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Biomedical subjects

E Rabin

Publications and source records attributed to E Rabin.

At least 19 recordsLinked to original sources

Analysis of human postural responses to recoverable falls.

We studied the kinematics and kinetics of human postural responses to "recoverable falls." To induce brief falling we used a Hold and Release (H&R) paradigm. Standing subjects actively resisted a force applied to their sternum. When this force was quickly released they were suddenly off balance. For a brief period, approximately 125 ms, until restoring forces were generated to shift the center of foot pressure in front of the center of mass, the body was in a forward fall acted on by gravity and ground support forces. We were able to describe the whole-body postural behavior following release using a multilink inverted pendulum model in a regime of "small oscillations." A three-segment model incorporating upper body, upper leg, and lower leg, with active stiffness and damping at the joints was fully adequate to fit the kinematic data from all conditions. The significance of our findings is that in situations involving recoverable falls or loss of balance the earliest responses are likely dependent on actively-tuned, reflexive mechanisms yielding stiffness and damping modulation of the joints. We demonstrate that haptic cues from index fingertip contact with a stationary surface lead to a significantly smaller angular displacement of the torso and a more rapid recovery of balance. Our H&R paradigm and associated model provide a quantifiable approach to studying recovery from potential falling in normal and clinical subjects.

Accidental Falls↗

Stabilization of posture by precision touch of the index finger with rigid and flexible filaments.

Light touch of the index finger with a stationary surface at non-mechanically supportive force levels (<100 g) greatly attenuates the body sway of standing subjects. In three experiments, we evaluated the properties of finger contact and of the contacted object necessary to produce postural stabilization in subjects standing heel-to-toe with eyes closed, as well as how accurately hand position can be controlled. Experiment 1 involved finger contact with flexible filaments of different bending strengths, a flat surface, and an imagined spatial position. Contact with the flat surface was most effective in attenuating sway; the flexible filaments were much less effective but still significantly better than imagined contact. Experiment 2 compared the effectiveness of finger contact with a flexible filament, a rigid filament of the same diameter, a flat surface, and an imagined spatial position. The rigid filament and flat surface conditions were equally effective in attenuating body sway and were greatly superior to contact with the flexible filament, which was superior to imagined contact. Experiment 3 included five conditions: arms by sides; finger "contact" with an imagined spatial position; finger contact with a flat surface; finger contact with a flexible filament attempting to maintain it bent; and contact with the flexible filament attempting not to bend it. The arms by sides and finger "contact" with an imagined position conditions did not differ significantly; all three conditions involving actual finger contact showed significantly less center of pressure and hand sway, but contact with the flat surface was most effective in attenuating both postural and hand displacement. In all three experiments, the level of force applied in fingertip contact conditions was far below that necessary to provide mechanical stabilization. Our findings indicate that: (1) stimulation of a small number of receptors in the fingertip is adequate to allow stabilization of sway, (2) fingertip force levels as low as 5-10 g provide some stabilization, (3) contact with a stationary spatial referent is most effective, and (4) independent control of arm and torso occurs when finger contact is allowed.

Adult↗

[Aggressive surgical treatment for cholangiocarcinoma].

Surgery remains the only curative approach to cholangiocarcinoma. Despite operative difficulties concerning tumor location, vascular involvement or hepatic invasion curative resection (i.e. achievement of tumor free margins) carries good survival rates and is associated with low morbidity and mortality. Our experience with 31 patients with cholangiocarcinoma operated during the years 1993-1999 is presented. Twenty-five patients were found to have hilar cholangiocarcinoma, 3 carcinoma of mid-choledochus and 3 distal cholangiocarcinoma. All patients were evaluated by a diagnostic protocol including laparoscopy and laparoscopic ultrasound. Surgery consisted of local resection of the tumor with Roux en Y hepaticojejunostomy reconstruction. Three patients had concomitant hepatic resection for hilar cholangiocarcinoma while 3 patients had pancreaticoduodenectomy for distal cholangiocarcinoma. Adenocarcinoma was diagnosed in all patients. Curative resection was achieved in 19 patients and palliative resection (microscopically involved resected margins) in 12. One patient died at 60 days postop (3.5% mortality). Postoperative complications included cholangitis occurring in 10 patients who were referred with biliary drains, intraabdominal abscess (2 patients) and biliary leakage (1 patient) all treated conservatively. Overall survival rate was 82% at one year, 73% at two years and 45% at 5 years. When comparing curative resection with palliative resection, survival rates were 92% versus 71% for 1 year, 72% versus 50% for 2 year and 57% versus 14% for 5 years. Selection of patients using Laparoscopic Ultrasound combined with aggressive surgical approach enable curative or palliative resection 15 the only treatment modality which is significantly improved survival.

Adult↗

Fingertip contact suppresses the destabilizing influence of leg muscle vibration.

Touch of the hand with a stationary surface at nonmechanically supportive force levels (<1 N) greatly attenuates postural sway during quiet stance. We predicted such haptic contact would also suppress the postural destabilization caused by vibrating the right peroneus brevis and longus muscles of subjects standing heel-to-toe with eyes closed. In experiment 1, ten subjects were tested under four conditions: no-vibration, no-touch; no-vibration, touch; vibration, no-touch; and vibration, touch. A hand-held physiotherapy vibrator (120 Hz) was applied approximately 5 cm above the malleolous to stimulate the peroneus longus and brevis tendons. Touch conditions involved contact of the right index finger with a laterally positioned surface (<1 N of force) at waist height. Vibration in the absence of finger contact greatly increased the mean sway amplitude of the center of pressure and of the head relative to the no-vibration, no-touch control condition (P < 0.001). The touch, no-vibration and touch-vibration conditions were not significantly different (P > 0.05) from each other and both had significantly less mean sway amplitude of head and of center of pressure than the other conditions (P < 0.01). In experiment 2, eight subjects stood heel-to-toe under touch and no-touch conditions involving 40-s duration trials of peroneus tendon vibration at different duty cycles: 1-, 2-, 3-, and 4-s ON and OFF periods. The vibrator was attached to the subject's leg and remotely activated. In the no-touch conditions, subjects showed periodic postural disruptions contingent on the duty cycle and mirror image rebounds with the offset of vibration. In the touch conditions, subjects were much less disrupted and showed compensations occurring within 500 ms of vibration onset and mirror image rebounds with vibration offset. Subjects were able to suppress almost completely the destabilizing influence of the vibration in the 3- and 4-s duty cycle trials. These experiments show that haptic contact of the hand with a stable surface can suppress abnormal proprioceptive and motor signals in leg muscles.

Adult↗

Precision contact of the fingertip reduces postural sway of individuals with bilateral vestibular loss.

Contact of the hand with a stationary surface attenuates postural sway in normal individuals even when the level of force applied is mechanically inadequate to dampen body motion. We studied whether subjects without vestibular function would be able to substitute contact cues from the hand for their lost labyrinthine function and be able to balance as well as normal subjects in the dark without finger contact. We also studied the relative contribution of sight of the test chamber to the two groups. Subjects attempted to maintain a tandem Romberg stance for 25 s under three levels of fingertip contact: no contact; light-touch contact, up to 1 N (approximately 100 g) force; and unrestricted contact force. Both eyes open and eyes closed conditions were evaluated. Without contact, none of the vestibular loss subjects could stand for more than a few seconds in the dark without falling; all the normals could. The vestibular loss subjects were significantly more stable in the dark with light touch of the index finger than the normal subjects in the dark without touch. They also swayed less in the dark with light touch than when permitted sight of the test chamber without touch, and less with sight and touch than just sight. The normal subjects swayed less in the dark with touch than without, and less with sight and touch than sight alone. These findings show that during quiet stance light touch of the index finger with a stationary surface can be as effective or even more so than vestibular function for minimizing postural sway.

Aged↗

Haptic stabilization of posture: changes in arm proprioception and cutaneous feedback for different arm orientations.

Postural sway during quiet stance is attenuated by actively maintained contact of the index finger with a stationary surface, even if the level of applied force (<1 N) cannot provide mechanical stabilization. In this situation, changes in force level at the fingertip lead changes in center of foot pressure by approximately 250 ms. These and related findings indicate that stimulation of the fingertip combined with proprioceptive information about the hand and arm can serve as an active sensor of body position relative to the point of contact. A geometric analysis of the relationship between hand and torso displacement during body sway led to the prediction that arm and hand proprioceptive and finger somatosensory information about body sway would be maximized with finger contact in the plane of body sway. Therefore, the most postural stabilization should be possible with such contact. To test this analysis, subjects touched a laterally versus anteriorly placed surface while in each of two stances: the heel-to-toe tandem Romberg stance that reduces medial-lateral stability and the heel-to-heel, toes-outward, knees-bent, "duck stance" that reduces fore-aft stability. Postural sway was always least with finger contact in the unstable plane: for the tandem stance, lateral fingertip contact was significantly more effective than frontal contact, and, for the duck stance, frontal contact was more effective than lateral fingertip contact. Force changes at the fingertip led changes in center of pressure of the feet by approximately 250 ms for both fingertip contact locations for both test stances. These results support the geometric analysis, which showed that 1) arm joint angles change by the largest amount when fingertip contact is maintained in the plane of greatest sway, and 2) the somatosensory cues at the fingertip provide both direction and amplitude information about sway when the finger is contacting a surface in the unstable plane.

Adult↗

Antiglomerular basement membrane antibody-mediated nephritis with normal pulmonary and renal function. A case report and review of the literature.

Antiglomerular basement membrane (anti-GBM) antibody-mediated disease is usually characterized by a rapidly progressive glomerulonephritis with or without pulmonary hemorrhage. We report a case of anti-GBM-mediated nephritis that presented with hematuria and proteinuria. There was no evidence of renal insufficiency or pulmonary hemorrhage. Clinicians should be aware of this rare presentation of anti-GBM-mediated nephritis.

Adult↗

Loss of CD23 is a consequence of B-cell activation. Implications for the analysis of B-cell lineages.

When splenic CD5- B cells are stimulated with antiimmunoglobulin they become CD5+ and have a prolonged in vitro life. Further treatment with IL-6 induces a loss of surface CD23 and IgD; that is, they resemble freshly isolated peritoneal CD5+ cells. These data suggest that the CD5 phenotype is induced after sIg-mediated B-cell activation. Additional support for this view arises from the observation that the loss of CD23 and IgD can be induced by another activation inducer, LPS, although in this case CD5 is not expressed. Thus, activation by anti-Ig plus IL-6 or by LPS induces CD23 loss. Consistent with the hypothesis that the loss of CD23 is a consequence of activation, we now report that the surface expression of CD23 varies inversely with the amount of total cellular RNA. We also find both CD23 positive and negative B cells among freshly isolated splenic CD5- B cells. In young mice a proportion of small splenic CD5+ B cells are CD23+, providing additional evidence that CD23 is present on all B cells prior to activation. A comparison of the features of CD5+ B cells and the antibody responses to thymus-dependent and thymus-independent antigens leads us to hypothesize that the CD5 phenotype arises as a consequence of thymus-independent type 2 (TI-2) stimulation. The relationship of CD5 expression to B-cell lineage (fetal vs. adult bone marrow) is discussed.

Animals↗

Production of 17.2.25 mu transgenic and endogenous immunoglobulin in X-linked immune deficient mice.

In M54 mice transgenic for a completely rearranged mu(a) heavy chain there is a decrease in total B cells and the rearrangement of endogenous immunoglobulin genes is partially inhibited. Surprisingly, however, endogenous immunoglobulin gene rearrangement and significant heavy chain polypeptide production does occur. We tested the hypothesis that only CD5+ B cells produce endogenous immunoglobulin by taking advantage of the fact that X-linked immune deficient (xid) mice normally are deficient in CD5+ B cells. We found that the frequency of CD5+ splenic B cells was similar in XxidY transgenic and non-transgenic F1 males, and in XxidX transgenic and non-transgenic F1 females. In both XxidX and XxidY transgenic F1 mice some, but not all, splenic B cells are CD11b+. There was a striking deficit of splenic B cells expressing endogenous immunoglobulin in XxidY transgenic mice, although this was not true for peritoneal cells. Thus, the introduction of the 17.2.25 mu transgene does not prevent the development of CD5- B cells nor does it limit endogenous immunoglobulin gene arrangement and expression solely to CD5+ B cells. However, in mice capable of expressing B cell surface CD5 or CD11 this transgene can lead to expansion of the fraction of B cells positive for these molecules. We conclude that while the introduction of the 17.2.25 mu transgene alters the frequencies of B cell populations, maturation is not limited to one subpopulation.

Animals↗

Treatment of murine CD5- B cells with anti-Ig, but not LPS, induces surface CD5: two B-cell activation pathways.

Anti-Ig stimulated murine B cells express high levels of surface CD5 (ly-1) and increased CD44 while maintaining surface IgD, CD23 and J11d. Sorting of CD5- and CD5+ cells demonstrates that anti-Ig induces CD5 expression rather than the selective expansion of CD5+ cells. Anti Ig plus interleukin-6 (IL-6) induces the CD23, IgD, low ly-5 (B220) (CD45low), J11dhigh phenotype of typical CD5+ peritoneal B cells. In contrast, lipopolysaccharide (LPS)-stimulated B cells have high levels of CD44 but decreased surface IgD, CD23 and J11d and no CD5. Thus LPS and anti-Ig generate activated cells with differing phenotypes. Induced CD5+ cells have increased viability, even in the absence of added exogenous factors, while the viability of CD5- B cells is dependent on factors such as IL-4. We conclude that conventional CD5- B cells can be activated by either of two pathways: one generating CD5+ B cells; the other yielding conventional activated cells. We hypothesize that the first path requires slg cross-linking and corresponds to T-independent (type 2) stimulation, while cognate interaction with helper T cells in the absence of slg cross-linking induces B cells to enter the second path.

Animals↗

Pathology of laser-induced experimental aneurysms.

Aneurysms were produced in the common carotid artery of 35 rats by milliwatt CO2 laser welding of an adventitia patch over a hole. The aneurysmal sac was formed by collagen; the lumen was covered by an endothelial-like lining and partially thrombosed. The pathology of these aneurysms is similar to spontaneously occurring intracranial human aneurysms. This aneurysm model has properties (reliability, spontaneous bleeding tendency, minimal vessel manipulation, and pathological features) that make it theoretically advantageous for the induction of experimental intracranial aneurysms in larger animals.

Aneurysm↗

Induction of experimental aneurysms on the rat common carotid artery using a microsurgical CO2 laser.

Aneurysms were produced on the common carotid artery of rats by milliwatt CO2 laser welding of an adventitia patch over a hole. Sixty-nine animals were operated on. Aneurysms were present in 35 animals (51%), 7 of which ruptured spontaneously. The time to aneurysm formation was 1 week or longer. The adventitia patch aneurysm model has features (reliability, minimal vessel manipulation, histology similar to human berry aneurysm, and spontaneous bleeding tendency) that make it theoretically suitable for the induction of intracranial aneurysms in experimental animals. The microsurgical skills required to create and dissect the aneurysm make our experimental aneurysm useful as a teaching model in the development of microneurovascular surgery skills.

Aneurysm↗

Regulation of B-lymphocyte activation, proliferation, and immunoglobulin secretion.

Lymphocyte growth and differentiation are controlled by signals resulting from the interaction of antigen and cellular products, such as lymphokines, with specific cell membrane receptors. Resting B lymphocytes can be activated by low concentrations (1-5 micrograms/ml) of antibodies to membrane IgM, which is the B-lymphocyte receptor for antigen. The binding of anti-IgM to B cells causes a rapid increase in intracellular free calcium concentration ([Ca2+]i), in inositol phosphate concentration, and in protein kinase activity. Moreover, the effects of anti-IgM on B cells are mimicked by the combined use of calcium ionophores and phorbol esters. Since phorbol esters activate protein kinase c, this suggests that the increase in [Ca2+]i and in phosphatidylinositol metabolism stimulated by anti-IgM are critical events in B-cell activation. The entry into S phase of B cells stimulated with anti-IgM depends on the action of a T-cell-derived factor designated B-cell stimulatory factor (BSF)-1. This is a 20,000-Da protein which is a powerful inducer of class II major histocompatibility complex molecules. Although an important cofactor for B-cell proliferative responses to anti-IgM, its major locus of action is on resting B cells. B cells stimulated with anti-IgM and BSF-1 do not synthesize secretory IgM. However, if two additional T-cell-derived factors, B151-TRF and interleukin-2, are added to cultures, a substantial proportion of stimulated B cells produce secretory IgM. BSF-1 has also been shown to participate in the "switch" in Ig class expression. Resting B cells cultured with lipopolysaccharide will switch to IgG1 secretion in the presence of purified BSF-1.

Animals↗

Technique of experimental aneurysm formation in the rat common carotid artery using the milliwatt carbon dioxide laser and the adventitia patch model.

Aneurysms were induced in the rat common carotid artery by using the milliwatt carbon dioxide laser to weld an adventitia patch over a hole. This technique proved to be effective and reliable as demonstrated by the 100% incidence of aneurysm formation at the patch site in 28 rats killed 1 week or later after the procedure. It is suggested that this technique may be used to produce intracranial aneurysms in experimental animals due to the minimal vessel manipulation required.

Aneurysm↗

Umbilical artery catheterization complicated by multiple mycotic aortic aneurysms.

A premature infant had three pseudoaneurysms of the thoracic and abdominal aorta secondary to umbilical artery catheterization and sepsis. The infant had septicemia as the direct result of bacterial contamination of an umbilical artery catheter with Staphylococcus aureus. The thoracic pseudoaneurysm caused massive hemothorax and the infant's death. The upper abdominal aortic aneurysm developed at the level of the renal arteries and caused decreased left renal blood flow and renal hypoplasia. The lower abdominal aneurysm involved the right iliac artery and was complicated by mural thrombosis and ischemia of the right leg. To our knowledge, this is the first published case of multiple mycotic aortic aneurysms after umbilical artery catheterization.

Aorta, Abdominal↗