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White L. Cross immunity and vaccination against multiple microparasite strains. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 1998. [DOI: 10.1093/imammb/15.3.211] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Harvey PD, Howanitz E, Parrella M, White L, Davidson M, Mohs RC, Hoblyn J, Davis KL. Symptoms, cognitive functioning, and adaptive skills in geriatric patients with lifelong schizophrenia: a comparison across treatment sites. Am J Psychiatry 1998; 155:1080-6. [PMID: 9699697 DOI: 10.1176/ajp.155.8.1080] [Citation(s) in RCA: 222] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Although many geriatric patients with schizophrenia have been referred to nursing home care, little is known about their characteristics. Across nursing home and chronic hospital settings, the authors directly assessed poor outcome geriatric patients with schizophrenia and contrasted their cognitive, symptomatic, and adaptive functioning to that of acutely admitted patients with a better outcome over the lifetime course of the illness. METHOD The subjects were 97 chronically hospitalized patients with schizophrenia, 37 patients with chronic schizophrenia who lived in nursing homes, and 31 acutely admitted geriatric patients with schizophrenia. These patients were rated with the Positive and Negative Syndrome Scale, tested with a neuropsychological battery, evaluated with the Mini-Mental State examination, and rated on a scale of social and adaptive deficits, the Social Adaptive Functioning Evaluation scale. RESULTS Each group of patients proved discriminable from the other two: nursing home patients displayed the most severe adaptive deficits, and acutely admitted patients were the least cognitively impaired. Cognitive impairment was the strongest predictor of adaptive deficits for all three groups, and negative symptom differences among the groups were smaller than differences in cognitive impairment. Nursing home patients had the least severe positive symptoms, and the acutely ill and chronic hospital patients did not differ on positive symptoms. CONCLUSIONS Cognitive impairment is a predictor of both overall outcome and specific adaptive deficits. These data suggest that interventions aimed at cognitive impairment may have an impact on overall functional status. In comparison, positive symptom severity is less strongly correlated with overall adaptive outcome and is uncorrelated with specific deficits in adaptive skills.
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Byne W, White L, Parella M, Adams R, Harvey PD, Davis KL. Tardive dyskinesia in a chronically institutionalized population of elderly schizophrenic patients: prevalence and association with cognitive impairment. Int J Geriatr Psychiatry 1998; 13:473-9. [PMID: 9695037 DOI: 10.1002/(sici)1099-1166(199807)13:7<473::aid-gps800>3.0.co;2-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chronically hospitalized geriatric inpatients with schizophrenia are at particular risk for both tardive dyskinesia (TD) and cognitive impairment but have been insufficiently studied in this regard. Similarly, the relationship between TD and cognitive impairment has not be adequately addressed in this population. OBJECTIVES (1) To determine the prevalence of TD in a cohort of chronically institutionalized schizophrenic geriatric inpatients. (2) To examine the relationship between the manifestations of TD in various body regions and several potentially related variables including current pharmacological regimen, age, age at first hospitalization and cognitive status. METHOD TD was assessed by the Modified Simpson Dyskinesia Scale and cognitive status by the Mini-Mental State Examination (MMSE). The relationship between manifestations of TD and other variables was examined by t-tests, ANOVA, MANOVA and correlational analysis. RESULTS The prevalence of TD was 60%. Prevalence increased with age but was not related to current antipsychotic or anticholinergic regimen. Mean MMSE score did not differ between groups of patients with and without TD as defined by the criteria of Schooler and Kane (1982); however, the mean MMSE score was significantly (p < 0.0004) lower in subjects with orofacial TD as defined by Waddington and Youssef (1996), and the difference was not entirely accounted for by the older age of the latter group. CONCLUSIONS TD and cognitive impairment both increase with age. However, TD alone does not account for the severity of cognitive impairment in this population. The present study provides further support for the hypothesis that the correlation between TD and cognitive impairment holds primarily for the orofacial manifestations of TD.
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Larson EB, McCurry SM, Graves AB, Bowen JD, Rice MM, McCormick WC, Zee N, Homma A, Imai Y, White L, Masaki K, Petrovitch H, Ross W, Yamada M, Mimori Y, Sasaki H. Standardization of the Clinical Diagnosis of the Dementia Syndrome and Its Subtypes in a Cross-National Study: The Ni-Hon-Sea Experience. J Gerontol A Biol Sci Med Sci 1998; 53:M313-9. [DOI: 10.1093/gerona/53a.4.m313] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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White L. Cultural changes in healthcare. Postgrad Med 1998; 103:38. [PMID: 9633540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Petrovitch H, White L, Masaki KH, Ross GW, Abbott RD, Rodriguez BL, Lu G, Burchfiel CM, Blanchette PL, Curb JD. Influence of myocardial infarction, coronary artery bypass surgery, and stroke on cognitive impairment in late life. Am J Cardiol 1998; 81:1017-21. [PMID: 9576163 DOI: 10.1016/s0002-9149(98)00082-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Relations between cognitive test scores in later life and prior myocardial infarction (MI), coronary artery bypass graft surgery (CABG), and stroke were examined for this study. Subjects were 3,734 Japanese-American men (80% of surviving Honolulu Heart Program cohort) aged 71 to 93 years at the time of cognitive testing. Impairment was defined as scoring below the 16th percentile on a validated cognitive assessment scale. Prior MI, stroke, and CABG were established using hospital surveillance, history, and record review. After adjustment for age, years of education, and years of childhood spent in Japan, men with prior stroke were significantly more likely than others to have poor cognitive performance (odds ratio 4.4, 95% confidence limits 3.0 to 6.7). History of > 1 stroke was associated with an odds ratio of 50 (95% confidence limits 10.5 to 238.3). There was no significant association between cognitive performance and > or = 1 prior MI or history of CABG. Time between events and cognitive function testing did not affect results. Analyses support a significant association between clinical stroke and persistent cognitive impairment, but fail to implicate CABG or MI.
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Eckhardt SG, Baker SD, Eckardt JR, Burke TG, Warner DL, Kuhn JG, Rodriguez G, Fields S, Thurman A, Smith L, Rothenberg ML, White L, Wissel P, Kunka R, DePee S, Littlefield D, Burris HA, Von Hoff DD, Rowinsky EK. Phase I and pharmacokinetic study of GI147211, a water-soluble camptothecin analogue, administered for five consecutive days every three weeks. Clin Cancer Res 1998; 4:595-604. [PMID: 9533526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
GI1147211 is a 7-substituted 10,11-ethylenedioxy-20(S)-camptothecin analogue that inhibits the nuclear enzyme topoisomerase I. In this Phase I and pharmacological study, 24 patients with advanced solid malignancies received a total of 72 courses of GI147211 as a 30-min infusion daily for 5 consecutive days, at doses ranging from 0.3 to 1.75 mg/m2/day. Severe neutropenia precluded dose escalation above 1.5 mg/m2/day in minimally pretreated patients, and both severe neutropenia and thrombocytopenia were dose limiting in heavily pretreated patients at doses above 1.0 mg/m2/day. These doses are, therefore, recommended for subsequent Phase II evaluations of GI147211 in patients with comparable prior therapy. Nonhematological toxicities, including nausea, vomiting, fatigue, and anorexia, were mild to moderate. The disposition of GI147211 in blood was described by a linear three-compartment model, with renal elimination accounting for only 11% of drug distribution. No relationship was observed between the pharmacological exposure to GI147211 and effects on neutrophils; however, patients who developed dose-limiting myelosuppression did experience greater exposure to both the lactone and total forms of the drug. The hydrolysis kinetics of GI147211 revealed not only a shift of the drug to the inactive carboxylate form in human serum albumin but also stabilization of the lactone in erythrocytes, perhaps accounting for the observed lactone:total area under the concentration-time curve ratio of 0.27. These results indicate that GI147211 exhibits predictable toxicities and that further studies are warranted to determine the distinct role of this compound among currently available camptothecin analogues.
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Frey K, Holman S, Mikat-Stevens M, Vazquez J, White L, Pedicini E, Sheikh T, Kao TC, Kleinman B, Stevens RA. The recovery profile of hyperbaric spinal anesthesia with lidocaine, tetracaine, and bupivacaine. Reg Anesth Pain Med 1998; 23:159-63. [PMID: 9570604 DOI: 10.1097/00115550-199823020-00008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Surgical procedures previously considered too lengthy for the ambulatory surgery setting are now being performed during spinal anesthesia. The complete recovery profile of tetracaine and bupivacaine are now of interest but are not available in the literature. This study was conducted to compare times to ambulation, voiding, and complete block resolution, as well as the incidence of back and radicular pain, after spinal anesthesia with lidocaine, bupivacaine, and tetracaine. METHODS Twelve adult volunteers underwent spinal anesthesia on three separate occasions with three local anesthetics (lidocaine 100 mg, bupivacaine 15 mg, and tetracaine 15 mg in hyperbaric solutions) in random order and in a double-blind fashion. A 24-gauge Sprotte spinal needle was placed at the L2-3 interspace. The level of analgesia to pinprick was determined moving cephalad in the midclavicular line until a dermatome was reached at which the prick felt as sharp as over an unblocked dermatome. One dermatome caudad to this point was recorded every 5 minutes as the level of analgesia. We also recorded the times to voiding, unassisted ambulation, and complete resolution of sacral anesthesia. RESULTS There was no difference between tetracaine and bupivacaine in time taken for two- and four-segment regression of the analgesia level. However, times to ambulation and complete resolution of the block were significantly shorter with bupivacaine then with tetracaine. With lidocaine, times to four-segment regression, ambulation, voiding, and complete regression of the block were significantly shorter than with bupivacaine and tetracaine. Time to two-segment regression did not differ among local anesthetics. Back and radicular pain symptoms were reported by three subjects after lidocaine subarachnoid block but not after tetracaine or bupivacaine. CONCLUSION Among individual subjects, lidocaine exhibited the shortest recovery profile. However, the recovery profiles of the three anesthetics were very variable between subjects. Time to meeting discharge criteria after bupivacaine or tetracaine was faster in a few subjects than that after lidocaine in other subjects. For ambulatory anesthesia, times to two- and four-segment regression do not accurately predict time to readiness for discharge after spinal anesthesia.
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White L, Kellie S, Gray E, Toogood I, Waters K, Lockwood L, Macfarlane S, Johnston H. Postoperative chemotherapy in children less than 4 years of age with malignant brain tumors: promising initial response to a VETOPEC-based regimen. A Study of the Australian and New Zealand Children's Cancer Study Group (ANZCCSG). J Pediatr Hematol Oncol 1998; 20:125-30. [PMID: 9544162 DOI: 10.1097/00043426-199803000-00007] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Postoperative chemotherapy with indefinite postponement of radiation therapy in children < 4 years old with brain tumors was investigated in a multi-institutional study. PATIENTS AND METHODS From 1991 to 1995, 42 patients aged 3 to 47 months (median 20) with brain tumors were enrolled in a 2-phase chemotherapy protocol: 16 patients had medulloblastoma (MB); 8 had supratentorial primitive neuroectodermal tumor (PNET); 14 had ependymoma; and 4 had other tumors. The initial phase was comprised of 4 courses of the 3-drug regimen: vincristine (VCR), etoposide (VP-16), and intensive cyclophosphamide (CPA) in a previously reported schedule (VETOPEC). The continuation phase was comprised of 2-drug courses: A, CPA + VCR; B, cisplatin + VP-16; and C, carboplatin + VP-16, for a total duration of 64 weeks. RESULTS Response to VETOPEC was evaluable in 28 patients with postresection residual (25) and/or metastatic (1 M2, 6 M3) tumor. There were 9 complete responses (CR) and 9 partial responses (PR) with a combined CR + PR of 64% (95% confidence interval [CI] 44 to 81). In 12 evaluable patients with MB, CR + PR was 82% (48 to 98); in 6 patients with PNET, 50% (12 to 88); and, in 8 patients with ependymoma, 86% (42 to 99). Of 40 patients eligible for further analysis, 6 remain progression-free at a median of 30 months, 14 are alive at a median of 38 months, 29 have progressed at a median of 7 months (range, 2 to 37 months), and 26 have died. The progression-free and overall survival rates at 36 months are estimated to be 11% (95% CI 1 to 22) and 34% (18 to 50), respectively. CONCLUSIONS The initial response to the VETOPEC regimen is encouraging and warrants study of further dose escalation. Survival remains poor with current strategies in this high-risk population.
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Harel Z, Riggs S, Vaz R, White L, Menzies G. Adolescents and calcium: what they do and do not know and how much they consume. J Adolesc Health 1998; 22:225-8. [PMID: 9502010 DOI: 10.1016/s1054-139x(97)00174-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess knowledge about calcium and dietary intake among a sample of adolescents. METHODS A survey consisting of 24-h dietary recall and 14 questions assessing knowledge about calcium was administered to 1117 adolescents (52% girls and 48% boys) attending the ninth grade in five public schools. RESULTS A majority (98%) believed that dietary calcium is healthy, strengthens the bones (92%), and may prevent osteoporosis (51%), but only a few were aware of the role of calcium in neuromuscular function (20%) and blood pressure regulation (15%). About 60% knew that adolescence is a critical period for peak bone mass accretion. Only 19% were aware of the recommended dietary allowance (RDA) of calcium for adolescents [4 servings (1200 mg)/day]. The majority knew that dairy products are the main dietary source of calcium, but only 10% were aware of the calcium content of various dairy products. Only 45% knew about nondairy sources of calcium. The adolescents' main sources of calcium information were health teachers (55%) and parents (46%), while only 38% reported that their health care providers had discussed health benefits of calcium. Dairy products accounted for most of the reported daily calcium intake, and the majority (79%) reported consuming dairy products daily. "Dislike" and allergy were the main reasons given for not consuming dairy products. One third reported daily supplementation with vitamins and minerals, 68% of which contained 100-200 mg of elemental calcium. Calculated calcium intake (foods, beverages, and supplements) was 536 +/- 19 mg/24 h (45% of RDA) in girls and 681 +/- 28 mg/24 h (57% of RDA) in boys (p < 0.0001). CONCLUSIONS While adolescents are aware of the main health benefits of calcium, they lack specific information about daily requirements and calcium content of the various dietary sources. This lack of information may contribute to adolescents' suboptimal intake of calcium.
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Harvey PD, Lombardi J, Leibman M, Parrella M, White L, Powchik P, Mohs RC, Davidson M. Verbal fluency deficits in geriatric and nongeriatric chronic schizophrenic patients. J Neuropsychiatry Clin Neurosci 1998; 9:584-90. [PMID: 9447501 DOI: 10.1176/jnp.9.4.584] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study examined age-related differences and correlates of deficits on phonological and category fluency tasks performed by schizophrenic patients. Equal numbers (n = 41) of geriatric (age > 64) and nongeriatric chronically hospitalized schizophrenic patients were examined with tests of phonological and category fluency, verbal learning and delayed recall, confrontation naming, and reading, as well as overall estimates of cognitive impairment. Both types of fluency tests were performed very poorly by both groups. Age-related differences were found to be statistically significant. In both groups, category fluency impairments were correlated with deficits in naming, while phonological fluency deficits were best predicted by memory impairments. These data suggest that category fluency impairments are part of a general profile of impaired semantic functioning, whereas phonological fluency deficits may be induced by alterations in information processing capacity.
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Selig RA, White L, Gramacho C, Sterling-Levis K, Fraser IW, Naidoo D. Failure of iron chelators to reduce tumor growth in human neuroblastoma xenografts. Cancer Res 1998; 58:473-8. [PMID: 9458092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neuroblastoma (NB) is a high risk tumor of childhood, and raised serum ferritin is an adverse prognostic factor. The hypothesis that iron chelation therapy impacts tumor status and patient prognosis through changes in iron metabolism has been systematically evaluated here in a xenograft model of human NB. One of two iron chelators was given in seven different regimens to nude mice xenografted s.c. with either IMR-32, an established cell line, or JBN-1, heterotransplanted directly from a patient. Nude mice (a total of 160 in 24 cohorts) were given: desferrioxamine (DFO) by s.c. bolus or reservoir; 1,2-dimethyl-3-hydroxypyridin-4-one (L1), i.p. or orally; or saline. Measurements of mean Hb and liver iron levels were compared with corresponding saline cohorts per regimen as well as for pooled cohorts per agent for both cell lines. For IMR-32 xenografts, significant differences in Hb were achieved with L1 (10.9 g/dl pooled versus 13.7 g/dl controls) and in liver iron with DFO and L1 (235 microg/g and 306 microg/g, respectively, versus 520 microg/g). For JBN-1, the pattern was similar. With L1, H6 was 10.2 g/dl and controls were 11.7 g/dl (individual DFO cohorts were also significant); liver iron with DFO was 303 microg/g, liver iron with L1 was 270 microg/g, and controls were 387 microg/g. Additional therapy prior to tumor injection (67 mice and 10 cohorts) did not increase the depletion. Despite documentation of iron depletion, no reductions in tumor engraftment, latency, or tumor size at end point were achieved in the chelator-treated mice, compared with controls populations. Accordingly, inclusion of these iron chelators in clinical trials for NB appears unwarranted.
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Vandewater DA, White L. Nurse manager selection process (Part 1). Survey of selection process (Part 2). CANADIAN JOURNAL OF NURSING ADMINISTRATION 1998; 11:65-84. [PMID: 9616557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Queen Elizabeth II Health Sciences Centre developed as a result of the merger of the five adult hospitals in Halifax, Nova Scotia. The merge involved 7000 staff members, 2700 of whom were nursing staff. Although mergers are becoming relatively common amongst health care organizations, there is a paucity of information in the literature to describe such an enormous human resource effort. This two-part article describes the hiring process for the selection and placement of 52 nurse managers over a concentrated time period of six weeks. Issues identified and resolved included: unionized and non unionized head nurses, the role of nurse managers, varying educational preparations, the time frame and organization of the process itself, options for unsuccessful incumbents, and multi unit and multi site management. The second part of the article reports on the results of a survey which was carried out to obtain feedback from the applicants and the interview panel members. The survey was conducted within eight weeks of the conclusion of the hiring process. Overall the process was deemed successful, albeit stressful. Some of the problems encountered are discussed.
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White L. Assessing older people. COMMUNITY NURSE 1997; 3:16-18. [PMID: 9468993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Harvey PD, Sukhodolsky D, Parrella M, White L, Davidson M. The association between adaptive and cognitive deficits in geriatric chronic schizophrenic patients. Schizophr Res 1997; 27:211-8. [PMID: 9416650 DOI: 10.1016/s0920-9964(97)00068-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cognitive impairments have been shown to predict impairments in adaptive functioning in patients with chronic schizophrenia and to be more predictive of overall outcome than positive or negative symptoms of the illness. Both adaptive and cognitive impairments are multidimensional, and it is possible that correlations between these domains may be limited to certain aspects of these functions. In this study, 208 geriatric patients with chronic schizophrenia were examined with a cognitive battery and assessed with a structured scale to determine the extent of their adaptive functions. Instrumental and social skills deficits were more strongly correlated with cognitive impairments than with the severity of undercontrolled behavior. Each of the cognitive measures was correlated with global social-adaptive deficits, with minimal variation in the magnitude of correlations. These results suggest that interventions should be individually targeted to cognitive-adaptive impairments and undercontrolled behavior.
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Freedman DS, Serdula MK, Percy CA, Ballew C, White L. Obesity, levels of lipids and glucose, and smoking among Navajo adolescents. J Nutr 1997; 127:2120S-2127S. [PMID: 9339179 DOI: 10.1093/jn/127.10.2120s] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Although there is a high prevalence of overweight among Navajo children and adolescents, other risk factors for chronic disease in this population have received little attention. We therefore examined the distribution and interrelationships of overweight, cigarette smoking, blood pressure and plasma levels of lipids and glucose among 160 Navajo 12- to 19-y-olds. In agreement with previous reports, participants were approximately 2 kg/m2 heavier than adolescents in the general U.S. population, and the prevalence of overweight (> 85th percentile) was 35-40%. Levels of total cholesterol and blood pressure were similar to those in the general U.S. population, but Navajo adolescents had a 5-10 mg/dL lower median level of HDL cholesterol, and a 30 mg/dL higher median triglyceride level. Eight percent of the adolescents examined had either impaired glucose tolerance or diabetes mellitus as assessed through an oral glucose tolerance test (n = 10) or self-report (n = 1). Relative weight (kg/m2) was associated with adverse levels of lipids, lipoproteins and glucose, with overweight adolescents having a fivefold greater risk for elevated triglyceride levels than other adolescents. Tobacco use was fairly prevalent among boys (24% cigarettes, 23% smokeless tobacco), but not girls (9% cigarettes, 3% smokeless tobacco). Because of its associations with other risk factors and with various chronic diseases in later life, it may be beneficial to focus on the primary prevention of obesity among Navajo children and adolescents.
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Strauss KF, Mokdad A, Ballew C, Mendlein JM, Will JC, Goldberg HI, White L, Serdula MK. The health of Navajo women: findings from the Navajo Health and Nutrition Survey, 1991-1992. J Nutr 1997; 127:2128S-2133S. [PMID: 9339180 DOI: 10.1093/jn/127.10.2128s] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cancer-screening behaviors, reproductive history, risk behaviors during pregnancy and chronic disease risk factors were examined in a representative sample of 566 Navajo women residing on the Navajo Reservation in 1991-1992. Among all women 15 y and older, 59% were overweight, 4% were current smokers, 10% currently used smokeless tobacco and 12% were anemic. Seventy-one percent of Navajo women aged 18 and older reported ever having had a Pap smear, but only 35% of women aged 50 and over reported ever having had a mammogram. Among parous women, the prevalence of having received no prenatal care for any pregnancy declined from 60% among women 60 and older to 13% among women 20-29 y of age, and the prevalence of ever having had a child born at home declined from 82 to 2%. These data suggest marked secular improvement in these pregnancy-related risk behaviors. However, data on cancer-screening behaviors indicate opportunities to improve health of Navajo women by increasing their use of mammography and Pap smear screening services.
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Percy C, Freedman DS, Gilbert TJ, White L, Ballew C, Mokdad A. Prevalence of hypertension among Navajo Indians: findings from the Navajo Health and Nutrition Survey. J Nutr 1997; 127:2114S-2119S. [PMID: 9339178 DOI: 10.1093/jn/127.10.2114s] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hypertension and other chronic diseases are becoming increasingly important health problems for many Native American people, including the Navajo. A community-based survey that included three standardized measurements of blood pressures, was conducted during 1991-92 on the Navajo Reservation. Among the 780 adults examined, the overall age-standardized prevalence of hypertension, defined as an elevated systolic (> or = 140 mm Hg) or diastolic (> or = 90 mm Hg) blood pressure, or possession of prescription antihypertensive medications, was 19% (24% among men and 15% among women). The prevalence of hypertension increased with age and relative weight, and among men, was associated with diabetes mellitus. Among women, hypertension was associated with a central distribution of body fat, cigarette smoking, self-reported diabetes mellitus and impaired glucose tolerance. Although only 50% of the persons found to have elevated blood pressure at the examination reported they had been previously told that they had hypertension, persons who had been previously diagnosed with hypertension had a slightly higher rate (approximately 60%) of blood pressure control than that seen in the general U.S. population. On the basis of these results, the prevalence of hypertension among the Navajo appears to have substantially increased since the 1930s. Improved prevention and management of hypertension, especially for overweight and diabetic individuals, may reduce morbidity and mortality from cardiovascular and renal disease.
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Petrovitch H, Nelson J, Snowdon D, Davis DG, Ross GW, Li CY, White L. Microscope field size and the neuropathologic criteria for Alzheimer's disease. Neurology 1997; 49:1175-6. [PMID: 9339717 DOI: 10.1212/wnl.49.4.1175] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Gong Q, White L, Johnson R, White M, Negishi I, Thomas M, Chan AC. Restoration of thymocyte development and function in zap-70-/- mice by the Syk protein tyrosine kinase. Immunity 1997; 7:369-77. [PMID: 9324357 DOI: 10.1016/s1074-7613(00)80358-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Syk family of protein tyrosine kinases, consisting of ZAP-70 and Syk, associate with the pre- and alphabeta T cell antigen receptors (TCRs) and undergo tyrosine phosphorylation and activation following receptor engagement. Thymocyte development in zap-70-/- mice is blocked at the CD4+CD8+ TCR(lo) stage. The presence of Syk in the thymus has raised the possibility that Syk may be able to mediate TCR function. To determine if Syk can play a role in thymocyte development, we generated zap-70-/- mice expressing a human syk cDNA. Syk expression restored both thymocyte development and function. In addition, Syk function required the CD45 transmembrane protein tyrosine phosphatase. Hence, ZAP-70 and Syk can play overlapping functions and exhibit similar regulatory mechanisms in mediating alphabeta T cell development.
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Carpenter PA, White L, McCowage GB, Nayanar V, Toogood I, Shaw PJ, Lockwood L, Tiedemann K. A dose-intensive, cyclophosphamide-based regimen for the treatment of recurrent/progressive or advanced solid tumors of childhood: a report from the Australia and New Zealand Children's Cancer Study Group. Cancer 1997; 80:489-96. [PMID: 9241083 DOI: 10.1002/(sici)1097-0142(19970801)80:3<489::aid-cncr17>3.0.co;2-t] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Children with solid tumors that progress or recur after conventional multimodality therapies have a very poor prognosis. In a pilot study, vincristine, etoposide, and dose-escalated cyclophosphamide (VETOPEC) was shown to be a promising salvage regimen. Continued accrual of patients and increased duration of follow-up has resulted in substantial experience with VETOPEC. METHODS Between May 1991 and March 1994, 56 pediatric patients from 6 centers were enrolled in this study; 44 had recurrent or progressive tumors (Group A) and 12 had newly diagnosed, advanced tumors with a very poor prognosis (Group B). The VETOPEC regimen was comprised of vincristine, 0.05 mg/kg, on Days 1 and 14; etoposide, 2.5 mg/kg, on Days 1, 2, and 3; and fractionated, dose-escalated cyclophosphamide on Days 1, 2, and 3. The initial cyclophosphamide dose was 90 mg/kg (2.7 g/m2)/cycle with an escalation of 15 mg/kg/cycle in each subsequent cycle, to a maximum (over 6 cycles) of 165 mg/kg (5.0 g/m2)/cycle. Tumor response was evaluated every two to three cycles and included central review of imaging. RESULTS The combined and partial response rates for Groups A and B were 66% (25 of 38 patients) and 91% (10 of 11 patients), respectively. In Group A, best evaluable responses and event free (EF) survivors were observed with: brain tumors (7 of 9 patients; 2 EF at 39 and 45 months [mos], respectively), Wilms' tumor (6 of 7 patients; 3 EF at 37-49 mos), and lymphoma (4 of 4 patients; 2 EF at 52 and 59 mos, respectively); in Group B best evaluable responses and EF were observed with: neuroblastoma (5 of 6 patients; 1 disease free at 57 mos) and rhabdomyosarcoma (4 of 4 patients; no survivors). Hematologic toxicity was limiting despite support with myeloid growth factors in 33 patients. Four deaths in Group A and one in Group B were directly associated with this toxicity. Specifically, no cases of drug-related myocardial toxicity or pneumonitis were observed. CONCLUSIONS This chemotherapy regimen with its intense scheduling produced a high response rate and appreciable survival in patients with a variety of recurrent, progressive, or advanced solid tumors of childhood.
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McCowage GB, White L, Carpenter P, Lockwood L, Toogood I, Tiedemann K, Shaw PJ. Granulocyte-macrophage colony-stimulating factor in association with high-dose chemotherapy (VETOPEC) for childhood solid tumors: a report from the Australia and New Zealand Children's Cancer Study Group. MEDICAL AND PEDIATRIC ONCOLOGY 1997; 29:108-14. [PMID: 9180912 DOI: 10.1002/(sici)1096-911x(199708)29:2<108::aid-mpo8>3.0.co;2-i] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Combination chemotherapy with vincristine, etoposide, and high-dose, escalating cyclophosphamide (VETOPEC) is an effective regimen in pediatric patients with high-risk solid tumors. The toxicity of the regimen is predominantly haematologic. This study addressed the role of recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) following each cycle of chemotherapy in decreasing neutropaenia, incidence of fever/ hospitalization, and/or increasing chemotherapy dose-intensity. PATIENTS AND METHODS Twenty-nine children with recurrent solid tumors were treated with the VETOPEC regimen. Sequential cohorts of patients received no GM-CSF (Group I), or GM-CSF in a dosage of 5 micrograms/kg/day (Group II) or 10 micrograms/kg/day (Group III) on days 4-18 of each chemotherapy cycle. Up to four cycles of chemotherapy were analysed with respect to haematopoietic recovery, clinical parameters, and dose intensity. RESULTS Neutrophil recovery was significantly more rapid in patients treated with GM-CSF. Time to achieving an absolute neutrophil count (ANC) over 0.5 x 10(9)/L in Groups I, II, and III were 21, 18, and 16 days, respectively (P < 0.0001). Time to achieving an absolute neutrophil count (ANC) over 1.0 x 10(9)/L in Groups I, II, and III were 24, 19, and 17 days, respectively (P < 0.0001). There was no significant difference in the incidence of febrile neutropaenia between the three groups. Febrile neutropaenia occurred following 42, 68, and 62% of chemotherapy cycles in Groups I, II, and III, respectively (P = 0.27). Chemotherapy dose intensity was not different between the three groups. GM-CSF was associated with pericarditis and myalgias in one patient, and transient hypoxia/hypotension in another. CONCLUSION GM-CSF led to significantly more rapid neutrophil recovery following VETOPEC chemotherapy, but did not lead to any demonstrable clinical benefit, either in reducing febrile events, or in increasing chemotherapy dose intensity.
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Takle GB, Thierry AR, Flynn SM, Peng B, White L, Devonish W, Galbraith RA, Goldberg AR, George ST. Delivery of oligoribonucleotides to human hepatoma cells using cationic lipid particles conjugated to ferric protoporphyrin IX (heme). ANTISENSE & NUCLEIC ACID DRUG DEVELOPMENT 1997; 7:177-85. [PMID: 9212908 DOI: 10.1089/oli.1.1997.7.177] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The receptor-ligand interaction between hepatocyte heme receptors and heme was evaluated as a basis for developing a targeted cationic lipid delivery reagent for nucleic acids. Heme (ferric protoporphyrin IX) was conjugated to the aminolipid dioleoyl phosphatidylethanolamine (DOPE) and used to form cationic lipid particles with dioleoyl trimethylammonium propane (DOTAP). These lipids particles (DDH) protect oligoribonucleotides from degradation in human serum and increase oligoribonucleotide uptake into 2.2.15 human hepatoma cells (to a level of 50-60 ng oligo/10(4) cells) when compared with the same lipid particles (DD) prepared identically without heme. The DDH heme level that was optimal for oligoribonucleotide delivery was also optimal for maximum expression of plasmid-encoded luciferase. The enhancing effect of heme was evident only at net particle negative charge. Fluorescence microscopy showed that DDH delivered oligoribonucleotides into both the 2.2.15 cell cytoplasm and nucleus. DDH may thus be a potentially useful delivery vehicle for oligonucleotide-based therapeutics and transgenes, appropriate for use in such liver diseases as viral hepatitis, hepatoma, and hypercholesterolemia.
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MESH Headings
- Animals
- Carcinoma, Hepatocellular/pathology
- Cations
- Cell Line
- Cell Nucleus/metabolism
- Chlorocebus aethiops
- Cytoplasm/metabolism
- DNA, Recombinant/administration & dosage
- DNA, Recombinant/pharmacokinetics
- Drug Carriers
- Fatty Acids, Monounsaturated/administration & dosage
- Fatty Acids, Monounsaturated/chemistry
- Fatty Acids, Monounsaturated/pharmacokinetics
- Genes, Reporter
- Genetic Vectors/administration & dosage
- Genetic Vectors/pharmacokinetics
- Heme/administration & dosage
- Heme/chemistry
- Heme/pharmacokinetics
- Humans
- Kidney
- Liver Neoplasms/pathology
- Luciferases/biosynthesis
- Luciferases/genetics
- Mice
- Microscopy, Fluorescence
- Neoplasm Proteins/metabolism
- Oligoribonucleotides/administration & dosage
- Oligoribonucleotides/chemistry
- Oligoribonucleotides/pharmacokinetics
- Organ Specificity
- Particle Size
- Phosphatidylethanolamines/administration & dosage
- Phosphatidylethanolamines/chemistry
- Phosphatidylethanolamines/pharmacokinetics
- Quaternary Ammonium Compounds/administration & dosage
- Quaternary Ammonium Compounds/chemistry
- Quaternary Ammonium Compounds/pharmacokinetics
- Receptors, Cell Surface/metabolism
- Recombinant Fusion Proteins/biosynthesis
- Recombinant Fusion Proteins/genetics
- Species Specificity
- Tumor Cells, Cultured
- Vero Cells
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Roach T, Slater S, Koval M, White L, Cahir McFarland ED, Okumura M, Thomas M, Brown E. CD45 regulates Src family member kinase activity associated with macrophage integrin-mediated adhesion. Curr Biol 1997; 7:408-17. [PMID: 9197241 DOI: 10.1016/s0960-9822(06)00188-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adhesion of leukocytes to the extracellular matrix and to other cells is mediated by members of the integrin family of adhesion molecules. Src family kinases are activated upon integrin-mediated adhesion. In lymphocytes, CD45 is a leukocyte-specific transmembrane protein tyrosine phosphatase that activates Src family kinases associated with B-cell and T-cell antigen receptor signaling by constitutive dephosphorylation of the inhibitory carboxy-terminal tyrosine phosphorylation site. Here, we show that CD45 is also important in downregulating the kinase activity of Src family members during integrin-mediated adhesion in macrophages. RESULTS We found that CD45 colocalized with beta2 integrin and the Src family kinase p53/56(lyn) to adhesion sites in bone marrow-derived macrophages. Macrophages from CD45(-/-) mice were unable to maintain integrin-mediated adhesion. In adherent macrophages, absence of CD45 led to the hyperphosphorylation and hyperactivation of p56/59(hck) and p53/56(lyn), but not of p58(c-fgr). CD45 directly inactivated p59(hck) but not p56(lck) in transient transfection assays. Furthermore, coexpression of CD45 with p59(hck) or p56(lyn) containing a tyrosine to phenylalanine mutation at the carboxy-terminal negative regulatory site resulted in decreased tyrosine phosphorylation of the Src family member kinases due to dephosphorylation of the potentiating tyrosine phosphorylation site within the kinase domain. CONCLUSIONS Using primary bone marrow macrophages, these studies demonstrate that CD45 regulates Src family kinases and is required to maintain macrophage adhesion. CD45 decreases Src family kinase activity by dephosphorylating the tyrosine residue located within the kinase domain.
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