Cognitive rehabilitation in the elderly: overview and future directions.

This study provides an overview of the papers emanating from the experimental trial that evaluated a new cognitive rehabilitation program in older adults who were experiencing normal cognitive decline. The main features of the design are summarized, along with evidence that the training produced long-lasting improvement in memory performance, goal management, and psychosocial status. The benefits were attributed to several factors, including the program's emphasis on techniques that promoted efficient strategic processing. Limitations of the program and directions for future research are discussed.     

Regulation of eicosanoid synthesis by whole fetal rat brainex vivo

Intact cerebral hemispheres from 20-d-old rat fetuses incubated at 37°C in Dulbecco’s Modified Eagle Medium (DMEM) synthesize and release a number of arachidonic acid derived metabolites, such as thromboxane B₂ (TxB₂), 6-keto prostaglandin F1α (6k-PGF1α), and prostaglandin E₂ (PGE₂) eicosanoids. Synthesis is time-dependent and is stimulated upon addition of the calcium ionophore A23187(10 μM). Ionophore stimulation is prevented by EDTA/EGTA (5 mM each) ion chelators, dextran-70 (5%), and indomethacin (10 μM), a potent cyclooxygenase inhibitor. Ca²⁺ (2 mM) enhances ionophoremediated formation of TxB₂, 6K-PGF1α, and PGE₂ by 2.5-, 2.9-, and 4.2-fold, respectively; Mg²⁺ blocks ionophore stimulation. Freezing and thawing enhances release of eicosanoids to a level nearly the same as that obtained in the presence of A23187, indicating a common mode of action.     

Phase II trial of fazarabine (arabinofuranosyl-5-azacytidine) in patients with advanced pancreatic adenocarcinoma

We conducted a phase II evaluation of fazarabine 1.75–2.0 mg/m²hr over 72 hours every 28 days in 14 previously untreated patients with advanced adenocarcinoma of the pancreas. The intial dose was 1.75 mg/m²/hr in 10 patients, and 2.0 mg/m²hr in 4 patients. The dose was escalated in 8 patients, including all 4 who started at the higher dose level. Toxicity was unexpectedly mild. The median WBC nadir was 4.4 (range: 2.4–15.8)×10³/l, the median absolute neutrophil nadir was 3.2 (range: 0.9–13.0)×10³/l, and the median platelet count was 134.0 (range: 48.0–291.0)×10³/l. Gastrointestinal toxicity was generally mild. No major responses were seen, excluding, with 95% confidence, a response rate in excess of 20%.     

Phase II trial of edatrexate in patients with advanced pancreatic adenocarcinoma

We conducted a phase II evaluation of edatrexate in 17 previously untreated patients with advanced adenocarcinoma of the pancreas; 14 patients had at least one month of therapy. The initial dose was 80 mg/m²iv. Treatment was administered weekly for 5 weeks, then every other week. Toxicity was generally mild. The median WBC nadir was 5.4 (range 0.6–7.4)×10³/l, and the median platelet nadir was 164.0 (range 62.0–341.0)×10³/l. One patient died with sepsis and gastrointestinal bleeding associated with pancytopenia. Five patients had a mild rash. Nausea occurred in 6 patients, including 3 who had vomiting. In addition, 11 patients complained of vague malaise which seemed to begin within 24–48 hours after administration of edatrexate, and lasted for 2 to 3 days, resolving within 6 days of drug administration. Median survival was 85 days. Although 5 patients had stable disease, including one with relief of pain, no major responses were seen, excluding, with 95% confidence, a response rate in excess of 20%.     

Phase II trial of VP16-213 in non-small cell lung cancer (NSCLC)

Summary Fifty-one patients with non-small cell lung cancer (NSCLC) were treated, during a phase II trial, with 4 demethylepipodophyllotoxin--d-ethylidene glucoside (VP16-213). Forty-nine were evaluable for response, and of these two (4%) had partial responses lasting 5 and 6 months. Prior treatment with chemotherapy may have adversely affected response rate; none of the 24 previously treated patients had a major response. Myelosuppression was the dose limiting toxicity. Anorexia, nausea and vomiting, partial alopecia, and chills plus hypotension during drug infusion were the other toxic effects. We conclude that VP16-213 has only minimal activity as a single agent in NSCLC.Supported in part by NIH Grant No. CA-05826 and CA-09027, and by NCI Contract NO-1-CM 972744Demethylepipodophyllotoxin--d-Ethylidene Glucoside (NSC141540) was supplied by the Drug Evaluation Branch of the National Cancer Institute     

Percutaneous left atrial to femoral arterial bypass pumping for circulatory support in high-risk coronary angioplasty

Left atrial to femoral arterial bypass was evaluated as a means of supporting patients who were considered to be at high risk for the performance of percutaneous transluminal coronary angioplasty. A 20 French drainage catheter was inserted percutaneously into the left atrium via a modified transseptal technique. Blood was withdrawn from the left atrium and returned through a femoral arterial cannula using a roller pump. Thirteen patients were treated in this fashion with excellent circulatory support. Pump flows varied from 1.5 to 3 liters per minute and bypass time ranged from 27 to 106 min (mean 43±17). Aortic mean pressure was well supported during balloon inflation. No significant complications were encountered. Neither an oxygenator nor a perfusionist is required. The ability to obtain direct left ventricular decompression offers a major potential advantage. Further evaluation of this technique for the support of such patients is indicated. © 1993 Wiley-Liss, Inc.     

Thrombophilic polymorphisms in Israel

Three thrombophilic polymorphisms, FV G1691A, FII G20210A and MTHFR C677T were investigated in Israeli populations by FRET, (fluorescence resonance energy transfer) real-time PCR. We observe extensive variability in the frequencies of each of the polymorphisms, as has been observed in the study of other polymorphisms in these populations. Very high allele frequencies for FV G1691A (the highest 0.087 in Turkish and Greek Jews) and FII G20210A (the highest 0.061 in Georgian Jews) in some of the Israeli populations justify a clinical investigation to assess their risk for venous thrombosis. Principal Coordinates Analysis demonstrates that the Jewish populations are interspersed among the non-Jewish populations. The resemblance of some Jewish populations to certain non-Jewish populations coincides with findings based on classical markers.     

Comparison of maximal midexpiratory flow rate and forced expiratory flow at 50% of vital capacity in children

BACKGROUND: The mid-portion of the maximal expiratory flow-volume (MEFV) curve is often described by values of the mean forced expired flow as lung volume decreases from 75% to 25% of vital capacity (ie, forced expiratory flow, midexpiratory phase [FEF(25-75)]). It is common practice to report also forced expired flow at 50% of vital capacity (FEF(50)). STUDY OBJECTIVE: To investigate whether FEF(50) and FEF(25-75) are highly correlated or whether the difference between them reflects a degree of airways obstruction. Also, we wanted to investigate the correlation between the two in cases of irregularly shaped MEFV curves (ie, "saw-toothing"). DESIGN: Analysis of the correlation between FEF(50) and FEF(25-75) in a single determination. We assessed the relationship between the FEF(50)/FEF(25-75) ratio and the degree of airways obstruction, as reflected by other traditional parameters such as FEV(1), FEV(1)/FVC ratio, and specific airway conductance (SGaw). PATIENTS: There were 1,350 forced expiratory maneuvers performed by children with a broad range of pulmonary abnormalities. RESULTS: FEF(50) correlated with FEF(25-75) as follows: FEF(50) (L/s) = 0.041 + 1.136*FEF(25-75)(L/s); r(2) = 0.956; standard error of the estimate = 0.013; p < 0.0001. The FEF(50)/FEF(25-75) ratio remained stable and did not correlate with FEV(1) (r = 0.12), FEV(1)/FVC ratio (r = 0.11), or SGaw (r = 0.02; difference not significant). The correlation between FEF(25-75) and FEF(50) was similar for both the smooth curve (r = 0.97) and the irregular curve (r = 0.96). CONCLUSIONS: Although not identical, FEF(25-75) and FEF(50) are highly correlated, and the ratio of the two is fairly constant. Therefore, the practice of reporting both of them is unnecessary. We suggest that it is reasonable to prefer FEF(50).