Biomedical subjects
L Lewis
Publications and source records attributed to L Lewis.
Behavioral Intensive Care Unit (BICU): a new concept in the management of acute agitated behavior in elderly demented patients.
Intensive care units were developed in response to the perceived need for increased monitoring in critically ill medical patients. The same principle applies to elderly patients with severe agitated behaviors. These patients can be served by the Geriatric Behavioral Intensive Care Unit (BICU). The uniqueness of the program results from the application of a behavioral and environmental approach to the treatment of agitated behavior. The underlying strategy in the treatment process is to enhance the patient's ability to adapt to his or her home environment. Preliminary results have been encouraging, showing positive outcomes in diverse areas such as low level of institutional placement, patient quality of life, and caregiver symptoms of burden and depression.
Antibodies to platelet glycoprotein V in polytransfused patients with haematological disease.
Polytransfused patients often develop platelet-reactive antibodies (PRAb). These give positive reactions in the platelet immunofluorescence test (PIFT) and may be either lymphocytotoxic (LCTAb) or platelet-specific antibodies (PSAb). The latter may be detected in the PIFT using chloroquine-treated platelets (Chl-PIFT) or by immunoblotting. Serial samples from 106 multiply transfused patients with bone marrow failure were screened by PIFT using a microplate method and flow-cytometric analysis. PSAb activity was confirmed by Chl-PIFT. In 45 (42%) of the patients studied PSAb were detected; 37 (35%) formed LCTAb and 19 (51%) had co-existent PSAb. Sera from 25 of 27 patients with a positive Chl-PIFT, retested by immunoblotting, recognised determinants of Mr 82-160 kD on whole platelets. A large group became sensitised to a component of Mr 105-115 kD reduced (99 kD non-reduced) with similar electrophoretic mobility to GPIIIa using a monoclonal anti-GPIIIa and two human polyclonal anti-HPA-1a sera; some also produced anti-GPIIb. The largest group recognised a determinant of Mr 80-83 kD, probably glycoprotein V (GPV). Three sera were immunoblotted against thrombin-treated platelets and the results confirmed GPV specificity.
The pharmaceutical industry.
Pharmaceutical research once focused primarily on curing infectious diseases, many of which have been virtually eliminated. Today, there is growing emphasis on finding ways to prevent, treat, and cure chronic illnesses such as cardiovascular disease and cancer.
Evaluation of a supplementary retention program for black allied health sciences students.
The Medical College of Georgia's (MCG's) Minority Academic Advising Program (MAAP), which began in 1984, is a supplementary retention program for Black students. This paper describes an evaluation study of the effectiveness of MAAP within the MCG School of Allied Health Sciences (SAHS). The study sample consisted of 89 Black students who enrolled in the SAHS from fall 1978 to fall 1982 (preMAAP period) plus 129 Black students who entered the SAHS from fall 1984 through fall 1988 (MAAP period). The comparison group consisted of all other students who entered the SAHS (n = 1,884) within those same time periods. Using an evaluation design produced by merging a quasi-experimental and a time-series design, the authors found that the MAAP succeeded in increasing both the Black student retention-to-graduation rate and the time-persisted-in-program, to the extent that Black students achieved parity with other SAHS students.
Anti-sulfatide antibodies in neurological disease: binding to rat dorsal root ganglia neurons.
Increased titers of anti-sulfatide antibodies were detected by ELISA in 5 of 200 patients and control subjects. All 5 patients had sensory impairment; 4 had neuropathy, and one had multiple sclerosis. Of the patients with neuropathy, 2 had a clinical syndrome of small fiber sensory neuropathy with normal electrophysiological or nerve biopsy studies, 1 had a sensorimotor axonal neuropathy associated with IgM monoclonal gammopathy, and 1 had sensorimotor neuropathy with multifocal motor conduction block and anti-GM1 antibodies. The anti-sulfatide antibodies bound to the surface of unfixed rat dorsal root ganglia neurons and human neuroblastoma cells, and to fixed sections of central and peripheral myelin. No binding was detected following intraneural injection into rat sciatic nerves. Pre-absorption with sulfatide but not with galactocerebroside eliminated the tissue binding activity. These findings indicate that increased titers of anti-sulfatide antibodies are found in patients with sensory impairment but are not restricted to a particular neurological syndrome or type of neuropathy. The significance of anti-sulfatide antibodies is uncertain although sulfatide on dorsal root ganglia neurons may be a target antigen.
Evaluation of a summer prematriculation program for black and other nontraditional students.
This study evaluated the effectiveness of the Medical College of Georgia School of Medicine's Summer Prematriculation Program in facilitating participants' first-year achievement and retention from 1980 to 1989. The four-week curriculum included biochemistry, anatomy, immunology, learning skills, medical or anatomy terminology, and clinical forums. Of 101 black and 96 other nontraditional, at-risk students who had been invited to attend the program, the 115 attendees were compared with the 82 nonattendees on a variety of demographic and academic measures. For all measures examined, no statistically significant difference was found between the two groups. Several factors may have obscured the results. However, there were indications that the program had a favorable effect, including the evaluation by over 90% of the attendees that the program had contributed positively to their adjustment to medical school.
Prematriculation program grades as predictors of black and other nontraditional students' first-year academic performances.
This study explored the relative strengths of select background variables, including grades in a summer prematriculation program (SPP), as predictors of students' first-year academic performances. During the years 1980-1989, 115 black and other nontraditional prematriculants at the Medical College of Georgia School of Medicine attended a four-week SPP featuring courses in biochemistry, anatomy, and immunology. Canonical correlation analysis revealed that the combination of undergraduate grade-point average (GPA) and SPP grades in biochemistry and anatomy was the best predictor of the students' academic performances based upon their first-year grades in biochemistry, anatomy, and microbiology, and upon their GPAs for all first-year basic science courses. The authors conclude that SPP grades can be used to identify the specific academic weaknesses of nontraditional students at highest risk of falling into academic jeopardy.
Psychological treatment of adult psychiatric patients with traumatic frontal lobe injury.
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Two neuropsychological models and their psychotherapeutic implications.
Two neuropsychological models of normal brain functioning--cerebral laterality and hierarchical brain organization--are reviewed and their implications for psychotherapy are discussed. The purpose is not to reduce or translate complex psychological phenomena into neural terms or to suggest that psychopathology will ultimately be viewed as neuropathology. Rather, the effort is to point out convergences in findings of the two disciplines and to discuss the possible neurophysiological mechanisms underlying the resolution of psychopathology through psychotherapeutic interventions.
Multiround vital statistics survey in the Lao People's Democratic Republic.
The author discusses the multiround survey program begun in Laos in 1988 as a supplement to the first national census, taken in 1985. "The project had two broad objectives. The first was to provide training and support to selected village chiefs as a way of strengthening their role as civil registrars.... The second broad objective was to set up a system of statistical collection, involving regular visits to selected households, to provide good estimates of vital statistics." Some 300 villages or urban clusters were surveyed to determine their size and growth. The results were used to project future changes in the population's characteristics.
High-moisture diet for laboratory rats: nutrient analysis, growth, and organ weights.
A diet (KSC-25) to be sterilized by irradiation was formulated to contain 66% moisture and to provide the required nutrients for growing rats. Analyses of the irradiated dry diet provided data to evaluate its nutrient content. The diet was evaluated for its ability to supply all nutrients, including water, required by immature rats. Sixteen Sprague-Dawley rats were fed the high-moisture diet with or without access to a water bottle. Rats (n = 16) fed an irradiated purified diet in a meal form with access to a water bottle were the control animals. Feed efficiency, food and water consumption, and growth rate data were collected during the 28-day study. Organ weights were collected on day 28. The test diet met or exceeded the National Research Council (NRC) estimated nutritional requirements for immature laboratory rats. The 66% moisture KSC-25 diet provided all nutrients, including water, required by weanling male Sprague-Dawley rats for growth equivalent to the established purified diet.
High-moisture diet for laboratory rats: complete blood counts, serum biochemical values, and intestinal enzyme activity.
Rats were fed an irradiated high-moisture diet (KSC-25) with or without access to a water bottle. Physiologic values were compared between these two groups and a group of rats fed a purified diet. Hematologic and serum biochemical values, urine specific gravity, and intestinal enzyme activities were determined from samples collected from the three groups of rats. Sprague Dawley rats (n = 32) fed the irradiated high-moisture diet with or without a water bottle were the test animals. Rats (n = 16) fed an irradiated purified diet and water provided via a water bottle were the control group. The purified diet formulation modified AIN-76A, is a commonly used purified diet for laboratory rodents. All rats remained alert and healthy throughout the study. A comparison of the physiologic values of rats in this study with reported normal values indicated that all of the rats in the study were in good health. Significant differences (P less than 0.05) of the physiologic values from each rat group are reported.
Psychoanalytic psychotherapy with brain-injured adult psychiatric patients.
Scant attention has been paid to psychotherapy with patients who have acquired neurological conditions. In this paper the authors describe the common psychological problems and repetitive themes that emerge in the therapeutic process with these patients, as well as the salient attitudes toward therapy and the therapist that these patients manifest. Case vignettes illustrate the theoretical and technical considerations.
Diabetic retinopathy study results reveal combination therapy beneficial.
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Angiotensin II-producing enzyme III from acidified serum of nephrectomized dogs.
A highly active angiotensin-producing enzyme (enzyme III) was obtained from the serum of bilaterally nephrectomized dogs by acid treatment and ammonium sulfate fractionation. An inactive precursor (proenzyme III) was converted to enzyme III during prolonged storage (or by treatment with acid or with cathepsin G or by incubation at 38 degrees C as described in the following paper). Enzyme III reacted maximally at pH 7.7 and it produced up to 400 ng of angiotensin II/mL serum/h (i.e., amounts 4000 times higher than that generated by the endogenous renin present in serum after bilateral nephrectomy). Enzyme III produced angiotensin II at identical rates when either dog angiotensinogen or angiotensin I was used as substrate, but the rate was 710 times higher with synthetic tetradecapeptide renin substrate. Enzyme III is not identical to renin, cathepsin G, tonin, enzyme I, enzyme II, the calcium-dependent angiotensin I-converting enzyme, or the calcium-independent carboxy peptidase, which acts by sequential cleavage of angiotensin I. Enzyme III was inhibited by alpha-1-antitrypsin, diisopropyl fluorophosphate, and lima bean trypsin inhibitor (hence it is a serine proteinase). It was not inhibited by Captopril, Teprotide, or Enalapril. It had been reported previously that cathepsin G released from neutrophil granulocytes, by producing high local concentrations of angiotensin II, may provide a mobile means for modulating blood flow in tissue microvasculature during the inflammatory response. The present study offers a new, additional pathway, by enzyme III, for a similar rapid formation of angiotensin II from serum protein substrate or angiotensin I.
Angiotensin II-producing enzyme III from acidified serum of nephrectomized dogs. Activation of proenzyme III to enzyme III by cathepsin G.
Enzyme III and its inactive precursor proenzyme III have been obtained from the acidified serum of bilaterally nephrectomized dogs. Enzyme III occurs in a concentration producing angiotensin at a rate 50 times higher than the residual renin. Much higher concentrations of enzyme III have been obtained by three activation procedures: a) by storage for several months in the frozen state; b) by treatment at 0 degrees C and pH 3.0; or c) by incubation at 38 degrees C and pH 7.7. These procedures yielded levels of enzyme III that produced up to 400 ng angiotensin II/mL serum/h, i.e., 4000 times higher than the endogenous renin. Of further significance, the angiotensin II produced by enzyme III represents the octapeptide with the highest known vasoconstrictor activity. This is in contrast to renin, enzyme I, and enzyme II, all of which produced angiotensin I, the decapeptide without appreciable vasoconstrictor activity. The endogenous activating enzyme has been identified as cathepsin G by the following six experimental observations: both the endogenous activating enzyme and exogenous cathepsin G produced enzyme III from proenzyme III according to the same unusual sigmoid kinetics; they were blocked identically by antibody to human cathepsin G. Also, both were inhibited similarly by alpha-1-antitrypsin, lima bean trypsin inhibitor, diisopropyl fluorophosphate, or by an inhibitor present in dog serum. Thus, removal of this inhibitor and activation of proenzyme III by endogenous or by added cathepsin G are prerequisites to obtaining enzyme III; this provides a novel mechanism for the rapid formation of angiotensin II from serum protein substrate or from angiotensin I.
Expression of polymorphic B-cell antigens on human kidneys.
We have examined the expression on a panel of 22 human kidneys of polymorphic B-cell determinants recognized by mouse monoclonal antibodies. Monoclonal antibodies from a mouse immunized with an antigenic preparation from a DR4 positive B-cell line reacted preferentially with kidneys from DR4 positive donors (p less than 0.005), and the pattern of reactivity with kidney tissues was similar to that of antibodies to monomorphic determinants of class II. However, these antibodies did not show clear specificity for DR4 on lymphocytes in standard serological analyses. These results provide evidence for the expression of polymorphic class II determinants on human kidneys. Reasons for the differences in the apparent specificities of the monoclonal antibodies when tested on kidney sections and lymphocytes are discussed.