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Biomedical subjects

J Greenberg

Publications and source records attributed to J Greenberg.

At least 55 records · Page 3Linked to original sources

A photoreceptor gene mutation in an indigenous black African family with retinitis pigmentosa identified using a rapid screening approach for common rhodopsin mutations.

Hereditary retinal degenerations may be subdivided into those affecting predominantly the central (macular) or peripheral regions of the retina. Retinitis pigmentosa (RP) affects the photoreceptors; death of the rod cells is followed by a progressive loss of cone cells, resulting in relatively early loss of peripheral vision and progressive constriction of the visual fields. A mutation in the gene encoding the photoreceptor protein, rhodopsin, was the first molecular defect identified as a potential cause of inherited retinal degeneration (RD). In the study reported here, simple tests for rhodopsin involvement in 194 southern African patients with a history of retinal degeneration, including 14 black African patients, were performed. Two RP patients were identified with disease-causing mutations in the rhodopsin gene: one from a black African family in which a codon 347 mutation resulted in a Pro-Leu substitution, and one in a family of Caucasian origin where a codon 58 alteration resulted in a Thr-Arg substitution. This is the first report of a disease-causing rhodopsin mutation in an indigenous black African family with retinitis pigmentosa.

Black People↗

Cognitive, neuroimaging, and pathological studies in a patient with Pick's disease.

We conducted cognitive, imaging, and neuropathological studies on a patient with Pick's disease. The patient was impaired at interpreting sentences with complex grammatical constructions, differing significantly from control subjects and patients with Alzheimer's disease (AD). Evaluation of regional brain functioning at rest, with positron emission tomography, revealed reduced left frontal activity compared with control subjects and AD patients. Autopsy demonstrated the classic pathology of Pick's disease, including massive neuron loss and gliosis in the frontal and cingulate cortex as well as numerous tau-positive hippocampal Pick bodies. The abnormal tau proteins were phosphorylated at the same amino acid residues as AD paired helical filament tau (PHFtau), but they exhibited a unique migration profile on western blot. Our observations support the hypothesis that a distinct variety of hyperphosphorylated tau in Pick's disease compromises the long-term viability of selectively vulnerable populations of neurons in frontal cortices that contribute to sentence processing.

Aged↗

Correlation between Waardenburg syndrome phenotype and genotype in a population of individuals with identified PAX3 mutations.

Waardenburg syndrome (WS) type 1 is an autosomal dominant disorder characterized by sensorineural hearing loss, pigmentary abnormalities of the eye, hair, and skin, and dystopia canthorum. The phenotype is variable and affected individuals may exhibit only one or a combination of several of the associated features. To assess the relationship between phenotype and gene defect, clinical and genotype data on 48 families (271 WS individuals) collected by members of the Waardenburg Consortium were pooled. Forty-two unique mutations in the PAX3 gene, previously identified in these families, were grouped in five mutation categories: amino acid (AA) substitution in the paired domain, AA substitution in the homeodomain, deletion of the Ser-Thr-Pro-rich region, deletion of the homeodomain and the Ser-Thr-Pro-rich region, and deletion of the entire gene. These mutation classes are based on the structure of the PAX3 gene and were chosen to group mutations predicted to have similar defects in the gene product. Association between mutation class and the presence of hearing loss, eye pigment abnormality, skin hypopigmentation, or white forelock was evaluated using generalized estimating equations, which allowed for incorporation of a correlation structure that accounts for potential similarity among members of the same family. Odds for the presence of eye pigment abnormality, white forelock, and skin hypopigmentation were 2, 8, and 5 times greater, respectively, for individuals with deletions of the homeodomain and the Pro-Ser-Thr-rich region compared to individuals with an AA substitution in the homeodomain. Odds ratios that differ significantly from 1.0 for these traits may indicate that the gene products resulting from different classes of mutations act differently in the expression of WS. Although a suggestive association was detected for hearing loss with an odds ratio of 2.6 for AA substitution in the paired domain compared with AA substitution in the homeodomain, this odds ratio did not differ significantly from 1.0.

DNA-Binding Proteins↗

Appearance of birdshot retinochoroidopathy in a patient with myelodysplasia syndrome.

PURPOSE: To report the appearance of birdshot retinochoroidopathy in a patient with myelodysplasia syndrome. METHOD: Case report of a healthy 62-year-old woman who was fortuitously noted to have multiple atrophic spots in the posterior choroid and retina of each eye. RESULT: Subsequent medical evaluation included a blood cell count that disclosed pancytopenia, with a diagnosis of myelodysplasia made on bone marrow examination. CONCLUSION: An autoimmune response associated with the underlying myelodysplasia may be responsible for the appearance of atrophic retinal and choroidal lesions resembling birdshot retinochoroidopathy.

Chorioretinitis↗

Terror management and aggression: evidence that mortality salience motivates aggression against worldview-threatening others.

The hypothesis that mortality salience (MS) motivates aggression against worldview-threatening others was tested in 4 studies. In Study 1, the experimenters induced participants to write about either their own death or a control topic, presented them with a target who either disparaged their political views or did not, and gave them the opportunity to choose the amount of hot sauce the target would have to consume. As predicted, MS participants allocated a particularly large amount of hot sauce to the worldview-threatening target. In Studies 2 and 3, the authors found that following MS induction, the opportunity to express a negative attitude toward the critical target eliminated aggression and the opportunity to aggress against the target eliminated derogation. This suggests that derogation and aggression are two alternative modes of responding to MS that serve the same psychological function. Finally, Study 4 showed that MS did not encourage aggression against a person who allocated unpleasant juice to the participant, supporting the specificity of MS-induced aggression to worldview-threatening others.

Adult↗

Surgery for cervical myelopathy in geriatric patients.

OBJECTIVE: The number of geriatric patients seeking surgical treatment for cervical myelopathy is steadily increasing. Although anecdotal experiences have been good, insufficient data exists in the spine literature concerning this particular group. We decided to review our experience to determine efficacy of surgical management and examine our morbidity with this select group. METHODS: We undertook a retrospective review of all surgical procedures for nontraumatic cervical myelopathy performed at Mt Sinai Medical Center and Jackson Memorial Medical Center between January 1 1987 and June 1 1992, in patients older than 70 years of age (33 men and 18 women). RESULTS: A total of 53 cervical surgical procedures were performed in 51 patients (nine expansile laminoplasties, 20 anterior cervical diskectomies and fusion and 24 decompressive posterior laminectomies). The average hospital stay was 7.7 +/- 3.4 days. Twenty-one (41%) patients required inpatient rehabilitation; the remaining 30 patients received outpatient rehabilitative therapy. The major morbidity rate was 3.9%, and the minor morbidity rate was 5.8%. Perioperative medical complications included cardiac arrhythmias, hypertensive episodes, atelectasis, confusion, urinary dysfunction and hyponatremia. All of these complications resolved except in one patient. The perioperative mortality rate was 2%. Office follow-up was performed for a mean of 11.1 +/- 2.5 months postoperatively. Comparison of preoperative and postoperative functional status was performed using Nurick's criteria as described in the literature. At follow-up, 60.8% of the patients had improvement in their myelopathic symptoms, especially in regard to gait; 33.3% were stabilized and 5.9% had worsened neurological function. CONCLUSION: This study demonstrates that corrective surgical procedures for significant nontraumatic cervical myelopathy in the geriatric population may be performed safely, that is, with acceptable risk of morbidity and reasonable expectation for clinical improvement.

Aged↗

Preventing HIV infection: the effects of community linkages, time, and money on recruiting and retaining women in intervention groups.

Few studies have addressed recruitment and retention of participants in preventive interventions directed at human immunodeficiency virus (HIV), and these generally have not focused on women. In this study, part of the Women in Group Support (WINGS) project, we examine the experience of three sites in recruiting 444 high-risk women for a small group intervention to reduce risky sexual behavior. The intervention included six structured sessions, followed by a continuing series of client-focused, drop-in sessions. Incentives for participants included child care, food, and transportation tokens. Attendees at each structured session also received a cash incentive of $10-$20. Forty-six percent of the women were recruited from community sources, 35% from clinics, and 19% from drug programs. Across all recruitment sources, almost a third of the women reported having had a sexually transmitted disease (STD) in the past year, 88%-94% reported a risky male partner (who, they believed, had sex with other partners or with sex workers, was an injecting drug user, or was HIV positive), and 10%-36% reported trading sex for money or drugs. During 18 months of recruitment, each site averaged 34 screening interviews monthly to secure 8 eligible women a month who completed baseline interviews and reported for randomization. The average number of paid sessions attended by participants was five of six (83%). Average attendance at unpaid sessions was 1 of 12 (8%). Key facilitators to recruitment and retention included linkages with community agencies and monetary incentives. Our findings suggest that researchers and community service providers need to explore alternative strategies to paying women for attending group sessions (e.g., incorporating group interventions into existing program requirements) and balance these against the costs and recruitment effectiveness.

Adolescent↗

Terror management and meaning: evidence that the opportunity to defend the worldview in response to mortality salience increases the meaningfulness of life in the mildly depressed.

Previous terror management research has demonstrated that mildly depressed participants show a greater increase in worldview defense in response to reminders of their mortality than do nondepressed participants. Because the cultural worldview is posited to provide a meaningful conception of life, we hypothesized that mildly depressed participants who defend their worldview in response to mortality salience (MS) would increase their perception that the world is meaningful. A preliminary study first examined the Kunzendorf No Meaning Scale as a measure to assess perceptions of meaning. In the primary study, mildly depressed and nondepressed participants contemplated their own mortality or a neutral topic, evaluated two targets in a manner that either allowed them to defend their worldview or that did not, and then completed the Kunzendorf No Meaning Scale. As predicted, mildly depressed participants who had the opportunity to defend their worldview in response to mortality salience reported greater meaning in life than did mildly depressed participants who did not have the opportunity to defend their worldview, or mildly depressed participants not exposed to mortality salience. Implications for understanding and treating depression are briefly discussed.

Adult↗

Circumflex coronary artery dissection following waterskiing.

A previously healthy 35-year-old woman experienced chest discomfort following mild blunt chest trauma while waterskiing. During the following 48 h, she underwent evaluation in two separate emergency departments (EDs) where she was found to have normal ECGs and cardiac enzyme values. She was subsequently discharged from both EDs. Twelve hours after the second ED visit, she was discovered unconscious at home and was resuscitated from ventricular fibrillation. Emergency cardiac catheterization demonstrated moderate circumflex disease without angiographic evidence of a false lumen or intimal flap. Left ventriculography demonstrated posterolateral wall hypokinesis. Eight days after remaining ventilator-dependent and unconscious, the patient was declared brain-dead. At autopsy, the patient was found to have a dissection of the circumflex artery. Waterskiing is an unusual source of cardiac trauma; however, we believe this to be the first reported case of dissection in the circumflex artery following blunt chest trauma.

Adult↗

Sorsby fundus dystrophy: reevaluation of variable expressivity in patients carrying a TIMP3 founder mutation.

Interfamilial phenotypic variations in Sorsby fundus dystrophy (SFD) have given rise to controversy as to whether SFD constitutes more than 1 nosologic entity. The recent identification of the tissue inhibitor of metalloproteinases-3 (TIMP3) as the gene causing SFD has made it possible to readdress the question of genetic and clinical heterogeneity. In this study, we have extended previous findings on a Ser181Cys founder mutation in SFD families from the British Isles and show that carriers of this mutation residing in Canada, the United States, and South Africa likewise are descendants of the British ancestor. In addition, we have reevaluated the question of variable SFD phenotypes by analyzing the available clinical data on carriers of the Ser181Cys mutation.

Adolescent↗

Retinitis pigmentosa locus on 17q (RP17): fine localization to 17q22 and exclusion of the PDEG and TIMP2 genes.

This group has previously reported the mapping of a novel locus for autosomal dominant retinitis pigmentosa (adRP) in a South African kindred to 17q. Using a new series of microsatellite markers in this study, twopoint and multipoint analysis provide evidence for the localization of the disease gene to the 17q22 region. In addition, a second South African adRP family is shown to be linked to this 17q22 locus. Disease-associated haplotypes constructed for both families and multipoint linkage analysis place the gene in the 10-cM interval between D17S1607 and D17S1874. Three candidate genes on 17q were investigated: PDEG, the gamma subunit of rod phosphodiesterase; TIMP2, tissue inhibitor of metalloproteinases-2; and PRKCA, protein kinase C alpha. Recombination events between the adRP locus and: (1) a single-stranded conformation polymorphism in PDEG; and (2) a restriction fragment length polymorphism in TIMP2 provided evidence for the exclusion of these candidate genes as being responsible for adRP in the South African kindred.

3',5'-Cyclic-GMP Phosphodiesterases↗

Terror management theory and self-esteem: evidence that increased self-esteem reduces mortality salience effects.

On the basis of the terror management theory proposition that self-esteem provides protection against concerns about mortality, it was hypothesized that self-esteem would reduce the worldview defense produced by mortality salience (MS). The results of Experiments 1 and 2 confirmed this hypothesis by showing that individuals with high self-esteem (manipulated in Experiment 1; dispositional in Experiment 2) did not respond to MS with increased worldview defense, whereas individuals with moderate self-esteem did. The results of Experiment 3 suggested that the effects of the first 2 experiments may have occurred because high self-esteem facilitates the suppression of death constructs following MS.

Analysis of Variance↗

Terror management and cognitive-experiential self-theory: evidence that terror management occurs in the experiential system.

The authors hypothesized, on the basis of terror management theory and cognitive-experiential self-theory, that participants in an experiential mode of thinking would respond to mortality salience with increased worldview defense and increased accessibility of death-related thoughts, whereas participants in a rational mode would not. Results from 3 studies provided convergent evidence that when participants were in an experiential mode, mortality salience produced the typical worldview defense effect, but when participants were in a rational mode it did not. Study 4 revealed that mortality salience also led to a delayed increase in the accessibility of death-related thoughts only when participants were in an experiential mode. These results supported the notion that worldwide defense is intensified only if individuals are in an experiential mode when considering their mortality. Discussion focuses on implications for understanding terror management processes.

Adaptation, Psychological↗

Suppression, accessibility of death-related thoughts, and cultural worldview defense: exploring the psychodynamics of terror management.

Previous research has shown that after a mortality-salience (MS) treatment, death thought accessibility and worldview defense are initially low and then increase after a delay, suggesting that a person's initial response to conscious thoughts of mortality is to actively suppress death thoughts. If so, then high cognitive load, by disrupting suppression efforts, should lead to immediate increases in death thought accessibility and cultural worldview defense. Studies 1 and 2 supported this reasoning. Specifically, Study 1 replicated the delayed increase in death accessibility after MS among low cognitive load participants but showed a reversed pattern among participants under high cognitive load. Study 2 showed that, unlike low cognitive load participants, high cognitive load participants exhibited immediate increase in pro-American bias after MS. Study 3 demonstrated that worldview defense in response to MS reduces the delayed increase in death accessibility. Implications of these findings for understanding both terror management processes and psychological defense in general are discussed.

Affect↗

HIV-seropositive men who engage in high-risk sexual behaviour: psychological characteristics and implications for prevention.

A minority of people who test HIV seropositive continue to engage in sexual behaviour that places their partners at high risk for HIV infection. However, little is known about factors that contribute to sexual risk behaviour among. HIV-seropositive men. In this study, HIV-seropositive men participating in substance abuse support groups and HIV prevention programmes (n = 223) completed measures of demographic characteristics, sexual behaviour history, sensation-seeking (the propensity to seek optimal stimulation), and sexual compulsivity (persistent sexual preoccupations). Twenty-six per cent of the sample reported having recent multiple unprotected sexual intercourse partners. Across support group and prevention programme participants, men with multiple unprotected partners reported greater sexual compulsivity than men with one or no unprotected partners, but groups did not differ in terms of sensation-seeking. Results suggest that intensive therapeutic interventions are needed for a relatively small number of people who may contribute significantly to the HIV epidemic.

Adult↗

Planned early neck dissection before radiation for persistent neck nodes after induction chemotherapy.

Optimal management of advanced neck metastases as part of an organ preservation treatment approach for head and neck squamous carcinoma (HNSC) is unclear. Since 1989, our management paradigm for patients on organ preservation was modified to incorporate planned early neck dissection before radiation therapy for patients who did not achieve a complete response (CR) of neck nodes after induction chemotherapy (IC). The purpose of this study was to determine if planned early neck dissection is a safe and effective approach in the management of advanced nodal disease as part of organ preservation. Fifty-eight consecutive patients with advanced HNSC who were entered in organ preservation trials using induction chemotherapy and radiation with surgical salvage were studied. Median follow-up was 26 months. Of the 58 patients, 71% were stage IV. Patients were grouped by nodal response to chemotherapy and N class, and were analyzed with respect to patterns of recurrence, complications, and survival. Overall, the rate of CR of neck nodes was 49%. Fifty-one percent had less than a complete response of neck nodes after IC and required planned early neck dissection. There were no significant differences in patterns of recurrence, complications, interval time to start of radiation, recurrence, or survival rates between the CR and less than CR groups. These data suggest that planned early neck dissection for patients with less than CR in the neck after IC is not detrimental with respect to neck relapse or overall survival. We believe that planned early neck dissection can be safely incorporated into future organ preservation treatment protocols for patients with advanced head and neck carcinoma.

Adult↗

Familial streptomycin ototoxicity in a South African family: a mitochondrial disorder.

The vestibular and ototoxic effects of the aminoglycoside antibiotics (streptomycin, gentamycin, kanamycin, tobramycin, neomycin) are well known; streptomycin, in particular, has been found to cause irreversible, profound, high frequency sensorineural deafness in hypersensitive persons. Aminoglycoside ototoxicity occurs both sporadically and within families and has been associated with a mitochondrial DNA (mtDNA) 1555A to G point mutation in the 12S ribosomal RNA gene. We report on the molecular analysis of a South African family with streptomycin induced sensorineural deafness in which we have found transmission of this same predisposing mutation. It is now possible to identify people who are at risk of hearing loss if treated with aminoglycosides in the future and to counsel them accordingly. In view of the fact that aminoglycoside antibiotics remain in widespread use for the treatment of infections, in particular for tuberculosis, which is currently of epidemic proportions in South Africa, this finding has important implications for the family concerned. In addition, other South African families may potentially be at risk if they carry the same mutation.

Anti-Bacterial Agents↗