A study of chronic colonic diarrhoea and dysentery. II. Rectal biopsy study.
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Biopsy↗
Biomedical subjects
O Prakash
Publications and source records attributed to O Prakash.
NF-kappa B site-mediated negative regulation of the HIV-1 promoter by CCAAT/enhancer binding proteins in brain-derived cells.
Several transcription regulatory elements that interact with cellular DNA-binding proteins have been identified in the HIV-1 long terminal repeat (LTR). We have identified two sequence motifs in the U3 region of the LTR that are similar to the consensus 9-bp DNA-binding element of the CCAAT/enhancer-binding protein (C/EBP) family of transcription factors. One of the sequences (promoter-proximal) mapped immediately upstream of the NF-kappa B element, whereas the other (promoter-distal) completely overlapped the upstream stimulatory factor (USF) binding site. In this study, we investigated the role of the enhancer-proximal consensus C/EBP binding sequence in the expression of the HIV-1 LTR. In cotransfection assays we found that although this sequence is a functional C/EBP-responsive element, the regulation of the HIV promoter by C/EBP is very complex. C/EBP isoforms inhibited the phorbol 12-myristate 13-acetate (PMA)-stimulated HIV-1 promoter activity in human glioblastoma U138MG and neuroblastoma SHSY5Y cells, but not in HeLa epithelial cells, and this inhibition required the NF-kappa B element. C/EBP also downregulated the HIV NF-kappa B element-containing SV40 early promoter activity, regardless of the presence of the flanking C/EBP-binding sequences, in the two brain-derived cells. In electrophoretic mobility shift assays with nuclear extracts from HeLa and U138MG cells, purified C/EBP markedly increased the complex formation between endogenous proteins and the NF-kappa B DNA probe without detectable association with the complex. However, with extracts from U138MG cells but not from HeLa cells, a slow migrating complex was observed. Our data suggest that the C/EBP family of transcription factors can downregulate the HIV-1 promoter activity in CNS-derived cells through the NF-kappa B binding elements.
Animals↗
Challenges and opportunities for computerizing the anesthesia record.
Most observers would agree that the goal of computerizing the anesthesia record is a worthy one. Despite the fact that several academic groups and vendors have attempted to develop and provide computerized anesthesia charting, the practice is not widespread. In this review article, we attempt to outline the reasons for this reluctance to use computers for anesthesia charting. Where there are problems to be solved, there also are opportunities. We discuss the development of strategies to solve these problems and thus present opportunities for medical informatics professionals and anesthesiologists to work toward joint solutions. Solving these problems includes the development of consensus standards and working out technical, social, and educational difficulties. Details of the approaches recommended are outlined.
Anesthesia↗
Use of mass spectrometry and infrared CO2 analyzer for bedside measurement of cardiopulmonary function during anesthesia and intensive care.
In response to the increasing abilities to provide continuous and detailed information on the cardiopulmonary status during and after open heart surgery, we measured hemodynamic and pulmonary functions including cardiac index, end-tidal CO2, minute volume, dead space, ventilation/perfusion ratio, O2 consumption, and other derived variables with a mass spectrometer. This was found useful, for example, in evaluating the need for artificial ventilation in postoperative cardiac patients.
Adolescent↗
Cardiorespiratory and metabolic effects of profound hypothermia.
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Blood Pressure↗
Cardiorespiratory and metabolic effects of profound hypothermia.
At operation the body temperature of mechanically ventilated infants was initially decreased to 25--22 degrees C with surface cooling and further lowered to 16 degrees C by total body perfusion. During circulatory arrest, averaging 40 min, repair of complex intracardiac deformities was carried out. Rewarming to 36 degrees C was achieved by 35--65 min of total body perfusion. Of 29 infants, 23 under 10 kg survived their correction; normothermic ventilation without added CO2 was given throughout the cooling period. The following measurements were made: gas exchange, lung mechanics, heart rate, arterial pressure, right atrial pressure, cardiac output (Qt), ECG, core and nasopharyngeal temperature, as well as biochemical determinations. During surface cooling O2 consumption (VO2), CO2 production (VCO2), endtidal CO2 (PETCO2) and PaCO2 decreased proportionally and linearly with body temperature. Inspiratory resistance, total compliance, physiological dead space (VD/VT), and the single breath CO2 curve did not reveal disturbed lung function. Mean arterial pressure was 98, 90, and 70 mm Hg and heart rate was 141, 107, and 76 beat/min, at temperature 35, 30, and 25 degrees C, respectively. Cardiac index was 2.2 +/- 0.2 liter/min/m2 (mean +/- SEM, n = 25) 2 hours after surgery. Arterial lactate reached peak values of 4.1 +/- 0.3 mM/liter (n = 17), during rewarming but returned to normal. Respiratory alkalosis caused by hyperventilation during cooling caused no apparent harm. No neurological damage was observed. It is concluded that surface cooling performed with normothermic ventilation under guidance of core temperature, VO2, PETCO2, and VCO2, is a safe method.
Body Temperature↗
Lung mechanics in patients undergoing mitral valve replacement. The value of monitoring of compliance and resistance.
Measurements of compliance, resistance of the respiratory system, and left atrial pressure were made before, during, and after mitral valve replacement in 30 patients. Postoperatively left atrial pressures decreased, resistance decreased and compliance increased significantly. Monitoring and recordkeeping of lung mechanics were found to be useful in predicting the feasibility for extubation and as indicators of impending disasters, e.g., due to bleeding in the thoracic cavity.
Airway Resistance↗
Criteria for early extubation after intracardiac surgery in adults.
Of 142 adult patients undergoing open-heart surgery, 123 were extubated either in the operating room or within 3 hours after admission to the recovery room, to avoid the discomfort and risks of prolonged mechanical ventilation. The remaining 19 patients, who had impaired cardiac function, were mechanically ventilated for 1 to 7 days postoperatively. The most important criteria for cardiopulmonary malfunction indicating the need for continued mechnical ventilation were a low mixed venous O2 saturation (SVO2) of less than 60% and a high left atrial pressure (greater than 20 torr). Of the 123 patients, 118, had an uneventful postoperative recovery and 5 needed reintubation, 2 because of low SVO2 and 3 because of complications unrelated to respiratory management. Most adult patients can spontaneously breathe adequately immediately after or within 3 hours of completed open-heart surgery, but a thorough physiologic and clinical evaluation should precede extubation, to identify those who need prolonged mechanical ventilation in the postoperative phase. Criteria for selection of patients for early extubation are presented.
Adolescent↗