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Biomedical subjects

S Keller

Publications and source records attributed to S Keller.

At least 37 records · Page 2Linked to original sources

Effect of metal binding on electrogenic proton transfer associated with reduction of the secondary electron acceptor (QB) in Rhodobacter sphaeroides chromatophores.

The influence of metal ion (Cd(2+), Zn(2+), Ni(2+)) binding on the electrogenic phases of proton transfer connected with reduction of quinone Q(B) in chromatophores from Rhodobacter sphaeroides was studied by time-resolved electric potential changes. In the presence of metals, the electrogenic transients associated with proton transfer on first and second flash at pH 8 were found to be slower by factors of 3-6. This is essentially the same effect of metal binding that was observed on optical transients in isolated reaction centers (RC), where the metal ion was shown to inhibit proton transfer [Paddock, M. L., Graige, M. S., Feher, G., and Okamura, M. Y. (1999) Proc. Natl. Acad. Sci. U.S.A. 96, 6183-6188]. The effect of metal binding on the kinetics in chromatophores is, therefore, similarly attributed to inhibition of proton uptake, which becomes rate-limiting. A striking observation was an increase in the amplitude of the electrogenic proton-uptake phase after the first flash with bound metal ion. We attribute this to a loss of internal proton rearrangement, requiring that the protons that stabilize Q(B)(-) come from solution. In mutant RCs, in which His-H126 and His-H128 are replaced with Ala, the apparent binding of Cd(2+) and Ni(2+) was decreased, showing that the binding site of these metal ions is the same as found in RC crystals [Axelrod, H. L., Abresch, E. C., Paddock, M. L., Okamura, M. Y., and Feher, G. (2000) Proc. Natl. Acad. Sci. U.S.A. 97, 1542-1547]. Therefore, the unique proton entry point near His-H126, His-H128, and Asp-M17 that was identified in isolated RCs is also the entry point in chromatophores.

Alanine↗

Discriminative learning occasioned by the administration of a dopamine agonist.

RATIONALE: The repeated administration of psychostimulants usually brings about a progressive increment of the behavioral responses that they induce. We examined to what extent this sensitization is due to an associative learning process. OBJECTIVES: The dopamine agonist apomorphine elicits stereotyped pecking in pigeons, a response that increases with successive intramuscular injections. We tested whether this sensitized pecking would be discriminatively directed at environmental stimuli that had been present during the sensitization phase. METHODS: In a preliminary experiment we identified a pair of stimulus compounds that attracted an equal number of apomorphine peck responses. During discrimination training naive pigeons were exposed on 5 days to both a cage furnished with one of these stimuli after having been injected with apomorphine and to a cage furnished with the other stimuli after having been injected with saline. Then the birds were administered apomorphine (or saline) and tested in a cage that offered both compound stimuli simultaneously. A discrimination reversal training and renewed tests followed. RESULTS: The tests under apomorphine and saline showed that the pecking by the pigeons was virtually exclusively aimed at the specific environmental stimuli under which the sensitization to apomorphine had taken place. This discriminative stimulus control was reversed after the pigeons had been retrained with converse stimulus compound allocations. CONCLUSIONS: The sensitized apomorphine pecking of pigeons was subject to close control by environmental stimuli. The results thus support the hypothesis that the sensitization to psychostimulants may be due to a conditioning process. The conditioning occasioned by apomorphine injections in birds could be a useful model for the study of sensory-motor learning processes.

Animals↗

Readiness to adopt adequate postural habits: an application of the Transtheoretical Model in the context of back pain prevention.

Based on a biomechanical model, an adequate body posture can contribute to the prevention of back pain and back pain chronicity. This study examines the explanatory value of the Transtheoretical Model (TTM) for the adoption of adequate postural habits in a cross-sectional sample of 149 employees of a German administration unit (mean age 40.2 years, 50% female). Using newly developed instruments with satisfactory psychometric properties, basic assumptions of the TTM could be confirmed: self-efficacy and the perceived pros for maintaining a good body posture increased significantly across the stages, while the perceived cons decreased. Additionally, the use of preventive strategies for back pain prevention increased linearly and significantly across the stages of change. The study supports the applicability of the TTM for postural behavior. Considering stages of change as an intervening variable may contribute to clarifying the relationship between participation in low back schools and prevention of back pain chronicity. Longitudinal and intervention study data are needed to support these assumptions.

Adult↗

Implications of structural deficits for patient education in Germany.

Several changes in health politics and legal settings in recent years have affected the structure and practice of health promotion and patient education in Germany. The current legal background and its implications for patient education are discussed. Based on examples from four selected areas (cardiovascular diseases, diabetes mellitus, chronic pain, and asthma) the current practice of patient education in Germany is summarized. While many well-structured programs exist that are based on state-of-the-art guidelines, there is a lack of high quality research that documents the long-term effectiveness and cost-effectiveness of such approaches. Structural problems and an insufficient number of highly trained personnel result in the fact that many patients do not have access to standardized programs. Persisting compliance problems indicate that there is still room for improvement of patient education interventions. As important for the future, necessary changes in the legal settings and possible implications for the education of the educators are discussed.

Asthma↗

Validation of decisional balance and situational temptations measures for dietary fat reduction in a large school-based population of adolescents.

Brief, validated, and reliable theory-based measures specifically designed for use in large survey research with adolescent populations are needed to assess attitudes and behaviors about dietary fat consumption. This study validated two transtheoretical model (TTM)-based instruments in 2639 ninth graders from 12 Rhode Island high schools. The Decisional Balance Questionnaire for Adolescent Dietary Fat Reduction (DBQA) measures the importance adolescents assign to the pros and cons of reducing dietary fat consumption, while the Situational Temptations Questionnaire for Adolescents (STQA) measures temptations to eat high-fat foods as both a global construct and across three categories of challenging situations. Four competing models were compared for each instrument. An eight-item, correlated two-factor Pros and Cons model was validated for the decisional balance measure and a nine-item, three-factor hierarchical model was validated for situational temptations. The theoretically predicted relationships between stage of change and the pros and cons, as well as stage and situational temptations were supported. These results demonstrate that both measures have sound psychometric properties and are externally valid.

Journal Article↗

Sleep problems, health-related quality of life, work functioning and health care utilization among the chronically ill.

OBJECTIVES: To provide a comprehensive assessment of whether sleep problems among the chronically ill are associated with decrements in functional health and well-being, decreases in work functioning and increases in the use of health care services. DESIGN: Cross-sectional survey of patients from the Medical Outcomes Study (MOS), an observational study of functional health and well-being. Chronically ill patients (n = 3484) were sampled from health maintenance organizations, large multi-specialty groups, and solo or single-specialty group practices in Boston, Los Angeles, and Chicago. Chronic illness subgroups include: clinical depression (n = 527), congestive heart failure (229), diabetes (n = 577), recent myocardial infarction (n = 170), hypertension (n = 2206), asthma (n = 84), back problems (n = 771), and arthritis (n = 672). ANCOVA analyses of the relationship between sleep problems and SF-36 scales and summaries were performed. In addition, a 'relative impact' analysis determined what scales or summaries were most associated with sleep problems. MAIN OUTCOME MEASURES: Eight scales and two summary measures from the SF-36 Health Survey, work productivity and work quality measures and self-reports of health care utilization. RESULTS: Comparing chronically ill patients with no sleep problems to those with mild, moderate, or severe sleep problems revealed a direct association between sleep problems and decrements in health-related quality of life (HRQOL) as measured by SF-36 scales and summaries (MANOVA F 24.1; d.f. 24; p < or = 0.0001). In addition, significant differences in HRQOL were found when comparing patients with and without sleep problems within most of the disease groups studied. The relative impact analysis revealed that measures of mental health and the mental health summary were most associated with sleep problem severity in the total sample and chronic disease subsets, in comparison with measures of physical health. In addition, monotonic relationships were found between severity of sleep problems and decreases in work productivity and increases in health care utilization, as expected. CONCLUSIONS: The analyses revealed that sleep problems go hand in hand with poorer mental health, diminished work productivity and work quality and greater use of health care services. Sleep problems, therefore, may be a significant confounding factor in the interpretation of health outcomes among patients with chronic diseases.

Adult↗

The role of the initial 12-lead ECG in risk stratification of patients with acute coronary syndrome.

This article reviews the prognostic significance of the initial 12 lead ECG in acute coronary syndrome (ACS). In patients with non ST segment elevation ACS, the initial ECG may vary from a normal one to an ECG which demonstrates T wave inversion and ST segment deviation. Patients, who present with either a normal ECG or T wave inversion in less than 5 leads, are considered to be at low risk. Those patients who have ST segment depression or a combination of ST segment depression and elevation have the highest incidence of cardiac death, re-infarction and recurrent chest pain. In patients with ST segment elevation ACS, the mortality and morbidity is mostly influenced by infarct size. The ECG findings which correlate with infarct size are 1) the degree and extent of ST segment elevation, 2) the infarct related coronary artery and 3) distortion of the terminal portion of the QRS complex. Patients with acute anterior wall myocardial infarction due to a proximal occlusion of the left anterior descending (LAD) coronary artery have the worst short and long-term prognosis. The ECG manifestation of a proximal left anterior descending artery occlusion is ST segment elevation in lead aVL and the precordial leads, combined with ST segment depression in the inferior leads. With regard to patients who have an acute inferior wall myocardial infarction, the patients at highest risk are those with a proximal right coronary artery (RCA) occlusion artery and posterolateral extension. The ECG findings in proximal right coronary artery occlusion are ST segment in the inferior leads and in V4R. Less frequently ST segment elevations may be present in lead V1 and V2. Patients with posterolateral wall extension can be identified by the presence of ST segment depression in the right precordial leads. Finally, distortion of the terminal portion of the QRS complex is an important indicator of poor outcome. (Fig. 3, Ref. 42.)

Electrocardiography↗

Fusion of chromatophores from photosynthetic bacteria with a supported lipid layer: characterization of the electric units.

Direct electrometric measurements of membrane potential changes are a valuable tool for study of vectorial transfer of electrons, protons, and ions. Commonly model membrane systems are created by fusion of lipid/protein vesicles with lipid-coated thin films. We characterized the electric units resulting from this process using chromatophores from the purple bacterium Rhodobacter sphaeroides and either a Mylar film or a planar modified gold electrode as support. Investigation of the shunting activity of the ionophore gramicidin on the flash-induced potential change demonstrates fusion of individual chromatophores to form independent 'blisters', which preserve an interior aqueous compartment. Under current-clamp conditions the photovoltage follows the change of the membrane potential of the individual blisters.

Bacterial Chromatophores↗

Sepsis and catecholamine support are the major risk factors for critical illness polyneuropathy after open heart surgery'.

BACKGROUND: Critical illness polyneuropathy (CIP) remains a problem after open heart surgery. Recently, we reported about a retrospectively performed study pointing out that sepsis, the application of higher amounts of catecholamines and intervention such as chronic venovenous hemodiafiltration may be involved in the onset of CIP. A prospectively performed study is presented in order to evaluate the significance of risk factors initially after open heart surgery. METHODS: From June 1997 until September 1998, patients undergoing open heart surgery and being ventilated beyond 3 days were prospectively enrolled in the study and underwent a standard protocol of electromyographic investigation in order to determine CIP. Several items were recorded: amount of catecholamines, serum levels of urea, creatinine, albumin, and glucose. The duration of sepsis and chronic venovenous hemodiafiltration were reevaluated. Additionally the age, the left ventricular end-diastolic pressure prior to the operation, the time of ICU stay and the time of ventilatory support were compared. RESULTS: Within the observation period, 37 adult patients could be enrolled in the study, whereas 12 patients did develop CIP and 7 patients did not. Patients developing CIP required significantly different amounts of epinephrine (0.17 +/- 0.02 vs. 0.09 +/- 0.01 mg/kg/day, p < 0.05, t-test) higher amounts of norepinephrine (0.06 +/- 0.02 vs. 0.02 +/- 0.01 mg/kg/day, p<0.05, t-test), and lesser dosages of dobutamine (2.2 +/- 0.5 vs. 4.9 +/- 0.7, p<0.05, t-test). After cardiac surgery, the plasma levels of urea was initially significantly elevated in patients developing CIP (127.4 +/- 10.5 vs 97.3 +/- 18.5, p<0.05, t-test) Patients suffering from CIP stayed significantly longer in the ICU (40.3 +/- 11.7 vs. 19.6 +/- 11.3 days, p < 0.05 t-test) with an extended time of ventilator support. (769.6 +/- 05.0 vs 295.0 +/- 134.0 hours, p<0.05, t-test). Patients of the CIP group were suffering significant longer from sepsis than patients without CIP. CONCLUSIONS: Sepsis and catecholamine support and an increased level of urea were associated with the development of CIP. The prevention of sepsis and a modulation of the catecholamine support in order to improve microcirculatory flow may reduce the onset of CIP in patients undergoing open heart surgery.

Aged↗

Improving physician-delivered counseling in a primary care setting: lessons from a failed attempt.

BACKGROUND: The high prevalence of behavioral risk factors for cardiovascular diseases demands innovative approaches to achieving behavior change. Primary care physicians are in an ideal position for offering such interventions. PURPOSE: To evaluate whether training of primary care physicians in counseling skills based on the Transtheoretical Model (TTM) leads to motivational and behavioral changes in their patients. METHOD: Seventy-four primary care physicians in Germany were randomly assigned to either an intervention condition (one day of training in TTM-based counseling plus brochures matched to their patients' "stages of change") or a control condition (usual care). Baseline and 12-month follow-up data were collected from 305 of their patients who signed up for a health check-up. OUTCOME MEASURE: Patients' movements across the stages of change for smoking, diet, exercise and stress management. RESULTS: After 12 months, patients of physicians in the intervention group did not show more movement through the stages of change for any of the behaviors than did patients of control physicians. Additionally, there were no differences between groups in counseling frequency, counseling intensity, or patient satisfaction with counseling. CONCLUSIONS: A high dropout rate at follow-up and resulting "power" problems limit the possible conclusions. The high numbers of patients in early stages of change and the minimal improvement over time underline the need for improving motivational counseling skills of primary care physicians in Germany. In our study the dissemination of these strategies failed. We offer lessons we feel can be learned from this outcome. Further studies should focus on ways to enhance the process of educating physicians for implementing counseling strategies in primary care settings.

Clinical Trial↗

Enzymatic halogenation catalyzed via a catalytic triad and by oxidoreductases.

During the search for haloperoxidases in bacteria we detected a type of enzymes that catalyzed the peroxide-dependent halogenation of organic substrates. However, in contrast to already known haloperoxidases, these enzymes do not contain a prosthetic group or metal ions nor any other cofactor. Biochemical and molecular genetic studies revealed that they contain a catalytic triad consisting of a serine, a histidine, and an aspartate. The reaction they catalyze is actually the perhydrolysis of an acetic acid serine ester leading to the formation of peracetic acid. As a strong oxidizing agent the enzymatically formed peracetic acid can oxidize halide ions, resulting in the formation of hypohalous acid which then acts as the actual halogenating agent. Since hypohalous acid is also formed by the heme- and vanadium-containing haloperoxidases, enzymatic halogenation catalyzed by haloperoxidases and perhydrolases in general lacks substrate specificity and regioselectivity. However, detailed studies on the biosynthesis of several halometabolites led to the detection of a novel type of halogenases. These enzymes consist of a two-component system and require NADH and FAD for activity. Whereas the gene for one of the components is part of the biosynthetic cluster of the halometabolite, the second component is an enzyme which is also present in bacteria from which no halometabolites have ever been isolated, like Escherichia coli. In contrast to haloperoxidases and perhydrolases the newly detected NADH/FAD-dependent halogenases are substrate-specific and regioselective and might provide ideal tools for specific halogenation reactions.

Catalysis↗

Microtubule-dependent plus- and minus end-directed motilities are competing processes for nuclear targeting of adenovirus.

Adenovirus (Ad) enters target cells by receptor-mediated endocytosis, escapes to the cytosol, and then delivers its DNA genome into the nucleus. Here we analyzed the trafficking of fluorophore-tagged viruses in HeLa and TC7 cells by time-lapse microscopy. Our results show that native or taxol-stabilized microtubules (MTs) support alternating minus- and plus end-directed movements of cytosolic virus with elementary speeds up to 2.6 micrometer/s. No directed movement was observed in nocodazole-treated cells. Switching between plus- and minus end-directed elementary speeds at frequencies up to 1 Hz was observed in the periphery and near the MT organizing center (MTOC) after recovery from nocodazole treatment. MT-dependent motilities allowed virus accumulation near the MTOC at population speeds of 1-10 micrometer/min, depending on the cell type. Overexpression of p50/dynamitin, which is known to affect dynein-dependent minus end-directed vesicular transport, significantly reduced the extent and the frequency of minus end-directed migration of cytosolic virus, and increased the frequency, but not the extent of plus end-directed motility. The data imply that a single cytosolic Ad particle engages with two types of MT-dependent motor activities, the minus end- directed cytoplasmic dynein and an unknown plus end- directed activity.

Adenoviruses, Human↗

Patient factors and compliance with asthma therapy.

Compliance by patients to prescribed treatment regimens can be considered as the interface between effective therapy and effective disease management. Compliance can be affected by the nature of the relationship between the practitioner and the patient, and their attitudes towards each other. It has also been suggested that practitioner behaviour can influence patient behaviour and health status. However, each individual patient is influenced in his or her attitudes, and reactions to disease and its management, by a wide variety of patient-related factors. These include psychological variables such as mood, beliefs, and the knowledge, motivation and ability of the patient. Social factors may also play a role: these include age, marital and socioeconomic status and level of education. Results from a range of studies in patients with pulmonary or other diseases show that the psychosocial determinants of compliance are only poorly understood, and suggest that compliance cannot be predicted from patients' health status and that social factors are weak indicators only. Furthermore, it appears from available data that patients' beliefs about health issues are not as useful as indicators of likely compliance as was previously believed.

Adult↗

Different domains of the M-band protein myomesin are involved in myosin binding and M-band targeting.

Myomesin is a 185-kDa protein located in the M-band of striated muscle where it interacts with myosin and titin, possibly connecting thick filaments with the third filament system. By using expression of epitope-tagged myomesin fragments in cultured cardiomyocytes and biochemical binding assays, we could demonstrate that the M-band targeting activity and the myosin-binding site are located in different domains of the molecule. An N-terminal immunoglobulin-like domain is sufficient for targeting to the M-band, but solid-phase overlay assays between individual N-terminal domains and the thick filament protein myosin revealed that the unique head domain contains the myosin-binding site. When expressed in cardiomyocytes, the head domains of rat and chicken myomesin showed species-specific differences in their incorporation pattern. The head domain of rat myomesin localized to a central area within the A-band, whereas the head domain of chicken myomesin was diffusely distributed in the cytoplasm. We therefore conclude that the head domain of myomesin binds to myosin but that this affinity is not sufficient for the restriction of the domain to the M-band in vivo. Instead, the neighboring immunoglobulin-like domain is essential for the precise incorporation of myomesin into the M-band, possibly because of interaction with a yet unknown protein of the sarcomere.

Animals↗

Serum creatinine and blood urea nitrogen over a six-year period in the very old. Creatinine and BUN in the very old.

In a population of 141 very elderly subjects, there was a small but significant decline in BUN and creatinine at 3 years, which persisted at 6 years although partially attenuated. A similar pattern of falling BUN and creatinine was seen in the 31 subjects who began the study with mild azotemia. There was no significant change in the subjects' mean Body Mass Index during the 6-year period of observation. The azotemic subjects had a rate of death or dropout from the study similar to that of the entire cohort. Mean systolic blood pressure fell by 5.4 mm Hg (p < 0.05) and diastolic blood pressure by 2.1 mm Hg (p = NS) by 6 years. Users of diuretics or NSAID had a mean BUN and creatinine comparable to those not taking these medications. We conclude that BUN and serum creatinine do not necessarily increase with time in the old old, even in those with mild azotemia, hence, several determinations of these parameters may be needed to ensure accuracy. While renal function in the elderly probably does not improve with time, it may stabilize due to improvement in blood pressure. Use of diuretics and NSAID by functioning elderly individuals is not necessarily associated with worsening azotemia.

Aged↗

ECT in Texas: 19 months of mandatory reporting.

BACKGROUND: Texas law requires that all non-federal clinical facilities providing electroconvulsive therapy (ECT) report every treatment to the state's mental health agency. The resulting data provide total population information about treating physicians and hospitals; payment source; patient age, sex, ethnicity, diagnosis, and admission/consent status; symptom severity and response; numbers and types of treatments; and untoward events occurring within 14 days after treatment. METHOD: We reviewed all reports of ECT between September 1993 and April 1995 (2583 reports, approximately 15,240 treatments). RESULTS: About 6% (N = 117) of Texas psychiatrists performed ECT during the period, at 50 hospitals. One of 13 state-funded mental institutions performed ECT on-site; some occasionally contracted with private hospitals. Almost all patients (88.1%) were white. Some older age groups received proportionately more ECT than younger groups, but no sharp increase was associated with eligibility for Medicare. Five patients were less than 18 years of age; 70.3% were female. Virtually all patients (99.0%) consented to the treatment themselves (rather than by guardian), including committed-but-consenting patients (1.5%). Reports (5.8%) described multiple-monitored treatment (MMECT, not depatterning). Group data indicated generally good-to-excellent response, as measured by a five-point symptom-severity scale. Eight patients died within 14 days of a treatment, 2 possibly of anesthesia complications and 3 others in accidents or by suicide. Four were receiving maintenance treatments (generally about every other week). No death appeared related to ECT stimulus or seizure. CONCLUSION: ECT in Texas is performed by a small minority of psychiatrists and is unavailable to many patients who need it. It is most accessible to white patients who receive care outside the public sector. Our data support the common finding that ECT is generally safe and effective.

Adolescent↗