Medicine and Health Sciences Commons^™

Ubinuclein, A Novel Nuclear Protein Interacting With Cellular And Viral Transcription Factors., S Aho, M Buisson, T Pajunen, Y W Ryoo, J F Giot, H Gruffat, A Sergeant, Jouni Uitto

Department of Dermatology and Cutaneous Biology Faculty Papers

The major target tissues for Epstein-Barr virus (EBV) infection are B lymphocytes and epithelial cells of the oropharyngeal zone. The product of the EBV BZLF1 early gene, EB1, a member of the basic leucine-zipper family of transcription factors, interacts with both viral and cellular promoters and transcription factors, modulating the reactivation of latent EBV infection. Here, we characterize a novel cellular protein interacting with the basic domains of EB1 and c-Jun, and competing of their binding to the AP1 consensus site. The transcript is present in a wide variety of human adult, fetal, and tumor tissues, and the protein is …

The Pl(A2) Polymorphism Of Integrin Beta(3) Enhances Outside-In Signaling And Adhesive Functions., K Vinod Vijayan, Pascal J. Goldschmidt-Clermont, Christine Roos, Paul F. Bray

Cardeza Foundation for Hematologic Research

Genetic factors are believed to influence the development of arterial thromboses. Because integrin alpha(IIb)beta(3) plays a crucial role in thrombus formation, we analyzed receptor adhesive properties using Chinese hamster ovary and human kidney embryonal 293 cells overexpressing the Pl(A1) or Pl(A2) polymorphic forms of alpha(IIb)beta(3). Soluble fibrinogen binding was no different between Pl(A1) and Pl(A2) cells, either in a resting state or when alpha(IIb)beta(3) was activated with anti-LIBS6. Pl(A1) and Pl(A2) cells bound equivalently to immobilized fibronectin. In contrast, significantly more Pl(A2) cells bound to immobilized fibrinogen in an alpha(IIb)beta(3)-dependent manner than did Pl(A1) cells. Disruption of the actin cytoskeleton …

Global Cns Gene Transfer For A Childhood Neurogenetic Enzyme Deficiency: Canavan Disease., Paola Leone, Christopher G Janson, Scott J Mcphee, Matthew J During

Department of Neurosurgery Faculty Papers

The neurogenetic prototypic disease on which we chose to test our gene therapy strategy is Canavan disease (CD). CD is an autosomal recessive leukodystrophy associated with spongiform degeneration of the brain. At present the disease is uniformly fatal in affected probands. CD is characterized by mutations in the aspartoacylase (ASPA) gene, resulting in loss of enzyme activity. In this review, recent evidence is summarized on the etiology and possible treatments for CD. In particular, we discuss two gene delivery systems representing recent advances in both viral and liposome technology: a novel cationic liposome-polymer-DNA (LPD) complex, DCChol/DOPE-protamine, as well as recombinant …

Radiculopathy And Myelopathy At Segments Adjacent To The Site Of A Previous Anterior Cervical Arthrodesis., Alan S. Hilibrand, Gregory D. Carlson, M A Palumbo, P K Jones, H H Bohlman

Rothman Institute Faculty Papers

BACKGROUND: We studied the incidence, prevalence, and radiographic progression of symptomatic adjacent-segment disease, which we defined as the development of new radiculopathy or myelopathy referable to a motion segment adjacent to the site of a previous anterior arthrodesis of the cervical spine.

METHODS: A consecutive series of 374 patients who had a total of 409 anterior cervical arthrodeses for the treatment of cervical spondylosis with radiculopathy or myelopathy, or both, were followed for a maximum of twenty-one years after the operation. The annual incidence of symptomatic adjacent-segment disease was defined as the percentage of patients who had been disease-free at …

Clinical Problem-Solving. Through Thick And Thin., David R. Yu, Redonda Miller, Paul F. Bray

Cardeza Foundation for Hematologic Research

No abstract provided.

Identification Of Fetal Dna And Cells In Skin Lesions From Women With Systemic Sclerosis, Carol M. Artlett, J. Bruce Smith, Sergio A. Jimenez

Selected Works of Sergio Jiménez, MD, MACR

BACKGROUND: Systemic sclerosis is a disease of unknown origin which often occurs in women after their childbearing years. It has many clinical and histopathological similarities to chronic graft-versus-host disease. Recent studies indicate that fetal stem cells can survive in the maternal circulation for many years post partum. This finding suggests that fetal cells persisting in the maternal circulation or tissues could be involved in the pathogenesis of systemic sclerosis by initiating a graft-versus-host reaction.

METHODS: We used the polymerase chain reaction (PCR) to identify Y-chromosome sequences in DNA extracted from peripheral-blood cells and skin lesions from women with systemic sclerosis …

How Occupational Therapists Teach Older Patients To Use Bathing And Dressing Devices In Rehabilitation., Ruth Levine Schemm, Laura N. Gitlin

Department of Occupational Therapy Faculty Papers

OBJECTIVE: This article describes the methods occupational therapists use to teach bathing and dressing device use to older patients in rehabilitation programs. The relationship of three patient characteristics to five aspects of assistive device instruction was examined.

METHOD: The study sample included 86 patients and 19 occupational therapists who provided the assistive device training. Patients were 55 years of age or older and in rehabilitation for an orthopedic deficit, cerebrovascular accident, or lower limb amputation. Therapists recorded information on teaching methods, perceptions of patient knowledge, and expectations for future device use after each treatment session.

RESULTS: Patients received an average …

Student Level Ii Fieldwork Failure: Strategies For Intervention., Sharon A. Gutman, Paula Mccreedy, Prudence Heisler

Department of Occupational Therapy Faculty Papers

OBJECTIVE: This report describes how common student communicative and behavioral characteristics that appear to predict the existence of potential problems during Level II fieldwork were identified in order to develop and implement preventative interventions during the academic curriculum at New York University (NYU). RECORD REVIEW: A record review of NYU professional-level occupational therapy students from 1986 to 1995 was completed to identify common factors among students who performed well academically but failed clinical fieldwork. Eight communicative and behavioral characteristics were identified: (a) rigidity of thinking, (b) discomfort with the ambiguity that accompanies clinical reasoning, (c) lack of psychological insight, (d) …

Initial Multicenter Experience With Double Nucleoside Therapy For Human Immunodeficiency Virus Infection During Pregnancy., N S Silverman, D H Watts, J Hitti, D M Money, E Livingston, J Axelrod, J M Ernest, D Robbins, M M Divito

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To study maternal and neonatal effects of combination nucleoside analog therapy administered to human immunodeficiency virus (HIV)-infected pregnant women for maternal indications.

METHODS: A multicenter, prospective observational study was undertaken at six perinatal centers in the United States and Canada that supported regional referral programs for the treatment of HIV-infected pregnant women. Demographic, laboratory, and pregnancy outcome data were collected for 39 women whose antiretroviral treatment regimens were expanded to include more than one nucleoside analog for maternal indications. The 40 newborns were monitored at pediatric referral centers through at least three months of age to ascertain their HIV …

Determinants Of Antepartum Human Immunodeficiency Virus Testing In A Non-Medicaid Obstetric Population., E Cardonick, S Daly, M Dooley, K Elles, N S Silverman

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To determine voluntary human immunodeficiency virus (HIV) testing rates and factors influencing testing in a private obstetric practice.

METHODS: Antepartum patients were offered HIV testing after completing a self-assessment questionnaire. Perceived risks and demographics were correlated with testing rates.

RESULTS: Overall, 348/600 (58%) women consented to HIV testing. In a univariate analysis, patients with "any" perceived risk(s) were more likely to be tested. Single women and those with an at-risk partner(s) or a history of sexually transmitted disease (STD) were more likely to desire testing. These factors remained independently associated with voluntary testing in a multivariate regression model. No …

Stent Placement Compared With Balloon Angioplasty For Obstructed Coronary Bypass Grafts. Saphenous Vein De Novo Trial Investigators., M P Savage, J S Douglas, D L Fischman, C J Pepine, S B King, J A Werner, S R Bailey, P A Overlie, S H Fenton, J A Brinker, M B Leon, S Goldberg

Department of Medicine Faculty Papers

BACKGROUND: Treatment of stenosis in saphenous-vein grafts after coronary-artery bypass surgery is a difficult challenge. The purpose of this study was to compare the effects of stent placement with those of balloon angioplasty on clinical and angiographic outcomes in patients with obstructive disease of saphenous-vein grafts.

METHODS: A total of 220 patients with new lesions in aortocoronary-venous bypass grafts were randomly assigned to placement of Palmaz-Schatz stents or standard balloon angioplasty. Coronary angiography was performed during the index procedure and six months later.

RESULTS: As compared with the patients assigned to angioplasty, those assigned to stenting had a higher rate …

Glanzmann Thrombasthenia. Cooperation Between Sequence Variants In Cis During Splice Site Selection., Ying Jin, Harry C. Dietz, Robert A. Montgomery, William R. Bell, Iain Mcintosh, Barry Coller, Paul F. Bray

Cardeza Foundation for Hematologic Research

Glanzmann thrombasthenia (GT), an autosomal recessive bleeding disorder, results from abnormalities in the platelet fibrinogen receptor, GP(IIb)-IIIa (integrin alpha(IIb)beta3). A patient with GT was identified as homozygous for a G-->A mutation 6 bp upstream of the GP(IIIa) exon 9 splice donor site. Patient platelet GP(IIIa) transcripts lacked exon 9 despite normal DNA sequence in all of the cis-acting sequences known to regulate splice site selection. In vitro analysis of transcripts generated from mini-gene constructs demonstrated that exon skipping occurred only when the G-->A mutation was cis to a polymorphism 116 bp upstream, providing precedence that two sequence variations …

A Polymorphism Of A Platelet Glycoprotein Receptor As An Inherited Risk Factor For Coronary Thrombosis., Ethan J. Weiss, Paul F. Bray, Matthew Tayback, Steven P. Schulman, Thomas S. Kickler, Lewis C. Becker, James L. Weiss, Gary Gerstenblith, Pascal J. Goldschmidt-Clermont

Cardeza Foundation for Hematologic Research

BACKGROUND: Platelet glycoprotein IIb/IIIa is a membrane receptor for fibrinogen and von Willebrand factor, and it has an important role in platelet aggregation. It is known to be involved in the pathogenesis of acute coronary syndromes. Previously, we found a high frequency of a particular polymorphism, PlA2, of the gene encoding glycoprotein IIIa in kindreds with a high prevalence of premature myocardial infarction.

METHODS: To investigate the relation between the PlA2 polymorphism and acute coronary syndromes, we conducted a case-control study of 71 case patients with myocardial infarction or unstable angina and 68 inpatient controls without known heart disease. The …

Impact Of Spinal Cord Injury On The Life Roles Of Women., M Claire Quigley

Department of Occupational Therapy Faculty Papers

This qualitative study was conducted to explore and describe the role experience of five women whose lives were disrupted by a traumatic spinal cord injury and who later returned to their communities after completing intensive rehabilitation programs. In-depth interviews and participant observations were used to examine the experiences of these women. The findings exemplify how the women's use of adaptation and negotiation and the development of a new role as self-advocate facilitated the reestablishment of their life roles. As the women's occupational roles were redefined, the processes of adaptation and negotiation were evident in three aspects of their lives: daily …

Mentorship Experiences In A Group Of Occupational Therapy Leaders., Ruth Levine Schemm, Theodore Bross

Department of Occupational Therapy Faculty Papers

OBJECTIVES: The development of occupational therapy leaders is a long-held goal of many members of the American Occupational Therapy Association and of state associations. The initiation of mentor programs is a common means to accomplish this goal. These programs take time and effort, and, although occupational therapists have described how mentorship programs work in the literature, there are few articles that describe the actual mentorship experiences of occupational therapy leaders.

METHOD: To study the experiences of elected occupational therapy leaders, a 30-item questionnaire was distributed at the annual meeting of the Committee of State Association Presidents and completed by 53 …

A Randomized Comparison Of Coronary-Stent Placement And Balloon Angioplasty In The Treatment Of Coronary Artery Disease. Stent Restenosis Study Investigators., David L. Fischman, Martin B. Leon, Donald S. Baim, Richard A. Schatz, Michael P. Savage, Ian Penn, Katherine Detre, Lisa Veltri, Donald Ricci, Masakiyo Nobuyoshi, Michael Cleman, Richard Heuser, David Almond, Paul S. Teirstein, R. David Fish, Antonio Colombo, Jeffrey Brinker, Jeffrey Moses, Alex Shaknovich, John Hirshfeld, Stephen Bailey, Stephen Ellis, Randal Rake, Sheldon Goldberg

Department of Medicine Faculty Papers

BACKGROUND: Coronary-stent placement is a new technique in which a balloon-expandable, stainless-steel, slotted tube is implanted at the site of a coronary stenosis. The purpose of this study was to compare the effects of stent placement and standard balloon angioplasty on angiographically detected restenosis and clinical outcomes.

METHODS: We randomly assigned 410 patients with symptomatic coronary disease to elective placement of a Palmaz-Schatz stent or to standard balloon angioplasty. Coronary angiography was performed at base line, immediately after the procedure, and six months later.

RESULTS: The patients who underwent stenting had a higher rate of procedural success than those who …

Elevated Expression Of Type Vii Collagen In The Skin Of Patients With Systemic Sclerosis. Regulation By Transforming Growth Factor-Beta., Lidia Rudnicka, John Varga, Angela M. Christiano, Renato V. Iozzo, Sergio A. Jimenez, Jouni Uitto

Department of Dermatology and Cutaneous Biology Faculty Papers

A hallmark of systemic sclerosis (SSc) is the development of tissue fibrosis. Excessive production of several connective tissue components normally present in the dermis, including type I, III, V, and VI collagens as well as fibronectin and proteoglycans, is a consistent finding in the skin of SSc patients. Type VII collagen is a major constituent of anchoring fibrils, present in the skin at the dermal-epidermal basement membrane zone. TGF-beta has been shown to upregulate the expression of the type VII collagen gene. In this study, we assessed the expression of type VII collagen and TGF-beta in the skin of patients …

Management Decisions Made By Caregiver Spouses Of Persons With Alzheimer's Disease., Mary A. Corcoran

Department of Occupational Therapy Faculty Papers

OBJECTIVES: As the incidence of Alzheimer's disease increases, so does the effect on families and friends who assume caregiving responsibilities. Despite the proliferation of caregiving studies reported in the literature, little is known of the day-to-day management styles and preferences of caregivers. To develop, implement, and test interventions designed to sustain caregivers in their role, more information is needed about the caregiving experience. Results of a descriptive study are presented as a first step in understanding the complex process of choosing, organizing, and implementing everyday caregiving tasks.

METHOD: Subjects of the study were 26 persons who provide care for a …

Ochrobactrum Anthropi Bacteremia In A Child., Joel D. Klein, Stephen C. Eppes

Department of Pediatrics Faculty Papers

Children undergoing chemotherapy for cancer are at increased risk of supervening infection, including bacteremia. This may be due to immunosuppression as well as the presence of intravascular devices such as central venous catheters. Bacteria responsible for these infections include those found in the child's endogenous flora as well as in environmental sources. We report the case of a child with acute lymphoblastic leukemia (ALL) who developed bacteremia secondary to Ochrobactrum anthropi. Details of this extremely rare infection are the focus of this report.

Sequencing Of Cdna From 50 Unrelated Patients Reveals That Mutations In The Triple-Helical Domain Of Type Iii Procollagen Are An Infrequent Cause Of Aortic Aneurysms., Gerard Tromp, Yuli Wu, Darwin J. Prockop, Swarna L. Madhatheri, Caren Kleinert, James J. Earley, Jiapiao Zhuang, Orjan Norrgård, R. Clement Darling, William M. Abbott, C. William Cole, Pekka Jaakkola, Markku Ryynanen, William H. Pearce, James S.T. Yao, Kari Majamaa, Stanton N. Smullens, Zoran Gatalica, Robert E. Ferrell, Sergio A. Jimenez, Charles E. Jackson, Virginia V. Michels, Michael Kaye, Helena Kuivaniemi

Department of Biochemistry and Molecular Biology Faculty Papers

Detailed DNA sequencing of the triple-helical domain of type III procollagen was carried out on cDNA prepared from 54 patients with aortic aneurysms. The 43 male and 11 female patients originated from 50 different families and five different nationalities. 43 patients had at least one additional blood relative who had aneurysms. Five overlapping asymmetric PCR products, covering all the coding sequences of the triple-helical domain of type III procollagen, were sequenced with 28 specific sequencing primers. Analysis of the sequencing gels revealed only two nucleotide changes that altered the structure of the protein. One was a substitution of threonine for …

Regulation Of Human Lung Fibroblast Alpha 1(I) Procollagen Gene Expression By Tumor Necrosis Factor Alpha, Interleukin-1 Beta, And Prostaglandin E2., Arturo Diaz, Elena Munoz, Rosemary Johnston, Joseph H. Korn, Sergio A. Jimenez

Department of Medicine Faculty Papers

We investigated the participation of prostaglandin (PG) E2 in the regulation of the alpha 1(I) procollagen gene expression by tumor necrosis factor alpha (TNF alpha), and interleukin-1 beta (IL-1 beta) in normal adult human lung fibroblasts. TNF alpha (100 units/ml) and IL-1 beta (100 units/ml) stimulated the production of PGE2 and caused a dose-dependent inhibition of up to 54 and 66%, respectively, of the production of type I procollagen. Preincubation of cultures with indomethacin partially reversed the inhibition of procollagen production induced by the cytokines. Cytokine-stimulated endogenous fibroblast PG accounted for 35 and 68% of the inhibition induced by TNF …

A Model To Promote Activity Competence In Elders., Ruth E. Levine, Laura N. Gitlin

Department of Occupational Therapy Faculty Papers

This paper describes an occupational therapy home-based intervention in which purposeful activities were used to promote adaptation and competence in older adults with chronic disabilities. Seven home care therapists visited 17 randomly selected, community-living elders who were chronically disabled and who volunteered to participate in the program. The number of visits ranged from 3 to 10 and occurred over a 3-month period according to clients' needs and wishes. Therapists enhanced their ability to enter the client's social and cultural system by using participant-observation techniques and collaboratively identified activities. Therapists documented each home visit with a structured fieldnote form. An analysis …

Gender Differences In Dementia Management Plans Of Spousal Caregivers: Implications For Occupational Therapy., Mary A. Corcoran

Department of Occupational Therapy Faculty Papers

Occupational therapists treating older people with Alzheimer disease know that they must also consider the others who are affected by the disease, the informal caregivers. Intervention is most effective when it enables both the impaired person and the primary caregiver to manage the secondary symptoms of dementia. Unfortunately, little is understood about how caregivers approach and carry out their tasks and about why male and female caregivers respond differently to their caregiving role in terms of depression, burden, stress, and substance abuse. This paper discusses the effects of gender on dementia management plans of spousal caregivers. Husbands and wives have …

Childhood Typhoid Fever Diagnosed In An Urban U.S. Setting., Surinder K. Sodhi, Stephen C. Eppes, Joel D. Klein

Department of Pediatrics Faculty Papers

The majority of cases of childhood typhoid fever diagnosed in the United States occur in persons recently returned from travel abroad. We report two childhood cases of typhoid fever acquired in Mexico and India and diagnosed in an urban United States setting. This report describes these cases and provides insights into the pitfalls in recognizing this condition in a nonendemic setting as well as information concerning differential diagnosis and treatment.

Dementia Management: An Occupational Therapy Home-Based Intervention For Caregivers., Mary A. Corcoran, Laura N. Gitlin

Department of Occupational Therapy Faculty Papers

This paper describes an occupational therapy intervention designed for family caregivers of persons with dementia. The intervention, based on the framework of a competence-environmental press model and the principle of collaboration, was implemented during 5 home visits. Each visit was designed to build caregiving skills through collaboration in identifying problem areas, developing and implementing environmental strategies, and modifying management approaches. A case vignette illustrates the therapeutic process and outcomes. The theoretical rationale and structure of the intervention and innovative documentation for evaluation of the theoretic process are also presented.

An Emerging View Of Mastery, Excellence, And Leadership In Occupational Therapy Practice., Janice P Burke, Elizabeth Depoy

Department of Occupational Therapy Faculty Papers

The recent focus on clinical reasoning in occupational therapy, specifically on how therapists solve complex problems, has stimulated interest in how master clinicians think in practice. By gaining insight into how clinicians think and what they think about when they identify and solve problems, we may be able to identify clinical reasoning patterns and processes that occupational therapy students and novice therapists need to experience in order to progress in their practice or to emerge as leaders in their field. Observation of the way in which clinical masters and leaders view challenges and solve problems as manifested in their clinical …

Malignant External Otitis And Mastoiditis Associated With An Igg4 Subclass Deficiency In A Child., Ricardo Castro, Md, Norman Robinson, Md, Joel Klein, Md, William Geimeier, Md

Department of Pediatrics Faculty Papers

We have presented the first child in Delaware with malignant external otitis associated with IgG4 deficiency. Our patient needed three courses of intravenous antibiotics and twice required mastoidectomy, but has recovered completely following the restoration of the natural barrier between the internal and external ear, using a fascial graft from the large temporalis muscle. Some hearing deficit remains.

Home Adaptations For Persons With Chronic Disabilities: An Educational Model., Ruth E. Levine, Laura N. Giltin

Department of Occupational Therapy Faculty Papers

This paper offers a method by which to train students in the provision of culturally relevant, in-home environmental adaptations for persons with chronic disabilities. On the basis of a theoretical framework, the student therapist learns about the client's life-style and offers adaptations that evolve from a collaborative problem-solving process. The training process has been developed and refined over a 3-year period. A case study illustrates the student's application of theory and practice and the outcome for the client of this service provision approach.

Recurrent/Persistent Pneumonia In A 3 1/2-Year-Old-Girl Due To Acquired Immune Deficiency Syndrome., Ricardo Castro, Md, Joel Klein, Md, Rajeswary Padmalingam, Md, Stephen C. Eppes, Md

Department of Pediatrics Faculty Papers

The following is the report of the first case of a Delaware born child who developed AIDS, born from a mother who was not in a high risk camp.

Animal Bite Infections., Joel D. Klein, Md

Department of Pediatrics Faculty Papers

Animal bites have become alarmingly common and may represent a quiet epidemic. It is estimated that between 1 and 3.5 million animal bites occur annually in the United States. The highest incidence has consistently been in 5-to-14-year-old schoolchildren, who have greater contact with animals, especially house pets, on a daily basis. This article discusses the epidemiology, microbiology, clinical findings and management of animal bites infections.