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Biomedical subjects

R L Williams

Publications and source records attributed to R L Williams.

At least 145 records · Page 8Linked to original sources

The crystal structure of a human nucleoside diphosphate kinase, NM23-H2.

The 2.8 A resolution X-ray structure of NM23-H2 has been determined by molecular replacement using the structure of Myxococcus xanthus nucleoside diphosphate (NDP) kinase. NM23-H2 is a human NDP kinase. The enzyme catalyses phosphoryl transfer, binds DNA, and can activate the transcription of the c-myc oncogene in vitro. NM23 has also been reported to be a suppressor of metastasis in some types of tumours. Whereas the M. xanthus NDP kinase is a tetramer, NM23-H2 is a hexamer. The fold of NM23-H2 is identical to the fold of other NDP kinases. Two antiparallel helices joined by a turn form one edge of the nucleotide binding cleft. This region moves in a hinge-like fashion in response to substrate binding and crystal packing forces. Additional differences in conformation among the NDP kinases are principally in regions involved in protein-protein contacts within the oligomers. The only protein-protein interaction conserved among all NDP kinases is a dimeric interaction. Several mutations of NM23-H2 have been detected in tumour tissues. These mutations do not involve residues interacting with the substrates, and probably destabilise the enzyme without directly affecting the catalytic activity. Low level phosphorylation of serines has been reported for NM23 both in vitro and in vivo. The structure of the hexamer indicates that two serine residues that have been reported as being phosphorylated, Ser44 and Ser122, are on the surface of the hexamer, and are likely to be phosphorylated by exogenous kinases. In contrast, Ser120 is buried, and is most likely phosphorylated by a direct transfer from the phosphohistidine intermediate of the reaction mechanism.

Amino Acid Sequence↗

The 1.9 A crystal structure of a nucleoside diphosphate kinase complex with adenosine 3',5'-cyclic monophosphate: evidence for competitive inhibition.

The X-ray structure of Myxococcus xanthus nucleoside diphosphate (NDP) kinase complexed with adenosine 3',5'-cyclic monophosphate (cAMP) has been determined. The structure was solved by difference Fourier analysis. The refined structure has a crystallographic R-factor of 0.17 at 1.9 A resolution. The phosphoryl group and ribose moiety make extensive polar interactions with the protein, whereas the base interacts only with two hydrophobic residues. The comparison with the structure of the enzyme complex with the substrate adenosine diphosphate (ADP) reported earlier shows that cAMP and ADP interact similarly with the enzyme. The base of the cAMP is present in two conformations, syn and anti, with respect to the sugar. The syn conformer is dominant. Based on the effect of cAMP on phosphorylation of the human NDP kinase NM23, it had been proposed that cAMP might interact with NDP kinase in a manner distinct from other nucleotides. However, the structure of the M. xanthus NDP kinase/cAMP complex indicates that the nucleotide is a competitive inhibitor of the enzyme and occupies the usual nucleotide site. Kinetic assays of the NDP kinase activity in the presence of cAMP were done. Their results are consistent with a competitive character of the cAMP inhibition.

Adenosine Diphosphate↗

Nm23/nucleoside diphosphate kinase: toward a structural and biochemical understanding of its biological functions.

The nm23 gene, a putative metastasis suppressor gene, was originally identified by its reduced expression in highly metastatic K-1735 murine melanoma cell lines, as compared to related, low metastatic melanoma cell lines. Transfection of nm23 cDNA has been reported to suppress malignant progression in Drosophila and mammalian cells. Highly conserved homologues of nm23 have been found in organisms ranging from the prokaryote Myxococcus xanthus to Drosophila, where the gene is involved in normal development and differentiation. The product of the nm23 gene exhibits a nucleoside diphosphate kinase activity, yet the nucleoside diphosphate kinase activity of Nm23 does not correlate with its apparent biological functions. We review recent cellular, genetic, biochemical and X-ray crystallographic data to formulate and evaluate hypotheses concerning the molecular mechanism of nm23 action.

Animals↗

Fibroblast adhesion onto methyl-silica gradients with and without preadsorbed protein.

This study was designed to evaluate the interfacial interactions between proteins and cells and a model surface which varied in its surface energy. The adsorption of proteins from single and binary solutions was studied using ellipsometry and the adhesion and spreading of L929 fibroblasts has been quantified using image analysis. The results demonstrated that after 24 h incubation, multilayer adsorbed fibrinogen appeared to produce a surface most conductive to cell adhesion and spreading on both the hydrophilic and hydrophobic regions of the material. Fibronectin on its own did not produce an optimal surface for cell spreading. Albumin produced a suitable surface for cell spreading on the hydrophilic part of the surface, but created a highly unsuitable surface on the hydrophobic region of the specimens. Competition between proteins for adsorption to the surface and changes in protein conformation was evident, particularly on the hydrophobic part of the material, and this was shown to influence cell adhesion and spreading.

Adsorption↗

Product-limit survival functions with correlated survival times.

A simple variance estimator for product-limit survival functions is demonstrated for survival times with nested errors. Such data arise whenever survival times are observed within clusters of related observations. Greenwood's formula, which assumes independent observations, is not appropriate in this situation. A robust variance estimator is developed using Taylor series linearized values and the between-cluster variance estimator commonly used in multi-stage sample surveys. A simulation study shows that the between-cluster variance estimator is approximately unbiased and yields confidence intervals that maintain the nominal level for several patterns of correlated survival times. The simulation study also shows that Greenwood's formula underestimates the variance when the survival times are positively correlated within a cluster and yields confidence intervals that are too narrow. Extension to life table methods is also discussed.

Angina Pectoris↗

Forearm fractures in children: avoiding redisplacement.

We reviewed eighty-six children with closed extra-articular distal forearm fractures to determine the factors responsible for early redisplacement. The most important favourable prognostic factor was a perfect anatomical reduction on the immediate post-reduction radiograph. This was far more likely when the manipulation was performed by an experienced surgeon.

Adolescent↗

The provision of innervated skin cover for the injured thumb using dorsal metacarpal artery island flaps.

Provision of stable sensate skin is of great importance in reconstruction of the injured thumb. Island flaps based on the dorsal metacarpal arteries were used to resurface ten injured thumbs, and the degree of retained sensibility was assessed using static and moving two-point discrimination and the pick-up test. Results show that these flaps are capable of providing stable full-thickness skin cover in a single procedure and functional sensibility is retained in most cases. The second dorsal metacarpal artery island flap, previously advocated for use in small thumb defects only, has been successfully used as a large wraparound flap in two cases. In one of these it was used with free bone graft to increase the length of the thumb and an excellent functional result was achieved.

Adolescent↗

Nitric oxide synthesis inhibition does not improve the hemodynamic response to hemorrhagic shock in dehydrated conscious swine.

Nitric oxide (NO) may influence the hemodynamic response to hemorrhage. To test this hypothesis, the NO synthesis inhibitor N omega-nitro-L-arginine methyl ester (L-NAME) was administered to conscious, dehydrated swine during a 37% blood volume hemorrhage and a 180 min recovery period without fluid resuscitation. L-NAME (.75 mg/kg bolus plus constant infusion of .75 mg/kg/h) was given via a central intravenous catheter during the bleed. The selectivity and specificity of L-NAME as a NO synthesis inhibitor in pigs was validated in pilot studies. The present study shows that inhibition of NO synthesis with L-NAME had no significant effect on the major hemodynamic parameters during and after hemorrhage when compared to dehydrated and euhydrated control groups. Only stroke volume and A-VO2 were significantly different from controls. Mortality was 83% for the L-NAME group and 44% for controls at 180 min of recovery (NS). The results suggest that NO synthesis inhibition provides no hemodynamic benefit during hemorrhage in dehydrated, conscious swine.

Animals↗

Skiing injuries: the increasing workload.

All skiing injuries presenting to a fracture clinic during the period December 1992 to April 1993 were studied. Fifty five patients with 59 injuries were treated during this period. Thirty (54.5%) were male and 25 (45.5%) female. The mean age was 34 years (range 9-61). The anatomical distribution of injuries seen corresponded very closely with those seen in much larger studies abroad. There were 35 upper limb injuries (59.3%), 22 lower limb injuries (37.3%), with only two spine and trunk injuries (3.4%). While only two patients underwent surgery abroad, a further 12 needed surgical intervention on return, requiring a total stay of 61 'inpatient days'. The bulk of the workload was, however, on an outpatient basis, with a total of 172 appointments. Many advances have been made towards improving the safety of skiing. However with skiing becoming increasingly popular we can expect an increasing workload and cost associated with such injuries.

Adolescent↗

Relationship of self-management to personality types and indices.

This study addressed the relationship between self-management (as measured by the Lifestyle Approaches Inventory, Williams, Moore, Pettibone, & Thomas, 1992) and personality types and indexes (as measured by the Myers-Briggs Type Indicator, Myers & McCaulley, 1985) in a sample of 347 university students. Correlational analyses indicated that the self-management factor most consistently linked to the Myers-Briggs indices was Organization of Physical Space. The Myers-Briggs index most consistently correlated with the self-management factors was Judgment-Perception. Overall, male and female subjects showed similar patterns of relationships between the self-management and personality indices. When the self-management scores were compared for the various Myers-Briggs types, the analysis indicated that types having a J (planful and organized) or S (precise and practical) in the typology tended to score higher than those having a P (spontaneous and flexible) or N (imaginative and insightful).

Adolescent↗

Femoral nerve block in extracapsular femoral neck fractures.

We randomised 50 patients with extracapsular fractures of the femoral neck to receive either a bupivacaine femoral nerve block or systemic analgesia alone. A femoral nerve block was found to be an easy and effective procedure which significantly reduced perioperative analgesic requirements and postoperative morbidity.

Aged↗

Cluster sampling techniques in quantal response teratology and developmental toxicity studies.

This paper presents a model-free approach for evaluating teratology and developmental toxicity data involving clustered binary responses. In teratology studies, a major statistical problem arises from the effect of intralitter correlation, or the potential for littermates to respond similarly. Some statistical methods impose strict distributional assumptions to account for extra-binomial variation, while others rely on nonparametric resampling and empirical variance estimation techniques. Quasi-likelihood methods and generalized estimating equations (GEE), which model the marginal mean/variance relationship, also avoid strict distributional assumptions. The proposed approach, often used to analyze complex sample survey data, is based on a first-order Taylor series approximation and a between-cluster variance estimation procedure, yielding consistent variance estimates for binomial-based proportions and regression coefficients from dose-response models. The cluster sample technique, presented here in the context of a logistic dose-response model, incorporates many of the advantages of quasi-likelihood methods, are valid for any underlying nested correlation structure, and are adaptable to a variety of analytical settings. The results of a simulation study show the cluster sample technique to be a viable competitor to GEE methods currently receiving attention.

Abnormalities, Drug-Induced↗

A practical tool for community-oriented primary care community diagnosis using a personal computer.

BACKGROUND AND OBJECTIVES: Community-oriented primary care (COPC) is considered an attractive concept by many but has had limited implementation due to a lack of practical methodology. An important step in COPC is assessment of a community's health status, using health indicators as one means of assessment. Currently, there is no easy way to combine these indicators and examine their distribution over a community. This study analyzed a process for doing that by using a personal computer. METHODS: For the community studied, all available community-based health indicators were identified. A process for combining these indicators, using commonly available database and spreadsheet software, was developed and analyzed for cost, clinical utility, and problems encountered. RESULTS: Problems were encountered with collecting and combining some data, but a clinically useful tool was produced. Costs, including purchase of all software (with mapping software), were $1,500-$2,000. CONCLUSIONS: With efforts to reduce the initial costs, this is a practical and clinically useful tool for viewing the geographic distribution of community health indicators. Such practical methodology is essential for COPC development.

Community Health Planning↗

Office laboratory procedures, office economics, patient and parent education, and urinary tract infection.

This section updates the reader on four important areas of office practice: office laboratory procedures, office economics, patient and parent education, and urinary tract infections. Dr. Michael Aldous reviews the recent literature about office laboratory procedures, including the continued impact of the Clinical Laboratory Improvement Ammendments, what is new in the diagnosis of streptococcal pharyngitis, urinalysis improvements, the diagnosis of anemia, and which patients should undergo cholesterol screening. Dr. Rickey Williams discusses the literature on office economics, including new technology for billing and charting, whether pediatricians should bill for telephone calls, and the latest information on health care policy and the changes offices are facing with the growing managed care market. Dr. Burris Duncan reviews patient and parent education, including new apporaches to infant colic, sleep positioning for the prevention of sudden infant death, the need for the hepatitis B vaccine (which has been slowly implemented), and finally ways that pediatricians can help with parenting. Dr. John Ey discusses the recent literature on urinary tract infections in children, including better ways of making the diagnosis, whether there are any new treatment approaches for urinary tract infections, useful investigational studies for evaluating the urinary system, and how best to follow up children with infected urinary tracts. We hope that this review will help the practicing pediatrician to better care for patients and provide each of you with a greater satisfaction in delivering health care in an office setting.

Child↗

Crystal structure of a diabody, a bivalent antibody fragment.

BACKGROUND: Diabodies are dimeric antibody fragments. In each polypeptide, a heavy-chain variable domain (VH) is linked to a light-chain variable domain (VL) but unlike single-chain Fv fragments, each antigen-binding site is formed by pairing of one VH and one VL domain from the two different polypeptides. Diabodies thus have two antigen-binding sites, and can be bispecific. Direct structural evidence is lacking for the connections and dimeric interactions between the two polypeptides of the diabody. RESULTS: The 2.6 A resolution structure has been determined for a bivalent diabody with a flexible five-residue polypeptide linker between the (amino-terminal) VH and (carboxy-terminal) VL domains. The asymmetric unit of the crystal consists of four polypeptides comprising two diabodies; for one of these polypeptides the linker can be traced between the VH and VL domains. Within each diabody the two associated VH and VL domains make back-to-back interactions through the VH domains, and there is an extensive VL-VL interface between the two diabodies in the asymmetric unit. CONCLUSIONS: The structure of the diabody is very similar to that which had been predicted by molecular modelling. Diabodies directed against cell-surface antigens should be capable of bringing together two cells, such as in cell-targeted therapy, because the two antigen-binding sites of the diabody are at opposite ends of the molecule and separated by approximately 65 A.

Amino Acid Sequence↗

Topical 0.050% betamethasone dipropionate. Pharmacokinetic and pharmacodynamic dose-response studies in humans.

BACKGROUND AND DESIGN: Effective topical drug therapy requires drug delivery into the skin to produce the desired pharmacodynamic response. For topical corticosteroids, the visual skin-blanching assay has been used to rank the potency of the corticosteroids and their overall efficacy. While vehicles have been shown to influence the resulting blanching response, the dose of drug applied has not always produced proportional differences in the blanching assay. The mechanism of the nonproportional pharmacodynamic response to the corticosteroid dose is unclear. We describe four methods for assessing the dose-response relationship of topical betamethasone dipropionate on the ventral forearm of six human subjects: duration, concentration, film thickness, and surface area. Drug uptake analysis in human stratum corneum and the resulting pharmacodynamic response, measured visually and with a chromameter, were performed with each method to quantify the dose-response relationship. RESULTS: Only the concentration and duration methods demonstrated an increase in mean drug uptake with increasing dose. The maximal mean pharmacodynamic response reflected the mean drug uptake with all four methods. Application conditions for maximal pharmacodynamic activity of topical betamethasone dipropionate in the skin include short duration of treatment (< or = 2 hours), a lower concentration than commercially marketed, and thin film thicknesses (1 to 5 microns). CONCLUSION: A dose response can be produced by increasing the drug concentration or the duration of application time. Achievement of steady-state betamethasone dipropionate uptake into the stratum corneum was not commensurate with the maximal pharmacodynamic response. Very small amounts of this potent corticosteroid within the skin appear to maximize the receptor response to drug.

Administration, Topical↗

Contact angles of substances used for internal tamponade in retinal detachment surgery.

In order to ascertain the tamponade effect of air and silicone oil we examined the contact angles subtended by ex vivo human retina, Teflon and Perspex to find a suitable experimental material which would mimic the surface properties of the retina at a three-phase interface. Using the captive bubble technique to measure the contact angle, it was found that air subtended a larger contact angle (38.8 degrees) with the retina than did silicone oil (18.2 degrees). On coating the Perspex surface with protein (PCP), it was observed that the surface properties were modified such that PCP subtended contact angles with air (43.0 degrees) and silicone oil (16.4 degrees) similar to those subtended by ex vivo human retina. Using PCP as an experimental material that mimics ex vivo human retina, spherical chambers were employed in order to examine qualitatively and to quantify the arc of contact obtained with air and silicone oil. It was found that air gave a greater arc of contact for the same percentage fill than silicone oil.

Air↗