Biomedical subjects
Publications and source records attributed to R Wilkinson.
This study focuses on the assessment and treatment of the conversations of a couple where one partner has aphasia. The assessment and treatment, informed by conversation analysis, are described, and some implications for the relation between language and psychosocial issues discussed.
A method is presented which can be used to assess the function of hepatocytes in complex culture configurations without disrupting the integrity of the cell environment. It utilises a fluorescent probe for cytochrome P450 dependent mixed function oxidase (MFO) activity diethoxy (5,6) chloromethylfluorescein, and confocal laser scanning microscopy. The MFO activity of individual cells in primary cultures of intact hepatocytes can be detected in situ, and quantified by image analysis. This may be a valuable means of monitoring the effect of culture conditions on the function of bioartificial liver devices, and could be used to assess the need for effective oxygenation of cells, the influence of shear stress and of exposure to patient serum during clinical use.
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Six flexible-leaflet prosthetic heart valves, fabricated from a polyetherurethaneurea (PEUE), underwent long-term fatigue and calcification testing. Three valves exceeded 800 million cycles without failure. Three valves failed at 775, 460, and 544 million cycles, respectively. Calcification was observed with and without associated failure in regions of high strain. Comparison with similar valves fabricated from a polyetherurethane (PEU) suggests that the PEU is likely to fail sooner as a valve leaflet. Localized calcification developed in PEUE leaflets at the primary failure site of PEU leaflets, close to the coaptation region of the three leaflets. The failure mode in PEU valves had the appearance of abrasion wear associated with calcification. High strains in the same area may render the PEUE leaflets vulnerable to calcification. Intrinsic calcification of this type, however, is a long-term phenomenon unlikely to cause early valve failure. Both polymers performed similarly during static in vitro and in vivo calcification testing and demonstrated a much lesser degree of calcification than bioprosthetic types of valve materials. Polyurethane valves can achieve the durabilities required of an implantable prosthetic valve, equaling the fatigue life of currently available bioprosthetic valves.
Familial factors are believed to be important in determining the high sodium-lithium countertransport activity (defined as >0.40 mmol Li/(h x l cell) at external sodium concentration of 140 mmol/L (Nae 140)) which is observed in a proportion of patients with essential hypertension. However, environmental factors such as pregnancy and dyslipidemia also affect activity. High sodium-lithium countertransport activity (Nae 140) in essential hypertension is mainly due to a low Michaelis constant (Km) and is associated with a high Vmax/Km ratio. In contrast, dyslipidemias affect Vmax. This study aimed to determine if there was evidence that Km and Vmax/Km ratios are influenced by familial factors. Sodium-lithium countertransport kinetics were measured in the 47 first degree relatives of 12 hypertensive probands with abnormal sodium-lithium countertransport kinetics and 35 normotensive control subjects. Sodium-lithium countertransport was measured as Na-stimulated Li efflux from lithium loaded erythrocytes. The relatives had significantly reduced Km and increased Vmax/Km compared to normal subjects. Eleven relatives had high sodium-lithium countertransport activity (Nae 140), associated with low Km and high Vmax/Km. The 14 relatives that were hypertensive had abnormalities of sodium-lithium countertransport kinetics. The results of this study suggest that familial factors are important in determining the Km and Vmax/Km of sodium-lithium countertransport activity. Studies aimed at determining the inheritance of sodium-lithium countertransport and its use as an intermediate phenotype of essential hypertension must measure its kinetic determinants to reduce the risk of confounding effects from other variables.
The deduced core (75RYPNVTI81) from a T-cell stimulatory epitope of the 38 kDa protein of M. tuberculosis was studied to identify the structural elements required for the creation of a synthetic peptide antigen from an epitope core, which alone was not capable of inducing CD4+ T-cell responses. Peptides were prepared with extensions composed of native and/or non-native sequences to clarify the role of the flanking regions adjacent to the epitope core. Their binding to isolated H-2-Ab MHC glycoprotein as well as T-cell stimulatory capacity were assayed using a specific murine hybridoma T-cell line [38.H6], lymph node cells from the native 20-mer peptide primed C57BL/10 mice and human PBMCs from sensitised individuals. Elongation of the epitope core by four alanines at both N- and C-terminals resulted in a 15-mer peptide A4-75-81-A4 which was stimulatory for hybridoma T-cells and showed a small decrease in H-2-Ab binding. Substitution of one Ala by Ser in the N-terminal flank had pronounced effect and peptide A2SA-75-81-A4 proved to be more effective than the native 20-mer sequence in the hybridoma as well as in the LN cell proliferation assays. The binding of this peptide and that of the native one were similar. Testing in human PBMC cultures from eight PPD positive individuals showed that in 50% of the donors' cells responded to the 'artificial' A2SA-75-81-A4 peptide. These results suggest that it is possible to construct simple, synthetic CD4+ T-cell stimulatory peptides of high potency from a non-stimulatory, 'silent' epitope core by addition of flanking residues not part of the native sequence.
The HLA class II isotype and allelic restrictions of peptide recognition were analyzed with T cells from a DRB1*1501/DRB1*0901 heterozygous donor. Nineteen T cell clones, all directed against the single mycobacterial epitope p21-40 were tested with HLA homozygous lymphoblastoid cell lines as antigen-presenting cells. The most striking finding has been, that several DR isotype restricted clones recognized the peptide in the context of both parental, but not of unrelated alleles. In contrast, DQ and DP restricted clones responded in the context of one parental allele only. Most DR promiscuous clones produced interferon-gamma but not IL-4, whereas most DQ and DP clones produced IL-4. We postulate that the confinement of DR promiscuity only to the parental alleles was established possibly during thymic maturation of T cells and that the proportions between monogamous and promiscuous T cells may play a role in the MHC mediated influences on host resistance to infections and other immune responses.
A nursing database which records patient details and treatments as fields in a standard database format is transformed into a collection, in text form, of patient case days with history. Each case is represented as text strings encoding the patient details, the current problems, treatments and their associated history. The cosine measure of similarity is used to compute a whole case similarity between a text query and the cases in text form. This standard text retrieval technique is used and compared to a simple rule base. In case-based reasoning, the similarity of cases is often computed by combining similarities of the case features involved. In this work the standard text retrieval function is modified to incorporate this case structure by combining individual matches of case components based on the cosine measure. The combination is based on a linear regression model for learning the weights assigned to the components of this retrieval function. For the 1355 records two tasks were tried: predicting the treatment for a new problem and predicting the treatment for a continuing problem when a change of treatment is required. Simple text retrieval was better than the rule base for one task and case structured retrieval was at least 18% better on both tasks. Further techniques are discussed.
Adult polycystic kidney disease (APKD) is a common hereditary disease with renal and extra-renal manifestations. There are at least three genes responsible for this disease. The polycystic kidney disease 1 (PKD1) gene product is a membrane protein involved in cell-cell and cell-matrix interactions and has a widespread tissue distribution. Abnormal membrane fluidity in erythrocytes from APKD patients is due to altered membrane proteins. Membrane fluidity of mononuclear cells is related to whole body insulin sensitivity. Insulin sensitivity might therefore be disturbed in APKD if the erythrocyte membrane abnormality is also present in other cells. Therefore, we investigated insulin sensitivity in 15 APKD patients and 20 normal subjects matched for age and sex. Insulin sensitivity was assessed by a short insulin tolerance test to derive the first-order rate constant for the disappearance of glucose (Kitt) and mononuclear leukocyte membrane fluidity was measured by fluorescence anisotropy. The Kitt value (% mmol.liter-1.min-1) was lower in APKD patients than in normal subjects [median (range) 2.2 (1.5 to 6.3) vs. 4.1 (2.0 to 5.4). P < 0.001]. Fasting plasma insulin concentrations were negatively correlated with the Kitt values (r = -0.66, P < 0.001). Core region anisotropy was significantly lower (higher fluidity) in leukocytes from APKD patients [mean (SEM) 0.164 (0.003) vs. 0.174 (0.001), P < 0.001]. Insulin sensitivity was positively correlated with the fluorescence anisotropy of the core region of leukocyte membranes (r = 0.81, P = 0.0001). In conclusion, APKD patients were insulin resistant and some patients were hyperinsulinemic, which may indicate increased cardiovascular risk. The cellular basis of the insulin resistance may be directly related to the proteins causing the disease or to the general change in membrane properties.
Lipids and lipoproteins have been associated with breast cancer risk; however, published results have been inconsistent. To clarify these associations, we measured fasting lipids in women undergoing breast biopsies. A case-control study examined the association of fasting levels of lipids with histologically defined breast cancer risk. Four groups of premenopausal women were assembled on the basis of histological appearance of breast tissue: 1) no epithelial proliferation (n = 102), 2) proliferation without atypia (n = 53), 3) atypical hyperplasia or carcinoma in situ (n = 53), and 4) node-negative invasive cancer (n = 102). A postoperative fasting blood specimen was analyzed for cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. Demographics, risk factors, diet, physical activity, fasting weight, and skin-fold thickness were measured. Triglyceride levels were significantly higher in women with node-negative invasive cancer (0.94 +/- 1.04 mg/ml) than in those with no epithelial proliferation (0.83 +/- 1.04 mg/ml, p = 0.03). This association persisted after adjustment for age, body size, lipids, reproductive and familial risk factors, and previous benign breast problems (p < 0.01), in keeping with an independent association of elevated triglycerides with breast cancer risk.
This article reports the findings of a survey of nurses' knowledge and anxieties about intravenous (i.v.) therapy. The anonymised questionnaire survey canvassed nurses' views on education in the use of i.v. devices, complications arising from i.v. therapy, and which side-effects caused them greatest concern for patient welfare. The author reports widespread dissatisfaction with the level of education that is provided and cites published guidelines and reports which can help to inform nurses.
The development of artificial skin substitutes based on cultured cells and biomaterials such as collagen requires an understanding of cellular interactions with the substrate. In this study, human keratinocytes were cultured on the surface of collagen sponges, and confocal laser-scanning microscopy (CLSM) was used to assess both the microstructure of the sponge, and the cell morphology and distribution throughout the sponge. It was found that the pore size increased with increasing depth into the sponge. Both pore size and fiber thickness increased during incubation for up to 10 days at 37 degrees C in culture medium in the absence of cells. This latter effect was not observed when the sponges were incubated in distilled water. Keratinocytes penetrated into the sponge even after only 3 days in culture. By 10 days in culture, the cells had penetrated to the maximum depth that could be examined (120 microns from the sponge surface). In the presence of cells, the inner structure of the collagen sponge had altered after 10 days in culture, with the collagen fibers becoming thicker, and pore geometry less regular. The mechanism responsible for this is unknown at present. Although the presence of the keratinocytes increases distortion of the sponge structure, factors from the medium itself also contribute to this effect. CLSM is a powerful tool for assessing cellular interactions with bioimplants, providing both qualitative and quantitative information. It offers many advantages over scanning electron microscopy (SEM) and histological techniques. CLSM minimizes the time-consuming, extensive preparation of samples required with the latter two methods, and allows noninvasive serial optical sectioning of intact samples.
Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. There is an increased prevalence of hypertension, which is an important risk factor for progressive renal impairment, in patients with IgAN. Changes in sodium-lithium countertransport (Na/Li CT) kinetics, particularly high Vmax/Km, have been shown in familial essential hypertension. In this study a high Vmax/Km was observed in IgA probands with hypertension and/or progressive renal impairment. Mean blood pressure was higher in the first-degree relatives of patients with IgAN compared with relatives of normotensive IgAN probands. These hypertensive relatives had an increased Vmax/Vm ratio and a low Km of Na/Li CT. There is a strong correlation of Vmax/Vm (r = 0.82) between the IgA probands and their first degree relatives, suggesting strong familial factors contributing to this Na/Li CT kinetic parameter. An increased Vmax/Km ratio of Na/Li CT seems to be a better marker for familial hypertension than Km alone and may be useful in identifying those patients who are at a greater risk of developing hypertension.
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In adult polycystic kidney disease (APCKD) the cytoskeleton of renal tubular cells is abnormal. In erythrocytes the cytoskeleton affects the fluidity of membrane lipids. The authors determined fluorescence anisotropy in intact erythrocytes and erythrocyte ghosts in 12 APCKD patients and 12 normal subjects. In APCKD whole erythrocytes had a much lower core-region anisotropy, which indicated higher membrane fluidity than normal (mean 0 center dot 175 vs. 0 center dot 224, P < 0 center dot 01). This abnormality was not detected in erythrocyte ghosts, which suggests that preparation of ghosts altered membrane lipid organization. This could be directly due to ghosting or secondary to the loss of cytoskeletal effects, which may be abnormal in APCKD.
BACKGROUND: The functions of membrane bound proteins are regulated by the physical properties of the cell membrane. Lymphocyte dysfunction in IgA nephropathy may therefore be related to abnormal cell membrane fluidity. In this study we have examined peripheral blood mononuclear cell membrane fluidity and the expression of HLA antigens on the surface of lymphocytes in IgA nephropathy subjects compared to normal controls and disease controls. METHODS: Twenty-two IgA nephropathy subjects with normal or mildly elevated serum creatinine (serum creatinine RESULTS: Fluorescence anisotropy for diphenylhexatriene of mononuclear cells from IgA nephropathy subjects was significantly lower compared to mononuclear cells from normal control subjects and disease control subjects, indicating higher membrane fluidity (median values, IgA nephropathy 0.161; normal control 0.175; disease control 0.175; P<0.001 and P<0.001). Fluorescence anisotropy for trimethylammonium-DPH was lower in the IgA nephropathy groups compared to the normal control group (median values, IgA nephropathy 0.268; normal control 0.274; P<0.001), but not significantly different compared to the disease control group (0.272). HLA class I expression on the surface of B lymphocytes was significantly higher in the IgA nephropathy group compared to the normal control and disease control groups (median values, IgA nephropathy 30364, normal control 15495; disease control 16907; P=0.0001 and P=0.002 respectively). CONCLUSION: This study provides evidence of abnormal cell membrane architecture and increased HLA class I expression in Iga nephropathy.