Collaboration with school nurses: improving the effectiveness of tuberculosis screening.

Objective: To compare tuberculosis skin test (TST) reading rates between children whose tests were read by school nurses following specific requests by physicians and those who relied on their parents to get their tests read, either at school or at the physician's office.

Design: A randomized controlled trial.

Setting: An urban hospital-based pediatric practice.

Epilepsy in Aging Populations.

Older adults pose special challenges when seizures or epilepsy occur. Increased risk for seizures is often unrecognized. Older adults may have milder epilepsy, and may not require or tolerate standard doses of anti-epileptic drugs (AEDs).

Pre-operative intra-aortic balloon counterpulsation in stable patients with left main coronary disease.

Objective: To determine whether prophylactic, pre-operative, intra-aortic balloon counterpulsation (IABC) improves clinical outcome in stable patients with severe left main coronary artery disease.

Methods: A post-hoc analysis of 457 prospectively tracked, non-randomized patients undergoing coronary artery bypass graft surgery (CABG) for left main stenoses 50% and multivessel coronary disease, but without any hemodynamic compromise or ongoing angina, was conducted. Patients with heart failure, shock, ongoing ischemia or previous CABG were excluded.

Mechanisms whereby rapid RV pacing causes LV dysfunction: perfusion-contraction matching and NO.

Incessant tachycardia induces dilated cardiomyopathy in humans and experimental models; mechanisms are incompletely understood. We hypothesized that excessive chronotropic demands require compensatory contractility reductions to balance metabolic requirements. We studied 24 conscious dogs during rapid right ventricular (RV) pacing over 4 wk.

Animal cloning--the route to new genomics in agriculture and medicine.

This paper reviews the origin and development of animal cloning in metazoans starting with primitive experiments performed during the late 1880's and early 1900's, followed by nuclear transplantation in amphibians in 1952, then extended to fish and insects in the 1960's, and finally to mammals in the 1980's. Emphasis is placed on the applications of mammalian cloning to agriculture, medicine, and the conservation of endangered species. In addition, the introduction of genes via random insertion or gene targeting into the genome of donor cells to be used for cloning has opened up another route for new genomics in agriculture and medicine.

Degranulation influences heparin-associated inhibition of RT-PCR in human lung mast cells.

Background: The study of gene expression from human lung mast cells (HLMC) has been limited by the ability to reliably detect mRNA transcripts from scant quantities of mast cell RNA contaminated with heparin.

Objective: As heparin is granule-associated within the mast cell, we examined the role of degranulation in altering the intrinsic ability of this proteoglycan to inhibit reverse transcription polymerase chain reaction (RT-PCR) from HLMC RNA. We also explored alternative means of RNA isolation to eliminate primary heparin contamination.

SIV cardiomyopathy in non-human primates.

While cardiac myocytes are not generally considered conventional cellular targets of retroviral infection with HIV-1, the increasing recognition of AIDS related cardiomyopathy has raised important questions as to the viral pathogenesis. Our laboratory has explored the role of simian immunodeficiency viral (SIV) infection in non-human primates as a suitable large-animal model to examine cardiac involvement. Our data suggest that in the presence of inflammatory myocarditis, SIV is localized to CD4 bearing inflammatory cells and not cardiac myocytes, suggesting that the heart may be an innocent bystander in AIDS cardiomyopathy.

Mechanisms of plaque stabilization for a charged calcium channel blocker in coronary artery disease.

Coronary artery disease (CAD) results from atherosclerosis, a systemic vascular disorder that is the leading cause of death and disability throughout much of the developed world. Because cellular changes associated with vulnerable atherosclerotic plaque are characterized by a loss of normal calcium regulation, there is strong interest in a potential antiatherosclerotic role for calcium channel blockers. This hypothesis has been supported by investigational studies conducted in well-defined cellular and animal models of atherosclerosis.

Characterization of antibody responses to annual influenza vaccination over four years in a healthy elderly population.

The effects of yearly influenza immunization on the level of antibody responses were assessed in 92 healthy elderly subjects immunized over four contiguous years (1993-1996) with a trivalent influenza vaccine that included A/Texas annually. Anti-A/Texas antibodies increased significantly and similarly post-vaccination each year, but returned to comparable baseline levels annually. Percentages of subjects with anti-A/Texas titers > or =40 post-vaccination were comparable over four years.

Ethnic diversity of class III genes in autoimmune disease.

One may wonder why the genes for the class III region are even situated in the human Major Histocompatibility Locus (MHC). However, on closer inspection we find that the genes for the complement components, tumor necrosis factor (TNF) and others may play an important role in host immune defenses. Thus, this region on chromosome six may be more appropriately thought of as an immune response area.

Future directions.

With the continued explosion of genetic technology, the number of disorders amenable to screening is expanding geometrically. Historically, most genetic screening has been in the newborn period. Much more can be done for the fetus if genetic screening and diagnosis are accomplished early in the pregnancy rather than after birth.

Second-trimester biochemical screening.

The past years have seen considerable progress in the area of biochemical screening. Increasing data have now clearly shown the advantages of multiple markers, particularly beta-hCG over AFP alone. There continues to be considerable controversy over the best mathematic algorithm and which markers are best (e.

Principles of screening.

Over the past several decades, the principles by which screening tests are performed have slowly been developed and refined. The key distinction for the clinician to understand is the difference between diagnostic tests, which give a definitive answer, and screening tests, which identify who among the low-risk population is at high risk.

Architectural-based interpretations of breast MR imaging.

Architectural features extracted from high spatial resolution MR images of the breast can help distinguish malignant from benign breast abnormalities and can help predict specific histopathologic diagnoses. Various breast pathologies consistently display certain MR architectural features. Individual architectural features have been incorporated into interpretation models that can improve the diagnostic performance of MR imaging over the use of individual features alone.

The p38 mitogen-activated protein kinase is involved in associative learning in rabbits.

This study examined the role of the mitogen-activated protein kinase (MAPK) family during acquisition of the rabbit's classically conditioned eye-blink response. Eye-blink conditioning produced a significant, bilateral activation of both extracellular signal-regulated protein kinases (ERKs) and p38 MAPK in the anterior cerebellar vermis. There was also a significant bilateral activation of ERKs in the dorsal hippocampus with no change in p38 MAPK.

Hepatocellular ubiquitin expression in alpha1-antitrypsin deficiency.

Studies of the ubiquitin-proteasome system in alpha1-antitrypsin (AAT) deficiency have been performed using only biochemical and molecular biology techniques on human cells as well as on AAT-deficient transduced cell lines. The objective of our study was to assess the immunohistochemical and topographic features of ubiquitin in the livers of AAT-deficient children with and without active liver disease. Fourteen cases of AAT deficiency were retrieved from our archives, along with 10 control liver specimens obtained from autopsies of age-matched children with no clinical, gross anatomic, or histologic evidence of liver disease.

Neurologic complications after lumbar spine surgery.

With the increasing complexity and number of lumbar spine operations being performed, the potential number of patients who will sustain perioperative complications, including those that involve neural structures, has also increased. Neurologic complications after lumbar spine surgery can be categorized by the perioperative time period during which they occur and by their mechanism of injury. Although the overall incidence of neurologic complications after lumbar surgery is low, the severity of these injuries mandates careful preoperative planning, awareness of risk, and meticulous attention to perioperative details.

Evidence for distinct cholesterol domains in fiber cell membranes from cataractous human lenses.

Previous studies in our laboratory have provided direct evidence for the existence of distinct cholesterol domains within the plasma membranes of human ocular lens fiber cells. The fiber cell plasma membrane is unique in that it contains unusually high concentrations of cholesterol, with cholesterol to phospholipid (C/P) mole ratios ranging from 1 to 4. Since membrane cholesterol content is disturbed in the development of cataracts, it was hypothesized that perturbation of cholesterol domain structure occurs in cataracts.

Role of cardiac nerves in the cardiovascular response to cocaine in conscious dogs.

Background: Although the cardiovascular toxicity of cocaine is well recognized, considerable controversy remains as to the relative contribution of local norepinephrine reuptake inhibition versus central stimulatory effects of cocaine in eliciting its cardiovascular actions. The purpose of the present study was to determine the role of cardiac nerves in mediating the left ventricular (LV) and coronary hemodynamic responses to cocaine.

Methods And Results: We studied the cardiovascular response to acute cocaine administration (1 mg/kg) in 10 intact, conscious dogs and 6 dogs with ventricular denervation (VD).

Functional outcome after repair of unruptured intracranial aneurysms.

Object: Repair of unruptured aneurysms is a reasonable course of action if their expected natural history is worse than the predicted risks of treatment. The purpose of this study was to examine the presenting symptoms of unruptured aneurysms and to test the hypothesis that unruptured intracranial aneurysms can be repaired without significant functional worsening. A second hypothesis was also examined--that is, that the experience of the surgeon, the aneurysm size, and the patient age can be used to predict functional outcome.

Treatment practices for childhood posttraumatic stress disorder.

Objective: This study surveyed practices in treating childhood PTSD among child psychiatrists and non-M.D. therapists with self-identified interest in treating traumatized children.

Calming the plaque to delay intervention for 24 hours in acute coronary syndromes.

One approach to management of patients with acute coronary syndromes involves use of pharmacologic therapy to passivate plaque for at least 24 hours before interventional procedures are undertaken. This approach is supported by the view that whatever subsequent treatment the patient receives will less likely be complicated. An important factor in revolutionizing treatment for acute coronary syndromes in recent years has been the introduction of potent new antithrombotic and antiplatelet pharmacologic therapies such as low-molecular-weight heparins and glycoprotein IIb/IIIa inhibitors.