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Biomedical subjects

G Levy

Publications and source records attributed to G Levy.

At least 73 records · Page 4Linked to original sources

Murine hepatitis virus strain 3 induces the macrophage prothrombinase fgl-2 through p38 mitogen-activated protein kinase activation.

The clinical syndrome of acute liver failure produced by fulminant viral hepatitis can be reproduced in mice by infection with murine hepatitis virus strain 3 (MHV-3). Although it is clear that MHV-3-induced hepatitis depends upon macrophage activation and the expression of a specific prothrombinase, fgl-2, the signaling pathways involved in virally stimulated cell activation are unclear. Since we had previously found that MHV-3 induces the tyrosine phosphorylation of cellular proteins, we investigated the roles of the mitogen-activated protein kinase (MAPK) proteins. In a series of Western blots, immunoprecipitation and in vitro kinase assay studies, we found that both the extracellular signal-related kinase (ERK) and p38 MAPK proteins are tyrosine-phosphorylated and activated following exposure of murine peritoneal exudative macrophages (PEM) to MHV-3. Although p38 phosphorylation and activity are induced soon after MHV-3 exposure, peaking by 1-5 min, ERK phosphorylation and activity increase more gradually, peaking at 20-30 min and gradually fading thereafter. Interestingly, whereas selective p38 inhibition with SB203580 (1-20 microM) abolished the virally stimulated induction of fgl-2 mRNA, protein, and functional activity, selective ERK inhibition with PD98059 (1-50 microM) limited fgl-2 functional activity but had little to no effect on fgl-2 mRNA or protein levels. Moreover, whereas inhibition of ERK had no effect on p38 activity, p38 inhibition consistently increased MHV-3-induced ERK activity. To ensure that these pathways were relevant in vivo, MHV-3 was injected intraperitoneally, and peritoneal exudative macrophages were collected. Again, MHV-3 exposure led to increased p38 and ERK tyrosine phosphorylation. These data argue that MHV-3 induces tightly interconnected ERK and p38 MAPK cascades in the macrophage both in vitro and in vivo. Although the ERK and p38 MAPK proteins have discordant effects at the level of fgl-2 expression, both converge at the level of its activity, suggesting that targeted MAPK inhibition may ultimately be useful in the modulation of viral hepatitis.

Animals↗

Impact of pharmacodynamic variability on drug delivery(1).

Modern pharmaceutical delivery systems are intended to produce plasma drug concentration versus time profiles that result in optimum therapeutic efficacy and a minimum of drug concentration-dependent adverse effects. To accomplish this requires that the drug delivery rate and temporal profile be based on the pharmacokinetic and pharmacodynamic characteristics of the specific medicinal agent. Pharmacokinetic and pharmacodynamic parameters are subject to considerable interindividual variability. Whereas the importance of pharmacokinetic variability is generally recognized, the significance of pharmacodynamic variability (i.e., variability in the relationship between effect intensity and drug concentration) is not as widely appreciated. Pharmacodynamic variability is typically quite large, reproducible, and often substantially exceeds the relative magnitude of pharmacokinetic variability. This article consists of a review of how to assess pharmacodynamic variability, clinical examples of pharmacodynamic variability of drugs with a wide range of indications, and an outline of mechanisms of pharmacodynamic variability.

Journal Article↗

Ribavirin inhibits viral-induced macrophage production of TNF, IL-1, the procoagulant fgl2 prothrombinase and preserves Th1 cytokine production but inhibits Th2 cytokine response.

Ribavirin, a synthetic guanosine analogue, possesses a broad spectrum of activity against DNA and RNA viruses. It has been previously shown to attenuate the course of fulminant hepatitis in mice produced by murine hepatitis virus strain 3. We therefore studied the effects of ribavirin on murine hepatitis virus strain 3 replication, macrophage production of proinflammatory mediators including TNF, IL-1, and the procoagulant activity (PCA), fgl2 prothrombinase; and Th1/Th2 cytokine production. Although ribavirin had inhibitory effects on viral replication (<1 log), even at high concentrations complete eradication of the virus was not seen. In contrast, at physiologic concentrations (up to 500 microg/ml), ribavirin markedly reduced viral-induced parameters of macrophage activation. With ribavirin treatment, the concentrations of PCA, TNF-alpha and IL-1beta all decreased to basal concentrations: PCA from 941 +/- 80 to 34 +/- 11 mU/10(6) cells; TNF-alpha from 10.73 +/- 2.15 to 2.74 +/- 0.93 ng/ml; and IL-1beta from 155.91 +/- 22.62 to 5.74 +/- 0.70 pg/ml. The inhibitory effects of ribavirin were at the level of gene transcription as evidenced by Northern analysis. Both in vitro and in vivo, ribavirin inhibited the production of IL-4 by Th2 cells, whereas it did not diminish the production of IFN-gamma in Th1 cells. In contrast, ribavirin had no inhibitory effect on TNF-alpha and IL-1beta production in LPS-stimulated macrophages. These results suggest that the beneficial effects of ribavirin are mediated by inhibition of induction of macrophage proinflammatory cytokines and Th2 cytokines while preserving Th1 cytokines.

Animals↗

Diagnostic accuracy of serological assays in pediatric inflammatory bowel disease.

BACKGROUND & AIMS: Accurate serological assays are desirable for the diagnosis of inflammatory bowel disease (IBD) types in the pediatric age group. The aim of this study was to test the diagnostic accuracy of modified assays for perinuclear (p) antineutrophil cytoplasmic antibodies (ANCAs) and anti-Saccharomyces cerevisiae antibodies (ASCAs) in patients with pediatric ulcerative colitis (UC) and Crohn's disease (CD) and in those without IBD. METHODS: With observers blinded to patients' diagnoses, serum specimens were analyzed for immunoglobulin (Ig) A and IgG ASCAs and ANCAs by enzyme-linked immunosorbent assay. The perinuclear location of ANCAs visualized by indirect immunofluorescence was confirmed by its disappearance after administration of deoxyribonuclease. RESULTS: IgA and IgG ASCA titers were significantly greater and highly specific for CD (95% for either, 100% if both positive). pANCA was 92% specific for UC and absent in all non-IBD controls. The majority of patients with CD positive for pANCA had a UC-like presentation. Disease location, duration, activity, complications, and treatment with immunosuppressive drugs did not have an impact on the ASCA or pANCA assay results. After resection, UC patients remained pANCA positive, in contrast to patients with CD, in whom ASCA titers decreased toward normal values postoperatively. CONCLUSIONS: ASCA and pANCA assays are highly disease specific for CD and UC, respectively. These serological tests can assist clinicians in diagnosing and categorizing patients with IBD and may be useful in making therapeutic decisions.

Adolescent↗

Cutting efficiency of a mid-infrared laser on human enamel.

In this study, the cutting ability of a newly developed dental laser was compared with a dental high-speed handpiece and rotary bur for removal of enamel. Measurements of the volume of tissue removed, energy emitted, and time of exposure were used to quantify the ablation rate (rate of tissue removal) for each test group and compared. Cutting efficiency (mm3/s) of the laser was calculated based on the mean volume of tissue removed per pulse (mm3/pulse) and unit energy expended (mm3/J) over the range of applied powers (2, 4, 6, and 8 W). The specimens were then examined by light microscopy and scanning electron micrographs for qualitative analysis of the amount of remaining debris and the presence of the smear layer on the prepared enamel surface. Calculations of the cutting efficiency of the laser over the range of powers tested revealed a linear relationship with the level of applied power. The maximum average rate of tissue removal by the laser was 0.256 mm3/s at 8 W, compared with 0.945 mm3/s by the dental handpiece. Light microscopy and scanning electron micrograph examinations revealed a reduction in the amount of remaining debris and smear layer in the laser-prepared enamel surfaces, compared with the conventional method. Based on the results of this study, the cutting efficiency of the high-speed handpiece and dental bur was 3.7 times greater than the laser over the range of powers tested, but the laser appeared to create a cleaner enamel surface with minimal thermal damage. Further modifications of the laser system are suggested for improvement of laser cutting efficiency.

Dental Cavity Preparation↗

[Infectious endocarditis on permanent endocavitary stimulation leads: apropos of 2 cases].

BACKGROUND: Permanent endocavitary pacemaker lead infectious endocarditis is rare. Two new cases are reported. CASE REPORTS: The first case appeared in a 63-year-old white woman with a permanent endocavitary pacemaker for 3 years. It was caused by Streptococcus bovis, unique to this pathology. The second case was caused by Streptococcus epidermidis in a diabetic 72-year-old woman. In these two cases, the clues to the diagnosis were hemocultures and transesophageal echocardiography. CONCLUSION: These two cases emphasize the importance of transesophageal echocardiography (TEE) for diagnosis and for driving treatment. Treatment is based on appropriate antibiotics and pacemaker removal. In the second, case, the material was surgically removed under cardiopulmonary bypass because of the size of the infection.

Aged↗

-Anesthesia and analgesia practice patterns in French obstetrical patients-.

OBJECTIVE: To assess the rate of epidural analgesia (EA) for parturition and the techniques of anaesthesia for Caesarean section (CS). STUDY DESIGN: Retrospective study. PATIENTS: A series of 84,235 deliveries. METHODS: The series was extracted from a total of 770,054 deliveries carried out in 1991, according to the number of births in each hospital (1/1 if the births were < or = 100 per year, up to 1/25 if they were > or = 2,000 per year). The data analyzed included: anaesthesia technique, whether or not there was an anaesthetist on night duty at the hospital, birth rate in the hospital, type of hospital: university (UH), general (GH) or private (PH). For vaginal deliveries, the mode of labour commencement (spontaneous or induced), the multiplicity of pregnancies and a history of past CS were also noted. RESULTS: Vaginal deliveries: the overall rate of EA was 37.2%. EA were not carried out in 5% of maternity hospitals. In cases of spontaneous labour, the average rate was 32.1%, significantly less than for induced labour (59.6%, P < 0.0001) and in cases of previous CS (39%, P < 0.05). There was no statistical difference in cases of multiple pregnancies (35.7%). The average rate of EA was correlated to the number of annual births (P < 0.001) and was increased when the anaesthetist was present in hospital at night (P < 0.001). It was also significantly lower in GH (P < 0.001) than in UH or PH, which were equivalent. Scheduled CS: general anaesthesia (GA) was carried out at a significantly higher rate than regional anaesthesia (RA) (49.7% vs 48.4%, P < 0.05). In 15.1% of hospitals, RA was not available. The incidence of RA was influenced neither by the rate of annual births nor by the presence of the anaesthetist in the hospital during night. However, RA was significantly less frequent in GH (46.3%, P < 0.001) than in UH (48.6%) and in PH (53.6%) which were equivalent. CS during labour: the incidence of RA was significantly higher than GA (53.2% vs 44.1%, P < 0.001). In 17.1% of hospitals, RA was never carried out. The rate of RA was correlated to the size of the maternity hospital, and significantly higher (P < 0.001) when the anaesthetist was present in hospital during night. The differences between UH, GH and EP were the same than for scheduled CS. CONCLUSION: In France in 1991, the average rate of 37.2% for EA for obstetrics was high when compared to the rate in United Kingdom. It was equivalent to those in United States and Ontario, Canada. The discrepancies between hospitals were mainly related to structural and organizational factors. The influence of the size of the maternity hospital, the 24-hour service of EA was also shown in other studies. However, the difference between GA and UH and PH is a French particularity. The high rate of GA for CS differs largely with those in the UK or the USA. The time saving aspect of GA was probably an important factor for the choice of this technique. This study must be reactualized and enlarged to determine the demand of EA for labour by parturients and obstetricians.

Analgesia, Epidural↗

Short-term itraconazole versus terbinafine in the treatment of tinea pedis or manus.

A total of 304 patients with a clinical diagnosis of palmar-type tinea pedis or manus and a positive mycologic examination were recruited into this double-blind, randomized, multicenter, phase III study. Patients were randomized to receive either oral itraconazole 200 mg twice daily (in the morning and evening) for 7 days, followed by placebo for 7 days (n = 153), or placebo in the morning and oral terbinafine 250 mg in the evening for 14 days (n = 151). At the first visit and 1, 2, and 6 weeks after the start of the study, signs and symptoms were assessed clinically, and scales were taken for mycologic assessments (microscopy and culture). At weeks 1, 2, and 6, the effectiveness of therapy was evaluated globally and given a rating of healed (absence of signs and symptoms), marked improvement (> or = 50% clinical improvement), considerable residual lesions (< 50% clinical improvement), no change, or worsened. The primary efficacy parameter was the mycologic cure rate at the follow-up end-point (week 6). The tolerability of the study medications was assessed at weeks 1 and 2. Adverse events were recorded at weeks 1, 2, and 6. Routine hematologic and biochemical tests were performed at the start of the study and after 1 week of treatment. No significant differences were seen in the baseline patient characteristics between the two groups. The rate of mycologic cure (negative microscopy and culture test result) was 79% in the itraconazole group and 80% in the terbinafine group at the follow-up end-point. The analysis of the 90% confidence interval for the difference between the treatment groups (-7.1, 5.4) and the outcome of the Blackwelder test (for two one-sided tests, P = 0.013 and P = 0.029) showed the two treatments to be equivalent. The results of the global evaluations of the efficacy in the two treatment groups are shown in Table 1. The rate of clinical response (healed or markedly improved) was 93% in the itraconazole group and 91% in the terbinafine group at the follow-up end-point. The analysis of the 90% confidence interval for the difference between the two groups (-2.5, 5.7) and the outcome of the Blackwelder test (for two one-sided tests, P = 0.004 and P < 0.001) showed the two treatments to be equivalent. The severity of the clinical signs and symptoms decreased from the baseline to the treatment end-point and from the treatment end-point to the follow-up end-point in both groups. At the double-blind treatment period end-point (week 2), the tolerability of the study medication was rated as very good or good in more than 97% of patients. During treatment, 21 of 153 patients (14%) in the itraconazole group and 28 of 151 patients (19%) in the terbinafine group reported adverse events. During follow-up, one patient in the itraconazole group and two in the terbinafine group reported adverse events. The most frequent events were headache, abdominal pain, nausea, vomiting, and hypertriglyceridemia. Two patients in the itraconazole group and four in the terbinafine group withdrew because of adverse events. Severe adverse events were reported by one patient in the itraconazole group and five in the terbinafine group. Serious adverse events were reported by two patients in the terbinafine group, although these were probably not drug related. No clinically relevant changes in laboratory variables were observed.

Antifungal Agents↗

Predicting effective drug concentrations for individual patients. Determinants of pharmacodynamic variability.

Variability in the relationship between pharmacological effect intensity and drug concentration (pharmacodynamics) is pronounced, usually exceeding pharmacokinetic variability. Whereas interindividual differences are large, intra-individual differences are much smaller, unless the individual experiences certain pathophysiological changes such as deterioration of renal function or progression of a chronic disease (for example, Parkinson's disease). Failure to appreciate the magnitude of interindividual variability in the pharmacodynamics of a drug can compromise fixed dose clinical trial outcomes, making the drug appear less effective or more toxic. In the face of pharmacodynamic variability it becomes important to identify useful predictors (covariates) of pharmacodynamic individuality to facilitate individually optimised pharmacotherapy. This requires clinical trial designs that incorporate extensive patient profiling, well beyond the usual short list of demographics (such as age, gender, race, bodyweight and smoking habits). In searching for predictors, it is helpful to appreciate the factors that may account for interindividual differences in the relationship between pharmacological effect intensity and drug concentration in plasma or other appropriate fluid. They include receptor density and affinity, the formation and elimination kinetics of endogenous ligands (such as the enkephalins), postreceptor transduction processes, homeostatic responses and the kinetic characteristics of transporters involved in drug transfer between fluids of distribution and the biophase. Correction of drug concentrations in plasma for protein binding, consideration of active and interactive metabolites, stereospecific assays and attention to drug distribution disequilibria are essential for successful identification of factors affecting pharmacodynamic variability. Pharmaceutical delivery systems (the 'hardware') must be combined with guidance for individualising drug dosage (the 'software' or user's manual) to provide for optimal and cost-effective pharmacotherapy.

Analysis of Variance↗

Color flow-directed Doppler studies of ovarian masses. Computer analysis.

OBJECTIVE: To determine if analyzing the entire color Doppler image (CDI) pulse wave of an ovarian mass can improve the ability to predict its histopathology. STUDY DESIGN: The CDI of 42 histopathologically diagnosed adnexal masses were retrospectively analyzed. Using an image analysis software program, the following parameters were calculated: area under the curve, compactness, Feret diameter, perimeter, shape factor and width of the waveform. Using an automated curve-fitting software program, the up and down slopes were processed separately for the optimal equation and coefficient for each slope. Two computerized neural networks were created, both consisting of an input layer, one hidden layer and an output layer of three neurons: benign, borderline and malignant. The first network contained two input neurons: pulsatility index (PI) and resistance index (RI). The second network contained 10 input neurons consistent with the shape and slope parameters calculated. The coefficient of determination (R2) was determined for each network. RESULTS: The neural network utilizing RI and PI failed to train (1,397 runs, 67,056 facts, R2 = 0.59, 0.12 and 0.43 for benign, borderline and malignant masses, respectively). The network using the 10 calculated parameters achieved an R2 of 0.96 after 685 runs and 27 facts. CONCLUSION: Analyzing the CDI studies of ovarian masses, using the entire pulse wave, improved the ability to differentiate between their benign, borderline and malignant histopathology.

Diagnosis, Differential↗

[Diagnosis of post-operative venous thrombosis using determination of plasma D-dimer].

PURPOSE: The D-Dimer test has been shown to be highly sensitive for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism. Two automatic quantitative tests giving a rapid response within 10 and 30 minutes have been recently marketed. In the postsurgery situation however, the role of the D-Dimer test remains controversial and the optimal cutoff value remains open. The aim of this study was to determine the cutoff value during the postoperative period. PATIENTS AND METHODS: One hundred three consecutive patients admitted to surgery were included. In all patients, D-Dimer test was performed every 2 or 4 days from admission to hospital discharge. The Vidas D-Dimer (Biomerieux, Marcy l'Etoile, France) and the STA Liatest D-DI (Diagnostica Stago, Asnières, France) were performed in parallel in all cases. RESULTS: Thirty-five patients were excluded because the follow-up period was too short. Results suggest that a D-Dimer value below 2 micrograms/ml has a negative predictive value of 100%. A D-Dimer value over 4 micrograms/ml would indicate suspected deep vein thrombosis in half of the cases, even without clinical signs. Dividing the patients into three groups according to the D-Dimer value, the two tests correlated poorly (r = 0.36 and 0.57) in the middle group (between 2 and 3 and between 3 and 4) and correctly for values below 2 or over 4 micrograms/ml (r = 0.83 and 0.78 respectively). CONCLUSION: These two optimum cutoff values (< 2 micrograms/ml and > 4 micrograms/ml) are useful for determining the need for further explorations for DVT. By limiting need for ultrasonography and contrast venography, the cost-efficacy ratio for the detection of DVT during the postoperative period is greatly improved with the D-Dimer screening strategy.

Fibrin Fibrinogen Degradation Products↗

Transverse vaginal septum: case report and review of the literature.

A case of perforated complete transverse vaginal septum in the upper third of the vagina in a patient presenting at 19 years of age for evaluation of primary infertility. Diagnosis was made by hysterosalpingography. The patient was treated surgically and conceived 2 months after the procedure. The finding of transverse vaginal septum in an asymptomatic infertility patient is highly unusual. We reviewed the literature since 1966 and summarized 73 cases. The review confirms the benign characteristics of this rare anomaly and supports the embryonic origin of the transverse septum from the vaginal plate.

Adult↗

Laparoscopic douglasectomy in the treatment of painful uterine retroversion.

BACKGROUND: One of the etiologies of pelvic pain in women, often unrecognized, is the Masters-Allen syndrome, which was described in 1955 as the "universal joint cervix" syndrome. It has the following three elements: (1) etiology: obstetrics-related trauma; (2) clinical findings: uterine retroversion with hypermobile cervix following elongation or desinsertion of the uterosacral ligaments; (3) anatomy: visualization of a tearing of the posterior serosa and subperitoneal fascia of the ligamentum latum. METHODS: Forty-one laparoscopic Douglasectomies with uterosacral ligamentopexy were performed in the department of Gynecology at the University Hospital of Caen during the period between 1990 and 1995 in patients with painful retroverted uterus. The patient selection was made thanks to the "pessary test." The surgical endoscopic procedure, identical to the operation first promoted by Jamain and Letessier in 1976 by laparotomy, is described. RESULTS: Total pain relief was experienced by 31 patients (75%) and partial relief by five patients (5%). Two main complications occurred, requiring one laparotomy (bleeding from a pelvic varicose vein with a concomitantly occurring breakdown of the washing-aspiration system) and one second laparoscopy at day 15 (one case of hematoma below the peritonization revealed by pain). Twenty-three women became pregnant again, and had normal deliveries except for two cesareans, with no recurrence of pain. Douglasectomy is compared to alternative techniques in the literature. Other indications for Douglasectomy are discussed. CONCLUSION: Douglasectomy is the only definitive procedure for restoring normal anatomy of the pelvic floor in case of painful uterine retroversion occurring in a setting of Masters-Allen syndrome. Additionally, it provides for pathological analysis of the excised peritoneum. The results of this procedure are excellent when the indication is correctly set, particularly as concerns positive pessary testing.

Adult↗

Subordinate appraisal of managers: "testing the theory".

Identifies the qualities of "ideal" line manager as perceived by three groups of professionals allied to medicine. Makes explicit the research methodology used to gather data, and reports the findings. Surveys three groups of professionals allied to medicine (PAM), namely, speech therapists, social workers (child health and adult physical health) and clinical psychologists. Offers an analysis of the data and draws some conclusions. Concludes with a reflection on the significance of the findings.

Allied Health Personnel↗

Subordinate appraisal of managers: a useful tool for the NHS.

Problems in recruiting and retaining professional staff are an ongoing concern to many NHS Trusts and professional heads of service. There is evidence from a wide variety of sources that direct line managers are frequently cited as a source of worker's stress and a cause of staff turnover. Reviews these issues and suggests subordinate appraisal of managers as one possible response.

Employee Performance Appraisal↗