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Biomedical subjects

R Friedman

Publications and source records attributed to R Friedman.

At least 55 records · Page 3Linked to original sources
PubMed1997

The dorsal transposition flap for congenital contractures of the first web space: a 20-year experience.

Fifty-four dorsal transposition flaps were performed in 38 patients (46 hands) for severe congenital thumb web-space contractures. At an average follow-up interval of 6 years, complications or unsatisfactory results had occurred in 100% of symbrachydactyly patients and in 27% of all other patients. Postoperative first web-space angle was augmented an average of 59 degrees with a distal flap two-point discrimination of 8 mm. Mean postoperative pinch and grip strengths were 58% and 72%, respectively, of the normal contralateral hand. Parental satisfaction with the functional results was high, and the aesthetic results were generally acceptable. With the exception of symbrachydactyly patients, the dorsal transposition flap remains an excellent reconstructive option for severe congenital contractures of the thumb web space.

Adolescent↗
PubMed1997

Emotional responses to goal attainment: strength of regulatory focus as moderator.

Goals with a promotion focus versus a prevention focus are distinguished. Chronic ideal goals (hopes and aspirations) have a promotion focus, whereas ought goals (duties and responsibilities) have a prevention focus. The hypothesis that emotional responses to goal attainment vary as a function of promotion versus prevention goal strength (conceptualized as goal accessibility) was tested in correlational studies relating chronic goal attainment (self-congruencies or self-discrepancies) to emotional frequency and intensity (Studies 1-3) and in an experimental study relating immediate goal attainment (i.e., success or failure) to emotional intensity (Study 4). All studies found that goal attainment yielded greater cheerfulness-dejection responses when promotion focus was stronger and greater quiescence-agitation responses when prevention focus was stronger.

Affect↗
PubMed1997

Renal functional response to protein loading in type 1 (insulin-dependent) diabetic patients on normal or high salt intake.

Insulin-dependent diabetes mellitus (IDDM) patients may have an increased intrarenal angiotensin II activity. In diabetic patients, captopril increases the renal hemodynamic response to an amino acid infusion. We investigated the effects of two salt diets on arterial pressure and renal response to a protein load in 10 normotensive (blood pressure < 140/90 mm Hg) IDDM patients (aged 30 +/- 3 years) who had diabetes for 7 +/- 4 years and normoalbuminuria levels [albumin excretion rate 4.8 (2.5-19.1) microg/min]. After 1 week of normal (approximately 100 mmol/day; approximately 100 mEq/l) and 1 week of high (approximately 300 mmol/day; approximately 300 mEq/l) salt intake, renal hemodynamic studies were performed at baseline and after a protein load (meat meal) of 100 g/1.73 m2. The mean 24-hour urinary sodium excretion levels were 99 +/- 27 and 293 +/- 80 mmol (mEq) with normal and high salt intake, respectively. No significant changes were seen in plasma sodium and glucose control with the normal and high salt diets, respectively: plasma sodium 135 +/- 3 vs. 137 +/- 1 mmol/l (mEq/l), (p = 0.08) and glycated hemoglobin 9.1 +/- 1.9 vs. 9.4 +/- 2.1% (p = 0.36). The body weight (70.9 +/- 12 vs. 71.8 +/- 13 kg; p = 0.015) was significantly higher with a high salt diet. The mean arterial pressure was similar with both diets (normal vs. high salt diet 91 +/- 9 vs. 89 +/- 6 mm Hg, p = 0.25). The plasma renin concentration [28 +/- 15 vs. 16 +/- 6 microU/ml(168 +/- 90 vs. 96 +/- 36 pmol/l), p = 0.013] and angiotensin II [8.8 +/- 4.4 vs. 6.4 +/- 3.5 pg/ml (0.052 +/- 0.025 vs. 0.038 +/- 0.021 nmol/l), p = 0.016] were significantly lower with the high salt diet. Following protein loading, the glomerular filtration rate increased with both diets: normal salt diet 114 +/- 26 vs. 128 +/- 30 ml/min/1.73 m2(1.9 +/- 0.43 vs. 2.13 +/- 0.50 ml/s/1.73 m2), p = 0.04; high salt diet 118 +/- 23 vs. 127 +/- 29 ml/min/1.73 m2 (1.97 +/- 0.38 vs. 2.12 +/- 0.48 ml/s/1.73 m2), p = 0.13. The change in renal plasma flow was similar to that of the glomerular filtration rate with normal and high salt intake, respectively: 566 +/- 94 vs. 617 +/- 142 ml/min/1.73 m2 (9.44 +/- 1.57 vs. 10.29 +/- 2.37 ml/s/173 m2), p = 0.0017; 572 +/- 125 vs. 600 +/- 110 ml/min/1.73 m2 (9.54 +/- 2.08 vs. 10.00 +/- 1.83 ml/s/1.73 m2), p = 0.057. In this subset of normotensive normoalbuminuric IDDM patients, a high salt intake did not promote an exaggerated renal response to the protein load despite inhibition of the renin-angiotensin system.

Adolescent↗
PubMed1997

TGFbeta2 knockout mice have multiple developmental defects that are non-overlapping with other TGFbeta knockout phenotypes.

The growth and differentiation factor transforming growth factor-beta2 (TGFbeta2) is thought to play important roles in multiple developmental processes. Targeted disruption of the TGFbeta2 gene was undertaken to determine its essential role in vivo. TGFbeta2-null mice exhibit perinatal mortality and a wide range of developmental defects for a single gene disruption. These include cardiac, lung, craniofacial, limb, spinal column, eye, inner ear and urogenital defects. The developmental processes most commonly involved in the affected tissues include epithelial-mesenchymal interactions, cell growth, extracellular matrix production and tissue remodeling. In addition, many affected tissues have neural crest-derived components and simulate neural crest deficiencies. There is no phenotypic overlap with TGFbeta1- and TGFbeta3-null mice indicating numerous non-compensated functions between the TGFbeta isoforms.

Abnormalities, Multiple↗
PubMed1997

Risk factors for decreased bone density in premenopausal women.

Osteoporosis is a major health problem. Little is known about the risk factors in premenopause. Sixty 40-50-year old patients with regular menses were studied cross-sectionally. None of the patients were on drugs known to interfere with bone mass. Patients answered a dietary inquiry and had their bone mineral density (BMD) measured. The Z scores were used for the comparisons. A blood sample was taken for the determination of FSH, SHBG, estradiol, testosterone, calcium and alkaline phosphatase. Calcium and creatinine were measured in 24-h urine. A Z score less than -1 was observed for the lumbar spine of 14 patients (23.3%), and for the femur of 24 patients (40%). Patients with a Z score less than -1 for the lumbar spine were older than patients with a Z score > or = -1 (45.7 vs 43.8 years) and presented higher values of alkaline phosphatase (71.1 +/- 18.2 vs 57.1 +/- 14.3 IU/l). Multiple regression analysis showed that a lower lumbar spine BMD was associated with higher values of alkaline phosphatase, lower calcium ingestion, a smaller body mass index (BMI), less frequent exercising, and older age. The patients with a Z score less than -1 for the femur were shorter than patients with a Z score > or = -1 (158.2 vs 161.3 cm). Multiple regression analysis showed that a lower femoral BMD was associated with lower BMI, higher alkaline phosphatase and caffeine intake, and less frequent exercising. A lower than expected BMD was observed in a significant proportion of premenopausal women and was associated with lower calcium intake, relatively lower physical activity and lower BMI. We conclude that the classical risk factors for osteoporosis may be present before ovarian failure, and their effect may be partly independent of estrogen levels.

Adult↗
PubMed1997

A stingray spine in the scapula of a bottlenose dolphin.

A stingray spine was found lodged in the scapula of a deceased 272 cm, male bottlenose dolphin (Tursiops truncatus) from South Carolina (USA) following skeletal preparation, nearly 6 mo after necropsy. No external puncture wound, internal bruising, or laceration of muscle tissue surrounding the scapula was evident during necropsy of the animal. Implantation of the spine did not appear to be related to the death of the dolphin, but probably occurred at an early age. Abnormal development of bone surrounding the spine resulted in the formation of a cavity at the wound site. Two mechanisms were considered as contributors for the cavity formation. These were the mechanical action of the spine stimulating the body's defense system for managing foreign objects, and the release of potent toxins from the spine sheath.

Animals↗
PubMed1996

Glucocorticoid repression of the mouse gonadotropin-releasing hormone gene is mediated by promoter elements that are recognized by heteromeric complexes containing glucocorticoid receptor.

We have identified two regions of the mouse gonadotropin-releasing hormone (GnRH) promoter, one between -237 and -201 (distal element) and the other between -184 and -150 (proximal element), which are required for glucocorticoid repression in transiently transfected GT1-7 cells. These sequences show no similarity to known positive or negative glucocorticoid response elements (nGREs) and do not function when placed upstream of heterologous viral promoters. The glucocorticoid receptor (GR) does not bind directly to the distal or proximal promoter elements but may participate in glucocorticoid repression of GnRH gene transcription by virtue of its association within multiprotein complexes at these nGREs. Electrophoretic mobility shift assays with GT1-7 nuclear extract demonstrate the presence of GR-containing protein complexes on GnRH nGREs. One protein that co-occupies the distal nGRE in vitro along with GR is the POU domain transcription factor Oct-1. Thus, the tethering of GR to the GnRH distal nGRE, by virtue of a direct or indirect association with DNA-bound Oct-1, could play a role in hormone-dependent transcriptional repression of the GnRH gene. In contrast, Oct-1 does not appear to be a component of the GR-containing protein complex that is bound to the proximal nGRE.

Animals↗
PubMed1996

The expression of and insulin binding to cellular thyroid hormone binding protein, but not insulin degrading enzyme, is increased during 3T3-L1 adipocytes differentiation.

Specific insulin binding to several proteins (cytosolic insulin binding proteins; CIBPs) in the isolated cytoplasm of numerous cell types has been demonstrated. CIBPs include insulin degrading enzyme (IDE), CIBP p55 (identified as cellular thyroid hormone binding protein (CTHBP), which is also known as protein disulfide isomerase, or glutathione insulin transhydrogenase). To assess the possible role of CIBP p55/CTHBP in insulin action, we compared 125I-insulin binding to CIBP in cytosol isolated from 3T3-L1 cells at various time points during differentiation of the adipocytes. Insulin did not bind to CTHBP in fibroblasts, but the labeling was markedly increased during adipocyte differentiation. In contrast, insulin binding to IDE did not change during differentiation. Protein expression level of CTHBP in the cytosol fraction increased gradually during the differentiation of adipocytes, whereas that of IDE did not change throughout the period. These data indicate that CTHBP, but not IDE, was up-regulated during differentiation of the adipocytes, suggesting that CIBP p55/CTHBP may play a role in regulating some insulin action, especially the counter regulation between insulin and other hormones during adipocyte differentiation.

3T3 Cells↗
PubMed1996

Trabeculectomy at the inferior limbus.

OBJECTIVE: To evaluate intraocular pressure (IOP) control and surgical complications following trabeculectomy with 5-fluorouracil (5-FU) or mitomycin at the inferior limbus. METHODS: The charts of all patients undergoing trabeculectomy at the inferior limbus from July 1984 to March 1993 were reviewed. Surgical success was defined as IOP greater than 4 mm Hg and less than 22 mm Hg and at least a 20% reduction from preoperative IOP. PATIENTS: All 101 eyes of 101 patients had undergone prior intraocular surgery at the superior limbus. Mean patient age was 57.5 +/- 2.0 (+/-SE) years; mean follow-up was 23.4+/-2.3 months; mean preoperative IOP was 32.8+/-0.9 mm Hg; and mean number of preoperative antiglaucoma medications was 2.8+/-0.1. RESULTS: Ninety-four eyes (93.1%) received postoperative 5-FU (mean total dose, 36.3+/-1.7 mg) and seven eyes (6.9%) received intraoperative mitomycin (0.5 mg/mL). Cumulative success for all eyes at 2 and 5 years was 56% and 38%, respectively. Intraocular pressure control without medications was achieved in 39% and 15% of eyes at 2 and 5 years, respectively. Complications included 5-FU epitheliopathy (34.0% of eyes receiving 5-FU), early wound leak (26.7%), choroidal effusion (25.7%), late bleb leak (12.9%), and late bleb-related endophthalmitis (11.9%). CONCLUSION: Although trabeculectomy at the inferior limbus offers the opportunity for surgical success in eyes at high risk of failure, this procedure carries an increased risk for late complications and should be reserved for cases in which the therapeutic options are extremely limited.

Adolescent↗
PubMed1996

Topographic EEG mapping of the relaxation response.

The purpose of this study was to assess the central nervous system effects of the relaxation response (RR) in novice subjects using a controlled, within- subjects design and topographic EEG mapping as the dependent measure. Twenty subjects listened to a RR and control audiotape presented in a counterbalanced order while EEG was recorded from 14 scalp locations. The RR condition produced greater (p < .0164) reductions in frontal EEG beta activity relative to the control condition. No significant differences were observed for any other frequency band or scalp region. These findings suggest that elicitation of the RR produces significant reductions in cortical activation in anterior brain regions in novice subjects.

Adolescent↗
PubMed1996

Perceived benefits in a behavioral-medicine insomnia program: a clinical report.

PURPOSE: This clinical replication series assessed the perceived outcome of individuals with chronic insomnia who spontaneously sought treatment at a hospital behavioral-medicine insomnia program. PATIENTS AND METHODS: Chronic insomnia patients who were treated with a group multifactor behavioral intervention completed posttreatment (n = 102) and 6-month follow-up (n = 70) questionnaires that assessed improvement. RESULTS: All patients reported improved sleep at posttreatment, with the majority (58%, 59) reporting significant improvement. Of sleep medication users, 91% (62/68) either eliminated or reduced medication use. At 6-month follow-up, 90% (63/70) of respondents rated improvement in sleep as either maintained or enhanced. CONCLUSION: These results suggest that patients spontaneously seeking treatment for insomnia, including sleep medication users and those with psychological comorbidity, derive significant benefit from a group multifactor behavioral intervention. Several factors, including maintenance of therapeutic gains at long-term follow-up, the average pretreatment duration of insomnia, previous unsuccessful treatment with psychotherapy and pharmacotherapy, and previous research, argue against nonspecific effects playing a significant role in these results.

Adult↗
PubMed1996

Decreased hospital utilization by older adults attributable to a home hospitalization program.

OBJECTIVE: To evaluate the cost effectiveness of a short-term home health care program for older people, Home Hospitalization (HH), compared with the alternative of regular ambulatory care with general or geriatric hospitalization as necessary. SETTING: Our HH was initiated in November 1991 to serve Jerusalem residents. Program staff included physicians, nurses, and paramedical professionals. Other medical/hospital services were provided nonselectively by the general medical personnel of the various hospitals in Jerusalem. STUDY DESIGN: Patients over the age of 65 were either referred to the HH program (study group, n = 36,500) or to routine medical care (control group; n = 9000) depending on their Sick Fund assignment. Hospital utilization rates per enrollee were studied prospectively and compared both between the two groups and with hospitalization rates in the year before the initiation of the program. RESULTS: During the first 26 months of operations, the HH program cared for 741 older persons for a total of 37,290 days' care at an average daily costs of $30.06 (1992) and $23.64 (1993). Annual general hospitalization rates per person declined in the study group from 2.80 days in the 1991 baseline period to 2.65 days in 1992 and to 2.54 days in 1993. Hospitalization rates in the control group increased from 2.62 in 1991 to 2.70 days/member and 2.71 days/member in 1992 and 1993, respectively. Annual geriatric hospitalization rates declined considerably in the study group from the 1991 baseline of 1.49 to 1.34 (1992) to 1.33 (1993). The control group experienced a small decrease from 1.64 (1991) to 1.58 (1992) and then a rise to 1.68 days per member in 1993. For the 26-month duration of the program, estimated savings of 20,773 general hospital days ($5.54 million) and 8486 geriatric hospital days ($0.98 million) exceeded its costs ($0.97 million), providing a cost/benefit ratio of 5.7/1. In addition, patient satisfaction was high. CONCLUSION: The HH program provided a cost effective substitute for care in a geriatric or general hospital for Jerusalem's elderly.

Aged↗
PubMed1996

Harnessing the power of the placebo effect and renaming it "remembered wellness".

The placebo effect yields beneficial clinical results in 60-90% of diseases that include angina pectoris, bronchial asthma, herpes simplex, and duodenal ulcer. Three components bring forth the placebo effect: (a) positive beliefs and expectations on the part of the patient; (b) positive beliefs and expectations on the part of the physician or health care professional; and (c) a good relationship between the two parties. Because of the heavily negative connotations of the very words "placebo effect, " the term should be replaced by "remembered wellness." Remembered wellness has been one of medicine's most potent assets and it should not be belittled or ridiculed. Unlike most other treatments, it is safe and inexpensive and has withstood the test of time.

Attitude to Health↗
PubMed1996

Multiple lipoprotein abnormalities in type I diabetic patients with renal disease.

The aim of this study was to characterize abnormalities of triglyceride-rich apolipoprotein (apo) B-containing lipoproteins in type I diabetic patients with elevated albumin excretion rates (AERs). Sixty-four patients (31 men, 33 women) with normoalbuminuria (AER <20 microg/min), 52 (35 men, 17 women) with microalbuminuria (AER 20-200 microg/min), and 37 (17 men, 20 women) with albuminuria (AER >200 microg/min) and 56 healthy control subjects matched for age and body weight were studied. The major finding was increased mass concentrations of the highly atherogenic intermediate-density lipoprotein fraction in patients with microalbuminuria (P < 0.05) and albuminuria (P < 0.05), compared with those with normoalbuminuria. Triglyceride, free cholesterol, cholesterol ester, and phospholipid concentrations in the VLDL, intermediate-density lipoprotein, and LDL (P < 0.05-0.01), as well as total cholesterol, total triglyceride, and apoB concentrations were higher in patients with renal disease than in those without. Notably, there were no differences between patients with microalbuminuria and albuminuria. Only minor compositional changes could be detected. Postheparin plasma lipoprotein lipase (LPL) activities were identical, but hepatic lipase activities were higher in microalbuminuric and albuminuric patients than in normoalbuminuric patients (P < 0.01). LPL activity and VLDL1, (Sf 60-400) (r = -0.528; P < 0.001) and VLDL2 (Sf 20-60) mass concentrations (r = -0.471; P < 0.001) were negatively related. In conclusion, in type I diabetic patients with early renal disease, there are multiple lipoprotein changes, which are potentially atherogenic and may contribute to the excess of macrovascular complications seen in such patients.

Adult↗
PubMed1996

Five-year prospective study of glomerular filtration rate and albumin excretion rate in normofiltering and hyperfiltering normoalbuminuric NIDDM patients.

OBJECTIVE: To evaluate the evolution of glomerular filtration rate (GFR) and albumin excretion rate (AER) of normofiltering (NF) and hyperfiltering (HF) normoalbuminuric NIDDM patients. RESEARCH DESIGN AND METHODS: A longitudinal study of 32 normoalbuminuric (AER < 20 micrograms/min) NIDDM patients and 20 age-, sex-, and BMI-matched normal individuals was done. Subjects had their GFR (51Cr-labeled EDTA single-injection method) measured at entry and after 40 and 60 months. At entry, 13 NIDDM patients had GFR values above the upper limit of the normal range in our laboratory (> 137 ml.min-1 x 1.73 m-2) and were considered as HF. In NIDDM patients, the 24-h AER (radioimmunoassay), HbA1c, urinary urea, and mean arterial blood pressure (MBP) were analyzed at entry and after 40 and 60 months. RESULTS: There was a significant decline of GFR in NIDDM patients and normal subjects at 60 months. The decline was significantly greater in HF patients (-0.61 ml.min-1.month-1; P = 0.001) than in NF (-0, 18) and control subjects (-0, 14); the rate of change in NF and control subjects was the same (P > 0.05). In stepwise multiple regression analysis, with GFR decline as the dependent variable and GFR and AER at baseline, age and change in MBP, change in urinary urea, change in HbA1c, and change in therapy as independent variables, only baseline GFR (R2 = 0.19, P = 0.002) and age (R2 = 0.31, P = 0.048) were significantly related to the outcome. At 60 months, AER raised > 20 micrograms/min in three HF and in four NF patients. In logistic regression analysis, only higher initial AER (although still in the normal range; P = 0.037) and an increase in urinary urea (P = 0.021) were significantly related to the later development of microalbuminuria. CONCLUSIONS: The GFR of normoalbuminuric NIDDM patients declines significantly over 60 months. This decline is associated to baseline GFR and age. HF NIDDM patients show a faster decline in GFR than NF patients, whose GFR falls at a rate that is compatible with the age-related change observed in normal control subjects. The development of microalbuminuria is related to higher baseline AER and to increases in urinary urea and is similar in NF (4 of 19) and HF (3 of 13) NIDDM patients (P > 0.05).

Adult↗
PubMed1996

The effects of relaxation response training on menopausal symptoms.

The specific aim of this study was to investigate the efficacy of elicitation of the relaxation response for the treatment of menopausal hot flashes and concurrent psychological symptoms. The volunteer sample consisted of 33 women, between the ages of 44 and 66 years, who were in general good health, with a minimum of 6 months without a menstrual period, experiencing at least five hot flashes per 24-h, and not using hormone replacement therapy. The setting was an outpatient clinic in a tertiary care teaching hospital. The interventions used were relaxation response training and an attention-control group and a daily symptom diary measuring both the frequency and intensity of hot flashes, the Spielberger State-Trait Anxiety Inventory (STAI), and the Profile of Mood Scale (POMS) were the measures used. This was a randomized, controlled, prospective study. Subjects were randomly assigned to one of three groups (relaxation response, reading, or control) for the 10-week study. The first 3 weeks of baseline measurement of frequency and intensity of hot flash symptoms, and the preintervention psychological scores were compared with the final 3 weeks measurement of frequency and intensity and the postintervention psychological scores for symptomatic improvement. The relaxation response group demonstrated significant reductions in hot flash intensity (p < 0.05), tension-anxiety (p < 0.05) and depression (p < 0.05). The reading group demonstrated significant reductions in trait-anxiety (p < 0.05) and confusion-bewilderment (p < 0.05). There were no significant changes for the control group. Daily elicitation of the relaxation response leads to significant reductions in hot flash intensity and the concurrent psychological symptoms of tension-anxiety and depression.

Affect↗
PubMed1996

Determinants of loneliness in Jerusalem's 70-year-old population.

This study aims to find the determinants of feelings of loneliness in 70 year olds living in Jerusalem. Results based on home interviews (n = 605) of a 40% systematic sample of 70 year olds in the electoral register showed that around 46.3% of females and 21.3% of males reported being lonely. Persons of European/North American origin felt less lonely than those of Asian or African origin, probably due to the former's wider social support network, perceiving friends, neighbors or other relatives as being available to back up children in an emergency. The major factors associated with loneliness were: being depressed, having a poor self-assessed health status, not attending synagogue, and being widowed but not remarried. Factors that did not reduce loneliness included having paid employment, watching TV or listening to the radio. No association was found between cognitive status and loneliness. Our systems model suggests a strong reciprocal relationship between loneliness and depression.

Aged↗