Biomedical subjects
L Kelly
Publications and source records attributed to L Kelly.
Four principles of family medicine. Do they serve us well?
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Short-term stimulation-induced decreases in brown fat temperature.
Electrical stimulation of the ventromedial hypothalamus (VMH) has been shown to activate brown adipose tissue (BAT) thermogenesis; we hypothesized that functional links between the VMH and other hypothalamic areas may serve to regulate intrinsic VMH control of brown fat heat production. Moveable electrodes were implanted in regions surrounding the VMH in adult male rats in order to assess any acute effect of activation of these structures alone on brown fat temperature. Stimulation in the area of the ventral lateral thalamic nucleus and the zona incerta (ZI) elicited a 0.2 to 0.8 degrees C drop from brown fat baseline temperature in 48 of 55 rats; the effective sites in the ZI area are restricted to the actual band of the nucleus. Application of the alpha-adrenergic blocker phentolamine prior to restimulation of active sites yielded mixed results; these findings are compatible with a role for the vasoconstrictive action of alpha-adrenergic receptors in the regulation of BAT temperature drops. The mechanisms underlying thermoregulatory responses or diurnal temperature cycling may provide a physiological context for the findings reported here.
Absence of negative attitudes toward childbearing among pregnant teenagers. A risk factor for a rapid repeat pregnancy?
OBJECTIVE: To test the hypothesis that adolescent mothers who conceive again during the first postpartum year express more positive attitudes toward childbearing while pregnant than do adolescent mothers who postpone further childbearing. METHOD: Prospective, cross-sectional, population-based survey. DESIGN: A racially diverse group of 200 consecutively enrolled, poor, pregnant 13- to 18-year-old patients in an adolescent-oriented maternity program were interviewed to determine why they had not used contraceptives prior to the index conception. The study participants were followed up prospectively for the first postpartum year. The data analysis included t tests, chi 2 tests, analysis of variance, and logistic regressions. RESULTS: The repeat pregnancy rate was 11.5% during the first postpartum year. As hypothesized, those who became pregnant again were more likely to have expressed positive attitudes toward childbearing during the index pregnancy (60.9% vs 39.6%; P = .05; odds ratio = 2.38; 95% confidence interval, 0.96-5.90). In addition, those who conceived again were more likely to have had a prior miscarriage, dropped out of school, abused illicit substances, moved away from home, and reported inadequate family support during the index pregnancy, and were less likely to plan to use levonorgestrel (Norplant) following delivery. The best model for predicting repeat pregnancy included education status, postpartum plans for Norplant use, and miscarriage history. Having a positive attitude toward childbearing during pregnancy was not included in the final model because it did not contribute to the model or affect any of the other parameters in the model. CONCLUSIONS: The sexually active teenaged mother who does not use contraception poses a perplexing diagnostic dilemma. The differential diagnosis is a long, complex one that includes ambivalent feelings about postponing future childbearing. This study demonstrates an indirect association between positive attitudes toward childbearing during pregnancy and repeat adolescent pregnancy. Our finding that this association operates through common linkages between maternal educational and contraceptive plans and both positive attitudes toward childbearing and repeat adolescent pregnancy suggests that interventions specifically targeting these underlying causes could reduce the unsafe sexual practices that persist among the participants in comprehensive adolescent-oriented maternity programs.
Why pregnant adolescents say they did not use contraceptives prior to conception.
OBJECTIVE: In this study we attempted to learn why childbearing adolescents failed to use contraceptives prior to conception. We hypothesized that among adolescents who elect to bear their children, positive and/or ambivalent feelings about having a baby are the most frequently cited reasons for not having used contraceptives. STUDY DESIGN: This is a cross-sectional, clinic-based survey of a racially and ethnically diverse group of 200 consecutively enrolled, poor, pregnant, 13-18-year-old patients in an adolescent-oriented maternity program. The participants completed a self-administered questionnaire which elicited information about environmental and personal risk factors for inconsistent use of contraceptives and information about the reasons they had not used contraceptives consistently prior to conception. Student's t-tests, Chi-square, and logistic regression analyses were used. RESULTS: The most frequently cited reasons for not using contraceptives prior to conception were: "I didn't mind getting pregnant" (20%) and "I wanted to get pregnant" (17.5%), followed by "I was using birth control but it didn't work (broke)" (12%), "I thought there was something wrong with me and I couldn't get pregnant" (9%) and "I just didn't get around to it" (9%). Teenagers who cited positive and/or ambivalent attitudes toward childbearing as their primary reason for not using contraceptives at the time of conception did not differ from others with regard to age, Medicaid status, gravidity, parity, frequency of living with parents, partner's age, depressive symptoms, or perceived family support. They were, however, more likely to have known the father of the baby for more than 6 months at the time of conception [odds ratio (OR) 2.53; 95% confidence interval (CI) 1.22-5.26) and to have dropped out of school (OR) 2.15; 95% CI 1.10-4.26]. CONCLUSIONS: The study hypothesis was supported. The absence of negative attitudes toward having babies rather than negative attitudes toward contraceptives is the most commonly cited reason for nonuse of contraceptives among childbearing adolescents. The results of this study may enable health care and social service providers to design more effective programs for preventing first and subsequent adolescent pregnancies.
Differences in laser-induced autofluorescence between adenomatous and hyperplastic polyps and normal colonic mucosa by confocal microscopy.
Laser-induced autofluorescence has been used to discriminate normal from adenomatous colonic mucosa. However, few studies to date have studied the origin of colonic autofluorescence. Using confocal microscopy (excitation wavelength 488 nm), we have shown that autofluorescence at this wavelength is present predominantly in the lamina propria of normal mucosa but in the epithelium in adenomatous and hyperplastic polyps. The intensity ratio of epithelial cell to lamina propria fluorescence was significantly lower (P < 0.0001) in normal mucosa (0.52 +/- 0.01) compared with either adenomatous (1.6 +/- 0.2) or hyperplastic polyps (1.7 +/- 0.15). However, the ratios were not significantly different between hyperplastic and adenomatous polyps. Thus, confocal microscopy enables the detection of the sites of autofluorescence within colonic mucosa and the quantitation of differences in fluorescence between different tissue types.
Improved competitive enzyme immunoassay for the diagnosis of bovine brucellosis.
A modification of the competitive enzyme-linked immunosorbent assay (C-ELISA) for differentiating the antibody response of cattle vaccinated with Brucella abortus strain 19 and B. abortus infected cattle is described. This assay utilizes lipopolysaccharide as the antigen, immobilized on a polystyrene matrix, and a monoclonal antibody (M84) with specificity for an epitope of the O-polysaccharide. A goat anti-mouse IgG antibody-enzyme conjugate is used for detection. The specificity of the modified assay was 99.7% when 1446 sera from brucellosis free herds were tested and it correctly identified 636 sera from B. abortus infected cattle as positive, using a cut-off of 30% inhibition, for a sensitivity estimate of 100%. No reactions were noted among 261 sera from vaccinated cattle. However, in testing 1147 sera that gave positive reactions in the buffered plate antigen test, the indirect ELISA, the complement fixation test or a combination of these tests from the serum bank, 31 gave positive reactions. Twenty-seven of the 31 sera originated from recently vaccinated cattle. The overall specificity for sera from vaccinated cattle was 97.3%. Because of the sensitivity and specificity of this procedure and its ease of performance, it would be a reasonable alternative as a single assay for serological diagnosis of brucellosis.
The expression of antisense and ribozyme genes targeting citrus exocortis viroid in transgenic plants.
Four ribozyme and antisense genes targeting citrus exocortis viroid (CEVd) positive- and negative-strand RNA molecules were constructed and used to transform the tomato Lycopersicon lycopersicum cv. UC82B. The tomato is a readily transformable plant and will support replication of CEVd following mechanical inoculation. The ribozyme genes contained three hammerhead catalytic motifs with long hybridizing arms and synthetic RNA transcripts were shown to cleave the target CEVd RNA molecule in vitro. Homozygous transgenic plants were produced from independent transformants expressing either ribozymes or antisense constructs. Inoculation of transgenic seedlings expressing antisense constructs targeting the negative-strand CEVd RNA molecule with CEVd resulted in a moderate reduction in the accumulation of CEVd RNA. In contrast, similarly inoculated transgenic plants expressing constructs targeting the positive-strand CEVd RNA molecule resulted in an increase in the rate of CEVd RNA accumulation. Addition of the ribozyme motifs to the antisense genes did not enhance their efficiency in the suppression of viroid replication and a moderation or elimination of the observed antisense effects was seen in plants expressing the corresponding catalytic RNA-encoding genes.
Characterisation of the subgenomic RNAs of an Australian isolate of barley yellow dwarf luteovirus.
We have characterised the subgenomic RNAs of an Australian isolate of BYDV-PAV. Northern blot analyses of infected plants and protoplasts have shown that this isolate synthesizes three subgenomic RNAs. Precise mapping of the transcription start sites of all three subgenomic RNAs and translational analyses of subgenomic RNA 2 and 3 have revealed a number of features. First, the transcription start site of subgenomic RNA 1 in this isolate differs markedly from the start site determined for an Illinois isolate of BYDV-PAV. Second, the start sites of subgenomic RNA 1 and 2 occur at a sequence that closely resembles the 5' end sequence of the genomic RNA (5'AGUGAAGA). Third, subgenomic RNA 2 appears to express ORF 6 of BYDV-PAV but the gene product is truncated due to the appearance of a new stop codon in the sequence. Last, subgenomic RNA 3, which is abundantly transcribed and encapsidated by the virus particle, appears to have no coding ability. We postulate that this novel subgenomic RNA has a regulatory function.
Sequence variability in the genome-3'-terminal region of BYDV for 10 geographically distinct PAV-like isolates of barley yellow dwarf virus: analysis of the ORF6 variation.
Nucleotide sequence of the genome terminal region 3' to the capsid-readthrough cistron were compared for 10 PAV-like isolates of barley yellow dwarf virus (BYDV) from three continents. The sequenced region varied in length from 853 to 864 nucleotides and the extent of sequence homology among the isolates ranged from 84 to 99%. Sequence variations occur mainly in two locations, one in the ORF6 coding region and the other near the genome 3' terminus. Sequence homology grouping reveals three genetically distinct clusters of PAV isolates (A, B and C). Cluster A consists of the Australian isolates, cluster B of one Canadian and three French isolates, and cluster C of the French isolate, RG. Dissimilarities with the corresponding genome-3'- terminal region of the BYDV-MAV serotype were greater than those observed between the PAV isolates alone. Comparison with the sequence of the 3' untranslated region of soybean dwarf virus revealed two stretches of nucleotide similarity, suggesting a common ancestor. Study of the coding ability revealed that the ORF6 is present in all the sequenced PAV isolates but differs in size and deduced amino acids composition. However, the fact that the majority of nucleotide changes are restricted to the third base position of the ORF6-codons suggests that ORF6 codes for a functional protein.
The use of divalent cation chelating agents (EDTA/EGTA) to reduce non-specific serum protein interaction in enzyme immunoassay.
An indirect enzyme immunoassay (ELISA) for detection of bovine antibody to Brucella abortus was modified by the addition of divalent chelating agents to the serum diluent. This addition resulted in an increase in specificity from 96.0% in the regular assay to 99.4% in the modified procedure. Of the 15,715 sera initially tested by the indirect ELISA, 691 that had given positive reactions were selected for retesting in the indirect ELISA with EDTA/EGTA added. The buffered plate antigen test (BPAT) correctly identified 98.6% of the samples as negative. The addition of chelating agents did not alter the sensitivity of the indirect ELISA, which correctly classified 609 sera from animals from which B. abortus had been isolated as positive. The sensitivity of the BPAT was 97.8%.
Raised urinary neopterin levels and Chlamydia trachomatis infection.
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Comparative analysis of neovascularization in primary cutaneous melanoma and Spitz nevus.
Spitz nevus is a well-known histologic simulator of malignant melanoma. Vascularity of human neoplasms has been associated with prognosis as well as propensity for metastasis. Were vascularity significantly different between melanoma and Spitz nevus, it could serve as a feature to distinguish between these two neoplasms. We evaluated the vascularity of a series of primary cutaneous melanomas ranging from thin superficial spreading to nodular lesions as well as superficial compound and nodular deep Spitz nevi by using light-microscopic evaluation of factor-VIII-stained sections. Vascularity was density graded and microvessels were counted per x200 and x400 field. Vascular density and microvessel counts were significantly different between melanomas of 2+ and 3+ vascularity compared with all types of Spitz nevi. Although nodular malignant melanomata tended to have a greater degree of vascularity than thin melanomas, there was a significant population of both of these subtypes having few or many vessels. We conclude that the number of microvessels per x200 and x400 field in areas of greatest vascularity is significantly less in Spitz nevus than in malignant melanoma. There is a subset of melanoma, however, in which the number of microvessels may be low. Nodular melanomata tended to have a greater number of vessels than did thin superficial spreading lesions. Evaluation of microvessel count may be of assistance when coupled with clinical and histologic findings in distinguishing between melanoma and Spitz nevus in selected cases.
Reinnervated lateral antebrachial cutaneous neurosome flaps in oral reconstruction: are we making sense?
Eight patients who underwent a partial glossectomy and associated floor of the mouth resection for squamous cell carcinoma were reconstructed with a sensate radial forearm flap in which the lateral antebrachial cutaneous nerve was anastomosed to the (divided) lingual nerve. The patients were compared prospectively with matched controls who received noninnervated forearm flaps for the same defect. A "blinded" therapist performed detailed sensory testing at least 6 months following surgery. In all modalities examined, the sensate proved superior to the nonsensate flap and not statistically different from the opposite side of the tongue. Two-point discrimination and pressure sensitivity were much greater in the innervated forearm flaps than in the forearms from which they came. The results are discussed with reference to the density of sensory receptors, the degree of cortical representation, and the subcortical anatomy of the neurosensory tracts. It appears that the density of sensory receptors is not directly related to the sensory potential in a given tissue transfer and that this potential is more related to the cortical fidelity of the recipient nerve. A historical matched cohort of 10 patients receiving pectoralis flaps for similar defects also was examined. Although the follow-up was longer, reinnervation was of a very low order--even worse than with noninnervated forearm flaps. This work supports the concept that sensory reinnervation should be attempted whenever possible following ablative oral surgery. This would include suture or grafting of major sensory nerves as well as the reinnervation of flaps.
Alloimmunisation via previous transfusion places female Kpb-negative recipients at risk for having children with clinically significant hemolytic disease of the newborn.
We report a case of clinically significant hemolytic disease of the newborn due to Kpb alloimmunisation requiring obstetric intervention. This case and a review of the literature are in contrast to reviews of hemolytic disease of the newborn that either ascribe no significance to the Kpb antigen or suggest that it causes only rare or mild disease. Analysis of our Kpb-negative donor pool suggests that prior transfusion greatly increases the chance of alloimmunisation. The role of frozen rare donor registry cells as a public resource is emphasised.
The treatment of severe behavior problems in school settings using a technical assistance model.
We evaluated the feasibility of local school personnel conducting functional analysis and reinforcement-based treatment procedures within actual classroom settings. Following an initial in-service workshop on functional assessment and differential reinforcement procedures, on-site technical assistance was provided two to four times per month to local school personnel working in transdisciplinary teams. Overall results suggest that local school personnel were able to implement all procedures adequately with periodic technical assistance. In addition, functional analysis was effective in identifying individual maintaining contingencies, the derived treatments were effective, and the results were maintained throughout the approximate 18 months of this investigation.
Rapid assay of lactoferrin in keratoconjunctivitis sicca.
We compared measurement of lactoferrin concentration by the LactoCard solid phase ELISA assay with the LactoPlate radial immunodiffusion assay in tears of normal patients and those with keratoconjunctivitis sicca. The LactoCard, a new lactoferrin assay, allows rapid determination of tear lactoferrin concentration in 10-15 min, a notable improvement over the 3 days required of the LactoPlate. There was no statistically significant difference between the accuracy of the two assays in normal patients nor in those patients with a diagnosis of keratoconjunctivitis sicca. Both assays showed a significant decrease in tear lactoferrin concentration in patients with severe keratoconjunctivitis sicca when compared to normal patients. The LactoCard is a rapid and reliable means of measuring tear lactoferrin concentration in a clinical setting.
Correlation of two-point discrimination and hand function following median nerve injury.
Two-point discrimination (2pd) (moving and static) and object identification were assessed in 43 patients after median nerve repair and graft in the middistal forearm. The mean age was 37 years (range, 16-78 yr). Twenty-six patients underwent primary median nerve repair and 17 had secondary median nerve grafts. The minimum follow-up time was 2 years. The values of moving 2pd and static 2pd ranged from 2 to > 16 mm. Both moving 2pd and static 2pd had strong correlational relationships with hand function as measured by object identification. Correlation coefficients for the relationship between 2pd (moving and static) and total objects identified ranged from 0.66 to 0.74.