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PubMedDate not supplied

Tumor lysis syndrome following single-dose mitoxantrone.

We report here a 16-year-old boy with pre-B-type acute lymphoblastic leukemia who developed acute tumor lysis syndrome (TLS) following 12 h mitoxantrone infusion. TLS is a distinct clinical entity which has been recognized most frequently with aggressive combination chemotherapy of rapidly proliferating hematologic neoplasms. There have been a few reports of single-agent-induced tumor lysis, but to our knowledge, this is the first case reported with mitoxantrone alone.

Adolescent↗

PubMed2000

Therapeutic limit setting in an assertive community treatment program.

OBJECTIVE: The study examined the use of therapeutic limit-setting activities by members of assertive community treatment teams with clients who had serious mental illness. METHODS: Case managers from 40 Veterans Affairs intensive psychiatric community care teams reported their use of 25 limit-setting activities with 1,564 veterans during the first six months of treatment. The 25-item measurement scale was factor analyzed, and a standard multiple regression procedure was used to regress scale scores on clients' characteristics, the frequency of case managers' contact with service providers and others, and clients' and case managers' perceptions about the therapeutic alliance. RESULTS: Case managers relied most frequently on informal verbal approaches to limit setting and relied least on formal legal restrictions. Factor analysis of the instrument, the Therapeutic Limit Setting (TLS) scale, reduced the number of items to 20 and resulted in a five-factor solution. The limit-setting factors were verbal guidance, money management, contingent withholding of services or support, enforced hospitalization, and invocation of external authorities. The TLS and its subscales were characterized by high internal consistency, modest intercorrelation, and unique relationships with variables related to clients' characteristics, the treatment process, and the therapeutic alliance. Case managers were more likely to set limits with clients who had more extensive hospitalization histories, a representative payee, recent alcohol or drug use, more arrests, and more severe symptoms. CONCLUSIONS: Case managers used a range of limit-setting strategies in assertive community treatment. Limit setting is a frequent and potentially important aspect of assertive community treatment that may be useful for comparing levels of assertiveness in assertive community treatment teams and other community-based rehabilitation services.

Assertiveness↗

PubMed2007

Least-squares methods for identifying biochemical regulatory networks from noisy measurements.

BACKGROUND: We consider the problem of identifying the dynamic interactions in biochemical networks from noisy experimental data. Typically, approaches for solving this problem make use of an estimation algorithm such as the well-known linear Least-Squares (LS) estimation technique. We demonstrate that when time-series measurements are corrupted by white noise and/or drift noise, more accurate and reliable identification of network interactions can be achieved by employing an estimation algorithm known as Constrained Total Least Squares (CTLS). The Total Least Squares (TLS) technique is a generalised least squares method to solve an overdetermined set of equations whose coefficients are noisy. The CTLS is a natural extension of TLS to the case where the noise components of the coefficients are correlated, as is usually the case with time-series measurements of concentrations and expression profiles in gene networks. RESULTS: The superior performance of the CTLS method in identifying network interactions is demonstrated on three examples: a genetic network containing four genes, a network describing p53 activity and mdm2 messenger RNA interactions, and a recently proposed kinetic model for interleukin (IL)-6 and (IL)-12b messenger RNA expression as a function of ATF3 and NF-kappaB promoter binding. For the first example, the CTLS significantly reduces the errors in the estimation of the Jacobian for the gene network. For the second, the CTLS reduces the errors from the measurements that are corrupted by white noise and the effect of neglected kinetics. For the third, it allows the correct identification, from noisy data, of the negative regulation of (IL)-6 and (IL)-12b by ATF3. CONCLUSION: The significant improvements in performance demonstrated by the CTLS method under the wide range of conditions tested here, including different levels and types of measurement noise and different numbers of data points, suggests that its application will enable more accurate and reliable identification and modelling of biochemical networks.

Algorithms↗

PubMed1976

Serum androgens in normal prepubertal and pubertal children and in children with precocious adrenarche.

Serum androgens testosterone (T), testosterone-like-substances (TLS), delta4-androstenedione (delta4), dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA) were measured in 85 normal girls and 101 normal boys grouped according to pubic hair development in Tanner stages I to IV/V. The pattern of change with puberty differed for each androgen. In boys T and TLS rose with the onset of puberty but showed a more abrupt rise later in puberty. DHT also was higher in boys in late puberty but did not demonstrate a steep rise. The other androgens did not show a sex difference at any stage of puberty. While delta4 steroids did not show an increase in the years before onset of puberty, DHEA was significantly higher in prepubertal children over 7 years than in those under 7 years (mean +/- SD 166 +/- 110 vs. 31 +/- 25, P less than 0.005). The most rapid increase of DHEA concentrations was observed with the appearance of pubic hair (Stage II) in boys and girls. This contrasted with the more gradual rise of delta4 in both sexes. The oldest boys and girls (Tanner stages IV/V) had mean concentrations of all androgens in the adult range except for DHT. Twenty-two girls with precocious adrenarche (PA) aged 3-8 years had mean concentrations of T, DHT, delta4 and DHEA that were significantly higher (P less than 0.05) than in prepubertal children, but similar to those of girls in stage II and significantly lower (P less than 0.02) than in late pubertal girls (stage IV/V). Longitudinal studies in 12 of the girls indicated fluctuation of androgen concentrations, especially DHEA, but in general no increase during the years of followup. Precocious adrenarche appears to be a non-progressive disorder associated with an advanced maturation of adrenal androgen to an early pubertal stage. A rise in all androgens measured was correlated with the development of sexual hair.

Adrenal Cortex↗

PubMed2006

Deficiency of the Caenorhabditis elegans DNA polymerase eta homologue increases sensitivity to UV radiation during germ-line development.

Defects in the human XPV/POLH gene result in the variant form of the disease xeroderma pigmentosum (XP-V). The gene encodes DNA polymerase eta (Poleta), which catalyzes translesion synthesis (TLS) past UV-induced cyclobutane pyrimidine dimers (CPDs) and other lesions. To further understand the roles of Poleta in multicellular organisms, we analyzed phenotypes caused by suppression of Caenorhabditis elegans POLH (Ce-POLH) by RNA interference (RNAi). F1 and F2 progeny from worms treated by Ce-POLH-specific RNAi grew normally, but F1 eggs laid by worms treated by RNAi against Ce-POLD, which encodes Poldelta did not hatch. These results suggest that Poldelta but not Poleta is essential for C. elegans embryogenesis. Poleta-targeted embryos UV-irradiated after egg laying were only moderately sensitive. In contrast, Poleta-targeted embryos UV-irradiated prior to egg laying exhibited severe sensitivity, indicating that Poleta contributes significantly to damage tolerance in C. elegans in early embryogenesis but only modestly at later stages. As early embryogenesis is characterized by high levels of DNA replication, Poleta may confer UV resistance in C. elegans, perhaps by catalyzing TLS in early embryogenesis.

Amino Acid Sequence↗

PubMed1995

Validation of 99Tcm-HMPAO leucocyte scintigraphy in ulcerative colitis by comparison with histology.

Leucocyte scintigraphy offers an alternative to more invasive techniques in the investigation of inflammatory bowel disease. The accuracy of 99Tcm-HMPAO leucocyte scintigraphy has not been assessed by comparison with colonic histology, which was the aim of this study. 15 patients with ulcerative colitis underwent 99Tcm-HMPAO leucocyte scintigraphy (TLS) less than 5 days before colonoscopy. Histological features of mucosal biopsies were compared with total and segmental colonic TLS scores. Segmental and total scintigraphy scores correlated most strongly with histological grades for acute inflammation (r = 0.75, p < 0.001 and r = 0.9, p < 0.001, respectively) and chronic inflammatory cell infiltration in the lamina propria (r = 0.76, p < 0.001 and r = 0.86, p < 0.001, respectively). 99Tcm-HMPAO leucocyte scintigraphy detected acute inflammation in the colon of patients with ulcerative colitis with a sensitivity of 91% and negative predictive value of 80% and localized acute inflammation to a particular colonic segment with a sensitivity of 82%, specificity of 94%, accuracy of 88%, positive predictive value of 94% and negative predictive value of 91%. 99Tcm-HMPAO leucocyte scintigraphy positivity predicts and localizes colonic acute inflammation with a high degree of confidence, but negative scintigraphy does not exclude acute inflammation.

Adult↗

PubMed2003

Contrast-to-noise ratio of multiple slice spin lock technique: prospects for liver imaging.

Spin lock (SL) MRI technique has been demonstrated to provide similar lesion/liver contrast to conventional MR technique. Multiple slice SL technique allows a large number of slices to be collected within a given repetition time due to the short echo time. In addition, the short echo time reduces movement and susceptibility artefacts. In the present study, the potential of the multiple slice SL technique in liver imaging was evaluated by using tissue nuclear magnetic resonance (NMR) information and tissue NMR parameters obtained at 0.1 T. 10 healthy volunteers were imaged at 0.1 T for the measurement of tissue T1rho, T1, and T2 relaxation times. Tissue radiofrequency-attenuation information was obtained from the literature, and included in the contrast-to-noise ratio (CNR) calculations. Our results demonstrated that by increasing the number of slices the acquired liver-to-spleen CNR decreases with all locking field durations (locking time, TL). However, with small TLs, the difference is small which is important for liver MRI where a wide coverage, i.e. large number of slices, is important. Long locking pulse durations are more favourable than short TLs if large flip angles are used. With an optimal combination of a moderate amount of slices, reasonably large flip angle, and TL of the order of 20 ms, high CNR is achieved in SL MRI.

Adult↗

PubMed1997

Iterative total least-squares image reconstruction algorithm for optical tomography by the conjugate gradient method.

We present an iterative total least-squares algorithm for computing images of the interior structure of highly scattering media by using the conjugate gradient method. For imaging the dense scattering media in optical tomography, a perturbation approach has been described previously [Y. Wang et al., Proc. SPIE 1641, 58 (1992); R. L. Barbour et al., in Medical Optical Tomography: Functional Imaging and Monitoring (Society of Photo-Optical Instrumentation Engineers, Bellingham, Wash., 1993), pp. 87-120], which solves a perturbation equation of the form W delta x = delta I. In order to solve this equation, least-squares or regularized least-squares solvers have been used in the past to determine best fits to the measurement data delta I while assuming that the operator matrix W is accurate. In practice, errors also occur in the operator matrix. Here we propose an iterative total least-squares (ITLS) method that minimizes the errors in both weights and detector readings. Theoretically, the total least-squares (TLS) solution is given by the singular vector of the matrix [W/ delta I] associated with the smallest singular value. The proposed ITLS method obtains this solution by using a conjugate gradient method that is particularly suitable for very large matrices. Simulation results have shown that the TLS method can yield a significantly more accurate result than the least-squares method.

Algorithms↗

PubMed2005

CXCR6 within T-helper (Th) and T-cytotoxic (Tc) type 1 lymphocytes in Graves' disease (GD).

OBJECTIVE: In Graves' disease (GD), stimulating anti-TSH receptor antibodies are responsible for hyperthyroidism. T-helper 2 (Th2) cells were expected to be involved in the underlying immune mechanism, although this is still controversial. The aim of this study was to examine the expression of CXCR6, a chemokine receptor that marks functionally specialized T-cells within the Th1 and T-cytotoxic 1 (Tc1) cell pool, to gain new insights into the running immune processes. METHODS: CXCR6 expression was examined on peripheral blood lymphocytes (PBLs) and thyroid-derived lymphocytes (TLs) of GD patients in flow cytometry. CXCR6 cDNA was quantified in thyroid tissues affected by GD (n = 16), Hashimoto's thyroiditis (HT; n = 2) and thyroid autonomy (TA; n = 11) using real-time reverse transcriptase PCR. RESULTS: The percentages of peripheral CXCR6(+) PBLs did not differ between GD and normal subjects. CXCR6 was expressed by small subsets of circulating T-cells and natural killer (NK) cells. CXCR6(+) cells were enriched in thyroid-derived T-cells compared with peripheral CD4(+) and CD8(+) T-cells in GD. The increase was evident within the Th1 (CD4(+) interferon-gamma(+) (IFN-gamma(+))) and Tc1 (CD8(+)IFN-gamma(+)) subpopulation and CD8(+) granzyme A(+) T-cells (cytotoxic effector type). Thyroid-derived fibro-blasts and thyrocytes were CXCR6(-). There was no significant difference between the CXCR6 mRNA levels in GD compared with HT and normal TA tissues. The lowest CXCR6 mRNA levels were obtained from thyroid nodules from TA patients and GD patients with low thyroid peroxidase autoantibody levels. CONCLUSIONS: CXCR6 was overexpressed in Th1 and Tc1 TLs compared with PBLs in GD. CXCR6 could be a marker for lymphocytes that have migrated into the thyroid and assist in the thyroid, independently of the bias of the underlying disease.

Adolescent↗

PubMed1989

Effect of bile acids on calcium efflux from isolated rat hepatocytes and perfused rat livers.

The changes in intracellular Ca2+ concentration [( Ca2+]i) of hepatocytes induced by certain bile acids are biphasic: an initial increase is followed by a more gradual decrease. This latter decline in [Ca2+]i may be due to an efflux of Ca2+ across the plasma membrane. This hypothesis was tested by studying the effect of different bile acids on the efflux of 45Ca from preloaded rat hepatocytes and isolated perfused rat livers. The following bile acids were studied: cholic (C), ursodeoxycholic (UDC), chenodeoxycholic (CDC), and deoxycholic (DC) acids; their taurine (T) conjugates (TC, TUDC, TCDC, and TDC); and the taurine, sulfate (S), and glucuronide (Glu) derivatives of lithocholic acid (TLC, LS, TLS, and LGlu, respectively). At 0.3 mM, all bile acids except C, TC, TCDC, UDC, and TUDC significantly increased 45Ca efflux from preloaded hepatocytes without affecting cell viability. Dose-response studies revealed that the minimum effective concentration needed to induce 45Ca efflux was 0.06 mM for LS, 0.8 mM for TCDC, and 10 mM for TC. Efflux of 86Rb from preloaded hepatocytes was not significantly altered by 0.1 mM LS, indicating relative specificity for calcium. TDC and DC, but not TC, increased 45Ca efflux from preloaded perfused rat livers. These results showed that bile acids known to increase [Ca2+]i (CDC, DC, TDC, and TLC) also increased 45Ca efflux from hepatocytes and perfused livers and that efflux was also stimulated by LS, TLS, and LGlu. The extent of this efflux was related to the hydrophobicity of the steroid nucleus of the bile acid. It is speculated that bile acid-induced increases in [Ca2+]i activate the plasma membrane Ca2+ pump resulting in increased Ca2+ efflux.

Animals↗

PubMed1999

[The clinico-pathological findings of the patients grouped as respiratory motor paralysis preceded type of ALS].

We reported five autopsied patients grouped as respiratory motor paralysis preceded type of ALS (R-ALS) classified as one clinical type of ALS from the patients living beyond respiratory failure reported in the previous paper, in which ALS the ontogenetically new motor functions in the "first motor system" proposed by Holstege involved first. The neuropathological changes of five patients were not limited in the degeneration of conventional "motor system" such as corticospinal tract and spinal and cranial motoneurons, but extended into the realm of "non-motor system", which could show the anterolateral myelin pallor in spinal cord by myelin staining, and detect the fibrillary gliosis of the anterior commissural area, the spinal grey matter of intemediate zone and anterior horn in all patients, and of medullary reticular formation in three one by Holzer staining. These pathological lesions could be included in the "first motor system". Considered from this study of the clinico-pathological findings of R-ALS based on "a new view of ALS", which respiratory failure in ALS is not terminus in ALS and total course of ALS might be TLS, it might be concluded that the clinico-pathologically involved initial lesions of ALS might be in the "first motor system", and include not only degenerations of "motor system", but also those of "non-motor system", which is the basically pathological lesions in ALS. Furthermore, the hitherto clinico-pathological ALS findings, which respiratory failure in ALS is terminus in ALS, could be included in this group, and showed as a part of ALS discussed from this study. Total clinico-pathological on ALS from the initial ones (R-type) to the advanced ones (TLS) including ALS-dementia should be considered further based on "the second and the third motor systems in addition to the first one".

Adult↗

PubMed2000

[Technical evaluation of video-assisted lung resection for lung cancer].

There are two major problems including indications and techniques in video-assisted lung resection for lung cancer. The current technique of video-assisted lung resection have various troublesome procedures as compared with conventional open thoracic surgery. We have designed a new thoracoscopic instrument as a ligation device. Between September 1997 and August 1999, 15 patients with early lung cancer underwent video-assisted lobectomy (VAL). In 5 patients, VAL was performed through skin incisions of 3 cm using this new device and at extraction of the resected lung the skin incision was elongated minimally (Group A). In 10 patients, a skin incision of 6-8 cm was made enough to perform VAL without the new device at the beginning of the operation (Group B). Total length of skin incisions (TLS) and total postoperative pleural discharge (TPD) were measured. TLS was 7.2 +/- 1.47 cm in group A, 11.9 +/- 4.50 cm in group B (p = 0.029). TPD was 492 +/- 256 ml in group A, 1.132 +/- 591 ml in group B (p = 0.032). TPD might be thought as an index of invasion of VAL and it was difficult to decrease TPD significantly. The new device made it possible to feel the ligature tension when the device was in touch with the chest wall. In a result, the device improved technical procedure of VAL and contributed toward less invasive surgery.

Evaluation Studies as Topic↗

PubMed1997

[A study on location of poles of terminal leads of ventricular fractionated potentials].

To eliminate the electromyogram-noise-signal from recording ventricular fractionated potentials (VFP) of the terminal leads(TLs), the multi-locations of leads were used to record ECG and VFP in 36 cases of controls and 68 cases of coronary heart disease. It was shown that the electromyogram-noise-signal could be minimized when TLs located separately at the point of infraclavicular cross lines axillaries media and the point of upperinguen cross lines axillaries media, and the essential formation of the ECG and VFP signals could not be changed except the QRS potentials becoming higher.

Arm↗

PubMed2002

AP-1 is essential for p67(phox) promoter activity.

The cytosolic NADPH oxidase cofactor p67(phox) has been shown to be one of the limiting factors in assembly and activation of this multi-protein enzyme complex and, therefore, must be highly regulated at the transcriptional level. In the present studies, we have further characterized the promoter for human p67(phox). Genomic sequence upstream of the translational start site (TLS; 2 kb) was cloned, and RACE was used to identify and compare the transcriptional start site (TSS) in two myeloid cell lines, HL-60 and PLB-985. Two major TSS were identified within the first intron for both cell lines, and one transcript isolated from PLB-985 cells started approximately 34 bp 5' of exon 1 and contained no intron 1 sequence. To identify regulatory regions of the promoter, a luciferase reporter was used to assay a series of promoter deletion constructs. The greatest transcriptional activity was observed for fragments containing at least 500 bp upstream of the TLS. Sequence analysis of the p67(phox) promoter revealed consensus binding sites for previously described transcription factors including AP-1 and PU.1. Site-directed mutagenesis of the AP-1 site demonstrated that this site was essential for basal transcription. EMSA, competition, and super-shift assays showed that this site was specifically recognized by nuclear factors of the AP-1 family. EMSA analysis and promoter-reporter assays with the PU.1 consensus sites at positions -176, -283, and -328 demonstrate that PU.1 binds the site at position -283 with high affinity. Mutagenesis of any one of the PU.1 sites reduced the basal transcriptional activity by approximately 50%, demonstrating that, although none of these sites is singularly responsible for the basal transcriptional activity, all three sites play some role in the transcriptional activity of the p67(phox) promoter. In support of this conclusion, mutagenesis of all three sites completely abrogated transcriptional activity.

Base Sequence↗

PubMed2001

[CyberKnife]

The CyberKnife is an image-guided robotic system designed for stereotactic radiosurgery. This system uses a lightweight, x-band linear accelerator, computer-controlled robotic arm, a pair of orthogonal x-ray imagers (TLS: Target Locating System), and a computer workstation. During the treatment, the TLS determines the location of the lesion and communicates these coordinates to the robot. The robot adjusts the position of the beam to the target. The accuracy of this system is 0.7 mm (median) at Osaka University. The CyberKnife system offers new options for radiosurgery/therapy. Stereotactic fractionated radiotherapy can now be performed with the same accuracy as single-fraction stereotactic radiosurgery. The frameless nature of CyberKnife allows tumors in the chest and abdomen to be treated as well. The real time tracking system option enables one to treat tumors that move with respiration, such as lesions in lung. Tumors in the lower spine, pancreas, and lung have already been treated in the USA. A description of the components, accuracy, and future of the CyberKnife will be presented.

Journal Article↗

PubMed2004

Improving treatment for tumor lysis syndrome: strategies for every oncology nurse.

Tumor lysis syndrome (TLS) is an oncologic emergency that occurs when a large number of rapidly dividing cells is lysed. Patients with cancer who have massive tumor burden with cells that are rapidly dividing are at particular risk for this potentially life-threatening complication. This program discussed the risk factors for developing TLS, the laboratory data used to diagnose the syndrome, the signs and symptoms associated with each of the metabolic abnormalities related to the syndrome, and patient management.

Emergencies↗

PubMed2005

Tumor lysis syndrome: pathophysiology, definition, and alternative treatment approaches.

Tumor lysis syndrome (TLS), a life threatening metabolic syndrome seen in malignancies with high tumor burden, is reviewed in this article. The new Cairo and Bishop classification system is discussed as well as the clinical management of this syndrome. Special emphasis is placed on the use of a relatively new agent, rasburicase, as an alternative to allopurinol in the management of TLS-associated hyperuricemia.

Diagnosis, Differential↗

PubMed2005

PKI-based secure mobile access to electronic health services and data.

Recent research works examine the potential employment of public-key cryptography schemes in e-health environments. In such systems, where a Public Key Infrastructure (PKI) is established beforehand, Attribute Certificates (ACs) and public key enabled protocols like TLS, can provide the appropriate mechanisms to effectively support authentication, authorization and confidentiality services. In other words, mutual trust and secure communications between all the stakeholders, namely physicians, patients and e-health service providers, can be successfully established and maintained. Furthermore, as the recently introduced mobile devices with access to computer-based patient record systems are expanding, the need of physicians and nurses to interact increasingly with such systems arises. Considering public key infrastructure requirements for mobile online health networks, this paper discusses the potential use of Attribute Certificates (ACs) in an anticipated trust model. Typical trust interactions among doctors, patients and e-health providers are presented, indicating that resourceful security mechanisms and trust control can be obtained and implemented. The application of attribute certificates to support medical mobile service provision along with the utilization of the de-facto TLS protocol to offer competent confidentiality and authorization services is also presented and evaluated through experimentation, using both the 802.11 WLAN and General Packet Radio Service (GPRS) networks.

Certification↗