Biomedical subjects
Publications and source records attributed to K Martin.
A 4-year-old boy with leukemic blasts of myeloid lineage was shown by bone marrow (BM) examination to have a balanced 7;12 translocation. To our knowledge, this translocation in association with acute myeloid leukemia (AML) has not been reported previously.
The transformation of an unpatterned epithelium into a patterned one is a fundamental issue in morphogenesis. This transformation occurs in a dramatic fashion in the developing eye imaginal disc, the primordium of the Drosophila compound eye. Molecular and developmental analyses reveals that the sine oculis (so) locus encodes a homeodomain-containing protein that is expressed and required in the unpatterned epithelium prior to morphogenesis. In mutants, cells undergo apoptosis. These findings argue that so plays an essential role in controlling the initial events of pattern formation in the eye disc. So is also expressed and required for the development of the rest of the fly visual system, including the optic lobes (i.e., those regions of the brain that process visual information). So is expressed in the optic lobe primordium prior to its invagination from the embryonic ectoderm; in so mutants, the optic lobe primordium fails to invaginate.
The rational discovery of a high affinity NK2 receptor antagonist is described utilizing a general strategy for peptoid design. The contribution to NK2 receptor binding affinity for each amino acid of the hexapeptide 'minimum fragment': Leu-Met-Gln-Trp-Phe-GlyNH2 (8c), was examined by preparing derivatives where each amino acid in turn was replaced with Ala in an 'alanine scan'. The results from this study indicated the primary importance of the Trp and Phe side-chain for binding and led to the observation that Z-Trp-PheNH2 (9a) is a micromolar affinity NK2 receptor dipeptide lead. Further exploration of structure-affinity via conformationally restricted analogues and N- and C-terminus modifications gave a selective, nanomolar affinity NK2 receptor antagonist, (2,3di-CH3OPh)CH2OCO(S)Trp(S)alpha-MePheGlyNH2, PD 147714 (19) with an K(i) = 1.4 nM (hamster urinary bladder membranes and using [125I]-iodohistidyl-NKA (0.1 nM) as the radioligand).
The rational design of a non-peptide tachykinin NK1 receptor antagonist, [(2-benzofuran)-CH2OCO]-(R)-alpha-MeTrp-(S)-NHCH(CH3)P h (28, PD 154075) is described. Compound 28 has a Ki = 9 and 0.35 nM for the NK1 receptor binding site in guinea-pig cerebral cortex membranes and human IM9, cells respectively (using [125I] Bolton-Hunter-SP as the radioligand). It is a potent antagonist in vitro where it antagonises the contractions mediated by SPOMe in the guinea-pig ileum (KB = 0.3 nM). Compound 28 is active in vivo in the guinea-pig plasma extravasation model, where it is able to block the SPOMe-induced protein plasma extravasation (monitored by Evans Blue) in the bladder with an ID50 of 0.02 mg kg-1 iv.
Serial observations of clinic and ambulatory blood pressure monitoring are presented for a 60-year-old woman whose arterial blood pressure was unaffected by removal of a functioning parathyroid adenoma. A pattern of "white coat hypertension" first detected 8 years ago remains unchanged to the present.
The effects of female and male infertility factors as well as the insemination regime on the outcome of donor insemination (DI) during 1001 spontaneous ovulatory cycles were assessed. Overall, the average monthly fecundability was 4.4% and the cumulative conception rate after nine cycles was 45%. Female DI recipients' age, nulligravidity or the presence of other infertility factors were associated with a significantly lower pregnancy rate. DI recipients of azoospermic partners had a significantly higher pregnancy rate. The likelihood of a successful pregnancy was higher when more frequent (> or = 1) inseminations were used or in association with higher cervical score and larger follicle diameter at the time of insemination. We suggest that female recipients of DI should be fully investigated before commencing DI treatment. Early resort to other methods of assisted reproduction should be considered in DI recipients aged > or = 35 years, or in younger women if they fail to conceive after nine cycles of DI. More frequent and better timing of inseminations is expected to improve the fecundability rate during spontaneous ovulatory DI cycles.
Medical and demographic data for trauma patients (n = 7120) admitted to 12 trauma centers in 1 year were reviewed. Data from New York State on all discharges for the same year (n = 2,535,501) were obtained and analyzed. Patients were identified as trauma patients based on NYC EMS trauma center advisory committee criteria translated into ICD-9-CM codes, and a computer-based algorithm was developed that identified 43,219 trauma patients. A standard resource cost (SRC) was also developed to compare relative cost among trauma and non-trauma patients in the same diagnosis-related groups (DRGs). The mean age of the 43,219 trauma patients was 43.1 years, 61.8% were male, the mean LOS was 13.4 days, the mean ISS was 10.4, and 61% were discharged from community hospitals. Trauma centers treated the more severely injured patients: mean ISSs were 12.3, 10.9, and 9.2 for level I, level II, and community hospitals, respectively. Payor mix varied by category, with 71% of penetrating trauma victims covered by Medicaid or self pay compared with 21% of blunt trauma victims. Level I centers treated twice as many self-pay and Medicaid patients as community hospitals. A comparison of relative cost showed that trauma patients cost 27.5 million dollars more than non-trauma patients in the same DRGs.
We have described a child with systemic onset juvenile chronic arthritis who presented initially with fever of unknown origin. Treatment of a presumed infection led to a severe allergic response with Stevens-Johnson syndrome, renal failure and DIC. This reaction obscured the features of the underlying disease and delayed the diagnosis.
A 15-year-old boy who presented with a short history of a diarrhoeal illness associated with encephalopathic features is described. Salmonella enteritidis phage type 4 was cultured from his stool. Although encephalopathy in the absence of CNS infection or electrolyte disturbance is well described in enteric fever, it is very rare in infections with non-typhoidal Salmonella serotypes and has not previously been described in association with S. enteritidis infection.
A multicentre retrospective survey of 67 children, who had attended an audiology clinic complaining of tinnitus, was carried out by questionnaire and by the study of the children's medical notes. Forty-two patient questionnaires were returned. Age of onset of tinnitus varied between infancy and 16 years. Tinnitus was more problematic in the children reported here than in those in previous studies. There was a close relationship of tinnitus to other associated symptoms, family history, personal past history and hearing loss. At the time of the study, 17% of children reported that their tinnitus had resolved.
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As a result of the turn toward recruitment from overseas in the 1980s, various challenges must be met and obstacles overcome to achieve harmony among multicultural staffs. A program was implemented to address volatile multicultural issues as part of the Nursing Incentive Reimbursement Award project in New Jersey. Nurses who participated in this sensitive program gave positive feedback, generally reporting that awareness was raised and collegial relationships improved. Specific interventions for dealing with a multicultural staff are offered.
The entrance to the cervical canal, the ectocervix, is covered by a stratified squamous epithelium. In the present study we demonstrate that the extracellular calcium levels regulate the differentiation of cultured human ectocervical epithelial cells (ECE cells). ECE cells growing in serum-free medium containing 0.09 mM calcium remain as individual cells that do not spread on the culture dish or form cornified envelopes. Increasing the extracellular calcium concentration results in a dose-dependent increase in ECE cell differentiation that is manifest by an increase in cornified envelope (superficial cell) formation. These morphological changes are accompanied by a twofold increase in the levels of involucrin, a precursor of the cornified envelope. The extent of increase in involucrin mRNA is similar to that of involucrin protein, suggesting that the regulation is at the level of involucrin mRNA synthesis and/or stability. Transglutaminase, a calcium-activated enzyme responsible for assembly of the covalent cross-links that form the cornified envelope, increases to a similar extent to the increase in cornified envelope formation, suggesting that in ECE cells, activation of transglutaminase may be the rate-limiting step in envelope assembly. These results and the finding of a calcium gradient in other stratifying epithelia in vivo, indicate that the calcium is likely to be an important regulator of ectocervical epithelial cell differentiation in vivo.
Apparent mineralocorticoid excess (AME) is a rare form of low renin hypertension caused by deficiency of 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD), the enzyme responsible for conversion of cortisol to the bio-inactive metabolite, cortisone. This results in prolonged cortisol half-life, activation of type I (mineralocorticoid) receptors by cortisol, sodium and fluid retention, and consequent childhood-onset hypertension. The cortisol secretion rate is low, perhaps due to cortisol's binding to type II (glucocorticoid) receptors and suppressing corticotropin secretion. Patients with AME thus lack stigmata of Cushing's syndrome. To evaluate any potential contribution of the type II (glucocorticoid) receptor to the development of hypertension in AME patients, we administered RU486, a steroid analogue that acts as a pure type II receptor blocker. Selective glucocorticoid receptor blockade did not decrease blood pressure in our patient; instead, a significant increase in average blood pressure was observed (125.1 +/- 1.7 pre-RU486 v 144.7 +/- 1.2 during RU486 treatment, P = .0001). We conclude that the type II receptor does not contribute to the development of hypertension in patients with AME.
Two conserved regions in the sequence of the NS5 gene of Flaviviruses were identified. Primers were designed from the consensus sequence of these regions and were used in a reverse transcription/polymerase chain reaction (RT/PCR) to amplify a region of the central european tick-borne encephalitis virus Kumlinge NS5 gene. The authenticity of the amplified fragment was confirmed by nucleotide sequencing. A band of the expected size was also obtained when this RT/PCR was applied to 13 other flaviviral RNAs. This method may be useful for characterisation of the NS5 genes of flaviviruses and as a potential pan-flavivirus diagnostic tool.
OBJECTIVE: To determine the relationship of demographic and clinical variables to cost, to revenue based on diagnosis-related groups, and to profit in patients in a pediatric intensive care unit (PICU). DESIGN: Prospective collection of clinical and demographic data of patients sampled. Detailed financial data for all patients discharged from the hospital were compiled by the office of financial planning. A combined data set was used for analysis. SETTING: A multidisciplinary PICU within a general, tertiary-care, teaching hospital in an urban environment. PATIENTS: Consecutive sample of 1174 pediatric patients discharged from the PICU during a 24-month period. MEASUREMENTS AND MAIN RESULTS: Hospital cost (not charges) determined according to industry standards. Revenue was determined by the DRG system. Of the 1174 cases identified, DRG coding and financial data were 97% complete. The mean loss (negative profit) per patient was $9218 +/- $33,676. Profit was significantly and adversely affected by outlier status, death, high risk of death, interhospital transfer, emergency admission, young age, and mechanical ventilation. Multivariate analysis revealed that duration of stay, death, interhospital transfer, and age negatively correlated with profit. CONCLUSION: Under a DRG-based reimbursement system, the operation of an active PICU with a broad referral base may not be desirable from a financial perspective. Similar studies at other institutions could help establish a data base with which the DRG system can be refined.
A study was undertaken to examine the feasibility of using naturally-occurring bacteriophages to assess the impact of re-laying on levels of viral contamination in Crassostrea gigas, the Pacific oyster. Two phages were chosen. One, male-specific (F+), was enumerated using Salmonella typhimurium. The other, a somatic phage, was detected using an, as yet, uncharacterized Escherichia coli. Investigations, using a variety of re-laying sites, demonstrated that numbers of F+ phage in oyster tissue declined more rapidly than those of somatic phage. For example, in oysters placed in commercially-used sea water ponds, F+ phage reached undetectable levels within 2-3 weeks, whereas somatic phage could still be detected 5 weeks after re-laying. The studies suggest that F+ phage may not be a suitable indicator for virus removal and that somatic phage may be better suited to this role.
An experimental acoustical re-injection system based on a wideband single-sideband generator has been developed. This has been used to present a clinical Doppler system with a simulated Doppler shift, as would be obtained from a unidirectional moving reflector. Development of this approach should permit independent electronic testing of forward and reverse channels, including mean and peak frequency calculations and measurement of channel separation. Sideband suppression of 28 dB minimum has been obtained for a range of ultrasound frequencies from 2.5 MHz to 10 MHz and audio frequency shifts up to 10 kHz.