All live births > or = 23 weeks at the University of Vermont in 1995 ( n = 2395 ) were retrospectively analyzed for delivery route , indication for cesarean , gestational age , parity , and practice group ( to reflect risk status ) .||NONE
The total cesarean rate was 14.4 % ( 344 of 2395 ) , and the primary rate was 11.4 % ( 244 of 2144 ) .||NONE
Abnormal presentation was the most common indication ( 25.6 % , 88 of 344 ) .||NONE
The `` corrected '' cesarean rate ( maternal-fetal medicine and transported patients excluded ) was 12.4 % ( 273 of 2194 ) , and the `` corrected '' primary rate was 9.6 % ( 190 of 1975 ) .||NONE
Furthermore , when all deliveries were analyzed , regardless of risk status but limited to gestational age > or = 36 weeks , the rates did not change ( 12.6 % , 280 of 2214 ; primary 9.2 % , 183 of 1994 ) .||NONE
Arrest of dilation was the most common indication in both `` corrected '' subgroups ( 23.4 and 24.6 % , respectively ) .||NONE
Cesarean rates at tertiary care hospitals should be compared with rates at community hospitals only after correcting for dissimilar patient groups or gestational age .||NONE
In the third trimester , the amniotic fluid index ( AFI ) may be affected by maternal fluid status .||NONE
As the ambient temperature increases , there is an increase in insensible fluid loss and the potential for dehydration .||NONE
We hypothesize that as temperature increases there would be a concomitant decrease in AFI .||NONE
From June 11 to August 16 , 1993 , during a period of unusual high heat , 42 women with singleton pregnancies between 27 and 40 weeks ' gestation undergoing serial antenatal testing had AFI determinations recorded at least weekly .||NONE
The daily high ambient temperature in our urban area was subsequently obtained .||NONE
A 2- , 3- , and 4-day mean temperature prior to the test date was compared to AFI using a Spearman-rank Correlation .||NONE
The daily high temperature ranged from 71 to 104 degrees F and AFI values ranged from 1.7 to 24.7 cm during the study period .||NONE
There was a significant correlation between the 2- , 3- , and 4-day mean temperature and AFI , with the 4-day mean being the most significant ( r = 0.31 , p & # 60 ; 0.001 ) .||NONE
Fluctuations in ambient temperature are inversely correlated to changes in AFI .||NONE
This relationship should be taken into account when interpreting the AFI as a measure of fetal well-being .||NONE
This study tested the hypothesis that to reduce the rate of macrosomic infants in gestational diabetes cases , good glycemic control should be initiated before 34 completed gestational weeks .||NONE
The study population included 84 women with gestational diabetes , ascertained by universal screening of all women attending the antenatal clinic of the Hadassah Medical Center , over a 2-year period .||DISONLY
The 60 women ( 71 % ) , who initiated treatment before 34 completed weeks , composed the `` early '' group .||NONE
The 24 women ( 29 % ) , who initiated treatment after the 34th week , composed the `` late '' group .||NONE
All patients were managed by an intensified protocol , including stringent glycemic control .||TREATONLY
In the `` early '' and `` late '' groups , mean gestational age at the beginning of treatment was 30.0 +/- 3.8 and 36.2 +/- 1.2 weeks , and duration of treatment was 9.6 +/- 4.1 and 3.7 +/- 1.8 weeks , respectively .||NONE
Maternal characteristics were similar in the two groups .||NONE
The rate of macrosomic and large-for-gestational-age infants were 5 and 11 % , respectively , in the early group as compared to 25 and 29 % in the `` late '' group ( p & # 60 ; 0.05 ) .||NONE
No significant differences were found between the two groups in the mode of delivery or Apgar scores .||NONE
We conclude that to reduce the rate of macrosomic infants in gestational diabetes cases , good glycemic control should be initiated before 34 completed gestational weeks .||PREVENT
Our aim was to investigate the contribution of certain antenatally detectable markers leading to the diagnosis of trisomic fetuses we observed over a period of 6 years .||NONE
In our study , we specifically analyzed the role played by advanced maternal age and sonographically discovered abnormalities in the detection of autosomal trisomies .||DISONLY
All together , 27 fetuses had this disorder , representing 28.7 % ( 27 of 94 ) of all cytogenetic aberrations detected at our center over the same period .||DISONLY
Down syndrome ( 12 cases ) and Edward syndrome ( 11 cases ) were the most common trisomies , while 4 cases of Patau syndrome were also diagnosed .||DISONLY
The most common indication leading to diagnosis was abnormal ultrasound finding ( 48.2 % ) , followed by advanced maternal age ( 44.4 % ) .||NONE
However , 63 % of the trisomic fetuses belonged to mothers aged 35 years and above .||NONE
Down syndrome fetuses ( 41.7 % ) had prenatally detected sonographic anomalies , 63.6 % for Edward syndrome , and all fetuses with Patau syndrome ( 4 of 4 ) showed abnormal sonographic signs .||DISONLY
Trisomy 21 presented with the following features : hydramnios , complex malformations , pyelectasis , and duodenal atresia .||DISONLY
Trisomy 18 fetuses showed hydramnios , intrauterine growth retardation , microcephaly , spina bifida , and nonimmune hydrops fetalis .||DISONLY
Signs observed in fetuses with trisomy 13 were : hydrocephalus , intrauterine growth retardation , oligoanhydramnios , complex malformations , severe fetal bradycardia and hydronephrosis .||DISONLY
The objective of this study was to determine if the rate of preeclampsia is increased in triplet as compared to twin gestations .||DISONLY
Fifty-three triplet pregnancies between 1986 and 1993 at The New York Hospital-Cornell Medical Center were reviewed .||NONE
These were matched for maternal age , parity , and race to twin gestations ( N = 53 ) from the same population .||NONE
Severe preeclampsia was defined by standard criteria .||DISONLY
Student 's t-test , Fisher exact test , and Chi-square were used for statistical analysis .||NONE
The rate of severe preeclampsia was increased significantly in the triplet group 12 of 53 ( 22.6 % ) as compared with the twin group 3 of 53 ( 5.7 % ) ( OR = 4.9 , 95 % CI 1.2-23.5 , p = 0.02 ) .||DISONLY
The rate of overall preeclampsia was not significantly different in the triplet 18 of 53 ( 33.96 % ) or twin 12 of 53 ( 22.6 % ) groups .||DISONLY
In this retrospective , case-controlled study , the rate of severe pre-eclampsia was significantly increased in triplet gestations as compared to twins although the overall rate of preeclampsia was not .||DISONLY
This information may be useful in counseling patients with high order multifetal gestations .||NONE
We conducted a survey and audit of thermal equipment use in very low-birth-weight infants in five Ohio neonatal intensive care units ( NICUs ) to document regional practice .||NONE
The survey indicated a variety of thermal care styles .||NONE
Two NICUs preferred to admit infants to incubators , the other three favoring radiant warmers .||NONE
These three NICUs moved infants from radiant warmers into incubators at significantly different mean ages .||NONE
The audit demonstrated inconsistent use of plastic covers , warming mattresses , and added humidity under radiant warmers , and discrepancies between survey responses and actual use within NICUs .||NONE
Inter-NICU variability of thermal equipment use may complicate fluid management .||NONE
This report describes a full-term newborn with massive fetomaternal hemorrhage .||DISONLY
Fetal movements were decreased 48 hr prior to delivery .||NONE
On the day of delivery , they were absent .||NONE
The nonstress test was abnormal with low biophysical profile and decreased beat-to-beat variability .||NONE
The infant presented with extreme pallor , hypotonia , hepatosplenomegaly , and ascites .||DISONLY
The initial hemoglobin was 2.2 g/dL , the Kleihauer-Betke stain was 27.6 % ( highest level ever reported ) .||NONE
Right temporal and cerebellar hemorrhages were present .||NONE
Sequelae include severe developmental delay and asymmetric double hemiplegia .||DISONLY
Omphalocele-Exstrophy-Imperforate anus-Spinal defects ( OEIS complex ) , a combination of omphalocele , exstrophy of the bladder , an imperforate anus and spinal defects , arises from a single localized defect in the early development of the mesoderm that will later contribute to infraumbilical mesenchyme , cloacal septum , and caudal vertebrae .||DISONLY
In this report , we document the perinatal features of two cases of OEIS complex associated with meningomyeloceles and severe lower limb defects , and discuss the prenatal diagnosis , inheritance , and differential diagnosis of this association of malformations .||DISONLY
Although long-term survival can be achieved by successful corrective surgery , the associated structural defects such as large meningomyelocele and severe limb aplasia or hypoplasia , as seen in our patient , can influence the patient 's quality of life . ||VAGUE
We would like to emphasize that an accurate prenatal diagnosis of OEIS complex and associated malformations is important for the detailed counseling of the family as well as appropriate perinatal management by the obstetricians , pediatric surgeons , urologists , neurosurgeons , and neonatologists .||DISONLY
Nonimmune hydrops fetails diagnosed at 21 weeks ' gestation with profound ascites , hydrothorax , and pericardial effusion receded gradually with regression of a subchorial placental lucencies immediately below the umbilical cord insertion .||DISONLY
Careful inspection of the delivered placenta revealed that there was a yellowish lesion of fibrin deposits below the cord insertion site , which resulted from the absorption of hematoma .||NONE
A subchorial placental hematoma , which detected as a subchorial placental lucencies by ultrasonography , can be a cause of reversible nonimmune hydrops fetalis .||DISONLY
The mitochondrial diseases are uncommon multisystem disorders characterized by the presence of functionally and/or structurally abnormal mitochondria .||DISONLY
As there have been few reports of the obstetrical care of affected patients , we wish to document two pregnancies in a woman with a Chronic Progressive External Ophthalmoplegia ( Kearns-Sayre-like syndrome ) .||DISONLY
Both pregnancies were complicated by preterm labor and hypertension .||DISONLY
CONTEXT : Four genetic loci have been identified as contributing to Alzheimer disease ( AD ) , including the amyloid precursor protein gene , the presenilin 1 gene , the presenilin 2 gene , and the apolipoprotein E gene , but do not account for all the genetic risk for AD .||DISONLY
OBJECTIVE : To identify additional genetic risk factors for late-onset AD .||NONE
DESIGN : A complete genomic screen was performed ( N=280 markers ) .||NONE
Critical values for chromosomal regional follow-up were a P value of .05 or less for affected relative pair analysis or sibpair analysis , a parametric lod score of 1.0 or greater , or both .||NONE
Regional follow-up included analysis of additional markers and a second data set .||NONE
SETTING : Clinic populations in the continental United States .||NONE
PATIENTS : > From a series of multiplex families affected with late-onset ( > or =60 years ) AD ascertained during the last 14 years ( National Insititute of Neurological Disorders and Stroke-Alzheimer 's Disease and Related Disorders Association diagnostic criteria ) and for which DNA has been obtained , a subset of 16 families ( 135 total family members , 52 of whom were patients with AD ) was used for the genomic screen .||NONE
A second subset of 38 families ( 216 total family members , 89 of whom were patients with AD ) was used for the follow-up analysis .||NONE
MAIN OUTCOME MEASURES : Linkage analysis results generated using both genetic model-dependent ( lod score ) and model-independent methods .||NONE
RESULTS : Fifteen chromosomal regions warranted initial follow-up .||NONE
Follow-up analyses revealed 4 regions of continued interest on chromosomes 4 , 6 , 12 , and 20 , with the strongest results observed forchromosome 12 .||NONE
Peak 2-point affecteds-only lod scores ( n=54 ) were 1.3 , 1.6 , 2.7 , and 2.2 and affected relative pairs P values ( n=54 ) were .04 , .03 , .14 , and .04 for D12S373 , D12S1057 , D12S1042 , and D12S390 , respectively .||NONE
Sibpair analysis ( n=54 ) resulted in maximum lod scores ( MLSs ) of 1.5 , 2.6 , 3.2 , and 2.3 for these markers , with a peak multipoint MLS of 3.5 .||NONE
A priori stratification by APOE genotype identified 27 families that had at least 1 member with AD whose genotype did not contain an APOE*4 allele .||NONE
Analysis of these 27 families resulted in MLSs of 1.0 , 2.4 , 3.7 , and 3.3 and a peak multipoint MLS of 3.9 .||NONE
CONCLUSIONS : A complete genomic screen in families affected with late-onset AD identified 4 regions of interest after follow-up .||NONE
Chromosome 12 gave the strongest and most consistent results with a peak multipoint MLS of 3.5 , suggesting that this region contains a new susceptibility gene for AD .||NONE
Additional analyses are necessary to identify the chromosome 12 susceptibility gene for AD and to follow up the regions of interest on chromosomes 4 , 6 , and 20 .||NONE
CONTEXT : A mutation in the BRCA1 gene may confer substantial risk for breast and/or ovarian cancer .||DISONLY
However , knowledge regarding all possible mutations and the relationship between risk factors and mutations is incomplete .||NONE
OBJECTIVES : To identify BRCA1 mutations and to determine factors that best predict presence of a deleterious BRCA1 mutation in patients with breast and/or ovarian cancer .||DISONLY
DESIGN : A complete sequence analysis of the BRCA1 coding sequence and flanking intronic regions was performed in 798 women in a collaborative effort involving institutions from the United States , Italy , Germany , Finland , and Switzerland .||NONE
PARTICIPANTS : Institutions selected 798 persons representing families ( 1 person for each family ) thought to be at elevated a priori risk of BRCA1 mutation due to potential risk factors , such as multiple cases of breast cancer , early age of breast cancer diagnosis , and cases of ovarian cancer .||DISONLY
No participant was from a family in which genetic markers showed linkage to the BRCA1 locus .||NONE
MAJOR OUTCOME MEASURES : Sequence variants detected in this sample are presented along with analyses designed to determine predictive characteristics of those testing positive for BRCA1 mutations .||NONE
RESULTS : In 102 women ( 12.8 % ) , clearly deleterious mutations were detected .||NONE
Fifty new genetic alterations were found including 24 deleterious mutations , 24 variants of unknown significance , and 2 rare polymorphisms .||NONE
In a subset of 71 Ashkenazi Jewish women , only 2 distinct deleterious mutations were found : 185delAG in 17 cases and 5382insC in 7 cases .||NONE
A bias in prior reports for mutations in exon 11 was revealed .||NONE
Characteristics of a patient 's specific diagnosis ( unilateral or bilateral breast cancer , with or without ovarian cancer ) , early age at diagnosis , Ashkenazi Jewish ethnicity , and family history of cancer were positively associated with the probability of her carrying a deleterious BRCA1 mutation .||DISONLY
CONCLUSIONS : Using logistic regression analysis , we provide a method for evaluating the probability of a woman 's carrying a deleterious BRCA1 mutation for a wide range of cases , which can be an important tool for clinicians as they incorporate genetic susceptibility testing into their medical practice .||NONE
CONTEXT : Approximately 9 % of prostate cancer cases have been estimated to result from inheritance of mutated prostate cancer susceptibility genes .||DISONLY
Few data exist as to whether there are clinical differences between prostate cancers that are inherited and those that occur in the general population .||DISONLY
OBJECTIVE : To investigate phenotypic characteristics of families potentially linked to the hereditary prostate cancer 1 ( HPC1 ) locus on chromosome 1q24-25 .||NONE
DESIGN : Retrospective case study in which clinical data were extracted from medical and pathological records .||NONE
FAMILIES : A total of 74 North American families with hereditary prostate cancer .||DISONLY
Prostate cancer cases from the National Cancer Data Base were used as a reference population for comparison .||NONE
MAIN OUTCOME MEASURES : The families were divided into 2 groups : either potentially linked ( 33 families with 133 men with prostate cancer ) , and thus likely to be carrying an altered HPC1 gene , or potentially unlinked ( 41 families with 172 men with prostate cancer ) , on the basis of haplotype analysis in the region of HPC1 .||DISONLY
The age at diagnosis of prostate cancer , serum prostate-specific antigen levels , digital rectal examination status , stage , grade , primary treatment of prostate cancers , and occurrence of other cancers were compared between the groups .||DISONLY
RESULTS : The mean age at diagnosis of prostate cancer for men in potentially linked families was significantly lower than for men in potentially unlinked families ( 63.7 vs 65.9 years , respectively , P=.01 ; mean age at diagnosis in the reference population was 71.6 years ) .||DISONLY
Higher-grade cancers ( grade 3 ) were more common in potentially linked families , and advanced-stage disease was found in 41 % of the case patients in potentially linked families compared with 31 % in both the potentially unlinked families and the reference groups ( P=.03 for the latter comparison ) .||DISONLY
In the other clinical parameters , we found no significant differences between the groups .||NONE
A modest excess of breast cancer and colon cancer was found in potentially linked families in comparison with potentially unlinked families , but this difference was not statistically significant .||DISONLY
CONCLUSIONS : Families that provide evidence for segregation of an altered HPC1 gene are characterized by multiple cases of prostate cancer that , in most respects , are indistinguishable from nonhereditary cases .||DISONLY
However , 3 characteristics were observed : younger age at diagnosis , higher-grade tumors , and more advanced-stage disease .||DISONLY
Our study shows that a significant fraction of hereditary prostate cancers are diagnosed in advanced stages , emphasizing the clinical importance of early detection in men potentially carrying prostate cancer susceptibility genes .||DISONLY
These findings support the current recommendations to screen men with a positive family history of prostate cancer beginning at age 40 years .||DISONLY
CONTEXT : Susceptibility to multiple sclerosis ( MS ) involves a genetically complex autoimmune component .||DISONLY
However , except for genes in the HLA system , specific susceptibility loci are unknown or unconfirmed .||NONE
OBJECTIVE : To investigate several loci spanning 3 candidate regions for a role in multiple sclerosis ( MS ) susceptibility in 2 ethnic groups using both single-locus and haplotype analyses .||DISONLY
The 3 regions include HLA on chromosome 6p21.3 , APOE on chromosome 19ql 3.2 , and MBP ( myelin basic protein ) on chromosome 18q23 .||NONE
DESIGN : Case-control association testing .||NONE
SUBJECTS : A total of 120 Caucasian patients with MS and 107 unrelated control individuals from California , and 32 patients and 32 unrelated control individuals from Beijing , China .||NONE
All patients with MS were diagnosed as having clinically definite disease according to published criteria .||NONE
MAIN OUTCOME MEASURES : Chi2 Testing of loci and individual alleles and haplotypes .||NONE
Haplotype frequencies were estimated with standard maximum likelihood methods .||NONE
RESULTS : The HLA effect is due to the class II DR2 haplotype , DRB1*1501-DQA1*0102-DRB1*0602 ; contributions to MS susceptibility from additional DRB1-DQB1 alleles or other HLA region loci were not observed .||NONE
Variation within the MBP locus on chromosome 18q23 showed no effect in MS .||NONE
The distribution of haplotypes from 5 loci within the chromosome 19q13.2 region , including D19S178 , D19S574 , APOE , APOC2 , and D19S219 , differed between patient and control samples .||NONE
D19S574 showed a significant effect ( P=.015 ) in Caucasian patients with MS due to the increased frequency of a single allele ( P=.002 ) .||NONE
The APOE variation , prominent in other neurological diseases , showed no influence on MS susceptibility , despite its location within the chromosome 19q13.2 region .||NONE
Interaction effects between DR2 and chromosome 19q13.2 or MBP in MS susceptibility were not apparent .||NONE
CONCLUSIONS : The significant chromosome 19q13.2 single-locus and multilocus haplotype associations with MS in Caucasian and Chinese patient samples indicate an effect from a nearby disease susceptibility locus .||NONE
These initial observations are an encouraging step toward the description of non-HLA genetic susceptibility to MS .||NONE
CONTEXT : There is a substantial risk of a second cancer for persons with hereditary retinoblastoma , which is enhanced by radiotherapy .||TO_SEE
OBJECTIVE : To examine long-term risk of new primary cancers in survivors of childhood retinoblastoma and quantify the role of radiotherapy in sarcoma development .||TO_SEE
DESIGN : Cohort incidence study of patients with retinoblastoma followed for a median of 20 years , and nested case-control study of a radiation dose-response relationship for bone and soft tissue sarcomas .||NONE
SETTING/PARTICIPANTS : A total of 1604 patients with retinoblastoma who survived at least 1 year after diagnosis , identified from hospital records in Massachusetts and New York during 1914 to 1984 .||DISONLY
RESULTS : Incidence of subsequent cancers was statistically significantly elevated only in the 961 patients with hereditary retinoblastoma , in whom 190 cancers were diagnosed , vs 6.3 expected in the general population ( relative risk ( RR ) , 30 ( 95 % confidence interval , 26-47 ) ) .||DISONLY
Cumulative incidence ( +/-SE ) of a second cancer at 50 years after diagnosis was 51.0 % ( +/-6.2 % ) for hereditary retinoblastoma , and 5.0 % ( +/-3.0 % ) for nonhereditary retinoblastoma .||DISONLY
All 114 sarcomas of diverse histologic types occurred in patients with hereditary retinoblastoma .||DISONLY
For soft tissue sarcomas , the RRs showed a stepwise increase at all dose categories , and were statistically significant at 10 to 29.9 Gy and 30 to 59.9 Gy .||DISONLY
A radiation risk for all sarcomas combined was evident at doses above 5 Gy , rising to 10.7-fold at doses of 60 Gy or greater ( P & # 60 ; .05 ) .||NONE
CONCLUSIONS : Genetic predisposition has a substantial impact on risk of subsequent cancers in retinoblastoma patients , which is further increased by radiation treatment .||TO_SEE
A radiation dose-response relationship is demonstrated for all sarcomas and , for the first time in humans , for soft tissue sarcomas .||NONE
Retinoblastoma patients should be examined for new cancers and followed into later life to determine whether their extraordinary cancer risk extends to common cancers of adulthood .||DISONLY
The objective of this study was to determine the rate of recent cocaine use among a metropolitan population of predominantly Hispanic and African-American women with preterm premature rupture of the membranes ( PROM ) and to ascertain the impact of cocaine on the latency period between rupture of membranes and delivery .||DISONLY
Urine toxicology screens were prospectively obtained on 147 women with preterm PROM .||DISONLY
The urine screen did not influence management decisions .||NONE
All women were expectantly managed without tocolytics until 37 weeks ' gestation unless they developed clinical chorioamnionitis , or nonreassuring fetal heart rate tracing or biophysical profile .||NONE
Demographic information , hours from rupture of membranes to delivery , gestational age , and birth weight at delivery were compared using Fisher 's exact , Mann-Whitney U , and randomization tests where appropriate .||NONE
The rate of positive urine drug screens for cocaine was 8.2 % .||NONE
Women in the cocaine positive group were of higher parity ( 3 , ( 0-7 ) vs. 1 , ( 0-6 ) , p = 0.001 ) and tended to be older ( 27 , ( 23-42 ) vs. 25 , ( 14-40 ) ) .||NONE
There was a higher rate of recent cocaine use among African-American women ( 20.4 % ) as compared to non-African-Americans ( 1.2 % , p = 0.0001 ) .||NONE
Cocaine-positive women presented at an earlier gestational age ( 32 weeks ' , ( 24-34 ) vs. 33 weeks ' , ( 23-36 ) , p = 0.02 ) and had a significantly longer membrane rupture to delivery interval than women with a negative urine drug screen ( 174 hr , ( 6-475 ) vs. 33 hours ( 1-833 ) , p = 0.01 ) .||NONE
There was no significant difference in the reason for delivery between the two groups of patients .||NONE
Recent cocaine use among women with preterm PROM is common in only some segments of an urban population .||DISONLY
Women with recent cocaine use present with ruptured membranes at an earlier gestational age and may actually have a longer latency period than women who do not use cocaine .||NONE
The objective of this article is to explore attitudes of an inner-city , pregnant cohort about general and HIV-related prenatal care .||NONE
Responses to an interview at initial prenatal care enrollment were compared using Chi-square and Fisher 's exact tests .||NONE
Of 75 women , drug users ( 51 % ) were more likely to say that they would defer initiating prenatal care ( P = 0.03 ) and to minimize the risk of drug or alcohol use to the fetus ( P = 0.04 ) .||NONE
Most ( 85 % ) viewed pregnancy as inappropriate for HIV infected women and primarily drug users ( P = 0.06 ) would abort if HIV infected .||DISONLY
Over half thought HIV transmission occurred most times or always .||DISONLY
Only 20 % had heard of a drug to reduce this risk , but 95 % would take such a therapy .||NONE
These inner-city , pregnant women disapproved of pregnancy if HIV infected and thought the risk of transmission was high .||DISONLY
They knew little of how to reduce this risk but nearly all would accept a drug to prevent transmission .||NONE
The association of parvovirus B19 infection and hydrops fetalis is well known .||DISONLY
However , the association of parvovirus and fetal pleural or pericardial effusions has not been reported .||DISONLY
We present five cases of isolated pleural or pericardial effusion with documented maternal parvovirus infection in four of these pregnancies .||DISONLY
In the absence of structural or karyotypic abnormalities , spontaneous resolution of the effusion portends for a successful pregnancy outcome .||NONE
BACKGROUND : Cochlear implantation is nowadays a reliable and well-accepted method of auditory rehabilitation in selected adults and children .||TREATONLY
METHODS : We present rehabilitation data on 21 adult patients provided with the Nucleus CI22 M cochlear implant using the SPEAK strategy .||NONE
RESULTS : Results of first tune-up show an open set speech understanding in approximately 50 % of patients .||NONE
Long-term results also reveal further improvement in patients who had no open set speech understanding .||NONE
Our data seem to indicate similar results in comparison to other groups using the CIS strategy .||NONE
CONCLUSIONS : In adults , open set speech understanding can be achieved even at the first tune-up .||NONE
Results of early rehabilitation seem to be influenced by duration and etiology of deafness , experience with hearing aids , and other factors .||DISONLY
Adverse drug effects are manifold and heterogenous .||NONE
Many situations may hamper the signalling ( i.e. the detection of early warning signs ) of adverse effects and new signals often differ from previous experiences .||NONE
Signals have qualitative and quantitative aspects .||NONE
Different categories of adverse effects need different methods for detection .||NONE
Current pharmacovigilance is predominantly based on spontaneous reporting and is mainly helpful in detecting type B effects ( those effects that are often allergic or idiosyncratic reactions , characteristically occurring in only a minority of patients and usually unrelated to dosage and that are serious , unexpected and unpredictable ) and unusual type A effects ( those effects that are related to the pharmacological effects of the drug and are dosage-related ) .||NONE
Examples of other sources of signals are prescription event monitoring , large automated data resources on morbidity and drug use ( including record linkage ) , case-control surveillance and follow-up studies .||NONE
Type C effects ( those effects related to an increased frequency of 'spontaneous ' disease ) are difficult to study , however , and continue to pose a pharmacoepidemiological challenge .||NONE
Seven basic considerations can be identified that determine the evidence contained in a signal : quantitative strength of the association , consistency of the data , exposure response relationship , biological plausibility , experimental findings , possible analogies and the nature and quality of the data .||NONE
A proposal is made for a standard signal management procedure at pharmacovigilance centres , including the following steps : signal delineation , literature search , preliminary inventory of data , collection of additional information , consultation with the World Health Organization Centre for International Drug Monitoring and the relevant drug companies , aggregated data assessment and a report in writing .||NONE
A better understanding of the conditions and mechanisms involved in the detection of adverse drug effects may further improve strategies for pharmacovigilance .||NONE
OBJECTIVE : To study the safety and efficacy of methylphenidate in children with the dual diagnosis of epilepsy and attention deficit hyperactivity disorder ( ADHD ) .||TREAT_FOR_DIS
STUDY DESIGN : Thirty children , aged 6.4 to 16.4 years , with epilepsy and ADHD were studied during a 4-month period .||DISONLY
During the initial 2 months of the study , the children were treated with antiepileptic drugs ( AEDs ) only , and for the remaining 2 months , methylphenidate was added at a morning dose of 0.3 mg/kg .||TREATONLY
They underwent neurologic assessment , brain computed tomography , IQ testing , and assessment with the Childhood Behavior Checklist at baseline before methylphenidate therapy .||TREATONLY
Electroencephalography , AED determinations , and the continuous-performance task ( CPT ) test were done at baseline and after 2 months of methylphenidate therapy .||NONE
A double-blind , crossover design was used to compare the effects of methylphenidate versus placebo on an electroencephalogram , AED levels , and the CPT .||TREATONLY
On the 2 days of testing , the child received AEDs and a capsule containing either placebo or methylphenidate .||TREATONLY
RESULTS : None of the 25 children of this sample who were seizure free had attacks while taking methylphenidate .||NONE
Of the 5 children with seizures , 3 had an increase in attacks , whereas the other 2 showed no change or a reduction .||DISONLY
There were no significant changes in AED levels or electroencephalographic findings .||NONE
Methylphenidate benefited 70 % of children according to parental report ; methylphenidate also enhanced performance on the CPT .||TREATONLY
Side effects of methylphenidate were mild and transient .||TREATONLY
CONCLUSION : Methylphenidate is effective in treating children with epilepsy and ADHD and safe in children who are seizure free .||TREAT_FOR_DIS
Caution is warranted for those still having seizures while receiving AED therapy .||NONE
The temporal properties of semantic and phonological processes in speech production were investigated in a new experimental paradigm using movement-related brain potentials .||NONE
The main experimental task was picture naming .||NONE
In addition , a 2-choice reaction go/no-go procedure was included , involving a semantic and a phonological categorization of the picture name .||NONE
Lateralized readiness potentials ( LRPs ) were derived to test whether semantic and phonological information activated motor processes at separate moments in time .||NONE
An LRP was only observed on no-go trials when the semantic ( not the phonological ) decision determined the response hand .||NONE
Varying the position of the critical phoneme in the picture name did not affect the onset of the LRP but rather influenced when the LRP began to differ on go and no-go trials and allowed the duration of phonological encoding of a word to be estimated .||NONE
These results provide electrophysiological evidence for early semantic activation and later phonological encoding .||NONE
The effects of alanine and glycine substitution for tryptophan upon the species heterogeneity of gramicidin A analogs incorporated into SDS micelles have been investigated .||NONE
The sequential replacement of the four tryptophan residues in gramicidin A at positions 15 , 13 , 11 , and 9 with glycine showed that there was no detectable effect at position 15 but increasing heterogeneity of species in the micelles proceeding toward the interior of the micelle at position 9 .||NONE
The replacement of tryptophan at positions 15 and 9 with alanine was found to produce more species heterogeneity than found with glycine substitution at the same positions .||NONE
An increase in the SDS concentration reduces the number of different species present in micelles .||NONE
With the Gly-11 , Gly-13 , and Gly-15 analogs , the increase in SDS concentration results in the formation of a single species ; however , for the Gly-9 , Ala-9 , and Ala-15 analogs , heterogeneity remains .||NONE
Molecular dynamics in torsion-angle space was applied to nuclear magnetic resonance structure calculation using nuclear Overhauser effect-derived distances and J-coupling-constant-derived dihedral angle restraints .||NONE
Compared to two other commonly used algorithms , molecular dynamics in Cartesian space and metric-matrix geometry combined with Cartesian molecular dynamics , the method shows increased computational efficiency and success rate for large proteins , and it shows a dramatically increased radius of convergence for DNA .||NONE
The torsion-angle molecular dynamics algorithm starts from an extended strand conformation and proceeds in four stages : high-temperature torsion-angle molecular dynamics , slow-cooling torsion-angle molecular dynamics , Cartesian molecular dynamics , and minimization .||NONE
Tests were carried out using experimental NMR data for protein G , interleukin-8 , villin 14T , and a 12 base-pair duplex of DNA , and simulated NMR data for bovine pancreatic trypsin inhibitor .||NONE
For villin 14T , a monomer consisting of 126 residues , structure determination by torsion-angle molecular dynamics has a success rate of 85 % , a more than twofold improvement over other methods .||NONE
In the case of the 12 base-pair DNA duplex , torsion-angle molecular dynamics had a success rate of 52 % while Cartesian molecular dynamics and metric-matrix distance geometry always failed .||NONE
The wavelet-transform method is used to quantify the magnetic resonance spectroscopy ( MRS ) parameters : chemical shift , apparent relaxation time T2 , resonance amplitude , and phase .||NONE
Wavelet transformation is a time-frequency representation which separates each component from the FID , then successively quantifies it and subtracts it from the raw signal .||NONE
Two iterative procedures have been developed .||NONE
They have been combined with a nonlinear regression analysis method and tested on both simulated and real sets of biomedical MRS data selected with respect to the main problems usually encountered in quantifying biomedical MRS , specifically `` chemical noise , '' resulting from overlapping resonances , and baseline distortion .||NONE
The results indicate that the wavelet-transform method can provide efficient and accurate quantification of MRS data .||NONE
BACKGROUND : Antiplatelet therapy with aspirin and systematic anticoagulation with warfarin reduce cardiovascular morbidity and mortality after myocardial infarction when given alone .||TREAT_FOR_DIS
In the Coumadin Aspirin Reinfarction Study ( CARS ) , we aimed to find out whether a combination of low-dose warfarin and low-dose aspirin would give superior results to standard aspirin monotherapy without excessive bleeding risk .||TREATONLY
METHODS : We used a randomised double-blind study design .||NONE
At 293 sites , we randomly assigned 8803 patients who had had myocardial infarction , treatment with 160 mg aspirin , 3 mg warfarin with 80 mg aspirin , or 1 mg warfarin with 80 mg aspirin .||TREAT_FOR_DIS
Patients took a single tablet daily , and attended for prothrombin time ( PT ) measurements at weeks 1 , 2 , 3 , 4 , 6 , and 12 , and then every 3 months .||NONE
Patients were followed up for a maximum of 33 months ( median 14 months ) .||NONE
FINDINGS : The primary event was first occurrence of reinfarction , non-fatal ischaemic stroke , or cardiovascular death .||DISONLY
1-year life-table estimates for the primary event were 8.6 % ( 95 % CI 7.6-9.6 ) for 160 mg aspirin , 8.4 % ( 7.4-9.4 ) for 3 mg warfarin with 80 mg aspirin , and 8.8 % ( 7.6-10 ) for 1 mg warfarin with 80 mg aspirin .||TREATONLY
Primary comparisons were done with all follow-up data .||NONE
The relative risk of the primary event for the 160 mg aspirin group compared with the 3 mg warfarin with 80 mg aspirin group was 0.95 ( 0.81-1.12 , p = 0.57 ) .||NONE
For spontaneous major haemorrhage ( not procedure related ) , 1-year life-table estimates were 0.74 % ( 0.43-1.1 ) in the 160 mg aspirin group and 1.4 % ( 0.94-1.8 ) in the 3 mg warfarin with 80 mg aspirin group ( p = 0.014 log rank on follow-up ) .||NONE
For the 3382 patients assigned 3 mg warfarin with 80 mg aspirin , the INR results were : at week 1 ( n = 2985 ) median 1.51 ( IQR 1.23-2.13 ) ; at week 4 ( n = 2701 ) 1.27 ( 1.13-1.64 ) ; at month 6 ( n = 2145 ) 1.19 ( 1.08-1.44 ) .||TREATONLY
INTERPRETATION : Low , fixed-dose warfarin ( 1 mg or 3 mg ) combined with low-dose aspirin ( 80 mg ) in patients who have had myocardial infarction does not provide clinical benefit beyond that achievable with 160 mg aspirin monotherapy .||TREAT_FOR_DIS
BACKGROUND : There is serological evidence for an association between Chlamydia pneumoniae and coronary heart disease .||DISONLY
We investigated the hypothesis that an antichlamydial macrolide antibiotic , roxithromycin , can prevent or reduce recurrent major ischaemic events in patients with unstable angina .||PREVENT
METHODS : The effect of roxithromycin was assessed in a double-blind , randomised , prospective , multicentre , parallel-group , placebo-controlled pilot study of 202 patients with unstable angina or non-Q-wave myocardial infarction .||TREAT_FOR_DIS
Patients were randomly assigned either roxithromycin 150 mg orally twice a day ( n = 102 ) or placebo orally twice a day ( n = 100 ) .||TREATONLY
The treatment was for 30 days .||NONE
Patients were followed up for 6 months .||NONE
We report the primary clinical endpoints ( cardiac ischaemic death , myocardial infarction , and severe recurrent ischaemia ) , assessed at day 31 , in 202 patients on an intention-to-treat basis .||DISONLY
FINDINGS : A statistically significant reduction in the primary composite triple endpoint rates was observed in the roxithromycin group : p = 0.032 .||NONE
The rate of severe recurrent ischaemia , myocardial infarction , and ischaemic death was 5.4 % , 2.2 % , and 2.2 % in the placebo group and 1.1 % , 0 % , and 0 % , in the roxithromycin group , respectively .||NONE
No major drug-related adverse effects were observed .||NONE
INTERPRETATION : Antichlamydial antibiotics may be useful in therapeutic intervention in addition to standard medication in patients with coronary-artery disease .||TREAT_FOR_DIS
Large-scale trials are needed to confirm these preliminary observations .||NONE
BACKGROUND : Stage Ib and IIa cervical carcinoma can be cured by radical surgery or radiotherapy .||TREAT_FOR_DIS
These two procedures are equally effective , but differ in associated morbidity and type of complications .||NONE
In this prospective randomised trial of radiotherapy versus surgery , our aim was to assess the 5-year survival and the rate and pattern of complications and recurrences associated with each treatment .||TREATONLY
METHODS : Between September , 1986 , and December , 1991 , 469 women with newly diagnosed stage Ib and IIa cervical carcinoma were referred to our institute .||TREATONLY
343 eligible patients were randomised : 172 to surgery and 171 to radical radiotherapy .||TREATONLY
Adjuvant radiotherapy was delivered after surgery for women with surgical stage pT2b or greater , less than 3 mm of safe cervical stroma , cut-through , or positive nodes .||NONE
The primary outcome measures were 5-year survival and the rate of complications .||NONE
The analysis of survival and recurrence was by intention to treat and analysis of complications was by treatment delivered .||NONE
FINDINGS : 170 patients in the surgery group and 167 in the radiotherapy group were included in the intention-to-treat analysis ; scheduled treatment was delivered to 169 and 158 women , respectively , 62 of 114 women with cervical diameters of 4 cm or smaller and 46 of 55 with diameters larger than 4 cm received adjuvant therapy .||NONE
After a median follow-up of 87 ( range 57-120 ) months , 5-year overall and disease-free survival were identical in the surgery and radiotherapy groups ( 83 % and 74 % , respectively , for both groups ) , 86 women developed recurrent disease : 42 ( 25 % ) in the surgery group and 44 ( 26 % ) in the radiotherapy group .||NONE
Significant factors for survival in univariate and multivariate analyses were : cervical diameter , positive lymphangiography , and adeno-carcinomatous histotype .||NONE
48 ( 28 % ) surgery-group patients had severe morbidity compared with 19 ( 12 % ) radiotherapy-group patients ( p = 0.0004 ) .||NONE
INTERPRETATION : There is no treatment of choice for early-stage cervical carcinoma in terms of overall or disease-free survival .||DISONLY
The combination of surgery and radiotherapy has the worst morbidity , especially urological complications .||DISONLY
The optimum therapy for each patient should take account of clinical factors such as menopausal status , age , medical illness , histological type , and cervical diameter to yield the best cure with minimum complications .||NONE
Today 's technology links health care providers and patients across town , in the next state or even another country .||NONE
Nursing across state lines poses complications : state-bound regulatory and licensure issues .||NONE
This article discusses many of the nutritional topics important to the intensivist .||NONE
Nutritional assessment , substrate immunonutrition , and disease specific issues are presented .||NONE
Early introduction of enteral feeds and the use of nutritional modulation are emphasized .||NONE
PROBLEM : To compare the expression by T-lymphocytes of an immunomodulatory protein known as progesterone-induced blocking factor ( PIBF ) in conception versus non-conception cycles even when there has been definite fertilization and embryo formation .||NONE
METHOD : PIBF expression on T lymphocytes was measured using an immunohistochemical method with a PIBF-specific polyclonal antibody .||NONE
These levels were determined in patients undergoing three types of therapy : non-in vitro fertilization ( IVF ) , IVF-embryo transfer ( ET ) , and frozen ET .||NONE
Sera were drawn 12 days from ovulation in non-IVF cycles or 9 days after ET and were assayed for PIBF and beta human chorionic gondotropin .||NONE
Comparison of the frequency of lymphocyte expression of PIBF in pregnant versus non-pregnant women were made .||NONE
RESULTS : PIBF was detected in 29.5 % of non-pregnant women and 52.5 % of pregnant women .||NONE
There were no differences in PIBF levels by therapy used in non-pregnant cases or in the pregnant group .||NONE
CONCLUSION : These data are consistent with the hypothesis that maternal expression of PIBF in T-lymphocytes soon after trophoblast invasion may depend on successful implantation .||NONE
Many amino acids contain an asymmetric centre , occurring as laevorotatory , L , or dextrorotatory , D , compounds .||NONE
It is generally assumed that abiotic synthesis of amino acids on the early Earth resulted in racemic mixtures ( L- and D-enantiomers in equal abundance ) .||NONE
But the origin of life required , owing to conformational constraints , the almost exclusive selection of either L- or D-enantiomers , and the question of why living systems on the Earth consist of L-enantiomers rather than D-enantiomers is unresolved .||NONE
A substantial fraction of the organic compounds on the early Earth may have been derived from comet and meteorite impacts .||NONE
It has been reported previously that amino acids in the Murchison meteorite exhibit an excess of L-enantiomers , raising the possibility that a similar excess was present in the initial inventory of organic compounds on the Earth .||NONE
The stable carbon isotope compositions of individual amino acids in Murchison support an extraterrestrial origin -- rather than a terrestrial overprint of biological amino acids-although reservations have persisted .||NONE
Here we show that individual amino-acid enantiomers from Murchison are enriched in 15N relative to their terrestrial counterparts , so confirming an extraterrestrial source for an L-enantiomer excess in the Solar System that may predate the origin of life on the Earth .||NONE
Home care workers face an increasing risk for workplace violence .||NONE
A proactive preventive approach is presented that suggests strategies to use during the previsit phase , the visit experience , and on an ongoing basis .||NONE
The miracidia of Fasciola hepatica and Trichobilharzia ocellata approach their host snails Lymnaea truncatula and L. stagnalis by increasing their rate of change of direction ( RCD ) in increasing gradients of snail-conditioned water ( SCW ) , and they perform a turnback swimming in decreasing gradients .||NONE
Both hostfinding responses in both species were induced by glycoconjugates with a molecular weight of > 30 kDa that were sensitive to hydrolysis with pronase E and oxidation with NaIO4 .||NONE
Alkaline cleavage revealed that they contained carbohydrates linked O-glycosidically via serine and N-acetylgalactosamine .||NONE
Miracidia clearly preferred SCW from their specific host snail versus other sympatric snail species and did not respond to water conditioned with fish , tadpoles , or leeches .||NONE
Differences in the chemical characteristics of SCW from the intermediate hosts L. truncatula and L. stagnalis could be shown by sodium dodecyl sulfate-polyacrylamide gel electrophoresis , blotting , and subsequent carbohydrate detection .||NONE
The first step of purification of the effective signaling SCW components from both snail species was achieved by ion-exchange chromatography .||NONE
Black patients with colon cancer in the Black/White Cancer Survival Study were found to have a poorer survival than white patients .||DISONLY
More advanced-stage disease at diagnosis was the primary determinant , accounting for 60 % of the excess mortality .||NONE
After adjusting for stage , factors such as poverty , other socioeconomic conditions , and treatment did not further explain the remaining survival deficit .||NONE
This study examined the aggressiveness of colon tumors in blacks and whites to explore its role in the racial survival differences .||DISONLY
Tumor characteristics of 703 cases of newly diagnosed invasive colon adenocarcinoma were centrally evaluated by a gastrointestinal pathologist , blinded in regard to the age , race , and sex of the patients .||DISONLY
Blacks were less likely to have poorly differentiated ( grade 3 ) tumors ( odds ratio ( OR ) , 0.44 ; 95 % confidence interval , 0.22-0.88 ) and lymphoid reaction ( OR , 0.49 ; 95 % confidence interval , 0.26-0.90 ) when compared with whites .||DISONLY
These black/white ( B/W ) differences remained statistically significant after adjusting for age , sex , metropolitan area , summary stage , socioeconomic status , body mass index , and health care access and utilization .||NONE
In addition , blacks were less likely to have high-grade ( grade 3 ) nuclear atypia , mitotic activity , and tubule formation , although these ORs did not reach a statistical significance level of 0.05 .||DISONLY
Similar B/W differences were observed for patients with advanced disease but not with early stage .||NONE
Comparison by anatomical subsite showed that blacks had statistically significantly better differentiated tumors for cancers of the proximal and transverse colon but not for the distal .||DISONLY
No racial differences were found for blood vessel and lymphatic invasion , necrosis , fibrosis , and mucinous type of histology .||DISONLY
The findings , therefore , are the opposite of those hypothesized .||NONE
After adjusting for stage , more aggressive tumor characteristics do not explain the adverse survival differential in blacks .||NONE
This suggests that there may be racial differences in environmental exposure , and that the intensity and mode of delivery of carcinogen insult as well as host susceptibility may differ by race and anatomical subsite .||NONE
Future studies should explore the B/W differences in tumor biology using molecular markers that precede the conventional histological parameters evaluated here .||NONE
A new method is described for detection of mutations in the lysosomal alpha-glucosidase gene ( GAA ) leading to Glycogen Storage Disease type II ( GSDII ) .||DISONLY
A key feature of the method is isolation and reverse transcription of mRNA followed by PCR amplification of lysosomal alpha-glucosidase cDNA with M13-extended primers .||NONE
Dye labeled primers are used for cycle sequencing and an ABI PRISM 377 DNA sequencing system for analysis .||NONE
The method is rapid and complementary to the automated sequencing of all the 19 , PCR amplified , coding exons of the GAA gene .||NONE
The advantages and pitfalls of this new method are discussed in the light of the results obtained with an infantile GSDII patient .||NONE
A new splice site mutation in the GAA gene of this patient was identified , IVS16 ( +2T -- > C ) , resulting in the deletion of 16 base pairs of exon 16 .||NONE
The presence of clinical autonomic dysfunction in patients with neurologic diseases , such as multiple sclerosis , Parkinson 's disease , and cerebrovascular accident , has become increasingly recognized in the past decade .||DISONLY
Very few autonomic tests have been done on pediatric patients thus far .||NONE
The purpose of this study was to investigate the autonomic function in patients with cerebral palsy using two noninvasive tests : sympathetic skin response ( SSR ) and R-R interval variation ( RRIV ) .||DISONLY
Twenty-four patients with cerebral palsy and 24 control subjects between the ages of 4 and 12 yr were enrolled in this study .||DISONLY
There was no significant difference of mean latency , amplitude , or amplitude ratio of SSR between the two groups under electric stimulus , startling stimulus , and deep breathing conditions .||NONE
No significant difference in frequency of absent response and asymmetric response was also noted .||NONE
Mean heart rate under relaxed sitting condition was significantly higher in the study group .||NONE
Significant negative correlation between heart rate and age was noted in the control group but was not present in the study group .||NONE
Also , there was no statistical difference of mean RRIV between the two groups .||NONE
No objective evidence of autonomic disturbance in patients with cerebral palsy was found in this study .||DISONLY
A two-credits per semester clinical medicine course was established in the Department of Physical Medicine and Rehabilitation ( PM & # 38 ; R ) in cooperation with the Johns Hopkins University undergraduate Human Biology faculty to present the variety of inpatient consultation personnel , units , patient diagnostic groups , and functional problems .||NONE
College students spend 4 hr weekly on the PM & # 38 ; R consultation service as team members under resident supervision .||NONE
The curriculum emphasizes student understanding of the roles of rehabilitation team members .||NONE
Objectives include demonstration of working knowledge of the Biopsychosocial Model , the World Health Organization Model of disablement and interdisciplinary rehabilitation intervention .||NONE
The course includes simulations of physical impairments , demonstrations of adaptive equipment , interactive chart reviews , readings , and audio lectures .||NONE
A retrospective sequential review was made of the last 100 physical medicine and rehabilitation consultations with student attendance .||NONE
The results confirm student exposure to many ward settings ( surgery , 30 % ; neurology/neurosurgery , 28 % ; medicine , 24 % ; intensive care , 15 % ; oncology , 2 % ; and psychiatry , 1 % ) , patient complexity ( averaging 10 problems ) , and multiple ICD-9 diagnosis categories ( circulatory , 36 % ; neurologic , 22 % ; musculoskeletal , 17 % ; neoplasms , 10 % ; injury , 5 % ; endocrine , 4 % ; infections , 3 % ; and others , 3 % ) .||NONE
The rehabilitation consultation service is particularly effective as an introduction to hospital-based medical practice due to the diagnostic variety of the patients , the functional approach of rehabilitation , and student exposure to multiple hospital settings .||NONE
The Biopsychosocial Model of medical practice is demonstrated through multiple interdisciplinary perspectives of needs and interventions for patients with obvious functional deficits .||NONE
This process develops a rudimentary understanding of the effect of illness on the person and the variety of medically effective therapeutic modalities .||NONE
This study is designed to investigate the immediate effectiveness of electrotherapy on myofascial trigger points of upper trapezius muscle .||TREAT_FOR_DIS
Sixty patients ( 25 males and 35 females ) who had myofascial trigger points in one side of the upper trapezius muscles were studied .||DISONLY
The involved upper trapezius muscles were treated with three different methods according to a random assignment : group A muscles ( n = 18 ) were given placebo treatment ( control group ) ; group B muscles ( n = 20 ) were treated with electrical nerve stimulation ( ENS ) therapy ; and group C muscles ( n = 22 ) were given electrical muscle stimulation ( EMS ) therapy .||TREATONLY
The effectiveness of treatment was assessed by conducting three measurements on each muscle before and immediately after treatment : subjective pain intensity ( ( PI ) with a visual analog scale ) , pressure pain threshold ( ( PT ) with algometry ) , and range of motion ( ( ROM ) with a goniometer ) of upper trapezius muscle ( lateral bending of cervical spine to the opposite side ) .||NONE
When the effectiveness of treatment was compared with that of the placebo group ( group A ) , there was significant improvement in PI and PT in group B ( P & # 60 ; 0.01 ) but not in group C ( P > 0.05 ) .||NONE
The improvement of ROM was significantly more in group C ( P & # 60 ; 0.01 ) as compared with that in group A or group B .||NONE
When each group was divided into two additional subgroups based on the initial PI , it was found that ENS could reduce PI and increase PT significantly ( P & # 60 ; 0.05 ) , but did not significantly ( P > 0.05 ) improve ROM , as compared with the placebo group for both subgroups .||NONE
EMS could significantly ( P & # 60 ; 0.05 ) improve ROM , but not PT , better than the placebo groups , for either subgroup .||NONE
It could reduce PI significantly more ( P & # 60 ; 0.05 ) than placebo controls only for the subgroup with mild to moderate pain , but not with severe pain .||NONE
For pain relief , ENS was significantly better ( P & # 60 ; 0.05 ) than EMS ; but for the improvement of ROM , EMS was significantly better ( P & # 60 ; 0.05 ) than ENS .||NONE
It is concluded that ENS is more effective for immediate relief of myofascial trigger point pain than EMS , and EMS has a better effect on immediate release of muscle tightness than ENS .||TREAT_FOR_DIS
Because activity and regular exercise are important factors to maintain general good health in senior citizens , we investigated whether senior dancing has any effect on peripheral or lumbar bone density .||NONE
We performed a prospective study over a12-mo period on bone density at a spinal and peripheral measuring site in 28 female senior members ( mean age : 67 +/- 2 yr ) of a dancing group in Vienna .||NONE
Lumbar bone mineral density was assessed by quantitative computed tomography ( qCT ) and radial bone density by single photon absorptiometry of the distal forearm .||NONE
The mean training time per week was 3.2 +/- 0.8 h. In the entire group of female dancers , no significant effects of dancing on radial or lumbar bone density could be observed .||NONE
Linear regression analysis showed that the lower the qCT at the beginning of the observation period , the higher was the percentage increase of spinal qCT in the entire group during 12 mo of dancing ( r = 0.52 , P & # 60 ; 0.0001 ) .||NONE
For additional evaluation , females were divided into two subgroups , osteoporotic or nonosteoporotic , based on x-rays and lumbar bone mineral density ( BMD ) as measured by qCT .||NONE
The group classified as dancers with osteoporosis ( group I ) showed a significant increase in lumbar bone density , whereas in the group of dancers without signs of osteoporosis ( group II ) , BMD remained unchanged .||DISONLY
Additionally , radial bone density did not show any changes in either group .||NONE
Group I showed a significant correlation between basal spinal BMD and the percentage change of BMD during the observation period ( r = 0.7 , P & # 60 ; 0.001 ) .||NONE
Changes of the biochemical parameters were observed in the bone-specific isoenzyme of alkaline phosphatase , a marker of osteoblastic activity , in group I giving additional evidence of increased bone formation .||NONE
OBJECTIVES : To estimate the prevalence of Chlamydia trachomatis in asymptomatic women attending general practice : to assess the potential of the ligase chain reaction as a screening tool ; and to evaluate selective screening criteria .||DISONLY
DESIGN : Cross sectional survey .||NONE
SETTING : Four general practices in northeast London .||NONE
SUBJECTS : 890 women aged 18-35 years attending general practice for a cervical smear or a `` young well woman '' check between October 1994 and January 1996 .||NONE
The women were tested for C trachomatis with confirmed enzyme immunoassay ( endocervical specimens ) and ligase chain reaction assay on urine specimens .||DISONLY
MAIN OUTCOME MEASURES : Prevalence of C trachomatis infection in women aged 18-35 on the basis of each test ; sensitivity and specificity of both tests in this population .||DISONLY
RESULTS : Prevalence of confirmed infection was 2.6 % ( 95 % confidence interval 1.6 % to 3.6 % ) in all women .||NONE
Prevalence on the basis of enzyme immunoassay was 1.6 % ( 0.8 % to 2.7 % ) , with a sensitivity of 60 % and a specificity of 100 % .||NONE
Prevalence on the basis of ligase chain reaction was 2.5 % ( 1.5 % to 3.9 % ) , with 90 % sensitivity and 99.8 % specificity .||NONE
Screening all women aged & # 60 ; or = 25 and all women who had had two or more partners in the past year would have detected 87 % ( 20/23 ) of infections .||NONE
CONCLUSION : Ligase chain reaction on urine samples performs at least as well as enzyme immunoassay on cervical specimens in this low prevalence population .||NONE
It offers potential as a non-invasive screening tool .||NONE
A simple selective screening strategy might be appropriate and would be able to detect most cases of infection .||DISONLY
However , a rigorous economic evaluation of possible screening strategies is needed first .||NONE
Recently , many advances have been made in the study of sexual differentiation , including the discoveries of the gene for antimÃ1/4llerian hormone as well as the gene for its receptor .||NONE
However , the etiology of the clinical syndrome of mÃ1/4llerian agenesis remains elusive .||NONE
We hypothesize that activating mutations of either the antimÃ1/4llerian hormone gene or its receptor gene may cause mÃ1/4llerian duct regression in a genetic female during embryogenesis .||NONE
This clinical commentary discusses the current management of the syndrome including the Abbe-McIndoe procedure , the most commonly used method of surgical correction , and the Frank vaginal dilation method , the most common nonsurgical method of correction .||TREATONLY
OBJECTIVES : Obesity is an important clinical problem , and the use of dexfenfluramine hydrochloride for weight reduction has been widely publicized since its approval by the Food and Drug Administration .||TREAT_FOR_DIS
However , animal and human studies have demonstrated toxic effects of fenfluramines that clinicians should be aware of when considering prescribing the drugs .||TREATONLY
Our purpose was to systematically review data on brain serotonin neurotoxicity in animals treated with fenfluramines and the evidence linking fenfluramines to primary pulmonary hypertension ( PPH ) .||SIDE_EFF
DATA SOURCES : Archival articles and reviews identified through a computerized search of MEDLINE from 1966 to April 1997 using `` fenfluramine ( s ) , '' `` serotonin , '' `` neurotoxicity , '' `` behavior , '' `` anorexigens , '' `` weight loss , '' and `` primary pulmonary hypertension '' as index terms .||NONE
STUDY SELECTION : Reports dealing with long-term effects of fenfluramines on brain serotonin neurons , body weight , and pulmonary function in animals and humans .||TREATONLY
DATA EXTRACTION : Reports were reviewed by individuals with expertise in serotonin neurobiology , neurotoxicity , neuropsychiatry , and pulmonary medicine and evaluated for appropriateness for inclusion in this review .||NONE
DATA SYNTHESIS : Fenfluramines cause dose-related , long-lasting reductions in serotonin axonal markers in all the animal species tested and with all the routes of drug administration used .||TREATONLY
Doses of fenfluramines that produce signs of brain serotonin neurotoxicity in animals are on the same order as those used to treat humans for weight loss when one takes into account known relations between body mass and drug clearance .||NONE
However , no human studies have been conducted , and the pathological and clinical potential for neurotoxicity in humans is unknown .||NONE
Appetite suppressants-most commonly fenfluramines -increase the risk of developing PPH ( odds ratio , 6.3 ) , particularly when used for more than 3 months ( odds ratio , > 20 ) .||SIDE_EFF
CONCLUSIONS : Fenfluramine and dexfenfluramine have been demonstrated to damage brain serotonin neurons in animal studies .||TREATONLY
It is not known if such damage occurs in humans or if there are clinical consequences .||NONE
Use of fenfluramines is associated with an increased risk of PPH .||SIDE_EFF
Future studies should address the long-term consequences of prolonged use of fenfluramines .||TREATONLY
Moxonidine ( Physiotens-Solvay ) was introduced last year as the first of a new class of centrally-acting antihypertensive agents , the selective imidazoline receptor agonists .||TREATONLY
The manufacturer claims that moxonidine `` accurately targets imidazoline receptors at the cardiovascular control centre in the brainstem '' and is `` as effective as current first-line therapies for essential hypertension `` .||TREAT_FOR_DIS
Other claims suggest that it causes fewer unwanted effects than older centrally-acting antihypertensive drugs such as clonidine and methyldopa .||TREATONLY
Is moxonidine a useful addition to the growing number of antihypertensives on the market ? ||TREATONLY
This article discusses dental anxiety and phobia .||NONE
The author presents background information , including incidence and etiology .||NONE
A discussion of evaluative techniques for assessing anxiety levels follows .||NONE
Examination and treatment planning are considered in relation to this patient 's special needs .||NONE
The article stresses behavioral treatment modalities that eliminate the debilitating phobia .||NONE
In closing , the author presents practical information regarding prevention of dental phobia and the merits of incorporating this type of patient into a dental practice .||NONE
In order to evaluate the applicability of anthelminthic treatment of wild foxes ( Vulpes vulpes ) to limit their infection with Echinococcus multilocularis , bait pellets , each containing 50 mg praziquantel , were repeatedly distributed in an area of 566 km2 where many foxes are infected , in southern Germany .||TREAT_FOR_DIS
After six baiting campaigns ( 15-20 baits/km2 ) over a period of 14 months , the prevalence of the cestode in foxes , initially 32 % , had fallen to 4 % .||NONE
The effect was most pronounced in the central part of the treated area , where no positive fox was found in the 2 months before the end of the trial .||NONE
The study was controlled for other factors that could influence the parasite 's prevalence , such as the availability of intermediate hosts .||NONE
While the potential of this baiting method to remove E .||NONE
multilocularis from wild hosts has been demonstrated , the question of its long-term efficacy and other unresolved problems have to be addressed by consecutive studies before routine application can be recommended .||NONE
In patients with chronic myeloid leukemia ( CML ) , the neoplastic ( BCR-ABL+ ) progenitor cells are characterized by an increased proliferative activity .||DISONLY
Whether these cells are also resistant to apoptosis and if so , under what conditions remains controversial .||NONE
We now show that highly purified populations of very primitive neoplastic progenitor cells obtained directly from CML patients survive and proliferate in vitro for several weeks in the absence of any added growth factors ( except insulin ) .||NONE
In contrast , purified primary normal progenitors maintained under the same conditions die rapidly .||NONE
Nevertheless , both primary CML cells and BCR-ABL+ BAF3 cells show the same dose-dependent sensitivity to TNF-alpha or ceramide-induced apoptosis as their respective normal counterparts .||NONE
In fact , time course studies demonstrated an even faster onset of apoptosis in ceramide-treated BCR-ABL+ BAF3 cells as compared to normal controls .||NONE
BCR-ABL+ cells treated with ceramide also showed a rapid and sequential increase in the tyrosine phosphorylation of p210 ( BCR-ABL ) , p46-56SHC and p120Cbl .||NONE
These findings suggest growth factor deprivation and treatment with TNF-alpha or ceramide trigger different initial events both of which can lead to apoptosis in factor-dependent hematopoietic cells .||NONE
However , in the first case , activation of apoptosis is blocked by the basal activity of p210 ( BCR-ABL ) , whereas in the second , the presence of p210 ( BCR-ABL ) appears to accelerate the onset of apoptosis by a mechanism that may involve an activation of its kinase function .||NONE
Clinically , the hallmark of the human amnesic syndrome is an impaired ability to consciously recollect or remember daily events .||DISONLY
If the medial region of the temporal lobes , including the hippocampus and related structures , is critical for establishing these new memories , then this brain region should be active whenever events are experienced , regardless of whether subjects are asked explicitly to learn and remember .||NONE
Here we show that the medial temporal region is active during encoding and that the hemisphere activated and the amount of activation depend on the type of stimulus presented ( objects or words ) , whether the stimulus can be encoded for meaning ( real objects and words versus nonsense objects and words ) , and task experience ( first versus the second time a task is performed ) .||NONE
These findings demonstrate that the medial temporal lobe memory system is engaged automatically when we attend to a perceptual event and that the location and amount of activation depend on stimulus characteristics ( physical form , meaning ) and experience .||NONE
The involvement of structures in the medial temporal lobe during the encoding of visual associations was studied with functional magnetic resonance imaging .||NONE
In 11 out of 12 normal healthy volunteers this task resulted in activation in posterior portions of the parahippocampal region , close to the collateral sulcus .||NONE
In seven subjects activation was encountered in the hippocampal formation .||NONE
The visual association task as adapted for this study may provide a sensitive measure to study anterograde amnesia prevalent in Alzheimer 's disease .||NONE
Therefore , the present paradigm enables the study of individual changes in learning and memory capacities over time .||NONE
Altered calcium ( Ca2+ ) homeostasis is thought to play a key role in aging and neuropathology resulting in memory deficits .||NONE
Several forms of hippocampal synaptic plasticity are dependent on Ca2+ , providing a potential link between altered Ca2+ homeostasis and memory deficits associated with aging .||NONE
The current study reviews evidence for Ca2+ dysregulation during aging which could interact with Ca ( 2+ ) -dependent synaptic plasticity .||NONE
The authors suggest that changes in Ca2+ regulation could adjust the thresholds for synaptic modification , favoring processes for depression of synaptic strength during aging .||NONE
Transiently evolked otoacoustic emissions ( TEOAE ) have been reported in several studies as absent in a small minority of normal ears .||NONE
Other studies have reported TEOAEs in all normal ears .||NONE
Differences between studies may arise directly from criteria for TEOAE identification , criteria for selection of normals , or statistically due to limited sample sizes .||NONE
In order to understand and model cochlear processes involved in TEOAE generation , it needs to be known whether the presence of normal hearing leads automatically to generation of TEOAEs .||NONE
The present study set out to establish in a large sample if any ears could be found that lacked TEOAEs despite normal hearing threshold levels ( HTL ) .||NONE
A total of 397 ears from highly cooperative adult subjects were examined under laboratory conditions .||NONE
Using cross correlation between replicate nonlinear waveforms as the criterion , TEOAEs were present in 99.2 % of the sample ( lower CI 98.1 % ) .||NONE
However , careful visual assessment of the recorded waveforms for the remaining ears did not unequivocally show absence of TEOAE characteristics in any ear with normal HTLs .||NONE
While TEOAE strength varies widely among ears , no clear evidence was found to show that TEOAEs can be absent when HTLs are normal .||NONE
In addition to a long form of 591 amino acids ( aa ) , two other forms of PRL receptor ( PRLR ) , differing in the length of their cytoplasmic domains , have been identified in the rat .||NONE
The Nb2 form , lacking 198 aa in the cytoplasmic domain , is able to transmit a lactogenic signal similar to the long form , whereas the short form of 291 aa is inactive .||NONE
The ability of PRL to activate the promoter of the beta-casein gene or the lactogenic hormone responsive element fused to the luciferase reporter was assessed in Chinese hamster ovary cells or 293 fibroblasts transiently transfected with PRLR cDNAs .||NONE
The function of the short form was examined after cotransfection of both the long and short forms .||NONE
These results clearly show that the short form acts as a dominant negative inhibitor through the formation of inactive heterodimers , resulting in an inhibition of Janus kinase 2 ( JAK2 ) activation .||NONE
The present study also investigates the possible participation of cytoplasmic receptors in the signal transduction pathway , using cotransfection experiments and a new approach that selectively determines the contribution of cytoplasmic receptors in the process of signal transduction .||NONE
We cotransfected Chinese hamster ovary cells with two cDNA constructs : a cytoplasmic ( soluble ) form of the receptor with a deleted signal peptide ( delta-19 ) , which is unable to bind PRL , and a functionally inactive receptor mutant ( lacking box 1 ) , which is anchored in the plasma membrane and able to bind PRL .||NONE
This approach has allowed us to show that delta-19 , lacking expression at the plasma membrane , can transduce the hormonal message , at least to a limited extent ( up to 30 % of wild type efficiency ) , providing that association/activation occurs with a PRL-PRLR complex initiated at the cell surface level ; box 1 of the cytoplasmic form is necessary to rescue this partial transcriptional activity of the inactive mutant .||NONE
This partial recovery is also parallel to the partial activation of JAK2 , indicating that the signal transduction pathway implicated JAK2 .||NONE
Our results provide evidence that heterodimerization of receptors can be implicated either in the positive or in negative activation of gene transcription .||NONE
BACKGROUND : Inadequate dietary intake of calcium and vitamin D may contribute to the high prevalence of osteoporosis among older persons .||DISONLY
METHODS : We studied the effects of three years of dietary supplementation with calcium and vitamin D on bone mineral density , biochemical measures of bone metabolism , and the incidence of nonvertebral fractures in 176 men and 213 women 65 years of age or older who were living at home .||NONE
They received either 500 mg of calcium plus 700 IU of vitamin D3 ( cholecalciferol ) per day or placebo .||NONE
Bone mineral density was measured by dual-energy x-ray absorptiometry , blood and urine were analyzed every six months , and cases of nonvertebral fracture were ascertained by means of interviews and verified with use of hospital records .||NONE
RESULTS : The mean ( +/-SD ) changes in bone mineral density in the calcium-vitamin D and placebo groups were as follows : femoral neck , +0.50+/-4.80 and -0.70+/-5.03 percent , respectively ( P=0.02 ) ; spine , +2.12+/-4.06 and +1.22+/-4.25 percent ( P=0.04 ) ; and total body , +0.06+/-1.83 and -1.09+/-1.71 percent ( P & # 60 ; 0.001 ) .||NONE
The difference between the calcium-vitamin D and placebo groups was significant at all skeletal sites after one year , but it was significant only for total-body bone mineral density in the second and third years .||NONE
Of 37 subjects who had nonvertebral fractures , 26 were in the placebo group and 11 were in the calcium-vitamin D group ( P=0.02 ) .||NONE
CONCLUSIONS : In men and women 65 years of age or older who are living in the community , dietary supplementation with calcium and vitamin D moderately reduced bone loss measured in the femoral neck , spine , and total body over the three-year study period and reduced the incidence of nonvertebral fractures .||PREVENT
The sterilization and contaminated waste disposal practices in all 14 dental clinics operated by the Southern Sydney Area Health Service were surveyed .||NONE
All of the clinics used autoclaves for sterilization .||NONE
All hand instruments , handpieces and triplex syringes were autoclaved between patients .||NONE
Chemical disinfection solutions were used in 12 of the 14 dental clinics , mainly for surface decontamination .||NONE
Five dental clinics had separate storage areas for contaminated waste which compiled with contaminated waste separation and disposal guidelines .||NONE
The practice of recapping needles with fingers and some inadequate washing facilities are areas that require particular attention .||NONE
Safety and efficacy are crucial but separate issues for vitamin and mineral supplements .||NONE
Misinterpretation of `` safe and adequate '' to mean `` safety limit '' would impose restrictions on vitamin and mineral intakes that are not needed to ensure safety .||NONE
Substantial evidence indicates that intakes greater than the recommended dietary allowances ( RDAs ) of certain vitamins and minerals such as calcium , folic acid , vitamin E , selenium , and chromium reduce the risk of certain diseases for some people .||NONE
Limitation of intakes to the RDAs would preclude reductions in disease risk from these nutrients .||NONE
The margin of safety between the usual dietary intake and the intake that would produce adverse effects varies greatly among the different nutrients .||NONE
Very high intakes of vitamins A and D , niacin , pyridoxine , and selenium have produced adverse effects .||NONE
Many widely discussed putative adverse effects of vitamin C , vitamin E , and trivalent chromium have little factual basis .||NONE
There is no evidence of adverse effects from beta-carotene supplements except in current heavy smokers .||NONE
The mutator hypothesis of tumorigenesis suggests that loss of chromosomal stability or maintenance functions results in elevated mutation rates , leading to the accumulation of the numerous mutations required for multistep carcinogenesis .||NONE
The human DNA mismatch repair ( MMR ) genes are highly conserved homologues of the Escherichia coli MutHLS system , which contribute to genomic stability by surveillance and repair of replication misincorporation errors and exogenous DNA damage .||NONE
Mutations in one of these MMR genes , hMSH2 , account for about half of all cases of genetically linked hereditary non-polyposis colorectal cancer .||NONE
Loss of function of p53 has also been proposed to increase cellular hypermutability , thereby accelerating carcinogenesis , although a clear role for p53 in genomic instability remains controversial .||NONE
p53 is mutated frequently in a wide range of human cancers , including colonic tumours .||DISONLY
Both Msh2- and p53-targeted knockout mice are viable and susceptible to cancer .||DISONLY
Here we demonstrate that combined Msh2 and p53 ablation ( Msh2-/-p53-/- ) results in developmental arrest of all female embryos at 9.5 days .||NONE
In contrast , male Msh2-/-p53-/- mice are viable , but succumb to tumours significantly earlier ( t1-2 is 73 days ) than either Msh2-/- or p53-/- littermates .||DISONLY
Furthermore , the frequency of microsatellite instability ( MSI ) in tumours from Msh2-/-p53-/- mice is not significantly different than in Msh2-/- mice .||NONE
Synergism in tumorigenesis and independent segregation of the MSI phenotype suggest that Msh2 and p53 are not genetically epistatic .||NONE
Our data ( Reddy et al. , Radiat .||NONE
Res .||NONE
141 , 252-258 , 1995 ) on the kinetics of the repair of potentially lethal damage in log-phase Chinese hamster V79 cells are used to test some predictions which arise from the different assumptions of the repair-misrepair ( RMR ) ( C .||NONE
A .||NONE
Tobias , Radiat .||NONE
Res .||NONE
104 , S77-S95 , 1985 ) , lethal-potentially lethal ( LPL ) ( S. B .||NONE
Curtis , Radiat .||NONE
Res .||NONE
106 , 252-270 , 1986 ) and double-strand break ( DSB ) ( J .||NONE
Y .||NONE
Ostashevsky , Radiat .||NONE
Res .||NONE
118 , 437-466 , 1989 ) models .||NONE
The LPL model defines the time available for repair of PLD ( t ( rep ) ) as the time taken to reach maximal survival in a delayed-plating recovery experiment .||NONE
Those data show that after this time has elapsed , contrary to the expectation of the LPL model , survival can be increased by changing the medium used for delayed plating from fresh growth medium to conditioned medium .||NONE
According to the RMR model , all potentially lethal lesions should also be committed by that time and be unavailable for repair in the new medium .||NONE
Only the DSB model correctly predicted that PLD ( = DSBs ) would still be available for repair after that time .||NONE
Second , data for split-dose recovery are used to predict the first-order kinetics time constant for DSB repair ( tau ( DSBR ) ) using the DSB model ( 24 +/- 1.5 min ) .||NONE
This value is nearly identical to the value of 27 +/- 1 min determined from the data obtained by Cheong et al. using pulsed-field gel electrophoresis ( PFGE ) ( Mutat .||NONE
Res .||NONE
274 , 111-122 , 1992 ) .||NONE
The value based on PFGE is used to calculate the value of t ( rep ) predicted by the DSB model ( 2.6 +/- 0.1 h ) , which agrees with the value determined experimentally as the time when changing the delayed-plating medium from growth medium to conditioned medium no longer gives the full recovery seen with delayed plating in conditioned medium ( 2.5 h ) .||NONE
However , some recovery was seen for a change in the medium ( growth medium to conditioned medium ) up to 5-6 h postirradiation .||NONE
Reanalysis of the original data on DSB repair shows that they are consistent with two first-order repair rates ( 18 +/- 7 min and about 52 min ) .||NONE
These results are consistent with two pools of DSBs ( or cells ) , each with their own t ( rep ) .||NONE
The early t ( rep ) , associated with tau ( fast ) , is predicted to be 1.7 +/- 0.7 h , and the late t ( rep ) , associated with tau ( slow ) , is predicted to be about 5 h. Both values are in excellent agreement with the times at which changing from growth medium to conditioned medium no longer gives the full recovery seen in conditioned medium only ( the early t ( rep ) ) , and the time when changing from growth medium to conditioned medium produces no further increase in survival ( the late t ( rep ) ) , respectively .||NONE
It is noted that attempts to correlate radiosensitivity with the rates of DSB repair , rather than using an explicit model such as the DSB model , are unlikely to be productive since survival depends on both tau ( DSBR ) and t ( rep ) ( as defined in the DSB model ) and the latter may be the more important determinant of radiosensitivity ( as it appears to be for ataxia telangiectasia cells compared to normal fibroblasts and for irs compared to V79 cells ) .||NONE
CONTEXT : Adolescents ' concerns about privacy in clinical settings decrease their willingness to seek health care for sensitive problems and may inhibit their communication with physicians .||NONE
OBJECTIVE : To investigate the influence of physicians ' assurances of confidentiality on adolescents ' willingness to disclose information and seek future health care .||NONE
DESIGN : Randomized controlled trial .||NONE
SETTING : Three suburban public high schools in California .||NONE
PARTICIPANTS : The 562 participating adolescents represented 92 % of students in mandatory classes .||NONE
INTERVENTION : After random assignment to 1 of 3 groups , the adolescents listened to a standardized audiotape depiction of an office visit during which they heard a physician who assured unconditional confidentiality , a physician who assured conditional confidentiality , or a physician who did not mention confidentiality .||NONE
MAIN OUTCOME MEASURES : Adolescents ' willingness to disclose general information , willingness to disclose information about sensitive topics , intended honesty , and likelihood of return visits to the physician depicted in the scenario were assessed by anonymous written questionnaire .||NONE
RESULTS : Assurances of confidentiality increased the number of adolescents willing to disclose sensitive information about sexuality , substance use , and mental health from 39 % ( 68/175 ) to 46.5 % ( 178/383 ) ( beta=.10 , P=.02 ) and increased the number willing to seek future health care from 53 % ( 93/175 ) to 67 % ( 259/386 ) ( beta=.17 , P & # 60 ; .001 ) .||NONE
When comparing the unconditional with the conditional groups , assurances of unconditional confidentiality increased the number of adolescents willing to return for a future visit by 10 percentage points , from 62 % ( 122/196 ) to 72 % ( 137/190 ) ( beta=.14 , P=.001 ) .||NONE
CONCLUSIONS : Adolescents are more willing to communicate with and seek health care from physicians who assure confidentiality .||NONE
Further investigation is needed to identify a confidentiality assurance statement that explains the legal and ethical limitations of confidentiality without decreasing adolescents ' likelihood of seeking future health care for routine and nonreportable sensitive health concerns .||NONE
BACKGROUND : Diabetic foot infections cause substantial morbidity and mortality .||DISONLY
Neutrophil superoxide generation , a crucial part of neutrophil bactericidal activity , is impaired in diabetes .||DISONLY
Granulocyte-colony stimulating factor ( G-CSF ) increases the release of neutrophils from the bone marrow and improves neutrophil function .||NONE
We assessed G-CSF as adjuvant therapy for the treatment of severe foot infections in diabetic patients .||TREAT_FOR_DIS
METHODS : 40 diabetic patients with foot infections were enrolled in a double-blind placebo-controlled study .||DISONLY
On admission , patients were randomly assigned G-CSF ( filgrastim ) therapy ( n = 20 ) or placebo ( n = 20 ) for 7 days .||TREATONLY
Both groups received similar antibiotic and insulin treatment .||TREATONLY
Neutrophils from the peripheral blood of these participants and from healthy controls were stimulated with opsonised zymosan , and superoxide production was measured by a spectrophotometric assay ( reduction of ferricytochrome C ) .||NONE
FINDINGS : G-CSF therapy was associated with earlier eradication of pathogens from the infected ulcer ( median 4 ( range 2-10 ) vs 8 ( 2-79 ) days in the placebo group ; p = 0.02 ) , quicker resolution of cellulitis < ( 7 ( 5-20 ) vs 12 ( 5-93 ) days ; p = 0.03 ) , shorter hospital stay ( 10 ( 7-31 ) vs 17.5 ( 9-100 ) days ; p = 0.02 ) , and a shorter duration of intravenous antibiotic treatment ( 8.5 ( 5-30 ) vs 14.5 ( 8-63 ) days ; p = 0.02 ) .||TO_SEE
No G-CSF-treated patient needed surgery , whereas two placebo recipients underwent to amputation and two had extensive debridement under anaesthesia .||TREATONLY
After 7 days ' treatment , neutrophil superoxide production was significantly higher in the G-CSF group than in the placebo group ( 16.1 ( 4.2-24.2 ) vs 7.3 ( 2.1-11.5 ) nmol per 10 ( 6 ) neutrophils in 30 min ; p & # 60 ; 0.0001 ) .||NONE
G-CSF therapy was generally well tolerated .||TREATONLY
INTERPRETATION : G-CSF treatment was associated with improved clinical outcome of foot infection in diabetic patients .||TREAT_FOR_DIS
This improvement may be related to an increase in neutrophil superoxide production .||NONE
BACKGROUND : Accelerated infusion of alteplase ( tissue plasminogen activator ) over a period of 90 minutes induces more rapid lysis of coronary-artery thrombi than a 3-hour infusion .||TREAT_FOR_DIS
With two bolus doses of alteplase , further shortening the duration of administration , complete reperfusion was achieved in more than 85 percent of the patients in initial angiographic studies .||TREATONLY
We tested the hypothesis that double-bolus alteplase is at least as effective as accelerated infusion .||TREATONLY
METHODS : In 398 hospitals , 7169 patients with acute myocardial infarction were randomly assigned to weight-adjusted , accelerated infusion of 100 mg of alteplase or to a bolus of 50 mg of alteplase over a period of 1 to 3 minutes followed 30 minutes later by a second bolus of 50 mg ( or 40 mg for patients who weighed less than 60 kg ) .||TREAT_FOR_DIS
The primary end point was death from any cause at 30 days .||NONE
The trial was stopped prematurely because of concern about the safety of the double-bolus injection .||TREATONLY
RESULTS : Thirty-day mortality was higher in the double-bolus group than in the accelerated-infusion group : 7.98 percent as compared with 7.53 percent .||NONE
The absolute difference was 0.44 percent , with a one-sided 95 percent upper boundary of 1.49 percent , which exceeded the prespecified upper limit of 0.40 percent to indicate equivalence in 30-day mortality between the two regimens .||NONE
The respective rates of any stroke and of hemorrhagic stroke were 1.92 and 1.12 percent after double-bolus alteplase , as compared with 1.53 and 0.81 percent after an accelerated infusion of alteplase ( P=0.24 and P=0.23 , respectively ) .||SIDE_EFF
CONCLUSIONS : Double-bolus alteplase was not shown to be equivalent , according to the prespecified criteria , to accelerated infusion with regard to 30-day mortality .||TREATONLY
There was also a slightly higher rate of intracranial hemorrhage with the double-bolus method .||SIDE_EFF
Therefore , accelerated infusion of alteplase over a period of 90 minutes remains the preferred regimen .||TREATONLY
BACKGROUND : Fenfluramine and phentermine have been individually approved as anorectic agents by the Food and Drug Administration ( FDA ) .||TREATONLY
When used in combination the drugs may be just as effective as either drug alone , with the added advantages of the need for lower doses of each agent and perhaps fewer side effects .||NONE
Although the combination has not been approved by the FDA , in 1996 the total number of prescriptions in the United States for fenfluramine and phentermine exceeded 18 million .||TREATONLY
METHODS : We identified valvular heart diseasein 24 women treated with fenfluramine-phentermine who had no history of cardiac disease .||TO_SEE
The women presented with cardiovascular symptoms or a heart murmur .||DISONLY
As increasing numbers of these patients with similar clinical features were identified , there appeared to be an association between these features and fenfluramine-phentermine therapy .||TREATONLY
RESULTS : Twenty-four women ( mean ( +/-SD ) age , 44+/-8 years ) were evaluated 12.3+/-7.1 months after the initiation of fenfluramine-phentermine therapy .||TREATONLY
Echocardiography demonstrated unusual valvular morphology and regurgitation in all patients .||NONE
Both right-sided and left-sided heart valves were involved .||NONE
Eight women also had newly documented pulmonary hypertension .||DISONLY
To date , cardiac surgical intervention has been required in five patients .||TREATONLY
The heart valves had a glistening white appearance .||NONE
Histopathological findings included plaque-like encasement of the leaflets and chordal structures with intact valve architecture .||NONE
The histopathological features were identical to those seen in carcinoid or ergotamine-induced valve disease .||DISONLY
CONCLUSIONS : These cases arouse concern that fenfluramine-phentermine therapy may be associated with valvular heart disease .||SIDE_EFF
Candidates for fenfluramine-phentermine therapy should be informed about serious potential adverse effects , including pulmonary hypertension and valvular heart disease .||SIDE_EFF
Between 1987 and 1992 , all patients presenting to the senior author with a symptomatic failed silicone implant arthroplasty refractory to conservative treatment were converted to a metatarsophalangeal joint arthrodesis .||TO_SEE
Internal fixation was achieved with either dual intrameduilary threaded Steinmann pins or an obliquely placed AO compression screw and a three- or four-hole one-third tubular dorsal neutralization plate .||NONE
Bone grafting was used to maintain hallux length .||TREATONLY
Successful arthrodesis was achieved in all five feet in patients with rheumatoid arthritis .||TREAT_FOR_DIS
Subjectively , patients improved from an average of 0.69 before arthrodesis to 4.89 after arthrodesis .||TREATONLY
The average walking tolerance improved from 1.11 to 4.80 , and the overall level of satisfaction improved from 0.0 to 4.79 .||NONE
The patient 's ability to wear shoes improved from 0.87 to 3.1 .||NONE
Successful arthrodesis produces a foot that is more functional and durable than excisional arthroplasty .||TREATONLY
Subjectively , these patients stated that their level of pain , walking tolerance , and overall satisfaction improved significantly after the arthrodesis .||TREATONLY
Clinically , there was no evidence of transfer lesions , tenderness , or hallux subluxation .||DISONLY
Hallux length was well maintained after surgery with bone grafting , but it was more difficult to obtain the alignment goals .||TREATONLY
The average postoperative metatarsophalangeal dorsiflexion angle was 15.6 degrees and the first metatarsophalangeal angle was 3.1 degrees .||NONE
Despite this , patient satisfaction was high .||NONE
Arthrodesis of the first metatarsophalangeal joint using a bone graft to salvage failed silicone implant arthroplasty produces acceptable subjective and radiographic results .||TREATONLY
Although technically demanding , it provides long-term stability to the hallux , restores weightbearing , and allows for maintenance of a propulsive gait .||NONE
We recommend this procedure instead of an excisional arthroplasty to maintain high level of function and overall patient satisfaction .||TREATONLY
OBJECTIVE : To estimate the crude incidence rates of cerebrovascular accidents among the black residents of Harare .||DISONLY
DESIGN : Prospective community-based study .||NONE
SETTING : Black residents of Harare , Zimbabwe .||NONE
PARTICIPANTS : Two hundred and seventy-three 'first-ever ' strokes prospectively identified over a 12-month period .||DISONLY
MAIN OUTCOME STUDY FACTORS : Cerebrovascular accident first-week fatality rate ; age- and sex-related incidence .||DISONLY
RESULTS : The crude incidence rate was estimated to be 30.7 per 100000 ( 95 % confidence interval 27.1-34.4 ) and the standardised rate was 68 per 100000 .||NONE
Fifty-one per cent of stroke victims were below the age of 54 years .||DISONLY
Thirty-five per cent of patients died within 1 week of the stroke .||NONE
Overall , the age-specific rates for both sexes rose with age , with the rates for women being higher at all age strata except for the group 45-54 years .||NONE
CONCLUSION : With a standardised rate of 68 per 100000 and a first-week mortality rate of 35 % , stroke must now be considered an important cause of morbidity and mortality in the population .||DISONLY
OBJECTIVE : To explore the long-term effect of calcium supplementation during pregnancy on the offspring 's blood pressure during childhood .||TREATONLY
DESIGN : Follow up of a population enrolled in a double blind , randomised , placebo controlled trial .||NONE
SETTING : Perinatal research unit , World Health Organisation 's collaborative research centre .||NONE
SUBJECTS : 591 children at a mean age of 7 years whose mothers were randomly assigned during pregnancy to receive 2 g/day of elemental calcium ( n = 298 ) or placebo ( n = 293 ) .||NONE
MAIN OUTCOME MEASURES : Mean blood pressure and rate of high blood pressure of children .||DISONLY
RESULTS : Overall , systolic blood pressure was lower in the calcium group ( mean difference -1.4 mm Hg ; 95 % confidence interval -3.2 to 0.5 ) than in the placebo group .||NONE
The effect was found predominantly among children whose body mass index at assessment was above the median for this population ( mean difference in systolic blood pressure -5.8 mm Hg ( -9.8 mm Hg to -1.7 mm Hg ) for children with an index > 17.5 and -3.2 mm Hg ( -6.3 mm Hg to -0.1 mm Hg ) for those with an index of > 15.7 to 17.5 ) .||NONE
The risk of high systolic blood pressure was also lower in the calcium group than in the placebo group ( relative risk 0.59 ; 0.39 to 0.90 ) and particularly among children in the highest fourth of body mass index ( 0.43 ; 0.26 to 0.71 ) .||NONE
CONCLUSION : Calcium supplementation during pregnancy is associated with lower systolic blood pressure in the offspring , particularly among overweight children .||TREATONLY
The fast reaction of peroxynitrite with CO2 and the high concentration of dissolved CO2 in vivo ( ca .||NONE
1 mM ) suggest that CO2 modulates most of the reactions of peroxynitrite in biological systems .||NONE
The addition of peroxynitrite to CO2 produces of the adduct ONOO-CO2- ( 1 ) .||NONE
The production of 1 greatly accelerates the decomposition of peroxynitrite to give nitrate .||NONE
We now show that the formation of 1 is followed by reformation of CO2 ( rather than another carbonate species such as CO3 = or HCO3- ) .||NONE
To show this , it is necessary to study systems with limiting concentrations of CO2 .||NONE
( When CO2 is present in excess , its concentration remains nearly constant during the decomposition of peroxynitrite , and the recycling of CO2 , although it occurs , can not be detected kinetically ) .||NONE
We find that CO2 is a true catalyst of the decomposition of peroxynitrite , and this fundamental insight into its action must be rationalized by any in vivo or in vitro reaction mechanism that is proposed .||NONE
When the concentration of CO2 is lower than that of peroxynitrite , the reformation of CO2 amplifies the fraction of peroxynitrite that reacts with CO2 .||NONE
Even low concentrations of CO2 that result from the dissolution of ambient CO2 can have pronounced catalytic effects .||NONE
These effects can cause deviations from predicted kinetic behavior in studies of peroxynitrite in noncarbonate buffers in vitro , and since 1 and other intermediates derived from it are oxidants and/or nitrating agents , some of the reactions attributed to peroxynitrite may depend on the availability of CO2 .||NONE
A prospective , randomized , placebo-controlled , double-blind , parallel-group , 6-month study assessed the efficacy and safety of ropinirole , a nonergoline D2-dopamine agonist , in patients with early Parkinson 's disease ( n = 241 ; Hoehn & # 38 ; Yahr stages I to III ) with limited or no prior dopaminergic therapy .||TREAT_FOR_DIS
Patients ( mean age , 62.8 years ) , stratified by concomitant use of selegiline , were randomized to ropinirole ( n = 116 ) or placebo ( n = 125 ) .||TREATONLY
The starting dose of ropinirole was 0.25 mg tid with titration to at least 1.5 mg tid ( maximum dose , 8 mg tid ) .||TREATONLY
Primary efficacy endpoint was the percentage improvement in Unified Parkinson 's Disease Rating Scale ( UPDRS ) motor score .||DISONLY
Ropinirole-treated patients had a significantly greater percentage improvement in UPDRS motor score than patients who received placebo ( +24 % vs -3 % ; p & # 60 ; 0.001 ) .||NONE
Ropinirole was well tolerated and patient withdrawals were infrequent .||TREATONLY
Most adverse experiences were related to peripheral dopaminergic activity .||NONE
Ropinirole monotherapy is an effective and well-tolerated therapeutic option for treatment of early Parkinson 's disease .||TREAT_FOR_DIS
Starfish oocytes can be fertilized after germinal vesicle breakdown ( GVBD ) and artificial parthenogenesis can be induced by activating the oocytes after GVBD ( post-GVBD activation ) .||NONE
In the present study , parthenogenotes were obtained by the activation of immature oocytes with caffeine before treatment with 1-methyladenine ( 1-MeAde ) to induce oocyte maturation .||TREATONLY
Most of the caffeine-treated eggs developed as tetraploids , as parthenogenotes produced by the post-GVBD activation .||NONE
The parthengenotes were derived only from eggs that failed to extrude polar bodies , mostly from eggs failing to extrude a second polar body .||NONE
Eggs derived from immature oocytes activated by A23187 , treated with 1-MeAde and post-treated with cytochalasin B failed to extrude polar bodies , and eventually developed into parthenogenetic embryos .||TREATONLY
These results indicate that the present parthenogenesis mechanism shares the same characteristics as that achieved by post-GVBD activation in the suppression of polar body formation as a key means for successful starfish parthenogenesis .||NONE
We hypothesized that fluoride partly acts by changing the levels of circulating calcium-regulating hormones and skeletal growth factors .||TREATONLY
The effects of oral fluoride on 24 female , Dutch-Belted , young adult rabbits were studied .||TREATONLY
The rabbits were divided into two study groups , one control and the other receiving about 16 mg fluoride/rabbit/day in their drinking water .||NONE
After 6 months of fluoride dosing , all rabbits were euthanized and bone and blood samples were taken for analyses .||TREATONLY
Fluoride treatment increased serum and bone fluoride levels by over an order of magnitude ( P & # 60 ; 0.001 ) , but did not affect body weight or the following serum biochemical variables : urea , creatinine , phosphorus , total protein , albumin , bilirubin , SGOT , or total alkaline phosphatase .||TREATONLY
No < DIS_SIDE_EFF_NO > skeletal fluorosis < /DIS_SIDE_EFF_NO > or < DIS_SIDE_EFF_NO > osteomalacia < /DIS_SIDE_EFF_NO > was observed histologically , nor did < TREAT_SIDE_EFF_NO > fluoride < /TREAT_SIDE_EFF_NO > affect serum PTH or Vitamin D metabolites ( P > 0.4 ) .||TO_SEE
BAP was increased 37 % ( P & # 60 ; 0.05 ) by fluoride ; serum TRAP was increased 42 % ( P & # 60 ; 0.05 ) ; serum IGF-1 was increased 40 % ( P & # 60 ; 0.05 ) .||NONE
Fluoride increased the vertebral BV/TV by 35 % ( P & # 60 ; 0.05 ) and tibial ash weight by 10 % ( P & # 60 ; 0.05 ) .||TREATONLY
However , the increases in bone mass and bone formation were not reflected in improved bone strength .||NONE
Fluoride decreased bone strength by about 19 % in the L5 vertebra ( P & # 60 ; 0.01 ) and 25 % in the femoral neck ( P & # 60 ; 0 .||NONE
05 ) .||NONE
X-ray diffraction showed altered mineral crystal thickness in fluoride-treated bones ( P & # 60 ; 0.001 ) , and there was a negative association between crystal width and fracture stress of the femur ( P & # 60 ; 0.02 ) .||NONE
In conclusion , fluoride 's effects on bone mass and bone turnover were not mediated by PTH .||NONE
IGF-1 was increased by fluoride and was associated with increased bone turnover , but was not correlated with bone formation markers .||NONE
High-dose fluoride treatment did not improve , but decreased , bone strength in rabbits , even in the absence of impaired mineralization .||TREATONLY
PURPOSE : To determine the effect of various methods of managing the posterior capsule and anterior vitreous on the rate of posterior capsule opacification in pediatric eyes implanted with posterior chamber intraocular lenses ( PC IOLs ) .||SIDE_EFF
SETTING : Cullen Eye Institute , Baylor College of Medicine , Houston , Texas , USA .||NONE
METHODS : We reviewed the charts of 20 eyes of 15 children ( aged 1.5 to 2 years ) who had primary cataract surgery with PC IOL implantation during the past 5 years .||TREAT_FOR_DIS
The posterior capsule and anterior vitreous were managed in a variety of ways : In 5 eyes , the posterior capsule was left intact ; in 15 eyes , a posterior continuous curvilinear capsulorhexis ( PCCC ) was performed - 6 with and 9 without anterior vitrectomy ; in 8 eyes , posterior optic capture was performed - 3 with and 5 without vitrectomy .||TREATONLY
The follow-up ranged from 1 to 4.5 years ( mean 2 years ) .||NONE
RESULTS : Visually significant secondary cataract developed in the five eyes with intact posterior capsules and in the four eyes that had PCCC without vitrectomy and without posterior optic capture ( i.e. , the optic was left in the capsular bag ) .||SIDE_EFF
The optical axis remained clear in the six eyes that had PC IOL implantation with vitrectomy ( with or without posterior optic capture ) .||TREATONLY
Initially , all eyes that had optic capture without vitrectomy also remained clear , but after 6 months , four of five developed opacification .||SIDE_EFF
CONCLUSION : In this series , PCCC with anterior vitrectomy was the only effective method of preventing or delaying secondary cataract formation in infants and children .||PREVENT
Evidence for the presence of a serotonin1A ( 5-HT1A ) receptor subtype in the salmonid fish brain has recently been presented .||NONE
In the present study the potent 5-HT1A receptor agonist , 8-hydroxy-2- ( di-n-propylamino ) -tetralin ( 8-OH-DPAT ) was tested for its effect on plasma cortisol concentrations in rainbow trout ( Oncorhynchus mykiss ) .||NONE
Blood was sampled and 8-OH-DPAT administered through a catheter in the dorsal aorta .||NONE
Thirty minutes after the injection of 40 microg of 8-OH-DPAT/kg , plasma cortisol levels had increased from 12 to 149 ng/ml , whereupon they fell , reaching baseline levels after 4 h. The effect of 1-40 microg 8-OH-DPAT/kg on plasma cortisol concentrations was dose-dependent .||NONE
The results lends further support to the hypothesis that the brain serotonergic system plays a key role in integrating autonomic , behavioral and neuroendocrine stress-responses in fish as well as mammals , suggesting that not only the structural and biochemical organization , but also the function of the serotonergic system has been conserved during vertebrate evolution .||NONE
OBJECTIVE : To assess the medicalising effect of prescribing antibiotics for sore throat .||TREAT_FOR_DIS
SETTING : 11 general practices in England .||NONE
DESIGN : Randomised trial of three approaches to sore throat : a 10 day prescription of antibiotics , no antibiotics , or a delayed prescription if the sore throat had not started to settle after three days .||TREAT_FOR_DIS
PATIENTS : 716 patients aged 4 and over with sore throat and an abnormal physical sign : 84 % had tonsillitis or pharyngitis .||DISONLY
OUTCOME MEASURES : Number and rate of patients making a first return with sore throat , pharyngitis , or tonsillitis .||DISONLY
Early returns ( within two weeks ) and complications ( otitis media , sinusitis , quinsy ) .||DISONLY
Outcomes were documented in 675 subjects ( 94 % ) .||NONE
RESULTS : Mean follow up time was similar ( antibiotic group 1.07 years , other two groups 1.03 years ) .||NONE
More of those initially prescribed antibiotics initially returned to the surgery with sore throat ( 38 % v 27 % , adjusted hazard ratio for return 1.39 % , 95 % confidence interval 1.03 to 1.89 ) .||TREAT_NO_FOR_DIS
Antibiotics prescribed for sore throat during the previous year had an additional effect ( hazard ratio 1.69 , 1.20 to 2.37 ) .||TREAT_FOR_DIS
Longer duration of illness ( > 5 days ) was associated with increased return within six weeks ( hazard ratio 2.90 , 1.70 to 4.92 ) .||NONE
Prior attendance with upper respiratory conditions was also associated with increased reattendance .||DISONLY
There was no difference between groups in early return ( 13/238 ( 5.5 % ) v 27/437 ( 6 % ) ) , or complications ( 2/236 ( 0.8 % ) v 3/434 ( 0.7 % ) ) .||NONE
CONCLUSIONS : Complications and early return resulting from no or delayed prescribing of antibiotics for sore throat are rare .||TREAT_FOR_DIS
Both current and previous prescribing for sore throat increase reattendance .||DISONLY
To avoid medicalising a self limiting illness doctors should avoid antibiotics or offer a delayed prescription for most patients with sore throat .||TREAT_NO_FOR_DIS
This study was designed to determine and compare the dose-response characteristics , speed of onset , and relative potency of single-dose epidural fentanyl ( F ) and sufentanil ( S ) for postoperative pain relief .||TREAT_FOR_DIS
Eighty women undergoing cesarean section ( C/S ) with epidural 2 % lidocaine with epinephrine ( 1 : 200 , 000 ) were randomly assigned to receive double-blind epidural administration of F ( 25 , 50 , 100 , or 200 microg ) or S ( 5 , 10 , 20 , or 30 microg ) ( n = 10 per group ) upon complaint of pain postoperatively .||TO_SEE
Visual analog scales ( VAS , 0-100 mm ) were used to assess pain and sedation at baseline ; at 3 , 6 , 9 , 12 , 15 , 20 , 25 , 30 , 45 , and 60 min ; and every 30 min until further analgesia was requested .||NONE
The study was terminated at 30 min if satisfactory analgesia was not achieved .||NONE
Side effects were recorded .||NONE
A dose-response was demonstrated for both opioids .||NONE
F 25 microg and S 5 microg were ineffective , with significantly fewer women achieving VAS scores & # 60 ; 10 mm ( P & # 60 ; 0.05 compared with F 100 or 200 microg and S 20 or 30 microg ) .||NONE
F 100 and 200 microg and S 20 and 30 microg all achieved VAS scores & # 60 ; 10 mm in all women with no differences in time to 50 % reduction in VAS ( mean 11-16 min ) and no differences in duration of analgesia ( mean 117-138 min ) .||NONE
The 50 % and 95 % effective dose values for each opioid to achieve a VAS score & # 60 ; 10 mm were F 33 microg and 92 microg and S 6.7 microg and 17.5 microg .||NONE
There were no differences among groups in sedation scores or side effects .||NONE
Our data suggest that the relative analgesic potency of epidural S : F is approximately 5 and that there are no differences between the opioids in the onset , duration , and effectiveness of analgesia when equianalgesic doses are administered postoperatively after lidocaine anesthesia for C/S .||NONE
We describe 2 cases in which intraoperative transesophageal echocardiography detected complications related to the proximal coronary arteries during homograft aortic valve and root replacement .||TREATONLY
In both cases , cardiopulmonary bypass could not be discontinued despite the use of large doses of inotropic drugs .||TREATONLY
Transesophageal echocardiography demonstrated aliasing on color flow mapping in the left main coronary artery in 1 case and proximal right coronary artery in the other , along with severely depressed left ventricular anterior wall and right ventricular function , respectively .||NONE
Coronary artery bypass grafting was performed in both cases , and the outcome was successful .||TREATONLY
Granulocyte colony-stimulating factor ( G-CSF ) has been used to improve granulocyte count in chronic neutropenia and myelodysplasia , to minimize the incidence and duration of neutropenia during conventional chemotherapy , and to mobilize peripheral blood stem cells prior to leukapheresis for use in autologous and allogeneic marrow transplantation .||TO_SEE
The most common toxicity is bone pain , and other reactions such as inflammation at the site of injection have also occurred .||SIDE_EFF
In patients with chronic neutropenia , splenomegaly has been described with long-term use , and extramedullary hematopoiesis has also been reported .||DISONLY
However , thus far , no life-threatening sequelae of these effects are found in the literature .||NONE
We now describe a case of spontaneous splenic rupture four days following a six-day course of G-CSF therapy in an allogeneic donor of peripheral blood stem cells .||SIDE_EFF
Evidence-based medicine ( EBM ) aids clinical decision making in all fields of medicine , including primary care .||NONE
General practice is characterized by particular emphasis on the doctor-patient relationship and on biomedical , personal and contextual perspectives in diagnosis .||NONE
Most evidence available to general practitioners ( GPs ) addresses only the bio-medical perspective and is often not directly applicable to primary care , as it derives from secondary or tertiary care .||NONE
Emphasis on the biomedical domain and the randomized controlled trial ( RCT ) alone reflects a reductionist approach that fails to do justice to the philosophy of general practice .||NONE
The art of medicine is founded on context , anecdote , patient stories of illness and personal experience , and we should continue to blend this with good quality and appropriate research findings in patient care .||NONE
Abdominal tuberculosis is not uncommon in the UK , especially in Asian immigrants .||DISONLY
It resembles Crohn 's disease clinically and radiologically , and it may be difficult to differentiate between them , even at laparotomy or histology .||DISONLY
The distinction is important , however , for proper management of the two conditions .||NONE
Every effort must be made to exclude abdominal tuberculosis before the patient is diagnosed as having Crohn 's disease and is treated with steroids .||TO_SEE
PURPOSE : The American Urological Association convened the Female Stress Urinary Incontinence Clinical Guidelines Panel to analyze the literature regarding surgical procedures for treating stress urinary incontinence in the otherwise healthy female subject and to make practice recommendations based on the treatment outcomes data .||TREAT_FOR_DIS
MATERIALS AND METHODS : The panel searched the MEDLINE data base for all articles through 1993 on surgical treatment of female stress urinary incontinence .||TREAT_FOR_DIS
Outcomes data were extracted from articles accepted after panel review .||NONE
The data were then meta-analyzed to produce outcome estimates for alternative surgical procedures .||TREATONLY
RESULTS : The data indicate that after 48 months retropubic suspensions and slings appear to be more efficacious than transvaginal suspensions , and also more efficacious than anterior repairs .||TREATONLY
The literature suggests higher complication rates when synthetic materials are used for slings .||TREATONLY
CONCLUSIONS : The panel found sufficient acceptable long-term outcomes data ( longer than 48 months ) to conclude that surgical treatment of female stress urinary incontinence is effective , offering a long-term cure in a significant percentage of women .||TREAT_FOR_DIS
The evidence supports surgery as initial therapy and as a secondary form of therapy after failure of other treatments for stress urinary incontinence .||TREAT_FOR_DIS
Retropubic suspensions and slings are the most efficacious procedures for long-term success ( based on cure/dry rates ) .||TREATONLY
However , in the panel 's opinion retropubic suspensions and sling procedures are associated with slightly higher complication rates , including longer convalescence and postoperative voiding dysfunction .||SIDE_EFF
A 55-year-old lady underwent repeat aortic valve replacement using a 16-mm Carbomedics prosthesis .||TREATONLY
She made an uneventful postoperative recovery and now leads an unrestricted life .||NONE
Doppler echocardiography reveals a 21-mm Hg gradient across the valve at rest .||NONE
This did not increase with an infusion of 30 mcg/kg per min of dobutamine , which resulted in an increase in the cardiac output from 1.96 to 5.46 l/min .||NONE
BACKGROUND : For more than 30 years it has been known that gastric acid secretion is inversely related to the extent and severity of corpal gastritis .||DISONLY
We therefore evaluated the effect of cure of Helicobacter pylori infection on basal and pentagastrin-stimulated acid secretion .||DISONLY
METHODS : Basal acid output ( BAO ) and maximal acid output ( MAO ) were assessed in 11 H. pylori-infected dyspeptic patients ( 8 women and 3 men ; mean age , 28 years ) before and after successful anti-H .||NONE
pylori therapy .||NONE
RESULTS : The gastritis index was significantly lower after therapy and was associated with an increase in both BAO and MAO after cure of the H. pylori infection ( BAO from 0.3 mmol/h and MAO from 4.8 mmol/h to 19 mmol/ h ) .||DISONLY
Basal and stimulated acid concentrations also increased ( 29.1 +/- 36.6 to 54 +/- 31 mmol/l and 72.5 +/- 46 to 120.1 +/- 30 mmol/l , respectively , for basal and stimulated acid concentrations ; P & # 60 ; 0.05 for peak and MAO , P = 0.07 for BAO ) .||NONE
CONCLUSION : Gastric acid secretion increased into the normal range after successful treatment of H. pylori infection , suggesting that gastric function can recover to normal or almost normal after cure of H. pylori infection .||DISONLY
OBJECTIVE : Reports suggest that there is an increased incidence of preeclampsia after a previously normal pregnancy if there is a change in paternity .||DISONLY
We hypothesize that there is a higher incidence of preeclampsia ( proteinuric hypertension ) in women conceiving by intrauterine insemination with donor sperm versus intrauterine insemination with partner sperm .||DISONLY
STUDY DESIGN : This was a retrospective cohort study .||NONE
In women with primary infertility all pregnancies achieved by either partner or donor intrauterine insemination carried to birth of a fetus ( > 20 weeks ) were identified .||TREAT_FOR_DIS
The medical records were examined for the maternal and pregnancy outcome data .||NONE
The relative risk and 95 % confidence interval were calculated for the risk of preeclampsia .||DISONLY
The baseline data were compared with t tests , chi 2 analysis and Fisher 's exact test where appropriate .||NONE
RESULTS : Forty-four patients in the partner intrauterine insemination group and 37 in the donor insemination group were identified as having primary infertility .||TREAT_FOR_DIS
Three cases of mild preeclampsia were found in the partner insemination program and nine cases of preeclampsia ( five severe , four mild ) in the donor insemination program ( relative risk 1.85 , 95 % confidence interval 1.20 to 2.85 ) . ||VAGUE
CONCLUSIONS : There is a higher incidence of preeclampsia in women conceiving by intrauterine insemination with washed donor sperm compared with intrauterine insemination with washed partner sperm . ||VAGUE
CONCLUSIONS : There is a higher incidence of preeclampsia in women conceiving by intrauterine insemination with washed donor sperm compared with intrauterine insemination with washed partner sperm . ||VAGUE
This supports , indirectly , an immunologic basis for preeclampsia .||DISONLY
The antigenic factor would appear to be located on the sperm as opposed to the seminal fluid itself .||NONE
After a rapid examination of a few basic concepts concerning cellular aging and programmed cell death , the aging of the tissues and organs , the authors discuss the principal theories on senescence .||NONE
They underline that it is necessary to agree in considering the various genetic and epigenetic , endogenous and exogenous mechanisms that lead to the complex aging phenomenon multiple and interrelated .||NONE
In particular they stress the hypothesis that senescence can be due to a sum of molecular damages caused by free radicals , and to the loss of telomeric DNA .||NONE
Radical reactions can cause mutations , inactivation or a decrease in the turnover of mitochondrial DNA which is more vulnerable than the nuclear genoma to the attack of mutagenic agents , acting also as a continuous source of initial and/or promoting factors of the carcinogenetic process .||NONE
The somatic cells become senescent because during cell division , they lose the mechanisms for the lengthening of the telomere .||NONE
The telomerase prevents the shortening of telomeres in neoplastic cells and therefore renders them immortal .||NONE
Paradoxically the protection of the telomere is exactly what must be avoided in the case of tumor cells .||NONE
Recently the demonstration that telomerase is not always involved in the restoration of telomere length shows the complexity of the problems connected to the cause of senescence .||NONE
Chromosomally integrated retroviral switch ( S ) substrates have been developed to reveal switch recombinase-like activities ( SRLA ) in pre-B and mature B cell lines .||NONE
Switch substrate retrovectors ( SSR ) contain a long-terminal repeat-driven neomycin ( Neo ) gene for proviral chromosomal maintenance ( pre- and post-S recombination ) and a CMV promoter-driven , chimeric hygromycin-thymidine kinase ( Hytk ) gene ( flanked by S mu and S gamma 2b recombination targets ) to select for ( ganciclovir ) and against ( hygromycin B ) S region recombination .||NONE
The retro-substrates ' strong , constitutive promoters ensure that variations in cellular switch recombinase activities are independent of S region accessibility control .||NONE
By initially selecting for proviral integrants in hygromycin followed by shifting into neomycin + ganciclovir to select for S sequence-mediated deletions , switch recombinations can be specifically forestalled in B cell lines whilst most switch-incompetent cells do not survive secondary selection .||NONE
A qualitative , direct PCR assay reveals that SSR recombinations are stochastic in B cell lines generating a product array akin to natural GH class switching .||NONE
A semi-quantitative DC-PCR assay detects a significant recombinase activity only in a restricted set of late stage pre-B and mature B cell lines .||NONE
BCL1B1 mature B cells have the highest level of recombinase activity with 25 % or more of proviral int