ASC:SIL ratio following implementation of the 2001 Bethesda System.

The 2001 Bethesda system (TBS 2001) eliminated the "satisfactory but limited by" category, benign cellular changes (BCC), and the designations "favor benign" (ASC-B) and "favor low grade" (ASC-L) for atypical squamous cells. We compared the unsatisfactory rate and atypical squamous cells:squamous intraepithelial lesions (ASC:SIL) ratio pre- and postimplementation of TBS 2001 to see if there was an increase in unsatisfactory specimens, ASC rate, and altered ASC:SIL ratio. Pap Tests (569,726) reviewed at the Cytopathology Laboratory of Women and Infants Hospital from 1998-2002 were included.

Primer on medical professionalism.

Medicine as a profession depends on a unique social contract between the public and health-care professionals. We define professionalism in medicine, provide examples of challenges in professionalism relevant to podiatric medicine, and offer resources on ethics and professionalism in medicine. "Medical professionalism" is the set of attitudes, values, and conduct exhibited by medical providers resulting from placing patients' and society's interests above their own.

Laboratory medicine and diagnostic testing.

The clinical laboratory is a vital component of modern podiatric medical practice. In order to interpret laboratory data correctly, the practitioner must understand the essentials of diagnostic testing. These essentials include precision, accuracy, sensitivity, specificity, and prevalence-based values of a given test.

Principles of diagnosing and managing postmenopausal osteoporosis for the podiatric physician.

Osteoporosis is an asymptomatic disease until a fracture occurs. The prevalence of osteoporosis will rise with the aging of the population. Recent advances have led to more efficacious treatment options.

Rheumatologic conditions of the foot.

Podiatric physicians are frequently the first clinicians with the opportunity to diagnose a rheumatologic disease. Awareness of the multisystem nature of the more common rheumatologic conditions will assist podiatrists in making the appropriate diagnosis. The specific joints affected, the temporal pattern of joint involvement, and the distribution of affected joints give clues to the diagnosis.

Acute and chronic renal failure.

Renal failure is defined as a deterioration of kidney function that results in the retention of nitrogenous waste products. It is increasingly prevalent in older populations, individuals with diabetes or hypertension, and postoperative patients. Therefore, podiatric physicians caring for these populations can expect to encounter this condition frequently.

Pulmonary disease: pneumonia, chronic obstructive pulmonary disease, asthma, and thromboembolic disease.

Although many medical problems are generally managed in concert with a general medical physician, it is important for the podiatric physician to be familiar with some of the major diseases of the lung. Pneumonia, an infectious process within the lung, is the sixth-leading overall cause of death. Antibiotic treatment, oxygen administration, and supportive care are the mainstays of its therapy.

Evaluation of common liver problems.

Diseases of the liver and abnormalities of liver enzyme levels are among the most common reasons for gastroenterology consultation for surgical patients. Although the differential diagnosis of liver disease is exceedingly broad, the majority of patients will have one of several common disorders. A familiarity with the major disorders affecting the liver and the approach to patients with liver disease is therefore useful for clinicians from all disciplines.

Infection and fever in the elderly.

The elderly make more frequent use of general podiatric medical services than the younger population. It is therefore important for podiatric physicians to become familiar with the general principles of infectious disease as applied to an elderly population, which is susceptible to a wider spectrum of disease with more subtle and unusual clinical signs and symptoms. This article reviews the diagnosis and evaluation of suspected infection, appropriate laboratory testing, patterns of specific infectious disease syndromes, and antibiotic use in the elderly.

Changes in mental status.

Change in mental status is a common symptom in the older, hospitalized patient. Often referred to as delirium, it may be the first indication of a serious medical condition. If delirium is not identified and treated promptly, it may lead to severe complications.

Geriatric pharmacology: safer prescribing for the elderly patient.

Adverse drug effects are common in elderly patients but can often be avoided. Judicious prescribing practices require the clinician to be aware of age-related changes in drug absorption, distribution, metabolism, and elimination. Clinicians may need to adjust drug dose, frequency, or the choice of drug altogether as they consider the physiologic changes of aging.

Perioperative medical assessment of the podiatric surgical patient.

Patients undergoing podiatric surgery should receive a thorough perioperative evaluation. Medical "clearance" is no longer sufficient; rather, formal risk assessment should be performed and risk-reducing strategies provided. A collaborative, multidisciplinary approach involving practitioners in internal medicine, anesthesiology, and podiatry is generally most appropriate.

Pharmacotherapy outcome in older pathological gamblers: a preliminary investigation.

Although pharmacotherapy is often effective for pathological gambling, little is known about how it affects older populations. The present study examines the response to pharmacotherapy in a series of pathological gamblers age 60 years and older. Fourteen older patients who fulfilled DSM-IV criteria for pathological gambling were treated in an outpatient clinic.

Modulation of hepatitis B virus secretion by naturally occurring mutations in the S gene.

Alteration in hepatitis B virus (HBV) secretion efficiency may have pathological consequences. Naturally occurring mutations that regulate virion secretion have not been defined. We recently identified HBV genomes displaying high (4B), substantially reduced (3.

Aging does not affect beta-agonist responsiveness after methacholine-induced bronchoconstriction.

Objectives: To assess the response to an inhaled beta-agonist alone or in combination with an anticholinergic agent after methacholine-induced bronchoconstriction in four age groups.

Design: Retrospective analysis.

Setting: Pulmonary function laboratory in a university-affiliated hospital.

Body esteem and mood among sedentary and active breast cancer survivors.

Objectives: To assess mood states and body esteem in 2 groups of breast cancer survivors, regular exercisers and sedentary women, and to examine these variables among younger and older women in each group.

Patients And Methods: Between 1998 and 2002, we conducted a cross-sectional study among early-stage breast cancer survivors at the Miriam Hospital in Providence, RI, comparing 40 women who reported regular exercise with 79 sedentary women. We used multivariate and univariate analyses to compare the exercisers with sedentary women on fitness, physical activity, and questionnaire measures of body esteem and mood.

Uncoupling protein-2 deficiency promotes oxidant stress and delays liver regeneration in mice.

The control of liver regeneration remains elusive. Because reactive oxygen species (ROS) are able to mediate cell growth arrest and activate proteins that inhibit the cell cycle, ROS production may have a negative impact on liver regeneration. We examined how liver regeneration is affected by uncoupling protein-2 (UCP2), an inner mitochondrial membrane carrier that senses and negatively regulates superoxide production.

Reduced expression of the cystic fibrosis transmembrane conductance regulator gene in the hypothalamus of patients with Alzheimer's disease.

Background: The cystic fibrosis transmembrane conductance regulator (CFTR) gene encodes an approximately 150-165 kD glycoprotein that is mutated in individuals with cystic fibrosis. Previous studies demonstrated expression of the CFTR gene in the hypothalamus, suggesting a potential role for this molecule in the regulation of systemic metabolic functions. Individuals with cystic fibrosis often exhibit wasting and marked reductions in body fat content.

Glycine decarboxylase mediates a postbinding step in duck hepatitis B virus infection.

Envelope protein precursors of many viruses are processed by a basic endopeptidase to generate two molecules, one for receptor binding and the other for membrane fusion. Such a cleavage event has not been demonstrated for the hepatitis B virus family. Two binding partners for duck hepatitis B virus (DHBV) pre-S envelope protein have been identified.

Open and laparoscopic appendectomy are equally safe and acceptable in children.

Background: The aim of this study was to evaluate prospectively whether laparoscopic (LA) and open appendectomy (OA) are equally safe and feasible in the treatment of pediatric appendicitis.

Methods: A total of 517 children with acute appendicitis were randomly assigned to undergo LA or OA appendectomy, based on the schedule of the attending surgeon on call. Patient age, sex, postoperative diagnosis, operating time, level of training of surgical resident, length of postoperative hospitalization, and minor and major postoperative complications were recorded.

Neuronal thread protein regulation and interaction with microtubule-associated proteins in SH-Sy5y neuronal cells.

In Alzheimer's disease (AD), neuronal thread protein (NTP) accumulates in cortical neurons and colocalizes with phospho- tau-immunoreactive cytoskeletal lesions that correlate with dementia. To generate additional information about the potential role of NTP in AD, we characterized its expression and regulation in human SH-Sy5y neuronal cells. Quantitative real-time reverse transcription-polymerase chain reactin and Western blot analysis demonstrated prominent insulin, moderate insulin-like growth factor, type 1 (IGF-1) and minimal nerve growth factor stimulation of NTP expression.

Diagnosis of blunt cerebrovascular injuries.

Purpose Of Review: Blunt cerebrovascular injuries (BCVI) are being increasingly recognized. The optimal criteria for screening, and the best diagnostic test, remain a matter of controversy. This review analyzes the available literature to propose management guidelines for the diagnosis of BCVI.

Sequence variation upstream of precore translation initiation codon reduces hepatitis B virus e antigen production.

Background & Aims: Most South African hepatitis B virus strains harbor point mutations immediately upstream of the precore AUG codon. The aim of this study was to determine their effect on hepatitis B e antigen expression.

Methods: The hepatitis B virus DNA sequence around the precore region was determined from sera of 45 black South Africans.

Inter-alpha inhibitor proteins in infants and decreased levels in neonatal sepsis.

Objective: Adjunctive tests are needed to predict sepsis in the newborn and to lower the rate or duration of unnecessary antibiotic use. We evaluated the normal Inter-alpha inhibitor protein (IaIp) values in infants and the association of plasma levels of IaIp with sepsis in term and preterm newborns.

Methods: Plasma IaIp levels were measured by enzyme-linked immunosorbent assay in samples from 135 newborn infants at a wide range of gestational ages (24-42 weeks).

Transient hypoxia causes Alzheimer-type molecular and biochemical abnormalities in cortical neurons: potential strategies for neuroprotection.

Familial Alzheimer's Disease (AD) has been linked to amyloid beta protein precursor (AbetaPP) and presenilin gene mutations. In sporadic AD, which accounts for the vast majority of cases, the pathogenesis of neurodegeneration is unknown; however, recent evidence suggests a role for oxidative stress. The present study demonstrates that transient hypoxic injury to cortical neurons causes several of the molecular and biochemical abnormalities that occur in AD including, mitochondrial dysfunction, impaired membrane integrity, increased levels of DNA damage, reactive oxygen species, phospho-tau, phospho-MAP-1B, and ubiquitin immunoreactivity, and AbetaPP cleavage with accumulation of Abeta-immunoreactive products.