Anthracycline adjuvant chemotherapy: how much is enough?
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Antibiotics, Antineoplastic↗
Biomedical subjects
M Levine
Publications and source records attributed to M Levine.
Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema.
OBJECTIVE: To provide information and recommendations for women and their physicians when making decisions about the management of lymphedema related to breast cancer. OPTIONS: Compression garments, pneumatic compression pumps, massage and physical therapies, other physical therapy modalities, pharmaceutical treatments. OUTCOMES: Symptom control, quality of life, cosmetic results. EVIDENCE: Systematic review of English-language literature retrieved primarily from MEDLINE (1966 to April 2000) and CANCERLIT (1985 to April 2000). Nonsystematic review of breast cancer literature published to October 2000. RECOMMENDATIONS: Pre- and postoperative measurements of both arms are useful in the assessment and diagnosis of lymphedema. Circumferential measurements should be taken at 4 points: the metacarpal-phalangeal joints, the wrists, 10 cm distal to the lateral epicondyles and 15 cm proximal to the lateral epicondyles. Clinicians should elicit symptoms of heaviness, tightness or swelling in the affected arm. A difference of more than 2.0 cm at any of the 4 measurement points may warrant treatment of the lymphedema, provided that tumour involvement of the axilla or brachial plexus, infection and axillary vein thrombosis have been ruled out. Practitioners may want to encourage long-term and consistent use of compression garments by women with lymphedema. One randomized trial has demonstrated a trend in favour of pneumatic compression pumps compared with no treatment. Further randomized trials are required to determine whether pneumatic compression provides additional benefit over compression garments alone. Complex physical therapy, also called complex decongestive physiotherapy, requires further evaluation in randomized trials. In one randomized trial no difference in outcomes was detected between compression garments plus manual lymph drainage versus compression garments alone. Clinical experience supports encouraging patients to consider some practical advice regarding skin care, exercise and body weight. [A patient version of these guidelines appears in Appendix 2.] VALIDATION: An initial draft of this document was developed by a task force sponsored by the BC Cancer Agency. It was updated and revised substantially by a writing committee and then submitted for further review, revision and approval by the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. SPONSOR: The steering committee was convened by Health Canada. COMPLETION DATE: October 2000.
Bandages↗
Clinical practice guidelines for the care and treatment of breast cancer: adjuvant systemic therapy for node-negative breast cancer (summary of the 2001 update).
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Antineoplastic Agents, Hormonal↗
The regulation of forkhead/HNF-3beta expression in the Ciona embryo.
The Ciona forkhead/HNF-3beta gene (Ci-fkh) is expressed in the primary axial tissues of the developing tadpole, including the notochord, endoderm, and rudimentary floor plate of the CNS. In an effort to determine the basis for this complex pattern of expression we have conducted a detailed analysis of the Ci-fkh 5'-regulatory region. Different 5' sequences were attached to a lacZ reporter gene and analyzed in electroporated Ciona embryos. A short regulatory sequence (AS) located approximately 1.7 kb upstream of the transcribed region is shown to be essential for expression in all three axial tissues. The proximal 20 bp of the AS contains overlapping Snail repressor elements and a T-box motif. Deleting these sequences causes the loss of reporter gene expression in the endoderm, as well as expanded expression in the neural tube. These results suggest that a T-box gene such as Ci-VegTR activates Ci-fkh expression in the endoderm, while the Ci-Sna repressor excludes expression from the lateral ependymal cells and restricts the Ci-fkh pattern to the rudimentary floor plate in ventral regions of the neural tube. We also present evidence for Ci-fkh positive autofeedback, whereby the Ci-Fkh protein binds to critical activator sites within the Ci-fkh 5'-regulatory region and helps maintain high levels of expression. We discuss these results with respect to forkhead/HNF-3beta regulation in vertebrates.
Animals↗
Is it inherently prejudicial to try a juvenile as an adult?
Given only information that a youth who could have been tried as either an adult or as a juvenile was being tried as an adult for murder, 218 undergraduate mock jurors were able to form consistent impressions of the defendant. A very high percent of our mock jurors included a criminal or juvenile justice history as part of that impression. A very large majority of the mock jurors also said that knowledge of that criminal history would be relevant to their vote of guilty. Almost all mock jurors said they would be influenced toward voting guilty by knowledge of a previous criminal history. Few of the other components of the impression were so closely correlated with a judgment of relevance, or with a judgment that they would be influenced toward voting guilty by the knowledge of that component of the stereotype. The effect is relatively specific to knowledge of a previous criminal history. The study has limited ecological validity. Nonetheless, we raise questions about whether the fact that a youth is put on trial as an adult is inherently prejudicial, and violates the Sixth Amendment right to an impartial jury.
Adolescent↗
Identification of lysine decarboxylase as a mammalian cell growth inhibitor in Eikenella corrodens: possible role in periodontal disease.
The pathogenesis of inflammatory periodontal disease was studied by examining the mechanism of HeLa and HL60 cell growth inhibition by cell-free saline-soluble extracts of Eikenella corrodens and bacterial plaque. Previous studies identified a protein (p80) as causing growth inhibition by E. corrodens extracts. After purification by two-dimensional SDS-PAGE, p80 was digested with protease lysC. Amino acid sequences were obtained and backtranslated for use as PCR primers. A 5840 nucleotide sequence containing a lysine decarboxylase gene was obtained from a Sau3 A1 genomic library of E. corrodens DNA. Lysine decarboxylase activity was present at physiologic pH in the E. corrodens extracts containing p80, and also in bacterial plaque. Both extracts caused growth inhibition by depleting lysine from cell culture media through conversion to cadaverine. Adding lysine, or immune goat IgG to a peptide derived from the active site sequence of E. corrodens lysine decarboxylase, retarded lysine depletion and growth inhibition. epsilon-Amino caproic acid specifically enhanced lysine decarboxylase activity at the low lysine concentration in HL60 cell culture media, and also increased the growth inhibition. Thus, lysine decarboxylases such as p80 inhibit growth by removing lysine from mammalian cell culture media. A new role for lysine decarboxylase activity in the microbial aetiology of periodontal disease is discussed.
Carboxy-Lyases↗
Everyday life and legal values: a concept paper.
This "concept paper" emerged from a Law and Human Behavior (LHB) Workshop, that was called by the journal's Editor, Richard Wiener, and held at St. Louis University on March 19-21, 1999. This workshop, which brought together 22 scholars and researchers in legal psychology, was part of James Ogloff's Presidential Initiative Project for the American Psychology/Law Society, and was supported by St. Louis University and an NSF grant. Prior to our arrival, each participant answered queries from the Editor about LHB and the field of psychology and law, and each was asked to offer five topics that were underrepresented in the journal or that we would like to see addressed in future issues. At the workshop, we were assigned to small groups, and the authors of this paper constituted one such group. The "charge" for all groups was to "develop plans for encouraging submissions in areas of psycholegal scholarship that continue to be infrequent topics of investigation," and then to develop a concept paper. The direction our group took is captured by our title, "Everyday Life and Legal Values," and within this paper we explicate the topic, identify a number of underrepresented research areas, suggest some research paradigms for investigating them, and present this within a "perspectival directions" frame that ties established lines of research to the newer ones we propose.
Humans↗
Mersilene mesh sling as an alternative to autogenous fascia lata in the management of ptosis.
PURPOSE: To evaluate the use of Mersilene mesh as a brow suspensory material and to compare it clinically against autogenous fascia lata. METHODS: A prospective study was carried out in which 80 eyes of 56 patients with ptosis and absent, poor or abnormal levator function were operated on. The patients were divided into two groups. In 46 eyes of 32 patients Mersilene mesh was used and in 34 eyes of 24 patients autogenous fascia lata was used. The results were recorded and analysed. RESULTS: The age range for the Mersilene group was larger than for the fascia lata group and female patients preferred Mersilene over fascia lata. The improvement in lid height was significant in all cases in both groups. The complication rates were similar in the two groups and the mesh was well tolerated by the patients. No cases of infection, sling exposure or extrusion occurred with the use of Mersilene. Lid lag and lagophthalmos occurred as a complication of the procedure itself and not the type of the sling material. The mean follow-up period was 33.8 months for both groups. CONCLUSION: We believe that Mersilene mesh is an effective alternative to autogenous fascia lata when the use of fascia lata is felt inappropriate.
Adolescent↗
Topical L-ascorbic acid: percutaneous absorption studies.
BACKGROUND: Reactive oxygen species generated by ultraviolet light result in photocarcinogenic and photoaging changes in the skin. Antioxidants protect skin from these insults. OBJECTIVE: This study defines formulation characteristics for delivering L-ascorbic acid into the skin to supplement the skin's natural antioxidant reservoir. METHODS: L-ascorbic acid or its derivatives were applied to pig skin. Skin levels of L-ascorbic acid were measured to determine percutaneous delivery. RESULTS: L-ascorbic acid must be formulated at pH levels less than 3.5 to enter the skin. Maximal concentration for optimal percutaneous absorption was 20%. Tissue levels were saturated after three daily applications; the half-life of tissue disappearance was about 4 days. Derivatives of ascorbic acid including magnesium ascorbyl phosphate, ascorbyl-6-palmitate, and dehydroascorbic acid did not increase skin levels of L-ascorbic acid. CONCLUSIONS: Delivery of topical L-ascorbic acid into the skin is critically dependent on formulation characteristics.
Administration, Cutaneous↗
An analogue instrument for the measurement of respiratory impedance using the forced oscillation technique.
The successful development of non-invasive assisted ventilation via a nasal mask has led to the requirement for improved methods of monitoring the respiratory system. Measurements of respiratory impedance during assisted ventilation using acoustic methods are showing considerable promise in providing this clinical data. The method involves imposing very low amplitude acoustic oscillations onto the spontaneous or assisted respiratory airflow. The subsequent interaction with the respiratory system modifies the pressure and flow relationship of the forced oscillations. The ratio of pressure to flow can be used to measure in real time the absolute value of respiratory input impedance. As a result a versatile, non-invasive and repeatable profile of respiratory mechanics is obtained. Using a 5 Hz conventional forced oscillation frequency, data highly sensitive to airflow obstruction and capable of tracking mechanical events and responses become available to the clinician. Recent studies with ventilated and sleeping subjects confirm future potential for the forced oscillation technique in vivo. We describe an instrument named the respiratory impedance monitor (5 Hz), which utilizes the forced oscillation technique (FOT). This fully developed device is designed in accordance with agreed international clinical guidelines. Comparative clinical data from normal subjects and patients with chronic obstructive pulmonary disease is presented.
Air Pressure↗
Characterization of the genomic structure of the human vitamin C transporter SVCT1 (SLC23A2).
Vitamin C (L-ascorbic acid), a critical cofactor for intracellular enzymatic reactions, functions as a scavenger of free oxygen radicals and is an essential micronutrient. Vitamin C is actively transported into cells by one of two closely related sodium-dependent transporters, SVCT1 or SVCT2. In this paper, we report the complete sequencing and gene structure of SLC23A2, the gene encoding SVCT1. The1797-bp cDNA sequence (open reading frame) of the SLC23A2 gene was derived from a compact genomic sequence of 7966 bp [translation initiation codon (ATG) to poly A tail], which is divided into 14 exons. Furthermore, repetitive or masked elements constituted 17.98% of the gene; there were 4 Alu sequences and 5 MIR (Mammalian Interspersed Repetitive element) sequences. A search for common variants in SLC23A2, using current bioinformatic tools and direct resequencing of control populations, failed to identify common single nucleotide polymorphisms. The start of transcription was mapped to a position -47 relative to the ATG; the immediate 5' sequence was determined and analyzed for possible consensus binding sites for known transcription factors. Our findings will serve as the foundation for investigation of the regulation and expression of the tissue-specific sodium-dependent vitamin C transporter, SLC23A2.
Base Sequence↗
Decision-making process--communicating risk/benefits: is there an ideal technique?
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Breast Neoplasms↗
What did we learn about interdisciplinary collaboration in institutions?
The Interdisciplinary Generalist Curriculum (IGC) Project significantly advanced collaboration in the development of medical school curricula. As primary care faculty began to work together they encountered and overcame many challenges inherent in this new process. Inclusion of other faculty and departments, as well as dedicated support from the deans' offices, became necessary to the success of the projects. The continuation of successful collaborative projects in the medical school environment requires a common commitment of faculty, students, department chairs, and the dean's office; protected time; and involvement of faculty from other disciplines. This article outlines initial models of collaboration implemented in the IGC Project, followed by a description of the expected and unexpected outcomes of these collaborative efforts, and a discussion of the emergence of new ways of collaborating, with recommendations for successful collaborative efforts.
Communication↗
The Interdisciplinary Generalist Curriculum Project at the University of Vermont College of Medicine: The Vermont Generalist Curriculum (VGC) Experience.
The University of Vermont College of Medicine received its Vermont Generalist Curriculum (VGC) subcontract as one of the second-cycle Interdisciplinary Generalist Curriculum (IGC) Project schools from 1995 to 1998. The Vermont program was jointly codirected by the chairs of family practice and pediatrics and the program director for internal medicine on a rotating basis and was overseen by a multidisciplinary steering committee that included generalists, basic scientists, specialists, and students. This committee provided guidance and support in recruitment of preceptors, continuous assessment and improvement of the courses, development of a clinical correlation manual for students in clinical offices, and cooperation around a jointly sponsored annual primary care meeting that included a joint scientific program, a research forum, and a faculty development workshop. The VGC has provided a pilot for many innovative curricular changes that have served as models for the school-wide curriculum redesign process currently under way at VERMONT: While the funding for this project ended in 1998, the changes, innovations, and collaboration born out of the project are valuable enough for the dean's office to maintain the VGC's funding and its steering committee for the future.
Curriculum↗
Therapist reporting of suspected child abuse and maltreatment: factors associated with outcome.
Several studies have found that making a report of suspected child abuse or maltreatment concerning a client in psychotherapy is more likely to have a positive outcome for the relationship or to effect no change, than to be damaging. The current study examined factors that were associated with outcome. Three variables, all of which concerned the client-therapist relationship, were found to be important for outcome. The quality of the relationship before the report made the greatest contribution to predicting outcome, with stronger alliances associated with positive outcome. Also important is the length of time in treatment, with longer periods of time related to positive outcome. In addition, more effective handling of making the report is related to positive outcome in that it differentiated improved from no-change groups. Lastly, statistical trends were found both for a relationship between therapist comfort in reporting and positive outcome, and for families tending to have more negative outcomes than adults in individual treatment or children. This is the first time that the examination of factors related to outcome was based upon information received from mental health professionals who were confirmed by CPS as reporters of suspected child abuse and maltreatment. Findings from this and related studies should be incorporated into training programs to ease concerns about the effects of reporting on the psychotherapy relationship and to offer guidance about factors that could increase positive outcomes. Such training could provide needed information to practitioners in reporting situations and enable more complete reporting.
Adult↗
Post hoc power analysis: an idea whose time has passed?
Using a hypothetical scenario typifying the experience that authors have when submitting manuscripts that report results of negative clinical trials, the pitfalls of a post hoc analysis are illustrated. We used the same scenario to explain how confidence intervals are used in interpreting results of clinical trials. We showed that confidence intervals better inform readers about the possibility of an inadequate sample size than do post hoc power calculations.
Confidence Intervals↗
Absent hematuria and expensive computerized tomography: case characteristics of emergency urolithiasis.
PURPOSE: We validated the descriptive characteristics of emergency cases presenting with urolithiasis, determined the incidence of normal urinalysis in such cases and compared the expense of diagnostic computerized tomography (CT) and excretory urography (IVP). MATERIALS AND METHODS: We retrospectively reviewed the charts of all consecutive patient visits to a community emergency department for 48 months. Explicit protocols for case selection, data abstraction and monitoring were used to maximize accuracy. Entry criteria were urolithiasis diagnosed by IVP, CT or stone passage, and urinalysis. Data analysis included descriptive statistics and the calculation of confidence intervals. RESULTS: From 159,083 emergency visits during this period 397 met study entry criteria. Absent hematuria was noted in 9% (95% confidence interval 7% to 12%) of patients with proved urolithiasis. There was no correlation of the degree of obstruction with absent hematuria. Most patients presenting with painful urolithiasis were male (73%), in the fifth decade of life (mean age 47 years), had stones in the mid ureter (32%) or at the ureterovesicular junction (44%) and received opiates for pain control (91%). Of the patients 48% presented between 5 p.m. and 7 a.m. when the radiology department was available only for emergency imaging. The diagnosis was made by CT in half of the patients, who were charged $1,409. The maximal insurance reimbursement was $673. The diagnosis was made by IVP in half of the patients, who were charged $445. The maximal insurance reimbursement was $141. CONCLUSIONS: Hematuria is not universally present in patients with painful urolithiasis and does not correspond to the degree of obstruction. Despite previous reports to the contrary, CT is significantly more expensive for patients than IVP.
Adolescent↗