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Biomedical subjects

S Schmid

Publications and source records attributed to S Schmid.

At least 19 recordsLinked to original sources

Cointegrase, a naturally occurring, truncated form of IS21 transposase, catalyzes replicon fusion rather than simple insertion of IS21.

The bacterial insertion sequence IS21 contains two genes, istA and istB, which are organized as an operon. IS21 spontaneously forms tandem repeats designated (IS21)2. Plasmids carrying (IS21)2 react efficiently with other replicons, producing cointegrates via a cut-and-paste mechanism. Here we show that transposition of a single IS21 element (simple insertion) and cointegrate formation involving (IS21)2 result from two distinct non-replicative pathways, which are essentially due to two differentiated IstA proteins, transposase and cointegrase. In Escherichia coli, transposase was characterized as the full-length, 46 kDa product of the istA gene, whereas the 45 kDa cointegrase was expressed, in-frame, from a natural internal translation start of istA. The istB gene, which could be experimentally disconnected from istA, provided a helper protein that strongly stimulated the transposase and cointegrase-driven reactions. Site-directed mutagenesis was used to express either cointegrase or transposase from the istA gene. Cointegrase promoted replicon fusion at high frequencies by acting on IS21 ends which were linked by 2, 3, or 4 bp junction sequences in (IS21)2. By contrast, cointegrase poorly catalyzed simple insertion of IS21 elements. Transposase had intermediate, uniform activity in both pathways. The ability of transposase to synapse two widely spaced IS21 ends may reside in the eight N-terminal amino acid residues which are absent from cointegrase. Given the 2 or 3 bp spacing in naturally occurring IS21 tandems and the specialization of cointegrase, the fulminant spread of IS21 via cointegration can now be understood.

Base Sequence

HIV-1 subtype E incidence and sexually transmitted diseases in a cohort of military conscripts in northern Thailand.

OBJECTIVES: To determine the rate of and risk factors for HIV-1 seroconversion and describe sexually transmitted disease (STD) prevalence rates for young men in northern Thailand. METHODS: Data were collected from self-administered questionnaires and serologic testing at enrollment in a prospective study in 1991 and at follow-up after 6, 17, and 23 months on a cohort of 1115 men selected by lottery for military conscription. RESULTS: A total of 14 men seroconverted to HIV-1 envelope subtype E. The overall HIV-1 incidence rate was 1.1 (95% confidence interval [CI], 0.6-1.8) per 100 person-years (PY) of follow-up. However, the rate was 2.0/100 PY for conscripts from the upper northern subregion of Thailand compared with 0.5/100 PY from other regions (adjusted rate ratio [RR] = 2.69; 95% CI, 0.8-12.2). On multivariate analyses, the behavioral factors associated with HIV-1 seroconversion were frequency of sex with female sex workers (FSWs; p = .04), receptive anal sex (adjusted RR = 6.73; 95% CI, 1.8-21.7), and large amount of alcohol consumption (adjusted RR = 3.12; 95% CI, 1.0-10.9). Genital ulceration was the STD most strongly associated with seroconversion. The prevalence of serologic reactivity to syphilis, Haemophilus ducreyi, and herpes simplex virus type 2 increased with greater frequency of sex with FSWs and was generally higher for men from the upper north. CONCLUSION: Young men in northern Thailand are at high risk for HIV-1, primarily through sex with FSWs; and other STDs are highly associated with HIV-1 incidence. As HIV-1 infection extends into the general population, intervention programs are needed to address the problem of sexual transmission apart from commercial sex venues.

Adult

Hyperfractionated radiotherapy and simultaneous cisplatin for stage-III and -IV carcinomas of the head and neck. Long-term results including functional outcome.

PURPOSE: To assess the survival rate, the probability of local control, the patterns of relapse and late sequelae including self-reported quality of life in patients treated with hyperfractionated radiotherapy (RT) and simultaneous CDDP chemotherapy for stage-III to stage-IV carcinomas of the head and neck. METHODS: From 1988 to 1994, 64 patients (median age 55.5 years) with carcinomas of different subsites, excluding the nasopharynx, were treated in a pilot study with 1.2 Gy bid (6 h interval; total dose 74.4 Gy) and simultaneous CDDP (20 mg/m2 daily, 5 days in week 1 and 5) and followed at regular intervals. Overall survival and local control, as well as the rates of late toxicity, were estimated using the actuarial method. Median follow-up was 3.3 years for all and 5.2 years for surviving patients. To assess the quality of life, the EORTC QLQ-C 30 questionnaire and the H&N35 module questionnaire were sent to the patients surviving with no evidence of disease or second primary tumors; they were answered by 15/23 (67%). RESULTS: Overall survival was 37% at 5 years, whereas disease-specific survival was 59%. Twenty-three patients died from uncontrolled head and neck cancer. Second primary tumors were observed in 13 patients, most frequently in the lung. Local control without salvage surgery was 74% at 5 years for all subsites and stages, and loco-regional disease-free survival was 72%. Eleven patients developed distant metastases, which was the only site of failure in 6 cases. Salvage surgery was successful in 2 cases. The actuarial estimates of > or = grade-3 late toxicity was 4% for the mandibular bone and 23% for dysphagia, and 50% of the patients experienced a permanent xerostomy. Self-reported global quality of life in surviving patients was good (mean 68 points on a scale 0 to 100); consequences of impaired salivary function had most impact on nutritional and social aspects. CONCLUSIONS: Hyperfractionated RT with concomitant CDDP is well tolerated and highly efficient in controlling moderately advanced to advanced cancers of the head and neck. Second primary tumors are the main cause of death after 3 years and were observed outside of the irradiated area, most frequently in the lung. Even after RT of large volumes to a high dose, salvage surgery can be successfully performed in individual cases. Self-reported quality of life of surviving patients is good, despite xerostomy-associated nutritional difficulties.

Adult

Alterations in channel density and kinetic properties of the sodium current in retinal ganglion cells of the rat during in vivo differentiation.

Changes in the kinetic properties of voltage-activated sodium currents (I(Na)) were studied in rat retinal ganglion cells during in vivo differentiation. Whole-cell recordings from cells maintained as retinal slices or whole-mounts were examined using the patch-clamp technique in the perforated patch mode. Voltage-clamp recordings revealed significant ontogenetic modifications in key properties of I(Na) and the present study described for the first time the detailed time course of such alterations. I(Na) was first expressed on embryonic day 17/18 (E17/18). Current density increased during development from an average of -81 pA/pF on E17/18 to a maximum of -747pA/pF on postnatal day 10/12 (P10/12). Simultaneously, the activation of I(Na) shifted towards more negative potentials, reflected by a shift in the potential of half-activation from -14.1 mV on E17/18 to - 37.5 mV on P10/12. No significant changes in these parameters were observed after P10/12. Steady-state inactivation shifted first towards more positive potentials, reflected by a shift in the potential of half-inactivation from -51 mV on E17/18 to -38 mV on P3/5, but shifted back towards more negative values thereafter (-44 mV in the adult). The most striking feature of I(Na) in rat RGCs was a transient slowing of I(Na) kinetics that was never described before. Time to peak and decay time constants increased between E20 and P5, resulting in slow and broad sodium currents within a developmental period that is characterized by intensive synaptogenesis in the target structures of retinal ganglion cells and maximum retinal ganglion cell death. Thereafter, time to peak and decay time constants decreased again to values found before E20, resulting in rapid sodium spikes. In conclusion, sodium currents in rat retinal ganglion cells displayed substantial electrophysiological changes during pre- and postnatal development. These changes in the sodium system had different temporal time patterns, indicating that they may play specific roles during the development of the visual system.

Aging

The influence of traffic vibrations on the radon potential.

The influence of traffic vibrations on the radon potential is analyzed in this study. Generally, the radon concentration in soil-gas increases through traffic vibrations. The influence of the vibrations is determined near railway tracks and heavy-traffic roads. Soils above natural, in-place, bedrock (solid and unconsolidated rocks) and backfills were studied. The type of vibrations, as well the soil material, have a pronounced influence on the amount of increase of the radon concentration. The spatial radius of influence is wider with railway traffic (>30 m) than with motor vehicle traffic (<25 m). Close to the traffic lanes the increase of the radon concentration by motor vehicle traffic is significantly higher (37%) than that by railway traffic (11.5%). There are no differences between locations, which lay above unconsolidated rock (11.1%), and locations above solid rock (11.8%). In addition to the increased radon concentrations, the averaged radon concentration decreases with increasing distance to the vibration source, but only at locations that lay above solid rock. Both phenomena can be explained by a "pump effect": the mechanical vibration of soil and mineral particles leads to an upward motion of the whole volume of soil-gas. During the vibrations the topmost soil layers lose radon to the atmosphere and as a result the upward transport is increased.

Automobiles

Prognostic value of dipyridamole thallium-201 screening to minimize perioperative cardiac complications in diabetics undergoing kidney or kidney-pancreas transplantation.

To minimize perioperative cardiac events, we utilize a screening protocol consisting of intravenous dipyridamole thallium-201 myocardial imaging (DPT), with the selective use of coronary angiography based on the presence of reversible defect(s) on DPT test. A retrospective study was performed to determine the prognostic value of this protocol and to identify any clinical parameters predictive of an abnormal DPT test. To accomplish this, a detailed chart analysis of 176 consecutive kidney (n = 89) and kidney-pancreas (n = 87) transplant recipients who had undergone pretransplant DPT testing was performed. The results of the DPT test were interpreted as normal in 111, fixed defect in 15, and reversible defect(s) in 50 patients. Forty-two of the 50 patients with reversible defect(s) underwent coronary angiography. Twelve of the 27 patients with significant coronary artery disease (CAD, > 50% stenosis in one or more coronary arteries) underwent pretransplant revascularization and the remaining 15 were treated medically. Cardiac events (documented acute myocardial infarction or sudden cardiac death) within 6 wk of transplant were stratified by the results of this protocol. Also, various clinical parameters were compared between patients with normal and abnormal (fixed and reversible defect) DPT tests. Only one of the 111 (0.9%) transplant recipients with a normal DPT test had a perioperative cardiac event. None of the 15 (0%) patients with a fixed defect and none of the 15 (0%) patients with reversible defect(s), but a nonsignificant (< 50% narrowing) coronary angiogram, had a perioperative cardiac event. Three of the 27 (11.1%) patients with reversible defect(s) and significant disease on coronary angiography, who had undergone pre-transplant revascularization or were managed medically, had a perioperative coronary event. Of 14 recipients parameters analyzed, age > 50 yr was the only variable predictive of an abnormal DPT test. We conclude that the incidence of perioperative cardiac events in patients with a normal or fixed defect, or reversible defect(s) but a nonsignificant (< 50% narrowing) coronary angiogram is very low, indicating the high correlation of these findings on DPT and an uneventful (cardiac) post-transplant course. The incidence of perioperative cardiac complications amongst the high-risk transplant recipients with reversible defect(s) and significant CAD on coronary angiogram may be minimized by appropriate preoperative medical management or revascularization. None of the clinical variables except age > 50 yr was predictive of an abnormal DPT test.

Adult

Comparison of clinical diagnosis and standard laboratory and molecular methods for the diagnosis of genital ulcer disease in Lesotho: association with human immunodeficiency virus infection.

A multiplex polymerase chain reaction (M-PCR) assay for Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus (HSV) was compared with clinical and standard laboratory methods for the diagnosis of genital ulcer disease (GUD) in 105 patients; 36% were human immunodeficiency virus (HIV)-seropositive. Chancroid (80%), syphilis (8%), and genital herpes (8%) were the most frequent diagnoses. H. ducreyi and HSV were isolated from ulcers of 43% and 18% of patients, respectively; in 35%, all cultures were negative and the laboratory diagnosis indeterminate. M-PCR detected H. ducreyi, T. pallidum, and HSV in 56%, 23%, and 26% of patients, respectively; (no definitive diagnosis, 6%). The proportion of patients with more than one agent was 4% by culture and 17% by M-PCR (P = .002). Resolved sensitivities of M-PCR for H. ducreyi and HSV cultures were 95% and 93%, respectively. The sensitivities of H. ducreyi and HSV cultures were 75% and 60%, respectively. HSV, detected in 47% of specimens from HIV-infected versus 16% from HIV-uninfected patients (P < .001), may be emerging as a more frequent cause of GUD.

Adolescent

Frey's syndrome after parotidectomy: a retrospective and prospective analysis.

Gustatory sweating is a well-known sequela after parotid surgery. In a retrospective and prospective study of patients undergoing parotid surgery, the onset, time course, extent, and treatment modalities of Frey's syndrome were analyzed. Twenty-two percent of the patients evaluated by questionnaires and 43% of the patients followed prospectively within 1 year were found to be symptomatic. Although the Minor starch-iodine test was positive in 38% of patients at 3 months, none of these patients experienced symptoms. Up to 12 months after surgery the rate of patients who tested positive increased to 96% and the total area of sweating expanded to a mean value of 18 cm2. Whereas most of the patients are not markedly disturbed, few patients (5% to 10%) suffer from severe gustatory sweating. These patients present a therapeutic challenge.

Adenoma, Pleomorphic

A clinical and histologic comparison of percutaneous dilational versus conventional surgical tracheostomy.

To directly compare percutaneous dilational tracheostomy (PDT) with conventional surgical tracheostomy, a prospective study was performed in 83 patients requiring tracheostomy for prolonged mechanical ventilation in the intensive care unit or after surgery for a large tumor in the upper respirodigestive tract. Median follow-up was 355 days after PDT and 338 days after conventional tracheostomy. The overall morbidity rate was significantly lower with PDT than with conventional tracheostomy (6.4% vs 36.1%; P < 0.001). Compared with conventional tracheostomy, PDT was also associated with a significantly lower incidence of postoperative bleeding (2.1% vs 13.9%; P < 0.05) and postoperative wound infection (0% vs 22.2%; P < 0.001). There were no clinical signs of laryngotracheal stenosis in either group. In conclusion, PDT is a simple, fast, safe bedside procedure that is associated with significantly lower morbidity than standard surgical tracheostomy.

Adult

Evaluation of a new treadmill exercise protocol.

STUDY OBJECTIVES: To confirm that a newly drafted treadmill exercise protocol designed on a theoretical basis to span a range of 0 to 200 W with approximately 25-W increments by alteration of either speed or grade from one stage to the next should correspond to a standard bicycle protocol consisting of 25-W steps. DESIGN: Randomized, crossover study to compare both exercise test modes. STUDY PARTICIPANTS: Twenty-one consecutive healthy volunteers. INTERVENTIONS: Subjects underwent both exercise tests until either exhaustion or completion of the respective protocol, and cardiopulmonary exercise parameters were assessed during either of them. For comparison, correlation coefficients (r) were calculated. RESULTS: Exercise tolerance time was 9% higher on the treadmill (p<0.05). Ten subjects completed the bicycle program, whereas 18 subjects did so on the treadmill. With both protocols, there were comparably linear increases in heart rate (r=0.885), oxygen uptake (r=0.925), oxygen uptake per body weight (r=0.944), carbon dioxide output (r=0.937), and minute ventilation (r=0.914). For the 2-min stage duration, a plateau in oxygen uptake was achieved with neither protocol. The ventilatory equivalent for oxygen, which is not linear, showed its minimum at comparable workloads, at the point of surpassing the anaerobic threshold. Correlation of oxygen pulse was fair (r=0.896). CONCLUSIONS: There was an excellent correlation of the parameters with respect to both measured values at identical workloads and slopes of both protocols, thus enabling comparability of treadmill and bicycle ergometry. Due to its practical handling, the new protocol may facilitate acceptance, especially when used for elderly or disabled patients.

Adult

[Acute otitis media with effusion: an overview of the pathogenesis and recommendations for therapy].

Otitis media is one of the most common diseases in infants and young children. A combination of important factors contributes to the pathogenesis of acute otitis media and otitis media with effusion. These are poor tubal function, the degree of mastoid pneumatization, nasopharyngeal colonization with pathogenic bacteria and viruses, the ascending infectious pathway along the Eustachian tube, the immune status of the host, allergic and environmental factors, and genetic predisposition. Only correct diagnosis and understanding of they underlying pathophysiology enables the clinician to target treatment of the various forms of otitis media. We review the current concepts regarding evaluation and management of the diseased child and focus on the indication and selection of antibiotic therapy, bearing in mind the resistance rate within Switzerland. Most patients can be treated medically. "Otitis prone" individuals and children suffering from chronic otitis media with effusion with documented hearing loss clearly benefit from surgical intervention. We analyze the different treatment modalities and present a step-wise treatment algorithm. Newer vaccination trials indicate immunogenic effects even in young infants and show promising results in experimental and clinical studies.

Acute Disease

Two-fold effect of Angiotensin II on voltage-dependent calcium currents in rat retinal ganglion cells.

Angiotensin II (AngII) is one of the most important vasoconstrictive hormones but is also known to act as a neuromodulator in the central nervous system (CNS). Recently, AngII-containing neurons have been identified in the inner nuclear layer and the ganglion cell layer of the retina of various vertebrate species. The present study was undertaken to investigate the physiological effect of AngII on voltage-activated ion channels in retinal ganglion cells of the rat, Ion currents were recorded in freshly dissociated cells in the whole-cell configuration of the patch-clamp technique. AngII concentrations of 1 to 100 microM had no effect on sodium currents but modulated the influx through high voltage-activated (HVA) calcium channels in a 2-fold manner. AngII (100 microM) increased the HVA-calcium current by 15 to 65% in 41% of the cells, whereas a current reduction of 18 to 69% was observed in 59% of the cells. AngII effects were reversible within a few seconds of reperfusion with bath solution. Calcium-current kinetics and current-voltage relations remained unaffected.

Angiotensin II

Decrease in pacemaker incidence after orthotopic heart transplantation.

A decrease in sinus node dysfunction and pacemaker requirement after orthotopic heart transplantation was observed over a 6.5-year period, probably indicating the effect of a learning curve. Indirect evidence suggests a traumatic genesis of sinus node dysfunction after cardiac transplantation.

Arrhythmia, Sinus

Developmental regulation of voltage-activated Na+ and Ca2+ currents in rat retinal ganglion cells.

The developmental regulation of voltage-gated Na+ and Ca2+ current expression was investigated in rat retinal ganglion cells (RGCs) using whole cell patch clamp recordings. Experiments were performed on retinal whole mounts and slices from embryonic day 14 (E14), the developmental stage where RGCs start to differentiate from their precursor cells, to postnatal day 25 (P25) where the retina is fully differentiated and the animals have opened their eyes. No voltage-activated ion currents could be detected earlier than E17. From E17/18 on, small voltage-gated Na+ and Ca2+ currents could be measured which increased remarkably in amplitude until P16. Analysis of current kinetics and application of specific calcium channel antagonists revealed an alteration in the contribution of different Ca2+ current components to the voltage-activated whole cell Ca2+ current in RGCs during development.

Action Potentials

Free jejunum transfers for functional reconstruction after tumour resections in the oral cavity and the pharynx: changes of morphology and function.

Oropharyngeal reconstruction following resections for locally advanced carcinoma by free jejunum transfer was studied in 31 consecutive cases over a period of 6 years, from 1988-1994. The most common site was the hypopharynx (n = 23). Reconstruction of the tonsillar region was performed in 5 cases and of the inner lining of the mouth in 5 cases. Two patients underwent neoglottic reconstruction, creating a tracheo-pharyngeal shunt. By use of an exteriorized jejunal segment for flap monitoring changes in morphology and function of a microvascular transferred denervated segment of jejunum could be monitored. The success rate was 94%. No evidence of fistula formation and local dehiscence were experienced in this series. Histological examinations showed some fibrotic changes 6 months after transplantation; lubrication and motility of the transplant were not severely altered. Biosynthesis, processing, and proteolytic activity of the jejunal epithelial cells were not impaired 2 weeks postoperatively.

Carcinoma, Squamous Cell