To determine whether asthmatic subjects have an increase in airway wall thickness that could enhance airway narrowing during bronchoprovocation, we examined the relationship between airway responsiveness and bronchial wall thickness measured by high-resolution computed tomography (HRCT). We studied 24 nonsmokers with asthma, of whom 13 had a fixed component of airflow obstruction (Group 1) and 11 had an optimal FEV1 of 80% or more of the predicted value (Group 2). These subjects were compared with a control group of 10 nonasthmatic subjects (Group 3). Measurements were taken of each subject's expiratory flows, bronchodilator response, lung volumes, and methacholine responsiveness. All subjects used an inhaled beta 2-agonist on demand, and 19 also used inhaled steroids (13 in a Group 1 and six in Group 2). HRCT sections were obtained at the top and base of the lung and at the level of the intermediary bronchus (IB), although only this last level was found adequate for analysis. The ratio of IB wall thickness to outer diameter (T/D) showed a negative relationship with the outer diameter in Group 1 only. The mean T/D ratio of IB was not significantly different in Groups 1, 2, and 3, with respective values of 0.16 +/- 0.01, 0.15 +/- 0.01, and 0.18 +/- 0.01 at TLC, and 0.16 +/- 0.01, 0.20 +/- 0.01, and 0.19 +/- 0.01 at FRC. In subjects with a fixed component of airflow obstruction, the thicker the airway wall in relation to its diameter, the lower was the PC20 for methacholine. This was not observed in the other study groups. No correlation was found between the T/D ratio and baseline FEV1.(ABSTRACT TRUNCATED AT 250 WORDS)
This study documented the effect of changes in male and female sex hormones and the selective estrogen receptor modulator (SERM) tamoxifen on weight gain and food consumption of rats from puberty to adulthood, and assessed whether age at onset of treatment affected outcome. In Study 1, male and female WKY rats were either neutered or sham-operated before puberty, and a subgroup of neutered females underwent estrogen replacement (ERT) at the age of puberty. In Study 2, subgroups of neutered females received either ERT or tamoxifen beginning well into the postpuberty period. Weekly body weight and food consumption were assessed, and food consumption was normalized to metabolic weight (body weight(0.67)). Neutering reduced the rate of weight gain in males (P < 0.05), but significantly increased it in females (P < 0.0001). ERT immediately reduced weight gain and prevented any further increase, resulting in weights below that of sham-operated females (P < 0.05). Tamoxifen prevented further weight gain and returned profiles to that of sham-operated females. Food consumption, normalized to metabolic weight, was similar in females and males, and both sexes showed a decrease through maturation to adulthood. Neutering decreased food consumption below that of sham-operated animals in both males and females (P < 0.05), and ERT returned it to sham levels. Despite the fact that tamoxifen had an effect on body weight similar to that of ERT, females receiving tamoxifen treatment consumed less food than both sham-operated and ERT females (P < 0.05). Weight gain is modulated by sex hormones in male and female rats, with both estrogen and tamoxifen exerting immediate effects in females, irrespective of the age at which treatment is initiated. Differences in food consumption do not appear to account for the effects of hormones and tamoxifen on body weight, suggesting that they exert a direct effect on overall body metabolism.
The degree of cyanosis adversely affects myocardial adenosine triphosphate, function, and clinical outcome of children who undergo cardiac operation. Children with cyanosis should be identified as a higher risk group that could be targeted for supportive interventions.
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