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Biomedical subjects

M C Hall

Publications and source records attributed to M C Hall.

At least 55 records · Page 3Linked to original sources

Frequency and characterization of p53 mutations in clinically localized prostate cancer.

OBJECTIVES: To determine the frequency of abnormal p53 expression and to characterize confirmed p53 mutations in tumors from patients with clinically localized adenocarcinoma of the prostate. METHODS: p53 protein nuclear accumulation was determined immunohistochemically in the initial diagnostic tumor specimens from 37 patients with clinically localized prostate carcinoma. Two primary antibodies were used on all specimens. Structural analysis of the p53 gene was performed using the methods of polymerase chain reaction (PCR)/single-strand conformation polymorphism (SSCP) and DNA sequencing. RESULTS: In 1 of the 37 (2.7%) tumor specimens, intense p53 nuclear staining was demonstrated using either antibody PAb 1801 or CM-1. The staining in this case was heterogeneous, with approximately 40% of tumor nuclei staining for p53. This tumor specimen was microdissected and DNA was extracted. Following PCR amplification, abnormally migrating bands were noted on SSCP analysis of exon 8. DNA sequencing confirmed the mutation as a C-->A transversion in codon 281 (asp-->glu). PCR/SSCP analysis of exons 5 through 8 was also performed for seven additional tumors that were negative for p53 nuclear accumulation by immunohistochemical (IHC) methods. All of these specimens demonstrated wild-type p53. CONCLUSIONS: The results of this study confirm and extend our previous findings that p53 mutations are rare in clinically localized adenocarcinoma of the prostate. In detecting clonal p53 mutations, standard immunohistochemical technique correlates reliably with structural p53 gene analysis of the evolutionary conserved domains encompassing exons 5-8. Importantly, most reports have demonstrated that p53 mutations detected by IHC are a late step in the progression of prostate cancer and are associated with advanced disease, dedifferentiation, and the acquisition of androgen independence.

Adenocarcinoma↗

Nutrients, body composition and exercise are related to change in bone mineral density in premenopausal women.

This study determined relationships among total energy intake, nutrient intake, body composition, exercise group status, and annual rates of change (slopes) in bone mineral density in 66 Caucasian premenopausal women (mean age, 34.4 +/- 2.7) taking calcium supplements. Body composition components measured by dual-energy X-ray absorptiometry included fat mass, soft tissue lean mass, and bone mineral density (g/cm2) of total body, spine (lumbar vertebrae 2-4), and three femur sites measured at baseline, 5, 12, and 18 mo. Nutrients were not significant variables in regression models predicting bone mineral density slopes (rates of change) at any femur site. The only significant variable in models predicting Ward's triangle bone mineral density slope was the initial fat mass and, for trochanter, exercise. Significant variables (P < 0.05) in models predicting total body bone mineral density slope included the initial fat mass and fat mass slope plus either vitamin A, carotene, fiber, magnesium, or phosphorus (R2 from 0.31 to 0.25) and fat mass slope plus sodium (R2 = 0.24). The significant variable in the model predicting L2-4 slope was energy intake (R2 = 0.17, P < 0.05). We conclude that nutrient intake, exercise, and body composition are related to bone mineral density rate of change and that relations among these variables vary by bone site.

Absorptiometry, Photon↗

Practical techniques for assessing body composition in middle-aged and older adults.

The purpose of this study was to compare the relationships of anthropometric, bioelectrical impedance analysis (BIA), and near infrared interactance (NIR) measurements with a multiple-component (MC) criterion estimate of body composition derived from body density (D), body water (W), and bone mineral (B) in 48 white adults aged 49-80 yr. Relative errors of predicting the MC criterion from the practical measurements were determined by simple regressions within gender and calculated as the SEE divided by the criterion mean and expressed as a percentage. Relative errors were lowest for the BIA variable, height2/resistance (4.8-5.0%), higher for body mass index and the sum of 10 skinfold thicknesses (7.0-14.5%), and highest for NIR-derived optical density readings at the biceps and the sum of 10 sites (10.8-15.8%). Due to the low relative prediction error for height2/resistance, sex-specific BIA formulas for estimating fat-free mass from D, W, and B (FFM-DWB) were developed. The SEEs for predicting FFM-DWB from BIA, weight, and age were both 1.5 kg in women and men. Because BIA is not limited to ambulatory subjects, it is concluded that BIA may be a particularly useful, practical technique for estimating body composition in older adults.

Aged↗

Management of erectile dysfunction after radical prostatectomy.

Sexual rehabilitation is a vital component of the overall care of the prostate cancer patient and contributes significantly to the subsequent quality of life. Despite the development of and refinements in the anatomic approach to radical prostatectomy, there will continue to be a large pool of patients with erectile dysfunction after surgery. Although cancer control is always of primary importance, potency is often a consideration of great concern to patients when deciding between the various treatment options for clinically localized prostate cancer. Preoperative counseling informing the patient that erectile dysfunction can be successfully managed in most cases with therapy tailored to the goals and expectations of both the patient and the partner is essential. This article presents an overview of the approach to and management of the patient with erectile dysfunction after radical prostatectomy focusing on three main therapies: vacuum constriction devices, intravernoal injections, and prosthetic penile implants.

Erectile Dysfunction↗

Exposure of intestinal segments to hemiacidrin: analysis of metabolic and histological effects using a rat model.

Using a previously reported rat model, we examined the effects of intestinal perfusion with hemiacidrin on calcium and magnesium homeostasis, and inspected the intestinal segments for histological alterations following exposure to the solution. Intestinal irrigation with hemiacidrin resulted in a significant increase in serum magnesium. Urinary excretion rates of calcium increased 8-fold and magnesium excretion rates increased 5-fold over control values. Hemiacidrin appeared to have detrimental effects on the integrity of the intestinal mucosa, and irrigation should be done with caution in patients whose urinary tract has been reconstructed with intestinal segments.

Animals↗

Significance of tumor angiogenesis in clinically localized prostate carcinoma treated with external beam radiotherapy.

OBJECTIVES: To determine the prognostic significance of microvessel density (a measure of tumor angiogenesis) in comparison with other prognostic factors for patients with clinically localized prostatic carcinoma treated with external beam radiotherapy. METHODS: Microvessel density was quantified within the initial invasive carcinoma from the diagnostic transurethral resection specimen of 25 patients with a mean follow-up of 44 months. Microvessels were identified by immunohistochemical staining of endothelial cells for factor VIII-related antigen in formalin-fixed, paraffin-embedded tissue. Microvessels were counted in a x200 field (0.754 mm2) in the area of maximal angiogenesis. RESULTS: Microvessel density correlated with several pretreatment prognostic factors, including prostate-specific antigen (PSA) (p < 0.0001), tumor grade (p = 0.006), and ploidy (p = 0.016). The degree of tumor angiogenesis also correlated with outcome following external beam radiotherapy. The mean microvessel count in the nine tumors from patients who failed radiotherapy (ie, had rising PSA and/or clinical relapse) was 97.0 +/- 33.6 (+/- SD) per x200 field compared with 46.1 +/- 17.1 for the 16 patients with no evidence of failure (p < 0.0001). Increased microvessel density was also associated with a significantly worse actuarial outcome at 4 years using either biochemical relapse (rising PSA) or a composite endpoint of rising PSA or clinical relapse (p = 0.0003). CONCLUSIONS: The intratumoral quantification of tumor angiogenesis may prove valuable as a prognostic indicator in patients with clinically localized prostate cancer treated with radiotherapy.

Aged↗

Quinolone resistance in veterinary isolates of Salmonella.

Twenty-seven nalidixic acid-resistant (MIC > or = 256 mg/L) isolates of salmonella from veterinary sources were also less susceptible to fluoroquinolones (range of MICs of ciprofloxacin, 0.12-2 mg/L). Six isolates were cross-resistant to one or more chemically unrelated antibacterial agents. The concentrations of enrofloxacin that inhibited DNA synthesis by 50% were similar to the MIC values for 23 of 27 isolates, suggesting a mutation in gyrA. Insertion of pNJR3-2 (gyrA) in nine of 20 isolates increased susceptibility to quinolones, suggesting that resistance was due to mutation in gyrA. Five of 27 isolates had reduced levels of accumulation of enrofloxacin. Two of the five also had increased susceptibility to quinolones when pNJR3-2 was introduced. None of the outer membrane protein profiles of the resistant isolates differed from those of sensitive control strains. Three of 27 isolates had differences in lipopolysaccharide profiles compared to control strains. Although the MIC of ciprofloxacin was less than the recommended UK break point concentrations for most isolates, the increasing incidence of quinolone-resistance in salmonella from veterinary sources is a matter of concern.

Animals↗

Biomarkers associated with prostate cancer progression.

In search of biomarkers that predict of human prostate cancer progression, we hypothesized that these markers must be expressed in prostatic epithelial cells during multi-step prostate carcinogenesis. Since both genetic and epigenetic factors have been implicated in human prostate cancer development, two osseous-metastatic experimental models were developed in our laboratory, one based on gene transfection and the other on stromal-epithelial interaction studies. In the genetic model, PC-3 cells transfected with point-mutated c-erbB-2/neu oncogene subsequently acquired the potential to metastasize from the prostate to soft tissues and the skeleton. In the epigenetic model, sublines derived from the parental androgen-dependent LNCaP cell line metastasized from the primary tumor to the lymph node and bone. Cells with known lineage relationships were cloned from both the primary and the metastatic tumors and were characterized extensively using cellular, biochemical, immunohistochemical, and molecular techniques. Relevant stage-specific biomarkers associated with prostate cancer progression in these two models were defined and used to evaluate human prostate tissues obtained from the clinic. In this communication, we focused our discussion on the potential importance of c-erbB-2/neu oncogene, vimentin, hepatocyte growth factor/scatter factor and its receptor, c-met oncogene, tumor angiogenesis and neuroendocrine factors as biomarkers for human prostate cancer progression.

Animals↗

Resistance exercise training is associated with decreases in serum low-density lipoprotein cholesterol levels in premenopausal women.

BACKGROUND: Aerobic exercise training is associated with reduced serum concentrations of triglycerides, increased concentrations of high-density lipoprotein cholesterol, and minimal changes in serum levels of total cholesterol or low-density lipoprotein cholesterol. There are few data on the effects of resistance exercise on blood lipid levels. METHODS: Premenopausal women were randomly assigned to a supervised resistance exercise training program (n = 46) or a control group (n = 42) for 5 months. Serum was analyzed for levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. Body composition and dietary intake were also measured. RESULTS: The exercise group showed a 0.33 +/- 0.03-mmol/L (mean +/- SE) decrease in total cholesterol level and a 0.36 +/- 0.001-mmol/L decrease in low-density lipoprotein cholesterol level that was significantly different from the control group. No significant changes were noted in serum high-density lipoprotein cholesterol or triglyceride levels in either group. Changes in body composition showed no significant correlations with changes in total cholesterol or low-density lipoprotein cholesterol. There were no significant differences in nutrient intake between the groups. CONCLUSION: In healthy, premenopausal women, with normal baseline lipid profiles, 5 months of resistance exercise training was associated with significant decreases in serum total cholesterol and low-density lipoprotein cholesterol concentrations.

Adult↗

Morphologic and functional alterations of intestinal segments following urinary diversion.

The current study was undertaken to determine the effect of chronic urinary diversion on both the morphology and absorptive function of intestine. Adult female Wistar rats (N = 8) underwent urinary diversion by interposing a 10-12 cm. segment of distal ileum between the bladder and sigmoid colon following urethral ligation. Control animals (N = 8) underwent sham laparotomies. Three months later, the diverted segment and a 10-12 cm. segment of distal ileum in control animals were studied. The intestinal segments were studied morphologically by both light microscopy and transmission electron microscopy. By using a previously reported in vivo intestinal perfusion model, the transport properties of the intestinal segments were examined. There were prominent and consistent morphological alterations in the diverted segments when compared with normal ileum. These changes consisted of marked mucosal atrophy evidenced by loss of microvilli with decreased villi-to-crypt ratio in diverted segments. Diverted ileum secreted more sodium and absorbed less chloride than normal ileum though this difference was not statistically significant. Water flux into the intestinal lumen was higher in diverted bowel (p = .06). The absorption of ammonium, potassium, and urea, as well as bicarbonate secretion, was the same in the diverted ileum as in normal ileum. There was also no significant difference in pH change or osmolar flux between the two groups. In conclusion, the results of this study indicate that despite morphological changes as a result of chronic exposure of urine, intestinal segments continue to transport urinary solutes similar to normal nondiverted segments. This represents the first convincing evidence that the reason for the low incidence of metabolic alterations following urinary diversion is not due to decreased absorptive capacity of the intestinal mucosa.

Animals↗

Detection of small changes in body composition by dual-energy x-ray absorptiometry.

The ability of dual-energy x-ray absorptiometry (DEXA) to detect small changes in body composition was studied in 17 men and women during a dehydration-rehydration protocol. Scale weight (BW) and total mass (TM) from DEXA were highly related (r > 0.99) as were estimates of fat-free mass (r = 0.99) and percent fat (r = 0.97) from DEXA and densitometry. Changes in BW of approximately 1.5 kg due to fluid loss and gain were highly correlated (r = 0.90) with both changes in TM and soft-tissue mass (STM) by DEXA but less so (r = 0.67) with changes in lean-tissue mass (LTM). Mean changes in TM, STM, and LTM were not different (P > 0.05) from changes in BW. Estimates of bone mass and fat were unaffected by changes in hydration. We conclude that DEXA is able to detect small individual changes in TM and STM and is also useful for detecting group changes in LTM.

Absorptiometry, Photon↗

Ciprofloxacin resistance in clinical isolates of Salmonella typhimurium obtained from two patients.

Two patients (patients A and B) infected with Salmonella typhimurium failed ciprofloxacin therapy, and the posttherapy isolates had reduced susceptibilities to quinolones; 6 of 11 isolates from patient B were also cross-resistant to chemically unrelated agents. No transferable resistance, chloramphenicol-acetylating enzymes, or beta-lactamases were detected. For 13 of 14 isolates, the concentrations of ciprofloxacin that inhibited DNA synthesis by 50% were similar to the MICs, suggesting a mutation in gyrA. Insertion of pNJR3-2 (gyrA) in the posttherapy isolate from patient A and 5 of 11 of the posttherapy isolates from patient B resulted in lower quinolone MICs, also suggesting that resistance was due to a mutation in gyrA. Three of the five isolates also had reduced levels of accumulation of quinolones. All six cross-resistant isolates from patient B had reduced levels of accumulation of quinolones, but only one isolate had increased susceptibility when pNJR3-2 was inserted. Despite the lack of OmpF seen in five isolates from patient B, there was no correlation with decreased levels of quinolone accumulation. All isolates had identical smooth lipopolysaccharide profiles. The mechanism of apparently reduced accumulation has yet to be determined.

Anti-Infective Agents↗

Prediction of body composition in premenopausal females from dual-energy X-ray absorptiometry.

Four methods for predicting body composition were compared in premenopausal females (n = 100), 28-39 yr old, by using underwater weighing (UWW) as the criterion method. The four methods were dual energy X-ray absorptiometry (DEXA), skinfolds, bioelectrical impedance, and body mass index. The sample had a mean percent fat (%fat) of 29.7 +/- 6.8% (SD) by DEXA and 29.9 +/- 5.8% measured by UWW. DEXA yielded a standard error of estimate (SE) of 2.4% (r = 0.91) for the prediction of %fat from UWW. When %fat was estimated from other methods, larger SEs were obtained: 3.0% for skin-folds, 3.3% for body mass index, and 2.9% for bioelectrical impedance (height2/resistance) plus weight. Individual body density values derived from UWW were corrected for bone mineral variation. DEXA predicted the corrected body density with a lower SE (0.0040 vs. 0.0053 g/ml) than the original density values. We conclude that DEXA was a precise method and correlated highly with fat-free body weight and %fat from UWW in this homogeneous female sample.

Absorptiometry, Photon↗

Hospital patient satisfaction: correlates, dimensionality, and determinants.

This paper investigates the correlates, dimensionality, and determinants of patient satisfaction in the hospital health care encounter. All of the individual hospital characteristics assessed were found to be significantly related to patient satisfaction. The findings suggest that patients evaluate hospital service quality along four distinct dimensions. The relative importance of these four factors in predicting overall satisfaction, in descending order, is: (1) physician/capabilities, (2) nurses/staff, (3) amenities, and (4) accessibility. In combination, these four factors explain 63 percent of overall patient satisfaction.

Clinical Competence↗

Effects of injection site and flow rate on the distribution of injected solutions in an extracorporeal membrane oxygenation circuit.

The effects of injection site and flow rates on drug distribution within an extracorporeal membrane oxygenation (ECMO) circuit were studied. Two commercially available reservoirs (30 mL and 50 mL) were connected to a closed ECMO circuit that did not include the membrane oxygenator and heater. The circuit was filled with 150-170 mL of a 9.5% dextran solution in deionized, distilled water with a viscosity approximating that of blood. Flow rates of the circulating solution were set at 75 mL/min and 375 mL/min. Bordeaux red dye was injected into an ECMO circuit at prereservoir, postreservoir, and intrareservoir sites, and samples were obtained from these sites for analysis. Gentamicin was also injected at the prereservoir site, with samples obtained from the reservoir, reservoir tubing, and the prereservoir and postreservoir sites. Postreservoir dye injections resulted in complete mixing at any flow rate. Prereservoir injections at flow rates less than 250 mL/min resulted in incomplete mixing of dye, whereas intrareservoir injections resulted in incomplete mixing at any flow rate. Gentamicin injection was also affected by flow rate, resulting in higher concentrations within the reservoir and reservoir tubing. In patients on ECMO, drug distribution may be substantially altered if drugs are given as a bolus at prereservoir or intrareservoir sites. Efforts should be made to select injection sites that will provide safe and therapeutic drug delivery while minimizing the effects of the ECMO circuit on drug distribution.

Critical Care↗

Mechanism of ammonium transport by intestinal segments following urinary diversion: evidence for ionized NH4+ transport via K(+)-pathways.

Using a previously reported in vivo intestinal perfusion model in the rat, we have shown that net total ammonium absorption accounts for the majority of the acid load resulting from urinary intestinal diversion. In the present study, by varying perfusate pH and therefore NH3 concentrations, we demonstrated that the net flux of total ammonium did not correlate with non-ionized NH3 concentrations (r = .039). This indicates that the basic mechanism of total ammonium flux is via ionized NH4+ movement. To more precisely define the transport processes involved, we manipulated this system with the following chemical and pharmacologic probes of electrolyte transport: amiloride (0.5 mM/l.), furosemide (1 mM/l.), 2,4,6-triaminopyrimidine (TAP) (15 mM/l.), methylprednisolone (3 mg./100 gm./B.W.) S.Q. x 3 days followed by perfusion, and barium (Ba2+) (15 mM/l.). Net solute flux was not significantly altered by the mucosal addition of amiloride or TAP. Methylprednisolone treated rats exhibited significantly diminished Na+ secretion (p less than .01) and increased Cl- absorption (p less than .05) without affecting net total ammonium flux providing evidence for the inducibility of Na+ conductance channels and against significant NH4+ movement via this pathway. The mucosal addition of furosemide resulted in significantly decreased net absorption of both total ammonium (p less than .001) and K+ (p less than .05). The addition of Ba2+ resulted in a three-fold reduction of ammonium absorption (p less than .001) and a greater than ten-fold reduction in K+ absorption (p less than .001). The observation of significant inhibition of ammonium absorption by furosemide and barium suggests that K+ transport pathways play a significant role in the intestinal transport of NH4+.

Acidosis↗

Mechanism of ammonium transport: inhibition by potassium and barium.

Elucidating the precise mechanism of intestinal ammonium transport is critical to the understanding of the acidosis associated with intestinal urinary diversion. Unfortunately, it is incompletely understood and controversial. Recently, we have shown that furosemide and Ba2+ significantly inhibit ammonium absorption in the ileum. On the basis of this and other data, we have suggested that ionized ammonium absorption occurs via K(+)-transport pathways. The present study examines intestinal ammonium absorption and its inhibition by K+ and Ba2+ utilizing a simplified in vivo system in rat distal ileum. Ammonium absorption demonstrates a tendency towards saturation at initial concentrations between 0 and 300 mM/l. Above 300 mM/l. there was a marked increase in ammonium absorption suggesting a possible biological effect of high NH4+ concentrations on the intestinal segment. Potassium inhibits ammonium absorption. K+ (50 mM/l.) significantly inhibited ammonium at an initial concentration of 100 mM/l. (p less than 0.05) and K+ (100 mM/l.) inhibited ammonium absorption at both 50 and 100 mM/l. (p less than 0.05 and p less than 0.01 respectively). Potassium inhibition of ammonium absorption was lost at concentrations above 200 mM/l. suggesting that K+ inhibition occurs via a competitive mechanism. Ba2+ (25 mM/l.) was shown to be a potent inhibitor of ammonium absorption. This significant inhibition persisted at high initial ammonium concentrations suggesting a complex, noncompetitive mechanism of inhibition. In conclusion, this study provides important data further suggesting that ammonium transport in the intestine occurs via K+ transport pathways, and suggests that the traditionally held mechanism of nonionic ammonium diffusion needs reevaluation.

Animals↗

Long-term metabolic effects of urinary diversion: a comparison of myelomeningocele patients managed by clean intermittent catheterization and urinary diversion.

We previously reported that chronic urinary diversion through intestinal segments may have adverse effects on bone and mineral metabolism. This study examined the long-term health of patients managed by urinary diversion (94% by ileal conduit) for neuropathic bladders secondary to myelomeningocele defects and compared them to a control population of myelomeningocele patients managed by intermittent catheterization. Of the patients 93 were studied by personal interview, chart review, morphometric analysis, serum studies and dual-photon bone density determination. Average followup was 23 +/- 6 years in the urinary diversion group and 17 +/- 5 years in the intermittent catheterization group. Fractures occurred in 40% of the patients in both groups. Patients with a urinary diversion had an increased need for surgery to correct spinal curvature (57% versus 40%) and a significantly increased incidence of complications resulting from orthopedic procedures (17% versus 3%, p less than or equal to 0.05). There was also an adverse effect on renal function. The urinary diversion group had an increased incidence of radiographic renal deterioration (57% versus 8%, p less than 0.001), nephrolithiasis (43% versus 2%, p less than 0.001), pyelonephritis (60% versus 21%, p less than 0.001) and intermittent metabolic acidosis (20% versus 5%, p = 0.05). Surgery was required in 37% for stomal complications and in 17% for ureterointestinal stricture. Linear growth was adversely affected by urinary diversion. Patients with urinary diversion had decreased lengths for all morphometric parameters and a greater percentage of them were at or below the 10th percentile standards. Serum electrolytes, liver function studies, vitamin D3 and parahormone showed no differences in the 2 groups. No patient had a significant metabolic acidosis at the time of study. Bone densities were significantly diminished in both groups and not significantly different. This study strongly suggests that urinary diversion through intestinal segments is associated with adverse effects on bone health.

Bone Density↗