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Biomedical subjects

B Hill

Publications and source records attributed to B Hill.

At least 37 records · Page 2Linked to original sources
PubMed2000

Gender differences in state-wide EMS transports.

There are gender differences in emergency medical services (EMS) transports and management based on diagnosis. Data were extracted from the EMS State Ambulance Transport database. This database exists because of a legal requirement that all EMS transports generated by 911 calls and all interhospital transports be reported to the State EMS Bureau. All ambulance transports reported to the State EMS Division during 1995 were evaluated. Cases were excluded if they were aborted, admission or discharge transports, outpatient transports, or cases listed as "other" without a diagnosis. Gender-related treatment differences were determined for problems for which EMTs have specific treatment options. These were cardiac arrest, chest pain, allergic reactions, and extremity fractures. Results were compared using a two-tailed Chi squared or Fischer's Exact with significance at P < .05. Odds Ratios (OR) and 95% confidence intervals (CIs) were calculated. There were a total of 164,595 ambulance transports reported to the State EMS Division. Of these 76,074 (46%) were men and 88,521 (54%) were women. Of these, 50,211 were excluded. This left 52,607 injury transport and 61,777 illnesses transport. Men were significantly more likely than women to have injuries related to all-terrain vehicle accidents, motorcycle accidents, RV accidents, burns, gunshot wounds, and stab wounds. Men were significantly more likely than women to have illnesses related to cardiac arrest, dead on arrivals (DOAs), drowning, and smoke inhalation. For cardiac arrest transports, significantly more male patients presented ventricular fibrillation, more males received defibrillation, lidocaine, and bicarbonate, but more women received atropine. Male chest pain patients were more likely to receive oxygen and morphine and less likely to receive nitroglycerin. Male allergic reaction patients were more likely to receive an i.v. and subcutaneous epinephrine. Male extremity fracture patients were more likely to get an i.v. line, but there was no difference in morphine use or splinting. There are numerous disease-specific gender differences in the demographics of illness and injury transported by EMS. The use of various medications and procedures may also be related to gender. Understanding these differences may help in preparing EMS professionals for patient management.

Blood Pressure↗
PubMed1999

Optimization of retroviral gene transduction of mobilized primitive hematopoietic progenitors by using thrombopoietin, Flt3, and Kit ligands and RetroNectin culture.

We have investigated the ability of several cytokine combinations to improve retrovirus-mediated transduction of human primitive hematopoietic progenitors (PHPs) from mobilized peripheral blood (MPB). Retroviral infection of CD34+ cells was performed by culture on fibronectin fragment CH-296 (RetroNectin, RN), using the truncated human nerve growth factor receptor (NGFR) as the transgene reporter. Transgene expression among progeny of PHPs was assayed by FACS analysis after long-term stromal culture (LTC). Transgene delivery to PHPs was assessed by PCR of individual stromal culture-derived methylcellulose colonies (LTC-CFCs). Compared with interleukin 3 (IL-3), IL-6, and leukemia inhibitory factor (LIF), the combination of thrombopoietin (TPO), Flt3 ligand (FL), and Kit ligand (KL) effected a 73-fold increase in NGFR expression among CD34+ cells (to 14%) and a 14-fold increase in NGFR expression among total cells (to 10%) after LTC. In addition, a 2.4-fold increase in neo gene marking of LTC-CFCs was observed. A preclinical study comparing the effect of high-speed centrifugation ("spinoculation") or culture on RN during exposure to retroviral particles in teflon cell culture bags showed no difference in the efficiency of transduction of PHPs between these two methods.

Antigens, CD34↗
PubMed1999

Rubiginoside, a farnesyl glycoside from Lepisanthes rubiginosa.

Chemical investigation of the methanolic fraction of Lepisanthes rubiginosa bark has led to the isolation and characterisation of a new tetrasaccharide derivative of farnesol named rubiginoside along with known triterpenoid saponins.

Carbohydrate Conformation↗
PubMed1999

The use of the Fogarty catheter in 1998.

Catheter-mediated thromboembolectomy has evolved over the last three decades along with changes in vascular disease patterns. As in situ arterial thrombosis has become more common both in natural arteries and prosthetic grafts, changes in mechanical thromboembolectomy have been necessary to optimize treatment strategies. A variety of devices and techniques are now available for transluminal clot removal including the original thromboembolectomy catheter, newer adherent clot catheters, graft thrombectomy catheters, thru-lumen balloon catheters and methods that involve fragmentation and removal of fresh thrombus by hydrodynamic means.

Catheterization↗
PubMed1999

The emergence of decreased susceptibility to vancomycin in Staphylococcus epidermidis.

BACKGROUND: Coagulase-negative staphylococci (CNS) are the major cause of nosocomial bloodstream infection. Emergence of vancomycin resistance among CNS is a serious public health concern, because CNS usually are multidrug-resistant, and glycopeptide antibiotics, among which only vancomycin is available in the United States, are the only remaining effective therapy. In this report, we describe the first bloodstream infection in the United States associated with a Staphylococcus epidermidis strain with decreased susceptibility to vancomycin. METHODS: We reviewed the hospital's microbiology records for all CNS strains, reviewed the patient's medical and laboratory records, and obtained all available CNS isolates with decreased susceptibility to vancomycin. Blood cultures were processed and CNS isolates identified by using standard methods; antimicrobial susceptibility was determined by using minimum inhibitory concentration (MIC) and disk-diffusion methods. Nares cultures were obtained from exposed healthcare workers (HCWs) to identify possible colonization by CNS with decreased susceptibility to vancomycin. RESULTS: The bloodstream infection by an S. epidermidis strain with decreased susceptibility to vancomycin occurred in a 49-year-old woman with carcinoma. She had two blood cultures positive for CNS; both isolates were S. epidermidis. Although susceptible to vancomycin by the disk-diffusion method (16-17 mm), the isolates were intermediate by MIC (8-6 microg/mL). The patient had received an extended course of vancomycin therapy; she died of her underlying disease. No HCW was colonized by CNS with decreased susceptibility to vancomycin. CONCLUSIONS: This is the first report in the United States of bloodstream infection due to S. epidermidis with decreased susceptibility to vancomycin. Contact precautions likely played a role in preventing nosocomial transmission of this strain, and disk-diffusion methods may be inadequate to detect CNS with decreased susceptibility to vancomycin.

Anti-Bacterial Agents↗
PubMed1998

Sustained gene expression in retrovirally transduced, engrafting human hematopoietic stem cells and their lympho-myeloid progeny.

Inefficient retroviral-mediated gene transfer to human hematopoietic stem cells (HSC) and insufficient gene expression in progeny cells derived from transduced HSC are two major problems associated with HSC-based gene therapy. In this study we evaluated the ability of a murine stem cell virus (MSCV)-based retroviral vector carrying the low-affinity human nerve growth factor receptor (NGFR) gene as reporter to maintain gene expression in transduced human hematopoietic cells. CD34(+) cells lacking lineage differentiation markers (CD34(+)Lin-) isolated from human bone marrow and mobilized peripheral blood were transduced using an optimized clinically applicable protocol. Under the conditions used, greater than 75% of the CD34(+) cell population retained the Lin- phenotype after 4 days in culture and at least 30% of these expressed a high level of NGFR (NGFR+) as assessed by fluorescence-activated cell sorter analysis. When these CD34(+)Lin-NGFR+ cells sorted 2 days posttransduction were assayed in vitro in clonogenic and long-term stromal cultures, sustained reporter expression was observed in differentiated erythroid and myeloid cells derived from transduced progenitors, and in differentiated B-lineage cells after 6 weeks. Moreover, when these transduced CD34(+)Lin-NGFR+ cells were used to repopulate human bone grafts implanted in severe combined immunodeficient mice, MSCV-directed NGFR expression could be detected on 37% +/- 6% (n = 5) of the donor-type human cells recovered 9 weeks postinjection. These findings suggest potential utility of the MSCV retroviral vector in the development of effective therapies involving gene-modified HSC.

Animals↗
PubMed1998

Comparative study of BacT/Alert FAN bottles and standard BacT/Alert bottles.

A total of 5,230 paired blood cultures were studied. One sample was divided between aerobic and anaerobic BacT/Alert standard bottles, and the other divided between aerobic and anaerobic BacT/Alert FAN bottles. There were 44 occasions where Staphylococcus aureus was recovered only from the FAN bottles, compared to six where only the standard bottles were positive (p < 0.001), and 21 occasions where Escherichia coli was isolated only from FAN bottles, compared to eight occasions where only the standard bottles were positive for this organism (p < 0.05). In 21 of 28 cases reviewed where S. aureus was isolated from FAN bottles only the patient had been receiving anti-staphylococcal antibiotics. However, only 2 of 30 cases where Gram-negative bacilli were isolated from FAN bottles had documented recent appropriate antibiotic therapy. Patients in whom FAN bottles are more likely to recover organisms cannot be selected on the basis of documented antibiotic treatment.

Anti-Bacterial Agents↗
PubMed1998

Suspected Brazilian purpuric fever in a toddler with overwhelming Epstein-Barr virus infection.

We describe a toddler from Connecticut who developed purulent conjunctivitis, fever, and a morbilliform rash. Blood cultures were positive for Haemophilus influenzae biogroup aegyptius; further investigation was performed to assess the possibility that the illness was consistent with Brazilian purpuric fever, which, to our knowledge, has not been reported in the United States. This isolate shared morphological and some biochemical characteristics with previously studied H. influenzae biogroup aegyptius strains but differed according to slide agglutination testing, plasmid characterization, and ribotyping. Blood and tissue samples obtained during his hospitalization were also positive for Epstein-Barr virus. The child died 8 days after hospitalization. Fifty other cases of invasive H. influenzae infection were identified by active surveillance studies. Of the 49 viable surveillance isolates, 10 were biotype III (two of which had the same ribotype as the strain from our case.

Bacteremia↗
PubMed1998

A diagnostic approach to chest pain based on history and ancillary evaluation.

Pain is a major reason patients seek health care. Chest pain, in particular, is a serious concern for patients and clinicians because of its potentially life-threatening implications--misdiagnosis can be fatal. Diagnosis of chest pain is complicated by shared neurologic pathways for thoracic and abdominal visceral organs. The importance of a medical history in the differential diagnosis is discussed. A helpful mnemonic is offered both as an organizational guide for novice practitioners and as a reminder for the seasoned clinician. Included are detailed discussions regarding the neuroanatomy of chest pain, followed by common historical presentations and physical findings related to selected cardiovascular and noncardiovascular etiologies of the condition. A brief discussion of confirmatory laboratory evaluations is included. Several etiologies not discussed in detail are presented in table format.

Chest Pain↗
PubMed1998

Older people's lives in the inner city: hazardous or rewarding?

An exploratory, qualitative study was used to investigate the social health needs of older residents of a low-income inner-Sydney area characterised by multiple social and environmental hazards. The research was conducted to inform the development by the South Eastern Sydney Area Health Promotion Unit of a strategy to promote the health, wellbeing and independence of older people. As part of a needs assessment process, the investigation focused on specific subgroups of the population believed to be highly disadvantaged and neglected. In-depth interviews were conducted with 40 residents aged 60 to 86 years who were recruited through community centres, service providers and neighbours. The interviews were supplemented by observational field notes. We describe key dimensions of the physical and social environment, the many hazards it presented to vulnerable elderly residents and the practices they adopted in meeting their everyday needs in relation to shopping, meals, mobility outside the home and social participation. The description is from the perspectives of residents themselves. Key factors discussed include the neighbourhood, housing, activities of daily living, safety and security, and social participation. We explore the implications of our findings for the development of effective public health practice. The environmental hazards, such as pedestrian safety and traffic management, affect the whole population and require interventions at government level. Others, such as inadequate hygiene and food storage facilities in rented premises, also require an approach at the level of public policy and environmental change, but need to be carefully targetted and implemented.

Aged↗
PubMed1998

CDC group O-3: phenotypic characteristics, fatty acid composition, isoprenoid quinone content, and in vitro antimicrobic susceptibilities of an unusual gram-negative bacterium isolated from clinical specimens.

Between 1983 and 1994, 13 phenotypically similar unidentified clinical isolates were received by the Special Bacteriology Reference Laboratory, Centers for Disease Control and Prevention (CDC). Sources included blood (four strains), lung (three strains), knee fluid and duodenal tissue (one strain each), bone, and lymph node tissue (two strains each). All were aerobic glucose-oxidizing, slender, long, curved gram-negative rods that utilized xylose, sucrose, and maltose; did not grow on MacConkey agar in 1 to 2 days; were oxidase positive; hydrolyzed esculin; and grew on Campylobacter selective medium. All were negative for urease, indole, nitrate reduction, and gelatin hydrolysis. All were motile by means of a single polar flagellum with a noticeably short wavelength; however, motility was sometimes difficult to demonstrate. The cellular fatty acid compositions of these strains, as analyzed by gas-liquid chromatography, were unique, characterized by relatively large amounts of 16:1omega7c, 16:0, and 18:1omega7c with smaller amounts of 12:0, 3-OH-12:1, 14:0, 15:0, 18:0, Br-19:1, and 19:0cyc11-12. High-performance liquid chromatography and mass spectrometry of the quinone extracts of three representative strains showed ubiquinone-10 as the major component. Based on the breakpoints for the family Enterobacteriaceae, all the strains were susceptible in vitro to aminoglycosides, sulfamethoxazole-trimethoprim, and chloramphenicol but were resistant to most beta-lactams except imipenem. The MICs of amoxicillin-clavulanate and ciprofloxacin for these strains clustered around the breakpoints, which makes it difficult to predict the strains' response in vivo to these agents. This group has been designated CDC oxidizer group 3 (O-3).

Adult↗
PubMed1998

Hematopoietic progenitor cells of lymphocytes and dendritic cells.

Lymphocytes and dendritic cells (DCs) are critical for immune responses, yet how they develop from pluripotent hematopoietic stem cells is poorly defined. In humans and mice, it is possible to isolate phenotypically defined subsets of bone marrow (BM) cells that represent intermediate progenitors without long-term repopulating characteristics but with specific lineage differentiation properties. For instance, murine BM CD34+ CD45RA+ cells are progenitors for B and T lymphocytes with no in vivo repopulation activity. In human BM, a small subset (5%) of cells having the phenotype CD34+ Lin- CD10+ CD45RA+ CD38+ Thy-1- c-kit- represents a new class of hematopoietic progenitor cells that gives rise to lymphocytes [T, B, and natural killer (NK) cells] and to DCs but does not produce myeloid or erythroid cells. The identification of such progenitor cells provides the opportunity to define the differentiation and growth requirements for the production of lymphocytes and DCs. Genes involved in lineage specification can also be studied. Altogether, these studies have fundamental implications for understanding the biology of pivotal lineages of immune cells. This understanding could be used to treat a variety of immunodeficiencies and to design novel immunotherapies particularly in the context of hematopoietic cell transplantation.

Animals↗
PubMed1998

An investigation into lung correction for tangential breast irradiation.

A solid water breast phantom with a lung equivalent material was constructed to investigate interface effects of 6 MV tangential photon fields. The phantom was built so that Thermo-luminescence Dosimeters (TLD) could be used for comparison to a pencil beam and Equivalent Tissue-Air-Ratio (ETAR) algorithms. The investigation highlighted the limitations in both of these algorithms under clinically anatomical conditions. At the lung/tissue interface both algorithms showed errors between 3-12% depending on the position of the TLD. In tissue greater than 1 cm from the interface region the errors on average were within +/- 5%. Dose comparisons in lung tissue showed similar results to the interface region. These results indicate that normalisation of Reference Dose in the interface region for tangential breast treatments cause over or under estimates of dose.

Breast↗
PubMed1997

Functional and phenotypic characterization of cord blood and bone marrow subsets expressing FLT3 (CD135) receptor tyrosine kinase.

The class III receptor tyrosine kinase FLT3/FLK2 (FLT3; CD135) represents an important molecule involved in early steps of hematopoiesis. Here we compare cell-surface expression of FLT3 on bone marrow (BM) and cord blood (CB) cells using monoclonal antibodies (MoAbs) specific for the extracellular domain of human FLT3. Flow cytometric analysis of MACS-purified BM and CB cells showed that 63% to 82% of BM CD34+ and 88% to 95% of the CB CD34+ cells coexpress FLT3. Clonogenic assays and morphological characterization of FACS-sorted BM CD34+ cells demonstrate that colony-forming unit-granulocyte-macrophage (CFU-GM) and immature myelo-monocytic precursor cells are enriched in the subpopulation staining most brightly with the FLT3 MoAb whereas the majority of the burst-forming units-erythroid (BTU-E) and small cells with lymphoid morphology are found in the FLT3- population. In contrast, statistically indistinguishable proportions of CFU-granulocyte-erythrocyte-megakaryocyte-macrophage (CFU-GEMM) and more primitive cobblestone area forming cells (CAFC) were detected in both fractions, albeit the FLT3+ fraction consistently showed more CAFC activity than the FLT3- fraction. Although in both, BM and CB the majority of CD34+CD117+ (KIT+), CD34+CD90+ (Thy-1+), and CD34+CD109+ cells coexpress FLT3, three-color phenotypic analyses are consistent with the functional findings and suggest that the most primitive cells defined as CD34+CD38-, CD34+CD71low, CD34+HLA-DR-, CD34+CD117low, CD34+CD90+, and CD34+CD109+ express low levels of cell-surface FLT3 and were therefore not enriched to a statistically significant extent with the bright versus negative sorting scheme. Thus, clear segregation of the most primitive progenitors from BM CD34+ cells was confounded by low apparent levels of FLT3 cell-surface expression on these cells, whereas myeloid progenitors unambiguously segregated with the FLT3 brightest cells and erythroid progenitors with the FLT3 dimmest. Additional phenotypic analyses using MoAbs against progenitor/stem cell markers including the mucinlike molecule MGC-24v (CD164), the receptor tyrosine kinases TIE, FMS (CD115), and KIT (CD117) further illustrate the differences in surface antigen expression profiles of BM and CB CD34+ cells. Notably, CD115 is rarely detected on CB CD34+ cells, whereas 20% to 25% of the BM CD34+FLT3+ cells are CD115+. Furthermore, 80% to 95% of the CB CD34+CD117+ but only 60% to 75% of the BM CD34+CD117+ cells coexpress FLT3. Only a negligible amount of CD34+CD19+ are detected in CB, while in BM 20% to 30% of CD34+CD19+ presumed pro/pre-B cells coexpress FLT3. In contrast, the majority of the CD34+CD164+ and CD34+TIE+ subsets in both CB and BM coexpress FLT3. Analysis of unseparated cells showed that FLT3 expression is not restricted to CD34+ subsets. About 65% to 70% of lymphocyte-gated BM CD34-FLT3+ cells are positive for the monocytic marker CD115 whereas 25% to 30% of these cells consist of CD10 expressing B-cell precursors. Finally, CD34- monocytes in BM, CB, and PB express FLT3 whereas granulocytes are FLT3-. Our data show that detectable FLT3 appears first at low levels on the surface of primitive multilineage progenitor cells and disappears during defined stages of B-cell development, but is upregulated and maintained during monocytic maturation.

Bone Marrow↗
PubMed1997

The characterization, molecular cloning, and expression of a novel hematopoietic cell antigen from CD34+ human bone marrow cells.

The adhesion molecule BEN/SC1/DM-GRASP (BEN) is a marker in the developing chicken nervous system that is also expressed on the surface of embryonic and adult hematopoietic cells such as immature thymocytes, myeloid progenitors, and erythroid progenitors. F84.1 and KG-CAM, two monoclonal antibodies to rat neuronal glycoproteins with similarity to BEN, cross-react with an antigen on rat hematopoietic progenitors, but F84.1 only also recognizes human blood cell progenitors. We have defined the antigen recognized by F84.1 as the hematopoietic cell antigen (HCA). HCA expression was detected on 40% to 70% of CD34+ fetal and adult bone marrow cells and mobilized peripheral blood cells. Precursor cell activity for long-term in vitro bone marrow cell culture was confined to the subset of CD34+ cells that coexpress HCA. HCA is expressed by the most primitive subsets of CD34+ cells, including all rhodamine 123(lo), Thy-1+, and CD38(-/lo) CD34+ adult bone marrow cells. HCA was also detected on myeloid progenitors but not on early B-cell progenitors. We also describe here the cloning and characterization of cDNAs encoding two variants of the human HCA antigen (huHCA-1 and huHCA-2) and of a cDNA clone encoding rat HCA (raHCA). The deduced amino acid sequences of huHCA and raHCA are homologous to that of chicken BEN. Recombinant proteins produced from either human or rat HCA cDNAs were recognized by F84.1, whereas rat HCA but not human HCA was recognized by antirat KG-CAM. Expression of either form of huHCA in CHO cells conferred homophilic adhesion that could be competed with soluble recombinant huHCA-Fc. The molecular cloning of HCA and the availability of recombinant HCA should permit further evaluation of its role in human and rodent hematopoiesis.

Adult↗