Temporal relationship between the development of anti-HLA antibodies and the development of bronchiolitis obliterans syndrome after lung transplantation.
Explore the source record for details and available documents.
Antibody Formation↗
Biomedical subjects
J Cooper
Publications and source records attributed to J Cooper.
High resolution X-ray analyses of renin inhibitor-aspartic proteinase complexes.
Inhibitors of the conversion of angiotensinogen to the vasoconstrictor angiotensin II have considerable value as antihypertensive agents. For example, captopril and enalapril are clinically useful as inhibitors of angiotensin-converting enzyme. This has encouraged intense activity in the development of inhibitors of kidney renin, which is a very specific aspartic proteinase catalysing the first and rate limiting step in the conversion of angiotensinogen to angiotensin II. The most effective inhibitors such as H-142 and L-363,564 have used non-hydrolysable analogues of the proposed transition state, and partial sequences of angiotensinogen (Table 1). H-142 is effective in lowering blood pressure in humans but has no significant effect on other aspartic proteinases such as pepsin in the human body (Table 1). At present there are no crystal structures available for human or mouse renins although three-dimensional models demonstrate close structural similarity to other spartic proteinases. We have therefore determined by X-ray analysis the three-dimensional structures of H-142 and L-363,564 complexed with the aspartic proteinase endothiapepsin, which binds these inhibitors with affinities not greatly different from those measured against human renin (Table 1). The structures of these complexes and of that between endothiapepsin and the general aspartic proteinase inhibitor, H-256 (Table 1) define the common hydrogen bonding schemes that allow subtle differences in side-chain orientations and in the positions of the transition state analogues with respect to the active-site aspartates.
Angiotensinogen↗
A second example of anti-Lu14.
Anti-Lu 14 has been found in the serum of a gravida 2 pregnant woman who had not been given any blood transfusions. Her husband is Lu:14 but otherwise of common Lutheran blood type. Maternal immunization probably occurred during the first pregnancy. The second child did not inherit the father's Lu14 gene and was not affected by the maternal antibody.
Female↗
A critical review of the role of the major histocompatibility complex in fertilization, preimplantation development and feto-maternal interactions.
From conception to old age, the major histocompatibility complex (MHC) is at the centre of immune responses that aid survival, fitness and adaptation of mammalian species to the environment. Its main function is that of controlling adaptive immunity, particularly T-cell-mediated immunity towards pathogens. In several species, including humans, the MHC is also able to elicit T-cell-mediated immune responses to allogeneic MHC antigens (non-self MHC antigens expressed by another individual from the same species). Although this phenomenon was originally identified in mice by the somewhat unnatural means of tissue transplantation, it was soon realized that it may also play an important role in the natural state, since the mammalian fetus in the maternal uterus is semi-allogeneic, due to the presence of MHC genes inherited from the father. Thus, during normal pregnancy the maternal immune system undergoes changes that lead to tolerance of the fetus. The MHC can play a dual role in the reproduction process: firstly influencing mating choice in some species, affecting the mother-father MHC matching; and secondly influencing the development of the fertilized ovum during the preimplantation period. In this review we examine the role of the MHC at three distinct levels: (i) MHC expression in gametes and its role in fertilization; (ii) MHC expression in placental tissue; and (iii) MHC expression in embryonic tissue. We suggest that the MHC plays a pleiotropic role, both in fitness (survival and reproductive success) and in development, thereby ensuring the survival of the species in future generations.
Animals↗
A hospital wellness program: where challenge meets opportunity.
Explore the source record for details and available documents.
Health Promotion↗
Temporary regional cerebral ischemia in the cat. A model of hemorrhagic and subcortical infarction.
A comparison was made on some of the effects that temporary and permanent occlusion of the middle cerebral artery may have on the circulation to the ipsilateral hemisphere in the cat. Reperfusibility of the corresponding capillary bed was unimpaired for the initial six hours after occluding the vessel, as demonstrated by in vivo intravenous injection of carbon black. Short-term occlusion of the middle cerebral artery, followed by re-opening of the vessel, resulted in either (a) no demonstrable parenchymal lesions (i.e., areas of softening), (b) smaller lesions, or (c) infarctions that were either hemorrhagic or confined to the subcortical white matter of the ipsilateral hemisphere.
Animals↗
Head nurses: their practice and education.
Explore the source record for details and available documents.
Educational Status↗
The transmission of donor-derived malignant melanoma to a renal allograft recipient.
The transmission to organ transplant recipients of donor origin malignancy in the allograft has been described. Here we report the transmission of malignant melanoma in a renal allograft transplanted from a multiorgan donor. The lung transplant recipient presented with an allograft lesion that was proven to be melanoma and of donor-origin based on human leukocyte antigen (HLA)-DR typing. One renal allograft recipient was undergoing his second deceased donor renal transplant, having lost his first graft from recurrent IgA nephropathy. He was unsensitized and immunosuppression consisted of tacrolimus, mycophenolate and prednisolone. He achieved stable graft function and there were no episodes of rejection. Four and a half months post-transplant a diagnosis of donor origin melanoma in the lung recipient was made and his immunosuppression was stopped. He presented with clinical rejection two wk later and a transplant nephrectomy was undertaken. Histology demonstrated vascular and cellular rejection and there was a 3-mm melanoma deposit with no evidence of tumour infiltrating lymphocytes. Three years post-transplant he remained clinically well with no evidence of melanoma and received his third deceased donor renal transplant. This was complicated by cellular rejection in the first week treated with methylprednisolone and vascular rejection at day 10 treated with anti-thymocyte globulin. Three months post-transplant he has achieved good allograft function and remains well with no evidence clinically or on imaging of metastatic melanoma. The other renal allograft recipient was receiving his first deceased donor transplant, having end-stage renal failure of uncertain aetiology. His immunosuppression was not stopped until melanoma was proven in the renal allograft pair six months post-transplant and he then presented with clinical rejection six wk later. Transplant nephrectomy was undertaken and histology did not demonstrate melanoma, but severe vascular and cellular rejection was evident. At three-yr post-transplant he remains disease free clinically and on imaging. At present, the cardiac allograft recipient has no evidence of transmitted melanoma. The highest risk of transmission of donor origin melanoma appears to be from donors who are older and have died from an intracerebral haemorrhage. It is likely these donors have metastatic melanoma and their intracerebral haemorrhage is not primary but has occurred in an unrecognized metastatic cerebral deposit. While the occurrence of donor-transmitted malignancy is not common, the outcome is often fatal.
Graft Rejection↗
Status epilepticus manifesting as reversible Wernicke's aphasia.
Ictal aphasia in adults is a rare phenomenon, with the majority of reported cases showing a nonfluent Broca's or mixed aphasic speech pattern associated with disturbances of level of consciousness. There is usually only one prolonged episode of aphasia with evidence of lateralized neurological findings and structural pathology on CAT scan. We describe a patient with intermittent episodes over a 10-year period of a fluent Wernicke's aphasia associated with paroxysmal posterior temporoparietal spike-wave activity on the EEG. Interictally, the patient was clear of neurologic signs and symptoms. These episodes were repeatedly misdiagnosed as psychotic breaks and treated with antipsychotic medication and psychiatric hospitalization. Unless language performance is assessed, these cases of focal epilepsy may be diagnosed as schizophrenic "word-salad," leading to delay of appropriate treatment.
Aphasia↗
Using a primary nurse manager to implement DCCT recommendations in a large pediatric program.
PURPOSE: This study was conducted to determine whether recommendations from the Diabetes Control and Complications Trial (DCCT) could be implemented in a large pediatric population using a diabetes clinical nurse specialist program coordinator dedicated to intensive management. METHODS: Patients' charts were reviewed to examine HbA1c levels from before the results of the DCCT were published and again 1 year after the recommendations were implemented. Patients who met the following criteria (N = 124) were enrolled: type 1 diabetes, less than 18 years old, followed at Yale for 1 year prior to the results of the DCCT and 1 year after, and HbA1c level recorded in the medical chart. RESULTS: HbA1c levels were significantly lower 1 year after implementing the DCCT protocol; 3 years later these same patients improved even further as evidenced by another decrease in HbA1c levels. The patients were taking more insulin (more Ultralente and regular insulin and less NPH) and had an increased number of injections at both the 1-year and 3-year follow-up points. CONCLUSIONS: The DCCT protocol can be implemented in a large population of pediatric patients with the help of a nurse who is dedicated and available to the patients for ongoing adjustments and provides creative ways to overcome the barriers to achieving normoglycemia.
Adolescent↗
The challenges and benefits of job sharing in palliative care education.
This article examines the authors' experience of job sharing a post in palliative care education. It discusses the concept of job sharing and examines factors such as power sharing, compatibility and other people's perception of the job sharing role. Effective communication is identified as a key issue. Benefits such as reduced professional isolation, increased job satisfaction and the opportunity to offer the knowledge and skills of two people are highlighted. The authors identify the factors which they consider to be crucial to the success of job sharing.
Education, Nursing, Continuing↗
Managing malignant ulcers effectively.
This article aims to bring together current methods of research, thinking and practice related to the treatment and care of patients with a malignant ulcer. With appropriate care and treatment, interventions can effectively decrease social isolation and anxiety while increasing cosmetic comfort for the sufferers of this distressing problem. It is important to stress that the psychological support and interventions offered to this client group are of equal importance as the level of physiological treatment and care.
Bandages↗
Teaching patients in post-operative eye care: the demands of day surgery.
In this article, the author examines how advances in day case surgery have changed ophthalmic surgical units and the need for patient education. Relevant theories of teaching, specific needs for adult teaching and patients' attitudes and beliefs are discussed. The author highlights the need to use innovative approaches to overcome the problem of teaching patients in a short period of time.
Adult↗
The new world order: the market in the post-health reform era.
Explore the source record for details and available documents.
Delivery of Health Care↗
Choosing the right health care partners: lessons from Louisiana.
Explore the source record for details and available documents.
Delivery of Health Care, Integrated↗
Badge of courage.
Explore the source record for details and available documents.
History, 19th Century↗