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1.
Opt Lett ; 47(9): 2350-2353, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35486797

RESUMO

This work advances laser absorption spectroscopy with measurements of aluminum monoxide (AlO) temperature and column density in extreme pressure (P > 60 bar) and temperature (T > 4000 K) environments. Measurements of the AlO A2Πi-X2Σ+ transition are made using a microelectromechanical system, tunable vertical cavity surface emitting laser (MEMS-VCSEL). Simultaneous emission measurements of the AlO B2Σ+-X2Σ+ transition are made along a line of sight that is coaxial with the laser absorption. Absorption temperature fits agree with emission spectra for a T = 3200 K, P = 9 bar case. In cases with T > 4000 K, P > 60 bar, absorption fits match the ambient temperature while emission fits over-estimate it, owing to high optical depths. These data juxtapose passive and active spectroscopic methods and demonstrate the versatility of AlO laser absorption in high-pressure and high-temperature environments where experimental data remain scarce, and engineering models will benefit from refined measurements.

2.
Artigo em Inglês | MEDLINE | ID: mdl-35573857

RESUMO

Imaging phantoms are used to calibrate and validate the performance of magnetic resonance imaging (MRI) systems. Many new materials have been developed for additive manufacturing (three-dimensional [3D] printing) processes that may be useful in the direct printing or casting of dimensionally accurate, anatomically accurate, patient-specific, and/or biomimetic MRI phantoms. The T1, T2, and T2* spin relaxation times of polymer samples were tested to discover materials for use as tissue mimics and structures in MRI phantoms. This study included a cohort of polymer compounds that was tested in cured form. The cohort consisted of 101 standardized polymer samples fabricated from: two-part silicones and polyurethanes used in commercial casting processes; one-part optically cured polyurethanes used in 3D printing; and fused deposition thermoplastics used in 3D printing. The testing was performed at 3 T using inversion recovery, spin echo, and gradient echo sequences for T1, T2, and T2*, respectively. T1, T2, and T2* values were plotted with error bars to allow the reader to assess how well a polymer matches a tissue for a specific application. A correlation was performed between T1, T2, T2* values and material density, elongation, tensile strength, and hardness. Two silicones, SI_XP-643 and SI_P-45, may be usable mimics for reported liver values; one silicone, SI_XP-643, may be a useful mimic for muscle; one silicone, SI_XP-738, may be a useful mimic for white matter; and four silicones, SI_P-15, SI_GI-1000, SI_GI-1040, and SI_GI-1110, may be usable mimics for spinal cord. Elongation correlated to T2 (p = 0.0007), tensile strength correlated to T1 (p = 0.002), T2 (p = 0.0003), and T2* (p = 0.003). The 80 samples not providing measurable signal with T1, T2, T2* relaxation values too short to measure with the standard sequences, may be useful for MRI-invisible fixturing and medical devices at 3 T.

3.
J Cancer Educ ; 29(4): 698-701, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24633725

RESUMO

Several studies have found a link between health literacy and participation in cancer screening. Most, however, have relied on self-report to determine screening status. Further, until now, health literacy measures have assessed print literacy only. The purpose of this study was to examine the relationship between participation in cervical cancer screening (Papanicolaou [Pap] testing) and two forms of health literacy-reading and listening. A demographically diverse sample was recruited from a pool of insured women in Georgia, Massachusetts, Hawaii, and Colorado between June 2009 and April 2010. Health literacy was assessed using the Cancer Message Literacy Test-Listening and the Cancer Message Literacy Test-Reading. Adherence to cervical cancer screening was ascertained through electronic administrative data on Pap test utilization. The relationship between health literacy and adherence to evidence-based recommendations for Pap testing was examined using multivariate logistic regression models. Data from 527 women aged 40 to 65 were analyzed and are reported here. Of these 527 women, 397 (75 %) were up to date with Pap testing. Higher health literacy scores for listening but not reading predicted being up to date. The fact that health literacy listening was associated with screening behavior even in this insured population suggests that it has independent effects beyond those of access to care. Patients who have difficulty understanding spoken recommendations about cancer screening may be at risk for underutilizing screening as a result.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Seguro Saúde , Teste de Papanicolaou/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal , Adulto , Idoso , Feminino , Seguimentos , Acessibilidade aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Inquéritos e Questionários , Neoplasias do Colo do Útero/psicologia
4.
Science ; 243(4887): 66-9, 1989 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-17780424

RESUMO

Evidence suggests that superconducting, orthorhombic YBa(2)Cu(3)O(6+x)+ (x greater, similar 0.5) is always produced by oxidation of the oxygen-deficient, tetragonal form (x less, similar 0.5) of this phase (commonly referred to as 123). A synthetic route whereby solution-derived, carbon-free precursors are decomposed at 650 degrees to 700 degrees C in inert atmosphere to yield tetragonal 123 is now available. Appropriate precursors include hydrated oxides derived from the hydrolysis of organometallic solutions and aqueous solution-derived hyponitrites. Subsequent oxidation of the tetragonal phase at 400 degrees C results in submicrometer particles of orthorhombic 123. Superconductivity (T(c) onset approximately 87 K) has been confirmed in these materials by both Meissner effect and specific-heat measurements.

5.
J Natl Cancer Inst ; 91(10): 847-53, 1999 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-10340904

RESUMO

BACKGROUND: Payment for care provided as part of clinical research has become less predictable as a result of managed care. Because little is known at present about how entry into cancer trials affects the cost of care for cancer patients, we conducted a matched case-control comparison of the incremental medical costs attributable to participation in cancer treatment trials. METHODS: Case patients were residents of Olmsted County, MN, who entered phase II or phase III cancer treatment trials at the Mayo Clinic from 1988 through 1994. Control patients were patients who did not enter trials but who were eligible on the basis of tumor registry matching and medical record review. Sixty-one matched pairs were followed for up to 5 years after the date of trial entry for case patients or from an equivalent date for control patients. Hospital, physician, and ancillary service costs were estimated from a population-based cost database developed at the Mayo Clinic. RESULTS: Trial enrollees incurred modestly (no more than 10%) higher costs over various follow-up periods. The mean cumulative 5-year cost in 1995 inflation-adjusted U.S. dollars among trial enrollees after adjustment for censoring was $46424 compared with $44 133 for control patients. After 1 year, trial enrollee costs were $24645 compared with $23 964 for control patients. CONCLUSIONS: This study suggests that cancer chemotherapy trials may not imply budget-breaking costs. Cancer itself is a high-cost illness. Clinical protocols may add relatively little to that cost.


Assuntos
Institutos de Câncer/economia , Ensaios Clínicos como Assunto/economia , Neoplasias/economia , Estudos de Casos e Controles , Ensaios Clínicos Fase II como Assunto/economia , Ensaios Clínicos Fase III como Assunto/economia , Feminino , Custos Hospitalares , Hospitais de Prática de Grupo/economia , Humanos , Masculino , Análise por Pareamento , Minnesota , Neoplasias/terapia , Seleção de Pacientes , Estados Unidos
6.
Diabetes ; 48(7): 1473-81, 1999 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10389857

RESUMO

Clinical islet cell transplantation has resulted in insulin independence in a limited number of cases. Rejection, recurrence of autoimmunity, and impairment of normal islet function by conventional immunosuppressive drugs, e.g., steroids, tacrolimus, and cyclosporin A, may all contribute to islet allograft loss. Furthermore, intraportal infusion of allogeneic islets results in the activation of intrahepatic macrophages and endothelial cells, followed by production of proinflammatory mediators that can contribute to islet primary nonfunction. We reasoned that the beneficial effects of anti-CD154 treatment on autoimmunity, alloreactivity, and proinflammatory events mediated by macrophages and endothelial cells made it an ideal agent for the prevention of islet allograft failure. In this study, a nonhuman primate model (Papio hamadryas) was used to assess the effect of humanized anti-CD154 (hu5c8) on allogeneic islet engraftment and function. Nonimmunosuppressed and tacrolimus-treated recipients were insulin independent posttransplant, but rejected their islet allografts in 8 days. Engraftment and insulin independence were achieved in seven of seven baboon recipients of anti-CD154 induction therapy administered on days -1, 3, and 10 relative to the islet transplant. Three of three baboons treated with 20 mg/kg anti-CD154 induction therapy experienced delayed rejection episodes, first detected by elevations in postprandial blood glucose levels, on postoperative day (POD) 31 for one and on POD 58 for the other two. Re-treatment with three doses of anti-CD154 resulted in reversal of rejection in all three animals and in a return to normoglycemia and insulin independence in two of three baboons. It was possible to reverse multiple episodes of rejection with this approach. A loss of functional islet mass, as detected by reduced first-phase insulin release in response to intravenous glucose tolerance testing, was observed after each episode of rejection. One of two baboons treated with 10 mg/kg induction therapy became insulin independent post-transplant but rejected the islet graft on POD 10; the other animal experienced a reversible rejection episode on POD 58 and remained insulin independent and normoglycemic until POD 264. Two additional baboon recipients of allogeneic islets and donor bone marrow (infused on PODs 5 and 11) were treated with induction therapy (PODs -1, 3, 10), followed by initiation of monthly maintenance therapy (for a period of 6 months) on POD 28. Rejection-free graft survival and insulin independence was maintained for 114 and 238 days, with preservation of functional islet mass observed in the absence of rejection. Prevention and reversal of rejection, in the absence of the deleterious effects associated with the use of conventional immunosuppressive drugs, make anti-CD154 a unique agent for further study in islet cell transplantation.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Sobrevivência de Enxerto , Transplante das Ilhotas Pancreáticas , Fígado/cirurgia , Glicoproteínas de Membrana/imunologia , Animais , Ligante de CD40 , Feminino , Humanos , Masculino , Papio , Período Pós-Operatório , Fatores de Tempo , Transplante Homólogo
7.
Arch Intern Med ; 151(6): 1089-95, 1991 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-1904212

RESUMO

To predict the consequences of cholesterol screening among elderly Americans who do not have symptoms of heart disease, we explore the cost implications of a cholesterol screening program, evaluate evidence linking hypercholesterolemia to coronary heart disease and mortality in the elderly, and describe the likely effects of therapy of hypercholesterolemia. According to our calculations, if all Americans 65 years of age and older adhered to a cholesterol screening program similar to the one proposed by the National Cholesterol Education Program, minimum annual expenditures for screening and treatment would be between $1.6 billion and $16.8 billion, depending on the effectiveness of diet and the cost of the medications used to treat hypercholesterolemia. There is no direct evidence that this program would lessen overall morbidity or extend the lives of elderly Americans.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Cardiopatias/prevenção & controle , Hipercolesterolemia/prevenção & controle , Programas de Rastreamento/economia , Idoso , Custos e Análise de Custo , Feminino , Cardiopatias/mortalidade , Humanos , Masculino , Neoplasias/mortalidade , Fatores de Risco , Taxa de Sobrevida , Estados Unidos
8.
Bone Marrow Transplant ; 50(12): 1513-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26301967

RESUMO

In patients with multiple myeloma (MM) undergoing autologous hematopoietic cell transplantation (auto-HCT), peripheral blood progenitor cells may be collected following mobilization with growth factor alone (GF) or cytotoxic chemotherapy plus GF (CC+GF). It is uncertain whether the method of mobilization affects post-transplant outcomes. We compared these mobilization strategies in a retrospective analysis of 968 patients with MM from the Center for International Blood and Marrow Transplant Research database who received an auto-HCT in the US and Canada between 2007 and 2012. The kinetics of neutrophil engraftment (⩾0.5 × 10(9)/L) was similar between groups (13 vs 13 days, P=0.69) while platelet engraftment (⩾20 × 10(9)/L) was slightly faster with CC+GF (19 vs 18 days, P=0.006). Adjusted 3-year PFS was 43% (95% confidence interval (CI) 38-48) in GF and 40% (95% CI 35-45) in CC+GF, P=0.33. Adjusted 3-year OS was 82% (95% CI 78-86) vs 80% (95% CI 75-84), P=0.43 and adjusted 5-year OS was 62% (95% CI 54-68) vs 60% (95% CI 52-67), P=0.76, for GF and CC+GF, respectively. We conclude that MM patients undergoing auto-HCT have similar outcomes irrespective of the method of mobilization and found no evidence that the addition of chemotherapy to mobilization contributes to disease control.


Assuntos
Mobilização de Células-Tronco Hematopoéticas/métodos , Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo/sangue , Mieloma Múltiplo/terapia , Adolescente , Adulto , Idoso , Autoenxertos , Intervalo Livre de Doença , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Prospectivos , Recuperação de Função Fisiológica , Taxa de Sobrevida
9.
J Interferon Cytokine Res ; 16(8): 611-7, 1996 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8877732

RESUMO

A novel cytokine originally designated murine CTLA-8 was described as a cDNA isolated from an activated T cell hybridoma produced by fusing a mouse cytotoxic T cell clone and a rat T lymphoma. This cDNA, which contains mRNA instability sequences characteristic of many cytokines, encoded a putative secreted protein that was homologous to the ORF13 gene of Herpesvirus saimiri. The human homolog to this molecule has recently been identified as the proinflammatory cytokine IL-17. We describe the isolation of a cDNA encoding mouse IL-17 from a cDNA library generated from alpha beta TCR + CD4-CD8- thymocytes using a subtraction technique that enriched for activation specific genes. This cDNA shares 87.3% amino acid identity to the previously described murine CTLA-8. Comparison of murine CTLA-8 to a cDNA we isolated from activated rat splenocytes revealed that murine CTLA-8 is, in fact, the rat homolog of IL-17. Mouse IL-17 mRNA is specifically expressed by activated alpha beta TCR + CD4-CD8- T cells, a small subset with a potentially important role in immune regulation. Mouse, rat, and human IL-17 can induce IL-6 secretion in mouse stromal cells, indicating that all homologs can recognize the mouse receptor.


Assuntos
Interleucinas/genética , Camundongos/genética , Receptores de Antígenos de Linfócitos T alfa-beta/análise , Subpopulações de Linfócitos T/metabolismo , Animais , Células da Medula Óssea , Tecido Conjuntivo/efeitos dos fármacos , Tecido Conjuntivo/metabolismo , DNA Complementar/genética , DNA Complementar/isolamento & purificação , Biblioteca Gênica , Genes , Humanos , Interleucina-17 , Interleucina-6/metabolismo , Interleucinas/biossíntese , Interleucinas/farmacologia , Camundongos Endogâmicos BALB C , Dados de Sequência Molecular , Ratos , Proteínas Recombinantes de Fusão/farmacologia , Alinhamento de Sequência , Homologia de Sequência , Especificidade da Espécie , Técnica de Subtração , Células Tumorais Cultivadas
10.
Transplantation ; 62(6): 876-7, 1996 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-8824495

RESUMO

The dog has served traditionally as a model for marrow and organ transplantation. A key component of any study of transplantation is histocompatibility typing of donors and recipients. Towards the development of a less expensive, more simplified typing system within canine families, a new highly polymorphic microsatellite marker for the canine Major Histocompatibility Complex class II region was isolated and characterized. In addition, we report on the application of class I and class II microsatellite-based markers for following the inheritance of the alleles within the canine analog of the human HLA loci, DLA, through multi-generation pedigree.


Assuntos
Cães/imunologia , Teste de Histocompatibilidade/veterinária , Complexo Principal de Histocompatibilidade/genética , Repetições de Microssatélites , Alelos , Animais , Cães/genética , Linhagem , Reação em Cadeia da Polimerase , Polimorfismo Genético
11.
Transplantation ; 61(1): 54-61, 1996 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-8560574

RESUMO

This report updates the results of marrow transplantation at the Fred Hutchinson Cancer Research Center for patients with severe aplastic anemia whose donors were HLA-nonidentical relatives. Between 1970 and 1993, 40 patients received transplants for severe aplastic anemia from related donors other than HLA genotypically matched siblings. Nine patients (group 1) were conditioned with cyclophosphamide (Cy) at 50 mg/kg for 4 doses and received marrow from phenotypically HLA-matched relatives. With the exception of one accidental death, all patients are alive and disease free 3-18 years after transplantation. Thirty-one patients received marrow from HLA-mismatched relatives who differed by one or more loci. Fifteen of these patients (group 2) received Cy at 50 mg/kg for 4 doses without total body irradiation (TBI) and none survived. Because of failure to sustain engraftment in 9 of 14 evaluable patients in group 2, the regimen for HLA-mismatched patients was changed in 1984 to include Cy at 60 mg/kg for 2 doses and TBI was added at 1200 cGy to increase immunosuppression (group 3). Sixteen patients in group 3 received marrow grafts after failure to respond to immunosuppressive therapy. Eight of the 16 patients in group 3 remain alive without disease between 1.5 and 11.3 years after transplantation. In conclusion, transplants from phenotypically HLA-identical related donors can be carried after Cy alone and results are comparable to those observed with genotypically HLA-identical siblings. Transplants from related donors mismatched for one or more HLA loci require a more intensive conditioning regimen, for example, one containing TBI, to achieve sustained engraftment.


Assuntos
Anemia Aplástica/terapia , Transplante de Medula Óssea/imunologia , Antígenos HLA/imunologia , Adolescente , Adulto , Anemia Aplástica/imunologia , Criança , Pré-Escolar , Feminino , Seguimentos , Sobrevivência de Enxerto , Antígenos HLA/genética , Teste de Histocompatibilidade , Humanos , Masculino , Estados Unidos
12.
Mol Cell Endocrinol ; 126(1): 75-81, 1997 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-9027365

RESUMO

The rat S14 gene has been a useful model to study carbohydrate and triiodothyronine (T3) regulation of hepatic gene expression. To gain insight into the regulation and function of the S14 gene, we isolated the human S14 gene and studied its sequence, tissue specific expression, and transcriptional regulation by glucose and T3. The deduced amino acid sequence of the human S14 protein is 78% identical to that of the rat. Northern blot analysis showed that the S14-mRNA is a single species in human liver and is not present in human brain or HepG2 cells. Transfection studies in primary hepatocytes revealed that transcription of the human S14 gene is regulated by glucose and T3 in a similar manner to that of the rat gene. However, in HepG2 cells, T3 and glucose did not affect the transcription of the human S14 gene. These observations suggest that the S14 gene is highly conserved in mammals and is similarly regulated by carbohydrate and T3 in vivo. More importantly, the function of the human S14 gene may be critical in lipid metabolism in human liver as the rat S14 gene is in rodents.


Assuntos
Clonagem Molecular , Regulação da Expressão Gênica , Proteínas/genética , Sequência de Aminoácidos , Animais , Sequência de Bases , Northern Blotting , Regulação da Expressão Gênica/efeitos dos fármacos , Glucose/farmacologia , Humanos , Fígado/química , Dados de Sequência Molecular , Proteínas Nucleares , Proteínas/química , RNA Mensageiro/análise , Ratos , Mapeamento por Restrição , Homologia de Sequência , Fatores de Transcrição , Transfecção , Tri-Iodotironina/farmacologia
13.
Bone Marrow Transplant ; 22(2): 139-46, 1998 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9707021

RESUMO

The value of routine chronic graft-versus-host disease (GVHD) screening studies performed between 70 and 120 days after allogeneic marrow transplantation was retrospectively evaluated among 241 patients. All patients received methotrexate and cyclosporine for GVHD prophylaxis and survived without relapse more than 4 months after transplant. Ninety-one patients (38%) developed clinical extensive chronic GVHD requiring systemic therapy. Data on patients who developed clinical extensive chronic GVHD were compared with those on patients without chronic GVHD to determine which of the following screening tests predicted the subsequent development of clinical extensive chronic GVHD: skin biopsy, oral exam, lip biopsy, Schirmer's test, serum alkaline phosphatase, aspartate transaminase, immunoglobulin level and platelet count. In a univariable analysis, a positive oral examination and a low platelet count were predictive of chronic extensive GVHD development. In a multivariable analysis which adjusted for the contribution of other chronic GVHD risk factors, such as age and a history of acute GVHD none of the screening tests were predictive of chronic GVHD development. The risk factors in this multivariable analysis which had the strongest association with the development of chronic GVHD was a history of acute GVHD and use of corticosteroids at day 100 (RR = 3.9, P = 0.001). The use of corticosteroids for acute GVHD at day 100 had a predictive effect on chronic GVHD development independent of the grade of acute GVHD (RR = 2.1, P = 0.004). Based on these study results, the use of chronic GVHD screening tests may not be of value in predicting who will develop this complication. Patients on corticosteroids at day 100 should be considered for clinical trials to determine the efficacy of new immunosuppressive agents in preventing chronic GVHD.


Assuntos
Corticosteroides/uso terapêutico , Transplante de Medula Óssea/efeitos adversos , Doença Enxerto-Hospedeiro/prevenção & controle , Adulto , Criança , Pré-Escolar , Doença Crônica , Ciclosporina/uso terapêutico , Doença Enxerto-Hospedeiro/etiologia , Humanos , Imunossupressores/uso terapêutico , Programas de Rastreamento , Metotrexato/uso terapêutico , Análise Multivariada , Fatores de Risco , Transplante Homólogo
14.
Bone Marrow Transplant ; 33(8): 781-7, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-14767498

RESUMO

High-dose chemotherapy using melphalan (HDMEL) is an important component of many conditioning regimens that are given before autologous hematopoietic stem cell transplantation (AHSCT). In contrast to the situation in myeloma, and to a lesser degree acute leukemia, only a very limited published experience exists with the use of HDMEL conditioning as a single agent in doses requiring AHSCT for lymphoma, both Hodgkin lymphoma (HL) and especially non-Hodgkin lymphoma (NHL). Thus, we report results of treating 26 lymphoma patients (22 with NHL and four with HL) with HDMEL 220-300 mg/m(2) plus amifostine (AF) cytoprotection and AHSCT as part of a phase I-II trial. Median age was 51 years (range 24-62 years); NHL histology was varied, but was aggressive (including transformed from indolent) in 19 patients, indolent in two patients and mantle cell in one. All 26 patients had been extensively treated; 11 were refractory to the immediate prior therapy on protocol entry and two had undergone prior AHSCT. All were deemed ineligible for other, 'first-line' AHSCT regimens. Of these 26 patients, 22 survived to initial tumor evaluation on D +100. At this time, 13 were in complete remission, including four patients who were in second CR before HDMEL+AF+AHSCT. Responses occurred at all HDMEL doses. Currently, seven patients are alive, including five without progression, with a median follow-up in these latter patients of D +1163 (range D +824 to D +1630); one of these patients had a nonmyeloablative allograft as consolidation on D +106. Conversely, 14 patients relapsed or progressed, including five who had previously achieved CR with the AHSCT procedure. Two patients, both with HL, remain alive after progression; one is in CR following salvage radiotherapy. Six patients died due to nonrelapse causes, including two NHL patients who died while in CR. We conclude that HDMEL+AF+AHSCT has significant single-agent activity in relapsed or refractory NHL and HL. This experience may be used as a starting point for subsequent dose escalation of HDMEL (probably with AF) in established combination regimens.


Assuntos
Amifostina/administração & dosagem , Antineoplásicos Alquilantes/administração & dosagem , Transplante de Células-Tronco Hematopoéticas , Doença de Hodgkin/terapia , Linfoma não Hodgkin/terapia , Melfalan/administração & dosagem , Protetores contra Radiação/administração & dosagem , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Condicionamento Pré-Transplante/métodos , Transplante Autólogo
15.
Bone Marrow Transplant ; 32(5): 515-22, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12942099

RESUMO

The incidence, etiology, outcome, and risk factors for developing pneumonia late after hematopoietic stem cell transplantation (SCT) were investigated in 1359 patients transplanted in Seattle. A total of 341 patients (25% of the cohort) developed at least one pneumonic episode. No microbial or tissue diagnosis (ie clinical pneumonia) was established in 197 patients (58% of first pneumonia cases). Among the remaining 144 patients, established etiologies included 33 viral (10%), 31 bacterial (9%), 25 idiopathic pneumonia syndrome (IPS, 7%), 20 multiple organisms (6%), 19 fungal (6%), and 16 Pneumocystis carinii pneumonia (PCP) (5%). The overall cumulative incidence of first pneumonia at 4 years after discharge home was 31%. The cumulative incidences of pneumonia according to donor type at 1 and 4 years after discharge home were 13 and 18% (autologous/syngeneic), 22 and 34% (HLA-matched related), and 26 and 39% (mismatched related/unrelated), respectively. Multivariate analysis of factors associated with development of late pneumonia after allografting were increasing patient age (RR 0.5 for <20 years, 1.2 for >40 years, P=0.009), donor HLA-mismatch (RR 1.6 for unrelated/mismatched related, P=0.01), and chronic graft-versus-host disease (GVHD; RR 1.5, P=0.007). Our data suggest that extension of PCP prophylaxis may be beneficial in high-risk autograft recipients. Further study of long-term anti-infective prophylaxis based on patient risk factors after SCT appear warranted.


Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pneumonia/etiologia , Adulto , Feminino , Seguimentos , Doenças Hematológicas/complicações , Doenças Hematológicas/mortalidade , Doenças Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/mortalidade , Histocompatibilidade , Humanos , Incidência , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Infecções por Pneumocystis/etiologia , Pneumonia/epidemiologia , Pneumonia/mortalidade , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
16.
Ann N Y Acad Sci ; 850: 276-87, 1998 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-9668549

RESUMO

Preparative regimens for marrow allografts in thalassemia have two objectives. One is eradication of diseased marrow and the other suppression of host-versus-graft (HVG) reactions so that the allograft survives. A common regimen to accomplish these goals has combined high-dose busulfan with cyclophosphamide. Postgrafting immunosuppression with cyclosporine/methotrexate has been used for GVHD prevention. Some patients may die from regimen-related toxicity. Overall event-free survival is 75%. Occasional patients have become mixed donor/host hematopoietic chimeras and, yet, disease symptoms have abated. This has raised the possibility of developing safer and less toxic transplant programs that result in stable mixed hematopoietic chimerism. We have devised such a program in dogs consisting of a nonlethal dose of total body irradiation (200 cGy) before and a novel combination of mycophenolate mofetil and cyclosporine after transplant. Mixed donor/host chimerism (> or = 50% donor cells in all lineages) has persisted for > 80 weeks, even though immunosuppression was discontinued after five weeks.


Assuntos
Transplante de Medula Óssea , Talassemia beta/terapia , Animais , Protocolos Clínicos , Cães , Quimioterapia Combinada , Sobrevivência de Enxerto , Reação Hospedeiro-Enxerto , Humanos , Terapia de Imunossupressão/métodos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Quimeras de Transplante , Transplante Homólogo , Irradiação Corporal Total
17.
Obstet Gynecol ; 74(3 Pt 2): 528-35, 1989 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-2668826

RESUMO

Obstetric decisions regarding extremely premature infants are based in part on their long-term prognosis. This review pools data from perinatal center reports to update mortality and morbidity trends for each subgroup of very low birth weight infants. Throughout the last 10 years, there has been steady and statistically significant improvement in neonatal mortality rates among inborn very low weight infants (1500 g or less). The most substantial improvement of the 1980s over the late 1970s is in the 750-1000-g birth weight group, in which today's infants have about a 70% chance of surviving if they have access to neonatal intensive care. Mortality in infants born weighing less than 750 g is still very high; overall about two-thirds die, but results are highly variable across centers, with several centers reporting 50-70% survival. The rate of serious long-term disability increases with decreasing birth weight, but within each birth weight group, the proportion of survivors who have serious handicaps has not changed significantly since the introduction of neonatal intensive care. For infants born between 1975-1985, 26% of surviving infants with birth weights below 800 g, 17% of survivors with birth weights between 750-1000 g, and 11% of survivors with birth weights between 1000-1500 g have major handicaps at 1 or 2 years of age. Because many very sick newborns who previously would have died are now surviving, an increasing rate of handicap might have been expected.


Assuntos
Mortalidade Infantil/tendências , Recém-Nascido de Baixo Peso , Doenças do Recém-Nascido/epidemiologia , Humanos , Recém-Nascido , Prognóstico , Estados Unidos
18.
Ann Thorac Surg ; 71(3): 995-1002, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11269488

RESUMO

BACKGROUND: In today's cost-conscious health care environment, obtaining timely and accurate economic information regarding new medical technologies has become extremely important. The National Emphysema Treatment Trial, a multicenter, randomized controlled trial of lung volume reduction surgery (LVRS) plus medical therapy, versus medical therapy for patients with severe emphysema, includes a parallel cost-effectiveness analysis. METHODS: The analysis is designed to determine the cost-effectiveness of LVRS versus medical therapy for those who are eligible for the procedure. After describing theoretical foundations of cost-effectiveness analysis as they apply to this study, we describe the economic and quality of life data that are being collected alongside the clinical trial, methods of analysis, and approach to presenting the results. RESULTS: The cost-effectiveness of LVRS relative to medical therapy will be presented as costs per quality-adjusted life years gained. CONCLUSIONS: This analysis will provide timely economic data that can be considered alongside the clinical results of the National Emphysema Treatment Trial. As one of the largest clinical trials to include a parallel, prospective cost-effectiveness analyses, this study will also provide valuable practical information about conducting an economic analysis alongside a multicenter clinical trial.


Assuntos
Enfisema/cirurgia , Pneumonectomia/economia , Análise Custo-Benefício , Previsões , Humanos , Fatores de Tempo
19.
Cancer Chemother Pharmacol ; 35(5): 377-86, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-7850918

RESUMO

PURPOSE: It has been recognized that enhanced antioxidant defenses can contribute to the resistance of cancer cells displaying multidrug resistance (MDR) that arises in conjunction with the overexpression of P-glycoprotein (Pgp). The purpose of this study was to determine if the defenses against oxidant stress in MDR human leukemia cells (HL-60/AR) that overexpress multidrug-resistance-associated protein (MRP), but not Pgp, contribute to the mechanism of drug resistance in this cell line. METHODS: HL-60/AR cells were evaluated in comparison with wild-type cells with respect to sensitivity to the oxidants hydrogen peroxide (H2O2) and tert-butyl hydroperoxide (t-BuOOH), the activities and amounts of the antioxidant enzymes catalase and glutathione peroxidase (GSH-Px), and the effects that manipulation of the activities of these enzymes may have on cellular sensitivity to the oxidants and to daunorubicin. We also evaluated the ability of the cells to generate daunorubicin semiquinone free radical as measured by electron spin resonance (ESR) spectroscopy. RESULTS: HL-60/AR cells were > 10-fold resistant to the cytotoxic effects of the H2O2 or t-BuOOH as compared with parental, drug-sensitive HL-60 cells. This phenomenon could be attributed largely to elevated activity and protein levels of catalase in HL-60/AR cells. Furthermore, inhibition of catalase by 3-amino-1,2,4-triazole (AT) diminished the resistance of HL-60/AR to these oxidants by > 80% or > 50%, respectively. Despite these findings, AT was incapable of causing sensitization of HL-60/AR cells to the cytotoxic effects of daunorubicin. We found that the activity and amount of selenium-dependent glutathione peroxidase (GSH-Px) was no greater in HL-60/AR cells than in HL-60 cells. Cultivation of cells in selenium-deficient medium caused a marked reduction in GSH-Px activity in HL-60/AR cells and a profound inhibition of GSH-redox cycling manifested by a decrease in baseline hexose monophosphate shunt activity (HMPS) and markedly blunted stimulation of the HMPS by the oxidant t-BuOOH in both wild-type and resistant cells. These variations in GSH-Px activity and GSH-redox cycling, however, were not associated with an alteration in cellular sensitivity to daunorubicin. The failure of catalase inhibition or selenium manipulation of GSH-Px activity to affect daunorubicin cytotoxicity was not due to the inability of these cells to produce free-radical species of daunorubicin, since ESR studies revealed that the generation of daunorubicin semiquinone free radical by HL-60/AR cells was equal to and, in fact, 3-fold that obtained with HL-60 cells. CONCLUSIONS: In comparison with parental HL-60 cells, MRP-overexpressing HL-60/AR cells have demonstrable alterations in antioxidant defenses that are manifested by cellular resistance to the cytotoxic effects of H2O2 and t-BuOOH and by elevated protein levels and activity of catalase. Whether these alterations are epiphenomena or are related to overexpression of MRP remains to be determined. However, it does appear that the enhanced antioxidant defenses observed in HL-60/AR cells do not contribute to the resistance to daunorubicin manifested by this cell line. Although HL-60/AR cells generate daunorubicin semiquinone free radical to an extent equal to or greater than that observed in HL-60 cells, the failure of alterations in GSH-Px activity or inhibition of catalase to change the sensitivity of HL-60/AR cells to daunorubicin suggests that the cytotoxicity of daunorubicin in these cells in not mediated through H2O2 or other peroxide species detoxified by these enzymes.


Assuntos
Membro 1 da Subfamília B de Cassetes de Ligação de ATP/biossíntese , Catalase/metabolismo , Daunorrubicina/toxicidade , Oxidantes/metabolismo , Western Blotting , Catalase/antagonistas & inibidores , Catalase/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Simulação por Computador , Daunorrubicina/metabolismo , Resistência a Múltiplos Medicamentos , Espectroscopia de Ressonância de Spin Eletrônica , Glutationa Peroxidase/antagonistas & inibidores , Glutationa Peroxidase/metabolismo , Humanos , Peróxido de Hidrogênio/metabolismo , Peróxido de Hidrogênio/toxicidade , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/patologia , Oxidantes/toxicidade , Via de Pentose Fosfato/efeitos dos fármacos , Via de Pentose Fosfato/fisiologia , Peróxidos/metabolismo , Peróxidos/toxicidade , Espécies Reativas de Oxigênio , Células Tumorais Cultivadas , terc-Butil Hidroperóxido
20.
Health Psychol ; 10(1): 75-8, 1991.
Artigo em Inglês | MEDLINE | ID: mdl-2026133

RESUMO

Located the Nutrition for a Lifetime System (NLS-1), a prototype interactive information system, in a large supermarket to help users decrease high-fat food purchases and increase high-fiber food purchases. Study participants were randomly assigned to control (n = 23; used the NLS-1 to enter food purchases only) or experimental (n = 26; viewed videodisc instructional programs, received prompts, made commitments, received feedback from the NLS-1) conditions. According to data entered in the NLS-1 and actual food shopping receipts, experimental participants significantly reduced higher fat purchases. Increases in higher fiber purchases favored the experimental group but were not significant.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Gorduras na Dieta/efeitos adversos , Preferências Alimentares , Educação em Saúde/métodos , Ciências da Nutrição/educação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Preferências Alimentares/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Software
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