Metaphyseal osteomyelitis in a Labrador retriever.
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Animals↗
Biomedical subjects
M Sullivan
Publications and source records attributed to M Sullivan.
Responding to patient requests for physician-assisted suicide.
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Decision Trees↗
The unique roles of state hospital programs: keeping what works in an evolving system.
Ultimately, the outcome and cost-effectiveness research should convince a compassionate public that rehabilitation is worthwhile, wherever it takes place.
Community Mental Health Services↗
The DNA sequences required for apolipoprotein B expression in the heart are distinct from those required for expression in the intestine.
We recently reported that the apolipoprotein B (apo-B) gene is expressed in the heart and that the heart secretes apo-B-containing lipoproteins. We have also recently demonstrated that the tissue-specific expression of the apo-B gene is complex, with apo-B gene expression in the intestine being dependent on an enhancer element located very far from the structural gene (between 54 and 62 kb 5' to exon 1). In this study, we investigated whether these distant DNA sequences control or affect the expression of the apo-B gene in the heart. To address this issue, we analysed heart apo-B gene expression in heart tissue from a series of human apo-B transgenic mice generated from human genomic DNA constructs that ranged in size from 70 to 207 kb. All of these constructs contained the coding portion of the apo-B gene, but each contained different amounts of flanking sequences (5-120 kb 5' to the gene and 1.5-35 kb 3' to the gene). Each construct conferred human apo-B gene expression in the heart, including those containing as little as 5 kb of 5'-flanking sequences or as little as 1.5 kb of 3'-flanking sequences. These data support the idea that apo-B gene expression in the heart, unlike that in the intestine, is not affected by a distant enhancer element.
Animals↗
Unilateral negative pressure pulmonary edema during anesthesia with a laryngeal mask airway.
PURPOSE: To present a case of unilateral pulmonary edema after upper airway obstruction. CLINICAL FEATURES: In a 21-yr-old man, anesthesia was induced with propofol and maintained with N2O/O2/isoflurane via an LMA. After being placed in the lateral position, he had an episode of upper airway obstruction while breathing spontaneously. Hypoxemia (SpO2 80-83%) refractory to the administration of oxygen (F1O2 1.0) ensued following relief of the obstruction. Chest X-ray showed edema of the dependent lung. Treatment consisted of placing the patient in the sitting position and supplemental oxygen. The situation resolved over a few hours. CONCLUSION: If airway obstruction occurs in the lateral position, development of negative pressure pulmonary edema (NPPE) in the dependent lung is favoured by hydrostatic forces and possibly the elevated resting position of the dependent hemidiaphragm.
Adult↗
Mouse very low-density lipoprotein receptor (VLDLR): gene structure, tissue-specific expression and dietary and developmental regulation.
The very low density lipoprotein receptor (VLDLR) is a multifunctional apolipoprotein (apo) E receptor that shares a common structural feature as well as some ligand specificity to apo E with members of the low density lipoprotein receptor gene family. We have isolated and characterized the mouse VLDLR gene. The mouse VLDLR gene contains 19 exons spanning approximately 50 kb. The exon-intron organization of the gene is completely conserved between mouse and human. Since the 5'-flanking region of the mouse VLDLR gene contains two copies of a sterol regulatory element-1 like sequence (SRE-1), we next studied regulation of the VLDLR mRNA expression in heart, skeletal muscle and adipose tissue in C57BL/6, LDLR-/-, apo E-/- and LDLR-/-apo E-/- mice fed normal chow or atherogenic diet. The VLDLR mRNA expression was down-regulated 3-fold by feeding atherogenic diet in heart and skeletal muscle only in LDLR-/- mice. In contrast, VLDLR mRNA expression was up-regulated by atherogenic diet in adipose tissue in all animal models except double knockout mice. These results suggest that SRE-1 may be functional and VLDLR plays a role in cholesterol homeostasis in heart and skeletal muscle when LDLR is absent and that apo E is required for this modulation. Developmental regulation of the VLDLR mRNA expression was also tissue-specific. VLDLR mRNA expression in heart displayed significant up and down regulation during development. Maximal level was detected on post-natal day 3. However, the VLDLR mRNA levels in skeletal muscle remained relatively constant except a slight dip on post-natal day 7. In kidney and brain, VLDLR mRNA also peaked on post-natal day 3 but remained relatively constant thereafter. In liver, VLDLR mRNA expression was very low; it was barely detectable at day 19 of gestation and was decreased further thereafter. In adipose tissue, the VLDLR mRNA level showed an increase on post-natal day 13, went down again during weaning and then continued to increase afterwards. This developmental pattern as well as dietary regulation in adipose tissue supports the notion that VLDLR plays a role in lipid accumulation in this tissue. Although the primary role of VLDLR in heart, muscle and adipose tissue is likely in lipid metabolism, developmental pattern of this receptor in other tissues suggests that VLDLR has functions that are unrelated to lipid metabolism.
Adipose Tissue↗
Effect of finasteride on bother and other health-related quality of life aspects associated with benign prostatic hyperplasia. PLESS Study Group. Proscar Long-term Efficacy and Safety Study.
OBJECTIVES: To investigate the long-term effects of finasteride on bother and health-related quality of life (HRQOL) in men with symptomatic benign prostatic hyperplasia. METHODS: A large prospective 4-year placebo-controlled trial (PLESS) of 3040 men with moderate to severe lower urinary tract symptoms and an enlarged prostate was performed that included self-administered questionnaires assessing HRQOL. RESULTS: Significantly greater reductions in bother score were seen for finasteride compared with placebo at every time point after 4 months. Analysis of bother scores by baseline serum prostate-specific antigen (PSA), as it is highly correlated with prostate volume, suggested greater differences from placebo for men with PSA 1.4 ng/mL or greater, primarily due to worsening after the first-year improvement in the placebo group. An activity interference domain score was significantly improved for finasteride over placebo at each time point (P<0.01), with greater treatment differences in men with higher baseline PSA levels. Comparable results were seen for worry at each time point and embarrassment due to urinary symptoms in the last 2 years of the trial. Mean changes in sexual interest and satisfaction were somewhat better for the placebo group overall, as has been previously reported, but little difference between treatments was found in sexual satisfaction measures for men with PSA 1.4 ng/mL or greater. CONCLUSIONS: Compared with placebo, men receiving finasteride had significantly less bother, activity interference, and worry due to urinary symptoms, with more pronounced differences for men with baseline PSA 1.4 ng/mL or greater. As expected, sexual satisfaction and sexual drive were slightly worse for finasteride overall, but little difference in sexual satisfaction measures was found for men with a higher baseline PSA. Thus, HRQOL was improved for finasteride compared with placebo, especially for men with a baseline PSA 1.4 ng/mL or greater.
Aged↗
Three-dimensional kinematics of the forefoot, rearfoot, and leg without the function of tibialis posterior in comparison with normals during stance phase of walking.
BACKGROUND: Many studies have shown that lack of functional activity of tibialis posterior leads to changes in the longitudinal arch and affects the motion of the foot. A quantitative description of the affects on the motion of the foot in detail has not been reported. OBJECTIVE: To describe three-dimensional motion of the leg, rearfoot and forefoot with tibialis posterior dysfunction during stance phase of walking in comparison with normals. This study compared one case without the function of tibialis posterior with the ensemble average of 10 normals (five males, five females). METHODS: Subjects with 10, 12 mm retroreflective markers placed on their right leg, rearfoot and forefoot, performed five trials of walking at self-selected speed on a 10 m walkway. A four-camera three-dimensional motion analysis system and a synchronized force platform were used to record three-dimensional motions of the segments and force variables during stance phase of walking. RESULTS: The patterns and range of motion of the rearfoot relative to the leg, and the forefoot relative to the rearfoot demonstrated some differences between the tibialis posterior dysfunction case and normals. Most of the major differences occurred from just prior to heel-off through to toe-off, the period when a stable arch would be required. CONCLUSION: The observed differences in the three-dimensional foot motions of the tibialis posterior dysfunction case compared with normals during walking were consistent with the expected mechanical consequences of a foot without the function of tibialis posterior. The one exception was the inversion of the rearfoot which remained normal. RELEVANCE: Tibialis posterior dysfunction has been recognized as one of the significant impairments of the musculoskeletal system which affects normal walking. Dynamic investigation adds an understanding of how the muscle controls the foot during walking which is essential information for the diagnosis and the adjustment of treatment and rehabilitation for a tibialis posterior dysfunction case.
Adult↗
Hospitalization for motor vehicle injuries among American Indians and Alaska Natives in Washington.
OBJECTIVE: Little is known about the epidemiology of hospitalization for motor vehicle injury among American Indians and Alaska Natives (AI/ANs) in the Pacific Northwest. Current secondary data sources are inadequate to track this significant health problem. The purpose of this study was to determine the rate of hospitalization for motor vehicle injury in this population through linkage of Indian Health Service (IHS) patient registration data to a statewide hospital discharge database. METHODS: To create the numerator, IHS patient registration data were linked to Washington State hospital discharge abstracts from 1990 to 1994 for motor vehicle injury (ICD-9 E-codes 810-819). The denominator for this population was derived from the total number of IHS enrollees in 1992. Comparative numerator and denominator data for all residents were derived from the discharge database and Washington State intercensal population estimates, respectively. RESULTS: AI/ANs experienced a nearly two-fold higher rate of motor vehicle injury hospitalization (N = 588) compared to all residents [Incidence Ratio (I.R.): 1.82; 95% C.I. 1.52-2.19]. The greatest disparity in incidence rates occurred among 25-34 year olds (I.R. 2.18; 95% C.I. 1.53-3.10) and 35-44 year olds (I.R. 2.18; 95% C.I. 1.36-3.47). In-hospital mortality, severity of injury and length of stay were not different between the 2 groups. Median charges for American Indian hospitalizations were $6188 and the IHS was payer in, at most, 24% of hospitalizations. CONCLUSIONS: AI/ANs are at higher risk of hospitalization for motor vehicle injuries but, compared to all residents of Washington, appear to have similar severity of injuries and outcomes. Motor vehicle injury hospitalization among AI/ANs incurs substantial health care costs.
Accidents, Traffic↗
Genomic organisation of the human cyclic AMP-specific phosphodiesterase PDE4C gene and its chromosomal localisation to 19p13.1, between RAB3A and JUND.
PDE4C is one of four mammalian genes that encode multiple PDE4 cyclic AMP-specific phosphodiesterase isoforms that are inhibited by rolipram. Fluorescent in situ hybridisation localised PDE4C to the p13.1 region of human chromosome 19. Overlapping cosmid clones spanning the human PDE4C gene were identified and characterised. Analysis of this locus indicated that the PDE4C gene spans at least 38 kb, consists of at least 18 exons, and contains the marker D19S212 within an intron. Comparison of published human PDE4C cDNA sequences with those of the genomic DNA identified four alternatively spliced exons and the possibility that the PDE4C locus contains at least three alternative promoters. PDE4C-containing cosmids also contained the genes for the growth regulatory transcription factor, JUND, and the mini guanine nucleotide regulatory protein, RAB3A. The RAB3A gene was shown to consist of 5 exons spanning 7.9 kb, while the JUND gene was found to contain no introns. Analysis of cosmids containing PDE4C, JUND, and RAB3A showed that 27 kb separate JUND and PDE4C, while only 3.7 kb separate PDE4C and RAB3A. The three genes share the same orientation of transcription and are arranged in the order cen- 5'- JUND-PDE4C-RAB3A-3'-tel.
3',5'-Cyclic-AMP Phosphodiesterases↗
A prospective multicentre study in Sweden and Norway of mental distress and psychiatric morbidity in head and neck cancer patients.
A Swedish/Norwegian head and neck cancer study was designed to assess prospectively the levels of mental distress and psychiatric morbidity in a heterogeneous sample of newly diagnosed head and neck cancer patients. A total of 357 patients were included. The mean age was 63 years, and 72% were males. The patients were asked to answer the HAD scale (the Hospital Anxiety and Depression scale) six times during 1 year. The number of possible or probable cases of anxiety or depression disorder was calculated according to standardized cut-offs. Approximately one-third of the patients scored as a possible or probable case of a major mood disorder at each measurement point during the study year. There were new cases of anxiety or depression at each time point. The anxiety level was highest at diagnosis, while depression was most common during treatment. Females were more anxious than males at diagnosis, and patients under 65 years of age scored higher than those over 65. Patients with lower performance status and more advanced disease reported higher levels of mental distress and more often scored as a probable or possible cases of psychiatric disorder. Our psychometric analyses supported the two-dimensional structure and stability of the HAD scale. The HAD scale seems to be the method of choice for getting valid information about the probability of mood disorder in head and neck cancer populations. The prevalence of psychiatric morbidity found in this study emphasizes the importance of improved diagnosis and treatment.
Adolescent↗
Quality-of-life effects of psychosocial intervention in patients with head and neck cancer.
METHODS: Two studies of psychosocial interventions in head and neck cancer patients at different stages of their disease were performed. We explored the feasibility and effectiveness of different approaches, offered for the first time to this population. The first study concerned long-term group psychological therapy for patients with newly diagnosed head and neck cancer. Quality of life was measured longitudinally for 1 year and compared with that of a control group. The second study comprised a short-term psychoeducational program 1 year after treatment for head and neck cancer. Quality-of-life assessments were made repeatedly from diagnosis until 1 month after the intervention. RESULTS: Thirteen patients started the psychological group therapy, and 8 of them completed both the intervention and evaluation procedure. The quality of life of the therapy group improved more than that of a control group in most areas measured during the study year, in particular psychiatric morbidity, social functioning, emotional functioning, and global quality of life. The results indicate benefits from the therapy, although the therapy group scored worse than the control group at diagnosis. Most of the variables representing functioning and symptoms improved after the 1-week psychoeducational program, especially items reflecting "trouble eating" and "problems enjoying your meals." Patients' judgments of the intervention quality indicated satisfaction with all separate elements, mostly education, about cancer and the opportunity to socialize with the other guests. CONCLUSION: These pilot studies suggest that head and neck cancer patients can benefit from different psychosocial interventions. Quality-of-life questionnaires were well accepted and sensitive to changes during the studies. Thus our early findings seem promising and would justify confirmation in larger studies.
Adaptation, Psychological↗
Long-term effects of a pulmonary rehabilitation programme in outpatients with chronic obstructive pulmonary disease: a randomized controlled study.
Fifty patients with severe chronic obstructive pulmonary disease (FEV1 < 50% pred.) were randomized to a rehabilitation group and a control group. The rehabilitation group took part in an individualized multidisciplinary, outpatient 12-month rehabilitation programme. Exercise training was intensive during the first 6 weeks and was then gradually replaced by an individual home-training programme and booster sessions. Controls received the usual outpatient care. Positive effects were found in terms of maximum symptom-limited exercise tolerance and walking distance (13.5 and 12.1% increase, respectively) in the rehabilitation group compared with the controls. Quality of life measurements showed minor beneficial effects on the Sickness Impact Profile, indicating a higher level of activity. No effect was seen on the St George's Respiratory Questionnaire or the Mood Adjective Check List. Patients expressed their enthusiasm for the rehabilitation programme in a study-specific questionnaire.
Aged↗
Performance-based and self-reported physical functioning in low-functioning older persons: congruence of change and the impact of depressive symptoms.
This prospective cohort study examines the impact of depressive symptoms on changes in self-reported physical functioning in 574 low-functioning older persons. The data were collected in two waves in 1993 and 1995. Initial levels of depressive symptoms were not predictive for subsequent change in self-reported physical functioning. Changes in self-reported physical functioning were only moderately associated with changes in performance-based physical functioning. The strongest congruence of measured change between self-reported and performance-based physical functioning was found in older persons with increased depressive symptoms. The results suggest that preventing an increase in depressive symptoms may help prevent further deterioration in physical functioning in poorly functioning older persons.
Aged↗
Endothelin concentrations in monochorionic twins with severe twin-twin transfusion syndrome.
The objective of this study was to determine endothelin (ET-1) concentrations in monochorionic twin fetuses with and without twin-twin transfusion syndrome (TTTS). Fourteen monochorionic twin pregnancies complicated by TTTS and six without TTTS were studied. Matched maternal and fetal blood samples were obtained both in utero and at birth. Amniotic fluid samples were also collected from twin pairs. ET-1 concentrations were measured by radio-immunoassay. ET-1 concentrations in recipient fetuses were higher than in the donors both in utero(P < 0.001) and at birth (P < 0.01). Fetal concentrations of ET-1 in donors were similar to non-TTTS twins. Plasma ET-1 concentrations were significantly higher (P < 0.01) in recipient fetuses with severe hydrops than those with mild/no hydrops. Maternal concentrations of ET-1 were comparable in the two groups. Endothelin concentrations in recipient twins were 2(1/2) times higher than in their co-twins and this was related to the severity of hydrops.
Amniotic Fluid↗
Cognitive functioning in schizophrenia: implications for psychiatric rehabilitation.
Research in psychopathology and the cognitive neurosciences suggests new applications in psychiatric rehabilitation. Analysis of performance deficits on laboratory tasks can contribute to treatment planning, individual and family counseling, and staff consultation, much like it does in cases of brain injury and other types of central nervous system neuropathology. Recognition of the nature of cognitive impairments in schizophrenia can inform design of psychosocial techniques such as social and living skills training. Cognitive impairments are increasingly seen as potential targets for pharmacological and psychosocial treatment and rehabilitation. In this article, three key issues for application of cognitive technology in psychiatric rehabilitation of schizophrenia and related disorders are formulated as straightforward, clinically relevant questions: (1) What is the prognostic significance of cognitive impairment in acute psychosis? (2) Can cognitive functioning improve in the chronic, residual course? (3) How does cognitive improvement benefit other aspects of recovery and rehabilitation? These questions are addressed through review of previous findings and new multivariate analyses of cognitive functioning in the acute, post-acute, and chronic residual phases of schizophrenia.
Activities of Daily Living↗
Effects of cognitive treatment in psychiatric rehabilitation.
Ninety subjects with severe and disabling psychiatric conditions, predominantly schizophrenia, participated in a controlled-outcome trial of the cognitive component of Integrated Psychological Therapy (IPT), a group-therapy modality intended to reestablish basic neurocognitive functions. The cognitive therapy was delivered to subjects in the experimental condition during intensive 6-month treatment periods. Control subjects received supportive group therapy. Before, during, and after the intensive treatment period, all subjects received an enriched regimen of comprehensive psychiatric rehabilitation, including social and living skills training, optimal pharmacotherapy, occupational therapy, and milieu-based behavioral treatment. IPT subjects showed incrementally greater gains compared with controls on the primary outcome measure, the Assessment of Interpersonal Problem-Solving Skills, suggesting that procedures that target cognitive impairments of schizophrenia spectrum disorders can enhance patients' response to standard psychiatric rehabilitation, at least in the short term, in the domain of social competence. There was equivocal evidence for greater improvement in the experimental condition on the Brief Psychiatric Rating Scale disorganization factor and strong evidence for greater improvement on a laboratory measure of attentional processing. There was significant improvement in both conditions on measures of attention, memory, and executive functioning, providing support for the hypothesis that therapeutic procedures that target impaired cognition enhance response to conventional psychiatric rehabilitation modalities over a 6-month timeframe.
Adolescent↗
Treating depressed older adults in primary care: narrowing the gap between efficacy and effectiveness.
There is a gap between the efficacy of treatments for late-life depression under research conditions and the effectiveness of treatments as they occur in the "real world" of primary care. Considerable evidence supports the efficacy of treatments for late-life depression, but many depressed older adults either are not recognized or do not receive effective treatment for depression in primary care. Older adults face a range of special treatment barriers: knowledge deficits; losses and social isolation; multiple medical problems; and lack of financial resources. More research is needed to understand these barriers and to study the effectiveness of multifaceted, population-based disease management interventions for late-life depression in primary care.
Aged↗