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Biomedical subjects

C Lawrence

Publications and source records attributed to C Lawrence.

At least 19 recordsLinked to original sources

A potential generic downstream process using Cibracon Blue resin at very high loading capacity produces a highly purified monoclonal antibody preparation from cell culture harvest.

The use of a dye-ligand chromatography for the purification of monoclonal antibody (MAb) from cell culture and other feed streams has been largely overlooked in large scale production. Cibracon Blue dye (CB), a polycyclic anionic ligand, interacts with protein through a specific interaction between the dye, acting as a mimic of NAD+ and NADP+, or through non-specific electrostatic, hydrophobic, and other forces. In this paper, a CB resin was used to effectively and efficiently separate an IgG4 MAb from host and process impurities following the capture of the MAb on a Protein-A (PA) column. The CB unit operation, challenged at </=180 g MAb/L of resin with the PA eluate, reduced BSA (1-2 log), host cell protein (HCP; 2-3 log), MAb oligomer (31-85%), fragment (from approximately 0.8% to <0.1%), and other undesired MAb species. Purity, as measured by non-reducing (NR) SDS-PAGE, was improved 33-85%, to 92-99.5% overall (>99% by reducing SDS-PAGE). A facile three column scalable production scheme, employing CB as the second column in the process was used to generate highly purified MAb from cell culture harvest derived from two media of very different compositions. Free CB dye was </=1 ng/mg in MAb preparations purified through the three column process and then concentrated and buffer exchanged into the appropriate buffer using tangential flow filtration (TFF).

Animals↗

Control of an ACC-1-producing Klebsiella pneumoniae outbreak in a physical medicine and rehabilitation unit.

This article describes an outbreak of ACC-1-producing Klebsiella pneumoniae involving 40 patients. These were mainly men under 40 years old with a spinal cord injury, in a physical medicine and rehabilitation unit. The main risk factors were prolonged hospital stay, multiple-bed rooms, tracheostomy care and assisted defaecation. The outbreak was only controlled after the introduction of rigorous patient placement (i.e. single rooms or cohorting in the same room), while allowing the patients to have free access to the various technical services (e.g. physiotherapy and occupational therapy) and living spaces necessary for re-education.

Adult↗

Terminal ileal stricture in Crohn's disease: treatment using a metallic enteral endoprosthesis.

Enteral strictures are a frequent indication for surgery in Crohn's disease. Postoperative complications are increased in patients with poor preoperative nutritional status, which is common in this patient population. We present a 49-year-old female with longstanding Crohn's disease admitted to our Digestive Health Center with four weeks of increasing abdominal symptoms and radiographic evidence of small-bowel obstruction caused by ileal stricture. Given her poor nutritional status, our team elected to pursue metallic enteral stenting as a bridge to surgical resection. Two Wallstents were placed; luminal patency was subsequently confirmed by a fluoroscopic study. The patient tolerated regular diet and was discharged. When seen in follow-up, she remained asymptomatic and wished to defer surgical intervention indefinitely.

Contrast Media↗

Temporomandibular joint morphology following post-traumatic ankylosis in 26 patients.

This study evaluated the joint morphology on coronal computed tomography of ankylosed temporomandibular joints in 26 patients. All patients developed ankylosis following blunt trauma. Post-ankylosis joint morphology was assessed to determine if the precursor condylar fracture could be identified and this was compared to the condylar fracture prevalence to determine if any condylar fractures have an increased risk factor for ankylosis. Mean age at presentation was 20.9+/-14.41 years (range 6-58) and mean age at injury was 13.84+/-13.81 years (range 3-53). Thirty-seven joints were ankylosed in 26 patients (11 bilateral, 15 unilateral) with 27 joints in 19 patients showing vestiges of a medially dislocated condylar fracture (72.9% of joints). The prevalence of MDCF at our unit over a period of 6 months was 16.8% (16 of 95 condylar fractures). This suggests that a medially dislocated condylar fracture is more likely to ankylose than other condylar fractures. A hypothesis is proposed to explain this increased risk.

Adolescent↗

[Routine screening of antibiotic-resistant bacteria in acute rehabilitation units].

OBJECTIVES: The objective of this study was to evaluate the epidemiology of antibiotic-resistant bacteria among motor impaired patients admitted to an acute rehabilitation unit. METHODS: From January 2000 to December 2002, the acute rehabilitation units of R. Poincare Hospital have screened patients for methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase enterobacteria (ESBL-EB) carriage by nasal and rectal swab at admission, every month and exit. RESULTS: Finally, MRSA was isolated form screening or diagnosis samples of 360 patients and ESBL-EB from screening or diagnosis samples of 170 patients, corresponding respectively to an incidence of 3.6 for 1000 days of hospitalization (DH) and 1.7 for 1000 DH. 66% (236/360) of MRSA carriers and 58% of ESBL-EB carriers were identified only by screening samples. Carriage origin was identified for year 2002: Cases were imported for 40% (26/65) of MRSA carriers and 43% (18/42) of ESBL-EB carriers. The median acquisition delays were of 31 days [3-154] for MRSA and 19 days [3-317] for ESBL-EB. CONCLUSION: This allowed to set up contact precautions for more than 2 fold patients that would have allowed diagnosis samples alone.

Drug Resistance, Bacterial↗

Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma.

These guidelines for management of primary cutaneous squamous cell carcinoma present evidence based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation. To reflect the collaborative process for the UK, this article is subject to dual publication in the British Journal of Dermatology and the British Journal of Plastic Surgery.

Carcinoma, Squamous Cell↗

Axillary hyperhidrosis: eccrine or apocrine?

We review the literature regarding axillary hyperhidrosis, discuss normal sweat gland function and postulate on the respective roles of the eccrine, apocrine and apo-eccrine glands in the pathophysiology of excessive axillary sweating.

Apocrine Glands↗

[Molecular markers in the epidemiologic study of Legionella pneumophila infections].

PURPOSE: Legionnaires' disease is due to the inhalation of contaminated aerosols. The identification of the source of contamination in the aquatic environment is necessary to prevent the occurrence of new cases. A comparative study of clinical and environmental isolates is the basis of epidemiological investigations. CURRENT KNOWLEDGE AND KEY POINTS: Genotypic methods are now mainly used to compare bacterial strains. Some of these methods are based on the electrophoretic separation of DNA restriction fragments. When electrophoretic profile are complex, some fragments can be visualized after hybridization (ribotyping). Large-sized fragments can be separated by pulsed-field gel electrophoresis. Other techniques are based on gene amplification, such as AP-PCR. This technique is easy to perform but its discriminatory power and reproducibility are lower. Some procedures are combining enzymatic cleavage and gene amplification. Finally methods based on the nucleotide sequence analysis of some genes are being evaluated. FUTURE PROSPECTS AND PROJECTS: Techniques enabling the rapid comparison of various Legionella isolates will permit a quick detection of outbreaks and contribute to the identification of the source of contamination.

DNA, Bacterial↗

Improved resuscitation training of senior house officers in oral and maxillofacial surgery.

All healthcare professionals are expected to be competent at cardiopulmonary resuscitation. In a previous study [Br J Oral Maxillofac Surg 1999; 37: 1], senior house officers in oral and maxillofacial surgery (OMFS) expressed dissatisfaction about their training in resuscitation, and we now report the results of a follow-up survey. The amount of training in resuscitation has increased in the 5 years since the initial questionnaire, and 77% of the 73 respondents (n=56) been given such training in the 12 months before the present survey, compared to 48% in the previous study. Fifty-one (70%) now think that they would feel confident if required to resuscitate a patient who had a cardiorespiratory arrest, and this has increased from 47%. Despite this, 70 (96%) of senior house officers in OMFS stated that they wanted further training in cardiopulmonary resuscitation.

Cardiopulmonary Resuscitation↗

Rotational motion in liquid water is anisotropic: a nuclear magnetic resonance and molecular dynamics simulation study.

Experimental NMR measurements of the deuterium and (17)O T(1) relaxation times in deuterium-enriched liquid water have been performed from 275 to 350 K. These relaxation times can yield rotational correlation times of appropriate molecule-fixed unit vectors if the quadrupole coupling constants and asymmetry parameters are known. We determine the latter from ab initio studies of water clusters and experimental chemical shift measurements. We find that the rotational correlation time for the OD bond vector in D(2)(16)O varies from 5.8 ps at 275 K to 0.86 ps at 350 K, and that the rotational correlation time for the out-of-plane vector of dilute D(2)(17)O in D(2)(16)O varies from 4.4 ps at 275 K to 0.64 ps at 350 K. These results indicate that the rotational motion of water is anisotropic. Molecular dynamics simulations of liquid water are in good agreement with these experiments at the higher temperatures, but the simulation results are considerably faster than experiment at the lower temperatures.

Journal Article↗

Second generation knockout sickle mice: the effect of HbF.

Sickle transgenic mice expressing exclusively human globins are desirable for studying pathophysiology and testing gene therapy strategies, but they must have significant pathology and show evidence of amelioration by antisickling hemoglobins. Mice were generated that expressed exclusively human sickle hemoglobin with 3 levels of HbF using their previously described sickle constructs (cointegrated human miniLCRalpha2 and miniLCRbeta(S) [PNAS 89:12150, 1992]), mouse alpha- and beta-globin-knockouts, and 3 different human gamma-transgenes. It was found that, at all 3 levels of HbF expression, these mice have balanced chain synthesis, nearly normal mean corpuscular hemoglobin, and, in some cases, F cells. Mice with the least adult HbF expression were the most severe. Progressive increase in HbF from less than 3% to 20% to 40% correlated with progressive increase in hematocrit (22% to 34% to 40%) and progressive decrease in reticulocyte count (from 60% to 30% to 13%). Urine concentrating ability was normalized at high HbF, and tissue damage detected by histopathology and organ weight were ameliorated by increased HbF. The gamma-transgene that produces intermediate levels of HbF was introduced into knockout sickle mice described by Pàszty and coworkers that express the miniLCRalpha1(G)gamma(A)gammadeltabeta(S) transgene and have fetal but not adult expression of HbF. It was found that the level of HbF required to ameliorate low hematocrit and normalize urine concentrating defect was different for the miniLCRalpha2beta(S) and miniLCRalpha1(G)gamma(A)gammadeltabeta(S) mice. We conclude that knockout mice with the miniLCRalpha2beta(S) transgene and postnatal expression of HbF have sufficiently faithful sickle pathology to serve as a platform for testing antisickling interventions.

2,3-Diphosphoglycerate↗

Sex-related difference in amygdala activity during emotionally influenced memory storage.

We tested the possibility suggested by previous imaging studies that amygdala participation in the storage of emotionally influenced memory is differentially lateralized in men and women. Male and female subjects received two PET scans for regional cerebral glucose-one while viewing a series of emotionally provocative (negative) films, and a second while viewing a series of matched, but emotionally more neutral, films. Consistent with suggestions from several previously published studies, enhanced activity of the right, but not the left, amygdala in men was related to enhanced memory for the emotional films. Conversely, enhanced activity of the left, but not the right, amygdala in women was related to enhanced memory for the emotional films. These results demonstrate a clear gender-related lateralization of amygdala involvement in emotionally influenced memory, and indicate that theories of the neurobiology of emotionally influenced memory must begin to account for the influence of gender.

Adult↗

Dietary intake of elite figure skating dancers.

The main objective of the present study was to examine the dietary intake and physiological status of members of the US National Figure Skating Dance Team. Study participants included seven female and seven male figure skating dance pairs. Three-day food records were collected from each dancer and analyzed using a computerized nutrient database. Height, body weight and skinfold measurements were completed on each dancer. Body fat was estimated using the Jackson et al prediction equations. Fasting blood samples were collected for biochemical analysis. Total energy intake of female dancers (1416 kcal/d, 339 kjoules/day) was considerably lower than the dietary recommendations, while the male dancers appeared to have adequate energy intake (2837 kcal/d, 679 kjoules/day). Carbohydrate intake of both male and female dancers was below the recommendations, 44% and 51%, respectively, whereas total fat and protein intake of both male and female dancers were higher than the dietary recommendations. All dancers met at least 2/3(rd) of the dietary recommendations for all micro-nutrients, except folate and zinc intake of the female dancers, which were 68% and 62% of the recommended values. Although, blood lipid concentrations and other physiological parameters of the overall group were within normal ranges, two of the dancers (14% of the dancers) had elevated blood cholesterol concentrations and low iron status. The results of the present study suggest that these elite figure skating dancers, especially females, may not be consuming adequate amounts of energy-yielding nutrients and those that influence bone health. Future studies are needed to examine the effects of nutritional status on performance of these figure skating dancers and to develop strategies to improve the nutritional status of these elite dancers.

Journal Article↗

From blacklist to beacon, a case study in reducing dermatology out-patient waiting times.

At its worst our dermatology department had a waiting list for routine appointments of 57 weeks. As a result we started to lose contract income and consequently were unable to replace a retiring consultant. The service faced fragmentation and loss of the inpatient ward. Using a series of internally planned and driven initiatives it was possible to retrieve the situation. Our efforts were recognized by a national waiting list Beacon award in 1999. This study describes the methods used to increase new patient throughput, reduce demand and hence reduce waiting time for new patient appointments. Change was achieved only when medical, nursing staff, general practitioners, managers and health authorities were involved in the process. The changes needed to be led by a consultant enthusiast and managed effectively. There remains a constantly increasing demand for the service and reducing the waiting list simply invites a further increase in referral. In a resource-limited health care system the provider must be able to limit demand by using agreed referral exclusion criteria in order to balance supply and demand.

Ambulatory Surgical Procedures↗

Multiple antibiotic changes during the first 72 hours of hospitalization.

BACKGROUND: Increasing concern about inappropriate antibiotic use prompted us to examine whether our patients were receiving frequent and perhaps unwarranted changes of antibiotic therapy. METHODS: We evaluated antibiotic prescribing by the physicians in the Emergency Department and by those on the inpatient medical service during the first 72 hours of hospitalization in 119 patients admitted with suspected serious infections to an acute care, university-affiliated, municipal teaching hospital. The appropriateness of antibiotic prescriptions was assessed independently and retrospectively by 2 infectious disease specialists (each based at a different hospital) using a 4-grade scale (from 1 = wrong choice to 4 = appropriate). Of their evaluations of the 427 antibiotic regimens given to the 119 patients during 4 defined intervals during their first 72 hours of hospitalization, 90% agreed with each other within 1 grade. Their evaluations were then compared with the selections that had been made at each interval by the prescribing physicians. RESULTS: Successive prescribing physicians changed the antibiotic regimens in 77% of cases during the first 24 hours and in 56% during the next 48, often without apparent clinical or microbiologic indications. By 72 hours, the 119 patients had received a mean of 3.1 +/- 1.3 (+/-SD) different antibiotics, and 40 received between 4 and 7. Only 7% of the patients had no change in the regimen prescribed originally. CONCLUSIONS: Many patients had multiple changes of antibiotics, often unnecessarily, resulting in exposure to too many agents.

Anti-Bacterial Agents↗