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Biomedical subjects

T Mulligan

Publications and source records attributed to T Mulligan.

18 recordsLinked to original sources

Effects of folate receptor expression following stable transfection into wild type and methotrexate transport-deficient ZR-75-1 human breast cancer cells.

Two biochemically distinct systems, the high affinity folate receptor and the lower affinity reduced-folate carrier, have each been implicated in mediating the transport of folates and antifolates into cells. Previous studies from our laboratory have shown that methotrexate accumulation into wild type (WT) ZR-75-1 human breast cancer cells involves a system with characteristics of the reduced-folate carrier, that this system is deficient in methotrexate resistant (MTXR) ZR-75-1 cells in which methotrexate transport is undetectable and that neither breast cancer cell line expresses folate receptors. In this report we examined the possible interaction of the reduced-folate carrier with folate receptors by stably transfecting both WT ZR-75-1 and MTXR ZR-75-1 cells with an expression vector containing a folate receptor cDNA. Clones of stably transfected MTXR ZR-75-1 and WT ZR-75-1 cells expressing comparable levels of folate receptors were studied and compared to the nontransfected cell lines. Although nontransfected WT and MTXR ZR-75-1 cell lines require concentrations > or = 100 nM folic acid for growth, the expression of folate receptors in transfected WT and MTXR ZR-75-1 cells permitted the growth of both cell lines in low concentrations (1 nM) of folic acid. While the defect in the reduced-folate carrier system in MTXR ZR-75-1 cells inhibits their growth in medium containing low concentrations of folinic acid (< or = 1 microM), MTXR ZR-75-1 cells expressing folate receptors display uninhibited growth in 1 nM folinic acid. The accumulation of folic acid, folinic acid, and methotrexate is enhanced in folate receptor-transfected WT ZR-75-1 cells and MTXR ZR-75-1 cells. Furthermore, the accumulation of folates and antifolate was similar in both transfected WT and MTXR ZR-75-1 cell lines that expressed folate receptors. This suggests that alterations in the reduced-folate carrier do not affect folate receptor function. We also examined the effect of folate receptor expression on the sensitivity of WT and MTXR ZR-75-1 cells to methotrexate and to the lipophillic antifolate trimetrexate. Increased folate receptor expression decreased the sensitivity of WT ZR-75-1 cells toward the antifolate trimetrexate, presumably through increased uptake of reduced folates. Although the expression of the folate receptor enhanced the growth of both cell lines in low folate concentrations, it did not affect the sensitivity of either WT or MTXR ZR-75-1 cells to methotrexate.

Biological Transport

Bone marrow stromal fibroblasts secrete interleukin-6 and granulocyte-macrophage colony-stimulating factor in the absence of inflammatory stimulation: demonstration by serum-free bioassay, enzyme-linked immunosorbent assay, and reverse transcriptase polymerase chain reaction.

Bone marrow (BM) stromal fibroblasts produce hematopoietic growth factors (HGFs) in response to inflammatory mediators such as tumor necrosis factor-alpha or interleukin-1 alpha (IL-1 alpha). In the absence of such inflammatory stimuli, production of HGFs by BM stromal cells has been problematic and controversial. In vivo, however, basal hematopoiesis maintains blood counts within a normal homeostatic range even in the absence of inflammation, and HGFs are required for progenitor cell differentiation in vitro. To better ascertain the contribution of BM stromal fibroblasts to basal hematopoiesis, we therefore studied HGF production in quiescent BM stromal fibroblasts by three sensitive assays: serum-free bioassay, enzyme-linked immunosorbent assay, and reverse transcriptase polymerase chain reaction. Stromal fibroblasts were cultured in the presence or absence of normal human serum to determine if serum factor(s) present in the noninflammatory (basal) state induce secretion of HGFs. Human serum was found to induce or enhance transcription and secretion of granulocyte-macrophage colony-stimulating factor (GM-CSF) and enhance secretion of constitutively expressed IL-6. In contrast, no secretion of either granulocyte-CSF (G-CSF) or IL-3 was found. These data indicate that factors in normal human serum are active in enhancing GM-CSF and IL-6 production by stromal fibroblasts and suggest that these growth factors contribute to the maintainance of normal, basal hematopoiesis in vivo.

Adult

Sexual interest, activity, and satisfaction among male nursing home residents.

Structured interviews were conducted with all male residents (n = 116) of a Veterans Affairs Nursing Home to gather information on sexual interest, preference, activity levels, satisfaction, and distress. We excluded males with severe cognitive impairment, leaving a sample of 61. Of these, 30 had partners. Sexual interest was significantly higher among those with partners (p = 0.014), although those without partners reported that their interest would have been higher if they had a sexual partner. Sexual preference was strongly in favor of vaginal intercourse, regardless of the presence or absence of a partner. Among those with partners, coitus was reported to occur at least monthly by 17%, and other forms of sexual activity (e.g. hugging, kissing) were practiced at least monthly by 73%. Sexual satisfaction was high, and distress with relative sexual inactivity was remarkably low. We found age, functional status, and intercourse frequency to correlate positively with sexual satisfaction, whereas marital status, cognitive function, libido, and frequency of kissing were positive correlates of sexual distress. Institutionalized elderly males remain sexually interested, especially in coitus, and may benefit from counseling and home visits when a partner is available.

Adult

Sexuality and aging in male veterans: a cross-sectional study of interest, ability, and activity.

To gather data on sexuality, specifically in male veterans, and to test the hypothesis that aged males remain interested in sexual intercourse yet suffer from erectile failure, veterans age 30 to 99 were surveyed. The mailed survey had 88 questions and was pretested on young potent males and aged impotent males. From 1031 randomly selected subjects, there were 806 replies: 427 completed surveys, 247 refusals, and 132 who were too ill to participate (225 failed to reply). Among responders, sexual interest declined from a mean of 4.4/5 (4 = very interested, 5 = extremely interested) in men age 30-39 years to 2.0/5 (2 = slightly interested) in men age 90-99 (p less than 0.0001). Vaginal intercourse was consistently the preferred sexual activity; however, intercourse frequency was diminished from a mean of once per week in 30- to 39-year-olds to once per year in 90- to 99-year-olds (p less than 0.001). Frequency, rigidity, and duration of erections were less in aged compared to younger cohorts (p less than 0.0001). With these facts in mind, further research to bridge the libido-potency gap is warranted.

Adult

Interest in geriatrics education among family practitioners and internists in Virginia.

To determine primary care physicians' interest in continuing medical education (CME) in geriatrics, the authors surveyed all Virginia family practice (FP) physicians and internal medicine (IM) physicians, a total of 1,882. Sixty-one percent (1,139) responded, of which 56% were FP physicians and 44% were in IM. On a visual analog scale to measure the physicians' interest in geriatrics education (from 1 = unimportant to 10 = very important), the FP physicians' mean score was 6.4; the IM physicians' mean score was 6.1. The preferred form of education was a two-to-three-day conference, and the preferred topics were acute care, long-term care, and rehabilitation. Stepwise multiple regression showed that the physicians' intent to take the Added Qualifications in Geriatric Medicine examination was the major predictor of their interest in geriatrics education (R2 = .12, p = .0001). Also significant contributors were the total amount of geriatric care the physicians provided, the home visits they provided, their prior participation in geriatrics CME conferences, absence of a negative attitude toward the Medicare system, and their lack of confidence in their current knowledge of geriatrics. The final model could account for 20% of these physicians' interest in future CME in geriatrics (R2 = .20). These findings may help geriatrics educators develop methods to educate primary care providers about geriatrics.

Education, Medical, Continuing

Sexuality in dependent living situations.

Clearly, sexuality changes as we progress through life. For that segment of the aged population that resides independently in the community, sexual activity may continue unabated. In contrast, sexual activity for those elders who reside in nursing homes may change dramatically because of either functional inability or externally imposed behavioral guidelines. Through greater insight and compassion, it may be possible for care providers to enhance that component of life that was so stimulating and rewarding in early adulthood.

Aged

Urologic considerations in geriatric erectile failure.

In summary, an understanding of the anatomy and physiology of erection demonstrates how vulnerable this mechanism is to age-associated urologic disease and surgery. Malignant disease or surgical resection of the pelvic organs can disrupt neural pathways, and vascular disease or its reconstruction can disrupt vascular channels. Fortunately, advances in our understanding of the pathophysiology and treatment of erectile failure now permit the clinician and patient to choose from a variety of options. Nerve-sparing techniques can be used in pelvic surgery, and orthoses or self-injection can be used for the patient who prefers a nonsurgical approach. Finally, when nonsurgical options are unsatisfactory, a penile prosthesis can be implanted with success in the vast majority of patients. Through a compassionate and conscientious approach to geriatric erectile failure, the clinician can help patients regain a portion of life that often remains important despite aging and disease.

Aged

Geriatric sexual dysfunction.

More than half of males and females over the age of 80 report continued interest in sex but declining intercourse frequency, with a high incidence of male impotence. The authors cite nine common causes of erectile failure in the aged. Available treatment modalities include pharmacotherapy, external suction devices, introcorporeal injections, and penile prostheses.

Aged

The effect of vacuum devices on penile hemodynamics.

External vacuum devices are being used increasingly for the management of erectile dysfunction. There is limited information regarding the effect of vacuum devices on penile blood flow and potential for ischemic penile injury. The penile xenon washout rate was measured before and after application of 2 vacuum systems in 15 subjects. Compared to flaccid state measurements the xenon washout rate did not change significantly with the Synergist Erection System but it was significantly reduced with the Osbon ErecAid System. However, the degree and duration of decrease in penile blood flow that may result in ischemic changes are unknown.

Adult

Penile blood flow by xenon-133 washout.

Penile erectile failure is often attributed to abnormalities of vascular supply or drainage, but few direct measurements of penile blood flow have been made. We describe the xenon washout method for measurement of penile blood flow, and present the results obtained in a group of normal and impotent subjects. The procedure was performed with standard nuclear imaging equipment. Flaccid-state penile blood flow in the impotent patients studied was not significantly different from the normal group, suggesting that flaccid-state measurements may not be helpful in evaluation of erectile failure. However, this method can be used to measure penile venous outflow with stimulated or induced erection, and may provide a method for detecting abnormal venous leakage.

Adult

Why aged men become impotent.

Despite frequent erectile impotence in aged men, etiologic data are scarce. We evaluated 121 impotent male veterans (mean age, 68 +/- 5.3 years) to obtain information on potential pathophysiologic mechanisms. Subjects related a complete medical history and underwent physical examination, metabolic assessment, nocturnal penile tumescence monitoring, and vascular and neurologic assessment. The most frequent cause of impotence was the coexistence of neurologic and vascular disorders (30.3%). Other subjects had single causes, including vascular disease (21.1%), diabetic neuropathy (17.1%), nondiabetic neuropathy (10.5%), and psychopathology (9.2%). Remaining patients suffered from adverse drug effects (3.9%), hypogonadism (2.6%), and Peyronie's disease (1.3%). Five patients were objectively impotent on the basis of nocturnal penile tumescence, but otherwise normal. We conclude that geriatric impotence is primarily related to vascular or neurologic dysfunction. However, 15.7% of aged impotent men may have reversible impotence (eg, psychogenic causes or hypogonadism), and an additional 31.5% may have a treatable disorder (eg, penile neuropathy).

Aged

Erectile failure in the aged: evaluation and treatment.

With aging, there are changes in both libido and erectile function. Although the majority of aged men remain interested in sex, less than 15% report continued sexual intercourse. The cause of this "libido-potency gap" is due primarily to erectile failure. Penile erection is dependent upon a complex interaction of the autonomic nervous system, cardiovascular system, and local neurotransmitters such as acetylcholine and vasoactive intestinal polypeptide. Sexual stimulation causes augmented blood flow into the corpora cavernosa, and restricted outflow, resulting in penile rigidity. With aging, there is a decline in gonadal steroids, nerve conduction velocity, and vascular compliance, any of which could interfere with normal erections. When disease is superimposed on the normal changes of aging, erectile function is further impaired. Evaluation of an elderly male with impotence may consist of a detailed drug history and trial of alternate therapy, as in the case of adverse drug reactions. More often, evaluation entails hormonal assays, penile vascular assessment, neurologic assessment, and an evaluation of nocturnal erectile function. Based on the results of these assessments, appropriate treatment alternatives can be chosen. With the availability of multiple treatment options, patients and physicians can now choose from a range of noninvasive or invasive alternatives depending upon the etiology, associated disorders, and preference of the patient.

Aged

The role of aging and chronic disease in sexual dysfunction.

Sexual dysfunction is so highly prevalent in elderly males that it is often considered an inevitable consequence of "normal aging." To determine if other factors are related to an age-associated decline in sexual function, we surveyed two groups of elderly male veterans in a geriatric ambulatory care clinic: aged 65 to 75 years ("young-old") and aged over 75 ("old-old"). We compared their survey responses with responses from a general medical clinic for unstable medical patients, aged under 65 ("old-young"). Of 347 subjects surveyed, 225 completed a health and sexual function questionnaire (response rate = 65%). Absent libido was reported by 30% of old-young, 31% of young-old, and 47% of old-old. Erectile dysfunction was reported in 26% of old-young, 27% of young-old, and 50% of old-old (P less than .01). We used ordinal logistic regression and found overall sexual dysfunction to be significantly related to subjective poor health, diabetes mellitus, and incontinence (P less than .05), while controlling for age. These data suggest that, although sexual dysfunction is more common in the aged, it is often related more to comorbid illness than aging alone.

Aged

Parenteral antibiotic therapy for patients in nursing homes.

Since the number of aged Americans who require long-term care in nursing homes is increasing, attention has been focused on the cost-effective provision of medical care in the nursing home. In this health care setting, pneumonia and serious urinary tract infection are common among patients. These infections can now often be treated successfully with use of parenteral antibiotic therapy in the nursing home, thereby not subjecting the patient to the added stress of hospitalization. However, the physician's decision to use parenteral antibiotic therapy for the nursing home resident is complex and must be guided by the patient's condition, the wishes of the patient and family, the frequent shortage of professional staff, and the cost of the drug. Nevertheless, with these factors in mind, compassionate, high-quality care can often be provided in the nursing home in a cost-effective fashion.

Aged

Sexual function after heart transplantation.

To define sexual interest, ability, and activity before and after heart transplantation, we surveyed all discharged, male heart transplant recipients from our institution. Of the 115 potential subjects, 71 (62%) responded. Respondents were predominantly (89%) white, had a mean age of 47.9 years (24 to 64 years), and most (74%) were living with their spouses. Pretransplant libido was strong and remained unchanged after heart transplantation. Transplant recipients reported their partner's libido to be strong, and even stronger after transplantation than before (p = 0.033). In contrast, erectile rigidity and orgasmic ability were impaired before, and declined further after, the transplant procedure. Respondents perceived this gap between libido and sexual ability to be a problem, and interest in evaluation and treatment was high.

Attitude to Health

Behavioral and biochemical alterations following in utero exposure to methylmercury.

Behavioral changes induced in utero by methylmercury (MeHg) were studied with a non-invasive measure of patterns of effects in 1 to 35 day old rats. Lipid peroxidation (LP) and acetylcholinesterase (AChe) activity were used to compare effects in four different brain regions. MeHg (0, 2 or 6 mg/kg) was administered (PO) at day 6, 7, 8 and 9 of gestation. Rats were videotaped on day 10, 12, 20 and 34 and sacrificed on day 1, 13, 21 and 35. No changes in body or brain weights or other ancillary measures of growth and development occurred between 1-35 days. Cellular injury in brain regions as measured by LP was not altered by MeHg. AChe activity decreased in the anterior cortex and cerebellum on PN12. Frequency, dispersion and interactions of behavioral elements were determined. Frequency of grooming mode elements was decreased at 10, 12 and 34 days for 6 mg/kg, and at 12 and 34 days for 2 mg/kg pups. The frequency of exploratory mode elements increased at days 10 and 12 for 6 mg/kg, days 12 and 20 for 2 mg/kg pups. MeHg increased activities in the attention mode on PN12 at both doses. Behavior patterns were altered on all days observed, but these were not dose related. PN12 was observed to be the beginning of patterning (56 possible interactions). The 6 mg/kg group demonstrated a delay of pattern development at PN12 with a recovery to an altered array of behaviors at PN20. MeHg generally decreased interaction values (Chi2).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcholinesterase