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At least 253 records · Page 14Linked to original sources
PubMed2002

Conversion motor paralysis disorder: analysis of 34 consecutive referrals.

STUDY DESIGN: We present our cumulative experience with patients sustaining the most dramatic type of Conversion Disorder (CD) - Conversion Motor Paralysis. SETTING: Rehabilitation departments, Reuth Medical Center, Tel-Aviv and Sheba Medical Center, Tel-Hashomer, Israel. METHODS: During the period 1973-2000, 34 patients with neurological symptoms without any anatomical or physiological basis were admitted to both rehabilitation departments. This number consists of less than 1% of the total acute traumatic and non-traumatic spinal cord disorders admitted annually to these centers. RESULTS: Twenty-five of the subjects were men (mean age of 30 years) and nine were women (mean age of 31.4 years). Neurological symptoms included: paraplegia (complete or incomplete) (18), hemiplegia or hemi paresis (11), tetraplegia (complete or incomplete) (three), monoplegia (one), triplegia (one). The final diagnosis on discharge was CD in 30 of the 34 cases, the remaining four being diagnosed as malingering. Functionally, nine patients had a complete recovery, 10 a partial recovery and 15 remained unchanged. CONCLUSION: Disabled people who experienced traumatic events resulting in various disabilities are admitted usually to a rehabilitation center. However, some of them are later diagnosed as having Conversion Disorder or malingering. We believe that their participation in active regular and integrative rehabilitation process is beneficial to most of them. Most of these patients gain functional independence and return to the main stream of life.

Adult↗
PubMed1999

Endovascular, transperitoneal, and retroperitoneal abdominal aortic aneurysm repair: results and costs.

PURPOSE: Contemporary treatment of abdominal aortic aneurysms (AAA) includes transabdominal (TA), retroperitoneal (RP), and endovascular (EV) repair. This study compares the cost and early (30-day) results of a consecutive series of AAA repair by means of these three methods in a single institution. METHODS: A total of 125 consecutive AAA repairs between February 1993 and August 1997 were reviewed. Risk factors, 30-day morbidity and mortality rates, and hospital stay and cost were analyzed according to method of repair (TA, RP, EV). Cost was normalized by means of a conversion factor to maintain confidentiality. Cost analysis includes conversion to TA repair (intent to treat) in the EV group. RESULTS: One hundred twenty-five AAA repairs were performed with the TA (n = 40), RP (n = 24), or EV (n = 61) approach. Risk factors among the groups (age, coronary artery disease, hypertension, diabetes, chronic obstructive pulmonary disease, and cigarette smoking) were not statistically different, and thus the groups were comparable. The average estimated blood loss was significantly lower for EV (300 mL) than for RP (700 mL) and TA (786 mL; P>.05). Statistically significant higher cost for TA and RP for pharmacy and clinical laboratories (likely related to increased length of stay [LOS]) and significantly higher cost for EV in supplies and radiology (significantly reducing cost savings in LOS) were revealed by means of an itemized cost analysis. Operating room cost was similar for EV, TA, and RP. There were six perigraft leaks (9.6%) and six conversions to TA (9.6%) in the EV group. CONCLUSION: There were no statistically significant differences in mortality rates among TA, RP, and EV. Respiratory failure was significantly more common after TA repair, compared with RP or EV, whereas wound complications were more common after RP. Overall cost was significantly higher for TA repair, with no significant difference in cost between EV and RP. EV repair significantly shortened hospital stay and intensive care unit (ICU) use and had a lower morbidity rate. Cost savings in LOS were significantly reduced in the EV group by the increased cost of supplies and radiology, accounting for a similar cost between EV and RP. Considering the increased resource use preoperatively and during follow-up for EV patients, the difference in cost between TA and EV may be insignificant. EV repair is unlikely to save money for the health care system; its use is likely to be driven by patient and physician preference, in view of a significant decrease in the morbidity rate and length of hospital stay.

Aortic Aneurysm, Abdominal↗
PubMed2002

Use of laboratory tests and clinical symptoms for identification of primary HIV infection.

OBJECTIVE: To determine the sensitivity and specificity of symptoms, three HIV-1 RNA assays, a p24 antigen EIA and a third-generation enzyme immunoassay (EIA) antibody test for diagnosis of primary HIV infection (PHI). DESIGN: Prospective cohort in a university research program. PARTICIPANTS: Of 258 eligible persons screened for PHI, 40 had primary/early infection (22 preseroconversion, 18 within 6 months of seroconversion) and 218 did not. Seven participants with preseroconversion HIV-1 from a second center were added for evaluating laboratory tests. MAIN OUTCOME MEASURE: PHI, defined as a negative or indeterminate antibody test with subsequent conversion. Symptom analysis also included persons with antibody conversion of less than 6 months' duration. RESULTS: The symptoms most strongly associated with PHI in multivariate analysis were fever [odds ratio (OR) 5.2; 95% confidence interval (CI) 2.3-11.7] and rash (OR 4.8; 95% CI 2.4-9.8). The sensitivity and specificity, respectively, for detecting preseroconversion HIV infection were: p24 antigen, 79% and 99%; third-generation EIA, 79% and 97%; HIV-1 RNA by branched chain DNA 100% and 95%; HIV-1 RNA by polymerase chain reaction 100% and 97%; HIV-1 RNA by transcription-mediated amplification testing, 100% and 98%. False-positive HIV-1 RNA tests were not reproducible and had values < 3000 copies/ml, while only one person with confirmed PHI was in this range. CONCLUSIONS: Rash and fever indicated the highest risk of PHI. HIV-1 RNA tests are very sensitive for PHI but false-positive results occur. False-positive results can be reduced through duplicate testing and considering tests < 5000 copies/ml as indeterminate results requiring additional testing. p24 antigen was more specific than HIV-1 RNA testing but less sensitive.

Adult↗
PubMed1989

Visual conversion disorder: a case analysis of the influence of visual information.

We examined the influence of visual information on a decision task that was administered to an individual with monocular visual conversion disorder. Findings indicated that his performance was influenced by the visual information and by motivation instructions. The findings are discussed in terms of a model of hysterical blindness that recognizes the interplay of cognitive and motivational processes.

Adult↗
PubMed1996

New bioactive marine steroids from the Okinawan soft coral Clavularia viridis.

Eight new marine steroids were isolated from the Okinawan soft coral Clavularia viridis Quoy and Gaimard. Their structures were determined based on spectroscopic analysis, chemical conversion, and X-ray crystallographic analysis. Steroids 5 and 6 showed growth inhibition activity toward HeLa S3 cells and human diploid cells in vitro.

Animals↗
PubMed2004

New marine sesquiterpenoids and diterpenoids from the Okinawan soft coral Clavularia koellikeri.

Six new terpenoids (two maaliane-type sesquiterpenoids, 1 and 2, one aromadendrane-type sesquiterpenoid, 3, one noraromadendrane-type sesquiterpenoid, 4, and two neodolabellane-type diterpenoids, 5 and 6) were isolated from the Okinawan soft coral Clavularia koellikeri. The structures of these compounds were determined on the basis of the results of spectroscopic analysis, chemical conversion, and X-ray crystallographic analysis. Compound 6 exhibited modest growth-inhibition effect in vitro toward tumor cells.

Animals↗
PubMed2002

Complications and conversions in myeloproliferative disorders: an analysis of 356 cases.

OBJECTIVE: To investigate the complications and conversions in myeloproliferative disorders (MPD). METHODS: Three hundred and fifty six patients with MPD were reviewed, including 78 with etiologic thrombocythemia (ET), 93 with primary myelofibrosis (MF), 185 with polythythemia vera (PV). The clinical observation, follow-up, analysis with SPSS statistic software were performed. RESULTS: Out of the 356 cases, 101 (28.5%) developed thromboembolic events, 81 (22.8%) hemorrhage, 60 (16.9%) hypertension, 20 (5.6%) coronary heart disease, 3 (0.8%) hemolysis and 1 (0.3%) gastrointestinal ulcer, 2 (0.6%) calculus and 1 (0.3%) bone marrow necrosis. Twenty four patients (6.7%) developed MF (9 in ET, 15 in PV), 2 (0.6%) erythrocytosis (1 in ET, 1 in MF), 3 (0.8%) thrombocythemia (all in PV), 5 (1.4%) acute leukemia (2 in ET, 3 in MF) and 1 (0.3%) multiple myeloma (in ET). Eleven cases (3.1%) died, 5 (1.4%) from acute leukemia, 2 (0.6%) fatal hemorrhages, 1 (0.3%) each myocardial infarction and infectious shock, 2 (0.6%) unknown causes. CONCLUSION: Embolism and bleeding were the main complications in MPD. Conversions among ET, MF and PV hematological malignancies could occur.

Adolescent↗
PubMed2005

Establishment of cloned Anaplasma phagocytophilum and analysis of p44 gene conversion within an infected horse and infected SCID mice.

Diverse p44 alleles at the p44 expression locus (p44Es) encoding surface-exposed major membrane proteins, P44s, of Anaplasma phagocytophilum were hypothesized to be garnered by recombination to enact antigenic variation. However, this hypothesis has not been proven so far, due to inability to clone this obligate intragranulocytic rickettsia. To define the p44E recombination, we developed a novel method to clone A. phagocytophilum. This isogenic cloned population containing a defined p44E was used to infect a naive horse and severe combined immunodeficiency (SCID) mice. During a 58-day infection period in the blood of the horse, p44E conversion was evident in a total of 11 new p44Es, 48% (115/242) of the sequenced p44E population. During a 50-day infection period in the blood of SCID mice, p44E conversion was manifested in a total of 13 new p44Es, 42% (192/460) of the p44E population. Thus, similar levels of p44E convertants were detected in either the presence or absence of an acquired immune system, suggesting that T- and B-cell immune pressure was not essential for recombination and/or selection of the p44E variants. Analysis of sequentially changed p44Es revealed that the entire central hypervariable region of donor p44 pseudogenes or of donor full-length p44s replaced the same region of the resident p44E as a cassette. Putative recombination points were detected within p44 conserved regions flanking the central hypervariable region by the TOPALi analysis. Our results unambiguously demonstrated p44E recombination. The cloning method developed would facilitate precise analysis of the recombination process and the extent of diversity which the recombination creates in the antigenic repertoire.

Anaplasma phagocytophilum↗
PubMed1999

Application of the correct information unit analysis to the naturally occurring conversation of a person with aphasia.

The Correct Information Unit (CIU) analysis for measuring the communicative informativeness and efficiency of connected speech (Nicholas & Brookshire, 1993) was applied to the naturally occurring conversation of a person with moderate aphasia. Results indicated that, in this instance, reliable CIU measures could not be obtained. Intrarater reliability for CIU and %CIU was low, reaching only 72%, and interrater reliability was never greater than 63%. However, reliability of word counts was good. Post hoc analysis of rater disagreements in application of the CIU analysis revealed that the majority (72%) resulted from insufficiencies in the scoring rules that were originally designed to measure single speaker connected discourse. Two descriptive categories of disagreements were identified: interpretations of informativeness and absence of rules. The remaining 28% of disagreements were attributable to human error in the application of scoring rules. Comparison of findings with previous research and implications for future research are discussed.

Aphasia↗
PubMed1997

Nonlinear analysis of the pharmacological conversion of sustained atrial fibrillation in conscious goats by the class Ic drug cibenzoline.

Methods from nonlinear dynamics were applied to test the hypothesis that the dynamics of sustained atrial fibrillation (AF) is modified by the class Ic drug cibenzoline during pharmacological conversion. The experiments were performed in conscious goats in which sustained AF was induced by continuous maintenance of AF via programmed electrical stimulation. Data were collected from electrophysiological experiments in five goats to terminate sustained AF by continuous infusion of cibenzoline. Sets of five unipolar epicardial electrograms of one minute duration were recorded from the left and right atrial free wall during sustained AF (control), and at three episodes during infusion of cibenzoline, when the mean AF interval had been prolonged to 25%, 50% and 85% with respect to control. Ventricular far-field potentials were removed from atrial electrograms by a coherent averaging procedure. Using the Grassberger-Procaccia method, the dynamics of the local atrial electrograms was investigated by estimating the (coarse-grained) correlation dimension and correlation entropy from the correlation integral. The results were related to a recently proposed classification (types I-III) of AF based on the degree of complexity of atrial activation patterns. The coarse-grained correlation dimension D(cg) and entropy K(cg) indicated that sustained AF corresponded to type II. During drug administration the coarse-grained parameters were not significantly different from control. Scaling regions in the correlation integral were observed after infusion of cibenzoline (3 out of 5 goats) suggesting that the drug introduced low-dimensional features (type I) in the dynamics of AF (correlation dimension D ranging from 2.8 to 4.4 and correlation entropy K from 1.6 to 6.2 nats/s). Sinus rhythm recorded shortly after cardioversion was very regular (D<2 and K<3 nats/s). The hypothesis that the electrograms during AF and sinus rhythm were generated by a static transformation of a linear Gaussian random process was rejected using a test for time reversibility. The nonlinear analysis revealed that cibenzoline does not significantly alter the dynamics of sustained AF during pharmacological conversion other than a slowing down of the atrial activation and a somewhat increasing global organization of the atrial activation pattern. The sudden change in the dynamical behavior at cardioversion suggests a mechanism that is reminiscent of a bifurcation. (c) 1997 American Institute of Physics.

Journal Article↗
PubMed2000

Tetrad analysis shows that gene conversion is the major mechanism involved in mutation at the human minisatellite MS1 integrated in Saccharomyces cerevisiae.

Minisatellites are arrays of tandemly repeated DNA sequences which occur at thousands of locations in the human genome. They are frequently hypervariable with respect to allele length as a result of high rates of complex and incompletely understood recombination-based germline mutation events that alter the repeat copy number. MS1 is one of the most variable minisatellites so far isolated from the human genome. We have integrated MS1, flanked by synthetic markers, in the vicinity of a hot spot for meiotic double-strand breaks upstream of the LEU2 locus in chromosome III of Saccharomyces cerevisiae. Here we present the first tetrad analysis of mutations at a human minisatellite locus. The data showed that mutant alleles occur as single mutants in one of the spores in a tetrad, also when the mutant structure was the result of a combination of intra- and inter-allelic rearrangements. The conversional transfer of repeat units from one allele to the other was associated with flanking marker conversion which always involved the same flank of the minisatellite. The results demonstrate that conversion is the predominant mechanism by which minisatellite alleles mutate to new lengths, and also support the assumption that cis-acting elements are involved in the regulation of the mutational process in humans.

Base Sequence↗
PubMed2000

Spatial correlation analysis of the pharmacological conversion of sustained atrial fibrillation in conscious goats by cibenzoline.

The nonlinear spatial redundancy and the linear spatial correlation function were used to investigate to what extent non-linearity was involved in the coupling of atrial regions and how organization in activation patterns of sustained atrial fibrillation (AF) had been modified by administration of the class IC agent cibenzoline in the experimental model of sustained AF in instrumented conscious goats. Electrograms were measured in five goats during sustained AF and when the fibrillation interval had been prolonged to about 25%, 50% and 85% (CIB25, CIB50, CIB85) with respect to control. The nonlinear association length and linear correlation length were estimated along the principal axes of two-dimensional correlation maps estimated from the spatial redundancy and the spatial correlation function, respectively. The estimated short axis association length in the right atrium increased already shortly after the start of infusion (CIB25, +61%), and remained significantly different from control during the experiment, including the effects of non-simultaneous interaction. At CIB85 the association length had almost become twice as long with respect to control (increase from 16 to 29 mm, 89%), while in the left atrium changes were less pronounced (increase from 9 to 12 mm, +32%). The linearized association length which was estimated using multivariate surrogate data increased more gradually and was less sensitive to changes in spatial organization. The results of the spatial correlation analysis suggest that the drug-induced nonlinearity in the spatio-temporal dynamics of sustained AF is related to activation patterns which are characterized by extended uniformly propagating fibrillation wavefronts (AF type I). We conclude that cibenzoline enhanced the spatial organization of sustained AF associated with a transition from type II to type I AF activation patterns. This may destabilize the perpetuation of AF since an increase in association length is equivalent to a reduction of atrial tissue mass available to support reentrant circuits. The results are consistent with the hypothesis that larger association lengths result from fewer and larger reentrant circuits. It is argued that effects of diminished curvature of fibrillation wavefronts are anti-arrhythmic under conditions of suppressed excitability imposed by cibenzoline. Termination of AF may be mediated by a mechanism resembling a bifurcation of the dynamics which sets in when the ends of fractionated wavefronts cannot sufficiently curve anymore to maintain a positive balance of newly generated wavelets needed to sustain AF.

Animals↗
PubMed2004

An economic analysis of health plan conversions: are they in the public interest?

Over the last decade, managed-care companies have been consolidating on both a regional and national scale. More recently, nonprofit health plans have been converting to for-profit status, and this conversion has frequently occurred as a step to facilitate merger or acquisition with a for-profit company. Some industry observers attribute these managed-care marketplace trends to an industry shakeout resulting from increased competition in the sector. At the same time, these perceived competitive pressures have led to questions about the long-run viability of nonprofit health plans. Furthermore, some industry and government leaders believe that some nonprofits are already conducting themselves like for-profit health plans and question the state premium tax exemption ordinarily accorded to such plans. This paper examines related health policy issues through the lens of a case study of the proposed conversion of the CareFirst Blue Cross Blue Shield company to a for-profit public-stock company and its merger with the Wellpoint Corporation. Company executives and board members argued that CareFirst lacked access to sufficient capital and faced serious threats to its viability as a financially healthy nonprofit health care company. They also argued that CareFirst and its beneficiaries would benefit from merger through enhanced economies of scale and product-line extensions. Critics of the proposed conversion and merger raised concerns about the adverse impacts on access to care, coverage availability, quality of care, safety-net providers, and the cost of health insurance. Analyses demonstrate that CareFirst wields substantial market power in its local market, that it is unlikely to realize cost savings through expanded economies of scale, and that access to capital concerns are largely driven by the perceived need for further expansion through merger and acquisition. Although it is impossible to predict future changes in quality of care for CareFirst, analyses suggest that quality appears to be somewhat lower in for-profit national managed-care companies. Additional research is needed to assess the viability of true nonprofits, the potential effects of nonprofits and for-profit national managed-care plans on the evolution of local insurance and provider markets, and methods for effective oversight of nonprofit health plans.

Algorithms↗
PubMed2006

Comprehensive analysis of myeloid lineage conversion using mice expressing an inducible form of C/EBP alpha.

CCAAT/enhancer-binding protein (C/EBP) alpha is a critical regulator for early myeloid differentiation. Although C/EBPalpha has been shown to convert B cells into myeloid lineage, precise roles of C/EBPalpha in various hematopoietic progenitors and stem cells still remain obscure. To examine the consequence of C/EBPalpha activation in various progenitors and to address the underlying mechanism of lineage conversion in detail, we established transgenic mice expressing a conditional form of C/EBPalpha. Using these mice, we show that megakaryocyte/erythroid progenitors (MEPs) and common lymphoid progenitors (CLPs) could be redirected to functional macrophages in vitro by a short-term activation of C/EBPalpha, and the conversion occurred clonally through biphenotypic intermediate cells. Moreover, in vivo activation of C/EBPalpha in mice led to the increase of mature granulocytes and myeloid progenitors with a concomitant decrease of hematopoietic stem cells and nonmyeloid progenitors. Our study reveals that C/EBPalpha can activate the latent myeloid differentiation program of MEP and CLP and shows that its global activation affects multilineage homeostasis in vivo.

Animals↗
PubMed1992

Analysis of a gene conversion gradient at the HIS4 locus in Saccharomyces cerevisiae.

Heteroduplexes formed between genes on homologous chromosomes are intermediates in meiotic recombination. In the HIS4 gene of Saccharomyces cerevisiae, most mutant alleles at the 5' end of the gene have a higher rate of meiotic recombination (gene conversion) than mutant alleles at the 3' end of the gene. Such gradients are usually interpreted as indicating a higher frequency of heteroduplex formation at the high conversion end of the gene. We present evidence indicating that the gradient of conversion at HIS4 primarily reflects the direction of mismatch repair rather than the frequency of heteroduplex formation. We also identify a site located between the 5' end of HIS4 and the 3' end of BIK1 that stimulates heteroduplex formation at HIS4 and BIK1.

Alleles↗