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Biomedical subjects

M Sullivan

Publications and source records attributed to M Sullivan.

At least 235 records · Page 13Linked to original sources

Human immunodeficiency virus infection of the human thymus and disruption of the thymic microenvironment in the SCID-hu mouse.

Infection with the human immunodeficiency virus (HIV) results in immunosuppression and depletion of circulating CD4+ T cells. Since the thymus is the primary organ in which T cells mature it is of interest to examine the effects of HIV infection in this tissue. HIV infection has been demonstrated in the thymuses of infected individuals and thymocytes have been previously demonstrated to be susceptible to HIV infection both in vivo, using the SCID-hu mouse, and in vitro. The present study sought to determine which subsets of thymocytes were infected in the SCID-hu mouse model and to evaluate HIV-related alterations in the thymic microenvironment. Using two different primary HIV isolates, infection was found in CD4+/CD8+ double positive thymocytes as well as in both the CD4+ and CD8+ single positive subsets of thymocytes. The kinetics of infection and resulting viral burden differed among the three thymocyte subsets and depended on which HIV isolate was used for infection. Thymic epithelial (TE) cells were also shown to endocytose virus and to often contain copious amounts of viral RNA in the cytoplasm by in situ hybridization, although productive infection of these cells could not be definitively shown. Furthermore, degenerating TE cells were observed even without detection of HIV in the degenerating cells. Two striking morphologic patterns of infection were seen, involving either predominantly thymocyte infection and depletion, or TE cell involvement with detectable cytoplasmic viral RNA and/or TE cell toxicity. Thus, a variety of cells in the human thymus is susceptible to HIV infection, and infection with HIV results in a marked disruption of the thymic microenvironment leading to depletion of thymocytes and degeneration of TE cells.

Animals↗

Psychiatric and otologic diagnoses in patients complaining of dizziness.

BACKGROUND: Dizziness is a common and disabling symptom in primary care practice, especially among the elderly. Though there are many organic causes of dizziness, the results of medical workups are negative in the majority of patients. METHODS: A total of 75 patients with dizziness who were referred to a community otolaryngology practice received a structured psychiatric diagnostic interview (National Institute of Mental Health Diagnostic Interview Schedule) and questionnaires that assessed psychological distress as well as a complete otologic evaluation, including electronystagmogram. Patients with evidence of a peripheral vestibular disorder were compared with those without such evidence. RESULTS: While psychiatric diagnoses were present in both those with and without evidence of a peripheral vestibular disorder, those without such evidence had a greater mean number of lifetime psychiatric diagnoses as defined by the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, and specifically, a greater lifetime prevalence of major depression and panic disorder. This group also more frequently met criteria for somatization disorder, had more current and lifetime unexplained medical symptoms, and had more severe current depressive, anxiety, and somatic symptoms. CONCLUSIONS: Psychiatric diagnoses are common among patients with dizziness referred for otologic evaluation who do not show evidence of a peripheral vestibular disorder. Specific psychiatric disorders should be part of the differential diagnosis of patients who present with dizziness.

Adult↗

Osteoblastic gene expression during adipogenesis in hematopoietic supporting murine bone marrow stromal cells.

A growing body of data suggests that the bone marrow stroma contains a population of pluripotent cells capable of differentiating into adipocytes, osteoblasts, and lymphohematopoietic supporting cells. In this work, the murine stromal cell lines BMS2 and +/+ 2.4 have been examined as preadipocytes and adipocytes for evidence of osteoblastic gene expression. Adipocyte differentiation has been quantitated using fluorescence activated cell sorting. Within 7-10 days of adipocyte induction by treatment with glucocorticoids, indomethacin, and methylisobutylxanthine, between 40% to 50% of the cells contain lipid vacuoles and exhibit a characteristic adipocyte morphology. Based on immunocytochemistry, both the adipocytes and preadipocytes express a number of osteoblastic markers; these include alkaline phosphatase, osteopontin, collagen (I, III), bone sialoprotein II, and fibronectin. Based on biochemical assays, the level of alkaline phosphatase expression is not significantly different between preadipocyte and adipocyte cells. However, unlike rat cell lines, dexamethasone exposure causes a dose-dependent decrease in enzyme activity. The steady-state mRNA levels of the osteoblast associated genes varies during the process of adiopogenesis. The relative level of collagen I and collagen III mRNA is lower in adipocyte-induced cells when compared to the uninduced controls. Osteocalcin mRNA is detected in preadipocytes but absent in adipocytes. These data indicate that osteoblastic gene expression is detected in cells capable of undergoing adipocyte differentiation, consistent with the hypothesis that these cell lineages are interrelated.

Adipose Tissue↗

The impact of generalized malignant melanoma on quality of life evaluated by the EORTC questionnaire technique.

Eighty-nine patients with generalized malignant melanoma, 63% men and median age 53 years, were included in a longitudinal quality of life (QOL) study before the start of chemotherapy. QOL was assessed by the EORTC core questionnaire technique (QLQ-C36), a study-specific melanoma (MM) module and the Hospital Anxiety and Depression (HAD) scale. The questionnaires displayed good psychometric qualities and were able to document the florid symptomatology of disseminated melanoma. They were well accepted by the patients. Before treatment the patients reported a relatively low symptom burden, good physical and social functioning, moderate psychological distress and a high overall QOL rating during the past week. Fatigue and pain were the most frequent symptoms reported. The QOL measurement differentiated between subgroups of patients differing in performance status and the tumour burden. We conclude that the EORTC questionnaire technique is feasible and clinically relevant in generalized malignant melanoma patients.

Activities of Daily Living↗

Depressive symptoms and measures of disability: a prospective study.

OBJECTIVE: The purpose of this study was to test the hypothesis that decreases in severity of depressive symptoms in patients with chronic tinnitus would correlate with reductions in measures of functional disability. METHOD: This study describes the correlations between several measures of functional disability and Hamilton depression scores in two groups of patients with major depression and depressive symptoms (D-NOS) who were patients enrolled in a 12-week placebo-controlled, double-blind trial of nortriptyline. These patients had chronic severe tinnitus which was associated in most patients with high frequency hearing loss. The effect of whether affective symptoms improved and the patient's initial depression status (major depression versus depressive symptoms) are examined in order to increase understanding about the correlations between depressive symptoms and functional disability. RESULTS: Most measures of functional disability decreased synchronously with Hamilton Depression Scale scores in both patients with major depression and those with subclinical depressive symptoms. Patients whose depression improved had a significantly greater change in each disability measure than patients whose depression did not improve. This significant decrease in functional disability was seen in 11 of 13 scales in the improved D-NOS group, versus only 3 of the 13 scales in the unimproved D-NOS group; 9 of 13 scales of functional disability significantly decreased in the improved major depression group, versus 3 of 13 scales in the unimproved major depression group. CONCLUSIONS: The results suggest that there was a significant correlation between improvement in both major depression and depression-NOS symptoms, and decreases in measures of functional disability in an aging population with a chronic medical illness.

Adaptation, Psychological↗

The rheumatic patient's early needs and expectations.

During the last few years, studies have revealed that the need for psychosocial support and concrete social services are great in the early stages of the treatment of rheumatic diseases. The ability to keep a job, to do household chores, to participate in leisure activities and to maintain social relations is clearly impaired. Anxiety and depression are not unusual and often associated with weak support from relatives, loneliness and disturbed family relations. Nevertheless, the patients report resilience and determination to cope with the impacts of illness. Crisis intervention, vocational guidance and counselling about problems concerning the disease should be available and offered to the patients. As the patients seem to be unaccustomed to talking about their psychosocial problems, an empathetic and information-seeking attitude on the part of the health care staff is essential.

Adaptation, Psychological↗

The impact of intermittent claudication on quality of life evaluated by the Sickness Impact Profile technique.

Unselected patients suffering from intermittent claudication (n = 148) were invited to take part in a prospective study. Physical examination and several circulatory investigations were performed including a treadmill walking test, bicycle ergometry and a quality of life examination (Sickness Impact Profile, SIP, technique). The SIP has been reported to be sensitive enough to identify specific dysfunction profiles in several clinical conditions, but it has not been used on patients with intermittent claudication. The aim of this study was to determine to what extent quality of life was influenced by reduced walking ability in patients with intermittent claudication. If so, the SIP technique should then be a useful tool for determination of the degree of reduced exercise capacity in patients who may benefit from surgery instead of conservative treatment. A majority of the SIP categories, Sleep and rest, Emotional behaviour, Body care and movement, Home management, Mobility, Social interaction, Ambulation and Overall SIP were shown to be useful in confirming objective dysfunctions in our patients. The correlation between maximum walking ability and SIP scores indicated an approximate cut-off limit at 70 W walking capacity. Thus, significant reductions in everyday life function were demonstrated in patients with maximum walking ability below 70 W. Patients with intermittent claudication also suffered from several other dysfunctions in addition to walking disability. These factors may, as well, impact on quality of life without walking disability. Our results demonstrated that quality of life assessment by the SIP technique was a sensitive method for evaluation of overall dysfunction in patients with intermittent claudication.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Changes in amniotic arachidonic acid metabolism associated with increased cyclo-oxygenase gene expression.

OBJECTIVES: To study the differences in the metabolism of arachidonic acid, to prostaglandins and other eicosanoids, between amnion cells before and after labour. To study the changes in the expression of the type 1 cyclo-oxygenase gene associated with the changes in arachidonic acid metabolism. DESIGN: Amnion cells collected before labour, at elective caesarean section, and following spontaneous labour and delivery were established in mono-layer culture. Intracellular arachidonic acid pools were radio-labelled and the metabolic fate of endogenous archidonic acid was then studied using high performance liquid chromatography. RNA was extracted from the cell cultures and expression of the cyclooxygenase gene was studied using northern hybridisation to a sheep cyclo-oxygenase cDNA. RESULTS: Metabolism of endogenous arachidonic acid in amnion cells established in culture prior to labour is principally via lipoxygenase and epoxygenase enzyme pathways to di- and mono-HETEs and EET with little cyclo-oxygenase metabolism to prostaglandins. Following labour there is a large increase in arachidonic acid metabolism with a change in the cyclo-oxygenase: lipoxygenase enzyme pathway ratio in favour synthesis of prostaglandin E2. Whilst synthesis of lipoxygenase metabolites doubles, the increase in prostaglandin E2 synthesis is ten fold. Expression of the cyclo-oxygenase gene is significantly greater in cell cultures established following spontaneous labour and delivery than in those established following elective caesarean section prior to labour. CONCLUSIONS: In association with labour there is an increase in arachidonic acid metabolism in amnion cells and a change in the ratio of metabolism via cyclo-oxygenase and lipoxygenase enzyme pathways to increase synthesis of prostaglandin E2. This change is associated with increased expression of the cyclooxygenase gene.

Amnion↗

An enzyme-linked immunosorbent assay for the measurement of human IgA antibody responses to Epstein-Barr virus membrane antigen.

An enzyme-linked immunosorbent assay (ELISA) which uses a recombinant truncated form of the Epstein-Barr virus (EBV) membrane antigen gp350/250 has been developed and used to measure human IgA antibody responses to that antigen. From comparisons with conventional immunofluorescence assays (IFA) for measuring IgA antibody responses to EBV viral capsid antigens, the ELISA shows comparable specificity and is approximately 4-fold more sensitive. Since IgA antibodies to EBV indicate a high risk of developing nasopharyngeal carcinoma (NPC), the described ELISA, which is more sensitive and objective than IFA, has potential for use in the diagnosis of NPC and for large-scale screening to identify individuals at risk for the development of this disease.

Animals↗

Psychotherapy vs. pharmacotherapy: are psychiatrists polarized?--A survey of academic and clinical faculty.

Recent debate about the Osheroff vs. Chestnut Lodge case has highlighted the potential for polarization in psychiatric treatment. The degree to which community clinical psychiatric practice is polarized between psychological and biological treatments is not known. There are limitations in the combined treatment studies performed to date that influence their applicability to treatment planning in the community setting. A nearly exclusive focus on mood disorders and a neglect of the role of concurrent personality disorders and treatment interactions are among these. The data base available to guide a truly integrated practice of differential therapeutics is therefore quite limited. Against this background, we surveyed academic and clinical psychiatric faculty to determine treatment practices and rationales in three case with both Axis I and Axis II diagnoses. In each case, greater than 75% would utilize psychotherapy and consider its omission inappropriate. Medication use varied significantly from case to case. Our findings suggest that practicing psychiatrists combine psychotherapy and pharmacotherapy and that the perceived polarization between "biological" and "psychosocial" psychiatry may be more a matter of "philosophy" than practice.

Adult↗

"The Göteborg Quality of Life Instrument"--a psychometric evaluation of assessments of symptoms and well-being among women in a general population.

OBJECTIVE: To examine with psychometric analysis techniques the potential for constructing valid composite variables of "The Göteborg Quality of Life Instruments". DESIGN: Prospective population study of women in 1974-75 and in 1980-81. SETTING: City of Göteborg, Sweden. PARTICIPANTS: Representative samples of the general population of women in five age strata between 44 and 66 years of age in 1974-75, followed 1980-81 including new cohorts of women aged 26 and 38. 1302 women were examined in 1974-75 and 1408 in 1980-81. MAIN OUTCOME MEASURE: "The Göteborg Quality of Life instrument", constructed in the early 1970s to measure symptoms and well-being in a population study of men. RESULTS: Four multi-item scales were identified with satisfactory reliability and validity, i.e., they met defined criteria of multi-item scales and benefit from higher reliability than single questions. The psychological symptom scale comprised all ten questions intended to reflect depression and tension, while the physical symptom scale included all six pain questions, the general symptoms dizziness, breathlessness, and nausea, and general fatigue that belonged to both symptom scales. The social well-being scale comprises all well-being questions believed to reflect the broad concept of life satisfaction. The physical-mental wellbeing scale reflected satisfaction with both general and mental health. Several symptom and well-being questions were clearly outside the main clusters and should be treated as single items. CONCLUSIONS: Use of a few, distinct scales instead of a number of single questions should increase statistical power because the number of comparisons is greatly reduced and problems of chance findings are thus minimized.

Adult↗

Phenobarbital versus clonazepam for sedative-hypnotic taper in chronic pain patients. A pilot study.

A randomized, double-blind controlled trial is reported comparing phenobarbital and clonazepam for the purpose of sedative-hypnotic taper in inpatients with chronic, nonmalignant pain. After receiving the Minnesota Multiphasic Personality Inventory (MMPI) and a standardized psychiatric diagnostic interview, patients' baseline sedative-hypnotic use was assessed over 48 hours. Baseline use was converted into phenobarbital or clonazepam equivalents and administered in four doses daily using a blinded liquid pain cocktail. Baseline dose was maintained for two days and then tapered by 10% per day. Over the first week of taper, differences in mean and maximum Beck Anxiety and Benzodiazepine Withdrawal scores were not significant. However, when scales 1, 3, or 8 of the MMPI were taken as covariates, differences on the Withdrawal Scale only increased to a trend level for mean scores and to a significant level for maximum scores. These findings support the superiority of benzodiazepines over barbiturates for sedative-hypnotic taper for symptoms of withdrawal but not of recurrent or rebound anxiety.

Adult↗

Manufacturers, hospitals cooperate on imaging equipment acquisition.

In the past, some diagnostic imaging equipment manufacturers offered "boiler plate" financing strategies to healthcare organizations. Today, however, many employ representatives with backgrounds in finance and train them to work with hospitals to develop financing strategies appropriate for the organization. This consultive relationship allows equipment manufacturers to create customized financing plans to fit a hospital's individual needs. For example, radiologists and financial managers can now work with manufacturers' representatives to determine which imaging equipment would be the most appropriate and cost-effective for a particular hospital. Manufacturers' representatives also may consult with the hospitals' strategic planners to determine the most appropriate piece of equipment to buy and to arrange financing.

Capital Expenditures↗

The prognostic utility of delayed-type hypersensitivity skin testing in the evaluation of HIV-infected patients. Military Medical Consortium for Applied Retroviral Research.

Many reagents and techniques have been used for delayed-type hypersensitivity (DTH) skin testing in the evaluation of HIV-infected patients, resulting in varied interpretation of the utility of DTH skin testing in this population. We report the development of a simple algorithm for selection of DTH antigens and the clinical relevance of DTH skin testing in HIV disease. Antigens and concentrations for testing were first evaluated in a demographically matched, HIV-negative, immunologically healthy population. The testing scheme was then applied to the HIV population of interest for 5 years at several clinical sites. The antigens and concentrations selected resulted in 100% reactivity to two or more antigens in the HIV-negative cohort. Anergy is thus a distinct immunologic abnormality. Although some correlation (r2 = 0.6) of skin test reactivity and CD4 cell count was found in a cohort of HIV-infected individuals, anergy was found to be independently predictive of the development of symptomatic late-stage disease (Walter Reed Stage 6), AIDS, or death. This stepwise evaluation of skin testing and reagents has led to the modification of the skin testing protocol by defining the minimum number of antigens required and establishing the independent prognostic role of DTH skin testing in the evaluation of HIV-infected patients. The addition of mumps (40 CFU/ml), tetanus (1:10), and candida (1:10) to the purified protein derivative (PPD) skin test provides the critical controls to evaluate the status of PPD skin test in HIV-infected individuals as well as to provide a useful and prognostic clinical immunology evaluation.

Adult↗

Personality traits and early discontinuation from clinical trials in anxious patients.

Patients who discontinue early from clinical trials frequently give ambiguous or no reasons for leaving the study. Using Cloniger's Tridimensional Personality Questionnaire, we examined the potential role of personality traits in early discontinuation in patients with panic disorder and generalized anxiety disorder. Early dropouts and completers were comparable at baseline on demographic and clinical variables but differed significantly on the Tridimensional Personality Questionnaire. For panic disorder and generalized anxiety disorder patients combined, early dropouts scored higher on total novelty seeking, as well as on the novelty-seeking traits of both disorderliness/dislike of regimentation and impulsiveness. There was no significant interaction between dropout status and diagnosis for this finding, indicating it applied equally to both groups. This study suggests that personality traits involving novelty seeking may contribute to early discontinuation from clinical trials, independent of side effects, lack of efficacy, or at baseline, significantly worse symptoms of anxiety.

Adult↗

Health status assessment in rheumatoid arthritis. II. Evaluation of a modified Shorter Sickness Impact Profile.

OBJECTIVE: To develop a shortened form of the Sickness Impact Profile (SIP) for routine practice. METHODS: We used data from a study of health status in 99 women with rheumatoid arthritis (RA). A stepwise analysis model used physical discomfort (global rating), self-assessed pain (Body Symptom Scale), mental well-being (Mood Adjective Check List) and joint function (Keitel Index) to define important aspects of health. RESULTS: Short forms of the SIP for discrimination (53 items), evaluation (25 items) and prediction (28 items) compared well in validity to the original 136-item SIP. The discriminative short form showed excellent reliability (internal consistency), matching the level of the generic SIP. The evaluative and predictive short forms had acceptable but lower internal consistency than the original Profile. CONCLUSION: We suggest a 64-item core health status questionnaire (SIP-RA) to be included and further tested in the arsenal of routine measurements in outpatients with RA. The questionnaire should include physical (Body care and movement, Mobility), psychosocial (Emotional behavior, Social interaction, Alertness behavior, Communication) and free-standing (Sleep and rest, Home management, Recreation and past-times, Eating) SIP categories, and it will improve the description of patients with RA.

Adult↗

Swedish obese subjects (SOS)--an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined.

This part of an on-going intervention trial analyses impacts of obesity on psychosocial factors and health. The study sample comprised 800 obese men (BMI > or = 34 kg/m2) and 943 women (BMI > or = 38 kg/m2) ranging in age from 37 to 57 years. All participants completed standardized health-related quality of life measures, a validated obesity-specific eating inventory and study-specific questionnaires on current and past health status, use of medical care and medications, socioeconomic status, dietary habits, physical activity habits, weight history and familial history of obesity. Chronic patients and population samples were used as reference. The obese reported distinctly poorer current health and less positive mood states than the reference subjects, women being worse than men. Anxiety and/or depression on a level indicating psychiatric morbidity were more often seen in the obese and again women reported more affliction than men. Furthermore, the average poor mental well-being was worst than in chronically ill or injured patients, such as rheumatoid, cancer survivors and spinal cord injured persons. Predictors of perceived health and psychosocial functioning could be discerned using a comprehensive system of statistical analyses (16-28% explained variance). A background of both somatic and psychiatric morbidity was decisive for the health and psychosocial functioning in the obese; joint symptoms and angina pectoris dominated among somatic variables. Physical inactivity was the most prominent of traditional risk factors. The number of dieting attempts and body image were important weight correlates. Our results provide further evidence to the effect that severe obesity is a crippling condition.

Adult↗