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PubMed2003

Psychiatric comorbidity in patients with epilepsy: implications for diagnosis and treatment.

Psychiatric disorders frequently occur in patients with epilepsy but the diagnosis is frequently missed and therapeutic opportunities are often lost. These comorbidities assume greater importance as epidemiological data show their frequent association with impaired function and quality of life, and advances in neurobiology better define their pathophysiological relationship and therapies. Epilepsy presents a model for understanding psychiatric illness. Deciphering the role of different biological and environmental risk factors may help identify high-risk patients and allow for early intervention. Antiepileptic drugs are frequently used to manage psychiatric syndromes although the mechanisms of their psychotropic action remain uncertain. As recognition and treatment of comorbid psychiatric disorders in epilepsy remain suboptimal, we need to increase the awareness of physicians, patients, their caregivers, and the health care system. Better recognition will help to develop and implement appropriate diagnostic and treatment programs, and improve functional outcomes and quality of life in people with epilepsy.

Aged↗
PubMed2006

Delaying the primary surgical effort for advanced ovarian cancer: a systematic review of neoadjuvant chemotherapy and interval cytoreduction.

OBJECTIVE: To summarize the existing data on interval cytoreductive surgery and neoadjuvant chemotherapy as alternative treatment strategies for patients with advanced-stage ovarian cancer. METHODS: All investigational studies with evaluable survival data on interval cytoreductive surgery and neoadjuvant chemotherapy for ovarian cancer reported in the English language literature between 1989 and 2006 were systematically reviewed. RESULTS: Three randomized trials and six non-randomized studies of interval cytoreduction following suboptimal initial surgery were identified. Twenty-six studies, including a total of 1336 patients, reporting on neoadjuvant chemotherapy administered in lieu of primary cytoreductive surgery were analyzed according to the survival outcome achieved, the degree of surgical effort or success, and the particular selection criteria employed to justify deferring an attempt at primary cytoreductive surgery. CONCLUSIONS: Interval surgery following a concerted but suboptimal attempt at up-front cytoreduction does not appear to have an appreciable impact on survival outcome. Maximal primary cytoreductive surgery remains the standard of care for the majority of women with suspected advanced ovarian cancer. Neoadjuvant chemotherapy represents a viable alternative management strategy for the limited number of patients felt to be optimally unresectable by an experienced ovarian cancer surgical team; however, currently available data suggest that the survival outcome achievable with initial chemotherapy is inferior to successful up-front cytoreductive surgery. Additional research is needed to devise universal selection criteria for neoadjuvant chemotherapy, determine the most efficacious treatment program, and characterize the appropriate proportion of patients in which an attempt at primary surgery should be abandoned in favor of initial chemotherapy.

Chemotherapy, Adjuvant↗
PubMed2002

Ascaris lumbricoides among children in rural communities in the Northern Area, Pakistan: prevalence, intensity, and associated socio-cultural and behavioral risk factors.

The prevalence and intensity of Ascaris lumbricoides in 492 children from five rural villages in the Northern Area of Pakistan was examined. The overall prevalence of A. lumbricoides was 91% (95%CI 88.6-93.6) with geometric mean (GM) egg count intensities of 3985 eggs per g (epg). The most intense A. lumbricoides infections were found in children aged 5-8 years. We also investigated selected socio-cultural and behavioral variables for A. lumbricoides infections that might be relevant for the design of appropriate prevention and control programs. Univariate analysis associated A. lumbricoides intensity with age (P=0.004), location of household (P<0.01), defecation practices (P=0.02), soil eating habit (P<0.01), hand washing after defecation (P<0.01), and living with children under 5 years old (P=0.02). Multivariate analysis identified the children's age 5-8 (P<0.01), location of household in Surngo, Askole, and Stakchun where the pilot health care model activities were not done (P<0.01), and living with children under 5 years old (P=0.03) as variables statistically associated with the intensity of A. lumbricoides. The results indicated that there were certain clear risk factors in A. lumbricoides transmission, and that its intensity was influenced by age-related behavioral and environmental factors that contribute to exposure.

Animals↗
PubMed1991

Laser-excited fluorescence detection of gas-phase chromatography eluates.

A high-spectral-resolution laser-excited molecular fluorescence gas chromatographic (GC) detection system is evaluated. It utilizes a pulsed supersonic jet expansion to yield very-narrow-bandwidth (e.g. less than or equal to 0.1 nm) fluorescence excitation spectra that may be rapidly scanned via a tunable dye laser. A microcomputer synchronizes the entire system, collects data, performs calculations, and creates visual displays of results. The laser-excited fluorescence detection system was interfaced to a gas chromatograph to exploit both the selectivity of the chromatography and the excellent spectral selectivity of the detector. Fluorescence excitation chromatograms were acquired by monitoring fluorescence emission from selected transition wavelengths characteristic of the GC eluates. The excitation wavelengths were also programmed to change at appropriate retention times to provide greatest selectivities for individual analytes as they eluted, and to allow multiple analytes to be determined in a single elution. Response factors for the system varied appreciably from run to run, which precluded the use of external standard quantitation procedures. However, excellent stabilities for within-run relative response factors were sufficient to allow for good quantitative measurements using internal standard techniques.

Chromatography, Gas↗
PubMed1989

Who is dying of asthma and why?

Recognition of the high rates of mortality from asthma over the past 20 years has spurred greater efforts to prevent death from this potentially controllable pulmonary process. Some suggest that inadequate assessment and delayed treatment account for this epidemic of asthma fatalities. Both the natural progression of this condition and the risk factors are discussed. Once patients at greatest risk have been identified and the pattern of episodes has been analyzed, clinicians can carry out "reversibility trials" using a variety of management techniques to optimize lung function. This program will allow an appropriate and individualized treatment plan to be formulated, with steps taken to ensure compliance and to carry out diligent follow-up.

Asthma↗
PubMed2000

Complications with humeral head replacement.

Humeral head replacement has been shown to be an excellent surgical option for a variety of debilitating shoulder conditions. New techniques and advances in prosthetic design have furthered the success of this procedure. When performed without appropriate indications, exacting technique, and a tailored rehabilitation program, however, complications often result. Early recognition and appropriate management of these complications aid in achieving a satisfactory result.

Aged↗
PubMed1995

Murine B cell development: commitment and progression from multipotential progenitors to mature B lymphocytes.

B lymphocytes, the cellular source of antibody, are critical components of the immune response. They develop from multipotential stem cells, progressively acquiring the traits that allow them to function as mature B lymphocytes. This developmental program is dependent on appropriate interactions with the surrounding environment. These interactions, mediated by cell-cell and cell-matrix interactions, provide the growth and differentiation signals that promote progression along the developmental pathway. This chapter addresses the properties of developing B lineage cells and the nature of the environmental signals that support B lineage progression.

Animals↗
PubMed2000

Tumor doubling times in metastatic malignant melanoma of the uvea: tumor progression before and after treatment.

OBJECTIVE: To obtain estimates of growth rate of metastatic uveal melanoma to infer appropriate follow-up programs and to assess the impact of current chemoimmunotherapy regimens. DESIGN: Retrospective case series. PARTICIPANTS: Of 70 consecutive patients diagnosed with metastatic uveal melanoma from 1986 through 1998, 37 patients who attended regular follow-up and had measurable metastases were eligible for this study. METHODS: Tumor doubling time (DT) was calculated by the Schwartz formula using three presumed sizes of metastasis at last negative follow-up. DT was compared according to tumor characteristics, and time of micrometastasis was estimated. MAIN OUTCOME MEASURES: Doubling time of untreated and treated metastases. RESULTS: Doubling time of untreated metastases ranged from 34 to 220 days (median, 63 days). Regardless of the presumed size of metastasis at last screening, two thirds of the metastases had a DT between 30 and 80 days. No significant correlation between DT and the observed disease-free interval was detected. Assuming constant growth rate, most metastases had predictably initiated within 5 years before primary treatment. Mean DT during active treatment of metastases in 18 patients who did not show an objective response ranged from 25 to 2619 days (median, 255 days). CONCLUSIONS: Based on the estimated growth rates, a rational follow-up interval to detect metastatic uveal melanoma would be 4 to 6 months. Primary uveal melanomas that develop clinically detectable metastasis after conservative therapy may micrometastasize several years before treatment. These estimates are rough and must be confirmed by prospective studies. Current chemoimmunotherapy regimens slow down the growth rate of metastases even if objective response is not obtained.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Smoking and cardiovascular disease.

Mainstream and ETS exposure are strong risk factors for cardiovascular disease in men and women. The relationships between smoking and cardiovascular disease result from multiple mechanisms that interact to contribute to atherosclerosis, vascular injury, thrombosis, and vascular dysfunction. We are only now beginning to understand how smoking contributes to the genesis and progression of cardiovascular disease. Because of the complexity of the interactions between nicotine and the components of MSS, ETS, and sidestream smoke with the vasculature, it will take a great deal of time and effort to fully unravel the mechanisms by which smoking contributes to cardiovascular disease. In addition, cardiovascular risk in female smokers is complicated by hormonal variables that may contribute to greater relative risk. It is important that health care providers, educators, and policy makers recognize the changing patterns of smoking and the impact of smoking on cardiovascular disease, and continue campaigns aimed at enhancing smoking cessation in the general population and in teens. Rigorous research is needed on the changing cultural, psychosocial, and environmental factors that influence tobacco use to improve our understanding of racial/ethnic smoking patterns, and identify strategic tobacco control opportunities. The capacity of tobacco control efforts to keep pace with patterns of tobacco use and cessation depends on timely recognition of emerging prevalence and cessation patterns and the resulting development of appropriate community-based programs to address the factors involved. Smoking trends today will determine how heavy the health burden of cardiovascular disease and others will be among communities tomorrow. Programs that aim at early intervention and reflect cultural diversity will be the cornerstone in the battle against tobacco use. Continued interest in research, educational, and prevention efforts are needed to help curb the risk of cardiovascular disease from smoking in men and women.

Animals↗
PubMed2000

International trends in adolescent nutrition.

This paper addresses international trends in adolescent nutrition by reviewing the literature from English-language indexed journals and online sources from around the world. Information is presented by geographic region and by nation within region. The literature shows that malnutrition remains a significant problem for adolescents, worldwide, but that the types of nutritional problems impacting this group have changed significantly over the past two decades. While undernutrition and wasting are reported, these conditions, as well as growth stunting, seem to be on the decline. In developed countries, social pressures to achieve a distorted body image are creating a malnutrition of affluence among some groups of adolescents. There appears to be an increasing prevalence of obesity among adolescents worldwide, explained by widespread nutrition transitions to lipid-rich diets and a decrease in physical activity, especially among urban adolescents. These trends are of international importance as they imply the world will see a shift towards longer life spans for this adolescent cohort, with a concomitant increase in the prevalence of chronic diseases as it ages. The epidemiologic transition that will result may be a mixed blessing. It is likely to produce a larger and healthier international workforce, but it also has the potential of becoming a serious burden as demands for health care and support services for those with chronic diseases increase. To prevent inordinate health care demands on the international economy in the future, dietary recommendations with nutritional education programs that are culturally appropriate need to become national priorities.

Adolescent↗
PubMed1999

Topical agents used in association with cosmetic surgery.

Effective cosmetic surgery depends on proper preparation of the skin prior to the procedure, excellent wound care, and an appropriate postoperative skin maintenance program. Accomplishing this goal requires a thorough understanding of topical agents. Substances applied to the skin can alter barrier function, permeability, transepidermal water loss, immune response, wound repair, vasostability, collagen deposition, epidermal turnover, and melanin formation, to name a few. Each of these skin characteristics can affect the quality of the end surgical result. This article discusses topical agents used in association with cosmetic surgery.

Administration, Topical↗
PubMed1996

Poly(ethylene glycol)--lipid conjugates regulate the calcium-induced fusion of liposomes composed of phosphatidylethanolamine and phosphatidylserine.

The effect of poly(ethylene glycol)--lipid (PEG--lipid) conjugates on liposomal fusion was investigated. Incorporation of PEG--lipids into large unilamellar vesicles (LUVs) composed of equimolar phosphatidylethanolamine (PE) and phosphatidylserine (PS) inhibited calcium-induced fusion. The degree of inhibition increased with increasing molar ratio of the PEG conjugate and with increasing size of the PEG moiety. Inhibition appeared to result from the steric barrier on the surface of the liposomes which opposed apposition of bilayers and interbilayer contact. In the presence of a large excess of neutral acceptor liposomes, however, fusogenic activity was restored. The rate of fusion under these conditions depended on the initial molar ratio of the PEG conjugate in the PE:PS vesicles and the length and degree of saturation of the acyl chains which composed the lipid anchor. These results are consistent with spontaneous transfer of the PEG--lipid from PE:PS LUVs to the neutral lipid sink reducing the steric barrier and allowing fusion of the PE:PS LUVs. The primary determinant of the rate of fusion was the rate of transfer of the PEG--lipid, indicating that liposomal fusion could be programmed by incorporation of appropriate PEG--lipid conjugates. Interestingly, increasing the size of the PEG group did not appear to affect the rate of fusion. The implications of these results with respect to the design of fusogenic liposomal drug delivery systems are discussed.

Calcium↗
PubMed2001

Cervical cancer screening among Chinese immigrants in Seattle, Washington.

INTRODUCTION: Chinese American women have high rates of invasive cervical cancer, compared to the general population. However, little is known about the Pap testing behavior of ethnic Chinese immigrants. METHODS: We conducted a community-based survey of Chinese immigrants living in Seattle, Washington, during 1999. Two indicators of cervical cancer screening participation were examined: at least one previous Pap smear and Pap testing in the last 2 years. RESULTS: The overall estimated response rate was 64%, and the cooperation rate was 72%. Our study sample for this analysis included 647 women. Nearly one quarter (24%) of the respondents had never had a Pap test, and only 60% had been screened recently. Factors independently associated with cervical cancer screening use included marital status, housing type, and age at immigration. CONCLUSION: Our findings confirm low levels of cervical cancer screening among Chinese immigrants to North America. Culturally and linguistically appropriate Pap testing intervention programs for less acculturated Chinese women should be developed, implemented, and evaluated.

Journal Article↗
PubMed2001

[Endurance training for fitness--role of individualized training program].

There are many different aspects that should be taken into account when exercise counselling of trained and untrained persons is required. Factors to be considered include the endurance capacity (EC), the general sport skills and the goals of the individual willing to start a training program. First the advisor should try to characterize the EC of the person by estimating or measuring EC. Based on this information, advice for an individual training programme can be given. As a principle for cardio-respiratory fitness training, a person should at least practise three times per week 20-30 minutes in a moderate exercise intensity to achieve a sufficient training effect. When training more than three times/week people should vary the mode of exercise and training intensity to improve the quality of training and to avoid overcharge symptoms. After a certain duration of the training cycle, the plans should be adapted to new or changed conditions. A distinct improvement of EC can be expected after 8-12 weeks of regular training. The article gives an overview of the possibilities for testing and the planning of training, should help the reader either to start his own training program or to give appropriate advice to an athlete requiring training counselling.

Counseling↗
PubMed2006

The prevention of depressive symptoms in children and adolescents: A meta-analytic review.

Research on the prevention of depressive symptoms in children and adolescents was reviewed and synthesized with meta-analysis. When all 30 studies were included, selective prevention programs were found to be more effective than universal programs immediately following intervention. Both selective and indicated prevention programs were more effective than universal programs at follow-up, even when the 2 studies with college students were excluded. Effect sizes for selective and indicated prevention programs tended to be small to moderate, both immediately postintervention and at an average follow-up of 6 months. Most effective interventions are more accurately described as treatment rather than prevention. Suggestions for future research include testing potential moderators (e.g., age, gender, anxiety, parental depression) and mechanisms, designing programs that are developmentally appropriate and gender and culturally sensitive, including longer follow-ups, and using multiple measures and methods to assess both symptoms and diagnoses.

Adolescent↗
PubMed2001

Programmable and autonomous computing machine made of biomolecules.

Devices that convert information from one form into another according to a definite procedure are known as automata. One such hypothetical device is the universal Turing machine, which stimulated work leading to the development of modern computers. The Turing machine and its special cases, including finite automata, operate by scanning a data tape, whose striking analogy to information-encoding biopolymers inspired several designs for molecular DNA computers. Laboratory-scale computing using DNA and human-assisted protocols has been demonstrated, but the realization of computing devices operating autonomously on the molecular scale remains rare. Here we describe a programmable finite automaton comprising DNA and DNA-manipulating enzymes that solves computational problems autonomously. The automaton's hardware consists of a restriction nuclease and ligase, the software and input are encoded by double-stranded DNA, and programming amounts to choosing appropriate software molecules. Upon mixing solutions containing these components, the automaton processes the input molecule via a cascade of restriction, hybridization and ligation cycles, producing a detectable output molecule that encodes the automaton's final state, and thus the computational result. In our implementation 1012 automata sharing the same software run independently and in parallel on inputs (which could, in principle, be distinct) in 120 microl solution at room temperature at a combined rate of 109 transitions per second with a transition fidelity greater than 99.8%, consuming less than 10-10 W.

Adenosine Triphosphate↗
PubMed1980

Separation and quantification of the "middle molecules" in uremia.

A modification of a two-stage chromatographic procedure (molecular sieve followed by ion-exchange) to separate potentially toxic uremic "middle molecules" from body fluids has been established. The procedure has an analysis time less than half that previously reported with improved resolution. Elution volumes have been found to be reproducible to within 2% and concentrations (as measured by peak height) to within 10%. Careful attention, however, must be paid to artifacts that may arise from sample preparation, drug therapy, and dialysis conditions. Up to ten identifiable subpeaks were observed in sera, urine, and red cell hemolysate samples following ion-exchange separation of a molecular sieve peak in the middle molecule range (300 to 2000 daltons). Red cell concentrations of five of these moieties were significantly higher than those in serum. Four peaks were not detected at all in red cells, and one peak was not detected in sera or urine samples. In addition, although serum concentrations are elevated in uremia, red cell levels in patients with uremia are comparable with those obtained in normal subjects. If any of these species are subsequently shown to be uremic toxins, then their two-compartment distribution within the body has important ramifications in the choice of an appropriate mathematic model to program optimal dialysis therapy.

Body Fluids↗
PubMed2005

A conceptual framework for modeling aggregate and cumulative exposures to chemicals.

Computer simulation programs have been identified as useful tools for characterizing uncertainty and variability in longitudinal exposures to multiple sources by multiple routes of exposures. This paper provides a conceptual framework for such programs that separates and appropriately models the processes that determine uncertainty, inter- and intraindividual variability, as well as the processes that determine the relationships between the individuals and sources of exposure. The framework is based on a series of four nested loops. These are: the exposure event loop that models the route-specific doses to a person from one or more sources at one point in time; the time step loop that moves a person through time updating the sources and the person's characteristics, the interindividual variation loop that determines the initial characteristics of each person modeled, and finally the uncertainty loop that characterizes the uncertainty from model and parameter uncertainties. This framework provides a flexible and internally consistent approach for the design of simulation software.

Computer Simulation↗