Showing papers by "Rush University Medical Center published in 1995"

The prevalence and characteristics of fibromyalgia in the general population

Abstract: Objective. To determine the prevalence and characteristics of fibromyalgia in the general population. Methods. A random sample of 3,006 persons in Wichita, KS, were characterized according to the presence of no pain, non-widespread pain, and widespread pain. A subsample of 391 persons, including 193 with widespread pain, were examined and interviewed in detail. Results. The prevalence of fibromyalgia was 2.0% (95% confidence interval [95% CI] 1.4, 2.7) for both sexes, 3.4% (95% CI 2.3, 4.6) for women, and 0.5% (95% CI 0.0, 1.0) for men. The prevalence of the syndrome increased with age, with highest values attained between 60 and 79 years (>7.0% in women). Demographic, psychological, dolorimetry, and symptom factors were associated with fibromyalgia. Conclusion. Fibromyalgia is common in the population, and occurs often in older persons. Characteristic features of fibromyalgia–pain threshold and symptoms–are similar in community and clinic populations, but overall severity, pain, and functional disability are more severe in the clinic population.

Neuropathological Evidence of Graft Survival and Striatal Reinnervation after the Transplantation of Fetal Mesencephalic Tissue in a Patient with Parkinson's Disease

Abstract: Background Trials are under way to determine whether fetal nigral grafts can improve motor function in patients with Parkinson's disease. Some studies use fluorodopa uptake on positron-emission tomography (PET) as a marker of graft viability, but fluorodopa uptake does not distinguish between host and grafted neurons. There has been no direct evidence that grafts of fetal tissue can survive and innervate the striatum. Methods We studied a 59-year-old man with advanced Parkinson's disease who received bilateral grafts of fetal ventral mesencephalic tissue in the postcommissural putamen. The tissue came from seven embryos between 61/2 and 9 weeks after conception. The patient died 18 months later from a massive pulmonary embolism. The brain was studied with the use of tyrosine hydroxylase immunohistochemical methods. Results After transplantation, the patient had sustained improvement in motor function and a progressive increase in fluorodopa uptake in the putamen on PET scanning. On examination of the brai...

Efficacy and Safety of Monoclonal Antibody to Human Tumor Necrosis Factor α in Patients With Sepsis Syndrome: A Randomized, Controlled, Double-blind, Multicenter Clinical Trial

Abstract: Objective. —To evaluate the efficacy and safety of anti—tumor necrosis factor α monoclonal antibody (TNF-α MAb) in the treatment of patients with sepsis syndrome. Design. —Randomized, prospective, multicenter, double-blind, placebo-controlled clinical trial. Setting. —A total of 31 hospitals in the United States and Canada. Patients. —There were 994 patients with sepsis syndrome enrolled in this clinical trial, and 971 patients were infused with the study drug. Intervention. —Patients were prospectively stratified into shock or nonshock groups and then randomized to receive a single infusion of 15 mg/kg of TNF-α MAb, 7.5 mg/kg of TNF-α MAb, or placebo. Patients received standard aggressive medical and surgical care during the 28-day postinfusion period. Outcome Measure. —Twenty-eight-day all-cause mortality. Results. —The distribution of variables describing demographics, organ system dysfunction or failure, preinfusion Acute Physiology and Chronic Health Evaluation II score, number of organs failing at baseline, initial sites of infection, infecting microorganisms, antimicrobials used, and initial invasive procedures was similar among patients in the TNF-α MAb and placebo treatment arms. Among all infused patients, there was no difference in all-cause mortality in patients who received placebo as compared with those who received TNF-α MAb. In septic patients with shock (n=478), there was a trend toward a reduction in all-cause mortality, which was most evident 3 days after infusion: 25 of 162 patients treated with 15 mg/kg of TNF-α MAb died, 22 of 156 patients treated with 7.5 mg/kg of TNF-α MAb died, and 44 of 160 patients in the placebo group died (15 mg/kg: 44% reduction vs placebo, P =.01; 7.5 mg/kg: 48.7% reduction vs placebo, P =.004). At day 28, the reduction in mortality for shock patients was not significant for either dose of TNF-α MAb relative to placebo (15 mg/kg, 61 deaths among 162 patients [37.7% mortality]; 7.5 mg/kg, 59 deaths among 156 patients [37.8% mortality]; placebo, 73 deaths among 160 patients [45.6% mortality]; P =.20 for 7.5 mg/kg and P =.15 for 15 mg/kg). Serious adverse events were reported in 4.6% of all infused patients. No immediate hypersensitivity allergic reactions due to TNF-α MAb were reported. Serum sickness—like reactions were seen in 2.5% of patients receiving TNF-α MAb. Conclusions. —There was no decrease in mortality between placebo and TNF-α MAb in all infused patients. In septic shock patients who received TNF-α MAb, a significant reduction in mortality was present 3 days after infusion. Although a trend toward reduced mortality continued at 28 days following treatment with TNF-α MAb, the difference in mortality among shock patients treated with placebo or TNF-α MAb was not significant. ( JAMA . 1995;273:934-941)

Radiation Therapy Oncology Group (RTOG) 88–08 and Eastern Cooperative Oncology Group (ECOG) 4588: Preliminary Results of a Phase III Trial in Regionally Advanced, Unresectable Non-Small-Cell Lung Cancer

Abstract: Background: Regionally advanced, surgically unresectable non-small-cell lung cancer represents a disease with an extremely poor prognosis. External-beam irradiation to the primary tumor and regional lymphatics is generally accepted as standard therapy. The use of more aggressive radiation regimens and the addition of cytotoxic chemotherapy to radiotherapy have yielded conflicting results. Recently, however, results from clinical trials using innovative irradiation delivery techniques or chemotherapy before irradiation have indicated that patients treated with protocols that incorporate these modifications may have higher survival rates than patients receiving standard radiation therapy. Purpose: On the basis of these results, the Radiation Therapy Oncology Group (RTOG)-Eastern Cooperative Oncology Group (ECOG) elected to conduct a phase III trial comparing the following regimens: 1) standard radiation therapy, 2) induction chemotherapy followed by standard radiation therapy, and 3) twice-daily radiation therapy. Methods: Patients with surgically unresectable stage II, IIIA, or IIIB non-small-cell lung cancer were potential candidates. Staging was nonsurgical. Patients were required to have a Karnofsky performance status of 70 or more and weight loss less than 5% for 3 months prior to entry into the trial, to be older than 18 years of age, and to have no metastatic disease. Of the 490 patients registered in the trial, 452 were eligible. The disease in 95% of the patients was stage IIIA or IIIB. More than two thirds of the patients had a Karnofsky performance status of more than 80. Patients were randomly assigned to receive either 60 Gy of radiation therapy delivered at 2 Gy per fraction, 5 days a week, over a 6-week period (standard radiation therapy); induction chemotherapy consisting of cisplatin (100 mg/m 2 ) on days 1 and 29 and 5 mg/m 2 vinblastine per week for 5 consecutive weeks beginning on day 1 with cisplatin, followed by standard radiation therapy starting on day 50; or 69.6 Gy delivered at 1.2 Gy per fraction twice daily (hyperfractionated radiation therapy). Results: Toxicity was acceptable, with four treatment-related deaths. Three patients subsequently died of chronic pulmonary complications. Compliance with protocol treatment was acceptable. One-year survival (%) and median survival (months) were as follows: standard radiation therapy-46%, 11.4 months; chemotherapy plus radiotherapy-60%, 13.8 months; and hyperfractionated radiation therapy-51%, 12.3 months. The chemotherapy plus radiotherapy arm was statistically superior to the other two treatment arms (logrank P=.03). Conclusions: In «good-risk» patients with surgically unresectable non-small-cell lung cancer, induction chemotherapy followed by irradiation was superior to hyperfractionated radiation therapy or standard radiation therapy alone, yielding a statistically significant short-term survival advantage

Biomechanical risk factors for occupationally related low back disorders

Abstract: A continuing challenge for ergonomists has been to determine quantitatively the types of trunk motion and how much trunk motion contributes to the risk of occupationally-related low back disorder (LBD). It has been difficult to include this motion information in workplace assessments since the speed at which trunk motion becomes dangerous has not been determined. An in vivo study was performed to assess the contribution of three-dimensional dynamic trunk motions to the risk of LBD during occupational lifting in industry. Over 400 industrial lifting jobs were studied in 48 varied industries. The medical records in these industries were examined so that specific jobs historically categorized as either low, medium, or high risk for occupationally-related LBD could be identified. A tri-axial electrogoniometer was worn by workers and documented the three-dimensional angular position, velocity, and acceleration characteristics of the lumbar spine while workers worked at these low, medium, or high risk jobs. Workplace and individual characteristics were also documented for each of the repetitive lifting tasks. A multiple logistic regression model indicated that a combination of five trunk motion and workplace factors predicted well both medium risk and high risk occupational-related LBD. These factors included lifting frequency, load moment, trunk lateral velocity, trunk twisting velocity, and trunk sagittal angle. Increases in the magnitude of these factors significantly increased the risk of LBD. The analyses have enabled us to determine the LBD risk associated with combined changes in the magnitudes of the five factors. The results indicate that by suitably varying these five factors observed during the lift collectively, the odds of high risk group membership may decrease by over ten times. These results were related to the biomechanical, ergonomic, and epidemiologic literature. The five trunk motion and workplace factors could be used as quantitative, objective measures to redesign the workplace so that the risk of occupationally-related LBD is minimized.

Oral appliances for the treatment of snoring and obstructive sleep apnea: a review.

Abstract: This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's parameters for the practice of sleep medicine in North America. The 21 publications selected for this review describe 320 patients treated with oral appliances for snoring and obstructive sleep apnea. The appliances modify the upper airway by changing the posture of the mandible and tongue. Despite considerable variation in the design of these appliances, the clinical effects are remarkably consistent. Snoring is improved and often eliminated in almost all patients who use oral appliances. Obstructive sleep apnea improves in the majority of patients; the mean apnea-hypopnea index (AHI) in this group of patients was reduced from 47 to 19. Approximately half of treated patients achieved an AHI of < 10; however, as many as 40% of those treated were left with significantly elevated AHIs. Improvement in sleep quality and sleepiness reflects the effect on breathing. Limited follow-up data indicate that oral discomfort is a common but tolerable side effect, that dental and mandibular complications appear to be uncommon and that long-term compliance varies from 50% to 100% of patients. Comparison of the risk and benefit of oral appliance therapy with the other available treatments suggests that oral appliances present a useful alternative to continuous positive airway pressure (CPAP), especially for patients with simple snoring and patients with obstructive sleep apnea who cannot tolerate CPAP therapy.

Predicting the "Revolving Door" Phenomenon Among Patients With Schizophrenic, Schizoaffective, and Affective Disorders

Abstract: Objective A subpopulation of chronically mentally ill patients, sometimes referred to as "revolving door" patients, are frequently readmitted to psychiatric units. This study examined the relationships among demographic features, diagnostic characteristics, and frequency of hospitalization of patients from four state hospitals. Method Two semistructured, standardized instruments, the Schedule for Affective Disorders and Schizophrenia and a life events history, were administered to 135 inpatients who met the Research Diagnostic Criteria for schizophrenia (N = 56), schizoaffective disorder (N = 33), unipolar major depressive disorder (N = 23), and bipolar disorder (N = 23). Criminal history was assessed by arrest records. The main outcome measure was the number of hospitalizations. Results Chi-square and trend test analyses indicated that substance abuse and noncompliance with medication regimens were significantly associated with higher frequencies of hospitalization. A multiple regression model, which included alcohol/drug problems, medication noncompliance, and six sociodemographic and diagnostic variables (age, gender, race, marital status, years of education, and diagnosis) accounted for a significant proportion of the ability to predict frequency of hospitalization. Half of this predictability was due to the relationship of substance abuse and medication noncompliance with number of hospitalizations. Conclusions Alcohol/drug problems and noncompliance with medication were the most important factors related to frequency of hospitalization. Preventing these behaviors through patient education may reduce rehospitalization rates.

Age-specific incidence of Alzheimer's disease in a community population

Abstract: Objective. —To determine age-specific incidence rates of clinically diagnosed Alzheimer's disease. Design. —Cohort, followed a mean of 4.3 years. Setting. —East Boston, Mass. Participants. —Of 2313 persons aged 65 years and older who were initially free of Alzheimer's disease, 1601 participated in the ascertainment of incident disease (80% of survivors), 409 declined participation, and 303 died before the end of the follow-up period. A stratified sample of 642 persons received detailed clinical evaluation. Outcome Measure. —Diagnosis of new probable Alzheimer's disease through structured clinical evaluation including neurologic, neuropsychological, and psychiatric examination. Community incidence rates were computed by 5-year age groups, adjusted for gender, single year of age, length of follow-up interval, and sampling design. Results. —The estimated annual incidence of Alzheimer's disease in the population was 0.6% (95% confidence interval [Cl], 0.3% to 0.9%) for persons aged 65 to 69 years, 1.0% (95% Cl, 0.6% to 1.4%) for persons aged 70 to 74 years, 2.0% (95% Cl, 1.3% to 2.7%) for persons aged 75 to 79 years, 3.3% (95% Cl, 2.2% to 4.4%) for persons aged 80 to 84 years, and 8.4% (95% Cl, 3.7% to 13.1%) for persons aged 85 years and older. Conclusions. —The incidence of Alzheimer's disease is substantial and is approximately 14 times higher among persons older than 85 years compared with those between 65 and 69 years of age. ( JAMA . 1995;273:1354-1359)

Directional specificity of postural muscles in feed-forward postural reactions during fast voluntary arm movements

Abstract: Healthy subjects performed bilateral fast shoulder movements in different directions while standing on a force platform. Anticipatory postural adjustments were seen as changes in the electrical activity of postural muscles as well as displacements of the center of pressure and center of gravity. Postural muscle pairs of agonist-antagonist commonly demonstrated triphasic patterns starting prior to the first electromyographic (EMG) burst in the prime-mover muscle. Proximal postural muscles demonstrated the largest anticipatory increase in the background activity during movements in one of the two opposite directions (forward or backwards). These changes progressively decreased when movements deviated from the preferred direction and frequently disappeared during movements in the opposite direction. The patterns in distal muscles varied across subjects and could demonstrate larger anticipatory changes during movements forward and backwards as compared to movements in intermediate directions. Bilateral addition of inertial loads to the wrists did not change the general anticipatory patterns, while making some of their features more pronounced. Anticipatory postural adjustments were followed by later changes in the activity of postural muscles, also reflected in the mechanical variables. Changes in leg joint angles revealed a „hip-ankle strategy” during shoulder flexions and an „ankle strategy” during shoulder extensions. The study demonstrates different behaviors of proximal and distal muscles during anticipatory postural adjustments in preparation for fast arm movements. We suggest that the proximal muscles produce a general pattern of postural adjustments, while distal muscles take care of fine adjustments that are more likely to vary across subjects.

Landau-Kleffner syndrome : treatment with subpial intracortical transection

Abstract: Summary Landau—Kleffner syndrome (LKS) is an acquired epileptic aphasia occurring in childhood and associated with a generally poor prognosis for recovery of speech. It is thought to be the result of an epileptogenic lesion arising in speech cortex during a critical period of development. Utilizing a new surgical technique designed to eliminate the capacity of cortical tissue to generate seizures while preserving the normal cortical physiological function, we have treated 14 children with aphasia, seizures and a severely abnormal EEG by multiple subpial transection of the epileptogenic cortex. Seven of the 14 patients (50%) have recovered age-appropriate speech, are in regular classes in school and no longer require speech therapy. Four of the 14 (29%) have shown marked improvement, are speaking and understanding verbal instruction but are still receiving speech therapy. Thus, 11 of the 14(79%), none of whom had used language to communicate for at least 2 years, are now speaking—a rate of sustained improvement considered unusual in this disorder. This study documents the value of a treatment modality not previously used in LKS. Success depends on selection of cases having severe epileptogenic abnormality that can be demonstrated to be unilateral in origin despite a bilateral electrographic manifestation

Physiological Outcomes of Aerobic Exercise Training in Hemiparetic Stroke Patients

Abstract: Background and Purpose In hemiparetic individuals, low endurance to exercise may compound the increased energy cost of movement and contribute to poor rehabilitation outcomes. The purpose of this investigation was to describe how hemiparetic stroke patients responded to intense exercise and aerobic training. Methods Forty-two subjects were randomly assigned to an exercise training group or to a control group. Treatments were given three times per week for 10 weeks in similar laboratory settings. Baseline and posttest measurements were made of maximal oxygen consumption, heart rate, workload, exercise time, resting and submaximal blood pressures, and sensorimotor function. Results Only experimental subjects showed significant improvement in maximal oxygen consumption, workload, and exercise time. Improvement in sensorimotor function was significantly related to the improvement in aerobic capacity. After treatment, experimental subjects showed significantly lower systolic blood pressure at submaximal worklo...

A second large controlled clinical study of E5, a monoclonal antibody to endotoxin: Results of a prospective, multicenter, randomized, controlled trial

Abstract: ObjectiveTo evaluate the safety and efficacy of E5, a murine, monoclonal antibody directed against endotoxin, in the treatment of patients with Gram-negative sepsis.DesignA multicenter, randomized, double-blind, placebo-controlled trial.SettingFifty-three hospitals across the United States, includin

Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS).

Abstract: Background Increased left ventricular mass (LVM) by echocardiography is associated with increased risk of cardiovascular disease. Thus, it is of interest to compare the effects of both pharmacological and nonpharmacological approaches to the treatment of hypertension on reduction of LVM. Methods and Results Changes in LV structure were assessed by M-mode echocardiograms in a double-blind, placebo-controlled clinical trial of 844 mild hypertensive participants randomized to nutritional-hygienic (NH) intervention plus placebo or NH plus one of five classes of antihypertensive agents: (1) diuretic (chlorthalidone), (2) β-blocker (acebutolol), (3) α-antagonist (doxazosin mesylate), (4) calcium antagonist (amlodipine maleate), or (5) angiotensin-converting enzyme inhibitor (enalapril maleate). Echocardiograms were performed at baseline, at 3 months, and annually for 4 years. Changes in blood pressure averaged 16/12 mm Hg in the active treatment groups and 9/9 mm Hg in the NH only group. All groups showed signi...

Double Dissociation Between Memory Systems Underlying Explicit and Implicit Memory in the Human Brain

Abstract: Amnesic patients have impaired explicit memory that is evident in poor recall and recognition of words, yet can have intact implicit memory for words as measured by repetition priming, the enhanced efficiency for reprocessing those words The dissociation between explicit and implicit memory for words is a fundamental characteristic of normal cognition that could reflect two different functional architectures of the human brain two separate processing systems or two levels of operation of a single system with implicit memory less demanding of that system We present a patient who has a lesion in the right occipital lobe and who showed intact explicit and impaired implicit memory for words The deficit was specific to visual priming The double dissociation between explicit and implicit visual memory for words indicates that separate processing systems mediate these two forms of memory, and that a memory system in right occipital cortex mediates implicit visual memory for words

A Comparison of Laparoscopic and Open Adrenalectomies

Abstract: Objective: To compare the relative merits of conventional transabdominal and posterior methods with a laparoscopic approach for adrenalectomy. Design: A retrospective cohort study of consecutive series of patients having unilateral adrenalectomy for lesions less than 10 cm in diameter. Setting: University hospital. Patients: Ten patients who underwent laparoscopic adrenalectomy; 11, transabdominal adrenalectomy; and 13, posterior adrenalectomy. Main Outcome Measures: Operative time, estimated blood loss, length of hospital stay, and postoperative parenteral analgesic need. Results: There was no significant difference in the operative time for laparoscopic and anterior adrenalectomy (mean±SD, 212±77 minutes vs 174±41 minutes), but the time for posterior adrenalectomy was significantly shorter (139±36 minutes) ( P P Conclusions: Laparoscopic adrenalectomy may take longer to perform than conventional open approaches but it has clear-cut advantages in shortening postoperative hospital stay and lessening postoperative analgesic requirements. It may be the preferred method for most patients requiring adrenalectomy. (Arch Surg. 1995;130:489-494)

Anti-CD44 treatment abrogates tissue oedema and leukocyte infiltration in murine arthritis.

Abstract: A ubiquitous cell adhesion receptor, CD44, preferentially binds hyaluronan, a poly-saccharide macromolecule that is present in most extracellular matrices. Hyaluronan molecules have large hydrodynamic volumes that entrap substantial amounts of water and can therefore control tissue hydration (swelling). CD44 is overexpressed by synovial cells and leukocytes, and hyaluronan is overproduced in the rheumatoid synovium and in other inflammatory sites. Nevertheless, the role of the CD44–hyaluronan interaction during inflammation is unclear. Our evidence shows that the CD44 receptor plays a critical role in governing the migration of inflammatory leukocytes into the extravascular compartment of the synovium in murine arthritis. An anti-CD44 antibody induces a rapid loss of CD44 from both leukocytes and synovial cells and displays an inhibitory effect on cell–extracellular matrix interactions in the synovium. As a result, the administration of such an antibody abrogates tissue swelling and leukocyte infiltration, two major components of inflammation.

Light treatment for sleep disorders: consensus report. VI. Shift work.

Abstract: The unhealthy symptoms and many deleterious consequences of shift work can be explained by a mismatch between the work-sleep schedule and the internal circadian rhythms. This mismatch occurs because the 24-h zeitgebers, such as the natural light-dark cycle, keep the circadian rhythms from phase shifting to align with the night-work, day-sleep schedule. This is a review of studies in which the sleep schedule is shifted several hours, as in shift work, and bright light is used to try to phase shift circadian rhythms. Phase shifts can be produced in laboratory studies, when subjects are kept indoors, and faster phase shifting occurs with appropriately timed bright light than with ordinary indoor (dim) light. Bright light field studies, in which subjects live at home, show that the use of artificial nocturnal bright light combined with enforced daytime dark (sleep) periods can phase shift circadian rhythms despite exposure to the conflicting 24-h zeitgebers. So far, the only studies on the use of bright light for real shift workers have been conducted at National Aeronautics and Space Administration (NASA). In general, the bright light studies support the idea that the control of light and dark can be used to overcome many of the problems of shift work. However, despite ongoing practical applications (such as at NASA), much basic research is still needed.

Mortality and hallucinations in nursing home patients with advanced Parkinson's disease

Abstract: We monitored 11 patients with advanced Parkinson's disease (PD) who entered nursing homes over a 5-year period and assessed chronicity of nursing home care, mortality, and hallucinatory status. Two years after the original study's close, none of these patients had ever been discharged from the nursing homes and all were dead. The mortality rate among the nursing home patients was significantly greater than that in 22 community-dwelling subjects with PD who were matched for age, gender, and disease duration. Hallucinatory status was generally stable; 82% of patients had the same hallucinatory status (presence or absence) at the two assessments. Four subjects from the original community-dwelling control group entered nursing homes during the follow-up period. Whereas motor and intellectual impairment scores were similar between these patients and the remaining 18 in the community, the presence of hallucinations was significantly greater among patients transferred to nursing homes. The study demonstrates the permanency of nursing home placement in advanced PD and the high mortality associated with such placement. It also documents the chronicity of hallucinatory behavior in these patients with advanced PD and reinforces our previously reported observations on the relationship between hallucinations and placement in chronic-care facilities.

The role of motor action in anticipatory postural adjustments studied with self-induced and externally triggered perturbations

Abstract: This study investigated the relation between the magnitude of a motor action triggering a postural perturbation and the magnitude of anticipatory postural adjustments. Subjects stood on a force platform and held, in extended arms, a balloon with a 2.2-kg load suspended on a rigid cord. In different series, unloadings were induced by fast bilateral shoulder abduction movements, by popping the balloon with a tack taped to the subject's right middle finger, or by the experimenter popping the balloon. Anticipatory postural adjustments were seen during all self-initiated unloadings as changes in the level of activation of postural muscles and in displacements of the center of pressure. However, absolute values of these changes were significantly smaller in the series with balloon popping as compared to the series with shoulder abductions. Such reactions were absent when the unloading was triggered by the experimenter. We conclude that a self-triggered perturbation is always associated with anticipatory postural adjustments, while the magnitude of the adjustments may be scaled with respect to the magnitude of a motor action used to induce the perturbation.

Light Treatment for Sleep Disorders: Consensus Report IV. Sleep Phase and Duration Disturbances

Abstract: Advanced and delayed sleep phase disorders, and the hypersomnia that can accompany winter depression, have been treated successfully by appropriately timed artificial bright light exposure. Under entrainment to the 24-h day-night cycle, the sleep-wake pattern may assume various phase relationships to the circadian pacemaker, as indexed, for example, by abnormally long or short intervals between the onset of melatonin production or the core body temperature minimum and wake-up time. Advanced and delayed sleep phase syndromes and non-24-h sleep-wake syndrome have been variously ascribed to abnormal intrinsic circadian periodicity, deficiency of the entrainment mechanism, or--most simply--patterns of daily light exposure insufficient for adequate phase resetting. The timing of sleep is influenced by underlying circadian phase, but psychosocial constraints also play a major role. Exposure to light early or late in the subjective night has been used therapeutically to produce corrective phase delays or advances, respectively, in both the sleep pattern and circadian rhythms. Supplemental light exposure in fall and winter can reduce the hypersomnia of winter depression, although the therapeutic effect may be less dependent on timing.

Effects of ambient odors on slot-machine usage in a las vegas casino

Abstract: Studies have shown that ambient aromas impact on consumers' behavior. To further investigate such effects, for one weekend, two slot-machine areas in a Las Vegas casino were odorized, each with a different aroma. A third slot-machine area served as an unodorized control. The amounts of money gambled in slot machines located in the three areas were measured and compared for the weekend of the odorization and for the weekends before and after as well, to control for extraneous variables. Our data show that the amount of money gambled in the slot machines surrounding Odorant No. 1 during the experimental weekend was greater than the amount gambled in the same area during the weekends before and after the experiment by an average of 45.11% (p = < 0.0001). Further, the amount of the increase appeared greater on Saturday when the concentration of odorant was higher: mean increase on Saturday was 53.42% (p = < 0.0001) versus mean increase on Sunday of 33.66% (p = < 0.003). The amounts of money gambled in the slot machines surrounding Odorant No. 2 and in the control area did not change significantly compared to the previous weekend and the weekend following the experiment. The likely mechanism of action of the effective odorant and the implications of these results are discussed. © 1995 John Wiley & Sons, Inc.

Local and distant products from modularity.

Abstract: In this study, the local and distant distribution of solid and soluble products of corrosion from the head and neck junction of modular femoral total hip prosthetic components were characterized. Particulate corrosion products from retrieved implants and surrounding tissues were analyzed. Serum transport and urinary excretion of metal was measured in correlation with the degree of corrosion at the head and neck junction. Particles of metal oxides, metal chlorides, and chromium phosphate corrosion products were identified on implants of 10 designs from 6 manufacturers. The most abundant solid corrosion product on the implant and within the periprosthetic tissues (size range, < 1-200 micrometers) was an amorphous chromium orthophosphate hydrate-rich material. Serum cobalt and urine chromium concentrations were elevated significantly in patients with implants that had moderate to severe corrosion in comparison with those with no to mild corrosion. Solid corrosion products from modular femoral stems may accelerate articular wear via a 3-body mechanism. Phagocytosable particles of these corrosion products may stimulate macrophage-mediated periprosthetic bone loss. Systemic dissemination of metallic corrosion products raises the issue of systemic toxicity; however, no overt evidence of metal toxicity was observed in this study.

Measuring quality of life: 1995 update.

Abstract: Often, new treatments for cancer are evaluated solely on the basis of increased survival, depriving us of valuable information about other benefits and drawbacks of these treatments. It is important to raise the question of the quality of life as a companion to the question of quantity of life. The trade-off is not always between toxicity vs survival time; sometimes a treatment, however toxic, affords benefit not by virtue of increasing survival, but by palliation of tumor-induced pain or obstruction. Included in this paper is a table that reviews many available quality of life measures that have been designed for, or frequently used with, people with cancer. Proper selection of measures and supplementary questions is an important first step toward a successful evaluation of quality of life. Samples of many of these scales are included in the appendix.

Enhancement of bone ingrowth by transforming growth factor-beta.

Abstract: Enhancement of bone ingrowth with transforming growth factor-beta was evaluated in a canine model. Ten dogs had bilateral implantation of a titanium-fiber-metal-coated rod in the proximal part of the humerus. A three-millimeter gap between the outer surface of the porous coating and the surrounding cancellous bone was created to impair bone ingrowth. All of the implants were plasma-flame-sprayed with hydroxyapatite and tricalcium phosphate. In each animal, one implant was also treated with recombinant transforming growth factor-beta 1 while the other implant, which was not so treated, served as a paired control. Two doses of transforming growth factor-beta 1 were used: 335 micrograms in five animals and 120 micrograms in the other five. At four weeks, the amount of bone ingrowth in the implants that had been treated with 120 micrograms of transforming growth factor-beta 1 was threefold higher than that in the paired controls (p = 0.009), but with the numbers available there was no significant increase in bone ingrowth with the higher dose. The amount of new-bone formation in the three-millimeter gaps adjacent to the treated implants was twice that in the gaps of the paired controls, regardless of the dose. The differences between the treated and control implants with regard to the architecture of the new bone in the gap indicate that the mechanism of action of transforming growth factor-beta 1 may include both proliferation of osteoprogenitor cells and production of matrix by committed osteoblasts. Compared with the findings in a previous study in which this canine model was used, the data from the present investigation indicate that enhancement of bone ingrowth in implants that have been treated with a combination of a hydroxyapatite-tricalcium phosphate coating and transforming growth factor-beta 1 may exceed that obtainable with grafting of the gap with autogenous cancellous bone.

Nerve growth factor in Alzheimer's disease: defective retrograde transport to nucleus basalis.

Abstract: NGF immunohistochemistry was combined with quantitative optical densitometry to evaluate whether retrogradely transported NGF is altered within cholinergic basal forebrain (CBF) neurons in Alzheimer's disease (AD). In normal aged humans, almost all CBF neurons stained for NGF. Although fewer in total number, remaining CBF perikarya in AD displayed diminished (32%) or undetectable NGF immunoreactivity. Based upon these data we hypothesize that there is a defect in retrograde transport of NGF in AD which may be due to a abnormal production and/or utilization of the trk receptor. This defect may be a primary event mediating the degeneration of CBF neurons in AD.