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Biomedical subjects

John C Marshall

Publications and source records attributed to John C Marshall.

At least 19 recordsLinked to original sources

Progesterone acutely increases LH pulse amplitude but does not acutely influence nocturnal LH pulse frequency slowing during the late follicular phase in women.

Progesterone (P) is the primary effector of LH (and by inference gonadotropin-releasing hormone) pulse frequency slowing in cycling women, but the time course of this action is unclear. We hypothesized that P administration to estradiol (E2)-pretreated women would slow LH pulse frequency within 12 h. We studied eight normally cycling women in two separate cycles (follicular phase, cycle days 7-11). After 3 days of E2 pretreatment (0.2 mg/day via transdermal patches), a 25-h blood sampling protocol (starting at 0800) was performed to define LH pulsatility. Oral micronized P (100 mg) or placebo (PBO) was administered at 1800 in a randomized, double-blind fashion, with treatment crossover occurring during a subsequent cycle. The 10-h mean P concentration increased from 0.6+/-0.1 ng/ml before P (0800-1800) to 3.9+/-0.3 ng/ml after P administration (2200-0800, P<0.01). Ten-hour mean LH interpulse interval increased significantly after both P and PBO administration, with no significant difference between P and PBO. In contrast, mean LH, LH amplitude, and mean FSH increased significantly within 4 h of P administration, but not after PBO. We conclude that, in E2-pretreated women in the late follicular phase, 1) nocturnal LH pulse frequency is not acutely (within 12 h) influenced by P administration; 2) an acute increase in P causes pronounced augmentation of gonadotropin pulse amplitude within 4 h; and 3) LH pulse frequency slows overnight during the second half of the follicular phase.

Administration, Oral↗

Obesity and sex steroid changes across puberty: evidence for marked hyperandrogenemia in pre- and early pubertal obese girls.

CONTEXT: Peripubertal obesity is associated with abnormal sex steroid concentrations, but the timing of onset and degree of these abnormalities remain unclear. OBJECTIVE: The objective of the study was to assess the degree of hyperandrogenemia across puberty in obese girls and assess overnight sex steroid changes in Tanner stage 1-3 girls. DESIGN: This was a cross-sectional analysis. SETTING: The study was conducted at general clinical research centers. SUBJECTS: Thirty normal-weight (body mass index for age < 85%) and 74 obese (body mass index for age >or= 95%) peripubertal girls. INTERVENTION: Blood samples (circa 0500-0700 h) were taken while fasting. Samples from the preceding evening (circa 2300 h) were obtained in 23 Tanner 1-3 girls. MAIN OUTCOME MEASURES: Hormone concentrations stratified by Tanner stage were measured. RESULTS: Compared with normal-weight girls, mean free testosterone (T) was elevated 2- to 9-fold across puberty in obese girls, whereas fasting insulin was 3-fold elevated in obese Tanner 1-3 girls (P < 0.05). Mean LH was lower in obese Tanner 1 and 2 girls (P < 0.05) but not in more mature girls. In a subgroup of normal-weight Tanner 1-3 girls (n = 17), mean progesterone (P) and T increased overnight 2.3- and 2.4-fold, respectively (P <or= 0.001). In obese Tanner 1-3 girls (n = 6), evening P and T were elevated, and both tended to increase overnight [mean 1.4- and 1.6-fold, respectively (P = 0.06)]. CONCLUSIONS: Peripubertal obesity is associated with hyperandrogenemia and hyperinsulinemia throughout puberty, being especially marked shortly before and during early puberty. P and T concentrations in normal-weight Tanner 1-3 girls increase overnight, with similar but less evident changes in obese girls.

Adolescent↗

Mechanisms of hemispheric specialization: insights from analyses of connectivity.

Traditionally, anatomical and physiological descriptions of hemispheric specialization have focused on hemispheric asymmetries of local brain structure or local functional properties, respectively. This article reviews the current state of an alternative approach that aims at unraveling the causes and functional principles of hemispheric specialization in terms of asymmetries in connectivity. Starting with an overview of the historical origins of the concept of lateralization, we briefly review recent evidence from anatomical and developmental studies that asymmetries in structural connectivity may be a critical factor shaping hemispheric specialization. These differences in anatomical connectivity, which are found both at the intra- and inter-regional level, are likely to form the structural substrate of different functional principles of information processing in the two hemispheres. The main goal of this article is to describe how these functional principles can be characterized using functional neuroimaging in combination with models of functional and effective connectivity. We discuss the methodology of established models of connectivity which are applicable to data from positron emission tomography and functional magnetic resonance imaging and review published studies that have applied these approaches to characterize asymmetries of connectivity during lateralized tasks. Adopting a model-based approach enables functional imaging to proceed from mere descriptions of asymmetric activation patterns to mechanistic accounts of how these asymmetries are caused.

Animals↗

Neural mechanisms underlying spatial judgements on seen and imagined visual stimuli in the left and right hemifields in men.

We investigated the neural networks involved in spatial judgements on visual and imagined stimuli in the left and right hemifields. Twenty healthy male right-handers were scanned using fMRI. In an adaptation of the Mental Clock Test, subjects judged whether the angle between visually presented or to be imagined clock hands at a given time (e.g. "12:20") was >90 degrees or <90 degrees . The angle formed by the clock hands was always located either on the left or right hemifield of the clock face, constituting a 2x2 factorial design with factors stimulus type (visual "V", imagined "I") and attention to spatial hemifield (left "L", right "R"). The contrast I>V revealed a bilateral neural network which included the superior parietal, prefrontal and antero-dorsal cingulate cortex. While right superior parietal cortex was activated during both RV and LV, left superior parietal cortex was only active during RV. The contrast RI versus LI (and vice versa) did not reveal significant differences with respect to activation height. However, a masking procedure and the calculation of a laterality index showed that RI recruited larger areas in the left than in the right hemisphere, while LI led to symmetrical activations in both hemispheres. Our data thus confirm that there are hemifield-specific asymmetries in brain activity during spatial processing of both visual and imagined stimuli. Our data indicate, however, that these asymmetries are less clear and of a different nature in the latter. Overall, our findings converge with neuropsychological data showing that representational and visuospatial neglect do not always co-occur.

Adult↗

Oxidative stress generated by hemorrhagic shock recruits Toll-like receptor 4 to the plasma membrane in macrophages.

Oxidative stress generated by ischemia/reperfusion is known to prime inflammatory cells for increased responsiveness to subsequent stimuli, such as lipopolysaccharide (LPS). The mechanism(s) underlying this effect remains poorly elucidated. These studies show that alveolar macrophages recovered from rodents subjected to hemorrhagic shock/resuscitation expressed increased surface levels of Toll-like receptor 4 (TLR4), an effect inhibited by adding the antioxidant N-acetylcysteine to the resuscitation fluid. Consistent with a role for oxidative stress in this effect, in vitro H2O2 treatment of RAW 264.7 macrophages similarly caused an increase in surface TLR4. The H2O2-induced increase in surface TLR4 was prevented by depleting intracellular calcium or disrupting the cytoskeleton, suggesting the involvement of receptor exocytosis. Further, fluorescent resonance energy transfer between TLR4 and the raft marker GM1 as well as biochemical analysis of the raft components demonstrated that oxidative stress redistributes TLR4 to lipid rafts in the plasma membrane. Preventing the oxidant-induced movement of TLR4 to lipid rafts using methyl-beta-cyclodextrin precluded the increased responsiveness of cells to LPS after H2O2 treatment. Collectively, these studies suggest a novel mechanism whereby oxidative stress might prime the responsiveness of cells of the innate immune system.

Adaptor Proteins, Signal Transducing↗

The association of obesity and hyperandrogenemia during the pubertal transition in girls: obesity as a potential factor in the genesis of postpubertal hyperandrogenism.

CONTEXT: Adolescent hyperandrogenemia is considered a forerunner of adult polycystic ovary syndrome, but its etiology remains uncertain. OBJECTIVE: Our objective was to explore the hypothesis that peripubertal obesity is associated with hyperandrogenemia. DESIGN AND SETTING: We performed a cross-sectional analysis of data obtained at General Clinical Research Centers. SUBJECTS: Subjects were 41 obese [body mass index (BMI) for age, >or=95%] and 35 normal-weight (BMI for age, <95%) peripubertal girls. INTERVENTION: We used pooled blood samples (approximately 0500-0700 h; n = 64) while fasting or single morning (fasting) samples (n = 12). MAIN OUTCOME MEASURES: We assessed adiposity and androgen concentrations. RESULTS: BMI correlated with total testosterone (T) (r(s) = 0.59), SHBG (r(s) = -0.69), and free T (r(s) = 0.69); free T was three times as great in obese girls compared with normal-weight girls (P < 0.0001 for all). BMI correlated with insulin (r(s) = 0.52); both insulin and LH correlated with free T (r(s) = 0.45 and 0.44, respectively; P < 0.001 for all). When analyzing early pubertal girls (pubertal stages 1-3; n = 36) alone, BMI correlated with total T (r(s) = 0.65), SHBG (r(s) = -0.74), and free T (r(s) = 0.75); free T was five times as great in obese early-pubertal girls (P < 0.001 for all). BMI correlated with insulin (r(s) = 0.65), and insulin correlated with free T (r(s) = 0.63, P < 0.01 for both). BMI correlated with free T while simultaneously adjusting for age, pubertal stage, insulin, LH, and dehydroepiandrosterone sulfate. CONCLUSION: Peripubertal obesity is associated with marked hyperandrogenemia, which is especially pronounced in early puberty.

Adolescent↗

Using fMRI to decompose the neural processes underlying the Wisconsin Card Sorting Test.

The specific role of particular cerebral regions with regard to executive functions remains elusive. We conducted a functional magnetic resonance imaging (fMRI) study to segregate different network components underlying the Wisconsin Card Sorting Test (WCST), a test widely applied clinically to assess executive abilities. Three different test variants of the WCST, differing in task complexity (A > B > C), were contrasted with a high-level baseline condition (HLB). Cognitive subcomponents were extracted in a serial subtraction approach (A-C, A-B, B-C). Imaging data were further subjected to a correlational analysis with individual behavioral parameters. Contrasting A with the HLB revealed the entire neural network underlying WCST performance, including frontoparietal regions and the striatum. Further analysis showed that, within this network, right ventrolateral prefrontal cortex related to simple working memory operations, while right dorsolateral prefrontal cortex related to more complex/manipulative working memory operations. The rostral anterior cingulate cortex (ACC) and the temporoparietal junction bilaterally represented an attentional network for error detection. In contrast, activation of the caudal ACC and the right dorsolateral prefrontal cortex was associated with increased attentional control in the context of increasing demands of working memory and cognitive control. Non-frontal activations were found to be related to (uninstructed relative to instructed) set-shifting (cerebellum) and working memory representations (superior parietal cortex, retrosplenium). The data provide neural correlates for the different cognitive components involved in the WCST. They support a central role of the right dorsolateral prefrontal cortex in executive working memory operations and cognitive control functions but also suggest a functional dissociation of the rostral and caudal ACC in the implementation of attentional control.

Brain↗

Biomarkers of sepsis.

Sepsis is a highly heterogeneous clinical disorder currently characterized almost exclusively by the use of physiologic variables. A burgeoning interest in the potential descriptive role of biomarkers in sepsis holds the promise of transforming the diagnosis from a clinical one to a biologic one, and so permitting better evaluation and use of a spectrum of adjuvant therapies. Biomarkers provide information in one of three domains: diagnosis, prognosis, and monitoring of response to treatment. Their primary prognostic utility, however, is not in forecasting outcome, but in identifying patients who are more likely to benefit from (or be harmed by) a particular intervention. A proposed template for staging sepsis in a manner analogous to systems used in oncology provides a framework for evaluating sepsis biomarkers. The model stratifies patients on the basis of predisposition, insult, response, and organ dysfunction, generating the acronym PIRO. This brief review considers the methodologic basis for biomarker development and validation and situates some emerging sepsis biomarkers within the framework of the PIRO model.

Journal Article↗

Controversies in sepsis clinical trials: proceedings of a meeting of the International Sepsis Forum, Lausanne, Switzerland, September 29, 2001.

Despite some recent success with clinical trials studying innovative therapies in sepsis, the field remains predominantly one of failure despite compounds with significant preclinical activity. Preclinical animal experimentation remains an important component of drug development, and a portfolio approach is recommended. Failure in animals is more likely to predict failure in humans; however, success in animals often does not predict success in humans. Because the signal with innovative therapy of sepsis is likely to be low, an oncology model clinical trial approach, in which studies start with a high-risk homogeneous population and look for a large treatment effect with smaller numbers of patients, is likely to be more relevant than the commonly used cardiology model, in which studies search for a small treatment effect using large, heterogeneous, low-risk populations. With certain rules in place, improvement in organ function may be a worthwhile alternative to mortality as a clinical end point. Once a therapy is approved, adopting less stringent but still appropriate criteria for the use of that therapy in clinical practice may be appropriate.

Animals↗

Surgical decision-making: integrating evidence, inference, and experience.

Evidence-based medicine provides a well-developed framework for evaluation of clinical research. Well-designed and adequately powered randomized controlled trials provide the best information on therapeutic efficacy; however, extrapolation of the trials' conclusions to individual patients may be difficult, and for many important surgical problems, trial data are unavailable. A complementary approach of inferential decision-making helps address these limitations, and increases the clinician's confidence in the safety of an approach of unknown efficacy. Experience establishes norms and expectations, and emphasizes events that are uncommon but clinically important. Although it cannot eliminate uncertainty or controversy, the integration of analytic techniques of evidence, inference, and experience provides the surgeon with the best means of adapting treatment to the unique circumstances of the individual patient.

Clinical Competence↗

Sex differences in neural mechanisms underlying implicit symmetry processing.

Some species, including humans, prefer symmetrical to asymmetrical patterns. Preferences for symmetrical stimuli could have arisen in both sexes because specialized systems developed to detect and identify symmetrical stimuli, which are more likely to be figure than background. Females, it has been suggested, prefer symmetry because it may provide a cue to biological fitness when choosing a mate. Using functional magnetic resonance imaging, we found sex differences in neural activity when subjects distinguished figure from ground in abstract patterns whose component shapes differed in colour, brightness, and symmetry/asymmetry. Although no participant explicitly reported using symmetry as a decision criterion, women showed more neural activity than men in visual processing areas when the display contained a symmetrical shape. This enhanced activity in occipital cortex (middle and superior occipital gyrus) occurred bilaterally in women irrespective of whether they chose the symmetrical element in the display as the figure. Contrariwise, men showed a significant neural response in right temporal (superior temporal gyrus) and left parietal cortex (inferior parietal cortex/temporo-parietal junction) only when they chose a symmetrical element as the figure. The female brain thus appears to register symmetry automatically as a stimulus attribute, while the differential neurophysiological response of the male brain is dependent upon an explicit behavioural response to symmetry (choosing the symmetrical part of the display as figure), even if the criterion for choice (symmetry) is not reported verbally.

Adult↗

Up-regulation of functional CXCR4 expression on human lymphocytes in sepsis.

OBJECTIVE: Lymphocyte dysfunction has been documented in sepsis, and evidence suggests that lymphocyte infiltration contributes to tissue injury. The purpose of this study was to examine chemokine receptor expression and function in lymphocytes from septic patients and healthy donors. DESIGN: Observational study of septic patients and laboratory investigation of normal controls. SETTING: Tertiary care intensive care unit. PATIENTS AND SUBJECTS: Nine critically ill patients fulfilling criteria for the systemic inflammatory response syndrome and with a Sepsis Score of >/=3 were included in this study. Lymphocytes were also obtained from healthy volunteers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The total number of circulating leukocytes in septic patients was markedly increased; however, lymphocyte counts were decreased. Chemokine receptor expression on lymphocytes was examined by flow cytometry. CXCR4 expression on lymphocytes from septic patients was increased whereas CCR5 was decreased and CCR7 was unchanged. Lipopolysaccharide stimulation of normal lymphocytes increased CXCR4 expression but decreased CCR5 and did not change CCR7 expression. This lipopolysaccharide-stimulated CXCR4 expression required 20 hrs of stimulation and was accompanied by increased messenger RNA. Lymphocytes from septic patients or after lipopolysaccharide treatment demonstrated enhanced actin polymerization and migration in response to CXCL12. Taken together, sepsis and lipopolysaccharide up-regulated CXCR4 expression and enhanced lymphocyte activation and migration in response to CXCL12. CONCLUSIONS: Blocking CXCR4 and CXCL12 function may provide a novel therapeutic method for controlling systemic inflammation and tissue injury in sepsis.

Actins↗

Iatrogenesis, inflammation and organ injury: insights from a murine model.

The complex biology of critical illness not only reflects the initial insult that brought the patient to the intensive care unit but also, and perhaps even more importantly, it reflects the consequences of the many clinical interventions initiated to support life during a time of lethal organ system insufficiency. The latter may amplify or modify the response to the former and are eminently amenable to modulation by changes in practice. However, they rarely figure in conceptual models of critical illness and are almost never accounted for in preclinical models of disease. In the preceding issue of Critical Care, O'Mahony and colleagues reported on an animal model in which sequential insults--low-dose endotoxin followed by mechanical ventilation--induce much greater remote organ injury than either insult alone. Although animal models are poor surrogates for clinical illness, studies such as these provide valuable platforms for probing the complex interactions between insult and therapy that give rise to the intricate biology of critical illness.

Animals↗

Stimulation of FSHbeta transcription by blockade of endogenous pituitary follistatin production: Efficacy of adenoviral-delivered antisense RNA in the rat.

This study investigated FSHbeta transcriptional responses to the suppression of endogenous follistatin (FST) production using FST antisense RNA (FST-AS) expressing adenovirus constructs in female rat pituitary cells in vitro. Adenoviral delivery systems were characterized and optimized using an adenovirus-green fluorescent protein construct, and maximal infection (85-90% of cells) was seen 48 h post adenovirus treatment. A 424 bp fragment, which included the translational start site and exons 1-3 of the rat FST gene, was subcloned in the reverse orientation into an adenovirus vector. Construct efficacy was tested using cultured rat pituitary cells infected with the adenovirus-FST-AS construct. Infection with adenovirus-FST-AS increased FST-AS mRNA expression in a dose-dependent manner, reduced FST protein expression to undetectable levels, and stimulated increases in FSHbeta primary transcript and FSH secretion. Treatment with testosterone alone stimulated FSHbeta primary transcript and FSH release, and responses were doubled in the presence of adenovirus- FST-AS. These results demonstrate the effectiveness of adenovirus FST-AS in suppressing pituitary FST protein expression and enhancing FSH biological responses at the transcriptional level. Thus, the FST-deficient rat gonadotrope cell is a model that allows for the investigation of factors regulating FSHbeta expression, which might otherwise involve the autocrine/paracrine actions of FST.

Adenoviridae↗

Effect of a liberal versus restrictive transfusion strategy on mortality in patients with moderate to severe head injury.

OBJECTIVE: To compare a restrictive versus a liberal transfusion strategy in patients with moderate to severe closed head injury following multiple trauma in 13 Canadian intensive care units (ICUs). METHODS: This is a subgroup analysis of a multicenter randomized controlled clinical trial involving sixty-seven critically ill patients from the Transfusion Requirements in the Critical Care trial who sustained a closed head injury. Patients had a hemoglobin concentration less than 9.0 g/dL within 72 hours of admission to the ICU. Patients were randomized to a restrictive allogeneic red blood cell transfusion strategy (hemoglobin 7.0 g/dL and maintained between 7.0 and 9.0 g/dL) or a liberal strategy (hemoglobin 10.0 g/dL and maintained between 10.0 and 12.0 g/dL). RESULTS: Baseline characteristics in the restrictive ( n = 29) and the liberal ( n = 38) transfusion groups were comparable. Average hemoglobin concentrations and red blood cell units transfused per patient were significantly lower in the restrictive compared to the liberal group. The 30-day all-cause mortality rates in the restrictive group were 17% as compared to 13% in the liberal group (risk difference 4.1 with 95% confidence interval [CI], 13.4 to 21.5, p = 0.64). Presence of multiple organ dysfunction (12.1 +/- 6.4 versus 10.6 +/- 6.3, p = 0.35) and changes in multiple organ dysfunction from baseline scores adjusted for death (4.5 +/- 6.2 versus 3.4 +/- 6.2, p = 0.49) were similar between the restrictive and liberal transfusion groups, respectively. Median length of stay in ICU (10 days, interquartile range 5 to 21 days versus 8 days, interquartile range 5 to 11 days, p = 0.26) and hospital (27 days, interquartile range 14 to 39 days versus 30.5 days, interquartile range 17 to 47 days, p = 0.72) were similar between the restrictive and liberal transfusion groups. CONCLUSIONS: We were unable to detect significant improvements in mortality with a liberal as compared to restrictive transfusion strategy in critically ill trauma victims with moderate to severe head injury.

Adult↗