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Biomedical subjects

L E Miller

Publications and source records attributed to L E Miller.

At least 37 records · Page 2Linked to original sources
PubMed2000

A randomized prospective trial of intrarectal lidocaine for pain control during transrectal prostate biopsy: the Emory University experience.

PURPOSE: We prospectively evaluated the safety and efficacy of intrarectal lidocaine gel as anesthesia during transrectal prostate biopsy. MATERIALS AND METHODS: Of 63 consecutive men undergoing transrectal prostate biopsy 50 who qualified were enrolled in this study. Indications for the procedure were an abnormal prostate on digital rectal examination and/or elevated serum prostate specific antigen. Patients were randomized into group 1-25 who received 10 cc of 2% intrarectal lidocaine 10 minutes before the procedure and group 2-25 controls. No narcotics, sedation or analgesia was given. Pain during biopsy was assessed using a 10-point linear visual analog pain scale. RESULTS: In groups 1 and 2 median patient age was 63 and 66 years (p = 0.139), and median prostate specific antigen was 6.04 (range 1.07 to 263) and 7.24 (range 1.34 to 51.82) ng./ml. (p = 0.337). Digital rectal examination was normal and abnormal in 17 and 15 group 1, and in 8 and 10 group 2 patients, respectively. Ultrasound showed a median prostate volume of 43.6 cc (range 15.3 to 124) in group 1 and 40.3 (range 19.8 to 132) in group 2 (p = 0.710). Final histological results revealed prostate cancer in 7 men (28%) in each group. The median pain score during transrectal prostate biopsy was 2 (range 1 to 5) and 5 (range 1 to 7) in groups 1 and 2, respectively (p = 0.00001). No adverse events were noted. CONCLUSIONS: Intrarectal lidocaine gel is a simple, safe and efficacious method of providing satisfactory anesthesia in men undergoing transrectal prostate biopsy. We recommend its routine administration in all patients during this procedure.

Administration, Rectal↗
PubMed2000

Neurotransmitter modulation of interleukin 6 (IL-6) and IL-8 secretion of synovial fibroblasts in patients with rheumatoid arthritis compared to osteoarthritis.

OBJECTIVE: The sensory nervous system with the 2 neurotransmitters substance P (SP) and calcitonin gene related peptide (CGRP) is proinflammatory in experimental models of arthritis. The role of the sympathetic nervous system with norepinephrine (NE), adenosine, beta-endorphin, and methionine enkephalin (MENK) is not clearly understood. We studied the influence of these neurotransmitters on secretion of interleukin 6 (IL-6) and IL-8 in primary cultures of synovial fibroblasts of patients with rheumatoid arthritis (RA) compared to osteoarthritis (OA). METHODS: Fibroblasts were isolated using fresh synovial tissue of 5 patients with RA and 5 with OA who underwent knee joint replacement surgery. Modulation of spontaneous secretion of IL-6 and IL-8 was investigated in vitro using the neurotransmitters noted above. RESULTS: In RA fibroblasts, CGRP increased IL-6 and IL-8 secretion at 10(-10) to 10(-8) M (p at least < 0.01), which was not observed in OA fibroblasts. SP had no effect on either cytokine in RA fibroblasts but stimulated IL-8 secretion at 10(-8) M in OA fibroblasts (p < 0.01). In RA fibroblasts, adenosine and NE inhibited secretion of both cytokines at low concentrations (10(-8) M; p < 0.01). However, in OA fibroblasts there was a NE induced increase of IL-8 and IL-6 secretion at 10(-7) and 10(-6) M (p < 0.01), but no inhibition at lower concentrations (10(-8) M; p = NS). In RA fibroblasts, beta-endorphin and MENK inhibited IL-8 secretion at 10(-9) to 10(-7) M (p < 0.01), whereas in OA fibroblasts the dose response curve was shifted to lower concentrations (10(-12) M, 10(-11) M; p < 0.01). CONCLUSION: In OA fibroblasts, the sympathetic neurotransmitters were stimulatory at higher concentrations. CGRP was the most potent stimulatory neurotransmitter in RA fibroblasts whereas the sympathetic adenosine, NE, beta-endorphin, and MENK were inhibitory. This indicates a dualism of action of sympathetic and sensory neurotransmitters, with inhibitory and stimulatory effects on cytokine secretion of RA fibroblasts.

Aged↗
PubMed1999

In vitro superfusion method to study nerve-immune cell interactions in human synovial membrane in long-standing rheumatoid arthritis or osteoarthritis.

Reports on patients with hemiparalysis indicate the importance of the nervous system for the pathophysiology of rheumatoid arthritis (RA) or osteoarthritis (OA). Norepinephrine (NE) and opioids seem to be more antiinflammatory neurotransmitters whereas substance P is proinflammatory. The study aimed to investigate the direct noradrenergic nerve-immune cell interaction in human synovial membrane. We used a recently developed superfusion technique with electrical stimulation of synovial membrane to elicit local NE from synovial membrane slices. The readout parameter of synovial immune cells was interleukin-6 (IL-6). IL-6 was spontaneously secreted from RA and OA synovial membranes. Electrical field stimulation intensively reduced IL-6 secretion. In patients with OA or RA, this electrically induced reduction of IL-6 secretion was not significantly changed by alpha- or beta-adrenergic antagonists. The study demonstrates that local endogenous NE seem to play a minor role, which may be due to a depletion of NE or loss of noradrenergic fibers during chronic RA and OA.

Aged↗
PubMed1999

Prevalence and risk association for Trichinella infection in domestic pigs in the northeastern United States.

To determine Trichinella infection in a selected group of farm raised pigs, 4078 pigs from 156 farms in New England and New Jersey, employing various management styles, were selected based on feed type (grain, regulated waste, non-regulated waste). The number of pigs bled from each farm were based on detecting infection assuming a 0.05 prevalence rate. Serum was tested by enzyme-linked immunoassay for antibodies to Trichinella spiralis. Seropositive pigs were tested by digestion at slaughter (when possible) for the presence of Trichinella larvae. Questionnaires completed at the time of serum collection were used to develop descriptive statistics on farms tested and to determine measures of association for risk factors for the presence of Trichinella-seropositive pigs. A total of 15 seropositive pigs on 10 farms were identified, representing a prevalence rate of 0.37% and a herd prevalence rate of 6.4%. A total of nine seropositive pigs and one suspect pig from six farms were tested by digestion; four pigs (representing three farms) harbored Trichinella larvae at densities of 0.003-0.021 larvae per gram (LPG) of tissue; no larvae were found in six pigs. Risk factors which were significantly associated with seropositivity included access of pigs to live wildlife and wildlife carcasses on the farm; waste feeding had no statistically significant association with seropositivity for Trichinella infection in pigs. The presence of Trichinella infection in pigs in New England and New Jersey has declined during the past 12 years when compared with previous prevalence studies.

Animal Feed↗
PubMed1999

Correlation of primate superior colliculus and reticular formation discharge with proximal limb muscle activity.

We studied the discharge of neurons from both the superior colliculus (SC) and the underlying mesencephalic reticular formation (MRF) and its relation to the simultaneously recorded activity of 11 arm muscles. The 242 neurons tested with a center-out reach task yielded 2,586 pairs of neuron/muscle cross-correlations (normalized, such that perfect correlations are +/-1.0). Of these, 43% had peaks with magnitude as large as 0.15, a value that corresponds to the 5% level of significance, and 16% were as large as 0.25. The great majority of peaks in this latter group was positive. The median lag time within this group was 52 ms, indicating that the neuronal discharge tended to precede the correlated muscle activity. We found a small but significantly higher proportion of cells with these relatively strong correlations in the MRF than in the SC. For both areas, these occurred most frequently with muscles of the shoulder girdle and became less frequent for axial as well as for increasingly distal arm musculature. The results support a role for the SC and MRF in guiding the arm during reach movements via the control of proximal limb musculature.

Action Potentials↗
PubMed1999

A prospective study of transperineal prostatic block for transurethral needle ablation for benign prostatic hyperplasia: the Emory University Experience.

PURPOSE: We evaluate the feasibility, effectiveness and role of transperineal prostate block in providing anesthesia during minimally invasive radio frequency thermal therapy of the prostate. MATERIALS AND METHODS: A total of 38 consecutive patients undergoing transurethral needle ablation for symptomatic benign prostatic hyperplasia were entered in this prospective study. All patients received transperineal prostatic block as the main method of anesthesia. A mixture of equal volumes of 1% lidocaine and 0.25% bupivacaine, each with epinephrine (1:100,000 concentration ratio) was used. Pain control during the instillation of transperineal prostatic block and transurethral needle ablation was assessed using a 10-point linear analog pain scale and questionnaire. RESULTS: Median patient age was 65.5 years (range 47 to 79), with 21% of men in the eighth decade of life. Median American Urological Association symptom score was 25.0 (range 14 to 35), bother score was 20.0 (11 to 28), quality of life score was 4.0 (3 to 6) and peak urinary flow rate was 8.9 cc per second (3.5 to 15.7). Median sonographic prostate volume was 35.0 cc (range 17 to 129). Median volume of anesthetic agent used was 40.0 cc (range 30 to 60) per case (1.1 cc solution per 1 cc prostate tissue). No adverse events were encountered. Median pain score was 3.3 (range 1 to 6) during instillation of transperineal prostatic block and 1.0 (0 to 6) during transurethral needle ablation. Transperineal prostatic block proved highly effective and was a satisfactory method of anesthesia during transurethral needle ablation as judged by postoperative questionnaire. No sedation, narcotic or analgesia was required. All procedures were performed in the outpatient cystoscopy suite or office setting without support of an anesthesia team or conscious sedation monitoring. CONCLUSIONS: Transperineal prostatic block is a safe, convenient, effective and satisfactory method of minimally invasive anesthesia for transurethral needle ablation of the prostate in an outpatient office setting. Elderly patients and those at high surgical risk can be treated safely using this approach. Considerable cost saving is seen secondary to omission of charges related to anesthesia team support, recovery room facility and conscious sedation monitoring.

Aged↗
PubMed1998

A new technique of intraprostatic fiber placement to minimize thermal injury to prostatic urothelium during indigo interstitial laser thermal therapy.

A new technique of cystoscopic insertion of laser fiber into the prostate is described for interstitial laser thermal therapy in the treatment of benign prostatic hyperplasia. The technique uses the inherent physical properties of the fused silica laser fiber with the assistance of a standard cystoscope to insert the laser fiber into the inner region of the prostate gland. Laser thermal therapy is subsequently maintained within the inner prostate at a distance from the prostatic urothelium. The technique described is simple, safe, and minimizes the potential for thermal injury to the prostatic urothelium.

Burns↗
PubMed1998

Organization of reaching and grasping movements in the primate cerebellar nuclei as revealed by focal muscimol inactivations.

Two monkeys were trained to point to targets and to retrieve fruit bits from a Kluver board, bottles, and tubes. Once proficient in the tasks, the macaques underwent aseptic surgical implantation of a recording chamber over the cerebellar nuclei on the side of their preferred hand. After recovery from surgery, a series of mapping penetrations were completed to identify task-related areas within the cerebellar nuclei. Muscimol (4- 16 microgram; 1-2 microgram/microliter) was pressure injected at different sites within the forelimb zone, and the resultant deficits were observed as the monkeys performed the behavioral tasks. Quantitative measures of task performance were supplemented by direct observation of live and videotaped performance. The locations of nuclear inactivation sites were reconstructed from marking lesions and tracks visible in histological sections. Injections placed in the cerebellar interpositus nucleus and adjacent regions of dentate caused a variety of deficits in forelimb function. A prominent anteroposterior specialization was apparent within the forelimb zone of this intermediate nuclear region. Injections into the anterior interpositus nucleus and adjacent dentate impaired preshaping of the hand and the manipulation of objects, whereas injections placed more posteriorly in posterior interpositus nucleus and adjacent dentate produced deficits in the aiming of reach and the stability of the arm. During anterior injections, the monkeys failed to adequately extend their fingers in preparation for target contact, as documented for >85% of the reaches in the pointing task of monkey J. Up to 38% of the fruit bits it attempted to retrieve from the Kluver board were dropped. In comparison, during posterior inactivations, 15% were dropped and during control conditions 3% were dropped. The monkeys made significantly greater pointing errors during posterior inactivations (11 times for monkey J and 4 times for monkey C) than during anterior inactivations (8 times for monkey J and 2 times for monkey C). We refer to the region producing hand deficits as the anterior hand zone and the region producing reaching deficits as the posterior reach zone. These results are discussed in relation to the problem of achieving spatiotemporal coordination in the large population of nuclear cells that participate in any given movement. The results do not favor the hypothesis that coordination is achieved through a selection of Purkinje cells along beams of parallel fibers. Instead, it is proposed that distal and proximal musculature is coordinated by the adaptive influences of climbing fiber input to Purkinje cells. We envision a relatively nonspecific recruitment of anterior and posterior nuclear cells due to positive feedback in the limb premotor network, which then is shaped into an appropriate spatiotemporal pattern of discharge through the inhibitory input from Purkinje cells.

Animals↗
PubMed1998

Primate red nucleus discharge encodes the dynamics of limb muscle activity.

We studied the dynamical relationship between magnocellular red nucleus (RNm) discharge and electromyographic (EMG) activity of 10-15 limb muscles in two monkeys during voluntary limb movement. Recordings were made from 158 neurons during two different kinds of limb movement tasks. One was a tracking task in which the subjects were required to acquire targets displayed on an oscilloscope by rotating one of six different single degree of freedom manipulanda. During this task, we recorded the angular position of the manipulandum. The monkeys also were trained in several free-form food-retrieval tasks that were much less constrained mechanically. There was generally significantly greater neuronal discharge during the free-form tasks than during the tracking task. During both types of tasks, cross-correlation and impulse response functions calculated between RNm and EMG were predominantly pulse-shaped, indicating that the dynamics of the RNm discharge were very similar to those of the muscle activity. There was no evidence during either task for a substantial dynamical transformation (e.g., integration) between the two signals as had been previously suggested. In only 15% of the cases, did these correlations have step or pulse-step dynamics. There was a relatively broad, unimodal distribution of lag times between RNm and EMG, based on the time of occurrence of the peak correlation. During tracking, the mode of this distribution was approximately 50 ms, with 80% of the lags falling between -100 and 200 ms. During the free-form task, the mode was between 0 and 20 ms, with 65% of the lags between -100 and 200 ms. A positive lag indicates that RNm discharge preceded EMG. The shape and timing of both the cross-correlation and the impulse response functions were consistent with a model in which many RNm neurons contribute mutually correlated signals which are simply summed within the spinal cord to produce a muscle activation signal.

Animals↗
PubMed1997

Expression of pS2, c-erbB-2, and cathepsin D during the menstrual cycle in human breast cancers.

BACKGROUND: Many studies have addressed the effect of the timing of surgery for breast cancer relative to menstrual cycle phase, with conflicting results. Explanations for the possibility that survival could be altered by the appropriate timing of breast cancer surgery in humans remain speculative. METHODS: We examined the expression of three estrogen related proteins (c-erbB-2, cathepsin D, pS2) in the breast tumors from 69 premenopausal women sampled in different phases of the menstrual cycle. Data on S-phase fraction and hormone receptor expression were also analyzed. Immunohistochemical assays were used to measure the proteins of interest. S-phase fraction was determined by flow cytometry. Analyses were performed based on fraction of cells staining positive for the protein, density of stain, and a histoscore that combined both fraction of positive cells and density. RESULTS: We found no differences in c-erbB-2, cathepsin D, hormone receptor, or S-phase levels in tumors sampled in the follicular versus luteal phase, or perimenstrual versus periovulatory phase. The exception was pS2, which was expressed at greater levels during the luteal than during the follicular phase of the cycle (p < 0.01); but there was no difference in pS2 expression when the patients were classified as periovulatory versus perimenstrual. CONCLUSIONS: Our findings do not support a variation in c-erbB-2, cathepsin D, S-phase fraction, or receptor expression as an explanation for the differences in breast cancer prognosis when surgery is timed by menstrual cycle phase. The finding that pS2 (an indicator of hormone sensitivity, and possibly better prognosis) is expressed at higher levels in tumor samples during the luteal phase suggests that the biologic profile of breast tumors may vary with the menstrual cycle and that these variations deserve further study.

Adult↗
PubMed1996

Providing effective occupational therapy services: data-based decision making in school-based practice.

Educational practice is moving away from an "eligibility-oriented" student-problem approach toward a problem-solving approach that connects evaluation and interventions. This approach involves the identification of variables used to frame interventions, and, ultimately, it permits evaluation of intervention effectiveness. This article describes a problem-solving model developed and used within the Heartland Area Education Agency. This model relies on collecting baseline data and ongoing data, producing a basis not only for decision making, but also for evaluating the chosen intervention. This systematic and collaborative approach is used by the educational team to identify concerns about students' academic and nonacademic performance, to plan interventions, and to establish measurable outcomes.

Data Collection↗
PubMed1996

A magnetic field system using implanted sensors to track limb movements in the monkey.

This paper describes the design and construction of a magnetic field system with implanted sensors, capable of tracking limb orientation during unconstrained movements of awake, behaving monkeys. Tiny sensors (approximately 5 mm diameter) made from two orthogonal coils of wire are implanted in the monkey's upper arm, forearm, and hand. Three mutually orthogonal magnetic fields are detected by each sensor, providing sufficient information to determine the orientation of each limb segment. The use of implanted sensors and magnetic fields overcomes the two main difficulties associated with the use of existing tracking systems with monkeys. (1) It is impossible for the monkey to interfere with the sensors. (2) The sensors are never obscured because the body is permeable to magnetic fields. The tracking system provides highly accurate yaw, pitch, and roll orientation information for each limb segment within a cubical workspace approximately 50 cm on a side. Noise is less than 0.3 degrees, and long-term drift is on the order of 0.2 degrees/h. The system is insensitive even to large pieces of steel within the field, provided the sensors remain at least 10-15 cm from the metal.

Animals↗
PubMed1995

Motor co-ordinates in primate red nucleus: preferential relation to muscle activation versus kinematic variables.

1. Magnocellular red nucleus (RNm) neurones (n = 158) were recorded from two macaque monkeys during a tracking task using one of six single-degree-of-freedom manipulanda. This task allowed us to study discrete movements about most of the joints of the arm. Single-unit, kinematic and electromyographic (EMG) signals from ten to twenty muscles of the upper limb were collected for approximately 2 min while the monkey used a given manipulandum. Movements about different joints were studied by switching among manipulanda. 2. Cross-correlation functions were calculated between RNm discharge rate and the kinematic variables, position and velocity, and between RNm and each of the EMG signals. Statistically significant cross-correlation peaks were found in 24% of the position correlations, 22% of the velocity correlations and 32% of the EMG correlations. The highest correlations were for EMG, reaching above 0.60. The peak correlation provided an effective means of identifying neurones with strong functional relations to one or more movements and/or muscles. These could then be analysed in detail, on a trial-by-trial basis. 3. The similarity between the dynamics of EMG and velocity signals of many highly practised movements makes it difficult to determine which might be the more likely target of RNm control. Therefore, we sought exceptions to this pattern, in order to distinguish between these two possible modes of control. For example, at the end of a movement, muscles occasionally remained active as velocity approached zero. Small corrective movements were often accompanied by a disproportionately large EMG. During these periods, RNm activity usually followed the time course of one or more of the EMG signals as opposed to the velocity signal. In the majority of cases, RNm responses were bidirectional, less frequently unidirectional and rarely reciprocal. These patterns were similar to the patterns of muscle activity. They did not resemble the velocity signals unless the latter were passed through a rectifier. 4. The results support the hypothesis that the red nucleus generates motor commands in a muscle-based co-ordinate system. Covariation between RNm discharge and velocity may result indirectly from correlations between muscle activation and movement. We discuss how the cerebellar cortex might convert the distributed representation of target position, known to be present in the posterior parietal cortex, directly into dynamic, muscle-based commands in the rubro-cortico-cerebellar limb premotor network.

Animals↗
PubMed1994

A research feasibility assessment of regulatory information systems capacities for investigation of epidemiologic factors in pseudorabies.

Pseudorabies (PR) outbreak-investigation forms from 10 states having the most PR-infected herds were evaluated for agreement in question response-data type, information intent, and outbreak information categories. A question randomly selected from an investigation form had 0.6304 probability of being unique to a single state, and 0.0062 probability of being common to all states. Analysis of outbreak forms, on the basis of information intent, revealed that the probability of a randomly selected question being derived from an information category unique to a single state was 0.0323, whereas the probability of a question being derived from an information category shared by all states was 0.1935. A telephone survey revealed that state PR control officials did not believe additional research on between-herd spread of PR was necessary to successfully complete the eradication program. However, officials believed a better understanding of PR risk factors would enhance program effectiveness and build producer confidence.

Animals↗
PubMed1994

Developing an information resources management strategy for regulatory veterinary medicine: a national imperative.

Lack of a standardized information technology management strategy has resulted in state and federal information systems evolving separately, rather than in tandem. Absence of an information management strategy will eventually affect regulatory program management, epidemiologic research, and domestic and international livestock trade. Producers will ultimately pay the price for the lack of regulatory coordination of US animal health and disease information. The longer the development of state and federal information technology management strategies is postponed, the more cost-, labor-, and time-intensive correcting the deficiency will be. Development of a national information resources management environment is the first step in constructing state and federal information technology strategies.

Animal Diseases↗
PubMed1994

Nonprofit boards and perceptions of funding.

The study presented in this article examines the extent to which board characteristics and activities are associated with the executive director's level of certainty about future funding, using a sample of 127 human service agencies. The executive directors of agencies with low levels of funding adequacy expressed more certainty about future funding when their boards were more expert, influential, and involved in planning and fundraising activities. For agencies with more adequate funding, board expertise and activities were associated with lower levels of perceived funding certainty. This articles argues that, rather than improving agency performance, boards serve a homeostatic function, acting in crisis situations to return their organizations to stable equilibria.

Fund Raising↗
PubMed1994

The relative activation of muscles during isometric contractions and low-velocity movements against a load.

Surface electromyographic (EMG) and motor unit activity were measured in human arm muscles during isometric contractions and during movements against an elastic load. The direction of force applied proximal to the wrist and movement direction of the wrist were varied in a horizontal plane. During isometric contractions the direction in which the largest EMG activity was measured corresponded to the direction in which motor units had the smallest recruitment threshold, for each muscle. The same was found for movements against an elastic load. However, this direction was different for isometric contractions and for movements. Because the magnitude and sign of these changes varied for different muscles, this resulted in a different relative activation of muscles for the two conditions. The amplitude of the surface EMG during contractions against an elastic load was generally significantly larger than that for isometric contractions against the same load. For m. brachioradialis isometric conditions yielded occasionally increased EMG activity. The change in EMG activity could be attributed completely to changes in motor unit recruitment thresholds leading to proportionate changes in the number of recruited motor units. However, the initial firing rate of motor units at recruitment was the same under both conditions and, therefore, did not contribute to changes in amplitude of surface EMG activity.

Arm↗