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Biomedical subjects

G Cohen

Publications and source records attributed to G Cohen.

At least 127 records · Page 7Linked to original sources

Insertional inactivation of streptolysin S expression is associated with altered riboflavin metabolism in Streptococcus pyogenes.

Transposon Tn916 mutagenesis was used to create a mutant of Streptococcus pyogenes M type 3, designated ISS417, in which the ability to produce streptolysin S (SLS) and several other exoproteins was impaired. Concomitantly, the mutant became dependent upon riboflavin for growth and was able to grow in Todd Hewitt broth (THB) when supplemented with riboflavin or riboflavinrich yeast extract. The parent strain was apparently able to utilize THB-derived components as a substitute for riboflavin, while the mutant was not. Although the parent strain grew well in synthetic medium, it was unable to produce SLS, except when it was supplemented with a small amount of THB. Thus, a component of THB was able to "trigger" SLS formation in the parent strain. The mutant grew well in this medium, but was unable to produce SLS even when it was supplemented with THB. Southern hybridization analysis revealed that the ISS417 mutant harbours a single transposon insertion in its chromosome. Phage transduction experiments showed that the riboflavin dependency and the inability to make SLS phenotypes are co-transducible. The pleotrophic properties of the ISS417 mutant differ from those reported for insertional inactivation of the mga locus which regulates production of a number of surface proteins in S. pyogenes and the sar locus which regulates production of a number of exoproteins in Staphylococcus aureus. In view of the possibility that there exist a genetic linkage between the riboflavin biosynthetic pathway and expression of the oxygen-stable SLS, we hypothesize that SLS has a role in the growth economy of S. pyogenes.

Bacterial Proteins↗

Accumulation of ubiquitinated proteins in mouse neuronal cells induced by oxidative stress.

Ubiquitin protein conjugates are commonly detected in neuronal brain inclusions of patients with neurodegenerative disorders. The failure to eliminate the ubiquitin-protein deposits in the degenerating neurons may result from changes in the activity of the ubiquitin/ATP-dependent proteolytic pathway. This proteolytic pathway plays a major role in the degradation of short lived, abnormal and denatured proteins. Cadmium is a potent cell poison and is known to affect the ubiquitin pathway and to cause oxidative stress. Increases in protein mixed-disulfides (Pr-SSG) and decreases in glutathione (GSH) are often used as markers of oxidative stress. To investigate the relationship between the ubiquitin pathway and cellular glutathione (GSH), we treated HT4 cells (a mouse neuronal cell line) and rat mesencephalic primary cultures with different concentrations of the heavy metal. We observed marked increases in Pr-SSG as well as decreases in GSH, after exposure of HT4 cells or primary mesencephalic cultures to Cd2+. Furthermore, our results show that Cd2+ induced the accumulation of ubiquitinated proteins. Detection was by Western blotting of total cell extracts probed with antibodies that recognize ubiquitin-protein conjugates. These results suggest that the ubiquitin-pathway is closely involved in the cell response to cadmium-mediated oxidative stress.

Animals↗

Basic fibroblast growth factor stimulation of glial cells protects dopamine neurons from 6-hydroxydopamine toxicity: involvement of the glutathione system.

Neurotrophic factors have been shown to support the survival and promote the recovery of injured neurons both in vivo and in vitro. Here, we investigated whether glial cell line-derived neurotrophic factor (GDNF) and basic fibroblast growth factor (bFGF) could modify the damage to dopamine (DA) neurons in mesencephalic cultures caused by the neurotoxin 6-hydroxydopamine (6-OHDA). The data show that bFGF, but not GDNF, effectively protected DA neurons from 6-OHDA toxicity. Because bFGF is a glial mitogen, whereas GDNF is not, we tested whether glial cells participated in bFGF neuroprotection. Inhibition of glial cell proliferation completely prevented the protective effect of bFGF. Because oxidative events have been associated with 6-OHDA-induced damage, we examined the levels of glutathione (GSH) in control and bFGF-treated cultures. Cultures treated with bFGF had higher levels of GSH, which increased even further in response to 6-OHDA exposure. Control cultures failed to up-regulate GSH levels after 6-OHDA, suggesting a relationship between increased GSH levels and protection from 6-OHDA. Inhibition of glial cell proliferation prevented the rise in GSH in bFGF-treated cultures and abolished the increase after 6-OHDA treatment. Protection from 6-OHDA by bFGF was also diminished when GSH levels were decreased by the GSH synthesis inhibitor L-buthionine sulfoximine. Our study shows that stimulation of glial cells by bFGF allows the up-regulation of antioxidant defenses and supports cell survival during oxidative stress.

Animals↗

Utility of thyroid function screening in adolescent psychiatric inpatients.

OBJECTIVE: Thyroid function abnormalities have been associated with psychiatric symptoms. This study examines the utility of thyroid screening among adolescent psychiatric inpatients. METHOD: A retrospective chart review of 196 first-time admissions to an adolescent psychiatric unit was conducted. Charts were screened for demographics, presence/absence of thyroid function testing, history of thyroid disease, medication/illicit substance use, and other factors of influence on thyroid testing. Thyroid test results were reviewed for abnormalities. RESULTS: Thyroid function testing was conducted in 150 of the 196 admissions. Fifty-two patients had abnormalities, most of which were isolated abnormalities of thyroxine (T4) or triiodothyronine uptake (T3U). Laboratory diagnosis of hyperthyroidism and mild hypothyroidism was met by two and eight patients, respectively; five had profiles that were normal upon subsequent testing 1 week later. None of the patients was symptomatic, and none required thyroid supplementation or antithyroid medications. Gender differences in T4 and T3U were noted, and age was positively correlated with T3U. CONCLUSIONS: Thyroid function tests may be spuriously abnormal in routine screening of newly admitted psychiatric patients. Routine thyroid screening among adolescent psychiatric inpatients is unwarranted except in patients who display physical signs or symptoms suggestive of thyroid disease.

Adolescent↗

Pubic rami fracture: a benign pelvic injury?

OBJECTIVE: To present a consecutive series of older patients with pubic rami fractures and evaluate their long term functional outcome. STUDY DESIGN: Retrospective. METHODS: Sixty-three consecutive community-dwelling, ambulatory patients who sustained a public rami fracture and were treated at one hospital were reviewed. Fifty-two of sixty-three patients (83%) had radiographic evidence of pubic rami fracture at initial presentation; in the remaining eleven patients, the diagnosis of pubic rami fracture was made after additional imaging studies. Sixty patients (95%) required hospitalization for pain control and progressive mobilization. RESULTS: The hospital length of stay for the sixty admitted patients averaged fourteen days; patients who had three or more associated medical comorbidities or required use of a cane or walker for ambulation prior to fracture were more likely to have been hospitalized greater than two weeks. Thirty-eight patients were available for one year minimum follow-up; thirty-five of thirty-eight patients (92%) were living at home, 84% had no or mild complaints of hip/groin pain, 92% had returned to their prefracture ambulatory status, and 95% had returned to their performance function in activities of daily living. CONCLUSIONS: 1) Elderly patients with pubic rami fractures utilize substantial healthcare resources based upon length of stay and need for home care services; and 2) those patients who survive have a good prognosis with regard to long term pain relief and functional outcome.

Activities of Daily Living↗

The use of tretinoin as oral mucositis prophylaxis in bone marrow transplantation patients: a preliminary study.

OBJECTIVE: The examination of prophylactic efficacy of tretinoin on oral mucositis, post bone marrow transplantation (BMT). PATIENTS AND METHODS: The study population consisted of 11 patients undergoing BMT. Six tretinoin topically-treated patients (0.25 mg daily of 0.1% tretinoin cream) were matched with five non-treated control patients comparing mucositis severity, duration and analgetic (morphine) requirements. Concomitant follow-up included conditioning parameters associated with mucositis and engraftment. RESULTS: The mean of oral mucositis peak scores was significantly lower in the tretinoin-treated patients vs the non-treated patients (score 1.5 vs 3.6; P < 0.02). In the majority of cases the duration of the most severe phase of oral mucositis was shorter in the tretinoin-treated group as compared with the control. Only one patient in the experimental group required morphine analgesics compared with four patients in the control group. CONCLUSIONS: This preliminary study indicates that the severity of oral mucositis, both objective and subjective, in BMT patients may be reduced by 0.1% topical tretinoin cream, 0.25 mg, administered daily from the beginning of the BMT conditioning regimen until marrow engraftment.

Administration, Topical↗

Comparison of HPLC and enzymatic recycling assays for the measurement of oxidized glutathione in rat brain.

Glutathione (reduced, GSH and oxidized, GSSG) concentrations were analysed in rat cerebellar homogenate using high performance liquid chromatography with ultraviolet detection (HPLC-UV) or enzymatic recycling assays. GSSG levels found using the HPLC-UV assay were 200-fold higher than those obtained with the enzymatic recycling procedure. Reduction of synthetic GSSG by glutathione reductase showed total conversion to GSH as assessed by HPLC-UV analysis. In contrast, only approximately 50% of the HPLC peak for GSSG could be reduced by glutathione reductase. Increasing the period of incubation with glutathione reductase for longer than 15 min did not alter GSSG levels. These results suggest that another substance present in brain tissue is derivatized and eluted at the same time as GSSG using the HPLC-UV assay, thus contributing to the apparently high GSSG levels found employing this technique.

Animals↗

Karyotype 69,XXX/47,XX,+15 in a 2 1/2 year old child.

We present the clinical findings in a 2 1/2 year old girl with an unusual mosaic karyotype. Amniocentesis was performed at 35 weeks because of intrauterine growth retardation. The in situ cultures showed 47,XX,+15 in seven colonies, 69,XXX in four colonies, and in two colonies 46,XX was detected. Subcultures showed 69,XXX/47,XX,+15 with no normal cells. A small dysmorphic baby was born at term. Cytogenetic studies were performed on cord blood, amnion, and placental tissue immediately after birth and further studies on peripheral blood, bone marrow, muscle biopsy, and skin cultures at 1 1/2 years of age. FISH with two autosomal centromeric probes was performed on the peripheral blood sample. A normal cell line could not be seen in any postnatal tissue by either technique. The predominant cell line postnatally was 69,XXX. There were no cytogenetic polymorphisms and the parental origin of the different cell lines was not determined. Marked red cell macrocytosis of peripheral blood was noted on routine blood count. Bone marrow aspiration showed megaloblastic haemopoiesis without evidence of vitamin B12 or folate deficiency. At 2 1/2 years, the patient has significant developmental problems.

Abnormalities, Multiple↗

Late-life depression: how to make a difficult diagnosis.

Approximately 15% of persons age 65 and older have major depression. Risk factors include a recent loss (eg, widowhood or mastectomy), living alone, co-morbidities (eg, hypertension, stroke, cognitive deficits), and drug interactions. Warning signs of depression may include weight loss, sleep problems, feelings of guilt or worthlessness, loss of interest in sexual relations, or changes in activities of daily living. The diagnosis of depression is easy to miss if the physician doesn't look for it, because older persons often don't mention feeling depressed. Yet undetected depression can be deadly for older patients, who have the highest rate of suicide among all Americans. Plans for suicide may be direct or covert, as in not eating or not taking heart medication.

Age Distribution↗

Late-life depression: treatment strategies for primary care practice.

Most patients age 65 and older with symptoms of depression respond well to treatment. Choices of therapy include medications, electroconvulsive therapy (ECT), and psychotherapy. Every primary care physician should be comfortable with using at least two or three medicines from different drug classes. The likelihood of side effects depends on the antidepressant prescribed and other medications the patient might be taking. The combination of medication with psychotherapy appears more effective than one or the other alone. ECT is the treatment of choice when rapid results are needed (eg, if the patient is suicidal or losing weight quickly and in danger of a medical crisis). The physician/patient relationship can be a strong antidepressant.

Aged↗

Donor blood perfusion improves myocardial recovery after heart transplantation.

BACKGROUND: Improved methods of donor heart preservation may allow for prolonged storage and permit remote procurement. Previous attempts to use oxygenated perfusion circuits during storage have not gained widespread acceptance because they were either too impractical or complicated to use for remote harvest. We hypothesized that collection and perfusion of donor blood during prolonged storage may improve myocardial recovery. Our aim was to devise a safe, simple, cost-effective system that could be used in any hospital setting. METHODS: Yorkshire pigs (40 to 50 kg) were used to perform 16 orthotopic heart transplantations with either continuous perfusion with donor blood (BL, n = 8) or standard hypothermic storage (CON, n = 8). After administration of heparin, hypothermic (4 degrees C) cardioplegic arrest, and donor heart extraction, donor blood (2688 +/- 166 ml) was harvested in the BL group. After filtration for particulate matter, blood perfusion was initiated via a standard intravenous transfusion apparatus at room temperature (20 degrees C) and a pressure of 60 mm Hg and maintained during storage. Arterial and coronary sinus blood samples were obtained to examine myocardial oxygen extraction, lactate release, and acid production. A Millar micromanometer was used to measure left ventricular developed pressures at an end-diastolic pressure of 2 and 10 mm Hg both before and after transplantation. RESULTS: All pigs (eight of eight) in the BL group were successfully weaned off bypass compared to three of eight in the CON group (p < 0.01). Developed pressures (at left ventricular end-diastolic pressure = 10 mm Hg) was improved in the BL group (mean +/- SD: baseline: BL: 90 +/- 16 mm Hg vs CON: 83 +/- 12 mm Hg, p = NS; posttransplantation: BL: 66 +/- 8 mm Hg vs CON: 35 +/- 29 mm Hg, p < 0.05). Similarly, maximum dP/dt was higher in the BL group. Lactate release was higher at cross-clamp removal in the BL group (2.4 +/- 0.3 mmol/L vs 0.7 +/- 0.2 mmol/L, p < 0.01). There were no differences in oxygen extraction or acid production during reperfusion. CONCLUSIONS: Perfusion of donor blood improved the ability to wean off bypass after 4 hours of storage. Blood perfusion permitted persistent myocardial metabolism during the ischemic period, which led to improved functional recovery. Harvesting donor blood for subsequent perfusion during prolonged storage may improve the results of orthotopic heart transplantation and allow for more distant procurement of donor organs.

Animals↗

Immune dysfunction in uremia.

Among uremic patients on hemodialysis and continuous ambulatory peritoneal dialysis treatment infectious complications leading to a high incidence of morbidity and mortality are a well documented problem. Polymorphonuclear leukocytes (PMNLs) are the main cells of the unspecific defence system during bacterial infections. There is a number of partly interdependent factors responsible for the diminished PMNL functions (chemotaxis, phagocytosis, intracellular killing by proteolytic enzymes and toxic oxygen radicals) found in uremia: iron overload, elevated levels of intracellular calcium and hemodialysis treatment per se has been shown to be involved in altered PMNL functions. Uremic toxins are circulating plasma factors accumulating in the serum of uremic patients. They are thought to play a crucial role in inhibiting the unspecific immune defence. A number of uremic toxins has already been purified and characterized. In our laboratory, a granulocyte inhibiting protein (GIP) with homology to immunoglobulin light chains has been isolated. We could show that free immunoglobulin light chains per se are able to interfere with essential PMNL functions. A GIP with homology to beta 2-microglobulin was also isolated from dialysis patients. Angiogenin was purified from uremic patients as a PMNL degranulation inhibiting protein and complement factor D was shown to adversely affect PMNL functions. A modified form of ubiquitin isolated from peritoneal dialysis patients interferes with PMNL chemotaxis. Furthermore, p-cresol was identified as a uremic solute that impairs the respiratory burst activity of PMNL. There is also increased clinical evidence for profound defects in the specific immune defence in uremia, such as the high susceptibility to viral infections in uremic patients, the deficient responses of their T lymphocytes, and the significantly depressed specific antibody responses.

B-Lymphocytes↗

A peptide isolated from a patient on continuous ambulatory peritoneal dialysis has homology to ubiquitin and inhibits the chemotactic response of polymorphonuclear leukocytes.

Susceptibility to bacterial infections in the peritoneal cavity is a serious problem for peritoneal dialysis patients. Uremic toxins are among the causes of the diminished function of polymorphonuclear leuckocytes (PMNLs), cells of the local immune defense. We isolated from the peritoneal dialysis effluent of a uremic patient, a peptide that inhibits PMNL chemotaxis in a concentration-dependent manner. The amino terminus of this factor is identical to that of ubiquitin. The peptide shows the same size as ubiquitin on SDS-polyacrylamide gels, but has a more acidic isoelectric point than intact ubiquitin, which has no effect on PMNL chemotaxis. We conclude that we have isolated a modified form of ubiquitin and that this modification is responsible for its inhibiting effect on PMNL chemotaxis.

Chemotaxis, Leukocyte↗

Changing pattern of valve surgery.

BACKGROUND: Advances in surgical technique and perioperative myocardial protection have reduced the risk of aortic and mitral valve surgery. Improved methods of valve repair have reduced the proportion of patients who require valve replacement. However, patients who require valve replacement often have advanced disease and/or extensive calcification and may therefore be at increased risk for perioperative morbidity and mortality. METHODS AND RESULTS: We reviewed the results of 2898 patients who underwent aortic (AVR) or mitral (MVR) valve replacement at the Toronto Hospital. We compared patients who underwent surgery between January 1982 and December 1986 (early group) with those who were operated on between January 1989 and December 1993 (late group). The univariable and multivariable predictors of postoperative low-output syndrome (LOS) and operative mortality (OM) were determined for each time period. A total of 1779 patients underwent AVR (late, n = 997; early, n = 782). Multivariable analyses revealed that the late group had significantly more patients with independent pre-epidemiology operative risk factors for both OM and LOS. Despite the greater proportion of high risk patients, the incidence of postoperative LOS was lower in the late group (10% versus early, 14%; P = .012). There was no difference in OM between the two groups (late, 3.4% versus early, 3.7%; P = .732). A Total of 1119 patients underwent MVR (late, n = 493; early, n = 626). Compared with the early group, the late group had significantly more patients with preoperative multivariable risk factors for OM and LOS. There was no difference in postoperative LOS (late, 19% versus early, 21%; P = .361) or OM between the two groups (late, 5.8% versus early, 6.9%; P = .432). CONCLUSIONS: Despite an increase in high-risk patients, there was no significant increase in mortality or morbidity associated with aortic or mitral valve surgery.

Adult↗

The bacteriophage P1 lytic replicon: directionality of replication and cis-acting elements.

We have identified the direction of replication of a bacteriophage P1 lytic replicon. This was accomplished by constructing lambda P1 lysogens that contain a functional P1 lytic replicon and analysing which of two nearby bacterial DNA markers flanking the lambda prophage were amplified when that replicon was activated. We demonstrate that both DNA markers are coordinately amplified, a result consistent with lytic replication proceeding in a bidirectional fashion. To analyze the role of various elements comprising the lytic replicon, we assessed the ability of a wild type replicon to complement a defective replicon that contains a transposon inserted between an essential lytic replication gene (repL) and the promoter (P53) at which transcription of that gene is initiated. We show that the wild type replicon cannot complement the mutant replicon. The simplest hypothesis to explain this result is that either P53 or repL protein functions primarily in cis for the replicon to operate.

Bacteriophage P1↗