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Biomedical subjects

J L Miller

Publications and source records attributed to J L Miller.

At least 181 records · Page 10Linked to original sources

Mimotope/anti-mimotope probing of structural relationships in platelet glycoprotein Ib alpha.

A bacteriophage library displaying random decapeptides was used to characterize the binding preference of C-34, a monoclonal antibody originally raised against platelet-type von Willebrand disease platelets heterozygous for the mutation 23OWKQ (G --> V)233V234 in the alpha chain of glycoprotein Ib (GPIb alpha). Three rounds of biopanning C-34 against the library resulted in striking convergence upon the sequence WNWRYREYV. Since no portion of this sequence corresponds to a recognizable peptide sequence within human platelet GPIb alpha, it may be considered a "mimotope" of the naturally occurring C-34 epitope, presumably bearing similarity to it in three-dimensional structure. Synthetic AWNWRYREYV peptide preincubated with C-34 fully neutralized the ability of C-34 to inhibit platelet aggregation, with an IC50 of approximately 6 microg/ml. When biotinylated AWNWRYREYV was subsequently bioparmed against the original decapeptide library, the sole clone demonstrating inhibitory activity above background level in a functional platelet assay displayed the sequence RHVAWWRQGV, and chemically synthesized peptide fully inhibited ristocetin-induced aggregation, with an IC50 of 200-400 microg/ml. Synthesized RHVAWWKQGV peptide exerted only slight inhibition, whereas RHVAWWKQVV peptide showed potent inhibitory activity. Moreover, whereas synthesized wild-type 228YVWKQGVDVK237 GPIb alpha peptide was virtually without inhibitory activity, the 228YVWKQ(G -->V) 233VDVK237 peptide fully inhibited ristocetin-induced aggregation, with an IC50 of approximately 400 microg/ml. These studies raise the possibility of an intramolecular association of peptide regions within GPIb alpha that may play a role in the regulation of von Willebrand factor-dependent platelet aggregation.

Amino Acid Sequence↗

The influence of bolus volume and viscosity on anterior lingual force during the oral stage of swallowing.

The influence of bolus volume and viscosity on the distribution of anterior lingual force during the oral stage of swallowing was investigated using a new force transducer technology. The maximum force amplitudes from 5 normal adults were measured simultaneously at the mid-anterior, right, and left lateral tongue margins during 10 volitional swallows of 5-, 10-, and 20-ml volumes of water, applesauce, and pudding. Results indicated significant increases in peak force amplitude as viscosity increased. Volume did not significantly influence maximum lingual force amplitudes. Individual subjects demonstrated consistent patterns of asymmetrical force distribution across the lingual margins tested. The results suggest that bolus-specific properties influence the mechanics of oral stage lingual swallowing. This finding has important clinical implications in the assessment and treatment of dysphagic individuals.

Adult↗

Treatment with the Reliance urinary control insert: one-year experience.

The 1-year experience of 63 women using an intraurethral insert for the management of stress or mild mixed urinary incontinence is presented, emphasizing safety and efficacy. Objective criteria, including standardized pad weight tests and patient diaries, were employed to evaluate the device's effectiveness. At study outset, 82% of the patients were completely dry with the device in situ, with an additional 16% of patients significantly improved. At 12 months, 79% of the patients were completely dry, and 16% were significantly improved. This result is consistent with the significant improvement (P < 0.0001) in the number of urinary incontinence episodes reported in patient diaries. Women reported that the device significantly improved their ability to stay dry over a number of routine and physically demanding daily activities. The device was increasingly easy to use and more comfortable over time (P < 0.0001). The latter finding was confirmed by a decline in patient reports of "sensation of device presence" over the duration of the study (35% at 1 week v 7% at 12 months). Untoward events included gross hematuria (24%), device-related bladder mucosal irritation (9%), and symptomatic bacteriuria (30%). Such side effects were expected for this type of device, were easily managed without significant medical intervention, and did not result in any long-term clinical sequelae. The great reduction in the number of episodes of urinary incontinence, the low rate of significant problems associated with device use, and ease of use make the intraurethral insert a useful management alternative for women with stress urinary incontinence.

Adolescent↗

Case report: failure of adrenal scintigraphy to exhibit 131I cholesterol uptake in a CT-demonstrated, surgically proven aldosteronoma.

This is the case of a large 2 x 1.5 cm adrenal tumor demonstrated on CT scan that was proven biochemically and surgically to be an aldosteronoma and that did not concentrate 6-beta(131I)-iodo-methyl-19-norcholesterol (NP-59). Before the publication of this case, all CT-identified aldosteronomas of greater than 1 cm have concentrated NP-59. Previously, an adrenal mass of greater than 1 cm that failed to concentrate NP-59 was excluded from being an aldosteronoma. This concept must be reevaluated with the publication of this case.

19-Iodocholesterol↗

Interstitial cystitis in children.

PURPOSE: Interstitial cystitis has been rarely reported in children. We present our experience with 16 children in whom clinical symptomatology and cystoscopic findings were consistent with the diagnosis of interstitial cystitis. MATERIALS AND METHODS: We retrospectively reviewed the charts of 20 children referred for chronic sensory urgency, frequency and bladder pain who underwent cystoscopy and hydrodistension. Four patients were excluded from study because of infection identified at cystoscopy or lack of cystoscopic changes with hydro-distension. RESULTS: Patient age at onset of first symptoms ranged from 2 to 11 years (median 4.5) and age at diagnosis ranged from 3 to 16 years (mean 8.2). Of the 16 children 14 (88%) presented with symptoms of urinary frequency and sensory urgency, and in 13 (81%) lower abdominal pain was relieved by voiding. None of the children had motor urgency. Urodynamic evaluation in 8 cases revealed early bladder sensation with no evidence of involuntary bladder contractions. Diffuse glomerulations and terminal hematuria were demonstrated in all patients after hydro-distension. Followup was available for 14 patients. Relief of symptoms occurred after hydro-distension in all children except 1. Seven children (50%) required repeat hydro-distension. CONCLUSIONS: Children with symptoms of bladder pain, urinary frequency and sensory urgency have bladder changes on cystoscopy consistent with interstitial cystitis. Although rare, this condition is recognizable and it should not be confused with dysfunctional voiding in which complaints are secondary to involuntary bladder contractions.

Adolescent↗

Epidurals redefined in analgesia and anesthesia: a distinction with a difference.

Advances in our understanding of pain have created a new and meaningful distinction between epidural analgesia and anesthesia. The principles underlying this important difference are reviewed from a childbirth perspective and promote a reconsideration of the role of pain relief in labor versus the need for anesthesia at delivery. An epidural analgesic technique is presented with fresh implications for several old intrapartum practices. The analgesia/ anesthesia distinction in epidural therapy offers new opportunities and flexibility for safety and fulfillment in childbirth.

Analgesia, Epidural↗

Recombinant adeno-associated virus-mediated high-efficiency, transient expression of the murine cationic amino acid transporter (ecotropic retroviral receptor) permits stable transduction of human HeLa cells by ecotropic retroviral vectors.

Adeno-associated virus has a broad host range, is nonpathogenic, and integrates into a preferred location on chromosome 19, features that have fostered development of recombinant adeno-associated viruses (rAAV) as gene transfer vectors for therapeutic applications. We have used an rAAV to transfer and express the murine cationic amino acid transporter which functions as the ecotropic retroviral receptor, thereby rendering human cells conditionally susceptible to infection by an ecotropic retroviral vector. The proportion of human HeLa cells expressing the receptor at 60 h varied as a function of the multiplicity of infection (MOI) with the rAAV. Cells expressing the ecotropic receptor were efficiently transduced with an ecotropic retroviral vector encoding a nucleus-localized form of beta-galactosidase. Cells coexpressing the ecotropic receptor and nucleus-localized beta-galactosidase were isolated by fluorescence-activated cell sorting, and cell lines were recovered by cloning at limiting dilution. After growth in culture, all clones contained the retroviral vector genome, but fewer than 10% (3 of 47) contained the rAAV genome and continued to express the ecotropic receptor. The ecotropic receptor coding sequences in the rAAV genome were under the control of a tetracycline-modulated promoter. In the presence of tetracycline, receptor expression was low and the proportion of cells transduced by the ecotropic retroviral vector was decreased. Modulation of receptor expression was achieved with both an episomal and an integrated form of the rAAV genome. These data establish that functional gene expression from an rAAV genome can occur transiently without genome integration.

Amino Acid Transport Systems↗

Internal structure of voicing categories in early infancy.

It is well established that young infants process speech in terms of perceptual categories that closely correspond to the phonetic categories of adult language users. Recently, Kuhl (1991) has provided evidence that this correspondence is not limited to the region of category boundaries: At least by 6-7 months of age, vowel categories of infants, like those of adults, have an internal perceptual structure. In the current experiments, which focused on a consonantal contrast, we found evidence of internally structured categories in even younger infants-3-4 months of age. The implications of these findings for the nature of the infant's earliest language-universal categories are discussed, as is the role of exposure to the native language in shaping these categories over the course of development.

Adult↗

Oral hypoglycemic agents in type II diabetes mellitus.

The patient with type II, or non-insulin-dependent, diabetes mellitus (NIDDM) is characterized by obesity and insulin resistance, with resultant hyperinsulinemia and hyperglycemia. Sulfonylureas are the chief therapy for patients with NIDDM; for a limited time, these agents stimulate increased insulin secretion. With chronic administration, sulfonylureas improve the diabetic patient's insulin activity by increasing cellular insulin receptors and reducing insulin postreceptor defects. Metformin, a drug in the biguanide class, is now approved for use in the United States. This drug does not stimulate insulin release but works by lowering glucose in peripheral tissues. It can be used alone or in combination with a sulfonylurea. With sulfonylureas and metformin, therapy for the patient with NIDDM can be more effectively tailored.

Administration, Oral↗

Prostatodynia and interstitial cystitis: one and the same?

OBJECTIVES: To investigate further the observation that men with prostatodynia may represent a subset of patients with interstitial cystitis. METHODS: The charts of 20 patients with the diagnosis of nonbacterial prostatitis or prostatodynia who underwent cystoscopy and bladder hydrodistention were retrospectively reviewed. RESULTS: The primary complaint of all 20 patients was genital or rectal pain, or both. Ten patients reported irritative voiding symptoms. Twelve of the 20 patients developed petechial hemorrhages involving the bladder uroepithelium on hydrodistention. Bladder biopsies revealed no significant histopathologic abnormalities. Nine of the 12 patients who developed petechial hemorrhages reported symptomatic improvement at 2- to 3-week follow-ups compared with none of the 8 patients without petechial hemorrhages. CONCLUSIONS: These findings suggest that the diagnosis of interstitial cystitis should be considered in patients with nonbacterial prostatitis or prostatodynia.

Adult↗

Fetal bleeding in neonatal alloimmune thrombocytopenia mediated by anti-PlAl is not associated with inhibition of fibrinogen binding to platelet GPIIb/IIIa.

Antibody directed against the platelet-specific alloantigen, PlAl, is the most frequently reported cause of two syndromes, post-transfusion purpura (PTP), and neonatal alloimmune thrombocytopenia (NAIT). Numerous reports have indicated that anti-PlAl also has the ability to block certain responses of platelets to stimulation, including fibrinogen binding, platelet aggregation, and serotonin release. Because the PlAl epitope is located on platelet membrane glycoprotein (GP) IIb/IIIa that also contains the fibrinogen receptor, these effects may be mediated by antibody binding at or near the fibrinogen receptor site. This study examines the capacity of anti-PlAl from patients with PTP and from mothers of infants affected by the NAIT to block the binding of radio-labeled fibrinogen to washed human platelets stimulated by ADP and epinephrine. In six of the seven PTP patients, there was inhibition of fibrinogen binding, ranging from 28% to 84% inhibition. In contrast, all anti-PlAl sera from nine mothers of infants with NAIT, including four with intracranial hemorrhage, failed to inhibit fibrinogen binding. Despite the generally higher anti-PlAl titers of the PTP sera, the ability to inhibit fibrinogen binding did not appear attributable to antibody titers. These results suggest that interference with fibrinogen binding to platelets by maternal anti-PlAl does not underlie the increased risk of bleeding in NAIT, whereas inhibitory activity directed against fibrinogen binding appears to be a characteristic feature of the sera from PTP patients.

Antigens, Human Platelet↗

Remission of severe epidermolysis bullosa acquisita induced by extracorporeal photochemotherapy.

We report a patient with severe epidermolysis bullosa acquisita (EBA) whose disease was refractory to conventional treatments. New bullae continued to develop over greater than 50% of his body surface area despite therapy. His course was complicated by hyperglycaemia, sepsis, hypoxia caused by pulmonary Aspergillus infection and an idiopathic cardiomyopathy. His EBA resolved after treatment with extracorporeal photochemotherapy (ECP). Hence, ECP may be effective in the treatment of severe EBA which has failed to respond to standard treatment regimens.

Acute Disease↗