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Biomedical subjects

A Goldberg

Publications and source records attributed to A Goldberg.

At least 37 records · Page 2Linked to original sources
PubMed2001

Military trauma life support: a comprehensive training program for military physicians.

The Israel Defense Forces Medical Corps prepares Israeli physicians for their field duty as providers of prehospital trauma care under combat conditions. Many physicians have no previous experience with emergency medicine. Military trauma education has been improving continuously to meet this challenge. In 1990, the Advanced Trauma Life Support program was launched in Israel. In 1998, a task-oriented approach to military trauma. Military Trauma Life Support, was introduced. This course is integrated in the 3-month training period of medical officers. Its objectives are to provide a comprehensive curriculum in prehospital military trauma, to simulate realistic combat scenarios and injury patterns, and to add practical skills and prehospital experience. The practical section includes definitive airway management in hospital operating rooms, emergency procedures training on cadavers, and prehospital experience on civilian emergency medical services ambulances.

Curriculum↗
PubMed2000

mu-opioid receptors are present in vagal afferents and their dendritic targets in the medial nucleus tractus solitarius.

Ligands of the mu-opiate receptor (MOR) are known to influence many functions that involve vagal afferent input to the nucleus tractus solitarius (NTS), including cardiopulmonary responses, gastrointestinal activity, and cortical arousal. The current study sought to determine whether a cellular substrate exists for direct modulation of vagal afferents and/or their neuronal targets in the NTS by ligands of the MOR. Anterograde tracing of vagal afferents arising from the nodose ganglion was achieved with biotinylated dextran amine (BDA), and the MOR was detected by using antipeptide MOR antiserum. The medial subdivision of the intermediate NTS was examined by electron microscopy for the presence of peroxidase-labeled, BDA-containing vagal afferents and immunogold MOR labeling. MOR was present in both presynaptic axon terminals and at postsynaptic sites, primarily dendrites. In dendrites, MOR immunogold particles usually were located along extrasynaptic portions of the plasma membrane. Of 173 observed BDA-labeled vagal afferent axon terminals, 33% contained immunogold labeling for MOR within the axon terminal. Many of these BDA-labeled terminals formed asymmetric, excitatory-type synapses with dendrites, some of which contained MOR immunogold labeling. MORs were present in 19% of the dendrites contacted by BDA-labeled terminals but were present rarely in both the vagal afferent and its dendritic target. Together, these results suggest that MOR ligands modulate either the presynaptic release from or the postsynaptic responses to largely separate populations of vagal afferents in the intermediate NTS. These results provide a cellular substrate for direct actions of MOR ligands on primary visceral afferents and their second-order neuronal targets in NTS.

Afferent Pathways↗
PubMed2000

mu-Opioid receptors often colocalize with the substance P receptor (NK1) in the trigeminal dorsal horn.

Substance P (SP) is a peptide that is present in unmyelinated primary afferents to the dorsal horn and is released in response to painful or noxious stimuli. Opiates active at the mu-opiate receptor (MOR) produce antinociception, in part, through modulation of responses to SP. MOR ligands may either inhibit the release of SP or reduce the excitatory responses of second-order neurons to SP. We examined potential functional sites for interactions between SP and MOR with dual electron microscopic immmunocytochemical localization of the SP receptor (NK1) and MOR in rat trigeminal dorsal horn. We also examined the relationship between SP-containing profiles and NK1-bearing profiles. We found that 56% of SP-immunoreactive terminals contact NK1 dendrites, whereas 34% of NK1-immunoreactive dendrites receive SP afferents. This result indicates that there is not a significant mismatch between sites of SP release and available NK1 receptors, although receptive neurons may contain receptors at sites distant from the peptide release site. With regard to opioid receptors, we found that many MOR-immunoreactive dendrites also contain NK1 (32%), whereas a smaller proportion of NK1-immunoreactive dendrites contain MOR (17%). Few NK1 dendrites (2%) were contacted by MOR-immunoreactive afferents. These results provide the first direct evidence that MORs are on the same neurons as NK1 receptors, suggesting that MOR ligands directly modulate SP-induced nociceptive responses primarily at postsynaptic sites, rather than through inhibition of SP release from primary afferents. This colocalization of NK1 and MORs has significant implications for the development of pain therapies targeted at these nociceptive neurons.

Animals↗
PubMed2000

Multiple-dose efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia.

This multicenter trial evaluated the safety and efficacy of escalating doses of Niaspan (niacin extended-release tablets) and placebo (administered once-a-day at bedtime) in patients with primary hyperlipidemia on the percent change from baseline in levels of low-density lipoprotein (LDL) cholesterol and apolipoprotein B. Extended-release niacin was initiated at a dose of 375 mg/day, raised to 500 mg/day, and further increased in 500-mg increments at 4-week intervals to a maximum of 3,000 mg/day. A total of 131 patients (n = 87, extended-release niacin; n = 44, placebo) were treated for 25 weeks with study medication after a 6-week diet lead-in/drug washout phase and 2-week baseline LDL cholesterol stability phase. Significant decreases from baseline in levels of LDL cholesterol and apolipoprotein B became apparent with the 500-mg/day dose and were consistent at all subsequent doses (p < or =0. 05), reaching 21% and 20%, respectively, at the 3,000-mg/day dose. Significant increases from baseline in levels of high-density lipoprotein cholesterol became apparent with the 500-mg/day dose and were consistent at all subsequent doses (p < or = 0.05), reaching 30% at the 3,000-mg dose. Significant decreases from baseline in triglycerides and lipoprotein(a) occurred at the 1,000-mg dose and were apparent at all subsequent doses (p < or =0.05), reaching 44% and 26%, respectively, at the 3,000-mg dose. The most common adverse events were flushing and gastrointestinal disturbance. Transaminase increases were relatively small, and the proportion of patients who developed liver function abnormalities on extended-release niacin was not significantly different from placebo. Thus, extended-release niacin was generally well tolerated and demonstrated a dose-related ability to alter favorably most elements of the lipid profile.

Adult↗
PubMed2000

Hyper-releasability of mast cells in family members of infants with sudden infant death syndrome and apparent life-threatening events.

BACKGROUND: An allergic reaction with increased degranulation of mast cells has been suggested as a possible mechanism in sudden infant death syndrome (SIDS). STUDY DESIGN: Mast cell releasability was assessed in 2 study groups: A, 22 subjects, 16 first-degree relatives of infants who had had an apparent life-threatening event (ALTE) and 6 infants after ALTE and B, 46 first-degree relatives of SIDS cases. These groups were compared with 71 members of an age-matched control group. In each subject the skin wheal and flare reactions were measured after an intradermal injection of 0.02 mL of each of the following substances dissolved in phenol-saline solution: histamine 0.0001 mg/mL, histamine 0.001 mg/mL, codeine 0.5 mg/mL, codeine 1 mg/mL, compound 48/80 0.05 mg/mL, compound 48/80 0. 1 mg/mL, and phenol-saline solution. The size of wheal and flare skin reaction was assessed by computerized planimetry after the shape of the cutaneous response was copied onto a paper. RESULTS: The wheal and flare skin reaction to each of the substances was significantly larger in the 2 study groups compared with the control group (P <.05) except for the wheal reaction to compound 48/80 0.1 mg/mL, codeine 0.5 mg/mL, and histamine in both concentrations for group A and the wheal reaction to codeine 1 mg/mL and histamine in both concentrations for group B. All individuals with increased reaction belonged to 3 (50%) of 6 families with ALTE history and to 8 (73%) of 11 families with SIDS history. CONCLUSIONS: Increased mast cell hyper-releasability and degranulation take place in family members of some SIDS and ALTE cases and in some infants with ALTE, supporting a possible role for an immunologic mechanism in the pathophysiology of these entities.

Adult↗
PubMed2000

Insect sting-inflicted systemic reactions: attitudes of patients with insect venom allergy regarding after-sting behavior and proper administration of epinephrine.

BACKGROUND: Patients with insect venom allergy are at higher risk for development of a recurrent systemic reaction after re-sting. This risk significantly decreases with venom immunotherapy. Patients with insect venom allergy should be able to distinguish a life-threatening systemic reaction from all other various reactions after an insect sting. Accidental epinephrine injection by EpiPen has been reported in the past. Therefore patients with venom allergy should also be well trained in self-administration of their epinephrine when needed. OBJECTIVE: Our objective was to assess patients' attitudes regarding after-sting behavior and their capability to correctly self-administer the epinephrine autoinjector. METHODS: All patients with venom allergy attending our allergy unit either before commencement of or during venom immunotherapy answered a questionnaire addressing various aspects of their intended after-sting behavior. Using an EpiPen trainer device, patients' performance of EpiPen self-administration was evaluated. RESULTS: Ninety-six patients participated in the study. Seventy-six of them were equipped with an EpiPen device. Less than 30% of these patients carried it at all times. After re-sting, 50 (54%) patients planned to wait for the development of other symptoms before taking any further action. Twenty-two percent of the patients said that after re-sting they would immediately administer their EpiPen. Proper EpiPen administration technique was demonstrated by 44% of the patients. Having not reached the maintenance dose correlated with a better compliance with carrying of the EpiPen. EpiPen instruction provided by an allergist correlated with a better EpiPen administration technique by the patients. CONCLUSION: Many patients with venom allergy hold wrong ideas about after-sting behavior. Compliance with carrying EpiPen at all times and the ability to correctly administer it are both poor in most patients. Thorough and probably repeated instruction, both written and oral, provided by knowledgeable physicians is mandatory.

Adolescent↗
PubMed2000

Pilot study of combined blockade of the renin-angiotensin system in essential hypertensive patients.

BACKGROUND: Additive hemodynamic effects of combined blockade of the renin-angiotensin system by an angiotensin I converting enzyme inhibitor and an angiotensin II antagonist have been observed in sodium-depleted normotensive volunteers and in patients with congestive heart failure. OBJECTIVE: To investigate whether the same additive hemodynamic effects occur in patients with hypertension and to verify the safety of such an approach. DESIGN: Multicenter, randomized, double-blind, parallel-group, pilot study. PATIENTS: 177 patients with mild-to-moderate hypertension [diastolic blood pressure (DBP): 95-115 mmHg after a 4-week placebo run-in period] were included in the study. INTERVENTION: Combination therapy consisting of 50 mg losartan daily and 10 mg enalapril daily was administered for 6 weeks. The effects of this therapeutic regimen was compared with similar groups of patients who received either 50 mg losartan daily or 10 mg enalapril daily. MAIN OUTCOME MEASURES: 24-hour ambulatory mean DBP and clinic DBP measured at trough after 6 weeks of treatment. RESULTS: 24-hour ambulatory mean DBP did not significantly differ between treatment groups although the combination tended to lower BP more. The combination therapy was more effective on clinic DBP measured at trough than was losartan by 3.2 mmHg [confidence interval (95%, CI) 0.7-5.7 mmHg, P = 0.012], and more effective than enalapril by 4.0 mmHg (95% CI, 1.5-6.4 mmHg, P = 0.002). In a subgroup of 28 patients, higher plasma active renin and angiotensin I levels during blockade by the combination therapy were observed. This finding confirmed that the combination of the two agents inhibited the renin-angiotensin system to a greater extent than did either agent alone. CONCLUSION: A combination of 10 mg enalapril daily and 50 mg losartan daily safely induces a supplementary, although modest, fall in clinic DBP in patients with mild-to-moderate essential hypertension.

Adolescent↗
PubMed2000

ET-1 in the myocardial interstitium: relation to myocyte ECE activity and expression.

Increased plasma levels of endothelin-1 (ET-1) have been identified in congestive heart failure (CHF), but local myocardial interstitial ET-1 levels and the relation to determinants of ET-1 synthesis remain to be defined. Accordingly, myocardial interstitial ET-1 levels and myocyte endothelin-converting enzyme (ECE)-1 activity and expression with the development of CHF were examined. Pigs were instrumented with a microdialysis system to measure myocardial interstitial ET-1 levels with pacing CHF (240 beats/min, 3 wk; n = 9) and in controls (n = 14). Plasma ET-1 was increased with CHF (15 +/- 1 vs. 9 +/- 1 fmol/ml, P < 0.05) as was total myocardial ET-1 content (90 +/- 15 vs. 35 +/- 5 fmol/g, P < 0.05). Paradoxically, myocardial interstitial ET-1 was decreased in CHF (32 +/- 4 vs. 21 +/- 2 fmol/ml, P < 0.05), which indicated increased ET-1 uptake by the left ventricular (LV) myocardium with CHF. In isolated LV myocyte preparations, ECE-1 activity was increased by twofold with CHF (P < 0.05). In LV myocytes, both ECE-1a and ECE-1c mRNAs were detected, and ECE-1a expression was upregulated fivefold in CHF myocytes (P < 0.05). In conclusion, this study demonstrated compartmentalization of ET-1 in the myocardial interstitium and enhanced ET-1 uptake with CHF. Thus a local ET-1 system exists at the level of the myocyte, and determinants of ET-1 biosynthesis are selectively regulated within this myocardial compartment in CHF.

Animals↗
PubMed1999

Rapid degradation of an abnormal protein in Escherichia coli proceeds through repeated cycles of association with GroEL.

Molecular chaperones are necessary for the breakdown of many abnormal proteins, but their functions in this process have remained obscure. The rapid degradation of the abnormal fusion protein CRAG in Escherichia coli requires the molecular chaperones GroEL, GroES, and trigger factor and proceeds through the formation of a CRAG-GroEL-trigger factor complex. Also associated with GroEL are smaller discrete fragments of CRAG. Pulse-chase experiments showed that these fragments were short-lived intermediates in CRAG degradation formed by C-terminal cleavages. Thus, CRAG degradation is not highly processive. In cells lacking the ClpP protease, the generation of these fragments and their subsequent degradation were much slower than in the wild type. Dissociation of CRAG from GroEL was necessary for its digestion by the ClpP protease, because in a groES temperature-sensitive mutant, CRAG was stable and accumulated on GroEL. Furthermore, the expression of a dominant GroEL mutant defective in substrate dissociation slowed degradation of both CRAG and the fragments. Therefore, we suggest that CRAG degradation proceeds through multiple rounds of substrate binding to GroEL, followed by their GroES-dependent dissociation, which allows further digestion by the protease. In this multistep process, GroEL and GroES function repeatedly, apparently to allow further degradation of CRAG and its fragments by the protease.

ATP-Dependent Proteases↗
PubMed1999

Comparison of high-calorie, low-nutrient-dense food consumption among obese and non-obese adolescents.

OBJECTIVE: The purpose of this study was to determine whether obese adolescents eat more high-calorie low-nutrient-dense foods than non-obese adolescents. RESEARCH METHODS AND PROCEDURES: Using a cross-sectional design, 22 non-obese and 21 obese adolescents kept 14-day food records. Records provided estimates of total daily energy intake and caloric intake from five categories of high-calorie, low-nutrient-dense (HC) foods: candy, chips, soda, baked goods, and ice cream. Body composition was determined by 18O dilution and daily energy expenditure by doubly labeled water. Percentage of energy intake reported (%report) was calculated as the ratio of reported energy intake to measured energy expenditure (x 100%). RESULTS: Both groups underreported energy intake, but the percentage reported was significantly greater in the non-obese group (78.2+/-20.5% non-obese vs. 55.5+/-21.8% obese, p<0.001). Consumption of calories from chips and soda was similar among non-obese and obese adolescents. However, total energy intake from all HC foods was higher in the non-obese group than among the obese (617+/-356 kcal/day vs. 362+/-223 kcal/day; p<0.01) and represented 27.2+/-10.5% and 19.9+/-9.6% of reported energy intake in the non-obese and obese groups, respectively. After adjustment for under-reporting, the percentage of calories provided by each of the HC foods was similar in the obese and non-obese groups except for ice cream, which remained significantly greater in the non-obese group (p<0.05). DISCUSSION: Our findings suggest that both non-obese and obese adolescents consume a substantial portion of reported calories from HC foods and that obese adolescents do not consume more calories from these foods than non-obese adolescents. These data offer no evidence to support the widespread notion that obese adolescents eat more "junk food" than non-obese adolescents. Health professionals who treat obese adolescents must be aware that the excess calories in their diets may come from a variety of food sources and not solely from high-calorie snack foods.

Adipose Tissue↗
PubMed1999

Boundaries as pre-conditions.

Boundaries in psychoanalysis and psychotherapy can be considered either as indicators of moral transgressions or as guidelines for therapeutic intervention. This paper suggests that these categories be better delineated in the hope that less attention be paid to that of moral mistakes and more to that of treatment effectiveness.

Humans↗
PubMed1999

Debilitating beliefs, emotional distress and quality of life in patients given immunotherapy for insect sting allergy.

BACKGROUND: Patients who receive immunotherapy for systemic reaction to insect stings are told that once they reach maintenance dose they are almost 100% protected against future systemic reactions. However, we have observed that some patients continued to perceive themselves as highly debilitated by the allergy, and this perception had a significant impact on their quality of life. OBJECTIVE: To validate this clinical observation and to explore possible reasons for such an undesired psychological reaction. METHODS: The study group consisted of 97 patients who regularly attended an allergy outpatient clinic for venom immunotherapy, and who had been under medical surveillance for up to 8 years. They completed a questionnaire measuring debilitating beliefs, preoccupation with the systemic reaction event, emotional distress, perceived restriction by allergy, and perceived quality of life. We also recorded the duration of immunotherapy, physician-graded severity of the systemic reaction and the frequency at which immunotherapy was administered. The reference group consisted of patients who had not reached maintenance dose and were still at risk of recurrent systemic reactions. RESULTS: As many as one-third of the patients held self-imposed debilitating beliefs, were preoccupied with the systemic reaction event, perceived a moderate to severe impairment in their quality of life, and manifested symptoms of emotional distress. These psychological responses did not correlate with the immunotherapy dosage that had been reached. Patients who reached a full maintenance dose were doing no better psychologically than those in the reference group. Moreover, the length of time on immunotherapy did not result in attenuation of the psychological responses. CONCLUSION: This study demonstrates for the first time, the long-lasting psychological impact of a threatening systemic reaction. It suggests a need for intervention aimed at dispelling patients' unfounded and persisting debilitating beliefs.

Adolescent↗
PubMed1999

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Bibliographies as Topic↗