shukoor65/lab-rag-model huggingface dataset:
The role of behavioral research in the prevention and management of invasive diarrheas. Reduction in the prevalence of invasive diarrheal diseases can be facilitated by the development of models for systematic examination of behavioral risk factors that are associated with these illnesses. These factors include insufficient use of health care services, noncompliance with treatment, unhygienic behaviors, employment of poor feeding practices for infants and young children, and inappropriate handling of foods. Information on conditions that facilitate or constrain appropriate behaviors will assist the development of programs for the prevention and management of invasive diarrheas.
Amplification of the c-erbB oncogene is associated with malignancy in primary tumours of neuroepithelial tissue. In various primary brain tumours of neuroepithelial tissue recombinant DNA techniques were used to demonstrate changes of the epidermal growth factor receptor gene, which is homologous to the c-erbB oncogene. Twenty-one of 40 grade III/IV tumours, but only 1 of 16 grade I/II tumours were found to contain amplified and/or rearranged c-erbB sequences. This highly significant difference suggest that c-erbB amplification, rearrangement, or both, are important steps in malignant transformation in a subset of patients with neuroepithelial tumours.
Effect of immersion on residual volume of able-bodied and spinal cord injured males. This study compared residual lung volumes (RV) (oxygen dilution technique) of able-bodied (AB) and spinal cord injured (SCI) males on dry land in air (RVA) and immersed to the neck in water (RVW). The effects of significant differences in RV on calculations of body density (Db) and percent body fat (%BF) were also assessed. The subjects were eight AB, eight paraplegic (PARA), and eight quadriplegic (QUAD) males, ranging in age from 18 to 51 yr. There was a 0.99 correlation (P less than 0.001) between RVA and RVW for AB subjects but no significant correlations between RVA and RVW for the PARA or QUAD groups. RVA in the QUAD group was significantly higher than in the PARA or AB group (P less than 0.003). There were no differences in RVW among the three groups. In the QUAD group, RVA was significantly larger than RVW (P less than 0.001), but there were no significant differences between RVA and RVW for the PARA or AB subjects. Db and %BF did not differ significantly among the PARA or AB groups when calculated at RVA and RVW. However, for QUAD, both Db and %BF differed significantly (P less than 0.001) when calculated at RVA and RVW. It was concluded that, for the purpose of hydrostatic weighing, residual lung volume of quadriplegic persons should be measured with the subject immersed in water.
Specificities of serum alpha-fetoprotein in HBsAg+ and HBsAg- patients in the diagnosis of hepatocellular carcinoma. Serum alpha-fetoprotein level is often elevated in patients with chronic liver disease and patients with hepatocellular carcinoma. One of the most difficult problems frequently encountered in practice is differentiating hepatocellular carcinoma from chronic liver disease. This study investigated the specificity and predictive value positive of serum alpha-fetoprotein at various levels in the diagnosis of hepatocellular carcinoma, using 54 patients with histologically proven hepatocellular carcinoma and 200 patients with chronic liver disease (40 patients with chronic active hepatitis and 160 patients with cirrhosis) as nontumor controls. Among 254 patients, 170 (66.9%) were HBsAg+. A wide range of overlap (from 0 to 6,400 ng/ml) in the distribution of serum alpha-fetoprotein levels between hepatocellular carcinoma and chronic liver disease patients was observed mainly among HBsAg+ patients. In contrast, the overlapping range of serum alpha-fetoprotein levels between HBsAg- patients with hepatocellular carcinoma and chronic liver disease was remarkably narrow (from 0 to 200 ng/ml). Therefore the specificity and predictive value positive of alpha-fetoprotein at a given level were significantly lower in HBsAg+ than in HBsAg- patients, especially when alpha-fetoprotein was between 25 and 200 ng/ml. The specificities of alpha-fetoprotein at 200 ng/ml and 400 ng/ml in HBsAg+ patients were 79.8% and 91.5%, respectively, whereas these specificities were both 100% in HBsAg- patients. The predictive values positive at 200 ng/ml and 400 ng/ml in HBsAg+ patients were 53.6% and 72.5%, respectively, in contrast to 100% at both levels in HBsAg- patients. The serum alpha-fetoprotein level, which showed a predictive value positive of 95% in HBsAg+ hepatocellular carcinoma patients, was 3,200 ng/ml, whereas that in HBsAg- hepatocellular carcinoma patients, was 200 ng/ml. We conclude that serum HBsAg status should be considered when serum alpha-fetoprotein is measured as an independent test to diagnose hepatocellular carcinoma, and suggest that regular serum alpha-fetoprotein determination may be more useful in HBsAg- patients with chronic liver disease for the early diagnosis of hepatocellular carcinoma than in HBsAg+ patients.
Angiotropic large-cell lymphoma in a patient with adrenal insufficiency. Angiotropic large-cell lymphoma is a rare disorder characterized by a proliferation of malignant lymphoid cells within the lumina of small vessels. The skin and central nervous system are typically affected; however, involvement of other organs has been described. We document an unusual case of this disorder in a patient who suffered clinically significant adrenal insufficiency and subsequently died. Autopsy disclosed angiotropic large-cell lymphoma involving both adrenal glands.
Alternating sequential intracarotid BCNU and cisplatin in recurrent malignant glioma. The authors entered 43 patients with recurrent malignant glioma in a trial of alternating sequential intracarotid BCNU and cisplatin. Protocol design was alternating courses of BCNU (2 doses, 300 to 400 mg each) and cisplatin (2 doses, 150 to 200 mg each) each at 4-week to 6-week intervals. Eight of 40 patients (20%) evaluable after the first course of BCNU showed partial or minor response. Only 18 patients were evaluable after the first course of cisplatin, and 5 were evaluable after the second course of BCNU. Median survival was 9 months (range, 2 weeks to 6 years). Cerebral or ocular toxicity unique to this method of chemotherapy administration and failure to show clinical improvement were the most common reasons for removal from study. Because of the high attrition rate, the authors were unable to determine a meaningful response to alternating sequential BCNU and cisplatin or to test the clinical degree of cross-resistance to these agents in human malignant glioma.
Use of process evaluation to guide health education in Forsyth County's project to prevent cervical cancer. The Forsyth County, NC, Cervical Cancer Prevention Project is a 5-year public health education program designed to increase the proportion of black women in the county who are appropriately screened for cervical cancer. In this paper, the authors report on process evaluation--the procedures used to monitor the intervention and to insure that the target population was reached with a high quality, community-based health education program. A system that encompasses documentation of program activities, interviews with women in waiting rooms of primary care providers, semiannual interviews with a panel of approximately 100 women from the target population, and telephone followup with participants in direct education workshops was designed and implemented. Through October 1990, more than 2,100 interviews had been conducted. Data from these activities have facilitated continued development and refinement of educational materials, provided guidance for developing new strategies for reaching the target population, and provided continuous feedback to program managers to allow monitoring the impact of all program activities.
Postblepharoplasty ectropion. Prevention and management. Lower-eyelid malposition is one of the more serious complications encountered following lower-lid blepharoplasty, ranging in severity from mild lower-lid retraction to frank ectropion with marked lower-lid eversion. We define a grading system for postblepharoplasty lid malposition based on the severity of lower-lid retraction. In a critical review of 111 patients who underwent lower-lid blepharoplasty between January 1985 and January 1990, 15% were thought to have some degree of lower-lid retraction. Presence of lid laxity preoperatively and increasing amounts of skin excision at surgery were significant factors in the development of malposition. Placement of orbicularis suspension sutures tended to decrease the incidence of lid retraction. No patients had frank ectropion; however, three patients with grade 2 or 3 malposition required a secondary surgical procedure for correction. All three patients had resolution of their symptoms and good cosmetic results using standard treatment methods. A literature review and discussion of the causes, sequelae, and management of post-operative ectropion is presented as a reminder to surgeons performing blepharoplasty. Avoidance of this entity by appropriate preoperative assessment is emphasized, along with conservative operative technique. These factors combined are essential for the successful outcome of lower-lid blepharoplasty.
A prospective, randomized trial comparing combination half-dose tissue-type plasminogen activator and streptokinase with full-dose tissue-type plasminogen activator. Kentucky Acute Myocardial Infarction Trial (KAMIT) Group. BACKGROUND. The potential benefits of combination thrombolytic agents in the treatment of myocardial infarction remain uncertain. In a small pilot study, we demonstrated that combining half-dose tissue-type plasminogen activator (t-PA) with streptokinase (SK) achieved a high rate of infarct vessel patency and a low rate of reocclusion at half the cost of full-dose t-PA. METHODS AND RESULTS. We designed a prospective trial in which 216 patients were randomized within 6 hours of myocardial infarction to receive either the combination of half-dose (50 mg) t-PA with streptokinase (1.5 MU) during 1 hour or to the conventional dose of t-PA (100 mg) during 3 hours. Acute patency was determined by angiography at 90 minutes, and angioplasty was reserved for failed thrombolysis. Heparin and aspirin regimens were maintained until follow-up catheterization at day 7. Acute patency was significantly greater after t-PA/SK (79%) than with t-PA alone (64%, p less than 0.05). After angioplasty for failed thrombolysis, acute patency increased to 96% in both groups. Marked depletion of serum fibrinogen levels occurred after t-PA/SK compared with t-PA alone at 4 hours (37 +/- 36 versus 199 +/- 66 mg/dl, p less than 0.0001) and persisted 24 hours after therapy (153 +/- 66 versus 252 +/- 75 mg/dl, p less than 0.0001). Reocclusion (3% versus 10%, p = 0.06), reinfarction (0% versus 4%, p less than 0.05), and need for emergency bypass surgery (1% versus 6%, p = 0.05) tended to be less in the t-PA/SK group. Greater myocardial salvage was apparent in the t-PA/SK group as assessed by infarct zone function at day 7 (-1.9 SD/chord versus -2.3 SD/chord after t-PA alone, p less than 0.05). In-hospital mortality (6% versus 4%) and serious bleeding (12% versus 11%) were similar between the two groups. CONCLUSIONS. These results suggest that a less expensive regimen of half-dose t-PA with SK yields superior 90-minute patency and left ventricular function and a trend toward reduced reocclusion compared with the conventional dose of t-PA.
Fibrin glue vasal anastomosis compared to conventional sutured vasovasostomy in the rat. Vasectomy reversal has become a frequently performed surgical procedure with best results obtained with the use of the operating microscope and microsurgical technique. The present study was undertaken to evaluate the use of fibrin glue ("Tisseel", Immuno U.S., Inc.) for vasovasostomy and to compare this technique to conventional sutured vasovasostomy. Utilizing 60 male Sprague Dawley rats, a conventional two layered sutured anastomosis of vasovasostomy (30 rats) was compared to a fibrin glue technique of vasal anastomosis (30 rats). The fibrin glue technique was performed with two transmural sutures, was unstented, and utilized the biological glue to seal the anastomosis. The contralateral vas of each animal underwent vasectomy and reapproximation of unligated ends so that the rate of spontaneous recanalization could be accessed. Rats were sacrificed at 24 hours, one week, four weeks, and three months postvasovasostomy. The vasal specimens were evaluated for gross patency, presence and size of sperm granuloma, mean flow rates at varying infusion pressures, tensile strength measurements and histologic studies. Combining the one and three month groups, a similar patency rate was obtained by either technique; 83% (n = 18) for the sutured group, and 90% (n = 21) for the fibrin glue group. The rate of spontaneous recanalization of the contralateral vasa in the one and three month animals was 8% (n = 38). The mean flow rates obtained at high and low infusion pressures were not statistically different for the two techniques. The tensile strength of the glue anastomosis averaged 78% of the tensile strength achieved by the conventional sutured technique. The incidence of sperm granuloma after vasovasostomy was 28% for the fibrin glue group and 61% for the sutured group. Additionally, 67% of granulomas were small (less than 3 mm.) in the glue group, compared to only 36% in the sutured group. Histology revealed similar morphological changes in the area of anastomosis with either technique. Operative time for sutured vasovasostomy averaged 24 minutes, compared to an average of 11 minutes for the glue assisted vasovasostomy. The use of fibrin glue allowed the performance of a sperm tight patent anastomosis that had the advantages of reduced incidence of sperm granuloma formation, reduced operative time, and less microsurgical skill required to perform the anastomosis.
Long-lasting depression of the factor XII-dependent fibrinolytic system in patients with myocardial infarction undergoing thrombolytic therapy with recombinant tissue-type plasminogen activator: a randomized placebo-controlled study. In a randomized placebo-controlled study, seven patients with acute myocardial infarction allocated to intravenous treatment with 100 mg of recombinant tissue-type plasminogen activator (rt-PA) and seven patients allocated to placebo were studied during eight sampling periods before and after treatment. Seven patients with acute myocardial infarction treated intravenously with 1.5 million U of streptokinase were later studied during two sampling periods before and after treatment. The placebo group showed no significant deviations of endogenous factor XII-dependent fibrinolytic activity (p greater than 0.05). In the rt-PA group, this activity decreased significantly (p less than 0.001) after the infusion and remained depressed throughout the 1st 4 days. A significant decrease in activity (p less than 0.05) was also found in the streptokinase-treated patients. The depletion of factor XII-dependent fibrinolytic activity was not due to generation of inhibition or a depletion of factor XII, prekallikrein and plasminogen, but could be related to the proactivator of this system. It is concluded that rt-PA (and streptokinase) treatment in patients with acute myocardial infarction causes a prolonged depletion of factor XII-dependent fibrinolytic activity. This depression of endogenous fibrinolytic activity needs to be evaluated in relation to the enhanced risk of coronary reocclusion after thrombolytic therapy.
Correlation of histology and drug response of human tumors grown in native-state three-dimensional histoculture and in nude mice. An in vitro histoculture system in which a native-state collagen-sponge gel supports the three-dimensional growth of tumor tissue has been recently developed that allows the culture and drug response assay for most every tumor type. Important features of the histoculture system include the maintenance of three-dimensional tissue architecture and the use of histological autoradiography to measure nuclear incorporation of [3H]thymidine as an endpoint. We describe in this report in vitro-in vivo correlations for drug response and tumor histology by using human tumor xenografts grown in the native-state three-dimensional histoculture system and as xenografts in nude mice. This comparison eliminates many of the confounding variables seen in most correlative clinical trials. Results demonstrate (i) a very high preservation of in vivo tissue architecture in vitro, (ii) an 86% accuracy in vitro of predicting drug resistance in vivo using suprapharmacologic doses of drugs in vitro, and (iii) an overall predictive frequency of drug resistance and sensitivity ranging from 53% for 5-fluorouracil to 78% for doxorubicin.
Combination balloon-ultrasound imaging catheter for percutaneous transluminal angioplasty. Validation of imaging, analysis of recoil, and identification of plaque fracture. BACKGROUND. We investigated the hypothesis that an ultrasound transducer positioned within an angioplasty balloon could be used to perform quantitative assessment of arterial dimensions before and after percutaneous transluminal angioplasty (PTA) and to identify certain mechanical alterations consequent to PTA, including vascular wall recoil and the initiation of plaque fractures. METHODS AND RESULTS. A combination balloon-ultrasound imaging catheter (BUIC) that houses a 20-MHz ultrasound transducer within and halfway between the proximal and distal ends of an angioplasty balloon was used to perform PTA in 10 patients with peripheral vascular disease. Each PTA site was also evaluated before and after PTA by standard (nonballoon) intravascular ultrasound (IVUS) technique. In eight patients in whom satisfactory images were recorded with the BUIC before PTA, luminal cross-sectional area (XSA) of stenotic sites (0.10 +/- 0.01 cm2) did not differ significantly from measurements of XSA by IVUS (0.09 +/- 0.01 cm2, p = NS). Likewise, minimum luminal diameter (Dmin) measured by BUIC (0.34 +/- 0.02 cm) was similar to that measured by IVUS (0.33 +/- 0.01 cm, p = NS). In nine patients in whom satisfactory images were recorded with the BUIC after PTA, XSA measured by BUIC (0.29 +/- 0.03 cm2) did not differ significantly from XSA measured by IVUS (0.30 +/- 0.03 cm2, p = NS). Dmin measured by BUIC after PTA (0.57 +/- 0.02 cm) was also similar to Dmin measured by IVUS (0.57 +/- 0.03 cm, p = NS). After PTA, XSA and Dmin measured immediately after deflation were significantly less than balloon XSA and diameter at full inflation, indicating significant elastic recoil of the dilated site. For the nine patients in whom post-PTA images were satisfactory for quantitative analysis, including four patients in whom recoil was 39%, 46%, 50%, and 61%, percent recoil measured 28.6 +/- 7.2%. Finally, plaque fractures were identified on-line in six of 10 patients (60%); in each case, initiation of plaque fracture was observed at inflation pressures of 2 atm or less. CONCLUSIONS. The results of this preliminary human investigation indicate that an ultrasound transducer positioned within an angioplasty balloon can be used to perform quantitative and qualitative analyses of lumen-plaque-wall alterations immediately preceding, during, and immediately after PTA in patients with peripheral vascular disease.
Effects of rapid volume expansion on the right filling pressures after prosthetic valve surgery. The effects of rapid intravascular volume expansion were studied in 12 patients, 4 to 14 years after single prosthetic heart valve replacement. The data observed showed a statistically significant mean difference before and after volume expansion of right atrial mean pressure and right ventricular end diastolic and pulmonary capillary pressures. However, right atrial and pulmonary capillary pressures equilibration was not detected. The right atrial pressure form showed abnormal variations during inspiration. Dip and plateau right ventricular diastolic pressure configuration was recorded in 6 patients after expansion, was absent in 2 and questionable in 4. A deep Y descent with an M-shaped right atrial pressure form was recorded in all 12 patients. The explanation for these phenomena is unclear. Thus, in the absence of pressure equilibration and clinical evidence of constriction, the abnormalities recorded during rapid volume expansion should be cautiously interpreted.
Reproducibility of left ventricular myocardial volume and mass measurements by ultrafast computed tomography. Ultrafast computed tomography has been reported to be an accurate method of measuring left ventricular mass in dogs. To assess the interstudy, intraobserver and interobserver variability of left ventricular myocardial mass measurements in humans, left ventricular myocardial volume was measured three times within 24 h in 16 patients with ischemic heart disease. The mean percent difference of the mean of the three studies performed was -0.01 +/- 1.4% (range -2.9% to 3.6%). The regression analysis for the intraobserver variability at baseline was: Y = -4.33 + 1.03X; r = 0.99, SEE = 3.5 ml. The mean percent difference of the mean of the two sets of measurements performed by two independent observers was 0.28 +/- 2.1% (range -4.35% to 4.35%). The interobserver variability excluding papillary muscles at baseline study was: Y = -4.34 + 1.06X; r = 0.99, SEE = 1.5 ml. The regression analysis with versus without papillary muscles showed: Y = -8.72 + 0.97X; r = 0.96, SEE = 2.6 ml. Regression analysis to assess the variability of 24-h studies at end-systole versus end-diastole revealed: Y = 3.07 + 0.94X; r = 0.97, SEE = 1.8 ml. In conclusion, ultrafast computed tomography is a minimally invasive technique, with very low interstudy, intraobserver and interobserver variability for left ventricular myocardial volume and mass determinations in serial studies.
Cisplatin and novobiocin in the treatment of non-small cell lung cancer. A Southwest Oncology Group study. Novobiocin, a commercially available oral antibiotic, inhibits DNA topoisomerase II in a manner shown in cell culture to enhance the cytotoxicity of alkylating agents and cisplatin. Thirty-six patients were entered on a Phase II trial using high-dose cisplatin (100 mg/m2 on days 1 and 8 for four cycles) after steady-state dosing with novobiocin (1000 mg or four 250-mg capsules every 12 hours for six doses, four of which were administered before each dose of cisplatin). One patient remains on study and cannot be evaluated for response. No complete responses were seen. Three patients (8%) had partial responses and an additional patient had an unconfirmed partial response. The median survival time of all patients was just less than 7 months. These results are comparable with those of other concurrent Southwest Oncology Group (SWOG) Phase II and III trials of high-dose cisplatin in non-small cell lung cancer (NSCLC). Novobiocin plasma levels were obtained for three patients and were approximately 50% of the optimal concentration as reported in cell culture for potentiation of cytotoxicity. It was concluded that an optimum test of novobiocin as a modulator of cytotoxicity may require the availability of an intravenous preparation.