Travellers' diarrhoea and use of single-dose ciprofloxacin.
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Biomedical subjects
Publications and source records attributed to C Hall.
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alpha 1-chimaerin is a neuron-specific GTPase-activating protein for p21rac, a protein involved in morphological events. The mRNA is highly expressed in certain brain regions. It is also detected in cultured neuronal, but not in non-neuronal cells. As a first step towards understanding the mechanisms underlying this regulation, genomic clones containing the 5'-flanking region of the human alpha 1-chimaerin transcriptional unit were isolated and characterised. A cluster of multiple transcription start sites of alpha 1-chimaerin mRNAs was detected by primer-extension and S1-mapping analyses. The cluster was mapped to nucleotides -464 to -434 (relative to nucleotide A in the initiation codon) in genomic DNA. The 5'-proximal region contained no TATA box, initiator motif and Sp1-binding site. A 210-bp fragment with approximately 110 bp 5'-flanking sequence could function as a minimal promoter upon analysis using hybrid chloramphenicol acetyltransferase reporter constructs and transient transfection. Internal deletion and point-mutation experiments revealed that a GGCCAATC sequence located at nucleotides -519 to -512 was essential for alpha 1-chimaerin promoter activity. Mobility-shift assay showed the specific binding of nuclear factor(s) to this region, which was competed by the oligonucleotides corresponding to wild-type but not mutant forms. The data also suggest the existence of possible novel CCAAT-binding factor(s) interacting with the alpha 1-chimaerin CCAAT box binding site. A cell-type-preferred suppressor located in the 5'-distal region was found which may play a role in controlling neuron-specific expression of alpha 1-chimaerin mRNA. These findings of a specific promoter for alpha 1-chimaerin transcription will facilitate further studies on its neuronal-specific expression and function.
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OBJECTIVES: This study assessed the feasibility of an efficacy trial comparing angiotensin-converting enzyme inhibition and angiotensin II receptor antagonism in heart failure. Patients with moderate or severe heart failure whose condition had previously been stabilized by treatment with a converting enzyme inhibitor were randomly assigned to receive enalapril or losartan. The study was designed to detect any signs of clinical deterioration during double-blind treatment. BACKGROUND: Losartan is a specific, nonpeptide angiotensin II receptor-1 antagonist with a vasodilator hemodynamic profile similar to that of converting enzyme inhibitors. Although therapy with specific receptor blockade has certain theoretic advantages over nonspecific converting enzyme inhibition, demonstration of a comparable therapeutic effect in patients with congestive heart failure will require a major effort comparing two active agents. METHODS: One hundred sixty-six patients with stable heart failure in New York Heart Association functional class III or IV and an ejection fraction < or = 35% were included in a multicenter, double-blind, parallel, enalapril-controlled trial. After a 3-week stabilization period with optimal therapy, including digitalis, diuretic drugs and a converting enzyme inhibitor, patients were randomly assigned to 8 weeks of therapy with losartan, 25 mg/day (n = 52); losartan, 50 mg/day (n = 56); or enalapril, 20 mg/day (n = 58). Patients were assessed with frequent clinical and laboratory evaluation and exercise testing. RESULTS: No significant differences between groups in terms of changes in exercise capacity (6-min walk test), clinical status (dyspnea-fatigue index), neurohumoral activation (norepinephrine, N-terminal atrial natriuretic factor), laboratory evaluation or incidence of adverse experience were observed. CONCLUSIONS: The results suggest that losartan and enalapril are of comparable efficacy and tolerability in the short-term treatment of moderate or severe congestive heart failure. A trial designed to compare the efficacy, tolerability and effect on mortality of long-term angiotensin II receptor blockade with converting enzyme inhibition is both feasible and ethically responsible.
Studies in patients with moderate heart failure have shown a positive relation between atrial size and plasma atrial natriuretic peptide (ANP)(99-126) concentrations; however, the relation of the hormone level and left atrial size and left ventricular function in patients with severe chronic heart failure has not been determined. Fifty-three patients from the Cooperative North Scandinavian Enalapril Survival Study with severe chronic heart failure were evaluated with M-mode echocardiography and determination of plasma concentrations of ANP(99-126). In 35 patients, the plasma level of N-terminal ANP(1-98) was also measured. A significant negative relation was found between ANP(1-98), ANP(99-126), and left atrial diameter (r = -.28, P = .05 and r = -.41, P < .005, respectively). Plasma concentrations of both ANP(1-98) and ANP(99-126) were related to left ventricular systolic function as determined by the systolic time interval index (r = .4, P < .05 and r = .29, P < .05, respectively). A significant improvement of left ventricular systolic function was found in the enalapril group but not in the placebo group. After 6 weeks of therapy, no correlation was found between changes in left atrial size or systolic function or changes in either the ANP(1-98) or ANP(99-126) concentration. The results indicate that high ANP(1-98) or ANP(99-126) plasma concentration is determined by the depressed left ventricular function rather than increased left atrial size in patients with chronic severe heart failure. The findings suggest that the ANP release relation to atrial pressure/atrial size is distorted in severe heart failure.
The prevalence of forearm and hand disorders was examined by questionnaire and clinical examination in 199 automobile assembly line workers and in 186 controls. The pressure-pain threshold, hand grip force and hand anthropometry were also studied. There was an increased prevalence of de Quervain's disease for male automobile assembly line workers, and of carpal tunnel syndrome in female workers. The prevalence of symptoms in the forearm and hand during the last 7 days were twice as high among automobile assembly line workers than controls for both men and women. The occurrence of symptoms in the last 7 days was associated with de Quervain's disease, carpal tunnel syndrome and sick-leave due to forearm or hand problems, and it also influenced activities of daily living. Hand grip strength and anthropometrics were not associated with findings in the clinical examination or the occurrence of symptoms in the last 7 days. Low pressure-pain threshold was not associated with findings in the clinical examination, except for reported occurrence of symptoms in the last 7 days for women. Pressure-pain threshold as an indicator of tissue damage is discussed.
It has been demonstrated previously that administration of the antiprogestin mifepristone (RU 486; 1-5 mg daily) inhibits or delays both the pre-ovulatory luteinizing hormone (LH) surge and ovulation. To investigate this mechanism, dynamic tests of pituitary ovarian function were performed in six healthy women before and during the administration of mifepristone (2 mg daily for 30 days). On day 9 of the control and treatment cycles, samples of blood were collected every 15 min over 12 h for measurement of LH concentration. After 10 h, the responsiveness of the pituitary was tested by the i.v. injection of 10 micrograms of gonadotrophin-releasing hormone (GnRH). On day 10 of the control and treatment cycles, two patches releasing 200 micrograms/day of oestradiol were applied to skin on the abdomen for 3 days. Blood was collected at 24, 48, 59, 72, 81 and 96 h after application of the oestrogen patches for the measurement of gonadotrophin and ovarian hormone concentrations. Follicular development continued in all women during their treatment with mifepristone, and ovulation was suppressed (four women) or delayed (two women). There was no significant difference in the basal concentration of LH between the control and treatment cycles (mean +/- SE; 5.5 +/- 0.4 versus 7.7 +/- 0.4 IU/l respectively), or in the frequency (interpulse interval, 101 +/- 12 versus 105 +/- 13 min respectively) and the amplitude (2.1 +/- 0.4 versus 2.6 +/- 0.4 IU/l respectively) of LH pulses. The response to GnRH was similar. On day 10, the basal concentrations of LH, follicle-stimulating hormone (FSH), prolactin, oestradiol and progesterone and the diameter of the dominant follicle (15.7 +/- 1.8 versus 13.3 +/- 1.9 mm) were similar during control and treatment cycles. In control cycles, there were significant increases in the concentrations of LH and FSH within 72 h of application of the oestrogen patches. During treatment cycles, concentrations of FSH and LH remained low, and were significantly lower than the values observed during control cycles (P < 0.006). We conclude that the antiprogestin mifepristone disrupts ovulation by inhibiting the positive feedback effect of oestrogens and, hence, prevents or delays the generation of a pre-ovulatory LH surge.
It can be argued that imaginary practice and physical practice are functionally similar. Evidence in support of this hypothesis comes from several experiments demonstrating that interference effects from imaginary practice in motor learning and motor memory are similar in both direction and size to those resulting from physical practice. The purpose of the present study was to provide additional support for this finding using a retroactive interference paradigm. Sixty participants were required to practise performing a simple motor task that was to be completed in a criterion time of 700 ms. They then were randomly assigned to one of six groups. These groups differed in the amount and type of interpolated practice they experienced. One physical practice group attended one session of interpolated activity involving physical practice of another motor task. The other physical practice group participated in two such sessions. One imagery group attended a single session entailing imaginary practice of the same interpolated motor task, while the other imagery group had two such sessions. A fifth group experienced a combination of physical practice and rest periods for two interpolated sessions. A control group did not experience any interpolated activity sessions. Following the interpolated activity sessions, all groups were given a retention/reacquisition test on the original motor task. Imaginary and physical practice during the interpolated activity sessions caused similar interference effects on retention/reacquisition. All groups showed greater deviation from the criterion movement time (700 ms) during the retention test than the control group, and these deviations were in the expected direction given the nature of the interpolated motor task.
Alagille syndrome (AGS) is one of the major forms of chronic liver disease in childhood with severe morbidity and a mortality of 10 to 20%. It is characterised by cholestasis of variable severity with paucity of interlobular bile ducts and anomalies of the cardiovascular system, skeleton, eyes, and face. Previous studies suggest a wide variation in the expression of the disease and a high incidence of new mutations. To determine more accurately the rate of new mutations and to develop criteria for detecting the disorder in parents we systematically investigated parents in 14 families with an affected child. Clinical examination was supplemented by liver function tests, echocardiography, radiographic examination of the spine and forearm, ophthalmological assessment, and chromosome analysis. Six parents had typical anomalies in two or more systems pointing to the presence of autosomal dominant inheritance. Systematic screening of parents for the features defined in this study should improve the accuracy of genetic counselling.
We have measured cerebral blood flow with intracerebral laser-Doppler microprobes in pentobarbital-anesthetized pigs. We compared the results with measurements from laser-Doppler probes placed on the surface of the brain and with blood flow estimation by the radioactive microsphere method. The cerebral blood flow was varied by alterations in inspired carbon dioxide, hemorrhagic hypotension, and high cerebrospinal fluid pressure. The intracerebral probes and the surface probes showed parallel responses to variations in cerebral blood flow. The correlation was closest between surface probes and the intracerebral probes measuring from the cerebral cortex (r = 0.46; P < 0.005). The r value between laser-Doppler flowmetry and radioactive microspheres was 0.41 (P < 0.0005) for all measurements. The correlation to microspheres was best for the probes located 3 or 10 mm into the brain and poorest for the surface probe. In conclusion, intracerebral laser-Doppler flow measurements reflect changes in blood flow, and the technique appears useful for continuous estimates of cerebral blood flow.
We assessed the reliability and repeatability of a new computerized bone age system, both versions 3.4 and 3.5 (licensed by Discerning System Inc. and Ares Service SA, Serono), able to automatically assess bone age on a left hand and wrist radiograph. This computer system is based upon Tanner and Whitehouse's method (TW2), but there are important differences. Our sample included an initial group of 40 patients who had growth delay/constitutional delay of growth and puberty (n = 10), growth hormone insufficiency/deficiency (n = 15), low birth weight/Silver-Russell syndrome (n = 9), precocious puberty (n = 6), as well as 20 patients with various skeletal dysplasias (multiple epiphyseal dysplasia n = 7, pseudoachondroplasia n = 7, acrodysostosis n = 5, achondroplasia n = 1), 7 girls with Turner syndrome, and 10 boys with nephrotic syndrome on chronic corticosteroid treatment. Multiple anthropometric readings of the same radiographs demonstrated excellent repeatability of the assessment. In addition, the number of times that a manual insertion of a grade was required was similar in four different assessments. The computerized method did not entirely avoid errors in interpretation as the position of the x-ray on the screen was critical. There was a high manual insertion rate in radiographs of children with skeletal dysplasia. However, the computer assessment system, version 3.5, performed adequately for radiographs of children with normal bone morphology and Turner syndrome and had the advantage of a continuous scale of assessment.
To investigate the effect of hyperoxemia on the ocular circulation after a severe hypoxemic insult (8% O2 until base excess reached -20 mmol/l), we randomly reoxygenated newborn piglets with 100% (study group, n = 8) or 21% O2 (control group, n = 10). Retinal (RBF) and choroidal blood flow (ChBF) were measured with radioactive microspheres. The hypoxemic insult did not change RBF, while ChBF significantly decreased. However, a marked reduction in both retinal (RDO2) and choroidal oxygen delivery (ChDO2) was observed, probably resulting in hypoxia both in the inner and outer retina. At 5 and 20 min of reoxygenation a similar hyperemic response in the retina was seen in both groups. RDO2 also increased significantly and no significant differences between the 2 groups could be demonstrated. We found no indication of retinal vasoconstriction during hyperoxemia. We speculate that the vasodilating effect of the preceding hypoxemia overrules the vasoconstrictive effect of the retinal vessels normally found during hyperoxemia.
The color Doppler sonographic appearance of pyomyositis and the usefulness of this technique in guiding needle aspiration of an intramuscular abscess in a 15-year-old diabetic girl are described.
The pharmacokinetics and disposition of valproic acid (VPA) have been assessed in pregnant sheep after both maternal and fetal iv bolus administration. The time course of VPA and 16 of its metabolites was followed in maternal and fetal arterial blood, amniotic fluid, and fetal tracheal fluid for 48 hr after administration. Fetal blood gas, acid-base, metabolic, cardiovascular, and fetal breathing activity parameters were also monitored. The disposition of VPA in maternal serum is best described by a biexponential function with a terminal elimination half-life of 2.13 +/- 0.49 hr and volume of distribution of 0.242 +/- 0.036 liter/kg. VPA transfer to fetal serum and other fetal fluids was rapid after drug administration. There was significant fetal exposure to VPA after maternal dosing (mean AUCinfinityFA/AUCinfinityMA = 0.410 +/- 0.118). Similarly, the disposition of VPA in fetal serum after fetal dosing is best described by a biexponential decay with a terminal elimination half-life of 3.37 +/- 1.37 hr. Once again, VPA transfer to other fluids was rapid. However, unlike basic compounds studied previously, VPA did not accumulate extensively in either amniotic or fetal tracheal fluid. The following metabolites were detected after drug administration in these experiments: (E)- and (Z)-2-ene VPA, (E)- and (Z)-3-ene VPA, 4-ene VPA, 3-keto VPA, 4-keto VPA, 3-OH VPA, 4-OH VPA, 5-OH VPA, and 2-PGA. Both maternal and fetal bolus administration of VPA elicited a significant reduction in fetal breathing movements, which may be attributed to the drug's action on gamma-aminobutyric acid dynamics in the central nervous system (CNS). This suggests that the significant fetal exposure to VPA may produce further CNS-related effects in utero.
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The stimulus for secretion of the atrial peptides from the heart is a mechanical distension of the atria. We studied the changes in plasma levels of immunoreactive ANF (1-98) and ANF (99-126) after volume loading (NaCl 0.9%, 50 ml/kg in 10 min) in pigs that had their pericardium opened (peric-, n = 8) and compared these changes to those of pigs subjected to sham operation (peric+, n = 8). For irANF (99-126), the maximum increase was achieved 10 min after the start of loading: 18.6 +/- 5.5 pmol/l to 31.4 +/- 15.6 pmol/l. (P < 0.05) in peric+ and 23.9 +/- 6.5 pmol/l to 110.2 +/- 46.2 pmol/l (P < 0.05) in peric-. The maximum increase in irANF (1-98) took place after 15 min: 658.8 +/- 223.9 pmol/l to 791.0 +/- 229.4 pmol/l (P < 0.05) in peric+ and 769.9 +/- 228.5 pmol/l to 1136.7 +/- 348.6 pmol/l (P < 0.05) in peric-. For both peptides the maximal increase after loading was significantly greater when the pericardium had been removed. The results demonstrate that the intact pericardium restricts peptide release secondary to volume infusion in closed-chest pigs.