How can we "enrich" prenatal care?
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Female↗
Biomedical subjects
D Young
Publications and source records attributed to D Young.
The influence of breast surgery, breast appearance, and pregnancy-induced breast changes on lactation sufficiency as measured by infant weight gain.
We conducted a prospective study of the associations between several biologic and surgical breast factors and the onset of lactation in 319 healthy, motivated, primiparous women who were breastfeeding term, healthy, appropriate for gestational age or large for gestational age infants. During the last trimester of pregnancy subjects' breasts were examined for surgical incisions, size, symmetry, and nipple protuberance, and women estimated their prenatal breast enlargement. At two visits in the first two weeks postpartum, infants were weighted naked, and mothers reported the magnitude of postpartum breast engorgement when their milk came in. Breastfeeding was evaluated at each visit, and interventions were recommended for problems, with emphasis on maximizing milk yield. Lactation was deemed sufficient when an exclusively breastfed infant achieved an average weight gain of 28.5 g or more per day between the two visits. Infants gaining less than 28.5 g per day with breast milk exclusively, and those requiring formula supplement returned for a third visit at or before 21 days of age, when final lactation outcome was assessed based on weight gain between the second and third visits. Within three weeks postpartum 85 percent of the mothers achieved sufficient lactation, whereas 15 percent had persistent milk insufficiency despite intensive intervention. Of the study population, 6.9 percent had undergone previous breast surgery. Women with periareolar breast incisions were nearly 5 times more likely to have lactation insufficiency than were those without surgery (relative risk [RR] = 4.55; 95 percent confidence interval [CI] = 2.21-9.43; P less than 0.001). Insufficient lactation was significantly associated with minimal prenatal breast enlargement (P less than 0.02) and minimal postpartum breast engorgement when milk came in (P less than 0.001). Although not statistically significant, women with inverted nipples were more likely to have lactation insufficiency compared with those with normal nipples (RR = 2.94; 95% CI 1.05-8.20; P = .07). The findings from this study indicate that certain biologic and surgical breast variables are associated with lactation insufficiency.
Body Weight↗
Breastfeeding: can it compete in the marketplace?
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Advertising↗
Cloning and characterization of the aroA gene from Mycobacterium tuberculosis.
The aroA gene from Mycobacterium tuberculosis has been cloned by complementation of an aroA mutant of Escherichia coli after lysogenization with a recombinant DNA library in the lambda gt11 vector. Detailed characterization of the M. tuberculosis aroA gene by nucleotide sequencing and by immunochemical analysis of the expressed product indicates that it encodes a 5-enolpyruvylshikimate-3-phosphate synthase that is structurally related to analogous enzymes from other bacterial, fungal, and plant sources. The potential use of the cloned gene in construction of genetically defined mutant strains of M. tuberculosis by gene replacement is proposed as a novel approach to the rational attenuation of mycobacterial pathogens and the possible development of new antimycobacterial vaccines.
3-Phosphoshikimate 1-Carboxyvinyltransferase↗
Mutational mapping of RAS-responsive domains of the Saccharomyces cerevisiae adenylyl cyclase.
Large deletion and small insertion mutations in the adenylyl cyclase gene of Saccharomyces cerevisiae were used to map regions required for activation by RAS protein in vitro. The amino-terminal 605 amino acids were found to be dispensable for responsiveness to RAS protein. All other deletions in adenylyl cyclase destroyed its ability to respond to RAS. Small insertion mutations within the leucine-rich repeat region also prevented RAS responsiveness, while other insertions did not.
Adenylyl Cyclases↗
Phase II trial of interferon-beta-serine in metastatic renal cell carcinoma.
Interferon-beta-serine (IFN-beta-ser) is a muteine, recombinant IFN that is tolerated at a dose fivefold to 10-fold higher than IFN-alfa and interacts with the same cell membrane receptor as IFN-alfa. We hypothesized that at high doses IFN-beta-ser might induce a higher response rate than IFN-alfa in metastatic renal cell carcinoma. We undertook a phase II trial of IFN-beta-ser in patients with metastatic renal cell carcinoma. Patients were treated three times each week by a 2-hour intravenous infusion. Doses were escalated weekly (.25 to 5.5 mg, 1 mg = 180,000,000 U) until the maximum-tolerated treatment dose (MTTD) was determined. The MTTD is defined as one dose level less than that which caused grade 3 toxicity and was subsequently administered three times weekly for at least 4 weeks. Twenty-nine patients were entered, and 25 were assessable for response and toxicity. The performance status was 0-1 in all patients and only one patient received previous chemotherapy. The MTTD dose was 2.5 mg (range, 0.5 to 5.5 mg per treatment), although in 10 patients, doses were later deescalated because of cumulative toxicity. Initial dose-limiting toxicity and cumulative toxicity were fatigue, malaise, and fever in most patients. Hepatic transaminitis, neutropenia, and elevation of serum creatinine were also observed but were not dose-limiting. There was one complete response (CR) and four partial responses (PRs). All responses but one occurred in pulmonary metastases. The median time to response was 26 days (range, 17 to 102 days). These data demonstrate that IFN-beta-ser given in high doses exhibits significant antitumor activity in renal cell carcinoma; however, the objective response rate is 20%. This is no higher than previous IFN studies; therefore, we reject the hypothesis than IFN-beta-ser at high doses may induce a greater response rate than IFN-alfa. However, we did observe more responses than were seen in a similar trial undertaken with lower dose IFN-beta serine in renal cell carcinoma.
Adult↗
Pharmacokinetics of 2-F-ara-A (9-beta-D-arabinofuranosyl-2-fluoroadenine) in cancer patients during the phase I clinical investigation of fludarabine phosphate.
Fludara I.V. (fludarabine phosphate) (2-F-ara-adenosine monophosphate [2-F-ara-AMP], NSC 312887) is the 5'-phosphate of 2-F-ara-A-(9-beta-D-arabinofuranosyl-2-fluoroadenine), a derivative of ara-A that is resistant to deamination and selectively inhibits DNA synthesis. Concurrent with the phase I evaluation of 2-F-ara-AMP administered as a single intravenous (IV) bolus every 21 days to patients with advanced malignancy, plasma pharmacokinetic profiles of 2-F-ara-A were determined in 30 patients following the rapid infusion (2 to 5 minutes) of doses of 2-F-ara-AMP ranging from 80 to 260 mg/m2. The parent drug was almost quantitatively converted to 2-F-ara-A by apparent first-pass metabolism, with maximum levels of 2-F-ara-A and very low levels (less than 1 fmol/L) of 2-F-ara-AMP observed only in the plasma samples obtained shortly after dosing (2 to 4 minutes). The plasma concentration-time profiles exhibited three exponential phases. Plasma concentrations were computer fitted to a three-compartment open model using a zero-order input function for the injection period. The 2-F-ara-A harmonic mean half-lives were t1/2 alpha = 4.97 minutes, t1/2 beta = 1.38 hours, t1/2 gamma = 10.41 hours, and the mean residence time was 10.51 hours. The rate-limiting process for elimination of the drug from the body appeared to be release from tissue binding sites. The mean total-body plasma clearance was 67.98 +/- 19.58 mL/min/m2 (mean +/- SD). The mean central compartment volume of distribution (V1) was 7.49 L/m2 or 0.20 L/kg. The mean steady-state volume of distribution (Vdss) was 44.17 L/m2 or 1.19 L/kg, indicating that 2-F-ara-A is distributed and bound to the tissues of the body. Total-body clearance and the volume parameters Vdss and Vd gamma decreased with an increase in serum creatinine, indicating that these pharmacokinetic parameters depend upon renal function. Dose reduction in patients with renal dysfunction is recommended.
Antimetabolites, Antineoplastic↗
Indications for pulmonary artery flow-directed catheters.
The pulmonary artery flow-directed catheter (Swan-Ganz catheter) has been in clinical use for 20 years. These devices are now used by 80% of UK intensive care units for the diagnosis and monitoring of a wide range of cardiorespiratory problems. The principal indications for the use of pulmonary artery catheters and the evidence supporting these indications are outlined in this article.
Catheterization, Swan-Ganz↗
The oncogenic protein p60v-src has competence activity but does not activate phosphatidylinositol turnover or protein kinase C in Balb/c 3T3 cells.
A Balb/c 3T3 cell-line infected with the temperature-sensitive Rous sarcoma virus LA90 has been used to investigate the mitogenic activity of p60v-src and the possible role of phosphatidylinositol turnover and protein kinase C activation in this process. Activation of the p60v-src tyrosine kinase alone was only weakly mitogenic to serum-deprived cells. However, transient activation of the kinase dramatically increased the mitogenic response to epidermal growth factor. Mitogenicity was not additive with phorbol esters. Down-regulation of protein kinase C by chronic administration of phorbol ester did not block the mitogenic effect of p60v-src. Following short-term activation of p60v-src, analysis of protein phosphorylations by giant two-dimensional electrophoresis revealed only very minor changes in any of the 1000 or so detectable phosphoproteins, whereas the activation of protein kinase C by a sub-optimal dose of phorbol ester significantly increased the phosphorylation of at least 10 proteins. Short-term activation of p60v-src did not cause any detectable increase in phosphatidylinositol turnover, or in diacylglycerol level. These results indicate that p60v-src can act, like platelet-derived growth factor, to induce competence in Balb/c 3T3 fibroblasts. They also suggest that even though p60v-src may activate phosphatidylinositol turnover in some other cell-lines, this effect is probably indirect and is not essential for induction of the transformed phenotype or for p60v-src-dependent mitogenesis.
Animals↗
Prospective evaluation of clinical and pathologic detection of axillary metastases in patients with carcinoma of the breast.
Complete axillary dissection was performed in 287 patients undergoing modified radical mastectomy between 1984 and 1987 to identify patterns of axillary node metastases, as well as discontinuous axillary node ("skip") metastases. Positive pathologic findings were compared with preoperative clinical examinations in 266 patients and showed only 60 cases (22.6%) clinically suspicious for tumor, in contrast to 131 (45.6%) with pathologically confirmed positive lymph nodes. Axillary contents were classified level I, II, or III based on their relationship to the pectoralis minor muscle. An average of 24.2 nodes was resected per patient (level I, 10; level II, 8.1; and level III, 5.3). Tumors ranged in size from 0.5 to 12.0 cm (mean, 2.6 cm), and increasing tumor size was associated with an increased likelihood of positive nodes. The data on 204 patients with complete clinical and pathologic data show that of 119 patients with negative level I nodes a limited axillary dissection (level I only) would fail to identify 6 with positive level II and 2 with positive level III nodes, whereas of 85 patients with positive level I nodes limited axillary dissection would fail to identify 17 with positive level II nodes, 7 with positive level III nodes, and 27 with positive levels II and III nodes. Complete axillary dissection (levels I, II, and III) should be performed to stage patients accurately, as well as to remove tumor-involved nodes and diminish local axillary recurrences. Clinical examination of the axilla appears to be a poor means of identifying axillary metastatic cancer.
Adult↗
Evolution of the Colorado Organ Recovery Systems.
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Accidents, Traffic↗
Neurasthenia and related problems.
Neurasthenia is a diagnostic entity included in ICD-9 which is used in daily clinical practice in China and the Soviet Union, as well as some other Asian countries, so far as I know. Although it was eliminated from the psychiatric nosology in DSM-III of the United States and in several European countries, this disease has not disappeared. In my view, elimination of the category only indicates change of diagnostic concept without definite direction. Whether this change will be accepted by psychiatrists all over the world is still a question. The continued use of this diagnostic term in China is justifiable, I believe. The final resolution of these differences in views and practice remains for future development in psychiatric science.
Cross-Cultural Comparison↗
Localization by hand-held gamma probe of tumor labeled with antibody "cocktail".
Five groups (n = 4) of congenitally athymic female nude mice bearing subcutaneous implants of CX-1 and/or SW-1116 tumor in the hind limbs received iodine-125 radio-labeled monoclonal antibodies (MoAbs) B72.3 (two groups), 17-1A (two groups), and cocktail (one group) (iodogen method, 50 microCi/10 micrograms/mouse). Daily probe counts were made in duplicate with a hand-held detector over each tumor site and the front leg (background) for 21 days. Animals were sacrificed and appropriate well counts were obtained. All the single MoAb preparations localized well in both tumor cell lines. Uptake of monoclonal antibody 17-1A was similar in the two tumor cell lines, with counts initially high and slowly decreasing over the 21-day period. Tumor/background ratios continued to increase over time, indicating that both tumor lines have similar antigenic expression for the monoclonal antibody 17-1A. This was not the case for monoclonal antibody B72.3, which showed a preferential uptake by the CX-1 tumor, with higher initial counts and prolonged binding of the antibody, giving rise to higher tumor/background ratios. The mixture of monoclonal antibodies B72.3 and 17-1A markedly improved the uptake by the CX-1 tumor cell line but not that by the SW-1116 cell line, where the effect was negative when compared to the uptake of the single MoAb preparations. The use of a monoclonal antibody mixture can enhance targeting of some tumor sites. Due to the heterogeneity of tumor cell lines, even within the same animal, different mixtures of monoclonal antibodies are needed to increase the targeting of tumor.
Adenocarcinoma↗
Heat shock proteins and immunity.
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Animals↗
Monoclonal antibodies defining immunogenic regions of pili from Bacteroides nodosus strains 198 (A1), 265 (H1) and 336 (F1).
A total of 17 monoclonal antibodies (MoAb) were used to analyse the antigenic structure of pilus protein from three serogroups of Bacteroides nodosus. The four MoAb which agglutinated pili were serogroup (and subgroup) specific, and the agglutinating epitope was present on the pili monomer and dependent on the intra-chain disulfide bond. Non-agglutinating MoAb identified two further non-linear and serogroup-restricted epitopes on strain 198 (A1) pili and two linear epitopes on 336 (F1) and 265 (H1) pili. Three MoAb cross-reacted with pili from six of the eight major serogroups and recognized an epitope in the N-terminal region of the molecule. This panel of MoAb has therefore identified at least four epitopes on pilus protein and will facilitate serotopic analyses of the immunogenicity of each epitope in sheep during vaccination against footrot.
Animals↗
The adenylyl cyclase gene from Schizosaccharomyces pombe.
We cloned the adenylyl cyclase gene from the fission yeast Schizosaccharomyces pombe using low-stringency hybridization to the Saccharomyces cerevisiae adenylyl cyclase gene. The Sc. pombe gene encodes a 1692-amino acid-residue protein. The identity of this gene was confirmed by studies of its expression in Sa. cerevisiae. Expression of the carboxyl-terminal region of the Sc. pombe adenylyl cyclase protein will suppress a temperature-sensitive mutation in the Sa. cerevisiae adenylyl cyclase gene. Furthermore, Sa. cerevisiae that lack their endogenous adenylyl cyclase gene and express the carboxyl-terminal region of the Sc. pombe adenylyl cyclase protein have measurable adenylyl cyclase activity. The carboxyl-terminal region of this protein has strong homology with the catalytic domain of the Sa. cerevisiae adenylyl cyclase. Also, Sc. pombe adenylyl cyclase, like Sa. cerevisiae adenylyl cyclase, contains a tandemly repeated motif rich in leucine. Neither yeast protein is particularly homologous to the recently cloned Gs-responsive mammalian adenylyl cyclase [Krupinski, J., Coussen, F., Bakalyar, H. A., Tang, W.-J., Feinstein, P. G., Orth, K., Slaughter, C., Reed, R. R. & Gilman, A. G. (1989) Science 244, 1558-1564].
Adenylyl Cyclases↗
Evaluating selected internship candidates and their subsequent performances.
The authors compared selection criteria with subsequent performances of housestaff on a medical service over a 13-year period. The selection criteria studied included class rank, grades in the four major clinical clerkships, scores on the National Board of Medical Examiners Part I examination, Alpha Omega Alpha membership, and numerical ranking by the intern selection committee. Only the last criterion correlated significantly (p = .0015) with subsequent housestaff performance. The synthesis of all available information by an intern selection committee is valuable in choosing candidates with future promise.
Clinical Competence↗
Partial characterisation of the human erythrocyte antigen Pta.
Ghosts were prepared from erythrocytes positive for the rare blood group antigen Pta. Immunoblotting of the solubilised ghosts with anti-Pta located the antigen on a band with an Mr of 31,600, about 1,100 higher than that of sialoglycoprotein gamma. Binding to the same band was also observed when cytoskeleton preparations from Pt(a+) erythrocytes were immunoblotted with the antibody. Haemagglutination and immunoblotting experiments were consistent in demonstrating that the Pta antigen is not inactivated by treatment of intact erythrocytes with neuraminidase or trypsin but is destroyed by treatment with alpha-chymotrypsin, papain or pronase. The data indicate that the Pta antigen is carried on a 'new' erythrocyte membrane protein.
Blood Group Antigens↗