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Biomedical subjects

J M Schwarz

Publications and source records attributed to J M Schwarz.

At least 19 recordsLinked to original sources

Differential Crosslinking and Contractile Motors Drive Nuclear Chromatin Compaction.

During interphase, a typical cell nucleus features spatial compartmentalization of transcriptionally active euchromatin and repressed heterochromatin domains. In conventional nuclear organization, euchromatin predominantly occupies the nuclear interior, while heterochromatin, which is approximately 50% more dense than euchromatin, is positioned near the nuclear periphery. Peripheral chromatin organization can be further modulated by the nuclear lamina, which is itself a deformable structure. While a number of biophysical mechanisms for compartmentalization within rigid nuclei have been explored, we study a chromatin model consisting of an active, crosslinked polymer tethered to a deformable, polymeric lamina shell. Contractile motors, the deformability of the shell, and the spatial distribution of crosslinks all play pivotal roles in this compartmentalization. We find that a radial crosslink density distribution, even with a small linear differential of higher crosslinking density at the edge of the nucleus, combined with contractile motor activity, drives genomic segregation, in agreement with experimental observations. This arises from contractile motors preferentially drawing crosslinks into their vicinity at the nuclear periphery, forming high-density domains that promote heterochromatin formation. We also find an increased stiffness of nuclear wrinkles given the preferential heterochromatin compaction below the lamina shell, which is consistent with instantaneous nuclear stiffening under applied nanoindentation. We conclude with the potential for experimental validation of our model predictions.

Journal Article↗

Differential Crosslinking and Contractile Motors Drive Nuclear Chromatin Compaction.

During interphase, a typical cell nucleus features spatial compartmentalization of transcriptionally active euchromatin and repressed heterochromatin domains. In conventional nuclear organization, euchromatin predominantly occupies the nuclear interior, while heterochromatin, which is approximately 50% more dense than euchromatin, is positioned near the nuclear periphery. Peripheral chromatin organization can be further modulated by the nuclear lamina, which is itself a deformable structure. While a number of biophysical mechanisms for compartmentalization within rigid nuclei have been explored, we study a chromatin model consisting of an active, crosslinked polymer tethered to a deformable, polymeric lamina shell. Contractile motors, the deformability of the shell, and the spatial distribution of crosslinks all play pivotal roles in this compartmentalization. We find that a radial crosslink density distribution, even with a small linear differential of higher crosslinking density at the edge of the nucleus, combined with contractile motor activity, drives genomic segregation, in agreement with experimental observations. This arises from contractile motors preferentially drawing crosslinks into their vicinity at the nuclear periphery, forming high-density domains that promote heterochromatin formation. We also find an increased stiffness of nuclear wrinkles given the preferential heterochromatin compaction below the lamina shell, which is consistent with instantaneous nuclear stiffening under applied nanoindentation. We conclude with the potential for experimental validation of our model predictions.

Journal Article↗

1/d expansion for k-core percolation.

The physics of k-core percolation pertains to those systems whose constituents require a minimum number of k connections to each other in order to participate in any clustering phenomenon. Examples of such a phenomenon range from orientational ordering in solid ortho-para H2 mixtures to the onset of rigidity in bar-joint networks to dynamical arrest in glass-forming liquids. Unlike ordinary (k = 1) and biconnected (k = 2) percolation, the mean field k > or = 3-core percolation transition is both continuous and discontinuous, i.e., there is a jump in the order parameter accompanied with a diverging length scale. To determine whether or not this hybrid transition survives in finite dimensions, we present a 1/d expansion for k-core percolation on the d-dimensional hypercubic lattice. We show that to order 1/d3 the singularity in the order parameter and in the susceptibility occur at the same value of the occupation probability. This result suggests that the unusual hybrid nature of the mean field k-core transition survives in high dimensions.

Journal Article↗

Percolation of unsatisfiability in finite dimensions.

The optimization of two-dimensional Boolean formulas is studied using percolation theory, rare region arguments, and boundary effects. In contrast with mean-field results, there is no satisfiability transition as the constraint density is varied, although there is a logical connectivity transition. In the disconnected phase, there is a transition in the solution time. The thermodynamic ground state for this NP-hard optimization problem is unique; local solutions can be adjoined to find the global ground state. These results have implications for the computational study of disordered materials.

Journal Article↗

Continuous depinning transition with an unusual hysteresis effect.

We identify a strange hysteresis which occurs in models of the depinning transition with both elastic and transient overshoot stresses. This hysteresis occurs generically despite the fact that the phase transition is still second order. We calculate the size of the hysteresis gap exactly in a large class of models. Because it is caused by irrelevant perturbations, the hysteresis does not show up in the field theory of the continuum limit. But since it is a real phenomenon it may be a cause for the hysteresis observed in natural depinning. We therefore discuss its experimental and numerical signatures which include microscopic nucleation.

Journal Article↗

Driven depinning of strongly disordered media and anisotropic mean-field limits.

Extended systems driven through strong disorder are modeled generically using coarse-grained degrees of freedom that interact elastically in the directions parallel to the drive and slip along at least one of the directions transverse to the motion. In the limit of infinite-range elastic and viscous coupling this model has a tricritical point separating a region where the depinning is continuous, in the universality class of elastic depinning, from a region where depinning is hysteretic. Many of the collective transport models discussed in the literature are special cases of the generic model.

Journal Article↗

Depinning with dynamic stress overshoots: a hybrid of critical and pseudohysteretic behavior.

A model of an elastic manifold driven through a random medium by an applied force F is introduced and studied. The focus is on the effects of inertia and elastic waves, in particular stress overshoots in which motion of one segment of the manifold causes a temporary stress on its neighboring segments in addition to the static stress. Such stress overshoots decrease the critical force for depinning and make the depinning transition hysteretic with static and pinned configurations coexisting with the steadily moving phase for a range of F. We find that the steady-state velocity of the moving phase is, nevertheless, history independent and the critical behavior as the force is decreased is in the same universality class as in the absence of stress overshoots-the dissipative limit in which hysteresis cannot occur and theoretical analysis has been possible. To reach this conclusion, finite-size scaling analyses have been performed and a variety of quantities studied, including velocities, roughnesses, distributions of critical forces, and universal amplitude ratios. If the force is increased slowly from zero, the behavior is complicated with a spectrum of avalanche sizes occurring that seems to be quite different from the dissipative limit. Related behavior is seen as the force is increased back up again to restart the motion of samples that have been stopped from the moving phase. The restarting process itself involves both fractal-like and bubblelike nucleation. Hysteresis loops in small- and intermediate-size samples can be understood in terms of a depletion layer caused by the stress overshoots. Surprisingly, in the limit of very large samples the hysteresis loops vanish. Although complicated crossovers complicate the analysis, we argue that the underlying universality class governing this pseudohysteresis and avalanches is again that of the apparently very different dissipative limit. But there are history dependent amplitudes-associated with the depletion layer-that cause striking differences over wide ranges of length scales. Consequences of this picture for the statistics and dynamics of earthquakes on geological faults are briefly discussed.

Journal Article↗

Depinning with dynamic stress overshoots: mean field theory.

An infinite-range model of an elastic manifold pulled through a random potential by a force F is analyzed focusing on inertial effects. When the inertial parameter M is small, there is a continuous depinning transition from a small- F static phase to a large- F moving phase. When M is increased to M(c), a novel tricritical point occurs. For M>M(c), the depinning transition becomes discontinuous with hysteresis. Yet, the distribution of discrete "avalanche"-like events as the force is increased in the static phase for M>M(c) has an unusual mixture of first-order-like and critical features. The results may be relevant for the onset of crack propagation and for dynamics of geological faults.

Journal Article↗

First-passage-time exponent for higher-order random walks: using Lévy flights.

We present a heuristic derivation of the first-passage-time exponent for the integral of a random walk [Y. G. Sinai, Theor. Math. Phys. 90, 219 (1992)]. Building on this derivation, we construct an estimation scheme to understand the first-passage-time exponent for the integral of the integral of a random walk, which is numerically observed to be 0.220+/-0.001. We discuss the implications of this estimation scheme for the nth integral of a random walk. For completeness, we also address the n=infinity case. Finally, we explore an application of these processes to an extended, elastic object being pulled through a random potential by a uniform applied force. In so doing, we demonstrate a time reparametrization freedom in the Langevin equation that maps nonlinear stochastic processes into linear ones.

Journal Article↗

Metabolic effects of indinavir in healthy HIV-seronegative men.

BACKGROUND: Therapy with HIV protease inhibitors (PI) has been associated with hyperglycemia, hyperlipidemia and changes in body composition. It is unclear whether these adverse effects are drug related, involve an interaction with the host response to HIV or reflect changes in body composition. METHODS: Indinavir 800 mg twice daily was given to 10 HIV-seronegative healthy men to distinguish direct metabolic effects of a PI from those related to HIV infection. Fasting glucose and insulin, lipid and lipoprotein profiles, oral glucose tolerance (OGTT), insulin sensitivity by hyperinsulinemic euglycemic clamp, and body composition were measured prior to and after 4 weeks of indinavir therapy. RESULTS: Fasting glucose (4.9 +/- 0.1 versus 5.2 +/- 0.2 mmol/l; P = 0.05) insulin concentrations (61.7 +/- 12.2 versus 83.9 +/- 12.2 pmol/l; P < 0.05), insulin : glucose ratio (12.6 +/- 1.7 versus 15.9 +/- 1.9 pmol/mmol; P < 0.05) and insulin resistance index by homeostasis model assessment (1.9 +/- 0.3 versus 2.8 +/- 0.5;P < 0.05) all increased significantly. During OGTT, 2 h glucose (5.1 +/- 0.4 versus 6.5 +/- 0.6 mmol/l; P < 0.05) and insulin levels (223.1 +/- 48.8 versus 390.3 +/- 108.8 pmol/l;P =0.05) also increased significantly. Insulin-mediated glucose disposal decreased significantly (10.4 +/- 1.4 versus 8.6 +/- 1.2 mg/kg x min per microU/ml insulin; 95% confidence interval 0.6--.0;P < 0.01). There was no significant change in lipoprotein, triglycerides or free fatty acid levels. There was a small loss of total body fat (15.8 +/- 1.4 versus 15.2 +/- 1.4 kg;P = 0.01) by X-ray absorptiometry without significant changes in weight, waist : hip ratio, and visceral or subcutaneous adipose tissue by computed tomography. CONCLUSIONS: In the absence of HIV infection, treatment with indinavir for 4 weeks causes insulin resistance independent of increases in visceral adipose tissue or lipid and lipoprotein levels.

Adult↗

Gas chromatography/mass spectrometry method to quantify blood hydroxycitrate concentration.

Hydroxycitrate (HCA), a popular dietary supplement for weight loss, is a competitive inhibitor of ATP-citrate lyase, an extramitochondrial enzyme involved in the initial steps of de novo lipogenesis (DNL). Although animal studies have shown that HCA effectively inhibits DNL and induces weight loss, these findings have not been consistent in humans. This raises the possibility that the bioavailability of HCA may differ among species. We developed a new GC/MS method to measure HCA levels in blood, using [U-(13)C]citrate (CA*) as internal standard to account for losses associated with the isolation, derivatization, and measurement of HCA. HCA and CA* were derivatized with BSTFA + 10% TMCS and analyzed using PCI/GC/MS (CA*, m/z 471; and HCA, m/z 553). The plasma HCA concentration was measured over a 3.5-h period in four subjects having ingested 2 g of HCA. Their plasma HCA concentration ranged from 0.8 to 8.4 microg/ml 30 min and 2 h after ingestion, respectively. These results demonstrate that when taken acutely, HCA is absorbed, yet present in small quantities in human plasma. This simple method requiring minimal sample preparation is able to measure trace amounts of HCA with accuracy and precision.

Citrates↗

Mechanisms of action of beta-glucan in postprandial glucose metabolism in healthy men.

OBJECTIVE: To assess whether beta-glucan (which is fermented in the colon) lowers postprandial glucose concentrations through mechanisms distinct from a delayed carbohydrate absorption and inhibits de novo lipogenesis. DESIGN: Administration of frequent small meals each hour over 9 h allows a rate of intestinal absorption to be reached which is independent of a delayed absorption. A group of 10 healthy men received either an isoenergetic diet containing 8.9 g/day beta-glucan or without beta-glucan for 3 days. On the third day, the diet was administered as fractioned meals ingested every hour for 9 h. SETTING: Laboratory for human metabolic investigations. SUBJECTS: Ten healthy male volunteers. MAIN OUTCOME MEASURES: Plasma glucose and insulin concentrations, glucose kinetics, glucose oxidation, de novo lipogenesis. RESULTS: On the third day, plasma glucose and free fatty acid concentrations, carbohydrate and lipid oxidation, and energy expenditure were identical with beta-glucan and cellulose. Plasma insulin concentrations were, however, 26% lower with beta-glucan during the last 2 h of the 9 h meal ingestion. Glucose rate of appearance at steady state was 12% lower with beta-glucan. This corresponded to a 21% reduction in the systemic appearance rate of exogenous carbohydrate with beta-glucan, while endogenous glucose production was similar with both diets. De novo lipogenesis was similar with and without beta-glucan. CONCLUSION: Administration of frequent meals with or without beta-glucan results in similar carbohydrate and lipid metabolism. This suggests that the lowered postprandial glucose concentrations which are observed after ingestion of a single meal containing beta-glucan are essentially due to a delayed and somewhat reduced carbohydrate absorption from the gut and do not result from the effects of fermentation products in the colon.

Blood Glucose↗

The effects of recombinant human growth hormone on body composition and glucose metabolism in HIV-infected patients with fat accumulation.

GH has been proposed as a therapy for patients with HIV-associated fat accumulation, but the pharmacological doses (6 mg/d) used have been associated with impaired fasting glucose and hyperglycemia. In contrast, physiologic doses of GH ( approximately 1 mg/d) in HIV-negative men reduced visceral adiposity and eventually improved insulin sensitivity, despite initially causing insulin resistance. We conducted an open-label study to evaluate the effects of a lower pharmacologic dose of GH (3 mg/d) in eight men with HIV-associated fat accumulation. Oral glucose tolerance, insulin sensitivity, and body composition were measured at baseline, and 1 and 6 months. Six patients completed 1 month and 5, 6 months of GH therapy. IGF-I levels increased 4-fold within 1 month of GH treatment. Over 6 months, GH reduced buffalo hump size and excess visceral adipose tissue. Total body fat decreased (17.9 +/- 10.9 to 13.5 +/- 8.4 kg, P = 0.05), primarily in the trunk region. Lean body mass increased (62.9 +/- 6.4 to 68.3 +/- 9.1 kg, P = 0.03). Insulin-mediated glucose disposal, measured by a euglycemic hyperinsulinemic clamp, declined at month 1 (49.7 +/- 27.5 to 25.6 +/- 6.6 nmol/kg(LBM).min/pmol(INSULIN)/liter, P = 0.04); values improved at month 6 (49.2 +/- 22.6, P = 0.03, compared with month 1) and did not differ significantly from baseline. Similarly, the integrated response to an oral glucose load worsened at month 1 (glucose area under the curve 20.1 +/- 2.3 to 24.6 +/- 3.7 mmol.h/liter, P < 0.01), whereas values improved at month 6 (22.1 +/- 1.5, P = 0.02, compared with month 1) and did not differ significantly from baseline. One patient developed symptomatic hyperglycemia within 2 wk of GH initiation; baseline oral glucose tolerance testing revealed preexisting diabetes despite normal fasting glucose. In conclusion, GH at 3 mg/d resulted in a decrease in total body fat and an increase in lean body mass in this open-label trial. While insulin sensitivity and glucose tolerance initially worsened, they subsequently improved toward baseline. However, the dose of GH used in this trial was supraphysiologic and led to an increase in IGF-I levels up to three times the upper normal range. Because there are known adverse effects of long-term GH excess, the effectiveness of lower doses of GH should be studied. We also recommend a screening oral glucose tolerance test be performed to exclude subjects at risk for GH-induced hyperglycemia.

Adipose Tissue↗

Effects of enteral carbohydrates on de novo lipogenesis in critically ill patients.

BACKGROUND: Conversion of glucose into lipid (de novo lipogenesis; DNL) is a possible fate of carbohydrate administered during nutritional support. It cannot be detected by conventional methods such as indirect calorimetry if it does not exceed lipid oxidation. OBJECTIVE: The objective was to evaluate the effects of carbohydrate administered as part of continuous enteral nutrition in critically ill patients. DESIGN: This was a prospective, open study including 25 patients nonconsecutively admitted to a medicosurgical intensive care unit. Glucose metabolism and hepatic DNL were measured in the fasting state or after 3 d of continuous isoenergetic enteral feeding providing 28%, 53%, or 75% carbohydrate. RESULTS: DNL increased with increasing carbohydrate intake (f1.gif" BORDER="0"> +/- SEM: 7.5 +/- 1.2% with 28% carbohydrate, 9.2 +/- 1.5% with 53% carbohydrate, and 19.4 +/- 3.8% with 75% carbohydrate) and was nearly zero in a group of patients who had fasted for an average of 28 h (1.0 +/- 0.2%). In multiple regression analysis, DNL was correlated with carbohydrate intake, but not with body weight or plasma insulin concentrations. Endogenous glucose production, assessed with a dual-isotope technique, was not significantly different between the 3 groups of patients (13.7-15.3 micromol * kg(-1) * min(-1)), indicating impaired suppression by carbohydrate feeding. Gluconeogenesis was measured with [(13)C]bicarbonate, and increased as the carbohydrate intake increased (from 2.1 +/- 0.5 micromol * kg(-1) * min(-1) with 28% carbohydrate intake to 3.7 +/- 0.3 micromol * kg(-1) * min(-1) with 75% carbohydrate intake, P: < 0. 05). CONCLUSION: Carbohydrate feeding fails to suppress endogenous glucose production and gluconeogenesis, but stimulates DNL in critically ill patients.

Adult↗

Mortality and morbidity after hip fracture: can evidence based clinical pathways make a difference?

OBJECTIVE: To evaluate whether evidence based clinical pathways for acute management of hip fracture have an effect on patient care, short term mortality, or residential status. METHODS: Observational cohort study comparing management, as determined by medical record review, and outcomes, as determined by telephone followup 4 months post-fracture, before (n = 455) and after (n = 481) clinical pathway implementation within pathway hospitals as well as between patients admitted to hospitals with (n = 2) and without (n = 4) pathways. RESULTS: Mean age was 82 years, 80% were women and 30% were admitted from nursing homes. Significant improvement in best practice as recommended by evidence based clinical guidelines was evident in pathway hospitals for most components of care. However, compliance was variable and nonpathway hospitals performed better for some (use of spinal anesthesia, avoidance of urinary catheters). After adjusting for potential confounders, no difference was found in 4 month mortality between the pathway (17.6%) and non-pathway (16.8%) patients (OR 0.8, 95% CI 0.5-1.5). There was a nonsignificant reduction in median acute care hospital length of stay of 1 day (p = 0.200) for non-nursing home patients and a significant reduction of 1 day (p = 0.038) for nursing home patients in the pathway hospitals. There was a nonsignificant decrease in admission rates for new patients to nursing homes in pathway hospitals (18.5%) compared to non-pathway hospitals (24.3%) (OR 0.5, 95% CI 0.3-1.1). CONCLUSION: Clinical pathways were associated with increased use of evidence based best practice, some reduction in acute hospital length of stay, but no significant effect on 4 month mortality or residential status. Their development and maintenance were resource intensive and further work on the implementation of evidence based guidelines is needed to determine whether they can influence patient outcomes.

Aged↗

How best to fix a broken hip. Fractured Neck of Femur Health Outcomes Project Team.

OBJECTIVES: To develop evidence-based guidelines for the treatment of proximal femoral fractures to optimise functional outcome while minimising length of stay in hospital. DATA SOURCES: Systematic literature search of MEDLINE and CINAHL computer databases, bibliographies, and current contents of key journals for 1966-1995. STUDY SELECTION: English-language randomised controlled trials of all aspects of acute-care hospital treatment of proximal femoral fracture among subjects aged 50 years and over with proximal femoral fractures not due to metastatic disease. DATA EXTRACTION: Two independent reviewers, blinded to authors, institution and study results, followed a standard Cochrane Collaboration protocol and assessed study quality and treatment conclusions. When necessary, a third review was performed to reach consensus. RESULTS: Of the 120 articles published between 1966 and December 1995, 97 met the inclusion criteria. Fifteen clinical interventions were reviewed. Five were supported by National Health and Medical Research Council (NHMRC) level I evidence (prophylactic anticoagulants, prophylactic antibiotics, regional anaesthesia, pressure-relieving mattresses, and internal surgical fixation), two had no supporting randomised controlled trial evidence (time to surgery, time to mobilisation after surgery) and the remainder were classified as having Level II evidence. A review of current practice (1993-94) identified wide variability in these interventions across five acute-care hospitals in the Northern Sydney Area Health Service. CONCLUSIONS: Randomised controlled trial evidence (NHMRC Levels I and II) exists for many, but not all, aspects of hip fracture treatment. There is a need for changes to be made to some aspects of practice in accordance with evidence-based guidelines.

Anesthesia, Conduction↗

Musculoskeletal disability among elderly people in the community.

OBJECTIVES: To determine the prevalence and determinants of disability among elderly people living in the community. DESIGN: A cross-sectional postal questionnaire survey. SETTING: Northern Sydney Area Health Service. PARTICIPANTS: 1527 residents (622 men and 905 women) aged 65 years and over. MAIN OUTCOME MEASURES: Self-reported chronic illnesses, injuries or conditions; difficulties with activities of daily living assessed by the Health Assessment Questionnaire (HAQ); and home modification and use of functional aids. RESULTS: "Arthritis or rheumatism" was the leading long term condition, reported by 59.5%, 55.8% and 59.7% of women and 40.5%, 47.0% and 43.6% of men in the three age groups (65-74, 75-84 and 85 years and over), respectively. The back, neck and knees were the most common sites of pain and stiffness. Of the respondents, 23.4% of women and 24.3% of men reported regularly taking nonsteroidal anti-inflammatory drugs. Impaired performance of activities of daily living increased with age, with 53.9%, 70.7% and 89.6% of women and 37.6%, 63.6% and 73.2% of men in the respective age groups reporting at least some difficulty (HAQ score > 0). Multivariate analysis found self-reported poor general health, loss of a limb, arthritis or rheumatism, other long term conditions restricting physical activity, impaired vision, female sex, and age to be significant predictors of disability as measured by HAQ scores. Only 13.9% of women and 9.4% of men had made changes to their home. Functional aids were used by 27.7%, 37.3% and 65.9% of women and 15.6%, 33.4% and 59.1% of men in the respective age groups. CONCLUSION: Arthritis and rheumatism were the most prevalent chronic conditions among elderly people in the community, and were significantly associated with difficulty with performing activities of daily living, after controlling for effects of age, sex and other chronic conditions.

Activities of Daily Living↗