The therapeutic use of technology.
Explore the source record for details and available documents.
Adaptation, Psychological↗
Biomedical subjects
M Fishman
Publications and source records attributed to M Fishman.
AIDS mania.
Twenty patients with HIV infection and mania were grouped according to whether their first manic episode occurred when CD4 count was < 200 (late onset) or > or = 200 (early onset). The late-onset patients were less likely to have personal or family histories of mood disorder and more likely to have dementia or cognitive slowing. They also exhibited a different manic symptom profile. The different sociodemographic and symptom profiles associated with early-onset and late-onset mania may reflect differences in pathophysiology.
Acquired Immunodeficiency Syndrome↗
Substance abuse among children and adolescents.
Explore the source record for details and available documents.
Adolescent↗
Psychiatric morbidity on entry to an HIV primary care clinic.
OBJECTIVE: To ascertain the prevalence and predictors of psychiatric distress in an inner-city HIV primary care clinic. DESIGN: Cross-sectional study. SETTING: Inner-city adult HIV clinic. PARTICIPANTS: A series of 222 HIV-infected patients newly presenting to the medical clinic for evaluation over a 1-year period. OUTCOME MEASURES: A screening method, based on the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI), whose sensitivity, specificity and positive predictive value for psychiatric diagnosis were previously established in this clinic. RESULTS: Fifty-two per cent of participants scored above the screening threshold (i.e., scored > 14 on the BDI or > 6 on the GHQ). A comorbid substance use condition was the most powerful and consistent predictor of psychiatric distress (P < 0.05). Limited education and current unemployment contributed to higher scores on the BDI or the GHQ (P < 0.05). However, HIV illness variables and psychiatric personal or family histories were not significant predictors of psychiatric distress (P > 0.05 in all cases). CONCLUSIONS: Rates of psychiatric distress in inner-city adult HIV clinics are much higher than in the general population or than in other outpatient medical clinics. They are also not associated with what most clinicians perceive as traditional risk groups such as psychiatric histories and social disadvantage. These findings support the position that easy access to psychiatric care is essential to HIV clinics.
Adult↗
Health care focus documentation--more efficient charting.
A revised nursing documentation system is now user-friendly, multi-disciplinary and computer adaptable. Sixteen health care focus topics replaced nursing diagnoses and served as a common thread to coordinate documentation of patient care.
Efficiency, Organizational↗
Psychiatric issues and emergencies in HIV infection.
Emergency departments are frequently the entry point for patients infected with HIV. Psychiatric conditions may be the initial predominant presentation or an important concomitant factor. Because of the complexities of HIV infection, the serious medical nature of its associated psychiatric complications, the frequent presence of comorbid substance use and other behavioral disorders, and the multiple sites of treatment involved, psychiatrists, emergency physicians, and other professionals must work in collaboration in screening patients infected with HIV for mental disorders and in providing careful and rational care.
AIDS Dementia Complex↗
TNF induction of EL4 hyposensitivity to lysis by recombinant (soluble) and membrane-associated TNFs: TNF binding, internalization, and degradation.
EL4 mouse thymoma cells sensitive to TNF-mediated lysis only in the presence of cycloheximide (S-EL4) or in the presence or absence of cycloheximide (N-EL4) were used in these experiments. Murine tumor cell line (S-EL4) sensitivity to TNF cytotoxicity is augmented when cycloheximide is added together with TNF or when cycloheximide is added 1 hr before or after TNF. No enhanced sensitivity is observed when target cells are incubated with cycloheximide 2-4 hr before or after the addition of TNF. In the absence of cycloheximide, S-EL4 cells preexposed to murine TNF are less susceptible to lysis by TNF and TNF receptor-conjugated TNF but are lysed by integral membrane TNF. TNF-induced hyposensitivity is partially reversed by actinomycin D or by culturing the preexposed cells for 4 hr prior to TNF lytic assay. TNF preincubation of N- and S-EL4 cells results in an immediate decrease in 125I-TNF binding due to TNF receptor occupancy. Recovery of TNF-R occupancy and TNF internalization were subsequently noted.
Animals↗
Screening for psychiatric morbidity in a medical outpatient clinic for HIV infection: the need for a psychiatric presence.
OBJECTIVE: To ascertain the prevalence and type of psychiatric morbidity present in HIV infected patients presenting for the first time to a specialty HIV medical clinic. Also, to develop a way of screening for psychiatric cases in this setting using established self-report questionnaires. METHOD: Fifty patients who presented consecutively for medical care at the Johns Hopkins Hospital General HIV Clinic participated in this study. These patients were first screened using the General Health Questionnaire and the Beck Depression Inventory and subsequently underwent a comprehensive neuropsychiatric evaluation. RESULTS: Fifty-four percent were found to suffer from a psychiatric disorder with an additional 22 percent from an active substance use disorder. These rates are one-and-one-half to two times higher than those reported from other medical clinics. The GHQ and BDI used together as screens could identify psychiatric "cases" with a sensitivity of 81 percent and a specificity of 61 percent, an efficacy similar to that found in other clinics. CONCLUSIONS: Given the high prevalence of psychiatric disorders in HIV infected patients presenting for medical care, screening, evaluating, and treating for these disorders is crucial and should be pursued systematically. This is best done through the presence of a psychiatric team within HIV medical clinics rather than in affiliation with such clinics.
Ambulatory Care Facilities↗
Evaluation and treatment of psychiatric disorders associated with HIV infection.
Explore the source record for details and available documents.
AIDS Dementia Complex↗
TNF receptor involvement in TNF-mediated activities against syngeneic malignant and normal mouse thymocytes.
Receptor-dependent tumor necrosis factor (TNF)-mediated activities against mouse thymoma cells and normal thymocytes syngeneic for C57 mice were examined to determine the specific involvement of TNF receptors R1 and R2. Both receptors are expressed by EL4 thymoma cells and normal C57 thymocytes. TNF-mediated activities included (a) cytotoxicity, (b) induction of hyposensitivity to TNF-mediated lysis, (c) costimulatory stimulation of thymocyte proliferation, and (d) activation of NF-kB-like transcription factor. The ability of polyclonal antisera against TNF receptors to mimic the above TNF-mediated activities was determined. The results clearly showed that anti-TNF-R1 antibodies were cytotoxic against EL4 cells, induced hyposensitivity of S-EL4 to TNF lysis and activated the NF-kB-like transcription factor in EL 4 cells and syngeneic normal thymocytes. Antisera against TNF-R2 only mimicked TNF-mediated costimulation of thymocyte proliferation with IL2. No direct correlation was noted between TNF activation of NF-kB and TNF-mediated lysis.
Animals↗
Intramolecular dynamics in the environment of the single tryptophan residue in staphylococcal nuclease.
The dipole relaxational dynamics in the environment of a single tryptophan residue Trp-140 in staphylococcal nuclease was studied by time-resolved (multi-frequency phase-modulation) spectroscopy and selective red-edge excitation. The long-wavelength position of the fluorescence spectrum (at 343 nm) and the absence of red-edge excitation effects at 0 and 20 degrees C indicate that this residue is surrounded by very mobile protein groups which relax on the subnanosecond time scale. For these temperatures (0-20 degrees C) the steady-state emission spectra did not show the excitation-wavelength dependent shifts (red-edge effects) for excitation wavelengths from 295 to 308 nm; however, the anisotropy decay rate is slow (tens of nanoseconds). This suggests that the spectral relaxation is due to mobility of the surrounding groups rather than the motion of the tryptophan itself. The motions of the tryptophan surrounding are substantially retarded at reduced temperatures in viscous solvent (60% glycerol). The temperature dependence of the difference in position of fluorescence spectra at excitation wavelengths 295 and 305 nm demonstrate the existence of red-edge effect at sub-zero temperatures, reaching a maximum value at -50 degrees C, where the steady-state emission spectrum is shifted to 332 nm. The excitation and emission wavelength dependence of multi-frequency phase-modulation data at the half-transition point (-40 degrees C) demonstrates the existence of the nanosecond dipolar relaxations. At -40 degrees C the time-dependent spectral shift is close to monoexponential with the relaxation time of 1.4 ns.
Binding Sites↗
Divergence between cytotoxic effector function and tumor necrosis factor alpha production for inflammatory CD4+ T cells from mice with Sendai virus pneumonia.
Sendai virus pneumonia in beta 2-microglobulin-deficient [beta 2-m(-/-)] mice lacking CD8+ T cells is characterized by the development of CD4+ cytotoxic T lymphocytes that can be recovered directly from the respiratory tract. These CD4+ cytotoxic T lymphocytes are not found in beta 2-m (+/+) mice, though inflammatory CD4+ T cells from both beta 2-m (-/-) and beta 2-m (+/+) mice produce substantial amounts of tumor necrosis factor alpha. Blocking experiments with a monoclonal antibody that also inhibits tumor necrosis factor beta show that the secreted forms of these two cytokines are not responsible for virus-specific killing of class II major histocompatibility complex-compatible targets. Comparison of electron micrographs indicates that the CD4+ effectors from the beta 2-m (-/-) mice are potent inducers of apoptosis, while this is not the case for the beta 2-m (+/+) CD4+ set. These experiments further define the functional status of virus-specific CD4+ T cells responding in vivo in the presence or absence of CD8+ effectors.
Animals↗
Manic syndrome early and late in the course of HIV.
In a chart review at a hospital's infectious disease AIDS clinic, manic syndromes affected 8% of patients who had AIDS. Of the 14 patients with manic episodes, those without a family or personal history of mood disorder presented later in the course of HIV infection and had a higher prevalence of comorbid dementia.
AIDS Dementia Complex↗
Cytolytic activities of activated macrophages versus paraformaldehyde-fixed macrophages; soluble versus membrane-associated TNF.
Membrane-associated tumor necrosis factor (TNF) and soluble TNF were compared as to their lytic activities, and as to the kinetics of their expression by macrophages activated with LPS and/or IFN-gamma in the presence or absence of cycloheximide. EL 4 tumor cells, resistant and sensitive to lysis by recombinant TNF or membrane-associated TNF (paraformaldehyde (PF)-fixed activated macrophages) were used as targets. In the presence of cycloheximide the TNF-resistant S-EL4 cells were lysed by both TNFs. PF-fixed macrophages was cytolytic after 1 hr activation but not after 3 or more hours of activation. Their activity was totally inhibited by anti-TNF antibodies and was a composite of transmembrane (integral) TNF and soluble TNF conjugated to macrophage membrane TNF receptors. Treatment of the macrophages with glycine pH 3.0 buffer dissociated the conjugated TNF without affecting the integral membrane TNF. When macrophages were activated with LPS +/- IFN-gamma in the presence of cycloheximide or activated just with IFN-gamma their activity after fixation with paraformaldehyde was no longer detected. Nonfixed macrophages under these conditions still remained cytotoxic. Tumor cell susceptibility to membrane-associated TNF activity, in contrast to recombinant (soluble) TNF, was greatly reduced in the presence of nicotinamide, an inhibitor of ADP-ribosyltransferase, suggesting that the mechanisms of lysis by these TNFs may be different. The lytic activity of both TNFs was found to be receptor-dependent in that tumor cells, whose TNF binding sites were "down-regulated" by TPA, were rendered resistant to lysis by both membrane-associated and soluble TNFs.
Animals↗
Pancreatitis causing focal caliectasis.
Explore the source record for details and available documents.
Dilatation, Pathologic↗
Tumor necrosis factor-alpha analyzed within individual macrophages by combined immunocytochemistry and computer-aided image analysis.
Immunocytochemical staining procedures were combined with computer-aided image analysis to quantitate the relative intracellular production of tumor necrosis factor-alpha (TNF) within individual macrophages. Optimal conditions for time and methods for the activation of TNF production, fixation of cells for optimal immunocytochemical staining, and image analysis methods were determined. Thioglycolate elicited peritoneal macrophages were readily activated to significantly increased levels of intracellular TNF, as early as 1 hr after activation with lypopolysaccharide (LPS) + interferon-gamma: maximum intracellular TNF was evident after 2-3 hr. Both LPS and interferon-gamma was necessary to increase intracellular TNF. Normal alveolar macrophages also readily produced increased intracellular TNF, but normal peritoneal and splenic macrophages were poorly activated to TNF production. Acid stripping of receptor bound TNF allowed discrimination between intracellular TNF/integral membrane TNF, and TNF-receptor-bound TNF. Results stress the importance of studying these TNF forms early after activation. Applications for TNF quantitation by these means are discussed.
Animals↗
TPA induction of EL4 resistance to macrophage-released TNF: role of ADP-ribosylation in tumoricidal activities of TNF and other factors.
Activated macrophages synthesize and release numerous tumoricidal soluble factors that can be divided into receptor- or nonreceptor-dependent agents. Tumor necrosis factor (TNF) would be an example of the former. In our experimental model the killing of EL4 thymoma cells by syngeneic activated macrophages involves, but not exclusively, TNF. Our results show that approximately 50% of the anti-EL4 activity expressed by macrophages can be specifically inhibited with rabbit anti-mouse TNF antibody. EL4 variants resistant to the lytic activity of TNF were still susceptible to macrophage-mediated lysis. A tumor-promoting phorbol ester, TPA, rendered TNF-sensitive and -insensitive EL4 cells resistant to M phi-mediated lysis. However, TPA down-regulated TNF-specific binding sites on both TNF-sensitive and -resistant cell surface membranes, suggesting that resistance to TNF involves postligand:receptor events. Tumor cell G-protein involvement (ADP-ribosylation), as a result of TNF-TNF receptor interactions, was investigated. The results showed that pertussis toxin was cytotoxic against TNF-sensitive and -resistant EL4 cells but not against TPA-treated target cells. Inhibitors of ADP-ribosyltransferase inhibited pertussis toxin cytotoxicity and macrophage-mediated lysis but did not interfere with recombinant TNF lytic activity.
Animals↗
Binding of polymyxin B to rat alveolar macrophages.
The specific binding of radiolabeled polymyxin B (PmB) to rat alveolar macrophages was investigated. PmB retained its ability to inhibit lipopolysaccharide-induced tumor necrosis factor production by macrophages as long as one of five amino groups on PmB was unbound. Binding was saturable and temperature- and time-dependent, reaching steady state by 30 min at 37 degrees C and by 18 h at 4 degrees C. Macrophages had approximately 1.6 X 10(7) (Kd = 0.28 nM) PmB binding sites per cell. Lipid A had no appreciable effect on the number of sites. Binding did not occur to rat platelets, L929 fibroblast cells, a rat thymoma cell line, or precursor monocytic and myeloid cell lines. Precursor cells activated with 12-O-tetradecanoylphorbol-13-acetate acquired binding similar to that seen in alveolar macrophages, but L929 fibroblasts did not. Binding sites were sensitive to trypsin but not to phospholipase C. PmB may interact with specific binding sites involved in lipopolysaccharide-induced activation, production, or release of tumor necrosis factor by macrophages, inhibiting the effects of lipopolysaccharide on macrophages.
Animals↗