Effect of Growth Hormone (hGH) Replacement Therapy on Physical Work Capacity and Cardiac and Pulmonary Function in Patients with hGH Deficiency Acquired in Adulthood.

The effects of 6 months of replacement therapy with recombinant human GH (hGH) on physical work capacity and cardiac structure and function were investigated in 20 patients with hGH deficiency of adult onset in a double blind, placebo-controlled trial. The GH dose of 12.5 micrograms/kg BW was self-administered daily sc. Oxygen consumption (VO2), CO2 production, and ventilatory volumes were measured during exercise on a bicycle spiroergometer. M-Mode echocardiography was performed using standard techniques. The VO2 max data, expressed per kg BW (mL/min.kg BW) showed a significant increase from 23.2 +/- 2.4 to 30.0 +/- 2.3 (P < 0.01) in the hGH-treated group, whereas the VO2 max data, expressed per lean body mass (milliliters per min/kg lean body mass) did not change significantly in either group. Maximal O2 pulse (milliliters per beat) increased significantly from 15.2 +/- 5.6 to 19.6 +/- 3.3 mL/beat (P < 0.01), but remained constant in the placebo group. The maximal power output (watts +/- SE) increased significantly (P < 0.01) from 192.5 +/- 13.5 to 227.5 +/- 11.5 in the hGH-treated group, but remained constant in the placebo group. Cardiac structure (left ventricular posterior wall, interventricular septum thickness, left ventricular mass, left ventricular end-systolic dimension, and left ventricular end-diastolic dimension) as well as echocardiographically assessed cardiac function did not change significantly after 6 months of treatment in either group. We conclude that hGH replacement in hGH-deficient adults improves oxygen uptake and exercise capacity. These improvements in pulmonary parameters might be due to an increase in respiratory muscle strength and partly to the changes in muscle volume per se observed during hGH replacement therapy. Furthermore, an increased cardiac output might contribute to the improvement in exercise performance during hGH treatment. According to our data, hGH replacement therapy leads to an improvement of exercise capacity and maximal oxygen uptake, but has no significant effect on cardiac structure

Modeling the Miocene Climatic Optimum. Part I: Land and Atmosphere

This study presents results from the Community Climate System Model 3 (CCSM3) forced with early to middle Miocene (~20–14 Ma) vegetation, topography, bathymetry, and modern CO2. A decrease in the meridional temperature gradient of 6.5°C and an increase in global mean temperature of 1.5°C are modeled in comparison with a control simulation forced with modern boundary conditions. Seasonal poleward displacements of the subtropical jet streams and storm tracks compared to the control simulation are associated with changes in Hadley circulation and significant cooling of the polar stratosphere, consistent with previously predicted effects of global warming. Energy budget calculations indicate that reduced albedo and topography were responsible for Miocene warmth in the high-latitude Northern Hemisphere while a combination of increased ocean heat transport and reduced albedo was responsible for relative warmth in the high-latitude Southern Hemisphere, compared to the present. Model–data analysis suggests Miocene climate was significantly warmer and wetter than simulated here, consistent with previous uncoupled Miocene models and supports recent reconstructions of Miocene CO2 substantially higher than present

Modeling the Miocene Climatic Optimum: Ocean Circulation

Ocean circulation is investigated using the Community Climate System Model 3 (CCSM3) forced with early to middle Miocene (∼20–14 Ma) topography, bathymetry, vegetation and modern CO2. Significant bottom water formation is modeled in the Weddell Sea along with intermediate North Component Water formation in the North Atlantic. This is attributed primarily to stronger- and weaker-than-modern convective preconditioning in the Weddell and Labrador Seas, respectively. Global meridional overturning and gyre circulation is weaker in the Miocene due to weaker midlatitude westerlies in the southern hemisphere, caused by lowering of the meridional surface temperature gradient, in addition to regional influences on convection. Subsurface temperatures in the Miocene are significantly higher in the far North Atlantic, Greenland-Norwegian Seas and Arctic basin compared to the present. Ocean heat transport is symmetrical about the equator and resembles that simulated for late Cretaceous and early Cenozoic climates, suggesting the northern hemisphere dominated ocean heat transport active today developed after the middle Miocene. Simulated deep water warming in the Miocene is more than an order of magnitude lower than indicated by proxies. This discrepancy is not reconciled by higher CO2 due to the persistence of sea-ice at sites of deep water formation. This suggests that either the CCSM3 is insufficiently sensitive to Miocene boundary conditions, greater greenhouse forcing existed than is currently reconstructed, or that proxy records of warming are exaggerated. Given the diversity of global Miocene proxy records and their near-unanimous estimate of a significantly warmer Earth, the first two options are more likely

Independent Information of Nonspecific Biomarkers in Exhaled Breath Condensate

Background: Exhaled breath condensate (EBC) has been used for diagnosing and monitoring respiratory disorders. For clinical purposes the assessment of easy-to-obtain nonspecific markers seems particularly interesting. Objectives: As these measures are related to each other, our objective was to extract the independent information in global EBC markers across a range of respiratory disorders. Methods: EBC was collected from patients with asthma (n = 18), chronic obstructive pulmonary disease (n = 17), and cystic fibrosis (n = 46), as well as from lung transplant (LTX) recipients (n = 14) and healthy controls (n = 26). Samples were assessed for electrical conductivity, ammonia, pH, and nitrite/nitrate. pH was measured after both deaeration with argon and CO(2) standardization. Additionally, the fraction of exhaled nitric oxide (FE(NO)) was assessed. Factor analysis was applied to identify major factors concerning these measures. Results: Three independent factors were detected; the first comprised conductivity, ammonia, and pH, especially when standardized using CO(2), the second nitrite/nitrate, and the third FE(NO). Conductivity and ammonia were highly correlated (r = 0.968; p < 0.001). FE(NO) provided independent information mainly in asthma. The nonspecific EBC markers showed considerable overlap between patient groups and healthy subjects. However, conductivity, ammonia, pH standardized for CO(2) and nitrite/nitrate were increased in LTX recipients compared to healthy controls (p < 0.05 each). Conclusions: A panel of nonspecific easy-to-obtain exhaled breath markers could be reduced to 3 independent factors. The information content of conductivity, ammonia, and pH after CO(2) equilibration appeared to be similar, while FE(NO) was independent. The increased levels of these biomarkers in LTX might indicate a potential for their use in these patients. Copyright (C) 2010 S. Karger AG, Base

Procalcitonin: Importance for the diagnosis of bacterial infections

In contrast to calcitonin which is primarily synthesized in the thyroid, procalcitonin is a prohormone which is synthesized in many different tissues of infected organs. To diagnose mild, localized, or early infections an assay needs to have a functional assay sensivity of approximately 0.02μg/L. We demonstrated that procalcitonin modifies the outcome of respiratory infections with regard to minimizing the use of antibiotics and duration of antibiotic treatment. High concentrations, especially over time, indicate high risk of a severe outcome. In this respect, procalcitonin is superior to other infection markers, such as C-reactive protein. High procalcitonin levels can also be found in non-bacterial diseases, such as malaria, severe trauma, burns, and medullar carcinoma of the thyroid. Procalcitonin, as a marker, has improved the diagnosis of bacterial infections. However, procalcitonin needs to be used in conjunction with other laboratory markers, clinical examination, and medical histor

Procalcitonin und seine Bedeutung für die Diagnose bakterieller Infektionen

Procalcitonin ist das Pro-Hormon von Calcitonin. Im Gegensatz zu Calcitonin, welches primär in der Schilddrüse gebildet wird, wird Procalcitonin bei einer bakteriellen Infektion im Körper von allen infizierten parenchymatösen Organen produzier