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Biomedical subjects

L Hart

Publications and source records attributed to L Hart.

At least 19 recordsLinked to original sources
PubMed2000

Effects of inhaled corticosteroid therapy on expression and DNA-binding activity of nuclear factor kappaB in asthma.

We determined whether inhaled corticosteroid therapy modulates the expression of the transcription factor, nuclear factor kappa B (NF-kappaB), in patients with asthma. Fifteen stable patients with mild asthma underwent bronchoalveolar lavage (BAL) with bronchial biopsies in a double-blind, placebo-controlled and crossover study after placebo or after inhaled fluticasone propionate (500 microg twice daily). Fluticasone reduced the number of eosinophils in BAL fluid (BALF) and in airway biopsies, together with an improvement of bronchial responsiveness to methacholine. However, NF-kappaB DNA-binding in alveolar macrophages and in bronchial biopsies was not affected by fluticasone treatment. NF-kappaB expression was also measured by immunohistochemical staining with an antibody to the p65 component of NF-kappaB. Fluticasone caused an increase in the number of positive nuclear staining cells in the airway epithelium from 34. 1 +/- 5.0 to 64.1 +/- 8.0 per mm(2) (p = 0.002). In vitro studies of A549 epithelial cells stimulated by interleukin-1beta (IL-1beta) showed that dexamethasone increased p65 protein expression analyzed by Western blot. Despite an anti-inflammatory effect of fluticasone, there was no decrease in NF-kappaB-DNA binding and activation, indicating that this may not be a mechanism by which corticosteroids act in asthma. The significance of corticosteroid-induced increase in p65 protein expression is not known.

Administration, Inhalation↗
PubMed1999

The medical record. Informing your patients before they consent.

In the language of medical liability, no concept has received as much misinterpretation as "informed consent." In the last five years, most medical liability carriers have experienced a significant increase in claims that allege failure to obtain a proper informed consent prior to treatment. The authors discuss forensic testing of the medical record and offer recommendations for record-keeping. These suggestions, if followed, will help establish the reliability of the record as an accurate reflection of the treatment of the patient in any given case.

Adult↗
PubMed1999

Defining morning stiffness in rheumatoid arthritis.

OBJECTIVE: Morning stiffness is a common and clinically important symptom in patients with rheumatoid arthritis (RA); however, it has not performed well as a classification criterion, perhaps due to poor definition. This qualitative study was carried out to identify the characteristics of morning stiffness through the self-reports of patients with RA in order to develop a new patient centered definition. METHODS: Personal interviews with 24 patients with RA were analyzed independently by 2 reviewers using a grounded theory approach. A mail-out questionnaire was used to validate the information summarized from the interviews. RESULTS: These findings resulted in the following definition of morning stiffness in RA: slowness or difficulty moving the joints when getting out of bed or after staying in one position too long, which involves both sides of the body and gets better with movement. CONCLUSION: This new patient centered definition of morning stiffness may allow more precise classification of patients with RA.

Adult↗
PubMed1998

IkappaBalpha degradation and nuclear factor-kappaB DNA binding are insufficient for interleukin-1beta and tumor necrosis factor-alpha-induced kappaB-dependent transcription. Requirement for an additional activation pathway.

Two closely related IkappaBalpha kinases as well as the upstream kinase, NIK, which integrates interleukin-1beta (IL-1beta)- and tumor necrosis factor (TNF)-alpha-dependent activation of the transcription factor NF-kappaB have recently been described. However, in this emerging pathway the role of previously identified components of cytokine-induced NF-kappaB activation, namely phosphatidylcholine-specific phospholipase C and protein kinase C, remains unclear. We now show that, in A549 human alveolar epithelial cells, the activation of a stably transfected NF-kappaB-dependent reporter gene by TNF-alpha and IL-1beta is completely blocked by the phosphatidylcholine-specific phospholipase C inhibitor D609 and the protein kinase C inhibitor RO31-8220. However, IL-1beta-induced IkappaBalpha degradation as well as NF-kappaB nuclear translocation and DNA binding, as determined by Western blot and electro-mobility shift assay, respectively, are not affected by these inhibitors. A similar effect, although less pronounced, is observed with the p38 mitogen-activated protein kinase inhibitor SB 203580. On the basis of these data we propose the existence of a second signaling pathway induced by IL-1beta and TNF-alpha that is activated in parallel to the cascade leading to IkappaBalpha degradation and is specifically required for NF-kappaB-dependent transcriptional competency.

Cell Line↗
PubMed1998

Epidemiologic study of cats and dogs affected by the 1991 Oakland fire.

OBJECTIVE: To identify risk factors of pets affected by the 1991 Oakland, Calif fire for being lost, found, adopted, or reunited with owners. DESIGN: Retrospective cohort study. ANIMALS: 1,075 cats and 197 dogs affected by the fire and 221 cats and 128 dogs not affected by the fire. PROCEDURES: Records compiled from 1991 to 1995 by the Oakland Firestorm Pet Hotline were analyzed. RESULTS: Peak activity for the hotline was on days 3 and 4 after the fire, but decreased to a low, steady rate by day 21. Many pets were found that had been abandoned or were part of a large free-roaming population that existed at the time of the fire. Many were missing after the fire and presumed killed. The longer owners delayed looking for their pet, the lower the chance of being reunited. Pets wearing collars with the owners' names and addresses had a more than 10-fold chance of being reunited, compared with pets without collars. Increasing odds for adoption of lost pets was associated with their proximity to the fire. CLINICAL IMPLICATIONS: Hotlines set up after sudden impact disasters, such as the Oakland Firestorm Pet Hotline, will probably register primarily abandoned animals. Reunion of pets with their owners appears to be most likely for those that receive an overall better level of care than pets found at other times. Adoption of pets after this disaster was primarily by the person who found that animal and principally resulted when the pet was found close to the disaster area.

Animal Identification Systems↗
PubMed1998

Children's views of accident risks and prevention: a qualitative study.

OBJECTIVES: To examine children's accounts of injury risks and opportunities for prevention. SETTING: Schools, youth clubs, and a holiday activity scheme in the south east of England. METHODS: Sixteen focus groups were held with 7-11 year old children. Transcripts of the discussions were analysed using qualitative methods. RESULTS: Children were knowledgeable about injury risks and how to reduce them. They also saw injury prevention as primarily their own responsibility. However, they were also sophisticated in their criticisms of generalised prevention advice, and evaluated safety messages in the light of local environmental and social knowledge. Personal experience was more often reported as a reason for risk reduction than formal prevention advice. Risks for injury were not isolated from other risks faced. CONCLUSIONS: Effective educational interventions aimed at changing children's risk behaviour should build more on children's own competence and knowledge of their local environment, and stress the need to manage risks rather than avoid dangers.

Accident Prevention↗
PubMed1998

Improved patient outcomes at a urology nurse clinic.

A urology nurse clinic was developed to improve cost and quality of care outcomes for patients with benign prostatic hypertrophy amid cost constraints and the need for improved service delivery. Cost and quality of care outcomes were achieved through earlier discharge and improved assessment, education, and discharge planning for patients. The professional development of urology nurses also improved through increased practice of advanced assessment skills and broadened scope of practice.

Humans↗
PubMed1997

Auranofin.

Explore the source record for details and available documents.

Adolescent↗
PubMed1996

Utility of chest radiography and cystoscopy in the evaluation of patients with localized prostate cancer.

OBJECTIVES: Candidates for radical prostatectomy have been frequently evaluated with chest radiography and occasionally with cystoscopy. The utility of these studies was assessed. METHODS: A retrospective review of 236 cases of radical prostatectomy performed over 5 years was conducted. Chest x-ray results were correlated with certain comorbidities believed to be risk factors for radiographic abnormalities, including hypertension, cardiac disease, pulmonary problems, and tobacco use. Cystoscopic findings were analyzed with regard to urologic history and urinalysis results. RESULTS: Chest radiography was normal in 208 (88.1%) and abnormal in 28 (11.9%) patients. All 28 patients with abnormalities had one or more of the aforementioned risk factors. Sixty-two individuals (26.3%) had no risk factors, and chest radiography was uniformly normal in this group. Cystoscopy was performed in 91 patients. State Ta transitional cell carcinoma of the bladder was detected in 6 of these patients (6.6%); these 6 patients all had either a history of this problem or hematuria. One individual had a mild bladder-neck contracture that did not warrant treatment. Endoscopic findings were normal in the remaining patients. CONCLUSIONS: Chest radiography is not routinely needed to evaluate radical prostatectomy candidates. It should only be performed in patients who have or are at risk for cardiopulmonary disease. Cystoscopy is not warranted in this setting unless there is clinical suspicion of other urologic pathology.

Adult↗
PubMed1994

Correlation of prostate-specific antigen and prostate-specific antigen density with outcome of prostate biopsy.

OBJECTIVE: We attempt to correlate prebiopsy serum prostate-specific antigen (PSA) concentration and prostate-specific antigen density (PSAD) with histologic results of prostate biopsy. METHOD: Sixty-two consecutive patients underwent prostate biopsy because of elevated PSA greater than 4 ng/mL and/or abnormal findings on digital rectal examination (DRE). PSAD was calculated from dividing the serum PSA concentration by the prostate volume as determined by transrectal ultrasound (TRUS). PSA and PSAD were compared to biopsy outcome. RESULTS: The mean PSAD values of the cancer versus noncancer (benign prostatic tissue, benign prostatic hyperplasia, and prostatitis) groups were significantly different (p < 0.019). However, there was great overlap in individual values. The mean PSA levels of the cancer versus noncancer groups also were significantly different (p < 0.0079). In patients with PSA levels between 4 and 10 ng/mL, 11 of 32 (34%) had positive biopsy findings for cancer. Eleven of 29 patients (38%) with normal DRE findings and elevated PSA levels (> 4 ng/mL) had positive biopsy findings for cancer. Seven of 19 patients (37%) with normal DRE findings and elevated PSA levels between 4 and 10 ng/mL had positive biopsy specimens for cancer. CONCLUSIONS: PSAD, though suggestive, is not definitive for cancer or noncancer. Patients with inflammation (prostatitis) present in their biopsy specimens have serum PSA levels and PSAD values intermediate between those with benign tissue (without inflammation) and cancer. We think that prostate biopsy is important in patients with PSA levels between 4 and 10 ng/mL even if their DRE result is normal, as our data indicate that over one third of these patients harbor detectable prostate cancer.

Aged↗
PubMed1994

Characterization of tumor-infiltrating lymphocyte subsets from human renal cell carcinoma: specific reactivity defined by cytotoxicity, interferon-gamma secretion, and proliferation.

The detection of T cells with specificity for human renal cell carcinoma (RCC) has been difficult to document. In an attempt to improve our identification of RCC-reactive T cells, tumor-infiltrating lymphocytes (TIL) were expanded in interleukin-2/interleukin-4 (IL-2/IL-4) and then separated into CD4+ and CD8+ subsets using antibody-coated biomagnetic beads. TIL grown in IL-2/IL-4 expanded to greater numbers than TIL grown in IL-2 alone. From 16 patients in whom subset separation was performed, three CD4+ and three CD8+ TIL consistently had specificity for RCC that was detected by cytotoxicity, proliferation, or interferon-gamma (IFN-gamma) production. Four of the six lines were derived from the IL-2/IL-4 cultures. Two CD8+ TIL lines displayed specific lytic activity, lysing the autologous tumor but not allogeneic RCC or nonrenal tumors. Moreover, the lytic activity of these lines was blocked by anti-CD3 antibody, suggesting that tumor recognition was through the TCR/CD3 complex. Two additional TIL lines showed preferential lysis of RCC because they were cytotoxic for autologous tumor and one or more allogeneic RCC but not other tumor types. Two nonlytic CD4+ lines as well as the two CD8+ lines that were specifically lytic also produced IFN-gamma in response to the autologous tumor but not allogeneic RCC. Although these TIL lines produce IFN-gamma when stimulated with tumor alone, the addition of 5 U/ml of IL-2 significantly enhanced IFN-gamma secretion. The four TIL lines that showed specificity for RCC in terms of IFN-gamma production also had enhanced proliferation to the autologous RCC plus IL-2 but not to multiple allogeneic RCC plus IL-2. These studies demonstrate that TIL from RCC patients contain both CD4+ and CD8+ T cells that have specificity for RCC. In addition to cytotoxicity, specificity to RCC can be defined by IFN-gamma production and proliferation.

CD4-Positive T-Lymphocytes↗
PubMed1994

Helicobacter pylori eradication in patients with peptic ulcer disease: clinical consequences and financial implications.

We assessed clinical consequences and financial implications of Helicobacter pylori eradication in 175 patients with peptic ulceration, of whom 106 had been free from H. pylori infection for a mean of 3.2 years, while 69 remained infected. We used quarterly questionnaires to examine consumption of ulcer-healing medication and antacids. In the 106 successfully treated patients, gastrointestinal haemorrhage as a complication of peptic ulcer complications during the 344 patient years after eradication (0.003 per patient year) was 18-fold lower than during the 912 patient years before eradication (0.056 per patient year). Of the H. pylori-negative patients, 12-18% used ulcer-healing medication during any one of the three-month periods of the survey, compared with 34-51% of the patients with residual H. pylori infection. The average cost of the ulcer-healing drugs consumed by the H. pylori-negative patients was 30.59 pounds during the 12 months of the survey, compared with 99.05 pounds for H. pylori-positive patients. Consumption of antacids was also lower in the H. pylori-negative group. Successful eradication of H. pylori significantly reduced the annual cost of ulcer-healing drugs consumed by the patients with ulcer disease. Maintenance of ulcer remission following successful eradication of H. pylori also significantly reduced ulcer complications.

Antacids↗