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Weintraub M, Lin AY, Franklin J, Tucker MA, Magrath IT, Bhatia KG. Absence of germline p53 mutations in familial lymphoma. Oncogene 1996; 12:687-91. [PMID: 8637726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
p53, a tumor suppressor gene, is frequently mutated in sporadic human cancer, and inherited mutations in p53 predispose to the early onset of cancer. p53 mutations occur frequently in sporadic lymphoma, and, in mice deficient for p53, lymphoma is the most common type of malignancy. Families with an increased incidence of lymphoma have been described, suggesting an inherited predisposition to lymphoma in these circumstances. To determine whether the predisposition to lymphoma in these families results from germline mutations in p53, we analysed exons 4-11 of the p53 gene in 35 individuals from 19 lymphoma-prone kindreds. We found no germline p53 mutations in any of the individuals tested. However, p53 expression assessed by immunohistochemistry, which suggests mutation, was observed in 35% of the tumor samples from the familial Hodgkin's disease cases and in 13% of the familial non-Hodgkin's lymphoma cases. These results suggest that p53 mutations do not play a critical role in heritable susceptibility to lymphoma. p53 may act by different, non-mutation related mechanisms in this setting, or be involved in late events in the pathogenesis of these tumors.
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Franklin J. Sum rules for charmed baryon masses. PHYSICAL REVIEW. D, PARTICLES AND FIELDS 1996; 53:564-565. [PMID: 10019817 DOI: 10.1103/physrevd.53.564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Sextro M, Diehl V, Franklin J, Hansmann ML, Anagnostopoulos I, Marafioti T, Stein H. Lymphocyte predominant Hodgkin's disease--a workshop report. European Task Force on Lymphoma. Ann Oncol 1996; 7 Suppl 4:61-5. [PMID: 8836412 DOI: 10.1093/annonc/7.suppl_4.s61] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Since lymphocyte predominant Hodgkin's disease (LPHD) may comprise more than one entity, diagnostic criteria, clinical features, and treatment strategies are still being controversially discussed. Thus, in December 1994 a multinational project on lymphocyte predominant Hodgkin's disease was initiated by the European Task Force on Lymphoma. This project is aimed at clarifying the clinical and histopathological spectrum of LPHD, as well as its relation to T-cell- rich B-cell lymphoma and classical types of HD. 525 paraffin blocks and clinical data of 478 patients from 16 international centres were submitted. At the Third International Symposium on Hodgkin's Lymphoma in Cologne, 232 of these cases were discussed by an expert panel. The preliminary results are presented here. Most cases of LPHD were reclassified into nodular paragranuloma (NP) and lymphocyte rich classical HD. In both groups, a considerable number of cases with atypical features was observed. Few cases of NHL were found among the cohort. LPHD was generally treated according to common standards for HD. The whole group of LPHD did not have a better prognosis than NS; whereas early stage NP did perform better than early stage NS (data from the German Hodgkin's Lymphoma Study Group). There is however a striking discrepancy between good survival and the frequent relapses observed in NP which needs to be elucidated.
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Jones K, Rivera C, Sgadari C, Franklin J, Max EE, Bhatia K, Tosato G. Infection of human endothelial cells with Epstein-Barr virus. J Exp Med 1995; 182:1213-21. [PMID: 7595192 PMCID: PMC2192185 DOI: 10.1084/jem.182.5.1213] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Interleukin-6 (IL-6) promotes growth and tumorigenicity of Epstein-Barr virus (EBV)-immortalized B cells, and is abnormally elevated in the serum of solid organ transplant recipients who develop EBV-positive posttransplant lymphoproliferative disease (PTLD), but not in control transplant recipients. Endothelial cells derived from PTLD lesions were found to secrete spontaneously high levels of IL-6 in vitro for up to 4 mo. We examined possible mechanisms for sustained IL-6 production by endothelial cells. Here, we show that EBV can infect endothelial cells in vitro. After 3-4 wk incubation with lethally irradiated EBV-positive, but not EBV-negative cell lines, a proportion of human umbilical cord-derived endothelial cells (HUVECs) expressed in situ the EBV-encoded small RNAs (EBER). Southern blot analysis after polymerase chain reaction showed EBV DNA in HUVEC that had been incubated with lethally irradiated EBV-positive cells, but not in the controls. Exposure of HUVECs to lethally irradiated EBV-positive but not EBV-negative cell lines induced IL-6 production that was sustained for up to 120 d of culture. These studies identify endothelial cells as targets for EBV infection and raise the possibility that this infection may be important in the life cycle and pathology of EBV.
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Anwar N, Kingma DW, Bloch AR, Mourad M, Raffeld M, Franklin J, Magrath I, el Bolkainy N, Jaffe ES. The investigation of Epstein-Barr viral sequences in 41 cases of Burkitt's lymphoma from Egypt: epidemiologic correlations. Cancer 1995; 76:1245-52. [PMID: 8630905 DOI: 10.1002/1097-0142(19951001)76:7<1245::aid-cncr2820760723>3.0.co;2-d] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Epstein-Barr virus (EBV) is associated with many human neoplasms, including Burkitt's lymphoma (BL). Endemic BL in central Africa is more often EBV-associated than BL in the United States, where seroconversion for EBV occurs somewhat later than in Africa. Therefore, the EBV association rate in BL may correlate more with the socioeconomic status of the population studied, which influences the age of EBV seroconversion, than with such factors as malaria, which may relate to the overall higher incidence rate in endemic regions. METHODS Forty-one patients with BL in Egypt, which differs both climatically and racially from central African countries (i.e., Kenya, Uganda) where BL is endemic, were analyzed. All biopsies were evaluated for EBV-encoded RNAs (EBER1) by RNA in situ hybridization, analyzed for p53 protein expression using the monoclonal antibody D07, and immunophenotyped using a panel of monoclonal antibodies that included L26 (CD20), Leu 22 (CD43), and A6 (CD45RO). Twelve cases were evaluable for EBV subtype by polymerase chain reaction with EBV-specific primers. RESULTS The median age at diagnosis was 9 years (range, 2-22 years). The biopsy site was extranodal in 29 patients and nodal in 12 patients. All 41 cases were documented as B-cell neoplasms. A hybridization signal for EBER1 RNA was identified in greater than 95% of the neoplastic cells in 30 of 41 cases (73%), whereas no signal was observed in 11 cases (27%). Epstein-Barr virus subtype 1 was found in 10 patients, subtype 2 in two patients. Immunostaining for p53 was observed in greater than 5% of the neoplastic cells in 9 of 37 cases (24%). No significant correlation was observed between EBV positivity and sex, biopsy site, or p53 immunostaining. CONCLUSIONS The prevalence of EBV in BL from Egypt is slightly lower than in BL in endemic regions, but significantly higher than in sporadic BL. Epstein-Barr virus positivity probably reflects the socioeconomic status of the patient population, and age at seroconversion. The prevalence of EBV subtype 1 suggests that immunodeficiency does not play a role in Egyptian Burkitt's lymphoma, in contrast to endemic Burkitt's lymphoma, in which holoendemic malaria is thought to contribute to immunodeficiency, a higher incidence rate, and the observed prevalence of subtype 2.
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Franklin J. Addiction medicine--current concepts. J Insur Med 1995; 27:152-7. [PMID: 15323083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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133
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Franklin J. Bioinformatics and biotechnology information--some moves in Europe. DISEASE MARKERS 1994; 12:11-21. [PMID: 7842627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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134
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Mazmanian D, Sharma V, Persad E, Kueneman K, Burnham J, Franklin J, Hemmings M, Leiska G. Development and validation of a scale for rating mood states of psychiatric inpatients. HOSPITAL & COMMUNITY PSYCHIATRY 1994; 45:238-41. [PMID: 8188194 DOI: 10.1176/ps.45.3.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The authors assessed reliability and validity of a scale developed for use with inpatients on a mood disorders unit. The scale is used to rate a patient's mood along a quantitative continuum from -5, depressive stupor, through 0, euthymic, to 5, full mania. The scale lists behaviors that constitute criteria for each rating point. Mixed states and idiosyncratic behavior can also be assessed. METHODS Assessment of the scale's reliability and validity was based on data for 53 psychiatric inpatients. The scale's reliability was assessed by comparing nurses' ratings. Validity was assessed by comparing nurses' ratings with patients' self-ratings using previously validated self-report instruments as well as a patient self-report version of the scale. RESULTS Interrater reliability for the instrument was high (r = .84). Estimates of validity obtained using patient self-report measures ranged from .54 to .85. CONCLUSIONS The psychometric properties of the scale are comparable to and in some cases are superior to those reported for instruments that include more items and that take longer to complete.
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Kirk J, Staren ED, Franklin J, Saclarides TJ. Voice changes: an initial manifestation of colonic perforation. Gastrointest Endosc 1994; 40:125. [PMID: 8163126 DOI: 10.1016/s0016-5107(94)70045-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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137
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Williams AF, Franklin J. Annual economic costs attributable to cigarette smoking in Texas. Tex Med 1993; 89:56-60. [PMID: 8284776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The costs attributable to smoking in Texas continue to rise. The most recent estimates show more than $4 billion in 1990 can be associated with the direct health-care costs from treatments for disease and the indirect costs associated with mortality and morbidity. The breakdown of these estimates for adults 35 years and older shows 61% of the total costs was due to premature death caused by smoking, 29% due to direct health-care costs, and 9% attributable to indirect morbidity costs, which indicate lost wages caused by smoking-related illness. The 1990 smoking-attributable deaths estimated at 24,600 far exceed the accumulated deaths, 9430 in 1991, caused by auto accidents, homicide, AIDS, alcohol, fires, cocaine, crack, heroin, and morphine. The estimates are prepared by The University of Texas M.D. Anderson Cancer Center Office of the Vice President for Health Policy for the Office of Smoking and Health, Bureau of Chronic Disease Prevention and Control, Texas Department of Health.
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138
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Berg I, Butler A, Franklin J, Hayes H, Lucas C, Sims R. DSM-III-R disorders, social factors and management of school attendance problems in the normal population. J Child Psychol Psychiatry 1993; 34:1187-203. [PMID: 8245141 DOI: 10.1111/j.1469-7610.1993.tb01782.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Eighty 13-15-year-old children who failed to attend one of four schools for more than 40% of a term, without good reason, were studied. A systematic schedule (C.A.P.A.) was used in interviewing parents and children. Twenty-five had DSM-III-R Disruptive Behaviour Disorders and 15 had Anxiety/Mood Disorders. Truancy was associated with the former and school refusal with the latter but both often occurred without any Disorder. Fourteen children had neither school refusal nor truancy. Compared to controls, poor attenders came from materially disadvantaged homes. School refusal with anxiety disorders rarely received psychiatric treatment. Non-disturbed absentees were not usually dealt with appropriately.
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Newman D, Sauve MJ, Herre J, Langberg JJ, Lee MA, Titus C, Franklin J, Scheinman MM, Griffin JC. Survival after implantation of the cardioverter defibrillator. Am J Cardiol 1992; 69:899-903. [PMID: 1550019 DOI: 10.1016/0002-9149(92)90789-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The actuarial survival of 60 consecutive recipients of the implanted cardioverter defibrillator (ICD) were compared with 120 matched concurrent medically treated patients using a case-control design. All ICD patients and controls presented with either sustained ventricular tachycardia or ventricular fibrillation. Controls were matched to ICD recipients according to 5 variables: age, left ventricular ejection fraction, arrhythmia at presentation, underlying heart disease and drug therapy status. Mean ages were 58 and 59 years in ICD patients and controls, and the average ejection fractions were 36 and 35%. Coronary artery disease was present in 75 and 79% of ICD patients and controls, respectively. During follow-up, sudden deaths were fewer in ICD recipients than in controls (5 vs 10%, p less than 0.01). At 1 and 3 years, actuarial survival was 0.89 vs 0.72 and 0.65 vs 0.49 for ICD recipients and controls. The 5-year actuarial survival curves were significantly different by the Cox proportional hazards model (p less than 0.05). It is concluded that in this retrospective case-control study, the use of the ICD in the management of patients at risk for sudden death results in improved probability of survival.
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Johnson EM, Koike T, Franklin J. A "calcium set-point hypothesis" of neuronal dependence on neurotrophic factor. Exp Neurol 1992; 115:163-6. [PMID: 1728563 DOI: 10.1016/0014-4886(92)90242-i] [Citation(s) in RCA: 137] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this commentary, we discuss evidence suggesting that cytoplasmic free calcium concentration determines neurotrophic factor dependence. Developing sympathetic and neural crest-derived sensory neurons require nerve growth factor (NGF) for survival both in vivo and in vitro. Chronic depolarization of these cells in culture causes a modest sustained elevation of cytoplasmic calcium concentration and promotes their survival in the absence of NGF. The amount of calcium increase caused by depolarization is closely correlated with the ability of the cells to survive in NGF-free medium. At an optimal calcium concentration, that we refer to as a "set point," survival is equivalent to that of cells grown in the presence of NGF.
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141
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Saclarides TJ, Ko ST, Airan M, Dillon C, Franklin J. Laparoscopic removal of a large colonic lipoma. Report of a case. Dis Colon Rectum 1991; 34:1027-9. [PMID: 1834446 DOI: 10.1007/bf02049970] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 72-year-old white male was found to have a 6-cm submucosal mass at 35 cm on screening sigmoidoscopy. The lesion had all the characteristics of a submucosal lipoma. Instead of performing a laparotomy with its potential morbidity, the lesion was removed laparoscopically in its entirety without untoward operative sequelae. Laparoscopic techniques have had a profound impact on the treatment of patients with surgical disorders. This new technology can be applied to selected patients with colorectal diseases.
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Brown VR, Anthony PL, Franklin J. Proton-proton bremsstrahlung calculations at 280 MeV. PHYSICAL REVIEW. C, NUCLEAR PHYSICS 1991; 44:1296-1310. [PMID: 9967536 DOI: 10.1103/physrevc.44.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Milner LS, Jacobs DW, Thomson PD, Kala UK, Franklin J, Beale P, Levin SE. Management of severe hypertension in childhood Takayasu's arteritis. Pediatr Nephrol 1991; 5:38-41. [PMID: 1673862 DOI: 10.1007/bf00852840] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Six children presented with severe hypertension caused by Takayasu's arteritis (TA), of whom four had bilateral renal artery narrowing and two coarctation syndrome. Two presented with hypertensive encephalopathy and four with congestive cardiac failure. All had a strongly positive skin reactions to purified protein derivative of mycobacterium tuberculosis. Bilateral renal arterial bypass grafts performed in two children resulted in prolonged normalization of their blood pressures, but the grafts clotted 12-18 months later. Primary renal autotransplantation was unsuccessful in two children, one with bilateral renal arterial narrowing and iliac vessel involvement and one with a long coarctation. Secondary renal autotransplantation was successful in a third child with localized aortitis. A successful aortic patch graft was performed in one child with coarctation of the aorta. Angiotensin-converting-enzyme inhibitors should be used with caution in treating the hypertension caused by TA, since bilateral renal arterial narrowing is common and their administration may result in renal insufficiency. The long-term prognosis is guarded in severely hypertensive children with extensive vascular disease due to TA.
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Grefsheim S, Franklin J, Cunningham D. Biotechnology awareness study, Part 1: Where scientists get their information. BULLETIN OF THE MEDICAL LIBRARY ASSOCIATION 1991; 79:36-44. [PMID: 1998818 PMCID: PMC225482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A model study, funded by the National Library of Medicine (NLM) and conducted by the Southeastern/Atlantic Regional Medical Library (RML) and the University of Maryland Health Sciences Library, attempted to assess the information needs of researchers in the developing field of biotechnology and to determine the resources available to meet those needs in major academic health sciences centers. Nine medical schools in RML Region 2 were selected to participate in a biotechnology awareness study. A survey was conducted of the nine medical school libraries to assess their support of biotechnology research. To identify the information needs of scientists engaged in biotechnology-related research at the schools, a written survey was sent to the deans of the nine institutions and selected scientists they had identified. This was followed by individual, in-depth interviews with both the deans and scientists surveyed. In general, scientists obtained information from three major sources: their own experiments, personal communication with other scientists, and textual material (print or electronic). For textual information, most study participants relied on personal journal subscriptions. Tangential journals were scanned in the department's library. Only a few of these scientists came to the health sciences library on a regular basis. Further, the study found that personal computers have had a major impact on how biotechnologists get and use information. Implications of these findings for libraries and librarians are discussed.
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Murdoch DA, Gibbs S, Price CG, Easmon S, Franklin J, Lister TA, Tabaqchali S. Effect of ceftazidime and gentamicin on the oropharyngeal and faecal flora of patients with haematological malignancies. J Antimicrob Chemother 1990; 26:419-28. [PMID: 2228830 DOI: 10.1093/jac/26.3.419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Thirty-four patients with haematological malignancies were studied to investigate the effect of empirical broad-spectrum antibiotic therapy (ceftazidime and gentamicin) on the gastro-intestinal flora. Twenty-five patients with acute myeloid leukaemia or post-autologous bone-marrow transplantation were given framycetin, nystatin and colistin (Fracon), and two patients with non-Hodgkin's Lymphoma were on co-trimoxazole, as long-term gut prophylaxis. Semi-quantitative microbiology was carried out on oropharyngeal swabs and quantitative microbiology on faecal specimens. The oropharyngeal flora consisted mainly of streptococci, coagulase-negative staphylococci and coryneforms, and was little affected by ceftazidime/gentamicin. A strain of Enterobacter cloacae resistant to ceftazidime and gentamicin colonized one patient, who later developed septicaemia. The faecal flora of patients on Fracon was dominated by enterococci; the few enterobacteria present were eliminated by ceftazidime/gentamicin. The anaerobic flora was absent in 15% of patients; in the remainder, it consisted mainly of Bacteroides spp., and was little affected by ceftazidime/gentamicin. The faecal flora of patients not on Fracon always contained anaerobes, and some strains of enterobacteria persisted throughout antibiotic treatment. None of the patients was colonized by Clostridium difficile or Pseudomonas aeruginosa. Broad-spectrum therapy with ceftazidime and gentamicin appeared to have little effect on the gastro-intestinal flora, except to encourage the overgrowth of enterococci and reduce the numbers of enterobacteria.
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Dziembowski Z, Franklin J. Nucleon distribution amplitude and diquark clustering. PHYSICAL REVIEW. D, PARTICLES AND FIELDS 1990; 42:905-910. [PMID: 10012915 DOI: 10.1103/physrevd.42.905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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147
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Powell D, Franklin J, Arisaka F, Mosig G. Bacteriophage T4 DNA packaging genes 16 and 17. Nucleic Acids Res 1990; 18:4005. [PMID: 2374730 PMCID: PMC331121 DOI: 10.1093/nar/18.13.4005] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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148
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Franklin J, Gonçalves S, Cruz EC. [Tumor of the carotid body (paraganglioma)]. ACTA MEDICA PORT 1990; 3:89-93. [PMID: 2349894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Carotid body tumours (paragangliomas) are uncommon but rather an interesting pathology, due to the controversy that still remains regarding their histopathologic behaviour (malignancy?), as well as their diagnosis and management. Because of its nature being composed of chemoreceptor paraganglionic tissue, the carotid body responds to lower partial pressure of oxygen and can cause severe cardiovascular disturbances. Based upon a series of 12 cases, the authors reviewed this pathology in detail, and discussed the methods of diagnosis and treatment, which they considered more appropriate.
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Barnass S, Franklin J, Tabaqchali S. The successful treatment of multiresistant nonenteric salmonellosis with seven day oral ciprofloxacin. J Antimicrob Chemother 1990; 25:299-300. [PMID: 2329107 DOI: 10.1093/jac/25.2.299] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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150
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Abstract
Patients with multiple personality disorder (MPD) often present with subtle dissociative signs and symptoms rather than with the clear-cut, overt dissociative signs and symptoms usually associated with MPD. Because most MPD patients usually conceal their condition, there are only limited periods in their lives when they show florid, overt symptoms that can be easily diagnosed. During these other times, MPD patients often show subtle dissociative signs in their affects, thoughts, memories, behaviors, object relations, and transferences. These indirect manifestations of MPD are evidence of the patient's dissociative pathology and occur when their alters influence each other, partly emerge, or subtly shift. A familiarity with these subtle dissociative signs would allow the therapist to be aware of what MPD looks like when it is camouflaged and expressed indirectly. A recognition of these indirect manifestations would enable the clinician to suspect the diagnosis, explore the possible alters, and diagnose the patient's underlying dissociative pathology when present.
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