Showing papers by "Veterans Health Administration published in 1985"
TL;DR: The West Haven‐Yale Multidimensional Pain Inventory was developed in order to fill a widely recognized void in the assessment of clinical pain and is recommended for use in conjunction with behavioral and psychophysiological assessment strategies in the evaluation of chronic pain patients in clinical settings.
Abstract: The complexity of chronic pain has represented a major dilemma for clinical researchers interested in the reliable and valid assessment of the problem and the evaluation of treatment approaches. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) was developed in order to fill a widely recognized void in the assessment of clinical pain. Assets of the inventory are its brevity and clarity, its foundation in contemporary psychological theory, its multidimensional focus, and its strong psychometric properties. Three parts of the inventory, comprised of 12 scales, examine the impact of pain on the patients' lives, the responses of others to the patients' communications of pain, and the extent to which patients participate in common daily activities. The instrument is recommended for use in conjunction with behavioral and psychophysiological assessment strategies in the evaluation of chronic pain patients in clinical settings. The utility of the WHYMPI in empirical investigations of chronic pain is also discussed.
2,039 citations
TL;DR: Serial creatinine clearances were obtained for 446 normal volunteers in the Baltimore Longitudinal Study of Aging followed between 1958 and 1981 and there was a small group of patients who showed a statistically significant increase (P < 0.05) in Creatinine clearance with age.
Abstract: Serial creatinine clearances (5 to 14 studies) were obtained for 446 normal volunteers in the Baltimore Longitudinal Study of Aging followed between 1958 and 1981. When those subjects with possible renal or urinary tract disease and subjects on diuretics and antihypertensives were removed from the study, leaving a group of 254 "normal" subjects, the mean decrease in creatinine clearance was 0.75 ml/min/year. The slopes of the creatinine clearance vs. time fell into a normal (Gaussian) distribution around this mean. One third of all subjects followed had no absolute decrease in renal function (positive slope of creatinine clearance vs. time) and there was a small group of patients who showed a statistically significant increase (P less than 0.05) in creatinine clearance with age.
1,433 citations
TL;DR: The practice and theoretical basis of pain measurement is reviewed and critically examined in the areas of animal research, human subjects laboratory investigation and clinical study, and subjective report procedures are evaluated in human laboratory and clinical areas.
Abstract: The practice and theoretical basis of pain measurement is reviewed and critically examined in the areas of animal research, human subjects laboratory investigation and clinical study. The advantages and limitations of both physiological and behavioral methods are discussed in each area, and subjective report procedures are evaluated in human laboratory and clinical areas. The need for procedures that bridge these areas is emphasized and specific issues are identified. Progress in the technology of pain measurement over recent decades is reviewed and directions for future work are suggested.
1,057 citations
TL;DR: The immune system is regulated by the gonadal steroids estrogen, androgen, and progesterone, but the circulating levels of these steroids can also be affected by immune system function.
Abstract: The immune system is regulated by the gonadal steroids estrogen, androgen, and progesterone, but the circulating levels of these steroids can also be affected by immune system function. Such interactions appear to be mediated through the hypothalamic-pituitary-gonadal-thymic axis and depend on pituitary luteinizing hormone released by thymic factors under the control of the gonadal steroids.
1,044 citations
TL;DR: Clones of complementary DNA from genes whose expression is increased during the differentiation of adipocytes were used to study the molecular basis of cachectin's actions and found that when mature adipocyte were exposed to cachectIn, the messenger RNA's of those genes diminished and rapidly approached the levels present before differentiation.
Abstract: Certain infections and malignancies in mammals cause the development of a condition known as cachexia in which the animal continues to lose weight, often while consuming an adequate diet. When macrophages are stimulated with an endotoxin, they produce a factor or factors, termed cachectin, that inhibits the activity of fat-producing (lipogenic) enzymes in cultured adipocytes. This effect may reflect one of the physiological bases for cachexia. In the present study, clones of complementary DNA from genes whose expression is increased during the differentiation of adipocytes were used to study the molecular basis of cachectin's actions. In the presence of cachectin, the expression of the corresponding genes was reversibly and specifically inhibited. Furthermore, when mature adipocytes were exposed to cachectin, the messenger RNA's of those genes diminished and rapidly approached the levels present before differentiation.
519 citations
TL;DR: Clinical features that served to distinguish these seizures from complex partial seizures originating elsewhere included brief, frequent attacks, complex motor automatisms with kicking and thrashing, sexualAutomatisms, vocalization, and frequent development of complex partial status epilepticus.
Abstract: Complex partial seizures of medial or orbital frontal origin were documented in 10 of 90 patients with intractable epilepsy who were studied with depth electrodes. The clinical features that, in part, served to distinguish these seizures from complex partial seizures originating elsewhere included brief, frequent attacks, complex motor automatisms with kicking and thrashing, sexual automatisms, vocalization, and frequent development of complex partial status epilepticus. The constellation of clinical characteristics was often bizarre, leading to the erroneous diagnosis of hysteria. Stereotyped attack patterns helped establish the diagnosis of epilepsy. Interictal and ictal scalp electroencephalograms were often not helpful and were sometimes misleading.
441 citations
TL;DR: Properties of the persistent sodium conductance and the calcium conductance of layer V neurons from cat sensorimotor cortex were examined in an in vitro slice preparation by use of a single microelectrode, somatic voltage clamp, current clamp, intra- and extracellular application of blocking agents, andextracellular ion substitution.
Abstract: Properties of the persistent sodium conductance and the calcium conductance of layer V neurons from cat sensorimotor cortex were examined in an in vitro slice preparation by use of a single microelectrode, somatic voltage clamp, current clamp, intra- and extracellular application of blocking agents, and extracellular ion substitution. The persistent sodium current (INaP) attained its steady level within 2-4 ms of a step change in voltage at every potential where it could be examined directly [to about 40 mV positive to resting potential (RP)]. Because of its fast onset INaP can be activated during a single excitatory postsynaptic potential (EPSP) and can influence the subsequent voltage time course and cell excitability. Application of a depolarizing holding potential greater than or equal to 20 mV positive to RP could inactivate spikes, thus allowing examination of INaP at voltages positive to spike threshold. At every potential where INaP was visible, it was mixed with a slow outward current. After depressing potassium currents with blocking agents, INaP could be observed during depolarizations to about 40 mV positive to RP where it is normally hidden by the larger outward currents. Indirect evidence suggests that INaP is present and large during prolonged depolarizations greater than 50 mV positive to RP. INaP was blocked by intracellular injection of the lidocaine derivative QX-314, as well as by extracellular tetrodotoxin (TTX). INaP was much more sensitive to QX-314 than was the height and rate of rise of the spike. This observation and the results in paragraph 3 above are best explained by separate INaP and spike sodium channels. After blockade of INaP and sodium spikes, Ca2+ spikes could be evoked only if potassium currents were first depressed. The Ca2+-dependent nature of the regenerative potentials was indicated by their disappearance when Co2+ or Mn2+ was substituted for Ca2+ in the perfusate and by the appearance of greatly enhanced potentials of similar form when Ba2+ was substituted for Ca2+. Ba2+ substitution greatly enhanced evoked and spontaneous synaptic potentials. Prolonged-plateau action potentials could be evoked in the presence of TTX and Ba2+. Ca2+ spike threshold was 30-40 mV positive to RP, which is significantly more positive than sodium spike threshold. Results of voltage clamp in the normal perfusate and in the presence of Ca2+-blockers or Ba2+ indicated that little or no Ca2+ conductance is activated in the voltage range 25 mV positive to RP where INaP is the dominant ionic current.(ABSTRACT TRUNCATED AT 400 WORDS)
418 citations
TL;DR: Plasma levels of atrial natriuretic factor in healthy volunteers on a low sodium diet and on a high sodium diet suggest that atrialnatriUREtic factor plays an important role in the adaptation to increased sodium intake.
Abstract: Atrial natriuretic factor (ANF), a recently sequenced cardiac peptide, has been shown to have potent natriuretic, diuretic, and vasodilating effects in several species. We have developed a radioimmunoassay to measure the levels of immunoreactive ANF in human plasma. Plasma levels of ANF in healthy volunteers on a low sodium diet were 9.8 +/- 1.4 pmol/liter and increased to 21.9 +/- 3.0 on a high sodium diet. The levels of atrial natriuretic factor correlated directly with urinary sodium and inversely with plasma renin activity and plasma aldosterone levels. Patients with marked edema due to congestive heart failure had plasma levels of atrial natriuretic factor five times higher than normal (P less than 0.05), whereas patients with cirrhosis and edema had levels that were not different from normal. These results suggest that atrial natriuretic factor plays an important role in the adaptation to increased sodium intake.
324 citations
TL;DR: Speech and language assessment in 30 patients with dementia of the Alzheimer type and in 70 normal controls revealed that all Alzheimer patients were aphasic.
Abstract: Speech and language assessment in 30 patients with dementia of the Alzheimer type and in 70 normal controls revealed that all Alzheimer patients were aphasic. Throughout most of the course, the language disorder resembled transcortical sensory aphasia, and increasing language impairment correlated with increasing severity of dementia. Aphasia was present regardless of age of onset or family history of dementia. Aphasia is an important diagnostic criterion of dementia of the Alzheimer type.
319 citations
TL;DR: In this article, a computer simulation study was designed to investigate the extent to which the interrater reliability of a clinical scale is affected by the number of scales or scales used.
Abstract: A computer simulation study was designed to in vestigate the extent to which the interrater reliability of a clinical scale is affected by the number of cate gories or scale points (2, 3, 4, ... ,100). Results in dicate that reliability increases steadily up to 7 scale points, beyond which no substantial increases occur, even when the number of scale poirits is increased to as many as 100. These findings hold under the follow ing conditions: (1) The research investigator has insuf ficient a priori knowledge to use as a reliable guide line for deciding on an appropriate number of scale points to employ, and (2) the dichotomous and ordinal categories being considered all have an underlying metric or continuous scale format.
276 citations
TL;DR: Although the two patient groups were impaired relative to NC subjects on both recall and recognition of word lists, the performance of the HD patients was superior to that of the amnesics on the recognition test.
TL;DR: Patients with Alzheimer's dementia were distinguished from patients with Wernicke's aphasia by producing more empty phrases and conjunctions, whereas patients with EMTs with anomic aphasias produced more neologisms, and verbal and literal paraphasias.
Abstract: Fourteen measures of empty speech during a picture description task were examined in four subject groups—patients with Alzheimer's dementia, Wernicke's aphasias, anomic aphasias, and normal control...
TL;DR: Normal baselines of knee muscle strength for women up to 86 years of age are provided and it is likely that this relative weakness would not be detected on routine clinical examination using manual muscle testing.
Abstract: This study provides normal baselines of knee muscle strength for women up to 86 years of age. Knee muscle strength (torque) was measured during maximum isometric and dynamic (isokinetic) contractions in 72 normal healthy women in three age groups between 20 and 86 years. Strength of the oldest group ranged from 56 to 78% of that in the youngest group, depending on knee joint position. Strength values were greater for isometric contractions than for isokinetic contractions (performed at 36 degrees per second) and were approximately twice as great for the extensor as for the flexor muscles. For both muscle groups, the torque generated with the knee in 30 degrees of flexion was usually lower than that generated with the knee at the 45- or 60-degree position. Despite the significant deficit found in the strength of the oldest group, it is likely that this relative weakness would not be detected on routine clinical examination using manual muscle testing.
TL;DR: Sudden death during sleep in obstructive sleep apnea presumably results from a lethal cardiac arrhythmia, but the relative contributions of severe bradyarrhythmia, sinus pauses of 2 to 13 seconds' duration, second-degree heart block, and ventricular tachyarrh rhythms are unknown.
TL;DR: Results indicate that cholesterol, plant sterols, and 5 alpha-stanols are deposited prematurely and are associated with accelerated atherosclerosis in subjects with sitosterolemia with xanthomatosis.
TL;DR: It is argued that atypical subordinate categories are highly differentiated and should be responded to as fast as basic categories in object recognition, and the results supported this view and ruled out the hypothesis that objects are necessarily identified as members of basic categories before further identification.
Abstract: When people are asked to decide whether an object is in a given category, they generally respond faster when the category is at the basic level (e.g., car) than when it is at the superordinate level (e.g., vehicle) or the subordinate level (e.g., sedan). Basic categories have shorter and more frequent names, are learned earlier, and are usually more highly differentiated than other categories (they are both specific and distinctive), but it is not clear which of these factors is responsible for the faster response to basic categories. In three experiments with natural language categories, we found evidence that objects can be identified fastest as members of differentiated categories, even when such categories have longer names and are learned later than less differentiated categories. Specifically, we argued that atypical subordinate categories (e.g., racing car) are highly differentiated and should therefore be responded to as fast as basic categories in object recognition. The results supported this view and also ruled out the hypothesis that objects are necessarily identified as members of basic categories before further identification. We discuss the implications of these findings for the use of category names as definite descriptions in discourse. Language: en
TL;DR: The effects of interleukin‐3 (IL‐3) on colony formation by hemopoietic progenitors in methylcellulose cultures of spleen cells from 5‐fluorouracil (FU)‐treated mice suggest that IL‐3 is necessary for their continued proliferation.
Abstract: We studied the effects of interleukin-3 (IL-3) on colony formation by hemopoietic progenitors in methylcellulose cultures of spleen cells from 5-fluorouracil (FU)-treated mice. Purified IL-3 supported the growth of various types of multilineage colonies including blast cell colonies. The types of colonies were similar to those supported by pokeweed-mitogen spleen cell conditioned medium (PWM-SCM), except that IL-3 supported eosinophil and neutrophil expression better. Delayed addition of IL-3 to cultures 7 days after cell plating decreased the number of colonies to one-half the number in cultures with IL-3 added on day 0. It did not alter the proliferative and differentiation characteristics of late emerging multipotential blast cell colonies. These observations suggest that IL-3 does not trigger hemopoietic progenitors into active cell proliferation but is necessary for their continued proliferation. This permissive role of IL-3 is consistent with a stochastic model of stem cell proliferation which features random entry into cell cycle. IL-3 also supported the growth of multilineage colonies from single cells isolated from blast cell colonies by micromanipulation. This result shows that IL-3 acts directly on multipotential progenitors. Analysis of colonies derived from paired progenitors revealed disparate lineage expression and was in accordance with the stochastic model of stem cell differentiation.
TL;DR: The AD group showed a striking lateral asymmetry of cortical metabolism not favoring either hemisphere, which has not been previously reported, and these results have important implications for the diagnosis and perhaps the etiology of Alzheimer's disease.
TL;DR: A large body of evidence indicates a major role for the dynorphin/alpha-neo-endorphin kappa opioid receptor as one of the receptors involved in feeding modulation, and the finding that more than one opioid receptor is involved in the modulation of feeding is emphasized.
TL;DR: Elevated plasma vWF antigen levels before therapy may identify a subgroup of patients at special risk for arterial occlusive complications following cisplatin-based chemotherapy.
Abstract: Factor-VIII-related von Willebrand factor (vWF) multimers are synthesized by endothelial cells, and plasma vWF antigen levels are elevated in some disorders associated with endothelial cell perturbation We studied 13 patients during cisplatin-based combination chemotherapy for squamous cell carcinoma of the head and neck, esophagus, or lung Before therapy, 3 of the patients had vWF antigen levels that were greater than or equal to 400% of normal; and further elevations occurred during chemotherapy Two of these patients had cerebrovascular accidents, and the third had complications similar to the hemolytic-uremic and acute respiratory distress syndromes No abnormalities in plasma vWF patterns were detected Elevated plasma vWF antigen levels before therapy may identify a subgroup of patients at special risk for arterial occlusive complications following cisplatin-based chemotherapy
TL;DR: Serum alkaline phosphatase and bone Gla protein increased during progestagen administration, whereas urinary excretion of calcium and hydroxyproline fell significantly during treatment, independently of progestogen intake, leading to a positive calcium balance.
TL;DR: Evidence is presented that 5-methyltetrahydropteroylpentaglutamate (5-CH3-H4PteGlu5) is bound with high specificity, and is a powerful inhibitor of the enzyme Glycine N-methyltransferase.
TL;DR: Seven cholinergic drugs with diverse modes of action were found to enhance 72-h retention of passive avoidance; however, the effective doses were different for each of the drugs studied.
Abstract: Central cholinergic systems have long been implicated in the modulation of learning and memory processes in animals and man. Drugs that affect the central cholinergic system have been found either to enhance or to hinder performance in tests of learning and memory. Few studies have evaluated the effects of different cholinergic drugs within a single experimental paradigm and with a relatively wide dose range. The studies reported here investigated the effects of cholinergic drugs with diverse modes of action on the retention of a passive avoidance response. Physostigmine, arecoline, oxotremorine, nicotine, and 4-aminopyridine were administered IP immediately following the acquisition of a one-trial passive avoidance task. All of the drugs were found to enhance 72-h retention of passive avoidance; however, the effective doses were different for each of the drugs studied.
TL;DR: The 12-hr profiles of plasma glucose and insulin concentrations in 26 normal subjects ingesting a diet high in carbohydrate, protein, or fat have been determined and further indicate the need to consider the response of males and females separately.
Abstract: The 12-hr profiles of plasma glucose and insulin concentrations in 26 normal subjects ingesting a diet high in carbohydrate, protein, or fat have been determined. The diets were isocaloric and were given as three identical meals 4 hrs apart. In males the high carbohydrate diet resulted in glucose profiles similar to those obtained with the standard diet. In females the peak glucose concentration also was not increased but the glucose concentration remained elevated longer after each meal. In both groups the insulin curves followed the glucose curves. The post-meal glucose and insulin areas were significantly increased in the female group. The high protein diet resulted in only a small post-meal glucose rise particularly later in the day in both males and females. However, there was a sharp rise in insulin concentration after each meal. The total insulin area after each meal was nearly as great as with the standard diet. The high fat diet, which contained approximately the same carbohydrate content as the high protein diet, induced a clear increase in glucose concentration after each meal in the female group. However, the peak was progressively delayed with each meal. The insulin curves followed the glucose curves. In males a small, prolonged post-meal increase in glucose was observed after each meal. The insulin concentration increased modestly after the first meal and then remained elevated and changed little after the subsequent meals. These data help to define the glucose and insulin responses to meals varying greatly in protein, carbohydrate, and fat content and further indicate the need to consider the response of males and females separately.
TL;DR: Adjectival correlates indicated that females with higher testosterone concentrations perceive themselves as self-directed, action-oriented, resourceful individuals; women with lower testosterone concentration view themselves as conventional, socialized individuals, possessing a caring attitude coupled with an anxious and dejected mood.
Abstract: Eighty-four undergraduate female students completed Baucom's Masculinity and Femininity Scales, the Bem Sex Role Inventory, and the Adjective Check List. Testosterone concentration was determined from saliva samples provided by the women. The results indicated that sex role type was related to level of testosterone concentration. More specifically, undifferentiated females had much higher levels of testosterone concentration than did the feminine-sex-typed females. Also, females with high levels of masculinity (androgynous and masculine-sex-typed females combined) had somewhat higher testosterone levels than did feminine-sex-typed females. Adjectival correlates indicated that females with higher testosterone concentrations perceive themselves as self-directed, action-oriented, resourceful individuals; women with lower testosterone concentration view themselves as conventional, socialized individuals, possessing a caring attitude coupled with an anxious and dejected mood.
TL;DR: This article showed that PYY is one of the most potent orexigenic substances yet to be identified and may play a role in the pathogenesis of bulimic syndromes.
TL;DR: In this article, the rank of the Jacobian matrix of a model is defined as a measure of the probability that a model's predictions have zero probability of being correct by chance.
TL;DR: Good general agreement among readers is shown in scoring radiologic abnormalities of hands and wrists, when applied to a film set showing a broad spectrum of severity, and defines the sensitivity of radiologic detection of disease progression.
Abstract: Forty-one coded radiographic films from 16 patients with rheumatoid arthritis were read by 13 observers, using 4 different methods for scoring abnormalities. Although absolute scores differed widely among individual observers, correlation coefficients were greater than 0.850 for approximately 2 of 3 comparisons. When films were ranked, using the median rank of all readers, 72% of individual ranks were within 10% of the median ranks. Among serial films on individual patients, 92% of comparisons between early and late films were interpreted as demonstrating progression of abnormalities when mean standardized scores showed an increase in scores of 15 units or greater. Films with lesser changes were interpreted inconsistently. This study shows good general agreement among readers in scoring radiologic abnormalities of hands and wrists, when applied to a film set showing a broad spectrum of severity, and defines the sensitivity of radiologic detection of disease progression.
TL;DR: In this article, a series of investigator-generated open-ended questions were used to analyze the children's attitudes toward their pets, and it was hypothesized that the cognitive elements would progress from preoperational to concrete operations at seven and to formal operations at 13.
Abstract: 150 boys and 150 girls between the ages of 3 and 13 yr. were individually interviewed using a series of investigator-generated open-ended questions to analyze the children's attitudes toward their pets. It was hypothesized that the cognitive elements would progress from preoperational to concrete operations at seven and to formal operations at 13, that the affective elements would progress from egocentricity to empathy and perspective-taking, and that behavioral elements would progress from dependence on situational cues to caring behavior based on realistically assessed characteristics of pets. Although the data supported the second and third hypotheses, the cognitive elements progressed only from preoperational to concrete operations. There was no evidence that the 13-yr.-olds had entered the formal operations stage. Other data indicated that 90% owned pets but 99.3% wanted pets, a significant indication of children's over-all positive attitude toward pets. Further research was suggested.
TL;DR: It is suggested that patients with acute alcoholic hepatitis require additional nutritional therapy to maintain and improve their nutrition parameters, especially those related to marasmus; and that Hepatic Aid is well tolerated for this purpose.
Abstract: Patients with moderate to severe alcoholic hepatitis and features of protein-calorie malnutrition were studied with respect to changes in their nutritional status during 30 days of hospitalization. Thirty-four patients served as controls, were given a 2500 kcal hospital diet and allowed to eat ad libitum. Twenty-three patients were given, in addition to the hospital diet, a nutrition supplement high in calories, protein, and branched-chain amino acids (Hepatic Aid). Because of anorexia, the controls consumed lesser amounts of both calories and protein while those given the nutritional therapy exceeded their estimated energy requirements (116.1 %) and consumed a mean of 98.3 g of protein per day. This was well tolerated despite the fact that portal systemic encephalopathy was present in 72% of the patients. Mortality associated with the liver disease was comparable in both groups, 16.7% in the treated us 20.6% in the controls. In those patients that survived the 30 days of hospitalization, clinical and bio...