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At least 1,549 records · Page 86Linked to original sources
PubMed2004

Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome.

PURPOSE: To determine the survival outcomes, prognostic factors, and patterns of failure in patients with malignant mixed Müllerian tumor (MMMT) of the uterus. METHODS AND MATERIALS: Between 1954 and 1998, 300 patients with clinical Stage I-III MMMT of the uterus were treated with curative intent at The University of Texas M. D. Anderson Cancer Center. Their hospital records were reviewed to obtain patient and tumor characteristics; details of surgery, radiotherapy (RT), and chemotherapy; and long-term outcome. Surviving patients were followed for a median of 109 months (range 15-138). Survival rates were calculated using the Kaplan-Meier method, with differences assessed by log-rank tests. RESULTS: Of the 300 patients, 113 (38%) were treated with surgery alone, 160 (53%) with surgery plus adjuvant EBRT or ICRT, and 27 (9%) with RT alone. Forty-eight patients received adjuvant chemotherapy. At 5 years, the overall rates of survival and cause-specific survival were 31% and 33%, respectively. Women who were postmenopausal or had a history of prior pelvic RT, pain at presentation, clinical Stage II-III disease, uterine enlargement (>/=12 weeks), or an abnormal Papanicolaou smear finding had a significantly poorer prognosis than the other patients in the series. Of the 273 patients who underwent surgery, those who had positive abdominal washings, uterine length >10 cm, or extrauterine spread of disease to the cervix, adnexa, or peritoneum had a significantly worse prognosis than the other patients. Factors found on multivariate analysis to have an independent adverse influence on cause-specific survival included postmenopausal status (p = 0.0007, relative risk [RR] 3.3), uterine length >10 cm (p = 0.0001, RR 2.2), cervical involvement (p = 0.002, RR 1.8), and peritoneal involvement (p = 0.0001, RR 4.3). At 5 years, the rates of pelvic and distant disease recurrence for the entire group of 300 patients were 38% and 57%, respectively. The most common site of distant recurrence was the peritoneal cavity. Patients treated with pelvic RT had a lower rate of pelvic recurrence than patients treated with surgery alone (28% vs. 48%, p = 0.0002), but the overall survival rates (36% vs. 27%, p = 0.10) and distant metastasis rates (57% vs. 54%, p = 0.96) were not significantly different. However, patients treated with pelvic RT had a longer mean time to any distant relapse (17.3 vs. 7.0 months, p = 0.001) than patients treated with surgery alone. The use of adjuvant chemotherapy did not correlate with the survival rate or rate of distant metastasis. CONCLUSION: Adjuvant pelvic RT decreased the risk of pelvic recurrence and may delay the appearance of distant metastases after hysterectomy for MMMT. However, the survival rates remain poor because of a high rate of distant recurrence. As more effective systemic chemotherapy is developed to control microscopic distant disease, the role of RT in controlling locoregional disease in the pelvis and abdomen may become more important. Future research should consider programs that integrate surgery, RT, and chemotherapy to maximize the probability of cure.

Adult↗
PubMed2003

Epidemiology of substance use disorders in women.

Significant gender differences exist in the prevalence of substance use disorders in the United States. There is a trend among boys and girls aged 12 to 17 years toward comparable rates of use and initiation for alcohol, cocaine, heroin, and tobacco. If this trend continues, over time there may be a narrowing of the male-to-female prevalence ratios of substance abuse in the older age groups. This possibility is particularly disturbing because women have a heightened vulnerability to medical, physical, mental, and social consequences of substance use. Women also carry additional unique risks during pregnancy because of the effect on neonates. In addition, they have certain gender-specific cancer risks. Given this and the declining age of initiation of substance use in women, prevention and treatment efforts especially geared toward women (eg, education of all medical and paramedical staff, screening in primary care clinics, detection of drug use early in pregnancy or before conception, brief interventions and treatment programs that integrate women's needs) are exceedingly important to stop and ultimately reverse this growing trend.

Adolescent↗
PubMed2002

Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapse.

This prospective study examined the effect of medication compliance and substance abuse on 4 year outcome in 99 patients following a relapse of schizophrenia. Univariate survival analysis revealed longer community tenure in patients if they were over the age of 35 years, not admitted 2 years prior to the index episode, remained medication compliant and did not abuse substances during the follow-up interval. Comparisons between patients grouped according to medication compliance and current substance abuse indicated that those patients who regularly took their medication but also abused substances were readmitted to hospital sooner (median survival, 10 months) compared to compliant patients who did not use substances (37 months). For noncompliant patients, time to first readmission was shorter for patients with a dual diagnosis (5 months) compared to patients with a singular diagnosis of schizophrenia (10 months). Over the 4 year period, noncompliant patients with a dual diagnosis (n=28) accounted for 57% of all hospital readmissions for the cohort and averaged 1.5 admissions per patient year. These data indicate that much of the benefit that antipsychotic medication has on increasing community survival is reduced by substance abuse. This interval is further reduced in patients who are both substance abusers and noncompliant with medication resulting in a revolving door situation of frequent hospital admissions. Integrated treatment programs which address these issues are likely to reduce the need for hospital readmission in patients with a dual diagnosis.

Adult↗
PubMed2001

The completeness, validity, and timeliness of AIDS surveillance data.

PURPOSE: To assess the completeness, validity, and timeliness of the AIDS surveillance system after the 1993 change in the surveillance case definition. METHODS: To assess completeness of AIDS case reporting, three study sites conducted a comparison of their AIDS surveillance registries with an independent source of information. To evaluate validity, the same sites conducted record reviews on a sample of reported AIDS cases, we then compared agreement between the original report and the record review for sex, race, and mode of transmission. To evaluate timeliness, we calculated the median delay from time of diagnosis to case report, before and after the change in case definition, in each of the three study sites. RESULTS: After expansion of the case definition, completeness of AIDS case reporting in hospitals (> or = 93%) and outpatient settings (> or = 90%) was high. Agreement between the information provided on the original case report and the medical record was > 98% for sex, > 83% for each race/ethnicity group; and > 67% for each risk group. The median reporting delay after the change was four months, but varied by site from three to six months. CONCLUSIONS: The completeness, validity, and timeliness of the AIDS surveillance system remains high after the 1993 change in the surveillance case definition. These findings might be useful for programs implementing integrated HIV and AIDS surveillance systems.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Rehabilitation of a child with a spinal cord injury.

The incidence and sex distribution of spinal cord injury (SCI) changes with age. Motor vehicle accidents, bicycle accidents, sports accidents, and violence are major causes in the pediatric population. Pulmonary complications may be severe and life-threatening in the acute phase. Chronically, the degree of ventilatory support needed depends on the level of the injury, with high cervical injuries typically requiring life-long ventilatory support. Deep venous thrombosis, autonomic dysreflexia, hypercalcemia, heterotopic ossification, spasticity, neurogenic bowel and bladder, scoliosis, and pain all may be secondary to SCI. Numerous orthotic aids are available for rehabilitation. An integrated rehabilitation program may also include spasticity management, a bowel and bladder program, and other features geared to the individual patient.

Age Factors↗
PubMed2000

Does the plant mitochondrion integrate cellular stress and regulate programmed cell death?

Research on programmed cell death in plants is providing insight into the primordial mechanism of programmed cell death in all eukaryotes. Much of the attention in studies on animal programmed cell death has focused on determining the importance of signal proteases termed caspases. However, it has recently been shown that cell death can still occur even when the caspase cascade is blocked, revealing that there is an underlying oncotic default pathway. Many programmed plant cell deaths also appear to be oncotic. Shared features of plant and animal programmed cell death can be used to deduce the primordial components of eukaryotic programmed cell death. From this perspective, we must ask whether the mitochondrion is a common factor that can serve in plant and animal cell death as a stress sensor and as a dispatcher of programmed cell death.

Apoptosis↗
PubMed1998

The graduate training in medical information sciences in the Academic Medical Centre at the University of Amsterdam.

Since its inception in 1987, the 4-year Medical Information Sciences (MIS) curriculum at the Academic Medical Centre (AMC), Amsterdam has gone through several major changes. The present curriculum started in 1994. The course takes 4 years, the first 3 years are programmed in integrated modules of 7 weeks in duration each. In these modules much attention is given to interactive teaching, problem based learning and private study. Typical for the Amsterdam curriculum is a strong emphasis on the role and significance of data and information in health care and its management. The authors see information technology per se as auxiliary to this orientation. Presently, about 150 students follow the courses.

Curriculum↗
PubMed2001

Mouse-based phenogenomics for modelling human disease.

The powerful and wide-ranging genetic tools available in the laboratory mouse make it the major experimental model for studying mammalian gene function in vivo and modelling human disease traits. Large-scale random mutagenesis approaches, either gene-driven or phenotype-driven, promise to identify new clinically relevant phenotypes and their associated genes. Development of appropriate tools for assessing clinical phenotypes in mice is a crucial component of these endeavours, as is the establishment of the infrastructure for archiving and distribution of the growing mutant resource to the community. Integrated, multidisciplinary programs will be needed to fully exploit the power of the mouse in molecular medicine.

Academies and Institutes↗
PubMedDate not supplied

Health indicators for mothers and children in rural Herat Province, Afghanistan.

INTRODUCTION: Following years of conflict and neglect, major efforts now are underway to develop health policy and rehabilitate the health facilities in Afghanistan. As part of these efforts, there is a need to better understand the health status and health-seeking behaviors. As part of an effort to assist local non-governmental organizations (NGOs), a household survey of mothers with children under the age of five years was conducted in two rural districts of Herat Province, Karokh and Chesht-e-Sharif. METHODS: A two-stage, 30-cluster approach was used for each district. This included 622 mothers of 926 children under the age of five years living in the two districts. Outcome measures included demographic characteristics, antenatal services, immunization coverage, hemoglobin levels of the mothers, nutritional status and practices, environmental health indicators, recent illness, and health seeking behaviors. RESULTS: The mean value of ages of the mothers was 27 years with an average parity of 6.1. Less than 5% of mothers ever had attended school. Half of women had lost at least one child before the child reached the age of five years. Under-five-year mortality was estimated at 325. Only 29% of the women had attended an antenatal clinic during their last pregnancy. Virtually all deliveries occurred at home. Only 7.6% of women had received three doses of tetanus toxoid. Less than 9% of the children 12-59 months of age were fully immunized. According to the measurements of mid-upper-arm circumference (MUAC), 11% of children were malnourished. Although breastfeeding almost was universal, greater than one-third of the women did not start breastfeeding until the second day after delivery. Protected water sources and appropriate control of feces were lacking in both districts. In the previous two weeks, 45.7% of children had experienced diarrhea, and dysentery had occurred in 10%. Fever had been present in one-quarter of the children. CONCLUSIONS: Household health indicators indicate serious maternal and child health concerns in these two districts. Of particular concern is the poor immunization coverage, lack of reproductive health service, and the prevalence of common childhood illness in these populations. The feeding practices for children and the anemia among mothers also raised concerns. Poor environmental health contributes substantially to childhood illness. Without special emphasis, efforts to rebuild the health sector are likely to reach the household level only late in the process. An aggressive program to integrate community development and promotion of sound health practices is needed to improve the health of the Afghanistan people.

Adult↗
PubMedDate not supplied

Natural hazards: causes and effects. Lesson 5--Tropical cyclones (hurricanes, typhoons, baguios, cordonazos, tainos).

The many conclusions drawn and lessons learned from past cyclones can be used to mitigate and better respond to future occurrences. Some of the most helpful are listed below: 1) Outbreaks of cholera do not follow cyclones. Cholera must be endemic previously to a community; 2) Waterborne diseases do not increase as a result of cyclones; 3) Massive food aid rarely is required after a cyclone; 4) Used clothing almost never is needed. It usually is culturally inappropriate. Though accepted by disaster victims, it almost never is worn; 5) Blankets can be useful, but if they are needed, they usually can be found locally and do not need to be imported; 6) Assistance by outsiders is most effective in the reconstruction period, not the emergency phase; 7) Most needs are met by the victims themselves or their local governments; 8) In general, victims do not respond to disasters with abnormal behavior. Cyclones do not incite panic, hysteria, or rioting; 9) Cyclone relief and reconstruction programs should be integrated with long-term development programs; 10) When properly executed, reconstruction assistance can provide a strong stimulus to recovery and a base for future development work; 11) Reconstruction programs should seek to reduce vulnerability to future disaster; 12) Re-establishment of the local economy, income security, and agriculture usually are more important to cyclone victims than is material assistance; and 13) Churches, schools, and other large buildings that often are designated as cyclone shelters usually are not safe. The number of deaths attributed to destroyed or flooded shelters is alarming. Most experts agree that the best alternative is adequate warning and evacuation of the threatened areas.

Disaster Planning↗
PubMedDate not supplied

The consequence of land mines on public health.

An estimated 110 million land mines scattered in 64 countries continue to terrorize people and destroy human lives long after wars and fighting have ceased. Despite efforts to clear these devices, their numbers continue to increase and their presence constitutes a substantial threat to public health in affected countries. Direct consequences include both the physical and emotional injuries from the impact, flying debris, and structural collapse associated with their detonation. Indirect consequences include increases in the incidence of waterborne diseases, diarrhea, malnutrition, infectious diseases, and spread of the human immunodeficiency virus associated with the increased use of blood. Those at highest risk of these later consequences are mostly the disadvantaged poor, especially children. Psychiatric disorders, such as post-traumatic stress disorder, occur in those not directly injured as well as those physically wounded by the explosion. Besides efforts to ban production, stockpiling and export of land mines, a comprehensive and integrated health program aimed at the prevention, treatment, and rehabilitation of those injured directly or indirectly by land mines is needed urgently. Strategies should include mine-awareness programs, enhanced transport of those directly injured, training the villagers in first aid, augmenting the capacity and quality of treatment facilities, improving the psychological support and treatment capabilities, development of rehabilitation programs, and the institution and enhancement of public-health programs directed at the indirect consequences associated with the presence of land mines. Land mines constitute a major public health problem in the world that must be addressed.

Adult↗
PubMed2006

Elucidating amyloid beta-protein folding and assembly: A multidisciplinary approach.

Oligomeric, neurotoxic amyloid protein assemblies are thought to be causative agents in Alzheimer's and other neurodegenerative diseases. Development of oligomer-specific therapeutic agents requires a mechanistic understanding of the oligomerization process. This is a daunting task because amyloidogenic protein oligomers often are metastable and comprise structurally heterogeneous populations in equilibrium with monomers and fibrils. A single methodological approach cannot elucidate the entire protein assembly process. An integrated multidisciplinary program is required. We discuss here the synergistic application of in hydro, in vacuo, and in silico methods to the study of the amyloid beta-protein, the key pathogenetic agent in Alzheimer's disease.

Amino Acid Sequence↗
PubMed2004

Mapping the topology and determination of a low-resolution three-dimensional structure of the calmodulin-melittin complex by chemical cross-linking and high-resolution FTICRMS: direct demonstration of multiple binding modes.

Calmodulin serves as a calcium-dependent regulator in many metabolic pathways and is known to bind with high affinity to various target proteins and peptides. One such target is the small peptide melittin, the principal component of honeybee venom. The calmodulin-melittin system was used as a model system to gain further insight into target recognition of calmodulin. Using chemical cross-linking in combination with high-resolution Fourier transform ion cyclotron resonance mass spectrometry (FTICRMS), we have determined the interacting regions within the calcium-dependent calmodulin-melittin complex and thus the orientation of bound melittin. Using ambiguous distance restraints derived from the chemical cross-linking data in combination with recently developed computational methods of conjoined rigid body/torsion angle simulated annealing, we were able to generate low-resolution three-dimensional structure models of the calmodulin-melittin complex, for which no high-resolution structure exists to date. Our data provide evidence for the first time that calmodulin can recognize target peptides in two opposing orientations simultaneously. The general procedure for mapping interacting regions within the complex involves conjugation of calmodulin and melittin with several cross-linking reagents possessing different specificities and spacer lengths, followed by enzymatic proteolysis of the cross-linked complex. The highly complex peptide mixtures were subsequently analyzed by nano-HPLC, which was online coupled to a FTICR mass spectrometer equipped with a nano-electrospray ionization source. The mass spectra obtained in this manner were screened for possible cross-linking products using customized software programs. This integrated approach, exemplified for mapping the topology of the calmodulin-melittin complex, is likely to have wide-ranging implications for structural studies on protein-protein interactions.

Amino Acid Sequence↗
PubMed2002

Effects of triflumuron on the two-spotted spider mite, Tetranychus urticae (Acari: Tetranichydae).

The effects of triflumuron on the mortality, fecundity, and fertility of the two-spotted spider mite, Tetranychus urticae, were evaluated in the laboratory. No differences in toxicity for larvae, protonymphs and deutonymphs were observed, but immature stages were 3.8-times more susceptible than adults at the LC50. The compound exhibited a direct contact ovicidal activity influenced by eggs age. 48-72 h old eggs were significantly more sensitive than eggs of the other age classes. No hatch inhibition was observed in eggs laid by treated adult females using a sublethal dose at two physiological times (<12 and 48-72 h old). However. fecundity decreased in younger treated females, but it increased in the older-ones. The toxicity for immatures and eggs, and the sublethal effects described suggest that triflumuron could be an interesting incorporation in integrated pest programs of T. urticae.

Animals↗
PubMed2002

Programming of endogenous and exogenous saccades: evidence for a competitive integration model.

Participants were required to make a saccade to a uniquely colored target while ignoring the presentation of an onset distractor. The results provide evidence for a competitive integration model of saccade programming that assumes endogenous and exogenous saccades are programmed in a common saccade map. The model incorporates a lateral interaction structure in which saccade-related activation at a specific location spreads to neighboring locations but inhibits distant locations. In addition, there is top-down, location-specific inhibition of locations to which the saccade should not go. The time course of exogenous and endogenous activation in the saccade map can explain a variety of eye movement data, including endpoints, latencies, and trajectories of saccades and the well-known global effect.

Analysis of Variance↗
PubMed2000

A new method for the radiological investigation of residual ridge resorption in the maxilla.

OBJECTIVES: To develop a new method for assessing residual ridge resorption in the edentulous maxilla. METHODS: Defined experimental and reference areas in the maxilla were drawn on transparent film laid over a panoramic radiograph and digitized. Bone areas were measured with an integrated planimetry program and expressed as a ratio R. The effect of positioning errors on reliability of the method was investigated on dry skulls. The correlation between the change in ratio and actual bone loss was examined by progressively reducing the height of an artificial residual ridge on one skull. RESULTS: The coefficient of variation for the absolute ratio in different head positions was < 0.05 and its correlation coefficient of the change in R and the degree of resorption was r2 > or = 98.3%, P = 0.0001. CONCLUSIONS: Comparison of the experimental area with the reference area on serial panoramic radiographs appears suitable for the assessment of residual resorption in the maxilla.

Bone Resorption↗