Efeito do treinamento físico associado a um programa de perda de peso no controle clínico e nos fatores de saúde relacionados à qualidade de vida em asmáticos obesos

Introdução: O fenótipo asma-obeso caracteriza-se por uma asma mais grave, no qual o controle clínico é mais difícil de ser alcançado, mesmo sob terapia medicamentosa otimizada. A cirurgia bariátrica tem sido recomendada para perda de peso e melhora dos sintomas, porém os benefícios de intervenções não-cirúrgicas têm sido pouco estudados. Objetivo: Avaliar o efeito do treinamento físico associado a um programa de perda de peso no controle clínico da asma, qualidade de vida e sintomas psicossociais em asmáticos obesos. Métodos: 55 pacientes com asma moderada a grave e obesidade grau II (IMC >= 35 e < 39.9 kg/m2) foram alocados em 2 grupos: programa de perda de peso + placebo (PP+P) ou programa de perda de peso + exercícios (PP+E), sendo que o programa de perda de peso incluiu terapia nutricional e psicológica (12 sessões semanais de 60 minutos cada). O grupo PP+E associou exercícios aeróbios e resistidos programa de perda de peso, enquanto o grupo PP+P associou exercícios placebo (respiratórios e alongamentos), 2xvezes/semana, 60 minutos/sessão durante 3 meses. Antes e após as intervenções, foram avaliados o controle clínico da asma, os fatores de saúde relacionados a qualidade de vida (FSRQV), a capacidade física, a composição corporal, os sintomas de ansiedade e depressão, a qualidade do sono, a função pulmonar e as inflamações das vias aéreas e sistêmica. A comparação dos dados contínuos entre os grupos foi realizada por ANOVA de dois fatores com medidas repetidas e das variáveis categóricas pelo teste qui-quadrado. A correlação linear e a regressão linear múltipla foram utilizadas para avaliar associações entre as variáveis avaliadas. Resultados: Foram analisados os resultados de 51 pacientes que foram reavaliados. Comparado com o grupo PP+P, os pacientes que realizaram exercício apresentaram melhora no controle clínico da asma (- 0,7 [-1,3 - -0,3] vs. -0,3 [-0,9 - 0,4] escore ACQ; p=0,01) e nos FSRQV (0,8 [0,3 -2,0] vs. 0,4 [-0,3 - 0,9] escore AQLQ; p=0,02), respectivamente. Essa melhora parece ter sido consequência do aumento do condicionamento físico (3,0 [2,4-4,0] vs. 0,9 [-0,3-1,3] mL.O2/Kg/min; p < 0,001) e da perda de peso (6,8±3,5% vs. 3,1±2,6% do peso corpóreo; p < 0,001) nos pacientes do grupo PP+E, que também apresentaram uma melhora dos sintomas de depressão, da qualidade do sono (ronco, latência e eficiência) e dos níveis séricos de vitamina D. Houve também melhora da função pulmonar (capacidade vital forçada e volume de reserva expiratório) e das inflamações das vias aéreas (FeNO) e sistêmica (CCL2, CXCL9, IL-4, IL-6, TNF-alfa, IL-10 e leptina/adiponectina), que parecem ser possíveis mecanismos associados à melhora do controle clinico da asma nos pacientes do grupo PP+E (p < 0,05 para todas variáveis apresentadas). Conclusão: A inclusão do treinamento físico em um programa de perda de peso a curto prazo deve ser considerada como uma intervenção eficiente para associar à terapia medicamentosa da asma na melhora do controle clínico em asmáticos obesos

Textural Characterization of Micro- and Mesoporous Carbons Using Combined Gas Adsorption and n-Nonane Preadsorption

Porous carbon and carbide materials with different structures were characterized using adsorption of nitrogen at 77.4 K before and after preadsorption of n-nonane. The selective blocking of the microporosity with n-nonane shows that ordered mesoporous silicon carbide material (OM-SiC) is almost exclusively mesoporous whereas the ordered mesoporous carbon CMK-3 contains a significant amount of micropores (25%). The insertion of micropores into OM-SiC using selective extraction of silicon by hot chlorine gas leads to the formation of ordered mesoporous carbide-derived carbon (OM-CDC) with a hierarchical pore structure and significantly higher micropore volume as compared to CMK-3, whereas a CDC material from a nonporous precursor is exclusively microporous. Volumes of narrow micropores, calculated by adsorption of carbon dioxide at 273 K, are in linear correlation with the volumes blocked by n-nonane. Argon adsorption measurements at 87.3 K allow for precise and reliable calculation of the pore size distribution of the materials using density functional theory (DFT) methods.

Electrogram analysis and pacing are complimentary for recognition of abnormal conduction and far-field potentials during substrate mapping of infarct-related ventricular tachycardia.

BACKGROUND Mapping to identify scar-related ventricular tachycardia re-entry circuits during sinus rhythm focuses on sites with abnormal electrograms or pace-mapping findings of QRS morphology and long stimulus to QRS intervals. We hypothesized that (1) these methods do not necessarily identify the same sites and (2) some electrograms are far-field potentials that can be recognized by pacing. METHODS AND RESULTS From 12 patients with coronary disease and recurrent ventricular tachycardia undergoing catheter ablation, we retrospectively analyzed electrograms and pacing at 546 separate low bipolar voltage (<1.5 mV) sites. Electrograms were characterized as showing evidence of slow conduction if late potentials (56%) or fractionated potentials (76%) were present. Neither was present at (13%) sites. Pacing from the ablation catheter captured 70% of all electrograms. Higher bipolar voltage and fractionation were independent predictors for pace capture. There was a linear correlation between the stimulus to QRS duration during pacing and the lateness of a capturing electrogram (P<0.001), but electrogram and pacing markers of slow conduction were discordant at 40% of sites. Sites with far-field potentials, defined as those that remained visible and not captured by pacing stimuli, were identified at 48% of all pacing sites, especially in areas of low bipolar voltage and late potentials. Initial radiofrequency energy application rendered 74% of targeted sites electrically unexcitable. CONCLUSIONS Far-field potentials are common in scar areas. Combining analysis of electrogram characteristics and assessment of pace capture may refine identification of substrate targets for radiofrequency ablation.

Alkenones and SST of surface sediments (Appendix)

We have analysed alkenones in 149 surface sediments from the eastern South Atlantic in order to establish a sediment-based calibration of the U37K' paleotemperature index. Our study covers the major tropical to subpolar production systems and sea-surface temperatures (SST's) between 0° and 27°C. In order to define the most suitable calibration for this region, the U37K' values were correlated to seasonal, annual, and production-weighted annual mean atlas temperatures and compared to previously published culture and core-top calibrations. The best linear correlation between U37K' and SST was obtained using annual mean SST from 0 to 10 m water depth (U37K' = 0.033 T + 0.069, r**2 = 0.981). Data scattering increased significantly using temperatures of waters deeper than 20 m, suggesting that U37K' reflects mixed-layer SST and that alkenone production at thermocline depths was not high enough to significantly bias the mixed-layer signal. Regressions based on both production-weighted and on actual annual mean atlas SST were virtually identical, indicating that regional variations in the seasonality of primary production have no discernible effect on the U37K' vs. SST relationship. Comparison with published core-top calibrations from other oceanic regions revealed a high degree of accordance. We, therefore, established a global core-top calibration using U37K' data from 370 sites between 60°S and 60°N in the Atlantic, Indian, and Pacific Oceans and annual mean atlas SST (0-29°C) from 0 m water depth. The resulting relationship (U37K' = 0.033 T + 0.044, r**2 = 958) is identical within error limits to the widely used E. huxleyi calibrations of and attesting their general applicability. The observation that core-top calibrations extending over various biogeographical coccolithophorid zones are strongly linear and in better accordance than culture calibrations suggests that U37K' is less species-dependent than is indicated by culture experiments. The results also suggest that variations in growth rate of algae and nutrient availability do not significantly affect the sedimentary record of U37K' in open ocean environments.

Water chemistry controls on minor elemental concentrations and strontium isotopic compositions of freshwater biogenic carbonate in northeastern Washington streams

Tracking the movement of migratory freshwater fish is essential to those invested in rebuilding declining fish populations. Using strontium isotopic signatures to match calcified fish tissues to streams where fish spawn is a useful method of tracking migratory fish where physical tracking methods such as radio, acoustic, or external tags, have proven unsuccessful. In this study, we develop tools to practice this method of tracking fish in Lake Roosevelt and its upstream tributaries in Washington State by analyzing the elemental concentrations and 87Sr/86Sr ratios of water samples, and mussel shell samples. This study evaluates whether mussel shells act as an appropriate proxy for water chemistry by comparing the 87Sr/86Sr isotope ratios of water samples to the 87Sr/86Sr isotope ratios of mussel shells sampled from the same, or nearby, locations. We compare concentrations of Ba, Ca, Cd, Cu, Fe, Mg, Pb, Sr, and U in the water and mussel shell samples to determine the feasibility of using mussel shells as a proxy for water chemistry. If it is determined that the concentrations of these elements in mussel shells reflect that of the surrounding water composition, the elemental composition of mussel shells can be compared to that of calcified tissues in fish, such as otoliths, to infer the location of the natal stream. We report analyses of water and mussel shell samples collected from Lake Roosevelt, Sanpoil River, Spokane River, Colville River, Kettle River, Pend Oreille River, Kootenay River, and Columbia River in Washington State. Each of these rivers is a tributary to Lake Roosevelt, and each flows through different geologic units. We hypothesize that the differences in the rock units of each stream’s watershed are reflected in the elemental concentrations and strontium isotopic ratios of water in each stream and in the lake. We also hypothesize that the composition of the mussel shells will match the composition of the water samples, therefore allowing us to use the mussel shells as a proxy for local water chemistry. Additionally, we hypothesize that the composition of the mussel shells will vary by location, and that we will be able to then infer where a fish is from by matching the composition of the fish in question to the mussels we have analyzed. We found that 87Sr/86Sr values for water and mussel hinge samples collected from tributaries east of Lake Roosevelt are significantly higher than the 87Sr/86Sr values for samples collected from tributaries west of Lake Roosevelt with averages of 0.7235 and 0.7089, respectively. The average 87Sr/86Sr ratios for water and mussel hinge samples collected within Lake Roosevelt is 0.7158, which is between the averages for samples collected east and west of the lake. Generally, older rocks are exposed on the east side of the lake, and younger rocks on the west side of the lake, so our 87Sr/86Sr values support the hypothesis that geologic units are a primary control on water chemistry, and that tributary compositions mix to form an average weighed by flow in Lake Roosevelt. The 87Sr/86Sr values for water and mussel shell samples collected from the same locations have a strong, positive linear correlation, suggesting that mussel shell 87Sr/86Sr ratios reflect the 87Sr/86Sr ratios of the ambient water. With these data, we can distinguish between different streams and the lake, but cannot distinguish between samples from within the same stream or within Lake Roosevelt. The Sr:Ca and Fe:Ca ratios of water samples show positive correlations with mussel shell compositions, with R2 values of 0.82 and 0.52, respectively. Ratios of Mg, Ba, Cu, Cd, Pb, and U to Ca showed little or no positive correlation between water and mussel shell samples. The elemental concentration data collected for this study do not demonstrate whether a correlation between elemental ratios in water samples and elemental ratios in mussel shell samples collected from the same location exists. Positive Sr:Ca and Fe:Ca correlations for water versus mussel shell samples indicate that perhaps for some elements, the composition of mussel shells are representative of the composition of ambient water. Using elemental concentration ratios to complement 87Sr/86Sr isotopic data may enhance our ability to identify correlations between water and mussel shell samples, and ultimately between mussel shell and otolith samples. The hinge part of a mussel shell may be used as a proxy for local water composition because the mussel shell composition reflects that of the local ambient water. The hinge of the mussel has the same composition as the whole mussel shell. We measured variation of 87Sr/86Sr ratios in the water among different streams and Lake Roosevelt. The 87Sr/86Sr values for samples collected in tributaries east of Lake Roosevelt, which erode older rocks, are higher for mussel shell and water samples than the average 87Sr/86Sr values for mussel shell and water samples collected in tributaries west of Lake Roosevelt, which flow through younger rocks.

Toward better outcomes with tacrolimus therapy: Population pharmacokinetics and individualized dosage prediction in adult liver transplantation

Patient outcomes in transplantation would improve if dosing of immunosuppressive agents was individualized. The aim of this study is to develop a population pharmacokinetic model of tacrolimus in adult liver transplant recipients and test this model in individualizing therapy. Population analysis was performed on data from 68 patients. Estimates were sought for apparent clearance (CL/F) and apparent volume of distribution (V/F) using the nonlinear mixed effects model program (NONMEM). Factors screened for influence on these parameters were weight, age, sex, transplant type, biliary reconstructive procedure, postoperative day, days of therapy, liver function test results, creatinine clearance, hematocrit, corticosteroid dose, and interacting drugs. The predictive performance of the developed model was evaluated through Bayesian forecasting in an independent cohort of 36 patients. No linear correlation existed between tacrolimus dosage and trough concentration (r(2) = 0.005). Mean individual Bayesian estimates for CL/F and V/F were 26.5 8.2 (SD) L/hr and 399 +/- 185 L, respectively. CL/F was greater in patients with normal liver function. V/F increased with patient weight. CL/F decreased with increasing hematocrit. Based on the derived model, a 70-kg patient with an aspartate aminotransferase (AST) level less than 70 U/L would require a tacrolimus dose of 4.7 mg twice daily to achieve a steady-state trough concentration of 10 ng/mL. A 50-kg patient with an AST level greater than 70 U/L would require a dose of 2.6 mg. Marked interindividual variability (43% to 93%) and residual random error (3.3 ng/mL) were observed. Predictions made using the final model were reasonably nonbiased (0.56 ng/mL), but imprecise (4.8 ng/mL). Pharmacokinetic information obtained will assist in tacrolimus dosing; however, further investigation into reasons for the pharmacokinetic variability of tacrolimus is required.

Tissue-specific gene expression in soybean (Glycine max) detected by cDNA microarray analysis

We have constructed cDNA microarrays for soybean (Glycine max L. Merrill), containing approximately 4,100 Unigene ESTs derived from axenic roots, to evaluate their application and utility for functional genomics of organ differentiation in legumes. We assessed microarray technology by conducting studies to evaluate the accuracy of microarray data and have found them to be both reliable and reproducible in repeat hybridisations. Several ESTs showed high levels (>50 fold) of differential expression in either root or shoot tissue of soybean. A small number of physiologically interesting, and differentially expressed sequences found by microarray analysis were verified by both quantitative real-time RT-PCR and Northern blot analysis. There was a linear correlation (r(2) = 0.99, over 5 orders of magnitude) between microarray and quantitative real-time RT-PCR data. Microarray analysis of soybean has enormous potential not only for the discovery of new genes involved in tissue differentiation and function, but also to study the expression of previously characterised genes, gene networks and gene interactions in wild-type, mutant or transgenic; plants.

Comparative proteomic analysis of GS-NSO murine myeloma cell lines with varying recombinant monoclonal antibody production rate

We have employed an inverse engineering strategy based on quantitative proteome analysis to identify changes in intracellular protein abundance that correlate with increased specific recombinant monoclonal antibody production (qMab) by engineered murine myeloma (NSO) cells. Four homogeneous NSO cell lines differing in qMab were isolated from a pool of primary transfectants. The proteome of each stably transfected cell line was analyzed at mid-exponential growth phase by two-dimensional gel electrophoresis (2D-PAGE) and individual protein spot volume data derived from digitized gel images were compared statistically. To identify changes in protein abundance associated with qMab clatasets were screened for proteins that exhibited either a linear correlation with cell line qMab or a conserved change in abundance specific only to the cell line with highest qMab. Several proteins with altered abundance were identified by mass spectrometry. Proteins exhibiting a significant increase in abundance with increasing qMab included molecular chaperones known to interact directly with nascent immunoglobulins during their folding and assembly (e.g., BiP, endoplasmin, protein disulfide isomerase). 2D-PAGE analysis showed that in all cell lines Mab light chain was more abundant than heavy chain, indicating that this is a likely prerequisite for efficient Mab production. In summary, these data reveal both the adaptive responses and molecular mechanisms enabling mammalian cells in culture to achieve high-level recombinant monoclonal antibody production. (C) 2004 Wiley Periodicals, Inc.

Urinary arsenic speciation and porphyrins in C57B1/6J mice chronically exposed to low doses of sodium arsenate

Arsenic has been classified as a human carcinogen based on epidemiological data however the mechanism of its carcinogenicity is still unclear. Urinary biomarkers for chronic arsenic exposure would be valuable as an early warning indicator for timely interventions. In this study, young female C57BI/6J mice were given drinking water containing 0, 100, 250 and 500 mug As-v/L as sodium arsenate ad libitum for 12 months. Urine was collected bimonthly for urinary arsenic methylation assay and porphyrin analysis. All detectable arsenic species showed strong linear correlation with administered dosage and the arsenic methylation patterns were similar in all three treatment groups. No significant changes of methylation patterns were observed over time for either the control or test groups. Urinary coproporphyrin III was significantly increased in the 8th month in 250 and 500 mug/L groups and remained significantly dose-related after 10 and 12 months. Coproporphyrin I also showed a significant dose-response relationship after 12 months. Our results confirm that urinary arsenic is a useful biomarker for internal dose. The alteration of porphyrin profile suggests that arsenic can affect the heme metabolism and this may occur prior to the onset of arsenic induced carcinogenesis. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Effect of cyclic pneumatic soft tissue compression on simulated distal radius fractures

We investigated the effect of pneumatic pressure applied to the proximal musculature of the sheep foreleg on load at the site of a transverse osteotomy of the distal radius. The distal radii of 10 fresh sheep foreleg specimens were osteotomized and a pressure sensor was inserted between the two bone fragments. An inflatable cuff, connected to a second pressure sensor, was positioned around the proximal forelimb musculature and the leg then was immobilized in a plaster cast. The inflatable cuff was inflated and deflated repeatedly to various pressures. Measurements of the cuff pressure and corresponding change in pressure at the osteotomy site were recorded. The results indicated that application of pneumatic pressure to the proximal foreleg musculature produced a corresponding increase in load at the osteotomy site. For the cuff pressures tested (109.8-238.4 mm Hg), there was a linear correlation with the load at the osteotomy site with a gradient of 12 mm Hg/N. It is conceivable, based on the results of this study, that a technique could be developed to provide dynamic loading to accelerate fracture healing in the upper limb of humans.

Nitrenes, diradicals, and ylides. Ring expansion and ring opening in 2-quinazolylnitrenes

Tetrazolo[1,5-a] quinazoline (9) is converted to 2-azidoquinazoline (10) on sublimation at 200 degrees C and above, and the azide-tetrazole equilibrium is governed by entropy. 2-Quinazolylnitrenes 11 and 27 and/ or their ring expansion products 14 and 29 can undergo type I (ylidic) and type II (diradicaloid) ring opening. Argon matrix photolysis of 9/10 affords 2-quinazolylnitrene (11), which has been characterized by ESR, UV, and IR spectroscopy. A minor amount of a second nitrene, formed by rearrangement or ring opening, is also observed. A diradical (19) is formed rapidly by type II ring opening and characterized by ESR spectroscopy; it decays thermally at 15 K with a half-life of ca. 47 min, in agreement with its calculated facile intersystem crossing (19T -> 19OSS) followed by facile cyclization/rearrangement to 1-cyanoindazole (21) (calculated activation barrier 1- 2 kcal/mol) and N-cyanoanthranilonitrile (22). 21 and 22 are the isolated end products of photolysis. 21 is also the end product of flash vacuum thermolysis. An excellent linear correlation between the zero-field splitting parameter D (cm(-1)) and the spin density F on the nitrene N calculated at the B3LYP/EPRIII level is reported (R-2 = 0.993 for over 100 nitrenes). Matrix photolysis of 3-phenyltetrazolo[1,5-a] quinazoline (25) affords the benzotriazacycloheptatetraene 29, which can be photochemically interconverted with the type I ring opening product 2-isocyano-alpha-diazo-alpha- phenyltoluene (33) as determined by IR and UV spectroscopy. The corresponding carbene 37, obtained by photolysis of 33, was detected by matrix ESR spectroscopy.

Detection of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 2(PAI-2) in gingival crevicular fluid from healthy, gingivitis and periodontitis patients

Background: The regulation of plasminogen activation is a key element in controlling proteolytic events in the extracellular matrix. Our previous studies had demonstrated that in inflamed gingival tissues, tissue-type plasminogen activator (t-PA) is significantly increased in the extracellular matrix of the connective tissue and that interleukin 1 beta (IL-1 beta) can up regulate the level of t-PA and plasminogen activator inhibitor-2 (PAI-2) synthesis by human gingival fibroblasts. Method: In the present study, the levels of t-PA and PAI-2 in gingival crevicular fluid (GCF) were measured from healthy, gingivitis and periodontitis sites and compared before and after periodontal treatment. Crevicular fluid from 106 periodontal sites in 33 patients were collected. 24 sites from 11 periodontitis patients received periodontal treatment after the first sample collection and post-treatment samples were collected 14 days after treatment. All samples were analyzed by enzyme-linked immunosorbent assay (ELISA) for t-PA and PAI-2. Results: The results showed that significantly high levels of t-PA and PAI-2 in GCF were found in the gingivitis and periodontitis sites. Periodontal treatment led to significant decreases of PAI-2, but not t-PA, after 14 days. A significant positive linear correlation was found between t-PA and PAI-2 in GCF (r=0.80, p

VIOLÊNCIA PSICOLÓGICA CONJUGAL EM UNIVERSITÁRIOS: ESTUDO DE FATORES DE RISCO

A pesquisa aborda a violência psicológica tal como é definida pela Organização Mundial de Saúde (KRUG, 2002) Usamos também a definição de violência psicológica utilizada por Straus e Sweet (1992). Nosso objetivo geral foi identificar a ocorrência de violência psicológica conjugal entre estudantes universitários, e a correlação desta com fatores de risco. E os específicos foram verificar sua correlação com a auto-estima, a ingestão de álcool, a faixa etária, o número de filhos e o rendimento familiar dos participantes. Tivemos respondentes de ambos os gêneros, casados ou em união estável, com idades entre 16 e 60 anos e alunos da Universidade Metodista de São Paulo. A pesquisa de campo foi realizada na Universidade Metodista de São Paulo e abordou universitários da graduação, graduação tecnológica e cursos seqüenciais. Esta pesquisa é uma pesquisa descritiva e sua amostragem foi não-probabilística de conveniência, responderam ao instrumento 246 pessoas, que foram escolhidas com base nos critérios de inclusão e na sua disponibilidade imediata para responder à pesquisa. Obtivemos mais respondentes do gênero feminino (145) do que do masculino (100). O instrumento foi composto por: Escala de Táticas de Conflito (CTS1), Escala de Auto-Estima e Autoconceito de Rosenberg e um Questionário Sócio-demográfico Adaptado. A CTS 1 foi usada para medir a violência familiar, a escala de auto-estima foi usada para verificar a atitude positiva ou negativa das pessoas e o questionário foi usado para complementar dados sobre a história pessoal e conjugal dos respondentes. Foram analisados 246 instrumentos através do Estatístico SPSS 13,0 for Windows. Os resultados demonstraram que aproximadamente 30% das pessoas de ambos os gêneros e da amostra total apresentaram alto grau de violência psicológica. Verificamos que existe uma tendência de que quanto menor a auto-estima dos respondentes maior o grau de violência psicológica. Constatamos também a inexistência de correlação linear entre violência psicológica, costume de ingerir bebida alcoólica e quantidade de bebida alcoólica ingerida pelos respondentes. Este dado não é corroborado pela literatura pesquisada. Portanto, percebemos que o álcool em si diz pouco enquanto fator de risco para a ocorrência da violência psicológica. Sua articulação merece ser mais investigada e melhor delineada por meio da busca de conhecimentos e práticas que contribuam para a saúde da população. Concluímos que a violência psicológica conjugal muitas vezes é banalizada e tida como natural

Quantification of the relationship between, magnetoencephalographic (MEG) and blood oxygenation dependent (BOLD) images of brain function

Magnetoencephalography (MEG) is the measurement of the magnetic fields generated outside the head by the brain’s electrical activity. The technique offers the promise of high temporal and spatial resolution. There is however an ambiguity in the inversion process of estimating what goes on inside the head from what is measured outside. Other techniques, such as functional Magnetic Resonance Imaging (fMRI) have no such inversion problems yet suffer from poorer temporal resolution. In this study we examined metrics of mutual information and linear correlation between volumetric images from the two modalities. Measures of mutual information reveal a significant, non-linear, relationship between MEG and fMRI datasets across a number of frequency bands.

Tetrahydrobiopterin metabolism in dementia

The aim of this study was to establish levels of the enzymes involved in tetrahydrobiopterin (BH4) metabolism in human and rat brain preparations; to determine whether BH4 metabolism is altered in dementia, particularly in relation to senile dementia of the Alzheimer type (SDAT); and to examine the effect of aluminium on BH4 metabolism. Overall BH4 synthesis and dihydropteridine reductase (DHPR) activity were greater in the locus coeruleus than in the neocortex of elderly subjects. Sepiapterin reductase and DHPR activity showed a linear correlation with age in the temporal cortex. DHPR activity in the frontal cortex was relatively constant until the mid 60s and then fell with age. Overall BH4 synthesis showed a non-significant decline in temporal cortex and was significantly reduced in locus coeruleus preparations from SDAT subjects compared to control subjects. As DHPR, sepiapterin reductase and GTP cyclohydrolase activity were unaltered in SDAT we suggested that there is a lesion on the biosynthetic pathway between dihydroneopterin in triphosphate and BH4 in SDAT, possibly at the level of 6-pyruvoyl tetrahydropterin synthase. DHPR activity and BH4 synthesis capacity were unaltered in temporal cortex preparations from Huntingdon's disease subjects indicating that the defect in BH4 metabolism in SDAT is specific to the disease process and not a secondary consequence of dementia. The implications of altered BH4 metabolism in ageing and dementia are discussed. BH4 metabolism was examined in temporal and frontal cortex preparations from 4 subjects who had received peritoneal dialysis treatment. All patients had elevated serum aluminium levels. The data suggests that aluminium may inhibit DHPR activity in the frontal cortex resulting in diminished BH4 levels in the cells which leads to a compensatory increase in the activity of the biosynthetic pathway. Aluminium reversibly inhibited sepiapterin reductase activity in rat brain preparations but did not alter sepiapterin reductase activity in vivo. Overall BH4 synthesis and OTP cyclohydrolase activity were not affected by aluminium in vitro. The biosynthetic pathway was unaltered in rat brain preparations from animals receiving aluminium orally compared to control animals. DHPR activity was unaltered or increased in rat brain preparations from aluminium treated rats compared to the control group.