shukoor65/lab-rag-model huggingface dataset:
Alcohol craving in rehabilitation: assessment of nutrition therapy. If untreated, alcohol abuse, which often results from alcohol craving, causes major metabolic abnormalities, altered life-styles, lost productivity, and eventually death. Biochemical mechanisms that may contribute to alcohol craving include the stress response of the hypothalamic-pituitary adrenal axis, the endogenous opiate beta-endorphin system, neurotransmitter synthesis and release, hypoglycemia, and nutrient deficiencies. The macronutrient ratio of meals, the resulting insulin response, and nutrient blood levels can affect amino acid and nutrient transport across the blood-brain barrier. Researchers have reported that animals increase alcohol intake when fed nutrient-deficient diets or after stressful experience. A pilot study was designed to assess the effects of nutrition therapy added to a traditional rehabilitation program based on the 12-step program of Alcoholics Anonymous. One study group received traditional therapy; the other study group received traditional therapy and nutrition therapy consisting of modified menus and individualized nutrition counseling. Patients who received nutrition therapy reported significantly fewer hypoglycemic symptoms, lower sugar intake, less alcohol craving as well as significantly greater nutrient intakes; a greater number abstained from alcohol. These findings indicate that nutrition therapy can aid in the recovery from alcoholism.
Successful combined operation for Takayasu's arteritis. We report a case of Takayasu's arteritis complicated with aortic regurgitation and severe stenosis of the left coronary ostium and the innominate artery. Simultaneous surgical treatment of aortic valve replacement, coronary ostium endarterectomy, and aortosubclavian artery bypass using saphenous vein were performed. We discuss the choice of simultaneous operation and the option of surgical treatment for coronary ostium lesion due to Takayasu's arteritis.
Health implications of obesity in American Indians and Alaska Natives. American Indians and Alaska Natives (AI/ANs) are experiencing an epidemic of diabetes, increasing rates of coronary artery disease and hypertension, and poor survival rates for breast cancer that are likely partially attributable to the increasing prevalence of obesity over the past generation. Obesity may also contribute to the high rates of gallstones and to adverse outcomes of pregnancy in AI/ANs. Although overall mortality was not associated with obesity in Pima Indians (except in the most obese men), the relationship of obesity to longevity in other AI/AN groups is not known. Further study of the specific health effects of obesity in various groups of AI/ANs are needed. In the meantime, community-based programs to prevent obesity and its sequelae should be implemented in all AI/AN communities.
Standards for evaluating and reporting the results of surgical and percutaneous therapy for peripheral arterial disease. By adopting precise definitions of essential terms, developing objective criteria by which the various measures of success or failure can be judged, and establishing a standardized scheme by which severity of disease, degrees of improvement or deterioration, and risk factors that affect outcome can be graded, the quality of published reports of revascularization procedures for lower extremity ischemia can be greatly improved, allowing comparative evaluation of treatment modalities.
Verrucous carcinoma of the bladder. Verrucous carcinoma of the bladder unassociated with bilharzial cystitis is an exceedingly rare entity, with only 3 cases reported in the literature. We describe a patient and review the literature concerning verrucous carcinoma.
Undifferentiated carcinoma of parotid gland. Two cases of undifferentiated carcinomas of the major salivary glands were studied using immunohistochemical techniques. Results showed that this entity was a high grade malignant neoplasm arising from the excretory duct. Despite the undifferentiated appearance multiple immunophenotypes were evident in both cases.
Functional properties of the beta-globin locus control region in K562 erythroleukemia cells. In this report, we compare the function of the human beta-globin locus control region (LCR) in three K562 erythroleukemia cell assays, including (1) a transient transfection assay for "classical" enhancer activity, (2) a colony assay that detects "productive integration events," and (3) an assay that detects the ability of LCR fragments to confer hemin inducibility on linked, stably integrated gamma-globin promoters. Various LCR fragments were inserted into an expression vector consisting of an A gamma-globin promoter driving the neomycin phosphotransferase gene (gamma-neo). Using these vectors, we determined that a 2.5-kb DNA fragment containing LCR sites I through IV (previously named mu locus activation region [mu LAR]) had activity in all three assays; of the individual LCR sites, only site II was highly active in all three assays. One region within site II, consisting of tandem AP-1/NF-E2 consensus elements, had approximately 10% as much colony assay activity as the entire mu LAR. However, this region did not have detectable activity in a transient enhancer assay in uninduced K562 cells, nor was it capable of conferring hemin inducibility on linked gamma-globin promoters in stably transfected cells. Finally, we tested the ability of the mu LAR to activate promoters (beta-globin and cathepsin G) that are not normally expressed in K562 cells. beta-neo was minimally activated by the mu LAR in transient transfection experiments. The mu LAR increased the number of stably transfected colonies produced by beta-neo, but the absolute number of beta-neo colonies, with or without the mu LAR, was approximately 10% to 20% that of gamma-neo. In contrast, a minimal cathepsin G promoter was activated by the mu LAR in K562 cells. Our results suggest that LCR functions are dependent in part on the environments and the promoters with which the LCR is tested.
Effects of urokinase and heparin on minimal cross-sectional area of the culprit narrowing in unstable angina pectoris. The immediate and delayed effects of urokinase and heparin on minimal cross-sectional area of a patent ischemia-producing coronary artery were prospectively investigated in 43 patients with unstable angina. After baseline angiography, patients were randomized to 3 different treatment groups: group I--urokinase (1,000,000 U intravenous bolus dose), followed by heparin infusion 3 hours later; group II--heparin (10,000 U intravenous bolus, followed by continuous infusion); and group III--conventional therapy only (intravenous nitroglycerin, beta blockers and calcium antagonists). Angiography was repeated at 1 hour and at 8 days of treatment and minimal cross-sectional area was determined in the 35 patients who completed the study. In group I, minimal cross-sectional area increased from 0.84 +/- 0.48 mm2 at baseline to 0.94 +/- 0.49 mm2 at 1 hour (p less than 0.05), and to 1.00 +/- 0.51 mm2 at 8 days (p less than 0.01 vs baseline). In group II, a significant increase in minimal cross-sectional area was observed only at the 8-day angiography (0.64 +/- 0.39 mm2 at baseline; 0.67 +/- 0.37 mm2 at 1 hour [p = not significant]; and 0.79 +/- 0.48 mm2 at 8 days [p less than 0.01] vs baseline). In group III, no significant changes in minimal cross-sectional area occurred either at 1 hour or at 8 days. Thus, both urokinase and heparin improved lesion geometry in patients with unstable angina, although a large individual variation was noticed. The effect occurred earlier with urokinase than with heparin.
Predominant expression of lambda light chain in adult cases with non-T-cell acute lymphocytic and chronic myelogenous leukemia in lymphoid blast crisis. The authors investigated cytoplasmic immunoglobulins of the leukemic cells from 20 adult cases with non-T-cell acute lymphocytic leukemia (ALL) and from three cases with chronic myelogenous leukemia in lymphoid blast crisis using immunoelectron microscopy. They also studied these cases using various monoclonal antibodies. Of the 23 examined cases, nine were negative for both heavy and light chains of immunoglobulins; the authors defined these as common ALL. Two cases were positive for the mu chain but were negative for light chains; the authors defined these as pre-B-cell ALL. The remaining 12 cases were positive for either kappa or lambda light chains; these were defined as B-cell ALL. Of the 12 cases positive for light chains, 11 were positive for the lambda chain. Seven cases of the 11 positive cases for the lambda chain were negative for heavy chains. Eleven cases were positive either for both My4 and My9 or for one of the two antibodies. From these results, the authors conclude the following: (1) the ratio of pre-B-cell ALL among non-T-cell ALL cases (two of 23 cases) was lower in adults than in children; (2) of the light chain-positive cases, the lambda light chain-positive cases predominated (11 of 12 cases); (3) heavy chain-negative, lambda chain-positive cases (seven cases) were observed; and (4) one half of the leukemia cases showed dual phenotypes of B-cell and myeloid cell lineages.
Cytokine gene expression in the islets of the diabetic Biobreeding/Worcester rat. The Biobreeding Worcester rat provides one of the best models of autoimmune diabetes. Immunopathologic studies of acute diabetes show that the islets are infiltrated by T cells and macrophages. It has been hypothesized that the islets are damaged by the secretion of cytokines such as IL-1 and TNF-alpha and that their function may be altered by IL-6. In this study, we utilized in situ hybridization to determine the expression of the IL-1, TNF, and IL-6 genes within the pancreas of the acute diabetic Biobreeding Worcester rat. These studies showed that cells expressing IL-1, TNF, and IL-6 were present within the islets and in the exocrine pancreas surrounding islets, ducts, and vessels and in an interstitial location. Cells expressing TNF and IL-1 mRNA were present in about 20% of the islets, whereas cells expressing IL-6 were present in about 4% of the islets. Islets containing TNF- or IL-1-positive cells contained about three positive cells per islet whereas only about one IL-6-positive cell was present per islet. In 26% of the islets peri-insular TNF-positive cells were found. Peri-insular IL-1 positive cells were seen in 14% of the islets and 8% showed peri-insular IL-6 positive cells. In nondiabetic 30-day old DP or 90-day-old DR rats intra-islet cytokine gene expression was not seen. Our studies support the view that cytokines are important in beta cell destruction.
Cerebrovascular accident complicating acute myocardial infarction: incidence, clinical significance and short- and long-term mortality rates. The SPRINT Study Group. PURPOSE: The purpose of this study was to report the incidence, the antecedents, and the clinical significance of clinically recognized cerebrovascular accidents or transient ischemic attacks (CVA-TIA) complicating acute myocardial infarction. PATIENTS AND METHODS: During 1981 to 1983, a secondary prevention study with nifedipine (SPRINT) was conducted in 14 hospitals in Israel among 2,276 survivors of acute myocardial infarction. During the study, demographic, historical, and medical data were collected on special forms for all patients with diagnosed acute myocardial infarction in 13 of these 14 hospitals (the SPRINT registry, n = 5,839). Mortality follow-up was completed for 99% of hospital survivors for a mean follow-up of 5.5 years (range: 4.5 to 7 years). RESULTS: The incidence of CVA-TIA was 0.9% (54 of 5,839). The latter rate increased significantly only with age, from 0.4% among patients up to 59 years old to 1.6% among those aged greater than or equal to 70 years. Multivariate analysis identified age, congestive heart failure, and history of stroke as predictors of CVA-TIA during the acute phase of myocardial infarction. Patients with CVA-TIA exhibited a complicated hospital course, with a 15-day mortality rate of 41%. Subsequent mortality rates in survivors at 1 and 5 years were 34% and 59%, respectively. Rates at the same time points in patients without CVA-TIA were 16%, 11%, and 29% (p less than 0.01). In a multivariate analysis that included age, gender, congestive heart failure, history of previous myocardial infarction, and hypertension, CVA-TIA was independently associated with increased 15-day mortality (covariate-adjusted odds ratio [OR] = 2.62; 90% confidence interval [CI], 1.59 to 4.32), as well as subsequent 1-year (OR = 3.29; 90% CI, 1.70 to 6.36) and long-term (mean follow-up = 5.5 years) mortality (OR = 2.46; 90% CI, 1.30 to 4.69). CONCLUSION: In this large cohort of consecutive patients with myocardial infarction, CVA-TIA was a relatively infrequent complication of acute myocardial infarction. Factors independently favoring the occurrence of CVA-TIA were old age, previous CVA, and congestive heart failure. CVA-TIA occurring during acute myocardial infarction independently increased the risk of early death threefold as well as the risk of long-term mortality in early-phase survivors. (2.5-fold).
Low-back pain and disk degeneration in children: a case-control MR imaging study. Thirty-nine 15-year-old children with low-back pain (LBP) and 39 asymptomatic control children were selected from a population of 1,503 children of the same age for a magnetic resonance imaging study of the lumbar spine. Subjects with LBP were matched with control subjects by age, sex, and school class. Disk degeneration (DD) was present in 15 (38%) of the children with LBP and in 10 (26%) of the control subjects. Lumbar degeneration was most frequently associated with disk protrusion and Scheuermann-type changes. Of assessed structural abnormalities (disk protrusion, Scheuermann-type changes, transitional vertebra, and disk space narrowing), only disk protrusion was more common in children of the LBP group than in control subjects. The authors conclude that DD is a frequent finding among children with LBP at the age of 15 years. Asymptomatic (possibly physiologic) DD also is frequently found in children of this age. Whether DD associated with structural changes predisposes to low-back disorders can be confirmed only by means of a longitudinal follow-up study.
The Libyan Creutzfeldt-Jakob disease focus in Israel: an epidemiologic evaluation. In a country-wide study of Creutzfeldt-Jakob disease (CJD) in Israel, we diagnosed 114 cases, among them 49 Libyan-born, with onset of their disease during the years 1963-1987. After age adjustment, the mean annual incidence rate per million population was 43 among Libyan-born and 0.9 in the rest of the population. Among Jews born in Egypt and Tunisia, neighboring countries of Libya, the adjusted rates were higher than in the other Israelis (3.5 and 2.3 per million, respectively). Among Libyan Jews, there was no association between incidence rate of CJD and age at immigration, ie, duration of exposure to hypothetical infectious factor in Libya. The percent of familial cases among Libyan Jews (41 to 47%) is one of the highest ever published. Genetic factors seem to be important for the high incidence of CJD among Libyan Jews.
Paradoxical vocal cord motion: an unusual cause of stridor. Stridor due to obstructive causes is relatively common. Functional airway obstruction with paradoxical vocal cord motion is uncommon. Only 12 cases have been reported in the literature in the past 15 years. The majority were young female patients. We have recently encountered two cases. Lack of awareness of this condition caused several problems in management.
Seasonality of disease in Kuwait. To compare the seasonal variation in total mortality and deaths from cardiovascular, respiratory, and malignant disease, data were collected from North-East Scotland (Grampian region) and Kuwait. Seasonal differences were similar, in both timing and degree, for total mortality and deaths from circulatory disease, but were greater in Kuwait for respiratory disease. Peak mortality was during winter in both areas: in Grampian, when the climate is most uncomfortable, and in Kuwait, when the climate is at its most comfortable. Socioeconomic changes in Kuwait have been accompanied by a rapid fall in the degree of seasonality (deseasonality) for both total and infant mortality. These findings suggest that mortality peaks in winter, not because of a seasonally low temperature, but because of a seasonal fall in mean temperature irrespective of the annual mean temperature.
Limited heterogeneity of the HLA class II contribution to susceptibility to rheumatoid arthritis is suggested by positive associations with HLA-DR4, DR1 and DRw10. Most patients with rheumatoid arthritis (RA) exhibit an HLA class II epitope found on most DR4 and DR1 molecules. We have investigated the possibility of other associations being present in the minority of patients lacking these antigens. One hundred and eighty patients with classical or definite RA and 100 controls were assigned HLA-DR, DQ and DP types by a DNA-based system using sequence-specific oligonucleotides to probe amplified class II alleles amplified by the polymerase chain reaction. The expected associations with DR4 (relative risk 10, P less than 0.0001) and DR1 (relative risk 2.3, P less than 0.001) were observed and only 13% of individuals lacked both of these alleles compared with 54% of age- and race-matched controls. A significant association with DRw10 (P = 0.02) was also observed in the DR4/DR1-negative RA group (3/23 patients compared with 0/54 DR4/DR1-negative controls). No novel associations with other DR, DQ, or DP alleles were evident in contrast to some previous studies. The third allelic hypervariable region of the DR beta chain of DRw10 contains a similar amino acid sequence to that found in many DR4 and DR1 molecules. These results extend this correlation and suggest that this susceptibility determinant may account for the HLA-linked susceptibility in 89% of our cases of RA.
Von Hippel-Lindau disease and erythrocytosis: radioimmunoassay of erythropoietin in cyst fluid from a brainstem hemangioblastoma. A 59-year-old woman with von Hippel-Lindau disease developed erythrocytosis and a recurrent intracranial hemangioblastoma. Radioimmunoassay showed an elevated level of erythropoietin in her serum. Cyst fluid from the tumor also contained erythropoietin, concentrated a thousandfold relative to the serum level. Production of erythropoietin by hemangioblastomas may explain the erythrocytosis present in some patients with von Hippel-Lindau disease.
Serotonin antagonists: a new class of antiemetic agents. Despite a number of significant advances over the past decade, prevention and treatment of chemotherapy-induced emesis remain formidable problems, particularly with cisplatin-containing regimens. Nearly one third of patients receiving high-dose cisplatin still experience substantial emesis despite the best available conventional antiemetics, and the toxic effects of these agents remain quite troublesome. In recent years, a new class of agents, the serotonin antagonists, has been identified. These agents hold promise for clinical utility in a wide range of areas. Selective antagonists of the serotonin (5-hydroxytryptamine) type 3 (5-HT3) receptor have proven in early clinical trials to be potent antiemetic agents in patients receiving cytotoxic chemotherapy, with efficacy comparable to or superior to that of conventional antiemetics. Toxic effects to date with the 5-HT3 receptor antagonists have been modest. The current state of knowledge with respect to these agents as antiemetics for patients receiving cytotoxic chemotherapy is summarized.
Recombinant granulocyte-macrophage colony-stimulating factor after autologous bone marrow transplantation for relapsed non-Hodgkin's lymphoma: blood and bone marrow progenitor growth studies. A phase II Eastern Cooperative Oncology Group Trial. Sixteen patients with relapsed non-Hodgkin's lymphoma underwent autologous bone marrow transplantation and infusion of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF). Treatment consisted of involved-field radiotherapy, cyclophosphamide 60 mg/kg/d intravenously (IV) for 2 days, and fractionated total body irradiation (1,200 cGy). Autologous bone marrow was thawed and infused IV, followed 3 hours later by the first infusion of IV rhGM-CSF 11 micrograms/kg/d over 4 hours. Infusions of rhGM-CSF were continued daily until either both neutrophil count exceeded 1,500/microL and platelet count exceeded 50,000/microL, or until 30 days after marrow re-infusion. Toxicities encountered were mild and included fever, chills, hypertension, alopecia, rash, diarrhea, stomatitis, myalgias, and synovial (knee) effusions. Neutrophil recovery greater than 500/microL occurred a median of 14 days (range, 9 to 30 days) after marrow infusion, significantly earlier than in a comparable group of historic controls who recovered counts at a median time of 20 days (range, 12 to 51 days) (P = .00002). Median time to self-sustaining platelet counts greater than 20,000/microL was 23.5 days (range, 12 to 100 days), comparable with the historic group (P = .38). One bacteremia (central venous catheter exit site infection with Staphylococcus epidermidis) and one local infection (Giardia lamblia in stool) occurred. Patients received a median of 11.4 (range, 4.4 to 20.2) x 10(4) colony-forming unit granulocyte-macrophage (CFU-GM) progenitors per kg. Stem cell progenitors CFU-GM, CFU-granulocyte, erythroid, monocyte, megakaryocyte (CFU-GEMM), and burst-forming unit-erythroid (BFU-E) were detected in the bone marrow as early as 7 days after marrow re-infusion, and increased in proportion to peripheral blood counts, but by 30 to 60 days still remained much lower than before transplant. Neutrophils transiently decreased in 13 of 16 patients (median decrease, 42%) within 24 to 72 hours of discontinuing rhGM-CSF infusions. These data suggest that rhGM-CSF therapy enhances neutrophil recovery by forcing stem cells to produce mature elements at an enhanced rate but may not affect marrow stem cell and early progenitor population sizes.
Hemodynamics in the prone jackknife position during surgery. We examined the hemodynamic changes occurring with prone jackknife positioning during colorectal surgery. The operative procedure was restorative proctocolectomy with ileal J-pouch anal anastomosis in five patients with adenomatosis coli and six patients with ulcerative colitis and anoabdominal resection of the rectum with colonic J-pouch anal anastomosis in eight patients with rectal cancer. Nineteen patients (10 men and 9 women aged 41 +/- 19 years) were monitored with arterial and Swan-Ganz catheters during positioning. Measurements were obtained in the supine and prone positions (1 minute, 3 minutes), and the jackknife position (1, 3, 5, and 10 minutes), as well as before and after adoption of the Lloyd-Davies position (1, 3, 5, and 10 minutes). Turning the patient from the supine position to the prone position resulted in a significant decrease in the cardiac index (CI). However, following head-down rotation, the CI increased and returned to the value seen in the supine position (p less than 0.05). Heart rate (HR) slowed and mean arterial pressure (MAP) increased in the prone jackknife position. We concluded that the extent of the changes in cardiac function presented no serious problems.
Impassable ureteral strictures: management with percutaneous ureteroneocystostomy. Sixteen of 227 patients referred for percutaneous placement of a ureteral stent had impassable stenoses. Stenoses were benign (n = 8) or attributed to malignant retroperitoneal neoplasm (n = 8). Electrocautery was used to create a neotract between the stenosed ureter and the bladder or ileal loop. A double-J stent was placed after dilation of the tract by use of angioplasty. Neotracts were established and stents were placed in all patients. Complications (digestive tract fistulas) developed in two patients. This technique is safe if the electrode is placed close to the bladder or ileal loop. The procedure can be used as an alternative to surgery or permanent nephrostomy or in initial treatment of benign anastomotic stenosis.