[Recommendations for the use of intravenous thrombolytic therapy in cerebrovascular ischemic accident. French Society of Neurovascular Disorders].
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Brain Ischemia↗
Biomedical subjects
P Goldstein
Publications and source records attributed to P Goldstein.
A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital. European Epinephrine Study Group.
BACKGROUND: Clinical trials have not shown a benefit of high doses of epinephrine in the management of cardiac arrest. We conducted a prospective, multicenter, randomized study comparing repeated high doses of epinephrine with repeated standard doses in cases of out-of-hospital cardiac arrest. METHODS: Adult patients who had cardiac arrest outside the hospital were enrolled if the cardiac rhythm continued to be ventricular fibrillation despite the administration of external electrical shocks, or if they had asystole or pulseless electrical activity at the time epinephrine was administered. We randomly assigned 3327 patients to receive up to 15 high doses (5 mg each) or standard doses (1 mg each) of epinephrine according to the current protocol for advanced cardiac life support. RESULTS: In the high-dose group, 40.4 percent of 1677 patients had a return of spontaneous circulation, as compared with 36.4 percent of 1650 patients in the standard-dose group (P=0.02); 26.5 percent of the patients in the high-dose group and 23.6 percent of those in the standard-dose group survived to be admitted to the hospital (P=0.05); 2.3 percent of the patients in the high-dose group and 2.8 percent in the standard-dose group survived to be discharged from the hospital (P=0.34). There was no significant difference in neurologic status according to treatment among those discharged. High-dose epinephrine improved the rate of successful resuscitation in patients with asystole, but not in those with ventricular fibrillation. CONCLUSIONS: In our study, long-term survival after cardiac arrest outside the hospital was no better with repeated high doses of epinephrine than with repeated standard doses.
Adrenergic Agonists↗
The reliability and consistency of drug reporting in ethnographic samples.
Findings are addressed concerning the reliability of reporting on drug dealing and drug use. Reports provided in retrospective life history interviews are compared with reports gathered and summarized from eight prospective weekly interviews. Most subjects reporting involvement in drug dealing during the weekly interviews, also reported involvement in this behavior during the life history report. There was a tendency for subjects to deny current involvement in drug dealing during the life history reports, even though they reported involvement in drug dealing in the weekly interviews. Binary indicators derived from life history interviews about current drug use were consistent with reports provided prospectively. Subjects reported considerably higher use quantities and frequencies for substances in the life history reports than they did in the weekly interview reports. These results are examined in the context of other recent work examining the reliability of retrospective substance involvement reports. Implications for ethnographic research on drug use are discussed.
Adult↗
The synaptonemal complexes of the nematode Caenorhabditis elegans: gametic response to retinol.
Retinol (RO) is essential for normal gene expression and progression of gametogenesis. Excessive amounts of RO in the diet results in the condition termed 'hypervitaminosis A' which severely affects gametogenesis. In the present work, the nematode Caenorhabditis elegans was grown in different concentrations of RO for up to seven generations. Decreased fecundity was positively correlated with increasing concentrations of RO with successive generations. Decreased nuclear volume was positively correlated with increasing RO concentration for each generation. Abnormal chromatin condensation was present along the bivalent and the lengths of the synaptonemal complexes (SC) were consistently longer than in the wild-type. Increasing RO concentration was also negatively correlated with the presence of SCs. The presence of disjunction regulator regions (DRR), which are decondensed regions of chromatin along the bivalent which occur in specific numbers, was negatively correlated with increasing RO concentration. By the third generation, DRRs were no longer observed in any of the organisms. This study shows that high levels of retinol in the diet affect gene expression, via changes in chromosome structure, and interferes with gamete production by inhibiting the pairing of homologous chromosomes during meiotic prophase.
Animals↗
The nematode Caenorhabditis elegans is up to 39 times more sensitive to gamma radiation generated from 137Cs than from 60Co.
Survival after gamma irradiation (generated from either a 137Cs or 60Co source) was determined for two strains of the nematode Caenorhabditis elegans. Animals were between 1.3 and 39 times more sensitive to cesium than to cobalt. The magnitude of this differential sensitivity was dependent upon the strain, developmental stage and sex tested. Several control experiments eliminated trivial explanations for this difference. Since cobalt- and cesium-generated gamma particles have nearly identical energy depositions, the differential sensitivity likely reflects different mechanisms of processing the slightly different spectra of DNA damage induced by these two radiations. Sex-specific differences in radiation sensitivity were also noted and were likely due to the fact that males possess a single X chromosome rather than two, as do hermaphrodites.
Animals↗
The Cleveland Clinic Foundation Harry R. Horvitz Palliative Care Center.
In 1994, the Harry R. Horvitz Palliative Care Center opened as a dedicated inpatient palliative care unit within a comprehensive Palliative Care Program in the United States. The program is designated by the World Health Organization as a national and international demonstration project in the provision of palliative care. The mission of the program and the inpatient unit is to provide excellent care for patients with advanced cancer and their families throughout the illness and during bereavement. The need for the 23-bed inpatient unit was documented by the increasing number of cancer deaths each year and the complex physical and psychosocial problems patients and families experience throughout the course of their illness. Health care professionals specially trained in palliative care are an essential component of a dedicated program within a cancer center.
Fund Raising↗
The synaptonemal complexes of the meiotic parthenogenetic Antarctic nematode Panagrolaimus davidi: karyotype analysis and three-dimensional reconstruction of pachytene nuclei.
This study represents the first complete reconstruction of synaptonemal complexes (SCs) and analysis of the pachytene stage of meiosis prophase I in the genus Panagrolaimus. In the free-living meiotic parthenogenetic Antarctic nematode P. davidi, pachytene nuclei had an average nuclear volume of 40 microns 3. Seven synaptonemal complexes were present (n = 7) and the average total length was 65.1 microns. The SCs were attached to the NE at only one end. The nucleolar organizer region was restricted to a central position on the SC. The unstriated central element consisted of two linear components and lacked transverse filaments. Such a modification of the SC has been seen in only two other organisms; the amphimictic nematode Heterodera glycines and the meiotic parthenogenetic nematode Heterodera betulae. Recombination nodules were not evident in the pachytene nuclei. There was no apparent interlocking of bivalents. Morphologically distinct sex chromosomes were not observed.
Animals↗
High-dose and low-dose systemic corticosteroids are equally efficient in acute severe asthma.
The optimal amount of systemic corticosteroids to be used in acute severe asthma remains an unresolved issue. In this double-blind, randomized study we compared two doses of methylprednisolone (1 vs 6 mg.kg-1 q.d.) in asthmatics presenting with an acute severe asthma attack, unresponsive to an intensive beta 2-agonist regimen administered during a run-in period. Concurrent therapy, including oxygen, inhaled and intravenous salbutamol, and aminophylline was strictly standardized. The response was assessed by serial bedside spirometry. The primary outcome measurement was forced expiratory volume in one second (FEV1) (expressed as percentage of predicted values) at 24 and 44 h. The trial was designed in order to achieve a statistical power of 90%. Twenty three patients were included in the low-dose group and 24 in the high-dose group. Both groups were comparable in terms of demographic profiles, history of asthma, and severity of the current attack. Improvement in pulmonary function was similar in both groups. At 44 h, the mean (+/- SD) FEV1 values were 53 +/- 22 and 45 +/- 14% in the low and in the high-dose group respectively (NS). We conclude that high dose systemic corticosteroids offer no further benefit over low-doses in the treatment of severe acute asthma.
Acute Disease↗
Substance involvement among juvenile murderers: comparisons with older offenders based on interviews with prison inmates.
We evaluated substance involvement among incarcerated juvenile offenders convicted of murder of manslaughter. Patterns of substance involvement among juvenile offenders were compared with patterns found in older offenders. Irrespective of age group, close to one-third of all homicide perpetrators reported that they were affected by alcohol prior to the offense. In every age group, alcohol was the substance showing the highest rate of "regular" lifetime use and the highest rate of ingestion in the week preceding the homicide. In many respects, the reported substance use patterns in the 16-17-year-old age group were closer to the patterns demonstrated by the oldest (36+) age group than they were to the adjacent 18-20-year-old group. Juvenile offenders were generally less substance involved than all but the oldest group of offenders. Almost all of the juveniles who were substance involved prior to the homicide attributed the homicide to the effects of those substances. Narrative accounts suggest that substances (almost always alcohol) escalated impulsive, spontaneous violent outbursts. Implications for the interpretation of self-reports about substance use provided by murderers are also discussed.
Adolescent↗
Pachytene karyotype analysis of the nematode Meloidogyne spartinae in relation to the genus Meloidogyne.
Seven synaptonemal complexes (SC) were present in the pachytene nuclei of Meloidogyne spartinae. The SC was bipartite and consisted of two lateral elements, while lacking a striated central element. This pattern was similar in all Meloidogyne species studied thus far with the exception of M. microtyla. Each SC was attached by only one end to the nuclear envelope while the other end remained unattached and was free in the nucleoplasm. A bouquet formation at pachytene was absent. An average of eight recombination nodules were present on the SC during all stages of pachytene, although the length of SC increased approximately 77%, from an average of 78 to 138 microm from early to mid-late pachytene. In M. spartinae, there was no apparent relationship between SC length and amount of recombination at pachytene. In addition, nuclear volume increased >60% during pachytene while nucleolar volume decreased by approximately 35%. Two nucleolar organizer regions (NOR) were present during mid-pachytene, whereas other stages had only one NOR. This is the first time that two nucleoli have been identified at pachytene in any nematode. They were both the same chromosome yet in reverse order relative to the telomere attached to the nuclear envelope, suggesting that each telomere was competent to interact with the nuclear envelope.
Animals↗
Transgenerational, ultrastructural analysis on the antioxidative effects of tocopherol on early gametogenesis in Caenorhabditis elegans grown in 100% oxygen.
The random, free-radical-mediated oxidations of biological molecules result in membrane degradation leading to cellular deterioration (B. Halliwell, Free Radical Res. Commun. 9, 1-32, 1990). External oxygen, prooxidants, and internally produced oxygen free radicals (oxyradicals), interact and alter the nature of biomembranes. Antioxidants, e.g., tocopherol (Vitamin E), inhibit such oxidative damage of free radicals. In the present study, the nematode Caenorhabditis elegans was grown under hyperoxia (100% oxygen) with or without the addition of Vitamin E to the growth media. The nematodes were viable under such conditions for at least eight generations, although fecundity gradually decreased through successive generations, presumably due to genetic load. Vitamin E was also shown to have a protective effect against paraquat, which is a strong, intracellular, oxidizing agent. Ultrastructural observations of early meiosis showed that the formation of synaptonemal complexes was compromised and that the telomeres failed to attach to the nuclear envelope. Those nematodes grown in 100% oxygen with 200 micrograms/ml Vitamin E had normal meiotic structures and normal fecundity. Thus, the presence of enhanced levels of intracellular Vitamin E resulted in protection against oxidative stress during gametogenesis.
Animals↗
Managing a palliative oncology program: the role of a business plan.
Today's health-care environment demands that palliative-care programs operate in a businesslike manner. This report summarizes the business plan and the process followed to develop the Palliative Care Program at the Cleveland Clinic Foundation (CCF). The benefits generated from this effort and the lessons learned that may be helpful to other program managers are described. By disciplining itself to focus on financial, marketing, and operational issues, the Palliative Care Program is in a better position to advance its clinical services within the organization and in its market area, and can thereby serve its patients more effectively.
Financial Management↗
The role of marijuana in homicide.
In this paper we examine the relationship between marijuana use and homicide. Data derive from interviews with 268 individuals incarcerated in New York State correctional facilities for homicides that occurred in 1984. We found that in terms of lifetime use, marijuana was the most commonly used illicit drug in this sample; that about one-third of respondents who had ever used marijuana used the drug in the 24-hour period before the homicide; and that almost three-quarters of those respondents were experiencing some type of effect from the drug when the homicide occurred. A total of 18 respondents (7% of the total sample) said that the homicide was related to their marijuana use. We examine the reasons these respondents gave for this relationship and the other substances they reported using at the time of the homicide. We also demonstrate that from the perspective of a conceptual framework that specifies the ways that drugs and violence may be linked, there are various nuances in the ways that marijuana and homicide are related. We discuss the implications and limitations of using self-report data from perpetrators of violence for our understanding of the drugs-violence connection.
Adolescent↗
When plan summaries are inadequate.
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Documentation↗
Hypervitaminosis E and gametogenesis in Caenorhabditis elegans.
Expected benefits, i.e. increasing life span and vitality, from ingesting d,1-alpha tocopherol (vitamin E), are not realized using vitamin E acetate (VEA) since the acetate form is only slowly converted to vitamin E in either mammalian or nematode tissues. The resultant accumulation of VEA in the cytosol is toxic, which results in aberrations in nuclear morphology, decreased life span and production of progeny, increased mean reproductive day and general loss of vitality. Incorporation of VEA into membranes results in allosteric changes in membrane structure. Such changes are proportional to increasing concentrations of VEA, thereby inhibiting the attachment of the telomere to the nuclear envelope. Reproductive and chromosomal strategies are compromised such that synaptonemal complexes, normally found during pachytene in oocytes, are rarely present in those nematodes exposed to high concentrations of VEA. The resultant loss of SCs correlates with decreased progeny and the chromosomal aberrations characteristic of hypervitaminosis E.
Animals↗
Effects of dimethyl sulfone (DMSO2) on early gametogenesis in Caenorhabditis elegans: ultrastructural aberrations and loss of synaptonemal complexes from pachytene nuclei.
The free-living nematode Caenorhabditis elegans has been used extensively for studies in developmental and reproductive genetics. Recently, toxicologic studies have been initiated using specific sex chromosome mutations. In the present study, high incidence of male (him) mutants, him-5 and him-8, were treated with dimethyl sulfone (DMSO2), the primary metabolite of dimethyl sulfoxide (DMSO). In addition to differential effects on X-chromosome nondisjunction, loss of viability and fertility were observed. Much lower concentrations of DMSO2 were required to elicit the same aberrational effects characteristic of DMSO (1); thus, the toxicity of the former was significantly more potent. The observed decrease in life span was associated with senescent morphology of meiotic prophase nuclei, such that nuclei from young and old specimens could not be differentiated. Aging in oocytes at pachytene is characterized by nucleo-cytoplasmic aberrations, increased density of the nucleoplasm and cytoplasm, and decrease in numbers of mitochondria. Increasing concentrations of DMSO2 resulted in a corresponding decrease in fertility and increased production of abnormal gametes. At DMSO2 concentrations higher than 1.0%, synaptonemal complexes (SC) were absent from pachytene nuclei; thus, effective pairing and segregation of homologous chromosomes was prohibited. Since the SC is essential for regulating pairing and subsequent separation of bivalents, the lack of an SC explains the loss of fertility, due to the production of unbalanced gametes, observed in DMSO2-treated specimens.
Animals↗
[Hydatid cyst of the kidney in the child].
Three pediatric cases of hydatic cyst of the kidney are reported. This is a very rare condition in children. Usually, the presentation is a cystic space-occupying lesion of the kidney. Several diagnostic methods are available but it is stressed that ultrasonography may be sufficient. Surgical treatment is still necessary.
Child↗
Erratum: Theoretical basis for the Vogel-Fulcher-Tammann equation
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Journal Article↗