title stringlengths 0 1.13k | abstract stringlengths 1 15.7k | PMID int64 22 36.5M |
|---|---|---|
Early and extended early bactericidal activity of linezolid in pulmonary tuberculosis. | Linezolid, the first oxazolidinone approved for clinical use, has effective in vitro and promising in vivo activity against Mycobacterium tuberculosis. To evaluate the early and extended early bactericidal activity of linezolid in patients with pulmonary tuberculosis. Randomized open label trial. Thirty patients with newly diagnosed smear-positive pulmonary tuberculosis (10 per arm) were assigned to receive isoniazid (300 mg daily) and linezolid (600 mg twice daily or 600 mg once daily) for 7 days. Sputum for quantitative culture was collected for 2 days before and then daily during 7 days of study drug administration. Bactericidal activity was estimated by measuring the decline in bacilli during the first 2 days (early bactericidal activity) and the last 5 days of study drug administration (extended early bactericidal activity). The mean early bactericidal activity of isoniazid (0.67 log10 cfu/ml/d) was greater than that of linezolid twice and once daily (0.26 and 0.18 log10 cfu/ml/d, respectively). The extended early bactericidal activity of linezolid between Days 2 and 7 was minimal. Linezolid has modest early bactericidal activity against rapidly dividing tubercle bacilli in patients with cavitary pulmonary tuberculosis during the first 2 days of administration, but little extended early bactericidal activity. Clinical trial registered with www.clinicaltrials.gov (NCT00396084). | 18,787,216 |
Lung function in infants with cystic fibrosis diagnosed by newborn screening. | Progressive lung damage in cystic fibrosis (CF) starts in infancy, and early detection may aid preventative strategies. To measure lung function in infants with CF diagnosed by newborn screening and describe its association with pulmonary infection and inflammation. Infants with CF (n = 68, 6 weeks to 30 months of age) and healthy infants without CF (n = 49) were studied. Forced vital capacity, FEV(0.5), and forced expiratory flows at 75% of exhaled vital capacity (FEF(75)) were measured using the raised-volume rapid thoracoabdominal compression technique. Forty-eight hours later, infants with CF had bronchoalveolar lavage (BAL) for assessment of pulmonary infection and inflammation. In the CF group, the deficit in FEV(0.5) z score increased by -0.77 (95% confidence interval, -1.14 to -0.41; P < 0.001) with each year of age. The mean FEV(0.5) z score did not differ between infants with CF and healthy control subjects less than 6 months of age (-0.06 and 0.02, respectively; P = 0.87). However, the mean FEV(0.5) z score was lower by 1.15 in infants with CF who were older than 6 months of age compared with healthy infants (P < 0.001). FVC and FEF(75) followed a similar pattern. Pulmonary infection and inflammation in BAL samples did not explain the lung function results. Lung function, measured by forced expiration, is normal in infants with CF at the time of diagnosis by newborn screening but is diminished in older infants. These findings suggest that in CF the optimal timing of therapeutic interventions aimed at preserving lung function may be within the first 6 months of life. | 18,787,217 |
Sign language recognition by combining statistical DTW and independent classification. | To recognize speech, handwriting or sign language, many hybrid approaches have been proposed that combine Dynamic Time Warping (DTW) or Hidden Markov Models (HMM) with discriminative classifiers. However, all methods rely directly on the likelihood models of DTW/HMM. We hypothesize that time warping and classification should be separated because of conflicting likelihood modelling demands. To overcome these restrictions, we propose to use Statistical DTW (SDTW) only for time warping, while classifying the warped features with a different method. Two novel statistical classifiers are proposed (CDFD and Q-DFFM), both using a selection of discriminative features (DF), and are shown to outperform HMM and SDTW. However, we have found that combining likelihoods of multiple models in a second classification stage degrades performance of the proposed classifiers, while improving performance with HMM and SDTW. A proof-of-concept experiment, combining DFFM mappings of multiple SDTW models with SDTW likelihoods, shows that also for model-combining, hybrid classification can provide significant improvement over SDTW. Although recognition is mainly based on 3D hand motion features, these results can be expected to generalize to recognition with more detailed measurements such as hand/body pose and facial expression. | 18,787,250 |
Changes in h-reflex amplitude during massage of triceps surae in healthy subjects. | The purpose of this study was to investigate the effects of massage on neuromuscular excitability, as measured by changes in Hoffmann reflex (H-reflex) amplitudes. Nine healthy subjects (= 25.2 years; 2 males, 7 females), with no history of neurological disease, participated in the study. H-reflexes were elicited from the right soleus muscle by delivering square wave impulses (Grass S48 stimulator) of 1 msec duration to the posterior tibial nerve of the same leg. H-reflex peak to peak amplitudes were measured at 10 sec intervals, and a total of 10 recordings were made during each of five separate conditions (C1, C2, MASS, C3, and C4). Two pretreatment control (C1 and C2) conditions, separated by a 5-minute pause in the recordings, were immediately followed by the massage condition (MASS). H-reflex recordings were also made during the first 2 minutes of a 3-minute massage application to the right triceps surae muscle group. One post-treatment control (C3) condition was introduced immediately following the termination of the massage, and a second (C4) after a 5 minute delay. A one-way repeated measures analysis of variance revealed a significant difference among conditions (F4,32 = 32.26, p < 0.01) for individual means. Newman Keuls post hoc procedures for pair-wise comparisons revealed that all massage-control pairings were statistically different (p < 0.01). No other pairings (control-control) were significantly different. A 71% decrease in H-reflex amplitudes was observed during the massage, followed by a return to baseline levels immediately following the termination of the massage. These results suggest the use of massage as an alternative to other therapeutic modalities such as passive muscle stretching and tendon pressure to decrease spinal motoneuron excitability. J Orthop Sports Phys Ther 1990;12(2):55-59. | 18,787,257 |
Shoulder kinesthesia after anterior glenohumeral joint dislocation. | This article was presented in poster format at the Sixty-Third Annual Conference of the American Physical Therapy Association, San Antonio, TX, June 28-July 2,1987. The study was supported in part by the Montana Chapter of the American Physical Therapy Association and was submitted June 24, 1987; was with the authors for revision for 34 weeks; and was accepted June 9.1988. Reprinted from Physical Therapy with the permission of the American Physical Therapy Association. [Smith RL, Brunolli J: Shoulder kinesthesia after anterior glenohumeral joint dislocation. Phys Ther 69:106-112, 1989.]The purpose of this study was to examine kinesthesia in normal (uninjured) shoulders and in shoulders with a history of glenohumeral joint dislocations. Both shoulders of 10 healthy subjects and 8 subjects with a history of unilateral anterior dislocation were tested for accuracy of angular reproduction, threshold to sensation of movement, and end-range reproduction using a motor-driven shoulder-wheel apparatus. An analysis of variance revealed significant differences (p < 0.001) between the injured and uninjured shoulders for all three tests. Post hoc analysis showed significant differences (p < 0.02) between the involved shoulders and all uninvolved shoulders. No significant difference was found among the uninvolved shoulders. The results of this study indicate that kinesthetic deficits occur after glenohumeral dislocation and may result in abnormal neuromuscular coordination and subsequent reinjury of the shoulder. Clinicians should consider rehabilitation of shoulder kinesthesia using therapeutic activation of the shoulder joint and muscle receptors when treating patients with previous dislocations. J Orthop Sports Phys Ther 1990;11(11):507-513. | 18,787,264 |
Treatment of hepatocellular carcinoma. | Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, and is the third highest cause of cancer-related mortality. HCC usually develops in patients with chronic liver disease, particularly in those who also have cirrhosis. The possibility of curative treatment depends on both the stage of tumor and liver function. Effective treatments for HCC include percutaneous ablation, surgical resection, and liver transplantation. Both percutaneous ablation and surgical resection provide a high rate of complete responses and are assumed to improve survival that should exceed 50% at 5 years. Liver transplantation results in a better survival rate, and is not contraindicated by advanced liver dysfunction. However, its application is limited by the scarcity of donor organs. Treatments for advanced HCC include transarterial chemoembolization and chemotherapy. Although short-term prognosis of HCC patients has improved recently due to advances in early diagnosis and treatment, long-term prognosis is as yet far from satisfactory due to frequent recurrence. Prevention of recurrence of HCC remains one of the most challenging tasks in current hepatology. | 18,787,282 |
Drug-eluting stent treatment of a radiation-induced left internal mammary arterial graft stenosis. | A 62-year-old man underwent radiotherapy to the left upper chest for treatment of Pancoast syndrome on a background of previous coronary artery bypass grafting 12 years earlier. Within 1 year, he developed significant stenoses of both the left internal mammary artery (LIMA) graft and ostial left vertebral artery, presumably related to therapeutic radiation exposure. Initially diagnosed using computed tomography coronary angiography, the patient underwent percutaneous coronary intervention and insertion of a drug-eluting stent (DES) to the ostium of the LIMA graft via a left radial approach. He remains clinically well at 6-month follow-up. This is the first reported case in the literature of DES treatment of a radiation-induced vascular stenosis; however, the incidence of cardiovascular disease is elevated in such cases. In patients with a prior history of mantle radiation, consideration should be given to the routine assessment of internal mammary conduits prior to coronary artery bypass surgery. | 18,787,292 |
A 32-kDa tyrosine-phosphorylated protein shows a protease-dependent increase in dead boar spermatozoa. | Boar sperm TyrP32 is a 32-kDa tyrosine-phosphorylated protein that increases during the capacitation and acrosome reaction and during cryocapacitation. However, it is still unclear whether the increase in TyrP32 is an event that is limited to the process of sperm fertilization, including cryocapacitation. The aims of the present study were to demonstrate that TyrP32 is increased in dead spermatozoa after freeze-thawing without a cryoprotectant and to find the causal factors for this increase. Washed spermatozoa were resuspended in a salt solution and then frozen. The frozen samples were rapidly thawed in a warm water bath and then used for sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis (PAGE)/Western blotting to detect TyrP32, SDS-PAGE/silver staining of sperm proteins and staining of acrosomal contents with fluorescein isothiocyanate (FITC)-conjugated peanut agglutinin (PNA). In the samples before freezing, TyrP32 was barely detectable, and the distribution of the acrosomal contents was normal in most spermatozoa. One cycle of freeze-thawing induced an increase in TyrP32, a decrease in major sperm proteins and disorder in the acrosomal contents. However, the addition of a protease inhibitor (APMSF, 1 mM) suppressed the increase in TyrP32 and the decrease in the major sperm proteins, although it did not have any influence on the disorder in the acrosomal contents. Additionally, the spermatozoa did not exhibit any flagellar movement after freeze-thawing, which showed that almost all of them were dead. These results indicate that TyrP32 can show a protease-dependent increase in dead spermatozoa after freeze-thawing without a cryoprotectant even though the dead spermatozoa do not undergo cryocapacitation. | 18,787,309 |
[Determination of gossypol in feeds by HPLC]. | An HPLC method for determination of goosypol in feed was developed. Gossypol in food was extracted with acetic acid-water-phosphoric acid (85 : 15 : 1) for 20 min in a water bath at 100 degrees C. The extract was diluted with acetone-water (1 : 1), and injected into the HPLC. HPLC was performed with a Shodex C18M4E (4.6 mm i.d.x250 mm) column at a flow-rate of 1.0 mL/min, using a mobile phase of methanol-water (9 : 1) adjusted to pH 2.6 with phosphoric acid, and gossypol was detected with a UV detector (254 nm). A recovery test was conducted with cottonseed spiked with gossypol at 1,000 and 5,000 mg/kg, and with 2 kinds of formula feed spiked with gossypol at 58 and 580 mg/kg. The mean recoveries of gossypol were 90.8-105.0% and the relative standard deviations (RSD) were within 3.0%. A collaborative study was conducted with cottonseed and formula feed spiked with gossypol at 305 mg/kg in 8 laboratories. The average content of gossypol in cottonseed was 6,090 mg/kg, and the repeatability and reproducibility as the relative standard deviation (RSD(r) and RSD(R)) were 3.3% and 4.4%, while the mean recovery, RSD(r) and RSD(R) of gossypol in formula feed were 87.0%, 2.7% and 5.5%, respectively. | 18,787,315 |
Comparative effects of home- and group-based exercise on balance confidence and balance ability in older adults: cluster randomized trial. | Exercise can modify fall risk factors such as balance and mobility impairments. However, can exercise improve balance confidence? In one strength-training study, researchers reported that a change in balance confidence was not uniformly associated with changes in objective measures of fall risk or physical performance. In fact, some participants' balance confidence decreased while their physical abilities increased and vice versa. The aim of this study was to compare changes in balance confidence and balance ability resulting from three exercise interventions (home-based resistance and balance training (RBT), group-based RBT and group-based walking), and the concomitant relationships between change in balance confidence and change in ability. It was hypothesized that participants in the group-based RBT program would improve their balance confidence and performance more than those in the home-based or walking programs. In a cluster-randomized design, nine retirement villages were assigned to one of the three exercise groups. One hundred and sixty-seven independent-living residents (aged 65-96 years) participated. Each group exercised twice weekly for 20 weeks. Objective balance ability was measured using timed tandem and one-leg stands (static balance), and the 8-foot (2.5 m) up-and-go test (dynamic balance/agility). Balance confidence was assessed using the self-report Activities-specific Balance Confidence (ABC) Scale. Participants in the group-based RBT program improved their static balance scores more than those in the home-based program; however, improvements in balance confidence were greater among participants in the home-based program (all p < 0.05). Discordance between static balance and balance confidence change scores was evident for up to 20% of participants. Change in ABC score was weakly correlated with a change in the up-and-go test score. Exercise training can improve balance confidence and balance ability in retirement village residents. However, as has been shown previously, this study found that exercise interventions may improve balance ability without associated increases in balance confidence and vice versa. Whether the ABC score and balance ability can be enhanced by providing a tailored intervention to improve balance confidence in combination with a RBT program requires further study. | 18,787,321 |
Effect of phototherapy on neonatal heart rate variability and complexity. | Phototherapy is a common mode of treatment for neonatal hyperbilirubinemia. However, phototherapy has been reported to alter cardiovascular function by causing increased peripheral blood flow, diminished cardiac output and increased sympathetic activity that may be of concern particularly in sick or premature newborns. The effects of phototherapy on the autonomic nervous system modulation of heart rate in term neonates have not yet been investigated. The aim of the present study was to investigate the effects of phototherapy on the autonomic nervous system modulation of heart rate in healthy full-term jaundiced neonates. 30 full-term jaundiced infants were prospectively studied before and during phototherapy. Heart rate variability was analyzed with conventional time-domain, spectral, and time-dynamic techniques by using Poincaré plots. Phototherapy was found to cause significant diminution in the short- and long-term variability of heart rate in newborns as documented by time-domain analysis of heart rate variability, and visually demonstrated by using Poincaré plots. Spectral indices and heart rate were unchanged during phototherapy. A significant diminution in heart rate variability was documented during phototherapy, a phenomenon assumed to be centrally mediated. The reasons for this decrease are yet unknown. The use of time-dynamic analysis methods may offer important details on the newborn's physiology that cannot be revealed by traditional methods. | 18,787,336 |
Accumulation of CD8+CD45RA+CD62L+ T cells in acute chylothorax in neonates. | Acute chylothorax in neonates is a rare disease but results in significant loss of lymphatic cells. The purpose of the study was to determine whether acute chylothorax in neonates results in quantitative changes of lymphocyte subpopulations in peripheral blood and chyle. 6 neonates who had acute chylothorax after thoracic surgery due to transposition of the great arteries were prospectively enrolled in the study. Peripheral blood mononuclear cells (PBMC) and chylous fluid mononuclear cells (CFMC) including CD45RA+ and CD45RO+ T cells and the expression of the lymphocyte homing marker CD62L were investigated by fluorescence-activated cell sorting. In chyle, CD3+CD45RA+ T cells were significantly increased compared to peripheral blood (PMBC: median 65.8% of CD3+; range 32.3-76.9% vs. CFMC: 90.3%; 68.6-94.4%) (p = 0.02). In chyle, changes of percentages of the CD45RA+ were limited to CD8-expressing T cells (CD8+CD45RA+: PBMC: 77.3%; 69.3-85.6% vs. CFMC: 93.2%; 86.3-98.5%) (p = 0.02). The CD8+CD45RA+ were mainly CD62L+ (PBMC: 59.4%; 31.6-62.0% vs. CFMC: 87.8%; 62.7-90.7%) (p = 0.02). The study gives evidence that acute chylothorax in neonates results in immunophenotypic alterations and accumulation of certain T-cell subpopulations in the pleural cavity. Although limited by small numbers of patients due to the rare manifestation of the disease, we were able to demonstrate an abundance of CD8+CD45RA+ T cells expressing CD62L in the chyle compared to peripheral blood. However, whether CD62L expression may contribute to the accumulation of CD8+CD45RA+ T cells in chyle and whether quantitative changes of these specific cells are of clinical relevance has to be determined. | 18,787,342 |
Integrated analysis of copy number alterations and loss of heterozygosity in human pancreatic cancer using a high-resolution, single nucleotide polymorphism array. | To chart molecular genetic events in pancreatic cancer. We analyzed genome-wide copy number alterations and loss of heterozygosity (LOH) in 25 established pancreatic cancer cell lines using a high-density single nucleotide polymorphism (SNP) array. We verified the data using genomic PCR and applied them to clinical samples. Twenty-six homozygous deletion regions were detected in at least 1 cell line and LOH was found at 9p, 18q, 17p, 8p, 13q, 6q, 3p, 6p, 22q, 9q and 12q with high frequency (>50%), consistent with a previous study. Moreover, we found 23 amplified regions in at least 2 cell lines, including 8 unreported loci. We then examined representative genes at the 8 amplified loci in matched pairs of pancreatic cancer and normal tissues. The amplification was detected in 1 (7.1%) to 5 (35.7%) of 14 microdissected tissue specimens. Using high-resolution SNP arrays, we studied genome-wide copy number alterations and LOH simultaneously. We identified several novel and minute genomic amplifications, which contained candidate oncogenes in human pancreatic cancers. | 18,787,345 |
Concurrent chemoradiotherapy with weekly paclitaxel in malignant cerebral glioma treatment. | Anaplastic astrocytomas (AA) and glioblastomas (GB) are the most common malignant gliomas, and despite newly developed drugs and combined treatments, they still have an adverse prognosis. Paclitaxel is a cytotoxic agent with radiosensitizing properties and exerts objective growth inhibition in glioma tumor cells. From 1998 to 2002, 61 microneurosurgically treated patients were randomized to group I (18 GB, 14 AA) which received radiotherapy and weekly paclitaxel at dose of 100 mg/m(2), and group II (21 GB, 8 AA) which received only radiotherapy as a complementary treatment. Median overall survival was 27.96 months in group I and 23.06 months in group II with no statistical difference. The 12-month survival was 81% in group I and 76% in group II. Kaplan-Meier curves of both groups did not demonstrate any difference. Analysis of each histological subgroup (AA or GB) also showed no statistical difference in the survival curves. All 427 cycles were well tolerated with no treatment-associated deaths. Chemoradiotherapy with weekly paclitaxel is safe and tolerable although there was no increase in the overall survival and 12-month survival of malignant glioma patients. Further investigations modulating the paclitaxel entrance and delivery into the brain should be encouraged. | 18,787,350 |
Long-term survival of a patient with small cell lung cancer after nine lines of chemotherapy and radiation. | Small cell lung cancer (SCLC) results in death within 1-2 months if left untreated. Although therapeutic standards only comprise first- and second-line chemotherapy due to poor prognosis, a subset of patients may warrant a trial of further chemotherapy, as demonstrated in the following case. We present a 52-year-old man with confirmed anaplastic SCLC who survived 10 years while receiving 9 lines of chemotherapy including high-dose chemotherapy. Thoracic radiation, afterloading and radionuclide therapy supplemented the therapeutic management. Remarkably, he had two very long remission periods following topotecan. This case indicates that frequently repeated chemotherapy beyond second-line treatment in a subset of patients with limited-disease SCLC may result in long-term survival, even without ever achieving a complete remission. Close surveillance of responsiveness and appropriate in-time cytostatic treatment is proposed in the management of patients with SCLC who remain in good performance. | 18,787,355 |
Primary amelanotic melanoma of the vagina. | Primary malignant melanoma of the vagina is extremely rare, accounting for 0.3-0.8% of all malignant melanomas. True amelanotic vaginal melanoma showing no melanin on histological examination is exceedingly rare, accounting for only 2% of all vaginal melanomas. We describe a 31-year-old female patient who presented with locally advanced amelanotic melanoma of the vagina, with no evidence of metastatic spread on the computerized tomography (CT) scan, but who was subsequently diagnosed as suffering from metastatic disease by positron emission tomography (PET)-CT performed a few weeks following posterior pelvic exenteration. Specific immunohistochemical staining with melanoma markers should be performed to confirm or exclude a diagnosis of amelanotic melanoma in all patients presenting with a vaginal mass composed of undifferentiated epithelioid malignant cells. Fluorodeoxyglucose (FDG)-PET-CT should be performed as part of the preoperative evaluation, to identify the presence or absence of metastatic disease in all patients with vaginal melanoma. | 18,787,356 |
Cannabis-induced psychotic-like experiences are predicted by high schizotypy. Confirmation of preliminary results in a large cohort. | Cannabis use has been identified as a possible risk factor for developing schizophrenia. In a previous paper we reported preliminary evidence that cannabis use increases the likelihood of psychosis-like experiences in non-clinical respondents who scored highly on a measure of schizotypy. We now present findings from pooled data from 3 new follow-up studies comprising a sample of 477 respondents, of whom 332 reported using cannabis at least once. As in our previous study, the psychological effects of cannabis were assessed with the Cannabis Experiences Questionnaire, from which 3 subscales can be derived; encompassing pleasurable experiences, psychosis-like experiences and after-effects. The respondents also completed the brief Schizotypal Personality Questionnaire. Cannabis use was reported by 70% of the sample. Use per se was not significantly related to schizotypy. However, high scoring schizotypes were more likely to report both psychosis-like experiences and unpleasant after-effects associated with cannabis use. The pleasurable effects of cannabis use were not related to schizotypy. Exploratory factor analysis of the pooled data from this study and our previous report (providing a sample of >400 cannabis users) suggested a 3-factor solution. These were characterised as a psychotic-dysphoric index (factor 1), an expansive index (factor 2) and an intoxicated index (factor 3). Schizotypy was highly correlated with factors 1 and 3, though not with factor 2. High scoring schizotypes who use cannabis are more likely to experience psychotic-dysphoric phenomena and intoxicating effects during and after use. Our results confirm and expand the findings reported in our previous study. They are consistent with the hypothesis that cannabis use may be a risk factor for full psychosis in this group. | 18,787,359 |
Reference values for neonatal thyroid volumes in a moderately iodine-deficient area. | The reference ranges of thyroid volumes in neonates vary according to the iodine status of a specific region. In different studies, it ranged between 0.47 and 1.62 ml. It has been previously shown that Bursa city was a moderately iodine-deficient area. We therefore aimed at determining normal reference ranges of neonatal thyroid volumes in our moderately iodine-deficient area. In this cross-sectional study, thyroid volumes of 100 healthy fullterm neonates (51 boys and 49 girls; mean gestational age 38.9+/-1.1 weeks; and mean birth-weight 3370+/-446 g) were measured during the first week of life using thyroid ultrasonography. These data were compared with the gestational age, birth weight, gender, and TSH values of neonates as well as with maternal factors such as gestational diabetes, preeclampsia, smoking, medication use, and heart disease. All blood samples for TSH were taken during the first 5 days (mean 1.09+/-0.9 days). The mean TSH levels in all male and female neonates were 3.77+/-3.71, 4.57+/-3.61, and 2.93+/-3.66 mIU/l, respectively. This difference was statistically significant (p=0.006). Mean thyroid volumes for all male and female neonates were calculated as 0.82+/-0.18 (range 0.51-2.04), 0.84+/-0.21 (range 0.51-2.04), and 0.80+/-0.14 ml (range 0.58-1.30), respectively. There were no statistically significant differences in thyroid volumes with respect to gestational age, birth weight, gender, TSH values of neonates and maternal factors. Normal thyroid volumes in neonates vary between different regions. Local reference values should be used in thyroid volume assessment. Our results are in concordance with the literature and can be used as reference values for our region. | 18,787,384 |
The fold recognition of CP2 transcription factors gives new insights into the function and evolution of tumor suppressor protein p53. | The CP2 transcription factor (TFCP2) is a critical regulator of erythroid gene expression. Apart from the involvement in the transcriptional switch of globin gene promoters it activates an array of cellular and viral gene promoters. A number of homologous proteins was identified in genomes of Metazoa, with additional five homologues encoded by the human genome (TFCP2L1, UBP1, GRHL1, GRHL2, GRHL3). Although several experimental studies have already been published, the knowledge on the molecular mechanism of activity of this transcription factors remains very limited. Here we present the application of fold recognition and protein structure prediction in drafting the structure-to-function relationship of the CP2 family. The employed procedure clearly shows that the family adopts a DNA binding immunoglobulin fold homologous to the p53 (TP53) core domain, and a novel type of ubiquitin-like domain and a sterile alpha motif (SAM) form oligomerization modules. With a traceable evolution of CP2 family throughout the Metazoa group this protein family is highly likely to represent an ancestor of the critical cell cycle regulator p53. Based on this observation several functional hypotheses on structure-to-function relationship of p53 were drawn. The DNA motif recognized by p53 is a result of further specialization of the CP2 DNA-binding module. The analysis also shows the critical role of protein oligomerization for the function of this protein superfamily. Finally, the identification of distant homologs of TP53 allowed performing a phylogenetic footprinting analysis explaining the role of the specific amino acids important for both - the protein folding and the binding of DNA. | 18,787,404 |
Stromal SPARC expression and patient survival after chemoradiation for non-resectable pancreatic adenocarcinoma. | Pancreatic stellate cells (PSC) drive desmoplasia in pancreatic cancer. Our study analyzed both tumor and PSC, since interaction of these cell types may promote tumor progression. SPARC was expressed predominantly in the peritumoral and distal stroma. SPARC in distal stroma correlated inversely with overall survival of the patients with LAPC (p = 0.013) with a relative hazard of 2.23 (95% CI, 1.05 to 4.72; p = 0.036). TGFbeta1 in the tumor was also a negative prognostic factor (p = 0.03). Within the tumor cells, phospho-Akt correlated with TGFbeta1, SPARC and survivin. Tumor phospho-Akt correlated with stroma phospho-Akt, tumor TGFbeta1 correlated with stroma TGFbeta1 and alpha-SMA, tumor survivin correlated with stroma survivin and distal SPARC. Within the stroma, SPARC and TGFbeta1 correlated with alpha-SMA. Peritumoral SPARC correlated with distal SPARC. In vitro, SPARC was highly expressed in hPSC but not in Panc-1 cells. Exogenous SPARC did not change radiation resistance but increased the invasion of Panc-1 cells both in monoculture and in coculture with hPSC. Immunohistochemical expression of SPARC, CTGF, TGFbeta1, phospho-Akt, survivin and alpha-SMA was analyzed prior to chemoradiation in 58 locally advanced pancreatic cancer (LAPC) biopsy specimens. Fisher's exact test served to detect associations between tumor and PSC expression of markers. Kaplan-Meier analysis and multivariate analysis were used to evaluate the association of marker expression with overall survival. SPARC expression was analyzed in human pancreatic cancer cells (Panc-1) and in human PSC (hPSC) and the effect of SPARC on the invasion of Panc-1 cells was measured in monoculture or in coculture with hPSC. Our hypothesis of a detrimental effect of PSC on patient survival in LAPC after chemoradiation is supported by the inverse correlation of SPARC in distal stromal cells with patients survival. Furthermore in vitro data indicate that paracrine SPARC from PSC increases the invasion of pancreatic cancer cells. | 18,787,407 |
Emerging functions of c-kit and its ligand stem cell factor in dendritic cells: regulators of T cell differentiation. | The receptor tyrosine kinase, c-kit, and its ligand, stem cell factor (SCF), function in a diverse range of biological functions. The role of c-kit in the maintenance and survival of hematopoietic stem cells and of mast cells is well recognized. c-kit also plays an important role in melanogenesis, erythropoiesis and spermatogenesis. Recent work from our laboratory highlights an important role of c-kit in the regulation of expression of two molecules in dendritic cells (DCs), interleukin-6 (IL-6) and Jagged-2 (a ligand of Notch), which are known to regulate T helper cell differentiation. Our study shows that induction of c-kit expression and its signaling in DCs promotes Th2 and Th17 responses but not Th1 response. c-kit inhibition by imatinib mesylate (Gleevec) in DCs was previously shown to promote natural killer cell activation which may be due to dampening of IL-6 production by the DCs. Since dysregulation of c-kit function has been associated with various disease states including cancer, in this perspective we have focused on known and novel functions of c-kit to include molecules such as IL-6 and Notch that were not previously recognized to be within the purview of c-kit biology. We have also reviewed the differential expression pattern of SCF and c-kit on various cell types and its variation during development or pathology. The recognition of previously unappreciated roles for c-kit will provide better insights into its function within and beyond the immune system and pave the way for developing better therapeutic strategies. | 18,787,413 |
Comedo-ductal carcinoma in situ: A paradoxical role for programmed cell death. | Comedo-DCIS is a histologic subtype of preinvasive breast neoplasia that is characterized by prominent apoptotic cell death and has greater malignant potential than other DCIS subtypes. We investigated the mechanisms of apoptosis in comedo-DCIS and its role in conversion of comedo-DCIS to invasive cancer. Clinical comedo-DCIS excisions and the MCF10DCIS.com human breast cancer model which produces lesions resembling comedo-DCIS were analyzed. Apoptotic luminal and myoepithelial cells were identified by TUNEL and reactivity to cleaved PARP antibody and cell death assessed by Western blotting, Mitocapture and immunohistochemical assays. MCF10DCIS.com cells undergo spontaneous apoptosis in vitro, both in monolayers and multicellular spheroids; it is associated with increased mitochondrial membrane permeability, increase in Bax/Bcl-2 ratio and occurs via caspase-9-dependent p53-independent pathway. This suggests that apoptosis is stromal-independent and that the cells are programmed to undergo apoptosis. Immunostaining with cleaved PARP antibody showed that myoepithelial apoptosis occurs before lesions progress to comedo-DCIS in both clinical comedo-DCIS and in vivo MCF10DCIS.com lesions. Intense staining for MMP-2, MMP-3, MMP-9 and MMP-11 was observed in the stroma and epithelia of solid DCIS lesions prior to conversion to comedo-DCIS in clinical and MCF10DCIS.com lesions. Gelatin zymography showed higher MMP-2 levels in lysates and conditioned media of MCF10DCIS. com cells undergoing apoptosis. These data suggest that signals arising from the outside (microenvironmental) and inside (internal genetic alterations) of the duct act in concert to trigger apoptosis of myoepithelial and luminal epithelial cells. Our findings implicate spontaneous apoptosis in both the etiology and progression of comedo-DCIS. It is possible that spontaneous apoptosis facilitates elimination of cells thus permitting expansion and malignant transformation of cancer cells that are resistant to spontaneous apoptosis. | 18,787,417 |
Immuno-localization of CD44 and osteopontin in developing human kidney. | CD44 is observed in ureteric bud structures and is implicated in branching morphogenesis during early mouse renal development. Healthy adult kidney demonstrates minimal CD44, but CD44 is up-regulated in renal diseases. CD44 may mediate binding of calcium oxalate crystals to tubular epithelia via the ligands osteopontin (OPN) and hyaluronan. Because 15% of premature infants develop nephrocalcinosis, developmental tubular CD44 expression might promote nephrocalcinosis. We studied CD44 and OPN immuno-localization in developing human kidney by immunohistochemical analysis. Human renal tissue between 18 and 40 wk of gestation showed CD44 immuno-localization in ureteric buds, with staining decreasing with increasing gestational age; CD44 was rarely observed in developing renal tubules. OPN was diffusely observed in proximal tubules, rarely observed in distal tubules, ureteric buds or metanephric structures. These data support the role of CD44 in early human nephron formation and branching morphogenesis. Rare CD44 staining in developing tubular epithelium suggests no role for CD44 in promoting calcium oxalate adherence to tubular epithelia in premature infants. Immuno-localization of OPN in tubules supports its role in tubular differentiation, but OPN does not seem to be necessary during early nephron formation. | 18,787,423 |
Can outcome prediction data change patient outcomes and organizational outcomes? | Intensive care medicine consumes a high share of healthcare costs, and there is growing pressure to use the scarce resources efficiently. Accordingly, organizational issues and quality management have become an important focus of interest in recent years. Here, we will review current concepts of how outcome data can be used to identify areas requiring action. Using recently established models of outcome assessment, wide variability between individual ICUs is found, both with respect to outcome and resource use. Such variability implies that there are large differences in patient care processes not only within the ICU but also in pre-ICU and post-ICU care. Indeed, measures to improve the patient process in the ICU (including care of the critically ill, patient safety, and management of the ICU) have been presented in a number of recently published papers. Outcome assessment models provide an important framework for benchmarking. They may help the individual ICU to spot appropriate fields of action, plan and initiate quality improvement projects, and monitor the consequences of such activity. | 18,787,442 |
Update on ventricular assist device management in the ICU. | Mechanical circulatory support has a progressively increasing impact in the treatment of heart failure. The results of mechanical circulatory support are limited not only by the severity of the disease, which necessitated initiation of support, but also by the serious device-related adverse events. Optimized patient selection, improved patient management, and advanced device technology are interdependent key factors that contributed to the recently improved outcomes. The aim of this article is to summarize the current experience in application of mechanical circulatory support, focusing on the ICU management. Management should aim to prevent rather than treat serious complications and adverse events. Timing of intervention, optimization of the preimplantation patient status, patient and device management to ensure optimal hemodynamics, infection prevention, nutritional support, careful anticoagulation, and vigilance for early recognition and prompt treatment of 'minor' events before progression into major complications are essential elements of successful treatment. Critical patient care is a valuable adjunct to successful application of mechanical circulatory support, but it cannot counterbalance a late intervention, neither can it be fruitful in treating irreversible organ damage. Current management includes careful application of treatment protocols adjusted to recent experience, and also individualized care by a specialized team. | 18,787,451 |
CARD15 gene polymorphisms in Serbian patients with Crohn's disease: genotype-phenotype analysis. | Genetic heterogeneity and incomplete phenotype penetrance complicate genetic analysis of Crohn's disease (CD). Studies in western Europe have shown that CARD15 polymorphisms increase susceptibility to CD, but frequencies vary within different European populations. The aim here was to evaluate the prevalence of CARD15 mutations and their phenotypic correlation in a Serbian population. 131 patients with CD, 65 patients with ulcerative colitis, and 88 healthy controls were genotyped for three common mutations (R702W, G908R, Leu1007insC) by PCR-restriction fragment length polymorphism. chi and Student's t-test were used for statistical assessment. At least one CARD15 disease-associated allele was found in 35.11% patients with CD, 14.77% of healthy controls (P=0.001), and 7.69% patients with ulcerative colitis (P=0.0001). The L1007fs mutation showed a significant association with CD (P<0.0001). The frequency of R702W mutant allele was almost equal in the control group and CD patients Univariate analyses established that CARD15 carriers had a significantly higher risk of isolated ileal location [P=0.042; odds ratio (OR) 2.30; 95% confidence interval (CI): 1.02-5.19], fibrostenotic behavior (P<0.0001; OR 9.86; 95% CI: 4.29-22.62), surgical resection (P=0.036; OR 2.2; CI, 1.046-4.626), and earlier onset of disease (P=0.026). This study confirms that CARD15 carriers, especially L1007fs mutants, in central Europeans have an increased risk of CD and it is associated with earlier onset, ileal, fibrostenotic disease and a higher risk of surgery. Any influence of latitude is not matched by an east-west divide on the genotype frequency and phenotype of CD within Europe. | 18,787,464 |
The sentinel node technique is useful for studies of intestinal immunology in inflammatory bowel disease patients. | Mesenteric lymph nodes may play a crucial role in the pathogenesis of human inflammatory bowel disease. We have used the sentinel node technique to analyze mesenteric lymph nodes draining inflammatory lesions sentinel nodes and corresponding site of inflamed bowel in patients with ulcerative colitis or Crohn's disease. Thirty-two patients undergoing surgical treatment of inflammatory bowel disease were included. Sentinel nodes were identified intraoperatively. The T cells were harvested from the mesenteric lymph nodes and characterized by flow cytometry. The distribution of CD4CD62L (homing-marked) and CD4CD69 (activated) T cells was studied in mesenteric lymph nodes draining inflammation, nodes draining normal intestine, blood, and mucosa. The turnover of T cells was markedly increased in the lymph nodes connected to inflammatory segments. The immunologic activity of the sentinel lymph nodes correlated with the degree of intestinal inflammation. Mesenteric sentinel nodes provide important information about locoregional immunology and pathogenesis in inflammatory bowel disease. | 18,787,465 |
Assessment of 'nucleation time' as a predictor of cholelithiasis. | In the formation of gallstones, crystal nucleation is a key step, which is followed by precipitation and gradual growth of cholesterol crystals. A case-control study was carried out among 60 patients (30 patients, 14 males and 16 females, median age of 36 years, range 33-71 years, body mass index (BMI)=25.1+/-0.33 kg/m, who underwent laparoscopic cholecystectomy; 30 control individuals, 15 males and 15 females, median age of 38 years, range 33-70 years, BMI=24.5+/-0.23 kg/m, who underwent laparotomy and who had normal ultrasound scans of the gallbladder and no demonstrable stones). Bile aspirated from the common bile duct was ultrafiltered and anaerobically incubated at 37 degrees C. Incubated bile was examined daily by polarized light microscopy, for appearance of cholesterol crystals. Nucleation time (NT) of bile was assessed as the time taken for the first crystals to appear under polarized light microscopy. Age and BMI of control individuals were not different to those of cases studied. The overall mean NT was significantly shorter in patients versus controls (mean NT+/-SEM: patients, 1.76+/-0.2 days; vs. controls, 12.74+/-0.4 days, P=0.001). Of control individuals, females demonstrated a shorter NT compared with males (mean NT+/-SEM: females, 11.4+/-0.36 days; vs. males, 14.1+/-0.46 days, P=0.006). In contrast, there was no sex difference in NT in patients (mean NT+/-SEM: females, 1.7+/-0.24 days; vs. males, 1.8+/-0.2 days, P=0.7). NT in control individuals without gallstones was significantly prolonged compared with the NT in patients with established gallstone disease. Among the control individuals, females had a significantly shorter NT than males. Hence, the assessment of NT is predictor of cholelithiasis. | 18,787,471 |
Muscle and nerve responses after different intervals of electrical stimulation sessions on denervated rat muscle. | Electrical stimulation is a procedure used to treat denervated muscles. The number of electrical stimulation sessions varies across muscle rehabilitation protocols, from daily to certain days throughout the week. The purpose of this study was to evaluate how muscle and nerve respond to different intervals of electrical stimulation applied to denervated muscle. Denervation of rat gastrocnemius muscle was imposed via nerve crush, and electrical stimulation was applied to the muscle either daily (Monday through Friday) or on alternate days (Monday, Wednesday, and Friday). Four experimental groups were studied: denervated, denervated plus daily electrical stimulation, denervated plus alternate-day electrical stimulation, and control. On the 12th day after nerve crush, levels of MyoD, myostatin, and atrogin-1 gene expression, as well as muscle fiber and nerve morphometry, were evaluated. Expression levels of all three genes were higher in the denervated group when compared with control. Also, expression levels of MyoD and myostatin were higher in denervated plus alternate-day electrical stimulation and denervated plus daily electrical stimulation groups when compared with denervated. The denervated plus daily electrical stimulation group had lower atrogin-1 expression, lower density of intramuscular connective tissue, and better morphometric nerve characteristics when compared with the denervated and denervated plus alternate-day electrical stimulation. These results indicate that the responses of both muscle and nerve to electrical stimulation after muscle denervation depend on the intervals of electrical stimulation application. | 18,787,495 |
Laparoscopic adrenalectomy. | Laparoscopic adrenalectomy (LA) is the gold standard for the surgical management of small and medium adrenal masses. Nevertheless, there is still controversy for the laparoscopic treatment of adrenal carcinoma. The aim of this article was to report current standards on LA. The data for this review were obtained by a PubMed search of the English and Spanish available literature. The search was conducted with the term ''laparoscopic adrenalectomy''. Information identified was reviewed and the reference list of the identified articles was searched for further manuscripts. Experience with the procedure and technical nuances coined by the senior authors is also reflected in the manuscript. Even when available evidence in the literature is low for LA, it has become the standard of treatment for adrenal masses especially in benign lesions. The accurate preoperatory work-up and imaging remain cornerstone elements in surgical therapeutical decisions. The most employed surgical technique for LA is the lateral transabdominal, but novel approaches have been developed to treat surgically adrenal diseases and an objective evaluation of outcomes is awaited. Laparoscopic treatment of adrenal primary malignancy and metastases is still controversial although clear indications for laparoscopy in these cases are bounded to surgical experience. LA has definitively replaced open surgery in the surgical management of adrenal tumors < or = 12 cm, because of its advantages in terms of morbidity and recovery. Large and malignant tumors should be carefully approached by experienced laparoscopic surgeons. | 18,787,512 |
The effects of a 6-month sodium restriction on cardiac autonomic function in patients with mild to moderate essential hypertension. | The blood pressure-lowering mechanism of low-sodium diet is not fully understood. We assessed the effects of salt restriction on cardiac parasympathetic function as measured by heart-rate variability (HRV) in mild to moderate hypertensive patients. Eighty patients were randomized to a 6-month low- (N = 40) or normal (N = 40) sodium diet and a 24-h electrocardiogram (ECG) was carried out in the beginning of the study and at 6 months. Five time-domain and six frequency-domain HRV variables were analyzed: mean RR interval, standard deviation of normal RR intervals, mean of the standard deviations of all RR intervals for 5-min segments of the entire recording, percentage of differences between adjacent normal RR intervals exceeding 50 ms, square root of the mean of squared differences between adjacent normal RR intervals, total (0.01-0.40 Hz), high frequency (HF, 0.15-0.40 Hz), low frequency (LF, 0.04-0.15 Hz), very LF (0.01-0.04 Hz) and LF/HF ratio. Although blood pressure diminished significantly (systolic blood pressure (SBP) from 149.9 +/- 14.7 mm Hg to 130.3 +/- 11.8 mm Hg, P < 0.001 and diastolic blood pressure (DBP) from 98.0 +/- 6.4 mm Hg to 87.1 +/- 6.2 mm Hg, P <0.001) after 6 months in the salt reduction group, no significant differences in the change between the groups could be detected. A moderate, prolonged dietary sodium restriction does not alter HRV. Therefore, mechanisms other than cardiac autonomic mechanisms are likely to predominate in the blood pressure-lowering effect of salt restriction. | 18,787,516 |
Balancing early market access to new drugs with the need for benefit/risk data: a mounting dilemma. | Drug regulatory agencies are increasingly pressed by the challenge of finding the appropriate balance between the need for rapid access to new drugs and the need to ensure comprehensive data on their benefits and risks. This dilemma is not new, but has been made more prominent by recent high-profile drug withdrawals and conflicting demands, including the need to improve the efficiency of drug development on one hand, and the need to avoid exposing patients to unnecessary risks or possibly ineffective treatments on the other. Here, we summarize the current demands by stakeholders and the scientific and regulatory issues at stake, describe existing and emerging regulatory approaches, and speculate on future directions, such as evolution of the current regulatory model from a one-off marketing authorization to a life-cycle approach. | 18,787,530 |
[Elderly patients with chronic pain]. | Chronic pain is a serious and frequent health problem in elderly people. We have assessed main characteristics of chronic pain in elderly patients referred to a Norwegian multidisciplinary pain clinic. Medical records were assessed for patients with chronic pain who were at least 60 years old (n = 48) and treated at the Pain clinic, Haukeland University hospital in 2004. Pain was assessed in relation to sociodemographic, somatic and psychosocial factors. Pain in the lower extremities and various types of back pain were most frequently reported. Somatic and psychiatric comorbidity (including sleep disturbances) was prevalent. The results confirm findings from a number of studies on main characteristics of chronic pain conditions in the elderly. It is important that regular general practitioners emphasize psychosocial factors when assessing and treating chronic pain in the elderly. | 18,787,596 |
Cerebral ventricular volume and temperamental difficulties in infancy. The Generation R Study. | Numerous studies have provided evidence for subtle deviations in brain morphology in children with psychiatric disorders, but much less is known about the onset and developmental trajectory of these deviations early in life. We sought to determine whether variances in cerebral ventricular size in fetuses and newborns are associated with temperamental difficulties in infants. Within a population-based cohort study, we measured the size of the lateral ventricle of the fetus' brain twice during pregnancy. We used 3-dimensional cranial ultrasound to measure the cerebral ventricular volume of infants at age 6 weeks. We then related the size of the cerebral ventricular system to temperamental dimensions at age 3 months using the Mother and Baby Scales, and at age 6 months using the Infant Behavior Questionnaire for a total of 1028 infants. The size of the lateral ventricle of the fetuses in midpregnancy was not related to temperamental difficulties in infants; however, smaller lateral ventricles in late pregnancy were associated with higher activity levels at the age of 6 months. Infants with smaller ventricular volumes at age 6 weeks experienced higher activity levels, more anger or irritability and poorer orienting later in infancy. Children with the lowest ventricular volumes scored on average 0.15 (95% confidence interval 0.06-0.23, p = 0.001) points higher (23%) on activity levels than children with the highest ventricular volumes. Variations in ventricular size before and shortly after birth are associated with temperamental difficulties. Some of the morphologic differences between children with and without psychiatric disorders may develop very early in life. | 18,787,659 |
Top-down analysis of temporal hierarchy in biochemical reaction networks. | The study of dynamic functions of large-scale biological networks has intensified in recent years. A critical component in developing an understanding of such dynamics involves the study of their hierarchical organization. We investigate the temporal hierarchy in biochemical reaction networks focusing on: (1) the elucidation of the existence of "pools" (i.e., aggregate variables) formed from component concentrations and (2) the determination of their composition and interactions over different time scales. To date the identification of such pools without prior knowledge of their composition has been a challenge. A new approach is developed for the algorithmic identification of pool formation using correlations between elements of the modal matrix that correspond to a pair of concentrations and how such correlations form over the hierarchy of time scales. The analysis elucidates a temporal hierarchy of events that range from chemical equilibration events to the formation of physiologically meaningful pools, culminating in a network-scale (dynamic) structure-(physiological) function relationship. This method is validated on a model of human red blood cell metabolism and further applied to kinetic models of yeast glycolysis and human folate metabolism, enabling the simplification of these models. The understanding of temporal hierarchy and the formation of dynamic aggregates on different time scales is foundational to the study of network dynamics and has relevance in multiple areas ranging from bacterial strain design and metabolic engineering to the understanding of disease processes in humans. | 18,787,685 |
Is mate choice in humans MHC-dependent? | In several species, including rodents and fish, it has been shown that the Major Histocompatibility Complex (MHC) influences mating preferences and, in some cases, that this may be mediated by preferences based on body odour. In humans, the picture has been less clear. Several studies have reported a tendency for humans to prefer MHC-dissimilar mates, a sexual selection that would favour the production of MHC-heterozygous offspring, who would be more resistant to pathogens, but these results are unsupported by other studies. Here, we report analyses of genome-wide genotype data (from the HapMap II dataset) and HLA types in African and European American couples to test whether humans tend to choose MHC-dissimilar mates. In order to distinguish MHC-specific effects from genome-wide effects, the pattern of similarity in the MHC region is compared to the pattern in the rest of the genome. African spouses show no significant pattern of similarity/dissimilarity across the MHC region (relatedness coefficient, R = 0.015, p = 0.23), whereas across the genome, they are more similar than random pairs of individuals (genome-wide R = 0.00185, p<10(-3)). We discuss several explanations for these observations, including demographic effects. On the other hand, the sampled European American couples are significantly more MHC-dissimilar than random pairs of individuals (R = -0.043, p = 0.015), and this pattern of dissimilarity is extreme when compared to the rest of the genome, both globally (genome-wide R = -0.00016, p = 0.739) and when broken into windows having the same length and recombination rate as the MHC (only nine genomic regions exhibit a higher level of genetic dissimilarity between spouses than does the MHC). This study thus supports the hypothesis that the MHC influences mate choice in some human populations. | 18,787,687 |
Antibodies against a surface protein of Streptococcus pyogenes promote a pathological inflammatory response. | Streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes is a clinical condition with a high mortality rate despite modern intensive care. A key feature of STSS is excessive plasma leakage leading to hypovolemic hypotension, disturbed microcirculation and multiorgan failure. Previous work has identified a virulence mechanism in STSS where M1 protein of S. pyogenes forms complexes with fibrinogen that activate neutrophils to release heparin-binding protein (HBP), an inducer of vascular leakage. Here, we report a marked inter-individual difference in the response to M1 protein-induced HBP release, a difference found to be related to IgG antibodies directed against the central region of the M1 protein. To elicit massive HBP release, such antibodies need to be part of the M1 protein-fibrinogen complexes. The data add a novel aspect to bacterial pathogenesis where antibodies contribute to the severity of disease by promoting a pathologic inflammatory response. | 18,787,689 |
Acute and chronic effects of continuous positive airway pressure therapy on left ventricular systolic and diastolic function in patients with obstructive sleep apnea and congestive heart failure. | Obstructive sleep apnea (OSA) may contribute to the pathogenesis of congestive heart failure (CHF). Nocturnal continuous positive airway pressure (CPAP) therapy can alleviate OSA and may have a role in the treatment of CHF patients. To investigate the acute and chronic effects of CPAP therapy on left ventricular systolic function, diastolic function and filling pressures in CHF patients with OSA. Twelve patients with stable CHF (New York Heart Association II or III, radionuclide ejection fraction lower than 40%) underwent overnight polysomnography to detect OSA. In patients with OSA (n=7), echocardiography was performed at baseline (awake, before and during acute CPAP administration) and after 6.9+/-3.3 weeks of nocturnal CPAP therapy. Patients without OSA (n=5) did not receive CPAP therapy, but underwent a baseline and follow-up echocardiogram. In CHF patients with OSA, acute CPAP administration resulted in a decrease in stroke volume (44+/-15 mL versus 50+/-14 mL, P=0.002) and left ventricular ejection fraction ([LVEF] 34.8+/-5.0% versus 38.4+/-3.3%, P=0.006) compared with baseline, but no change in diastolic function or filling pressures (peak early diastolic mitral annular velocity [Ea]: 6.0+/-1.6 cm/s versus 6.3+/-1.6 cm/s, P not significant; peak early filling velocity to peak late filling velocity [E/A] ratio: 1.05+/-0.74 versus 1.00+/-0.67, P not significant; E/Ea ratio: 10.9+/-4.1 versus 11.3+/-4.1, P not significant). In contrast, chronic CPAP therapy resulted in a trend to an increase in stroke volume (59+/-19 mL versus 50+/-14 mL, P=0.07) and a significant increase in LVEF (43.4+/-4.8% versus 38.4+/-3.3%, P=0.01) compared with baseline, but no change in diastolic function or filling pressures (Ea: 6.2+/-1.2 cm/s versus 6.3+/-1.6 cm/s, P not significant; E/A ratio: 1.13+/-0.61 versus 1.00+/-0.67, P not significant; E/Ea ratio: 12.1+/-2.7 versus 11.3+/-4.1, P not significant). There was no change in left ventricular systolic function, diastolic function or filling pressures at follow-up in CHF patients without OSA. Acute CPAP administration decreased stroke volume and LVEF in stable CHF patients with OSA. In contrast, chronic CPAP therapy for seven weeks improved left ventricular systolic function, but did not affect diastolic function or filling pressures. The potential clinical implications of the discrepant effects of CPAP therapy on left ventricular systolic and diastolic function in CHF patients with OSA warrant further study. | 18,787,720 |
Second recurrence of familial cardiac myxomas in atypical locations. | Recurrence rates reported for cardiac myxomas are 4% to 7% for sporadic cases and 10% to 21% for familial cases. Although recurrence rates are high, second recurrences are rare. Familial cardiac myxomas in a mother and daughter are reported, both of whom had their second recurrences within six years. Both had recurrences in uncommon places, such as the left atrial posterior wall, between the left atrial appendage and the pulmonary vein, and the anterior mitral leaflet. | 18,787,723 |
Abdominal obesity and the metabolic syndrome: a surgeon's perspective. | Over the past decade, a major shift in the clinical risk factors in the population undergoing a cardiac surgery has been observed. In the general population, an increasing prevalence of obesity has largely contributed to the development of cardiovascular disorders. Obesity is a heterogeneous condition in which body fat distribution largely determines metabolic perturbations. Consequently, individuals characterized by increased abdominal fat deposition and the so-called metabolic syndrome (MetS) have a higher risk of developing coronary artery disease. Recent studies have also emphasized that visceral obesity is a strong risk factor for the development of heart valve diseases. In fact, individuals characterized by visceral obesity and its metabolic consequences, such as the small dense low-density lipoprotein phenotype, have a faster progression rate of aortic stenosis, which is related to increased valvular inflammation. Furthermore, the degenerative process of implanted bioprostheses is increased in subjects with the MetS and/or diabetes, suggesting that a process akin to atherosclerosis could be involved in the failure of bioprostheses. In addition to being an important risk factor for the development of cardiovascular disorders, the MetS is increasing the operative mortality risk following coronary artery bypass graft surgery. Thus, recent evidence supports visceral obesity as a global risk factor that is affecting the development of many heart disorders, and that is also impacting negatively on the results of patients undergoing surgical treatment for cardiovascular diseases. In the present paper, recent concepts surrounding the MetS and its implications in various cardiovascular disorders are reviewed along with the clinical implications. | 18,787,732 |
Clinical and microbiological characteristics of mycotic aneurysms in a medical center in southern Taiwan. | Mycotic aneurysm poses a high risk of mortality. This study evaluated the demographic and clinical characteristics and outcomes of hospitalized patients with mycotic aneurysm. Patients with mycotic aneurysm hospitalized between March 1996 and May 2006 at a medical center in southern Taiwan were retrospectively analyzed. Fifty two patients (38 men and 14 women; mean age, 64.5 +/- 15.6 years) were included. The leading underlying diseases were diabetes mellitus (40.4%), hypertension (21.2%), and renal disease and heart disease (19.2% each). The most common pathogens isolated from blood and/or resected tissue were Salmonella spp. (34.6%), Klebsiella pneumoniae (11.5%) and Staphylococcus aureus (11.5%). Mycotic aneurysms caused by Gram-negative bacilli were significantly more likely to occur in older patients (p=0.018) and at infrarenal sites (p=0.021). There were trends suggesting that mycotic aneurysms were more likely to be caused by Gram-negative bacilli in patients receiving steroid treatment and in those with underlying diabetes mellitus. Mycotic aneurysms caused by Gram-positive cocci were significantly more likely to occur in suprarenal arteries (p=0.048), especially intracranially (p=0.002), in younger patients (p=0.018) and in patients with concurrent endocarditis (p=0.008). The overall in-hospital mortality rate was 30.6%, and there was no significant difference in in-hospital mortality between mycotic aneurysms caused by Gram-negative bacilli and those due to Gram-positive cocci. The relationship between the anatomic site of mycotic aneurysm and the spectrum of culprit bacteria may help clinicians promptly choose appropriate antibiotic regimens on an empirical basis. Further study is required to understand better the role of K. pneumoniae in mycotic aneurysm in Taiwan. | 18,787,739 |
Perceived need for mental health care among non-western labour migrants. | There is a supposed higher prevalence of common mental disorders among many migrant groups. At the same time, problems are reported regarding underutilisation of mental health services by migrants. Since perceived need for care is a powerful predictor of actual care utilisation, we aimed to study the hypothesis that, given the same level of mental morbidity, non-Western migrants would perceive less need for mental health care than ethnic Dutch residents. Additionally, we studied the extent to which needs are met in both groups, as well as several possible barriers to care. A cross-sectional study with data from the 2004/2005 Amsterdam Health Monitor. Data were complete from 626 ethnic Dutch and non-Western (Turkish and Moroccan) labour migrants. Respondents participated in a structured interview in their own language, which included the perceived need for care questionnaire (PNCQ) and the composite international diagnostic interview (CIDI) version 2.1 for anxiety and depressive disorders. Perceived need was much higher among Turkish migrants. Among Moroccans the perceived need was comparable to ethnic Dutch. Turkish migrants also reported that needs were met less often than ethnic Dutch. Differences were explained by a higher prevalence of common mental disorders and higher symptom levels among Turkish. When differences in mental morbidity were taken into account, Moroccans perceived less need for information, drugs, referral to specialised mental health care, or for counselling. The most important barrier to care in all ethnic groups was the preference to solve the problem on one's own. In case of similar mental morbidity, perceived need for care was lower than among ethnic Dutch. The results did not support the hypothesis that in case of similar mental distress, needs of migrants were less often met than needs of ethnic Dutch. | 18,787,746 |
Effect of blood brain barrier permeability in recurrent high grade gliomas on the intratumoral pharmacokinetics of methotrexate: a microdialysis study. | Determining whether potentially therapeutic drug exposure is achieved within brain tumors in an exploratory clinical investigation would provide a rational basis for selecting agents for evaluation in phase II trials. This study investigated the use of microdialysis to assess intratumoral drug distribution in patients with recurrent high grade gliomas (HGG). Microdialysis catheters were placed during surgery for residual HGG 1-day before giving methotrexate (MTX) 12-g/m(2) by 4-h i.v. infusion. MTX was measured by Liquid Chromatography/Mass Spectrometry (LC/MS) in plasma and microdialysate during the infusion and for 24-h thereafter. Blood brain barrier (BBB) permeability of tissue in which the microdialysis probe was located was determined by digitally fusing brain CT and contrast enhanced MRI images. The microdialysis probe was located in contrast enhancing tumor in two patients and nonenhancing tissue in two others. Cerebral drug penetration, as indicated by the ratio of the area under the MTX concentration-time curves in brain extracellular fluid and plasma, was considerably greater in contrast enhancing tumor (0.28-0.31) than nonenhancing tissue (0.032-0.094). Nevertheless, MTX concentrations in ECF exceeded 2-microM, the average concentration for 50% cell kill against glioma cell lines in vitro, for 20-26 h in both regions of the tumor. Microdialysis is a very informative technique for characterizing the intratumoral pharmacokinetics of drugs, such as MTX, that do not freely penetrate the BBB. Establishing the catheter probe location relative to areas of BBB disruption is required to properly assess the significance of microdialysis data in this context. | 18,787,762 |
New antimicrobial drug resistance and epidemiological typing patterns of Staphylococci from clinical isolates and raw meats. | The antimicrobial susceptibilities of Staphylococcus isolated from clinical isolates and raw meats were tested for six different antimicrobial agents that are in widespread clinical use in Korea and four new antimicrobials, linezolid, quinupristin/dalfopristin, daptomycin, and tigecycline. And this study analyzed the mecA genes and genetic patterns of MRSA by performing epidemiological studies using the PCR method. 46%, 51%, and 79% of clinical isolates were identified as MRSA in 1998, 1999, and 2005, respectively, and the mecA gene was detected in 82% of these isolates. Of the 133 staphylococci isolated from raw meats, 18% of the isolates were found to be resistant to methicillin, but none of these isolates showed the presence of the mecA gene. New antimicrobials, which have rarely or not yet been used in Korean hospitals, showed high activity against all staphylococcal isolates including methicillin-resistant isolates. The randomly amplified polymorphic DNA (RAPD) patterns of MRSA isolates differed significantly between clinical isolates and raw meat isolates. | 18,787,791 |
Characterization of monolithic matrix patch system containing tulobuterol. | The aim of this study was to investigate the effect of the functional groups in acrylic adhesive on tulobuterol uptake, release rate and permeation rate across rat dorsal skin. In addition, the relationship between these parameters was identified in order to formulate the monolithic matrix patch system. Seven acrylate pressure sensitive adhesives were used in this study with three different functional groups as follows: (1) no functionality (DT-4098), (2) hydroxyl group (DT-2287, DT-2510, DT-2525, DT-2516), and (3) carboxyl group (DT-2353, DT-2852). Tulobuterol-uptake in PSA was determined by the drug-uptake method. The amount of tulobuterol-uptake in acrylic polymers with a carboxyl group was higher than those in acrylate pressure sensitive adhesives with either a hydroxyl group or a nonfunctional group. The release rate of tulobuterol from the monolithic patches was evaluated and DT-2353 and DT-2852, which contained a carboxyl group, showed lower release rates of tulobuterol than the other acrylate pressure sensitive adhesives. The skin permeation of tulobuterol was investigated using excised rat dorsal skin and the permeation rate of tulobuterol from DT-2353 and DT-2852 was also lower than the other acrylate pressure sensitive adhesives. Taking into consideration the relationship between all the parameters, pressure sensitive adhesives can be categorized into two groups: those containing a carboxylic acid functional group and those containing a non-carboxylic group. These results indicate that there was an interaction between the secondary amino group of tulobuterol and the carboxyl group of the acrylate polymer. Therefore, we suggest that a drug's chemical structure and functional groups in pressure sensitive adhesives must be considered in order to formulate a transdermal patch system. | 18,787,793 |
Analysis of acamprosate in beagle dog plasma by LC-MS-MS. | A rapid, sensitive, and specific analytical method was developed and validated to quantify acamprosate calcium in beagle dog plasma. The method employs a single plasma protein precipitation, and the analytes are separated by chromatography on an Acquity UPLC HSS T3 column and analyzed by mass spectrometry in the multiple reaction monitoring (MRM) mode. The method has a chromatographic run time of 1.25 min and a linear calibration curve over the range 200-10000 ng/mL (r(2)>0.9994). The intra-day and inter-day accuracy and precision were within 10.0% for the analyte. Acamprosate was stable during all sample storage, preparation, and analytical periods. This method was employed in a pharmacokinetic study of an acamprosate 333 mg enteric-coated tablet in 8 male beagle dogs that received single 666 mg doses (333 mg x 2 tablets). The proposed method enables identification and quantification in pharmacokinetic studies of acamprosate in beagle dog plasma. | 18,787,794 |
Protective effect of morin on the imipenem-induced nephrotoxicity in rabbits. | The present study investigated the protective effect of morin, a natural flavonoid, on the imipenem-induced nephrotoxicity in rabbits. Nephrotoxicity of imipenem was examined after the intravenous administrations of imipenem (200 mg/kg) to rabbits in the presence and the absence of morin (12, 25, 50 mg/kg, p.o.). Cytotoxicity of imipenem was also examined in the presence and the absence of morin (100 microM) by using MDCK cells overexpressing human organic anion transporter 1 and 3 (MDCK/hOAT1 or MDCK/hOAT3). Intravenous dosing of imipenem alone induced severe proximal tubular necrosis in rabbits, however, the concurrent use of morin (25 or 50 mg/kg, p.o.) significantly suppressed the histopathological damage in the kidney induced by imipenem. While imipenem was not cytotoxic in MDCK/hOAT1 cells over the tested concentrations up to 10 mM, it showed significant cellular toxicity with CC(50) of 0.77 mM in MDCK/hOAT3 cells, implying that OAT3 may involve more actively in the imipenem-induced nephrotoxicity. In addition, the cellular toxicity of imipenem decreased by approximately 20 folds in the presence of morin in MDCK/hOAT3 cells. In conclusion, the present study suggests that morin might be beneficial to reduce the nephrotoxicity of imipenem, at least in part, via the inhibition of OAT3-mediated renal excretion of imipenem. | 18,787,798 |
Angiotensin-converting enzyme D allele does not influence susceptibility to acute hypoxic respiratory failure in children. | The D allele of the I/D polymorphism in the angiotensin-converting enzyme (ACE) gene has been associated with an increased risk of ARDS in critically ill adults and severity of bronchopulmonary dysplasia in pre-term infants. We hypothesised that the presence of the hypoxia-associated ACE D allele would increase susceptibility to acute hypoxic respiratory failure (AHRF) in a cohort of critically ill children. Single-centre prospective observational cohort study. Children under 16 years of age requiring admission to a tertiary general PICU. A total of 216 Caucasian patients were enrolled. Thirty (13.9%) children developed AHRF and 13 were diagnosed with ARDS (6.0%). There was no significant difference in ACE D allele frequency between patient groups with or without AHRF (0.53 vs. 0.54). Variation in ACE activity does not influence the development of paediatric AHRF. This may reflect a different pathogenesis from adult ARDS. | 18,787,808 |
Plasmablastic lymphoma: CNS involvement, coexistence of other malignancies, possible viral etiology, and dismal outcome. | The clinical and pathological findings of plasmablastic lymphoma (PBL) have been described in the literature but the etiology is not well established, and treatment options are poorly defined. We reviewed patients with PBL in our institution to characterize the clinicopathologic features in our patient population. In this retrospective analysis from a single academic institution, five patients with PBL were identified and analyzed. Human immunodeficiency virus and human herpesvirus 8 (HHV-8) were identified in 40% (two out of five) and 80% (four out of five) of these patients, respectively. Central nervous system (CNS) involvement was identified in four out of five (80%) patients. Interestingly, three out of five patients had a concurrent or preceding second primary malignancy including small lymphocytic lymphoma, endometrial cancer, and nonsmall cell lung cancer. Most of the patients had advanced disease and a poor performance status at diagnosis. Only two of the patients received systemic chemotherapy with an initial partial response. All five patients died; the median overall survival was 1 month. Our experience in patients with PBL indicates that CNS involvement is more common than reported in the literature. Coexistence of a second primary malignancy may be frequent, and prognosis remains dismal with standard lymphoma therapy. Lastly, the role of HHV-8 in the etiopathogenesis needs further trials. | 18,787,825 |
Nonlinear simulations of solid tumor growth using a mixture model: invasion and branching. | We develop a thermodynamically consistent mixture model for avascular solid tumor growth which takes into account the effects of cell-to-cell adhesion, and taxis inducing chemical and molecular species. The mixture model is well-posed and the governing equations are of Cahn-Hilliard type. When there are only two phases, our asymptotic analysis shows that earlier single-phase models may be recovered as limiting cases of a two-phase model. To solve the governing equations, we develop a numerical algorithm based on an adaptive Cartesian block-structured mesh refinement scheme. A centered-difference approximation is used for the space discretization so that the scheme is second order accurate in space. An implicit discretization in time is used which results in nonlinear equations at implicit time levels. We further employ a gradient stable discretization scheme so that the nonlinear equations are solvable for very large time steps. To solve those equations we use a nonlinear multilevel/multigrid method which is of an optimal order O(N) where N is the number of grid points. Spherically symmetric and fully two dimensional nonlinear numerical simulations are performed. We investigate tumor evolution in nutrient-rich and nutrient-poor tissues. A number of important results have been uncovered. For example, we demonstrate that the tumor may suffer from taxis-driven fingering instabilities which are most dramatic when cell proliferation is low, as predicted by linear stability theory. This is also observed in experiments. This work shows that taxis may play a role in tumor invasion and that when nutrient plays the role of a chemoattractant, the diffusional instability is exacerbated by nutrient gradients. Accordingly, we believe this model is capable of describing complex invasive patterns observed in experiments. | 18,787,827 |
Multiscale agent-based cancer modeling. | Agent-based modeling (ABM) is an in silico technique that is being used in a variety of research areas such as in social sciences, economics and increasingly in biomedicine as an interdisciplinary tool to study the dynamics of complex systems. Here, we describe its applicability to integrative tumor biology research by introducing a multi-scale tumor modeling platform that understands brain cancer as a complex dynamic biosystem. We summarize significant findings of this work, and discuss both challenges and future directions for ABM in the field of cancer research. | 18,787,828 |
Implantation of retropupillar iris claw lenses with and without combined penetrating keratoplasty. | For aphakic patients without lens-supporting apparatus, secondary lens implantation can be considered. Literature on retropupillar iris claw lens implantation as a safe alternative to scleral fixated posterior chamber lenses is scarce. The study included 22 patients. In ten cases, an iris claw lens was implanted retropupillary without penetrating keratoplasty (group 1), in 12 patients the implantation of a retropupillar iris claw lens was combined with penetrating keratoplasty (group 2). Complications observed were retrospectively evaluated. Previous operations and accompanying diseases were compiled. Reasons for aphakia in group 1/group 2 included perioperative complications (60%/75%) and primary ocular trauma (40%/25%). Unless already performed in an earlier operation, anterior or complete vitrectomy was performed in both groups. Perioperative complications (within 1 week postoperatively) in group 1 included ocular hypotony in 20%, choroidal detachment in 10%, vitreous haemorrhage in 10% and intraocular lens (IOL) decentration in 10% of the cases; in group 2, transient intraocular pressure elevation in 8% of the cases. Postoperative complications (after the first postoperative week) in group 1 were lens tilt in 10%, lens luxation in 10%, cellular deposits (assumed to be macrophages) on lens surface in 10%, cornea guttata in 10% and epiretinal gliosis in 10% of the cases; in group 2, secondary glaucoma in 33%, iris defect in 8% and corneal ulcer in 8% of the cases. Retropupillar iris claw lenses are an alternative to scleral fixated secondary lenses, which are worth considering for aphakic patients without lens supporting apparatus. This approach appears to be recommendable even in cases requiring penetrating keratoplasty, and can be performed as a combined procedure. In these patients, the most frequent complication following iris claw lens implantation seems to be secondary glaucoma. | 18,787,833 |
[Health protection from an ethical point of view]. | Illness and health are terms open to interpretation. Their meaning depends on cultural backgrounds, societal designations and historical change. During the modern era, having been shaped by natural sciences, knowledge in medicine has grown exponentially. However, critical voices warn of a medicalization of the image of humanity or an "absolutization" of health. They emphasize that limits must be set to medical progress. In return it has to be highlighted that contemporary medicine has opened up new chances of therapy, prevention and palliative treatment (pain relief), which could not be applied previously. As a result, it is the responsibility of medicine to make available the highest possible measure of progress to patients. The medical profession is confronted with the task of supporting patients in their right to self-determination and their decision competence. For the individual human being, health is a fundamental good. Therefore, each human individual has the right to health protection and medical care which correspond to the latest medical knowledge available. By now, this right has been acknowledged by human rights conventions and numerous legal documents. From an ethical point of view, health protection has to be interpreted as 1) the right to defense, 2) the right to claim and 3) the patient's right to participate. It falls to medical ethics to substantiate the meaning of health protection for the different spheres of medical activity. | 18,787,857 |
Effect of tiotropium on cough reflex sensitivity in acute viral cough. | Cough is the most common complaint for which patients in the United States seek medical attention. Few, if any, effective therapies exist for the most common form of acute cough, that due to viral upper respiratory tract infection (URI). The aim of this study was to evaluate the effect of the anticholinergic agent tiotropium bromide on cough reflex sensitivity in subjects with acute viral URI. Otherwise healthy adult nonsmokers with acute viral URI were randomized to receive inhaled tiotropium, 18 microg once daily, or matched placebo, for 7 days. A control group of healthy volunteers underwent an identical protocol. Cough reflex sensitivity to inhaled capsaicin was measured at baseline (Day 0), and 1 h after the first (Day 1) and seventh (Day 7) dose of tiotropium or placebo. Concentrations of capsaicin inducing two or more (C (2)) and five or more coughs (C (5)) were determined. In subjects with URI, tiotropium (n = 11) demonstrated inhibition of cough reflex sensitivity relative to baseline (increased log C (2) [p = 0.004] and log C (5) [p = 0.0004]) after the first dose. No change occurred in the placebo group (n = 10). After 7 days, mean log C (2) was significantly increased in the tiotropium group relative to placebo (p = 0.03). Although FEF(25-75) was also increased in the tiotropium group (p = 0.016), there was no significant correlation between changes in cough reflex sensitivity and FEF(25-75). Tiotropium had no effect in healthy volunteers (n = 24). Tiotropium inhibits cough reflex sensitivity to capsaicin in subjects with acute viral URI. The antitussive effect of tiotropium may occur through a mechanism other than bronchodilation. | 18,787,899 |
Tracheobronchopathia osteochondroplastica: a rare large airway disorder. | Tracheobronchopathia osteochondroplastica (TO) is a rare disorder of the large airways characterized by the development of submucosal cartilaginous and bony nodules. The nodules involve the anterior and lateral walls and typically spare the posterior membranous wall. The clinical presentation of TO is variable and ranges from incidental diagnosis in asymptomatic patients during workup or management for unrelated medical problems, to devastating disease with central airway obstruction. Bronchoscopy remains the gold standard for diagnosing this condition. Radiographic studies play an important role in suggesting the diagnosis of TO and in the follow-up of this condition. The treatment of TO is usually symptomatic. with emphasis on the management and prevention of recurrent respiratory infections. Bronchoscopic or surgical treatment is usually reserved for symptomatic patients with severe airway narrowing and airflow obstruction. | 18,787,900 |
Missed opportunities in diabetes management: a longitudinal assessment of factors associated with sub-optimal quality. | In diabetic adults, tight control of risk factors reduces complications. To determine whether failure to make visits, monitor risk factors, or intensify therapy affects control of blood pressure, glucose, and lipids. A non-concurrent, prospective study of data from electronic files and standardized abstraction of hard-copy medical records for the period 1/1/1999-12/31/2001. Three hundred eighty-three adults with diabetes managed in an academically affiliated managed care program. Main exposure variable: Intensification of therapy or failure to intensify, reckoned on a quarterly basis. Hemoglobin A1c (A1c), systolic blood pressure (SBP), and LDL-cholesterol at the end of the interval. In this visit-adherent cohort, control of glycemia and lipids showed improvement over 24 months, but many patients did not achieve targets. Only those with the worst blood pressure control (SBP >or=160 mmHg) showed any improvement over 2 years. Failure to intensify treatment in patients who kept visits was the single strongest predictor of sub-optimal control. Compared to their counterparts with no failures of intensification, patients with failures in >or=3 quarters showed markedly worse control of blood glucose (A1c 1.4% higher: 95% CI: 0.7, 2.1); hypertension (SBP 22.2 mmHg higher: 95% CI: 16.6, 27.9) and LDL cholesterol (LDL 43.7 mg/dl higher: 95% CI: 24.1, 63.3). These relationships were strong, graded, and independent of socio-demographic factors, baseline risk factor values, and co-morbidities. Failure to intensify therapy leads to suboptimal control, even with adequate visits and monitoring. Interventions designed to promote appropriate intensification should enhance diabetes care in primary practice. | 18,787,908 |
From "us vs. them" to "shared risk": can animals help link environmental factors to human health? | Linking human health risk to environmental factors can be a challenge for clinicians, public health departments, and environmental health researchers. While it is possible that nonhuman animal species could help identify and mitigate such linkages, the fields of animal and human health remain far apart, and the prevailing human health attitude toward disease events in animals is an "us vs. them" paradigm that considers the degree of threat that animals themselves pose to humans. An alternative would be the development of the concepts of animals as models for environmentally induced disease, as well as potential "sentinels" providing early warning of both noninfectious and infectious hazards in the environment. For such concepts to truly develop, critical knowledge gaps need to be addressed using a "shared risk" paradigm based on the comparative biology of environment-host interactions in different species. | 18,787,924 |
Pharmacodynamic evaluation of oral estradiol nanoparticles in estrogen deficient (ovariectomized) high-fat diet induced hyperlipidemic rat model. | It is believed that estrogen deficiency contributes importantly to the pathogenesis of menopausal metabolic syndrome and symptoms can be ameliorated with estradiol therapy. The present study reports efficacy of 17-beta estradiol encapsulated nanoparticles in treating the postmenopausal dyslipidemic condition. Estradiol encapsulated poly(lactide-co-glycolide) (PLGA) nanoparticles were prepared by emulsion-diffusion-evaporation method and evaluated in estrogen deficient (ovariectomized) high fat diet induced hyperlipidemic rat model. The results obtained showed that estradiol nanoparticles were equally/more effective in treatment of estrogen deficient hyperlipidemic conditions at three times reduced dose and frequency in comparison to that of drug suspension administered orally. Together, these results demonstrate the ability of nanoparticles in improving oral bioavailability/efficacy of estradiol. | 18,787,933 |
Do faces capture the attention of individuals with Williams syndrome or autism? Evidence from tracking eye movements. | The neuro-developmental disorders of Williams syndrome (WS) and autism can reveal key components of social cognition. Eye-tracking techniques were applied in two tasks exploring attention to pictures containing faces. Images were (i) scrambled pictures containing faces or (ii) pictures of scenes with embedded faces. Compared to individuals who were developing typically, participants with WS and autism showed atypicalities of gaze behaviour. Individuals with WS showed prolonged face gaze across tasks, relating to the typical WS social phenotype. Participants with autism exhibited reduced face gaze, linking to a lack of interest in socially relevant information. The findings are interpreted in terms of wider issues regarding socio-cognition and attention mechanisms. | 18,787,936 |
Factors influencing long-term follow-up clinic attendance among survivors of childhood cancer. | Attendance at long-term follow-up clinic is necessary for survivors of childhood cancer to facilitate education about cancer-related health risks, early detection of treatment-related morbidity, and implementation of health-promoting interventions. Despite the need for continued care, barriers to clinic attendance exist. The purpose of this prospective study was to identify the demographic, medical, and logistic factors impacting clinic attendance and long-term follow-up care among survivors of childhood cancer. Adherence to clinic attendance was monitored among 941 long-term childhood cancer survivors scheduled for evaluation. Patients were classified as "attenders" or "non-attenders" based on the outcome of their first scheduled clinic appointment over a one year period. Social work staff contacted non-attenders by telephone to determine reasons for missed appointments. Nearly 15% of survivors were classified as non-attenders. Univariate findings revealed that older age, lower SES, being non-white, less medically insured, traveling by car, living shorter distance from clinic, having a scheduled social work consultation, and entering or exiting survivorship clinic were associated with clinic non-attendance (all p values < 0.05). The final multivariate model indicated that non-whites (OR = 1.88, 95% CI = 1.19-2.97), patients without insurance (OR = 2.36, 95% CI = 1.98-3.79), those traveling by car (OR = 12.74, 95% CI = 3.97-40.86), and those who have not experienced secondary cancer events (OR = 1.76, 95% CI = 0.94-3.28) were more likely to be non-attenders. Work or school conflicts were the primary reasons cited for missed appointments. Despite mechanisms designed to reduce financial burdens associated with attending survivorship clinic at our institution, demographic, medical, and logistic barriers exist which impact participation in long-term follow-up. IMPLICATIONS FOR CANCER SURVIVORS AND PROVIDERS: These results highlight the importance of developing tailored outreach strategies for survivors of childhood cancer at-risk for clinic non-attendance, particularly among underserved populations. | 18,787,958 |
Reversal of Brugada electrocardiographic pattern with sodium bicarbonate solution after amitriptyline overdose. | A Brugada electrocardiographic pattern (BEP) associated with tricyclic antidepressant (TCA) overdose has been reported rarely, but its reversal by sodium bicarbonate has not been described previously. We reported a case of amitriptyline overdose induced Type 1 BEP which was reversed by 150 mEq of intravenous sodium bicarbonate. | 18,788,005 |
Functional consequences of retinopetal fibers originating in the dorsal raphe nucleus. | The existence of centrifugal fibers projecting into the mammalian retina is well known. However, their precise physiological role is poorly understood. Here we report that stimulation of the dorsal raphe nucleus (DRN) in freely moving rats produces profound effects on the electroretinogram (ERG). Most notably, activation of the dorsal raphe-retinal pathway causes a significant decrease in the latency of the b-wave and accompanying oscillatory potentials. In addition, dorsal raphe stimulation leads to a significant increase in the amplitude of oscillatory potentials. These results, therefore, provide the first demonstration of a functional role for the retinopetal fiber system originating in the and suggest that this structure can exert a powerful influence over the temporal sharpness and efficacy of retinal responsiveness. | 18,788,023 |
Verbal working memory dysfunction in schizophrenia: an FMRI investigation. | Impaired processing of working memory information is one of the cognitive deficits seen in patients with schizophrenia. This study aims at corroborating the differences in the brain activities involved in the process of working memory between patients with schizophrenia and the controls. Twelve patients with schizophrenia and 11 controls participated in the study. Functional magnetic resonance imaging (fMRI) was used to assess cortical activities during the performance of a two-back verbal working memory paradigm using the Korean alphabet as mnemonic content. Group analysis revealed that inferior fontal, middle frontal, and superior temporal region showed decreased cortical activities in the patient group compared to those of the controls. This study showed a decreased activation in inferior fontal (BA 47), middle frontal (BA 6), and superior temporal (BA 22/38) neural networks from the patient group and confirmed the earlier findings on the impaired working memory of schizophrenic patients in the fMRI investigation. | 18,788,030 |
Volumizing effect of a new hyaluronic acid sub-dermal facial filler: a retrospective analysis based on 102 cases. | Many signs of aging are due to the loss of subcutaneous fat. Dermal fillers are non-surgical cosmetic treatments used to restore facial volume. Voluma is a new hyaluronic acid sub-dermal facial filler. The objective of this study was to assess its effectiveness in maintaining increased volume for up to 18 months post-treatment and its safety. Retrospective record analysis was made for 102 patients (93 females, nine males; mean age: 51.27 years) who received Voluma injected into the midface. All patients were assessed at baseline and at 1 month and 6-18 months post-injection. Investigator Global Aesthetic Improvement assessment after 1 month and 6-18 months showed that most patients were 'much' or 'very much' improved. Investigator volume loss assessment confirmed that most patients were either stage 1 or 2 (normal or slight ptosis) 1 month post-treatment, which was maintained at 6-18 months. Patient efficacy assessment was 'very good' or 'good' in most cases. Voluma provides aesthetic improvements according to investigator and patient assessment for up to 18 months post-treatment. Combination treatment comprising facial fillers and botulinum neurotoxin can enhance treatment benefits. Further methodologically rigorous studies are required to establish the performance of Voluma alone and in combination. | 18,788,032 |
Treatment with aspirin and dipyridamole is more effective than aspirin in reducing low shear blood viscosity. | Investigate effects of aspirin/dipyridamole and aspirin on blood viscosity (BV) in subjects with hyperhomocystememia (>14 micromol/L) and stable cardiovascular disease (CVD) or >or= 20% risk for CVD were the aims of this study. Forty-seven subjects were treated with 14 days of either aspirin/dipyridamole (25 mg/200 mg twice-daily) or aspirin (81 mg daily). BV was measured from fasting specimens at 37 degrees C from whole blood at shear rates ranging from 1,000 to 1s(-1) by using a scanning capillary viscometer (Rheolog; Rheologics Inc., Exton, Pennsylvania, USA). Aspirin/dipyridamole was more effective than aspirin therapy in reducing BV at shear rates of 1 s(-1) (-3.03 [-3.88, -2.17] mPas vs. -0.07 [-1.06, 0.92] mPas; P<0.0001) and 2 s(-1) (-1.86 [-2.72, -1.01] mPas vs. -0.21 [-1.20, 0.79] mPas; P=0.0136); however, there were no significant differences in blood viscosity at shear rates of 5 s(-1) to 1000 s(-1). Changes in hematocrit, a major determinant of whole BV, were greater in the aspirin/dipyridamole group than the aspirin group (P=0.043). After hematocrit adjustment, differences in BV between aspirin/dipyridamole and aspirin remained significant at 1s(-1) (-2.78 [-3.68, -1.88] mPas vs. -0.04 [-1.05, 0.98] mPas; P<0.0001) and 2 s(-1) (-1.62 [-2.52, -0.72] mPas vs. -0.17 [-1.19, 0.85] mPas; P=0.0315). These findings may have important clinical benefits in the CVD prevention and treatment due to the contribution of BV in tissue perfusion and thrombus formation. | 18,788,038 |
Synthesis of simple adenosine diphosphate ribose analogues. | [See figures]. The synthesis of analogues of adenosine diphosphate ribose and acetylated adenosine diphosphate ribose, modified at the northern pentose, is reported. The stereochemistry at the acetylated centers was chosen to minimize acetyl migration and dictated the overall synthetic strategy. | 18,788,043 |
Extraocular muscle cysticercosis: clinical features and management outcome. | Extraocular muscle cysticercosis is rare and can be classified based on the stage of evolution as viable, degenerating, and inactive. A tailored approach to therapy using a combination of albendazole and steroids has been proposed. In this study, we have evaluated the clinical features and response of "viable" extraocular muscle cysticercosis to a tailored therapy with oral albendazole and steroids. A retrospective review of 32 patients with viable extraocular muscle cysticercosis was performed over a 3-year period. Ultrasound examination was performed at 3 weeks and 6 weeks for resolution of the cyst and clinical signs following treatment with oral albendazole and prednisolone. The clinical presentation, ocular alignment, motility restriction, and ultrasound examination details were recorded on serial visits. The mean age was 19.5 years. The most common presenting signs included limitation of ocular motility in 75%, conjunctival mass in 37.5%, diplopia in 28.1%, and proptosis in 28.1% of the patients, respectively. Ocular alignment evaluation revealed esotropia in 3.1%, exotropia in 12.5%, and hypertropia in 6.25%. Restriction of abduction and abduction in elevation was present in two patients each. The average time for complete resolution was 65.9 days. All the patients had resolution, except four, who had residual motility limitation but were asymptomatic. Combination therapy with oral albendazole and steroids is effective in the management of viable extraocular muscle cysticercosis. However, residual motility restriction may persist despite treatment. | 18,788,057 |
Application of negative ion MS/MS to the identification of N-glycans released from carcinoembryonic antigen cell adhesion molecule 1 (CEACAM1). | Structures of N-glycans released from rat CEACAM1 expressed in human embryonic kidney cells were determined by MALDI and negative ion nanospray MS/MS techniques. The major carbohydrates were bi-, tri- and tetra-antennary complex glycans with and without sialic acid, fucose and bisecting GlcNAc residues. High-mannose glycans, predominantly Man(5)GlcNAc(2), were also found. The negative ion fragmentation technique easily identified the branching pattern of the triantennary glycans (mainly branched on the 6-antenna) and the presence of 'bisecting' GlcNAc residues (attached to the 4-position of the core mannose), features that are difficult to determine by traditional techniques. Sialic acids were in both alpha2-3 and alpha2-6 linkage as determined by MALDI-TOF MS following linkage-specific derivatization. | 18,788,072 |
Mechanisms and sequelae of E-cadherin silencing in hereditary diffuse gastric cancer. | Around 25-40% of cases of hereditary diffuse gastric cancer (HDGC) are caused by heterozygous E-cadherin (CDH1) germline mutations. The mechanisms for loss of the second allele still remain unclear. The aims of this study were to elucidate mechanisms for somatic inactivation of the wild-type CDH1 allele and to seek evidence for cadherin switching. Archival tumour material was analysed from 16 patients with CDH1 germline mutations and seven patients fulfilling HDGC criteria without CDH1 germline mutations. The 16 CDH1 exons were sequenced. E-cadherin promoter methylation was analysed by bisulphite sequencing and pyrosequencing and allele specificity was determined using polymorphic loci. Loss of heterozygosity was analysed using microsatellite markers. Cadherin expression levels were determined by real-time RT-PCR and immunohistochemistry. Six of 16 individuals with germline mutations had at least one second hit mechanism. Two exonic mutations (exon 9 truncating, exon 3 missense) and four intronic mutations which may affect splicing were identified. Tumours from 4/16 individuals had promoter hypermethylation that was restricted to the A allele haplotype in three cases. E-cadherin loss (mRNA and protein) generally correlated with identification of a second hit. In cases without germline E-cadherin mutations there was no evidence for somatic mutation or significant promoter methylation. P-cadherin (>25% cells) was expressed in 7/13 (54%) and 4/5 (80%) with and without germline CDH1 mutations, respectively, independent of complete E-cadherin loss. Overall, inactivation of the second CDH1 allele occurs by mutation and methylation events. Methylation is commonly allele-specific and is uncommon without germline mutations. P-cadherin over-expression commonly occurs in individuals with diffuse type gastric cancer. | 18,788,075 |
Analysis of Hispanic representation and conceptualization in psychology and law research. | Hispanics are now the largest minority group in the United States, yet research examining the impact this will have on the American legal system is limited. The first purpose of this article was to synthesize the studies that have been conducted, which have found that Hispanics have a perspective toward the police, the courts and the law, and jury decision making that is unique from those of Caucasians and other ethnic groups. The second purpose of this article was to analyze whether psychology and law research has been conducted in a manner conducive to identifying this unique Hispanic perspective. An analysis of 800 articles published in five psychology and law journals revealed that, while Hispanics were typically conceptualized properly, the proportion of articles devoted to the Hispanic perspective is disturbingly low. To increase understanding of the Hispanic perspective, psychology and law researchers must increase the amount of empirical attention given to Hispanics. | 18,788,079 |
Amyloidosis and diabetes in humans. | The relationship between amyloidosis and diabetes mellitus has been investigated with special regard to the islets of Langerhans. Little information is available in the literature about the relationship between diabetes mellitus and extrainsular amyloidosis. New data on the nature of amyloid and particularly its separation into two groups called "APUD-" and "Immunoamyloid" has induced us to reconsider the whole problem. The aim of this review is a reconstruction of the problem also on the basis of our experience. | 18,788,149 |
Immunohistochemical study of secretory component, secretory IgA and carcinoembryonic antigen in large bowel carcinomas. | The epithelium of 41 large bowel carcinomas was scored immunohistochemically on a semiquantitative basis for the presence of secretory component (SC), secretory IgA, and carcinoembryonic antigen (CEA). Both the tumour and the adjacent "transitional mucosa" were evaluated. The various immunofluorescence scores obtained, the histological grades of the tumours, their Dukes' stages, and the plasma CEA levels were subjected to non-parametric correlation analyses. Tumour SC was positively correlated with histological tumour grade and inversely related to Dukes' stage. Tumour secretory IgA generally showed a pattern similar to that of SC. Tumour CEA showed no correlation with any of the other parameters. The contents of SC and secretory IgA in the transitional mucosa were negatively correlated with Dukes' stage and plasma CEA. Whether the variations observed in the epithelial cell markers reflected primary events in the malignant development or secondary alterations is unknown. Nevertheless, especially the amount of tumour SC may turn out to be of prognostic value. | 18,788,158 |
Hemangioendothelioma of the thyroid gland--true endothelioma or anaplastic carcinoma? | After a critical histological re-examination of 26 cases of malignant hemangioendothelioma of the thyroid, and a comparison with 51 cases of anaplastic spindle and giant cell carcinoma, it becomes obvious that traumatic and shrinkage artefacts due to fixation, as well as superimposition of neoplastic and repair processes due to regressive changes--almost always seen in malignant hemangioendothelioma associated nodular goiter--may be misinterpreted as neoplastic vascular spaces (and therefore angioblastic tumour differentiation). Focal epithelial arrangements of tumour cells often observed in these malignant hemangioendotheliomas and the lack of objective light microscopic differential diagnostic criteria of anaplastic spindle and giant cell carcinoma make the high incidence of endotheliomas of the thyroid in European endemic goiter regions very questionable. Compared with anaplastic spindle and giant cell carcinoma, the incidence for (1) extrathyroid tumours that infiltrate into the trachea or the oesophagus, (2) lymph node metastases and (3) distant metastases is not statistically different in malignant hemangioendothelioma. Therefore we conclude that the tumours classified as malignant hemangioendothelioma in goitrous areas represent a special growth pattern of anaplastic spindle and giant cell carcinoma within adenomatous glands rather than a distinct tumour type. | 18,788,166 |
Sarcoma botryoides of the extrahepatic bile ducts. A light- and electron microscopic study of a case. | The clinical, light- and electron microscopic features of a sarcoma botryoides of the common bile duct of a 2 1/2-year-old boy are reported. Despite the absence of cross-striation under the light microscope, many tumour cells were found to contain abundant thin and thick filaments arranged in a sarcomere-like pattern at the electron-microscopic examination of originally paraffin-embedded material. Ultrastructural examination of embryonal rhabdomyosarcoma may be of value for a definite diagnosis also when only formalin-fixed and paraffin-embedded material is available. | 18,788,169 |
Public-private collaboration to improve oral health status of children enrolled in Head Start in New York City. | A comprehensive oral health care program for Head Start children in New York City is described. Head Start is a federally funded pre-school program for low-income families and their children. It provides activities that help children grow mentally, socially, emotionally and physically. In 1994, a public-private partnership was created between New York Administration for Children's Services and New York University College of Dentistry. The program consists of periodic visits to different Head Start centers by a dental team composed of pediatric dentists, residents, hygienists and students. At the center, the team provides diagnostic and preventive services to children and oral health education to children, parents and staff. Referrals are then made to the College of Dentistry or to a community provider for treatment and follow-up. Free transportation is provided between Head Start centers and the college clinic. Over 13 years, 25,000 children have received diagnostic, preventive and treatment services. | 18,788,178 |
Ixodid ticks on dogs belonging to people in rural communities and villages in Maputo Province, Mozambique. | The species composition and geographic distribution of ixodid ticks infesting domestic dogs owned by people in rural communities and villages in Maputo Province was established by collecting ticks from dogs at each of 27 localities spread throughout the province. Ticks were collected from a total of 132 dogs, and nine species belonging to four genera were identified. One dog was infested with six species, three with five and 13 with four species. Haemaphysalis elliptica followed by Rhipicephalus simus were present on dogs at most localities, and their geographic distribution in Maputo Province has been mapped for the first time. | 18,788,203 |
Acute and long-term effects of exposure to sodium monofluoroacetate (1080) in sheep. | Acute and long-term effects of a single, relatively high oral dose (0.25 and 0.30 mg/kg) of sodium monofluoroacetate (1080) on the survival and productivity of sheep were evaluated to establish a better understanding of 1080 poisoning and identify more specific changes diagnostic of toxicosis. In survivors, clinical signs of acute 1080 toxicosis such as salivation and lethargy were generally very mild. Fasted animals were more prone to 1080 toxicity. In animals that died, more severe signs, including tachypnoea, dyspnoea, and tremors occurred for 15-20 min prior to death. 1080 concentrations were highest in the blood > heart > skeletal muscle > liver. 1080 could not be detected in any of these organs of the animals that survived. Serum citrate concentrations were elevated for 4 days after dosing. No clinical or biochemical abnormalities were found in any animal after 4 days. Histopathological lesions were most marked in the heart and lung with inflammation, necrosis, and scattered foci of fibrous tissue in the myocardium, pulmonary oedema and inflammation of the lung. No adverse long-term effects on general health or reproductive performance were observed in any sheep that survived the first 4 days following exposure to 1080. The most reliable diagnostic indicators of 1080 exposure in sheep were measurement of its residues in blood, skeletal muscle and ruminal contents, increased serum citrate concentration, elevated heart rate, and characteristic electrocardiograph changes (up to 4 days after exposure). Death from 1080 is most likely to occur within 96 h, and animals that survived this period appeared normal. | 18,788,206 |
Clinical evaluation of the Admiral 1.35m2 hollow-fibre membrane oxygenator. | This prospective study was designed to evaluate the fundamental clinical performance of a new, small surface area oxygenator. Data were collected from twenty patients undergoing first-time coronary artery bypass grafting using this device. This study focuses on how the reduction of surface area and prime volume affects the essential function of the oxygenator in terms of oxygenation efficiency, heat transference, membrane pressure drops, haemolysis and safety. Oxygenation efficiency was deemed to be well within acceptable margins, even at high flows, over a temperature range of 32-36 degrees C. Heat-exchanger performance was assessed by recording the heater/chiller water temperature compared to retrospective data from a current standard oxygenator. Heater/ chiller water temperatures were on average 0.3 degrees C higher with the small surface oxygenator than the standard data. The air handling of the device was excellent and extremely safe. Haemolysis, measured as plasma free haemoglobin, did not increase during bypass (p > 0.05). This new oxygenator offers a reduced surface area and priming volume while still ensuring an acceptable safety reserve and performance. | 18,788,215 |
A clinical evaluation of the Dideco Kids D100 neonatal oxygenator. | In August 2006, Duke University Perfusion Services had the opportunity to be the first institution in the United States to clinically evaluate the Dideco D100 Neonatal Oxygenator. The device was used on six pediatric patients to facilitate correction or palliation of their cardiac defects, which included two arterial switch operations, two truncus arteriosus repairs, one stage 1 Norwood and one repair of total anomalous pulmonary venous return. The average patient weight was 3.1 kg. The average cardiopulmonary bypass (CPB) time was 135 minutes and the average cross-clamp time was 61 minutes. Arterial and venous blood gasses were drawn and used to calculate oxygen transfer. The average oxygen transfer was 14.8 +/- 10.3 ml/O2/min. The Dideco D100 Oxygenator is the first oxygenation device designed specifically for neonates. The Dideco D100 is a microporous hollow-fiber device. It has a static priming volume of 31 ml and a maximum rated flow of 700 ml/min. The integral hard-shell venous reservoir has a minimum operating level of 10 ml and a reservoir capacity of 500 ml. For this evaluation, the Dideco Kids D100 Neonatal Oxygenator performed adequately on patients weighing up to 5 kg. This device provides an excellent first step towards offering very small children appropriate circuitry without having to sacrifice safety or performance. | 18,788,216 |
Direct effects of volatile anesthetics on cardiac function. | The volatile anesthetics are a class of general anesthetic drugs used by the perfusionist during cardiopulmonary bypass (CPB). These agents are used in low doses in combination with other anesthetics to produce complete anesthesia. During CPB, these agents are capable of safely anesthetizing the paitent. It is well understood that these anesthetics act at the level of the central nervous system. However the intent of this study was to define the effects of isoflurane and sevoflurane on left ventricular function. C57BL/6 female mice were anesthetized with either isoflurane or sevoflurane at concentrations ranging from 0.5 to 5%. The cardiac function was assessed with transthoracic echocardiography (TTE). Sevoflurane caused a reduction of left ventricular function at lower concentrations compared with isoflurane. At concentrations of 2% and greater, sevoflurane significantly reduced cardiac output, ejection fraction, fractional shortening, and increased end-diastolic and end-systolic volumes. Isoflurane-induced reduction of left ventricular function was much less in magnitude when compared with sevoflurane. These data underscore the importance of using lower concentrations of volatile anesthetics during CPB especially during periods of cardiac recovery after aortic cross-clamp removal. | 18,788,217 |
Reduction of blood coagulation and monocyte-platelet interaction following the use of a minimal extracorporeal circulation system (Synergy) in coronary artery bypass grafting (CABG). | Cardiovascular surgery with cardiopulmonary bypass (CPB) induces activation of blood coagulation and systemic inflammation involved in post-operative complications. Our study evaluated the impact of the minimal extracorporeal circulation (mini-CPB) system (Synergy, Sorin Group) on these functional aspects. Twenty patients were randomly assigned to standard CPB (n = 10) or to Synergy (n = 10). Platelet expression of PAC-1, and monocyte/granulocyte-platelet conjugates were evaluated by flow cytometry. A leukocyte-platelet adhesion index was calculated after cell number normalization. ELISAs were performed to measure IL-6 and TNF-alpha, thrombin-antithrombin III complexes (TAT), prothrombin fragments (F1+2), beta-thromboglobulin (beta-TG) and sP-selectin (sCD62P). Blood samples were drawn at the time of anesthesia (T1), at the end of CPB (T2), and at 4 (T3) and 24 hours (T4) after weaning from CPB. All patients were similar for clinical characteristics. When compared to standard CPB, the Synergy showed lower levels of the monocyte-platelet adhesion index at T2 (0.023 +/- 0.005 vs 0.063 +/- 0.013, P = 0.0092) and T4 (0.031 +/- 0.003 vs 0.055 +/- 0.005, P = 0.0017), TAT complexes at T2 (27.175 +/- 5.967 vs 86.592 +/- 5.415, P = 0.0005) and T3 (26.977 +/- 2.468 vs 45.146 +/- 4.365, P = 0.0041), F1+2 fragments at T2 (2.222 +/- 0.226 vs 4.249 +/- 0.292, P = 0.0009), and sP-selectin at T3 (115.17 +/- 19.623 vs 169.554 +/- 19.709, P = 0.0703) and T4 (108.542 +/- 6.429 vs 140.799 +/- 14.771, P = 0.0833). In summary, the Synergy exhibited a lower post-operative activation of blood coagulation, together with a reduced interaction between circulating monocytes and platelets. | 18,788,218 |
Evaluation of short and tall stature in children. | Children and adolescents whose heights and growth velocities deviate from the normal percentiles on standard growth charts present a special challenge to physicians. Height that is less than the 3rd percentile or greater than the 97th percentile is deemed short or tall stature, respectively. A growth velocity outside the 25th to 75th percentile range may be considered abnormal. Serial height measurements over time documented on a growth chart are key in identifying abnormal growth. Short or tall stature is usually caused by variants of a normal growth pattern, although some patients may have serious underlying pathologies. A comprehensive history and physical examination can help differentiate abnormal growth patterns from normal variants and identify specific dysmorphic features of genetic syndromes. History and physical examination findings should guide laboratory testing. | 18,788,236 |
Genital mycoplasma infections among women in an urban community of northern Nigeria: do we need to search for them? | To determine the incidence of genital Mycoplasma infection among females in Jos. High vaginal swab (HVS) and or Endocervical swab (ECS) samples were obtained from 476 females undergoing vaginal examinations along with other females who volunteered to enroll in the study Samples were processed using standard laboratory procedures for the isolation of Mycoplasma species while information such as age, marital status, occupation and other clinical data were obtained using a questionnaire. The results obtained were analysed using SPSS 11.0 statistical methods and P values = or < 0.05 were considered significant. The overall incidence of genital Mycoplasma infection was found to be 29.6% (n=141); M. hominis, 12.1% (n=57); U. urealyticum 9.4% (n=45); mixed infection, 6.7% (n=32), and other Mycoplasmas, 1.4% (n= 7). Majority of the isolates were from those aged 20-35 years old (most sexually active group); 83% (n=52) of those who presented with vaginal discharge were infected with Mycoplasma spp. (P< 0.05); also, the incidence of infection among the separated/divorce/widowed group was significantly higher than the married group (P<0.05). Mycoplasmas are common genital organisms, hence should be sought out for from ECS probably on routine basis for suspected genital tract infections. | 18,788,259 |
Hepatitis B vaccination status and needle stick injuries among medical students in a Nigerian university. | Hepatits B virus (HBV) is the most common blood borne pathogen that poses an occupational risk to Health-care workers. The incidence of infection following needle stick injury has been reported to be high among medical students. Effective vaccines against HBV are available. The aim of this study was to determine the vaccination status and prevalence of needlestick injury among medical students in a tertiary institution in a developing country (Nigeria). Information regarding hepatitis B status, history of needlestick injury and awareness of risk factors for HBV were obtained from clinical medical students using a self administered questionnaire. Three hundred and forty six students responded. Three hundred and five (88.7%) agreed that medical education exposes one to HBV infection and 315 (91.6%) were aware of the availability of vaccine against HBV. Only 42 (47.7%) were vaccinated against HBV. Majority (57.4%) gave lack of opportunity as reason for non immunization while 34.7% had never given it a thought. One hundred and sixty-six (48%) of the respondents admitted to a previous needlestick injury and only 17 (10.2%) of those who reported history of needlestick injury had post-exposure prophylaxis against HBV infection. HBV vaccination status is very low among medical students in Nigeria and the prevalence of needle stick injuries is high. Universities must not only provide HBV vaccination free of charge but also enforce its use by these students. | 18,788,262 |
Radiation protection practices of staff during extra-corporeal shock wave lithotripsy at Okada, Nigeria. | The study was designed to find out the radiation protection practices of radiologists and other staff involved in the first extra-corporeal shock wave lithotripsy in Nigeria, performed at Igbinedion Hospital and Medical Research Centre, Okada. Some members of staff who were present when the extra-corporeal shock wave lithotripsy (ESWL) was used in the hospital at Okada were interviewed between November 2002 and August 2003. Radiology records of the hospital were studied. Literature search involved available publication on the procedure in local and international journals with interest in precautions to reducing radiation exposure. Only lead apron and lead gloves were used by the radiologists for radiation protection and shielding during fluoroscopy procedures. The fluoroscopy was the screen type with TV monitor. Multiple sessions were used in several patients with multiple pre- and post- treatment radiographic studies including contrast studies with average of two sessions per patient. All the patients were adults aged between 26 and 65 years with mean age of 42.5 years. 627-6000 shock waves were delivered over 45-135 minutes at intensity of 143-19KV depending on patients build and the size of the stones. The sizes of the patients varied from very obese with large bulk to slim built. Radiation monitoring of the staff and patients was not done. Staff believed that radiation effect from the lithotripsy procedure was low therefore adequate radiation monitoring and radiation reducing alteration in the procedure was rarely adopted. Extended fluoroscopy time, multiple fluoroscopy examinations, multiple treatment sessions and multiple x-ray examinations which increased both the patients' and staff's radiation exposures were noted. Proper radiation protection and monitoring of patients and staff are necessary to avoid the risks from low-level exposure to radiation such as in ESWL. | 18,788,264 |
[Research and application of computer-aided technology in restoration of maxillary defect]. | This paper presents a new method of designing restoration model of maxillectomy defect through Computer aided technology. Firstly, 3D maxillectomy triangle mesh model is constructed from Helical CT data. Secondly, the triangle mesh model is transformed into initial computer-aided design (CAD) model of maxillectomy through reverse engineering software. Thirdly, the 3D virtual restoration model of maxillary defect is obtained after designing and adjusting the initial CAD model through CAD software according to the patient's practical condition. Therefore, the 3D virtual restoration can be fitted very well with the broken part of maxilla. The exported design data can be manufactured using rapid prototyping technology and foundry technology. Finally, the result proved that this method is effective and feasible. | 18,788,275 |
[Brain MRI image segmentation based on active contour model using electrostatic field method]. | A modified Snake algorithm for medical image segmentation based on improved Greedy method and electrostatic field model is presented in this paper. Based on Greedy method, this algorithm features a new adjacent point selection strategy and the corresponding criteria, which can be used for searching the potential snake points. A new external image force based on electrostatic field model and the simplified force field computation based on preprocessing image are also introduced. Comparative experiments indicate the validity of the method. | 18,788,277 |
[Estimation of brain tissue's hemoglobin oxygen saturation (SO2) of rats by artificial neural network]. | A specifically designed fiber optical spectrum system was applied to measure the hemoglobin oxygen saturation (SO2) of living rat's brain tissue. Collections of in vivo visible absorption spectrum measured by the fiber optical spectrometer at different SO2 as well as their corresponding SO2 values measured by OXImeter were made on a kind of tissue model (i. e. the mixture of Intralipid and blood) and were used as the training data of an artificial neural network (ANN) which, after being trained, can put out SO2 value correctly when an absorption spectrum was put in. The SO2 values of 5 living rats' brain tissue at different depth were obtained, and the experimental error range was +/- 5%. This method is of great significance to important value for monitoring hemoglobin oxygen saturation at various depths in brain minimally invasive surgery. | 18,788,308 |
[Current status of researches in the development of blood tissue engineering product]. | The term "blood substitutes" includes plasma substitutes and blood cell substitutes in the broad sense, but in its narrow sense, it means red blood cell (RBC) substitutes, platelet substitutes and white blood cell (WBC) substitutes. The RBC substitutes includes perfluorocarbon, hemoglobin-based and encapsuled substitutes. The hemoglobin-based substitutes which was widely researched in the world includes human hemoglobin-based, animal hemoglobin-based and gene recombined hemoglobin based substitutes. The function and immunology of WBC is very complicated, so it is rarely used in clinic. Nowadays the platelet substitutes pursued by the researches and developments includes mainly the liposome and collagenic fiber species substitutes. | 18,788,321 |
[Volume regulated anion channel and ischemia/reperfusion injury of myocardium]. | It has been shown that a lot of diseases were related with the change or loss of Cl- channel functions. Among the Cl- channels, volume-regulated anion channel (VRAC) plays important roles in myocardial ischemia/reperfusion injury, cardiac arrhythmia and apoptosis; it may become a new target in the clinical treatment of heart diseases. This paper presents an overview of the physiological characteristics of VRAC and its relations with myocardial ischemia/reperfusion injury. | 18,788,323 |
Sensitivity and specificity of depression questionnaires in a college-age sample. | The authors evaluated the sensitivity and specificity of the Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) and Center for Epidemiological Studies-Depression Scale (CESD; L. S. Radloff, 1977) questionnaires for a college-student sample. Results indicate that the BDI-II and CES-D evidenced satisfactory levels of specificity and positive predictive value for current, past-year, and lifetime depressive disorder ratings on the Diagnostic Interview Schedule-IV (American Psychiatric Association, 1994). Researchers can use the questionnaires as valid initial screens in a two-stage process designed to identify individuals meeting Diagnostic and Statistical Manual of Mental Disorders-IV (American Psychiatic Association) criteria for depressive disorders. However, if the questionnaires are the only method used to select participants, the resulting sample may include a number of false positives. | 18,788,328 |
Pilot study of manual sugarcane harvesting using biomechanical analysis. | In many countries, sugar cane harvesting is a very labor-intensive activity in which workers usually become fatigued after manually cutting the cane for a few hours. They need frequent pauses for rest, and they experience sustained injuries from excessive stress on the joints and muscles of the body. The cutting tool and motion involved directly influence the stresses created. A cutting tool that has not been designed by taking into consideration occupational biomechanics can lead to unnecessary strains in the body's muscle system, resulting in injuries. The purpose of this research was to carry out a pilot study of the impact of two common manual sugarcane cutting tools and the cutting posture they induce on the body with the aid of biomechanics. The machete and the cutlass from South Africa and Guyana, respectively, were examined to determine the cutting forces. Using static strength prediction modeling, the body stress levels at the point of cut in the cutting motion were determined. The cutting postures of three subjects were contrasted, their extreme postures were identified, and suggestions were made to improve the ergonomics of the cutting activity. The results of this pilot study showed that the cutlass required less cutting force than the machete because of the slicing cut provided by the curved blade edge of the cutlass. However, the biomechanical analysis indicated that the bent blade of the machete required less flexion of the back and therefore was likely to cause less back fatigue and injury. An improved design of the sugarcane manual harvesting tool should incorporate the bend of the machete to reduce flexion and a curved cutting edge that provides a slicing cut. | 18,788,332 |
[Sternal resection and chest wall reconstruction for primitive neuroectodermal tumor of the sternum]. | Primitive neuroectodermal tumor of the sternum is rare. A 59-year-old woman referred to our department with anterior chest pain and a tumor in the sternum. The patient was diagnosed as primitive neuroectodermal tumor of the sternum by core biopsy of the lesion. She received 2 cycles of preoperative chemotherapy with vincristine, doxorubicin, cyclophosphamide, ifosfamide, etoposide. She underwent a total sternectomy with resection of adjacent bilateral costal cartilages and sternal ends of the clavicles. The skeletal defect of chest wall was reconstructed by polypropylene mesh-resin sandwich. The myocutaneus defect was reconstructed by the pedicled latissimus dorsi myocutaneus flap and the bilateral breast flaps. The postoperative course was uneventful and adjuvant radiotherapy was started 6 weeks after the operation. She died of distant metastases 3 months after the operation, although this patient was free from local recurrence. | 18,788,370 |
[Multiple calcifying fibrous pseudotumor of the pleura]. | A newly recognized distinctive fibrous soft tissue lesion called "calcifying fibrous pseudotumor" (CFPT) was recently described in the soft tissue of the extremities, trunk, scrotum, groin, neck, or axilla. But CFPT orgining from the pleura is rare. A 44-year-old woman was admitted to our hospital for an investigation of a chest radiographic abnormality. The complete resection was performed through mini-thoracotomy utilizing video assisted thoracoscopic surgery. Microscopically, the lesion was mostly composing dense collagenous tissue and scattered calcifications. The postoperative course was uneventful and no recurrence is observed 18 months after operation. We report succsessful surgical treatment for multiple CFPTs. | 18,788,375 |
[Successful management of ruptured aortic arch aneurysm infected with methicillin-resistant Staphylococcus aureus]. | A 64-year-old woman was admitted due to back pain and dyspnea. She was suffering from fever of unknown origin for a few weeks without aortic aneurysm by enhanced chest computed tomography (CT). Chest CT taken 1 month later revealed rupture of aortic arch aneurysm. Total arch replacement was performed with in situ grafting under selective cerebral perfusion combined with deep hypothermic circulatory arrest. Rifampicin (RFP) was sprinkled on the graft at operation and omentopexy was done 5 days after the 1st operation. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated on the culture of the aneurysmal wall, therefore, polymyxin B immobilized fiber with direct hemoperfusion (PMX-DHP) was also conducted with antibiotic therapy. Her clinical course after the 2nd operation was uneventful with no infective complication. We report a successful case of ruptured aneurysm of aortic arch infected with MRSA and review our strategy as one of feasible options without using homograft or preparative RFP-bonded vascular prosthesis. | 18,788,376 |
[Successful perioperative management with non-invasive positive pressure ventilation in muscular dystrophy with thymoma; report of a case]. | We report a case of muscular dystrophy with thymoma that was detected by chance at the examination of his fatal arrhythmia. He has hypercapnea and restrictive pulmonary disfunction, but non-invasive positive pressure ventilation (NPPV) had not been introduced. Thymo-thymectomy was performed through reversed L-shaped mediansternotomy. NPPV was effective in his perioperative management. | 18,788,386 |
[Molecular pathogenesis of chronic kidney disease]. | High blood pressure, poor glycemic control, obesity, metabolic syndrome, dyslipidemia, smoking and older age are the risk factors for susceptibility to and initiation of CKD. In these conditions, systemic blood pressure can be transmitted to the glomerular capillary network because of impairment of autoregulationary mechanism existing on the afferent arteriole of glomerulus. Glomerular hypertension and endothelial dysfunction are regarded as the common mechanisms underlying in the development of CKD. Albuminuria reflects the dysregulation of glomerular hemodynamics and vascular damage. Low-grade albuminuria (below the current microalbuminuria threshold) is the independent risk factor for the development of CVD. The renin-angiotensin system(RAS), insulin resistance and increased sympathetic nerve activity are implicated in the development of glomerular hypertension and endothelial dysfunction. Endothelial dysfunction could be caused by decrease of BH4 resultant eNOS uncoupling. Endothelial dysfunction could be regarded as the common mechanisms which link CKD and cardiovascular diseases. | 18,788,393 |
[A study of surgical procedures for inverted papilloma in the nasal cavity and paranasal sinuses]. | Inverted papilloma, although benign, recurs frequently and may become malignant, making definitive initial resection extremely important. We evaluated surgical procedures for recurrence and sites, with special reference to management of the orbital plate of the ethmoid and lacrimal bones, in 24 patients (32 cases) with inverted papilloma of the nasal cavity and paranasal sinuses undergoing surgical resection from 2000. Nine of the 32 showed recurrence, all around the ethmoid orbital plate. Up to 2002, recurrence was noted in 7 of 17 cases (41%), so we changed surgical selection criteria. Since 2003, we have conducted partial and combined excision of the orbital plate of the ethmoid and lacrimal bones (extended operation of the extranasal ethmoid and frontal sinuses) in cases in which tumors adhered to the orbital plate, noting recurrences in only 2 of 15 cases (13%). A number of reports advocate endoscopic sinus surgery to minimize invasiveness for inverted papilloma, but partial and combined excision of the orbital plate is indispensable, in progressive inverted papilloma cases to reduce recurrent. | 18,788,423 |
[Clinical analysis of patients with tuberculosis admitted on an emergency cases]. | A retrospective study was made of 75 patients with tuberculosis and tuberculous pleurisy who received medical care in our hospital from 2002 through 2006. Of the 75 patients, 9 were admitted as tertiary emergency cases, and 12 patients were admitted by ambulance as secondary emergency cases. We studied the reason for their emergency medical admission, and the process of diagnosing 21 patients as tuberculosis. In some cases, the reasons for emergency admission were cardiorespiratory arrest, loss of consciousness, and injury resulting from a traffic accident, not common symptoms of tuberculosis such as dyspnea, hemoptysis and bloody sputum. Chest radiographic findings of most patients showed tuberculosis, and other cases were likely to be diagnosed as tuberculosis from their medical history or back-ground such as being homeless, previous tuberculosis, and receiving for therapy of tuberculosis. It was not so difficult to diagnose our cases as tuberculosis, nevertheless we may have an unconscious patient with normal chest radiograph. These data suggest that any patients visiting the emergency room may possibly have tuberculosis even if they are without respiratory symptoms. | 18,788,430 |
[A case of severe pulmonary hypertension associated with COPD treated with epoprostenol]. | A rare case of chronic obstructive pulmonary disease (COPD) with severe pulmonary hypertension (PH) was found in a 68-year-old man. COPD was diagnosed in his 50s, from which time he received home oxygen therapy. In January 2007, he was admitted due to progression of dyspnea. On admission to our hospital, arterial blood gas analysis showed severe hypoxemia. Moreover, echocardiographic findings demonstrated severe deviation of the interventricular septum toward the left ventricle, with right ventricular dilatation. Cardiac catheterization data demonstrated pulmonary arterial hypertension with a low cardiac output. Because severe PH is uncommon in patients with COPD and there was no apparent etiology of PH other than COPD, we thought this case was predominantly a pulmonary vascular disease such as idiopathic pulmonary arterial hypertension. Though we first treated this patient with bosentan, it was not effective. Therefore, he was treated with continuous infusion of epoprostenol. Epoprostenol administration along with bosentan resulted in decrease of BNP and right ventricular function improvement. We report a case of severe PH due to severe COPD treated with continuous administration of epoprostenol. | 18,788,437 |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.