RESUMEN
Until now only limited and controversial data are available concerning the presence of steroid hormone receptors in the human vocal fold. A sum of 140 slides from 104 patients were investigated including 25 Reinke's edemas, 19 cases of recurrent respiratory papillomatosis, 19 polyps, 10 epithelial hyperplasias without or with dysplasias, 4 carcinomas in situ, 20 laryngeal carcinomas as well as 7 fresh cadaver samples without macroscopic alterations. The median patient age was 58 years. Paraffin-embedded tissue was incubated with monoclonal antibodies for estrogen-alpha, androgen and progesterone. Androgen receptors were expressed most frequently, followed by estrogen receptors, whereas no progesterone receptors were identified. Receptor staining could be detected with different densities and locations within the different vocal fold pathologies, but not in the autopsy samples. Our study could clearly demonstrate the presence of hormone receptors in the human vocal fold. Androgen receptors were most frequently detected, especially in the basal and intermediate layer of the stratified epithelium and the lamina propria. Whether the high incidence of steroid hormone receptors in some vocal fold pathologies has implications on their pathogenesis must be evaluated by further studies.
Asunto(s)
Receptores Androgénicos/metabolismo , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Pliegues Vocales/metabolismo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Niño , Preescolar , Femenino , Humanos , Inmunohistoquímica , Enfermedades de la Laringe/metabolismo , Enfermedades de la Laringe/patología , Masculino , Persona de Mediana Edad , Pliegues Vocales/patología , Adulto JovenRESUMEN
BACKGROUND: Epidemiological analysis of injury patterns and mechanisms help in identifying the expertise that military surgeons need in a combat setting and also in adjusting training requirements accordingly. This paper attempts to assess the surgical specialties and skills of particular importance in the management of casualties in crisis areas. METHODS: MEDLINE (1949-2007) and Google search were used. Causes of death among casualties in Afghanistan and the Iraq war were analyzed. RESULTS: The leading causes of injury were explosive devices, gunshot wounds, aircraft crashes, and terrorist attacks. Of the casualties, 55% died in hostile action and 45% in nonhostile incidents. Chest or abdominal injuries (40%) and brain injuries (35%) were the main causes of death for soldiers killed in action. The case fatality rate in Iraq was approximately half as high as in the Vietnam War. In contrast, the amputation rate was twice as high. Approximately 8-15% of the deaths appeared to be preventable. CONCLUSIONS: Military surgeons must have excellent skills in the fields of thoracic, visceral, and vascular surgery as well as practical skills in neurosurgery and oral and maxillofacial surgery. It also is of vital importance to ensure the availability of sufficient medical evacuation capabilities. Furthermore, there is a need for a standardized registration system for all injuries similar to the German Trauma Registry.
Asunto(s)
Accidentes de Aviación , Traumatismos por Explosión/epidemiología , Medicina Militar , Especialidades Quirúrgicas , Terrorismo , Heridas y Lesiones/epidemiología , Heridas por Arma de Fuego/epidemiología , Traumatismos Abdominales/epidemiología , Traumatismos Abdominales/mortalidad , Traumatismos Abdominales/cirugía , Accidentes de Aviación/mortalidad , Afganistán , África , Américas , Amputación Quirúrgica/estadística & datos numéricos , Asia , Traumatismos por Explosión/mortalidad , Traumatismos por Explosión/cirugía , Lesiones Encefálicas/epidemiología , Lesiones Encefálicas/mortalidad , Lesiones Encefálicas/cirugía , Europa (Continente) , Hospitales Militares , Humanos , Irak , MEDLINE , Traumatismos Torácicos/epidemiología , Traumatismos Torácicos/mortalidad , Traumatismos Torácicos/cirugía , Heridas y Lesiones/mortalidad , Heridas y Lesiones/cirugía , Heridas por Arma de Fuego/mortalidad , Heridas por Arma de Fuego/cirugíaRESUMEN
The Lung Health Study enrolled 3,923 participants in a smoking cessation intervention program, and followed them for 5 years. The study provided intensive group interventions for participants who had relapsed. The purpose of this analysis was to describe and evaluate these Restart programs. Among 1,004 relapsed participants, the percent not smoking at 5th year was higher for men who had used Restart (47) compared to those who had not (28), but not for women (42 vs. 33). Overall, there was equivocal evidence of the impact of the Restart programs due to limitations in the evaluation design. Because relapse is a common feature of efforts to quit smoking, relapse intervention programs need further study and more rigorous evaluation.
Asunto(s)
Terapia Conductista/métodos , Cese del Hábito de Fumar/métodos , Prevención del Hábito de Fumar , Adulto , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Pulmonares Obstructivas/prevención & control , Enfermedades Pulmonares Obstructivas/rehabilitación , Masculino , Persona de Mediana Edad , Psicoterapia de Grupo , Recurrencia , Fumar/psicologíaRESUMEN
Although use of cigarettes and alcohol is positively related, there is a lack of evidence whether changes in smoking are followed by changes in drinking. The Lung Health Study recruited 5,887 adult smokers and randomized 2/3 to a smoking cessation intervention and 1/3 to a control group. "Heavy drinkers" were excluded from the sample. After a year in the study, 42% of the intervention participants reported that they had stopped smoking, compared to 11% of the controls. There was no corresponding difference between intervention and control participants in the use of alcohol after one year, although the study provided a high level of power to detect such a difference.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Cese del Hábito de Fumar/estadística & datos numéricos , Adulto , Consumo de Bebidas Alcohólicas/prevención & control , Consumo de Bebidas Alcohólicas/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Cese del Hábito de Fumar/psicologíaRESUMEN
BACKGROUND: Reported alcohol intake has an inverse association with body weight in women but is related to greater weight or no differences in weight in men. However, the relationship of alcohol consumption to weight appears to be less reliable in cigarette smokers and may be modified by the pattern of alcohol intake. The objective of this investigation was to examine the relationship of both aggregate alcohol intake and daily modal intake to body mass index (BMI) in male and female cigarette smokers. METHODS: Cigarette smoking habits, body weight, and alcohol intake were assessed during screening for a clinical trial of early intervention for chronic obstructive pulmonary disease. Analyses are based on 3616 men and 2141 women cigarette smokers between 35 and 60 years of age. RESULTS: There were no significant differences in BMI between alcohol drinkers and abstainers in either men or women. However, following regression adjustment for age, education, and cigarettes/day, total weekly alcohol intake was related to a lower BMI in both men and women, whereas a greater modal intake (drinks on a day alcohol is consumed) was related to a greater BMI in both men and women. CONCLUSIONS: The association of alcohol use to BMI in moderate to heavy cigarette smokers appears to be modified by the pattern of intake. Although the factors underlying this association are unclear, increased modal alcohol intake may serve as a marker for dietary or behavioural factors linked to greater body weight in cigarette smokers.
Asunto(s)
Consumo de Bebidas Alcohólicas/fisiopatología , Peso Corporal , Fumar/fisiopatología , Adulto , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores SexualesRESUMEN
OBJECTIVE: This analysis examines the role of alcohol consumption in success at quitting smoking. METHOD: Participants were 3,977 men and women in the Lung Health Study, a prospective investigation of the effect of smoking cessation and an inhaled bronchodilator on the airways of smokers with mild lung function impairment. Participants reporting more than 25 drinks per week, or 8 or more drinks per occasion once a month or more, or alcoholics who drank in the past year were excluded from the sample. RESULTS: There was no relationship between amount of alcohol consumed at baseline and smoking status after 1 year. Among both men and women receiving a smoking cessation intervention, those who drank eight or more drinks per occasion (binge drinkers) were more likely to be current smokers after 1 year, and to smoke more cigarettes per day than those without a history of binge drinking. These relationships were largely absent among control participants. Participants who identified themselves as former or recovering alcoholics at baseline did not differ from the other participants in their smoking behavior after 1 year. When volume of drinking and drinking of eight or more drinks per occasion were compared in polychotomous ordinal logistic regressions, only binge drinking predicted failure at smoking cessation. CONCLUSIONS: Binge but not volume of drinking was related to failure in attempts to quit smoking. The common factor may be that binge drinking and relapse to smoking both represent loss of control.
Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Cese del Hábito de Fumar/psicología , Adulto , Consumo de Bebidas Alcohólicas/psicología , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Ipratropio/administración & dosificación , Enfermedades Pulmonares Obstructivas/rehabilitación , Masculino , Persona de Mediana Edad , Cooperación del Paciente/psicología , Recurrencia , Resultado del TratamientoRESUMEN
Cross-sectional studies have associated cigarette smoking in men with elevated androstenedione and little net effect on other sex steroids. However, it is not clear if such findings reflect the impact of nicotine exposure or if sex hormone levels change following smoking cessation. The relationship of the reported number of cigarettes smoked per day and salivary cotinine to salivary testosterone and androstenedione was examined in 221 men aged 35 to 59 years at baseline and 1 year following randomization into a clinical trial including a smoking-cessation intervention. At baseline, salivary cotinine was related to increased salivary androstenedione and testosterone following control for age, body mass, alcohol intake, and time of day of specimen collection (partial r = +.14 and +.30 P < .05 and .01, respectively). The reported number of cigarettes smoked per day was unrelated to either hormone. At the first annual visit, there was a significant decrease in the salivary androstenedione of men who had quite smoking and were currently using nicotine gum (94 v 60 pg/mL, P < .05, n = 34) and of men who had quit smoking and were not exposed to nicotine (86 v 56 pg/mL, P < .05, n = 48), whereas the salivary androstenedione of men who remained smokers at the first annual visit was unchanged (83 v 85 pg/mL, n = 139). Salivary testosterone levels were not significantly affected by a change in smoking status.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Goma de Mascar , Nicotina/administración & dosificación , Saliva/metabolismo , Cese del Hábito de Fumar , Testosterona/metabolismo , Adulto , Estudios Transversales , Humanos , Masculino , Persona de Mediana Edad , FumarRESUMEN
Spirometer temperature was measured automatically during all years of the Lung Health Study. Short- and long-term changes in temperature were analyzed for the 23 dry-rolling-seal volume spirometers used at the 10 clinical centers involved in the study. Within-test-session spirometer temperature increased a mean of 0.3 degrees C, and as much as 3.0 degrees C during methacholine challenge testing. The maximal change in spirometer temperature during a test day exceeded 4 degrees C more than 5% of the time. Month-to-month changes of more than 15 degrees C were not uncommon. If ambient temperature had been assumed to apply to all maneuvers and used for BTPS corrections, FEV1, and FVC measurement errors of up to 6% would have occurred. When using volume spirometers, the temperature of air inside the spirometer should be measured accurately during each breathing maneuver.
Asunto(s)
Espirometría/instrumentación , Temperatura , Termómetros , Pruebas de Provocación Bronquial , Estudios de Evaluación como Asunto , Volumen Espiratorio Forzado , Humanos , Espirometría/normas , Espirometría/estadística & datos numéricos , Termómetros/normas , Termómetros/estadística & datos numéricos , Factores de Tiempo , Estados Unidos , Capacidad VitalRESUMEN
The extent and predictors of weight change were assessed among sustained nonsmoking special intervention participants in the Lung Health Study. The intervention included a 12-session group program and 2-mg nicotine gum. At 12 months, female sustained quitters (SQs; n = 248) had gained a mean of 8.4% (5.3 kg) of their baseline weight, whereas male SQs (n = 443) had gained 6.7% (5.5 kg). By 24 months, female SQs had gained 9.8% of their baseline weight compared with 6.9% for men. Nicotine gum usage delayed a portion of the weight gain. Multiple regression analysis showed that weight gain at 12 months was associated with a higher baseline salivary cotinine level, a lower baseline body mass index, drinking less alcohol per week, and a lower cotinine level at 12 months (indicating less or no nicotine gum use). We conclude that moderate weight gain is a long-term consequence of smoking cessation--a portion of which can be delayed with 2-mg nicotine gum.
Asunto(s)
Agonistas Colinérgicos/uso terapéutico , Nicotina/análogos & derivados , Ácidos Polimetacrílicos/uso terapéutico , Polivinilos/uso terapéutico , Cese del Hábito de Fumar/psicología , Aumento de Peso , Adulto , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Pulmonares Obstructivas/rehabilitación , Masculino , Persona de Mediana Edad , Nicotina/uso terapéutico , Análisis de Regresión , Factores de Riesgo , Factores Sexuales , Dispositivos para Dejar de Fumar TabacoRESUMEN
This study investigates the relation of salivary cotinine and of the reported number of cigarettes smoked per day to body mass index among middle-aged male (n = 3,538) and female (n = 2,096) cigarette smokers participating in screening for entry to a clinical trial of early intervention in chronic obstructive pulmonary disease (Lung Health Study) from 1986 to 1989. Both before and after controlling for age, education, and alcohol intake, the number of cigarettes smoked per day was positively related to body mass index among both men and women, whereas salivary cotinine levels were negatively related to body mass index among both men and women. The opposite relation of salivary cotinine and of reported number of cigarettes smoked per day to body mass index is discussed with regard to nicotine metabolism, energy intake, and measurement issues in the assessment of cigarette smoke exposure.
Asunto(s)
Índice de Masa Corporal , Cotinina/análisis , Tamizaje Masivo/métodos , Saliva/química , Fumar/epidemiología , Adulto , Factores de Edad , Consumo de Bebidas Alcohólicas/epidemiología , Análisis de Varianza , Escolaridad , Metabolismo Energético , Estudios de Evaluación como Asunto , Femenino , Humanos , Modelos Lineales , Enfermedades Pulmonares Obstructivas/etiología , Masculino , Persona de Mediana Edad , Nicotina/metabolismo , Caracteres Sexuales , Fumar/efectos adversos , Fumar/metabolismo , Prevención del Hábito de FumarRESUMEN
OBJECTIVES: Sources of measurement error in assessing smoking status are examined. METHODS: The Lung Health Study, a randomized trial in 10 clinical centers, includes 3923 participants in a smoking cessation program and 1964 usual care participants. Smoking at first annual follow-up was assessed by salivary cotinine, expired air carbon monoxide, and self-report. Each of these measures is known to contain some error. Sensitivity and specificity were calculated by comparing a biochemical measure with self-report to produce an undifferentiated estimate of error. Classification error rates due to imprecision of the biochemical measures and to the error in self-report were estimated separately. RESULTS: For cotinine compared with self-report, the sensitivity was 99.0% and the specificity 91.5%. For carbon monoxide compared with self-report, the sensitivity was 93.7% and the specificity 87.2%. The classification error attributed to self-report, estimated by comparing the results from intervention and control groups, was associated with the responses of 3% and 5% of participants, indicating a small but significant bias toward a socially desirable response. CONCLUSIONS: In absolute terms in these data, both types of error were small.
Asunto(s)
Monóxido de Carbono/análisis , Cotinina/análisis , Saliva/química , Autorrevelación , Fumar , Adulto , Pruebas Respiratorias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Fumar/psicología , Cese del Hábito de FumarRESUMEN
The Chronic Obstructive Pulmonary Disease Early Intervention Trial, or Lung Health Study, is a multicenter randomized clinical trial sponsored by the Division of Lung Diseases of the National Heart, Lung, and Blood Institute. The hypothesis being tested is that over a 5-year period, a comprehensive intervention program can reduce both the rate of decline in pulmonary function and the rates of respiratory morbidity and mortality in middle-aged smokers with mild to moderate airflow obstruction. The primary outcome variable of the trial is the annual rate of decline of maximum postbronchodilator FEV1. Secondary outcomes are the development of respiratory and nonrespiratory morbidity and mortality. After screening 73,694 cigarette smokers, aged 35 to 60 years, 5,887 participants were randomized into three equal groups: usual care, smoking intervention with daily use of a metered-dose inhaler with ipratropium bromide, and smoking intervention with inhalation of placebo. Eligible participants had a ratio of FEV1 to forced vital capacity (FVC) of 70 percent or less, were free of known life-limiting conditions, expressed willingness to enter the intervention program if so randomized, and gave written informed consent prior to entry into the trial. Spirometry, methacholine challenge, and questionnaires were strictly standardized within and across centers. The purpose of this report is to describe the characteristics of randomized participants at the time of entry into the study. For both sexes, three measures of lung function--average cross-sectional FEV1/FVC ratio, FEV1, and FEV1 percentage of predicted normal--showed slight downward trends for each successively older 5-year age cohort. The increase in FEV1 after isoproterenol was 15 percent or more in only 2.4 percent of men and 2.8 percent of women. A positive response to methacholine (defined as a fall in FEV1 of > 20 percent from baseline at concentrations up to 25 mg/ml) occurred in 63 percent of men and 87 percent of women. The cross-sectional prevalences of cough, phlegm, wheeze on most days or nights, and shortness of breath were 49 percent, 43 percent, 32 percent, and 43 percent, respectively. Respiratory symptoms were reported by a higher proportion of participants in the younger age groups than in the older age groups. Participants who reported cough, phlegm, and/or wheeze averaged lower FEV1 percent predicted and higher probability of positive response to methacholine than participants who did not. Shortness of breath appeared to be significantly associated with lower lung function and higher reactivity in men but not in women.(ABSTRACT TRUNCATED AT 400 WORDS)
Asunto(s)
Enfermedades Pulmonares Obstructivas/terapia , Adulto , Pruebas de Provocación Bronquial , Femenino , Humanos , Enfermedades Pulmonares Obstructivas/fisiopatología , Masculino , Persona de Mediana Edad , Mecánica RespiratoriaRESUMEN
The Lung Health Study is a randomized clinical trial designed to determine whether a smoking intervention program and prescription of an inhaled bronchodilator can reduce the annual rate of decline of FEV1 (FEV1 slope) in cigarette smokers with mild to moderate airflow limitation. During the recruitment period, spirometry measurements were obtained during three screening visits from 5,887 cigarette smokers 35 to 60 yr of age. To improve the statistical power of the study to detect significant differences in the FEV1 slopes among study groups, the spirometry testing protocol carefully controls for multiple factors that are known to increase intraindividual variability of FEV1 and FVC results. These factors include participant preparation, maneuver acceptability and reproducibility, technician training and performance monitoring, equipment design and calibration, and result processing. The objective of this report is to describe the success of the spirometry quality control program in minimizing the short-term intraindividual FEV1 variability. The mean difference between the FEV1 values obtained at the second and third screening visits (mean 25 days apart) was +5.7 ml in women and -14.7 ml in men, with a mean intraindividual variability of 119 ml in women and 162 ml in men, with a coefficient of variation of 5.8% for both. During only 2.1% of the test sessions were participants unable to produce three acceptable FVC maneuvers with the two best FEV1 values matching within 5% or 100 ml. Institution of site visits and technician performance monitoring was associated with improved test session quality grades and maintenance of high quality grades thereafter.
Asunto(s)
Broncodilatadores/farmacología , Volumen Espiratorio Forzado , Fumar/efectos adversos , Espirometría/normas , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Control de Calidad , Capacidad VitalRESUMEN
Spear, a high protein oat variety, was evaluated during 2 consecutive yr for yields of forage dry matter and for feeding value as a silage to heifers, steers, and lactating cows. In yr 1 and 2, Spear yielded 7% and 13% less forage dry matter per hectare than Burnett, a comparative oat variety. Crude protein contents in silages were similar for varieties both years. In yr 1, Holstein heifers fed high protein and medium protein oat silages gained the same amount of weight but less weight than heifers fed alfalfa-brome hay. In a total collection digestion trial with six lactating cows, digestibilities of Spear were less than Burnett oat silage or alfalfa-brome hay. In yr 2, Spear and Burnett silages were fed ad libitum without a concentrate mixture to seven Holstein heifers each. Average daily gains were higher with Spear than Burnett. Apparent digestibilities as determined with steers tended to be less for Spear than Burnett. Dry matter intakes, milk yield, and composition were similar in a switchback lactation trial with ten cows fed spear or Burnett in oat silage supplemented with a concentrate at 1 kg per 3 kg milk produced.
Asunto(s)
Alimentación Animal/análisis , Fenómenos Fisiológicos Nutricionales de los Animales , Grano Comestible , Ensilaje/análisis , Animales , Bovinos , Industria Lechera , Digestión , Femenino , Lactancia , Embarazo , Proteínas/análisisRESUMEN
Three different methods of measurement are used to objectify the maximum load-carrying capacity of individual pairs of teeth. For these, use is made of a mechanical, electric, and elastooptic measuring instrument. The measurement results obtained using the mechanical and electric instruments are largely identical. They are in the neighborhood of 20 kgf and 50 kgf for incisors and molars, respectively, of male subjects. The results obtained for female test subjects were lower by an average of 10 kgf. The mechanical and electric measuring instruments may be used for the examination of a larger number of test subjects as well as under pathological conditions.
Asunto(s)
Análisis del Estrés Dental/instrumentación , Femenino , Humanos , Incisivo , Masculino , Diente MolarRESUMEN
Alfalfa-brome hay, haylage, .5% urea-treated corn silage, or .5% urea plus 1% dried whey-treated corn silage was fed as the only forage to one of four groups of 10 lactating cows per group for a lactation trial of 10 wk. Rumen samples were collected via stomach tube 3 to 4 h after the morning feeding. The pH of the rumen samples from cows fed hay was higher than for cows fed haylage, urea-treated corn silage, and urea-whey corn silage, 6.69 versus 6.36, 6.40, and 6.50. Total volatile fatty acids and propionate were highest from cows fed urea-whey corn silage and were higher on all three fermented forages than cows fed hay. Acetate/propionate ratio was highest from cows fed hay and lowest from cows fed corn silages. Butyrate was highest from cows fed haylage or hay. Milk protein composition was not affected by ration although nonprotein nitrogen of milk was highest from cows fed the urea-treated corn silages. Oleic acid and total unsaturated fatty acids were lowest in milk fat from cows fed hay while palmitic acid was highest from cows fed hay and haylage. These results suggest that type of forage fed may cause small changes in rumen fermentation and in milk composition. The importance of these changes is unknown but may affect properties of dairy products produced from this milk.