Biomedical subjects
R J Hawley
Publications and source records attributed to R J Hawley.
Can proximal nerve lesions give rise to a "Tinel-like" sign distally?
Explore the source record for details and available documents.
Frequency of median mononeuropathy in patients with mild diabetic neuropathy in the early diabetes intervention trial (EDIT)
Explore the source record for details and available documents.
Slippery slope.
Explore the source record for details and available documents.
Neurochemical correlates of sympathetic activation during severe alcohol withdrawal.
Cerebrospinal fluid (CSF) was obtained from 17 patients during acute alcohol withdrawal. Eight of these 17 patients had a second lumbar puncture a mean of 11.9 +/- 8.1 (SD) days later, when the clinical signs of alcohol withdrawal had subsided. CSF 3-methoxy-4-hydroxyphenylglycol concentrations declined significantly (p < 0.05) during the course of alcohol withdrawal from 52.0 +/- 22.1 (SD) to 39.6 +/- 12.6 pM/ml. In early withdrawal, there was a significant positive correlation between CSF norepinephrine (NE) and corticotropin releasing hormone (CRH) concentrations (r = 0.95, p < 0.001). Both NE and CRH concentrations correlated positively with diastolic blood pressure (r = 0.88, p < 0.001 and r = 0.62, p < 0.05, respectively). In all samples, CSF 5-hydroxyindole acetic acid concentrations correlated positively with CSF-homovanillic acid concentrations (r = 0.83, p < 0.001). These findings indicate significant perturbations of the noradrenergic neuronal system and a change in CRH-NE interactions during acute alcohol withdrawal.
NGF induces the expression of the VGF gene through a cAMP response element.
NGF is a peptide growth factor that plays a key role in the differentiation and survival of neurons in both the PNS and CNS. NGF acts through both transcription-dependent and transcription-independent mechanisms to regulate the differentiation of PC12 cells. To better understand the regulation of gene expression by NGF, we have defined a cis-acting sequence that is immediately upstream of the transcription start site of the VGF (a2/NGF33.1) gene that is required for induction by NGF. Within this sequence is a consensus cAMP response element (CRE) embedded in a 14 base pair palindrome. Mutations in this CRE eliminate induction of the VGF gene both by NGF and by agents that act via cAMP. Although this sequence confers transcriptional induction by both NGF and cAMP, it is not sufficient to allow induction by epidermal growth factor, acidic or basic fibroblast growth factor, or phorbol 12-myristate 13-acetate (PMA). Thus, this sequence defines an element that is selectively activated by NGF and cAMP. Promoter fragments from the VGF gene that include the core CRE efficiently bind the inducible transcription factor CREB, while fragments bearing mutations that eliminate NGF and cAMP inducibility fail to do so. Sequence comparisons and hybridization studies indicate that there are at least two alternatively spliced forms of VGF mRNA, and the accumulation of both of these forms is similarly regulated by NGF and cAMP.
Ventricular late potentials in myotonic dystrophy.
OBJECTIVE: To determine the prevalence of ventricular late potentials, as determined by signal-averaged electrocardiography, in patients with myotonic dystrophy. DESIGN: Cross sectional, with blinded analysis of all electrocardiographic data. SETTING: Outpatient departments of a Veterans Affairs medical center and a tertiary care private hospital. PARTICIPANTS: Twenty-four patients with myotonic dystrophy. Patients were excluded from the study if they had either a history suggestive of significant ventricular arrhythmias or electrocardiographic evidence of a bundle-branch block. Two comparison groups were also formed; one group included 44 healthy employees at the tertiary hospital and the other, 30 cardiac patients with inducible ventricular tachycardia. MAIN RESULTS: A time-domain analysis of the signal-averaged electrocardiograms showed that 75% of patients with myotonic dystrophy met one criterion for the presence of late potentials, 67% met two criteria, and 29% met all three criteria. Spectrotemporal mapping in these patients showed markedly abnormal spectral peaks with a mean factor of normality that was significantly lower than that of the normal volunteers; the frequency of electrocardiographic abnormalities approached that seen in patients with known ventricular tachycardia. The presence of late potentials correlated directly with the length of the PR interval and inversely with left ventricular fractional shortening. CONCLUSIONS: In our study, the prevalence of late potentials on signal-averaged electrocardiography in patients with myotonic dystrophy approached that seen in cardiac patients with inducible ventricular tachycardia. It is possible that ventricular arrhythmias play a role in the occurrence of sudden death in some patients with myotonic dystrophy.
Progressive motor neuron disease associated with electrical injury.
A patient in perfect health prior to electrical shock developed an ALS-like syndrome after the shock. Onset of the disease occurred in the limb through which the shock entered, and subsequently followed a course well-described in previous case reports. Possible mechanisms of disease are discussed.
Myotonic heart disease: a clinical follow-up.
We followed 37 patients with myotonic dystrophy for a mean of 6 years. Two developed atrial flutter or fibrillation, 6 developed a new bundle branch block, 1 developed complete heart block requiring a pacemaker, and another with progressive 1st-degree heart block and a widening QRS interval had a sudden death. Most patients had predictable, gradually progressive disease of their cardiac conduction system. We recommend that patients with progressive atrioventricular block or widening QRS interval due to myotonic heart disease have yearly ECGs and be questioned about syncope or presyncope to determine the need for a cardiac pacemaker.
Multiple proteins are produced from the dec-1 eggshell gene in Drosophila by alternative RNA splicing and proteolytic cleavage events.
The defective chorion-1 gene (dec-1) in Drosophila encodes follicle cell proteins necessary for proper eggshell assembly. A distinctive feature of the gene is the production of multiple products by both alternative RNA splicing and proteolytic processing events. DNA and protein sequencing studies have revealed several dec-1 protein products. The predominant translation product, fc106, has a vitelline membrane-like N-terminal domain followed by a glutamine, methionine-rich central region, largely in the form of 26 amino acid repeats. During late stage 10 the N-terminal portion of fc106 is cleaved, yielding s80, a major eggshell protein. Conceptual translation of the DNA sequence as well as molecular analyses of several dec-1 mutants suggest that the less abundant alternatively spliced RNAs encode primary translation products with different carboxy terminal ends. These results are discussed with respect to previous genetic analyses of dec-1 mutants as well as with respect to potential protein-protein interactions which may underlie stabilization of this complex extracellular structure.
Cloning and analysis of the dec-1 female-sterile locus, a gene required for proper assembly of the Drosophila eggshell.
Female-sterile mutations at the dec-1 (defective chorion-1) locus of Drosophila severely disrupt the organization of the eggshell late in oogenesis. Previous characterization of dec-1 mutations has correlated the defects with failure to accumulate an early eggshell protein that undergoes proteolytic cleavage during choriogenesis. To enable further study of the regulation and processing of dec-1 products, we have molecularly cloned the locus and characterized its transcripts. Chromosome jumping was used to isolate a deficiency breakpoint within the locus. Overlapping genomic clones from a wild-type library were then obtained, and a region including the dec-1 locus was identified by hybridization to cDNA probes complementary to RNA from stage 9-10 egg chambers. Analysis of genomic rearrangements associated with the locus verified its identity. Two transcripts from the locus have been identified and characterized using cDNA clones, RNase protection, and primer extension analyses. A 4.0-kb transcript accumulates maximally in stages 9-10, when the primary follicle cell protein associated with dec-1 mutations is synthesized. A second transcript of 5.8 kb, generated by alternative splicing, accumulates during stages 11-12. These results are discussed in light of previous analysis of dec-1 mutations.
Comparative leukocyte esterase-nitrite and BAC-T-SCREEN studies using single and multiple urine volumes.
The Chemstrip LN and BAC-T-SCREEN filtration systems were used to evaluate 980 urine specimens rapidly for the presence of microorganisms. Multiple volumes of individual specimens were also tested using the BAC-T-SCREEN to determine whether this procedure enhanced test performance. Ninety-nine specimens (10%) could not be processed because of interfering substances or clogging of the BAC-T-SCREEN. Analysis of the remaining 881 samples showed these test results for the Chemstrip LN system: sensitivity, 48%; specificity, 93%; positive predictive value (PPU), 88%; and negative predictive value (NPV), 71%. The BAC-T-SCREEN results using multiple urine volumes were (for 1 mL) sensitivity, 88%; specificity, 98%; PPV, 97%; NPV, 92%; for 2 mL, sensitivity, 94%; specificity, 96%; PPV, 94%; NPV, 96%; for 3 mL, sensitivity, 98%; specificity, 95%; PPV, 93%; NPV, 98%. Analyzing multiple urine volumes permitted detection of 92% of urine samples with colony-forming units of 10(4) or less. The BAC-T-SCREEN system proved superior to Chemstrip LN for detecting microorganisms in urine specimens, and analyzing multiple urine volumes enhanced test sensitivity.
Treatment of amyotrophic lateral sclerosis with the TRH analog DN-1417.
Thyrotropin-releasing hormone has been reported to increase strength in patients with amyotrophic lateral sclerosis (ALS). DN-1417 is an analog of thyrotropin-releasing hormone, which has less endocrinologic activity, but more anterior horn cell stimulating effect (with no "autorefractory state"). However, 2 mg DN-1417, IM twice a day for 1 month in an open-label trial, produced no objective improvement of strength in nine patients with ALS. No patient entered the double-blind, placebo-controlled phase of the trial.
Five-year follow-up of Friedreich's ataxia cardiomyopathy.
Ten patients with Friedreich's ataxia were reexamined at a five-year follow-up with electrocardiography and echocardiography. The three patients who initially had had the smallest left ventricular diastolic dimensions relative to their body surface areas (decreased 23% to 25% below predicted dimensions) had undergone dilatation of their left ventricles and atria, with decreasing fractional shortening of the left ventricle, but stable to decreasing ventricular wall thickness. The other seven patients, whose ventricular diastolic dimensions were initially closer to those predicted for their body surface areas, had not undergone significant dilatation. However, their left ventricular posterior walls and interventricular septa had thickened at a mean rate of 0.019 mm/mo. The interplay of these tendencies to hypertrophy and dilatation may explain the disagreement about the type of hypertrophic cardiomyopathy in Friedreich's ataxia.
Cerebrospinal fluid 3-methoxy-4-hydroxyphenylglycol and norepinephrine levels in alcohol withdrawal. Correlations with clinical signs.
Cerebrospinal fluid (CSF) and plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) concentrations were significantly elevated in patients during the alcohol withdrawal syndrome. When CSF MHPG was corrected using a formula proposed to determine CSF MHPG levels of central origin, these values were still significantly elevated when compared with control values. The MHPG concentrations in CSF also showed significant positive correlations with heart rate, systolic and diastolic blood pressures, tremor, anorexia, and sweating. The results of this study indicate increased presynaptic release of norepinephrine during alcohol withdrawal.