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Biomedical subjects

J M Chen

Publications and source records attributed to J M Chen.

At least 91 records · Page 5Linked to original sources
PubMed2000

[Studies on melatonin gelatin microspheres for intranasal administration].

AIM: To increase the bioavailability of melatonin (MT), MT gelatin microspheres (MT-GMS) for intranasal administration were prepared. METHODS: MT-GMS were prepared using emulsifying-cross linking technique. Orthogonal tests were used to optimize the preparation conditions. The residence time of technetium-99m (99mTc) labeled gelatin microspheres (GMS) in the nasal cavity of rabbits as compared to gelatin solution, was investigated using gamma scintigraphy. Furthermore the bioavailability in rabbits was examined for evaluating MT-GMS. RESULTS: The mean diameter of MT-GMS was 50.2 microns, the particle size focused on 30-70 microns. The drug content was 13.48%. The release profile in vitro showed sustained effect. The residence time of GMS in the nasal cavity of rabbits was longer than that of gelatin solution. After intranasal administration in rabbits, the bioavailability of MT-GMS was 87.47% as compared to vein injection, while the bioavailability of MT solution was 69.72%. CONCLUSION: MT-GMS prepared could meet the needs of intranasal administration, and could increase the bioavailability of MT.

Administration, Intranasal↗
PubMed2000

[Determination of organochlorine pesticide multi-residues in Astragalus membranaceus (Fisch.) Bge. var. mongholicus (Bge.) Hsiao, Panax notoginseng (Burk.) F. H. Chen and P. quin quefolium L].

OBJECTIVE: To determine 15 organochlorine pesticide residues in Astragalus membranaceus, Panax notoginseng and P. quinquefolium. METHODS: The 15 organochlorine pesticides were extracted from samples with mixed solvents by ultrasonication, cleaned up by a column packed with Florisil, and then separated by capillary gas chromatography with electron capture detector(CGC-ECD). The capillary column was DB-5(15 m x 0.32 mm x 0.25 microns); injector temperature 240 degrees C; detector temperature 320 degrees C; the column temperature program initial 100 degrees C (hold 0.5 min), rate of 20 degrees C min-1 to 210 degrees C (hold 0.5 min), rate of 8 degrees C min-1 to 240 degrees C (hold 10 min). The column head-pressure was 58.84 kPa. The injection was splitless and the injection volume was 1 microliter. RESULT AND CONCLUSION: The average recoveries and RSD are in the range of 78.30%-130.1% and 0.75%-31.9% at two spiked mixed organochlorine pesticide levels, respectively. All the samples have organochlorine pesticide residues.

Astragalus propinquus↗
PubMed2000

[The preoperative application of selective catheterization and embolism of the external carotid artery in treating tumors with enriched blood supply in the base of skull].

OBJECTIVE: Embolizing the feeding vessels of the tumors with enriched blood supply in the base of skull in order to reduce the bleeding during operation. METHOD: Under digital subtraction angiographic control, superselectively catheterizing the external carotid artery, thus occluding the terminal branches of the feeding arteries of the tumor with particles of liquidized gelfoam. RESULT: Nine cases studied showed that the angiography of the feeding vessels of the tumor disappeared relatively. The bleeding decreased significantly during operation. The postoperative pathological findings showed that the entity of the tumor was congested with gelfoam. CONCLUSION: After figuring out the blood supply of the tumor, superselective catheterization of the external carotid artery followed by occlusion of the feeding vessels can reduce the size of the tumor and diminish the bleeding during operation, thus can improve the safety of the operation. It should be one of the crucial preoperation measures.

Adolescent↗
PubMed1999

Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery.

BACKGROUND: Recent investigations at our institution have studied a variety of vasodilatory shock states that are characterized by vasopressin deficiency and pressor hypersensitivity to the exogenous hormone. Our experience in adults prompted the use of arginine-vasopressin (AVP) in a similar group of critically ill children. METHODS AND RESULTS: This report describes our early experience (from February 1997 through April 1998) in 11 profoundly ill infants and children (5 male, 6 female) ages 3 days to 15 years (median, 35 days) treated with AVP for hypotension after cardiac surgery which was refractory to standard cardiopressors. Although underlying heart disease was present (congenital heart defects in 10 and dilated cardiomyopathy in 1), only 2 patients had severely depressed cardiac function as demonstrated by 2D echocardiogram before administration of AVP. All patients were intubated and receiving multiple catecholamine pressors and inotropes, including dobutamine (n=10), epinephrine (n=8), milrinone (n=7), and dopamine (n=4) before receiving AVP. Five patients received AVP intraoperatively immediately after cardiopulmonary bypass, 5 in the intensive care unit within 12 hours of surgery, and 1 on postoperative day 2 for hypotension associated with sepsis. The dose of AVP was adjusted for patient size and ranged from 0.0003 to 0.002 U. kg(-1). min(-1). During the first hour of treatment with AVP, systolic blood pressure rose from 65+/-14 to 87+/-17 mm Hg (P<0. 0001; n=11), and epinephrine administration was decreased in 5 of 8 patients and increased in 1. Plasma AVP levels before treatment were available in 3 patients and demonstrated AVP depletion (median, 4.4 pg/mL; n=3). All 9 children with vasodilatory shock survived their intensive care unit stay. The 2 patients who received AVP in the setting of poor cardiac function died, despite transient improvement in blood pressure. CONCLUSIONS: Infants and children with low blood pressure and adequate cardiac function after cardiac surgery respond to the pressor action of exogenous AVP. AVP deficiency may contribute to this hypotensive condition.

Adolescent↗
PubMed1999

Vasopressin deficiency and pressor hypersensitivity in hemodynamically unstable organ donors.

BACKGROUND: Solid organ donors often develop hypotension due to vasodilation, and recently we observed that a variety of vasodilatory states are characterized by vasopressin deficiency and hypersensitivity. Thus, we investigated the prevalence of vasopressin deficiency in hypotensive solid organ donors without clinical evidence of diabetes insipidus; we also investigated the vasopressor effect of vasopressin replacement in hypotensive donors. METHODS AND RESULTS: Fifty organ donors were evaluated for hemodynamic instability, (mean arterial pressure [MAP]</= 70 mm Hg despite the use of catecholamine vasopressors), and in those unstable donors who were not already receiving exogenous vasopressin, low-dose vasopressin was administered as a continuous infusion (0. 04 to 0.1 U/min). MAP, catecholamine requirements, serum vasopressin, and serum osmolality were obtained before and after vasopressin administration. Ten patients meeting the enrollment criteria received vasopressin and MAP increased from 72.2+/-3.5 to 89.8+/-4.2 mm Hg, (P<0.05), allowing for complete discontinuation of catecholamine pressors in 4 (40%) patients and a decrement in pressor dose in 4 (40%). Plasma vasopressin levels (2.9+/-0.8 pg/mL) were low for the degree of hypotension. CONCLUSIONS: Hemodynamically unstable organ donors without clinically apparent diabetes insipidus display a defect in the baroreflex-mediated secretion of vasopressin. In these patients, low-dose vasopressin significantly increases blood pressure with a pressor response sufficient to reduce catecholamine administration.

Adolescent↗
PubMed1999

NMR solution structure of the catalytic fragment of human fibroblast collagenase complexed with a sulfonamide derivative of a hydroxamic acid compound.

The solution structure of the catalytic fragment of human fibroblast collagenase (MMP-1) complexed with a sulfonamide derivative of a hydroxamic acid compound (CGS-27023A) has been determined using two-dimensional and three-dimensional heteronuclear NMR spectroscopy. The solution structure of the complex was calculated by means of hybrid distance geometry-simulated annealing using a combination of experimental NMR restraints obtained from the previous refinement of the inhibitor-free MMP-1 (1) and recent restraints for the MMP-1:CGS-27023A complex. The hydroxamic acid moiety of CGS-27023A was found to chelate to the "right" of the catalytic zinc where the p-methoxyphenyl sits in the S1' active-site pocket, the isopropyl group is in contact with H83 and N80, and the pyridine ring is solvent exposed. The sulfonyl oxygens are in hydrogen-bonding distance to the backbone NHs of L81 and A82. This is similar to the conformation determined by NMR of the inhibitor bound to stromelysin (2, 3). A total of 48 distance restraints were observed between MMP-1 and CGS-27023A from 3D 13C-edited/12C-filtered NOESY and 3D 15N-edited NOESY experiments. An additional 18 intramolecular restraints were observed for CGS-27023A from a 2D 12C-filtered NOESY experiment. A minimal set of NMR experiments in combination with the free MMP-1 assignments were used to assign the MMP-1 (1)H, 13C, and 15N resonances in the MMP-1:CGS-27023A complex. The assignments of CGS-27023A in the complex were obtained from 2D 12C-filtered NOESY and 2D 12C-filtered TOCSY experiments.

Catalysis↗
PubMed1999

Cardiac transplantation in a patient with protein S deficiency.

Cardiac transplantation was successfully performed in a patient with end-stage ischemic cardiomyopathy and hereditary protein S deficiency who had undergone two previous coronary artery bypass graft procedures. Routine intraoperative heparinization and reversal with protamine was undertaken, and the antifibrinolytic agent aprotinin was infused throughout the procedure without perioperative hemorrhage or thrombosis. Systemic anticoagulation with intravenous heparin was resumed on postoperative day 2, and the patient was then converted to Lovenex as outpatient anticoagulation to facilitate routine surveillance endomyocardial biopsies.

Anticoagulants↗
PubMed1999

Left ventricular assist device bridge-to-transplant network improves survival after failed cardiotomy.

BACKGROUND: Postcardiotomy cardiogenic shock has been reported to occur following 2% to 6% of cardiac surgical procedures. Both the mandatory New York state cardiac surgery database and a voluntary ventricular assist device registry have reported hospital discharge rates of only 25% in postcardiotomy patients supported with ventricular assist devices. Although many centers have access to short-term mechanical cardiac assist devices, most lack a dedicated team which can resuscitate these critically ill patients. Equally important, these centers do not have easy access to effective cardiac replacement options, including implantable left ventricular assist devices (LVADs) and heart transplantation. METHODS: A referral network based upon the use of implantable LVADs as a bridge to transplantation in patients with postcardiotomy heart failure was established in the New York City region. Cardiac surgery centers were encouraged to contact our center early following any failed cardiotomy. RESULTS: Forty-four patients entered our postcardiotomy network: 12 recovered without an implantable LVAD, 23 received implantable LVADs, and six expired without long-term LVAD support. Of the 44 referrals, 29 (66%) survived to hospital discharge. Of the 23 patients receiving implantable LVADs, two recovered myocardial function and underwent LVAD explant, 14 were bridged to heart transplant, one underwent an emergent heart transplant, and six expired. Of the 23 implantable LVAD patients, 17 (74%) survived to hospital discharge. CONCLUSIONS: Regional networks centered around bridge-to-transplant facilities that have an aggressive approach to implantable LVAD placement may substantially improve the survival rate of patients with postcardiotomy heart failure.

Adult↗
PubMed1999

Time-dependent cellular population of textured-surface left ventricular assist devices contributes to the development of a biphasic systemic procoagulant response.

OBJECTIVE: Textured-surface left ventricular assist devices (LVAD) have been shown to enhance ventricular function and survival in patients with end-stage heart failure. Furthermore, we have described a procoagulant physiology in our LVAD population with sustained thrombin generation (elevated thrombin-antithrombin III complex and prothrombin fragment 1+2) and fibrinolysis (D-dimers), even up to 335 days after LVAD placement. To explain such sustained activation of coagulation, we speculated that the LVAD surface selectively adsorbed and promoted activation of circulating blood cells. METHODS: In a prospective study of 20 patients with LVADs, we examined samples of peripheral blood as well as cells harvested from the surface of the LVADs at the time of their explantation for procoagulant proinflammatory markers. RESULTS: Analysis of the cells populating the LVAD surface revealed the presence of pluripotent hematopoietic CD34(+) cells, as well as cells bearing monocyte (CD14)/macrophage (CD68) markers, which also expressed procoagulant tissue factor. Reverse transcriptase-polymerase chain reaction confirmed cellular activation on the LVAD surface, revealing transcripts for interleukin 1alpha, interleukin 2, and tumor necrosis factor alpha, in addition to vascular cell adhesion molecule-1 consistent with their capacity to continually recruit and activate circulating cells, thereby propagating their response. In the periphery, elevated levels of tissue factor were found in the plasma of patients with LVADs, along with enhanced procoagulant activity. CONCLUSION: These observations suggest that the LVAD surface selectively absorbs and activates circulating hematopoietic precursor and monocytic cells, thereby creating a sustained prothrombotic and potentially proinflammatory systemic environment.

Adolescent↗
PubMed1999

Volume-outcome relationships in cardiovascular operations: New York State, 1990-1995.

BACKGROUND: It has been known for nearly 20 years that, in cardiovascular operations, a significant inverse relationship exists between clinical outcomes and the volume of procedures performed. Interestingly, this relationship persists 2 decades after it was recognized. OBJECTIVE: The purpose of this study was to examine the relationship between hospital volume and in-hospital deaths in 3 cardiovascular procedures: coronary artery bypass grafting, elective repair of abdominal aortic aneurysms, and repair of congenital cardiac defects. METHODS: The database includes all patients who were hospitalized in New York State during the years 1990 to 1995. Using standard logistic regression techniques, we analyzed the relationship between hospital volume and outcome. RESULTS: No correlation exists between hospital volume and in-hospital deaths in coronary artery bypass grafting. Statewide, 31 hospitals performed 97,137 operations over the 6-year period (overall mortality rate, 2. 75%). By contrast, most of the hospitals statewide (195 of 230 hospitals) performed 9847 elective abdominal aortic aneurysm repairs with an overall mortality rate of 5.5%. In abdominal aortic aneurysm operations, a significant inverse relationship between hospital volume and in-hospital deaths was determined. Sixteen hospitals performed 7199 repairs for congenital cardiac defects. A significant inverse relationship (which was most pronounced for neonates) was found between volume and death. CONCLUSIONS: The importance of these findings lies in the rather striking difference between the volume-outcome relationship found for operations for abdominal aortic aneurysms and congenital cardiac defects and the lack of such a relationship for coronary artery bypass grafting. This observation may be largely explained by the quality improvement program in New York State for bypass operations since 1989. If so, these results have important implications for expanding the scope of quality improvement efforts in New York State.

Adolescent↗
PubMed1999

Long-term survival after cardiac retransplantation: a twenty-year single-center experience.

OBJECTIVE: To identify risk factors for survival after cardiac retransplantation and compare the survival after retransplantation with that after primary cardiac transplantation. METHODS: A retrospective analysis of 952 patients undergoing cardiac transplantation for the treatment of end-stage heart disease at a single center between 1977 and October 1997. Of these, 43 patients (4.5%) underwent cardiac retransplantation for cardiac failure resulting from transplant-related coronary artery disease, rejection, and early graft failure. RESULTS: No significant difference in actuarial patient survival was found by Kaplan-Meier analysis at 1, 2, and 5 years between patients undergoing primary transplantation and those undergoing retransplantation 76%, 71%, and 60% versus 66%, 66%, and 51%, respectively (P =.2). Multivariable analysis identified a shorter interval between transplants and an initial diagnosis of ischemic cardiomyopathy as significant risk factors for death after retransplantation (P =.04 and.03, respectively). Since 1993, when our criteria for patient selection for retransplantation were revised on the basis of earlier experience to exclude patients with allograft dysfunction as a result of primary graft failure and those with intractable acute rejection occurring less than 6 months after transplantation, the survival has been significantly better (<1993 = 45%, 45%, and 33% versus >/=1993 = 94%, 94%, and 94% at 1, 2, and 4 years, respectively, P =.003). CONCLUSION: The long-term outcome of cardiac retransplantation is comparable with that of primary transplantation, especially in patients with transplant-related coronary artery disease. Patient characteristics and other preoperative variables should assist in the rational application of retransplantation to ensure optimal use of donor organs.

Actuarial Analysis↗
PubMed1999

Improved survival rates support left ventricular assist device implantation early after myocardial infarction.

OBJECTIVES: Implantation of left ventricular assist devices (LVADs) early after acute myocardial infarction (MI) has traditionally been thought to be associated with high mortality rates due to technical limitations and severe end-organ dysfunction. At some experienced centers, doctors have refrained from earlier operation after MI to allow for a period of hemodynamic and end-organ stabilization. METHODS: We retrospectively investigated the effect of preoperative MI on the survival rates of 25 patients who received a Thermocardiosystems Incorporated LVAD either <2 weeks (Early) (n = 15) or >2 weeks (Late) (n = 10) after MI. Outcome variables included perioperative right ventricular assistance (and right-sided circulatory failure), hemodynamic indexes, percent transplanted or explanted, and mortality. RESULTS: No statistically significant differences were demonstrated between demographic, perioperative or hemodynamic variables between the Early and Late groups. Patients in the Early group demonstrated a lower rate of perioperative mechanical right ventricular assistance, but had a higher rate of perioperative inhaled nitric oxide use. In addition, 67% of patients in the Early group survived to transplantation and 7% to explantation, findings comparable to those in the Late group (60% and 0% respectively). CONCLUSIONS: This clinical experience suggests that patients may have comparable outcomes whether implanted early or late after acute MI. These data therefore support the early identification and timely application of this modality in post-MI LVAD candidates, as this strategy may also reveal a subgroup of patients for whom post-MI temporary LVAD insertion may allow for full ventricular recovery.

Adult↗
PubMed1999

Improved survival in patients with acute myocarditis using external pulsatile mechanical ventricular assistance.

BACKGROUND: Acute myocarditis remains a disease with a variable clinical course, from full ventricular recovery to complete heart failure; to date, few cases have been reported that describe the efficacy of temporary mechanical ventricular assistance for its treatment. METHODS: We evaluated the voluntary world registry with the use of an external pulsatile ventricular assist device (the ABIOMED BVS 5000 [BVS]) for acute myocarditis to determine the impact of mechanical ventricular assistance on outcome. Variables analyzed included patient demographics, serum chemistries, and overall hemodynamics prior to BVS, while on BVS support, and after BVS explanation. Postoperative parameters included re-operation, bleeding, respiratory failure, renal failure, and infections, neurologic, or embolic events. RESULTS: Eighteen patients in the ABIOMED world registry underwent BVS implantation for myocarditis; 11 (61.1%) had complete pre-operative and hemodynamic data for analysis. Patients were supported for 13.2 +/- 17.0 days, after which time 7 (63.6%) patients survived to explanation of the device and 2 (18.2%) underwent transplantation. Elevated admission serum chemistries (blood ureanitrogen [BUN], creatinine, transaminases) and hemodynamics (central venous pressure [CVP], mean pulmonary arterial pressure [PAP], pulmonary capillary wedge pressure [PCW], cardiac index [CI], all normalized during the period of device support. Estimated ejection fractions in the 7 explanted patients ranged between 50 to 60% at routine evaluation 3 years after device removal. CONCLUSIONS: Temporary mechanical ventricular assistance represents an efficacious therapy for acute myocarditis in patients with hemodynamic decompensation despite maximal medical therapy. Failure to achieve full ventricular recovery while on device support still allows for other surgical alternatives, including implantation of a long-term implantable ventricular assist device, or cardiac transplantation.

Acute Disease↗
PubMed1999

Arginine vasopressin in the management of vasodilatory hypotension after cardiac transplantation.

Vasodilatory hypotension requiring the administration of catecholamine pressors may occur following cardiopulmonary bypass. We investigated the hemodynamic response to arginine vasopressin (AVP) in 20 patients who developed vasodilatory hypotension after cardiac transplantation. In this cohort, AVP infusion (0.1 U/min) significantly increased mean arterial pressure and decreased norepinephrine requirements, allowing rapid discontinuation of norepinephrine infusions in 7 patients. Judicious use of this novel agent in appropriately selected patients may minimize end-organ sequelae of hypotension and high-dose catecholamine therapy.

Arginine Vasopressin↗
PubMed1999

Molecular dynamics analysis of the structures of ras-guanine nucleotide exchange protein (SOS) bound to wild-type and oncogenic ras-p21. Identification of effector domains of SOS.

The X-ray crystal structure of the ras oncogene-encoded p21 protein bound to SOS, the guanine nucleotide exchange-promoting protein, has been determined. We have undertaken to determine if there are differences between the three-dimensional structures of SOS bound to normal and oncogenic (Val 12-p21) proteins. Using molecular dynamics, we have computed the average structures for both complexes and superimposed them. We find four domains of SOS that differ markedly in structure: 631-641, 676-691, 718-729, and 994-1004. Peptides corresponding to these sequences have been synthesized and found to be powerful modulators of oncogenic p21 in cells as described in an accompanying paper. We find that the SOS segment from 809-815 makes contacts with multiple domains of ras-p21 and can facilitate correlated conformational changes in these domains.

Models, Molecular↗
PubMed1999

Identification of the site of inhibition of oncogenic ras-p21-induced signal transduction by a peptide from a ras effector domain.

We have previously found that a peptide corresponding to residues 35-47 of the ras-p21 protein, from its switch 1 effector domain region, strongly inhibits oocyte maturation induced by oncogenic p21, but not by insulin-activated cellular wild-type p21. Another ras-p21 peptide corresponding to residues 96-110 that blocks ras-jun and jun kinase (JNK) interactions exhibits a similar pattern of inhibition. We have also found that c-raf strongly induces oocyte maturation and that dominant negative c-raf strongly blocks oncogenic p21-induced oocyte maturation. We now find that the p21 35-47, but not the 96-110, peptide completely blocks c-raf-induced maturation. This finding suggests that the 35-47 peptide blocks oncogenic ras at the level of raf; that activated normal and oncogenic ras-p21 have differing requirements for raf-dependent signaling; and that the two oncogenic-ras-selective inhibitory peptides, 35-47 and 96-110, act at two different critical downstream sites, the former at raf the latter at JNK/jun, both of which are required for oncogenic ras-p21 signaling.

Animals↗
PubMed1999

Common conformational effects in the p53 protein of vinyl chloride-induced mutations.

The tumor suppressor gene p53 has been identified as the most frequent site of genetic alterations in human cancers. Vinyl chloride, a known human carcinogen, has been associated with specific A --> T transversions at codons 179, 249, and 255 of the p53 gene. The mutations result in amino acid substitutions of His --> Leu at residue 179, Arg --> Trp at residue 249, and He --> Phe at residue 255 in highly conserved regions of the DNA-binding core domain of the p53 protein. We previously used molecular dynamics calculations to demonstrate that the latter two mutants contain certain common regions that differ substantially in conformation from the wild-type structure. In order to determine whether these conformational changes are consistent for other p53 mutants, we have now used molecular dynamics to determine the structure of the DNA-binding core domain of the Leu 179 p53 mutant. The results indicate that the Leu 179 mutant differs substantially from the wild-type structure in certain discrete regions that are similar to those noted previously in the other p53 mutants. One of these regions (residues 204-217) contains the epitope for the monoclonal antibody PAb240, which is concealed in the wild-type structure, but accessible in the mutant structure, and another region (residues 94-110) contains the epitope for the monoclonal antibody PAb1620, which is accessible in the wild-type structure, but concealed in the mutant structure. Immunologic analyses of tumor tissue known to contain this mutation confirmed these predicted conformational shifts in the mutant p53 protein.

Animals↗