A comparison of the effect of estrogen with or without progesterone on mood and physical symptoms in postmenopausal women.

Using a randomized, placebo-controlled design, this study assessed the effects of estrogen alone (ES) or in combination with cyclic progesterone (EP) on daily ratings of mood and physical symptoms before and after 6 months of daily hormone treatment. Fifty-four postmenopausal women were recruited from the community at large and specifically selected as being asymptomatic at the time of enrollment and without significant psychiatric history. Ratings were obtained every day for 30 days prior to treatment and again every day during the last 30 days of treatment.

Chronic motor dysfunction after stroke: recovering wrist and finger extension by electromyography-triggered neuromuscular stimulation.

Background And Purpose: After stroke, many individuals have chronic unilateral motor dysfunction in the upper extremity that severely limits their functional movement control. The purpose of this study was to determine the effect of electromyography-triggered neuromuscular electrical stimulation on the wrist and finger extension muscles in individuals who had a stroke > or = 1 year earlier.

Methods: Eleven individuals volunteered to participate and were randomly assigned to either the electromyography-triggered neuromuscular stimulation experimental group (7 subjects) or the control group (4 subjects).

Effects of ethanol on working memory and attention in pigeons.

To determine whether the effects of ethanol on working memory are mediated by a secondary effect on attention, dose-response curves for ethanol were determined in eight pigeons trained under a titrating matching-to-sample (TMTS) procedure, in eight pigeons trained under a discrete-trial measure of attention, and in eight pigeons trained under a continuous-trial measure of attention. Ethanol decreased accuracy under the TMTS procedure following the three highest doses (1, 1.8, and 3 g/kg).

Practice as an intervention to improve speeded motor performance and motor learning in Parkinson's disease.

Individuals with Parkinson's disease have difficulty initiating and performing complex, sequential movements. Practice generally leads to faster initiation and execution of movements in healthy adults, however, whether practice similarly improves motor performance in patients with Parkinson's disease remains controversial. To assess the effects of practice on motor performance, patients with Parkinson's disease and control subjects practiced two, rapid arm-reaching tasks with different levels of movement complexity for 120 trials each over 2 days.

Psychological Correlates of Mental Stress-induced Ischemia in the Laboratory: The Psychophysiological Investigation of Myocardial Ischemia (PIMI) Study.

Participants consisted of 184 patients (160 males, 24 females) with positive angiograms or prior myocardial infarctions who displayed at least 1 mm of ST segment depression on a standardized treadmill test. Mean scores on the Reward Dependence subscale of the Tridimensional Personality Questionnaire were higher in patients displaying ischemia during mental stress. Patients who reported higher levels of irritability/anger in response to the Speech stressor were also more likely to display ischemia.

Purkinje cell vulnerability to developmental ethanol exposure in the rat cerebellum.

Background: Ethanol exposure is a consistent and reliable producer of neuronal toxicity, especially during periods of enhanced neuronal vulnerability. For rat cerebellar Purkinje cells, the postnatal period during the time of the brain growth spurt exhibits the greatest vulnerability to ethanol. Analyses of studies completed over more than 20 years provides sufficient detail to allow for the determination of the specific vulnerable window for ethanol-induced loss of Purkinje cells.

Clinical and dosimetric predictors of radiation-induced esophageal toxicity.

Purpose: To evaluate the incidence, severity, and clinical/dosimetric predictors of acute and chronic esophageal toxicities in patients with non-small cell lung cancer (NSCLC) treated with high-dose conformal thoracic radiation.

Methods And Materials: Ninety-one patients with localized NSCLC treated definitively with high-dose conformal radiation therapy (RT) at Duke University Medical Center (DUMC) were reviewed. Patient characteristics were as follows: 53 males and 38 females; median age 64 yr (range 46-82); stage I--16, II--3, IIIa--40, IIIb--30, X--2; dysphagia pre-RT--6 (7%).

Conformal radiation therapy treatment planning reduces the dose to the optic structures for patients with tumors of the paranasal sinuses.

Purpose: Compare dose distributions of traditional versus conformal beam orientations in paranasal sinus malignancies.

Materials And Methods: Maximum normal tissue doses, dose volume histograms (DVH), normal tissue complication probabilities (NTCP), and the percentage of each normal tissue receiving >80% of the average target dose (V80) were calculated.

Results/conclusions: Conformal planning reduced the V80 to the optic nerves and chiasm as well as the normal tissue maximum doses to the ipsilateral and contralateral optic nerves and chiasm, and mean NTCPs.

A double-blind study of capacitively coupled electrical stimulation as an adjunct to lumbar spinal fusions.

Study Design: A randomized double-blind prospective comparison with a placebo control. This report of the results is the first in an ongoing study.

Objectives: To evaluate the effect of noninvasive capacitively coupled electrical stimulation on the success rate of lumbar spine fusion surgery, and to compare active with placebo stimulators as adjuncts to contemporary fusion techniques.

High stress responsivity predicts later blood pressure only in combination with positive family history and high life stress.

High cardiovascular responsivity to stressors has not consistently improved prediction of later blood pressure increases beyond the predictive effects of baseline pressure. Animal models suggest that genetic susceptibility to hypertension and frequent stress exposure are important modulating factors in stress-related hypertension. Thus in 103 men originally tested at age 18 to 22 years and reassessed 10 years later, interactive effects of genetic susceptibility (defined as 1 or more hypertensive parents) with high stress responsivity (defined as top 25% on the basis of blood pressure and cardiac responses during both reaction time and cold pressor tasks) were examined in relation to follow-up systolic and diastolic levels and to change in blood pressure status from normal (diastolic<80 mm Hg) to marginally elevated (diastolic 85 to 95 mm Hg).

Low hot pain threshold predicts shorter time to exercise-induced angina: results from the psychophysiological investigations of myocardial ischemia (PIMI) study.

Objectives: The purpose of this study was to test whether cutaneous thermal pain thresholds are related to anginal pain perception.

Background: Few ischemic episodes are associated with angina; symptoms have been related to pain perception thresholds.

Methods: A total of 196 patients with documented coronary artery disease underwent bicycle exercise testing and thermal pain testing.

Potassium supplementation induces beneficial cardiovascular changes during rest and stress in salt sensitive individuals.

The typical American diet includes high salt and low potassium, a pattern linked to elevated blood pressure (BP) in cross-cultural studies. This study compared resting and stress cardiovascular responses on a high salt, low potassium diet to those observed during 2 interventions: salt restriction and potassium supplementation. Forty-seven percent of the primarily normotensive sample (n = 67 adults) were salt sensitive, showing a decrease in mean arterial pressure > or = 5 mmHg during low salt and equivalent reductions during high potassium.

Descriptive epidemiology of blood pressure response to change in body position. The ARIC study.

The epidemiology of a common measure of cardiovascular reactivity, the change in systolic blood pressure (DeltaSBP) from the supine to the standing position, is described in a cohort of 13 340 men and women aged 45 to 65 years enrolled in the Atherosclerosis Risk in Communities (ARIC) Study. The distribution of DeltaSBP was found to be symmetrical and unimodal, with a mean value near zero (-0.45 mm Hg).

Postexercise vasodilatation reduces diastolic blood pressure responses to stress.

Regular physical exercise is known to reduce cardiovascular risk. We examined the effects of a single bout of moderate bicycle exercise on hemodynamic measures at rest and in response to the foot cold pressor (CP) and mental arithmetic (MA). Sedentary males and females (N = 32) were tested twice, following 20 minutes of moderate exercise (exercise day) versus 20 minutes of quiet rest (control day).

Dysregulation of cardiovascular and neuroendocrine responses to stress in premenstrual dysphoric disorder.

Twelve women with prospectively confirmed premenstrual dysphoric disorder (PMDD or PDD) were compared with 12 healthy control subjects for cardiovascular and neuroendocrine responses to speech and mental arithmetic (Paced Auditory Serial Addition Task) stressors during both the follicular and luteal phases of the menstrual cycle. Structured clinical interview was used to assess psychiatric and abuse histories, and standardized questionnaires were administered to assess current life stress. Results revealed that PMDD women had significantly lower stroke volume, cardiac output and cortisol levels but significantly elevated norepinephrine and total peripheral resistance at rest and also during mental stressors compared with control subjects.

Intragastric intubation: important aspects of the model for administration of ethanol to rat pups during the postnatal period.

One technique for the controlled delivery of ethanol to neonatal rat pups is intragastric intubation. Often, the vehicle used for delivery of ethanol is composed of a nutrient mixture to compensate for decreased suckling or other possible nutritional compromise. This study analyzed the selection of nutrient vehicle, the combination of experimental treatment groups within a litter, and the overall litter size on the growth rate of ethanol-intubated and intubated-control pups, compared with mother-raised control pups.

Enhanced cardiovascular and catecholamine responses in women with depressive symptoms.

To test the hypothesis that cardiovascular and sympathetic nervous system responses before and during behavioral stressors are exaggerated among subjects with depressed mood who do not have clinical depressive disorder. Sixty healthy women aged 18-49 were initially asked to complete the Beck Depression Inventory (BDI). The 15 with the highest (Depressive Symptom group) and the 15 with the lowest BDI scores (Control group) underwent stress testing including baseline, postural challenge, a speech task describing responses to a recent anger-arousing experience and recovery.

Reproducibility of mental stress-induced myocardial ischemia in the Psychophysiological Investigations of Myocardial Ischemia (PIMI).

Objective: Many patients with coronary artery disease (CAD) develop myocardial ischemia in response to mental stress. This has been documented both in the natural environment and in the laboratory. However, the reproducibility of laboratory mental stress-induced ischemia has not been investigated.

Radiation techniques for the treatment of Hodgkin's disease with combined modality therapy or radiation alone.

This article reviews radiation techniques including field arrangements, anatomic borders, and doses for the treatment of Hodgkin's disease when radiotherapy is being used as the sole treatment and when it is part of a planned combined modality program with chemotherapy. We describe the techniques currently in use at Duke University Medical Center. Particular emphasis is placed on the evidence regarding the appropriate extent of the treatment field and the doses of radiation necessary to achieve local control.

Ischemic but not thermal pain sensitivity varies across the menstrual cycle.

Objective And Method: Findings from both animal and human research suggest that pain sensitivity changes across the menstrual cycle; however, among humans the nature of these menstrual cycle effects remains unclear. The present study used a repeated-measures design to evaluate changes in thermal and ischemic pain responses during three phases of the menstrual cycle, midfollicular (postmenstrual), ovulatory, and mid-to-late luteal (premenstrual), in 11 healthy women. The cycle phase during which subjects began their participation was determined randomly.

Heart rate variability in patients with coronary artery disease: differences in patients with higher and lower depression scores.

Objective: This study tested the hypothesis that coronary artery disease patients with higher depression scores have lower heart rate variability during daily life.

Method: Thirty-three men and nine women, ranging in age from 46 to 79, with coronary artery disease and exercise-induced ischemia were studied. The standard deviation of normal R-R intervals (SDNN) and average heart rate were obtained from 24-hour ambulatory electrocardiographic monitoring.

Florence Nightingale and holistic philosophy.

Florence Nightingale lived at a time when allopathy and homeopathy were competing for dominance in medical care. Nightingale's philosophy of health and healing was more similar to the holistic philosophy of homeopathy than to the mechanistic philosophy of allopathy. Why, then, did Nightingale align organized nursing with allopathic medicine? Perhaps Nightingale, always the pragmatist, understood that allopathy would gain the dominant position in medicine.