Biomedical subjects
Publications and source records attributed to D Cole.
Faced with the requirement to effectively plan their services, many nurses say they do not have time to do so. This article shows how one team took time out for this process, and thus enabled it to give its service real direction.
The energy metabolism of the intestinal parasite, Giardia lamblia, involves the iron-sulphur protein, pyruvate:ferredoxin oxidoreductase. Cell fractionation studies showed that this enzyme is associated with the membranes. NADH and NADPH dehydrogenases were found in both the membrane and cytosolic fractions. EPR spectroscopic studies showed the presence of iron-sulphur clusters in the membrane fraction and in the cytosolic fraction, non-sedimentable at 6 x 10(6) g.min. An acidic, soluble protein fraction was separated from the cytosol. It had an EPR spectrum in the reduced state, characteristic of the 2[4Fe-4S] type of ferredoxin, with g-factors at 2.04. 1.93 and 1.89, and the midpoint redox potential was estimated to be -360 mV. This species is probably a ferredoxin, like those of anaerobic bacteria such as Clostridium and Desulfovibrio spp. and also that of Entamoeba histolytica. The protein was readily and irreversibly oxidized to give [3Fe-4S] clusters.
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Until the new Act is in operation, and assuming it has strong and clear sections covering competence, the Medical Council of New Zealand is left with the need to manage unorthodoxy as a form of misconduct unless there is a mental health problem. Charges of misconduct unless there is a mental health problem. Charges of misconduct may arise of there is: harm to patients inadequate information and consent including false representation of the theoretical base of diagnostic method or management, or the training of the doctor, short cuts in the standard methods of diagnosis with the use of unproven and unrecognised methods, treatment programmes that are inappropriate, unjustified, unproven or unsupported by a substantial body of opinion, or that omit consideration if orthodox methods. exploitation in terms of securing patients, financial gain and inadequate aftercare.
The common protozoon, Giardia intestinalis, parasitizes the upper small intestine of man, and is often refractory to treatment by metronidazole. Defective oxygen-scavenging mechanisms have been implicated as a cause of metronidazole resistance of another flagellate Trichomonas vaginalis, where metronidazole is also the most common drug treatment. Oxygen consumption of six clinical isolates of G. intestinalis and one line selected for resistance to metronidazole was measured over 0-50 microM-O2 using an oxygen electrode open for gas exchange. At > 30 microM-O2, inhibition of respiration was demonstrated in all seven stocks. Apparent oxygen affinities (KmO2) were found to range from 0.5 to 5.2 microM-O2; however, isolates from patients who failed to respond to treatment with metronidazole did not have measurably defective O2-scavenging capabilities compared with metronidazole-sensitive isolates. These strains did, however, show elevated NADPH-oxidase activities compared with metronidazole-sensitive strains. Results indicate that biochemical mechanisms of drug resistance in G. intestinalis may be quite different from those operating in T. vaginalis.
PURPOSE: Based on preclinical evidence in murine models that interleukin-6 (IL-6) mediates regression of metastatic tumors, we performed a phase I study of recombinant human IL-6 in patients with refractory advanced malignancies to determine its pharmacokinetics, toxicities, and possible immunologic and antitumor effects. PATIENTS AND METHODS: Recombinant IL-6 was administered as a single subcutaneous dose daily for 7 days, with 7 days off therapy followed by another 7 days of IL-6. Doses were escalated in cohorts of three patients starting at 3 micrograms/kg/d, provided that toxicity at the preceding dose level was not dose-limiting. Dose-limiting toxicity was defined as grade III or IV major organ toxicity that did not resolve to grade II or less in 24 hours after stopping IL-6, using the National Cancer Institute Common Toxicity Criteria. Patients were treated with 3, 10, and 30 micrograms/kg/d IL-6 subcutaneously. RESULTS: Three patients each were treated at the 3- and 10-micrograms dose levels. Two of five patients treated with 30 micrograms/kg/d IL-6 subcutaneously had grade III major organ toxicity that required IL-6 therapy to be discontinued. All patients experienced fever, chills, and minor fatigue. Significant increases in C-reactive protein (CRP), fibrinogen, platelet counts, and lymphocyte IL-2 receptor levels were seen in patients at the 10- and 30-micrograms/kg dose levels. Decreases in albumin and hemoglobin were observed, particularly at the 30-micrograms/kg dose level. The half-life (T1/2 beta) was 4.2 hours, with a peak IL-6 level at 5 hours. No antitumor responses were seen. CONCLUSION: A safely tolerated dose of daily subcutaneous IL-6 is 10 micrograms/kg, with hepatotoxicity and cardiac arrhythmia being the dose-limiting toxicities at 30 micrograms/kg. Phase II trials of IL-6 administered subcutaneously daily for at least 7 days for two cycles with an intervening week of rest are recommended for phase II trials. However, patients with extensive replacement of liver by tumor and abnormal liver functions should receive IL-6 therapy with caution.
The law stipulates that death is irreversible. Patients treated in accord with the Pittsburgh protocol have death pronounced when their condition might well be reversed by intervention that is intentionally withheld. Nevertheless, the protocol is in accord with the medical "Guidelines for the Determination of Death." However, the Guidelines fail to capture the intent of the law, which turns out to be a good thing, for the law embodies a faulty definition of death. The inclusion of "irreversible" in the legal definition makes that definition excessively demanding and out of step with the ordinary concept of death. On this basis the protocol is absolved of the moral but not the legal charge that it involves vivisection.
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The present study examined the value of laboratory tests in predicting condom breakage for 20 lots of latex condoms which differed in age, storage history and laboratory test performance. Two-hundred-sixty-two participating U.S. couples used a total of 4589 latex condoms (mean = 229 condoms per lot, range 224-235). Breakage rates ranged from 3.5 percent for a brand new condom lot to 18.6 percent for a lot that was 81 months old at the time of the study. The statistical predictor models, separately using ultimate elongation from the tensile test, the Condom Quality Index from the airburst volume test, and the percent of condoms failing the airburst volume test as the independent variables and the condom breakage rate as the dependent variable, all appear to have a high level of accuracy in predicting condom breakage in use. The three models had correlation coefficients (R2s) of 0.81, 0.74 and 0.69, respectively. Perhaps the most unexpected result was that the age of the condom lot was the best predictor of condom breakage during use (correlation coefficient (R2) = 0.92). Although the present investigation does not provide sufficient justification to use age as the only factor for decisions on condom lot disposition, it does provide some guidance.
The microaerophilic protozoon Trichomonas vaginals responds to extracellular changes in oxygen concentration: acetate, lactate, ethanol, H2 and CO2 formation, as well as glucose-depletion rates, are affected. All these variables except ethanol production rates, also differed between clinically metronidazole-sensitive (1910) and resistant (IR78 and CDC85) strains. Most interesting were the greatly increased glucose-scavenging rates of resistant isolates and their low specific activities of hydrogenase and H2 formation rates by comparison with the metronidazole-sensitive strain. Results suggest that all three strains of this parasite are well adapted to the O2 levels prevailing in situ (13-56 microM). Thus, vaginal oxygen tensions have more pronounced effects on the balances of fermentation products in the resistant strains, and results indicate that these strains may then use hydrogenosomal pathways to their advantage.
A brief exposure to iodine vapour was used to screen for mutants of the yeast Saccharomyces cerevisiae affected in development. Besides obtaining a large number of asporogenous mutants, two novel mutations were identified that permitted germination of spores to occur in conditions (sporulation medium) in which the wild-type would not germinate. These two mutations were named gdr1 and gdr2 for germination derepressed. Both alter nutritional control of germination, but not the kinetics of germination in glucose-containing medium.
A cDNA, cRKIN1, encoding a putative homologue of the yeast (Saccharomyces cerevisiae) SNF1-encoded protein-serine/threonine kinase, has been isolated from a library prepared from rye endosperm mRNA. Northern blot analysis demonstrated the presence of cRKIN1-related transcripts in developing endosperms but not in shoots, and Southern blot analysis showed the presence of a small gene family. SNF1 plays a central role in carbon catabolite repression in yeast and expression of the RKIN1 sequence in yeast snf1 mutants restored SNF1 function. This suggests that the RKIN1 protein has a role in the control of carbon metabolism in endosperms of rye.
Because the initial evaluation of N,N',N''-triethylenethiophosphoramide (thioTEPA) preceded the standardized approach to the Phase I trials, uncertainty surrounds the recommended dose. Since it has recently been demonstrated that an almost 100-fold increase in dose can be administered in bone marrow transplant regimens, we conducted a Phase I reevaluation of thioTEPA. ThioTEPA was administered i.v. in 50 ml 5% dextrose in water over 10 min. Twenty-seven patients were entered at doses ranging from 30 to 75 mg/m2. The major toxic effect was myelosuppression; thrombocytopenia greater than or equal to grade 3 occurred in four of seven patients, and leukopenia greater than or equal to grade 3 in two of seven patients at 75 mg/m2. Among eight patients at 65 mg/m2 only two had greater than or equal to grade 3 myelosuppression making this the recommended new phase II dose for the majority of patients. Moderate (grade 2) easily controlled nausea and vomiting was the only other major side effect. There was no alopecia or mucosal or neurological toxicity. Three partial remissions were observed among nine previously treated ovarian cancer patients. Plasma concentrations of thioTEPA and its major active metabolite triethylenephosphoramide (TEPA) were measured by gas chromatography. The half-life of thioTEPA ranged from 51.6 to 211.8 min, and its pharmacokinetics was dose dependent; total body thioTEPA clearance decreased with increasing dose. The half-life of TEPA was considerably longer than that of the parent compound (3.0 to 21.1 h); as a result, the area under the plasma concentration-time curve (AUC) of TEPA was severalfold greater than that of the parent compound. The ratio of TEPA AUC to thioTEPA AUC decreased with increasing dose, suggesting that formation of TEPA is a saturable step in elimination. The AUC and total body clearance of thioTEPA, but not of TEPA, were closely correlated with neutrophil but not platelet toxicity.
A patient who developed pupillary dilation on the side of a large cerebral hemorrhage underwent serial examinations, computed tomography, and magnetic resonance imaging. Autopsy dissection was performed to allow in situ examination of the structures near the third nerves and tentorial edge. The origin of the oculomotor nerve was displaced medially, causing the distal nerve to "kink" over the clivus just posterior to the clinoid. Transtentorial herniation of the medial temporal lobe did not appear to play a role in third-nerve compression.
Mice homozygous for a mutant allele (an/an) causing a lifelong macrocytic anemia (Hertwig's anemia) also demonstrate an inability to deliver their offspring, despite normal ovulation, conception, implantation, and fetal development. We investigated the roles of estrogen and relaxin in the etiology of the reproductive defect in the Hertwig's anemia mice. Immunoreactive relaxin levels were undetectable in the nonpregnant controls, whereas levels in both timed-pregnant controls and timed-pregnant affected mice were significantly higher than in nonpregnant controls, but not significantly different from each other. Mean interpubic ligament length in the pregnant Hertwig's anemia mice was significantly greater than that in nonpregnant controls, but significantly less than that in the pregnant controls on Day 18 of pregnancy. Porcine relaxin was administered to nonpregnant affected and unaffected littermates and to nonpregnant controls. Whereas controls showed a significant response to porcine relaxin, neither the Hertwig's anemia mice nor their unaffected littermates responded to the porcine relaxin. Additional study was performed to determine estradiol effects in the affected and control animals utilizing detailed computerized morphometric analysis of uterine horns and cervices from immature, estradiol-injected controls and Hertwig's anemia mice. Results demonstrated a statistically significant trophic effect of estradiol upon uterine horn and cervical enlargement, as assessed by weight and volume, in controls. Only a slight, non-significant effect was seen in Hertwig's anemia mice. Additional histological effects of estradiol, including endometrial enfolding observed in controls, were not present in Hertwig's anemia mice. Lack of response to both estrogen and relaxin is responsible for the parturitional defect in Hertwig's anemia mice.
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