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B A Shapiro

Publications and source records attributed to B A Shapiro.

At least 73 records · Page 4Linked to original sources
PubMed1989

Preliminary evaluation of an intra-arterial blood gas system in dogs and humans.

The reliability and accuracy of an intra-arterial fluorescent optode system to measure continuously pHa, PaCO2, and PaO2 were evaluated in a dog model and in a group of critically ill patients. Six hundred sixty-three arterial blood gas (ABG) samples were analyzed for pHa, PaCO2, and PaO2 in the dog studies. The intra-arterial blood gas system (IBGS) indicated a steady state in 420 instances for pH, 359 instances for PaCO2, and 256 instances for PaO2. Comparison of these ABG and IBGS values by linear regression analysis revealed r = .97 for pHa, .95 for PaCO2, and .96 for PaO2. The mean +/- SD of the difference between ABG and IBGS was -0.02 +/- 0.03 for pHa, 1.05 +/- 3.8 for PaCO2, and -17 +/- 13 for PaO2. Nonsteady states were correctly identified by the IBGS in every instance. Comparisons between 79 temporally matched ABG and IBGS values, exclusive of in vivo calibration samples, in 12 critically ill patients revealed r = .97 for pHa, .96 for PaCO2, and .99 for PaO2. The difference was 0.002 +/- 0.02 for pHa, 0.44 +/- 2.97 for PaCO2, and -1.22 +/- 9.34 for PaO2. We conclude that it is possible to measure continuously pHa, PaCO2, and PaO2 with the IBGS in critically ill patients for periods from 3 to 25.5 h while maintaining the ability to monitor BP and withdraw blood samples from the arterial cannula. Agreement between the two techniques is within clinically acceptable ranges for pHa and PaCO2, whereas PaO2 measurement by the IBGS requires further refinement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Helix stability in prokaryotic promoter regions.

Prokaryotic promoters have been extensively studied to relate sequence features to promoter function. Here we examine the relationship between double-helix stability and promoter activity. The double-helix stability is evaluated from sequence data by free energy computation, based on reported values of dinucleotide free energies for strand separation. For a collection of 168 promoters, we find that within a 500-nucleotide span around the transcription initiation site the -10 region is the least stable. There is no correlation between the free energies and the rates of RNA polymerase-promoter open complex formation measured for 25 promoters. We also compare the free energies of 121 promoter mutations across the -35 and -10 consensus regions with the free energies of the corresponding wild-type sequences. These pairwise mutant-wild-type comparisons provide a particularly good test since the examined sequences differ only in one nucleotide so that all other sequence-dependent effects remain the same. About 80% of the mutations in the -10 region that show increased/reduced promoter activity are less/more stable than the wild types. The observed high free energy peak and the mutation data strongly support the conjecture that the instability, or melting properties, of the -10 region plays a significant role in promoter function.

Cells↗
PubMed1988

An algorithm for comparing multiple RNA secondary structures.

A new distributed computational procedure is presented for rapidly determining the similarity of multiple conformations of RNA secondary structures. A data abstraction scheme is utilized to reduce the quantity of data that must be handled to determine the degree of similarity among multiple structures. The method has been used to compare 200 structures with easy visualization of both those structures and substructures that are similar and those that are vastly different. It has the capability of processing many more conformations as a function of research requirements. The algorithm is described as well as some suggestions for future uses and extensions.

Algorithms↗
PubMed1988

Changes in venous blood lactate, venous blood gases, and somatosensory evoked potentials after tourniquet application.

The effects of inflation of a 7-cm tourniquet applied to the upper arm of eight volunteers on venous lactate, venous blood gases, and ulnar nerve somatosensory evoked potentials (SSEPs) were investigated. The inflation pressure was 100 mmHg over the systolic pressure. Venous blood samples for lactate and blood gas determinations were withdrawn before tourniquet inflation; immediately and at 2, 5, 10, 15 min after tourniquet deflation; and additionally at 30, 45, and 60 min after deflation in the last four volunteers. SSEP stimulating surface electrodes were placed over the ulnar nerve at the wrist. Recording electrodes were placed over the ipsilateral ulnar groove of the elbow, Erb's point, and on the contralateral cortex. Averaged responses were acquired before inflation of the tourniquet, every 5-10 min during tourniquet inflation, and every 5-10 min for 45-60 min after tourniquet deflation. The tourniquet was inflated for 36 +/- 11 min. After deflation of the tourniquet, postdeflation pain and paresthesias were felt by five volunteers; these occurred at 30-120 s after deflation and lasted for 75-120 s. The postdeflation pains were characterized as burning, cramping, paresthesias, buzzing, or severe expansion of the hand. The venous blood lactate levels were significantly elevated for 10 min, and the time course of its change did not correlate with reperfusion pain. The PO2 and O2Hb saturation in venous blood were significantly elevated for 10-15 min after deflation. The elevated lactate and PO2 levels in the presence of a restored blood flow probably result from continued anaerobic muscle metabolism secondary to capillary closure from the tourniquet-induced ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Unreliability of oxygen tension-based indices in reflecting intrapulmonary shunting in critically ill patients.

Measurement of intrapulmonary shunting (Qsp/Qt), a widely used method for monitoring disturbances of pulmonary oxygen transfer in critically ill patients, involves calculation of arterial and mixed venous oxygen contents. In circumstances where mixed venous blood samples are not readily available, oxygen tension-based indices such as the alveolar to arterial oxygen tension differences (P[A-a]O2), arterial oxygen tension to alveolar oxygen tension ratio (PaO2/PAO2), PaO2 to FIO2 ratio (PaO2/FIO2) and respiratory index (RI) are widely utilized to reflect Qsp/Qt. Oxygen content-based indices such as the estimated shunt are not as widely utilized as the oxygen tension indices. In 75 critically ill patients in whom a pulmonary artery catheter was being utilized to augment clinical care, comparisons were made between Qsp/Qt and P(A-a)O2, PaO2/PAO2, PaO2/FIO2, RI, and estimated shunt to determine which index best reflected Qsp/Qt. Correlations between Qsp/Qt and estimated shunt were good (r = .94) and poor for the P(A-a)O2 (r = .62), PaO2/PAO2 (r = .72), PaO2/FIO2 (r = .71), and RI (r = .74). We conclude that there are no real substitutes for venous oxygen contents in critically ill patients. When pulmonary artery blood is not available for analysis, oxygen tension-based indices are unreliable reflectors of Qsp/Qt while the estimated shunt, an oxygen content-based index, provides a more reliable reflection of Qsp/Qt.

Aged↗
PubMed1988

Authoritative medical direction can assure cost-beneficial bronchial hygiene therapy.

A bronchial hygiene (BH) program for non-Intensive Care Unit (ICU) patients in which regimens are determined by respiratory therapy evaluators is described. The medical director of Respiratory Care was given control of orders by the medical staff and assumed responsibility for the evaluators' decisions. Patterns of BH utilization were analyzed for 24 months and were compared with BH utilization patterns in a preceding similar program in which orders were controlled by primary care physicians. Extra-ICU BH therapy (BHT) decreased by 61 percent and neither morbidity nor mortality was undesirably affected. Cost savings exceeded $250,000 per year. Authoritative medical direction of such a program results in cost-beneficial utilization of BHT, provides an excellent guide for resident physicians to learn appropriate utilization of such therapy, provides for quality assurance and medical necessity documentation, and is well accepted by the medical staff.

Cost-Benefit Analysis↗
PubMed1988

Arterial blood gas monitoring.

A clinically relevant presentation of interpretation of arterial blood gas measurements in the critically ill patient is presented. Oxygenation deficits are discussed in relation to differentiation of pulmonary, cardiovascular, and metabolic causes. Metabolic acid base balance is discussed with special emphasis on the low cardiac output state (CPR). Ventilation deficits are discussed in terms of alveolar ventilation, deadspace ventilation and CO2 stores. The future trends of continuous blood gas monitoring are discussed.

Acid-Base Imbalance↗
PubMed1987

An interactive dot matrix system for locating potentially significant features in nucleic acid molecules.

An interactive computer system using a dot matrix approach has been developed and used to determine potentially significant features due to distortions in the B-DNA helix as a result of variations of purine and pyrimidine patterns. Sequences were compared using matrices which were generated using the Calladine-Dickerson rules (C.R. Calladine, J. Mol. Biol. 161, 343-352, 1982 and R.E. Dickerson, J. Mol. Biol. 166, 419-441, 1983). Having control over various parameters to enhance different aspects of the visual appearance of these matrices was helpful in discovering patterns that were not known a priori. Specifically, it was found that a pattern of alternating doublets of purines and pyrimidines appear to exist in regulatory regions. This event is shown to be beyond probabilistic expectation.

Base Sequence↗
PubMed1986

A sequence analysis system encompassing rules for DNA helical distortion.

Recently, it has been shown by Calladine (1982) and Dickerson (1983) that DNA distortions due to steric clashes between opposing purines and pyrimidines can be quantitated based upon four sum functions. The distortions involve helical twist, roll, torsion angle variations and propeller twist. It is the contention of the authors that these perturbations in structure act as information carriers for various external DNA interactions. This paper describes a system that incorporates these four rules and various other functions that permit the systematic interactive exploration for significant patterns as a consequence of these steric clashes.

Base Sequence↗
PubMed1986

Structural support for the perception of growth.

Previous studies have shown that the effects of a particular class of geometric transformations, known as cardioidal strain, are perceived as growth when applied to a variety of animate and even inanimate objects. The current study demonstrates that the effects of these growth transformations are not completely independent of the object undergoing change, but depend critically on certain structural characteristics. When cardioidal strain is applied to a straight-line, right-angle, robotlike structure, there is no consistent effect on the age level of the figure. However, as the structural contours become more curved and less angular, the effects of this transformation are seen as increasingly more like growth. In contrast, the effects of a shear transformation are not perceived as growth on any of the profiles. These findings are examined in light of the critical physical properties that may be responsible for this notion of biological forms as well as their implications for our understanding of the information about events.

Age Factors↗
PubMed1986

Perioperative complications of elective tracheostomy in critically ill patients.

This study was designed to examine prospectively the incidence of perioperative complications associated with elective tracheostomy in critically ill patients. An experienced surgeon and anesthesiologist participated in every tracheostomy procedure. In 81 procedures, there was no loss of airway control for greater than 20 sec, no airway obstruction, no blood loss exceeding 50 ml, and no aspiration. One patient (1.2%) had cardiovascular instability. During the next 48 h, two patients (2.4%) required wound packing to control hemorrhage but did not require blood transfusion and two patients (2.4%) had evidence of supraclavicular subcutaneous emphysema that was physiologically inconsequential. There was no perioperative mortality or major morbidity associated with the tracheostomy procedure. We conclude that, under controlled conditions, elective tracheostomy can be performed safely in critically ill patients.

Adolescent↗