects completed a 3-day dietary record. After a 24-hour diet and exercise control period, including a 12-hour fast, venous blood was collected. Plasma was analyzed for total cholesterol, high-density lipoprotein cholesterol (HDL-C), total lipid, vitamin E, and low-density lipoprotein (LDL) vitamin E concentrations. Each subject then exercised on a treadmill at 60% of measured maximal oxygen consumption for 30 minutes. Postexercise samples were collected 5 minutes after the activity. RESULTS: Multivariate analysis of variance and follow-up Tukey post hoc tests indicated that the cardiac rehabilitation group had lower total fat and monounsaturated fat intake in the diet than the other groups, and the competitive-endurance trained group had higher HDL-C levels. Plasma vitamin E was higher in the cardiac rehabilitation group, but the statistical differences disappeared when expressed per unit of plasma total lipid. The vitamin E content of LDL was not different among the groups. A single exercise session did not alter the plasma lipoprotein or vitamin E status. CONCLUSIONS: These results suggest that habitual activity level of healthy individuals or a single session of exercise does not influence the plasma vitamin E or LDL vitamin E concentrations. However, patients in an endurance cardiac rehabilitation program tend to show normal to elevated plasma vitamin E status.

Cytokeratins as serum markers in lung cancer: a comparison of CYFRA 21-1 and TPS.

We examined two recently described cytokeratin markers, CYFRA 21-1 (cytokeratin fragment recognized by KS 19-1 and BM 19-21 antibodies) and TPS (specific M3 epitope of the tissue polypeptide antigen), in 405 lung cancer patients (91 small-cell and 314 non-small-cell lung cancers) and 59 patients presenting with nonmalignant pulmonary disease. Sensitivity-specificity relationship, as analyzed by receiver operating characteristic curves, demonstrated a higher accuracy of CYFRA 21-1 in comparison with TPS in both small-cell and non-small-cell lung cancers. Thresholds of 3.6 ng/ml and 140 U/L for CYFRA 21-1 and TPS respectively gave a 90% to 95% specificity. Sensitivity of CYFRA 21-1 was the highest in squamous-cell carcinomas (0.61) and the lowest in small-cell lung cancers (0.36), whereas sensitivity of TPS did not vary significantly according to histology (overall sensitivity, 0.40). In non-small-cell lung cancers, both serum CYFRA 21-1 and serum TPS distributions varied significantly according to Mountain's stage of the disease, nodal status, tumor status, and performance status, inasmuch as the worse each above-mentioned variable became, the higher the median and interquartile serum marker level was. Neither CYFRA 21-1 nor TPS was able to accurately discriminate between stage IIIa (marginally resectable) and stage IIIb (unresectable) non-small-cell lung cancers, however. In both small-cell and non-small-cell lung cancers, univariate survival analyses demonstrated that either a CYFRA 21-1 level over 3.6 ng/ml or a TPS level over 140 U/L significantly indicated a poor survival rate. In the whole population, taking into account other significant variables, Cox's model analysis demonstrated that a poor performance index, an advanced stage of the disease, the presence of metastases, elevated serum lactate dehydrogenase, and high serum CYFRA 21-1 (odds ratio, 1.74; 95% confidence interval, [1.33-2.27] were independent prognostic variables. We concluded that CYFRA 21-1 is a significant determinant of survival. Other applications of cytokeratin markers in lung cancer are still limited.

The effect of physical activity on all cause mortality compared to cardiovascular mortality: a review of research and recommendations.

The American Heart Association states that sedentary lifestyle is a major risk factor for CVD comparable to hypercholesterolemia, hypertension, and cigarette smoking. Nearly 60% of Missourians are sedentary. This article reviews and summarizes recent literature on physical inactivity and mortality, makes recommendations to physicians regarding exercise and health benefits, and discusses the contributions physicians can make toward increasing physical activity levels in their patients.

The Missouri Cardiovascular Health Plan: a focus on prevention.

The authors describe a framework for planning, implementing, and evaluating cardiovascular health programs in Missouri. Populations targeted for intervention are identified, and the role of the physician in supporting community-based cardiovascular health promotion is explored.

Physiological parameters related to distance running performance in female athletes.

The purpose of this study was to investigate the relationship between running pace for the 5 km, the 10 km, and the 16.09 km (10 mile) distances and the following variables: oxygen uptake and treadmill speed at predetermined lactate accumulation points (2.0 and 4.0 mmol.l-1), oxygen uptake (running economy) at three submaximal standardized treadmill speeds (196, 215, and 241 m.min-1), and maximal oxygen uptake. Thirteen moderately to highly conditioned (VO2max = 59.7 +/- 5.3 ml.kg-1.min-1; VO2 at 2.0 mmol.l-1 of plasma lactate = 46.6 +/- 4.1 ml.kg-1.min-1) female runners between the ages of 18 and 33 yr volunteered to participate. All subjects performed the laboratory tests and the 5 km, 10 km, and 16.09 km competitive time trials on an outdoor 5 km course. The correlation coefficients (r) between each race pace and maximal oxygen uptake (VO2max), speed (s) at 2.0 mmol.l-1 plasma lactate accumulation (PLA2s), and speed at 4.0 mmol.l-1 plasma lactate accumulation (PLA4s) ranged between 0.84 and 0.94. The oxygen costs of running at each of the three submaximal paces were correlated moderately with each race pace (r = -0.40 to -0.63). Hierarchal stepwise multiple regression analyses produced equations with two independent variables which explained 94 to 97% of the variability in race performance.

Seroepidemiological study on sexually transmitted diseases and hepatitis B in African promiscuous heterosexuals in relation to HTLV-III infection.

A seroepidemiological study was performed on HTLV-III, T. pallidum, C. trachomatis and Hepatitis B virus (HBV), in Butare, Rwanda, among 33 female prostitutes, 25 male customers of prostitutes, and 60 male and female controls. As compared with female controls the prostitutes had a higher prevalence of antibodies to HTLV-III (29/33 versus 4/33, p less than 0.001), T. pallidum (TPHA: 27/33 versus 6/33, p less than 0.001; RPR: 19/33 versus 2/33, p less than 0.001; FTA-Abs: 27/33 versus 5/33, p less than 0.001) and C. trachomatis (IgG IF: 31/33 versus 13/33, p less than 0.001). HBV serological markers were more often detected in the prostitutes than in the female controls (31/33 versus 18/33, p less than 0.001) although HBs antigen carriage rate was similar in both groups. As compared with male controls, the male customers of prostitutes had more frequently detectable antibodies to HTLV-III (7/25 versus 2/27, p = 0.05), and a positive RPR (10/25 versus 1/27, p less than 0.01). Among the 118 individuals studied, odds ratios and trend analysis disclosed a significant association between HTLV-III seropositivity and a positive TPHA, RPR, FTA-Abs, Chlamydia IgG IF test and serological markers to HBV. No association was found between HTLV-III seropositivity and HBs Ag carriage. This study suggests that HTLV-III has to be considered as an infectious agent transmitted among promiscuous Central African heterosexuals by sexual contact and/or parenteral contact with unsterile needles used for STD treatments.

The Efficacy and Risk of Intense Aerobic Circuit Training in Coronary Artery Disease Patients Following Bypass Surgery.

In brief: This study describes the influence of highly intense aerobic circuit training on the cardiorespiratory fitness of 31 coronary artery disease (CAD) patients who had undergone bypass surgery. The patients trained at 84.2% of heart rate (HR) reserve three times a week for 12 weeks. Duration per session progressed from 25 to 60 minutes over the first six weeks. Results showed that the subjects improved significantly in estimated peak mets, percent body fat, resting HR, HR and rate pressure product (RPP) response to standard submaximal exercise (7.2 mets), and maximal RPP. In addition, there were no abnormal responses related to cardiovascular or musculoskeletal complications. Thus, this type of exercise is an effective, safe, and attractive cardiorespiratory training method for CAD patients following bypass surgery.

Cardiac rehabilitation at Boone Hospital Center, Columbia, Mo.

The cardiac rehabilitation program at this Missouri hospital begins as soon as a hospitalized patient's condition is stable and while physical activity is still limited following infarction or bypass. The second phase is a hospital-based outpatient program of prescribed exercise. Education, psychologic support, and the positive aspects of exercise are emphasized during all phases.

Factors influencing tutors' perceptions of retarded children.

After tutoring experience 5 college students who tutored handicapped children responded more negatively and 27 tutors of nonhandicapped children responded less negatively to labels, Mentally Handicapped Child and Normal Child, than previously. The former label was more negatively rated than Normal Child.

The maximal steady state versus selected running events.

To investigate the relationship between the maximal steady state (MSS) and selected running events, seven males (mean = 37.6 years) who were experienced competitive distance runners were studied. From a series of 10-min steady-state treadmill runs, MSS (treadmill velocity, VO2, or heart rate where lactic acid concentration was 2.2 mM/L of venous blood) was determined for all subjects. Treadmill velocity at MSS averaged 258.9 +/- 29.0 m/min. The subjects subsequently performed maximal time trials or races at 13.7 m (15 yd), 45.7 m (50 yd), 402.3 m (440 yd), 3.22 km (2 miles), 8.05 km (5 miles), 16.09 km (10 miles), and 20 km (12.44 miles). Running paces for the 402.3-m, 3.22-km, 8.05-km, 16.09-km, and 20-km distances were all correlated significantly with the treadmill pace at MSS (r = 0.84 to 0.995). The highest correlation was between the MSS treadmill velocity and the 8.05-km pace. The mean for a 6.44-km (4 miles) flat section of the 16.09-km run was identical to the mean treadmill velocity at MSS (258.9 m/min). These data indicate that the pace for essentially aerobic events (3.22 km to 20 km) can be closely approximated by knowledge of a runner's MSS, or conversely that the MSS can be predicted very closely from the pace during an all-out 3.22-km, 8.05 km, 16.09-km, or 20-km run.