Management of adhesive small-bowel obstruction.
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Humans↗
Biomedical subjects
R Klein
Publications and source records attributed to R Klein.
Change in visual acuity associated with cataract surgery. The Beaver Dam Eye Study.
PURPOSE: Cataract is the most common age-related eye disease in most countries worldwide. However, unlike many age-related eye diseases, therapy, in the form of cataract surgery, is successful in restoring at least some function in the vast majority of patients. The purpose of this investigation is to evaluate the change in vision related to specific kinds of cataract and cataract surgery in a population-based study in Beaver Dam, Wisconsin. METHODS: The data are derived from the Beaver Dam Eye Study, a population-based incidence study of age-related eye disease. Participants were seen for their baseline evaluation (n = 4926) between March 1, 1988, and September 14, 1990, and for a follow-up examination (n = 3684) an average of 4.8 years later. All examinations, interviews, lens photography, and grading were performed using standard protocols. The age range was 43 to 84 years at the census preceding the baseline examination. RESULTS: For those with no cataract at baseline and without cataract surgery at follow-up, there was an average decline of 0.5 letters (on a logMAR scale) in the right eye by the follow-up examination. In persons with any cataract at baseline and without cataract surgery at follow-up, there was a decrease of four letters. When cataract surgery was done in the interval, it was associated with a significant (P < 0.0001) nine-letter (2-line) improvement in visual acuity. CONCLUSION: Cataract surgery in this population was associated with a significant improvement in visual acuity. It is appropriate to evaluate visual acuity, cataract, and visual needs in planning for eye care in aging populations.
Adult↗
Cigarette smoking and ten-year progression of diabetic retinopathy.
PURPOSE: To examine the association between cigarette smoking and the incidence and progression of diabetic retinopathy. METHODS: A population-based cohort study of 708 adult younger-onset persons with diabetes, 485 older-onset persons taking insulin, and 502 older-onset persons with diabetes not taking insulin who participated in baseline, 4-year, and 10-year examinations. Incidence and progression of retinopathy and progression to proliferative retinopathy were measured as determined by fundus photography. RESULTS: Neither smoking status nor pack-years smoked showed significant associations with increased risk of retinopathy. CONCLUSIONS: Cigarette smoking is not a risk factor for the long-term incidence of retinopathy. However, the failure to find an association between smoking and diabetic retinopathy does not imply that persons with diabetes who smoke should not stop as cigarette smoking is a risk factor for other complications and associated conditions of diabetes, particularly cardiovascular disease.
Adolescent↗
Changes in visual acuity in a population. The Beaver Dam Eye Study.
PURPOSE: To describe the change in visual acuity over a 5-year period in persons participating in a large population-based study. METHODS: Best-corrected visual acuity was measured, after refraction, with logMAR charts using a modification of the Early Treatment Diabetic Retinopathy Study protocol in 3684 persons living in Beaver Dam, Wisconsin, who ranged in age from 43 to 86 years at the time of a baseline examination from 1988 to 1990, and at a follow-up examination from 1993 to 1995. RESULTS: The change in the number of letters read correctly over the 5-year period varied from 0.4 +/- 4.9 (mean +/- standard deviation) in people between 43 and 54 years of age to -5.2 +/- 15.4 in people 75 years of age or older at baseline. Over the 5-year period, vision became impaired (20/40 or worse in the better eye) in 2.9% of the population and severely impaired (20/200 or worse in the better eye) in 0.3%. The visual angle doubled in 1.7% of the population, and 2.4% had improved vision. People 75 years of age or older at baseline were 12.5 times (95% confidence interval [Cl], 8.6-18.2; P < 0.001) more likely to have impaired vision, 9.7 times (95% Cl, 5.9-16.0; P < 0.001) more likely to have doubling of the visual angle, and 78 times more likely (95% Cl, 9.9-614.1; P < 0.001) to have severe visual impairment than people younger than 75 years of age at baseline. People 75 years of age or older who were living in nursing homes or group homes were 3.8 times more likely to have impaired vision, 3.3 times more likely to have severely impaired vision, and 5.7 times more likely to have a doubling of the visual angle than those not residing in a nursing home or a group home. CONCLUSION: These data provide precise population-based estimates of incidence of visual loss over a wide spectrum of ages and show that decreased visual acuity in people 75 years of age is a common finding, especially in those who are in nursing homes or group homes.
Adult↗
Health status and hypertension: a population-based study.
We describe the relation between self-reported hypertension and measures of health-related quality of life (HRQOL) in a community-dwelling population. In a cross-sectional study, 1430 randomly selected adults, aged 45 to 89 years, were interviewed to obtain a medical history and health status measures, including the SF-36 questionnaire, the Quality of Well Being (QWB) index, and time trade-off (TTO) assessments. A total of 519 participants reported being affected by hypertension (HTN group). The HTN group, compared to the No HTN group, had significantly lower age-adjusted health status scores measured by the General Health scale of the SF-36 and by TTO, with differences between groups for each measure comprising approximately 5% of the total scale. HTNs also had a significant decline in general health status measures associated with increasing numbers of antihypertensive medications but not with specific classes of medications. We conclude that hypertension and hypertension drug therapy are associated with clinically meaningful decreases in reported health status.
Aged↗
CMV infection after allogeneic bone marrow transplantation is associated with the occurrence of various autoantibodies and monoclonal gammopathies.
Recent findings indicate that the kinetics of B-cell reconstitution after marrow transplantation mimic normal ontogeny. The early B-cell repertoire during ontogeny is characterized by a high degree of autoreactivity and interconnectivity. Therefore, in a prospective analysis, 95 consecutive recipients of an allogeneic marrow transplant were screened for the occurrence of various autoantibodies and 47 of these 95 were also screened for monoclonal gammopathies. None of the patients developed antibodies specific for systemic autoimmune disorders. In contrast, a high prevalence of natural antibodies (79/95) was found early post-transplant, with 58 of these 79 patients developing two or more autoantibodies. According to multiple regression, the mean number of natural antibodies (95% confidence limits in parentheses) depends significantly (P = 0.006) on the status of CMV infection: 0.9 (0.4; 1.6) CMV-negative: 2.0 (1.0; 3.3) asymptomatic CMV infection; 3.1 (1.7; 5.0) CMV disease. Sex, age, underlying disease, conditioning therapy, acute graft-versus-host disease and CMV serology of donor and recipient pretransplant did not affect the number of natural autoantibodies. Monoclonal gammopathies were detected in 12/47 patients with a predominance of the IgG-kappa subtype. All these 12 patients suffered from a viral infection (CMV, n = 11: influenza strain A, n = 1). The high degree of self-reactivity post-transplant further supports the hypothesis that B-cell reconstitution mimics ontogeny. Moreover, these data indicate nonspecific polyclonal, CMV-mediated, presumably T-cell independent B-cell stimulation and disturbed T-cell regulatory function following allogeneic BMT.
Adolescent↗
Studies in sheep examining plasma follistatin elevations due to frequent blood sampling or surgery.
UNLABELLED: This study examined the effects of the anticoagulant heparin on plasma follistatin (FS) concentrations used during blood sampling in Corriedale ewes. Plasma FS concentrations increased acutely (P < 0.01) following a bolus intravenous injection of heparin (3200 U). To determine whether frequent sampling per se can also increase plasma FS concentrations, ewes were sampled using a substitute anticoagulant, ethylenediamine tetraacetic acid. Frequent sampling had no effect on plasma FS concentrations. alpha-2 Macroglobulin concentrations were measured before and after bilateral ovariectomy and sham ovariectomy to determine whether this agent causes an increase in plasma FS concentrations 10-12 h after laparotomy. No differences in plasma alpha-2 macroglobulin concentrations were observed at the time of the observed increase in plasma FS concentrations. IN CONCLUSION: (1) heparin caused acute elevations in plasma FS concentrations probably by binding to FS, thereby reducing its plasma clearance; (2) rapid blood sampling per se did not elevate plasma FS concentrations; (3) alpha-2 macroglobulin concentrations were not elevated at the same time as plasma FS concentrations 10-12 h after surgery; and (4) the small increase in alpha-2 macroglobulin concentrations before surgery was attributable to a stress-induced response as seen in other species.
Animals↗
Regulation and characterization of the interferon-alpha present in patients with advanced human immunodeficiency virus type 1 disease.
To examine a possible association between plasma viremia and interferon-alpha (IFN-alpha) in patients with the acquired immunodeficiency syndrome (AIDS), we performed IFN plasma immunoadsorption by apheresis (IFN-alpha apheresis) in four volunteers with AIDS who had sustained levels of endogenous plasma IFN-alpha. IFN-alpha apheresis with two plasma volume exchanges was performed daily for 5 days. Clinical signs and symptoms and hematologic, virologic, and immunologic parameters were monitored. Two subjects developed anemia from phlebotomy, and one had a catheter++-associated bacteremia. The IFN-alpha apheresis was effective only in transiently removing IFN-alpha: depletion of IFN-alpha led only to its rapid reconstitution. Cell-associated HIV-1 was unchanged, but three of four subjects had a modest decrease in culturable plasma virus burden following the procedures. The recovery of in vivo HIV-1-related IFN-alpha by apheresis allowed its biologic and biochemical characterization. The HIV-1 IFN-alpha showed characteristics on ELISA, western blot, and biologic assays similar to two subspecies of the natural protein. The natural, recombinant, and HIV-1-induced IFN-alpha s demonstrated nearly identical antiviral activities. The HIV-1 IFN-alpha eluted from the column was not acid labile. The inability of large amounts of plasma IFN-alpha found in some patients with AIDS to affect viral burden likely reflects properties of the virus or of host factors independent of IFN-alpha.
Acquired Immunodeficiency Syndrome↗
Conceptual and methodologic issues in quantifying perceptual accuracy in childhood asthma.
Delineated methodologic issues in the study of symptom perception in childhood asthma. A review of past and recent psychophysiological and clinical studies of both adults and children presents the methodologic and analytic approaches that have been applied to quantify perceptual accuracy. Peak expiratory flow rate, forced expiratory volume in the first second, and force expiratory flow can serve as objective measures of asthma. A visual analog scale, a numerical guess, and a categorical description as subjective measures all have clear strengths and weaknesses. Correlational analysis of subjective-objective data, arithmetic differences between subjective guess and objective value, and an error grid categorization can each be applied to calculate an accuracy index on an individual subject. Illustrative examples reveal that the same data lead to different indices depending on the method chosen. Empirical research is needed to standardize various methodologic approaches. Given the increasing prevalence, severity, and morbidity of pediatric asthma, the study of symptom perception may be a critical component in our understanding of asthma management, and will likely lead to useful clinical interventions.
Adolescent↗
The NHS and the new scientism: solution or delusion?
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Health Services Research↗
Polymyositis, alopecia universalis, and primary sclerosing cholangitis in a patient with Crohn's disease.
We report a 36-year-old man with Crohn's disease, primary sclerosing cholangitis, and alopecia universalis. Six years after the onset of intestinal disease, the patient developed severe muscular pain and weakness of the neck. Muscle biopsy revealed myositis. Immunosuppressive treatment led to a significant improvement of muscular symptoms. Myositis in inflammatory bowel disease appears to be an important differential diagnosis in corticoid myopathy. Both alopecia and polymyositis are rarely associated with inflammatory bowel disease; thus, they have to be discussed as extraintestinal manifestations.
Adult↗
Dynamical correlations in suspensions of charged rodlike macromolecules.
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Journal Article↗
Nonexponential relaxation of density fluctuations in charge-stabilized colloids.
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Journal Article↗
Structure and short-time dynamics of polydisperse charge-stabilized suspensions.
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Journal Article↗
Plasma follistatin concentrations increase following lipopolysaccharide administration in sheep.
1. The effect of inflammation induced by lipopolysaccharide (LPS) injection on plasma follistatin (FS) concentrations was investigated. 2. Plasma FS and tumour necrosis factor-alpha concentrations increase following LPS administration in ewes. 3. The rise in FS is similar, but more sustained, to that previously observed after surgery. 4. These results indicate a possible functional link between FS, inflammation and the acute-phase response.
Analysis of Variance↗
Diabetic retinopathy.
Diabetic retinopathy is a leading cause of loss of vision in the United States. Results of recent population-based studies and randomized controlled clinical trials suggest that glycemic control can lower the incidence and prevent the progression of retinopathy and loss of vision associated with diabetes. In addition, data from clinical trials showed that timely photocoagulation treatment of severe proliferative retinopathy or clinically significant macular edema prevents loss of vision. This report reviews the epidemiology of diabetic retinopathy and highlights areas in need of further epidemiologic research.
Diabetic Retinopathy↗
Timing of neuronal death in trkA, trkB and trkC mutant embryos reveals developmental changes in sensory neuron dependence on Trk signalling.
The sensory neurons of the embryonic mouse trigeminal ganglion are supported in culture by different neurotrophins at successive stages of development. Initially the neurons survive in response to BDNF and NT3 and later switch to becoming NGF-dependent (Buchman, V. I. and Davies, A. M. (1993), Development 118, 989-1001). To determine if this in vitro switch in neurotrophin responsiveness is physiologically relevant, we studied the timing of neuronal death in the trigeminal ganglia of embryos that are homozygous for null mutations in the trkA, trkB and trkC genes, which encode receptor tyrosine kinases for NGF, BDNF and NT3, respectively. In wild-type embryos, the number of pyknotic nuclei increased from E11 to peak between E13 and E14, and decreased gradually at later ages, becoming negligible by birth. Neuronal death in the trigeminal ganglia of trkA-/- embryos also peaked between E13 and E14, but was almost threefold greater than in wild-type embryos at this stage. Whereas there was no significant difference between the number of pyknotic nuclei in trkA-/- and wild-type embryos at E11 and E12, there was a substantial increase in the number of pyknotic nuclei in the trigeminal ganglia of trkB-/- at these earlier stages. Counts of the total number of neurons in E13 trigeminal ganglia revealed a marked decrease in trkB-/- but not trkA-/- or trkC-/- embryos. Consistent with the later onset of excessive neuronal death in trkA-/- embryos, there was a marked decrease in the neuronal complement of the trigeminal ganglia of trkA-/- embryos at E15. These results demonstrate that TrkB signalling is required for the in vivo survival of many trigeminal neurons during the early stages of target field innervation before they become NGF-dependent.
Animals↗
The testis is not the major source of circulating follistatin in the ram.
The aims of this study were to determine the plasma concentrations of follistatin in rams and to assess if the testis contributes to circulating follistatin and if there is uptake or production of follistatin by the head in rams. Catheters were inserted in the carotid artery, jugular vein and spermatic vein of intact rams during the non-breeding season (experiment 1; n = 5) and breeding season (experiment 2; n = 4). In experiment 1, blood samples were collected from 5 rams every 10 min for 4 h, commencing 20-60 min after surgery. After 2 h of sampling 1 microgram gonadotrophin-releasing hormone (GnRH) was injected intravenously. In experiment 2, blood samples were collected from 4 of the rams used in experiment 1 by venipuncture 30 and 15 min before surgery and every 15 min throughout surgery. Commencing 1 h after surgery, matched samples were taken from each of the vessels every 10 min for 4 h (1-4 h after surgery), then every hour for 20 h (4-24 h after surgery) and then every 10 min for 4 h (24-28 h after surgery). In both experiments, follistatin secretion was non-pulsatile and there were no significant differences between the concentrations of follistatin in any of the vessels. There was a significant (P < 0.05) increase in the concentrations of follistatin in each of the vessels throughout the 4 h of 10-min sampling in both experiments. In experiment 2 plasma concentrations of follistatin in the jugular vein were significantly (P < 0.05) lower before surgery than at other stages of the experiment. During the non-breeding season (experiment 1) the concentrations of follistatin in all vessels were about 2-fold higher (P < 0.001) than during the breeding season (experiment 2). Concentrations of follistatin were measured in the testicular tissue of the ram, bull, monkey and rat and were found to be 13.6, 2.1, 2.5, 0.8 ng/g testis respectively. In experiment 3, blood samples were collected every 15 min for 4 h from castrated rams (n = 6) in the absence of treatment with testosterone propionate (TP) and after 7 days of treatment with a physiological dose of TP during the breeding and non-breeding seasons. There was no effect of stage of breeding season or TP on the plasma concentrations of follistatin and these concentrations in the castrated rams were similar to the concentrations in the intact rams in experiment 2. In experiment 4, the function of Leydig cells was stimulated by administration of human chorionic gonadotrophin but this had no effect on plasma concentrations of follistatin. These experiments show that the concentrations of follistatin in the plasma of rams are measurable, that the testis is not the major contributor to circulating follistatin and that there is no significant uptake or production of follistatin by the head in rams. It appears that the contribution of the testis to circulating follistatin may vary with the stage of the breeding season, being greater during the non-breeding season than the breeding season. The gonadotrophins and testosterone do not appear to have a direct effect on the secretion of follistatin in rams. The increase in concentrations of circulating follistatin during surgery and more frequent blood sampling suggest a stress-related effect on the production of follistatin.
Animals↗