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Biomedical subjects

J Shepherd

Publications and source records attributed to J Shepherd.

At least 37 records · Page 2Linked to original sources
PubMed1992

Patients presenting to family physicians after a fall: a report from the Ambulatory Sentinel Practice Network.

BACKGROUND: Patients who fall present a diagnostic challenge to family physicians. The diagnostic workup of these patients must be thorough enough to detect and treat important causes of the fall yet not subject patients to unnecessary tests. Previous studies have provided only limited guidance for primary care physicians because in general they occurred in settings other than primary care and focused on a single age group. METHODS: The Ambulatory Sentinel Practice Network (ASPN) conducted a 6-month study of primary care patients of all ages presenting after a fall, or with medical problems resulting from a fall. ASPN clinicians collected information about the history, physical examination findings, and follow-up of these patients. Causes of falls were grouped into three categories: external reasons for falling, internal reasons related to gait, and internal reasons unrelated to gait. RESULTS: Participating clinicians identified 431 patients who had falls out of the 256,680 seen for any reason during the study period. The patients ranged in age from 1 to 94 years. The rate of falls for patients increased rapidly after age 65 years. Most falls occurred for reasons external to the patient, but internal reasons, both nonlocomotor and locomotor, increased after age 65 years. No nonlocomotor causes for a fall were found in patients younger than 65 years of age. Also, the rate of hospitalization of patients seen for falls was greater in the geriatric age group. CONCLUSIONS: The results highlight the need for further research about falls, particularly those occurring in pediatric and young adult patients. Furthermore, correcting environmental hazards and modifying gait problems in the elderly by increasing lower extremity and truncal strength could decrease the risk of falling.

Accidental Falls↗
PubMed1991

Restriction fragment length polymorphisms in the Apo B gene in relation to coronary heart disease in a southern Asian population.

We have examined DNA polymorphisms associated with the apolipoprotein B gene in 95 Sri Lankan males with ischaemic heart disease and 95 matched controls. For polymorphisms detected using the XbaI or MspI enzymes the allele frequency in Sri Lankans contrasted markedly from that in Caucasians. Overall, there was no significant association of any allele studied with coronary disease cases in this sample. There was, however, a significant difference observed between the XbaI allele frequency in normotriglyceridaemic or normocholesterolaemic CHD cases compared with the allele frequency in the controls.

Alleles↗
PubMed1991

Familial combined hyperlipidaemia linked to the apolipoprotein AI-CII-AIV gene cluster on chromosome 11q23-q24.

Familial combined hyperlipidaemia (FCHL) is a common inherited disorder of lipid metabolism with a prevalence of 0.5-2.0% (refs 1, 2). It is estimated to cause 10% of premature coronary heart disease. The underlying metabolic and genetic defects in FCHL have not been identified, but a population study has suggested an association between FCHL and an XmnI restriction fragment length polymorphism (RFLP) within the apolipoprotein AI-CIII-AIV gene cluster. Here we confirm this association and show that it results from linkage disequilibrium between FCHL and the 6.6-kilobase (kb) allele of the XmnI RFLP. Subsequent analysis in seven FCHL families, ascertained through a proband carrying the 6.6 kb XmnI allele, demonstrated linkage to the AI-CIII-AIV cluster on 11q23-q24, zeta = 6.86 with no recombinants. This assignment will facilitate the identification of the mutation that causes hyperlipidaemia in these families.

Apolipoprotein A-I↗
PubMed1991

"Paradoxical" effects of morphine on antipredator defense reactions in wild and laboratory rats.

In a Fear/Defense Test Battery, measuring defensive reactions to a present, approaching and contacting predator, the highest dose of morphine tested (7.5 mg/kg) reliably reduced vocalization to dorsal contact, to vibrissae stimulation, and to an anesthetized conspecific in laboratory-bred wild R. norvegicus. Except for a dose-dependent reduction in flinch/jump reactions to dorsal contact (taps), other defensive behaviors (flight, freezing, etc.) were not reliably altered by morphine treatment (0, 1.0, 2.5, 7.5 mg/kg). Vocalization responses to vibrissae stimulation in wild-trapped R. rattus were reliably increased following naloxone (1.0 and 10.0 mg/kg) administration, lending support for opiate receptor involvement in the mediation of defensive vocalization. In the Anxiety/Defense Test Battery, measuring defensive reactions to situations associated with a predator (cat) or with cat odor, laboratory rats showed no decrease in defensive behavior with morphine (0, 1.0, 5.0 mg/kg). In direct contrast to the above findings, the effects of morphine treatment in this test battery suggested a generalized increase in defensiveness to noncontacting and nonpainful threat stimuli. These effects included a decrease in time spent near the cat compartment, with a complementary increase in time spent at maximum distance, a decrease in transits between these sections, an increase in crouching, and a decrease in grooming and rearing. This pattern of results suggests that morphine may have two opposing effects on defensive behavior, a generalized enhancement, together with a more specific reduction of responses to tactile or painful stimulation. A very widespread pattern of reliable sex or sex x drug effects in the Anxiety/Defense Test Battery was in good agreement with previous reports of sex differences in these tests, with females generally more defensive than males. Consonant with previous findings, no reliable sex differences were found with the Fear/Defense Test Battery, although several values approached an acceptable level of statistical significance.

Animals↗
PubMed1991

Diabetes decreases sensitivity of adipocyte lipolysis to inhibition by Gi-linked receptor agonists.

(1) Streptozotocin-diabetes decreased the responsiveness of noradrenaline- or forskolin-stimulated lipolysis to inhibition by phenylisopropyladenosine (PIA), prostaglandin E1 (PGE1) and nicotinate in rat adipocytes. (2) Diabetes had no effect on high affinity binding of [3H]PIA to adipocyte plasma membranes. (3) Plasma membranes from diabetic animals had increased abundance of alpha-subunits of Gi1 and Gi2. The effect of pertussis toxin in overcoming inhibition of lipolysis by PIA was delayed in adipocytes from diabetic rats. (4) Diabetes decreased the GTP-dependent right-wards shift in the dose-curve for displacement of the antagonist [3H]DPCPX by PIA in adipocyte plasma membranes. (5) It is concluded that, despite increased abundance of Gi in diabetic adipocytes, less of this is functional. This may contribute to reduced sensitivity to PIA, PGE1 and nicotinate and explains some of the loss of control of lipolysis in insulin-dependent diabetes.

Adipose Tissue↗
PubMed1991

Metabolism of apolipoprotein B-containing lipoproteins in subjects with nephrotic-range proteinuria.

Although hyperlipidemia is a well recognized complication of the nephrotic syndrome, the precise disturbances of lipoprotein metabolism which cause the elevated plasma lipid and lipoprotein concentrations have not been clearly defined in humans. This study examines the metabolism of apolipoprotein B-containing lipoproteins in patients with nephrotic-range proteinuria and in healthy controls. Two radioiodinated tracers of very low density lipoproteins (VLDL1, Sf60 to 400, and VLDL2, Sf20 to 60), were used to trace the metabolism of apolipoprotein B through the delipidation cascade from very low density lipoproteins (VLDL) to low density lipoproteins (LDL). The data from the apoB specific radioactivity curves and the pool sizes of apoB in four subfractions were analyzed by a multicompartmental modeling procedure using the SAAM 30 program. The main findings in the nephrotic group were: 1.) a consistent decrease in the fractional rate of apoB transfer from VLDL1----VLDL2 (median values-nephrotic 0.92 pools/day vs. controls 3.66, P less than 0.02) and from VLDL2----IDL (1.49 vs. 2.74, P less than 0.05); 2.) increased secretion of apoB into VLDL2 (14.5 mg/kg/day vs. 4.2, P less than 0.02); 3.) a trend towards decreased removal of IDL and LDL attributable to a defect in LDL receptor-mediated removal as previously shown (Metabolism 39:187-192, 1990). These findings suggest that catabolic defects of the apo B-containing lipoproteins are as important as increased hepatic synthesis in the pathogenesis of nephrotic hyperlipidemia in humans.

Apolipoproteins B↗
PubMed1991

The isolation, characterisation and quantification of the equine plasma lipoproteins.

Plasma lipoproteins were isolated from eight Thoroughbred horses and eight Shetland ponies on the basis of particle size by gel filtration chromatography and according to density using rate-zonal ultracentrifugation. Three major classes corresponding to very low density lipoproteins (VLDL), low density lipoproteins (LDL) and high density lipoproteins (HDL) were identified and characterised by their lipid and apolipoprotein compositions. The particle size distributions of each class were determined by electron microscopy and non-denaturing polyacrylamide gradient gel electrophoresis. HDL was found to dominate the equine lipoprotein spectrum, accounting for 61 per cent of the total plasma lipoprotein mass (VLDL 24 per cent, LDL 15 per cent). The VLDL class was isolated as a single population of particles that were triglyceride rich and cholesterol, phospholipid and protein poor. Equine LDL was characteristically cholesterol rich and was found to be polydisperse comprising three subfractions that were discrete with respect to particle size and lipid composition. The HDL class was composed of homogeneous particles that were typically protein rich. Apolipoprotein (apo) B was the major protein of VLDL and LDL, and presented two components on polyacrylamide gel electrophoresis with molecular weights in the region of human apoB-100 and a third in VLDL similar to that of apoB-48. ApoA-I was the predominant protein in equine HDL. Although there were no breed differences in the physical or chemical properties of each lipoprotein class, the Shetland ponies had higher plasma triglyceride and VLDL concentrations than their Thoroughbred counterparts.

Animals↗
PubMed1991

Influence of apolipoprotein E polymorphism on apolipoprotein B-100 metabolism in normolipemic subjects.

This study examined apolipoprotein (apo) B metabolism in normolipemic subjects homozygous for the apo E2 (n = 4), apo E3 (n = 5), or apo E4 (n = 5) phenotype. Radioiodinated very low density lipoprotein (VLDL1) (ultracentrifuge flotation rate [Sf] 60-400) and VLDL2 (Sf 20-60) were injected into volunteers and the conversion of apo B was followed through intermediate density lipoprotein (IDL) to low density lipoprotein (LDL). Subjects homozygous for E3 converted approximately 50% of LVDL2 to LDL, the remainder being lost by direct catabolism. Those with the E2 phenotype produced less VLDL1, but converted more of it to VLDL2 (compared to E3 subjects). They displayed a characteristic dyslipidemia with the presence of slowly catabolized VLDL1 and VLDL2 remnants. LDL levels were low owing to increased direct catabolism of VLDL2 and IDL and a reduced efficiency of delipidation; only 25% of VLDL2 apo B was directed to LDL production. In contrast, E4 subjects converted more VLDL2 apo B to LDL than E3 subjects. About 70% of VLDL2 apo B was found in LDL; direct catabolism of VLDL and IDL was reduced as was the fractional catabolic rate of LDL (0.2 vs. 0.26 in E3 subjects). These changes in the VLDL----IDL----LDL metabolic cascade can in part be explained by alterations in hepatic LDL receptors with E2 subjects having higher and E4 subjects lower activities than those in E3 homozygotes.

Adult↗
PubMed1991

A comparison of commercial kits for the measurement of lipoprotein(a).

Five commercial kits for the assay of lipoprotein(a) were investigated and two of these, the Immuno Enzyquick and Biopool TintElize, both enzyme-linked immunoassays, were studied in detail. Whilst there was a strong correlation between the results obtained using the two methods there was a significant difference between the absolute values. In view of its higher precision at low levels and robust performance, the Enzyquick kit (Immuno Ltd) was selected for use in this laboratory.

Enzyme-Linked Immunosorbent Assay↗
PubMed1991

Progression and regression of atheroma.

Normal human arteries accumulate lipid in the intima with increasing age. These lipids are laid down in proportion to their distribution in low-density lipoprotein, suggesting that they are derived from this source. With their accretion, the amount of cholesterol and its esters in the subintimal space increases significantly, leading to the development of insoluble crystals which are difficult to remove by any therapeutic intervention. It has been shown that treatment with a low-cholesterol diet combined with lipid-lowering drug treatment can halt progression of atherosclerotic lesions, but as yet ther is no conclusive evidence that consistent lesion regression is possible.

Adult↗
PubMed1991

Koilocytotic atypia and underlying dysplasia.

BACKGROUND: Several studies have examined the agreement between Papanicolaou smear cytology and subsequent biopsy results in the diagnosis of cervical dysplasia. However, few studies have focused specifically on koilocytotic (KC) atypia. Given the increasing frequency of reporting KC atypia on Papanicolaou smears, we sought to obtain more information on the relationship between Papanicolaou smears and subsequent colposcopically directed cervical biopsies. METHODS: Retrospectively, we compared the Papanicolaou smears and colposcopically guided biopsy results for 132 college women who had abnormal Papanicolaou smears (KC, cervical intraepithelial neoplasia [CIN], or reactive atypia [RA]). Data were compiled through systematic review of the charts of these women. The cervical biopsies were taken 6 months or less after the Papanicolaou smears. RESULTS: Of 99 women having only KC atypia on cytology, histology revealed concordance in 51 cases and underlying dysplasia in 16 cases. Only one biopsy revealed CIN III, and no biopsies showed invasive carcinoma. We also noted variation in the histologic results between the laboratories that analyzed the biopsy specimens. In comparing the biopsy results after one or two KC atypic Papanicolaou smears 6 months or less apart, we found no statistically significant difference. CONCLUSIONS: These findings suggest that physicians who obtain an initial Papanicolaou smear read as KC atypia could obtain a second smear 3 months later to determine if there is persistent KC atypia before advising a patient to have cervical biopsy. In addition, physicians also should know the limitations of the laboratories providing them with information.

Adolescent↗
PubMed1990

An investigation of the relationships between body condition and plasma lipid and lipoprotein concentrations in 24 donkeys.

Obese donkeys are susceptible to a hyperlipaemic crisis characterised by high plasma triglyceride concentrations. In this study, the relationships between the body condition of 24 donkeys and their basal lipid metabolism were investigated. Plasma cholesterol, triglyceride and lipoprotein cholesterol concentrations were measured in healthy donkeys classified according to their body condition as thin, ideal or obese. There were significant differences between the groups in the concentrations of triglyceride and very low density lipoprotein (VLDL), which increased in concentration with body condition (P less than 0.05). Cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) concentrations were similar in all the groups. Triglyceride and VLDL concentrations were positively correlated with body weight (r = 0.82) and plasma free fatty acid concentration (r = 0.48). There were no significant differences in basal plasma concentrations of insulin or cortisol. These results suggest that obesity in donkeys is associated with changes in lipid and lipoprotein metabolism that might predispose the animals to hyperlipaemia.

Animals↗