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Biomedical subjects

J B Murphy

Publications and source records attributed to J B Murphy.

At least 19 recordsLinked to original sources
PubMed1999

A nod factor binding lectin with apyrase activity from legume roots.

A lectin isolated from the roots of the legume, Dolichos biflorus, binds to Nod factors produced by rhizobial strains that nodulate this plant and has a deduced amino acid sequence with no significant homology to any lectin reported to date. This lectin also is an enzyme that catalyzes the hydrolysis of phosphoanhydride bonds of nucleoside di- and triphosphates; the enzyme activity is increased in the presence of carbohydrate ligands. This lectin-nucleotide phosphohydrolase (LNP) has a substrate specificity characteristic of the apyrase category of phosphohydrolases, and its sequence contains four motifs characteristic of this category of enzymes. LNP is present on the surface of the root hairs, and treatment of roots with antiserum to LNP inhibits their ability to undergo root hair deformation and to form nodules on exposure to rhizobia. These properties suggest that this protein may play a role in the rhizobium-legume symbiosis and/or in a related carbohydrate recognition event endogenous to the plant.

Amino Acid Sequence↗
PubMed1999

Inverse relationship between systemic resistance of plants to microorganisms and to insect herbivory.

Pre-inoculation of plants with a pathogen that induces necrosis leads to the development of systemic acquired resistance (SAR) to subsequent pathogen attack [1]. The phenylpropanoid-derived compound salicylic acid (SA) is necessary for the full expression of both local resistance and SAR [2] [3]. A separate signaling pathway involving jasmonic acid (JA) is involved in systemic responses to wounding and insect herbivory [4] [5]. There is evidence both supporting and opposing the idea of cross-protection against microbial pathogens and insect herbivores [6] [7]. This is a controversial area because pharmacological experiments point to negative cross-talk between responses to systemic pathogens and responses to wounding [8] [9] [10], although this has not been demonstrated functionally in vivo. Here, we report that reducing phenylpropanoid biosynthesis by silencing the expression of phenylalanine ammonialyase (PAL) reduces SAR to tobacco mosaic virus (TMV), whereas overexpression of PAL enhances SAR. Tobacco plants with reduced SAR exhibited more effective grazing-induced systemic resistance to larvae of Heliothis virescens, but larval resistance was reduced in plants with elevated phenylpropanoid levels. Furthermore, genetic modification of components involved in phenylpropanoid synthesis revealed an inverse relationship between SA and JA levels. These results demonstrate phenylpropanoid-mediated cross-talk in vivo between microbially induced and herbivore-induced pathways of systemic resistance.

Adaptation, Physiological↗
PubMed1998

Lack of an association between insulin-like growth factor-I and body composition, muscle strength, physical performance or self-reported mobility among older persons with functional limitations.

OBJECTIVE: The hypothesis that decreased growth hormone (GH) secretion contributes to the functional decline that occurs with aging is far from substantiated. There have been few studies addressing the distribution and correlates of IGF-I, an indicator of GH activity, in nonclinical populations. As part of a growth hormone intervention trial, we examined the cross-sectional relations between IGF-I levels and multiple measures of physical function, body composition, and strength in a group of older men and women exhibiting mild to moderate reductions in measured physical performance. METHODS: Using a variety of advertising techniques, 155 older subjects were recruited from a metropolitan area to participate in a growth hormone and exercise intervention study. At baseline, all subjects had blood drawn for IGF-I and underwent testing of body composition using dual X-ray absorptiometry, muscle strength using isokinetic dynamometry, and functional assessment using timed performance measures and self-report. Associations between levels of IGF-I, body composition, strength, and physical function were assessed after dividing men and women separately into tertiles of IGF-I as well as treating IGF-I as a continuous variable. RESULTS: Men had higher IGF-I levels than women, and a significant inverse correlation was observed between age and IGF-I in men (r=-0.29, P=.009). There were no clear trends for associations between tertiles of IGF-I, and any of the variables tested. Linear regression models with IGF-I treated as a continuous measure were not associated significantly with any of the measures of physical function, body composition, or strength (all P > 0.05). CONCLUSIONS: In conclusion, although IGF-I levels declined with age in men, these data did not demonstrate an association between IGF-I and measures of muscle strength, body composition, or physical functioning. These findings support the growing body of evidence that IGF-I levels may not be an indicator of growth hormone activity in older persons.

Aged↗
PubMed1994

Use of magnetic resonance imaging scanning in adrenocortical carcinoma with vena caval involvement.

We report on 2 cases of an adrenocortical carcinoma with vena caval involvement. Preoperative evaluation included a magnetic resonance imaging (MRI) scan confirming the presence of vena caval involvement. Extremely precise detail of the vena caval tumor thrombus was very helpful in preparing for the surgical extirpation. MRI detail far outweighed what was seen on the computed tomography scan and venacavogram. The MRI scan correlated exactly with what was found surgically. Although MRI scanning has been used to evaluate renal tumors with vena caval extension, few cases have been reported with similar adrenal tumors.

Adrenal Cortex Neoplasms↗
PubMed1994

Physical and functional assessment of the elderly stroke patient.

A functionally oriented approach to acute stroke care should take place in parallel with traditional medical management, since the medical care provided during the first days and weeks after a stroke affects the patient's ultimate disability status. The components of the functionally oriented approach include a comprehensive history and physical examination, through which information is obtained on current disabilities and abilities, risk factors for common poststroke complications, psychologic and social resources, and environmental barriers that preclude maximal functioning.

Affect↗
PubMed1994

Recurrence of breast carcinoma following immediate reconstruction: a 13-year review.

To evaluate the effect of immediate reconstruction on the incidence, location, detection, and treatment of recurrent breast cancer, a review of 306 patients operated on according to a standard protocol during the 10-year period 1979 through 1988 was performed. Reconstruction techniques included submuscular implants (207), tissue expanders (84), and musculocutaneous flaps (15). During a minimum follow-up period of 3 years with a mean of 6.4 years, 60 patients (19.6 percent) developed recurrent disease, at a mean interval to recurrence of 31 months. The first locations of recurrences were local (16), regional (11), and systemic (33). Recurrence rates by stage included stage I, 7 patients (5.2 percent); stage II, 45 patients (32.1 percent); and stage III, 8 patients (40 percent). It was not possible to include comparisons with internal control groups of patients in our institution who were not reconstructed or who had delayed reconstructions, thereby preventing conclusions based on such comparisons. Our recurrence data are similar to literature reports of recurrence rates in patients who were not reconstructed after mastectomy. Detection and treatment of recurrences were not inhibited by the reconstructions. When radiation therapy was used in the treatment of local recurrences, the development of symptomatic capsular contracture was recorded in 58 percent of the patients.

Adenocarcinoma↗
PubMed1993

Screening for older persons.

Our screening recommendations for older individuals are outlined in Figures 1 and 2. Our recommendations are parsimonious for two reasons. First, we are concerned about the potential harm of using unproven screening strategies. Second, when there are effective screening strategies, many of the target group are not being adequately screened. We agree with Clayman that it is much wiser to invest our scarce resources on improving the screening rates for clearly efficacious interventions before investing in strategies where efficacy is in question.

Aged↗
PubMed1992

The Pitt-UNOS Liver Transplant Registry.

Since the establishment of the scientific LTR, the frequency of OLTX has been increasing. Between 1988 and 1991, the number of procedures performed on pediatric patients increased by 28.2%, and among adult patients OLTX increased 84.8%. During this same period, the number of transplant centers performing OLTX rose 62.5% for children, and 54.7% for adult recipients. In 1991 there was a larger proportion of recipients under 1 year of age than in previous years. The effect was to lower the median age at transplantation from over 2 to between 1 and 2. In pediatric recipients of initial transplantation in 1991, compared with earlier recipients, the functional status at time of liver transplantation was improved. Fewer children were in the ICU while awaiting transplantation, and more were able to wait at home. Multiorgan transplantations in pediatric patients remained relatively rare, but a larger portion of these procedures in 1991 than was seen previously included the small intestine. Biliary atresia remained the most common indication for liver transplantation among children, accounting for over 55% of all OLTX procedures in 1991. There was a significant change in the racial distribution among adult recipients. Compared with previous years, there were greater proportions of Hispanic and Asian recipients in 1991. Adult recipients were older in 1991 than previously, and the median age increased from 46 to 49. As with pediatric recipients, adult recipients had better functional status in 1991 than earlier recipients. The increase in positive CMV serology was likely to be a function of older age. Among multiorgan recipients, the combination of liver and pancreas only was much less common in 1991 than previously. As was found previously (1), alcoholic cirrhosis continued to be the most common reason for OLTX, with the proportion of patients diagnosed with this condition increasing in 1991. Twice as many patients with cystic fibrosis were recipients in 1991 as in the prior 3 years. There were decreases in the proportion of patients receiving OLTX due to fulminant liver failure, metabolic disease, and malignant neoplasms. The cumulative probability of surviving (without retransplantation) 4 years after initial transplantation was 0.74 (0.61) for pediatric recipients. Univariate (unadjusted) analyses detected significant differences in survival for age (the youngest recipients had the worst survival), UNOS description (poorer functional status just prior to transplantation led to poorer survival), and primary liver disease (survival was worst for recipients transplanted due to fulminant liver failure, and best for patients with alpha-1 antitrypsin deficiency).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

The mutagenicity of electrocautery smoke.

Careful analysis of electrocautery smoke produced during breast surgery has found organic compounds that are unidentifiable with current analytical techniques. The purpose of this study was to determine the potential mutagenicity of the smoke produced by the electrocautery knife during reduction mammaplasty. Multiple air samples were collected in the operating room during two reduction mammaplasty procedures. Airborne smoke particles were tested for mutagenic potential in both tester strains of Salmonella typhimurium (TA98 and TA100) using the standard Salmonella microsomal test (Ames test). All testing was performed by the Hazard Evaluations and Technical Assistance Branch of the National Institute of Occupational Safety and Health. The smoke produced with the electrocautery knife during reduction mammaplasty was found to be mutagenic to the TA98 strain. The Ames test, an established technique for evaluating the mutagenicity of a substance, was convincingly positive for the smoke collected during the breast surgery. Whether the smoke represents a serious health risk to operating room personnel is not known. Development of techniques to limit electrocautery smoke exposure in the operating room appears to be needed, and surgeons should attempt to minimize their exposure.

Adolescent↗
PubMed1991

Follow-up report of immediate stabilization of mandibular surgical defects after tumor resection.

This study constitutes a follow-up of a study completed in March 1988, involving 18 patients receiving bone plate stabilization for the repair of surgical defects after mandibular resection. An additional 11 cases are presented with follow-up periods of 3 to 23 months. Of the original study of 18 patients, follow-up was available for 13. Of these 13, five patients died, three as a result of their tumors. One patient was previously reported to have had recurrent disease and loss of the stabilization plate. One patient lost the plate in an area of recurrent tumor just before succumbing to his malignancy. The remaining three died with their stabilization plates in place and functioning. The eight remaining patients with long-term follow-up and 11 additional patients with shorter-term results are now described.

Bone Plates↗
PubMed1991

The provision of physical activity to hospitalized elderly patients.

Physical activity has been recognized as an important aspect of patient care for nearly 50 years. Yet, deconditioning and functional decline of hospitalized elderly patients continue to be reported. Such outcomes suggest that a good system for providing activity in hospitals is lacking. In this retrospective study we assessed the provision of physical activity to 500 elderly patients (100 in each of five hospitals) during the first 7 days of hospitalization. No activity order was in effect on 13% of the 3500 patient days reviewed. When activity was ordered, patient activity was different from the activity permitted by the physician orders on 41% of the days. Patients who remained in bed or in a chair rarely received physical therapy, never had physician orders for exercises, and never performed exercises with the nurses. These findings demonstrate that the current practices for the provision of physical activity in hospitals are ineffective.

Aged↗
PubMed1991

Liver transplantation in the United States: 1988 to 1990.

Between 1988 and 1990, the frequency of liver transplantation in the United States increased by 57%. During this same period, the number of transplant centers performing this procedure increased from 58 to 80. Despite this increase, only 15 centers reported a total of at least 100 procedures during these 3 years, compared to 25 centers that performed 12 or less liver transplantations. Recipient characteristics have been changing over time: a larger proportion of recipients were males in 1990 than in 1988 or 1989. The distribution of recipients changed dramatically; the median age increased by 4 years, due to an increased proportion of transplantations among those age 40 and older and a decrease in children younger then age 10. Another major change was in functional status; in 1988 and 1989, over half of the recipients were hospitalized while awaiting transplantation, but this was reversed in 1990, when the majority of patients was at home awaiting transplantation. Furthermore, the proportion of patients in the highest functional class more than tripled. Alcoholic liver disease, which in 1989 became the most common primary liver disease of patients undergoing liver transplantation, continues to be the indication for an increasing number of recipients. The proportion of recipients with biliary atresia and primary biliary cirrhosis, the most common diagnoses in 1988, continues to decrease. Most of the mortality was noted in the first 6 months, when overall cumulative patient mortality was about 20%, half of which occurred in the first 4 weeks after OLTX. The cumulative 3-year posttransplant survival rate was 67%. Similarly, cumulative retransplant-free survival rates were 84% at 1 month and 58% at 3 years. As previously described (1), recipient factors associated with survival included age, UNOS description, diagnosis, and ABO matching. Older recipients, those with poorer functional status at time of transplantation, recipients with either fulminant liver failure or malignancies, and those who received a graft from an ABO-compatible or -incompatible donor, had the worst survival rates. Furthermore, in the current analysis we found that the outcome of recipients was affected adversely by grafts from female donors. Racial differences were noted, but the large quantity of missing data precluded definitive statements regarding any association with survival. Both recipient and donor ages were significant prognostic factors. For adults in the multivariate model, increasing recipient age was associated with higher mortality. Among children, however, younger donor age seemed to have an adverse effect on recipient survival. Donor characteristics also changed during this period.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1991

The post-operative care of the older patient: the geriatric and rehabilitation perspective.

As the population of our nation and our state grows older operative procedures will be performed at increasing rates on older patients. Unique aspects of older persons and the conditions with which they are afflicted place them at high risk for loss of function, medical complications, and surgical complications in the perioperative period. Only by conducting comprehensive preoperative assessments, establishing appropriate goals, maintaining meticulous perioperative care and beginning rehabilitation early will it be possible to reduce these risks and maximize the functional outcome for the older surgical patient.

Activities of Daily Living↗
PubMed1991

Older Rhode Islanders: demography, health status and the implications for the practice of medicine.

There is a large and growing elderly population in Rhode Island and that population is getting older. Rhode Island's elders are maldistributed geographically and represent a larger proportion of the population than nationally. Most have significant chronic conditions and many have major limitations in functional abilities. Relatively few reside in long-term care facilities and generally, the community-dwelling population rates their health favorably. The elderly in Rhode Island make more physician visits than any other segment of the population and account for a disproportionate number of hospital and nursing home days. The number of primary care physicians practicing adult medicine in Rhode Island has diminished and if the trends of graduating medical students continue, further decreases are to be expected. The costs of health care for the elderly in Rhode Island have skyrocketed over the last 20 years, and are projected to continue to increase dramatically over the next 40-50 years in part as a result in the growth of the state's elderly population. These cost increases will be magnified if health care costs in general continue to outpace other segments of our economy. If Rhode Island is to adequately meet the health care needs of older Rhode Islanders over the next 40-50 years, major changes must occur. Initiatives to prevent or forestall the onset of chronic illnesses and resultant functional limitations are likely to improve the quality of life of older Rhode Islanders as well as positively influence the costs of health care for this segment of our state's population.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Liver transplantation in the United States: 1988 to 1989.

Orthotopic liver transplantation was performed more often in 1989 than in 1988. This procedure was performed at 57 institutions in 1988 and at 64 in 1989. Among the 53 institutions in which OLTX was performed in both years, the tendency was to increase volume. Volume in 1988 was not an indicator for volume increase or decrease in the next year. For example, about 60% of the centers which performed 5-9 OLTXs in 1988 had a greater volume in 1989. This was similar to the percentage among centers which performed 30-49 OLTXs in 1988. Only centers which performed at least 100 OLTXs in 1988 increased in volume uniformly (3 centers). There was about a 25% increase in the number of OLTX recipients, and the characteristics of the recipient population changed. In 1989, as compared to 1988, there was a larger proportion of recipients over age 40 with a concomitant proportionate decrease in pediatric recipients. Indications for OLTX were also different. In 1988, biliary atresia and primary biliary cirrhosis were the major diagnoses for which OLTX was performed. In 1989, however, alcoholic cirrhosis was the most prevalent diagnosis among OLTX recipients, accounting for more than 1 of every 7 procedures. We also found that the distribution of UNOS description changed. Significantly more recipients were classified in the best functional group, and significantly more recipients were on life support in 1989 compared to 1988. Whether this reflects a change in the actual functional status of recipients, or change in the management of these patients, is a topic for further research.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Aspiration associated with long-term gastric versus jejunal feeding: a critical analysis of the literature.

Neurogenic oropharyngeal dysphagia (NOD), common among rehabilitation populations, is a risk factor for aspiration. A history of recurrent aspiration is an indication for gastric feedings according to some physicians, although according to others it is a contraindication to gastric feedings and an indication for jejunal feedings. In light of these divergent opinions, the literature from 1978 to 1989 on aspiration in patients with severe NOD was examined to determine whether empiric evidence supports the preferential use of a gastric or a jejunal feeding site. The data reviewed did not support the preferential use of either feeding site. Forty-five studies met inclusion criteria. Two studies compared aspiration rates in patients receiving gastric feedings to those receiving jejunal feedings. Another study reported complications with gastric and jejunal feedings but did not compare the two feeding groups. Forty-two studies evaluated either gastric (36) or jejunal (6) feedings. The relative risks of aspiration associated with gastric and jejunal feedings could not be determined reliably because of heterogenous and inadequately described patient populations, poorly described data collection methods, nonoperational definitions of aspiration, small sample sizes, and unspecified time frames, feeding protocols, and care settings. Few data about long-term jejunal feeding, extremely variable data on the risk of aspiration during long-term gastric feeding, and much variation in clinical practice support a need for further research designed to determine the proper role for gastric and jejunal feeding. Recommendations for research and the role of the rehabilitation team in determining the best enterostomy site are suggested.

Deglutition Disorders↗