Adult Pa Research Articles

Effect of Cholecalciferol Supplementation on Vitamin D Status and Cathelicidin Levels in Sepsis: A Randomized, Placebo-Controlled Trial.

To compare changes in vitamin D status and cathelicidin (LL-37) levels in septic ICU patients treated with placebo versus cholecalciferol. Randomized, placebo-controlled, trial. Medical and surgical ICUs of a single teaching hospital in Boston, MA. Thirty adult ICU patients. Placebo (n = 10) versus 200,000 IU cholecalciferol (n = 10) versus 400,000 IU cholecalciferol (n = 10), within 24 hours of new-onset severe sepsis or septic shock. Blood samples were obtained at baseline (day 1) and on days 3, 5, and 7, to assess total 25-hydroxyvitamin D, as well as vitamin D-binding protein and albumin to calculate bioavailable 25-hydroxyvitamin D. Plasma LL-37 and high-sensitivity C-reactive protein levels were also measured. At baseline, median (interquartile range) plasma 25-hydroxyvitamin D was 17 ng/mL (13-22 ng/mL) and peaked by day 5 in both intervention groups. Groups were compared using Kruskal-Wallis tests. Relative to baseline, on day 5, median change in biomarkers for placebo, 200,000 IU cholecalciferol, and 400,000 IU cholecalciferol groups, respectively, were as follows: 1) total 25-hydroxyvitamin D, 3% (-3% to 8%), 49% (30-82%), and 69% (55-106%) (p < 0.001); 2) bioavailable 25-hydroxyvitamin D, 4% (-8% to 7%), 45% (40-70%), and 96% (58-136%) (p < 0.01); and 3) LL-37: -17% (-9% to -23%), 4% (-10% to 14%), and 30% (23-48%) (p = 0.04). Change in high-sensitivity C-reactive protein levels did not differ between groups. A positive correlation was observed between bioavailable 25-hydroxyvitamin D and LL-37 (Spearman ρ = 0.44; p = 0.03) but not for total 25-hydroxyvitamin D and LL-37. High-dose cholecalciferol supplementation rapidly and safely improves 25-hydroxyvitamin D and bioavailable 25-hydroxyvitamin D levels in patients with severe sepsis or septic shock. Changes in bioavailable 25-hydroxyvitamin D are associated with concomitant increases in circulating LL-37 levels. Larger trials are needed to verify these findings and to assess whether optimizing vitamin D status improves sepsis-related clinical outcomes.

Intervenção com procedimentos de autossugestão na autoeficácia e controlo da dor

Introduction - Pain is the predominant complaint in many medical diseases and carries several implications for the patient 1‑4 . The present study aimed to evaluate the effectiveness of a self‑suggestive intervention, as a complement to medical treatment, in the patients' self‑efficacy and pain control. Methodology - For this aim, 205 adult pa‑ tients suffering from pain were randomized in two groups that received different interven‑ tions during 12 weeks: IAS group received a self‑suggestive intervention and ISAS group received an intervention without self‑suggestion. The two groups were compared regard‑ ing the changes in self‑efficacy and pain control over the 12 weeks. Results and discus- sion - The results showed a statistically significant increase of these variables in the IAS group but not in the ISAS group, suggesting the efficacy of the self‑suggestive interven‑ tion. This study represents an important contribution to the clinical practice with patients suffering from pain.

Development and Evaluation of an Evidence-Based Nursing Protocol for Fever Management in Adult Patients

Purpose: This study was designed to develop, to implement and evaluate a fever management nursing protocol for adult patients. Methods: This study was conducted through seven steps following both the guideline develop- ment procedures of the Scottish Intercollegiate Guidelines Network and the Model of the Asan Medical Center Evidence-Based Practice, as follows: 1) identifying the clinical needs and composition of the protocol development group; 2) identifying and evaluating the evidence; 3) assessing the level of evidence and grading recom- mendations; 4) forming a protocol; 5) evaluating the protocol using an expert group validity test and identifying barriers to its implementation; 6) protocol development; and 7) evaluation of practical improvement measures fol- lowing implementation of the protocol. Results: The evidence-based protocol for fever management in adult pa- tients was completed and includes five domains and 15 items. The protocol had good content validity (CVI=.90) and nursing practice could be improved after implementation of the protocol. Conclusion: This nursing protocol can be used as a guide for nursing in febrile adult patients. We recommend that further guidelines be updated in an interdisciplinary manner in order to foster local adaptation of the best clinical practices.

Tracking of Physical Activity from Childhood to Adulthood

To examine 1) relationships between adult PA at 35 yr and PA as a child, and 2) the influence of enhanced primary school physical education (physed+) and of parental PA upon the long-term tracking of PA in the offspring. PA data from the 1970-1977 Trois-Rivieres Growth and Development Study, completed when the children were aged 10-12 yr, were compared with PA data collected on 166 of the same subjects in 1996-1998, when aged 34.9 +/- 1.1 yr. The weekly duration of total PA, intense PA, light PA, organized PA, and total sedentary behaviors other than sleep as a child were each correlated with a questionnaire assessment of total weekly PA as an adult. Considering males and females jointly, adult PA showed a significant but weak association with childhood PA, correlations for total PA, intense PA, light organized PA, and nonorganized PA amounting to r = 0.20, 0.18, 0.12, and 0.19, respectively. In males (N = 79), the total time spent during childhood in organized PA was associated with adult PA (r = 0.26, P < 0.05), due to students who received physed+ (r = 0.34). In females, also, a higher PA frequency as an adult was significantly associated with physed+. There was no association of PA patterns between children and their parents. Our results suggest a positive impact of early required physical education upon adult PA but provide little evidence of an overall association between time spent in other categories of PA during childhood and PA as an adult.

Expression of myofibrillar proteins and parvalbumin isoforms in white muscle of dorada during development

Several polyacrylamide gel electrophoresis techniques were used to study developmental changes in myofibrillar protein composition and parvalbumin distribution in the myotomal muscle of Brycon moorei. Two myosin LC2 chains and two troponin I isoforms were successively detected. Up to four troponin T isoforms were synthesized. Slow red‐muscle myofibrils from adult fish showed no common component (except actin) with larval, juvenile or adult fast white‐muscle myofibrils. During growth of B. moorei, two classes of parvalbumin isoforms were sequentially expressed: larval PA I, PA IIa, and PA IIb and adult PA III. In adult fish, the content in Tn T‐2 isoform decreased from the anterior to the posterior myomeres, in favour of Tn T‐1 and Tn T‐4. The parvalbumin content also diminished from the rostral to the caudal muscle. The fast rate of transition from larval to adult isoforms appeared to parallel the extremely fast growth of B. moorei. Sequential expression of these isoforms presumably reflected variations in the contractile properties of the muscle fibres, required by changes in physiological demands of the propulsive musculature.

Coxalgia crónica: necrosis avascular de la cabeza femoral

Avascular bone necrosis is a very rare patholo gical entity that can appears in an primary way or a secondary one due to diverse factors. It can be found in a few levels, especially in the femoral he ad and the carpal navicular bone in the adult pa tient. If the lession is located in the femoral head le ads to a hip pain, a very frequent clinical manifes tation studied in Primary Health Care centers, so it is very important its early and differential diagno sis, above all, in the case that exist risk factors. We present a clinical case of avascular necro s i s of the femoral head and perform a current biblio graphic revision on the matter.

Organization of the human paraventricular hypothalamic nucleus

The cyto- and chemoarchitecture of the human paraventricular hypothalamic nucleus (Pa) was studied with the aid of three-dimensional computer reconstruction. The adult human Pa is a vertically elongated structure that abuts the wall of the third ventricle (3V) medially and is indented dorsolaterally by the descending fornix. Chemoarchitecture revealed the following five subnuclei in the human Pa. The most prominent of these is the magnocellular subnucleus (PaM) occupying the ventrolateral quadrant of the Pa and comprised of a concentration of large arginin-vasopressin (AVP)- and acetylcholinesterase (AChE)-positive cells, and small calbindin (Cb)-positive neurons. Rostrally, the PaM is succeeded by the small anterior parvicellular subnucleus (PaAP), which contains small AChE-, AVP- and tyrosin hydroxylase (TH)-positive cells. Dorsal to the PaM is found the dorsal subnucleus (PaD), containing large spindle-shaped TH-, oxytocin (OXY)-, and AChE-positive cells, as well as a population of small Cb-positive neurons. Abutting the wall of the 3V and medial to PaM and PaD is the parvicellular subnucleus (PaP). The PaP contains small cells immunoreactive for corticotropin-releasing factor (CRF), neuromedin K receptor (NK3), and nonphosphorylated neurofilament protein (SMI32). The posterior subnucleus (PaPo) is situated posterior to the descending column of the fornix; it replaces all above-mentioned subdivisions caudally, and is a chemoarchitectonic amalgam that includes dispersed large AChE-, OXY-, AVP- and TH-positive cells, as well as small NK3-, CRF-, SMI32- and Cb-immunoreactive neurons. The present findings suggest that the human PaM and PaD are homologues to the magnocellular subnuclei of the rat Pa, whereas the human PaP and PaPo correspond to the rat medial parvicellular and posterior subnuclei, respectively. J. Comp. Neurol. 423:299–318, 2000. © 2000 Wiley-Liss, Inc.

Organization of the human paraventricular hypothalamic nucleus

The cyto- and chemoarchitecture of the human paraventricular hypothalamic nucleus (Pa) was studied with the aid of three-dimensional computer reconstruction. The adult human Pa is a vertically elongated structure that abuts the wall of the third ventricle (3V) medially and is indented dorsolaterally by the descending fornix. Chemoarchitecture revealed the following five subnuclei in the human Pa. The most prominent of these is the magnocellular subnucleus (PaM) occupying the ventrolateral quadrant of the Pa and comprised of a concentration of large arginin-vasopressin (AVP)- and acetylcholinesterase (AChE)-positive cells, and small calbindin (Cb)-positive neurons. Rostrally, the PaM is succeeded by the small anterior parvicellular subnucleus (PaAP), which contains small AChE-, AVP- and tyrosin hydroxylase (TH)-positive cells. Dorsal to the PaM is found the dorsal subnucleus (PaD), containing large spindle-shaped TH-, oxytocin (OXY)-, and AChE-positive cells, as well as a population of small Cb-positive neurons. Abutting the wall of the 3V and medial to PaM and PaD is the parvicellular subnucleus (PaP). The PaP contains small cells immunoreactive for corticotropin-releasing factor (CRF), neuromedin K receptor (NK3), and nonphosphorylated neurofilament protein (SMI32). The posterior subnucleus (PaPo) is situated posterior to the descending column of the fornix; it replaces all above-mentioned subdivisions caudally, and is a chemoarchitectonic amalgam that includes dispersed large AChE-, OXY-, AVP- and TH-positive cells, as well as small NK3-, CRF-, SMI32- and Cb-immunoreactive neurons. The present findings suggest that the human PaM and PaD are homologues to the magnocellular subnuclei of the rat Pa, whereas the human PaP and PaPo correspond to the rat medial parvicellular and posterior subnuclei, respectively.

Reference Service in the Children's Department:

Reference and information requests received b the Children's Services Department of The Urbana (l~inois! Free Library were analyzed according to the types of ques- tions asked and the distribution of adult and childiyoung adult patrons making the requests. It was found that a sub- stantial pro ortion of the re uests were made by adult pa- trons, and tiat adult and chiljren tend to ask different kinds of questions. Children tended to ask for assistance of an es- sentially mechanical nature, such as help in locating items and assistance with audiovisual materials. Adults tended to ask complex reader's advisory questions, reference questions, and questions concerning library policies and programs. It is sug- gested that children's departments need to make greater ef- forts to deliberately serve their adult patrons, that the analy- sis of reference and informational questions can lead to better collection development decisions, and that thorough commu- nity analysis may be essential to the effective functioning of a children's department.