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PubMed1998

Infant psychiatry viewed from a world perspective.

Infant psychiatry, a relatively new and growing field, recognizing that clinically relevant problems can be identified in infants and young children. Infant mental health emphasizes the importance of both preventive intervention and treatment approaches. The World Association for Infant Mental Health is an interdisciplinary and international organization devoted to furthering our understanding of infant psychiatry with the following goals: (i) to promote education, research and study of the effects of emotional development during infancy on later normal and pathological development; (ii) to promote research and study of the mental health of parents, families, and other caregivers of infants; (iii) to promote the development of scientifically based programs of care, intervention, and prevention of mental impairment in infancy; and (iv) to facilitate international cooperation among individuals concerned with promoting optimal development of individuals. In this paper, I will present current work on major areas of concern for infant psychiatry and relate them to psychoanalytic perspectives in this area.

Child Psychiatry↗
PubMed1998

Continuous unilateral epileptiform discharge and language delay: effect of functional hemispherectomy on language acquisition.

PURPOSE: To assess the efficacy of functional hemispherectomy in promoting language acquisition in a child with severe language delay and continuous left hemispheric epileptiform discharge in the absence of clinical seizures. We report a 6-month-old girl who initially presented with a right hemiparesis secondary to a lesion of probable prenatal origin in the distribution of the left middle cerebral artery. Weeks later, she developed infantile spasms. At 1.5 years of age, because of intractable seizures, the patient had fenestration of the left porencephalic cyst and anterior temporal lobectomy. The seizures ceased; however, language development remained limited to 35 words at 3.5 years of age. The EEG showed almost continuous epileptiform activity over the left hemisphere with no independent epileptiform potentials contralaterally. She underwent a functional left hemispherectomy. METHODS: Imaging, electroencephalographic investigation, pre- and postoperative psychological and speech assessment were carried out. RESULTS: Considerable language, speech, and behavior improvement was noted within 2 months of surgery. CONCLUSIONS: Interictal epileptiform discharges can interfere with the development of contralateral hemispheric function in the absence of clinical seizures. Early functional hemispherectomy may have a role in promoting optimal language development in appropriately selected patients. Although the primary indication for functional hemispherectomy is to control intractable seizures, a secondary proposed indication is to reduce functional impairment of the other hemisphere by electrical interference.

Brain↗
PubMedDate not supplied

Severe preeclampsia: implications for critical-care obstetric nursing.

Severe preeclampsia can have a catastrophic effect on maternal-fetal outcome; therefore, perinatal nurses must have a working knowledge of related pathophysiologic processes to perform advanced assessment and interpret data. Technologic adjuncts developed over the past decade, such as the fiberoptic pulmonary artery catheter, allow more precise assessment of maternal hemodynamic status and oxygenation for some patients. With such information, the health-care team can guide therapy to promote optimal outcomes.

Adult↗
PubMed1994

Intrapartal nursing care: research into practice.

One of the nursing profession's major goals is to advance the ideal of research-based nursing practice. Much has been written during the past decade about the difficulties inherent in achieving the goal of applying research findings to practice. With the increasing national interest in promoting optimal women's health care reforms, one area that should receive renewed interest is that of intrapartal nursing care in the hospital setting. In particular, second stage labor management is supported by considerable research, much of it conducted by nurses, that has not been incorporated into mainstream nursing care. This article discusses the issues surrounding research utilization within the context of nursing practice today, particularly in relation to existing barriers. Using intrapartal nursing care as a focal point to examine these issues, implications for a stronger emphasis on an empirical basis for practice are be identified. Recommendations for approaches to facilitate the process of research utilization by maternity nurse clinicians also is delineated.

Clinical Nursing Research↗
PubMedDate not supplied

Home care of the battered pregnant woman: one battered woman's pregnancy.

Perinatal nurses in the home care setting should screen all women for battering. Pregnant women who are battered need nursing education and intervention to help break the cycle of abuse and promote optimal maternal and fetal outcomes. This case report describes nursing care in the home for a battered pregnant patient at high risk.

Adult↗
PubMed2000

The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children.

OBJECTIVES: Eosinophilic esophagitis, previously confused with esophageal inflammation due to gastroesophageal reflux, has recently begun to be distinguished from it. We undertook this analysis of our large series of children with the condition to clarify its spectrum: its presenting symptoms; its relation to allergy, respiratory disease, and reflux; its endoscopic and histological findings; and its diagnosis and therapy. METHODS: We analyzed the details of our clinical series of 30 children with eosinophilic esophagitis, defining it as > or =5 eosinophils per high power field in the distal esophageal epithelium. Retrospective chart review was supplemented by prospective, blinded, duplicate quantitative evaluation of histology specimens, and by telephone contact with some families to clarify subsequent course. Presentation and analysis of the series as a whole is preceded by a case illustrating a typical presentation with dysphagia and recurrent esophageal food impactions. RESULTS: Presenting symptoms encompass vomiting, pain, and dysphagia (some with impactions or strictures). Allergy, particularly food allergy, is an associated finding in most patients, and many have concomitant asthma or other chronic respiratory disease. A subtle granularity with furrows or rings is newly identified as the endoscopic herald of histological eosinophilic esophagitis. Histological characteristics include peripapillary or juxtaluminal eosinophil clustering in certain cases. Association with eosinophilic gastroenteritis occurs, but is not common. Differentiation from gastroesophageal reflux disease is approached by analyzing eosinophil density and response to therapeutic trials. Therapy encompasses dietary elimination and anti-inflammatory pharmacotherapy. CONCLUSION: Awareness of the spectrum of eosinophilic esophagitis should promote optimal diagnosis and treatment of this elusive entity, both in children and in adults.

Adolescent↗
PubMed1993

Characterization of the serum requirement for macrophage-mediated killing of Treponema pallidum ssp. pallidum: relationship to the development of opsonizing antibodies.

Serum pools were collected from rabbits bled at various times after intra-testicular infection with Treponema pallidum ssp. pallidum. These were tested for their ability to opsonize T. pallidum and promote killing of the organisms by macrophages. Compared to normal sera, significant opsonization was first seen on day 10 of infection as measured by both ingestion (P < 0.001) and macrophage-mediated killing (P = 0.006); significant levels of functional antibodies persisted through 300 days of infection. Although opsonic activity peaked early in infection, antibodies that promoted optimal macrophage-mediated killing developed much later, suggesting that these two functions may represent activities of antibodies with differing specificities or affinities. The initial development of antibodies that augment both phagocytosis and killing corresponds with the in vivo clearance of treponemes from the primary site of infection. These observations support the hypothesis that macrophages are the major effector mechanism for elimination of T. pallidum during early syphilis infection.

Animals↗
PubMed1984

Utilization of general case programming for teaching health education behaviors to students with severe handicaps.

Students with severe handicaps are acquiring safety behaviors through the implementation of systematic instruction. Absent from this instruction is the inclusion of generalization strategies. Included in this article is a procedure for selecting representative teaching examples to promote optimal generalization. This procedure is referred to as general case programming. The steps of this strategy are delineated using an example of applying an adhesive bandage to a cut.

Curriculum↗
PubMed1987

Identification of trophic factors and transplanted cellular environments that promote CNS axonal regeneration.

As indicated in this review, we have begun to elucidate cellular environments and trophic factors that promote the regeneration of adult mammalian CNS neurons. In the present paradigm, bilateral aspiration lesions of the fornix-fimbria are used to axotomize septal neurons and transect the septal cholinergic projection to the dorsal hippocampus in order to evaluate the influence of trophic factors, such as NGF, on neuronal survival and the ability of cellular transplants of PNS tissue to promote axonal regeneration in vivo. Initial results demonstrate that NGF is a potent trophic molecule that prevents retrograde degeneration of septal cholinergic neurons. Observations from transplantation studies demonstrate that viable Schwann cells obtained from PNS nerve grafts or Schwann cell-ECM cultures provide a favorable cellular milieu for CNS regeneration. These cellular transplants induce a remarkable sprouting response from septal cholinergic neurons and promote the rapid elongation of septal axons that reinnervate the denervated hippocampus. In stark contrast to the Schwann cell-laden transplants, transplants including only ECM channels synthesized by cultured Schwann cells do not promote axonal regeneration within the time periods that we have examined. Therefore, we hypothesize that viable Schwann cells are crucial for the process of regeneration because they contribute both trophic and tropic factors to the injured CNS neurons. The significant early sprouting phenomenon associated with transplants containing Schwann cells strongly suggests that soluble Schwann cell-synthesized factors induce axon elongation and possibly enhance the survival of injured septal neurons. The trophic factors probably function in a manner similar, if not identical, to the action of NGF on axotomized septal neurons. Moreover, Schwann cells appear to provide tropic signals, such as LAM or a LAM-NGF complex, that can act, when in the proper stereoconfiguration, to promote the elongation and orientation of regenerating axons. Thus, our current data indicate that in order to promote optimal axonal regeneration from injured CNS neurons, both trophic and tropic factors must be supplied from exogenous sources.

Animals↗
PubMed1991

Nutrient intake of an ultraendurance cyclist.

Meeting the energy demands of ultraendurance cycling requires careful planning and monitoring of food and fluid intake. This case study presents the nutrient intake of a cyclist while training for and competing in the Race Across AMerica (RAAM). Carbohydrate accounted for 65% of the calories consumed during training (4,743 kcal), 75% during 24-hr races (10,343 kcal), and 78% during RAAM (8,429 kcal). Gastrointestinal complaints during RAAM included nausea, feeling of fullness, and abdominal distension. Although probably exacerbated by sleep deprivation, these problems were all diet related. Based on this experience, it appears that by controlling the carbohydrate concentration of beverages, limiting dietary fiber, and relying on carbohydrate as the primary energy source, one could both control gastrointestinal symptoms and promote optimal performance in training and in ultramarathon cycling.

Adult↗
PubMed1992

Efficacy of chromium supplementation in athletes: emphasis on anabolism.

As the biologically active component of glucose tolerance factor (GTF), the essential trace mineral chromium is now being marked to athletes. GTF potentiates insulin activity and is responsible for normal insulin function. Thus, insulin's effects on carbohydrate, fat, and protein metabolism are dependent upon the maintenance of adequate chromium stores. Due to excessive chromium loss and marginal chromium intake, athletes may have an increased requirement for chromium. Therefore, in some circumstances the dietary supplementation of a chromium compound may be efficacious. The restoration and maintenance of chromium stores via supplementation would promote optimal insulin efficiency, necessary for high-level athletic performance. However, potential anabolic effects of enhanced insulin function would likely be marginal, and reports of short-term anabolic increases from the supplementation of an organic chromium compound need to be confirmed.

Animals↗
PubMed1999

Nutritional and physiological status of U.S. national figure skaters.

This study assessed the nutrient intake, body composition and biochemical indices of National Figure Skating Championship competitors. Four-day diet records, fasting blood samples, and anthropometric measurements were obtained 2 months after the National Championships from 41 figure skaters 11-18 years of age. Energy, carbohydrate, fat, dietary fiber and cholesterol intake were significantly lower compared to the NHANES III averages for adolescents in the U.S. In general, the mean intakes for most vitamins except vitamin D and E were above the recommended intake. But the athletes had lower intakes of vitamin E and B12, and higher intakes of vitamin C, and thiamin (females only) compared with NHANES III. The mean intakes of magnesium, zinc, and iodine by the male skaters were below the recommended levels, as were the mean intakes of calcium, iron, phosphorus, magnesium, and zinc by the female skaters. Also, the number of servings from vegetable, fruit, dairy, and meat groups were below the recommended levels. Biochemical indices of nutritional status were within normal limits for all skaters. But plasma electrolyte concentrations were indicative of potential dehydration status. The results suggest there is a need to develop dietary intervention and educational programs targeted at promoting optimal nutrient and fluid intakes by these athletes to maintain performance and improve long-term health status.

Adolescent↗
PubMed1996

Influence of opsonization conditions on C3 deposition and phagocyte binding of large- and small-capsule Cryptococcus neoformans cells.

Previous studies demonstrated that, following opsonization with normal human serum (NHS), phagocytes bind greater numbers of small-capsule Cryptococcus neoformans cells than yeast cells with large capsules. The present study tested the hypothesis that suboptimal deposition of opsonic C3 fragments contributes to this disparity. C neoformans was grown under conditions promoting large or small capsules and was incubated at various concentrations in NHS. At low concentrations of yeast cells (125 cells per microl of NHS), the deposition of C3 fragments per unit of capsule volume and the binding of yeast cells to cultured human monocytes were similar for yeast cells having large and small capsules. However, at higher cell concentrations, large-capsule cells exhibited suboptimal coating with C3 fragments and markedly diminished monocyte binding compared with small-capsule cells. Thus, the inverse correlation between capsule size and phagocyte binding can be overcome by conditions promoting optimal C3 deposition.

Complement C3↗
PubMed1997

Identification of a replication-competent pathogenic human immunodeficiency virus type 1 with a duplication in the TCF-1alpha region but lacking NF-kappaB binding sites.

Multiple human immunodeficiency virus type 1 (HIV-1) sequences with deletions of NF-kappaB binding sites at both the 5' and 3' long terminal repeats (LTRs) were identified in serial samples collected from an infected individual. The effect of this deletion on the level of transcription was studied by transient transfection of an LTR-driven luciferase reporter gene and by infection with a full-length recombinant HIV-1 containing a luciferase reporter (HIVHXBluc). Detectable levels of gene expression were found in both systems, in the presence or absence of the viral transactivator Tat. Interestingly, a duplication of a putative TCF-1alpha motif was found in place of the NF-kappaB elements in these viruses. Higher transcriptional activity was observed with HXBLTR (NF-kappaB intact) than with the patient's LTR (NF-kappaB deleted), suggesting that the NF-kappaB binding sites may promote optimal levels of viral gene transcription. The ability of these viruses with NF-kappaB deleted to replicate and cause substantial decline in CD4 cell counts demonstrates that the NF-kappaB binding sites are not absolutely required for viral replication or pathogenicity in vivo. These results are consistent with the notion that the HIV-1 LTR possesses functional redundancy which allows it to interact with multiple transcription factors, thereby ensuring viral replication in a variety of cell types.

Base Sequence↗
PubMed1982

Growth retardation in asthma: role of calorie deficiency.

Height and weight were recorded and nutrient intake assessed during a 1-year period in 8 short asthmatic children who subsequently received energy supplements for a further year. None received systemic steroids. Total energy intakes in 6 of the children were reduced but no relationship between intakes and linear growth was found. Linear growth performance did not improve despite the fact that energy intake was normalised by supplementation, although some children showed an accelerated weight gain. We suggest that calorie supplementation is not effective for promoting optimal linear growth in short asthmatic children.

Adolescent↗
PubMed1992

Role of spore coats in the germinative response of Bacillus cereus to adenosine and its analogues.

Spores of the strain NCIB 8122 of Bacillus cereus have been depleted of coats by treatment with 0.1% sodium dodecyl sulfate--200 mM 2-mercaptoethanol--0.5 M NaCl (pH 9.6). The coat-depleted spores did not show any decrease in viability, heat resistance, refractility, dipicolinic acid content, or specific activities of several protoplastic enzymes. The germinative response of the coat-depleted spores to adenosine and several analogues thereof was found qualitatively similar to that obtained with intact spores. However, germination kinetics appeared to be affected by coat removal, since germination rate measured as loss of refractility was eight times slower even at inducer concentrations 10-fold higher than those required to promote optimal germination response of intact spores. Loss of heat resistance, on the other hand, was hardly affected by coat removal. These results suggest that, even though spore coats are not essential for the triggering reaction, they are required for a rapid evolution of the later events in the germination process.

Adenosine↗
PubMed1994

Uterine vascular permeability after uterine stimulation to rats differentially sensitized for the decidual cell reaction.

Uterine vascular permeability (VP) was assessed after unilateral intrauterine injection of sesame oil to rats given either optimal sensitization for the decidual cell reaction or one of several forms of suboptimal sensitization. The study was intended to determine the relationship between changes in uterine VP and imminent endometrial decidualization. Uterine VP was estimated by the rate at which the uterine volume of distribution of i.v. injected 125I-labeled albumin approached the uterine extracellular fluid volume (ECFV). When ideal sensitization was provided, uterine VP was significantly greater in stimulated than nonstimulated horns at 4, 8, 16, and 32 h after stimulation (p < 0.05). Maximum VP in stimulated horns occurred at 8 h, with the time for the 125I-labeled albumin volume to reach half the uterine ECFV (t1/2) estimated to be 30 min. Different types of sensitization resulted in different levels of uterine VP in stimulated and nonstimulated horns, with maximal VP occurring in stimulated horns of rats that had previously received optimal sensitization for decidualization. We conclude that endometrial decidualization is preceded by significant increases in uterine VP and that optimal sensitization promotes an optimal VP response.

Animals↗
PubMed2004

Differential regulation of fatty acid trapping in mouse adipose tissue and muscle by ASP.

Acylation-stimulating protein (ASP) is a lipogenic hormone secreted by white adipose tissue (WAT). Male C3 knockout (KO; C3(-/-)) ASP-deficient mice have delayed postprandial triglyceride (TG) clearance and reduced WAT mass. The objective of this study was to examine the mechanism(s) by which ASP deficiency induces differences in postprandial TG clearance and body composition in male KO mice. Except for increased (3)H-labeled nonesterified fatty acid (NEFA) trapping in brown adipose tissue (BAT) of KO mice (P = 0.02), there were no intrinsic tissue differences between wild-type (WT) and KO mice in (3)H-NEFA or [(14)C]glucose oxidation, TG synthesis or lipolysis in WAT, muscle, or liver. There were no differences in WAT or skeletal muscle hydrolysis, uptake, and storage of [(3)H]triolein substrate [in situ lipoprotein lipase (LPL) activity]. ASP, however, increased in situ LPL activity in WAT (+64.8%, P = 0.02) but decreased it in muscle (-35.0%, P = 0.0002). In addition, after prelabeling WAT with [(3)H]oleate and [(14)C]glucose, ASP increased (3)H-lipid retention, [(3)H]TG synthesis, and [(3)H]TG-to-[(14)C]TG ratio, whereas it decreased (3)H-NEFA release, indicating increased NEFA trapping in WAT. Conversely, in muscle, ASP induced effects opposite to those in WAT and increased lipolysis, indicating reduced NEFA trapping within muscle by ASP (P < 0.05 for all parameters). In conclusion, novel data in this study suggest that 1) there is little intrinsic difference between KO and WT tissue in the parameters examined and 2) ASP differentially regulates in situ LPL activity and NEFA trapping in WAT and skeletal muscle, which may promote optimal insulin sensitivity in vivo.

Adipose Tissue↗