shukoor65/lab-rag-model huggingface dataset:
Perfusion redistribution after alveolar flooding: vasoconstriction vs. vascular compression. We compared the effects of left caudal lobe (LCL) alveolar hypoxia on regional pulmonary blood flow (PBF) with the effects due to alveolar edema induced by plasma instilled directly into the LCL airways of 16 dogs. Regional measurements were made with positron emission tomography. After hypoxic ventilation of the LCL (n = 11), the LCL-to-right caudal lobe (L/R) PBF ratio fell from 0.94 +/- 0.21 during 100% oxygen ventilation of the LCL to 0.46 +/- 0.21 (P less than 0.05). After instillation of either isooncotic (n = 5) or hypooncotic plasma (n = 3) into the LCL, the L/R PBF ratio was similar to that during LCL hypoxia (0.50 +/- 0.27 and 0.64 +/- 0.10, respectively, P less than 0.05 compared with 100% oxygen ventilation of the LCL before plasma instillation). The changes in regional PBF due to LCL hypoxia and plasma instillation could be completely prevented (n = 8) by the prior administration of a single dose of endotoxin (15 micrograms/kg iv). In contrast to previous work, these results indicate that perfusion redistribution occurs regardless of the oncotic state of alveolar edema. More importantly, any change that does occur in regional PBF can be completely prevented by blocking regional vasoconstriction, indicating that mechanical compression cannot be the major factor determining the regional response of PBF to alveolar flooding.
Percutaneous transluminal coronary angioplasty utilizing prolonged balloon inflations: initial results and six-month follow-up. Coronary angioplasty (PTCA) using prolonged balloon inflation has obviated emergency coronary bypass surgery in some patients with acute occlusions at the time of PTCA. However, the use of prolonged balloon inflations has not been shown to improve long-term restenosis rates. As an alternative to the passive autoperfusion catheter, we evaluated a hemoperfusion system in which blood was obtained from the side arm of an arterial sheath and infused through the central lumen of standard balloon catheters via a modified Medrad IV pump during balloon inflation. PTCA was performed in 71 male patients (median age 57 yr). The median balloon inflation time was 4.8 minutes and the median rate of blood perfusion was 30 ml/min. PTCA was successful (lumen increase by 20 percentage points) in 83% of patients (59/71) with diameter stenosis decreasing from a median 82% to 30%. Emergency coronary bypass was required in four patients (5%). Angiographic data for six-month followup was available on 37 patients. The restenosis rate (loss of 50% of gain) was 46% (17/37). The conclusion is that prolonged balloon inflation angioplasty has a role in complicated PTCA but offers no advantage in improving long-term restenosis rates in elective PTCA.
The relation of dizziness to functional decline. OBJECTIVE: to assess the effect of dizziness on the probability that an older person will die or become functionally disabled within 2 years. Dizziness is a common symptom for which the prognosis is uncertain. This report compares the prognoses for dizzy and not-dizzy older people in order to assist clinicians who diagnose and treat these patients. DESIGN: a prospective study of a representative sample of elderly (70+) non-institutionalized Americans. Elderly subjects (n = 3,798) in the Longitudinal Study of Aging (LSOA) were asked questions about the presence of dizziness, medical conditions, and functional disability in 1984. The cohort was reinterviewed about functional disability in 1986. OUTCOME MEASURE: transition from functional ability to disability after 2 years. RESULTS: Bivariate analyses showed that dizziness predicts functional decline but not mortality. Multivariate models revealed that age, race, sensory impairment, vascular disease, and other morbidity are independent predictors of becoming disabled. Controlling for these potential confounders, dizziness does not predict an increased probability of becoming disabled. CONCLUSION: Elderly people who are dizzy should be evaluated for the presence of these related conditions.
Use of a rapid, efficient inoculation method to induce papillomas by cottontail rabbit papillomavirus DNA shows that the E7 gene is required. A simple inoculation method to induce papillomas efficiently with cottontail rabbit papillomavirus (CRPV) DNA is described. Using a jet injector, recombinant CRPV DNA is easily delivered to 100 or more sites per rabbit and induces typical epithelial papillomas in approximately 50% of those sites. Papillomas begin to form by 3 weeks and continue to develop for up to 7 weeks, a pattern similar to that reported following infection with intact virus. This system readily lends itself to investigation of viral gene function by delivering mutant viral genomes into an immunologically intact host. Two mutations in the E7 open reading frame were introduced into the complete CRPV genome and analyzed by this method. One was a frameshift mutation encoding just nine amino-terminal amino acids of the E7 protein; the other was an in-frame insertion mutation at position 9. Both E7 mutations were in a region of homology to the 300-kDa protein binding domain of adenovirus E1A protein. Neither mutant construct was able to induce papillomas, thereby demonstrating that the E7 gene participates in this biologic function. Exploitation of this approach, which demonstrates that a papillomavirus E7 gene is involved in the induction of papillomas in vivo, should permit detailed studies into molecular mechanisms involved in papilloma induction, malignant conversion, and host immune response. The high efficiency of papilloma induction with recombinant CRPV DNA suggests that the jet injector can also be used to study the biologic effects of other genetic elements in rabbits or in other species.
Complement consumption in a patient with necrobiotic xanthogranuloma and paraproteinemia. Necrobiotic xanthogranuloma and paraproteinemia have been reported to be associated with acquired deficiency of the early components of the classic pathway of complement. We describe a patient in whom activation of complement was suggested by a high level of C3d, an accelerated catabolism of C1q, and a rapid consumption of C4 after an intravenous infusion of fresh-frozen plasma. This infusion was followed by an episode of pulmonary edema. Patients with complement deficiency or depletion should be monitored closely while receiving plasma, to avoid this potential complication.
Idarubicin: a second-generation anthracycline. Because of its in vitro activity in leukemic cell lines and Phase I studies of acute leukemia, Phase II and III clinical trials with idarubicin hydrochloride were conducted in patients with acute lymphocytic leukemia or acute nonlymphocytic leukemia. In the Phase III comparative trials between the combinations of idarubicin and cytarabine and daunorubicin hydrochloride and cytarabine, the idarubicin/cytarabine combination resulted in significantly greater complete remission rates and longer overall survival in two of three studies conducted in the US. As a result, the Food and Drug Administration approved intravenous idarubicin with a Class 1A rating in September 1990 for use in combination with other antileukemic drugs (e.g., cytarabine) for the treatment of acute myelogenous leukemia in adults. The recommended dose of idarubicin is 12 mg/m2 daily for three days by slow intravenous injection in combination with cytarabine. Although idarubicin causes myelosuppression similar to that described with daunorubicin, the incidence of cardiotoxicity in animal models is lower. Idarubicin also has the advantage of oral administration, but the oral formulation of the drug remains investigational. The use of idarubicin in pediatric patients also remains to be established.
Fat-saturation MR imaging of the upper abdomen. The fat-saturation (fatsat) MR technique decreases the signal intensity of fat, thereby enhancing the definition of upper abdominal organs and reducing artifacts while maintaining the T1 and T2 information available on spin-echo sequences. To evaluate the potential of fatsat in examining the abdomen, we conducted a prospective study involving 30 subjects, including four normal volunteers, 18 patients investigated for liver disease, and eight patients studied for miscellaneous abdominal disease. Short TR, 300-600/15-20 (TR/TE), and long TR, 2000-2500/20-30, 70-80, spin-echo images with and without fatsat were compared. The images were evaluated both qualitatively and quantitatively. Qualitative assessment was made with receiver-operating-characteristic (ROC) curve analysis of the confidence level of observers to detect the presence of disease, comparing fatsat with standard spin-echo sequences. ROC analysis showed greater interpreter confidence and accuracy for fatsat sequences than for standard spin-echo sequences. The measured signal-difference-to-noise (SD/N) ratio comparing upper abdominal organs with surrounding tissue revealed the highest values for short TR/TE regular spin echo, followed by short TR/TE fatsat. The highest SD/N ratio for hepatic masses was with long TR/TE fatsat followed by short TR/TE fatsat. The results of this study suggest that the fatsat technique may improve abdominal MR imaging.
Pediatric cardiac rehabilitation. Sixteen patients participated in a Pediatric/Young Adult Cardiac Rehabilitation Program that included exercise training, education about cardiovascular diseases, dietary counseling, and counseling on stress management. Seven patients completed the program, and complete data were available on six. The subjects demonstrated significant changes in their hemodynamics and exercise tolerance after completing the program. Resting blood pressure decreased by 7%, from 119 +/- 12 to 111 +/- 10 mm Hg; peak oxygen consumption increased by 20%, from 31.9 +/- 4.3 mL/kg of body weight per minute to 38.4 +/- 6.0 mL/kg of body weight per minute; and exercise treadmill time increased by 21%, from 8.5 +/- 1.4 to 10.3 +/- 1.0 minutes. No complications occurred during exercise training or testing. Supervised exercise training at moderate intensity is safe and produces significant and beneficial changes in hemodynamics and exercise time in children with cardiac disease.
Hyperalgesia induced in the rat by the amino-terminal octapeptide of nerve growth factor. Nerve growth factor (NGF) in the mouse submandibular gland undergoes cleavage of its amino-terminal octapeptide when salivation is induced by epinephrine. The significance of this event is uncertain; cleaved NGF demonstrates bioactivity and no function has been attributed to the octapeptide produced (NGF-OP; Ser-Ser-Thr-His-Pro-Val-Phe-His). Enzyme inhibition studies indicating structural relatedness of NGF-OP and bradykinin (BK) prompted us to determine whether NGF-OP would elicit BK-like actions. We found that like BK, NGF-OP induced a decrease in mechanical nociceptive threshold (i.e., produced hyperalgesia) in the hairy skin of the rat. This effect was dose-dependent and sequence-specific; like BK it was attenuated by sympathectomy and indomethacin pretreatment. However, NGF-OP actions appeared to be distinct from those for BK in that tissue injury was required for NGF-OP to induce hyperalgesia. Furthermore, we found no evidence that NGF-OP bound to or activated BK receptors. Our data indicate that NGF-OP is a distinct mediator of hyperalgesia. We suggest that NGF-OP alters pain threshold in the injured target regions of NGF-responsive neurons.
Chinese medicinal herbs reverse macrophage suppression induced by urological tumors. Tumors are known to produce factors suppressing macrophage function. In this study we demonstrated in vitro suppression of macrophage chemiluminescent oxidative burst associated with viable cells and cell-free extracts of two urological neoplasms--murine renal cell carcinoma (Renca) and murine bladder tumor (MBT). Suppression was reversed by extracts of two Chinese medicinal herbs, Astragalus membranaceus (AM) and Ligustrum lucidum (LL). Murine macrophage cell line J774 was incubated with either the viable tumor cells or the cell-free tumor extract for 18 hours at 37C and 5% CO2. Chemiluminescent oxidative burst as an indicator of macrophage function was triggered by adding zymosan A suspension containing luminol and assayed in an automated luminometer. Photon emission over time was counted and the results were expressed as integrated photon emission. Significant dose-related depression of oxidative burst occurred with either the viable tumor cells or the cell-free tumor extracts. Depression was partially or completely reversed by the presence of 50-100 micrograms./ml. of either the AM or the LL extract. AM and LL have previously been shown to modulate immune response. Data from this study suggest that they may also exert their antitumor activity via abolition of tumor-associated macrophage suppression.
Effects of DM-9384, a cyclic derivative of GABA, on amnesia and decreases in GABAA and muscarinic receptors induced by cycloheximide. The effects of N-(2,6-dimethyl-phenyl)-2-(2-oxo-1-pyrrolidinyl)-acetamide [DM-9384], a cyclic derivative of GABA, were investigated in the cycloheximide (CXM)-induced amnesia animal model using the passive avoidance task. Pre- and post-training and pre-retention test administration of DM-9384 attenuated the CXM-induced amnesia as indicated by prolongation of step-down latency. Aniracetam, another cyclic derivative of GABA, also showed antiamnesic effects. Scopolamine, a muscarinic ACh receptor antagonist, and the GABA antagonists, picrotoxin and bicuculline, all antagonized the antiamnesic effects of DM-9384. CXM decreased the number of GABAA and muscarinic ACh receptor binding sites. DM-9384 not only inhibited this effect but actually increased the latter. These results suggest that DM-9384 attenuates CXM-induced amnesia by interacting with GA-BAergic and AChergic neuronal systems and enhancing protein synthesis in the brain.
Extracellular matrix disruption and pain after eccentric muscle action. Pain, stiffness, and indicators of muscle damage occur at different times after eccentric muscle action. After a single bout of maximal resisted lengthening of the elbow flexors, elbow position, pain perception, and indicators of cellular damage were measured. Immediately postexercise, a significant decrease in resting muscle length was observed that continued to 48 h. At this time, an increase in perceived muscle soreness was noted (P less than 0.05), and a biopsy of the biceps brachii revealed mast cell degranulation, separations of the extracellular matrix from myofibers, and increased plasma constituents in the extracellular space. It is proposed that myofiber disruption allows intracellular proteins to escape and extracellular proteins and ions to enter, causing swelling, whereas the disrupted extracellular matrix initiates the inflammatory response, which includes the release of mast cell granules seen at 48 h postexercise. Thus the delayed sensation of pain (soreness) after repeated eccentric muscle actions probably results from inflammation in response to extracellular matrix disruption.
Use of recombinant human interferon gamma to enhance neutrophil chemotactic responses in Job syndrome of hyperimmunoglobulinemia E and recurrent infections. Recombinant human interferon gamma enhances neutrophil respiratory burst and bactericidal activity in patients with chronic granulomatous disease. Mononuclear leukocytes of patients with the hyperimmunoglobulinemia E syndrome (Job syndrome) produce low or undetectable levels of this lymphokine. For these reasons we have restudied neutrophil chemotaxis in a group of our patients with the syndrome and determined the effect of recombinant human interferon gamma on the responses. Each of the patients had neutrophil chemotactic responses ranging from 22% to 55% of simultaneous control values (p less than 0.001). After incubation with interferon gamma, a significant improvement in chemotactic responsiveness was observed in the neutrophils of each of the patients (mean 301% of baseline chemotaxis; p less than 0.008). These data suggest the need for a double-blind, placebo-controlled trial of interferon gamma in a larger group of patients with the syndrome of hyperimmunoglobulinemia E and recurrent infections.
Alveolar hydatid disease of the liver: a report on thirty-nine surgical cases in eastern Anatolia, Turkey. The charts of 39 consecutive patients who underwent surgery between 1979 and 1989 with a diagnosis of alveolar hydatid disease (AHD) of the liver were reviewed. The analysis of these cases from eastern Anatolia, which is the endemic region in Turkey, was undertaken to determine the current experience for AHD lesions. Of these patients, 33 (84.6%) had unresectable disease and the remaining six patients (15.4%) were treated by hepatic resection of the primary lesion. In the unresectable cases, laparotomy with biopsy was the most commonly used surgical procedure (56.4%), followed by tube drainage of the necrotic cavity (18.0%), marsupialization (5.1%), and cystojejunostomy (5.1%). Diagnostic studies and operative findings were useful in detecting the AHD lesions. Differential diagnosis was established mainly by histopathologic examination of a biopsy specimen or resected tissue. Pulmonary metastases were seen in two cases, and mortality occurred due to brain metastases in two other cases. Mebendazole was administered postoperatively to 19 patients with indications for 1) advanced AHD, 2) adjuvant therapy to radical and palliative surgical procedures, and 3) recurrences of disease after hepatic resection. The patients were treated with daily doses of approximately 50 mg/kg for periods of one and six years (median 3.2 years). Encouraging results were obtained in 11 of nineteen patients. Five-year survival was seen in 8 of the patients with AHD in this series. There were 18 deaths (46.2%) in our 39 patients. Long-term follow-up was not possible in four cases, and 17 patients (43.6%) were still living. The causes of mortality were advanced AHD in 14 cases, brain metastases in two, and acute myocardial infarction in another two.
No excess prior cancer in patients with uveal melanoma. To determine whether there were more prior cancers in uveal melanoma patients than in a geographically matched control group, the authors compared the history of prior cancer in 407 uveal melanoma patients who lived in the western United States with that of 870 control subjects. Control subjects were selected by random digit dial and frequency-matched for age at diagnosis of patient, race, and sex. Fifty-one (12.5%) patients and 86 (9.9%) control subjects reported skin cancers whereas 25 (6.1%) patients and 47 (5.4%) control subjects reported other cancers. No statistically significant elevated estimates of relative risk (RR) were found for uveal melanoma with history of skin cancer in either men (RR = 1.4, 95% confidence interval (CI) = 0.87-2.3) or women (RR = 1.1, 95% CI = 0.58-2.0), or with history of other prior cancer in either sex (men, RR = 1.0, 95% CI = 0.42-2.2; women, RR = 1.1, 95% CI = 0.55-2.1). Data from this study do not support an association between prior cancer and increased risk of uveal melanoma.
Rehabilitating elderly cardiac patients. The aging cardiovascular system undergoes many anatomic and physiologic changes. Increased vascular resistance, myocardial "stiffness," abnormalities of rhythmicity of the sinoatrial node, irregular cardiac rhythms, and alterations in heart rate and blood pressure responses are all seen more frequently in older patients. These changes are likely to impair these patients' ability to make the rapid adjustments necessary to maintain cardiac output during exercise and activity. When cardiovascular disease processes are superimposed on the "normal" concomitants of aging, greater alterations in hemodynamic response to exercise activity are noted than usually occur in younger cardiac patients. Exercise testing of older cardiac patients is safe and is usually needed to prescribe an appropriate intensity of exercise activity. The choice of the exercise protocol, the timing of the exercise test in relation to taking prescribed cardiac medication, the choice of exercise equipment, and special considerations for devices such as pacemakers and automatic implantable cardiodefibrillators must be considered before the exercise test is done. Many of these factors and the presence of either silent or overt cardiac symptoms or untoward hemodynamic events will also affect the exercise prescription. Elderly patients usually show substantial functional improvement when participating in a cardiac rehabilitation program and comply well with prescribed exercise. Early educational intervention may be crucial to reducing disability in these patients.
Glycerol injection into the trigeminal ganglion provokes a selective increase in human cerebral blood flow. Fourteen patients suffering from idiopathic trigeminal neuralgia (refractory to medication) were treated by injection of glycerol into the trigeminal ganglion. The changes in cerebral blood flow (CBF) after glycerol injection were quantified by intravenous 133Xe emission tomography. There was a significant 11% (P less than 0.01) increase in ipsilateral CBF and an 8% (P less than 0.05) increase in contralateral CBF 1 h after glycerol injection. The interhemispheric difference was significant (P less than 0.05). The increase was significantly greater in the ipsilateral internal carotid territory, in the anterior cerebral artery and middle cerebral artery territories (superficial (P less than 0.05), deep territories (P less than 0.001]. We suggest that these changes are due to the release of substance P and/or calcitonin gene-related peptide, from terminals of the trigeminal-vascular system during glycerol injection.
Intraoperative localization of colorectal cancers using radiolabelled monoclonal antibodies. Radiation detectors may allow the intraoperative localization of small cancer deposits following administration of radiolabelled tumour-associated antibodies. This technique was evaluated in 16 patients with colorectal tumours (14 cancers, one adenoma, one lipoma) with the 111In-labelled monoclonal antibody (MAb) ICR2 which recognizes the tumour-associated epithelial membrane antigen (EMA). At operation counting was carried out (3 x 20 s per site) using a hand-held radiation probe over the primary lesions and any palpable lymph nodes in the mesocolon. The tumour to normal colon (T/NC) ratio of counts recorded at operation was more than 1.5:1 in eight of the 14 patients with cancer (mean(s.d.), 1.54(0.41):1) and 0.91:1 and 1.06:1 respectively in the two patients with benign tumours. Node to normal colon ratios were higher in lymph nodes containing metastases. The uptake of radiolabelled antibody (T/NC ratio) was higher in EMA-expressing cancers than in those not expressing the target antigen (mean(s.d.), 2.45(0.65):1 versus 1.40(0.20):1, P = 0.019). An abdominal tumour model was also developed. Radioactively filled containers of 0.5-10 ml representing tumour deposits were suspended in a tank of 111In solution representing the background activity found in normal tissues. The ratio of radioactivity in the 'tumour' to that of background varied from 2:1 to 8:1. The 'tumour' was considered to be detectable if the mean counts recorded over the 'tumour' exceeded the mean of counts recorded over background by three standard deviations. At a ratio of 2:1 only 'tumours' greater than 5 ml could be detected with a sodium iodide probe and those over 10 ml could be detected with a cadmium telluride (CdTe) probe. At a ratio of 8:1, 'tumours' of 0.5 ml could be detected with either probe. At all ratios and counting periods the NaI probe was more sensitive than the CdTe.