The American journal of the medical sciences
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Increasing early success-post lung transplant has been tempered by the long-term development of histologic bronchiolitis obliterans (OB) or of the progressive airway obstruction which is called bronchiolitis obliterans syndrome (BOS). Multiple lines of evidence suggest that OB/BOS is due to an injury directed against the epithelial cells in the airways of the donor lung by the immune system of the recipient. ⋯ Results of treatment with augmented immunosuppression have been disappointing but the treatment of complicating infections in the allograft can be beneficial. Multicenter studies are needed to assess the efficacy of new immunosuppressive agents in preventing or treating OB/BOS.
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To determine predictors of left ventricular mass (LVM) and hypertrophy (LVH), 56 black and 30 white normotensive healthy youths (mean age 12.6 +/- 2.3 years at initial visit) were studied twice, 2.5 years apart. During the initial visit, anthropometric variables and hemodynamics were measured at rest and before, during, and after 4 physical and behavioral stressors. 2-D directed M-mode echocardiography was performed to derive LVM. ⋯ Youth with LVH at follow-up were taller, heavier, and exhibited greater blood pressure reactivity at initial evaluation. These findings are important since interventional strategies can be developed that target obesity and exaggerated reactivity to stress.
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Randomized Controlled Trial Comparative Study Clinical Trial
Racial differences in ambulatory blood pressure and echocardiographic left ventricular geometry.
We examined the racial differences in left ventricular (LV) geometric pattern in relation to 24-hour ambulatory blood pressure (BP) monitoring and the presence or absence of a nocturnal BP dip. Our study confirms the blunting of nocturnal BP dip among black hypertensives. Body mass index, rather than race, was a major determinant of left ventricular hypertrophy. ⋯ A six-fold higher prevalence of concentric remodeling was observed in blacks as compared with whites. The impaired nocturnal BP dip in blacks may contribute to the different hemodynamic pattern. Determinants of myocardial oxygen consumption were significantly higher in black hypertensives.
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We evaluated the willingness of clients at a large urban sexually transmitted diseases (STD) clinic in the southeastern United States to participate in future trials of preventive vaccines for HIV type 1 (HIV-1). A single trained interviewer administered an oral survey instrument to STD clinic clients over a 4-week enrollment period. The participants were 167 randomly selected clients (90 men and 77 women), most of whom were young, African-American heterosexuals. ⋯ Overall, 67% of clients expressed willingness to consider participation in an HIV-1 vaccine trial. By univariate analysis, prior HIV-1 testing was significantly associated with willingness to participate (P = 0.04). Multivariate analysis revealed that female gender (P = 0.05) and prior HIV-1 testing (P = 0.03) were significant predictors of willingness to participate.
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The primary purposes of this article are to highlight important issues related to cardiovascular risk factors and behavior life-styles in young women and to examine racial (black-white) differences in risk factors that relate to cardiovascular disease. In childhood, some girls show cardiovascular risk factors of higher blood pressure levels, dyslipidemia, and obesity, all of which continue into young adulthood. ⋯ Trends of obesity are documented; and young white girls are continuing to use tobacco, more so than boys and black girls. Although the onset of clinical cardiovascular disease is delayed in women, the stage is set in childhood for the development of early cardiovascular risk.