Biomedical subjects
A Jain
Publications and source records attributed to A Jain.
The Pittsburgh randomized trial of tacrolimus compared to cyclosporine for hepatic transplantation.
BACKGROUND: Tacrolimus (formerly FK506) was first used clinically in 1989 to successfully replace cyclosporine in hepatic transplant recipients who were experiencing intractable rejection or as the baseline drug from the time of operation. After extensive pilot experience, an institutional review board-mandated clinical trial comparing cyclosporine with tacrolimus was performed. STUDY DESIGN: From February 16, 1990 to December 26, 1991, 154 patients were recruited. The competing drugs were combined with equal induction doses of prednisone in both arms of the study for the first 81 patients and with subsequently higher doses of prednisone in the remaining 35 patients who received cyclosporine and were entered into the trial. Drug crossover was permitted for lack of efficacy or adverse events. End points were rejection confirmed by biopsy and treatment failure leading to retransplantation or death. RESULTS: Seventy-nine patients were randomized to the tacrolimus arm and 75 to the cyclosporine arm during 1990 and 1991. All patients were available for follow-up throughout the trial, which terminated on May 30, 1995. The mean duration of follow-up was four years. Patients randomized to the tacrolimus arm were less likely to experience acute rejection than were those receiving cyclosporine, with 36.2 percent of the patients receiving tacrolimus and 16.8 percent of the patients receiving cyclosporine showing freedom from rejection at one year (p = 0.003, likelihood ratio test). Survival of patients over the course of the study was virtually the same in the two groups.
Polymerase chain reaction-based detection of bacteria in semen.
OBJECTIVE: To determine if the presently used bacterial detection techniques provide accurate and complete profiles of microorganisms found in human semen. DESIGN: Routine bacterial cultures and molecular biology techniques using polymerase chain reaction (PCR), with a universal eubacterial primer, cloning, then sequence analysis were used to detect bacteria (culturable or nonculturable) in the semen. SETTING: University and hospital-based research laboratory. PATIENTS: Thirty infertile men and nine semen donors, all with no symptoms of a urinary tract infection, donated semen for the study. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Detection of bacteria using routine cultures and molecular biology techniques. RESULTS: Using PCR, we found > 10(4) bacteria/mL in the semen of 66% of the infertile asymptomatic men and 66% of the semen donors. This contrasts with our routine culture results which detected "significant" bacteriospermia in only 27% of the infertile men and in none of the preselected semen donors. From four of these semen specimens, DNA sequence analysis identified an average of nine different bacterial species per specimen, with close to 90% of the species being anaerobes. CONCLUSIONS: These data indicate that the present microbiologic detection methods underestimate the incidence of significant bacteriospermia, particularly anaerobic bacteria. The molecular biologic methods should help researchers confirm or refute the role of infection in male infertility.
Effect of Leishmania donovani antigens on superoxide anion generation by mice polymorph in vitro.
The present study was planned to study the effect of priming of BALB/c mice peritoneal polymorphs (PMNLs) by viable, heat killed and formaline fixed promastigotes of L. donovani and soluble extract of proteins of L. donovani promastigotes on their capacity to produce toxic oxygen radicals (TOR). TOR production was measured by superoxide dismutase (SOD), inhibitable cytochrome C reduction and nitroblue tetrazolium reduction tests. No significant stimulation or inhibition in SOD inhibitable cytochrome C reduction and nitroblue tetrazolium reduction was seen when PMNLs were primed by soluble leishmanial protein, and formalin fixed and denatured promastigotes for both 60 and 90 min. Priming of BALB/c mice peritoneal polymorphs with live promastigotes of L. donovani for more than 60 min produced approximately 30 per cent inhibition in superoxide generation as measured by both the tests (P < 0.05). The inhibition in superoxide generation by polymorphs may be one of the important escape mechanisms in the causation of the visceral leishmaniasis.
Comparative evaluation of serological tests for diagnosis of visceral leishmaniasis.
Sensitivity and specificity of the direct agglutination (DAT) and indirect immunofluorescent test (IFT) have been compared with indirect immunoperoxidase assay (IPA) for the serodiagnosis of visceral leishmaniasis. IPA and DAT were found to be more sensitive and specific than IFT. Indirect immunoperoxidase test was found to be better than DAT as preparation of antigen is easy. Less amount of antigen is required, storage of antigen in slide form is more convenient and shelf life is longer. It is easier to read and interpret immunoperoxidase with the help of ordinary light microscope and chances of false positive and false negatives are negligible.
New blood free biphasic medium with haemoglobin for cultivation of Leishmania donovani promastigotes.
A simple biphasic growth medium for cultivation of L. donovani promastigotes is described. A successful attempt has been made to replace the blood/serum from regular medium by bovine hemoglobin powder. Medium is easy to prepare within 4 hr. It is simple, reliable inexpensive and autoclavable. Ingredients used in the media preparation are readily available at low cost and components of the medium prepared in large quantities, could be stored at 4 degrees C for month without significantly altering their growth supporting potential. After an inoculation of 1 x 10(5) promastigotes/ml, it was possible to cultivate 1-3 x 10(2) promastigotes/ml from the above described media.
Combination vaccines: some practical considerations.
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Follow-up of primary Palmaz-Schatz stent placement for atherosclerotic renal artery stenosis.
A Palmaz-Schatz stent was successfully placed in 92 stenotic renal arteries (76 patients) for (1) hypertension in 62 (82%), and/or (2) chronic renal failure (serum creatinine > or = 1.5 mg/dl) and preservation of renal function in 39 (51%). Patients were followed to assess clinical and angiographic 6-month outcome. Angiography, performed in 45 of 62 eligible patients (73%) and in 56 of 74 treated arteries (76%), showed restenosis occurring in 14 renal arteries (25%). Serum creatinine improved or remained stable in 78% of patients. In patients with chronic renal failure, improvement or stability was observed in 55%. Blood pressure recordings significantly decreased for the entire cohort (systolic: 168 +/- 25 to 156 +/- 22 mm Hg, p < 0.0001; diastolic: 87 +/- 11 to 81 +/- 11 mm Hg, p < 0.005), and for hypertensive patients with normal creatinine (systolic: 179 +/- 20 to 155 +/- 23 mm Hg, p < 0.0001; diastolic: 92 +/- 9 to 83 +/- 12 mm Hg, p < 0.002). These follow-up data of a prospective, nonrandomized, observational study showed that stent recanalization of atherosclerotic renal artery stenoses was beneficial with regard to renal function and blood pressure response, and had a restenosis incidence of 25%.
Should patients positive for HIV infection receive pneumococcal vaccine?
Pneumococcal vaccination effectively reduces the incidence of invasive pneumococcal disease in normal subjects. Such invasive pneumococcal disease is 100 times more common in patients with HIV infection than in healthy people, so it seems logical to target this group of patients for vaccination. Few clinics routinely vaccinate patients positive for HIV, despite Department of Health guidelines. This is because of uncertainty about the vaccine's efficacy in HIV disease. There are many reasons to suspect that the vaccine will fail to protect these patients, including the fact that antibodies alone may not be sufficient protection against all serogroups of Pneumococcus and the vaccine works in healthy people but not immunocompromised subjects. Vaccination of HIV positive patients may not be indicated, at least for the time being. The cost of vaccinating such patients in the absence of data showing efficacy may well be less than the cost of a necessarily large and lengthy trial. But the truth must be sought to end current indecision.
Rehabilitation outcome 5 years after 100 lower limb amputations.
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Management of coronary artery rupture: covered stent or microcoil embolization.
The management of three cases of coronary artery rupture is described: (1) after high-pressure balloon angioplasty following uneventful placement of three Gianturco-Roubin stents, (2) following balloon angioplasty of an occluded diagonal branch, and (3) subsequent to rotational ablation of a left main and proximal circumflex arteries. Placement of an autologous vein-covered Palmaz stent or microcoil embolic vessel occlusion solved each problem. In each case, emergency surgery was avoided; subsequent management, including anticoagulation (when indicated), was performed without incident. This is the first communication detailing correction of a coronary vessel rupture with an autologous vein-covered stent or by microcoil embolic vessel occlusion.
DNA fingerprinting of Brassica juncea cultivars using microsatellite probes.
The genetic variability in the Brassica juncea cultivars was detected by employing in-gel hybridization of restricted DNA to simple repetitive sequences such as (GATA)4, (GACA)4 and (CAC)5. The most informative probe/enzyme combination was (GATA)4/EcoRI, yielding highly polymorphic fingerprint patterns for the B. juncea cultivars. This technique was found to be dependable for establishing the variety specific patterns for most of the cultivars studied, a prerequisite for germplasm preservation. The results of the present study were compared with those reported in our earlier study in which random amplification of polymorphic DNA (RAPD) was used for assessing the genetic variability in the B. juncea cultivars.
Glutathione metabolism in newborns: evidence for glutathione deficiency in plasma, bronchoalveolar lavage fluid, and lymphocytes in prematures.
Respiratory distress in premature newborns is associated with deficiency of surfactant in the bronchoalveolar lining fluid; this may be influenced by a local deficiency of antioxidants. Severe L-buthionine-S,R-sulfoximine-induced depletion of glutathione (GSH, a major antioxidant) in rodents is associated with lung type 2 cell lamellar body damage and decreased concentrations in lung and bronchoalveolar lavage fluid (BALF) of phosphatidyl choline (a major component of surfactant). At birth, prematurely born newborns (30-34 weeks) had lower peripheral venous plasma GSH concentrations than term (> 36 weeks) babies; these levels decreased further with increasing prematurity (< 27 weeks, with respiratory distress). On day 2, the peripheral venous plasma GSH concentrations reached a nadir, and the lowest levels were found in the most premature newborns. Lymphocyte GSH concentrations were lowest on day 2 and day 7, and in prematures (< 27 weeks, with respiratory distress) remained below adult lymphocyte GSH levels for at least 4 weeks. At birth, prematures (< 27 weeks, with respiratory distress) had a central plasma arterio-venous (A-V) GSH gradient across the lung (an estimate of lung uptake of GSH) of 0.72 +/- 0.15 (mean +/- SD) mumol/L; on day 2, the A-V gradient did not change significantly (0.49 +/- 0.09 mumol/L). At birth, these prematures had markedly decreased BALF GSH concentrations (compared with adult levels), and they were not significantly changed during the first 4 weeks of life. These results suggest that GSH deficiency is present in prematures and that it increases with the degree of prematurity. At birth, GSH deficiency will compromise the lungs' defense against oxidative stress injury. Oxidative stress is likely to increase if hyperoxic treatment is given for respiratory distress in these infants.
Outpatient laparoscopic appendectomy.
Laparoscopy has allowed surgeons the ability to perform procedures which result in less postoperative discomfort, earlier return to daily activities, and better cosmesis. For example, laparoscopic cholecystectomy has virtually replaced open cholecystectomy, and many of these operations are performed in the outpatient setting. The role of laparoscopic appendectomy is yet to be defined, however. Over an 18-month period from February 1992 to July 1993, 75 laparoscopic appendectomies were performed at Kaiser Permanente Medical Center in Los Angeles. Thirty-five of the patients undergoing this procedure were outpatients. While there were a total of three complications, including two intraabdominal abscesses, there were no complications in the outpatient appendectomy group. Laparoscopic appendectomy may be safely performed in the outpatient setting in patients with acute nonperforated appendicitis.
Maternal serum creatine kinase as a biochemical marker of tubal pregnancy.
OBJECTIVE: To evaluate the role of serum creatine kinase as a possible marker for diagnosis of tubal pregnancy. METHODS: Five groups of patients were included in this prospective study: group A, 20 patients with tubal pregnancies; group B, 20 patients with missed abortions; group C, 20 patients with pelvic inflammatory disease; group D, 10 patients with acute appendicitis; group E (controls), 20 patients with normal pregnancies matched for age and gestation. Total creatine kinase levels were measured in the serum of all five groups. RESULTS: Creatine kinase levels were found to be > or =75 IU/l in all patients with tubal pregnancies, which was significantly higher than in the other four groups (P < 0.0001). CONCLUSION: Our results indicate that maternal serum creatine kinase can be an important biochemical marker in suspected tubal pregnancy.
Detection of myocardial ischemia.
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L-2-oxothiazolidine-4-carboxylate, a cysteine precursor, stimulates growth and normalizes tissue glutathione concentrations in rats fed a sulfur amino acid-deficient diet.
The efficiency of L-2-oxothiazolidine-4-carboxylate, a cysteine precursor, in stimulating glutathione synthesis and growth was evaluated in growing rats. Animals were fed a sulfur amino acid-deficient diet (0.25% L-methionine and no cysteine) supplemented with L-2-oxothiazolidine-4-carboxylate (0.35%) for 3 wk and compared with age-matched animals receiving the sulfur amino acid-deficient diet alone. Rats fed the sulfur amino acid-deficient diet had lower glutathione concentrations in bronchoalveolar lining fluid, lung, lymphocytes, and liver than rats fed a sulfur amino acid-deficient diet supplemented with L-2-oxothiazolidine-4-carboxylate. Rats fed the supplemented diet had normal tissue and bronchoalveolar lining fluid glutathione levels. Central venous plasma glutathione concentrations, mostly reflecting liver excretion, were less affected by L-2-oxothiazolidine-4-carboxylate supplementation. Rats fed L-2-oxothiazolidine-4-carboxylate supplementation had normal weight gain compared with a much lower weight gain in animals fed the sulfur amino acid-deficient diet alone. Thus, L-2-oxothiazolidine-4-carboxylate increased tissue glutathione concentrations and stimulated growth in rats. The lung glutathione status of the rats was reflected by glutathione concentrations in lymphocytes and the bronchoalveolar lining fluid, but not by the central venous plasma glutathione concentrations.
Electron transfer, target excitation, and ionization in H++Na(3s) and H++Na(3p) collisions in the coupled-Sturmian-pseudostate approach.
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