Living again. Family treatment at KIDS of North Jersey.
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Adolescent↗
Biomedical subjects
M Newton
Publications and source records attributed to M Newton.
Bone composition measured by x-ray scattering.
Ten composite samples consisting of cortical bone and adipose tissue, in known proportions, were made. The intensity of monochromatic x-rays (energy 8 keV) scattered by these samples was determined as a function of the modulus of the scattering vector, K. The ratio of the heights of peaks at K values of around 134 and 22 nm-1 provided a measure of the ratio of adipose tissue to bone mineral in these samples. This method was then used to determine the ratio of adipose tissue to mineral in samples of trabecular bone from 16 vertebral bodies. The results were correlated with measurements of the bone composition determined by ashing (r = 0.66) and histomorphometry (r = 0.66). Furthermore, the ashing and histomorphometry results were correlated with each other (r = 0.68). The feasibility of using higher energy x-rays (35-80 keV) for obtaining the same information from bone within the body is briefly discussed.
Adipose Tissue↗
Objective clinical evaluation of physical impairment in chronic low back pain.
The aim of this study was to investigate physical impairment in patients with chronic low back pain, to develop a method of clinical evaluation suitable for routine use, and to consider the relationship between pain, disability, and physical impairment. Twenty-seven physical tests were investigated. Permanent anatomic and structural impairments of spinal deformities, spinal fractures, surgical scarring, and neurologic deficits were excluded as not relevant to the patient with low back pain in the absence of nerve root involvement or previous surgery. Three consecutive 20-patient reproducibility studies were used to develop reliable methods of examination for 23 of the tests. Only four tests were excluded as unreliable: sacral angle, pelvic tilt, and separate lumbar and pelvic extension, none of which are part of routine clinical examination or have any proven relationship to disability. The remaining 23 physical tests were evaluated in 70 asymptomatic subjects and 120 patients with chronic low back pain. Passive knee flexion, passive hip flexion, hip flexion strength, hip abduction strength, pain reproduction on each of these tests, and the prone extension strength test were excluded because they were too closely related to nonorganic and behavioral responses to examination. Eight tests successfully discriminated patients with low back pain from normal subjects and were significantly related to self-report disability in activities of daily living: pelvic flexion, total flexion, total extension, lateral flexion, straight leg raising, spinal tenderness, bilateral active straight leg raising, and sit-up. Factor analysis failed to demonstrate an underlying statistical dimension of physical impairment. However, an empirical combination of total flexion, total extension, average lateral flexion, average straight leg raising, spinal tenderness, bilateral active straight leg raising, and sit-up provided an equally satisfactory alternative. Simple cut-offs from normal subjects made the scale simple and quick to use. This final scale successfully discriminated 78% of patients and normal subjects and explained 25% of the variance of disability, with a specificity of 86% and sensitivity of 76%. This scale provides an objective clinical evaluation that meets the criteria for evaluating physical impairment, yet is simple, reliable, and suitable for routine clinical use. It should, however, be emphasized that all the tests included in the final scale are measures of current functional limitation rather than of permanent anatomic or structural impairment. This raises questions about the physical basis of permanent disability due to chronic low back pain.
Activities of Daily Living↗
Reviewing the "big three" injection routes.
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Education, Nursing, Continuing↗
The effect of transplantation site and islet mass on long-term survival and metabolic and hormonal function of canine purified islet autografts.
Determination of the long-term function of islet transplantation in relation to the implantation site and the numbers of islets is of scientific interest and, with human islet transplant trials in progress, is a pressing clinical question. In this study, highly purified canine islets were isolated by collagenase digestion and Ficoll purification, and autotransplanted into either the spleen (in 10 dogs) or the liver (in 12 dogs). Dogs transplanted with islets into the spleen or liver received 264,300 +/- 20,300 (mean +/- SEM) and 158,600 +/- 15,000 islet equivalents (150-microns-sized islets) respectively. Graft survival at 1 yr was 86% in intrasplenic islet autografts (ISTx) and 50% in intraportal islet autografts (IPTx). Intravenous glucose tolerance tests and mixed meal-oral glucose tests were performed 1-12 mo from islet transplantation. Compared to controls, ISTx and IPTx dogs showed a similar decrease of glucose tolerance after both intravenous glucose tolerance tests and mixed meal-oral glucose tests. On intravenous glucose tolerance tests, plasma insulin levels were lower in ISTx than in IPTx dogs and controls. On mixed meal-oral glucose tests, insulin values were higher in IPTx dogs than in controls. There was a positive correlation (r = .56, p < 0.05) between the number of transplanted islet equivalents and the K values. These results demonstrate that, in dogs with islet transplant: 1) long-term islet survival can be achieved in the spleen better than in the liver; 2) islet survival is related to the mass of transplanted islets in the spleen, but not in the liver, where other factors probably affect islet survival; 3) the ability of metabolizing glucose is reduced after both intrasplenic and intraportal islet autografts; 4) both reduced insulin secretion (predominant in ISTx dogs on intravenous glucose tolerance testing) and insulin resistance (predominant in IPTx dogs on mixed meal-oral glucose tests) are the probable causes of the decreased glucose tolerance.
Animals↗
Glucose metabolism, insulin sensitivity, and glucagon secretion in dogs with intraportal or intrasplenic islet autografts.
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Animals↗
Use of the polymerase chain reaction for homology probing of butyrylcholinesterase from several vertebrates.
Genomic blots from man, monkey, cow, sheep, pig, rabbit, dog, rat, mouse, guinea pig, and chicken DNA were hybridized with probes derived from the four exons of the human butyrylcholinesterase gene (BCHE) (Arpagaus, M., Kott, M., Vatsis, K. P., Bartels, C. F., La Du, B. N., and Lockridge, O. (1990) Biochemistry 29, 124-131). Results showed that the BCHE gene was present in a single copy in the genome of all these vertebrates. The polymerase chain reaction was used to amplify genomic DNA from these animals with oligonucleotides derived from the human BCHE coding sequence. The amplified segment contained 423 bp of BCHE sequence including the active site serine of the enzyme (amino acid 198) and a component of the anionic site, aspartate 70. Amplification was successful for monkey, pig, cow, dog, sheep, and rabbit DNA, but unsuccessful for rat, guinea pig, mouse, and chicken DNA. Amplified segments were cloned in M13 and sequenced. The mouse sequence was obtained by sequencing a genomic clone. The highest identity of the human amino acid sequence was found with monkey (100%) and the lowest with mouse (91.5%). The sequence around the active site serine 198, Phe-Gly-Glu-Ser-Ala-Gly-Ala, was conserved in all eight animals as was the anionic site component, aspartate 70. A phylogenetic tree of mammalian butyrylcholinesterases was constructed using the partial BCHE sequences.
Amino Acid Sequence↗
The effects of exercise in a coronary rehabilitation programme.
Twenty-two male and female patients who had recently suffered a myocardial infarction were randomly assigned to a treatment group who participated in a 10-week exercise-based cardiac rehabilitation programme or a routine care group who did not participate in the rehabilitation programme. Physiological and psychological function were assessed before the programme started and after it finished. Results indicated that the treatment group did not improve physiological functioning more than the control group but they did evidence statistically significant improved psychological functioning. This investigation appears to be the first attempt to assess the potential benefits of an exercise-based cardiac rehabilitation programme in Glasgow and supports the suggestion that exercise-based cardiac rehabilitation has psychological benefits.
Aged↗
Molecular cloning of mouse acetylcholinesterase: tissue distribution of alternatively spliced mRNA species.
We have isolated cDNA clones encoding acetylcholinesterase from mouse muscle and brain. The polymerase chain reaction was used to amplify cDNA clones from C2 myotubes encoding the entire open reading frame and large segments of the 5' and 3' untranslated regions. The muscle cDNA clones were used to isolate clones from a brain library encoding the same mRNA species. The mouse clones encode a catalytic subunit containing a C-terminal sequence similar to that of the hydrophilic species of Torpedo. The mouse acetylcholinesterase sequence shares approximately 88% and 61% amino acid identity with bovine and Torpedo acetylcholinesterases, respectively, but only 52% identity with mouse butyrylcholinesterase, the sequence of which we have also deduced by molecular cloning. Northern blot and RNAase protection analyses indicate that the cDNA clones were derived from the acetylcholinesterase transcript that predominates in most expressing tissues. In contrast, erythroid cells are enriched in an mRNA species whose sequence diverges from that of the cDNA in the region encoding the C-terminus of the enzyme.
Acetylcholinesterase↗
The glucose tolerance curve in the aging.
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Aged↗
Tropical spastic paraparesis and human T cell lymphotropic virus type 1 in the United Kingdom.
Twenty-one patients with tropical spastic paraparesis (TSP), all of whom were born in the Caribbean and who had migrated to the United Kingdom, are described. All had a progressive spastic paraparesis developing many years after immigration and all 19 tested had antibodies to the human T cell lymphotropic retrovirus type 1 (HTLV1). The clinical and laboratory features and visual, auditory and somatosensory evoked potentials are described. Details of magnetic resonance scanning of the brain and, in a few cases, the spinal cord are compared with those found in multiple sclerosis. The antibody titres to HTLV1 assessed by particle agglutination, Western blot, antibody-directed cell mediated cytotoxicity and pseudotype neutralization were higher than in asymptomatic infected relatives and in patients with adult T cell leukaemia. Some, but not all, of the IgG oligoclonal bands in the CSF were directed against HTLV1. IgM oligoclonal bands directed against HTLV1 were found in 2 patients. Sixty of the 64 first degree relatives of 11 Jamaican patients with TSP were traced in the UK and the Caribbean; 20-30% of those born in the Caribbean had antibodies to HTLV1, irrespective of their present place of residence, whilst none of those born in the UK, who were the children of the patients, had antibodies. The original pathological material obtained from the Caribbean by Montgomery et al. (1964) is reviewed. These results are discussed in relation to animal retroviral neurological diseases, particularly visna in sheep which has clinical and pathological features closely similar to TSP. It is proposed that TSP is due to a HTLV1 infected lymphocyte/macrophage immune-mediated inflammatory response in the spinal cord.
Adult↗
Double-wire angioplasty of the right coronary artery bifurcational stenosis.
Two cases of distal right coronary artery (RCA) bifurcational stenoses involving ostia of the posterolateral (PLA) and the posterior descending (PDA) branches in patients who underwent successful coronary angioplasty using a double-wire technique are reported. A single guiding catheter and sequential balloon inflations were utilized in one, and two guiding catheters and simultaneous balloon inflations in the other. The indications, techniques, and outcomes are described.
Angiography↗
Psychologic, physical, nutritional, and technologic aspects of intravenous infusion during labor.
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Attitude of Health Personnel↗
Nurse-identified problems in the management of alcoholic patients.
The purpose of this exploratory study was (1) to identify and rank the patient problems of hospitalized alcoholics that medical-surgical nurses view as difficult to manage, (2) to identify the factors that contribute to the difficulty in care, (3) to identify interventions used by nurses in an attempt to resolve patient problems and (4) to describe relationships between nurses and the identified patient problems. Subjects (N = 83) completed and returned an open-ended questionnaire by listing the physiological and psychosocial patient problems, factors and interventions. Selected demographic and biographic data were also collected. A nursing diagnosis classification described by others served as a basis and was adapted for the nursing diagnosis categories. Nominal data were analyzed using frequency distributions and percentages. The most difficult physiological problems in caring for alcoholic persons were categorized from subjects' responses using the nursing diagnoses of "potential for injury," "alterations in nutrition-elimination" and "fluid volume deficit." The nursing diagnosis categories of "ineffective individual coping," "ineffective family coping" and "noncompliance" comprised the most difficult psychosocial patient problems. A majority of subjects reported having limited classroom and clinical experience with alcoholism; 80% expressed a need for additional inservice education. It is recommended that nursing educational programs include didatic and clinical content about alcoholism, focusing on problem areas identified and on family dynamics, communication, coping strategies and time-management strategies.
Adult↗
Coping with diagnosis related groups. The changing role of the nursing home.
In an attempt to document the changing role of a specific nursing home in the delivery of medical care since the initiation of diagnosis related groups (DRGs), we studied 100 consecutive patients initially admitted to the Veterans Administration Medical Center-Milwaukee Nursing Home Care Unit (NHCU) during the first 23 weeks of 1986 (post-DRGs). Patient characteristics, reason for NHCU admission, and patients' final disposition were determined and compared with those of consecutive patients admitted to the same facility during an identical time period in 1983 (pre-DRGs). More than seven times as many patients were admitted in 1986, and prior to NHCU admission the acute care hospital stay was significantly shorter in 1986 (22 vs 60 days). Whereas in 1983, most patients (94%) were admitted to the NHCU for long-term care placement, in 1986, the majority of patients (64%) were admitted for continuation of therapy started in the acute care hospital. In 1983 only two patients (9%) required hospital readmission within ten days of NHCU admission, compared with 22 (22%) of the patients in 1986. At the termination of the study period, none of the 31 patients admitted to the NHCU in 1983 had been discharged; in comparison, 33% of the patients in 1986 were discharged home. We conclude that in 1986 certain nursing homes drastically changed their role in the delivery of medical care, and are now functioning as extensions of acute care hospitals. Such a role is advantageous in allowing patients to be quickly discharged from the acute care hospital; however, the changing role presents new problems and challenges.
Aged↗
Ligand-receptor interactions required for commitment to the activation of the interleukin 2 gene.
Concanavalin A (Con A), which together with phorbol myristate acetate (PMA) can activate the human T cell line Jurkat to produce interleukin 2 (IL 2), is shown to depend on the expression of the T3/T cell antigen receptor heterodimer (T3/Ti) complex to induce activation. alpha-methyl mannoside was able to reverse all of the observed effects of Con A on intracellular biochemical events. Therefore, ligand-receptor occupancy appears to be required for sustaining biochemical events associated with triggering the T3/Ti complex. Studies of the time-dependent requirements for the two stimuli required for activation revealed that simultaneous stimulation with both Con A and PMA is required for 2 to 4 hr for the cell to commit itself to activation, as measured by the appearance of secreted IL 2. This 2- to 4-hr requirement correlated precisely with the appearance of IL 2 mRNA, and the appearance of IL 2 transcripts depended on protein synthesis during this critical time period.
Antigens, Differentiation, T-Lymphocyte↗
Molecular events involved in regulating human interferon-gamma gene expression during T cell activation.
The human T cell line Jurkat is a useful model of regulated T cell activation. After in vitro treatment of Jurkat with phytohemagglutinin (PHA) and phorbol ester (PMA), RNA transcripts of both interleukin 2 (IL 2) and interferon-gamma (IFN-gamma) appear, followed by secretion of both biologically active lymphokines. Employing the nuclear run-on technology, we first confirmed that the expression of both lymphokines after T cell activation is regulated at the transcriptional level. By using the recombinant approach of DNase I hypersensitivity mapping, we had previously localized a structurally unique, lymphocyte-specific genomic domain in the first intron of the human IFN-gamma gene that correlated with the transcriptional potential of that gene. By using several T cell lines that differ in their inducible expression of IFN-gamma, we have now localized several additional structural domains within the human IFN-gamma gene that appear to be coordinately involved in regulating expression. These include: a distal 5' flanking region site also seen only in T lymphocytes that can express the gene, a proximal, promoter-associated site that appears only after PHA/PMA-mediated IFN-gamma induction, and a second intronic site seen only in T cells whose IFN-gamma gene is selectively inactive. Collectively, our data suggest that T cell activation is accompanied by transcriptional level induction of lymphokine gene expression. In the case of IFN-gamma, T cell nuclei possess specific structural domains within the gene itself that seem to participate both positively and negatively in activation-mediated regulatory events.
Base Sequence↗