Randomized double-blind safety study of enoxaparin versus unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes treated with tirofiban and aspirin: the ACUTE II study. The Antithrombotic Combination Using Tirofiban and Enoxaparin.

Background: In comparison with treatment with unfractionated heparin (UFH) and aspirin (ASA), both tirofiban administered with UFH and ASA, and enoxaparin plus ASA have shown superiority in reducing cardiac ischemic events in patients with unstable angina and non-ST-segment elevation myocardial infarction. Replacing UFH with enoxaparin when tirofiban is administered to patients may offer further therapeutic benefit, but could also increase bleeding.

Objective: Our objective was to provide estimates of the frequency of bleeding complications, as defined by means of the Thrombolysis In Myocardial Infarction(TIMI) group, and collect data on clinical efficacy of the combination of tirofiban with enoxaparin plus ASA.

Prostate cryoablation: a scientific rationale for future modifications.

This investigation was designed to identify potential directions for future modification of the percutaneous prostate cryoablation procedure. An analysis of prostate cancer location and volume in radical prostatectomy specimens was performed to evaluate the potential clinical consequences of these proposed modifications. A list of recommendations for improvements in the prostate cryoablation procedure was compiled from informal discussions held with participants in 9 training courses and conferences on prostate cryoablation over 18 months.

Decreased IL-2, IFN-gamma, and IL-10 production by aged mice during the acute phase of E55+ retrovirus infection.

We previously reported that aged mice demonstrated a 12-week delay in virus clearance compared to young mice after infection with E55+ murine leukemia retrovirus (E55+MuLV). The current study demonstrates that both the levels of IL-2, IFN-gamma, and IL-10 and the number of cells producing IL-2 and IFN-gamma were lower at 2 and 4 weeks postinfection (p.i.

Multifocal atrophic gastritis and gastric carcinoma.

Gastric carcinoma remains a major cause of morbidity and mortality worldwide despite its significant decline in recent years. H. pylori infection begins with nonatrophic gastritis, and most individuals continue to have nonatrophic H.

An assessment of residents' abilities to detect and manage domestic violence.

Despite increased awareness of domestic violence (DV), little is known about residents' preparedness to diagnose and respond appropriately to abuse victims. We designed a pilot study to examine this. Seventy-one internal medicine residents participated in a 10-station standardized patient-based Clinical Skills Assessment.

Forced expiratory time and bronchial hyperresponsiveness to methacholine.

Pulmonary junction tests (PFTs) are normally performed prior to methacholine inhalation challenges (MICs). In contrast to normal baseline spirometry (FEV1, FEF25%-27%, FVC), we have observed patients with positive MICs having shortened forced expiratory times (FET100%) in the baseline pre-MIC PFT. We prospectively evaluated the correlation of abnormalities in baseline pre-MIC FET100% in patients who have positive vs.

Enoxaparin in unstable angina/non-ST-segment elevation myocardial infarction: treatment benefits in prespecified subgroups.

Background: Two large-scale phase III clinical trials, the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events (ESSENCE) trial and the Thrombolysis in Myocardial Infarction (TIMI) 11B study, have shown the low-molecular-weight heparin, enoxaparin, to be more effective than unfractionated heparin (UFH) in reducing the risk of death and severe cardiac events in patients with rest unstable angina and/or non-ST-segment elevation myocardial infarction (NSTEMI). However, patients with NSTEMI acute coronary syndromes are a heterogeneous group.

Methods: A meta-analysis using pooled data from ESSENCE and TIMI 11B was performed to examine the efficacy of enoxaparin in different patient subgroups.

Emergency department preparedness for the evaluation and treatment of victims of biological or chemical terrorist attack.

This study evaluated the preparedness of Emergency Departments (EDs) in the greater Philadelphia area to evaluate and treat victims of a terrorist biological or chemical agent release. All hospitals with EDs in the survey target area were included. A survey instrument consisting of 38 questions was mailed to the physician director of each ED.

Sexual diergism of hypothalamo-pituitary-adrenal cortical responses to low-dose physotigmine in elderly vs. young women and men.

We previously demonstrated that the reversible cholinesterase inhibitor, physostigmine (PHYSO), administered to normal young adult women and men (average age 35 years) at a dose that produced few or no side effects, resulted in a sex difference (sexual diergism) in hypothalamo-pituitary-adrenal cortical (HPA) axis responses: Plasma ACTH(1-39), cortisol, and arginine vasopressin (AVP) concentrations increased to a significantly greater extent in the men than in the women. To explore the effect of age on these sexually diergic hormone responses, in the present study we used the same dose of PHYSO (8 microg/kg IV) to stimulate ACTH(1-39), cortisol, and AVP secretion in normal elderly, non-estrogen-replaced women and elderly men (average ages 73 years and 70 years, respectively). The subjects underwent three test sessions 5-7 days apart: PHYSO, saline control, and a second session of PHYSO.

Ruptured right coronary artery aneurysm presenting as a myocardial mass.

Rupture of a coronary artery aneurysm may result in a contained hematoma and an intramyocardial mass. We present a case of a contained coronary artery aneurysm rupture presenting as a mass in the right ventricle. The mass was suspected in a preoperative transthoracic echocardiogram and identified at the time of elective coronary artery bypass surgery.

Expansion of the Knops blood group system and subdivision of Sl(a).

Background: Complement receptor type 1 (CR1), which bears the Knops (Kn [KN]) blood group antigens, is involved in the rosetting of Plasmodium falciparum- infected RBCs with uninfected cells. As a first step in understanding this interaction, the molecular basis for the blood group antigens encoded by CR1 was investigated.

Study Design And Methods: An antibody from a white donor who exhibited an apparent anti-Sl(a) was used for population studies of several racial groups.

Reflex sympathetic dystrophy.

Reflex sympathetic dystrophy (RSD) is composed of five major features: pain, swelling, autonomic dysregulation, movement disorders, and atrophy and dystrophy. RSD is caused by an injury to a specific nerve or the C- and A-delta fibers that innervate the involved tissue. It is a progressive illness that spreads with time and may encompass the entire body.

Use of ligase chain reaction for laboratory identification of Chlamydia trachomatis and Neisseria gonorrhoeae in adolescent women.

Study Objective: To compare the ligase chain reaction (LCR) with culture for the detection of Neisseria gonorrhoeae (GC) and with culture and direct fluorescent antibody (DFA) for identification of Chlamydia trachomatis (CT) in cervical specimens from adolescent women.

Design: A prospective study of test performance.

Setting: Two urban, hospital-based adolescent clinics.

Prolonged E55+ retrovirus expression in aged mice is associated with a decline in the anti-virus immune response.

E55+ murine leukemia retrovirus (E55+ MuLV) infection of young and aged C57BL/6 (B6) mice was used to investigate the relationship between increased incidences of infection and decreased immune responsiveness of elderly individuals. Young mice decreased E55+ MuLV burden to below detectable levels by 8 weeks postinfection (p.i.

The inhibition of calcium signaling in T lymphocytes from old mice results from enhanced activation of the mitochondrial permeability transition pore.

Aging attenuates calcium signaling in T lymphocytes from old mice. Aging also attenuates the sustained elevation of cell free calcium by ionomycin, which is similar to the T cell receptor signal. In T lymphocytes from young mice, the ionomycin-induced elevation of cell free calcium was inhibited by collapsing the mitochondrial membrane potential by uncouplers and ionophores, and activation of the permeability transition.

Splenic arteries and veins in pediatric sickle cell disease.

The goal of this study was to verify the existence and prevalence of large vessel lesions outside the central nervous system in young patients with sickle cell disease. Thus, 17 spleens resected because of episodes of sequestration or infarction and 41 controls were studied. Anomalies of arteries and veins were detected in all spleens from sickle cell disease patients, but no definite correlation with age, sex, type of sickle hemoglobin, or frequency of sequestration episodes could be established.

Chromosome rearrangement with no apparent gene mutation in familial adenomatous polyposis and hepatocellular neoplasia.

We have identified a constitutional inversion in chromosome 5 associated with familial adenomatous polyposis in three generations of a Mexican family. Two of three siblings developed hepatic neoplasia in infancy. The gene truncation assay failed to demonstrate a truncated protein in the segment harboring the adenomatous polyposis coli (APC) genes.

Modification of glutamate binding sites in newborn brain during hypoglycemia.

We have shown that acute insulin-induced hypoglycemia leads to specific changes in the cerebral NMDA receptor-associated ion channel in the newborn piglet. The present study tests the hypothesis that exposure to acute hypoglycemia in the newborn will alter the glutamate binding site of both NMDA and kainate receptors. Studies were performed in 3-6 days-old piglets randomized to control (n=6) or hypoglycemic (n=6) groups.

Self-control: theory and research.

Theory and research on self-control were reviewed. Selected research is summarized along with some conclusions from clinical practice. Self-control difficulties are of central importance for many psychiatric disorders.

Self-control: toward systematic training programs.

Selected literature is reviewed regarding the question, How may children's self-control skills be developed or improved through training? It is premature to give up on psychosocial methods of training self-control. Self-control is fostered by being in a long-term positive relationship with a dependable person who communicates the value of this goal; working at self-control challenges carefully chosen to be at the correct level of difficulty for present skill; getting many positive models of the successful exercise of self-control; logging in many hours of practice where valued rewards are contingent upon greater and greater exercise of effort; learning that valued rewards can be obtained by effort, and thereby learning to enjoy effort; using fantasy rehearsal; learning compliance skills; learning verbal concepts (including a term for self-control itself) that affect the world view in ways conducive to this skill; learning the art of self-instruction; learning to remove oneself from tempting stimuli, physically and mentally; and learning self-monitoring.

Apoptosis and the systolic dysfunction in congestive heart failure. Story of apoptosis interruptus and zombie myocytes.

Although previously it was believed that apoptosis could not occur in the terminally differentiated tissue, such as adult heart muscle cells, recent studies in endomyocardial biopsies from patients with dilated cardiomyopathy and in explanted hearts from patients with end-stage heart failure undergoing cardiac transplantation have demonstrated histologic evidence of apoptosis. Whereas neurohormonal activation during heart failure leads to compensatory hemodynamic alterations, coupled with ventricular dilatation, it induces transcription factors and myocyte hypertrophy. Persistent growth stimulation in terminally differentiated cells may lead paradoxically to apoptotic cell death.

Mode and timing of treatment failure (recurrent ischemic events) after hospital admission for non-ST segment elevation acute coronary syndromes.

Background: Clarification of the specific clinical course of non-ST-segment elevation acute coronary syndromes (NSTEMI ACS), including recurrent ischemic events and need for coronary revascularization, is important given the increasing economic pressure to shorten the length of hospitalization and therefore the duration of acute therapy. To examine the mode and timing of subsequent cardiac events, we analyzed pooled data from the ESSENCE and TIMI 11B studies of antithrombotic therapy in NSTEMI ACS.

Methods: The daily event rates (with confidence intervals) during the first 43 days and the monthly average event rates during the first year were tabulated for 7081 patients.

Role of humoral and cell-mediated immunity in protection from influenza disease after immunization of healthy elderly.

While influenza immunization significantly reduces the risk of pneumonia and associated deaths, vaccination of elderly only affords 30-50% protection against influenza disease. The purpose of this study was to: (1) evaluate the consistency of immune responses across multiple years in young and elderly; (2) determine the contribution of antibody and cell-mediated responses in protection after immunization with influenza vaccine. Independently living healthy elderly (>200/year; mean age 78.