Cystic fibrosis in a Puerto Rican female homozygous for the R1066C mutation.
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Adult↗
Biomedical subjects
D Klein
Publications and source records attributed to D Klein.
Continuous quality improvement, total quality management, and reengineering: one hospital's continuous quality improvement journey.
In recent years, there has been significantly increasing interest in the application of continuous quality improvement (CQI) and total quality management (TQM) in the health care arena. This case analysis is designed to identify and assess the strategies and processes that led to the successful implementation of CQI in the Emergency Care Center at St. Mary's Hospital in Grand Rapids, MI.
Admitting Department, Hospital↗
Bull's eye! Management tool helps target costs and bag savings.
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Contract Services↗
Assessing quality in managed care: health plan reporting of HEDIS performance measures.
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Benchmarking↗
Signal-enhancing switched protocols to study higher-order cognitive tasks with PET.
UNLABELLED: We tested the effectiveness of a switched protocol when it is used to detect signals that result from the study of a higher-order cognitive task with PET. Using language tasks that have been studied extensively in our laboratories, we compared the signal-to-noise ratio (S/N) and statistical significance of the activation signals detected in PET images of regional cerebral blood flow (rCBF), obtained using a standard activation protocol, and of activity concentration, obtained using a switched protocol. METHODS: Four volunteers were studied with PET while they were performing synonym-generation and word-repetition tasks (activation and baseline tasks, respectively). Each volunteer had three activation/baseline and three baseline/ activation scans. Data for each scan were collected in two frames (60 and 120 sec long). During the first 60 sec, data were collected using a standard activation protocol. Subjects then switched tasks, and acquisition continued for 120 sec. Two images were obtained from each scan: an rCBF image using the first frame and an activity-concentration image using both frames. Images were transformed into Talairach space, subtracted and averaged within and across subjects. Parametric t-statistic images were generated for each protocol, and the magnitude and significance of the activation signals yielded by the two acquisition methods were compared. RESULTS: All the activation foci detected using measurements of rCBF were detected when the switched protocol was used; this protocol, in addition, yielded better S/N values. The cognitive component introduced by task-switching in switched protocols did not yield extra statistically significant foci. In single subjects, the average improvement in the signal significance from regions of activation, at a 95% confidence level, was between 6% and 25%. When scans were averaged across subjects, the switched protocol yielded improvements in signal statistical significance of up to 38%. CONCLUSION: We present evidence suggesting that switched protocols can be used to study higher-order cognitive tasks and that they yield activation foci with S/N values that are greater than those of equivalent foci detected using an rCBF protocol. Switched protocols appear to be easy to apply to the testing of higher-order cognitive functions. However, the extra cognitive requirement of switching tasks during data acquisition may be a limiting factor when switched protocols are used to study memory processes.
Adult↗
Alcohol and drug CAGE screeners for pregnant, low-income women: the California Perinatal Needs Assessment.
The purpose of this study is to evaluate a revised CAGE and a new drug version of the CAGE as screeners for risk of heavier or problem alcohol and/or drug use among a population of low-income, pregnant women and adolescents (n = 1147) recruited from 19 agencies in two California counties. Two versions of the CAGE were used in this analysis: (1) the 4-item Alcohol CAGE, using the year before knowing about pregnancy as the timeframe (as opposed to lifetime prevalence), and (2) a newly developed 4-item Drug CAGE using the same timeframe. The two instruments were assessed on sensitivity, specificity, and area under the receiver operating characteristic curve by using self-reported periconceptional heavier or problem alcohol and drug use as the criteria for the 12 months before knowing about the pregnancy. The results indicate that, for the Alcohol CAGE, the cut-point of 1 yielded the highest sensitivity, while maximizing sensitivity and specificity (receiver operating characteristic analysis) for this sample. For heavier drug use, the Drug CAGE had a high sensitivity rate with a cut-point of 3. The Drug CAGE was not a useful screener for periconceptional lighter drug and marijuana use. These results demonstrate the utility of a revised version of the Alcohol CAGE that incorporates a more specific timeframe (the year before pregnancy) to screen pregnant, low-income women for at-risk heavier or problem alcohol use. The Drug CAGE, which uses the same timeframe, seems to be an effective tool for identifying pregnant, low-income women at risk for heavier drug use only. More psychometric works needs to be done to refine the Drug CAGE for detecting at-risk use of lighter drugs and marijuana.
Adolescent↗
Obligatory role of the LIFG in synonym generation: evidence from PET and cortical stimulation.
We report results from a patient in whom we obtained converging evidence from positron emission tomography (PET) and intraoperative stimulation mapping to support a one-way dissociation between the functional areas involved in word repetition and synonym generation. Intraoperative stimulation mapping interfered with synonym generation but did not disturb word repetition at the same left inferior frontal site at which a cerebral blood flow (CBF) increase had been observed for a synonym generation task. The results for this single subject suggest that the functional areas involved in different aspects of linguistic processing are dissociable and that specific disruption under conditions of cortical stimulation can be correlated with the brain regions identified via PET as the most active during performance of a specific task.
Adult↗
Site-directed mutagenesis of the Actinomadura R39 DD-peptidase.
The role of various residues in the conserved structural elements of the Actinomadura R39 penicillin-sensitive dd-peptidase has been studied by site-directed mutagenesis. Replacement of Ser-298 of the 'SDN loop' by Ala or Gly significantly decreased the kcat/Km value for the peptide substrate, but only by a factor of 15 and had little effect on the other catalytic properties. Mutations of Asn-300 of the same loop and of Lys-410 of the KTG triad yielded very unstable proteins. However, the N300S mutant could be purified as a fusion protein with thioredoxin that exhibited decreased rates of acylation by the peptide substrate and various cephalosporins. Similar fusion proteins obtained with the N300A, K410H and K410N mutants were unstable and their catalytic and penicillin-binding properties were very strongly affected. In transpeptidation reactions, the presence of the acceptor influenced the kcat/Km values, which suggested a catalytic pathway more complex than a simple partition of the acyl-enzyme between hydrolysis and aminolysis. These results are compared with those obtained with two other penicillin-sensitive enzymes, the Streptomyces R61 dd-peptidase and Escherichia coli penicillin-binding protein (PBP) 5.
Actinomycetales↗
Binding of Cu to metallothionein in tissues of the LEC rat with inherited abnormal copper accumulation.
Long-Evans Cinnamon (LEC) rats aged 16 +/- 4 weeks with histopathological alterations of liver and kidney, exhibited elevated Cu levels in liver, kidney and spleen which were 52, 27 and 5 times higher than those of the respective tissues of age-matched Wistar rats. About 61% of hepatic and about 38% of renal Cu was recovered in the cytosolic fraction. Metallothionein (MT) levels were found to correlate with the cytosolic Cu concentrations in liver and kidney. According to differential MT analysis, about 68 and 82% of hepatic and renal MT was loaded with Cu. The portion of MT which binds Cu was negatively correlated with the ratio of cytosolic Zn/Cu in all organs investigated. Despite high MT levels and the high percentage of Cu binding to MT, particularly in liver and kidney, considerable amounts of Cu remained unbound to MT. This non-MT bound Cu showed good correlation with the total cytosolic Cu content, and might play a crucial role in the pathogenesis of Cu toxicosis.
Animals↗
Class I mhc genes of cichlid fishes: identification, expression, and polymorphism.
Cichlid fishes of the East African Rift Valley lakes constitute an important model of adaptive radiation. Explosive speciation in the Great Lakes, in some cases as recently as 12 400 years ago, generated large species flocks that have been the focus of evolutionary studies for some time. The studies have, however, been hampered by the paucity of biochemical markers for phylogenetic reconstruction. Here, we describe a set of markers which should help to alleviate this problem. They are the class I genes of the major histocompatibility complex. We provide evidence for the existence of at least 17 class I loci in cichlid fishes, and for extensive polymorphism of three of these loci. Since the polymorphism has a trans-species character, it will be possible to use it in investigating the founding events of the individual species. The sequences of the cichlid class I fishes support the monophyly of actinopterygian fish on the one hand, and of tetrapods on the other.
Animals↗
Rapid identification of viable retrovirus-transduced cells using the green fluorescent protein as a marker.
Various methods for determining the expression of the beta-galactosidase (beta-gal) gene after retroviral transduction were compared as a means to assess retroviral titre. To allow better comparison, different retroviral vectors were constructed carrying two mutants of the green fluorescent protein and assessed as sensitive markers of retroviral gene transfer. It could be demonstrated that GFP is generally superior to beta-gal in terms of sensitivity, speed and non-invasiveness of assay, allowing easy direct FACS sorting of populations of transduced cells. This opens the possibility of enrichment by sorting of ex vivo transduced cells in gene therapy protocols.
Animals↗
The use of porphyrins for eradication of Staphylococcus aureus in burn wound infections.
The assessment of deuteroporphyrin-hemin complex as an agent for the treatment of burn wounds infected with a multiple-drug resistant strain of Staphylococcus aureus was performed. The effect of the porphyrin on the survival of the infectious bacteria was first assayed in culture, and later tested as well in a burned infected animal model. The addition of deuteroporphyrin and hemin, separately or together (as a complex) to a growing culture of S. aureus was monitored during 8 hours. It was found that deuteroporphyrin alone was strongly bactericidal only after photosensitization. On the other hand, hemin alone was moderately bactericidal but light independent. A combination of both deuteroporphyrin and hemin was extremely potent even in the dark and did not require illumination to eradicate the bacteria. The in vivo experiments by application of the above porphyrins in combination to infected burn wounds in guinea pigs was an effective way to reduce dramatically the contaminating S. aureus. Reduction of more than 99% of the viable bacteria was noted after the porphyrin mixture was dropped on the eschar or injected into the eschar, an effect that lasted for up to 24 hours. The deuteroporphyrin-hemin complex may be suggested as a new bactericidal treatment of S. aureus infected burns since it was found to be a potent and promising anti-Staphylococcal agent.
Administration, Topical↗
Linking sociological with physiological data: the model of effort-reward imbalance at work.
While socio-epidemiologic studies documented impressive associations of indicators of chronic psychosocial stress with cardiovascular (c.v.) disease evidence on patho-physiologic processes is still limited. In this regard, the concept of heightened c.v. and hormonal reactivity (RE) to mental stress was proposed and explored. While this concept is a static one we suggest a more dynamic two-stage model of RE where recurrent high responsiveness (stage 1) in the long run results in attenuated, reduced maximal RE due to functional adaptation (stage 2). We present results of an indirect test of this hypothesis in a group of 68 healthy middle-aged men undergoing a modified Stroop Test: in men suffering from high chronic work stress in terms of effort-reward imbalance significantly reduced RE in heart rate, adrenaline and cortisol was found after adjusting for relevant confounders. In conclusion, results underscore the potential of linking sociological with physiological data in stress research.
Humans↗
[Laparoscopic cholecystectomy during pregnancy].
The decision whether to perform cholecystectomy during pregnancy, and in what manner, is complex. A 26-year-old pregnant woman was admitted because of persistent biliary colic, which did not respond to conservative treatment. Laparoscopic cholecystectomy was done, with a normal course and without negative effects on the pregnancy. Contraindications to laparoscopic cholecystectomy are becoming fewer as technique improves and experience accumulates. This case report is added to the other few reported, which reinforce the view that pregnancy should no longer be considered a contraindication to laparoscopic cholecystectomy.
Adult↗
Penile mass caused by the newly described organism Mycobacterium celatum.
We report a penile infection in a man with the acquired immunodeficiency syndrome caused by a newly described infectious organism, Mycobacterium celatum. Mycobacterium tuberculosis is the only mycobacterial species previously reported to cause infection in the penis. This is only the third documented human infection with M celatum, and the first to involve the genitourinary system.
AIDS-Related Opportunistic Infections↗
[Risk of hyperthyroidism in examinations with contrast media].
Investigations with contrast media inevitably lead to the patient being exposed to large amounts of iodine. Under certain preconditions this gentails danger for the patient by causing either iodine-induced hyperthyroidism, which is difficult to treat, or even a thyrotoxic crisis. Patients with normal thyroid function and size have only minute changes of thyroid hormones and TSH within the normal range and are not at risk. Patients with unknown hyperthyroidism--independent of the etiological form--and patients with functional autonomy are at risk of exacerbation of pre-existing hyperthyroidism or development of iodine-induced hyperthyroidism. This development depends on two factors: a) the volume of autonomous tissue and b) the quantity of iodine exposure. Besides contrast media, other sources of iodine excess are possible, such as iodine-containing disinfectants, secretolytic agents, antiarrhythmics like amiodarone, eye drops and ointments, geriatrics, skin ointments, toothpaste etc. The development of hyperthyroidism can be prevented by combined treatment with antithyroid drugs and perchlorate in the case of preexisting hyperthyroidism or the urgent clinical suspicion of thyrotoxicosis or with perchlorate alone, when the patients is euthyroid and does not have a large nodular goitre.
Contrast Media↗
2-Chloroacetophenone is an effective glutathione depletor in isolated rat hepatocytes.
The glutathione (GSH) depleting effect of 2-chloroacetophenone (CN) was studied in freshly isolated rat hepatocytes. CN proved to be more effective in depleting GSH than diethylmaleate, phorone or styrene oxide. The reaction between GSH and CN followed a 1:1 stoichiometry, allowing adjustment of cellular GSH concentrations at distinct levels. After incubating cells (8 mg protein/ml) with 200 mumol CN/l for 5 min, GSH depletion was almost complete without signs of cytotoxicity. At 300 mumol/l CN, GSH depletion persisted, and cytotoxicity occurred after 30 min. Activities of cytochrome P450 dependent enzymes, even at concentrations up to 500 mumol CN/l, were only marginally affected. Therefore, CN is of particular value for in vitro studies at decreased availability of GSH.
Animals↗
[Indications for total parenteral nutrition or small intestine transplantation?--Prognostic factors in short bowel syndrome].
After massive intestinal resection resulting in short bowel syndrome it is often unclear if the patient will remain on total parenteral nutrition (TPN) or regain enteral autonomy. Small bowel transplantation or bowel-lengthening procedures could potentially be a therapeutic option for patients confined to life-long parenteral nutrition. Initiated early in the course of the disease this could prevent frequent serious complications of long-term parenteral nutrition. However, it is unclear which factors determine the outcome of these patients. For further information on the long-term prognosis, data of 33 patients with short bowel syndrome operated in our institution from 1982 to 1995 were retrospectively analyzed and the present status of all living patients evaluated. Gender, age or underlying disease had no influence on the adaptation of the small intestine or the duration of TPN in the surviving patients. Return to enteral autonomy mainly depended upon the length of the remaining small and large bowel. Thus the further course of the disease can be predicted and necessary measures can be taken as this information is always available at the time of initial surgery.
Adult↗