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Biomedical subjects

C J Harris

Publications and source records attributed to C J Harris.

51 records · Page 3Linked to original sources

Comparison of angiotensinogen and tetradecapeptide as substrates for human renin. Substrate dependence of the mode of inhibition of renin by a statine-containing hexapeptide.

The kinetic properties of two different substrates for human renin, a synthetic tetradecapeptide and the natural substrate human angiotensinogen, have been compared. While the Vmax was similar for the two substrates, the Km values differed by a factor of 10, i.e., 11.7 +/- 0.7 microM (tetradecapeptide) and 1.0 +/- 0.1 microM (angiotensinogen). The mode of inhibition of renin by a statine (Sta)-containing hexapeptide, BW897C, that is a close structural analog of residues 8-13 of human angiotensinogen (Phe-His-Sta-Val-Ile-His-OMe), was determined for the two substrates. Competitive inhibition was observed when tetradecapeptide was the substrate (Ki = 2.0 +/- 0.2 microM), but a more complex mixed inhibition mode (Ki = 1.7 +/- 0.1 microM, Ki' = 3.0 +/- 0.23 microM) was found with angiotensinogen as substrate. This mixed inhibition probably results from the formation of an enzyme-inhibitor-substrate or enzyme-inhibitor-product complex and reflects the more extensive interactions that the protein angiotensinogen, as opposed to the small tetradecapeptide substrate, can make with renin. We conclude that the mixed inhibition observed when angiotensinogen is used as renin substrate could be important in the clinical application of renin inhibitors because it is less readily reversed by increased concentrations of substrate than is simple competitive inhibition.

Amino Acids↗

Mammogram interpretation by physician assistants.

The objective of this study was to determine whether a health maintenance organization (HMO) desirous of providing low-cost, quality mammography could employ physician assistants (PAs) to interpret mammograms under the supervision of HMO radiologists. After intensive training in mammographic interpretation, four PAs individually interpreted 727 mammograms of 470 normal breasts, 75 breasts with benign breast masses, and 182 breasts with cancer. The interpretations by the PAs were more sensitive and as specific as those made by six HMO radiologists who interpreted the same cases, and as effective as those by radiologists described in the literature. In receiver-operating-characteristic curve analysis, the areas under curves for PAs were larger than those under curves for radiologists. Interpretations by PAs took less time and cost less than did those by radiologists; the dispositions recommended by PAs were similar to those recommended by radiologists. We conclude that properly trained, evaluated, and supervised PAs can interpret mammograms. Legal, practical, and ethical considerations dictate that this can best be accomplished under the direction of radiologists who are well trained in mammography.

Female↗

Human renin: a new class of inhibitors.

A new class of human renin inhibitor is described, containing a novel analogue of the peptide bond. High inhibitory potency was observed for octapeptide-length substrate analogues but inhibition progressively weakened as the molecule was shortened from the amino terminal end.

Amino Acid Sequence↗

Dorsovertical lumbotomy approach for surgery of upper urinary tract calculi.

During a 30-month interval 26 patients underwent pyelolithotomy or upper ureterolithotomy through the dorsovertical lumbotomy approach. The intraoperative course and postoperative performance were compared to those in a similar group of patients operated upon using the standard flank incision. Our analysis established the superiority of the dorsovertical lumbotomy incision for all factors evaluated, especially postoperative drainage, analgesic use and hospital stay. The surgical steps are described in detail and the relative contraindications are discussed.

Adult↗

Citrullinemia: prenatal diagnosis of an affected fetus.

We monitored a pregnancy in a family at risk for citrullinemia due to argininosuccinic acid (ASA) synthetase deficiency. ASA synthetase activity in cultured epithelioid amniotic fluid cells from the fetus at risk was less than 2% of control epithelioid amniotic fluid cell activity. An increased concentration of citrulline was found in the at-risk amniotic fluid (0.14 mumol/ml) as compared with fluid from six controls and one at-risk but unaffected pregnancy (trace). The pregnancy was terminated, and the in utero diagnosis was confirmed by assay of ASA synthetase activity in cultured fetal skin fibroblasts (4.4% of control activity). In addition, all five fetal tissues studied had significant accumulation of citrulline, whereas control fetal tissues had none. These data provide evidence that, if precise control is maintained over tissue culture variables, citrullinemia can be diagnosed successfully in utero by microassay of ASA synthetase activity in cultured amniotic fluid cells. They also suggest that amniotic fluid citrulline concentrations provide strong adjunctive evidence for this prenatal diagnosis.

Amino Acid Metabolism, Inborn Errors↗

Partial trisomy 14 (q23 leads to qter) via segregation of a 14/X translocation.

An infant with delayed development and multiple congenital anomalies was found to possess a duplication of 14q23 leads to qter. This imbalance arose through segregation of a maternal 14/X translocation, observed in only 28% of the mother's cells. Although the X-chromosome-derived portion of the translocation was late replicating in the proposita, the autosomal segment was not inactivated, leading to functional trisomy for distal 14q. Phenotypic comparison to cases with similar duplications does not allow the clinical description of a partial trisomy syndrome.

Abnormalities, Multiple↗

Care for all: 10 reforms that could save the system.

The many problems of medical care in the United States have been stated and restated. These problems have evolved over the years and cannot be attributed to one or even a few causes. Most proposals for change are for single problems and their remedy will not produce meaningful reform, much less stop medical inflation. Today's problems are yesterday's solutions. There are 10 reforms that, if accomplished, could bring fairness, cost accountability, and financial controls to the health care system, while retaining competition and choice.

Cost Control↗

Influence of a mobile worksite health promotion program on health care costs.

The continued rising cost of health care has prompted some business to invest in mobile worksite health promotion programs, which screen employees for health risk and pursue risk reduction through counseling, health education, and referral to medical treatment. The purpose of this study was to examine the influence of a mobile worksite health promotion program on health care costs. We conducted a five-year retrospective study on 1,325 city employees insured by the City of Mesa, Arizona. Of these, 340 had participated in the CIGNA Health-plan mobile worksite health promotion program for two years. The participants were age-matched and sex-matched with 340 control subjects who were also employed and insured by the city. We analyzed participant and control group health care costs for two years before and two years after program initiation. Repeated measures analysis of variance (2 x 2 MANOVA) indicated a significant decrease in health care costs in both groups (P < .0063). The control group had a 7% decrease, while the participant group decreased 16%. Further analysis showed specific reductions in general sickness, outpatient and inpatient claims, and total claims use. Costs for substance abuse/psychological treatment and for emergency care did not decrease. Benefit-to-cost ratio for the entire program resulted in a $3.6 savings for every dollar spent. Mobile worksite health promotion programs can be effective in reducing employee health care expenditures among both program participants and nonparticipants.

Cost-Benefit Analysis↗