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Biomedical subjects

D Smith

Publications and source records attributed to D Smith.

At least 1,297 records · Page 72Linked to original sources
PubMedDate not supplied

Development, implementation, and evaluation of a medical Spanish curriculum for an emergency medicine residency program.

A 45-hour medical Spanish curriculum for an emergency medicine residency program was implemented in response to a need for "functionally bilingual" physicians in our practice setting, and to reduce reliance on translation assistance from nursing and clerical personnel. Course goals were to achieve a vocabulary level of 5,000-10,000 words for participants, and to achieve sufficient language capabilities for basic information exchange, obtaining uncomplicated medical histories, conducting unassisted physical examinations, and giving patient discharge instructions. Feedback obtained from post course interviews and instructor assessment indicated that the curriculum employed resulted in the attainment of the above goals for fully participating physicians.

Curriculum↗
PubMedDate not supplied

Ethanol decreases progesterone synthesis in human placental cells: mechanism of ethanol effect.

Fetal alcohol syndrome (FAS) is a set of signs and symptoms in offsprings born to mothers who abuse alcohol during pregnancy. We postulated that impairment in the placental endocrine function contribute to FAS. In this study, we examined in vitro effects of ethanol on the placental cells' (cytotrophoblast cells) capacity to synthesize progesterone. Cytotrophoblast cells were isolated from normal term placenta and were incubated (2 x 10(6)) with 20-, 30-, and 40-mM doses of ethanol for 6 h. Progesterone was measured in the incubate by RIA. The results showed that, at the 20-mM dose of ethanol, progesterone synthesis was significantly decreased (p less than 0.01), at the 30-mM dose level there was a further decrease of 20%. The differences between 30- and 40-mM ethanol dose levels were not significant. To determine the mechanism of ethanol effects on progesterone synthesis, cytotrophoblast cells were preincubated with 30 mM ethanol followed by 10 microliters of LDL (10 microliters LDL = 80 micrograms cholesterol) and vice versa. The results showed that ethanol effects on progesterone synthesis was dependent on whether ethanol was added prior to or following the addition of LDL in the medium. If ethanol was added in the medium prior to LDL, progesterone synthesis was decreased significantly (p greater than 0.01); however, when ethanol was added after the LDL, ethanol had no effect on progesterone synthesis. In the experiment where ethanol and LDL were added simultaneously in the medium, ethanol blunted the stimulatory effect of LDL on progesterone synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Dose-Response Relationship, Drug↗
PubMedDate not supplied

Valsartan, a new angiotensin II antagonist: antihypertensive effects over 24 hours.

This study was done to assess the antihypertensive efficacy of once-daily valsartan 20 mg, 80 mg, 160 mg, and 320 mg over 24 hours using ambulatory blood pressure monitoring (ABPM). A total of 217 adult outpatients with uncomplicated essential hypertension (office mean sitting diastolic blood pressure [DBP] of > or = 95 to < or = 115 mm Hg) participated in this multicenter, double-masked, placebo-controlled study. Patients were randomized to receive valsartan 20 mg, 80 mg, 160 mg, 320 mg, or placebo for 8 weeks. Twenty-four-hour ABPM was done at baseline and after 8 weeks of treatment. All valsartan doses produced significant decreases in average ambulatory systolic blood pressure (SBP) and DBP over 24 hours compared with placebo. A trend to greater reductions compared with placebo was observed for doses of valsartan 80 mg and greater (80 mg, -6.61 mm Hg DBP, -11.04 mm Hg SBP; 160 mg, -5.51 mm Hg DBP, -10.61 mm Hg SBP; 320 mg, -8.44 mm Hg DBP, -14.34 mm Hg SBP) compared with valsartan 20 mg (-3.52 mm Hg DBP, -5.92 mm Hg SBP). Valsartan produced consistent reductions compared with placebo during both day (> 6 AM to < or = 10 PM) and night (> 10 PM to < or = 6 AM). However, in all groups, the circadian pattern of blood pressure over 24 hours was preserved and was similar to that observed at baseline (but shifted into the normotensive range in a parallel fashion). The data show that single daily doses of valsartan 80 mg and greater provide effective control of both DBP and SBP over a 24-hour period without loss of diurnal variation.

Antihypertensive Agents↗
PubMedDate not supplied

Does race or socioeconomic status predict adverse outcome after out of hospital cardiac arrest: a multi-center study.

OBJECTIVE: To assess whether socioeconomic status (SES) or race is associated with adverse outcome after an out-of-hospital cardiac arrest (OHCA). METHODS: A convenience sample of OHCA of presumed cardiac origin from seven suburban cities in Michigan, 1991-1996. Median household income (HHI), utilizing patient home address and 1990 census tract data, was dichotomized above and below 1990 state median income. Patient race was dichotomized as black or white. Outcome was defined as survival to hospital discharge (DC). Multiple logistic regression and Pearson's chi2 values were used for analysis. RESULTS: Of 1317 cases with complete data for analysis, the average age was 67.3 +/- 16.0, 939 (71.1%) were white, 587 (44.4%) arrests were witnessed (WIT), and 65 (4.9%) were DC alive. There was no significant difference between races with respect to WIT arrests, V(T)/V(F) arrest rhythms, and a small difference in EMS response interval. Whites were more likely to be above median HHI (57.1 vs. 26.2%, P < 0.001). Adjusted odds ratios for predictors of survival were WIT arrest (OR = 3.76, 95% CI (1.7, 8.2)), V(T)/V(F) (OR = 8.74, 95% CI (3.7, 10.8), but not race (OR = 0.68, 95% CI (0.3, 1.4)) or SES (OR = 1.51, 95% C1 0.8, 2.8). CONCLUSION: In this population, neither race nor SES was independently associated with a worse outcome after OHCA.

Black or African American↗
PubMedDate not supplied

A controlled trial of imipramine for the treatment of methamphetamine dependence.

At the Drug Detoxification Program of the Haight Ashbury Free Clinics, we conducted a randomized clinical trial of imipramine in the treatment of methamphetamine dependence. The purposes of the trial were to test the efficacy of imipramine as a treatment for methamphetamine dependence and to establish the feasibility of conducting a controlled clinical trial at the Clinic. Thirty-two subjects were randomly assigned to receive either 10 or 150 mg/day of imiprine for 180 days. Imipramine 10 mg/day was the control. Subjects received intensive counseling. Retention in treatment was significantly longer for subjects who were treated with 150 mg of imipramine compared to control (median days: 33.0 vs. 10.5). There were no consistent differences in percent of urine samples positive for methamphetamine, Beck Depression Inventory scores, or craving. Determination of the full extent of imipramine's utility in the treatment of methamphetamine dependence awaits a larger trial.

Adult↗
PubMedDate not supplied

Internal consistency of echocardiographic estimates of the severity of left ventricular outflow obstruction.

To determine their internal consistency, M-mode and Doppler echocardiography were used to estimate the gradient across the left ventricular outflow tract during 74 evaluations of 50 infants, children, and young adults with congenital valvular (n = 43), subvalvular (n = 6), and supravalvular (n = 1) aortic stenosis. By M-mode the gradient was estimated from the wall-stress formula (left ventricular pressure = 225 x wall thickness/end-systolic diameter) minus systolic blood pressure determined by sphygmomanometry. Doppler (pulsed or continuous wave) methods utilized the Bernoulli formula (gradient = 4 x V2). There was good agreement between the M-mode and Doppler estimates of outflow gradient in most patients (r = 0.69, standard error of the estimate = 26.9). In 46 of 74 comparisons (62%) the two estimates differed by less than 20 mm Hg, and the estimates placed the patient in the same clinical class (mild, moderate, or severe). In 22 patients undergoing cardiac catheterization, there was only a fair correlation between the M-mode (r = 0.50) and Doppler (r = 0.58) gradients and those obtained at catheterization. Each noninvasive technique yielded major overestimates or underestimates of the gradient in several instances. The M-mode and Doppler techniques for estimating the severity of congenital aortic stenosis are complementary. Their combined use minimizes but does not totally eliminate errors of overestimation or underestimation of outflow gradient.

Adolescent↗
PubMedDate not supplied

Neuro-fuzzy closed-loop control of depth of anaesthesia.

The utility of the auditory evoked potential (AEP) is under investigation as a feedback signal for the automatic closed-loop control of general anaesthesia using neural networks and fuzzy logic. The AEP is a signal derived from the electroencephalogram (EEG) in response to auditory stimulation, which may be useful as an index of the 'depth' of anaesthesia. A simple back-propagation neural network can learn the AEP and provides a satisfactory input to a fuzzy logic infusion controller for the administration of anaesthetic drugs, but the problem remains that of reliable signal acquisition.

Anesthesia, Closed-Circuit↗
PubMedDate not supplied

Discontinuous appendiceal involvement in ulcerative colitis: pathology and clinical correlation.

Continuous mucosal involvement from the rectum proximally is one of the hallmarks of ulcerative colitis. However, recent pathologic series report appendiceal ulcerative colitis in the presence of a histologically normal cecum, representing a "skip" lesion. The clinical significance of this finding has not been established. Eighty patients, 54 males and 26 females, average age 37.9 years (range 14 to 82 years) who underwent proctocolectomy for ulcerative colitis from January 1990 to September 1995 were examined to determine the rate of discontinuous appendiceal involvement. Excluded were 12 patients with prior appendectomy and 11 with fibrotic obliteration of the appendiceal lumen. Of the remaining 57 patients, seven (12.3%) had clear appendiceal involvement in the presence of a histologically normal cecum. These seven patients clinically were indistinguishable from the 50 patients without skip involvement of the appendix in terms of age at surgery, pretreatment medications, type of surgery, interval from diagnosis to definitive procedure, complications, functional results, and clinical course. Discontinuous appendiceal involvement was found in 12.3% of patients undergoing proctocolectomy for ulcerative colitis, and clinically these patients behave as those without this feature.

Adolescent↗
PubMedDate not supplied

Structural alteration of viral homologue of receptor proto-oncogene fms at carboxyl terminus.

A role for proto-oncogenes in the regulation and modulation of cell proliferation has been suggested by the findings that the B-chain of platelet-derived growth factor (PDGF) is encoded by the proto-oncogene sis and that the erb-B oncogene product is a truncated form of the epidermal growth factor (EGF) receptor. Furthermore, the product of the proto-oncogene fms (c-fms) may be related or identical to the receptor for macrophage colony-stimulating factor (CSF-1). v-fms is the transforming gene of the McDonough strain of feline sarcoma virus (SM-FeSV) and belongs to the family of src-related oncogenes which have tyrosine-specific kinase activity. Furthermore, nucleotide sequence analysis of the v-fms gene product revealed topological properties of a cell-surface receptor protein. To elucidate the features involved in the conversion of a normal cell-surface receptor gene into an oncogenic one, we have now determined the complete nucleotide sequence of a human c-fms complementary DNA. The 972-amino-acid c-fms protein has an extracellular domain, a membrane-spanning region, and a cytoplasmic tyrosine protein kinase domain. Comparison of the feline v-fms and human c-fms sequences reveals that the proteins share extensive homology but have different carboxyl termini.

Amino Acid Sequence↗
PubMedDate not supplied

Islet amyloid polypeptide (amylin) modulates chylomicron metabolism in rats.

1. Amylin is a pancreatic peptide that has been shown to be able to induce a state of peripheral insulin resistance. Hyperamylinaemia, which occurs in type 2 diabetes, may be central to a number of metabolic abnormalities present in the diabetic state. Because lipoprotein metabolism is often disturbed in diabetes, we investigated whether amylin was a regulating factor of lipoprotein metabolism in rats; specifically, whether exogenous amylin influences production and clearance of triglyceride (TG)-rich lipoproteins. 2. When amylin was given acutely to rats or by way of infusion, total plasma TG was significantly elevated. Acute doses of amylin decreased fractional clearance rates of TG-rich lipoproteins by 45%. Hydrolysis of lipoproteins by endothelial lipases was not decreased; rather, amylin appeared to reduce hepatic uptake of TG-rich lipoproteins, following conversion to the remnant form. Consistent with the kinetic data in vivo, cell culture studies found that amylin reduced the high-affinity uptake of remnant lipoproteins, probably by inhibiting low-density lipoprotein receptor expression. 3. We have found that amylin can influence the kinetics of TG-rich lipoproteins in vivo and in vitro. Amylin can reduce chylomicron uptake, most probably by regulating lipoprotein receptors either directly, or via modulation of insulin activity. Increased levels of amylin in type 2 diabetes may contribute to the raised concentration of TG-rich remnant lipoproteins present in this disease.

Amyloid↗