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PubMed1996

Hospital admission risk profile (HARP): identifying older patients at risk for functional decline following acute medical illness and hospitalization.

OBJECTIVES: To develop and validate an instrument for stratifying older patients at the time of hospital admission according to their risk of developing new disabilities in activities of daily living (ADL) following acute medical illness and hospitalization. DESIGN: Multi-center prospective cohort study. SETTING: Four university and two private non-federal acute care hospitals. PATIENTS: The development cohort consists of 448 patients and the validation cohort consists of 379 patients who were aged 70 and older and who were hospitalized for acute medical illness between 1989 and 1992. MEASUREMENTS: All patients were evaluated on hospital admission to identify baseline demographic and functional characteristics and were then assessed at discharge and 3 months after discharge to determine decline in ADL functioning. RESULTS: Logistic regression analysis identified three patient characteristics that were independent predictors of functional decline in the development cohort: increasing age, lower admission Mini-Mental Status Exam scores, and lower preadmission IADL function. A scoring system was developed for each predictor variable and patients were assigned to low, intermediate, and high risk categories. The rates of ADL decline at discharge for the low, intermediate, and high risk categories were 17%, 28%, and 56% in the development cohort and 19%, 31%, and 55% in the validation cohort, respectively. Patients in the low risk category were significantly more likely to recover ADL function and to avoid nursing home placement during the 3 months after discharge. CONCLUSION: Hospital Admission Risk Profile (HARP) is a simple instrument that can be used to identify patients at risk of functional decline following hospitalization. HARP can be used to identify patients who might benefit from comprehensive discharge planning, specialized geriatric care, and experimental interventions designed to prevent/reduce the development of disability in hospitalized older populations.

Activities of Daily Living↗
PubMed1978

Discrimination between oral streptococci by pyrolysis gas-liquid chromatography.

Washed organisms, including strains of Streptococcus mitior, S. mutans, and S. sanguis, were examined by curie-point pyrolysis gas-liquid chromatography. A linear discriminant function based upon three items from the output data was adequate for segregating the strains according to species. Strains with intermediate properties were also encountered. Sources of variability in cultures were evaluated, chromatographic performance was maintained throughout the investigation, and matching performance from a duplicate pair of chromatographic columns was demonstrated.

Dental Plaque↗
PubMed1995

New concepts for interpretation of intracoronary velocity and pressure tracings.

The development of quantitative angiography and the introduction of new imaging techniques cannot replace functional methods of assessing the severity of stenosis. Measurement of transstenotic pressure gradient and poststenotic flow velocity using miniaturised sensors with guidewire technology offers an alternative to the conventional non-invasive methods that is immediately applicable in the catheterisation laboratory during interventional procedures. The complexity of the coronary circulation, however, makes it difficult to establish simple cut-off criteria to identify the presence of a flow-limiting stenosis. For intermediate lesions or in the presence of variable haemodynamic conditions, the accuracy of the assessment can be improved by the application of more complex indices proposed and validated in the laboratory animals. Two of these indices are myocardial fractional flow reserve and the slope of the instantaneous relation between pressure or pressure gradient and flow velocity.

Blood Flow Velocity↗
PubMed1995

Differential distribution of synaptotagmin I and rab3 in the anterior pituitary of four mammalian species.

In the anterior pituitary of rat, gerbil, hamster and guinea pig, the presence and cellular distribution of the synaptic vesicle-associated proteins synaptotagmin I and rab3 were analyzed by immunoblotting and by immunocytochemical staining of serial semithin sections. Our results show that rab3 proteins are ubiquitously expressed in all endocrine cell types of both the anterior and intermediate lobe. In many cells, rab3 immunoreactivity was concentrated beneath the plasmalemma. This intracellular distribution coincided with the distribution of secretory granules, suggesting a possible association of rab3 proteins with the latter organelles. The staining patterns observed using two monoclonal rab3 antibodies with different isoform specificities are compatible with the recent suggestion that rab3B is the dominant rab3 isoform in anterior pituitary cells. However, we could demonstrate that also rab3A is present in endocrine adenohypophyseal cells, albeit at low levels. In contrast to rab3, synaptotagmin I immunoreactivity was only detected in a limited number of adenohypophyseal endocrine cells. Whereas the monoclonal synaptotagmin I antibody consistently failed to immunostain lactotrophs and endocrine cells of the intermediate lobe, other endocrine cell types displayed variable immunoreactivities towards this antibody. Although a low level of synaptotagmin I expression in the immunonegative cells cannot be excluded, the above observation may reflect a differential distribution of synaptotagmin isoforms in endocrine organs, as it has been described for the nervous system. Our study has established that endocrine cells of the anterior pituitary are endowed with proteins of the rab3 and synaptotagmin families which are generally thought to play important roles in the regulation of the trafficking and/or exocytosis of secretory organelles and, hence, probably fulfil similar functions in adenohypophyseal cells.

Animals↗
PubMed1994

Comparison of facility and research diagnoses in first-admission psychotic patients.

OBJECTIVE: The present study investigated the concordance of clinical and research-based DSM-III-R diagnoses in community, public, and university hospital first-admission patients. In addition to demographic characteristics, information and criterion variance were assessed as explanations for the diagnostic disagreements. METHOD: As part of the Suffolk County (New York) Mental Health Project, 223 first-admission subjects with a psychotic disorder were interviewed with the Structured Clinical Interview for DSM-III-R, and consensus diagnosis was made by two project psychiatrists. Clinical diagnoses were abstracted from discharge summaries obtained subsequent to the research diagnoses, and reasons for disagreement between the two diagnoses were determined. RESULTS: Moderate overall agreement between facility and research diagnoses was found, with highest agreement with the university facility, lowest with the public facilities, and intermediate agreement with the community facilities. Demographic variables were not significantly associated with diagnostic discordance. Apparent reasons for diagnostic disagreement included evidence of variability in information available to clinicians and research psychiatrists (N = 39 or 48% of cases with disagreement), as well as in clinical judgment in the application of DSM-III-R criteria (N = 42 or 52% of cases with disagreement). CONCLUSIONS: Considerable differences between facility and research diagnoses remain, especially in the public and community sectors; these differences can be attributed to information and criterion variance. Longitudinal follow-up is necessary to establish the predictive validity of the initial clinical and research diagnoses. Future research should also address other possible reasons for these discrepancies.

Adult↗
PubMedDate not supplied

Wheat bran decreases aberrant crypt foci, preserves normal proliferation, and increases intraluminal butyrate levels in experimental colon cancer.

BACKGROUND: Dietary wheat bran protects against colon cancer, but the mechanism(s) of this effect is not known. Butyrate, produced by colonic bacterial fermentation of dietary polysaccharides, such as wheat bran, induces apoptosis and decreases proliferation in colon cancer cell lines. Whether similar effects occur in vivo is not well defined. We hypothesized that wheat bran's antineoplastic effects in vivo may be mediated in part by butyrate's modulation of apoptosis and proliferation. METHODS: Male F344 rats were fed wheat bran-supplemented or an isocaloric, isonitrogenous fiber-free diet. Rats were treated with one dose of the carcinogen azoxymethane or vehicle with sacrifice after 5 days (tumor initiation); or two doses (days O and 7) with sacrifice after 56 days (tumor promotion). Study variables included fecal butyrate levels and the intermediate biomarkers of colon carcinogenesis, aberrant crypt foci (ACF), and changes in crypt cell proliferation and apoptosis. RESULTS: During tumor initiation, wheat bran produced greater apoptosis (p = .01), a trend toward less proliferation, and preserved the normal zone of proliferation (p = .01). At tumor promotion, wheat bran decreased the number of ACF (proximal colon, p = .005; distal colon, p = .047) and maintained the normal proliferative zone. The fiber-free diet shifted the zone of proliferation into the premalignant pattern in both studies. Wheat bran produced significantly higher fecal butyrate (p = .01; .004, .00001) levels than the fiber-free diet throughout the tumor promotion study. CONCLUSIONS: Wheat bran increased apoptosis and controlled proliferation during tumor initiation and resulted in decreased ACF. Wheat bran's antineoplastic effects occurred early after carcinogen exposure, and were associated with increased fecal butyrate levels.

Animals↗
PubMed1984

Effects of very small doses of urine on acceleration and delay of sexual maturation in female house mice.

Four types of chemosignal donors were used: adult intact males, grouped adult intact females, pregnant females and lactating females. A daily dose of 0.001 ml urine was sufficient to produce the same degree of acceleration or delay known to occur with whole urine from each donor type. With 0.00001 ml the age of puberty did not differ from that of water-treated controls for any of the treatments. With the intermediate, 0.0001 ml/day dose, the results were variable, depending upon the donor type. The results indicate that for young mice daily exposure to extremely small quantities of urine can influence the physiological events accelerating or delaying puberty.

Animals↗
PubMed2002

Infant holding policies and practices in neonatal units.

PURPOSE: To describe neonatal unit policies and practices regarding the holding of infants by parents. DESIGN: U.S. national cross-sectional descriptive survey. SAMPLE: Nurses representing 215 neonatal units providing regional-level (22 percent), community-level (45 percent), and intermediate-level (33 percent) care. MAIN OUTCOME VARIABLE: Proportion of respondents who reported neonatal intensive care unit criteria permitting parents and family members to hold their infant by conventional and skin-to-skin methods. RESULTS: All but one of the neonatal units offered parents the chance to hold their extubated infants conventionally; 73 percent offered parents to hold their extubated infants skin-to-skin. Sixty-four percent of neonatal units offered parents the option to hold their intubated infants conventionally. In contrast, only 45 percent of the units offered parents to hold their intubated infants skin-to-skin. Factors that influenced parental holding practices included potential benefits to infants and parents, concerns about infant safety, and level of support from neonatal staff members.

Attitude of Health Personnel↗
PubMed2003

The posttranslational phase of gene expression: new possibilities in molecular diagnosis.

Proteins in general and secretory proteins in particular undergo posttranslational processes before they reach the structure in which they can fulfill their functional purpose. The protein precursor may undergo a wide variety of proteolytic cleavages, N- and C-terminal trimmings and amino acid derivatizations in cells that express the protein. Occasionally, the same precursor is differently processed in different cell types and, in addition, diseased cells may process a given precursor abnormally. For instance, the translational process is often either increased or decreased in diseased cells, which render the ensuing modifications of the precursor incomplete. As a result, a variable mixture of precursors and processing-intermediates accumulates. Measurement of a single protein or peptide component of the posttranslational processing cascade may not facilitate the diagnosis of a disease, because the pattern of precursors and processing products vary individually among patients. In order to exploit disturbed posttranslational processing for diagnostic use, and--at the same time--provide an accurate measure of the translational product, a simple analytical principle named "processing-independent analysis" (PIA) has been designed. PIA-methods quantitate the total mRNA product irrespective of the degree of precursor processing. PIA-methods have recently been developed for a number of prohormones and neuroendocrine proteins, and their diagnostic potential appears promising in early diagnosis of tumors and cardiovascular diseases. The present review describes posttranslational processing patterns for some neuroendocrine proteins. Second, PIA-measurements of precursor-products are mentioned with indication of problems and pitfalls. Finally, PIA-results obtained in diagnosis of neoplastic and cardiovascular diseases are highlighted. But first general aspects of the posttranslational processing are reviewed as a necessary basis for the understanding of the new diagnostic possibilities.

Animals↗
PubMed2026

Diagnostic Challenge: Angiomatoid Fibrous Histiocytoma with EWSR1 Rearrangement.

This image report aims to illustrate the diagnostic value of integrating various diagnostic modalities to distinguish angiomatoid fibrous histiocytoma (AFH) from malignant soft tissue tumors. A 33-year-old man presented with a painful palpable mass in the medial left thigh. Magnetic resonance imaging revealed a 27 × 23 × 20 mm intramuscular lesion in the vastus medialis with a mixed T1 signal, predominantly high T2/STIR signal, internal hyperintense foci, a capsule-like rim, septations, heterogeneous enhancement, and marked peritumoral edema extending beyond the apparent tumor margins. Because these findings raised concern for a malignant soft tissue tumor, wide excision was performed after biopsy suggestive of low-grade sarcoma. Histologically, the tumor comprised spindle to epithelioid cells arranged in fascicular and storiform patterns surrounded by a lymphoid cuff. Immunohistochemistry showed positivity for CD68, CD99, and EMA, partial desmin and S-100 expression, and a Ki-67 index of 15%. Differential diagnosis included AFH and a malignant peripheral nerve sheath tumor. FISH demonstrated EWSR1 rearrangement, while PCR testing for EWSR1-CREB1 and EWSR1-ATF1 was negative. Although the specific fusion partner could not be identified, an EWSR1 rearrangement, together with the histologic and immunohistochemical findings, was considered supportive but not definitive for AFH. AFH, a rare intermediate tumor with nonspecific imaging features and variable pathology, makes diagnosis challenging. This case emphasizes the need to consider AFH in the diagnosis of intramuscular tumors with disproportionate peritumoral edema and highlights the role of molecular analysis in confirming the diagnosis.

angiomatoid fibrous histiocytoma↗
PubMed1994

Characteristics of health data: structure and relationships.

The characteristics of health data are diverse and vary by discipline. Health data can be viewed from three perspectives. They can be examined at a basic level of different variable types and database constructions. At an intermediate level, the way data are structured in a facility is a model of how an organization works. A computerized information system is a model of how work is performed. An understanding of facility data architecture and data structure is essential for adapting both manual and computerized systems to the rapid changes occurring in health care today. Lastly from the highest-level perspective, for communication and exchange of health data to be possible across all components of the health care delivery system, standards for data must be adopted by all institutions and individuals involved in the development of health data information systems. To expedite such exchange, the American Medical Informatics Association (AMIA) has recommended standards for patient, provider, and site-of-care identifiers; computerized message exchanges; and medical record content and structure. AMIA has also recommended the use of the universal medical language system as the basis for future developments in a universal medical language.

Abstracting and Indexing↗
PubMed1975

Acanthocephalus parksidei sp. n. (Acanthocephala: Echinorhynchidae) from Wisconsin fishes.

Acanthocephalus parksidei sp. n. is described from over 4,000 specimens recovered from 11 fish hosts in the Pike River, southeastern Wisconsin. A parksidei is a highly variable acanthocephalan which appears to present an intermediate form between the only 2 other members of the same genus, A. dirus and A. jacksoni, described from North American freshwater fishes. It is structurally similar to the larger A. dirus but is separated from it primarily by having fewer proboscis hook rows and hooks per row. It is separated from A. jacksoni on the basis of its slender body form, relatively larger size of male reproductive system in proportion to body size, as well as other features. It differs from the larger European A. lucii by having smaller proboscis hooks, different hook root shape, smaller proboscis receptacle, and smaller embryos.

Acanthocephala↗
PubMed2002

Management of mild to moderate aortic stenosis at the time of coronary artery bypass grafting.

An increasing number of patients are referred for coronary artery bypass surgery (CABG) with the presence of mild to moderate aortic stenosis (AS). It is well accepted that patients with severe AS and coronary artery disease (CAD) should undergo combined aortic valve replacement (AVR) and CABG, which carries an operative mortality of approximately 5-7%. For patients with CAD and mild AS, controversy persists regarding concomitant AVR during CABG. It has been shown that AS progresses at a rate of 5-10 mmHg per year, and the valve area decreases by about 0.1 cm2 per year. The progression of AS is more rapid in elderly patients, in the presence of CAD, and in patients with a calcific degenerative etiology. In contrast, patients with congenital bicuspid valves or rheumatic pathology demonstrate slower progression of disease. Despite these observations, it is difficult to predict reliably the progression of disease for an individual. Thus, an attempt should be made to identify patients who are likely to progress rapidly from mild to severe AS and who would therefore benefit from AVR/CABG. Our approach regarding the decision to perform an AVR/CABG is based on aortic valve gradient and area. If the gradient is >25 mmHg, AVR should be considered. If the gradient is <10 mmHg, then only CABG is performed. Severities of leaflet calcification and leaflet mobility are factors that should be taken into account when deciding to perform concomitant AVR/CABG for intermediate gradient (10-25 mmHg). Additional important variables include the etiology of aortic valve disease, the rate of progression of AS, the patient's life expectancy, and general condition. For patients with mild AS who are undergoing CABG, a tailored approach involving intraoperative transesophageal echocardiography and valve inspection is the most appropriate surgical option.

Aortic Valve Stenosis↗
PubMedDate not supplied

Microsomal deacetylation of isomeric acetamidobiphenyls.

In vitro rates of deacetylation were measured with carcinogenic and noncarcinogenic isomeric arylamides using microsomal preparations from guinea pig, hamster, rat, mouse, rabbit and dog. Following incubation at 37 degrees, the substrate and hydrolysis products were extracted into ether and the corresponding aromatic amine quantified by gas-liquid chromatography. The data show that rates of deacetylation were both species and isomer dependent. In general, the highest rate of deacetylation in microsomes from all species was recorded with 2-acetamidobiphenyl (2-AABP); however, the mouse uniquely deacetylated 4-acetamidobiphenyl (4-AABP) most rapidly. The meta isomer 3-acetamidobiphenyl (3-AABP) was deacetylated at an intermediate rate in all species investigated. The variability in the rates of deacetylation within species may reflect the heterogeneity of the deacetylase enzymes and may be an important factor in amine/amide carcinogenesis.

Aminobiphenyl Compounds↗
PubMed1987

Neonatal enterococcal sepsis: case-control study and description of an outbreak.

An increased incidence of neonatal sepsis caused by Group D streptococci, specifically enterococci (GDE), during a recent 6-month period prompted a 5-year review of enterococcal sepsis in our neonatal intensive care unit. Sixteen episodes occurred in 14 babies. GDE accounted for 8 of 19 (42%) episodes of neonatal bacteremia during the epidemic period vs. only 8 of 159 (5%) episodes during the remaining 4.5 years (endemic period) (P less than 0.001). Blood isolates were all identified as Streptococcus faecalis. A combination of three strain-typing methods successfully distinguished the epidemic organisms from endemic nursery strains of GDE and from "background" GDE flora in the hospital. Nursery isolates were all susceptible to ampicillin, intermediate or resistant to the aminoglycosides and variably resistant to the newer cephalosporins. There were no differences in antibiotic susceptibilities of the GDE or in characteristics of the patients that were unique to the epidemic. Neonates with GDE sepsis had a mean birth weight of 913 g, a mean gestational age of 27 weeks and a mean age of onset of sepsis of 8.5 weeks. Twenty-five controls, matched for birth weight and admission date, were identified. Significant differences (P less than 0.05) between cases and controls included: use of a nonumbilical central line (71 vs. 32%); days central line in place (26.5 vs. 6.5 days); and bowel resection (29 vs. 4%). This is the first reported outbreak of S. faecalis sepsis in neonates. GDE are important nosocomial pathogens that must be considered in late onset neonatal sepsis.

Cross Infection↗
PubMedDate not supplied

The sertolian epithelium in the testis of men affected by 'Sertoli-cell-only syndrome'.

Because of the architectural complexity of the seminiferous epithelium, the Sertoli cell is extremely difficult to study. The individual cellular constituents of the tubular wall are intimately associated with one another; especially Sertoli cells and germinal cells are tightly connected. As implied by the name, Sertoli-cell-only syndrome (SCOS) is characterized by the presence of only Sertoli cells in the seminiferous tubule. The absence of germinal cells makes this condition ideal for the morphological study of Sertoli cell. Testicular biopsy specimens of subjects affected by SCOS were studied under light and electron microscopy. The Sertoli cells appeared to be morphologically normal, except for their shape, that appears to be columnar as result of the complete absence of the germinal cells. The cellular outlines were irregular, particularly at the base, but the cytoplasm contained normal organelles and inclusions. The presence of both pale and dark elements was evident. These differences in staining reflect the variability in concentration of glycogen particles and intermediate microfilaments in the cytoplasm. In spite of these differences between Sertoli cells in SCOS and those in normal subjects, SCOS represents a satisfactory model for the morphological and functional analysis of the Sertoli cells.

Actin Cytoskeleton↗
PubMed1994

Effects of blunt scaling on periodontal status and subgingival microorganisms. A pilot study.

Clinical and microbiological effects of 3 periodontal treatments were investigated: (i) scaling and root planing with sharp instruments combined with pocket flushing, (ii) scaling with blunt plastic curettes and pocket flushing, and (iii) pocket flushing alone. Clinically comparable, randomized sites of 8 patients with progressive adult periodontitis were treated 4 times in intervals of approximately 4 months. Prior to each re-treatment and at the end of the study all sites were clinically monitored and the subgingival microflora was examined. Results showed that all treatments were effective in reducing pocket depths and the subgingival microflora, while attachment levels remained unchanged. At individual sites treatment responses were of considerable heterogeneity. In general, clinically improving sites had strongly reduced and sites loosing > or = 3 mm of attachment high residual bacterial cell numbers. Sites with intermediate residual subgingival plaque levels showed quite variable clinical responses. This preliminary study suggests that weakly abrasive procedures could be very valuable for the initial treatment of periodontal lesions. This hypothesis should be further tested in comprehensive clinical trials.

Adult↗
PubMed1994

Determination of control coefficients in intact metabolic systems.

The control structure of a metabolic system can in principle be determined without the need for purification of the component enzymes and study of their kinetic properties, provided that their activities can be perturbed by amounts sufficient to produce measurable changes in the steady-state variables, i.e. the fluxes through the system and the concentrations of the intermediates. Each perturbation is characterized in terms of the co-response coefficients of all pairs of variables, i.e. the slopes of the lines produced when the logarithm of one variable is plotted against the logarithm of another, both varying in response to the same perturbation. If all the co-response coefficients are assembled into a matrix, the inverse of this matrix can be transformed into a matrix containing all the component elasticities, which can be inverted to provide the complete matrix of control coefficients. In a simple three-enzyme pathway studied, the analysis proves not to require unrealistically high accuracy in the original co-response measurements: even with errors with standard deviation +/- 5.77 degrees in the angles to the horizontal of the lines in the co-response plots (equivalent at best to errors of +/- 20% in the corresponding co-response coefficients), the final control coefficient matrix may be adequate for assessing the control structure of the system. Examination of literature data from studies of mitochondrial respiration and of gluconeogenesis indicates that considerably higher precision than this is achievable.

Enzymes↗