Biomedical subjects

R A Stern

Publications and source records attributed to R A Stern.

At least 19 recordsLinked to original sources

PubMed2001

A comparison of administration procedures for the Rey-Osterrieth Complex Figure: flowcharts versus pen switching.

The Rey-Osterrieth Complex Figure (ROCF) is commonly used to assess visuospatial skills, visuoconstruction, visual memory, and executive functioning. Two different methods are traditionally used to record the order in which the figure is drawn: the flowchart method and the pen-switching method. Although it has been suggested that pen switching may interfere with performance, to date no research has been conducted to assess whether ROCF performance significantly differs due to administration method. As part of routine neuropsychological evaluation, 100 inpatients and outpatients were randomly assigned to either method. Using the Boston Qualitative Scoring System and the traditional 36-point scoring method, the authors unexpectedly found that the pen-switching group generally performed better than the flowchart group, and productions drawn with pen switching were also significantly faster to score.

Adult↗

PubMed2000

Radiolabeling brachytherapy sources with Re-188 through chelating microfilms: stents.

Rhenium-188 (Re-188, T(1/2) = 17 h) emits beta particles (E(max) = 2. 12 MeV) having an ideal range for intravascular brachytherapy and certain cancer brachytherapies. Re-188 was attached to metal wafers and stents via a chelating microfilm, and these brachytherapy sources characterized in vitro and in vivo. To prepare the sources, a siloxane film containing reactive amines was plasma deposited on the metal, a chelating microfilm conjugated to the amines, and the chelating microfilm used to attach Re-188. Re-188 was selectively bound to materials coated with the chelating microfilm. Binding correlated with the amount of radionuclide used. Wafers (1 cm(2)) bound up to 62.9 MBq (1.7 mCi) of Re-188 with yields generally near 30%. Stents bound up to 26.6 MBq (720 microCi). Typically, stents were labeled to bind 4-12 MBq and deposit 10-30 Gy at 2 mm in the arterial wall. In phantom studies, the longer nitinol stents deposited doses of 2.3 Gy/MBq (0.085 Gy/microCi), while shorter stainless steel stents deposited 4.62 Gy/MBq (0.171 Gy/microCi). After placement in arteries of pigs, only the Re-188-stents were detected by scintigraphy at times up to 24 h. Scintigraphy did not detect activity in other organs. Blood sampling (0.1-24 h) detected maximum radioactivity (up to 388 cpm/mL/100micro Ci) at 6 h. We conclude that on-demand radiolabeling of stents and other brachytherapy sources with Re-188 can be performed routinely.

Biocompatible Materials↗

PubMed2000

Visuoconstructional problems in dementia: contribution of executive systems functions.

Visuoconstructional ability was assessed by asking patients diagnosed with Alzheimer's disease (AD), ischaemic vascular dementia (IVD), and Parkinson's disease (PD) and a normal control group (NC) to copy a modification of the Rey-Osterrieth Complex Figure (M-ROCF). The drawings of the NC group were superior to all dementia participants. AD patients generally outperformed IVD and PD patients; however, there were few differences between IVD and PD groups. Nonetheless, the drawings of IVD and PD patients were very fragmented and contained numerous perseverations and omissions. Despite these errors, patients with IVD and PD obtained higher delayed recognition memory scores than AD patients. Correlational analyses among dementia patients between neuropsychological tests and the copy of the M-ROCF found that accurate figure copy was most consistently correlated with tests of working memory, that is, tests requiring patients to monitor their behavior and sustain a complex mental set while performing mental manipulations. By contrast, no relationship between executive function tests related to measures of response selection/inhibition or other domains of neuropsychological functioning was found.

Aged↗

PubMed2000

The Boston Qualitative Scoring System as a measure of executive functioning in Rey-Osterrieth Complex Figure performance.

The Boston Qualitative Scoring System (BQSS) for the Rey-Osterrieth Complex Figure (ROCF) includes five scores (Planning, Fragmentation, Neatness, Perseveration, and Organization) developed to measure the executive aspects of ROCF productions. To assess the convergent and discriminant validity of the BQSS, these five scores were compared to scores on four traditional tests of executive functioning, as well as to three non-executive measures, in 141 adult patients. BQSS executive variables significantly correlated with the traditional executive measures and were less correlated with discriminant measures. The BQSS Organization summary score also significantly differentiated patients with either no, mild, or severe executive dysfunction. These results support the construct validity of the BQSS and demonstrate that the ROCF may be a useful measure of executive functioning.

Adolescent↗

PubMed2000

Differential impact of executive dysfunction on verbal list learning and story recall.

The California Verbal Learning Test (CVLT) and the Logical Memory (LM) subtest from the Wechsler Memory Scale-Revised (WMS-R) are generally thought to be interchangeable measures of verbal memory. However, little is known about the effects of executive dysfunction on these tasks. The present study involved 96 patients referred for neuropsychological evaluation who were classified as having either significant executive dysfunction (SED) or minimal executive dysfunction (MED) based on the number of impaired executive tasks. Results showed that the SED group performed significantly worse on CVLT total words learned and most of the recall conditions compared to the MED patients (p <.01). However, performance on both immediate and delayed LM did not significantly differentiate the groups. CVLT measures of semantic clustering, perseveration, intrusions, and false positive errors did not appear to account for the group differences. The current study strongly suggests that the CVLT and the LM subtest are differentially associated with executive dysfunction, and argues for the inclusion of both types of tasks in a comprehensive neuropsychological evaluation.

Adult↗

PubMed2000

High versus low basal cortisol secretion in asymptomatic, medication-free HIV-infected men: differential effects of severe life stress on parameters of immune status.

The authors hypothesized that HIV-infected men with high basal cortisol secretion would exhibit greater stress-related reductions in the ratio of Th1/Th2 cell-derived cytokines and numbers of CD8+ T and NK lymphocytes than low basal cortisol secretors. A semistructured interview was used to assess life stress during the preceding 6 months of 94 HIV-infected men classified as high and low cortisol secretors (n = 47/group). Increased levels of severe life stress were highly correlated with lower numbers of CD8+ T cells, CD16+ and CD56+ NK cells, CD57+ cells, and higher DHEA-S concentrations in the high cortisol group. Conversely, no significant correlations were found in the low cortisol group. No correlations were found between stress and CD4+ T helper/inducer cell counts, cytokine production, or testosterone levels in either participating group. These data suggest that severe stress in combination with high glucocorticoid activity may modify select parameters of immune status in HIV-infected men.

Adaptation, Psychological↗

PubMed1999

Measurement of mood states in stroke patients: validation of the visual analog mood scales.

OBJECTIVE: The Visual Analog Mood Scales (VAMS) were recently developed by Stern and colleagues to assess mood state in neurologically impaired patients. These brief scales require that a patient place a single pen mark along a 100mm vertical line to indicate how he or she presently feels. Although previous studies have garnered evidence in support of the validity of these brief scales when administered to psychiatric patients and healthy young adult and geriatric control subjects, it is presently unknown whether the VAMS are valid measures of internal mood state in neurologically impaired stroke patients. The purpose of the present investigation was to assess reliability and validity of the VAMS in a stroke-patient population. PARTICIPANTS: Participants were 41 (21 men and 20 women) inpatients admitted for either acute stroke or rehabilitation following stroke. DESIGN: Participants completed both the VAMS and a modified version of the Profile of Mood States (POMS). Nonparametric multitrait-multimethod analyses were performed using the Pearson correlations among and between the six subscales of the VAMS and the POMS. CONCLUSION: The VAMS possess good convergent and discriminant validity when administered to stroke inpatients, providing further support for the utility of these brief, easily administered scales.

Adult↗

PubMed1999

Assessment of mood states in aphasia.

Depression is common in patients with stroke and other neurological conditions. Accurate assessment and diagnosis is critical in understanding the causes of mood disturbance in these patients and in establishing effective treatments. Examination of mood states, however, is difficult in patients with aphasia, impaired emotional expression, and other communication and cognitive difficulties. Most standardized measures of mood are inappropriate for this population due to the instruments' linguistic, attention, and other cognitive demands. The Visual Analog Mood Scales (VAMS) are psychometrically sound measures, developed specifically for neurologically impaired patients in general and aphasic patients in particular. These very brief scales assess eight mood states: sad, happy, tense, afraid, tired, energetic, confused, and angry. The utility of these scales in clinical practice is presented, as are specific recommendations and guidelines for the assessment of mood in patients with aphasia and other communication deficits.

Aphasia↗

PubMed1999

Rey-Osterrieth Complex Figure performance in adults with attention deficit hyperactivity disorder: a validation study of the Boston Qualitative Scoring System.

Rey-Osterrieth Complex Figure (ROCF) productions from 18 adults with Attention Deficit Hyperactivity Disorder (ADHD) were compared to 18 matched controls using the Boston Qualitative Scoring System (BQSS). ADHD adults showed impairment in measures of configural accuracy, planning, and neatness. A logistic regression model resulted in 75% sensitivity and 81% specificity in discriminating ADHD from control subjects. In contrast, there was no significant difference on the traditional ROCF 36-point score, and the sensitivity and specificity for the 36-point score were lower (68% and 71%, respectively). These findings suggest persisting executive dysfunction in adults with ADHD that can be detected in ROCF productions. Thus, the BQSS may be a useful tool contributing to the neuropsychological evaluation of adults with ADHD.

Adult↗

PubMed1998

Neurobehavioral functioning in asymptomatic HIV-1 infected women.

Numerous reports have assessed the neuropsychological functioning of medically asymptomatic HIV-1 infected men. However, to date there have been no published studies of the neuropsychological functioning of asymptomatic HIV-1 infected women, even though women represent the fastest-growing demographic group of HIV-1 infected individuals. In this investigation, 31 women (17 asymptomatic HIV-1 seropositive, 14 seronegative) were administered a battery of neurocognitive and neuropsychiatric instruments. Participants in both groups were matched for age, education, months since injection drug use, and substance use. Group comparisons revealed no significant differences in any of the neurocognitive or neuropsychiatric measures. The results of this preliminary study suggest that clinically significant differences in neurobehavioral function are unlikely in medically asymptomatic HIV-1 infected women compared to seronegative controls. However, additional studies are needed with larger sample sizes and with careful attention to possible confounding or masking variables.

Adult↗

PubMed1997

The clinical significance of focal active colitis.

Focal crypt injury by neutrophils (cryptitis/crypt abscesses), or focal active colitis (FAC), is a common isolated finding in endoscopic colorectal biopsies. Focal active colitis is often thought of as a feature of Crohn's disease, but may also be seen in ischemia, infections, partially treated ulcerative colitis, and as an isolated finding in patients undergoing endoscopy to exclude neoplasia. Clinical, endoscopic, and pathological data were retrospectively reviewed from 49 patients with focal active colitis, who had no other diagnostic findings on colorectal biopsy and no history of chronic inflammatory bowel disease. The histological findings were correlated with clinical diagnoses. Follow-up information was available for 42 of 49 focal active colitis patients. None developed inflammatory bowel disease; however, 19 patients had an acute self-limited colitis-like diarrheal illness, 11 had incidental focal active colitis (patients without diarrhea that were endoscoped to exclude colonic neoplasia and found to have asymptomatic FAC), 6 had irritable bowel syndrome, 4 had antibiotic-associated colitis, and 2 had ischemic colitis. Twenty patients were immunosuppressed, and 19 were taking nonsteroidal anti-inflammatory drugs. No histological features predicted final diagnoses. FAC did not predict the development of chronic colitis, even when mild crypt distortion or slight basal plasmacytosis was present. The preponderance of acute self-limited colitis and antibiotic-associated colitis among the FAC patients, along with the high number of immunosuppressed patients, support the conclusion that most FAC cases are infectious. The incidental detection of FAC in patients undergoing endoscopy to exclude colonic neoplasia was not clinically significant. The role of nonsteroidal anti-inflammatory drugs in FAC deserves further study.

Adolescent↗

PubMed1997

Detection of human papillomavirus DNA in keratoacanthomas by polymerase chain reaction.

The etiology of keratoacanthomas is unknown, but human papillomavirus (HPV) has been suspected to be involved in the pathogenesis of this lesion because koilocytic changes may be observed and because HPV has been found in cutaneous squamous-cell carcinomas and premalignant keratoses in immunosuppressed patients. We analyzed DNA extracted from 39 keratoacanthomas from 22 "at-risk" patients (nine patients undergoing UV light and/or anthralin therapy for psoriasis, 10 solid organ transplant recipients, one patient with xeroderma pigmentosa, one patient with acquired immunodeficiency syndrome, and one patient undergoing therapy for non-Hodgkin's lymphoma) for the presence of HPV. The results were compared with analyses of DNA extracted from 30 keratoacanthomas from 28 patients at no known increased risk for these lesions. Using polymerase chain reaction (PCR) primers designed to detect multiple HPV types (including 6, 11, 16, 18, 31, and 33), HPV was detected in seven keratoacanthomas from six of the at-risk patients and in eight sporadic keratoacanthomas from eight patients without risk factors. HPV was also present in one of 26 nonlesional skin controls. Statistical analysis showed a significant difference in the prevalence of HPV DNA sequences found in keratoacanthomas compared to normal control skin (p = 0.038). The presence of virus by PCR could not be predicted by histologic evaluation. Sequence analysis showed the presence of HPV types 11, 13, 24, 33, and 57. Although these results confirm the frequent presence of HPV in keratoacanthomas, the role of this virus in the etiology and pathogenesis of these lesions remains to be elucidated.

DNA, Viral↗

PubMed1997

Severe life stress as a predictor of early disease progression in HIV infection.

OBJECTIVE: Although there is evidence that stress is associated with alterations in immunity, the role of emotional factors in the onset and course of immune-based diseases such as cancer and AIDS has not been established. This prospective study was designed to test the hypothesis that stressful life events accelerate the course of HIV disease. METHOD: Ninety-three HIV-positive homosexual men who were without clinical symptoms at the time of entry into the study were studied for up to 42 months. Subjects received comprehensive medical, neurological, neuropsychological, and psychiatric assessments every 6 months, including assessment of stressful life events during the preceding 6-month interval. Several statistical approaches were used to assess the relation between stress and disease progression. RESULTS: The time of the first disease progression was analyzed with a proportional hazard survival method, which demonstrated that the more severe the life stress experienced, the greater the risk of early HIV disease progression. Specifically, for every one severe stress per 6-month study interval, the risk of early disease progression was doubled. Among a subset of 66 subjects who had been in the study for at least 24 months, logistic regression analyses showed that higher severe life stress increased the odds of developing HIV disease progression nearly fourfold. the degree of disease progression was also predicted by severe life stress when a proportional odds logistic regression model was used for analysis. CONCLUSIONS: This report presents the first evidence from a prospective research study that severe life event stress is associated with an increased rate of early HIV disease progression.

Adult↗

PubMed1997

Asymptomatic HIV-infected women: preliminary study of quantitative EEG activity and performance on a continuous performance test.

Several studies have examined the electrophysiological correlates of human immunodeficiency virus (HIV) infection in medically asymptomatic men. Although the rates of HIV infection are increasing at a greater rate in women than men, there have been no publications to date of electrophysiological functioning in HIV-infected women. In the present study, quantitative electroencephalographic (qEEG) activity was measured in 22 women (11 asymptomatic HIV-seropositive and 11 HIV-seronegative) utilizing a procedure comprised of three auditory continuous performance tests and a set of qEEG components derived from principal components analysis. No significant group differences were found in qEEG or in performance on the continuous performance tests; however, task-related differences were detected across groups between simple and complex language tasks in EEG fast beta power, delta power, and a left-hemisphere principal components analysis-derived EEG component. In examining the electrophysiological correlates of HIV infection, researchers might employ a similar methodology while increasing the sample size and varying the task modality or difficulty.

Adult↗

PubMed1997

Use of thyroid hormone to diminish the cognitive side effects of psychiatric treatment.

Electroconvulsive therapy (ECT) and lithium are highly effective treatments for mood disorders. Both treatments, however, are associated with cognitive side effects which reduce patient compliance and treatment satisfaction. Both therapies also have a significant effect on hypothalamic-pituitary-thyroid axis (HPT) activity. Preliminary results from a double-blind, placebo-controlled study of adjunctive thyroid hormone (T3) and ECT showed better memory function in patients receiving T3 compared with placebo. This neuroprotective effect of T3 has been confirmed using electroconvulsive shock (ECS) in rats, and shown to be independent of the number of electrical stimulations. Results of studies in patients with bipolar disorder taking lithium have demonstrated that cognitive deficits are significantly related to diminished thyroid status, but not lithium levels. Preliminary evidence also shows that adjunctive thyroid hormone improves cognitive functioning in patients taking lithium. These findings, if replicated and confirmed, indicate a potential role for adjunctive thyroid hormone in reducing the cognitive side effects of these important psychiatric treatments. This, in turn, may lead to improved treatment compliance, diminished overall morbidity, and reduced healthcare utilization.

Animals↗

PubMed1996

Influence of cognitive reserve on neuropsychological functioning in asymptomatic human immunodeficiency virus-1 infection.

OBJECTIVE: To evaluate the influence of cognitive reserve or brain reserve capacity on neuropsychological performance in early human immunodeficiency virus (HIV)-1 infection. DESIGN: Cross-sectional group comparison study, based on neuropsychological performance, of HIV-1 seropositive and HIV-1 seronegative participants. SUBJECTS: Seventy-five medically asymptomatic HIV-1-seropositive homosexual or bisexual men and 50 HIV-1-seronegative homosexual or bisexual male controls. Subjects were grouped by HIV-1 status (seropositive vs seronegative) and by cognitive reserve scores (low reserve vs high reserve). MEASURES: Cognitive reserve scores were based on a combination of years of education, a measure of occupational attainment, and an estimate of premorbid intelligence. Performance on a battery of neuropsychological tests was summarized by empirically derived factor scores and clinical summary ratings. RESULTS: The HIV-1-seropositive subjects with low cognitive reserve scores exhibited significantly greater deficits on measures of attention and information processing speed, verbal learning and memory, executive functioning, and visuospatial performance than did the HIV-1-seropositive subjects with high cognitive reserve scores. In contrast, there were no significant group differences on these measures between both groups of HIV-1-seronegative subjects. CONCLUSIONS: Early neuropsychological impairments in HIV-1 infection are most evident in individuals with lower cognitive reserve. As has been found in other neurologic disorders, such as Alzheimer's disease, individuals with greater cognitive reserve may be less sensitive to the initial clinical effects of the underlying neuropathologic process.

Adolescent↗

PubMed1996

Analysis of chronic endometritis for Chlamydia trachomatis by polymerase chain reaction.

Chronic endometritis is characterized histologically by plasma cells infiltrating endometrial stroma. Although it has been speculated that many instances of chronic endometritis are infectious, the origin of most cases is not apparent by routine histopathologic evaluation. Chlamydia trachomatis, an obligate intracellular bacterium, is known to cause chronic endometritis in the setting of pelvic inflammatory disease. The authors analyzed 43 specimens of histopathologically diagnosed chronic endometritis from 38 patients for C trachomatis by PCR using primers for the single-copy major outer membrane protein (MOMP) gene. C trachomatis was detected in only one such case in which dense plasma cell infiltrates were present and concurrent C trachomatis infection of the cervix was documented. Using serially diluted DNA from formalin-fixed, paraffin-embedded McCoy cells, the sensitivity of this method was shown to be equivalent to a single infected cell in a paraffin section. In conjunction with the results of other studies, these data indicate a limited role, if any, of C trachomatis in the origin of mild or moderate chronic endometritis.

Adolescent↗

PubMed1996

Endometrial ablation using a distensible multielectrode balloon.

The VestaBlate system uses a multielectrode intrauterine balloon as a device to create effective and safe endometrial ablation (EA). The surface of the distensible balloon is impregnated with thermistors and thin, platelike electrodes. It is designed to deliver low-power electroenergy to the endometrium. Unlike the resectoscope techniques that require nonelectrolytic fluids for uterine distention, moving electrodes at high power outputs, and other variables that are operator dependent, the VestaBlate is computer controlled using a standard type electrosurgical generator. A respiratory enzyme stain, nitroblue tetrazoleum, was used to determine the extent and depth of tissue necrosis to a myometrial depth of 2 to 4 mm with uniform destruction of tissue with power setting at 45 W for a 4-minute application of energy. Sixty-nine patients have been treated, with 45 followed for at least 3 to 9 months. The amenorrhea rate is 40%; the oligomenorhea-hypomenorrhea rate is 49%.

Electrodes↗