Search PubMed⌕ Search

Biomedical subjects

D Lee

Publications and source records attributed to D Lee.

At least 127 records · Page 7Linked to original sources
PubMed2001

Accompany the sick: a unique practice in Chinese hospitals by patients' relatives and friends.

There is a practice commonly found in many Chinese hospitals called 'accompany the sick' (pei ban). It means that many patients' relatives or friends 'live' with patients in the hospital. Such practice can benefit patients in that the visitors are providing psychological support and carrying out some bedside nursing care to the patients. However, it also creates many problems to nurses and hospitals such as overcrowding, an over-demand of hospital resources, and maintaining quality care. There is no study of such practice. In order to gain better understanding of 'accompany the sick', its impact on nursing practice and nursing professional development, identifying the contributing factors of such practice is needed. This is an ethnographic case study of a public hospital in western China. The study has discovered a number of factors that contribute to the practice, such as the Chinese concept of duty of care, the geographic and economic situation, and the unique culture of nursing practice. This is a pilot study and the result of this study will contribute to further study in nurses' work in China.

China↗
PubMed2001

Automatic skeleton generation for visualizing 3D, time-dependent fluid flows: application to the virtual aneurysm.

Intracranial aneurysms are the primary cause of non-traumatic subarachnoid hemorrhage. Difficulties in identifying which aneurysms will grow and rupture arise because the physicians lack important anatomic and hemodynamic information. Through simulation, this data can be captured, but visualization of large simulated data sets becomes cumbersome, often resulting in visual clutter and ambiguity. To address these visualization issues, we developed an algorithm that extracts a skeleton of the patterns in 3D, time-dependent blood flow. The algorithm decomposes the blood flow into "bare-bones" components that can be visualized individually or superimposed together to formulate an understanding of the flow patterns in the aneurysm.

Cerebrovascular Circulation↗
PubMed2001

Thyroid auto-antibodies, lymphocytic infiltration and the development of post-operative hypothyroidism following hemithyroidectomy for non-toxic nodular goitre.

BACKGROUND: Auto-immune thyroiditis, associated with detectable thyroid auto-antibodies (TAAs) and lymphocytic infiltration into the gland, is known to be associated with progressive development of hypothyroidism. This study examines those patients who required surgical treatment of non-toxic nodular goitre by hemithyroidectomy to determine whether the presence of TAAs in the circulation and/or lymphocytic infiltration of the gland resulted in a significant degree of post-operative hypothyroidism. METHOD: This was a prospective study, with data collected retrospectively. All patients operated on for thyroid disease in the unit over a 5-year period were documented, and those patients treated by hemithyroidectomy for non-toxic nodular goitre formed the study group. TAAs were measured, histology re-examined and patients followed up for at least 2 years to detect clinical or sub-clinical hypothyroidism. RESULTS: Of the 158 patients who comprised the study group, 38 (24.1%) developed hypothyroidism. Forty-one (25.9%) had circulating levels of TAAs, 31 of these (75.6%) having high levels. Of these 41 patients, 22 (53.7%) became hypothyroid. Twenty (64.5%) of the 31 patients with high levels of TAAs required post-operative thyroxine. Of the remaining 117 patients with no detectable TAAs, only 16 (13.7%) became hypothyroid. CONCLUSION: All patients requiring treatment by hemithyroidectomy should have circulating TAA measurements carried out pre-operatively. If positive, they should be followed up indefinitely because of the strong possibility (P < 0.001) of the development of hypothyroidism.

Adolescent↗
PubMed2001

Antiretroviral activity and safety of abacavir in combination with selected HIV-1 protease inhibitors in therapy-naive HIV-1-infected adults.

OBJECTIVE: To assess antiretroviral efficacy and safety of abacavir in combination with selected HIV-1 protease inhibitors. DESIGN: A 48-week, open-label study. MATERIALS AND METHODS: Eighty-two antiretroviral naive HIV-1-infected adults (CD4 cell count > or = 100 cells/mm3, plasma HIV-1 RNA > or = 5,000 copies/ml) were randomly assigned to receive abacavir (300 mg twice daily) in combination with standard doses of one of five protease inhibitors: indinavir, saquinavir soft-gel, ritonavir, nelfinavir or amprenavir. Adults who met protocol-defined switch criteria at or after week 8 could modify their randomized therapy. Antiretroviral activity was assessed by the proportion of subjects with plasma HIV-1 RNA < or = 400 and < or = 50 copies/ml, and by changes in plasma HIV-1 RNA levels and CD4 cell counts. Safety was assessed by monitoring clinical adverse events and laboratory abnormalities. RESULTS: At week 48, the proportion of subjects in the indinavir, saquinavir, ritonavir, nelfinavir and amprenavir groups with plasma HIV-1 RNA < or = 400 copies/ml was 53, 50, 50, 41 and 56%, respectively, and the proportion with HIV-1 RNA < or = 50 copies/ml was 47, 56, 50, 47, and 44%, respectively (by intent-to-treat analysis). Median reductions from baseline in plasma HIV-1 RNA for each group ranged from 1.7 to 2.4 log10 copies/ml. The median CD4 cell count increase from baseline was 195, 131, 116, 136 and 259 cells/mm3 in the indinavir, saquinavir, ritonavir, nelfinavir, and amprenavir groups, respectively. Overall, the most common adverse events attributed to study drugs were diarrhoea, nausea, malaise/fatigue, headache and perioral paresthesia. The frequency of treatment-limiting adverse events did not differ between groups. CONCLUSIONS: Abacavir is safe and effective when used in combination with a protease inhibitor.

Administration, Oral↗
PubMed2001

Transthoracic and transesophageal echocardiographic diagnosis of aneurysm of the sinus of Valsalva: a review of five year experience.

BACKGROUND: Aneurysms of the sinus of Valsalva (SVA) are uncommon congenital lesions. The clinical presentations vary from asymptomatic to progressive heart failure following rupture of the aneurysm into an adjacent cardiac chamber. Retrograde aortogram is the diagnostic tool of choice preoperatively. Recent studies have demonstrated that the SVA can be accurately diagnosed using transthoracic two-dimensional, and color Doppler flow mapping, even for surgical preparation without cardiac catheterization. We report our 5-year experience of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in the evaluation of SVA. METHODS: Eleven adult patients with SVA with or without rupture were studied using both TTE and TEE. All of the diagnoses were subsequently comfirmed by either cardiac catheterization or surgical findings. RESULTS: Aneurysms originated in the right coronary sinus (n = 9) and noncoronary sinus (n = 2); they ruptured into the right ventricle in 5 patients and the right atrium in 5 patients. An unruptured right SVA was noted in 1 patient. Both TTE and TEE could identify the site of the aneurysm, rupture sites, and the receiving chamber equally well. Co-existent cardiac lesions included 11 cases of valvular aortic regurgitation (mild in 7, moderate in 2 and severe in 2). Two cases of perimembranous type ventricular septal defect (VSD) and 6 cases of supracristal type VSD (including 1 case of tetraology of Fallot, 3 supracristal, 1 muscular and 1 subaortic) were noted. Three cases were complicated with valvular vegetations (1 aortic valve, 1 aortic and tricuspid valve and 1 aortic and pulmonic valve). One patient had patent ductus arteriosus and 2 patients had pulmonic valvular stenosis. CONCLUSIONS: TEE provides clearer definition for the detailed anatomy of the ruptured sac and co-existent cardiac lesions than TTE through high resolution and closer approach. We conclude that TEE is a powerful complementary diagnostic tool in the evaluation of patients with SVA. TEE also provides additionally useful information for guiding the surgical approach and for assessing the operative results even without cardiac catheterization.

Adult↗
PubMed2001

Cryopreservation of ovarian tissue: banking reproductive potential for the future.

Cryopreservation of ovarian tissue is a technology that holds promise for banking reproductive potential for the future. It may be apropos for cancer survivors who have undergone treatment with sterility-inducing chemotherapy. Although there is some evidence suggesting cellular and molecular injury with the freezing and thawing process, there are examples in both animals and humans that transplantation of cryopreserved ovarian tissue can effectively bank reproductive potential for the future. This technology may ultimately have applications for in vitro fertilization, and preventing natural or iatrogenic menopause.

Animals↗
PubMed2000

True recurrence vs. new primary ipsilateral breast tumor relapse: an analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management.

PURPOSE: The purpose of this study was to classify all ipsilateral breast tumor relapses (IBTR) in patients treated with conservative surgery and radiation therapy (CS+RT) as either new primary tumors (NP) or true local recurrences (TR) and to assess the prognostic and therapeutic implications of this classification. METHODS AND MATERIALS: Of the 1152 patients who have been treated at Yale-New Haven Hospital before 1990, 136 patients have experienced IBTR as their primary site of failure. These relapses were classified as either NP or TR. Specifically, patients were classified as NP if the recurrence was distinctly different from the primary tumor with respect to the histologic subtype, the recurrence location was in a different location, or if the flow cytometry changed from aneuploid to diploid. This information was determined by a detailed review of each patient's hospital and/or radiotherapy record, mammograms, and pathologic reports. RESULTS: As of 2/99, with a mean follow-up of 14. 2 years, the overall ipsilateral breast relapse-free rate for all 1152 patients was 86% at 10 years. Using the classification scheme outlined above, 60 patient relapses were classified as TR, 70 were classified as NP and 6 were unable to be classified. NP patients had a longer mean time to breast relapse than TR patients (7.3 years vs. 3.7 years, p < 0.0001) and were significantly younger than TR patients (48.9 years vs. 54.5 years, p < 0.01). Patients developed both TR and NP at similar rates until approximately 8 years, when TR rates stabilized but NP rates continued to rise. By 15 years following original diagnosis, the TR rate was 6.8% compared to 13.1% for NP. Of the patients who had been previously tested for BRCA1/2 mutations, 17% (8/52) had deleterious mutations. It is noteworthy that all patients with deleterious mutations had new primary IBTR, while patients without deleterious mutations had both TR and NP (p = 0.06). Ploidy was evenly distributed between TR and NP but NP had a significantly lower S phase fraction (NP 13.1 vs. TR 22.0, p < 0.05). The overall survival following breast relapse was 64% at 10 years and 49% at 15 years. With a mean follow-up of 10.4 years following breast relapse, patients with NP had better 10-year overall survival (TR 55% vs. NP 75%, p < 0.0001), distant disease-free survival (TR 41% vs. NP 85%, p < 0.0001), and cause-specific survival (TR 55% vs. NP 90%, p < 0.0001). CONCLUSION: It appears that a significant portion of patients who experience ipsilateral breast tumor relapse following conservative surgery and radiation therapy have new primary tumors as opposed to true local recurrences. True recurrence and new primary tumor ipsilateral breast tumor relapses have different natural histories, different prognoses, and, in turn, different implications for therapeutic management.

Adult↗
PubMed2000

Dysregulated expression of androgen-responsive and nonresponsive genes in the androgen-independent prostate cancer xenograft model CWR22-R1.

Treatment of metastatic prostate cancer with androgen-ablation often elicits dramatic tumor regressions, but the response is rarely complete, making clinical recurrence inevitable with time. To gain insight into therapy-related progression, changes in gene expression that occurred following androgen-deprivation of an androgen-dependent prostate tumor xenograft, CWR22, and the emergence of an androgen-independent tumor, CWR22-R, were monitored using microarray analysis. Androgen-deprivation resulted in growth arrest of CWR22 cells, as evidenced by decreased expression of genes encoding cell cycle components and basal cell metabolism, respiration and transcription, and the induced expression of putative negative regulatory genes that may act to sustain cells in a nonproliferative state. Evolution of androgen-independent growth and proliferation, represented by CWR22-R, was associated with a reentry into active cell cycle and the up-regulation of several genes that were expressed at low levels or absent in the androgen-dependent tumor. Androgen repletion to mice bearing androgen-independent CWR22-R tumors induced, augmented, or repressed the expression of a number of genes. Expression of two of these genes, the calcium-binding protein S100P and the FK-506-binding protein FKBP51, was decreased following androgen-deprivation, subsequently reexpressed in CWR22-R at levels comparable with CWR22, and elevated further upon treatment with androgens. The dysregulated behavior of these genes is analogous to other androgen-dependent genes, e.g., prostate-specific antigen and human kallikrein 2, which are commonly reexpressed in androgen-independent disease in the absence of androgens. Other androgen-responsive genes whose expression decreased during androgen-deprivation and whose expression remained decreased in CWR22 were also identified in CWR22-R. These results imply that evolution to androgen-independence is due, in part, to reactivation of the androgen-response pathway in the absence of androgens, but that this reactivation is probably incomplete.

Androgens↗
PubMed2000

Capillary zone electrophoresis of a recombinant adenovirus.

Adenovirus preparations are used as vectors in a number of gene therapy clinical development programs. The success of commercial production of adenovirus will strongly depend on the development of methods to define the recombinant virus product by analysis as opposed to being defined by the manufacturing process. While most analytical techniques examine portions of the virus, e.g. proteins or DNA, ion-exchange chromatography has been used to separate intact virus at low efficiency. A free zone capillary electrophoretic method was developed for high-efficiency separations of adenovirus 5. Experimental conditions such as buffer pH and concentration were explored which produced a high-efficiency separation in less than 20 min. The virus band was identified by collection of CE fractions and examination using a cell based assay. Initially, a single virus peak is found in fresh virus samples. After as little as one freeze-thaw in 1 x phosphate-buffered saline with 2% sucrose, the active virus migrates as a regular series of peaks. The nature of the virus modification leading to the differing electrophoretic mobilities is presently under investigation.

Adenoviridae↗
PubMed2000

Rapid transbilayer phospholipid redistribution associated with exocytotic release of neurotransmitters from cholinergic nerve terminals isolated from electric ray Narke japonica.

Asymmetric phospholipid distribution between the outer and inner monolayers of cholinergic synaptosomal membranes at rest and their redistribution upon depolarization-induced acetylcholine (ACh) release were investigated. Translocation of phospholipids between the monolayers was measured using fluorescence-labeled phospholipid probes, NBD-PS, NBD-PE, and NBD-PC. The percentage of probes in the inner leaflet at equilibrium in synaptosomes at rest was estimated to be 63% (NBD-PS), 36% (NBD-PE), and 31% (NBD-PC). Depolarization-induced exocytosis induced rapid redistribution of these probes. Approximately 35% of PS and PC in the inner leaflet moved to the outer leaflet, whereas only 16% of PE moved. To further elucidate the mechanism of exocytosis and membrane fusion at presynaptic nerve terminals in the future, the rapid phospholipid translocation associated with exocytosis must be taken into account.

4-Chloro-7-nitrobenzofurazan↗
PubMed2000

Crystal structures of cytochrome P450nor and its mutants (Ser286-->Val, Thr) in the ferric resting state at cryogenic temperature: a comparative analysis with monooxygenase cytochrome P450s.

Cytochrome P450nor (P450nor) is a heme enzyme isolated from the denitrifying fungus Fusarium oxysporum and catalyzes the NO reduction to N2O. Crystal structures of the wild type and two Ser286 mutants (Ser286-->Val, Ser286-->Thr) of P450nor have been determined for the ferric resting forms at a 1.7 A resolution at cryogenic temperature (100 K). We carried out three comparative analyses: (1) between the structures of P450nor at room temperature and cryogenic temperature, (2) between the structures of P450nor and four monooxygenase P450s, and (3) between the structures of the WT and the Ser286 mutant enzymes of P450nor. Comparison of the charge distribution on the protein surface suggests that proton and electron flow to the heme site is quite different in P450nor than in monooxygenase P450s. On the basis of the mutant structures, it was found that a special hydrogen-bonding network, Wat99-Ser286-Wat39-Asp393-solvent, acts as a proton delivery pathway in NO reduction by P450nor. In addition, the positively charged cluster located beneath the B'-helix is suggested as possible NADH binding site in P450nor, from which the direct two-electron transfer to the heme site allows to generate the characteristic intermediate in the NO reduction. These structural characteristics were not observed in structures of monooxygenase P450s, implying that these are factors determining the unique NO reduction activity of P450nor.

Binding Sites↗
PubMed2000

Eosin interaction of alpha-synuclein leading to protein self-oligomerization.

Among various dyes including congo red, thioflavin S, thioflavin T, eosin, rhodamine 6G, and phenol red, the eosin was the only dye that induced self-oligomerization of alpha-synuclein in the presence of a chemical coupling reagent of N-(ethoxycarbonyl)-2-ethoxy-1, 2-dihydroquinoline. To analyze chemical nature of the eosin interaction with alpha-synuclein, the phenomenon of self-oligomerization was further examined with eosin congeners such as ethyl eosin, eosin B, phloxine B, erythrosin B, and rose bengal. The followings are the conclusions we have reached. First of all, intactness of the benzoate moiety of eosin and the negative charge on the carboxylic group of the dye are important factors leading to the specific interaction with alpha-synuclein. Secondly, the localized negative charge on the xanthene moiety of eosin is another critical factor for the interaction. As far as substituting halides are concerned, bromides and iodides on the xanthene moiety of the dyes do not make any difference on the alpha-synuclein interaction because both eosin and erythrosin B have induced the common phenomenon of self-oligomerization. The binding curve between eosin and alpha-synuclein was sigmoidal as the dye concentrations were increased. A double reciprocal plot of the saturation curve showed that the maximum number of eosin binding sites on alpha-synuclein was 1.85 with a dissociation constant of 390 microM. The dye binding to the protein appeared to occur via a positive cooperativity. The eosin binding site(s) was suggested to be located predominantly on the NAC region and partly related to the acidic C-terminus of alpha-synuclein. It has been, therefore, expected that this information might be useful to develop alpha-synuclein interactive molecules, which could provide eventual preventive or possible therapeutic means against various alpha-synuclein related disorders including Parkinson's disease.

Dose-Response Relationship, Drug↗
PubMed2000

Relationship among discharges of neighboring neurons in the rat prefrontal cortex during spatial working memory tasks.

The relationship among discharges of neurons that were recorded simultaneously with tetrodes in the rat medial prefrontal cortex was analyzed. Spatial working memory tasks were divided into several distinct stages based on the behavioral correlates of individual neurons, and interneuronal correlation of signal (mean discharge rate at each stage) and noise (trial-to-trial deviation from the signal) was calculated. Behavioral correlates of neighboring neurons were quite heterogeneous and, accordingly, average signal correlation was relatively low ( approximately 0.16). Noise correlation was even lower ( approximately 0.06), but neuronal noise was more correlated among the neurons with similar signals. Spikes underlying the signal and noise correlation among the prefrontal cortical neurons were loosely synchronized over a few hundred milliseconds. These results suggest that neighboring prefrontal cortical neurons process largely independent information and have weakly correlated noise and that precisely synchronized spikes play a relatively minor role in producing the correlated signal and noise among these neurons.

Action Potentials↗