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Biomedical subjects

R J Howard

Publications and source records attributed to R J Howard.

At least 109 records · Page 6Linked to original sources
PubMed1994

Left ventricular remodelling and disparate changes in contractility and relaxation during the development of and recovery from experimental heart failure.

OBJECTIVES: Canine pacing induced heart failure is characterised by impaired left ventricular contractility and relaxation, and clinical recovery after cessation of pacing. It is unclear whether the impairment is responsive to adrenergic stimulation. The aim of this study was to assess left ventricular contractility and relaxation and their response to beta adrenergic stimulation during heart failure and after recovery. METHODS: Eight dogs were paced (250 beats.min-1) for 3 weeks to severe heart failure and recovered for 4 weeks after cessation of pacing. During these periods, haemodynamic and echocardiographic measurements were made with and without beta adrenergic stimulation. RESULTS: At heart failure, impaired left ventricular contractility was evidenced by reduced dP/dt [1412(SD 156) mm Hg.s-1 from 2437(382) mm Hg.s-1 at control, p < 0.01] and a downward displacement of the velocity of circumferential fibre shortening-end systolic wall stress relation. Impaired left ventricular relaxation was evidenced by raised end diastolic pressure [35(6) mm Hg from 7(4) mm Hg at control, p < 0.01] and prolonged relaxation time constant tau [28(4) ms from 17(6) ms, p < 0.01]. The ability of beta adrenergic stimulation to augment contractility was reduced: there was blunted dP/dt response to dobutamine. The ability of beta adrenergic stimulation to shorten relaxation was maintained: there was a similar degree of shortening of tau by dobutamine. At recovery, dP/dt returned to control and the shortening-stress relation moved upward, suggesting return of contractility. The response of dP/dt to dobutamine was restored. However, tau remained prolonged indicating persistent abnormal relaxation. CONCLUSION: In pacing induced heart failure, there is a dissociation between the normal ability of beta adrenergic stimulation to augment contractility and shorten relaxation, and a differential capacity for recovery of contractility and relaxation.

Animals↗
PubMed1994

Recovery of attenuated baroreflex sensitivity in conscious dogs after reversal of pacing induced heart failure.

OBJECTIVE: Rapid ventricular pacing reliably induces severe congestive heart failure in dogs, with an associated attenuation of baroreflex sensitivity. Unique to this model is the capacity for rapid recovery of haemodynamics and plasma noradrenaline following the cessation of pacing; however, whether baroreflex sensitivity will similarly recover is unknown. The aims of this study were (1) to assess baroreflex control of heart rate in response to acute hypertensive and hypotensive stimuli during the development of and recovery from severe heart failure, and (2) to correlate baroreflex sensitivity with haemodynamic and echocardiographic indices and with noradrenaline concentrations. METHODS: Serial assessments were performed on six dogs paced to severe heart failure and then allow to recover for four weeks. R-R interval and systolic blood pressure were monitored during administrations of phenylephrine and nitroprusside and the slope (ms.mm Hg-1) of the resultant R-R interval-systolic blood pressure relationship was used to define baroreflex sensitivity. RESULTS: Control phenylephrine and nitroprusside derived slopes were 27.05(SD 7.88) and 17.1(11.03) ms.mm Hg-1 respectively. After one week of pacing the phenylephrine derived slope was unchanged while the nitroprusside slope tended to be attenuated. In severe heart failure, both slopes were severely attenuated, at 1.88(6.45) ms.mm Hg-1 (phenylephrine) and 4.21(3.28) ms.mm Hg-1 (nitroprusside) (both p < 0.05). Intrinsic heart rate, noradrenaline concentrations and cardiac filling pressures were raised at severe heart failure while cardiac output and systolic blood pressure were significantly reduced. Recovery of baroreflex control of heart rate was evident as early as 48 h following pacing cessation and was maintained after four weeks recovery. Haemodynamics, cardiac output, and noradrenaline also returned to control while cardiac dilatation persisted. Nitroprusside and phenylephrine derived slopes were inversely correlated with intrinsic heart rate and pulmonary arterial/capillary wedge pressures respectively. CONCLUSIONS: Despite marked attenuation of baroreflex control of heart rate at severe heart failure, rapid recovery was seen in response to both hypotensive and hypertensive stimuli. The speed with which recovery occurs suggests that attenuation of baroreflex sensitivity at severe heart failure is likely to be mediated by functional alterations rather than morphological damage.

Animals↗
PubMed1994

Management of pregnancy when maternal blood has a very high level of fetal haemoglobin.

Fetal blood normally has a higher oxygen affinity than maternal blood because of the predominance of haemoglobin (Hb) F in the former and of Hb A in the latter; this predominance facilitates the transfer of oxygen from maternal to fetal blood. We report two patients who had exclusively or predominantly Hb F in their blood and were managed differently. When patient 1 became pregnant she had regular exchange blood transfusions in order to reduce her Hb F from 80% to below 50%; patient 2, who had 100% Hb F, was not transfused before, during or after her pregnancy. Each patient delivered a normal healthy baby. We conclude that the differential oxygen affinity produced by the combination of Hb A in the maternal blood and Hb F in the fetal blood is not indispensable to ensure an oxygen supply adequate for normal fetal development and growth.

Adult↗
PubMed1994

Blood transfusion in pregnancies complicated by maternal sickle cell disease. Effects on blood rheology and uteroplacental Doppler velocimetry.

Doppler ultrasound gives a measure of downstream resistance to blood flow. In this study it has been used to assess the change in placental vascular resistance following blood transfusion in pregnancies complicated by sickle cell disease. Eight women with homozygous sickle cell disease were followed prospectively to assess the effect of transfusion on haemoglobin S percentage, blood and plasma viscosity and uteroplacental Doppler velocimetry. Measurements were made immediately pre and post-transfusion and after several weeks when the desired improvement in haemoglobin S had been achieved. Despite significant changes in haemoglobin S levels and consequent rheological change there was found to be no change in measurements of resistance in the uteroplacental circulation as assessed by Doppler ultrasound.

Anemia, Sickle Cell↗
PubMed1994

Myocardial energetics and blood flow in acute rapid ventricular pacing.

The mechanism whereby chronic rapid ventricular pacing induces severe heart failure is unclear, but the phenomenon is associated with a reduction in left ventricular ATP levels. Accordingly, the current study was undertaken to evaluate the acute effects of rapid ventricular pacing on hemodynamics, left ventricular adenine nucleotide levels, myocardial blood flow, and oxygen consumption. Anesthetized dogs (n = 7) were studied in sinus rhythm and during 30 min of pacing at 250 beats/min. Pacing caused a significant (means +/- SD, all p < 0.001) decrease in cardiac output (3.0 +/- 0.6 to 2.0 +/- 0.6 L/min) and peak left ventricular systolic pressure (133 +/- 14 to 82 +/- 10 mmHg (1 mmHg = 133.3 Pa)) and an increase in pulmonary wedge pressure (10 +/- 2 to 18 +/- 3 mmHg). Following pacing, the peak first derivative of left ventricular pressure and the relaxation time constant, tau, remained unchanged compared with baseline values. Myocardial blood flow and oxygen consumption both increased by 70% with pacing. The transmural distribution of myocardial blood flow and myocardial lactate consumption remained unchanged. There was no change in left ventricular ATP or ADP levels with the observed increase in myocardial oxygen consumption. Therefore, the hemodynamic deterioration associated with acute rapid ventricular pacing, in contrast to that of chronic pacing, is not associated with perturbed myocardial energetics.

Adenine Nucleotides↗
PubMed1994

Malaria, the red cell, and the endothelium.

Erythrocytes infected with mature stages of Plasmodium falciparum malaria adhere to vascular endothelial cells in postcapillary venules of several organs. In some patients, infected cells also form rosettes with uninfected erythrocytes. The special pathology of acute cerebral malaria appears to result from excessive adherence of infected cells in cerebral vessels coupled with occlusion of cerebral blood flow in microvessels by infected cell rosettes. Several endothelial cell proteins have been identified as potential receptors for infected erythrocyte adherence to vascular endothelium, including thrombospondin, CD36, intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), and endothelial leukocyte adhesion molecule-1 (ELAM-1). The receptor on infected erythrocytes that mediates adhesion to endothelial cells has been identified as a very large malarial protein on infected cells called PfEMP1. PfEMP1 has been shown to bind to CD36 and thrombospondin in vitro. Antibody-mediated blockade or reversal of infected erythrocyte adherence to vascular endothelium is postulated not only to decrease the pathology of blood-stage malaria, but also to lead to infected cell destruction and clearance, especially in the spleen. PfEMP1 is therefore a prime candidate malarial protein for inclusion in a multicomponent asexual malaria vaccine.

Cell Adhesion Molecules↗
PubMed1994

Quantitative magnetic resonance imaging volumetry distinguishes delusional disorder from late-onset schizophrenia.

BACKGROUND: Late paraphrenia is recognised as a heterogeneous disorder. This is reflected by the division of such patients into schizophrenia and delusional disorder in ICD-10. Earlier imaging studies have suggested that major structural abnormalities may be associated with the onset of psychosis in later life. METHOD: Fifty late paraphrenics and 35 age-matched healthy controls underwent structural magnetic resonance imaging of the whole brain in the coronal plane. Measurements were made of intracranial and brain volumes and the volumes of the intracerebral and extracerebral cerebrospinal fluid spaces. RESULTS: No differences in intracranial, brain or extracerebral cerebrospinal fluid volumes between patients and controls were found. Late paraphrenic patients had greater lateral and third ventricle volumes than controls and the left lateral ventricle was larger than the right. When the patients were divided into appropriate ICD-10 diagnoses: paranoid schizophrenia (n = 31) and delusional disorder (n = 16), lateral ventricle volumes in the delusional disorder patients were much greater than those of the schizophrenics and almost twice those of controls. CONCLUSIONS: Structural brain differences underly diagnostic heterogeneity within late paraphrenia. The brains of late onset schizophrenics are only subtly different from those of healthy elderly individuals.

Age of Onset↗
PubMed1994

The promise of asexual malaria vaccine development.

This review presents several reasons to support the belief that an asexual vaccine for human malaria caused by Plasmodium falciparum will be developed. It lists many of the current vaccine candidates that we think are ready for human trials and it summarizes a strategy for the development of an asexual vaccine.

Animals↗
PubMed1994

Increased incidence of rejection in patients with delayed graft function.

Because of the difficulties in diagnosing rejection in patients with delayed graft function, such patients were routinely biopsied 7-10 days after kidney transplantation. We found histologic evidence of rejection in 48% of the cases during the lst month posttransplant, a proportion that was significantly higher than in patients with immediate graft function. Furthermore, the 2-year graft survival in patients with delayed graft function and rejection, but not in those without rejection, was significantly lower than in patients with immediate function. The results suggest that there is an association between delayed graft function and rejection and that rejection is the component responsible for the decreased graft survival previously reported for patients with delayed graft function.

Adult↗
PubMed1994

Structural remodelling in heart failure: gelatinase induction.

OBJECTIVE: Rapid ventricular pacing in the dog produces severe congestive cardiac failure in association with neurohumoral activation and marked depression of cardiac function. This syndrome is associated with left ventricular dilation, significant wall thinning, assumption of a more globular shape and disruption of the cardiac collagen infrastructure, given that the fibrillar collagen network is a major determinant of cardiac architecture. The purpose of the present study was to investigate whether there was evidence of increased activity of matrix metalloproteinases. The authors speculated that it could play an important permissive role in myocyte realignment, thereby resulting in the changes in cardiac size and shape. DESIGN: Twenty-one male mongrel dogs underwent ventricular pacing and were allocated into one of three groups: early heart failure (n = 6), severe heart failure (n = 7) and recovered heart failure (n = 8). Measurements included echocardiographic and hemodynamic parameters, plasma noradrenaline levels, left ventricular noradrenaline levels and matrix metalloproteinase activity. RESULTS: The study showed gelatinase activity present in normal left ventricular tissue predominantly attributable to a 72 kDa gelatinase (85%) and, to a much lesser extent, by a 92 kDa gelatinase (15%). Levels of 92 kDa gelatinase increased slightly within one week and reached maximal levels with severe heart failure, where it represented over one-half of the total gelatinase activity. In animals allowed to recover for four weeks, 92 kDa gelatinase decreased significantly to approximately 50% of the levels observed at severe heart failure. The levels of 72 kDa gelatinase did not change significantly during any experimental condition. Significant correlations between 92 kDa percentage activity and systolic and diastolic left ventricular areas across all time-points were evident (r = 0.59 and 0.63, respectively, P < 0.05 for both). CONCLUSION: The association of 92 kDa gelatinase with changes in left ventricular area suggests a possible modulating role for this matrix metalloproteinase in disruption of the fibrillar components of the left ventricular extracellular matrix.

Animals↗
PubMed1994

Quantity of blood inoculated in a needlestick injury from suture needles.

We wanted to quantify the amount of blood inoculum present on several commonly used surgical and phlebotomy needles and to determine the effect of single or double gloving, the depth of needle penetration and needle size on inoculum volume. Nineteen, 22 gauge and 25 gauge phlebotomy needles, as well as the tapered suture needles from zero, 3-0 and 5-0 sutures and a cutting needle from a 4-0 suture were assessed. The needles were dipped into blood labeled with 125I-epidermal growth factor and then embedded 2 or 5 millimeters into an agarose gel. The volume of blood inoculum ranged from 133 to 683 nanoliters for the phlebotomy needles and from 35 to 366 nanoliters for the suture needles. Needles were then passed through none, one or two layers of surgical glove material before embedding the needles 5 millimeters into agarose gel. The use of one layer of surgical glove resulted in a significant (p < 0.001) decrease in inoculum from tapered suture needles, but not from the cutting needles. Two gloves were even more efficient (p < 0.001) than one glove at removing blood from all suture needles, including the cutting needle. However, surgical glove material did not significantly reduce the volume of blood inoculum transferred by the phlebotomy needles. The size of the needle and depth of penetration were found to have a significant influence on inoculum.

Blood↗
PubMed1994

Infections in the immunocompromised patient.

Specific microorganisms have certain types of host defenses directed at them. Inhibition of different host defenses, therefore, leads to an increased risk of the host for infection with different organisms. This article discusses the types of infections present in immunocompromised patients as well as a general approach to diagnosis and treatment.

AIDS-Related Opportunistic Infections↗
PubMed1993

Identification of SVTCG in thrombospondin as the conformation-dependent, high affinity binding site for its receptor, CD36.

Thrombospondin (TSP) binds to its cellular receptor, CD36 (glycoprotein IV or IIIb), and participates in many adhesive cell interactions. We have shown that the CD36-TSP interaction occurs in a stepwise, conformation-dependent process. CD36 sequence 139-155 binds TSP and induces a second CD36-binding site, which binds CD36 sequence 93-110 with high affinity. To characterize this high affinity CD36-binding site on TSP, an anti-TSP monoclonal antibody (mAb), 7A-1e, was identified that showed augmentation of TSP binding in the presence of CD36 peptide P139-155. Purified mAb 7A-1e IgG specifically blocked both P139-155-augmented CD36 binding and P139-155-dependent CD36 peptide P93-110 binding to TSP, indicating that the binding sites on TSP for mAb 7A-1e and P93-110 are closely related. mAb 7A-1e IgG inhibited collagen-induced platelet aggregation in platelet-rich plasma. SVTCG is a cell adhesive motif in TSP. Both mAb 7A-1e and P93-110 specifically bound to a TSP peptide containing SVTCG, and the binding of mAb 7A-1e or P93-110 to TSP was inhibited by soluble SCTCG peptide. The SVTCG cell adhesive domain in TSP is the conformation-dependent, high affinity binding site for CD36 sequence 93-110.

Amino Acid Sequence↗