Percutaneous radiologic, surgical endoscopic, and percutaneous endoscopic gastrostomy/gastrojejunostomy: comparative study and cost analysis

p27kip1 (p27) protein is an inhibitor of cyclin and cyclin-dependent kinase complexes and prevents progression of cells from G1 to the S phase of the cell cycle. p27 might have tumor suppressor activity, and decreased p27 expression is associated with aggressive tumor behavior in several human malignancies. The object of this study was to evaluate p27 expression in prostatic adenocarcinoma treated by radical prostatectomy and to assess its association with numerous morphologic and clinical features. One hundred thirty-eight prostatic adenocarcinomas were evaluated for p27 expression by quantifying nuclear immunohistochemical staining. p27 expression was tested for association with patient age, family history of prostate cancer, preoperative serum prostate-specific antigen level, Gleason score, extraprostatic extension, seminal vesicle involvement, lymph node metastases, tumor-node-metastasis stage, DNA ploidy by flow cytometric analysis, and subclinical biochemical failure. p27 expression was analyzed as a continuous variable, and we also classified the tumors as low expressors (< 50% of cells p27 positive) or high expressors (> 50% of cells p27 positive) for comparison. Patients with adenocarcinomas that exhibited low p27 expression had higher mean Gleason scores than did high expressors (7 vs. 6.2, respectively; P = .002). Low p27 expression correlated with positive surgical margins (P = .05), seminal vesicle involvement (P = .007), lymph node metastasis (P = .03), and aneuploid cancers (P = .003), but it did not correlate with subclinical biochemical failure. p27 expression correlated with a number of prognostic morphologic features in prostatic adenocarcinoma, and the evaluation of p27 expression might provide additional prognostic information.     

Prevalence of Blastocystis hominis infection in schoolchildren from Bolivar City, Venezuela

Blastocystis hominis is found in about 25% of feces in normal asymptomatic people. Its pathogenic role is still discussed. A prospective study was performed to determine the prevalence of B. hominis infection in schoolchildren from Bolivar City. We evaluated 446 children, between five and fourteen years old, both sexes, using direct examination of feces and Willis Method. They were also evaluated clinically. Results showed that B. hominis had a prevalence of 16.8%. We did not find a statistically significant association between sex (P > 0.05) or age and infection with B. hominis (x2 = 1.94 g.l = 4). In 39 schoolchildren (52.0%) we identified other parasites along with B. hominis, the most frequent was Trichuris trichiura as helminth and Giardia lamblia as protozoan. We observed B. hominis alone in 36 cases (48.0%). There was a spectrum of clinical symptoms in 41 (54.7%) of all children evaluated. Diarrhea was the most frequently clinical manifestation observed. Other studies are necessary to determine clinical relevance of B. hominis in school population in Bolivar City.     

Annotated bibliography: studies evaluating decision-support interventions for patients

As the size of the older population grows and mortality rates continue to decline, an unprecedented number of women will live to very old age. Recent research has provided a better understanding of the impact of disability in the older population, risk factors for disability, and the consequences of disability. Older women have consistently been found to have higher prevalence rates of disability than men of the same age. This difference does not result from women developing disability more often than men, but rather surviving longer with their disabilities. This effect may be explained at least in part by the differences in the diseases underlying disability in older women and men. Interventions that can reduce the burden of disability in the aging population are now being explored. In the next century, it will be increasingly important to develop new prevention and treatment strategies that address the functional consequences of chronic disease in the population of women living to older and older ages.     

DNA transfer into vascular smooth muscle using fusigenic Sendai virus (HVJ)-liposomes

Manipulation of the genetic machinery of cells both in vitro and in vivo is becoming an ever more important means of elucidating pathways of molecular and cellular biochemistry. In addition, gene therapy has been proposed as a novel and potentially powerful treatment for both inherited and acquired diseases. Successful gene transfer and gene blockade generally depend on high efficiency delivery of exogenous DNA or RNA into living cells, and much effort has therefore been focused on the development of methods for achieving this delivery in a safe and effective manner. We describe here our application of fusigenic Sendai virus (HVJ)-liposome technology toward the effective delivery of DNA into vascular smooth muscle cells (VSMC) in cell culture. Cellular uptake and intracellular distribution of oligodeoxynucleotide (ODN) after transfection with HVJ-liposome complexes was characterized using fluorescent (FITC)-labeled ODN, and the biologic effect of HVJ-liposome mediated transfection was demonstrated via inhibition of DNA synthesis in cultured VSMC using antisense ODN against basic fibroblast growth factor.     

Kinetic interactions of tazobactam with beta-lactamases from all major structural classes

Tazobactam was shown to be a potent inhibitor of group 1, 2a, 2b, and 2b' beta-lactamases. Extended kinetic studies with class A and C serine beta-lactamases showed that the PC1, TEM-2, and P99 enzymes all were reversibly inhibited prior to inactivation of the enzymes. The CcrA metallo-beta-lactamase was less well inhibited, with a 50% inhibitory concentration at least 3 orders of magnitude less favorable than those for most serine beta-lactamases. The numbers of hydrolytic turnovers of tazobactam before inactivation were 2 for PC1, 125 for TEM-2, 50 for P99, and 4,000 for the CcrA enzyme. In spectral studies, transient intermediates were formed after reaction of tazobactam with the PC1, TEM-2, and CcrA beta-lactamases, corresponding to enzyme-associated intermediates responsible for hydrolysis of tazobactam. Chromophores absorbing at 270 nm (CcrA) and 288 nm (TEM-2 and PC1) were observed for these reaction intermediates. The P99 cephalosporinase formed a stable complex with a UV maximum at 295 nm. Incubation of tazobactam with all of the enzymes resulted in accumulation of a tazobactam reaction product with a short-wavelength absorbance. This product has characteristics similar to those of the major eucaryotic metabolite of tazobactam. Possible reaction mechanisms are presented to explain the findings. In conclusion, both serine-based and metallo-beta-lactamases were irreversibly inactivated by tazobactam following an initial transient inhibition phase.     

Developing and gaining acceptance for patient care protocols

The difficulties students experience in applying theory to practice are well documented and educationalists have employed a variety of techniques in an effort to enhance effective application. This paper describes the utilization of one such teaching/learning strategy in a diploma level course in management for registered nurses and midwives. As problem-solving individual contracts of learning, 'ripple effect' plans enabled course participants to apply general principles of management theory to specific nursing management practice in their everyday world of nursing and midwifery work, making changes in practice and procedure which were visible and real.     

A study of parasitic reactions between NH3 and TMGa or TMAI

The growth of AlGaN using organometallic vapor phase epitaxy has been studied as a function of reactor pressure in a horizontal reactor. At atmospheric pressure, GaN with growth efficiency comparable to that of GaAs in the same reactor is obtained. In addition, the GaN growth efficiency changes little at different reactor pressures. These results indicate that the parasitic reaction between TMGa and NH₃ is not substantial in the reactor used in this study. On the other hand, A1N growth at atmospheric pressure has not been possible. By lowering the reactor pressure below 250 Torr, A1N deposition is achieved. However, the growth efficiency decreases at higher reactor pressures and higher growth temperatures, indicating that a strong parasitic reaction occurs between TMAI and NH₃. For the ternary AlGaN, lower pressure also leads to more Al incorporation. The results indicate that parasitic reactions are much more severe for TMAI+NH3 than for TMGa+NH₃.     

Energy-dependent accumulation of fluoroquinolones in quinolone-resistant Klebsiella pneumoniae strains

The intracellular accumulation of norfloxacin and pefloxacin in Klebsiella pneumoniae was evaluated. The roles of lipopolysaccharide, capsule, and outer membrane proteins were not important for the intrabacterial accumulation of fluoroquinolones in isogenic strains with known outer membrane alterations. In fluoroquinolone-resistant clinical isolates also expressing GyrA alterations, an active efflux leading to decreased accumulation of the drugs enhanced their resistance to these agents.