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Biomedical subjects

M Cohen

Publications and source records attributed to M Cohen.

At least 199 records · Page 11Linked to original sources
PubMed2000

In vitro methods for measuring the dry matter digestibility of ruminant feedstuffs: comparison of methods and inoculum source.

We conducted this study to evaluate the new in vitro system, DAISY", to determine dry matter (DM) digestibility in ruminant feedstuffs. Results from the DAISY" were compared to those obtained by the traditional Tilly and Terry method. The traditional method buffer was used for both methods. We also compared two sources of rumen inoculum from sheep and dairy cows. Seventeen different feeds were tested, grouped into roughage, concentrate, and CP supplements. The experiment was replicated on two different occasions for all feeds and the two sources of inoculum. The source of inoculum and the time at which it was collected had no effect on the in vitro DM digestibility of the feedstuffs in either of the methods. The DAISY" DM digestibility value compared well with the traditional method values for the roughage group; however, for some feedstuffs in the concentrate and CP supplement groups, the DAISY" values were significantly higher than the traditional method values. Regression analysis of the feeds that resulted in similar values with the two methods revealed that the DAISY" method can be used to predict in vitro digestibility with relatively small variation.

Animal Feed↗
PubMed2000

Prognostic factors in prostate cancer. College of American Pathologists Consensus Statement 1999.

BACKGROUND: Under the auspices of the College of American Pathologists, a multidisciplinary group of clinicians, pathologists, and statisticians considered prognostic and predictive factors in prostate cancer and stratified them into categories reflecting the strength of published evidence and taking into account the expert opinions of the Prostate Working Group members. MATERIALS AND METHODS: Factors were ranked according to the previous College of American Pathologists categorical rankings: category I, factors proven to be of prognostic importance and useful in clinical patient management; category II, factors that have been extensively studied biologically and clinically but whose importance remains to be validated in statistically robust studies; and category III, all other factors not sufficiently studied to demonstrate their prognostic value. Factors in categories I and II were considered with respect to variations in methods of analysis, interpretation of findings, reporting of data, and statistical evaluation. For each factor, detailed recommendations for improvement were made. Recommendations were based on the following aims: (1) increasing uniformity and completeness of pathologic evaluation of tumor specimens, (2) enhancing the quality of data collected pertaining to existing prognostic factors, and (3) improving patient care. RESULTS AND CONCLUSIONS: Factors ranked in category I included preoperative serum prostate-specific antigen level, TNM stage grouping, histologic grade as Gleason score, and surgical margin status. Category II factors included tumor volume, histologic type, and DNA ploidy. Factors in category III included perineural invasion, neuroendocrine differentiation, microvessel density, nuclear roundness, chromatin texture, other karyometric factors, proliferation markers, prostate-specific antigen derivatives, and other factors (oncogenes, tumor suppressor genes, apoptosis genes, etc).

Biomarkers, Tumor↗
PubMed2000

Tools for the practice manager.

Managers must ensure that financial and human resources are used efficiently and effectively in the accomplishment of an organization's objectives. This involves establishing plans and performance standards and correcting deviations from those plans and standards.

Delivery of Health Care↗
PubMed2000

Combination enoxaparin and abciximab therapy during percutaneous coronary intervention: "NICE guys finish first".

Data from randomized clinical trials support the administration of both enoxaparin and platelet glycoprotein IIb/IIIa blockade to patients who present with non-ST segment evaluation acute coronary syndromes. Enoxaparin does not activate platelets, has a more predictable dose response that facilitates weight-adjusted dosing and may have enhanced antithrombotic (increased anti-Xa activity) and safety (reduced anti-IIa activity) properties when compared with unfractionated heparin. Abciximab administration during percutaneous coronary intervention reduces the incidence of ischemic adverse outcomes and may improve survival in long-term follow-up. The preliminary experience with combining abciximab and intravenous enoxaparin during percutaneous coronary intervention in the NICE-4 Trial demonstrates a low incidence of minor/major bleeding (TIMI definition) and transfusion and infrequent major cardiac events to 30 days follow-up. Future algorithms to facilitate the transition of patients from the clinical service who have received subcutaneous administration of enoxaparin to the cardiac catheterization laboratory prior to percutaneous coronary intervention are forthcoming and will provide seamless integration of "optimal" adjunctive pharmacology through the course of hospitalization for patients with non-ST elevation acute coronary syndromes.

Abciximab↗
PubMed2000

Regional differences in cardiovascular mortality in Minnesota.

Cardiovascular disease is the leading cause of death in the United States. Initial results from our health survey in the Red River Valley of Minnesota suggested elevated cardiovascular mortality in men and women in younger age groups there compared with the rest of the state. Similarly, earlier published longitudinal studies of cardiovascular mortality in Minnesota revealed increased cardiovascular mortality in counties west of a diagonal line drawn through the tip of the arrowhead region (northeast Minnesota) to the southwest corner of the state. In this study we examined cardiovascular mortality by geographic region with respect to economic factors, residence patterns, and ethnic group. Since these regions vary in geology and major land use, environmental factors were considered as well. Our present data show a significant elevation in cardiovascular mortality from 1987-1997 in men and women aged 25-59 in northwest and northeast Minnesota counties compared with central-metro counties. In contrast, south-central Minnesota shows a rate of cardiovascular mortality for that age group similar to that seen in the central-metro region. The increase in cardiovascular deaths from myocardial infarct in the younger groups in the more rural, less affluent areas of northwest Minnesota is nearly two times higher than in the central-metro counties. Genetic factors may play a role in the increased mortality recorded for northeast Minnesota. Environmental contaminants such as pesticides are additional considerations. Finally, our data suggest the need to address long-standing regional cardiovascular mortality differences and rural health care access in Minnesota.

Adult↗
PubMed2000

Increased regional cerebral perfusion by 99mTc hexamethyl propylene amine oxime single photon emission computed tomography in post-traumatic stress disorder.

OBJECTIVE: Because of the treatment resistance and chronic affective lability of many post-traumatic stress disorder (PTSD) patients and the hypothesized association of these behaviors with temporal and limbic structures, a study was conducted to determine whether these patients would exhibit alterations in regional cerebral perfusion in the temporal and limbic regions compared with age-matched normal volunteers at rest. METHOD: We studied 17 patients using 99mTc hexamethyl propylene amine oxime single photon emission computed tomography. Seven of the patients were on a selective serotonin reuptake inhibitor, five were on a tricyclic antidepressant, and five were on no medication at the time of the study. Patients were compared with eight age-matched normal controls. RESULTS: All PTSD patients showed a relative increase in regional cerebral perfusion in the anterior and posterior cingulate regions bilaterally, the right temporal and parietal regions, the right caudate/putamen region, and the left orbital and hippocampal regions compared with the control group. When the group of PTSD patients who were free of medication were compared with the control group, increased regional cerebral perfusion was found in the right and left caudate/putamen regions and the right orbital and anterior cingulate cortex bilaterally. CONCLUSIONS: PTSD is associated with increased regional blood flow in limbic areas and the right temporal and parietal cortex compared with age-matched normal volunteers.

Adult↗
PubMed2000

Combination Enoxaparin and Abciximab During Percutaneous Coronary Intervention: A New Standard of Care?

Evidence from randomized trials supports the administration of platelet glycoprotein (GP) IIb/IIIa blockade both to patients undergoing percutaneous coronary intervention (PCI) and those presenting with non-ST elevation acute coronary syndromes (ACSs). Similarly, the low molecular weight heparin (LMWH), enoxaparin, has demonstrated superior efficacy when compared with unfractionated heparin (UFH) in the treatment of patients with non-ST elevation ACS. Algorithms for seamless integration of pharmacotherpy through the course of hospitalization for patients who present with ACS and who require PCI will likely combine therapy with enoxaparin and platelet GP IIb/IIIa blockade (abciximab). Our preliminary experience with combination enoxaparin and abciximab as adjunctive pharmacotherapy for PCI suggests that this strategy is safe and effective and may offer advantages over a conventional strategy, which employs UFH.

Journal Article↗
PubMed2000

A community rheumatology practice offers an educational experience comparable to that of a university tertiary care center.

OBJECTIVE: To compare the teaching value of rheumatology patients seen in either a community rheumatology practice or in a tertiary care university center. METHODS: Consecutive patients seen at the 2 sites over a one month period were assessed for rheumatology diagnosis, complexity of rheumatologic disease, and treatments received, including number of interventions performed. The overall pedagogic value of the encounter was rated by the rheumatologist for both medical students and postgraduate trainees. RESULTS: Rheumatology patients were comparable at the 2 sites for overall pedagogic value, rheumatology diagnostic category, and complexity of disease. At the community site, however, there were more patients evaluated, more procedures performed, and more new treatments introduced. CONCLUSION: Contrary to current perceptions, comparable pedagogic value of rheumatology patients was observed outside a tertiary care setting. In the changing climate of education, and considering resource limitations that influence current rheumatology practice, community based rheumatology has the potential to offer a valuable educational experience.

Community Health Services↗
PubMed2000

What is complementary medicine?

BACKGROUND: Medicine has a central aim of achieving health and wellbeing and many healthcare practices have developed to achieve this. Currently, patient spending on complementary therapies exceeds out of pocket spending on orthodox therapies. The increased use of complementary medicine by the public is paralleled by many doctors either using, or interested in using, a wider range of therapeutic approaches. OBJECTIVE: To define complementary medicine and explore what distinguishes it from mainstream medicine. DISCUSSION: Despite growing interest into complementary therapies by doctors and government, it often seems there are two parallel healthcare systems--'conventional' and 'complementary', or 'orthodox' and 'unorthodox'--operating without much interaction. Descriptions of this division claim to be based on scientific merit or political acceptance. However, it may be more appropriate to consider therapies as existing across a spectrum with multiple, complementary dimensions. Thus, the science of medicine aimed at achieving cures can be seen to complement the art of medicine, which aims to enhance health. Optimal healthcare delivery requires a 'holistic' or 'integrative' approach.

Complementary Therapies↗
PubMed2000

Initial experience with the low-molecular-weight heparin, enoxaparin, in combination with the platelet glycoprotein IIb/IIIa blocker, tirofiban, in patients with non-ST segment elevation acute coronary syndromes.

Enoxaparin, a low-molecular-weight heparin, and tirofiban, an intravenous platelet glycoprotein IIb/IIIa receptor antagonist, have each been shown to be effective in reducing cardiac ischemic events compared to unfractionated heparin alone in separate trials of patients with unstable angina and non-Q wave myocardial infarction. The combination of these agents may offer further therapeutic benefit. In a pilot study (ACUTE I), fifty-five patients with non-Q wave myocardial infarction were randomized to receive double-blind treatment with tirofiban (0.1 microg/kg/min intravenously) for 48/108 hours co-administered with either enoxaparin (1 mg/kg sc q 12 hours) (n = 26) or unfractionated heparin (intravenous, adjusted to activated partial thromboplastin time) (n = 27). Co-administration of tirofiban and enoxaparin was generally well tolerated. Plasma clearance of tirofiban was similar for enoxaparin and unfractionated heparin-treated patients. When combined with tirofiban, enoxaparin, relative to unfractionated heparin, resulted in less variability and a trend toward greater inhibition of platelet aggregation using 5 microM adenosine phosphate agonist. More patients achieved target inhibition of platelet aggregation (> 70%) in the tirofiban and enoxaparin group (84% versus 65%; p = 0.19). Median bleeding time was 21 minutes for tirofiban and enoxaparin versus 30 minutes for tirofiban and unfractionated heparin (p = non-significant). For a given level of inhibition of platelet aggregation, bleeding time was less prolonged with tirofiban and enoxaparin than tirofiban and unfractionated heparin (adjusted mean bleeding time 19.6 versus 24.9 minutes, respectively; p = 0.02). There were no major or minor bleeding events in either group by the TIMI criteria. The more consistent inhibition of platelet aggregation and lower adjusted bleeding time of tirofiban and enoxaparin versus tirofiban and unfractionated heparin support the therapeutic potential of combining these two agents. These observations have now been extended to more than 500 patients.

Angina, Unstable↗
PubMed1999

Nephrogenic diabetes insipidus in a dog with intestinal leiomyosarcoma.

Nephrogenic diabetes insipidus was diagnosed in a dog with an intestinal leiomyosarcoma. The diagnosis of nephrogenic diabetes insipidus was made on the basis of results of serum biochemical tests, urinalyses, and a water-deprivation test, along with a lack of response to exogenous administration of vasopressin following the water-deprivation test. The temporal association between resection of the intestinal mass and resolution of clinical signs of diabetes insipidus (i.e., polyuria and polydipsia) and between recurrence of clinical signs and detection of metastatic disease suggests that there may have been a causal relationship, and nephrogenic diabetes insipidus may have developed as a paraneoplastic syndrome in this dog.

Animals↗
PubMed1999

Combination therapy with tirofiban and enoxaparin in acute coronary syndromes.

BACKGROUND: Tirofiban, an intravenous glycoprotein IIb/IIIa antagonist, and enoxaparin, a low molecular weight heparin, have each been shown to be effective at reducing cardiac ischemic events compared to unfractionated heparin alone in separate trials of patients with unstable angina and non-Q-wave myocardial infarction. The combination of these agents may offer further therapeutic benefit. MATERIALS AND METHODS: Fifty-five patients with non-Q-wave myocardial infarction were randomized to receive double-blind treatment with tirofiban (0.1 microgram/kg/min i.v.) for 48-108 h coadministered with either enoxaparin (1 mg/kg sc q 12 h) (n=26) or unfractionated heparin (i.v. adjusted to activated partial-thromboplastin time) (n=27) to evaluate pharmacokinetics, pharmacodynamics, and safety. The primary objective of the study was to investigate the effect of unfractionated heparin versus enoxaparin on the plasma clearance of tirofiban. RESULTS: Coadministration of tirofiban and enoxaparin was generally well tolerated. Plasma clearance of tirofiban was 176.7+/-59.8 and 187.5+/-81.8 ml/min, respectively, for enoxaparin and unfractionated heparin-treated patients (P=NS). The mean difference was well within the prespecified criterion for comparability. Administration of tirofiban with enoxaparin vs. unfractionated heparin resulted in lesser variability and a trend towards greater inhibition of platelet aggregation using 5 microM adenosine phosphate agonist. More patients achieved target inhibition of platelet aggregation >70% in the tirofiban and enoxaparin group (84% vs. 65%, P=0.19). Median bleeding time was 21 min for tirofiban and enoxaparin vs. > or =30 min for tirofiban and unfractionated heparin (P=NS). For a given level of inhibition of platelet aggregation, bleeding time was less prolonged with tirofiban and enoxaparin than tirofiban and unfractionated heparin (adjusted mean bleeding time 19.6 vs. 24.9 min, P=0.02). Tirofiban plasma concentration and clearance were comparable whether coadministered with enoxaparin or unfractionated heparin. There were no major or minor bleeding events in either group by the TIMI criteria. INTERPRETATION: The more consistent inhibition of platelet aggregation and lower adjusted bleeding time of tirofiban and enoxaparin vs. tirofiban and unfractionated heparin support the therapeutic potential of combining these two agents. These data from the first clinical report of coadministration of a glycoprotein IIb/IIIa receptor antagonist and a low molecular weight heparin are consistent with prior data which show differential pharmacodynamic effects of enoxaparin and unfractionated heparin on platelet aggregation.

Angina, Unstable↗