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Biomedical subjects

J Rogers

Publications and source records attributed to J Rogers.

At least 181 records · Page 10Linked to original sources

Aggregation state-dependent activation of the classical complement pathway by the amyloid beta peptide.

Activation of the classical complement pathway has been widely investigated in recent years as a potential mechanism for the neuronal loss and neuritic dystrophy characteristic of Alzheimer's disease (AD) pathogenesis. We have previously shown that amyloid beta peptide (A beta) is a potent activator of complement, and recent evidence suggesting that the assembly state of A beta is crucial to the progress of the disease prompted efforts to determine whether the ability of A beta to activate the classical complement pathway is a function of the aggregation state of the peptide. In this report, we show that the fibrillar aggregation state of A beta, as determined by thioflavin T fluorometry, electron microscopy, and staining with Congo red and thioflavine S, is precisely correlated with the ability of the peptide to induce the formation of activated fragments of the complement proteins C4 and C3. These results suggest that the classical complement pathway provides a mechanism whereby complement-dependent processes may contribute to neuronal injury in the proximity of fibrillar but not diffuse A beta deposits in the AD brain.

Amyloid beta-Peptides↗

Effectiveness of clemastine fumarate for treatment of rhinorrhea and sneezing associated with the common cold.

Limited data support the use of first-generation antihistamines for treatment of the common cold. The purpose of this study was to test the effectiveness of clemastine fumarate, a first-generation antihistamine, for treatment of sneezing and rhinorrhea associated with naturally occurring common colds. Four hundred three subjects (202 clemastine fumarate recipients and 201 placebo recipients) who reported new onset (< 24 hours) of cold symptoms that included rhinorrhea or sneezing were studied. At baseline (day 1), the mean symptom-severity scores +/- SEM for the clemastine fumarate and placebo groups were not significantly different. The mean rhinorrhea-severity score +/- SEM was not different on day 2; however, on day 3, the mean rhinorrhea-severity score +/- SEM was 1.02 +/- 0.07 for the clemastine fumarate group and 1.39 +/- 0.07 for the placebo group (P < .001). This treatment effect persisted on day 4. A significant effect on sneezing was noted on days 2-4. Sedation occurred in 14% of the clemastine fumarate-treated subjects and 1.5% of the placebo-treated subjects (P < .0001).

Adolescent↗

Prospective study of how students' humanism and psychosocial beliefs relate to specialty matching.

PURPOSE: To determine whether students who match to different specialties are different in their humanistic behaviors and attitudes about the psychosocial aspects of medicine. METHOD: From May 1992 to February 1995 data were collected from 405 students at the Baylor College of Medicine who participated in a required six-week family medicine clerkship. Two instruments were used to collect data: the Humanism Scale and the Physician Belief Scale. The students' humanism was rated by standardized patients (SPs) during the clerkship's objective structured clinical examination; the SPs used an abbreviated scale, consisting of eight items rated on a seven-point scale. The Physician Belief Scale, consisting of 32 items rated on a five-point scale, measures beliefs about the psychosocial aspects of patient care; it was completed by each student prior to the beginning of the clerkship. Specialty match data were based on National Resident Matching Program results at graduation. For statistical analysis, specialties were divided into four groups: primary care, medical, surgical, and support. RESULTS: The students who matched to primary care specialties had significantly higher mean humanism scores than did the students who matched to support specialties. Also, the students who matched to primary care specialties had significantly higher belief-scale scores than did the students who matched to surgery or support specialties. CONCLUSION: The differences between the students matching to various specialties found in this study were only partly consistent with the differences found in another study of resident physicians in the same specialties. The postgraduate residency experience may thus be an important factor accounting for this difference between students and physicians.

Career Choice↗

Short Form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire.

The aim of this study was to assess the acceptability, validity and reliability of the Short Form 36 quality of life questionnaire in 166 adult patients following discharge from a general intensive care unit. Reliability was quantified by measuring internal consistency using correlation among items and Cronbach's alpha coefficient. Reliability coefficients were calculated from two-way analysis of variance. Construct validity was tested by examining differences in scores between sex and age groups. Content validity was reflected by the spread of dimension scores. Acceptability to patients appeared reasonable, although considerable nursing time was required to administer the questionnaire. The measures of reliability exceeded recognised statistical standards in all but two instances. Construct validity was confirmed by lower scores being reported by women and older age groups. The scores of six of the eight dimensions were spread throughout the entire range of possible scores suggesting acceptable content validity.

Adolescent↗

Changes in quality of life after intensive care: comparison with normal data.

The Short Form 36 was used to compare critically ill patients' premorbid quality of life with normal values and investigate any changes following 6 months convalescence. One hundred and sixty-six survivors completed the Short Form 36 at discharge from intensive care. The answers given by survivors were significantly lower than normal for all dimensions. However, 21 patients who suffered from acute life-threatening conditions were identified and their overall scores were similar to normal values. After 6 months, 95 questionnaires were returned. Patients who had suffered acute pathologies reported significant decreases in quality of life whilst other patients with pre-existing ill health reported significant improvement with reduced pain and better mental health, vitality and social function. This study suggests that quality of life of most patients admitted to intensive care is not as good as in the normal population but does not deteriorate except for those patients admitted after acute life-threatening events.

Acute Disease↗

Reliability of the next of kins' estimates of critically ill patients' quality of life.

The aim of this study was to determine the reliability and validity of relatives' assessment of patients' quality of life and to measure the agreement between patients' and relatives' responses to the Short Form 36 quality of life questionnaire, at discharge from and 6 months following intensive care treatment. Ninety-nine patient-relative pairs were studied. Reliability was quantified by using measures of internal consistency (Cronbach's alpha and correlation coefficients) and reliability coefficients. Relatives' responses met the required standards of reliability and validity, but reliability was consistently weaker in the mental health dimension. Relatives' and patients' scores differed significantly in six dimensions at discharge; however, agreement between patients' and relatives' responses, as measured by the Kappa statistic, was fair, improved over 6 months, and was greatest in aspects concerning physical health. We conclude that relatives are able to give a good proxy assessment of functional aspects of quality of life.

Adolescent↗

Geropsychiatric restraint use.

OBJECTIVES: To investigate predictors and reasons for restraint use with geropsychiatric patients. DESIGN: A prospective, correlational study. SETTING: The geriatric unit of an acute-care psychiatric hospital. PARTICIPANTS: Twenty-one staff nurses and 131 patients admitted consecutively over a period of 6 months. MEASUREMENTS: Disruptive behaviors were measured with the Nursing Home Behavior Problem Scale (NHBPS), cognitive function was measured with the Mini-Mental State Examination (MMSE), mobility was measured with a Functional Mobility Screen (FMS), and reasons for restraint use were obtained with a questionnaire completed by nurses. RESULTS: Patients with a diagnosis of dementia, impaired mobility, or behavioral problems were more likely to be restrained. The most frequent reasons given by staff for restraint use were an unsteady gait and a risk of falling. The incidence of restraint use was 27.1%. CONCLUSIONS: The use of restraint with geropsychiatric patients may be more common than previously reported and requires further investigation.

Accidental Falls↗

Bone formers: osteophyte and enthesophyte formation are positively associated.

OBJECTIVE: To test the hypothesis that enthesophyte formation and osteophyte growth are positively associated and to look for associations between bone formation at different sites on the skeleton so that a simple measure of bone formation could be derived. METHODS: Visual examination of 337 adult skeletons. All common sites of either enthesophyte or osteophyte formation were inspected by a single observer who graded bone formation at these sites on a 0-3 scale. The total score for each feature was divided by the number of sites examined to derive an enthesophyte and an osteophyte score. Cronbach's alpha and principal components analysis were used to identify groupings. RESULTS: Enthesophyte formation was associated with gender (M > F) and age. There was a positive correlation between enthesophytes and osteophytes (r = 0.65, 95% confidence interval, 0.58 to 0.71) which remained after correction for age and gender. Principal components analysis indicated four different groupings of enthesophyte formation. By choosing one site from each group a simple index of total skeletal bone formation could be derived. CONCLUSIONS: Osteophytes and enthesophytes are associated, such that a proportion of the population can be classified as "bone formers". Enthesophyte groupings provide some clues to aetiopathogenesis. Bone formation should be investigated as a possible determinant of the heterogeneity of outcome and of treatment responses in common musculoskeletal disorders.

Adult↗

Laparoscopic accessory splenectomy in recurrent chronic immune thrombocytopenic purpura.

Splenectomy is the definitive treatment for most cases of idiopathic thrombocytopenic purpura (ITP). We present the case of a patient who was discovered to have ITP at age 5 and was treated medically for 3 years with decreasing response to medication. At age 8, he underwent splenectomy, after which the platelet count stabilized at approximately 200,000/mm3. Two years later he again had symptoms of thrombocytopenia and was treated medically with moderate success. At age 12, during hospitalization for bleeding, his liver/spleen scan gave negative results. Symptoms persisted, and when the patient was 13 a second scan found two small areas of uptake in the area of the splenic bed suggestive of secondary accessory splenic activity. The platelet count at that time was 6,000/mm3. Laparoscopy was performed, and after careful dissection of the left-upper quadrant, two globular masses, the larger of which was 3 x 2 x 2 cm, were removed without incident. The latest platelet count, 3 months after laparoscopic secondary accessory splenectomy, was 169,000/mm3, and a follow-up scan shows no uptake in the area of the spleen.

Child, Preschool↗

Charge-based binding of complement component C1q to the Alzheimer amyloid beta-peptide.

Activation of the classical pathway in Alzheimer's disease derives from the binding of the first protein, subcomponent C1q, to the amyloid beta-peptide (A beta). Analysis of the binding of C1q to A beta by competitive enzyme-linked immunosorbent assay shows that A beta fragments 1-16 and 1-28 but not 12-28 and 17-42 are capable of inhibiting the A beta/C1q interaction, implicating the A beta 1-11 region as the C1q binding site. Binding is also shown to be inhibited by conditions of high ionic strength, suggesting that charged side chains in the A beta 1-11 region are critical to the A beta/c1q interaction. Ultrastructural evidence of binding is provided by platinum replica electron microscopy. Along with a previous demonstration of the 14-26 region of the C1q A chain as the A beta binding site, these findings suggest that attractions between a negative charge cluster in A beta 1-11 and a positive charge cluster in C1qA14-26 mediate the binding of A beta and C1q.

Alzheimer Disease↗

Reuse of single use items in minimal access surgery.

UK Government guidelines state that single use instruments, including those used in minimal access surgery, should not be reprocessed because of the risk of-patient injury. In order to determine the incidence of this practice in minimal access surgery a questionnaire was issued to all participants of an Advanced Laparoscopy for Theatre Personnel course between 1994 and 1996. There was a 55% response rate. 27% of respondents had resterilised an instrument within the past year. More senior nurses resterilised more often and the request was usually made by Senior Registrars and Consultants, 52% of resterilised instruments were used with diathermy, the commonest being scissors. The practice was almost exclusive to the NHS. Since the course 44% of respondents have changed their practice. These results have implications for patient safety, staff indemnity, education and training for nurses and surgeons involved in minimal access surgery.

Equipment Reuse↗

Platelet aggregation and neutrophil sequestration in the mesenteric circulation in inflammatory bowel disease.

BACKGROUND AND OBJECTIVES: Mesenteric microvascular thrombosis may be an early pathogenic event in Crohn's disease (CD), and intravascular platelet aggregates have been identified in mucosal biopsies in ulcerative colitis (UC). Activated platelets are involved in thrombogenesis and exhibit inflammatory properties. In active inflammatory bowel disease (IBD) increased numbers of platelet aggregates are detectable in the peripheral circulation. The aim of this study was to test the hypothesis that in IBD, platelet aggregation is triggered in the mesenteric vasculature. PATIENTS AND METHODS: Platelet numbers, platelet aggregate ratios and differential leucocyte counts were compared in mesenteric arterial and venous blood obtained from paired vessels at the time of intestinal resection from 13 patients with inflammatory bowel disease and, as controls, 6 patients with colonic carcinoma or diverticular disease. RESULTS: In UC and CD, but not in controls, fewer neutrophils were found in blood draining the intestine compared with that supplying it (arteriovenous gradient median 1.0 x 10(9)/l (interquartile range 0.2-1.3) for UC, P < 0.05; 0.8 (0.2-1.5) for CD, P < 0.02; 0.4 (-0.3-1.1) for controls, P = NS). In CD, increased numbers of circulating platelet aggregates were identified in venous samples (platelet aggregate ratio 0.83 (0.71-0.93)) than in paired arterial samples (0.99 (0.95-1.01), P < 0.02) and control venous samples (0.99 (0.93-0.97), P < 0.05). The mesenteric arteriovenous gradient for neutrophils in IBD reflects their migration into the extravascular tissue and lumen of the inflamed intestine. Increased circulating platelet aggregates in the mesenteric venous circulation support the hypothesis that platelet activity is stimulated in the mesenteric microcirculation in CD.

Adult↗

cAMP-dependent phosphorylation of two sites in the alpha subunit of the cardiac sodium channel.

The voltage-sensitive Na+ channel is responsible for generating action potentials in the heart which are critical for coordinated cardiac muscle contraction. Cardiac Na+ channels are regulated by cAMP-dependent phosphorylation, but the sites of phosphorylation are not known. Using mammalian cells expressing the rat cardiac Na+ channel (rH1) alpha subunit and site-specific antibodies, we have shown that the alpha subunit of rat heart Na+ channel is phosphorylated selectively by cAMP-dependent protein kinase (PKA) in vitro and in intact cells. Analysis of the sites of phosphorylation by two-dimensional phosphopeptide mapping and site-directed mutagenesis of fusion proteins revealed that the cardiac alpha subunit is phosphorylated selectively in vitro by PKA on Ser526 and Ser529 in the intracellular loop connecting homologous domains I and II (LI-II). These two residues were phosphorylated in intact cells expressing the rH1 alpha subunit when PKA was activated. Our results define a different pattern of phosphorylation of LI-II of cardiac and brain Na+ channels and implicate phosphorylation of Ser526 and Ser529 in the differential regulation of cardiac and brain Na+ channels by PKA.

Amino Acid Sequence↗

Relative efficacies of amyloid beta peptide (A beta) binding proteins in A beta aggregation.

The aggregation of amyloid beta peptide (A beta) into its fibrillar, cross beta-pleated configuration is generally viewed as a critical event in the pathophysiology of Alzheimer's disease (AD). A diverse group of molecules, the A beta binding proteins, has been evaluated for their effects on this process. However, most of these studies have used micromolar or greater reagent concentrations, and their different methods have not permitted quantitative comparisons of the efficacy of different A beta binding proteins in augmenting or inhibiting aggregation. In the present work we have undertaken a coherent analysis using fluorimetry of thioflavin T-stained experimental solutions. The complement protein C1q, serum amyloid P, and transthyretin significantly enhanced the formation of precipitable, cross beta-pleated aggregates in solutions of 800 nM A beta 1-42. Under these same experimental conditions, alpha 1-antichymotrypsin had no significant effect on the aggregation process, and both the E3 and E4 isoforms of apolipoprotein E were significant inhibitors. There was a non-significant trend toward the E3 isoform exhibiting greater inhibition than the E4 isoform. Of the aggregation-facilitating molecules, C1q was substantially and significantly the most potent.

Alzheimer Disease↗

Phospholipase A2 engineering. Deletion of the C-terminus segment changes substrate specificity and uncouples calcium and substrate binding at the zwitterionic interface.

It has been suggested [Dijkstra, B. W., Drenth, J., & Kalk, K. H. (1981) Nature 289, 604-606] that the interfacial binding site of phospholipase A2 (PLA2) involves a large number of residues, including a cluster at the N-terminus and another cluster at the C-terminus. The approaches of multiple mutation and deletion were used to test the roles of the C-terminal residues of bovine pancreatic PLA2 overexpressed in Escherichia coli. A double mutant K120A/K121A and a deletion mutant delta 115-123/ C27A were constructed, and structural and functional analyses were performed on both mutants. The double mutant showed little perturbation in the global structure on the basis of proton NMR and X-ray crystallographic analyses. The proton NMR analysis of the deletion mutant suggested that a few residues at the active site, the hydrophobic channel, and the calcium binding loop are perturbed, but the global conformation is not changed. The mutants were then characterized for catalytic and binding properties by use of various kinetic and spectroscopic methods. The double mutant behaved in a manner similar to that of the wild type (WT) PLA2 in every property examined. The deletion mutant was found to show an interesting change of substrate specificity. The kcat,app of the zwitterionic DC8PC micelles but not the anionic DC8PM micelles decreased by a factor of > 100; however, the activity of DC8PC was restored upon addition of 4 M NaCl. The results of fluorescence spectroscopic studies indicate that the deletion mutant behaves in a manner similar to that of WT in the binding to anionic vesicles and to zwitterionic neutral diluent. Thus, the binding affinity of the enzyme to the interface (the E to E* step) should not be the main cause for the change in substrate specificity. The cause lies at least partially in the binding of substrate or inhibitor to the active site of the enzyme at the interface, i.e., the E* to E*L step, as revealed by the results of equilibrium binding studies. The equilibrium dissociation constants of ligands are generally higher for the deletion mutant (relative to WT) at the zwitterionic interface but not at the anionic interface. The cause for the low affinity of an active site-directed ligand to the active site at the zwitterionic interface could be related to the inability of Ca2+ to enhance ligand binding for the deletion mutant. This is in contrast to the WT PLA2 for which Ca2+ binding enhances binding of the substrate to the active site. Overall, the structural and functional perturbations caused by deleting the C-terminal segment are modest, but the changes in substrate specificity and the uncoupling between substrate and calcium binding are interesting and significant.

Amino Acid Sequence↗