Biomedical subjects

G Divine

Publications and source records attributed to G Divine.

14 recordsLinked to original sources

PubMed2006

Influence of hepatitis C on renal function after liver transplantation.

Liver transplantation (OLT) is often complicated by renal failure. Hepatitis C (HCV) is said to be a risk factor for renal failure after OLT, but few studies have analyzed this directly. We evaluated all patients who received a liver transplant from 1995 through 2003. There were 147 patients infected with HCV and 202 not infected. Patients with HCV were further divided into 114 patients with benign HCV and 33 patients with severe HCV defined by bridging fibrosis or cirrhosis. The groups were evaluated for the development of renal insufficiency defined as a creatinine above 1.8 mg/dL on three consecutive occasions or renal failure as defined by the need for dialysis or renal transplant. The incidence of renal failure in patients with HCV was 10.2% and in patients without HCV was 3.5% (P = .004). Patients with severe HCV had an incidence of 12.1% vs 9.7% for patients with mild HCV. The linear trend in renal failure from non-HCV to mild HCV to severe HCV was significant (P = .012). The incidence of renal insufficiency was 23.4% in patients with HCV and 14.9% in patients without HCV (P = .080). The incidence was 32.3% in patients with severe HCV and 20.6% in patients with mild HCV. The trend in renal insufficiency across the three groups was mildly significant (P = .042). On multivariate analysis, HCV was a risk factor for renal failure with a relative risk of 2.58 (P = .045). The study suggests that HCV and the severity of recurrent HCV are risk factors for renal dysfunction after liver transplantation.

Creatinine↗

PubMed2001

A Web-based diabetes care management support system.

BACKGROUND: Because of the often asymptomatic nature of diabetes and the long period between sustained hyperglycemia and observable complications, appropriate diabetes care relies on a long-term program of secondary prevention. Yet routine monitoring and screening among patients with diabetes is less than optimal. To support the provision of routine care to patients with diabetes, the Center for Health Services Research, Henry Ford Health System (Detroit), developed a Web-based Diabetes Care Management Support System (DCMSS). A nonrandomized, longitudinal study was conducted (January 1, 1998-October 31, 1999) with 13,325 health maintenance organization patients with diabetes who were aligned to 190 primary care providers practicing in 31 primary care clinics. RESULTS: Three DCMSS features--clinical practice guidelines, patient registries, and performance reports--were made available via a corporate intranet within an existing electronic medical record. The effect of DCMSS usage frequency was evaluated on the likelihood of a patient's receipt of glycated hemoglobin testing, lipid profile testing, and retinal examinations. Logistic regression models controlling for patient sociodemographic and clinical characteristics, and the testing history of the patient, the primary care physician, and the primary care clinic, were fit using generalized estimating equation methods. The more often a physician used DCMSS, the more likely his or her patients were to receive lipid profile testing (OR [odds ratio] = 1.01, 95% CI [confidence interval] = 1.01-1.02). Compared with patients of physicians who never used the system, patients of physicians who initiated 12 sessions were an estimated 19% more likely (95% CI = 7%-33%) to receive lipid profile testing. The analyses also suggested that the likelihood of a patient receiving a retinal exam was associated with system usage (OR = 1.01, 95% CI = 1.01-1.01). No relationship was found between system use and glycated hemoglobin testing. CONCLUSIONS: Computerized systems of clinical practice guidelines, patient registries, and performance feedback may help improve the rate of routine testing among patients with diabetes.

Adult↗

PubMed2001

Provider type and the receipt of general and diabetes-related preventive health services among patients with diabetes.

OBJECTIVE: Using a measure of provider type that includes "shared care" to determine the contribution of provider type on receipt of general and diabetes-related preventive health services. METHODS: Automated clinical and administrative data were used to identify adult patients with type 1 and 2 diabetes receiving care from a multispecialty, salaried group practice and enrolled in a large health maintenance organization between 3/97 and 2/98 (n = 10,991). Logistic regression models were fit using generalized estimating equation approaches to evaluate the contribution of provider type on service receipt. MEASURES: Preventive service receipt included receipt of glycated hemoglobin and lipid testing, retinal examinations, pneumococcal vaccines, Papanicolaou (Pap) smears, and mammograms. Multivariable analyses adjusted for age, sex, race, marital status, household income, diabetes-related comorbidities and complications, prescription drug use, laboratory testing results, and frequency of medical care contact. RESULTS: Patients seeing an endocrinologist and primary care physician (PCP) were more likely than those seeing endocrinologists alone to receive glycated hemoglobin testing (OR, 1.42), lipid testing (OR, 1.72), mammograms (OR, 2.12), and Pap smears (OR, 2.36), and more likely than those seeing PCPs alone to receive glycated hemoglobin testing (OR, 1.79), lipid testing (OR, 1.54), retinal examinations (OR, 1.33), and mammograms (OR, 1.43). Compared with patients seeing PCPs only, patient's seeing endocrinologists only were more likely to receive retinal examinations (OR, 1.37) and less likely to receive Pap smears (OR, 0.46). CONCLUSIONS: Care delivered by no one single provider type is associated with greater receipt of all recommended services. Instead, patients seeing both an endocrinologist and a PCP are most likely to receive recommended services.

Adult↗

PubMed2001

Two-color, cytokeratin-labeled dna flow cytometric analysis of 332 breast cancers: lack of prognostic value with 12-year follow-up.

CONTEXT: DNA flow cytometry of breast cancer is a proposed tumor marker of prognostic significance that is of controversial clinical utility because of lack of standardization and confirmatory studies. OBJECTIVE: To evaluate the prognostic significance of the more informative technique of multiparametric 2-color DNA flow cytometry as recommended by the 1992 DNA Cytometry Consensus Conference. DESIGN: Three hundred thirty-two breast carcinomas with 7 to 12 years of follow-up were prospectively analyzed as fresh tumors that were mechanically dissociated into whole cell suspensions. These suspensions were dual fluorescence-labeled with propidium iodide (DNA) and antibodies to cytokeratin (epithelium) and leukocyte common antigen (internal leukocyte control) for gated analysis of subpopulations. Multicycle software with histogram-dependent algorithms employing background, aggregate, and debris correction were used in DNA and cell-cycle quantitation. Data were analyzed according to the DNA Flow Cytometry Consensus Conference recommendations. RESULTS: DNA ploidy and proliferation stratified into 3 categories were not predictive of overall or disease-free survival. Sixty-five percent of tumors were nondiploid, and 35.4% were diploid. Two hundred six tumors were able to be evaluated for synthesis-phase fraction (SPF) analysis, with 74 of 206 cases in the low range (<13.4%), 36.4% in the intermediate range (>13.5 to <25.4%), and 27.6% in the high SPF (>25.5%) category. Aneuploid tumors tended to have a higher SPF. Univariate survival analysis showed prognostic significance of the following: tumor size, stage, TNM components, vascular invasion, nuclear grade, and histologic grade. Only T classification, presence of positive axillary lymph nodes, and distant metastases were significant independent predictors of survival in multivariate Cox regression models. Age and hormone receptor status showed no prognostic significance. Synthesis-phase fraction was significantly correlated with tumor size, stage, T classification, nuclear and histologic grade, presence of estrogen or progesterone receptors, and axillary lymph node status. None of the histologic parameters showed any significant association with DNA aneuploidy, except for high nuclear and histologic grade and the absence of estrogen receptors. CONCLUSIONS: Despite the use of state-of-the-art processing and flow cytometry analytic techniques, DNA ploidy and proliferation measurements were not predictive of survival in any stage of breast cancer. However, select histopathologic parameters and TNM stage were significant predictors of survival in univariate and multivariate analyses. We conclude that DNA ploidy and proliferation measurements do not provide significant prognostic information for clinicians to integrate into therapeutic decision making for patients with breast cancer.

Breast Neoplasms↗

PubMed2000

The association of HER-2/neu amplification with breast cancer recurrence.

HYPOTHESIS: Amplification of the HER-2/neu oncogene in 25% of breast cancers is associated with a shortened disease-free survival. DESIGN: Retrospective analysis of a patient population referred to a tertiary care facility for HER-2/neu testing. The mean follow-up was 56 months. SETTING: Large, urban, tertiary care hospital. PATIENTS: From 1995 to 1999, a consecutive sample of 190 patients with breast cancer had tissue samples tested for overexpression of the cell surface oncoprotein by immunostaining (IM) or amplification of the HER-2/neu oncogene by fluorescence in situ hybridization or both. Forty-nine subjects were excluded because they had tissue samples tested at our institution but received their treatment elsewhere. All patients tested for HER-2/neu after diagnosis with breast cancer in 1999 (n = 47) were excluded from analysis because of short follow-up time. One patient was excluded who had in situ ductal carcinoma. The remaining 93 patients were analyzed. RESULTS: Of 93 patients, 40 (43%) had gene amplification. Overall, patients with oncogene amplification had a shorter median disease-free interval (22 months) compared with controls (40 months) (P =.003). Analysis by the Cox regression model showed that the HER-2/neu status remained significantly associated with time to relapse even after adjusting for age and tumor grade (P =.002; adjusted relative risk, 2.4; 95% confidence interval, 1.4-4.4). No association was found between gene amplification and tumor grade (P =.98), estrogen/progesterone receptor status (P = .29 and P = .43, respectively), or lymph node status (P = .98). Seventy-two patients (77%) eventually had disease recurrence, with 18 (25%) of these recurring locally. CONCLUSIONS: The HER-2/neu oncogene is an independent prognostic indicator of a subset of breast cancers that are at high risk of early recurrence, regardless of tumor grade, estrogen/progesterone receptor status, and lymph node status. Patients amplifying the HER-2/neu oncogene have a shorter disease-free survival than patients without the oncogene.

Breast Neoplasms↗

PubMed2000

Decline in osteocyte lacunar density in human cortical bone is associated with accumulation of microcracks with age.

Despite osteocytes' ideal position to sense the local environment and thereby influence bone remodeling, the function of osteocytes in bone remains controversial. In this study, histomorphometric examination of male and female femoral middiaphyseal cortical bone was conducted to determine if bone's remodeling response, indicated by tissue porosity and accumulation of damage, is associated with osteocyte lacunar density (number of osteocyte lacunae per bone area). The results support the sensory role of the osteocyte network as the decline in osteocyte lacunar density in human cortical bone is associated with the accumulation of microcracks and increase in porosity with age. Porosity and microcrack density increased exponentially with a decline in osteocyte lacunar density indicating that a certain minimum number of osteocytes is essential for an "operational" network. No gender-related differences were found in the relationship of osteocyte lacunar density to age, porosity, or microcrack density. The coefficient of variation of osteocyte lacunar density increased linearly with age, indicating that aging bone tissue is characterized by increased heterogeneity in the spatial organization of osteocytes. Osteocyte lacunar density, porosity, and microcrack density exhibited the same exponential probability density distribution in the donor population, indicating their regulation by similar biological phenomena.

Adolescent↗

PubMed2000

Carboxyamido-triazole induces apoptosis in bovine aortic endothelial and human glioma cells.

Carboxyamido-triazole (CAI), an inhibitor of non-voltage-gated calcium channels, has been studied in Phase I/II clinical trials following the identification of its inhibitory effects on tumor cell invasion and motility. It has also been reported to inhibit human endothelial cell proliferation, migration, and adhesion to the basement membrane. In glioma, biological assays have shown CAI to be active in inhibiting the phenotypes of invasion and angiogenesis. The exact mechanism of action is not clearly understood, although it appears to work via inhibition of calcium influx in several signal transduction pathways that inhibit cell cycle progression. Recent evidence implicates apoptosis as a contributing mechanism of chemotherapy-induced tumor cytotoxicity. Therefore, we studied the effects of CAI on apoptosis in bovine aortic endothelial cells and a human glioma cell line (U251N) using a variety of methods, including: (a) cell morphology; (b) terminal deoxynucleotidyl transferase-mediated nick end labeling analysis of in situ DNA strand breaks; (c) agarose gel electrophoresis to visualize DNA fragmentation; and (d) flow cytometry. Here we report that the kinetics of CAI-induced apoptosis in bovine aortic endothelial cells and glioma cells was determined to be both dose and time dependent in micromolar concentrations achievable in brain tissue in vivo.

Animals↗

PubMed1999

Bone mineral density (BMD) in obesity effect of weight loss.

It is generally believed that bone mineral density (BMD) is increased in obese subjects, but the effect of weight loss on BMD has not been well studied. Therefore, we evaluated BMD among 11 obese women (mean age 45.5 +/- 14.2 years) before and after weight loss achieved by ingesting an 800 calorie diet for 12 weeks. BMD measurements were made at baseline, 6 months and 1 year intervals. Urinary hydroxyproline:creatinine (H:Cr), calcium:creatinine (Ca:Cr) ratios were measured as indices of bone turnover. Mean weight at baseline was 103.8 +/- 15.8 kg and decreased to 83.2 +/- 12.2 at six months and was 85.8 +/- 14.2 kg at one year. Total body, hip and lumbar spine BMD were 1.12 +/- 0.07, .87 +/- 0.11, and 1.02 +/- 0.12 gm/cm2, respectively. Total body BMD was significantly lower at 12 months compared to baseline. No significant change was observed in BMD of the lumbar spine. There was also a significant decrease in hip BMD at six months and 12 months compared to baseline. H:Cr and Ca:Cr ratios did not change over time. We conclude that weight loss achieved by VLCD is accompanied by a statistically significant change in BMD, but the BMD remained in the normal range.

Body Weight↗

PubMed1998

Early (1 h) administration of tissue plasminogen activator reduces infarct volume without increasing hemorrhagic transformation after focal cerebral embolization in rats.

We assessed the incidence of hemorrhagic transformation and infarct volume after early intravenous infusion of recombinant human tissue plasminogen activator (rht-PA) in a newly developed rat cerebral embolic model. Male Wistar rats (n=60) were subjected to middle cerebral artery (MCA) occlusion by a single fibrin rich clot. One hour after embolization, rats were assigned to the following groups: (1) rht-PA treated group (n=20); (2) vehicle treated group (n=20); and (3) saline treated group (n=20). Neurological deficits, lodgement of a clot at the origin of the MCA, infarction volume and microscopic hemorrhage were measured. Animals exhibited moderate to severe neurological deficits 1 h after MCA occlusion in all groups. Administration of rht-PA significantly (P<0.05) reduced the incidence of lodgement of a clot at the origin of the MCA (30%) compared with the saline treated group (100%) and the vehicle treated group (80%). A significant (P<0.05) reduction of percent hemispheric infarct volume was detected between the saline (33.2+/-3.71%) and the rht-PA groups (19.4+/-3.3%). However, no significant difference was found in the total area of microscopic hemorrhage of the rht-PA (0.05+/-0.02 mm2), the vehicle (0.02+/-0.01 mm2), and the saline (0.03+/-0.02 mm2) treated groups. No significant difference of percent hemispheric infarct volume (P=0.08) was observed between the vehicle and the rht-PA treated groups. This study demonstrates that treatment with rht-PA reduced infarct volume without increasing intracerebral hemorrhage in rats with large cerebral infarction when treatment was initiated at 1 h of the onset of embolization.

Animals↗

PubMed1995

Design issues in studies of radon and lung cancer: implications of the joint effect of smoking and radon.

Many case-control studies have been undertaken to assess whether and to what extent residential radon exposure is a risk factor for lung cancer. Nearly all these studies have been conducted in populations including smokers and nonsmokers. In this paper, we show that, depending on the nature of the joint effect of radon and tobacco on lung cancer risk, it may be very difficult to detect a main effect due to radon in mixed smoking and nonsmoking populations. If the joint effect is closer to additive than multiplicative, the most cost-effective way to achieve adequate statistical power may be to conduct a study among never-smokers. Because the underlying joint effect is unknown, and because many studies have been carried out among mixed smoker and nonsmoker populations, it would be desirable to conduct some studies with adequate power among never-smokers only.

Case-Control Studies↗

PubMed1994

Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit. A randomized, controlled, single-blind study.

OBJECTIVE: To determine the efficacy and safety of cimetidine and sucralfate prophylaxis for stress-related gastrointestinal hemorrhage in patients admitted to a medical intensive care unit. SETTING: Medical intensive care unit of a nonprofit, university-affiliated teaching hospital. PATIENTS: 300 patients admitted to the medical intensive care unit during a 10-month period. DESIGN: Randomized, controlled, single-blind clinical trial. INTERVENTION: Patients were assigned to receive no prophylaxis (control), 1 g sucralfate given orally every 6 hours, or continuous intravenous cimetidine titrated to maintain gastric pH at 4.0, intervention was maintained until the occurrence of clinically severe hemorrhage, onset of drug-related complications, death, or discharge from the medical intensive care unit. OUTCOME MEASURES: The primary outcome measure was the incidence of clinically severe hemorrhage from endoscopically verified stress-related gastritis. Other outcome measures were transfusion requirements, duration of medical intensive care unit stay, incidence of nosocomial pneumonia, adverse drug reactions, and death. RESULTS: 100 patients were randomly assigned to each treatment. The three groups were similar with regard to demographic characteristics, intensive care unit admission diagnoses, and APACHE II scores. Stress-related hemorrhage was seen in 6% of control participants and in 5% of those receiving sucralfate or cimetidine (relative risk compared with control, 0.83 for each group; 95% CI, 0.26 to 2.64; P = 0.75). No statistically significant differences were found for transfusion requirements, duration of medical intensive care unit stay, and mortality rates among the three groups. Nosocomial pneumonia was diagnosed in 6%, 12%, and 13% of controls, sucralfate recipients, and cimetidine recipients, respectively (sucralfate: relative risk, 2.0 [CI, 0.79 to 5.01], P = 0.14; cimetidine: relative risk, 2.2 [CI, 0.88 to 5.33], P = 0.09). Prophylaxis caused no definite adverse drug reactions. CONCLUSIONS: The observed effects of cimetidine and sucralfate on the incidence and severity of hemorrhage from stress-related gastritis were not significant when compared with no treatment. Routine prophylaxis with these agents for patients entering the medical intensive care unit does not seem warranted.

Adult↗

PubMed1993

Differences between men and women with HIV-related Pneumocystis carinii pneumonia: experience from 3,070 cases in New York City in 1987.

Although women make up the fastest growing group of persons with AIDS, studies of human immunodeficiency virus (HIV)-infected persons reported to date have included predominantly or exclusively men. We evaluated sex differences in sociodemographic characteristics, hospital characteristics, in-hospital resource use, and short-term mortality rates for 2,526 men and 544 women admitted for their first-episode of HIV-related Pneumocystis carinii pneumonia (PCP) in New York City in 1987. Compared with men, women were significantly less likely to be white (81% vs. 54%, p < or = 0.001) or have private health insurance (80% vs. 58%, p < or = 0.001), and more likely to be admitted through an emergency room (79% vs. 71%, p < or = 0.001) and receive care at hospitals that had less experience treating PCP (p < or = 0.001). Women were more likely than men to die in the hospital [33% vs. 24%; crude odds ratio = 1.56, confidence interval (CI) = 1.28-1.91, p < or = 0.001]. In a logistic regression model, the risk of death in the hospital was associated with age 60-65 years [adjusted odds ratio (AOR) = 4.19, CI = 2.13-8.21], not having private health insurance (AOR = 1.37, CI = 1.08-1.75), admission through the emergency room (AOR = 1.54, CI = 1.21-1.96), and receiving care at hospitals with less experience treating PCP (AOR = 1.63, CI = 1.15-2.30), but women were not significantly more likely to die in the hospital than men (AOR = 1.18, CI = 0.93-1.50). Poorer access to medical care as well as higher use of hospitals with less experience treating AIDS may account for the difference in mortality rates observed in women with HIV-related PCP.

AIDS-Related Opportunistic Infections↗

PubMed1991

The utility of the Psychosomatic Symptom Checklist among hospitalized patients.

We examined the utility of the Psychosomatic Symptom Checklist in an inpatient medical setting with particular emphasis on the putative ability of the PSC to discriminate psychosomatic from nonpsychosomatic patients. First, 80 hospitalized psychosomatic patients were compared to 80 hospitalized medical patients on the PSC. Second, a sample of 187 psychosomatic patients was studied to examine the relationship among psychosomatic distress, depression, and functional impairment. The results indicate that while psychosomatic patients scored significantly higher than comparable medical patients on the PSC, discriminant analyses indicate that the PSC is not able to identify psychosomatic patients in an inpatient medical setting. Factor analyses and correlations show that the PSC is positively related to increased depression and decreased functional status. Results are interpreted in light of current psychosomatic theory.

Depression↗

PubMed1984

Effects of head-out water immersion on the urinary excretion of phosphate, calcium and magnesium in the awake dog.

The present study was undertaken to define the effects of heat-out water immersion on the urinary excretion of phosphate (UPO4V), calcium (UCaV), and magnesium (UMgV) in the awake dog. 53 dogs were divided into three groups: group I, time-control, from 10 a.m. to 4 p.m.; group II, immersion for 2 h, studied from 10 a.m. to 4 p.m., and group III, immersion for 2 h, studied from 4 p.m. to 10 p.m. Our results show that head-out water immersion did not alter the spontaneous pattern of UPO4V. When immersion was performed from 1 p.m. to 3. p.m. (group II), it had no effect on UCaV but induced a significant increase in UMgV although fractional excretion of Mg (FEMg) remained unchanged. When immersion was performed from 7 p.m. to 9 p.m. (group III), however, both UCaV and UMgV increased significantly. FECa also increased significantly in this group but FEMg again remained unchanged. The changes in UCaV were dissociated with UNaV. Changes in plasma PO4 (PPO4) and arterial pH were unrelated to changes in UCaV or UPO4V. Our findings show that head-out water immersion induces significant increases in UCaV and UMgV by mechanisms which are independent of parathyroid hormone (PTH) or acid base changes. The rise in UMgV seems to be related to an increase in the filtered load, while the increases in UCaV are secondary to changes in the renal tubular handling of calcium. Thus, under these experimental circumstances, Ca and Mg reabsorption seem to occur via different distal tubular pathways.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗