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Biomedical subjects

E James

Publications and source records attributed to E James.

At least 19 recordsLinked to original sources
PubMed1996

Yersinia enterocolitica transmission from a red cell unit 34 days old.

In 1993 the North London Blood Transfusion Centre received its first report of Yersinia enterocolitica transmission from a unit of red cells supplied to a local hospital. The recipient was a 23-year-old male who was neutropenic following a third cycle of chemotherapy for treatment of acute myeloblastic leukaemia (FAB type M6) and received a 34-day-old red cell unit. During transfusion the patient developed septicaemia and endotoxin-mediated shock. The transfusion was stopped immediately and broad spectrum antibiotics administered immediately on suspicion of bacteraemia from the transfused unit. This prompt action undoubtedly prevented a fatal outcome. Y. enterocolitica was isolated from the blood bag. Antibody was also detected in the bag and in a sample taken from the donor 39 days post-donation. Antibody to serotype 03 was identified, the commonest serotype reported in transfusion-transmitted Y. enterocolitica. The donor reported no gastrointestinal upset or illness prior to donation. This transfusion reaction might not have occurred had the red cells been transfused earlier in their storage period, but would not have been prevented by the exclusion of donors with a history of gastrointestinal illness as the donor was asymptomatic. Nor would it have been prevented by inspecting the blood for a change in colour, as no such change was observed. Y. enterocolitica is a significant problem in transfusion medicine and transmission is generally associated with a high mortality rate. Hospitals should be urged to investigate bacteriologically all appropriate transfusion reactions so that the true extent of the problem in the United Kingdom can be assessed.

Adult↗
PubMed1995

Segregation of pANCA antigenic recognition by DNase treatment of neutrophils: ulcerative colitis, type 1 autoimmune hepatitis, and primary sclerosing cholangitis.

Antineutrophil cytoplasmic antibodies (ANCA) have been identified in the serum of 50-80% of ulcerative colitis (UC) patients. UC-associated ANCA yield a perinuclear staining pattern (pANCA) with alcohol-fixed neutrophils. More recently, pANCA have been detected in the serum of patients with primary sclerosing cholangitis (PSC) and other autoimmune liver diseases. Up to 70% of PSC patient sera and up to 92% of sera from patients with well-defined type 1 autoimmune hepatitis (type 1 AIH) were found to express pANCA. Such expression by patients with PSC and type 1 AIH raises questions concerning the relationship of these pANCA to each other and to that of UC. Differences and similarities in pANCA characteristics are found among the three diseases, suggesting the use of pANCA to define specific disease subgroups. Our recent finding that the UC-associated pANCA reactive antigen was localized within the nuclear domain prompted an examination of whether DNase treatment of neutrophils would alter antigenic recognition by the pANCA of UC, PSC, and type 1 AIH. While loss of antigenic recognition after DNase digestion of neutrophils was a dominant feature of the UC-associated pANCA, the majority of PSC and type 1 AIH pANCA recognized cytoplasmic constituents. These results further support the feasibility of defining and/or distinguishing disease subgroups based on the characterization of respective pANCA.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1995

Reevaluation of the effectiveness of environmental designs to reduce robbery risk in Florida convenience stores.

Prevention of intentional injuries to convenience store workers has focused on prevention of robbery. Data from a cross-sectional study of the effectiveness of environmental designs to deter robbery in Florida convenience stores were reanalyzed in order to determine the effect of confounding from local crime risk factors and other environmental designs on robbery rate. Results of this reanalysis were applied to a review of the literature. Of 14 store design factors and 5 local crime risk factors considered, concealed access/escape routes, cash register located at the back or the side of the store, high county crime rate, and high county population size were significantly associated with increased robbery rate. Poor cash handling policy was significantly related to a decreased robbery rate. Results also indicated that local crime factors and some environmental designs confound the relationship between other environmental designs and robbery rate. Conclusions from this reanalysis indicated that studies of the effectiveness of environmental designs to deter robbery must adjust for confounding. Although environmental design tends to be an effective robbery deterrent strategy, results from studies have been inconsistent as to the effectiveness of specific design factors. This inconsistency is partially explained by lack of adjustment for confounding from local crime risk factors and multiple environmental design factors. Areas for further research are discussed.

Crime↗
PubMed1994

[Obstetrical and perinatal aspects in renal transplantation].

This study evaluates the record of 14 pregnant women all of whom have received living donor renal transplants, and their control and delivery was done in our Service. Five women have had more than one pregnancy. The latency period between renal transplantation and pregnancy was 39.3 months. Blood pressure figures were acceptable in 73% of the patients before pregnancy and 28% evolved during their postpartum period with blood pressure over 140/90. In those cases where pregnancy was longer than first trimester the percentage of successful gestation was 93% with 41% premature births, 38% growth retardation at birth, and there was 10% spontaneous abortions. Eighty three percent of pregnancies delivered by cesarean section.

Adolescent↗
PubMed1993

Compact thermally-denatured state of a staphylococcal nuclease mutant from resonance energy transfer measurements.

Thermal denaturation of a staphylococcal nuclease mutant K78C, where lysine 78 is replaced by cysteine, was studied by circular dichroism (CD) and resonance energy transfer. CD spectra suggest that residual structures remain in the denatured state. Steady-state energy transfer from intrinsic tyrosines to a single and intrinsic tryptophan was measured at different temperatures. In the thermally-denatured state of K78C, there is still a substantial degree of energy transfer from tyrosine(s) to tryptophan, indicating residual structures in the denatured state. The cysteine residue in mutant K78C was labeled with a cysteine specific probe IAEDANS. Fluorescence decays of the tryptophan were measured to estimate distance distributions between Trp 140 and IAEDANS at position 78. Measurements were done as a function of temperature from 4 degrees C (native) to 65 degrees C (denatured) both with and without Ca2+ and inhibitor pdTp. Below 30 degrees C, the apparent distance distribution of both the ligand-free nuclease and the enzyme with bound pdTp can be adequately described by a Gaussian model. Above 40 degrees C, where the ligand-free nuclease but not the ternary complex begins to denature, two different populations are required to fit the data both with and without pdTp. One population has a compact structure and the other has an expanded structure. As temperature rises, the population of the expanded structure increases. At the highest temperature, the non-native compact structure is still the major form (60 to 70%). The overall thermally-denatured states of staphylococcal nuclease mutant K78C in the absence and presence of ligands are thus compact and heterogeneous.

Chemical Phenomena↗
PubMed1992

Compact denatured state of a staphylococcal nuclease mutant by guanidinium as determined by resonance energy transfer.

The protein from a mutant clone of staphylococcal nuclease with a cysteine substituting for a lysine at position 78 was prepared and labeled with a cysteine-specific fluorescent probe 5-[[2-[(iodoacetyl)-amino]ethyl]amino]naphthalene-1-sulfonic acid (IAEDANS). Time-resolved nonradiative energy-transfer studies were done using the single tryptophan at position 140 as the energy donor and the IAEDANS as the receptor. Changes in distance and distance distributions were observed as a function of increasing guanidinium (GuHCl) concentration (0-2 M) and in the presence or absence of Ca2+ and inhibitor 2'-deoxythymidine 3',5'-diphosphate (pdTp). In the native state, both the ternary complex and the noncomplexed protein are best fit with one population having an average donor-acceptor distance of approximately 23 A and an "apparent" full width at half-maximum (fwhm) of distance distribution of approximately 18 A. Besides the contribution of linker arm of the acceptor, it appears that there are some conformational heterogeneties either due to the disordering of the tryptophan region or due to the whole protein in the native state. During GuHCl unfolding, the average distance remains relatively constant up to GuHCl concentrations where both the ternary complex and the ligand-free protein are denatured (1-1.3 M). The compact denatured states persist up to 2 M GuHCl. At 2 M GuHCl, the heterogeneity of the denatured state in the ternary complex is much larger than that of the ligand-free nuclease. The results show that the denatured states of staphylococcal nuclease mutant K78C by GuHCl are compact and these compact denatured states are likely due to residual structures or incompletely disrupted hydrophobic cores under these conditions.

Amino Acid Sequence↗
PubMed1992

Heparin-induced thrombocytopenia in the newborn.

This pilot study was initiated to determine whether heparin-induced thrombocytopenia occurs in the newborn and whether thromboembolic complications in the newborn could be related to heparin-induced thrombocytopenia. Thirty-four infants in whom thrombocytopenia (less than 70,000/mm3) (n = 23), precipitous (30% to 50%) fall in platelet count (n = 5), or thromboses (n = 6) developed while they were receiving heparin were studied. Heparin-associated antiplatelet antibodies were demonstrated in 14 infants by platelet aggregation testing. The average gestational age (29 +/- 6 weeks); birth weight (1300 +/- 945 gm); and platelet count at birth (234,000/mm3 +/- 111,000/mm3) of these 14 infants did not differ statistically from the 20 infants without heparin-associated antiplatelet antibodies. An umbilical artery catheter was inserted in all infants except a single patient from each group. Aortic thrombosis was documented by abdominal ultrasonography in 11 of 13 (85%) infants with heparin-associated antiplatelet antibodies. One patient died with a midgut volvulus before the aorta could be examined. Five aortic thromboses were detected in the 20 infants without heparin-associated antiplatelet antibodies. Bleeding was not associated with the heparin-induced thrombocytopenia. One patient with previously demonstrated thrombocytopenia and heparin-associated antiplatelet antibodies had recurrent thrombocytopenia when reexposed to heparin; her platelet count recovered after heparin withdrawal. Thus heparin-induced thrombocytopenia does occur in preterm and term infants receiving heparin and is associated with arterial thromboses. Therefore infants receiving any form or amount of heparin must be carefully monitored for heparin-induced thrombocytopenia.1+

Autoantibodies↗
PubMed1992

Retroperitoneal hematoma after blunt trauma.

We reviewed retrospectively 233 consecutive patients with retroperitoneal hematoma (RPH) resulting from blunt trauma. This study group represented 2.9 per cent of all admissions for blunt trauma and 13 per cent of all admissions for blunt abdominal trauma. Motor vehicle accidents predominated as the cause of injury. Fifty-five per cent of the patients had fractures of the pelvis. Laparotomy was the primary method used in diagnosing RPH (73 per cent). The RPH was located in zone I in 14 per cent of patients, zone II in 37 per cent, zone III in 46 per cent and zone IV in 3 per cent. The RPH was explored in 35 per cent of all patients. Major vessels were the most common organ system injured (21 per cent) in patients with zone I RPH. The kidney was the most commonly injured organ (27 per cent) in patients with zone II RPH. Injury of either the pancreas or duodenum in 14 per cent of patients with right-sided zone II RPH indicates the need for careful evaluation of those organs at operation. Patients with zone III RPH associated with fractures of the pelvis should be explored only rarely--when main iliac vascular injury is suspected (4.6 per cent in this series). Otherwise, a systematic approach using external fixator devices and angiographic embolization should be used. The over-all morbidity and mortality rates of 59 and 39 per cent, respectively, emphasize the need for aggressive resuscitation, rapid control of hemorrhage and a multidisciplinary approach to the management of these patients.

Abdominal Injuries↗
PubMed1991

Evaluation of a comprehensive algorithm for blunt and penetrating thoracic and abdominal trauma.

The objective was to develop a single branched-chain decision tree for both blunt and penetrating thoracic and abdominal trauma and to test its feasibility to track clinical decisions. The algorithm consisted of 14 specific patient management loops and 31 decision nodes. During a 4-month period, the management decisions and clinical course of 434 trauma patients were prospectively observed. Thirty-four patients had no signs of life on arrival to the emergency department (ED) and were excluded from the statistical evaluation; the remaining 400 patients constituted the study group. The mean Injury Severity Score (ISS), Penetrating Abdominal Trauma Index (PATI), and Trauma Score (TS) scores in the series were 21 +/- 10, 34 +/- 12, and 13 +/- 3. The overall patient mortality of the study group was 17 per cent; it was 61 per cent in those patients with major deviations from the algorithm and 6 per cent in patients who complied with the algorithm. The ISS, PATI, and TS scores were 29 +/- 9, 32 +/- 12, and 13 +/- 2 in patients with deviations and 20 +/- 10, 37 +/- 12, and 14 +/- 2 in patients who complied with the algorithm. Of the 37 patients who died with major deviations from the algorithm, the deviation was directly contributory to death in 21 cases (57%) and probably contributory in another 14 cases (38%). There were 108 patients with ISS scores between 20 and 50. In this group, mortality was 55 per cent when a major deviation occurred and 5 per cent without major deviations from the algorithm. The authors conclude that the survival of trauma patients may be improved by following the specific management criteria outlined by the algorithm.

Abdominal Injuries↗
PubMed1989

Uptake of 131I-metaiodobenzylguanidine by 6-23 rat medullary thyroid carcinoma.

Uptake of 131iodine-metaiodobenzylguanidine (131I-MIBG) by 6-23 rat medullary thyroid carcinoma (MTC), was studied in vitro and in vivo. In vitro, there was an 8-fold increase in 131I uptake by 6-23 cells when labeled with 131I-MIBG (131I 24 +/- 15 cpm/10(6) cells, 131I-MIBG 196 +/- 9 cpm/10(6) cells). MIBG uptake in vitro was the same at 4 degrees C and 37 degrees C. In contrast, 131I-MIBG uptake by PC-12 rat pheochromocytoma cells were 200 times greater (131I-MIBG 42,412 +/- 6,755 cpm/10(6) cells). 131I-MIBG uptake by rat MTC cells in vitro were of a comparable magnitude to the uptake of 131I-MIBG by rat ileal enterochromaffin cells (RIE-1) and mouse colon cancer cells (MC-26). In vivo, uptake of 131I-MIBG by 6-23 MTC tumor was considerably less than in the normal tissues (muscle, liver, spleen, kidney, adrenal and thyroid). Gamma camera studies of 131I-MIBG uptake by 6-23 MTC tumors growing in Wag-Rij rats were only transiently positive in 1 out of 4 rats studied. We conclude that 131I-MIBG is poorly taken up by rat medullary thyroid carcinoma and is an unpredictable marker for localization of rat MTC.

3-Iodobenzylguanidine↗