Biomedical subjects
Publications and source records attributed to L Stone.
In this article, the author outlines the factors which will influence the development of dermatology nursing services in the future. Nurses must be correctly prepared to develop the necessary new roles and how this could be achieved is discussed.
OBJECTIVES: To measure levels of the major Dermatophagoidespteronyssinus allergen (Der p 1) in homes in Wellington, New Zealand, and to examine factors which affect these levels. METHODS: As part of a study of risk factors for asthma among 474 8-10-year-old children, standard procedures were used to collect reservoir dust and to measure Der p 1 levels on the living room floor and child's bedroom floor and bedding. Der p 1 levels were analysed both as geometric mean microg/g of fine dust and as microg/m2. Questionnaires collected information about factors which might influence these levels, and an average relative humidity in the bed and on the bedroom floor was also measured. RESULTS: Similar geometric mean levels of Der p 1 were found at each floor site - 25.5 microg/g (95% CI: 22.8-28.5) in the living room and 26.4 microg/g (95% CI: 23.7-29.3) on the child's bedroom floor. The geometric mean level of Der p 1 in the child's bed was 46.6 microg/g (95% CI: 42.3-51.3). After controlling for possible confounders, geometric mean living room and bedroom floor Der p 1 levels were significantly higher in households with older carpet than households with no carpets or newer carpets, and higher in the autumn. Households with three or more children had higher levels of Der p 1 than households with fewer children. Bedding levels were significantly higher in beds with kapok or inner sprung mattresses, or wool underlays and at relative humidities above the mean (51%). CONCLUSION: The very high levels of house dust mite allergen (Der p 1) found in Wellington are likely to be due to a variety of life-style and climatic factors. However, the type and age of floor covering appears to be the single most important factor.
This study examined the effect of streptozotocin-induced diabetes on biliary reduced glutathione (GSH) efflux. Biliary GSH efflux was measured before and after acivicin, an irreversible inhibitor of gamma-glutamyl transpeptidase (GGT). One week after streptozotocin treatment, liver GGT activity doubled in diabetic rats but was inhibited by approximately 90% after acivicin to levels comparable to controls. Despite maximal GGT inhibition, biliary GSH efflux in untreated diabetic rats decreased progressively to approximately 10% of control levels by week 4 and was partially restored by insulin. The mechanism for the decrease in biliary GSH efflux was not increased paracellular permeability. GSH transport kinetics, ATP-stimulated taurocholate, and oxidized glutathione (GSSG) transport in canalicular liver plasma membrane prepared from diabetic and control rats were similar. Inhibition of protein kinase C (PKC) with high-dose H-7 increased biliary GSH efflux in diabetic animals to near control basal levels. In conclusion, streptozotocin-induced diabetic rats exhibit a progressive impairment in biliary GSH transport. One of the responsible mechanisms is heightened PKC tone in diabetic animals.
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A cross-sectional evaluation of 243 unipolar, nonpsychotic outpatients with major depression was conducted. All subjects were diagnosed by RDC with SADS-L structured interviews. Diagnoses included RDC primary/secondary, RDC endogenous/nonendogenous and Winokur's family-history subtypes. Symptom severity was assessed by the 17-item Hamilton Rating Scale for Depression. Chronic depression was defined as the current episode of major depression lasting at least 2 years, corresponding to DSM-III-R and -IV criteria. Patients with chronic depression (n = 64) were compared with those with nonchronic depression (n = 179). Chronicity was not related to gender, symptom severity, prior length of illness, age at onset of illness, RDC endogenous/nonendogenous, RDC primary/secondary or Winokur's family-history subtypes. Those with chronic depression were older and had fewer major depressive episodes than the nonchronic group. That the chronic group had fewer total episodes of depression than the nonchronic group, but a similar age at onset, is consistent with the notion that patients in a current chronic episode have characteristically longer depressive episodes throughout the course of their illness. Those with chronic episodes may be subject to psychological, biological and/or sociocultural factors that preclude an earlier episode remission for these individuals.
In the LEW/N rat model, a decreased hypothalamic-pituitary-adrenal (HPA) axis response to inflammatory and immune mediators confers susceptibility to the development of a variety of inflammatory and immune diseases, including experimental allergic encephalomyelitis. In humans with optic neuritis, early intervention with steroids is associated with a decrease in the number of patients who go on to develop multiple sclerosis (MS). The current study was designed to determine whether patients with MS show evidence of a hypoactive HPA axis. Thirteen patients with MS were studied at baseline and with provocative tests of HPA axis function [ovine CRH, arginine vasopressin (AVP), and ACTH stimulation]. Compared to matched controls, patients with MS had significantly higher plasma cortisol levels at baseline. Despite this hypercortisolism and in contrast to patients with depression who had similar elevations in plasma cortisol levels, patients with MS showed normal, rather than blunted, plasma ACTH responses to ovine CRH, suggesting that the pathophysiology of hypercortisolism in MS is different from that in depression. Patients with MS also showed blunted ACTH responses to AVP stimulation and normal cortisol responses to high and low dose ACTH stimulation. Taken together, these findings are compatible with data from studies of experimental animals exposed to chronic inflammatory stress, which showed mild increased activation of the HPA axis with increased relative activity of AVP in the regulation of the pituitary-adrenal axis. These data do not support a role for hypocortisolism in MS once the disease is established.
Devising a method capable of distinguishing a low-dimensional chaotic signal that might be embedded in a noisy stochastic process has become a major challenge for those involved in time-series analysis. Here a null hypothesis approach is used in conjunction with a known nonlinear predictive test, to probe for the presence of chaos in epidemiological data. A probabilistic set of rules is used to stimulate a historic record of New York City measles outbreaks, generally understood to be governed by a chaotic attractor. The simulated runs of 'surrogate data' are carefully constructed so as to be free from any underlying low-dimensional chaotic process. They therefore serve as a useful null model against which to test the observed time series. However, despite the assumed differences between the dynamics of measles outbreaks and the null model, a nonlinear predictive scheme is found to be unable to differentiate between their characteristic time series. The methodology confirms that, if there is in fact a chaotic signal in the measles data, it is extremely difficult to detect in time series of such limited length. The results have general relevance to the analysis of physical, ecological and environmental time series.
The adoption of Primary Health Care in developing countries brought a new interest in the influence of cultural factors in community health programs. This paper traces the changes in the way that the role of culture has been analyzed in relation to community health issues and in particular with respect to 'community participation'. A look at recent perspectives shows that the fate of community health programs has come to be seen as relying more on structural factors in health care systems than on cultural factors within local communities. There has also been an increasing emphasis on political factors or power relationships within and between health agencies, governments, and various levels of national health care systems. These perspectives raise new questions for community health programs and the strategy of community participation.
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Dystonic tics, in contrast to clonic tics, are relatively slow and temporarily sustained twisting, pulling, or squeezing movements producing briefly maintained abnormal postures. Because dystonic tics often present diagnostic difficulties, we studied these motor tics in 156 patients with Tourette's syndrome (TS). In addition to clonic motor and vocal/phonic tics, seen in all patients, 89 (57%) of them exhibited one or more dystonic tics. The most common dystonic tics were oculogyric deviations (43 patients), blepharospasm (23), and dystonic neck movements (11). Blinking (110) and facial twitching (86) were the most common clonic tics. Except for possibly a greater familial occurrence, a higher frequency of previous head trauma, and associated attention deficit disorder, the group of patients with dystonic tics did not significantly differ in any of the major clinical variables from those TS patients without dystonic tics. We conclude that dystonic tics are typical motor manifestations of TS and that patients with these motor tics are not different from those with more typical clonic tics.
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Fulminant preseptal eyelid cellulitis developed in two previously healthy children, aged 17 months and 8 years, following minor trauma. Despite appropriate intravenous antibiotic therapy, lid necrosis with ulceration developed in both patients. In both cases group A beta-hemolytic Streptococcus was the causative agent. Spontaneous granulation of the ulcerated areas resulted in cicatricial defects, which in one case may require surgical correction. Neither child had a past history of susceptibility to infection. Group A beta-hemolytic Streptococcus has been known to cause lid gangrene, but almost all previously documented cases occurred in debilitated or elderly patients.
The net rates of uptake of "new" and loss of "old" 2R,4'R,8'R-alpha-tocopherol (RRR-alpha-TOH, which is natural vitamin E) have been measured in the blood and in nine tissues of male guinea pigs over an eight week period by feeding diets containing deuterium-labelled alpha-tocopheryl acetate (d6-RRR-alpha-TOAc). There was an initial two week "lead-in" period during which 24 animals [the "high" vitamin E (HE) group] received diets containing 36 mg of unlabelled (d0) RRR-alpha-TOAc and 250 mg of ascorbic acid per kg diet, while another 24 animals [the "low" vitamin E (LE) group] received diets containing 5 mg d0-RRR-alpha-TOAc and 250 mg ascorbic acid per kg diet. The HE group was then divided into three equal subgroups, which were fed diets containing 36 mg d6-RRR-alpha-TOAc and 5000 mg [the "high" vitamin C (HEHC) subgroup], 250 mg [the "normal" vitamin C (HENC) subgroup] and 50 mg [the "low" vitamin C (HELC) subgroup] ascorbic acid per kg diet. One animal from each group was sacrificed each week and the blood and tissues were analyzed for d0- and d6-RRR-alpha-TOH by gas chromatography-mass spectrometry. The LE group was similarly divided into three equal subgroups with animals receiving diets containing 5 mg d6-RRR-alpha-TOAc and 5,000 mg (LEHC), 250 mg (LENC) and 50 mg (LELC) ascorbic acid per kg diet with a similar protocol being followed for sacrifice and analyses. In the HE group the total (d0(-) + d6-) RRR-alpha-TOH concentrations in blood and tissues remained essentially constant over the eight week experiment, whereas in the LE group the total RRR-alpha-TOH concentrations declined noticeably (except in the brain, an organ with a particularly slow turnover of vitamin E). There were no significant differences in the concentrations of "old" d0-RRR-alpha-TOH nor in the concentrations of "new" d6-RRR-alpha-TOH found in any tissue at a particular time between the HEHC, HENC and HELC subgroups, nor between the LEHC, LENC and LELC subgroups. We conclude that the long-postulated "sparing" action of vitamin C on vitamin E, which is well documented in vitro, is of negligible importance in vivo in guinea pigs that are not oxidatively stressed in comparison with the normal metabolic processes which consume vitamin E (e.g., by oxidizing it irreversibly) or eliminate it from the body.(ABSTRACT TRUNCATED AT 400 WORDS)
Twenty-three extremities in 17 brain-injured adults were prospectively studied to evaluate the effectiveness of percutaneous phenol blocks of the musculocutaneous nerve in controlling spasticity of the biceps and brachialis muscles. Twenty-one (93%) of the extremities improved after the initial injection. The mean resting position decreased from 120 degrees of flexion to 69 degrees. Elbow range of motion increased an average of 53 degrees. There were no complications. Two patients did not respond to the initial injection and required repeat nerve blocks. Concomitant phenol motor point block of the brachioradialis muscle further improved elbow motion. The mean duration of the block was 5 months. Follow-up averaged 21 months. This study indicates that percutaneous phenol injection of the musculocutaneous nerve provides reliable, temporary relief of spasticity in patients with potential for further neurologic improvement.
The relationship between juvenile delinquency and psychiatric disorders remains poorly understood. However, it is becoming more apparent that the spectrum of psychiatric illness present in juvenile delinquents is broader than once believed. Fifteen female juvenile delinquents committed to a residential treatment program were assessed for DSM-III diagnoses, using a structured diagnostic interview, the Diagnostic Interview for Children and Adolescents (DICA). A search of the literature revealed no other reports using the DICA in female juvenile delinquents. A broad spectrum of current and past diagnoses was discovered, including conduct disorder (100%), substance abuse/dependence (87%), major depression (67%), and anxiety disorders (47%). The average number of lifetime diagnoses per subject was 4.7; current diagnoses averaged 3.4 per subject. Additionally, criminal and status offense records were obtained for each subject. No significant relationship was noted between diagnoses and categories of offense. These results add further evidence for the presence of frequent and severe psychiatric disturbances in this population, and the need for increased clinical and research efforts by the psychiatric community.
The likelihood of obtaining interpretable results is as important as sensitivity and specificity in selecting diagnostic tests. We reviewed medical and radiologic records of 140 consecutive inpatients over the age of 65 years who underwent a nonemergent barium enema. In 43 (31%) of these patients, the examination was incomplete or the results were uninterpretable. Thirteen patients could not retain the barium, and 27 patients had too much stool. Characteristics associated with an inadequate barium enema included confusion (adjusted odds ratio, 3.5), fever (adjusted odds ratio, 4.1), and cachexia (adjusted odds ratio, 2.7). Characteristics more common among subjects unable to retain barium than among subjects with too much stool were diarrhea (38% vs 18%) and fecal incontinence (31% vs 0%). The high frequency of inadequate results suggests that clinicians should consider whether a barium enema is the appropriate test in elderly patients with these characteristics, and, if so, what interventions may increase the chance for success.
Fifty adult patients who sustained a traumatic brain injury (TBI) were screened for the presence of a peripheral nerve injury (PNI). All suspected patients had diagnostic electromyography performed in order to confirm the clinical findings. The incidence of PNI with TBI was 34%. A variety of nerve injuries were seen, the most frequent of which were ulnar nerve entrapment at the elbow (10%) and brachial plexus injuries (10%). No patient initiated a complaint that led to the diagnosis. In addition, all the neuropathies were missed prior to admission. The neuropathies commonly were found in the neurologically impaired extremity and associated with spasticity. The results of this study suggest that patients sustaining a TBI have a significant and higher incidence of PNI as a complication than previously reported.
We have analyzed Na+,K+-ATPase (EC 3.6.1.3) alpha- and beta-subunit mRNA expression in rat tissues and cell lines derived from the rat central nervous system. Substantial differences in the tissue and developmental specificity of expression were found for the genes encoding three isoforms of the alpha subunit. Transcripts of the alpha 1-subunit gene were detected in all tissues tested, whereas alpha 2- and alpha 3-subunit mRNA species were expressed predominantly in brain. The pattern of expression of beta-subunit mRNA also was complex and tissue specific but was distinct from that of any of the alpha-subunit mRNAs. Cell lines derived from the rat central nervous system and the pheochromocytoma PC12 expressed the mRNAs for all three alpha-subunit isoforms, whereas beta-subunit mRNA was detected only in PC12 cells. The distinct expression patterns of rat Na+,K+-ATPase mRNAs suggest that different members of the ATPase family may have specialized functions.