[Qualifications of hospital personnel].
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Health Occupations↗
Biomedical subjects
M Haas
Publications and source records attributed to M Haas.
Accident followed by unusual complications.
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Adult↗
Characterization of direct readout contacts of the Myb DNA-binding domain.
The Myb protein contacts its recognition sequence by means of direct protein-DNA interactions. We used site-directed mutagenesis in order to substitute amino acids crucial for these contacts and probed the mutant proteins for their DNA-binding and transactiving activities. We could show that amino acids involved in direct readout contacts do not contribute equivalently in the recognition process.
Amino Acid Substitution↗
Protection by verapamil and nifedipine against ischaemia-induced loss of [3H]-(+)-PN 200-110 binding sites in the rat heart.
We have studied the effects of 60 min global ischaemia and 30 min of subsequent reperfusion on the binding of [3H]-(+)-PN 200-110 and [3H]-(-)-devapamil (desmethoxyverapamil or D888) in rat heart membranes. The hearts were perfused in the Langendorff-mode and pretreated with 1 mumol/l verapamil, 30 nmol/l and 1 mumol/l nifedipine. After 60 min of global ischaemia in the absence of drugs, we found a reduction of [3H]-(+)-PN 200-110 binding sites, without changes in the equilibrium dissociation binding constant (Kd). After the subsequent reperfusion maximum specific binding (Bmax) was further reduced, whereas the Kd remained constant. [3H]-devapamil binding sites were influenced to a lower extend and showed only a decrease in Bmax at reperfusion. Pretreatment with 1 mumol/l verapamil completely prevented the changes which were observed for [3H]-(+)-PN 200-110. Pretreatment with a low, vasodilating concentration (30 nmol/l) of nifedipine displayed selective protection against the extra reduction in Bmax which was observed during reperfusion. It is concluded that calcium antagonists show protection against the ischaemia-induced loss of dihydropyridine binding sites in relation to their negative inotropic, energy-saving activity. Furthermore, nifedipine at low, vasodilating but not negative inotropic concentrations protects against further reperfusion-induced injury, which protection may be related to an improved flow during reperfusion.
Animals↗
The hypothesis that antagonism of fentanyl analgesia by 2-chloroprocaine is mediated by direct action on opioid receptors.
BACKGROUND AND OBJECTIVES: Although 2-chloroprocaine continues to be a useful drug for epidural anesthesia in obstetrics, it has the anomalous action of decreasing the analgesic effectiveness of subsequently administered epidural fentanyl. Some investigators have suggested that 2-chloroprocaine may act at an opioid receptor site to antagonize the effects of fentanyl. The purpose of our studies was to investigate this hypothesis. METHODS: Radioligand binding assays using the mu and kappa opioid receptor-selective radioligands [3H]-DAMGO and [3H]-U69,593, respectively, were performed to determine the potencies of lidocaine, 2-chloroprocaine, and 2-chloroprocaine metabolites at the mu and kappa opioid receptor sites. Electrophysiologic experiments in in vitro hippocampal slice preparations were then used to examine the effects of 2-chloroprocaine at these opioid receptor subtypes. RESULTS: Lidocaine caused a partial reduction of [3H]-DAMGO binding, which was dose-limited owing to the solubility of lidocaine. 2-Chloroprocaine caused complete displacement of [3H]-DAMGO binding, with a median effective concentration of 1.44 +/- 0.36 mM. The EC50 values for [3H]-U69,593 displacement were 177 +/- 47 microM for 2-chloroprocaine and 2.53 +/- 0.48 mM for lidocaine. Assuming a competitive interaction between anesthetic and opioid, the Ki value for 2-chloroprocaine was 435 microM at mu receptors and 49 microM at kappa receptors. In the mu activity bioassay, 2-chloroprocaine reversed the increased neuronal excitability caused by fentanyl, but this effect was further reduced by naloxone. In addition, 2-chloroprocaine did not reverse the after depolarization caused by fentanyl. In the kappa activity bioassay, 2-chloroprocaine produced effects similar to the kappa agonist U69, 593, but these were not antagonized by naloxone. CONCLUSIONS: Although 2-chloroprocaine has binding affinity at mu and kappa opioid receptor sites, it does not appear to act through an opioid receptor to antagonize the physiologic effects of fentanyl.
Analgesics↗
Human T-cell lymphotropic virus type-I antibodies in Falashas and other ethnic groups in Israel.
Epidemiological studies of the human T-cell leukaemia/lymphoma virus type I (HTLV-I), a type-C retrovirus of the human T-lymphotropic virus family, have used serological surveys to identify population subgroups possessing a high prevalence of naturally occurring HTLV-I-specific antibodies. Studies carried out to delineate the global distribution of the virus have demonstrated natural antibodies to HTLV-I in the serum of healthy donors from specific geographical areas, and have defined viral endemic areas in Japan, the Caribbean basin, Africa and the southeastern United States. Such studies have suggested that the prevalence of HTLV-I antibodies is directly correlated with age, is associated with the clinical syndrome of adult T-cell lymphoma, and is associated with transmission from mother to child. A separate subtype of the human retrovirus, HTLV-II (refs 21, 22), has also been identified. The population of Israel in part comprises groups of immigrants of various ethnic and geographical origins. Because of this, and the fact that Israel has a highly developed public health system, we surmised that the ethnic groups in Israel could be used in a seroepidemiological survey of HTLV infection. The serological survey reported here demonstrates a high prevalence of HTLV-I antibodies in new immigrants from Ethiopia. This previously ethnically and geographically isolated group, the 'Black Jews' or 'Falashas', from the Gondar region in the northern rural highlands of Ethiopia, has the highest endemic rate of HTLV-I yet reported outside Japan.
Adult↗
A descriptive study of medical and chiropractic patients with chronic low back pain and sciatica: management by physicians (practice activities) and patients (self-management).
BACKGROUND: A practice-based study of ambulatory patients with low back pain noted a long-term outcome advantage for self-referred chiropractic (DC) patients over medical (MD) patients within a subgroup of patients with chronic low back pain and radiating pain below the knee. The frequency of self-care education by physicians in both provider cohorts coupled with current thinking on management of chronic low back pain led to an exploration and description of physicians' noncore practice activities and patients' self-management attitudes and behaviors. METHODS: A longitudinal, practice-based, observational study was undertaken in 14 general practice and 51 chiropractic community-based clinics. We enrolled 2945 consecutive patients with ambulatory low back pain of mechanical origin; of these, 268 comprised the subgroup of patients with chronic low back pain and radiating pain below the knee. The patients' low back status was followed for 1 year. Data on physicians' practice activities were obtained from doctor questionnaires completed at each patient visit and from chart abstraction. Patient data obtained from self-administered questionnaires at enrollment included sociodemographics, complaint characteristics, health status, and health encounter preferences. Questionnaires mailed at 2 weeks, 1 month, 3 months, 6 months, and 12 months collected data on low back complaint status and satisfaction with treatment. At 1 to 3 years follow-up, mailed questionnaires collected data on patients' self-management attitudes and behaviors. RESULTS: Physicians' core practice activities were as expected. Exercise plans and self-care education (>55%) were conspicuous in the frequency of their use in the DC cohort. MD patients appeared to rely more on family and friends for support during periods of back trouble. DC patients were characterized by greater self-efficacy motivation (P = .000). Both groups showed evidence of self-care activities during and between bouts of back pain, although MD patients were far more likely to choose bed rest (P = .007). CONCLUSIONS: The chiropractic encounter may have enhanced patients' self-efficacy motivation, leading to better coping abilities and better pain and disability outcomes. Understanding, respecting, and capitalizing on the role and influence of psychosocial factors can help all physicians become more effective healers and counselors for their patients with back pain.
Adult↗
Potentials and limitations of the low-molecular-weight protein lysozyme as a carrier for renal drug targeting.
Selective targeting of drugs to the kidney may enable an increased renal effectiveness combined with a reduction of extrarenal toxicity. Intrarenal delivery to the proximal tubular cell can be achieved using low-molecular-weight proteins, such as lysozyme. Administration of high dosages of lysozyme, required to study the effects of such conjugates in vivo, however, is restricted since a partial escape of the renal reabsorption and the occurrence of unwanted effects on systemic blood pressure and renal function may occur. The purpose of this study was to investigate the optimal parenteral administration schedule and the maximum dose of lysozyme, providing the most optimal tubular reabsorption and at the same time a minimal effect on blood pressure and renal hemodynamics, comparing continuous infusion of lysozyme with single dose injections. Urinary lysozyme excretion increased dose-dependently, both during continuous infusion and intravenous bolus injections. However, this loss of intact lysozyme into the urine was much higher after 3 injections of in total 250 mg x kg(-1) x 6 h(-1) (51.8+/-3.7% of the dose) compared to the same dose administered by continuous infusion (11.7+/-2.4%, P < 0.001). Continuous infusion of lysozyme up to 1000 mg x kg(-1) in 6 hours had no effect on systemic blood pressure, whereas a bolus injection of lysozyme (167 mg x kg(-1)) resulted in reversible blood pressure lowering of 52.2+/-2.2% (P<0.001). A dose-dependent decline of the glomerular filtration rate was observed at dosages of lysozyme higher than 100 mg x kg(-1) x 6 h(-1), with a maximal reduction of 53.0+/-3.7% after infusion of 1000 mg x kg(-1) x 6 h(-1). Effective renal plasma flow was less affected and only lowered statistically significant at dosages of 500 (-12.6+/-3.3%, P<0.05) to 1000 mg x kg(-1) x 6 h(-1) (-17.2+/-3.9%, P<0.01). We conclude that bolus injections of lysozyme should not be used for renal targeting purposes since it results in considerable tubular loss of lysozyme in the urine as well as cardiovascular side effects. In contrast, continuous infusion of lysozyme using dosages sufficient for renal drug targeting (maximally 15 mg x kg(-1) x h(-1)) only has minimal effects on blood pressure and renal hemodynamics, with a minimal urinary lysozyme loss as well.
Animals↗
The economic evaluation of health care.
Economic evaluation is the comparative analysis of alternative courses of action in terms of both costs and consequences. Economic evaluation can also be called economic appraisal or the cost-benefit approach. The basis of economic evaluation lies in comparing costs and benefits of an intervention, program or service. The most important reasons for undertaking an economic evaluation are that resources (e.g., money, time, staff, equipment) are scarce compared with the demands made on them, and that such resource constraints require choices to be made. In this paper, four types of economic evaluations (cost-minimisation, cost-effectiveness, cost-utility and cost-benefit analyses) are described.
Australia↗
A critique of patient satisfaction.
Measures of patient satisfaction have been developed primarily so that patients could furnish health care providers and services with feedback on the quality of health care provided to them. However, the theoretical underpinnings of the concept of patient satisfaction are under-developed and the framework within which patient satisfaction has evolved is considered by some to be in need of review and overhaul. In this article, the concept and measurement of patient satisfaction is critically reviewed. Potentially better ways of asking patients (and their families and carers) to describe and/or assess their care are suggested.
Patient Satisfaction↗
[Interstitial pneumopathy due to flecainide].
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Adrenal Cortex Hormones↗
A roentgenological evaluation of the relationship between segmental motion and malalignment in lateral bending.
OBJECTIVE: A radiographic study was undertaken to determine the relationship between static vertebral malalignment and segmental lumbar motion in lateral bending. DESIGN: Survey. SETTING: Chiropractic college student health center and private chiropractic clinic. PARTICIPANTS: 249 subjects: 114 with low back pain, 29 asymptomatic with no history and 106 asymptomatic with history. Of these, 194 were freshman volunteers and 55 were new private clinic low back pain patients. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Net lumbar segmental tilt and rotation in lateral bending: corrected and uncorrected for segmental malposition with the patient standing in the upright neutral position. RESULTS: There was moderate to good negative correlation of malalignment with segmental tilt motion and segmental motion asymmetry (r = -.42 to -.89, p less than .001). Correlation of malalignment with motion from the ideal neutral segmental position of perfect alignment was modest (r = .16-.42). A large variation in segmental motion was found for all segmental malalignments. CONCLUSIONS: This study suggests that malalignment is associated with segmental tilt motion in lateral bending, although large subject variability greatly compromises predictability on an individual basis. This study also indicates that segmental malposition may complicate the palpation of active range of motion. This is because the malalignment itself may facilitate a greater arc of segmental motion in the direction of comparative restriction in movement from the ideal neutral position to the extreme of lateral flexion.
Adolescent↗
Lumbar motion trends and correlation with low back pain. Part I. A roentgenological evaluation of coupled lumbar motion in lateral bending.
OBJECTIVE: A radiographic study was undertaken to describe the relationship between coupled lumbar motion in lateral bending and the presence of low back pain symptomatology, evaluate trends of coupled motion and determine if these trends were attributable to chance confluence of independent motions. DESIGN: Survey. SETTING: Chiropractic college student health center and private chiropractic clinic. PARTICIPANTS: 249 subjects: 114 with low back pain, 29 asymptomatic with no history and 106 asymptomatic with history. Of these, 194 were freshman volunteers and 55 were new private clinic low back pain patients. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Lumbar segmental coupled motion categories according to the scheme of Cassidy and Grice, as well as a modified scheme. RESULTS: Statistical analysis demonstrated no significant relationship (p = .01) between coupled lumbar motion and low back pain. When viewed intersegmentally, approximately half of all lumbar motion was type II; symmetric motion was rare and attributable to chance confluence of individual segmental motion. CONCLUSIONS: This study suggests that back pain is not an indication for the routine use of lateral bending films for the identification of abnormal coupled motion. Furthermore, each segmental categorization appears to be independent of contralateral categorization as well as motion at all other segmental levels. It is also suggested that type II motion cannot be ruled out as a normal variant. Finally, the ubiquity of coupled motion asymmetry suggests that symmetry must be reevaluated as a criterion for normal spinal function.
Adolescent↗
[The effect of age and educational level on the risk profile of men and women in industrial occupations].
The authors investigated a population group of 660 men and 440 women aged 35-60 years selected in the Skoda works and examined as part of the integrated programme of prevention of chronic non-infectious diseases. The risk profile of subjects associated with the life-style of the population was evaluated with regard to sex, age and education. It was revealed that the blood pressure rises with age and body weight in men and women. With rising body weight rises also the triglyceride and uric acid level and in women also the total cholesterol level. The authors confirmed the relationship between smoking and the thiocyanate blood level. The magnesium level declines with age in both sexes and correlates with the reported alcohol intake. Men and women with higher education smoke less, have a lower body weight and lower triglyceride blood levels. Women have also a lower total cholesterol level. University educated men consume less alcohol, while the reverse is true in university educated women.
Adult↗
The reliability of reliability.
Forty-five original articles addressing the subject of examiner reliability were reviewed to determine if the findings were adequately substantiated by the statistical analyses and experimental designs employed by the authors. Only 10 studies were determined to have properly supported conclusions, while an additional three studies contained correct conclusions by coincidence. Eight investigations had invalid designs and three contained claims that were contradicted by the author's findings. Half the studies were found to have conclusions that were based on inappropriate or inconclusive statistical analysis. To date, the research presented in the chiropractic literature cannot substantiate claims concerning the reliability of any diagnostic instrumentation or palpatory procedures commonly employed by chiropractic physicians.
Chiropractic↗
Interexaminer concordance in detecting joint-play asymmetries in the cervical spines of otherwise asymptomatic subjects.
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Cervical Vertebrae↗
A radiographic study of sacral base, sacrovertebral, and lumbosacral disc angles in persons with and without defects in the pars interarticularis.
There remains a lack of definitive evidence regarding the etiology of pars defects, though evidence is mounting in favor of micro-trauma. Approximation of the articular facets, as occurs in subjects with increased sacral base angles, may result in greater stress to this area, leading to the development of pars defects. Alternatively, pars defects may facilitate approximation of the articular facets, resulting in a higher sacral base angle. The purpose of this study was to determine whether persons with spondylolysis have greater sacral base angles compared to persons without spondylolysis. The sacral base, sacrovertebral, and lumbosacral disc angles were measured on 30 subjects with radiographic evidence of spondylolysis at L5, and on 95 radiographically normal subjects. A 26% difference in the sacral base angle between spondylolytic and normal males was discovered. The results for females were inconclusive due to the sample size. Baseline data for the sacral base, sacrovertebral and lumbosacral disc angles were established for both normal and spondylolytic males and females. No relationship was found between spondylolysis and these two angles.
Analysis of Variance↗
Skin blade versus deep blade: a vehicle of contamination in podiatric surgery.
A total of 166 surgical blades consisting of control blades, skin blades, and deep blades were cultured from 50 elective podiatric surgical cases. Five blades from four cases cultured Staphylococcus epidermidis. The practice of changing from skin blade to deep blade to reduce contamination of a clean surgical wound is not supported by the data obtained in this study.
Disinfection↗