Biomedical subjects
Publications and source records attributed to V Clark.
Peripheral pulmonary artery stenosis is a rare congenital anomaly often associated with the maternal rubella syndrome. Two patients with the disorder underwent four successful pregnancies.
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Thirty-one snap-frozen human prostate specimens containing examples of benign hyperplasia, prostatic intraepithelial neoplasia (PIN), and invasive carcinoma were analyzed using a panel of 24 antibodies and one lectin. Twenty-seven additional routinely processed radical prostatectomy specimens were studied using selected probes known to work on formalin-fixed paraffin-embedded material. Three probes, anticytokeratin KA4, anti-vimentin V9, and the lectin from Ulex europaeus (UEA-1), demonstrated phenotypic similarities between PIN and invasive carcinoma. Whereas the luminal cells of normal or hyperplastic prostatic epithelium are minimally reactive with KA4 (4%) or UEA-1 (0%) and strongly reactive with anti-vimentin (91%), both the PIN and invasive carcinoma are reactive with KA4 (89% and 93%, respectively) and UEA-1 (96% and 93%, respectively) and minimally reactive with anti-vimentin (15% and 0%, respectively). The increased KA4 staining was shown to be in part due to detection of cytokeratin 19, by using cytokeratin-19-specific antibodies, 4.62 and LP2K. The reasons for the increased expression of this cytokeratin and the decreased expression of vimentin are unclear but seem to indicate a phenotypic relationship between the PIN lesions and invasive carcinoma.
We tracked 96 percent of a sample of 1,942 nursing home patients admitted to a nursing home for the first time in 1982-83. Patients discharged alive from the nursing home were followed for two years or until death. The relative time spent at home, in hospitals, and in skilled nursing facilities is reported. Of the 705 patients discharged from their initial nursing home admission to homes in the community, about 50 percent made only one transfer and only 15 percent made four or more transfers. Of the 509 discharged to a hospital, 26 percent died there and 37 percent of the 374 survivors made four or more moves in the next two years. In all, 1,332 patients were discharged alive and they spent almost two-thirds of the subsequent two years, or their remaining lifetimes, in the community. Of those who transferred only once, over two-thirds of their follow-up time was spent in their own homes. Policies concerned with long-term care should use some type of actuarial data base to successfully plan and implement long-term care insurance.
This study compares the personal characteristics, measures of functional status/case mix, and immediate discharge outcomes of two cohorts of nursing home patients (1980 and 1984). All of these patients had a prior history of nursing home care and all were readmitted to skilled nursing facilities from hospitals. In 1984, readmissions were more disabled, more debilitated, and significantly less likely to return home. They were almost twice as likely to be rehospitalized within 30 days of discharge from the hospital (26.7 percent versus 48.9 percent). Analyses showed poorer health status and an increased proportion of nursing home deaths and rehospitalizations in the 1984 group to be a function of time (1984 versus 1980) rather than of insurance coverage (Medicare versus other). Nursing home readmissions appear to be quite sensitive to cost-containment efforts, and they may require additional hospital days to stabilize their conditions in an effort to reduce the rate of hospital readmissions and the overall cost of care.
The authors compared the personal characteristics, measures of functional status/case mix, and discharge outcomes of nursing home patients admitted to skilled nursing facilities (SNFs) in 1984 for the first time (first admissions) to those of patients with a prior history of nursing home care (readmissions). Compared to first admissions, readmitted patients were more disabled and debilitated, significantly less likely to return home, and more likely to be hospitalized. History of a prior nursing home admission is an important indicator of prognosis, service needs, length of stay (LOS) of patients in the nursing home, and their discharge outcomes. Location before admission--home versus hospital--was associated with case-mix descriptors and LOS but was unrelated to discharge outcomes, except for those readmitted from hospitals, who returned home less often and were more likely to die in the SNFs.
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Nucleic acid probes promise to be very useful in the detection of infectious agents. Several RNA probes have been developed by random cloning of chromosomal DNA for the detection of Bacteroides fragilis. Four such probes prepared by transcription of inserts of 400 bp, 800 bp, 2.4 kbp, and 6 kbp all hybridized to denatured B. fragilis DNA on nitrocellulose, but did not bind to DNA from a variety of other Bacteroides spp. or from selected aerobic strains. Each probe readily detected five clinical isolates of B. fragilis and did not react with 11 clinical isolates representing four other species in the "B. fragilis group".
We examined the discharge outcomes and admission characteristics of patients admitted to Southern California skilled nursing facilities (SNFs) for the first time following an episode of hospitalization in 1980, 1982-83 (all pre-prospective payment system), and all admissions during July through September 1984 (post-prospective payment). The proportion of patients covered by Medicare on admission was 18 per cent in 1980, 36 per cent in 1982-83, and 57 per cent in 1984. For patients discharged within 30-60 days to SNFs, in all three time periods more Medicare than non-Medicare patients were bed-bound, had indwelling catheters, and were comatose. There were only modest case-mix differences between the groups and no changes over time in discharge outcomes, including the proportion dying in the SNF, or being returned to a hospital. The time-related changes that were found preceded the implementation of the diagnosis related group (DRG) based prospective payment system.
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Unsatisfactory intrafamilial relationships and child-rearing practices have frequently been implicated as prime determinants of personalities that are susceptible to drug and alcohol abuse. Five thousand forty-four US Army soldiers were surveyed by anonymous questionnaires. The reported occurrence of a variety of activities, events and behaviors in childhood among drug and alcohol abusers were compared to non users. Childhood antecedents that were associated with non-use of illegal drugs and which showed as much as a 20% difference in reported occurrence between abusers and non-users of illegal drugs were: spanking, church attendance, first alcoholic drink after 15 years, and perceived "happy" parental marriage. These associations were found uithin white and non-white groups and in subjects with divorced or separated parents. There was no antecedent that showed as much as a 20% difference in reported occurrence between alcohol abusers and non-users.
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The cardioprotective agent ICRF-187 [(+)-1,2-bis(3,5-dioxopiperazinyl-1-yl)propane, ADR-529] has shown a great deal of promise against what may be an iron-based adriamycin-induced cardiotoxicity. ICRF-187 likely exerts its actions through its rings-opened hydrolysis product, which has a structure similar to EDTA and like-wise strongly binds metal ions. The 105,000g soluble supernatant fraction of homogenates of porcine liver and kidney, but not of heart, enzymatically caused a ring-opening hydrolysis of ICRF-187 at the rate of 1.2, 1.4, and less than 0.15 nmol.(mg protein)-1.min-1, respectively. This enzymatic hydrolysis of ICRF-187 was completely abolished by 4-chlorobenzenesulfonamide, which suggested that dihydropyrimidine amidohydrolase (DHPase) might be, in large part, responsible for the ICRF-187 hydrolase activity. Bovine liver DHPase was isolated and was shown to enzymatically hydrolyze ICRF-187 with a Vmax of 14,900 nmol.(mg DHPase)-1.min-1, a value that exceeded that of its natural substrates. The KM for ICRF-187 of 6.7 mM was, however, much larger than that of its natural substrates. The enzyme kinetics were consistent with DHPase acting on ICRF-187 to form one-ring-opened hydrolysis product only. Thus, DHPase is not able to act on the one-ring-opened hydrolysis product to produce two-ring-opened product. The Ki for 4-chlorobenzenesulfonamide inhibition of DHPase was measured to be 26 microM.
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