Showing papers by "University of Tennessee Health Science Center published in 1991"
TL;DR: It is indicated that a unique metabolic pathway exists in adipocytes that mediates desensitization of the insulin-responsive GTS, and that an early step in this pathway involves the conversion of fructose 6-phosphate to glucosamine 6- phosphate by the first and rate-limiting enzyme of the hexosamine pathway, glutamine:fructose-6-ph phosphate amidotransferase.
971 citations
TL;DR: The risk of epipodophyllotoxin-related AML depends largely on the schedule of drug administration, and radiotherapy and the initial biologic features of the leukemic blast cells do not appear to have critical roles.
Abstract: Background and Methods. Treatment of cancer with the epipodophyllotoxins (etoposide and teniposide) has been linked to the development of acute myeloid leukemia (AML) in children and adults, but the factors that might influence the risk of this complication of therapy are poorly defined. We therefore assessed the importance of potential risk factors for secondary AML in 734 consecutive children with acute lymphoblastic leukemia who attained complete remission and received continuation (maintenance) treatment according to different schedules of epipodophyllotoxin administration. Results. Secondary AML was diagnosed in 21 of the 734 patients, in 17 of whom this complication was the initial adverse event. Prolonged administration of epipodophyllotoxin (teniposide with or without etoposide) twice weekly or weekly was independently associated with the development of secondary AML (P<0.01 by Cox regression analysis). The overall cumulative risk of AML at six years was 3.8 percent (95 percent confidence...
669 citations
TL;DR: The timing of retinal vascular events correlated more closely with postconceptional age than with postnatal age, implicating the level of maturity more than postnatal environmental influences in governing the timing of these vascular events.
613 citations
TL;DR: Prophylactic low-dose aspirin started early in pregnancy in women with chronic hypertension is not effective in reducing the frequency of superimposed preeclampsia and should be avoided.
430 citations
TL;DR: This case demonstrates that thiopurine methyltransferase deficiency does not absolutely contraindicate merc laptopurine therapy, and it provides insight into the mechanism of excessive toxic effects of mercaptopurine sometimes observed in children with acute lymphocytic leukemia.
387 citations
TL;DR: Outcome within risk groups was not significantly affected by the speed of rotation of drug pairs during continuation treatment, and various high-risk subgroups had apparently improved responses to this treatment.
382 citations
TL;DR: The findings indicate that FMMV is a viable option for short-term (one to four days) ventilatory support of patients with hypercapnic respiratory failure and insufficiency.
309 citations
TL;DR: Results indicated that parental influences have a marked effect on food selection; both the threat of parental monitoring and actual parental monitoring lowered the number of nonnutritious foods chosen and total caloric content of the meal.
303 citations
TL;DR: Women with severe preeclampsia that developed in the second trimester underwent follow-up for an average of 5.4 years and had chronic hypertension and long-term maternal complications included two maternal deaths and two other patients with end-stage renal disease requiring dialysis are concluded.
301 citations
TL;DR: It is indicated that the GP contains at least 3 electrophysiologically different types of neurons, that GP projections to the Str, the STh, and the SN are of short latency pathways, and that Str stimulation evokes short latency EPSPs followed by IPSPs and late EPSPs in GP neurons.
294 citations
Journal Article•
GlaxoSmithKline1, Novartis2, University of Tennessee Health Science Center3, University of California, Los Angeles4, Medical University of South Carolina5, Georgia Regents University6, Drexel University7, Yale University8, University of Wisconsin-Madison9, Johns Hopkins University10, Harvard University11, Columbia University12, Ohio State University13, Emory University14, University of Iowa15, Brown University16, Stanford University17, Cornell University18
TL;DR: Clomipramine was generally well tolerated and was effective in reducing obsessive and compulsive symptoms and was superior on the basis of the physicians' and patients' evaluations of global therapeutic change.
Abstract: Two double-blind studies at 21 centers evaluated the therapeutic efficacy, safety, and tolerability of up to 300 mg/d of clomipramine hydrochloride or an equivalent number of placebo capsules in the treatment of 520 patients with obsessive-compulsive disorder, of whom 239 had had the disorder for at least 2 years (study 1) and 281 had been ill for at least 1 year (study 2). On the two principal measures of the severity of the disorder, ie, the Yale-Brown Obsessive Compulsive Scale and the National Institute of Mental Health Global Obsessive Compulsive Scale, clomipramine was significantly more effective than placebo in both studies. The mean reduction in the Yale-Brown Obsessive Compulsive Scale score at the end of 10 weeks of treatment was 38% and 44% in studies 1 and 2, respectively, for the clomipramine-treated patients and 3% and 5% for the placebo-treated patients. The drug was also found to be superior on the basis of the physicians' and patients' evaluations of global therapeutic change. The most frequently observed adverse effects during clomipramine therapy were those typically associated with tricyclic antidepressant drugs. Although uncommon, the occurrence of seizures and elevated aminotransferase values are potentially serious side effects of clomipramine. Clomipramine was generally well tolerated and was effective in reducing obsessive and compulsive symptoms.
TL;DR: It is indicated that the fibroproliferative process occurring in the lungs of patients with late ARDS gives rise to clinical manifestations identical to those of pneumonia and is potentially responsive to steroid treatment.
Journal Article•
TL;DR: Single-dose intramuscular methotrexate appears to be an effective medical treatment for the unruptured ectopic pregnancy of 3.5 cm or less in greatest dimension with or without cardiac activity.
TL;DR: The results are promising, but additional data on the background sensitivity and specificity of in situ hybridization in flow-sorted fetal cells will be necessary to minimize subjective interpretation and permit clinical application.
TL;DR: It is suggested that ED crowding is concentrated in metropolitan areas and in a smaller subset of hospitals, and that hospitals with similar adverse effects regardless of ownership are affected.
TL;DR: Biotinamide shares many of the useful features of biocytin, but can be selectively electrophoresed with positive current and can be dissolved at higher concentrations with little detriment in the electrical properties of the recording electrode.
TL;DR: The mechanism of DNA ejection, viral assembly and evolution are related to the structure of bacteriophage ΦX174, a T = 1 capsid whose major folding motif is the eight–stranded antiparallelβ barrel found in many other icosahedral viruses.
Abstract: The mechanism of DNA ejection, viral assembly and evolution are related to the structure of bacteriophage ΦX174. The F protein forms a T = 1 capsid whose major folding motif is the eight–stranded antiparallelβ barrel found in many other icosahedral viruses. Groups of 5 G proteins form 12 dominating spikes that enclose a hydrophilic channel containing some diffuse electron density. Each G protein is a tight β barrel with its strands running radially outwards and with a topology similar to that of the F protein. The 12 'pilot' H proteins per virion may be partially located in the putative ion channel. The small, basic J protein is associated with the DNA and is situated in an interior cleft of the F protein. Tentatively, there are three regions of partially ordered DNA structure, accounting for about 12% of the total genome.
TL;DR: The concepts behind the measurement of quality that underline the continuous quality improvement model are emphasized and examples of how these concepts can be immediately applied to guide improvement in the quality of physician care are given.
Abstract: There has been a growing interest by health care leaders in the continuous quality improvement method of quality management. This method uses measurements of quality "indicators" to initiate and drive organizational changes in a never-ending cycle of continuous improvement. Many discussions of the continuous quality improvement method have emphasized the organizational and attitudinal changes necessary to fully implement the model while deemphasizing the uses of measures of quality to guide improvement. In this article, we emphasize the concepts behind the measurement of quality that underlie the continuous quality improvement model and give examples of how these concepts can be immediately applied to guide improvement in the quality of physician care. (JAMA. 1991;266:1817-1823)
Journal Article•
TL;DR: Several in vitro studies suggest that HA is part of a feedback loop that promotes cell proliferation and migration in actively growing tissues, and the role of HA in water homeostasis could favor tissue hydration, which has a well-known beneficial effect on healing.
TL;DR: Findings indicate that a majority (55%) of this clinical population develop symptoms characteristic of post-traumatic stress disorder, whereas abused children and adolescents who do not develop associated post- traumatic stress disorder symptoms exhibit more anxiety, depression, externalizing behaviors, and more problems overall.
Abstract: This study describes the reactions of children and adolescents to physical and/or sexual abuse, suggesting two distinct symptom pictures. Findings indicate that a majority (55%) of this clinical population develop symptoms characteristic of post-traumatic stress disorder, whereas abused children and adolescents who do not develop associated post-traumatic stress disorder symptoms exhibit more anxiety, depression, externalizing behaviors, and more problems overall. Significant differences were also found between children and adolescents reacting to single event abuse who display more behavior disorders and victims of ongoing abuse who appear significantly more disturbed, with symptoms ranging from depression to psychosis.
TL;DR: Plasma endothelin levels are significantly increased in women with preeclampsia and particularly in those with the hemolysis, elevated liver enzymes, and low platelet count syndrome, suggesting an association with widespread endothelial damage.
TL;DR: It is demonstrated that IL-1 promotes NREMS in the rat, however, unlike previously reported findings in rabbits, the circadian rhythm of sleep regulation strongly interferes with the sleep-promoting activity of IL- 1 in rats.
Abstract: Rats received various doses of interleukin 1 (IL-1) (range, 0.5-25.0 ng) or pyrogen-free saline intracerebroventricularly during the rest (light) and the active (dark) cycles of the day, and sleep-wake activity and brain temperature were determined for 6 h. Low doses of IL-1 (0.5 ng at night, 2.5 ng during the day) increased both the duration of non-rapid-eye-movement sleep (NREMS) and electroencephalogram (EEG) slow-wave activity during NREMS episodes. Increasing doses of IL-1 had divergent effects on NREMS duration and EEG slow-wave activity, and the direction of the changes depended on the diurnal cycle. Thus NREMS duration was promoted at night and EEG slow-wave amplitudes during the day, whereas NREMS duration during the day and EEG slow-wave amplitudes at night were suppressed after higher doses of IL-1. High doses of IL-1 also induced decreases in rapid-eye-movement sleep during both phases of the day. Each dose of IL-1 that promoted NREMS also tended to increase brain temperature. These results demonstrate that IL-1 promotes NREMS in the rat. However, unlike previously reported findings in rabbits, the circadian rhythm of sleep regulation strongly interferes with the sleep-promoting activity of IL-1 in rats.
TL;DR: Long-term follow-up of sodium-sensitive and sodium-resistant groups has shown that although blood pressure levels are approximately equal in the two groups during sodium depletion, resumption of a daily sodium intake of about 150 meq results in significantly higher levels of blood pressure and forearm vascular resistance in the Sodium-sensitive group.
Abstract: Several laboratories have examined the relation between salt intake and blood pressure in both experimental animals and humans. The human studies have used widely varying methodologies and different criteria for sodium sensitivity. Nonetheless, these studies have produced convincing data that the blood pressure of some individuals is far more sensitive to the effects of sodium depletion or loading than that of others. Furthermore, a minority of the population appears to comprise acutely salt-sensitive individuals. Some studies have shown that sodium-sensitive individuals share several characteristics. They include increased forearm vascular resistance, decreased venous compliance, suppressed plasma renin activity, and lower circulating aldosterone concentration. These findings have also been described in the Dahl salt-sensitive rat, which suggest a genetic link in humans as well as the rat. Long-term follow-up of sodium-sensitive and sodium-resistant groups has shown that although blood pressure levels are approximately equal in the two groups during sodium depletion, resumption of a daily sodium intake of about 150 meq results in significantly higher levels of blood pressure and forearm vascular resistance in the sodium-sensitive group. This difference persists for at least 12 months.
Journal Article•
TL;DR: It is concluded that methotrexate/citrovorum is safe, effective, and helps to preserve reproductive performance when used as primary therapy for unruptured ectopic pregnancy and for treatment of persistent disease following a conservative surgical procedure.
TL;DR: It is concluded that decisions about patients' functional level should be based on performance testing, and patients' own ratings are most accurate, followed by family ratings.
Abstract: BACKGROUND. Important clinical decisions often hinge on patients' functional status. Previous studies have shown disagreement among sources of ratings of patients' functional status. This study compared patient self-ratings, family member ratings, and physician ratings of patient function to performance-based functional testing criteria. METHODS. Five activities of daily living of 73 older patients were studied at admission to a rehabilitation unit following discharge from an acute care community hospital. Data were collected from patients, family members, and physicians and were compared with performance-based function testing. RESULTS. Patient ratings were significantly more accurate than physician ratings for walking, transferring, and telephoning. Patients were significantly more accurate than family members for rating walking and telephoning, but patients were not significantly more accurate than family members or physicians for rating eating or dressing. CONCLUSIONS. We conclude that decisions about...
TL;DR: The results suggest that HVPC, in conjunction with good nursing care, can significantly increase the healing rate of pelvic ulcers in patients with spinal cord injury.
Abstract: The purpose of this study was to assess the efficacy of high voltage pulsed direct current (HVPC) for healing of pressure ulcers in patients with spinal cord injury. Seventeen patients having pressure ulcers in the pelvic region were randomly assigned to either an HVPC group or a placebo HVPC group. Treatments were given for 1 hour a day for 20 consecutive days. The HVPC protocol consisted of an aluminum-foil electrode placed over the ulcer and set at negative polarity in reference to the dispersive electrode placed on the thigh. Stimulator frequency was set at 100 pps, and an intensity of 200 V was used. Measurements of ulcer surface area were conducted before treatment and after treatment days 5, 10, 15, and 20. To measure ulcer area (in square millimeters), slides taken at each measurement time were projected at actual size, traced, and digitized. Percentage of change compared with pretreatment ulcer size was calculated for each measurement time. Ulcers in the HVPC group demonstrated significantly greater percentage-of-change decreases from their pretreatment size than did ulcers in the placebo group at days 5, 15, and 20. The results suggest that HVPC, in conjunction with good nursing care, can significantly increase the healing rate of pelvic ulcers in patients with spinal cord injury.
TL;DR: The isolation of a new testis-specific gene, Sby, mapping to the DNA deleted from the Sxrb region (the ΔSxrb interval), which has extensive homology to the X-linked human ubiquitin-activating enzyme El.
Abstract: THE Sxr (sex-reversed) region, a fragment of the Y chromosome short arm, can cause chromosomally female XXSxr or XSxrO mice to develop as sterile males1–3. The original Sxr region, termed Sxra, encodes: Tdy, the primary sex-determining gene; Hya, the controlling or structural locus for the minor transplantation antigen H–Y (ref. 4); gene(s) controlling the expression of the serologically detected male antigen (SDMA)5; Spy, a gene(s) required for the survival and proliferation of A spermatogonia during spermatogenesis6,7; Zfy-l/Zfy-2, zinc-finger-containing genes of unknown function8; and Sry, which is probably identical to Tdy (ref. 9). A deletion variant10 of Sxra, termed Sxrb, which lacks Hya, SDMA expression, Spy and some Zfy-2 sequences, makes positional cloning of these genes possible. We report here the isolation of a new testis-specific gene, Sby, mapping to the DNA deleted from the Sxrb region (the ΔSxrb interval). Sby has extensive homology to the X-linked human ubiquitin-activating enzyme El (ref. 11). The critical role of this enzyme in nuclear DNA replication12 together with the testis-specific expression of Sby suggests Sby as a candidate for the spermatogenic gene Spy.
TL;DR: The absence of appreciable degeneration and necrosis in tumor cells suggests that this type of androgen deprivation may act through suppression rather than ablation of prostatic cancers.
Abstract: Prostate glands exposed to androgen deprivation with leuprolide -+ flutamide were evaluated for pathologic changes which might be related to therapy. Comparing pretreatment and posttreatment tissue by visual discrimination using light microscopic study revealed treatment-related alterations in the size and distribution of neoplastic glands in 60% of cases. Quantitative measurements documented glandular changes in an even greater percentage of cases. Although distinctive, the histologic pattern was not specific for leuprolide/flutamide. The absence of appreciable degeneration and necrosis in tumor cells suggests that this type of androgen deprivation may act through suppression rather than ablation of prostatic cancers. The relationship between treatment-related histologic effects and initial tumor grade and clinical stage as well as expression of prostate-specific antigen was studied. Accurate histologic assessment of leuprolide/flutamide-treated prostate glands should not be a problem so long as specimens are thoroughly examined and drug-related variations in tumor morphologic features are appreciated. Cancer 68:821-828,1991.
TL;DR: In this paper, the clinical and biologic significance of childhood acute mixed-lineage leukemia diagnosed by stringent criteria was defined, and 25 cases of acute lymphoblastic leukemia expressing greater than or equal to 2 myeloid-associated antigens (My+ ALL), and 16 cases with acute myeloidal leukemia (Ly+ AML) were identified.
TL;DR: There is disagreement regarding the ideal screening test to be used for identifying patients for clinical trials dealing with prevention of the disorder.