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Biomedical subjects

L Fox

Publications and source records attributed to L Fox.

At least 55 records · Page 3Linked to original sources
PubMed1996

The role of self-help programs in the rehabilitation of persons with severe mental illness and substance use disorders.

Substance abuse treatment programs in the United States frequently incorporate self-help approaches, but little is known about the use of self-help groups by individuals with dual disorders. This paper brings together several current studies on the role of self-help programs in treating substance use disorders among individuals with severe mental illness. These studies indicate that only a minority of individuals with dual disorders become closely linked to self-help. Psychiatric diagnosis and possibly social skills are correlates of participation. Dually disorders consumers often experience the use of 12-step philosophy and jargon by mental health professionals as alienating and unempathic. The authors propose suggestions for incorporating self-help approaches into the comprehensive community care of individuals with dual disorders.

Alcoholism↗
PubMed1996

State of dermatology training: the residents' perspective.

Changes in health care delivery necessitate modification in dermatology training. While the residents at The University of Alabama at Birmingham were planning their 1995-1996 curriculum, several questions regarding the most appropriate allocation of time and resources arose. Interest in other residency curricula prompted the development of a national survey of dermatology residents. Our purpose was to provide comprehensive data regarding the didactic, clinical, surgical, and other aspects of today's U.S. dermatology residency training from the perspective of the residents. It is hoped these data will assist dermatology residency programs with evaluation of their current curricula. A comprehensive 31-question multiplechoice survey was mailed to 631 residents in 70 U.S. dermatology residency programs. Results were tabulated and median values and percentages of responses were obtained. A Wilcoxon rank-sum test, a chi-square analysis, and logistic regression analysis were performed on survey items on the basis of residents' satisfaction with the training program. Two hundred forty-eight responses (39%) were returned with all years of training well represented. Median values and percentages obtained outlined the didactic, clinical, surgical, and other aspects of dermatology residency training. Seventeen percent of residents believed they were not being adequately trained. Satisfaction with training was noted with more didactic faculty involvement, consultations and research, and surgical procedures performed per month. Residents with enriched didactic, clinical, and surgical training experiences are more satisfied with their training programs.

Alabama↗
PubMed1996

Serum albumin in continuous peritoneal dialysis: its predictors and relationship to urea clearance.

We investigated the predictors of serum albumin and the relationship between serum albumin and urea kinetic indices in continuous peritoneal dialysis (CPD). In a training set (TS) of 143 urea kinetic studies performed in 92 CPD patients, stepwise logistic regression identified high/high-average peritoneal solute transport, diabetes, advanced age and high daily drain volume normalized by body water as predictors of low serum albumin (< 35 g/liter). This analysis was then substantiated in a validation set (VS) of 187 kinetic studies performed in another 102 CPD patients. The calculated area under the receiver operating characteristic (ROC) curve by this logistic regression model was 0.782 (95% CI, 0.745 to 0.819). Logistic regression was repeated in the TS using only the first kinetic study from each patient, and it identified high/high-average peritoneal solute transport, diabetes, and advanced age as predictors of low albumin. Using only the first kinetic study from each patient in the VS, the second logistic regression model calculated an area under the ROC curve equal to 0.850 (95% CI, 0.810 to 0.890). The relative risk (RR) of serum albumin < 35 g/liter was computed for all kinetic studies after combining the TS and the VS and using non-diabetic CPD subjects aged < or = 61 years with low/low average peritoneal solute transport as the reference group. The RR with only one risk factor present ranged from 1.076 (age > 61 years) to 6.792 (high/high-average transport). The RR with two risk factors present ranged from 5.200 to 9.729. The RR with all three risk factors present was 9.100 (95% CI, range 3.923 to 21.111). A subset of 37 CPD patients had a second urea kinetic study 8 +/- 5 months after an increase in the amount of dialysis due to low urea clearance and/or uremic symptoms. The weekly KT/V urea increased from 1.40 +/- 0.24 to 2.10 +/- 0.31 after the increase in the CPD dose. With the increase in dialysis, the protein catabolic rate increased substantially; however, the mean serum albumin remained stable (from 33.9 +/- 4.6 to 33.3 +/- 6.2 g/liter; decrease 18; increase 15; same 4). In comparison to the subjects who had a decrease in serum albumin after the increase in KT/V, those with the increase in serum albumin were younger (44.2 +/- 11.2 vs. 54.3 +/- 16.2 years, P = 0.044) and had a higher serum urea after the increase in the dose of CPD (22.4 +/- 7.8 vs. 17.0 +/- 6.0 mmol/liter, P = 0.037). We conclude that the major predictors of low serum albumin in CPD are advanced age, diabetes, and high/high-average peritoneal solute transport, but not urea kinetic studies. An increase in the dose of dialysis does not cause a consistent rise in serum albumin in underdialyzed CPD subjects. However, a subset of younger patients may be able to increase their serum albumin in response to the increase in KT/V.

Adult↗
PubMed1995

HIV replication in IL-2-stimulated peripheral blood mononuclear cells is driven in an autocrine/paracrine manner by endogenous cytokines.

Replication of HIV is regulated by virus-encoded regulatory proteins, as well as by a variety of cellular factors including cytokines. In the present study, we have investigated the autocrine/paracrine effects of endogenous cytokines on HIV replication in primary PBMCs of healthy HIV seronegative individuals. Addition of rIL-2 to cultures between 0 and 72 h after isolation of PBMCs allowed the replication of primary HIV isolates and laboratory-adapted HIV strains to levels comparable with or greater than those obtained in parallel cultures of autologous PHA-blasts. In this regard, both major cellular targets of HIV infection, CD4+ T lymphocytes and mononuclear phagocytes, were maintained for several weeks in IL-2-stimulated PBMC cultures and virion production was observed in both cell lineages. The kinetics of secretion of several cytokines (such as TNF-alpha, IL-1 beta, IL-6, and IFN-gamma), as well as expression of cellular activation markers, paralleled HIV replication in IL-2-stimulated PBMCs. Endogenous pro-inflammatory cytokines and IFN-gamma played a major role in the regulation of HIV replication in IL-2-stimulated PBMCs, as determined by the ability of several anti-cytokine Abs or antagonists to suppress HIV production; this was not the case in parallel cultures of autologous PHA-blasts. Thus, IL-2-stimulated PBMCs may represent a more physiologic in vitro system than PHA-blasts for the study of HIV infection and replication, and should prove useful in investigating the role of cytokines and other host factors in the regulation of HIV production.

Antibodies, Monoclonal↗
PubMed1995

Cross-sectional analysis of erythropoietin use in CPD: its relation to azotemic index clearances.

The association between the use of erythropoietin and urea or creatinine clearance was studied in two populations on continuous peritoneal dialysis (CPD) residing either at an altitude of 1600 m (n = 194) or at sea level (n = 108). Among peritoneal and total KT/V urea and creatinine clearance (CCr) indices, only total CCr was lower in the high altitude group receiving erythropoietin than in the corresponding group not receiving erythropoietin (68.0 +/- 34.9 vs 82.9 +/- 40.9 L/1.73 m2 weekly, p < 0.01). However, 24-hour urine volume and urinary KT/V urea and CCr were consistently lower in the groups receiving erythropoietin than in those not receiving erythropoietin. Total weekly KT/V urea < or = 1.70 and CCr < or = 52 L/1.73 m2 were considered indicators of inadequate CPD. Although the percent of patients receiving erythropoietin did not differ overall between groups with adequate and those with inadequate CPD, a trend towards more frequent use of erythropoietin was found in the sea level group with inadequate CCr versus the group with adequate CCr (28.2% vs 16.9%, p = 0.084). In CPD decreased renal function is associated with more frequent use of erythropoietin. Whether inadequate total urea or creatinine clearance is also associated with more frequent erythropoietin use requires further study.

Altitude↗
PubMed1995

The minimal dose of dialysis required for a target KT/V in continuous peritoneal dialysis.

This study attempted to define the minimal dose of dialysis needed to produce a target KT/V in continuous peritoneal dialysis (CPD). In a training set of 143 clearance studies performed in 92 CPD patients, logistic regression identified low urine volume (UV) and low dialysate drain volume normalized by body water (DV/V) as predictors of weekly KT/V urea < or = 1.70. Solution of the regression equation with UV fixed at 0.00 1/24 h and at different probabilities of low KT/V provided a series of minimal DV/V values consistent with weekly KT/V > or = 1.70 in anuria. The accuracy of the logistic regression model and of the DV/V cut-offs was tested in a validation set (VS) of 189 urea kinetic studies performed in another 102 CPD patients. In the VS, the area under the Receiver Operating Characteristic curve generated by the regression model was 0.832 (95% Confidence Interval: 0.798-0.866). The DV/V cut-off value of 0.301 per 24 h, calculated by solving the regression model at p = 0.442 and with UV = 0, identified studies with weekly KT/V < 1.70 with a sensitivity of 89.3% and a specificity of 78.1% in anuric VS subjects (n = 60). Use of only the first urea kinetic study from each patient did not modify the predictors of KT/V or the cut-off values derived from solution of the regression model. The DV/V cut-off of 0.324 per 24 h, derived from the logistic regression model predicting KT/V < or = 1.90, identified KT/V < 1.90 in VS anuric subjects with a sensitivity of 94.3% and a specificity of 81.0%. Low UV and DV/V predict low KT/V urea in CPD. Prescribed 24 h exchange volume in anuric CPD subjects should be calculated to produce DV/V values exceeding 0.301 1/24 h per 1 body water for a KT/V of 1.70 and 0.324 1/24 h per 1 body water for a target weekly KT/V of 1.90.

Creatinine↗
PubMed1993

Predicting the course of peritonitis in patients receiving continuous ambulatory peritoneal dialysis.

BACKGROUND: Peritonitis is a common problem for patients receiving continuous ambulatory peritoneal dialysis. Episodes that do not respond to antibiotics within 96 hours are associated with substantial morbidity and mortality. The purpose of this study was to develop a method for identifying these patients at the time of hospital admission. METHODS: We reviewed all cases of peritonitis associated with continuous ambulatory peritoneal dialysis that occurred at the Albuquerque (NM) Veterans Affairs Medical Center during a 10-year period. Episodes of peritonitis were randomly assigned to a training set or a validation set. Persistent infections were those lasting more than 96 hours. For training cases, stepwise logistic regression was used to develop a predictive model for persistent infection using information available at the time of hospital admission. The model was then used to assign validation cases to "high-" and "low-risk" categories. The group difference in the proportion of persistent cases was tested by chi 2 analysis. RESULTS: Sixty patients had 120 episodes of peritonitis during the study period. Of 63 episodes assigned to the training set, 26 (41.3%) lasted more than 96 hours (persistent cases) and 37 were cured in 96 hours or less (usual cases). Compared with usual cases, persistent episodes were characterized by a higher age at presentation and a greater decline from preinfection values for hemoglobin and serum potassium, serum urea nitrogen, creatinine, albumin, and calcium. Advanced age and marked declines in serum potassium and albumin levels were identified by logistic regression as independent risk factors for persistent infection. The model identified 28 of 57 validation cases as high risk. Compared with low-risk cases, these episodes were much more likely to be persistent (64.3% vs 24.1%; P = .002) and result in death (32.1% vs 3.4%; P = .005). CONCLUSIONS: Advanced age and marked declines in serum albumin and potassium levels are poor prognostic signs in peritonitis associated with continuous ambulatory peritoneal dialysis. Patients with these findings should be treated aggressively.

Age Factors↗
PubMed1993

Peritoneal catheter loss and death in continuous ambulatory peritoneal dialysis peritonitis: correlation with clinical and biochemical parameters.

Clinical and biochemical parameters associated with the removal of the peritoneal catheter and death following continuous ambulatory peritoneal dialysis (CAPD) peritonitis were analyzed in 120 episodes of peritonitis. Episodes resulting in catheter removal (n = 24, 20%) and those ending in patient death (n = 12, 10%) were respectively compared with episodes in which peritoneal catheters were saved and from which the patients survived. Variables associated with catheter removal included advanced age, long duration of peritonitis, coexisting exit-site/tunnel infection, infection caused by pseudomonas or fungi, elevated aspartate aminotransferase (AST) and malnutrition at presentation with peritonitis (serum albumin 29.5 +/- 7.6 g/L vs 33.8 +/- 4.8 g/L in episodes in which the catheters were saved, p = 0.014), and worsening malnutrition during peritonitis. Variables associated with death from peritonitis included diabetes mellitus, persistence of the infection, removal of the peritoneal catheter, infection with pseudomonas, malnutrition prior to the infection (serum albumin 29.5 +/- 3.2 g/L vs 34.7 +/- 4.2 g/L in survivors, p < 0.001), presentation with elevated AST and worsening malnutrition, and the development of pronounced malnutrition during infection (serum albumin 18.1 +/- 4.1 g/L vs 28.9 +/- 5.8 g/L in survivors, p < 0.001). Deaths were caused primarily by cardiovascular events. Both removal of the peritoneal catheter and death as consequences of CAPD peritonitis are associated with malnutrition and pseudomonas infection. In addition, death is more frequent in diabetic patients.

Humans↗
PubMed1992

Comparative effects of endothelin (ET-1) and U46619 on human saphenous vein and gastroepiploic artery, sources of human autologous grafts.

The effects of endothelin (ET-1) on smooth muscle contractile activity were investigated and compared in human saphenous vein and gastroepiploic artery, vessels frequently used in revascularization procedures. ET-1 contracted saphenous vein and gastroepiploic artery in a concentration-dependent manner. The peptide produced a greater maximal effect in the vein than in the artery and, in both preparations, ET-1 was less efficacious than U46619, an agent which mimics the actions of thromboxane A2 at the thromboxane A2/prostaglandin H2 receptor. The contractile response to ET-1 declined spontaneously at a more rapid rate in the artery than in the vein. The present data indicate that ET-1 has significant contractile activity in both vessels which are used for coronary arterial bypass surgery and suggest that although, a weaker vasoconstrictor than U46619, the peptide could induce vasospasm in both graft vessels.

Arteries↗
PubMed1992

Frequency of reisolation of Staphylococcus aureus from multiple sequential milk samples.

Bacterial cultures were performed on multiple sequential composite samples of milk from 1,172 cows in 9 dairy herds. If the initial diagnosis of Staphylococcus aureus infection was based on the first positive culture, an average of 37.8% of subsequent cultures on the same cows were negative for S aureus. However, if the initial diagnosis of S aureus infection was confirmed by 2 or 2 of 3 sequential positive cultures and any conversions from S aureus positive to negative were confirmed by 2 or 2 of 3 sequential negative cultures, then only 17.0% converted to a negative diagnosis. Conversion of cows from S aureus culture-positive to -negative varied between herds; 8.1 to 69% for single cultures and 0.0 to greater than 40% for confirmed cultures.

Animals↗
PubMed1992

Lupus nephritis in a pediatric renal transplant recipient.

A case of aggressive lupus nephritis in a pediatric renal transplant patient is described. She initially presented with end-stage glomerulonephritis for which an underlying etiology could not be determined. Ten months after cadaveric renal transplantation, systemic lupus erythematosus was diagnosed, when she developed diffuse proliferative glomerulonephritis in association with antinuclear antibody, anti-double-stranded DNA antibody and extrarenal manifestations of lupus. It is plausible that she developed recurrent rather than de novo lupus nephritis following transplantation. Reactivation of lupus nephritis in a renal transplant is unusual in adults, and is previously unreported in children.

Antibodies↗
PubMed1992

Metabolic differences between persistent and routine peritonitis in CAPD.

Changes in 10 metabolic parameters (body weight, blood hemoglobin, and serum albumin, urea, creatinine, cholesterol, triglycerides, potassium, calcium and phosphorus) were compared in 28 episodes of routine peritonitis and 27 episodes of persistent peritonitis. These infections occurred in 20 CAPD patients, all of whom acquired both types of peritonitis on separate occasions. Coagulase-negative staphylococci predominated in the routine infections, while Staphylococcus aureus and Gram-negative bacilli, especially Pseudomonas, were associated with persistent peritonitis. Decreases during infection were significantly larger in persistent as compared with routine peritonitis episodes for all 10 nutritional parameters. Time required for recovery of all nutritional variables except serum potassium and urea was significantly longer in the persistent episodes. Persistent peritonitis led to peritoneal catheter loss in 13 of the 27 episodes and was associated with 4 deaths, while routine peritonitis was associated with neither catheter loss nor death. In contrast to routine peritonitis, persistent CAPD peritonitis is associated with severe malnutrition, considerable morbidity, and mortality.

Blood Proteins↗
PubMed1990

Mechanism of aluminum-induced inhibition of hepatic glycolysis: inactivation of phosphofructokinase.

Aluminum, an abundant element in the earth's crust, has been implicated in various pathological disorders and low concentrations of this element have recently been shown to inhibit brain glycolysis. However, despite the fact that aluminum accumulates in high concentrations in the liver, potential effects of this metal on hepatic intermediary metabolism have not been explored. In perfused livers from untreated rats, maximal rates of production of lactate plus pyruvate (glycolysis) were 93 +/- 15 mumols/g/hr. Glycolysis was severely inhibited in livers from aluminum-treated rats (0.5 mg/kg, 6 hr before experiment) with maximal rates of only 23 +/- 4 mumols/g/hr. In contrast, glucose production (glycogenolysis) and hepatic oxygen uptake were not altered significantly by prior treatment with aluminum. In livers from fasted rats, pretreatment with aluminum did not influence gluconeogenesis or production of lactate and pyruvate from fructose (5 mM). This finding indicates that pyruvate kinase is not inhibited by aluminum and implicates phosphofructokinase, hexokinase and/or glucokinase as sites for the inhibitory effect of aluminum on glycolysis. In liver homogenates from untreated rats, increasing concentrations of aluminum did not show any appreciable effect on hexokinase or glucokinase activity but did cause progressive decreases in phosphofructokinase activity. Therefore, aluminum-induced inhibition of liver phosphofructokinase, an important control site in the glycolytic pathway, is most likely responsible for aluminum-induced inhibition of hepatic glycolysis.

Adenosine Triphosphate↗