Short- and long-term physiologic and pharmacologic control of blood pressure in pediatric patients.

The incidence of hypertension is rising in the general population. A parallel trend is present in children and adolescents. This reflects more intensive treatment and improved patient survival after a wide range of serious systemic illnesses that can lead to hypertension.

Development, impact, and measurement of enhanced physical diagnosis skills.

Evidence suggests that the quality and frequency of bedside clinical examination have declined. We undertook the study to (1) determine whether intensive instruction in physical examination enhances medical student skills and (2) develop a tool to evaluate those skills using a modified observed structured clinical examination (OSCE). This was a randomized, blinded, prospective, year-long study involving 3rd year students at the Albert Einstein College of Medicine.

Divergent roles of endothelial NF-kappaB in multiple organ injury and bacterial clearance in mouse models of sepsis.

To define the roles of endothelial-intrinsic nuclear factor kappaB (NF-kappaB) activity in host defense and multiple organ injury in response to sepsis, we generated double transgenic (TG) mice (EC-rtTA/I-kappaB alpha mt) that conditionally overexpress a degradation-resistant form of the NF-kappaB inhibitor I-kappaB alpha (I-kappaB alpha mt) selectively on vascular endothelium. The EC-rtTA/I-kappaB alpha mt mice had no basal, but a relatively high level of doxycycline-inducible, I-kappaB alpha mt expression. I-kappaB alpha mt expression was detected in endothelial cells, but not in fibroblasts, macrophages, and whole blood cells, confirming that transgene expression was restricted to the endothelium.

Posterior cerebral artery infarction associated with carotid dissection.

Unlabelled: Posterior circulation stroke may rarely be associated with occlusive disease in the anterior circulation, such as in the context of a direct (fetal) origin of the posterior cerebral artery (PCA) from the internal carotid artery (ICA), or in the presence of a persistent trigeminal artery. Carotid dissection is an increasingly recognized cause of anterior circulation ischemia. It is possible that in the setting of certain cerebral hemodynamics, embolism from carotid dissection could cause PCA infarction via a patent posterior communicating artery.

Interleukin-10 production after pro-inflammatory stimulation of neutrophils and monocytic cells of the newborn. Comparison to exogenous interleukin-10 and dexamethasone levels needed to inhibit chemokine release.

Background: Neutrophils followed by monocytic cells are recruited into the lung during the early development of bronchopulmonary dysplasia (BPD).

Objectives: We determined: (1) the capacity of polymorphonuclear leukocytes (PMNs) and peripheral blood monocytic cells (PBMCs) of the newborn to produce and release the anti-inflammatory cytokine, interleukin (IL)-10, after stimulation by lipopolysaccharide (LPS) or tumor necrosis factor (TNF), and (2) the levels of exogenous IL-10 and/or dexamethasone (DEX) needed to inhibit the release of the pro-inflammatory chemokine IL-8 from stimulated cells.

Methods: PMNs and PBMCs were isolated from cord blood of healthy term infants.

Lipopolysaccharide causes Sp1 protein degradation by inducing a unique trypsin-like serine protease in rat lungs.

We have previously demonstrated that challenge of rat or mice with lipopolysaccharide (LPS) in vivo promotes Sp1 protein degradation. The protease responsible for the LPS-induced Sp1 degradation has not been identified. In this study, we have identified, characterized and partially purified an LPS-inducible Sp1-degrading enzyme (LISPDE) activity from rat lungs.

Endometrial cells in pap smears of postmenopausal women: cytohistologic correlation.

Objective: To evaluate the significance of endometrial cells in Papanicolaou (Pap) smears of postmenopausal women.

Materials And Methods: We reviewed all Pap smears of postmenopausal women from 1992 to 1999. Follow-up endometrial tissue obtained within 1 year of any Pap smear containing benign endometrial cells or foamy histiocytes was also reviewed.

Chronic intermittent hypoxia activates nuclear factor-kappaB in cardiovascular tissues in vivo.

Obstructive sleep apnea (OSA) is an important risk factor for cardiovascular morbidity and mortality. The mechanisms through which OSA promotes the development of cardiovascular disease are poorly understood. In this study, we tested the hypotheses that chronic exposure to intermittent hypoxia and reoxygenation (CIH) is a major pathologic factor causing cardiovascular inflammation, and that CIH-induces cardiovascular inflammation and pathology by activating the NF-kappaB pathway.

Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature.

Compression of the left renal vein between the aorta and the superior mesenteric artery has been termed the nutcracker syndrome. Obstruction of left renal vein outflow results in venous hypertension with the formation of intra- and extrarenal collaterals and/or the development of gonadal vein reflux. To date, a variety of clinical symptoms due to mesoaortic compression of the left renal vein (nutcracker syndrome) have been described.

Two models of psychiatric rehabilitation: a need for clarity and integration.

Two distinct models are identifiable in the processes of psychiatric rehabilitation: treatment and training. The treatment model, which also can be presented as the "medical model," approaches the issues on the basis of defect which needs to be diagnosed and rectified. On the other hand, the training model, which can also be referred to as the "educational model," approaches the situation from the perspective of recognizing what strengths or abilities the individual may have which can be brought to bear constructively, and how to orchestrate that process.

Nitric oxide and glomerulonephritis.

Glomerulonephritis is a common clinical condition that is caused by immune-mediated injury to the kidney and is characterized by dysfunction of the glomerular capillary filtration barrier. Nitric oxide (NO), a ubiquitous molecule with many biological functions throughout the body, has been evaluated as an inflammatory mediator in these circumstances. NO may induce glomerular injury directly or may act via stimulation of a host of other inflammatory mediators.

A report of primary brain fibrosarcoma with literature review.

Primary fibrosarcoma of the central nervous system (CNS) is an extremely rare tumor. To the best of our knowledge, only 40 cases have been reported in the literature. We document such a case in a 9-year-old child who presented with a short history of headache and vomiting.

Lack of physician concordance with guidelines on the perioperative use of beta-blockers.

Background: The American College of Physicians recommends perioperative use of beta-blockers for certain patients to improve outcomes after surgery. Study of physician behavior with respect to guidelines and recommended practices have shown that beta-blockers have been underutilized after myocardial infarction. We evaluated physician concordance with the perioperative use of beta-blockers along with a specialty-related difference in the frequency of perioperative beta-blocker use.

Cardiac disease in children with primary glomerular disorders-role of focal segmental glomerulosclerosis.

Anecdotal reports suggest a higher frequency of serious cardiac complications, particularly cardiomyopathy and congestive heart failure (CHF), in children with focal segmental glomerulosclerosis (FSGS). We report the occurrence of cardiac disease in children with FSGS compared with other glomerular causes of primary nephrotic syndrome (NS). A chart review was performed on all patients evaluated at the Schneider Children's Hospital between 1985 and 2003 with a diagnosis of membranoproliferative glomerulonephritis (MPGN), membranous nephropathy (MN), focal global glomerulosclerosis (FGGS), and FSGS.

Outcome after renal transplantation in children: results of follow-up by nephrologists in a primary referral center.

Pediatric patients who receive a kidney transplant require extended follow-up to monitor graft function and for management of complications. Because of convenience, most patients are sent back to the nephrologists who referred them for transplantation (the primary nephrologist) for long-term care. As a consequence, many pediatric nephrologists who provide this extended care are not associated with a transplant center.

Evaluation of failure to thrive: diagnostic yield of testing for renal tubular acidosis.

Background: Failure to thrive (FTT) poses a diagnostic dilemma for pediatricians. The kidney disorder that is considered most often is renal tubular acidosis (RTA). However, the prevalence of RTA may be overestimated, leading to unnecessary referrals for subspecialty evaluation.

BRCA1 inhibition of telomerase activity in cultured cells.

Telomerase, an enzyme that maintains telomere length, plays major roles in cellular immortalization and cancer progression. We found that an exogenous BRCA1 gene strongly inhibited telomerase enzymatic activity in human prostate and breast cancer cell lines and caused telomere shortening in cell lines expressing wild-type BRCA1 (wtBRCA1) but not a tumor-associated mutant BRCA1 (T300G). wtBRCA1 inhibited the expression of the catalytic subunit (telomerase reverse transcriptase [TERT]) but had no effect on the expression of a subset of other components of the telomerase holoenzyme or on the expression of c-Myc, a transcriptional activator of TERT.

Body composition and resting energy expenditure in clinically stable, non-weight-losing patients with severe emphysema.

Study Objectives: To characterize the metabolic status of weight-stable and clinically stable individuals with advanced emphysema.

Patients: Seventy-nine patients with severe emphysema (FEV(1), 29 +/- 13% of predicted [mean +/- SD]) evaluated for enrollment in the National Emphysema Treatment Trial and 20 age-matched healthy subjects were studied.

Setting: Pulmonary function laboratory of university-affiliated teaching hospital.

Induction of mammary gland differentiation in transgenic mice by the fatty acid-binding protein MRG.

A mammary-derived growth inhibitor-related gene (MRG) was previously identified and characterized. MRG induces differentiation of mammary epithelial cells in vitro and its expression is associated with mammary differentiation. To further define the role of MRG on mammary gland differentiation, a MRG transgenic mice model under the control of mouse mammary tumor virus promoter was established and the effect of MRG on mammary gland differentiation was investigated at histological and molecular levels.

Diagnosis and management of infectious esophagitis associated with human immunodeficiency virus infection.

Esophageal disease is a common complication and cause of morbidity in patients with human immunodeficiency virus (HIV) infection. Opportunistic infections are the leading cause of esophageal complaints and may be a predictor of poor long-term prognosis, presumably as a reflection of severe underlying HIV immunodeficiency. The esophagus may be the site of the first acquired immunodeficiency syndrome (AIDS)-defining opportunistic illness in a large number of patients.