Pack more punch with your Rxs.
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Drug Industry↗
Biomedical subjects
R Green
Publications and source records attributed to R Green.
Dealing with prejudice in the ED.
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Age Factors↗
Determination of blood folate using acid extraction and internally standardized gas chromatography-mass spectrometry detection.
Whole blood folate level is a superior indicator of folate nutritional status than serum/plasma level. Problems with and lack of confidence in results of current whole blood folate assays have limited its popularity for assessing folate nutritional status. Here, an acid extraction GCMS detection method that measures total folate whole blood is presented. Folates are released from the matrix of whole blood and cleaved to para-aminobenzoic acid (pABA) by acid hydrolysis in the presence of [(13)C(6)]pABA as internal standard (IS). The hydrolysate is passed over a C18 resin to remove heme. The pABA isotopomers are ethyl esterified, isolated on C18 resin, and trifluoroacetylated. Following normal-phase HPLC separation, the isotopomers are silylated to their tBDMS derivatives. The abundance of these derivatives are measured at m/z 324 for [(13)C(6)]pABA as IS and m/z 318 for pABA from whole blood folate. Our method uses readily available chemicals and our results agree well with those using Lactobacillus casei, the current gold standard reference assay. The presence of folate analogs (methotrexate) or antibacterials (sulfonamines) does not affect our method. This feature makes it useful in monitoring folate status of patients undergoing chemotherapy. Before using our method, pABA supplements must be discontinued for a few days.
Acids↗
Evidence for cystic fibrosis transmembrane conductance regulator-dependent sodium reabsorption in kidney, using Cftr(tm2cam) mice.
The aims of this study were to investigate (a) if renal Na(+) handling was normal in Cftr(tm2cam) delta F508 cystic fibrosis mice, (b) whether adaptation to dietary salt depletion was preserved and (c) whether Cftr(tm2cam) delta F508 mice exhibited enhanced amiloride-sensitive Na(+) absorption. In Na(+)-replete animals (maintained on a 0.32 % NaCl diet) given a 150 mM NaCl i.v. maintenance infusion, there was no difference in fractional Na(+) excretion (FE(Na)) between wild-type (0. 42 +/- 0.06 %, n = 12) and Cftr(tm2cam) delta F508 mice (0.47 +/- 0.13 %, n = 7). Amiloride infusion significantly increased FE(Na) in both wild-type (3.14 +/- 0.83 %, n = 6) and Cftr(tm2cam) delta F508 mice (3. 47 +/- 0.63 %, n = 9), though with no significant difference between genotypes. A 14 day dietary salt restriction (animals maintained on a 0.03 % NaCl diet) and maintenance infusion with a 15 mM NaCl vehicle caused a reduction in FE(Na) to 0.14 +/- 0.05 %, n = 8 in wild-type mice and 0.14 +/- 0.04 %, n = 8 in Cftr(tm2cam) delta F508 mice. No significant difference in the ability to adapt to low salt conditions was apparent comparing the two genotypes. Treatment of salt-restricted mice with amiloride resulted in a blunted natriuresis in both wild-type mice (FE(Na) = 1.10 +/- 0.16 %, n = 7) and Cftr(tm2cam) delta F508 mice (FE(Na) = 1.97 +/- 0.29 %, n = 9). The natriuresis induced by amiloride was significantly greater in Cftr(tm2cam) delta F508 mice than in wild-type controls. In conclusion, Cftr(tm2cam) delta F508 mice exhibit normal renal salt excretion when either salt replete or salt restricted. Enhanced amiloride-sensitive FE(Na) is consistent with increased Na(+) absorption via the amiloride-sensitive sodium channel ENaC, in cystic fibrosis kidney, but this was only observed during salt restriction.
Amiloride↗
Prevalence, severity and associated features of gastro-oesophageal reflux and dyspepsia: a population-based study.
AIMS: To describe the prevalence and severity of dyspepsia and gastro-oesophageal reflux in the community, to investigate their association with lifestyle factors and to evaluate the consultation pattern for these conditions. METHOD: A previously validated questionnaire was posted to 1000 adults randomly selected from the electoral rolls of the greater Wellington region. It investigated symptoms of dyspepsia, reflux, lifestyle and consultation pattern over the previous twelve months. RESULTS: Response rate was 81.7%. Prevalence of dyspepsia was 34.2%. Prevalence of reflux was 30%. The overall prevalence of both symptom groups combined was 45.2%. Most subjects had multiple symptoms. Results indicated 63% of subjects with reflux also had symptoms of dyspepsia and 56% of subjects with dyspepsia showed symptoms of reflux. Although 69% of subjects with heartburn used over-the-counter medications, only 17% consulted medical practitioners. Current and ex-smokers had a higher prevalence of reflux. Dyspeptic symptoms were not associated with alcohol intake or aspirin use. Prevalence of dyspeptic symptoms did not change with increasing age. CONCLUSIONS: Dyspepsia is very common in the community. Significant overlap among the subgroups of dyspepsia makes a classification, based on symptoms alone, of questionable value. Frequency and severity of symptoms should be incorporated in the definition to exclude those subjects with trivial symptoms.
Adolescent↗
Ribosomal translocation: EF-G turns the crank.
Recent results from cryo-electron microscopy have shown that substantial structural rearrangements in both elongation factor EF-G and the ribosome occur during tRNA translocation. The observed sites of interaction between EF-G and the ribosome are consistent with molecular mimicry models for EF-G function.
Cryoelectron Microscopy↗
In vivo characterization of renal iron transport in the anaesthetized rat.
1. In vivo microinjections of 55FeCl3 were made to assess renal iron (Fe2+/3+) transport in the anaesthetized rat. 2. Following microinjection into proximal convoluted tubules (PCTs), 18.5 +/- 2.9 % (mean +/- s.e.m., n = 11) of the 55Fe was recovered in the urine. This recovery was not dependent on the injection site indicating that iron is not reabsorbed across the surface convolutions of the proximal tubule. 3. Following microinjection into distal convoluted tubules (DCTs) 46.1 +/- 6.1 % (n = 8) of the injected 55Fe was recovered. Taken together the recovery data from the PCT and DCT microinjection studies indicate that the transport of iron occurs in the loop of Henle (LH) and collecting duct system. 4. In vivo luminal microperfusion was used to examine iron transport by the LH in more detail. In tubules perfused with 7 micromol l-1 55FeCl3, 52.7 +/- 8. 3 % (n = 8) of the perfused 55Fe was recovered in the collected fluid, indicating significant iron reabsorption in the LH. Addition of copper (Cu2+ as 7 micromol l-1 CuSO4), manganese (Mn2+ as 7 micromol l-1 MnSO4) or zinc (Zn2+ as 7 micromol l-1 ZnSO4) to the perfusate did not affect reabsorption of water, Na+ or K+, but increased recovery of 55Fe to 83.5 +/- 6.8 % (n = 8, P < 0.04), 75.8 +/- 5.9 (n = 6, not significant, n.s.) and 67.9 +/- 3.8; (n = 9, n.s. ), respectively. 5. Thus, iron transport in the LH can be reduced by the addition of copper or manganese to the luminal perfusate suggesting that these ions may compete with iron for a common transport pathway. However, this pathway may not be shared by zinc.
Anesthesia↗
Association between thymoma and second neoplasms.
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Adult↗
The disparate maternal aunt-uncle ratio in male transsexuals: an explanation invoking genomic imprinting.
A significant skewing in the sex ratio in favour of females has been reported for the families of homosexual men such that there are fewer maternal uncles than aunts. This finding is repeated for a large series of transsexual families in this study. Four hundred and seventeen male-to-female transsexuals and 96 female-to-male transsexuals were assessed. Male-to-female transsexuals have a significant excess of maternal aunts vs. uncles. No differences from the expected parity were found for female-to-male transsexuals or on the paternal side. A posited explanation for these findings invokes X inactivation and genes on the X chromosome that escape inactivation but may be imprinted. Our hypothesis incorporates the known familial traits in the families of homosexuals and transsexuals by way of retention of the grand parental epigenotype on the X chromosome. Generation one would be characterized by a failure to erase the paternal imprints on the paternal X chromosome. Daughters of this second generation would produce sons that are XpY and XmY. Since XpY expresses Xist, the X chromosome is silenced and half of the sons are lost at the earliest stages of pregnancy because of the normal requirement for paternal X expression in extra-embryonic tissues. Females survive by virtue of inheriting two X chromosomes, and therefore the possibility of X chromosome counting and choice during embryonic development. In generation three, sons inheriting the paternal X after its second passage through the female germline survive, but half would inherit the feminizing Xp imprinted genes. These genes could pre-dispose the sons to feminization and subsequent development of either homosexuality or transsexualism.
Family Characteristics↗
Management of a Jehovah's witness with thrombotic thrombocytopaenic purpura/haemolytic uraemic syndrome.
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Aged↗
Case management for people with severe mental disorders.
BACKGROUND: Since the 1960s, in many parts of the world, large psychiatric were closed down and people were treated in outpatient clinics, day centres or community mental health centres. Rising readmission rates suggested that this type of community care may be less effective than anticipated. In the 1970s case management arose as a means of co-ordinating the care of severely mentally ill people in the community. OBJECTIVES: To determine the effects of case management as an approach to caring for severely mentally ill people in the community. Case management was compared against standard care on four main indices: (i) numbers remaining in contact with the psychiatric services; (ii) extent of psychiatric hospital admissions; (iii) clinical and social outcome; and (iv) costs. SEARCH STRATEGY: Electronic searches of CINAHL (1997), the Cochrane Schizophrenia Group's Register of trials (1997), EMBASE (1980-1995), MEDLINE (1966-1995), PsycLIT (1974-1995) and SCISEARCH (1997) were undertaken. References of all identified studies were searched for further trial citations. SELECTION CRITERIA: The inclusion criteria were that studies should be randomised controlled trials that (i) had compared case management to standard community care; and (ii) had involved people with severe mental disorder mainly between the ages of 18-65. Studies of case management were defined as those in which the investigators described the intervention as 'case' or 'care' management rather than 'Assertive Community Treatment' or 'ACT'. DATA COLLECTION AND ANALYSIS: A study was carried out to test the reliability of the inclusion criteria. Categorical data were extracted twice and then cross-checked, any disagreements being resolved by discussion. Odds ratios and the number needed to treat were estimated. Continuous data collected by a measuring instrument was only included if the instrument (i) had been described in a peer-reviewed journal; (ii) was a self-report or had been completed by an independent rater; and (iii) provided a summary score for a broad area of functioning. Normally distributed continuous data were included if means and standard deviations were available. Non-normal data were included if analysed either after transformation or using non-parametric methods. Tests for heterogeneity were conducted. MAIN RESULTS: Case management increased the numbers remaining in contact with services (for case management odds ratio = 0.70; 99%CI 0.50-0. 98; n=1210). Case management approximately doubled the numbers admitted to psychiatric hospital (OR 1.84; 99% CI 1.33-2.57; n=1300). Except for a positive finding on compliance, from one study, case management showed no significant advantages over standard care on any psychiatric or social variable. Cost data did not favour case management but insufficient information was available to permit definitive conclusions. REVIEWER'S CONCLUSIONS: Case management ensures that more people remain in contact with psychiatric services (one extra person remains in contact for every 15 people who receive case management), but it also increases hospital admission rates. Present evidence suggests that case management also increases duration of hospital admissions, but this is not certain. Whilst there is some evidence that case management improves compliance, it does not produce clinically significant improvement in mental state, social functioning, or quality of life. There is no evidence that case management improves outcome on any other clinical or social variables. Present evidence suggests that case management increases health care costs, perhaps substantially, although this is not certain. In summary, therefore, case management is an intervention of questionable value, to the extent that it is doubtful whether it should be offered by community psychiatric services. It is hard to see how policy makers who subscribe to an evidence-based approach can justify retaining case management as 'the cornerstone' of community mental hea
Case Management↗
Immunisation of lambs with drug-abbreviated Haemonchus contortus infections: protection against homologous and heterologous challenge.
Haemonchus contortus is known as a prolific parasite, producing high numbers of eggs. It could therefore be used as a cheap source of larvae for immunisation of lambs. The value of immunisation would be improved if the immunity produced gave protection against not only homologous but also heterologous infections. Because antibody cross-reactivity between Haemonchus and Ostertagia has been well established, we wanted to know whether drug-abbreviated infections of H. contortus would stimulate production of antibodies that would cross-react with Trichostrongylus colubriformis. The results obtained from these trials indicated that H. contortus drug-abbreviated infections produced significant immunity against not only Haemonchus but also O. circumcincta. Immunisation increased the level of immunoglobulin E (IgE) and IgE-specific antibodies against T. colubriformis, but the differences between experimental and control animals were not statistically significant. Significantly higher levels of IgG-specific antibodies against T. colubriformis were observed.
Animals↗
Glasgow Coma Scale: variation in mortality among permutations of specific total scores.
OBJECTIVE: The objective of this study was to determine whether different score permutations of the Glasgow Coma Scale (GCS) giving the same GCS total score were associated with significantly different mortality. DESIGN: For each GCS total we compared the mortality associated with each of the different GCS permutations using a Fisher's exact test. The relationship between components of the GCS score and mortality was also examined using uni- and multivariate logistic regression. SETTING: Data were collected from the intensive care unit at Wellington Hospital, a multidisciplinary, tertiary referral unit. PATIENTS: We analysed the GCS and mortality data from all admissions over a 4 year period (January 1994-January 1998). Patients with GCS scores of 3 or 15 were excluded, since these two total scores do not have multiple permutations, leaving 1,390 patients with GCS scores of 4-14 for analysis. RESULTS: The incidence of mortality was significantly different for the different permutations for total GCS scores of 7, 9, 11 and 14. CONCLUSIONS: It is possible for patients to have the same total GCS score, but significantly different risks of mortality due to differences in the GCS profile making up that score. This suggests that GCS scores may be more useful reported in terms of profiles rather than totals. This could also have implications for the use of other scoring systems such as Acute Physiology and Chronic Health Evaluation and Simplified Acute Physiology Score.
Craniocerebral Trauma↗
Endovascular grafting in patients with short proximal necks: an analysis of short-term results.
OBJECTIVES: To evaluate the safety of endovascular graft placement in patients with short proximal aneurysm necks, and assess factors contributing to endoleak formation. METHODS: 55 patients were enrolled over a two year period from five centers following the placement of a Talent endograft with a suprarenal stent. Preoperative and 30-day post-implant CT scans were retrospectively analyzed in a blinded fashion by two physicians. Aortic measurements were obtained, the amount of thrombus was subjectively graded, and any extravasation of contrast into the aneurysm sac defined an endoleak. The data were analyzed using a t-test. Analyses compared patients with proximal necks<10mm (SN), n=13) to those with longer necks (LN, n=42), and then contrasted patients with endoleaks (n=12), to those without (n=43). RESULTS: Endoleak rates were identical in the SN and LN groups (21 and 23%). Maximal aneurysm size was larger in the SN group (63 vs 56 mm, P<0.05). Endoleaks were more frequently noted in larger aneurysms (P<0.05), but not related to SN (P=0.6). There was no correlation between endoleaks and the amount of thrombus, aneurysm length, proximal neck diameter or other morphologic characteristics. One of 12 endoleaks resulted from a problem with proximal fixation, nine were due to perfusing vessels, and two were undefined. The proximal neck diameter increased (0.9 mm) over the 30 days (P<0.005). CONCLUSIONS: Short-term proximal fixation can be achieved in proximal necks measuring less than 10mm. The narrow margin of acceptable seal mandates careful follow-up. Larger aneurysms were associated with an increased incidence of endoleaks. SNs were associated with larger aneurysms, but not with an increased incidence of endoleaks. Proximal neck dilation was noted, but likely relates to the placement of an oversized endograft during this brief period of observation.
Aortic Aneurysm, Abdominal↗
Mechanical versus chemical thrombolysis: an in vitro differentiation of thrombolytic mechanisms.
PURPOSE: To assess differing mechanisms of thrombolysis determining time to reperfusion, completeness of thrombus dissolution, and embolic potential. MATERIALS AND METHODS: An in vitro perfusion model designed to mimic arterial flow conditions was created. Bifurcated limbs allowed continuous flow through one channel and the placement of radiolabeled (iodine-125) thrombus housed in a 5-cm segment of polytetrafluoroethylene graft in the other. The three experimental groups consisted of a standard continuous urokinase infusion, a pulsed pressurized injection of saline, and a similar injection with urokinase. A continuous infusion of 5% dextrose served as a control group. Time to reflow (as assessed with ultrasonic flow monitoring), completeness of thrombus dissolution (I-125 liberated into solution), and the number and size of embolic particles produced (detected by a series of graduated filter sizes) were analyzed. RESULTS: Time to reflow was significantly faster for both groups when pressurized injections were used (P < .001). There was no reflow in the control arm at 90 minutes. Completeness of thrombus dissolution was higher when a continuous infusion of urokinase was used in comparison to either of the power injection groups or the control (P < .05). The amount of embolic debris produced was significantly lower with a continuous infusion of urokinase compared with either of the power lysis groups (P < .05), but significantly greater than the control arm (P < .001). The size of the embolic particles in the power pulsed lysis groups was significantly decreased by the addition of urokinase (P < .05). CONCLUSIONS: Reflow is more rapidly established by the use of mechanical means. However, a less complete dissolution of thrombus in conjunction with a greater amount of embolic debris is achieved with this approach. The size of the embolic particles produced is reduced by the addition of a thrombolytic agent.
Blood Vessel Prosthesis↗
Birth order and ratio of brothers to sisters in transsexuals.
BACKGROUND: As previous studies with homosexual males have revealed a later birth order, more older brothers and more brothers than sisters, this research was extended to a large series of transsexual males and females, some of whom are homosexual. METHODS: The male sample comprised 442 male-to-female transsexuals, subdivided by sexual partner preference: 106 homosexual, 135 heterosexual, 155 bisexual and 46 asexual. One hundred female-to-male transsexuals were also studied: 75 homosexual, 16 bisexual, seven heterosexual and five asexual. Birth order was computed by both Slater's Index and Berglin's Index. RESULTS: Homosexual male-to-female transsexuals have a later than expected birth order and more older brothers than other subgroups of male-to-female transsexuals. Each older brother increases the odds that a male transsexual is homosexual by 40 %. CONCLUSIONS: Hypotheses explaining the extension of prior findings to this large sample of transsexual males include a progressive maternal immunization to the male foetus either through the H-Y antigen or protein-bound testosterone or alterations in foetal androgen levels in successive pregnancies, all modifying male psychosexual development. Data on the sexual orientation of younger brothers of homosexual male transsexuals in this study are not consistent with the progressive immunization hypothesis.
Adult↗
Family cooccurrence of "gender dysphoria": ten sibling or parent-child pairs.
Ten (10) sets of siblings or parent-child pairs concordant for gender identity disorder (transsexualism) or gender identity disorder and transvestitism are reported. For concordant gender identity disorder, there is one set of male monozygotic twins; three sets of non-twin brothers; one brother-and-sister pair; one set of sisters; and one father and son. With gender identity disorder and transvestism, there is one transsexual father with a gender dysphoric; transvestic son; one transvestic father with a gender dysphoric, transvestic son; and one transvestic father with a transsexual daughter. The emerging technology of genetic markers makes collation of such families a potentially valuable resource for unraveling the origins of atypical gender identity.
Adult↗