Biomedical subjects
M Reilly
Publications and source records attributed to M Reilly.
Are nurses knowledgeable in regards to latex allergy?
Lack of knowledge concerning latex allergy may lead to a life-threatening adverse reaction to natural rubber latex. Registered nurses need a latex allergy knowledge base to provide latex-safe health care to clients and to create a latex-safe environment. This research explored the current knowledge base of registered nurses as related to (1) the care of clients at risk for latex allergy, or diagnosed with latex allergy, and (2) the provision of a latex-safe environment for all populations. This article describes this research and its implications for nurses. A copy of the Latex Allergy Knowledge Base Self-Assessment Questionnaire is included at the conclusion of the article.
In vivo-in vitro evaluation of the impact of accelerated stability conditions on a hydrophilic matrix tablet.
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Novel indices of oxidant stress in cardiovascular disease: specific analysis of F2-isoprostanes.
The development of methods to measure specific isoprostanes affords a unique opportunity to investigate both the role of oxidant stress as a mechanism of disease in vivo and to select rational doses of putative antioxidant drugs and vitamins for evaluation in human disease. The ability to measure these compounds directly in situ at the site of their formation, to immunolocalize them to target cells in atherosclerotic plaque and other tissues (61) and to assess their biosynthesis non-invasively in urine promises to elucidate the role of lipid peroxidation in cardiovascular disease.
Endoscopic management of food-filled duodenal diverticulum mimicking a pancreatic tumour.
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Degradation characteristics of PLLA-PGA bone fixation devices.
Parietal craniotomies of the mature rabbit skull were repositioned and fixed with resorbable plate and screws made of LactoSorb (Walter Lorenz Surgical, Jacksonville, FL) poly L-lactic acid (PLLA) and polyglycolic acid (PGA) in 20 mature rabbits. Changes in the resorbable devices as well as at the tissue-implant interface were evaluated at 2, 6, 9, and 12 months postoperatively. At 2 months, no change in the size of the implants was seen with a noninflammatory layer of surrounding fibrous tissue and intense birefringence of the screws. At 6 months, substantial loss of implant size had occurred, accompanied by fibrovascular and a macrophage cellular infiltrate. At 9 months, more than 95% of the implant was resorbed, with a small amount remaining in the screw hole. Other than macrophages within the remaining material, very few giant cells were seen. By 1 year, no evidence of birefringent macromolecular polymer debris could be found. No contraindications for the clinical use of this specific PLLA-PGA copolyer could be found when implanted on craniofacial bone surface.
Anesthesia and the elderly.
Older individuals with more complex medical histories are reaching the operating suite in growing numbers. Anesthesia in particular poses a special area of concern for elders. These individuals require a special approach to the assessment, planning, and implementation of care.
Music distraction in burn patients: influencing postprocedure recall.
Care of burn patients does not need to depend solely on traditional pharmacological approaches. Care plans should include measures to maximize factors that can positively impact on both awareness and recall. Innovative nursing interventions such as music focused on modification of an impersonal noxious environment can greatly enhance patient outcome.
Multigeneration maternal transmission in Italian families with neural tube defects.
Periconceptional vitamin supplementation with folate prevents about three-quarters of expected cases of neural tube defects (NTDs) in clinical trials. However, vitamin action may be regulated at the level of the gene, and individual susceptibility to environmental agents, including dietary components, also may be under genetic control. We investigated the presence of familial factors in a retrospective case control study of neural tube defects in Genoa, Italy. Cases included all patients treated at a single pediatric neurosurgical service. Controls matched on age and sex came from the same hospital. We found strong evidence for the contribution of genetic factors in this study. There was an excess risk of 14 for the occurrence of NTDs in first-degree relatives compared to controls (P < .0005). There was no difference in sex ratio in any group of relatives, but maternal grandparents of children with a high spinal lesion had 14% fewer off-spring than paternal grandparents (P < .005), possibly because of excess miscarriages. Our study is the first to show complex patterns of inheritance in spina bifida families affecting three generation in one clinical subgroup and preferentially on the mother's side. These results support a role for genomic imprinting and highlight the value of multidisciplinary epidemiologic and clinical studies that include multiple generations. New studies incorporating dietary and genetic approaches will help clarify and extend these findings.
Modulation of oxidant stress in vivo in chronic cigarette smokers.
BACKGROUND: Free radical-induced oxidative damage is thought to be involved in the pathogenesis of diseases associated with cigarette smoking. We examined the production of 8-epi-prostaglandin (PG) F2 alpha, a stable product of lipid peroxidation in vivo, and its modulation by aspirin and antioxidant vitamins in chronic cigarette smokers. METHODS AND RESULTS: We performed the following studies: (1) a cross-sectional comparison of smokers and control subjects, (2) an examination of the dose-response relationship, (3) an exploration of the effect of smoking cessation (3 weeks) and nicotine patch supplementation, (4) the effect of aspirin consumption, and (5) the effects of 5 days' dosing with vitamin E (100 and 800 U), vitamin C (2 g), and their combination. 8-epi-PGF2 alpha excretion (in pmol/mmol, mean +/- SEM) was 176.5+/-30.6 in heavy smokers, 92.7+/-4.8 (P<.05) in moderate smokers, and 54.1+/-2.7 (P<.005) in nonsmokers. Urinary levels fell from 145.5+/-24.9 to 114.6+/-27.1 (week 2, P<.05) and 112.6+/-24.9 (week 3, P<.05) on cessation of smoking. Aspirin treatment failed to suppress urinary levels of 8-epi-PGF2 alpha despite a significant reduction in urinary 11-dehydro-TxB2 production and suppression of 8-epi-PGF2 alpha and TxB2 in serum. Vitamin C (pre, 194.6+/-40.9; post, 137.2+/-34.1; P<.05) and a combination of vitamin C and E (pre, 171.0+/-39.8; post, 133.5+/-29.6 P<.05) suppressed urinary 8-epi-PGF2 alpha, whereas vitamin E alone had no effect. CONCLUSIONS: Urinary 8-epi-PGF2 alpha may represent a noninvasive, quantitative index of oxidant stress in vivo. Elevated levels of 8-epi-PGF2 alpha in smokers may be modulated by quitting cigarettes and switching to nicotine patches or by antioxidant vitamin therapy.
Optimal sampling strategies for two-stage studies.
The optimal allocation of available resources is the concern of every investigator in choosing a study design. The recent development of statistical methods for the analysis of two-stage data makes these study designs attractive for their economy and efficiency. However, little work has been done on deriving two-stage designs that are optimal under the kinds of constraints encountered in practice. The methods presented in this paper provide a means of deriving designs that will maximize precision for a fixed total budget or minimize the study cost necessary to achieve a desired precision. These optimal designs depend on the relative information content and the relative cost of gathering the first- and second-stage data. In place of the usual sample size calculations, the investigator can use pilot data to estimate the study size and second-stage sampling fractions. The gains in efficiency that can result from such carefully designed studies are illustrated here by deriving and implementing optimal designs using data from the Coronary Artery Surgery Study.
8-Epi PGF2 alpha: specific analysis of an isoeicosanoid as an index of oxidant stress in vivo.
1. Excessive free radical generation is thought to contribute to tissue injury in a broad spectrum of diseases. A particular constraint in addressing this hypothesis has been the inability to assess free radical generation in vivo and the lack of information on drugs or vitamins which act as effective antioxidants in vivo. 2. Traditional approaches have relied upon measures of substrate oxidizability or spin trapping of free radical adducts ex vivo. It is unknown how these measurements might relate, in a quantitative fashion, to the generation of reactive oxygen species in vivo. Isoeicosanoids are free radical catalyzed products of arachidonic acid. One of these compounds, 8-epi prostaglandin F2 alpha (8-epi PGF2 alpha) exhibits biological activity and may function as an autacoid. Specific analysis of this 8-epi PGF2 alpha isomer indicates that it is elevated in certain syndromes thought to be associated with oxidant stress. These include vascular reperfusion, paracetamol poisoning and liver cirrhosis. Apparently healthy individuals who smoke cigarettes or consume alcohol exhibit dose dependent increments in excretion of 8-epi PGF2 alpha. Excretion is depressed by antioxidant vitamins, although not by the nonspecific cyclooxygenase (COX) inhibitor, aspirin, even though 8-epi PGF2 alpha may be formed by either COX-1 or COX-2. 3. Specific analysis of this and other isoeicosanoids may afford an opportunity to evaluate the effects of antioxidant interventions in human diseases characterized by excessive lipid peroxidation in vivo.
Changes in the amplitude of the nasal cycle associated with symptoms of acute upper respiratory tract infection.
Nasal airflow is normally asymmetrical and subject to spontaneous reciprocal changes which are often referred to as the 'nasal cycle'. The nature of these spontaneous changes in nasal resistance is poorly understood and little information is available about how they are affected by nasal disease. In order to understand the changes in nasal resistance in health and disease it is important to record unilateral resistance rather than express results as total nasal resistance. Unilateral resistance is subject to continuous reciprocal changes and therefore new measurements were developed in this study in order to quantify the nasal resistance of each nasal passage. Twelve human subjects (age 19-38) with symptoms of acute respiratory tract infection (URTI) were recruited for the study which involved serial measurements of unilateral nasal airway resistance using the technique of posterior rhinomanometry over a period of six hours. Measurements were made on one day when subjects had symptoms of URTI and then repeated 6-8 weeks later when subjects were healthy. The results of this study show that all of the subjects exhibited spontaneous reciprocal changes in nasal airway resistance on both study days but that there was a significant increase in the amplitude of the changes in resistance when the subjects had symptoms of URTI with one nasal passage often becoming severely congested. In order to quantify the amplitude of the reciprocal changes in nasal resistance two new measures were used. The minimum and maximum nasal airway resistance recorded for each nasal passage during the six hour recording period (MIN NAR and MAX NAR). Mean MIN NAR with URTI was 0.4 Pa cm3s +/- 0.07 which was not significantly different from mean MIN NAR in health which was 0.36 Pa cm3s +/- 0.05 (p = 0.22, n = 20). The mean MAX NAR during URTI was 2.44 Pa cm3s +/- 0.38 and this decreased significantly to 1.36 +/- 0.17 when recorded during healthy conditions (p = 0.01, n = 20). The increased amplitude of spontaneous reciprocal changes in nasal airway resistance associated with symptoms of URTI is proposed to be due to an increased filling pressure to the nasal venous sinusoids associated with a nasal inflammatory response. A model is proposed to explain the role of the nasal sympathetic vasoconstrictor tone and nasal venous filling pressure in the control of nasal airway resistance and to help explain the periods of unilateral nasal obstruction often associated with allergic and infective rhinitis.
Expression of SPARC during development of the chicken chorioallantoic membrane: evidence for regulated proteolysis in vivo.
SPARC is a secreted glycoprotein that has been shown to disrupt focal adhesions and to regulate the proliferation of endothelial cells in vitro. Moreover, peptides resulting from the proteolysis of SPARC exhibit angiogenic activity. Here we describe the temporal synthesis, turnover, and angiogenic potential of SPARC in the chicken chorioallantoic membrane. Confocal immunofluorescence microscopy revealed specific expression of SPARC protein in endothelial cells, and significantly higher levels of SPARC were observed in smaller newly formed blood vessels in comparison to larger, developmentally older vessels. SPARC mRNA was detected at the earliest stages of chorioallantoic membrane morphogenesis and reached maximal levels at day 13 of embryonic development. Interestingly, steady-state levels of SPARC mRNA did not correlate directly with protein accumulation; moreover, the protein appeared to undergo limited degradation during days 10-15. Incubation of [125I]-SPARC with chorioallantoic membranes of different developmental ages confirmed that extracellular proteolysis occurred during days 9-15, but not at later stages (e.g., days 17-21). Comparison of peptides produced by incubation with chorioallantoic membranes with those generated by plasmin showed an identical pattern of proteolysis. Plasmin activity was present throughout development, and in situ zymography identified sites of plasminogen activator activity that corresponded to areas exhibiting high levels of SPARC expression. Synthetic peptides from a plasmin-sensitive region of SPARC, between amino acids 113-130, stimulated angiogenesis in the chorioallantoic membrane in a dose-dependent manner; in contrast, intact SPARC was inactive in similar assays. We have shown that SPARC is expressed in endothelial cells of newly formed blood vessels in a manner that is both temporally and spatially restricted. Between days 9 and 15 of chorioallantoic membrane development, the protein undergoes proteolytic cleavage that is mediated, in part, by plasmin. SPARC peptides released specifically by plasmin induce angiogenesis in vivo. We therefore propose that SPARC acts as an intrinsic regulator of angiogenesis in vivo.
Human immunodeficiency virus DNA in urethral secretions in men: association with gonococcal urethritis and CD4 cell depletion.
To evaluate the prevalence and correlates of human immunodeficiency virus (HIV)-infected cells in urethral secretions, samples were collected from 106 HIV-seropositive men with and without urethritis. HIV DNA was detected by polymerase chain reaction in 27% of 184 urethral specimens and was associated with CD4 cell depletion (P for trend, .03) and with urethritis (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.6) or gonorrhea (OR, 2.9; 95% CI, 1.5-5.8). Two multivariate models were constructed that included age, CD4 cell count < 200/mm3, and either urethritis or gonococcal infection. Detection of HIV-infected cells in urethral secretions was independently associated with < 200 CD4 cells/mm3 (OR, 2.2; 95% CI, 0.9-5.2; P = .05) and urethritis (OR, 2.7; 95% CI, 1.3-5.3; P = .003) in the first model and with gonococcal infection (OR, 3.2; 95% CI, 1.6-6.4; P < .001) in the second model. Successful treatment of gonococcal urethritis was associated with a 2-fold reduction in urethral HIV DNA (44% vs. 21%; P = .02). Thus, treatment of gonococcal urethritis may be an effective strategy for reducing HIV transmission.
Participation of glomerular endothelial cells in the capillary repair of glomerulonephritis.
In many glomerular diseases severe injury to the mesangium may occur, leading to matrix dissolution and damage to the glomerular capillaries. Although the destruction of glomerular architecture may lead to permanent injury, in some cases spontaneous recovery occurs. The mechanisms that mediate this recovery are unknown. In this study we provide evidence for glomerular capillary repair (angiogenesis) in the adult injured glomerulus. Injection of anti-Thy 1 antibody into rats results in severe mesangiolysis with capillary ballooning, microaneurysm formation, and loss of endothelial cells in addition to mesangial cells. Although mesangial proliferation is a major response to injury, proliferation of endothelial cells also can be documented from days 2 to 14 in association with repair of the capillaries. The endothelial cell proliferation peaks on days 2 and 7, when it is seven- to ninefold greater than normal. Many of the endothelial cells display morphological features of angiogenesis. The initial wave of endothelial cell proliferation can be reduced by 40% with neutralizing anti-basic fibroblast growth factor antibodies (P < 0.001). The later glomerular endothelial cell proliferation is associated with upregulated expression of vascular permeability factor/endothelial cell growth factor (VPF/VEGF) and an increase of flk, a VPF/VEGF receptor. Although PDGF is expressed in this model, anti-PDGF antibody treatment did not affect the endothelial cell proliferative response. In summary, glomerular endothelial cells have an active role in the glomerular response to injury. Glomeruli are capable of healing microaneurysms, and the mechanism involves basic fibroblast growth factor- and VPF/VEGF-mediated endothelial proliferative responses.
Bilateral subdural collections invisible on a CT brain scan.
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Formation of 8-iso-prostaglandin F2 alpha by human platelets.
F2-isoprostanes are free radical catalyzed prostaglandin F2 isomers formed from arachidonic acid in an enzyme independent manner (1). Analogous families of other prostaglandin isomers have also been described. Detection of these compounds in vivo has been postulated to represent an approach to the quantitative assessment of free radical generation in humans (2). Additionally, the 8-iso analogues of PGF2 alpha and PGE2 have been shown to induce vasoconstriction, a response which is prevented by pharmacological antagonists of the thromboxane receptor (3). Consequently, it is conceivable that these particular isomers might exhibit an autacoidal function. We chose to explore the factors which regulate the biosynthesis of one of these compounds, 8-iso-PGF2 alpha, in vivo and by human platelets in vitro, to understand more clearly how the discovery of these compounds might be exploited to further our understanding of free radical catalyzed processes in vivo.