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Biomedical subjects

R Kraemer

Publications and source records attributed to R Kraemer.

At least 55 records · Page 3Linked to original sources

Expression of the v-crk oncogene product in PC12 cells results in rapid differentiation by both nerve growth factor- and epidermal growth factor-dependent pathways.

The transforming gene of the avian sarcoma virus CT10 encodes a fusion protein (p47gag-crk or v-Crk) containing viral Gag sequences fused to cellular sequences consisting primarily of Src homology regions 2 and 3 (SH2 and SH3 sequences). Here we report a novel function of v-Crk in the mammalian pheochromocytoma cell line, PC12, whereby stable expression of v-Crk induces accelerated differentiation, as assessed by induction of neurites following nerve growth factor (NGF) or basic fibroblast growth factor (bFGF) treatment compared with the effect in native PC12 cells. Surprisingly, however, these cells also develop extensive neurite processes after epidermal growth factor (EGF) stimulation, an event which is not observed in native PC12 cells. Following EGF or NGF stimulation of the v-CrkPC12 cells, the v-Crk protein itself became tyrosine phosphorylated within 1 min. Moreover, in A431 cells or TrkA-PC12 cells, which overexpress EGF receptors and TrkA, respectively, a GST-CrkSH2 fusion protein was indeed capable of binding these receptors in a phosphotyrosine-dependent manner, suggesting that v-Crk can directly couple to receptor tyrosine kinase pathways in PC12 cells. In transformed fibroblasts, v-Crk binds to specific tyrosine-phosphorylated proteins of p130 and paxillin. Both of these proteins are also complexed to v-Crk in PC12 cells, as evidenced by their coprecipitation with v-Crk in detergent lysates, suggesting that common effector pathways may occur in both cell types. However, whereas PC12 cellular differentiation can occur solely by overexpression of the v-Src or oncogenic Ras proteins, that induced by v-Crk requires a growth factor stimulatory signal, possibility in a two-step process.

Animals↗

Protease-antiprotease imbalance in the lungs of children with cystic fibrosis.

Cystic fibrosis (CF) is characterized in the lung by chronic purulent bronchitis culminating in pulmonary insufficiency. There is evidence to suggest that neutrophil elastase (NE) released by neutrophils on the respiratory epithelial surface plays a major role in the pathogenesis of this lung disease. This study sought to determine the age of onset of the chronic neutrophil-dominated inflammation in CF and the consequences to the NE-anti-NE screen on the respiratory epithelial surface of the CF lung. NE and anti-NE defensive molecules were evaluated in respiratory epithelial lining fluid (ELF) in 27 children with stable CF (1 to 18 yr of age). Despite normal antigenic concentrations of alpha 1-antitrypsin (alpha 1AT) and secretory leukoprotease inhibitor (SLPI), 25 of 27 children with CF had neutrophil-dominated inflammation (> 500 neutrophils/microliters ELF). Active NE was found in ELF in 20 of 27 children, including two of four aged 1 yr. Western blot analysis showed the majority of alpha 1AT and SLPI molecules to be complexed and/or degraded. These observations demonstrate that a chronic imbalance of the NE-anti-NE protective screen develops early on the respiratory epithelial surface in persons with CF and is likely well established by 1 yr of age, with resultant potential for lung damage.

Adolescent↗

[Assessment of intrapulmonary ventilation disorders in children with bronchial asthma using the nitrogen elimination technique].

Stratification of functional abnormalities evaluated by whole-body plethysmography in asthmatic children can be characterized into three functional groups: pulmonary hyperinflation (H: TGV > mean + 2SD), bronchial obstruction (O: Raw > mean + 2SD) and a mixed type, group M, including both abnormalities. The multibreath nitrogen washout (MBNW) offers the possibility to measure FRC and calculate the amount of trapped gases (TG = TGV-FRCMBNW). Furthermore ventilation inequalities can be estimated by mathematical analysis of the washout curve from which indexes such as the lung clearance index (LCI), the mean dilution number (MDN) and the moment ratio (m2:m0 = M-ratio) can be obtained. In 69 asthmatic children (age 5-17 y; 38 boys, 31 girls) body plethysmography and MBNW were performed in the symptom free interval. The questions were, at what extend TG are present within the different functional groups, and which parameters best describe ventilation inequalities. The group attribution was H: 23, M: 16, O: 30. The highest amount of TG was found in H (36.4 +/- 22.2% TGV), then in M (26.6 +/- 23.1% TGV) and in O (19.4 +/- 16.0% TGV). In 33/50 cases presenting with normal TGV, TG mainly was at cost of a low FRC (13 in H, 8 im M, 12 in O). In 19 cases FRC was higher than TGV (3 in H, 1 in M 15 in O). TG was closely related with LCI, MDN and M-ratio. Most pronounced ventilation inequalities were found in group M showing a correlation only with FRC, but not with TGV.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Acute asthma attack in children].

Asthma is one of the most common problems confronting the emergency department physician. It is estimated that 10 to 15% of the population have had manifestations of asthma. In pediatric patients it is the most common chronic disease, and is the leading cause of school absence. Asthma can be associated with a significant morbidity in terms of exercise intolerance and disruption of the family unit. In the present article, reference is given to three entities: bronchiolitis, wheezy bronchitis and bronchial asthma. The etiopathogenetic factors and mechanisms involved are reviewed in the light to give a rationale for what should be undertaken to treat and, thereafter, avoid asthmatic attacks in infants and children. Each occurrence of an asthmatic attack should provoke reflections concerning the actual state of diagnosis and the actual state of treatment. The final goals of an adequate long-term management of asthmatic children, which is unavoidable for most, are symptom freedom and optimized lung function. Good management will clearly help to avoid serious asthmatic attacks and to impede the development of an ongoing immunoallergic process of airway inflammation.

Algorithms↗

Induction of basic fibroblast growth factor mRNA and protein synthesis in smooth muscle cells by cholesteryl ester enrichment and 25-hydroxycholesterol.

Basic fibroblast growth factor (bFGF) is a potent smooth muscle cell mitogen. Smooth muscle cell and macrophage-derived foam cells, resulting from cholesteryl ester accretion, are hallmark characteristics of atherosclerosis. We wanted to determine if bFGF synthesis is altered during cholesteryl ester accumulation in smooth muscle cells. Cholesteryl ester enrichment causes a 3-fold increase in bFGF in cellular lysates and a 3-fold increase in steady state mRNA levels for bFGF, as compared with control cells. Conditioned media from cholesteryl ester-enriched smooth muscle cells contains 6 times more mitogenic activity than conditioned media from control cells; this activity is neutralized by an antibody directed against bFGF but not by an antibody directed against platelet-derived growth factor. These results suggest that cholesteryl ester enrichment also enhances bFGF release. Since oxysterols have been implicated in the pathogenesis of atherosclerosis, we determined if oxysterols could affect bFGF production and release. 25-Hydroxycholesterol also increases the release of bFGF-like mitogens from smooth muscle cells, as well as increasing mRNA transcript levels for bFGF. Cholesteryl ester enrichment and 25-hydroxycholesterol did not promote bFGF release secondary to cell injury. In conclusion, these data define a basic mechanism for smooth muscle cell hyperplasia during atherogenesis involving the generation of bFGF by smooth muscle cell-derived foam cells.

Animals↗

Comparison of different inhalation schedules to control childhood asthma.

In a double-blind, placebo-controlled study control of asthma was assessed by diary symptom cards, peak-flow measurements and lung function within 3 treatment groups over a 6 months period. 36 children (25 boys, 11 girls 5.5 to 13.2 years of age) with exogen allergic, perennial asthma inhaled either beclomethasone dipropionate (BDP) with salbutamol (S) or disodium cromoglycate (DNCG) with S or a placebo preparation with S from metered dose inhalers (MDI) through a large-spaced auxiliary device (Volumatic). At entry, after 2 and 4 months lung function tests were performed evaluating changes in the degree of pulmonary hyperinflation, bronchial obstruction, and bronchial hyperreactivity (BHR). Daily PF measurements showing wide variations (up to 10-12%) were insensitive to indicate any significant changes. In contrast evaluation of symptom diaries presented dramatic improvement during the first 3 months of the study. In addition, the DNCG group showed significant improvement of BHR (p = 0.02). Moreover, the majority of patients on regular therapy with salbutamol and placebo showed an increase of airway resistance. It is concluded that even in mild childhood asthma, for optimal control a combination of a beta 2-stimulant as bronchodilator and DNCG or BDP as protector should be applied.

Administration, Inhalation↗

Psychosomatic symptoms in asthmatic children and adolescents.

In order to identify different patterns of association between physical and psychical symptoms in childhood asthma 102 children have been investigated. Somatic investigations included clinical examination, whole-body plethysmography, total IgE and RAST of specific allergens such as pollens, mites and animals. Psychosocial assessment comprised a semi-structured interview and questionnaires (Achenbach, CBCL and Olson, FACES II). There were typical psychosocial patterns in function of aetiopathogenetic groups. The infection-induced asthma was accompanied by high anxiety and here the most school problems were found. Children with seasonal asthma were psychologically healthy whereas those with perennial asthma showed important psycho-vegetative difficulties secondary to chronic somatic disease. Atypical asthma was found to be most often associated with real psychiatric symptoms. We concluded that psychosocial findings are heterogeneous and should be interpreted in relation to somatic manifestations.

Adolescent↗

Assessment of functional abnormalities in infants and children with lung disease.

Lung function testing in infants and children has to cover a wide palette of various investigational procedures and the fact that babies can predominantly only be tested asleep and young children may not cooperate accurately must be taken into account. There is still a life-span between 2 and 5 years in which lung function testing is impossible. Different techniques for infants lung function testing (spirometry, squeeze-jacket method, forced oscillation technique, occlusion technique, whole-body infant-plethysmography, multibreath nitrogen washout (MBNW), interruption technique), which helps already in early childhood to evaluate objectively clinical findings in infants after infant respiratory distress syndrome (iRDS) with/or without hyaline membrane disease (HMD), developing or not developing broncho-pulmonary dysplasia (BPD), wheezy bronchitis or cystic fibrosis (CF) are available. Lung function techniques in children include spirometry, whole-body plethysmography, multibreath nitrogen washout (MBNW), interruption technique, bronchial challenge tests, exercise testing.

Child↗

A new method for assessing flow-volume measurements by means of a simple isoflow electronic pocket device (IfloPen).

The IfloPen is a new device for measuring isoflows featuring specific information about the effort-independent part of the flow-volume curve. Whereas the recording of the latter normally requires expensive equipment, the IfloPen is a handy, portable and simple device. In addition, the isoflow technique requires minimal cooperation. Significant correlations have been found between the isoflow-points measured with the IfloPen and PF, MEF50, MEF25 and FEV1 (p < 0.001). The IfloPen showed better correlations with spirometric lung function data than with the Peak-flow-Meter. Even experimentally induced bronchial obstruction during a bronchial challenge with carbachol can be measured functionally by the IfloPen, showing similar changes as obtained by the FEV1 and the MEF50 (p < 0.001). From a practical point of view, the IfloPen features a new device to measure more accurately bronchial obstruction (no overestimation, physiological breathing maneuver, good practicability). It can therefore be used in medical practice and is a suitable device for home monitoring.

Adolescent↗

The interrupter technique--a renaissance of a non-invasive approach for lung function testing in infants and children.

The analysis of the postocclusional rapid oscillatory mouth pressure transients pao(t) after expiratory flow interruption during 100 ms features additional information to the conventional interrupter technique. The analysis focuses on the sudden oscillatory rise in pressure after flow interruption and the following damped oscillation. By calculating the first derivative of pao(t) ( = change in pressure), the frequency omega 0 and damping characteristic d of the pressure swings reflecting the inertive and elastic properties of the thoracopulmonary system can be computed. The interrelationship between omega 0 respectively d and different sizes of lung volume respectively characteristics of airway mechanics (airway resistance (Raw) and/or maximal expiratory flow at 50% vital capacity (MEF50)) was evaluated in 5 healthy adult subjects (28-37 y) and 10 healthy children (7-14 y). The measured frequency was statistically significantly related to lung volume (p < 0.05) and varied between 66 Hz in healthy adults and 91 Hz in children. The damping factor d increased with increasing airway resistance (n.s.) and decreasing MEF50 (p < 0.005). These findings add further arguments to the conjecture previously intimated that development of the viscoelastic properties of the lung are defined by characteristics of airway mechanics in close relationship to lung growth. In consequence, alterations in mechanical properties observed in diseased lungs have functionally closely be evaluated in relation to actual lung volumes (pulmonary hyperinflation, restrictive lung disease).

Adolescent↗

The lung clearance index (LCI) as an estimate of ventilation inequalities in patients with cystic fibrosis.

Assessment of respiratory function is indispensable for provision and control of respiratory care in infants and children with lung disease. Based on plethysmographic measurements and the multibreath nitrogen washout (MBNW) distinction of patients with cystic fibrosis (CF) into different functional groups revealed that the mixed type (TGV > 130 % pred. and Raw > 130 % pred.) has to be considered as worst: highest degree of trapped gases (TG) and ventilation inequalities and consequently most impeded gas exchange. Best predictor in patients with abnormal gas exchange are the degree of bronchial obstruction (Raw) and the amount (TG). Vital capacity (VC) as overall estimate of lung function is best predicted by TG, FEV1 and MEF50. The major merit of the MBNW technique is the possibility to have the amount of TG estimated. Based on the present the calculation of the LCI adds no further information of sufficient clinical importance, remaining the question open, whether the assessment of the so called "moment ratios" from the entire washout curve would feature a better estimate of disturbed lung physiology.

Adolescent↗

Relationship between bone mineral density and dietary intakes in the elderly.

Dietary protein and/or calorie insufficiencies represent an important problem in elderly patients. The biological and clinical implications, and particularly the influence on bone mass of undernutrition in the elderly, have not been completely defined, although several studies have demonstrated a high prevalence of dietary insufficiencies in patients with a recent fracture of the proximal femur. In the present study the relationship between dietary intakes, physical performance and bone mineral density (BMD) was examined in hospitalized elderly patients. The study comprised 74 patients (48 women, mean age 82 years; and 26 men, mean age 80 years) who were hospitalized for various medical indications. They were divided into two groups according to their dietary protein intakes, evaluated during the first 28 days in hospital while on a regular diet. The first group consisted of 26 patients (14 women and 12 men) whose protein intake was equal to or greater than 1 g per kilogram of ideal body weight. The second group consisted of 48 patients (34 women and 14 men) who consumed less than 1 g of protein per kilogram of ideal body weight. The two groups differed also in their energy, carbohydrate, lipid and calcium intakes. Patients in the group with the higher protein intake displayed higher BMD at the level of the femoral neck as measured by dual-photon absorptiometry. The men in this group also had higher lumbar spine BMD. After 4 weeks in hospital the women with a higher protein intake had significantly enhanced bicipital and quadricipital muscle strength and better performance as indicated by the increased capacity to climb stairs.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Practical interest in the detection of functional abnormalities in infants and children with lung disease.

There are new techniques which have been developed in order to assess objective functional data concerning the severity and type of abnormalities in infants and children with lung disease. In the present review some applications of the various techniques are given in connection with deductions, which can be based on such functional findings. Insight into the mechanisms leading to lung disease and the institution of appropriate therapeutic guidelines largely depend on whether the degree of pulmonary hyperinflation or restriction, of bronchial obstruction, of bronchial hyperreactivity, of ventilation inequalities and the function of gas exchange can be objectively evaluated. Recent advances in the non-invasive assessment of lung function in infants and children promises progress in this task.

Adolescent↗

Interfering factors to sensitivity and specificity of bronchial reactivity in children.

Bronchial reactivity to carbachol, estimated by the PD65, the provocation dose of inhaled carbachol inducing a 65% increase of baseline respiratory resistance, was measured in 355 asthmatic children (age 8.7 +/- 2.6 years) and 149 healthy children (age 11.8 +/- 2.3 years). The frequency distribution of PD65 showed apart from 2 minima at 480 micrograms and 960 micrograms 2 significant peaks at 240 micrograms (p = 0.003) and 1200 micrograms (p = 0.01) to carbachol, reflecting a hyperreactive class (PD65 < 480 micrograms), an intermediate class (481 micrograms < PD65 < 960 micrograms) and a normo-reactive class (PD65 > 961 micrograms). The intermediate class is characterised by a considerable overlap between "health" and "disease". However, taking into account the degree of air pollution in which healthy children are living (best related factor to specificity) and the type of initial lung function disorder in asthmatic children, (the MEF50 to be the best related factor for specificity), weighed specificity and sensitivity improved from 64 to 88%. Evaluating bronchial responsiveness in children, such interfering factors should be strongly considered.

Adolescent↗

Whole-body plethysmography in the clinical assessment of infants with bronchopulmonary diseases.

Infant whole-body plethysmography offers a unique possibility of measuring end-expiratory resting level (thoracic gas volume; TGV), and hence lung volume in its close interrelationship to airway function (airway resistance; R(aw), its reciprocal value, airway conductance, Gaw). Therefore, this technique is a valuable aid for objective evaluation of lung diseases in infants. This article gives an overview of the physiological background of this particular measuring technique and its usefulness in the clinical routine. Plethysmographic data obtained in infant survivors of the infant respiratory distress syndrome (iRDS), in infants with cystic fibrosis (CF) and in the so-called 'wheezy infants' are presented. Special emphasis is given to the fact that in such infants the interrelationship between changes in end-expiratory resting level and the deficit in airway mechanics is of great importance and, consequently, for the determination of functional lung derangement in each particular case of lung disease, both TGV and the closely related R(aw) and Gaw have to be evaluated. This recommendation has to be kept in mind when the different diagnostic tools for evaluation of treatment facilities are applied in this particular young age group of patients with lung disease. In children as in adult patients, inhalative treatment must be considered the mainstay of all therapeutic measures. However, in infants, the efficacy of such treatment regimens must first be evaluated by adequate functional investigations. Infant whole-body plethysmography offers one such possibility.

Bronchitis↗

Specific approach on dose-response curves to inhaled carbachol assessed by the interruption technique in children.

To determine significant thresholds obtained by bronchial challenge tests in children for assessment of bronchial reactivity, changes of respiratory resistance (Rint) induced by inhaled carbachol were evaluated in 20 asthmatic children (10 boys and 10 girls, mean age 9.1 +/- 2.8 y, range 5 to 15 y) and 20 healthy control children (10 boys and 10 girls, mean age 12.1 +/- 2.6 y, range 8 to 16 y). Baseline lung function was assessed by whole body plethysmography. The carbachol challenge test was performed by the interruption technique. The objectives were to search for the most predictable provocation dose (PD) according to statistical and practical considerations. The statistical argument is given by the condition that the target PD must definitively be out of the measurement error of baseline values. From the practical point of view, the object is to provoke the subjects the least amount possible. As thresholds of bronchial reactivity, the provocation doses inducing a 50%, 65%, 75%, or 100% increase in baseline Rint (PD50, PD65, PD75, PD100) were computed by a 4th power polynomial function analysis including data points of the entire dose-response curve. In comparison, a new threshold, the "variance based" provocation dose (PDvb), was defined as threshold to be definitively above the range of the baseline Rint variation before initiating challenge [PDvb > mean + 2 SD range of Rint(0)]. Although the PD50, PD65, PD75, and PD100 can be adequately computed by the 4th power function from the whole dose-response curve, comparison between the different provocation thresholds revealed that PDvb gives the best values to differentiate between healthy and asthmatic children (p < 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗

The "wheezy infant" diagnosis, epidemiology and management.

Already in the earliest childhood, the onset of an allergic/immunologic inflammatory process may be caused on the basis of an inherited predisposition by an exaggerated mediator-release in the mucosa. Repeated action of trigger factors maintain this inflammation and provoke exacerbations of asthmatic symptoms. The protective task of the bronchial mucosa can not be fulfilled anymore. However, the most important goal of the approach to identify and treat wheezy infants is to avoid structural damage of bronchi and the lung by the underlying process for later life. General measures of treatment such as prophylaxis against house-dust-mite exposure, improved breathing technique and improvement of lung clearance are indispensable measures of an individually adapted, effective symptomatic (bronchodilators) and protective (cromoglycate, topical steroids) drug therapy in infants and young children with the so called "wheezy baby syndrome". A successful therapy should ensure a physiological development of the child.

Administration, Inhalation↗