Biomedical subjects

M Bridget Zimmerman

Publications and source records attributed to M Bridget Zimmerman.

At least 19 recordsLinked to original sources

PubMed2007

The -20 and -217 promoter variants dominate differential angiotensinogen haplotype regulation in angiotensinogen-expressing cells.

A number of naturally occurring polymorphisms exist in the human angiotensinogen locus, some of which have been associated with essential hypertension, preeclampsia, and other medical disorders. However, to date there has been no comprehensive determination of the significance of specific haplotypes in relation to the regulation of angiotensinogen expression. We cloned the promoters extending from -1219 to +125 bp from 11 ethnically diverse individuals to acquire a representative cross-section of known haplotype diversity. Eight nonredundant haplotypes were identified, fused to luciferase, and studied for their effect on transcriptional regulation in human astrocyte, proximal tubule, and hepatocyte cell lines endogenously expressing angiotensinogen and in a mouse adipocyte cell line. The studies were carried out under baseline conditions, in the presence of the angiotensinogen enhancer, and in response to hormonal stimulation by dexamethasone, beta-estradiol, or testosterone. A statistical model was then constructed to assess the significance of individual polymorphisms. The polymorphisms with the greatest effect on transcription in these cell lines were located at -20 and -217. There were modest haplotype-specific effects of the angiotensinogen enhancer and no haplotype-specific effects of beta-estradiol, dexamethasone, or testosterone treatment. We conclude the following: (1) the -20 and -217 polymorphisms have the largest influence on angiotensinogen transcription, (2) other polymorphisms have a much smaller impact on angiotensinogen transcription, and (3) the transcriptional influence of the promoter polymorphisms may act cell specifically. Therefore, our data support a hypothesis that polymorphisms in the angiotensinogen promoter may act cell specifically to differentially regulate the level of angiotensinogen transcription in angiotensin-producing tissues.

Adipose Tissue↗

PubMed2007

Optic disc edema in non-arteritic anterior ischemic optic neuropathy.

We investigated the clinical characteristics, time to resolution and the factors that influence it, and evolutionary pattern of optic disc edema (ODE) in non-arteritic anterior ischemic optic neuropathy (NA-AION). Our study was conducted in 591 consecutive patients (749 eyes) with NA-AION who fulfilled our inclusion criteria. On their first visit to our clinic, all patients had a detailed ophthalmic and medical history, a comprehensive ophthalmic evaluation, and stereoscopic color fundus photography and fluorescein fundus angiography. On each follow-up visit, the same ophthalmic evaluation was performed, except for fluorescein fundus angiography. The effect of steroid therapy on ODE was evaluated in a "patient choice study" in 723 eyes, i.e., patients who voluntarily opted to have (343 eyes) or not have (380 eyes) this therapy. To identify the factors that influence time to ODE resolution, parametric regression models for interval-censored data were fitted by maximum likelihood estimation using an SAS procedure. Our results indicate that the overall median time (25-75th percentile) to spontaneous resolution of ODE from the onset of visual loss was 7.9 (5.8-11.4) weeks. The ODE resolution time was longer in diabetics than in non-diabetics (p = 0.003) in the single factor model. Multi-factor analysis showed that worse initial visual field defects (p < 0.0001) and worse visual acuity (p = 0.04) were associated with a faster resolution of ODE. Those treated with steroid therapy within 2 weeks after onset of NA-AION had significantly (p = 0.0006) faster ODE resolution than untreated cases. Severity of initial visual loss and systemic diseases were identical in steroid treated and untreated patients. A characteristic evolutionary pattern of ODE in NA-AION was observed. In conclusion, our study showed that in NA-AION the time course for resolution of ODE is shorter with greater severity of initial visual field and visual acuity loss, which may relate to the number of axons permanently damaged during the acute stage. Steroid therapy was associated with shorter time to resolution of ODE. Resolution of ODE goes through a characteristic evolutionary process.

Aged↗

PubMed2006

A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections.

OBJECTIVE: We evaluated 4 important outcomes associated with postoperative nosocomial infection: costs, mortality, excess length of stay, and utilization of healthcare resources. DESIGN: The outcomes for patients who underwent general, cardiothoracic, and neurosurgical operations were recorded during a previous clinical trial. Multivariable analyses including significant covariates were conducted to determine whether nosocomial infection significantly affected the outcomes. SETTING: A large tertiary care medical center and an affiliated Veterans Affairs Medical Center. PATIENTS: A total of 3,864 surgical patients. RESULTS: The overall nosocomial infection rate was 11.3%. Important covariates included age, Karnofsky score, McCabe and Jackson classification of the severity of underlying disease, National Nosocomial Infection Surveillance system risk index, and number of comorbidities. After accounting for covariates, nosocomial infection was associated with increased postoperative length of stay, increased costs, increased hospital readmission rate, and increased use of antimicrobial agents in the outpatient setting. Nosocomial infection was not associated independently with a significantly increased risk of death in this surgical population. CONCLUSION: Postoperative nosocomial infection was associated with increased costs of care and with increased utilization of medical resources. To accurately assess the effects of nosocomial infections, one must take into account important covariates. Surgeons seeking to decrease the cost of care and resource utilization must identify ways to decrease the rate of postoperative nosocomial infection.

Adult↗

PubMed2006

Structured journal club as a tool to teach and assess resident competence in practice-based learning and improvement.

PURPOSE: To describe the use of the journal club as a tool to teach and assess competency in practice-based learning (PBL) and improvement among residents in ophthalmology. DESIGN: Interventional case series. PARTICIPANTS: Ophthalmology residents. SETTING: Three academic ophthalmology residency programs in the United States. METHODS: A survey was performed of self-assessed skills in PBL among residents in ophthalmology training before and after the implementation of a structured review checklist during a traditional resident journal club. The survey had 5 domains, including (A) appraise and assimilate evidence, (B) read a journal article critically, (C) use a systematic and standardized checklist, (D) apply knowledge of study designs and statistical methods, and (E) maintain a self-documented written record of compliance. The respondents scored their ability (range, 1-5). RESULTS: The use of a structured journal club tool was associated with a statistically significant improvement in self-assessed ability in all 5 domains. CONCLUSIONS: Although validity, reliability, and long-term efficacy studies are necessary, the structured journal club is one method of teaching and assessing resident competency in PBL and improvement.

Clinical Competence↗

PubMed2006

Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure.

Low-dose thiazide-type diuretics are recommended as initial therapy for most hypertensive patients. Chlorthalidone has significantly reduced stroke and cardiovascular end points in several landmark trials; however, hydrochlorothiazide remains favored in practice. Most clinicians assume that the drugs are interchangeable, but their antihypertensive effects at lower doses have not been directly compared. We conducted a randomized, single-blinded, 8-week active treatment, crossover study comparing chlorthalidone 12.5 mg/day (force-titrated to 25 mg/day) and hydrochlorothiazide 25 mg/day (force-titrated to 50 mg/day) in untreated hypertensive patients. The main outcome, 24-hour ambulatory blood pressure (BP) monitoring, was assessed at baseline and week 8, along with standard office BP readings every 2 weeks. Thirty patients completed the first active treatment period, whereas 24 patients completed both. An order-drug-time interaction was observed with chlorthalidone; therefore, data from only the first active treatment period was considered. Week 8 ambulatory BPs indicated a greater reduction from baseline in systolic BP with chlorthalidone 25 mg/day compared with hydrochlorothiazide 50 mg/day (24-hour mean = -12.4+/-1.8 mm Hg versus -7.4+/-1.7 mm Hg; P=0.054; nighttime mean = -13.5+/-1.9 mm Hg versus -6.4+/-1.8 mm Hg; P=0.009). Office systolic BP reduction was lower at week 2 for chlorthalidone 12.5 mg/day versus hydrochlorothiazide 25 mg/day (-15.7+/-2.2 mm Hg versus -4.5+/-2.1 mm Hg; P=0.001); however, by week 8, reductions were statistically similar (-17.1+/-3.7 versus -10.8+/-3.5; P=0.84). Within recommended doses, chlorthalidone is more effective in lowering systolic BPs than hydrochlorothiazide, as evidenced by 24-hour ambulatory BPs. These differences were not apparent with office BP measurements.

Adult↗

PubMed2006

Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry.

BACKGROUND: The epidemic of morbid obesity has increased bariatric procedures performed. Trend analyses provide important information that may impact individual practices. METHODS: Patient data from 137 surgeons were examined from 1987 to 2004 (41,860 patients) using Cochran-Armitage Trend test and Generalized Linear Model. RESULTS: Over an 18-year period, surgeon preference for combined restrictive-malabsorptive procedures increased from 33% to 94%, while simple gastric restriction decreased correspondingly (P < .0001). Surgeons per worksite doubled and cases per surgeon increased 71%. Laparoscopic procedures increased to 24%. The percentage of males, mean operative age, and initial body mass index (BMI) increased significantly (P < .0001). Postoperative hospital stay decreased from 5.0 to 3.9 days (P < .0001). The most common procedure in 2004 was Roux-en-Y gastric bypass (RYGB) (59%). CONCLUSION: Bariatric surgery patients are now older and heavier, length of stay is shorter, and the laparoscopic approach is more frequent. From 1987 to 2004, the general trend shows a clear preference for combined restrictive-malabsorptive operations.

Adult↗

PubMed2006

Decreased E-cadherin but not beta-catenin expression is associated with vascular invasion and decreased survival in head and neck squamous carcinomas.

OBJECTIVE: We wished to correlate the expression of E-cadherin and beta-catenin in squamous carcinomas of the head and neck to outcome and other clinicopathologic variables. STUDY DESIGN AND SETTING: This retrospective study was carried out in a tertiary care setting. The tumors of 45 patients who had their head and neck squamous carcinoma primarily treated by resection were evaluated immunohistochemically with antibodies to E-cadherin and beta-catenin. Thirty-two tumors arose in the oral cavity, 9 tumors originated in the larynx, and 4 tumors began in the hypopharynx. Patient outcome and the clinicopathologic variables of tumor site, tumor stage, cervical lymph node status, tumor differentiation, perineural invasion, and vascular invasion were correlated to immunohistochemical expression of E-cadherin and beta-catenin. RESULTS: Low expression of E-cadherin in the tumors was significantly associated with decreased overall survival (P = 0.004), disease-free survival (P = 0.007), and vascular invasion (P = 0.02) but not with other clinicopathologic variables. beta-catenin expression was not significantly associated with any of the studied clinicopathologic variables. CONCLUSION: Decreased E-cadherin but not beta-catenin expression is associated with decreased survival in patients with head and neck squamous carcinomas. SIGNIFICANCE: Detection of loss of E-cadherin expression may help predict which patients with head and neck squamous cell carcinoma will experience a worse outcome compared to patients whose tumors have not lost this tumor suppressor. EBM RATING: C-4.

Adult↗

PubMed2006

Interleukin-6, histamine, and methylhistamine as diagnostic markers for interstitial cystitis.

OBJECTIVES: To examine the specificity and sensitivity of the inflammatory markers histamine, methylhistamine, and interleukin-6 (IL-6) in the urine of patients with interstitial cystitis compared with that in healthy controls. METHODS: A total of 40 women with interstitial cystitis and 29 healthy controls collected 24-hour urine samples. During the 24 hours before urine collection, all participants refrained from consuming foods and medications that could contain bioactive amines. Methylhistamine and histamine were measured using radioimmunoassay kits and were normalized to urinary creatinine levels; IL-6 was measured using enzyme-linked immunosorbent assay. The data were analyzed by t tests, logistic regression analysis, and receiver operating characteristics. RESULTS: IL-6 and histamine were significantly greater in the patients with interstitial cystitis than in the controls (P = 0.0003 and P = 0.038, respectively). The methylhistamine levels were also greater in the patients with interstitial cystitis than in the controls, but the results did not reach significance (P = 0.063). Using a combination of IL-6 and methylhistamine/creatinine, cutoff points were established. Using these cutoff points, the sensitivity was 70.0%, specificity 72.4%, positive predictive value 77.8%, and negative predictive value 63.6%. CONCLUSIONS: All three markers--histamine, methylhistamine, and IL-6--were greater in the patients with interstitial cystitis than in the controls. A combination of methylhistamine and IL-6 could be used as a sensitive and specific marker for interstitial cystitis.

Adult↗

PubMed2006

Impact of comorbidities on the measurement of health in patients with ankle osteoarthritis.

BACKGROUND: Investigators seeking to understand the impact of musculoskeletal disorders commonly use validated outcome instruments to assess the effect of diseases on physical function and quality of life. However, the influence of concomitant systemic or musculoskeletal comorbidities on these scores has not been widely considered in orthopaedic research. The purpose of this study was to determine how morbidity unrelated to the ankle influences the perception of physical function and pain by patients with ankle osteoarthritis. METHODS: Short Form-36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, Ankle Osteoarthritis Scale (AOS) pain scale scores, demographic data, and systemic and musculoskeletal comorbidities were determined prospectively for 195 patients with ankle osteoarthritis and ninety-five age and gender-matched controls. The effect of systemic and musculoskeletal comorbidities on each of the scores was determined. RESULTS: On the average, patients with ankle osteoarthritis had a relatively normal MCS score (47 +/- 13 points) and a markedly diminished PCS score (32 +/- 8 points). Both of these scores averaged 50 +/- 9 points in the control group. The AOS pain score averaged 61 +/- 23 points in the group with ankle osteoarthritis, whereas it averaged 10 +/- 15 points in the control group. We found the perception of ankle pain by patients with ankle osteoarthritis to be significantly and linearly associated with the number of other musculoskeletal problems (not related to the foot or ankle). CONCLUSIONS: The degree of physical impairment associated with ankle osteoarthritis, as measured with the SF-36, is equivalent to that reported to be associated with severely disabling medical problems including end-stage kidney disease and congestive heart failure. The perception of ankle health status as measured with a validated, patient-oriented, anatomically specific instrument is influenced by the patients' perception of their overall musculoskeletal comorbidity status. The authors of clinical studies using these instruments should adjust for concomitant musculoskeletal disease.

Ankle Joint↗

PubMed2006

Decreased fragile histidine triad gene protein expression is associated with worse prognosis in oral squamous carcinoma.

CONTEXT: Fragile histidine triad (FHIT) gene is thought to be a tumor suppressor; abnormalities in expression have been reported in a variety of neoplasms. OBJECTIVE: To determine whether abnormalities of FHIT protein expression or loss of heterozygosity in the FHIT gene were correlated with survival or other clinical parameters in patients with oral cavity squamous cell carcinoma. DESIGN: Fifty-three patients with initial surgical treatment of oral cavity squamous cell carcinoma were followed a minimum of 5 years or until death. The FHIT protein expression was studied by immunohistochemistry in all patients, and a subset of 20 patients was studied for allelic loss of heterozygosity and microsatellite instability using formalin-fixed, paraffin-embedded tissue. RESULTS: Sixty-one percent of patients whose tumors had reduced FHIT expression were dead of disease, and 37% of patients whose tumors exhibited preserved FHIT expression were dead of disease at 5-year follow-up. Log-rank analysis showed that patients retaining FHIT expression had a longer overall survival (P = .03) and disease-free survival (P = .01). The FHIT expression was not correlated with node status or clinical stage. Loss of heterozygosity was seen in 10 (50%) of 20 tumors, low levels of microsatellite instability in 4 (20%) of 20 tumors, and high levels of microsatellite instability in 1 (5%) of 20 tumors tested. CONCLUSIONS: The FHIT gene was associated with a worse survival outcome when its expression was reduced in patients with oral cavity squamous cell carcinoma. Loss of heterozygosity in the gene was common, but no correlation with protein expression was found. Neither loss of heterozygosity nor microsatellite instability was found to correlate with survival. Because genomic alterations involving loss of heterozygosity of the FHIT gene were not associated with protein expression in these tumors, the presence or absence of FHIT expression may be controlled by other factors.

Acid Anhydride Hydrolases↗

PubMed2006

Changes in medications administered in schools.

The purpose of this descriptive, cross-sectional study was to determine if there have been changes in the type and number of attention deficit/hyperactivity disorder (AD/HD) medications administered in schools since the introduction of long-acting stimulants. A survey was sent to 1,000 school nurses randomly selected from the National Association of School Nurses membership, with 339 returned (34%). Between 2000 and 2003 the proportion of students receiving any prescription medication (2.9/100 vs. 1.0/100), methylphenidate (1.2 vs. 0.2), or amphetamine/dextroamphetamine (0.3/100 vs. 0.1/100) was significantly reduced ( p < .0001). High school students took fewer prescription ( p < .0001) and AD/HD medications ( p < .0001), but more nonprescription medications than other students. A total of 163 different prescription medications and 28 nonprescription medications were administered during the typical school day. This study suggests that the use of long-acting stimulants has significantly reduced the number of prescription medications administered in schools. This reduction has been accompanied by a dramatic increase in the range of medications administered, making the medication administration process in schools more complex, not less.

Adolescent↗

PubMed2005

Quadriphasic waveforms are superior to triphasic waveforms for transthoracic defibrillation in a cardiac arrest swine model with high impedance.

BACKGROUND: We have demonstrated previously that triphasic waveform shocks were superior to biphasic waveform shocks for transthoracic defibrillation. Our purpose was to compare the efficacy and safety of quadriphasic versus triphasic shocks for transthoracic defibrillation in a porcine model. METHODS: Sixteen adult swine (19-25 kg, mean: 21.5 kg) were deeply anesthetized and intubated. To simulate impedance of the human chest, fixed electrical resistors (25 or 50 ohms) was placed in series with the defibrillator and the chest of each pig. After 30 s of electrically induced VF, each pig received transthoracic shocks, using either a truncated exponential triphasic waveform (5 ms positive pulse duration, 5 ms negative pulse duration and 5 ms positive pulse duration, total waveform duration 15 ms) or a quadriphasic waveform (5/5/5/5 ms, total waveform duration 20 ms). Each pig received transthoracic triphasic and quadriphasic shocks at three selected energy levels (50, 100 and 150 J) in random sequence. Four shocks were delivered at each energy level to construct an energy versus % success curve. Success was defined as VF termination at 5 s after shock. The total shocks were divided into three groups based on the delivered energy actually delivered to the animal: <40, 40-65 and >65 J. Delivered energy = (animal impedance/total impedance) times selected energy of the shock. RESULTS: For high-impedance animals (86-102 ohms), quadriphasic waveform shocks achieved significantly higher percent shock success than triphasic shocks for the termination of VF at the energy levels of >65 J actually delivered (quadriphasic 72.7+/-12.2%, triphasic 38.9+/-7.7%, p<0.02). No differences in the shock success between quadriphasic and triphasic waveforms were found for other two energy levels. There were no differences in ventricular tachycardia or asystole after shocks between quadriphasic and triphasic waveforms. CONCLUSION: In this porcine model, 20 ms (5/5/5/5) quadriphasic shocks were superior to 15 ms (5/5/5) triphasic shocks for transthoracic defibrillation in animals with impedances that simulated high impedance in humans.

Animals↗

PubMed2005

Hypothermia improves defibrillation success and resuscitation outcomes from ventricular fibrillation.

BACKGROUND: Induced hypothermia is recommended to improve neurological outcomes in unconscious survivors of out-of-hospital ventricular fibrillation (VF) cardiac arrest. Patients resuscitated from a VF arrest are at risk of refibrillation, but there are few data on the effects of already existing hypothermia on defibrillation and resuscitation. METHODS AND RESULTS: Thirty-two swine (mean+/-SE weight, 23.0+/-0.6 kg) were divided into 4 groups: normothermia (n=8), mild hypothermia (35 degrees C) (n=8), moderate hypothermia (33 degrees C) (n=8), and severe hypothermia (30 degrees C) (n=8). Hypothermia was induced by surrounding the animal with ice, and VF was electrically induced. After 8 minutes of unsupported VF (no CPR), the swine were defibrillated (biphasic waveform) with successive shocks as needed and underwent CPR until resumption of spontaneous circulation or no response (> or =10 minutes). First-shock defibrillation success was higher in the moderate hypothermia group (6 of 8 hypothermia versus 1 of 8 normothermia; P=0.04). The number of shocks needed for late defibrillation (> or =1 minute after initial shock) was less in all 3 hypothermia groups compared with normothermia (all P<0.05). None of the 8 animals in the normothermia group achieved resumption of spontaneous circulation compared with 3 of 8 mild hypothermia (P=NS), 7 of 8 moderate hypothermia (P=0.001), and 5 of 8 severe hypothermia (P=0.03) animals. Coronary perfusion pressure during CPR was not different between the groups. CONCLUSIONS: When VF was induced in the setting of moderate or severe hypothermia, resuscitative measures were facilitated with significantly improved defibrillation success and resuscitation outcome. The beneficial effect of hypothermia was not due to alteration of coronary perfusion pressure, which suggests that changes in the mechanical, metabolic, or electrophysiological properties of the myocardium may be responsible.

Animals↗

PubMed2005

The rate of visual field loss in optic nerve head drusen.

PURPOSE: To define the rate of visual field loss in patients with optic nerve head drusen (ONHD). DESIGN: Retrospective chart review. METHODS: Goldmann visual field (GVF) testing from initial visit and last follow-up examination were quantified using the modified Esterman grid technique. The rate of visual field loss was calculated by comparing the initial GVF to the last follow-up GVF. A comparative analysis of GVF and age at initial evaluation was performed on all patients with an initial GVF only. SETTING: Tertiary academic care center. PARTICIPANTS: Inclusion criteria for the rate analysis: (1) diagnosis of ONHD and (2) at least 36 months of follow-up with serial GVF testing. EXCLUSION CRITERIA: (1) patients with glaucoma or glaucoma-suspect; (2) history or examination evidence for other ocular disease; and (3) drusen-related macular causes of visual loss. RESULTS: Thirty-two of 292 charts were included in the rate analysis. The rate of visual field loss was 1.58%. There was no statistically significant difference between men and women (P = .74). One hundred eighty patients were included in the initial visual field analysis. There was a significant negative correlation between age and GVF, with older patients having lower GVF scores with a Spearman correlation of -0.42 (P < 0.0001); 73% of these 180 patients had mild, minimal, or no visual field loss. CONCLUSIONS: The rate of visual field loss for ONHD over a 36-month interval of time was 1.6% per year. Patients with minimal or no visual field loss were younger, and patients with moderate or severe visual loss were older.

Adult↗

PubMed2005

Central retinal artery occlusion: visual outcome.

PURPOSE: To investigate systematically the natural history of visual outcome in central retinal artery occlusion (CRAO). DESIGN: Cohort study. METHODS: At entry, 244 consecutive patients (260 eyes) with CRAO (seen consecutively from 1973 to 2000) had a detailed ocular and medical history and ocular evaluation. CRAO eyes were classified into four categories: non-arteritic (NA) CRAO (171 eyes), NA-CRAO with cilioretinal artery sparing (35), transient NA-CRAO (41), and arteritic CRAO (13). RESULTS: Within 7 days of onset of CRAO, initial visual acuity differed among the four CRAO types (P < .0001). In eyes with vision of counting fingers or worse, it improved in 82% of eyes with transient NA-CRAO, 67% of eyes with NA-CRAO with cilioretinal artery sparing, and 22% of eyes with NA-CRAO. Visual acuity improved primarily within the first 7 days (P < .0001). In the central 30-degree visual field, central scotoma was most common. Central visual field improved in 39% with transient NA-CRAO, 25% with NA-CRAO with cilioretinal artery sparing, and 21% with NA-CRAO. Peripheral visual field was normal in 62.9% of eyes with transient NA-CRAO and 22.1% in those with NA-CRAO. In 51.9% of eyes with NA-CRAO, the only remaining visual field was a peripheral island. Peripheral fields improved in NA-CRAO (39%) and in transient NA-CRAO (39%). CONCLUSIONS: Classification of CRAO is crucial for understanding differences in visual outcome. Marked improvement in visual acuity and visual field can occur without treatment and is determined by several factors. Visual field information is essential to evaluate visual disability in CRAO.

Adult↗

PubMed2005

Telomerase activity as a potential diagnostic marker for triage of abnormal Pap smears.

OBJECTIVES: To determine whether there is an association between high levels of telomerase and premalignant cervical disease and to provide a preliminary analysis of telomerase activity as a potential triage strategy. MATERIALS AND METHODS: Premenopausal women were invited to participate in the study during routine gynecologic visits as well as visits where colposcopy was performed. Samples were taken from the cervix using a broom device and placed in cold phosphate-buffered saline. A total of 92 samples were evaluated. Cells were counted and lysed, and a semiquantitative measure of telomerase activity was determined using a commercially available telomerase enzyme-linked immunosorbent assay kit. The presence of human papillomavirus (HPV) types 16 and 18 was assessed by polymerase chain reaction analysis. One-way analysis of variance was used to test for the association of telomerase activity with cytology, HPV type 16 or 18 status, and colposcopy and/or biopsy findings. RESULTS: When telomerase levels were analyzed according to Pap smear results, there were no differences among four groups of cytology findings (normal, atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion). When colposcopy and/or biopsy results were considered, significantly higher levels of telomerase were detected in cervical intraepithelial neoplasia (CIN) 2,3 samples than in normal Pap smear samples and CIN 1 samples (p = .035). There was no significant difference in telomerase levels between samples that tested positive for HPV type 16 or 18 and those that did not (p = .111). CONCLUSIONS: Telomerase levels were significantly higher in cytologic samples from women with biopsy-proven CIN 2,3 than in samples from women with normal cytology results or CIN 1. These results warrant larger studies to determine whether telomerase activity may be a useful triage tool for abnormal cytologic findings.

Adolescent↗

PubMed2005

Metoclopramide effect on breastfeeding the preterm infant: a randomized trial.

OBJECTIVE: To investigate the effect of metoclopramide on breast milk volume and duration of breastfeeding in women delivering preterm. METHODS: Women who planned to breastfeed and delivered between 23 and 34 weeks of gestation were eligible to participate in this randomized, double-blind, placebo-controlled study. Women were randomized to receive 10 mg of metoclopramide or placebo 3 times a day for 10 days, starting within 96 hours of birth. Breastfeeding education was standardized for all women. Mothers recorded the volume of breast milk expressed at each pumping for 17 days. Duration of breastfeeding was measured by monthly follow-up phone calls to each subject. RESULTS: Sixty-nine women were enrolled and 57 (82%) women completed the study: 28 in the metoclopramide group and 29 in the placebo group. The 2 groups were similar in age, education, ethnicity, gestational age, and marital status. There was no significant difference between breast milk volumes in the metoclopramide and placebo groups at each of the 17 days of the study (P = .26 to .98; test for mean metoclopramide effect P = .80). There was no significant difference between groups in duration of breastfeeding, with a median of 8.8 weeks, an interquartile range of 3.4 to 12.0 weeks for the metoclopramide group and a median of 8.6 weeks, and an interquartile range of 5.6 to 16.9 weeks for the placebo group (P = .09). CONCLUSION: Metoclopramide did not improve breast milk volume or duration of breastfeeding in this population of women. Regardless of therapy received, breastfeeding duration in this study of preterm mothers was poor. LEVEL OF EVIDENCE: I.

Adult↗

PubMed2005

Association between valsalva and cough leak point pressures and pelvic organ prolapse quantification in women with stress incontinence.

PURPOSE: Women with urodynamically documented stress urinary incontinence (SUI) and urethral hypermobility may have a higher pelvic organ prolapse quantification (POP-Q) stage according to anterior POP-Q measurements. In this study we determined if POP-Q system anterior components representing the urethrovesical junction (anterior wall point Aa/Ba) and/or POP-Q stage has a relationship with leak point pressure testing. MATERIALS AND METHODS: Of the 1,511 women who underwent video fluoro-urodynamics during 1997 to 2003 at our institution 88 with only evidence of SUI with negative Valsalva leak point pressure and positive cough leak point pressure (CLPP) were selected. RESULTS: Average patient age was 58.6 years (range 32 to 89). Of the 88 women 82 had complete POP-Q examinations available, which revealed stages 0 to III in 21 (25.61%), 20 (24.39%), 40 (48.78%) and 1 (1.22%), respectively. The association between POP-Q stage/components and positive CLPP showed no significant difference in mean positive CLPP among POP-Q stages (p = 0.178) or components (p = 0.42 to 0.97). The test for linear trend was not significant (p = 0.636) for POP-Q stages/components (p = 0.40 to 0.93). No significant difference in volume at which positive CLPP occurred was observed among POP-Q stages (p = 0.283) or components (p = 0.13 to 0.75). The proportion of patients with leakage at 200 cc did not differ significantly among POP-Q stages (p = 0.119) or components (p = 0.15 to 0.60). CONCLUSIONS: Analysis of women with urodynamic evidence of SUI with negative Valsalva leak point pressure and positive CLPP did not show any significant association with components of the POP-Q system or with POP-Q stages. Findings support that POP-Q measurements should not be interpreted as indicators of urethral hypermobility when evaluating women with SUI.

Adult↗