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Biomedical subjects

R Duncan

Publications and source records attributed to R Duncan.

At least 127 records · Page 7Linked to original sources
PubMed1994

The impact of the addition of an acupuncture treatment program to an existing metro-Dade County outpatient substance abuse treatment facility.

There are several varieties of treatment facilities and modalities for dealing with substance abuse. In this study, the addition of acupuncture treatments to the usual care program at an existing county-based substance abuse treatment clinic was tested. Men and women who voluntarily attended the clinic or who were remanded by the court to attend were randomized to receive usual care, usual care plus frequent urine testing, or usual care plus frequent urine testing and acupuncture treatments. Clients who received acupuncture treatments in addition to the usual care and frequent urine testing became clean (as measured by negative urine tests) in 57% of the time required for the frequent urine testing group. Difficulties experienced included low counselor compliance with the protocol and a high drop-out rate, indicating that further research is necessary; however, this study demonstrates that acupuncture can be a feasible and effective addition to existing drug treatment programs.

Acupuncture Points↗
PubMed1994

Polymer conjugates. Pharmacokinetic considerations for design and development.

Soluble polymer conjugates have only recently been introduced into clinical practice. They can be subdivided into 2 main categories: polymer-protein conjugates, so far the most widely studied; and polymer-drug conjugates, particularly those containing conventional antitumour agents, that are still at an early stage of development. Polymer conjugation can be used to alter the biodistribution, elimination and rate of metabolism of covalently bound drugs. In the case of protein adducts, polymer conjugation prolongs the protein plasma elimination half-life (5- to 500-fold increases in elimination half-life have been reported), reduces proteolytic degradation and has the added benefit of reducing immunogenicity. Cellular uptake of low molecular weight drugs convalently bound to polymeric carriers is restricted to the endocytic route. Thus, the organ and subcellular distribution of the drug can be modified. Cellular uptake has been used to facilitate drug targeting and decreased toxicity. In this review, the theoretical rationale for polymer conjugation is described, as is the limited clinical pharmacokinetic experience with polymer conjugates. As an alteration of the pharmacokinetic profile of a drug was one of the underlying arguments for creation of polymeric conjugates, more clinical pharmacokinetic studies are urgently needed to permit the validation of appropriate pharmacokinetic models that can be used in the future to assist in the optimisation of clinical protocols, and improved conjugate design.

Asparaginase↗
PubMed1994

A polymer-Triton X-100 conjugate capable of PH-dependent red blood cell lysis: a model system illustrating the possibility of drug delivery within acidic intracellular compartments.

Poly(amidoamines) are soluble polymers containing tertiary amino and amido groups regularly arranged along the macromolecular chain, and their net average charge alters considerably as pH changes from neutral to acidic leading to a change in conformation. This property provides the possibility to design polymer-drug conjugates that are, following intravenous administration, relatively compacted and thus protect a drug payload in the circulation, but following pinocytic internalisation into acidic intracellular compartments unfold permitting pH-triggered intracellular drug delivery. To study the feasibility of this approach, a covalent conjugate of a poly(amidoamine) (MBI) was prepared to contain the membrane lytic non-ionic detergent Triton X-100 (as a model), and its ability to lyse red blood cells in vitro was used as an indicator of conjugate conformation at at different pHs. Although Triton X-100 was highly lytic at pH 5.5, 7.4 and 8.0, and the parent polymer MBI was not lytic under any conditions, the conjugate only showed concentration-dependent red blood cell lysis at pH 5.5. Moreover, incubation of human leukaemic cells (CCRF) with these substrates showed conjugate to be more toxic than MBI (IC50 values of 100 micrograms/ml and 650 micrograms/ml respectively) and less toxic than Triton X-100 (IC50 of 1 microgram/ml).

Animals↗
PubMed1993

Synthetic polymer derivatives as substrata for neuronal adhesion and growth.

The adhesion and viability of dissociated neurons of rat cerebral hemispheres onto methacrylate and methacrylamide hydrogels, either unmodified or containing collagen, basement membrane proteins, and glucosamine, were measured in vitro. The degree of cell adhesion was affected by properties of the polymers such as hydrophilicity, hydrophobicity, presence of reactive chemical groups, and incorporation of biological molecules. Adhesion was promoted by attachment of glucosamine to the polymer backbone. Viability was enhanced by the presence of basement membrane proteins within the polymer network. Morphological studies of cells seeded, both onto and within the polymeric matrices, demonstrated the capacity of such substrates to support neuritic outgrowth. The potential of these in vitro assays in the design of polymeric matrices as neural tissue repair promoter substrate is discussed.

Acrylamides↗
PubMed1993

Arthroscopic inferior capsular shift for multidirectional instability of the shoulder: a preliminary report.

Ten consecutive patients with involuntary multidirectional instability who did not respond to rehabilitative treatment were managed by an arthroscopic modification of the inferior capsular shift procedure described by Altcheck and Warren. All patients were reviewed 1-3 years postoperatively using both the satisfactory/unsatisfactory system of Neer and the Bankart rating scale of Rowe. The average Bankart score was 90 (range 75-95) and all patients had a satisfactory result according to the Neer system. The arthroscopic capsular shift procedure appears to provide satisfactory results in the management of selected patients with multidirectional instability as evidenced in this preliminary report.

Adolescent↗
PubMed1993

Ictal/postictal SPECT in the pre-surgical localisation of complex partial seizures.

Single photon emission computed tomography (SPECT) used in conjunction with HM-PAO (Ceretec-Amersham International) was used to image regional cerebral blood flow (rCBF) in 28 patients with medically intractable complex partial seizures during or soon after a seizure, and interictally. Changes from interictal rCBF were seen in 26/28 (93%) patients. The main findings were; 1) During the seizure--hyperperfusion of the whole temporal lobe; 2) Up to 2m postically--hyperperfusion of the hippocampus with hypoperfusion of lateral temporal structures; 3) From 2-15m postically--hypoperfusion of the whole temporal lobe. When compared with EEG and MRI data, correct localisation to one temporal lobe was obtained in 23 patients. In one further patient bilateral temporal foci, and in a further two patients frontal foci, were correctly identified. There were no disagreements between EEG and SPECT localisation. Temporal lobe surgery was successful (by the criterion of at least 90% reduction in seizure frequency) in all but one of the 23 patients operated on. It is concluded that ictal/postictal SPECT is a reliable technique for the presurgical localisation of complex partial seizures. The data indicate a likely sequence of changes in rCBF during and after complex partial seizures of temporal lobe origin.

Adolescent↗
PubMed1993

Brainstem encephalitis and the Miller Fisher syndrome.

A case is described of a man with an acute onset areflexic ataxic syndrome with partial ophthalmoparesis and normal limb muscle power. There was evidence of both a peripheral neuropathy and a brainstem encephalitis. The patient made a full recovery and the interrelationship and nosology of brainstem encephalitis and the Miller Fisher syndrome are discussed.

Adult↗
PubMed1993

Asymptomatic and neurologically symptomatic HIV-seropositive subjects: results of long-term MR imaging and clinical follow-up.

Cranial magnetic resonance (MR) images were prospectively obtained in 74 human immunodeficiency virus (HIV)-seropositive subjects, all of whom had undergone MR imaging 24-42 months earlier. The images were interpreted by neuroradiologists blinded to the subject's clinical status and were compared with the initial MR images and clinical findings. Ten subjects had mild neurologic symptoms, with mildly abnormal unchanged images in five (50%). Sixty-four subjects were neurologically asymptomatic, with mildly abnormal images in 13 (20%), most of which remained unchanged. chi 2 analysis revealed a significant difference (P = .042) between the asymptomatic and symptomatic groups with regard to the number of subjects with abnormal follow-up images. The number of abnormal images in the asymptomatic subjects was significantly less than that in the symptomatic subjects. During follow-up of 2-3 1/2 years, most asymptomatic subjects had persistently normal MR images. When abnormal, the imaging abnormalities were usually static and minor.

Adult↗
PubMed1993

Targeting of N-(2-hydroxypropyl)methacrylamide copolymer-doxorubicin conjugate to the hepatocyte galactose-receptor in mice: visualisation and quantification by gamma scintigraphy as a basis for clinical targeting studies.

N-(2-hydroxypropyl)methacrylamide (HPMA) copolymers containing doxorubicin and galactosamine have been developed to target the hepatocyte galactose receptor with the aim of organ-specific chemotherapy of primary and metastatic liver disease. Previous biodistribution studies in rats and mice have used tyrosinamide incorporated into the copolymer structure to permit labelling with 125I, enabling quantification of polymer distribution by dissection analysis. Radiolabelling of this copolymer with 131I, a radionuclide suitable for gamma scintigraphy, and the imaging analysis of its biodistribution in mice are reported. The present studies are the first to confirm the feasibility of imaging HPMA copolymer biodistribution, and such gamma scintigraphy will be of great value for clinical pharmacokinetic studies with this compound. Gamma scintigraphy is virtually the only non-invasive method of assessing hepatic uptake of this and similar materials.

Animals↗
PubMed1993

Polymeric drug-carriers containing doxorubicin and melanocyte-stimulating hormone: in vitro and in vivo evaluation against murine melanoma.

N-(2-Hydroxypropyl)methacrylamide (HPMA) copolymers containing doxorubicin (DOX, approximately 8% by weight) bound via the lysosomally degradable spacer Gly-Phe-Leu-Gly and, in certain cases, also melanocyte-stimulating hormone (MSH, 5-10% by weight) were synthesized with the aim of developing a drug conjugate for site-specific delivery to malignant melanoma. Polymer-bound MSH, like free MSH, was able to stimulate tyrosinase activity in B16F10 cells in vitro, confirming the ability of conjugated hormone to interact with the MSH receptor. Similarly, a 125I-labelled conjugate containing MSH was captured by B16F10 cells in vitro more rapidly than a similar polymer without the targeting moiety. HPMA copolymers containing DOX bound via the lysosomally degradable Gly-Phe-Leu-Gly linkage were cytotoxic to a mouse melanoma cell line (M3 S91) in vitro, the MSH-containing conjugate being more active than that without (although the difference in the ID50 was not significant). When administered intraperitoneally or intravenously to C57BL/6J mice bearing intraperitoneal B16F10 tumours, HPMA copolymers containing DOX linked via this biodegradable spacer (with or without MSH) significantly increased animal survival, the maximum ratio of the mean survival of the test group (T) to that of the untreated control (C) T/C observed (approximately 200) over the dose range 5-20 mg DOX/kg being similar to that seen for free DOX. In contrast, neither polymer conjugates containing DOX bound via a non-degradable linkage (Gly-Gly) nor free MSH showed antitumour activity. In mice bearing established subcutaneous B16F10 tumours, biodegradable polymer-bound DOX conjugates given intraperitoneally were more effective than free DOX (which was virtually inactive in this system); conjugates containing MSH were significantly more effective than those without, the maximum T/C being approximately 148 and 324 respectively. Preliminary pharmacokinetic experiments showed evidence of selective MSH targeting of polymer conjugates to subcutaneous B16F10.

Acrylamides↗
PubMed1992

Site-directed mutagenesis of the C-terminal portion of reovirus protein sigma 1: evidence for a conformation-dependent receptor binding domain.

Oligonucleotide site-directed mutagenesis was used to modify the type 3 (T3) reovirus cell attachment protein sigma 1 at residues located in the three regions (designated C, D, and E in the C-terminal one-third of sigma 1) that are highly conserved between the three reovirus serotypes. Of the eight residues targeted for mutagenesis, five (one in region C, and two each in regions D, and E) are conserved among all three proteins. Wild-type (wt) and mutant sigma 1 forms were synthesized in an vitro transcription/translation system and subjected to structural and functional analysis. None of the mutations affected the ability of sigma 1 to form trimers. However, mutation (all representing drastic changes) in any of the five triply conserved residues (Tyr326, Asn369, Phe370, Tyr450, and Pro451) caused a complete or partial abrogation of sigma 1 cell binding function, whereas mutation in any of the other three residues (Ser325, Ser327, and Asp365) had no adverse effect. The structural integrity of the mutant proteins was then probed using trypsin, chymotrypsin, and a neutralizing monoclonal anti-sigma 1 antibody. In all cases, the loss of cell binding function was associated with a drastic conformational change in the C-terminal globular head of sigma 1. These results suggest that conserved residues in the three highly conserved regions in the C-terminal portion of sigma 1 play important structural and functional roles and are involved in proper head folding and generation of a conformation-dependent receptor binding domain.

Amino Acid Sequence↗
PubMed1992

Interictal HM-PAO SPECT: a routine investigation in patients with medically intractable complex partial seizures?

Single photon emission computed tomography (SPECT) is increasingly being used as an adjunctive technique in the localisation of epileptogenic foci prior to surgery. As yet, few studies have been undertaken to establish the clinical associations of areas of reduced cerebral perfusion. Sixty-three consecutive patients (15 male, 48 female; median age 30 years, range 14-57 years) with medically intractable complex partial seizures (median/month 8, range 1-36) were investigated as outpatients. All had normal high resolution computerised X-ray tomography (CT) of brain. Twenty-seven (47%) exhibited significant perfusion defects on SPECT scanning with a rotating gamma camera system using Tc-99 HM-PAO. There were no significant differences between patients with normal and abnormal scans in terms of age at scanning or at onset of epilepsy or number of seizures. Patients with perfusion defects did, however, have longer median histories of epilepsy than those with normal scans (normal: 10 years, abnormal: 22 years; P = 0.01). Patients with abnormal scans were no more likely to have suffered febrile convulsions in early childhood. The correlation of abnormal SPECT scans with routine surface EEG recordings was poor with only 41% of cases showing clear agreement between the site of hypoperfusion and focal epileptic activity. It is not yet possible to predict clinically those patients who will exhibit perfusion defects on interictal TC-99 HM-PAO SPECT scanning.

Adolescent↗
PubMed1992

Sleep disturbances in men with asymptomatic human immunodeficiency (HIV) infection.

During the clinical latency phase of human immunodeficiency virus (HIV) disease the central nervous system may be infected and begin to manifest subtle dysfunction. Our early investigations demonstrated persistent alterations in the sleep architecture of HIV-infected asymptomatic men. The major aims of this study were to delineate alterations of sleep architecture in asymptomatic HIV-infected men, to identify and describe sleep behavior complaints and to seek a correlation between objective sleep parameters and subjective complaints of sleep behavior. The study sample consisted of 24 men, 14 HIV-infected and 10 HIV-negative, age-matched controls. The protocol included a comprehensive history and physical, two polysomnograms, urine toxicity, detailed written sleep questionnaire, the Pittsburgh Sleep Quality Index, the Spielberger State-Trait Anxiety Test and the Beck Depression Inventory. Our results indicated that sleep architecture differed from controls in that wakefulness, slow-wave sleep [SWS-stage 3 and 4 nonrapid eye movement (NREM) sleep] and stage rapid eye movement (REM) sleep were more evenly dispersed throughout the night. In particular, SWS was prevalent during the second half of recorded sleep. The observed changes in the NREM/REM cycle could not be explained on the basis of underlying psychopathology. Just as the course of individuals with HIV infection varies, it is expected that sleep abnormalities will vary. Considering the known relationships between NREM stage 3 and 4 and immune system function, it is possible that the observed alterations in the NREM/REM cycle are related to coincident changes in immunologic function. Quantitative measures of NREM sleep, especially SWS and REM sleep, are perhaps of greater significance than relative measures of sleep stages.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Drug-polymer conjugates: potential for improved chemotherapy.

Use of polymeric drug delivery systems is rapidly becoming an established approach for improvement of cancer chemotherapy. Zoladex, a poly lactide-co-glycolide subcutaneous implant that delivers a luteinizing hormone releasing hormone analog over 28 days, is now the treatment of choice for prostate cancer, and a polyanhydride matrix containing BCNU is currently in phase III evaluation for treatment of glioma multiforme. Soluble polymers were first proposed as targetable drug carriers in the mid-1970s, and although the first conjugates are still at an early stage of development some, e.g. SMANCS (styrene maleic acid-neocarzinostatin) and monomethoxypolyethyleneglycolasparaginase, are now undergoing clinical evaluation and show considerable promise. Polymeric drug delivery systems are usually designed to produce an improved pharmacokinetic profile of an antitumor agent (controlled release) and in addition soluble carriers can achieve either first-order (organ specific) or second-order (tumor specific) drug targeting by virtue of the fact that they are usually administered intravenously and should theoretically access primary and secondary disease. Soluble polymeric carriers have the potential to improve the activity of conventional antitumor agents, peptide and protein drugs, and have recently been used in constructs for delivery of oligonucleotides. With increased awareness that the successful design of a polymeric drug delivery systems can only be achieved with prior consideration of the pathology and stage of the disease, tumor accessibility, biochemistry and cell biology of the target site, choice of appropriate therapeutic agent(s) and understanding of their fundamental mode of action, we have seen the emergence of a number of exciting and potentially more selective antitumor therapies based on polymer technologies. Here, the basic principles for design of soluble polymeric drug delivery systems are explained and illustrated using examples drawn from our studies on the development of N-(2-hydroxypropyl)methacrylamide copolymer conjugates for use in cancer chemotherapy. Those soluble polymeric carriers that are undergoing clinical evaluation are briefly reviewed.

Animals↗
PubMed1992

Antigenic and genomic differences of two Jasper strains of infectious pancreatic necrosis virus.

Strains of infectious pancreatic necrosis virus (IPNV-Jasper) obtained from two different laboratories were compared serologically with polyclonal and monoclonal antibodies. Nucleotide sequence and restriction endonuclease patterns of 359-bp fragment of genome segment A cDNA were also compared. Substantial differences were found in both analyses that will support the fact that the two Jasper strains are not identical.

Animals↗
PubMed1992

Immediate internal fixation of open fractures of the diaphysis of the forearm.

Immediate (within 24 h) open reduction and internal fixation of 103 open fractures of one or both bones of the forearm was accomplished in 69 patients between 1980 and 1989. Fifty-four of the 103 patients were reevaluated 1 to 7 years postinjury (average 2.5 years) to determine the efficacy of this treatment. Forty-five (90%) of the 50 patients with Grade I, II, or IIIA injuries had satisfactory results. The four patients with Grade IIIB or IIIC injuries had unacceptable results. This study demonstrates, as have previous investigations, that immediate open reduction and internal fixation of open forearm fractures provide acceptable results in Grades I, II, and selected Grade III injuries. The subdivision of Grade III fractures into A, B, and C types provides a previously unreported statistically significant difference in the results obtained in management of these injuries. The difference in results in Grade I, II, and IIIA injuries as compared to the Grade IIIB and C injuries was statistically significant (p = 0.0004). The difference in Grade IIIA injuries as compared to Grade IIIB and C injuries was also significant (p = 0.014). Immediate open reduction and internal fixation can be recommended in Grade I, II, and IIIA open forearm fractures. Although it is unclear from this report whether the results in Grade IIIB and C fractures were due to the management protocol, the severity of the initial injury, or combined factors, immediate open reduction and plate fixation yielded poor results in these injuries.

Academic Medical Centers↗
PubMed1992

Epilepsy, cerebral blood flow, and cerebral metabolic rate.

Penfield's observations in the 1930s provided the first systematic evidence of changes in regional cerebral blood flow (rCBF) associated with focal seizures. Further studies in humans and animals confirmed increases in cerebral blood flow and metabolism during generalised seizures, but the interictal, ictal, and postictal changes in focal epilepsy have begun to be elucidated in the last decade with the advent of in vivo imaging techniques such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) and, in the case of animal studies, of autoradiography. Most studies have been of temporal lobe epilepsy. Interictally, the characteristic finding has been reduced blood flow and/or metabolism in the affected temporal lobe, or more extensively in the ipsilateral hemisphere. The few studies to date of ictal or postictal changes have been of rCBF using SPECT. They show hyperperfusion of the whole temporal lobe ictally, hyperperfusion of the hippocampus, combined with hypoperfusion of lateral structures in the immediate postictal period. Later in the postictal period, hypoperfusion alone is seen. Studies of focal seizures in animals have shown hyperperfusion and hypermetabolism at the site of the focus often with widespread depression of both parameters in the ipsilateral neocortex. Limited studies of coupling between blood flow and metabolism in humans have suggested that flow during seizures is adequate for metabolic demand, although some animal studies have suggested localised areas of uncoupling. The results of modern in vivo imaging of ictal and postictal changes in blood flow and metabolism have correlated well with Penfield's observations, and these changes are now being used to help localise epileptic foci, allowing wider use of the surgical treatment he pioneered.

Animals↗