The MDR phenotype in hematologic malignancies: prognostic relevance and future perspectives

The multidrug resistant (MDR) phenotype has been suspected as a major cause of treatment failure in hematologic malignancies. Numerous studies have investigated the expression of the MDR1 gene product, P-glycoprotein, in leukemia, lymphoma and myeloma. Studies in myelogenous leukemia and myeloma have so far provided best evidence for a significant correlation between P-glycoprotein expression and response to chemotherapy, although large discrepancies in the proportion of positive cells limit any definite conclusion. Differences in P-glycoprotein detection techniques and methodology may account for the divergent results thus emphasizing the necessity for standardized methods of detection. Despite this, encouraging clinical results have been obtained using MDR modulators in combination with conventional chemotherapy to inhibit the activity of the P-glycoprotein pump. The paper summarizes currently available clinical data and provides guidelines for future trials aimed to reverse the MDR phenotype. The potential of idarubicin to overcome the MDR phenotype is also discussed.     

Gastrointestinal disease and its management

Gastrointestinal (GI) diseases involving the alimentary tract and hepatobiliary system are common in geriatric dogs and cats. Inflammatory disorders predominate, but motility disturbances and degenerative lesions may also cause GI signs in affected animals. Treatment is directed at correction of the underlying cause and often requires tissue biopsy. The prognosis is good in many diseases with appropriate drug nutritional, and/or surgical therapy.     

Crisis in social psychology: The relevance of relevance.

Considers that external influences on social psychology for socially relevant research are misguided and potentially destructive to the progress of the discipline. Social psychologists have studied socially relevant topics for years and if their findings are not generalizable to community problems it is because they are not relevant to the constructs to which they pertain. Once conceptual relevance is obtained by reevaluation of existent research methods, social relevance will inevitably follow. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sixty years of psychosurgery: its present status and its future

STUDY OBJECTIVES: To compare the results of open myomectomy with those of laparoscopic myomectomy, and to assess complications, surgical results, total hospital cost, and morbidity associated with each procedure. DESIGN: Retrospective chart review. SETTING: Private practice of one surgeon, and Department of Obstetrics and Gynecology, Rush Medical College, Chicago, Illinois. PATIENTS: Ninety-eight women with symptomatic uterine leiomyomata. INTERVENTIONS: Forty-nine consecutive laparoscopic myomectomies were performed between 1993 and 1995, and 49 open myomectomies were performed between 1983 and 1995. MEASUREMENTS AND MAIN RESULTS: Indications for both procedures were similar, including menometrorrhagia, pelvic pain, and enlarging myomata. Mean operating time for open myomectomies was 133 minutes versus 264 minutes for laparoscopies (p <0.0001). Mean blood loss was 340 ml and 110 ml, respectively (p <0. 001). The greatest blood loss was 1000 ml in the open group and 800 ml in the laparoscopic group. Uterine size at surgery was 12 to 14 weeks in 42.9% of the open group and 9 to 11 weeks in 51% of the laparoscopy group. The open group incurred a total of 272 hospital days versus 29 days in the laparoscopic group (maximum 25 and 3 days, respectively; mean 5.6 and 0.6 days, respectively; p <0.001). The frequency of postoperative complications was higher in the open group (17) than in the laparoscopic group (5, p = 0.0068). Of patients in whom postoperative adhesions were evaluated, the overall frequency of adhesions was lower in the laparoscopic group. Three women in the open group required postoperative transfusions, compared with none in the laparoscopic group. Seven pregnancies have thus far occurred in the laparoscopic group. Three women delivered at term by elective cesarean section, at which no evidence of uterine dehiscence was found. Estimated average cost of each procedure, expressed in April 1995 dollars using the Consumer Price Index, were $14,461 for open myomectomies and $13,814 for laparoscopies (p = 0.65). Linear regression with residual analysis was performed on costs for both groups and revealed significantly increasing time trend for open myomectomies. During the years of this study, the open procedures increased in price at a rate of $868/year. The cost of laparoscopic myomectomies showed no time trend. CONCLUSIONS: Compared with open myomectomy, laparoscopic myomectomy had lower morbidity, no identifiable trend of increasing hospital cost, minimal hospital stay, and fewer complications.     

Elder mistreatment: its relevance to older women

Elder mistreatment, both abuse and neglect, is an important health care problem for women since they are involved as victims and as perpetrators. The incidence of both forms of such mistreatment is increasing, and both often occur within the context of long-term care. Elder abuse occurs in both unidirectional and dual directional forms, and includes parent abuse and spouse abuse. Elder neglect occurs in two forms; neglect by others and self-neglect. While elderly men and women are both neglected and/or abused, women may suffer greater physical and psychological consequences. To date, researchers have inadequately addressed the relevance of gender to both forms of elder mistreatment. This literature review addresses what is currently known about elder abuse and neglect that is of particular relevance to older women.     

Intelligence: Its measurement and its relevance for education.

Argues that even though there is much more to intelligent behavior than is measured by intelligence tests and even though test data have been abused by many people, scores from tests have relevance for teachers and others working with children. Psychologists concerned with levels of intellectual ability must recognize the voids and provide more and better information to users. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Umwelt and its relevance to animal communication: Introduction to special issue.

This introduction applies J. von Uexküll's (1934/1957) concept of the Umwelt to the study of animal communication, particularly as it pertains to studies presented at a recent workshop on animal communication in the context of the environment. The environment is conceived broadly in the articles that follow, including the many physical and social environments in which an animal may find itself. The Umwelt concept is briefly expanded here to include also the personal microenvironment of the signaler in which the signal is embedded into the suite of concurrent nonsignaling behaviors of the individual. Other animals may even infer aspects of the signaler's own immediate Umwelt by noticing accompanying attentional cues such as the direction of eye gaze. In this way, part of the Umwelt can be accessible to companions, facilitating the communication process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relevance of Freud's psychoanalysis in the 21st century: Its science and its research.

The relevance of psychoanalysis and its place within its intellectual and cultural surround has been a major issue over the whole of its now more than a century-long history. A very significant aspect of that concern has been the status of psychoanalysis as a theory of the mind, and as a basis for the application of that theory in the conduct of a therapy for the disorders of the mind. This article reviews in depth the long-standing debate about psychoanalysis as a scientific theory, the kind of science that psychoanalysis is--or can be--and the place of research, empirical as well as conceptual (with particular focus upon research into the nature of the therapeutic change process and its desired outcomes), in the incremental growth of that theory and its therapeutic applications in an ever expanding and increasingly secure knowledge base. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mortality analysis of Pleistocene bears and its paleoanthropological relevance

Bear bones and Paleolithic stone artefacts often co-occur in Pleistocene cave deposits of Eurasia, raising the question of how these associations come about and the need for effective methods with which to obtain a clear answer. Building upon knowledge of modern bears, I present a method for testing two competing hypotheses about the causes of bear mortality in hibernation contexts. The first hypothesis proposes that age-dependent deaths resulted from non-violent causes (principally starvation), implying that bears' presence in a cave was not linked in time to human activities there. The second hypothesis proposes that random bear deaths in caves resulted from hunting by humans or other large predators, implying a temporal link between them; the expectation of a nonselective age pattern in this circumstance arises from the fact that the individual characters of hibernating bears are hidden from predators. Three elements of the method and its development are presented: (1) a brief review of the biological bases of hibernation-related mortality in modern Ursus, its paleontological consequences, and test expectations drawn therefrom; (2) a detailed, illustrated technique for age-scoring isolated bear cheek teeth based on tooth eruption-wear sequences, developed primarily for cave and brown bears; and, (3) a simple, accurate way to evaluate real cases in terms of contrasting mortality models. The final step is demonstrated by application to a Middle Pleistocene cave bear assemblage (Ursus deningeri) from Yarimburgaz Cave in Turkey, a large collection found in general stratigraphic association with Paleolithic artefacts. The advantages of the method include its ability to (a) handle small samples, (b) use isolated tooth specimens, and (c) evaluate cases simultaneously in terms of idealized age structure models and the variation that normally is associated with each under natural conditions. While the more obvious benefit of bear mortality analysis may be to research on ancient bear demography, the principles and procedures offered here are equally pertinent to archaeological studies of carnivore-mediated formation processes in cave sites. As is generally true in taphonomic research, however, bear mortality patterns are most effective when used in combination with independent lines of evidence to address questions about assemblage formation.     

The kinetics of intergranular oxygen penetration in nickel and its relevance to weldment cracking

The ductility of nickel and nickel-base superalloys is severely reduced by intergranular penetration of oxygen at elevated temperatures. Using Ni270 as a model material, quantitative diffusion parameters are obtained for the penetration of oxygen along grain boundaries. The technique involves observation of gas bubbles, believed to be carbon dioxide, resulting from a reaction between diffusing oxygen and residual carbon concentrated at the grain boundaries. The kinetics are such as to embrittle nickel subjected to a typical superalloy heat treatment. The implications of this observation taken in conjunction with previous publications are discussed relative to the role of oxygen attack in heat-affected zone cracking of superalloys.     

The RSNA-AUR-ARRS introduction to research program for 2nd year radiology residents: effect on career choice and early academic performance. Radiological Society of North America. Association of University Radiologists. American Roentgen Ray Society

STUDY OBJECTIVE: To determine whether quantitative measurement of end-tidal carbon dioxide (ETCO2) can differentiate between cardiac and obstructive causes of respiratory distress. DESIGN: Prospective observational study. SETTING: Emergency department (ED) of a tertiary care hospital. PATIENTS: Adult patients who presented to the ED with moderate-to-severe dyspnea. Patients were excluded if they were unable to cooperate with the performance of peak expiratory flow rate (PEFR) or ETCO2 tests, were younger than 18 years of age, or had received prehospital intervention for their respiratory distress. INTERVENTIONS: Physicians obtained an ETCO2 level and PEFR prior to ED pharmacologic intervention. A hand-held capnometer with digital read-out was used to obtain the ETCO2 level. The patient's age, sex, initial vital signs, breath sounds and medication history, the presence or absence of diaphoresis and/or orthopnea, the duration of symptoms, the chest radiograph interpretation, and final diagnosis were also recorded. MEASUREMENTS and RESULTS: Forty-two patients were eligible for inclusion in the analysis. The mean ETCO2 level was 31.1+/-9.4 mm Hg; the mean PEFR was 161.3+/-53.1 L/min. The ETCO2 levels for pulmonary edema/congestive heart failure (CHF) patients differed significantly from those of asthma/COPD patients (27.1+/-7.8 mm Hg vs 33.4+/-9.6 mm Hg; p=0.0375). However, no single ETCO2 level was found to be a reliable predictor of diagnosis. CONCLUSION: ETCO2 levels for pulmonary edema/CHF patients differ significantly from those of asthma/COPD patients. However, no single ETCO2 level reliably differentiates between the two disease processes.     

School psychology: Dimensions of its dilemmas and future directions.

The diversity in school psychology (SP) raises problems in uniformly defining the nature of its research, training, and practice. Several major dilemmas confronting SP, including its affiliation with professional psychology, its relationship to clinical psychology and practice in the schools, entry-level issues, competency-based criteria in training, and its scientific basis are examined. Both Division 16 of the American Psychological Association and the National Association of School Psychologists are asked to consider them in a spirit of cooperation. (55 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perioperative nutritional therapy and its relevance for postoperative outcome

The clinical effect of perioperative nutrition was analyzed from 28 controlled clinical trials. Preoperative nutritional support is indicated only in patients with high-grade malnutrition and can reduce the postoperative morbidity and mortality in these patients. If the nutritional status is normal preoperatively, artificial nutrition may influence the postoperative outcome negatively. A clinical benefit from postoperative nutritional support has been proven only in patients not able to eat an adequate oral diet within 1 week. In 20% of these case a cardiopulmonary complication was observed during total parenteral nutrition. The infusion of D5W is sufficient in the majority of surgical patients even after major procedures.