Electroconvulsive treatment, neurology, and psychiatry.
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Aged↗
Biomedical subjects
D Cohen
Publications and source records attributed to D Cohen.
Randomized comparison of elective stent implantation and coronary balloon angioplasty guided by online quantitative angiography and intracoronary Doppler. DESTINI Study Group (Doppler Endpoint STenting INternational Investigation).
BACKGROUND: The purpose of this study was to compare long-term outcomes of coronary stenting in all lesions (elective stenting) or only in lesions with inadequate morphological and functional results after balloon angioplasty (guided PTCA). METHODS AND RESULTS: Treatment of multivessel disease, with any lesion length and vessel size, was allowed provided that all lesions were suitable for stent implantation. Patients were randomized to elective stent implantation (n=370) or guided PTCA (n=365). An optimal PTCA result (residual diameter stenosis </=35%, coronary flow reserve measured with a Doppler guidewire >2.0, absence of threatening dissections) was achieved in 166 lesions (43%). The remaining 218 lesions underwent stent implantation (provisional stenting). Final residual diameter stenosis was lower in the elective and provisional stent groups (9.3% and 10.2%) than in the optimal PTCA group (24.8%, P:<0. 00001). On an intention-to-treat analysis, the probability of >/=1 major adverse cardiac event at 12 months was 17.8% in the elective stenting group and 18.9% in the guided PTCA group (20.1% for optimal PTCA and 18.0% for the provisional stenting subgroup, P:=NS). The incidence of repeat target lesion revascularization at 1 year was 14. 9% in the elective stent group and 15.6% in the guided PTCA group (17.6% for optimal PTCA and 14.1% for the provisional stenting subgroup, P:=NS). CONCLUSIONS: When balloon angioplasty is guided by online quantitative angiography and Doppler-derived coronary flow reserve, with provisional stenting reserved for suboptimal results, early and late clinical outcomes are comparable to those achieved by elective stenting of all patients.
Angiography↗
Dr. Jack Kevorkian and cases of euthanasia in Oakland County, Michigan, 1990-1998.
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Adult↗
Quantum-mechanical nonperturbative response of driven chaotic mesoscopic systems
Consider a time-dependent Hamiltonian H(Q,P;x(t)) with periodic driving x(t) = Asin(Omegat). It is assumed that the classical dynamics is chaotic, and that its power spectrum extends over some frequency range |omega| A(prt), where A(prt) approximately Planck's over 2pi, the system may have a relatively strong response for Omega>omega(cl) due to QM nonperturbative effect.
Journal Article↗
HDAC1, a histone deacetylase, forms a complex with Hus1 and Rad9, two G2/M checkpoint Rad proteins.
HDAC1 is a member of the histone deacetylase family, which plays an important role in modulating the eukaryotic chromatin structure. Numerous studies have demonstrated its involvement in transcription and in tumorigenesis. To better understand the functions and regulation of HDAC1, a yeast two-hybrid screening approach was chosen to identify novel interactions involving HDAC1. Human HDAC1 was found to interact specifically in yeast, mammalian cells, and in vitro with the human Hus1 gene product, whose Schizosaccharomyces pombe homolog has been implicated in G(2)/M checkpoint control. Both HDAC1 and Hus1 proteins localize to the nuclei. Furthermore, HDAC1 and Hus1 were found to exist in a complex with Rad9, a known Hus1-interacting factor. In addition, bioinformatics analysis of the protein sequences of Hus1, Rad1, and Rad9, three checkpoint Rad proteins that form a complex, revealed that they all contain a putative proliferating cell nuclear antigen (PCNA) fold, raising the possibility that these factors may bind to DNA in a PCNA-like ring structure. The results reported in this study strongly suggest a novel pathway involving HDAC1 in G(2)/M checkpoint control through the interaction with a functional Rad complex that may utilize a PCNA-like structure. Therefore, physically and functionally similar apparatus may function during G(2)/M checkpoint and DNA replication.
Amino Acid Sequence↗
Randomized trial of a specialist genetic assessment service for familial breast cancer.
BACKGROUND: Because of the growing demand for genetic assessment, there is an urgent need for information about what services are appropriate for women with a family history of breast cancer. Our purpose was to compare the psychologic impact and costs of a multidisciplinary genetic and surgical assessment service with those of current service provisions. METHODS: We carried out a prospective randomized trial of surgical consultation with (the trial group) and without (the control group) genetic assessment in 1000 women with a family history of breast cancer. All P: values are from two-sided tests. RESULTS: Although statistically significantly greater improvement in knowledge about breast cancer was found in the trial group (P: =.05), differences between groups in other psychologic outcomes were not statistically significant. Women in both groups experienced statistically significant reductions in anxiety and found attending the clinics to be highly satisfying. An initial specialist genetic assessment cost pound 14.27 (U.S. $22.55) more than a consultation with a breast surgeon. Counseling and genetic testing of affected relatives, plus subsequent testing of family members of affected relatives identified as mutation carriers, raised the total extra direct and indirect costs per woman in the trial group to pound 60.98 (U.S. $96.35) over costs for the control subjects. CONCLUSIONS: There may be little benefit in providing specialist genetics services to all women with a family history of breast cancer. Further investigation of factors that may mediate the impact of genetic assessment is in progress and may reveal subgroups of women who would benefit from specialist genetics services.
Adult↗
Deformations and dilations of chaotic billiards: dissipation rate, and quasiorthogonality of the boundary wave functions
We consider chaotic billiards in d dimensions, and study the matrix elements M(nm) corresponding to general deformations of the boundary. We analyze the dependence of |M(nm)|(2) on omega = (E(n)-E(m))/Planck's over 2pi using semiclassical considerations. This relates to an estimate of the energy dissipation rate when the deformation is periodic at frequency omega. We show that, for dilations and translations of the boundary, |M(nm)|(2) vanishes like omega(4) as omega-->0, for rotations such as omega(2), whereas for generic deformations it goes to a constant. Such special cases lead to quasiorthogonality of the eigenstates on the boundary.
Journal Article↗
Payment for immunosuppression after organ transplantation. American Society of Transplantation.
Dramatic improvements in organ transplantation have meant that a growing number of patients must take expensive immunosuppressive medications for the rest of their lives. Currently, Medicare covers most transplantation procedures in the United States, but ends coverage for outpatient immunosuppressive medications after 36 months. Evidence suggests that at least some patients have reduced immunosuppression and their transplants fail because they cannot afford these medication costs. In the years since the advent of effective immunosuppressive therapy, the US Congress has struggled with this issue, and in 1999 temporarily extended medication coverage for eligible patients (based on age and disability) by 8 months. However, a more permanent solution is needed. We advocate that Medicare should cover the cost of all immunosuppressive therapy for all solid organ transplant recipients who cannot afford to pay. A number of potentially cost-effective approaches could be taken, but, in any case, something must be done to ensure that transplants do not fail because recipients cannot pay for immunosuppression.
Federal Government↗
Behavioral alterations associated with apoptosis and down-regulation of presenilin 1 in the brains of p53-deficient mice.
Presenilin 1 (PS1) expression is repressed by the p53 tumor suppressor. As shown herein, wild-type PS1 is an effective antiapoptotic molecule capable of significantly inhibiting p53-dependent and p53-independent cell death. We analyzed, at the functional and molecular levels, the brains of p53 knockout mice. Surprisingly, we found that lack of p53 expression induces apoptotic brain lesions, accompanied by learning deficiency and behavioral alterations. p53-deficient mice show an unexpected overexpression of p21(waf1) with subsequent down-regulation of PS1 in their brains. This process is progressive and age-dependent. These data indicate that the p53 pathway, besides affecting tumor suppression, may play a major role in regulating neurobehavioral function and cell survival in the brain.
Animals↗
[Development of molecular tests for rapid detection of enteropathogens].
Amplification of specific DNA sequences by polymerase chain reaction (PCR), enables rapid, sensitive and direct, specific identification of pathogens at very low concentrations in clinical samples. Studies in recent years have reported identification of several enteropathogens directly from stool samples by PCR. The amplification process includes the use of primers complementary to the DNA sequences specific to the pathogen, thus relying on the pathogen's genotype, rather than its phenotype on which identification by the methods of classical microbiology were based. We have developed PCR protocols for the differential identification of enteropathogens resembling the normal flora (enterotoxigenic E. coli (ETEC), E. coli O-157), Shigella spp, and the detection of enteropathogens that can not be grown on classic growth media (Norwalk virus). The amplification process is inhibited by several substrates present in fecal material (phenol, hemoglobin), limiting DNA extraction by phenol. The protocols we have developed for direct detection of Shigella spp and ETEC in stools circumvent inhibition of PCR by the use of a 4-hour pre-enrichment step in brain-heart infusion broth. Rapid and accurate identification of enteropathogens is important for prompt and focused intervention to stop the chain of transmission in outbreaks of gastroenteritis in military and civilian populations.
Dysentery, Bacillary↗
Unification of perturbation theory, random matrix theory, and semiclassical considerations in the study of parametrically dependent eigenstates
We consider a classically chaotic system that is described by a Hamiltonian H(Q,P;x), where x is a constant parameter. Specifically, we discuss a gas particle inside a cavity, where x controls a deformation of the boundary or the position of a "piston." The quantum eigenstates of the system are |n(x)>. We describe how the parametric kernel P(nmid R:m) = | |(2) evolves as a function of deltax = x-x(0). We explore both the perturbative and the nonperturbative regimes, and discuss the capabilities and the limitations of semiclassical as well as random waves and random-matrix-theory considerations.
Journal Article↗
Wave packet dynamics in energy space, random matrix theory, and the quantum-classical correspondence
We apply random-matrix-theory (RMT) to the analysis of evolution of wave packets in energy space. We study the crossover from ballistic behavior to saturation, the possibility of having an intermediate diffusive behavior, and the feasibility of strong localization effect. Both theoretical considerations and numerical results are presented. Using quantal-classical correspondence considerations we question the validity of the emerging dynamical picture. In particular, we claim that the appearance of the intermediate diffusive behavior is possibly an artifact of the RMT strategy.
Journal Article↗
[Diabetes mellitus after treatment with clozapine].
In a 40-year old patient with schizophrenia treated with sustained-action perfenazine for schizophrenia, diabetes mellitus type 2 and hypertension developed when clozapine was added to the regimen. The blood sugar values and the blood pressure normalized when clozapine was discontinued two weeks later. When he was 44 years old, clozapine was resumed as the psychotic symptoms did not subside. Diabetes mellitus reappeared and did not disappear after discontinuation of the clozapine. Insulin therapy was necessary. An association between the emergence of diabetes mellitus and the use of clozapine is suggested. Previously 15 cases of diabetes mellitus emerging during treatment with clozapine were described in the international literature. Monitoring of blood glucose is advised in patients with a positive family history of diabetes mellitus or with a personal history of impaired glucose tolerance.
Adult↗
Audiometric configurations following exposure to explosions.
OBJECTIVE: To determine the configurations in pathologic audiograms obtained in patients shortly after exposure to an explosion. DESIGN, SETTING, AND PATIENTS: Audiograms were performed in 143 patients (286 ears; 76 males and 67 females, with a mean age of 34.6 years [range, 11-79 years]) sent to the Department of Otolaryngology and Head and Neck Surgery in a city hospital located in the center of Jerusalem, Israel, after being injured in 4 severe explosions occurring in Jerusalem during 1995-1997. Most of the audiograms were obtained within 4 hours after the explosion, and the remaining were obtained within 4 days of the explosion. RESULTS: Of 200 pathologic audiograms, 93 (46%) showed a downward slope configuration, 82 (41%) showed a dip configuration, and 25 (12%) were flat. There were 38 audiograms (19%) with 6-kHz dips. In 82% of the patients, the audiometric configurations were similar in both ears. Patients with a slope configuration on the audiogram were significantly older than those with a dip configuration (mean age, 40.8 vs 32.8 years; P<.01). CONCLUSIONS: There does not appear to be a single typical audiometric configuration in patients exposed to explosions. The slope and dip configurations are most frequently seen and are approximately equal in their incidence. This observation may lead to better understanding damage to the inner ear as a result of an explosion. This study is distinctive because of the large number of audiograms obtained and the fact that most of them were obtained immediately after the explosion.
Adolescent↗
From transcription regulation to cell cycle checkpoint.
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Amino Acid Sequence↗
Application and evaluation of denaturing HPLC for molecular genetic analysis in tuberous sclerosis.
Tuberous sclerosis (TSC) is an autosomal dominant disorder characterised by the development of hamartomas in multiple tissues and organs. TSC exhibits locus heterogeneity with genes at 9q34 (TSC1) and 16p13.3 (TSC2) that have 21 and 41 coding exons, respectively. The mutational spectrum at both loci is wide and previous studies have shown that 60%-70% of cases are sporadic and represent new mutations. We have formatted denaturing high performance liquid chromatography (DHPLC) for rapid screening of all coding exons of TSC1 and TSC2. DHPLC analysis detected likely disease-causing mutations in 103 of 150 unrelated cases (68%), compared with 92/150 (61%) and 87/150 (58%) for single-strand conformation polymorphism analysis (SSCP) and conventional heteroduplex analysis (HA), respectively. Capital, consumable and labour costs were determined for each exon screening procedure. Estimated costs per patient sample depended on throughput, particularly for DHPLC, where a high proportion of costs are fixed, and were pounds sterling 257, pound sterling 216 and pound sterling 242 for DHPLC, SSCP and HA, respectively, assuming a throughput of 252 samples per year, or pound sterling 354, pound sterling 233 and pound sterling 259, assuming a throughput of 126 samples per year. DHPLC had the advantages of increased sensitivity and reduced labour costs when compared with more traditional approaches to exon screening but, unless expensive DHPLC equipment is being efficiently utilised for a very high proportion of the time available, overall costs are slightly higher.
Chromatography, High Pressure Liquid↗
Electroconvulsive therapy in adolescence.
The aim of this work is to discuss the ethical issues regarding the use of electroconvulsive therapy (ECT) in adolescents. Ethical implications of ECT in adolescents are analyzed in the light of general medical ethics, which include five prominent principles with respect to autonomy, nonmaleficence, beneficence, justice, and cautiousness. As adults, adolescents with acute psychotic impairment raise an inherent conflict between the respect for the patient's autonomy, on the one side, and the principle of beneficence on the other. However, this age group presents particular dilemmas: (i) As any adolescent suffering from a psychiatric illness is a highly vulnerable subject, society asks for particular attention. The consequence of potential overprotection is that the adolescent may remain untreated because of unrealistic fears regarding ECT. (ii) Some of these fears are linked to the cognitive secondary effects of ECT. Although preliminary data are reassuring, more empirical research on this population should be encouraged. (iii) Cautiousness recommends the use of ECT in limited indications catatonia, mood disorders, and intractable acute psychotic disorders. We conclude that there is no ethical reason to ban the use of ECT in adolescents. Ethical options in clinical practice must be evaluated empirically with respect to the consequences for the patient. Dogmatic views should be set aside.
Adolescent↗
Caregivers for persons with Alzheimer's disease.
Families have always cared for relatives with dementia, but scientific advances in diagnosis, management, and treatment will make caring more challenging as more people are diagnosed in early stages and more live longer in severe stages with better health care. This paper discusses the increasing prevalence, the economic value and cost of caregiving, the impact of caregiving in families with and without dementia, the subjective experience of dementia and quality of life, the ethical challenges of clinician-family partnerships, the complexity of family systems and processes that impact care patterns, homicide-suicide in caregiving, long-term care staff training, and theoretic models.
Aged↗