Death Index Research Articles

Association of Depression and Stress in Acute Myocardial Infarction: a case-control study

<p><strong>Background: </strong>Psychosocial factors have been reported to be independently associated with coronary artery disease (CAD). However, the stress variable is still sub detailed and there are few studies that used coronary angiography (CA) to assess CAD.</p><p><strong>Objectives: </strong>To compare levels of depression, stress and stressful life events in three groups of individuals: post-MI (Myocardial Infarction) patients; patients presenting symptoms and no previous MI, who underwent cardiac catheterization and had non-significant obstructive CAD and individuals with no symptoms of cardiac disease or others diseases.</p><p><strong>Methods:</strong> We conducted a case-control study, with two cases groups and one control group. The study included 105 patients with recent Myocardial Infarction (MI group), 101 patients with cardiac symptoms and normal CA (CS group), and 100 patients without symptoms of disease (NS group). Multivariate logistic regression was used to assess, stress and vital events, with an Odds Ratio of 95% confidence interval (CI), controlling for age, sex, education level, income, social support group, Body Mass Index (BMI), sedentary lifestyle and family history of MI or sudden death.</p><p><strong>Results: </strong>MI patients group showed depression with an OR= 4.47(95% CI, 2:36 to 8:46, p<.001), and stress OR= 5.37(95%CI, 2.94-9.78, p <.001) whereas CS group showed depression: OR= 6.95(95%CI, 3.64-13.28, p <.001) and stress: OR = 9.18 (95%CI, 4.73-17.82, p <.001) compared to patients without symptoms. After adjusting for risk factors: age, sex, education, income, social support, obesity, sedentary lifestyle, family history of MI or sudden death, the OR showed the following variation: in the MI group, depression OR= 2.51 (95%CI, 1:05 to 5:98, p = .038), stress, OR= 8.76(95%CI, 3:48 to 22:01, p <.001), and CS group, depression OR= 3.25(95%CI, 1.40-7.55,p <01) and stress OR= 12.24 (95%, CI, 4.81-31.14, p <.001). The raised effect of variable stress after adjustment was promoted by the age, sex and physical inactivity variables, and did not affect the significance level (p <.001).</p><p><strong>Conclusions: </strong>This study has demonstrated that subjects with cardiac symptoms without overt CAD, present similar depression and/or stress levels than post-MI patients. And also, post-MI patients and CS patients have more stress and depression than controls, even when adjusted for age, sex, education level, family income, social support, obesity, sedentary lifestyle and family history of MI and / or sudden death.</p>

Childhood parental death as a risk factor for lung cancer in the Shanghai Cohort Study.

e20577 Background: Accumulating evidence indicates that adverse childhood experiences (ACEs) substantially increase the risk of negative health behaviors and outcomes later in life. Multiple studies have documented that ACEs are associated with increased rates of cigarette smoking, but just one prospective study, with only 64 cases, reported an increased risk of lung cancer. Methods: The present study explored childhood ( < 12y) parental death, one of the most profoundly stressful ACEs, as a risk factor for adult cigarette smoking and lung cancer in the Shanghai Cohort Study, a population-based prospective cohort of 18,244 men aged 45-64 years in Shanghai, China, enrolled during 1986-1989. Information on parental death, smoking history, and other lifestyle factors were collected by trained nurse interviewers at baseline. Cancer incidence among cohort participants has been identified through annual in-person interviews and linkage analyses with databases of the Shanghai Cancer Registry and death index. Aft...

A 9–year audit of obstetric patients admitted to the intensive care unit

Objective To assess etiology and risk factors of obstetric patients of admitted to the Intensive Care Unit, First Affiliated Hospital of Kunming Medical University. Methods One hundred and seventy–four cases of obstetric patients admitted to the Intensive CareUnit during pregnancy or in the postpartum period were retrospectively classified into three groups: maternal without life–threatening conditions (WLTC), maternal near–miss (MNM), and maternal death (MD), according to their outcomes. The indicators for obstetrical criteria were evaluated. Chi–square test and Yates correlated formula were used for statistical analyses. Results Among the 174 patients, 6 patients(3.4%) were deceased, 130 cases (74.7%) were maternal near–miss, and 38 cases (21.8%) were in without potentially life–threatening conditions. Main clinical manifestations of MNM were infusion of erythrocyte suspension≥5 U(26.9%,35/130), hysterectomy due to hemorrhage or infection (14.9%,19/130), pulse oximetry lower than 90% for more than one hour (14.6%, 19/130), jaundice in severe preeclampsia (10.0%, 13/130) and uncontrollable convulsions (7.7%, 10/130). Main complications of MNM were maternal hypertension (including preeclampsia, severe preeclampsia and hemodialysis, elevated liver enzymes and low platelet levels syndrome), which was 36.1%(47/130), following by obstetrical hemorrhage (28.5%, 37/130) and heart diseases (13.8%, 18/130). Maternal mortality rate was 0.224‰, incidence rate of MNM was 4.9‰, MNM/maternal death was 21.7 : 1, and the death index was 4.4%. Multiparity, previous caesarean section and jobless in life–threatening (LTC, i.e. MD+ MNM) group were higher than those in the WLTC group [16.2%(22/136) vs 0.0%(0/38), χ2=5.648; 61.0%(83/136) vs 34.2%(13/38), χ2=7.587; 85.3%(116/136) vs 55.2%(21/38), χ2=14.225; all P 7 days, caesaraen section and preterm delivery in LTC group were higher than those in WLTC group [68.4%(93/136) vs 7.8%(3/38), χ2=41.526; 19.1%(26/136) vs 0.0%(0/38), χ2=7.103; 58.1%(79/136) vs 7.9%(3/38), χ2=28.050; 70.6%(96/136) vs 42.1%(16/38), χ2=9.301; 87.5%(119/136) vs 50.0%(19/38), χ2=23.220; 63.0%(85/136) vs 39.5%(15/38), χ2=5.535; all P<0.05]. Conclusions Hypertensive disorders in pregnancy and obstetric hemorrhage are main causes for obstetric patients admitted to the ICU. Multiparity, previous caesarean section and jobless are risk factors of obstetric patients admitted to the ICU. Key words: Intensive care units; Hypertension, pregnancy–induced; Postpartum hemorrhage; Critical illness; Pregnancy outcome

Transplantation-Free Survival and Interventions at 3 Years in the Single Ventricle Reconstruction Trial

In the Single Ventricle Reconstruction (SVR) trial, 1-year transplantation-free survival was better for the Norwood procedure with right ventricle-to-pulmonary artery shunt (RVPAS) compared with a modified Blalock-Taussig shunt (MBTS). At 3 years, we compared transplantation-free survival, echocardiographic right ventricular ejection fraction, and unplanned interventions in the treatment groups. Vital status and medical history were ascertained from annual medical records, death indexes, and phone interviews. The cohort included 549 patients randomized and treated in the SVR trial. Transplantation-free survival for the RVPAS versus MBTS groups did not differ at 3 years (67% versus 61%; P=0.15) or with all available follow-up of 4.8±1.1 years (log-rank P=0.14). Pre-Fontan right ventricular ejection fraction was lower in the RVPAS group than in the MBTS group (41.7±5.1% versus 44.7±6.0%; P=0.007), and right ventricular ejection fraction deteriorated in RVPAS (P=0.004) but not MBTS (P=0.40) subjects (pre-Fontan minus 14-month mean, -3.25±8.24% versus 0.99±8.80%; P=0.009). The RVPAS versus MBTS treatment effect had nonproportional hazards (P=0.004); the hazard ratio favored the RVPAS before 5 months (hazard ratio=0.63; 95% confidence interval, 0.45-0.88) but the MBTS beyond 1 year (hazard ratio=2.22; 95% confidence interval, 1.07-4.62). By 3 years, RVPAS subjects had a higher incidence of catheter interventions (P<0.001) with an increasing HR over time (P=0.005): <5 months, 1.14 (95% confidence interval, 0.81-1.60); from 5 months to 1 year, 1.94 (95% confidence interval, 1.02-3.69); and >1 year, 2.48 (95% confidence interval, 1.28-4.80). By 3 years, the Norwood procedure with RVPAS compared with MBTS was no longer associated with superior transplantation-free survival. Moreover, RVPAS subjects had slightly worse right ventricular ejection fraction and underwent more catheter interventions with increasing hazard ratio over time. http://www.clinicaltrials.gov. Unique identifier: NCT00115934.

Effect of Maternal Mortality on Survival of Under-Five Children

With regards to children who are born shortly before their mother's death (index), the cumulative proportion of survival up to 60 months of age was significantly lower (0.39 vs. 0.81) than those born just before the last child (penultimate) of the same mother. Such a difference is mainly due to high mortality in the first six months of age. Over the period between 1974 and 2005, survival improved among the penultimate but not the index children. For index children, the cumulative proportion of survival up to 60 months of age was significantly higher (0.79 vs. 0.51) if adopted by other households by the age of 15 days compared to those who stayed in their own households. Again for index children, the cumulative proportion of survival up to 60 months of age was significantly higher (0.82 vs. 0.70) for those who stayed in their own households where a grandmother was present compared to the presence of other female household members.

Analysis of clinical features and early warning indicators of death from hand, foot and mouth disease in Shandong province

To understand the clinical features of death from hand, foot and mouth disease (HFMD) and to explore the early warning index of HFMD death. A total of 41 HFMD death cases were collected as case group in Shandong province between 2009 and 2011, and another 123 serious HFMD cases were selected as control group according to the similar gender, place of origin and hospital level, with the ratio at 1:3. We investigated the general situation, clinical treatment, past medical history, clinical symptoms and signs of the ill children, and applied the conditional logistic regression to explore early warning index of HFMD death. The rate of patients who had symptoms in nervous system, digestive system, circulatory system and respiratory system were separately 90.2% (37/41), 58.5% (24/41), 53.7% (22/41) and 90.2% (37/41) in case group; and the proportions were 44.7% (55/123), 13.8% (17/123), 10.6% (13/123) and 12.2% (15/123) respectively in control group. The difference between the two groups showed statistical significance (χ(2) = 25.881, 32.791, 34.011, 86.505, P < 0.05). In case group, 37 patients had neurogenic pulmonary edema, 26 patients got encephalitis, 15 patients had respiratory and circulatory failure, 7 patients got pulmonary hemorrhage, 4 patients had multiple organ failure, 4 patients got myocarditis and 1 patient had cerebral hernia. According to multi-factor logistic regression analysis, the early warning indicators of HFMD death included neck resistance (case group: 34.1% (14/41), control group: 4.1% (5/123); OR = 7.145, 95%CI: 1.748 - 29.204), vomiting (case group: 58.5% (24/41), control group: 13.8% (17/123); OR = 5.632, 95%CI: 1.793 - 17.685) and increase of heart rate (case group: 53.7% (22/41), control group: 10.6% (14/123), OR = 6.370, 95%CI: 1.517 - 26.743). In the process of clinical treatment and care, we should interfere the serious HFMD patients with neck resistance, vomiting and increase of heart rate, and thereby reduce the death from HFMD.

Body mass index, smoking, and risk of death between 40 and 70 years of age in a Norwegian cohort of 32,727 women and 33,475 men

Overweight-obesity and smoking are two main preventable causes of premature death. Because the relationship between smoking and body mass index (BMI) complicates the interpretation of associations between BMI and death risks, direct estimates of risks associated with joint exposures are helpful. We have studied the relationships of BMI and smoking to middle age (40-69 years) death risk-overall and by causes-in a Norwegian cohort of 32,727 women and 33,475 men who were 35-49 years old when baseline measurements and lifestyle information were collected in 1974-1988. Individuals with a history of cancer, cardiovascular disease or diabetes at baseline were excluded. Mortality follow-up was through 2009. The relationship between BMI and middle age death risk was U-shaped. Overall middle age death risks were 11% in women and 21 % in men. The combination of obesity and heavy smoking resulted in fivefold increase in middle age death risks in both women and men: For women middle age death risk ranged from 6 % among never smokers in the 22.5-24.9 BMI group to 31% (adjusted 28%) in obese (BMI > 30 kg/m(2)) heavy smokers (≥20 cigarettes/day). The corresponding figures in men were 10% and 53% (adjusted 45%). Obese never smokers and light (1-9 cigarettes/day) smokers in the 22.5-24.9 BMI groups both experienced a twofold increase in middle age risks of death. For women, cancer (56%) was the most common cause of death followed by cardiovascular disease (22%). In men, cardiovascular disease was most common (41%) followed by cancer (34%). Cardiovascular disease deaths were more strongly related to BMI than were cancer deaths.

Light, polarizing, and transmission electron microscopy:Three methods for the evaluation of sperm quality

Semen from 33 patients were evaluated by light microscopy (LM) obtaining sperm concentration, percent motility, percentage of sperm with normal morphology (PAP staining), and percentage of dead sperm (Eosin Y stained). The samples were observed by polarizing microscopy (PM), that evaluates sperm morphology and the viability by birefringence of organelles, and it provides a PM index (percentage of birefringent, viable, motile sperm) and a percentage of dead, non-birefringent sperm. Sperm were processed for transmission electron microscopy (TEM) and TEM data were elaborated with a mathematical formula able to provide a fertility index (FI, number of sperm free of structural defects) and percentages of sperm immaturity and necrosis (dead sperm). To test the reliability of these techniques, the values of normal acrosome, nucleus, midpiece, and tail and the presence of cytoplasmic residues obtained with the three methods were compared. With the exception of cytoplasmic residues (P = 0.40), significant differences in the evaluation of each organelle were observed and TEM analysis resulted as the most stringent screening. In addition, relationships among relevant sperm variables were investigated. Motility showed positive correlations with the percentage of normal tail, midpiece, and PM index (P < 0.01), but it exhibited negative correlations with indices of sperm death (non-birefringent sperm: P < 0.05; percentage of eosin Y stained sperm: P < 0.05; necrosis: P < 0.01), which were positively correlated with each other (P < 0.01). Positive correlations were found between indices expressing normal sperm morphology: FI with PM index (P < 0.01) and with the percentage of normal sperm (PAP staining) (P < 0.01), which in turn were correlated with the PM index (P < 0.001). Sperm immaturity showed positive correlations (P < 0.01) with the presence of cytoplasmic residues detected with the three methods. In conclusion, LM, PM, and TEM are reliable techniques in evaluating sperm quality. PM appears to offer several advantages ‘midway’ between LM and TEM and it should be considered in sperm analysis.

Body-Mass Index and Risk of Death in Asians

To the Editor: The study by Zheng et al. (Feb. 24 issue) 1 seeks to fill a major gap in the under - standing of the relationship between body-mass index (BMI) and mortality in Asians, who repre - sent more than 60% of the global population. The results of the study suggest that the effect of BMI on cardiovascular mortality differs between East Asian and Indian-Bangladeshi subjects. In their analysis of BMI and cancer mortality, the authors report that leanness is associated with greater risk. Although the study has controlled for the effect of smoking, tobacco chewing, a com - mon practice in the Indian population, is not con - sidered. Smokeless tobacco is associated with an increased risk of cancer, particularly oral cancer. 2

Human neuroblastoma SH-SY5Y cells show increased resistance to hyperthermic stress after differentiation, associated with elevated levels of Hsp72

Purpose: Terminally differentiated neurones in the central nervous system need to be protected from stress. We ask here whether differentiation of progenitor cells to neurones is accompanied by up-regulation of Hsp72, with acquisition of enhanced thermotolerance.Materials and methods: Human neuroblastoma SH-SY5Y cells were propagated in an undifferentiated form and subsequently differentiated into neurone-like cells. Thermotolerance tests were carried out by exposure of cells to various temperatures, monitoring nuclear morphology as index of cell death. Abundance of Hsp72 was measured in cell lysates by western immunoblotting.Results: The differentiation of SH-SY5Y cells was accompanied by increased expression of Hsp72. Further, in both cell states, exposure to mild hyperthermic stress (43°C for 30 min) increased Hsp72 expression. After differentiation, SH-SY5Y cells were more resistant to hyperthermic stress compared to their undifferentiated state, correlating with levels of Hsp72. Stable exogenous expression of Hsp72 in SH-SY5Y cells (transfected line 5YHSP72.1, containing mildly elevated levels of Hsp72), led to enhanced resistance to hyperthermic stress. Hsp72 was found to be inducible in undifferentiated 5YHSP72.1 cells; such heat-treated cells displayed enhanced thermotolerance. Treatment of cells with KNK437, a suppressor of Hsp72 induction, resulted in acute thermosensitisation of all cell types tested here.Conclusions: Hsp72 has a major role in the enhanced hyperthermic resistance acquired during neuronal differentiation of SH-SY5Y cells. These findings model the requirement in intact organisms for highly differentiated neurones to be specially protected against thermal stress.

Abstract 3049: Clinical Outcomes after Urgent Coronary Artery Bypass Surgery in Patients on Clopidogrel: Are the Risks Tangible or Anecdotal?

PURPOSE : Clopidogrel is indicated in acute and chronic coronary syndromes and often administered prior to angiography. These patients are often sent subsequently for coronary artery bypass grafting (CABG) surgery, where potential increase in bleeding risk must be balanced with risk of ongoing ischemia if CABG delayed. This study aimed to test the hypothesis that patients undergoing urgent CABG who received clopidogrel, versus those who did not, have worse bleeding outcomes and early mortality. METHODS : We reviewed 451 consecutive patients (04/2005–12/2006) who underwent urgent CABG at our institution: 262 never received clopidogrel pre-CABG, 189 received clopidogrel &lt;5 days prior. The latter all received intraoperative antifibrinolytics. The primary endpoint was in-hospital death, massive transfusion (&gt;10U PRBC) or massive blood loss (&gt;2L chest-tube loss/24 hrs). RESULTS : Patient characteristics were comparable between groups. Prior MI (71% vs 46%), NYHA class 3– 4 (94% vs 81%) and prior PCI (22% vs 13%) were higher in the clopidogrel group (p&lt;0.05). Cross-clamp time was statistically higher in the clopidogrel group (97±30 vs 90±28 min, p=0.02); cardiopulmonary bypass and total operative times were similar. There was no difference in the primary endpoint of in-hospital death or massive bleeding indices (clopidogrel: 7% vs no clopidogrel: 6%, p=0.9). Death, bleeding indices, renal failure, post-op MI and stroke, were no different even after adjusting for the date of stopping clopidogrel pre-CABG. Chart audit showed bleeding as a significant contributor to cause of deaths, was no different in either cohort. After multivariable regression analysis, clopidogrel or the duration it was stopped pre-CABG, were not predictors of outcomes (death, MI, stroke or chest reopening for bleeding). Significant independent predictors of the primary endpoint included pre-op renal dysfunction, peripheral vascular disease and pre-op hemoglobin. CONCLUSION : Clopidogrel, or the time it was stopped prior to CABG, was not a risk factor for in-hospital death, massive bleeding, or other poor early outcomes in patients undergoing urgent CABG. Practice measures such as the use of antifibrinolytic agents may ameliorate the adverse effects of clopidogrel.

Clinical cosmobiology: distribution of deaths during 180 months and cosmophysical activity. The Lithuanian study, 1990–2004 The role of cosmic rays

The aim of this study is a next step of our previous, initial, publications--to explore the links between monthly death number (total, and for the major death causes and each gender) with levels of monthly cosmophysical activity in a long-term, big cohort observation. Death number during 180 consecutive months from the National Registry of Lithuania for years 1990-2004 were studied. A total of 630,205 deaths were analyzed (333,035 males). For comparison, monthly indices of solar activity, geomagnetic activity, and cosmic ray activity and year and month (1-12) of the study were used. The cosmophysical data were obtained from space research centers in the USA, Russia, and Finland. Statistics. Pearson correlation coefficients (r) and their probabilities (P) between compared parameters were calculated. A multivariate model of prediction was designed. It was a significant correlation between total monthly death number and indices of cosmic ray activity and, inverse, of solar activity; in men stronger than in women. Monthly geomagnetic activity was significantly correlated with traffic accidents, ischemic heart disease/stroke ratio, suicide victim number. Deaths from stroke, noncardiovascular causes, suicide, traffic accidents were related with cosmic ray activity and, inverse, with solar activity. Relationship of ischemic heart disease/stroke ratio to year of observation showed additional evidence for the growing role of stroke in cardiovascular mortality. Monthly death number is linked to cosmic ray activity, and inverse, to solar activity. Central place of stroke-related deaths in cardiovascular mortality is emerging. Geomagnetic activity, in monthly account, plays a relatively minor role. We presume that forces antagonistic to cosmic ray activity, like solar activity and geomagnetic activity, can prevent some negative biologic effects of cosmic ray.

Age‐related histopathological lesions in the Mongolian gerbil ventral prostate as a good model for studies of spontaneous hormone‐related disorders

The Meriones unguiculatus (Mongolian) gerbil has demonstrated significant prostatic responses to hormonal treatments, and to drugs against human prostatic hyperplasia. Spontaneous neoplasia develops in the older animals. Thirty gerbils (age 18 months) were divided into non-affected and prostatic lesion bearers and the prostate lesions were evaluated morphologically, immunohistochemically and quantitatively. The most frequent changes were in epithelial sites and, namely prostatic intraepithelial neoplasias, microinvasive carcinomas and adenocarcinomas. In the stromal compartment, cellular hyperplasia, when verified, was always associated with the sites of anomalous epithelium. Additionally, larger deposition of collagen fibrils, generating stromal fibrosis, was found in all the old gerbils analysed. The quantitative analysis showed that prostatic tissue proportions differed in altered areas, being specific for each lesion type. Isolated nuclear and nucleolar parameters were not effective in diagnosing the malign potential of lesions. However, the cellular proliferation and death indexes indicated larger cellular turnover in invasive lesions such as carcinomas. With these analyses, it could be verified that old gerbils present high propensity to develop spontaneous prostate changes and this may aid in a better understanding of the biological behaviour of human prostate cancer.

Correlation of magnetic resonance spectroscopic and growth characteristics within Grades II and III gliomas

The accurate diagnosis of World Health Organization Grades II and III gliomas is crucial for the effective treatment of patients with such lesions. Increased cell density and mitotic activity are histological features that distinguish Grade III from Grade II gliomas. Because increased cellular proliferation and density both contribute to the in vivo magnetic resonance (MR) spectroscopic peak corresponding to choline-containing compounds (Cho), the authors hypothesized that multivoxel MR spectroscopy might help identify the tumor regions with the most aggressive growth characteristics, which would be optimal locations for biopsy. They investigated the ability to use one or more MR spectroscopic parameters to predict the MIB-1 cell proliferation index (PI), the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling cell death index (DI), the cell density, and the ratio of proliferation to cell death (PI/DI) within different regions of the same tumor. Patients with presumed Grades II or III glioma underwent 3D MR spectroscopic imaging prior to surgery, and two or three regions within the tumor were targeted for biopsy retrieval based on their spectroscopic features. Biopsy specimens were extracted from the tumor during image-guided resection, and the PI, DI, and cell density were assessed in the specimens using immunohistochemical methods. The authors found that the relative levels of Cho and N-acetylaspartate (NAA) correlated with the cell density, PI, and PI/DI ratio within different regions of the same tumor and that the association held for the subpopulation of nonenhancing tumors. The association was stronger in tumors with large ranges of Cho/NAA values, irrespective of the presence of contrast enhancement. The findings demonstrate the validity of using MR spectroscopy to identify regions of aggressive growth in presumed Grade II or III gliomas that would be suitable targets for retrieving diagnostic biopsy specimens.

Dynamic change of apoptosis of alveolar cells in ischemia-reperfusion induced pulmonary injury: an experimental study with rats

To observe the dynamic changes of alveolar apoptosis in ischemia-reperfusion (IR) induced pulmonary injury, and to evaluate the roles of these two cell death styles, apoptosis and necrosis, in the progress of lung function deterioration in pulmonary IR injury. Fifty-four Sprague-Dawley rats were made ischemia/reperfusion models by ischemia and reperfusion in situ in single lung. Thirty-six of the 54 rats in the experimental group were re-divided into 6 equal subgroups to undergo detection of partial pressure of oxygen (PaO2) of blood in left atrium, detection of lung tissue wet weight/dry weight ratio, histology of lung by light microscope, examination of ultrastructural changes of cells by transmission electron microscopy, and quantitative detection of apoptotic cells in the right middle lobe by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) 0 h, 0.5 h, 1 h, 2 h, 6 h, and 12 h respectively after the reperfusion (subgroups R0, R(0.5), R1, R2, R6, and R12). Another 18 rats in the experimental group were re-divided into 3 subgroups of 6 rats to undergo insertion of venous catheter into the main pulmonary artery via right ventricle to perfuse trypan blue so as to evaluate the cell death degree. The death index was observed under light microscope and the necrosis index was indirectly calculated by the equation: death index = apoptotic index + necrosis index. Thirty-six rats underwent sham operation. Twelve rats were used as preoperative blank controls. Proliferation of alveolar type II, but not alveolar type I cell, accompanied by ultrastructural morphological changes were seen 1 h, 2 h, and 6 h after reperfusion, the most prominently 2 h after reperfusion. Apoptotic index was elevated since 1 h after reperfusion, and peaked 2 h after reperfusion. Statistical analysis indicated that, compared with apoptotic index, the necrotic index was of more prominent correlation with blood oxygen partial pressure and wet/dry weight ratio. Alveolar apoptosis occurs in the early stage of reperfusion, and becomes the most prominent 2 h after reperfusion. Most apoptotic cells are alveolar type II cells. In the two styles of cell death in pulmonary IR injury, alveolar necrosis is more prominently correlated with progress of lung function deterioration.

Multiple Meanings of Minority Concentration: Incorporating Contextual Explanations into the Analysis of Individual-Level U.S. Black Mortality Outcomes

Prior research on mortality for U.S. blacks focuses on the detrimental effects of minority concentration and residential segregation in metropolitan areas on health outcomes. To date, few studies have examined this relationship outside of large U.S. central cities. In this paper, we extend current research on the minority concentration and mortality relationship to explain the rural advantage in mortality for nonmetropolitan blacks. Using data from the 1986–1994 linked National Health Interview Survey/National Death Index, we examine the rural-urban gap in mortality for U.S. blacks. Our findings indicate that blacks in nonmetropolitan areas experience a lower risk of mortality than metropolitan central city blacks after indicators of socio-economic and health status are controlled. Our findings also point to the importance of accounting for contextual factors. Net of individual level controls, minority concentration exerts differential effects across metropolitan and nonmetropolitan areas, such that nonmetropolitan black residents experience a lower risk of mortality in high minority concentration areas than blacks in metropolitan central city areas. This finding suggests a reconceptualization of the meaning for minority concentration with respect to studies of health outcomes in nonmetropolitan communities.

The Reformation of the Dead. Death and Ritual in Early Modern Germany, 1450-1700

List of Illustrations List of Abbreviations Acknowledgements Death, Ritual and the Reformation PART ONE: SEPARATING THE LIVING FROM THE DEAD Souls: The Death of Purgatory and the Reformation Bodies: Placing the Dead in the German Reformation PART TWO: THE LUTHERAN FUNERAL RITUAL TO 1700 The Formation of the Lutheran Funeral Ritual Honor and Violence: Funerals in the Confessional Age From Disgrace to Distinction: Nocturnal Burial in Seventeenth Century Germany Death, Ritual and History Index

Enhancement of cisplatin cytotoxicity by terbium in cisplatin-resistant MDA/CH human breast cancer cells.

The development of cisplatin resistance is a major problem in the treatment of cancer patients with cisplatin chemotherapy. The membrane binding of terbium (Tb3+) has been shown to increase the cellular accumulation of cisplatin in breast cancer cells. Therefore, the ability of Tb3- to modulate the cytotoxicity of cisplatin was investigated in cisplatin-sensitive (MDA) and cisplatin-resistant (MDA/CH) MDA-MB-231 human breast cancer cells. The cytotoxic parameters of cisplatin were determined using live cell microfluorometry and median effect analysis. MDA/CH cells (IC50 = 142 +/- 9 microM) were found to be approximately 3.3-fold more resistant to cisplatin than MDA cells (IC50 = 43.5 +/- 3.0 microM). In both cell lines, the IC50 value for cisplatin was reduced two-fold in the presence of 80 microM Tb3+, thus indicating that the cytotoxicity of cisplatin is increased by Tb3+. The cytotoxic activity of cisplatin alone was observed to be 5.7 and 1.6 times more potent than that of Tb3+ alone in MDA and MDA/CH cells, respectively. Combination index analyses revealed that the interaction between cisplatin and Tb3+ was only synergistic at very low indices of cell death in MDA cells. However, in MDA/CH cells, the two drugs were synergistic up to intermediate levels of cell death. Our results suggest that the enhancement of cisplatin cytotoxicity by Tb3- is more effective in cisplatin-resistant MDA/CH cells than in cisplatin-sensitive MDA cells. Therefore, terbium is potentially useful in cisplatin combination therapy for breast cancer patients, especially for those patients who have developed resistance to the drug.

Different patterns of cell proliferation and death and oncogene expression in cutaneous malignant melanoma.

Ninety-six cutaneous melanomas (CMs) were investigated aiming at finding differences, if any, among the main four clinicopathological types, for Bcl-2, c-myc and p53 protein expression, and for tumor cell proliferation and death indices. Proliferation was assessed by calculating the mitotic index (MI, number of mitoses) and the MIB1 labelling index (M-LI, number of MIB1+ nuclei), and tumor cell death by calculating the apoptotic index (AI, number of apoptoses) among 1000 tumor cells. CMs were subdivided into thin (<1 mm) and intermediate thickness (1-4 mm) tumors. Bcl-2 expression did not significantly change among different types. c-myc Expression decreased especially in thicker superficial spreading (SSM) and lentigo maligna melanoma (LMM) types. p53 Expression was higher in nodular melanoma (NM) and in acral lentiginous melanoma(ALM), which also showed the highest degrees of proliferation. AI was significantly higher in thin rather than in intermediate thickness SSMs, LMMs and ALMs (8.4 vs. 2; 6.1 vs. 2.3, and 5.8 vs. 3.6, respectively). AI was low in thin (1.7) and intermediate thickness (1.9) NMs, which also showed high MI (3.9 and 4.5, respectively), and M-LI (16.7 and 2.9, respectively). Thin and intermediate thickness ALMs also showed high MI and M-LI (4.1 vs. 5.2 and 11.3 vs. 14.6, respectively). Bcl-2 is among genes which inhibit apoptotic death, whereas c-myc and p-53 genes promote this process. In CMs, no relation was found between Bcl-2 expression, MI, PI, and AI. All SSMs, LMMs, and ALMs with a high AI showed a high c-myc expression and were negative for p53. c-myc, Although highly expressed, did not promote a significant apoptotic death in NM type. Bc12, c-myc, and p53 were not equally expressed nor equally related to tumor cell turnover in all CMs, suggesting their different influence on the various types and stages, and the role of other factors in CM growth control.

Evidence for retarded kidney growth in sudden infant death syndrome.

The aim of the study was to compare the growth rate of the kidneys of infants who died of sudden infant death syndrome (SIDS) and control babies under 1 year; 227 infants who died in St. Petersburg from 1983 to 1990 and who met the criteria for SIDS were included in the study; 138 infants who died suddenly of respiratory infections within the same period constituted a control group. The infants did not have signs of dehydration, malformations, tumours or intrauterine infections. Morphologically the kidneys were intact. Factors which might influence the weight of the kidneys at the time of death were: the cause of death (whether SIDS or not), gender, gestational age, weight, length and ponderal index at birth, age, weight and length at death. Stepwise (forward) linear regression analysis identified three variables which in combination most accurately and independently influenced the predicted weight of the kidneys. These were the cause of death, gender and weight at the time of death. The weight of the kidneys increased by 6.0 g for each increase in total body weight of 1,000 g [95% confidence interval (CI) 5.0-7.0 g], in boys the kidney weight was 3.3 g (95% CI 1.6-5.0 g) higher than in girls and in the SIDS babies kidney weight was 2.5 g (95% CI 0.8-4.2 g) less than controls. Delayed kidney growth may be an indicator of increased risk of SIDS in infants under 1 year and may contribute in some cases.