PubMed Health⌕ Search

Biomedical subjects

S Webster

Publications and source records attributed to S Webster.

At least 37 records · Page 2Linked to original sources
PubMed1996

Professional ethics and managed care in dermatology.

The way health care is financed in the United States is changing quickly. Fee-for-service arrangements in which health care providers exercised great autonomy over health care services financed by third-party payers is quickly giving way to a variety of managed care approaches. The driving force behind this change is the desire to control the growth of health care cost. In the simplest term, costs are controlled in a managed care system by controlling the provision of services. Broadly speaking, 1 of 2 methods is used to control costs. Either physician behavior or subscriber behavior is modified or limited.

Adult↗
PubMed1995

Multivalent binding of complement protein C1Q to the amyloid beta-peptide (A beta) promotes the nucleation phase of A beta aggregation.

Activation of the classical complement pathway has been proposed as a mechanism of neurodegeneration in Alzheimer's disease. This activation is a result of the binding of C1q to amyloid beta-peptide (A beta). Recent work has shown that A beta/C1q binding has an additional consequence: enhanced formation of the neurotoxic, fibrillar, cross beta-pleated A beta configuration. Here we show that C1q enhances A beta aggregation at physiologically relevant, nanomolar concentrations of the peptides, and demonstrate that the kinetics of this enhancement are consistent with a nucleating interaction. We also show that the intact, multimeric structure of C1q, which offers multiple A beta binding sites spaced at 2-3 nm intervals, is required.

Alzheimer Disease↗
PubMed1995

Factors predicting the recurrence of adhesive small-bowel obstruction.

BACKGROUND: A long-standing debate exists about whether stable patients who have adhesive small-bowel obstruction (ASBO) are best managed operatively or nonoperatively. In addition, the factors that predict recurrence have not been established. PATIENTS AND METHODS: We conducted a retrospective cohort study using medical records of 31 ASBO patients managed operatively and 59 managed nonoperatively. Follow-up data for up to 12.8 years after the index ASBO were collected from medical records. RESULTS: Life-table analyses found that ASBO recurred after 53% of initial episodes and 85% or more of second, third, or later episodes. Recurrence was much more rapid after third or later episodes than after first or second episodes. Recurrence occurred sooner and more frequently in patients managed nonoperatively than in patients managed operatively. These differences became statistically significant only after the second episode. CONCLUSIONS: The number of prior episodes is the strongest predictor of recurrence. The optimal management strategy is a function of the number of prior episodes a patient has experienced. Nonoperative management appears reasonable for stable patients who are having their first episode. Operative strategies appear best for those experiencing second episodes. Neither strategy yields acceptable outcomes in patients experiencing third or later episodes.

Adolescent↗
PubMed1994

Enhanced aggregation and beta structure of amyloid beta peptide after coincubation with C1q.

Several lines of evidence now suggest that aggregation of soluble amyloid beta peptide (A beta) into a cross beta sheet configuration may be an important factor in mediating potential neurotoxicity of A beta. Synthetic A beta has been shown to self aggregate in vitro. Here, we demonstrate that coincubation of freshly solubilized A beta with C1q, a complement component known to bind A beta in vitro and to colocalize with A beta in vivo, results in as much as a 7-fold enhancement of A beta aggregation, as well as a 2-4-fold enhancement of beta structure within aggregates. The addition of C1q to preformed A beta aggregates also results in significantly increased resistance to aggregate resolubilization.

Amyloid beta-Peptides↗
PubMed1994

Tip of the iceberg.

Explore the source record for details and available documents.

Bedding and Linens↗
PubMed1994

Molecular and biological characterization of simian immunodeficiency virus macaque strain 32H proviral clones containing nef size variants.

The proviral genome of the 32H reisolate of simian immunodeficiency of macaques (SIVmac32H) has been cloned and sequenced. Including both long terminal repeats, it is 10277 base pairs in length and contains open reading frames for all known SIV genes (gag, pol, vif, vpx, vpr, tat, rev, env and nef). This is the first report of an infectious SIVmac molecular clone which contains no premature termination codons. Three molecular clones of SIVmac32H have been constructed differing in sequence only within their last 1.2 kb. Two of the molecular clones, SIVmac32H(pJ5) and SIVmac32H (pC8), differ in the nef coding region by an in-frame deletion of four amino acids in pC8 and two conservative amino acid changes; other nucleotide changes in the 3' LTR were not associated with known functionally critical motifs. The third clone, SIVmac32H(pB1), contains the last 1.2 kb of the SIVmac251 clone pBK28. The biological properties of virus produced after electroporation of these clones into C8166 cells has been assessed by infection of rhesus and cynomolgus macaques, time to seroconversion and by induction of cytopathic effects upon co-cultivation of infected rhesus peripheral blood lymphocytes with C8166 cells. The viruses obtained from these clones have identical growth kinetics in vitro but differ in their ability to persist in macaques. Macaques infected with pJ5 derived virus remain viraemic longer than macaques infected with pC8-derived virus. PCR analysis of circulating provirus indicates that the nef gene evolved over time in pJ5 virus-infected macaques, whereas late in infection in pC8 virus-infected macaques the nef gene remained invariant in sequence. These results support the observation that a nef deletion mutant of SIVmac239 lost its pathogenic potential and resulted in low-level viraemia when rhesus macaques were infected. Virus challenge pools for vaccine studies have been prepared for pJ5 using both human and monkey cell substrates and these stocks have been titrated both in vitro and in vivo. Virus has also been prepared from pC8 and titrated in vitro. This virus pool is being assessed as an attenuated live-virus vaccine in macaques. Since only virus originating from the SIVmac239 molecular clone is known to cause AIDS-like symptoms in rhesus macaques consistently, the SIVmac32H molecular clones should tell us more about which viral sequence features are important for the pathogenesis of AIDS.

Amino Acid Sequence↗
PubMed1994

Morphological alterations in endothelial cells associated with the release of von Willebrand factor after thrombin generation in vivo.

von Willebrand factor (vWF) is synthesized by endothelial cells and stored in endothelium-specific granules, the Weibel-Palade (WP) bodies. The release of vWF from endothelial cells in vitro in response to secretagogues such as thrombin is considered to result in the loss of WP bodies through the fusion of the WP bodies with the plasma membrane. Biochemical and morphological techniques, including transmission (TEM) and scanning (SEM) electron microscopy, were used to examine the plasma profile of vWF in parallel with morphological alterations in endothelial cells associated with the generation of thrombin in vivo. There was a rapid loss of high-molecular-weight multimers of the circulating vWF, with full recovery within 1 hour. Simultaneously, TEM demonstrated that the endothelial cells lost WP bodies and became severely vacuolated; this was associated with the appearance of craters in the endothelial surface on SEM. Release of stored vWF in WP bodies seemed to follow the fusion of multiple rather than individual WP bodies, with the resulting vacuole fusing and rupturing through the plasmatic membrane. Within 1 hour there was increased morphological evidence of metabolic organelle activity associated with replacement of WP bodies, presumably due to de novo synthesis of the basic protomer and its packaging in high-molecular-weight multimeric form in the storage organelles.

Analysis of Variance↗
PubMed1993

Complications of intracranial pressure monitoring in fulminant hepatic failure.

In patients with fulminant hepatic failure, brain oedema and the resulting intracranial hypertension often lead to death; intracranial pressure (ICP) monitoring may therefore be valuable. However, there is uncertainty about the hazards of implanting ICP monitoring devices. We carried out a survey of complications associated with ICP monitoring among centres performing liver transplantation in the USA (n = 262 patients). Epidural transducers were the most commonly used devices and had the lowest complication rate (3.8%); subdural bolts and parenchymal monitors (fibreoptic pressure transducers in direct contact with brain parenchyma and intraventricular catheters) were associated with complication rates of 20% and 22%, respectively. Fatal haemorrhage occurred in 1% of patients undergoing epidural ICP monitoring, whereas subdural and intraparenchymal devices had fatal haemorrhage rates of 5% and 4%. Thus, in the setting of fulminant hepatic failure, epidural transducers may be the safest choice for ICP monitoring, even though they are known to be less precise than the other devices.

Adult↗
PubMed1993

The development of homologous (canine/anti-canine) antibodies in dogs with haemophilia A (factor VIII deficiency): a ten-year longitudinal study.

The development of inhibitors to factor VIII in patients with haemophilia A remains as a serious complication of replacement therapy. An apparently analogous condition has been described in a canine model of haemophilia A (Giles et al., Blood 1984; 63: 451). These animals and their relatives have now been followed for 10 years. The observation that the propensity for inhibitor development was not related to the ancestral factor VIII gene has been confirmed by the demonstration of vertical transmission through three generations of the segment of the family related to a normal (non-carrier) female that was introduced for breeding purposes. Haemophilic animals unrelated to this animal have not developed functionally significant factor VIII inhibitors despite intensive factor VIII replacement. Two animals have shown occasional laboratory evidence of factor VIII inhibition but this has not been translated into clinical significant inhibition in vivo as assessed by clinical response and F.VIII recovery and survival characteristics. Substantial heterogeneity of inhibitor expression both in vitro and in vivo has been observed between animals and in individual animals over time. Spontaneous loss of inhibitors has been observed without any therapies designed to induce tolerance, etc., being instituted. There is also phenotypic evidence of polyclonality of the immune response with variable expression over time in a given animal. These observations may have relevance to the human condition both in determining the pathogenetic factors involved in this condition and in highlighting the heterogeneity of its expression which suggests the need for caution in the interpretation of the outcome of interventions designed to modulate inhibitor activity.

Animals↗
PubMed1993

Comparison of serum antibody reactivities to a conformational and to linear antigenic sites in the external envelope glycoprotein of simian immunodeficiency virus (SIVmac) induced by infection and vaccination.

Forty-six overlapping peptides (20-mers) representing the amino acid sequence of the external envelope glycoprotein of simian immunodeficiency virus (SIVmac; 32H isolate) were used to investigate linear antigenic sites recognized by antibodies in sera from SIV-infected rhesus macaques and in animals vaccinated with formalin-inactivated SIV. The reactivity to a discontinuous antigenic site as defined by a neutralizing monoclonal antibody was measured by competition assay. The majority of infected macaques recognized three linear antigenic determinants within the V1, V3 and C5 regions of the external glycoprotein. Animals infected with virus derived from the molecular clone SIVmac 32H (pJ5) showed broader reactivity to peptides with half of these animals having antibodies to the V2 region in addition to the V1, V3 and C5 regions. The majority of animals produced antibodies in response to the discontinuous epitope although these responses were weaker in animals infected with molecularly cloned virus. Seven of eight animals given vaccine in syntex adjuvant formulation (saf-1) produced antibodies in response to the discontinuous epitope and all reacted with peptides from the V1, V2 and V3 regions but only half recognized the C5 region. Animals receiving vaccine in alum adjuvant generally showed weaker responses to the discontinuous and linear determinants than those receiving saf-1 adjuvanted vaccine.

Amino Acid Sequence↗
PubMed1993

Reduction of cerebral perfusion precedes rise of intracranial pressure in rats with ischemic fulminant liver failure.

In fulminant liver failure, brain edema may progress to intracranial hypertension. However, the rise in intracranial pressure is a late event in this sequence. We investigated the relationship between cerebral perfusion and development of intracranial hypertension in a well-characterized model of fulminant liver failure, the rat subjected to hepatic devascularization (n = 11). In addition, we examined the effects of hyperglycemia on the development of brain edema because high blood glucose level can exacerbate other forms of brain edema, as seen in stroke. Intracranial pressure was continuously monitored with a cisterna magna catheter; relative changes in blood flow were continuously assessed with a Doppler flow probe on the internal carotid artery. Cerebral perfusion decreased by 62%, with the greatest reduction before the onset of increased intracranial pressure. Intracranial pressure did not change until 2 hr before death, at which time it increased exponentially. Brain water in fulminant liver failure rats was significantly increased compared with that in controls. Hyperglycemia (200 to 220 mg/dl) had no effect on time elapsed until loss of corneal reflex, percentage of brain water, maximal intracranial pressure or pattern of change in cerebral perfusion compared with euglycemia (80 to 100 mg/dl). Sham-operated animals showed no changes in measured parameters. We conclude that a linear reduction in cerebral perfusion precedes the rise of intracranial pressure in this model, a decrease that may reflect changes in brain metabolic activity at the time that brain edema develops. Carotid blood flow monitoring may be a useful noninvasive tool for the detection of cerebral events in fulminant liver failure.

Animals↗
PubMed1992

Complement activation by beta-amyloid in Alzheimer disease.

Alzheimer disease (AD) is characterized by excessive deposition of the beta-amyloid peptide (beta-AP) in the central nervous system. Although several lines of evidence suggest that beta-AP is neurotoxic, a mechanism for beta-AP toxicity in AD brain remains unclear. In this paper we provide both direct in vitro evidence that beta-AP can bind and activate the classical complement cytolytic pathway in the absence of antibody and indirect in situ evidence that such actions occur in the AD brain in association with areas of AD pathology.

Alzheimer Disease↗
PubMed1992

Smoking alters the relationship between maternal zinc intake and biochemical indices of fetal zinc status.

Maternal smoking impairs fetal zinc status. This study was designed to clarify the effect of smoking on the relationship between maternal zinc intake and zinc status in mother and fetus. Zinc was measured with atomic-absorption spectroscopy. Statistical analyses consisted of descriptive statistics, simple correlations, and stepwise multiple regression. The results suggest that maternal plasma zinc, red blood cell zinc, and alkaline phosphatase at term are not related to maternal zinc intake. In the nonsmoking parturient both cord-vein plasma zinc and cord-vein alkaline phosphatase activity are positively related to maternal zinc intake. In the smoking parturient there is no relationship between maternal zinc intake and fetal zinc status except for a negative relation with cord-vein plasma zinc. Relations between maternal zinc intake and placental zinc can be shown with stepwise-multiple-regression techniques. The data suggests that maternal zinc intake is related not to maternal zinc status but to fetal zinc status in a normal pregnancy. The relation is altered in the pregnancy complicated by smoking.

Alkaline Phosphatase↗
PubMed1991

Intracranial pressure waves and intracranial hypertension in rats with ischemic fulminant hepatic failure.

Brain edema and intracranial hypertension are a major cause of death in fulminant hepatic failure. We have shown that brain water measured in rats after hepatic devascularization (portacaval anastomosis followed in 24 to 48 hr by ligation of the hepatic artery) increases with the progression of encephalopathy. In this study, we examined whether intracranial hypertension develops in this model of fulminant hepatic failure. Using a fiberoptic pressure transducer, intracranial pressure rose from 3.3 +/- 1.1 mm Hg to 23.7 +/- 2.7 mm Hg (mean +/- S.E.M.) by the time the corneal reflex was lost; intracranial pressure was unchanged in control rats. Immediately after ligation of the hepatic artery, intracranial pressure was normal and remained stable until the last hours of the experiment, when it progressively rose, suggesting a loss of intracranial compliance. In addition, sudden and short episodes of marked increases in intracranial pressure (greater than 50 mm Hg) not related to seizure activity markedly decreased cerebral perfusion pressure. Internal carotid artery blood flow, an indirect measure of cerebral perfusion, decreased 29% +/- 12% by the end of the experiment. The time elapsed from ligation of the hepatic artery until loss of the corneal reflex (range 340 to 940 min) was related to the change in cerebral perfusion pressure, suggesting that an increase in systemic arterial pressure at the time of the initial rise in intracranial pressure may result in an increased length of survival. In this animal model, widely used to study the pathogenesis of hepatic encephalopathy, intracranial hypertension invariably appears in the terminal phase of the course. The development of intracranial pressure waves may be an indication that brain herniation is imminent.

Animals↗
PubMed1991

The life shortening effects of treatment with doxorubicin and/or local irradiation on a cohort of young C3Hf/Sed mice.

The long-term consequences of treating a cohort of C3Hf/Sed mice in early life with either local-field single dose radiation, systemic doxorubicin, or both, are reported in this study. Significant life shortening was observed in all treatment groups. Median survival times (days) from time of treatment were: control, 690; 35 Gy, 560; 70 Gy, 460; 5 mg/kg doxorubicin, 580; 10 mg/kg doxorubicin, 350; 35 Gy + 5 mg/kg doxorubicin, 510; 70 Gy + 10 mg/kg doxorubicin, 310. Mice receiving hind limb irradiation died principally from induced sarcomas in a dose dependent fashion (80% after 70 Gy and 55% after 35 Gy). Those treated with doxorubicin alone showed an increase in the actuarial incidence of spontaneous malignancies but died mainly from non-malignant causes. Histological examination did not reveal any characteristic cardiac, renal or pulmonary lesions. Doxorubicin did not increase the rate of development of radiation induced sarcomas in mice treated with combined modality.

Animals↗
PubMed1990

Physiological effects of a weight loss regimen practiced by college wrestlers.

The effects of weight loss (dehydration) techniques (which mimicked techniques used prior to actual competition) used by intercollegiate wrestlers on selected physiological parameters (strength, anaerobic power, anaerobic capacity, the lactate threshold (LT), and peak aerobic power) were examined in seven intercollegiate wrestlers. During the 36 h weight loss period, subjects lost 3.3 kg (4.9% body weight), all of which occurred during the 12 h prior to weigh-in, using exercise in a rubberized sweat suit. Weight loss resulted in a reduction in upper body but not lower body strength measures (peak torque and average work per repetition). Anaerobic power and anaerobic capacity were significantly reduced in a dehydrated state (81.4 kgm.s-1, normal weight; 63.9 kgm.s-1, weight loss; 1984.3 kgm.40 s-1, normal weight; 1791.4 kgm.40 s-1, weight loss). Analyses of treadmill data revealed the following: 1) velocity was decreased at LT (4.4%) and peak (6.5%) during weight loss (P less than 0.05); 2) VO2 peak was significantly reduced with weight loss (6.7%, P less than 0.05); 3) treadmill time to exhaustion was significantly reduced in the weight loss state (12.4%) (35.7 min, normal weight; 31.3 min, weight loss). It was concluded that typical wrestling weight loss techniques result in deleterious effects on strength, anaerobic power, anaerobic capacity, the lactate threshold, and aerobic power.

Adolescent↗