Biomedical subjects
D S Smith
Publications and source records attributed to D S Smith.
Remedial therapy after stroke: a randomised controlled trial.
Of 1094 patients with a confirmed stroke admitted to Northwick Park, a district general hospital, 364 (33%) died while in hospital, 215 (20%) were fully recovered when discharged, and 329 (30%) were too frail or too ill from diseases other than stroke to be considered for active rehabilitation. Only 121 (11%) were suitable for intensive treatment. They and 12 patients referred direct to outpatients were allocated at random to one of three different courses of rehabilitation. Intensive was compared with conventional rehabilitation and with a third regimen which included no routine rehabilitation, but under which patients were encouraged to continue with exercises taught while in hospital and were regularly seen at home by a health visitor. Progress at three months and 12 months was measured by an index of activities of daily living. Improvement was greatest in those receiving intensive treatment, intermediate in those receiving conventional treatment, and least in those receiving no routine treatment. Decreasing intensity of treatment was associated with a significant increase in the proportions of patients who deteriorated and in the extent to which they deteriorated. Probably only a few stroke patients, mostly men, are suitable for intensive outpatient rehabilitation, but for those patients the treatment is effective and realistic.
Intensive rehabilitation after stroke: service implications.
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Structural features associated with movement and 'catch' of sea-urchin spines.
Spine catch ligaments of a sea urchin Arbacia punctulata were extended under constant load. Ligaments from an undisturbed animal may show any extension rate from zero (catch state) to rapid extension to failure. Replacing the preparation bath with CA(2)- and Mg(2+)-free sea water reversibly abolishes the catch state. The fine structure of the outermuscle layer and inner ligament cone associated with the spine base is described. The unstriated paramyosin muscles bear thin flanges and form compact interlocking rows. Subsurface cisternae are associated with the plasma membrane. The muscles are innervated by glia-free axons ending in bulbous terminals containing lucent synaptic vesicles. The ligament comprises cylindrical bundles of collagen fibrils: one or more minute muscle fibers (paramyosin) lie parallel with and closely adjoining each bundle. The mean diameter of these muscles is 0.3 micrometers and they occupy 2-3% of the ligament's cross-sectional area. Axons containing electron-opaque secretory droplets accompany the muscles between the collagen bundles: the cell bodies of these neurones generally lie on the outer surface of the ligament. When an urchin points a spine, the ligament on the side of the contracting spine muscle shortens but does not buckle. A function of the intraligamental muscles is to effect this non-buckled shortening. The catch mechanism (which reside entirely within the ligament) may be due either to the intraligamental muscles and/or to a locked polymer mechanism in which matrix molecules between collagen fibrils are reversibly cross-linked by divalent cations.
Organization of native and in vitro-reassembled myosin filaments from lobster tonic muscle.
Tonic muscle of the crusher claw of the American lobster (Homarus americanus) was investigated with respect to sarcomeric organization and the capacity for self-assembly of extracted myosin for comparison with the same properties of rabbit muscle. Native myosin filaments in the lobster muscle are much longer than in rabbit skeletal fibers, and differ further in sarcomeric organization in showing an actin-to-myosin relationship in which two actin filaments are shared between adjacent myosins in a 12-membered orbital. The self-assembly of lobster myosin into filaments comparable in length and the fine structure to the natural filament was achieved in the presence of excess Mg2+, a condition not required for rabbit myosin self-assembly. Results of in situ and self-assembly studies indicate a difference in molecular organization between lobster and rabbit myosin filaments and of the inferred presence of regulatory factors in the formation of these ultrastructural elements. These studies represent the groundwork for an investigation of in vitro polymerization of actin in association with the synthetic lobster myosin filament.
Tannic acid staining of "microtubules' in venom-secreting cells of a stingray.
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Direct determination of propranolol in serum or plasma by fluoroimmunoassay.
A fluoroimmunoassay for the determination of serum of plasma levels of propranolol was developed using antibodies to propranolol coupled to magnetizable solid-phase particles and fluorescein-labeled propranolol as tracer. The method was sufficiently sensitive, precise, and specific for application to routine monitoring of propranolol therapy, and gave good correlation (r = 0.99) with a widely used ultraviolet fluorometric method in the assay of patients' specimens. The fluoroimmunoassay involves the same instrumentation as the fluorometric assay and has practical advantages, including greater sensitivity (only 100 microliters of sample required), avoidance of an extraction step, and visible-wavelength fluorometry, which permits the use of disposable plastic apparatus throughout the entire procedure.
Influence of high dose fentanyl on cerebral blood flow and metabolism.
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A review of fluoroimmunoassay and immunofluorometric assay.
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Russian historical demography and family history.
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Restriction endonuclease cleavage of DNA obtained from herpes simplex isolates of two patients with bilateral herpetic disease.
Restriction enzyme analysis was utilized to investigate HSV isolates from bilateral lesions of skin and/or cornea. In the first case (DM) type 1 HSV was obtained from a lesion on the right eye lid in 1977 and from a recurrence in 1979 consisting of dendritic lesions on the left cornea as well as skin lesions on the right naris. HSV virus was isolated in the second case (BL) from a right corneal lesion in 1979. Ten months later HSV was again isolated from a recurrence on the right cornea and from multiple skin lesions on the left cheek. DNA obtained from all HSV isolates were cleaved with Hpa I, Bgl II, Kpn I, Hind III, and Eco RI. A comparison of DNA cleavage patterns following agarose electrophoresis revealed that the virus isolates from DM were different from those of BL. However, all of the isolates obtained from each patient were identical. Therefore, these type 1 isolates obtained from anatomical sites supplied by contralateral trigeminal nerves were due to reactivation and/or reinfection with endogenous virus rather than exogenous infection.
The effect of plasma exchange on the in vitro monocyte function of patients with immune complex diseases.
In vitro function tests were performed on peripheral blood monocytes isolated from patients with putative immune complex diseases undergoing therapeutic plasma exchange. Bacterial killing by monocytes improved significantly after plasma exchange (pre: 29 +/- 5%; post: 39 +/- 3%). The intracellular content of the acid hydrolase N-acetylglucosaminidase (NAG) after in vitro culture rose significantly following plasma exchange (pre: 48.3 +/- 21 nmol mg protein-1 hr-1; post: 76.6 +/- 30.6), although the amount of NAG released into the supernatant was unchanged. Plasma exchange also resulted in reduced levels of immune complexes (IC) and clinical improvement in most patients. The beneficial effect of plasma exchange in patients with IC diseases may be partly due to removal of IC which are known to influence the functional activity of cells of the mononuclear macrophage series.
The interaction of B29-fluoresceinthiocarbamyl-insulin with adipocyte membranes.
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A proposed solution to a fine-structural puzzle: the organization of gill cuticle in a crayfish (Panulirus).
Crayfish gill cuticle is approximately 2 micron thick and comprises an epicuticle and an endocuticle, which is subdivided into outer and inner layers. Sections demonstrate indistinct lamellae in the outer endocuticle and vertically striated lamellae in the inner endocuticle. Microfibrils cannot be seen in sections. Difficulties in interpretation of the fibrous architecture of the cuticle from thin sections have been overcome by examining tilted series of micrographs of sections and also by making freeze-fracture replicas of the cuticle, which reveal the microfibrils clearly. A model for the endocuticle based on a helicoidal configuration of microfibrillar laminae is proposed and the vertically striated structures seen in sections of the outer layer are accounted for by including regular rows of particles oriented perpendicular to microfibrils. The model is compared with cuticles and coverings reported from other invertebrates.
Knee-joint temperature measurement using a differential thermistor thermometer.
A simple method for measuring joint inflammation with a differential thermistor probe thermometer was applied to acute synovitis of the knee. Temperature assessments were made immediately before and serially after intra-articular steroid therapy. The method was capable of showing a significant difference in temperature between inflamed and normal knees. Knee temperature assessments correlated well with clinical parameters and were essentially independent of room temperature.
Assessment of motor function in studies of chronic disability.
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