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Biomedical subjects

K M Sullivan

Publications and source records attributed to K M Sullivan.

At least 145 records · Page 8Linked to original sources
PubMed1993

Analysis of 6 VNTR loci by 'multiplex' PCR and automated fluorescent detection.

The polymerase chain reaction was used to amplify six small variable number of tandem repeat loci in two reactions (D19S20 co-amplifying with D17S5 and D1S80; D17S766 co-amplifying with D16S83 and D17S24). When coupled with fluorescent detection of the products, this provides a rapid, highly discriminating automated test. Preferential amplification of small alleles, leading to 'allelic dropout' was found to occur in D19S20 and D16S83. Population databases are presented for Caucasians and Afro-Caribbeans at loci D19S20, D16S83 and D17S24, and for Asians at D19S20.

Alleles↗
PubMed1993

The application of mitochondrial DNA typing to the study of white Caucasian genetic identification.

Mitochondrial DNA (mtDNA) from 100 unrelated British White Caucasians was extracted, amplified and directly sequenced. Sequences of approximately 800 nucleotides were obtained from 2 hypervariable segments within the non-coding region of the mitochondrial genome. A total of 91 different sequences were observed with an average nucleotide diversity of 1.1%. The most diverse pair of sequences differed at 3.6% of their nucleotide (nt) sites. Comparison to a consensus reference sequence showed that each region was polymorphic to a similar extent. Different methods of genetic analysis were used to examine the variation in each region, including pairwise comparisons, which demonstrated that although the data did not fit a Poisson distribution, the fit was closer to a Negative Binomial distribution.

Base Sequence↗
PubMed1993

Acute respiratory illness in the community. Frequency of illness and the agents involved.

Investigations of respiratory illnesses and infections in Tecumseh, Michigan, USA, were carried out in two phases, together covering 11 years. During the second phase, there were 5363 person-years of observation. Respiratory illness rates in both males and females peaked in the 1-2 year age group and fell thereafter. Adult females had more frequent illnesses than adult males; illnesses were less common in working women than in women not working outside the home. Isolation of viruses fell with increasing age; rhinoviruses were the most common isolate. Influenza infection rates, determined serologically, suggested relative sparing of young children from infection with type A (H1N1) and type B. Infection rates were highest in adult age groups for type A (H3N2). The isolation and serological infection rates were used to estimate the extent to which laboratory procedures underestimated the proportion of respiratory illnesses caused by each infectious agent; data from other studies were also used in this estimation. Severity of respiratory illnesses was assessed by the proportion of such illnesses that resulted in consultation of a physician. Rhinoviruses produced the greatest number of consultations. Overall, physician consultations were associated with 25.4% of respiratory illnesses.

Adolescent↗
PubMed1993

Long-term survival and cure after marrow transplantation for congenital hypoplastic anaemia (Diamond-Blackfan syndrome).

Four patients with Diamond-Blackfan syndrome (congenital hypoplastic anaemia) whose disease was resistant to corticosteroid treatment and who were red blood cell transfusion-dependent, were given marrow grafts from allogeneic human-leucocyte-antigen (HLA)-identical siblings. The patients were conditioned with regimens including cyclophosphamide and busulfan. Three of four patients had sustained and complete marrow engraftment. One patient showed early signs of haematopoietic recovery but died on day 35 of pulmonary toxicity. The three surviving patients are well with normal haematopoiesis and Karnofsky performance scores of 100%, 3.0, 7.4 and 10.6 years after transplantation. Congenital hypoplastic anaemia can be treated successfully by allogeneic marrow grafts.

Acute Disease↗
PubMed1993

Estimates of the US health impact of influenza.

OBJECTIVES: Data from the Tecumseh Community Health Study were used to estimate excess morbidity owing to influenza, and results were compared with estimates made previously using different methodology for an Institute of Medicine report. METHODS: Study participants from Tecumseh, Michigan, were classified as infected or noninfected based on laboratory results. The excess numbers of respiratory illnesses, respiratory illness days, and bed and restricted activity days experienced by the infected compared with the noninfected were estimated. RESULTS: The number of excess influenza-related respiratory illnesses was lower than that estimated in the Institute of Medicine report, in which all illnesses of certain characteristics occurring during an influenza season were attributed to influenza. It is now estimated that the US population under 20 years of age experiences a yearly average of 13.8 to 16.0 million influenza-related excess respiratory illnesses; for older individuals, the yearly estimate is 4.1 to 4.4 million excess illnesses. CONCLUSIONS: For public health purposes, estimates of excess morbidity as well as of total morbidity associated with influenza should be used in setting health priorities.

Adolescent↗
PubMed1993

A rapid and quantitative DNA sex test: fluorescence-based PCR analysis of X-Y homologous gene amelogenin.

A rapid, simple and reliable sex test that entails PCR amplification of a segment of the X-Y homologous gene amelogenin has been developed. We used a single pair of primers spanning part of the first intron which generated 106-bp and 112-bp PCR products from the X and Y homologues, respectively, that can be analyzed simply by agarose gel electrophoresis. Less than 1 ng of template DNA is required for gender assignment, and the test has been automated by the fluorescent tagging of the PCR products that are then quantitated during electrophoresis by automated fluorescence-detection technology. Quantitation enables sex chromosome aneuploidy to be determined, and the amelogenin intron sequence can also be co-amplified with several highly polymorphic microsatellite loci, thereby providing a combined gender/identity DNA test.

Amelogenin↗
PubMed1993

Fatal eosinophilia myalgia syndrome in a marrow transplant patient attributed to total parenteral nutrition with a solution containing tryptophan.

A 16-year-old white male with acute biphenotypic leukemia developed evidence of the eosinophilia myalgia syndrome associated with total parenteral nutritional support with solutions containing tryptophan, which were given during his initial induction chemotherapy and also after autologous marrow transplantation. He developed pronounced eosinophilia and a vasculitic skin rash, myalgias of the abdomen, upper trunk, and neck, and died of respiratory distress with no evidence of an infectious etiology. Autopsy revealed diffuse vasculitis involving the heart, lungs, kidneys, testes, spleen, liver, skin, gut wall and marrow with neuritis of gut wall nerves and ganglia. Thus, the eosinophilia myalgia syndrome can be associated with parenteral tryptophan administration.

Adolescent↗
PubMed1993

Recovery after allogeneic marrow transplantation: prospective study of predictors of long-term physical and psychosocial functioning.

No prospective data have documented the physical and psychosocial functioning of patients before and after BMT. In this study 67 allogeneic transplant patients completed standardized self-report measures pre-transplant. Survivors were re-assessed at 90 days (n = 34) and 1 year (n = 31) post-transplant. Telephone interviews established 4-year work history and performance status. Physical function was most impaired at 90 days post-transplant, with a return to pre-transplant levels of functioning by 1 year in most areas. By 2 years post-transplant, 68% of patients had returned to full-time work. Only 9% of 4-year survivors failed to return to full-time occupations. Mean levels of anxiety and depression did not change over the first year. Pre-transplant, 27% of patients reported depression and 41% reported elevated anxiety. Greater emotional distress at 1 year was predicted by pre-transplant family conflict, non-married status and development of less severe chronic GVHD. Impaired physical recovery at 1 year was predicted by more severe chronic GVHD, pre-transplant physical impairment and family conflict. The large majority of long-term survivors returned to full-time employment with normal physical and psychosocial functioning, although recovery took longer than 1 year for approximately 40%. Family relationships were important determinants of physical and emotional recovery.

Adult↗
PubMed1992

Ursodeoxycholic acid treatment of refractory chronic graft-versus-host disease of the liver.

OBJECTIVE: To determine the safety and efficacy of ursodeoxycholic acid treatment in patients with chronic graft-versus-host disease (GVHD) of the liver. DESIGN: Open-label study in which each patient served as his or her own control. SETTING: Private practice and a university bone marrow transplant center. PATIENTS: Twelve patients with refractory chronic GVHD of the liver were studied after allogeneic bone marrow transplantation. INTERVENTIONS: After baseline data collection, patients were given ursodeoxycholic acid (UDCA, 10 to 15 mg/kg body weight per day) for 6 weeks. After discontinuation of the drug, patients were followed for an additional 6 weeks. Doses of immunosuppressive drugs were unchanged for these 12 weeks. MEASUREMENTS: Signs, symptoms, Karnofsky performance scores, hematocrit, total leukocyte count, absolute neutrophil count, platelet count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, gamma-glutamyltransferase (GGT), total serum bilirubin, prothrombin time, serum creatinine, and blood urea nitrogen were assessed. RESULTS: Serum tests of cholestatic liver injury measured at 2, 4, and 6 weeks showed improvement compared with baseline. At 6 weeks, the percent decrease from baseline in total serum bilirubin was 33% (P less than 0.005); in alkaline phosphatase the decrease was 32% (P less than 0.038); and in AST the decrease was 37% (P less than 0.007). After discontinuation of UDCA therapy, 11 patients were followed for 6 additional weeks. All showed significant worsening in liver function test results. Symptom scores were unchanged throughout the study. One patient with pruritus improved while receiving therapy with UDCA. No adverse effects were observed. CONCLUSION: Therapy with UDCA was safe, well-tolerated, and efficacious in the short-term treatment of refractory chronic GVHD of the liver. Further investigation is needed to evaluate the long-term effects of UDCA therapy.

Bilirubin↗
PubMed1992

Heat-stable antigen is a costimulatory molecule for CD4 T cell growth.

Optimal induction of clonal expansion by normal CD4 T cells requires a ligand that can engage the T cell receptor as well as functionally defined costimulatory activity on the same antigen-presenting cell surface. While the presence of effective costimulation induces proliferation, T cell receptor ligation in its absence renders T cells inactive or anergic. The molecular basis of this costimulatory activity remains to be defined. Here we describe a monoclonal antibody that can block the costimulatory activity of splenic accessory cells. Treatment with this antibody not only blocks the proliferation of CD4 T cells to a T cell receptor ligand, but also induces T cell nonresponsiveness to subsequent stimulation. Sequence analysis of the antigen recognized by this antibody indicates that it recognizes a protein that is identical to heat-stable antigen. Gene transfer experiments directly demonstrate that this protein has costimulatory activity. Thus, heat-stable antigen meets the criteria for a costimulator of T cell clonal expansion.

Animals↗
PubMed1992

Characterisation of HLA DQ alpha for forensic purposes. Allele and genotype frequencies in British Caucasian, Afro-Caribbean and Asian populations.

Allele and genotype frequencies for British Caucasian, Afro-Caribbean and Asian populations were determined for a total of over 600 unrelated individuals at the HLA-DQ alpha locus. These were analysed by polymerase chain reaction amplification of the DNA followed by hybridisation to allele specific oligonucleotide probes in a reversed dot-blot test. Six different alleles were detected and the allele distributions for the 3 populations analysed displayed significant differences. However, the British Caucasian genotypes were statistically very similar to previously published data from US Caucasians as were British Afro-Caribbean genotype frequencies with US Black data. In Caucasians the allele frequencies ranged from 5.2% to 26.9% with a power of discrimination of 0.93. DQ alpha genotype frequencies of Caucasian and Afro-Caribbean populations do not deviate from Hardy-Weinberg equilibrium. However, the Asian data displayed significant deviation due to excess homozygotes.

Alleles↗
PubMed1992

Identification of human remains by amplification and automated sequencing of mitochondrial DNA.

The highly decomposed remains of a corpse were identified by the amplification and direct sequencing of mitochondrial (mt) DNA. Degraded DNA was extracted from bone fragments and a necrotic skin sample and amplified at 2 hypervariable segments within the mitochondrial non-coding region using 2 rounds of nested PCR. Both strands of the amplified regions were sequenced and compared with each other to ensure fidelity of the data. Sequences from the bone and skin were found to be identical and matched data generated from a blood sample provided by a presumptive sister of the deceased. Thus, this evidence was consistent with the sister and the deceased being related.

Base Sequence↗
PubMed1992

Marrow transplantation following escalating doses of fractionated total body irradiation and cyclophosphamide--a phase I trial.

Thirty-six patients with advanced hematologic malignancy were entered into a Phase I study designed to define the maximum tolerated dose of unshielded total body irradiation delivered from dual 60 Cobalt sources at an exposure rate of 8 cGy/min and given in fractions twice daily for total doses ranging from 12 Gy to 17 Gy. All patients received cyclophosphamide, 120 mg/kg administered over 2 days before total body irradiation. Allogeneic marrow was infused from HLA-identical siblings (n = 29) or one locus HLA incompatible family members (n = 3); three patients received cryopreserved autologous marrow and one patient received syngeneic marrow. The maximum tolerated dose of total body irradiation given as 2 Gy fractions twice a day was 16 Gy. One of eight patients receiving 12 Gy, none of four receiving 14 Gy, three of 20 receiving 16 Gy, and two of four receiving 17 Gy developed severe (Grade 3-4) regimen-related toxicity. The primary dose limiting toxicity was pneumonitis, followed by veno-occlusive disease of the liver, renal impairment, and mucositis. Five patients (14%) are alive, four disease-free 798-1522 days posttransplant. Twenty (56%) relapsed posttransplant. Further investigation of regimens containing 16 Gy of hyperfractionated total body irradiation is warranted to assess anti-tumor efficacy.

Adolescent↗
PubMed1992

Treatment of acute graft-versus-host disease with a nonmitogenic anti-CD3 monoclonal antibody.

Treatment with the monoclonal antibody OKT3 specific for the CD3 complex associated with the T cell antigen receptor can reverse acute rejection of human renal allografts. However, efficacy of anti-CD3 antibodies for treatment of patients with acute graft-versus-host disease after marrow transplantation has not been established. The dose-limiting side effects resulting from T cell activation induced by some anti-CD3 antibodies in vivo have discouraged their use for this application. We now report a phase I-II study of GVHD treatment with the anti-CD3 antibody BC3, a monoclonal murine IgG2b that, unlike OKT3, does not activate T cells. Fourteen patients were treated with BC3 after progression of acute GVHD despite treatment with cyclosporine and corticosteroids, and three patients received BC3 as primary treatment for GVHD. BC3 was administered at a dose of 0.1 or 0.2 mg/kg/day for seven or eight days. Five patients achieved complete resolution of GVHD, eight patients had partial improvement, two patients had no change, and two patients had progression of GVHD on therapy. Responses were sustained in 8 of 13 patients. Mild chills, fever, hypertension, and chest discomfort occurred in various combinations following 6 of 17 (35%) initial infusions of BC3 and following 4 of 99 (4%) subsequent infusions. In each instance it was possible to continue BC3 therapy without adjusting the dose or treatment schedule. In each patient treated, the absolute count of peripheral blood lymphocytes decreased transiently but returned to baseline within 22 hr after the first infusion. Circulating T cells had surface CD3 molecules saturated by the infused antibody in all but one patient. Four patients survived longer than one year after treatment with antibody BC3, and 13 patients died of infection or organ failure. Administration of the nonmitogenic anti-CD3 antibody BC3 was associated with improvement in the clinical manifestations of GVHD with minimal acute toxicity. Efficacy of antibody treatment did not depend on depletion of circulating T cells. Therefore, antibody BC3 may be achieving therapeutic immunosuppression by modulating T cell function. Controlled studies in patients treated earlier in the course of GVHD should determine whether antibody BC3 can improve survival.

Adult↗