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Biomedical subjects

J M Miller

Publications and source records attributed to J M Miller.

At least 361 records · Page 20Linked to original sources
PubMed1992

Prevalence of serotypes of Xanthomonas maltophilia from world-wide sources.

Since its development in 1988, a serologic typing scheme for Xanthomonas maltophilia, based on 31 O antigens, has been successfully used to serotype isolates involved in nosocomial outbreaks in the United States. To determine if this serotyping scheme would be useful in typing X. maltophilia isolates from world-wide sources, we obtained additional isolates from 10 countries; of 900 isolates tested, 795 (88.3%) were typable. In order of predominance, the three most common serotypes were 10, 3 and 19. These three serotypes were most frequently associated with respiratory and blood isolates. This serotyping system is useful as an epidemiologic screening method for universal typing of outbreaks of X. maltophilia infections.

Global Health↗
PubMed1992

Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients.

OBJECTIVE: To determine risk factors for and modes of transmission of Xanthomonas maltophilia infection/colonization. DESIGN: Surveillance and cohort study. SETTING: A 470-bed tertiary trauma-referral community hospital. PATIENTS: From January 1, 1988 to March 17, 1989, 106 intensive care unit patients developed X maltophilia infection/colonization. We defined a case as any intensive care unit patient who, from July 15, 1988, through March 17, 1989 (epidemic period), had X maltophilia infection/colonization greater than or equal to 48 hours after intensive care unit admission. We identified 45 case patients and 103 control patients (persons in the shock-trauma intensive care unit for greater than or equal to 72 hours during the epidemic period who had no X maltophilia-positive culture). RESULTS: Cases were significantly more likely to occur in the shock-trauma intensive care unit than in all other intensive care units combined. Mechanical ventilation, tracheostomy, being transported to the hospital by airplane, and receipt of a higher mean number of antimicrobials were risk factors for X maltophilia infection/colonization. Risk of X maltophilia infection/colonization was significantly greater among cases exposed to a patient with a X maltophilia surgical wound infection than among those without such exposure (relative risk = 1.3, p = .03). Animate and inanimate cultures revealed X maltophilia contamination of the hospital room of a patient with an X maltophilia surgical wound infection, of respiratory therapy equipment in this patient's room, of respirometers shared between patients, and of shock-trauma intensive care unit personnel's hands. Related environmental and clinical isolates were serotype 10. CONCLUSIONS: Mechanically ventilated patients receiving antimicrobials in the shock-trauma intensive care unit were at increased risk of X maltophilia infection/colonization. Patients with draining X maltophilia surgical wound infections served as reservoirs for X maltophilia, and contamination of the respirometers and the hands of shock-trauma intensive care unit personnel resulted in patient-to-patient transmission of X maltophilia.

Cohort Studies↗
PubMed1992

1-Methyl-4-phenylpyridinium produces excitotoxic lesions in rat striatum as a result of impairment of oxidative metabolism.

The effects of 1-methyl-4-phenylpyridinium (MPP+) were studied in rat striatum. Using freeze-clamp, microwave, and water-suppressed proton chemical shift magnetic resonance imaging techniques, MPP+ resulted in marked increases in lactate and a depletion of ATP for up to 48 h after the injections. MPP+ produced dose-dependent depletions of dopamine, serotonin, gamma-aminobutyric acid, and substance P that were partially blocked at 1 week by prior decortication or completely blocked by MK-801 at 24 h. The lesions showed relative sparing of somatostatin-neuropeptide Y neurons, consistent with N-methyl-D-aspartate (NMDA) excitotoxicity. MPP+ produces impairment of oxidative phosphorylation in vivo, which may result in membrane depolarization with persistent activation of NMDA receptors and excitotoxic neuronal degeneration. An impairment of energy metabolism may therefore underlie slow excitotoxic neuronal death in neurodegenerative diseases.

1-Methyl-4-phenylpyridinium↗
PubMed1992

Reevaluation of the API 20E identification system versus conventional biochemicals for identification of members of the family Enterobacteriaceae: a new look at an old product.

The API 20E bacterial identification system has been used for 19 years, often as the standard with which other identification systems are compared. Because the accuracy of this system compared with conventional biochemical tests has not been determined in many years, we evaluated the API 20E linear strip by using 291 typical and atypical strains of the family Enterobacteriaceae taken from a culture collection. At 24 h, the API 20E correctly identified by genus and species 229 of 291 (78.7%) of the strains, using Salmonella and Shigella serotyping where indicated. At 48 h, 95.2% were correctly identified by using additional biochemical tests as recommended by the manufacturer. The API 20E misidentified eight (2.7%) strains; these strains were not limited to any particular genus. When 81 of these Enterobacteriaceae strains were arranged into a weighted assortment correlating to the frequency with which they might be found in a clinical laboratory, the API 20E correctly identified 71 (87.7%) at 24 h and 78 (96.3%) at 48 h. This evaluation concluded that the accuracy of the identification of Enterobacteriaceae strains at 24 h (78.7%) may be significantly lower than that of earlier evaluations. However, there is no significant difference in the ability of the API 20E to correctly identify "challenge" type organisms (229 of 291) versus routine hospital isolates (71 of 81) (P greater than 0.05), but the system is not as accurate as the conventional biochemical method of identification.

Bacterial Typing Techniques↗
PubMed1992

Examination of whether persistently indeterminate human immunodeficiency virus type 1 Western immunoblot reactions are due to serological reactivity with bovine immunodeficiency-like virus.

The bovine lentivirus, known as bovine immunodeficiency-like virus (BIV), is genetically, structurally, and antigenically related to human immunodeficiency virus type 1 (HIV-1). It is not known whether sera from persons exposed to BIV proteins would show either positive or indeterminate reactivity on HIV-1 antibody tests. We used a BIV Western blot (immunoblot) analysis to examine human sera characterized as HIV-1 antibody positive, HIV-1 antibody negative, HIV-1 persistently indeterminate, HIV-1 p17 antibody positive only, HIV-1 p24 antibody positive only, human T-cell leukemia virus type 1 (HTLV-1) p19 antibody positive only, or HTLV-1 p24 antibody positive only. None of these sera were positive by Western blot to BIV-specific proteins. Many of these sera, however, displayed strong reactivities to bovine cell culture antigens on blots prepared from both mock-infected and BIV-infected cell cultures. The HIV-1 p17 and p24 antibody-positive and the HTLV-1 p19 and p24 antibody-positive sera were further examined by Western blot to bovine leukemia virus (BLV) and were found to be negative. We examined sera from laboratory personnel at risk for BIV exposure, including two laboratory workers who were exposed to BIV by accidental injection with BIV-infected cell culture material, and found no evidence of seroconversion to BIV-specific proteins. We tested 371 samples of fetal bovine sera, each sample representing serum pooled from one to three fetuses. All samples were negative by BIV Western blot. To date, we have not detected any human sera with antibody to BIV-specific proteins. Our data indicate that persistently indeterminate results on HIV-1 Western blot are not caused by a human antibody response to BIV proteins.

Animals↗
PubMed1992

Evaluation of the autoSCAN-W/A system for rapid (2-hour) identification of members of the family Enterobacteriaceae.

We evaluated the ability of the Baxter autoSCAN-W/A System (MicroScan Division, Baxter Diagnostics, Inc., West Sacramento, Calif.) to use the rapid (2-h) gram-negative identification panel for accurate identification of members of the family Enterobacteriaceae. At 2 h, 353 of 467 (75.6%) strains in a challenge set of biochemically typical and atypical stock cultures were correctly identified to genus and species. Another 76 (16.3%) strains were correctly identified to genus and species after the performance of recommended additional biochemical testing. Thus, at 24 h, 91.9% of the 467 strains were correctly identified. Twenty-two strains (4.7%) were identified to the correct genus but the incorrect species, and 16 strains (3.4%) were misidentified. Of these 16 strains, 9 were incorrect at 2 h, and 7 were incorrect after the additional testing. Because the system is based on fluorogenic substrates, no conventional tests were readily available with which to compare aberrant reactions. These results suggest that the autoSCAN-W/A with its rapid gram-negative panels is acceptable for the identification of the Enterobacteriaceae in a clinical microbiology laboratory.

Bacterial Typing Techniques↗
PubMed1992

Characterization of early pathogenic effects after experimental infection of calves with bovine immunodeficiency-like virus.

The early pathogenic effects of bovine immunodeficiency-like virus (BIV) were studied in calves experimentally inoculated with BIV. All animals inoculated with BIV R29-infected cells seroconverted by 6 weeks postinoculation, and BIV was recoverable from each animal at 2 weeks postinoculation. However, levels of BIV replication in vivo appeared to be low. In situ hybridization studies indicated that during peak periods of viral replication in vivo, less than 0.03% of peripheral blood mononuclear cells were expressing detectable levels of viral RNA. Moreover, the levels of viral RNA in these cells in vivo were less than 1/10 the levels observed in persistently infected cells in vitro. BIV-inoculated calves had significantly higher numbers of circulating lymphocytes, and follicular hyperplasia was observed in lymph nodes, hemal nodes, and spleen. The histopathological changes observed in BIV-infected calves were similar to changes found early after infection with the immunosuppressive lentiviruses, including human immunodeficiency virus type 1.

Animals↗
PubMed1992

Cochlear blood flow and microvascular resistance changes in response to hypertonic glycerol, urea, and mannitol infusions.

The effect of hyperosmotic agents on cochlear blood flow (CBF) was tested in normal guinea pigs and in guinea pigs having prior unilateral operations to ablate the endolymphatic duct. Laser-Doppler-measured CBF was normalized to remove apparent changes related directly to systemic blood pressure. Hyperosmotic fluids were given via venous infusion: glycerol (20% and 40% solutions), urea (10%, 30%, and 40% solutions), and mannitol (40% solution). All agents were dissolved in 0.9% saline and the mixtures were given at a rate of 0.3 to 0.6 mL/min for 5 minutes. Control infusions were of 0.9% saline and isotonic dextran 70 (Pharmacia). All hyperosmotic infusions resulted in similar increases in normalized cochlear blood flow (nCBF) that extended to a maximum of 300% of the baseline value in a dose-dependent way during the infusion time period. Within approximately 30 minutes following infusions, nCBF had returned to baseline levels. Saline infusion alone had little effect on nCBF, but isotonic dextran 70 gave a sustained increase to 122% of the baseline levels. There was no difference between the responses of nCBF in hydropic and normal cochleas for either control or hyperosmotic solutions. Measurements of systemic hematocrit at time intervals during and following the infusions showed that transient reductions of up to approximately 8% (for the maximum osmotic challenge) occurred during the infusion. It is concluded that the hyperosmotic treatments tested here are equally effective for short-term enhancements of nCBF in both normal and hydropic cochleas. The basis of the flow increase is partially rheologic and partially due to a local vasodilation.

Animals↗
PubMed1992

Expression of the major mammalian stress protein in the rat cochlea following transient ischemia.

The transient expression of stress proteins in cells exposed to adverse environmental conditions is thought to provide a survival advantage. In the present study, the expression of the major mammalian stress protein, Hsp72, was characterized in the rat peripheral auditory system following varying periods of unilateral cochlear ischemia and reperfusion. Western blot analysis of whole cochlear homogenates revealed Hsp72 expression after as little as 5 minutes of cochlear ischemia. Cochlear Hsp72 immunoreactivity following 10 minutes of ischemia was observed within 2 hours, remained evident through 6 hours, and decreased toward control levels by 12 hours. Preliminary immunocytochemical localization data revealed Hsp72 expression in the outer hair cells. The characterization of Hsp72 expression following transient ischemia represents the first step toward understanding the role that stress proteins have in the protection of the mammalian auditory system.

Animals↗
PubMed1992

Experimental basis for lidocaine therapy in cochlear disorders.

In order to further our basic understanding of the effects of lidocaine hydrochloride in the inner ear, cochlear potentials and blood flow (CBF) were assessed after intravenous (i.v.), anterior inferior cerebellar artery (AICA), and local round window (RW) lidocaine administrations in guinea pigs and rats. Lidocaine RW applications produced a dose dependent decrease in compound action potentials (CAP) and cochlear microphonics (CM). The sensitivity changes were more pronounced at high frequencies. These findings suggest that lidocaine has specific pharmacological action in the inner ear other than simple anesthesia of the auditory nerve. The basal turn endocochlear potentials (EP) were not altered by topical lidocaine, implicating altered organ of Corti function following local application of lidocaine. RW applications of lidocaine had no effect on CBF or systemic blood pressure (BP). I.v. infusions caused substantial reductions in BP. In the case of systemic infusions the percent changes in CBF were equal to and accountable by the BP changes. The microinfusions (50 mg/ml, 100 nl/min) through AICA produced a 30%, long lasting increase in CBF. However, neither systemic lidocaine nor AICA infusions had an effect on CAP or CM. These findings indicate that systemically given lidocaine may not cross the blood-cochlear barrier and that the cochlear electrophysiological effects due to lidocaine when given locally are partly mediated by direct influence on cochlear hair cell function; they also suggest that lidocaine-induced interference with active ion transport in the lateral wall or an influence on CBF are not contributing factors.

Action Potentials↗
PubMed1992

A prospective comparison of terbutaline and magnesium for tocolysis.

OBJECTIVE: To compare the tocolytic efficacy and side effects of parenteral and oral magnesium and terbutaline. METHODS: Ninety-eight patients in labor between 23-35 weeks were prospectively entered into a controlled trial of intravenous and oral magnesium versus subcutaneous and oral terbutaline. Tocolytic effectiveness was judged by delay of delivery for 48 hours or 1 week, and to 37 weeks or more. The need to change therapy to the alternate drug was identified, as were side effects. Entrance characteristics of the population, initial pelvic examination, and concomitant infection or cervicovaginal isolates were noted. Outcomes included gestational age at delivery, birth weights, and Apgar scores. Outcome analysis was based on initial tocolytic therapy. RESULTS: Significantly more patients in the magnesium group delivered at 37 weeks or more: 34 of 46 versus 27 of 52 (P < .05). No significant differences were found for delivery by 48 hours or 1 week. The interval between treatment and delivery was greater for magnesium: 7.1 +/- 3.9 versus 5.0 +/- 3.2 weeks (P < .005). Failure to achieve 37 completed weeks was more often due to obstetric complications than to preterm labor itself. Tocolytic effectiveness was reduced if secondary therapy or re-treatment was required or if the patient had cervical dilatation of 3 cm or greater. Infectious complications were common but were not associated with tocolytic effectiveness. Side effects were more noticeable with oral magnesium and subcutaneous terbutaline. CONCLUSIONS: For short-term tocolysis, no significant difference was found between magnesium and terbutaline. Magnesium was associated with a higher term delivery rate. Idiopathic preterm labor accounted for only a small part of the overall prematurity in the study population.

Adult↗
PubMed1992

Two centuries of medical organization and licensure in Maryland.

In 1766, the first American medical society was established in New Jersey. It was not until 1968, more than 200 years later, that the state medical societies would finally mold a satisfactory means of medical qualification and licensure.

History, 18th Century↗
PubMed1992

A note on the intermixture of the African black and the western European races.

Several observations seem pertinent when previous work is combined with the present investigation. The intermixture of the black and white races in the United States is an ongoing, continuous phenomenon. Different genes transfer at dissimilar rates. The concept of the time at which the Duffy blood proteins of the African black was entirely Fy should probably be extended backward to an earlier date. Calculations to derive a completely negative Fy frequency should be cushioned by the fact that intermixture of the Caucasoid and black races took place before the onset of the slave trade.

Black People↗
PubMed1992

The 1990 contract: have patients noticed?

We carried out a questionnaire survey in a Semi-urban General Practice in Renfrewshire to evaluate patients' knowledge and understanding of changes to General Practitioner services six months after implementation of 'The 1990 Contract'. The survey assessed the point prevalence of patients' knowledge in an opportunity sample. A total of 237 patients attending morning surgery during one week in September 1990 were asked to complete a short questionnaire. Despite 38% of respondents declaring they were aware of the changes, only 10% of the respondents showed evidence of understanding of the changes. There was a lack of perceived usefulness of Well Person Checks despite a relatively good understanding of what this involves. Most of the recent changes in General Practice were perceived as being useful or extremely useful to patients after they had been explained. It is suggested that further publicity with careful targeting and explanation is required before the public can make appropriate and effective use of these changes.

Contract Services↗