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Biomedical subjects

J E Sullivan

Publications and source records attributed to J E Sullivan.

30 records · Page 2Linked to original sources
PubMed1989

Reliability of a new device used to measure shoulder subluxation.

The purposes of the study were to determine the reliability of a new device used to quantify shoulder subluxation and to estimate its standard error of measurement. The device is an L-shaped thermoplastic jig with a metric tape measure embedded in it. A sliding beak-like marker, which can be anchored with a thumbscrew, is used to identify landmarks and to measure the amount of subluxation. Eight male and two female hemiplegic subjects, 40 to 80 years old, consented to be measured for subluxation. Three standardized subluxation measurements were taken by one investigator to determine the reliability with a single rater. One measurement was taken by a second investigator and compared with the first measurement obtained by the first investigator to determine the reliability using more than one rater. Both investigators were experienced physical therapists. Each measurement was read by the other investigator, who disassembled the jig and cleaned the marks from the patient between measurements. For both analyses, an analysis of variance for repeated measurements reflected no differences between measurements attributable to raters. The unbiased intraclass correlation coefficient for a single measurement by a single rater was .89 (p less than .01) and for more than one rater was .74 (p less than .01). The standard error of measurement was +/- 0.77 mm for a single rater and +/- 1.20 mm for more than one rater. We recommend the jig as a tool to measure shoulder subluxation in patients.

Adult↗
PubMed1985

Augmented immunity in cancer patients treated with alpha-interferon.

Thirty patients with metastatic colon or breast cancer were treated with recombinant alpha-interferon, clone A, 9 to 50 X 10(6) units/sq m, i.m., 3 times weekly for up to 4 months. Immunological parameters including natural killer activity, antibody-dependent cellular cytotoxicity, an assay of inhibition of tumor cell growth in culture, and quantification of leukocyte subsets were monitored serially. Statistically significant increases in the inhibition of tumor growth and in the proportion of peripheral blood mononuclear cells bearing the T10 marker were observed both early and late in the treatment course in the population as a whole (p less than 0.03 and p less than 0.0001, respectively). The true maximum effect in the assay of inhibition of tumor growth was probably higher, since the monitoring was not performed at peak activity for this assay. Other immune parameters, including natural killing, could not be shown to change consistently in the population as a whole, although interferon effects could be discerned easily in the activity profiles of some individual patients. The two patients with tumor response showed increased putative tumor immunity by these measures. These data confirm results previously published supporting the responsiveness of these parameters to interferon as administered clinically and may provide the basis for optimization of interferon dose and scheduling.

Antibody-Dependent Cell Cytotoxicity↗
PubMed1983

Preliminary observations of immunomodulatory activity of lymphoblastoid interferon-alpha administered every other day or weekly.

Patients with metastatic malignant melanoma were treated with a purified, natural mixture of lymphoblastoid interferon-alpha. Patients were randomized to receive 15 X 10(6) U/m2 every other day for 2 weeks, in cycles separated by a variable rest period of at least 1 week, or to receive 5 X 10(6) U/m2 weekly. The first schedule was an intensive treatment regimen, at or near the maximum tolerated dose; the second was intended to provide maximum opportunity for augmented natural, antitumor immunity to be expressed. A preliminary evaluation of the modulation of natural killing, antibody-dependent cellular cytotoxicity, and monocyte-mediated tumor growth inhibition in the first nine patients entered into the trial is presented. Increased activity in the three assays was frequently seen in the 2-3 days after interferon administration; the peak was usually short-lived, and no sustained increases were observed. There was a tendency for more frequent augmentation in patients on the weekly schedule, and augmentation of monocyte-mediated tumor growth inhibition was more readily apparent than increases in the other activities. No tumor responses were observed and no correlation of tumor response with immunomodulation was possible.

Cytotoxicity, Immunologic↗
PubMed1982

Clonal analysis of restriction antigens for human TNP-specific cytotoxic T lymphocytes.

Previous studies of populations of human TNP-specific cytotoxic T lymphocytes have shown a preference for HLA-matched, TNP-modified targets. However, substantial killing of modified targets mismatched for serologically defined HLA antigens is also observed. The present report concerns oligoclonal and monoclonal populations of TNP-specific cytotoxic lymphocytes from a single donor whose lymphocytes were primed in vitro to TNP-modified autologous lymphocytes and frozen in aliquots. Conditions for the expansion of precursors of cytotoxic cells to sufficient numbers for assay are described. Expansion required IL 2-containing supernatants and stimulator or feeder lymphocytes in great excess; PHA, present in the IL 2-containing supernatants, was not required. TNP modification of the stimulators in secondary cultures was not required but appeared to enhance activity. Oligoclonal populations showed marked preference for TNP-modified targets sharing any of 3 of the 4 HLA-A and -B antigens of the donor (Aw24, B8, Bw44) when compared with targets sharing only the 4th antigen (A1) or no antigens. Monoclonal TNP-specific populations showed marked preference for certain TNP-modified targets when tested against a panel, but the pattern often did not correspond with the serologically defined HLA-A and -B antigens. The data suggest that most or all TNP-specific cytotoxic clones are restricted in their killing patterns by determinants associated closely with but not necessarily identical to the serologically defined HLA-A and -B antigens.

Clone Cells↗
PubMedDate not supplied

Prognostic value of pre- and postoperative cardiac troponin I measurement in children having cardiac surgery.

The objective of this study was to determine if perioperative elevation of cardiac troponin I (cTnI) predicts mortality in infants and children after surgical correction of congenital heart defects. One hundred infants and children having open heart surgery were studied. Blood samples for cTnI analysis were collected before cardiopulmonary bypass (CPB) and at 4, 8, 12, and 24 h after initiation of CPB. Demographic information, cardiac defect, repair performed, duration of CPB, complications, and outcome were recorded. Cardiac defects were categorized as atrial septal defect (ASD), ventricular septal defect (VSD), hypoplastic left heart syndrome (HLHS), complex, and "other." Baseline cTnI was significantly lower in survivors (mean 0.42 ng/ml, median 0.35 ng/ml) than in nonsurvivors (mean 1.89, median 1.30), p = 0.0001. Baseline cTnI was significantly higher in the HLHS group (mean 1.47, median 1.10) than in all other subgroups (mean 0.62, median 0.35), p </= 0.009. There were no significant differences between survivors and nonsurvivors at the remaining sampling times. Children who died from cardiac failure (n = 2) were more likely to have 4 h cTnI >125 ng/ml compared to survivors (2 of 90). Within cardiac defect subgroups, 4 h cTnI was significantly higher in the complex group (mean = 53.51, median = 32.30) than in the ASD (mean = 23.84, median = 19.85) and other (mean = 21.59, median 21.50) subgroups. Perioperative measurement of cTnI identifies children within specific cardiac defect subgroups at risk of mortality after cardiac surgery. We speculate that detection of myocardial injury may decrease mortality and morbidity in children with complicated congenital cardiac lesions by leading to improvements in perioperative management.

Female↗
PubMedDate not supplied

Evaluating IAIMS at Yale: information access.

OBJECTIVE: To evaluate use of information resources during the first year of IAIMS implementation at the Yale-New Haven Medical Center. The evaluation asked: (1) Which information resources are being used? (2) Who uses information resources? (3) Where are information resources used? (4) Are multiple sources of information being integrated? DESIGN: Measures included monthly usage data for resources delivered network-wide, in the Medical Library, and in the Hospital; online surveys of library workstation users; an annual survey of a random, stratified sample of Medical Center faculty, postdoctoral trainees, students, nurses, residents, and managerial and professional staff; and user comments. RESULTS: Eighty-three percent of the Medical Center community use networked information resources, and use of resources is increasing. Both status (faculty, student, nurse, etc.) and mission (teaching, research, patient care) affect use of individual resources. Eighty-eight percent of people use computers in more than one location, and increases in usage of traditional library resources such as MEDLINE are due to increased access from outside the Library. Both survey and usage data suggest that people are using multiple resources during the same information seeking session. CONCLUSIONS: Almost all of the Medical Center community is using networked information resources in more settings. It is necessary to support increased demand for information access from remote locations and to specific populations, such as nurses. People are integrating information from multiple sources, but true integration within information systems is just beginning. Other institutions are advised to incorporate pragmatic evaluation into their IAIMS activities and to share evaluation results with decision-makers.

Academic Medical Centers↗