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Biomedical subjects

E Gray

Publications and source records attributed to E Gray.

At least 55 records · Page 3Linked to original sources

Prostatic adenocarcinoma labelled with a monoclonal antibody and polyclonal serum: a quantitative assessment.

OBJECTIVE: To investigate the detection of tissue prostate-specific antigen (PSA) using a monoclonal antibody or polyclonal serum in patients with localized prostate cancer. PATIENTS AND METHODS: Fifteen samples of prostatic tissue from patients with localized prostate cancer were assessed for PSA using monoclonal antibodies and polyclonal serum. The intensity and area of chromogen precipitation in several microscopic fields was determined using image analysis. RESULTS: There were significant differences in the intensity and distribution of PSA labelling in the tumour between the methods; polyclonal serum was more sensitive in detecting PSA in tissue sections. Notably, there was a focal "possible clonal' pattern of negative labelling with the monoclonal antibody, which contrasted with the positivity of the polyclonal marker. CONCLUSIONS: The loss of PSA expression in some poorly differentiated cancers may represent the loss of specific epitopes rather than loss of the entire protein.

Adenocarcinoma↗

Inhibition of thrombin generation by heparin and LMW heparins: a comparison of chromogenic and clotting methods.

Inhibition of thrombin generation by heparin and low-molecular-weight (LMW) heparins is an important parameter which relates to their anticoagulant actions in vivo. Previous studies in our laboratory used a clotting assay for assessment of thrombin generation but other published studies have used a chromogenic method. We have therefore measured the inhibition of thrombin generation by unfractionated heparin (UFH) and LMW heparins by a modified chromogenic method using microtitre plates and compared the results with the clotting method. The degree of inhibition of thrombin generation when calculated from both peak thrombin concentrations and areas under the curve in the chromogenic assay was the same. When the activities of each heparin were expressed as EC80, i.e. concentrations required for 80% inhibition of thrombin generation, the EC80 were higher in the chromogenic assay than in the clotting system. However when the potencies of the LMW heparins were expressed as percentages of that of the UFH standard by parallel line analysis, the differences between clotting and chromogenic assay results were small and not statistically significant (P > 0.05). This study demonstrates the feasibility of measuring inhibition of thrombin generation by a modified chromogenic method using microtitre plates, and shows that the results with this method are similar to those obtained with the clotting method.

Anticoagulants↗

Inhibition of tissue factor and cytokine release.

The effect of inhibitors of cytokine release and plasma coagulation on lipopolysaccharide (LPS)-induced tissue factor and interleukin-6 (IL-6) was investigated. Dexamethasone, an inhibitor of cytokine production, inhibited LPS-induced tissue factor and IL-6 release by mononuclear cells (MNC), but enhanced IL-1beta-evoked tissue factor activity. Clinical antithrombin (AT) concentrates inhibited, in a dose-dependent manner, tissue factor and IL-6 production by MNC and human umbilical vein endothelial cells (HUVEC). The three AT preparations tested, when compared using the same antithrombin unit, had different potencies. Activated protein C (APC) augmented LPS stimulation of HUVEC and further increased the production of tissue factor and IL-6. The same effect was not observed with MNC; LPS-induced tissue factor and IL-6 release were unaffected by APC. Truncated tissue factor pathway inhibitor (TFPI1-161) inhibited LPS-induced MNC tissue factor and IL-6 production, but was unable to prevent LPS stimulatory activity on HUVEC. These data suggest a complex interaction between the coagulation pathway and the cytokine network.

Blood Coagulation↗

The systemic and cerebral kinetics of thiopental in sheep: enantiomeric analysis.

Thiopental is used as a racemate (rac-thiopental). Enantiomeric pharmacokinetic differences could therefore influence the onset and duration of anesthesia of rac-thiopental. We studied the systemic and cerebral kinetics of R(+)- and S(-)-thiopental in five adult ewes after a 2-min intravenous infusion of 500 mg rac-thiopental sodium. Systemic kinetic values were determined from the time course of concentrations in arterial plasma; cerebral kinetic values were deduced from the time course of the concentration differences between arterial and superior sagittal sinus blood plasma. Enantiomeric differences were found in both sites, with the (R:S) ratio of thiopental enantiomer blood concentrations initially being > or = 1 then decreasing to < 1 after approximately 60 min. This is consistent with the finding of the mean total body clearance of R(+)-thiopental being 17% (SD 12%) greater than that of S(-)-thiopental (P = .04). Sagittal sinus plasma concentrations of both enantiomers followed closely behind those in arterial plasma and this is consistent with facile bidirectional exchange of thiopental between plasma and brain. No significant differences were found between enantiomers in the rates of brain influx or efflux. Onset and regression of anesthesia occurred while the enantiomer blood concentrations were similar. Hence published pharmacokinetic-pharmacodynamic models of the onset of thiopental effects probably are not significantly compromised by neglecting the enantiomeric duality of thiopental, but models based on its elimination kinetics could be compromised if enantiomeric differences are neglected.

Anesthetics, Intravenous↗

Collaborative study on assays of activated FIX (FIXa). On behalf of the factor VIII and factor IX subcommittee of the ISTH. International Society on Thrombosis and Haemostasis.

A collaborative study has been organised by NIBSC to examine the performance of FIXa assays between laboratories, and to investigate the need for a standard. Ampoules of 3 materials, one monocomponent concentrate (coded C) and 2 different preparations of purified human FIXa (one proposed reference preparation, coded A and a test material coded B), have been assayed in 11 laboratories for FIXa using either the NIBSC method or a local method, with local standards (if available, coded D) to determine their potencies. The data showed high between assay variability; with the exception of one laboratory, most of the between assay variation expressed as %geometric coefficients of variation (gcv) were over 15%. The interlaboratory gcv when preparation B was assayed against the local standard was over 1700%, suggesting that most of the local standards are poorly calibrated. The %gcv was improved to 80% when reference A was used as the standard. These data clearly show that an international reference standard for FIXa would help to standardise FIXa preparations and would also improve in house assays for FIXa. However, an accelerated degradation study has shown that reference A is not suitable as a long term standard and another material with suitable stabilizers has to be established as an international standard for FIXa.

Factor IX↗

A comparison of flow and image DNA cytometry in prediction of patient prognosis in surgically resected small cell lung cancer.

We have previously reported that flow cytometric tumor DNA content may be of prognostic significance in surgically resected small cell lung cancer (SCLC). We are particularly interested in determining prospective parameters for better selection of 'good prognosis' patients to proceed to surgery. Since flow cytometric measurements are poorly, if at all, applicable to endoscopic biopsy and cytology specimens we compared an image cytometric system to flow cytometry and clinical parameters in an extended series of surgically resected SCLC. Clinical follow-up was obtained on 75 patients having surgical resection for SCLC in the years 1981-92. Paraffin blocks were prepared for cytometry in standard fashion. Flow DNA histograms were characterised as diploid/tetraploid (n = 45) or DNA aneuploid (n = 27). DNA histograms obtained by image analysis were divided into type I (peridiploid n = 43) or type II (non-diploid with a minority of cells in peridiploid region; n = 31); 5c exceeding rate, 2c deviation index and malignancy grade were also computed. Overall two year survival was 27/75 patients (36%). Stage of disease was confirmed as a predictor of outcome with only 3/17 (18%) N2 patients surviving for 2 years as compared to 24/52 (46%) patients with N0/N1 disease. Image cytometric histogram classification just reached statistical significance with type I histograms indicating a better prognosis (20/43 survivors (47%) versus 7/31 (23%) patients with type II profiles, P < 0.05). Flow cytometry, 5cER, 2cD1 and malignancy grade were not useful in predicting prognosis. The results do not indicate a significant role for cytometry in SCLC.

Carcinoma, Small Cell↗

Novel forms of B-domain-deleted recombinant factor VIII molecules. Construction and biochemical characterization.

Recombinant molecules similar to the smallest active plasma-derived factor VIII molecule, a complex of an 80-kDa and a 90-kDa polypeptide chain lacking the B domain, have been produced using various factor VIII cDNA constructs in order to obtain primary translation products which were efficiently processed into the 80 + 90-kDa complex. Three types of single-chain cDNAs encoding B-domain-deleted derivatives factor VIII were designed, taking account of sites at Arg740 and Glu1649, assumed to be important for processing factor VIII. In the type 1 constructs, either Arg747, Arg752, or Arg776 in the N-terminal region of factor VIII B domain was fused to the N-terminus (Glu1649) of the 80-kDa subunit. In the type 2 construct r-VIII SQ, Ser743 was fused to Gln1638, creating a link of 14 amino acids between the C-terminus (Arg740) of the 90-kDa chain and N-terminus of the 80-kDa chain, whereas in type 2 r-VIII RH, Arg747 was fused to His1646. In the type 3 constructs, the B-domain was completely removed or replaced with 1-4 Arg residues. After expression in Chinese hamster ovary cells, the type 1 derivatives and the type 3 derivatives with 0-2 Arg residues inserted were found to be only partially processed and contained a large amount of the 170-kDa primary translation product. In contrast, most of the type 2 derivatives r-VIII SQ and r-VIII RH and the type 3 derivatives r-VIII R4 and r-VIII R5 containing three or four extra Arg residues preceding the N-terminus of the 80-kDa chain were processed into the desired 80 + 90-kDa chain complexes. The feature common to the most efficiently processed factor VIII deletion derivatives was that they contained the recognition motif for proteolytic cleavage by the membrane-bound subtilisin-like protease furin, which is expressed in most types of cells; that is, basic amino acid residues at positions -1 and -4 relative to the cleavage site at Glu1649. Biochemical studies of r-VIII SQ and r-VIII R5, two of the most effectively processed factor VIII derivatives, showed that both proteins had a normal factor VIII cofactor function, and had N- and C-termini of the 80-kDa and 90-kDa chains corresponding to those found in plasma-derived factor VIII.

Amino Acid Sequence↗

Myocarditis and haemolytic uraemic syndrome.

A 13 year old girl is reported who presented with haemolytic uraemic syndrome (HUS) due to Escherichia coli O157:H7 infection. She died during the acute phase of the illness after an episode of unexplained sudden circulatory collapse. Postmortem examination confirmed the diagnosis of HUS and showed histological evidence of myocarditis manifested by the presence of inflammatory cell infiltration in the myocardium and around the conducting system.

Adolescent↗

Interobserver variation in cell selection for DNA image cytometry.

AIMS: To describe a systematic investigation of interobserver differences in interpretation of nuclear morphology in preparations of small cell lung cancer (SCLC). METHODS: The screening/reviewing facility on the highly optimised microscope environment was used to individually tag 127 nuclei, chosen to reflect the spectrum of morphological appearances in nuclear preparations from three biopsy specimens of SCLC. Each nucleus was reviewed and labelled as control (lymphocyte), malignant or unsatisfactory by each of four observers. DNA histograms were plotted for each specimen using the nuclei identified as malignant by each participant. The histograms were compared in terms of identification of DNA stemlines and by calculation of a 5c exceeding rate (5cER). RESULTS: Interobserver variation in assessment of morphology was seen in 55.1% of nuclei. Disagreement occurred most frequently in the malignant/unsatisfactory category. Differences in morphological classification had little influence on histogram assessment by means of visual inspection but did show an effect on 5cER. CONCLUSIONS: There are significant interobserver differences in subjective assessment of nuclear morphology in cytometric preparations. This effect may seriously influence cytometric measurements.

Carcinoma, Small Cell↗

Measurement of activated factor IX in factor IX concentrates: correlation with in vivo thrombogenicity.

Current in vitro tests for thrombogenicity of FIX concentrates used for prothrombin complex concentrates (PCCs), are of little value when applied to high purity FIX (HP FIXs). In the present study, we have developed a chromogenic assay for activated FIX (FIXa) and evaluated its ability to predict in vivo thrombogenic potential of HP FIXs in a modified Wessler stasis model. Among the HP FIXs, only 1 out of 7 products had no detectable FIXa; this product also showed no in vivo thrombogenicity. In the other 6 products, FIXa content ranged from 0.15-1.2 U/1000 in FIX, and all showed some evidence of in vivo thrombogenicity, with mean thrombus scores ranging from 0.25-4. There was a significant positive correlation (r = 0.55, p < 0.02) between FIXa levels and in vivo thrombogenicity of HP FIXs. NAPTT data were not significantly correlated with the in vivo results and the TFCT also showed no direct correlation with the mean thrombus score. These results indicate that HP FIXs may still carry a small residual thrombotic risk and measurement of FIXa content of these products may be a better predictor of thrombogenicity than the current in vitro tests.

Animals↗

The HOME tutor: a new tool for training in microscope skills.

AxioHOME is a new concept in microscope design. It is a microscope with a visual display unit mounted in the head permitting computer generated displays to be projected on to the real microscope image when viewed down the eyepieces. This allows the annotation of the microscope image with both text and graphics. The AxioHOME system was used for the construction of complex interactive tutorials for the training and assessment of students. The basis of a tutorial is that features of interest on a microscope slide are indicated to the student who is then provided with either information or questions about those features. In turn the student can also annotate the slide with comments for later discussion with the teacher. The system therefore allows a dialogue between teacher and student. The creation of tutorials is time consuming. It takes approximately 10 min of teacher time to create 1 min of student time. However since the same tutorial can be used by numerous students this releases the teacher from repetitive training. The student response to this teaching method has been very positive. The main criticism being that insufficient teaching material was available.

Computer-Assisted Instruction↗

A collaborative study of proposed European Pharmacopoeia reference preparations of low molecular mass heparin.

A European collaborative study, in which 16 laboratories participated, was carried out to assess the performance of the European Pharmacopoeia (EP) monograph methods for anticoagulant activities (anti-Xa and anti-IIa assays) of low molecular mass (LMM) heparin and to assess the suitability of six candidate materials as the EP working standard for LMM heparin. There was good interlaboratory agreement for both types of assays as indicated by most gcy's being less than 10%, indicating acceptable performance of the EP assay methods. All the candidate preparations gave dose-response curves parallel to the 1st International Standard for Low Molecular Weight heparin and to each other. All preparations, possibly with the exception of E and F, gave similar performance as measured by interlaboratory agreement and would be suitable as working standards. Based on these data, preparations A, B, C and D have been established by the EP as official EP Biological Reference Preparations and they will be issued as successive batches.

Anticoagulants↗

Measurement of tissue factor pathway inhibitor in normal and post-heparin plasma.

Assay methods for the detection of both tissue factor pathway inhibitor (TFPI) function (two-stage chromogenic assay) and for TFPI antigen levels (competitive ELISA) have been developed and applied to the measurement of TFPI in normal plasma, in post-heparin plasma and to recombinant TFPI. There was good correlation in TFPI levels, measured using the two methods (r = 0.848; P < 0.001) in the normal plasma samples (n = 21) with the values ranging from 0.6 to 1.4 units per ml relative to a normal reference plasma pool (assigned 1.0 unit per ml). The post-heparin plasma samples were associated with increased levels of both TFPI functional activity and antigen. However, there was poor correlation between the two methods, with an increase in antigen levels greatly exceeding the increase in functional activity. This discrepancy was also found with recombinant TFPI and may reflect the different responses of the two assay methods to lipoprotein-bound TFPI (in the normal plasma reference) and the 'free' TFPI in post-heparin plasma and recombinant TFPI. These findings have implications in the choice of suitable reference materials for the assay of TFPI.

Binding, Competitive↗

Peripheral T lymphocyte depletion by apoptosis after CD4 ligation in vivo: selective loss of CD44- and 'activating' memory T cells.

We have demonstrated that a single intravenous bolus of rat anti-CD4 MoAb caused a small but prolonged increase in apoptosis in murine lymph nodes. We have quantified this process using the novel Highly Optimized Microscope Environment (HOME) interactive images analysis system and shown that the increase in apoptosis was sufficient to account for the observed depletion of the peripheral CD4+ T cell subset. This occurred in the absence of any other exogenous signal. Furthermore, there was no evidence of an inflammatory or necrotic response in the tissues, indicating that this was unlikely to be Fc or complement-mediated antibody killing. The anti-CD4-induced depletion selectively removed CD44- T cells. Using mice previously immunized with yeast-derived HIV-1 p24 recombinant protein there was sparing of memory T cell function after in vivo anti-CD4 treatment, except during a window of less than 24 h duration, when simultaneous exposure to antigen and anti-CD4 antibody resulted in the depletion of specific memory T lymphocyte function. This indicated that a very minor alteration in the frequency of apoptosis had a marked effect on cell number over time, and suggested that opportunistic infection associated with CD4+ T cell depletion may be explained by loss of memory cells when there is antigenic stimulation at the same time as CD4 ligation. These results have implications for the pathology of HIV-associated disease which is associated with ligation of CD4 molecules in vivo.

Animals↗

Relocation accuracy on HOME computerized microscopes.

A major practical advantage of the HOME (highly optimized microscope environment) computerized microscope is the facility for relocating cells or other microscopic objects. Features can be marked directly on the microscope image using a mouse-driven cursor, and an interactive finder can then be used to relocate the marked features. Tests on a prototype HOME microscope have shown that positions can be relocated with an accuracy of standard deviation (SD) < 7 microm. The marked features could also be relocated on a second HOME microscope, although with somewhat reduced accuracy (standard deviations of < 17 microm). The system provides a very user-friendly environment for tasks requiring relocation of microscopic objects.

Calibration↗

Low affinity heparin is an antithrombotic agent.

We have investigated the antithrombotic activities and haemorrhagic side effects of a low affinity heparin (LAH). In the rabbit thrombosis model using activated human serum as the thrombogenic challenge, the effect of LAH on 10' and 20' stasis was studied. At 10' stasis, 150 micrograms/kg of LAH reduced thrombus formation by 67% and total prevention was achieved at 500 micrograms/kg. At 20' stasis, 150 micrograms/kg was totally ineffective, 500 micrograms/kg was partially effective and 1000 micrograms/kg was required to achieve complete prevention of thrombosis. Mean peak circulatory level following infusion of 500 micrograms/kg of LAH was found to be 1.6 micrograms/ml by heparin cofactor II based assay and 0.13 iu/ml by anti-factor Xa assay. Thrombin generation tests of the same post injection samples showed an 80% reduction in thrombin production when compared with pre-injection samples. At 2.5 mg/kg, the mean bleeding time ratio (challenge:control) measured in the rabbit ear template model was 1.25 (cf saline control 0.88). Compared with results from previous studies on unfractionated heparin and dermatan sulphate, LAH is approximately 6 times less effective than UFH but 5 times more potent than dermatan sulphate. Since the mean bleeding time for UFH at 2.5 mg/kg was previously found to increase nearly two fold over the control value, LAH may present a lesser haemorrhagic risk than UFH. These data suggest that LAH is more effective in directly preventing venous thrombosis than dermatan sulphate. Although LAH is not as effective as UFH on a weight basis in the impairment of thrombogenesis, it may carry significantly lower bleeding risk.

Animals↗

Nursing concerns associated with radical skull base surgery: a case study.

Historically, surgical management of extensive neoplasms of the cranial base has been limited by anatomical boundaries. However, major theoretical and technological advances now permit radical surgical resections. The perioperative nursing care of these patients is challenging and requires a wealth of knowledge and skills. The complexity of caring for patients undergoing radical skull base surgery is highlighted through a case study.

Adult↗