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Biomedical subjects

B A Clark

Publications and source records attributed to B A Clark.

At least 37 records · Page 2Linked to original sources
PubMed1997

Effects of oral and intravenous rehydration on ratings of perceived exertion and thirst.

The purpose of this investigation was to compare the effects of oral and intravenous saline rehydration on differentiated ratings of perceived exertion (RPE) and thirst. Eight men underwent three randomly assigned rehydration treatments following a 2- to 4-h exercise-induced dehydration bout to reduce body weight by 4%. Treatments included 0.45% saline infusion (i.v.), 0.45% saline oral ingestion (ORAL), and no fluid (NF). Following rehydration and rest (2 h total), subjects walked at 50% VO2max for 90 min at 36 degrees C (EX). Central RPE during ORAL was lower (P < 0.05) than i.v. and NF throughout EX. Local RPE during NF was higher (P < 0.05) than i.v. and ORAL at minutes 20 and 40 of EX and overall RPE during NF was higher (P < 0.05) than ORAL at minutes 20 and 40 of EX. Significant correlations were found between overall RPE and mean skin temperature for i.v. (r = 0.72) and NF (r = 0.75), and between overall RPE and thirst ratings for i.v. (r = 0.70). Thirst ratings were not different among trials at postdehydration. Following rehydration, thirst was higher (P < 0.05) during NF than i.v. and ORAL and lower (P < 0.05) during ORAL than i.v. at all subsequent time points. Results suggest that oral rehydration is likely to elicit lower RPE and thirst ratings compared with intravenous rehydration.

Adult↗
PubMed1996

Evidence for a C-terminal turn in PBAN. An NMR and distance geometry study.

The solution conformation of the pheromone biosynthesis activating neuropeptide (PBAN) of the moth Helicoverpa zea has been determined using homonuclear two-dimensional nuclear magnetic resonance techniques and distance geometry-restrained energy minimization. The insect peptide hormone showed a random distribution of conformers in aqueous solution, whereas in a less polar medium of trifluoroethanol and water, a reordering process was observed. In particular, the C-terminal region (Phe-Ser-Pro-Arg-Leu-NH2) adopts a type I' beta-turn conformation, residues 20-27 are in a helix conformation, and residues 1-19 exhibit a high degree of flexibility. Direct observation of the C-terminal beta-turn configuration of PBAN is consistent with a previous report that showed a rigid, cyclic analog of the C-terminal pentapeptide of PBAN retained pheromonotropic activity [Nachman, R.J., Kuniyoshi, H., Roberts, V.A., Holman, G.M. & Suzuki, A. (1993). Biochem. Biophys. Res. Commun. 661-666]. Furthermore, our results show no interaction between the C-terminal turn and the rest of the polypeptide chain, thus providing further evidence that the C-terminal turn is indeed the important conformation recognized by the PBAN receptor.

Amino Acid Sequence↗
PubMed1996

Extrarenal potassium homeostasis with maximal exercise in end-stage renal disease.

Serum potassium levels rise substantially during vigorous exercise as a result of the release of potassium from contracting muscle cells. Widespread use of erythropoietin has allowed for increased exercise capacity in patients with ESRD, raising the concern for severe exertional hyperkalemia. The aim of this study was to determine whether ESRD is associated with alterations in potassium and the neurohumoral mediators of extrarenal potassium disposal with maximal exercise. Eight stable hemodialysis patients (aged 37 +/- 16 yr, mean +/- SE) and eight healthy control subjects (aged 44 +/- 13 yr) exercised to exhaustion, using a graded cycle ergometer. There were no significant differences in exercise performance between groups as assessed by peak work rate, maximal oxygen consumption, and rate pressure product. Although the baseline potassium level was higher in the dialysis group (5.0 +/- 0.2 mEq/L) than in control subjects (4.5 +/- 0.1 mEq/L), both groups had a similar pattern of increase during exercise (with an increment of approximately 1 mEq/L) and a similar return to baseline after exercise. However, the dialysis patients had higher basal norepinephrine levels (820 +/- 104 versus 441 +/- 56 pg/mL, P < 0.01) and a greater response to exercise (3122 +/- 429 versus 1696 +/- 424 pg/mL, P < 0.01), higher basal insulin levels (11 +/- 1 versus 7 +/- 1 microU/mL, P < 0.05), higher insulin post-exercise levels (19 +/- 3 versus 11 +/- 1 microU/mL, P < 0.05), and higher basal aldosterone levels (621 +/- 250 versus 109 +/- 13 pg/mL, P < 0.05) with an increase response to exercise (1100 +/- 350 versus 350 +/- 17 pg/mL, P < 0.05). In summary, despite higher basal potassium, dialysis patients have normal potassium responses to maximal exercise. More vigorous insulin, catecholamine, and aldosterone levels may contribute to the maintenance of extrarenal potassium homeostasis in ESRD.

Adult↗
PubMed1995

Hypotensive response to atrial natriuretic peptide administration is enhanced with age.

BACKGROUND: Plasma levels of atrial natriuretic peptide (ANP) increase with age. To test the hypothesis that the cardiovascular response to ANP is age dependent and to examine the role of the increased levels of ANP in the hypotensive response to orthostatic challenge, we compared the hemodynamic response of young and elderly subjects to ANP infusion and orthostatic challenge. METHODS: Blood pressure, heart rate, forearm cutaneous resistance, plasma ANP, and plasma norepinephrine were measured in the supine position and following upright tilt before and after a 60-minute infusion of atrial natriuretic peptide (0.05 microgram/kg/min) in 7 young (27 +/- 4 years) and 5 elderly (74 +/- 4 years) normotensive, healthy subjects. RESULTS: Prior to ANP infusion, the response to upright tilt was similar in both groups. Infusion of ANP produced similar steady state plasma levels of ANP in both groups (young: 435 +/- 49 pg/ml; elderly: 429 +/- 32 pg/ml). Supine systolic blood pressure decreased by 4 +/- 2 mmHg in the young subjects and by 18 +/- 8 mmHg in the elderly subjects after infusion (p < .08). In contrast, changes in supine heart rate, forearm cutaneous resistance, and plasma norepinephrine were similar in both groups (delta heart rate: young +5 +/- 3 beats/min, elderly +4 +/- 2 beats/min; delta forearm cutaneous resistance: young -38 +/- 9%, elderly -40 +/- 6%; delta norepinephrine: young +55 +/- 11%, elderly: +43 +/- 13%). ANP infusion abolished the vasoconstrictor response normally associated with orthostatic challenge in both groups, despite a significant release of catecholemines and an enhanced heart rate response. This resulted in significant systolic blood pressure reduction in both young (-7 +/- 2 mmHg, p < .05) and elderly subjects (-16 +/- 4 mmHg, p < .05). The drop in systolic blood pressure in response to upright tilt and ANP infusion was four times larger in the elderly subjects (change from pre-ANP level: young -8 +/- 3 mmHg, elderly -32 +/- 5 mmHg, p < .005).

Adult↗
PubMed1995

Reduced renal response to low-dose dopamine infusion in the elderly.

BACKGROUND: Increasing age is associated with a number of changes in renal function, including a diminished capacity to excrete salt and water loads and an increased susceptibility to acute renal failure. Dopamine is a renal autocoid important in diuresis and natriuresis and may also serve to protect against ischemic renal injury. The aim of this study was to assess the renal response to a low-dose dopamine infusion in healthy young vs elderly individuals. METHODS: Five healthy young (28 +/- 2 yr) and elderly (68 +/- 3 yr) subjects underwent evaluation of renal function and blood pressure before, during, and after a 3-hour infusion of dopamine (1 microgram/kg/min) in the Clinical Research Center of Beth Israel Hospital. RESULTS: Renal plasma flow, estimated by clearance of para-aminohippurate clearance, was significantly lower in the elderly than in the young subjects, but both groups increased estimated renal plasma flow by approximately 30% during dopamine infusion. Endogenous creatinine clearance was also significantly lower in the elderly. During dopamine infusion, creatinine clearance rose significantly only in the young. Both young and old had a similar natriuretic response to dopamine although urine flow and free water clearance were significantly lower in the old. Neither group had significant changes in blood pressure or heart rate. CONCLUSIONS: Resistance to the actions of dopamine on creatinine clearance in the elderly may reflect an inability to respond to endogenous dopamine at times of physiologic stress with resulting susceptibility to azotemia.

Adult↗
PubMed1995

Aldosterone responses to hyperkalemia in healthy elderly humans.

Plasma aldosterone levels are reported to be lower in healthy elderly individuals compared with young individuals, a difference exaggerated by sodium depletion or upright posture. The aim of this study was to determine the aldosterone response to increases in serum potassium with advancing age. In the Clinical Research Center, six healthy young (20 to 35 yr of age) and six healthy elderly (65 to 85 yr of age) subjects underwent evaluation of their aldosterone responses to potassium infusion (0.5 mEq/kg over 45 min). Both young and elderly subjects had similar basal serum potassium levels (4.3 +/- 0.2 versus 4.4 +/- 0.1 mEq/L), similar sodium and potassium excretion amounts and similar increase in serum potassium levels during infusion (to 5.0 +/- 0.2 versus 5.1 +/- 0.1 mEq/L). However, elderly subjects had lower basal levels of plasma aldosterone and a blunted aldosterone response to potassium infusion (P < 0.05, analysis of variance). Advancing age is characterized by relative hypoaldosteronism in the basal state as well as in response to hyperkalemia. This may contribute to an increased susceptibility to hyperkalemia if other potassium regulatory systems fail.

Adult↗
PubMed1995

Potassium homeostasis and hyperkalemic syndromes.

Acute hyperkalemia can be a life-threatening consequence of a variety of pathologic, pharmacologic, and iatrogenic disorders. Recognition and prompt therapy often reverse the electrophysiologic complications within minutes. Therefore, physicians must have a thorough understanding of potassium homeostasis. The causes of hyperkalemia, intracellular-to-extracellular shifts of potassium, excess exogenous potassium loads, and pseudohyperkalemia are discussed.

Homeostasis↗
PubMed1994

Voltage-gated currents in rabbit retinal astrocytes.

The voltage-gated currents of the astrocytes associated with the retinal capillaries of the rabbit retina were studied using whole-cell patch clamp recording. The resting potential of these cells was -70 +/- 4.8 mV (mean +/- SEM; n = 54), and the input resistance and cell capacitance were 558 +/- 3.6 M omega and 19.5 +/- 1.8 pF respectively. Depolarization to potentials positive to -50 mV evoked rapidly activating inward and outward currents. The inward current was transient, eliminated by substitution of choline for Na+ in the bathing solution, and reduced by 50% in the presence of 1 microM tetrodotoxin. The time-to-peak of the Na+ current was more than twice that for the Na+ current found in retinal neurons. The glial Na+ current was half-inactivated at -55 mV. A transient component of the outward K+ current was blocked by external 4-aminopyridine while a more sustained component was blocked by external tetraethylammonium. At potentials between -150 and -50 mV the membrane behaved Ohmically. Voltage-gated currents in retinal astrocytes recorded in situ appear qualitatively similar to those described for some glial cells in vitro.

4-Aminopyridine↗
PubMed1994

The effect of growth temperature on Staphylococcus aureus binding to type I collagen.

Many strains of Staphylococcus aureus produce a collagen-binding surface protein that could enable these strains to colonize tissues such as bone. Previous studies indicated that the expression of the collagen receptor varies with growth conditions. We report here that the growth temperature influences the ability of some S. aureus strains to produce this receptor. S. aureus isolates from human, osteomyelitic bone were grown at 37 degrees C and 42 degrees C and tested for agglutination of collagen-coated latex beads. Binding by 42 degrees C grown cells was significantly reduced in five of the seven isolates studied, including a complete loss of collagen binding in three of these isolates. In an 125I-collagen-binding assay, the binding ability of one of these isolates, strain #16, was 20-fold lower if grown at 42 degrees C. Reduced collagen binding by this isolate could be demonstrated after only two cell divisions at 42 degrees C and the cells regained the ability to bind collagen when shifted back to 37 degrees C. Sodium dodecyl sulfate (SDS)-PAGE confirmed the presence of proteins at 117 kDa in strain #16 and 135 kDa in SMH which were absent following growth at 42 degrees C. Chicken IgG, specific for the 117 kDa protein, was found to react in immunoblot assays with these proteins as well as a protein of 135 kDa extracted from S. aureus Cowan 1. The antibody did not react with proteins extracted from non-binding strains. Strains #15 and #21, collagen-binders at both 37 degrees C and 42 degrees C, produced immunoreactive proteins at 110 and 135 kDa, respectively, in lysates from cells grown at both temperatures. Antibody against a recombinant form of a previously characterized collagen receptor was used to confirm cross-reactivity with these novel collagen receptors. These data suggest that the ability to produce the collagen receptor is temperature sensitive in some S. aureus strains associated with osteomyelitis. It is proposed that a better understanding of the environmental effects on collagen receptor production could enhance our understanding of staphylococcal infections in bone and joints.

Animals↗
PubMed1994

A new approach to assessment and documentation of conscious sedation during endoscopic examinations.

Assessment and documentation of patient responses to treatment and/or invasive procedures are important facets of nursing care. The purpose of this article is to describe a tool for assessing and quantifying a patient's response to sedation and tolerance of a specific diagnostic and/or therapeutic procedure. Use of the conscious sedation scale will allow the nurse to objectively measure the patient's outcome. This tool will also facilitate better patient care and documentation and substantiate nursing intervention.

Procedural Sedation↗
PubMed1994

Increased susceptibility to thiazide-induced hyponatremia in the elderly.

Hyponatremia is a common cause of morbidity in the elderly, and thiazide diuretics are often implicated. Eleven healthy young volunteers, eight healthy old volunteers, and five elderly patients with a history of thiazide-induced hyponatremia were studied to determine susceptibility to thiazide-induced hypoosmolality in age. Each of the healthy subjects ingested a water load (20 mL/kg) after 3 days of hydrochlorothiazide (HCTZ) (100 mg/day) or placebo. Although there were no differences in minimum Uosm between young and old, the healthy old had lower hourly free water clearances (CH2O) as compared with the young and a greater decline in serum osmolality in response to water loading (P < 0.05). HCTZ impaired minimum urine osmolality and CH2O and delayed recovery of serum osmolality after the water load in both healthy young and old (P < 0.005, placebo versus HCTZ), but the impairment in the latter two parameters was greater in the healthy elderly (P < 0.05, young versus old). Vasopressin levels were not different between healthy young and old (1.9 +/- 0.3 versus 2.0 +/- 1.0 pm with placebo; 3.0 +/- 0.7 versus 4.4 +/- 1.0 with HCTZ). Five of the young subjects were restudied after the addition of ibuprofen (400 mg thrice daily) to the thiazide and placebo regimens. Creatinine clearance was not changed, but free water clearance and serum osmolality after water loading were significantly reduced to a degree similar to that seen in the elderly subjects on the thiazide regimen (P < 0.05), suggesting an important role for renal prostaglandins in the defense against hyponatremia.

Adult↗
PubMed1993

Effect of glucose, insulin, and hypertonicity on atrial natriuretic peptide levels in man.

To determine the effects of hyperglycemia and hyperinsulinemia on atrial natriuretic peptide (ANP) levels in man, we studied normotensive nondiabetic volunteers (aged 25 to 63 years) during infusion of insulin and/or 20% dextrose (glucose clamp technique) to achieve three different states of "glycemia/hyperinsulinemia," as follows: (1) euglycemia for 2 hours during infusion of insulin (80 mU.m-2.min-1), resulting in plasma insulin levels of approximately 1,200 pmol/L (n = 9); (2) moderate stable hyperglycemia at a level of 11 mmol/L (198 mg/dL) for 2 hours, with infusion of glucagon-like peptide-1 (7-37) amide (GLP-1) during the second hour, which increased endogenous insulin responses to approximately 2,100 pmol/L (n = 9); and (3) marked stable hyperglycemia at a level of 18.5 mmol/L (330 mg/dL) for 2 hours, with endogenous insulin responses of approximately 720 pmol/L (n = 9). In addition, six patients with non-insulin-dependent diabetes mellitus were studied with the GLP-1 protocol at a hyperglycemic level of 14.5 mmol/L (261 mg/dL). In normal subjects, plasma ANP levels increased significantly from 3.0 +/- 0.4 to 4.6 +/- 0.8 pmol/L during marked hyperglycemia, but did not change during euglycemia or moderate hyperglycemia despite higher insulin levels (P < .01, ANOVA). Sodium excretion rates were also highest during the marked hyperglycemic study (125 +/- 14 v 91 +/- 7 v 74 +/- 10 mumol/min, P < .05, marked v moderate hyperglycemia v euglycemia). In diabetic subjects, ANP levels increased significantly from 12.5 +/- 4.1 to 21.1 +/- 5.0 pmol/L during hyperglycemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Stimulus-bound perseveration after frontal ablations in marmosets.

Marmosets with bilateral ablations of either the lateral or ventral surface of the frontal lobes were found to perseverate on object but not spatial serial reversal. They also perseverated on reversal of a visuospatial task where different stimuli required different spatial responses. No differences were found between the two lesion groups. Since the control animals showed mild perseveration on spatial but not object serial reversal it is argued that frontal ablations do not lead to perseveration of a natural tendency but rather that object and visuospatial perseveration are forms of stimulus-bound behaviour which do not occur when the animal is performing a spatial task in which stimulus position is irrelevant. Perseveration was reduced by pretreatment with a dopamine-blocking drug (haloperidol). It is suggested that information from temporal lobe mechanisms, involved in long-term memory, and from frontal lobe mechanisms, which exert shorter acting influences on behaviour, compete within the basal ganglia to determine stimulus choice. The ascending dopaminergic pathway may modulate the balance between these competing factors.

Animals↗
PubMed1993

The need to reevaluate trisomy screening for advanced maternal age in prenatal diagnosis.

OBJECTIVES: Fluorescence in situ hybridization aneuploidy screening promises immediate results. To evaluate aneuploidy screening in prenatal diagnosis, the prenatal records at Oregon were reviewed. STUDY DESIGN: Karyotype reports of 7240 amniocentesis samples referred for advanced maternal age were retrospectively reviewed for numeric and structural chromosome abnormalities. RESULTS: The frequency of abnormal karyotypes was 2.5%; 1.4% were age-related trisomies and sex-chromosome aneuploids, and 1.1% were non-age-related abnormalities. The incidence of structural rearrangements was 0.9%, of which 70% were familial but not suspected on the basis of family history. CONCLUSIONS: Structural chromosome abnormalities were twice as common as previously reported, representing a significant unrecognized risk for subsequent pregnancies and other family members. Fluorescence in situ hybridization aneuploidy screening would not routinely detect structural chromosome abnormalities, which were twice as frequent as numeric aneuploidy at age 35 years. Routine use of fluorescence in situ hybridization for prenatal diagnosis should not be adopted without a prospective study of its accuracy, reliability, and impact on prenatal diagnosis.

Amniocentesis↗
PubMed1993

Sequential evaluation of islet cell responses to glucose in the transplanted pancreas in humans.

We evaluated the hormonal and metabolic responses of denervated pancreas allografts in nine volunteers 3 to 12 months after the transplant (initial) and again 1 year later (follow-up). Eight of the patients received simultaneous pancreas-kidney transplants. The glucose clamp technique was used to create a square wave of hyperglycemia 5.5 mmol/L above the basal glucose level for 2 hours. A biphasic insulin response was evident in each subject, both initially and at follow-up. The initial plasma insulin response was fourfold higher in patients with pancreas-kidney transplants than in normal volunteers. However, the plasma insulin response of the patients with pancreas-kidney transplants at the follow-up study was more similar to that of the normal controls. The plasma glucagon levels were elevated in follow-up clamp studies. Hepatic glucose production and glucose disposal were similar in both studies. At the follow-up examination only, GLUT4, the major insulin-sensitive glucose transporter, was measured in muscle homogenates by immunoblotting. GLUT4 levels in the patients with pancreas-kidney transplants were only 55% as abundant as in normal volunteers. This may be due, in part, to immunosuppressive therapy or to persistent, albeit reduced, levels of hyperinsulinemia even 2 years after transplantation. We concluded that, despite systemic drainage of the pancreas and immunosuppressive therapy, pancreatic insulin secretion, peripheral insulin levels, and muscle insulin responsiveness are restored toward normal levels approximately 2 years after the transplant.

Adult↗
PubMed1993

Effects of ioversol versus iothalamate on endothelin release and radiocontrast nephropathy.

RATIONALE AND OBJECTIVES: Certain radiocontrast agents, including iothalamate, iohexol, and ioxaglate, release the renal vasoconstrictor peptide endothelin from vascular endothelium in a way that might contribute to radiocontrast nephropathy. The effects of the nonionic, low osmolar agent, ioversol, on endothelin release and renal function are investigated. METHODS: Effects of ioversol were compared with equi-iodine doses of iothalamate when applied to cultured bovine aortic endothelial cells or injected into normal rats and rats preconditioned by uninephrectomy, salt depletion, and indomethacin (USIC) to develop radiocontrast nephropathy. RESULTS: In comparison with iothalamate, ioversol had a greatly reduced propensity to stimulate the release of endothelin, from cultured cells and when injected into anesthetized rats. Ioversol produced less renal vasoconstriction than did iothalamate, in control and in USIC rats, and the development of radiocontrast nephropathy, assessed by creatinine clearance and morphologic damage to the renal medulla, was largely avoided. CONCLUSIONS: These results strengthen the hypothesis that endothelin release induced by radiocontrast agents is correlated with their renal toxicity and therefore, may play a role in radiocontrast nephropathy.

Animals↗
PubMed1992

Atrial natriuretic peptide levels in the prediction of congestive heart failure risk in frail elderly.

OBJECTIVE: To develop a noninvasive clinical predictive model for acute congestive heart failure (CHF) in a frail elderly cohort using bedside clinical assessment (medical history and physical examination) and venous atrial natriuretic peptide (ANP) levels. DESIGN: One-year prospective blinded cohort study. SETTING: Life care facility. PARTICIPANTS: Three hundred thirty-one frail, elderly volunteers free of acute illness at study entry (mean +/- SD age, 88 +/- 7 years; 23% male, 77% female). MAIN OUTCOME MEASURE: Clinical episodes of CHF with confirmation of acute pulmonary edema by chest roentgenogram. RESULTS: Fifteen percent of the elderly cohort developed at least one episode of CHF during the 1-year follow-up period. Those developing CHF had significantly higher mean +/- SE ANP values at study entry: 493 +/- 55 vs 207 +/- 15 pmol/L. The risk for development of CHF rose progressively with increasing ANP levels at study entry. In multivariate analysis, only two independent variables significantly predicted CHF: ANP value greater than 200 pmol/L (adjusted odds ratio [OR], 7.9; 95% confidence interval [CI], 3.2 to 19.2) and history of CHF in the previous year (adjusted OR, 7.0; 95% CI, 2.9 to 17). Stratifying the cohort by these two variables results in three CHF risk groups: 55% of the population at 3% annual risk of CHF, 37% of the population at 20% to 24% annual risk of CHF, and 8% of the population at 66% annual risk of CHF. CONCLUSIONS: This simple clinical prediction model identifies elderly subjects at risk for CHF and allows appropriate focusing of medical resources for prevention, early detection, and treatment of this highly morbid clinical syndrome.

Acute Disease↗