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PubMed2003

Identification of specific gene expression profiles in human mast cells mediated by Toll-like receptor 4 and FcepsilonRI.

Rodent mast cells (MCs) are reported to play a pivotal role in both innate and adaptive immunity. However, there is so far no evidence that human MCs are involved in innate immunity. We found that a functional Toll-like receptor 4 (TLR4) was expressed on human MCs when it was up-regulated by interferon gamma (IFN-gamma). To systematically explore how human MCs modulate the immune system following TLR4-mediated activation and FcepsilonRI aggregation, we used high-density oligonucleotide probe arrays (GeneChip) to compare the lipopolysaccharide (LPS)-induced gene expression profile with the IgE/anti-IgE-mediated profile in MCs. Both a shared core response, and LPS- or anti-IgE-specific programs of gene expression were observed in MCs. Furthermore, MCs exhibited an antiviral response gene program in response to IFN-gamma, and LPS sustained that expression. Compared with the LPS-stimulated gene expression profile of human peripheral blood mononuclear cells, LPS-stimulated MCs specifically induced a subset of genes that included a Th2 cytokine and chemokines that recruit Th2 cells and eosinophils. These results reveal that human MCs express tailored pathogen- and antigen-specific immune responses and that human MCs may play important roles in innate and adaptive immunity.

Chemokine CCL1↗
PubMed2004

Ignored hallmarks of carcinogenesis: stem cells and cell-cell communication.

Hanahan and Weinberg (2000, Cell 100: 57-70) listed "hallmarks" of cancer that must be considered in order to understand the underlying determinants of carcinogenesis: (a) self-sufficiency in growth signals; (b) insensitivity to growth-inhibitory (antigrowth) signals; (c) evasion of programmed cell death (apoptosis); (d) limitedless replicative potential; (e) sustained angiogenesis; and (f) tissue invasion and metastasis. While these are important phenotypic markers, important concepts--the role of pluripotent stem cells and gap junctional intercellular communication (GJIC)--must be brought into this analysis of carcinogenesis. Carcinogenesis is a multistage, multimechanism process consisting of a single cell that has been irreversibly blocked from terminal differentiation (the initiation stage). The promotion phase is a potentially reversible or interruptible clonal expansion of the initiated cell by a combination of growth stimulation and inhibition of apoptosis. When the expanded initiated cells accrue sufficient mutations and epigenetic alterations to become growth stimulus independent and resistant to growth inhibitors and apoptosis, to have unlimited replicative potential and invasive and metastatic phenotypes, then the progression phase has been achieved. The hypothesis that integrates these hallmarks is that the stem cell and its early progenitor cell are the target cells for the initiation event. These cells are naturally immortal and become mortal only when they are induced to terminally differentiate and lose their telomerase activity. These two types of initiated cells are suppressed by either secreted negative growth regulators (the stem cells) or GJIC (the early initiated progenitor cells). Promoters inhibit either the secreted growth inhibitor to initiated stem cells or GJIC between the initiated progenitor cells and the normal progenitor cells. When a stable resistance to the secreted negative growth regulator or permanent downregulation of GJIC has occurred, the cell has entered the progression phase. These two new concepts contradict the current paradigm that the first phase of carcinogenesis is the immortalization of a normal cell followed by its neoplastic transformation. Our hypothesis is that the first stage of carcinogenesis must prevent the "mortalization" or terminal differentiation of a naturally immortal cell. Chemoprevention and chemotherapeutic implications suggest that one must induce connexin genes in initiated stem cells and restore GJIC in initiated early progenitor cells.

Animals↗
PubMed1998

Varying types of circus movement re-entry with both normal and dissociated contralateral conduction causing different right and left atrial rhythms in canine atrial flutter.

The purpose of this study was to develop an animal model of atrial flutter (AFL) or fibrillation (AFB) and to determine precisely the pathway of atrial activation during arrhythmias induced by programmed stimulation. In 10 dogs, a shunt from the left subclavian artery to the left upper pulmonary vein was created to produce left atrial enlargement. Five months later, using programmed electrical stimulation, it was possible to induce 17 sustained atrial tachycardias in 9 of the 10 dogs, including 9 episodes of AFL caused by circus movement re-entry, 6 episodes of focal tachycardia, and 2 episodes of AFB. Short cycle length left atrial tachycardias caused by either circus movement or a focus did not propagate in a uniform 1:1 pattern to the right atrium (RA), resulting in RA dissociation. In these arrhythmias, complex wavefronts from both current and preceding left atrial cycles coexisted in the RA. Circus movement was associated with a spectrum of different re-entrant pathways with different path lengths. These differences in the path length were determined by various ways in which obstacles such as the superior vena cava and orifice of the right atrial appendage or pulmonary vein orifices were combined by contiguous areas of functional block.

Animals↗
PubMed1999

What individual, provider, and community characteristics predict employment of individuals with mental retardation?

Characteristics influencing employment of individuals with mental retardation were analyzed to evaluate employment rates for county providers. Participants in the sample (N = 11,743) earned at least $50 per week for a 6-month period. Good physical and emotional health, being male, age between 18 and 49, IQ between 50 and 75, and good adaptive skills were associated with employment. Eighteen percent of the variability in employment rates was explained by the ratio of individuals served by the Boards to the county population and the percentage of the county population living in rural settings. Median income, unemployment rates, and poverty explained 22% of the variance in noncompetitive employment rates. Results suggest that health promotion programs could help individuals with mental retardation obtain and sustain employment.

Adolescent↗
PubMed2002

Clinical characteristics of induced nonclinical ventricular tachycardia in nonischemic cardiomyopathy.

The clinical significance of induced nonclinical ventricular tachycardia (NCVT) in nonischemic dilated cardiomyopathy (DCM) remains controversial. Twenty-eight patients with sustained VT or ventricular fibrillation related to DCM underwent programmed ventricular stimulation (PVS) to induce VT. However, VT was not induced in four patients. Based on the morphology of induced ventricular arrhythmia, we classified the remaining 24 patients into NCVT (n = l1 ) and clinical VT (CVT) groups (n = 13), then evaluated the prognosis for a mean follow-up period of 22 months. The cycle length of induced NCVT was significantly shorter than that of induced CVT (277 +/- 38 ms vs 325 +/- 63 ms, P < 0.05). Appropriate antiarrhythmic agents were selected by serial PVS in 36% of the NCVT group and in 38% of the CVT group (4/11 vs 5/13). Among patients who had been treated by PVS guided drug therapy, arrhythmic events were observed in 75% of the NCVT group and 80% of the CVT group (3/4 vs 4/5). The total incidence of sudden death in the NCVT group was higher than that in the CVT group (5/11: 45% vs 4/13: 31%). In conclusion, induced NCVT and CVT are refractory to pharmacological therapy and both have an important characteristic value in DCM.

Adult↗
PubMed2004

Effects of a driver enforcement program on yielding to pedestrians.

A driver-yielding enforcement program that included decoy pedestrians, feedback flyers, written and verbal warnings, and saturation enforcement for a 2-week period was evaluated in the city of Miami Beach using a multiple baseline design. During baseline, data were collected at crosswalks along two major corridors. Treatment was introduced first at selected crosswalks without traffic signals along one corridor. A week later, enforcement was shifted to crosswalks along the second corridor. Results indicated that the percentage of drivers yielding to pedestrians increased following the introduction of the enforcement program in each corridor and that these increases were sustained for a period of a year with minimal additional enforcement. The effects also generalized somewhat to untreated crosswalks in both corridors, as well as to crosswalks with traffic signals.

Automobile Driving↗
PubMed1997

Withdrawal symptoms and previous attempts to quit smoking: associations with self-efficacy.

This study examines the relationship between self-efficacy and sustained smoking cessation in Dutch quitters attending a group program for smoking cessation in 1991. Increase in self-efficacy during treatment was found to be a predictor of outcome after controlling for demographic characteristics and cessation history variables. Relapsers (n = 75) showed more negative relationships between self-efficacy and withdrawal symptoms than long-term abstainers (n = 58). Relapsers who were more depressed during the attempt under study were less self-efficacious at the end of treatment. In addition, the duration of the previous attempt to quit smoking proved to be differently associated with self-efficacy for quitters and relapsers.

Adult↗
PubMed2001

Veterinary practice management: teaching needs as viewed by consultants and teachers.

A study was conducted to assess veterinary practice management (VPM) educational and research needs from the perspective of consultants and teachers. An online focus group discussion was designed, involving two separate groups (consultants and teachers). One week was allocated to each group, with five to eight questions posed per day. Pseudonyms were used to provide confidentiality. Teachers were selected by inviting the primary VPM course coordinator at each AAVMC school. Consultants required at least two recommendations and were selected in a stratified, non-random manner to achieve both geographic and disciplinary diversity. Participation was stronger within the consultant group: 98 pages of data were generated by the consultants and 35 pages by teachers. Participants agreed that the sub-optimal economic conditions that characterize the veterinary profession are reflective of relatively low-level management skills. This situation establishes the need to strengthen VPM educational and research programs. Many specific suggestions were provided. It was recommended that a cooperative effort between academia and the private sector be employed. However, participants recognized that successful DVM education programs in VPM will be difficult to achieve and sustain without strong support from college administrators and faculties.

Consultants↗
PubMedDate not supplied

The impact of continuing education on patient outcomes in the elderly hip fracture population.

As the health care system is oriented to provide service with finite dollars, nursing educators are being asked to demonstrate how continuing education for staff improves patient outcomes. The purpose of this study was to evaluate the impact of an orthopedic-geriatric continuing education program for nurses on the elderly patient who had sustained a hip fracture. A significant difference was found between the control and experimental unit patients with respect to time to first ambulation and length of stay on the orthopedic unit.

Aged↗
PubMed1998

Echinostomiasis: a common but forgotten food-borne disease.

Human echinostomiasis, endemic to southeast Asia and the Far East, is a food-borne, intestinal, zoonotic parasitosis attributed to at least 16 species of digenean trematodes transmitted by snails. Two separate life cycles of echinostomes, human and sylvatic, efficiently operate in endemic areas. Clinical symptoms of echinostomiasis include abdominal pain, violent watery diarrhea, and anorexia. The disease occurs focally and transmission is linked to fresh or brackish water habitats. Infections are associated with common sociocultural practices of eating raw or insufficiently cooked mollusks, fish, crustaceans, and amphibians, promiscuous defecation, and the use of night soil (human excrement collected from latrines) for fertilization of fish ponds. The prevalence of infection ranges from 44% in the Philippines to 5% in mainland China, and from 50% in northern Thailand to 9% in Korea. Although the patterns of other food-borne trematodiases have changed in Asia following changes in habits, cultural practices, health education, industrialization, and environmental alteration, human echinostomiasis remains a health problem. The disease is most prevalent in remote rural places among low-wage earners and in women of child bearing age. Echinostomiasis is aggravated by socioeconomic factors such as poverty, malnutrition, an explosively growing free-food market, a lack of supervised food inspection, poor or insufficient sanitation, other helminthiases, and declining economic conditions. Furthermore, World Health Organization control programs implemented for other food-borne helminthiases and sustained in endemic areas are not fully successful for echinostomiasis because these parasites display extremely broad specificity for the second intermediate host and are capable of completing the life cycle without involvement of the human host.

Amphibians↗
PubMed1999

QT dispersion as a noninvasive predictor of inducible ventricular tachycardia.

The QT dispersion (QTD) on the surface electrocardiogram is a noninvasive marker of heterogeneity of ventricular repolarization. An increased QTD has been associated with spontaneous ventricular arrhythmias. We investigated the relationship of QTD to inducible reentrant sustained ventricular tachycardia (VT) in 66 patients who underwent programmed electrical stimulation. Thirty-three patients had inducible VT and 33 had noninducible VT with up to three extra stimuli. The QTD was significantly longer in patients with inducible VT (79+/-30 ms) compared with those in whom VT was noninducible (50+/-20 ms, P < .0001). QTD of > or =70 ms had a sensitivity of 67%, a specificity of 94%, a positive predictive value of 92%, and a negative predictive value of 74% for inducible VT. We conclude that QTD is an easily measurable electrocardiographic index that is increased in patients with inducible VT, and a QTD of > or =70 ms is highly predictive of VT inducibility.

Adult↗
PubMed2002

Initiatives to meet the challenge of providing water services to the most underprivileged communities: tools and oportunities--the case of Empresas Públicas de Medellín (EEPPM).

Due to problems such as migration from rural areas to cities and to the difficulties generated by those displaced by violence, the water utility companies in developing counties are faced with the challenge of supplying this service to communities that have settled in an irregular and disorganized manner. The challenge public utility services face is solving the problem without letting such circumstances impinge on the financial feasibility of the company. In order to achieve this, it is essential to design programs with a prominent degree of community participation and self-management, which may even change this social problem into a commercial opportunity. This paper portrays EEPPM's experience in four successful programs within this field, illustrating their benefits as regards sustainability and replication.

Community Participation↗
PubMed2005

[Ankle sprain. Management of recent lesions and prevention of secondary instability].

Ankle sprains are among the most common musculoskeletal injuries. The vast majority of these injuries are lateral ligament sprains, resulting from inversion of the plantar-flexed foot. Initial management should include rest, ice, compression and elevation. Functional treatment proved to provide the quickest recovery and an earlier return to work without compromising the lateral mechanical stability. Surgical management of acute ankle sprains is rarely, if ever, indicated. Patients who continue to sustain multiple recurrent inversion sprains despite a supervised rehabilitation program aimed at improving proprioception and strengthening of the peroneal muscles are candidate for surgical reconstruction of the lateral ankle ligaments.

Ankle Injuries↗
PubMed1986

Ventricular late potentials and inducible ventricular tachyarrhythmias as a marker for ventricular tachycardia after myocardial infarction.

To assess the predictive value of ventricular late potentials and programmed ventricular stimulation, 379 patients without a history of sustained ventricular tachycardia, dizziness or syncope were studied prospectively. Group I included patients referred for coronary angiography. Group II consisted of patients who survived an episode of acute myocardial infarction and who were studied within 6 weeks after onset. During follow-up (mean 13 months), 16 patients died. Six of these patients died suddenly within one hour. The prevalence of sudden cardiac death was lower (0.8%) in group I compared to group II (3.0%). There was no correlation between results of both methods and the subsequent occurrence of sudden cardiac death. Symptomatic sustained ventricular tachycardia was documented in 10 patients (2.6%). Only one patient in group I later developed symptomatic sustained ventricular tachycardia in contrast to nine cases in group II. Symptomatic sustained ventricular tachycardia could be predicted in patients in the early postmyocardial infarction period (group II). By using various combinations of parameters, the highest predictive value for subsequent sustained ventricular tachycardia was reached by the following combination: Late potentials of 40 ms duration or more, induction of monomorphic sustained ventricular tachycardia at rates below 270 beats min-1 and interval after myocardial infarction less than 6 weeks. In conclusion, both techniques seemed to be promising for the identification of patients at risk of ventricular tachycardia after myocardial infarction.

Action Potentials↗
PubMed1979

Patterns of activation in ventricular arrhythmias of late myocardial infarction in dogs.

Ventricular arrhythmias were produced in 12 dogs 4 to 6 days after coronary artery ligation by programmed ventricular stimulation. The electrocardiogram and 7 composite electrograms from endocardial and epicardial surfaces of the ischemic, border and normal zones, as well as from the right ventricle, were recorded during and after programmed ventricular stimulation. The ventricular arrhythmias were preceded and sustained by delayed, fragmented activity in the ischemic epicardial zone bridging diastole. Efferent pathways from the ischemic epicardium led to direct epicardial spread to adjacent normal epicardium in most instances. Efferent pathways into the endocardial regions were also observed, but to a lesser extent. The efferent reentry pathways led to both ventricles, and produced right and left ventricular arrhythmias in 8 of the 12 dogs; they were exclusively of left ventricular origin in the remaining 5. Classification of right and left ventricular arrhythmias may only be related to the exit points and not necessarily to their origin.

Animals↗
PubMed1984

The natural history of diabetic nephropathy: unpredictable insulin requirements--a further clue.

Diabetic nephropathy has evolved into the single most prevalent cause of uremia among patients sustained by the United States End Stage Renal Disease program. Clarification of the natural history of kidney involvement and insufficiency in Type I and II diabetes has improved substantially over the past 5 years. However, it remains a poorly understood and relatively underreported morbid entity. This report reviews the problem, then reconstructs the natural history of diabetic nephropathy by studying the course of 50 Type I and Type II uremic diabetics treated with hemodialysis at The Long Island College Hospital. It traces the various stages from hyperglycemia to proteinuria to renal failure, and then reports morbidity, including cardiac, eye, stroke, and amputation complications. A new paradox is herein reported--the unpredictable insulin requirement, including new insulin need for the first time once hemodialysis was begun, in 8 of 50 patients studied.

Adult↗
PubMed1995

[Value of cardiac pacing in hypertrophic obstructive cardiomyopathy refractory to medical treatment].

Recent studies have shown that dual-chamber cardiac pacing could improve patients with hypertrophic obstructive cardiomyopathy resistant to medical treatment. After a brief historical review, the authors report the present status of this original therapeutic option. The results of different studies are in agreement and show that the functional improvement is associated with a large reduction of the intraventricular pressure gradient with permanent DDD pacing. Although the exact mechanism of the improvement remains unknown, all groups underline the importance of complete and permanent ventricular capture. This requires precise regulation of the atrioventricular delay which in most cases must be programmed at a value inferior to 90 ms, which compromises ventricular filling which is already abnormal under basal conditions. The inefficacy of pacing in some cases is explained by the necessity of selecting a very short atrioventricular delay which alters diastolic function and finally masks the benefits of ventricular capture. In this particular situation, the authors propose improving atrioventricular synchrony by pharmacological prolongation of the PR interval, or, when unsuccessful, by ablation of the atrioventricular junction. This attitude was adopted in 5 cases when pacing with an AVD programmed between 20 and 70 ms, provided only a partial haemodynamic result. Improved atrioventricular synchrony allowed selection of an AVD of 100 to 150 ms, so reducing the gradient by more than 70%, compared with 30% under the initial programming parameters. The authors conclude that a positive and sustained benefit of cardiac pacing can only be obtained by an individualised regulation of pacing parameters to optimize atrioventricular synchrony which seems to be the key element of success.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Percutaneous injuries on the "front line": a survey of housestaff and nurses.

Our objective was to assess the frequency of work-related percutaneous injuries in two high-risk groups and to compare patterns of injury and reporting in these groups. Data were collected through an anonymous, self-administered survey distributed to all full-time nurses and housestaff. The survey results were compared to Employee Health Service records. Surveys were returned by 258 of 330 housestaff and 455 of 593 nurses for a response rate of 77% (housestaff = 78%; nurses = 76%). The respondents were highly representative of the nursing divisions and residency programs surveyed. The percentage of nurses who had ever sustained percutaneous injuries was 64.7%; for housestaff it was 74.1% (prevalence difference = -9.4%, 95% confidence interval [CI] = -16.4%, -2.4%). The percentage of nurses who had sustained recent injuries was 34.6%; for housestaff it was 43.0% (prevalence difference = -8.4%, 95% CI = -15.9%, -0.9%). Injuries with syringe needles were the most common, followed by injuries with suture needles, scalpels, and then a variety of other sharp objects and instruments. The nurses were more likely to seek care as directed by hospital policy at the Employee Health Service (reporting difference = 29.7%, 95% CI = 19.5%, 39.9%) or the Emergency Room (reporting difference = 11.9%, 95% CI = 8.1%, 20.0%). Knowledge of policy increased the probability of reporting by nurses. The housestaff were more likely to evaluate injuries themselves (reporting difference = -16.7%, 95% CI = -26.8%, -6.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗