shukoor65/lab-rag-model huggingface dataset:
Recognition of human 60 kD heat shock protein by mononuclear cells from patients with juvenile chronic arthritis. A postulated mechanism for autoimmune disorders is that the immunoreactivity develops against bacterial antigens which show a high degree of sequence homology with mammalian proteins. The mycobacterial 65 kD heat shock protein (hsp) has been implicated in several forms of arthritis. Substantial amounts of the human 60 kD homologue (hsp60) were produced by insertion of the gene into Escherichia coli. To investigate the hypothesis that T-cell reactivity is directed against the endogenous hsp, T-cell proliferation of synovial-fluid and peripheral-blood mononuclear cells in response to hsp60 was studied in samples from six patients with juvenile chronic arthritis (JCA) and nine adult patients with rheumatoid arthritis (RA). There was no T-lymphocyte proliferative response to purified fractions of hsp60 in mononuclear cells from RA patients or healthy children and young adults. However, both synovial-fluid and peripheral-blood mononuclear cells from JCA patients showed substantial proliferative responses. There was a significant correlation between the stimulation indices for human hsp60 and for mycobacterial hsp65 (r = 0.948, p less than 0.02). A similar correlation for hsp60 and mycobacterial hsp70 did not achieve significance. Immunohistochemistry showed that hsp65 and hsp70 homologues were expressed in the synovial membrane in these patients but not in controls. These findings suggest a sequence of events in which hsps become expressed during synovial inflammation and function as autoantigens. In JCA this may be manifested by specific T-cell reactivity which apparently is lost in the more bone-eroding and non-remitting adult disease.
Synchronous arytenoid and pancreatic neuroendocrine carcinoma. Neuroendocrine laryngeal carcinoid tumours are uncommon. The supraglottis is the main location of these tumours. Eighty-one cases have been reported in the world literature. We present the first case of a synchronous laryngeal and pancreatic neuroendocrine tumour.
Importance of left ventricular systolic function in the assessment of left ventricular diastolic function with Doppler transmitral flow velocity recording. To study the effect of left ventricular systolic function on the Doppler transmitral flow velocity pattern, Doppler echocardiographic variables were correlated with hemodynamic indexes in 11 control subjects and 58 patients with heart disease. All underwent cardiac catheterization performed with use of a Millar micromanometer. The time constant of left ventricular isovolumetric pressure decrease and left ventricular end-diastolic myocardial stiffness was calculated. The 58 patients were classified into two groups according to ejection fraction: group I (n = 30; ejection fraction greater than 55%) and group II (n = 28; ejection fraction less than 50%). Compared with the control subjects, patients in group I had impairment only of left ventricular relaxation (time constant 47 +/- 9 vs. 38 +/- 3 ms; p less than 0.01), whereas patients in group II had, in addition to impaired left ventricular relaxation (time constant 52 +/- 11 vs. 38 +/- 3 ms; p less than 0.01), increased preload, increased pulmonary capillary pressure (12 +/- 8 vs. 5 +/- 3 mm Hg; p less than 0.01) and increased myocardial stiffness (2,018 +/- 980 vs. 1,050 +/- 218 g/cm2; p less than 0.01). In group I, there was a significant partial correlation coefficient between the time constant and deceleration half-time (r = 0.54). In group II, a strong correlation existed between myocardial stiffness and peak atrial filling velocity (r = -0.71) and between myocardial stiffness and the ratio of peak atrial to peak rapid filling velocity (r = -0.71).
A critical evaluation of new agents for the treatment of sepsis. OBJECTIVE - To evaluate new treatments directed against endotoxin, tumor necrosis factor alpha, and interleukin 1 for use in sepsis and related disorders (sepsis syndrome and septic shock). DATA SOURCES - Investigations of these treatments in animal models, healthy human volunteers, and patients with sepsis and related disorders. STUDY SELECTION - Particular attention was paid to studies of patients with sepsis and related disorders, especially randomized, double-blind, controlled trials. DATA EXTRACTION - Animal studies and investigations with human volunteers were judged by how closely the experimental model replicated the clinical disorder (sepsis). Patient trials were assessed by sample size and design. Results of all studies were used to evaluate the likelihood that a given treatment would reduce mortality. DATA SYNTHESIS - Direct comparison of E5 and HA-1A antibody studies is difficult because of differences in their design, definitions of shock, and methods of subgroup analysis. However, both antibodies improve outcome in some subgroups: E5 benefits patients with gram-negative infection (bacteremic or focal) who do not have refractory shock, and HA-1A benefits those with gram-negative bacteremia (regardless of whether shock is present) but not those with focal gram-negative infection. Two agents that may be beneficial in gram-positive and gram-negative infection are monoclonal antibodies to tumor necrosis factor alpha and receptor antagonists to interleukin 1. Preliminary results with both are reviewed. CONCLUSIONS - All three types of treatment may improve outcome in sepsis. The best results will probably be obtained with combination therapy that interrupts multiple points of the inflammatory cascade underlying sepsis.
Islet amyloid polypeptide in proliferating pancreatic B cells during development, hyperplasia, and neoplasia in humans and mice. The occurrence of islet amyloid polypeptide (IAPP) immunoreactivity was investigated in fetal pancreas, islet cell hyperplasia, and tumors in humans and mice. Transgenic mice heritably developing endocrine tumors of the pancreas (AVP/SV40, Rip 1 Tag2/Rip2PyST1 and Glu2-Tag strains) were used as murine models of islet cells proliferative disease. In the mouse, IAPP immunoreactivity was found in B cells at embryonic day 12 (E12), paralleling the onset of insulin immunoreactivity. In hyperplastic/dysplastic islets and in B-cell tumors of transgenic mice (n = 16), IAPP immunoreactivity was localized consistently to insulin-immunoreactive cells. Ultrastructural single- and double-immunogold labeling of transgenic mice B-cell tumors (n = 3) showed insulin and IAPP to be colocalized in beta granules. In human fetuses, IAPP immunoreactivity was found in insulin-immunoreactive B cells, but at a later gestational age than the onset of insulin immunoreactivity. In pancreatic specimens of infantile/neonatal persistent hyperinsulinemic hypoglycemia (11 cases) and in pancreatic endocrine tumors (21 cases, 10 of which were functioning insulinomas), IAPP immunoreactivity was found consistently in insulin-immunoreactive B cells. Congo-red-positive amyloid deposits present in tumors also were IAPP immunoreactive. Ultrastructural single and double immunogold labeling of infantile/neonatal persistent hyperinsulinemic hypoglycemia cases (n = 3) and functioning insulinomas (n = 2) showed IAPP and insulin to be colocalized in beta granules. In addition, IAPP immunoreactivity was observed in amyloidlike fibrils. These findings indicate that IAPP is a constitutive component of B cells. Possible relationships between IAPP and insulin expression and interspecies differences are suggested and discussed.
Repair of abdominal aortic aneurysms. A statewide experience. The results of elective treatment of abdominal aortic aneurysms are excellent in many institutions. To our knowledge, however, no study has compared the results in a large geographic area in which patients were treated by a variety of surgeons and hospitals. We studied the results of repairing abdominal aortic aneurysms for all Medicare recipients during a single year in Kentucky. One hundred thirty-six operations were performed by 52 surgeons in 31 hospitals. Overall operative mortality was 18%; elective and emergency operative mortality rates were 6% and 49%, respectively. Advancing age did not affect outcome, but mortality due to ruptured aneurysms was higher in smaller hospitals than in larger hospitals. The low mortality for elective repair of abdominal aortic aneurysms in an elderly population by numerous surgeons in divergent hospitals is a strong indication for its liberal use compared with the high mortality and morbidity of emergency surgery.
Anticardiolipin and antineutrophil antibodies in giant cell arteritis. IgG anticardiolipin antibodies (aCL) were found in a patient with Takayasu's arteritis and then in 11 of 22 patients with temporal arteritis (TA) studied prospectively. In comparison IgG aCL were found in only one of 18 elderly controls with rheumatoid arthritis and one of 47 healthy elderly controls. In TA IgG aCL were more frequent in those with acute disease (8/12), in those with an accompanying history of polymyalgia rheumatica (9/13), p less than 0.05); and levels normalized with corticosteroid treatment. Antineutrophil cytoplasmic antibodies (c-ANCA) were present in one patient with TA who had no systemic disease.
Evolution of insulin secretory response to glucose by perifused islets from lean (FA/FA) rats chronically infused with glucose. Chronic infusion of nondiabetic rats with glucose for up to 7 days modified the insulin secretory response by subsequently perifused islets. Thus, on the 1st day of infusion with 40% glucose, the islets responded to 16.7 mM glucose with a 3.9-fold increase in insulin release during the first 10 min with no significant change during the second-phase insulin output compared with the control group. On the 2nd day, there was a 2-fold enhancement of insulin release during the initial 10 min of stimulation, the second phase being a similar to control islets. On the 5th day of infusion, the pattern of insulin release was not significantly different from the control group. After 7 day of infusion, there was a 46% decrease in first-phase and a 33% decrease in second-phase insulin response to glucose. The response to 10 mM arginine plus 5 mM glucose was not modified by chronic glucose infusion. Priming experiments indicate that islets from rats infused for 7 days were not able to recover the normal pattern of secretion in vitro. Islets from 7-day glucose-infused rats contained 75% more protein and had a significantly higher insulin content than control islet, suggesting that insulin synthesis is not involved in the loss of the response observed. Glucose metabolism by the islets was modified by glucose infusion with a significant increase in glucose utilization and no changes in glucose oxidation, suggesting that alterations in mitochondrial oxidative events are involved in the phenomenon of desensitization.
Long-term results of choledochoduodenostomy in the treatment of choledocholithiasis: assessment of 225 cases. During a 10-year period 2610 patients were operated on for biliary lithiasis; in 225 (8.6 per cent) cases the operation concluded with a choledochoduodenostomy. The commonest preoperative diagnosis (62.2 per cent) in these 225 patients was choledocholithiasis; 30 patients had previously had a cholecystectomy. After choledochoduodenostomy, 4.0 per cent of patients had an intra-abdominal complication; six patients developed an intra-abdominal abscess and three developed an external biliary fistula. Four patients (1.8 per cent) died, three from pulmonary complications and one from a biliary fistula. After a mean follow-up period of 4.6 years, 71.5 per cent of patients were asymptomatic. The remainder suffered from dyspepsia (15.1 per cent), colicky pain (8.7 per cent) or episodes of cholangitis (4.7 per cent). Endoscopy in the symptomatic patients allowed the following conclusions: (a) no patient with dyspepsia had a problem at the anastomosis; (b) 27 per cent of those with colic had anastomotic stenosis or the sump syndrome; and (c) all patients with cholangitis had anastomotic stenosis and residual calculi.
Adequacy of preparation for barium enema among elderly outpatients. OBJECTIVE: To determine whether outpatients 75 years of age or older have a higher rate of inadequate bowel preparation for barium enema and of complications associated with the preparation and the test than patients aged 55 to 74 years. DESIGN: Cross-sectional survey. SETTING: Radiology department in a teaching hospital. PATIENTS: Patients 55 years or older referred for a barium enema from March to August 1988. OUTCOME MEASURES: All films were reviewed independently by a study radiologist blind to the staff radiologist's report. Patients were interviewed by telephone within several days after the test to assess the occurrence of problems during the preparation or the test. MAIN RESULTS: Of the 213 patients assessed 72 were excluded: 43 refused to participate or could not be contacted, 16 had previously undergone colonic surgery, and 13 were excluded for other reasons. The remaining 141 patients were separated into three age groups: those 55 to 64 years (46 patients), those 65 to 74 (47) and those 75 or older (48). In 104 cases (74%) the bowel had been prepared adequately; there was no significant difference between the three groups with regard to the adequacy of preparation. The incidence of problems reported by the patients did not differ significantly between the groups. CONCLUSIONS: Outpatients aged 75 years or more are no more likely than those aged 55 to 74 to have problems with bowel preparation or the barium enema itself. Age should not be a criterion for exclusion from barium enema. To try to lower the rate of poor bowel preparation clinicians and radiologists should consider counselling patients more carefully about the importance of proper preparation. Also, the current method of preparation could be examined to determine whether simple changes would significantly improve colon cleanliness.
Transmission of hepatitis C virus by organ transplantation BACKGROUND. Liver disease is a frequent and major complication after organ transplantation. We sought to determine whether hepatitis C virus (HCV) is transmitted by organ transplantation and whether it causes post-transplantation liver disease. METHODS. Serum samples from all cadaver organ donors to the New England Organ Bank between 1986 and 1990 were screened retrospectively for antibodies to HCV (anti-HCV) by enzyme-linked immunosorbent assay (ELISA). We reviewed the hospital records of all recipients of organs from anti-HCV-positive donors for evidence of liver disease. Serum samples from recipients obtained before transplantation and during follow-up were analyzed for anti-HCV. RESULTS. Of 716 organ donors, 13 (1.8 percent) were positive for anti-HCV. Their organs (19 kidneys, 6 hearts, and 4 livers) went to 29 recipients. Non-A, non-B hepatitis developed after transplantation in 14 of the 29 (48 percent), for a prevalence 7.4 times the 6.5 percent prevalence after transplantation from untested donors that was previously reported by two institutions in the organ bank (P less than 0.0001). The liver disease began a mean of 3.8 months after transplantation and became chronic in 12 patients; the other 2 had subfulminant hepatic failure. Liver disease was more frequent in the patients who had received antilymphocyte preparations (P = 0.04). HCV was the cause of the post-transplantation liver disease in 12 of the 13 recipients (92 percent) for whom serum samples were available. Anti-HCV was detected by ELISA in eight and enzyme immunoassay in one; in three others, HCV RNA was detected by polymerase chain reaction in serum samples obtained after transplantation. CONCLUSIONS. Organ transplantation can transmit hepatitis C. This raises serious questions about the continued acceptance of organs from donors positive for anti-HCV.
Prostaglandin F2 alpha inhibits the ammoniagenic response to acute acidosis in LLC-PK1 cells. A kidney epithelial cell line, LLC-PK1, which does not synthesize prostaglandins, provides an ideal in vitro model system to investigate the effect of prostaglandins in the regulation of renal ammoniagenesis. Previous studies from our laboratory have demonstrated significant increases in glutamine-dependent ammonia and alanine production by rocked cultures of LLC-PK1 cells subjected to either acute metabolic or respiratory acidosis. In the study presented here, experiments were conducted to investigate the role of prostaglandin F2 alpha (PGF2 alpha) and prostaglandin E2 (PGE2) in the response of ammonia metabolism to acute metabolic acidosis by LLC-PK1 cells. A low dose of PGF2 alpha (0.1 ng/mL) dramatically inhibited the stimulatory effect of a low pH (pH 6.8) on ammonia production. In contrast, the inhibition of cytosolically generated alanine was less dramatic and averaged only 20% of the effect on ammonia production. Furthermore, PGF2 alpha increased cellular alpha-ketoglutarate concentration, suggesting an increase in intramitochondrial pH. Thus, the cellular mechanism of PGF2 alpha action appears to involve either interference with the cytosolic pH signal or its translation to the intramitochondrial compartment. The inhibitory response of PGF2 alpha on pH-stimulated ammoniagenesis was progressively lost at higher concentrations. Both low-dose (0.1 ng/mL) and high-dose (10 ng/mL) PGF2 alpha had no significant effect on the basal rates of ammonia and alanine production at pH 7.4. PGE2, on the other hand, did not exhibit any significant response on ammonia or alanine production at either pH 6.8 or 7.4 when given in a wide range of doses.
Treatment of children with Down syndrome and growth retardation with recombinant human growth hormone. The effect of recombinant human growth hormone on children with Down syndrome who had growth retardation and microcephaly was examined. Thirteen children with trisomy 21 without congenital heart disease who were short for age (-1.19 to -3.5 standard deviation score) and microcephalic (-1.58 to -6.60 standard deviation score) were given recombinant human growth hormone, 0.1 mg/kg subcutaneously, 3 days a week for 1 year. Before treatment, peak serum growth hormone concentrations were less than 10 micrograms/L after levodopa and clonidine stimulation tests in five patients, after clonidine in three patients, and after levodopa in three patients. Three patients had nocturnal integrated growth hormone concentrations of 0.5, 1.5 and 0.65 micrograms/L, respectively. The mean growth rate before treatment was 5.4 +/- 1.6 cm/yr and increased to 12.2 +/- 3.2 cm/yr (p less than 0.001) after 12 months of recombinant human growth hormone treatment. The mean head circumference standard deviation score before treatment was -3.1 +/- 1.3 and increased to -2.3 +/- 1.2 (p less than 0.001) at 12 months. Bone age before and 1 year after treatment increased in correspondence with chronologic age. Plasma hemoglobin A1c concentration was normal during treatment with recombinant human growth hormone. The mean plasma concentrations of insulin-like growth factor I at baseline and at 12 months were 0.54 +/- 0.19 U/ml and 1.25 +/- 0.97 U/ml, respectively (p less than 0.02). We conclude that recombinant human growth hormone therapy can result in a significant increase in annual growth rate and head circumference in children with Down syndrome, without significant side effects.
A pilot study of stanozolol for advanced breast carcinoma. Eighteen patients with advanced metastatic carcinoma of the breast who had been previously treated with other hormone therapy were treated with stanozolol in a pilot study to assess its efficacy and toxicity. In a heavily pretreated population of patients with advanced breast cancer, three patients (16.6%) had partial responses (PR) and five patients (27.7%) had stable disease (SD). Toxicity was far less than that expected with androgen therapy. Stanozolol should be investigated in large groups of patients to establish its role more fully in the management of metastatic breast carcinoma.
Cutaneous botryomycosis. We report four cases of cutaneous botryomycosis. The predisposing factors included alcoholism, diabetes, and trauma. Clinically, the patients had nodules, suppurative plaques, or ulcers. In two cases, Staphylococcus aureus was cultured. In one case Neisseria species was cultured and in another a coagulase-negative Staphylococcus and Corynebacterium species were the only organism cultured. All patients responded to systemic antibiotic therapy.
A unique bone-like variant of alkaline phosphatase. The authors describe an unusual variant of alkaline phosphatase (ALP) discovered in a patient with a 90-fold increase in serum ALP. The variant ALP was indistinguishable from the bone isoenzyme when subjected to chemical inhibition, heat inactivation, lectin precipitation, and routine electrophoresis. However, treatment with neuraminidase produced a marked decrease in the ALP variant's electrophoretic mobility and a reduction in its molecular weight. A bone marrow biopsy revealed metastatic infiltration of the bone marrow by adenocarcinoma of the prostate accompanied by a remarkable amount of new bone formation, suggesting a bone origin for the unusual isoenzyme. The authors believe this to be the first report of an ALP variant with these properties.
Migraine and epilepsy with infantile onset and electroencephalographic findings of occipital spike-wave complexes. An EEG finding of temporo-occipital or temporo-parieto-occipital spike-wave complexes, suppressed by eye opening, coexisting with classical migraine, was observed in 14 children; in 13 of these patients, seizures were present. Classical migraine, visual phenomena and seizures coexisted in different clinical patterns.
In-vitro DNA synthesis of keratinocytes in normal human skin, psoriasis, seborrhoeic keratosis, Bowen's disease and basal cell carcinoma. The DNA-synthesizing cells in benign and malignant keratotic diseases including psoriasis, seborrhoeic keratosis, Bowen's disease and basal cell carcinoma were studied. Cells in S-phase were labelled after small pieces of the lesions were incubated in tissue culture medium that contained 5-bromo-2'-deoxyuridine (BrdU). The labelling of DNA was analysed using the labelling index and pattern. Although the malignant diseases tended to show a higher DNA labelling index, neither this nor the loss of polarity alone was associated with malignancy. However, a higher DNA labelling index together with a loss of polarity was characteristic for malignancy.
Disorders of the hair and scalp in children. A wide variety of disorders involving the scalp and hair exist that may be encountered in the pediatric and adolescent population. An approach to the differential diagnosis of many of these conditions can be considered once the patient is found to have either alopecia, scaling, or tumors of the scalp. Certainly other causes of scalp or hair disease exist but the more common disorders can be appropriately considered in this manner.