Biomedical subjects
S Dunn
Publications and source records attributed to S Dunn.
Ionic channel currents in cultured neurons from human cortex.
Ionic channels in human cortical neurons have not been studied extensively. HCN-1 and HCN-1A cells, which recently were established as continuous cultures from human cortical tissue, have been shown by histochemical and immunochemical methods to exhibit a neuronal phenotype, but expression of functional ionic channels was not demonstrated. For the present study, HCN-1 and HCN-1A cells were cultured in Dulbecco's modified Eagle's medium with 15% fetal calf serum, in some cases supplemented with 10 ng/ml nerve growth factor, 10 microM forskolin, and 1 mM dibutyryl cyclic adenosine monophosphate to promote differentiation. Cells or membrane patches were voltage clamped using conventional patch clamp techniques. In HCN-1A cells, we identified a tetrodotoxin-sensitive Na+ current, two types of Ca2+ channel current, including L-type current and a second type that in some respects resembled N-type current, and four types of K+ current, including a delayed outward rectifier that showed voltage-dependent inactivation, two types of noninactivating Ca(2+)-activated K+ channels with slope conductances of 146 and 23 pS (K+i/K+o 145 mM/5 mM), and less frequently, a noninactivating, intermediate conductance channel that was not sensitive to internal Ca2+. When HCN-1A cells were examined after 3 days of exposure to differentiating agents, pronounced morphological changes were evident but no differences in ionic currents were apparent. HCN-1 cells also exhibited K+ and Ca2+ channel currents, but Na+ currents were not detected in these cells.(ABSTRACT TRUNCATED AT 250 WORDS)
Registration of dental radiographs using projective geometry.
Dunn and van der Stelt recently introduced a new model of radiographic image registration which makes use of the correspondence of 3D structures (Dunn SM, van der Stelt P. Dentomaxillofac Radiol 1992; 21: 142-7; Dunn SM et al. Dentomaxillofac Radiol 1993; 22: 77-80). Using a synthetic projective geometry, an algorithm was developed that utilized five-point projective invariants to describe the relative location of each image pixel. A limitation of this synthetic approach is that there will always be a single line passing through the image that cannot be registered. In this paper, an algorithm which is based upon an analytical projective geometry is introduced. This algorithm describes each image pixel by using a coordinate system called a reference triangle. It was shown experimentally that this algorithm successfully registers the entire image. It can also perform the registration almost six times faster than the original algorithm.
Epitope mapping of monoclonal antibodies to the Escherichia coli F1 ATPase alpha subunit in relation to activity effects and location in the enzyme complex based on cryoelectron microscopy.
The interaction of Escherichia coli F1 ATPase (ECF1) with several different monoclonal antibodies (mAbs) specific for the alpha subunit has been examined. The epitopes for each of the mAbs have been localized by using molecular biological approaches to generate fragments of the alpha subunit. The binding of several of the mAbs has also been examined by cryoelectron microscopy of ECF1 Fab complexes. One of the mAbs, alpha II, bound in the region Asn 109-Val 153 without affecting ATPase activity. Most of the mAbs bound in the C-terminal third of the alpha subunit. MAb alpha 1 bound between residues Gln 443 and Trp 513. This mAb activated ATPase activity and was visualized in cryoelectron microscopy, superimposed on the alpha subunit, indicating that the epitope was on the top or bottom of ECF1 in the hexagonal projection. Other mAbs to the C-terminus, including alpha D which also activated the enzyme, reacted between Gly 371 and Trp 513 but failed to bind to small overlapping fragments within this sequence. The epitopes for these mAbs are probably formed by the folded polypeptide which occurs only in Western analysis when long stretches of the alpha subunit are present, suggesting that the C-terminus of alpha is a self-folding domain. In cryoelectron microscopy, Fab fragments for alpha D were seen extending from the sides of the ECF1 complex in hexagonal projection.
Comparative studies of isolated CD3: CD8, CD3: CD3, and monovalent CD3 binding on CD8+ T-cell activation: model of progressive T-cell receptor aggregation synergism.
The TCR and CD8 complexes of CD8+ T cells bind to different regions of MHC class I molecules and both play important roles in the response of the CD8+ T cells to Ag/MHC on APCs. In this report, we mimicked common MHC binding with an anti-CD3:anti-CD8 (CD3,8) BSMAB to isolate the effect of CD3: CD8 pairing, compared this with the effect of CD3: CD3 pairing by the parental bivalent anti-CD3 MAB, and with monovalent anti-CD3 binding by an anti-CD3: anti-CD4 (CD3,4) BSMAB. CD3: CD8 pairing induced an increase in cytosolic free [Ca2+] 1.5 to 3.0-fold greater than the increase induced by CD3: CD3 pairing whereas monovalent CD3 binding induced only 20%-30% of the increase. Postbinding receptor migration studies suggested that microaggregation increased from monovalent CD3 binding to CD3: CD3 pairing to CD3: CD8 pairing. Further studies revealed that progressively higher concentrations of antibodies were needed from CD3,8 to CD3,3 to CD3,4 to initiate the same degree of DNA synthesis. These results demonstrated that Ti/CD3 and CD8 can indeed be bridged by a single molecule. A model of direct CD8: CD3 synergism was raised as a possible explanation for the enhanced activation induced by CD3: CD8 pairing. The observed parallel between all three parameters and the number of TCRs that can be directly linked by the Abs raised a nonmutually exclusive model whereby CD3 binding induces activated TCR intermediaries (aTCRi) that progressively synergize with other adjacent aTCRis. In this model, this dominant inter-aTCRi synergism may be enhanced by the di- and multimeric CD8 alpha chains serving as aTCRi-aggregation foci.
Urinary tract infections in children with posterior urethral valves after kidney transplantation.
The records of 14 boys with posterior urethral valves who had renal failure and subsequently underwent renal transplantation were reviewed to determine the postoperative incidence of urinary tract infection relative to that of 29 male transplant children without valves, who served as controls. There were no significant differences between the posterior urethral valve patients and controls with regard to age, donor source, immunosuppression, followup after transplantation or mean calculated creatinine clearance. Vesicoureteral reflux was found in 1 child with posterior urethral valves and 3 of the children in the control group (p not significant). A total of 15 urinary tract infections occurred in 5 children (36%) with posterior urethral valves, for a rate of 1 per 30 patient-months of followup, and 6 urinary tract infections occurred in 2 controls (7%), for a rate of 1 per 216 patient-months of followup (p < 0.05). However, only 1 of 26 controls (4%) without vesicoureteral reflux had urinary tract infection, for a rate 1 per 1,144 patient-months (p < 0.01). Conversely, the rate of urinary tract infections in controls with vesicoureteral reflux was similar to that of children with posterior urethral valves. Of the 5 children with posterior urethral valves 4 had the initial urinary tract infection within 2 months of transplantation and 10 of 15 episodes occurred within the first 4 months. Antimicrobial prophylaxis did not appear to decrease the rate of infection in children with posterior urethral valves. A history of posterior urethral valves increases the frequency of urinary tract infection after renal transplantation but the usefulness of antimicrobial prophylaxis and the relationship to long-term graft function remain to be determined. Urinary tract infection rarely develops in other transplanted boys without vesicoureteral reflux.
Integrating care for the geriatric patient. Examples from the Social HMO (SHMO).
Managing the care of geriatric patients with chronic disease focuses attention on the functional impairments that place these patients at risk in the home environment. Maintaining patients in their preferred home settings requires physicians to coordinate effective discharge planning and long-term community care resources. A service coordinator or case manager can play a key role in coordinating the broad array of services needed, as well as linking the providers involved. A coordinated acute and long-term care service delivery system is described, with examples from the Social HMO (SHMO). Data are presented on SHMO enrollee demographic characteristics, chronic disease conditions and functional levels, as well as data on care plans, utilization and costs. A case example illustrates how ongoing medical and long-term care are integrated. Implications for geriatric care and HMO practice are discussed, with recommendations for improving geriatric care in the next generation of SHMO sites.
Effect of recipient's race on pediatric renal allograft survival: a single-center study.
One hundred twenty-seven children (83 males, 44 females, 86 white, 41 nonwhite; mean age 12.1 years) who received 160 renal transplants between 1980 and 1989 were retrospectively studied. Variables such as age, sex, primary diagnosis, type, HLA-DR mismatching, and repeated transplants were compared between races and found not to be significant. However, HLA-A and -B cadaveric-graft mismatching, which was equivalent between whites and nonwhites prior to 1985 (pre-cyclosporine A era), has significantly favored whites (49% with 0 to 2 HLA-A and -B mismatch vs 16% in nonwhites) since 1985 (P less than .05), and a significantly higher proportion of nonwhite patients (59%) were receiving medical assistance (P less than .0001). Graft survival was evaluated with significantly poorer results in nonwhites as compared to whites (P less than .05). Although no difference was found between white and nonwhite cadaveric-graft survival before 1985, nonwhites had significantly worse graft survival since 1985 (72% vs 59% for 1 year and 61% vs 24% for 3 years in whites and nonwhites, respectively; P less than .05). Subpopulations such as nonwhite adolescents, nonwhite females, nonwhites with repeated transplants, and all low socioeconomic patients were identified as high-risk children with poor long-term survival. It is concluded that secondary to poorer matching since 1985 there has been decreased graft survival in nonwhites despite cyclosporine A. Attempts to improve matching and attention to high-risk groups are needed for equivalent survival.
Combined liver-kidney transplantation in a child with primary hyperoxaluria.
A 3.5-year-old boy presented with end-stage renal disease and bilateral nephrocalcinosis. Renal biopsy demonstrated marked parenchymal calcium oxalate deposition and a diagnosis of primary hyperoxaluria (PH) was made. Following 2 years of hemodialysis he received two renal allografts which were lost at 7 and 11 months, respectively, due to biopsy-proven recurrent oxalosis. Combined liver-kidney transplantation was then performed, after which renal and hepatic function initially stabilized. The patient died on the 28th postoperative day, of infectious complications and progressive respiratory insufficiency. However, comparisons between the patterns of urinary oxalate excretion noted after the isolated renal and liver-kidney transplants indicated that, following the latter, successful biochemical correction of the enzyme defect responsible for type 1 PH had occurred.
On the receiving end. IV: Validation of quality of life indicators.
Four measures of patient functioning and a mood adjective list currently used in trials of the International Breast Cancer Study Group (IBCSG), and an 8-item Linear Analogue Self Assessment (LASA) instrument measuring specific side effects of cancer and cancer treatment (GLQ-8), were cross-validated against three established measures of quality of life, mood and psychological adjustment to cancer, in a heterogeneous sample of cancer patients. Correlations between new and established measures were high, indicating good convergent and concurrent validity. Compliance on the longer mood measures was relatively poor. Despite the difficulty in developing direct and methodologically sound measures of quality of life, the regular inclusion of practical indicators of aspects of quality of life in clinical trials would allow improved assessment of the cost-benefit ratio of treatment to outcome in cancer patients.
A shock to the systems.
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The other side of the story.
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Table-sag errors in CT treatment planning.
It is common practice to utilize CT scans in place of patient contours for computerized treatment planning. Our experience, in particular with pelvic patients, is that setting up the patient for a CT scan using landmarks from a radiation therapy simulator does not always produce accurate field margins. In general, the treatment field center as produced by the CT scan is superior to the center as defined by the simulator film. We have determined this problem to be caused by simulator table sag as compared to the CT. We offer suggestions to correct the problem.
Fix up your fixturing!
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Viral hepatitis.
Viral hepatitis is the most common serious contagious disease caused by viruses that attack the liver. Approximately 70,000 cases are reported to the Centers for Disease Control each year, representing only a fraction of U.S. cases. There are five types of viral hepatitis currently known: Hepatitis A--formerly called infectious hepatitis; Hepatitis B--formerly called serum hepatitis, and the most serious form; Hepatitis C--formerly called non-A, non-B hepatitis; Hepatitis D--formerly called delta hepatitis; Hepatitis E--formerly called enteric or epidemic non-A, non-B hepatitis. The following Open Forum, prepared by leading EMS experts, explores the differences among the types of hepatitis, signs and symptoms, and EMS implications.
Will you still love me tomorrow? Lessons in loyalty.
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