Alterations in the functional properties of dorsal root ganglion cells with unmyelinated axons after a chronic nerve constriction in the rat.
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Animals↗
Biomedical subjects
M Petersen
Publications and source records attributed to M Petersen.
A genomic polymorphism within the tumor necrosis factor locus influences plasma tumor necrosis factor-alpha concentrations and outcome of patients with severe sepsis.
OBJECTIVES: To determine the allele frequency and genotype distribution of a bi-allelic tumor necrosis factor (TNF) gene polymorphism and plasma TNF-alpha concentrations in postoperative intensive care unit (ICU) patients suffering from severe sepsis. DESIGN: Prospective, consecutive entry study of patients with severe sepsis in a postoperative ICU. SETTING: University hospital. PATIENTS: Forty patients with diagnosis of severe sepsis, admitted to the ICU between June 1993 and December 1994. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A 782 basepairs fragment of genomic DNA, including the polymorphic site of the restriction enzyme Ncol within the TNF locus, was amplified by means of polymerase chain reaction. The genotype of each patient was determined after Ncol digestion of the amplified product and subsequent agarose gel electrophoresis. Reading the size of the resulting DNA bands from the agarose gel demonstrated the genotype, as defined by the two alleles TNFB1 and TNFB2. Serial blood samples were drawn every sixth hour during the first 48 hrs and every 12th hour thereafter, for < or = 96 hrs after diagnosis. TNF-alpha plasma concentrations were detected by an enzyme-linked immunosorbent assay. Assessment of organ dysfunction was performed by calculating a Multiple Organ Failure score. The overall allele frequency (TNFB1 0.35; TNFB2 0.65) and genotype distribution (TNFB1 homozygotes 10%; TNFB1/TNFB2 heterozygotes 48%; TNFB2 homozygotes 42%) in 40 patients with severe sepsis were comparable with those values found in normal individuals. Development of multiple organ failure occurred in 33 (82.5%) of 40 patients, whereas 23 (57.5%) of 40 patients did not survive. In contrast to the overall allele frequency, nonsurvivors showed a significantly higher prevalence of the allele TNFB2(p < .005). Patients homozygous for the allele TNFB2 demonstrated a higher mortality rate than heterozygous (TNFB1/TNFB2) patients (p = .0022). In addition, patients with TNFB2 homozygotes displayed higher circulating TNF-alpha concentrations as well as higher Multiple Organ Failure scores compared with heterozygous (TNFB1/TNFB2) patients. CONCLUSIONS: The bi-allelic Ncol polymorphism within the TNF locus is a genomic marker for patients with increased TNF-alpha response and poor prognosis in severe sepsis. The amount of TNF released in situations of severe infection and sepsis appears to be influenced genetically. TNFB2 homozygous individuals displaying increased circulating TNF plasma concentrations combined with high mortality rate may be included in future studies testing anti-TNF strategies in severe sepsis.
Acute Disease↗
Etiology and age have only a limited influence on the course of acute pancreatitis.
In a retrospective study of 602 patients with a first attack of acute pancreatitis, it was investigated whether the etiology of the disease and age of the patient are negative factors. There was no significant difference concerning hospital stay, respiratory and renal insufficiency, indication for surgery, or mortality rate among the different etiological groups. However, pancreatic pseudocysts developed significantly more frequently in alcoholics than in patients with other etiologies (p < 0.001 to p = 0.007). There was also no difference concerning hospital stay and respiratory insufficiency among the age groups. The increased incidence of renal insufficiency probably is related to physiological alteration with age, but the indication for dialysis did not increase. Pancreatic pseudocysts were more frequent in patients between 31 and 40 years of age, which was also the peak age group of alcoholics. Indication for surgery was the same for all age subgroups. The increase in mortality rate with age was weakly significant (p = 0.049). For the etiological subgroups, an increase in mortality with age was found only for biliary pancreatitis patients (p = 0.003). It is concluded that etiology and age of the patient have only limited influences on the course of acute pancreatitis.
Acute Disease↗
Cognitive behavioral pain and anxiety interventions in pediatric oncology centers and bone marrow transplant units.
Although research conducted on the treatment of pain and anxiety in children has found a number of cognitive behavioral interventions to be effective, it is not known to what extent this research has been put into practice. The purpose of this project was to obtain information on the use of cognitive behavioral interventions to help children and families cope with the pain and anxiety experienced during lumbar punctures and bone marrow aspirations. In this descriptive study, 15 Pediatric Bone Marrow Transplant Units and 32 Pediatric Hematology/Oncology Centers from across the country were surveyed using a questionnaire developed to obtain information on the use and effectiveness of cognitive behavioral interventions and the availability of support services. This survey indicates that most centers use a number of cognitive behavioral interventions to help children cope with painful procedures. However, some interventions, such as providing information before procedures and positive reinforcement after procedures, are used more frequently than interventions, such as rhythmic breathing, distraction, and imagery, that require more time and training. A variety of support services were available, although psychological services were primarily available on an as needed basis and support groups were not usually offered on an ongoing basis. In general, nurses are the major providers of these interventions, with other professionals providing interventions specific to their training. Nurses need to continue to study appropriate ways to incorporate use of effective cognitive behavioral interventions into the routine care of children with cancer.
Adolescent↗
Nucleoskeleton and nucleo-cytoplasmic transport in oocytes and early development of Xenopus laevis.
We use amphibian oocytes and eggs as favorite biological systems to study various cell biological phenomena. We have analyzed the role of the zinc finger protein TFIIIA and ribosomal protein L5 in nucleo-cytoplasmic transfer of 5S ribosomal RNA and report on the structural requirements of the 5S RNA for the interaction with TFIIIA. Furthermore, we have used the oocyte/egg system to analyze the kinetics of the posttranslational isoprenylation of oocyte nuclear lamin B3 and its fate during egg maturation. We demonstrate, that isoprenylation of newly synthesized lamins takes place in the oocyte cytoplasm before uptake into the nucleus and show, that the isoprene modifications alone are not sufficient to maintain stable association of lamins with nuclear envelope derived membranes in eggs. Finally, initial results of the identification of cis-acting sequence elements, involved in translational repression of lamin mRNAs in oocytes, are reported.
Animals↗
Morbidity and mortality in 602 patients with acute pancreatitis seen between the years 1980-1994.
The course of a first attack of acute pancreatitis was evaluated in a retrospective study of 602 patients, who were admitted between 01.01.1980 and 30.09.1993 to the Centers of Internal Medicine and Surgery of the University of Göttingen (n = 417) and from 16.11.1986 to 30.06.1994 to the Municipal Hospital of Lüneburg (n = 185). Etiology was biliary tract disease in 227 (37.7%), alcohol abuse in 177 (29.4%), unknown in 133 (22.1%), and other causes in 65 (10.8%) patients. Mean hospital stay was 27.9 +/- 24 days (x +/- SD), median 23 days. Pancreatic pseudocysts developed in 14.3% of the patients, and surgical treatment was necessary in 11.1%. Within the first 48 hours, respiratory insufficiency was observed in 63.2% of the 204 patients undergoing arterial blood gas analysis while renal impairment occurred in 32.6% of 602 patients. Artificial ventilation was indicated in 12.5%, and dialysis in 7% of the patients. Mortality rate was 6.1%, correlating significantly with respiratory and renal impairment and procedures in connection with these complications and also with transfers from other hospitals.
Acute Disease↗
Developmental disabilities and insurance concerns.
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Child↗
Cardiac pacing for prevention of recurrent vasovagal syncope.
PURPOSE: To review the status of cardiac pacing for the treatment of patients with recurrent vasovagal syncope. DATA SOURCES: A MEDLINE search for English- and French-language articles published between 1980 and 1994 about cardiac pacing for prevention or treatment of vasovagal syncope. The term cardiac pacing was used in conjunction with the terms vasovagal, neurally mediated, or neurocardiogenic syncope, but not with the term carotid sinus hypersensitivity. STUDY SELECTION: Case reports and series from peer-reviewed journals were selected if they documented the presence of vasovagal syncope and assessed pacing effectiveness using tilt-table testing, clinical follow-up, or both. Four case reports and four series met these criteria. DATA EXTRACTION: Findings were summarized individually. Statistical analysis of combined data was inappropriate given differences among studies in patient selection, testing, and follow-up. RESULTS: Pacing may be useful in selected patients with predominantly cardioinhibitory vasovagal responses. Pacing alone may eliminate symptoms in 25% of these patients and may prevent abrupt cardiovascular collapse in others (such as those in whom syncope occurs with minimal or no premonitory sensation). However, interpretation of most available reports has been limited both by the uncertainty associated with using the tilt-table technique to assess pacing effectiveness and by relatively short-term follow-up. CONCLUSIONS: The usefulness of cardiac pacing for patients with recurrent vasovagal syncope remains only partly understood. Randomized controlled trials are needed for this and other aspects of the treatment of this condition. Additionally, substantial room remains for innovation both in earlier recognition of imminent vasovagal syncope by implantable devices and in specifically designing cardiac pacing algorithms for treatment of this condition.
Algorithms↗
Assessment of mortality in the construction industry in the United States, 1984-1986.
Construction, one of the larger industries in the United States, employs 7.6 million workers, many in skilled trades occupations. Previously published data about potential worksite exposures and mortality of construction site workers are limited. We analyzed occupation and industry codes on death certificates from 19 U.S. states to evaluate mortality risks among men and women usually employed in construction occupations. Proportionate mortality ratios (PMRs) for cancer and several other chronic diseases were significantly elevated among 61,682 white male construction workers who died between 1984 and 1986. Men younger than age 65, who were probably still employed immediately prior to death, had significantly elevated PMRs for cancer, asbestos-related diseases, mental disorders, alcohol-related disease, digestive diseases, falls, poisonings, traumatic fatalities that are usually work-related, and homicides. Elevated PMRs for many of the same causes were observed to a lesser degree for black men and white women whose usual industry was construction. In addition, women experienced excess cancer of the connective tissue and suicide mortality. Various skilled construction trades had elevated PMRs for specific sites, such as bone cancer and melanoma in brickmasons, stomach cancer in roofers and brickmasons, kidney and bone cancer in concrete/terrazzo finishers, nasal cancer in plumbers, pulmonary tuberculosis in laborers, scrotal cancer and aplastic anemia in electricians, acute myeloid leukemia in boilermakers, rectal cancer and multiple sclerosis in electrical power installers, and lung cancer in structural metal workers. Using a standard population of blue collar workers did not result in fewer elevated PMRs for construction workers. Despite lifestyle differences and other limitations of the study, the large numbers of excess deaths observed in this study indicate the need for preventive action for construction workers.
Accidents, Occupational↗
Regulation and inhibition of collagenase expression by long-wavelength ultraviolet radiation in cultured human skin fibroblasts.
The cellular mechanisms responsible for the connective tissue changes produced by chronic exposure to UV light are poorly understood. Collagenase, a metalloproteinase, initiates degradation of types I and III collagen and thus plays a key role in the remodeling of dermal collagen. Collagenase synthesis by fibroblasts and keratinocytes involves the protein kinase C (PKC) second messenger system, and corticosteroids have been shown to suppress its synthesis at the level of gene transcription. Long-wavelength UV light (UVA, 320-400 nm) stimulates the synthesis of interstitial collagenase, as well as increasing PKC activity, in human skin fibroblasts in vitro. This study explores the regulation of collagenase expression by UVA in cultured human skin fibroblasts. Specifically, the time course, the effect of actinomycin D, an inhibitor of RNA synthesis, as well as the effect of PKC inhibitors and dexamethasone on expression of collagenase following UVA irradiation were examined. After UVA irradiation, collagenase mRNA rose rapidly between 4 and 12 h postirradiation, peaking 18 h post-UVA. Actinomycin D completely suppressed the UVA-induced increase in collagenase mRNA. Thus, new RNA synthesis is required for the UVA-induced increase in collagenase mRNA. The PKC inhibitor, H-7, blocked the increase in collagenase mRNA in response to UVA in a dose-dependent manner. Similarly, dexamethasone also inhibited collagenase gene expression induced by UVA in a dose-dependent fashion; the majority of the inhibitory effect was seen within the first 4 h after irradiation. These studies demonstrate that the effect of UVA on collagenase gene expression is regulated at the pretranscriptional level and may involve the PKC pathway.
Cells, Cultured↗
Functional changes in dorsal root ganglion cells after chronic nerve constriction in the rat.
1. We studied the effects of a chronic nerve constriction on the evoked responses in dorsal root fibers in the rat to norepinephrine and to thermal stimuli applied either to the dorsal root ganglion (DRG) or the site of nerve injury. We recorded a total of 59 C fibers, 15 A delta-fibers, and 46 A beta-fibers from the L5 dorsal root of the rats 11-52 days after a loose ligation of the ipsilateral sciatic nerve. Most fibers were identified by the presence of spontaneous activity (SA) that originated partially at and/or proximal to the injury site. In addition, we recorded 20 C fibers, 1 A delta-fiber, and 28 A beta-fibers from the dorsal roots of normal, uninjured neurons. 2. In nerve-injured rats, the SA of some C fibers was generally increased by cooling and decreased by heating either site. In contrast, the SA of most A beta-fibers was increased by heating either the injury site or the DRG. Cooling the DRG decreased SA in A beta-fibers, whereas cooling the injury site typically had no effect. Excitatory responses were not evoked in any fiber group when the same thermal stimuli were applied to the nerve or DRG tested in normal, uninjured rats. 3. Norepinephrine (< 0.5 mM) applied either to the injury site or the DRG increased the SA of most C fibers and A delta-fibers but only a minority of A beta-fibers in previously injured nerves. The threshold concentration for excitation of the DRG somata of C fibers was 0.01 mM. No effects were found for fibers in uninjured nerves. 4. The effect of norepinephrine was blocked by a pretreatment with yohimbine, an alpha 2-blocker, but not with prazosin, an alpha 1-blocker. 5. Stimulation of the sympathetic trunk (L2-L3) excited most C fibers and a minority of A beta-fibers. In contrast, the SA of a minority of C fibers and A beta-fibers was depressed during sympathetic stimulation. 6. After a chronic nerve constriction the DRG becomes a source of abnormal activity modulated by sympathetically released norepinephrine acting on alpha 2 receptors in DRG somata. This neuropathic activity may contribute to cutaneous pain and hyperalgesia.
Animals↗
Nonphysical factors that affect work hardening success: a retrospective study.
The high cost of health care and limited information regarding the effects of work hardening have prompted a need to further study work hardening programs. The purpose of this study was to determine the success of a work hardening program that included physical, occupational, and psychological therapies, and to determine if there are nonphysical factors associated with successful work hardening. One hundred medical records of injured workers with low back pain and other musculoskeletal disorders were retrospectively reviewed. Factors examined included months of injury, education level, sex, race, presence of an attorney, prior surgery, pain behaviors, smoking, medication use, and diagnosis severity. Seventy-six percent of the subjects successfully completed the program, and 50% of the subjects were returned to work at discharge. Nonphysical factors that limited successful work hardening were presence of pain behaviors (p < .01), attorney representation (p < .01), McAndrews score above 70 (p < .05), and education less than high school (p < .05). The author concludes that the return to work rate for injured workers in this study is comparable to rates of previous studies and that there are nonphysical factors associated with the success of work hardening.
Adult↗
Acute abdominal pain in chronic pancreatitis: hemorrhage from a pseudoaneurysm?
An alcoholic, 67-year old retired male nurse complained of abdominal pain, loss of appetite and weight loss of 10 kg within one year. Based on elevated serum enzyme levels, ultrasonography and computed tomography examinations, an acute attack of chronic pancreatitis with several pancreatic pseudocysts was diagnosed. Ultrasonographically, an 1.8 cm phi, echo-free, pulsatile, space-occupying lesion, suggestive of a pancreatic pseudoaneurysm, was found at the right lateral margin of an almost echo-free pseudocyst measuring 6.8 x 5.6 x 5.0 cm in the head of the pancreas. Shortly before the planned discharge when the patient felt well, he developed acute abdominal pain. An immediate ultrasound examination showed an inhomogenous and echo-dense pseudocyst, in short, an acute hemorrhage. Rupture of the pseudoaneurysm of the Arteria gastroduodenalis was suspected and later confirmed by angiography and laparotomy. After proximal an distal ligation of the vessel and fibrin sealing of the inner surface of the cyst, the patient recovered and, under alcohol abstinence, has been free of symptoms since one year.
Abdomen, Acute↗
Arthroscopic portals of the wrist: an anatomic study.
Wrist arthroscopy has become an accepted diagnostic technique, and it is starting to be a useful therapeutic tool. Extensor tendons, the radial artery, and dorsal sensory nerve branches are at risk of injury during this procedure; however, understanding periportal anatomy should make wrist arthroscopy safer. Wrist arthroscopic portals were established in 19 fresh cadaver wrists, after which the limbs were dissected and periportal anatomy was described and quantified. The 1-2, 6R, and 6U portals were the most perilous, while the midcarpal, 3-4, 4-5, and distal radioulnar joint portals were relatively safe. Even "safe" portals had occasional adjacent sensory nerve branches and tendons. A safe technique of establishing wrist arthroscopy portals is emphasized.
Arthroscopy↗
Implementation of the AHCPR pain guidelines for children.
Successful implementation of Agency for Health Care Policy and Research (AHCPR) clinical practice guidelines must involve an institutional commitment and an interdisciplinary effort. This article describes how a pediatric nursing research committee took the leadership role in implementing the AHCPR acute pain guidelines for children. Steps toward implementation included assessment of current practice methods, nursing interventions, interdisciplinary interventions, and plans for evaluating the practice change through the institutional quality assessment and improvement program.
Acute Disease↗
Low energy laser therapy in rheumatoid arthritis.
Low energy laser (LEL) is a widely used treatment for a variety of musculoskeletal disorders although convincing documentation of the effect is missing. We have examined the LEL effect on Rheumatoid Arthritis (RA) in a double blind placebo controlled study. Twenty-two patients completed the study (10 receiving LEL treatment) according to the protocol. A significant effect on pain score was found due to LEL treatment, but when data were corrected for disease variation the effect disappeared. No effect of LEL could be demonstrated on the other assessed variables: grip strength, morning stiffness, flexibility, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP). In conclusion, we did not find that LEL had any clinically relevant effects on RA.
Adult↗
Job task and psychosocial risk factors for work-related musculoskeletal disorders among newspaper employees.
OBJECTIVES: A cross-sectional study was conducted to assess the association of upper extremity musculoskeletal disorders and work-related factors among employees using video display terminals at a large metropolitan newspaper. METHODS: The study included 1050 randomly selected workers from four departments. The workers were asked to complete questionnaires on symptoms, job tasks, and psychosocial and work organization conditions. Musculoskeletal disorders of the upper extremities were defined by frequency, duration, and intensity of symptoms not attributable to acute injury. Data were analyzed with the use of logistic regression. RESULTS: A total of 973 workers completed the survey. The one-year period prevalence rate for any musculoskeletal disorder of the upper extremities was 41%. Neck symptoms (26%) were the most frequently reported, followed by hand or wrist (22%), shoulder (17%), and elbow (10%) symptoms. Greater time working at the video display station was associated with increased hand or wrist symptoms in a dose-response relationship. In addition, variables corresponding to increased work-load demands (eg, increased time working under deadline and increased job pressure) were associated with increased neck, shoulder, and hand or wrist disorders. Women were more likely to report symptoms in several areas, but this finding may reflect the concentration of women in jobs involving more risk factors. CONCLUSIONS: The results suggest a high prevalence of musculoskeletal disorders of the upper extremities among newspaper employees, and they provide additional evidence that increased work load, time pressure, and greater hours of computer use are related to the occurrence of work-related musculoskeletal disorders among these workers, particularly for disorders in the hand or wrist area.
Adult↗
Lipase/amylase ratio: not helpful in the early etiological differentiation of acute pancreatitis.
The value of the lipase/amylase ratio for early etiological differentiation of acute pancreatitis was tested in 103 consecutive patients with acute pancreatitis from an ongoing prospective study. On admission, amylase, but not lipase, was significantly lower in alcoholics than in nonalcoholics in general and especially in patients with biliary pancreatitis. Alcoholics as a group had significantly higher lipase/amylase ratios than non-alcoholics and patients with acute biliary pancreatitis. But although the mean values of the ratio were significant, sensitivity, specificity, positive and negative predictive values of lipase/amylase ratio were insufficient to separate alcoholics from nonalcoholics, patients with alcohol-induced pancreatitis from those with biliary etiology, and patients with biliary pancreatitis from those with pancreatitis of other etiologies in the individual case. Finally, there was no correlation between the ratio and the amount of pancreatic changes as judged from computed tomography. We concluded that the ratio does not allow for early routine clinical differentiation between etiologies of pancreatitis and evaluation of the severity of the disease.
Acute Disease↗