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Biomedical subjects

M M Smith

Publications and source records attributed to M M Smith.

At least 91 records · Page 5Linked to original sources

Rapid identification of highly active and selective substrates for stromelysin and matrilysin using bacteriophage peptide display libraries.

The discovery of useful peptide substrates for proteases that recognize many amino acids in their active sites is often a slow process due to the lack of initial substrate data and the expense of analyzing large numbers of peptide substrates. To overcome these obstacles, we have made use of bacteriophage peptide display libraries. We prepared a random hexamer library in the fd-derived vector fAFF-1 and included a "tether" sequence that could be recognized by monoclonal antibodies. We chose the matrix metalloproteinases stromelysin and matrilysin as the targets for our studies, as they are known to require at least 6 amino acids in a peptide substrate for cleavage. The phage library was treated in solution with protease and cleaved phage separated from uncleaved phage using a mixture of tether-binding monoclonal antibodies and Protein A-bearing cells followed by precipitation. Clones were screened by the use of a rapid screening assay that identified phage encoding peptide sequences susceptible to cleavage by the enzymes. The nucleotide sequence of the random hexamer region of 43 such clones was determined for stromelysin and 23 for matrilysin. Synthetic peptides were prepared whose sequences were based on some of the positive clones, as well as consensus sequences built from the positive clones. Many of the peptides have kcat/KM values as good or better than those of previously reported substrates, and in fact, we were able to produce stromelysin and matrilysin substrates that are both the most active and smallest reported to date. In addition, the phage data predicted selectivity in the P2 and P'1 positions of the two enzymes that were supported by the kinetic analysis of the peptides. This work demonstrates that the phage selection techniques enable the rapid identification of highly active and selective protease substrates without making any a priori assumptions about the specificity or the "physiological substrate" of the protease under study.

Amino Acid Sequence↗

Contamination and infection of fractures resulting from gunshot trauma in dogs: 20 cases (1987-1992).

Medical records of 20 dogs with gunshot fractures were reviewed to determine the prevalence of preoperative contamination and postoperative osteomyelitis. Fractures were repaired primarily by application of a bone plate (n = 16) or external fixator (n = 2) in buttress fashion or application of interfragmentary screws and pins (n = 2). In 17 dogs, an autogenous bone graft was also used. Results of bacteriologic culture of swab specimens obtained intraoperatively for 15 of the 16 dogs that received antimicrobials preoperatively and for all 4 dogs that did not receive antimicrobials preoperatively were negative. Three dogs developed osteomyelitis at 6, 8, and 10 weeks following surgery; for all 3, results of bacteriologic culture of specimens obtained intraoperatively had been negative. Fracture healing was uncomplicated in the remaining dogs (mean follow-up time, 23 months; range, 2 to 58 months). Despite the potential for contamination associated with gunshot trauma, results indicated a low prevalence of preoperative fracture contamination and postoperative osteomyelitis. These results imply either a low contamination rate or treatable contamination of the perifracture area.

Animals↗

Updated management strategy for patients with cervical osteophytic dysphagia.

Anterior cervical osteophytes impinging upon the pharynx or esophagus constitute a rare cause of dysphagia. In severe cases, surgical removal of these osteophytes can provide symptomatic relief. We describe a patient of this type who failed to improve postoperatively, only to be found subsequently to have a carcinoma of the base of the tongue. To assist other clinicians in evaluating similar patients, and also to emphasize the great utility of modern radiologic techniques in these cases, we propose a diagnostic algorithm that incorporates magnetic resonance or computerized tomographic imaging.

Aged↗

Evaluation of horizontal and vertical tracheotomy healing after short-duration tracheostomy in dogs.

PURPOSE: The purpose of the study was to assess healing of horizontal and vertical tracheotomy after short-duration tracheostomy in dogs using clinical, radiographic, endoscopic, and histologic methods. MATERIALS AND METHODS: Horizontal tracheotomy (n = 6) between the third and fourth tracheal rings or vertical tracheotomy (n = 6) across tracheal rings three through five was performed for airway management during laryngoplasty. Tracheostomy tubes were maintained for 6 hours with low-pressure cuff inflation time limited to the first 1.5 hours. Cervical radiographs and tracheoscopy were performed preoperatively and at postoperative weeks 2, 4, 8, and 12. Ten of the 12 dogs were killed 12 weeks after tracheostomy. RESULTS: There was no significant difference in preoperative and postoperative tracheal diameter or change in endoscopic tracheal circumference at the tracheostomy site when dogs were compared based on type of tracheotomy. Three dogs with horizontal tracheotomies had evidence of scar (web) within the tracheal lumen 12 weeks after surgery. All vertical tracheotomies had a mild, ventral, triangular deformity. Histologic examination of vertical tracheotomy sites showed complete restoration of the pseudostratified columnar epithelium. Horizontal tracheotomies healed with a single layer of columnar epithelium. Intraluminal scar was composed primarily of loose connective tissue. CONCLUSION: Based on the results of this study, vertical tracheotomy shows more consistent healing compared with horizontal tracheotomy after short-duration tracheostomy. No evidence was found to support the preferential recommendation of horizontal tracheotomy for short-duration tracheostomy airway management.

Animals↗

Skull trauma and mandibular fractures.

This article discusses the treatment of skull and mandibular fractures in small animals as well as fixation techniques, including interdental fixation, external skeletal fixation, intraoral splints, wiring, and pinning. Information is provided on the treatment of loose and damaged teeth in the fractured area. Management of temporomandibular joint luxation also is addressed.

Animals↗

Voltage-gated calcium currents have two opposing effects on the secretion of aldosterone.

Using Ca2+ channel blockers with different specificities for L- and T-type Ca2+ channels, we have investigated the roles of these two channel types in K(+)-induced aldosterone secretion. In whole cell voltage-clamp experiments, the spider toxin omega-agatoxin-IIIA (omega-Aga-IIIA) completely blocks L-type Ca2+ channels but has no effect on T-type Ca2+ channels. In contrast, Ni2+ and 1,4-dihydropyridines block both L- and T-type Ca2+ channels. Secretion induced by 7 mM extracellular K+ concentration ([K+]o) is unaffected by omega-Aga-IIIA but is strongly inhibited by Ni2+ or the 1,4-dihydropyridine, nitrendipine. This suggests that physiological increases in [K+]o stimulate aldosterone secretion primarily by enhancing Ca2+ entry through T-type Ca2+ channels. Surprisingly, secretion induced by 60 mM [K+]o is enhanced by omega-Aga-IIIA or Ni2+ and is inhibited by the L-type Ca2+ channel activator BAY K 8644. Nitrendipine (1 nM) also stimulates such secretion, although higher concentrations are inhibitory (concentration inhibiting 50% of maximal response approximately 30 nM). If extracellular Ca2+ concentration is reduced from 1.25 to 0.5 mM, secretion induced by 60 mM [K+]o is enhanced, and Ni2+ or low nitrendipine become inhibitory. Together, these results that L-type Ca2+ currents can reduce steroidogenesis and that the role of these currents was previously misconstrued because 1,4-dihydropyridines modify secretion by multiple mechanisms. Thus Ca2+ entry can function as a negative modulator of steroid secretion.

Agatoxins↗

Cannulated screws for odontoid screw fixation and atlantoaxial transarticular screw fixation. Technical note.

Cannulated screw systems use thin Kirschner wires (K-wires) that have been drilled into the bone to direct screw trajectories accurately into small bone fragments. Use of the K-wires avoids overdrilling the pilot holes and allows fixation of adjacent bone fragments during screw insertion. Hollow tools and hollow screws are inserted into the bone over the K-wires. Cannulated screw fixation is useful in the cervical spine to stabilize odontoid fractures and to treat atlantoaxial instability. This report describes techniques for successful cannulated screw insertion and methods to minimize complications. Cannulated screws have several distinct advantages compared to noncannulated screws: 1) the K-wires guide the screw position into the bone; 2) the K-wire trajectory can be repositioned easily if the original trajectory was not ideal; 3) the K-wires allow continuous fixation of adjacent unstable bone fragments; and 4) the K-wires prevent migration of unstable bone fragments during screw insertion. Complications associated with the K-wire (breakage, repositioning, and advancement) can be minimized using precise operative techniques, a specialized tool system, and intraoperative fluoroscopic monitoring. A unique cannulated screw tool system was developed specifically for upper cervical fixation to allow percutaneous drilling using long tunneling devices, tissue sheaths, drill guides, and long K-wires. These tools allow delivery of cannulated fracture-fixation screws at a low angle to the spine through long soft-tissue trajectories. Cannulated screws have significant advantages compared to noncannulated screws for fixation of the unstable cervical spine.

Bone Screws↗

Carbohydrate absorption from fruit juice in young children.

OBJECTIVE: To compare carbohydrate absorption following ingestion of apple juice and white grape juice in 28 healthy children. DESIGN: Randomized, double-blind crossover study. SETTING: Outpatient pediatric clinic at Maimonides Medical Center. PARTICIPANTS: A total of 18 healthy infants (mean age 6.3 months) and 10 toddlers (mean age 18.0 months), representing those ages when juice is first introduced (6 months) and when juice comprises a large portion of the diet (18 months). METHODS: Breath hydrogen (H2) testing was performed after age-specific servings of white grape juice or apple juice, 4 and 8 ounces respectively, were consumed. These portions provided approximately 1 g of fructose per kg of body weight. Breath H2 responses of > 20 ppm were considered positive, indicating incomplete absorption of fruit juice carbohydrates. RESULTS: In the combined age groups, carbohydrate malabsorption occurred more frequently after apple juice consumption (54%) than after white grape juice (19%; P < .001). Significant differences in area under the breath H2 curve (AUC) were also found between the two juices in both age groups. Among toddlers, the differences between the mean peak breath H2 responses were significant (48 ppm after apple juice consumption compared with 12 ppm after white grape juice; P < .001). These differences were not significant in the infant group. Significant differences (P < .05) were seen between the two age groups after consumption of apple juice; the toddlers exhibited a greater number of positive breath H2 responses and higher peak responses compared with the infants. Data from the children who drank both juices showed significant differences in peak breath H2 responses after consumption of apple juice compared with white grape juice (P < .005). CONCLUSIONS: The study demonstrated less carbohydrate malabsorption following ingestion of white grape juice compared with apple juice in healthy 6- and 18-month-old children.

Beverages↗

Treatment of a mandibular periodontal interproximal defect with a bone graft in a dog.

A 10-year-old German shepherd dog presented with a periodontal 10 mm interproximal defect between the left mandibular fourth premolar and first molar teeth. Bone graft removed from the caudoventral portion of the ipsilateral hemimandible was placed in the defect as a component of the periodontal treatment plan. The use of bone graft likely contributed to periodontal pocket reduction.

Alveolar Bone Loss↗

Type III omega-agatoxins: a family of probes for similar binding sites on L- and N-type calcium channels.

The peptide omega-agatoxin-IIIA (omega-Aga-IIIA) from venom of the funnel web spider Agelenopsis aperta is the only known agent that blocks L-type and N-type Ca channels with equal high potency (IC50 < or = 1 nM). From the same venom, we have purified and sequenced a family of peptides which are homologous to omega-Aga-IIIA but vary over 100-fold in their relative affinity for L-type versus N-type Ca channels. One of these, omega-Aga-IIIB, is 76 amino acids long and identical to omega-Aga-IIIA in 66 positions. We identified two other similar peptides, omega-Aga-IIIC and omega-Aga-IIID, as well as one single amino acid variant of omega-Aga-IIIA and two of omega-Aga-IIIB. The type III omega-agatoxins exhibit similar but distinct activities on voltage-gated Ca channels. omega-Aga-IIIA, omega-Aga-IIIB, and omega-Aga-IIID are nearly indistinguishable in their actions at the insect neuromuscular junction (no effect at 0.1 microM), on atrial T-type Ca channels (no effect at 0.5 microM), and in two assays for synaptosomal Ca channels: they are nearly equipotent inhibitors of 125I-omega-conotoxin GVIA binding to rat brain synaptic membranes (IC50 = 0.17-0.33 nM) and blockers of the K(+)-induced 45Ca2+ influx into chick brain synaptosomes (omega-Aga-IIIB, 1.2 nM; omega-Aga-IIIA, 2.4 nM). In contrast, omega-Aga-IIIA is a better blocker of locust Ca channels (IC50 approximately 10-50 nM) than is omega-Aga-IIIB. Finally, although omega-Aga-IIIA, omega-Aga-IIIB, and omega-Aga-IIID all block atrial L-type Ca channels, omega-Aga-IIIA is over 100-fold more potent. Thus, although type III omega-agatoxins appear to recognize a binding site common to L- and N-type Ca channels, omega-Aga-IIIB and omega-Aga-IIID identify differences between the two channels.

Agatoxins↗

The effects of orally administered calcium pentosan polysulfate on inflammation and cartilage degradation produced in rabbit joints by intraarticular injection of a hyaluronate-polylysine complex.

OBJECTIVE: To determine the antiinflammatory and cartilage-protecting activities of orally administered calcium pentosan polysulfate (CaPPS) in a rabbit model of inflammatory arthritis. METHODS: A single intraarticular injection of a preformed polycation complex (PC) of poly-D-lysine and hyaluronan was used to induce joint inflammation; saline was injected into the contralateral joint as a control. Animals were killed 1, 4, 7, or 10 days post-PC injection. CaPPS, at 5 mg/kg, 10 mg/kg, or 75 mg/kg, was given every 48 hours commencing 7 days prior to PC injection. Serum interleukin-6 (IL-6), synovial fluid (SF) prostaglandin E2, cell numbers, and cartilage proteoglycan (PG) content, composition, and biosynthesis were determined for PC- and saline-injected joints. RESULTS: In PC-injected, non-drug-treated animals, serum IL-6 activity, SF leukocyte numbers, and prostaglandin E2 levels were elevated, while cartilage PG content and biosynthesis were reduced. CaPPS at 10 mg/kg, but not at 5 mg/kg, decreased serum IL-6 levels but maintained cartilage PG concentration and biosynthesis. However, SF leukocyte counts and prostaglandin E2 levels (except on day 1) were not reduced. CONCLUSION: The ability of CaPPS to attenuate serum IL-6 levels and preserve cartilage PGs in inflamed rabbit joints suggests that this substance could be of value as an effective orally administered chondroprotective, antiarthritic drug.

Administration, Oral↗

Isolation of myocardial L-type calcium channel gating currents with the spider toxin omega-Aga-IIIA.

The peptide omega-agatoxin-IIIA (omega-Aga-IIIA) blocks ionic current through L-type Ca channels in guinea pig atrial cells without affecting the associated gating currents. omega-Aga-IIIA permits the study of L-type Ca channel ionic and gating currents under nearly identical ionic conditions. Under conditions that isolate L-type Ca channel currents, omega-Aga-IIIA blocks all ionic current during a test pulse and after repolarization. This block reveals intramembrane charge movements of equal magnitude and opposite sign at the beginning of the pulse (Q(on)) and after repolarization (Q(off)). Q(on) and Q(off) are suppressed by 1 microM felodipine, saturate with increasing test potential, and are insensitive to Cd. The decay of the transient current associated with Q(on) is composed of fast and slow exponential components. The slow component has a time constant similar to that for activation of L-type Ca channel ionic current, over a broad voltage range. The current associated with Q(off) decays monoexponentially and more slowly than ionic current. Similar charge movements are found in guinea pig tracheal myocytes, which lack Na channels and T-type Ca channels. The kinetic and pharmacological properties of Q(on) and Q(off) indicate that they reflect gating currents associated with L-type Ca channels. omega-Aga-IIIA has no effect on gating currents when ionic current is eliminated by stepping to the reversal potential for Ca or by Cd block. Gating currents constitute a significant component of total current when physiological concentrations of Ca are present and they obscure the activation and deactivation of L-type Ca channels. By using omega-Aga-IIIA, we resolve the entire time course of L-type Ca channel ionic and gating currents. We also show that L- and T-type Ca channel ionic currents can be accurately quantified by tail current analysis once gating currents are taken into account.

Agatoxins↗

Body composition and spontaneous growth hormone secretion in normal short stature children.

This study was designed to compare the relationship of measured and estimated indices of adiposity with the spontaneous GH secretion (SGHS) in 37 normal short stature children. Fifteen of the 37 patients (10 males and 5 females) were pubertal, and 22 (17 males and 5 females) were prepubertal. All patients underwent a review of their medical history, a physical exam, laboratory tests, and a nutritional assessment that included anthropometry and evaluation of body composition by bioelectric impedance. The percentage of body fat and body fat mass index were used as measured indices of adiposity. The weight for height ratio, body mass index, and body mass index z-scores were calculated and used as estimated indices of adiposity. Our results showed that SGHS is greatly influenced by variations in adiposity in normal short stature children, and measured indices of adiposity demonstrated the strongest negative correlation with SGHS. Gender differences were apparent in the degree of adiposity that modified SGHS, and it appears that adiposity altered the amplitude of GH pulses in pubertal patients and the number of pulses in prepubertal children. These results suggest that interpretation of SGHS must take into account body composition and gender in addition to pubertal status.

Adipose Tissue↗

Acanthosis Nigricans among Native Americans: an indicator of high diabetes risk.

Prevalence of the skin lesion acanthosis nigricans was determined in two tribal communities in Texas and Nebraska. Thirty-eight percent of the Alabama-Coushatta tribe of Texas had acanthosis nigricans. Nineteen percent of Omaha and Winnebago tribal children had the skin lesion; the youngest children had the least acanthosis nigricans. Among weight-matched Alabama-Coushatta, fasting insulin concentrations were twofold higher in subjects with the lesion. It was concluded that acanthosis nigricans is highly prevalent among Native Americans and that its presence suggests insulin resistance. Thus, it may identify those with the highest risk for non-insulin-dependent diabetes mellitus in this population.

Acanthosis Nigricans↗

Speech by any other name: the role of communication aids in interaction.

The functional communication systems of four physically disabled children with severe speech impairment were evaluated in terms of: (1) perceived dominant modes of communication; (2) observed frequency of communication mode occurrence; and (3) role of communication device in total communication system. All four subjects used a range of communication modes to reflect personal and listener preferences, and in response to differing conversational requirements. 'Standard' communication modes were mentioned more frequently by teachers and parents, and were observed more frequently in interactions. Augmentative and alternative communication devices played a limited but important role within total communication systems. A hierarchy of influences affecting the choice of communication mode is suggested.

Child↗

Effects of 'stroke-belt' residence, screening blood pressure and personal history risk factors on all-cause mortality among hypertensive veterans.

OBJECTIVES: To seek regional differences within the USA in the 'all-cause mortality' of hypertensive men during the 14 years following institution of antihypertensive treatment, and to determine how other pretreatment data can be related to that all-cause mortality. DESIGN: In the mid-1970s pretreatment clinical data were collected and computerized for 5698 hypertensive veterans. Deaths during the subsequent 14 years were obtained from the Veterans Administration Beneficiary Identification and Record Location System and the National Death Index. Relationships between pretreatment data and death were sought using chi 2- and z-tests for bivariate comparisons and logistic regression for multivariate analyses. PATIENTS: Half of the 5698 previously untreated male hypertensive military veterans were Black. Their mean age was 52.3 years and mean pretreatment blood pressure was 160/104 mmHg. Additional pretreatment data included body mass index, cigarette and alcohol usage, age and self-reported comorbidities. These patients began antihypertensive treatment during 1974-1975 in 28 special Veterans Administration outpatient clinics throughout the USA. RESULTS: During the 14 years after treatment began, 2283 of these patients (40%) died. Those from the southeastern USA, i.e. in the 'Stroke Belt', were 1.32-fold more likely to die than patients living elsewhere. Other pretreatment characteristics positively related to all-cause mortality included age, systolic blood pressure, cigarette and alcohol usage, and self-reported comorbidities. Race was unrelated to mortality. CONCLUSION: All-cause mortality was increased among hypertensive subjects from the southeastern USA. The reasons for this excess mortality remain unclear. Other pretreatment characteristics were also related to mortality, but race was not.

Adult↗