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Biomedical subjects

J M Lewis

Publications and source records attributed to J M Lewis.

At least 91 records · Page 5Linked to original sources

Subcellular distribution of the alpha subunit(s) of Gi: visualization by immunofluorescent and immunogold labeling.

The subcellular distribution of the alpha subunit(s) of Gi has an obvious bearing on the ability of this protein to interact with receptors and targets and on its potential to serve in still unexplored capacities. In this study, we have examined the distribution of Gi alpha by means of light and electron microscopy. The cells employed were mouse 3T3 fibroblasts, normal rat kidney fibroblasts, rat C6 glioma cells, human umbilical vein endothelial cells, and human 293 kidney fibroblasts. By indirect immunofluorescence, two patterns of Gi alpha were evident. The more prominent was that associated with phase-dense, cytoplasmic structures exhibiting a tubule-like morphology. A similar distribution was noted for mitochondria, indicating attachment to a subset of microtubules. The second pattern appeared as a diffuse, particulate fluorescence associated with the plasma membrane. By immunogold labeling and electron microscopy, two populations of Gi alpha were again evident. In this instance, labeling of the plasma membrane was the more prominent. Gold particles were most often evenly distributed along the plasma membrane and were concentrated along microspikes. The second, less abundant population of Gi alpha represented the subunit (or fragments) within lysosomes. Specificity in immunolabeling was confirmed in all instances by immunotransfer blotting, the use of antibodies differing in specificities for epitopes within Gi alpha, the absence of labeling with preimmune sera, and the decrease in labeling after preincubation of antisera with appropriate peptides. These results support the proposal that several populations of Gi alpha exist: those evident within the cytoplasm by immunofluorescence, those present at the plasma membrane, and those evident within lysosomes by immunogold labeling.

Amino Acid Sequence↗

The changing face of adolescent inpatient psychiatric treatment.

Widespread changes in the criteria and resources for psychiatric inpatient treatment of adolescents present enormous challenges and demand serious and far-reaching adaptive efforts. Among these efforts may be a redesigning of the inpatient treatment milieu to accommodate different patient populations for whom different models of treatment and therapeutic strategies are necessary. This paper describes the redesigning and successful integration of an adolescent inpatient unit at a private psychiatric hospital to include separate treatment tracks for three different patient populations. An intensive/reconstructive treatment track provides the long-term inpatient treatment of youth with treatment-refractory personality disorders who have the clinical justification and resources for therapy that aspires to effect structural personality change. An acute crisis intervention track provides short-term inpatient treatment with an adaptation-oriented and highly focused approach to patients who have had limited previous treatment, are confined to short lengths of stay by financial constraints, or for whom regression should be discouraged. Finally, a psychosocial skills treatment group conducts longer term inpatient treatment for neurobiologically impaired patients. Psychotic, severely developmentally disturbed, profoundly abused patients, and those with extremely primitive personalities characterized by an abundance of deficits cannot tolerate the emotional and interpersonal intensity of a reconstructive treatment approach, but can benefit from a supportive, developmental, ego-building strategy.

Adolescent↗

Systems, stress, and survival: psychiatric hospitals in the 1990s.

Presented at the invitation of the President of the National Association of Private Psychiatric Hospitals, January 30, 1991, Marco Island, Florida, this paper is addressed to those whose interest in psychiatric hospitals centers around quality-of-care issues and who today are concerned about the deleterious impact of many forces upon the quality of hospital care. The author begins with comments about systems under stress, then turn to the quality-of-care issues, and end with some speculations about the future of psychiatric hospitals.

Continuity of Patient Care↗

Percutaneous transluminal coronary angioplasty in octogenarians.

OBJECTIVE: To assess the safety and short- and long-term outcomes of percutaneous transluminal coronary angioplasty in octogenarians. DESIGN: Retrospective chart review of clinical series. SETTING: Referral-based university medical center. PATIENTS: Consecutive series of 54 octogenarian patients (mean age, 82.4 years) who had percutaneous transluminal coronary angioplasty between March 1980 and December 1988. Of these patients, 91% presented with severe angina (Canadian Cardiovascular Society Class III or IV); 59% had unstable angina. Twenty-six patients (48%) had had a previous myocardial infarction and 15 (28%) had had previous coronary artery bypass surgery. Multivessel disease was present in 44 patients (81%). Follow-up ranged from 1 to 50 months (mean, 19 months). INTERVENTION: Percutaneous transluminal coronary angioplasty. MEASUREMENTS AND MAIN RESULTS: The angiographic success rate was 50 of 54 (93%; 95% CI, 81% to 98%) and the clinical success rate was 49 of 54 (91%; CI, 79% to 97%). Two patients had procedure-related myocardial infarction. Two patients died in the hospital, 1 from cardiac tamponade because of pacemaker perforation and 1 from cardiogenic shock after a myocardial infarction despite successful angioplasty. During the follow-up period 4 patients required bypass surgery, 2 had myocardial infarction, and 7 died (4 deaths were cardiac). Eleven patients (20%) had re-stenosis, 7 of whom were managed with repeat angioplasty, including 1 patient who had four procedures. At follow-up, 42 of 45 survivors (93%) were asymptomatic or had class II angina. The Kaplan-Meier survival for all patients, including those who died in the hospital, was 87% at 1 year and 80% at 3 years. Cumulative freedom from major cardiac events (death, myocardial infarction, or coronary bypass surgery) was 81% at 1 year and 78% at 3 years. CONCLUSIONS: Percutaneous transluminal coronary angioplasty can be done in octogenarians with a high rate of angiographic and clinical success, low complication rate, and a favorable long-term (3-year) outcome. As such, it is a treatment option in managing advanced coronary artery disease in this fragile group of patients.

Age Factors↗

Factors influencing the outcome of balloon aortic valvuloplasty in the elderly.

This study describes the short- and long-term outcome of 44 consecutive percutaneous balloon aortic valvuloplasty procedures performed in 42 elderly patients (age 77.8 +/- 7 years) with calcific aortic stenosis. The initial success rate was 95%, with the peak aortic valve pressure gradient declining from a mean of 82 +/- 32 mm Hg to 44 +/- 23 mm Hg and aortic valve area increasing from a mean of 0.59 +/- 0.15 cm2 to 0.83 +/- 0.40 cm2. One procedure-related death occurred and an additional three patients died less than or equal to 30 days after balloon aortic valvuloplasty. These patients all had New York Heart Association (NYHA) class IV heart failure symptoms prior to the procedure and their mean left ventricular ejection fraction (LVEF) (28 +/- 7%) was lower than that of hospital survivors (52 +/- 13%) (as was their ratio of left ventricular [LV] wall thickness-to-cavity ratio [0.50 +/- 0.10 versus 0.70 +/- 0.15]). At the time of hospital discharge after valvuloplasty, 76% of patients were asymptomatic or markedly improved (NYHA class I or II). After a mean follow-up of 15.5 months (range 2 to 26 months), however, 10 patients had died and 15 had undergone aortic valve replacement for recurrence of NYHA class III or IV symptoms. The adjusted 1- and 2-year survivals were 0.68 and 0.62, respectively, and adjusted 2-year event-free survival was 0.25. Proportional hazard regression analysis indicated that LVEF less than 40% was the only variable affecting survival (p less than 0.01) and was a possible indicator of event-free survival (p = 0.07).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

A functionalized superparamagnetic iron oxide colloid as a receptor directed MR contrast agent.

We have synthesized a surface functionalized superparamagnetic iron oxide colloid whose clearance from the vascular compartment was inhibited by asialofetuin but not fetuin. Unlike other particulate or colloidal magnetic resonance (MR) contrast agents, the agent of the current communication is not withdrawn from the vascular compartment by cells of the macrophage-monocyte phagocytic system, as indicated by its selective increase in hepatic relaxation rates. Because of this we refer to this colloid as a hepatic selective (HS) MR contrast agent. At 20 mumol Fe/kg the HS MR agent darkened MR images of liver. The HS MR agent exhibited no acute toxicity when injected into rats at 1800 mumol Fe/kg. Based on these observations, surface functionalized superparamagnetic iron oxide colloids may be the basis of MR contrast agents internalized by receptor mediated endocytosis generally, and by the asialoglycoprotein receptor in particular.

Animals↗

TCR gamma/delta+ dendritic epidermal T cells as constituents of skin-associated lymphoid tissue.

The epidermis of all strains of normal mice is populated by two distinct dendritic, bone marrow-derived cells: Langerhans cells and CD4-CD8- Thy-1+ dendritic epidermal T cells (DETC). The overwhelming majority of DETC are an unusually homogeneous population of thymic-dependent cells which express CD3-associated T-cell antigen receptors (TCRs) of the gamma/delta type, thereby distinguishing them from conventional CD4+CD8- or CD4-CD8+ T cells expressing CD3-associated alpha/beta TCR. Most DETC are ontogenetically primitive, derived from early fetal thymocytes with a preferential, but poorly understood tropism for the epidermis. Like the TCR on other populations of gamma/delta cells, which preferentially populate other epithelia such as in the gut and lung, the TCR on most DETC selectively utilize particular variable (V) gene segments (i.e., V gamma 3 and V delta 1 for DETC vs V gamma 5 and V delta 4 or V delta 6 for intestinal intraepithelial lymphocytes). However, unlike other gamma/delta populations whose TCR junctional regions exhibit marked heterogeneity, DETC junctional diversity is extremely limited. This lack of TCR heterogeneity among DETC suggests they recognize a narrow range of physiologic ligands (antigens) and that this recognition is restricted not by conventional polymorphic class-I or class-II MHC molecules, but rather by relatively nonpolymorphic self MHC-like molecules of the class Ib MHC type [e.g., Qa, TL, and CD1 (T6)]. Additional studies are required to clarify precisely what DETC recognize, their relevant biological functions, as well as their relationship(s) to the gamma/delta cells recently identified in human skin.

Animals↗

First clinical trial of a new superparamagnetic iron oxide for use as an oral gastrointestinal contrast agent in MR imaging.

The authors report the results of preclinical testing and initial clinical application of a superparamagnetic iron oxide specifically prepared as a contrast agent for magnetic resonance (MR) imaging of the gastrointestinal tract. MR imaging was performed at 0.6 and 1.5 T in 15 volunteers. Images of the upper abdomen and pelvis were obtained before and after ingestion of the contrast material at doses of 22.5-225.0 mg of iron in 600-900 L. Two readers scored the images. Delivery of contrast material into the proximal and distal small bowel, with obvious loss of signal intensity (T2 enhancement), was achieved in all subjects. Enhanced images showed improved delineation of the head and tail of the pancreas, anterior margins of the kidneys, and paraaortic region. The contrast agent did not generate artifacts, an improvement over prototype formulations evaluated previously in animals. Except for a brief episode of diarrhea in five subjects, the agent was well tolerated. Use of this contrast agent improved the diagnostic quality of abdominal MR images by enabling the distinction of the bowel from nonbowel structures at concentrations that did not produce image distortion.

Adult↗

An economic evaluation of the differences between intensive and extensive beef production systems.

A model to evaluate economic criteria involved when cattle are raised on high-forage diets prior to finishing or finished directly after weaning was developed using data from two experiments. In Exp. 1, each year for 3 yr, 136 Charolais-cross calves were weaned and allotted to either an intensive system, in which they were immediately finished on a high-grain diet, or an extensive system, in which they were wintered on crop residues, grazed on summer pasture and finished on a high-grain diet. In Exp. 2, 160 British breed steers were wintered, in one of eight different wintering systems utilizing crop residues, using supplemental protein and(or) alfalfa hay. After wintering, the steers grazed summer pasture and then were finished on a high-grain diet. Overall cost of gain and final "break-even" price were lower for cattle finished through the extensive system except when the price of corn was very low in relationship to other inputs. Interest costs were higher for cattle in the extensive system. Increasing the feeder calf purchase price had almost no effect on differences between the systems. Corn price and purchase price affected both systems similarly, whereas interest rate, wintering yardage and finishing yardage affected each system differently. Because of the additional weight produced through the extensive system, it yielded lower final "break-even" prices in most situations.

Animal Feed↗

Evaluation of intensive vs extensive systems of beef production and the effect of level of beef cow milk production on postweaning performance.

Charolais-sired calves from three groups of beef cows, similar in growth potential and mature size but different in genetic potential for milk production (5.6, 7.7, 9.0 kg/d; low, medium, and high, respectively), were allotted to two beef production systems each year for 3 yr. At weaning, calves in an intensive (Int) system went directly into the feedlot for finishing (236 d); calves in an extensive (Ext) system were wintered on corn residues (195 d), grazed pasture (115 d) and then were finished (122 d). Postweaning effects of increased weaning weight due to increased level of milk were small and not affected by growing-finishing system. Only the steer calves from the low milk-producing cows showed evidence (P less than .01) of compensatory growth postweaning in response to reduced levels of milk during the suckling phase. Cattle from the Ext system were heavier (P less than .01) before (388 vs 233 kg) and after (595 vs 531 kg) the finishing phase than Int system cattle. During finishing, cattle from the Ext system made more rapid gains (1.70 vs 1.36 kg/d) and consumed more feed (12.4 vs 8.5 kg/d, 2.52 vs 2.19% of average BW) but were less efficient (.137 vs .160, gain/feed) than cattle from the Int system (P less than .05). Extensive systems of beef production produced more total kilograms of beef per animal but they were 196 d older at slaughter.

Animal Husbandry↗

Effects of rate of gain during winter on subsequent grazing and finishing performance.

Sixty mixed British breed yearling steers (237 kg) were used each year for 2 yr to study the effects of rate of gain during the winter on subsequent pasture and finishing performance. Winter gains of .28, .38 and .50 kg/d (P less than .05) were established for the low, medium and high gain treatments, respectively. Daily gain of steers on pasture was reduced (P less than .01) 81 g for each 100-g increase in winter daily gain. No differences in BW were observed among the treatment groups after grazing summer pasture. Wintering performance did not affect finishing performance. Daily gains during the finishing period increased slightly as pasture gain decreased due to increased feed intake, but efficiency was not altered. These data suggest that within this range of ADG during the winter and under the conditions of this study, it was not beneficial to winter cattle for an ADG more than .28 kg/d.

Animal Feed↗

Marriage, adult adjustment, and early parenting.

The impact of parents' marriages, measured prenatally, on their parenting of firstborn, 3-month-old infants was assessed. Though the association between marriage and parenting was the focus, adult psychological adjustment was measured also to rule out the alternative hypothesis that psychological adjustment relates to both marital quality and parenting quality and accounts for any association between them. Hierarchical multiple regression analyses in which parental adjustment was entered first as a covariate were used to test the relation between close/confiding marriages and parenting of 3-month-old infants. From the findings, it was concluded that even when differences in individual psychological adjustment are taken into account, mothers are warmer and more sensitive with their infants and fathers hold more positive attitudes toward their infants and their roles as parents when they are in close/confiding marriages. It is asserted that qualities of marriage play an important part in the development of parent-child relationships.

Female↗

Refractory chronic periodontitis: effect of oral tetracycline hydrochloride and root planning.

Refractory chronic periodontitis of 16 patients was treated by root planing and adjunctive tetracycline hydrochloride therapy. The antibiotic was taken orally one hour before root planing and continued for six days at a dosage of 250 mg six hourly. The clinical data for each patient were recorded as the number of probing depths in each of the 1-3 mm, 4-6 mm and 7-10 mm ranges. The Multivariate Analysis of Variance (MANOVA) procedure for repeated measurements was used to analyse the data. The results demonstrated that the number of sites with probing depths of 4-6 mm and 7-10 mm associated with incisors, canines, premolars and molars decreased with a corresponding increase in the number of sites in the 1-3 mm range. Incisor and canine teeth showed a better response to treatment than premolars, which responded better than molars. The cases were followed for varying periods of time from six months to two years following antibiotic therapy. The probing depth reduction achieved following root planing and tetracycline hydrochloride therapy was maintained during this review period.

Administration, Oral↗

Service-mix in general dental practice in Australia.

An understanding of the current service-mix in private general practice in Australia and the factors that may influence its distribution is important in the anticipation of the future practice of dentistry. The present study aimed to describe service-mix, to investigate the association of service-mix with characteristics of presenting patients, and to identify and discuss a number of factors which may be influencing change in service-mix. Service-mix was dominated by restorative, diagnostic and preventive services and a limited number of services accounted for most service provision or dentist time. Both the broad areas of service and more frequently provided services were related to age of presenting patients. Service-mix appears to be changing over time. Changing needs and expectations of patients and philosophies and technologies available to dentists are among factors that push or pull service-mix in new directions. However, changing service-mix and practitioner variation require considerably more exploration.

Adolescent↗

Requirement and supply of dental services in Victoria.

The appropriateness of dental manpower has become a great uncertainty in the changing practice of dentistry. This paper presents research on the requirement for and supply of dental services in Victoria between 1984 and 1996. The requirement for dental services was found to be increasing due to population growth and higher per capita demand due to decreased endentulism. The supply of dental services was found to be mildly decreasing due to balanced supplementation and attrition processes and subtle sex ratio and age distribution changes among dentists. The resulting market excess, even after consideration of idle capacity and transfer of services supplied to dental therapists, provides a marked contrast to many, but not all, developed countries. It also offers an opportunity to shape occupational and specialty distribution to the advantage of dental professions and the public.

Age Factors↗

The provision of periodontal services in general dental practice in Australia.

Recent studies have documented the low percentage of professional services which are associated with periodontal care. The aims of the present study were to describe the provision of periodontal services by private general practice dentists in Australia and to investigate the variation of provision of periodontal services. Using a day log approach via a mailed questionnaire one in eight services provided were found to be related to periodontal care. Most were of a preventive nature. There was great variation between dentists in the number of services provided indicating the possibility of both under and overservicing. The findings are discussed with regard to the changing philosophies of provision of periodontal services and known methods of eliciting change among providers.

Adolescent↗

Intraocular pressure response to topical dexamethasone as a predictor for the development of primary open-angle glaucoma.

In a retrospective study we reviewed the records of 788 subjects who had been corticosteroid tested with 0.1% dexamethasone four times daily to one eye for six weeks. All subjects had normal kinetic visual fields and optic nerve heads in both eyes at the time of testing and were followed up for a minimum of five years. Some subjects had normal baseline intraocular pressures whereas others were considered to have ocular hypertension. Of 276 individuals who were high corticosteroid responders (intraocular pressure greater than 31 mm Hg during dexamethasone administration), 36 (13.0%) developed glaucomatous visual field loss during the follow-up period. Only nine of 261 individuals (3.4%) who were intermediate responders (intraocular pressure 20 to 31 mm Hg during dexamethasone administration) and none of 251 individuals who were low responders (intraocular pressure less than 20 mm Hg during dexamethasone administration) developed glaucomatous visual field loss. However, the ability of the intraocular pressure response to dexamethasone to predict the development of glaucomatous visual field loss was not as good as the predictive power of a multivariate model that included patient age, race, baseline intraocular pressure, baseline outflow facility, baseline cup/disk ratio, and systemic hypertension.

Adult↗

Assessment of myocardial perfusion in humans by contrast echocardiography. I. Evaluation of regional coronary reserve by peak contrast intensity.

Myocardial contrast echocardiography was performed during coronary angiography with 2 ml of sonicated meglumine diatrizoate sodium 76% (meglumine) in 40 patients (ranging in age from 25 to 79 years) before and 10 to 15 s after intracoronary injection of papaverine, 8 mg into the right coronary artery (n = 43) and 10 mg into the left (n = 46). The same protocol was repeated in 17 patients 5 to 10 min after completion of coronary angioplasty. In 13 patients with normal coronary angiograms, peak contrast intensity corrected for background myocardial intensity was measured in 36 regions and was found to increase after papaverine from 36 +/- 16 to 55 +/- 22 U (p less than 0.001). In contrast, in the 27 patients with angiographic evidence of coronary artery disease, peak intensity in 64 regions remained unchanged after papaverine (35 +/- 22 versus 36 +/- 23 U). An increase in peak intensity greater than or equal to 10 U was 80% sensitive and 92% specific for coronary artery disease. After successful coronary angioplasty, peak intensity in the involved regions improved significantly (p less than 0.001) during baseline contrast injections (from 32 +/- 16 to 50 +/- 25 U) as well as in the postpapaverine contrast injections (from 30 +/- 12 to 60 +/- 26 U). In conclusion, measurement of peak contrast intensity after intracoronary injections of sonicated meglumine provides a relative index of myocardial perfusion that allows assessment of regional coronary reserve in patients with coronary artery disease. This may be of particular value in evaluating the immediate effects of coronary angioplasty on myocardial perfusion.

Adult↗