Flexibility: ticket to survival. Interview by Lisa Schnirring.
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Economics, Medical↗
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Results for “LISA”
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Toughing out the business climate. Interview by Lisa Schnirring.
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Health Care Costs↗
Community nursing care study: preparing for Lisa.
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Community Health Services↗
Debate continues over use of disposable handpieces. Interview by Lisa Rotella.
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Cost-Benefit Analysis↗
The MONA LISA hypothesis in the time of leptin.
The regulation of body fat stores is a problem of energy and nutrient balance that can be most readily viewed as a feedback system. Several elements are involved in any feedback system, including afferent signals, a controller that senses the afferent signals and transduces their information and then activates efferent controls that regulate the controlled system. The recent discovery of leptin has provided a major missing link in the feedback control system. This afferent signal is produced exclusively in fat cells of nonpregnant mammals but can be produced in the placenta as well. This circulating peptide has a very strong relationship to the level of body fat and its absence experimentally and clinically produces massive obesity. In the controller, or brain, several anatomic regions play a central role in regulating fat stores. Damage to the ventromedial nucleus (VMH) or the paraventricular nucleus (PVN) in the hypothalamus produces massive obesity in mammals and birds. Injury to the central nucleus of the amygala will also produce obesity. In contrast, damage to the lateral hypothalamus reduces body fat. The syndrome of leptin deficiency or defects in the leptin receptors produce a massive obesity that is metabolically similar to the VMH or PVN lesion syndromes of obesity, suggesting that leptin may have its metabolic effects through these medial hypothalamic centers. Support for this idea has come from studies showing that damage to the PVN or VMH will block the effects of leptin. A number of neuropeptides and monoamines are involved with modulating of food intake and fat stores. Both serotonin, acting through 5-HT2C receptors, and norepinephrine, acting through beta 2 and/or beta 3 receptors, reduce food intake. A variety of peptides also influence food intake and body fat. Neuropeptide Y, dynorphin, galanin, and melanocyte-stimulating hormone all increase food intake. In contrast, a large number of peptides--including cholecystokinin, corticotrophin-releasing hormone/urocortin, enterostatin, insulin, leptin, alpha-MSH, and TRH--reduce food intake. Chronic administration of neuropeptide Y, acting through Y-5 receptors, can produce chronically increased food intake and obesity. This syndrome is similar to the VMH syndrome and suggests that NPY must be acting as an inhibitor of a feeding system. The melanocortin receptor system may be particularly important because a mouse that does not express MC4 receptors is massively overweight. These central systems modulate food intake and fat stores by the controlled system. Glucocorticoids from the adrenal gland are important in obesity, since adrenalectomy will reverse or prevent the development of all forms of obesity. The sympathetic nervous system is also important because low sympathetic activity is associated with experimental and clinical obesity. The reciprocal relationship between food intake and sympathetic activity has been a robust relationship, suggesting that beta receptors in the periphery or brain may be involved in feeding control. In one model of dietary obesity resulting when animals eat a high-fat diet, the syndrome is blocked by inhibitory adrenal steroid activity. These animals show a lower level of sympathetic activity and a low level of brain serotonin. Finally, they show an enhanced sensitivity to essential fatty acids when these are applied to the tongue or given into the gut. In this chapter, the control of energy stores as fat is viewed as a feedback system. Leptin is perceived as a key afferent signal and glucocorticoids and the sympathetic nervous system through beta receptors as essential elements of this control system.
Animals↗
Steady-state free precession with myocardial tagging: CSPAMM in a single breathhold.
A method is presented that combines steady-state free precession (SSFP) cine imaging with myocardial tagging. Before the tagging preparation at each ECG-R wave, the steady-state magnetization is stored as longitudinal magnetization by an alpha/2 flip-back pulse. Imaging is continued immediately after tagging preparation, using linearly increasing startup angles (LISA) with a rampup over 10 pulses. Interleaved segmented k-space ordering is used to prevent artifacts from the increasing signal during the LISA rampup. First, this LISA-SSFP method was evaluated regarding ghost artifacts from the steady-state interruption by comparing LISA with an alpha/2 startup method. Next, LISA-SSFP was compared with spoiled gradient echo (SGRE) imaging, regarding tag contrast-to-noise ratio and tag persistence. The measurements were performed in phantoms and in six subjects applying breathhold cine imaging with tagging (temporal resolution 51 ms). The results show that ghost artifacts are negligible for the LISA method. Compared to the SGRE reference, LISA-SSFP was two times faster, with a slightly better tag contrast-to-noise. Additionally, the tags persisted 126 ms longer with LISA-SSFP than with SGRE imaging. The high efficiency of LISA-SSFP enables the acquisition of complementary tagged (CSPAMM) images in a single breathhold.
Artifacts↗
Difference in sero-diagnostic values among KL-6-associated mucins classified as cluster 9.
KL-6 classified as Cluster 9 (MUC-I) is a circulating high-molecular-weight mucin-like molecule. Serum level of KL-6 was measured by a sandwich assay using KL-6 antibody as not only a catcher but also as a tracer. We established 2 additional monoclonal antibodies (MAbs), LISA 101 and EH-123, reacting with KL-6 epitopes different from the epitope recognized by KL-6 antibody. The KL-6-associated mucins detected by the sandwich assay using LISA 101 or EH-123 antibody as a catcher and KL-6 antibody as a tracer were designated as LISA 1-6 and CAM 123-6 respectively. The diagnostic values as the serum markers of KL-6, LISA 1-6 and CAM 123-6 were evaluated measuring their levels in the same serum from healthy individuals and from patients with pulmonary, pancreatic and breast adenocarcinomas. KL-6 was increased abnormally at high rates of more than 50% in pancreatic cancer and in benign lung diseases, LISA 1-6 only in pancreatic cancer, and CAM 123-6 only in pulmonary adenocarcinoma. In benign lung diseases, however, LISA 1-6 and CAM 123-6 were increased abnormally at the rates of only 5.3% and 0% respectively. These observations clearly indicate that LISA 1-6 and CAM 123-6 constitute a part of KL-6, but that they are superior to KL-6 as tumor markers for pancreatic cancer and for pulmonary adenocarcinoma respectively, because of their much lower false-positive rates.
Adenocarcinoma↗
Neocortical activation: modulation by multiple pathways acting on central cholinergic and serotonergic systems.
The present experiments examined the central systems which mediate the electrocorticographic activation induced by electrical stimulation of forebrain and midbrain areas known to play a role in cerebral activation. In urethane-anesthetized rats, 100-Hz electrical stimulation of the amygdaloid cmplex or dorsal raphe changed neocortical electrocorticographic activity from large irregular slow activity (LISA; 1-6 Hz, up to 2 mV) to low voltage fast activity (LVFA; less than 0.5 mV, including frequencies above 10 Hz). The LVFA during amygdala stimulation, but not that during dorsal raphe stimulation, was completely abolished and replaced by LISA after administration of the anti-muscarinic agent scopolamine (5 mg/kg, i.p.), confirming previous work suggesting that neocortical LVFA is maintained by two distinct neurochemical inputs to the cortex that can be dissociated using anti-muscarinic drugs. Electrical stimulation of the locus coeruleus area or of the superior colliculus also suppressed LISA and induced LVFA. The LVFA during stimulation of the locus coeruleus area was abolished by the anti-muscarinic drug atropine (50 mg/kg, i.p.), whereas the LVFA during superior colliculus stimulation was atropine-resistant but could be abolished by the serotonergic antagonists methiothepin (5 mg/kg, i.p.) or ketanserin (5 mg/kg, i.p.). Stimulation of 44% of electrode sites in the orbitofrontal cortex produced neocortical LVFA which was reduced by atropine and completely abolished by additional administration of methiothepin. Stimulation of the entorhinal or cingulate cortex was ineffective in producing LVFA and often resulted in the appearance of epileptiform activity. Single-pulse electrical stimulation of those sites that effectively induced atropine-sensitive LVFA (amygdala, locus coeruleus area) produced excitation of over 65% of those extracellularly recorded basal forebrain neurons that fired at higher rates during the presence of neocortical LVFA relative to LISA. About 80% of basal forebrain cells that were more active during LISA relative to LVFA were inhibited by single-pulse stimulation of the amygdala or locus coeruleus area. The present results suggest that widely distributed neuronal systems can produce electrocorticographic activation by acting through mechanisms sensitive to anti-muscarinic or anti-serotonergic drugs, suggeting that these activating influences involve the release of acetylcholine and/or serotonin. Those neural systems that produce atropine-sensitive (i.e., putative cholinergic) LVFA, believed to be dependent on the cholinergic innervation of the cortex arising in the basal forebrain, may produce electrocorticographic activation by exciting basal forebrain cells that appear to contribute to neocortical LVFA, while concurrently inhibiting cells that may contribute to LISA.
Acetylcholine↗
Adequate protection of the public against food-transmitted diseases of microbial aetiology. Achievements and challenges, half a century after the introduction of the Prescott-Meyer-Wilson strategy of active intervention.
No dramatic change in the approach to supplying microbiologically safe foods and meals to the consumer occurred immediately upon the introduction, in the 1930's, by S.C. Prescott and K.F. Meyer in the U.S. and Sir Graham Wilson in the U.K. of the principle of taking preventive remedial measures rather than merely examining final product samples. Thus morbidity and the economic impact of food-borne disease of microbial aetiology continued to rise and new food-transmitted pathogens continued to be identified. The 1930 strategy was not implemented until 1970 when food processing specialists in the U.S. launched a similar approach under the new acronym 'HACCP' (hazard analysis: critical control points). This relies on (i) identification, by meticulous ecological studies, of hazardous practices and locations, termed 'critical points' by the new generation; (ii) elimination of such hazards by developing processing techniques designed to control contamination and colonization of foods--also given an innovative term, viz. GMP; (iii) validation of the elaborated procedures by a new stem to the Science of Public Health: risk assessment, perhaps better termed Safety Science; (iv) upon introduction of the validated GMP's monitoring limited numbers of samples--which have become fully representative because of process management--for ecologically valid marker organisms, indicating incidental going-out-of-control of manufacture or distribution. This implementation of the Prescott-Meyer-Wilson maxim has been given the name longitudinally integrated safety assurance, charmingly acronymized to LISA. Introduction of LISA eliminates all previously existing or perceived difficulties about microbiological target values ('standards') for foods. These can henceforth be empirically assessed from surveys on samples obtained from factories or catering establishments previously inspected for adherence to LISA, deficiencies having, where necessary, been rectified prior to the examination of samples. Unfortunately, a more general adoption of the LISA maxim in food technology occurred at almost the same time as people became concerned about the perceived negative health impact of processing food for safety. This culminated in widespread rejection of foods decontaminated by low dose gamma irradiation. While behaviourial scientists seriously attempt to identify the mechanisms of this anxiety and devise means of reassurance, food scientists should continue to elaborate innovative LISA procedures. In this context three promising areas of research and development are briefly discussed.
Animals↗
Management of invasive pulmonary aspergillosis in hematology patients: a review of 87 consecutive cases at a single institution.
Eighty-seven patients with hematologic malignancies and invasive pulmonary aspergillosis (IPA) were identified between 1982 and 1995. Of these, 39 underwent lung resection on the basis of radiological detection of at least 1 lesion with imaging suggestive of aspergillosis (LISA). IPA was confirmed histologically in 35. The presence of LISA had 90% positive predictive value for IPA. The actuarial survival at 2 years was 36% for 37 patients treated surgically, 20% for 12 patients with unresected LISA but no cultures of Aspergillus species, and 5% for 21 patients diagnosed only by isolation of Aspergillus from respiratory secretions. Analysis by proportional hazard models showed a significant independent negative association between the radiological appearance of LISA and death from all causes. Relapsed hematologic disease was independently significantly associated with death. Age, sex, surgery, previous bone marrow transplantation, or Aspergillus isolation were not independent predictors of death. IPA presenting as LISA carries a relatively good prognosis, possibly explaining the better survival of patients undergoing surgery for such lesions.
Adolescent↗
Conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting: its effect on outcome.
The surgical outcome of patients requiring conversion to cardiopulmonary bypass (CPB) during myocardial revascularization using the less invasive surgical approach (LISA) was assessed. The LISA was recently introduced as a technique for complete myocardial revascularization without CPB. It combines avoidance of CPB with the versatility of a median sternotomy for access to all coronary vessels. We have previously demonstrated reduced risk-adjusted mortality and complications in off-CPB coronary artery bypass grafting (CABG) using LISA compared to standard myocardial revascularization. From January to December 1997, 1210 patients underwent isolated CABG at our institution. Of these patients, 832 (63%) were scheduled as on-CPB cases and 378 (37%) as off-CPB. Of the off-CPB patients, 48 were converted to CPB. Team A surgeons used LISA as their primary strategy for CABG whereas team B surgeons used off-CPB CABG in selected patients. Conversions were divided in three classes: Class I patients were converted when the surgeon considered complete revascularization impossible off-CPB; Class II patients were converted due to hemodynamic instability during the procedure; and Class III patients were converted due to graft malfunction, determined by flow measurements or clinical evidence. There were four deaths. All had perioperative infarctions and required intra-aortic balloon pump (IABP). Conversion to CPB occurred in up to 25% of patients scheduled for off-CPB CABG. When off-CPB cases are done using the comprehensive LISA technique and modern technology, conversion rates may be reduced to 11%. Conversion is in general well tolerated except when it is instituted for graft malfunction combined with hemodynamic instability or collapse.
Adult↗
Pharmacophore analysis of the nuclear oxysterol receptor LXRalpha.
A cell-free assay was developed for the orphan nuclear receptor LXRalpha that measures the ligand-dependent recruitment of a peptide from the steroid receptor coactivator 1 (SRC1) to the nuclear receptor. Using this ligand-sensing assay (LiSA), the structural requirements for activation of the receptor by oxysterols and related compounds were studied. The minimal pharmacophore for receptor activation was shown to be a sterol with a hydrogen bond acceptor at C24. 24(S),25-Epoxycholesterol (1), which meets this criterion, is among the most efficacious of the oxysterols and is an attractive candidate as the LXRalpha natural hormone. Cholenic acid dimethylamide (14) showed increased efficacy compared to 1, whereas the unnatural oxysterol 22(S)-hydroxycholesterol (4) was shown to be an antagonist of 1 in the LiSA. The structural requirements for SRC1 recruitment in the LiSA correlated with the transcriptional activity of compounds in a cell-based reporter assay employing LXRalpha-GAL4 chimeric receptors. Site-directed mutagenesis identified Trp(443) as an amino acid critical for activation of LXRalpha by oxysterol ligands. This information was combined with the structure-activity relationship developed from the LiSA to develop a 3D homology model of LXRalpha. This model may aid the design of synthetic drugs targeted at this transcriptional regulator of cholesterol homeostasis.
Amino Acid Sequence↗
Changing referral pattern in off-pump coronary artery bypass surgery: a strategy for improving surgical results.
BACKGROUND: We have previously shown that a less invasive surgical approach (LISA) can reduce mortality and morbidity in coronary artery bypass grafting (CABG). This appears to have led to the referral of increasingly high risk patients for this procedure as compared to patients undergoing traditional CABG. The purpose of this paper is to compare preoperative risk factors and postoperative complications in both LISA and conventional CABG cases using the New York State database. METHODS: From January 1997 to September 1998, 1,993 patients underwent CABG in our institution: 1,384 with CPB (group A) and 609 without CPB (group B). In group B (LISA), a well defined strategy was followed in an effort to prevent hemodynamic instability during coronary exposure, avoid myocardial ischemia, verify graft patency, and use alternative surgical incisions in reoperations. RESULTS: Analysis of preoperative risk factors using the NYS database showed a significant increase in comorbidities in group B (p < 0.005), while at the same time postoperative complications and risk-adjusted mortality were lower (p = NS). CONCLUSION: Our data demonstrates that by using the LISA, high risk patients can undergo CABG with equal or lower mortality and morbidity than traditional CABG.
Comorbidity↗
Less Invasive Surfactant Administration Using Video Laryngoscope to Decrease Pain in Neonates: A Randomized Controlled Trial.
OBJECTIVES: To assess whether the use of video laryngoscope, when compared to conventional laryngoscope decreases pain (assessed by Faceless Acute Neonatal Pain Scale) in preterm neonates while administering surfactant by LISA. METHODS: Preterm neonates < 35 weeks requiring FiO2 > 0.3 on CPAP pressure of at least 6 cm of H2O were administered surfactant by LISA technique either by video laryngoscope (Intervention) or conventional laryngoscope (Control). Faceless Acute Neonatal Pain Scale was used to determine pain 5 min before the procedure, immediately, 5 min, and 10 min after the procedure. The primary outcome was severity of pain; secondary outcomes were time taken to complete the procedure, number of attempts, incidence of IVH, and adverse events during the procedure. RESULTS: In total, 42 neonates of < 35 weeks gestation with comparable baseline demographics were randomized into 2 groups. The median (IQR) FANS score immediately post-procedure in the intervention arm was 2 (2-4) versus 2 (1-4) in the control arm, p = 0.79. There was no statistical difference in the secondary outcomes studied. CONCLUSION: The two groups had no difference in the pain score. The pain experienced by neonates during the LISA procedure was moderate and of short duration and it did not depend on the type of laryngoscope used. Moderate pain during the procedure can be managed with nonpharmacological measures; thereby, the use of sedatives or analgesics can be avoided, which might be of concern. There was no difference in the number of attempts or in time taken to complete the procedure when performed by neonatologists experienced in using conventional laryngoscopes compared to video laryngoscopes. TRIAL REGISTRATION: Clinical Trial Registry of India: CTRI/2022/09/045204 on 05.09.2022.
Humans↗
5-Hydroxytryptamine (5-HT) agonists: effects on neocortical slow wave activity after combined muscarinic and serotonergic blockade.
In freely-moving rats treated with a combination of reserpine (10 mg/kg, i.p.) and scopolamine (5 mg/kg, i.p.), neocortical low voltage fast activity (LVFA) associated with continuous multiunit activity (MUA) was abolished and replaced by 2-6 Hz large irregular slow activity (LISA) above 1.5 mV associated with a burst-suppression pattern of MUA. Administration of the monoamine oxidase inhibitor pargyline (50-100 mg/kg, i.p.) completely suppressed 2-6 Hz LISA and restored normal-appearing LVFA and continuous MUA. The 5-hydroxytryptamine (5-HT) receptor agonists quipazine (0.5-20 mg/kg, i.p.), (+/-)-DOI (0.1-5 mg/kg, s.c.), and buspirone (0.1-10 mg/kg, i.p.), but not 8-hydroxy-2-(di-n-propylamine) tetraline (8-OH-DPAT, 0.05-0.8 mg/kg, s.c.) and RU 24969 (1-30 mg/kg, i.p.), produced a partial suppression of 2-6 Hz LISA and restored some lower voltage activity (< 1 mV) above 6 Hz associated with continuous MUA. However, as opposed to pargyline, no receptor agonist tested restored continuous, normal-appearing LVFA. Even though agonists at 5-HT receptors can produce some activation of neocortical slow wave activity after combined cholinergic and serotonergic blockade, this effect is not equivalent to that observed after restoration of endogenous 5-HT transmission.
Animals↗
Career options: the increasing demand for courtroom nurses.
Gail Hoffman and Lisa Michaels first met at the University of Miami School of Nursing in the early seventies. Because of their mutual interest in pediatrics and their desire to stay in South Florida, both expected that their paths would cross again at some time during their nursing careers. But neither of them expected that 20 years later the crossroads would be in a courtroom, both working for a defense attorney on a medical malpractice case. Now, in Smith v Mizrahi, Gail is a nurse paralegal assigned to the case through her employment at Green, Williams, & Conrad, P.A., and Lisa was called to serve as an expert witness. Although the coincidence of Gail and Lisa's reacquaintance is unique, their career change stories are not.
Career Choice↗
Nelfinavir induces liposarcoma apoptosis and cell cycle arrest by upregulating sterol regulatory element binding protein-1.
"HIV protease-induced lipodystrophy syndrome" is associated with the use of HIV protease inhibitors for treatment of HIV infection. In-vitro studies suggest that alteration of sterol regulatory element binding protein-1 levels underlie its pathogenesis. We postulated that HIV protease inhibitors may represent a novel class of antiliposarcoma agents. SW872, FU-DDLS-1 and LiSa-2 liposarcoma, and HT1080 and 293 nonliposarcoma cell lines were treated with HIV protease inhibitors (nelfinavir, ritonavir, saquinavir, indinavir and amprenavir), and clonogenic assays were performed. Nelfinavir exhibited the most potent inhibition of clonogenicity, and further assays for proliferation, cell cycle and apoptosis were performed with nelfinavir. Immunoblots were performed for sterol regulatory element binding protein-1, proapoptotic and cell cycle-related protein expression after nelfinavir treatment. Finally, a sterol regulatory element binding protein-1-inducible SW872 cell line was developed to examine the phenotype resulting from upregulated sterol regulatory element binding protein-1. Nelfinavir selectively inhibited clonogenicity and proliferation, and induced G1 cell cycle block and induced apoptosis in a dose-dependent manner in SW872 and LiSa-2 cells, whereas it had minimal or no effect on these parameters in FU-DDLS-1 or nonliposarcoma cells. Nelfinavir induced significant sterol regulatory element binding protein-1 expression in a dose-dependent and time-dependent fashion in sensitive SW872 and LiSa-2 cells, modestly in HT1080 cells, but not in nelfinavir-insensitive FU-DDLS-1 and 293 cells without inducing adipocytic differentiation. Forced expression of sterol regulatory element binding protein-1 in inducible-SW872 cells led to the induction of proapoptotic and antiproliferative proteins, and consequent reduction of cellular proliferation. Our data indicate that nelfinavir represents a novel class of antiliposarcoma agent that acts by selectively upregulating sterol regulatory element binding protein-1 expression in liposarcomas.
Antineoplastic Agents↗
Identification of a new plasmid-encoded sec-dependent bacteriocin produced by Listeria innocua 743.
Listeria innocua 743 produces an inhibitory activity demonstrating broad-spectrum inhibition of Listeria monocytogenes isolates. Gel-electrophoretic analysis of culture supernatants indicated that two inhibitors with different molecular weights were produced by this strain. Insertion of Tn917 into a 2.9 Kb plasmid (pHC743) generated mutants with either an impaired ability or a loss in ability to produce one of the inhibitors. Sequence analysis of the transposon insertion regions revealed the presence of two continuous open reading frames, the first encoding a new pediocin-like bacteriocin (lisA) and the second encoding a protein homologous with genes involved in immunity toward other bacteriocins (lisB). Translation of the bacteriocin gene (lisA) initiates from a noncanonical start codon and encodes a 71-amino-acid prebacteriocin which lacked the double glycine leader peptidase processing site common in other type II bacteriocins. Alignment of the sequence with the processed N termini of related bacteriocins suggests that the mature bacteriocin consists of 43 amino acids, with a predicted molecular mass of 4,484 Da. Mutants containing insertions into lisA were sensitive to the inhibitor, indicating that lisAB forms a single operon and that lisB represents the immunity protein. Cloning of an amplicon containing the lisAB operon into Escherichia coli resulted in expression and export of the bacteriocin. This finding confirms that the phenotype is dependent on the structural and immunity gene only and that export of this bacteriocin is sec dependent. This is the first confirmation of bacteriocin production in a Listeria spp., and it is of interest that this bacteriocin is closely related to the pediocin family of bacteriocins produced by lactic acid bacteria.
Amino Acid Sequence↗