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Biomedical subjects

B Quinn

Publications and source records attributed to B Quinn.

At least 55 records · Page 3Linked to original sources
PubMed1999

Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial.

200 adult respiratory distress syndrome patients were included in a prospective multicenter randomized trial to determine the efficacy of computerized decision support. The study was done in 10 medical centers across the United States. There was no significant difference in survival between the two treatment groups (mean 2 = 0.49 p = 0.49) or in ICU length of stay between the two treatment groups when controlling for survival (F(1df) = 0.88, p = 0.37.) There was a significant reduction in morbidity as measured by multi-organ dysfunction score in the protocol group (F(1df) = 4.1, p = 0.04) as well as significantly lower incidence and severity of overdistension lung injury (F(1df) = 45.2, p < 0.001). We rejected the null hypothesis. Efficacy was best for the protocol group. Protocols were used for 32,055 hours (15 staff person years, 3.7 patient years or 1335 patient days). Protocols were active 96% of the time. 38,546 instructions were generated. 94% were followed. This study indicates that care using a computerized decision support system for ventilator management can be effectively transferred to many different clinical settings and significantly improve patient morbidity.

Adult↗
PubMed1998

A model of hydrogen bond formation in phosphatidylethanolamine bilayers.

We have modelled hydrogen bond formation in phospholipid bilayers formed, in excess water, from lipids with phosphatidylethanolamine (PE) headgroups. The hydrogen bonds are formed between the NH3+ group and either of the PO2- or the (sn2 chain) C=O groups. We used a model that represented the conformational states accessible to a PE headgroup by 17 states and modelled lipid dipole-dipole interactions using a non-local electrostatics theory to include the effects of hydrogen bonding in the aqueous medium. We used Monte-Carlo simulation to calculate equilibrium thermodynamic properties of bilayers in the fluid (T = 340 K) or gel (T = 300 K) phases of the bilayer. We defined Eh to be the difference in free energy between a hydrogen bond formed between a pair of lipid groups, and the energy of hydrogen bonds formed between water and those two groups, and we required its average value, [Eh], to be approximately -0.3kcal/mol (approximately -0.2 X 10(-13) erg) as reported by T.-B. Shin, R. Leventis, J.R. Silvius, Biochemistry 30 (1991) 7491. We found: (i) Eh = -0.9 X 10(-13) erg gave [Eh] = -0.21 X 10(-13) erg (gel phase) and [Eh] = -0.19 X 10(-13) erg (fluid phase). (ii) The relative number of C=O groups on the sn2 chain calculated to take part in interlipid hydrogen bonding in the fluid phase compared to the gel is 1.06 which compares well with the experimental ratio of approximately 1.25 (R.N.A.H. Lewis, R.N. McElhaney, Biophys. J. 64 (1993) 1081). The ratio of such groups taking part in interlipid hydrogen bonding compared to water hydrogen bonding in each phase was calculated to lie between 0.16 and 0.17. (iii) We calculated the distribution of positions of the headgroup moieties, P, O, CH2(alpha), CH2(beta) and N, and found that, in both phases, the O lay furthest from the hydrocarbon chain layer (average approximately 5.3A) with the PO2 and NH3 groups lying at approximately 5A. This results in the P-N dipole lying nearly parallel to the bilayer plane in both phases. The thickness of the headgroup layer underwent essentially no change on going from the gel to the fluid phase. The 2H NMR quadrupole splittings for the alpha and beta CH2 groups were 4.9 and 5.7kHz (fluid phase) and 7.1 and 7.3 kHz (gel phase), respectively, on the assumption of sufficiently rapid rotation around the z-axis. (iv) In both phases, the location of the NH3+ group exhibited a strong peak around 5.2 A into the aqueous medium, with much smaller peaks around 2.6 and 7.8 A, the two CH2 groups exhibited narrower, double-peaked distributions and the O and the PO2 each exhibited a narrow single peak. (v) PE headgroups, in a homogeneous gel phase, exhibited dipolar orientational long-range order in the plane of the bilayer. The distribution of orientation angles exhibited a full width at half height of between approximately 40 degrees and approximately 50 degrees. In a fluid phase no such order was observed. (vi) The number of hydrogen bonds did not differ substantially between the fluid and gel phases. This model is unlikely to display any significant effect of hydrogen bonding upon the "main" hydrocarbon chain melting phase transition at Tm, except, possibly, a broadening of any hysteresis, compared to the case of PC bilayers where interlipid hydrogen bonding is absent.

Computer Simulation↗
PubMed1998

Comparison of ceftiofur sodium and oxytetracycline for treatment of acute interdigital phlegmon (foot rot) in feedlot cattle.

OBJECTIVE: To determine whether ceftiofur sodium would be useful for treatment of acute interdigital phlegmon (foot rot) in cattle. DESIGN: Randomized controlled trial. ANIMALS: 308 cross-bred yearling steers with clinical signs of acute interdigital phlegmon (i.e., lameness with interdigital swelling, interdigital lesions, or both). PROCEDURE: Steers were randomly assigned to 1 of 3 treatment groups: ceftiofur at a dosage of 0.1 mg/kg (0.045 mg/lb) of body weight, IM, every 24 hours; ceftiofur at a dosage of 1.0 mg/kg (0.45 mg/lb), IM, every 24 hours, and oxytetracycline at a dosage of 6.6 mg/kg (3 mg/lb), IM, every 24 hours. All animals were treated for 3 days; treatment was considered successful if animals were no longer lame on day 4. Biopsy specimens were collected prior to treatment from 5 animals in each group and submitted for anaerobic bacterial culture and histologic examination. RESULTS: Success rates for the high-dosage ceftiofur (94/129; 73%) and oxytetracycline (87/128; 68%) groups were significantly higher than that for the low-dosage ceftiofur group (5/50; 10%), but there were no significant differences between the high-dosage ceftiofur and oxytetracycline groups. Anaerobic bacteria most frequently isolated from biopsy specimens were Porphyromonas levii and Provetella intermedia. CLINICAL IMPLICATIONS: Use of ceftiofur at a dosage of 1.0 mg/kg for treatment of cattle with acute interdigital phlegmon was as effective as use of oxytetracycline at a dosage of 6.6 mg/kg. However, ceftiofur has a negligible withdrawal time and, therefore, may be a better choice for treatment of near-market weight animals.

Acute Disease↗
PubMed1998

Synaptophysin staining in normal brain: importance for diagnosis of ganglioglioma.

Neuronal and mixed glioneuronal tumors traditionally have comprised a very small percentage of intrinsic central nervous system neoplasms, although they are somewhat more common among juvenile brain tumors and in the temporal lobe. Neuronal differentiation increasingly is recognized in pleomorphic xanthoastrocytoma, intraventricular neurocytoma, and subependymal giant cell astrocytoma. However, the diagnostic distinctions between subtle ganglioglioma (with rare neurons) and infiltrating glioma with entrapped neurons and between infiltrating oligodendroglioma and parenchymal neurocytoma are problematic but may be clinically important. Recently, it was proposed that perisomatic synaptophysin immunostaining in the human central nervous system reliably and selectively discriminates neoplastic from nonneoplastic neurons. Using this criterion, the number of brain stem and spinal cord gangliogliomas could be increased substantially. We canvassed synaptophysin immunostaining patterns in the normal brain stem, cerebellum, and forebrain, and found that synaptophysin-positive neurons are distributed broadly in the normal human brain. In disturbed neocortical tissue, such as near vascular malformations, synaptophysin-positive neurons and irregular white-matter synaptophysin immunostaining are visualized. Although synaptophysin-positive neurons are found in gangliogliomas and archipelagos of synaptophysin reactivity are found in neurocytomas, these patterns clearly are not pathognomonic for glioneuronal tumors and must be interpreted with caution whenever other histologic or ultrastructural evidence of neuronal differentiation is lacking.

Adult↗
PubMed1997

Headache etiology in a pediatric emergency department.

BACKGROUND: Headache may be the presenting complaint of serious diagnoses such as meningitis, brain tumor, or shunt malfunction, yet no previous studies have examined the spectrum of diagnoses for the pediatric emergency department (ED) population with a chief complaint of headache. METHODS: In 1993, 53,988 visits were made to the ED of an urban children's hospital. Six hundred ninety-six patients (1.3%) had a chief complaint of headache. Half of these visits, distributed randomly throughout the year, were chosen for review; total sample size was 288. RESULTS: Patient age ranged from two to 18 years (2-5 years, 24.3%; 6-12 years, 57.6%; 13-18 years, 18.1%). The spectrum of ED diagnoses included viral illness (39.2%), sinusitis (16.0%), migraine (15.6%), post-traumatic headache (6.6%), streptococcal pharyngitis (4.9%), and tension headache (4.5%). No cases of brain tumor or bacterial meningitis were identified at the time of ED visit. The only serious neurologic conditions diagnosed were 15 cases of viral meningitis (5.2%), one shunt malfunction, one newly diagnosed hydrocephalus, one Burkitt's lymphoma patient with newly diagnosed CNS infiltration, and one punctate hemorrhage post head trauma. Two thirds of patients had radiologic and/or laboratory tests. Positive findings were as follows: 45.6% of sinus radiographs, 16.3% of rapid streptococcal antigen tests, 60.9% of lumbar punctures, and 19.0% of brain imaging studies. The frequency of serious and nonserious conditions as a cause of headache was compared to data from general EDs. CONCLUSION: Serious conditions presenting with the chief complaint of headache in the pediatric ED were not common in our population. The most frequent diagnoses in our review were viral illness, sinusitis, and migraine, in contrast to adult studies in which tension headache and migraine were most common. Only 6.6% of patients had serious neurologic diagnoses, which is in the range reported for general EDs. Of the serious conditions in our study, 80% were viral meningitis.

Adolescent↗
PubMed1997

CD44 expression in astrocytic tumors.

CD44 belongs to a family of adhesion molecules displayed by a wide range of normal and malignant cells. Several studies implicated its presence as a marker for poor prognosis or metastases, especially in breast and colon cancer. CD44 has been proposed as an invasion marker for glioblastoma. We studied 75 astrocytic tumors with different degrees of anaplasia including juvenile pilocytic astrocytoma (JPA), low-grade astrocytoma (LGA), anaplastic astrocytoma (AA), and glioblastoma multiforme (GBM) to determine whether standard CD44 (CD44s) can be used as a clinically useful marker distinguishing between low- and high-grade gliomas. Archival paraffin-embedded tissues from 19 JPAs, 20 LGAs, 17 AAs, and 19 GBMs were immunostained with standard CD44 monoclonal antibody and compared with glial fibrillary acidic protein, using the streptavidin-complex peroxidase technique. Immunostaining was rated on a three-tiered scale by two observers. The expression of variant-splice forms of CD44 (CD44v) have been variably reported in brain tumors; a subset of these gliomas were tested with anti-CD44v monoclonal antibodies. In the tumors studied, 89% of JPAs, 90% of LGAs, 76% of AAs, and 84% of GBMs have 2+ or 3+ intensity for CD44s. Low- and high-grade gliomas showed no significant difference in staining (P > .05). Therefore, CD44s does not seem to correlate with the grading range of astrocytomas. The overall intensity of CD44s immunostaining usually, but not always, showed concordance with glial fibrillary acidic protein immunostaining, but the distinctive membrane staining of CD44s surface staining revealed fine cytologic detail in tumor cell processes in diagnostic sections. Some very anaplastic tumors were negative for CD44s, and gliomas were immunonegative for CD44v6. If variant chains (CD44v) are not found in gliomas and if this large series of low- and high-grade gliomas show no difference in CD44 expression, other factors must be explored to understand the differential behavior of low- and high-grade astrocytomas.

Alternative Splicing↗
PubMed1996

A differentiated silver intensification procedure for the peroxidase-diaminobenzidine reaction.

Several silver-based procedures have been developed to intensify the peroxidase-catalyzed diaminobenzidine polymer used as a marker in immunohistochemistry. Many of these methods use acutely unstable reagents or reagents that are not amenable to batch processing. We describe a new procedure with an initial treatment in dilute ammoniacal silver, followed by a differentiation step to remove background staining and a final toning in 0.2% gold chloride. The procedure provides a jet-black intensification of the tan diaminobenzidine product, is amenable to batch processing of free-floating sections and slide-mounted sections, and does not require acid-cleaned glassware.

3,3'-Diaminobenzidine↗
PubMed1995

Fluoro nissl green: a novel fluorescent counterstain for neuroanatomy.

Fluorescent neuroanatomic techniques, such as immunofluorescence and retrograde and anterograde tracing studies, derive great utility from their specificity. However, the specificity can be a drawback as well, in that it may be difficult to assess labeled neurons or neural processes in their cytoarchitectonic context. We report the characteristics of a newly synthesized fluorescent counterstain, Fluoro Nissl Green (3,8-diamino-10H-quindoline) with spectral characteristics similar to fluorescein. This Nissl-like counterstain can be used as a green neuronal counterstain for red-emitting markers such as rhodamine and Di-I.

Alkaloids↗
PubMed1995

Chronic encephalitis associated with epilepsy: immunohistochemical and ultrastructural studies.

Chronic encephalitis has been recognized as a cause of epilepsy since the work of Rasmussen et al. in the late 1950s. Despite this, few immunohistochemical studies of the affected brain tissue have been attempted. We have studied specimens of brain tissue from seven patients with this condition who underwent therapeutic multilobar cortical resection or hemispherectomy. Immunohistochemical studies were carried out using antibodies to glial fibrillary acidic protein (GFAP), proliferating cell nuclear antigen (PCNA, PC10), T lymphocytes (UCHL-1), B lymphocytes (L26), macrophages and microglia (HAM-56), and major histocompatibility complex molecules (LN3 and beta 2-microglobulin). Additionally, the results of preliminary immunohistochemical and ultrastructural investigation of possible immune complex deposition in blood vessel walls of affected brain tissue are presented. The pattern of GFAP immunoreactivity suggested a patchy and/or laminar disease process in most patients. GFAP immunoreactive cells were especially prominent around microvessels in some cases, suggesting an abnormality and perivascular collections of inflammatory cells, seen to a variable extent in all cases, contained abundant cells immunolabelled with UCHL-1, LN3 and beta 2-microglobulin. L26-labelled B lymphocytes were extremely sparse. Anti-PCNA frequently labelled microvascular endothelial cells, rare pericytes and occasional cells with microglial/macrophage morphology. The data suggest that chronic encephalitis found in patients with epilepsy results from patchy but widespread parenchymal brain injury, in the course of which cells of both microglial and lymphocyte series accumulate or proliferate within brain.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Unilateral hippocampal mossy fiber sprouting and bilateral asymmetric neuron loss with episodic postictal psychosis.

Rarely are both sides of the hippocampus available for pathological study in a patient with intractable temporal lobe epilepsy (TLE). The authors report a patient with TLE investigated with bilateral depth electrodes who had an episode of postictal psychosis. The patient died 4 weeks after temporal lobectomy of unknown reasons, despite complete postmortem examination and clinical evidence of postsurgery seizure control. Pathological examination of surgical and autopsy hippocampal specimens found bilateral asymmetric neuron losses. However, only the resected epileptogenic hippocampus showed the profile of neuron loss typical of mesial temporal sclerosis (MTS) and abnormal mossy fiber synaptic reorganization. Quantitative depth electroencephalographic (EEG) analysis of the postictal psychotic event showed that it was not associated with a cluster of seizures, increased postictal depth EEG spike activity, or insufficient antiepileptic medication. These results support the hypothesis that ipsilateral hippocampal epileptogenesis is associated with MTS and mossy fiber sprouting. The results also suggest that the etiology of postictal psychosis in this patient was initiated by an ictal event and the behavior apparently depended on seizure propagation outside the hippocampus. The relevance of these two findings to the literature is discussed.

Adult↗