The effect of folate and cobalamin on osteoarthritic hands.

Objective: Historically diet and arthritis have been cause/effect associated but the idea is controversial with little evidence that specific diet components are effective treatment. This controlled, double-blinded, crossover study reports the effect of folate and cobalamin supplements in 26 humans diagnosed for an average 5.7 years with idiopathic osteoarthritis of the hands who had been medicated by prescribed nonsteroidal anti-inflammatory drugs (NSAID).

Functional endoscopic sinus surgery in patients with normal computed tomography scans.

Eighteen patients were operated on by functional endoscopic sinus surgery who had no ostiomeatal unit obstruction on computed tomography scan and had unremarkable paranasal sinuses. These patients also had no apparent ostiomeatal unit obstruction on diagnostic nasal endoscopy. Data were collected on these patients regarding the impact of very limited functional endoscopic sinus surgery on their principal complaint of recurrent sinusitis with facial pain/headache thought to be of sinogenic origin.

Functional endoscopic sinus surgery in patients with chronic sinusitis and asthma.

Twenty asthma patients who underwent functional endoscopic sinus surgery for chronic sinusitis were studied. Medical records and questionnaire data for these 20 patients were studied regarding the impact of sinus disease and functional endoscopic sinus surgery on their asthma. We found that 95% reported that their asthma was worsened by their sinus disease (95% confidence interval, 0.

First principles: physical science concepts as a foundation for advanced studies in physiology.

The importance of mathematics and physical science to physiology is amply evident in both the classic and current literature of this field. Students who have completed typical medical school preparatory programs, however, have been poorly equipped to embark on serious graduate study in physiology. Because undergraduate education in the sciences is typically structured as narrowly defined, disjointed degree programs in separate disciplines, students of biology have had only limited access to the resources of physical science departments.

Severe dysphagia from an Angelchik prosthesis: futility of routine esophageal testing.

A 33-year-old woman presented with progressive dysphagia 3 years after implantation of an Angelchik prosthesis for esophageal reflux disease. Routine esophageal testing was normal. Esophagogastroduodenoscopy and computed tomography suggested migration of the prosthesis.

Alternative splicing of pre-mRNAs encoding the nonstructural proteins of minute virus of mice is facilitated by sequences within the downstream intron.

mRNAs R1 and R2 of the parvovirus minute virus of mice encode the two essential viral regulatory proteins NS1 and NS2. Both RNAs are spliced between map units 44 and 46 (nucleotides 2280 and 2399); R2 RNAs are additionally spliced upstream between map units 10 and 39 (nucleotides 514 and 1989), using a nonconsensus donor and poor 3' splice site. The relative accumulation of R1 and R2 is determined by alternative splicing: there is twice the steady-state accumulation of R2 relative to that of R1 throughout viral infection, though they are generated from the same promoter and have indistinguishable stabilities.

Longstanding hyperprolactinemia associated with systemic lupus erythematosus: possible hormonal stimulation of an autoimmune disease.

Objective: To describe 4 women in whom hyperprolactinemia was associated with the development of systemic lupus erythematosus (SLE).

Methods: Clinical assessment and followup (2 cases). Chart review and interviews with the attending rheumatologist (2 cases).

Angiotensin II associated cardiac myocyte necrosis: role of adrenal catecholamines.

Objective: Cardiac myocyte necrosis is associated with an endogenous increase in angiotensin II or a subpressor dose of angiotensin II. In each case, raised plasma angiotensin II, together with aldosterone, results in cardiac myocyte necrosis followed by scarring. Arterial hypertension is non-contributory.

Market shares for rural inpatient surgical services: where does the buck stop?

Utilization of surgical services by rural citizens is poorly understood, and few data are available about rural hospitals' surgical market shares and their financial implications. Understanding these issues is particularly important in an era of financially stressed rural hospitals. In this study information about rural surgical providers and services was obtained through telephone interviews with administrators at Washington state's 42 rural hospitals.

Immunotherapy in patients undergoing functional endoscopic sinus surgery.

A total of 283 consecutive patients with chronic sinusitis underwent functional endoscopic sinus surgery. There were 72 allergic patients and 211 nonallergic patients. Data were collected on the effect of immunotherapy on middle meatotomy patency, synechiae formation, and recurrent polyps in allergic patients.

Processing and surface presentation of the Mycoplasma hyorhinis variant lipoprotein VlpC.

The variant surface lipoprotein VlpC of Mycoplasma hyorhinis was shown to be processed by cleavage of a characteristic prokaryotic prolipoprotein signal peptide. In addition, a vlpC::phoA fusion protein expressed and translocated in Escherichia coli was recognized by surface-binding monoclonal antibodies, which identified the characteristic region II of Vlps, containing divergent external sequences proximal to the membrane, as an exposed portion of these surface proteins subject to immune recognition and selection.

Frequency of seal disruption with the sarns centrifugal pump in postcardiotomy circulatory assist.

We have used the Sarns centrifugal pump for uni- or biventricular assist in 58 patients with postcardiotomy cardiogenic shock. This device utilizes a spinning impeller pump that is magnetically coupled to a motor imparting rotary motion to incoming perfusate. Nine patients (16%) experienced 22 device failures, which consisted of a nonvisible disruption of the seal within the pumphead.

Angiotensin-converting enzyme, bradykinin, and angiotensin II receptor binding in rat skin, tendon, and heart valves: an in vitro, quantitative autoradiographic study.

Angiotensin converting enzyme (ACE), an ectoenzyme bound to vascular endothelial cells, is also found at tissue sites (TACE) normally composed of fibrillar collagen and fibroblasts. For example, TACE is present in the adventitia of intramural coronary arteries and matrix of heart valves, as well as the fibrous tissue that follows the chronic administration of angiotensin II (AII) or aldosterone. At these sites bradykinin (BK) receptor but not AII receptor binding has been observed, suggesting that in fibrous tissue TACE uses BK as substrate.

Incidence of nonarteritic and arteritic anterior ischemic optic neuropathy. Population-based study in the state of Missouri and Los Angeles County, California.

This population-based study was undertaken to obtain information on age-, sex-, and race-specific incidence of nonarteritic and arteritic anterior ischemic optic neuropathy for the State of Missouri and for Los Angeles County, California. Among subjects who were 50 or older the estimated mean annual incidence rates per 100,000 population were 2.30 for nonarteritic anterior ischemic optic neuropathy and 0.

The public perception of head injury in Missouri.

Head injury constitutes a significant public health concern. Despite increasing recognition of the morbidity and mortality associated with head injury, there exist few statewide estimations of the prevalence and public perception of head injury. Knowledge of the public's perception can facilitate the funding and planning for the treatment and rehabilitation of persons with head injury.

Rural hospital inpatient surgical volume: cutting-edge service or operating on the margin?

Surgical services are an important part of modern health care, but providing them to isolated rural citizens is especially difficult. Public policy initiatives could influence the supply, training, and distribution of surgeons, much as they have for rural primary care providers. However, so little is known about the proper distribution of surgeons, their contribution to rural health care, and the safety of rural surgery that policy cannot be shaped with confidence.

Orthofix external fixation of distal radius fractures: complications associated with screw size.

We did a retrospective analysis of 28 patients who were treated with the Orthofix external fixation system for complex fractures of the distal radius to study complications associated with screw size. The 14 patients in group 1 had a 4.5/3.

Measuring the quality of care: reforming the health care system.

Elements of meaningful health care reform must include the ability of patients, providers, and payers to select services offering quality care at an affordable price. To achieve this goal, an appropriate definition of quality needs to be articulated and adopted; data capturing the definition needs to be collected; and appropriate measures need to be selected to analyze that data. Results need to be publically available to assist in making informed choices.

Intrathyroidal cell phenotype in murine lymphocytic and granulomatous experimental autoimmune thyroiditis.

In-vitro mouse thyroglobulin (MTg) activated spleen cells from immunized donor mice can induce experimental autoimmune thyroiditis (EAT) after transfer to recipient mice. The intrathyroidal cellular infiltrate consists primarily of mononuclear cells (lymphocytic EAT). Cells cultured with MTg together with anti-IL2R antibody induce EAT with a granulomatous histopathology in which the thyroid infiltrate contains mononuclear cells (MNC) in addition to PMN's histiocytes, and multinucleated giant cells.

Effects of endothelins on collagen turnover in cardiac fibroblasts.

Objectives: Endothelins (ET-1 and ET-3) may be promoters of tissue remodeling, including fibrillar collagen accumulation. The hypothesis that ET-1 and ET-3 each modify cardiac fibroblast collagen turnover was tested.

Methods: Confluent adult rat cardiac fibroblasts were maintained for 24 hours in medium with 0.

Extracellular ATP prevents the release of stored Ca2+ by autonomic agonists in rat submandibular gland acini.

In dose-dependent fashion, extracellular ATP reduces the increase in cytosolic Ca2+ concentration ([Ca2+]o) due to mobilization of cellular Ca2+ stores by both epinephrine [half-maximal inhibitory concentration (IC50) = 35.7 +/- 12.9 microM; Hill coefficient (NH) = -2.

Randomized, prospective comparison of first- and second-generation cephalosporins as infection prophylaxis for cardiac surgery.

Surgical wound infections after cardiovascular surgery may be life threatening and are resource intensive. Second-generation cephalosporins are purported to have a broader antimicrobial spectrum than first-generation cephalosporins and, therefore, may be more efficacious for infection prophylaxis. We have conducted a randomized prospective study of 702 patients undergoing open heart surgery to test the hypothesis that the second-generation cephalosporin, cefuroxime, will be more efficacious for infection prophylaxis than the first-generation cephalosporin, cefazolin.

Heterologous C-terminal sequences disrupt transcriptional activation and oncogenesis by p59v-rel.

Members of the NF-kappa B/rel family of transcription factors are regulated through a trans association with members of a family of inhibitor proteins, collectively known as I kappa B proteins, that contain five to eight copies of a 33-amino-acid repeat sequence (ankyrin repeat). Certain NF-kappa B/rel proteins are also regulated by cis-acting ankyrin repeat-containing domains. The C terminus of p105NF-kappa B, the precursor of the 50-kDa subunit of NF-kappa B, contains a series of ankyrin repeats; proteolytic removal of this ankyrin domain is necessary for the manifestation of sequence-specific DNA binding and nuclear translocation of the N-terminal product.

Clinical trials in adult respiratory distress syndrome.

The need for randomized clinical trials in adult respiratory distress syndrome (ARDS) is now recognized. With this recognition comes the need for researchers to implement proper trial design and for the clinician to be able to interpret results as they apply to clinical practice. The heterogeneity of ARDS as related to etiology, stage, and severity creates the potential for maldistribution of patients in the clinical trial.