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Biomedical subjects

H Suh

Publications and source records attributed to H Suh.

At least 73 records · Page 4Linked to original sources

Pharmacokinetic and local tissue disposition studies of naproxen-following topical and systemic administration in dogs and rats.

The pharmacokinetic profiles of naproxen in blood and synovial fluid (SF) following topical and i.v. bolus administration in dogs, and the local tissue disposition of the drug following topical and oral administration in rats, were investigated to assess the feasibility of topical delivery of naproxen for local and systemic effects. The naproxen gel in poloxamer 407 (PF-127) was applied on the stifle joint of dogs, and serum and synovial fluid samples were collected. For local tissue disposition studies, the naproxen gel was applied on the dorsal skin in rats, and blood, skin, and muscle samples were taken at 3, 6, and 12 h postdose after removing the residual gel from the skin. Steady state serum concentrations occurred at approximately 20 h after topical doses and lasted for the next approximately 30 h in dogs. Similar SF-serum concentration ratios of naproxen were found between i.v. (0.61 +/- 0.16) and topical (0.55 +/- 0.14) routes of administration. Following the i.v. dose, the half-life of naproxen in SF (approximately 60 h) was significantly longer than that in serum (approximately 40 h). The bioavailability of naproxen in the topical gel was approximately 2% of the applied dose in dogs. A large accumulation of drug in the epidermis, dermis, and muscle tissue beneath the gel application site was found in rats. Isopropyl myristate (IPM) significantly increased the systemic absorption as well as the concentrations of naproxen in the underlying dermis and muscle tissues, but exerted little effect on the disposition of naproxen in the epidermis.

Administration, Oral↗

Amino acid profile and nitric oxide pathway in patients on continuous ambulatory peritoneal dialysis: L-arginine depletion in acute peritonitis.

To gain insights into the amino acid metabolism and L-arginine-nitric oxide system, we studied 21 control continuous peritoneal dialysis (CPD) patients and 13 patients with 15 episodes of acute peritonitis. The concentrations of amino acids, including L-arginine, were measured in the peritoneal dialysate and in the serum. The data demonstrate that patients with end-stage renal disease on CPD who have acute peritonitis develop L-arginine deficiency. The majority of patients with acute bacterial peritonitis have increased nitric oxide production as judged by the level of nitrites in the dialysate. The recovery from peritonitis is associated with a decline in nitric oxide generation. Paradoxically, there is a smaller subgroup of these patients that shows low nitrite levels during acute peritonitis. The nitrite to L-arginine ratio in the peritoneal dialysate is increased in patients with peritonitis, further suggesting the development of substrate deficiency. These findings implicate L-arginine as a conditionally essential amino acid in CPD patients with acute peritonitis and raise questions concerning the necessity of L-arginine supplementation.

Acute Disease↗

Serum albumin and depression in end-stage renal disease.

The purpose of our study was to determine whether albumin influenced patients' depression or whether depression influenced patients' albumin. Patients from a tertiary care university medical hospital were assessed for both serum albumin and depression [Beck Depression Inventory (BDI)] at two time points separated by 6 months. Data were collected for 72 patients (43 male, 29 female; mean age 54 years). The sample consisted of 32 hemodialysis and 40 peritoneal dialysis patients. The outcome measures were changes in depression and albumin over time. Regression analysis indicated that all three Time 1 measures of BDI, BDICOG (BDI cognitive), and BDISOM (BDI somatic) significantly predicted decreases in albumin from Time 1 to Time 2 (beta = -0.22, p < 0.002; beta = -0.17, p < 0.015; beta = -0.23, p < 0.002, respectively). However, Time 1 measures of albumin did not predict changes in BDI, BDICOG, or BDISOM (beta = -0.04, p < 0.738; beta = -0.08, p < 0.375; beta = -0.07, p < 0.618, respectively). Thus depression at Time 1 predicted decreases in albumin from Time 1 to Time 2. The reverse effect that albumin influences depression from Time 1 to Time 2 was not found. In conclusion, this study suggests that depression influences the nutritional status indicated by albumin levels. Thus poor nutritional status may mediate the relation between depression and mortality in end-stage renal disease (ESRD).

Adult↗

Decreased L-arginine during peritonitis in ESRD patients on peritoneal dialysis.

Deficient production of nitric oxide may be responsible for the defective defense barrier and persistence of bacterial infection. To gain insight into amino acid-metabolism and L-arginine-nitric oxide system, we studied 34 end-stage renal disease (ESRD) patients on peritoneal dialysis (PD) (20 males, 14 females, with a mean age of 53.5 years and a mean duration on PD of 29.7 months). The concentrations of amino acids, including L-arginine, were measured in peritoneal dialysate and in the serum. The data demonstrated that patients with ESRD on PD have normal serum amino-acid profiles, whereas those with acute peritonitis develop L-arginine deficiency (from 99 +/- 9 to 52 +/- 9 mumol/L). In addition, levels of asparagine, glycine, proline (nonessential) as well as valine, threonine, and lysine (essential) were reduced in patients with peritonitis. The majority of patients with acute bacterial peritonitis have increased nitric oxide production as judged by the level of nitrites in the dialysate (36 +/- 2 vs 57 +/- 6 mumol/L). The recovery from peritonitis was associated with a decline in nitric-oxide generation. There was a smaller subgroup of these patients that showed paradoxically low nitrite levels during acute peritonitis. The nitrite: L-arginine ratio in the peritoneal dialysate was increased in patients with peritonitis, further suggesting the development of substrate deficiency. These findings implicate L-arginine as a conditionally essential amino acid in PD patients with acute peritonitis. Further studies are needed to address the issue of L-arginine supplementation in such patients.

Acute Disease↗

Persistent exit-site/tunnel infection and subcutaneous cuff removal in PD patients.

The purpose of our study was to investigate catheter outcome of persistent exit-site/tunnel infections (ESI/TIs) in peritoneal dialysis (PD) patients. The patients underwent removal of subcutaneous cuff due to persistent ESI/TI from January 1989 to December 1996 in a tertiary referral university hospital. Two hundred and twenty-three patients (138 male, 85 female) underwent 244 double-cuff coiled Swan neck catheter implantations surgically. Twenty-nine patients (11.8%) had persistent ESI/TI for more than 6 months with the same organism. Sixteen patients (52%) underwent subcutaneous cuff excision. Thirteen (48%) patients refused and were managed conservatively. Two hundred and forty-three episodes of ESI/TI were observed over 4970 patient-months with a rate of 0.58 episodes/patient/year. Twenty-nine patients (11.8%) had persistent ESI/TI with S. aureus in 19, Pseudomonas aeruginosa in 9 (31%), and Serratia marcescens in one (3%) patient. Fourteen (88%) persistent ESI/TIs resolved after subcutaneous cuff excision. None of the patients with ESI/TI responded to conservative treatment. ESI/TI-related peritonitis decreased from 11 episodes to 5 episodes after cuff excision. In contrast, episodes of peritonitis increased from one to 9 with conservative management during a follow-up of mean 18 months (4-38 months). Four (31%) catheters were lost in the conservative group, while 3 (19%) were lost after cuff excision. ESI/TI-related peritonitis decreased after subcutaneous cuff excision but increased with conservative management for ESI/TI. ESI/TI resolved in 88% of the patients after cuff excision, while none resolved with conservative treatment.

Adolescent↗

Effectiveness and mode of action of isopropyl myristate as a permeation enhancer for naproxen through shed snake skin.

The effectiveness and mode of action of isopropyl myristate (IPM) as an enhancer for the permeation of naproxen through shed snake skin have been investigated. The highest naproxen permeability was afforded by IPM (36.2 x 10(-4) cm h-1), followed by menthol (25.0 x 10(-4) cm h-1), oleic acid (11.1 x 10(-4) cm h-1), azone (7.3 x 10(-4) cm h-1) and control (1.4 x 10(-4) cm h-1). Whereas the permeability of un-ionized naproxen (47.4 x 10(-5) cm h-1) was much greater than that of ionized naproxen (1.11 x 10(-5) cm h-1), IPM-treatment of the intact skin increased the flux of ionized naproxen significantly more (50-fold) than that of un-ionized naproxen (15-fold). The large effect of pH on the permeation of naproxen through the intact stratum corneum became insignificant after extraction of lipids from the skin. Similar permeation of naproxen through intact and delipidized skin after IPM treatment indicated that the lipid barrier of the skin was largely impaired by IPM. Direct application of IPM to skin yielded a 2.6-fold higher naproxen permeability than the application of IPM as gel. A greater amount of naproxen was absorbed from 1% test gel (pH 5) containing IPM than from 10% commercial gel (pH 7) containing no IPM. These results show that use of IPM can significantly improve the bioavailability of naproxen in topical preparations.

Animals↗

Plasminogen activator inhibitor-1 and peritoneal transport in peritoneal dialysis patients.

Plasminogen activator inhibitor-1 (PAI-1) is involved in the accumulation of extracellular matrix in various tissues. Since peritoneal interstitium is one of the resistance sites for transport during peritoneal dialysis (PD), the peritoneal PAI-1 level may have a significant effect on peritoneal transport. It was the purpose of this study to examine the associations between plasma or dialysate PAI-1 levels and the variables of peritoneal transport during peritoneal equilibration tests (PET) in 25 stable, adult PD patients. The dialysate PAI-1 levels increased with dwell time. Hematocrit was a positive predictor of plasma PAI-1 concentration and the change of dialysate PAI-1 amount scaled by body surface area (delta DPAI/ BSA). The peritoneal clearance of PAI-1 was higher than expected for its molecular size, suggesting a local production of PAI-1 in peritoneal tissue. The mass transfer coefficient of creatinine scaled by BSA (MTCcr/BSA) was a positive predictor of delta D PAI/BSA, suggesting the diffusion of plasma PAI-1 into the peritoneal cavity also accounted for part of the increased dialysate PAI-1 levels during PET. delta DPAI/BSA was a positive predictor of MTC of urea (ur) MTCwr/BSA and MTCcr/BSA, parameters for diffusive transport. Our findings are consistent with the hypothesis that peritoneal PAI-1 level has a significant effect on peritoneal transport during PD.

Adult↗

Antifungal prophylaxis for secondary fungal peritonitis in peritoneal dialysis patients.

Our objective was to evaluate antifungal prophylaxis for secondary fungal peritonitis in peritoneal dialysis patients. The study was designed to investigate antifungal prophylaxis for fungal peritonitis and to compare the incidence of fungal peritonitis without (January, 1991-July, 1993) and with (August, 1993-December, 1995) antifungal prophylaxis. In a tertiary-referral university hospital, 122 end-stage renal disease (ESRD) patients (77 male, 45 female) during period A (1/91-7/93) were observed for 1832 patient-months with no antifungal prophylaxis. One hundred and twelve ESRD patients (71 male, 41 female) during period B (8/93-12/95) were observed over 1705 patient-months with antifungal prophylaxis with fluconazole. Fluconazole 200 mg was given orally (po) as first dose at the onset of antibiotic therapy, then 100 mg po every other day, and was continued for one week after the antibiotic therapy. Forty-nine patients (28 male, 21 female; mean age 48.8 years) developed 105 episodes of peritonitis during period A. Forty-eight patients (36 male, 12 female; mean age 53.8 years) developed 95 episodes of peritonitis during period B. Fifteen episodes of fungal peritonitis occurred over 1832 patient-months during period A. while four episodes of fungal peritonitis were observed over 1705 patient-months during period B. Twelve episodes of secondary fungal peritonitis occurred during period A, while only two episodes occurred during period B. This incidence of secondary fungal peritonitis was significantly reduced with antifungal prophylaxis (p < 0.02). No side effect of fluconazole was observed. In conclusion, secondary fungal peritonitis was significantly decreased following fluconazole antifungal prophylaxis at our center.

Adult↗

Endogenous peritonitis and related outcome in peritoneal dialysis patients.

Our objective was to study endogenous peritonitis and related catheter outcome in peritoneal dialysis (PD) patients. The study was designed to investigate endogenous peritonitis and related catheter loss in all end-stage renal disease (ESRD) patients who started peritoneal dialysis from January, 1989 to September, 1995. In a tertiary-referral university hospital, 192 ESRD patients (117 male, 75 female) who entered the home program from 1/89 to 9/95 were studied. Sixteen episodes of endogenous peritonitis occurred in 15 PD patients (7 male, 8 female) with a mean age of 63 years (range 33-81 years). Five patients were diabetic. Two hundred and seventeen episodes of peritonitis in 192 patients occurred over 4149 patient-months, resulting in one episode/19.1 patient-months. Sixteen episodes of endogenous peritonitis were encountered in 15 patients, accounting for 7% of all episodes of peritonitis. The mean duration of PD before contracting endogenous peritonitis was 24.2 months (range 7-52 months). Eleven episodes were related to diverticular leak/perforation, three to sigmoidoscopy/colonoscopy/PEG procedures, one to unknown etiology, and one to cholecystitis. During 11 episodes, severe constipation preceded. All the patients were initially treated conservatively with antibiotics. Five episodes (31%) responded to antibiotic therapy alongside antifungal prophylaxis and continued PD. One episode (6%) required cholecystectomy without catheter removal and resumed PD. Six episodes (38%) required catheter removal due to subsequent fungal peritonitis in a mean of 11 days (range 3-24 days): 4 patients transferred to hemodialysis and 2 patients resumed PD. Three patients underwent catheter removal along with colectomy and colostomy: 2 patients transferred to hemodialysis and 1 patient died in ten days. One patient refused surgery and died in 16 days. Endogenous peritonitis resulted in a high incidence of catheter loss and dropout from PD. Peritonitis due to bowel leak without frank bowel perforation can be managed with antibiotic therapy and antifungal prophylaxis. Aggressive management of constipation may decrease endogenous peritonitis.

Adult↗

Multiple use of disposable (tubing) set of HomeChoice automated peritoneal dialysis (APD) system in PD patients.

Our objective was to evaluate the multiple use of the tubing set of the HomeChoice automated peritoneal dialysis (PD) system in PD patients. The study was designed to reuse the tubing set of the HomeChoice automated PD system for two to seven treatments, each of 16-24 hours duration, in end-stage renal disease (ESRD) patients, and to continue to use the same set if the patient was disconnected for any reason. In a tertiary-referral university hospital, 17 ESRD patients on PD, admitted to a university hospital from January, 1995 to September, 1995, were studied. The patients were disconnected and connected in between or during PD treatments. Five-liter bags were used. All the fluid was either set initially or added as clinically indicated. One hundred and thirty-eight PD treatments were performed with the HomeChoice automated PD system, using 30 disposable (tubing) sets. Sixty-three disconnections were made for ambulation, transfer to other units, surgery, physical therapy, radiological investigations, and special procedures in between and during PD treatments. No episode of peritonitis occurred. The multiple use resulted in a 78% reduction in tubing sets and drain-line extension sets used, thereby reducing the disposable supplies and creating a substantial saving in nursing time. The multiple use of tubing sets of the HomeChoice automated PD system was safe and economical in patients undergoing automated PD in a hospital setting.

Catheters, Indwelling↗

The cytoplasmic domains of immunoglobulin (Ig) alpha and Ig beta can independently induce the precursor B cell transition and allelic exclusion.

In mature B cells, signals transduced through membrane immunoglobulin (Ig) produce cellular activation, yet the same receptor can also mediate deletion and silencing of autoreactive B cells. In addition, Ig expression during the antigen-independent phase of B cell development regulates the precursor B (pre-B) cell transition and allelic exclusion. To account for the diverse regulatory functions induced by membrane Ig, it has been proposed that individual receptor components have independent physiologic activities. Here we establish a role for Ig alpha in the pre-B cell transition and allelic exclusion. We find that the cytoplasmic domain of Ig alpha contains sufficient information to trigger both of these antigen-independent events. Direct comparisons of the cytoplasmic domains of Ig alpha and Ig beta show that the two are indistinguishable in the induction of the pre-B cell transition and allelic exclusion. Our experiments suggest that, despite the reported differences in certain biochemical assays, Ig alpha and Ig beta have redundant functions in the developing B cell.

Alleles↗

The role of Ig beta in precursor B cell transition and allelic exclusion.

Lymphocytes express multicomponent receptor complexes that mediate diverse antigen-dependent and antigen-independent responses. Despite the central role of antigen-independent events in B cell development, little is known about the mechanisms by which they are initiated. The association between the membrane immunoglobulin (Ig) M heavy chair (micron) and the Ig alpha-Ig beta heterodimer is now shown to be essential in inducing both the transition from progenitor to precursor B cells and subsequent allelic exclusion in transgenic mice. The cytoplasmic domain of Ig beta is sufficient to induce these early antigen-independent events by a mechanism that requires conserved tyrosine residues in this protein.

Alleles↗

Subcutaneous cuff removal in persistent exit-site/tunnel infections in peritoneal dialysis.

The purpose of this study was to analyze catheter outcome of persistent exit-site/tunnel infections (ESI/TIs) in peritoneal dialysis patients who underwent removal of the subcutaneous cuff due to persistent ESI/TI from January 1989 to June 1994. One hundred and sixty-eight patients (98 male, 70 female) from our tertiary university hospital underwent 177 double-cuff coiled Swan neck catheter implantations surgically. Nineteen patients (11%) had persistent ESI/TIs for more than 6 months. Thirteen persistent ESI/TIs responded to subcutaneous cuff removal. One hundred and fifty-four episodes of ESI/TI in 168 patients were observed over 3189 patient-months (0.58 episodes/patient-year). Nineteen patients (11%) had persistent ESI/TI with Staphylococcus aureus in 12 and Pseudomonas aeurginosa in 7 patients without episode of peritonitis except 2 patients with Staphylococcus aureus. Thirteen persistent ESI/TI resolved after subcutaneous catheter removal without catheter loss, 8 with Staphylococcus aureus and 5 with Pseudomonas. Sixteen catheters were lost due to fungal peritonitis and two secondary to recurrent bacterial peritonitis. None of the catheters were removed as a result of ESI/TI and related peritonitis. Subcutaneous cuff removal in persistent ESI/TI in peritoneal dialysis patients can significantly reduce catheter loss related to ESI/TI.

Bacteria↗

Peritoneal transport in type I (insulin-dependent) and type II (noninsulin-dependent) diabetic peritoneal dialysis patients.

Alterations in the fibrinolytic system have been demonstrated in noninsulin-dependent diabetic patients (NIDDM) but not in insulin-dependent diabetic patients (IDDM). Since the activity of the fibrinolytic system can affect the turnover of extracellular matrix and therefore theoretically can affect the peritoneal transport, we tried to determine if there was a difference in the performance of the peritoneal equilibration test (PET) between IDDM and NIDDM patients receiving peritoneal dialysis (PD). The PET data from 11 IDDM patients (2 female, 9 male) and 13 NIDDM patients (3 female, 10 male) were reviewed. These two groups of patients were matched in gender, duration of end-stage renal disease, PD, and hypertension, blood pressure, degree of uremia, weekly KT/V, and body surface area. The IDDM patients (41.4 +/- 13.9 years) were younger than the NIDDM patients (58.8 +/- 7.1 years, p = 0.0026). There were no differences in hematocrit and serum chemistry profile including glucose and albumin between the two groups. Our data showed that there was no difference in PET performance between IDDM and NIDDM patients.

Adult↗

Increased peritoneal solute transport in diabetic peritoneal dialysis patients.

Microangiopathy has been observed in the peritoneum of diabetic patients, and an increase in vascular permeability to small and large molecules has been described in the skeletal muscle of diabetic patients. Therefore, we examined the peritoneal equilibration test (PET) data from 19 diabetic and 19 nondiabetic stable peritoneal dialysis (PD) patients. These two groups of patients were matched in terms of age, gender, duration of PD and hypertension, incidence of peritonitis, levels of blood pressure, degree of uremia, levels of serum lipids, hematocrit, weekly KT/V, and body surface area. Compared to the nondiabetics, the diabetics had higher dialysate-to-serum ratios or mass transfer coefficients of urea or creatinine. These differences were not related to their differences in serum sodium or glucose. Regression analysis showed that the duration of hypertension was a negative determinant of peritoneal transport of urea and creatinine in diabetic patients. Our results suggest that the diabetic patients had a higher peritoneal diffusive transport of small solutes, which was offset by their duration of hypertension.

Biological Transport↗

Transformation by homeobox genes can be mediated by selective transcriptional repression.

Altered transcription is a recurrent theme in the field of cancer biology. But despite the central role of transcription in transformation, little is known about the mechanism by which dominant nuclear oncogenes induce malignancies. Homeobox family proteins are prominent examples of transcriptional regulators which control development and can function as oncogenes. Here we explore the molecular basis for transformation by this class of regulators using Oct-2 and Oct-1. We show that the DNA binding POU domains of these proteins are selective and sequence-specific transcriptional repressors that produce malignant lymphomas when they are expressed in T cells of transgenic mice. Mutagenesis experiments identified a specific set of promoters, those containing octamer regulatory elements, as the targets for transformation by selective inhibition of gene expression.

Animals↗

TCR selection and allelic exclusion in RAG transgenic mice that exhibit abnormal T cell localization in lymph nodes and lymphatics.

RAG-1 and RAG-2 are developmentally regulated genes that are essential for V(D)J recombination and lymphocyte development. Expression of RAG-1 and RAG-2 by thymocytes is normally limited to cells that have not completed selection. We have previously documented that persistent expression of the recombinase activating genes (RAG) in transgenic mice results in aberrant thymic development, altered lymphatic microanatomy, and a profound immunodeficiency. Here we further document the pathologic changes found in TG.RAG-1,2 mice and examine the role of TCR recombination and positive and negative thymic selection, as well as allelic exclusion, in the etiology of the phenotype. We find that neither selection nor TCR allelic exclusion can be overcome by transgenic expression RAG-1 and RAG-2 under the control of an lck promoter.

Alleles↗

A regulatory role for recombinase activating genes, RAG-1 and RAG-2, in T cell development.

RAG-1 and RAG-2 are developmentally regulated genes that are essential for the assembly of antigen receptors in lymphoid cells. Here we describe transgenic mice that carry RAG-1 and RAG-2 under the control of the proximal lck promoter. Persistent expression of RAG-1 and RAG-2 was associated with incomplete thymopoiesis and profoundly compromised cellular immunity. In addition, RAG transgenic mice rapidly developed lymphadenopathy, splenomegaly, and lymphocytic perivascular infiltrates. These effects required both RAG-1 and RAG-2, since mice that carried either gene exclusively were indistinguishable from wild-type controls. We propose that in addition to a previously documented role in V(D)J recombination, RAG-1 and RAG-2 expression must be properly regulated for completion of normal T cell development

Animals↗