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Biomedical subjects

R J Smith

Publications and source records attributed to R J Smith.

At least 307 records · Page 17Linked to original sources

Congenital oral synechiae.

Major congenital synechiae of the oral cavity constitute a clinically confusing spectrum of abnormalities. On the basis of clinical data, we propose two categories: 1) abnormalities secondary to persistence of the buccopharyngeal membrane and 2) abnormalities secondary to formation of ectopic membranes. An ectopic membrane results from abnormal fusion and can be subclassified as a subglossopalatal membrane, glossopalatal ankylosis, or syngnathia. This classification is supported by embryologic studies and is used to reclassify all cases reported since 1900. Distinct differences, such as the presence of associated limb anomalies, emerge; these are reviewed and add support to the proposed classification.

Abnormalities, Multiple↗

Bipolar hooked-wire electromyographic technique in the evaluation of pediatric vocal cord paralysis.

Laryngeal electromyography is a valuable test to assess vocal cord paralysis in adults. This technique can be applied and adapted to the pediatric patient. In the operating room under general anesthesia and endoscopic guidance, bipolar hooked-wire electrodes are passed percutaneously through the anterior neck skin into both thyroarytenoid muscles. Electromyographic signals are evaluated during light anesthesia and on awakening. A critical appraisal of this technique is presented, including an analysis of sources of electrical interference in the operating room.

Adolescent↗

Polymerase chain reaction amplification of DNA from archival celloidin-embedded human temporal bone sections.

A method was developed for fast and efficient isolation of DNA from formalin-fixed, decalcified, celloidin-embedded human temporal bone sections for subsequent use in polymerase chain reaction (PCR) DNA amplification. The method relies on the use of an enzymatic digestion with proteinase K to release and solubilize the patient's DNA from an individual 20- to 25-microns temporal bone section. The method described should be of great value to those investigators extracting DNA from archival individual human temporal bone sections for polymerase chain reaction assays of specific genetic alterations associated with temporal bone pathologies. The molecular characterization of viral infections, oncogenes, or other etiological agents of disease using PCR could provide important information regarding the etiopathogenesis of many auditory, vestibular, and facial nerve disorders, such as autoimmune hearing loss, congenital hearing losses, Meniere's disease, otosclerosis, or Bell's palsy.

Collodion↗

The use of computers in teaching clinical laboratory science.

The Transfusion Medicine Tutor (TMT) has been designed to study the use of computers in teaching concepts and problem- solving skills important in the field of clinical laboratory science. This system provides students with an opportunity to gain experience by solving a wide range of actual cases, and coaches these students when they are having difficulties. This system is designed specifically to detect and respond to a variety of errors that students may make while solving cases, and to suggest more advanced problem-solving methods when appropriate. This article describes the concepts behind the design of TMT.

Journal Article↗

Time-to-tumour risk assessment for 1,3-butadiene based on exposure of mice to low doses by inhalation.

The excess risk for cancer due to lifetime occupational exposure to 1,3-butadiene at the proposed US Occupational Safety and Health Administration standard of 2 ppm was estimated on the basis of a quantitative risk assessment. The risk assessment was based on a recent study by the US National Toxicology Program of the carcinogenicity of butadiene in B6C3F1 mice, using exposure concentrations ranging from 6.25 to 625 ppm butadiene and controls. Cancer risks were estimated using a multistage Weibull time-to-tumour model; the dose was based on the external butadiene concentration, owing to the low-dose linearity of butadiene metabolism. The parameters of the time-to-tumour model were estimated for seven tumour sites in male mice and nine in female mice. The risk estimates were extrapolated from mice to humans on the basis of body weight raised to the three-fourths power, and the median lifespan of mice was equated to a human lifespan of 74 years. Estimates of excess risk for lifetime occupational exposure (8 h/day, 5 days/week, 50 weeks/year, for 45 years) to 2 ppm butadiene ranged from 0.2 per 10,000 workers, based on female mouse heart haemangiosarcomas, to 600 per 10,000 workers, based on female mouse lung tumours. An analysis was performed to assess the effects of varying the modelling assumptions (incidental versus fatal tumours, inclusion or exclusion of the 625-ppm dose group, and basis for interspecies scaling) on the risk estimates from the female mouse lung tumour model. Depending on the assumptions, estimates of lifetime excess risk derived from the female mouse lung model ranged from 60 per 10,000 to 1600 per 10,000. These results suggest that exposures to butadiene in the work place should be reduced to the lowest feasible level.

Administration, Inhalation↗

Primary aldosteronism caused by an adrenal tumor: a correctable cause of hypertension.

Primary aldosteronism due to an adrenal tumor is rare. When found, it can be treated surgically and cured. This is a case report of a 41-year-old man with a long history of severe hypertension who complained of weakness and weight loss. Laboratory studies revealed hypokalemia and marked elevation of the serum aldosterone level. A computed tomography scan revealed a left adrenal mass that increased in size over 3 months' time. A left adrenalectomy was done, and the patient has had a dramatic decrease in his blood pressure and has returned to work.

Adrenal Gland Neoplasms↗

Hospitalization and injury influence on the prosecution of drunk drivers.

The influence that injury and hospitalization from alcohol-related motor vehicle crashes may have on subsequent prosecution for drunk driving was studied utilizing concurrent controls consisting of three cohorts of drivers. The cohorts were drunk and injured drivers, drunk and not injured drivers, and sober and injured drivers. Even though the majority of intoxicated drivers were identified by police as having been drinking, evidentiary testing was not uniform. Culpability for the crash was high in the drunk cohorts compared with the sober drivers, and yet there was a statistically significant difference in the conviction rate of injured drunk drivers (59%) compared with uninjured drunk drivers (100%). Injury and hospitalization for drunk drivers after motor vehicle crashes affords protection from prosecution, and may enable ongoing risk-taking behavior by the drunk driver.

Accidents, Traffic↗

Separation of the enantiomers of some potassium channel activators using an alpha 1-acid glycoprotein column.

The separations of the enantiomers of some 3,4-dihydro-2,2'-dimethyl-2H-1-benzopyrans and a related tetrahydronaphthalene on alpha 1-acid glycoprotein (Chiral-AGP) are presented, together with the results from an investigation of the effects of organic modifier and pH on the separations achieved. The general utility of Chiral-AGP in separating the enantiomers of compounds from this class of antihypertensive agents is demonstrated in this paper.

Antihypertensive Agents↗

Clinical variability and genetic heterogeneity within the Acadian Usher population.

A number of Usher syndrome (USH) families are found among the French-Acadians living in southwestern Louisiana. These families are descended from a few common ancestors, suggesting that USH may be homogeneous within this ethnic group. However, we report distinct phenotypic variability. Based on differences in psychomotor development and tests of auditory and vestibular function, Acadian individuals with both USH Type 1 and Type 2 can be identified. One additional family, with unusual findings, represents a third clinical phenotype. Linkage data strongly support these clinical observations.

Blindness↗

Insulin-like growth factor I receptor gene structure.

The insulin-like growth factor I (IGF I) receptor is a tyrosine kinase-containing transmembrane protein that plays an important role in cell growth control. We have isolated and characterized human genomic DNA clones containing the entire coding sequence of the IGF I receptor. Results of restriction analysis and sequencing of multiple overlapping clones were consistent with the existence of a single IGF I receptor gene. The complete receptor coding sequence is contained in 21 exons. There is striking homology with the insulin receptor gene in overall size (approximately 100 kilobases) and in the number and size of individual exons. An exon analogous to the alternatively spliced exon 11 of the insulin receptor gene could not be detected. An alternative internal splice site corresponding to a known alternatively spliced mRNA transcript was shown to be located at the 5' end of exon 14. Knowledge of the structure of the IGF I receptor gene should facilitate further studies on the structural determinants of receptor function, the relationships between insulin and IGF I receptors, and the molecular basis for multiple IGF I receptor species.

Amino Acid Sequence↗

The glutamate dehydrogenase gene of Clostridium symbiosum. Cloning by polymerase chain reaction, sequence analysis and over-expression in Escherichia coli.

The gene encoding the NAD(+)-dependent glutamate dehydrogenase (GDH) of Clostridium symbiosum was cloned using the polymerase chain reaction (PCR) because it could not be recovered by standard techniques. The nucleotide sequence of the gdh gene was determined and it was overexpressed from the controllable tac promoter in Escherichia coli so that active clostridial GDH represented 20% of total cell protein. The recombinant plasmid complemented the nutritional lesion of an E. coli glutamate auxotroph. There was a marked difference between the nucleotide compositions of the coding region (G + C = 52%) and the flanking sequences (G + C = 30% and 37%). The structural gene encoded a polypeptide of 450 amino acid residues and relative molecular mass (M(r) 49,295 which corresponds to a single subunit of the hexameric enzyme. The DNA-derived amino acid sequence was consistent with a partial sequence from tryptic and cyanogen bromide peptides of the clostridial enzyme. The N-terminal amino acid sequence matched that of the purified protein, indicating that the initiating methionine is removed post-translationally, as in the natural host. The amino acid sequence is similar to those of other bacterial GDHs although it has a Gly-Xaa-Gly-Xaa-Xaa-Ala motif in the NAD(+)-binding domain, which is more typical of the NADP(+)-dependent enzymes. The sequence data now permit a detailed interpretation of the X-ray crystallographic structure of the enzyme and the cloning and expression of the clostridial gene will facilitate site-directed mutagenesis.

Amino Acid Sequence↗

Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study.

OBJECTIVE: To determine whether glutamine-supplemented parenteral nutrition improves nitrogen retention and reduces hospital morbidity compared with standard parenteral nutrition after bone marrow transplantation. DESIGN: Double-blind, randomized, controlled clinical trial. SETTING: University teaching hospital. PATIENTS: Forty-five adults receiving allogeneic bone marrow transplants for hematologic malignancies. INTERVENTION: Parenteral nutrition was initiated the day after bone marrow transplantation (day 1). The experimental solution was supplemented with L-glutamine (0.57 g/kg body weight per day) and provided estimated requirements for energy and protein. The control solution was a standard, glutamine-free, isonitrogenous, isocaloric formula. MEASUREMENTS: Nitrogen balance was determined between days 4 and 11 in the initial 23 patients. The incidence of clinical infection and microbial colonization, time until bone marrow engraftment, indices of clinical care, and other data related to hospital morbidity were recorded for all patients. RESULTS: The glutamine-supplemented patients (n = 24) were clinically similar to the controls (n = 21) at entry. Nutrient intake was similar in both groups; however, nitrogen balance was improved in the glutamine-supplemented patients relative to the controls (-1.4 +/- 0.5 g/d compared with -4.2 +/- 1.2; P = 0.002). Fewer experimental patients developed clinical infection (three compared with nine in the control group; P = 0.041), and the incidence of microbial colonization was also significantly reduced. Hospital stay was shortened in patients receiving glutamine supplementation (29 +/- 1 d compared with 36 +/- 2 d; P = 0.017). CONCLUSION: Patients receiving glutamine-supplemented parenteral nutrition after bone marrow transplantation had improved nitrogen balance, a diminished incidence of clinical infection, lower rates of microbial colonization, and shortened hospital stay compared with patients receiving standard parenteral nutrition. These effects occurred despite no differences between groups in the incidence of fever, antibiotic requirements, or time to neutrophil engraftment.

Adult↗

A histologic study of nonmorphogenetic forms of hereditary hearing impairment.

It appears that many forms of syndromic and nonsyndromic hereditary hearing impairment are secondary to either neuroepithelial or cochleosaccular dysfunction. Making this distinction can be difficult in human temporal bone specimens; however, this added knowledge may ultimately provide prognostic and therapeutic information in hearing habilitation. Fundamental studies using animal models of different types of hereditary deafness may also prove useful in this respect.

Adult↗

Screening audiometry using the high-risk register in a level III nursery.

Several factors, including those in the high-risk register, were studied in 1240 graduates of an intensive care nursery who underwent auditory brain-stem response testing. Univariate analysis, with chi 2 and Fisher's Exact Test, and stepwise logistic regression were used to identify variables associated with auditory brain-stem response outcomes. Results suggest that factors in the high-risk register do not carry equal weight and that universal screening in the intensive care nursery may be preferable.

Apgar Score↗

Postreceptor events associated with human neutrophil activation by interleukin-8.

Recombinant human monocyte-derived interleukin-8 (IL-8M), recombinant human endothelium-derived IL-8 (IL-8E), and a recombinant human truncated form of IL-8 (IL-8T) stimulated a time-dependent (t 1/2 approximately 2-3 s) and concentration-dependent (0.1-100 nM) release of azurophil (myeloperoxidase) and specific (vitamin B12 binding protein, gelatinase) granule constituents from cytochalasin B-treated human neutrophils (HNs) wherein IL-8T = IL-8M greater than IL-8E. An increase in the cytosolic free calcium concentration ([Ca2+]i) was greater in IL-8T- than in IL-8M- or IL-8E-activated HNs, and IL-8T was more potent than either IL-8M or IL-8E in sequentially desensitizing the HNs to the effects of the other IL-8 forms. IL-8 induced a time- and concentration-dependent (0.1-100 nM) increase in the production of inositol 1,4,5-trisphosphate (IP3) in HNs. U-73122 (1-[6-[[17 beta-3-methoxyestra-1,3,5(10)-trien-17- yl]amino]hexyl]-1H-pyrrole-2,5-dione), a potent inhibitor of phospholipase C-catalyzed events in HNs, suppressed IL-8-triggered IP3 production, increased [Ca2+]i and granule exocytosis in HNs. The membrane-associated activity of the alpha and beta subtypes of protein kinase C was significantly enhanced in IL-8-activated cells.

Antibodies↗

Regulation of glucose kinetics in trauma patients by insulin and glucagon.

The current study was undertaken to evaluate the contribution of insulin and glucagon to regulation of glucose metabolism in man following severe, traumatic injury by manipulating concentrations of insulin and glucagon with infusions of somatostatin. Glucose kinetics were assessed with [U-14C, 6-(3)H]glucose in severely injured patients and compared with data obtained from patients recovering from minor, elective operative procedures. Glucose production was significantly increased in subjects with traumatic injury compared with control subjects (13.0 +/- 0.63 mumol/kg/min v 8.6 +/- 0.27 mumol/kg/min). There was no impairment in glucose oxidation by the injured patients. Modulation of insulin and glucagon with somatostatin indicated that non-insulin-mediated glucose uptake (NIMGU) was significantly elevated in injured patients (12.2 +/- 0.94 mumol/kg/min v 7.4 +/- 0.61 mumol/kg/min). Hepatic glucose output (HGO) in the absence of glucagon was also significantly elevated in injured patients (12.2 +/- 1.20 mumol/kg/min v 5.8 +/- 1.08 mumol/kg/min). Indirect calorimetry showed a 27% increase in resting energy expenditure (REE). Increased protein oxidation accounted for 56% of the increase in REE. Changes in carbohydrate and lipid oxidation accounted for 28% and 15% of the increase in REE. There was no correlation between the injury severity score of the injured patient and the degree of metabolic abnormality. It is concluded from these studies that (1) injured patients have a high rate of glucose turnover in the absence of glucagon and insulin; (2) the reliance on glucose as a source of energy is not diminished in injured subjects; and (3) increases in protein oxidation account for the majority of the increased REE found in injured patients.

Adolescent↗