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Biomedical subjects

R G Harper

Publications and source records attributed to R G Harper.

At least 37 records · Page 2Linked to original sources

Placental copper transport in the rat: role of low-molecular-weight ligands.

In this study we investigated whether two low-molecular-weight (LMW) ligands with high affinity for copper (Cu) play a role in the transplacental transport of Cu in the rat. Dams on days 20-21 of gestation were anesthetized and injected via the femoral vein with 5 mg/kg (79 mumol/kg) Cu in 0.5 ml, as either the acetate [Cu(AcO)2], as a 1;10 mixture with L-histidine [Cu(His)10], or as the Cu-(glycyl-glycyl-L-histidine) [G-G-H] complex. Controls received saline. After laparotomy, several fetuses and their placentas were removed at 0, 10, 20, 40, and 60 min after injection, simultaneously with dam blood. Peak Cu concentration in dam plasma occurred at 10 min and was highest following Cu(AcO)2 injection. At 10 and 20 min the placentas from the Cu(AcO)2 and the Cu(G-G-H) groups had higher Cu levels than the controls. By 40 min placentas from all rats injected with Cu had similar Cu concentrations. In the Cu(AcO)2 group there was a positive correlation between dam plasma and placental Cu (r = 0.527, P < 0.05). A sharp downhill gradient was observed between dam and fetus. Fetal plasma Cu levels did not differ among all groups at any time. The data indicate that LMW ligands do not enhance overall maternal-to-fetal Cu transfer, but that an excess of His may inhibit the release of Cu from placenta to fetus.

Acetates↗

SPECT findings on psychosis in Alzheimer's disease.

OBJECTIVE: This study examined whether psychosis in Alzheimer's disease is associated with cerebral perfusion patterns appreciable by single photon emission computed tomography (SPECT) scans. METHOD: All cooperative outpatients enrolled in an Alzheimer's disease research center with the diagnosis of probable Alzheimer's disease and a Clinical Dementia Rating of mild or moderate were interviewed with their primary caregivers. Current and past psychiatric functioning was assessed by using the Hamilton Depression Rating Scale, the Structured Clinical Interview for DSM-III-R, and the Behavioral Pathology in Alzheimer's Disease Rating Scale. Patients without premorbid psychosis received SPECT scans, and the scans of the patients with delusions or hallucinations (N = 30) were compared to the scans of patients without these symptoms (N = 16). RESULTS: The patients with delusions (N = 29) had hypoperfusion of the left frontal lobe in relation to the right frontal lobe. The patients with hallucinations (N = 10) had hypoperfusion in the parietal lobe. CONCLUSIONS: Psychotic patients with Alzheimer's disease had a pattern of cerebral blood flow deficits significantly different from that of nonpsychotic patients. This suggests that patterns of cerebral dysfunction may be expressed symptomatically as psychosis.

Alzheimer Disease↗

Clinical variables associated with psychosis in Alzheimer's disease.

OBJECTIVE: The authors explored whether personal or family history of major mental illness, negative symptoms, or behavioral measures are associated with positive psychotic symptoms in Alzheimer's disease. METHOD: Fifty-seven patients with Alzheimer's disease were studied prospectively during interviews with the patients and their primary caregivers. RESULTS: Psychotic patients with Alzheimer's disease did not differ in cognitive functioning from nonpsychotic patients with Alzheimer's disease. No association was found between personal or family history of mental illness and psychosis. Asociality was the only negative symptom associated with psychosis. Psychotic patients had more behavioral disturbances. CONCLUSIONS: Positive psychotic symptoms in Alzheimer's disease are not associated with certain aspects of cerebral functioning but are associated with behavioral disturbances.

Aged↗

Clozapine for acute and maintenance treatment of psychosis in Parkinson's disease.

In a prospective, open-label study, 12 patients manifesting psychosis associated with Parkinson's disease were treated with clozapine. Cognitive functioning and type of psychotic symptoms were measured prior to treatment, and changes in psychiatric and behavioral symptoms were studied by using the Behave-AD Scale. Significant resolution in psychotic symptoms was found and improvement in global behavioral status observed in all cases, with 10 patients maintaining improvement at follow-up. Careful initiation and titration of the drug resulted in few side effects, and dementia was not found to be a contraindication to such treatment.

Aged↗

Erythropoietin (EPO) levels in fetal rats after ritodrine and terbutaline administration.

Beta-2 sympathomimetics, such as terbutaline, have been shown to alter erythropoietin (EPO) secretion in animal studies. More recently introduced sympathomimetics, such as ritodrine, have been extensively used to inhibit uterine contractions in preterm labor. It has not been determined what effect ritodrine may have on EPO production. We investigated the effect of RD administered to rats in the last day of gestation on the dam and the fetuses' levels of EPO. Rats at the 20th day of gestation were given, under anesthesia, either 3000 micrograms/kg ritodrine over a 10-min period or a similar volume of saline as control (CTL). Fetuses were removed at 0 and 4 h after injection. Ritodrine administration produced a decrease of dam EPO (23.4 +/- 4.2 to 12.0 +/- 2.9 pmol/ml), while the CTL showed no changes. The fetuses from the ritodrine-injected dams exhibited a marked decline over the 4-h period, while the CTL fetuses did not change. In other experiments 500 micrograms terbutaline was administered daily during the last 5 days of rat gestation. The drug produced a significant decline in EPO at delivery time, but plasma EPO in the pups was unchanged. Blood hematocrits were comparable to those of controls. The data show that acute administration of ritodrine reduces fetal and dam plasma EPO, while long-term terbutaline treatment late in gestation alters maternal, but not fetal plasma EPO, indicating that neither drug has any direct regulatory effect on the erythropoietic ability of the fetuses.

Animals↗

Oral rehydration solutions (ORS): enhancement by a soluble fiber.

OBJECTIVE: This study was designed to test the hypothesis that, in an animal model of protein-energy malnutrition (PEM), carboxymethylcellulose (CMC), a viscous additive for the World Health Organization Oral Rehydration Solution (WHO-ORS), previously found to be effective in rats with osmotic diarrhea as an enhancer of water and sodium absorption, would also improve the performance of the WHO-ORS. This hypothesis was based on the changes in fluid and electrolyte transport that could be induced by an increase in the viscosity. METHODS: We evaluated CMC in young rats fed a low-protein, low-energy diet for 3 weeks to induce PEM. Control (CTL) rats were fed a nutritionally complete diet. The ORS were tested with an in vivo perfusion procedure under anesthesia. RESULTS: CMC addition (0, 2.5, 5.0 and 10.0 g/L) sharply increased the rates of net water and sodium absorption in both groups of rats, especially in the PEM animals. Net water absorption increased from (means +/- SEM) 0.75 +/- 0.06 to 2.21 +/- 0.18, 3.35 +/- 0.20 and 8.46 +/- 0.84 microL/min x cm in the PEM rats (0, 2.5, 5.0 and 10.0 g/L CMC, respectively). For the same CMC concentrations, sodium absorption improved from 178.8 +/- 20.3 to 402.4 +/- 18.4, 486.4 +/- 29.2 and 898.4 +/- 21.4 nmol/min x cm, respectively. CTL rats also showed marked increases. Rates of lumen-to-serosa water influx improved in both groups without major changes in water efflux. Net water and sodium absorption appeared related to the log of the ORS viscosity. CONCLUSIONS: The results further support the concept that increased viscosity induced by CMC enhances the effectiveness of ORS.

Absorption↗

Oral rehydration solutions: increased water and sodium absorption by addition of a viscosity-enhancing agent in a rat model of chronic osmotic diarrhea.

Viscosity-enhancing agents such as carboxymethylcellulose (CMC) can alter absorption of solutes and fluid exchange in the small intestine. We investigated whether the standard World Health Organization oral rehydration solution (WHO-ORS) with the addition of CMC would improve net water and sodium absorption in rats using an in vivo intestinal perfusion technique. Four WHO-ORS, containing either 0, 2.5, 5.0, or 10.0 g/L of CMC, were perfused in rats with a well-tested model of cathartic-induced chronic osmotic diarrhea (D) and in normal controls (C). In D rats, the ORSs with CMC improved sodium absorption at the three concentrations used (p < 0.01). The same effect was shown in C rats. Net water absorption was also enhanced in D rats given ORSs with CMC, although the changes in C animals were less marked. The improvement in sodium and water absorption in both C and D rats positively correlated with the log of relative ORS viscosity. Ultrastructural examination of tissues perfused with 10 g/L of CMC showed an extended brush border glycocalyx. This study indicates that CMC added to WHO-ORS in the perfused rat jejunum improves the effectiveness of the solution by increasing sodium and water absorption.

Animals↗

Limitation of private attending pediatricians' neonatal intensive care privileges in level III institutions throughout the United States.

OBJECTIVE: To determine the privileges of Private Attending Pediatricians (PAP) in caring for newborns requiring intensive (ITC), intermediate (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUs) throughout the United States. DESIGN: A two-page mail questionnaire was sent to 429 Level III NICUs to obtain the statement best describing the PAPs' privileges, the number of PAP, and some of the PAPs' functions. Level III NICUs were classified by geographic region as Eastern, Central, or Western United States. RESULTS: Responses were received from 301 NICUs (70%) representing 48 states, the District of Columbia, and > 9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' privileges partially or completely. In 32% (88/279), the PAP were not allowed to render any type of NICU care. In 18% (51/279) of the institutions, the PAP were allowed to render CC only. In 27% (76/279) of the institutions, the PAP were allowed to render IMC and CC only. Limitation of PAPs' privileges were reported in all geographic areas in the U.S., were more pronounced in the Eastern than the Central or Western sections of the country, and were noted in institutions with small (< or = 10) as well as large (> or = 60) numbers of PAP. Limitation of PAPs' privileges was determined by the PAP him/herself in many institutions. Proficiency in resuscitation was considered to be a needed skill. Communication with parents of an infant under the care of a neonatologist was encouraged. CONCLUSIONS: The PAPs' privileges were limited partially or completely in most Level III NICUs. Knowledge of this restricted role impacts significantly on curriculum design for pediatric house officers, number and type of health care providers required for Level III NICUs and future house officer's career choices.

Chi-Square Distribution↗

Pulmonary mechanics and gas exchange: effect of lateral positioning during recovery from respiratory distress syndrome.

Sixteen stable intubated premature infants without a clinically significant patent ductus arteriosus were studied during recovery from respiratory distress syndrome in order to determine the effects of left and right lateral, as compared to supine, positioning. Pulmonary mechanics were measured for spontaneous breaths 5 and 15 minutes after positioning, and arterial blood gases 15 minutes after positioning. Infants were randomized to 1 of 2 position sequences: (1) supine, left, supine, right or (2) supine, right, supine, left. No significant differences were detected between positions for dynamic compliance, tidal volume/kg, and total, inspiratory and expiratory pulmonary resistance. Likewise, no significant differences in PaO2 or PaCO2 were detected between the positions. The sequence of positions did not affect the pulmonary mechanics of spontaneous breaths or arterial blood gases. This suggest that short-term lateral positioning as well as supine positioning can be utilized without deleterious effects on pulmonary mechanics and gas exchange in neonates recovering from respiratory distress syndrome.

Analysis of Variance↗

Development of copper intestinal absorption in the rat.

We investigated changes in the kinetic characteristics of copper absorption at three stages of rat development: suckling, weanling, and adolescence, as well as the inducibility of metallothionein (MT) in small intestine and kidney. Using an in vivo, single-pass intestinal perfusion procedure, we found that the rates of copper absorption in suckling and weanling rats were concentration-dependent and there was no difference between these two groups of rats. However, in adolescent rats, there was a saturable component, with an apparent Kt of 10-13 microM, and a nonsaturable component with a diffusion coefficient of 3.2 s-1 (3.2 x 10(-5) cm2/s). Intestinal copper retention was also concentration-dependent; the suckling rats showed much greater tissue levels of this element than the weanlings or the adolescents. MT intestinal content after stimulation with ip zinc chloride was significantly higher in the adolescent rats than that in the weanlings and sucklings, indicating that physiological mechanisms other than MT induction may play a role in copper retention early in life. The increase in MT levels in adolescence may be related to the onset of copper absorption saturability in the mature small intestine.

Age Factors↗

Tracheostomy: acute and long-term mortality and morbidity in very low birth weight premature infants.

Thirty-six very low birth weight premature infants (VLBW-PT) born at 24 to 32 weeks gestation and with birth weights 635 to 1,360 g who had tracheostomies performed for acquired subglottic stenosis or for prolonged mechanical ventilation were followed in relation to acute and long-term mortality and morbidity. Mortality due to the tracheostomy occurred in 4 patients (11%); mortality from all other causes was 25%. Death after hospital discharge was associated with the nonuse of prescribed cardiorespiratory monitors. Complications < 1 week postsurgery occurred in 31% of infants and complications > or = 1 week postsurgery occurred in 64% of infants. Fifty percent of infants required tracheostomy for > 2 years and/or extensive reconstructive surgery of the airway. Parents should be counselled that VLBW-PT infants with a tracheostomy may require extended medical and home care. An effective home care program requires parental training in tracheostomy care, the use of ancillary equipment, and infant cardiopulmonary resuscitation.

Female↗

Brief neuropsychologic differentiation of demented versus depressed elderly inpatients.

Recent investigations have suggested the utility of brief, psychometric screening batteries in the early detection of abnormal mental decline. This study extended the investigation of one of these batteries, comprised of three tests (Controlled Oral Word Association, Visual Retention, Temporal Orientation), to the difficult issue of differentiating dementia from depression in a hospitalized sample composed of a group of depressed only patients (N = 50) vs an age-matched demented group (N = 50), some of whom presented mixed dementia/depression syndromes. Demented patients consistently performed more poorly as a group than depressed patients on each of the three measures. This was the case even when three-group (demented only, mixed demented/depressed, depressed only) comparisons were conducted. Impairment was more common on one or more tests with demented vs depressed patients. However, limitations for screening purposes and for the definitive detection of dementia were noted in view of only moderate predictive power of the tests with discriminant function analysis. Nevertheless, the potential clinical utility of the three tests in the general hospital and other primary care settings was apparent.

Aged↗

Plasma ammonia levels in very low birth weight preterm infants.

The mean plasma ammonia level at birth of 36 very low birth weight infants (< or = 32 weeks of gestation) was 71 +/- 26 mumol/L (121 +/- 45 micrograms/dl), which is similar to the mean level in preterm infants born at > or = 32 weeks of gestational age. Plasma ammonia levels declined to 42 +/- 14 mumol/L (72 +/- 24 micrograms/dl) at 7 days of age; mean ammonia levels at 14, 21, and 28 days of age were similar to that at 7 days of age and to the mean plasma ammonia level of 14 healthy term infants at birth (45 +/- 9 mumol/L (77 +/- 16 micrograms/dl)).

Ammonia↗

Nonulcer dyspepsia associated with psychiatric disorder.

Studies of dyspepsia show a 1% to 2% prevalence in adults, and 25% to 40% of these patients do not have a physical reason for their symptoms. These findings prompted us to do a retrospective follow-up study of 390 patients having motility studies for chest pain and gastrointestinal (GI) symptoms; 278 (71%) responded. Patients were asked to complete a self-rating symptom questionnaire regarding current GI symptoms and current symptoms of anxiety, panic, and depression; they were also asked to complete the Brief Symptom Inventory. Two groups were compared--those with known heart disease and those without heart disease. Substantial numbers of patients in both groups satisfied criteria for generalized anxiety disorders (> 70%), panic disorder (> 30%), and major depression (> 35%). GI symptoms compatible with nonulcer dyspepsia were strongly associated with a psychiatric diagnosis. Our data suggest that anxiety and depressive states are strongly associated with dyspepsia and other GI symptoms not caused by ulcer disease.

Anxiety Disorders↗

In vitro effect of indomethacin on polymorphonuclear leukocyte function in preterm infants.

Random motility and chemotaxis of polymorphonuclear leukocytes (PMN) was evaluated after in vitro exposure to 0, 300, 600, and 900 ng/mL (0.84, 1.68, and 2.52 mumol/L) of indomethacin. PMN were obtained from cord blood of 22 preterm infants of less than 37 wk gestation. For comparison, PMN were obtained from cord blood of seven healthy full-term infants and from venous blood of 10 normal adults. In preterm infants, a significant decrease of random motility and chemotaxis of PMN was noted at all three drug concentrations; impairment of PMN function was dose dependent in the three groups (p < 0.0001), with the greatest effect seen at 900 ng/mL (2.52 mumol/L). Significant impairment of random motility was noted in full-term infants when compared with adults at all indomethacin concentrations and in chemotaxis at 300 and 600 ng/mL (0.84 and 1.68 mumol/L). The study indicates that indomethacin has an adverse effect on PMN random motility and chemotaxis, which is more pronounced in preterm infants.

Adult↗

Effect of maternal labor and mode of delivery on polymorphonuclear leukocyte function in healthy neonates.

In this study, effect of maternal labor and mode of delivery on polymorphonuclear leukocyte (PMN) chemiluminescence and random and chemotactic motility was evaluated in healthy full-term neonates. PMN were obtained from cord blood of three groups of neonates: group I, 24 vaginally delivered neonates; group II, 22 neonates delivered by elective cesarean section without labor; and group III, 18 neonates delivered by cesarean section after labor. In group III, six neonates were delivered by cesarean section for fetal distress with acidemia and 12 for failure of progression of labor. Peak chemiluminescence of PMN in group III was depressed compared with groups I and II (p < 0.01). There was no difference in the peak chemiluminescence of PMN from neonates in group I versus group II. Random motility of PMN in group III was increased compared with the random motility in groups I and II (p < 0.05). Chemotactic motility of PMN was comparable in all three groups. In group III, a negative correlation was noted between peak chemiluminescence of PMN and the duration of labor (p < 0.001), whereas no such correlation was observed in group I despite a similar duration of labor. There was no correlation between duration of labor and random and chemotactic motility of PMN in groups I and III. The results of this study indicate that labor and mode of delivery per se have no effect on PMN function and that factors other than labor such as fetal acidemia, fetal distress, arrested labor, or maternal administration of drugs may play a role in alteration of PMN function.

Cell Movement↗

Psychotherapy: past training and current practice.

Our 1988 survey of Texas psychiatrists indicates that hospital work is more common, and long-term psychotherapy less common than it had been in the 1982 APA survey. Almost 85% reported long-term psychotherapy experience as residents. Thirty-nine percent reported multiple patients treated for approximately 2 years. Use of audio techniques by resident and teacher in the post-1970-trained group predicted current long-term therapy activity as did an experience of personal therapy and seeing a patient at least twice weekly in training. Concurrent drug use is widely reported for long-term psychotherapy patients and to a lesser degree in psychoanalysis. Our data suggest a shift to increased hospital work and decreased long-term psychotherapy.

Attitude of Health Personnel↗