Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.

Context: Influenza virus is a major cause of illness, disruption to daily life, and increased use of health care in all age groups.

Objective: To assess the safety and effectiveness of intranasally administered trivalent, live, attenuated influenza virus (LAIV) vaccine for reducing illness, absenteeism, and health care use among healthy, working adults.

Design: Randomized, double-blind, placebo-controlled trial conducted from September 1997 through March 1998.

Short-term outcomes of treatment for musculoskeletal disorders in a hospital-based alternative and complementary medicine clinic.

Objective: Musculoskeletal (MS) disorders are among the more common conditions for which patients seek relief. The treatment of choice for MS disorders in Western medicine is the administration of nonsteroidal anti-inflammatory (NSAID) agents. However, patients in increasing numbers are seeking out complementary/alternative medicine (CAM) for MS disorders.

Fecal occult blood tests in occult gastrointestinal bleeding.

Occult gastrointestinal bleeding is diagnosed by using one of the commercially available fecal occult blood tests (FOBTs). Guaiac-based slide tests are most frequently used, although the more specific immunochemical methods are promising. The guaiac tests are inexpensive, nonspecific, qualitative measures of stool blood, and their use requires dietary and drug restrictions.

Colorectal cancer in inflammatory bowel disease: a continuing problem.

Purpose: Because of the increased risk of colorectal cancer in patients with inflammatory bowel disease, surveillance colonoscopy with mucosal biopsies for dysplasia has been advocated to prevent malignancy or permit its early diagnosis. However, despite adoption of colonoscopic surveillance programs by many clinicians, we have noted a pattern of continued referrals for inflammatory bowel disease-associated malignancy. This study was undertaken in an effort to characterize this cohort of patients.

Relation of salivary cotinine to blood pressure in middle-aged cigarette smokers.

Background: In laboratory research, nicotine administration is associated with increases in blood pressure. In epidemiologic research, however, the amount of reported cigarette smoking has no consistent relation with blood pressure. The objective of this study was to examine the relation of a nicotine metabolite (salivary cotinine) to systolic and diastolic blood pressure in current smokers being screened for entry to a clinical trial.

Brain energy stores in C57BL/6 mice after C. parvum injection.

Activation of the immune system has been associated with the development of fatigue of unknown cause. We were interested in brain energy stores (e.g.

Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease.

Background: Influenza vaccine is underused in groups targeted for vaccination.

Objective: To define the effects of influenza and the benefits of influenza vaccination in elderly persons with chronic lung disease.

Design: Retrospective, multiseason cohort study.

Aberrant expression of MUC5AC and MUC6 gastric mucin genes in colorectal polyps.

Altered mucin glycosylation and the de novo appearance of gastric mucin antigens have been described in colonic adenomas. The purpose of our study was to determine if expression of the gastric mucin genes MUC5AC and MUC6 occurs in colorectal adenomas and whether this correlates with histopathologic criteria of malignant potential. Immunohistochemical staining using antibodies against MUC5AC and MUC6 tandem repeat synthetic peptides was performed on specimens of normal colon mucosa (n = 26), hyperplastic polyps (n = 9) and adenomatous polyps (n = 111).

Primary and secondary stroke prevention in atrial fibrillation.

Atrial fibrillation, with a prevalence of 6% in those over 65 years, is responsible for 75-100 x 10(3) strokes each year in the United States. These strokes are more severe and have less favorable long-term prognosis than strokes due to other mechanisms. Modern trials show that warfarin reduces stroke rate by about 70% and aspirin by about 20%.

Regulation of regional norepinephrine spillover in heart failure: the effect of angiotensin II and beta-adrenergic agonists in the forearm circulation.

Background: Prejunctional receptors for angiotensin II (A-II) and norepinephrine (NE) have been reported to facilitate NE release. If operative in patients with congestive heart failure (CHF), such receptors could participate in positive feedback cycles amplifying sympathoactivation.

Methods And Results: A-II and isoproterenol (ISO) would increase regional NE spillover via facilitation of presynaptic release of NE in the forearm circulation of patients with chronic stable CHF.

Severe sepsis in the emergency department and its association with a complicated clinical course.

Objective: Infection severity as determined by clinical criteria has been recently classified and studied in hospitalized inpatients. The objective of the study was to use modified criteria to determine the clinical course associated with three levels of infection severity in infected patients admitted from the ED.

Methods: This was a retrospective cohort study involving all patients 18 years of age and older admitted through the ED of an urban teaching hospital during a four-month period whose primary reason for requiring hospitalization was an infection that was recognized in the ED.

Expression of cardiac troponin T isoforms in skeletal muscle of renal disease patients will not cause false-positive serum results by the second generation cardiac troponin T assay.

The purpose of this study was to determine whether the two monoclonal anti-cardiac troponin T (cTnT) antibodies used in the second generation cTnT assay (capture Ab, M11.7; detection Ab, M7) would detect expression of cTnT isoforms in skeletal muscle from chronic renal disease patients. Skeletal muscle biopsies obtained from 45 chronic renal disease patients (as well as human heart muscles and normal human skeletal muscles) were prepared for Western blot analysis and blotted with the following anti-cTnT antibodies: M 11.

Structural vascular changes in hypertension: role of angiotensin II, dietary sodium supplementation, blood pressure, and time.

The dose and time dependence of angiotensin II (Ang II) induced hypertension and structural vascular changes and the effect of dietary sodium supplementation on these relationships were investigated. Male Sprague-Dawley rats were treated with 50, 100, or 200 ng . kg-1 .

Codeine and oxycodone use in patients with chronic rheumatic disease pain.

Objective: Opioid treatment of chronic rheumatic disease pain is controversial because of concerns regarding efficacy, toxicity, tolerance, dependence, and abuse. This study examined opioid use in a cohort of patients with pain due to defined rheumatic diseases.

Methods: Opioid use was studied retrospectively in a cohort of 644 rheumatology clinic patients.

Kappa-opioid potentiation of tumor necrosis factor-alpha-induced anti-HIV-1 activity in acutely infected human brain cell cultures.

Opioids have been postulated to play an immunomodulatory role in the pathogenesis of HIV-1. Synthetic kappa-opioid receptor (KOR) ligands have been found to inhibit HIV-1 expression in acutely infected microglial cell cultures. We recently found that interleukin(IL)-1beta and tumor necrosis factor(TNF)-alpha have antiviral effects in acutely infected mixed glial/neuronal cell cultures.

Kappa-opioid modulation of human microglial cell superoxide anion generation.

Opioids have been postulated to play an immunomodulatory role in the CNS. Recently, we found that priming microglia with interferon (IFN)-gamma or tumor necrosis factor (TNF)-alpha resulted in an enhanced production of superoxide anion, a reactive oxygen intermediate that may be pathogenic during brain inflammation. In the present study, we investigated the effects of trans-3,4-dichloro-N-methyl-N[2-(1-pyrolidinyl)cyclohexyl]benze neaceamide methanesulfonate (U50,488), a selective kappa-opioid ligand, on microglial cell superoxide production when cells were primed with cytokines or stimulated with phorbol myristate acetate.

Cardiac troponin T isoforms expressed in renal diseased skeletal muscle will not cause false-positive results by the second generation cardiac troponin T assay by Boehringer Mannheim.

The purpose of this study was to determine whether the two monoclonal anti-cardiac troponin T (cTnT) antibodies (MAbs) used in the second generation cTnT assay by Boehringer Mannheim (BM, capture Ab, M11.7; detection Ab, M7) would detect cTnT isoforms expressed in human skeletal muscle in response to chronic renal disease (CRD). cTnT expression was examined in skeletal muscle biopsies obtained from 45 CRD patients, as well as nondiseased human heart (n = 3) and skeletal muscle (n = 3).

Tyrosine-rich crystals associated with oncocytic salivary gland neoplasms.

Objective: Crystalloids have been identified ultrastructurally within the epithelial cells of Warthin's tumors, but there have been no studies characterizing crystals or crystalloids in Warthin's tumors by light microscopy. The finding of abundant needle-shaped crystals in a fine-needle aspirate of a cystadenoma of the parotid prompted us to examine the prevalence of crystals and crystalloids in oncocytic salivary gland neoplasms.

Design: Ninety-seven oncocytic neoplasms (93 Warthin's tumors, 3 cystadenomas, and 1 oncocytoma) excised at our institution between 1950 and 1996 were examined, to identify crystals.

Re-expression of p16INK4a in mesothelioma cells results in cell cycle arrest, cell death, tumor suppression and tumor regression.

Absence of expression of the p16IKN4a gene product is commonly observed in mesothelioma tumors and cell lines, while wild-type pRB expression is maintained. We have examined the biologic and potential therapeutic role of re-expressing p16INK4a gene product in mesothelioma cells and tumors. Following transduction with a p16INK4a expressing adenovirus (Adp16), over-expression of p16INK4a in mesothelioma cells resulted in cell cycle arrest, inhibition of pRB phosphorylation, diminished cell growth, and eventual death of the transduced cells.

The effects of clinical pathways for renal transplant on patient outcomes and length of stay.

Objectives: Clinical pathways have been implemented nationwide but little is understood about their effects on efficiency of care and patient outcomes. The present study examined the effects of both development and implementation of two renal transplant pathways.

Methods: Cohorts of patients at a university hospital were compared before, during, and after the development and implementation of two renal transplant clinical pathways: isolated renal transplant from cadaveric donors (n = 170) or from living donors (n = 178).

Do molecular markers predict survival in non-small-cell lung cancer?

Patients with non-small-cell lung cancer (NSCLC) survive for variable lengths of time, even when adjustment is made for pathological stage. Numerous reports suggest that biological markers predict survival in patients undergoing surgery for NSCLC with curative intent, but many of these claims are unconfirmed or conflicting. We postulated that the use of multiple putative markers might provide greater power in predicting survival.

The importance of identifying depression in patients with rheumatoid arthritis: evaluation of the beck depression inventory.

Depression is common in patients with chronic illness including rheumatoid arthritis (RA). Identifying depression accurately and treating it appropriately are important for helping to maintain function in patients with RA. Several self-administered screening tools are available that are sensitive for the detection of depression in medical outpatients and are easy to use in a clinic setting.

Effect of amlodipine on norepinephrine kinetics and baroreflex function in patients with congestive heart failure.

Background: The use of calcium channel blocking drugs is controversial in heart failure, partly because of concerns about neurohormonal stimulation. Preliminary data suggest that the newer agent amlodipine may be useful in this syndrome. Suppression of sympathetic activity either directly or by sensitized baroreflex function could be contributing factors to the clinical use of this drug.

Comparison of melphalan and prednisone with vincristine, carmustine, melphalan, cyclophosphamide, and prednisone in the treatment of multiple myeloma: results of Eastern Cooperative Oncology Group Study E2479.

Background: The Eastern Cooperative Oncology Group (ECOG) performed a Phase III comparison of melphalan and prednisone (MP) with vincristine, carmustine (BCNU), melphalan, cyclophosphamide, and prednisone (VBMCP) in an attempt to determine which of these regimens should be the standard treatment for multiple myeloma.

Methods: Four hundred seventy-nine previously untreated patients with multiple myeloma from 23 ECOG institutions were enrolled. Treatment, assigned by randomization, consisted of either 4-week cycles of MP or 5-week cycles of VBCMP.