Search PubMed⌕ Search

Biomedical subjects

R Thomas

Publications and source records attributed to R Thomas.

At least 415 records · Page 23Linked to original sources
PubMed1994

Decision making system.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Toward classification of dysphagic patients using biomechanical measurements.

Identification of a patient at risk of aspiration is a major problem in the rehabilitation of the dysphagic patient. The present methods of diagnosis are based on clinical evaluation or videofluorography or fiberoptic endoscopic examination of swallowing (FEES). Recently, we developed biomechanical techniques for noninvasive quantitative assessment of the dysphagic patient. The purpose of the present investigation was to assess the clinical validity of the technique. In a double-blind study, both biomechanical test results and videofluorography (including bedside evaluation) results were used to independently classify the patients into four categories of risk for aspiration. Of the 36 patients studied, there was complete agreement between the biomechanical and clinical classifications in 21 patients. In 11 patients, the biomechanical technique overestimated the risk by one category, and underestimated the risk by one category in four patients. The biomechanical technique presents a useful tool for continued patient assessment; however, further studies are needed.

Adult↗
PubMed1994

Evidence for a defect of antibody-dependent cellular cytotoxic (ADCC) effector function and anti-HIV gp120/41-specific ADCC-mediating antibody titres in HIV-infected individuals.

Antibody-dependent cellular cytotoxicity (ADCC) is an important antiviral effector mechanism. However, its role, as well as the functional integrity of the ADCC-effector cells in HIV infections, is not well understood. For studying gp120/41-specific ADCC, we recently developed a virus-free target cell system, using a natural killer (NK) cell activity-resistant human lymphoid cell line of B lineage, which was transfected with the env gene of the human immunodeficiency virus type 1 (HIV-1); gp120/41-expressing cell clones were thus selected. In this study, these gp120/41-expressing cloned cells were used as targets in a gp120/41-specific ADCC assay for (a) examining the functional integrity of ADCC-effector cells from HIV-seropositive individuals, and (b) titrating the sera of these individuals for gp120/41-specific, ADCC-mediating antibodies. Our data indicate for the first time that the percentage of sera positive for ADCC-mediating antibodies to gp120/41 is higher in individuals with CD4 counts < or = 400 and > or = 200/mm3. The individuals with CD4 counts < 200/mm3 were found to have the lowest titers of these antibodies in their sera. The ADCC-effector function of the peripheral blood mononuclear cells (PBMC) of HIV-infected individuals was significantly (p < 0.05) reduced as compared to the PBMC from healthy, HIV-seronegative individuals. Further, human recombinant IL2 and interferon-gamma were found to exert a significant (p < 0.05) enhancing effect on ADCC mediated by PBMC from these HIV-infected individuals.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Monoclonal↗
PubMed1994

Angiocentric T cell lymphoma masquerading as cutaneous vasculitis.

Angiocentric T cell lymphoma may present with cutaneous inflammatory lesions masquerading as cutaneous vasculitis both clinically and pathologically. We describe a case of angiocentric T cell lymphoma. Although initial biopsies in this patient resembled polyarteritis nodosa, subsequent biopsies exhibited more characteristic changes and immunohistochemical stains confirmed the diagnosis of large cell angiocentric cutaneous T cell lymphoma. It is important to differentiate these diseases as treatment and prognostic implications are very different.

Adult↗
PubMed1994

Phacoemulsification--a senior surgeon's learning curve.

We sought to prospectively document and evaluate the learning curve of an experienced extracapsular surgeon making a supervised transition from extracapsular cataract extraction (ECCE) to phacoemulsification. Over a period of 2 weeks, 51 phacoemulsification procedures using an endocapsular nucleofractis technique were performed by a single senior surgeon at the Christian Medical College in Vellore, India under the supervision of a visiting US expert with more than 15 years' experience in the technique. Vitreous loss occurred in seven eyes (six prior to the stage of cortical aspiration); failure of capsulorhexis necessitated conversion to standard ECCE in four. Injury to the inferior iris during phacoemulsification was cosmetically significant in three eyes. Two eyes had mild persistent localized corneal edema, but there were no instances of permanent corneal damage. One eye had intraoperative displacement of the nucleus into the vitreous. In one eye with vitreous loss, the implanted intraocular lens dislocated into the vitreous cavity. Two patients had clinically detectable cystoid macular edema at 6 weeks. Eleven patients were lost to follow up after 3 weeks. Six weeks after surgery, 36 of the remaining 40 eyes (90%) had achieved a best-corrected visual acuity of 6/6. We conclude that phacoemulsification requires supervised learning, even for an experienced surgeon. Complications still occurred, but were restricted to the unfamiliar steps of the surgery. Factors identified in the first 2 days of surgery (10 cases) as critical in the smooth transition to phacoemulsification were careful selection of initial cases, a successful capsulorhexis, and hydrodissection with vigorous nucleus mobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Astigmatism↗
PubMed1994

Incidence, prevalence and possible risk factors for pneumonitis in patients with rheumatoid arthritis receiving methotrexate.

OBJECTIVE: Methotrexate (MTX) is being used increasingly to treat rheumatoid arthritis (RA). Pneumonitis is a serious side effect of MTX therapy (P-MTX). Our aim was to determine in patients with RA the incidence and prevalence of P-MTX in Western Australia and identify risk factors for the development of this adverse reaction. METHODS: Patients with P-MTX were identified by (a) direct communication with rheumatologists in Western Australia, (b) use of a computerized clinical database, (c) questionnaire inquiry of all other rheumatologists in Australia. Possible risk factors for P-MTX were examined using age/sex matched case controls selected from the computerized clinical database. RESULTS: Ten definite and 3 probable cases of P-MTX were identified. Local incidence of P-MTX was 1/35.4 patient years MTX treatment; if definite and probable cases are included (1/49.6 patient years MTX treatment for definite cases alone). Twelve patients with P-MTX were compared with 24 age/sex matched controls. A shorter duration of MTX treatment and a higher incidence of preexisting lung disease were observed in P-MTX cases but these differences were not statistically significant. No difference was observed between the P-MTX and control patients with respect to rheumatoid factor, duration of RA, use of tobacco, dose of MTX, serum creatinine, creatinine clearance or concurrent treatment with aspirin, nonsteroidal antirheumatic drugs or prednisolone. CONCLUSION: Our results indicate that in hospital clinic patients with RA pneumonitis is a common adverse reaction. They suggest that hypersensitivity is probably responsible for most cases of pneumonitis associated with MTX, but preexisting lung disease may confer increased risk.

Aged↗
PubMed1993

The denaturation of DNA.

Nucleic acids display a very characteristic ultraviolet absorption spectrum with a maximum near 260 nm and a minimum near 230 nm. It was discovered in 1950 that the spectrum of native DNA is much lower than the spectrum calculated from its constituent nucleotides (nt). The observed absorbance strongly increases (hyperchromic effect), not only following hydrolysis, but also following mild treatments, known to respect the phosphoester bonds between nt (and to have little effect on the molecular weight). These results show that DNA has a secondary structure made of secondary valence interactions between the nitrogen bases, and that this secondary structure collapses (DNA denaturation) following mild treatments (low pH, high temperature or, even simply, low salt concentration).

DNA↗
PubMed1993

Comparative accessory cell function of human peripheral blood dendritic cells and monocytes.

The capacity of human peripheral blood (PB) dendritic cells (DC) and monocytes to facilitate T cell activation and the interaction molecules employed were compared. We have shown that precursors of DC constitute 2 to 3% of circulating PBMC, and can be isolated as CD33+CD14dim cells, whereas monocytes are CD33+CD14bright. Freshly obtained DC expressed similar densities of HLA-DR and the accessory molecules LFA-3, ICAM-1, and B7 as monocytes; after a 36-h incubation the expression of HLA-DR, ICAM-1, and B7 increased on both APC. Accessory cell function was examined in PB T cell cultures stimulated by suboptimal concentrations of immobilized mAb to CD3, and by stimulation of an allospecific T cell line. Freshly isolated monocytes and DC were comparable accessory cells in these assays, but their accessory function was increased by in vitro preincubation, although cultured DC and monocytes were comparably active. In contrast, DC were much more effective stimulators of freshly isolated allogeneic T cells than monocytes. DC were much more effective stimulators of freshly isolated allogeneic PB CD4+ naive and memory T cells than monocytes, whereas DC and monocytes were comparable accessory cells for memory and naive T cells stimulated with immobilized anti-CD3. The accessory molecules ICAM-1, LFA-3, and B7 were used comparably by DC and monocytes for accessory function in the presence of immobilized anti-CD3 and in the MLR, and none was unique for either APC population. These accessory molecules costimulated T cells in an additive fashion. Although immature blood DC and monocytes expressed minimal B7 and did not utilize it as an accessory molecule, B7 played an important role in the increased accessory function of differentiated APC. The results indicate that PB DC and monocytes function most efficiently after differentiation into mature cells that express increased amounts of MHC and other accessory molecules. Because DC and monocytes exhibit comparable accessory function in anti-CD3 T cell stimulation, differences in the expression of MHC molecules and/or their bound peptides are likely to explain the markedly enhanced capacity of DC to stimulate allogeneic PB T cells.

Adult↗
PubMed1993

Cell growth and lambda phage development controlled by the same essential Escherichia coli gene, ftsH/hflB.

The lambda phage choice between lysis and lysogeny is influenced by certain host functions in Escherichia coli. We found that the frequency of lambda lysogenization is markedly increased in the ftsH1 temperature-sensitive mutant. The ftsH gene, previously shown to code for an essential inner membrane protein with putative ATPase activity, is identical to hflB, a gene involved in the stability of the phage cII activator protein. The lysogenic decision controlled by FtsH/HflB is independent of that controlled by the protease HflA. Overproduction of FtsH/HflB suppresses the high frequency of lysogenization in an hflA null mutant. The FtsH/HflB protein, which stimulates cII degradation, may be a component of an HflA-independent proteolytic pathway, or it may act as a chaperone, maintaining cII in a conformation subject to proteolysis via such a pathway. Suppressor mutations of ftsH1 temperature-sensitive lethality, located in the fur gene (coding for the ferric uptake regulator), did not restore FtsH/HflB activity with respect to lambda lysogenization.

ATP-Dependent Proteases↗
PubMed1993

'Big sister' and critics.

Health care: Clinton is ready to negotiate, but Hillary continues her crusade for converts, hoping to silence opponents and avoid compromise. She is failing on both fronts.

Health Care Reform↗
PubMed1993

Prediction of cardiovascular death in men undergoing noninvasive evaluation for coronary artery disease.

OBJECTIVE: To develop prediction rules from clinical and exercise test data identifying patients at high and low risk for cardiovascular events among a group of male veterans. DESIGN: Prognostic study with prospective gathering of data and routine follow-up of consecutive patients referred for exercise testing. Patients only underwent noninvasive evaluation for coronary artery disease. No validation cohort is yet available. SETTING: A 1200-bed Veterans Affairs Medical Center. PATIENTS: Of 3609 men referred for exercise testing between 1984 and 1990, 2546 patients remained evaluable after exclusion of those who underwent subsequent cardiac catheterization, those with significant valvular heart disease, and those who had previous coronary artery bypass surgery. MEASUREMENTS: Evaluation included recording of clinical data on a standardized form and a standard treadmill test followed by assessment of cardiovascular events. RESULTS: During a mean follow-up period (+/- SD) of 2.75 (+/- 18) years, 119 cardiovascular deaths and 44 nonfatal myocardial infarctions occurred in 2546 patients. The Cox proportional hazards model showed the following characteristics to be statistically independent predictors of time until cardiovascular death: history of congestive heart failure or digoxin use, exercise-induced ST depression, change in systolic blood pressure during exercise, and exercise capacity. Using a simple score based on one item of clinical information (history of congestive heart failure or digoxin use) and three exercise test responses (ST depression, exercise capacity, and change in systolic blood pressure), 77% of patients were categorized as low risk (annual cardiac mortality rate, less than 2%), 18% as moderate risk (annual cardiac mortality rate, 7%), and 6% as high risk (annual cardiac mortality rate, 15%; hazard ratio, 10; 95% confidence interval, 6 to 17). This model has not yet been validated. CONCLUSIONS: Variables available from the usual non-invasive work-up of patients with known or suspected coronary artery disease can be used to predict future risk for cardiovascular death.

Aged↗