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Biomedical subjects

J Smith

Publications and source records attributed to J Smith.

At least 397 records · Page 22Linked to original sources

Primary cardiac sarcoma: a novel treatment approach.

Primary cardiac sarcomas carry a dismal prognosis with no known curative therapy using standard treatment approaches. By its very location, the possibility of a radical complete resection--the underlying principle in the management of any soft-tissue sarcoma--is precluded. While literally in a continuous "blood bath," cardiac sarcomas are associated with a very high rate of hematogenous metastases. This report describes the management of a case in a 51-year-old white man with a high-grade unresectable cardiac sarcoma who was treated with hyperfractionated (twice daily) radiotherapy to a total dose of 7,050 cGy along with a radiosensitizer, (5'-iododeoxyuridine. The patient currently is disease-free and functioning well more than 5 years following this novel treatment approach.

Antineoplastic Agents↗

Can phonological awareness training facilitate minimal pair therapy?

This study evaluated a new therapy approach. 18 children with phonological disorders resistant to conventional therapy had phonological awareness training followed by conventional speech therapy. The children's speech production improved as did their phonological awareness. In this heterogeneous group, the patterns revealed in their individual responses to therapy proved diagnostically significant.

Child↗

3D visual presentation of shoulder joint motion.

The 3D visual presentation of biodynamic events of human joints is a challenging task. Although the 3D reconstruction of high contrast structures from CT data has been widely explored, then there is much less experience in reconstructing the small low contrast soft tissue structures from inhomogeneous and sometimes noisy MR data. Further, there are no algorithms for tracking the motion of moving anatomic structures through MR data. We represent a comprehensive approach to 3D musculoskeletal imagery that addresses these challenges. Specific imaging protocols, segmentation algorithms and rendering techniques are developed and applied to render complex 3D musculoskeletal systems for their 4D visual presentation. Applications of our approach include analysis of rotational motion of the shoulder, the knee flexion, and other complex musculoskeletal motions, and the development of interactive virtual human joints.

Adult↗

A national center for biocomputation: in search of a patient-specific interactive virtual surgery workbench.

This report describes the three-dimensional imaging and virtual environment technologies developed in NASA's Biocomputation Center for scientific purposes that have now led to applications in the field of medicine. A major goal is to develop a virtual environment surgery workbench for planning complex craniofacial and breast reconstructive surgery, and for training surgeons.

Breast Neoplasms↗

testing.

Explore the source record for details and available documents.

Brain↗

Surviving and thriving with Vision 2006: information technology in the curriculum.

To prepare graduates for the new roles envisioned in the American Health Information Management Association's Vision 2006, which places emphasis on information technology and the management of health information, a model curriculum has been developed for health information administration and health information technology programs in which information technology and information systems have been strengthened. With these new directions come the expense and problems of purchasing and maintaining computer systems necessitated by these changes. There can be great resistance on the part of deans and other individuals to authorize the procurement of the hardware and software needed to establish a computer laboratory. The article describes a cost-effective alternative.

Certification↗

Battered woman syndrome.

Recent judgments in the Court of Appeal have highlighted the significance of battered woman syndrome. This article describes the origin and features of the syndrome and some of its shortcomings. Medical aspects and legal applications of the concept are discussed.

Battered Women↗

Vignettes of a pulmonary rehabilitation team.

A successful comprehensive pulmonary rehabilitation program depends on these key pieces: thorough planning, an experienced coordinator who is a patient advocate, a dedicated and supportive medical director, enthusiastic and committed team members, the use of program graduates as volunteers, and providing the essential components of pulmonary rehabilitation, which consist of assessment, patient training, exercise, psychosocial intervention, and follow-up. The patients are the most important members of the team. Their courage, dedication, and determination to make their quality of life the best it can be is truly an inspiration to all of us.

California↗

The safety of automatic versus manual blood pressure cuffs for patients receiving thrombolytic therapy.

BACKGROUND: Patients receiving thrombolytic therapy for acute myocardial infarction require frequent monitoring of blood pressure. Historically, many nurses have been reluctant to use automatic blood pressure cuffs during thrombolytic therapy because of concern that the automatic cuffs might increase risk of bleeding. This concern is not based on research findings but on case reports, anecdotal observations, and possible myths in clinical practice. OBJECTIVE: To determine the safety of using automatic blood pressure cuffs during thrombolytic therapy in patients with acute myocardial infarction. METHODS: Ninety-six patients with acute myocardial infarction who received thrombolytic therapy (streptokinase or tissue plasminogen activator) were randomized to have blood pressure measurements obtained with either automatic or manual blood pressure cuffs. Patients were checked at least every 2 hours for purpuric lesions (petechiae, ecchymoses, or hematomas). The study ended after 24 hours of measurements or when a purpuric lesion was noted. RESULTS: We found no significant difference in frequency of purpuric lesions between patients who had blood pressure measured with a manual cuff and patients who had blood pressure measured with an automatic cuff. The most common purpuric lesions noted were ecchymoses. A significant difference was noted in the frequency of purpuric lesions depending on which thrombolytic agent was used, regardless of cuff type. CONCLUSIONS: Automatic blood pressure cuffs are as safe as manual blood pressure cuffs in patients with acute myocardial infarction who are receiving thrombolytic therapy.

Adult↗

Synthetic real estate: bringing corporate finance to health care.

The changing landscape of health care has caused hospitals, health care systems, and other health care organizations to look for ways to finance expansions and acquisitions without "tainting" their balance sheets. This search has led health care executives to a financing technique that has been already embraced by Fortune 500 companies for most of this decade and more recently adopted by high-tech companies: synthetic real estate. Select case studies provide examples of the more creative financial structures currently being employed to meet rapidly growing and increasingly complex funding needs.

Capital Financing↗

Compression bandaging effects on lower extremity peripheral and sub-bandage skin blood perfusion.

Laser-Doppler blood perfusion was simultaneously measured on both great toes and the lateral upper-calf before and during fore-foot-to-knee compression bandaging of one test-leg in ten vascularly healthy female volunteers. Two bandaging methods were sequentially used separated by a 30 minutes interval. Bandage A consisted of a layer of zinc impregnated gauze and an elastic wrap; bandage B had the elastic wrap only. Sub-bandage pressures of the test-leg were measured at distal and proximal lateral below-knee standardized sites. The study purpose was to determine the effects of moderate compression pressure achieved for bandages A under and distal to bandaged regions. Initial (mean +/- sem_ sub-bandage pressure achieved for bandages A and B were similar, being respectively 32.9 +/- 2.8 and 28.4 +/- 3.9 mm Hg. Both bandages types were associated with significant reductions in test-leg toe blood perfusion amounting to 44.2 +/- 13.1 percent and 27.5 +/- 10.5 percent for bandages A and B respectively. Contrastingly, test-leg sub-bandage blood perfusion did not differ from its pre-bandage baseline mean level for either bandage type. These findings show that a widely used bandaging method and a slight variant each significantly reduces distal (toe) blood perfusion without reducing sub-bandage skin perfusion. Absence of sub-bandage perfusion decreases may be related to a partially compensating reflex vasodilatory response, but such effects if present are inadequate to prevent reductions in distal perfusion. These results reinforce the need for due care and risk-benefit consideration with respect to therapeutic compression levels.

Adult↗

Heel-skin microvascular blood perfusion responses to sustained pressure loading and unloading.

OBJECTIVE: Sustained heel pressure during surgery and during acute and long-term care residence can cause heel blood flow deprivation sufficient to cause pressure ulcers. Because little is known about the amount and distribution of heel blood perfusion changes under these conditions, the aim of this study was to characterize the main features of these changes. METHODS: Heel blood perfusion by laser Doppler imaging (LDI, 40 x 40 mm scans) was measured in 11 vascularly normal persons before (10 minutes), during heel loading (40 minutes) and after off-loading (20 minutes). Loading was done with subjects supine and one heel on a transparent plate through which LDI data were obtained during loading. Analyses were on progressively increasing areas around the central compression site using 10 x 10, 20 x 20, 30 x 30, and 40 x 40 mm assay areas at each of multiple time points during the 70-minute test. RESULTS: (1) Heel perfusion is rapidly and significantly reduced on loading (P < 0.01) with the greatest reduction within the central heel area; (2) perfusion remains uniformly depressed throughout the loading interval; (3) off-loading is associated with a rapid onset, specially heterogeneous hyperemia which exceeds baseline (P < 0.01) for 10 minutes. CONCLUSIONS: The present seminal findings may serve as a guide to develop sorely needed microvascular tests to help classify heel breakdown risk on a patient-by-patient basis.

Adult↗

Detection of cancer cells in peripheral blood of breast cancer patients using reverse transcription-polymerase chain reaction for epidermal growth factor receptor.

The epidermal growth factor receptor (EGFR) has been reported to be expressed in high levels in primary breast cancer by immunohistochemistry. In the present study, a reverse transcription (RT)-PCR assay using EGFR primers was developed and evaluated for the detection of circulating micrometastases in the blood of breast cancer patients. Total RNA was extracted from breast cancer cell lines and from the blood of 23 control individuals and 37 breast cancer patients. After reverse transcription, outer and nested primers for EGFR were used for cDNA amplification. RNA integrity was confirmed with parallel RT-PCR amplification using beta2-microglobulin primers. PCR products were electrophoresed on agarose gels containing ethidium bromide and visualized by UV photography. Southern blotting was used to confirm EGFR specificity. The nested EGFR RT-PCR assay was capable of detecting a lower limit of 100 fg of total RNA from the A431 cell line. EGFR RNA was identified from the blood of 4 of 18 (22%) metastatic breast cancer patients, 0 of 6 locally recurrent breast cancer patients, 0 of 13 adjuvant breast cancer patients, and 0 of 23 controls (P = 0.03, metastatic versus control). The 18 metastatic breast cancer patients all had progressive disease at the time of blood sampling. The identity of the four EGFR-positive bands was confirmed by Southern blotting. The presence of RT-PCR positivity for EGFR was not a treatment-related phenomenon, because three of the four EGFR-positive patients were not receiving treatment at the time of blood collection. RT-PCR for EGFR is a sensitive and specific method for the detection of circulating micrometastases in a proportion of patients with metastatic breast cancer.

Biomarkers, Tumor↗

The Aspergillus nidulans cnxABC locus is a single gene encoding two catalytic domains required for synthesis of precursor Z, an intermediate in molybdenum cofactor biosynthesis.

The Aspergillus nidulans complex locus, cnxABC, has been shown to be required for the synthesis of precursor Z, an intermediate in the molybdopterin cofactor pathway. The locus was isolated by chromosome walking a physical distance of 65-kilobase pairs from the brlA gene and defines a single transcript that encodes, most likely, a difunctional protein with two catalytic domains, CNXA and CNXC. Mutations (cnxA) affecting the CNXA domain, mutants (cnxC) in the CNXC domain, and frameshift (cnxB) mutants disrupting both domains have greatly reduced levels of precursor Z compared with the wild type. The CNXA domain is similar at the amino acid level to the Escherichia coli moaA gene product, while CNXC is similar to the E. coli moaC product, with both E. coli products encoded by different cistrons. In the wild type, precursor Z levels are 3-4 times higher in nitrate-grown cells than in those grown on ammonium, and there is an approximately parallel increase in the 2.4-kilobase pair transcript following growth on nitrate, suggesting nitrate induction of this early section of the pathway. Analysis of the deduced amino acid sequence of several mutants has identified residues critical for the function of the protein. In the CNXA section of the protein, insertion of three amino acid residues into a domain thought to bind an iron-sulfur cofactor leads to a null phenotype as judged by complete loss of activity of the molybdoenzyme, nitrate reductase. More specifically, a mutant has been characterized in which tyrosine replaces cysteine 345, one of several cysteine residues probably involved in binding the cofactor. This supports the proposition that these residues play an essential catalytic role. An insertion of seven amino acids between residues valine 139 and serine 140, leads to a temperature-sensitive phenotype, suggesting a conformational change affecting the catalytic activity of the CNXA region only. A single base pair deletion leading to an in frame stop codon in the CNXC region, which causes a null phenotype, effectively deletes the last 20 amino acid residues of the protein, indicating that these residues are necessary for catalytic function.

Amino Acid Sequence↗