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Biomedical subjects

R J Miller

Publications and source records attributed to R J Miller.

At least 199 records · Page 11Linked to original sources

Some notes on the impact of treating AIDS patients in hospices.

As part of a larger nation-wide study of attitudes of hospice personnel, we incorporated questions about patient autonomy and economic justice in which we asked the respondents to share their beliefs about AIDS patients compared to patients terminally ill with other diagnoses. The convenience sample of 826 hospice workers, 76% of whom were clinical professionals (nurses, physicians, social workers) rated terminally ill patients and those with AIDS the same in terms of right to refuse life sustaining medical therapy. Although over one half believed that we are not currently spending enough on the care of AIDS patients, 25% thought that we spend too much on those terminally ill with other diagnoses. Issues of survival time, costs of care, and staff concerns about treating AIDS patients in hospices are briefly discussed.

Acquired Immunodeficiency Syndrome↗

Hospice and the do-not-resuscitate order.

Recent passage of the Patient Self-Determination Act will require health care providers to develop policies concerning patients' wishes for life prolonging therapy. Since American hospice programs have generally had do-not-resuscitate (DNR) policies since their inception we thought it timely to review the experience of hospice programs with the DNR order. Many programs assume that a signed DNR order is a prerequisite to being accepted as a hospice patient. Other programs are more flexible. This lack of uniformity exposes the unresolved issue within the hospice community as to what is considered appropriate hospice or palliative care. Problems with paramedics responding to 911 calls and not respecting DNR orders or living wills are also discussed.

Advance Directives↗

Neuropeptide Y inhibits Ca2+ influx into cultured dorsal root ganglion neurones of the rat via a Y2 receptor.

1. The identity of the neuropeptide Y (NPY) receptor associated with the observed inhibition of neuronal Ca2+ currents (ICa) in rat dorsal root ganglion (DRG) cells has been established on the basis of agonist responses to analogues and carboxy terminal (C-terminal) fragments of the NPY molecule. 2. Whole cell barium currents (IBa) in DRG cells were reversibly inhibited by 100 nM NPY, 100 nM PYY and C-terminal fragments of NPY in a manner that correlated with the length of the NPY fragments (for inhibition of the IBa NPY = PYY greater than NPY2-36 greater than NPY13-36 greater than NPY16-36 greater than NPY18-36 much greater than NPY25-36). 3. C-terminal fragments of NPY were also effective in reversibly reducing the ICa, the associated increase in the intracellular Ca2+ concentration [( Ca2+]i) and the increased [Ca2+]i produced by evoked action potentials in the DRG cells. In addition, a Ca(2+)-activated Cl- conductance was also reversibly reduced by NPY fragments only when accompanied by a reduction in Ca2+ entry. 4. We conclude that the Y2 receptor for neuropeptide Y is coupled to inhibition of Ca2+ influx via voltage-sensitive calcium channels in DRG cells.

Action Potentials↗

Analysis of adenosine actions on Ca2+ currents and synaptic transmission in cultured rat hippocampal pyramidal neurones.

1. The role of adenosine receptors in reducing calcium currents (ICa) and in triggering presynaptic inhibition was studied using whole-cell patch-clamp techniques to record ICa and synaptic currents from the cell bodies of cultured rat hippocampal pyramidal neurones. Recordings of intracellular Ca2+ using the indicator dye Fura-2 were used to obtain further insights into the actions of adenosine agonists. 2. The adenosine analogue 2-chloroadenosine (2-CA) reduced ICa in these neurones. This action was also evident when Ba2+ was used as the charge carrier through Ca2+ channels. Adenosine also reduced the influx of Ca2+ into the cell body during a depolarizing voltage-clamp pulse as measured with Fura-2. The potency of various adenosine receptor agonists was as follows: cyclopentyladenosine greater than cyclohexyl-adenosine greater than or equal to R-phenylisopropyladenosine greater than 2-CA greater than S-phenylisopropyladenosine, consistent with the pharmacological profile of an A1 adenosine receptor. 3. The specific A1 receptor antagonist cyclopentyltheophylline (CPT) blocked the actions of 2-CA on ICa in a competitive fashion. 4. The actions of 2-CA on ICa were abolished by pre-incubation of cultured cells with pertussis toxin (PTX; 250 ng/ml). Intracellular dialysis with the GTP analogue GTP-gamma-S (guanosine-5'-O-(3-thiotriphosphate] enhanced the actions of 2-CA and rendered the response irreversible. 5. Excitatory postsynaptic currents (EPSCs) were recorded from pyramidal neurones under whole-cell voltage clamp by stimulating nearby neurones with an extracellular electrode. 2-CA potently and reversibly reduced the amplitude of EPSCs. This action was shown to be due to presynaptic inhibition of neurotransmitter release. 6. The order of potency of different adenosine agonists in reducing EPSCs was as follows: cyclopentyladenosine greater than cyclohexyladenosine greater than or equal to R-phenylisopropyladenosine greater than 2-CA greater than S-phenylisopropyladenosine. CPT inhibited the action of 2-CA in a competitive fashion. 7. The effects of 2-CA on synaptic transmission were abolished by pre-treatment with 250 ng/ml PTX, indicating that a PTX-sensitive G-protein is involved in this action. 8. These results indicate that activation of adenosine receptors does induce a reduction in ICa in hippocampal pyramidal neurones. Furthermore, this effect and the reduction of excitatory synaptic transmission by adenosine analogues are both mediated by PTX-sensitive G-proteins and have identical pharmacological properties.

2-Chloroadenosine↗

GABAB receptor-mediated inhibition of Ca2+ currents and synaptic transmission in cultured rat hippocampal neurones.

1. The effects of activation of GABAB receptors on Ca2+ currents (ICa) were investigated by application of whole-cell patch-clamp techniques to pyramidal neurones and non-pyramidal interneurones from the rat hippocampus grown in cell culture. 2. (+/-)-Baclofen (10 microM) reduced ICa evoked in pyramidal neurones at 0 mV from a holding potential of -80 mV by 33 +/- 3%. Inhibition could be observed at the peak of ICa with significant inhibition still present after 200 ms at 0 mV. When Ba2+ was used as the charge carrier (IBa) baclofen inhibited 28 +/- 3% of the current at -20 mV from a holding potential of -80 mV. The GABAB receptor antagonist 2-OH-saclofen (50-200 microM) blocked the actions of baclofen. 3. The selective Ca2+ channel blocker, omega-conotoxin fraction GVIA (omega-CgTX), was used to characterize the Ca2+ currents inhibited by baclofen. omega-CgTX (5 microM) blocked 24 +/- 3% of IBa. Following block of the omega-CgTX-sensitive current, baclofen inhibited significantly less current than under control conditions. 4. Addition of the dihydropyridine Ca2+ channel antagonist nimodipine (1 microM) inhibited 18 +/- 5% of ICa at 0 mV from a holding potential of -80 mV and 44 +/- 9% from a holding potential of -40 mV. In addition, nimodipine partially occluded subsequent responses to application of baclofen. 5. In the presence of both 5 microM-omega-CgTX and 200 nM-nimodipine, responses to baclofen were almost completely blocked at depolarized holding potentials where the dihydropyridines are most effective. 6. Inclusion of 500 microM-guanosine 5'-O-(3-thiotriphosphate) (GTP-gamma-S) in the patch pipette enhanced the response to a subsaturating concentration of baclofen and rendered the response irreversible. Subsequent addition of the adenosine receptor agonist 2-Cl-adenosine (2-CA) (1 microM; which also reduces ICa under control conditions) was without effect, suggesting that these two receptor-effector pathways converge. 7. The actions of baclofen on ICa were blocked by pre-treatment of the cultures with pertussis toxin (250 ng/ml). 8. Baclofen also inhibited ICa in non-pyramidal neurones from the hippocampus, but was slightly less effective. 9. Baclofen reduced both excitatory- and inhibitory postsynaptic currents (EPSCs and IPSCs) recorded as a consequence of extracellular stimulation of presynaptic neurones. This action was blocked by 2-OH-saclofen (200 microM) and also by pretreatment of the cultures with pertussis toxin.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Essential hypertension: hostility, psychiatric symptoms and marital stress in patients and spouses.

Scores on self-report questionnaire measures of hostility, psychiatric symptoms, marital dissatisfaction, and assertion discomfort/behaviour were compared for male (n = 26) and female (n = 25) patients with essential hypertension and their spouses, and matched normotensive controls. Correlations and factor analysis revealed clinically meaningful associations between elevated psychiatric symptoms, hostility, and assertive behaviour. These differed for male and female patients, especially regarding assertive behaviour. The findings suggest that communication training might be helpful for a sizeable proportion of married patients with essential hypertension.

Adult↗

Variables related to the type of postsecondary education experience chosen by young adults with learning disabilities.

This article examines selected variables related to the type of postsecondary education experience chosen by young adults with learning disabilities (N = 225). A one-way analysis of variance was utilized to identify significant differences between groups participating in alternative postsecondary education experiences. Variables related to use of community resources, community mobility, participation in vocational education while in high school, autonomy, peer influence, and gender were found to be significant factors that differentiate among groups. Recommendations for further research are discussed.

Adolescent↗

The effect of ingested alcohol on fusion latency at various viewing distances.

Although diplopia is a frequently reported symptom of severe alcohol intoxication, there have been few past attempts to describe in any systematic fashion the specific impact of alcohol on fusion. In the present experiment, fusion latency was assessed for 8 male emmetropes. At the beginning of the alcohol condition, they consumed a drink containing 1.4 ml/kg of 95% ethanol, plus diluent. For the placebo condition, the drink consisted only of diluent. In each condition, fusion latency (the time required to fuse a binocularly visible target) was recorded for targets requiring a magnitude of vergence that varied from +10 through -2 meter angles, in 1-meter-angle steps. It was found that the far point of fusion approached the observer as a direct function of intoxication level. Furthermore, fusion latency increased for optically far and near targets as a systematic function of intoxication, with no effect of alcohol on intermediate targets. The results were consistent with previous findings of alcohol-induced narrowing of vergence range, suggesting that alcohol causes the farthest and nearest distances at which fusion latency is affected to approach an intermediate value. Measurable effects on fusion latency were observed with blood alcohol levels as low as 0.05%-0.06%, considerably below the legal limit for operating a motor vehicle in most states.

Adult↗

Joint-venture, capitation model can strengthen market share.

As health maintenance organizations (HMOs) and preferred provider organizations (PPOs) control an increasingly larger percentage of the healthcare market, many hospitals are entering capitation contracts to capture and preserve market share. A joint-venture and capitation model may provide an additional mechanism for large referral centers and community hospitals to jointly maintain or increase market share through improved service delivery. While the model includes many benefits, hospitals should thoroughly consider ramifications. Only through substantial institutional commitment, careful planning, and ongoing management will the model prove successful.

Capitation Fee↗

The properties of intracellular calcium stores in cultured rat cerebellar neurons.

Cerebellar Purkinje neurons contain a remarkable array of cellular components potentially concerned with regulation of the free cytoplasmic Ca2+ concentration, [Ca2+]i. These include high concentrations of Ca(2+)-binding proteins, inositol 1,4,5-triphosphate receptors (IP3R), and ryanodine receptors (RyR). The latter two molecules are thought to be associated with intracellular Ca2+ stores. We have examined the properties of such stores in cultured rat cerebellar neurons taken from 16 d rat embryos. In this system, about half of the neurons could be identified as Purkinje-like cells, as indicated by staining for the Ca(2+)-binding protein calbindin D-28k, as well as for IP3R and RyR. In double immunofluorescent staining, the IP3R and RyR immunoreactivity primarily colocalized with the staining for calbindin. The cells responded to glutamate, kainate, and quisqualate with large increases in the somatic [Ca2+]i but failed to respond directly to NMDA (10-50 microM). Furthermore, the neurons expressed active membrane conductances, repetitive action potential firing, and spontaneous firing patterns similar to those reported for cerebellar Purkinje neurons in vivo. Action potential firing produced changes in somatic [Ca2+]i that were quite small or absent in most cells. However, blocking spike repolarization with tetraethylammonium (5 mM) produced substantial transient elevations in somatic [Ca2+]i, suggesting the expression of some Ca2+ channels in the somatic membrane. Caffeine (10 mM) released Ca2+ from intracellular stores in about one-half of the cultured neurons. This effect could be repeated if the stores were first reloaded by a depolarization-induced elevation in [Ca2+]i. The effects of caffeine were reduced by prolonged application of ryanodine (10 microM). We were also able to demonstrate that the caffeine-sensitive Ca2+ stores could regulate electrophysiological events in some cells, altering patterns of spontaneous activity. Furthermore, in the presence of caffeine, [Ca2+]i signals induced by an evoked spike train were larger and accompanied by long-lasting after hyperpolarizations. We conclude that in addition to providing a releasable pool of Ca2+, the caffeine-sensitive stores also influence cellular events by their contribution to Ca2+ buffering.

Animals↗

Block of neuronal Ca++ influx by the anti-ischemic agent TA3090.

We examined the effect of the novel anti-ischemic drug, TA3090 on Ca++ entry into peripheral and central neurons. TA3090 inhibited voltage-dependent Ca++ entry into rat dorsal root ganglion (DRG) and sympathetic neurons. The degree of inhibition produced by the drug was voltage-dependent. TA3090 also inhibited Ca++ entry into DRG cells elicited by trains of action potentials. TA3090 inhibited Ca++ influx into neurons from the hippocampus. As in peripheral neurons, TA3090 blocked Ca++ influx associated with a Ca++ current in voltage-clamped cells or elicited by trains of action potentials. Furthermore, TA3090 blocked Ca++ influx stimulated by glutamate or N-methyl-D-aspartate. In addition, TA3090 blocked excitatory glutamate-mediated synaptic transmission between hippocampal pyramidal neurons. These data indicate that the protective effects of TA3090 in the brain under ischemic conditions may be partly or completely due to its ability to inhibit neuronal Ca++ influx.

Animals↗

Inhibition of calcium currents in cultured myenteric neurons by neuropeptide Y: evidence for direct receptor/channel coupling.

Single channel recordings from rat myenteric plexus neurons demonstrated the presence of two categories of Ca2+ channels. One type of Ca channel had a slope conductance of 27 pS and was sensitive to dihydropyridines while the other channel type had a conductance of 14 pS and was dihydropyridine-insensitive. The 14 pS channel was mostly inactivated at a holding potential of -40 mV, while the 27 pS channel was much more resistant to depolarized holding potentials. A majority of whole-cell current was reprimed by the use of negative holding (-90 mV) potentials, when compared to that obtained at a holding potential of -40 mV. These properties are consistent with N- and L-type Ca channels previously described. In general, the inactivating part of the whole-cell Ca2+ current, selectively reprimed by negative holding potentials, was inhibited by neuropeptide Y (NPY). Depolarization-induced [Ca2+]i transients assessed using fura-2 showed that the inhibitory effects of nitrendipine and NPY were additive. The effects of NPY were abolished by pertussis toxin pretreatment. Single-channel experiments showed that neither the 14 nor the 27 pS Ca channel currents were inhibited by the addition of NPY outside the patch pipette. These results suggest that NPY modulates N-type Ca2+ channels selectively in these neurons and that an easily diffusible second messenger does not appear to participate in receptor/channel coupling.

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethy↗

Potassium channel activators abolish excitotoxicity in cultured hippocampal pyramidal neurons.

When hippocampal pyramidal neurons are grown in culture they develop excitatory synaptic contacts. If these cultures are perfused with Mg2(+)-free, glycine supplemented medium the neurons exhibit fluctuations in [Ca2+]i and associated cell death ('excitotoxicity'). These phenomena involve the activation of NMDA receptors. When cultures are treated with the K(+)-channel activators cromakalim and diazoxide both the [Ca2+]i fluctuations and the neuronal death are abolished. These effects are reversed by the sulfonylurea glyburide. It thus appears that K(+)-channel activators may be a novel therapeutic intervention in epilepsy and associated disorders.

Action Potentials↗