Regulation of the uterine epidermal growth factor receptor by estrogen.
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Animals↗
Biomedical subjects
R M Gardner
Publications and source records attributed to R M Gardner.
The role of smart medical systems in the Space Station.
NASA is developing a Health Maintenance Facility to provide medical equipment and supplies requisite for the Space Station to be launched in the late 1990s. An essential component of this medical facility is a computerized Medical Decision Support System which will expedite medical officers' efforts to maintain the crew's health. The computerized system includes four major functions: 1. A data collection and storage system with a self-contained medical expert scheme for performing treatment protocols. The expert system has 'data driven' and 'time driven' capabilities to facilitate automatic decision-making functions. 2. An integrated medical record and medical 'reference' information management component. 3. An inventory management system for medical supplies and pharmaceuticals. 4. Video, audio, and data communications between the medical officer in the Space Station and ground-based medical personnel. This paper discusses the design of such computerized data collection, communications and expert medical systems as will be developed for use in a Space Station Health Maintenance Facility.
Aerospace Medicine↗
Medical information bus: the key to future integrated monitoring.
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Computer Systems↗
Implementation of a computerized patient advice system using the HELP clinical information system.
A COMputerized Patient Advice System (COMPAS) was designed to test the feasibility of using the HELP clinical information system to direct the respiratory therapy of intensive care (ICU) patients acutely ill with adult respiratory distress syndrome. A modified black-board control architecture allowed the application of knowledge in either a forward or a backward chaining mode. Expert clinicians recommended decision logic and actions for five different modes of ventilatory support. The clinical staff used COMPAS to manage the ICU ventilatory support of five patients for a total of 624 hr. During that time there were 407 decision-making opportunities. COMPAS automatically generated therapy suggestions 379 (93.1%) times and the clinical staff accepted COMPAS's recommendation in 320 (84.4%) of these cases. These results suggest that the ventilatory support of severely ill ICU patients can be managed by a clinical information system using a blackboard control architecture.
Algorithms↗
Development of a computerized laboratory alerting system.
Using the capabilities of the HELP medical information system at LDS Hospital, a Computerized Laboratory Alerting System (CLAS) was developed. CLAS monitors and alerts for the presence of life-threatening conditions in hospitalized patients which are indicated by laboratory test results. Alerts are posted on computer terminals on the hospital's nursing divisions, where they are reviewed and acknowledged by hospital staff so that appropriate treatment can be rapidly instituted. CLAS was evaluated to determine its effectiveness in relaying alerts to the clinical staff, and improvements were made to develop an effective user interface. Initial average alert response times on nursing divisions ranged from 5.1 to 58.2 hr. The average alert response time dropped to 3.6 hr when alert review was integrated with laboratory result review, and to 0.1 hr after installation of a flashing light to notify hospital staff of the presence of new alerts.
Clinical Laboratory Information Systems↗
Mirror feedback and judgments of body size.
Body size perception was measured in 44 obese and normal weight subjects using a video TV methodology. Subjects performed a task whereby they manipulated the size of their body image on a TV screen. Subjects viewed their images in the presence and absence of a full length mirror. Subjects were more accurate judging body size with the mirror present. Subjects also responded more slowly and made more adjustments of their body image when the mirror was present. No differences between obese and normal weight subjects were found. Ramifications of the findings for individuals who diet are discussed.
Body Constitution↗
Regulation of uterine epidermal growth factor (EGF) receptors by estrogen in the mature rat and during the estrous cycle.
Previous work has shown that the immature rat uterus contains epidermal growth factor (EGF) receptors and that tissue levels of this receptor are increased by the administration of exogenous estrogens. This study was undertaken to determine if estrogen administration also elevated EGF receptor levels in the mature animal and if the growth factor receptor levels varied in concert with endogenous estrogens throughout the estrous cycle. In the mature, castrate rat administration of estradiol, but not non-estrogenic steroids, causes a 2-3-fold elevation of uterine EGF receptors as judged by ligand binding. This increase is maximum in 18 h and is due to an increase in the number of binding sites. In cycling animals EGF receptor levels are low at metestrus, rise at diestrus, reach a maximum (approximately twice metestrus values) at proestrus, and then return at estrus to metestrus levels. These changes in EGF receptor levels parallel changes in plasma estrogens and occupied nuclear estrogen receptor reported by other workers. These results indicate that uterine EGF receptors are increased by exogenous estrogens in both mature and immature animals, and support a physiological role for estrogens in the regulation of this growth factor receptor.
Animals↗
Improved perioperative antibiotic use and reduced surgical wound infections through use of computer decision analysis.
A prospective study was performed over a two-year period to determine whether computer-generated reminders of perioperative antibiotic use could improve prescribing habits and reduce postoperative wound infections. During the first year, baseline patterns of antibiotic use and postoperative infection rates were established. During the second year, computer-generated reminders regarding perioperative antibiotic use were placed in the patient's medical record prior to surgery and patterns of antibiotic use and postoperative wound infections monitored. Hospitalized patients undergoing non-emergency surgery from June to November 1985 (3,263 patients), and from June to November 1986 (3,568) were monitored with respect to indications for perioperative antibiotic use, timing of antibiotic use and postoperative infectious complications. Perioperative antibiotic use was considered advisable for 1,621 (50%) patients in the 1985 sample and for 1,830 (51%) patients in the 1986 sample. Among these patients, antibiotics were given within two hours before the surgical incision in 638 (40%) of the 1985 sample and 1,070 (58%) of the 1986 sample (p less than 0.001). Overall, postoperative wound infections were detected in 28 (1.8%) of 1,621 patients in 1985 compared with 16 (0.9%) of 1,830 such patients in 1986 (p less than 0.03). We conclude that computer-generated reminders of perioperative antibiotic use improved prescribing habits with a concurrent decline in postoperative wound infections.
Anti-Bacterial Agents↗
Subjective equality and just noticeable differences in body-size judgments by obese persons.
Body-size estimates by obese and normal-weight subjects were compared using two different procedures with a TV-video methodology. In the continuous method subjects adjusted an image larger or smaller until they judged a correct TV-image had been achieved. In the second procedure the method of constant stimuli was used wherein values corresponding to the point of subjective equality (PSE) and difference threshold (DL) were determined. No differences between obese and normal-weight subjects were obtained with these procedures. On the continuous task subjects slightly underestimated body size and were more accurate on descending trials where they adjusted the size of the image downwards. With the second procedure, an average PSE of -.62% was obtained, with an average DL = 7.27%. Different PSE values were obtained when subjects were judging whether their image was distorted too wide or too thin. Data from the two procedures are compared and ramifications for the study of body size are discussed.
Body Constitution↗
The effect of estradiol on collagen structure and organization in the immature rat uterus.
An examination of collagen ultrastructure in the lamina propria of the immature ovariectomized rat uterus revealed that a single injection of estradiol (40 micrograms/kg) produced a biphasic effect on collagen structure and organization. In saline-treated animals (controls) dense populations of collagen bundles were seen throughout the extracellular matrix (EX). Cross-sections of these bundles suggested that the bundles run parallel to the long axis of the uterus and thin filaments seemed to form cross-links between collagen fibers. In contrast, large clear spaces, collagen fragments, and loosely packed bundles of collagen were observed in the EX of animals injected with estradiol 24 hr earlier. In a time course study (0, 1, 2, 4, 24, and 48 hr), estradiol treatment altered collagen structure and organization 1 hr following administration. Collagen bundles did not appear to be as densely packed as in control tissues and large clear spaces were evident in the EX. Two hours following estrogen administration, collagen fibers appeared to be fragmented and seemed to be separating from the plasma membrane of stromal cells. Four hours following estrogen administration, large clear spaces occupied most of the EX in the lamina propria. Collagen fragments were diffusely distributed throughout the EX and small cross-sectional patches of collagen bundles were present. In 48-hr-treated animals, collagen bundles reappeared and were often closely associated with the plasma membrane of stromal cells. The collagen was not as abundant as in control animals. An overview of the cellular organization of the lamina propria revealed that stromal cells in control tissues were more densely packed than in estradiol-treated tissues (4, 24, and 48 hr) and the stromal cell size appeared to increase in hormone-treated tissues. These responses provide a good model system to study the role of estradiol in the control of collagen structure and organization in the uterus.
Animals↗
Blockade of epidermal growth factor-induced uterine contractions by indomethacin or nordihydroguaritic acid.
Epidermal growth factor (EGF) induces uterine contractions in an in vitro system. As an initial approach to elucidating the cellular mechanism for this action of EGF, we have characterized this effect pharmacologically in uteri from castrate, estrogenprimed mature rats. EGF-induced contractions are observed in both intact tissue and isolated myometrium, are dependent on extracellular calcium and are inhibited by nifedipine and chlorpromazine. Both indomethacin and nordihydroguaritic acid (NGA) inhibit EGF-induced uterine contractions. At the maximum doses which do not affect contractile responses to prostaglandin E2 or carbachol, indomethacin (10 microM) alone or NGA (1 microM) alone only decrease the effect of EGF by 60 to 80%, but indomethacin and NGA in combination abolish totally the response to the growth factor. Arachidonic acid also causes uterine contractions in this system. EGF increases uterine contractions in the presence of a submaximal (1 microM) but not a maximal (10 microM) dose of arachidonic acid. These findings suggest that EGF-induced contractions result from a mobilization of myometrial arachidonic acid, production of intermediates via both lipoxygenase and cyclooxygenase catalyzed pathways and a resultant influx of extracellular calcium.
Animals↗
Computerizing the intensive care unit: current status and future directions.
Computers are serving intensive care patients by simplifying and improving the accuracy of data acquisition, facilitating communications, storing and organizing patient records, and providing expert suggestions. The future will bring many changes in the way nurses practice in intensive care. The computer should be considered an evolutionary tool to help effect these changes.
Communication↗
Spirometry and flow-volume curves.
Spirometry is the best and most widely used pulmonary function test. Equipment recommendations are made and performance information about different types of spirometers is given. Methods for obtaining clinically applicable spirometric results for use in making diagnostic and treatment decisions are presented. Selection and use of reference or "normal" values and interpretive strategies are discussed.
Forced Expiratory Flow Rates↗
Nursing in London--a capital experience?
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Career Choice↗
Body image distortion in anorexics as a non-sensory phenomenon: a signal detection approach.
Body image in anorexic and normal weight female subjects was investigated with a video TV monitor. Eighteen subjects were presented with a task in which they manipulated their body size to obtain "ideal" and actual images and a task wherein they judged the accuracy of a projected image of their body. There were no differences in estimated actual body size between anorexics and control subjects. For both groups, ideal images were below their actual image. For the second task, a signal detection analysis revealed no sensory sensitivity differences between weight groups. Anorexic subjects were more likely to report an image of themselves as distorted, regardless of whether distortion was present. Both weight groups adopted a strict criterion when they were viewing a heavy image of themselves. The finding that body estimation difference between anorexics and controls is non-sensory are discussed, and ramifications for treatment of anorexia are described.
Adult↗
Portable computers used for respiratory care charting.
We studied the feasibility of using a portable lap computer (PLC) for bedside documentation of respiratory care procedures. Three Radio Shack TRS-80 Model 100 (PLCs) were used to capture and transfer the charting by phone into the hospital information system (HIS). Charting on the PLC could be done anywhere at the convenience of the therapist. Transferring data from the PLC to the HIS could be accomplished from any patient room, since all had phone jacks. Once information was entered into the HIS, it became immediately available for review on all nursing station terminals. A 39-day study of 5,019 entries was conducted using 12 therapists of whom 6 were randomly selected to carry PLCs and the other 6 used conventional ward terminals. We found that: 1) There was no statistically significant difference between PLC and nursing terminal entry in productivity or promptness of reporting; 2) Ward terminals were generally available for entry; 3) Cost, maintenance, initial training required, and therapist preference favored ward entry. We conclude that a PLC can be used in a clinical setting as a means of collecting and reporting data from the bedside, and as an input device to a larger computer system, but offers considerable disadvantages in comparison to entry at conventional terminals on the HIS if they are readily accessible.
Computers↗
The biological assessment of vitamin D3 metabolites produced by rumen bacteria.
Biological assays were performed to evaluate 10-oxo-19-nor-vitamin D3 (10-oxo-D3) and 5(E) 25-hydroxy-10-oxo-19-nor-vitamin D3 (25-OH-10-oxo-D3) two bacterial products of vitamin D3 (D3) and 25-hydroxyvitamin D3 (25-OHD3) metabolism, respectively. The 5(Z) and 5(E) isomers of 10-oxo-D3 were, respectively, 40- and 80-fold less active than D3 in stimulating Ca+2 absorption from the gut. 25-Hydroxy-10-oxo-D3 did not stimulate Ca+2 absorption. Only 5(Z) 10-oxo-D3 induced mobilization of bone Ca+2. In addition, both 10-oxo-D3 and 25-OH-10-oxo-D3 showed poor affinities for either the plasma D3-binding protein or the thymus 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] receptor. 10-Keto-D3 exhibited a plasma half-life of only 6 min. This was a much shorter half-life than that exhibited by other vitamin D metabolites and was expected because of the poor affinity 10-oxo-D3 has for the plasma vitamin D binding protein. Bacterial metabolism of D3 deactivates the vitamin, which allows ruminants to tolerate relatively large oral doses of D3.
Animals↗
Distortion of body image in the obese: a sensory phenomenon.
Body weight in 42 obese and normal weight subjects was measured using a video TV monitor. Tasks included a continuous task where subjects manipulated the width of their body image on TV, and a discrete task, where they judged the accuracy of their TV image which was presented as either normal, too heavy, or too thin. Subjects rated their full body, body regions which included face, waist, and thighs, and two inanimate control objects. Results from the continuous task revealed that obese subjects overestimated body size more than normals. There was also a significant difference in the ratings of the four body regions, with all regions overestimated. Judgements were more accurate for body regions and control objects on ascending trials where the subjects had to increase the width of the image. No differences were obtained between obese and normals on judgements of the control objects. On the discrete discrimination task, a signal detection analysis revealed sensory sensitivity differences between obese and normal weight subjects. Obese subjects were poorer at detecting size distortions of the body regions. The thin/normal discrimination was more difficult than the heavy/normal discrimination. No response criterion differences were found between obese and control subjects, although subjects adopted a more strict criterion with the thin/normal discriminations. Implications of these findings for clinical intervention in eating disorders are discussed.
Adult↗