Showing papers by "Veterans Health Administration published in 1982"
TL;DR: The anatomy, physiology and biochemistry of opiomelanotropinergic neurons are reviewed and the implications of multi-neurotransmitter and multi-hormone neurons and cells are discussed.
540 citations
TL;DR: Corticotrophin releasing factor decreases food intake after starvation and during the nocturnal feeding phase in rats, and this decrease appears to be associated with CRF producing a marked increase in grooming.
411 citations
TL;DR: The widespread but selective distribution of neurons containing CRF-like immunoreactivity supports the neuroendocrine role of this peptide and suggests that CRF, similarly to other neuropeptides, may also function as a neuromodulator throughout the brain.
Abstract: The immunocytochemical localization of neurons containing the 41 amino acid peptide corticotropin-releasing factor (CRF) in the rat brain is described. The detection of CRF-like immunoreactivity in neurons was facilitated by colchicine pretreatment of the rats and by silver intensification of the diaminobenzidine end-product. The presence of immunoreactive CRF in perikarya, neuronal processes, and terminals in all major subdivisions of the rat brain is demonstrated. Aggregates of CRF-immunoreactive perikarya are found in the paraventricular, supraoptic, medial and periventricular preoptic, and premammillary nuclei of the hypothalamus, the bed nuclei of the stria terminalis and of the anterior commissure, the medial septal nucleus, the nucleus accumbens, the central amygdaloid nucleus, the olfactory bulb, the locus ceruleus, the parabrachial nucleus, the superior and inferior colliculus, and the medial vestibular nucleus. A few scattered perikarya with CRF-like immunoreactivity are present along the paraventriculo-infundibular pathway, in the anterior hypothalamus, the cerebral cortex, the hippocampus, and the periaqueductal gray of the mesencephalon and pons. Processes with CRF-like immunoreactivity are present in all of the above areas as well as in the cerebellum. The densest accumulation of CRF-immunoreactive terminals is seen in the external zone of the median eminence, with some immunoreactive CRF also present in the internal zone. The widespread but selective distribution of neurons containing CRF-like immunoreactivity supports the neuroendocrine role of this peptide and suggests that CRF, similarly to other neuropeptides, may also function as a neuromodulator throughout the brain.
410 citations
TL;DR: It is suggested that the mouse embryo inherits a large supply of maternal mRNA but that the bulk of this RNA is eliminated in the 2-cell embryo, and that the accumulation of poly(A)+ RNA is proportional to oocyte growth.
379 citations
TL;DR: The majority of incontinent patients had substantial cognitive impairment and limitations in mobility and the severity of these impairments was related to the extent ofincontinence.
Abstract: Among elderly nursing home patients, urinary incontinence is a prevalent and costly condition. In seven nursing homes studied, 419 (50%) of the elderly patients were incontinent of urine. Most had been incontinent at admission (64%), had more than one incontinent episode per day or a catheter (72%), and had concomitant fecal incontinence (64%). The majority of incontinent patients had substantial cognitive impairment and limitations in mobility. The severity of these impairments was related to the extent of incontinence. Complications such as urinary tract infection and skin breakdown occurred in almost 45% and were more common in patients with catheters. Physicians recorded incontinence as a problem, or any efforts to evaluate it, in the nursing home records of less than 15% of these patients. (JAMA1982;248:1194-1198)
331 citations
TL;DR: Monitoring of sleep and waking EEGs from healthy nondemented elderly men and inpatients for whom the diagnosis was probable senile dementia of Alzheimer's type suggested that correlative neuropathologic data might provide an understanding of the basis for the sleep, EEG, and mental‐function factors that undergo change in SDAT.
Abstract: Sleep and waking EEGs from 11 healthy nondemented elderly men and from ten inpatients for whom the diagnosis was probable senile dementia of Alzheimer's type (SDAT), were monitored in the subjects' typical home or ward environments or in the sleep laboratory, according to their customary sleep schedules. Aged normal subjects (age range, 56-85 years) had less Stage 3 and Stage 4 sleep, less REM sleep, and more wakefulness than normally observed in young adults. Patients with SDAT (age range, 56-88 years) had even less Stage 3 sleep, no Stage 4 sleep, and very little REM sleep, and experienced fragmentation of their sleep, with frequent awakenings. These sleep variables were significantly different in the SDAT and control groups (MANOVA). Examination of the 24-hour plots of sleep/waking patterns revealed prominent fragmentation of the diurnal sleep/waking rhythm in SDAT patients, with frequent daytime napping and nighttime periods of wakefulness. In addition, significant group differences were observed for the EEG variable, dominant occipital frequency. More qualitative EEG variables (diffuse slowing, spindle activity, and paroxysmal discharges) also differed between groups. It is suggested that correlative neuropathologic data might provide an understanding of the basis for the sleep, EEG, and mental-function factors that undergo change in SDAT.
331 citations
TL;DR: Assessment of social skills deficits can proceed along topographical, functional, and information-processing lines and will require attention to the psychometric properties and multidimensional focus of evaluative instruments.
Abstract: Deficiencies in social skills, important in the functional adjustment and rehabilitation of persons with schizophrenia, derive from inadequate learning experiences, disuse, anxiety, cognitive disturbances, and amotivational states. Social skills training programs should be specifically organized to compensate for these varied sources of deficiency in interpersonal competence. Assessment of social skills deficits can proceed along topographical, functional, and information-processing lines. Assessment technology is in its early stages of development and will require attention to the psychometric properties and multidimensional focus of evaluative instruments.
325 citations
TL;DR: All of the 16 cell lines, the 3 fresh specimens, and the direct bone marrow preparation had a common deletion of the short arm of chromosome #3, and this specific chromosomal abnormality was not found in five non-SCLC cell lines studied and is of major potential biological and diagnostic importance.
310 citations
TL;DR: It was found that the stromal cells became progressively donor in origin with time after transplantation and some reacted with antibody directed against factor VIII-associated antigen, indicating that the in vitro microenvironment is transplantable and composed in part of endothelial-like cells.
Abstract: The method for long-term culture of marrow cells in vitro as described by Dexter1 has recently been successfully applied to human marrow2,3 and is dependent on the development of an adherent stromal cell layer consisting of cells described as “endothelial-like cells, fat cells, and macrophages” 4. The present study was designed to determine the origin and composition of the stromal cells forming the in vitro ‘microenvironment’ and maintaining haematopoeisis in long-term cultures grown from marrows of 14 patients who received marrow transplants from HLA identical siblings of the opposite sex. The presence of a Y chromosome was used as a marker to establish the donor or recipient origin of the cells. We found that the stromal cells became progressively donor in origin with time after transplantation and some reacted with antibody directed against factor VIII-associated antigen. In addition, donor-derived in vitro stromal cells synthesized both interstitial and basal lamina collagen types, indicating that the in vitro microenvironment is transplantable and composed in part of endothelial-like cells.
256 citations
TL;DR: Present evidence indicating that CCK is a central neurotransmitter or neuromodulator includes its regional distribution with localization within neuronal cell bodies and axons; the demonstration that it can be synthesized in neuronal tissue; the fact that it is released by depolarizing stimuli in vitro ; and the presence of specific, high affinity receptors for CCK in the brain.
227 citations
Journal Article•
TL;DR: It is concluded that choice of IA system for research or teaching purposes should be based on behaviors and outcomes of particular interest and importance to the user.
Abstract: Interactional analysis (IA) systems have been devised and applied to doctor-patient dialogues to describe encounters and to relate process to outcomes. Prior work in this area has been typified by the use of a single taxonomy for classifying verbal behaviors and limited outcomes (compliance and/or satisfaction). We applied three different IA systems (Bales, Roter's modified Bales with affective ratings, and Stiles' "Verbal Response Modes") to 101 new-patient visits to a general medical clinic for which multiple outcomes had been determined: several measures of patient knowledge of problems at conclusion of visit; patient compliance with drugs (over the ensuing three months); and patient satisfaction with the visit (perceived technical, interpersonal and communication quality). Within IA systems, cross tabulations and multiple regressions were performed to relate encounter events to outcomes. Across IA systems, multiple regression R2 and R2 adjusted (R2a) for the number of independent variables entering were used to characterize strength of relationships. Roter's IA system showed stronger relationships to outcomes of knowledge (41% R2, 27% R2a) and compliance (44% R2, 28% R2a) than did Bales' or Stiles' systems. R2 for patient satisfaction was identical for Bales and Roter (35%), and greater than R2 for Stiles (14%). We conclude that choice of IA system for research or teaching purposes should be based on behaviors and outcomes of particular interest and importance to the user. Based on audioreview of tapes, Roter's approach is less time-consuming and may perform as well as more complex systems requiring transcript analysis.
TL;DR: Three interactional analysis systems were used to characterize behavioral elements of provider–patient dialogues of 101 new-patient visits in a general medical clinic and several relationships taken together indicate that physician teaching in the concluding segment may be important.
Abstract: Three interactional analysis (IA) systems (Bales', Roters modified Bales and Stiles' "Verbal response modes") were used to characterize behavioral elements of provider-patient dialogues of 101 new-patient visits in a general medical clinic. In a previous article, the explanatory power of these IA systems was compared. In this article, specific provider and patient behaviors within segments of the encounter (introduction-history, physical examination and conclusion), which were shown to be related to encounter outcomes of knowledge, compliance and satisfaction, were examined. Review of interactional behaviors entering regression analysis with a significant F-to-enter (p less than or equal to 0.05) and supplementary contextual analyses suggested the importance of several categories of physician and patient behavior. Behaviors manifesting tension bear important and complex relationships to encounter outcomes. For example, patient and physician expressions of tension generally bear strong negative relationships to patient satisfaction, while patient expressions interpreted as tension release are positively related to both satisfaction and compliance. The timing of other behaviors appears to be critical to subsequent outcomes. If patient requests for medication occur early in the encounter, this behavior is positively related to subsequent patient satisfaction. However, if they occur in the concluding segment, a negative relationship results. Finally, several relationships taken together indicate that physician teaching in the concluding segment may be important. While useful observations may emerge from application of currently available IA techniques, the resulting information is best characterized as hypothesis-generating. These IA systems have many limitations, and research is needed to derived more clinically oriented systems that may permit more consistent demonstrations of critical process-outcome relationships.
TL;DR: Elastase activity of the aorta may determine aneurysm formation and may inhibit development of concomitant occlusive disease.
TL;DR: A conceptual framework to summarize and integrate the rapidly expanding theoretical, empirical, and clinical literature on depression is presented in this article, which views depression as resulting from the interplay of several domains of variables, including personal and environmental resources, environmental Stressors, and the individual's appraisal and coping responses to specific stressful events.
TL;DR: It is suggested that naloxone suppresses drinking behavior due to alterations in taste perception after a 15-hour deprivation of tap water following a 15 hour deprivation of heroin.
TL;DR: The results demonstrate that fetal ethanol exposure enhances adult pituitary-adrenal responses to certain stressors, including alcohol, and suggest that the long-term effects may be mediated by developmental actions of alcohol on central neural mechanisms involved in the regulation of this neuroendocrine system.
Abstract: Pregnant female rats were fed either a 5.0–5.5% w/v ethanol-containing liquid diet ad lib or pair-fed the isocaloric control diet during gestation weeks 2 and 3. At 75–105 days of age, female offspring of the ethanol-treated dams showed significantly greater corticosterone responses than pair-fed- or normally-derived offspring to the stress of cardiac puncture or of noise and shaking, while pituitary-adrenal responses to exposure to a novel environment, cold or 2–3 days of fasting were normal. Adrenal sensitivity to ACTH in dexamethasone-suppressed adult offspring was unaffected by the prenatal treatment. The results demonstrate that fetal ethanol exposure enhances adult pituitary-adrenal responses to certain stressors, including alcohol as demonstrated previously, and suggest that the long-term effects may be mediated by developmental actions of alcohol on central neural mechanisms involved in the regulation of this neuroendocrine system.
TL;DR: The results provide evidence in man for extrarenal production of both 24,25(OH)2D and, by two independent assays, of 1 alpha , 25(OH), and indicate that serum values of the two dihydroxy metabolites of vitamin D in anephric subjects vary with the serum concentration of the precursor 25-OHD.
Abstract: Recent studies provide evidence for extrarenal production of 1 alpha ,25-dihydroxyvitamin D [1 alpha ,25(OH)2D]. To investigate this possibility, serum vitamin D, 25-hydroxyvitamin D (25-OHD), 24,25-dihydroxyvitamin D [24,25(OH)2D], and 1 alpha ,25(OH)2D were measured in eight adult anephric subjects. All were undergoing hemodialysis and three of them were receiving vitamin D, 50,000 or 100,000 U/d. Serum vitamin D was elevated in two of the patients given vitamin D and was abnormally low in the others. Mean serum 25-OHD was increased in patients given vitamin D (94.0 +/- 7.6 ng/ml) and was normal in the others (16.4 +/- 0.9 ng/ml, P less than 0.001). Mean serum 24,25(OH)2D was normal in patients given vitamin D (1.38 +/- 0.27 ng/ml) and was low in the others (0.25 +/- 0.08 ng/ml, P less than 0.001). Serum 24,25(OH)2D correlated significantly with serum 25-OHD (r = 0.848, P less than 0.01). Mean serum 1 alpha ,25(OH)2D determined by receptor assay was 5.8 +/- 1.9 pg/ml in patients who were not given vitamin D and was 14.1 +/- 0.6 in those who were given vitamin D (P less than 0.001). Serum 1 alpha ,25(OH)2D correlated significantly with serum 25-OHD (r = 0.911, P less than 0.01). Mean serum 1 alpha ,25(OH)2D, measured by bioassay, was 8.3 +/- 1.9 pg/ml in patients who were given vitamin D and was 15.9 +/- 2.4 pg/ml in those who were given vitamin D (P less than 0.05). There was a significant correlation between the values for serum 1 alpha ,25(OH)2D obtained with the two methods (r = 0.728, P less than 0.01). The results (a) provide evidence in man for extrarenal production of both 24,25(OH)2D and, by two independent assays, of 1 alpha , 25(OH)2D, and (b) indicate that serum values of the two dihydroxy metabolites of vitamin D in anephric subjects vary with the serum concentration of the precursor 25-OHD.
TL;DR: While physical and psychosocial disease impacts were positively correlated, the association diminished with longer duration of disease, and the self-administered SIP appears to be practical and useful in clinical settings.
Abstract: The treatment of chronic disease is often directed at preservation of function, but most functional measures are crude, and rarely include indicators of psychosocial status. The Sickness Impact Profile (SIP) is a newer "health status" measure designed to comprehensively assess such outcomes. The functional and psychosocial impacts of rheumatoid arthritis and their relation to disease duration were measured by having 79 patients self-administer the SIP. Disease impacts were pervasive, including effects on leisure, social, and sexual activities, as well as physical function. While physical and psychosocial disease impacts were positively correlated, the association diminished with longer duration of disease. The self-administered SIP appears to be practical and useful in clinical settings. Specific results may help to target patient education, increase physician awareness of the distress patients experience, suggest the need for social and rehabilitative services, and help monitor responses to therapy. ( Arch Intern Med 1982;142:879-882)
TL;DR: The most parsimonious interpretation of these studies is that kappa agonists are endogenous initiators of feeding and thatKappa receptors are maximally saturated at times of food deprivation and during spontaneous feeding.
TL;DR: This Annotation considers the progressive differentiation of marrow stem cells into platelets and the regulatory activities involved therein.
Abstract: Much insight into platelet production and function has been gained by examination of megakaryocytes and their precursors. Since the last major reviews on this subject (Ebbe, 19 76; Breton-Gorius & Reyes, 19 76). significant advances have occurred in our knowledge of megakaryocytopoiesis. This field was recently stimulated by the first conference devoted to the in vitro study of megakaryocytes (Evatt et al, 1981). This Annotation considers the progressive differentiation of marrow stem cells into platelets and the regulatory activities involved therein.
TL;DR: None of these patients manifested bleeding, hemolysis, splenomegaly, or other clinical features of systemic lupus erythematosus, and washed frozen platelets partially corrected the abnormality induced by the anticoagulant.
Abstract: Chronic administration of chlorpromazine is associated with the development of a lupus-like circulating anticoagulant and a variety of immunological abnormalities. The prevalence of these findings was studied in 123 psychiatric patients. The anticoagulant was present in 11 of 30 patients receiving chlorpromazine (CPZ), in none of 17 patients who had been off phenothiazine therapy for over a year and in none of 53 controls. It was also seen in 5 of 13 patients who had been switched from CPZ to another phenothiazine even after several years being off CPZ. The anticoagulant was characterized by prolongation of the partial thromboplastin time, thromboplastin dilution test, and Russell's viper venom time. Washed frozen platelets partially corrected the abnormality induced by the anticoagulant. In all but one case the anticoagulant was associated with positive antinuclear antibody test and/or increased serum IgM. Six of 16 patients also had decreased complement levels, and two had a positive direct Coombs' test. None of these patients manifested bleeding, hemolysis, splenomegaly, or other clinical features of systemic lupus erythematosus.
TL;DR: The authors identify six items from the Zung Self-Rating Depression Scale that may serve as a simple screening instrument for the detection of depression in geriatric medical patients.
Abstract: Depression, a common and treatable psychiatric disorder in later life, is often overlooked in geriatric medical patients. The authors evaluated the validity of two self-rating depression scales, the Zung Self-Rating Depression Scale and the Popoff Index of Depression, for 55 elderly patients. They compared these ratings with the diagnosis assigned by a psychiatrist who was blind to scale results and who interviewed these patients using DSM-III criteria. The two scales correctly classified 80% and 69% of the subjects, respectively. The authors identify six items from the two scales that may serve as a simple screening instrument for the detection of depression in geriatric medical patients.
TL;DR: It was confirmed that the satiety effect of peripherally administered cholecystokinin (10 micrograms/kg) was mediated through the vagus, and the satieties effect of peripheral administration of TRH and calcitonin were not present in vagotomized animals.
TL;DR: A panel of monoclonal antibodies reactive with normal lymphocyte subsets was used to classify cases of lymphocytic leukemia on the basis of cell surface antigen expression, finding that B-cell lineage cancers that were examined were reactive with both the HLA-DR and Leu-1 antibodies.
TL;DR: Data show that when treatment with bile acid sequestrants causes an increase in plasma VLDL-TG, the increase is due to an increment in production and not to a decrease in catabolism.
Abstract: An increase in plasma very low density lipoprotein-triglycerides (VLDL-TG) is seen frequently during treatment with bile acid-binding resins. The purpose of this study was to determine whether this increment in VLDL-TG is due mainly to an increase in synthesis of VLDL, or to an enhanced catabolism. Three types of patients were studied: (1) 7 normotriglyceridemic subjects. (2) 4 obese patients, and (3) 9 hypertriglyceridemic patients. Before treatment they underwent a study of VLDL-TG kinetics that employed multicompartmental analysis of specific activity curves following injection of 3H-glycerol. The patients were then treated with a bile acid-binding resin, either cholestyramine or colestipol, for several weeks to several months. At the end of the treatment period, they were readmitted to the hospital for a second study of VLDL-TG kinetics. The patients showed a variable response to resin therapy. Many had an increase in concentrations of VLDL-TG, but others had no change or even a slight decrease. However, analysis of the data showed a high correlation between change in production rates of VLDL-TG and change in concentration. Also, when the data for the 20 patients were combined, there was a statistically significant increase in both synthetic rates and concentrations of VLDL-TG; in contrast, the fractional catabolic rate (FCR) was unchanged by therapy. Therefore, our data show that when treatment with bile acid sequestrants causes an increase in plasma VLDL-TG, the increase is due to an increment in production and not to a decrease in catabolism.
TL;DR: The immunopathologic data presented support an immune complex-mediated pathogenesis for this disease process and emphasize both the frequency of this disorder and the varied disease settings within which it may manifest.
Abstract: • Thirty-nine patients with clinical, histologic, and immunofluorescence evidence of leukocytoclastic (necrotizing) vasculitis were studied for the presence of circulating immune complexes. These patients were selected prospectively during a three-year interval from patients seen in a dermatology clinic. Clinical and serologic data are summarized and representative cases are presented. This large series of patients with leukocytoclastic vasculitis emphasizes both the frequency of this disorder and the varied disease settings within which it may manifest. The immunopathologic data presented support an immune complex-mediated pathogenesis for this disease process. (Arch Dermatol1982;118:296-301)
TL;DR: Data suggest that clinician competence to a certain extent is modeled by the discourse analysis, and a model of listener interaction with text was pursued whereby constituent statements of discourse are organized on interpretation into hierarchal structures according to their mutual presupposition relationships.
TL;DR: The concept of dopamine being primarily responsible for the initiation of chewing behavior and the opiates regulating food ingestion is compatible with the observations reported here and demonstrated the close interaction between dopaminergic an dopiate systems in the regulation of food intake.
Abstract: Intraventricular administration of the dopamine agonist, bromergocryptine, reliably induces feeding over a narrow dose range with a bell-shaped curve. Bromergocryptine (80 μg) induced feeding is inhibited by the dopamine antagonist, haloperidol (0.5 mg/kg) and the opiate antagonist, naloxone (10 and 1 mg/kg). The leucine-enkephalin containing opioid peptide, dynorphin-(1–13) induces feeding which is inhibited by haloperidol (0.5 and 0.1 mg/kg) and by naloxone (1 mg/kg). Of the common satiety factors tested only bombesin (10 μg/kg subcutaneously) inhibited both dynorphin-(1–13) and bromergocryptine induced feeding. Cholecystokinin-octapeptide (10 and 20 μg/kg, subcutaneously), thyrotropin-relasing hormone (10 and 20 μg), ICV) and calcitonin (1 unit, ICV) all failed to inhibit dynorphin-(1–13)-induced feeding. Calcitonin and CCK-8 but not TRH inhibited bromergocryptine-induced feeding. These studies have demonstrated the close interaction between dopaminergic an dopiate systems in the regulation of food intake. The concept of dopamine being primarily responsible for the initiation of chewing behavior and the opiates regulating food ingestion is compatible with the observations reported here.
TL;DR: It is suggested that skinfolds are a more effective means of assessing subcutaneous fat than ultrasound, especially when the large difference in cost of equipment is considered.
Abstract: Ultrasound (A-scan mode) and skinfold methods were evaluated in the measurement of subcutaneous fat thickness and prediction of total fat weight (by whole body potassium counting). Based on intraobserver correlations on 39 men at 15 body sites, skinfold caliper measurements were more reproducible than ones obtained by ultrasound. Measurements made with the two techniques at the same site typically produced different mean estimates of fat thickness. However, scores were often highly correlated with each other, indicating similar relative rankings of subjects by each technique. Skinfolds were more highly correlated with total fat weight than were ultrasound measurements, but body weight. Anthropometric measurements were highly correlated with fatness because of their association with body weight, and when this relationship was statistically controlled for, they typically lost their predictive effectiveness. Multiple regression analyses revealed that the best predictors of fat weight were body weight along with skinfold and ultrasound measurements. These results suggest that skinfolds are a more effective means of assessing subcutaneous fat than ultrasound, especially when the large difference in cost of equipment is considered.