Search PubMed⌕ Search

Biomedical subjects

L M Nelson

Publications and source records attributed to L M Nelson.

At least 37 records · Page 2Linked to original sources
PubMed1999

Physical trauma and family history of neurodegenerative diseases in amyotrophic lateral sclerosis: a population-based case-control study.

This population-based case-control study was conducted in three counties in western Washington state (USA) between 1990 and 1994 to assess the association between amyotrophic lateral sclerosis (ALS) and several hypothesized risk factors, including a family history of neurodegenerative diseases, physical trauma (fractures, electrical shocks, and surgeries), rural residence, travel, and medical history. One hundred seventy-four cases with ALS, newly diagnosed by neurologists, were identified through several case-finding methods. Two controls (n = 348), who were matched to each case by gender and age (+/-5 years), were identified through random digit telephone dialing or Medicare lists. Exposure data were collected through structured in-person interviews. A greater proportion of cases (2. 3%) than controls (0.9%) reported a first-degree relative with ALS, resulting in an odds ratio of 3.1 (95% CI, 0.6-15.7). For a positive family history of ALS among second-degree relatives, the odds ratio was 4.0 (95% CI, 1.0-16.6). Overall, reports of first- or second-degree relatives with ALS yielded a significantly elevated odds ratio of 3.3 (95% CI, 1.1-9.9). No association was found with a family history of Alzheimer's disease or Parkinson's disease, or with a family history of the neurodegenerative diseases as a group. No significant associations were demonstrated for any of the other factors analyzed, including a history of fractures, electrical shocks, or surgeries, a history of residence in rural areas, a history of travel to areas in the western Pacific where ALS is endemic, and a medical history of polio, polio immunization, or tetanus immunization.

Adolescent↗
PubMed1999

A mouse gene encoding an oocyte antigen associated with autoimmune premature ovarian failure.

Autoimmune premature ovarian failure causes young women to develop menopausal symptoms and infertility. A similar syndrome appears in mice with postthymectomy autoimmune premature ovarian failure. We demonstrate that these mice develop antibodies against a 125-kDa protein located in the oocyte cytoplasm (ooplasm). By screening a mouse ovarian complementary DNA expression library with autoimmune serum, we have identified a novel mouse gene with a 3.75-kb ovarian transcript, the expression of which is restricted to the oocyte. The longest open reading frame (3333 bp) encodes an oocyte-specific protein, designated OP1 (ooplasm-specific protein 1). The protein is composed of 1111 amino acids with a predicted molecular mass of 125,502 Da. Based on its primary structure, it appears to be novel and has no motifs to suggest a localization other than in the cytoplasm. The ability of immune serum from mice with ovarian autoimmunity to react specifically with recombinant OP1 raises the possibility that OP1 as an antigen may play a role in murine autoimmune premature ovarian failure.

Amino Acid Sequence↗
PubMed1999

Epidemiologic approaches to the study of Parkinson's disease etiology.

The etiology of Parkinson's disease has been enigmatic to clinicians, epidemiologists, and basic scientists since the clinical syndrome was first described in 1817. Mendelian inheritance probably accounts for a small proportion of Parkinson's disease. Apart from an increasing risk with age, the most consistent epidemiologic observation has been an inverse relation with cigarette smoking. Neither selective survival of nonsmokers nor behavioral characteristics of smokers can explain this seemingly protective association. Interest in environmental exposures, particularly pesticides, metals, and industrial solvents, heightened substantially following the discovery of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), a street drug contaminant, as a cause of human parkinsonism. Epidemiologic and toxicologic research has since been guided to a great extent, although not exclusively, by mechanisms of MPTP toxicity. Efforts to characterize gene/environment interactions have also intensified in recent years. In this review, we evaluate recent evidence concerning the etiology of Parkinson's disease, with emphasis on environmental and lifestyle exposures and their potential interactions with genetic susceptibility traits. The most challenging aspects of epidemiologic research into Parkinson's disease causation include methodologic difficulties surrounding case definition, completeness of case ascertainment, selection of appropriate controls in case-control studies, and assessment of environmental exposures. We conclude with recommendations for future research directions.

Age Distribution↗
PubMed1998

Bone loss in young women with karyotypically normal spontaneous premature ovarian failure.

OBJECTIVE: To evaluate the effects of karotypically normal spontaneous premature ovarian failure on femoral neck bone mineral density. METHODS: Eighty-nine women with karyotypically normal spontaneous premature ovarian failure who desired fertility were evaluated at a tertiary care academic center and underwent hip and spinal bone density measurements by conventional dual-photon absorptiometry. Seventy-seven of the women (87%) had sought medical advice previously and had taken a variety of estrogen and progestin replacement regimens at least intermittently. The median (range) age was 32 (20-39) years, and the median (range) time since diagnosis was 1.5 (0.5-11) years. Findings were compared with a reference group of 218 regularly menstruating women of similar age. RESULTS: Sixty of the 89 women with premature ovarian failure (67%, 95% confidence interval 57, 77) had a femoral neck bone mineral density more than 1 standard deviation (SD) below the mean of the reference group (P < .001, chi2 with Yates correction). Even in women in whom the bone mineral density measurement was made within just 1.5 years of the diagnosis, nearly one-half (47%) had a femoral neck bone mineral density more than 1 SD below the mean of the reference group (P < .01). CONCLUSION: Two-thirds of young women with karyotypically normal spontaneous premature ovarian failure have a femoral neck bone mineral density more than 1 SD below the mean of a reference group. These young women need early education regarding strategies to maintain their bone mass and ongoing medical evaluation to maintain compliance with these strategies.

Absorptiometry, Photon↗
PubMed1998

Premature ovarian failure.

In 1% of women, premature ovarian failure develops by 40 years of age, a condition causing amenorrhea, infertility, sex steroid deficiency, and elevated gonadotropins. Early loss of ovarian function has significant psychosocial sequelae and major health implications. These young women have a nearly two-fold age-specific increase in mortality rate. Among women with spontaneous premature ovarian failure who have a normal karyotype, half have ovarian follicles remaining in the ovary that function intermittently. Indeed, pregnancies have occurred after the diagnosis of premature ovarian failure. Thus, premature ovarian failure should not be considered as a premature menopause. Young women with this disorder have a 5% to 10% chance for spontaneous pregnancy. Attempts at ovulation induction using various regimens fail to induce ovulation rates greater than those seen in untreated patients; however, oocyte donation for women desiring fertility is an option. Young women with premature ovarian failure need a thorough assessment, sex steroid replacement, and long-term surveillance to monitor therapy. Estrogen-progestin replacement therapy should be instituted as soon as the diagnosis is made. Androgen replacement should also be considered for women with low libido, persistent fatigue, and poor well-being despite taking adequate estrogen replacement. Women with premature ovarian failure should be followed up for the presence of associated autoimmune endocrine disorders such as hypothyroidism, adrenal insufficiency, and diabetes mellitus.

Adult↗
PubMed1998

Recursive partitioning for the identification of disease risk subgroups: a case-control study of subarachnoid hemorrhage.

Recursive partitioning is a nonparametric technique that produces a classification tree in which subjects are assigned to mutually exclusive subsets according to a set of predictor variables. We examined the utility of recursive partitioning as a supplement to logistic regression for the multivariable analysis of data from case-control studies, demonstrating the technique using data from women enrolled in a population-based study of subarachnoid hemorrhage. The classification tree produced by recursive partitioning consisted of three main risk subgroups: (1) elderly women who had long-standing hypertension and who were not smokers, (2) middle-aged women who were cigarette smokers and frequent binge drinkers, and (3) women in whom risk variables indicate relative estrogen deficiency (i.e., postmenopausal status, no recent exposure to hormone replacement therapy, cigarette smoking). As a supplemental method, recursive partitioning not only identifies subgroups with varying risks, but also may uncover interactions between variables that may be overlooked in the traditional application of logistic regression to case-control data.

Aged↗
PubMed1998

The genetic origins of ovarian failure.

Premature ovarian failure (POF) is a condition characterized by cessation of ovarian function before the age of 40. The recent meeting at the National Institute of Child Health and Human Development brought together experts from diverse disciplines to share current perspectives on the genetic and physiologic origins of POF, with the idea that insights gained from these studies may provide important clues about the regulation of normal ovarian aging and perhaps aging processes in general. It was suggested that several murine genes, including Zfx, c = kit, and the kit ligand, should be fertile candidates for investigation of the etiology of POF in human families. The specific roles of the human DIA and FMR1 gene products in germ cell development need clarification in murine models, and there are more as yet unidentified genes residing on the long arm of the X chromosome that are also implicated in the regulation of human ovarian function. Genes acting at later stages of oocyte or ovarian follicle function, such as gonadotropin hormones and receptors, are responsible for POF in some women. POF has been found to be a heterogeneous disorder, the dissection of which offers promising insights into mechanisms governing germ cell origination, migration, and proliferation, meiotic mechanisms, and factors governing oocyte maturation and survival.

Adult↗
PubMed1998

Human follicle fluid vascular endothelial growth factor concentrations are correlated with luteinization in spontaneously developing follicles.

Vascular endothelial growth factor (VEGF) is a cytokine that induces angiogenesis. Angiogenesis is a prominent histologic component of the luteinization process. Luteinization is also characterized by granulosa cell progesterone secretion in response to the luteinizing hormone (LH) surge. Local VEGF production in human pre-ovulatory follicles, induced by LH, was postulated to be a luteinization mediator in women. To investigate this hypothesis, serum and fluid from the dominant follicle of 31 healthy regularly cycling multiparous women undergoing laparoscopic sterilization were obtained. VEGF was measured by enzyme-linked immunosorbent assay, and LH and progesterone were measured by radioimmunoassay. Follicle aspiration was performed at a median of 13 days from the last menstrual period (range 11-17 days). The median pre-ovulatory follicle diameter was 16 mm (range 11-23 mm). Follicle fluid VEGF concentrations (mean 6900 pg/ml, range 1200-17 100 pg/ml) were correlated positively with follicle fluid progesterone concentrations (mean 10 176 nmol/l, range 636-66780 nmol/l, r=0.62, P=0.002). This correlation was even tighter (r=0.87, P < 0.0001) when only samples from the 22 women in the earliest stages of follicle luteinization were considered. In these women serum LH concentrations were also correlated with follicle fluid VEGF concentrations (r=0.51, P=0.02). Our findings demonstrate the close dynamic relationship between VEGF production and early luteinization in human follicles during normal non-stimulated cycles.

Adult↗
PubMed1998

Assessment of occupational exposures in community-based case-control studies.

Assessing occupational exposures in community-based studies is a challenge for investigators because there are no standardized or validated approaches for collecting information regarding occupational history. The strengths and limitations of the methods available for assessing occupational exposures are reviewed. In community-based case-control studies, the prevalence of most chemical agents is low. The common sources of misclassification in these studies are addressed, as are strategies for dealing with misclassification bias. Methods to assess the presence and magnitude of differential reporting by cases and controls are outlined, together with analytic strategies to improve the classification of occupational exposures.

Bias↗
PubMed1998

Human ZP3 restores fertility in Zp3 null mice without affecting order-specific sperm binding.

The mammalian zona pellucida surrounding ovulated eggs mediates sperm binding at fertilization, provides a postfertilization block to polyspermy, and facilitates passage of pre-implantation embryos down the oviduct. Although the three zona proteins (ZP1, ZP2, ZP3) are well conserved, mammalian fertilization is relatively specific and human sperm do not bind to the mouse zona pellucida. There are considerable in vitro data that ZP3 acts as a primary sperm adhesion molecule in mice and, by analogy, a similar role has been postulated for human ZP3. Genetically altered mice lacking ZP3 (Zp3(tm/tm)) do not form a zona pellucida and are infertile. To rescue this phenotype, transgenic mice expressing human ZP3 (67% identical to mouse ZP3) were produced and bred with Zp3(tm/tm) null mice. The resultant human ZP3 rescue females had chimeric zonae pellucidae composed of mouse ZP1, mouse ZP2 and human ZP3. Human ZP3 expressed in mouse oocytes had an apparent mass (64 kDa) indistinguishable from native human ZP3 and distinct from mouse ZP3 (83 kDa). Despite the presence of human ZP3, human sperm did not bind to the chimeric zona pellucida, and notwithstanding the absence of mouse ZP3, mouse sperm bound to ovulated eggs in vitro and fertility was restored in vivo. These data have implications regarding the molecular basis of mouse and human sperm binding to their respective zonae pellucidae.

Animals↗
PubMed1998

Autoimmune premature ovarian failure: of mice and women.

Autoimmunity is a well-established mechanism of premature ovarian failure and may be the dominant cause of reversible premature ovarian failure. Because of its strong analogy with the human disease, murine experimental post-thymectomy autoimmune oophoritis may provide insight into the pathogenesis of autoimmune premature ovarian failure in women and might open new avenues to specific diagnostic and therapeutic methods. We reviewed the literature on murine experimental post-thymectomy autoimmune oophoritis in order to compare and contrast it with human autoimmune premature ovarian failure, to which it is similar in several ways. The histologic distribution of the ovarian lymphocytic infiltration is similar, and both have reduced natural killer cell activity. Susceptibility appears to be associated with genes outside the major histocompatibility complex in both the mouse and the human. Finally, the mouse model disorder is associated with a persistent neonatal-like Th2 response, which suggests possible similarities with autoimmune polyglandular failure type 1 in humans. In this condition autoimmunity develops despite an impaired cellular immune response.

Animals↗
PubMed1997

Occupational exposures and amyotrophic lateral sclerosis. A population-based case-control study.

This population-based case-control study was conducted in three countries in western Washington State to evaluate associations between workplace exposures and the risk of amyotrophic lateral sclerosis (ALS). Cases (n = 174) were all newly diagnosed with ALS by neurologists during 1990-1994, and controls (n = 348), who were matched according to age (+/-5 years) and sex, were identified via random-digit dialing or Medicare enrollment files. Four industrial hygienists blindly assessed detailed lifetime job histories for exposures to metals, solvents, and agricultural chemicals. Case-control comparisons were made for jobs held between 15 years of age and 10 years prior to the cases' dates of diagnosis. After adjustment for age and education, ever exposure to agricultural chemicals was associated with ALS (odds ratio (OR) = 2.0, 95% confidence interval (CI) 1.1-3.5); this association was observed separately in men (OR = 2.4, 95% CI 1.2-4.8) but not in women (OR = 0.9, 95% CI 0.2-3.8). Among men, the odds ratio for low exposure to agricultural chemicals (below the median level for exposed controls) relative to no exposure was 1.5 (95% CI 0.4-5.3), and for high exposure, it was 2.8 (95% CI 1.3-6.1) (p for trend = 0.03). Similar analyses based on the panel's assessment of exposures to metals and solvents showed no associations. These findings suggest an association between ALS and agricultural chemicals in men.

Adolescent↗
PubMed1997

Murine postthymectomy autoimmune oophoritis develops in association with a persistent neonatal-like Th2 response.

Autoimmune oophoritis develops in some patients despite evidence of impaired cellular immunity. Here, using the murine postthymectomy model of autoimmune oophoritis, we investigate the hypothesis that neonatal thymectomy induces autoimmune oophoritis by disrupting the normal postnatal balance of T helper cell regulation. Stimulated CD4+ splenic lymphocytes from adult mice sham-operated as neonates produced the expected T helper type 1 (Th1) predominant response normally seen in adult mice (low levels of interleukin-4 and high levels of interferon gamma). In contrast, cells from adult mice thymectomized as neonates produced an inappropriate neonatal-like Th2-predominant response (high levels of interleukin-4 and low levels of interferon-gamma). Manipulations that restored the postnatal shift to an adult Th1-dominant pattern ameliorated the autoimmune oophoritis. Thus, neonatal thymectomy abrogates the postnatal shift to a Th1-dominant pattern, and the resulting persistent neonatal-like Th2-dominant response is tightly associated with the development of postthymectomy autoimmune oophoritis. These results (i) suggest that the postnatal shift to the normal adult Th1/Th2 balance is established by a thymus-dependent process and (ii) raise the possibility that specific genetic defects, as yet to be determined, might mimic the effect of neonatal thymectomy in this model, impair the development of normal Th1/Th2 balance, and be a cause autoimmunity. These results hold implications for the pathogenesis and possibly for the therapy of autoimmune polyglandular failure in humans.

Adoptive Transfer↗
PubMed1997

Fetal carriers of the factor V Leiden mutation are prone to miscarriage and placental infarction.

OBJECTIVES: The factor V Leiden mutation is the most common genetic predisposition to thrombosis. However, little is known concerning the reproductive outcome of mutation carriers or prenatal expressivity of this thrombogenic mutation. Our purpose was to examine whether this mutation presents phenotypically as miscarriage or idiopathic placental thrombosis. STUDY DESIGN: We performed two studies. First, a case-control comparison to determine whether fetal or maternal carriers of the factor V Leiden mutation are at risk for spontaneous miscarriage was performed, and, second, a cohort study evaluating placental infarction in fetuses carrying this mutation was performed. RESULTS: We found a twofold increase in the factor V Leiden carrier frequency in 12 of 139 (8.6%) abortuses compared with 17 of 403 (4.2%) unselected pregnant women seen in the labor and delivery suite and, even more remarkable, a tenfold increase in the fetal carrier frequency in 10 of 24 (42%) placentas with > 10% placental infarction compared with 7 of 372 (1.9%) placentas with < 10% placental infarction. CONCLUSIONS: These findings suggest a prenatal phenotype and effects of this mutation at the fetoplacental interface. If large prospective studies confirm these findings, then testing for this thrombogenic mutation should be considered in women and placental tissue from spontaneous abortuses and placentas with evidence of placental infarction. In addition to identifying individuals and families at risk for thrombosis, this information may help to improve our understanding of hemostasis and circulatory disturbances at the fetoplacental interface.

Abortion, Spontaneous↗
PubMed1997

The incidence of the factor V Leiden mutation in an obstetric population and its relationship to deep vein thrombosis.

OBJECTIVE: A common missense mutation in the factor V gene, the Leiden mutation, renders factor Va resistant to cleavage inactivation by activated protein C and predisposes patients to thrombotic events. We sought to evaluate the prevalence of the Leiden mutation and the associated thromboembolic events in a community hospital's low-risk obstetric population. STUDY DESIGN: Deoxyribonucleic acid was extracted from whole blood of 407 women. The polymerase chain reaction was used to amplify exon 10 of the factor V gene, followed by enzymatic digestion with MnI 1 for mutation detection. Medical charts were reviewed and patient characteristics, including age, gravidity, parity, obstetric complications, medical complications, and mode of delivery, were recorded. RESULTS: Fourteen of the 407 women carried the factor V Leiden mutation (13 heterozygotes and 1 homozygous mutant) for an allele frequency of 3%, consistent with the published carrier rate. Four of the 14 carriers (28%) had deep venous thrombosis, whereas the frequency of deep venous thrombosis in this obstetric population was <1%. Another patient carrying the mutation had a consumptive coagulopathy of unknown etiology at 20 weeks' gestation, necessitating delivery. CONCLUSIONS: The Leiden mutation is relatively common in the general obstetric population. The high rate of deep venous thrombosis noted in our series suggests the need for genetic testing for this mutation in women with a thrombotic event during pregnancy.

Adult↗
PubMed1997

Routine endocrine screening for patients with karyotypically normal spontaneous premature ovarian failure.

OBJECTIVE: To evaluate the usefulness of routine screening for other associated autoimmune endocrine disorders in patients with karyotypically normal spontaneous premature ovarian failure. METHODS: One hundred nineteen women with karyotypically normal spontaneous premature ovarian failure (FSH exceeding 40 mIU/mL) who desired fertility were evaluated at a tertiary care academic center by physical examination, measurement of serum free thyroxine and TSH, ACTH stimulation test, fasting serum glucose, 3-hour glucose tolerance test, measurement of serum electrolytes including total calcium, and measurement of serum vitamin B12. RESULTS: Twenty-two of 119 patients (18.5%) were known to have hypothyroidism and three were known to have Addison disease. Ten new cases of hypothyroidism and three new cases of diabetes mellitus were discovered. However, no new cases of adrenal insufficiency, hypoparathyroidism, or pernicious anemia were found. CONCLUSION: Screening for hypothyroidism and diabetes appears justified in those patients with karyotypically normal spontaneous premature ovarian failure who desire fertility. However, our findings suggest that in these patients, testing for other associated autoimmune endocrine disorders may be reserved for those with clinical indications.

Adolescent↗
PubMed1997

Post-thymectomy murine experimental autoimmune oophoritis is associated with reduced natural killer cell activity.

PROBLEM: Natural killer (NK) cells can influence the immune response by secreting potent lymphokines. It has been suggested that NK cells have a suppressive action on B cells, and that impaired NK cell activity may play a role in some types of autoimmunity. NK cell abnormalities have been reported in women with premature ovarian failure. We therefore examined NK cell activity during the development of murine experimental autoimmune oophoritis, which serves as a model for autoimmune ovarian failure in women. METHOD OF STUDY: Neonatally thymectomized and sham-operated C57B1/6 x A/J (B6A) mice were prepared and sacrificed at 4, 6, 8, and 10 weeks after surgery. Splenic NK cell activity was determined in groups of five or more mice by measuring the percent specific lysis of target YAC-1 lymphoma cells using a standard 4-hr chromium release cytotoxicity assay. The number of splenic NK cells in neonatally thymectomized and sham-operated animals was also compared using flow cytometry. In a subsequent experiment, interleukin 12 (IL-12; NK cell-stimulating factor) was administered to neonatal mice before neonatal thymectomy. RESULTS: Neonatally thymectomized mice with associated autoimmune oophoritis had a 75% reduction in the number of splenic NK cells, and 50% or greater reduction in splenic NK cell activity at 4, 6, and 8 weeks after surgery. IL-12 treatment before neonatal thymectomy maintained NK cell activity and was shown to ameliorate the associated autoimmune oophoritis. CONCLUSION: Murine post-thymectomy autoimmune oophoritis is associated with reduced NK cell number and impaired NK cell activity, and in these respects the model is similar to premature ovarian failure in women. Research to define the relationship between NK cell abnormalities and the mechanism of ovarian failure in this model might lend insight into the pathogenesis of premature ovarian failure in women.

Animals↗