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Biomedical subjects

C L Murray

Publications and source records attributed to C L Murray.

At least 37 records · Page 2Linked to original sources
PubMed1995

Recognition and evaluation of oncology-related symptoms in the emergency department.

STUDY OBJECTIVE: To identify the oncology patient population presenting to the emergency department and examine the causes and clinical management of oncology symptoms in the ED. DESIGN: Retrospective review of 5,640 adult patients, with the following variables identified for oncology patients presenting to the ED: age, sex, cancer type, cancer stage, previous cancer treatment, previous hospitalization, presenting symptoms, treatment provided in the ED, admission and discharge data, and day, time, and length of ED visit. SETTING: Community teaching hospital with annual ED census of 31,000. PARTICIPANTS: All adult oncology patients who presented to the ED during the study period. We identified these patients by cross-referencing ED logs and tumor registry records. RESULTS: Cancer history was identified for 284 of the 5,640 adult ED admissions (5%). Forty-three percent (n = 122) of the 284 patients with cancer history had an oncology-related ED visit. The most common symptoms of these patients were gastrointestinal (48%), pain (40%), neurologic (38%), cardiac (25%), and pulmonary (23%). Ten percent of patients with oncology-related ED visits died during the admission, and 48% died within 1 year of the ED visit. CONCLUSION: Oncology patients present to the ED with symptoms of undiagnosed malignancy, complications of cancer treatment, and acute disease-related symptoms. Knowledge of an individual's cancer history and ability to recognize oncologic symptoms are important to the management of oncology patients.

Aged↗
PubMed1995

Health care delivery reorganization innovative outcome: universal computerized patient identification.

Twenty-three large employers in the Minneapolis/St. Paul area formed the business health care action coalition group (BHCAC) to obtain medical care for their employees and families. Requirements of BHCAC included: 1) detailed reporting of outcomes of both preventive and standard health care, 2) development and successful implementation of practice guidelines, and 3) development of a functioning automated medical record. The coalition was contracted to meet these requirements. A nonprofit foundation--the Institute for Clinical Systems Integration (ICSI)--was formed and the data standards committee created. To ensure registration information transmitted by network would be attached to the correct patient's computer file; a standardized registration data set was agreed upon to be recorded in a uniform manner. This innovative change has allowed, encouraged, and required that clinical data be transferable electronically among organizations. The following are the ICSI data standard requirements for ICSI member organizations: the Health Level 7 (HL7) is to be used for data transmission [1]. Fields to be used include: 1) Social Security Number (SSN): The SSN was chosen as the patient identifier for the reasons listed in [2]. Record the official SSN assigned by the Social Security Administration; record a pseudo-SSN if a social security number is not available following the Veterans Administration (VA) Hospital algorithm. 2) Name: Use the American National Standards Institute (ANSI) Healthcare Informatics Standards Planning Panel (HISPP) and Message Standards Developers Subcommittee (MSDS) Standard for representation of a person's name [3]; completely record all of the person's legal name (including any punctuation, hyphenated and double last names); nicknames and appellations are to be recorded separately; salutations and suffixes are optional, but must be placed in separate computer fields from other name parts. 3) Gender: Allowable values include FEMALE, MALE, OTHER, UNKNOWN. 4) Date of Birth: Include the day, month, year (including century); permitted is approximate or estimated birth dates provided they are indicated as such. Use the ANSI HISPP MSDS standard for date representation [4]. 5) Address: Record at least one address; multiple addresses desirable identified by type or usage (i.E., home, business, office). Allow two or more lines for street, city, U.S. state or Canadian Province; identify by standard two-letter postal abbreviation--zip code (at least 5-digits, preferably 9) or postal code and country. 6) Home ID or Medical Record Number (MRN): Record if different than Social Security Number.

Female↗
PubMed1994

A putative nicotine pump at the metabolic blood-brain barrier of the tobacco hornworm.

In mammals, P-glycoprotein immunostaining at the blood-brain barrier has implicated the multidrug pump in the restricted movement of many cytotoxic agents into the central nervous system (CNS). Since many insects require a sophisticated blood-brain barrier system to protect their CNS from plant-derived neurotoxins, we have investigated the possibility that a P-glycoprotein homolog constitutes a component of the insect blood-brain barrier. We have used the nicotine-resistant tobacco hornworm (Manduca sexta) to address this issue. Manduca has been previously shown, in physiological studies, to have an alkaloid (nicotine/morphine/atropine) pump at its excretory malpighian tubules. We show (1) that the tubules are P-glycoprotein immunopositive, (2) that Manduca has a metabolic blood-brain barrier for nicotine, (3) that the barrier co-localizes with P-glycoprotein immunostaining, and (4) that detoxifying enzymes as well as the nicotine pump are likely to account for the metabolic blood-brain barrier to nicotine. These findings may provide insights on two major fronts, the troublesome problem of multi-insecticide resistance, a phenomenon that parallels multidrug resistance in tumor cells, and the problem of tolerance to addictive neuroactive drugs like nicotine or morphine.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1994

Oral D-fenfluramine and neuroendocrine challenge: problems with the 30 mg dose in men.

Ten healthy male volunteers of normal weight received 30 mg of D-fenfluramine, a putative selective releaser of 5-hydroxytryptamine (5-HT), and placebo by mouth in balanced order at a 1 week interval after a light breakfast. Blood was taken for estimation of plasma cortisol and prolactin, and the patients completed self rating scales for stress and arousal and rated themselves on visual analogue scales for mood, hunger and alertness at appropriate time points from 30 min before to 300 min after drug/placebo ingestion. There were no statistically discernible effects of D-fenfluramine on either hormone measures or subjective ratings. The failure to find effects may be due to a too low dose of D-fenfluramine and/or a lower sensitivity to the drug in men compared with women. More information is required on the dose/response relationship and drug absorption especially after food. However, the findings cast doubt on results already obtained employing this dose of the drug in studies that have included male subjects. Furthermore, the interpretation of earlier studies with D,L-fenfluramine at a dose of 60 mg is also made more uncertain by the failure to confirm that the more selective D-isomer produces equivalent effects.

Administration, Oral↗
PubMed1992

Effects of a single dose of the acetylcholinesterase inhibitor velnacrine on recognition memory and regional cerebral blood flow in Alzheimer's disease.

The effects of a single oral dose of the acetylcholinesterase inhibitor velnacrine maleate on word and object recognition memory and regional uptake of 99mTc-exametazime were examined in patients with Alzheimer's disease. Word recognition memory was marginally improved 2 h after 75 mg velnacrine. With the same dose of velnacrine a relative increase in superior frontal uptake of 99mTc-exametazime was shown with single photon emission computed tomography (SPECT). This suggests increased regional perfusion and metabolism as a consequence of cholinergic stimulation. The effect did not co-vary with the degree of memory improvement, but, instead, more cognitively impaired patients showed a greater increase in tracer uptake after velnacrine, suggesting cholinergic hypersensitivity in the brains of Alzheimer patients.

Aged↗
PubMed1992

Unilateral voluntary hand movement and regional cerebral uptake of technetium-99m-exametazime in human control subjects.

The study examines the sensitivity of a region of interest approach to detect functional changes in brain metabolism with SPECT and split-dose 99mTc-exametazime by replicating a simple hand movement experiment previously carried out with PET. Regional uptake of 99mTc-exametazime was determined in 12 healthy controls before and during a thumb-digit opposition task. Analysis of regional uptake was carried out blind to the hand used in the opposition task and showed a significant unilateral activation effect in a pericentral region of interest with opposite results in left- and right-handed activation. The maximum contralateral increase in tracer uptake was 16% before and 26% after correction for back diffusion. This is in good agreement with previous results employing absolute cerebral blood flow determination with PET and confirms the usefulness of 99mTc-exametazime SPECT for the examination of functional metabolic changes.

Aged↗
PubMed1990

Effect of endocervical specimen quality on detection of Chlamydia trachomatis and on the incidence of false-positive results with the Chlamydiazyme method.

Duplicate endocervical swabs were collected from 1,675 patients to assess the effects of variations in specimen quality on Chlamydiazyme (Abbott Laboratories) detection of Chlamydia trachomatis and the incidence of false-positive results. One swab (at random) from each patient was tested for C. trachomatis antigen by using the standard Chlamydiazyme procedure. A 200-microliter volume of 0.9% saline was added to the other swab from each patient. After vortexing, 20 microliters was smeared on a slide for Papanicolaou (Pap) staining and the remaining specimen was then tested with the Chlamydiazyme assay. The Chlamydiazyme result was positive for 170 (10.1%) and 165 (9.8%) of the stained and unstained duplicate specimens, respectively (no significant difference). Pap stains on smears from 1,536 (91.7%) of the patients were analyzed, and endocervical and/or metaplastic (E-M) cells were detected in 789 (51.4%) smears. Of these 1,536 stained and analyzed specimens, 150 (9.8%) were Chlamydiazyme positive but only 132 (88.0%) of the positive results were confirmed by repeating the test and using a monoclonal blocking antibody (Abbott). Confirmed Chlamydiazyme-positive results were obtained from only 34 (4.6%) of 747 specimens lacking E-M cells but from 98 (12.4%) of 789 specimens containing the cells (P less than 0.001). Of the 150 initially Chlamydiazyme-positive results obtained with Pap-stained, analyzed specimens, 12 (26.1%) of 46 were falsely positive from specimens lacking E-M cells but only 6 (5.8%) of 104 were falsely positive from specimens containing E-M cells (P less than 0.01). C. trachomatis antigen was detected significantly more frequently and false-positive results were significantly less common from specimens in which E-M cells were detected.

Adolescent↗
PubMed1986

The effect of pramiracetam (CI-879) on the acquisition of a radial arm maze task.

The effect of the nootropic drug pramiracetam (CI-879) on acquisition of a radial arm maze task was examined in the rat. Two doses of pramiracetam (7.5 mg/kg and 15 mg/kg) were administered daily prior to testing for 7 weeks in a 16-arm radial maze in which nine arms were baited with food. This procedure permitted a distinction between working memory (short-term) and reference memory (long-term). Both doses of pramiracetam significantly improved performance in the reference memory component of the task, but did not significantly affect the working memory component. These data indicate that pramiracetam can enhance some aspects of spatial learning and memory in the rat.

Animals↗
PubMed1986

Pilocarpine and physostigmine attenuate spatial memory impairments produced by lesions of the nucleus basalis magnocellularis.

The effects of bilateral ibotenic acid-induced lesions of the nucleus basalis magnocellularis (nBM) on the acquisition and retention of several spatial memory tasks were studied in the rat. Maintenance of spatial memory in a food search task was impaired following nBM lesions. Acquisition of spontaneous alternation and reinforced alternation in a T-maze was also significantly impaired in animals with these lesions. In contrast, the animals with nBM lesions were not impaired in the acquisition of a position habit in a T-maze. In several of the tasks there was evidence of some learning in the lesion animals after substantial training, although they were significantly deficient when compared with the controls. Administration of the cholinergic agonists physostigmine sulfate or pilocarpine nitrate prior to behavioral testing resulted in a rapid and significant improvement in the performance of the lesion animals. The ibotenate-induced lesions significantly reduced the activity of choline acetyltransferase (CAT) in the anterior and the posterior neocortex. Hippocampal CAT activity was not changed. The results indicate that the cholinergic projections originating in the nBM are involved in the learning and memory of spatial tasks.

Animals↗
PubMed1985

The hospice concept. Comfort care for dying patients.

The hospice movement is a relatively new but fast-growing approach to caring for the terminally ill. Central to the hospice concept is a team of care-givers who provide care at all levels, not only to the patient but to the family as well. Although the physician serves as adviser, the patient or family makes the final decisions regarding care. The patient is permitted to maintain control as long as possible, thus preserving the right to die with dignity. Home care is a goal of the hospice concept, but in some situations hospital or nursing home care is required. Hospice care does not end with the death of the patient but extends to helping the family during the bereavement period.

Family↗
PubMed1985

Learning and memory deficits after lesions of the nucleus basalis magnocellularis: reversal by physostigmine.

The role of the cholinergic nucleus basalis magnocellularis in spatial learning and memory was studied in the rat. Animals received bilateral injections of ibotenic acid (5 micrograms/microliters) into the region of the nucleus basalis magnocellularis. Six weeks postoperatively they were deprived of food and trained for 5 weeks in a 16-arm radial maze in which 9 of the arms were baited with food. The nucleus basalis magnocellularis-lesioned animals showed significant deficits in the acquisition of the task. Further analysis of the data indicated that this was due primarily to a deficit in reference (long-term) as opposed to working (short-term) memory. After the 5-week training period the nucleus basalis magnocellularis-lesioned animals received intraperitoneal injections of physostigmine sulphate (0.5 mg/kg) 30 min before each daily trial for 1 week. This treatment resulted in a significant improvement in the performance of the spatial memory task on all three measures. The ibotenate lesions reduced the activity of choline acetyltransferase by about 40% in the anterior cortex and by 15% in the posterior cortex. Hippocampal choline acetyltransferase activity was not affected, indicating that the septohippocampal cholinergic projection was spared by the lesions. The activity of glutamate decarboxylase was not affected in any of these regions. These results suggest that the cholinergic projections of the nucleus basalis magnocellularis play an important role in the acquisition of a spatial memory task.

Animals↗
PubMed1984

Reporting the patterns of local medical practices with cancer patients to community hospital physicians: the methodology.

This is a presentation of the methods chosen to present initial data to the physician site committees in the Minneapolis-West Metro Community Hospital Cancer Program. This data will be presented at approximately six-month intervals so that guidelines can be modified, to maximize the effectiveness of the physician management guidelines. The reporting system has been designed to allow each hospital to look at its own data as compared to the aggregate total of all the hospitals (but never another individual hospital), and to allow more detailed studies within a local hospital using the usual quality assurance procedures. The goal is to help in meeting the American College of Surgeons requirement of accredited cancer programs of continued surveillance of the cancer treatment given and the results in hospitals, and to document the effect of the Community Hospital Cancer Program upon cancer patient management.

Computers↗
PubMed1983

Tumors: the Cancer Information System (CIS) of the Minneapolis-West Metropolitan CHCP.

The Cancer Information System of the Minneapolis-West Metropolitan Community Hospital Cancer Program, using the Upper Midwest Oncology Registry System, avoids duplication of effort, is cost effective, has means of quality control, abstracts clinically useful data, provides a case summary, the data is immediately available, has a protocol system to assist the site committees, and provides both structured reports and a Query System for analysis of the data.

Hospitals, Community↗
PubMed1982

Nucleotide sequences of transcription and translation initiation regions in Bacillus phage phi 29 early genes.

phi 29 DNA directs the synthesis of three major proteins of Mr = 22,400, 13,900, and 10,500 in a cell-free transcription-translation system derived from Bacillus subtilis. We have determined the locations of the coding regions for these early proteins on the phi 29 genome, and our results are in agreement with genetic evidence that the 22.4-kilodalton protein is the product of cistron 17 (p17) and the 13.9-kilodalton protein is the product of cistron 6 (p6). The 13.9-kilodalton and 10.5-kilodalton proteins are encoded on a polycistronic mRNA previously designated G3b RNA. We have determined the nucleotide sequence of a HindIII restriction fragment of phi 29 DNA, the H fragment, that encodes the 13.9-kilodalton protein and contains two early promoters, G3a and G3b. The nucleotide sequence of the ribosome binding site contains a polypurine region capable of forming a very stable complex with nine bases on the 3' end of B. subtilis 16 S rRNA. This strong Shine-Dalgarno complementarity supports the hypothesis that an extensive mRNA . rRNA interaction is a requirement for efficient translation by B. subtilis ribosomes (McLaughlin, J. R., Murray, C. L., and Rabinowitz, J. C. (1981) J. Biol. Chem. 256, 11283-11291). The nucleotide sequences of both promoters are very similar to the "consensus" sequence for Escherichia coli promoters. While E. coli RNA polymerase initiates transcription from both of these promoters in vitro, only the G3b promoter is utilized by B. subtilis RNA polymerase under the same conditions.

Bacillus subtilis↗
PubMed1981

Plasmid-directed expression of Staphylococcus aureus beta-lactamase by Bacillus subtilis in vitro.

A plasmid carrying the Gram-positive Staphylococcus aureus PC1 beta-lactamase gene is active in directing a cell-free transcription and translation system from Bacillus subtilis. The major protein synthesized has been identified as the S. aureus beta-lactamase on the basis of peptide mapping. The protein is larger than the extracellular enzyme by about Mr = 3100. Significant in vitro translation of the beta-lactamase mRNA occurs in the absence of the initiation factor fraction as is characteristic of translation of mRNAs of Gram-positive origin. The 1250 base transcript that encodes the beta-lactamase and leader sequence has been mapped on the plasmid molecule.

Bacillus subtilis↗
PubMed1981

Unique features in the ribosome binding site sequence of the gram-positive Staphylococcus aureus beta-lactamase gene.

The base sequence of the ribosome binding site region of the Gram-positive Staphylococcus aureus beta-lactamase gene has been determined. The leader peptide sequence of 24 amino acids which precedes the NH2 terminus of extracellular S. aureus beta-lactamase has also been established. This initiation site possesses two unique features not observed for most initiation sites recognized by Escherichia coli ribosomes. A novel initiation codon, UUG, initiates protein synthesis with methionine; and a very strong Shine-Dalgarno complementarity containing five G-C base pairs precedes the UUG initiation codon. The strong Shine-Dalgarno complementarity may explain the reduced translational dependence on initiation factor IF-3 function that has been observed for the beta-lactamase mRNA and other mRNAs from Gram-positive bacteria. We suggest that this extent of complementarity between the mRNA and this extent of complementarity between the mRNA and the ribosome may be a requirement for efficient initiation by Bacillus subtilis and other Gram-positive ribosomes, and may provide the basis for the observed inability of the Gram-positive systems to translate most of the mRNAs from Gram-negative bacteria.

Amino Acid Sequence↗