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Biomedical subjects

M Roberts

Publications and source records attributed to M Roberts.

At least 109 records · Page 6Linked to original sources

Delivery of the Pertactin/P.69 polypeptide of Bordetella pertussis using an attenuated Salmonella typhimurium vaccine strain: expression levels and immune response.

Pertactin/P.69, a surface-associated polypeptide antigen of Bordetella pertussis, was expressed in a Salmonella typhimurium aroA aroD vaccine strain, BRD509, using different expression systems, and the immune response in mice against these constructs was compared. Initially, Pertactin/P.69 was expressed on the surface of BRD509 from a single copy of the gene encoding the antigen localized on the Salmonella chromosome. As previously shown, secretory and humoral antibody responses could not be detected following multiple immunization with this strain (BRD640). However, a strong anti-Pertactin/P.69 proliferative response was observed in murine splenocytes following a single oral dose with BRD640. The stimulated splenocytes secreted interferon-gamma but not interleukin-5, indicating that BRD640 induced a Th1 type T-helper response against Pertactin/P.69. We wished to construct a vaccine strain that might induce secretory and humoral responses against Pertactin/P.69 as well as a cell-mediated immune response. Consequently, Pertactin/P.69 was expressed at high levels in the cytoplasm of BRD509 under the control of the inducible nirB promoter from a ColE1-based replicon. Anti-Pertactin/P.69 immune responses were not observed following immunization of BALB/c mice with this strain (BRD975). Priming of the immune system against Pertactin/P.69 was, however, observed following oral immunization with BRD975 and boosting subcutaneously with purified Pertactin/P.69 antigen. The major anti-Pertactin/P.69 IgG subclass detected in boosted mice was IgG2a; thus, as BRD640, BRD975 appeared to induce a Th1 type T-helper response against Pertactin/P.69.

Animals↗

Excellent outcome of cardiac transplantation using domino donor hearts.

OBJECTIVE: Domino cardiac transplantation affords flexible and optimal organ utilization, provides hearts unaffected by brain death, allows prospective tissue matching, and subsequent transplantation with short allograft ischemic times. A retrospective review of our experience with domino cardiac transplantation has been made. METHODS: Seventy-two of 119 patients who underwent heart-lung transplantation from 1988 on served as domino cardiac donors (40 males, 32 females; mean age of 32 years; mean weight of 51 kg). The domino donor diagnoses were cystic fibrosis (n = 47), bronchiectasis (n = 9), primary pulmonary hypertension (n = 6), emphysema (n = 7), pulmonary fibrosis (n = 2) and Eisenmenger's syndrome (n = 1). Forty-seven domino hearts were transplanted at our institution and 25 were exported to other centres in the United Kingdom. The 72 domino cardiac recipients were 62 males and 10 females, mean age of 47 years, mean weight of 60 kg, with ischemic heart disease (n = 32), cardiomyopathy (n = 36) and other conditions (n = 4). RESULTS: There were four deaths (5.6%) at less than 30 days (2 from multiple organ failure, 1 from primary allograft failure and 1 from acute rejection). Actuarial survival estimates and 1 and 5 years were 77 +/- 5.2% nd 69 +/- 6.3%, respectively. This compared favourably with survival data obtained in 234 non-domino cardiac recipients. In the patients transplanted at Papworth, there was no difference in the incidence of rejection (0.6 +/- 0.05 versus 0.7 +/- 0.03 events per 100 patient days for the first 12 months) or in the freedom from graft atherosclerosis (74 +/- 3% versus 70 +/- 3% at 5 years) between the domino and non-domino groups. CONCLUSIONS: The use of domino hearts donated by recipients of heart-lung transplants is beneficial and is associated with an excellent early and longer-term outcome.

Actuarial Analysis↗

The management of post-cardiac transplantation coronary artery disease.

OBJECTIVE: Allograft coronary artery disease remains the single greatest limitation to long term survival after cardiac transplantation. It is peculiarly aggressive in its behavior and diffuse in its nature. The role of conventional approaches to coronary artery revascularisation were studied in a selected group of cardiac transplant recipients. METHODS: Of the 557 patients undergoing cardiac transplantation at our unit between January 1979 and December 1993, all were screened for the development of allograft coronary artery disease routinely after 2 years and yearly thereafter or after 4 years. Twenty patients with allograft coronary artery disease were considered suitable for treatment by conventional means 17 of whom had undergone transplantation for ischaemic cardiomyopathy and the others for dilating cardiomyopathy. Percutaneous transluminal coronary angioplasty was performed in 18, 25-103 months after transplantation (mean 60 months) all of whom had severe proximal stenoses and reversible defects on perfusion scans. None suffered chest pain. Coronary artery bypass grafting was performed in 5, 95-105 months after transplantation (mean 101 months) 2 of whom had post-infarction unstable angina and 3 had severe triple vessel disease, dyspnoea, and perfusion abnormalities. RESULTS: The primary success rate for PTCA was 84% (16/19). Two lesions restenosed and 3 patients had progressive disease which necessitated coronary revascularisation. No patient died. Of the 5 patients undergoing coronary artery surgery 2 died perioperatively, one from acute left ventricular failure and one from acute rejection. All 18 survivors have improved perfusion scans. Following surgery, all survivors had improvement in dyspnoea and relief of angina. Five late deaths a mean of 89 months after transplantation were from coronary artery disease (4) and lung malignancy (1). CONCLUSIONS: Revascularisation by PTCA and CABG is feasible and successful in selected cardiac transplant recipients. Further study is required to determine the effect of revascularisation on prognosis.

Adult↗

Magnetic resonance imaging in alcoholic Korsakoff's syndrome: evidence for an association with alcoholic dementia.

A magnetic resonance imaging study of 19 alcoholic Korsakoff patients, 17 non-amnesic alcoholics and 23 non-alcoholic controls was undertaken. Several measures of ventricular size and interhemispheric area were significantly greater in the Korsakoff patients. Interhemispheric fissure size was greater in the non-amnesic alcoholics than the non-alcoholic controls. Cortical grey matter T1 values were essentially the same for the three groups, whereas the deep grey and the white matter T1 values for the Korsakoff patients were significantly greater than the non-alcoholic controls. These results indicate widespread cerebral atrophy in alcoholic Korsakoff patients, which is largely subcortical and does not develop independently of the diencephalic pathology. Alcoholic dementia may be a more severe form of alcoholic Korsakoff syndrome, aetiologically related to the nutritionally-induced diencephalic pathology, rather than the neurotoxic effects of alcohol on the cortex.

Adult↗

Cardiac outcome after peripheral vascular surgery. Comparison of general and regional anesthesia.

BACKGROUND: Despite evidence that regional anesthesia may be associated with fewer perioperative complications than general anesthesia, most studies that have compared cardiac outcome after general or regional anesthesia alone have not shown major differences. This study examines the impact of anesthetic choice on cardiac outcome in patients undergoing peripheral vascular surgery who have a high likelihood of associated coronary artery disease. METHODS: Four hundred twenty-three patients, between 1988 and 1991, were randomly assigned to receive general (n = 138), epidural (n = 149), or spinal anesthesia (n = 136) for femoral to distal artery bypass surgery. All patients were monitored with radial artery and pulmonary artery catheters. Postoperatively, patients were in a monitored setting for 48-72 h and had daily electrocardiograms for 4-5 days and creatine phosphokinase/isoenzymes every 8 h x 3, then daily for 4 days. Cardiac outcomes recorded were myocardial infarction, angina, and congestive heart failure. RESULTS: Baseline clinical characteristics were not different between anesthetic groups. Overall, the patient population included 86% who were diabetic, 69% with hypertension, 36% with a history of a prior myocardial infarction, and 41% with a history of smoking. Cardiovascular morbidity and overall mortality were not significantly different between groups when analyzed by either intention to treat or type of anesthesia received. In the intention to treat analysis, incidences of cardiac event or death for general, spinal, and epidural groups were 16.7%, 21.3%, and 15.4%, respectively. The absolute risk difference observed between general and all regional anesthesia groups for cardiac event or death was -1.6% (95% confidence interval -9.2%, 6.1%) This reflected a nonsignificant trend for lower risk of postoperative events with general anesthesia. CONCLUSIONS: The choice of anesthesia, when delivered as described, does not significantly influence cardiac morbidity and overall mortality in patients undergoing peripheral vascular surgery.

Aged↗

Role of the Bordetella pertussis P.69/pertactin protein and the P.69/pertactin RGD motif in the adherence to and invasion of mammalian cells.

The role of the Bordetella pertussis P.69/pertactin protein in mammalian cell adhesion and invasion was investigated. Salmonella strains expressing surface-associated P.69/pertactin from a chromosomally located prn gene were significantly more invasive than isogenic parental strains. This effect was most pronounced in the poorly invasive, semi-rough S. typhimurium strain LB5010. Escherichia coli K-12 strain HB101 harbouring the plasmid p41869D, which encodes the full-length prn gene under the control of the tac promoter on the broad-host-range plasmid pMMB66EH, was significantly more adhesive to HEp-2 and Chinese Hamster Ovary (CHO) cells growing in culture than E. coli HB101(pMMB66EH). However, the ability of E. coli to invade mammalian cells was not affected by P.69/pertactin expression. P.69/pertactin-mediated adhesiveness of HB101 to HEp-2 and CHO cells was not influenced by the viability of the bacterial cells. However, adherence was markedly reduced when assays were performed for less than 3 h, at 4 degrees C or in the presence of cycloheximide, suggesting the active participation of the eukaryotic cell in bacterial adhesion. Site-directed mutagenesis was used to mutate Asp to Glu in an Arg-Gly-Asp (RGD-->RGE) sequence present in mature P.69/pertactin and the mutated gene was cloned in the same broad-host-range vector (plasmid p41869E). This mutation had no detectable influence on the ability of P.69/pertactin to mediate adhesion of HB101 to HEp-2 or CHO cells. Plasmids p41869D and p41869E were introduced into the bvg-negative B. pertussis strain BP347. Expression of P.69RGD or P.69RGE did not enhance the adhesiveness of BP347 for epithelial (HEp-2 and CHO) cells.

Animals↗

Oral immunization of interleukin-4 (IL-4) knockout mice with a recombinant Salmonella strain or cholera toxin reveals that CD4+ Th2 cells producing IL-6 and IL-10 are associated with mucosal immunoglobulin A responses.

Mucosal immunoglobulin A (IgA) responses are often associated with Th2-type cells and derived cytokines, and interleukin-4 (IL-4) knockout (IL-4-/-) mice with impaired Th2 cells respond poorly to oral antigens. However, we have noted that IL-4-/- mice have normal mucosal IgA levels, which led us to query whether different oral delivery systems could elicit mucosal immunity. Two oral regimens were used: (i) a live recombinant Salmonella strain which expresses fragment C (ToxC) of tetanus toxin, and (ii) soluble tetanus toxoid (TT) with cholera toxin (CT) as an adjuvant. Oral immunization of IL-4-/- mice with recombinant Salmonella vaccine expressing ToxC induced brisk mucosal IgA and serum IgG (mainly IgG2a) anti-TT antibody responses. TT-specific CD4+ T cells from spleen or Peyer's patches produced gamma interferon, indicative of Th1 responses; however, IL-6 and IL-10 were also seen. Oral immunization of IL-4-/- mice with TT and CT induced weak mucosal IgA to TT; however, brisk IgA anti-CT-B responses and CT-B-specific CD4+ T cells producing IL-6 and IL-10 were also noted. These results show that although IL-4-dependent antibody responses are impaired, mucosal IgA responses are induced in IL-4-/- mice. These result suggest that certain cytokines, i.e., IL-6 and IL-10 from Th2-type cells, play an important compensatory role in the induction and regulation of mucosal IgA responses.

Adjuvants, Immunologic↗

Immune response in mice following immunization with DNA encoding fragment C of tetanus toxin.

Tetanus toxin is a potent neurotoxin synthesized by Clostridium tetani. Immunization with fragment C protein, the nontoxic C-terminal domain of tetanus toxin, will protect mice against lethal challenge with tetanus toxin. A synthetic gene encoding fragment C (tetC) had previously been shown to express high levels of fragment C in Saccharomyces cerevisiae. A plasmid, pcDNA3/tetC, which encodes the synthetic tetC gene expressed under the control of the human cytomegalovirus major intermediate-early promoter/enhancer region, was constructed. Expression of fragment C was observed in eukaryotic cells growing in vitro following transfection with pcDNA3/tetC. The immune response induced by intramuscular immunization with pure pcDNA3/tetC DNA was evaluated in a murine model. Anti-fragment C serum immunoglobulin and proliferative responses in splenocytes were observed in BALB/c mice following two immunizations with pcDNA3/tetC. The major immunoglobulin G subclass that recognized fragment C was immunoglobulin G2a, and the stimulated splenocytes secreted high levels of gamma interferon. Immunity to tetanus is dependent on the presence of neutralizing serum antibodies against tetanus toxin. Sufficient anti-fragment C serum immunoglobulins were induced by DNA-mediated immunization to protect mice against lethal challenge with tetanus toxin.

Animals↗

Altered glomerular permselectivity to neutral dextrans and heteroporous membrane modeling in human pregnancy.

Hyperfiltration precedes renal function loss in several nephropathies. Animal studies suggest this may be due to accompanying increases in transglomerular capillary hydrostatic pressure difference (delta P) and/or altered glomerular processing of macromolecules. Renal hemodynamics increase strikingly in human pregnancy. To test the hypothesis that these alterations are not potentially harmful, clearances of inulin, p-aminohippurate, and neutral dextrans were measured at 16- and 36-wk gestation, then 4 mo postpartum, in 11 normotensive women. Results were analyzed using two computer modeling programs. Glomerular filtration rate and renal plasma flow (RPF) were markedly elevated in early and late pregnancy (135 +/- 6 and 895 +/- 53 and 135 +/- 6 and 754 +/- 32 ml/min, respectively, vs. 87 +/- 7 and 520 +/- 17 ml/min postpartum). Gestational hyperfiltration was primarily due to RPF increments with a minor contribution from decrements in capillary oncotic pressure. Fractional dextran clearances (particularly the smaller dextrans, 30-39 A radii) were lower in early pregnancy, decreasing further in late pregnancy. There was no evidence of increased delta P and alterations in glomerular membrane porosity resolved postpartum. These data provide a database by which to study effects of pregnancy on chronic renal disease.

Adult↗

Violence among psychiatric in-patients at an Interim Secure Unit: changes in pattern over a two-year period.

A retrospective study of recordings of all violent episodes among in-patients requiring restraint was undertaken over a two-year period during which the nature of admissions to the unit changed to an increase in mentally abnormal offenders (those admitted through the criminal justice system and detained under criminal sections of the Mental Health Act). It was found that those detained under criminal sections were less likely to be aggressive, were of relatively older age and less likely to repeat the violence than their mentally ill counterparts detained under civil sections. In addition to the past history of violence, verbally abusive behaviour was the best predictor of subsequent physical aggression though only a minority of patients displaying serious physical assault showed verbally abusive behaviour. Deterioration in mental health and staff-patient interaction were seen as major contributory factors to aggression which will also explain a greater degree of aggression directed towards the staff. Further comparative analysis of aggressive behaviour of mentally ill patients detained under civil sections and mentally abnormal offenders is warranted.

Adult↗

Factors predictive of stroke outcome in a rehabilitation setting.

Accurate outcome prediction following stroke is important for proper delivery of poststroke care. It has been difficult to determine specific factors that provide reliable and accurate predictions of outcome, particularly for patients with intermediate deficit severities. Age and severity of deficit have repeatedly been found to be most reliable, but only as rough estimates and for patients at either extreme of the disability spectrum. This paper reports a prospective study of consecutive rehabilitation admissions (N = 536) to determine the influence of preselected factors. Outcome was analyzed in terms of functional improvement and disposition. Patients younger than 55 years or with an admission Functional Independence Measure (FIM) greater than 80 almost universally went home. Admission FIMs less than 40 were associated with nearly certain nursing home discharge. The comprehensive FIM score was a stronger predictor of outcome than motor impairment in isolation. An admission FIM of 60 or greater was associated with a higher probability of functional improvement during rehabilitation. Small-vessel strokes had the best outcome. Intracerebral hemorrhages improved more than ischemic strokes but more slowly. Right hemisphere lesions did worse than left. Comorbidities influenced outcome only when several conditions accumulated. The absence of a committed caregiver at home increased the risk of nursing home discharge. Suggestions for rehabilitation triage are given.

Aged↗

Incontinence after stroke in a rehabilitation setting: outcome associations and predictive factors.

Urinary incontinence (UI) after stroke is common and associated with overall poor functional outcomes. There is controversy regarding which factors contribute to incontinence after stroke and which factors may be predictive of recovery of continence. This study investigated consecutive stroke admissions to an inpatient rehabilitation hospital and evaluated the impact of several pre-selected factors on the presence of UI and its recovery. We also studied the impact of UI on outcome in terms of functional abilities with the Functional Independence Measure (FIM) and in terms of disposition. UI on admission was associated with severe functional impairment with large infarctions and was probably caused by general severity rather than specific impairment of neuromicturition control. Patients with less impairment (admission FIM > 60) and small vessel strokes were likely to recover continence. UI on admission had a negative impact on outcome.

Aged↗

Quality of life and pharmaco-economic aspects of obsessive-compulsive disorder. A South African survey.

OBJECTIVE: The quality of life and pharmaco-economic aspects of obsessive-compulsive disorder (OCD) have received relatively little research attention to date. We aimed to gather preliminary data on these in a South African patient sample. DESIGN: A survey of members of the Obsessive-Compulsive Disorder Association of South Africa was undertaken by means of a detailed self-report questionnaire. RESULTS: Results of the survey suggest that OCD causes significant morbidity, leading to clear distress and Interference with academic, occupational, social and family function. Unfortunately, correct diagnosis and appropriate treatment have been delayed in many patients, and the financial costs of such incorrect management are likely to be considerable. CONCLUSION: Much further work needs to be done by the medical profession and by interested consumers to raise awareness about OCD and to provide information about its management. In South Africa, it is particularly Important to undertake such psycho-education at a primary health care level and to impact on patients of low socio-economic status.

Activities of Daily Living↗

Mutants of Escherichia coli heat-labile toxin lacking ADP-ribosyltransferase activity act as nontoxic, mucosal adjuvants.

A nontoxic mutant (LTK7) of the Escherichia coli heat-labile enterotoxin (LT) lacking ADP-ribosylating activity but retaining holotoxin formation was constructed. By using site-directed mutagenesis, the arginine at position 7 of the A subunit was replaced with lysine. This molecule, which was nontoxic in several assays, was able to bind to eukaryotic cells and acted as a mucosal adjuvant for co-administered proteins; BALB/c mice immunized intranasally with LTK7 and ovalbumin developed high levels of serum and local antibodies to ovalbumin and toxin. In addition, mice immunized intranasally with fragment C of tetanus toxin and LTK7 were protected against lethal challenge with tetanus toxin. Thus nontoxic mutants of heat-labile toxin can act as effective intranasal mucosal adjuvants.

Adjuvants, Immunologic↗

Multifocal motor neuropathy human sera block distal motor nerve conduction in mice.

Multifocal motor neuropathy (MMN) is associated with serum autoantibodies to gangliosides, but their pathogenic role is uncertain. We have used a novel approach to study the effects of serum and plasma from 8 patients with this syndrome, 6 of whom were anti-GM1 positive. The nerve stimulus required to evoke muscle contraction and endplate potentials (EPPs) was measured in the mouse phrenic nerve-diaphragm preparation during 4 to 6 hours of direct application (plasma at 1:1 or serum 1:2 dilution) and following intraperitoneal injection of plasma (1 ml/day) for 1 to 5 days ("passive transfer"). Direct application of MMN serum or plasma produced a progressive increase in stimulus threshold, followed by complete block of nerve-evoked muscle contraction in 3 cases, and an associated decline to about 50% of the EPP amplitude followed by sudden loss of EPPs. These effects were complement independent. Even with complete block of nerve-evoked EPPs, miniature EPP (MEPP) frequency could be increased by raising external K+ to depolarize the nerve terminal directly. Passive transfer of 1 ml of MMN plasma (n = 5) for 3 days caused similar but less marked changes. These results demonstrate that serum factors in MMN can block nerve conduction at distal motor nerves.

Adult↗

The relationship between heart rate variability and measures of body habitus.

There is a well-recognized relationship between autonomic nervous system function and body habitus although few studies have addressed the role of the parasympathetic nervous system. A decrease in parasympathetic nervous-system-mediated heart rate variability in obesity may in part explain the mortality and morbidity that are associated with the obese state. We used multiple linear regression techniques to explore the relationship between measures of heart rate variability and anthropometric indices in 597 male participants in the Normative Aging Study. After adjustment for age and log10 heart rate, weight and body mass index were significant predictors of both the expiratory to inspiratory ratio (E/I ratio) and the difference between maximum and minimum heart rate (HRMax-Min). The abdomen-to-hip ratio and percentage body fat were not significant predictors of measures of heart rate variability. A one standard deviation change in the anthropometric index (weight, body mass index) resulted in a decrease in the E/I ratio of 0.010-0.014 and a decrease in the HRMax-Min of 0.486-0.715 beats/min. A change in the anthropometric index across the distribution (5-95 percentile) resulted in a decrease in the E/I ratio of 0.032-0.037 and a decrease in the HRMax-Min of 1.56-2.39 beats/min. These results indicate that heart rate variability and overall body size are correlated. This association could in part explain the mortality and morbidity that is associated with the obese state.

Adipose Tissue↗

The characterization of chromosomal rearrangements by a combined micro-FISH approach in a patient with myelodysplastic syndrome.

We report the application of a combined strategy: chromosome microdissection, degenerate oligonucleotide primed-PCR, and reverse chromosome painting (micro-FISH), as well as forward chromosome painting, for the characterization of chromosomal rearrangements in a MDS patient with the karyotype 46,XX, -11, +r analyzed by G-banding. The karyotype was refined as 46,XX,der(2)t(2;11) (q35;?p13),der(11)dic r(11)(:p13-->q13::p13-->q13:). Our study demonstrated that the chromosome composition of a neoplasia can be identified more systematically and accurately using these combined molecular cytogenetic approaches. The DOP-PCR methodology modified is suitable for the practical application of micro-FISH on specimens prepared for routine banding analysis.

Aged↗