Biomedical subjects

L S Martin

Publications and source records attributed to L S Martin.

At least 19 recordsLinked to original sources

PubMed2000

Parental decision-making differences between patients in two healthcare systems for choroid plexus cysts.

We evaluated the medical-sociological implications of parental perception of risk and decision-making choices for prenatally ascertained choroid plexus cysts (CPC) between two obstetric populations. The Wayne State University (WSU) Reproductive Genetics database and the Madigan Army Medical Center (MAMC) experience were reviewed to compare the rates of aneuploidy and invasive testing for cases with CPC. Aneuploidy rates were compared between those with isolated CPC, CPC with advanced maternal age (AMA), and CPC associated with multiple anomalies. In the WSU cohort 186 cases were identified, of whom 27 (15%) declined invasive fetal testing. In the remaining 159 cases, aneuploidy was present in 2/132 (1.5%) isolated CPC, 3/11 (27%) CPC with AMA, and 15/16 (93%) CPC with multiple anomalies. In the MAMC cohort 107 cases were identified, of whom 99 (92%) declined invasive fetal testing. No aneuploidy cases were found in the 3/12 AMA cases or 5/95 non-AMA cases that underwent amniocentesis. The two cases of aneuploidy with isolated CPC cannot be ignored, and provide an estimated attributable risk of at least 0.8%, a higher risk than 38 years of age. However, the parental sociologic context may be as important for decision-making as the genetic-prognostic risk.

Abnormalities, Multiple↗

PubMed2000

[Autonomic neuropathy in a diabetic population. Validity of cardiovascular tests and correlations with the complications].

The disfunction of the autonomic system nervous is a frequent finding in diabetes mellitus. Among objective tests proposed for its diagnosis, those assessing cardiovascular reflexes (cardiovascular tests: CVTs) explore the autonomic functionality by means of a group of standardized manoeuvres of relatively easy execution that study the baroreceptorial reflex arc. In our study, CVTs were performed in a population of 207 diabetic patients with no symptoms of autonomic neuropathy. A computerized automatic system (Cardionomic) was utilized. CTVs included: Deep Breathing, Lying to Standing, Valsalva Manoeuvre, Orthostatic Hypotension, Standing to Lying and Cough Test. Diabetic patients were broken down in groups according to: a) age, b) HbA1c levels, c) disease duration. We have then compared the presence of diabetic complications between the group of diabetics positive for cardiovascular disautonomia (CVD+) with another group of diabetics who were negative for cardiovascular disautonomia (DCV-). Our results show a remarkable correlation between autonomic neuropathy and patients age, HbA1c levels and disease duration. Also they show a strong positive correlation between CDV+ and the severity of arteriopathy. We conclude that autonomic neuropathy may play an important role in the pathogenesis of diabetic arteriopathy.

Adult↗

PubMed1999

Using the towel bath to give tender care in dementia: a case example.

Using the "towel" bath to clean the skin for such residents as Helen results in a reduction of agitation and an increase in comfort as the skin is cleansed. The "towel" bath is a very useful technique which should be incorporated into educational training programs for any care provider who will be working with persons with dementia. It is a procedure that can be adapted to the care of the most challenging resident and will help staff begin to display person-centred care for the resident who is afraid of care procedures and responds negatively as a result. The procedure itself addresses the issues of water temperature and privacy in a way that traditional basin bathing makes difficult. The "towel" bath should be included in the practice repertoire and used on a regular basis by all practitioners who work in this area of geriatric specialty.

Aged↗

PubMed1997

Serum levels of tumour necrosis factor-alpha predict response to recombinant human erythropoietin in patients with myelodysplastic syndrome.

We measured pretreatment serum levels of tumour necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) in 25 patients with myelodysplastic syndrome receiving recombinant human erythropoietin (rhEPO) at dosages up to 300 U/kg thrice weekly for 12 weeks. Both TNF-alpha and IL-1 beta levels were measured using commercially available enzyme-linked immunoassays. A complete response (CR) was defined as a rise in untransfused haemoglobin concentrations of at least 2 g/dl or a 100% decrease in RBC transfusion requirements over the treatment period; a partial response (PR) was an increase in untransfused haemoglobin values of 1-2 g/dl or a decrease in RBC transfusion requirements equal to or greater than 50%; no response (NR) was defined as a response less than a PR. After 12 weeks of rhEPO treatment, four patients showed a CR, five patients a PR, and 16 patients NR. Serum levels of both TNF-alpha (80.5 %/- 64.8 vs 8.1 +/- 4.2 ng/l, P < 0.001) and IL-1 beta (60.4 +/- 49.9 vs 8.9 +/- 4.7 ng/l, P < 0.001) were higher in MDS patients than in a group of 28 normal controls. Responders (CR + PR) showed significantly lower serum levels of TNF-alpha than non-responders (21.6 +/- 26.2 vs 106.3 +/- 60.8 ng/l, P < 0.001), whereas IL-1 beta concentrations between those who benefited from therapy and unresponsive cases were not significantly different (39.8 +/- 48.9 vs 73.4 +/- 48.2 ng/l, P = 0.120). It is noteworthy that TNF-alpha levels were within the normal range in all responsive patients but one, whereas all non-responders presented elevated cytokine concentrations. No relationship was found between TNF-alpha or IL-1 beta values and haemoglobin levels, transfusion requirement, serum EPO or ferritin concentrations. We conclude that pre-treatment TNF-alpha levels might help to select those MDS patients who are most likely to benefit from rhEPO treatment.

Adult↗

PubMed1996

Aneuploidy among prenatally detected neural tube defects.

We have reported previously a 10% aneuploidy detection rate among 39 cases of fetal neural tube defects (NTD). Subsequently we amassed an additional experience of over 17,000 prenatal diagnosis cases over a 5-year period. During this period 106 cases of NTDs were identified; 44 with anencephaly, 62 with open spina bifida. The average maternal age of this population with NTDs was 29 years (15-40); 6 patients declined amniocentesis. Six of 100 cytogenetic studies were aneuploid; one anencephalic fetus had inherited a maternal marker chromosome, and 5 NTD cases had trisomy 18. The average maternal age of the aneuploid cases was 31 (19-40); 3 were 35 years or older. Four of 5 trisomy 18 cases had multiple congenital anomalies (MCA). The overall aneuploidy detection rate in our cohort was 5-6%, while aneuploidy occurred in 2% of the isolated NTD cases, and 24% of the MCA cases. Combining the earlier experience, 4/39 aneuploidy (2 trisomy 18, 4p+, del 13q) yields an aneuploidy detection frequency of 10/145 (7%), of which most (7/10) had trisomy 18. These data support fetal karyotyping for accurate diagnosis, prognosis, and recurrence-risk counseling.

Adolescent↗

PubMed1995

Respirators, recommendations, and regulations: the controversy surrounding protection of health care workers from tuberculosis.

Recent nosocomial outbreaks of tuberculosis have increased concern about the occupational acquisition of tuberculosis by health care workers. The Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, and the Occupational Safety and Health Administration, Department of Labor, have issued recommendations and regulations in an effort to decrease health care workers' risk for exposure to patients with infectious tuberculosis. Within the CDC, the National Center for Infectious Diseases, the National Center for Prevention Services, and the National Institute for Occupational Safety and Health collaborated to produce the 1994 Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities. As stated in the Draft Guidelines, the major components of health care worker protection from Mycobacterium tuberculosis infection include administration or source controls, engineering controls, and respiratory protective devices. We review the evolution of the seemingly conflicting recommendations for respiratory protective devices made by these Centers of the CDC and explain how the recommendations in the current CDC Guidelines were reached.

Centers for Disease Control and Prevention, U.S.↗

PubMed1995

Program development in military toxicology laboratories.

Military toxicology evolved from needs identified during the World Wars. The Army, Navy and Air Force developed toxicological capabilities in response to their respective operational needs. These 3 previously separate military toxicology efforts have been integrated into Tri-Service Toxicology in response to the continually changing and growing operational needs of the military. The continual process of program development must be initiated in order for Tri-Service Toxicology to improve, grow and better serve its customers. Program development entails developing and maintaining good customer relationships and cooperative relationships with other governmental agencies, industry and academia. The benefits of identifying and obtaining customers and collaborators will substantially outweigh the costs incurred by committing to the implementation of program development within Tri-Service Toxicology.

Humans↗

PubMed1995

Induction and subcellular localization of two major stress proteins in response to copper in the fathead minnow Pimephales promelas.

In the present study we characterize the stress response induced by copper in the fathead minnow, Pimephales promelas. The fathead minnow epithelial cell line ATCC CCL 42 was used to examine the induced synthesis and subcellular localization of the two major stress proteins, stress 70 and cpn60. Western blot analysis demonstrated increased stress70 in cells exposed to 400 and 500 microM Cu. Two-dimensional analysis revealed three isoforms of stress70, one of 70 kDa and two of 72 kDa, at the highest Cu concentration. Chaperonin60 abundance did not change over the same range of Cu concentrations. Indirect immunofluorescence microscopy revealed that stress70 localized in the cytoplasm, particularly in the paranuclear region. Chaperonin60 was localized in mitochondria. Further, when we examined the stress response elicited by Cu in fathead minnow larvae in vivo, we found that Cu induced the stress response at nominal Cu concentrations that were more than an order of magnitude lower that in the cell culture. This disparity between the concentration of Cu, which induced the stress response in cells in culture and in vivo, may be the result of differences in Cu complexation that alter its availability, uptake and toxicity.

Animals↗

PubMed1994

Tissue-specific differences in accumulation of stress proteins in Mytilus edulis exposed to a range of copper concentrations.

This study examines the expression and accumulation of two major stress proteins, stress70 and chaperonin60 (cpn60), in the gill and mantle of blue mussels, Mytilus edulis, which were exposed to a range of Cu concentrations for 7 days. Scope-for-growth (SFG), mortality, and Cu accumulation in gill and mantle tissue were also measured to monitor the physiological effects of Cu exposure in the organisms. In general Cu accumulated to a greater extent in gill relative to mantle tissue. A reduction of SFG index and increased mortality was also observed at the two highest Cu concentrations. We found no significant differences between the two tissues in the expression of cpn60 and stress70 for mussels exposed to Cu ranging from 0 to 10 micrograms/liter Cu (cpn60) and 0 to 32 micrograms/liter Cu (stress70) in sea-water. However, differences in the stress response were observed between the gill and the mantle tissue of mussels exposed to higher Cu concentrations. Chaperonin concentrations were greater than an order of magnitude higher in the gill than in the mantle for these mussels. Further, although the accumulation of stress70 was similar between the two tissues, two additional proteins reacted with antibody to stress70 in gill, but not mantle tissue, of mussels exposed to 100 micrograms/litter Cu. This study suggests that the physiological processes involved in contaminant uptake, distribution, and detoxification may affect the tissue-level expression of the stress response in multicellular organisms. Further, the intensity of the stress response and relative concentrations of chaperonin and stress70 among tissues may help identify tissues which are the most vulnerable to damage caused by a particular environmental stressor.

Animals↗

PubMed1994

Participatory control in chronic hospital-based hemodialysis patients.

The purpose of this study was to determine chronic hospital-based hemodialysis patients' perceptions of control over selected aspects of hemodialysis care and to compare the patients' ratings with the global ratings of nurses caring for them. Two versions of a 14-item Hemodialysis Control Questionnaire (HCQ) were developed, one for patients (HCQ-P) and one for nurses (HCQ-N). Forty-seven patients and 32 nurses rated both perceived and desired control for each aspect of hemodialysis care on the HCQ. Reasons for their ratings were elicited and recorded. High test-retest reliability was established for both perceived and desired control on the HCQ-P and the desired control component of the HCQ-N. Patients rated their overall perceived and desired control as moderate, likewise the nurses' global score for desired control was rated as moderate. Item-by-item analysis revealed that nurses overestimated the patients' desired control over technical aspects of care but underestimated the patients' desire for more control over nontechnical aspects of care. The content analysis of the verbatim responses supported the quantitative findings.

Adult↗

PubMed1994

Using genograms and ecomaps in schools.

Genograms and ecomaps are visual tools for assessing and planning care for children and adolescents. Using a simple format of the family tree, school nurses can enhance nursing care by viewing students in the context of their history and the connections that are part of their everyday life. Genograms and ecomaps can be used to clarify information and organize it in a brief, but relatively comprehensive, format. A case study illustrates the application of these techniques in the school setting.

Adolescent↗

PubMed1994

Copper inhibits the induction of stress protein synthesis by elevated temperatures in embryos of the sea urchin Strongylocentrus purpuratus.

A major component of the cellular stress response entails the induced synthesis of a suite of stress proteins under environmentally adverse conditions that functions to protect organisms from environmentally induced damage. Here, we examined induction of the stress response in the embryos of the sea urchin Strongylocentrus purpuratus under a combination of environmentally realistic conditions. First, we examined the response elicited over a range of free cupric ion activities, (Cu2+), using a metal buffer system to control trace metal speciation. We observed no pronounced differences in translational patterns in embryos exposed to free cupric ion activities, (Cu2+), of 10(-13)-10(-9) M by metabolic labeling, 1-dimensional electrophoresis and autoradiography. Further separation by 2-dimensional electrophoresis, however, revealed electrophoretically discernable variants of several groups of proteins at the higher Cu concentrations and the synthesis of a 60 kDa protein at (Cu2+) of 10(-9) M. In addition, there were differences in the stress response induced by heat-shock treatment in embryos cultured in seawater with different Cu concentrations; radiolabel was incorporated into a greater number of cellular proteins in embryos at lower (Cu2+) and the induced synthesis of stress proteins was greater. These data suggest that elevations in (Cu2+) impair the ability of the embryos to mount the stress response upon exposure to elevated temperatures and that Cu may alter critical developmental pathways by inhibiting the synthesis of regulatory proteins. Such effects on gene expression can result in manifestations that have been widely attributed to Cu toxicity, including developmental abnormalities and increased sensitivity to environmental extremes. We suggest that the particular sensitivity of embryonic systems upon exposure to multiple stressors may be a consequence of these mechanisms.

Animals↗

PubMed1994

Use of infection control guidelines by workers in healthcare facilities to prevent occupational transmission of HBV and HIV: results from a national survey.

OBJECTIVE: Develop national estimates of compliance with infection control guidelines by workers in healthcare facilities to prevent occupational transmission of hepatitis B virus (HBV) and human immunodeficiency virus. DESIGN: A national survey of 3,094 workers in hospitals. SETTINGS: United States ambulatory care hospitals with emergency rooms. RESULTS: While the sampled hospitals had policies that incorporated the Centers for Disease Control and Prevention's (CDC) infection control guidelines, only 55% of patient care staff, 56% of physicians, and 30% of housekeeping staff reported receiving at least one of the shots recommended in the HBV vaccination series. About one half of patient care staff reported that they recapped used needles at least sometimes after giving injections and after drawing blood. Only 43% of patient care staff "always" wore gloves to draw blood. While most patient care staff "always" changed gloves between patients, only 61% reported that they "always" washed their hands after taking off their gloves. One half of patient care staff reported a percutaneous exposure to a patient's blood, and one quarter reported a percutaneous exposure in the past year. The most common cause of these exposures was recapping used needles. CONCLUSIONS: Efforts to reduce exposures to bloodborne pathogens will involve compliance with the Occupational Safety and Health Administration bloodborne pathogens standard and the CDC's infection control guidelines, continued education and training, and emphasis on engineering controls where applicable.

Acquired Immunodeficiency Syndrome↗

PubMed1994

HIV-1 and bleach.

Explore the source record for details and available documents.

Disinfection↗

PubMed1994

Fetal compromise associated with extreme fetal bile acidemia and maternal primary sclerosing cholangitis.

BACKGROUND: Primary sclerosing cholangitis is a rare form of progressive biliary inflammation and fibrosis of unknown etiology that ultimately destroys the liver, leading to cirrhosis, liver failure, and death. Only one prior case has been reported in pregnancy. CASE: Our patient had the diagnosis of primary sclerosing cholangitis made 2 years before conception. Her course was remarkable for retroplacental hemorrhage at 14-16 weeks and preplacental hemorrhage at 28-34 weeks, with fetal growth retardation, spontaneous premature rupture of the membranes, meconium-stained amniotic fluid, fetal bradycardia, and peripartal exacerbations of her disease. Most uniquely, however, in our case the fetal compromise was associated with an extreme elevation of the bile acid level to greater than 2000 mg/dL in the fetal circulation. CONCLUSION: The extreme elevation of fetal bile acidemia at levels greater than 40 times normal in our case may well represent the pathophysiologic link between aberrations of maternal bile acid metabolism during pregnancy and fetal compromise.

Adult↗

PubMed1993

Stress proteins as biomarkers of contaminant exposure in archived environmental samples.

Stress proteins have been shown to provide information on the biological impact of toxic chemicals to organisms and to predict adverse consequences of that exposure. In this study we have examined the accumulation to two major stress proteins, hsp60 and hsp70, in banked samples to determine if they accumulate at high levels in organisms exposed to contaminants in their environment. We found that relative to laboratory controls, stress proteins concentrations were elevated in mussels and fish tissue collected as part of the NOAA National Status and Trends Program. Sediment and water chemistry from the stations where these organisms were collected and data on contaminant body burdens of these same organisms indicated that they had been exposed to contaminants for long durations in their environment. This study suggests that stress protein accumulation may provide a method for quantifying adverse biological impacts of exposure to chemicals in the environment when examined in wild populations from contaminated sites. This approach may also prove valuable in retrospective studies when used in banked specimens which have been collected as part of a large scale surveillance monitoring programs.

Animals↗

PubMed1993

The isolation of cDNAs from OATL1 at Xp 11.2 using a 480-kb YAC.

Using an ornithine-delta-aminotransferase (OAT) cDNA, we identified five YACs that cover two nonadjacent OAT-related loci in Xp11.2-p11.3, designated OATL1 (distal) and OATL2 (proximal). Because several retinal degenerative disorders map to this region, we used YAC2 (480 kb), which covers the most distal part of OATL1, as a probe to screen a retinal cDNA library. From 8 x 10(4) plaques screened, we isolated 13 clones. Two were OAT cDNAs. The remaining 11 were divided into eight groups by cross-hybridization. Groups 1-4 contain cDNAs that originate from single-copy X-linked genes in YAC2. Each has an open reading frame of > 500 bp and detects one or more transcripts on a Northern blot. The gene for each was sublocalized and ordered in YAC2. The cDNAs in groups 5-8 contained two or more Alu sequences, had no open reading frames, and did not detect transcripts. The cDNAs from groups 1-4 provide expressed sequence tags and identify candidate genes for the genetic disorders that map to this region.

Chromosomes, Fungal↗

PubMed1993

Using the mission statement to craft a least-restraint policy.

St. Peter's Hospital used the Mission Statement as a foundation upon which to build a new "Least Restraint Policy." The Mission Statement guided the change process by assisting us to 1) identify the need for change, 2) identify the values and beliefs on which a new policy should be based, 3) identify the need for interdisciplinary planning, and 4) identify the need for staff and family education before implementation of the new policy.

Aged↗