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Biomedical subjects

A Barker

Publications and source records attributed to A Barker.

At least 37 records · Page 2Linked to original sources

Prenatal sonographic appearances of Klippel-Trenaunay-Weber syndrome.

A case of prenatal Klippel Trenaunay-Weber syndrome is presented, with a description of the sonographically observed disease progression in utero. The appearance of a complex thoracic multicystic mass in association with progressive unilateral lower limb enlargement was strongly suspicious of this disorder. Colour-flow Doppler studies of the cutaneous haemangiomata in utero were not of diagnostic assistance in this case. The prenatal detection of the large cutaneous haemangiomata was of critical importance in minimizing delivery trauma for the mother and fetus.

Adult↗

Dimeric lac repressors exhibit phase-dependent co-operativity.

Transcription of the lac operon in Escherichia coli is repressed by the binding of Lac repressor (LacR) to lac operator O1, a pseudo-palindromic sequence centred 11 bp downstream of the transcription start. Full repression of the wild-type promoter by wild-type, tetrameric LacR requires the presence of at least two operator sequences that must not only be in close proximity to O1, 401 bp and 92 bp for the auxiliary operators O2 and O3, respectively, but must also be present on the same side of the DNA helix. LacR mutants lacking the C-terminal heptad repeat and thus only capable of dimer formation still repress, but at a much reduced level. Their repression of the lac promoter is comparable to repression by tetrameric LacR when both auxiliary operators are destroyed. We have examined the residual repression, by dimeric LacR, of a series of constructs containing a CAP-independent promoter and two lac operators, O1 and Oid, separated by a series of spacers increasing in size by single base-pair increments. Surprisingly, repression of these constructs still exhibits phase dependence. The periodicity of maxima is similar to the helical repeat of DNA in vivo, as measured by phase-dependent repression with tetrameric LacR, although the magnitude of repression is much smaller than that obtained in previous experiments with tetrameric LacR. Two additional variants of dimeric LacR with altered C termini that were tested also show phase dependence. Control experiments show that the presence of O1 is required for repression in this system. In the absence of O1, occupancy of the auxiliary operator does not lead to repression. The magnitudes of repression maxima correlate best with the overall basic nature of the C terminus. Weak, unspecific contacts by this region with DNA seem sufficient to explain the observed periodicity. It remains to be seen whether additional factors are also involved in this residual repression.

Amino Acid Sequence↗

Towards a mutant analysis of the tertiary structures of functional DNA-binding motifs.

Transcription factors have specific regions, often alpha helices, with which they recognise DNA. These regions are more or less disordered off DNA. Some examples are listed here. However, a detailed mutant analysis of this phenomenon is missing. It could show to what extent DNA binding in vitro and in vivo is harmed when such a region is artificially made rigid by suitable substitutions and could reveal how much transcription factors have improved by having been selected to carry unstable recognition domains.

Binding Sites↗

Operator search by mutant Lac repressors.

The Escherichia coli Lac and Gal repressors are two members of a large family of bacterial repressor proteins that share significant sequence and structural homology. Efficient repression by all family members requires specific binding to a site or sites close to the transcriptional start of the genes regulated. Both LacR and GalR have to bind to at least two sites for efficient repression, yet they differ in one important respect: LacR is a homotetramer whereas GalR is a homodimer. In an attempt to understand this difference, we studied the operator binding activity of a LacR variant that has the DNA-binding specificity of GalR (LacR-V17A18). A tetrameric version of this protein shows a 30-fold decrease in association rate to operator located on a long (lambda) DNA molecule, in comparison to wild-type LacR, while a dimeric version of this protein shows an unaltered association rate in comparison to dimeric LacR. This reduction in association rate correlates with a broadened DNA-binding specificity for base-pairs 4 and 5 of the operator: examination of an additional LacR variant with an even broader DNA-binding specificity indicates that a tetrameric version also shows a 30-fold decrease in association rate in comparison to wild-type LacR, while a dimeric version again shows an unaltered association rate in comparison to dimeric LacR. This difference in association rate in vitro correlates with whether a tetrameric or dimeric variant of LacR of a given DNA-binding specificity will repress lacZ under control of a single operator more efficiently in vivo. We therefore propose that the formation of stable homotetramers becomes a distinct disadvantage unless a high degree of DNA-binding specificity is also present, and demonstrate that this in indeed the case for GalR-mediated repression of the gal operon. This functional constraint seems to have influenced the evolution of the LacI-GalR family of repressors, most of which have a relatively broad specificity of DNA-binding and most of which form only stable homodimers.

Bacterial Proteins↗

Scopolamine-induced cognitive impairment as a predictor of cognitive decline in healthy elderly volunteers: a 6-year follow-up.

OBJECTIVE: To determine if scopolamine-induced cognitive impairment in healthy elderly people predicts cognitive decline 6 years later. DESIGN: Prospective cohort study. SETTING: Elderly care research unit. PARTICIPANTS: Healthy elderly people who were part of a volunteer panel of research subjects. INTERVENTIONS: Scopolamine 0.2 mg administered subcutaneously at baseline. MAIN OUTCOME MEASURES: Cognitive drug research computerized cognitive testing battery pre- and post-scopolamine, with repeat testing over 6 years later. MAIN RESULTS: 16/24 subjects were retested. Although marked decrements in cognitive functioning were seen with scopolamine, there was little change in performance over 6 years, and no significant association was seen between scopolamine-induced decrement and change over time. CONCLUSIONS: The scopolamine challenge test is not likely to play a role in the preclinical diagnosis of Alzheimer's disease.

Aged↗

Living with schizophrenia: caring for a person with a severe mental illness.

Data from a survey of a total population of patients with schizophrenia or schizoaffective disorder were used to examine the relationship between patient behaviours and the experience of caregiving. Carers were more distressed by depressed behaviours in the patient than any other type of behaviour, including behaviour associated with florid psychotic episodes. The number of patient needs met by the caregiver was also associated with a negative appraisal of caregiving. A comparison of patients who were living with an informal carer and those who were living alone or in hostel accommodation showed that the former group were less likely than the latter to have been either and inpatient or a day patient during the previous year.

Adult↗

Effect of sialoadenectomy and epidermal growth factor administration on liver regeneration after partial hepatectomy.

Epidermal growth factor (EGF), a mitogen in vitro for hepatocytes, produces in various cell lines changes similar to those observed very rapidly in hepatocytes after partial hepatectomy (PH). These changes include ion movements, membrane hyperpolarization and proto-oncogene expression. A stimulatory effect of EGF on liver regeneration can therefore tentatively be associated with the events occurring within the first 3 hours after a PH, sometimes referred to as the "priming phase." To assess this hypothesis, we examined in Wistar rats the effect of EGF deprivation produced by sialoadenectomy (SX) performed before or after a PH of 70%. SX at the time of PH significantly decreased the 3H-thymidine uptake in the DNA 24 hours later (147 +/- 14 DPM per microgram of DNA, mean +/- SE) compared with a simple PH (322 +/- 16; P < .01), but also compared with results obtained when PH is combined with a sham sialoadenectomy (SSX) or in rats pair-fed with the sialoadenectomized rats. This incomplete inhibition was confirmed by a decreased rise in thymidine kinase (TK) activity and by reduced proliferating cell nuclear antigen (PCNA) labeling and mitotic indices 30 hours after PH. By contrast, SX did not inhibit the early expression of c-jun and c-fos, or of c-myc, 30 or 120 minutes after PH, respectively. A reduction of DNA synthesis was also obtained when SX was performed 3 hours after PH (127 +/- 15 DPM per microgram of DNA vs. 350 +/- 21 in SSX; P < .001) but not when SX was delayed until the 6th or the 17th hour after PH. It was sufficient to administer EGF (40 microg) from the third to the ninth hour to correct the reduction of [3H]thymidine uptake in rats sialoadenectomized before PH. These results indicate that the diminished EGF availability following SX decreases or at least delays liver regeneration, and that the effect of EGF on liver regeneration does not seem related to the early changes of proto-oncogene expression, but rather to events occuring later, at the time of reported internalization and binding of EGF to its nuclear receptors.

Animals↗

Sweet's syndrome and associated sarcoidosis--a rare clinical case.

Sweet's syndrome is frequently idiopathic; however, it has been associated with malignancy in up to 20% of reported cases. We report a case of concurrent presentation of Sweet's syndrome with sarcoidosis. Although this association has been infrequently described we feel that this could be an alternative diagnosis in patients with Sweet's syndrome who present with mediastinal lymphadenopathy with or without erythema nodosum. The relevant literature on this subject is reviewed.

Humans↗

Leg ulcer management in a nurse-led, hospital-based clinic.

This paper describes the clinical outcomes from a nurse-led leg ulcer clinic over a period of three and a half years. Leg ulcers were assessed in a structured way and venous ulcers were treated with four-layer compression bandaging. The study involved retrospective analysis of 159 patients with 180 venous leg ulcers. Overall healing rates were 64.5% at 12 weeks, 84.1% at 24 weeks and 91.4% at 36 weeks. Healing rates were not affected by a history of previous ulceration or by bilateral limb ulceration. However, healing rates varied with previous ulcer duration, ulcer size and patient mobility.

Activities of Daily Living↗

Bleomycin therapy for cystic hygroma.

Intralesional bleomycin injection was used as sclerosant therapy for sixteen patients with cystic hygroma. An excellent (complete clinical resolution) response was obtained in seven (44%) patients, a good (> 50% response) result in seven (44%), and a poor or no response in two (12%). Minor transient side effects (fever, vomiting, cellulitis, skin discoloration) were seen in six patients, and there were no serious side effects. The results suggest that bleomycin intralesional sclerosant is effective therapy for cystic hygroma, with response rates comparable to those of surgical removal, but with the advantage of avoiding inadvertent nerve damage and scarring.

Bleomycin↗

High dose rate (HDR) brachytherapy technique: for carcinoma of uterine cervix using Nucletron applicators.

This study describes our existing treatment method for high dose rate (HDR) brachytherapy of carcinoma of uterine cervix using Nucletron applicators. Based on our clinical experience with low dose rate (LDR) brachytherapy since 1986, we deliver 40-45Gy by external and 30Gy by internal radiation therapy. The change in regimen using HDR brachytherapy is that internal radiation dose is given in 5 fractions at weekly intervals following external radiotherapy. We have analyzed the dosimetry of 20 patients; total of 100 treatments done at our center using ring-tandem (R-T) and ovoid-tandem (O-T) applicator combinations. Since O-T applicator has more flexibility of using desired tandem length and reduced rectum and bladder dose due to internal shielding inside the ovoids, we have made the transition from R-T to O-T combination of applicator. The dose volume histogram of the isodose curve indicates that there is an increase in isodose volume with the O-T applicator by as much as 1.5 times as compared to R-T applicator. In majority of the treatments, rectum and bladder doses are less than 70% of target dose, however in very few treatments, the bladder dose has increased to more than the target dose, in which case, the applicators were reseated and added more packing or reduced the dose per fraction, for better tolerance of late responding normal tissues. All our dose calculations are checked with an independent calculation method and agreement was obtained with in 5-7% discrepancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Brachytherapy↗

A prevalence study of age-associated memory impairment.

BACKGROUND: Age-associated memory impairment (AAMI) describes a non-disease ageing-related decline in memory. Pharmacological treatment trials have been reported and DSM-IV has introduced a term for the disorder. No prevalence study with the original criteria has previously been published. METHOD: An age-stratified sample was taken of 50-95-year-olds registered with a local health centre. Diagnosis of AAMI was made by questionnaire, cognitive testing, and medical and psychiatric assessment. RESULTS: Prevalence rates for the total population and for the over-50s were estimated to be 5.8% and 18.5%, respectively. These rates are dramatically affected by minor alterations to individual criteria. CONCLUSIONS: It appears AAMI is less common than previous estimates suggested, although the diagnostic criteria do not satisfactorily define people with an age-related decline in memory. Complaint of memory decline is more strongly correlated with measures of affect and personality than with measures of current memory test performance or estimates of memory decline.

Age Factors↗

Liver procurement without in situ portal perfusion. A safe procedure for more flexible multiple organ harvesting.

The outcome after liver transplantation when grafts were retrieved from the donor by the classical aortic and portal cooling (APC) method was compared with the outcome when exclusively aortic in situ perfusion (AC) was used. Retrospectively, 163 donor hepatectomies performed over a 20-month period were reviewed to analyze overall graft (APC n = 78, AC n = 85) and patient outcome. The global graft and patient survival rates were not significantly lower in the APC group, except for 3-month graft survival (APC 72%, AC 87%; P = 0.015). However, this could be unrelated to the technique. In a subgroup of 140 cases (APC n = 64, AC n = 76), a more detailed analysis was performed. Populations of donors and recipients were similar. The graft injury and the immediate graft function were not significantly different between both groups. A multivariate analysis shows that low donor weight (P = 0.007), donor hypernatremia (P = 0.014), and in situ portal perfusion (P = 0.045) were significant determinants of a higher postoperative peak of glutamic pyruvic transaminase. In summary, in this series, routine human liver procurement using exclusive aortic perfusion seemed to be at least as safe as using a combined aortic and portal perfusion technique. This simplified method may also represent some advantages for combined pancreas and intestinal harvesting in the future.

Adenosine↗

Technical problems in shipped hepatic allografts: the UCL experience.

Due to developments in surgical techniques and organ preservation, the shipping of renal and extrarenal organs is becoming increasingly more frequent. During the period from 1 January 1991 to 31 December 1992, 39 of 180 (21%) implanted liver allografts were shipped to our center by local harvesting teams. The fact that each of nine livers (23.1%) presented with minor and major (vascular and parenchymatous) problems stresses the need for better surgical training and standardization in procurement techniques. The introduction of a liver allograft feedback report could be an easy way to perform quality control.

Belgium↗

Preformed antibody and complement rebound after plasma exchange: analysis of immunoglobulin isotypes and effect of splenectomy.

UNLABELLED: Splenectomy (Sx) has been proposed to attenuate post-PE (plasma exchange) rebound of isoagglutinins and xenogenic (XG) antibody (Ab) in both ABO-incompatible allografts and discordant xenografts. This study analyses the qualitative nature and kinetics of serum immunoglobulins as well as complement resynthesis after PE in sham-operated (PE) and splenectomized (PE+Sx) syngeneic LOU/C rats; non-PE sham-operated or splenectomized animals were used as controls. PE was performed in unanesthetized, unheparinized rats. Immunoglobulin isotypes and subclasses (IgM, IgG1, IgG2 alpha, IgG2b) of total circulating Ab were measured pre-PE and up to 21 days post-PE, using ELISA (enzyme-linked immunosorbent assay) and specific mouse antirat monoclonal Ab. Antiguinea-pig (GP) XG Ab (IgM, IgG2a) serum levels were measured using cellular ELISA with cultured GP endothelial cells as targets. Sx alone significantly reduced XG IgM serum levels (p < 0.0001). Maximal rebound of total and XG IgM was observed on day 3 post-PE, reaching 674% and 187% of the pre-PE levels, respectively; these overshoots were entirely suppressed by Sx (p < 0.005 for total IgM; p < 0.0001 for XG IgM). Total IgG2a, IgG2b and IgG1 as well as XG IgG2a serum levels did not show significant overshoot post-PE. The activity of the complement classical pathway (mean +/- SD), assessed by CH50, was decreased at 51 +/- 19% of basal value 15 minutes after PE, and had returned to baseline level by day 2 post-PE with or without Sx. IN CONCLUSION: (1) Six alone significantly reduced XG IgM serum levels; (2) early post-PE Ab rebound was mainly observed for IgM; (3) both total and XG IgM rebound was inhibited by Sx. This suggests that Sx probably removes a significant proportion of IgM producing cells undergoing post-PE stimulation. These data provide a rationale for combining PE with Sx in ABO-incompatible and discordant XG transplantation.

Animals↗

Conversion from cyclosporine to FK506 for salvage of immunocompromised pediatric liver allografts. Efficacy, toxicity, and dose regimen in 23 children.

Twenty-three pediatric liver transplant recipients (median age 3.9 years) were converted from cyclosporine A-based immunosuppression to FK506 for uncontrollable acute rejection (AR; n = 16), chronic rejection (n = 4), or predominantly nonspecific hepatitis (n = 3). Of these, 19 had received poly- or monoclonal anti-T lymphocyte antibodies either for AR prophylaxis or therapy before FK506 conversion. Full clinical and histologic responses to FK506 therapy were observed in 11/16 cases of AR compared with 0/7 cases of non-AR indications (P = 0.006). Acute FK506 toxicity included renal dysfunction in 12/23 children (52%), neurological disorders in 7/23 (30%), and isolated hyperkalemia in 2/23 (9%), with a poor correlation with the corresponding FK506 trough plasma level. Moreover, a significant impairment of glomerular filtration rate was recorded in the 12 children who received FK506 treatment for more than 6 months (P = 0.002). FK506 therapy had to be definitively withdrawn in 6 cases (fatal infections: n = 4; persistent tremor: n = 1; reason unrelated to FK506: n = 1). Five children developed a lymphoproliferative syndrome (LPS), leading to death in 3 cases despite cessation of the immunosuppressive therapy; in the other 2 patients, LPS was controlled, and the children were successfully retransplanted for chronic rejection under FK506. The occurrence of Epstein-Barr virus primary infection under FK506 therapy was found to constitute a significant risk factor for LPS (P = 0.027). In summary, full response to FK506 conversion was observed in 69% of uncontrollable AR cases; however, 74% and 22% of this probably over-immunosuppressed population experienced major adverse events and LPS under FK506 therapy, respectively.

Adolescent↗