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Biomedical subjects

J A Manning

Publications and source records attributed to J A Manning.

At least 37 records · Page 2Linked to original sources

Echocardiographic definition of right pulmonary venous connection at catheterization.

Traditional methods of identifying partial anomalous pulmonary venous connection to the right atrium in the presence of an atrial defect are not always reliable. Twenty patients were studied with a new technique in which the catheter is introduced into the right superior pulmonary vein followed by echocardiographic assessment of the catheter position in relation to the left atrium and atrial septum. The insertion site of the right pulmonary veins was detected in every patient and in ten patients has been verified at operation. This approach can be performed rapidly and appears to be accurate as well as reliable.

Adolescent↗

Respiratory syncytial viral infection in infants with congenital heart disease.

Occasional reports have suggested that infants with congenital heart disease may have an increased risk of severe illness from respiratory syncytial virus (RSV) infection. We prospectively studied 699 infants hospitalized during the winters of 1976 through 1980, when RSV was prevalent in the community; 229 of these infants had proved RSV infections acquired either before admission or during hospitalization; 27 had both congenital heart disease and RSV infection, and 46 had congenital heart disease without RSV infection. Infected infants with congenital heart disease had significantly more severe illness than those without congenital heart disease, as judged by the requirement for intensive care and assisted ventilation and by the mortality rate (37 per cent vs. 1.5 per cent, P less than 0.01). The infection was acquired nosocomially by 21 per cent of infected infants; the mortality rate from nosocomial infection was also higher in infants with congenital heart disease (44 per cent vs. 5 per cent, P less than 0.01). Pulmonary hypertension was the one condition particularly associated with severe RSV illness. Eight of the 11 infants (73 per cent) with congenital heart disease and pulmonary hypertension died during their RSV illness. The courses in infants with congenital heart disease with and without RSV infection were also compared. Their ages, types of cardiac lesions, and incidence of pulmonary hypertension were similar, but the infants with RSV infection had a higher mortality rate (37 per cent vs. 6.5 per cent, P less than 0.1).

Cross Infection↗

Fatty acid binding protein. Isolation from rat liver, characterization, and immunochemical quantification.

Fatty acid-binding protein (FABP) was identified and isolated from rat liver cytosol by gel filtration, thin layer isoelectric focusing, and affinity chromatography. FABP (Mr 12,080 +/- 80) exists in several immunochemically identical forms differing in isoelectric pH, which may in part reflect differences in their respective complements of bound endogenous ligand. FABP-bound fatty acids accounted for 60% of total cytosolic long chain fatty acids but contained no detectable phospholipid; the substantial enrichment of FABP in 18:2 and 20:4 as compared with whole liver homogenate was not influenced by homogenization of tissue in EDTA. The amino acid composition of FABP suggests that it is closely related or identical with certain similar neutral and acidic cytosolic proteins reported from other laboratories. By quantitative radial immunodiffusion, FABP concentration in cytosol from livers of sexually mature female rats exceeded that from mature males (51.7 +/- 3.0 versus 39.8 +/- 4.0 micrograms/mg of protein, p less than 0.05), confirming earlier studies in which sex steroid effects on rates of fatty acid utilization were correlated with FABP concentration as determined by means of a binding assay. The abundance of FABP, its importance in the cytosolic binding of endogenous as well as exogenous fatty acids, and its demonstrated correlation with rates of hepatocyte fatty acid utilization provide additional evidence for its relationship to the cellular metabolism of long chain fatty acids.

Aging↗

Parenteral indomethacin for closure of the patent ductus arteriosus. Clinical experience with 67 preterm infants.

During a 19-month period, 23% of preterm infants had symptomatic patent ductus arteriosus (PDA). Intravenous indomethacin was administered to 67 infants with successful closure in 91% of the patients and in 83% of those with birth weights less than 1,000 g. No differences were found between the number of doses required and birth weight, gestational age, or age at initial therapy. Transient alterations in renal function were common after therapy, but mild renal failure occurred in only four infants. The incidence of intraventricular hemorrhage and necrotizing enterocolitis in treated infants was similar to that in the total preterm population. Cicatricial retrolental fibroplasia developed in one patient. Bronchopulmonary dysplasia occurred more frequently in infants with PDA, but a decreased incidence was found after early ductal closure. Intravenous indomethacin administration successfully effects ductal closure without major complications in preterm infants.

Age Factors↗

Two-dimensional echocardiographic identification of pulmonary artery branch stenosis.

Pulmonary artery branch stenosis is a not uncommon congenital lesion, noted in approximately 4% of children at the time of cardiac catheterization. Real-time 2-dimensional echocardiography was used to examine 10 patients with angiographically documented pulmonary branch stenosis. Five cases of pulmonary artery branch narrowing were identified by echocardiography without prior knowledge of angiographic findings. In 5 other patients whose angiographic results were known, the narrowings were identified in 4 of 5 cases. These results demonstrate the feasibility of evaluating pulmonary branch stenosis with the nonionizing, noninvasive method of 2-dimensional echocardiography.

Adolescent↗

Coronary artery injury by a valved external conduit.

A 4-month-old infant underwent repair of type I truncus arteriosus and died immediately after as a consequence of left main coronary artery compression by the metallic stent in the Dacron conduit. To avoid injury to the coronary vasculature, the future location of the porcine valve ring should be assessed and relocated if necessary.

Bioprosthesis↗

Sex steroid modulation of fatty acid utilization and fatty acid binding protein concentration in rat liver.

The mechanism by which sex steroids influence very low density hepatic lipoprotein triglyceride production has not been fully elucidated. In previous studies we showed that [(14)C]oleate utilization and incorporation into triglycerides were greater in hepatocyte suspensions from adult female rats than from males. The sex differences were not related to activities of the enzymes of triglyceride biosynthesis, whereas fatty acid binding protein (FABP) concentration in liver cytosol was greater in females. These findings suggested that sex differences in lipoprotein could reflect a sex steroid influence on the availability of fatty acids for hepatocellular triglyceride biosynthesis. In the present studies, sex steroid effects on hepatocyte [(14)C]oleate utilization and FABP concentration were investigated directly. Hepatocytes from immature (30-d-old) rats exhibited no sex differences in [(14)C]oleate utilization. With maturation, total [(14)C]oleate utilization and triglyceride biosynthesis increased moderately in female cells and decreased markedly in male cells; the profound sex differences in adults were maximal by age 60 d. Fatty acid oxidation was little affected. Rats were castrated at age 30 d, and received estradiol, testosterone, or no hormone until age 60 d, when hepatocyte [(14)C]oleate utilization was studied. Castration virtually eliminated maturational changes and blunted the sex differences in adults. Estradiol or testosterone largely reproduced the appropriate adult pattern of [(14)C]oleate utilization regardless of the genotypic sex of the treated animal. In immature females and males, total cytosolic FABP concentrations were similar. In 60-d-old animals, there was a striking correlation among all groups (females, males, castrates, and hormone-treated) between mean cytosolic FABP concentration on the one hand, and mean total [(14)C]oleate utilization (r = 0.91) and incorporation into triglycerides (r = 0.94) on the other. In 30-d-old animals rates of [(14)C]oleate utilization were greater, relative to FABP concentrations, than in 60-d-old animals. The sex differences that characterize fatty acid utilization in adult rat hepatocytes are not present in cells from immature animals, and reflect in part the influence of sex steroids. It remains to be determined whether the observed relationship of hepatic FABP concentration to [(14)C]oleate utilization in adult cells is causal or secondary to changes in cellular fatty acid uptake effected through another mechanism. In either case, modulation of triglyceride-rich lipoprotein production by six steroids appears to be mediated to a significant extent by their effects on hepatic fatty acid utilization.

Aging↗

Sex differences in long chain fatty acid utilization and fatty acid binding protein concentration in rat liver.

Female sex and estrogen administration are associated with increased hepatic production of triglyceride-rich lipoproteins; the basis for this has not been fully elucidated. Inasmuch as hepatic lipoprotein production is also influenced by FFA availability and triglyceride biosynthesis, we investigated sex differences in FFA utilization in rat hepatocyte suspensions and in the components of the triglyceride biosynthetic pathway. Isolated adult rat hepatocyte suspensions were incubated with albumin-bound [(14)C]oleate for up to 15 min. At physiological and low oleate concentrations, cells from females incorporated significantly more (14)C into glycerolipids, especially triglycerides, and into oxidation products than did male cells, per milligram cell protein. At 0.44 mM oleate, incorporation into triglycerides in female cells was approximately twice that in male cells. Comparable sex differences were observed in cells from fasted animals and when [(14)C]-glycerol incorporation was measured. At higher oleate concentrations, i.e., fatty acid:albumin mole ratios in excess of 2:1, these sex differences were no longer demonstrable, suggesting that maximal rates of fatty acid esterification and oxidation were similar in female and male cells. In female and male hepatic microsomes, specific activities of long chain acyl coenzyme A synthetase, phosphatidate phosphohydrolase, and diglyceride acyltransferase were similar, but glycerol-3-phosphate acyltransferase activity was slightly greater in females at certain substrate concentrations. Microsomal incorporation of [(14)C]oleate into total glycerolipids was not significantly greater in females. In further contrast to intact cells, microsomal incorporation of [(14)C]oleate into triglycerides, although significantly greater in female microsomes, accounted for only a small fraction of the fatty acid esterified.The binding affinity and stoichiometry of partially purified female hepatic fatty acid binding protein (FABP) were similar to those of male FABP. In contrast, the concentration of FABP, per milligram cytosolic protein, was 44% greater in female liver than in male, as indicated by measurement of [(14)C]oleate binding and of 280 nm OD in the FABP fraction of 105,000 g supernate after gel filtration chromatography. These experiments demonstrate profound sex differences in hepatocyte utilization of long chain fatty acids at concentrations within and below the physiological range, and suggest that these are attributable at least in part to corresponding differences in cytosolic FABP concentration. At higher FFA concentrations, sex differences in hepatocyte FFA utilization are virtually eliminated, suggesting that under these conditions, differences in FABP concentration are not rate determining. Sex differences in hepatic lipoprotein production may largely reflect these important differences in the initial stages of hepatocyte FFA utilization.

Albumins↗

Trial of bivalent influenza A vaccine in high-risk infants.

A vaccine trial involving 50 high-risk infants, aged six to 36 months, was performed for evaluation of the safety of a split-virus bivalent influenza A vaccine. After immunization, 18% of the infants developed a fever of greater than or equal to 100 F and 7% had fever of greater than or equal to 102 F. Other reactions to the vaccine were few. However, the reaction index of these high-risk infants to the bivalent vaccine was higher than those of older children receiving the same vaccine and normal infants receiving the monovalent vaccine. Forty-one percent of the infants responded with a titer of hemagglutination-inhibiting antibody of greater than or equal to 1:20 to the A/Victoria/75 component of the bivalent vaccine, and 35% responded to the A/New Jersey/8/76 component. This result suggested that this vaccine used in two doses would be an effective vaccine for infants. The infants generally tolerated the vaccine well. Nevertheless, the rapid development of fever would be of concern in the infant whose underlying disease was marginally compensated.

Antibodies, Viral↗

Echocardiographic studies of abnormalities associated with coarctation of the aorta.

Echocardiograms were performed in thirty-six patients (aged 4 to 36 years) with proven coarctation of the aorta. Nineteen patients (53%) were found to have marked diastolic eccentricities of their aortic valves (Eccentricity Index greater 1.5), indicating the presence of bicuspid aortic valves. One of these patients also had multilayered aortic root echoes in diastole. Five patients had angiographic proof of their aortic valve morphologies which corroborated the echo findings. Five patients with bicuspid aortic valves showed mitral valve diastolic flutter indicative of aortic regurgitation. Idiopathic hypertrophic subaortic stenosis (IHSS) was suspected in four patients (11%) with abnormal systolic anterior motion of the mitral valve; three of these patients also had asymmetric septal hypertrophy. There was catheterization proof of IHSS in one patient. Two patients (5.6%) demonstrated mitral valve proplapse.

Amyl Nitrite↗