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David Shapiro

Publications and source records attributed to David Shapiro.

12 recordsLinked to original sources
PubMed2003

A 5-year follow-up of ambulatory blood pressure in healthy older adults.

BACKGROUND: This study assessed 5-year changes in ambulatory blood pressure (ABP) in healthy, older individuals and determined the extent to which it could be predicted from earlier BP measures and other cardiovascular risk factors. METHODS: A total of 162 men and women, aged 55 to 79 years, with no prior medical disorders, completed a medical examination and two 24-h ABP sessions. The procedures were repeated 5 years later in 80% (130) of these subjects. A modified hierarchical regression analysis was used to determine whether initial ABP and casual blood pressure (CBP) measures and demographic and physical examination data could predict ABP in 5 years. RESULTS: The CBP and most ABP levels during waking and sleep increased after 5 years. However, CBP remained in the normotensive range for 73% of the subjects. The ABP variability tended to decrease over time. The ABP and CBP measures accounted for at least 50% of the variance in the prediction of ABP level after 5 years. In comparison, the predictability of ABP variability was quite low, particularly during sleep (<30% of the variance accounted for). CONCLUSIONS: The ABP and CBP were good predictors of future ABP level in healthy older subjects, but ABP variability was more difficult to predict. Except for age, none of the standard cardiovascular risk factors contributed significantly to the prediction of ABP level or variability.

Aged↗
PubMed2003

Who should be doing laparoscopic bariatric surgery?

BACKGROUND: The training and credentialing of surgeons for laparoscopic bariatric surgery is controversial. We sought to determine if there is an association between surgeons' practice and choice of open or laparoscopic bariatric surgery. METHODS: Members of the ASBS were surveyed via email. Associations were tested with Cochran-Mantel-Haenszel or Pearson's chi-square. RESULTS: 104/472 members responded; 65% were in private practice; 47% did 1-5 operations/week, 48% offered open procedures only, and 76% undertook gastric bypass. Respondents believe that laparoscopic procedures: should mimic open ones (77%), are safe (63%), should be evaluated by clinical trials (48%), and that expertise in bariatric surgery is more important than laparoscopic experience. 75% believe that courses and preceptorships are important. Regarding laparoscopic operations, surgeons doing only open procedures believe that: 1) the ASBS should be the main credentialing body; 2) surgeons should do > 25 open before laparoscopic ones; and 3) clinical trials are needed (P < 0.02, all). Surgeons with laparoscopic training or practices believe that laparoscopic surgery is safe and effective (P < 0.002). Both laparoscopic and open surgeons believe bariatric surgeons should be the only surgeons doing laparoscopic bariatric procedures (P < 0.008). CONCLUSIONS: There is consensus that laparoscopic bariatric surgery should be undertaken only by surgeons with strong interest in bariatric surgery. Laparoscopic bariatric surgeons should incorporate lessons learned from open surgery. Both laparoscopic and open bariatric surgeons should seek added expertise via courses and preceptorships. The skepticism of surgeons with 'open' practices could be addressed by clinical trials. The ASBS should maintain its leadership position and foster emerging technologies.

Clinical Competence↗
PubMed2002

Ambulatory blood pressure and brain atrophy in the healthy elderly.

BACKGROUND: Brain lesions and atrophy increase with age and hypertension. OBJECTIVE: To evaluate the relationship of age and ambulatory blood pressure (BP) to brain atrophy in healthy elderly individuals. METHODS: MRI volume measurements (normalized to intracranial volume) were taken of total brain and lateral and third ventricles in 155 healthy men and women who went through extensive medical examinations. Younger (56 to 66 years old) and older (67 to 80 years old) subgroups were compared on casual and 24-hour ambulatory BP values and MRI volume measurements. RESULTS: Older subjects had smaller brain volumes and larger lateral and third ventricles. Compared with women, men had larger lateral and third ventricles. With age controlled for, greater sleep systolic BP (SBP) variability was associated with smaller brain volumes; greater waking and sleep SBP variability were associated with larger lateral and third ventricles. Subjects with higher casual and waking SBP and waking diastolic BP had larger lateral ventricles. Among older subjects, only those with elevated SBP had smaller brain volumes and larger lateral ventricles. CONCLUSIONS: These results indicate that if BP levels are within the upper normal range, even healthy individuals with no prior diagnosis of hypertension are more likely to have brain atrophy than those with lower BP. Moreover, not only do BP level and variability relate to brain atrophy, but the combination of high level and greater variability shows an even stronger relationship to brain atrophy than either one of these variables alone.

Aged↗
PubMed2002

Gamma 3 gene-disrupted mice selectively deficient in the dominant IgG subclass made to bacterial polysaccharides. II. Increased susceptibility to fatal pneumococcal sepsis due to absence of anti-polysaccharide IgG3 is corrected by induction of anti-polysaccharide IgG1.

Bacterial polysaccharides (PS) are type 2 T-independent Ags that elicit Abs restricted in isotype to IgM and predominantly IgG2 in humans and IgM, and IgG3 in mice. Humans with IgG2 subclass deficiency are susceptible to sinus and pulmonary infections with PS-encapsulated bacteria. We previously developed an IgG3-deficient mouse by disrupting the gamma3 H chain constant region gene via targeted mutagenesis. Mutant mice lacking IgG3 were backcrossed for 10 generations to wild-type (WT) BALB/c mice to generate BALB/c mice that have complete absence of IgG3. WT mice immunized with type 3 Streptococcus pneumoniae capsular PS made anti-PS IgM, IgG3, and small quantities of IgG1, which opsonized S. pneumoniae for killing by polymorphonuclear leukocytes. These mice were protected against death from lethal doses of type 3 S. pneumoniae. In contrast, IgG3(-/-) mice made similar titers of anti-PS IgM and IgG1 as WT mice but no IgG3, and had poorly opsonic sera with significantly increased mortality after S. pneumoniae challenge. Immunization of IgG3(-/-) mice with type 3 S. pneumoniae PS conjugated to carrier protein CRM(197)-elicited IgM and high-titer IgG1 Abs, restored serum opsonization, and gave protection from mortality after S. pneumoniae, challenge comparable to WT mice. We conclude that mice lacking the dominant IgG3 subclass made to bacterial PS are more susceptible to fatal S. pneumoniae sepsis than WT mice, but that IgG1 induced by a S. pneumoniae glycoconjugate can adequately protect against S. pneumoniae sepsis. This model suggests that IgG subclass of anti-PS Ab is an important component of immunity to encapsulated bacteria.

Alleles↗
PubMed2002

Situations and moods associated with smoking in everyday life.

On 4 days, in everyday situations, 21 female and 26 male smokers used an electronic diary to record situations and moods at times of smoking and at control nonsmoking occasions. Self-reports of particular locations, activities, posture, consumption, social context, moods, and internal states were specifically associated with smoking. Real-time assessments in everyday situations provide useful information about the interplay of environmental factors and internal states in smoking. The findings suggest that conditioning and learning processes play a role in smoking and should be considered in smoking cessation programs.

Adult↗
PubMed2002

Theoretical reflections on Wilhelm Reich's Character Analysis.

The ideas contained in Wilhelm Reich's Character Analysis, while very influential, have not been thoroughly exploited in psychoanalysis and psychotherapy. These ideas, aimed particularly at producing genuine change rather than mere intellectual understanding, are reexamined. Further implications of them are discussed.

Character↗
PubMed2002

Is bariatric surgery safe in academic centers?

Contemporary outcomes of bariatric surgery are not well defined. Our aim was to document the outcomes of bariatric surgery on the basis of surgeon caseload and affiliation. We analyzed prospectively collected Florida-wide hospital discharge data. Forty-four surgeons undertook bariatric surgery in 933 patients during 1999. The ten surgeons who averaged more than two operations/month undertook 764 operations; 162 (17%) were done by academic surgeons. Complications [14% vs 7% (P = 0.008, chi-square)], length of stay (5 +/- 0.7 vs 4 +/- 0.1 days), and hospital charges (in thousands) ($31 +/- 4.0 vs $24 +/- 0.4) were greater in academic than in community-based centers (P < 0.05, Wilcoxon rank-sum). However, 36 per cent of patients operated upon by academic surgeons had a high Severity Index compared with only 16 per cent of patients operated upon by community-based surgeons (P < 0.001, chi-square). In high-risk patients complications (40% vs 46%), length of stay (7 +/- 1.0 vs 6 +/- 0.4 days), and hospital charges (in thousands) ($42 +/- 6 vs $35 +/- 2) were similar between academic and community-based surgeons. We conclude that outcomes of bariatric surgery in high-risk patients are similar among academic and community-based surgeons. Academic surgeons undertake bariatric surgery in high-risk patients more frequently than community-based surgeons, which underlies their increased complication rate. These prospectively collected data reflect surgical outcomes more accurately than clinical series and will impact our practice of bariatric surgery.

Academic Medical Centers↗
PubMedDate not supplied

Protection of chickens from infectious bronchitis by in ovo and intramuscular vaccination with a DNA vaccine expressing the S1 glycoprotein.

We have constructed a DNA vaccine (pDKArkS1-DPI) expressing the S1 glycoprotein (Arkansas DPI) of infectious bronchitis virus (IBV) to examine protective immunity after in ovo and intramuscular DNA immunization. Birds receiving in ovo DNA followed by live virus vaccination at 2 wk of age were 100% protected from clinical disease. Birds receiving only live virus vaccine or only in ovo DNA vaccination were < or = 80% protected. IBV was detected up to 10 days postchallenge in unvaccinated control groups, whereas birds receiving in ovo DNA and live virus vaccination cleared IBV from tracheal samples before day 5 postchallenge. Transcription of the S1 gene was confirmed in lung tissue after in ovo vaccination by an antisense riboprobe, and the S1 protein was detected by immunohistology in the heart and bursa. In a separate experiment, birds were injected intramuscularly with either 50, 100, or 150 microg of the DNA vaccine at 1 day of age and then again with either 100, 200, or 300 microg of the DNA vaccine, respectively, at 14 days of age. At 10 days postchallenge, no clinical signs were observed and no challenge virus was reisolated from the birds vaccinated with 150 microg and 300 microg of DNA. Between DNA-vaccinated birds and nonvaccinated control birds, no statistical differences were observed for IBV-specific serum antibodies as detected by enzyme-linked immunosorbent assay or the virus neutralization test. These data indicate that DNA vaccination with the S1 gene either in ovo or intramuscularly can provide birds with some protection against clinical disease after homologous IBV challenge.

Animals↗