Representation of the Black Elderly in Detroit Metropolitan Nursing Homes

This paper presents the results of an analysis of the distribution of black elderly patients in the long-term care systems of Detroit City, Wayne, and Oakland counties, Michigan. These areas were chosen because of their proximity to Wayne State University and because Detroit has a large black population. Wayne and Oakland counties are largely suburban areas. Black, long-term care utilization was compared with the black elderly representation of the base population in these three locations. The sex-specific distribution between whites and blacks in long-term care populations revealed that black men utilized the greatest amount of long-term care and were more dependent on Medicaid. One hundred twenty-one licensed nursing homes were contacted by telephone and a follow-up questionnaire was sent to the respondents during the five-month study périod.     

Lyme borreliosis in Portugal caused by Borrelia lusitaniae?

BACKGROUND: Borrelia lusitaniae was isolated from an Ixodes ricinus tick in Portugal in 1993 for the first time. Further, this borrelia genospecies has been found in ixodid ticks collected around the coasts of southern Portugal and North Africa. Its reservoir has not been defined yet. B. lusitaniae was isolated once until now from a patient with a long standing and expanding skin disorder. PATIENT AND METHODS: A 46-year-old Portuguese woman presented with a skin lesion on the left thigh which had evolved slowly over ten years. The patient reported limb paraesthesias, cramps, chronic headaches, and cardiac rhythm disturbances. History of tick bites was negative nor had the patient ever noticed a skin lesion comparable with erythema chronicum migrans. Skin biopsies were taken for histological evaluation, culture and DNA detection. Antibodies to borrelia were searched by indirect immunofluorescence assay and Western-blot. RESULTS: A bilateral carpal tunnel syndrome and local synovitis was diagnosed. Dermato-histology was normal, serology was negative. Spirochaetal organisms were cultured from a skin biopsy and identified as B. lusitaniae. The patient improved after a 2-week course of intravenous ceftriaxone; the skin lesions did not expand further. CONCLUSIONS: This culture confirmed skin infection by B. lusitaniae in a patient from Portugal suggests an additional human pathogen out of the B. burgdorferi sensu lato complex in Europe, particularly in Portugal.     

Activation of blood coagulation in patients undergoing postoperative blood salvage and re-infusion of unwashed whole blood after total knee arthroplasty

BACKGROUND: Perioperative blood salvage is commonly used in cardiovascular surgery and has been more recently introduced in major orthopedic surgery. Limited information is available on the influence of re-infused whole blood on the hemostatic system in orthopedic patients. MATERIALS AND METHODS: The aim of this study was to assess whether perioperative salvage and re-infusion of unwashed whole blood is associated with an activation of blood coagulation in patients undergoing total knee replacement. Consecutive patients receiving re-infusion were included in the study (n=13). Patients undergoing total knee replacement without perioperative blood salvage and re-infusion served as controls (n=6). In patients receiving re-infusion thrombin-antithrombin complexes (TAT), plasmin-antiplasmin complexes (PAP) and fibrinogen were assayed at the following times: before surgery (baseline), immediately before re-infusion (T0), immediately (T1), 2 h (T2) and 24 h (T3) after the end of re-infusion. In control patients blood samples were drawn at the average times corresponding to each of the sampling time in the patients receiving re-infusion. The first post-surgery LMWH dose was given within 12 h after surgery. RESULTS: TAT and PAP increased after surgery both in patients receiving re-infusion and controls. An increase of TAT and PAP was observed immediately after re-infusion with respect to baseline (TAT 513.1 +/- 259.1 microg/l vs. 5.3 +/- 4.9, p<0.0001; PAP 7408.0 +/- 1892.1 microg/l vs. 461.4 +/- 217.1, p<0.0001) and to controls (TAT 60.4 +/- 26.9 microg/l, p=0.002; PAP 2208.3 +/- 1446.4 microg/l, p<0.001). The levels of TAT and PAP in patients receiving re-infusion remained high at 2 h after re-infusion compared to those of the controls (TAT 124.1 +/- 38.3 microg/l vs. 38.08 +/- 18.9, p=0.016; PAP 5690.7 +/- 1435.5 microg/l vs. 1613.9 +/- 706.0, p<0.001) and decreased 24 h thereafter. Fibrinogen level was lower in patients receiving re-infusion compared to controls. CONCLUSIONS: Whole blood re-infusion is associated with an activation of blood coagulation in patients undergoing total knee replacement. The clinical relevance of this activation has to be tested in prospective studies with adequate sample size.     

Transfection of MS-36 melanoma cells with gef gene inhibits proliferation and induces modulation of the cell cycle

The gef gene, found in Escherichia coli DNA, encodes a small (50 amino acids) protein which is related to cell-killing functions. We used the MS-36 melanoma cell line as an experimental model to examine the usefulness of the gef gene as a new strategy for cancer therapy. We transfected MS-36 cells using the pMAMneo vector, and induced gef gene expression with dexamethasone. This decreased the proliferation rate of MS-36TG by as much as 85% in comparison with MS-36 parental cells. The decrease in cell growth was accompanied with significant modifications of the cell cycle and morphology. The G1-phase gradually disappeared, with accumulation in the S-phase. However, studies with annexin V-FITC and 7-aminoactinomycin D failed to demonstrate induction of apoptosis. Morphological changes were an increase in cell size and the number of filopodia, and especially the appearance of pore-like alterations in the cell membrane which were not seen in parental cells. Our results demonstrate that the gef gene, a system independent of the administration of a prodrug, significantly reduces the proliferation of MS-36 cells. This gene may therefore be considered a new candidate for cancer gene therapy.     

An Internet-based exercise as a component of an overall training program addressing medical aspects of radiation emergency management

The use of ionizing radiation and radioactive materials continues to increase worldwide in industry, medicine, agriculture, research, electrical power generation, and nuclear weaponry. The risk of terrorism using weapons of mass destruction or simple radiological devices also has increased, leading to heightened concerns. Radiation accidents occur as a consequence of errors in transportation of radionuclides, use of radiation in medical diagnosis and therapy, industrial monitoring and sterilization procedures, and rarely, nuclear power generation. Compared to other industries, a small number of serious radiation accidents have occurred over the last six decades with recent cases in the Republic of Georgia, Peru, Japan, and Thailand. The medical, psychological, and political consequences of such accidents can be considerable. A number of programs designed to train medical responders in the techniques of radiation accident management have been developed and delivered in many countries. The low frequency of serious radiation accidents requires constant re-training, as skills are lost and medical staff turnover occurs. Not all of the training involves drills or exercises in which responders demonstrate learning or communication over the broad spectrum of medical response capabilities. Medical preparedness within the context of a total emergency response program is lacking in many parts of the world, particularly in Central and Eastern Europe and the Newly Independent States. This paper describes an effort to enhance medical preparedness in the context of a total program of international cooperation and conventions facilitated by the International Atomic Energy Agency. The paper concludes that novel application of telecommunications technology as part of a training activity in radiation accident preparedness can help address gaps in training in this field in which preparedness is essential but experience and practical field exercises are lacking.     

Cartilaginous melanoma: case report and review of the literature

Malignant melanoma can present a variety of histopathological patterns. Cartilaginous change in the absence of osteogenic differentiation is extremely rare in malignant melanoma, being among the least frequent of the wide range of melanoma histologic patterns. We report a case of a 47-year-old woman with a subungual nodule on her right great toe for many years. Histopathological examination of the lesion led to a diagnosis of malignant melanoma with cartilaginous differentiation devoid of concomitant osseous areas. It would appear that this unusual form of melanoma has a predilection for acral location, particularly the subungual region. Malignant melanoma with chondroid stroma should therefore be considered in the differential diagnosis of cartilaginous lesions of the toes and fingers. Careful examination of the overlying epidermis and identification of an in situ component of melanoma may be necessary in order to establish the correct diagnosis.     

Progression of experimental lesions of atherosclerosis: Assessment by kinetic modeling of black‐blood dynamic contrast‐enhanced MRI

Pharmacokinetic modeling of dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) is used to noninvasively characterize neovasculature and inflammation in atherosclerotic vessels by estimating perfusion characteristics, such as fractional plasma volume v_p and transfer constant K^trans. DCE‐MRI has potential to study the evolution of nascent lesions involving early pathological changes. However, currently used bright‐blood DCE‐MRI approaches are difficult to apply to small lesions because of the difficulty in separating the signal in the thin vessel wall from the adjacent lumen. By suppressing the lumen signal, black‐blood DCE‐MRI techniques potentially provide a better tool for early atherosclerotic lesion assessment. However, whether black‐blood DCE‐MRI can detect temporal changes in physiological kinetic parameters has not been investigated for atherosclerosis. This study of balloon‐injured New Zealand White rabbits used a reference‐region‐based pharmacokinetic model of black‐blood DCE‐MRI to evaluate temporal changes in early experimental atherosclerotic lesions of the abdominal aorta. Six rabbits were imaged at 3 and 6 months after injury. K^trans was found to increase from 0.10 ± 0.03 min^?1 to 0.14 ± 0.05 min^?1 (P = 0.01). In histological analysis of all twelve rabbits, K^trans showed a significant correlation with macrophage content (R = 0.70, P =0.01). These results suggest black‐blood DCE‐MRI and a reference‐region kinetic model could be used to study plaque development and therapeutic response in vivo. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.