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Biomedical subjects

J Trainor

Publications and source records attributed to J Trainor.

14 recordsLinked to original sources
PubMed2001

Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics.

BACKGROUND: Cerebral edema is an uncommon but devastating complication of diabetic ketoacidosis in children. Risk factors for this complication have not been clearly defined. METHODS: In this multicenter study, we identified 61 children who had been hospitalized for diabetic ketoacidosis within a 15-year period and in whom cerebral edema had developed. Two additional groups of children with diabetic ketoacidosis but without cerebral edema were also identified: 181 randomly selected children and 174 children matched to those in the cerebral-edema group with respect to age at presentation, onset of diabetes (established vs. newly diagnosed disease), initial serum glucose concentration, and initial venous pH. Using logistic regression we compared the three groups with respect to demographic characteristics and biochemical variables at presentation and compared the matched groups with respect to therapeutic interventions and changes in biochemical values during treatment. RESULTS: A comparison of the children in the cerebral-edema group with those in the random control group showed that cerebral edema was significantly associated with lower initial partial pressures of arterial carbon dioxide (relative risk of cerebral edema for each decrease of 7.8 mm Hg [representing 1 SD], 3.4; 95 percent confidence interval, 1.9 to 6.3; P<0.001) and higher initial serum urea nitrogen concentrations (relative risk of cerebral edema for each increase of 9 mg per deciliter [3.2 mmol per liter] [representing 1 SD], 1.7; 95 percent confidence interval, 1.2 to 2.5; P=0.003). A comparison of the children with cerebral edema with those in the matched control group also showed that cerebral edema was associated with lower partial pressures of arterial carbon dioxide and higher serum urea nitrogen concentrations. Of the therapeutic variables, only treatment with bicarbonate was associated with cerebral edema, after adjustment for other covariates (relative risk, 4.2; 95 percent confidence interval, 1.5 to 12.1; P=0.008). CONCLUSIONS: Children with diabetic ketoacidosis who have low partial pressures of arterial carbon dioxide and high serum urea nitrogen concentrations at presentation and who are treated with bicarbonate are at increased risk for cerebral edema.

Age Factors↗
PubMed1992

Good housekeeping.

Explore the source record for details and available documents.

Insurance, Liability↗
PubMed1988

The role of membrane protein sulfhydryl groups in hydrogen peroxide-mediated membrane damage in human erythrocytes.

The formation of spectrin-hemoglobin complex following treatment of red cells with hydrogen peroxide (H2O2) has previously been shown to be associated with alterations in cell shape, decreased membrane deformability and increased recognition of modified cells by anti-IgM immunoglobulin in a phagocytic assay by monocytes. Prior treatment with carbon monoxide completely inhibited the H2O2-associated membrane changes, indicating a role for oxidized hemoglobin in the complex formation. Also, in a cell-free system, blockage of sulfhydryl (SH) groups on purified spectrin by N-ethylmaleimide significantly reduced the complex formation, suggesting a role for SH groups of spectrin in crosslinking process. The present study was undertaken to examine the role of SH blockade by N-ethylmaleimide on intact red cells undergoing oxidative damage. Pretreatment of erythrocytes with N-ethylmaleimide at concentrations ranging from 0.1 to 0.2 mM resulted in decreased lipid peroxidation and spectrin hemoglobin crosslinking. Moreover, pretreatment with N-ethylmaleimide resulted in less marked alterations in cell shape and membrane deformability as well as reduced recognition of peroxidized cells by antiglobulin serum. N-Ethylmaleimide treatment had no effect on methemoglobin formation. Studies with 14C-labeled N-ethylmaleimide showed that over 50% of N-ethylmaleimide was incorporated into spectrin. Pretreatment of cells with higher concentrations of N-ethylmaleimide (over 0.2 mM) was associated with membrane dysfunction independent of H2O2. These results imply that blocking of reactive SH groups leads to reduced interaction of spectrin with oxidized globin. These data, along with our prior observations, indicate that SH groups on spectrin play an important role in hemoglobin oxidation-induced formation of spectrin-hemoglobin complex and the resultant deleterious effects on membrane properties.

Electrophoresis, Polyacrylamide Gel↗
PubMed1987

Short-term economic change and the utilization of mental health facilities in a metropolitan area.

The relationship between economic change and mental disorder has been examined by several investigators over the past century. The purpose of this paper is to explore this basic relationship and determine its direction in a large Metropolitan area. A time series analysis was undertaken to investigate whether or not unemployment and indicators of mental health are related over time. Trends in the following four indicators of mental health were examined: 1. Number of admissions to all psychiatric facilities serving Metropolitan Toronto. 2. Number of admissions to one provincial psychiatric hospital (Queen Street Mental Health Centre) in Toronto, which serves a chronic population. 3. Number of discharges from Queen Street Mental Health Centre. 4. Number of admissions plus those assessed and not admitted to Queen Street Mental Health Centre. In order to assess the possible delayed effects of unemployment, correlation analyses were computed for several lag times. "Lag time" is defined here as the time delay between unemployment and its potential effects on mental health indicators. Lag times used were zero, three, six and twelve months. The best equation found was for a six month lag, indicating an inverse relationship; as unemployment increases, admissions and discharges decrease. Results suggest that there are no simple relationships between the dependent and independent variables. Observed trends may be due to much wider exogenous factors such as hospital capacity and changing admission criteria.

Community Mental Health Centers↗
PubMed1986

A participatory approach to the evaluation design of a case management program for the long-term mentally ill.

Resistance by clinical staff is a problem frequently encountered in the course of implementing an evaluation. This paper examines the process of developing a comprehensive evaluation for a case management program for the long-term mentally ill in Metropolitan Toronto. A participatory approach was used in the design and implementation of this evaluation. Parties involved included Ministry of Health officials, hospital administrators, outside consultants, the case manager co-ordinator, case managers, and the evaluators. The goal was to elicit both understanding and support from these key actors. The advantages of this approach are highlighted, as are the limitations and problems encountered.

Community Mental Health Centers↗
PubMed1986

The politics of normalization.

The concept of normalization is an influential paradigm in mental health. However, little attention has been paid to how the psychiatrically disabled fare in the competition for generic services. Four psychiatric aftercare areas were examined: income maintenance, housing, vocational-educational, social-recreational. Results indicate that generic services do not successfully support the chronic patient in three of the four areas examined. Only in the field of vocational-educational support have generic agencies made a serious effort, and even here the most seriously disabled patients still rely on specialized services. The authors suggest that the theory of normalization is constructed on fundamentally erroneous assumptions and discuss alternative rather than normative programs for the long-term mentally ill.

Aftercare↗
PubMed1985

Demonstration of haemoglobin associated with isolated, purified spectrin from senescent human red cells.

Employing a direct and sensitive radioimmunoassay (RIA) we have confirmed the presence of haemoglobin associated with isolated, purified spectrin from senescent red cells. Haemoglobin associated with spectrin occurs in the highest amount in cells with an MCHC greater than 36 g/dl and is approximately 3% of the total spectrin extract. Spectrin from the young cells had the least haemoglobin, while an intermediate amount was found in unfractionated, whole red cells. The RIA results were in close approximation with estimation of the haemoglobin-spectrin complex obtained by carefully integrating the Coomassie blue stain profiles from 4% SDS PAGE in densitometric scans from isolated spectrin.

Densitometry↗
PubMed1985

Properties and characterization of vesicles released by young and old human red cells.

We have presently demonstrated morphologic differences between young and senescent red cells following 18 h of metabolic depletion in vitro. Young and old red cells both form echinocytes, whereas only young cells demonstrated myelin forms or microspheres. Furthermore, vesicles were released in greater quantities into the cell-free supernatant from young cells. Isolated vesicles from both young and old red cells contained lipids, intrinsic membrane proteins (especially band 3), and haemoglobin, and they were also enriched in acetylcholinesterase (AChE). Young cells produced more vesicles than old cells but the composition of the low density vesicles was similar except that haemoglobin-spectrin complex was found exclusively in vesicles from young cells. Oxidation of young red cells prior to metabolic depletion prevented both myelin formation and vesicle release.

Acetylcholinesterase↗
PubMed1985

Effect of hydrogen peroxide exposure on normal human erythrocyte deformability, morphology, surface characteristics, and spectrin-hemoglobin cross-linking.

To further define the conditions for forming spectrin-hemoglobin cross-linking in human erythrocyte membranes and to examine its possible effects on membrane function, we incubated normal human erythrocytes for up to 3 h in concentrations of H2O2, varying from 45 to 180 microM, in an azide phosphate buffer, pH 7.4. The chemical changes observed indicated that methemoglobin formation occurred early and at a low concentration (45 microM). Morphologic changes characterized by increased echinocyte formation occurred in a dose-dependent fashion. In addition, decreased cell deformability commensurate with increased membrane rigidity was found. Finally, an increase in cell recognition as determined by monocyte phagocytosis and adherence in vitro, as well as decreased phosphatidylcholine accessibility to bee venom phospholipase A2, was found in H2O2-treated erythrocytes compared with controls. Both of these latter changes were closely correlated with the extent of spectrin-hemoglobin cross-linking. In addition to these protein-mediated interactions, lipid peroxidation also occurred after H2O2 exposure, as shown by generation of fluorescent amino propene derivatives. The addition of the antioxidant, butylated hydroxytoluene, decreased the fluorescent derivatives, but did not prevent the effects on membrane function. This suggests that lipid peroxidation, though present, was not necessary for the membrane changes found. In contrast, spectrin-hemoglobin aggregation and the alterations in membrane function were completely prevented by prior exposure of the erythrocytes to carbon monoxide.

Carbon Monoxide↗