The impact of a clinical rotation in hospice: medical students' perspectives.

Medical educators agree that training in end-of-life care (EOLC) must be an integral part of medical education at all levels. While progress in this area of education has taken place, many gaps still exist. This article describes the self-reported impact of a required one-week hospice rotation for third-year medical students.

Isotropic MRI of the knee with 3D fast spin-echo extended echo-train acquisition (XETA): initial experience.

Objective: The purpose of our study was to prospectively compare a recently developed method of isotropic 3D fast spin-echo (FSE) with extended echo-train acquisition (XETA) with 2D FSE and 2D fast recovery FSE (FRFSE) for MRI of the knee.

Subjects And Methods: Institutional review board approval, Health Insurance Portability and Accounting Act (HIPAA) compliance, and informed consent were obtained. We studied 10 healthy volunteers and one volunteer with knee pain using 3D FSE XETA, 2D FSE, and 2D FRFSE.

Hospice pharmaceutical cost trends.

Hospices are required to provide pharmaceuticals under the Medicare Hospice Benefit. Since there are no data describing these costs for hospice programs, this study analyzes data from a cross-sectional survey of 34 hospices concerning their pharmaceutical cost trends. Most respondents reported higher pharmaceutical-related costs between 1998 and 2002, but a significant minority reported that their costs had decreased.

Outcomes and characteristics of patients discharged alive from hospice.

Objectives: To describe outcomes and characteristics of patients discharged alive from hospice.

Design: Prospective cohort study using a telephone survey.

Setting: Hospices (n=18) participating in the Population-Based Palliative Care Research Network during the 1-year study period.

Hyperoxia activates NF-kappaB and increases TNF-alpha and IFN-gamma gene expression in mouse pulmonary lymphocytes.

Hyperoxia-associated production of reactive oxygen species leads to neutrophil infiltration into the lungs and increased pulmonary proinflammatory cytokine expression. However, the initial events induced by hyperoxia, and leading to acute inflammatory lung injury, remain incompletely characterized. To explore this issue, we examined nuclear transcriptional regulatory factor (NF-kappaB and NF-IL-6) activation and cytokine expression in the lungs following 12 to 48 h of hyperoxia exposure.

Effect of vitamin E deficiency and supercritical fluid aerosolized vitamin E supplementation on interleukin-1-induced oxidative lung injury in rats.

We hypothesized that alterations in lung vitamin E levels would impact the development of acute oxidative lung injury. We found that dietary induced deficiency of vitamin E diminished lung tissue levels of vitamin E and increased lung leak following intratracheal administration of interleukin-1 (IL-1) to rats. Conversely, rats administered vitamin E directly to the lungs as an inhaled aerosol (0.

Xanthine oxidase promotes neutrophil sequestration but not injury in hyperoxic lungs.

Neutrophil accumulation in alveolar spaces is a conspicuous finding in hyperoxia-exposed lungs. We hypothesized that xanthine oxidase (XO)-derived oxidants contribute to retention of neutrophils in hyperoxic lungs. Rats were subjected to normobaric hyperoxia (100% O2) for 48 h, and lungs were assessed for neutrophil sequestration (morphometry and lavage cell counts) and injury (lavage albumin levels and lung weights).

Interleukin-1-induced lung neutrophil accumulation and oxygen metabolite-mediated lung leak in rats.

We found that intratracheal administration of recombinant interleukin-1 alpha (IL-1) into rats rapidly (< 5 h) increased neutrophils in lung lavages and caused an acute edematous lung injury which was reflected by lung albumin accumulation (lung leak) and histological abnormalities (perivascular cuffing). These IL-1-dependent processes were inhibited by prior administration of recombinant IL-1 receptor antagonist and did not occur following administration of heated IL-1. Several lines of evidence suggested that neutrophil-derived oxygen metabolites contributed to lung leak.

Toxic effects of dimethylthiourea in rats.

Dimethylthiourea (DMTU) is a small, highly diffusible molecule that effectively scavenges toxic oxygen metabolites in vitro and reduces oxidative injury in many biologic systems. Nonetheless, for unknown reasons, DMTU has occasionally failed to decrease damage in some systems where injury is presumed to be mediated by oxygen metabolites. We hypothesized that the inconsistent pattern of protection might partially reflect a direct toxicity of DMTU.

Postinsult treatment with N-acetyl-L-cysteine decreases IL-1-induced neutrophil influx and lung leak in rats.

We found that intratracheal administration of interleukin-1 alpha (IL-1) rapidly (5 h) increased leak of 125I-labeled albumin from the blood into the lung (lung leak), influx of neutrophils into lung lavages, lung oxidized glutathione (GSSG) levels, breath hydrogen peroxide (H2O2) concentrations, and lung histological abnormalities in intact rats. Since N-acetyl-L-cysteine (NAC) increases glutathione (GSH) levels in vivo and scavenges oxygen radicals in vitro, we tested the effect of NAC given intravenously on lung changes following intratracheal IL-1 administration. We found that administration of NAC immediately before or 2.

Effects of dimethylthiourea in hyperoxic injury.

Pretreatment with a single dose of the oxygen metabolite scavenger 1,3-dimethyl-2-thiourea (DMTU) decreased hyperoxia-induced injury (as assessed by measurement of pleural effusions and increases in hematocrits and blood acid-soluble sulfhydryl levels) in rats that were exposed to hyperoxia for 48 hours. However, the degree of protection was not proportional to DMTU dose. An intermediate dose of DMTU (250 mg/kg) reduced injury more than a lower dose of 125 mg/kg and at least as effectively as the higher, widely used dose of 500 mg/kg DMTU.

A comparison of the ocular hypotensive efficacy of twice-daily 0.25% levobunolol to 0.5% timolol in patients previously treated with 0.5% timolol.

Treatment with noncardioselective beta-adrenoceptor antagonists (e.g., 0.

Human phagocytic cells as oxygen metabolite scavengers.

Human neutrophils or monocytes decreased hydrogen peroxide (H2O2) concentrations in vitro. Neutrophils or monocytes decreased H2O2 concentrations as well as human erythrocytes. Treatment with aminotriazole or azide decreased both phagocyte and erythrocyte catalase activity and the ability of each cell to decrease H2O2 concentrations in vitro.

Xanthine oxidase is increased and contributes to paraquat-induced acute lung injury.

Two lines of investigation suggested that xanthine oxidase- (XO) derived O2 metabolites contribute to paraquat- (PQ) induced acute lung injury. First, PQ treatment increased lung XO activity and decreased lung xanthine dehydrogenase activity. Second, lung albumin uptake increased compared with control values in untreated XO-replete but not tungsten-treated XO-depleted lungs in rats treated with PQ.

Albumin decreases hydrogen peroxide and reperfusion injury in isolated rat hearts.

Perfusion with human serum albumin decreased myocardial hydrogen peroxide (H2O2) levels (as assessed by inactivation of myocardial catalase activities following aminotriazole pretreatment) and increased myocardial ventricular developed pressures (DP), contractility (+dP/dt) but not relaxation rate (-dP/dt) in isolated crystalloid perfused rat hearts subjected to normothermic global ischemia (20 min) and then reperfusion (40 min). Albumin also decreased H2O2 concentrations in vitro. The findings support the possibility that albumin may act as a protective O2 metabolite scavenger in vivo.

Blood sulfhydryl level increases during hyperoxia: a marker of oxidant lung injury.

Blood acid-soluble sulfhydryl, but not glutathione (GSH), levels increased during the development of acute edematous lung injury in rats exposed to normobaric hyperoxia for 48 h or more. A relationship between increases in blood sulfhydryl levels, lung injury, and O2 metabolite generation during exposure to hyperoxia was suggested by two observations. First, increases in blood sulfhydryl levels occurred simultaneously with increases in lung oxidized glutathione (GSSG) levels and lung GSSG-to-GSH ratios (GSSG/GSH).

Erythrocytes decrease myocardial hydrogen peroxide levels and reperfusion injury.

Reperfusion with untreated, carbon monoxide-treated, or glutaraldehyde-fixed human erythrocytes (RBC) increased ventricular function and decreased myocardial hydrogen peroxide (H2O2) levels [assessed by H2O2-dependent aminotriazole (AMT) inactivation of myocardial catalase activities] of ischemic, isolated rat hearts. In contrast, reperfusion with RBC that lacked catalase (AMT treated) and/or glutathione (N-ethylmaleimide treated) did not increase ventricular function or decrease myocardial H2O2 levels as much as reperfusion with untreated RBC. By comparison, reperfusion with superoxide dismutase-depleted (diethyldithiocarbamate-treated) or anion channel-inhibited (diisothiocyanodisulfonic acid stilbene-treated) RBC increased ventricular function and decreased myocardial H2O2 levels the same as untreated RBC.

Dimethylthiourea prevents hydrogen peroxide and neutrophil mediated damage to lung endothelial cells in vitro and disappears in the process.

Dimethylthiourea (DMTU) progressively disappeared following reaction with increasing amounts of hydrogen peroxide (H2O2) in vitro. DMTU disappearance following reaction with H2O2 was inhibited by addition of catalase, but not aminotriazole-inactivated catalase (AMT-catalase), superoxide dismutase (SOD), mannitol, benzoate or dimethyl sulfoxide (DMSO) in vitro. By comparison, DMTU disappearance did not occur following addition of histamine, oleic acid, elastase, trypsin or leukotrienes in vitro.

Hyperoxia and self- or neutrophil-generated O2 metabolites inactivate xanthine oxidase.

Xanthine oxidase (XO) and xanthine dehydrogenase (XD) activities decreased in lungs isolated from rats and cultured lung endothelial cells that had been exposed to hyperoxia. Purified XO activity also decreased after addition of a variety of chemically generated O2 metabolite species (superoxide anion, hydrogen peroxide, hydroxyl radical, or hypochlorous acid), hypoxanthine, or stimulated neutrophils in vitro. XO inactivation by chemically, self-, or neutrophil-generated O2 metabolites was decreased by simultaneous addition of various O2 metabolite scavengers but not their inactive analogues.

Prolapse of a rigid anterior chamber lens through an iridectomy: report of ten cases.

I have observed ten cases in which a rigid anterior chamber lens prolapsed through the iridectomy. The lens dislocation was associated with cystoid macular edema in four cases and threatened the cornea in two cases. Vitrectomy and replacement with a flexible lens resulted in good vision.

Persistent bactericidal defect in neutrophils from a young woman who recovered from toxic shock syndrome.

We have previously found transient menstruation-associated abnormalities in the in vitro bactericidal function of neutrophils from females who have recovered from toxic shock syndrome (TSS). We now report the case of a young woman who has also recovered from TSS, but who has a persistent, non-menstruation-associated defect in the ability of her neutrophils to kill Staphylococcus aureus in vitro.

Erythrocytes from cigarette smokers contain more glutathione and catalase and protect endothelial cells from hydrogen peroxide better than do erythrocytes from nonsmokers.

Recent observations regarding the ability of intracellular erythrocyte (RBC) antioxidants to decrease O2 metabolite-mediated injury to lung tissues has prompted interest in the RBC antioxidants of patients with lung disease. We found that RBC from 14 healthy, age- and gender-matched cigarette smokers contained more (p less than 0.05) glutathione (6.

In situ measurements of chemical distributions in a deep-sea hydrothermal vent field.

Large changes in the concentration of sulfide around a hydrothermal vent in the Galápagos Rift provide direct evidence for the consumption of sulfide by the organisms of the vent community. These changes were detected with a new chemical analyzer capable of measuring silicate, sulfide, oxygen, and temperature on the sea floor at depths of 2500 meters. More than 10,000 measurements showed systematic variations in the sulfide and oxygen concentrations due to biogenic oxidation of sulfide in the hydrothermal solutions.