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Biomedical subjects

G T Smith

Publications and source records attributed to G T Smith.

At least 55 records · Page 3Linked to original sources

Telemedicine for dermatology care in rural patients.

BACKGROUND: Rural patients who develop dermatologic disorders often do not seek specialty care because of multiple logistical and economic factors. OBJECTIVE: To assess the effect of teledermatology consultations on the cost of care for a given episode of illness. METHODS: Telemedicine records were reviewed for 119 visits by 87 patients referred for teledermatology consultation over a 17-month period. RESULTS: Seven patients (8%) required follow-up in the dermatologist office for extended care, while 20 patients (23%) (52 visits) underwent follow-up teledermatology evaluation. The average duration of the dermatologic condition for each patient prior to the telemedical consultation was 17 months. The average of care for the diagnosed dermatologic condition, for all patients during an average period of 8 months prior to teledermatology was $294, compared with $141 for the 6 months after diagnosis by teledermatology. CONCLUSIONS: Telemedicine can be effective for dermatology consultation in new patients referred from rural communities. Our data indicate teledermatology can decrease the cost of care for the diagnosed condition.

Cost-Benefit Analysis↗

Effects of eicosapentaenoic and gamma-linolenic acid on lung permeability and alveolar macrophage eicosanoid synthesis in endotoxic rats.

OBJECTIVES: Proinflammatory eicosanoids (cyclooxgenase and lipoxygenase metabolites of arachidonic acid) released by alveolar macrophages play an important role in endotoxin-induced acute lung injury. We investigated the effect of prefeeding rats for 21 days with enteral diets that provided the anti-inflammatory fatty acids, eicosapentaenoic acid and gamma-linolenic acid (derived from fish oil and borage oil, respectively), as compared with an n-6 fatty acid-enriched diet (corn oil) on the following: a) lung microvascular protein permeability, arterial blood pressure, and platelet and white blood cells in a model of endotoxin-induced acute lung injury; b) alveolar macrophage prostaglandin and leukotriene synthesis; and c) liver and alveolar macrophage phospholipid fatty acid composition. DESIGN: Prospective, randomized, controlled, double-blind study. SETTING: Research laboratory at a university medical center. SUBJECTS: Male Long-Evans rats, weighing 250 g. INTERVENTIONS: Rats were randomized into four dietary treatment groups and fed nutritionally complete diets (300 kcal/kg/day), containing 55.2% of the total calories from fat with either 97% corn oil, 20% fish oil, 20% fish and 5% borage oil, or 20% fish and 20% borage oil for 21 days. On day 22, lung microvascular protein permeability, mean arterial pressure, and platelet and white blood cell counts were determined for 2 hrs after an intravenous injection of Salmonella enteritidis endotoxin (10 mg/kg). In a second group of prefed rats, the phospholipid fatty acid composition was determined in liver and alveolar macrophages. Alveolar macrophages were harvested by bronchoalveolar lavage and stimulated in vitro with a calcium ionophore (A23187), and the concentrations of leukotrienes B4 and B5, thromboxane A2, prostaglandin E2, and 6-keto-prostaglandin F1 alpha were measured in a third group of prefed rats. MEASUREMENT AND MAIN RESULTS: Lung permeability was greatest with corn oil and was significantly attenuated with 20% fish oil and 20% fish and 5% borage oil, and this effect approached significance with 20% fish and 20% borage oil (p = .06). The early and late hypotensive effects of endotoxin were attenuated with 20% fish oil, 20% fish and 5% borage oil, and 20% fish and 20% borage oil, as compared with corn oil. Concentrations of leukotriene B4, prostaglandin E2, and thromboxane B2 released from A23187-stimulated alveolar macrophages were significantly lower with 20% fish oil and 20% fish and 20% borage oil, as compared with corn oil. The increase in lung microvascular protein permeability with 20% fish and 20% borage oil was not significantly different than the lung microvascular protein permeability that was found in animals receiving 20% fish oil (p = .20) and 20% fish and 5% borage oil (p = .31). Alveolar macrophage and liver phospholipid concentrations of arachidonic acid were lower, and the concentrations of eicosapentaenoic acid and docosahexaenic acid were higher, with 20% fish oil, and 5% borage oil, and 20% fish and 20% borage oil, as compared with corn oil. Dihomo-gamma-linolenic acid, the desaturated and elongated intermediate of gamma-linolenic acid, was increased with 20% fish and 20% borage oil, as compared with 20% fish oil and 20% fish and 5% borage oil. CONCLUSIONS: The severity of pulmonary microvascular protein permeability and the degree of hypotension were reduced with fish or fish and borage oil diets, as compared with corn oil, in endotoxic rats. The reduced synthesis of the proinflammatory arachidonic acid-derived mediators, leukotriene B4, thromboxane B2, and prostaglandin E2 from stimulated alveolar macrophages was indicative of a decrease in arachidonic acid and an increase in eicosapentaenoic acid and docosahexaenoic acid in cell membrane phospholipids.

Animals↗

Linear least squares compartmental-model-independent parameter identification in PET.

A simplified approach involving linear-regression straight-line parameter fitting of dynamic scan data is developed for both specific and nonspecific models. Where compartmental-model topologies apply, the measured activity may be expressed in terms of: its integrals, plasma activity and plasma integrals--all in a linear expression with macroparameters as coefficients. Multiple linear regression, as in spreadsheet software, determines parameters for best data fits. Positron emission tomography (PET)-acquired gray-matter images in a dynamic scan are analyzed: both by this method and by traditional iterative nonlinear least squares. Both patient and simulated data were used. Regression and traditional methods are in expected agreement. Monte-Carlo simulations evaluate parameter standard deviations, due to data noise, and much smaller noise-induced biases. Unique straight-line graphical displays permit visualizing data influences on various macroparameters as changes in slopes. Advantages of regression fitting are: simplicity, speed, ease of implementation in spreadsheet software, avoiding risks of convergence failures or false solutions in iterative least squares, and providing various visualizations of the uptake process by straight line graphical displays. Multiparameter model-independent analyses on lesser understood systems is also made possible.

Algorithms↗

Evaluation of fluorine-18-BPA-fructose for boron neutron capture treatment planning.

UNLABELLED: Boron neutron capture therapy (BNCT) using 4-[10B]boronophenylalanine-fructose (BPA-Fr) is in Phase II clinical trials to validate BNCT as a treatment for glioblastoma multiforme and melanoma. Successful BNCT depends on knowledge of the distribution of boron-containing agents in both tumor and normal tissue as currently determined by chemical confirmation of boron deposition in surgically removed malignant tissue before BNCT. METHODS: We used PET to noninvasively obtain in vivo information on the pharmacokinetics of the 18F-labeled analog of BPA-Fr in two patients with glioblastoma multiforme. Time-activity curves generated from the bolus injection of 18F-BPA-Fr were coinvolved to simulate a continuous infusion used for BNCT therapy. RESULTS: Distribution of 18F-BPA-Fr by PET was found to be consistent with tumor as identified by MR imaging. The 18F-BPA-Fr tumor-to-normal brain uptake ratio was 1.9 in Patient 1 and 3.1 in Patient 2 at 52 min after injection. The 18F-BPA-Fr uptake ratio in glioblastoma paralleled that of nonlabeled BPA-Fr seen in patients as previously determined by boron analysis of human glioblastoma tissue obtained from pre-BNCT surgical biopsy. CONCLUSION: Knowledge of the biodistribution of BPA-Fr enables pre-BNCT calculation of expected tissue dosimetry for a selected dose of BPA-Fr at a specific neutron exposure. Fluorine-18-BPA-Fr PET is capable of providing in vivo BPA-Fr biodistribution data that may prove valuable for patient selection and pre-BNCT treatment planning.

Boron Compounds↗

Seasonal plasticity in the song nuclei of wild rufous-sided towhees.

Seasonal changes in the brain nuclei that control song behavior in songbirds are among the most striking examples of plasticity in the adult vertebrate brain. Although seasonal changes in the size of these brain nuclei have been found in several species in captivity, results on seasonal changes in the song nuclei of wild songbirds have been equivocal. In the present study, I measured plasma testosterone (T) concentrations and the size of song nuclei across seasons in wild male rufous-sided towhees (Pipilo erythrophthalmus). I found seasonal changes in both T concentrations and the size of song nuclei that were as large as or larger than those observed in this species in captivity. These results demonstrate that seasonal plasticity of the song nuclei occur in wild, as well as captive, songbirds.

Animals↗

Differentiating benign from malignant lung lesions using "quantitative" parameters of FDG PET images.

UNLABELLED: Fluorine-18 labeled deoxyglucose positron-emission tomography (FDG-PET) applications in oncology include the differential diagnosis of chest masses and single pulmonary nodules. However, FDG is not tumor-specific; rather, it also accumulates in inflammatory processes. This study was performed to identify image parameters that would improve the specificity of PET. METHODS: Twenty-six patients who had benign and malignant lung lesions were examined retrospectively. Positron-emission tomography data were acquired in dynamic scanning mode after intravenous bolus of 250-402 MBq of FDG. Standardized uptake values (SUVs) were calculated and Patlak analyses were performed in selected regions of interest in the PET images. Positron-emission tomography results were related to histological diagnosis (N = 49) or clinical follow-up (N = 3). RESULTS: The specificity and sensitivity of the original PET scan reports, which was based on visual image interpretation and loosely applied SUVs, was 100% and 73%, respectively. Using the SUVs with a cut-off value of 3.8 and Kpat value with a cut-off at 0.025 min-1 improved the specificity to 81% and 85%. CONCLUSION: FDG-PET image interpretation can be facilitated by using SUV information or the accumulation rate of the radiotracer (Patlak). With additional validation, this method could have a significant cost-effective impact on the medical/surgical management of chest masses.

Adult↗

Human in vivo comparative study of zinc and copper transmetallation after administration of magnetic resonance imaging contrast agents.

RATIONALE AND OBJECTIVES: The authors compare in vivo transmetallation of three magnetic resonance contrast agents in humans in terms of their kinetic stability. METHODS: Blood and urine samples were taken before and after the intravenous injection of gadolinium (Gd)-HP-DO3A, Gd-DTPA, or Gd-DTPA-BMA at 0.1 mmol/kg to healthy volunteers. Serum and urine were assayed for zinc, copper, and Gd, using inductively coupled plasma atomic emission spectrometer. RESULTS: Gadolinium-DTPA-BMA caused the highest increase in zinc excretion among the three agents. Gadolinium-HP-DO3A did not cause a significant increase in zinc excretion. In serum, although Gd-DTPA-BMA exhibited a decrease in zinc concentration, the difference between the drugs was not statistically significant. CONCLUSIONS: The difference in observed zinc excretion among the chelates studied reflects in vivo transmetallation of the magnetic resonance contrast media and correlates with the respective kinetic inertia for transmetallation, rather than thermodynamic stability constants. Gadolinium-HP-DO3A was found to be the most kinetically inert among the three drugs tested.

Contrast Media↗

Use of PG-21 immunocytochemistry to detect androgen receptors in the songbird brain.

The avian song control system is an excellent model in which to study the effects of gonadal steroid hormones on neural and behavioral plasticity. Several of the brain regions that control song behavior concentrate androgens and/or estrogens. Investigations of the distribution and regulation of androgen receptors have been limited by the lack of a reliable immunocytochemical method to detect androgen receptors in the songbird brain. We describe a protocol by which the PG-21 polygonal antibody to the rat androgen receptor can be used to label androgen receptor-containing cells in the songbird brain. By treating songbirds of several species with testosterone 90 min before sacrifice and by using relatively low concentrations (0.5 0.75 microg/ml) of PG-21 antibody to reduce nonspecific background staining, we were able to obtain strong specific labeling of cell nuclei in androgen-sensitive brain regions. This technique will facilitate the study of the role of androgens in mediating neural plasticity in the avian brain. Testosterone pretreatment may also facilitate the use of this antibody to label androgen receptors in tissues from a wide array of nonmammalian species.

Animals↗

Short-term responses to periodontal therapy in insulin-dependent diabetic patients.

This investigation studied relative changes in periodontal conditions of 18 insulin-dependent diabetic patients. Measures of gingival inflammation, crevicular fluid aspartate aminotransferase (AST) levels, probing depth and attachment levels, the presence of three periodontal pathogens (Porphyromonas gingivalis, Bacteroides forsythus, and Actinobacillus actinomycetemcomitans) and serum antibody titers to these bacteria, and blood sugar levels (glycosylated hemoglobin, HbAlc) were studied before and 2 months after non-surgical debridement. Antibody titers to the same bacteria were also studied in sera from 18 sex- and age-matched periodontally healthy and non-diabetic subjects. Periodontal conditions showed significant improvement. The mean probing depth at 4 of the worst sites selected in each patient decreased from 5.7 mm to 4.8 mm (p < 0.0001). The mean full width probing depth changed from 2.9 mm (s.d. +/- 0.2) to 2.5 mm (s.d. +/- 0.3). A mean gain of 0.4 mm attachment level was recorded (P < 0.0001). The mean AST value decreased from 1009 microIU to 518 microIU (P < 0.006). Minimal differences in mean glycosylated hemoglobin values (HbAlc) were noticed before and after treatment. A. actinomycetemcomitans was never detected. P. gingivalis was present at 7% of the sites both before and after treatment. B. forsythus was found at 29% of sites (50% of patients) before and at 36% of sites (61% of patients) after treatment. Positive associations were found between the presence of B. forsythus and AST values, gingival index, probing depth, and attachment level (P < 0.05). Baseline serum IgG titers to P. gingivalis were significantly lower in the patients with diabetes (9.5 ELISA units vs. 28.5 ELISA units in the healthy controls). IgG titers to B. forsythus did not differ between diabetic and non-diabetic subjects. No changes in IgG titers occurred after treatment. Clinical improvements after mechanical non-surgical therapy in patients with insulin-dependent diabetes mellitus were modest after 2 months. Treatment did not eliminate B. forsythus and P. gingivalis and did not affect IgG titer responses. More intense therapy, and longer follow-up times, may be necessary to see more pronounced clinical and systemic effects.

Adult↗

Hepatic extraction efficiency and excretion rate of technetium-99m-mebrofenin in dogs.

UNLABELLED: Quantitative hepatobiliary scintigraphy aids in the diagnosis of hepatic disease. Two scintigraphic parameters that have great value in discriminating between hepatocellular and biliary disease are hepatic extraction fraction (HEF), which is a measure of the hepatic extraction efficiency (HEE), and hepatic excretion rate. It is generally accepted that hepatic extraction fraction is normally 100%, but a review of the literature provided little information on the actual HEF of 99mTc-mebrofenin. METHODS: We determined the HEE of 99mTc-mebrofenin in nine normal dogs after direct injection into the afferent hepatic vasculature using a two-compartment model. The forward and reverse rate constants for the two-compartment model were solved by a simple graphic approach and a more complex numerical approach using a nonlinear least squares algorthm. The HEEs were determined using both methods. RESULTS: The HEE for the graphic and numerical methods of analysis were not significantly different and were calculated to be 92.2 +/- 4.75% (mean +/- s.d.) and 91.2 +/- 4.44% (mean +/- s.d.) by each method, respectively. The half-time clearance of 99mTc-mebrofenin was 19.10 +/- 4.86 min (mean +/- s.d.). CONCLUSION: This study validates the assumption that the normal HEE of 99mTc-mebrofenin is nearly 100%, barring species differences.

Aniline Compounds↗

Seasonal changes in song nuclei and song behavior in Gambel's white-crowned sparrows.

In males of several songbird species, the morphology of forebrain nuclei that control song changes seasonally. The only seasonally breeding songbird in which seasonal changes in the structure of song control nuclei have been reported not to occur is the nonmigratory Nuttall's subspecies of white-crowned sparrow. In the present study, we manipulated photoperiod and plasma testosterone concentrations in captive male white-crowned sparrows of the migratory Gambel's subspecies. Males exposed to photoperiods and plasma testosterone concentrations typical of those experienced by wild breeding males had larger song control nuclei than males held on a winter photoperiod. We also found seasonal changes in stereotype of spectral and temporal parameters of song in wild Gambel's white-crowned sparrows. We hypothesize that seasonal changes in the song control nuclei may correlate with seasonal changes in song stereotypy.

Animals↗

Expectancy for social facilitation from drinking: the divergent paths of high-expectancy and low-expectancy adolescents.

Using a 3-wave longitudinal design, adolescents were studied over a 2-year period during which many first began to drink. Covariance structure modeling showed that teens' expectancy for social facilitation from alcohol and their drinking experience influenced each other in a reciprocal, positive feedback fashion: the greater the expectancy endorsement, the higher subsequent drinking levels, and the higher the drinking levels, the greater the subsequent expectancy endorsement. This model fit the data quite well; comparison models, in which expectancy (or drinking) had no independent influence on future drinking (or expectancy), showed significantly poorer fit than the present model. Initial nondrinkers' social expectancy predicted individual differences in the rate of drinking increase over the 2 years. Results bolster the hypothesis that expectancy actively influences drinking and point to the importance of expectancy-based intervention efforts.

Adolescent↗

Crack cocaine mimicking pulmonary embolism on pulmonary ventilation/perfusion lung scan. A case report.

Cocaine inhalation is associated with multiple pulmonary complications including pulmonary infiltrates, pulmonary edema, barotrauma, tracheal injury, and alveolar hemorrhage. Little has been reported about ventilation/perfusion (V/Q) lung scanning in patients who smoke cocaine. The authors report a case of inhalation cocaine abuse mimicking pulmonary embolism by V/Q scan criteria. This case report documenting perfusion abnormalities within hours of cocaine smoking which resolved within days provides the first in vivo evidence for pulmonary vasoconstriction.

Adult↗

Self-reported drinking and alcohol-related problems among early adolescents: dimensionality and validity over 24 months.

OBJECTIVE: Researchers rely on adolescents' self-reports of alcohol consumption and alcohol-related problems, despite little evidence concerning their validity. We assessed the reliability and validity of adolescents' self-reports, employing collateral validation and focusing on the understudied transitional years of early adolescence. METHOD: Subjects were 214 boys and 247 girls who participated in school-wide surveys that assessed drinking, drunkenness and alcohol-related problems each year for 3 years. These measures were validated by collateral (peer) reports and by separate, 7-day drinking calenders. Internal consistency and test-retest reliability were also assessed. RESULTS: Results replicated findings with older adolescents that drinking/drunkenness and alcohol-related problems fall on two partially overlapping dimensions. Scales assessing each dimension had moderate to high internal consistency and high test-retest stability. Correlations with collateral reports were relatively strong for the drinking/drunkenness scale, moderate for a dichotomous variable reflecting the presence or absence of alcohol-related problems, and more modest for the alcohol-related problems scale. Correlations with diary reports of drinking behavior were strong for drinking/drunkenness. Results generally replicated across gender and over time. CONCLUSIONS: Researchers can have some confidence in the reliability and validity of early adolescents' survey self-reports, particularly of alcohol consumption (alcohol-related problems occurred with low base rates, perhaps limiting validity coefficients). Because drinking/drunkenness and alcohol-related problems shared 30% of their variance, factors other than consumption (e.g., personality factors) apparently influenced the experience of alcohol-related problems.

Adolescent↗