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At least 1,153 records · Page 64Linked to original sources
PubMed1999

Preoperative assessment of cardiac risk in noncardiac major vascular surgery.

We evaluated whether a preoperative clinical algorithm allows an adequate stratification in cardiac risk and the predictive value of dipyridamole thallium-201 scintigraphy and rest echocardiography for postoperative adverse cardiac outcomes. Three hundred twenty patients undergoing 338 vascular surgery procedures were prospectively stratified into low, intermediate, and high risk. The low- and intermediate-risk patients underwent surgery without further diagnostic evaluation. In 7 high-risk patients the vascular procedure was canceled (1 died of myocardial infarction at 6-month follow-up), 9 underwent presurgical myocardial revascularization (1 died of myocardial infarction), and 49 underwent vascular surgery with perioperative intensive care treatment. Hospital mortality was 3.8%. Cardiac mortality and morbidity were 1.5% and 10.4%, respectively. We observed a significant difference in "hard" (death, myocardial infarction, pulmonary edema, major arrhythmias) and "soft" (myocardial ischemia, minor arrhythmias) events between groups, p <0.001. Previous pulmonary edema was a predictive variable of cardiac outcomes (multiple logistic regression analysis). Ninety-nine of 220 intermediate-risk patients randomly underwent dipyridamole thallium-201 scintigraphy: 37 had redistribution, 10 persistent, and 52 no defects; 7 of 13 soft and hard cardiac events occurred in patients without redistribution defects. Sensitivity, specificity, and positive and negative predictive values of redistribution defects for postoperative adverse outcomes were 38%, 63%, 14%, 87%, respectively. This algorithm may provide a safe and cost-effective approach (average cost saving per patient $1,500) to cardiac risk stratification. These results suggest that routine use of dipyridamole thallium-201 scintigraphy for screening of intermediate-risk patients may not be warranted.

Adult↗
PubMed2003

Right ventricular diastolic dysfunction in the postoperative period of tetralogy of Fallot.

OBJECTIVE: To assess right ventricular diastolic function in the intermediate postoperative period of repair of tetralogy of Fallot. METHODS: We carried out a case-control study with 60 patients divided into 2 groups as follows: 1) group I - 30 patients who had undergone repair of tetralogy of Fallot and 2) group II - 30 healthy children. The 2 groups were paired for age, sex, and body surface. The flows in the pulmonary and tricuspid valves were analyzed with Doppler echocardiography. The presence of anterograde flow at the end of diastole in the pulmonary artery defined restrictive right ventricular physiology. Surgical, radiological, electrocardiographic, and echocardiographic variables were analized in the group I. RESULTS: The velocity of the A wave and the E/A ratio for the tricuspid valve showed significant differences between the groups. Cases with E/A < 1.30 predominated in inspiration (group I - 19/30, and group II - 5/30). The duration of the QRS complex on the electrocardiogram was significantly increased in patients with E/A <1.30. Nineteen (63.3%) patients had restrictive right ventricular physiology, which had a longer postoperative period, longer duration of the QRS complex, and a lower E/A ratio in inspiration. The surgical and radiological variables showed no statistical difference. CONCLUSION: Restrictive right ventricular physiology was detected on the intermediate follow-up of most patients undergoing repair of tetralogy of Fallot. The postoperative period and QRS duration were increased in patients with impairment in diastolic function.

Adolescent↗
PubMed2006

Outcomes for adolescent Hispanic hemodialysis patients: findings from the ESRD Clinical Performance Measures Project.

BACKGROUND: There is limited information regarding outcomes of dialytic care for Hispanic adolescent hemodialysis patients. METHODS: Ethnicity information was collected for all adolescent in-center hemodialysis patients for the Centers for Medicare & Medicaid Services 2000 End-Stage Renal Disease (ESRD) Clinical Performance Measures Project. Associations between intermediate outcomes and Hispanic ethnicity were determined. Associations of ethnicity and other demographic/clinical variables with hospitalization and transplantation during the 12-month follow-up period were examined. RESULTS: Twenty-two percent of patients were identified as Hispanic; 40%, as non-Hispanic black; and 32%, as non-Hispanic white. Hispanic patients were younger and more likely to have congenital/urological causes of ESRD. More Hispanic patients had a mean single-pool Kt/V of 1.2 or greater compared with non-Hispanic blacks and non-Hispanic whites (87% versus 73% and 79%; P = 0.036). More Hispanic patients had a mean serum albumin level of 3.5/3.2 g/dL (bromcresol green/bromcresol purple method) or greater (> or = 35/32 g/L; 91% versus 82% and 76%; P = 0.017). More Hispanic patients compared with non-Hispanic blacks and non-Hispanic whites were dialyzed with a catheter for 90 days or longer (30% versus 21% and 23%; P = 0.027). In the final multivariate Cox proportional hazard models, Hispanic patients were at a slightly decreased risk for hospitalization compared with non-Hispanics (adjusted hazard ratio [adjHR], 0.63; P = 0.031) and were as likely to undergo a first transplantation as non-Hispanic whites (adjHR, 0.56; P = 0.099). CONCLUSION: Adolescent Hispanic hemodialysis patients experience equivalent or better intermediate outcomes of dialytic care than non-Hispanics. They experienced a decreased risk for subsequent hospitalization and are as likely to undergo transplantation within 12 months as non-Hispanic whites.

Adolescent↗
PubMed2002

Transient advanced mental impairment: an underappreciated morbidity after aortic surgery.

OBJECTIVES: To determine the incidence, risk factors, and associated morbidity of transient advanced mental impairment (TAMI) after aortic surgery. METHODS: We retrospectively studied the charts of 188 consecutive patients undergoing elective aortic reconstruction during a recent 6-year period at a university hospital. All patients were lucid on admission and nonintubated at the time of evaluation at least 2 days after operation. TAMI was defined as disorientation or confusion on 2 or more postoperative days. Preoperative, intraoperative, and postoperative clinical variables were examined statistically for associations with TAMI. RESULTS: Fifty-three patients (28%) had development of TAMI 3.9 plus minus 2.8 days after operation. Stepwise logistic regression analysis selected the following independent predictors for TAMI: age >65 years (odds ratio [OR], 7.9; 95% confidence interval [CI], 2.7 to 23.7), American Society of Anesthesiology physical status classification >3 (OR, 2.8; 95% CI, 1.3 to 5.9), diabetes mellitus (OR, 3.4; 95% CI, 1.2 to 9.8), old myocardial infarction (OR, 2.4; 95% CI, 1.1 to 5.3), and hypertension (OR, 2.3; 95% CI, 1.0 to 5.3). Alcohol consumption was not significantly associated with TAMI. In the postoperative period, patients with TAMI were more likely to have hypoxia (P <.001), a need for reintubation (P <.001), pneumonia (P <.001), congestive heart failure (P =.003), and kidney failure (P =.05). In addition, patients with TAMI had a longer duration of endotracheal intubation (3.7 plus minus 7.8 vs 0.6 plus minus 1.2 days, P <.001), stay in the intensive care unit (8.9 plus minus 9 vs 3.9 plus minus 2 days, P <.001), and postoperative hospital stay (14.8 plus minus 11 vs 9.2 plus minus 5 days, P <.001) than patients without TAMI. Twenty (38%) patients with TAMI were discharged to intermediate-care facilities, compared with 11 (8%) patients without TAMI (P <.001). Postoperative variables conferring the largest relative risks for development of TAMI included oxygen saturation less than 92% (5.4), the need for reintubation (3.3), congestive heart failure (3.3), and pneumonia (3.2). TAMI, conversely, conferred the largest relative risks for development of postoperative congestive heart failure (15.3), the need for reintubation (9.3), pneumonia (7.1), and the need for ICU readmission (3.8). CONCLUSIONS: These data show that TAMI is prevalent among patients undergoing aortic reconstruction and is associated with dramatically increased morbidity and postoperative hospitalization rates.

Adult↗
PubMed2006

Dyslipidemia prevalence, treatment, and control in the Multi-Ethnic Study of Atherosclerosis (MESA): gender, ethnicity, and coronary artery calcium.

BACKGROUND: To assess the implementation challenge facing the Third Report of the Adult Treatment Panel (ATP III) of the National Cholesterol Education Program, we determined the prevalence, treatment, and control of dyslipidemia, including ethnic and gender differences, in persons free of known clinical cardiovascular disease (CVD). In addition, this report provides information about the presence of coronary artery calcium (CAC) across groups defined by risk and recommendations for the use of lipid-lowering drugs. METHODS AND RESULTS: The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter cohort study of 6814 persons aged 45 to 84 years who were free of clinical CVD at baseline (2000-2002). Participants with complete fasting lipid profiles (n=6704) were evaluated for CVD risk and self-reported use of lipid-lowering therapy. CAC was assessed by CT. Drug treatment thresholds and goals were defined according to ATP III. Models were constructed to adjust for age, clinic site, risk factors, socioeconomic characteristics, and healthcare access variables with the use of Poisson regression. Overall, 29.3% (1964/6704) had dyslipidemia, among whom lipid-lowering drug therapy was reported by 54.0% (1060/1964). Control to ATP III goal was observed in 75.2% (797/1060) of participants with treated dyslipidemia and 40.6% (797/1964) of participants with dyslipidemia. Men were more likely than women to qualify for drug therapy and less likely to be treated and controlled. Relative to non-Hispanic whites, Chinese Americans were less likely to qualify for drug treatment, but no differences in treatment and control rates were observed. Black and Hispanic Americans had prevalence of dyslipidemia that was comparable to that of non-Hispanic whites but were less likely to be treated and controlled. Ethnic disparities were attenuated substantially by adjustment for healthcare access variables; however, the gender disparities persisted despite adjustment for risk factors, socioeconomic characteristics, and healthcare access variables. Control of dyslipidemia was achieved less commonly in the CVD high- and intermediate-risk groups than in the low-risk group. Among high-risk individuals, 19.7% of those who did not qualify for lipid-lowering drug treatment had CAC >400. The proportion of drug treatment-qualifying persons who were not treated differed by presence and severity of CAC, with 48.0%, 46.8%, and 39.6% of eligible persons with no CAC, with CAC >0 and <400, and with CAC >400 not receiving treatment, respectively (P for difference=0.04). CONCLUSIONS: Dyslipidemia is common among persons without CVD. The quality of care for dyslipidemia is suboptimal in general and variable by CVD risk group, ethnicity, and gender. The utility of incorporating CAC screening into the risk stratification and treatment process should be investigated in light of the substantial proportions of persons with CAC who are currently classified as not requiring treatment. Research and quality improvement programs are needed to optimize management of dyslipidemia.

Aged↗
PubMed2002

Radioimmunoscintigraphy (RIS) with bectumomab (Tc99m labeled IMMU-LL2, Lymphoscan) in the assessment of recurrent non-Hodgkin's lymphoma (NHL).

UNLABELLED: The efficacy of a Tc99m-labeled anti-lymphoma antibody fragment, bectumomab [LymphoScan], was retrospectively examined in the staging of recurrent or newly diagnosed non-Hodgkin's lymphoma (NHL) [7 patients] and to assess targeting before radioimmunotherapy (RIT) [14 patients]. Performance was graded relative to conventional imaging. Tumors included 7 low-grade, 11 intermediate-grade, and 3 high-grade histologic subtypes. Computed x-ray tomography, radiogallium imaging, FDG-PET, and bone marrow biopsy defined 117 sites. Bectumomab revealed 56% of these sites. In 4 patients bectumomab uncovered five sites not evident by conventional imaging. In addition, it uncovered one site in the brain, an area not covered in the standard work-up of asymptomatic patients. Bectumomab imaging most often failed in central abdominal and thoracic locations, and excelled in revealing disease in the head and neck. Relative to Ga67 citrate imaging, the performance of bectumomab was variable, with no clear relation to anatomic location; there was better targeting of low and intermediate grade NHL. Radiogallium out-performed bectumomab imaging in 23 sites, 19 of which were in patients with high or intermediate-grade disease. Bectumomab was superior to radiogallium at six sites, five of which involved low-grade tumor. CONCLUSION: Bectumomab shows promise as a pre-RIT probe for targeting of B-cell NHL. It excelled at defining small volume, low-grade disease. However, as a purely diagnostic agent, its performance was variable.

Antibodies, Monoclonal↗
PubMed1998

Reference values for selected hematologic and biochemical variables in Holstein bulls of various ages.

OBJECTIVE: To determine reference ranges for hematologic and serum biochemical variables of bulls residing at an artificial insemination center. ANIMALS: 225 healthy Holstein bulls categorized by age into yearling, intermediate age, and adult groups. PROCEDURE: Hematologic and serum biochemical analyses were performed on 1 blood and 1 serum sample from each bull. RESULTS: Significant differences associated with age were identified for 25 of 33 variables. Serum creatinine concentration for clinically normal adult bulls (2.44+/-0.33 mg/dl) was higher than previously reported reference values for adult cattle. There was a reversal of the segmented neutrophil-to-lymphocyte ratio between yearling (0.85:1) and adult (2.6:1) bulls. This was associated with a significant and marked decrease in absolute numbers of lymphocytes per microliter between yearling (5,801+/-1,683) and adult (1,307+/-509) bulls. CLINICAL RELEVANCE: Reference values for selected clinicopathologic variables were generated from the data.

Aging↗
PubMed2006

Inferring causal relationships among intermediate phenotypes and biomarkers: a case study of rheumatoid arthritis.

MOTIVATION: Genetic association analysis is based on statistical correlations which do not assign any cause-to-effect arrows between the two correlated variables. Normally, such assignment of cause and effect label is not necessary in genetic analysis since genes are always the cause and phenotypes are always the effect. However, among intermediate phenotypes and biomarkers, assigning cause and effect becomes meaningful, and causal inference can be useful. RESULTS: We show that causal inference is possible by an example in a study of rheumatoid arthritis. With the help of genotypic information, the shared epitope, the causal relationship between two biomarkers related to the disease, anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF) has been established. We emphasize the fact that third variable must be a genotype to be able to resolve potential ambiguities in causal inference. Two non-trivial conclusions have been reached by the causal inference: (1) anti-CCP is a cause of RF and (2) it is unlikely that a third confounding factor contributes to both anti-CCP and RF.

Arthritis, Rheumatoid↗
PubMed1994

[Predictors of treatment success after microsurgical operation of lumbar intervertebral disk displacement].

As far as medical decision making is based on weighing up individual risks and chances of a certain patient receiving a certain treatment, some knowledge is required about signs and symptoms which are associated with a certain outcome: they are called risk factors, or predictive factors. In lumbar intervertebral disc surgery, the most frequent undesired effect of the treatment is unsuccessfulness. Reviewing the literature about risk factors for unsuccessfulness, one recognizes a lot of unconfirmed or even contradictory findings. This inconsistency can possibly be attributed to the common use of a very simplified, unidimensional definition of the target variable "success of treatment". That is why we performed a prospective observational trial on 109 patients in whom the success of lumbar intervertebral disc microsurgery was assessed after half a year using six different target variables. The rate of treatment success varied considerably, from 44% (when "return to previous occupation" served as the target variable) to 91% (with regard to "subjective contentedness"). Further target variables were intensity of sciatica, intensity of low back pain, activities of daily living, and postoperative paresis, giving intermediate success rates. We were able to identify some risk factors (for instance, duration of sick leave and of the recent pain episode, preoperative paresis, intensity of psychosomatic complaints), each of them being relevant to some of the target variables, but none of them associated with all of the target variables. We conclude that the multidimensional rating of treatment successes seems to promote risk research in multidimensional diseases.

Absenteeism↗
PubMed1987

Changes in phrenic, mylohyoid, and hypoglossal nerve activities that follow intravenous infusions of aminophylline.

We determined whether or not administrations of aminophylline would produce differential changes in activities of the hypoglossal nerve and the mylohyoid branch of the trigeminal nerve, compared with phrenic nerve activity. The former two nerves innervate muscles influencing the upper airway, whereas the phrenic nerve innervates the diaphragm, a major muscle of the ventilatory pump. Neural activities were recorded in decerebrate, vagotomized, paralyzed, and ventilated cats. Peak integrated phrenic activity generally increased with intravenous infusions of cumulative doses of aminophylline ranging from 1.0 to 64 mg/kg. The concomitant changes in trigeminal and hypoglossal activities were extremely variable. In some animals, peak integrated trigeminal and/or hypoglossal activities rose progressively with increasing doses of aminophylline. For other animals, maximum levels of neural activities were attained at intermediate doses and declined at higher dose levels. Results were similar in animals having bilateral sections of the carotid sinus nerves. The variable changes in neural activities may reflect the multiple sites of action of aminophylline in the brain stem.

Action Potentials↗
PubMed1994

Applicability of the International Index for aggressive lymphomas to patients with low-grade lymphoma.

PURPOSE: Variables used to build up the International Index for aggressive lymphomas (age, performance status, stage, extranodal involvement, and lactic dehydrogenase [LDH]) are also important in low-grade lymphoma. To assess the prognostic value of this index in low-grade lymphoma, we have applied it to a series of 125 patients. PATIENTS AND METHODS: One hundred twenty-five patients with low-grade lymphoma who were diagnosed at a single institution over a 20-year period and treated with standard chemotherapy were studied. End points of the study were response to therapy and survival according to the International Index. In addition to the International Index, main initial and evolutive variables were evaluated. Univariate and multivariate methods were used. RESULTS: After applying the International Index, the patients divided into four risk groups: low (36% of cases), low-intermediate (32%), high-intermediate (20.8%), and high (11.2%), with complete response (CR) rates in the four groups being 60%, 35%, 23%, and 21%, respectively. Ten-year overall survival rates for the risk groups were as follows: low, 73.6%; low-intermediate, 45.2%; high-intermediate, 53.5%; and high, 0% (P < .001). When the International Index was included in a multivariate analysis, along with the main initial variables, International Index (P < .001) and sex (male, worse) (P = .038) were the only parameters related to survival. When response to therapy was also included, achievement of CR (P < .0001) and International Index (P < .001) were the most important factors. In patients who achieved a CR, the International Index was the only parameter related to survival (P = .051). The results were the same when the International Index was applied to the subset of 107 patients with follicular lymphoma. CONCLUSION: In this study, the International Index has been found to be an important prognostic tool in low-grade lymphomas. Such an index could be used to predict prognosis not only in aggressive, but also in low-grade lymphomas.

Actuarial Analysis↗
PubMed1999

Variables predicting reintubation after cardiac surgical procedures.

BACKGROUND: This study sought to determine patient characteristics, processes of care, and intermediate outcomes as predictors of reintubation after cardiac surgical procedures. METHODS: We performed a retrospective case-control study that included all patients undergoing cardiac surgical intervention who required reintubation and an equal number of control patients not requiring reintubation. Putative risk factors were analyzed univariately by chi2, Fisher exact, Student's t, or Mann-Whitney tests. A logistic regression model was developed using data from patients requiring reintubation for cardiorespiratory reasons. RESULTS: Of the 1,000 consecutive patients reviewed, 41 (4.1%) required reintubation (30 [3%] for cardiorespiratory reasons and 11 [1.1] for unplanned operations). Univariate predictors of reintubation (p<0.05) were older age, chronic obstructive pulmonary disease, New York Heart Association functional class IV, preoperative renal failure, lower arterial oxygen tension, insertion of intraaortic balloon pump, longer time in the operating room, longer duration of cardiopulmonary bypass times, positive fluid balance, postoperative renal failure, and worse pulmonary mechanics. Patients requiring reintubation also required a longer initial period of mechanical ventilation (median, 16.3 versus 6.0 hours; p<0.05). Excellent prediction was found with a model consisting of four variables: operating room time, respiratory rate, vital capacity, and chronic obstructive pulmonary disease. CONCLUSIONS: Patients who required reintubation were sicker and had worse respiratory function and more comorbidity. Prompt extubation did not contribute to reintubation. Patients identified as having a high risk for reintubation should be followed up closely, and interventions should be directed to treating the problems leading to reintubation.

Aged↗
PubMed1997

Sequence profiles of immunoglobulin and immunoglobulin-like domains.

Immunoglobulins (Ig) are highly modular proteins, consisting of variable and constant domains, which have clear, conserved sequence patterns. These sequence patterns have allowed T-cell receptor (TCR) and major histocompatibility complex (MHC) molecule domains, as well as some cell adhesion, cell surface receptor and muscle protein domains, to be identified as forming a superfamily of related proteins together with the Ig-domains. The domains of these proteins have been grouped into four sets: variable (V-set), constant-1 (C1-set), constant-2 (C2-set) and intermediate (I-set). X-ray and NMR studies have shown that these domains form a Greek-key beta-sandwich structure with the sets differing in the number of strands in the beta-sheets as well as in their sequence patterns. The conserved sequence elements in the major sets of Ig and Ig-like molecules have previously been reported as general sequence profiles. This work examines the variability within these sets. Detailed sequence profiles and consensus sequences for these sets and groups have been constructed and a novel form of presentation has been developed to overcome some of the drawbacks of current methods of presenting consensus sequences. The profiles that were constructed allow a comparison of the similarities and differences among the sets of Ig and Ig-like sequences and provide a means by which sequences can be tested for compatibility with Ig-like sequence motifs. As well, the sequence separations of the main residues in the characteristic "pin" structure of Ig-like molecules were examined for variation among the groups. From the profiles constructed here, measures of the degree of conservation within the groups of molecules were determined. These measures were used to assist in a reconsideration of possible evolutionary pathways between the major structural groups of the Ig-superfamily.

Amino Acid Sequence↗
PubMed1996

Myosin phenotype and SDH enzyme variability among motor unit fibers.

Motor units in cat diaphragm and tibialis posterior muscles were classified physiologically as slow-twitch, fast-twitch, fatigue-resistant, fast-twitch fatigue-intermediate, or fast-twitch fatigable. Motor unit fibers were then identified by glycogen depletion and classified as type I, IIa, IIb, or IIx on the basis of myofibrillar adenosinetriphosphatase-staining profiles and immunoreactivity for myosin heavy-chain (MHC) isoforms. In both muscles, slow-twitch and fast-twitch fatigue-resistant units comprised type I and IIa fibers expressing MHC-slow and MHC-2A isoforms, respectively. Fast-twitch fatigue-intermediate and fast-twitch fatigable units comprised type IIx fibers expressing the MHC-2X isoform. Some fast-twitch fatigue-intermediate units had a mixed composition with a few fibers (approximately 10%) expressing the MHC-2A isoform. Motor unit fiber succinate dehydrogenase (SDH) activity was quantified, and variability was estimated by the interquartile range, which was lower among motor unit fibers than in adjacent fibers of the same histochemical type but comparable to that along the length of individual fibers. We conclude that, despite the mixed-MHC phenotype of some diaphragm and tibialis posterior motor units, SDH activity is relatively uniform. This supports the hypothesis that motoneurons exert a predominant influence on muscle fiber SDH activity.

Animals↗
PubMedDate not supplied

Prediction of severe coronary artery disease and long-term outcome in patients undergoing vasodilator SPECT.

BACKGROUND: Vasodilator perfusion imaging has not been extensively evaluated for predicting severe coronary artery disease (CAD) or long-term prognosis. METHODS AND RESULTS: The goals of this study were to develop a model to predict left main/3-vessel CAD in patients undergoing vasodilator thallium 201 imaging and coronary angiography (angiographic population) and to test the long-term prognostic value of this model in a separate cohort of patients who were not referred for angiography (prognostic population). In the angiographic population (n = 653) the chi2 value of the clinical model (containing the variables age, sex, and prior myocardial infarction) in the prediction of severe CAD was 32. The addition of 3 vasodilator Tl-201 variables (magnitude of ST-segment depression, summed reversibility score, and increased lung uptake) increased the model chi2 value to 114 (P <.001). Only 9% of predicted low-risk patients versus 57% of predicted high-risk patients had severe CAD. In the prognostic population (n = 521) survival rates free of cardiac death or myocardial infarction at 7 years were 91%, 73%, and 51%, respectively, for patient groups predicted to be at low, intermediate, and high risk of severe CAD (P <.001). CONCLUSIONS: Clinical and vasodilator Tl-201 variables can accurately predict the risk of severe CAD. Stress Tl-201 variables add incremental information to clinical variables. The same model also predicts patient outcome.

Adenosine↗
PubMed2005

Pre- and post-selection paradoxes and contextuality in quantum mechanics.

Many seemingly paradoxical effects are known in the predictions for outcomes of intermediate measurements made on pre- and post-selected quantum systems. Despite appearances, these effects do not demonstrate the impossibility of a noncontextual hidden variable theory, since an explanation in terms of measurement disturbance is possible. Nonetheless, we show that for every paradoxical effect wherein all the pre- and post-selected probabilities are 0 or 1 and the pre- and post-selected states are nonorthogonal, there is an associated proof of the impossibility of a noncontextual hidden variable theory. This proof is obtained by considering all the measurements involved in the paradoxical effect--the preselection, the post-selection, and the alternative possible intermediate measurements--as alternative possible measurements at a single time.

Journal Article↗
PubMed1999

[Switching to Neoral in patients with a stable kidney transplant. Retrospective study].

BACKGROUND: The aim of this retrospective study of patients with stable kidney transplantation was to evaluate "in the field" whether conversion from Sandimmune to Neoral led to a reduced variability of cyclosporinemia. METHODS: 153 patients were included in the study, from 16 centres in Piedmont, and were observed for a period of 13 months each. Data from the statutory controls specified in Piedmont for the follow-up of kidney transplantation patients were used in the evaluation. RESULTS: The mean coefficient of variation for cyclosporinemia (CV%) after conversion was slightly lower than pre-conversion CV% (22% vs 24%; p = 0.054). If the patients were divided into subgroups however, it was observed that only subjects who had presented a high CV% in Sandimmune (30%), equivalent to 23% of the population, showed greater stability in Neoral, whereas those who already presented satisfactory stability (CV% 20%), 45% of the population, underwent a deterioration of CV% in 42% of cases. The remaining 32% of patients revealed an intermediate level. CONCLUSIONS: In conclusion, this study showed that conversion to neoral is certainly indicated in those patients with a high variability of cyclosporinemia levels in sandimmun. It is not regarded as beneficial in patients with low levels of variability, also owing to the added cost. In patients with intermediate levels, ongoing studies on survival following transplantation using these two formulations will indicate the advantages or otherwise of conversion.

Adult↗
PubMed1997

Processing of cathepsins L, B and D in psoriatic epidermis.

Proteinase activity is increased in psoriatic epidermis. To elucidate the involvement of enzymes in psoriatic epidermis, the expression of cathepsins, L, B and D was investigated by Western blotting and immunohistological studies. Normal epidermis contained abundant inactive precursors (39 kDa) of cathepsins L and B and an inactive intermediate form (45 kDa) of cathepsin D. Cathepsin L in psoriasis was processed to a variable extent from the precursor to a single-chain form (30 kDa) and a mixture of single- and heavy-chain (25 kDa) forms of the active mature enzyme, corresponding to the immunohistological staining patterns 'diffuse dense', 'small granular', and unevenly distributed 'condensed granular'. Cathepsin B showed a mixture of precursor form (39 kDa) and single-chain (30 kDa) forms and was expressed as a 'diffuse dense' staining pattern in the mid-spinous layer and as a 'condensed' pattern in the upper spinous and granular layers. Cathepsin D was processed to the heavy-chain (31 kDa) form of activated mature enzyme with small granular staining and a mixture of heavy-chain and degraded protein (28 kDa) with larger and more condensed granular staining. The distribution patterns of 'small granular' cathepsin L, and of cathepsins B and D expression in suprabasal keratinocytes were very similar to that of involucrin. After complete clinical resolution of psoriasis by 8-methoxypsoralen plus UVA treatment, the expression of the three cathepsins was normalized. These results suggest that cathepsins L, B and D in forms activated to a variable extent may be involved in the pathology of psoriasis.

Adolescent↗