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Biomedical subjects

S Blumenthal

Publications and source records attributed to S Blumenthal.

At least 37 records · Page 2Linked to original sources
PubMed1994

Adenovirus-mediated gene transfer of rat apolipoprotein B mRNA-editing protein in mice virtually eliminates apolipoprotein B-100 and normal low density lipoprotein production.

Apolipoprotein (apo) B-100 is the major protein component in low density lipoprotein (LDL); it contains the binding domain for the LDL receptor and the attachment site for apolipoprotein(a) in lipoprotein(a). ApoB-48 is colinear with the amino-terminal half of apoB-100 and misses the part of the molecule required for LDL receptor interaction and lipoprotein(a) formation. ApoB-48 mRNA is produced by the editing of apoB-100 mRNA, a process by which the codon CAA for Gln-2153 is changed to UAA, an in-frame stop codon. We used the cloned catalytic component of the rat apoB mRNA-editing enzyme (REPR) to construct a replication-defective recombinant adenoviral vector containing REPR cDNA (AvREPR) and a control vector (Av1LacZ4) containing a beta-galactosidase cDNA to investigate the effect of REPR gene delivery in C57BL/6 mice. Intravenous injection of AvREPR in mice resulted in efficient transduction of liver cells, where REPR mRNA and protein were overexpressed, reaching a peak at 7 and 12 days, returning toward control levels at 39 days after AvREPR administration. ApoB mRNA editing activity in liver extracts showed changes parallel to those of REPR mRNA expression; the proportion of edited apoB mRNA in the total hepatic apoB mRNA increased from approximately 60% to more than 90% at the peak of REPR expression. The proportion of plasma apoB-100 in AvREPR-transduced animals decreased from approximately 50% to < 10% of total plasma apoB concentration. Plasma very low density lipoproteins were polydisperse in control animals with an average diameter of 54.9 +/- 20.6 nm (uninjected control) and 54.7 +/- 16.8 nm (Av1LacZ4-treated), respectively. They became much smaller (average diameter 39.3 +/- 12.7 nm) and more uniform in size at day 12 following AvREPR administration. On the same day, the normal plasma LDL (26.2-25.5 nm) was almost completely eliminated in treated animals. Adenovirus-mediated transfer of the REPR cDNA is an efficient method to reduce plasma apoB-100 and normal LDL production.

APOBEC-1 Deaminase↗
PubMed1994

Inhibition of Na(+)-glucose cotransport in kidney cortical cells by cadmium and copper: protection by zinc.

Properties of the inhibition of Na(+)-glucose cotransport by Cd2+ in mouse kidney cortical cells have been determined. In no case was any inhibition observed before 3 hr. The extent of inhibition was dependent upon both the concentration of Cd2+ and the length of exposure. Kinetic studies showed that metallothionein mRNA induction by Cd2+ was initiated within 1 hr after incubation with Cd2+ began and peaked by 3-6 hr. Metallothionein protein increased more slowly, beginning at 3 hr and continuing for at least 9 hr. The protein had both Cd2+ and Zn2+ bound to it throughout this period. Nevertheless, a pool of nonmetallothionein Cd2+ appeared after 3 hr, coinciding with the onset of inhibition of Na(+)-glucose cotransport, and increased over the next 9 hr. Pretreatment of cells with Zn2+ protected them from the effects of Cd2+ on Na(+)-glucose cotransport. It delayed the onset of inhibition of transport as well as the extent of inhibition. Detailed analysis of the distribution of Cd2+ and Zn2+ in the soluble fraction of these cells showed that the concentration of non-metallothionein bound Cd2+ was not suppressed by the presence of Zn-metallothionein after the onset of exposure to Cd2+. Incubation of cells with larger concentration of Zn2+ and Cu2+ also inhibited Na(+)-glucose cotransport.

Animals↗
PubMed1993

Complications of the Wiltse Pedicle Screw Fixation System.

The purpose of the current study is to retrospectively review the incidence and types of complications occurring using a single pedicle screw fixation system for lumbar spine fusions. For a 3-year period beginning in July 1987, 470 patients underwent spinal fusion and instrumentation with the Wiltse Pedicle Screw Fixation System. Although multiple configurations of the Wiltse System were included, the predominant construct was that of segmental pedicle screw fixation. Complications occurred in a total of 29 patients, for an overall complication rate of 6%. Among the complications were 10 wound problems (2%) that included 2 seromas requiring drainage and 3 superficial wound infections. The remaining five wound complications were deep wound infections requiring irrigation and debridement. The overall deep wound infection rate was 1%. Neurologic complications occurred in two patients, one with temporary foot drop and one with persistent L5 nerve root irritation confirmed by electromyogram (EMG). Both of these patients underwent anatomic workup, which failed to reveal any evidence of impingement by either screw or other hard tissue. Two intraoperative complications occurred, both involving fracture of the L5 pedicle. No adverse sequela resulted. There were 15 hardware complications, for an overall rate of 3%. This included four patients with broken screws (a total of eight screws). There were three failures at the screw-bone interface, as well as four patients with uncoupling of the screw rod linkage. In addition, there were four broken rods encountered. A total of 122 Wiltse devices were removed, for an overall removal rate of 25%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Total quality management: administrative and clinical applications in nursing homes.

OBJECTIVE: Describe the application of the Total Quality Management (TQM) model to the unique work force, resident population, and regulatory issues that characterize long term care settings. DESIGN: The key differences between TQM and current management and training practices in nursing homes are described. A specific data-based example is provided of a successful TQM application to health care involving clinical work processes related to incontinence care. CONCLUSION: Significant organizational and clinical obstacles must be overcome if TQM is to improve the quality of life and satisfaction of nursing home residents and their families as it has improved the efficiency and product quality in hospital and non-health-care settings.

Clinical Competence↗
PubMed1992

National survey of current arrangements for diversion from custody in England and Wales.

OBJECTIVES: To assess the extent and nature of psychiatric assessment schemes based at magistrates' courts in England and Wales for the early diversion of mentally disordered offenders from custody and to determine the response of the NHS to new initiatives concerning alternatives to custody for this group. DESIGN: Postal survey of the probation service, petty sessional divisions, mental health provider units, and district purchasing authorities in England and Wales. SUBJECTS: All chief probation officers (n = 55), clerks to the justices (n = 284), managers of mental health provider units (n = 190), and purchasers of mental health services (n = 190) in each of the district health authorities. MAIN OUTCOME MEASURES: Number of psychiatric assessment schemes, practical difficulties in their operation, extent of regular liaison with health and social services; current and future intentions to purchase or provide services for diversion from custody. RESULTS: Data were obtained from every magistrates' court. Forty eight psychiatric assessment schemes were identified with another 34 under development. Particular problems were lack of adequate transport arrangements, difficulties with hospital admissions, and overdependence on key people. There was little liaison between health, social services, and members of the criminal justice system. Twenty five of the 106 purchasers who responded had a policy dealing with diversion, and 39 had a scheme under development; 56 purchasers had no current or future plans about diversion. Sixty nine of the 150 providers who responded reported that diversion was included in their current or next business plan. CONCLUSION: Schemes to divert mentally disordered offenders from the criminal justice system are often hampered by lack of adequate transport arrangements, difficulties in hospital admissions, and overdependence on key people.

Commitment of Persons with Psychiatric Disorders↗
PubMed1992

NIH conference. Chronic fatigue syndrome research. Definition and medical outcome assessment.

A workshop was held 18 to 19 March 1991 at the National Institutes of Health to address critical issues in research concerning the chronic fatigue syndrome (CFS). Case definition, confounding diagnoses, and medical outcome assessment by laboratory and other means were considered from the perspectives of key medical specialties involved in CFS research. It was recommended that published Centers for Disease Control (CDC) case-definition criteria be modified to exclude fewer patients from analysis because of a history of psychiatric disorder. Specific recommendations were made concerning the inclusion or exclusion of other major confounding diagnoses, and a standard panel of laboratory tests was specified for initial patient evaluation. The workshop emphasized the importance of recognizing other conditions that could explain the patient's symptoms and that may be treatable. It was viewed as essential for the investigator to screen for psychiatric disorder using a combination of self-report instruments followed by at least one structured interview to identify patients who should be excluded from studies or considered as a separate subgroup in data analysis. Because CFS is not a homogeneous abnormality and because there is no single pathogenic mechanism, research progress may depend upon delineation of these and other patient subgroups for separate data analysis. Despite preliminary data, no physical finding or laboratory test was deemed confirmatory of the diagnosis of CFS. For assessment of clinical status, investigators must rely on the use of standardized instruments for patient self-reporting of fatigue, mood disturbance, functional status, sleep disorder, global well-being, and pain. Further research is needed to develop better instruments for quantifying these domains in patients with CFS.

Centers for Disease Control and Prevention, U.S.↗
PubMed1992

Gender differences in pharmacokinetics and pharmacodynamics of psychotropic medication.

OBJECTIVE: This review explores the theoretical background for and empirical evidence supporting gender-related differences in pharmacokinetics and pharmacodynamic properties of psychotropic medications. METHOD: The authors reviewed all English-language articles on this topic that involved original research using human subjects. RESULTS: Limited evidence suggests that young women seem to respond better to and require lower doses of antipsychotic agents and benzodiazepines than young men. The administration of exogenous hormones interacts with medications, changing plasma levels and possibly conferring greater risks for toxicity. Young women may have an enhanced response to nontricyclic antidepressants. CONCLUSIONS: Too little basic and clinical research has been conducted on sex differences in therapeutic effects and side effects of psychopharmacological treatments. Addressing these differences as well as similarities will lead to safer and more effective treatment for all patients.

Adolescent↗
PubMed1990

[Integration and reintegration of first admission psychiatric patients].

In the framework of a prospective follow-up study, development and outcome of the occupational and social status in 258 first-admission psychiatric patients was investigated. Interviews were made at the time of discharge, 1 year and 5 years later. For that reason prospective data exist on the prehospital and hospital time as well as on short-term and long-term course. Social adjustment, occupational rehabilitation, early retirement, social status and pre- and post-hospital occupational integration were investigated. It must be placed on record, that psychiatric patients are subjected to severe negative changes in their occupational and social life even after the first hospital treatment. Type and quantity of disintegration depended on the diagnostic group. Schizophrenic patients differed from the other patients in every intergration area.

Alcoholism↗
PubMed1989

Work and psychiatric illness: the significance of the posthospitalization occupational environment for the course of psychiatric illnesses.

The value of the reintegration and rehabilitation of inpatients vocationally was studied. Certain of the vocational experiences (unemployment and stressful working conditions) of former psychiatric inpatients were examined, with attention being paid to their stabilizing or destabilizing effect on symptomatic behaviour. A cohort of 230 first-time admissions for treatment of various disorders were interviewed while hospitalized and 1 year later. A 20-item list prepared by INFAS was used for indexing stressful working conditions. Psychopathological states were assessed with the help of the Present State Examination of Wing et al. (1973). The results indicate that mentally ill persons (especially those with organic or affective disorders), when confronted with unemployment after discharge from hospital, will usually respond by developing new or worse syndromes. Stressful working conditions appear to have very different effects in schizophrenia and affective disorders, viz. deterioration and amelioration of psychopathological syndromes respectively.

Humans↗
PubMed1989

Mortality and rate of suicide of first admission psychiatric patients. A 5-year follow-up of a prospective longitudinal study.

Patients who commit suicide in a psychiatric hospital are, in general, patients who have had previous admission or who have already made at least one suicide attempt. The following study focuses upon an earlier time within the course of a psychiatric illness, that is the time of first admission, and examines the rate of suicide of 258 patients after 5 years. Two control groups were selected: first admitted psychiatric patients who did not commit suicide, and patients who died a 'natural death'. We analyzed how the suicides were integrated into the vocational, social and medical areas of life before they were admitted to the hospital. Further it was possible to identify predictors of future suicide.

Female↗
PubMed1988

The problem of readmission with respect to occupational factors. Course and predictive influences after 5 years.

In this study the course of Readmission after one, 2.5 and 5 years was examinated at a sample of 258 first admitted psychiatric patients of different diagnostic groups. In the analysis occupational, soziodemographic and clinical parameters of these patients were related to the readmission after 5 years and studied if these parameters allow a predictive statement. It was shown that 40%-60% (dependent of diagnoses) of the patients were readmitted in a period of 5 years. The course of the readmission also varied in the different diagnostic groups. The most striking result was the rate of readmission of the schizophrenic psychoses which was at the time of the 1 year catamnesis below average after the 2.5 year analysis however above average. Beside these findings occupational and clinical predictors were identified in all diagnostic groups with exception of the schizophrenic psychoses group. The results are discussed and attention is put on possible consequences to prevent rehospitalization.

Follow-Up Studies↗
PubMed1988

[Outcome, course and prognosis of the vocational status of psychiatric patients hospitalized for the 1st time--results of a multiple factor study].

In the framework of a prospective longitudinal investigation, the occupational course of first-admission psychiatric patients was analyzed for the first year (1980) and the fifth (1984) post-discharge from the clinic. Findings indicate that, to quite an important degree, tendencies towards occupational disintegration had existed already immediately after the first in-patient treatment episode. This applied almost totally independent of the clinical diagnosis given at the time of the first hospitalization. Only persons with substance abuse illness had been affected clearly less often, the situation four years later being however comparable. Except for the groups of neurotic and personality disorders, the occupational situation had by then however tightened drastically for all of the diagnostic groups, a structural analysis making it clear that this development had initiated already in the course of the first year. Thus, all patients who had been without work over the entire first year of the five-year period, had already reached the "terminal point" in their employment history. As far as diagnoses are concerned, our study confirms the experience that a schizophrenic illness will by no means always entail a straight course toward an unfavourable outcome. The investigation at the same time however also indicated that non-schizophrenic illnesses take a more unfavourable course than had been expected. In relation to earlier longitudinal catamnestic studies of persons with schizophrenia, the findings for our schizophrenic patients moreover were markedly worse, this discrepancy being presumed to be accounted for by the different methods applied, different selection criteria, as well as differences in economic activity at the time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Readmission of psychiatric patients hospitalized for the first time--course and predictive factors after 5 years].

In this study the course of rehospitalisation after one, 2 1/2 and 5 years was examined in a sample of 113 readmitted patients of different diagnostic groups. In a second step of analysis occupational, sociodemographic and clinical parameters of these patients were related to the readmission after 5 years and studied if these parameters allow a predictive statement. It was shown that 40%-60% (dependent of diagnoses) of the patients were readmitted in a period of 5 years. The course of the rehospitalization also varied in the different diagnostic groups. The most striking result was the rate of readmission of the schizophrenic psychoses which was at the time of the 1 year catamnesis below average after the 2 1/2 years analysis however above average. Besides these findings occupational and clinical predictors were identified in all diagnostic groups with exception of the schizophrenic psychoses group. The results are discussed and attention is put on possible consequences to prevent rehospitalization.

Follow-Up Studies↗
PubMed1988

[Rehabilitation of pension--which course do psychiatric patients follow after their first inpatient treatment in a psychiatric hospital? Results of a prospective longitudinal study].

Placing persons having a mental illness in the open labour market has in recent years become increasingly difficult. The question therefore arises whether an attempt should be made to improve occupational access through rehabilitative measures, or whether pensioning would not be the more appropriate action. In the framework of a prospective 5-year catamnestic study of first-admission psychiatric patients, the course taken by them was investigated, as well as the factors that had been relevant in the decision to pension the patients, or to provide rehabilitative services. It was found that pensioning and rehabilitative measures differ in no essential degree as to their shares, and that both types of approach had occurred in only very few cases. Disease-specific factors (psychopathological symptoms, readmission) are suggested to be involved concerning the route taken. Pensioning on the one hand, and rehabilitation service provision on the other, are linked with the age and diagnoses of the patients, as well as the extent of their social activities.

Alcoholism↗