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7788621
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Alcohol and polysubstance abuse among women.
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A review of the literature in this relatively new field highlights the legitimacy of gender-specific research on substance abuse in women. Consistent findings compared to men include a higher physical vulnerability to alcohol, a higher risk of assortative mating, the reported association of traumatic events with the onset of substance abuse, a higher psychiatric comorbidity and a shorter interval between first problem and first treatment episode. Intravenous drug use remains the major source of growth of HIV infection among women. Family assessment and treatment as well as the involvement of female role models are critical to the recovery process. Gender-specific services may be recruiting women who might not otherwise have sought treatment for their substance abuse. Further investigation is required in order to distinguish the relative significance of the genetic versus environmental vulnerability of women, the impact of rapidly changing social mores on the onset, pattern and course of substance abuse, possible gender-specific alcohol typologies, the validity of the recall of traumatic events as well as the program variables required in reaching out and engaging women on the path to recovery.
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7788620
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Immigrant and refugee children in Canada.
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In view of Canada's commitment to immigration, understanding the sources of successful adaptation by immigrant and refugee children is vital. This paper reviews the literature on the mental health of migrant children and suggests an agenda for future research.
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7788619
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Learning how to differ: agreement and reliability statistics in psychiatry.
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Whenever two or more raters evaluate a patient or student, it may be necessary to determine the degree to which they assign the same label or rating to the subject. The major problem in deciding which statistic to use is the plethora of different techniques which are available. This paper reviews some of the more commonly used techniques, such as Raw Agreement, Cohen's kappa and weighted kappa, and shows that, in most circumstances, they can all be replaced by the intraclass correlation coefficient (ICC). This paper also shows how the ICC can be used in situations where the other statistics cannot be used and how to select the best subset of raters.
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7788612
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[Atypical depression: evolution toward a specific pharmacologic and efficacious treatment?].
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The present article reviews different concepts of atypical depression. Of these, major depression associated with panic disorder would have a specific meaning according to some pharmacological and prognosis studies. It seems that this type of depression is quite frequent and has a significantly worse prognosis than major depression alone. Controlled studies comparing the efficacy of tricyclic antidepressants to phenelzine concluded in favour of the latter in general. It is generally thought that atypical depression would respond better to monoamine oxidase inhibitors (MAOI), but it would seem that it is mainly major depression associated with panic disorder that could predict this kind of response to treatment. Second generation antidepressants have not been studied systematically for this purpose even though preliminary reports seem promising.
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7788608
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Perforation of the small bowel: a case report.
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Nontraumatic perforation of the small bowel is rare. A 71-year-old man presented with a perforated jejunum 8 weeks after receiving streptokinase therapy for acute myocardial infarction. This was complicated by a bleeding duodenal ulcer, renal failure, ischemia of one toe and confusion. Renal biopsy showed cholesterol emboli. Examination of the resected specimen of jejunum revealed multiple cholesterol emboli but no other disorder. Cholesterol embolization has been associated with angiography, vascular surgery and thrombolytic therapy for myocardial infarction. Acute renal failure and ischemia of the digits as seen in this patient is also a common presentation of cholesterol embolization syndrome.
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7788607
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Pulsatile buttock mass: report of two cases and a review of the literature.
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The presence of any pulsatile mass suggests an underlying aneurysm. When such masses occur in the buttock, the differential diagnosis includes aneurysms arising from branches of gluteal vessels or aneurysms developing in a persistent sciatic artery (PSA). The investigation and management of two patients with pulsatile masses are described. Review of the embryologic aspects of these masses and the important literature on the subject led to the conclusions that when a pulsatile buttock mass is encountered, an anomalous PSA should be suspected. A gluteal artery aneurysm can be treated by ligation or occlusion, but for a sciatic artery aneurysm surgical ablation is necessary and distal perfusion must be achieved postoperatively.
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7788606
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Modern war surgery: the experience of Bosnia. 1: Deployment.
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In the first of two papers on the experience of a Canadian military surgical team in the former Yugoslavia, the authors describe the deployment of the field surgical hospital, the medical structure that supported the Canadian battle group. The hospital was made up of tent sections erected within an unfinished concrete factory building. The hospital comprised a treatment area for sick parades and reception, a pharmacy, a resuscitation area for nonambulatory casualties, a laboratory, an x-ray section, an operating room and sterilization section and a ward. The hospital could be mobilized if necessary. The setup proved to be functional for the treatment of injured soldiers. Although long delays were expected because of difficulties in transporting the injured, the patients reached the hospital in a reasonable time after injury and could be treated satisfactorily. During the period of its deployment, this hospital was used more than any other Canadian hospital in the United Nations mission. This experience allowed the authors to identify deficiencies and to correct them quickly.
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7788605
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Routine outpatient laparoscopic cholecystectomy.
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To determine what proportion of patients booked for elective cholecystectomy can be treated on an outpatient basis and what criteria will predict the need for hospital admission. A prospective analysis. A 306-bed, nonteaching, acute-care community hospital on the outskirts of a major urban centre. One hundred consecutive patients in private referral practice scheduled for outpatient laparoscopic surgery between November 1992 and January 1994. Laparoscopic cholecystectomy. The proportion of patients who successfully avoided hospital admission, the degree of discomfort, complications and the objective criteria that assist in predicting the need for initial or eventual hospital admission. Outpatient cholecystectomy was successful in 87% of the patients, and patient acceptance of the procedure was good. Advanced age, major associated health problems, acute cholecystitis and longer operations were the criteria most likely to lead to hospital admission, although none of these factors, alone or in combination, was a contraindication to outpatient cholecystectomy. Outpatient laparoscopic cholecystectomy can be performed successfully in most patients. There are four criteria that increase the likelihood of hospital admission after this procedure.
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7788604
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Reoperation for cysts of the thyroglossal duct.
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To determine the causes of recurrence of thyroglossal duct cysts (TDCs). A case series. A university-affiliated children's hospital. Between 1974 and 1990, 121 children were treated for TDCs. They ranged in age from 1 month to 18 years. Of these 121 children, 23 had recurrent TDC. Simple aspiration of the cyst, incision and drainage, cystectomy without hyoidectomy and the Sistrunk operation. Initial procedures that led to recurrence and procedures that resulted in cure. Six children had recurrence of TDCs after simple cystectomy without hyoidectomy; all were cured by the Sistrunk operation. Fourteen children with infected cysts initially underwent a variety of procedures with recurrence and were eventually managed by the Sistrunk operation. TDCs recurred in eight of these. Three children without infected cysts had recurrence after the Sistrunk operation. Of 34 TDCs infected initially, 40% recurred, whereas of 87 TDCs that were not infected initially, only 8% recurred. Simple cystectomy without hyoidectomy and pre-existing infection are the main causes of recurrence of TDCs.
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7788603
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Ancrod as prophylaxis or treatment for thromboembolism in patients with multiple trauma.
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To report the initial clinical experience with fibrinogen depletion using ancrod as prophylaxis and treatment for deep vein thrombosis and pulmonary embolism (DVT/PE) in patients with multiple trauma. A series of cases, selected because of their extreme risk of DVT/PE or because of the appearance of thromboembolic complications despite prophylaxis using conventional methods. University teaching hospital. A referred sample comprising 30 patients with multiple blunt trauma. The mean injury severity score was 30. Most cases involved a combination of lower extremity, pelvic and chest injuries. Fibrinogen was slowly depleted over 24 to 36 hours and the concentration maintained at 0.2 to 0.5 g/L thereafter. Ancrod was continued prophylactically (22 patients) or for established DVT/PE (8 patients) until the patients were mobilized or until there was no longer a contraindication to heparin, or until treatment with warfarin became practical. Monitoring for DVT by duplex ultrasonography or iodine-125-labelled-fibrinogen scanning, whichever could be applied. Twenty patients were treated with ancrod for prophylaxis from the outset because it offered theoretic and practical benefits over other methods. No patient treated with ancrod for prophylaxis suffered a clinically significant DVT/PE. Patients in whom heparin prophylaxis failed and who experienced thromboembolic complications were effectively managed with ancrod. There were no deaths and no bleeding complications specifically due to the therapy. Slow depletion of fibrinogen with ancrod may provide a safe and effective means to prevent DVT/PE in multiple trauma patients or to treat DVT/PE when the risk of bleeding from heparin is great. This initial experience should be evaluated by a randomized controlled trial.
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7788602
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The history of vascular surgery in Canada.
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The clinical specialty of vascular surgery in Canada began before the Second World War with the introduction of heparin into clinical practice by Gordon Murray of Toronto. He showed that heparin could prevent thrombosis during the repair of blood vessels and was useful in the treatment of spontaneous arterial and venous occlusion. The unfavourable war experience with arterial ligation for trauma led to an interest in the direct repair of vascular injuries by surgeons returning to civilian practice. Embolectomy, first performed in the late 1940s, was the other early vascular operation. Aortic surgery initially depended upon the use of cadaver homografts, and a number of programs were started in the early 1950s, only to be abandoned as synthetic grafts became available. Infrainguinal bypass grafting with saphenous vein evolved in clinics set up to treat varicose veins and varicose ulcers. The first in-situ grafts were done by Paul Cartier of Montreal in 1960. By this time, reconstruction for aneurysmal and occlusive disease was well established throughout Canada. Specific fellowships in vascular surgery were first offered in the 1970s, as clinical units were set up in teaching hospitals. Surgeons concentrating on vascular disease founded the Canadian Society for Vascular Surgery (CSVS) in 1978 and approached the Royal College of Physicians and Surgeons of Canada to establish training requirements in their specialty. The first qualifying examination was held in 1983, and by 1994 certificates of special competence had been awarded to 178 candidates. The pioneers in Canadian vascular surgery are acknowledged and their contributions summarized.
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7788601
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Reconstructive surgery for lower limb salvage.
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The authors review the principles of reconstructive surgery for lower limb salvage after severe lower limb trauma to determine factors that have been used as decision-making criteria for limb salvage or amputation in severe lower extremity injuries and the methods of reconstruction and their outcome. The use of scoring systems and their value in acute decision making (primary amputation or limb salvage) are described. Soft-tissue reconstructive techniques, with emphasis on the use of flaps and the importance of selecting the best technique and time for the reconstruction are reviewed. Skeletal reconstructive techniques are described, including available options and currently held views on indications and use of the best contemporary methods. It is essential for the physician to make a good initial decision on the need for primary amputation or limb salvage. A multidisciplinary approach is fundamental to successful salvage.
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7788600
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Management of the compromised lower extremity.
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Musculoskeletal injury associated with vascular compromise is a limb-threatening situation. When these injuries are associated with open fractures, the risk of limb loss is increased. In the case of an open fracture of the tibia associated with vascular compromise distal to the popliteal artery trifurcation, limb salvage is rarely indicated. Attempts at limb salvage in open tibial fractures are associated with a high risk of complication, prolonged recovery and poor function. Early amputation is more effective than delayed amputation.
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7788599
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The traumatized ischemic lower limb: a search for the optimal treatment.
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To improve the surgical results of closed injuries of the femoropopliteal arterial axis. A retrospective study over 20 years. A university-affiliated hospital. Fifty-nine patients (95% male, mean age 29 years) with 63 blunt injuries to the femoropopliteal arterial axis, treated by eight surgeons. Thrombectomy with saphenous vein patch arterioplasty; primary end-to-end anastomosis, saphenous vein interposition and saphenous vein bypass. Death rate, incidence and causes of amputation and late outcome of salvaged limbs. The death rate was 8.5%, the amputation rate was 25% and the long-term disability of salvaged limbs was 80%. Earlier ablation of two infected extremities and of another one responsible for acute renal failure would have reduced the death rate to 3% at the expense of increasing the amputation rate to 35%. The level of arterial disruption, the degree of soft-tissue damage and the ischemia time greatly influenced limb survival and long-term disability. The ischemia time is the single factor that can be modified by the medical team. If its duration is less than 15 hours, the amputation rate decreases. However, the ischemia time should be reduced to less than 7 hours to assure limb salvage without sequela. Early diagnosis and priority of the arterial repair over associated orthopedic injuries are essential to reduce the ischemia time. Despite successful revascularization, early amputation is the only means of saving life in some cases.
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7788593
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Leadership: a nursing perspective.
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The Task Force for Collaborative Nursing Education Models was a successful collaboration involving female nurse administrators. The nature of leadership in the Task Force was studied as part of a larger research project examining the process of collaboration that evolved over the 40 months of its existence (October 1987-February 1991). A retrospective qualitative case study approach was used. Data were collected from an analysis of documents that had been generated by the group, and from 36 semi-structured interviews with the 28 Task Force members. Findings and conclusions about leadership were validated during a final group interview with eight selected members. Findings of this study support the following contentions: women lead differently than men, and leadership is a collective process rather than a specialized role assumed by a single person who influences the work of other group members. Leadership was also found to rotate among group members according to the issue being considered and the expertise of those present. These findings did not support the positivist theories of leadership prevalent in current nursing management text books.
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7788591
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Mothers of children with chronic conditions: supportive and stressful interactions with partners and professionals regarding caregiving burdens.
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Ninety mothers appraised the specific sources and types of social support they received in relation to specific types of demands of caring for a child with a chronic condition. Qualitative data were collected during home interviews with the mothers of children with diabetes, spina bifida, or cystic fibrosis. Virtually all of the mothers described primary caregiver demands that were directly related to the child's condition, such as physical care, health care in illness situations, and the child's psychological and social development. Many mothers also reported secondary demands related to their own needs, family roles and relationships, and the mother's activities outside the home. Mothers experienced gaps in the support provided for specific caregiving burdens and encountered stressful interactions with their partners and health professionals in particular.
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7788588
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Women's paid/unpaid work and health: exploring the social context of everyday life.
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Literature from various disciplines was reviewed to obtain a description of the working lives of Canadian women. This analysis drew on the work of Smith (1987, 1990) and other feminist and critical theorist authors who have argued that much of women's work remains invisible and undervalued. Patterns of normative thought or social ideology may obscure the extent and value of women's contributions. It is suggested here that an "ideology of separate spheres" operates in the designation of paid activity in the public sphere as work, whereas activities pursued in the private sphere of the home are overlooked. It is further argued that women's heavy involvement in unpaid activities that support and sustain others results in a state of lesser citizenship, and women's own prerequisites of health are often compromised. Women's work often takes place outside the formal economy, within a "shadow" or subsistence economy (Illich, 1981) which is essential for the continued health of others.
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7788590
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Nurses' work: balancing personal and professional caregiving careers.
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Forty full-time nurses who were also responsible for providing care to individuals in their private lives volunteered for a qualitative study of combined caregiving careers. Each respondent kept a diary of caregiving activities during two representative 24-hour periods, and was interviewed prior to, and after diary-recording. Most nurses experienced high levels of stress associated with caregiving in both their professional and private lives. In general, they were relatively satisfied with their lives in both spheres, and felt a slightly greater sense of control in their work lives than in their home lives. Regarding the tensions/conflicts they alluded to, the following themes emerged: an ethic of high expectation, feeling torn between two worlds, a sense of working in isolation, and working in overdrive. The rewards/benefits included remuneration, recognition and self-esteem, opportunities for personal growth, and opportunities for family growth.
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7788583
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[Development of a plastic capillary tube for Saling fetal blood analysis. Evaluation of pH-metry with standard references].
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In order to avoid mouth suction and danger of glass breakage during collection and to avoid mixing of the sample with a piece of wire and an external magnet immediately after collection, an unbreakable plastic capillary tube was designed with increased heparin coating and surface and reduced diffusion distance. For assessing agreement between pH measurements of blood samples obtained with the new plastic capillary tube and a commercial glass capillary tube, umbilical blood pH-values of 41 births were analyzed simultaneously by both methods. The mean difference between paired pH-values, the corresponding 95%-confidence interval and the true limits of agreement were calculated. The pH-values obtained with the plastic capillary tube are systematically lower, with a mean pH decrease of 0.009 units, and there is an additional random variation with a standard deviation of 0.009 pH units. The true limits of agreement: [-0.031, 0.013] represent the interval of the worst expected pH difference. The increased heparin availability in the plastic capillary tube may be the reason for the systematic pH deviation of -0.009 units. However this difference does not seem to be clinically relevant and the statistical evaluation shows a sufficiently good agreement between the pH measurements.
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7788582
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[Comparison of surface tension with determination of the L/S ratio in amniotic fluid for prediction of fetal lung maturity].
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In 83 specimen of amniotic fluid both a dynamic measurement of the surface tension by the Wilhelmy-balance and a determination of the lecithin-sphingomyelin-ratio were performed in 1987-1992 in order to predict a respiratory-distress-syndrome (RDS) of the newborn. 7 cases showed divergent results of both methods. In comparison with the measurement of surface tension by the Wilhelmy-balance, determination of the lecithin/sphingomyelin-ratio showed more false positive results (4:1). Both methods provided false negative results in two cases each. In two cases both methods showed false positive results, with RDS occurring in spite of predicted lung maturity. In our high risk-collective 5 of 83 newborns developed a severe RDS. All of them were delivered by caesarean section. A secondary deficiency of surfactant as a result of fetal hypoxia or acidosis as well as a possible influence of the way of delivery might be responsible for the development of RDS. The Wilhelmy-balance, which can be used as a bed-side-method, provides similar results in the prediction of fetal lung maturity compared to the L/S-ratio.
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7788581
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[Results of neonatal hearing screening with transitory evoked otoacoustic emissions].
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From 1. 10. 1992-31. 12. 1993 a hearing screening was performed in 994 preterm and term babies (765 healthy neonates and 229 neonates with risk factors for hearing loss) by means of transient evoked otoacoustic emissions (TEOAE). There was a bilateral absent of emissions in 4.3% of the healthy neonates and 11.8% of the risk babies. 8 from 32 healthy neonates and 10 from 22 risk babies also had a negative test result in the control investigation. 16 of these children showed in 7 cases a severe hearing impairment in expanded pedaudiological investigations. The registration of TEOAE is a recommendable method for a hearing screening in neonates.
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7788580
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[Rate of prematurity and perinatal mortality in the Yaoundé (Cameroon) University Gynecologic Clinic 1982-1992> An analysis of 680 cases].
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The authors made an analysis of perinatal mortality on 680 cases of premature births recorded between 1982 and 1992 in the CHU maternity, Yaoundé (Cameroon). During this period, 13,555 births were recorded. The frequency of premature births stood at 5%. The most important etiological factors responsible for these 680 premature cases were depicted as malaria infection and anemia (22.2%), premature rupture of the membranes (13%), multiple pregnancies (11.9%), preeclampsia (10.2%), antepartnal bleeding (5.7%), and urogenital infections (5.0%). The perinatal mortality rate was 16.7% (114 cases). There were 37 cases of antepartual foetal deaths (5.4%), 24 cases of intrapartual foetal deaths (3.2%) and 31 cases of neonatal deaths (4.5%). Perinatal mortality reduced with an increase in the gestation period and the weight of the foetus. The authors noted with astonishment that perinatal mortality was twice as high in cases of non ruptured membranes (19.5%) when compared to premature ruptures of the membrane (10.2%). A plus 30 minutes duration of the expulsion phase was estimated to be a factor that increases perinatal mortality. Breech presentation with a 32.8% perinatal mortality, when compared to cephalic presentation (7.5%), portrays an important risk factor in premature births. Perinatal mortality of premature babies in cases of spontaneous births is two time higher (16.2%) than in cases of caesarean section (7.8%).
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7788578
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[Morbidity and mortality of retarded and normal weight premature infants].
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Differences of fetal outcome between appropriate for gestational age (AGA) and small for gestational age (SGA) preterm newborns with birth weight below 2500 g and gestational age ranging from 27 to 36 weeks have been evaluated. As described by Rohrer SGA have been divided into symmetrical retarded and asymmetrical retarded newborns using ponderal index. Therefore distribution of ponderal index on our local population has been analysed. SGA more often had an Apgar score below 6 five minutes post partum (p = 0.01) and their mothers more often announced abuse of nicotine during pregnancy. AGA have been on respiratory ventilation significantly longer than SGA (p = 0.001) and photo therapy because of hyperbilirubinaemia more often had to be performed on AGA (p = 0.02). AGA have spent a longer time at the neonatal intensive care unit than SGA (p = 0.0006). No differences could be found in mortality between AGA and SGA. Preterms with low ponderal index had no different outcome than SGA with normal ponderal index.
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7788579
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[Premature labor in HIV infected women. Swiss "HIV and Pregnancy" Study Group].
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In the Swiss Study "HIV and pregnancy" we observed 153 singleton pregnancies of HIV-positive women. 23 (15%) of those ended with a premature delivery. For drug addicts (n = 100), the incidence of prematurity, 20%, significantly higher than in those free of drugs (n = 53) with 5.6%. The most frequent cause of prematurity was premature labor or rupture of the membranes (n = 13), followed by maternal illness (n = 8) and fetal complications (n = 2). Women with premature delivery tended to have lower CD4 cell counts than those with term delivery (29.4% vs 12.0% with < 200 CD4 cells/microliters). Low CD4 cell counts and drug consumption are two independent but cumulative risks for severe infections. 16 of the 153 women (12 with, 4 without drug consumption) had severe infections during pregnancy; in 4 cases (25%), this led to prematurity. The most common infection was pneumonia (14/16), further one case of pyelonephritis and one of cerebral toxoplasmosis. Two of these 16 infants (12.5%) were HIV-positive. We could not confirm a relationship between prematurity and vertical HIV transmission. Of the HIV-classified children, 3/18 (16.7%) premature infants and 16/74 (21.6%) term infants were infected.
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7788577
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[Discriminant analytic model for prognostic assessment of pregnancies at risk for premature labor].
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We examined 114 women with preterm labor using discriminance analysis to assess predictive values in terms of prolongation of gestational age and gestational age at the time of delivery. We used parameters like medical history, clinical features, infections, Doppler sonography and cardiotocography. Maternal temperature, cardiotocographic findings, premature rupture of membranes, number of abortions and pregnancy terminations and cervical dilatation at the time of admission contribute significantly to predict prolongation of pregnancy (< or = as well as > 7 days). Our results from this analysis showed sensitivity and specificity of 0.70 and 0.97 and positive and negative predictive values of 0.89 and 0.91, respectively. We observed significant differences concerning parameters like preterm rupture of membranes, cervical dilatation, pathological bacteria in the vagina and pathological Doppler values between subsequent preterm and term deliveries in pregnancies with a prolongation of > 7 days was. Upon reclassifying our results, we obtained sensitivity and specificity of 0.69 and 0.89 and positive and negative predictive values of 0.78 and 0.84, respectively. Early prognostic assessment of preterm labor can be made with discriminance analysis. The results inspire us to perform a prospective examination of the therapy plan that we have obtained.
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7788575
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Comparative study between European and American species of Polistes using sera from European sensitized subjects.
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Although the different vespid species of the genus Polistes are found all over the world, studies about allergy sensitization to these species have been made mainly in North America. We studied the specific IgE in a large group of sera from patients sensitized to Polistes dominulus (PD) and determined the crossreactivity with another important European Polistes (P. gallicus [PG]) and with five American relevant species of this genus: P. exclamans (PE), P. fuscatus (PF), P. metricus (PM), P. annularis (PAN) and P. apachus (PAP). Studies indicated that 96.7% of sera with IgE positive to PD were positive to PG. No case positive to just PG was found. The comparison of these two European species with the American relatives indicated that most cases were positive to all the insects although there were significant differences in the radioallergosorbent test (RAST) value. These results were confirmed by RAST inhibition studies, and indicate that although the European and American species are closely related, species specific allergenic differences exist. These data suggest that in vivo studies should be carried out in order to determine the sensitivity and specificity of the European venoms compared with the American species.
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7788573
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HLA-DR expression is induced on keratinocytes in delayed hypersensitivity but not in allergen induced late-phase reactions.
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In view of increasing evidence suggesting an active immunoregulatory role of the skin keratinocytes and the observation that the differentiation of allergen specific T lymphocytes is critical in the development of allergy, we evaluated epidermal expression of HLA-DR antigen in skin reactions induced with an atopen (house dust mite) and with an non-atopic antigen (Hemocyanin). Two groups of patients with house dust mite (Dermatophagoides pteronyssinus [Der p]) allergy were compared, one group was skin tested with Der p, the other group was immunized and subsequently skin tested with Helix pomatia Hemocyanin (HPH). Biopsy specimens taken at 48 h after the HPH (n = 11) and Der p (n = 11) tests were analysed immunohistologically. Reactions in both groups were comparable in size. Immunohistological analysis showed domination by CD4+ lymphocytes. Expression of HLA-DR antigen by epidermal keratinocytes was observed in six out of 11 of the HPH induced reactions, but in none of the Der p induced reactions. Eosinophils were spotted only throughout the Der p induced reactions, showing a good correlation with the number of CD4 positive lymphocytes. The lack of HLA-DR expression by keratinocytes during the allergen-induced reaction, compared with the Hemocyanin induced reaction can be the result of a difference in cytokine profile of the lymphocytes dominating the dermal infiltrate. On the other hand evidence exists that defective HLA-DR expression by keratinocytes enhances antigen induced lymphocyte activation, and may thus contribute to the development of allergen-specific T-lymphocytes.
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7788574
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Immunological study of Melkersson-Rosenthal syndrome. Lack of response to food additive challenge.
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A study was made of six patients with Melkersson-Rosenthal syndrome (MRS) to establish the aetiological role of foodstuffs and/or additives and the possible associated immunological alterations. In all cases Melkersson-Rosenthal syndrome (MRS) was diagnosed both clinically and histologically, excluding other causes of orofacial granulomatosis (OFG). A detailed study of possible triggering factors was performed in all patients. Blood analysis, x-rays and cultures, were always within normal limits, with the exception of the finding of circulating immune complexes (CICs) in three patients with facial palsy associated, and C-reactive protein positivity in two patients who presented persistent labial oedema. All patients were subjected to skin-prick tests with common inhalant allergens and with foods when sensitization to foods were suspected, and patch tests with European Standard Series and pastry components, organic dyes, perfumes and fragrances series. The results were negative in all cases. When asymptomatic, the patients were subjected to a double-blind oral challenge, under placebo control, with additives (monosodium glutamate, tartrazine, sulfites, erythrosine, paraoxybenzoate, sodium benzoate, lactose, aspirin, and annate), which was again negative. In no case did the patients refer the appearance of outbreaks with exposure to foods or contactants, and the course of the disease was unaffected by exclusion diets and the elimination of contactants. To conclude, we observed no sensitization to foods, additives or contactants in our patients. Likewise, there were no antecedents of atopy or hereditary predisposition related to the aetiopathogeny of MRS. The significance of the CIC encountered only in patients with facial paralysis remains to be established, due to the limited number of patients studied.
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7788572
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Differences between specificities of IgE and IgG4 antibodies: studies using recombinant chain 1 and chain 2 of the major cat allergen Felis domesticus (Fel d) I.
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IgE- and IgG4 antibodies were compared for reactivity with recombinant chain 1 and chain 2 of the cat allergen Felis domesticus (Fel d) I. Recombinant chain 1 and chain 2 were coupled to sepharose and tested in IgE- and IgG4 radioallergosorbent test (RAST) experiments. Substantial IgE- and IgG4 binding was found. The fraction of Fel d I-specific antibody that bound to the recombinant chains was calculated. For chain 1, the mean value of this fraction was 0.30 for IgE and 0.23 for IgG4 (P = 0.05). For chain 2, the mean value of this fraction was 0.19 for IgE and 0.13 for IgG4 (P = 0.02). These results indicate that differences in fine specificity exist between IgE and IgG4 antibodies. Moreover, these findings support our results with chemically prepared peptides derived from these two chains and suggest that the B cells producing IgE antibodies are more likely to recognize a less 'native' form of Fel d I, compared with IgG4.
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7788571
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House dust mite allergen levels in two cities in Canada: effects of season, humidity, city and home characteristics.
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The homes of 120 patients with asthma, 57 in Vancouver and 63 in Winnipeg, were studied. The characteristics of the homes were assessed by a questionnaire. Dust samples were collected and the indoor relative humidity was measured four times during the year covering all four seasons in both cities. Mite allergen levels were determined using monoclonal antibodies against Der p I and Der f I by the ELISA method. The mean levels of both mite allergens in mattress and floor samples in the homes in Vancouver and in Winnipeg were relatively low for all seasons. Mite allergen levels were found to be associated with city, season and individual home differences. They were significantly higher in Vancouver than in Winnipeg. Der p I and Der f I in mattress samples in both cities and Der f I in floor samples in Vancouver, varied by season. The indoor relative humidity level in the homes in Vancouver were also significantly higher than those in Winnipeg. There was, however, no significant association between the levels of indoor relative humidity and the levels of mite allergens after adjusting for variations in city, season and individual home. Although individual home differences were highly associated with mite allergen levels, only a few home characteristics were found to be related to mite allergen levels such as the type and the age of the home, the type of heating, the use of feather pillows and the number of occupants in the homes. Whether low levels of mite allergens are partially responsible for the relatively low prevalence of childhood asthma in Canada remains to be investigated.
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7788569
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The allergen of Ficus benjamina in house dust.
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Ficus benjamina, a member of the Moraceae family, is a tropical, non-flowering green plant which is widely used for ornamental purposes. It is an occupational allergen in plant keepers but sensitization is also increasingly found in non-occupationally exposed atopic and non-atopic patients. The allergen of Ficus benjamina is located in the plant sap, a so-called latex. By radioallergosorbent test-(RAST)-inhibition studies allergen could also be demonstrated in the dust collected from the leaf surface and in dust samples from the floor of rooms where the plant was placed. These findings could result in more extensive preventive measures in patients sensitized to Ficus benjamina. In addition there is some evidence that possibly a crossreactivity between latex of Ficus benjamina and latex from the rubber tree Hevea brasiliensis, a member of the Euphorbiaceae family, may exist.
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7788570
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Seasonal appearance of grass pollen allergen in natural, pauci-micronic aerosol of various size fractions. Relationship with airborne grass pollen concentration.
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In a study during the 1993 grass pollen season at Leiden, the relationship between atmospheric pollen allergen carried by five size fractions of pauci-micronic (few microns) particles and the grass pollen count was investigated. Sampling was carried out on dry days, and atmospheric pollen allergen in the particle fractions was assessed by a RAST-inhibition assay while grass pollen quantities were measured with a volumetric pollen trap. It appears that the atmospheric presence of grass pollen allergen in all size fractions is restricted mainly to the period of presence of grass pollen grains. Before and after the grass pollen season atmospheric grass pollen allergen quantities are generally very low. It is concluded that a routinely performed grass pollen count is a reliable measurement for the estimation of the amount of atmospheric grass pollen allergen, also in the pauci-micronic particle fraction.
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7788563
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Purification and identification of two distinct isoforms of rabbit pancreatic cholesterol esterase.
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Cholesterol esterase (CEases; E.C. 3.1.13) has been purified to homogeneity from rabbit pancreas. The method of purification consists of homogenization of total pancreas, high speed centrifugation, anion exchange column chromatography on S-Sepharose, size exclusion on Sephacryl followed by affinity chromatography on heparin agarose. During the purification procedure, two distinct isoforms of CEases have been identified. Both forms are similar in their molecular weights, bile salt requirement and pH optima but differ in their sensitivity to heparin. Isoform-I is resistant and isoform-II is sensitive to heparin. In the normal pancreas of the adult rabbit, the amount of each of the enzymes appears to be in equimolar concentrations. Physiological significance of the existence of heparin sensitive and resistant forms by the same tissue is unclear. In view of the significant role played by heparin in the modulation of CEase activity and several other physiological functions, these two isoforms may have different mechanisms of action on the hydrolysis of carboxyl esters of cholesterol and vitamins.
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7788562
|
Effect of dietary fiber at weaning on protein glycosylation in the rat small intestine.
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Changes in protein glycosylation which can be modulated by dietary factors are observed in the rat intestinal mucosa at the weaning period. Experiments were performed to evaluate the involvement of dietary fibers in the regulation of such modifications. Groups of rats were abruptly weaned at 19 days of age on semi-synthetic diets differing in dietary fiber content (fiber-free, 10% pectin or 10% cellulose) given for 4 and 10 days. Glycoprotein sugars, activities of the fucosylation pathway and caecal contents were analyzed. Neutral sugar contents in glycoproteins of the small intestinal mucosa were increased in teh fiber-fed groups as compared to fiber-free group, only after 4 days but not after 10 days of diet. Diet-induced modifications in the glycoprotein fucose content of the small intestinal mucosa are partly explained by the coordinated evolution of different activities involved in the fucosylation pathway (GDP-fucose production and breakdown, fucosyltransferase and fucosyltransferase inhibitor). Caecal contents of short chain fatty acids were significantly different between the three groups after 4 but not after 10 days of diet. There was no correlation between caecal short chain fatty acid contents and activities involved in the fucosylation pathway. The introduction of dietary fibers at weaning induced marked but transient changes in glycoprotein sugars and the fucosylation pathway. The results demonstrate that fucosylation is regulated in several ways including changes in fucosyltransferase activity but that caecal fermentation of dietary fibers was not directly responsible for the observed changes.
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7788561
|
The purification and properties of glutathione reductase from the cestode Moniezia expansa.
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Glutathione reductase has a central role in glutathione metabolism and as such is a potential target for chemotherapy. The aim of the work was to purify and characterise glutathione reductase from the cestode Moniezia expansa and to compare the properties of the helminth enzyme with its mammalian counterpart. The enzyme was purified by a combination of anion exchange and affinity chromatography and further characterized by chromatofocusing and gel electrophoresis. Analysis revealed a single isoenzyme of glutathione reductase in Moniezia expansa, with a pI of 5.8. The enzyme was a homodimer of native molecular weight 114 kDa, subunit weight 63 kDa. Enzyme activity was affected by buffer concentration and the presence of monovalent sodium salts. The pH optimum was 7.4 with NADPH as cofactor and 5 with NADH. The Kma for oxidized glutathione was 76 microM and for NADPH and NADH, 21 and 350 microM respectively. In addition to oxidized glutathione only the mixed disulphide between CoA and glutathione (CoASSG) showed any significant activity as substrate. The cestode enzyme was inhibited by a variety of compounds including arsonic derivatives, 2,4,6 trinitrobenzene sulfonate 1,3-bis (2-chlorethyl)-1-nitrosourea and oxidized glutathione. In conclusion the glutathione reductase of M. expansa resembles the mammalian enzyme in its general physical properties and its substrate and inhibitor profile. However, the parasite enzyme shows an unusually high activity with the mixed disulphide of coenzyme A and glutathione (CoASSG) and appears to be more sensitive to inhibition by sodium ions.
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7788560
|
Expression of stress proteins in cultured HT29 human cell-line; a model for studying environmental aggression.
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The current study was undertaken to investigate the expression of stress proteins (HSP) in cultured human HT29 cells submitted to stressing events under in vitro conditions. Heat shocks (45 degrees C, for 15-60 min) or cold shocks (+ 1 degree C for 4 hr) were found to modify cell growth (growth curves) and to enhance HSP expression. In most cases, changes in HSP expression are much more pronounced than changes in cell growth. Exposure to 8% ethanol for 15 min resulted in both growth inhibition and HSP overexpression. Propanol-1 was found to be more toxic since 5% concentration given for 15 min stops cell growth. 2.5% propanol-1 for 15 min induces a slight reduction of cell growth but a clear-cut overexpression of stress proteins. We conclude that expression of stress proteins, especially those of the HSP68/70 family, constitutes a more sensitive response than changes in growth rate in case of external aggression. This could make our model an interesting biological sensor to environmental physical or chemical pollutants.
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7788559
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Brain mRNA from infants of aluminium-exposed lactating rabbits.
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The neurotoxicity of aluminium (Al) involves bundling of neurofilaments, increased chromatin binding and decreased protein synthesis in Al injected rabbits. Thus, using an amphipathic Al ligand, maltol, experiments were carried out to examine whether or not administration of Al to lactating mother rabbits reduces brain protein synthesis in their offspring. Lactating mother rabbits received s.c. injections 3 times weekly of aluminium (Al) maltolate (1 mg Al/kg body wt) or an equivalent weight of maltol, for 4 weeks post-partum. Polysome preparations were obtained from the brain of their infants in order to assess mRNA translation in cell-free protein synthesizing systems. The brain polysomes showed a statistically significant reduction in the incorporation of [14C]leucine into protein. The poly (A)+ and poly (A)- fractions obtained from these polysomes showed reductions of 44% or more in the incorporation of [35S]methionine into protein. A variety of products separated by SDS-polyacrylamide gel electrophoresis all exhibited decreased labelling. These experiments suggest that infant rabbits exposed to a highly neurotoxic form of Al in milk exhibit changes in brain protein synthesis which resemble those in infants injected directly with Al.
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7788557
|
Absorption spectroscopy of the complexation between superpotent guanidinium sweeteners and specific monoclonal antibodies.
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Spectroscopic studies of antibody-antigen interactions can provide useful information about the interactive motifs and energetics involved in the intermolecular association process. In this study we used absorption spectroscopy to examine the interactions between five different monoclonal antibodies (mAb) and four superpotent ligand sweeteners. Quantitative changes in the absorption spectra in the wavelength range of 230-800 nm were utilized for the determination of intrinsic association constants and thermodynamic parameters of the mAb-ligand complexes. The intrinsic association constants for the mAb-ligand complexes were found to be in the range of 10(7)-10(5) lM-1 and were in agreement with previous radioimmunoassay determinations. For two mAb, qualitative changes in the spectra in the 340 nm range could be identified and were related to the presence of charge-transfer interaction between the guanidinium ligand and aromatic residues in the binding site of the mAb. A charge transfer spectra was observed in mAb NC10.8 with two different sweetener ligands. The thermodynamic parameters of the ligand-mAb interactions were analyzed by van't Hoff plots and in almost all cases the reactions were found to be enthalpically driven. The determinations of intrinsic affinity and thermodynamic parameters may be useful in computer-aided molecular modelling studies of the antibody binding pocket and predicted ligand docking orientations. Antibody NC6.8 was found to react with this set of sweetener ligands in a rank order that is related to their sweetness potencies and the spectroscopic findings for NC6.8 are in agreement with the X-ray diffraction data of the Fab-ligand crystal structures.(ABSTRACT TRUNCATED AT 250 WORDS)
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7788558
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Determination of carbonic anhydrase-III by enzyme-immunoassay in liver, muscle and serum of male rats with streptozotocin-induced diabetes mellitus.
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Insulin has a plethora of metabolic effects but its action on carbonic anhydrase-III (CA-III), a key enzyme in acid-base regulation, has been little studied. The present studies examined the effects of streptozotocin induced diabetes on the concentrations of CA-III. The concentration of CA-III in the liver, muscles and serum of rats with experimental diabetes mellitus was measured by the method of enzyme-immunoassay. Streptozotocin-induced diabetes mellitus resulted in a reduction in concentration of CA-III in the liver and serum, but not in skeletal muscles, of adult male rats. A 98% reduction in hepatic CA-III content relative to control values was observed. The reduction in CA-III content in the liver was restored to control value by administration of insulin. The CA-III content in serum of diabetic rats declined to approx. 25% of control values, but the reduction was unaffected by administration of insulin. The concentration of CA-III in the liver and serum of diabetic rats was not influenced by administration of methyltestosterone. Although the content of CA-III in m. rectus femoris, m. tibialis craniaris and m. soleus differed, no significant difference of CA-III content was found between diabetes mellitus and control rats. The effect of chronic diabetes mellitus on CA-III content was obviously different between liver and muscle, suggesting that the regulation of CA-III biosynthesis differs between these two tissues. These results suggest that biosynthesis of CA-III in hepatocytes of rats is influenced by irregular patterns of GH secretion brought about by diabetes mellitus.
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7788554
|
[Hemofiltration ameliorating reperfusion injury after complete cerebral ischemia: an experimental study].
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The effects of hemofiltration on cerebral resuscitation were studied by using resuscitation model of potassemia-induced cardiac arrest and cardiopulmonary bypass. Sixteen rabbits were divided into control group (CG) and hemofiltration group (HFG). Blood lactic acid, lipid peroxidant (LPO), serum iron, middle molecular substance (MMS) were determined. Neurologic deficit score (NDS) system was used to evaluate neurologic function. The level of blood lactic acid was increased in both CG and HFG. It was higher in CG than in HFG (P > 0.05). Serum iron was increased in CG, however, it was decreased in HFG. The difference between the two groups was significant (P < 0.01). LPO was increased significantly in CG and there was no obvious changes in HFG. MMS was increased gradually during reperfusion in CG, whereas it was decreased in HFG. There was significant difference in the corresponding times of the two groups. NDS of CG was higher than that of HFG (32 +/- 12 vs 18 +/- 10) (P < 0.01). These data demonstrate that hemofiltration is able to eliminate ischemic and reperfusional toxic products quickly. Additionally, free iron, agonist factor of catalyzing free radical reaction, does not increase because free radicals and lactic acid are eliminated quickly, inhibiting free radical tissue injury and improving cerebral resuscitation.
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7788555
|
[Affection of growth of zinc deficiency growing rats].
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Fifty male Sprague-Dawley rats with an average live mass of 42 +/- 4g were divided into 5 groups of 10 animals each. An artificial semi-systhesis diet was given to the animals. Group 1 received a control diet (32.2 mg Zn/kg DM), and group 2 a zinc deficient diet (3.4 mg Zn/kg DM) ad libitum. The animals of group 3 were pair fed to group 2 with a diet (84.9 mg Zn/KgDM). Diets of group 4 and 5 contained zinc (4.4 and 5.5 kg Zn/micrograms DM), respectively. The two groups also pair fed to group 2. The food intake and live mass gain were observed every day. After 26 days of experiment, the animals were decapitated; the blood samples were collected for the analysis of serum zinc, zinc binding capacity, and alkaline phosphatase.
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7788553
|
[Clinicopathologic characteristics of primary liver cancer in patients younger than 35 years].
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To investigate clinicopathologic characteristics of primary liver cancer (PLC) in young adults, 77 patients younger than 35 years were compared with 603 patients older than 35 years during the same period. In the young patients, PLC showed a low incidence of PLC detected at mass survey (young 15.6% versus older 28.7%, P < 0.05); a low incidence of hepatitis history (young 36.8% versus older 66.3%, P < 0.01); a high incidence of positive hepatitis B virus surface antigen (HBsAg) (young 79.2% versus older 67.6%, P < 0.05); a low incidence of associated cirrhosis (young 64.9% versus older 90.7%, P < 0.01); larger tumor size (PLC > 5cm; young 87.0% versus older 73.0%, P < 0.01); a more advanced stage of the disease in TNM classification (stage III; young 29.9% versus older 18.2%, P < 0.05). It is suggested that hepatitis B virus (HBV) may play an important role in the development of PLC without associated liver cirrhosis in the young patients. A close periodic surveillance of young adults with a positive HBsAg is important to detect PLC at an early stage.
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7788551
|
[Detection of c-myc translocation in human lung cancer cells by fluorescence in situ hybridization (FISH)].
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c-myc gene amplification has been found in lung cancer, however, it can not explain all cases of lung cancer with c-myc gene overexpression. Gene translocation is one of the ways by which oncogene is activated. But the old methods for detecting gene mutations are not so effective for the detection of gene translocation, especially in solid tumors. Fluorescence in situ hybridization (FISH) can be used to detect gene translocation more efficiently. Using FISH, we discovered c-myc gene translocation in a lung adenocarcinoma cell line GLC-82 and SV40T-transformed human bronchial epithelial cells. In GLC-82, c-myc gene translocated to the short arm of a C group marker chromosome. In the SV40T-transformed epithelial cells, c-myc gene translocated to 14q32, which was the same as that found in Burkitt's lymphomas. Translocation was related to oncogene activation. c-myc translocation may play an important role in the carcinogenesis of lung cancer.
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7788552
|
[Experimental study on in vivo hematopoietic regulation of interleukin-6 gene therapy].
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Interleukin-6 (IL-6), a pleiotropic cytokine, is involved in extensive immune regulation and hematopoietic regulation. We observed the effect of fibroblast mediated human IL-6 gene therapy on hematopoiesis. The platelet counts started to increase at day 4 after implantation of IL-6 highly secreting fibroblast cells and peaked at day 10 and lasted at high level for 22 days. The neutrophil counts were elevated after their implantation, but WBC did not show any remarkable increase. The CFU-GM and CFU-MK in bone marrow and spleen were also increased significantly. The results demonstrated that fibroblasts mediated human IL-6 gene therapy can significantly augment in vivo hematopoietic functions in bone marrow and spleen and elevate the number of nuetrophils and platelets. This study provides a new approach to treat thrombopenia and chemotherapy or radiotherapy-induced hematopoietic suppression.
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7788550
|
[Expression and loss of heterozygosity of DCC gene in human lung cancer].
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The level of DCC mRNA expression was evaluated in tissue specimens from lung cancer patients by semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) combined with Southern blot analysis. Obvious reduction of DCC gene expression was observed in 4 of 7 specimens (55%). In two specimens DCC transcript could only be detected after Southern blot hybridization of RT-PCR product. The average level of DCC expression in cancer tissue was about 45% of normal tissue as estimated by laser densitometer. We also studied DNA samples for loss of heterozygosity (LOH) at DCC locus at two polymorphic sites. Among the 15 specimens including 7 samples for RT-PCR, 9 (60%) were informative at either of two polymorphic sites. LOH was observed in 5 (55%). Two at the MspI-RFLP (restriction fragment length polymorphism) site and 3 at the site of VNTR (variable number of tandem repeat). These results suggest that allele loss and decreased expression of DCC gene are frequent events and the possible involvement of DCC gene in the pathogenesis of human lung cancer.
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7788549
|
[Inhibition of growth factor stimulation of mitogen-activated protein kinase by prostaglandin E2 in rat renal mesangial cells].
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Activation of the mitogen-activated protein kinase (MAPK) pathway is believed to play a critical role in normal and pathophysiologic proliferation of mesangial cells. Recent studies have shown that MAP kinase activation by growth factors in other cell types involves activation of the low molecular weight G-protein ras and the protooncogene serine kinase c-raf-1. In this study the role of this pathway in rat renal mesangial cells was assessed. 20ng/ml of platelet-derived growth factor (PDGF), 10(-8) mol/L epidermal growth factor (EGF) as well as phorbol ester (10(-6) mol/L PMA) rapidly activated MAP kinase by 3-4 fold in these cells. PDGF and EGF, but not PMA were able to activate c-raf-1 and ras activity. Stimulation with inflammatory mediator PGE2 (50 mumol/L) or elevation of Intracellular cAMP by treatment of cells with forskolin (25 mumol/L) markedly blunted activation of MAP kinase induced by PDGF and EGF, but not PMA. Consistent with this observation, PGE2 abolished growth factor induced activation of c-raf-1. However, ras activation induced by growth factor was not affected by PGE2 and forskolin. These results suggest that MAP kinase activation can occur by at least two separate pathways in mesangial cells. Tyrosine kinase receptors activate MAP kinase through activation of ras and raf. This pathway can be blocked by PGE2 and elevation of cAMP, presumably by interfering with the ability of ras to activate raf. In addition, activation of protein kinase C by phorbol esters can activate MAP kinase in a ras/raf-independent manner. This pathway is not sensitive to inhibition by PGE2 or cAMP. It is likely that activation of each of these pathways, both resulting in a stimulated MAP kinase, will have different physiologic consequences in mediating mesangial cells growth.
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7788548
|
[Image analysis for intercellular adhesion molecule-1 expression in MRI/lpr mice: effects of Chinese herb medicine].
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To clarify the role of intercellular adhesion molecule-1 (ICAM-1) on pathogenesis of autoimmune lupus nephritis in MRL/lpr mice and the effects of Chinese herb medicine (stragalin), a computer image analysis system was used to study immunodepositions of ICAM-1, immunoglobulins and C3 in renal tissue sections of the mice. ICAM-1 was found in the mesangial area and deposited along the glomerular capillary walls in MRL/lpr mice. The distribution intensity of ICAM-1, immunoglobulins and C3 were significantly decreased after treatment with stragalin in form of decoction per os in the mice. We found that ICAM-1 might play an important role in pathogenesis of autoimmune lupus nephritis in MRL/lpr mice and Chinese herb medicine has some inhibition effects on immunodepositions in renal tissue of MRL/lpr mice.
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7788547
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[In situ expression of intercellular adhesion molecule-1 in human glomerulonephritis].
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We conducted immunocytochemical analysis with in situ hybridization technique to investigate the presence and role of intercellular adhesion molecule-1 (ICAM-1) in normal and diseased kidneys. A total of 64 renal biopsy specimens were classified in three groups according to the degree of cellular proliferation in glomerulus. Group A presented no or mild proliferation (n = 38). Group B showed definite proliferation (n = 21). Group C had glomerular sclerosis (n = 5). The ratio of cases exhibiting increased glomerular ICAM-1 expression in lupus nephritis (9/10) was significantly different from that in minimally changed disease (1/5) (P = 0.017). Glomerular ICAM-1 expression level correlated well with the cellular proliferation and infiltration in glomerulus (B&A: P < 0.001; C&B: P < 0.05). The percentage of cases with tubular ICAM-1 positivity in group B (81.0%) and group C (100%) was greater than that in group A (52.6%), which was also correlated with that of interstitial cell infiltration. In situ hybridization of 9 renal biopsies with digoxigenin labelled oligo probe proved immunocytochemical findings. We conclude that glomerular ICAM-1 expression level is correlated with inflammatory degree of glomerulus and that tubular ICAM-1 expression is associated with interstitial cell infiltration.
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7788546
|
[Different expressions of alpha 2 (IV) and alpha 3 (IV) collagen mRNAs in renal glomeruli of IgA nephropathy].
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The levels of extracellular matrix protein mRNAs were increased prior to the appearance of histological glomerulosclerosis in isolated glomeruli from several animal models. Striker studied renal biopsies (Seminar in Nephrology, 13:508,1993). We made a comparable study in human renal biopsies to assess the levels of glomerular alpha 2 (IV) and alpha 3 (IV) collagen gene expressions in renal biopsies. Renal biopsy specimens were obtained from 11 patients (7 IgA nephropathy and 4 mesangial proliferative glomerulonephritis). Glomerular lesion was divided into 5 grades. The amount of collagen type IV in glomerular matrix was evaluated by immunoperoxidase staining using a monoclonal antibody to type IV collagen. For gene expression analysis, glomeruli were dissected out from about 10% of each biopsy specimen. The expressions of alpha 2 (IV) and alpha 3 (IV) collagen mRNAs were analyzed by using in situ reverse transcription coupled with polymerase chain reaction. Each PCR reaction contained an amount of cDNA template equivalent to that obtained from 1/10 of a glomerulus, alpha 2 (IV) and alpha 3 (IV) collagen mRNAs were detected in all specimens. All 3 cases of IgAN with grade III glomerular lesion had a more marked increment of glomerular alpha 2 (IV) collagen cDNA than that of the other 3 IgAN patients with grade II lesion (the intensity of PCR product, grade III 0.54 +/- 0.12, VS grade II 0.25 +/- 0.08, P < 0.05). No discrepancies were detected in the level of glomerular alpha 3 (IV) collagen cDNA and the intensity of collagen IV staining between these two groups of IgAN. Interestingly, in MsPGN patients there was no difference in the expression of glomerular alpha 2 (IV) collagen mRNA between grade II and grade III glomerular lesions. The results suggested that the detection of glomerular alpha 2 (IV) collagen mRNA level in IgAN patients may help to define the pathological classification.
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7788544
|
Gastrointestinal emergencies in the patient with AIDS.
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The clinical importance of gastrointestinal disorders among patients with acquired immunodeficiency syndrome (AIDS) is enormous. Estimates of gastrointestinal complaints among AIDS patients range from 30% to 90%. Many of these patients may be chronically ill and have multiple simultaneous opportunistic pathogens and neoplasms. The diagnosis and management of serious gastrointestinal complications that often occur in the setting of chronic illness represent major challenges in the care of patients with AIDS.
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7788542
|
Acute mesenteric ischemia.
|
The term acute mesenteric ischemia (AMI) is applied to a wide spectrum of bowel injury within the distribution of the superior mesenteric vessels, ranging from reversible alterations in bowel function to transmural necrosis of the bowel wall. Intensivists not only are called upon to manage this catastrophic disease but also may be faced with AMI as a consequence of other illnesses that they treat.
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7788543
|
Emergencies in inflammatory bowel disease.
|
Ulcerative colitis and Crohn's disease, the principal IBDs, are characterized most often by a chronic relapsing course. Despite the protracted nature of these disorders they can present in an acute manner as gastrointestinal emergencies. The urgent manifestations include both intestinal and extraintestinal disease. Extraintestinal emergencies can be ocular, rheumatologic, hematologic, and urologic. Intestinal emergencies often are more severe and can be life-threatening. These may include obstruction, abscesses, perforation, and hemorrhage. The successful management of such complications depends on early diagnosis and the judicious and timely use of both medical and surgical therapies.
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7788541
|
Diarrhea in the intensive care patient.
|
Approximately one third of patients admitted to the ICU develop diarrhea during their hospitalization. Diarrhea can lead to further complications, such as volume depletion and wound infection, and can significantly increase medical costs. The most common causative factors are medications, enteral feedings, and C. difficile infections. These may be implicated alone or in combination. Further investigations of the pathophysiology of ICU diarrhea as well as potential therapies are needed to clarify the proper approach to this important and complex problem.
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7788540
|
Complications of chronic liver disease.
|
The patient with advanced cirrhosis presents unique challenges to the critical care physician, in great measure because of the protean functions attributable to the liver and the multiplicity of derangements that may occur. Portal hypertension, once it develops, is the source of potentially devastating complications that include life-threatening hemorrhage, infection, renal failure, and coma. Parenchymal disease can result in coagulopathy as well as altered handling of both endogenous (hormones, metabolites) and exogenous (drugs) substances. Cirrhosis also can be complicated by the development of HCC, which may worsen portal hypertension, deplete parenchymal reserves, and result in catastrophic complications. The prospect of cure by liver transplantation in selected cases serves to underscore the importance of prompt and vigilant management of patients with decompensated cirrhosis in the critical care setting.
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7788539
|
Fulminant hepatic failure.
|
Fulminant hepatic failure is a devastating complication of viral hepatitis, hepatotoxic exposures, and a variety of other acute liver diseases. Although this syndrome is associated with high mortality, liver transplantation can be life saving. This article discusses the medical management of fulminant hepatic failure and emphasizes complications, determinants of survival, and patient selection for liver transplantation.
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7788538
|
Variceal hemorrhage.
|
Variceal hemorrhage is a complication of portal hypertension that has high mortality and high recurrence rates. Management of variceal bleeding involves three areas: treatment of active hemorrhage, prevention of rebleeding, and prevention of first variceal bleeding. There are two main therapeutic avenues: methods directed at reducing portal pressure, such as pharmacologic therapy, shunt surgery, and TIPS; and methods that act locally by decreasing or interrupting blood flow through a specific varice, such as sclerotherapy, banding, and balloon tamponade. The relative effectiveness of each of these interventions is discussed in this article.
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7788537
|
Lower intestinal hemorrhage.
|
Lower intestinal hemorrhage, defined as bleeding originating below the ligament of Treitz, is a common clinical problem frequently requiring hospital admission. The two chief causes, vascular ectasia and diverticulosis, are degenerative diseases usually found in the elderly. This article focuses on those disease entities that potentially can result in significant lower intestinal blood loss. It also discusses a generalized approach to the diagnostic evaluation leading to specific management of the patient presenting with this problem.
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7788536
|
The critical care management of nonvariceal upper gastrointestinal bleeding.
|
Upper gastrointestinal hemorrhage, although accounting for more than 300,000 annual hospital admissions in the United States, continued to have about a 10% mortality rate over the past 50 years. Whether this is secondary to the increasing age of patients admitted with UGI hemorrhage, and their comorbid diseases, is unknown. The major approach to these patients includes volume and cardiovascular resuscitation, as well as surgical and gastroenterology consultation. Both clinical signs and endoscopic features in patients aid in predicting those at high risk of either rebleeding or dying, allowing for more aggressive steps, including endoscopic therapy of the bleeding site and surgery. Improved intensive care measures and endoscopic therapies for these patients may account for the signs of a recent decline in this mortality rate during the past 10 years.
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7788535
|
Stress-related mucosal disease. Pathophysiology, prevention, and treatment.
|
The advent of gastrointestinal endoscopy has allowed us to follow the morphologic results of severe stress on the gastrointestinal mucosa. It has become clear, however, that the presence of mucosal abnormalities does not always correlate with the presence of overt bleeding, or with the effect of bleeding on the overall outcome of such patients. In fact, the incidence of severe gastrointestinal hemorrhage, secondary to stress-related mucosal disease, has been decreasing over the past decade, as the care of these critically ill patients has improved. In patients who do have overt hemorrhage, however, the mortality rate is extremely high. It therefore remains the duty of the clinician to identify patients who are at high risk of having overt hemorrhage, and ensure that they receive adequate prophylactic therapy.
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7788534
|
Acute pancreatitis. Surgical management.
|
In general, the best approach to pancreatitis is to recognize its presence early, resuscitate the patient aggressively, and employ nutritional and medical therapy to avoid complications. Nonetheless, either because of trauma or failure of medical therapy, some patients develop complications (e.g., hemorrhagic or necrotizing pancreatitis, abscess, pseudocyst, or fistula) that require operative intervention. Expert surgical judgment is required to decide which patients require surgery, when to operate, and what operation(s) to perform. Many of these patients require multiple surgical procedures and are critically ill, requiring careful attention to nutritional support, ventilatory management, and surveillance for sepsis. The care of these patients requires a multidisciplinary approach involving personnel in internal medicine, gastroenterology, radiology, surgery, anesthesiology, and nursing. Pancreatitis does not respect the boundaries of class, race, creed, gender, or traditional specialty interests; only by using a collegial approach, which shares expertise in a multidisciplinary fashion, is it possible to optimize patient care and salvage critically ill patients with this deadly disease.
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7788533
|
Acute pancreatitis. Medical management.
|
The medical management of acute pancreatitis is primarily supportive and involves making the patient nulla per os, providing adequate intravenous hydration, and controlling pain with analgesics. Systems to identify patients with severe pancreatitis at risk for morbidity and mortality are available but require supplementation with frequent, experienced clinical observation. A number of modalities to inhibit pancreatic secretion or pancreatic proteases have not been successful in clinical trials, although larger studies in patients with more severe pancreatitis are required to ultimately assess their effectiveness. The empiric use of imipenem and long-term peritoneal lavage in patients with severe or necrotizing pancreatitis appear promising but further studies are needed. The removal of impacted gallstones in patients with severe pancreatitis or cholangitis is useful, provided an expert endoscopist is available. Improvements in our ability to document pancreatic infection early by CT-directed aspiration have markedly improved our ability to manage pancreatic infection.
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7788532
|
Biliary tract emergencies. Endoscopic and medical management.
|
The application of therapeutic ERCP and interventional radiology has significantly altered the treatment of biliary tract emergencies. Although surgery is the principal treatment for acute cholecystitis, nonoperative alternatives exist for high-risk patients. New, prospective, randomized trials have demonstrated that endoscopic management of severe cholangitis is superior to surgery, and that endoscopic sphincterotomy and stone extraction are superior to conservative treatment in severe gallstone pancreatitis. ERCP allows nonoperative management of postoperative bile leaks as well.
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7788531
|
The abdomen as source of sepsis in critically ill patients.
|
Among patients with life-threatening sepsis that has no clear site of origin, the abdomen continues to be a probable and tractable possibility. The cavity has the microbiologic and anatomic potential for sudden or indolent sepsis and the cause may be either obvious or obscure. The abdomen or the various structures may be primary sources that are secondary and independent of disease that brought the patient to peril. They also could be secondary and dependent upon an abdominal operation complicated by sepsis. The partnership of intensivist and surgical consultant, addressing possibilities and challenges, must identify the most probable cause and the most timely response for positive intervention in the critically ill patient threatened by sepsis.
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7788530
|
In vitro processing of heteroduplex loops and mismatches by endonuclease VII.
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Endonuclease VII is a Holliday-structure resolving enzyme of phage T4 which cleaves at junctions of branched DNAs and at mispairings. In extension of these findings we report the following: i) Endonuclease VII can discriminate between a large heteroduplex loop and a TT mismatch arranged in tandem, 6 nt distant from each other, in the same heteroduplex molecule. The enzyme cleaves two nucleotides 3' from the base of the loop or the TT mismatch. ii) Similar to its reactions with mismatches cleavage of heteroduplex loops by endonucleave VII can also initiate correction of perfect double-strandedness by T4 DNA polymerase and T4 DNA-ligase in vitro. Loops of 8 nt and 20 nt were repaired efficiently. iii) For the first time endonuclease VII cleavage sites were also mapped in single-stranded DNA if it was part of the 20-nt loop. This suggests that looping of single-stranded DNA can induce formation of secondary structures, which are recognizable by endonuclease VII.
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7788528
|
Cloning and characterization of rat cellular nucleic acid binding protein (CNBP) cDNA.
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We cloned and sequenced the cDNAs which code for rat cellular nucleic acid binding protein (CNBP). In-frame insertion/deletion differences were found among the clones at two sites in the open reading frame, suggesting alternative splicing of the message or the presence of multiple genes which code for this protein. The deduced amino acid sequence revealed that one rat CNBP sequence was completely identical to its human counterpart. This striking conservation, together with the fact that homologous genes have been found in various organisms including Schizosaccharomyces pombe, suggests that CNBP plays a basic biological role in eukaryotic cells. The recombinant GST-CNBP fusion protein produced in Escherichia coli bound to a G-rich single-stranded RNA and DNA in a sequence-specific manner.
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7788527
|
Prediction of the coding sequences of unidentified human genes. III. The coding sequences of 40 new genes (KIAA0081-KIAA0120) deduced by analysis of cDNA clones from human cell line KG-1.
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We isolated full-length cDNA clones from size-fractionated cDNA libraries of human immature myeloid cell line KG-1, and the coding sequences of 40 genes were newly predicted. A computer search of the GenBank/EMBL databases indicated that the sequences of 14 genes were unrelated to any reported genes, while the remaining 26 genes carried some sequences with similarities to known genes. Significant transmembrane domains were identified in 17 genes, and protein motifs that matched those in the PROSITE motif database were identified in 11 genes. Northern hybridization analysis with 18 different cells and tissues demonstrated that 10 genes were apparently expressed in a cell-specific or tissue-specific manner. Among the genes predicted, half were isolated from the medium-sized cDNA library and the other half from the small-sized cDNA library, and their average sizes were 4 kb and 1.4 kb, respectively. As judged by Northern hybridization profiles, small-sized cDNAs appeared to be expressed more ubiquitously and abundantly in various tissues, compared with that of medium-sized cDNAs.
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7788526
|
Comparative analysis of mouse NotI linking clones with mouse and human genomic sequences and transcripts.
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NotI cleavage sites are frequently associated with CpG islands that identify the 5' regulatory sites of functional genes in the genome. Therefore we analyzed a sample of 22 NotI linking clones prepared from mouse brain DNA, to determine whether these mouse NotI site associated clones could be used for comparative analysis of mouse and human genomes by cross-reaction with both mouse and human genomic DNA and RNA in Southern and Northern hybridization. We further examined whether we could establish the identity of these clones with known genes by comparing the nucleotide sequences surrounding the NotI site with the GenBank database. We observed that 70% of the clones cross-hybridized with human DNA and that 4 of 11 tested clones (36%) detected a transcript in human HeLa cells RNA whereas 73% clones (8/11) detected transcripts in mouse RNAs from one or more organs. Single pass sequence analysis was successful on 16 of 19 clones. The GC content in these sequence was very high (48.8% to 73.8%) suggesting that 12 of 16 sequenced clones contained a CpG island. Three out of 19 clones showed significant similarity with previously analyzed mouse gene sequences in GenBank, including the mouse rRNA gene family, cathepsin and the scip POU-domain genes. In addition, two sequences showed significant similarity to the human and rabbit protein phosphatase 2A-beta subunit and the human transforming growth factor-beta. Thus, 5 of 16 clones showed homology with identified genes. These results and the recent work of using RLGS methods for genetic mapping indicate that NotI linking clones can be used to efficiently cross reference a comparative analysis of the mouse and human genomic maps.
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7788524
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Cloning and sequencing of sulfite reductase alpha subunit gene from Saccharomyces cerevisiae.
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A DNA fragment of 2.1 kb was specifically amplified by PCR with primers based on the amino acid sequences obtained from the N-terminal region and the cyanogen bromide-derived peptide of the sulfite reductase alpha subunit in Saccharomyces cerevisiae. With this fragment as a probe, the gene coding for the sulfite reductase alpha subunit was isolated from a genomic library of S. cerevisiae. Sequencing analysis revealed that the gene contains a 3105-bp open reading frame, which is large enough to code for a protein of 1035 amino acid residues. The transcript of the sulfite reductase alpha subunit gene was detected by Northern analysis after methionine deprivation, but the amount of the transcript did not directly correlate with the enzyme activity. The DNA fragment containing the sulfite reductase alpha subunit gene rescued the met10 phenotype by complementation.
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7788525
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cDNA sequences of three kinds of beta-tubulins from rice.
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Complete nucleotide sequences of three kinds of rice beta-tubulin cDNA clones (pTUB22, R1623 and R2242) were determined. Southern hybridization indicated that these beta-tubulins consist of one gene family. Using RFLP mapping, these three beta-tubulin cDNAs were mapped to different chromosomes indicating at least three loci for the beta-tubulin gene. The deduced amino acid sequences of these cDNAs showed a high similarity to other plant beta-tubulins. The asparagine residue located at the 100th amino acid from the N-terminus of plant beta-tubulins was also conserved with these three beta-tubulins. This asparagine is thought to be responsible for the sensitivity against rhizoxin, the toxin of the pathogen of rice seedling blight, Rhizopus sp. a soil-borne microorganism. Expression of the three beta-tubulin genes was analyzed by Northern blotting and all three clones were expressed in root, the possible target tissue of rhizoxin. These results suggest that these clones are candidates of beta-tubulins targeted by rhizoxin.
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7788523
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Cloning and identification of the hemG gene encoding protoporphyrinogen oxidase (PPO) of Escherichia coli K-12.
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Cells of the VSR751 strain, which was previously isolated as a photoresistant revertant of the visA-deleted (hemH-deleted) strain of Escherichia coli K-12, accumulated uroporphyrin (uro), coproporphyrin (copro) and protoporphyrin IX (proto), but did not accumulate as much protoporphyrin as cells of the parental strain (hemH-deleted). Therefore, we concluded that strain VSR751 must be defective in protoporphyrinogen oxidase (PPO), the product of the hemG gene. By complementation analysis using VSR751, we isolated and identified this gene. The hemG gene is located at 86 mim on the E. coli chromosome, just upstream of the rrnA operon, and is transcribed clockwise in the same direction as the rrnA operon. This gene encodes a 181-amino acid protein with a calculated molecular mass of about 21 kDa. Sequence analysis revealed the presence of flavodoxin motif, suggesting tha a cofactor of this enzyme is flavin mononucleotide, which is consistent with the previous report that the mammalian PPO had the flavin cofactor.
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7788520
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Spontaneous variations in congestion of the nasal mucosa.
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Nasal patency shows spontaneous variations but is also influenced by exercise and allergic conditions. These variations have not been described in detail with regard to allergy. The purpose of this study was to examine whether these variations are different in nonallergic subjects and in subjects with nasal allergy to pollen out of the pollen season. We examined 12 of each type of subject in the winter on two days for seven hours in a climatic chamber with constant temperature and relative humidity, one day for examination of spontaneous variations and one day for examination of exercise response. Every 15 minutes the volume of the nasal cavities, minimum cross-sectional areas, and areas at fixed distances from the nostril were measured by acoustic rhinometry. Symptoms were scored by a questionnaire. There were more pronounced spontaneous variations expressed as the coefficient of variation of nasal volume in allergic than in nonallergic subjects (14% against 9%, P = .004). A nasal cycle was observed in four of the nonallergic subjects and three of the allergic subjects. In the postexercise period, the spontaneous variations in the nonallergic subjects were increased but decreased in the allergic subjects. Exercise increased nasal patency more in the allergic subjects but only significantly for the cross-sectional area at 3.3 cm (105% compared with 43% in the nonallergic subjects, P = .05). In contrast, pharmacologic decongestion in the allergic subjects showed a tendency to be more pronounced for the nasal cavity volume (55% increase versus 42%, P = .08). There was no difference between the groups in nasal symptom scores. Allergic subjects out of the pollen season have more congested and more sensitive nasal mucosa than nonallergic subjects.
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7788519
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Asthma and related atopic disorders in outpatients attending an urban HIV clinic.
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Drug hypersensitivity and pruritic cutaneous disorders are common in human immunodeficiency virus (HIV)-infected patients. Systematic cross-sectional studies, detailing the pattern of atopic disease, however, have not been performed in patients with HIV infection. To analyze the relationships between atopic disease and factors relating to lifestyle, environment, gender, genetics, and HIV disease-associated immune cell depletion. CD4 cell counts and interview data were recorded in a survey of 136 adult patients attending a community hospital-based HIV outpatient clinic. The reported presence of various atopic and related conditions (including asthma, hay fever, otitis, sinusitis, and dermatitis) were analyzed for prevalence and associations with CD4 cell depletion, family atopy, and other factors using logistic regression. Seventeen percent and 15% of patients claimed to have asthma and hay fever, respectively. Eleven percent claimed chronic nasal symptoms without known hay fever. A recent CD4 count > or = 200 cells/dL was significantly associated with current asthma (P = .01) and this association remained after adjusting for other significant factors. The mean recent log CD4 count for patients with current asthma was significantly higher than other patients (5.63 +/- .73 versus 4.92 +/- 1.38, P = .001). There was no association between rhinitis and CD4 cell depletion. Histories of recent sinusitis (24%) and ear infections (16%) were common, and were significantly associated with current hay fever +/- chronic nasal symptoms (P < .05). Chronic pruritic rashes or eczema were reported in 29% and were more frequent in those with CD4 counts < 200/dL. Family histories of either asthma or hay fever were significantly associated with several condition including hay fever +/- chronic nasal symptoms, otitis, drug allergy, chronic pruritic rashes or eczema, and asthma. Although atopic disorders in the setting of HIV infection appear to have some clinical associations similar to that reported for the general population, asthma appears to have a predilection towards less severe CD4 cell depletion. The potential role of chronic rhinitis +/- family atopy as risk factors for sinusitis and otitis may be important because treatment of selected individuals with rhinitis may potentially decrease some paranasal disease-related morbidity in HIV infection.
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7788518
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Nedocromil sodium versus theophylline in the treatment of reversible obstructive airway disease.
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Previous clinical therapeutic research has shown that inhaled nedocromil sodium can replace maintenance oral sustained release theophylline in the management of asthma patients. To compare directly the efficacy and safety of nedocromil sodium and sustained release theophylline. Using a randomized, double-blind, double-dummy, parallel-group design, 105 patients with reversible obstructive airways disease (77 asthmatic patients) recruited from four referred-care clinics received, in addition to their existing therapy, 4 mg nedocromil sodium four times daily or sustained release theophylline (maximum daily dose 13 mg/kg) for 6 weeks. Patients with serum theophylline levels within the therapeutic range of 10 to 20 micrograms/mL were retained for efficacy analysis. All were included in a tolerability analysis. Day and nighttime symptoms, inhaled bronchodilator use, morning tightness, cough, and twice daily peak flows were recorded on diary cards. Disease severity, lung function and unusual events were evaluated bi-weekly, and opinion of treatment after 6 weeks. Both treatments improved symptoms, inhaled bronchodilator use and lung function to the same extent. Both treatments were very to moderately effective in > 70% patients. The occurrence of gastrointestinal (P < .05) and central nervous system (P < .01) unusual events was significantly lower for nedocromil sodium compared with theophylline treated patients. Nedocromil sodium and theophylline were equally effective in this group of patients but nedocromil sodium treatment was associated with significantly fewer side effects, and therefore may be the treatment of choice.
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7788517
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Clinical and immunologic surveys of Hymenoptera hypersensitivity in Japanese forestry workers.
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The increased incidence of bee-sting allergy among beekeepers is well known, whereas Hymenoptera hypersensitivity among forestry workers, who are frequently stung by Hymenoptera, is not well understood. To elucidate the nature of Hymenoptera hypersensitivity among forestry workers and analyze the mechanism involved in Hymenoptera-induced systemic reactions. A questionnaire was administered and yellow jacket venom-specific IgE antibody titers measured in 323 forestry workers and 100 age-matched office workers with little occupational exposure to Hymenoptera stings as a control group. From the questionnaire it was found that the percentage of systemic reactions to Hymenoptera stings was significantly greater in the forestry workers than in the control subjects (P < .01). The number of sting exposures was significantly higher in the forestry workers than in the control subjects (P < .01) and was closely correlated with episodes of systemic reaction. Yellow jacket venom-specific IgE antibody titers were significantly higher in forestry workers with episodes of systemic reaction compared with those with only local or large local reactions to Hymenoptera (P < .05), although more than half of these subjects had undetectable IgE antibody titers to yellow jacket venom. IgE antibody titers against yellow jacket venom were closely correlated with those of paper wasp (rs = .802, P < .001), which is another frequent source of Hymenoptera stings. In workers with episodes of sting exposure within the most recent 3 years, the period from the last sting was not correlated with yellow jacket venom-specific IgE antibody titers. The number of sting exposures may contribute to systemic reactions to Hymenoptera sting, and some mechanism other than IgE mediated hypersensitivity may also be involved in Hymenoptera-induced systemic reactions.
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7788516
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Cerebral toxoplasmosis in childhood and adult HIV infection treated with 1-4 hydroxynaphthoquinone and rapid desensitization with pyrimethamine.
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We describe a child and an adult infected with the human immunodeficiency virus (HIV) who developed cerebral lesions consistent with toxoplasmosis. A biopsy in the child and IgG ELISA in both patients confirmed the diagnosis of Toxoplasma gondii. The patients were initially treated with pyrimethamine, however, computerized tomography studies (CT scan) revealed progression of a left frontal and temporoparietal lesion. Therapy in the child was changed to pyrimethamine, clindamycin, and azithromycin. Repeat CT scan showed further disease progression and therapy was changed to high-dose pyrimethamine (3 mg/kg/d) and azithromycin. A subsequent CT scan disclosed further radiologic progression with increasing edema. The adult patient developed a maculopapular rash during attempted treatment with pyrimethamine. Introduction of 2 (trans-4[4 chlorophenol] cyclohexy[3-hydroxy-1, 4 naphthoquinone] (HNPQ) an experimental antiparasitic compound previously used only in adult HIV clinical trials, was instituted in the child and rapid oral desensitization to pyrimethamine was initiated in the adult patient. HNPQ resulted in resolution of the cerebral lesion in the child and rapid oral desensitization to pyrimethamine produced an excellent clinical response in the adult. To our knowledge, these are the first cases of childhood and adult cerebral toxoplasmosis treated successfully with HNPQ and rapid oral desensitization to pyrimethamine. HNPQ and pyrimethamine desensitization should be considered as alternate modes of therapy in patients who become intolerant or fail to respond to traditional therapy for toxoplasmosis.
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7788514
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Soluble serum interleukin 2 receptors in patients with asthma and allergic bronchopulmonary aspergillosis.
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When T cells are activated, they produce two distinct surface receptors for interleukin 2 (IL2). One of these surface receptors is a 55-kD protein called IL2Ra which is released into peripheral blood following T cell activation. This soluble protein (sIL2R) can be measured in peripheral blood utilizing an ELISA, and thus provides an indirect indicator of T cell activation. The purpose of this study was to determine whether allergic bronchopulmonary aspergillosis (ABPA) was associated with increased soluble interleukin 2 receptors (sIL2R). We used the Immunoenzymometric Assay Kit (Immunotech International, Marseille, France) which had a monoclonal antibody to sIL2R to sensitize wells. To determine the degree of T cell activation in patients with asthma and ABPA, we have evaluated the concentration of sIL2R in the peripheral blood in four groups: (1) 26 nonatopic patients, (2) 39 patients skin test positive to Aspergillus who did not have serologic evidence of ABPA, (3) 14 patients with quiescent ABPA, and (4) 13 patients who had a new roentgenographic infiltrate from ABPA. The mean concentration of sIL2R in the four groups were 24.5 pM (+/- 16.7), 38.4 pM (+/- 27.2), 48.4 pM (+/- 28.2), and 64.8 pM (+/- 33.0), respectively. Group 4 was greater than groups 1 and 2 (P < .05), and group 3 was greater than group 1 (P < .05). In patients with ABPA that is flaring, there is greater T cell activation than in either nonatopic controls or in patients who have asthma. Patients with ABPA in remission also had significantly greater T cell activation than nonatopic controls.
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7788515
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Major inhalant allergens in Mauritius.
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Bronchial asthma appears to be an important but neglected problem in tropical countries. There is little information about the role of atopy in tropical climates and how atopy is related to asthma there. The present work was aimed at determining the pattern of total serum IgE-titers among a group of patients suffering from asthma in Mauritius. Twenty-five asthmatic patients and ten controls who met the criteria for the study were registered. A comprehensive clinical evaluation was followed by allergy skin testing (prick test) to common aeroallergens. Serum total IgE levels were measured in all 35 participants. Of 22 patients studied, 22 had significant levels of IgE when tested to airborne allergens. Positive skin tests against Dermatophagoide pteronyssinus and Dermatophagoide farinae correlated well with the presence of serum total IgE. Sixteen patients also had had moderate to severe exacerbations throughout the year. The results suggest that house dust mite is an important allergen producing symptoms throughout the year in our patients.
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7788513
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Phenytoin-related immunodeficiency associated with Loeffler's syndrome.
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Phenytoin is one of the most commonly prescribed drugs in the United States. Its use is associated with a myriad of adverse reactions, including: eosinophilia, selective IgA deficiency and panhypogammaglobulinemia, pseudolymphoma, Stevens-Johnson syndrome, and interstitial pneumonia. To report a case of immunodeficiency manifest by panhypogammaglobulinemia and a low helper-to-suppressor ratio secondary to phenytoin crossreactivity with phenobarbital and carbamazepine complicated by hepatotoxicity, eosinophilia, and fleeting pulmonary infiltrates. Case report; immunoglobulin levels, T and B cell studies, and radiologic evaluation of patient. A 37-year-old Oriental female taking phenytoin and phenobarbital for seizure prophylaxis after resection of a grade IV astrocytoma of the left frontal lobe, developed a rash, elevated liver function tests, and cervical lymphadenopathy with parotid gland enlargement. The abnormalities resolved with discontinuation of the drugs and the patient was discharged on carbamazepine. Eight weeks later the patient was readmitted with fever, slowed mentation, elevated liver function tests, and panhypogammaglobulinemia. Clonazepam was substituted for carbamazepine and the patient subsequently developed a rash and further elevation of her liver function tests. The clonazepam was discontinued and the patient was treated with methylprednisolone. She subsequently developed Loeffler's syndrome and a T cell deficiency with a decreased helper-to-suppressor cell ratio. She was treated with increased doses of methylprednisolone and granulocyte stimulating factor with complete resolution of her symptoms. Phenytoin is associated with a myriad of side effects, including, rash, eosinophilia, panhypogammaglobulinemia, pseudolymphoma, Stevens-Johnson syndrome, immunosuppression in brain tumor patients, and rarely, pulmonary complications such as Loeffler's syndrome. Cross-reactivity with other anticonvulsant agents capable of forming arene oxide intermediates occurs in the cytochrome P-450 system.
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7788511
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Bronchial hyperreactivity revisited.
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The purpose of this article is to review bronchial reactivity: how it is detected, what are the clinical and pathologic correlates and what treatment modulates it. Is it a good diagnostic test for a disease such as asthma? Is it a reasonable parameter to follow in assessing disease severity and response to treatment? Recent studies on human subjects in the English language medical literature involving bronchial hyperreactivity. In particular all studies were sought that correlated indices of inflammation obtained either by bronchoalveolar lavage or biopsy with degree of bronchial hyperresponsiveness. Pertinent studies reviewing disease association with presence of bronchial hyperreactivity were sought. All studies of treatment with inhaled corticosteroids were reviewed and those in which the subjects could be classified as having either mild or moderately severe asthma on the basis of the clinical information given were used to provide data on correlation of bronchial reactivity and disease severity. The relationship of bronchial reactivity and any disease state is not straightforward. It is not clear what causes hyperreactivity of the airways but there must be other factors besides inflammation as bronchial hyperreactivity can occur without microscopic evidence of inflammation. Hyperresponsiveness does not appear to be as sensitive or specific for the diagnosis of asthma as previously thought, or as closely related to the severity of asthma. Effects of treatment appear to be somewhat independent of their impact on bronchial responsiveness. Airway hyperresponsiveness can be found in many circumstances. Its relationship to symptom production and clinical course in any disease is not clear. Further studies are needed to elucidate the relationship between airways hyperreactivity, asthma, and other lung diseases and the factors that lead to increased bronchial reactivity.
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7788509
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Effectiveness of smokeless ashtrays.
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Most environmental tobacco smoke (ETS) issues from the tips of smoldering cigarettes between puffs. Smokeless ashtrays are designed to reduce ETS exposure by removing particulate and/or gas-phase contaminants from this plume. This paper describes an experimental investigation of the effectiveness of four smokeless ashtrays: two commercial devices and two prototypes constructed by the authors. In the basic experimental protocol, one or more cigarettes was permitted to smolder in a room. Particulate or gas-phase pollutant concentrations were measured in the room air over time. Device effectiveness was determined by comparing pollutant concentrations with the device in use to those obtained with no control device. A lung deposition model was applied to further interpret device effectiveness for particle removal. The commercial ashtrays were found to be substantially ineffective in removing ETS particles because of the use of low-quality filter media and/or the failure to draw the smoke through the filter. A prototype ashtray using HEPA filter material achieved better than 90% particle removal efficiency. Gas-phase pollutant removal was tested for only one prototype smokeless ashtray, which employed filters containing activated carbon and activated alumina. Removal efficiencies for the 18 gas-phase compounds measured (above the detection limit) were in the range of 70 to 95%.
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7788508
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Enzymes for enhancing bioremediation of petroleum-contaminated soils: a brief review.
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During the 1950s and 1960s, hundreds of thousands of underground storage tanks (and above-ground storage tanks) containing petroleum products and hazardous chemicals were installed. Many of these tanks either have been abandoned or have exceeded their useful lives and are leaking, thereby posing a serious threat to the nation's surface and groundwater supplies, as well as to public health. Cleaning up releases of petroleum hydrocarbons or other organic chemicals in the subsurface environment is a real-world problem. Biological treatment of hydrocarbon-contaminated soil is considered to be a relatively low-cost and safe technology; however, its potential for effectively treating recalcitrant wastes has not been fully explored. For millions of years, microorganisms such as bacteria, fungi, actinomycete, protozoa, and others have performed the function of recycling organic matter from which new plant life can grow. This paper examines the biological treatment technology for cleaning up petroleum product-contaminated soils, with special emphasis on microbial enzyme systems for enhancing the rate of biodegradation of petroleum hydrocarbons. Classifications and functions of enzymes, as well as the microbes, in degrading the organic contaminants are discussed. In addition, the weathering effect on biodegradation, types of hydrocarbon degraders, advantages associated with enzyme use, methods of enzyme extraction, and future research needs for development and evaluation of enzyme-assisted bioremediation are examined.
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7788507
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Factors regulating megakaryocyte progenitor commitment to polyploidization.
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Recognizable megakaryocytes are polyploid cells generated by a clonogenic, diploid progenitor, termed CFU-MKC (colony forming unit, megakaryocyte). In order to quantify polyploidization, ploidy histograms of megakaryocytes determined by microphotometric or flow cytometric measurements of megakaryocyte DNA have generally been used. However these techniques provide no information on the rate of commitment of CFU-MKC to polyploidy. Using a technique of clonal analysis determining the distributions of the number of doublings (NbD) undergone by CFU-MKC before committing to polyploidization, the polyploidization probability of CFU-MKC could be derived. This probability was found to be a constant independent from CFU-MKC mitotic history, since NbD distributions are exponential functions characterized by a constant rate of decay per doubling. By studying the effects of growth factors on polyploidization probability, it was also shown that: (1) this parameter is negatively regulated by growth factors contained in poke-weed or WEHI conditioned media, as well as by erythropoietin; (2) commitment to polyploidization does not require prior CFU-MKC division; (3) bipotent erythroid-megakaryocyte progenitors have a lower polyploidization probability than CFU-MKC; (4) determination of polyploidization probability reflects the activity of growth factors with greater accuracy than megakaryocyte colony count.
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7788506
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Cortical memory in Paramecium: a theoretical approach to the structural heredity.
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Structural heredity is frequently encountered in ciliates. In particular, during division of Paramecium the cortical characteristics of the 2 daughter cells are inherited from those of the mother cell. Genesis of new structures is therefore only possible if there are pre-existing older structures. We attempted to simulate this phenomenon with a model already used to describe the structure and morphogenesis of the cortex of Paramecium. We show that to initiate spatial organization it is enough to choose special starting conditions which comprise the primer of the structure, even if highly localized and at a low concentration of morphogens. This property does not question the basic concepts of genomic heredity.
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7788505
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Activation of human thymocytes induces the phosphorylation of protein tyrosine phosphatase 1C.
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Phosphorylation of docking proteins is essential for signal transduction. In this report we provide evidence that activation of human thymocytes in culture induces the phosphorylation of the protein tyrosine phosphatase 1C (PTP 1C). Thymocytes were activated with Con A, PMA or Con A+PMA. The enzyme is phosphorylated on its serine and threonine residues. Phosphorylation occurs within 5 min and lasts for 24 h. PTP 1C is phosphorylated by PKC in vivo and in vitro; however, phosphopeptide mapping suggests that in addition to PKC other kinases phosphorylate the enzyme. On the maps of tryptic digests of cultured thymocytes more radiolabeled phosphopeptides are visualized than on the maps of digests of PTP 1C phosphorylated with partially purified PKC alpha or beta. Phosphorylation of PTP 1C decreases its activity, whereas dephosphorylation increases its activity, suggesting that phosphorylation of PTP 1C takes part in the regulation of signal transduction.
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7788504
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Mycobacterial polar glycopeptidolipids enhance resistance to experimental murine candidiasis.
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Intraperitoneal administration of polar glycopeptidolipids extracted from Mycobacterium chelonae (pGPL-Mc) greatly increased the resistance of mice against a lethal disseminated Candida albicans infection. This enhanced resistance was demonstrated by an increase in the number of survivors and the prolongation of the mean survival time of animals following a lethal challenge. These effects were dependent upon the infective dose of Candida albicans, the dose of pGPL-Mc and the timing of its administration. This enhanced resistance was correlated with the development and persistence of a hyperleukocytosis, associated with a long lasting increase in the number of polymorphonuclear neutrophils. On the contrary, no candidacidal effect of the serum collected from pretreated mice was observed; suggesting that the ability of pGPL-Mc to increase resistance against Candida albicans infection is likely to be mediated by polymorphonuclear neutrophils. These results confirm previously described immunostimulating properties of pGPL-Mc and open the way for the evaluation of its effect in the prevention of opportunistic infections in neutropenic patients.
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7788503
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7 Alpha-hydroxylation of 27-hydroxycholesterol in rat brain microsomes.
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27-hydroxycholesterol is shown to be 7 alpha-hydroxylated by microsomal preparations of rat brain. The apparent Km was about 2 microM and Vmax about 15 pmol/min x mg protein. The reaction might modulate biological functions of 27-hydroxycholesterol, such as its suppressive effect on the activity of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, and supports the possibility of bile acid formation in the brain.
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7788502
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Ultrastructural localization of cellular prion protein (PrPc) in synaptic boutons of normal hamster hippocampus.
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The cellular prion protein (PrPc) is a membrane sialoglycoprotein synthesized in the central nervous system and extraneural tissues. Its post-translational modification produces an accumulation of abnormal isoform PrPsc found in brains of transmissible neurodegenerative disorders in animals (scrapie and bovine spongiform encephalopathy) and humans (Kuru, Creutzfeldt-Jakob disease, Gerstmann-Sträussler-Scheinker syndrome). One major unanswered question relative to PrPc concerns its physiological role in brain neurons, depending largely on the limited knowledge of its subcellular localization. Using a highly-sensitive immunogold electron microscopy technique, we reported that in the hamster dentate gyrus, the synaptic boutons constituted the submicroscopic site where PrPc was observed. This detection was obtained with 2 highly-specific polyclonal antibodies for prion protein. PrPc localization was assigned, both on structural basis and on its co-localization with synaptophysin. The presence of PrPc in synaptic terminals should provide additional informations on its possible role in neuronal transmission and on the implication of synapses in the pathogenesis of spongiform encephalopathies.
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7788501
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Tat-induced lesions in transgenic mice do not correlate with the HIV-1 LTR transactivation.
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The product of the tat gene is the most potent transcriptional trans-activator of the HIV-1 LTR (Human Immunodeficiency Virus type 1 Long Terminal Repeat) and might be predicted to be one of the HIV-1 proteins involved in the pathogenesis of AIDS-associated tumors. Deciphering its role in vivo may imply generation of transgenic mouse models displaying different spectra of tat expression. However, it remains difficult to correlate the mRNA expression, the protein production and the eventual pathological consequences in the animal. Our goal in this work was to elaborate a binary transgenic system allowing such an approach, the correlation of the transgene expression in different tissues and the production of the Tat protein, tested as a trans-activator in vivo, with its pathogenic effects. No direct linkage was evident between the degree of transactivation and pathogenesis. Indeed, only benign lesions were observed in malpighian epithelia, where the production of the Tat protein was clearly evidenced by its transactivating property.
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7788500
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Hammerhead ribozyme: a three dimensional model based on photo-crosslinking data.
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The hammerhead ribozyme is a small catalytic RNA motif made up of 3 base-paired stems connected by conserved sequences which are essential for catalysis. We have modelled its 3 dimensional structure, taking advantage of proximity data between several substrate and ribozyme residues determined by photo-crosslinking experiments. It is characterized by an Y shape of the 3 stems stabilized in the central core by a network of hydrogen bonds involving in particular 2 non Watson-Crick G:A base-pairs. The 5' conserved sequence CUGA makes a sharp turn, the G residue exchanging hydrogen bonds with a conserved base-pair of stem III. The substrate is stretched at the cleavage site. Overall this structure is consistent with that deduced from X-ray crystallography but differences are observed at the level of the CUGA turn.
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7788499
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LIM domain proteins.
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The LIM domain is a cysteine-rich domain composed of 2 special zinc fingers that are joined by a 2-amino acid spacer. Some proteins are constituted by LIM domains only while others contain a variety of different functional domains. LIM proteins form a diverse group which includes transcription factors and cytoskeletal proteins. The primary role of LIM domains appears to be in protein-protein interaction, through the formation of dimers with identical or different LIM domains or by binding distinct proteins. In LIM homeodomain proteins, LIM domains seem to function as negative regulatory domains. LIM homeodomain proteins are involved in the control of cell lineage determination and the regulation of differentiation, and LIM-only proteins may have similar roles. LIM-only proteins are also implicated in the control of cell proliferation since several genes encoding such proteins are associated with oncogenic chromosome translocations. In analyzing sequence relationships between LIM domains we suggest that they may be arranged into 5 groups which appear to correlate with the structural and functional properties of the proteins containing these domains.
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7788497
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Cerebellar hypoplasia in the second trimester associated with microcephaly at birth.
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The antenatal diagnosis of microcephaly is most commonly made in the third trimester. Biometric measurements of the head of three or four standard deviations below the mean are suggestive of microcephaly. We report a case of microcephaly where abnormalities in intracerebral architecture, i.e. cerebellar hypoplasia, were noted early in the second trimester.
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7788496
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Early fetal endocardial fibroelastosis and critical aortic stenosis: a case report.
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Endocardial fibroelastosis is characterized by an abnormal thickening of the endocardium of one or both ventricles; the disorder may occur with or without other cardiac anomalies. A diagnosis of endocardial fibroelastosis in utero using fetal echocardiography may be made on the basis of increased echodensity of the endocardium and poor contractility of the ventricle. We describe a case of very early diagnosis of fibroelastosis and aortic valve stenosis observed in utero at 14 weeks' gestation by transvaginal echocardiography.
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7788495
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Characterization of placenta accreta using transvaginal sonography and color Doppler imaging.
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The safe use of transvaginal sonography in patients with placenta previa has been confirmed, and has revolutionized precise placental localization. The aim of our study was to evaluate the efficacy of transvaginal sonography and color-coded blood flow in the prediction of placenta accreta. Twenty-one patients with persistent placenta previa were scanned using transvaginal sonography and color-coded flow. Suspicion for placenta accreta consisted of total placenta previa at term with several placental lacunae exhibiting marked or turbulent blood flow, as seen with color Doppler transvaginal sonography from within the placenta, extending into the surrounding tissues. Five of the patients exhibited sonographic placental patterns suspicious for placenta accreta and one patient exhibited placental and cervical blood flow described as lacunar. Five Cesarean hysterectomies were performed for placenta accreta. Every placenta accreta was correctly diagnosed sonographically by the use of color flow studies. One patient with suspicion of placenta accreta delivered at another institution, a Cesarean hysterectomy was performed, and the pathology was confirmed. The one placenta previa exhibiting turbulent lacunar flow in the cervical area only was not confirmed to be an accreta at Cesarean section, although hemostasis was difficult at the placental bed. The remaining 15 patients with placenta previa and who on sonography were not suspicious for placenta accreta underwent uncomplicated Cesarean section. Transvaginal sonography and color Doppler imaging improve the diagnostic accuracy in the prediction of placenta accreta in patients with persistent placenta previa. A pattern of turbulent blood flow extending from the placenta into the surrounding tissues should alert the physician to the possibility of placenta accreta.
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7788494
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Doppler flow velocimetry of the umbilical artery, uteroplacental arteries and fetal middle cerebral artery in prolonged pregnancy.
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A total of 153 pregnant women, of at least 287 days' menstrual age, were studied in a prospectively designed cross-sectional trial. In addition to the non-stress test, contraction stress test, sonographic estimate of amniotic fluid and grade of placental maturation, Doppler measurements of the resistance index (RI) were taken in the umbilical artery, the uteroplacental arteries in the region of placental implantation and the fetal middle cerebral artery. Data were analyzed with regard to asphyxia and otherwise complicated fetal outcome. Furthermore, a possible relationship between grade of placental maturation, Doppler flow velocity waveforms and fetal outcome was investigated. Doppler resistance indices in the umbilical artery, uteroplacental arteries in the region of placental implantation and fetal middle cerebral artery did not change significantly with increasing gestation from 41 to 43 weeks. The grade of placental maturation on ultrasound examination was not related to fetal outcome or Doppler indices in the first two vessels. In all vessels examined in this study, the majority of Doppler measurements in pregnancies with subsequent asphyxia or otherwise complicated fetal outcome were within the 95% prediction interval for patients with normal fetal outcome. None of the patients showed absent diastolic flow in the umbilical artery. With the use of a cut-off value of RI = 0.62 in the umbilical artery, asphyxia could be predicted with 37% sensitivity and 75% specificity. Oligohydramnios and antpartum cardiotocography predicted asphyxia with 16% and 8% sensitivity and 95% and 96% specificity, respectively. Sensitivity for prediction of otherwise complicated fetal outcome by umbilical artery Doppler was only 7%.(ABSTRACT TRUNCATED AT 250 WORDS)
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7788493
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Doppler studies of the placental and fetal circulation in pregnancies with preterm prelabor amniorrhexis.
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This study has investigated the effect of intrauterine infection on placental perfusion, fetal circulation and fetal oxygenation in patients with preterm prelabor amniorrhexis. In 69 pregnancies with preterm prelabor amniorrhexis, Doppler ultrasound studies of the uterine and umbilical arteries and the fetal middle cerebral artery and thoracic aorta were performed. Within 1 h after the Doppler studies, cordocentesis and amniocentesis were carried out for microbiological investigations and measurement of blood pO2 and pH. In the amniorrhexis group, there were no significant differences from the appropriate normal mean for gestation in any of the Doppler indices or blood gas results. Furthermore, there were no significant differences between the groups with positive fetal blood or amniotic fluid cultures and those with no evidence of infection. These data demonstrate that, in preterm prelabor amniorrhexis, microbial invasion of the amniotic cavity and fetal bacteremia are not associated with detectable changes in placental perfusion, fetal circulation or fetal oxygenation.
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7788492
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Development of a training model for ultrasound-guided invasive procedures in fetal medicine.
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Training in ultrasound-guided procedures in fetal medicine is currently available in a few major fetal medicine units. Unlike elective surgical procedures, cordocentesis is usually performed without sedation as an outpatient procedure and active supervision of the trainee intensifies the anxiety already felt by the patient. In addition, the complication rate is higher in the initial few procedures or when the procedure is not regularly practiced. We have developed a comprehensive method of training for transabdominal invasive procedures using a medical model that simulates the in vivo situation.
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7788491
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Routine prenatal ultrasound screening for fetal abnormalities: 22 years' experience.
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We describe the results of routine obstetric ultrasound examination over a period of 22 years (1970-91) at the Institut Universitari Dexeus, Barcelona, Spain. A total of 1006 malformed fetuses or neonates were identified at abortion or delivery. The prevalence of fetal abnormalities was 3.03%. Fetal anomalies were diagnosed antenatally in 788 (78.33%) cases. Early prenatal diagnosis (before 22 weeks of gestation) was made in 598 (59.44%) cases. The detection of malformed fetuses increased from 19.75% in the first phase of the study (1970-74) to 96.33% in the last phase (1990-91). The specificity of the method was over 99% throughout the study period. The most frequently diagnosed anomalies were urinary tract anomalies (22.86% of cases), followed by head and neck anomalies (18.68%), musculoskeletal anomalies (8.64%), heart anomalies (7.35%) and gastrointestinal anomalies (7.35%). The earliest diagnosed malformations were those of the thoracoabdominal wall (81.08%), followed by defects of the urinary tract (70.86%) and of the diaphragm (70.83%).
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7788490
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Fetal suprarenal masses: sonographic appearance and differential diagnosis.
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We present eight cases of suprarenal masses detected sonographically in fetuses of 20-41 weeks. The appearances of the masses included hyperechoic (n = 2, both pulmonary sequestrations), solid isoechoic (n = 1, a neuroblastoma), purely cystic (n = 3, two neuroblastomas, one enteric cyst) and mixed or complex (n = 2, one neuroblastoma and one renal cyst). Three of the fetuses with neuroblastoma had normal scans in the second trimester, and in all four the neuroblastomas were detected after 36 weeks. This study demonstrates the differential diagnosis of suprarenal masses in fetuses. Neuroblastomas can have a solid, purely cystic or complex sonographic appearance. Although not all suprarenal masses are neuroblastomas, the newborn with a prenatally detected suprarenal mass should be evaluated for the possibility of a neuroblastoma, since early diagnosis of this malignancy can be curative.
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7788489
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First-trimester ultrasound screening for fetal aneuploidies in women over 35 and under 35 years of age.
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In a prospective screening study, the utility of the thickness of first-trimester simple hygroma in sonographic screening for fetal chromosomal aberrations was examined. A total of 3380 women, 1280 of whom were 35 years or over, and 2100 of whom were under 35 years, were screened by ultrasound at 9-12 weeks of gestation. The thickness of fetal nuchal simple hygroma was measured. Women over 35 years of age underwent transabdominal chorionic villus sampling (CVS). In women under 35 years of age, CVS was offered only if the thickness of nuchal hygroma was at least 3 mm, or in cases of parental chromosomal abnormalities. A total of 46 chromosomal anomalies were detected, of which 43 (93.5%) showed simple hygroma. The incidence of first-trimester simple nuchal hygroma in pregnancies of women over 35 and under 35 years of age was 5.4% (69 cases) and 1.28% (27 cases), respectively, and the percentage of chromosomal abnormalities was 2.9% and 0.43%, respectively. The risks of trisomies and poor pregnancy outcome were increased at larger sizes of first-trimester simple hygroma. A sensitivity of 93.5% and a specificity of 98.4% of the method were found. Using a measurement of first-trimester simple hygroma of > or = 3 mm to identify pregnancies at risk for chromosomal anomalies at 9-12 weeks of pregnancy is a useful method for selection of women with high and low risk for aneuploidy.
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7788488
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Early development of the hindbrain: a longitudinal ultrasound study from 7 to 12 weeks of gestation.
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Twenty-nine healthy pregnant women were examined by transvaginal ultrasound to evaluate embryonic development in vivo between 7 and 12 weeks of gestation. The rhombencephalon with its fourth ventricle, the cerebellum and the choroid plexuses of the fourth ventricle were identified and measured. The cavity of the rhombencephalon, the future fourth ventricle, was always visible from 7 weeks, initially lying superiorly in the head of the embryo. The cerebellum and the choroid plexuses of the fourth ventricle became distinguishable during week 8. The volume of the rhombencephalic cavity was estimated. The shape and size of these rhombencephalic structures, their position in relation to each other and their relation to other brain structures changed specifically during the embryonic and early fetal period. This sonoembryological development corresponded to the descriptions in classical embryological literature.
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