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Accurately low SpO2 readings. Research is needed to determine whether pulse oximetry improves patient outcomes or processes of care; it may be that pulse oximetry is unnecessary and unhelpful and therefore an inappropriate use of health care resources ; in some settings.
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Journal of the National Cancer Institute, Vol. 97, No. 24, December 21, 2005.
As seen in Table 2, relapses have occurred in 0 of low-risk patients and 3 of 15 high-risk patients. Two of the relapses were simultaneously molecular and hematologic; both occurred 9 months from CR date. Both patients achieved a second CR, one with ATRA plus ATO plus GO and the second with idarubicin plus ATRA. Both remain in second CR, the first patient 21 months after an allogeneic stem cell transplantation and the second 2 months after an autologous stem cell transplantation. The third relapse was initially molecular, at 12 months from CR date, but, despite addition of GO, central nervous system CNS ; relapse occurred 3 months later, and the marrow remained PCR positive. The patient did not wish further treatment. No patients have died in CR. The study remained open to new patients until very recently, thus reducing the median follow-up time in the 36 patients who remained in first CR. The median time from CR date to most recent CBC, which was normal in all cases, was 16 months in these 36. The corresponding time was 15 months in the 24 low-risk patients, and 20 months in the 12 high-risk patients Table 2 ; . Because of the somewhat artificial reduction in median follow-up time, it is instructive to note that 12 patients remain in first CR with their most recent CBC obtained 12 to 24 months from CR date, 8 additional patients remain in first CR with their most recent CBC obtained 24 to 36 months from CR date, and 1 patient's most recent CBC was 37 months from CR date Table 2 ; , bearing in mind that bone marrow aspirates were not always done in conjunction with blood counts.
Difference; 17% higher 3-h urinary excretion of 7-hydroxycoumarin in females compared with males was reported by Ujjin et al. 2002 ; , and the study by Iscan et al. 1994 ; showed 11% higher 7-hydroxycoumarin excretion in women compared with men in a 2-h coumarin test. A third study showed significantly higher activity in women compared with men only in a subpopulation with lower coumarin hydroxylase activity Xu et al., 2002c ; . Significant gender differences have not been detected in the amount or activity of CYP2A6 in liver microsomes in several studies with a small number of samples Pearce et al., 1992; Shimada et al., 1994; Bourrie et al., 1996; Chauret et al., 1997; Baker et al., 2001; Schmidt et al., 2001 ; . A tendency for slower glucuronidation of nicotine and cotinine in women compared with men was reported in a study using human liver microsomes Ghosheh and Hawes, 2002a ; . However, no gender differences in glucuronidation were detected in one study measuring urinary excretion of glucuronides of nicotine, cotinine, and 3 -hydroxycotinine after infusion of nicotine and cotinine Benowitz et al., 1999 ; . ii. Pregnancy and Menstrual Cycle. Pregnancy has a marked inducing effect in nicotine and especially cotinine clearance. Clearance is increased by 60 and 140% for nicotine and cotinine, respectively, in pregnancy compared with postpartum Dempsey et al., 2002 ; . Nicotine is a rapidly cleared drug with a high affinity for CYP2A6, and its rate of clearance is primarily controlled by hepatic blood flow, whereas the rate of cotinine clearance is primarily determined by the activity of metabolizing enzymes in liver. The finding that in pregnancy cotinine clearance is increased more than nicotine clearance indicates that increase in clearance is most likely caused by induction of CYP2A6 and not by an increase in hepatic blood flow. A study comparing women during pregnancy and again postpartum found that mean salivary cotinine concentration per cigarette was higher when not pregnant 3.5 versus 9.9 ng ml ; consistent with higher cotinine clearance during pregnancy Rebagliato et al., 1998 ; . Pregnant smokers had a substantially lower level of serum nicotine than expected when standardized for their nicotine intake compared with population-based values Selby et al., 2001 ; . Nicotine and cotinine glucuronidation is induced by pregnancy, whereas 3 -hydroxycotinine glucuronidation is not Dempsey et al., 2002 ; . Menstrual cycle follicular phase versus luteal phase ; has no effect on nicotine and cotinine pharmacokinetics in healthy nonsmoking women Hukkanen et al., 2005 ; . The above-mentioned results show that sex has substantial effects on nicotine and cotinine metabolism. Higher metabolism of nicotine and cotinine is detected in women compared with men, in users of oral contraceptives compared with women not using oral contraceptives, and in pregnant women compared with the same subjects postpartum. Furthermore, the inducing effect.
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On a dark December day in 1998 I became an involuntary member of the young survivors club. I didn't want to join. In fact, I had spent two days praying that I wouldn't be eligible. By being a part of this group everything that was familiar to me was fleeing and I was left with uncertainty and fear. Maybe you have been there as well. Inducted into the club because of breast cancer at young age. I was twenty-six. As if it weren't enough to have cancer, I was also in limbo. Constantly being told, `you're too young to have cancer.' My friends, God bless them, just couldn't relate as I began to deal with issues that they never even considered. They were very helpful in many ways but I always felt set apart in normal conversations. While they were able to discuss when they would have baby number 2 or 3, I would quietly think `If only that were my biggest problem'. My ability to be carefree was gone. Are you in the young survivors club? Have you faced menopause, infertility, loss of breasts, body image issues, or the possibility of dying young and leaving behind young children that might not even remember you? These are just a few of the issues that may accompany the words, `it's cancer'. Don't get me wrong, I know that I blessed to be a survivor. Continuing to have a quality life for eight years after stage IV cancer is a gift, and I thankful for that. But sometimes it seems as though I have already been through things that my friends won't face for years. I mean really, do you.
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Finlayson, K., Pennington, A.J., Kelly, J.S. 2001b ; [3H]Dofetilide binding in SHSY5Y and HEK 293 cells expressing a HERG-like K + channel? Eur J Pharmacol 412, 202-212. Fossa, A.A., Wisialowski, T., Magnano, A., Eric, W., Winslow, R., Gorczyca, W., Crimin, K., Raunig, D.L. 2005 ; Dynamic beat-to-beat modeling of the QT-RR interval relationship: analysis fof QT prolongation during alterations of autonomic state versus human ether a-gogo-related gene inhibition. Journal of Pharmacology and experimental therapeutics 312: 1-11. Franz, M.R. 1991 ; Method and theory of monophasic action potential recording. Progress in Cardiovascular Diseases 6: 347-368. Gintant, G.A., Limberis, J.T., McDermott, J.S., Wegner, C.D., Cox, B.F. 2001 ; The canine Purkinje fiber: an in vitro model system for acquired long QT syndrome and drug-induced arrhythmogenesis. Journal of Cardiovascular Pharmacology 37: 607-618. Gonzalez, J.E., Maher, M.P. 2002 ; Cellular fluorescent indicators and voltage ion probe reader VIPRTM ; : tools for ion channel and receptor drug discovery. Recept Channels 8, 283295. Guth, B.D., Germeyer, S., Kolb, W., Markert, M. 2004 ; Developing a strategy for the nonclinical assessment of proarrhythmic risk of pharmaceuticals due to prolonged ventricular repolarization. Journal of Pharmacological and Toxicological Methods. 49: 159-169. Hamlin, R.L., Kijtawornrat, A., Keene, B.W., Hamlin, D.M. 2003 ; QT and RR intervals in conscious and anesthetized guinea pigs with highly varying RR intervls and given QTc a lengthening test articles. Toxicological Sciences 76: 437-42. Hamlin, R.L., Kijtawornrat, A., Keene, B.W. 2004 ; How many cardiac cycles must be measured to permit accurate RR, QT, and QTc estimates in conscious dogs? J Pharmacol Tox Methods 50: 103-108. Hauser, D., Stade, M., Schmidt, A., Hanauer, G. 2005 ; Cardiovascular parameters in anaesthetized guinea pigs: a safety pharmacology screening model. Journal of Pharmacological and Toxicological Methods 52: 106-114. Hayashi, S., Yoshihid, K., Tabo, M., Fukuda, H., Itoh, T., Shimosato, T., Amano, H., Saito, e M., Morimoto, H. Yamada, K., Kanda, A., Ishitsuka, T., Yamazaki, T., Kiuchi, Y., Taniguchi, S., Mori, T., Shimizu, S., Tsurubuchi, Y., Yasuda, S., Kitani, S., Shimada, C., Kobayashi, K., Komeno, M., Kasai, C., Hombo, T., Yamamoto, K. 2005 ; QT PRODACT: A multi-site study of in vitro action potential assays on 21 compounds in isolated guinea-pig papillary muscles. J Pharmacological Sciences 99: 423-437. Haverkamp, W., Breithardt, G., Camm, A.J., Janse, M.J., Rosen, M.R., Antzelevitch, C., Escande, D., Franz, M., Malik, M., Moss, A., Shah, R. 2000 ; The potential for QT prolongation and pro-arrhythmia by non-anti-arrhythmic drugs: clinical and regulatory implications report on a policy conference of the European society of cardiology. Cardiovascular Research 47: 219-233. Herron, W., Towers, C., Templeton, A. 2004 ; Experiences in method development for the analysis of in vitro study solutions for content. Journal of Pharmacological and Toxicological Methods 49: 211-216. 34.
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C. Schilling1, L. Gallicchio2, S. Miller3, L. M. Lewis1, H. Zacur3 and J. A. Flaws1. 1Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, MD, 2Department of Epidemiology, Johns Hopkins University, Baltimore, MD and 3Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD. Little is known about the etiology of hot flashes, though millions of women experience hot flashes each year during their transition to menopause. We have previously shown that current alcohol use reduces the risk of frequent and severe hot flashes in midlife women and that this association is not mediated by estrogen levels. The purpose of this study was to examine the relation between current alcohol use, androgen levels, and hot flashes in midlife women using a case-control study design. Cases were midlife women who reported ever experiencing hot flashes n 362 ; . Controls were midlife women who reported never experiencing hot flashes n 264 ; . Each participant completed a questionnaire and provided a blood sample that was used to measure androgen levels androstenedione and testosterone ; by enzyme-linked immunosorbent assay. The results indicate that current alcohol users had lower odds than non-users of experiencing any hot flashes odds ratio OR ; : 0.66, 95% confidence interval CI ; : 0.45, 0.96 ; , independent of age, race, obesity, and smoking habits. When androstenedione or testosterone levels were added to the model, the odds of experiencing any hot flashes were unchanged OR: 0.66, 95% CI: 0.45, 0.97 ; . In addition, current alcohol users had similar levels of androstenedione geometric mean: users 2.040.10 ng ml, non-users 2.010.19 ng ml; p 0.7 ; and testosterone geometric mean: users 0.470.03 ng ml, non-users 0.510.11 ng ml; p 0.5 ; compared to non-users of alcohol. These data suggest that current alcohol use is associated with a reduced risk of hot flashes in midlife women by a mechanism that may not include changes in androgen levels. Supported by NIH Grant AG18400 and a grant from the Women's Health Research Group at the University of Maryland.
526. Schiffmann R, Kopp JB, Austin HA III, et al. Enzyme replacement therapy in Fabry disease: a randomized controlled trial. JAMA 2001; 285: 27439. Yalcinkaya S, Kumbasar SD, Semiz E, et al. Sustained ventricular tachycardia in cardiac hemochromatosis treated with amiodarone. J Electrocardiol 1997; 30: 1479. Strobel JS, Fuisz AR, Epstein AE, et al. Syncope and inducible ventricular fibrillation in a woman with hemochromatosis. J Interv Card Electrophysiol 1999; 3: 2259. Short EM, Winkle RA, Billingham ME. Myocardial involvement in idiopathic hemochromatosis. Morphologic and clinical improvement following venesection. J Med 1981; 70: 12759. Davison ET, Davison MJ. Triiodothyronine T3 ; toxicosis with hypokalemic periodic paralysis and ventricular tachycardia. J Electrocardiol 1995; 28: 1614. Nesher G, Zion MM. Recurrent ventricular tachycardia in hypothyroidism report of a case and review of the literature. Cardiology 1988; 75: 3016. Osborn LA, Skipper B, Arellano I, et al. Results of resting and ambulatory electrocardiograms in patients with hypothyroidism and after return to euthyroid status. Heart Dis 1999; 1: 811. Aragona M, Aragona F. [Pheochromocytoma and catecholamine cardiomyopathy]. Pathologica 1992; 84: 197203. Singh AK, Nguyen PN. Refractory ventricular tachycardia following aortic valve replacement complicated by unsuspected pheochromocytoma. Thorac Cardiovasc Surg 1993; 41: 3723. Michaels RD, Hays JH, O'Brian JT, et al. Pheochromocytoma associated ventricular tachycardia blocked with atenolol. J Endocrinol Invest 1990; 13: 9437. Shimizu K, Miura Y, Meguro Y, et al. QT prolongation with torsade de pointes in pheochromocytoma. Heart J 1992; 124: 2359. Viskin S, Fish R, Roth A, et al. Clinical problem-solving. QT or not QT? N Engl J Med 2000; 343: 3526. Colao A. Are patients with acromegaly at high risk for dysrhythmias? Clin Endocrinol Oxf ; 2001; 55: 3056. Kahaly G, Olshausen KV, Mohr-Kahaly S, et al. Arrhythmia profile in acromegaly. Eur Heart J 1992; 13: 516. Colao A, Ferone D, Marzullo P, et al. Long-term effects of depot longacting somatostatin analog octreotide on hormone levels and tumor mass in acromegaly. J Clin Endocrinol Metab 2001; 86: 277986. Minniti G, Moroni C, Jaffrain-Rea ML, et al. Marked improvement in cardiovascular function after successful transsphenoidal surgery in acromegalic patients. Clin Endocrinol Oxf ; 2001; 55: 30713. Suyama K, Uchida D, Tanaka T, et al. Octreotide improved ventricular arrhythmia in an acromegalic patient. Endocr J 2000; 47 Suppl ; : S735. 543. Lombardi G, Colao A, Marzullo P, et al. Improvement of left ventricular hypertrophy and arrhythmias after lanreotide-induced GH and IGF-I decrease in acromegaly. A prospective multi-center study. J Endocrinol Invest 2002; 25: 9716. Colao A, Marzullo P, Cuocolo A, et al. Reversal of acromegalic cardiomyopathy in young but not in middle-aged patients after 12 months of treatment with the depot long-acting somatostatin analogue octreotide. Clin Endocrinol Oxf ; 2003; 58: 16976. Izumi C, Inoko M, Kitaguchi S, et al. Polymorphic ventricular tachycardia in a patient with adrenal insufficiency and hypothyroidism. Jpn Circ J 1998; 62: 5435. Abdo A, Bebb RA, Wilkins GE. Ventricular fibrillation: an extreme presentation of primary hyperaldosteronism. Can J Cardiol 1999; 15: 3478. Sade E, Oto A, Oto A, et al. Adrenal adenoma presenting with torsade de pointes--a case report. Angiology 2002; 53: 4714. Geist M, Dorian P, Davies T, Greene M, Newman D. Hyperaldosteronism and sudden cardiac death. J Cardiol 1996; 78: 6056. Chang CJ, Chen SA, Tai CT, et al. Ventricular tachycardia in a patient with primary hyperparathyroidism. Pacing Clin Electrophysiol 2000; 23: 5347. Whang W, Bigger JT Jr. Diabetes and outcomes of coronary artery bypass graft surgery in patients with severe left ventricular dysfunction: results from the CABG Patch Trial database. The CABG Patch Trial Investigators and Coordinators. J Coll Cardiol 2000; 36: 116672. Marques JL, George E, Peacey SR, et al. Altered ventricular repolarization during hypoglycaemia in patients with diabetes. Diabet Med 1997; 14: 64854 and indinavir.
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Luhu's diesel gas turbine system. In addition, the design of the Luhai's bridge and superstructure exhibits a number of stealthy characteristics particularly in comparison to the Luhu's structure ; . These design features include a streamlined superstructure with inclined angles and two solid masts with fewer protruding electronic sensor arrays. The stepped superstructure may have been designed with the intention to equip the Luhai with vertical launch systems, possibly for SAMs for an enhanced area-defense capability. The absence of such a system on the Luhai suggests that that option was deferred for a time.55 These improvements in naval design and production have continued with the next generation of destroyers. Around 2000, China began building two new classes of destroyers, skipping over the Luhai--of which only one was built.56 This is the first time in PRC naval history that only one of a new class of destroyer class was built. ; The follow-on classes to the Luhai represent important advances in the shipbuilding industry's overall design and production techniques. The first new class of guided-missile destroyer is known as the Luyang I 052B-class; two were built at the Jiangnan Shipyard and are currently being outfitted with weapon systems, sensors, and electronics. An additional two vessels, known as Luyang II 052C-class guided-missile destroyers, are also currently being built at Jiangnan. The latter have a similar design as the former, but they appear to be optimized for air-defense missions. Both new classes have reportedly.
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Tricyclic antidepressants. A dose-response relation was apparent as prescriptions of tricyclic agents increased from occasional one prescription: standardized incidence ratio 0.8 ; to periodic 24 prescriptions: standardized incidence ratio 1.4 ; to regular 5 prescriptions: standardized incidence ratio 2.5 ; use. Given the possible association between antidepressant medications and non-Hodgkin's lymphoma and the increase in use of antidepressant medications since the 1970s, further investigation in this area is warranted 26 ; . Our study evaluated the association between antidepressant medication use and the risk of non-Hodgkin's lymphoma using a population-based case-control study in Ontario.
Spontaneously recovers. However, it has been observed that some patients with hypothyroidism secondary to Hashimoto's thyroiditis and chronically replaced with L-T~ may recover normal thyroid function in association with the disappearance of TSH-inhibiting immunoglobulins 75, 76 ; . Also, in a Japanese population with a markedly elevated ambient iodine intake, hypothyroid patients with Hashimoto's thyroiditis may recover normal thyroid function following iodine restriction 77 ; . Therapy of hypothyroidism during pregnancy is discussed below. B. Subclinical hypothyroidism Subclinical hypothyroidism has been defined as an asymptomatic disorder with normal serum total and free thyroid hormone concentrations and slightly increased basal and TRH-&nulated serum TSH concentrations 78 ; . It unclear whether subclinical hypothyroidism consistently progresses to overt hypothyroidism, although patients with subclinical hypothyroidism and with circulating antithyroid antibodies more often do 79, 80 ; . Due to the uncertainty of the biological significance of subclinical hypothyroidism, L-T~ therapy of this condition is not recommended by all 78 ; . Thus, it is not surprising that treatment of patients with subclinical hypothyroidism with thyroid hormone has led to conflicting therapeutic results. In patients with subclinical hypothyroidism treated with 25-50 rg L-T., daily, a significant decrease in serum TSH with an increase in serum T4 concentrations has been reported 81 ; . In these patients, peripheral indices of thyroid hormone action, such as serum cholesterol, were not affected by L-T~ treatment whereas others, such as cardiac function, were improved 81 ; . Another study confirmed that L-T~ treatment did not affect serum triglycerides, cholesterol, and high density lipoprotein concentrations but did restore to normal such cardiac indices as the left ventricular ejection fraction 82 ; . Cooper et al. 83 ; failed to show any significant improvement in a wide variety of metabolic parameters including sleeping heart rate, urinary sodium excretion, peripheral nerve conduction velocities, and fasting serum triglyceride, total cholesterol, and high density. lipoprotein HDL ; concentrations. In contrast, other studies have reported that L-T~ treatment of these patients increased serum HDL and apolipoprotein A and decreased low-density lipoprotein LDL ; cholesterol concentrations 84, 85 ; . The variability in the reported lipid responses to L-T~ therapy in patients with subclinical hypothyroidism has recently been emphasized by Franklyn and associates 86 ; . The restoration of the serum TSH to normal did not significantly affect serum lipid values, but total and LDL lipids did significantly decrease when TSH suppressive doses of L-T~ were employed. A double-blind cross-over study demonstrated that L-T~ treatment at a dose of 100 rg daily in women with subclinical hypothyroidism improved psychometric tests and symptoms rating 87 ; . A slight improvement in the general score of nonspecific symptoms and an increase in systolic ejection time was also observed in a double-blind, placebo-controlled trial 83 ; . These findings taken together suggest that the beneficial and intal.
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Patient and Treatment Characteristics From 6 95 until 12 00 a total of 94 patients with AML or high-risk MDS have undergone APCT with FAI or with FM. Their characteristics are summarized in Table 1. All subjects signed written informed consents and were treated under M.D. Anderson Cancer Center protocols approved by the institutional review board. Patients received one of three preparative regimens. The truly non ablative regimen consisted of a combination of fludarabine 30 mg m2 given intravenously daily for 4 days followed 4 hours later by an infusion of cytarabine 1 gm m2. In addition to these two agents patients also received idarubicin 12 mg m2 intravenously daily for 3 days. Patients receiving the reduced intensity conditioning regimen received either fludarabine 25-30 mg m2 for 4-5 days in combination with melphalan 140 or 180 mg m2 total dose GVHD prophylaxis consisted of a combination of tacrolimus FK506, Prograf, Fujisawa ; or cyclosporine and methotrexate 5 mg m2 intravenously on days 1, 3, 6, and 11 post transplant. Tacrolimus or cyclosporine levels were monitored three times a week and kept at therapeutic ranges of 5-15 ng dl for tacrolimus and 150-300 ng dl for cyclosporine during the first 50 days and then tapered at the discretion of the primary physician depending on donor type, disease status at time of transplantation, presence or absence of GVHD, presence of residual donor cells as documented by chimerism or cytogenetic analysis. Antibacterial, antifungal and antiviral prophylaxis consisted of trimethoprim-sulfamethoxazole for Pneumocystis Carinii prophylaxis, acyclovir or valacyclovir for herpes simplex prophylaxis, and surveillance CMV antigenemia testing for all patients with preemptive use of ganciclovir in the event of a positive antigenemia test. All patients received filgrastim G-CSF, Neupogen, Amgen, Thousand and idarubicin
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