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Biomedical subjects

J L Young

Publications and source records attributed to J L Young.

At least 37 records · Page 2Linked to original sources
PubMed1998

A retrospective review of the incidence and rehabilitation outcome of concomitant traumatic brain injury and ligamentous knee injury.

OBJECTIVES: To estimate the incidence of ligamentous knee injuries in patients with traumatic brain injury (TBI) involved in pedestrian versus motor vehicle collisions (PVMVC), to identify associated risk factors, and to compare rehabilitation outcomes and costs in TBI patients with and without ligamentous knee injury. DESIGN: Retrospective, case control. SETTING: An academic rehabilitation hospital with a large metropolitan referral base. PATIENTS: Twenty-three consecutive adolescent and adult subjects admitted for acute inpatient rehabilitation after a PVMVC from January 1, 1994, to January 1, 1996. RESULTS: Five subjects (22%) were found to have a ligamentous knee injury, one with bilateral injuries. Two of these six injuries were diagnosed only after presentation to the rehabilitation setting. The most common injury was an anterior cruciate ligament (ACL) disruption in 5 of 6 knees. A coupled ACL and medial collateral ligament injury was identified in 4 of 6 injured knees. The risk of ligamentous knee injury was most closely associated with the presence of a tibial plateau fracture (n=3) (chi2=12.420, p < .001). There was no statistical difference between groups with and without ligamentous knee injuries with respect to age, gender, inpatient acute or rehabilitation length of stay, admission, discharge, or change in motor Functional Independence Measure (FIM) interval measures, or rehabilitation costs. Four of the 5 patients with ligamentous knee injuries were successfully managed nonoperatively. A case illustrating longitudinal management is presented. CONCLUSIONS: TBI and ligamentous knee injuries, in particular ACL injuries, are common comorbidities after PVMVC. Physicians must maintain a high index of suspicion for ligamentous knee injuries in this population, particularly when a tibial plateau fracture is present. TBI patients with and without ligamentous knee injuries can have comparable functional outcomes when the ligament injuries are identified and appropriately managed, without incurring undue cost or length of inpatient rehabilitation.

Adolescent↗
PubMed1998

Creatine kinase elevations and aggressive behavior in hospitalized forensic patients.

The relationship between creatine kinase (CK) and aggressive behavior was tested in 195 males consecutively admitted to a forensic hospital. Among patients receiving antipsychotic medication, the most violent patients had higher CK levels than less violent patients. This was not the case in patients who did not receive antipsychotic medication. CK levels were not influenced by age, ethnicity, or clinical diagnosis. CK levels were however influenced by prior assaultiveness and restraints. When these two factors were controlled for, CK levels remained strongly associated with subsequent violence. CK appears to be a potential predictor of violent behavior. It has the advantage of easy availability in comparison to other biological markers of aggression (e.g., 5-HIAA). Prospective studies are needed to confirm the validity of this biobehavioral association.

Adolescent↗
PubMed1998

Analysis of T cell subsets present in the peripheral blood and synovial fluid of reactive arthritis patients.

OBJECTIVE: Reactive arthritis (ReA), a HLA-B27 associated arthropathy, develops in susceptible people after infection with certain bacteria. T cells have been implicated in the pathogenesis of the arthritis but which of the different subsets is involved is still debated. This study has further elucidated the role of the CD4+ and CD8+ T cells by examining the expression of various surface markers associated with activation. METHODS: Three colour flow cytometry was used to examine the phenotype of the T cells within the synovial fluid (SF) and peripheral blood (PB) of ReA patients. RESULTS: ReA SF, compared with paired PB, contained a higher percentage of CD69+, CD25+, and HLA-DR+ CD3+ T cells. The majority of SF T cells also expressed the putative memory marker CD45RO. Within the T cell subsets, CD25 was expressed primarily on the CD4+ T cells; however more CD8+ T cells were HLA-DR+. CONCLUSION: The results show that both CD4+ and CD8+ T cell populations demonstrate evidence of recent activation. Whether these cells are involved in inducing inflammation, regulating the inflammation, or have become active as a result of migration through the endothelium, remains to be determined by functional studies.

Adult↗
PubMed1998

Reconsideration of sexual misconduct by clergy counselors: the case of F.G. v. MacDonell.

In the last decade, concerns about clergy counselors' liability for malpractice has focused on allegations of sexual abuse. Thus far, courts have not adjudicated a complaint of clergy malpractice. Their reasons have centered on concern for freedom of religion under the First Amendment. Therefore, there is a need to find another way to deal with the obvious reality that violating others' rights to satisfy one's own sexual appetites is not a valid expression of religious belief or practice. The authors, upon reviewing cases decided up to a few years ago, concluded that the complaint of breach of fiduciary duty provides a highly fitting way for courts to fairly assess complaints of sexual misconduct brought against clergy counselors. Now, the New Jersey Supreme Court has clearly recognized this complaint as an approach to the problem.

Clergy↗
PubMed1997

Effect of polymorphism of the HLA-DPA1 chain on presentation of antigenic peptides.

Human T-cell clones that recognize a peptide from mycobacterial heat shock protein 60 in the context of HLA-DP were found to be sensitive to changes in the DPA1 chain of the restricting element, optimal responses being seen with the combination HLA-DPA1*0201 and HLA-DPB*0301. HLA-DP dimers containing HLA-DPA1*01 were only able to present antigenic peptides to T-cell clones when peptides were present throughout the period of coculture of T cells with antigen presenting cells. In contrast the optimal HLA-DP dimer could also stimulate T-cell clones maximally when incubated with peptides for 1 h and then thoroughly washed. This suggests that the DPA1 polymorphism influenced the strength of binding of antigenic peptides to the HLA-DP dimer. Modeling studies identified amino acid 31 of DPA1 as the polymorphic residue most likely to account for this effect. This is the first demonstration that the relatively limited polymorphism displayed by DPA1 has functional consequences.

Amino Acid Sequence↗
PubMed1997

In vitro responses of human CD45R0brightRA- and CD45R0-RAbright T cell subsets and their relationship to memory and naive T cells.

The cellular basis of immunological memory, particularly with respect to T cells is not understood. In humans, monoclonal antibodies to CD45 have been used to identify memory (CD45R0) and naive (CD45RA) T cells. However, this identification has been called into question by various studies which suggest that high molecular weight CD45 isoforms may be re-expressed by previously activated cells. In the present study, using cultures which supported responses of naive T cells, we examined the responses of purified CD45R0brightRA- or CD45R0(-)-RAbright T cell subsets. The former subset was found to respond preferentially to recall antigens with minimal responses apparent to neo-(or non-recall)-antigens. The inverse pattern was found for CD45R0-RAbright T cells, which converted to CD45R0brightRA- after stimulation with a neo-antigen. Moreover, the two populations of T cells exhibited distinct response kinetics with a faster response evident from the CD45R0brightRA- T cells compared to the CD45R0-RAbright subset. The poor responses of CD45R0-RAbright T cells to recall antigens compared to neo-antigens suggests that this putative naive population is specifically depleted of reactive T cells following an encounter with antigen. We propose that T cell priming results in the stimulation of many CD45R0-RAbright T cells with various T cell receptor specificities from which memory T cells are selected for survival. If re-expression of higher molecular weight isoforms does occur in humans in vivo, our results suggest that R0 expression would be retained (CD45R0+RA+). Alternatively, if primed CD45R0-RAbright T cells exist, they are not prevalent in peripheral blood and thus may be sequestered within lymphoid tissues. Our data support the view that in human peripheral blood, CD45R0bright and CD45RAbright expression identify memory and naive CD4+ T cells, respectively.

Adult↗
PubMed1997

Human gamma delta T-cell recognition of Yersinia enterocolitica.

We have studied the human gamma delta T-cell response to Yersinia enterocolitica, a facultative intracellular bacterium which causes gastroenteritis and, particularly in human leucocyte antigen (HLA)-B27+ individuals, reactive arthritis (ReA). A marked proliferation of that cytotoxic gamma delta T cells is seen when Yersinia-infected lymphoblastoid cell lines or fixed intact Yersinia are added to cultures of mononuclear cells derived from the synovial fluid of ReA patients or from the peripheral blood of healthy donors. In contrast, heat-inactivated Yersinia fail to stimulate the gamma delta T-cell response. The gamma delta T-cell lines generated killed both autologous and allogeneic infected cell lines. Interestingly, a T-cell line generated from synovial fluid mononuclear cells (SFMC) killed infected autologous cell lines and a cell line matched for HLA-B27 less well than infected allogeneic target cells. gamma delta T-cell clones isolated from this line were found to express V gamma 9V delta 2 T-cell receptor (TCR) and also killed infected mismatched cells more efficiently than autologous targets. Moreover, from experiments using major histocompatability complex (MHC)-deficient cell lines, it was apparent that target cell recognition was MHC independent. Our results suggest that gamma delta T cells can be involved in immunity to Yersinia enterocolitica and should be taken into account when considering immunopathological mechanisms leading to reactive arthritis.

Amino Acid Sequence↗
PubMed1997

The disc at risk in athletes: perspectives on operative and nonoperative care.

Low back pain is the most common cause of disability in individuals below the age of 45 and the third most common cause of disability overall. Although acute back pain is generally felt to have a high probability of spontaneous resolution, the high recurrence rate of low back pain challenges the notion that resolution of symptoms is accompanied by restitution of function. Athletes who have lumbar spine dysfunction represent a particular challenge to the treating physician due to their high levels of activity and expectation of return to sport. Injuries to the intervertebral disc in the lumbar spine are a particular subset of spine injury. Management of intervertebral disc injuries, which is the focus of this section, is fraught with controversy. Although the majority of intervertebral disc injuries can be treated conservatively, the decision to follow an aggressive conservative versus surgical course in any given athlete must be made on an individual case basis.

Athletic Injuries↗
PubMed1996

Recurrent self-injurious behavior in forensic patients.

A high prevalence of self-injurious behavior has been reported in the forensic psychiatric population and the correctional psychiatric population. Severely and recurrently self-destructive patients pose great therapeutic challenges. The present study examined forensic patients who engaged in multiple acts of self-injury while hospitalized and compared them to forensic patients who engaged in a single act of self-injury. The groups did not differ on demographic or diagnostic measures, but the recurringly self-injurious patients were more frequently and more severely aggressive against others (verbally as well as physically), and required longer hospitalization. The results are interpreted to suggest that the high cost of recurring self-injury in human and financial terms may be reduced by a strategy of early and vigorous intervention.

Adult↗
PubMed1996

Subjective, laryngoscopic, and acoustic measurements of laryngeal reflux before and after treatment with omeprazole.

Laryngeal manifestation of gastroesophageal reflux is felt to be prevalent in our society. In general, diagnosis has been based primarily on symptoms. Historically, additional testing included laryngoscopy, barium swallow, manometry, and more recently, single- and double-probe pH monitoring. We evaluated 68 patients who were symptomatically suggestive of having reflux laryngitis. We administered surveys grading their symptoms. All patients underwent standardized videolaryngostroboscopic evaluation and computerized acoustic analysis. Patients then underwent a uniform therapy of dietary restrictions and omeprazole, a hydrogen ion inhibitor, for 12 weeks. Patients were then retested. This regimen demonstrated an 85% success of relieving symptoms. Utilizing the new laryngoscopic grading system, improvement was found to be statistically significant in improvement of all findings except granulomas. In patients with the pretherapy complaint of hoarseness, acoustic measures of jitter, shimmer, habitual frequency, and frequency range all showed significant improvement. The authors conclude that in patients with symptomatic reflux laryngitis, standardized videolaryngoscopy and, if hoarse, acoustic analysis are useful exam techniques to aide diagnosis and monitor therapy. Anti-reflux therapy with omeprazole is effective and improvement can be objectively demonstrated with the techniques described.

Adult↗
PubMed1995

Evidence for the elaboration of multiple axons by developing dentate granule cells.

A sample of 185 Neurobiotin-filled dentate granule cells has been collected from rats aged P14 to P120 in a study of the effects of serotonin (5-hydroxytryptamine, 5-HT) depletion on granule cell development. A small number (5.9%) of these neurons exhibit more than one axon. These neurons have morphologies consistent with that described for dentate granule cells. One axon typically arises from the soma while additional axons take origin from either dendrites or the soma. Both axons may be mossy fibers or one axon may be a mossy fiber and the second assume a morphology and distribution similar to that described for interneurons. These latter neurons therefore exhibit a mixed phenotype by having a granule cell morphology and an interneuronal axon type. These data suggest that some granule cells give rise to multiple mossy fibers or express a mixed axonal phenotype during maturation.

Animals↗
PubMed1995

In vitro proliferative responses of human peripheral blood mononuclear cells to non-recall antigens.

Primary in vitro proliferative responses of naive T cells to antigens other than superantigens and alloantigens have been little studied. Two tissue culture techniques have been reported which support in vitro antigen priming of T cells. These methods require various degrees of cellular manipulation and culture vessels other than standard microtitre plates. We report here that primary proliferative responses to non-recall antigens can be readily obtained using unselected human PBMC prepared from either adult or cord blood. Cells proliferate whether cultured in 2 ml volumes, 200 microliters microcultures or 20 microliters hanging drops. The variation in the proliferative responses increases as the culture volume is decreased such that considerable errors are apparent when Terasaki culture plates are used. The lowest stimulation indices are also observed in the 20 microliters microcultures. Nevertheless, similar response patterns are noted for the differing culture vessels; generally, proliferative responses reach peak magnitude only after 7 days of culture. The initial concentration of PBMC in culture influences the magnitude of the reactions such that halving the cell numbers frequently leads to greater than 50% reduction in the measured responses. The results of this study indicate that neither a specialised culture vessel nor complex cellular manipulation are required for in vitro priming of T cell immunity. Consequently, this area of immunology should be readily amenable to further study.

Adult↗
PubMed1995

Cancer. Introduction.

This supplement presents the study of various histologic types of cancers diagnosed in the populations covered by the Surveillance, Epidemiology, and End Results (SEER) Program. It describes the SEER program and the coding of histologic type by the International Classification of Diseases for Oncology. Each of the 19 articles deals with the histologic types of cancer found in major sites or with specific histologic types, such as lymphomas or melanomas. Histologic types have been grouped based on those developed by Dr. John Berg. Data presented in this supplement are based on more than one million microscopically proven invasive cancers and 98,000 in situ cancers diagnosed during the period 1973-1987 in areas covered by the SEER Program.

Adolescent↗
PubMed1995

Childhood cancer.

BACKGROUND: Cancers of individual organs generally are composed of various histologic types, each with its own frequency and demographic patterns. For childhood cancers in particular, a classification of cancers by histologic type is important for understanding the etiology and progression of the disease. METHODS: Data from the Surveillance, Epidemiology, and End Results (SEER) Program on 9308 microscopically confirmed malignant neoplasms in children younger than age 15, newly diagnosed during 1973-1987, were made available for analysis. Tumors were grouped histologically according to a classification previously utilized in an international volume of childhood cancer incidence. RESULTS: The most frequent histologic types were acute lymphocytic leukemia (23.6%), astrocytoma (9.6%), neuroblastoma (6.6%), and Wilms' tumor (6.4%). Acute lymphocytic leukemia accounted for 75% of childhood leukemia. The most common form of Hodgkin's disease was the nodular sclerosing subtype, which was diagnosed in 56% of all cases. Burkitt's and Burkitt-like disease accounted for approximately one third of non-Hodgkin's lymphoma, the sex ratio (male to female) being unusually high (5.7). Among the brain tumors, glioma was of interest because 198 cases (excluded from this analysis) were diagnosed without histologic confirmation--due, no doubt, to their inaccessibility for biopsy because they were located in the brain stem. The most common histologic type of soft tissue sarcoma was rhabdomyosarcoma, which accounted for 51% of the total, more than half of which were of the embryonal type. To the authors' knowledge, this report offers for the first time the relative frequencies of rare types of leukemias, such as megakaryoblastic leukemia, in childhood. This report also includes the frequencies of 21 rarer forms of soft tissue sarcoma. Five forms of childhood cancer had a 5-year relative survival rate of 85% or better. Of the cancers with the poorest outcome, three had relative survival rates of 46.5-49%; the relative survival rate of acute myelogenous leukemia was only 26.4%. The trends in survival over time for 21 types of childhood cancer also are included in this report. CONCLUSIONS: Further refinements in classification now are available through laboratory techniques utilizing molecular biology, immunology, and cytogenetics, which are of importance in etiologic studies, diagnosis, treatment, and prognosis. It would be important in the future for cancer registries to record the results of relevant laboratory tests for further analysis by subtype.

Adolescent↗